Steve Solomon, WHO Principal Legal Officer, co-chairs Precious Matsoso and Roland Driece, and  Jaouad Mahjour, Head of WHO Secretariat to intergovernmental negotiating body.

“Get this done” – and if you disagree, don’t block consensus, was the heartfelt plea made by World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyessus to member states negotiating a pandemic agreement on Friday (3 May).

Tedros was addressing the ‘stocktake’ in the middle of the final 10-day meeting of the intergovernmental negotiating body (INB), and it was clear that member states were nowhere close to the finish.

“You are here for the same reason this organisation was created in the first place – because global threats demand a global response,” said Tedros.

“I appreciate that all of you are making compromises you did not want to make. I appreciate that, article-by-article, paragraph-by-paragraph, word-by-word, you are converging on a consensus, although you’re not there yet.

“I also appreciate that consensus does not mean unanimity. I recognise that there may be delegations who, despite their good faith efforts, may not be in a position to join a consensus, but they have a choice. They can choose not to block consensus.”

Evoking “the people of the world”, including future generations, those struggling to survive and those mourning family members who died during COVID-19, Tedros said: “Please, get this done, for them.”

Pandemic Agreement negotiations status (3 May).

At the stocktake, INB co-chairs told stakeholders that revised text has been circulated for Articles 4, 6, 10 and 19, and there is broad agreement on parts of Articles 4, 6 and 10.

New text for Articles 13, 13bis, 14, 17 and 20 still need to be circulated. Meanwhile,  Chapter 1 (definitions) and Chapter 3 have not yet been discussed.

However, at a media briefing later on Friday INB co-chairs said that agreement had been reached on Article 18, an innocuous article on communication. However, they were cagey about giving any specifics on the negotiations, stressing that countries “are trying to find each other”

“Nothing is agreed yet, but also nothing has been taken out yet,” said co-chair Roland Driece, adding that negotiations became complex when trade issues became involved.

“It’s not uncommon, actually is quite normal, that everything should come together almost in the last couple of days,” he added. “It’s standard negotiation practice that countries will only give up on what’s important for them when they see the whole picture.”

Driece added: “In the situation that we would not find consensus by the end of the week, we will report that to the World Health Assembly and it’s up to the World Health Assembly then to decide what should be happening next.” 

Matsoso concluded the briefing by warning: “The window of opportunity is closing, and once it closes, it will be a missed opportunity intergenerationally because there are new priorities and we cannot afford to miss this.  We can only but encourage countries to work towards finalising the agreement.”

Member states will be meeting in working groups on contentious articles over most of the weekend, then the 12-hour daily schedule resumes officially on Monday.

The programme for next week involves finalising all text. Working groups will meet in mornings to discuss and “yellow” text, indicating which areas are ready to be put up for discussion. Plenary sessions will be held in the afternoons to read and “green” this text. There is also time for breakouts and working groups in evenings.

Image Credits: WHO, Nina Schwalbe.

Surgeons in Burkina Faso operate on a patient after undergoing surgical training at the Geneva University Hospitals (HUG) as part of an international collaboration.

In the universe of Geneva’s global health hub, which includes dozens of international NGOs and WHO as the brightest star in the solar system, a parallel universe of locally-grown health and humanitarian collaborations have also developed around the University of Geneva and Geneva University Hospitals.

GENEVA – Ten years ago, two medical professionals from Madagascar met up with Dr Alexandra Calmy, a leading infectious disease expert at the Geneva University Hospitals (HUG in French) at the Geneva Health Forum to tell her about the bane of TB-meningitis that they were confronting in their country among people with HIV or weakened immunity – a disease that has a 40% mortality rate. 

“They told me ‘we are really in trouble in Madagascar with TB-Meningitis – we don’t know what to do and we have no way to diagnose and treat them efficiently,” recalled Calmy.  

That chance meeting proved to be the beginning of a major collaboration between the HUG and a hospital in Madagascar that introduced, firstly, more accurate GeneXpert diagnostics for earlier intervention, and later, two alternative treatment options for TB-meningitis. 

That eventually led to a grant from the European Union’s EDCTP, and a randomized, multi-country trial of the new treatments  in Madagascar as well as three other African countries – Ivory Coast, South Africa and Uganda (INTENSE-TBM), now underway. 

International Geneva’s ‘global health hub’ 

A training session in Mali for health professionals about therapeutic patient education and diabetes co-organized by the Malian Ministry of Health, HUG and the NGO, Santé Diabète

The story is one of dozens of examples of research innovations and health and international development success stories that have emerged out of a unique ecosystem of the University of Geneva and its university hospital affiliate, working in partnership with the city’s many NGOs and international aid organizations, all part of the constellation known as “International Geneva”.  

Others call it the Geneva ‘Global Health Hub’- with the World Health Organization as the center of the solar system –  around which dozens of other planets and satellites revolve.  

The projects stimulated by the University-HUG collaborations, per se, range from new medicine regimes like the one being tested for TB, to new, easy-to-use diagnostic tools for conditions such as cervical cancer, long-neglected in developing regions. 

They also span an enormous range of initiatives to actually introduce innovations into health systems and build the capacity of medical professionals. Examples of the latter include educating nurses to provide diabetes control information and training community health workers in refugee settings.   

In fact, the labyrinth of collaborations, particularly in the health and humanitarian arena, is so extensive and complex that it is difficult to map and describe. At the core are the HUG, the University of Geneva Faculty of Medicine and the University’s Geneva Centre of Humanitarian Studies.  

Around these, are a satellite array of collaborations and partnerships with WHO, ICRC, Médecins Sans Frontières and other, smaller, but influential Swiss-based NGOs, such as Terre des Hommes. The Geneva Health Forum, convening this year on 27-29 May, historically has played a key role as a platform to showcase many of the initiatives and bring stakeholders together.  

And finally, the ‘State’ of Geneva, and its “Service of International Solidarity” stand as the backbone behind all of these efforts – funding directly and indirectly over CHF 40 million in international health and development projects in the name of the “State of Geneva” – a title reflecting the influence it wields. And that is in addition to financial support from the Swiss national government’s department of Development and Cooperation (DDC)

HUG equalization fund ‘kickstarts’ innovative projects

The HUG has funded or partially funded nearly 100 health and humanitarian collaborations across the globe over the past six years.

A report on the HUG’s collaborations cites a total of 97 international health projects, entirely or partly funded by the Hospital, in the most vulnerable countries of sub-Saharan Africa and the world, over the past six years for a total of more than 3 million CHF, says Calmy. Some 43 projects are currently ongoing, with 20 new projects approved in 2023, she adds.  

The HUG finances start-up projects based on a “Fond de Péréquation” capitalized by doctors’ income from private patient visits to the hospital, Calmy notes. (The English translation is “Equalization Fund” – with all that implies). 

The fund enables HUG-affiliated staff to propose and launch innovative projects from the grassroots in their areas of expertise, notes Calmy, providing a unique laboratory for creative collaborations. Proposals can be submitted by any health professional – from doctors and  nurses to psychologists and dieticians.

“We are here to provide the kickstart,” added Calmy who is co-chair of the HUG Commission of Humanitarian Affairs and International Cooperation, that administers the medical facility’s programme – in collaboration with a parallel Commission at the University of Geneva. 

“You want to do cervical cancer detection in Cameroon.  You have to map what is going on there, what is the expertise, who are your contacts.  So we’ll give you the money to kickstart – after that you can go to the Canton, the ICRC, the Confederation for help in obtaining larger grants for research and implementation.”  

A nurse-led project launched in education about chronic diseases is one such example that she cites. A noteworthy feature of the HUG approach is its eclectic sponsorship of a very diverse portfolio, she adds.  

“We are well aware that we are funding diverse projects, there is no line in terms of themes, countries, or types of projects. Anyone in this hospital that has expertise, identified partners, and wants to do a project, can make a proposal,” she said. 

Seeking coherence amidst diversity

Alexandra Calmy, HUG Vice-Dean for Clinical Research and co-chair of the Medical Faculty’s Commisson for Humanitarian Affairs at the HUG-University  Humanitarian Conference “Assises de l’Humanitaire”, 9 October 2023

At the same time, there is growing recognition that more coherence and coordination amongst a wide array of initiatives would be useful – to share lessons learned and ensure maximum impact. 

That plethora of programmes and projects led all of the partners to hold a first-ever stocktaking event in October 2023, to seek a common direction and way forward. 

Called simply the Assises de L’Humanitaire (Humanitarian Conference)” the one-day encounter brought together stakeholders from the HUG and University system, along with the Swiss Confederation, Geneva State, WHO, ICRC and a wide array of other international organizations working with the Geneva-based institutions.

Now, six months later, a report on the findings and recommendations for a way forward is soon to be published. 

“I think the conclusion was that ours is still a good approach. But we wanted to explore new ways of doing things better,” said Blanchet.  

Key themes that emerged as recommendations include an increased focus on facilitating south-south along with north-south collaborations, and in-country partnerships that emphasize the education and training of local actors to ensure sustainability and scale up of projects. 

“But we want to remain a laboratory of ideas,” Calmly said.

‘Assises de l’Humanitaire was the triangle’  

The day was particularly important in terms of helping the University and the HUG share experiences between themselves and better align, said Karl Blanchet, who is the director of the university’s Geneva Centre for Humanitarian Studies. 

“The Assises de l’humanitaire was this triangle of the Geneva Centre, the Faculty of Medicine and the HUG. There were two objectives to all meet and all be aware to make sure that we are aware of what we do in different parts of the world,” he said.

“The next step is to formalize relationships and contribution to these programmes,” he added, noting the wide range of UN and NGO actors, like MSF and ICRC involved in individual projects.

The same network of collaborations underpins many of the events featured in the Geneva Health Forum, co-founded by the HUG, the University of Geneva and its Faculty of Medicine in 2006. 

This year’s GHF takes place 27-29 May, and coincides with the kickoff of the 77th World Health Assembly.  Health and Environment, Migration Health and Equity and Malaria Elimination are the key themes.  But a day-long session on  “International Hospital Collaborations” is also taking place on 29 May. Held in French, it will look even more deeply at some of the topics discussed at the conference last October.   

“The aim of the seminar is to collectively question the way partnerships between hospitals in the global north and global south are designed, and how to promote ethics and sustainable solutions within the frame of these partnerships,” said Bruno Lab, head of Humanitarian and International Cooperation Affairs at the HUG. 

“It’s a dive into the specific domain of long-term technical assistance projects. Through multi-year collaborations, the objectives are set around capacity building, teaching and research.”

Karl Blanchet, head of the University of Geneva’s Centre for Humanitarian Affairs

Many HUG staff also have joint appointments in the University of Geneva’s Medical Faculty, which also hosts an array of international health research initiatives, under the research portfolios of various departments. 

The Centre for Humanitarian Studies, therefore, collaborates with both institutions, and others, in a range of health and humanitarian research and education projects, says Blanchet. 

Examples of the former include a research study on reducing the impact of attacks on healthcare, as well as a five-university initiative on re-imagining the future of global health, he adds

But there are also collaborations in field settings on priorities like teaching doctors how to perform war surgery or a new programme in community health for refugees. 

The latter, targeting long-time refugees in Jordan and Kenya, provides students with a basic education that allows them to gain employment as health workers, as well as to qualify for further university training in their host countries, Blanchet says. 

The end result is better integration into local communities and health systems after decades as refugees.  

“During the COVID pandemic, the first settings that were closed in lockdown were in refugee camps,” Blanchet recalls. “”So we created a course not only to help refugees deal with health issues in their community, but to be able to get jobs.

“It’s the first advanced course on community health accredited by a University Faculty of Medicine, for students and refugees who cannot demonstrate their level of studies.  If they finish the certificate, they can go onto national university,” he said. 

University ‘open to the world’

Blanchet himself has a strong public health background. He came to the centre as an academic from the London School of Tropical Hygiene and Medicine.

He found the pace much faster and topical than the usual university ivory tower.    

“I can’t tell you how amazing this environment is,” he said. “When I arrived at this new post, where we are grappling with some of the most challenging environments, people would tell me, over and over, ‘just tell me what you need.’

That led to initiatives such as a website publishing briefs on the latest scientific knowledge about  COVID in Ukrainian after  the 2022 Russian invasion; as well as the hosting of leading Afghan health experts in the Centre, including the former minister of health, following the Taliban’s takeover of Kabul. 

The centre is likewise involved in an initiative to help medical students in conflict-ridden regions such as Gaza, Iran, Pakistan and Afghanistan to complete their studies in host countries abroad.  And there are now plans now in the works to host an international symposium soon on the rebuilding of Gaza’s health system, he confides.  

“These are all examples of the agility of the teams and the faculty,” he said. “The University of Geneva is so anchored in the news and what is going on – and they want to make sure that they can contribute, not only to research but as a university open to the world.” 

Paula Dupraz-Dubois contributed reporting to this story

Image Credits: Hopitaux Universitaires de Genève, Hopitaux Universitaires de Genève, Geneva University Hospitals , Paula Dupraz-Dubois.

Milking a cow in Texas. H5N1 Avian influenza is spreading among US cattle herds, most probably during the time of milking.

Most H5N1 infections spreading through US dairy cattle and other animal populations are likely going undetected despite stepped up surveillance by the US Department of Agriculture, Michael Osterholm, director of the Centre for Infectious Disease Research and Policy (CIDRAP), told Health Policy Watch on Wednesday.

Osterholm spoke as a growing number of infectious experts were sounding alarm bells about the expanding spread of the deadly virus to mammalian populations – and especially dairy cattle in the United States, where some 36 herds have so far been infected, according to the latest US Centers for Disease Control and Prevention (CDC) update April 30. Sanitation gaps and lax surveillance in industrial dairy operations are facilitating H5N1 transmission, experts now suggest. 

Total number of H5N1 cases in different animals in the US. Infection spread in dairy cattle, the newest ‘terrain’ for the virus, is causing the most concern.

And “most” infections are likely going undetected due to farmer reluctance to have cattle and employees tested for avian flu, warned Osterholm, an internationally-known expert. 

“We need much more extensive follow up, serology studies and close monitoring of mixing vessel animal species, e.g. pigs,” Osterholm stressed in emailed remarks. 

He noted that pig infections, for example, constitute a “mixing vessel animal species” because they can become co-infected with both animal and human forms of avian influenza, increasing the risks of spread to humans of a virus that has a greater than 50% fatality rate.

On the positive side, Osterholm added that it was “very unlikely” pasteurized milk could transmit the infection if pasteurization “is done properly.”

Policymakers have taken their ‘eye off the ball’ of ‘One Health’ principles

“Policymakers have again taken their eyes off the ball in efforts to protect humanity from new pandemics,” stated Dr Nigel Sizer, an Executive Director of the non-profit Preventing Pandemics at the Source (PPATS), as part of a stiff warning  issued Tuesday by half a dozen international experts on the wave of H5N1 infections.

“In this case, it is hard not to point the finger at lax monitoring and regulation of animal agriculture in the United States and elsewhere,” Sizer said.

Colorized transmission electron micrograph of Avian influenza A H5N1 viruses (seen in gold) grown in MDCK cells (seen in green).

The expanding outbreak takes place as WHO member states are in the throes of finalizing a draft Pandemic Accord agreement, where a commitment to stronger “One Health” measures for preventing spillovers of animal pathogens to humans remains a sticking point for some countries in the Global South. 

But in the case of the USA, a dearth of surveillance is also a hallmark of the rapidly expanding avian flu outbreak in the Global North, other experts also pointed out.  

“The situation with avian influenza across the United States exemplifies the inherent hypocrisy and vested economic interests around Pandemic Prevention, Preparedness, and Response,” said Dr. Christian Walzer, Executive Director of Health at the Wildlife Conservation Society, and a professor at the University of Veterinary Medicine in Vienna, Austria, in the PPATS statement of experts.

“As one hundred ninety-four member states of the World Health Organization (WHO) are negotiating perceived responsibilities and equity around a new Pathogen Access and Benefits-Sharing [PABS] Mechanism – while the Global North is demanding transparent and rapid access to pathogen data from the Global South to develop diagnostics, vaccines, and therapeutics, it seems unwilling to share such information with the world,” Walzer said.

Spread through milking machines

Among dairy cows, H5N1 appears to be transmitting rapidly through their mammary glands via virus contaminated milking machines, Stat News reported on Tuesday. The milking equipment is typically not sanitized between sessions with individual animals, becoming an obvious transmission path to infection by more and more cows from the herd.

Experts such as Jared Taylor, a professor of veterinary pathobiology at Oklahoma State University, noted that the H5N1 infections in cattle herds reported so far have been  limited to lactating dairy cows. And the ones who produce most milk – and therefore spend more time on the milking machines – have the highest disease incidence.

Even more worrisome is the potential presence of the virus in raw milk – which some consumers in the USA as well as in Europe prefer as a more ‘natural’ alternative.

US states where H1N5 has been detected in cattle

There also have been virus remnants found in pasteurised milk. “The role of pasteurization in inactivation of the virus […] is currently being investigated,” states a 23 April assessment by the WHO, issued jointly with the UN Food and Agriculture Organization (FAO) and the World Organisation for Animal Health (WOAH).

Infection with H5N1 from pasteurised milk is, however, “very unlikely, if [the pasteurisation is] done properly,” Osterholm said.

As compared with consumers, farm workers who have everyday contact with cattle are, however, at a far higher risk of infection. And the one case of human infection reported in March, does not reflect the scale of the disease spread to people, experts say because farmers have been reluctant to allow testing of cattle or employees, and such testing remains voluntary. 

That’s why “most” cases likely go undetected, Osterholm told Health Policy Watch.

Avian influenza as symptom of world’s failure to apply ‘One Health’ measures

Virus spillovers to more and more species are a direct effect of the poor animal management practices in the  intensive livestock production conditions that are common throughout the developed world today, said Sizer in the statement on April 30.

“Improved animal husbandry conditions, more rigorous inspection standards, as well as better reporting and sharing of animal health information could reduce the risk of these outbreaks as well as improve the welfare of the animals we consume,” he asserted. “We must question for how much longer consumers will have to worry that the price of a cheap sausage or steak is the risk of another global pandemic.”

One Health principles recognize the interlinkages between ecosystems, animal and human health, and call for enhanced collaboration between sectors to prevent zoonotic spillover into human populations. 

“This outbreak highlights the need for One Health approaches for preventing spillovers and interventions to reduce risk of such threats ‘at source’,” argued Dr. Malik Peiris, Professor of Virology at the School of Public Health at The University of Hong Kong, and a leading H5N1 expert.

Pigs are an important possible intermediary host for avian influenza.

“There is still a widespread philosophy of aiming for maximum profit in meat production, when it should be about optimizing food security, food safety, animal welfare and ecological sustainability,” added Dr. Dirk Pfeiffer, Professor of One Health at City University of Hong Kong, in the same statement, adding: 

 “Global investors who see opportunities in making money out of meat production should be aware that ‘growing cattle, pigs or chickens’ is not the same as making parts for mobile telephones.”

WHO still ranks human health risks as low or low-to moderate

In its 23 April assessment, WHO ranked avian influenza risks to humans as low generally insofar as human-to-human transmission has never been documented, and low-to-moderate for those “with exposure to infected birds or animals or contaminated environments.”

Only one human case connected with the US outbreak has been reported, a cattle worker from Texas.

Since 2003, WHO reported only rare instances of human infections all from close contact with animals. Even so, the mortality was “extraordinarily high,” according to WHO Chief Scientist Jeremy Farrar. He was referring to the 52% mortality rate registered amongst the 889 human cases of H5N1 reported to WHO between 2003 and 1 April 2024.

Jeremy Farrar, WHO Chief Scientist, during a press briefing April 18

“Being one of the few people around the world who have actually treated patients with H5N1 […] this remains I think an enormous concern,” Farrar stressed at an April 18 media briefing in Geneva. From 1996 until 2013, Farrar was Director of the Oxford University Clinical Research Unit in Ho Chi Minh City, where he and a Vietnamese colleague identified the re-emergence of the deadly bird flu, or H5N1, in humans in 2004. 

What worries experts the most is the virus’s expanding host range. Naturally found in wild birds, avian influenza has developed a limited ability to infect other species, including mammals. The recent joint assessment by WHO, FAO and WOAH reports mentions the virus as the probable source of infection in sea mammals, multiple fur animal farms and ferret-to-ferret infections, according to some studies.

The list of infected animals is getting longer: cats, dogs, goat kids or polar bears, already known to suffer from the disease were recently joined by a walrus, as The Guardian reported.

“The great concern, of course, is […] that that virus now evolves and develops the ability to infect humans. And then critically, the ability to go from human-to-human transmission,” Farrar told the media briefing.

Reassurance, but… 

Other WHO officials have still sought to issue a more reassuring note.

Speaking at another WHO press briefing on April 24, Dr. Maria Van Kerkhove, a WHO epidemiologist, asserted that appropriate surveillance systems are working well.

“We are concerned about this particular virus because we know influenza has the potential to cause epidemics that have the potential to cause pandemics,” she said. “And that’s why we have a global system in place to monitor, detect, and to rapidly do risk assessments to look at viruses that could potentially be used in vaccines as we go forward. There’s a lot of work in place right now,” she said.

Since the beginning of 2021, 28 detections of H5N1 in humans have been reported to WHO, with all nine cases reported in Europe or North America being assymptomatic or mild cases, notes the WHO/FAO/WOAH joint assessment. Still the three agencies also recommended tougher monitoring – calling on national authorities to  use “active case finding and serologic methods, as well as work with national agencies to understand the exposure and risk from milk and milk products.”

Osterholm, like other experts doubts that US authorities have the situation under control. What’s needed is, among others, a “much more extensive follow up,” said Osterholm. 

He also advises a close monitoring of pigs, which have “influenza virus receptors for both avian and human influenza viruses.

“If they get coinfected with both viruses simultaneously then viral reassortment can occur and a new human virus emerge, like what happened in 2009 with the new H1N1 [strain] that emerged in swine in Mexico.” 

With editing and reporting contributions by Elaine Ruth Fletcher 

Image Credits: Josh Kelahan, US CDC, CDC/ Courtesy of Cynthia Goldsmith, Flickr: Dutchairplaneshooter.

On the final day of INC-4, delegates held talks until the early hours of the morning trying to find a way forward

The fourth session of the UN intergovernmental negotiating committee (INC) to develop an international legally binding instrument on plastic pollution ended in Ottawa on Tuesday with “an advanced draft text of the instrument and agreement on inter-sessional work ahead”, according to the UN Environment Programme (UNEP).

Delegates engaged in text-based discussion on the revised draft for the first time, but there were major sticking points – especially on limiting plastic production. The European Union (EU) proposed extending the meeting but delegates failed to agree on the proposal, according to the Earth Negotiation Bulletin.

Other issues on the table related to emissions and releases; product design; waste management; problematic and avoidable plastics; financing, and a just transition.

The INC members agreement to hold inter-sessional work – expert meetings between the official INC sessions –  to work on “convergence on key issues” ahead of the next negotiating session, INC5, will take place in Busan, Korea, in November.

The inter-sessional groups will look at financing to achieve the objectives of the instrument and approaches to address  plastic pollution and chemicals of concern in plastic products and product design, focusing on products that can be recycled and reused. 

Long road to agreement

INC5 is supposed to adopt an agreement, but there is still a long road ahead as “meetings to discuss the technical elements of the text diverged on almost all points of discussion, from problematic and avoidable plastics to product design, composition and performance,” according to the Earth Negotiation Bulletin..

“We came to Ottawa to advance the text and with the hope that members would agree on the intersessional work required to make even greater progress ahead of INC-5. We leave Ottawa having achieved both goals and a clear path to landing an ambitious deal in Busan ahead of us,” said Inger Andersen, UNEP executive director.

 “The work, however, is far from over. The plastic pollution crisis continues to engulf the world and we have just a few months left before the end of year deadline agreed upon in 2022. I urge members to show continued commitment and flexibility to achieve maximum ambition.”

However, several NGOs that attending as observers were unhappy with the influence of member states with significant fossil fuel industries. Most plastics are made from oil and gas derivatives.

“Despite hearing people from polluted communities around the world give sensible proposals to curb the lifecycle harms of plastics, fossil fuel and petrochemical interests are still shamelessly blocking progress and focusing on utterly inadequate plastic waste management,” said Julie Teel Simmonds, a senior attorney at the Center for Biological Diversity (CBD).

While Rwanda and Peru, part of the high-ambition coalition, proposed production reductions,  a coalition of fossil fuel–aligned countries, including Russia, China, and Saudi Arabia, objected to treaty measures to address plastic production, according to the CBD. 

Not ‘if ‘but ‘how’

“Canada is committed to reaching a final agreement at INC-5 in the Republic of Korea before year end. We are no longer talking about ‘if’ we can get there, but ‘how.’ Together we can land one of the most significant environmental decisions since the Paris Agreement and the Kunming Montreal Global Biodiversity Framework,” said Steven Guilbeault, Canada’s Minister of Environment and Climate Change, who hosted INC4. 

“We are doing everything we can to raise the international profile of the plastic pollution crisis so that the agreement gets the global attention it deserves to cross the finish line.”

INC chairperson Ambassador Luis Vayas said that “some common ground” had been found and “I firmly believe that we can carry this same spirit forth to Busan to deliver on our mandate.” Delegates accepted Vayas’ proposal for a legal drafting group to ensure legal clarity in the text of the future agreement.

Jyoti Mathur-Filipp, executive secretary of the INC secretariat,  said that “compromise and commitment remains strong at this advanced stage of the negotiations”.

“Members should arrive in Busan ready to deliver on their mandate and agree a final text of the instrument. This is more than a process – it is the fulfilment of your commitment to saving future generations from the global scourge of plastic pollution.”

Image Credits: Kiara Worth/IISD.

A rollout of malaria vaccine in Western African countries with a special focus on immunising children is an important step towards eliminating the disease

Rollout of malaria vaccines are starting in Benin, Sierra Leone and Liberia, and the West African countries plan to deliver more than 800 000 doses of the RTS,S or R21 vaccines, according to WHO.

The new vaccine will be added to their immunisation programmes for children, and are expected to protect over 200,000 children from the life-threatening disease. The RTS.S vaccine can be administered to children as young as five months old.

In another promising development against malaria, a new formulation of a malaria treatment, Coartem, has proven to be safe and efficacious for babies under five kilograms, a previously overlooked group of patients.

Pharmaceutical company Novartis and Medicines for Malaria Venture (MMV), a leading product development partnership, announced that their product has good efficacy and safety and is appropriate for babies in the wake of the successful CALINA study.

The trial data have been submitted for regulatory review, they informed during the Multilateral Initiative on Malaria conference.

“Infants below five kilograms make up a critical neglected group, and developing antimalarials specifically suited to their needs is essential to malaria control efforts,” said Wiweka Kaszubska, MMV vice president.

The new formulation, known as Coartem <5 kg Baby, uses a new ratio and dose of artemether-lumefantrine to account for metabolic differences in babies under 5kg to minimise the risk of overdose and toxicity.

“Infants under five kg can be affected by placental malaria, leading to poor birth outcomes, or contract malaria from the bite of an infected mosquito. The prevalence of the disease in this age and weight group is poorly understood, and it is therefore often misdiagnosed,” according to a company media release.

Current antimalarials have not been developed small babies, who are usually treated with tablets meant for children above 5 kg adjusted by weight – yet, these tiny patients handle drugs differently due to the immaturity of their metabolising organs.

Decreasing the burden

Malaria is a life-threatening infectious disease with an estimated 249 million cases and 608 000 deaths in 2022, according to the World Malaria Report 2023. It is present in 85 countries, with 95% of cases in the African region. Most of the fatalities in the region – four out of five – are children under the age of five.

“With the new, safe and efficacious malaria vaccine, we now have an additional tool to fight this disease. In combination with insecticide-treated nets, effective diagnosis and treatment, and indoor spraying, no child should die from malaria infection,” said Dr Austin Demby, the Minister of Health of Sierra Leone.

The emerging interventions will likely decrease the burden of malaria substantially. In the recent years, (2019-2023), a pilot malaria vaccine programme in Ghana, Kenya and Malawi reached over two million children, showing a significant reduction in malaria illness. It also reached a 13% drop in overall child mortality and a reduction in hospitalisations.

Benin, Liberia and Sierra Leone joined five other African countries that have already implemented the rollout of the newly developed malaria vaccines.

Image Credits: WHO.

African leaders who attended at the high level meeting in Addis Ababa on Saturday.

African leaders want “explicit commitments” to debt relief and debt restructuring mechanisms, including debt swaps to support country-level pandemic prevention, preparedness and response (PPPR) in the pandemic agreement.

This is one of the continent’s demands, made on the eve of the World Health Organization’s (WHO) pandemic agreement talks, following a high-level meeting of African health ministers and diplomats on Saturday.

At the meeting, a key African Union (AU)  leader warned against postponing the adoption of a pandemic agreement, saying it might never be passed.

The pandemic agreement negotiations entered their final two-week phase in Geneva on Monday with 10 May as the deadline for what observers are describing as an “instrument of essentials” – a basic text that will be fleshed out by further talks in the next couple of years, as reported recently by Health Policy Watch.

The first communique from the African leaders’ Saturday meeting was withdrawn a few hours after its release. 

The new statement released on Monday was identical except it removed a reference to the Pandemic Fund in its call for “an international financing mechanism” to support countries’ pandemic-proofing efforts.

It also wants the accelerated “operationalisation of the financing of the African Epidemic Fund”.

Support for PABS

The continent supports a “multilateral pathogen access and benefit sharing system (PABS)” that provides legal certainty to users and providers and ensures improved access to pandemic-related health products and technologies.

The draft agreement proposes a WHO-coordinated PABS system but for the operational details of this contested proposal are to be finalised by May 2026.

Africa also wants “measures to establish regionally-distributed production of pandemic-related health products” and “commitments to organise and resource technical support” on all equity-related provisions. 

Pandemic prevention, preparedness, and response (PPPR) demands relate largely to national and regional responsibilities, with measures such as the enactment of “domestic laws providing for broad exemptions and limitations to intellectual property to address public health emergencies”, and supply chain diversification and logistics streamlining throughout the continent.

Africa also wants the various WHO-coordinated mechanisms in the agreement – such as on research and development and technology transfer – to be operationalised and accountable to the Conference of Parties, a multi-country structure which is set to govern the agreement.

“Africa stands ready to play its part and comments to engage actively in the ongoing negotiations and finalisation of the draft pandemic agreement,” the statement concludes.

AU warns against postponement

“I don’t think postponing an agreement is going to be in our interest because we may postpone forever. I look forward to us consolidating our common position today, consolidating our negotiating positions and ensuring that Africa’s interests are represented in the global pandemic agreement negotiations,” said AU deputy chairperson, Dr Monique Nsanzabaganwa, during the opening of the ministerial meeting.

AU deputy chairperson Dr Monique Nsanzabaganwa warns against delaying the agreement.

She also urged pragmatism when addressing the meeting on Saturday, explaining that several African demands – such as a seat at the G20 – had taken years to achieve.

“In some situations, we don’t have even a choice because we need to continue being pragmatic as we look for all conditions that can allow us some equity and some flexibilities and conducive conditions for us to do what we’ll have to do for ourselves,” she said.

She also warned of the likelihood of another COVID-like pandemic in the not so distant future, adding that it is “crucial that we work together to strengthen our collective preparedness and ensure that Africa’s voice is heard in global health discussions”.

While Africa’s negotiators wanted a win-win situation, in negotiations “there is always give and take”, said Nsanzabaganwa, who hails from Rwanda.

“We have also the duty to continue pressing for multilateralism to work.”

Meanwhile, Zambia’s health minister, Sylvia Masebo, who chairs the Africa CDC board, called on the African negotiators to ensure “equitable access to pandemic-related health products” and “increased access to vaccines, diagnostics and therapeutics, ensuring that no one is left behind”. 

Africa CDC Director-General Dr Jean Kaseya said that unity and a common African position in the negotiations was key.

 

An exhausted looking WGIHR co-chair Ashley Bloomfield reports back on the process

The World Health Organization’s (WHO) working group has failed to meet its deadline of Friday (26 April) for amending the rules governing global disease outbreaks – the International Health Regulations (IHR) – and will reconvene.

This emerged late afternoon on Friday (26 April) at a briefing after the week-long Working Group of Amendments to the IHR (WGIHR), when drawn co-chair Dr Ashley Bloomfield announced that the group would reconvene on 16 and 17 May for a final two days’ negotiation.

“The mood in the room has been outstanding, and we have worked really hard to make amazing progress. We’re not quite cracking the bottles of champagne and sparkling grape juice, but we were getting very close and I have every sense that you are all committed to finishing the job,” said Bloomfield.

WHO Deputy Director General Dr Mike Ryan commended the group, saying he was “very confident” that the IHR would be  “a clearer, better instrument for your efforts, something that we can apply better on your behalf and on behalf of the people that you serve”.

The WGIHR has asked member states to submit written inputs, particularly on the articles that the meeting failed  to reach agreement on or did not discuss, by 6 May and it will reconvene for a further two days after that.

The Articles that still need agreement relate to technology transfer, financing and governance.

However, many of the WGIHR members are also part of the pandemic agreement talks, which start on Monday 29 April under the intergovernmental negotiating body (INB). The programme of work for the INB envisages 12-hour days, so there will be no space for IHR talks until after 10 May.

However, the two processes are closer linked and the definitions adopted by the IHR, including all the phases that led up to the WHP Director General declaring a public health emergency of international concern (PHEIC), will be used in the pandemic agreement.

The World Health Assembly, which is due to ratify the amendments, begins on 27 May, so time is very tight.

The WGIHR will submit an updated proposed text to member states by 10 May.

The ongoing global spread of “bird flu” infections to mammals including humans is a significant public health concern

While no cases of human-to-human transmission have been recorded in the current H5N1 avian outbreak, scientists are concerned about its transmission speed in mammals and whether this might result in a mutated pathogen that can infect people more easily.

“H5N1 is (an) influenza infection, predominantly started in poultry and ducks and has spread effectively over the course of the last one or two years to become a global zoonotic – animal – pandemic,” said Dr Jeremy Farrar, the World Health Organization’s (WHO) Chief Scientist.

“The great concern, of course, is that in doing so and infecting ducks and chickens – but now increasingly mammals – that that virus now evolves and develops the ability to infect humans. And then critically, the ability to go from human-to-human transmission,” Farrar told a media briefing in Geneva last week.

At the WHO’s global media briefing on Wednesday, WHO epidemiologist Dr Maria Van Kerkhove that “we have not seen human-to-human transmission in the recent cases, and I think that’s really important because there’s a lot of news right now on influenza”.

Spread in US dairy herds  

H5N1  has been detected in cattle in 33 dairy herds in eight US states, according to the latest US Centers for Disease Control and Prevention (CDC) report on 24 April. Remnants of the virus have also been detected in raw milk. 

US CDC described “this degree of spread outside of birds & poultry is unprecedented and concerning” and the US Department of Agriculture has restricted interstate cow transport to limit the spread of the disease.

One human infection has been reported in a Texas, cattle farm worker in late March. Genomic sequencing from this patient found that each individual gene segment was “closely related to viruses detected in dairy cattle” in Texas, according to US CDC.

“While minor changes were identified in the virus sequence from the patient specimen compared to the viral sequences from cattle, both cattle and human sequences maintain primarily avian genetic characteristics and, for the most part, lack changes that would make them better adapted to infect mammals,” it noted.

“There are no markers known to be associated with influenza antiviral resistance found in the virus sequences from the patient’s specimen and the virus is very closely related to two existing candidate vaccine viruses that are already available to manufacturers, and which could be used to make vaccine if needed,” added. 

Overall, the genetic analysis “supports CDC’s conclusion that the human health risk currently remains low”.

US public officials said that Tamiflu, an antiviral effective for treating influenza, is stockpiled for a potential emergency, NPR reported. Some candidate vaccines for H5N1 are also in development and there are some options for enhancing present supply.

US states where H5N1 has been detected in cattle

Historically, human cases of the H5N1 virus are so far very rare, with only 889 cases reported to the WHO since 2003, all involving people who came in contact with infected animals. 

But virus mortality reaches 52%, which is “extraordinary high”, said Farrar, who urged close monitoring and investigation of the outbreaks in US cattle by public health authorities “because it may evolve into transmitting in different ways”.

“Do the milking structures of cows create aerosols? Is it the environment which they’re living in? Is it the transport system that is spreading this around the country?” he asked. “This is a huge concern and I think we have to … make sure that if H5N1 did come across to humans with human-to-human transmission that we were in a position to immediately respond with access equitably to vaccines, therapeutics and diagnostics.”

Different strains, different severity

Though avian influenza viruses naturally occur in wild water birds, some variants are also known to develop the ability to infect other animals. The virus has multiple variants of differing severity and transmission possibilities. 

A case of human infection with the much milder strain of avian influenza virus (H9N2) was confirmed in Viet Nam on 9 April by the International Health Regulations (IHR) National Focal Point, as WHO reported. The same virus strain was also detected in three patients in China,according to the Centre for Health Protection of Hong Kong.

H9N2 usually results in mild infections of the upper respiratory tract, mostly affecting children. It is a low pathogenic avian influenza, usually showing only mild disease in chickens and other poultry, according to the US CDC.

Systems in place to respond

Maria van Kerkhove

“We are concerned about this particular virus because we know influenza has the potential to cause epidemics,” said Van Kerkhove. “That’s why we have a global system in place to monitor detect, to rapidly do risk assessments to look at viruses that could potentially be used in vaccines as we go forward.”

However, she expressed confidence that risks of an outbreak in human populations remain low and that existing WHO surveillance systems competent to monitor any developments. 

”We have a global influenza surveillance and response system that’s been in place for 70 years. And within this systems, there are strong surveillance components, made up of labs around the world, made up of many partner agencies,” she assured the media briefing.

Dr Michael Ryan, WHO’s Executive Director of the Health Emergencies Programme, backed Van Kerkhove: “We have a system that can measure and we have countermeasures ready to go should anything happen and that’s all we can do in public health.”  

“We can’t stop living because viruses threaten us. What we can do is be ready to respond,” he said,.

The Pandemic Influenza Preparedness Framework “has been in place again for 20 years and has provided a framework for collaboration between WHO labs and industry for the sharing of material, for the sharing of vaccines”, added Ryan. 

Image Credits: Charlotte Kesl/ World Bank.

Outdoor workers are at a high potential health risk as climate change worsens heat.

Over 70% of the world’s workforce faces potential health risks due to climate change, according to the latest report by the International Labour Organization (ILO) released earlier this week. Nearly 1.6 billion outdoor workers are also at risk from high levels of air pollution.

“More than 70% of our workers are exposed to excessive heat at least one point in their working lives. That’s 2.4 billion workers globally out of a global workforce of 3.4 billion,” said Manal Azzi, Senior Specialist on Occupational Safety and Health (ILO) at the report launch at the United Nations in Geneva.

The report, Ensuring safety and health at work in a changing climate, states that climate change is already having a serious impact on the safety and health of workers in all regions of the world. The share of global workers impacted by climate change hazards has increased by about from 65% in 2020 to 70% in 2024, the report said.

Workers in the world’s most impoverished regions face heightened risks from scorching heatwaves, prolonged droughts, raging wildfires, and devastating hurricanes, according to the ILO.

 

Range of climate-linked health risks

The report notes that numerous health conditions in workers have been linked to climate change, including cancer, cardiovascular disease, respiratory illnesses, kidney dysfunction and mental health conditions. The impact includes the 1.6 billion workers exposed to UV radiation, with more than 18,960 work-related deaths annually from non-melanoma skin cancer.

“More than 22 million workers are suffering from sicknesses and injuries related to exposure to excessive heat and these can range from injuries in transport, in traffic accidents due to bad night of sleep because it was excessively hot, to construction accidents, injuries, slips and falls related to the exposure to heat,” Azzi said.

Many deaths are also directly related to the impact of climate change. “Nearly 20,000 workers are dying yearly because of these injuries in the workplace related to rising temperatures and to exposure to excessive heat, indoor and outdoor heat, and losing millions – over two million disability-adjusted years – are lost because of injuries and deaths related to heat,” said Azzi, who is the ILO’s specialist on occupational safety and health.

A traditional brick factory in Tozeur, southern Tunisia. In Africa and South Asia brick making and waste burning are major sources of air pollution.

High levels of air pollution causing harm

The report also said that nearly 1.6 billion outdoor workers are at risk of health impacts due to worsening air pollution, particularly those working in the transport sector and firefighters.

Around 860,000 work-related deaths have been attributed to air pollution for outdoor workers annually.

The report noted that modified weather patterns due to climate change have influenced levels of outdoor air pollutants, such as ground-level ozone, fine (PM2.5) and course (PM10) particulate matter, nitrogen dioxide (NO2), and sulphur dioxide (SO2).

Rise in vector-borne diseases

With increasing temperatures and higher humidity, more pesticides are also being used in the agriculture sector. According to the report, there are more than 870 million workers in agriculture that are likely to be exposed to pesticides, with more than 300,000 deaths attributed to pesticide poisoning annually.

Azzi notes that “15,000 people die due to parasitic and vector-borne diseases exposed to in the workplace”.

“Obviously, these include a lot of diseases like dengue, rabies and various diseases that are increasing in regions that we never used to see them before. Malaria has even increased and we’re seeing it’s shown in countries that it never used to be before.”

The ILO has planned a meeting in 2025 with government, employer and worker representatives to provide policy guidance on climate hazards.

Image Credits: Unsplash, WHO/Diego Rodriguez.

HIV medicine dolutegravir.

The government of Colombia has issued its first-ever compulsory license to enable access to generic versions of the key HIV medicine dolutegravir, without permission from the patent owner, ViiV Healthcare.

Dolutegravir is recommended as part of the preferred first-line antiretroviral treatment regimen for people living with HIV, including during pregnancy, as per the guidance of the World Health Organization (WHO). Dolutegravir has fewer side effects and a lower risk of developing resistance. 

UNAIDS has described the move as an “important breakthrough in public health measures” that  breaks “the monopoly”, and could mean that the price of the life-saving medicine is reduced by as much as 80%.

“When the power to produce health technologies is held by a few companies, the result all too often is that countries can’t afford the high prices and people who need newer products cannot access them,” said Luisa Cabal, UNAIDS Regional Director for Latin America and the Caribbean.

“This decision provides the government with the legal conditions to manufacture or purchase more affordable versions of this essential first-line antiretroviral treatment for all people living with HIV in Colombia, including Venezuelan migrants”, said Ms Cabal.

“We are confident that this decision will have an impact across the whole region and beyond, as many middle-income countries are struggling to access generic markets of key health products to prevent and treat HIV infection.”

Prohibitive costs

This move has also been welcomed by Médecins Sans Frontières (MSF), Public Citizen and Global Humanitarian Progress Corporation Colombia.

“Colombia’s decision to issue a compulsory license for dolutegravir is great news because, until now, we have not been able to introduce dolutegravir in our medical operations, as the costs have been prohibitive,” said Dr Carmenza Gálvez, MSF’s medical coordinator for Colombia and Panama.

Although generic versions of dolutegravir are available internationally for a fraction of ViiV’s price through voluntary licenses with the Medicines Patent Pool (MPP), ViiV excluded Colombia and many middle-income countries from being able to benefit from its license with MPP, allowing ViiV to maintain its monopoly and continue to charge high prices in Colombia and other countries excluded from the license. 

The Global Fund buys generic dolutegravir for $22.80 per patient per year, while Pan-American Health Organization (PAHO) can procure it for $44 – but Colombia cannot access these prices. 

According to the Colombian government, the estimated cost of dolutegravir sold by ViiV under the brand name, Tivicay, is around $1,224 per patient per year in 2023.  If Colombia can procure the generics for $44, it will be able to treat 27 people for what it is paying for one person at present.

According to UNAIDS, Colombia hosts the largest number of Venezuelan migrants in the world (2.9 million as of October 2022), and “recent studies have shown a 0.9% HIV prevalence among this migrant population, almost double the 0.5% HIV prevalence among the country’s adult population”.

Compulsory licensing is a provision in the World Trade Organization (WTO) Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS Agreement). It enables governments to supply its citizens with generic versions of patented treatments either through domestic production or imports, ensuring health products’ prices are affordable.

The 2001 WTO Declaration on the TRIPS agreement and public health reaffirmed the rights of member states to make use of all flexibilities in the TRIPS agreement to protect public health, including compulsory licenses. More recently, in the 2021 Political Declaration on HIV/AIDS, countries committed to make use of TRIPS flexibilities, specifically geared to promoting access to medicines.