WHO Director-General Dr Tedros Adhanom Ghebreyesus with Hanan Balkhy of Saudi Arabia, taking the oath as the new WHO Eastern Mediterranean Regional Director.

The World Health Organization’s (WHO) executive board confirmed the appointment of three new regional directors on Tuesday, which are both controversial and historic.

The election of Saima Wazed,  the daughter of Bangladesh’s prime minister, to lead the South-East Asia region has already been mired in allegations of nepotism.

Tonga’s Dr Saia Ma’u Piukala steps into his role as the head of the Western Pacific office, following his predecessor’s dismissal for alleged racism. He has his work cut out in the region with many small-island nations weathering climate impacts, and the added pressure to restore trust among the staff in the regional offices.

The Eastern Mediterranean has its first female leader in Hanan Balkhy of Saudi Arabia. Balkhy takes charge as the region is experiencing a staggering humanitarian crisis in Gaza which has left over 25,000 dead, and in Sudan where an estimated 11 million people are in need of urgent healthcare.

The three regions are home to around 60% of the world’s population and face a range of health challenges from climate change to infectious disease as well as conflict, making the appointments critical in the delivery of healthcare.

WHO Director-General Tedros Dr Tedros Adhanom Ghebreyesus remarked that it was the first time a high-profile post was being transferred from one woman to another, as Wazed took over from India’s Poonam Khetrapal, who was the first woman in the post of South-East Asia’s Regional Director.

“The success of this organization depends on close collaboration, co-operation, co-ordination, and trust between headquarters and the regional offices and country offices,” Tedros said, assuring the new directors all the support they needed from him as well as the colleagues in the WHO offices.

While the elections for the regional directors were conducted last year, the appointments were confirmed at the ongoing 154th executive board meeting of the world health body that will continue until Saturday.

The new appointees spell out priority areas

All three appointees spelt out their priority areas for their region reflecting the health challenges the countries in their region face, as they took charge.

Balkhy said her region had a large number of displaced populations, with both strong and fragile economies. “We aim to enhance end-to-end supply chains, ensuring essential medicines and supplies reach all populations, not an easy task for many in the region. Additionally, we will foster collaborations to build skilled and sufficient health workforce to serve diverse populations across the regions,” she said.

Wazed highlighted improving mental health awareness and services as one of her key priority areas, along with women and children. “I look forward to devising and implementing specific interventions for women and children, including pregnant women. This will be created with education, empowerment and prevention in mind, structured with the life course approach,” she said.

In his emotional speech, Piukala said that his journey from a small island to his current role showed that everyone can have something to contribute. He listed strengthening primary healthcare as a key priority area as well as bringing more people in the region under the ambit of universal healthcare.

“In recent years, our region accounted for 80% of the total global new displacement related to disasters, becoming the world’s most climate-vulnerable region. Critically, every person deserves access to basic preventive care,” he said.

Dr Tedros with Dr Saia Ma’u Piukala, the new Western Pacific Regional Director. Piukala is the first Pacific Islander to be appointed to the post.

Conflict of interest

The WHO election in South-East Asia region has been mired in controversy, with Bangladesh allegedly using its political clout to get Wazed elected. Unlike in other regions, she only had one other competitor, Shambhu Prasad Acharya, a WHO and public health veteran.

Wazed is now tasked with providing WHO policy advice to her mother’s government, but the WHO has not addressed the potential conflict of interest.

Within the public health community concerns were raised about the lack of transparency in the elections and there have been a call for reforms. Medical journal The Lancet also carried an editorial on the need to protect the integrity of WHO’s regional offices.

New South-East Asia Regional Director Saima Wazed and WHO. Director-General Tedros Dr Tedros Adhanom Ghebreyesus.

In her first speech on appointment, Wazed paid tribute to her mother. “I’d like to express my big thanks to Prime Minister Sheikh Hasina, not only for the leadership she has demonstrated over the decades of governance in our country and in our region, but also as my mother for teaching me how to lead with compassion and care,” she said.

Image Credits: WHO, WHO, WHO.

Canada expressed concern that the EB might be over-prescriptive.

Variation between the six regions of the World Health Organization (WHO) on how their regional directors are nominated – and whether these should be standardised – generated substantial discussion at the body’s executive board (EB) meeting on Tuesday.

A report from the WHO’s legal counsel on regional nominations noted key areas where a  lack of alignment between the regions could be addressed, including on the scrutiny of candidates and transparency of procedures.

For example, criteria for the assessment of candidates are inconsistent, with some not specifying educational qualifications, professional experience or managerial skills. The Africa region is alone in specifying “a medical background”.

The Pan American Health Organization (PAHO) does not have a code of conduct for the nomination process, aimed at promoting an open, fair, equitable and transparent nomination process.

South-East Asia Region does not specify the shortlisting of five candidates if there are more than five candidates for the position, or how this would take place.

All regions provide for the interviews of candidates with the exception of the European Region, where the interviews take place at a private meeting of the Regional Committee. 

Only PAHO and Europe hold a live candidates’ forum, comprising an oral presentation and a question-and-answer session between candidates and members of the region.

All regions except Europe and the Western Pacific Region explicitly limit nominations to people from the region.

Too prescriptive

However, Canada contended that “a minimum common standard beyond the current direction from the EB regarding criteria might be found to be too prescriptive or limiting” and “would also represent a considerable extension of the board’s authority over these processes”. 

Instead, it proposed that the EB put forward “a menu of best practices that regions can draw on from as appropriate”.

Australia contended that any minimum common standard “should be supported by accepted best practice” and also “protect autonomy to account for regional contexts”.

It supported the proposal for the WHO Secretariat to prepare documents for regional committees on “ways to enhance transparency, accountability and integrity of the election process”.

Meanwhile, Comores on behalf of the 47 African members, rejected a “single approach which will be to the benefit of some regions but not necessarily to the benefit of all”. 

Later, the Africa region represented by Ethiopia said it would support “measures to enhance transparency, accountability and integrity of the election process” for the WHO Director General. Ethiopia previously contested the reappointment of Dr Tedros Adhanom Ghebreyesus.

The board deferred any decision on regional director election processes at the request of Denmark, which asked for more time to achieve consensus. 

Wide support for measures to stop sexual exploitation 

The Director-General’s report on the implementation of measures to prevent and respond to sexual misconduct was also discussed on Tuesday, receiving appreciation and support from a wide range of EB members.

The implementation plan focuses on a range of issues including accountability, policies, investigation capacity, training, dedicated human resources, victim- and survivor-centred support and culture change. 

“The Secretariat is ensuring alignment and consistency between the implementation plan and the three-year strategy on preventing and responding to sexual misconduct, 2023 to 2025,” according to the report.

Commending the WHO secretariat’s efforts to root out sexual exploitation, the EB’s programme, budget and administration committee (PBAC) proposed “a comprehensive stocktaking review no later than January 2025 to assess whether the key actions and the reforms contained in the three-year strategy had led to the intended results”.

German’s Björn Kümmel has a key driver of the investment round proposal.

By hosting a high-level “investor round” to raise flexible funding for its operations, the World Health Organization (WHO) will address one of its “greatest overall risks, namely dependency on the very few number of donors”.

This is according to Germany’s Björn Kümmel, chair of the WHO Working Group on Sustainable Financing, who told the WHO’s executive board meeting on Monday that there is “completely fragmented resource mobilisation” throughout the global body.

Executive board members supported the proposal for an investor round – likely to be held in November – with uncharacteristic enthusiasm on Monday.

The idea of a WHO investment jamboree similar to those hosted by the Global Fund and Gavi, was accepted in principle by last year’s World Health Assembly, but it charged the WHO Director-General with investigating how it would operate, including costs versus potential income.

Dr Tedros Adhanom Ghebreyesus reported back to the board that the “expected benefits outweigh the additional costs of the investment round”.

WHO finances is largely earmarked

Currently, the majority of WHO funding comes from donors for earmarked projects which can distort the global programme of work.

To correct this distortion, the WHA resolved that member states need to increase their  “assessed contributions” – currently barely covering 16% of WHO’s budget – and the WHO needs to raise more flexible donor funding.

Not sustainable

“The average length of a grant in WHO is 13 months. This is everything else but predictable,” Kümmel told the board.

“There are 3,300 grants in this organisation with individual reporting requirements with the consequence that the technical staff, that needs to provide norms and standards for the world, is raising earmarked funds for their units in order to be paid and to be able to run the programmes. This is not effective, and this is certainly not sustainable,” added Kümmel, whose working group has been working on reforming WHO’s financing since 2021.

Meanwhile, Tedros told the board that he was embarrassed by the fact that the many WHO staff members were on 60-day rolling contracts due to financial restraints, which made them vulnerable and undermined stability.

“If you talk about motivated and fit-for-purpose workforce, retaining and attracting talent without sustainable financing is impossible,” said Tedros.

 Kümmel asserted that the investment round has the potential to be “truly catalytic” for all reforms that the board is pushing, and  has the potential to introduce more flexible and predictable financing.

The WHO Working Group on Sustainable Financing’s report to the 2023 WHA highlighted that WHO’s budget is “up to 86 % dependent on generous donors and that only roughly 14 % of WHO’s finances are truly predictable”.

“This situation has put WHO at severe risk, including its independence, its integrity, its agility and certainly also its mandated role to be the world’s leading and coordinating authority in global health,” said the report.

While board members accepted the proposal for an investor round, they want input on the investor case due to be developed by May, and urged that the case should be closely linked to the WHO’s 14th global programme of work (GPW), which was also discussed on Monday.

WHO investment round timeline

Image Credits: WHO.

INB co-chairs Precious Matsoso and Roland Driece brief the WHO executive board meeting.

Misinformation, waning interest and entrenched positions threaten the World Health Organization’s (WHO) two pandemic-related negotiations aimed at strengthening future pandemic responses, according to a briefing given to the WHO executive board meeting on Monday.

Draft agreements from the two processes – to establish a pandemic accord and to update the International Health Regulations (IHR) – are due to be presented to the World Health Assembly in May.

But agreement will only be reached if member states are prepared to compromise and push back against “fake news, lies and conspiracy theories”, said WHO Director General Dr Tedros Adhanom Ghebreyesus.

A global misinformation campaign is pushing the notion that the pandemic agreement and changes to the IHR will “cede sovereignty to WHO and give the WHO Secretariat the power to impose lockdowns or vaccine mandates on countries”, said Tedros. 

“We cannot allow this milestone in global health to be sabotaged by those who spread lies, either deliberately or unknowingly. We need your support to counter these lies by speaking up at home and telling your citizens that this agreement and an amended IHR will not, and cannot, cede sovereignty to WHO and that it belongs to the member states,” he insisted.

Right-wing politicians and conspiracy theorists have been pushing an anti-WHO agenda using the pandemic negotiations for some time (see example below).

Dr Ashley Bloomfield, co-chair of the Working Group on IHR Amendments (WGIHR), called on member states to counter the “nonsense” that the pandemic negotiations are WHO power grabs rather than member state driven processes.

“It is essential that member states reiterate this point domestically and also fully support the DG and his efforts,” said Bloomfield.

He also stressed that member states need to meet the deadline “as it will take a further 18 months for any amendments to come into force”.

Mandates and flexibility

Dr Ashley Bloomfield (R) briefs the WHO executive board.

Noting that the WGIHR only had two more meetings before the May deadline, Bloomfield also urged member states “to make sure that your negotiators have both the mandate and the flexibility to achieve consensus during these last two meetings, so that we end up with changes that truly strengthen the IHR and enable more equitable and pandemic prevention preparedness and response”.

Meanwhile, the Intergovernmental Negotiating Body (INB) negotiating the pandemic accord also has two more meetings including a mammoth two-week meeting in February, and INB co-chair Precious Matsoso said that the INB planned to update member states much more regularly about progress and problems during the next few months.

Her co-chair, Roland Driece, added that the world had learnt “the hard way.. that we were not ready to face a pandemic collectively”.

“We’re only as strong as the weakest link. It’s a cliché, but it’s true and that’s why we need to work together, help each other getting where we want to be and be as strong as possible when it comes to preparing for responding to and acting on pandemics,” said Driece.

Meanwhile, Tedros urged member states to compromise and find a middle ground as  “everyone will have to give something or no one will get anything”, said Tedros.

However, Tedros also expressed concern that there was very little time before the May deadline, and that impetus to achieve pandemic-related agreements was waning.

‘Get it done’

Dr Tedros and Dr Mike Ryan brief the WHO executive board.

Communities experienced three years of “horror” during the COVID pandemic, alongside regional horrors such as outbreaks of Lassa fever, Ebola, yellow fever and cholera, said Dr Mike Ryan, WHO Executive Director of Health Emergencies.

“Communities are struggling to deal with the constant pressure of health emergencies and,  on top of that, the fear of another pandemic,” said Ryan.

“This pandemic didn’t just affect the health sector. It ripped apart our social, economic and political systems and has become a multi-trillion-dollar problem for the world.”

The pandemic agreements need to “reduce the impact of inconsistency and incoherence between member states”. 

“Even in the midst of geopolitical disagreements over so many things around the world at the moment, I think this is one thing the world agrees on,” said Ryan.

“We just disagree on how to get there and the means. But we have one chance. This is the one opportunity we have under the leadership of the World Health Assembly to come to an agreement and I would plead with you on behalf of the health workers of the world and the communities that they serve: Get it done. Do not waste this opportunity.”

Up to 20 African countries are gearing up to rollout WHO-recommended malaria vaccines in 2024.

The Central African country of Cameroon became the first country globally to implement routine malaria vaccinations on Monday, marking a significant stride in the fight against the deadly disease that claims over half a million lives annually, primarily affecting children under five in Africa.

According to Aurélia Nguyen, Chief Programme Officer of Gavi the Vaccine Alliance, the RTS,S vaccine will be administered in 42 districts across the nation, targeting children over the age of 5 months, in areas with the highest risk of malaria.

The moment marks the historic start of routine malaria vaccinations in African countries for the first time ever, said WHO and Gavi, the Vaccine Alliance in simultaneous announcements on Monday.  Over 30 African countries have expressed interest in introducing the vaccine, with 20 aiming to introduce it in 2024, said Gavi in an press briefing last Friday, which was embargoed until Monday.  The aim is to reach approximately 6.6 million children with the malaria vaccine through 2024 and 2025.

Cameroon, the first country to participate in the rollout, has been grappling with rising malaria cases and deaths since 2017, with nearly 30% of all hospital consultations attributed to the mosquito-borne illness. The vaccine rollout is expected to bring about a substantial reduction in both cases and fatalities, providing relief to affected families and alleviating strain on the country’s healthcare system.

More than 331, 000 doses of malaria vaccine landed in Yaoundé on Tuesday 22nd November, to support the kick-off of the vaccination campaign.

Several other countries have already received shipments of vaccine doses as well, and are gearing up for launch. Others are waiting for delivery a second WHO-approved malaria vaccine, the R21/Matrix-M,  which is to be produced by the Serum Institute of India in even larger quantities than the RTS,S, WHO and Gavi said in the press briefing.

Why it matters

Gavi emphasised the historical significance of this moment. Having invested in studies and urged manufacturers to expedite the vaccine’s development, the vaccine alliance said it is now delivering approved vaccines to those in need. It also described collaborations with partners to ensure that vaccination is integrated into essential interventions like the distribution of bed nets.

Dr Mohammed Abdulaziz, Head of Disease Control and Prevention at Africa Centres for Disease Control and Prevention, noted that the vaccine has been validated through trials in several African countries to have a significant impact on reducing clinical cases, particularly in high-burden areas.

He described the integration of the malaria vaccine into routine immunisation in African countries as a strategic shift to address insecticide and drug resistance, as well as the effects of climate change on malaria.

Beyond medical benefits, he said the vaccine has the potential to improve educational outcomes and cognitive abilities, breaking the cycle of adversity for future generations. He added that the partnerships involved in the vaccine implementation suggest that there would be equitable distribution of doses which in return could result in a decrease in malaria morbidity and mortality among children. Beyond adopting strategies, he urged all African Union member states to take up the vaccine for better health outcomes.

A vaccine that is already saving lives

The vaccine has already reached more than two million children and Kate O’Brien, the World Health Organization’s (WHO) Director of Immunisation, Vaccines and Biologicals, said the vaccine’s safety and life-saving efficacy, demonstrated in successful pilot programs, have prompted a broader rollout across Africa as part of routine services.

It has already been implemented in large-scale programs in Ghana, Kenya, and Malawi, reaching over two million children, leading to a 13% reduction in deaths among eligible children and a significant decrease in severe malaria hospitalizations, said O’Brien, speaking at Friday’s press briefing.

“The malaria vaccines have been shown to reduce clinical malaria cases by more than half in the year after vaccination. And that level of efficacy goes up when the vaccine is provided seasonally,” said O’Brien.

“In that case, that prevents about three quarters or 75% of malaria cases. So if we think about the 250 million in malaria cases that occur every year, a childhood vaccine with this level of efficacy can result in major reductions in malaria illness and death.”

She added that the coordinated pilot programs demonstrated high demand for the malaria vaccine without compromising other preventive measures, and expressed gratitude to scientists, African researchers, health workers, international partners, and donors for their collaborative efforts in achieving this progress, marking a significant step toward improving child health in Africa.

While acknowledging the long road of development for malaria vaccines, Andrew Jones, Principal Advisor for UNICEF’s Supply Division’s Vaccine Centre, described the imminent mass introductions as a reflection of progress in ensuring every child at risk of malaria receives the vaccine.

This, he said, is a giant step forward in collective efforts to save children’s lives and reduce the malaria burden. While celebrating the achievement, he anticipated ongoing innovation, and said he is looking forward to the development and rollout of even more effective and user-friendly next-generation vaccines.

The four-dose quagmire

To achieve the best outcomes from the vaccine, every child should receive four doses, which Jones described as unusual for routine childhood immunisation vaccines and noted that it could pose an additional challenge to some countries.

Dr Dorothy Achu, malaria adviser for WHO’s African Regional Office, noted that it will be important to communicate to parents that getting all the doses gives their children a higher chance of celebrating lots of birthdays. She also expressed WHO Africa’s preparedness to support countries to roll out the vaccine.

Dr Dorothy Achu, regional malaria adviser for WHO Africa

“We want to congratulate countries that have taken this bold step after the pilot phase and we encourage all endemic countries, and especially the high-burden countries to this vaccine and to deploy them. We are also committed to supporting them as we have been doing already – preparing the countries to roll out the vaccine,” she said.

Working with local partners

One of the lessons from the COVID-19 vaccination experience in Africa has been the need to involve local partners and for the malaria vaccination rollout in Cameroon, said Mbianke Livancliff, Senior Immunization Officer, Value Health Africa, an NGO improving community health in Cameroon, is one of the local partners involved in the rollout.

Livancliff said the timing of the vaccine arrival in the country is timely and highlighted the excitement within communities in Cameroon, recalling the positive response to the first vaccine shipment.

He said the organisation has been actively engaging with communities to understand dynamics, expectations, and concerns, addressing potential rumours and dispelling myths. He added that discussions are being held with community leaders, religious leaders, and various groups to educate them on the vaccine’s effectiveness. He said feedback from these engagements will inform the national policy for the vaccine introduction.

“The communities understand that this is not something that is just happening now. This has been in development over the years, going through rigorous processes to ensure the vaccines are safe and effective for children. Like with every vaccine, there are conspiracies, rumours, and myths. Understanding those dynamics within communities will help in the acceptance of these vaccines,” he said.

Image Credits: WHO.

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

There will be close to 10 billion people in the world by 2050, and if the World Health Organization estimates are correct, as many as 22% of them – or 22 billion people – will be over 60.

A separate study by American doctors found that by that same year, the number of people living with dementia could be as high as 132 million – three times the current number.

The Organisation for Economic Co-operation and Development (OECD) estimates that impaired brain health drains as much as $8.5 trillion a year from the global economy in lost productivity. This number will increase as the population ages.

“We must better understand the brain and provide access to tools and information to help people nurture brain health as part of One Health in every community, country and health system,” according to the Davos Alzheimer’s Collaborative (DAC), a Swiss-based foundation and a US 501c3 initiated by The World Economic Forum (WEF) and The Global CEO Initiative on Alzheimer’s Disease (CEOi).

The DAC held a round-table discussion at Davos to discuss the need to prioritise brain health globally, especially given brain health’s impact on human and societal well-being, productivity, and resilience.

The discussion brought together leaders representing international organisations, scientists, experts from the healthcare industry, policymakers, and forward-thinking visionaries spanning both private and public sectors. Their collective aim was to delve into the significance of brain health as a crucial economic imperative, underscore the pressing requirement for ongoing global collaboration, and emphasise the essential role of fortifying health systems to ensure the well-being of populations with all levels of resources.

Moderated by George Vradenburg, founding chairman of the DAC, the discussion encompassed a range of critical topics, such as advancing the development of immunotherapies and vaccines, expediting interventions through the lens of patients’ groups, evaluating the effectiveness of public-private partnerships, intensifying efforts in risk reduction and prevention education, spotlighting the disproportionate impact on women, and emphasising the imperative for strengthened initiatives in data-sharing.

The event also kicked off a new network of global “Brain Health Ambassadors,” who will commit to promoting the inclusion of brain health at the primary care level and the international prevention of Alzheimer’s and related dementias. His Excellency Luis Gallegos, Chairman of the Board of UNITAR and former Minister of Foreign Affairs of Ecuador, became the first inaugural Brain Health Ambassador.

His Excellency Luis Gallegos, Chairman of the Board of UNITAR and former Minister of Foreign Affairs of Ecuador
His Excellency Luis Gallegos, Chairman of the Board of UNITAR and former Minister of Foreign Affairs of Ecuador

The Brain Health Imperative

“There is no question that we are all living longer, and that is good news,” Vradenburg said.

He emphasised that prolonged life spans contribute positively to society and the economy as individuals work for an extended period. Yet, he noted a potential oversight: “Rarely do you hear people talking about your brain span equaling your health span.”

Vradenburg expressed concern about the prevalence of individuals spending the last decade of their lives enduring some form of dementia.

“The prevalence of this disease is huge – nearly 50 million people around the world,” Vradenburg said. “But the disease starts 25 years or so before you get symptoms. So, this estimate of 50 million people diagnosed worldwide needs to be multiplied by a factor of eight to get the total number of people actually experiencing the disease.”

The silver lining is that today, doctors and scientists better understand what enables brain resilience and what can prevent Alzheimer’s, Vradenburg said. Moreover, as innovation accelerates and populations age, more countries and leaders see brain health as an economic, societal, and policy imperative.

“Governments, businesses, international organisations, and the scientific and advocacy communities everywhere are paying attention like never before. We have reached a critical inflexion point for action,” according to Vradenburg. He reminded that “2023 was a pretty good year” for people with Alzheimer’s, as the first disease-modifying drug was fully approved by the American Food and Drug Administration and covered by Medicare.

“For the patient community, this is excellent news,” he said. However, he admitted that the drug only has a moderate benefit – reducing the rate of decline by up to 27%, that it has side effects, and that it is expensive.

Prof Miia Kivipelto from the Karolinska Institute highlighted the current abundance of information regarding the factors influencing Alzheimer’s, particularly genetics, and the preventive measures available.

According to her, adopting a healthy lifestyle is pivotal, such as maintaining a balanced diet, participating in regular physical activity, practising relaxation techniques, effectively managing stress, and engaging in cognitive stimulation. She emphasized that the indicators for optimal cardiovascular health align with those crucial for maintaining brain health, including blood pressure regulation, cholesterol management, prevention of obesity, and controlling diabetes.

“What is good for the heart is good for the brain,” Kivipelto said.

Cognitive Reserve Strategies

Neuroplasticity is also crucial, noted Prof Murali Doraiswamy of Duke University.

“The important thing is that the brain is plastic throughout our lifetime,” he said.

Consider infants—they employ multiple senses, biting, smelling, and even testing the rebound of objects, Doraiswamy said. Participating in such multisensory activities is instrumental in shaping the networks within the brain. These networks, in turn, play a pivotal role in forming memories and experiences.

Prof Murali Doraiswamy of Duke University
Prof Murali Doraiswamy of Duke University

Doraiswamy highlighted the enduring presence of neuroplasticity even in the later stages of life and said researchers have explored various electrical and chemical stimuli in rodent models to augment neuroplasticity. While cautioning that these methods haven’t been applied to humans yet, he suggested the possibility of their future application.

Additionally, Doraiswamy introduced the concept of “cognitive reserve.”

“Cognitive reserve can simply be thought of as how many excess networks you have built up in your brain over a lifetime of experiences,” he said. “That reserve capacity is what protects you from decline if you suffer from a neurodegenerative disease. So, think of it as having access to cell phone towers and the more cell phone towers, you have a couple of get knocked out, you still have power.

“So it’s crucial for us to learn how to develop and monitor cognitive reserve.”

He said that physicians can evaluate an individual’s brain and cognitive reserve using state-of-the-art digital tools, including those accessible through smartphones.

“I think in addition to all of the pharmacotherapies that pioneers are developing, we need also to develop non-pharmacological ways,” Doraiswamy continued. “Now, with digital tools such as smartphone apps, it’s possible to create a closed-loop system where you can do cognitive self-testing at home in the comfort and convenience of your home. You can also send those reports to your doctor. And you can also decide to train what parts of your abilities are below normal for five minutes a day using these tools.”

Global Brain Health Initiatives

Drew Holzapfel, executive director of CEOi, said some programs are already underway and working. For example, this year, his organisation is collaborating with eight flagship sites in five countries to improve how Alzheimer’s disease is diagnosed. His organisation funded 19 programs in 12 countries in 2023.

“We’re trying to speed up the time from detection to diagnosis so that we can get care to the people who need it as fast as possible,” Holzapfel said.

His organisation’s second focus is creating collaborations to scale Alzheimer’s and brain health longitudinal clinical trial research. In India, for example, a group of high-volume clinics is looking at AI’s role in brain health. In another example, they work with ophthalmologists there to help detect cognitive impairment early and get those people into the health system.

The group has also started to look at how brain health and climate change are interconnected with partners in Kenya, Slovenia, and Chile.

Finally, he said, they are working on finding ways to engage governments.

“There have been a lot of governments and international organisations that have made commitments to Alzheimer’s. And so we’re committed to working with these governments to ensure we bring those commitments forward,” Holzapfel said.

Dr Noémie Le Pertel, a senior fellow and founding chair for the Economics of Well-being and Global Human Flourishing Working Group at the Human Flourishing Network, housed at Harvard University’s Institute for Quantitative Social Science, said her team is currently undertaking the world’s most comprehensive study on mental health, physical well-being, and various childhood predictors, encompassing the entire lifespan.

Le Pertel said: “The call to action that I wanted to put forward was really for leaders in the room who are working in organisations, what can we do and how can we join forces to seize the opportunity to work in the workforce to upskill people to understand the role of their brain health, and how it impacts not only organisation, society, the economy, but the future of our society?”

Image Credits: Courtesy of the Davos Alzheimer’s Collaborative, Courtesy of the Davos Alzheimer's Collaborative, Courtesy of the Davos Alzheimer's Collaborative.

WHO has released a novel set of guidelines on the ethics and governance of artificial intelligence (AI) in large multi-modal models (LMMs), a type of generative AI frequently used in healthcare.

The guidelines include 40 recommendations for governments as well as other actors, such as technology companies and health care providers. Based on 2021 WHO guidelines for responsible AI usage, the new document takes into account the latest technological advances and the challenges they bring.

“We need transparent information and policies to manage the design, development, and use of LMMs to achieve better health outcomes and overcome persisting health inequities,” said Dr. Jeremy Farrar, WHO’s Chief Scientist.

LMMs – like Chat GPT, for instance – can produce various types of outputs, independent of the type of training data fed into the system. This type of algorithmic machine learning is unique insofar as it can mimic human communication and perform more innovative tasks beyond those explicitly programmed.

Advanced technologies offer new opportunities but also risk enhancing existing problems of discrimination and bias, inequalities in access, lack of privacy or automation bias: too much confidence in machines, said Farrar, at a WHO press conference launching the guidelines on Thursday.

AI is increasingly used in the health sector for many diverse purposes – from drug development to patient diagnosis as well as data management and administration. In its guidelines, WHO also outlined expanding applications, such as self-guided diagnosis and treatment as well as medical and nursing education.

WHO Bangladesh Office data analysts are in the control room, where dengue related data is monitored and stored.

Diagnosis is a field where LMM use holds a promise of substantial improvement. Models are used to detect various conditions, from tuberculosis, through reproductive and mental health to several types of cancer.

As any new technology, LMMs carry risks in case of inappropriate usage. Yet, stresses  Farrar, “we should not be scared of but rather responsible towards new technology.”

‘I wanted to ask LMM to write the opening remarks – but is that ethical?’

At a WHO-organised webinar Friday, leading WHO and external experts delved deeper into usage, threats and benefits to generative AI in healthcare.

With this rapidly developing technology, new possibilities can be both promising and unpredictable, panelists stressed.

“I wanted to ask an LMM to write those [opening] remarks for me but then I wondered if it’s ethical,” joked Alain Labrique of WHO’s Digital Health & Innovation division. With this rapidly developing technology, new possibilities can be both promising and unpredictable, panelists stressed.

Because of LMM’s complexity, the threats associated with other AI types are even more salient – including risk of data biases. 

“From the Global South perspective, diversity is crucial, especially to ensure data is adequately representative, ” remarked Keymanthri Moodley of Stellenbosch University, in South Africa.

Another concern is data privacy and cybersecurity threats to health systems relying more and more on LMMs. “We need to ensure adequate data collection, storage and sharing regulations. It is crucial to ensure the patients’ safety,” said Moodley.

Limits of accuracy and reliability 

The models’ outputs also still tend to have limited accuracy and reliability. As most resources in the field of AI are in the hands of for-profit enterprises, the models’ predictions can be skewed towards a solution beneficial for their designers. Despite those pitfalls, LMM usage also carries risk of overly trusting the machine’s recommendations.

Good, reliable AI can also turn out to be inaccessible to many healthcare systems, enhancing existing inequalities.

To mediate the existing risks, the guidelines propose policies and good practices to ensure responsible LMM use. The authors stress the importance of including all relevant actors from the design phase on, focusing on the product’s transparency, inclusion and enabling possibility for voicing concerns.

Key recommendations for governments and developers in the second phase of AI deployment

The new WHO guidelines encourage governments to audit and monitor LMM usage as well as ensuring that reliability and accuracy standards are met. The models must also be checked for respecting state and international law in cases that affect, for instance, a person’s dignity, autonomy or privacy.

“Governments from all countries must cooperatively lead efforts to effectively regulate the development and use of AI technologies, such as LMMs,” said Labrique.

Image Credits: WHO, WHO/Fabeha Monir, WHO.

A man melts lead metallic wastes, often used in the production of cooking pots, at a recycling warehouse in Koumassi, Abidjan, Ivory Coast.

The US government will commit $4 million to tackle lead poisoning, supporting developing countries to curtail lead in consumer goods like paints and toys in which the use of lead is still widespread, USAID administrator Samantha Power announced at the World Economic Forum in Davos.

Power also called for more resources and action towards the issue that kills nearly a million people, mostly children, every year, and affects the brain and neurological development of one in two children in low- and middle-income countries.

“For decades lead has poisoned kids in their classrooms, their bedrooms, their playgrounds, led lurks in the food that kids eat, the water they drink, the medicines they take, and of course the paint, brightening their bedroom walls and the toys that are helping them learn and grow,” she said at a press conference Thursday.

Currently, funding by donors toward lead mitigation efforts is approximately $15 million per year.

“Lead poisoning affects hundreds of millions of children worldwide, contributing to educational gaps and harming health and development. The US government’s commitment to make this a development priority is a welcome turning point,” said Susannah Hares, senior policy fellow and director of education at the think tank Center for Global Development.

USAID is the agency responsible for administering foreign aid and development assistance on behalf of the US government. At Davos, Power advocated for a global drive to support rolling out and enforcing binding regulations to curtail lead in consumer goods ranging from paints to spices, and cosmetics.

Control over consumer goods like paint, spices, and cosmetics contaminated with lead can save millions of lives.

Lead – a potent neurotoxin

Lead is a potent neurotoxin with no safe level of exposure, and lead poisoning can cause severe brain damage, according to the World Health Organization (WHO).

Globally, lead poisoning kills around a million people each year – more than mortality caused by HIV and malaria combined. A majority of these deaths are concentrated in poor countries.

WHO has identified lead as one of 10 chemicals of major public health concern needing action by member states to protect the health of workers, children, and women of reproductive age, as lead can be transferred from a pregnant mother to the fetus.

Lead can affect children’s brain development, resulting in reduced intelligence quotient (IQ), causing behavioural changes such as reduced attention span and increased antisocial behaviour, and reduced educational attainment. This affects a society fundamentally.

Pilots in India and South Africa

USAID administrator Samantha Power speaking at the World Economic Forum in Davos.

The $4 million will be used to lead mitigation efforts in India and South Africa. USAID will support local governments in developing strategies and addressing exposure risks, especially amongst children, who are particularly vulnerable to the effects of lead. The agency will also help with a nationwide survey of blood lead levels in children in Bangladesh, Power said in her remarks.

USAID will also join the Global Alliance to Eliminate Lead Paint, a partnership that has catalyzed legally binding controls on lead paint in almost 40 countries. The partnership is coordinated by the United Nations Environment Programme (UNEP).

USAID has missions in more than 80 countries. Around 51 of these countries are yet to introduce binding regulations on lead in paint, so the agency is well-positioned to advocate for and support lead mitigation efforts.

While lead in petrol has been phased out in all countries, lead in paint continues to be a cause of wide concern.

The challenge of enforcement

Lead poisoning is costing Africa $134 million each year, said Tanzania’s Labour Minister Mudrick Soragha at the Davos event. “And now I’m very happy to note that there’s a general consensus within the global community that we need to get rid of this harmful chemical substance. And for us it is critically important as a country to note that we are not alone in the fight.”

Soragha said that given the weaker health and regulatory systems in many low- and middle-income countries, effective response is a challenge.

“The issue is how to have the proper mechanism of enforcing those regulations, and making sure that our regulatory bodies have the capacity to be able to identify the products that have lead, and how to remove them,” Soragha added.

It is clear that the response will have to be global. “To eliminate lead poisoning, is an ambitious but achievable goal, as evidenced by the huge strides taken by countries like Bangladesh and Georgia. But if this is to happen, it’s crucial for other countries and donors to join the effort and invest in monitoring, proven solutions, and research,” Hares said.

Image Credits: EPA/L. Koula, Global Alliance on Health and Pollution.

Investing in women’s health can boost the world economy, says a new report.

The final hours of the World Economic Forum in Davos on Thursday saw the launch of a new  Global Alliance for Women’s Health which has the broad ambition of, “re-shaping the future of women’s health and the global economy.”

So far 42 organizations have expressed interest in joining the alliance, including government leaders and representatives from the private sector, entertainment industry, and philanthropic space. The alliance partners have already pledged $55 million.

The health alliance is a response to a WEF and McKinsey Health Institute report released this week that says improving women’s access to health services would allow more women to live healthier, higher-quality lives, and provide an unprecedented boost to the global economy.

Currently, health burdens for women are systematically underestimated, with datasets that exclude or undervalue important conditions, the report says. Women are also more likely to face barriers to care, and experience diagnostic delays and/or suboptimal treatment, according to the report.

The benefits of investing in women’s health have been estimated as high as $1 trillion annually by 2040 or an increase of 1.7% per capita GDP, according to the report. It would improve health outcomes for over 3.9 billion people globally, the report says, referring to the number of women in the global population.

The health alliance will pledge new commitments from governments, philanthropies, and pharmaceutical companies, among others, across three pillars: financing, science and innovation, and agenda-setting. So far partners have pledged $55 million to improve women’s health outcomes.

“Our analysis demonstrates that addressing the women’s health gap and investing in women’s health must be a priority for every country,” said Shyam Bishen, head of the Centre for Health and Healthcare at the World Economic Forum (WEF). “Beyond improving women’s quality of life, ensuring women have access to innovations in healthcare is one of the best investments that countries can make for their societies and their economies.”

Investing in Women’s Health Linked to Economic Growth

Despite living longer than men, on average, women spend 25% more of their lives in poor health, the report found. Improved investment in women’s health services including, but also going beyond the standard maternal and child health packages available in most countries could improve that.

The report said improving diagnostics, data on women-specific conditions like ovarian cancer, and directing more investments towards women’s health and research is needed.

“Investing in women’s health shows a positive return on investment: for every $1 invested, ~$3 is projected in economic growth,” the report says.

Surprisingly the report found that the economic return of such investments would be greatest in higher-income settings where the ratio is around $3.5 returned to $1 invested due to their higher economic participation. But even in low-income settings the benefit would exceed the costs and would be an estimated $2 in benefits for every $1 invested – or double.

In low-income settings, every dollar invested in women’s health will result in twice the economic benefits, according to the latest report by the World Economic Forum.

“Investing in women’s health goes far beyond individual women. It is a direct investment in families, communities, societies, and economies,” said Anita Zaidi, President, the Gender Equality Division, at the Bill & Melinda Gates Foundation, in a press release. “Our collective future rests on closing the women’s health gap.”

Key commitments towards women’s health

The new health alliance will be guided by a governing board, comprised of world leaders representing the diversity of stakeholders that must be involved to advance investments in women’s health.

As a part of the alliance, Tower Capital Group, an economic development entity will commit over $25 million in 2024. In addition, Rotary International will launch the Rotary Healthy Communities Challenge, an initiative that will provide $30 million for disease prevention and treatment, focusing on maternal and child health in the Democratic Republic of Congo, Mozambique, Nigeria, and Zambia.

“Quality, affordable, and accessible healthcare, particularly in the context of women’s health, is a critical aspect of ensuring the well-being of women,” said Nisia Trindade Lima, Brazil’s Health Minister who will also serve as the co-chair of the alliance along with Zaidi. “This is a critical moment for a greater mobilization across sectors to invest in women’s health, keeping in mind the imperatives of equity and integral care.”

Image Credits: WEF Glosing the Women’s Health Gap 2024 report.

WHA76
The World Health Assembly in it’s May 2023 session. Now, member states have only four more months to reach the deadline for agreement on a pandemic accord.

As we approach the final months of member-state negotiations over a World Health Organization Pandemic Accord, due to come before the World Health Assembly in May, the efforts to forge a consensus have witnessed modest progress. However, the original divide between developed and developing countries on key issues such as finance, access and benefit sharing, transfer of health technologies, and ‘One Health’  approaches to pandemic prevention, continue to cast a long shadow over the process. Some critics worry that an accord, if and when one is achieved by the 2024 deadline, may be less meaningful in terms of substance and impact, because of the compromises required to reach an agreement.

This issue of the Governing Pandemics Snapshot, the latest in the Geneva Graduate Institute series, recaps highlights of the past six months of negotiations. It takes a closer look at three strategic issues:

  • The conundrum of parallel negotiations over a new ”Pandemic Accord’ alongside negotiations over revisions to existing WHO International Health Regulations governing health emergencies;
  • Proposals for turning the new Pandemic Accord into a WHO Pandemic “regulation” – sidestepping the thorny issue of country ratification;
  • Complex issues around the sharing of pathogen genetic sequence data (GSD), essential for the development of new medicines and vaccines – but also a resource that developing countries assert needs recompense from the pharma industry.

Key negotiation highlights: a recap of the past months

Following our last update in July 2023, several more sessions of the Intergovernmental Negotiating Body (INB), the WHO member state-led body negotiating the text, took place throughout 2023 and until the end of the year.

The sixth meeting of the WHO member state Intergovernmental Negotiating Body (INB), convened on July 17-21, 2023, had special significance as it centered around the draft compilation text of the proposed WHO Convention, Agreement or Other international Instrument (CA+). That draft, published in June, was developed by the six-member state body guiding negotiations, known as the “Bureau”. The “Bureau” text laid out multiple options for language on key, disputed issues related to issues such as access to medicines and vaccines, pathogen sharing, and One Health.

The July INB meeting was preceded by a series of informal inter-sessional meetings. These sessions, guided by volunteer co-facilitators, aimed to foster understanding and dialogue on key articles of the Bureau’s text. The sessions focused on a specific set of topics including Research & Development (R&D), Access and Benefit-Sharing, and Global Supply Chain and Logistics.

The practice of supplementing the formal INB sessions with informal meetings continued after INB 6, becoming a regular feature of the negotiation process. Following this approach, the INB Drafting Group, also open to all INB members, convened again from September 4-6, engaging in discussions on the three aforementioned topics. Additionally, they addressed articles related to  “One Health” approaches to preventing pandemics (e.g. through better management of pandemic risks related to AMR, livestock, wild animal trade and deforestation), as well as the co-development and transfer of technology and know-how.

Intersessional work persisted throughout September; this culminated in a one-day meeting of the INB Drafting Group on September 22. The group mandated the Bureau to prepare a new text of the pandemic accord in mid-October, intending to set the stage for the commencement of textual negotiations during INB 7 in early November and December 2023.

WHO Director-General Tedros Adhanom Ghebreyesus at Davos: to prepare for the next pandemic, countries have to focus on strengthening primary healthcare.

UN adopts political declaration on pandemics

In late September 2023, the spotlight shifted from Geneva to New York City, where a High-Level Meeting on Pandemic Preparedness and Response unfolded on the sidelines of the 78th United Nations General Assembly. The purpose was to convene Heads of State to highlight the issue and secure commitments from UN Member States to strengthen pandemic prevention, preparedness, and response (PPPR) at the global level. The result was a non-binding UNGA political declaration. Despite its symbolic political significance, the declaration was criticized for being rhetorical and lacking tangible commitments by member states to take concrete steps on policies and investments that could improve prevention, preparedness, and response.

Pandemic Accord “negotiating text” and a fresh round of criticism  

In October, the spotlight shifted back to Geneva where the Bureau unveiled the proposal for the Negotiating Text of the WHO Pandemic Agreement. Unlike the June version, this negotiating text selected just one option for language and approach to each of the contested articles, incorporating what the Bureau viewed as language with the greatest potential for agreement.

However, the text faced significant criticisms. To name a few, developing countries expressed concerns over the heavy burden imposed by proposed pandemic prevention and surveillance measures.

Those objections including even the very general reference in Paragraph 8 of the preamble to the support for the “One Health” approach to “multi-sectoral collaboration at national, regional and international levels to: safeguard human health; detect and prevent health threats at the animal and human interface, zoonotic spill-over and mutations; and sustainably balance and optimize the health of people, animals and ecosystems […]”.

Developing countries also objected to what they regarded as relatively weak provisions on equitable access to medicines, vaccines and other countermeasures.

Conversely, several developed countries voiced firm opposition to a reference to countries to: “commit to agree upon, within the framework of relevant institutions, time-bound waivers of intellectual property rights to accelerate or scale up the manufacturing of pandemic-related products to the extent necessary to increase the availability and adequacy of affordable pandemic-related products [Article 11.3 (a)].

Civil society stakeholders have, meanwhile, lamented the perceived lack of ambition in provisions ensuring more equitable access to pandemic-related products, including the lack of reference to “access” provisions in relation to public R&D funding for medicines and vaccine development.

Others noted the absence of clear financing commitments for pandemic preparedness and response, and the intention to postpone many contentious issues post-adoption, risking a dilution of the accord’s substance and impact.

The INB 7 unfolded over the period of November 6-10, resuming on December 4-6. This time, civil society stakeholders were invited to be physically present at the WHO premises, although not in the room where the proceedings were held.

This phase primarily involved an initial reading of the negotiating text, during which Member States suggested edits or deletions and thus contributed to yet another revision of the draft text.

So, rather than allowing for the beginning of formal negotiations, the INB 7 process resulted in a lengthy and intricate “rolling text,” with each and every option incorporated once again – as had been the case in June. It appeared as if parties held firm in their stances, showing no inclination to yield ground on their original positions and increasing mistrust among negotiators.

This raises the question: are we moving backward instead of forging ahead?

Plenary panel of UN GA High-Level Meeting on Pandemic Prevention, Preparedness and Response in September 2023.

Tackling additional challenges as we near the finish line

With the May 2024 deadline looming forward, at least three additional challenges stand out.

Firstly, process. The current approach to negotiations is perceived as lacking effectiveness. The iterative textual method used so far involves the repeated issuance of new document versions by the Bureau, with member states subsequently incorporating edits without substantial engagement in real negotiations. The October text, which was originally  30 pages, had thus ballooned to around 100 pages by the end of the INB 7 sessions in December. This prompts legitimate questions about the ability of this process to bring parties closer to the finish line.

Secondly, time. The intricate and contentious nature of the issues at hand, combined with extensive small group work outside the official timetable, adds to the complexity. This year, there are only 19 official negotiation days scheduled for full INB group meetings on the calendar. So achieving any result poses a formidable challenge even to the most seasoned and well-intentioned diplomats.

Thirdly, momentum. Amidst a myriad of pressing global issues competing for political attention, focus, and financial resources, and with leading actors like the United States worldwide gearing up for nationwide elections in 2024, there is a shadow of uncertainty around the commitment of member states to embrace new global health rules and to prioritize pandemic prevention. Obtaining such commitments will likely be even more difficult if the current May 2024 deadline for the conclusion of negotiations and WHA review is pushed back – diminishing the sense of urgency and focus.

The next months will reveal if these challenges are surmountable.

Link to the other topics in this month’s issue of Governing Pandemics Snapshot here: