Members of the US West Virginia National Guard’s Task Force Chemical, Biological, Radiological and Nuclear (CBRN) Response Enterprise (CRE) (TF-CRE) assist staff, medical personnel, and first responders of an Eastbrook Center nursing home with COVID-19 testing.

The US plans to double the number of countries it supports to prevent infectious disease outbreaks, opting for bilateral agreements with at least 100 countries, according to its new Global Health Security Strategy (GHSS).

“Recent outbreaks, from mpox to Marburg, cholera, and other diseases… are wake-up calls for anyone who thought COVID was a once-in-a-lifetime experience,” said Dr Stephanie Psaki, US Coordinator for Global Health Security.

“US national security and prosperity depend on countries around the world being prepared to prevent outbreaks when possible, and to rapidly detect and respond to emerging infectious-disease threats when they occur,” added Psaki, who is also White House National Security Council’s Deputy Senior Director for Global Health and Biodefense. 

“Global health and community health are all interconnected,” remarked Dr Michelle A Williams, former dean of Harvard’s School of Public Health. “A threat anywhere is a threat everywhere when a pathogen can travel anywhere in the world in 72 hours.” 

New roadmap

The GHSS provides a roadmap for strengthening US preparedness for future pandemics and biological threats through expanded global health partnerships. 

The plan will extend US commitments to an additional 50 countries to help protect themselves against outbreaks and pandemic, which will double the countries the US currently supports on public health

“Over the last three years, we have more than doubled our global health partnerships – working directly with 50 countries to ensure they can more effectively prevent, detect, and control outbreaks. And we are working with partners to support an additional 50 countries to save even more lives and minimize economic losses,” writes US President Joe Biden in the plan’s foreword.

The plan “will ensure we remain vigilant to possible threats at this critical moment and help set a more secure, sustainable, and healthy course for our people and for people around the world,” adds Biden.

The GHSS’s three overarching goals are: to strengthen global health security capacities through bilateral partnerships; catalyze political commitment, financing, and leadership; and increasing the linkages between health security and complementary programs. 

The US strategy comes as the World Health Organization’s (WHO) 194 member states are struggling to ratify a global pandemic agreement. While the US is participating in these negotiations, historically it has preferred bilateral agreements as a more efficient way to bolster global health security. 

“Collectively the actions that we are taking right now will make the United States and the rest of the world safer from the next pandemic,” said Psaki, who was speaking at a DC-based Center for Strategic and International Studies event. 

COVID-19 lessons

The GHSS notes that the COVID-19 pandemic offered critical lessons, “including on the importance of political leadership, diplomatic engagement, strong and resilient health systems, multisectoral approaches, risk communication and community engagement, research partnerships, and improving equitable access to medical countermeasures.”

These lessons mean that the GHSS pays close attention to areas health security challenges stress like supply chain resiliency, health care delivery, and public health workforce capacity, risk communication, and health equity. 

“The COVID-19 pandemic has underscored the imperative of building a stronger GHS architecture, including the institutions, organizations, international legal frameworks, policies, and measures to address and respond to health emergencies with international implications while protecting national security and sovereignty,” says the report. 

“We saw how this global health challenge caused local consequences for our hospitals, our schools, and our communities. No sector of the economy or society was immune,” writes Biden in the foreword. 

Complex factors

The GHSS notes the increasingly complex factors shaping global health. “Even as the world recovers from the COVID-19 pandemic, the key drivers of disease emergence and spread are increasing rapidly, including the growth and mobility of populations, human encroachment on animal habitats, wildlife trade and trafficking, loss of biodiversity and the impact of climate change.”

These risks are further exacerbated by other social and economic factors, including “complex humanitarian crises, environmental degradation, land use change, unsustainable development and rapid urbanization, globalized travel and trade networks, emerging technologies, and inequitable access to existing vaccines.”

This One Health approach means that US global health security policy explicitly promotes  human animal, plant, and environmental health, while also meeting a slew of national and global goals. These goals cover sectors ranging from climate, resilience, food security and nutrition, to economic development, biodiversity, and conservation. 

Preventing spillover events are a key GHHS One Health initiative; the strategy highlights the need for improved veterinary bio-surveillance and biosecurity measures, and rapid information sharing. The developing H5N1 outbreak in dairy cows illustrates the potential for zoonotic diseases to jump to humans. 

New country partnerships

The policy highlights that “core to the US government strategy is working with countries around the world to ensure they are better able to prevent, detect, and respond to global health security threats.”

The US is already working to respond to one such threat – mpox –in the DRC by providing immunizations. 

“The goal is for each partner country, or regional entity, to achieve demonstrated capacity in at least five health security technical areas (eg laboratory systems, surveillance, antimicrobial resistance) based on individual country priorities.”

The US government identifies partner countries based on health security needs and the likelihood and vulnerability of an outbreak. These partnerships, while backed through US funding, stress the importance of initiatives where partner countries “have full ownership and strong capacities, with political, legislative, and financial support for the programs, human resources, and systems necessary to maintain a high level of health security.”

Funding and implementation

Several US agencies will implement this policy including the US State Department, the Centers for Disease Control and Prevention (CDC), Health and Human Services (HHS), and the US Agency for International Development (USAID). Psaki will oversee the multi-agency effort to enact the strategy.

Biden is asking Congress for $1.2 billion to implement this strategy,  which will be channelled mainly to USAID, the State Department, and the CDC. 

Image Credits: U.S. Army National Guard/Edwin L. Wriston.

Including genetic data from Africans is crucial for achieving equitable pharmacogenomics.

Pharmacogenomics research in Africa transcends mere regional healthcare improvements: it represents a pivotal step in addressing pressing global health challenges and propelling medical science forward for all. 

A revolution is sweeping through the field of medicine, redefining how we approach the treatment of diseases. Africa must not be left behind in this transformative journey. Pharmacogenomics, the study of how genetic variations influence an individual’s response to therapeutic drugs, holds immense promise for healthcare by facilitating personalized treatments tailored to an individual’s genetic makeup. However, Africa faces a significant challenge due to a critical lack of tailored therapeutics for its genetically diverse population.

Africa’s population is projected to double by 2050 and boasts the most diverse population genetics globally. A study published in 2020 involving 426 Africans explored the breadth of genomic diversity across Africa and yielded over three million novel genetic variants previously undocumented.

Study published in 2020 found a huge breadth of genomic diversity among just 426 African individuals – only a fraction has been studied.

Despite the potential to significantly impact global health and enhance our understanding of genetic diseases worldwide, less than 5% of the data in the pharmacogenomics database, PharmGKB, comes from African populations. Additionally, of over 300 drugs for which the US Food and Drug Administration provides pharmacogenetic advice, only 15 have been studied in African groups.

Despite calls for more diversity in genomics studies, the gap continues to widen, with researchers revealing a 5% increase in genomics studies conducted in individuals of European descent by June 2021, up from 81% in 2016. This lack of representation hampers efforts to use African genomic data in global disease prevention and management, highlighting a significant genomic data gap.

How can we ensure that pharmacogenomics research in Africa leads to more equitable healthcare and bridges this genomic data gap?

Data sovereignty

Firstly, data sovereignty is crucial to ensure that African populations benefit from and retain ownership of their genetic data in pharmacogenomics research. Historically, these populations have been overlooked in treatment developments, as seen during the COVID-19 pandemic, where they were last in line.

It is crucial to implement safeguards to ensure that new treatments developed are affordable and accessible, and that knowledge gleaned from studying the genomes of people on the continent actually benefits those people. There should also be mechanisms in place to ensure that the benefits of genomic research are shared equitably, particularly with the communities that contribute their genetic data.

To prevent this from recurring, collaboration between researchers, pharmaceutical companies, research institutions, and African governments is key.  We must build local capacity and infrastructure for genomic research, empowering communities, fostering trust, and ensuring that research outcomes are relevant and beneficial to the continent.

I have been involved in research on how artificial intelligence (AI) can help to tailor drugs for Africa, and I’m excited by the promise this approach holds.  Initiatives like Project Africa GRADIENT (Genomic Research Approach for Diversity and Optimizing Therapeutics) exemplify the importance of data sovereignty, showcasing how collaborations can empower African populations and ensure the relevance of research outcomes.

Project Africa GRADIENT is a partnership with GlaxoSmithKline (GSK), Novartis, and the South African Medical Research Council (SAMRC), which aims to understand Africa’s genetic diversity and its impact on treatment responses. A total of nine projects across Africa are currently being supported under Project Africa GRADIENT.

This includes our project in collaboration with Ersilia Open Source Initiative where we are using AI to identify prevalent genetic variants affecting the metabolism of malaria and tuberculosis drugs, and incorporating the effects of these variants in existing mathematical modelling tools to come up with tailored drug doses for diverse African patient populations.

Building African capacity for genomics research

Second, collaborative initiatives like Project Africa GRADIENT are instrumental in building local research capacity and training the next generation of African scientists in cutting-edge genomic research and AI technologies. This capacity building is essential for sustainable improvements in healthcare delivery and research on the continent. Investing in local talent will help in addressing immediate healthcare needs and creating a legacy of expertise that will drive future innovations in healthcare.

University of Cape Town Holistic Drug Discovery and Development (H3D) Centre, a place of innovative medical research.

New regulatory frameworks

Third, the policy implications of pharmacogenomics research in Africa are profound and require regulatory frameworks that protect patient privacy and ensure equitable access to personalised medicine. Governments and regulatory bodies should play a crucial role in supporting and regulating genomic research to maximise its benefits for African populations.

This includes implementing policies that incentivise pharmaceutical companies and research institutions to prioritize diversity in clinical trials and research. By establishing robust policies, we can create an environment that fosters innovation while safeguarding the rights and well-being of African populations.

Public awareness as a lynchpin

The public remains the lynchpin of the success of all these novel innovations. Public awareness and engagement are crucial aspects of genomic research, especially in Africa, where cultural and ethical considerations are important.  As partners in this work, we must build a chorus of awareness among the public about the benefits and misconceptions of pharmacogenomics research among African populations. This engagement is essential for fostering a sense of ownership among African communities and shaping the future of healthcare while also building trust.

I continue to be motivated by homegrown solutions for achieving health equity. By focusing on the diverse genetic makeup of African populations, we can develop tailored treatments that benefit everyone, irrespective of geographical boundaries. To make this a reality, we need continued collaboration, investment, and commitment from governments, pharmaceutical companies, research institutions and communities.

It’s time to prioritize African voices and expertise in healthcare research and ensure no one is left behind in the quest for equitable and effective healthcare worldwide. Together, we can bridge the health gap and create a healthier, more equitable future for generations to come.

Professor Kelly Chibale is the Neville Isdell Chair in African-centric Drug Discovery and Development at the University of Cape Town, and founder and director of the university’s Holistic Drug Discovery and Development (H3D) Centre.

 

Image Credits: Sangharsh Lohakare/ Unsplash, Nature, Choudhury et al. (2020).

A child is vaccinated against Meningitis A in Chad; a new five-strain vaccine just introduced in Nigeria offers hope of eliminating meningitis as a public health problem, says WHO.

Immunisation has saved at least 154 million lives over the past 50 years, since the ​​World Health Organization (WHO) launched its Expanded Programme on Immunization (EPI) in 1974.

Of the lives saved, 146 million were children under five, and 101 million were babies.  Global infant deaths have reduced by 40%  and more than halved in Africa.

“That’s an average of more than 1000 a day and six every minute of every year for the past 50 years,” said WHO Director-General, Dr Tedros Adhanom Ghebreyesus, at a WHO press conference Wednesday that celebrated the program’s successes while warning of the setbacks to vaccination programmes from regional conflicts, the legacy of COVID and other risks. 

The measles vaccine has had the biggest impact on reducing infant mortality, accounting for 60% of the lives saved – 94 million.

This is according to a landmark WHO-led study, whose key findings were published on Wednesday to coincide with the start of World Immunisation Week (24-30 April).

The study used mathematical and statistical models to estimate the impact of 50 years of vaccination against EPI’s 14 priority pathogens. 

The 14 pathogens are diphtheria, Haemophilus influenzae type B, hepatitis B, Japanese encephalitis, measles, meningitis A, pertussis, invasive pneumococcal disease, polio, rotavirus, rubella, tetanus, tuberculosis, and yellow fever.

More children live to celebrate their fifth birthday

Dr Ephrem Lemango, UNICEF

 EPI –  now renamed the Essential Programme on Immunization – celebrates its 50th next month. When it was launched fewer than 5% of infants whereas today, 84% of infants are protected with three doses of the vaccine against diphtheria, tetanus and pertussis (DTP) – the global marker for immunization coverage.

“Today more children live to celebrate their fifth birthday than any moment in history,” said Dr Ephrem Lemango, UNICEF associate director and chief of immunization, at the press briefing.

“Vaccines are among the most powerful inventions in history, making once-feared diseases preventable,” said Dr Tedros. 

“Thanks to vaccines, smallpox has been eradicated, polio is on the brink, and with the more recent development of vaccines against diseases like malaria and cervical cancer, we are pushing back the frontiers of disease. With continued research, investment and collaboration, we can save millions more lives today and in the next 50 years.”

As the result of the polio vaccination, more than 20 million people are able to walk today who would otherwise have been paralysed, and the world is on the verge of eradicating polio.

More lives are expected to be saved in the next 50 years by additional vaccines, such as the new HPV vaccine that prevents most cases of cervical cancer, and vaccines against malaria, meningitis, dengue, COVID-19, respiratory syncytial virus (RSV).

Missing doses and rising vaccine hesitancy

Despite the successes, during the COVID-19 pandemic, 67 million children didn’t receive all the vaccinations they needed between 2020 and 2022, and nearly 49 million never received a single dose, according to the WHO.  

Coverage of at least 95% of children with two measles vaccines doses is needed to protect communities from outbreaks. 

Currently, the global coverage rate of the first dose of measles vaccine is only 83% and the second dose is just 74%. Reported measles cases increased by a staggering 84% in just one year between 2022-2023. 

A rise in anti-vaccine sentiment has also seen a decrease in immunisation against measles specifically, as well as vaccination more generally, in developed countries and particularly the US. For example, 28% of Americans  believe that parents should be able to decide not to vaccinate their children (up 12 points since 2019), according a 2023 survey by the Pew Research Center.

The decline in support for vaccine requirements for children has been driven by changing views among Republicans: 57% now support requiring children to be vaccinated to attend public schools, down from 79% in 2019, according to Pew.

UNICEF, Gavi and Gates Foundation as key drivers of the success

A baby is vaccinated at a UNICEF-supported health centre in Abidjan, Côte d’Ivoire.

UNICEF is one of the largest buyers of vaccines in the world, procuring more than two billion doses every year on behalf of countries and partners for reaching almost half of the world’s children. 

“This massive human achievement has only been possible through collective determination and effort led by governments and partners, with the help of scientists, healthcare workers, civil society and volunteers. Sustained cooperation and investment are essential to carry the achievements of the past half-century into the future,” said Catherine Russell, executive director of UNICEF.

In 2000, the vaccine alliance, Gavi, was created to help the poorest countries in the world increase immunisation coverage and benefit from new vaccines. 

Today Gavi has helped protect a whole generation of children and now provides vaccines against 20 infectious diseases, including HPV vaccine that protects against cervical cancer, and vaccines for outbreaks of measles, cholera, yellow fever, Ebola and meningitis. 

“Gavi was established to build on the partnership and progress made possible by EPI, intensifying focus on protecting the most vulnerable around the world,” said Gavi CEO Dr Sania Nishtar. 

“In a little over two decades we have seen incredible progress – protecting more than a billion children, helping halve childhood mortality in these countries, and providing billions in economic benefits. Vaccines are truly the best investment we can make in ensuring everyone, no matter where they are born, has an equal right to a healthy future: we must ensure these efforts are fully funded to protect the progress made and help countries address current challenges of their immunization programmes.”

New vaccine opportunities for meningitis, malaria and dengue

Dr Tedros Adhanom Ghebreyesus, WHO director general.

The rollout of a new vaccine for meningitis, which immunises against five bacterial strains at once, offers the first “real hope of being able to eliminate meningitis as a public health problem,” said Tedros. The vaccine was launched just last month by Nigeria in its northern states where officials aim to vaccinate 1 million people hit hard by meningitis recently.  He noted that he would be joining global health leaders in Paris Friday for a first-ever high level meeting on defeating meningitis.

“The defeating meningitis by 2030 roadmap requires an initial investment of 130 million US dollars,” said Tedros. “Which is frankly loose change compared to the return that investment will deliver as well as preventing over $900,000 and nearly 3 million cases of meningitis by 2030. He added that “defeating meningitis would save billions of dollars in health costs and lost productivity – and as part of an integrated primary health care program can also help to combat antimicrobial resistance (AMR).”

Two new malaria vaccines are also being rolled out in half a dozen African countries, with many more states planning to join the campaign, said Tedros.  Malaria vaccines, he said, could “save tens of thousands of young lives every year” in the case of a disease that now kills some 608,000 people annually.

Finally, vaccines are playing a novel role in the response to a widening dengue outbreak, including more than 5.2 million cases reported in the Americas over just the first quarter of 2024 – more than all of 2023 combined.

“Last year, WHO recommended use of a new dengue vaccine for children aged six to 16 in areas where Dengue is present,” said Tedros.  “Countries including Brazil are now using the vaccine are now using the vaccine – although the supplies constraints and costs are still releatiely high.”

DRC declares mpox a health emergency – finally setting stage for vaccine rollout

Dr Rosamund Lewis, WHO technical lead for mpox

Meanwhile, the Democratic Republic of Congo (DRC) two weeks ago declared its swelling mpox outbreak as a national health emergency – finally setting the stage for introduction of two novel mpox vaccines against a worrisome rise in deadly Clade 1 cases of the disease, particularly among children.

So far no vaccines have been used at all in the DRC outbreak – due to multiple hurdles ranging from global supply lines to bureaucratic barriers in a country wracked by armed conflicts, poverty and multiple disease challenges.

“Now that the government two weeks ago determined that the mpox outbreak in the country constitutes a health emergency, the Ministry of Health has a direction.  And they have issued their statement that they intend to introduce vaccines in the country,” said WHO’s Dr Rosamund Lewis. “So the next step is the vaccine assessment by the national regulatory authority of the two vaccines that the National Immunization Technical Advisory Group has recommended, and open immunization strategies.”

Those vaccines include a Japanese-made mpox vaccine,  LC16 KMB, which is approved for use in children, and the Bavarian Nordic’s MVA-BN vaccine, which has not yet been approved for child use and requires two jabs to be effective.

“I think it’s important to note that the MVA-BN vaccine is very similar to the vaccine for Ebola and that does have authorization for children. So we know a lot about the safety of these vaccines in children,” said Dr Kate O’Brien, director of WHO’s Immunization Programme. Even so, it will be important to conduct more studies simultaneously with rollout to determine how the vaccines can best be deployed among at-risk groups.

“It’s really important as the rollout of vaccine happens, that it’s done in such a way that the information is collected in a scientific way, so that we really strengthen the evidence that will lead to a better understanding of exactly how the vaccines can best be used,” O’Brien said.

‘Humanly possible’ campaign

Also on Wednesday, WHO, UNICEF, Gavi, and the Bill and Melinda Gates Foundation (BMGF) launched a worldwide communication campaign on Wednesday, Humanly Possible, which calls on world leaders to advocate, support and fund vaccines and the immunization programmes that deliver these lifesaving products.  The campaign follows on WHO’s announcement last year of The Big Catchup – a strategy that aims to recoup ground lost during the COVID pandemic, in terms of immunization coverage. 

“It’s inspiring to see what vaccines have made possible over the last 50 years, thanks to the tireless efforts of governments, global partners and health workers to make them more accessible to more people,” said Dr Chris Elias, BMGF president of Global Development 

“We cannot let this incredible progress falter. By continuing to invest in immunization, we can ensure that every child – and every person – has the chance to live a healthy and productive life.”

  • with reporting by Elaine Ruth Fletcher 

Image Credits: UNICEF, Gavi.

Woman with dementia (illustrative)
Woman with dementia (illustrative)

A team of researchers from the Nuffield Department of Clinical Neurosciences at the University of Oxford have identified diabetes, traffic-related air pollution exposures and alcohol use as the most harmful out of 15 modifiable risk factors for dementia.

Their paper, published last month in Nature Communications, examines how genetic traits and modifiable risk factors affect the vulnerability of the more fragile LIFO (“last in, first out”) brain network.

Fig. 1: Vulnerable ‘last in, first out’ (LIFO) network of higher-order brain regions that degenerate earlier and faster than the rest of the brain.
Fig. 1: Vulnerable ‘last in, first out’ (LIFO) network of higher-order brain regions that degenerate earlier and faster than the rest of the brain.

The researchers studied nearly 40,000 people from the United Kingdom Biobank who were over 45 and had brain scans. They assessed how the LIFO brain network is linked to 161 modifiable risk factors, classified according to 15 broad categories: blood pressure, cholesterol, diabetes, weight, alcohol consumption, smoking, depressive mood, inflammation, pollution exposures, hearing, sleep, socialisation, diet, physical activity and education.

They found that seven genetic clusters were significantly associated with the development of dementia. Amongst these clusters, two are found in the genes related to both male and female traits. These genes play a role in determining antigens in the XG blood system. Furthermore, the research showed that after accounting for age and sex effects, diabetes, exposure to traffic-related pollution, and frequency of alcohol consumption most negatively impact these genetic areas. In other words, these factors can make these “weak spots” in our genes more vulnerable.

Nitrogen dioxide assessed as a ‘proxy’ for traffic-related air polution

In terms of air pollution, exposure to nitrogen dioxide (NO2) was assessed – as a “proxy for traffic-related air pollution” the researchers stated.  Traffic emissions are one of the largest, but not the only, source of NO2 emissions worldwide – fossil fuel power plants are another leading source. A growing body of evidence has linked NO2 exposures, as well as ground level ozone (O3) for which it is a precursor, to asthma and other chronic and acute lung disorders.

In 2021, WHO slashed by 75% guideline levels for annual average NO2 exposures, while halving guideline limits for PM2.5 (small particulates).  But stricter emissions limits on gasoline and diesel vehicles have been less effective in reducing NO2 than other pollutants – leaving persistently high concentrations across some major cities in Europe and China and rising NO2 concentrations in parts of South Asia and the Middle East.

NASA satellite image (2018) reflects persistently high NO2 levels in China and parts of Europe, as well as growing levels in South Asia, as compared to 2005.

“The bottom line is that this study gives a biological basis to the risk factors and disease outcomes,” explained Dr Vaibhav Narayan, Executive Vice President and Head of Strategy and Innovation for the Davos Alzheimer’s Collaborative. “This is an important advancement and makes the whole area of prevention more science-based and could allow us to develop more targeted interventions.”

Vulnerability of Brain Regions to Aging and Disease

Previously, the researchers had pinpointed the LIFO network as a vulnerable area of the brain that matures later in adolescence but deteriorates earlier in old age. They also found that this specific brain network is especially susceptible to conditions like schizophrenia and Alzheimer’s disease.

“We know that a constellation of brain regions degenerate earlier in aging, and in this new study, we have shown that these specific parts of the brain are most vulnerable to diabetes, traffic-related air pollution − increasingly a major player in dementia − and alcohol, of all the common risk factors for dementia,” Prof Gwenaëlle Douaud, who led this study, said in a release. “We have found that several variations in the genome influence this brain network, and they are implicated in cardiovascular deaths, schizophrenia, Alzheimer’s and Parkinson’s diseases, as well as with the two antigens of a little-known blood group, the elusive XG antigen system, which was an entirely new and unexpected finding.”

A study published last year in the Lancet found that 12 modifiable factors, all included in this study, account for 40% of dementia cases worldwide. But this new study goes further in prioritizing what risk factors make the biggest contribution to brain degeneration.

Alzheimer's Disease and dementia can lead to loneliness in old age.
Alzheimer’s disease is the most common type of dementia found in elderly people.

“What makes this study special is that we examined the unique contribution of each modifiable risk factor by looking at all of them together to assess the resulting degeneration of this particular brain ‘weak spot,” added co-author Prof Anderson Winklerf from the National Institutes of Health and The University of Texas Rio Grande Valley in the United States. “It is with this kind of comprehensive, holistic approach − and once we had taken into account the effects of age and sex − that three emerged as the most harmful: diabetes, air pollution, and alcohol.”

Expanding Research Horizons: Inclusivity and Global Perspectives

Narayan said that the next step is to make similar studies more inclusive.

“This study is of a limited population in the United Kingdom—people with good higher education status and high levels of affluence—and it is quite possible that the relative importance of these risk factors varies across diverse populations worldwide.”

He said other factors such as pesticide use, extreme heat, indoor air pollution and climate change also could have comparatively larger impacts in different parts of the world.

“This deserves to be studied as much,” he concluded.

Image Credits: Pixabay, Nature Communications Screenshot, NASA , Photo by Steven HWG on Unsplash.

Planet well-being and human health are interconnected issues – one cannot be achieved without the other, according to Kinari Webb, an American medical doctor, public health innovator and thought leader interviewed on the most recent episode of the Global Health Matters podcast.

During the special “Dialogues” episode, Webb speaks with host Dr. Garry Aslanyan about her experiences in the rainforests that led her to establish the non-profit organisation Health in Harmony and write the book “Guardians of the Trees.” Webb and her team have developed a model that provides health care as an incentive to protect the environment.

“Without access to basic services … communities are often driven to destroy their local ecosystem, even when they really don’t want to do that,” Webb told Aslanyan. When these communities were asked what they would need so that they and the rainforests could thrive, “people said … they needed health care access. Sure enough, that came out straight. Without that, we cannot protect the forest, we cannot thrive, and we need organic farming training. They also wanted help with education for their kids.”

Webb and her team were able to work with these communities to help them implement incentives and other programs to achieve these goals. In Health in Harmony’s first sites, after 10 years, they saw a 90% drop in logging households, stabilisation of the loss of the primary forest, 52,000 acres of rainforest grew back, and a 67% drop in infant mortality, according to Webb.

Moreover, at Health in Harmony, they talk to the community about why issues exists and help them develop solutions rather than treating them from the outside. This can be seen, for example, in Madagascar, where they worked with the community to “design these comprehensive food systems that they just needed access to a little bit of education or certain kinds of seeds or a little bit of help with irrigation systems, things like that. Suddenly, they go from one rice crop a year to three.”

Webb said, “We are facing the end of civilisation. We don’t realise that even if we stopped 100% of all fossil fuel emissions and continue to lose rainforests at the rate that we are losing them, it would still be game over. Rainforests are absolute. They are the heart and the lungs of the world. We really need to think about that in that way. We can amputate an arm and still survive, not well, but we can survive. But without the heart and lungs, we won’t make it.”

What were the key lessons she wanted to share with other public health professionals:

1 – Radical listening

“Those closest to a problem understand it in its fullest depth and know the best solutions,” Webb said.

2 – Reciprocity

“We all have something to give; it’s about equal, loving respect and gift-giving mutually around the world,” she concluded.

Previous “Dialogues” episode: A conversation with Olusoji Adeyi.

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

Image Credits: Global Health Matters.

“Having taken up smoking at the age of 14, I was smoking 40 [cigarettes] a day by the age of 20. And as a 21st birthday present to myself I gave up. But today, 40 years later […] I still feel like a fag sometimes. That is how addictive smoking is,” said Andrea Leadsom, a Member of Parliament in the United Kingdom. She was addressing the lower chamber just before an ambitious tobacco regulation draft bill passed a second reading.

“This is not about freedom to choose; it is about freedom from addiction,” she highlighted.

On 16 April, the UK parliamentarians voted for a progressive ban on tobacco products which makes it illegal to ever sell cigarettes to people born after 1 January 2009. The legal age for buying tobacco products would increase by one year every year until it eventually covers the entire population.

The draft legislation will now be referred to a committee for detailed discussion and amendments. Once these have been dealt with, Parliament will vote again, and should it pass a third reading, it would go to the House of Lords for a final vote, possibly as soon as in mid-June.

Strictest in the world

Should the new law pass, it will be one of the strictest in the world. Similar legislation, aiming to create a smoke-free generation, was overturned in New Zealand with a change of government. In Malaysia, the proposed generational tobacco ban was abandoned due to industry pressure.

“We’re hopeful it will get to a point further than all the other policies in the world,” Jorge Alday, director of tobacco industry watchdog, STOP, part of the global public health organisation, Vital Strategies. However, he admitted uncertainty about the bill’s chances against the weight of the tobacco lobby’s influence.

Aside from gradually increasing the minimum age for legally buying cigarettes until it covers more and more people, the bill also proposes an additional fine on selling tobacco to underage smokers, a new tax on vaping, a ban on disposable e-cigarettes and restrictions on their content, flavours and packaging, according to the BBC.

According to the UK’s Office of National Statistics, 6.4 million people, or almost 13% of the country’s population, smoked cigarettes in 2022. There has been a significant decline in cigarette use in the last decade, contrary to the use of new tobacco products, which are on the rise. 

E-cigarettes, or vapes, were most popular among those aged 16 to 24 years, reaching 15.5% of that population in 2022, an increase of roughly a third from 2021. Amongst ex-smokers, e-cigarettes are also frequently used with traditional cigarettes or instead of them, among ex-smokers.

Smoking also creates a considerable burden on healthcare. In England alone, there were 474 400 smoking-related hospital admissions in 2015/16, costing almost £2m, according to Action for Smoking and Health.

Efficient policy

“We know that other age restriction policies work to reduce youth uptake,” says Alday. “Monitoring and surveillance would be needed to confirm the impact, but it doesn’t have to be a huge investment and the UK already has some good monitoring systems in place.”

Critics argue that it would be complicated to enforce the bill, ensuring the retailers aren’t selling to young people. That, some cigarette makers argue, also can create space for more illicit trade.

“I think it’s a false argument. Even if there was an increase it wouldn’t be to the extent the tobacco industry suggests,” Alday said, adding that “the tobacco industry makes this comment for any policy.”

He also doesn’t think that “subtracting cigarettes as an alternative necessarily makes vaping more attractive.”

Regulations that ensure young people never begin smoking, otherwise known as a ‘tobacco generational endgame,’ could be a particularly efficient way to reduce smoking prevalence, proponents say. 

Although no government has yet to see such a policy through to the end, that’s what the studies done so far suggest, according to STOP.

Notably, nine out of ten adults who smoke daily first try smoking by the age of 18 and only about 7,5% are successful in quitting, even though over a half of them try, according to the US Centre for Disease Control and Prevention (CDC). This makes policies targetting adolescents not using cigarettes as yet the most effective.

“At the end of the day we’re talking about young people who are not starting to smoke,” Alday concludes.

Image Credits: Zaya Odeesho/ Unsplash.

A new report from the World Meteorological Organisation (WMO) warns that the Asian continent is the world’s most disaster-prone region, and extreme heat is becoming more severe. 

The warming trend in Asia has nearly doubled over the last three decades, the UN’s meteorological agency reports. In its State of the Climate in Asia 2023, the WMO shows how this has happened largely in the north in places like Siberia, China and Japan. 

Despite the growing health risks posed by extreme heat, heat-related mortality is frequently not reported. While extreme heat is becoming more severe, the highest number of casualties and economic losses were caused by floods and storms. 

Warmer seas, heavier rainfall 

Warming of the upper ocean (0m–700m) is particularly strong in the North-Western Arabian Sea, the Philippine Sea and the seas east of Japan – more than three times faster than the global average. Warmer oceans tend to make cyclones more powerful and unpredictable. Cyclone Mocha, which hit Bangladesh and Myanmar last year, was the strongest cyclone in the Bay of Bengal in the last decade. It touched speeds of 280 km per hour and rapidly intensified in one day. 

While the number of named tropical cyclones, 17, over the western North Pacific Ocean and the South China Sea, was below average, the rainfall in China, Japan, the Philippines, and the Republic of Korea was record-breaking. Hong Kong recorded an hourly rainfall total of 158.1 mm on 7 September 2023, the highest since records began in 1884.

Several stations in Vietnam observed record-breaking daily rainfall amounts in October. In West Asia too there was heavy rainfall and flooding in Saudi Arabia, the United Arab Emirates, and Yemen. 

Of 79 disasters analysed, most were related to flood and storm events, with more than 2,000 fatalities and nine million people directly affected

“The report’s conclusions are sobering. Many countries in the region experienced their hottest year on record in 2023, along with a barrage of extreme conditions, from droughts and heatwaves to floods and storms. Climate change exacerbated the frequency and severity of such events, profoundly impacting societies, economies, and, most importantly, human lives and the environment that we live in,” said WMO Secretary-General Celeste Saulo.

The report covers a vast geographical expanse, from the Arabian desert to the Barents Sea in the Arctic Circle. This sea is identified as a climate change hotspot. Higher ocean temperature impacts the sea-ice cover which melts and in turn, increases temperatures further because darker sea surfaces can absorb more solar energy than the highly reflective sea-ice. The reduction in sea ice has led to controversial moves by several countries (Russia, Norway and others) to exploit the region particularly as it allows for easier shipping routes. 

Particularly high average temperatures were recorded from western Siberia to central Asia and from eastern China to Japan. Source: WMO State of the Climate in Asia 2023

Extreme heat becoming severe 

The heat, however, is a bigger challenge than water-related hazards. Overall, Asia’s annual mean, near-surface temperature last year was the second highest on record at 0.91°C above the 1991-2020 average, and 1.87° above the 1961-1990 average. The global average temperature last year was 1.45°C above the pre-industrial era, very close to the 1.5° threshold recognised by the Paris Agreement. However, for Asia, WMO doesn’t use that pre-Industrialisation baseline because of insufficient data. 

Many parts of Asia experienced extreme heat events and record-breaking heat in 2023. Japan experienced its hottest summer on record. China experienced 14 high-temperature events in summer, with six stations breaking their temperature records. In India, severe heatwaves in April and June resulted in about 110 reported fatalities due to heatstroke. However, this is likely to be an underestimation as heat-related deaths are frequently not reported. 

Tackle climate change and air pollution together

WMO’s report terms Asia the world’s most diaster-prone region. Making many communities here a lot more vulnerable is the high level of air pollution across the continent. In South Asia, Bangladesh, Pakistan, and India are the three most polluted countries in the world, and global warming and pollution is linked, officials say. 

“Air pollution and climate change are interrelated in that if you reduce greenhouse gas emissions, then you also help tackle air pollution. There is also a close link between heatwaves, ozone pollution and poor air quality. So the message is that we need to tackle both together,” a WMO spokesperson told Health Policy Watch. 

At the heart of Asia lies the largest volume of ice outside the polar regions. The Tibetan Plateau contains approximately 100,000 square kilometres of glaciers. Most have been retreating for decades and at an accelerating rate. Melting glaciers threaten future water security

Twenty out of 22 observed glaciers in the High Mountain Asia region showed continued mass loss. One of the glaciers, Urumqi Glacier No 1, in Eastern Tien Shan, recorded its second-highest negative mass balance during 2022-23 since measurements began in 1959.

Permafrost, which is soil that continuously remains below 0° for two or more years, is thawing rapidly across northern Asia. As it melts, it can release methane a greenhouse gas that traps more heat in the short term than carbon dioxide. 

Overview of reported disasters in 2023 associated with hydro-meteorological hazards in the Asia region. Source: WMO State of the Climate in Asia 2023

Call for urgent, tailored action

With emissions of greenhouse gases not being cut fast enough, the world is almost certainly going to cross the threshold of 1.5° above pre-industrial times. Beyond that limit, climate scientists project more intense, frequent, and unpredictable extreme weather events with devastating consequences on life. 

The WMO has flagged an “urgent” need for what it calls tailored support and services to effectively mitigate rising disaster risks. What this means is more than general weather forecasts, the spokesperson told HPW. An example would be a heat-health early warning aimed at health professionals, or an impact-based forecast not just of how much rainfall but what the impact will be in terms of flooding in an urban area.

WGIHR co-chairs Ashley Bloomfield, Abdullah Assiri and Dr Tedros

The penultimate meeting of a World Health Organization (WHO) working group to amend the International Health Regulations (IHR) began in Geneva on Monday amid stakeholder praise and criticism for the latest 64-page draft.

The IHR are legally binding and sets out countries’ rights and obligations in handling public health events and emergencies that have the potential to cross borders. But they were found lacking during the COVID-19 pandemic and the Working Group on Amendments to the IHR (WGIHR) has been considering over 300 amendments over the past two years.

WHO Director-General Dr Tedros Adhanom Ghebreyesus said that the draft “reflects the patience, flexibility and commitment” of the WGIHR.

He also expressed appreciation for the inclusion “pandemic emergency” within the process of declaring a Public Health Emergency of International Concern (PHEIC).  Amazingly, the current  IHR neither mention nor define a pandemic.

However, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) described the “pandemic emergency” along with several other new definitions as “excessively vague”,  which made it “very difficult for industry to assess the overall instrument”. 

Other terms condemned for vagueness include “early action alerts”, stages in the PHEIC process, and “references to health products”, said the IFPMA’s Grega Kumer.

The IFPMA also believes the process of declaring the early action alerts and PHEIC leaves room for “discretion and interpretation” instead of being “based on science and evidence-based criteria”. 

Article 13 attracts the most attention

The IHR’s amended  Article 13, dealing with the “public health response, including access to health products”, attracted the most attention from stakeholders.

Knowledge Ecology International (KEI) welcomed the” transparency mandate” contained in Article 13 (9C). 

This calls on state parties to publish “relevant terms of government-funded research agreements for health products needed to respond to a public health emergency of international concern as well as information where relevant on pricing policies regarding these products and technologies to support equitable access”, said KEI’s Thiru Balasubramaniam.

“Article 13.7 envisions that WHO plays a coordinating role among state parties during public health emergencies of international concern. This coordinating role involves the facilitation of equitable access to health products, including through technology transfer on mutually agreed terms,” added Balasubramaniam.

KEI suggested two options to encourage technology transfer and know-how to facilitate the development of drugs, vaccines and other countermeasures. 

One would “create incentives for parties to share some rights acquired from publicly funded R&D or procurements in a reciprocal manner with parties that also share”. The other would “provide money or other incentives to acquire rights to patented inventions, know-how and other inputs from private rights holders”.

The Coalition for Epidemic Preparedness Innovations (CEPI) described as “commendable” that Article 13 made provision for state parties to allocate sustainable financing, but added that “they should have the support of the WHO in building, strengthening and maintaining core capacities” and in public health emergency, this should extend to “local production capacity development”. 

“Equally, in this article, we would like to see broader requirements for embedding equitable access terms in public funding contracts, including data sharing, affordable and sustainable pricing, manufacturing scale-up and technology transfers,” said CEPI.

Third World Network (TWN), an alliance of non-profit organisations from the Global South, welcomed the proposed language on WHO’s role in equitable access to deliver health products, but said “specific methods for achieving this remain absent, particularly in Article 13.7.”

TWN also that Article 4.2 bis and 13.1 shift the “implementation burden to state parties, contradicting the common but differentiated responsibilities principle and abandoning support for developing countries”.

Health Action International’s Senior Policy Advisor, Jaume Vidal, condemned attempts by some countries to “water down and remove suggested amendments seeking to scale up production, diversify manufacturing and guarantee a steady supply of health technologies”.

The IFPMA said that some recommendations in Article 13 lack balance and pre-empt the outcome of the pandemic agreement negotiations, “in particular, the WHO-coordinated mechanisms and networks”.

Threat of avian flu

Although the WGIHR meeting is set to close on Friday to enable the intergovernmental negotiation body (INB) on the pandemic agreement to resume next week, Tedros encouraged the group to “take more sessions together if you need them”.

But WGIHR co-chair Dr Ashley Bloomfield urged member states to “work towards Friday this week as a firm deadline”. 

“We are all aware the INB process remains live with another two weeks of intense negotiations scheduled following this meeting,” said Bloomfield. “We continue to work closely with the INB co-chairs and the Bureau to ensure our work is aligned.

“One reason it is important for us to complete our work this week is so that there can be a full focus on the INB negotiations in the following two weeks to maximise the chance of success in that crucial process.”

Bloomfield added: “You will all be aware of the growing concern about the threat of H5N1 bird flu highlighted by the WHO just last week. We have the opportunity to ensure that the world is better prepared both individual countries and collectively to address that thread through strengthening core capacities in all states parties.”

World Bank president Ajay Banga (centre) addresses an event to announce the new focus. He is flanked by Shakuntala Santhiran and WHO’s Dr Tedros.

The World Bank aims to support countries to deliver “quality, affordable health services” to 1.5 billion people by 2030, it announced during its ‘spring’ meeting in Washington this week.

It will expand its current focus from maternal and child health to include “coverage throughout a person’s lifetime, including non-communicable diseases”; hard-to-reach areas, including remote villages, cities, and countries; and working with governments to “cut unnecessary fees and other financial barriers to health care”, the Bank announced on Thursday.

“The Bank has been working in 100 countries for a while on a maternal and neonatal effort to improve the delivery of care to women and young babies,” said World Bank president Ajay Banga at an event to announce the Bank’s new focus. 

“We want to widen our aperture to include the diseases across adults, adolescents and old age.”

Banga said that the Bank intended to “really reach them…  actually touching the person with a medical appointment, either physical or telehealth, working on this expanded range of noncommunicable diseases, that’s the effort we’re going to try and put in by now in 2030”. 

World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus said that around 4.5 billion people lacked adequate health coverage, while two billion face financial hardship trying to get health services, some “descending into poverty” as a result.

The task is complicated by what the Bank describes as “intertwined challenges, such as climate change, pandemics, conflicts, societal ageing, and a projected shortfall of 10 million healthcare workers by 2030”.

How will this be achieved?

“A lot of hard work, a lot of knowledge, a lot of financing, and a lot of partnerships,” is how the aim will be realised, said Banga.

“Financing is the obvious one. We’re a money bank and a knowledge bank. But even the money we can put to work will never be enough. We’re talking about putting to work 50% more money per year than what we used to spend on health care, pre- the pandemic,” he said.

But governments and the private sector would also have to invest in the effort.

Low-income countries spend an average of $21 per person, per year on health care. 

“That’s not going to get to health care workers in remote areas. So we have to give them share financing, concessional and grant financing,” said Banga.

Middle-income countries have more money available, but “may not have the right regulatory policies to create the multiplier that you want to create” – which could be done through private sector involvement.

“We can help with incentivizing them to create the right regulatory platforms and the right policies.”

This could involve private sector involvement in manufacturing essential medicines, or fortifying basic foods with vitamins.

Discussions with countries would involve identifying what they need to do to break through their barriers to deliver their share of the 1.5 billion – skills, infrastructure, medicines.

“We bring a diversification of knowledge. We understand water, we understand climate, we understand agriculture. We understand how those connect to health challenges.

“We can bring that knowledge as a partner, not just our financing, not just our ability to advise governments on regulatory policy, but our ability to help understand the intersections between these different causes of healthcare problems in the intertwined challenges that we are going through,” Banga concluded.

The World Health Organization (WHO) has published a new technical report including updated terminology to describe pathogens that are transmitted through the air, following “an extensive, multi-year, collaborative effort”.

It follows confusion and contestation between scientists during the COVID-19 pandemic because of the “varying terminologies” and  “gaps in common understanding”, said the WHO.

These “contributed to challenges in public communication and efforts to curb the transmission of the pathogen”.

However, a number of scientists called out the WHO itself for being slow to acknowledge that SARS-CoV2 could be transmitted in the air.

“Together with a very diverse range of leading public health agencies and experts across multiple disciplines, we are pleased to have been able to address this complex and timely issue and reach a consensus,” said Dr Jeremy Farrar, WHO’s Chief Scientist. 

“The agreed terminology for pathogens that transmit through the air will help set a new path for research agendas and implementation of public health interventions to identify, communicate and respond to existing and new pathogens.”

Experts and four major public health agencies – the Africa Centres for Disease Control Prevention, Chinese Center for Disease Control and Prevention, European Centre for Disease Prevention and Control and US Centers for Disease Control and Prevention – were consulted between 2021 and 2023.

Away with ‘aerosols’ and ‘droplets’

Instead of ‘aerosols’ and ‘droplets’, the report uses the new descriptor, ‘infectious respiratory particles’ (IRPs), describing these as existing “on a continuous spectrum of sizes, and no single cut-off points should be applied to distinguish smaller from larger particles”. 

This facilitates a “away from the dichotomy of previously used terms: ‘aerosols’ (generally smaller particles) and ‘droplets’ (generally larger particles)”.

These IRPs are transmitted by people infected by a respiratory pathogen “through their mouth or nose by breathing, talking, singing, spitting, coughing or sneezing”. 

‘Through the air’

Under the umbrella of ‘through the air’ transmission, the report advises the use of two descriptors. The first is “airborne transmission or inhalation” for cases when IRPs are expelled into the air and inhaled by another person, who could be at quite a distance from the infected person.

The second is “direct deposition” for cases when IRPs are expelled into the air from an infectious person, and are then directly deposited on the exposed mouth, nose or eyes of another person nearby.

The pathogens covered include those that cause respiratory infections, such as COVID-19, influenza, measles, Middle East respiratory syndrome (MERS), severe acute respiratory syndrome (SARS), and tuberculosis.

Image Credits: Towfiqu Barbhuiya/ Unsplash.