Dr Jean Kaseya and Dr Sabin Nsanzimana.

While Rwanda appears to have its Marburg virus outbreak under control with no new cases reported in the past three days in Rwanda, mpox continues to spread – now affecting 18 countries with 3051 new cases in the past week.

Since declaring the Marburg outbreak three weeks ago, Rwanda has confirmed 62 cases, of which 15 have died, 38 have recovered and nine cases are still receiving treatment with the majority improving, said Health Minister Dr Sabin Nsanzimana on Thursday.

“The case fatality rate overall is 24% and we’ve vaccinated 856 people,” Nsanzimana told an Africa Centres for Disease Control and Prevention (CDC) briefing, describing the trend as “very encouraging”.

As the vaccine is “investigational”, its rollout required more rigorous consent, sampling and documentation, but demand for it has been “very high”, he added.

the vaccines you are providing highly accepted, especially among healthcare providers. Around 90% of those infected are health workers and their close contacts from the intensive care units of two hospitals that treated the very first patients. The index patients was co-infected with malaria which slowed the diagnosis of Marburg, which has similar symptoms.

Rwanda’s health ministry has also tested over 4,000 people “to make sure we don’t miss any cases”, added Nsanzimana.

He attributed “intense activity on the ground”, ring vaccination [vaccinating the close contacts of people with Marburg] and new antivirals for the turnaround in what is the biggest Marburg outbreak ever recorded. 

The virus, which is from the same family as Ebola and, in some outbreaks, has killed over 80% of those infected.

While the zoonotic origin of the outbreak is still unknown, Nsanzimana said Rwanda will be reporting its findings on the the serology and gene sequencing of the virus within a few days. At the same time, it has a team on the ground hunting for the source of the virus.

Mpox ‘not under control’

Mpox cases have now been identified in 18 African countries, with new additions being Zambia and Zimbabwe. In the past week, 3051 new cases have been reported – including two male prisoners in Uganda.

“Mpox is not under control,” warned Africa CDC Director-General Dr Jean Kaseya.

Despite calling a continental meeting in April to warn countries of the risk, cases have risen exponentially: from slightly under 6,000 then to 42,438 suspected mpox cases at present – although only 8,113 have been clinically confirmed.

A rapid test to diagnose mpox is in the pipeline and will transform the testing landscape, said Kaseya.

Kaseya flagged the threat to internally displaced people (IDP), particularly in the Democratic Republic of Congo (DRC), and prisoners – both groups characterised by close contact.

In the eastern DRC, conflict has displaced some 2.5 million people who are now living in camps in close quarters with limited access to water, sanitation and hygiene. 

The two Ugandan prisoners were initially diagnosed with chicken pox – which has small lesions that are itchy not painful like mpox.

DRC vaccination plan includes MSM, transgender people

The DRC’s vaccination campaign started two weeks ago in three provinces – North Kivu, South Kivu and Tshopo – and is “moving well”, said Kaseya, who hails from DRC.

The country’s plan includes men who have sex with men (MSM) and sex workers, as mpox can be sexually transmitted.

In DRC, same-sex sexual contact is not outlawed as it is in many of the other countries currently affected by mpox – Uganda, Burundi, Kenya, Tanzania, Zambia and Zimbabwe.

“When are talking about MSM, we are clear as Africa CDC. We are saying all human beings have the same rights, and we are supporting countries to plan vaccination for all of them, including men having sex with other men,” said Kaseya empathically.

“We are proud and we are glad to see in DRC that we have MSM included,” he added.

Kaseya said that early messaging about mpox Clade 1B only being associated with sexual transmission was wrong – as was the failure to talk about MSM as the main mode of transmission iun the 2022 outbreak.

“There was the stigma talking about men having sex with other men as the main transmission mode of mpox. But if we put it in the context in Africa, that one in some countries is still a taboo. 

“We believe with our effort, what we are doing is sensitizing countries, and we are proud to see that DRC are mentioning that.”

He added that risk communication and community engagement involving “people who are openly saying we are these key populations” was also important.

Uganda tightened its anti-LGBTQ laws recently and, while it plans to test all 1,087 prisoners who possibly had contact with the two prisoners recently diagnosed with mpox, it is unclear how it will approach MSM as a mode of transmission other than to crack down further on smae-sex activity.

Dirty smoke billows from chimneys in Poland.

Europe is now poised to deliver cleaner, healthier air – thanks to adoption this week of the revised Ambient Air Quality Directive (AAQD) by the European Union. This marks a crucial victory for the health and wellbeing of millions across the EU and serves as a beacon for the clean air movement worldwide.

The AAQD underpins Europe’s air quality standards, and its revision is a significant breakthrough in addressing the public health crisis of air pollution. 

Each year, air pollution cuts short the lives of nearly 300,000 Europeans, contributing to respiratory illnesses, cardiovascular disease, and other serious health conditions, according to the EU’s impact assessment report.

Improving air quality is a public health imperative. It’s also crucial for the environment and the economy, making the case for stronger EU-wide legislation even clearer.

A healthier future

The revised AAQD brings Europe’s air quality standards closer to the World Health Organization’s (WHO) air quality guidelines. It sets tougher, legally binding limits on harmful pollutants like nitrogen dioxide (NO₂) and fine particulate matter (PM2.5), representing a doubling of ambition for these two major pollutants, in line with WHO’s interim targets. 

These pollutants have long been linked to severe health impacts that are particularly harmful for vulnerable groups, such as babies and young children and people with certain conditions such as Chronic Obstructive Pulmonary Disease. 

By delivering cleaner air, the AAQD could mean the difference between a lifetime of illness and a healthy future for future generations.

The AAQD also strengthens the monitoring and measuring provisions for air quality, introducing air quality roadmaps to support progress ahead of its 2030 deadline. The new rules bring about a fairer regime for people affected by air pollution as the rules for access to justice and compensation for those whose health have been impacted by dirty air have been improved.

Some of the most polluted regions within member states can delay meeting the new targets for up to 10 years (until 2040) under certain conditions. Although these derogations (or exceptions) provide more leeway than originally envisaged, the compromise, alongside strict conditions for delays, ensure that none of the 27 Member States are left behind. 

Significant impact if properly implemented

Overall, the Directive remains a significant win with ambitious targets and tightly regulated conditions for any delays. Importantly, the initially proposed ambition on limit values remained intact following the two-year legislative process, despite widespread pushback against legislation falling under the EU Green Deal, indicating the scale of this victory for clean air campaigners.   

One of the key reasons for the AAQD’s success is that it is both an environmental law and a critical public health intervention. By recognising that air quality is a matter of life and death, policymakers have acknowledged the need to protect the most vulnerable in our society. 

The impact of the new legislation in Europe will be significant if the AAQD is properly implemented. The new rules can prevent more than 55% of premature deaths linked to air pollution in the EU. That’s not just a number – that’s hundreds of thousands of people, each with families, who will live longer, healthier lives.

In addition to delivering significant health and environmental benefits, improving the air we breathe makes economic sense. Investing €6 billion annually in cleaner air will deliver up to €121 billion in benefits (according to the EU’s analysis). 

That’s equivalent to building hundreds of new hospitals or creating hundreds of thousands of new jobs in green industries. Echoing this analysis, the Brussels-based think tank, Bruegel, estimated that implementing clean air measures could boost economic growth by €50 to €60 billion every year[3] and save  approximately €600 billion each year in the European Union, the equivalent to 4% of GDP.

Ripple effect

The importance of the AAQD extends beyond the EU’s borders. By taking decisive action, the EU has positioned itself among the global leaders in air quality management, setting an example for other regions grappling with similar challenges. 

Air pollution is a global problem, responsible for eight million premature deaths annually worldwide, as reported in the British Medical Journal, and the EU’s solutions will, I hope, inspire other countries to pursue stronger actions.

Ongoing engagement and sustained political will are key to ensuring the success of these measures. The real test will come as member states move to transpose the Directive into law and work to implement these new standards. 

National and local governments will need to invest in cleaner technologies, green transport and clean heating while improving air quality monitoring and ensuring that enforcement is taken seriously.

Let’s celebrate this moment, but also remain focused on the work that still needs to be done. Air pollution is an invisible killer, shortening lives and ravaging our communities. With this new Directive, we are fighting back.

Jane Burston founded and leads the Clean Air Fund (CAF), a global philanthropic organisation working with governments, funders, businesses and campaigners to create a future where everyone breathes clean air. Before setting up CAF, Jane worked as head of Climate and Energy Science in the UK government. Prior to that, as head of Energy and Environment at the UK National Physical Laboratory, she managed a team of 150 scientists working in air quality, GHG measurement and renewable energy. 

 

Image Credits: Janusz Walczak/ Unsplash.

BERLIN – Countries worldwide, regardless of income level, can halve premature death rates by 2050, a new Lancet report presented at the closing of the World Health Summit in Berlin suggests.

Fifteen key health threats are driving premature deaths worldwide, with tobacco use leading the pack “by far”, the Lancet Commission for Investing in Health found. Targeting interventions in these areas – with over half involving maternal, newborn, child, and infectious diseases – could dramatically reduce global deaths before age 70, the Commission said.

“Sharp reductions in mortality and morbidity can be achieved by focusing on 15 priority conditions,” Dr Angela Chang from the University of Southern Denmark and lead author of the report, told a panel at the World Health Summit in Berlin on Tuesday. “Doubling down on past health investments, focusing resources on a narrow set of conditions, scaling up financing and developing new technologies can continue to have an enormous impact despite the headwinds.”

The 15 priority conditions, selected from over 17,000 internationally recognized health diagnoses, account for approximately 80% of the life expectancy gap between most regions and the North Atlantic, defined in the report as North America and Europe. 

These conditions account for 86% of the gap between China and the North Atlantic, and 74% between sub-Saharan Africa and the North Atlantic.

“There’s a 22-year gap in life expectancy between Sub-Saharan Africa and the North Atlantic, Chang explained. “Close to 80% of this gap can be explained by these 15 priority conditions, and over half of the difference can be attributed to eight infectious and maternal health conditions.”

If the global goal is met, the average premature mortality rate worldwide would fall to about 15%, matching levels currently seen in Europe and North America—today’s global benchmark.

Achieving this would mean dramatic improvements for billions, especially in low- and middle-income countries. In Sub-Saharan Africa, the worst-performing region, premature mortality sits at 52%.

Setting priorities straight

The report’s optimism is rooted in historical data. Globally, the probability of dying before 70 has halved since the 1960s, falling from 62% to 31% for individuals born in 2019.

Thirty-seven countries, including populous nations like Bangladesh, China, Japan, and Vietnam, have already halved their premature death rates in similar or shorter periods than the 26 years remaining until the 2050 target date. 

The Commission recommends public financing for essential medicines targeting the 15 key conditions driving premature mortality. It suggests mobilizing international funding and joint procurement efforts, similar to strategies used by GAVI, PEPFAR, and the Global Fund, to reduce costs for patients and governments alike.

“Inadequate access to medicines and high out-of-pocket costs are major threats to cutting premature mortality,” Chang noted. “We learned from the Global Fund’s experience how national government subsidies can steer resources towards priority interventions and reduce out-of-pocket payments.” 

While the Commission believes halving premature mortality by 2050 is globally achievable, it acknowledges this target may be “perhaps only aspirational for some countries, realistically speaking.”

“We have a tendency to focus on the new, shiny things,” Chang added. “Our message is for countries to stay focused on these priority conditions.”

‘Tobacco is the new tobacco’

Six out of ten smokers, or 750 million people globally want to quit tobacco use.

High tobacco taxes are “by far” the most crucial policy tool for reducing premature deaths, according to the report.

“You often hear about other risk factors, but we argue tobacco is the new tobacco,” Chang explained.

Recent research suggests raising excise taxes on tobacco, alcohol, and sugary drinks by 50% could yield $2.1 trillion for low- and middle-income countries over five years. This could boost healthcare spending in these nations by 40% if directed towards health initiatives.

The Commission highlights the Middle East and North Africa as an example of untapped potential in tobacco control. With 160 million smokers and rising prevalence among youth and women, the region faces a growing health crisis.

Egypt’s smoking rates doubled between 2000 and 2018, while tobacco became more affordable in conflict-affected countries like Iraq and Syria. The region’s tobacco taxes, second-lowest globally, fall far short of the World Health Organization’s recommended 70% excise tax.

“Despite wide experience with its successful use, tobacco taxation remains a policy tool that is still greatly underused,” the Commission found. “Raising taxes on tobacco can do more to reduce premature mortality than any other single health policy.”

High risk of  ‘COVID magnitude’ pandemic in next decade

The Lancet Comission estimates there is a 23% change of a COVID-scale pandemic in the next decade.

New modeling for the Commission’s report indicates a 23% chance of a pandemic as severe as COVID-19 occurring within a decade. Unprepared health systems could see progress on reducing premature deaths plummet if caught off guard again.

“There is a high risk of another pandemic of Covid-like magnitude,” Chang warned. “To put it another way, in most years there will be zero pandemic deaths, and in some years there will be millions of pandemic deaths.”

The Commission’s analysis estimates an average of 2.5 million deaths per year due to pandemics when viewed over a long time horizon. This figure is comparable to the current annual death toll from AIDS, malaria, and tuberculosis combined, and significantly exceeds even pessimistic projections for annual climate change-related deaths in coming decades.

“People should wake up at that figure,” Helen Clark, former Prime Minister of New Zealand, warned the summit. 

The warning from the Commission comes as global headwinds from conflict, climate change and debt hammer health budgets. Neglecting pandemic preparedness could have severe consequences, particularly for poorer countries less equipped to handle sudden outbreaks.

“We need to learn the lessons not just from COVID, but from Mpox, Ebola … and avoid this panic-neglect cycle,” said Dr Seth Berkley, former CEO of Gavi, the Vaccine Alliance. “Unfortunately, I don’t think we’re doing a very good job.” 

From 1993 to Berlin 

A figure from the World Bank’s 1993 report making the case for health as an economic investment.

The Lancet Comission report is the latest in a line of studies that traces its lineage back to a pivotal World Bank report that changed the landscape of global health finance.

The World Bank’s 1993 report, Investing in Health, the only report on health ever published by the Bank, was the first to make an argument still used by health advocates and ministers across the globe: health is an investment. 

“The World Bank saying investing in health is no just a cost to society, but an investment that was justified on pure economic grounds … was revolutionary,” Berkley recalled. “Prior to this, people saw it as a cost – if you get richer, you can afford health, but this really changed the thinking.” 

The Commission’s work has expanded on the World Bank’s initial calculations, incorporating factors such as the impact of out-of-pocket health costs on economies and personal livelihoods. This broader perspective has significantly increased the estimated economic benefits of maintaining healthy societies, from the World Bank’s initial 11% to 24%.

“The important thing is that each one of these reports, including this one, says the case is better than ever for investing in health, and we need to keep talking about that, particularly at a time when the headwinds are so strong,” Berkley emphasizes.

The latest report continues this tradition, reaffirming that health investment remains one of the most effective strategies for improving both individual and societal outcomes.

“Today, the case is better than ever for going for mortality reduction,” said Dr Gavin Yamey, director of Duke University’s Center for Policy Impact in Global Health and lead author of the commission report “It’s a prize within reach. It will have extraordinary health, welfare and economic benefits.”

Image Credits: Sarah Johnson.

At a HIVR4P’s press conference: Jeremy Nuttall, Elizabeth Irungu, Mark Marzinke, Alessandro Grattoni, William Hahn and Colleen Kelley.

LIMA, Peru – The infection-prevention potential of Lenacapavir,  the long-acting anti-HIV injectable administered just twice a year, took centre stage at the fifth HIV Research for Prevention Conference (HIVR4P) held last week.

However, several other important studies were also unveiled, including an injectable that combines contraception and HIV protection, results from a three-month vaginal ring, and real-world findings from Zambia’s rollout of long-acting injectable cabotegravir. 

Lenacapavir in diverse populations

Lenacapavir reduced HIV infections by 96% in a gender-diverse population, according to results from the PURPOSE 2 trial, which enrolled over 3,200 participants from Argentina, Brazil, Mexico, Peru, South Africa, Thailand, and the US between June 2021 and December 2023. 

Participants were randomly assigned to one of two groups: one receiving lenacapavir injections every six months and the other taking daily oral pills for pre-exposure prophylaxis (PrEP) with matched placebos.

The average age of participants was 28, with over one-third under the age of 25. Around 70% identified as non-white, and the gender breakdown featured cisgender men, transgender men, transgender women, and non-binary individuals who have sex with partners assigned male at birth.

At 39 weeks, only two HIV cases occurred in the lenacapavir group of 2,179 individuals, translating to a 96% reduction in HIV incidence, according to Dr Colleen Kelley from Emory University. 

In contrast, there were nine new HIV cases among the 1,087 participants taking daily oral TDF pills (comprising tenofovir disoproxil fumarate and emtricitabine and marketed as Truvada). This makes lenacapavir 89% more effective than oral PrEP.

The findings echoed earlier results from the PURPOSE 1 trial, which showed 100% efficacy in preventing HIV among cisgender women in Africa. With regulatory filings expected to begin globally by the end of 2024, lenacapavir has the potential to be a transformative HIV prevention tool. Future phases of the study will focus on other groups, including women in the US (PURPOSE 3) and people who inject drugs (PURPOSE 4).

The twice-yearly injectable, lenacapavir (marketed as Sunlenca in the US) could make a huge difference to HIV prevention is widely accessible.

Injectable contraceptive and HIV prevention in one 

For millions of young women worldwide, two major health concerns often intersect: HIV acquisition and unintended pregnancy. 

Many have expressed a preference for a method that protects against both. At the conference, Melissa Peet from CONRAD presented results from a promising solution—a silica-based hydrogel injectable that combines HIV antiretroviral drugs with contraception in a single shot.

In designing this dual-purpose method, researchers selected long-acting cabotegravir (CAB-LA) as the HIV prevention drug and levonorgestrel (LNG) as the contraceptive. 

The hydrogel injectable they developed is a silica-biodegradable material comprising two compartments, one for each medication. The injectable is capable of delivering both drugs with a single injection offering dual protection for three months.

Preclinical tests in rats showed sustained drug levels in the bloodstream without significant interactions or safety concerns, and the researchers are now conducting additional studies in non-human primates to fine-tune dosing and asses the duration of protective drug concentration.

No interactions between Cabotegravir and contraceptives

One concern with combining HIV prevention and contraception has been the potential for drug interactions, particularly between long-acting HIV medications like cabotegravir (CAB-LA) and commonly used contraceptives. 

To address this, Dr. Mark Marzinke from Johns Hopkins University presented results from a sub-study within the HPTN 084 trial to explore any potential interactions.

The study included 170 participants from South Africa with a median age of 23. A total of 80 women were randomised to the CAB-LA arm and 90 in the oral PrEP arm. Participants used three types of hormonal contraceptives: etonogestrel implants, injectable norethindrone, or medroxyprogesterone acetate (MPA), alongside either CAB-LA or oral PrEP. 

Researchers measured drug concentrations at enrolment and again at weeks 25, 49, and 73 to determine if there were any drug interactions. The results were reassuring: plasma concentrations of the contraceptives remained high enough to prevent pregnancy in both the CAB-LA and oral PrEP groups. 

CAB-LA concentrations were also consistent across contraceptive types, indicating that CAB-LA does not interfere with contraceptive effectiveness. However, tenofovir concentrations were unquantifiable for most participants, regardless of contraceptive type, due to low adherence to oral PrEP.

New data on the three-month vaginal ring

For women seeking long-term HIV prevention, the dapivirine vaginal ring, sometimes called the PrEP ring, has been a promising option. This is a flexible silicone ring that is placed in the vagina that releases the anti-HIV drug, dapivirine, over a month.

Delegates at the conference heard results from a South African study comparing the bioavailability of the standard one-month dapivirine ring with a new three-month version.

The study enrolled 124 women, but only 104 completed the trial. This was a crossover trial with two treatment phases: half the group started with the one-month ring (containing 25 mg of dapivirine) and then switched to the three-month ring, containing 100 mg of dapivirine. The other group followed the reverse order; they began with the three-month ring and later switched to the one-month ring.

The three-month ring was identical to the one-month version in silicone, dimensions, and appearance. Plasma and vaginal fluid samples were collected throughout the study to measure drug levels.

Based on dapivirine concentrations in plasma, results showed that the three-month ring provided greater overall drug exposure than the one-month version, indicating equal or possibly higher efficacy in preventing HIV.

Jeremy Nuttall from the Population Council’s Center for Biomedical Research, who presented the findings, noted that the reduced frequency of ring changes might increase acceptability and adherence, potentially improving overall effectiveness. 

He also highlighted that the estimated cost of the three-month ring is $16, making it a potentially more affordable option, projecting that the three-month ring could become available on the market by 2026.

Roxana Bretoneche protesting about the lack of community participation at HIVR4P.

Real-world results from Zambia’s CAB-LA rollout

Zambia became the first country in sub-Saharan Africa to roll out long-acting injectable PrEP (CAB-LA) beyond clinical trials, sharing results from their first three months (February to April 2024) in real-world settings. 

A total of 609 individuals with a median age of 24 were enrolled across six health facilities in two districts. Among the clients, 55% were female, 20% were adolescent boys and young men, 7% identified as key populations, and 40% as other high-risk populations.

Adamson Ndhlovu from Zambia’s JSI USAID DISCOVER-Health Project shared that over 90% of participants due for their second injection received it on time. 

A total of 24 participants (about 4%) discontinued CAB-LA. Most discontinuations were due to hepatitis B (20 cases), with two participants stopping due to pregnancy, one due to a severe rash, and one because of severe pain at the injection site. Those who discontinued were switched to oral PrEP.

During a press briefing at the conference, Professor Lloyd Mulenga from Zambia’s Ministry of Health stated that four of those enrolled had acquired HIV, explaining that they likely had undetected HIV at the time they started PrEP.

The real-world implementation of CAB-LA is anticipated to expand, as ViiV Healthcare, the manufacturer, announced at the conference its plans to triple the supply of cabotegravir that will be available for low- and middle-income countries in 2025-2026 to at least two million doses.

 

Image Credits: Nicole Bergman / IAS, Gilead, Nicole Bergman / IAS.

Dr Jean Kaseya, Africa CDC Director General, accused the US of creating panic around Rwanda’s Marburg outbreak.

The Africa CDC has slammed the US government’s recent Level 3 travel advisory for Rwanda as unfair and baseless, arguing it undermines Rwanda’s proactive efforts to contain a Marburg outbreak. With rapid testing, vaccinations, and coordinated emergency response measures in place, Rwanda’s leaders insist the country poses no international threat and warn that travel restrictions could stoke panic and discourage transparency in future health crises.

Dr Jean Kaseya, Director General of Africa CDC, called the US decision “unfair” during a press briefing Thursday, accusing Washington of creating unnecessary panic. On October 7, state department increased the advisory level from 2 to 3, with the caveat to “reconsider travel in Rwanda due to an outbreak of Marburg Virus Disease”.

New US travel advisory on Rwanda, issued 7 October 2024.

Kaseya emphasized that Rwanda had taken a transparent and comprehensive approach to controlling the Marburg outbreak, which was declared on September 27.

“Rwanda collaborated with all partners, including the U.S., to show that there is no risk of spreading this disease,” he stated. He pointed to the country’s proactive measures, such as stringent screening processes at Kigali International Airport, effective contact tracing, and cross-border surveillance, as evidence of Rwanda’s commitment to preventing international transmission.

The press conference also featured remarks from Rwanda’s Minister of Health, Dr. Sabin Nsanzimana, who detailed the country’s rapid response efforts, which include intensive testing, vaccination campaigns targeting healthcare workers and high-risk groups, and the use of multiple therapeutic options. “We are working closely with partners across the world… although this is the most dangerous virus in the world, we came up stronger to respond,” said Nsanzimana.

Marburg outbreak, mapping both cases and location of contacts as of 2 October.

Rwanda has so far confirmed 58 cases of Marburg virus disease, with a case fatality rate (CFR) of 22%.  While that is four to five times higher than the average CFR of COVID in the first six months of the pandemic, it is significantly lower than the fatality rate of previous Marburg outbreaks in other parts of the Africa region, Nsanzimana contended.

Historically, the case fatality rate of Marburg has averaged 50%, according to WHO, although it has varied between 24-88% in different outbreak contexts.  The virus, which causes haemorrhagic fever, is in the same family as the virus that causes Ebola virus disease. Bats are regarded as a key virus reservoir.  

Rwanda’s use of advanced therapeutics and vaccine trials

Nsanzimana attributed the relatively low fatality rate to the country’s early detection of cases, rapid isolation protocols, and the administration of supportive treatments, such as antiviral drugs and monoclonal antibodies, administered to critically ill patients.

“The earlier you detect, the better the outcome,” he noted, underscoring the importance of prompt diagnosis and immediate response.

Marburg Rwanda
Rwandan Minister of Health, Sabin Nsanzimana speaking at the Africa CDC press briefing on Thursday.

Rwanda has also already administered over 200 doses of an investigational Marburg vaccine developed by the Sabin Vaccine Institute, he revealed. The vaccination campaign, which began this week, prioritizes healthcare workers and individuals in close contact with confirmed cases. The minister announced plans to expand the vaccination effort to additional high-risk groups in collaboration with international partners. “Our aim is to vaccinate as many people at risk as quickly as possible,” he added.

Despite the positive strides made, Nsanzimana acknowledged the need for more vaccine doses and indicated that Rwanda is actively working to secure additional supplies to protect healthcare workers and communities.

Rwanda has adopted an open-label approach to the vaccine trial to expedite protection for at-risk groups, Nsanzimana said. But due to the deadly nature of the disease, the initial protocol does not include a delayed-arm trial, but plans are in place to expand the study and consider alternative methodologies as more data becomes available.

“Our focus now is on saving lives and preventing transmission. We can explore more complex trial designs as we move forward,” he said.

Criticism of travel bans

Amid growing concerns about travel restrictions, both Kaseya and Nsanzimana argued that imposing travel bans is counterproductive during outbreaks, as they may deter transparency and international collaboration. “Let us be guided by facts and science,” Nsanzimana stated, pointing out that Rwanda’s efforts to contain the virus should be viewed as a model rather than grounds for punitive measures. Kaseya added that the country’s centralized emergency response system and comprehensive cross-border surveillance demonstrate its preparedness and should be encouraged, not penalized.

The Africa CDC chief emphasized that travel advisories based on limited evidence could harm not only the affected country but also the global community by discouraging other nations from reporting outbreaks in a timely manner. He disclosed that following discussions, the U.S. government had agreed to consult with Africa CDC before issuing any future travel-related advisories regarding the continent. “We need to ensure that decisions are based on evidence and consultation with local health authorities,” Kaseya said.  US officials have also praised Rwanda’s rapid outbreak response, in comments like one from Rwanda’s US Amassador Eric Kneedler on X, who called it a “model” for the region. 

Strengthening cross-border cooperation and surveillance

Kaseya and Nsanzimana also highlighted the need for cross-border cooperation and surveillance efforts aimed at containing the Marburg virus and preventing regional spread. Kaseya announced that Africa CDC is deploying rapid diagnostic testing and bolstering surveillance capabilities in neighboring countries to ensure that any potential cases are quickly identified and isolated. He revealed that more than 5,000 test kits have already been distributed to high-risk areas, and plans are underway to establish rapid testing stations at key border points.

Rwanda also revealed it has set up a centralized emergency response center that integrates all relevant services, including health workers, the military, police, and ambulance services. This coordinated approach, the minister said, allows for rapid deployment of medical personnel and other resources across the country. “The mechanism they put in place is impressive,” Kaseya said. “When a call comes in, they can locate an ambulance anywhere in the country, not just in Kigali, and deploy personnel quickly.”

Ongoing mpox outbreak: a public health concern

Roundup of mpox cases in the African region.

At the briefing, Kaseya also stressed that the ongoing mpox outbreak remains a significant public health issue across the continent, with 3,186 new cases and 53 deaths recorded during the last week of September across Africa. The Democratic Republic of Congo (DRC), Nigeria, Uganda, and other nations are grappling with the virus, which continues to spread due to limited testing capabilities and low vaccination rates. Neighboring Republic of Congo, reported its first mpox case in the capital of Brazzavile, after six weeks of no case reports.. 

The lack of sufficient laboratory infrastructure was highlighted as a major challenge in countries like Liberia and the DRC, where low testing rates hinder accurate tracking of the outbreak. “The outbreak is still there, still increasing, and we need to stay focused to stop it,” Kaseya warned, urging affected countries to prioritize improving laboratory capacity and access to diagnostics.

Mpox vaccination campaigns underway in DRC

During the briefing, officials provided updates on the mpox vaccination rollout in the DRC, where a campaign targeting high-risk regions commenced on October 5. The first phase has seen 1,654 individuals vaccinated in DRC’s eastern regions such as North Kivu, South Kivu, where M23 militias control much of the territory. Kaseya acknowledged the logistical challenges faced during the rollout, particularly the distribution of vaccines to remote and conflict-prone regions. He commended the DRC government for prioritizing vaccination in areas with the highest burden of cases and reiterated Africa CDC’s commitment to supporting similar efforts in other affected countries, including Nigeria and the Central African Republic.

Calls for solidarity

Calling for greater regional and global solidarity in the fight against disease outbreaks, Kaseya and Nsanzimana both emphasized that health crises in one region can quickly affect others. 

In addition to pressing the US to lift its Level 3 travel advisory, the Africa CDC director repeated his commitment to working with the WHO and other partners to strengthen outbreak response systems across the continent.

This includes pushing for the finalization of a global pandemic agreement that would accelerate knowledge transfer, ease intellectual property restrictions on developing countries’ use of new and patented drug formulations, and facilitate local manufacturing of vaccines and therapeutics in Africa.

“The travel ban is not a solution,” Kaseya stated, calling for continued collaboration and evidence-based decision-making. “Let us continue to work in solidarity. We are one planet, and we must face these challenges together.”

Image Credits: Africa CDC, US State Department , WHO, Africa CDC .

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

Governments worldwide allocated almost $700 million (15%) more international development aid to fossil fuel expansion in 2022 than to projects improving better air quality – which typically also promote green energy and reduce climate emissions, according to a new report from the Clean Air Fund.

This marks a sharp reversal from 2021 when international aid from governments, bilateral development agencies, and multilateral development banks for clean air initiatives briefly overtook the investments in fossil fuel development.

The latest data also shows aid for fossil fuel expansion has more than quadrupled, rising from $1.2 billion to $5.4 billion in just one year.  Although investments in clean air projects nearly doubled, from $2.4 to $4.7 billion, the net result was that fossil fuel investments regained the historic lead once more – in terms of global development priorities. 

International aid for fossil fuel development as compared to projects that improve air quality over five years.

The new CAF analysis hones in on international aid funding that is targeted to addressing outdoor air pollution in comparison to fossil-fuel prolonging investments, says Merel Krediet, one of the report’s authors. “This outdoor air quality funding hones in on projects that explicitly target air pollution,” she said.

A separate analysis looks at climate investments in clean energy and transport systems that may  have implicit air quality co-benefits – even though air quality is not cited as a project objective.  On a brighter note, this latter category may in fact be quite large, amounting to as much as $27 billion in 2022, and $94 billion between 2018-2022, according to the CAF analysis. The assessment was based on review of an OECD investment data base, and other climate investment data.

Even so, Jane Burston, CEO of the Clean Air Fund (CAF), described the “shocking increase in aid funding to fossil fuels” as  “a wake-up call”. 

“The world cannot continue down this path of propping up polluting practices at the expense of global health and climate stability. We need to see a drastic shift towards supporting clean air initiatives and debt-free aid to communities who need it most,” said Burston.

CAF warns that the problem is compounded by the structure of the clean air aid, with 92% of funding towards air quality initiatives provided as loans, while only 6% is allocated as grants. 

“This loan-heavy model would place an unsustainable burden on low-income, heavily polluted countries that cannot afford to take on additional debt,” said CAF in a statement on Thursday.
“This stands in stark contrast with other areas of international development funding  such as healthcare and education. On average, 63% of official development assistance is funded as grants.”

Significant proportion of deaths from air pollution are attributable to fossil fuel emissions

Smoking chimneys air pollution
Power plant running on fossil fuels emits air pollution over a city skyline. A large proportion of air pollution-related deaths are due to fossil fuel emissions.

A significant proportion of the estimated 8.3 million annual deaths caused by outdoor air pollution globally are attributable to fossil fuel emissions – and over half according to some of the most recent estimates. Despite this, governments continue to channel aid into fossil fuel prolonging and expanding projects, while clean air initiatives receive less than 1% of available ODA funding, overall. 

Toxic air also carries immense economic costs, with the combined impact of premature deaths, lost productivity, and healthcare expenses for diseases like cancer, heart disease, and dementia running into trillions of dollars each year. The World Bank estimates this “dirty air tax” drains around 6.1% of global annual GDP.

Report on ‘dirty air’ ODA investments come ahead of COP29 discussion of new goals for climate finance

These findings come just ahead of the upcoming UN Climate Conference (COP29) in Baku, 11-22 November, where negotiators are expected to focus significant attention on climate finance goals.  At the conference, leaders and negotiators will reassess international funding strategies and attempt to hammer out a “New Collective Quantified Goal (NCQG)” for accelerating climate finance. 

CAF and other clean air advocates want to seize the moment to secure commitments on increased air quality funding –  with an emphasis on providing grants instead of loans to already heavily-indebted low- and middle income countries.”

There is also a need to address the significant inequalities seen in funding for low-income countries, particularly in sun-rich regions of Africa and the Middle East, and some middle- or upper-middle-income states in Asia, Europe and Latin America.

“There are wide ‘funding deserts’ because funding is spread unevenly across regions,” the report states. For example, outdoor air quality funding for every country in Africa and the Middle East was only a third of the funding channelled to one Asian country, the Philippines ($1.5 billion versus $4.7 billion from 2018 – 2022).”

Over the same period, low-income countries such as Chad and Somalia receive much less funding than upper middle-income countries such as Serbia and Costa Rica: $2 versus $73 of overall air quality funding per capita.

 “Even as countries pledge to reduce their emissions, increase their climate change ambitions and transition away from fossil fuels, the figures tell a different story,” said Adalberto Maluf, National Secretary of Urban Environment and Environmental Quality in Brazil,” in a comment on the report’s findings. 

“International public funding does not come close to meeting the scale of the challenge or unlocking the significant opportunity of investment in air quality. What funding exists often does not reach the most affected geographies, communities and vulnerable people. It doesn’t have to be this way. 

“Brazil, as G20 chair and the incoming COP Presidency, is proud to be championing another vision for the planet: one where humans and nature co-exist in harmony, where we respect the environment we are blessed with, and where economic prosperity doesn’t come at the expense of our health and wellbeing.”

Barbara Buchner, Global Managing Director of Climate Policy Initiative, which co-authored the report, said: “Air pollution and climate change are driven by the same root causes, and share the same solutions. Directing limited public funds towards fossil fuel projects and subsidies is locking in harmful emissions for decades to come. International aid and climate finance should prioritize initiatives that improve air quality, delivering significant health, economic, and climate benefits.”

  • Elaine Ruth Fletcher contributed reporting to this story.

Image Credits: INGImage, WHO/Diego Rodriguez, Clean Air Fund.

(L-R) WHO’s Yvan J-F. Hutin, Mateusz Hasso-Agopsowicz and Martin Friede, launch new report quantifying how vaccines could reduce deaths from drug resistant pathogens.

Better use of existing pneumonia and typhoid vaccines as well as new TB and pneumonia vaccines that are currently in clinical trials, could save over half a million deaths annually from drug resistant pathogens that don’t respond to antibiotics, according to a new WHO report on how vaccine strategies can reduce antimicrobial resistance (AMR).

And over a longer term, better use of existing vaccines as well as the development of new vaccines against 24 deadly pathogens could reduce the number of antibiotics needed by 22% or 2.5 billion defined daily doses globally every year, supporting worldwide efforts to address AMR, according to the report, published on Thursday.

“Antimicrobial resistance in reality, is a sort of a race between the microbes or the bugs that are getting smarter to evade the antimicrobials, with the antibiotics and the new medicines,” said Yvan J-F. Hutin, Director of Surveillance, Prevention and Control, AMR Division, WHO, at a press conference on Thursday discussing the report.

Along with more judicious use of available drugs, preventing diseases from ever occurring is a critical AMR strategy, he added. And along with better water, sanitation and hygiene, vaccination is an important, but oft-overlooked AMR prevention tool.

“Within the prevention pillar, vaccination is really important,” Hutin said. That means, “using the vaccines that we have today to increase the coverage, and pushing the vaccines that are close to the finish line, in terms of research and development, like TB, and having the vision to say that for certain pathogens, certain microbes, we don’t have the vaccine yet, but it would make a lot of sense to have this these vaccines.”

Prioritizing vaccine development to prevent AMR deaths, as well as deaths from the disease

Guatemalan infant immunized against Haemeophilus influenze (Hib) – wider Hib vaccination can help combat development of AMR down the road.

“We’ve known for many years that vaccines could play a role in controlling or contributing to the control of antimicrobial resistance, but we haven’t, up until today, been able to say which vaccines and what the impact really could be,” added Martin Friede, Head of the Product & Delivery Research team, within WHO’s Department of Immunization, Vaccines and Biologicals.

“Vaccines have been developed for the last 50 years based on the prioritization,.. of deaths that happened due to that pathogen,” he added.  But that ignored the ancillary effect of pathogen drug resistance when people became ill, and antibiotic treatments failed. “This latest report, however, adds in the element of avoidable deaths from drug resistant pathogens. So now we have a new metric against which we can incorporate into our prioritization methodologies and say, well, not only can we prevent deaths due to the pathogen, but we can prevent antibiotic use.

“We have a good start citing point which to say, these are the vaccines, these are the pathogens where we would have the greatest impact,” on reducing AMR.

There are an estimated 1.13 million deaths annually due to drug resistant pathogens – and more than five million deaths overall are attributable directly indirectly to AMR, according to the latest WHO research.

The report estimates that wider use of already available vaccines against Haemophilus influenzae type B (Hib), a bacteria causing both pneumonia and meningitis, as well as typhoid vaccines could avert up to 106 000 of the deaths annually associated with the development of AMR from antibiotic use when unvaccinated children and adults become ill.

Benefits of wider use of available vaccines, in terms of AMR-related deaths, illness and disability avoided.

Every year, vaccines against Streptococcus pneumoniae could save 33 million antibiotic doses, if the Immunization Agenda 2030 target of 90% of the world’s children were vaccinated, as well as older adults. Vaccines for typhoid could save 45 million antibiotic doses, if their introduction was accelerated in high-burden countries.

And wider application of brand new malaria vaccines now being rolled out, could save up to 25 million antibiotic doses, which are often misused to try to treat malaria, which is caused by the Plasmodium falciparum parasite and other related strains, not a bacteria.

Tuberculosis vaccines would make a major dent in AMR deaths

Health worker visits a patient’s home in Peru to provide TB treatment. MDR-TB is a growing problem making many drugs ineffective for treatment.

TB vaccines could have the highest impact once experimental vaccines  now in clinical trials are approved and widely available, the report finds.  That’s a particular priority given the widening arc of multi-drug resistant forms of TB. Administration of 1.2-1.9 billion antibiotic doses could be averted – a significant portion of the 11.3 billion doses used annually against the diseases covered in the report. Nearly 200,000 more deaths associated with AMR could thus be averted annually.

AMR related deaths, illness and disability that could be avoided from vaccines in late-stage R&D.

Further down the line, vaccines for other deadly pathogens such as Klebsiella pneumoniae, in early stage development could save several hundred thousand more lives, once they are available.

Vaccines could significantly reduce the substantial economic costs of AMR

Globally, the hospital costs of treating resistant pathogens evaluated in the report are estimated at US$ 730 billion each year. If vaccines could be rolled out against all the evaluated pathogens, they could save a third of the hospital costs associated with AMR, the report’s authors also concluded.

“The actual cost of treating these infections is incredibly high, $730 billion every year,” Hutin said. “And what we have found that if we put together all the vaccines that we had evaluated, if we have a scenario that they could be widely used, that reaches those people who need these vaccines, that could avert up to a third of these costs, so quite a large, substantial, quite a large proportion that could contribute to reduction of AMR.”

 

Image Credits: Twitter:@WHO, UNICEF 2024 , WHO , WHO PAHO.

Heavy metals from bombs, such as those Russia is using against Ukraine, are poisoning environments in conflict zones and fueling AMR.

Conflict is a “bio-incubator” of anti-microbial resistance (AMR) yet this is not being recognised or addressed sufficiently, according to Professor Richard Sullivan.

Drug-resistant pathogens thrive in war wounds that are treated in sub-optimal conditions and in environments contaminated by heavy metals from bombs, said Sullivan, who is co-director of the Centre for Conflict and Health Research at King’s College in London.

The risk is huge with around 30% of the global population – 2.4 billion people – currently living in conflict zones, Sullivan told an event hosted by the Geneva Graduate Institute’s Global Health Centre on Wednesday.

Sullivan, who is a surgeon, said he frequently saw patients with dirty shrapnel wounds that took a long time to heal.

“Studies of surgical site infections in most conflict situations found that 70-80% are contaminated with multi-drug-resistant organisms,” he added.

Current conflict – Gaza, Sudan and Ukraine – involves “the increasing use of heavy munitions, and fighting in built-up areas”, which is causing “extraordinary toxification of the environment”, said Sullivan.

“Every single day, about 5,000 to 6000 155 millimetre shells are dropped on Ukrainian or Russian lines. These contain about 10 kilograms of RDX TNT and they contaminate the grounds with heavy metals – and that is just the shells, never mind all the propellant contamination that’s going on from the other types of weapons,” said Sullivan.

These heavy metals cause cell mutations in pathogens that help to drive AMR within the environment. 

Dr Kefas Samson from the WHO’s AMR Division said that the impact of AMR – estimated by The Lancet to have caused five million deaths in 2019 – was likely to be under-estimated because it is hard to collect data in war zones.

Meanwhile, Sullivan added that there were a “lot of implementation gaps” to prevent AMR in wars zones, including better training of health workers to “debride wounds” (remove dead and infected flesh), and provision of kits for infected wounds.

Implementing the UN Political Declaration

Despite the huge role of conflict in AMR, this is barely acknowledged in the United Nations Political Declaration on AMR adopted at the High-Level Meeting on AMR last month.

What the Declaration does do, however, is empower the Quadripartite Alliance – the Food and Agricultural Organisation (FAO), World Health Organization (WHO), World Organisation of Animal Health (WOAH) and the UN Environment Programme – to oversee the implementation of the declaration.

WHO’s Samson said that the Quadripartite’s priority is to support member states to deliver on the declaration – the most concrete aim of which is to reduce AMR deaths by 10% by 2030.

The declaration also charges the Quadripartite with setting up an independent panel to conduct research on AMR by the end of 2025, but the mechanics of this still need to be worked out with member states, said Samson.

No targets for ‘contentious issues’

Member states declined to set targets for certain “contentious issues” because they asked for evidence, added Samson – something that the independent panel needs to address.

A huge gap in the declaration is the failure of member states to commit to a target on reducing the use of antibiotics in the agricultural sector – where 80% are consumed.

“There are commitments in terms of strengthening global governance, there are commitments in terms of financing. There are commitments for health sector targets, for the animal health sector, health sector targets, and agriculture and the environment,” said Samson.

He added that, unlike geopolitical difficulties hampering other multilateral negotiations, there was “some unanimity within the international community and member states to see AMR as a real threat to global health, which requires very urgent actions”.

Ambassador Matthew Wilson from Barbados

Saudi Arabia hosts a Global High-Level Ministerial Conference on AMR on 15-16 November to discuss the implementation of the declaration, and how to raise the $100 million target to assist countries to develop plans to mitigate AMR.

However, Barbadian Ambassador Matthew Wilson described this amount as “modest”, and likely to be just enough to “catalyze the achievement of at least 60% of countries having achieved funded plans by 2030”.

Damien Somé from the Global Antibiotic Research & Development Partnership (GARDP) said that another massive challenge is the “dry pipeline” – only a handful of pharmaceutical companies are investing in finding new antibiotics.

Substantial investment was needed in R&D to find new antibiotics, added Somé.

Image Credits: UNDP.

Helen Rochford-Brennan
Helen Rochford-Brennan

Helen Rochford-Brennan, a 72-year-old Irish woman living with Alzheimer’s, was first diagnosed at 57, with a more complete diagnosis following five years later. At the time, there were no life-enhancing medications, leaving her to face the grim reality of her brain’s gradual decline, enduring what she described as “many dark days.”

“Imagine having a new medication,” Rochford-Brennan said. “My quality of life when I was diagnosed would have been improved. Right now, I have to work really hard to make my life joyful.”

Since her diagnosis, Rochford-Brennan has become a vocal advocate for early detection and access to transformative treatments for people with dementia. She told Health Policy Watch that if existing treatments aren’t approved across all OECD countries or remain available only to the wealthy, it would constitute a human rights violation.

“I need to know that everyone is going to have access,” she emphasised.

Alzheimer’s currently affects over 55 million people worldwide, costing the economy more than $1.3 trillion each year – or more than $15 trillion in a single decade. By 2050, the number of people with Alzheimer’s is expected to nearly triple.

“The world has never thought of the brain as an organ of the body that should be subject to health prevention and research,” said George Vradenburg, founding chair of Davos Alzheimer’s Collaborative (DAC). “The world needs to focus on brain health because it is so central to so much cost and suffering around the world.”

Davos Alzheimer’s Collaborative Founding Chairman George Vradenburg
Davos Alzheimer’s Collaborative Founding Chair George Vradenburg

In 2013, the G8 (now G7) pledged to stop Alzheimer’s by 2025, with a goal to make disease-modifying treatments widely accessible by then. As 2025 approaches, there has been significant progress in early detection, expanding research, and developing therapies. However, DAC stressed in a statement that more needs to be done to ensure fair access to these treatments worldwide, along with greater global investment to tackle this growing health crisis.

To advance these efforts, DAC, along with the European Brain Council, the Global CEO Initiative on Alzheimer’s Disease, the Associazione Italiana Malattia di Alzheimer, and Fondazione Prada, hosted a side event at the G7 Health Ministerial Meeting in Italy. It focused on accelerating cooperation in research, healthcare readiness, and access to innovative treatments.

During the event, organisers called on G7 leaders to address the urgent global challenge of Alzheimer’s and dementia by taking bold steps to ensure widespread and equitable access to life-extending therapies and the latest innovations.

The choice to hold the event in Italy was significant, noted Vradenburg, as Italy has the second-oldest population in the world. By 2050, more than a third of its people will be 65 or older. Currently, 44% of Italians in that age group report memory loss or other cognitive issues as major problems.

George Vradenburg, founding chairman of Davos Alzheimer's Collaborative, speaks at an event in Italy on October 8, 2024.
George Vradenburg, founding chair of Davos Alzheimer’s Collaborative, speaks at an event in Italy on 8 October, 2024.

The event brought together global health ministers, leaders in public health, and experts in dementia and Alzheimer’s. Key participants included OECD Deputy Secretary-General for Health Yoshiki Takeuchi, Charlotte Refsum from the Tony Blair Institute (TBI), UK Dementia Task Force Co-Chair Hilary Evans, US White House Global Health Security Coordinator Stephanie Psaki, and Japan’s Counsellor for Dementia Policy Planning, Yoshimasa Tosaka.

“OECD countries must lead by example by placing dementia higher in the policy agenda,” Takeuchi emphasised. “We must work together to address diagnosis challenges, improve quality of care and support efforts in monitoring outcomes for people with dementia, while continuing to promote research and development for innovative treatments which make a difference in the lives of people with dementia.”

At the event’s conclusion, the partners issued five specific calls to action for G7 governments:

  • Expand global and cross-sector collaboration: Strengthen partnerships between governments, private sectors, scientific communities, philanthropic organisations, and others to foster innovation in dementia research.
  • Invest in healthcare system preparedness: Equip healthcare systems with the resources and capabilities needed to use the latest tools, from cognitive screening and early detection to accurate diagnosis and effective treatment and care.
  • Improve early detection and diagnosis: Build the capacity to detect cognitive impairment early and provide accurate diagnoses, utilising blood-based biomarkers and other technologies starting at the primary care level.
  • Accelerate Alzheimer’s treatment development and delivery: Speed up the creation and distribution of therapies, including new disease-modifying drugs and immunotherapies.
  • Promote global research, access, and equity: Conduct research across diverse populations and develop strategies that work for countries at all resource levels.

A growing global challenge

Alzheimer’s is a neurodegenerative disease that worsens over time, starting with physical changes in the brain, such as the build-up of toxic amyloid plaques, which can occur up to 20 years before symptoms become apparent. Currently, it can take up to two years for a person to receive a diagnosis, and many countries still lack access to the latest diagnostic tools for detecting cognitive impairment.

New treatments are emerging. FDA-approved drugs like Leqembi, for mild dementia, and Kisunla, for early-stage Alzheimer’s, are now available in countries such as the US, UK, Japan, Hong Kong, the UAE, China, and Israel. However, European regulators have rejected both drugs, leaving most European citizens without access.

“Science and industry are starting to deliver groundbreaking, disease-modifying therapies, and more are on the way,” said Vradenburg. “Now we need to ensure these innovations reach the families who need them.”

He urged G7 nations to lead the way by boosting Alzheimer’s research funding and developing healthcare models that ensure early detection, diagnosis, and treatment are universally and equitably available to all, regardless of income.

Vradenburg also criticised the European Medicines Agency for rejecting the drugs, pointing out that, according to the European Commission, over 20% of the EU’s 448.8 million people are 65 or older.

“Decisions about these medications should be made between patients and their doctors, not by bureaucrats in Brussels,” he said, referencing concerns over potential side effects. “Patients should be informed of the risks and benefits and decide for themselves—not the government.”

Push for preventative healthcare

At the event, TBI’s Charlotte Refsum advocated for greater investment in preventative healthcare. She told Health Policy Watch that while people in developed countries are living longer, they aren’t necessarily living in good health. This leads to a growing financial strain on healthcare systems, with increasing costs and a shrinking tax base as more sick people leave the workforce.

“We all know prevention is a good idea, but we are trying to convince governments of its economic necessity,” Refsum said.

She explained that many governments see healthcare spending as a “black hole.” However, TBI’s stance is that not all health spending is equal, and investing in prevention can yield significant returns compared to funding more hospitals or treatments.

Refsum also highlighted the importance of delivering preventative care through innovative, non-traditional means. Instead of relying solely on general practitioners or family doctors, she suggested providing support where people already are—online, at home, or in their communities.

“We have to think about different models of care that make better use of pharmacies, gyms, workplaces, and other local resources,” she said.

The Lancet Commission on Dementia estimates that addressing risk factors like smoking, high blood pressure, high cholesterol, obesity, and inactivity can reduce dementia risk by up to 45%.

Refsum pointed to New Zealand’s CBAX tool, a spreadsheet model with a database that helps agencies monetise impacts and conduct cost-benefit analyses. In the health sector, this tool is being used to assess people’s risk factors for certain life events, justifying investment in areas like children’s and young people’s health.

“This is a good example of using data to target prevention more effectively,” Refsum said.

Helen Rochford-Brennan (far right) participates in the "Advancing Global Collaboration for Dementia and Healthy Aging" event on October 8, 2024.
Helen Rochford-Brennan (far right) participates in the “Advancing Global Collaboration for Dementia and Healthy Aging” event on October 8, 2024. Other members of the panel include from left: Drew Holzapfel of the Davos Alzheimer’s Collaborative; Yoshimasa Tosaka of the Ministry of Health, Labour and Welfare of Japan; Hilary Evans-Newton of Alzheimer’s Research UK; and Howard Bergman of McGill University.

Rochford-Brennan also expressed hope that the conference would inspire G7 countries to listen to the needs of dementia patients and invest not only in treatments but also in the infrastructure surrounding detection, care, and ongoing support.

“The cost would be so much less if newly diagnosed people could stay at work, continue their lives, and have another 20 years of productive living,” Rochford-Brennan said. “There are so few countries in Europe with a dementia plan. We need to ensure healthcare systems provide early diagnosis and long-term, individualised support.”

Image Credits: Courtesy of Helen Rochford-Brennan, Courtesy of the Davos Alzheimer’s Collaborative, Courtesy of the Davos Alzheimer's Collaborative.

Palestinian children being getting the oral polio vaccine during the first phase of vaccinations in northern Gaza in September.

The second round of polio vaccinations for Gaza’s children are due to begin on Monday – but the World Health Organization’s (WHO) Eastern Mediterranean Region (EMRO) is assessing whether it may be affected by Israel’s renewed military activity in northern Gaza, including evacuation orders for three hospitals over the past 48 hours.

WHO EMRO officials appealed to Israel for a “humanitarian pause” to enable it to complete its polio vaccination campaign at a media briefing on Tuesday.

The first polio case in Gaza in 25 years was identified in a 10-month-old baby in August and the virus has also been detected in wastewater samples. In response, the WHO launched a mass vaccination campaign last month, which reached some 540,000 children under the age of 10 – 90% of all kids in this age group.

However, these children need a second polio vaccine within four weeks.

Dr Rick Brennan, EMRO’s regional emergency director, said that the WHO was still trying to determine how Israel’s new evacuation orders, for both the hospitals and various parts of the territory, would affect the polio vaccination campaign.

“Of course, what we need to successfully conduct the campaign is a pause in military operations. We were able to get that temporary pause for the previous round and we need that again,” said Brennan.

He added that it was “absolutely vital” to both complete the second round of vaccinations and get the cooperation of the relevant authorities to do so.

Dr Rick Brennan, WHO EMRO’s regional emergency director

“We’re working on it very hard right now,” he added.

The WHO has planned its vaccination campaign in three phases – in southern, central and northern Gaza. Brennan estimates each phase will take three days, with an extra day or two to find children who have missed out.

“We’re using a broad combination of measures: vaccinating kids in health facilities, sending teams out to communities, and working with community members to ensure that children are brought to sites where vaccinations are going on.”

Unlike the first vaccinations, children will also get vitamin A. 

“Vitamin A is very important for the immune system, particularly with the high level levels of food insecurity, with 96% of the population in Gaza at crisis levels of food insecurity,” said Brennan, describing “significantly increased rates of acute malnutrition in kids under the age of five”.

Extensive damage to population and health facilities

WHO EMRO regional director Dr Hanan Balkhy

Less than half of Gaza’s hospitals are functioning due to “damaged infrastructure, lack of fuel, supplies and human resources, and ongoing attacks”, EMRO regional director Dr Hanan Balkhy told the briefing.

Of the 15,600 requests for medical evacuations, only 5,130 have been approved, “leaving thousands of Gazans stranded without essential care”, she added.

“Twelve months of conflict in Gaza has resulted in 6% of the entire population killed or injured. Many of the injured are women and children who now face lifelong disabilities,” Balkhy said.

“Ninety percent of Gaza’s population is displaced and living in overcrowded shelters with limited access to food, water, or health care. And they are repeatedly on the move, with further evacuation orders issued over the past few days,” she added.

Describing health service delivery under such circumstances as “daunting”, Balkhy paid tribute to the health workers of Gaza “who continue to work heroically under unimaginable conditions”.

Almost 1000 health workers have been killed in the year-long conflict, according to the Gaza Health Ministry, while 289 United Nations staff  have also lost their lives in “one of the most dangerous places in which the UN and partners operate”, said Balkhy.

“For the past 12 months, WHO and its partners have repeatedly called for an end to the conflict in Gaza. However, the situation continues to escalate in the occupied Palestinian territory and across the region,” she added.

She also expressed “extreme concern” about the escalation of violence in Lebanon, with “almost 12,000 people killed or injured, and more than 540,000 people internally displaced”.

The WHO EMRO, one of the most conflict-ridden regions of the world where an estimated one in six people need humanitarian assistance, holds its annual regional committee meeting next week.

Image Credits: WHO.