Deadly Mpox Transmission in DR Congo Happening Under Radar; Most Victims are Children 13/03/2024 Zuzanna Stawiska Patient participating in a clinical trial of Tpoxx, an antiviral treatment for the mpox virus, in the Democratic Republic of Congo. A leading Geneva-based global health organization has decried the lack of tests available for mpox in the Democratic Republic of the Congo (DRC) – where an outbreak declared in 2023 continues unchecked – saying that children are the main victims. “The mpox situation in the DRC is deeply alarming and the lack of tests for both mpox and HIV means it’s unclear just how bad the mpox situation is and what the underlying comorbidities are,” said Dr Ayoade Alakija, Chair of the Board at FIND in a press release. According to FIND, a global non-profit dedicated to accelerating access to diagnostics, only 16% of suspected mpox cases in DRC undergo a PCR test. Among suspected cases that are tested, six out of ten test results are positive, underlining the degree of under-estimation of confirmed mpox cases. “Testing capacity for mpox and HIV in the DRC is severely limited, meaning that many likely cases of mpox in the country are treated as suspected cases only,” Dr Sergio Carmona, FIND CEO and chief medical officer said. Left unchecked – virus risks further spread abroad Alakija compared the current mpox outbreak in the DRC with the situation during the COVID-19 pandemic, when many African countries were left behind in terms of tests and treatments and vaccines. THREAD: As deadly #mpox virus (MPXV) outbreak emerges, children are increasingly at risk due to a lack of diagnostic testing capacity. Recent findings reveal that transmission routes are expanding.https://t.co/P4ls065eAm — FIND (@FINDdx) March 12, 2024 Left unchecked, the deadly Clade I form of the mpox virus now circulating in the DRC risks spreading further in Africa and beyond, she warned. “The people that are being prioritized for tests, treatment and vaccination are not in the outbreak countries in Africa,” she noted, referring to the rollout of measures in high- and middle-income countries over the past two years to counter the much milder, Clade I, form of the mpox virus that exploded in 2022. “We can either mobilize resources and fight the deadly mpox outbreak now in the DRC, or we can let the virus continue to spread and fight it when it is imported into other countries,” Alakija said. DRC outbreak is the largest ever recorded According to the US Centers for Disease Control (US CDC) the current DRC mpox outbreak is the largest ever recorded, with cases reported in 22 out of the DRCs 26 provinces. Some 12,569 suspected cases and 581 deaths have been reported since 1 January 2023. From the start of 2022 to January 2024, the DRC reported 21,630 suspected MPXV cases and 1,003 deaths. Around 85% of deaths in this period were children under 15 years of age, according to WHO data. Epidemic curve shown by month for cases reported to WHO from the African region. Recent cases mostly in DRC. Potentially ‘distinct’ Clade I strain and new patterns of transmission Mpox is a viral infection, which belongs to the same virus family as smallpox. It was traditionally confined to remote, rural areas of central and western Africa, where transmission was sporadic and occurred primarily through human contact with rodents and other small mammals. The virus burst onto the global arena in 2022 when WHO declared a global health emergency after the milder, Clade II form of mpox, began to spread through dozens of countries worldwide, infecting thousands of people, mainly through sexual transmission, and particularly men having sex with men. The global health emergency was declared over in 2023 following the scale up of diagnostics and vaccination in middle- and high-income countries, aimed at high-risk groups. Over the past year, however, global health authorities have expressed rising alarm over the increased circulation of the more deadly Clade 1 of mpox throughout central and east Africa – including through patterns of sexual transmission, including heterosexual transmission, not previously seen. In the case of the eastern DRC, female sex workers found to be among the leading groups transmitting the disease, along with transmission through close familial or community contacts, according to a study published Tuesday on the pre-print health sciences platform, MedRxiv. The study looked at transmission patterns in the city of Kamituga, in DRC’s south Kivu province. The sustained community-level transmission of mpox now seen in Kamituga “is…. being driven by a distinct Clade I mpox strain, possibly a novel subgroup, as confirmed with qPCR,” the researchers from over a dozen countries found. Mpox has similar symptoms as smallpox, including painful blisters and rash, fever, chills and fatigue. In the case of the milder, Clade II form of the virus, most patients recover after a few weeks of supportive care, WHO says. Image Credits: WHO. Who Will Finance Countries’ Pandemic Response: Pandemic Fund, WHO or a New Entity? 12/03/2024 Kerry Cullinan COVID-19 screening in Bangkok, Thailand: Financing future pandemic preparedness and response is unclear. Many practical questions about how the pandemic agreement will be implemented – including how to finance countries’ pandemic prevention, preparedness and response (PPPR) – seem likely to be ceded to the Conference of Parties (COP). According to the latest pandemic agreement draft, a “Coordinating Financial Mechanism” will support the implementation of the pandemic agreement and the International Health Regulations (IHR) (see Article 20). “There’s a key debate with Article 20 within the negotiations about whether the coordinating mechanism should be hosted by the Pandemic Fund, the World Health Organization (WHO), or whether a new entity should be created,” Professor Garrett Wallace Brown, chair of Global Health Policy at the University of Leeds, told a Geneva Global Health Hub (G2H2) media briefing on Tuesday. “There’s seemingly little appetite for a new institution, and there is a strong narrative being promoted for the Pandemic Fund in order to decrease fragmentation,” added Wallace Brown, who is director-designate of new WHO Collaboration Centre for Health Systems and Health Security. The Pandemic Fund’s Priya Basu has made a strong bid for her entity to become this mechanism, telling Devex this week that a new fund to support PPPR would mean “duplication”. Professor Garrett Wallace Brown, chair of Global Health Policy at the University of Leeds But Wallace Brown said that “final decisions about the details of the coordinating mechanism are being offloaded to the Conference of the Parties (COP), which I think is a wise decision given the circumstances”. “There are only nine negotiating days left and there are lots of details to work through. But I think it’s only wise if the COP is representative, inclusive, proportional to risk and deliberative, meaning a move away from business as usual.” In conversation with delegates involved in the Intergovernmental Negotiating Body (INB) thrashing out the pandemic agreement, Wallace Brown said that “what they want to do is make the wording strong enough to show that there’s a commitment to a coordinating mechanism and a commitment to financing those”. In addition, they were “being somewhat more clear about what types of financing and what types of mechanisms would be housed underneath that, but offshoring those details for 12 months – I’m suggesting 24 months – to try to work out exactly how that is done”. Domestic funds? According to the draft, the financing mechanism would include a pooled fund for PPPR, and may include “contributions received as part of operations of the [Pathogen Access and Benefit-Sharing System], voluntary funds from both states and non-state actors and other contributions to be agreed upon by the Conference of the Parties”. G2H2 co-chair Nicoletta Dentico However, G2H2 co-chair Nicoletta Dentico warned that poorer countries were mired in debt and debt cancellation should be a consideration to help these countries. “Fifty four low-income countries with severe debt problems had to spend more money on debt servicing than on the COVID disease in 2020,” said Dentico, who heads the global health justice program at Society for International Development (SID). “Contrary to the WHO Framework Convention on Tobacco Control, the [pandemic agreement] text opened for the final negotiations stubbornly ignores the repeated calls for legal safeguards that are indispensable to immunise the treaty implementation and financing from vested corporate interests,” added Dentico. Mariska Meurs from the Dutch health NGO WEMOS, warned that “domestic funding for pandemic prevention preparedness and response must not undermine other domestic public health priorities”. “The draft pandemic treaty text worryingly includes ‘innovative financing mechanisms’, which often means using public funds not for heath, but to attract private-for-profit investors. Instead, the pandemic treaty should embrace the most obvious and fair avenues for funding pandemic prevention, preparedness and response: global tax justice and debt cancellation”. “But undermining other domestic public health priorities is exactly what we’ve seen happening under COVID-19. We’ve witnessed the shifts in global and domestic funding and how funding for basic health care has gone down,” warned Meurs. “The text, as it lies before us now, does not acknowledge or try to remedy this.” Mariska Meurs from the Dutch health NGO WEMOS “The draft pandemic treaty text worryingly includes ‘innovative financing mechanisms’, which often means using public funds not for heath, but to attract private-for-profit investors. Instead, the pandemic treaty should embrace the most obvious and fair avenues for funding pandemic prevention, preparedness and response: global tax justice and debt cancellation,” said Meurs. Pandemic Fund ‘black box’ Low and middle-income countries are more in favour of the pandemic financing mechanism being housed in the WHO “because they see it as being more representative” than the Pandemic Fund, said Wallace Brown. But donors “are less keen because they see it as a mechanism that would give them less control of how funds are spent”. However, for the Pandemic Fund to become the PPPR mechanism would require “radical changes” not “minor tweaks as we’re currently being told”. Some of the problems with the fund, are that it only focuses on three elements of PPPR and this “creates vertical silos”, and there is no explicit guidance in the fund’s governance framework on “how equity will be addressed in either the fund process or with reference to prioritise beneficiaries of programmes”, according to Wallace Brown. In addition, the first round of funding was eight times over-subscribed but the selection process “was not clear”. “Applications that met the scorecard threshold for funding had to be rejected, and it remains unclear exactly how the governing board made their final decisions,” he added. Describing his personal view on the way forward as “agnostic”, Wallace Brown said he had been studying the Pandemic Fund for a while and “think it’s a bit of a black box”. However, the WHO would need capacity building to become the mechanism “They do handle funds, they have the contingency fund for emergencies. They are able to make funding available to people and have processes for that, but they don’t have it at the same scale as a World Bank,” he said. “Or there could even be a third entity. So at the moment, I’m remaining agnostic. I think there needs to be better analysis, better evidence to decide what works and what doesn’t work” – and these kinds of details “won’t be decided in nine days”. Image Credits: Prachatai/Flickr. Pharma Describes Draft Pandemic Agreement as a ‘Step Backwards’ 12/03/2024 Kerry Cullinan Lab technician at a pharmaceutical company conducting a test. The new draft of the pandemic agreement “is a step backwards rather than forwards”, according to Thomas Cueni, Director General of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA). “It is critical that any agreement takes steps to ensure equity in access to medicines and vaccines in future pandemics, whilst preserving the innovation ecosystem that delivered a vaccine just 326 days after the SARS-CoV2 genome sequence was first sequenced,” said Cueni. Article 12 of the current draft proposes that manufacturers pay an annual subscription fee to a yet-to-be-formed World Health Organization (WHO) Pathogen Access and Benefit-Sharing (PABS) System. In exchange, they would get “rapid, systematic and timely access to biological materials of pathogens with pandemic potential and the genetic sequence data (GSD) for such pathogens”. The article also proposes that manufacturers provide “real-time contributions of relevant diagnostics, therapeutics or vaccines” with 10% free and 10% at not-for-profit prices during public health emergencies of international concern or pandemics. ‘Uncertainties will cause delays’ But Cueni was dubious: “Stringent requirements for accessing pathogen data would severely impact responses to future pandemics and basic research and development (R&D). “Conditions, uncertainties, and negotiations surrounding pathogen access will cause delays in the developing medical countermeasures, leading to significant public health consequences, including loss of lives and unnecessary economic pressures. In the COVID-19 pandemic context, even a one-month delay could have meant an extra 400,000 lives lost.” The pharmaceutical industry has warned that a mandatory financial contribution could dis-incentivise companies from joining the PABS system. “The pharmaceutical industry is determined to continue to play our part in these final stages – sharing our experience, evidence and expertise to help deliver an agreement that will better protect the world when the next pandemic hits,” Cueni said. Thomas Cueni, Director General of the IFPMA. This week, the biopharmaceutical industry published a statement on how companies can work between pandemics – as well as when a pandemic hits – to deliver equitable access to medical countermeasures on the basis of public health risks, needs and demands.” The statement was signed by a broad range of trade associations aside from the IFPMA, including the Developing Countries Vaccine Manufacturers Network, DCVMN, Europe (EFPIA), the US (PhRMA) and Japan (JPMA), and the Biotechnology Innovation Organization (BIO). The companies detail the commitments to pre- and during pandemic measures. These include improving surveillance; research on pathogens of pandemic potential; voluntary licensing and technology transfer based on “mutually agreed terms to improve geographic diversity of manufacturing”; real-time allocation of part of production, and equity-based tiered pricing. Companies are also engaged in ongoing activities to support health system preparedness, whether by building clinical trial and regulatory capacity and harmonization, health care worker and community health worker trainings, or the continual investment needed to establish and maintain new technologies and platforms. “With a final draft of a pandemic agreement now published, negotiators should redouble their efforts to find consensus as there is still much work to be done before an agreement can be reached, added Cueni. Previously, Cueni warned that “It would be better to have no pandemic treaty than a bad pandemic treaty.” Image Credits: AMR Industry Alliance, World Health Summit. Partnership for Healthy Cities Achieves Big Wins Over Short Time 07/03/2024 Kerry Cullinan Accra has reduced traffic crashes by 20% over seven years CAPE TOWN – From Accra to Kathmandu, a global partnership of 74 cities has had remarkable success in addressing some of the key drivers of sickness and death since it was launched seven years ago. Ghana’s capital city, Accra, has cut traffic crashes by 20%. In India, Bengaluru is virtually smoke-free – not even hookahs are allowed. Nepal’s Kathmandu has installed air quality sensors to assess air pollution while a number of Latin American cities are supporting better nutrition of their school children. “The Partnership for Health Cities (PHC) was formed in 2017 to address non-communicable diseases (NCDs) and injuries, which are responsible for 80% of deaths globally,” said Bloomberg Philanthropies’ Kelly Larson, welcoming city representatives to the PHC’s summit in Cape Town this week. “This opportunity for us to come together is very unique because we are all facing the same challenges and you can learn so much from one another. We really do believe in the power of cities to make change. We are here to support you in your efforts to know that you are leading the way on this,” added Larson, whose organisation supports the partnership, along with the World Health Organization (WHO) and Vital Strategies. The partnership started with 54 cities but now consists of 74 cities that collectively represent over 300 million people. Each city in the PHC chooses to work in one of six key work areas: food policy, overdose prevention, tobacco control, road safety, safe and active mobility (such as promoting cycling) or data surveillance. The cities are encouraged to root their work in public health policies and to win as much public support as possible for these. The PHC’s Policy Accelerator supports cities to create and implement these policies. “Cities are a place where people are particularly at risk. There is a huge concentration of people exposed to risk of NCD and injuries,” said the WHO’s Etienne Krug. “But cities are a particularly good place to think about interventions for a number of reasons,” he added. “First of all, they enforce national laws but they can also enhance these with additional regulations. City leaders are geographically close to their populations. It is easier for multi-sectoral approaches than at national level.” Bengaluru: A model smoke-free city Bengaluru in India has become a model smoke-free city India’s Dr Vishal Rao has been an advocate for smoke-free laws for a number of years in Bengaluru (Bangalore) and its state, Karnataka. This is hardly surprising as a head and neck surgical oncologist at a cancer hospital and has treated numerous tumours in the thyroid, parotid, and salivary glands caused by tobacco use. “We first prioritised creating a policy framework around smoking, and have built this policy around the three R’s – making somebody responsible, have it reviewed and reported,” Rao told Health Policy Watch. Dr Vishal Rao from Bengaluru “We prioritised smoke free policy because we realised that Bengaluru is a cosmopolitan economic hub with a very vibrant culture of pubs, clubs, cafes, bars and restaurants, all of which were rampantly violating the smoke free laws,” said Rao, who is also a member of the Karnataka government’s High Power Committee on Tobacco Control. “Reducing and protecting the non-smokers required a comprehensive approach of policy intervention which is why the mayor and the [state] commissioner came out with the government order completely banning smoking in hotels, bars, restaurants, clubs, pubs and cafes unless they have a designated smoking room which is compliant with the law,” said Rao. The requirements for these designated smoking rooms were so onerous – including no sales or services of any sort being allowed – that most places opted not to set them up. A couple of weeks back, the state government also banned hookah bars – including hookah with tobacco, flavoured and herbal hookah – becoming the first state to do so. The pushback has been immediate, with the Hookah Association lodging around 12 litigation cases against the new laws, said Rao. For Rao, the partnership is less about the grants cities get and more about sharing strategies, tactics and “allowing champions to emerge” to promote the various themes – his city won an award at last year’s summit for its efforts. Accra: All the laws but little implementation Rita Agyen Takyi is an advisor to Accra’s mayor on international affairs Rita Agyen Takyi is an advisor to Accra’s mayor on international affairs and the city’s focal person on road safety, the issue her city has chosen. “Ghana has all the laws. But we needed enforcement, implementation and public awareness,” Takyi told Health Policy Watch. Accra’s Bloomberg Road Safety initiative started in 2015 and it joined the partnership at its launch in 2017. Over half the city’s road traffic deaths involved pedestrians, cyclists and motorcyclists. Public awareness campaigns have included encouraging the use of seat belts and helmets, speed limit signs and speed detectors for traffic police, direction signs painted on roads and fixed painted bollards to prevent motorcyclists from entering pedestrian crossings. “We have reduced traffic crashes by 22% since 2021/22,” said Takyi, who also credits this success to Accra bringing different stakeholders “out of their silos” and into one forum with a common goal. Latin American cities prioritise food policy Five cities in Latin America have chosen to focus on food policy. Quito in Ecuador is concerned with the nutrition of children, the city’s Marysol Ruilova told the Cape Town summit. Quito has developed a policy requiring only healthy foods to be advertised near and at schools, and is also providing clean free water in 20 pilot schools. However, since the COVID-19 pandemic, there has been an increase in child malnutrition so the city has focused on school feeding schemes. Cordoba is focusing on school nutrition, including promoting water Similarly, Córdoba in Argentina is preparing to restrict the sale and advertising of unhealthy food and beverages in schools and requiring healthy alternatives, while Cali in Colombia is also ensuring that scholars have access to nutritious and wholesome meals during school hours. Lima in Peru is also working to create healthier school environments through enforcement of a new policy that restricts sales and advertising of unhealthy products. Montevideo in Uruguay is incentivizing food services to provide healthier meals to public sector workers, through its “Healthy Canteens” initiative. Cape Town: Socio-economic determinants of health Cape Town mayor Geordin Hill-Lewis addresses the opening of the summit. Host city Cape Town has been involved in tobacco control and food policy-related initiatives while part of the PHP. “Against the backdrop of incredibly challenging national economic circumstances and very deep and wide local poverty, our city is still demonstrating progress,” Mayor Geordin Hill-Lewis told the summit.“But you cannot build a prosperous city or achieve our dream of a city of hope without also focusing on public health in a serious way.” One of the things that Cape Town is currently focusing on is identifying and addressing the socio-economic determinants of health in the city and addressing these through infrastructure planning, service provision and job creation. “Cape Town has a very high burden of NCDs and other preventable deaths. And, while we have a good understanding of the various factors that contribute to that burden, this programme will provide crucial information that can help determine strategies going forward,” according to Councillor Patricia Van der Ross. Image Credits: Partnership for Health Cities, Kerry Cullinan. New Global Commitments Make Elimination of Cervical Cancer Possible 06/03/2024 Sophia Samantaroy & Kerry Cullinan The WHO set an ambitious goal of having 90% of girls vaccinated against HPV by 2030 Eliminating cervical cancer is within reach, thanks to new commitments by governments, donors and other partners, including pledges of almost $600 million, made at the first-ever global forum on cervical cancer in Cartagena de Indias in Colombia. Every two minutes, a woman dies from cervical cancer, although vaccination against human papillomavirus (HPV), the leading cause of cervical cancer, can prevent the vast majority of cases. Cervical cancer is the fourth most common cancer in women worldwide, but disproportionately affects women and their families in low and middle-income countries (LMICs). Less than 5% of women in many LMICs are ever screened for cervical cancer, and over 90% of the 348 000 cervical cancer deaths in 2022 took place in LMICs. Furthermore, only one in five adolescent girls were vaccinated against HPV in 2022. Country commitments Low and middle income countries experience the highest burden of cervical cancer However, a number of countries stepped up at the forum. These include the Democratic Republic of Congo (DRC), which has committed to introduce the HPV vaccine as early as possible, targeting girls aged 9 to 14 years. Ethiopia aims to reach at least 95% of all 14-year-old girls with the HPV vaccine this year, and screen one million eligible women every year for cervical cancer and to treat 90% of those screened who present with positive precancerous lesions. Further, HPV single dose has been approved to be introduced this year and scaled up as part of the country’s Expanded Program on Immunization plans. Africa’s most populous country, Nigeria, has committed to vaccinating 80% of girls 9 to 14 years old by 2026, including those who are no longer at school. The nearly $600 million in new funding includes $180 million from the Bill and Melinda Gates Foundation, $10 million from UNICEF, and $400 million from the World Bank. Elimination of a cancer Experts gathered in Colombia to discuss global collaboration for cervical cancer elimination “If these ambitions to expand vaccine coverage and strengthen screening and treatment programs are fully realized, the world could eliminate a cancer for the first time,” according to the World Health Organization (WHO). In 2022, the WHO revised its HPV vaccination recommendation from two to one-dose of the HPV vaccine, making it much easier and cheaper for countries to reach those who need it. The WHO Americas region made a similar recommendation 2023, and WHO’s African regional just followed suit with its own recommendation. “We have the knowledge and the tools to make cervical cancer history, but vaccination, screening and treatment programmes are still not reaching the scale required,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This first global forum is an important opportunity for governments and partners to invest in the global elimination strategy and addressing the inequities that deny women and girls access to the life-saving tools they need.” However, many LMICs face an uphill battle. Malawian Minister of Health Kandodo Chiponda described the challenges her country faces at the forum’s opening plenary. Some 60% of Malawi’s population of over 20 million is under 35, and cervical cancer is the highest cancer burden, with the incidence rate as high as 70 per 100,000. Mortality figures are 52 per 100,000, said Chiponda, who also announced the opening of the first ever cancer center in Malawi. Chiponda noted that women have limited time and resources to seek care, limited access to screening and diagnostic services, and are subject to misinformation about vaccinations. She emphasized the need for cross-sector collaborations and the strengthening of primary healthcare to reach women and girls in remote areas. ‘Miracle of modern medicine’ “Cervical cancer is a disease of inequity” – Dr. Tedros Adhanom Ghebreyesus, WHO Director-General “The HPV vaccine is one of the most impactful vaccines on the planet and has already helped save thousands of lives,” said Aurélia Nguyen, Gavi’s chief programme officer. Despite the efficiency and safety of the HPV vaccine, high costs, supply chain issues, and difficulties in reaching remote populations keep the vaccine out of reach for many. “More girls urgently deserve the same protection, which is why in partnership with countries, Gavi has set an ambitious goal to help vaccinate 86 million adolescent girls by 2025. With bold commitment and decisive action, we can look forward to a future where cervical cancer has been eliminated for good.” Describing HPV vaccines as “a miracle of modern medicine”, Dr Chris Elias, the Bill and Melinda Gates Foundation’s president of global development, said that there is “no reason why women should die from cervical cancer.” “Now is the time for governments and partners around the world to increase HPV vaccine access and protect future generations from cervical cancer.” Image Credits: Unsplash, IARC/WHO, Global Cervical Cancer Elimination Forum, GCCEF/WHO. European Parliament Challenged to Enable Non-EU Countries to Benefit from Medical Products Made Under Compulsory Licences 05/03/2024 Kerry Cullinan The European Parliament is to vote on a regulation to allow compulsory licencing during crises. The European Parliament has been challenged to amend a proposed law to enable countries outside the European Union (EU) to benefit from medical products produced under compulsory licences during crises. The proposed regulation aims to ensure that, “during specific crises or emergencies”, the EU can issue a compulsory licence to enable the production of certain products – such as vaccines and medicines during a pandemic. A compulsory licence gives governments the power to allow a third party to use a patent without the authorisation of the patent-holder, subject to certain conditions. “Compulsory licensing can therefore complement current EU efforts to improve its resilience to crises,” according to the EU. But the draft regulation currently prohibits the export of any products produced under compulsory licences outside the EU. On Tuesday, a group of over 70 influential civil society organisations and academics wrote a letter to the European Parliament challenging them to “support crucial amendments allowing the export of medical tools to third countries in the proposed Union Compulsory License”. “The COVID-19 pandemic has made clear that major health emergencies need to be addressed at local, national, regional and global level and showcased that the EU’s advanced industrial capacity can be used to help protect EU citizens while also aiding and supplying non-EU countries, aligning with the principle that “No one is safe until everyone is safe”,” the letter notes. “It is therefore disheartening to note that, when preparing for the next crisis, the EU risks turning its back on the rest of the world, including non-EU countries in Europe, with this compulsory licence proposal,” it adds. EU harmonisation Impetus for the new regulation stems from the fact that there is “no EU-wide harmonisation of compulsory licensing for the domestic market”, according to the EU, which adds that the new regulation has two main objectives. “First, it aims to enable the EU to rely on compulsory licensing in the context of the EU crisis instruments. Second, it introduces an efficient compulsory licensing scheme, with appropriate features, to allow a swift and appropriate response to crises, with a functioning internal market, guaranteeing the supply and the free movement of crisis-critical products subject to compulsory licencing in the internal market.” The letter’s signatories, including Médecins Sans Frontières, Health Action International (HAI) and Oxfam, state that they support EU compulsory licences as they have “the potential to foster a more effective response to public health challenges”. But by prohibiting exports, the current draft – which has been put forward for a plenary vote of the European Parliament – goes against flexibilities enshrined in the World Trade Organization (WTO) Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS Agreement), according to the letter. “This limitation is problematic, especially considering the use of a Union compulsory license would likely be triggered by situations that would affect not only EU countries but also countries outside of the EU, either in the region or globally,” they add. Pandemics ‘don’t respect borders’ Making exports available under an EU compulsory licence “is not just a matter of international solidarity but is also in the EU’s interest” as it could “help in controlling potential outbreaks and emergencies that could spill over into the EU, allowing EU-based manufacturers to respond promptly to the needs of non-EU countries”. “This vote is important for a number of reasons,” according to HAI Senior Policy Advisor Jaume Vidal. “Embracing TRIPS flexibilities is, of course, a welcome step, but the current proposal risks becoming an ‘EU First’ response when it comes to pandemics and health emergencies, reminiscent of the inequities seen during the COVID-19 pandemic. “Secondly, at a time when countries are negotiating a pandemic accord, a restrictive use of the proposed Union compulsory license that would limit exports would be sending an ominous message to negotiators. Finally, in times of greatest need, the EU would do well to remember that pandemics don’t respect borders or blocs, and that no one is safe, until everyone is safe.” Image Credits: Thijs ter Haar. UN Environment Assembly Concludes With Renewed Commitments to Tackle Climate, Biodiversity and Pollution 04/03/2024 Disha Shetty The sixth UN Environment Assembly was held in Nairobi The sixth United Nations Environment Assembly (UNAE-6) ended last Friday in Nairobi, Kenya with the adoption of a Ministerial Declaration affirming member states’ commitment to slowing climate change, protecting biodiversity, and creating a pollution-free world. The assembly, which attracted over 5,600 delegates from 190 countries, also adopted 15 resolutions covering a range of issues including chemicals, waste, metals and minerals and protecting the environment during and after conflicts. “As governments, we need to push for more and reinvent partnerships with key stakeholders to implement these mandates. We need to continue to partner with civil society, continue to guide and empower our creative youth, and also with the private sector and philanthropies,” said Leila Benali, UNEA-6 President and the Minister of Energy Transition and Sustainable Development of Morocco. Benali noted that the resolutions called for enlightened leadership and urged scaling up means of implementation, enhancing national capacity to implement action plans and policies, and strengthening the science-policy interface. Evidence of the extent of environmental degradation and its impact on individuals keeps rising. Along with updated estimates of air pollution-related deaths at 8.3 million annually, a host of recent studies have also linked excessive levels of air pollution with health issues ranging from increased neo-natal mortality to Alzheimer’s. Most recently, one Nature study linked spikes in air pollution with increased risk of deaths by suicide. Leila Benali, UNEA-6 President and the Minister of Energy Transition and Sustainable Development of Morocco. A slew of UN reports released during the assembly last week also presented a grim picture of the immediate future. Data from the 2024 Global Resource Outlook warned that without urgent action to reduce global consumption and production, extraction of natural resources could rise by 60 % from 2020 levels. This would worsen climate and pollution impacts, with consequently greater risks to biodiversity and human health, the report said. It also blamed the high levels of material consumption in upper-middle and high-income countries for the problem. The report said that the rich countries use six times more resources and generate 10 times climate impacts than low-income ones. The Global Waste Management Outlook 2024 showed that without a seismic shift away from ‘take-make-dispose’ societies towards circular economy and zero-waste approaches, the world’s waste pile could grow by two-thirds by 2050, and its cost to health, economies and the environment could double. It reiterated that only a drastic reduction in waste generation will secure a liveable and affordable future, and ways to convert waste into a reusable resource would have to be employed. Another UNEP report on Used Heavy Duty Vehicles and the Environment launched during a Climate and Clean Air Conference held ahead of UNEA, sounded the alarm on the rise of emissions from these heavy polluters, and their negative climate and health impacts. Resolutions on improving response The assembly also held its first Multilateral Environmental Agreements (MEA) Day that was dedicated to the international agreements addressing the most pressing environmental issues. UNEA-6 welcomed youth to host their own environmental summit, which called for greater inter-generational equity. “The President has gavelled resolutions that address desertification, land restoration and more. We also have a ministerial declaration that affirms the international community’s strong intent to slow climate change, restore nature and land, and create a pollution-free world,” Inger Andersen, UN Evironmental Programme Executive Director, said. “UNEP will now take forward the responsibilities you have entrusted to us in these new resolutions. In addition to keeping the environment under review. In addition to fulfilling our obligation to serve as an authoritative advocate for action across the triple planetary crisis,” Andersen added. “In our quest to confront the monumental environmental challenges of our time—climate change, biodiversity loss, and pollution—there is but one path forward: teamwork. We share one Earth, bask under the same sun, and we must recognize that there is no backup plan. There’s no other planet waiting for us to escape to,” said Abdullah Bin Ali Amri, Oman’s chair of the Environment Authority and president-elect of the next UNEA, which will be held in December 2025 in Nairobi. WHO Issues Guidelines for Expanding Access to Hearing Aids 01/03/2024 Zuzanna Stawiska A patient with age-related hearing loss (Presbycusis), receiving free treatment from the NGO, All Ears Cambodia. Over 400 million people with hearing loss could benefit from hearing devices. However, less than 20% of those people actually get hearing aids. That’s one of the findings cited in new World Health Organisation guidelines on improving access to hearing care, published Friday, just ahead of World Hearing Day. “Unaddressed hearing loss is a global public health challenge and incurs an estimated cost of over US$ 1 trillion annually. Given the global shortage of ear and hearing care specialists, we have to rethink how we traditionally deliver services,” said Dr Bente Mikkelsen, director of the WHO’s Department for Noncommunicable Diseases. By 2050, nearly 2.5 billion people are projected to experience a degree of hearing loss, as populations around the world age. More than 700 million will likely require hearing rehabilitation, estimates the WHO. But nearly 80% of people with disabling hearing loss live in low-income countries – which historically have lacked capacity for providing assistive devices like hearing aids. Fighting misconceptions and lack of resources But addressing hearing loss is not necessarily expensive. An investment of $1.4 per person annually would be sufficient to scale up ear and hearing care services worldwide, WHO said. To overcome current limitations of capacity, the guidelines encourage more service delivery by non-specialists, based in primary health care settings. Debunking misconceptions and stigma around hearing loss is another key aim of the guidelines, created with the support of ATscale Global Partnership for Assistive Technology. “Common myths about hearing loss often prevent people from seeking the services they require, even where these services are available,” said Dr Shelly Chadha, technical lead for ear and hearing care at WHO. “Any effort to improve hearing care provision through health system strengthening must be accompanied by work to raise awareness within societies and address stigma related to ear and hearing care.” Image Credits: WHO/Miguel Jeronimo. Alzheimer’s Experts Review Progress and Challenges in a ‘Transformative Moment’ 01/03/2024 Sophia Samantaroy WASHINGTON, DC – When US Senator Amy Klobuchar’s father, the late Jim Klobuchar, was diagnosed with Alzheimer’s disease, the noted Minnesota newspaper columnist gradually stopped recognizing her – although he retained “a kind of savoir faire” to the very end with words, jokes and storytelling based on the decades of “lines enmeshed in his memory,” she recalled. Senator Amy Klobuchar (D-MN) In the United States, one in every three seniors will be diagnosed with Alzheimer’s. The disease affects roughly 55 million people globally and is the seventh leading cause of death. “But it’s not just the numbers. It’s the fathers and mothers, it’s the brothers and sisters,” remarked Klobuchar, (D-MN), who recounted the story of her father’s illness at a high-level event here this week, organized by the Davos Alzheimer’s Collaborative (DAC) together with Scientific American. The meeting of the collaborative, a Swiss and US-based foundation launched at the World Economic Forum in 2021, brought together some 100 Alzheimer researchers and front-line clinicians as well as policymakers and industry and civil society advocates, to share progress on new innovations in diagnosing and treating the disease – as well as challenges faced in getting those same innovations into healthcare systems globally. But the event, co-hosted by Scientific American, also was marked by moments of personal reflections, both comic and tragic. Not only Klochubar, but other speakers in the room referred to their own experiences in dealing with family members with Alzheimer’s disease – what Senator Susan Collins (R-ME) termed “the defining disease” of her generation. Joining together across borders and cultures Alzheimer’s is a growing issue worldwide as populations age And while much of the attention around Alzheimer’s so far has been in the United States and other countries of the global north, the disease is a growing problem worldwide, as populations age and people live longer, but not always healthier lives. Researchers predict that lower and middle income countries will soon bear the brunt of Alzheimer’s disease – much as they already do with regards to other noncommunicable diseases. Alzheimer’s disease is projected to affect more than 100 million people globally 2050 And as in all disease research, a global approach can help identify new therapies more effectively and cost-efficiently. “Rather than succumb to despair, what we’re doing is joining together across borders, cultures, and languages to chart a future for the world of prevention, effective treatment, and one day, a cure,” said Collins, who lost a brother to Alzheimer’s. Along with being vice-chair of the powerful Senate Appropriations Committee, Collins is also founder and co-chair of a Congressional Task Force on Alzheimer’s disease. George Vradenburg, founding chairman of the Davos Alzheimer’s Collaborative “I want to speak on behalf of families…50 million families worldwide are struggling with this disease.” said DAC chairman George Vradenburg, who first launched the initiative in response to a challenge by WEF founder and executive director Klaus Schwab. He said that DAC was committed to “including researchers, clinicians and families in this fight globally, ensuring that no corner of the world is left untouched by our efforts.” Added Collins, “We need a global approach modeled on what we’ve done with AIDS, tuberculosis, and malaria. And we know that that kind of global collaborative approach to bring the research directly to a broader spectrum of countries and communities will remove long standing barriers to care and help us eliminate disparities.” “A transformative moment”: Novel diagnostic tests, gene sequencing, and precision medicine Moderator Jeremy Abbate, VP and publisher of Scientific American with former NIH Director Dr. Elias Zerhouni, University of Washington’s Dr. Suzanne Schindler and Dr. Jeffrey Burns, University of Kansas Medical Center Early Alzheimer’s disease research was rather akin to “staring up a cliff,” said former US National Institutes of Health (NIH) director Elias Zerhouni, one of the other speakers at the event. Now, however, the world has reached a turning point where, “we can truly have a global approach.” Improved genetic sequencing, the advent of digital and biological markers, novel drugs, and a more open mindset to alternative hypotheses have seen Alzheimer’s disease research leap into a new era. “We have an explosion of ways to test for Alzheimer’s disease,” remarked Suzanne Schindler, Associate Professor of Neurology at Washington University School of Medicine. Among them are blood tests that can measure up to 5,000 various proteins- a method faster and less invasive than dreaded spinal taps. Other panelists shared this optimism, citing the use of amyloid pet-scans and other diagnostics to more accurately assess Alzheimer’s progression in patients. Genetic sequencing too is cheaper, a marked change since the early days when researchers remained in the dark about the potential genetic drivers of the disease. ‘More than buildup of amyloid plaques’ One of the causes of Alzheimer’s appears to be the abnormal accumulation of tau proteins in the brain, eventually forming tangles inside neurons, seen here With these tools comes an understanding that “the disease is more than just about build up [of amyloid plaques],” commented Jeffrey Burns, Professor of Neurology at University of Kansas Medical Center. New research into disease risk factors is moving beyond conventional descriptions of amyloid plaques and tau protein pathways to include research into inflammation and lifestyle factors. The future of prevention, he speculated, will increasingly lie in more holistic lifestyle approaches undertaken in tandem with medications. “We don’t just give patients with heart disease medication, we tell them to modify their diet, their lifestyle. “I believe we will prevent the disease,” Burns added. Early Alzheimer’s detection remains a missing link Phyllis Ferrell (center left,) Arindam Nandi, and Terry Fulmer discuss the implications of an aging society with Jeremy Abbate. One major challenge is the need to move new knowledge into hospitals and health clinics; currently it can take as long 17-20 years for innovations to get into clinical practice due to outdated models of care. “We are building bullet trains, but running them on the same wooden tracks,” said Dr Phyllis Ferrell, DAC advisor on healthcare systems preparedness. Too often, practitioners still take a “wait and see” approach, while symptoms of cognitive impairment go unrecognized or undiagnosed until much later in the disease course. She urged a shift to a more preventative approach with screenings and help manage cognitive symptoms early. “Why did it take four separate visits to get my dad an inconclusive diagnosis?” Ferrell asked. “Early detection gives people the time to focus on what matters most to them,” she added. “It provides an opportunity to implement positive lifestyle changes and address risk factors, pursue treatment options and/or enroll in a clinical trial.” Getting new innovations into practice Ferrell also bemoaned the frustration families feel over the lack of access to new diagnostics and therapeutics – in the wake of progress made in research. In 2010 the NIH funded Alzheimer’s disease research to the tune of $400 million annually. Fourteen years later, the annual investment is now close to $4 billion, she noted. Yet, despite this influx of funding for research, there’s a huge gap emerging in affordable and available drugs. “We have innovations that are ready, but are not being used,” she said, adding “Yes, to research, but we need to do things today. Let’s go after clinically ready innovations.” Staying the course on research Senator Susan Collins (R-ME)- a leading champion in Congress for Alzheimer’s disease research. At the same time, more research into the disease remains critical to find even more effective preventive strategies as well as possible cures. This means building specimen repositories across the country, performing skin tests for early detection of Alzheimer-related protein abnormalities traditionally only detectable from brain biopsies, and other research. Zerhouni called it breaking the “taboo of the brain” – an area of human physiology where research was historically inadequate. “This is a frontier that has to be broken.” For many years, such research was impeded by social taboos around Alzheimer’s disease. “People used to just call it senility,” said Collins, who has been the leading champion of Alzheimer’s research and action on Capitol Hill for over a decade. Collins last year initiated bipartisan legislation in the US Congress to help maintain the funding for Alzheimer’s research, as well as supporting initiatives to bring down the cost of new drugs in the US for Alzheimer patients. At $345 million billion a year, the disease is currently the most costly disease in the nation to treat, she says. A global economic burden Globally, Alzheimer’s disease also presents an enormous economic burden – costing the world’s economies some $1.3 trillion, in terms of medications as well as care – much of it unpaid, noted Population Council economist Arindam Nandi. In the past, economic data came mostly from high income countries, Now, data is available from lower and middle-income countries like India and China. “These data depict a worrying trend; the percentage of unpaid care is higher in these countries, meaning that caregivers are not able to get other jobs, decreasing economic output,’ he said. Nandi also mentioned that predictive models forecast the shifting burden of disease from high income countries to middle and low income countries. “We don’t know how these populations will fare.” Investments in these countries are needed to strengthen their overall public health measures. Meanwhile, the US and high income countries can learn from the experiences of low and middle income countries, which often are first to devise lower-costs methods for detecting and treating diseases. DAC, for instance, funded an Early Detection Flagship program involving six countries, including the US, Scotland, Jamaica, Japan, Mexico and Brazil. They participated in a pilot designed to increase access to early detection and diagnosis of the disease through the use of innovative new screening tools. “One of the things I loved [about the Early Detection program] was watching the US and high resource countries learn from LMICs,” Ferrell observed. “As the founder of the Brain and Mind Institute of Aga Khan University once said, ‘when it comes to Alzheimer’s disease we are all developing nations.’ “ Image Credits: Getty Images, Pixelmestudio/DAC, National Institutes on Aging , UCLA , S. Samantaroy/HPW. WHO Calls for Private Sector Accountability Amid Massive Obesity Increase 01/03/2024 Kerry Cullinan Member states have been slow to implement WHO policies to address obesity, including taxes on sugary drinks and restrictions on marketing junk food to kids The private sector “must be held accountable for the health impacts of their products”, warned the head of the World Health Organization (WHO) amid news that obesity has quadrupled in children and more than doubled in adults since 1990. Dr Tedros Adhanom Ghebreyesus was speaking ahead of the release of a huge global obesity study involving over 220 million people from more than 190 countries published in The Lancet on Friday. “Getting back on track to meet the global targets for curbing obesity will take the work of governments and communities, supported by evidence-based policies from WHO and national public health agencies,” added Tedros. Countries with highest obesity rates 2022 Tonga, American Samoa and Nauru have the world’s highest obesity rates, affecting some 60% of their adult populations. “The largest increases are in some countries in the Pacific, the Caribbean, the Middle East and North Africa, and some of the newly high income countries like Chile,” said senior author Professor Majid Ezzati, of Imperial College in London, at a media briefing on Thursday. The US is the only high-income country that features in the ten worst affected countries – with the 10th highest obesity rate in men. Some 43.8% of US women and 41.6% of men were living with obesity in 2022. Meanwhile, obesity is slowing in a handful of west European countries – notably Spain and France. However, countries with the lowest obesity rates are generally low-income countries with high rates of under-nutrition, with a few exceptions such as Japan and Viet Nam. Countries with lowest obesity rates 2022 Huge rise in child obesity In 1990, around 31 million children (2,1% of boys and 1.7% of girls) were obese. But 32 years later, there had been a fourfold increase in both boys (to 9,3%) and girls (6.9%) affecting almost 160 million children. “It is very concerning that the epidemic of obesity that was evident amongst adults in much of the world in 1990 is now mirrored in school-aged children and adolescents,” said Ezzati. Professor Majid Ezzati, of Imperial College in London While boys are more likely to be obese than girls globally, this trend is reversed in adulthood with many more women than men living with obesity. But men seem to be catching up. Obesity in men has nearly tripled over the past 32 years, while it has doubled in women. “Different forms of malnutrition still coexist in many countries,” said Dr Francesco Branca, WHO Director of Nutrition and Food Safety and one of the co-authors of the study. “The child who was undernourished in the first years of life can later become overweight or obese as an adolescent or an adult. Undernutrition and obesity are two faces of the same problem, which is the lack of access to healthy diets.” Greater risk of NCDs Undernourished people are more susceptible to infectious diseases, while obesity can lead to Type 2 diabetes, heart disease, certain cancers and affect bone health and reproduction, added Branca, who was also addressing the briefing. “The increase in the double burden of malnutrition is a result of a transition in food system and lifestyle that has not been governed by public health policies,” he added. However, despite WHO guidelines on what countries can do to address the massive rise in consumption of energy-dense ultra-processed food, adoption by member states has been slow. At the World Health Assembly in 2022, member states adopted the WHO Acceleration plan to stop obesity. Core interventions include promoting breastfeeding, regulating marketing of ultra-processed food and drinks to kids, taxation and warning labels on foods high in fats, salt and sugar. Dr Francesco Branca, WHO Director of Nutrition and Food Safety “The reason why the epidemic has progressed so quickly is because the policy action has not been incisive enough,” said Branca, adding that countries had focused on behaviour change rather than “structural elements, which is the policies around food environment”. However, he added that more countries were taxing sugary drinks, although “not many countries have done it for sufficiently long time and in ways that are demonstrated to be most effective”. “Very few countries put a restriction on marketing food to children. We know that some South American countries are taking that action much more effectively, and we look forward seeing the impact of those policies,[as well as] having warning signs on the processed food which would really discourage people from f buying products which are high in salt, sugar and fat”. If these policies were implemented, this would likely lead to food and beverage companies reformulating their products to reduce harmful ingredients, he added. Role of new weight-loss pills? Branca said that the WHO was currently looking at the efficacy of the new drugs called glucagon-like peptide 1 (GLP-1) agonists – such as Wegovy, Ozempic – which have been approved as weight-loss medication in some countries. “The solution is still is a transformation of the food system and in the environment such obesity can be prevented,” Branca stressed. However, the GLP-1 drugs could provide a tool to help those that already live with obesity, as long as they were integrated into a primary healthcare package to manage obesity that included guidance on exercise and diet. The new study was conducted by the NCD Risk Factor Collaboration (NCD-RisC), in collaboration with the World Health Organization (WHO), and involved over 1,500 researchers. They based their analysis on body mass index (BMI). Adults with BMI 30kg/m2 and over were classified as obese and underweight if their BMI was below 18.5kg/m2. For children, BMI was adjusted according to age. . 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Who Will Finance Countries’ Pandemic Response: Pandemic Fund, WHO or a New Entity? 12/03/2024 Kerry Cullinan COVID-19 screening in Bangkok, Thailand: Financing future pandemic preparedness and response is unclear. Many practical questions about how the pandemic agreement will be implemented – including how to finance countries’ pandemic prevention, preparedness and response (PPPR) – seem likely to be ceded to the Conference of Parties (COP). According to the latest pandemic agreement draft, a “Coordinating Financial Mechanism” will support the implementation of the pandemic agreement and the International Health Regulations (IHR) (see Article 20). “There’s a key debate with Article 20 within the negotiations about whether the coordinating mechanism should be hosted by the Pandemic Fund, the World Health Organization (WHO), or whether a new entity should be created,” Professor Garrett Wallace Brown, chair of Global Health Policy at the University of Leeds, told a Geneva Global Health Hub (G2H2) media briefing on Tuesday. “There’s seemingly little appetite for a new institution, and there is a strong narrative being promoted for the Pandemic Fund in order to decrease fragmentation,” added Wallace Brown, who is director-designate of new WHO Collaboration Centre for Health Systems and Health Security. The Pandemic Fund’s Priya Basu has made a strong bid for her entity to become this mechanism, telling Devex this week that a new fund to support PPPR would mean “duplication”. Professor Garrett Wallace Brown, chair of Global Health Policy at the University of Leeds But Wallace Brown said that “final decisions about the details of the coordinating mechanism are being offloaded to the Conference of the Parties (COP), which I think is a wise decision given the circumstances”. “There are only nine negotiating days left and there are lots of details to work through. But I think it’s only wise if the COP is representative, inclusive, proportional to risk and deliberative, meaning a move away from business as usual.” In conversation with delegates involved in the Intergovernmental Negotiating Body (INB) thrashing out the pandemic agreement, Wallace Brown said that “what they want to do is make the wording strong enough to show that there’s a commitment to a coordinating mechanism and a commitment to financing those”. In addition, they were “being somewhat more clear about what types of financing and what types of mechanisms would be housed underneath that, but offshoring those details for 12 months – I’m suggesting 24 months – to try to work out exactly how that is done”. Domestic funds? According to the draft, the financing mechanism would include a pooled fund for PPPR, and may include “contributions received as part of operations of the [Pathogen Access and Benefit-Sharing System], voluntary funds from both states and non-state actors and other contributions to be agreed upon by the Conference of the Parties”. G2H2 co-chair Nicoletta Dentico However, G2H2 co-chair Nicoletta Dentico warned that poorer countries were mired in debt and debt cancellation should be a consideration to help these countries. “Fifty four low-income countries with severe debt problems had to spend more money on debt servicing than on the COVID disease in 2020,” said Dentico, who heads the global health justice program at Society for International Development (SID). “Contrary to the WHO Framework Convention on Tobacco Control, the [pandemic agreement] text opened for the final negotiations stubbornly ignores the repeated calls for legal safeguards that are indispensable to immunise the treaty implementation and financing from vested corporate interests,” added Dentico. Mariska Meurs from the Dutch health NGO WEMOS, warned that “domestic funding for pandemic prevention preparedness and response must not undermine other domestic public health priorities”. “The draft pandemic treaty text worryingly includes ‘innovative financing mechanisms’, which often means using public funds not for heath, but to attract private-for-profit investors. Instead, the pandemic treaty should embrace the most obvious and fair avenues for funding pandemic prevention, preparedness and response: global tax justice and debt cancellation”. “But undermining other domestic public health priorities is exactly what we’ve seen happening under COVID-19. We’ve witnessed the shifts in global and domestic funding and how funding for basic health care has gone down,” warned Meurs. “The text, as it lies before us now, does not acknowledge or try to remedy this.” Mariska Meurs from the Dutch health NGO WEMOS “The draft pandemic treaty text worryingly includes ‘innovative financing mechanisms’, which often means using public funds not for heath, but to attract private-for-profit investors. Instead, the pandemic treaty should embrace the most obvious and fair avenues for funding pandemic prevention, preparedness and response: global tax justice and debt cancellation,” said Meurs. Pandemic Fund ‘black box’ Low and middle-income countries are more in favour of the pandemic financing mechanism being housed in the WHO “because they see it as being more representative” than the Pandemic Fund, said Wallace Brown. But donors “are less keen because they see it as a mechanism that would give them less control of how funds are spent”. However, for the Pandemic Fund to become the PPPR mechanism would require “radical changes” not “minor tweaks as we’re currently being told”. Some of the problems with the fund, are that it only focuses on three elements of PPPR and this “creates vertical silos”, and there is no explicit guidance in the fund’s governance framework on “how equity will be addressed in either the fund process or with reference to prioritise beneficiaries of programmes”, according to Wallace Brown. In addition, the first round of funding was eight times over-subscribed but the selection process “was not clear”. “Applications that met the scorecard threshold for funding had to be rejected, and it remains unclear exactly how the governing board made their final decisions,” he added. Describing his personal view on the way forward as “agnostic”, Wallace Brown said he had been studying the Pandemic Fund for a while and “think it’s a bit of a black box”. However, the WHO would need capacity building to become the mechanism “They do handle funds, they have the contingency fund for emergencies. They are able to make funding available to people and have processes for that, but they don’t have it at the same scale as a World Bank,” he said. “Or there could even be a third entity. So at the moment, I’m remaining agnostic. I think there needs to be better analysis, better evidence to decide what works and what doesn’t work” – and these kinds of details “won’t be decided in nine days”. Image Credits: Prachatai/Flickr. Pharma Describes Draft Pandemic Agreement as a ‘Step Backwards’ 12/03/2024 Kerry Cullinan Lab technician at a pharmaceutical company conducting a test. The new draft of the pandemic agreement “is a step backwards rather than forwards”, according to Thomas Cueni, Director General of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA). “It is critical that any agreement takes steps to ensure equity in access to medicines and vaccines in future pandemics, whilst preserving the innovation ecosystem that delivered a vaccine just 326 days after the SARS-CoV2 genome sequence was first sequenced,” said Cueni. Article 12 of the current draft proposes that manufacturers pay an annual subscription fee to a yet-to-be-formed World Health Organization (WHO) Pathogen Access and Benefit-Sharing (PABS) System. In exchange, they would get “rapid, systematic and timely access to biological materials of pathogens with pandemic potential and the genetic sequence data (GSD) for such pathogens”. The article also proposes that manufacturers provide “real-time contributions of relevant diagnostics, therapeutics or vaccines” with 10% free and 10% at not-for-profit prices during public health emergencies of international concern or pandemics. ‘Uncertainties will cause delays’ But Cueni was dubious: “Stringent requirements for accessing pathogen data would severely impact responses to future pandemics and basic research and development (R&D). “Conditions, uncertainties, and negotiations surrounding pathogen access will cause delays in the developing medical countermeasures, leading to significant public health consequences, including loss of lives and unnecessary economic pressures. In the COVID-19 pandemic context, even a one-month delay could have meant an extra 400,000 lives lost.” The pharmaceutical industry has warned that a mandatory financial contribution could dis-incentivise companies from joining the PABS system. “The pharmaceutical industry is determined to continue to play our part in these final stages – sharing our experience, evidence and expertise to help deliver an agreement that will better protect the world when the next pandemic hits,” Cueni said. Thomas Cueni, Director General of the IFPMA. This week, the biopharmaceutical industry published a statement on how companies can work between pandemics – as well as when a pandemic hits – to deliver equitable access to medical countermeasures on the basis of public health risks, needs and demands.” The statement was signed by a broad range of trade associations aside from the IFPMA, including the Developing Countries Vaccine Manufacturers Network, DCVMN, Europe (EFPIA), the US (PhRMA) and Japan (JPMA), and the Biotechnology Innovation Organization (BIO). The companies detail the commitments to pre- and during pandemic measures. These include improving surveillance; research on pathogens of pandemic potential; voluntary licensing and technology transfer based on “mutually agreed terms to improve geographic diversity of manufacturing”; real-time allocation of part of production, and equity-based tiered pricing. Companies are also engaged in ongoing activities to support health system preparedness, whether by building clinical trial and regulatory capacity and harmonization, health care worker and community health worker trainings, or the continual investment needed to establish and maintain new technologies and platforms. “With a final draft of a pandemic agreement now published, negotiators should redouble their efforts to find consensus as there is still much work to be done before an agreement can be reached, added Cueni. Previously, Cueni warned that “It would be better to have no pandemic treaty than a bad pandemic treaty.” Image Credits: AMR Industry Alliance, World Health Summit. Partnership for Healthy Cities Achieves Big Wins Over Short Time 07/03/2024 Kerry Cullinan Accra has reduced traffic crashes by 20% over seven years CAPE TOWN – From Accra to Kathmandu, a global partnership of 74 cities has had remarkable success in addressing some of the key drivers of sickness and death since it was launched seven years ago. Ghana’s capital city, Accra, has cut traffic crashes by 20%. In India, Bengaluru is virtually smoke-free – not even hookahs are allowed. Nepal’s Kathmandu has installed air quality sensors to assess air pollution while a number of Latin American cities are supporting better nutrition of their school children. “The Partnership for Health Cities (PHC) was formed in 2017 to address non-communicable diseases (NCDs) and injuries, which are responsible for 80% of deaths globally,” said Bloomberg Philanthropies’ Kelly Larson, welcoming city representatives to the PHC’s summit in Cape Town this week. “This opportunity for us to come together is very unique because we are all facing the same challenges and you can learn so much from one another. We really do believe in the power of cities to make change. We are here to support you in your efforts to know that you are leading the way on this,” added Larson, whose organisation supports the partnership, along with the World Health Organization (WHO) and Vital Strategies. The partnership started with 54 cities but now consists of 74 cities that collectively represent over 300 million people. Each city in the PHC chooses to work in one of six key work areas: food policy, overdose prevention, tobacco control, road safety, safe and active mobility (such as promoting cycling) or data surveillance. The cities are encouraged to root their work in public health policies and to win as much public support as possible for these. The PHC’s Policy Accelerator supports cities to create and implement these policies. “Cities are a place where people are particularly at risk. There is a huge concentration of people exposed to risk of NCD and injuries,” said the WHO’s Etienne Krug. “But cities are a particularly good place to think about interventions for a number of reasons,” he added. “First of all, they enforce national laws but they can also enhance these with additional regulations. City leaders are geographically close to their populations. It is easier for multi-sectoral approaches than at national level.” Bengaluru: A model smoke-free city Bengaluru in India has become a model smoke-free city India’s Dr Vishal Rao has been an advocate for smoke-free laws for a number of years in Bengaluru (Bangalore) and its state, Karnataka. This is hardly surprising as a head and neck surgical oncologist at a cancer hospital and has treated numerous tumours in the thyroid, parotid, and salivary glands caused by tobacco use. “We first prioritised creating a policy framework around smoking, and have built this policy around the three R’s – making somebody responsible, have it reviewed and reported,” Rao told Health Policy Watch. Dr Vishal Rao from Bengaluru “We prioritised smoke free policy because we realised that Bengaluru is a cosmopolitan economic hub with a very vibrant culture of pubs, clubs, cafes, bars and restaurants, all of which were rampantly violating the smoke free laws,” said Rao, who is also a member of the Karnataka government’s High Power Committee on Tobacco Control. “Reducing and protecting the non-smokers required a comprehensive approach of policy intervention which is why the mayor and the [state] commissioner came out with the government order completely banning smoking in hotels, bars, restaurants, clubs, pubs and cafes unless they have a designated smoking room which is compliant with the law,” said Rao. The requirements for these designated smoking rooms were so onerous – including no sales or services of any sort being allowed – that most places opted not to set them up. A couple of weeks back, the state government also banned hookah bars – including hookah with tobacco, flavoured and herbal hookah – becoming the first state to do so. The pushback has been immediate, with the Hookah Association lodging around 12 litigation cases against the new laws, said Rao. For Rao, the partnership is less about the grants cities get and more about sharing strategies, tactics and “allowing champions to emerge” to promote the various themes – his city won an award at last year’s summit for its efforts. Accra: All the laws but little implementation Rita Agyen Takyi is an advisor to Accra’s mayor on international affairs Rita Agyen Takyi is an advisor to Accra’s mayor on international affairs and the city’s focal person on road safety, the issue her city has chosen. “Ghana has all the laws. But we needed enforcement, implementation and public awareness,” Takyi told Health Policy Watch. Accra’s Bloomberg Road Safety initiative started in 2015 and it joined the partnership at its launch in 2017. Over half the city’s road traffic deaths involved pedestrians, cyclists and motorcyclists. Public awareness campaigns have included encouraging the use of seat belts and helmets, speed limit signs and speed detectors for traffic police, direction signs painted on roads and fixed painted bollards to prevent motorcyclists from entering pedestrian crossings. “We have reduced traffic crashes by 22% since 2021/22,” said Takyi, who also credits this success to Accra bringing different stakeholders “out of their silos” and into one forum with a common goal. Latin American cities prioritise food policy Five cities in Latin America have chosen to focus on food policy. Quito in Ecuador is concerned with the nutrition of children, the city’s Marysol Ruilova told the Cape Town summit. Quito has developed a policy requiring only healthy foods to be advertised near and at schools, and is also providing clean free water in 20 pilot schools. However, since the COVID-19 pandemic, there has been an increase in child malnutrition so the city has focused on school feeding schemes. Cordoba is focusing on school nutrition, including promoting water Similarly, Córdoba in Argentina is preparing to restrict the sale and advertising of unhealthy food and beverages in schools and requiring healthy alternatives, while Cali in Colombia is also ensuring that scholars have access to nutritious and wholesome meals during school hours. Lima in Peru is also working to create healthier school environments through enforcement of a new policy that restricts sales and advertising of unhealthy products. Montevideo in Uruguay is incentivizing food services to provide healthier meals to public sector workers, through its “Healthy Canteens” initiative. Cape Town: Socio-economic determinants of health Cape Town mayor Geordin Hill-Lewis addresses the opening of the summit. Host city Cape Town has been involved in tobacco control and food policy-related initiatives while part of the PHP. “Against the backdrop of incredibly challenging national economic circumstances and very deep and wide local poverty, our city is still demonstrating progress,” Mayor Geordin Hill-Lewis told the summit.“But you cannot build a prosperous city or achieve our dream of a city of hope without also focusing on public health in a serious way.” One of the things that Cape Town is currently focusing on is identifying and addressing the socio-economic determinants of health in the city and addressing these through infrastructure planning, service provision and job creation. “Cape Town has a very high burden of NCDs and other preventable deaths. And, while we have a good understanding of the various factors that contribute to that burden, this programme will provide crucial information that can help determine strategies going forward,” according to Councillor Patricia Van der Ross. Image Credits: Partnership for Health Cities, Kerry Cullinan. New Global Commitments Make Elimination of Cervical Cancer Possible 06/03/2024 Sophia Samantaroy & Kerry Cullinan The WHO set an ambitious goal of having 90% of girls vaccinated against HPV by 2030 Eliminating cervical cancer is within reach, thanks to new commitments by governments, donors and other partners, including pledges of almost $600 million, made at the first-ever global forum on cervical cancer in Cartagena de Indias in Colombia. Every two minutes, a woman dies from cervical cancer, although vaccination against human papillomavirus (HPV), the leading cause of cervical cancer, can prevent the vast majority of cases. Cervical cancer is the fourth most common cancer in women worldwide, but disproportionately affects women and their families in low and middle-income countries (LMICs). Less than 5% of women in many LMICs are ever screened for cervical cancer, and over 90% of the 348 000 cervical cancer deaths in 2022 took place in LMICs. Furthermore, only one in five adolescent girls were vaccinated against HPV in 2022. Country commitments Low and middle income countries experience the highest burden of cervical cancer However, a number of countries stepped up at the forum. These include the Democratic Republic of Congo (DRC), which has committed to introduce the HPV vaccine as early as possible, targeting girls aged 9 to 14 years. Ethiopia aims to reach at least 95% of all 14-year-old girls with the HPV vaccine this year, and screen one million eligible women every year for cervical cancer and to treat 90% of those screened who present with positive precancerous lesions. Further, HPV single dose has been approved to be introduced this year and scaled up as part of the country’s Expanded Program on Immunization plans. Africa’s most populous country, Nigeria, has committed to vaccinating 80% of girls 9 to 14 years old by 2026, including those who are no longer at school. The nearly $600 million in new funding includes $180 million from the Bill and Melinda Gates Foundation, $10 million from UNICEF, and $400 million from the World Bank. Elimination of a cancer Experts gathered in Colombia to discuss global collaboration for cervical cancer elimination “If these ambitions to expand vaccine coverage and strengthen screening and treatment programs are fully realized, the world could eliminate a cancer for the first time,” according to the World Health Organization (WHO). In 2022, the WHO revised its HPV vaccination recommendation from two to one-dose of the HPV vaccine, making it much easier and cheaper for countries to reach those who need it. The WHO Americas region made a similar recommendation 2023, and WHO’s African regional just followed suit with its own recommendation. “We have the knowledge and the tools to make cervical cancer history, but vaccination, screening and treatment programmes are still not reaching the scale required,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This first global forum is an important opportunity for governments and partners to invest in the global elimination strategy and addressing the inequities that deny women and girls access to the life-saving tools they need.” However, many LMICs face an uphill battle. Malawian Minister of Health Kandodo Chiponda described the challenges her country faces at the forum’s opening plenary. Some 60% of Malawi’s population of over 20 million is under 35, and cervical cancer is the highest cancer burden, with the incidence rate as high as 70 per 100,000. Mortality figures are 52 per 100,000, said Chiponda, who also announced the opening of the first ever cancer center in Malawi. Chiponda noted that women have limited time and resources to seek care, limited access to screening and diagnostic services, and are subject to misinformation about vaccinations. She emphasized the need for cross-sector collaborations and the strengthening of primary healthcare to reach women and girls in remote areas. ‘Miracle of modern medicine’ “Cervical cancer is a disease of inequity” – Dr. Tedros Adhanom Ghebreyesus, WHO Director-General “The HPV vaccine is one of the most impactful vaccines on the planet and has already helped save thousands of lives,” said Aurélia Nguyen, Gavi’s chief programme officer. Despite the efficiency and safety of the HPV vaccine, high costs, supply chain issues, and difficulties in reaching remote populations keep the vaccine out of reach for many. “More girls urgently deserve the same protection, which is why in partnership with countries, Gavi has set an ambitious goal to help vaccinate 86 million adolescent girls by 2025. With bold commitment and decisive action, we can look forward to a future where cervical cancer has been eliminated for good.” Describing HPV vaccines as “a miracle of modern medicine”, Dr Chris Elias, the Bill and Melinda Gates Foundation’s president of global development, said that there is “no reason why women should die from cervical cancer.” “Now is the time for governments and partners around the world to increase HPV vaccine access and protect future generations from cervical cancer.” Image Credits: Unsplash, IARC/WHO, Global Cervical Cancer Elimination Forum, GCCEF/WHO. European Parliament Challenged to Enable Non-EU Countries to Benefit from Medical Products Made Under Compulsory Licences 05/03/2024 Kerry Cullinan The European Parliament is to vote on a regulation to allow compulsory licencing during crises. The European Parliament has been challenged to amend a proposed law to enable countries outside the European Union (EU) to benefit from medical products produced under compulsory licences during crises. The proposed regulation aims to ensure that, “during specific crises or emergencies”, the EU can issue a compulsory licence to enable the production of certain products – such as vaccines and medicines during a pandemic. A compulsory licence gives governments the power to allow a third party to use a patent without the authorisation of the patent-holder, subject to certain conditions. “Compulsory licensing can therefore complement current EU efforts to improve its resilience to crises,” according to the EU. But the draft regulation currently prohibits the export of any products produced under compulsory licences outside the EU. On Tuesday, a group of over 70 influential civil society organisations and academics wrote a letter to the European Parliament challenging them to “support crucial amendments allowing the export of medical tools to third countries in the proposed Union Compulsory License”. “The COVID-19 pandemic has made clear that major health emergencies need to be addressed at local, national, regional and global level and showcased that the EU’s advanced industrial capacity can be used to help protect EU citizens while also aiding and supplying non-EU countries, aligning with the principle that “No one is safe until everyone is safe”,” the letter notes. “It is therefore disheartening to note that, when preparing for the next crisis, the EU risks turning its back on the rest of the world, including non-EU countries in Europe, with this compulsory licence proposal,” it adds. EU harmonisation Impetus for the new regulation stems from the fact that there is “no EU-wide harmonisation of compulsory licensing for the domestic market”, according to the EU, which adds that the new regulation has two main objectives. “First, it aims to enable the EU to rely on compulsory licensing in the context of the EU crisis instruments. Second, it introduces an efficient compulsory licensing scheme, with appropriate features, to allow a swift and appropriate response to crises, with a functioning internal market, guaranteeing the supply and the free movement of crisis-critical products subject to compulsory licencing in the internal market.” The letter’s signatories, including Médecins Sans Frontières, Health Action International (HAI) and Oxfam, state that they support EU compulsory licences as they have “the potential to foster a more effective response to public health challenges”. But by prohibiting exports, the current draft – which has been put forward for a plenary vote of the European Parliament – goes against flexibilities enshrined in the World Trade Organization (WTO) Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS Agreement), according to the letter. “This limitation is problematic, especially considering the use of a Union compulsory license would likely be triggered by situations that would affect not only EU countries but also countries outside of the EU, either in the region or globally,” they add. Pandemics ‘don’t respect borders’ Making exports available under an EU compulsory licence “is not just a matter of international solidarity but is also in the EU’s interest” as it could “help in controlling potential outbreaks and emergencies that could spill over into the EU, allowing EU-based manufacturers to respond promptly to the needs of non-EU countries”. “This vote is important for a number of reasons,” according to HAI Senior Policy Advisor Jaume Vidal. “Embracing TRIPS flexibilities is, of course, a welcome step, but the current proposal risks becoming an ‘EU First’ response when it comes to pandemics and health emergencies, reminiscent of the inequities seen during the COVID-19 pandemic. “Secondly, at a time when countries are negotiating a pandemic accord, a restrictive use of the proposed Union compulsory license that would limit exports would be sending an ominous message to negotiators. Finally, in times of greatest need, the EU would do well to remember that pandemics don’t respect borders or blocs, and that no one is safe, until everyone is safe.” Image Credits: Thijs ter Haar. UN Environment Assembly Concludes With Renewed Commitments to Tackle Climate, Biodiversity and Pollution 04/03/2024 Disha Shetty The sixth UN Environment Assembly was held in Nairobi The sixth United Nations Environment Assembly (UNAE-6) ended last Friday in Nairobi, Kenya with the adoption of a Ministerial Declaration affirming member states’ commitment to slowing climate change, protecting biodiversity, and creating a pollution-free world. The assembly, which attracted over 5,600 delegates from 190 countries, also adopted 15 resolutions covering a range of issues including chemicals, waste, metals and minerals and protecting the environment during and after conflicts. “As governments, we need to push for more and reinvent partnerships with key stakeholders to implement these mandates. We need to continue to partner with civil society, continue to guide and empower our creative youth, and also with the private sector and philanthropies,” said Leila Benali, UNEA-6 President and the Minister of Energy Transition and Sustainable Development of Morocco. Benali noted that the resolutions called for enlightened leadership and urged scaling up means of implementation, enhancing national capacity to implement action plans and policies, and strengthening the science-policy interface. Evidence of the extent of environmental degradation and its impact on individuals keeps rising. Along with updated estimates of air pollution-related deaths at 8.3 million annually, a host of recent studies have also linked excessive levels of air pollution with health issues ranging from increased neo-natal mortality to Alzheimer’s. Most recently, one Nature study linked spikes in air pollution with increased risk of deaths by suicide. Leila Benali, UNEA-6 President and the Minister of Energy Transition and Sustainable Development of Morocco. A slew of UN reports released during the assembly last week also presented a grim picture of the immediate future. Data from the 2024 Global Resource Outlook warned that without urgent action to reduce global consumption and production, extraction of natural resources could rise by 60 % from 2020 levels. This would worsen climate and pollution impacts, with consequently greater risks to biodiversity and human health, the report said. It also blamed the high levels of material consumption in upper-middle and high-income countries for the problem. The report said that the rich countries use six times more resources and generate 10 times climate impacts than low-income ones. The Global Waste Management Outlook 2024 showed that without a seismic shift away from ‘take-make-dispose’ societies towards circular economy and zero-waste approaches, the world’s waste pile could grow by two-thirds by 2050, and its cost to health, economies and the environment could double. It reiterated that only a drastic reduction in waste generation will secure a liveable and affordable future, and ways to convert waste into a reusable resource would have to be employed. Another UNEP report on Used Heavy Duty Vehicles and the Environment launched during a Climate and Clean Air Conference held ahead of UNEA, sounded the alarm on the rise of emissions from these heavy polluters, and their negative climate and health impacts. Resolutions on improving response The assembly also held its first Multilateral Environmental Agreements (MEA) Day that was dedicated to the international agreements addressing the most pressing environmental issues. UNEA-6 welcomed youth to host their own environmental summit, which called for greater inter-generational equity. “The President has gavelled resolutions that address desertification, land restoration and more. We also have a ministerial declaration that affirms the international community’s strong intent to slow climate change, restore nature and land, and create a pollution-free world,” Inger Andersen, UN Evironmental Programme Executive Director, said. “UNEP will now take forward the responsibilities you have entrusted to us in these new resolutions. In addition to keeping the environment under review. In addition to fulfilling our obligation to serve as an authoritative advocate for action across the triple planetary crisis,” Andersen added. “In our quest to confront the monumental environmental challenges of our time—climate change, biodiversity loss, and pollution—there is but one path forward: teamwork. We share one Earth, bask under the same sun, and we must recognize that there is no backup plan. There’s no other planet waiting for us to escape to,” said Abdullah Bin Ali Amri, Oman’s chair of the Environment Authority and president-elect of the next UNEA, which will be held in December 2025 in Nairobi. WHO Issues Guidelines for Expanding Access to Hearing Aids 01/03/2024 Zuzanna Stawiska A patient with age-related hearing loss (Presbycusis), receiving free treatment from the NGO, All Ears Cambodia. Over 400 million people with hearing loss could benefit from hearing devices. However, less than 20% of those people actually get hearing aids. That’s one of the findings cited in new World Health Organisation guidelines on improving access to hearing care, published Friday, just ahead of World Hearing Day. “Unaddressed hearing loss is a global public health challenge and incurs an estimated cost of over US$ 1 trillion annually. Given the global shortage of ear and hearing care specialists, we have to rethink how we traditionally deliver services,” said Dr Bente Mikkelsen, director of the WHO’s Department for Noncommunicable Diseases. By 2050, nearly 2.5 billion people are projected to experience a degree of hearing loss, as populations around the world age. More than 700 million will likely require hearing rehabilitation, estimates the WHO. But nearly 80% of people with disabling hearing loss live in low-income countries – which historically have lacked capacity for providing assistive devices like hearing aids. Fighting misconceptions and lack of resources But addressing hearing loss is not necessarily expensive. An investment of $1.4 per person annually would be sufficient to scale up ear and hearing care services worldwide, WHO said. To overcome current limitations of capacity, the guidelines encourage more service delivery by non-specialists, based in primary health care settings. Debunking misconceptions and stigma around hearing loss is another key aim of the guidelines, created with the support of ATscale Global Partnership for Assistive Technology. “Common myths about hearing loss often prevent people from seeking the services they require, even where these services are available,” said Dr Shelly Chadha, technical lead for ear and hearing care at WHO. “Any effort to improve hearing care provision through health system strengthening must be accompanied by work to raise awareness within societies and address stigma related to ear and hearing care.” Image Credits: WHO/Miguel Jeronimo. Alzheimer’s Experts Review Progress and Challenges in a ‘Transformative Moment’ 01/03/2024 Sophia Samantaroy WASHINGTON, DC – When US Senator Amy Klobuchar’s father, the late Jim Klobuchar, was diagnosed with Alzheimer’s disease, the noted Minnesota newspaper columnist gradually stopped recognizing her – although he retained “a kind of savoir faire” to the very end with words, jokes and storytelling based on the decades of “lines enmeshed in his memory,” she recalled. Senator Amy Klobuchar (D-MN) In the United States, one in every three seniors will be diagnosed with Alzheimer’s. The disease affects roughly 55 million people globally and is the seventh leading cause of death. “But it’s not just the numbers. It’s the fathers and mothers, it’s the brothers and sisters,” remarked Klobuchar, (D-MN), who recounted the story of her father’s illness at a high-level event here this week, organized by the Davos Alzheimer’s Collaborative (DAC) together with Scientific American. The meeting of the collaborative, a Swiss and US-based foundation launched at the World Economic Forum in 2021, brought together some 100 Alzheimer researchers and front-line clinicians as well as policymakers and industry and civil society advocates, to share progress on new innovations in diagnosing and treating the disease – as well as challenges faced in getting those same innovations into healthcare systems globally. But the event, co-hosted by Scientific American, also was marked by moments of personal reflections, both comic and tragic. Not only Klochubar, but other speakers in the room referred to their own experiences in dealing with family members with Alzheimer’s disease – what Senator Susan Collins (R-ME) termed “the defining disease” of her generation. Joining together across borders and cultures Alzheimer’s is a growing issue worldwide as populations age And while much of the attention around Alzheimer’s so far has been in the United States and other countries of the global north, the disease is a growing problem worldwide, as populations age and people live longer, but not always healthier lives. Researchers predict that lower and middle income countries will soon bear the brunt of Alzheimer’s disease – much as they already do with regards to other noncommunicable diseases. Alzheimer’s disease is projected to affect more than 100 million people globally 2050 And as in all disease research, a global approach can help identify new therapies more effectively and cost-efficiently. “Rather than succumb to despair, what we’re doing is joining together across borders, cultures, and languages to chart a future for the world of prevention, effective treatment, and one day, a cure,” said Collins, who lost a brother to Alzheimer’s. Along with being vice-chair of the powerful Senate Appropriations Committee, Collins is also founder and co-chair of a Congressional Task Force on Alzheimer’s disease. George Vradenburg, founding chairman of the Davos Alzheimer’s Collaborative “I want to speak on behalf of families…50 million families worldwide are struggling with this disease.” said DAC chairman George Vradenburg, who first launched the initiative in response to a challenge by WEF founder and executive director Klaus Schwab. He said that DAC was committed to “including researchers, clinicians and families in this fight globally, ensuring that no corner of the world is left untouched by our efforts.” Added Collins, “We need a global approach modeled on what we’ve done with AIDS, tuberculosis, and malaria. And we know that that kind of global collaborative approach to bring the research directly to a broader spectrum of countries and communities will remove long standing barriers to care and help us eliminate disparities.” “A transformative moment”: Novel diagnostic tests, gene sequencing, and precision medicine Moderator Jeremy Abbate, VP and publisher of Scientific American with former NIH Director Dr. Elias Zerhouni, University of Washington’s Dr. Suzanne Schindler and Dr. Jeffrey Burns, University of Kansas Medical Center Early Alzheimer’s disease research was rather akin to “staring up a cliff,” said former US National Institutes of Health (NIH) director Elias Zerhouni, one of the other speakers at the event. Now, however, the world has reached a turning point where, “we can truly have a global approach.” Improved genetic sequencing, the advent of digital and biological markers, novel drugs, and a more open mindset to alternative hypotheses have seen Alzheimer’s disease research leap into a new era. “We have an explosion of ways to test for Alzheimer’s disease,” remarked Suzanne Schindler, Associate Professor of Neurology at Washington University School of Medicine. Among them are blood tests that can measure up to 5,000 various proteins- a method faster and less invasive than dreaded spinal taps. Other panelists shared this optimism, citing the use of amyloid pet-scans and other diagnostics to more accurately assess Alzheimer’s progression in patients. Genetic sequencing too is cheaper, a marked change since the early days when researchers remained in the dark about the potential genetic drivers of the disease. ‘More than buildup of amyloid plaques’ One of the causes of Alzheimer’s appears to be the abnormal accumulation of tau proteins in the brain, eventually forming tangles inside neurons, seen here With these tools comes an understanding that “the disease is more than just about build up [of amyloid plaques],” commented Jeffrey Burns, Professor of Neurology at University of Kansas Medical Center. New research into disease risk factors is moving beyond conventional descriptions of amyloid plaques and tau protein pathways to include research into inflammation and lifestyle factors. The future of prevention, he speculated, will increasingly lie in more holistic lifestyle approaches undertaken in tandem with medications. “We don’t just give patients with heart disease medication, we tell them to modify their diet, their lifestyle. “I believe we will prevent the disease,” Burns added. Early Alzheimer’s detection remains a missing link Phyllis Ferrell (center left,) Arindam Nandi, and Terry Fulmer discuss the implications of an aging society with Jeremy Abbate. One major challenge is the need to move new knowledge into hospitals and health clinics; currently it can take as long 17-20 years for innovations to get into clinical practice due to outdated models of care. “We are building bullet trains, but running them on the same wooden tracks,” said Dr Phyllis Ferrell, DAC advisor on healthcare systems preparedness. Too often, practitioners still take a “wait and see” approach, while symptoms of cognitive impairment go unrecognized or undiagnosed until much later in the disease course. She urged a shift to a more preventative approach with screenings and help manage cognitive symptoms early. “Why did it take four separate visits to get my dad an inconclusive diagnosis?” Ferrell asked. “Early detection gives people the time to focus on what matters most to them,” she added. “It provides an opportunity to implement positive lifestyle changes and address risk factors, pursue treatment options and/or enroll in a clinical trial.” Getting new innovations into practice Ferrell also bemoaned the frustration families feel over the lack of access to new diagnostics and therapeutics – in the wake of progress made in research. In 2010 the NIH funded Alzheimer’s disease research to the tune of $400 million annually. Fourteen years later, the annual investment is now close to $4 billion, she noted. Yet, despite this influx of funding for research, there’s a huge gap emerging in affordable and available drugs. “We have innovations that are ready, but are not being used,” she said, adding “Yes, to research, but we need to do things today. Let’s go after clinically ready innovations.” Staying the course on research Senator Susan Collins (R-ME)- a leading champion in Congress for Alzheimer’s disease research. At the same time, more research into the disease remains critical to find even more effective preventive strategies as well as possible cures. This means building specimen repositories across the country, performing skin tests for early detection of Alzheimer-related protein abnormalities traditionally only detectable from brain biopsies, and other research. Zerhouni called it breaking the “taboo of the brain” – an area of human physiology where research was historically inadequate. “This is a frontier that has to be broken.” For many years, such research was impeded by social taboos around Alzheimer’s disease. “People used to just call it senility,” said Collins, who has been the leading champion of Alzheimer’s research and action on Capitol Hill for over a decade. Collins last year initiated bipartisan legislation in the US Congress to help maintain the funding for Alzheimer’s research, as well as supporting initiatives to bring down the cost of new drugs in the US for Alzheimer patients. At $345 million billion a year, the disease is currently the most costly disease in the nation to treat, she says. A global economic burden Globally, Alzheimer’s disease also presents an enormous economic burden – costing the world’s economies some $1.3 trillion, in terms of medications as well as care – much of it unpaid, noted Population Council economist Arindam Nandi. In the past, economic data came mostly from high income countries, Now, data is available from lower and middle-income countries like India and China. “These data depict a worrying trend; the percentage of unpaid care is higher in these countries, meaning that caregivers are not able to get other jobs, decreasing economic output,’ he said. Nandi also mentioned that predictive models forecast the shifting burden of disease from high income countries to middle and low income countries. “We don’t know how these populations will fare.” Investments in these countries are needed to strengthen their overall public health measures. Meanwhile, the US and high income countries can learn from the experiences of low and middle income countries, which often are first to devise lower-costs methods for detecting and treating diseases. DAC, for instance, funded an Early Detection Flagship program involving six countries, including the US, Scotland, Jamaica, Japan, Mexico and Brazil. They participated in a pilot designed to increase access to early detection and diagnosis of the disease through the use of innovative new screening tools. “One of the things I loved [about the Early Detection program] was watching the US and high resource countries learn from LMICs,” Ferrell observed. “As the founder of the Brain and Mind Institute of Aga Khan University once said, ‘when it comes to Alzheimer’s disease we are all developing nations.’ “ Image Credits: Getty Images, Pixelmestudio/DAC, National Institutes on Aging , UCLA , S. Samantaroy/HPW. WHO Calls for Private Sector Accountability Amid Massive Obesity Increase 01/03/2024 Kerry Cullinan Member states have been slow to implement WHO policies to address obesity, including taxes on sugary drinks and restrictions on marketing junk food to kids The private sector “must be held accountable for the health impacts of their products”, warned the head of the World Health Organization (WHO) amid news that obesity has quadrupled in children and more than doubled in adults since 1990. Dr Tedros Adhanom Ghebreyesus was speaking ahead of the release of a huge global obesity study involving over 220 million people from more than 190 countries published in The Lancet on Friday. “Getting back on track to meet the global targets for curbing obesity will take the work of governments and communities, supported by evidence-based policies from WHO and national public health agencies,” added Tedros. Countries with highest obesity rates 2022 Tonga, American Samoa and Nauru have the world’s highest obesity rates, affecting some 60% of their adult populations. “The largest increases are in some countries in the Pacific, the Caribbean, the Middle East and North Africa, and some of the newly high income countries like Chile,” said senior author Professor Majid Ezzati, of Imperial College in London, at a media briefing on Thursday. The US is the only high-income country that features in the ten worst affected countries – with the 10th highest obesity rate in men. Some 43.8% of US women and 41.6% of men were living with obesity in 2022. Meanwhile, obesity is slowing in a handful of west European countries – notably Spain and France. However, countries with the lowest obesity rates are generally low-income countries with high rates of under-nutrition, with a few exceptions such as Japan and Viet Nam. Countries with lowest obesity rates 2022 Huge rise in child obesity In 1990, around 31 million children (2,1% of boys and 1.7% of girls) were obese. But 32 years later, there had been a fourfold increase in both boys (to 9,3%) and girls (6.9%) affecting almost 160 million children. “It is very concerning that the epidemic of obesity that was evident amongst adults in much of the world in 1990 is now mirrored in school-aged children and adolescents,” said Ezzati. Professor Majid Ezzati, of Imperial College in London While boys are more likely to be obese than girls globally, this trend is reversed in adulthood with many more women than men living with obesity. But men seem to be catching up. Obesity in men has nearly tripled over the past 32 years, while it has doubled in women. “Different forms of malnutrition still coexist in many countries,” said Dr Francesco Branca, WHO Director of Nutrition and Food Safety and one of the co-authors of the study. “The child who was undernourished in the first years of life can later become overweight or obese as an adolescent or an adult. Undernutrition and obesity are two faces of the same problem, which is the lack of access to healthy diets.” Greater risk of NCDs Undernourished people are more susceptible to infectious diseases, while obesity can lead to Type 2 diabetes, heart disease, certain cancers and affect bone health and reproduction, added Branca, who was also addressing the briefing. “The increase in the double burden of malnutrition is a result of a transition in food system and lifestyle that has not been governed by public health policies,” he added. However, despite WHO guidelines on what countries can do to address the massive rise in consumption of energy-dense ultra-processed food, adoption by member states has been slow. At the World Health Assembly in 2022, member states adopted the WHO Acceleration plan to stop obesity. Core interventions include promoting breastfeeding, regulating marketing of ultra-processed food and drinks to kids, taxation and warning labels on foods high in fats, salt and sugar. Dr Francesco Branca, WHO Director of Nutrition and Food Safety “The reason why the epidemic has progressed so quickly is because the policy action has not been incisive enough,” said Branca, adding that countries had focused on behaviour change rather than “structural elements, which is the policies around food environment”. However, he added that more countries were taxing sugary drinks, although “not many countries have done it for sufficiently long time and in ways that are demonstrated to be most effective”. “Very few countries put a restriction on marketing food to children. We know that some South American countries are taking that action much more effectively, and we look forward seeing the impact of those policies,[as well as] having warning signs on the processed food which would really discourage people from f buying products which are high in salt, sugar and fat”. If these policies were implemented, this would likely lead to food and beverage companies reformulating their products to reduce harmful ingredients, he added. Role of new weight-loss pills? Branca said that the WHO was currently looking at the efficacy of the new drugs called glucagon-like peptide 1 (GLP-1) agonists – such as Wegovy, Ozempic – which have been approved as weight-loss medication in some countries. “The solution is still is a transformation of the food system and in the environment such obesity can be prevented,” Branca stressed. However, the GLP-1 drugs could provide a tool to help those that already live with obesity, as long as they were integrated into a primary healthcare package to manage obesity that included guidance on exercise and diet. The new study was conducted by the NCD Risk Factor Collaboration (NCD-RisC), in collaboration with the World Health Organization (WHO), and involved over 1,500 researchers. They based their analysis on body mass index (BMI). Adults with BMI 30kg/m2 and over were classified as obese and underweight if their BMI was below 18.5kg/m2. For children, BMI was adjusted according to age. . 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Pharma Describes Draft Pandemic Agreement as a ‘Step Backwards’ 12/03/2024 Kerry Cullinan Lab technician at a pharmaceutical company conducting a test. The new draft of the pandemic agreement “is a step backwards rather than forwards”, according to Thomas Cueni, Director General of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA). “It is critical that any agreement takes steps to ensure equity in access to medicines and vaccines in future pandemics, whilst preserving the innovation ecosystem that delivered a vaccine just 326 days after the SARS-CoV2 genome sequence was first sequenced,” said Cueni. Article 12 of the current draft proposes that manufacturers pay an annual subscription fee to a yet-to-be-formed World Health Organization (WHO) Pathogen Access and Benefit-Sharing (PABS) System. In exchange, they would get “rapid, systematic and timely access to biological materials of pathogens with pandemic potential and the genetic sequence data (GSD) for such pathogens”. The article also proposes that manufacturers provide “real-time contributions of relevant diagnostics, therapeutics or vaccines” with 10% free and 10% at not-for-profit prices during public health emergencies of international concern or pandemics. ‘Uncertainties will cause delays’ But Cueni was dubious: “Stringent requirements for accessing pathogen data would severely impact responses to future pandemics and basic research and development (R&D). “Conditions, uncertainties, and negotiations surrounding pathogen access will cause delays in the developing medical countermeasures, leading to significant public health consequences, including loss of lives and unnecessary economic pressures. In the COVID-19 pandemic context, even a one-month delay could have meant an extra 400,000 lives lost.” The pharmaceutical industry has warned that a mandatory financial contribution could dis-incentivise companies from joining the PABS system. “The pharmaceutical industry is determined to continue to play our part in these final stages – sharing our experience, evidence and expertise to help deliver an agreement that will better protect the world when the next pandemic hits,” Cueni said. Thomas Cueni, Director General of the IFPMA. This week, the biopharmaceutical industry published a statement on how companies can work between pandemics – as well as when a pandemic hits – to deliver equitable access to medical countermeasures on the basis of public health risks, needs and demands.” The statement was signed by a broad range of trade associations aside from the IFPMA, including the Developing Countries Vaccine Manufacturers Network, DCVMN, Europe (EFPIA), the US (PhRMA) and Japan (JPMA), and the Biotechnology Innovation Organization (BIO). The companies detail the commitments to pre- and during pandemic measures. These include improving surveillance; research on pathogens of pandemic potential; voluntary licensing and technology transfer based on “mutually agreed terms to improve geographic diversity of manufacturing”; real-time allocation of part of production, and equity-based tiered pricing. Companies are also engaged in ongoing activities to support health system preparedness, whether by building clinical trial and regulatory capacity and harmonization, health care worker and community health worker trainings, or the continual investment needed to establish and maintain new technologies and platforms. “With a final draft of a pandemic agreement now published, negotiators should redouble their efforts to find consensus as there is still much work to be done before an agreement can be reached, added Cueni. Previously, Cueni warned that “It would be better to have no pandemic treaty than a bad pandemic treaty.” Image Credits: AMR Industry Alliance, World Health Summit. Partnership for Healthy Cities Achieves Big Wins Over Short Time 07/03/2024 Kerry Cullinan Accra has reduced traffic crashes by 20% over seven years CAPE TOWN – From Accra to Kathmandu, a global partnership of 74 cities has had remarkable success in addressing some of the key drivers of sickness and death since it was launched seven years ago. Ghana’s capital city, Accra, has cut traffic crashes by 20%. In India, Bengaluru is virtually smoke-free – not even hookahs are allowed. Nepal’s Kathmandu has installed air quality sensors to assess air pollution while a number of Latin American cities are supporting better nutrition of their school children. “The Partnership for Health Cities (PHC) was formed in 2017 to address non-communicable diseases (NCDs) and injuries, which are responsible for 80% of deaths globally,” said Bloomberg Philanthropies’ Kelly Larson, welcoming city representatives to the PHC’s summit in Cape Town this week. “This opportunity for us to come together is very unique because we are all facing the same challenges and you can learn so much from one another. We really do believe in the power of cities to make change. We are here to support you in your efforts to know that you are leading the way on this,” added Larson, whose organisation supports the partnership, along with the World Health Organization (WHO) and Vital Strategies. The partnership started with 54 cities but now consists of 74 cities that collectively represent over 300 million people. Each city in the PHC chooses to work in one of six key work areas: food policy, overdose prevention, tobacco control, road safety, safe and active mobility (such as promoting cycling) or data surveillance. The cities are encouraged to root their work in public health policies and to win as much public support as possible for these. The PHC’s Policy Accelerator supports cities to create and implement these policies. “Cities are a place where people are particularly at risk. There is a huge concentration of people exposed to risk of NCD and injuries,” said the WHO’s Etienne Krug. “But cities are a particularly good place to think about interventions for a number of reasons,” he added. “First of all, they enforce national laws but they can also enhance these with additional regulations. City leaders are geographically close to their populations. It is easier for multi-sectoral approaches than at national level.” Bengaluru: A model smoke-free city Bengaluru in India has become a model smoke-free city India’s Dr Vishal Rao has been an advocate for smoke-free laws for a number of years in Bengaluru (Bangalore) and its state, Karnataka. This is hardly surprising as a head and neck surgical oncologist at a cancer hospital and has treated numerous tumours in the thyroid, parotid, and salivary glands caused by tobacco use. “We first prioritised creating a policy framework around smoking, and have built this policy around the three R’s – making somebody responsible, have it reviewed and reported,” Rao told Health Policy Watch. Dr Vishal Rao from Bengaluru “We prioritised smoke free policy because we realised that Bengaluru is a cosmopolitan economic hub with a very vibrant culture of pubs, clubs, cafes, bars and restaurants, all of which were rampantly violating the smoke free laws,” said Rao, who is also a member of the Karnataka government’s High Power Committee on Tobacco Control. “Reducing and protecting the non-smokers required a comprehensive approach of policy intervention which is why the mayor and the [state] commissioner came out with the government order completely banning smoking in hotels, bars, restaurants, clubs, pubs and cafes unless they have a designated smoking room which is compliant with the law,” said Rao. The requirements for these designated smoking rooms were so onerous – including no sales or services of any sort being allowed – that most places opted not to set them up. A couple of weeks back, the state government also banned hookah bars – including hookah with tobacco, flavoured and herbal hookah – becoming the first state to do so. The pushback has been immediate, with the Hookah Association lodging around 12 litigation cases against the new laws, said Rao. For Rao, the partnership is less about the grants cities get and more about sharing strategies, tactics and “allowing champions to emerge” to promote the various themes – his city won an award at last year’s summit for its efforts. Accra: All the laws but little implementation Rita Agyen Takyi is an advisor to Accra’s mayor on international affairs Rita Agyen Takyi is an advisor to Accra’s mayor on international affairs and the city’s focal person on road safety, the issue her city has chosen. “Ghana has all the laws. But we needed enforcement, implementation and public awareness,” Takyi told Health Policy Watch. Accra’s Bloomberg Road Safety initiative started in 2015 and it joined the partnership at its launch in 2017. Over half the city’s road traffic deaths involved pedestrians, cyclists and motorcyclists. Public awareness campaigns have included encouraging the use of seat belts and helmets, speed limit signs and speed detectors for traffic police, direction signs painted on roads and fixed painted bollards to prevent motorcyclists from entering pedestrian crossings. “We have reduced traffic crashes by 22% since 2021/22,” said Takyi, who also credits this success to Accra bringing different stakeholders “out of their silos” and into one forum with a common goal. Latin American cities prioritise food policy Five cities in Latin America have chosen to focus on food policy. Quito in Ecuador is concerned with the nutrition of children, the city’s Marysol Ruilova told the Cape Town summit. Quito has developed a policy requiring only healthy foods to be advertised near and at schools, and is also providing clean free water in 20 pilot schools. However, since the COVID-19 pandemic, there has been an increase in child malnutrition so the city has focused on school feeding schemes. Cordoba is focusing on school nutrition, including promoting water Similarly, Córdoba in Argentina is preparing to restrict the sale and advertising of unhealthy food and beverages in schools and requiring healthy alternatives, while Cali in Colombia is also ensuring that scholars have access to nutritious and wholesome meals during school hours. Lima in Peru is also working to create healthier school environments through enforcement of a new policy that restricts sales and advertising of unhealthy products. Montevideo in Uruguay is incentivizing food services to provide healthier meals to public sector workers, through its “Healthy Canteens” initiative. Cape Town: Socio-economic determinants of health Cape Town mayor Geordin Hill-Lewis addresses the opening of the summit. Host city Cape Town has been involved in tobacco control and food policy-related initiatives while part of the PHP. “Against the backdrop of incredibly challenging national economic circumstances and very deep and wide local poverty, our city is still demonstrating progress,” Mayor Geordin Hill-Lewis told the summit.“But you cannot build a prosperous city or achieve our dream of a city of hope without also focusing on public health in a serious way.” One of the things that Cape Town is currently focusing on is identifying and addressing the socio-economic determinants of health in the city and addressing these through infrastructure planning, service provision and job creation. “Cape Town has a very high burden of NCDs and other preventable deaths. And, while we have a good understanding of the various factors that contribute to that burden, this programme will provide crucial information that can help determine strategies going forward,” according to Councillor Patricia Van der Ross. Image Credits: Partnership for Health Cities, Kerry Cullinan. New Global Commitments Make Elimination of Cervical Cancer Possible 06/03/2024 Sophia Samantaroy & Kerry Cullinan The WHO set an ambitious goal of having 90% of girls vaccinated against HPV by 2030 Eliminating cervical cancer is within reach, thanks to new commitments by governments, donors and other partners, including pledges of almost $600 million, made at the first-ever global forum on cervical cancer in Cartagena de Indias in Colombia. Every two minutes, a woman dies from cervical cancer, although vaccination against human papillomavirus (HPV), the leading cause of cervical cancer, can prevent the vast majority of cases. Cervical cancer is the fourth most common cancer in women worldwide, but disproportionately affects women and their families in low and middle-income countries (LMICs). Less than 5% of women in many LMICs are ever screened for cervical cancer, and over 90% of the 348 000 cervical cancer deaths in 2022 took place in LMICs. Furthermore, only one in five adolescent girls were vaccinated against HPV in 2022. Country commitments Low and middle income countries experience the highest burden of cervical cancer However, a number of countries stepped up at the forum. These include the Democratic Republic of Congo (DRC), which has committed to introduce the HPV vaccine as early as possible, targeting girls aged 9 to 14 years. Ethiopia aims to reach at least 95% of all 14-year-old girls with the HPV vaccine this year, and screen one million eligible women every year for cervical cancer and to treat 90% of those screened who present with positive precancerous lesions. Further, HPV single dose has been approved to be introduced this year and scaled up as part of the country’s Expanded Program on Immunization plans. Africa’s most populous country, Nigeria, has committed to vaccinating 80% of girls 9 to 14 years old by 2026, including those who are no longer at school. The nearly $600 million in new funding includes $180 million from the Bill and Melinda Gates Foundation, $10 million from UNICEF, and $400 million from the World Bank. Elimination of a cancer Experts gathered in Colombia to discuss global collaboration for cervical cancer elimination “If these ambitions to expand vaccine coverage and strengthen screening and treatment programs are fully realized, the world could eliminate a cancer for the first time,” according to the World Health Organization (WHO). In 2022, the WHO revised its HPV vaccination recommendation from two to one-dose of the HPV vaccine, making it much easier and cheaper for countries to reach those who need it. The WHO Americas region made a similar recommendation 2023, and WHO’s African regional just followed suit with its own recommendation. “We have the knowledge and the tools to make cervical cancer history, but vaccination, screening and treatment programmes are still not reaching the scale required,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This first global forum is an important opportunity for governments and partners to invest in the global elimination strategy and addressing the inequities that deny women and girls access to the life-saving tools they need.” However, many LMICs face an uphill battle. Malawian Minister of Health Kandodo Chiponda described the challenges her country faces at the forum’s opening plenary. Some 60% of Malawi’s population of over 20 million is under 35, and cervical cancer is the highest cancer burden, with the incidence rate as high as 70 per 100,000. Mortality figures are 52 per 100,000, said Chiponda, who also announced the opening of the first ever cancer center in Malawi. Chiponda noted that women have limited time and resources to seek care, limited access to screening and diagnostic services, and are subject to misinformation about vaccinations. She emphasized the need for cross-sector collaborations and the strengthening of primary healthcare to reach women and girls in remote areas. ‘Miracle of modern medicine’ “Cervical cancer is a disease of inequity” – Dr. Tedros Adhanom Ghebreyesus, WHO Director-General “The HPV vaccine is one of the most impactful vaccines on the planet and has already helped save thousands of lives,” said Aurélia Nguyen, Gavi’s chief programme officer. Despite the efficiency and safety of the HPV vaccine, high costs, supply chain issues, and difficulties in reaching remote populations keep the vaccine out of reach for many. “More girls urgently deserve the same protection, which is why in partnership with countries, Gavi has set an ambitious goal to help vaccinate 86 million adolescent girls by 2025. With bold commitment and decisive action, we can look forward to a future where cervical cancer has been eliminated for good.” Describing HPV vaccines as “a miracle of modern medicine”, Dr Chris Elias, the Bill and Melinda Gates Foundation’s president of global development, said that there is “no reason why women should die from cervical cancer.” “Now is the time for governments and partners around the world to increase HPV vaccine access and protect future generations from cervical cancer.” Image Credits: Unsplash, IARC/WHO, Global Cervical Cancer Elimination Forum, GCCEF/WHO. European Parliament Challenged to Enable Non-EU Countries to Benefit from Medical Products Made Under Compulsory Licences 05/03/2024 Kerry Cullinan The European Parliament is to vote on a regulation to allow compulsory licencing during crises. The European Parliament has been challenged to amend a proposed law to enable countries outside the European Union (EU) to benefit from medical products produced under compulsory licences during crises. The proposed regulation aims to ensure that, “during specific crises or emergencies”, the EU can issue a compulsory licence to enable the production of certain products – such as vaccines and medicines during a pandemic. A compulsory licence gives governments the power to allow a third party to use a patent without the authorisation of the patent-holder, subject to certain conditions. “Compulsory licensing can therefore complement current EU efforts to improve its resilience to crises,” according to the EU. But the draft regulation currently prohibits the export of any products produced under compulsory licences outside the EU. On Tuesday, a group of over 70 influential civil society organisations and academics wrote a letter to the European Parliament challenging them to “support crucial amendments allowing the export of medical tools to third countries in the proposed Union Compulsory License”. “The COVID-19 pandemic has made clear that major health emergencies need to be addressed at local, national, regional and global level and showcased that the EU’s advanced industrial capacity can be used to help protect EU citizens while also aiding and supplying non-EU countries, aligning with the principle that “No one is safe until everyone is safe”,” the letter notes. “It is therefore disheartening to note that, when preparing for the next crisis, the EU risks turning its back on the rest of the world, including non-EU countries in Europe, with this compulsory licence proposal,” it adds. EU harmonisation Impetus for the new regulation stems from the fact that there is “no EU-wide harmonisation of compulsory licensing for the domestic market”, according to the EU, which adds that the new regulation has two main objectives. “First, it aims to enable the EU to rely on compulsory licensing in the context of the EU crisis instruments. Second, it introduces an efficient compulsory licensing scheme, with appropriate features, to allow a swift and appropriate response to crises, with a functioning internal market, guaranteeing the supply and the free movement of crisis-critical products subject to compulsory licencing in the internal market.” The letter’s signatories, including Médecins Sans Frontières, Health Action International (HAI) and Oxfam, state that they support EU compulsory licences as they have “the potential to foster a more effective response to public health challenges”. But by prohibiting exports, the current draft – which has been put forward for a plenary vote of the European Parliament – goes against flexibilities enshrined in the World Trade Organization (WTO) Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS Agreement), according to the letter. “This limitation is problematic, especially considering the use of a Union compulsory license would likely be triggered by situations that would affect not only EU countries but also countries outside of the EU, either in the region or globally,” they add. Pandemics ‘don’t respect borders’ Making exports available under an EU compulsory licence “is not just a matter of international solidarity but is also in the EU’s interest” as it could “help in controlling potential outbreaks and emergencies that could spill over into the EU, allowing EU-based manufacturers to respond promptly to the needs of non-EU countries”. “This vote is important for a number of reasons,” according to HAI Senior Policy Advisor Jaume Vidal. “Embracing TRIPS flexibilities is, of course, a welcome step, but the current proposal risks becoming an ‘EU First’ response when it comes to pandemics and health emergencies, reminiscent of the inequities seen during the COVID-19 pandemic. “Secondly, at a time when countries are negotiating a pandemic accord, a restrictive use of the proposed Union compulsory license that would limit exports would be sending an ominous message to negotiators. Finally, in times of greatest need, the EU would do well to remember that pandemics don’t respect borders or blocs, and that no one is safe, until everyone is safe.” Image Credits: Thijs ter Haar. UN Environment Assembly Concludes With Renewed Commitments to Tackle Climate, Biodiversity and Pollution 04/03/2024 Disha Shetty The sixth UN Environment Assembly was held in Nairobi The sixth United Nations Environment Assembly (UNAE-6) ended last Friday in Nairobi, Kenya with the adoption of a Ministerial Declaration affirming member states’ commitment to slowing climate change, protecting biodiversity, and creating a pollution-free world. The assembly, which attracted over 5,600 delegates from 190 countries, also adopted 15 resolutions covering a range of issues including chemicals, waste, metals and minerals and protecting the environment during and after conflicts. “As governments, we need to push for more and reinvent partnerships with key stakeholders to implement these mandates. We need to continue to partner with civil society, continue to guide and empower our creative youth, and also with the private sector and philanthropies,” said Leila Benali, UNEA-6 President and the Minister of Energy Transition and Sustainable Development of Morocco. Benali noted that the resolutions called for enlightened leadership and urged scaling up means of implementation, enhancing national capacity to implement action plans and policies, and strengthening the science-policy interface. Evidence of the extent of environmental degradation and its impact on individuals keeps rising. Along with updated estimates of air pollution-related deaths at 8.3 million annually, a host of recent studies have also linked excessive levels of air pollution with health issues ranging from increased neo-natal mortality to Alzheimer’s. Most recently, one Nature study linked spikes in air pollution with increased risk of deaths by suicide. Leila Benali, UNEA-6 President and the Minister of Energy Transition and Sustainable Development of Morocco. A slew of UN reports released during the assembly last week also presented a grim picture of the immediate future. Data from the 2024 Global Resource Outlook warned that without urgent action to reduce global consumption and production, extraction of natural resources could rise by 60 % from 2020 levels. This would worsen climate and pollution impacts, with consequently greater risks to biodiversity and human health, the report said. It also blamed the high levels of material consumption in upper-middle and high-income countries for the problem. The report said that the rich countries use six times more resources and generate 10 times climate impacts than low-income ones. The Global Waste Management Outlook 2024 showed that without a seismic shift away from ‘take-make-dispose’ societies towards circular economy and zero-waste approaches, the world’s waste pile could grow by two-thirds by 2050, and its cost to health, economies and the environment could double. It reiterated that only a drastic reduction in waste generation will secure a liveable and affordable future, and ways to convert waste into a reusable resource would have to be employed. Another UNEP report on Used Heavy Duty Vehicles and the Environment launched during a Climate and Clean Air Conference held ahead of UNEA, sounded the alarm on the rise of emissions from these heavy polluters, and their negative climate and health impacts. Resolutions on improving response The assembly also held its first Multilateral Environmental Agreements (MEA) Day that was dedicated to the international agreements addressing the most pressing environmental issues. UNEA-6 welcomed youth to host their own environmental summit, which called for greater inter-generational equity. “The President has gavelled resolutions that address desertification, land restoration and more. We also have a ministerial declaration that affirms the international community’s strong intent to slow climate change, restore nature and land, and create a pollution-free world,” Inger Andersen, UN Evironmental Programme Executive Director, said. “UNEP will now take forward the responsibilities you have entrusted to us in these new resolutions. In addition to keeping the environment under review. In addition to fulfilling our obligation to serve as an authoritative advocate for action across the triple planetary crisis,” Andersen added. “In our quest to confront the monumental environmental challenges of our time—climate change, biodiversity loss, and pollution—there is but one path forward: teamwork. We share one Earth, bask under the same sun, and we must recognize that there is no backup plan. There’s no other planet waiting for us to escape to,” said Abdullah Bin Ali Amri, Oman’s chair of the Environment Authority and president-elect of the next UNEA, which will be held in December 2025 in Nairobi. WHO Issues Guidelines for Expanding Access to Hearing Aids 01/03/2024 Zuzanna Stawiska A patient with age-related hearing loss (Presbycusis), receiving free treatment from the NGO, All Ears Cambodia. Over 400 million people with hearing loss could benefit from hearing devices. However, less than 20% of those people actually get hearing aids. That’s one of the findings cited in new World Health Organisation guidelines on improving access to hearing care, published Friday, just ahead of World Hearing Day. “Unaddressed hearing loss is a global public health challenge and incurs an estimated cost of over US$ 1 trillion annually. Given the global shortage of ear and hearing care specialists, we have to rethink how we traditionally deliver services,” said Dr Bente Mikkelsen, director of the WHO’s Department for Noncommunicable Diseases. By 2050, nearly 2.5 billion people are projected to experience a degree of hearing loss, as populations around the world age. More than 700 million will likely require hearing rehabilitation, estimates the WHO. But nearly 80% of people with disabling hearing loss live in low-income countries – which historically have lacked capacity for providing assistive devices like hearing aids. Fighting misconceptions and lack of resources But addressing hearing loss is not necessarily expensive. An investment of $1.4 per person annually would be sufficient to scale up ear and hearing care services worldwide, WHO said. To overcome current limitations of capacity, the guidelines encourage more service delivery by non-specialists, based in primary health care settings. Debunking misconceptions and stigma around hearing loss is another key aim of the guidelines, created with the support of ATscale Global Partnership for Assistive Technology. “Common myths about hearing loss often prevent people from seeking the services they require, even where these services are available,” said Dr Shelly Chadha, technical lead for ear and hearing care at WHO. “Any effort to improve hearing care provision through health system strengthening must be accompanied by work to raise awareness within societies and address stigma related to ear and hearing care.” Image Credits: WHO/Miguel Jeronimo. Alzheimer’s Experts Review Progress and Challenges in a ‘Transformative Moment’ 01/03/2024 Sophia Samantaroy WASHINGTON, DC – When US Senator Amy Klobuchar’s father, the late Jim Klobuchar, was diagnosed with Alzheimer’s disease, the noted Minnesota newspaper columnist gradually stopped recognizing her – although he retained “a kind of savoir faire” to the very end with words, jokes and storytelling based on the decades of “lines enmeshed in his memory,” she recalled. Senator Amy Klobuchar (D-MN) In the United States, one in every three seniors will be diagnosed with Alzheimer’s. The disease affects roughly 55 million people globally and is the seventh leading cause of death. “But it’s not just the numbers. It’s the fathers and mothers, it’s the brothers and sisters,” remarked Klobuchar, (D-MN), who recounted the story of her father’s illness at a high-level event here this week, organized by the Davos Alzheimer’s Collaborative (DAC) together with Scientific American. The meeting of the collaborative, a Swiss and US-based foundation launched at the World Economic Forum in 2021, brought together some 100 Alzheimer researchers and front-line clinicians as well as policymakers and industry and civil society advocates, to share progress on new innovations in diagnosing and treating the disease – as well as challenges faced in getting those same innovations into healthcare systems globally. But the event, co-hosted by Scientific American, also was marked by moments of personal reflections, both comic and tragic. Not only Klochubar, but other speakers in the room referred to their own experiences in dealing with family members with Alzheimer’s disease – what Senator Susan Collins (R-ME) termed “the defining disease” of her generation. Joining together across borders and cultures Alzheimer’s is a growing issue worldwide as populations age And while much of the attention around Alzheimer’s so far has been in the United States and other countries of the global north, the disease is a growing problem worldwide, as populations age and people live longer, but not always healthier lives. Researchers predict that lower and middle income countries will soon bear the brunt of Alzheimer’s disease – much as they already do with regards to other noncommunicable diseases. Alzheimer’s disease is projected to affect more than 100 million people globally 2050 And as in all disease research, a global approach can help identify new therapies more effectively and cost-efficiently. “Rather than succumb to despair, what we’re doing is joining together across borders, cultures, and languages to chart a future for the world of prevention, effective treatment, and one day, a cure,” said Collins, who lost a brother to Alzheimer’s. Along with being vice-chair of the powerful Senate Appropriations Committee, Collins is also founder and co-chair of a Congressional Task Force on Alzheimer’s disease. George Vradenburg, founding chairman of the Davos Alzheimer’s Collaborative “I want to speak on behalf of families…50 million families worldwide are struggling with this disease.” said DAC chairman George Vradenburg, who first launched the initiative in response to a challenge by WEF founder and executive director Klaus Schwab. He said that DAC was committed to “including researchers, clinicians and families in this fight globally, ensuring that no corner of the world is left untouched by our efforts.” Added Collins, “We need a global approach modeled on what we’ve done with AIDS, tuberculosis, and malaria. And we know that that kind of global collaborative approach to bring the research directly to a broader spectrum of countries and communities will remove long standing barriers to care and help us eliminate disparities.” “A transformative moment”: Novel diagnostic tests, gene sequencing, and precision medicine Moderator Jeremy Abbate, VP and publisher of Scientific American with former NIH Director Dr. Elias Zerhouni, University of Washington’s Dr. Suzanne Schindler and Dr. Jeffrey Burns, University of Kansas Medical Center Early Alzheimer’s disease research was rather akin to “staring up a cliff,” said former US National Institutes of Health (NIH) director Elias Zerhouni, one of the other speakers at the event. Now, however, the world has reached a turning point where, “we can truly have a global approach.” Improved genetic sequencing, the advent of digital and biological markers, novel drugs, and a more open mindset to alternative hypotheses have seen Alzheimer’s disease research leap into a new era. “We have an explosion of ways to test for Alzheimer’s disease,” remarked Suzanne Schindler, Associate Professor of Neurology at Washington University School of Medicine. Among them are blood tests that can measure up to 5,000 various proteins- a method faster and less invasive than dreaded spinal taps. Other panelists shared this optimism, citing the use of amyloid pet-scans and other diagnostics to more accurately assess Alzheimer’s progression in patients. Genetic sequencing too is cheaper, a marked change since the early days when researchers remained in the dark about the potential genetic drivers of the disease. ‘More than buildup of amyloid plaques’ One of the causes of Alzheimer’s appears to be the abnormal accumulation of tau proteins in the brain, eventually forming tangles inside neurons, seen here With these tools comes an understanding that “the disease is more than just about build up [of amyloid plaques],” commented Jeffrey Burns, Professor of Neurology at University of Kansas Medical Center. New research into disease risk factors is moving beyond conventional descriptions of amyloid plaques and tau protein pathways to include research into inflammation and lifestyle factors. The future of prevention, he speculated, will increasingly lie in more holistic lifestyle approaches undertaken in tandem with medications. “We don’t just give patients with heart disease medication, we tell them to modify their diet, their lifestyle. “I believe we will prevent the disease,” Burns added. Early Alzheimer’s detection remains a missing link Phyllis Ferrell (center left,) Arindam Nandi, and Terry Fulmer discuss the implications of an aging society with Jeremy Abbate. One major challenge is the need to move new knowledge into hospitals and health clinics; currently it can take as long 17-20 years for innovations to get into clinical practice due to outdated models of care. “We are building bullet trains, but running them on the same wooden tracks,” said Dr Phyllis Ferrell, DAC advisor on healthcare systems preparedness. Too often, practitioners still take a “wait and see” approach, while symptoms of cognitive impairment go unrecognized or undiagnosed until much later in the disease course. She urged a shift to a more preventative approach with screenings and help manage cognitive symptoms early. “Why did it take four separate visits to get my dad an inconclusive diagnosis?” Ferrell asked. “Early detection gives people the time to focus on what matters most to them,” she added. “It provides an opportunity to implement positive lifestyle changes and address risk factors, pursue treatment options and/or enroll in a clinical trial.” Getting new innovations into practice Ferrell also bemoaned the frustration families feel over the lack of access to new diagnostics and therapeutics – in the wake of progress made in research. In 2010 the NIH funded Alzheimer’s disease research to the tune of $400 million annually. Fourteen years later, the annual investment is now close to $4 billion, she noted. Yet, despite this influx of funding for research, there’s a huge gap emerging in affordable and available drugs. “We have innovations that are ready, but are not being used,” she said, adding “Yes, to research, but we need to do things today. Let’s go after clinically ready innovations.” Staying the course on research Senator Susan Collins (R-ME)- a leading champion in Congress for Alzheimer’s disease research. At the same time, more research into the disease remains critical to find even more effective preventive strategies as well as possible cures. This means building specimen repositories across the country, performing skin tests for early detection of Alzheimer-related protein abnormalities traditionally only detectable from brain biopsies, and other research. Zerhouni called it breaking the “taboo of the brain” – an area of human physiology where research was historically inadequate. “This is a frontier that has to be broken.” For many years, such research was impeded by social taboos around Alzheimer’s disease. “People used to just call it senility,” said Collins, who has been the leading champion of Alzheimer’s research and action on Capitol Hill for over a decade. Collins last year initiated bipartisan legislation in the US Congress to help maintain the funding for Alzheimer’s research, as well as supporting initiatives to bring down the cost of new drugs in the US for Alzheimer patients. At $345 million billion a year, the disease is currently the most costly disease in the nation to treat, she says. A global economic burden Globally, Alzheimer’s disease also presents an enormous economic burden – costing the world’s economies some $1.3 trillion, in terms of medications as well as care – much of it unpaid, noted Population Council economist Arindam Nandi. In the past, economic data came mostly from high income countries, Now, data is available from lower and middle-income countries like India and China. “These data depict a worrying trend; the percentage of unpaid care is higher in these countries, meaning that caregivers are not able to get other jobs, decreasing economic output,’ he said. Nandi also mentioned that predictive models forecast the shifting burden of disease from high income countries to middle and low income countries. “We don’t know how these populations will fare.” Investments in these countries are needed to strengthen their overall public health measures. Meanwhile, the US and high income countries can learn from the experiences of low and middle income countries, which often are first to devise lower-costs methods for detecting and treating diseases. DAC, for instance, funded an Early Detection Flagship program involving six countries, including the US, Scotland, Jamaica, Japan, Mexico and Brazil. They participated in a pilot designed to increase access to early detection and diagnosis of the disease through the use of innovative new screening tools. “One of the things I loved [about the Early Detection program] was watching the US and high resource countries learn from LMICs,” Ferrell observed. “As the founder of the Brain and Mind Institute of Aga Khan University once said, ‘when it comes to Alzheimer’s disease we are all developing nations.’ “ Image Credits: Getty Images, Pixelmestudio/DAC, National Institutes on Aging , UCLA , S. Samantaroy/HPW. WHO Calls for Private Sector Accountability Amid Massive Obesity Increase 01/03/2024 Kerry Cullinan Member states have been slow to implement WHO policies to address obesity, including taxes on sugary drinks and restrictions on marketing junk food to kids The private sector “must be held accountable for the health impacts of their products”, warned the head of the World Health Organization (WHO) amid news that obesity has quadrupled in children and more than doubled in adults since 1990. Dr Tedros Adhanom Ghebreyesus was speaking ahead of the release of a huge global obesity study involving over 220 million people from more than 190 countries published in The Lancet on Friday. “Getting back on track to meet the global targets for curbing obesity will take the work of governments and communities, supported by evidence-based policies from WHO and national public health agencies,” added Tedros. Countries with highest obesity rates 2022 Tonga, American Samoa and Nauru have the world’s highest obesity rates, affecting some 60% of their adult populations. “The largest increases are in some countries in the Pacific, the Caribbean, the Middle East and North Africa, and some of the newly high income countries like Chile,” said senior author Professor Majid Ezzati, of Imperial College in London, at a media briefing on Thursday. The US is the only high-income country that features in the ten worst affected countries – with the 10th highest obesity rate in men. Some 43.8% of US women and 41.6% of men were living with obesity in 2022. Meanwhile, obesity is slowing in a handful of west European countries – notably Spain and France. However, countries with the lowest obesity rates are generally low-income countries with high rates of under-nutrition, with a few exceptions such as Japan and Viet Nam. Countries with lowest obesity rates 2022 Huge rise in child obesity In 1990, around 31 million children (2,1% of boys and 1.7% of girls) were obese. But 32 years later, there had been a fourfold increase in both boys (to 9,3%) and girls (6.9%) affecting almost 160 million children. “It is very concerning that the epidemic of obesity that was evident amongst adults in much of the world in 1990 is now mirrored in school-aged children and adolescents,” said Ezzati. Professor Majid Ezzati, of Imperial College in London While boys are more likely to be obese than girls globally, this trend is reversed in adulthood with many more women than men living with obesity. But men seem to be catching up. Obesity in men has nearly tripled over the past 32 years, while it has doubled in women. “Different forms of malnutrition still coexist in many countries,” said Dr Francesco Branca, WHO Director of Nutrition and Food Safety and one of the co-authors of the study. “The child who was undernourished in the first years of life can later become overweight or obese as an adolescent or an adult. Undernutrition and obesity are two faces of the same problem, which is the lack of access to healthy diets.” Greater risk of NCDs Undernourished people are more susceptible to infectious diseases, while obesity can lead to Type 2 diabetes, heart disease, certain cancers and affect bone health and reproduction, added Branca, who was also addressing the briefing. “The increase in the double burden of malnutrition is a result of a transition in food system and lifestyle that has not been governed by public health policies,” he added. However, despite WHO guidelines on what countries can do to address the massive rise in consumption of energy-dense ultra-processed food, adoption by member states has been slow. At the World Health Assembly in 2022, member states adopted the WHO Acceleration plan to stop obesity. Core interventions include promoting breastfeeding, regulating marketing of ultra-processed food and drinks to kids, taxation and warning labels on foods high in fats, salt and sugar. Dr Francesco Branca, WHO Director of Nutrition and Food Safety “The reason why the epidemic has progressed so quickly is because the policy action has not been incisive enough,” said Branca, adding that countries had focused on behaviour change rather than “structural elements, which is the policies around food environment”. However, he added that more countries were taxing sugary drinks, although “not many countries have done it for sufficiently long time and in ways that are demonstrated to be most effective”. “Very few countries put a restriction on marketing food to children. We know that some South American countries are taking that action much more effectively, and we look forward seeing the impact of those policies,[as well as] having warning signs on the processed food which would really discourage people from f buying products which are high in salt, sugar and fat”. If these policies were implemented, this would likely lead to food and beverage companies reformulating their products to reduce harmful ingredients, he added. Role of new weight-loss pills? Branca said that the WHO was currently looking at the efficacy of the new drugs called glucagon-like peptide 1 (GLP-1) agonists – such as Wegovy, Ozempic – which have been approved as weight-loss medication in some countries. “The solution is still is a transformation of the food system and in the environment such obesity can be prevented,” Branca stressed. However, the GLP-1 drugs could provide a tool to help those that already live with obesity, as long as they were integrated into a primary healthcare package to manage obesity that included guidance on exercise and diet. The new study was conducted by the NCD Risk Factor Collaboration (NCD-RisC), in collaboration with the World Health Organization (WHO), and involved over 1,500 researchers. They based their analysis on body mass index (BMI). Adults with BMI 30kg/m2 and over were classified as obese and underweight if their BMI was below 18.5kg/m2. For children, BMI was adjusted according to age. . 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Partnership for Healthy Cities Achieves Big Wins Over Short Time 07/03/2024 Kerry Cullinan Accra has reduced traffic crashes by 20% over seven years CAPE TOWN – From Accra to Kathmandu, a global partnership of 74 cities has had remarkable success in addressing some of the key drivers of sickness and death since it was launched seven years ago. Ghana’s capital city, Accra, has cut traffic crashes by 20%. In India, Bengaluru is virtually smoke-free – not even hookahs are allowed. Nepal’s Kathmandu has installed air quality sensors to assess air pollution while a number of Latin American cities are supporting better nutrition of their school children. “The Partnership for Health Cities (PHC) was formed in 2017 to address non-communicable diseases (NCDs) and injuries, which are responsible for 80% of deaths globally,” said Bloomberg Philanthropies’ Kelly Larson, welcoming city representatives to the PHC’s summit in Cape Town this week. “This opportunity for us to come together is very unique because we are all facing the same challenges and you can learn so much from one another. We really do believe in the power of cities to make change. We are here to support you in your efforts to know that you are leading the way on this,” added Larson, whose organisation supports the partnership, along with the World Health Organization (WHO) and Vital Strategies. The partnership started with 54 cities but now consists of 74 cities that collectively represent over 300 million people. Each city in the PHC chooses to work in one of six key work areas: food policy, overdose prevention, tobacco control, road safety, safe and active mobility (such as promoting cycling) or data surveillance. The cities are encouraged to root their work in public health policies and to win as much public support as possible for these. The PHC’s Policy Accelerator supports cities to create and implement these policies. “Cities are a place where people are particularly at risk. There is a huge concentration of people exposed to risk of NCD and injuries,” said the WHO’s Etienne Krug. “But cities are a particularly good place to think about interventions for a number of reasons,” he added. “First of all, they enforce national laws but they can also enhance these with additional regulations. City leaders are geographically close to their populations. It is easier for multi-sectoral approaches than at national level.” Bengaluru: A model smoke-free city Bengaluru in India has become a model smoke-free city India’s Dr Vishal Rao has been an advocate for smoke-free laws for a number of years in Bengaluru (Bangalore) and its state, Karnataka. This is hardly surprising as a head and neck surgical oncologist at a cancer hospital and has treated numerous tumours in the thyroid, parotid, and salivary glands caused by tobacco use. “We first prioritised creating a policy framework around smoking, and have built this policy around the three R’s – making somebody responsible, have it reviewed and reported,” Rao told Health Policy Watch. Dr Vishal Rao from Bengaluru “We prioritised smoke free policy because we realised that Bengaluru is a cosmopolitan economic hub with a very vibrant culture of pubs, clubs, cafes, bars and restaurants, all of which were rampantly violating the smoke free laws,” said Rao, who is also a member of the Karnataka government’s High Power Committee on Tobacco Control. “Reducing and protecting the non-smokers required a comprehensive approach of policy intervention which is why the mayor and the [state] commissioner came out with the government order completely banning smoking in hotels, bars, restaurants, clubs, pubs and cafes unless they have a designated smoking room which is compliant with the law,” said Rao. The requirements for these designated smoking rooms were so onerous – including no sales or services of any sort being allowed – that most places opted not to set them up. A couple of weeks back, the state government also banned hookah bars – including hookah with tobacco, flavoured and herbal hookah – becoming the first state to do so. The pushback has been immediate, with the Hookah Association lodging around 12 litigation cases against the new laws, said Rao. For Rao, the partnership is less about the grants cities get and more about sharing strategies, tactics and “allowing champions to emerge” to promote the various themes – his city won an award at last year’s summit for its efforts. Accra: All the laws but little implementation Rita Agyen Takyi is an advisor to Accra’s mayor on international affairs Rita Agyen Takyi is an advisor to Accra’s mayor on international affairs and the city’s focal person on road safety, the issue her city has chosen. “Ghana has all the laws. But we needed enforcement, implementation and public awareness,” Takyi told Health Policy Watch. Accra’s Bloomberg Road Safety initiative started in 2015 and it joined the partnership at its launch in 2017. Over half the city’s road traffic deaths involved pedestrians, cyclists and motorcyclists. Public awareness campaigns have included encouraging the use of seat belts and helmets, speed limit signs and speed detectors for traffic police, direction signs painted on roads and fixed painted bollards to prevent motorcyclists from entering pedestrian crossings. “We have reduced traffic crashes by 22% since 2021/22,” said Takyi, who also credits this success to Accra bringing different stakeholders “out of their silos” and into one forum with a common goal. Latin American cities prioritise food policy Five cities in Latin America have chosen to focus on food policy. Quito in Ecuador is concerned with the nutrition of children, the city’s Marysol Ruilova told the Cape Town summit. Quito has developed a policy requiring only healthy foods to be advertised near and at schools, and is also providing clean free water in 20 pilot schools. However, since the COVID-19 pandemic, there has been an increase in child malnutrition so the city has focused on school feeding schemes. Cordoba is focusing on school nutrition, including promoting water Similarly, Córdoba in Argentina is preparing to restrict the sale and advertising of unhealthy food and beverages in schools and requiring healthy alternatives, while Cali in Colombia is also ensuring that scholars have access to nutritious and wholesome meals during school hours. Lima in Peru is also working to create healthier school environments through enforcement of a new policy that restricts sales and advertising of unhealthy products. Montevideo in Uruguay is incentivizing food services to provide healthier meals to public sector workers, through its “Healthy Canteens” initiative. Cape Town: Socio-economic determinants of health Cape Town mayor Geordin Hill-Lewis addresses the opening of the summit. Host city Cape Town has been involved in tobacco control and food policy-related initiatives while part of the PHP. “Against the backdrop of incredibly challenging national economic circumstances and very deep and wide local poverty, our city is still demonstrating progress,” Mayor Geordin Hill-Lewis told the summit.“But you cannot build a prosperous city or achieve our dream of a city of hope without also focusing on public health in a serious way.” One of the things that Cape Town is currently focusing on is identifying and addressing the socio-economic determinants of health in the city and addressing these through infrastructure planning, service provision and job creation. “Cape Town has a very high burden of NCDs and other preventable deaths. And, while we have a good understanding of the various factors that contribute to that burden, this programme will provide crucial information that can help determine strategies going forward,” according to Councillor Patricia Van der Ross. Image Credits: Partnership for Health Cities, Kerry Cullinan. New Global Commitments Make Elimination of Cervical Cancer Possible 06/03/2024 Sophia Samantaroy & Kerry Cullinan The WHO set an ambitious goal of having 90% of girls vaccinated against HPV by 2030 Eliminating cervical cancer is within reach, thanks to new commitments by governments, donors and other partners, including pledges of almost $600 million, made at the first-ever global forum on cervical cancer in Cartagena de Indias in Colombia. Every two minutes, a woman dies from cervical cancer, although vaccination against human papillomavirus (HPV), the leading cause of cervical cancer, can prevent the vast majority of cases. Cervical cancer is the fourth most common cancer in women worldwide, but disproportionately affects women and their families in low and middle-income countries (LMICs). Less than 5% of women in many LMICs are ever screened for cervical cancer, and over 90% of the 348 000 cervical cancer deaths in 2022 took place in LMICs. Furthermore, only one in five adolescent girls were vaccinated against HPV in 2022. Country commitments Low and middle income countries experience the highest burden of cervical cancer However, a number of countries stepped up at the forum. These include the Democratic Republic of Congo (DRC), which has committed to introduce the HPV vaccine as early as possible, targeting girls aged 9 to 14 years. Ethiopia aims to reach at least 95% of all 14-year-old girls with the HPV vaccine this year, and screen one million eligible women every year for cervical cancer and to treat 90% of those screened who present with positive precancerous lesions. Further, HPV single dose has been approved to be introduced this year and scaled up as part of the country’s Expanded Program on Immunization plans. Africa’s most populous country, Nigeria, has committed to vaccinating 80% of girls 9 to 14 years old by 2026, including those who are no longer at school. The nearly $600 million in new funding includes $180 million from the Bill and Melinda Gates Foundation, $10 million from UNICEF, and $400 million from the World Bank. Elimination of a cancer Experts gathered in Colombia to discuss global collaboration for cervical cancer elimination “If these ambitions to expand vaccine coverage and strengthen screening and treatment programs are fully realized, the world could eliminate a cancer for the first time,” according to the World Health Organization (WHO). In 2022, the WHO revised its HPV vaccination recommendation from two to one-dose of the HPV vaccine, making it much easier and cheaper for countries to reach those who need it. The WHO Americas region made a similar recommendation 2023, and WHO’s African regional just followed suit with its own recommendation. “We have the knowledge and the tools to make cervical cancer history, but vaccination, screening and treatment programmes are still not reaching the scale required,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This first global forum is an important opportunity for governments and partners to invest in the global elimination strategy and addressing the inequities that deny women and girls access to the life-saving tools they need.” However, many LMICs face an uphill battle. Malawian Minister of Health Kandodo Chiponda described the challenges her country faces at the forum’s opening plenary. Some 60% of Malawi’s population of over 20 million is under 35, and cervical cancer is the highest cancer burden, with the incidence rate as high as 70 per 100,000. Mortality figures are 52 per 100,000, said Chiponda, who also announced the opening of the first ever cancer center in Malawi. Chiponda noted that women have limited time and resources to seek care, limited access to screening and diagnostic services, and are subject to misinformation about vaccinations. She emphasized the need for cross-sector collaborations and the strengthening of primary healthcare to reach women and girls in remote areas. ‘Miracle of modern medicine’ “Cervical cancer is a disease of inequity” – Dr. Tedros Adhanom Ghebreyesus, WHO Director-General “The HPV vaccine is one of the most impactful vaccines on the planet and has already helped save thousands of lives,” said Aurélia Nguyen, Gavi’s chief programme officer. Despite the efficiency and safety of the HPV vaccine, high costs, supply chain issues, and difficulties in reaching remote populations keep the vaccine out of reach for many. “More girls urgently deserve the same protection, which is why in partnership with countries, Gavi has set an ambitious goal to help vaccinate 86 million adolescent girls by 2025. With bold commitment and decisive action, we can look forward to a future where cervical cancer has been eliminated for good.” Describing HPV vaccines as “a miracle of modern medicine”, Dr Chris Elias, the Bill and Melinda Gates Foundation’s president of global development, said that there is “no reason why women should die from cervical cancer.” “Now is the time for governments and partners around the world to increase HPV vaccine access and protect future generations from cervical cancer.” Image Credits: Unsplash, IARC/WHO, Global Cervical Cancer Elimination Forum, GCCEF/WHO. European Parliament Challenged to Enable Non-EU Countries to Benefit from Medical Products Made Under Compulsory Licences 05/03/2024 Kerry Cullinan The European Parliament is to vote on a regulation to allow compulsory licencing during crises. The European Parliament has been challenged to amend a proposed law to enable countries outside the European Union (EU) to benefit from medical products produced under compulsory licences during crises. The proposed regulation aims to ensure that, “during specific crises or emergencies”, the EU can issue a compulsory licence to enable the production of certain products – such as vaccines and medicines during a pandemic. A compulsory licence gives governments the power to allow a third party to use a patent without the authorisation of the patent-holder, subject to certain conditions. “Compulsory licensing can therefore complement current EU efforts to improve its resilience to crises,” according to the EU. But the draft regulation currently prohibits the export of any products produced under compulsory licences outside the EU. On Tuesday, a group of over 70 influential civil society organisations and academics wrote a letter to the European Parliament challenging them to “support crucial amendments allowing the export of medical tools to third countries in the proposed Union Compulsory License”. “The COVID-19 pandemic has made clear that major health emergencies need to be addressed at local, national, regional and global level and showcased that the EU’s advanced industrial capacity can be used to help protect EU citizens while also aiding and supplying non-EU countries, aligning with the principle that “No one is safe until everyone is safe”,” the letter notes. “It is therefore disheartening to note that, when preparing for the next crisis, the EU risks turning its back on the rest of the world, including non-EU countries in Europe, with this compulsory licence proposal,” it adds. EU harmonisation Impetus for the new regulation stems from the fact that there is “no EU-wide harmonisation of compulsory licensing for the domestic market”, according to the EU, which adds that the new regulation has two main objectives. “First, it aims to enable the EU to rely on compulsory licensing in the context of the EU crisis instruments. Second, it introduces an efficient compulsory licensing scheme, with appropriate features, to allow a swift and appropriate response to crises, with a functioning internal market, guaranteeing the supply and the free movement of crisis-critical products subject to compulsory licencing in the internal market.” The letter’s signatories, including Médecins Sans Frontières, Health Action International (HAI) and Oxfam, state that they support EU compulsory licences as they have “the potential to foster a more effective response to public health challenges”. But by prohibiting exports, the current draft – which has been put forward for a plenary vote of the European Parliament – goes against flexibilities enshrined in the World Trade Organization (WTO) Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS Agreement), according to the letter. “This limitation is problematic, especially considering the use of a Union compulsory license would likely be triggered by situations that would affect not only EU countries but also countries outside of the EU, either in the region or globally,” they add. Pandemics ‘don’t respect borders’ Making exports available under an EU compulsory licence “is not just a matter of international solidarity but is also in the EU’s interest” as it could “help in controlling potential outbreaks and emergencies that could spill over into the EU, allowing EU-based manufacturers to respond promptly to the needs of non-EU countries”. “This vote is important for a number of reasons,” according to HAI Senior Policy Advisor Jaume Vidal. “Embracing TRIPS flexibilities is, of course, a welcome step, but the current proposal risks becoming an ‘EU First’ response when it comes to pandemics and health emergencies, reminiscent of the inequities seen during the COVID-19 pandemic. “Secondly, at a time when countries are negotiating a pandemic accord, a restrictive use of the proposed Union compulsory license that would limit exports would be sending an ominous message to negotiators. Finally, in times of greatest need, the EU would do well to remember that pandemics don’t respect borders or blocs, and that no one is safe, until everyone is safe.” Image Credits: Thijs ter Haar. UN Environment Assembly Concludes With Renewed Commitments to Tackle Climate, Biodiversity and Pollution 04/03/2024 Disha Shetty The sixth UN Environment Assembly was held in Nairobi The sixth United Nations Environment Assembly (UNAE-6) ended last Friday in Nairobi, Kenya with the adoption of a Ministerial Declaration affirming member states’ commitment to slowing climate change, protecting biodiversity, and creating a pollution-free world. The assembly, which attracted over 5,600 delegates from 190 countries, also adopted 15 resolutions covering a range of issues including chemicals, waste, metals and minerals and protecting the environment during and after conflicts. “As governments, we need to push for more and reinvent partnerships with key stakeholders to implement these mandates. We need to continue to partner with civil society, continue to guide and empower our creative youth, and also with the private sector and philanthropies,” said Leila Benali, UNEA-6 President and the Minister of Energy Transition and Sustainable Development of Morocco. Benali noted that the resolutions called for enlightened leadership and urged scaling up means of implementation, enhancing national capacity to implement action plans and policies, and strengthening the science-policy interface. Evidence of the extent of environmental degradation and its impact on individuals keeps rising. Along with updated estimates of air pollution-related deaths at 8.3 million annually, a host of recent studies have also linked excessive levels of air pollution with health issues ranging from increased neo-natal mortality to Alzheimer’s. Most recently, one Nature study linked spikes in air pollution with increased risk of deaths by suicide. Leila Benali, UNEA-6 President and the Minister of Energy Transition and Sustainable Development of Morocco. A slew of UN reports released during the assembly last week also presented a grim picture of the immediate future. Data from the 2024 Global Resource Outlook warned that without urgent action to reduce global consumption and production, extraction of natural resources could rise by 60 % from 2020 levels. This would worsen climate and pollution impacts, with consequently greater risks to biodiversity and human health, the report said. It also blamed the high levels of material consumption in upper-middle and high-income countries for the problem. The report said that the rich countries use six times more resources and generate 10 times climate impacts than low-income ones. The Global Waste Management Outlook 2024 showed that without a seismic shift away from ‘take-make-dispose’ societies towards circular economy and zero-waste approaches, the world’s waste pile could grow by two-thirds by 2050, and its cost to health, economies and the environment could double. It reiterated that only a drastic reduction in waste generation will secure a liveable and affordable future, and ways to convert waste into a reusable resource would have to be employed. Another UNEP report on Used Heavy Duty Vehicles and the Environment launched during a Climate and Clean Air Conference held ahead of UNEA, sounded the alarm on the rise of emissions from these heavy polluters, and their negative climate and health impacts. Resolutions on improving response The assembly also held its first Multilateral Environmental Agreements (MEA) Day that was dedicated to the international agreements addressing the most pressing environmental issues. UNEA-6 welcomed youth to host their own environmental summit, which called for greater inter-generational equity. “The President has gavelled resolutions that address desertification, land restoration and more. We also have a ministerial declaration that affirms the international community’s strong intent to slow climate change, restore nature and land, and create a pollution-free world,” Inger Andersen, UN Evironmental Programme Executive Director, said. “UNEP will now take forward the responsibilities you have entrusted to us in these new resolutions. In addition to keeping the environment under review. In addition to fulfilling our obligation to serve as an authoritative advocate for action across the triple planetary crisis,” Andersen added. “In our quest to confront the monumental environmental challenges of our time—climate change, biodiversity loss, and pollution—there is but one path forward: teamwork. We share one Earth, bask under the same sun, and we must recognize that there is no backup plan. There’s no other planet waiting for us to escape to,” said Abdullah Bin Ali Amri, Oman’s chair of the Environment Authority and president-elect of the next UNEA, which will be held in December 2025 in Nairobi. WHO Issues Guidelines for Expanding Access to Hearing Aids 01/03/2024 Zuzanna Stawiska A patient with age-related hearing loss (Presbycusis), receiving free treatment from the NGO, All Ears Cambodia. Over 400 million people with hearing loss could benefit from hearing devices. However, less than 20% of those people actually get hearing aids. That’s one of the findings cited in new World Health Organisation guidelines on improving access to hearing care, published Friday, just ahead of World Hearing Day. “Unaddressed hearing loss is a global public health challenge and incurs an estimated cost of over US$ 1 trillion annually. Given the global shortage of ear and hearing care specialists, we have to rethink how we traditionally deliver services,” said Dr Bente Mikkelsen, director of the WHO’s Department for Noncommunicable Diseases. By 2050, nearly 2.5 billion people are projected to experience a degree of hearing loss, as populations around the world age. More than 700 million will likely require hearing rehabilitation, estimates the WHO. But nearly 80% of people with disabling hearing loss live in low-income countries – which historically have lacked capacity for providing assistive devices like hearing aids. Fighting misconceptions and lack of resources But addressing hearing loss is not necessarily expensive. An investment of $1.4 per person annually would be sufficient to scale up ear and hearing care services worldwide, WHO said. To overcome current limitations of capacity, the guidelines encourage more service delivery by non-specialists, based in primary health care settings. Debunking misconceptions and stigma around hearing loss is another key aim of the guidelines, created with the support of ATscale Global Partnership for Assistive Technology. “Common myths about hearing loss often prevent people from seeking the services they require, even where these services are available,” said Dr Shelly Chadha, technical lead for ear and hearing care at WHO. “Any effort to improve hearing care provision through health system strengthening must be accompanied by work to raise awareness within societies and address stigma related to ear and hearing care.” Image Credits: WHO/Miguel Jeronimo. Alzheimer’s Experts Review Progress and Challenges in a ‘Transformative Moment’ 01/03/2024 Sophia Samantaroy WASHINGTON, DC – When US Senator Amy Klobuchar’s father, the late Jim Klobuchar, was diagnosed with Alzheimer’s disease, the noted Minnesota newspaper columnist gradually stopped recognizing her – although he retained “a kind of savoir faire” to the very end with words, jokes and storytelling based on the decades of “lines enmeshed in his memory,” she recalled. Senator Amy Klobuchar (D-MN) In the United States, one in every three seniors will be diagnosed with Alzheimer’s. The disease affects roughly 55 million people globally and is the seventh leading cause of death. “But it’s not just the numbers. It’s the fathers and mothers, it’s the brothers and sisters,” remarked Klobuchar, (D-MN), who recounted the story of her father’s illness at a high-level event here this week, organized by the Davos Alzheimer’s Collaborative (DAC) together with Scientific American. The meeting of the collaborative, a Swiss and US-based foundation launched at the World Economic Forum in 2021, brought together some 100 Alzheimer researchers and front-line clinicians as well as policymakers and industry and civil society advocates, to share progress on new innovations in diagnosing and treating the disease – as well as challenges faced in getting those same innovations into healthcare systems globally. But the event, co-hosted by Scientific American, also was marked by moments of personal reflections, both comic and tragic. Not only Klochubar, but other speakers in the room referred to their own experiences in dealing with family members with Alzheimer’s disease – what Senator Susan Collins (R-ME) termed “the defining disease” of her generation. Joining together across borders and cultures Alzheimer’s is a growing issue worldwide as populations age And while much of the attention around Alzheimer’s so far has been in the United States and other countries of the global north, the disease is a growing problem worldwide, as populations age and people live longer, but not always healthier lives. Researchers predict that lower and middle income countries will soon bear the brunt of Alzheimer’s disease – much as they already do with regards to other noncommunicable diseases. Alzheimer’s disease is projected to affect more than 100 million people globally 2050 And as in all disease research, a global approach can help identify new therapies more effectively and cost-efficiently. “Rather than succumb to despair, what we’re doing is joining together across borders, cultures, and languages to chart a future for the world of prevention, effective treatment, and one day, a cure,” said Collins, who lost a brother to Alzheimer’s. Along with being vice-chair of the powerful Senate Appropriations Committee, Collins is also founder and co-chair of a Congressional Task Force on Alzheimer’s disease. George Vradenburg, founding chairman of the Davos Alzheimer’s Collaborative “I want to speak on behalf of families…50 million families worldwide are struggling with this disease.” said DAC chairman George Vradenburg, who first launched the initiative in response to a challenge by WEF founder and executive director Klaus Schwab. He said that DAC was committed to “including researchers, clinicians and families in this fight globally, ensuring that no corner of the world is left untouched by our efforts.” Added Collins, “We need a global approach modeled on what we’ve done with AIDS, tuberculosis, and malaria. And we know that that kind of global collaborative approach to bring the research directly to a broader spectrum of countries and communities will remove long standing barriers to care and help us eliminate disparities.” “A transformative moment”: Novel diagnostic tests, gene sequencing, and precision medicine Moderator Jeremy Abbate, VP and publisher of Scientific American with former NIH Director Dr. Elias Zerhouni, University of Washington’s Dr. Suzanne Schindler and Dr. Jeffrey Burns, University of Kansas Medical Center Early Alzheimer’s disease research was rather akin to “staring up a cliff,” said former US National Institutes of Health (NIH) director Elias Zerhouni, one of the other speakers at the event. Now, however, the world has reached a turning point where, “we can truly have a global approach.” Improved genetic sequencing, the advent of digital and biological markers, novel drugs, and a more open mindset to alternative hypotheses have seen Alzheimer’s disease research leap into a new era. “We have an explosion of ways to test for Alzheimer’s disease,” remarked Suzanne Schindler, Associate Professor of Neurology at Washington University School of Medicine. Among them are blood tests that can measure up to 5,000 various proteins- a method faster and less invasive than dreaded spinal taps. Other panelists shared this optimism, citing the use of amyloid pet-scans and other diagnostics to more accurately assess Alzheimer’s progression in patients. Genetic sequencing too is cheaper, a marked change since the early days when researchers remained in the dark about the potential genetic drivers of the disease. ‘More than buildup of amyloid plaques’ One of the causes of Alzheimer’s appears to be the abnormal accumulation of tau proteins in the brain, eventually forming tangles inside neurons, seen here With these tools comes an understanding that “the disease is more than just about build up [of amyloid plaques],” commented Jeffrey Burns, Professor of Neurology at University of Kansas Medical Center. New research into disease risk factors is moving beyond conventional descriptions of amyloid plaques and tau protein pathways to include research into inflammation and lifestyle factors. The future of prevention, he speculated, will increasingly lie in more holistic lifestyle approaches undertaken in tandem with medications. “We don’t just give patients with heart disease medication, we tell them to modify their diet, their lifestyle. “I believe we will prevent the disease,” Burns added. Early Alzheimer’s detection remains a missing link Phyllis Ferrell (center left,) Arindam Nandi, and Terry Fulmer discuss the implications of an aging society with Jeremy Abbate. One major challenge is the need to move new knowledge into hospitals and health clinics; currently it can take as long 17-20 years for innovations to get into clinical practice due to outdated models of care. “We are building bullet trains, but running them on the same wooden tracks,” said Dr Phyllis Ferrell, DAC advisor on healthcare systems preparedness. Too often, practitioners still take a “wait and see” approach, while symptoms of cognitive impairment go unrecognized or undiagnosed until much later in the disease course. She urged a shift to a more preventative approach with screenings and help manage cognitive symptoms early. “Why did it take four separate visits to get my dad an inconclusive diagnosis?” Ferrell asked. “Early detection gives people the time to focus on what matters most to them,” she added. “It provides an opportunity to implement positive lifestyle changes and address risk factors, pursue treatment options and/or enroll in a clinical trial.” Getting new innovations into practice Ferrell also bemoaned the frustration families feel over the lack of access to new diagnostics and therapeutics – in the wake of progress made in research. In 2010 the NIH funded Alzheimer’s disease research to the tune of $400 million annually. Fourteen years later, the annual investment is now close to $4 billion, she noted. Yet, despite this influx of funding for research, there’s a huge gap emerging in affordable and available drugs. “We have innovations that are ready, but are not being used,” she said, adding “Yes, to research, but we need to do things today. Let’s go after clinically ready innovations.” Staying the course on research Senator Susan Collins (R-ME)- a leading champion in Congress for Alzheimer’s disease research. At the same time, more research into the disease remains critical to find even more effective preventive strategies as well as possible cures. This means building specimen repositories across the country, performing skin tests for early detection of Alzheimer-related protein abnormalities traditionally only detectable from brain biopsies, and other research. Zerhouni called it breaking the “taboo of the brain” – an area of human physiology where research was historically inadequate. “This is a frontier that has to be broken.” For many years, such research was impeded by social taboos around Alzheimer’s disease. “People used to just call it senility,” said Collins, who has been the leading champion of Alzheimer’s research and action on Capitol Hill for over a decade. Collins last year initiated bipartisan legislation in the US Congress to help maintain the funding for Alzheimer’s research, as well as supporting initiatives to bring down the cost of new drugs in the US for Alzheimer patients. At $345 million billion a year, the disease is currently the most costly disease in the nation to treat, she says. A global economic burden Globally, Alzheimer’s disease also presents an enormous economic burden – costing the world’s economies some $1.3 trillion, in terms of medications as well as care – much of it unpaid, noted Population Council economist Arindam Nandi. In the past, economic data came mostly from high income countries, Now, data is available from lower and middle-income countries like India and China. “These data depict a worrying trend; the percentage of unpaid care is higher in these countries, meaning that caregivers are not able to get other jobs, decreasing economic output,’ he said. Nandi also mentioned that predictive models forecast the shifting burden of disease from high income countries to middle and low income countries. “We don’t know how these populations will fare.” Investments in these countries are needed to strengthen their overall public health measures. Meanwhile, the US and high income countries can learn from the experiences of low and middle income countries, which often are first to devise lower-costs methods for detecting and treating diseases. DAC, for instance, funded an Early Detection Flagship program involving six countries, including the US, Scotland, Jamaica, Japan, Mexico and Brazil. They participated in a pilot designed to increase access to early detection and diagnosis of the disease through the use of innovative new screening tools. “One of the things I loved [about the Early Detection program] was watching the US and high resource countries learn from LMICs,” Ferrell observed. “As the founder of the Brain and Mind Institute of Aga Khan University once said, ‘when it comes to Alzheimer’s disease we are all developing nations.’ “ Image Credits: Getty Images, Pixelmestudio/DAC, National Institutes on Aging , UCLA , S. Samantaroy/HPW. WHO Calls for Private Sector Accountability Amid Massive Obesity Increase 01/03/2024 Kerry Cullinan Member states have been slow to implement WHO policies to address obesity, including taxes on sugary drinks and restrictions on marketing junk food to kids The private sector “must be held accountable for the health impacts of their products”, warned the head of the World Health Organization (WHO) amid news that obesity has quadrupled in children and more than doubled in adults since 1990. Dr Tedros Adhanom Ghebreyesus was speaking ahead of the release of a huge global obesity study involving over 220 million people from more than 190 countries published in The Lancet on Friday. “Getting back on track to meet the global targets for curbing obesity will take the work of governments and communities, supported by evidence-based policies from WHO and national public health agencies,” added Tedros. Countries with highest obesity rates 2022 Tonga, American Samoa and Nauru have the world’s highest obesity rates, affecting some 60% of their adult populations. “The largest increases are in some countries in the Pacific, the Caribbean, the Middle East and North Africa, and some of the newly high income countries like Chile,” said senior author Professor Majid Ezzati, of Imperial College in London, at a media briefing on Thursday. The US is the only high-income country that features in the ten worst affected countries – with the 10th highest obesity rate in men. Some 43.8% of US women and 41.6% of men were living with obesity in 2022. Meanwhile, obesity is slowing in a handful of west European countries – notably Spain and France. However, countries with the lowest obesity rates are generally low-income countries with high rates of under-nutrition, with a few exceptions such as Japan and Viet Nam. Countries with lowest obesity rates 2022 Huge rise in child obesity In 1990, around 31 million children (2,1% of boys and 1.7% of girls) were obese. But 32 years later, there had been a fourfold increase in both boys (to 9,3%) and girls (6.9%) affecting almost 160 million children. “It is very concerning that the epidemic of obesity that was evident amongst adults in much of the world in 1990 is now mirrored in school-aged children and adolescents,” said Ezzati. Professor Majid Ezzati, of Imperial College in London While boys are more likely to be obese than girls globally, this trend is reversed in adulthood with many more women than men living with obesity. But men seem to be catching up. Obesity in men has nearly tripled over the past 32 years, while it has doubled in women. “Different forms of malnutrition still coexist in many countries,” said Dr Francesco Branca, WHO Director of Nutrition and Food Safety and one of the co-authors of the study. “The child who was undernourished in the first years of life can later become overweight or obese as an adolescent or an adult. Undernutrition and obesity are two faces of the same problem, which is the lack of access to healthy diets.” Greater risk of NCDs Undernourished people are more susceptible to infectious diseases, while obesity can lead to Type 2 diabetes, heart disease, certain cancers and affect bone health and reproduction, added Branca, who was also addressing the briefing. “The increase in the double burden of malnutrition is a result of a transition in food system and lifestyle that has not been governed by public health policies,” he added. However, despite WHO guidelines on what countries can do to address the massive rise in consumption of energy-dense ultra-processed food, adoption by member states has been slow. At the World Health Assembly in 2022, member states adopted the WHO Acceleration plan to stop obesity. Core interventions include promoting breastfeeding, regulating marketing of ultra-processed food and drinks to kids, taxation and warning labels on foods high in fats, salt and sugar. Dr Francesco Branca, WHO Director of Nutrition and Food Safety “The reason why the epidemic has progressed so quickly is because the policy action has not been incisive enough,” said Branca, adding that countries had focused on behaviour change rather than “structural elements, which is the policies around food environment”. However, he added that more countries were taxing sugary drinks, although “not many countries have done it for sufficiently long time and in ways that are demonstrated to be most effective”. “Very few countries put a restriction on marketing food to children. We know that some South American countries are taking that action much more effectively, and we look forward seeing the impact of those policies,[as well as] having warning signs on the processed food which would really discourage people from f buying products which are high in salt, sugar and fat”. If these policies were implemented, this would likely lead to food and beverage companies reformulating their products to reduce harmful ingredients, he added. Role of new weight-loss pills? Branca said that the WHO was currently looking at the efficacy of the new drugs called glucagon-like peptide 1 (GLP-1) agonists – such as Wegovy, Ozempic – which have been approved as weight-loss medication in some countries. “The solution is still is a transformation of the food system and in the environment such obesity can be prevented,” Branca stressed. However, the GLP-1 drugs could provide a tool to help those that already live with obesity, as long as they were integrated into a primary healthcare package to manage obesity that included guidance on exercise and diet. The new study was conducted by the NCD Risk Factor Collaboration (NCD-RisC), in collaboration with the World Health Organization (WHO), and involved over 1,500 researchers. They based their analysis on body mass index (BMI). Adults with BMI 30kg/m2 and over were classified as obese and underweight if their BMI was below 18.5kg/m2. For children, BMI was adjusted according to age. . 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New Global Commitments Make Elimination of Cervical Cancer Possible 06/03/2024 Sophia Samantaroy & Kerry Cullinan The WHO set an ambitious goal of having 90% of girls vaccinated against HPV by 2030 Eliminating cervical cancer is within reach, thanks to new commitments by governments, donors and other partners, including pledges of almost $600 million, made at the first-ever global forum on cervical cancer in Cartagena de Indias in Colombia. Every two minutes, a woman dies from cervical cancer, although vaccination against human papillomavirus (HPV), the leading cause of cervical cancer, can prevent the vast majority of cases. Cervical cancer is the fourth most common cancer in women worldwide, but disproportionately affects women and their families in low and middle-income countries (LMICs). Less than 5% of women in many LMICs are ever screened for cervical cancer, and over 90% of the 348 000 cervical cancer deaths in 2022 took place in LMICs. Furthermore, only one in five adolescent girls were vaccinated against HPV in 2022. Country commitments Low and middle income countries experience the highest burden of cervical cancer However, a number of countries stepped up at the forum. These include the Democratic Republic of Congo (DRC), which has committed to introduce the HPV vaccine as early as possible, targeting girls aged 9 to 14 years. Ethiopia aims to reach at least 95% of all 14-year-old girls with the HPV vaccine this year, and screen one million eligible women every year for cervical cancer and to treat 90% of those screened who present with positive precancerous lesions. Further, HPV single dose has been approved to be introduced this year and scaled up as part of the country’s Expanded Program on Immunization plans. Africa’s most populous country, Nigeria, has committed to vaccinating 80% of girls 9 to 14 years old by 2026, including those who are no longer at school. The nearly $600 million in new funding includes $180 million from the Bill and Melinda Gates Foundation, $10 million from UNICEF, and $400 million from the World Bank. Elimination of a cancer Experts gathered in Colombia to discuss global collaboration for cervical cancer elimination “If these ambitions to expand vaccine coverage and strengthen screening and treatment programs are fully realized, the world could eliminate a cancer for the first time,” according to the World Health Organization (WHO). In 2022, the WHO revised its HPV vaccination recommendation from two to one-dose of the HPV vaccine, making it much easier and cheaper for countries to reach those who need it. The WHO Americas region made a similar recommendation 2023, and WHO’s African regional just followed suit with its own recommendation. “We have the knowledge and the tools to make cervical cancer history, but vaccination, screening and treatment programmes are still not reaching the scale required,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This first global forum is an important opportunity for governments and partners to invest in the global elimination strategy and addressing the inequities that deny women and girls access to the life-saving tools they need.” However, many LMICs face an uphill battle. Malawian Minister of Health Kandodo Chiponda described the challenges her country faces at the forum’s opening plenary. Some 60% of Malawi’s population of over 20 million is under 35, and cervical cancer is the highest cancer burden, with the incidence rate as high as 70 per 100,000. Mortality figures are 52 per 100,000, said Chiponda, who also announced the opening of the first ever cancer center in Malawi. Chiponda noted that women have limited time and resources to seek care, limited access to screening and diagnostic services, and are subject to misinformation about vaccinations. She emphasized the need for cross-sector collaborations and the strengthening of primary healthcare to reach women and girls in remote areas. ‘Miracle of modern medicine’ “Cervical cancer is a disease of inequity” – Dr. Tedros Adhanom Ghebreyesus, WHO Director-General “The HPV vaccine is one of the most impactful vaccines on the planet and has already helped save thousands of lives,” said Aurélia Nguyen, Gavi’s chief programme officer. Despite the efficiency and safety of the HPV vaccine, high costs, supply chain issues, and difficulties in reaching remote populations keep the vaccine out of reach for many. “More girls urgently deserve the same protection, which is why in partnership with countries, Gavi has set an ambitious goal to help vaccinate 86 million adolescent girls by 2025. With bold commitment and decisive action, we can look forward to a future where cervical cancer has been eliminated for good.” Describing HPV vaccines as “a miracle of modern medicine”, Dr Chris Elias, the Bill and Melinda Gates Foundation’s president of global development, said that there is “no reason why women should die from cervical cancer.” “Now is the time for governments and partners around the world to increase HPV vaccine access and protect future generations from cervical cancer.” Image Credits: Unsplash, IARC/WHO, Global Cervical Cancer Elimination Forum, GCCEF/WHO. European Parliament Challenged to Enable Non-EU Countries to Benefit from Medical Products Made Under Compulsory Licences 05/03/2024 Kerry Cullinan The European Parliament is to vote on a regulation to allow compulsory licencing during crises. The European Parliament has been challenged to amend a proposed law to enable countries outside the European Union (EU) to benefit from medical products produced under compulsory licences during crises. The proposed regulation aims to ensure that, “during specific crises or emergencies”, the EU can issue a compulsory licence to enable the production of certain products – such as vaccines and medicines during a pandemic. A compulsory licence gives governments the power to allow a third party to use a patent without the authorisation of the patent-holder, subject to certain conditions. “Compulsory licensing can therefore complement current EU efforts to improve its resilience to crises,” according to the EU. But the draft regulation currently prohibits the export of any products produced under compulsory licences outside the EU. On Tuesday, a group of over 70 influential civil society organisations and academics wrote a letter to the European Parliament challenging them to “support crucial amendments allowing the export of medical tools to third countries in the proposed Union Compulsory License”. “The COVID-19 pandemic has made clear that major health emergencies need to be addressed at local, national, regional and global level and showcased that the EU’s advanced industrial capacity can be used to help protect EU citizens while also aiding and supplying non-EU countries, aligning with the principle that “No one is safe until everyone is safe”,” the letter notes. “It is therefore disheartening to note that, when preparing for the next crisis, the EU risks turning its back on the rest of the world, including non-EU countries in Europe, with this compulsory licence proposal,” it adds. EU harmonisation Impetus for the new regulation stems from the fact that there is “no EU-wide harmonisation of compulsory licensing for the domestic market”, according to the EU, which adds that the new regulation has two main objectives. “First, it aims to enable the EU to rely on compulsory licensing in the context of the EU crisis instruments. Second, it introduces an efficient compulsory licensing scheme, with appropriate features, to allow a swift and appropriate response to crises, with a functioning internal market, guaranteeing the supply and the free movement of crisis-critical products subject to compulsory licencing in the internal market.” The letter’s signatories, including Médecins Sans Frontières, Health Action International (HAI) and Oxfam, state that they support EU compulsory licences as they have “the potential to foster a more effective response to public health challenges”. But by prohibiting exports, the current draft – which has been put forward for a plenary vote of the European Parliament – goes against flexibilities enshrined in the World Trade Organization (WTO) Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS Agreement), according to the letter. “This limitation is problematic, especially considering the use of a Union compulsory license would likely be triggered by situations that would affect not only EU countries but also countries outside of the EU, either in the region or globally,” they add. Pandemics ‘don’t respect borders’ Making exports available under an EU compulsory licence “is not just a matter of international solidarity but is also in the EU’s interest” as it could “help in controlling potential outbreaks and emergencies that could spill over into the EU, allowing EU-based manufacturers to respond promptly to the needs of non-EU countries”. “This vote is important for a number of reasons,” according to HAI Senior Policy Advisor Jaume Vidal. “Embracing TRIPS flexibilities is, of course, a welcome step, but the current proposal risks becoming an ‘EU First’ response when it comes to pandemics and health emergencies, reminiscent of the inequities seen during the COVID-19 pandemic. “Secondly, at a time when countries are negotiating a pandemic accord, a restrictive use of the proposed Union compulsory license that would limit exports would be sending an ominous message to negotiators. Finally, in times of greatest need, the EU would do well to remember that pandemics don’t respect borders or blocs, and that no one is safe, until everyone is safe.” Image Credits: Thijs ter Haar. UN Environment Assembly Concludes With Renewed Commitments to Tackle Climate, Biodiversity and Pollution 04/03/2024 Disha Shetty The sixth UN Environment Assembly was held in Nairobi The sixth United Nations Environment Assembly (UNAE-6) ended last Friday in Nairobi, Kenya with the adoption of a Ministerial Declaration affirming member states’ commitment to slowing climate change, protecting biodiversity, and creating a pollution-free world. The assembly, which attracted over 5,600 delegates from 190 countries, also adopted 15 resolutions covering a range of issues including chemicals, waste, metals and minerals and protecting the environment during and after conflicts. “As governments, we need to push for more and reinvent partnerships with key stakeholders to implement these mandates. We need to continue to partner with civil society, continue to guide and empower our creative youth, and also with the private sector and philanthropies,” said Leila Benali, UNEA-6 President and the Minister of Energy Transition and Sustainable Development of Morocco. Benali noted that the resolutions called for enlightened leadership and urged scaling up means of implementation, enhancing national capacity to implement action plans and policies, and strengthening the science-policy interface. Evidence of the extent of environmental degradation and its impact on individuals keeps rising. Along with updated estimates of air pollution-related deaths at 8.3 million annually, a host of recent studies have also linked excessive levels of air pollution with health issues ranging from increased neo-natal mortality to Alzheimer’s. Most recently, one Nature study linked spikes in air pollution with increased risk of deaths by suicide. Leila Benali, UNEA-6 President and the Minister of Energy Transition and Sustainable Development of Morocco. A slew of UN reports released during the assembly last week also presented a grim picture of the immediate future. Data from the 2024 Global Resource Outlook warned that without urgent action to reduce global consumption and production, extraction of natural resources could rise by 60 % from 2020 levels. This would worsen climate and pollution impacts, with consequently greater risks to biodiversity and human health, the report said. It also blamed the high levels of material consumption in upper-middle and high-income countries for the problem. The report said that the rich countries use six times more resources and generate 10 times climate impacts than low-income ones. The Global Waste Management Outlook 2024 showed that without a seismic shift away from ‘take-make-dispose’ societies towards circular economy and zero-waste approaches, the world’s waste pile could grow by two-thirds by 2050, and its cost to health, economies and the environment could double. It reiterated that only a drastic reduction in waste generation will secure a liveable and affordable future, and ways to convert waste into a reusable resource would have to be employed. Another UNEP report on Used Heavy Duty Vehicles and the Environment launched during a Climate and Clean Air Conference held ahead of UNEA, sounded the alarm on the rise of emissions from these heavy polluters, and their negative climate and health impacts. Resolutions on improving response The assembly also held its first Multilateral Environmental Agreements (MEA) Day that was dedicated to the international agreements addressing the most pressing environmental issues. UNEA-6 welcomed youth to host their own environmental summit, which called for greater inter-generational equity. “The President has gavelled resolutions that address desertification, land restoration and more. We also have a ministerial declaration that affirms the international community’s strong intent to slow climate change, restore nature and land, and create a pollution-free world,” Inger Andersen, UN Evironmental Programme Executive Director, said. “UNEP will now take forward the responsibilities you have entrusted to us in these new resolutions. In addition to keeping the environment under review. In addition to fulfilling our obligation to serve as an authoritative advocate for action across the triple planetary crisis,” Andersen added. “In our quest to confront the monumental environmental challenges of our time—climate change, biodiversity loss, and pollution—there is but one path forward: teamwork. We share one Earth, bask under the same sun, and we must recognize that there is no backup plan. There’s no other planet waiting for us to escape to,” said Abdullah Bin Ali Amri, Oman’s chair of the Environment Authority and president-elect of the next UNEA, which will be held in December 2025 in Nairobi. WHO Issues Guidelines for Expanding Access to Hearing Aids 01/03/2024 Zuzanna Stawiska A patient with age-related hearing loss (Presbycusis), receiving free treatment from the NGO, All Ears Cambodia. Over 400 million people with hearing loss could benefit from hearing devices. However, less than 20% of those people actually get hearing aids. That’s one of the findings cited in new World Health Organisation guidelines on improving access to hearing care, published Friday, just ahead of World Hearing Day. “Unaddressed hearing loss is a global public health challenge and incurs an estimated cost of over US$ 1 trillion annually. Given the global shortage of ear and hearing care specialists, we have to rethink how we traditionally deliver services,” said Dr Bente Mikkelsen, director of the WHO’s Department for Noncommunicable Diseases. By 2050, nearly 2.5 billion people are projected to experience a degree of hearing loss, as populations around the world age. More than 700 million will likely require hearing rehabilitation, estimates the WHO. But nearly 80% of people with disabling hearing loss live in low-income countries – which historically have lacked capacity for providing assistive devices like hearing aids. Fighting misconceptions and lack of resources But addressing hearing loss is not necessarily expensive. An investment of $1.4 per person annually would be sufficient to scale up ear and hearing care services worldwide, WHO said. To overcome current limitations of capacity, the guidelines encourage more service delivery by non-specialists, based in primary health care settings. Debunking misconceptions and stigma around hearing loss is another key aim of the guidelines, created with the support of ATscale Global Partnership for Assistive Technology. “Common myths about hearing loss often prevent people from seeking the services they require, even where these services are available,” said Dr Shelly Chadha, technical lead for ear and hearing care at WHO. “Any effort to improve hearing care provision through health system strengthening must be accompanied by work to raise awareness within societies and address stigma related to ear and hearing care.” Image Credits: WHO/Miguel Jeronimo. Alzheimer’s Experts Review Progress and Challenges in a ‘Transformative Moment’ 01/03/2024 Sophia Samantaroy WASHINGTON, DC – When US Senator Amy Klobuchar’s father, the late Jim Klobuchar, was diagnosed with Alzheimer’s disease, the noted Minnesota newspaper columnist gradually stopped recognizing her – although he retained “a kind of savoir faire” to the very end with words, jokes and storytelling based on the decades of “lines enmeshed in his memory,” she recalled. Senator Amy Klobuchar (D-MN) In the United States, one in every three seniors will be diagnosed with Alzheimer’s. The disease affects roughly 55 million people globally and is the seventh leading cause of death. “But it’s not just the numbers. It’s the fathers and mothers, it’s the brothers and sisters,” remarked Klobuchar, (D-MN), who recounted the story of her father’s illness at a high-level event here this week, organized by the Davos Alzheimer’s Collaborative (DAC) together with Scientific American. The meeting of the collaborative, a Swiss and US-based foundation launched at the World Economic Forum in 2021, brought together some 100 Alzheimer researchers and front-line clinicians as well as policymakers and industry and civil society advocates, to share progress on new innovations in diagnosing and treating the disease – as well as challenges faced in getting those same innovations into healthcare systems globally. But the event, co-hosted by Scientific American, also was marked by moments of personal reflections, both comic and tragic. Not only Klochubar, but other speakers in the room referred to their own experiences in dealing with family members with Alzheimer’s disease – what Senator Susan Collins (R-ME) termed “the defining disease” of her generation. Joining together across borders and cultures Alzheimer’s is a growing issue worldwide as populations age And while much of the attention around Alzheimer’s so far has been in the United States and other countries of the global north, the disease is a growing problem worldwide, as populations age and people live longer, but not always healthier lives. Researchers predict that lower and middle income countries will soon bear the brunt of Alzheimer’s disease – much as they already do with regards to other noncommunicable diseases. Alzheimer’s disease is projected to affect more than 100 million people globally 2050 And as in all disease research, a global approach can help identify new therapies more effectively and cost-efficiently. “Rather than succumb to despair, what we’re doing is joining together across borders, cultures, and languages to chart a future for the world of prevention, effective treatment, and one day, a cure,” said Collins, who lost a brother to Alzheimer’s. Along with being vice-chair of the powerful Senate Appropriations Committee, Collins is also founder and co-chair of a Congressional Task Force on Alzheimer’s disease. George Vradenburg, founding chairman of the Davos Alzheimer’s Collaborative “I want to speak on behalf of families…50 million families worldwide are struggling with this disease.” said DAC chairman George Vradenburg, who first launched the initiative in response to a challenge by WEF founder and executive director Klaus Schwab. He said that DAC was committed to “including researchers, clinicians and families in this fight globally, ensuring that no corner of the world is left untouched by our efforts.” Added Collins, “We need a global approach modeled on what we’ve done with AIDS, tuberculosis, and malaria. And we know that that kind of global collaborative approach to bring the research directly to a broader spectrum of countries and communities will remove long standing barriers to care and help us eliminate disparities.” “A transformative moment”: Novel diagnostic tests, gene sequencing, and precision medicine Moderator Jeremy Abbate, VP and publisher of Scientific American with former NIH Director Dr. Elias Zerhouni, University of Washington’s Dr. Suzanne Schindler and Dr. Jeffrey Burns, University of Kansas Medical Center Early Alzheimer’s disease research was rather akin to “staring up a cliff,” said former US National Institutes of Health (NIH) director Elias Zerhouni, one of the other speakers at the event. Now, however, the world has reached a turning point where, “we can truly have a global approach.” Improved genetic sequencing, the advent of digital and biological markers, novel drugs, and a more open mindset to alternative hypotheses have seen Alzheimer’s disease research leap into a new era. “We have an explosion of ways to test for Alzheimer’s disease,” remarked Suzanne Schindler, Associate Professor of Neurology at Washington University School of Medicine. Among them are blood tests that can measure up to 5,000 various proteins- a method faster and less invasive than dreaded spinal taps. Other panelists shared this optimism, citing the use of amyloid pet-scans and other diagnostics to more accurately assess Alzheimer’s progression in patients. Genetic sequencing too is cheaper, a marked change since the early days when researchers remained in the dark about the potential genetic drivers of the disease. ‘More than buildup of amyloid plaques’ One of the causes of Alzheimer’s appears to be the abnormal accumulation of tau proteins in the brain, eventually forming tangles inside neurons, seen here With these tools comes an understanding that “the disease is more than just about build up [of amyloid plaques],” commented Jeffrey Burns, Professor of Neurology at University of Kansas Medical Center. New research into disease risk factors is moving beyond conventional descriptions of amyloid plaques and tau protein pathways to include research into inflammation and lifestyle factors. The future of prevention, he speculated, will increasingly lie in more holistic lifestyle approaches undertaken in tandem with medications. “We don’t just give patients with heart disease medication, we tell them to modify their diet, their lifestyle. “I believe we will prevent the disease,” Burns added. Early Alzheimer’s detection remains a missing link Phyllis Ferrell (center left,) Arindam Nandi, and Terry Fulmer discuss the implications of an aging society with Jeremy Abbate. One major challenge is the need to move new knowledge into hospitals and health clinics; currently it can take as long 17-20 years for innovations to get into clinical practice due to outdated models of care. “We are building bullet trains, but running them on the same wooden tracks,” said Dr Phyllis Ferrell, DAC advisor on healthcare systems preparedness. Too often, practitioners still take a “wait and see” approach, while symptoms of cognitive impairment go unrecognized or undiagnosed until much later in the disease course. She urged a shift to a more preventative approach with screenings and help manage cognitive symptoms early. “Why did it take four separate visits to get my dad an inconclusive diagnosis?” Ferrell asked. “Early detection gives people the time to focus on what matters most to them,” she added. “It provides an opportunity to implement positive lifestyle changes and address risk factors, pursue treatment options and/or enroll in a clinical trial.” Getting new innovations into practice Ferrell also bemoaned the frustration families feel over the lack of access to new diagnostics and therapeutics – in the wake of progress made in research. In 2010 the NIH funded Alzheimer’s disease research to the tune of $400 million annually. Fourteen years later, the annual investment is now close to $4 billion, she noted. Yet, despite this influx of funding for research, there’s a huge gap emerging in affordable and available drugs. “We have innovations that are ready, but are not being used,” she said, adding “Yes, to research, but we need to do things today. Let’s go after clinically ready innovations.” Staying the course on research Senator Susan Collins (R-ME)- a leading champion in Congress for Alzheimer’s disease research. At the same time, more research into the disease remains critical to find even more effective preventive strategies as well as possible cures. This means building specimen repositories across the country, performing skin tests for early detection of Alzheimer-related protein abnormalities traditionally only detectable from brain biopsies, and other research. Zerhouni called it breaking the “taboo of the brain” – an area of human physiology where research was historically inadequate. “This is a frontier that has to be broken.” For many years, such research was impeded by social taboos around Alzheimer’s disease. “People used to just call it senility,” said Collins, who has been the leading champion of Alzheimer’s research and action on Capitol Hill for over a decade. Collins last year initiated bipartisan legislation in the US Congress to help maintain the funding for Alzheimer’s research, as well as supporting initiatives to bring down the cost of new drugs in the US for Alzheimer patients. At $345 million billion a year, the disease is currently the most costly disease in the nation to treat, she says. A global economic burden Globally, Alzheimer’s disease also presents an enormous economic burden – costing the world’s economies some $1.3 trillion, in terms of medications as well as care – much of it unpaid, noted Population Council economist Arindam Nandi. In the past, economic data came mostly from high income countries, Now, data is available from lower and middle-income countries like India and China. “These data depict a worrying trend; the percentage of unpaid care is higher in these countries, meaning that caregivers are not able to get other jobs, decreasing economic output,’ he said. Nandi also mentioned that predictive models forecast the shifting burden of disease from high income countries to middle and low income countries. “We don’t know how these populations will fare.” Investments in these countries are needed to strengthen their overall public health measures. Meanwhile, the US and high income countries can learn from the experiences of low and middle income countries, which often are first to devise lower-costs methods for detecting and treating diseases. DAC, for instance, funded an Early Detection Flagship program involving six countries, including the US, Scotland, Jamaica, Japan, Mexico and Brazil. They participated in a pilot designed to increase access to early detection and diagnosis of the disease through the use of innovative new screening tools. “One of the things I loved [about the Early Detection program] was watching the US and high resource countries learn from LMICs,” Ferrell observed. “As the founder of the Brain and Mind Institute of Aga Khan University once said, ‘when it comes to Alzheimer’s disease we are all developing nations.’ “ Image Credits: Getty Images, Pixelmestudio/DAC, National Institutes on Aging , UCLA , S. Samantaroy/HPW. WHO Calls for Private Sector Accountability Amid Massive Obesity Increase 01/03/2024 Kerry Cullinan Member states have been slow to implement WHO policies to address obesity, including taxes on sugary drinks and restrictions on marketing junk food to kids The private sector “must be held accountable for the health impacts of their products”, warned the head of the World Health Organization (WHO) amid news that obesity has quadrupled in children and more than doubled in adults since 1990. Dr Tedros Adhanom Ghebreyesus was speaking ahead of the release of a huge global obesity study involving over 220 million people from more than 190 countries published in The Lancet on Friday. “Getting back on track to meet the global targets for curbing obesity will take the work of governments and communities, supported by evidence-based policies from WHO and national public health agencies,” added Tedros. Countries with highest obesity rates 2022 Tonga, American Samoa and Nauru have the world’s highest obesity rates, affecting some 60% of their adult populations. “The largest increases are in some countries in the Pacific, the Caribbean, the Middle East and North Africa, and some of the newly high income countries like Chile,” said senior author Professor Majid Ezzati, of Imperial College in London, at a media briefing on Thursday. The US is the only high-income country that features in the ten worst affected countries – with the 10th highest obesity rate in men. Some 43.8% of US women and 41.6% of men were living with obesity in 2022. Meanwhile, obesity is slowing in a handful of west European countries – notably Spain and France. However, countries with the lowest obesity rates are generally low-income countries with high rates of under-nutrition, with a few exceptions such as Japan and Viet Nam. Countries with lowest obesity rates 2022 Huge rise in child obesity In 1990, around 31 million children (2,1% of boys and 1.7% of girls) were obese. But 32 years later, there had been a fourfold increase in both boys (to 9,3%) and girls (6.9%) affecting almost 160 million children. “It is very concerning that the epidemic of obesity that was evident amongst adults in much of the world in 1990 is now mirrored in school-aged children and adolescents,” said Ezzati. Professor Majid Ezzati, of Imperial College in London While boys are more likely to be obese than girls globally, this trend is reversed in adulthood with many more women than men living with obesity. But men seem to be catching up. Obesity in men has nearly tripled over the past 32 years, while it has doubled in women. “Different forms of malnutrition still coexist in many countries,” said Dr Francesco Branca, WHO Director of Nutrition and Food Safety and one of the co-authors of the study. “The child who was undernourished in the first years of life can later become overweight or obese as an adolescent or an adult. Undernutrition and obesity are two faces of the same problem, which is the lack of access to healthy diets.” Greater risk of NCDs Undernourished people are more susceptible to infectious diseases, while obesity can lead to Type 2 diabetes, heart disease, certain cancers and affect bone health and reproduction, added Branca, who was also addressing the briefing. “The increase in the double burden of malnutrition is a result of a transition in food system and lifestyle that has not been governed by public health policies,” he added. However, despite WHO guidelines on what countries can do to address the massive rise in consumption of energy-dense ultra-processed food, adoption by member states has been slow. At the World Health Assembly in 2022, member states adopted the WHO Acceleration plan to stop obesity. Core interventions include promoting breastfeeding, regulating marketing of ultra-processed food and drinks to kids, taxation and warning labels on foods high in fats, salt and sugar. Dr Francesco Branca, WHO Director of Nutrition and Food Safety “The reason why the epidemic has progressed so quickly is because the policy action has not been incisive enough,” said Branca, adding that countries had focused on behaviour change rather than “structural elements, which is the policies around food environment”. However, he added that more countries were taxing sugary drinks, although “not many countries have done it for sufficiently long time and in ways that are demonstrated to be most effective”. “Very few countries put a restriction on marketing food to children. We know that some South American countries are taking that action much more effectively, and we look forward seeing the impact of those policies,[as well as] having warning signs on the processed food which would really discourage people from f buying products which are high in salt, sugar and fat”. If these policies were implemented, this would likely lead to food and beverage companies reformulating their products to reduce harmful ingredients, he added. Role of new weight-loss pills? Branca said that the WHO was currently looking at the efficacy of the new drugs called glucagon-like peptide 1 (GLP-1) agonists – such as Wegovy, Ozempic – which have been approved as weight-loss medication in some countries. “The solution is still is a transformation of the food system and in the environment such obesity can be prevented,” Branca stressed. However, the GLP-1 drugs could provide a tool to help those that already live with obesity, as long as they were integrated into a primary healthcare package to manage obesity that included guidance on exercise and diet. The new study was conducted by the NCD Risk Factor Collaboration (NCD-RisC), in collaboration with the World Health Organization (WHO), and involved over 1,500 researchers. They based their analysis on body mass index (BMI). Adults with BMI 30kg/m2 and over were classified as obese and underweight if their BMI was below 18.5kg/m2. For children, BMI was adjusted according to age. . Image Credits: World Obesity Federation. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
European Parliament Challenged to Enable Non-EU Countries to Benefit from Medical Products Made Under Compulsory Licences 05/03/2024 Kerry Cullinan The European Parliament is to vote on a regulation to allow compulsory licencing during crises. The European Parliament has been challenged to amend a proposed law to enable countries outside the European Union (EU) to benefit from medical products produced under compulsory licences during crises. The proposed regulation aims to ensure that, “during specific crises or emergencies”, the EU can issue a compulsory licence to enable the production of certain products – such as vaccines and medicines during a pandemic. A compulsory licence gives governments the power to allow a third party to use a patent without the authorisation of the patent-holder, subject to certain conditions. “Compulsory licensing can therefore complement current EU efforts to improve its resilience to crises,” according to the EU. But the draft regulation currently prohibits the export of any products produced under compulsory licences outside the EU. On Tuesday, a group of over 70 influential civil society organisations and academics wrote a letter to the European Parliament challenging them to “support crucial amendments allowing the export of medical tools to third countries in the proposed Union Compulsory License”. “The COVID-19 pandemic has made clear that major health emergencies need to be addressed at local, national, regional and global level and showcased that the EU’s advanced industrial capacity can be used to help protect EU citizens while also aiding and supplying non-EU countries, aligning with the principle that “No one is safe until everyone is safe”,” the letter notes. “It is therefore disheartening to note that, when preparing for the next crisis, the EU risks turning its back on the rest of the world, including non-EU countries in Europe, with this compulsory licence proposal,” it adds. EU harmonisation Impetus for the new regulation stems from the fact that there is “no EU-wide harmonisation of compulsory licensing for the domestic market”, according to the EU, which adds that the new regulation has two main objectives. “First, it aims to enable the EU to rely on compulsory licensing in the context of the EU crisis instruments. Second, it introduces an efficient compulsory licensing scheme, with appropriate features, to allow a swift and appropriate response to crises, with a functioning internal market, guaranteeing the supply and the free movement of crisis-critical products subject to compulsory licencing in the internal market.” The letter’s signatories, including Médecins Sans Frontières, Health Action International (HAI) and Oxfam, state that they support EU compulsory licences as they have “the potential to foster a more effective response to public health challenges”. But by prohibiting exports, the current draft – which has been put forward for a plenary vote of the European Parliament – goes against flexibilities enshrined in the World Trade Organization (WTO) Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS Agreement), according to the letter. “This limitation is problematic, especially considering the use of a Union compulsory license would likely be triggered by situations that would affect not only EU countries but also countries outside of the EU, either in the region or globally,” they add. Pandemics ‘don’t respect borders’ Making exports available under an EU compulsory licence “is not just a matter of international solidarity but is also in the EU’s interest” as it could “help in controlling potential outbreaks and emergencies that could spill over into the EU, allowing EU-based manufacturers to respond promptly to the needs of non-EU countries”. “This vote is important for a number of reasons,” according to HAI Senior Policy Advisor Jaume Vidal. “Embracing TRIPS flexibilities is, of course, a welcome step, but the current proposal risks becoming an ‘EU First’ response when it comes to pandemics and health emergencies, reminiscent of the inequities seen during the COVID-19 pandemic. “Secondly, at a time when countries are negotiating a pandemic accord, a restrictive use of the proposed Union compulsory license that would limit exports would be sending an ominous message to negotiators. Finally, in times of greatest need, the EU would do well to remember that pandemics don’t respect borders or blocs, and that no one is safe, until everyone is safe.” Image Credits: Thijs ter Haar. UN Environment Assembly Concludes With Renewed Commitments to Tackle Climate, Biodiversity and Pollution 04/03/2024 Disha Shetty The sixth UN Environment Assembly was held in Nairobi The sixth United Nations Environment Assembly (UNAE-6) ended last Friday in Nairobi, Kenya with the adoption of a Ministerial Declaration affirming member states’ commitment to slowing climate change, protecting biodiversity, and creating a pollution-free world. The assembly, which attracted over 5,600 delegates from 190 countries, also adopted 15 resolutions covering a range of issues including chemicals, waste, metals and minerals and protecting the environment during and after conflicts. “As governments, we need to push for more and reinvent partnerships with key stakeholders to implement these mandates. We need to continue to partner with civil society, continue to guide and empower our creative youth, and also with the private sector and philanthropies,” said Leila Benali, UNEA-6 President and the Minister of Energy Transition and Sustainable Development of Morocco. Benali noted that the resolutions called for enlightened leadership and urged scaling up means of implementation, enhancing national capacity to implement action plans and policies, and strengthening the science-policy interface. Evidence of the extent of environmental degradation and its impact on individuals keeps rising. Along with updated estimates of air pollution-related deaths at 8.3 million annually, a host of recent studies have also linked excessive levels of air pollution with health issues ranging from increased neo-natal mortality to Alzheimer’s. Most recently, one Nature study linked spikes in air pollution with increased risk of deaths by suicide. Leila Benali, UNEA-6 President and the Minister of Energy Transition and Sustainable Development of Morocco. A slew of UN reports released during the assembly last week also presented a grim picture of the immediate future. Data from the 2024 Global Resource Outlook warned that without urgent action to reduce global consumption and production, extraction of natural resources could rise by 60 % from 2020 levels. This would worsen climate and pollution impacts, with consequently greater risks to biodiversity and human health, the report said. It also blamed the high levels of material consumption in upper-middle and high-income countries for the problem. The report said that the rich countries use six times more resources and generate 10 times climate impacts than low-income ones. The Global Waste Management Outlook 2024 showed that without a seismic shift away from ‘take-make-dispose’ societies towards circular economy and zero-waste approaches, the world’s waste pile could grow by two-thirds by 2050, and its cost to health, economies and the environment could double. It reiterated that only a drastic reduction in waste generation will secure a liveable and affordable future, and ways to convert waste into a reusable resource would have to be employed. Another UNEP report on Used Heavy Duty Vehicles and the Environment launched during a Climate and Clean Air Conference held ahead of UNEA, sounded the alarm on the rise of emissions from these heavy polluters, and their negative climate and health impacts. Resolutions on improving response The assembly also held its first Multilateral Environmental Agreements (MEA) Day that was dedicated to the international agreements addressing the most pressing environmental issues. UNEA-6 welcomed youth to host their own environmental summit, which called for greater inter-generational equity. “The President has gavelled resolutions that address desertification, land restoration and more. We also have a ministerial declaration that affirms the international community’s strong intent to slow climate change, restore nature and land, and create a pollution-free world,” Inger Andersen, UN Evironmental Programme Executive Director, said. “UNEP will now take forward the responsibilities you have entrusted to us in these new resolutions. In addition to keeping the environment under review. In addition to fulfilling our obligation to serve as an authoritative advocate for action across the triple planetary crisis,” Andersen added. “In our quest to confront the monumental environmental challenges of our time—climate change, biodiversity loss, and pollution—there is but one path forward: teamwork. We share one Earth, bask under the same sun, and we must recognize that there is no backup plan. There’s no other planet waiting for us to escape to,” said Abdullah Bin Ali Amri, Oman’s chair of the Environment Authority and president-elect of the next UNEA, which will be held in December 2025 in Nairobi. WHO Issues Guidelines for Expanding Access to Hearing Aids 01/03/2024 Zuzanna Stawiska A patient with age-related hearing loss (Presbycusis), receiving free treatment from the NGO, All Ears Cambodia. Over 400 million people with hearing loss could benefit from hearing devices. However, less than 20% of those people actually get hearing aids. That’s one of the findings cited in new World Health Organisation guidelines on improving access to hearing care, published Friday, just ahead of World Hearing Day. “Unaddressed hearing loss is a global public health challenge and incurs an estimated cost of over US$ 1 trillion annually. Given the global shortage of ear and hearing care specialists, we have to rethink how we traditionally deliver services,” said Dr Bente Mikkelsen, director of the WHO’s Department for Noncommunicable Diseases. By 2050, nearly 2.5 billion people are projected to experience a degree of hearing loss, as populations around the world age. More than 700 million will likely require hearing rehabilitation, estimates the WHO. But nearly 80% of people with disabling hearing loss live in low-income countries – which historically have lacked capacity for providing assistive devices like hearing aids. Fighting misconceptions and lack of resources But addressing hearing loss is not necessarily expensive. An investment of $1.4 per person annually would be sufficient to scale up ear and hearing care services worldwide, WHO said. To overcome current limitations of capacity, the guidelines encourage more service delivery by non-specialists, based in primary health care settings. Debunking misconceptions and stigma around hearing loss is another key aim of the guidelines, created with the support of ATscale Global Partnership for Assistive Technology. “Common myths about hearing loss often prevent people from seeking the services they require, even where these services are available,” said Dr Shelly Chadha, technical lead for ear and hearing care at WHO. “Any effort to improve hearing care provision through health system strengthening must be accompanied by work to raise awareness within societies and address stigma related to ear and hearing care.” Image Credits: WHO/Miguel Jeronimo. Alzheimer’s Experts Review Progress and Challenges in a ‘Transformative Moment’ 01/03/2024 Sophia Samantaroy WASHINGTON, DC – When US Senator Amy Klobuchar’s father, the late Jim Klobuchar, was diagnosed with Alzheimer’s disease, the noted Minnesota newspaper columnist gradually stopped recognizing her – although he retained “a kind of savoir faire” to the very end with words, jokes and storytelling based on the decades of “lines enmeshed in his memory,” she recalled. Senator Amy Klobuchar (D-MN) In the United States, one in every three seniors will be diagnosed with Alzheimer’s. The disease affects roughly 55 million people globally and is the seventh leading cause of death. “But it’s not just the numbers. It’s the fathers and mothers, it’s the brothers and sisters,” remarked Klobuchar, (D-MN), who recounted the story of her father’s illness at a high-level event here this week, organized by the Davos Alzheimer’s Collaborative (DAC) together with Scientific American. The meeting of the collaborative, a Swiss and US-based foundation launched at the World Economic Forum in 2021, brought together some 100 Alzheimer researchers and front-line clinicians as well as policymakers and industry and civil society advocates, to share progress on new innovations in diagnosing and treating the disease – as well as challenges faced in getting those same innovations into healthcare systems globally. But the event, co-hosted by Scientific American, also was marked by moments of personal reflections, both comic and tragic. Not only Klochubar, but other speakers in the room referred to their own experiences in dealing with family members with Alzheimer’s disease – what Senator Susan Collins (R-ME) termed “the defining disease” of her generation. Joining together across borders and cultures Alzheimer’s is a growing issue worldwide as populations age And while much of the attention around Alzheimer’s so far has been in the United States and other countries of the global north, the disease is a growing problem worldwide, as populations age and people live longer, but not always healthier lives. Researchers predict that lower and middle income countries will soon bear the brunt of Alzheimer’s disease – much as they already do with regards to other noncommunicable diseases. Alzheimer’s disease is projected to affect more than 100 million people globally 2050 And as in all disease research, a global approach can help identify new therapies more effectively and cost-efficiently. “Rather than succumb to despair, what we’re doing is joining together across borders, cultures, and languages to chart a future for the world of prevention, effective treatment, and one day, a cure,” said Collins, who lost a brother to Alzheimer’s. Along with being vice-chair of the powerful Senate Appropriations Committee, Collins is also founder and co-chair of a Congressional Task Force on Alzheimer’s disease. George Vradenburg, founding chairman of the Davos Alzheimer’s Collaborative “I want to speak on behalf of families…50 million families worldwide are struggling with this disease.” said DAC chairman George Vradenburg, who first launched the initiative in response to a challenge by WEF founder and executive director Klaus Schwab. He said that DAC was committed to “including researchers, clinicians and families in this fight globally, ensuring that no corner of the world is left untouched by our efforts.” Added Collins, “We need a global approach modeled on what we’ve done with AIDS, tuberculosis, and malaria. And we know that that kind of global collaborative approach to bring the research directly to a broader spectrum of countries and communities will remove long standing barriers to care and help us eliminate disparities.” “A transformative moment”: Novel diagnostic tests, gene sequencing, and precision medicine Moderator Jeremy Abbate, VP and publisher of Scientific American with former NIH Director Dr. Elias Zerhouni, University of Washington’s Dr. Suzanne Schindler and Dr. Jeffrey Burns, University of Kansas Medical Center Early Alzheimer’s disease research was rather akin to “staring up a cliff,” said former US National Institutes of Health (NIH) director Elias Zerhouni, one of the other speakers at the event. Now, however, the world has reached a turning point where, “we can truly have a global approach.” Improved genetic sequencing, the advent of digital and biological markers, novel drugs, and a more open mindset to alternative hypotheses have seen Alzheimer’s disease research leap into a new era. “We have an explosion of ways to test for Alzheimer’s disease,” remarked Suzanne Schindler, Associate Professor of Neurology at Washington University School of Medicine. Among them are blood tests that can measure up to 5,000 various proteins- a method faster and less invasive than dreaded spinal taps. Other panelists shared this optimism, citing the use of amyloid pet-scans and other diagnostics to more accurately assess Alzheimer’s progression in patients. Genetic sequencing too is cheaper, a marked change since the early days when researchers remained in the dark about the potential genetic drivers of the disease. ‘More than buildup of amyloid plaques’ One of the causes of Alzheimer’s appears to be the abnormal accumulation of tau proteins in the brain, eventually forming tangles inside neurons, seen here With these tools comes an understanding that “the disease is more than just about build up [of amyloid plaques],” commented Jeffrey Burns, Professor of Neurology at University of Kansas Medical Center. New research into disease risk factors is moving beyond conventional descriptions of amyloid plaques and tau protein pathways to include research into inflammation and lifestyle factors. The future of prevention, he speculated, will increasingly lie in more holistic lifestyle approaches undertaken in tandem with medications. “We don’t just give patients with heart disease medication, we tell them to modify their diet, their lifestyle. “I believe we will prevent the disease,” Burns added. Early Alzheimer’s detection remains a missing link Phyllis Ferrell (center left,) Arindam Nandi, and Terry Fulmer discuss the implications of an aging society with Jeremy Abbate. One major challenge is the need to move new knowledge into hospitals and health clinics; currently it can take as long 17-20 years for innovations to get into clinical practice due to outdated models of care. “We are building bullet trains, but running them on the same wooden tracks,” said Dr Phyllis Ferrell, DAC advisor on healthcare systems preparedness. Too often, practitioners still take a “wait and see” approach, while symptoms of cognitive impairment go unrecognized or undiagnosed until much later in the disease course. She urged a shift to a more preventative approach with screenings and help manage cognitive symptoms early. “Why did it take four separate visits to get my dad an inconclusive diagnosis?” Ferrell asked. “Early detection gives people the time to focus on what matters most to them,” she added. “It provides an opportunity to implement positive lifestyle changes and address risk factors, pursue treatment options and/or enroll in a clinical trial.” Getting new innovations into practice Ferrell also bemoaned the frustration families feel over the lack of access to new diagnostics and therapeutics – in the wake of progress made in research. In 2010 the NIH funded Alzheimer’s disease research to the tune of $400 million annually. Fourteen years later, the annual investment is now close to $4 billion, she noted. Yet, despite this influx of funding for research, there’s a huge gap emerging in affordable and available drugs. “We have innovations that are ready, but are not being used,” she said, adding “Yes, to research, but we need to do things today. Let’s go after clinically ready innovations.” Staying the course on research Senator Susan Collins (R-ME)- a leading champion in Congress for Alzheimer’s disease research. At the same time, more research into the disease remains critical to find even more effective preventive strategies as well as possible cures. This means building specimen repositories across the country, performing skin tests for early detection of Alzheimer-related protein abnormalities traditionally only detectable from brain biopsies, and other research. Zerhouni called it breaking the “taboo of the brain” – an area of human physiology where research was historically inadequate. “This is a frontier that has to be broken.” For many years, such research was impeded by social taboos around Alzheimer’s disease. “People used to just call it senility,” said Collins, who has been the leading champion of Alzheimer’s research and action on Capitol Hill for over a decade. Collins last year initiated bipartisan legislation in the US Congress to help maintain the funding for Alzheimer’s research, as well as supporting initiatives to bring down the cost of new drugs in the US for Alzheimer patients. At $345 million billion a year, the disease is currently the most costly disease in the nation to treat, she says. A global economic burden Globally, Alzheimer’s disease also presents an enormous economic burden – costing the world’s economies some $1.3 trillion, in terms of medications as well as care – much of it unpaid, noted Population Council economist Arindam Nandi. In the past, economic data came mostly from high income countries, Now, data is available from lower and middle-income countries like India and China. “These data depict a worrying trend; the percentage of unpaid care is higher in these countries, meaning that caregivers are not able to get other jobs, decreasing economic output,’ he said. Nandi also mentioned that predictive models forecast the shifting burden of disease from high income countries to middle and low income countries. “We don’t know how these populations will fare.” Investments in these countries are needed to strengthen their overall public health measures. Meanwhile, the US and high income countries can learn from the experiences of low and middle income countries, which often are first to devise lower-costs methods for detecting and treating diseases. DAC, for instance, funded an Early Detection Flagship program involving six countries, including the US, Scotland, Jamaica, Japan, Mexico and Brazil. They participated in a pilot designed to increase access to early detection and diagnosis of the disease through the use of innovative new screening tools. “One of the things I loved [about the Early Detection program] was watching the US and high resource countries learn from LMICs,” Ferrell observed. “As the founder of the Brain and Mind Institute of Aga Khan University once said, ‘when it comes to Alzheimer’s disease we are all developing nations.’ “ Image Credits: Getty Images, Pixelmestudio/DAC, National Institutes on Aging , UCLA , S. Samantaroy/HPW. WHO Calls for Private Sector Accountability Amid Massive Obesity Increase 01/03/2024 Kerry Cullinan Member states have been slow to implement WHO policies to address obesity, including taxes on sugary drinks and restrictions on marketing junk food to kids The private sector “must be held accountable for the health impacts of their products”, warned the head of the World Health Organization (WHO) amid news that obesity has quadrupled in children and more than doubled in adults since 1990. Dr Tedros Adhanom Ghebreyesus was speaking ahead of the release of a huge global obesity study involving over 220 million people from more than 190 countries published in The Lancet on Friday. “Getting back on track to meet the global targets for curbing obesity will take the work of governments and communities, supported by evidence-based policies from WHO and national public health agencies,” added Tedros. Countries with highest obesity rates 2022 Tonga, American Samoa and Nauru have the world’s highest obesity rates, affecting some 60% of their adult populations. “The largest increases are in some countries in the Pacific, the Caribbean, the Middle East and North Africa, and some of the newly high income countries like Chile,” said senior author Professor Majid Ezzati, of Imperial College in London, at a media briefing on Thursday. The US is the only high-income country that features in the ten worst affected countries – with the 10th highest obesity rate in men. Some 43.8% of US women and 41.6% of men were living with obesity in 2022. Meanwhile, obesity is slowing in a handful of west European countries – notably Spain and France. However, countries with the lowest obesity rates are generally low-income countries with high rates of under-nutrition, with a few exceptions such as Japan and Viet Nam. Countries with lowest obesity rates 2022 Huge rise in child obesity In 1990, around 31 million children (2,1% of boys and 1.7% of girls) were obese. But 32 years later, there had been a fourfold increase in both boys (to 9,3%) and girls (6.9%) affecting almost 160 million children. “It is very concerning that the epidemic of obesity that was evident amongst adults in much of the world in 1990 is now mirrored in school-aged children and adolescents,” said Ezzati. Professor Majid Ezzati, of Imperial College in London While boys are more likely to be obese than girls globally, this trend is reversed in adulthood with many more women than men living with obesity. But men seem to be catching up. Obesity in men has nearly tripled over the past 32 years, while it has doubled in women. “Different forms of malnutrition still coexist in many countries,” said Dr Francesco Branca, WHO Director of Nutrition and Food Safety and one of the co-authors of the study. “The child who was undernourished in the first years of life can later become overweight or obese as an adolescent or an adult. Undernutrition and obesity are two faces of the same problem, which is the lack of access to healthy diets.” Greater risk of NCDs Undernourished people are more susceptible to infectious diseases, while obesity can lead to Type 2 diabetes, heart disease, certain cancers and affect bone health and reproduction, added Branca, who was also addressing the briefing. “The increase in the double burden of malnutrition is a result of a transition in food system and lifestyle that has not been governed by public health policies,” he added. However, despite WHO guidelines on what countries can do to address the massive rise in consumption of energy-dense ultra-processed food, adoption by member states has been slow. At the World Health Assembly in 2022, member states adopted the WHO Acceleration plan to stop obesity. Core interventions include promoting breastfeeding, regulating marketing of ultra-processed food and drinks to kids, taxation and warning labels on foods high in fats, salt and sugar. Dr Francesco Branca, WHO Director of Nutrition and Food Safety “The reason why the epidemic has progressed so quickly is because the policy action has not been incisive enough,” said Branca, adding that countries had focused on behaviour change rather than “structural elements, which is the policies around food environment”. However, he added that more countries were taxing sugary drinks, although “not many countries have done it for sufficiently long time and in ways that are demonstrated to be most effective”. “Very few countries put a restriction on marketing food to children. We know that some South American countries are taking that action much more effectively, and we look forward seeing the impact of those policies,[as well as] having warning signs on the processed food which would really discourage people from f buying products which are high in salt, sugar and fat”. If these policies were implemented, this would likely lead to food and beverage companies reformulating their products to reduce harmful ingredients, he added. Role of new weight-loss pills? Branca said that the WHO was currently looking at the efficacy of the new drugs called glucagon-like peptide 1 (GLP-1) agonists – such as Wegovy, Ozempic – which have been approved as weight-loss medication in some countries. “The solution is still is a transformation of the food system and in the environment such obesity can be prevented,” Branca stressed. However, the GLP-1 drugs could provide a tool to help those that already live with obesity, as long as they were integrated into a primary healthcare package to manage obesity that included guidance on exercise and diet. The new study was conducted by the NCD Risk Factor Collaboration (NCD-RisC), in collaboration with the World Health Organization (WHO), and involved over 1,500 researchers. They based their analysis on body mass index (BMI). Adults with BMI 30kg/m2 and over were classified as obese and underweight if their BMI was below 18.5kg/m2. For children, BMI was adjusted according to age. . Image Credits: World Obesity Federation. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
UN Environment Assembly Concludes With Renewed Commitments to Tackle Climate, Biodiversity and Pollution 04/03/2024 Disha Shetty The sixth UN Environment Assembly was held in Nairobi The sixth United Nations Environment Assembly (UNAE-6) ended last Friday in Nairobi, Kenya with the adoption of a Ministerial Declaration affirming member states’ commitment to slowing climate change, protecting biodiversity, and creating a pollution-free world. The assembly, which attracted over 5,600 delegates from 190 countries, also adopted 15 resolutions covering a range of issues including chemicals, waste, metals and minerals and protecting the environment during and after conflicts. “As governments, we need to push for more and reinvent partnerships with key stakeholders to implement these mandates. We need to continue to partner with civil society, continue to guide and empower our creative youth, and also with the private sector and philanthropies,” said Leila Benali, UNEA-6 President and the Minister of Energy Transition and Sustainable Development of Morocco. Benali noted that the resolutions called for enlightened leadership and urged scaling up means of implementation, enhancing national capacity to implement action plans and policies, and strengthening the science-policy interface. Evidence of the extent of environmental degradation and its impact on individuals keeps rising. Along with updated estimates of air pollution-related deaths at 8.3 million annually, a host of recent studies have also linked excessive levels of air pollution with health issues ranging from increased neo-natal mortality to Alzheimer’s. Most recently, one Nature study linked spikes in air pollution with increased risk of deaths by suicide. Leila Benali, UNEA-6 President and the Minister of Energy Transition and Sustainable Development of Morocco. A slew of UN reports released during the assembly last week also presented a grim picture of the immediate future. Data from the 2024 Global Resource Outlook warned that without urgent action to reduce global consumption and production, extraction of natural resources could rise by 60 % from 2020 levels. This would worsen climate and pollution impacts, with consequently greater risks to biodiversity and human health, the report said. It also blamed the high levels of material consumption in upper-middle and high-income countries for the problem. The report said that the rich countries use six times more resources and generate 10 times climate impacts than low-income ones. The Global Waste Management Outlook 2024 showed that without a seismic shift away from ‘take-make-dispose’ societies towards circular economy and zero-waste approaches, the world’s waste pile could grow by two-thirds by 2050, and its cost to health, economies and the environment could double. It reiterated that only a drastic reduction in waste generation will secure a liveable and affordable future, and ways to convert waste into a reusable resource would have to be employed. Another UNEP report on Used Heavy Duty Vehicles and the Environment launched during a Climate and Clean Air Conference held ahead of UNEA, sounded the alarm on the rise of emissions from these heavy polluters, and their negative climate and health impacts. Resolutions on improving response The assembly also held its first Multilateral Environmental Agreements (MEA) Day that was dedicated to the international agreements addressing the most pressing environmental issues. UNEA-6 welcomed youth to host their own environmental summit, which called for greater inter-generational equity. “The President has gavelled resolutions that address desertification, land restoration and more. We also have a ministerial declaration that affirms the international community’s strong intent to slow climate change, restore nature and land, and create a pollution-free world,” Inger Andersen, UN Evironmental Programme Executive Director, said. “UNEP will now take forward the responsibilities you have entrusted to us in these new resolutions. In addition to keeping the environment under review. In addition to fulfilling our obligation to serve as an authoritative advocate for action across the triple planetary crisis,” Andersen added. “In our quest to confront the monumental environmental challenges of our time—climate change, biodiversity loss, and pollution—there is but one path forward: teamwork. We share one Earth, bask under the same sun, and we must recognize that there is no backup plan. There’s no other planet waiting for us to escape to,” said Abdullah Bin Ali Amri, Oman’s chair of the Environment Authority and president-elect of the next UNEA, which will be held in December 2025 in Nairobi. WHO Issues Guidelines for Expanding Access to Hearing Aids 01/03/2024 Zuzanna Stawiska A patient with age-related hearing loss (Presbycusis), receiving free treatment from the NGO, All Ears Cambodia. Over 400 million people with hearing loss could benefit from hearing devices. However, less than 20% of those people actually get hearing aids. That’s one of the findings cited in new World Health Organisation guidelines on improving access to hearing care, published Friday, just ahead of World Hearing Day. “Unaddressed hearing loss is a global public health challenge and incurs an estimated cost of over US$ 1 trillion annually. Given the global shortage of ear and hearing care specialists, we have to rethink how we traditionally deliver services,” said Dr Bente Mikkelsen, director of the WHO’s Department for Noncommunicable Diseases. By 2050, nearly 2.5 billion people are projected to experience a degree of hearing loss, as populations around the world age. More than 700 million will likely require hearing rehabilitation, estimates the WHO. But nearly 80% of people with disabling hearing loss live in low-income countries – which historically have lacked capacity for providing assistive devices like hearing aids. Fighting misconceptions and lack of resources But addressing hearing loss is not necessarily expensive. An investment of $1.4 per person annually would be sufficient to scale up ear and hearing care services worldwide, WHO said. To overcome current limitations of capacity, the guidelines encourage more service delivery by non-specialists, based in primary health care settings. Debunking misconceptions and stigma around hearing loss is another key aim of the guidelines, created with the support of ATscale Global Partnership for Assistive Technology. “Common myths about hearing loss often prevent people from seeking the services they require, even where these services are available,” said Dr Shelly Chadha, technical lead for ear and hearing care at WHO. “Any effort to improve hearing care provision through health system strengthening must be accompanied by work to raise awareness within societies and address stigma related to ear and hearing care.” Image Credits: WHO/Miguel Jeronimo. Alzheimer’s Experts Review Progress and Challenges in a ‘Transformative Moment’ 01/03/2024 Sophia Samantaroy WASHINGTON, DC – When US Senator Amy Klobuchar’s father, the late Jim Klobuchar, was diagnosed with Alzheimer’s disease, the noted Minnesota newspaper columnist gradually stopped recognizing her – although he retained “a kind of savoir faire” to the very end with words, jokes and storytelling based on the decades of “lines enmeshed in his memory,” she recalled. Senator Amy Klobuchar (D-MN) In the United States, one in every three seniors will be diagnosed with Alzheimer’s. The disease affects roughly 55 million people globally and is the seventh leading cause of death. “But it’s not just the numbers. It’s the fathers and mothers, it’s the brothers and sisters,” remarked Klobuchar, (D-MN), who recounted the story of her father’s illness at a high-level event here this week, organized by the Davos Alzheimer’s Collaborative (DAC) together with Scientific American. The meeting of the collaborative, a Swiss and US-based foundation launched at the World Economic Forum in 2021, brought together some 100 Alzheimer researchers and front-line clinicians as well as policymakers and industry and civil society advocates, to share progress on new innovations in diagnosing and treating the disease – as well as challenges faced in getting those same innovations into healthcare systems globally. But the event, co-hosted by Scientific American, also was marked by moments of personal reflections, both comic and tragic. Not only Klochubar, but other speakers in the room referred to their own experiences in dealing with family members with Alzheimer’s disease – what Senator Susan Collins (R-ME) termed “the defining disease” of her generation. Joining together across borders and cultures Alzheimer’s is a growing issue worldwide as populations age And while much of the attention around Alzheimer’s so far has been in the United States and other countries of the global north, the disease is a growing problem worldwide, as populations age and people live longer, but not always healthier lives. Researchers predict that lower and middle income countries will soon bear the brunt of Alzheimer’s disease – much as they already do with regards to other noncommunicable diseases. Alzheimer’s disease is projected to affect more than 100 million people globally 2050 And as in all disease research, a global approach can help identify new therapies more effectively and cost-efficiently. “Rather than succumb to despair, what we’re doing is joining together across borders, cultures, and languages to chart a future for the world of prevention, effective treatment, and one day, a cure,” said Collins, who lost a brother to Alzheimer’s. Along with being vice-chair of the powerful Senate Appropriations Committee, Collins is also founder and co-chair of a Congressional Task Force on Alzheimer’s disease. George Vradenburg, founding chairman of the Davos Alzheimer’s Collaborative “I want to speak on behalf of families…50 million families worldwide are struggling with this disease.” said DAC chairman George Vradenburg, who first launched the initiative in response to a challenge by WEF founder and executive director Klaus Schwab. He said that DAC was committed to “including researchers, clinicians and families in this fight globally, ensuring that no corner of the world is left untouched by our efforts.” Added Collins, “We need a global approach modeled on what we’ve done with AIDS, tuberculosis, and malaria. And we know that that kind of global collaborative approach to bring the research directly to a broader spectrum of countries and communities will remove long standing barriers to care and help us eliminate disparities.” “A transformative moment”: Novel diagnostic tests, gene sequencing, and precision medicine Moderator Jeremy Abbate, VP and publisher of Scientific American with former NIH Director Dr. Elias Zerhouni, University of Washington’s Dr. Suzanne Schindler and Dr. Jeffrey Burns, University of Kansas Medical Center Early Alzheimer’s disease research was rather akin to “staring up a cliff,” said former US National Institutes of Health (NIH) director Elias Zerhouni, one of the other speakers at the event. Now, however, the world has reached a turning point where, “we can truly have a global approach.” Improved genetic sequencing, the advent of digital and biological markers, novel drugs, and a more open mindset to alternative hypotheses have seen Alzheimer’s disease research leap into a new era. “We have an explosion of ways to test for Alzheimer’s disease,” remarked Suzanne Schindler, Associate Professor of Neurology at Washington University School of Medicine. Among them are blood tests that can measure up to 5,000 various proteins- a method faster and less invasive than dreaded spinal taps. Other panelists shared this optimism, citing the use of amyloid pet-scans and other diagnostics to more accurately assess Alzheimer’s progression in patients. Genetic sequencing too is cheaper, a marked change since the early days when researchers remained in the dark about the potential genetic drivers of the disease. ‘More than buildup of amyloid plaques’ One of the causes of Alzheimer’s appears to be the abnormal accumulation of tau proteins in the brain, eventually forming tangles inside neurons, seen here With these tools comes an understanding that “the disease is more than just about build up [of amyloid plaques],” commented Jeffrey Burns, Professor of Neurology at University of Kansas Medical Center. New research into disease risk factors is moving beyond conventional descriptions of amyloid plaques and tau protein pathways to include research into inflammation and lifestyle factors. The future of prevention, he speculated, will increasingly lie in more holistic lifestyle approaches undertaken in tandem with medications. “We don’t just give patients with heart disease medication, we tell them to modify their diet, their lifestyle. “I believe we will prevent the disease,” Burns added. Early Alzheimer’s detection remains a missing link Phyllis Ferrell (center left,) Arindam Nandi, and Terry Fulmer discuss the implications of an aging society with Jeremy Abbate. One major challenge is the need to move new knowledge into hospitals and health clinics; currently it can take as long 17-20 years for innovations to get into clinical practice due to outdated models of care. “We are building bullet trains, but running them on the same wooden tracks,” said Dr Phyllis Ferrell, DAC advisor on healthcare systems preparedness. Too often, practitioners still take a “wait and see” approach, while symptoms of cognitive impairment go unrecognized or undiagnosed until much later in the disease course. She urged a shift to a more preventative approach with screenings and help manage cognitive symptoms early. “Why did it take four separate visits to get my dad an inconclusive diagnosis?” Ferrell asked. “Early detection gives people the time to focus on what matters most to them,” she added. “It provides an opportunity to implement positive lifestyle changes and address risk factors, pursue treatment options and/or enroll in a clinical trial.” Getting new innovations into practice Ferrell also bemoaned the frustration families feel over the lack of access to new diagnostics and therapeutics – in the wake of progress made in research. In 2010 the NIH funded Alzheimer’s disease research to the tune of $400 million annually. Fourteen years later, the annual investment is now close to $4 billion, she noted. Yet, despite this influx of funding for research, there’s a huge gap emerging in affordable and available drugs. “We have innovations that are ready, but are not being used,” she said, adding “Yes, to research, but we need to do things today. Let’s go after clinically ready innovations.” Staying the course on research Senator Susan Collins (R-ME)- a leading champion in Congress for Alzheimer’s disease research. At the same time, more research into the disease remains critical to find even more effective preventive strategies as well as possible cures. This means building specimen repositories across the country, performing skin tests for early detection of Alzheimer-related protein abnormalities traditionally only detectable from brain biopsies, and other research. Zerhouni called it breaking the “taboo of the brain” – an area of human physiology where research was historically inadequate. “This is a frontier that has to be broken.” For many years, such research was impeded by social taboos around Alzheimer’s disease. “People used to just call it senility,” said Collins, who has been the leading champion of Alzheimer’s research and action on Capitol Hill for over a decade. Collins last year initiated bipartisan legislation in the US Congress to help maintain the funding for Alzheimer’s research, as well as supporting initiatives to bring down the cost of new drugs in the US for Alzheimer patients. At $345 million billion a year, the disease is currently the most costly disease in the nation to treat, she says. A global economic burden Globally, Alzheimer’s disease also presents an enormous economic burden – costing the world’s economies some $1.3 trillion, in terms of medications as well as care – much of it unpaid, noted Population Council economist Arindam Nandi. In the past, economic data came mostly from high income countries, Now, data is available from lower and middle-income countries like India and China. “These data depict a worrying trend; the percentage of unpaid care is higher in these countries, meaning that caregivers are not able to get other jobs, decreasing economic output,’ he said. Nandi also mentioned that predictive models forecast the shifting burden of disease from high income countries to middle and low income countries. “We don’t know how these populations will fare.” Investments in these countries are needed to strengthen their overall public health measures. Meanwhile, the US and high income countries can learn from the experiences of low and middle income countries, which often are first to devise lower-costs methods for detecting and treating diseases. DAC, for instance, funded an Early Detection Flagship program involving six countries, including the US, Scotland, Jamaica, Japan, Mexico and Brazil. They participated in a pilot designed to increase access to early detection and diagnosis of the disease through the use of innovative new screening tools. “One of the things I loved [about the Early Detection program] was watching the US and high resource countries learn from LMICs,” Ferrell observed. “As the founder of the Brain and Mind Institute of Aga Khan University once said, ‘when it comes to Alzheimer’s disease we are all developing nations.’ “ Image Credits: Getty Images, Pixelmestudio/DAC, National Institutes on Aging , UCLA , S. Samantaroy/HPW. WHO Calls for Private Sector Accountability Amid Massive Obesity Increase 01/03/2024 Kerry Cullinan Member states have been slow to implement WHO policies to address obesity, including taxes on sugary drinks and restrictions on marketing junk food to kids The private sector “must be held accountable for the health impacts of their products”, warned the head of the World Health Organization (WHO) amid news that obesity has quadrupled in children and more than doubled in adults since 1990. Dr Tedros Adhanom Ghebreyesus was speaking ahead of the release of a huge global obesity study involving over 220 million people from more than 190 countries published in The Lancet on Friday. “Getting back on track to meet the global targets for curbing obesity will take the work of governments and communities, supported by evidence-based policies from WHO and national public health agencies,” added Tedros. Countries with highest obesity rates 2022 Tonga, American Samoa and Nauru have the world’s highest obesity rates, affecting some 60% of their adult populations. “The largest increases are in some countries in the Pacific, the Caribbean, the Middle East and North Africa, and some of the newly high income countries like Chile,” said senior author Professor Majid Ezzati, of Imperial College in London, at a media briefing on Thursday. The US is the only high-income country that features in the ten worst affected countries – with the 10th highest obesity rate in men. Some 43.8% of US women and 41.6% of men were living with obesity in 2022. Meanwhile, obesity is slowing in a handful of west European countries – notably Spain and France. However, countries with the lowest obesity rates are generally low-income countries with high rates of under-nutrition, with a few exceptions such as Japan and Viet Nam. Countries with lowest obesity rates 2022 Huge rise in child obesity In 1990, around 31 million children (2,1% of boys and 1.7% of girls) were obese. But 32 years later, there had been a fourfold increase in both boys (to 9,3%) and girls (6.9%) affecting almost 160 million children. “It is very concerning that the epidemic of obesity that was evident amongst adults in much of the world in 1990 is now mirrored in school-aged children and adolescents,” said Ezzati. Professor Majid Ezzati, of Imperial College in London While boys are more likely to be obese than girls globally, this trend is reversed in adulthood with many more women than men living with obesity. But men seem to be catching up. Obesity in men has nearly tripled over the past 32 years, while it has doubled in women. “Different forms of malnutrition still coexist in many countries,” said Dr Francesco Branca, WHO Director of Nutrition and Food Safety and one of the co-authors of the study. “The child who was undernourished in the first years of life can later become overweight or obese as an adolescent or an adult. Undernutrition and obesity are two faces of the same problem, which is the lack of access to healthy diets.” Greater risk of NCDs Undernourished people are more susceptible to infectious diseases, while obesity can lead to Type 2 diabetes, heart disease, certain cancers and affect bone health and reproduction, added Branca, who was also addressing the briefing. “The increase in the double burden of malnutrition is a result of a transition in food system and lifestyle that has not been governed by public health policies,” he added. However, despite WHO guidelines on what countries can do to address the massive rise in consumption of energy-dense ultra-processed food, adoption by member states has been slow. At the World Health Assembly in 2022, member states adopted the WHO Acceleration plan to stop obesity. Core interventions include promoting breastfeeding, regulating marketing of ultra-processed food and drinks to kids, taxation and warning labels on foods high in fats, salt and sugar. Dr Francesco Branca, WHO Director of Nutrition and Food Safety “The reason why the epidemic has progressed so quickly is because the policy action has not been incisive enough,” said Branca, adding that countries had focused on behaviour change rather than “structural elements, which is the policies around food environment”. However, he added that more countries were taxing sugary drinks, although “not many countries have done it for sufficiently long time and in ways that are demonstrated to be most effective”. “Very few countries put a restriction on marketing food to children. We know that some South American countries are taking that action much more effectively, and we look forward seeing the impact of those policies,[as well as] having warning signs on the processed food which would really discourage people from f buying products which are high in salt, sugar and fat”. If these policies were implemented, this would likely lead to food and beverage companies reformulating their products to reduce harmful ingredients, he added. Role of new weight-loss pills? Branca said that the WHO was currently looking at the efficacy of the new drugs called glucagon-like peptide 1 (GLP-1) agonists – such as Wegovy, Ozempic – which have been approved as weight-loss medication in some countries. “The solution is still is a transformation of the food system and in the environment such obesity can be prevented,” Branca stressed. However, the GLP-1 drugs could provide a tool to help those that already live with obesity, as long as they were integrated into a primary healthcare package to manage obesity that included guidance on exercise and diet. The new study was conducted by the NCD Risk Factor Collaboration (NCD-RisC), in collaboration with the World Health Organization (WHO), and involved over 1,500 researchers. They based their analysis on body mass index (BMI). Adults with BMI 30kg/m2 and over were classified as obese and underweight if their BMI was below 18.5kg/m2. For children, BMI was adjusted according to age. . Image Credits: World Obesity Federation. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
WHO Issues Guidelines for Expanding Access to Hearing Aids 01/03/2024 Zuzanna Stawiska A patient with age-related hearing loss (Presbycusis), receiving free treatment from the NGO, All Ears Cambodia. Over 400 million people with hearing loss could benefit from hearing devices. However, less than 20% of those people actually get hearing aids. That’s one of the findings cited in new World Health Organisation guidelines on improving access to hearing care, published Friday, just ahead of World Hearing Day. “Unaddressed hearing loss is a global public health challenge and incurs an estimated cost of over US$ 1 trillion annually. Given the global shortage of ear and hearing care specialists, we have to rethink how we traditionally deliver services,” said Dr Bente Mikkelsen, director of the WHO’s Department for Noncommunicable Diseases. By 2050, nearly 2.5 billion people are projected to experience a degree of hearing loss, as populations around the world age. More than 700 million will likely require hearing rehabilitation, estimates the WHO. But nearly 80% of people with disabling hearing loss live in low-income countries – which historically have lacked capacity for providing assistive devices like hearing aids. Fighting misconceptions and lack of resources But addressing hearing loss is not necessarily expensive. An investment of $1.4 per person annually would be sufficient to scale up ear and hearing care services worldwide, WHO said. To overcome current limitations of capacity, the guidelines encourage more service delivery by non-specialists, based in primary health care settings. Debunking misconceptions and stigma around hearing loss is another key aim of the guidelines, created with the support of ATscale Global Partnership for Assistive Technology. “Common myths about hearing loss often prevent people from seeking the services they require, even where these services are available,” said Dr Shelly Chadha, technical lead for ear and hearing care at WHO. “Any effort to improve hearing care provision through health system strengthening must be accompanied by work to raise awareness within societies and address stigma related to ear and hearing care.” Image Credits: WHO/Miguel Jeronimo. Alzheimer’s Experts Review Progress and Challenges in a ‘Transformative Moment’ 01/03/2024 Sophia Samantaroy WASHINGTON, DC – When US Senator Amy Klobuchar’s father, the late Jim Klobuchar, was diagnosed with Alzheimer’s disease, the noted Minnesota newspaper columnist gradually stopped recognizing her – although he retained “a kind of savoir faire” to the very end with words, jokes and storytelling based on the decades of “lines enmeshed in his memory,” she recalled. Senator Amy Klobuchar (D-MN) In the United States, one in every three seniors will be diagnosed with Alzheimer’s. The disease affects roughly 55 million people globally and is the seventh leading cause of death. “But it’s not just the numbers. It’s the fathers and mothers, it’s the brothers and sisters,” remarked Klobuchar, (D-MN), who recounted the story of her father’s illness at a high-level event here this week, organized by the Davos Alzheimer’s Collaborative (DAC) together with Scientific American. The meeting of the collaborative, a Swiss and US-based foundation launched at the World Economic Forum in 2021, brought together some 100 Alzheimer researchers and front-line clinicians as well as policymakers and industry and civil society advocates, to share progress on new innovations in diagnosing and treating the disease – as well as challenges faced in getting those same innovations into healthcare systems globally. But the event, co-hosted by Scientific American, also was marked by moments of personal reflections, both comic and tragic. Not only Klochubar, but other speakers in the room referred to their own experiences in dealing with family members with Alzheimer’s disease – what Senator Susan Collins (R-ME) termed “the defining disease” of her generation. Joining together across borders and cultures Alzheimer’s is a growing issue worldwide as populations age And while much of the attention around Alzheimer’s so far has been in the United States and other countries of the global north, the disease is a growing problem worldwide, as populations age and people live longer, but not always healthier lives. Researchers predict that lower and middle income countries will soon bear the brunt of Alzheimer’s disease – much as they already do with regards to other noncommunicable diseases. Alzheimer’s disease is projected to affect more than 100 million people globally 2050 And as in all disease research, a global approach can help identify new therapies more effectively and cost-efficiently. “Rather than succumb to despair, what we’re doing is joining together across borders, cultures, and languages to chart a future for the world of prevention, effective treatment, and one day, a cure,” said Collins, who lost a brother to Alzheimer’s. Along with being vice-chair of the powerful Senate Appropriations Committee, Collins is also founder and co-chair of a Congressional Task Force on Alzheimer’s disease. George Vradenburg, founding chairman of the Davos Alzheimer’s Collaborative “I want to speak on behalf of families…50 million families worldwide are struggling with this disease.” said DAC chairman George Vradenburg, who first launched the initiative in response to a challenge by WEF founder and executive director Klaus Schwab. He said that DAC was committed to “including researchers, clinicians and families in this fight globally, ensuring that no corner of the world is left untouched by our efforts.” Added Collins, “We need a global approach modeled on what we’ve done with AIDS, tuberculosis, and malaria. And we know that that kind of global collaborative approach to bring the research directly to a broader spectrum of countries and communities will remove long standing barriers to care and help us eliminate disparities.” “A transformative moment”: Novel diagnostic tests, gene sequencing, and precision medicine Moderator Jeremy Abbate, VP and publisher of Scientific American with former NIH Director Dr. Elias Zerhouni, University of Washington’s Dr. Suzanne Schindler and Dr. Jeffrey Burns, University of Kansas Medical Center Early Alzheimer’s disease research was rather akin to “staring up a cliff,” said former US National Institutes of Health (NIH) director Elias Zerhouni, one of the other speakers at the event. Now, however, the world has reached a turning point where, “we can truly have a global approach.” Improved genetic sequencing, the advent of digital and biological markers, novel drugs, and a more open mindset to alternative hypotheses have seen Alzheimer’s disease research leap into a new era. “We have an explosion of ways to test for Alzheimer’s disease,” remarked Suzanne Schindler, Associate Professor of Neurology at Washington University School of Medicine. Among them are blood tests that can measure up to 5,000 various proteins- a method faster and less invasive than dreaded spinal taps. Other panelists shared this optimism, citing the use of amyloid pet-scans and other diagnostics to more accurately assess Alzheimer’s progression in patients. Genetic sequencing too is cheaper, a marked change since the early days when researchers remained in the dark about the potential genetic drivers of the disease. ‘More than buildup of amyloid plaques’ One of the causes of Alzheimer’s appears to be the abnormal accumulation of tau proteins in the brain, eventually forming tangles inside neurons, seen here With these tools comes an understanding that “the disease is more than just about build up [of amyloid plaques],” commented Jeffrey Burns, Professor of Neurology at University of Kansas Medical Center. New research into disease risk factors is moving beyond conventional descriptions of amyloid plaques and tau protein pathways to include research into inflammation and lifestyle factors. The future of prevention, he speculated, will increasingly lie in more holistic lifestyle approaches undertaken in tandem with medications. “We don’t just give patients with heart disease medication, we tell them to modify their diet, their lifestyle. “I believe we will prevent the disease,” Burns added. Early Alzheimer’s detection remains a missing link Phyllis Ferrell (center left,) Arindam Nandi, and Terry Fulmer discuss the implications of an aging society with Jeremy Abbate. One major challenge is the need to move new knowledge into hospitals and health clinics; currently it can take as long 17-20 years for innovations to get into clinical practice due to outdated models of care. “We are building bullet trains, but running them on the same wooden tracks,” said Dr Phyllis Ferrell, DAC advisor on healthcare systems preparedness. Too often, practitioners still take a “wait and see” approach, while symptoms of cognitive impairment go unrecognized or undiagnosed until much later in the disease course. She urged a shift to a more preventative approach with screenings and help manage cognitive symptoms early. “Why did it take four separate visits to get my dad an inconclusive diagnosis?” Ferrell asked. “Early detection gives people the time to focus on what matters most to them,” she added. “It provides an opportunity to implement positive lifestyle changes and address risk factors, pursue treatment options and/or enroll in a clinical trial.” Getting new innovations into practice Ferrell also bemoaned the frustration families feel over the lack of access to new diagnostics and therapeutics – in the wake of progress made in research. In 2010 the NIH funded Alzheimer’s disease research to the tune of $400 million annually. Fourteen years later, the annual investment is now close to $4 billion, she noted. Yet, despite this influx of funding for research, there’s a huge gap emerging in affordable and available drugs. “We have innovations that are ready, but are not being used,” she said, adding “Yes, to research, but we need to do things today. Let’s go after clinically ready innovations.” Staying the course on research Senator Susan Collins (R-ME)- a leading champion in Congress for Alzheimer’s disease research. At the same time, more research into the disease remains critical to find even more effective preventive strategies as well as possible cures. This means building specimen repositories across the country, performing skin tests for early detection of Alzheimer-related protein abnormalities traditionally only detectable from brain biopsies, and other research. Zerhouni called it breaking the “taboo of the brain” – an area of human physiology where research was historically inadequate. “This is a frontier that has to be broken.” For many years, such research was impeded by social taboos around Alzheimer’s disease. “People used to just call it senility,” said Collins, who has been the leading champion of Alzheimer’s research and action on Capitol Hill for over a decade. Collins last year initiated bipartisan legislation in the US Congress to help maintain the funding for Alzheimer’s research, as well as supporting initiatives to bring down the cost of new drugs in the US for Alzheimer patients. At $345 million billion a year, the disease is currently the most costly disease in the nation to treat, she says. A global economic burden Globally, Alzheimer’s disease also presents an enormous economic burden – costing the world’s economies some $1.3 trillion, in terms of medications as well as care – much of it unpaid, noted Population Council economist Arindam Nandi. In the past, economic data came mostly from high income countries, Now, data is available from lower and middle-income countries like India and China. “These data depict a worrying trend; the percentage of unpaid care is higher in these countries, meaning that caregivers are not able to get other jobs, decreasing economic output,’ he said. Nandi also mentioned that predictive models forecast the shifting burden of disease from high income countries to middle and low income countries. “We don’t know how these populations will fare.” Investments in these countries are needed to strengthen their overall public health measures. Meanwhile, the US and high income countries can learn from the experiences of low and middle income countries, which often are first to devise lower-costs methods for detecting and treating diseases. DAC, for instance, funded an Early Detection Flagship program involving six countries, including the US, Scotland, Jamaica, Japan, Mexico and Brazil. They participated in a pilot designed to increase access to early detection and diagnosis of the disease through the use of innovative new screening tools. “One of the things I loved [about the Early Detection program] was watching the US and high resource countries learn from LMICs,” Ferrell observed. “As the founder of the Brain and Mind Institute of Aga Khan University once said, ‘when it comes to Alzheimer’s disease we are all developing nations.’ “ Image Credits: Getty Images, Pixelmestudio/DAC, National Institutes on Aging , UCLA , S. Samantaroy/HPW. WHO Calls for Private Sector Accountability Amid Massive Obesity Increase 01/03/2024 Kerry Cullinan Member states have been slow to implement WHO policies to address obesity, including taxes on sugary drinks and restrictions on marketing junk food to kids The private sector “must be held accountable for the health impacts of their products”, warned the head of the World Health Organization (WHO) amid news that obesity has quadrupled in children and more than doubled in adults since 1990. Dr Tedros Adhanom Ghebreyesus was speaking ahead of the release of a huge global obesity study involving over 220 million people from more than 190 countries published in The Lancet on Friday. “Getting back on track to meet the global targets for curbing obesity will take the work of governments and communities, supported by evidence-based policies from WHO and national public health agencies,” added Tedros. Countries with highest obesity rates 2022 Tonga, American Samoa and Nauru have the world’s highest obesity rates, affecting some 60% of their adult populations. “The largest increases are in some countries in the Pacific, the Caribbean, the Middle East and North Africa, and some of the newly high income countries like Chile,” said senior author Professor Majid Ezzati, of Imperial College in London, at a media briefing on Thursday. The US is the only high-income country that features in the ten worst affected countries – with the 10th highest obesity rate in men. Some 43.8% of US women and 41.6% of men were living with obesity in 2022. Meanwhile, obesity is slowing in a handful of west European countries – notably Spain and France. However, countries with the lowest obesity rates are generally low-income countries with high rates of under-nutrition, with a few exceptions such as Japan and Viet Nam. Countries with lowest obesity rates 2022 Huge rise in child obesity In 1990, around 31 million children (2,1% of boys and 1.7% of girls) were obese. But 32 years later, there had been a fourfold increase in both boys (to 9,3%) and girls (6.9%) affecting almost 160 million children. “It is very concerning that the epidemic of obesity that was evident amongst adults in much of the world in 1990 is now mirrored in school-aged children and adolescents,” said Ezzati. Professor Majid Ezzati, of Imperial College in London While boys are more likely to be obese than girls globally, this trend is reversed in adulthood with many more women than men living with obesity. But men seem to be catching up. Obesity in men has nearly tripled over the past 32 years, while it has doubled in women. “Different forms of malnutrition still coexist in many countries,” said Dr Francesco Branca, WHO Director of Nutrition and Food Safety and one of the co-authors of the study. “The child who was undernourished in the first years of life can later become overweight or obese as an adolescent or an adult. Undernutrition and obesity are two faces of the same problem, which is the lack of access to healthy diets.” Greater risk of NCDs Undernourished people are more susceptible to infectious diseases, while obesity can lead to Type 2 diabetes, heart disease, certain cancers and affect bone health and reproduction, added Branca, who was also addressing the briefing. “The increase in the double burden of malnutrition is a result of a transition in food system and lifestyle that has not been governed by public health policies,” he added. However, despite WHO guidelines on what countries can do to address the massive rise in consumption of energy-dense ultra-processed food, adoption by member states has been slow. At the World Health Assembly in 2022, member states adopted the WHO Acceleration plan to stop obesity. Core interventions include promoting breastfeeding, regulating marketing of ultra-processed food and drinks to kids, taxation and warning labels on foods high in fats, salt and sugar. Dr Francesco Branca, WHO Director of Nutrition and Food Safety “The reason why the epidemic has progressed so quickly is because the policy action has not been incisive enough,” said Branca, adding that countries had focused on behaviour change rather than “structural elements, which is the policies around food environment”. However, he added that more countries were taxing sugary drinks, although “not many countries have done it for sufficiently long time and in ways that are demonstrated to be most effective”. “Very few countries put a restriction on marketing food to children. We know that some South American countries are taking that action much more effectively, and we look forward seeing the impact of those policies,[as well as] having warning signs on the processed food which would really discourage people from f buying products which are high in salt, sugar and fat”. If these policies were implemented, this would likely lead to food and beverage companies reformulating their products to reduce harmful ingredients, he added. Role of new weight-loss pills? Branca said that the WHO was currently looking at the efficacy of the new drugs called glucagon-like peptide 1 (GLP-1) agonists – such as Wegovy, Ozempic – which have been approved as weight-loss medication in some countries. “The solution is still is a transformation of the food system and in the environment such obesity can be prevented,” Branca stressed. However, the GLP-1 drugs could provide a tool to help those that already live with obesity, as long as they were integrated into a primary healthcare package to manage obesity that included guidance on exercise and diet. The new study was conducted by the NCD Risk Factor Collaboration (NCD-RisC), in collaboration with the World Health Organization (WHO), and involved over 1,500 researchers. They based their analysis on body mass index (BMI). Adults with BMI 30kg/m2 and over were classified as obese and underweight if their BMI was below 18.5kg/m2. For children, BMI was adjusted according to age. . Image Credits: World Obesity Federation. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Alzheimer’s Experts Review Progress and Challenges in a ‘Transformative Moment’ 01/03/2024 Sophia Samantaroy WASHINGTON, DC – When US Senator Amy Klobuchar’s father, the late Jim Klobuchar, was diagnosed with Alzheimer’s disease, the noted Minnesota newspaper columnist gradually stopped recognizing her – although he retained “a kind of savoir faire” to the very end with words, jokes and storytelling based on the decades of “lines enmeshed in his memory,” she recalled. Senator Amy Klobuchar (D-MN) In the United States, one in every three seniors will be diagnosed with Alzheimer’s. The disease affects roughly 55 million people globally and is the seventh leading cause of death. “But it’s not just the numbers. It’s the fathers and mothers, it’s the brothers and sisters,” remarked Klobuchar, (D-MN), who recounted the story of her father’s illness at a high-level event here this week, organized by the Davos Alzheimer’s Collaborative (DAC) together with Scientific American. The meeting of the collaborative, a Swiss and US-based foundation launched at the World Economic Forum in 2021, brought together some 100 Alzheimer researchers and front-line clinicians as well as policymakers and industry and civil society advocates, to share progress on new innovations in diagnosing and treating the disease – as well as challenges faced in getting those same innovations into healthcare systems globally. But the event, co-hosted by Scientific American, also was marked by moments of personal reflections, both comic and tragic. Not only Klochubar, but other speakers in the room referred to their own experiences in dealing with family members with Alzheimer’s disease – what Senator Susan Collins (R-ME) termed “the defining disease” of her generation. Joining together across borders and cultures Alzheimer’s is a growing issue worldwide as populations age And while much of the attention around Alzheimer’s so far has been in the United States and other countries of the global north, the disease is a growing problem worldwide, as populations age and people live longer, but not always healthier lives. Researchers predict that lower and middle income countries will soon bear the brunt of Alzheimer’s disease – much as they already do with regards to other noncommunicable diseases. Alzheimer’s disease is projected to affect more than 100 million people globally 2050 And as in all disease research, a global approach can help identify new therapies more effectively and cost-efficiently. “Rather than succumb to despair, what we’re doing is joining together across borders, cultures, and languages to chart a future for the world of prevention, effective treatment, and one day, a cure,” said Collins, who lost a brother to Alzheimer’s. Along with being vice-chair of the powerful Senate Appropriations Committee, Collins is also founder and co-chair of a Congressional Task Force on Alzheimer’s disease. George Vradenburg, founding chairman of the Davos Alzheimer’s Collaborative “I want to speak on behalf of families…50 million families worldwide are struggling with this disease.” said DAC chairman George Vradenburg, who first launched the initiative in response to a challenge by WEF founder and executive director Klaus Schwab. He said that DAC was committed to “including researchers, clinicians and families in this fight globally, ensuring that no corner of the world is left untouched by our efforts.” Added Collins, “We need a global approach modeled on what we’ve done with AIDS, tuberculosis, and malaria. And we know that that kind of global collaborative approach to bring the research directly to a broader spectrum of countries and communities will remove long standing barriers to care and help us eliminate disparities.” “A transformative moment”: Novel diagnostic tests, gene sequencing, and precision medicine Moderator Jeremy Abbate, VP and publisher of Scientific American with former NIH Director Dr. Elias Zerhouni, University of Washington’s Dr. Suzanne Schindler and Dr. Jeffrey Burns, University of Kansas Medical Center Early Alzheimer’s disease research was rather akin to “staring up a cliff,” said former US National Institutes of Health (NIH) director Elias Zerhouni, one of the other speakers at the event. Now, however, the world has reached a turning point where, “we can truly have a global approach.” Improved genetic sequencing, the advent of digital and biological markers, novel drugs, and a more open mindset to alternative hypotheses have seen Alzheimer’s disease research leap into a new era. “We have an explosion of ways to test for Alzheimer’s disease,” remarked Suzanne Schindler, Associate Professor of Neurology at Washington University School of Medicine. Among them are blood tests that can measure up to 5,000 various proteins- a method faster and less invasive than dreaded spinal taps. Other panelists shared this optimism, citing the use of amyloid pet-scans and other diagnostics to more accurately assess Alzheimer’s progression in patients. Genetic sequencing too is cheaper, a marked change since the early days when researchers remained in the dark about the potential genetic drivers of the disease. ‘More than buildup of amyloid plaques’ One of the causes of Alzheimer’s appears to be the abnormal accumulation of tau proteins in the brain, eventually forming tangles inside neurons, seen here With these tools comes an understanding that “the disease is more than just about build up [of amyloid plaques],” commented Jeffrey Burns, Professor of Neurology at University of Kansas Medical Center. New research into disease risk factors is moving beyond conventional descriptions of amyloid plaques and tau protein pathways to include research into inflammation and lifestyle factors. The future of prevention, he speculated, will increasingly lie in more holistic lifestyle approaches undertaken in tandem with medications. “We don’t just give patients with heart disease medication, we tell them to modify their diet, their lifestyle. “I believe we will prevent the disease,” Burns added. Early Alzheimer’s detection remains a missing link Phyllis Ferrell (center left,) Arindam Nandi, and Terry Fulmer discuss the implications of an aging society with Jeremy Abbate. One major challenge is the need to move new knowledge into hospitals and health clinics; currently it can take as long 17-20 years for innovations to get into clinical practice due to outdated models of care. “We are building bullet trains, but running them on the same wooden tracks,” said Dr Phyllis Ferrell, DAC advisor on healthcare systems preparedness. Too often, practitioners still take a “wait and see” approach, while symptoms of cognitive impairment go unrecognized or undiagnosed until much later in the disease course. She urged a shift to a more preventative approach with screenings and help manage cognitive symptoms early. “Why did it take four separate visits to get my dad an inconclusive diagnosis?” Ferrell asked. “Early detection gives people the time to focus on what matters most to them,” she added. “It provides an opportunity to implement positive lifestyle changes and address risk factors, pursue treatment options and/or enroll in a clinical trial.” Getting new innovations into practice Ferrell also bemoaned the frustration families feel over the lack of access to new diagnostics and therapeutics – in the wake of progress made in research. In 2010 the NIH funded Alzheimer’s disease research to the tune of $400 million annually. Fourteen years later, the annual investment is now close to $4 billion, she noted. Yet, despite this influx of funding for research, there’s a huge gap emerging in affordable and available drugs. “We have innovations that are ready, but are not being used,” she said, adding “Yes, to research, but we need to do things today. Let’s go after clinically ready innovations.” Staying the course on research Senator Susan Collins (R-ME)- a leading champion in Congress for Alzheimer’s disease research. At the same time, more research into the disease remains critical to find even more effective preventive strategies as well as possible cures. This means building specimen repositories across the country, performing skin tests for early detection of Alzheimer-related protein abnormalities traditionally only detectable from brain biopsies, and other research. Zerhouni called it breaking the “taboo of the brain” – an area of human physiology where research was historically inadequate. “This is a frontier that has to be broken.” For many years, such research was impeded by social taboos around Alzheimer’s disease. “People used to just call it senility,” said Collins, who has been the leading champion of Alzheimer’s research and action on Capitol Hill for over a decade. Collins last year initiated bipartisan legislation in the US Congress to help maintain the funding for Alzheimer’s research, as well as supporting initiatives to bring down the cost of new drugs in the US for Alzheimer patients. At $345 million billion a year, the disease is currently the most costly disease in the nation to treat, she says. A global economic burden Globally, Alzheimer’s disease also presents an enormous economic burden – costing the world’s economies some $1.3 trillion, in terms of medications as well as care – much of it unpaid, noted Population Council economist Arindam Nandi. In the past, economic data came mostly from high income countries, Now, data is available from lower and middle-income countries like India and China. “These data depict a worrying trend; the percentage of unpaid care is higher in these countries, meaning that caregivers are not able to get other jobs, decreasing economic output,’ he said. Nandi also mentioned that predictive models forecast the shifting burden of disease from high income countries to middle and low income countries. “We don’t know how these populations will fare.” Investments in these countries are needed to strengthen their overall public health measures. Meanwhile, the US and high income countries can learn from the experiences of low and middle income countries, which often are first to devise lower-costs methods for detecting and treating diseases. DAC, for instance, funded an Early Detection Flagship program involving six countries, including the US, Scotland, Jamaica, Japan, Mexico and Brazil. They participated in a pilot designed to increase access to early detection and diagnosis of the disease through the use of innovative new screening tools. “One of the things I loved [about the Early Detection program] was watching the US and high resource countries learn from LMICs,” Ferrell observed. “As the founder of the Brain and Mind Institute of Aga Khan University once said, ‘when it comes to Alzheimer’s disease we are all developing nations.’ “ Image Credits: Getty Images, Pixelmestudio/DAC, National Institutes on Aging , UCLA , S. Samantaroy/HPW. WHO Calls for Private Sector Accountability Amid Massive Obesity Increase 01/03/2024 Kerry Cullinan Member states have been slow to implement WHO policies to address obesity, including taxes on sugary drinks and restrictions on marketing junk food to kids The private sector “must be held accountable for the health impacts of their products”, warned the head of the World Health Organization (WHO) amid news that obesity has quadrupled in children and more than doubled in adults since 1990. Dr Tedros Adhanom Ghebreyesus was speaking ahead of the release of a huge global obesity study involving over 220 million people from more than 190 countries published in The Lancet on Friday. “Getting back on track to meet the global targets for curbing obesity will take the work of governments and communities, supported by evidence-based policies from WHO and national public health agencies,” added Tedros. Countries with highest obesity rates 2022 Tonga, American Samoa and Nauru have the world’s highest obesity rates, affecting some 60% of their adult populations. “The largest increases are in some countries in the Pacific, the Caribbean, the Middle East and North Africa, and some of the newly high income countries like Chile,” said senior author Professor Majid Ezzati, of Imperial College in London, at a media briefing on Thursday. The US is the only high-income country that features in the ten worst affected countries – with the 10th highest obesity rate in men. Some 43.8% of US women and 41.6% of men were living with obesity in 2022. Meanwhile, obesity is slowing in a handful of west European countries – notably Spain and France. However, countries with the lowest obesity rates are generally low-income countries with high rates of under-nutrition, with a few exceptions such as Japan and Viet Nam. Countries with lowest obesity rates 2022 Huge rise in child obesity In 1990, around 31 million children (2,1% of boys and 1.7% of girls) were obese. But 32 years later, there had been a fourfold increase in both boys (to 9,3%) and girls (6.9%) affecting almost 160 million children. “It is very concerning that the epidemic of obesity that was evident amongst adults in much of the world in 1990 is now mirrored in school-aged children and adolescents,” said Ezzati. Professor Majid Ezzati, of Imperial College in London While boys are more likely to be obese than girls globally, this trend is reversed in adulthood with many more women than men living with obesity. But men seem to be catching up. Obesity in men has nearly tripled over the past 32 years, while it has doubled in women. “Different forms of malnutrition still coexist in many countries,” said Dr Francesco Branca, WHO Director of Nutrition and Food Safety and one of the co-authors of the study. “The child who was undernourished in the first years of life can later become overweight or obese as an adolescent or an adult. Undernutrition and obesity are two faces of the same problem, which is the lack of access to healthy diets.” Greater risk of NCDs Undernourished people are more susceptible to infectious diseases, while obesity can lead to Type 2 diabetes, heart disease, certain cancers and affect bone health and reproduction, added Branca, who was also addressing the briefing. “The increase in the double burden of malnutrition is a result of a transition in food system and lifestyle that has not been governed by public health policies,” he added. However, despite WHO guidelines on what countries can do to address the massive rise in consumption of energy-dense ultra-processed food, adoption by member states has been slow. At the World Health Assembly in 2022, member states adopted the WHO Acceleration plan to stop obesity. Core interventions include promoting breastfeeding, regulating marketing of ultra-processed food and drinks to kids, taxation and warning labels on foods high in fats, salt and sugar. Dr Francesco Branca, WHO Director of Nutrition and Food Safety “The reason why the epidemic has progressed so quickly is because the policy action has not been incisive enough,” said Branca, adding that countries had focused on behaviour change rather than “structural elements, which is the policies around food environment”. However, he added that more countries were taxing sugary drinks, although “not many countries have done it for sufficiently long time and in ways that are demonstrated to be most effective”. “Very few countries put a restriction on marketing food to children. We know that some South American countries are taking that action much more effectively, and we look forward seeing the impact of those policies,[as well as] having warning signs on the processed food which would really discourage people from f buying products which are high in salt, sugar and fat”. If these policies were implemented, this would likely lead to food and beverage companies reformulating their products to reduce harmful ingredients, he added. Role of new weight-loss pills? Branca said that the WHO was currently looking at the efficacy of the new drugs called glucagon-like peptide 1 (GLP-1) agonists – such as Wegovy, Ozempic – which have been approved as weight-loss medication in some countries. “The solution is still is a transformation of the food system and in the environment such obesity can be prevented,” Branca stressed. However, the GLP-1 drugs could provide a tool to help those that already live with obesity, as long as they were integrated into a primary healthcare package to manage obesity that included guidance on exercise and diet. The new study was conducted by the NCD Risk Factor Collaboration (NCD-RisC), in collaboration with the World Health Organization (WHO), and involved over 1,500 researchers. They based their analysis on body mass index (BMI). Adults with BMI 30kg/m2 and over were classified as obese and underweight if their BMI was below 18.5kg/m2. For children, BMI was adjusted according to age. . Image Credits: World Obesity Federation. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy
WHO Calls for Private Sector Accountability Amid Massive Obesity Increase 01/03/2024 Kerry Cullinan Member states have been slow to implement WHO policies to address obesity, including taxes on sugary drinks and restrictions on marketing junk food to kids The private sector “must be held accountable for the health impacts of their products”, warned the head of the World Health Organization (WHO) amid news that obesity has quadrupled in children and more than doubled in adults since 1990. Dr Tedros Adhanom Ghebreyesus was speaking ahead of the release of a huge global obesity study involving over 220 million people from more than 190 countries published in The Lancet on Friday. “Getting back on track to meet the global targets for curbing obesity will take the work of governments and communities, supported by evidence-based policies from WHO and national public health agencies,” added Tedros. Countries with highest obesity rates 2022 Tonga, American Samoa and Nauru have the world’s highest obesity rates, affecting some 60% of their adult populations. “The largest increases are in some countries in the Pacific, the Caribbean, the Middle East and North Africa, and some of the newly high income countries like Chile,” said senior author Professor Majid Ezzati, of Imperial College in London, at a media briefing on Thursday. The US is the only high-income country that features in the ten worst affected countries – with the 10th highest obesity rate in men. Some 43.8% of US women and 41.6% of men were living with obesity in 2022. Meanwhile, obesity is slowing in a handful of west European countries – notably Spain and France. However, countries with the lowest obesity rates are generally low-income countries with high rates of under-nutrition, with a few exceptions such as Japan and Viet Nam. Countries with lowest obesity rates 2022 Huge rise in child obesity In 1990, around 31 million children (2,1% of boys and 1.7% of girls) were obese. But 32 years later, there had been a fourfold increase in both boys (to 9,3%) and girls (6.9%) affecting almost 160 million children. “It is very concerning that the epidemic of obesity that was evident amongst adults in much of the world in 1990 is now mirrored in school-aged children and adolescents,” said Ezzati. Professor Majid Ezzati, of Imperial College in London While boys are more likely to be obese than girls globally, this trend is reversed in adulthood with many more women than men living with obesity. But men seem to be catching up. Obesity in men has nearly tripled over the past 32 years, while it has doubled in women. “Different forms of malnutrition still coexist in many countries,” said Dr Francesco Branca, WHO Director of Nutrition and Food Safety and one of the co-authors of the study. “The child who was undernourished in the first years of life can later become overweight or obese as an adolescent or an adult. Undernutrition and obesity are two faces of the same problem, which is the lack of access to healthy diets.” Greater risk of NCDs Undernourished people are more susceptible to infectious diseases, while obesity can lead to Type 2 diabetes, heart disease, certain cancers and affect bone health and reproduction, added Branca, who was also addressing the briefing. “The increase in the double burden of malnutrition is a result of a transition in food system and lifestyle that has not been governed by public health policies,” he added. However, despite WHO guidelines on what countries can do to address the massive rise in consumption of energy-dense ultra-processed food, adoption by member states has been slow. At the World Health Assembly in 2022, member states adopted the WHO Acceleration plan to stop obesity. Core interventions include promoting breastfeeding, regulating marketing of ultra-processed food and drinks to kids, taxation and warning labels on foods high in fats, salt and sugar. Dr Francesco Branca, WHO Director of Nutrition and Food Safety “The reason why the epidemic has progressed so quickly is because the policy action has not been incisive enough,” said Branca, adding that countries had focused on behaviour change rather than “structural elements, which is the policies around food environment”. However, he added that more countries were taxing sugary drinks, although “not many countries have done it for sufficiently long time and in ways that are demonstrated to be most effective”. “Very few countries put a restriction on marketing food to children. We know that some South American countries are taking that action much more effectively, and we look forward seeing the impact of those policies,[as well as] having warning signs on the processed food which would really discourage people from f buying products which are high in salt, sugar and fat”. If these policies were implemented, this would likely lead to food and beverage companies reformulating their products to reduce harmful ingredients, he added. Role of new weight-loss pills? Branca said that the WHO was currently looking at the efficacy of the new drugs called glucagon-like peptide 1 (GLP-1) agonists – such as Wegovy, Ozempic – which have been approved as weight-loss medication in some countries. “The solution is still is a transformation of the food system and in the environment such obesity can be prevented,” Branca stressed. However, the GLP-1 drugs could provide a tool to help those that already live with obesity, as long as they were integrated into a primary healthcare package to manage obesity that included guidance on exercise and diet. The new study was conducted by the NCD Risk Factor Collaboration (NCD-RisC), in collaboration with the World Health Organization (WHO), and involved over 1,500 researchers. They based their analysis on body mass index (BMI). Adults with BMI 30kg/m2 and over were classified as obese and underweight if their BMI was below 18.5kg/m2. For children, BMI was adjusted according to age. . Image Credits: World Obesity Federation. Posts navigation Older postsNewer posts