Attacks on health facilities and services has become a deliberate tactic of war.

Climate and conflict-related malnutrition in the Horn of Africa, rising gender-based violence in Haiti and attacks on medical facilities are some of the challenges facing the World Health Organization (WHO) as it seeks $1.5 billion to finance its emergency response.

“For those facing emergencies, disruptions to essential health services often mean the difference between life and death,” WHO Director-General Dr Tedros Adhanom Ghebreyesus told the launch of the global body’s health emergency appeal on Monday.

The WHO needs the money to address 41 emergencies affecting an estimated 87 million people – greater than the populations of Germany, France or the UK.

“There are only two ways to reduce the human suffering caused by health crises: increase the funding or reduce the needs. Neither is happening at the moment. The cost of inaction is one the world cannot afford,” added Tedros.

“The greater Horn of Africa is one of the most vulnerable regions when it comes to climate change and that appears through erratic rainfalls rising temperatures which then translates into droughts and floods,”  said Liesbeth Albrecht, WHO’s incident manager in that region.

“The increase in these deadly climate related disasters together with conflict has driven extremely high levels of hunger. Currently more than 50 million people are food insecure, which represents more than 30% increase compared to mid-2022. 

“We’re seeing the highest numbers in years of malnourished children, including 2.7 million, with severe acute malnutrition, which not only increases their risk of starvation, but also weakens these kids’ immunity, which makes them much more susceptible to disease,” she added.

People fleeing drought and conflict in the Horn of Africa take refuge in a temporary camp.

Lawlessness and rape

Meanwhile, Haiti recorded an increase of over 150% in serious crimes such as kidnappings, murders and gender based violence, particular rape.

“Armed gangs now control 80% of the capital, Port-au-Prince, and gang activity has forced hundreds of thousands of people to flee their homes,” said Dr Oscar Barreneche, WHO’s Haiti representative.

“As the violence spreads in the country, almost half of Haitians are facing food insecurity, which explains the whopping 30% increase in the case of acute severe child malnutrition observed recently.”

In the first half of last year, 6000 cases of gender-based violence were recorded, and only 16% of those affected received health services, he added.

Dr Mike Ryan, WHO’s executive director of health emergencies, said that he was concerned about the “rapid increase in hunger, driven by climate driven and conflict” globally.

“Famine is what weakens the human immune system; weakens the human capacity to resist disease and very often creates conditions for a secondary health crisis,” said Ryan.

Dr Mike Ryan, WO executive director of health emergencies.

Deliberate attacks on health facilities

“We are witnessing an era in which attacking healthcare has become a tactic of war,” added Ryan. “Not euphemistically referred to before as collateral damage or accidental damage, but actually fundamentally a weapon that is used to increase terror and to deny people the health services that they need.”

Martin Griffiths, United Nations Under-Secretary-General for Humanitarian Affairs, said 2023 had been a year where health institutions had been targeted as a priority in territories such as Sudan, Gaza and Ukraine.

“That red cross sign, which was there to protect people, has become a sign for an attack,” said Griffiths.

In 2023, there were 1300 attacks on health care across 19 countries, resulting in more than 700 deaths and 1100 injuries to health workers and patients, he added.

“In the Occupied Palestinian Territories alone, more than 624 attacks on healthcare have resulted in the deaths of 619 health workers and patients and the injury of 826 others as of 11 January,” said Griffiths.

Denise Brown, UN humanitarian co-ordinator in Ukraine, said that the availability of health care “holds a community together”. 

“Every community needs a doctor, needs a nurse, needs a health care professional; a place to go when you’re sick when you have a baby to deliver, surgery, vaccinations,” said Brown. 

“So unfortunately, the flip side of that is that the loss of healthcare disrupts the well being of a community. People have to leave and that’s what we see oftentimes in the communities directly impacted by the war in Ukraine. 

“The loss of health care is also the beginnings of the loss of a sense of community. Following the full scale invasion by the Russian Federation February 2022, according to WHO, there have been more than 1400 attacks on health infrastructure in Ukraine.”

‘Small price’ to protect health

Paying tribute to the WHO’s leadership in emergencies, Griffiths said that when he visited humanitarian crises, he often found Tedros and Ryan were already there.

“In 2023, WHO led the health cluster in meeting the health needs of 102 million people across 29 countries. They supported more than 44 million primary health care consultations. WHO deployed more than 8000 mobile clinics and help to distribute 30 million oral cholera vaccine doses,” said Griffiths, adding that the need was expected to be even greater this year.

“The sum asked is a very small price to pay to protect the health of the most vulnerable and to prevent deepening of the global health crisis,” added Griffiths.

Image Credits: International Committee of the Red Cross, WHO.

A fire in a favela in Brazil

The world is world is “plagued” by a duo of dangerous crises: climate and conflict, according to the World Economic Forum (WEF) ahead of its annual meeting, in Davos starting on Monday.

“Underlying geopolitical tensions combined with the eruption of active hostilities in multiple regions is contributing to an unstable global order characterised by polarising narratives, eroding trust and insecurity,” notes WEF managing direct Saadia Zahidi, writing in the forum’s Global Risks Report 2024.

Insights about risks were sought from 1,490 experts across academia, business, government, the international community and civil society in September and October last year.

Lethal conflicts from Sudan to Gaza and Israel; record-breaking heat and societal discontent were high on the risk agenda.

Two-thirds of respondents rank “extreme weather” as the top risk most likely to present a material global crisis this year, as well as over the next 10 years.

Misinformation and disinformation emerged as the key short-term threat over the next two years, and is  anticipated to “further widen societal and political divides”.

“As close to three billion people are expected to head to the electoral polls across several economies – including Bangladesh, India, Indonesia, Mexico, Pakistan, the United Kingdom and the United States – over the next two years, the widespread use of misinformation and disinformation, and tools to disseminate it, may undermine the legitimacy of newly elected governments,” according to the report.

“Resulting unrest could range from violent protests and hate crimes to civil confrontation and terrorism.”

Societal polarisation features in the top three risks over both the current and two-year time frames, and is closely linked to economic downturn.

WEF Global Risks 2024

The cost-of-living crisis remains a major concern in the outlook for 2024.

“High rates of job churn – both job creation and destruction – have the potential to result in deeply bifurcated labour markets between and within developed and developing economies,” notes the report.

Meanwhile, interstate armed conflict, with the report warning of “conflict contagion”.

The report also flags the global South’s growing “dissatisfaction with the continued political, military and economic dominance of the global North”.

“Historical grievances of colonialism, combined with more recent ones regarding the costs of food and fuel, geopolitical alliances, the United Nations and Bretton Woods systems, and the loss and damage agenda, could accelerate anti-Western sentiment over the next two years.”

Over 2,800 leaders are convening in Davos under the theme, Rebuilding Trust, and will focus on achieving security and cooperation; growth and job creation, artificial intelligence and “a long-term strategy for climate, nature and energy”

Reduce energy demand

Transition to solar would help companies’ energy demand

Meanwhile, the WEF has also called on companies and countries to adopt measures to reduce the demand for energy in order to reduce carbon emissions and save cash.

The forum made the call to reduce what it calls “energy intensity” – the amount of energy used per unit of gross domestic product (GDP) –in a new report that was also released on the eve of its annual meeting.

A 31% reduction in energy intensity and up to $2 trillion in annual savings is possible if certain measures are taken, according to modelling.

“Actions are doable today, at attractive returns with existing technology, and so it is believed this establishes a compelling case to act as much on energy demand as supply in the journey to net zero,” according to the report.

It describes three “levers” to reduce energy use. The first is “energy savings”– essentially through operational improvement interventions. 

The second is “energy efficiency” measures that require capital expenditure. 

The final lever is “value chain collaboration”, where companies work directly with suppliers and business partners to reduce cost. 

The WEF calls on each sector to develop a “roadmap” to guide company and government action. 

“Company and national energy transition plans are needed to capture the benefits of managing energy consumption while integrating supply-side actions. Businesses across the energy demand and supply spectrum will need to work together with governments to develop these plans and increase awareness of the routes and results available to address barriers to action.”

Some of the examples of reduced energy include the digital optimization of plant operations, and automation and electrification of transport in mining and extractive industries, which use  around 8% of global energy. 

The vast majority of energy use in mining – some 93% – is used for extraction, intra-mine movement and crushing, all of which are equipment focused. 

“An automated truck network has the potential to save 15-20% of transport energy demand, through the optimisation of routing, uptime and throttle input,” according to the report.

Tensions between security and sustainability

“The energy transition creates immense and growing tensions between the imperatives of security, affordability and sustainability,” according to the report.

“On energy security, the first challenge is to simultaneously maintain a secure and stable supply of energy amid an increasingly volatile geopolitical situation, all while transforming today’s hydrocarbon-dominated supply,” it adds.

During 2021-22, energy shortages as a result of Russia’s invasion of Ukraine saw European governments procuring oil and gas from the flows normally destined to other emerging markets and developing economies (EMDE), which had to use more coal and face higher energy prices. 

The second challenge is affordability, particularly the population is expected to expand by two billion people and GDP is set to double by 2050.

“This will intensify pressure on energy supply systems, particularly in EMDE, which are responsible for approximately 60% of current demand. These markets need a clear range of routes to economic growth, which include abundant access to affordable clean energy,” notes the report. 

The third challenge is sustainability to meet this growth in energy demand in a way that keeps the world on track to meet the 2050 Paris Agreement. Most scenarios forecast a significant shortfall in clean energy supply by 2050, which is why more efficient energy use is imperative.

Image Credits: Zubair Hussain/ Unsplash, Denys Argyriou/ Unsplash, WEF.

Mature Nipah Virus particles (blue) close to the periphery of an infected VERO cell (purple)

The first clinical trial of a vaccine for Nipah, a deadly communicable disease mostly found in South-East Asia, is about to start, the Oxford Vaccine Group announced.

Despite 25 years of outbreaks and its WHO status of a priority disease, there is no treatment or vaccine for Nipah up to this date. 

“This vaccine trial is an important milestone in identifying a solution that could prevent local outbreaks occurring, while also helping the world prepare for a future global pandemic” – highlights Dr. In-Kyu Yoon, acting executive director of Vaccine Research & Development at the Coalition for Epidemic Preparedness Innovations (CEPI).

Nipah is a paramyxovirus, the same family as measles, and is carried by fruit bats. Infections occur after people or animals eat fruit contaminated with bat urine or saliva, or have contact with other infected animals or people. 

Even though Nipah outbreaks are typically small-scale, its devastating mortality rate – sometimes reaching 75% – and the fact that it is transmitted both from animals and among people are reasons enough to consider it a potential threat.

The disease attacks the central nervous system or the respiratory system. In most extreme cases, it can lead to a coma in under two days.

The most recent outbreak of September 2023, in India’s district Kerala, was contained quickly thanks to a systematic and decided response. From its first detection in 1998, there were over 600 cases, with many proving fatal.

The new vaccine trial will first be tested on 50 healthy individuals aged 18-55 with a vaccine is developed by the Oxford Vaccine Group and funded by CEPI. It is using the same platform as a previous creation of the team, the Oxford/AstraZeneca COVID-19 vaccine.

“Nipah has epidemic potential, with its fruit bat hosts found in areas home to over two billion people,” said Yoon. “This trial is a step forward in efforts to build a suite of tools to protect against this killer virus.”

Image Credits: NIAD.

A report surveying 58,000 people across five continents has found that there is significant support for climate action.

There is overwhelming support for immediate government action on climate change, according to a global report from 23 countries.

Over three-quarters (77%) of people agree with the statement, “It is essential that our government does whatever it takes to limit the effects of climate change,” and just over 10% disagree, according to the report produced by non-profit Potential Energy Coalition, research institute Yale Program on Climate Change Communication, and philanthropies Meliore Foundation and Zero Ideas.

Some 58,000 people across five continents were surveyed to gauge support for climate action and what messages motivate people to work towards accelerating climate action.

Last year was the hottest on record by a huge margin, according to the World Meteorological Organization (WMO). Apart from smashing temperature records, the average global temperatures were on many occasions 1.45° C higher than the pre-industrial era, and just shy of breaching the target of 1.5° C set by the Paris Agreement in 2015.

Next week global leaders will meet in Davos, Switzerland to discuss urgent global issues, including climate change.

“We cannot afford to wait any longer. We are already taking action but we have to do more and we have to do it quickly. We have to make drastic reductions in greenhouse gas emissions and accelerate the transition to renewable energy sources,” said WMO Secretary-General Celeste Saulo, who took charge at the start of the year.

Climate action requires global consensus, and according to this report by Potential Energy Coalition, it exists already.

Across all 23 countries surveyed there was support for climate action. The narrative that most resonated with people was the generational narrative about protecting the planet for their children.

Safeguarding next generation resonates most

According to message testing, people are not looking for endless economic growth or jobs. Instead, across every country, concern for the next generation was the dominant reason for action on climate change – 12 times more popular than creating jobs.

“In randomised controlled trial message tests, the most effective narrative — the urgent generational message — lifted the level of global strong support for climate action by an average of 11% points,” the report says.

“In every country in the study, the ‘later is too late’ narrative outperformed messages focused on economic opportunity, fighting injustice, improving health, or even preventing extreme weather,” according to the report.

Protecting the planet for future generations was the biggest motivator for climate action, 12 times more powerful than job growth.

“When we talk about this, about the urgency to act for our kids, for what we love, it moves people a lot,” said Jessica Lu, senior manager for strategy and analytics at Potential Energy Coalition. “This was by far the most effective, the most universal message.

“The data is saying repeatedly, what is the thing that matters most? It’s our love for the next generation, protecting all the things that we care about so that they have a livable and safe future,” she said.

Lu added that another important takeaway is that, when the message is done right, it can move people across age, gender, countries and political spectrum.

United States stands out as an anomaly

There was great support for climate action in developing countries but lower support in the countries with high per capita emissions of carbon.

For instance, citizens from the United States – responsible for 25% of the historic carbon emissions – showed the least support for climate action. In contrast, in countries like Chile and Kenya that are extremely vulnerable to climate change citizens expressed large support for climate action.

The report also found that how a message is framed has a significant impact on how it is received.

“Frames that included the words mandate, ban or phaseout on average had nine points lower support (and in some cases, up to 20 points lower support) than those that did not. Framings that included ideas like upgrading, setting standards, making solutions accessible, and reducing dependency performed significantly better,” the report says.

US has the least among of support for climate policy, compared to the other 22 countries surveyed.

It is okay to create worry

Over the years, as the climate coverage, so has the anxiety around it among those consuming the news. There are reports about young people feeling paralysing fear and therapists having to deal with a rise in climate anxiety.

John Marshall, the founder and CEO of Potential Energy Coalition, said simple messages that educate people about climate change and let people know that is a concern are the most effective.

“It’s okay to create worry. And in fact, it makes sense to create worry because most people don’t know enough about this. So go through the front door, talk about climate, convey the nature of the risk, and give solutions. That is much more effective than getting super creative about ideas, about jobs and prosperity,” Marshall said.

Image Credits: Unsplash.

Incoming Gavi CEO Sania Nishtar

Pakistan Senator Dr Sania Nishtar  has been appointed new CEO of the global vaccine alliance, Gavi, and will take up the position on 18 March.

This follows the previous appointee, Dr Muhammad Pate, pulling out last June – six weeks before he was due to take office, in order to serve as health minister of Nigeria.

Nishtar has had a 30 year career as a global public health leader. Her roles have included Special Assistant to Pakistan’s Prime Minister on Social Protection and Poverty Alleviation, and Federal Health Minister during her country’s 2013 caretaker government.

She was the inaugural Chair of the UN Secretary-General’s Independent Accountability Panel (IAP) for women’s and children’s health and Co-Chair of the World Health Organization’s (WHO) Independent High-level Commission on Non-communicable Diseases.

She also founded the non-profit NGO think tank, Heartfile, to campaign for health reform in Pakistan. 

Nishtar graduated from Khyber Medical College in Peshawar, Pakistan, top of her class. She is a Fellow of the Royal College of Physicians and received a PhD from King’s College London, which awarded her an honorary Doctorate in Science, Honoris Causa, in 2019. 

In 2020, she was listed on one of the BBC’s 100 Women, a list of inspiring and influential women from around the world.

“Over three decades of leadership at the national and global levels, Dr Nishtar has built a reputation as a tireless advocate for health equity, an innovative thinker and a proven doer when it comes to solving complex challenges,” said Professor José Manuel Barroso, Chair of the Gavi Board.

“I am impressed by her accomplishments and excited by the possibilities her appointment brings for our Alliance and our ambitions to protect future generations.”

Enormous task

Meanwhile, Nishtar said that “health starts with life-saving vaccines”. 

“Over the past 23 years, Gavi has been one of the most impactful organisations in global health. The task ahead is enormous – from health impacts of climate change, to the need to tackle vaccine inequity, prepare for future outbreaks and boost routine immunisation, which I believe is the gateway to achieving Universal Health Coverage,” she added.

“I am honoured by the trust the Gavi Board has placed in me and look forward to working with Gavi’s talented staff and skilled Alliance partners to ensure Gavi reaches hundreds of millions of children in lower-income countries with life-saving vaccines against deadly and debilitating diseases.”

Gavi’s fifth five-year strategic period drawing to a close at the end of 2025, and the organisation will seek board approval during this year for its next five-year strategy for 2026–2030. 

Image Credits: Gavi.

Dr Tedros with Cabo Verde Prime Minister Ulisses de Pina Correia e Silva at the ceremont to mark the country conquering malaria.

Cabo Verde was certified as malaria-free on Friday by the World Health Organization (WHO), only the third African country to have achieved this milestone.

The country, an archipelago of 10 islands off the West African coast near Senegal, joins 43 countries including African countries Mauritius and Algeria in eliminating malaria. 

Its last indigenous malaria case was recorded in January 2018.

“WHO’s certification of Cabo Verde being malaria-free is testament to the power of strategic public health planning, collaboration, and sustained effort to protect and promote health,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. 

Certification is granted when a country has shown “with rigorous, credible evidence” that the chain of indigenous malaria transmission by Anopheles mosquitoes has been interrupted nationwide for at least the past three consecutive years, and that the country has the capacity to prevent the re-establishment of transmission, according to the WHO.

“The certification as a malaria-free country has a huge impact, and it’s taken a long time to get to this point,” said Cabo Verde Prime Minister Ulisses Correia e Silva. “In terms of the country’s external image, this is very good, both for tourism and for everyone else. The challenge that Cabo Verde has overcome in the health system is being recognised.”

Collaboration

Cabo Verde included the elimination of malaria in its national health policy in 2007. A strategic malaria plan from 2009 to 2013 focused on expanded diagnosis, early and effective treatment, and the reporting and investigating all cases. 

To stem the tide of imported cases from mainland Africa, diagnosis and treatment were provided free of charge to international travellers and migrants.

Even during the COVID-19 pandemic, the country focused on improving the quality and sustainability of vector control and malaria diagnosis, strengthening malaria surveillance –   particularly at ports, airports, in the capital city and areas with a risk of malaria re-establishment.

The Ministry of Health worked with other government departments focused on the environment, agriculture, transportation, and tourism. The inter-ministerial commission for vector control was chaired by the Prime Minister and ensured collaboration, including  from community-based organisations and NGOs.

“This is an extraordinary accomplishment, a beacon of hope at a time when climate change threatens to slow down our progress in the global fight against malaria,” said Peter Sands, Executive Director of the Global Fund, which has assisted to fund the country’s anti-malaria efforts.

“What’s now crucial is that we do not lower our guard, and that we help Cabo Verde sustain this achievement and prevent the reintroduction of malaria. With this aim in mind, we will continue to fund vector control interventions and ensure quality case management and disease surveillance for another three years.”

Sands also called for use of new products that have proven to be safe and effective – such as next-generation insecticide-treated nets, insecticides, diagnostics, treatments or vaccines. 

“At the same time, it is crucial to build the supply chain, human resources for health and disease surveillance systems to support quality service delivery,” said Sands.

The Global Fund provides 65% of all international financing for malaria programs and has invested more than US$17.9 billion in malaria control programs as of June 2023.

Marion Koopmans addresses the WHO consultation

The World Health Organization (WHO) launched a series of consultations with the scientific community this week aimed at building consensus about how best to identify and address the pathogens most likely to cause epidemics and pandemics.

The first consultation kicked off on Tuesday, with some of the world’s top scientists addressing how to develop a scientific framework for epidemics and pandemics.

Hosted by the WHO’s Research and Development (R&D) Blueprint, it is one of four planned consultations to be held over the next few weeks as the WHO prepares to release an updated list of priority pathogens that pose epidemic and pandemic threats.

The priority pathogen list was last updated in 2018 and the WHO has indicated that it will publish a new list in the first half of this year.

Since November 2022, the WHO has focused on entire classes of viruses or bacteria rather than individual pathogens that pose threats in a process chaired by US virologist Dr Barney Graham from Morehouse School of Medicine in Atlanta.

“Over 200 scientists from 53 countries are independently evaluating the evidence related to 30 viral families, one core group of bacteria, and “Pathogen X” – an unknown pathogen with the potential to trigger a severe global epidemic,” according to WHO. 

“This new approach will also help identify representative viruses (or prototypes) within a viral family as a pathfinder in generating evidence and filling knowledge gaps that may then apply to other viruses of threat in the same family.”

Priority list ‘almost finished’

Dr Marie Paule Kieny, chair of the working group on Rhabdoviridae viruses, told Tuesday’s consultation that the WHO was “almost finished” prioritising the 30 viral families for their pandemic potential and whether there are medical countermeasures to stop their spread.

“From early 2024, WHO will start phase two, which will be a public health prioritisation [of the pathogens] with a process involving a prioritisation advisory committee with 40 to 50 experts where the output is expected to be the final shortlist of viral and bacterial families with pandemic potentials, including prototype pathogens,” said Kieny.

“It is absolutely indispensable that trials to demonstrate the efficacy of medical countermeasures are integrated into the outbreak response,” she added.

Once the list had been finalised, it would enable the “scaling up of a scientific approach to pandemic preparedness and will unravel a number of scientific opportunities,” said Kieny. 

Rapid research to stop outbreaks

British virologist Dr Peter Daszak offered a view from the field, showing how rapid research could prevent outbreaks.

Daszak’s team has identified a virus with similar properties to SARS CoV2 in caves in China frequented by bats and humans collecting their faeces to fertilise their crops.

“Here we have a virus in bats right now in a cave that’s used by people who are highly exposed to faeces and this is a virus that shed in bat faeces,” said Daszak.

“It has real potential for emergence. But the good news is, because we could do serological assays and we have a lot of access to human sera from the region, we know that most people in the region have either had COVID or have been vaccinated and that will provide really good protection, we think against this virus.”

By encouraging people to wear PPE and working with them to understand the risks, the scientists and local health authorities could reduce the potential for this virus to spill over, he added.

“If we target our surveillance, if we use the right technological approaches, we can discover really interesting and important new evidence of potential spillover of pathogens and do something about it, try and prevent that from becoming an outbreak,” concluded Daszak.

Bringing research and public health together

Renowned Dutch virologist Dr Marion Koopmans told the meeting that “the evolving global pathogen surveillance network” offered a huge opportunity for collaboration on “building surveillance and sequencing capacity for the common pathogens”.

However, she added that every region has its own pathogen hotspots and priorities.

“We need sampling designed that bears in mind the likely disease emergence scenario in each region. Do I want to be able to detect it pre-emergence, for instance, for vector-borne diseases going forward… or do I want to develop it into an early warning surveillance including, for instance, wastewater surveillance,” said Koopmans.

“the opportunities are there, the tools are there. They need to be further developed for routine implementation and that to me is the next step. What that requires in terms of collaboration is much closer connection between the more research type work in clinical settings and public health settings, rather than setting up separate data and sample collection studies for emerging diseases,” she added.

The next two consultations take place next Thursday and Friday, with the fourth to be held in February.

Wounded people wait to be treated at Al Shifa Hospital in Gaza City. Al Shifa is barely functioning due to lack of staff and supplies due to Israel’s closure of the area.

The World Health Organization’s (WHO) Director General has appealed to Israel to permit it to deliver more medical supplies to Gazan health facilities, particularly in northern Gaza, after Israel refused to allow WHO convoys to travel to the area seven times in the past two weeks.

“We call on Israel to approve requests by WHO and other partners to deliver humanitarian aid,” Dr Tedros Adhanom Ghebreyesus said at the global body’s first press conference of the year on Wednesday.

“We have the supplies, the teams and the plans in place. What we don’t have is access. WHO has had to cancel six planned missions to northern Gaza since 26 December, when we had our last mission because our requests were rejected, and assurances of safe passage were not provided. A mission plan for today has also been cancelled,” said Tedros.

He said that the situation in Gaza was “indescribable” with almost 90% of the population of 1.9 million people being displaced.

“People are standing in line for hours for a small amount of water, which may not be clean or bread, which alone is not sufficiently nutritious. Only 15 hospitals are functioning even partially. The lack of clean water and sanitation and overcrowded living conditions are creating the ideal environment for disease to spread,” he added.

“This Sunday marks the 100th day of the conflict in Israel and the occupied Palestinian territory,” Tedros noted. 

“We continue to call for the release of the remaining hostages, and we continue to call on all sides to protect health care in accordance with their obligations under international humanitarian law. Health care must always be protected and respected it cannot be attacked and it cannot be militarised.”

Dr Tedros Adhanom Ghebreyesus

Gaza laboratories destroyed

However, the WHO is unable to say what diseases are spreading as there is no way of diagnosing diseases because the facilities of Gaza Central Public Health Laboratory are no longer functional, said Dr Mike Ryan, WHO’s head of health emergencies.

The Central Public Health Laboratory had been in place for the last 40 years, providing “very high quality, environmental and human health sampling systematically across Gaza”, Ryan added.

“We are trying to make arrangements for samples to be taken out of the country and tested, and in other places to bring in mobile labs,” said Ryan. “And these are the trade-offs when you talk about access. Do you replace a truck of food with a truck of lab supplies? Which truck has more priority? Do you bring in water testing equipment or bring in water?”

Declaring WHO’s readiness to assist in Gaza, Ryan hit out at those criticising UN agencies for not doing enough.

“If you continue to destroy infrastructure, if you continue to draw destroy services at this rate, and then you blame the people who are trying to come in and support and help and provide life-saving assistance, who’s to blame here?” Ryan asked.

“Is it the people who are destroying the infrastructure and destroying the livelihoods and destroying the services? Or is it those who are trying to help restore those services under intense bombardment, under the threat of violence?”

Meanwhile, Dr Rik Peeperkorn, WHO’s Jerusalem-based representative for the Occupied Palestinian Territory, added that 16 out of 21 other planned United Nations humanitarian convoys carrying food, fuel and water to areas of northern Gaza that are now under Israeli military control had also been refused entry Gaza in January alone.

Peeperkorn also expressed concern that hostilities and evacuation orders were intensifying in southern Gaza close to Nasser and Gaza European Hospitals in Khan Younis, the only operational referral hospitals there, as well as Al Aqsa Hospital, in Gaza’s central region  – which together serve around two million people.

Image Credits: @alijadallah66 /Al Andalou News Agency, WHO .

Air pollution data for 2023 across seven cities in India, including its capital Delhi, shows air pollution levels either remained the same or worsened in winter months despite a national programme to improve air quality.

PUNE, India – India’s National Clean Air Programme (NCAP) was launched five years ago and has provided budgets to 131 Indian cities to respond to air pollution.

But over half of this money had not been used by the end of 2023, according to the latest figures released by the government, while the programme’s impact on reducing pollution has been “mixed”. This is according to an analysis of air pollution levels since NCAP was initiated, conducted by Climate Trends.

The NCAP’s initial target was to reduce two key air pollutants – PM10 and PM2.5 (ultra-fine particulate matter) – by 20 to 30% by 2024, but in September 2022, this target was revised to a 40% reduction by 2026.

“In 49 cities, PM2.5 data was available for all five years. Out of these, 27 cities recorded improvements in PM2.5 levels from 2019 to 2023,” according to the report.

“Similarly, for PM10, data across five years was available for 46 cities. Of these, 24 cities saw an improvement in their PM10 levels.”

The most significant improvement in air pollution was seen in Varanasi, the home constituency of India’s Prime Minister, Narendra Modi, where PM 2.5 air pollution was reduced by 72% and PM10 by 69%, according to government data.

However, IQAir still shows “unhealthy” levels of air pollution in Varanasi. The improvement the government data shows does not always match those by independent monitors and concerns have been raised in the past by advocates and activists about the government figures.

Several cities experienced increases in PM2.5 from 2019 to 2023. These include Navi Mumbai (46% increase), Ujjain (46%) and Mumbai (38%).

“Such marginal and short-lived improvements show that we need a science-based, well-planned, and comprehensive action plan which takes into account sources of pollution and meteorological factors,” said Aarti Khosla, Director of Climate Trends.

Around 99% of the world’s population breathes in air that exceeds the pollution standards set by the World Health Organization (WHO).

But the Indo-Gangetic plain that stretches from Pakistan in the west to Bangladesh in the east is home to some of the world’s most polluted cities like Lahore, Delhi, Kolkata and Dhaka. The region is a plain bordered by the Himalayas in the north which makes air flow difficult, causing pollution to remain in the air over some of the most densely populated cities in the world.

Addressing other sources of pollution

A lot of the conversation in Delhi around its air pollution has been focussed on stubble burning in neighbouring states as farmers clear their fields for the next planting season. While stubble burning has reduced, other sources of pollution have not.

“In Delhi, it is important to mention that fire counts (stubble burning events) decreased considerably in Punjab and Haryana in this season of October and November, which contributes a significant portion to the emission of PM2.5,” said S K Dhaka, Professor in the Department of Physics at Delhi University’s Rajdhani College.

“Despite the fact that the pollution level remains high in November, and remains similar in December, there is a need to address other sources of emissions such as transport, construction, and operation of thermal power plants in Delhi NCR,” Dhaka says.

A significant part of India’s air pollution comes from the energy sector. The country’s coal usage to generate energy has continued to grow, despite climate commitments at the international level. Coal is a highly polluting source of energy and its use has doubled in the past ten years to meet the demands of a growing population as well as the industrial sector. India’s pollution numbers reflect the emissions that have not changed much.

Kolkata’s air pollution has been on the whole lower in both 2022 and 2023 which suggests that efforts to control and manage pollution have been effective.

Some cities like Kolkata have shown improvements compared to the national average that show strategies when implanted effectively can deliver results. Kolkata was one of the few cities that used most of the budget it received from the NCAP to address air pollution.

Data across the past five years has found that some cities experienced increases in pollution concentrations, underscoring the complexity of achieving air quality targets.

Increased advocacy has led to an increase in air quality monitoring in most cities, with a significant number seeing an increase in active monitors, according to Climate Trends.

No progress in the past year

Meanwhile, air pollution levels in most major cities in India either remained the same or worsened in the winter months of 2023 in comparison to 2022.

This is according to an analysis of data from India’s Central Pollution Control Board (CPCB)  from seven Indian cities, Delhi, Chandigarh, Lucknow, Varanasi, Patna, Kolkata and Mumbai.

“Comparing monthly average pollution levels between 2022 and 2023 shows some improvements, especially in Lucknow and Varanasi, but at the same time in the winter months, where air quality matters more than other months due to fog and temperature drop, we see that cities of Delhi and Chandigarh are either the same across years or worse off,” says Climate Trends director Khosla, who conducted the analysis.

The data underscores the need for targeted interventions to address the specific seasonal challenges.

In 2023, Delhi experienced a surge in winter pollution compared to 2022 that has been attributed to factors like meteorological conditions and increased emissions.

Image Credits: Unsplash, Climate Trends, Unsplash.

COVID
The WHO has urged countries to continue to sequence COVID-19 samples to monitor variants.

The JN.1 COVID-19 variant is completing its global takeover, with the number of new cases having increased by 52% during the 28 days leading up to the end of the year, according to the World Health Organization (WHO). 

In the United States, JN.1 accounts for more than 60% of COVID-19 cases, according to the Centers for Disease Control and Prevention – and all of this on top of rising influenza and Respiratory Syncytial Virus (RSV) waves. 

“The pandemic is far from over,” stressed American scientist Eric Topol in an opinion piece in the Los Angeles Times. 

What is JN.1?

JN.1 is a derivative of the BA.2.86 Omicron subvariant of SARS-Cov-2 but with more than 30 mutations. Israeli variant trackers first discovered it in August. WHO first spoke about JN.1 at a press conference on 19 October press as a variant “to keep a close eye on.” Last month, it named JN.1 a “variant of interest” (VOI) but nit the more serious “variant of concern” (VOC). 

According to Topol, “by wastewater levels, JN.1 is now associated with the second-biggest wave of infections in the United States in the pandemic, after Omicron.” He said the level indicates that around two million Americans are infected with JN.1 daily.

Although many people are carrying the virus and CDC data shows that US COVID-19 hospitalizations have continued to increase in the last two months, JN.1 has not caused the surge of hospitalizations seen in Omicron. 

This is also the case in other countries, including Israel, where it was first discovered, according to Cyrille Cohen, the head of the field of life sciences and medicine for the Israel Science Foundation and a professor at Bar-Ilan University. He said the country is seeing 10 to 20 cases of severe COVID-19 disease in hospitals on any given day, compared to as many as 1,400 two years ago. 

At the same time, studies are starting to show that the updated COVID-19 vaccines developed by Pfizer, Moderna and others are eliciting antibodies against JN.1 – at least in vitro, according to Cohen. 

For example, Kaiser Permanente recently released a report that showed a vaccine booster conferred approximately 60% protection against hospitalization for JN.1 and other recently identified variants. 

However, Cohen cautioned that it can be challenging to determine the impact of COVID-19 vaccines today as people have had so many shots at different intervals and of different versions. Moreover, most people have either been exposed to or are sick with COVID-19. 

The other issue is that vaccine uptake is deficient. CDC data as of 5 January showed that only 8% of eligible children and 19.4% of eligible adults had received the updated 2023-24 COVID-19 vaccine. The percentage jumped to around a third (38%) among adults over 65. 

Many more people are opting to take the influenza vaccine: 44% of children and 45% of adults, including 70% of adults over 65. 

Evaluating JN.1: What to ask

Whenever there is a new variant, you need to ask three questions, explained Peter Chin-Hong, a professor of medicine and infectious disease at the University of California, San Francisco: Is it more transmissible? Do the vaccines work? Does it cause more severe disease?

Is it more transmissible?

Chin-Hong told Health Policy Watch that the data indicates JN.1 is more transmissible “because it is rising to the top of the charts very quickly.” He said that at the beginning of November 2023, JN.1 accounted for between 5% and 8% of all US cases, and today it is the most common variant. 

Can it evade vaccines?

The answer here, Chin-Hong said, is generally no. He said the studies show that the vaccine works as long as people are newly inoculated. He recommended the vaccine for immuno-compromised people with pre-existing medical conditions and those over the age of 75. For these people, he said, “just being infected a year ago and getting the first two shots will not be enough.”

Does it cause more severe disease?

According to Chin-Hong, there is no evidence that JN.1 has caused more severe diseases so far and no evidence that it will. This is true in the countries currently experiencing a rise in the variant, and also from data in Singapore and other countries where JN.1 has been the predominant variant for longer, he said. 

In those countries, the variant did not seem to cause more people to be hospitalized. 

Moreover, he added that antiviral drugs such as Paxlovid and Remdesivir continue to work to curtail the severity of the virus. 

Instead, he said his concern is that JN.1 will exploit the world’s COVID-19 complacency. The majority of countries have not kept up testing or vaccination, and given its high price tag, many low- and middle-income countries do not have access to drugs like Paxlovid. 

“Those are the vulnerabilities that JN.1 will exploit,” Chin-Hong said. 

COVID-19: ‘a new era’

But Cohen said he believes the world and COVID-19 are “in another era” since WHO ended the virus’s official pandemic status in May 2023. He noted that COVID-19 is not the same threat as at the pandemic’s beginning or even during Delta. 

“With the Omicron era that started exactly two years ago, the infection decreased in intensity,” Cohen said. Moreover, “since most of us were exposed to COVID at least once in our lifetime, there is also some kind of protective [herd] immunity.”

That does not mean, however, that the medical and scientific community should not be taking JN.1 or COVID seriously, Chin-Hong stressed. He said WHO should hurry to give the variant a Greek letter name, such as Pi, to “allow governments and people to mobilize” and fight the virus. 

“Right now, people are fed up with COVID,” Chin-Hong told Health Policy Watch. “Giving it a letter will give something to people to latch onto: let’s vaccinate against Pi, get medicines, and have a global talk about sequencing.

“These things have trickle-down effects,” he continued. “Giving it a name would also help the everyday person believe he still has something to pay attention to.”

Chin-Hong and Cohen said that information remains crucial and that countries should continue to sequence to identify variants of concern. 

“We need to monitor those variants because it is not the end of COVID,” Cohen said. Just like with flu, which has an intense strain every 10-20 years, he said that COVID-19 could also once again have a more dangerous strain.”

As Topol wrote in the LA Times: “Inevitably, there will be another strain in the future that we are not at all prepared for and will lead to yet another very big wave across the planet.”

Image Credits: Photo by Mufid Majnun on Unsplash.