Vaccine
Health workers prepare a vaccine

The rising number of US citizens declining vaccinations is threatening population immunity to certain diseases, according to two US Food and Drug Administration (FDA) leaders.

“The situation has now deteriorated to the point that population immunity against some vaccine-preventable infectious diseases is at risk, and thousands of excess deaths are likely to occur this season due to illnesses amenable to prevention or reduction in severity of illness with vaccines,” according to FDA Commissioner Dr Robert Califf and Dr Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research writing in the journal, JAMA.

They cite a recent measles outbreak in central Ohio involving 85 children, 36 of whom (42%) had to be hospitalized for complications.

High-income parents ‘prefer social media’

“It is sobering to note that vaccine hesitancy to childhood vaccines, such as the measles, mumps, and rubella vaccine, has been found to cluster in middle- to high-income areas among parents with at least a college degree who preferred social media narratives over evidence-based vaccine information delivered by clinicians,” they note.

In addition, only 35% of people older than 65 have had the updated COVID-19 vaccine (XBB.1.5 monovalent), which is about half the rate in this age group in the UK.

“Contrary to a wealth of misinformation available on social media and the internet, data from various studies indicate that since the beginning of the COVID-19 pandemic, tens of millions of lives were saved by vaccination. The benefits of these vaccines in prevention were largest in older individuals. However, studies show that people of all ages who are up to date on vaccination benefit and have a lower risk of developing long COVID,” they note.

Mortality per Million Individuals From COVID-19 in the US Depending on Vaccination Status

Uptake of the influenza vaccine amongst US citizens over 65 is also inadequate. 

“Vaccination rates against these respiratory pathogens are inadequate, and this is most distressing in older individuals in whom the benefits of vaccination in reducing hospitalization and death are eminently clear.”

Califf and Marks urge the clinical and biomedical community to “redouble efforts to provide accurate plain-language information” about the benefits and risks of vaccination. 

“We believe that the best way to counter the current large volume of vaccine misinformation is to dilute it with large amounts of truthful, accessible scientific evidence,” they argue.

Clinicians who provide care are the most trusted source of information about health decisions, while retail pharmacists perform this role for people who lack a primary care clinician or who are uninsured.

“All those working in health care, while being straightforward about the risks, need to better educate people regarding the benefits of vaccination, so that individuals can make well-informed choices based on accurate scientific evidence,” they urge.

Ironically, 2024 is the fiftieth anniversary of the World Health Organization’s Expanded Programme on Immunization (EPI), which aimed to ensure equitable access to life-saving vaccines for every child, regardless of their geographic location or socioeconomic status. 

Texas case against Pfizer 

The FDA leaders’ appeal comes shortly after Texas Attorney General Ken Paxton launched court action against Pfizer late last year for “false, deceptive, and misleading acts and practices” relating to its COVID-19 vaccine.

“The pharmaceutical company’s widespread representation that its vaccine possessed 95% efficacy against infection was highly misleading,” according to Paxton in a media release.

Paxton, who is seeking more than $10 million in fines, claims he is “pursuing justice for the people of Texas, many of whom were coerced by tyrannical vaccine mandates to take a defective product sold by lies”.

In response, Pfizer has applied for the case to be moved to the Northern District of Texas, saying that the case has no merit. It also claims that it is immune from liability under federal and state law in terms of the Public Readiness and Emergency Preparedness (PREP) Act for Medical Countermeasures Against COVID-19 passed in 2020.

“The FDA … is in the best position to resolve questions concerning the accuracy and propriety of statements Pfizer allegedly made concerning the COVID-19 vaccine, which the FDA itself vetted, authorized, and approved,” according to Pfizer in its legal filing.

Paxton’s court action has been hailed by anti-vaxxers on social media, many of whom are supporters of Donald Trump, in a country where uptake of vaccinations have become politicised, particularly during the pandemic. Republican supporters are significantly less likely to be vaccinated against COVID-19 than Democrats and died in greater numbers during the pandemic.

Image Credits: WHO Afro region, JAMA.

The first two girls ever vaccinated with the malaria vaccine RTS,S in Ghana. Now a second vaccine, R21/Matrix-M has been added to WHO’s recommended procurement lists.

The World Health Organization (WHO) has added the R21/Matrix-M malaria vaccine to its list of ‘prequalified’ vaccines, paving the way for bulk procurement and mass deployment of the new vaccine across malaria-endemic countries by UNICEF and other global health agencies.

The prequalification of the world’s second malaria vaccine, developed by Oxford University and manufactured by Serum Institute of India (SII), is expected to greatly expand access to malaria vaccination, particularly in malaria endemic regions of sub-Saharan Africa where supplies of the already available RTS,S vaccine cannot alone meet the high demand, said WHO in a statement on Thursday.

Some 100 million doses of the new vaccine are reportedly ready for rollout by SII, a major supplier of vaccines in Africa.

“Today marks a huge stride in global health as we welcome the prequalification of R21/Matrix-M, the second malaria vaccine recommended for children in malaria endemic areas,” said Dr Kate O’Brien, Director of the Department of Immunization, Vaccines and Biologicals. “This achievement underscores our relentless commitment to wiping out malaria which remains a formidable foe causing child suffering and death.”

Nearly half a million children in WHO’s African Region die from malaria each year – making it one of the continent’s biggest early childhood killers, despite declining death rates over the past two decades.  Globally, in 2022, there were an estimated 249 million malaria cases and 608,000 malaria deaths across 85 countries.

R21 malaria vaccine administration in clinical trials sponsored by Oxford University, which concluded with regulatory approval of the world’s second malaria vaccine.

Prequalification ensures safe manufacture of the vaccine

In October, WHO recommended use of the R21/Matrix-M vaccine,  developed by Oxford University and manufactured by Serum Institute of India, for the prevention of malaria in children following a review by the Strategic Advisory Group of Experts (SAGE) on Immunization and the Malaria Policy Advisory Group.

However, WHO “prequalification” remains a prerequisite for bulk vaccine procurement by UN agencies as well as for many other donor-supported programmes in countries. Effectively, the pre-qualification label confirms that the manufacture of the vaccine, in this case by SII, meets international standards.

“Achieving WHO vaccine prequalification ensures that vaccines used in global immunization programmes are safe and effective within their conditions of use in the targeted health systems,” said Dr Rogério Gaspar, Director of the Department of Regulation and Prequalification.

The first malaria vaccine to be approved by WHO, RTS,S/AS01 vaccine, obtained prequalification status in July 2022.  While the second vaccine R21/Matrix-M seemed to show even better results in some of clinical trials conducted prior to regulatory approval, WHO has said both are equally effective, noting that the two vaccines have not actually been tested head-to-head.

“Both vaccines are shown to be safe and effective in clinical trials, for preventing malaria in children,” said WHO in its statement. “When implemented broadly, along with other recommended malaria control interventions, they are expected to have a high public health impact.”

Image Credits: WHO/Fanjan Combrink, University of Oxford/Tom Wilkinson.

Nurses| Cameroon
Student nurses prepare for the morning rounds at the Ndop District Hospital in Cameroon.

The worldwide shortage of nurses should be considered a “global health emergency” – yet governments are failing to invest in measures to retain these essential workers, according to Howard Catton, CEO of the International Council of Nurses (ICN).

“The US has lost 100,000 nurses since 2020 and is predicted to lose up to 600,000 by 2027. The number of nurses leaving the UK register is also up since 2020. And in Switzerland, the dropout rates of new nursing students in their first year and second year is between 18 and 36%,”  Catton told a briefing hosted by ACANU, the Geneva UN press association.

Despite increasing evidence of nurses leaving or planning to leave the workforce, “governments are not in sufficiently prioritising investment in the nursing workforce”, he added.

“Improved working conditions and support and investment for the current nursing workforce need to be a priority to hold those nurses that we have.”

Governments are more focused on recruitment than retention of nurses, added Catton – and international recruitment by certain wealthy countries is decimating the healthcare in less affluent countries.

Recruitment from ‘red list’ countries

Howard Catton, CEO of the International Council of Nurses (ICN)

“A small number of high-income countries are driving 70% to 80% of recruitment activity,  overwhelmingly from countries in a weaker position than themselves. 

“Just in recent days, the UK announced that it had reached a target to recruit 50,000 more nurses earlier than planned. But it turns out 93% of those 50,000 were internationally recruited nurses, and we know that 6,000 of them came from the most vulnerable countries – the red list countries, that the World Health Organization (WHO) advises not to recruit from.”

Fiji has lost 25% of its nurses in the last year to Australia and New Zealand, he added.

In 2023, the WHO identified 55 countries – 37 from Africa – with “low workforce density” that might require “safeguards against active international recruitment” of their health workforce.

“The focus of government action, where we do see it, appears more on recruitment than retention,” said Catton.

“Recruitment, of course, is important in the medium to long term. But there’s a time lag. And the most simple, incontrovertible truth is that improved working conditions and support and investment for the current nursing workforce need to be priorities to hold in those nurses that we have.”

The rise in nurses’ strikes and disputes is an indication of the impact of the post-pandemic cost of living crisis, with a fall in real pay being reported even in Italy, Portugal, Finland and the UK. 

However, said Catton, “The approaches governments are adopting are unsustainable, and we’re concerned that there is a risk of more disputes and unrest over the year to come without the prioritisation of investment”. 

Pamela Cipriano, president of the International Council of Nurses (ICN)

ICN president Pamela Cipriano pointed out that slogans such as “health for all”, ‘leave no one behind’ and universal health coverage all depend on nurses – yet there is insufficient investment in nurses and nursing. 

“We need to move nurses from being invincible to being considered invaluable,” she added, cautioning those wanting to bring in workers who are less experienced and less expensive, “We urge great caution because someone with lesser education and training cannot replace the expertise of a nurse.”

Support for nurses in Palestine 

While the ICN did not involve itself in geopolitics, “there should be complete protection of health care facilities, health care workers and civilians in any area of conflict and war”, said Cipriano.

“We know that that’s been violated [in the occupied territories of Palestine], so we have spoken out against that. We, along with many other groups are calling for peace but also very specifically, protection of health care facilities and adherence to international law.”

The ICN had provided some financial support to Palestinian nurses, who are currently not being paid, “but not anywhere near the magnitude that they would need and hoping that we can help them to connect with other groups that can provide some financial support”, she added. 

Aside from financial support, Cipriano noted that nurses in the occupied territories needed education to deal with “new patient groups” as “the wounds of war are different from normal care”.

“Right now, we know they’re working in conditions where electricity, water supplies, medications, are at risk, so they are working in serious disaster conditions,” said Cipriano.

“Many times our other associations step up to help one another, either financially or it may be that regionally, there can be physical support.”

Tribute to Israeli nurse held hostage

Cipriano also paid tribute to Nili Margalit, an Israeli nurse kidnapped by Hamas on 7 October and held hostage for 55 days.

“She’s a 41-year-old nurse and… [she was able to] get medications to the people who were in the tunnel where she was being kept, to give them hope, to be the communicator, to be the organiser.,” said Cipriano 

“That is what nurses do. They rise in the face of crisis, as well as [during] the daily and life events that that people are facing. 

“In conflict and crisis, we can rely on nurses even though we know it also takes a tremendous mental toll on their well-being.”

Image Credits: © Dominic Chavez/The Global Financing Facility.

Some of those petitioning against Uganda’s Anti-Homosexuality Act in court on Monday, including Pepe Onziema (left) and Frank Mugisha (centre).

The court challenge to Uganda’s Anti-Homosexuality Act, one of the harshest anti-LGBTQ laws in the world, began in Kampala on Monday before five Constitutional Court judges.

The Act, which was passed by an overwhelming majority of Members of Parliament in May, includes penalties such as a life sentence for same-sex acts between consenting adults, 10 years in prison for “attempted homosexuality;” the death penalty for “aggravated homosexuality” and 20 years in prison for  “promotion of homosexuality”.

However, there is unlikely to be much more live court action after Deputy Chief Justice Richard Buteera, chair of the hearing, agreed to entertain written submissions rather than live hearings.

This followed a request by the lawyers representing the eight petitioners, including MP Fox Odoi-Oywelowo, and LGBTQ leaders Frank Mugisha and Pepe Onziema,  that they wished to proceed by way of written submissions.

Respondents, the Attorney General, supported by evangelical Pastor Martin Ssempa and Watoto Church elder Stephen Langa, served the petitioners with their written submissions at the hearing, and the court directed the respondents to reply by 5pm on 20 December.

Thereafter, the court will deliver its judgment “on notice”, either in court or electronically.

Commenting on the decision, Nicholas Opiyo, the attorney for the petitioners, said that the intention was “to avoid the theatrical intention of some of the people admitted into the process whose only objective appeared to be using the court as a platform to raise money and profile”. 

“In the end, a decorous process to preserve the integrity of the court and the hearing was chosen over and above oral presentation,” added Opiyo on X inan apparent reference to Ssempa’s attempts to use the court challenge to fundraise for his anti-LGBTQ crusade.

Researchers threaten to withdraw after directive 

Meanwhile, Uganda’s National Council for Science and Technology faced international condemnation for directing all researchers to report anyone who violated, or was suspected to be violating, the Act in their research programmes to the police.

In an open letter sent to Dr Martin Ongol, acting secretary of the council, some 260 researchers worldwide call on him to immediately withdraw a directive he issued on 27 October.

 

The directive informed researchers that “the duty of confidentiality in research may be waived for the purposes of reporting to the relevant authorities the commission of an offence” in terms of the Anti-Homosexuality Act.

The Act itself obliges citizens to report anyone who has committed or intends to commit any offence under the Act or face “a criminal penalty or a fine”.

“This Directive means we cannot uphold our moral commitment to the rights of our study participants to life, health, dignity, integrity, self-determination, privacy, and confidentiality,” notes the letter.

“We are asking you to immediately withdraw this Directive, if not, we will be forced to reassess our current research in Uganda and our future research plans.”

Uganda has already paid heavily for its homophobia, with the county’s new World Bank loans currently on hold along with new grants from the US President’s Emergency Plan for AIDS Relief (PEPFAR), the country’s exclusion from the US African Growth and Opportunity Act (AGOA) that gives preferential trading terms to select African governments and US visa sanctions on key supporters of the Act, including all the MPs who voted for it.

Global spending on health increased during 2021 at the height of the COVID-19 pandemic, reaching a record $9.8 trillion or 10.3% of global gross domestic product (GDP) – mostly as a result of governments devoting more domestic resources to health,

Country spending was highest on hospitals, accounting for 40% of expenditure, followed by ambulatory care (outpatients) providers (19%–24%) and pharmacies (16%–23%). 

The fastest growth in spending was on preventive care providers, such as public health institutions and disease control agencies. 

This is according to the World Health Organization’s (WHO) Global Health Expenditure Report 2023, based on data from 50 countries.

However, the per capita spending was “unequal”, the report notes, with high-income countries spending an average of $4001 per person in comparison to a mere $45 in low-income countries. Upper-middle-income countries spent $531, which was substantially more than the $146 per person in lower-middle-income countries.

“The distribution of global spending on health remained highly skewed in 2021: 79% was in high-income countries, which are home to less than 16% of the world population,” according to the report. 

“Low-income countries accounted for only 0.24% of the global health expenditure, despite having an 8% share of the world’s population.”

Spending on COVID-19 rose in real terms in 39 of 48 countries with data, accounting for 11% of government and compulsory insurance health spending in 2021, up from 7% in 2020. 

There was “no evidence” that the additional COVID-19 spending meant countries spent less on other diseases, or that spending on COVID-19 vaccines meant less money for testing and treatment, the report finds, stating: 

“The analysis suggests that the increased spending for COVID-19 did not crowd out spending for other health needs, although it might have affected the rate of growth of spending for these other purposes.” 

In addition, out-of-pocket spending on health in low-income countries fell in 2020 and 2021 but rose to pre-pandemic levels in high, upper-middle and lower-middle-income countries in 2021 after a decline in 2020.

Lack of data on spending patterns

The WHO said that action is still needed at the domestic and international levels to improve data collection on spending patterns. 

“While most countries regularly report aggregated health spending data, few consistently report the critical details that underpin these high-level results. Accordingly, only a partial view of the spending dynamics during the COVID-19 pandemic – by provider, function, and disease and condition – is possible in this report.”

The report also notes the lack of information on health capital investment “which limits the insights into this critical area of health policy”. 

“More effort is needed, therefore, to improve data collection and increase the number of countries developing and reporting disaggregated health account data. Key to this is institutionalising health account practices at the country level.”

Hard to sustain higher spending levels

External aid was “crucial” in supporting government spending in 2021 in low and lower-middle-income countries. However, sustaining government health spending and external aid at 2021 levels may be challenging given “the deterioration in global economic conditions and the rise in debt-servicing obligations”.

“Amid this more difficult financing environment, a key challenge for countries will be to resist the urge to de-prioritize government spending on health. Doing so risks rolling back progress towards universal health coverage,” according to the report.

Image Credits: WHO African Region , WHO PAHO.

Dr Anshu Banerjee, WHO director for maternal, newborn, child, adolescent health and ageing, described the new guidelines as “a tool to support a holistic approach to chronic low back pain care”.

The World Health Organization (WHO) has released its first guidelines for addressing low back pain, a condition affecting an estimated 619 million people, or one in 13 worldwide.

The new guidelines are designed to enhance care quality for millions suffering from the condition, offering healthcare professionals a range of non-surgical treatments applicable in primary and community care settings. The guidelines also list treatments to avoid, including lumbar braces, traction-based physical therapies, and opioid painkillers.

The prevalence of low back pain is expected to surge as the global population ages, with estimates predicting a rise to 843 million affected individuals by 2050. Low back pain currently accounts for 8.1% of years lived with disability globally, according to the WHO.

“To achieve universal health coverage, the issue of low back pain cannot be ignored, as it is the leading cause of disability globally,” said Dr Bruce Aylward, WHO assistant director-general for universal health coverage and life course, in a press release accompanying the guideline launch.

Nine out of ten cases of low back pain are chronic, deeply affecting patients’ ability to work and stay active in family and social life, often leading to broader economic and mental health consequences. The guidelines emphasise mental health care as crucial in treating these conditions.

Chronic low back pain also has significant economic repercussions at the national level, pushing individuals out of the workforce and straining health systems.

The annual global costs associated with low back pain exceed $50 billion and potentially reach up to $100 billion at the upper end of estimates, according to the British Medical Journal. This financial impact is especially pronounced in low- and middle-income countries (LMICs), where 80-90% of employment involves heavy labour, significantly increasing the prevalence of LBP compared to high-income nations.

The WHO guidelines provide a multifaceted approach to treatment, emphasising patient education in self-care techniques, structured exercise programs, spinal manipulative therapy, and massage, while cautioning against certain treatments like traction and therapeutic ultrasound.

WHO officials emphasised that while the guidelines provide a general framework, adapting them to local clinical practices is essential for effective implementation.

“Addressing chronic low back pain requires an integrated, person-centred approach,” said Banerjee. “This means considering each person’s unique situation and the factors that might influence their pain experience.”

Recognising low back pain as a national health priority is crucial for optimising healthcare management in this area, WHO stressed – a step many countries have yet to take.

Image Credits: Adam McGuffie.

Vidya Kishnan and Garry Aslanyan on "Dialogues," a new series from the Global Health Matters podcast.
Vidya Kishnan and Garry Aslanyan on “Dialogues,” a new series from the Global Health Matters podcast.

The elimination of tuberculosis cannot be achieved if medicines are locked in a “patent panoply,” according to Indian author and journalist Vidya Kishnan.

Speaking to Garry Aslanyan on the most recent episode of Dialogues, a new series from the Global Health Matters podcast, the author of “Phantom Plague: How Tuberculosis Shaped History” said that “everything that happened in COVID has been happening for decades with TB.

“In India, the entire TB program got ‘Covidized,’ down to the helpline of the Ministry [of Health], and infections and respiratory diseases don’t simply go away,” Kishnan said. “So, the first thing we need to do is look at how technology is transferred because vaccines and drugs first and foremost, it’s technology. It’s somebody’s intellectual property. And I feel like TB elimination cannot, will not be achieved if the medicines, the latest most humane therapy, is locked in a patent panoply.”

The most exasperating aspect, according to Kishnan, is that the advancements in tuberculosis therapies resulted from a sincere collaboration within the public domain. Universities, student funds, and philanthropic contributions collectively supported these efforts. Notably, several late-stage clinical trials for bedaquiline took place in India and South Africa, with patients actively contributing to the process.

“It’s really unfair that you use patients for research, but then when … all of these drugs came out of industrial scale subsidies to pharmaceutical companies, and others in patent panoplies.”

Throughout her writing career, Kishnan has dedicated considerable effort to investigating and documenting the profound impact of tuberculosis on individuals from various backgrounds in India. In her book, she delves into critical questions concerning the intersection of race and caste within policies that shape the dynamics of tuberculosis spread and control in the contemporary context of her home country.

Kishnan tells Aslanyan that in India, people live in congested cities and are still segregated by race, caste, and class. Pathogens do not respect these boundaries. However, the rich generally access medicines, whereas the poor are left behind.

In India, tuberculosis has reemerged as the foremost infectious disease killer. She said the lessons from previous pandemics underscore a fundamental truth: No one can be considered safe until everyone is protected from the threat.

“I feel like a stuck record saying this over and over again everywhere I speak. But it was quite surreal to see the science denialism and the racism and casteism in my country, all of the things I had read about, the xenophobia, all of it just came to life in the past three years,” Kishnan said. “If we are greedy and if we think in these myopic ways, I don’t see any way we will prevail over these pathogens despite all the fruits of modern medicine.”

Aslanyan concluded: “This conversation reminds us, as global health professionals, of many challenges on the long road ahead toward the ultimate goal of tuberculosis elimination and the importance of community engagement.”

Listen to previous episodes of Dialogues on Health Policy Watch.

Image Credits: Global Health Matters (TDR), Global Health Matters Podcast (TDR).

Dr Olivi Ondchintia Putilala Silalahi, WHO Indonesia national professional officer for routine immunization, inspects a COVID-19 vaccination site in Indonesia.

A spike in COVID-19 cases in Southeast Asia has prompted Indonesia, Singapore and Malaysia to reintroduce screening for travellers at airports.

In the past week, Indonesia has installed thermal body scanners at Jakarta International Airport and the main ferry line.

The Bali Port Health Office has also implemented thermal checks at three border entry points: Benoa Port, Celuk Bawang, and I Gusti Ngurah Rai International Airport, and appealed to travellers to wear masks – particularly if they are feeling unwell.

Should a tourist or foreign national test positive for COVID-19 upon arrival, they will be immediately quarantined in a designated health facility or referral hospital in Bali, according to a circular issued this week by the Ministry of Health.

The Indonesian health authorities have also urged citizens to wear masks, ensure they are fully vaccinated and postpone travel to areas that are reporting a spike in COVID-19 cases.

https://twitter.com/BloombergAU/status/1735242493136920598

Jump in cases in Singapore

In Singapore, COVID cases increased by 10,000 in a single week, jumping from 22,000 to 32,035 in the week ended 2 December, according to the health ministry.

“The increase in cases could be due to a number of factors, including waning population immunity and increased travel and community interactions during the year-end travel and festive season,” said the Ministry of Health. 

“We urge the public to exercise precaution, personal and social responsibility,” said the Singaporean Health Ministry.

“When travelling overseas, stay vigilant and adopt relevant travel precautions, such as wearing a mask at the airport, purchasing travel insurance, and avoiding crowded areas with poor ventilation.”

“Everyone is advised to keep up to date with their COVID-19 vaccinations. This includes an additional dose around one year after their last vaccine dose for those aged 60 years and above, medically vulnerable persons, and residents of aged care facilities,” it added.

Malaysia COVID cases: 14 December 2023

Meanwhile, cases in Malaysia doubled in a week, jumping from 6,796 cases at the end of November to nearly 13,000 by 9 December, according to the New Strait Times.

Malaysian Health Minister Dzulkefly Ahmad recommended on Thursday that people wear masks and get a COVID-19 booster if they were elderly or had co-morbidities, according to the Strait Times.

Image Credits: WHO Indonesia.

Rush hour traffic in Ho Chi Minh City in Vietnam.

Ten countries have slashed their road traffic deaths in half between 2010 and 2021, while  35 others have reduced deaths by between 30% and 50%, according to the World Health Organization’s (WHO) Global Status Report on Road Safety 2023 released this week.

The big achievers are Belarus, Brunei, Denmark, Japan, Lithuania, Norway, Russia, Trinidad and Tobago, United Arab Emirates and Venezuela.

Meanwhile, there was an overall global reduction in deaths of 5% over the period, with 1.19 million people dying per year.

“Yet with more than two deaths occurring per minute and over 3,200 per day, road traffic crashes remain the leading killer of children and youth aged 5–29 years,” according to the WHO.

“The tragic tally of road crash deaths is heading in the right direction, downwards, but nowhere near fast enough,” says WHO Director-General, Dr Tedros Adhanom Ghebreyesus. “The carnage on our roads is preventable. We call on all countries to put people rather than cars at the centre of their transport systems, ensuring the safety of pedestrians, cyclists and other vulnerable road users.”

The majority of road traffic deaths occurred in the WHO’s South-East Asia Region (28%), followed by the Western Pacific (25%), African Region (19%), the Americas (12%), and the Eastern Mediterranean Region (11%). The least occurred in the European Region (5%).

Some 90% of deaths occur in low- and middle-income countries (LMICs), and the risk of death is three times higher in low-income than high-income countries despite low-income countries only having 1% of the world’s motor vehicles.

More than half of fatalities occur among pedestrians, cyclists and motorcyclists, in particular those living in LMICs. Pedestrian deaths rose 3% to 274,000 over the decade, accounting for 23% of global fatalities. Deaths among cyclists rose by nearly 20% to 71,000, accounting for 6% of global deaths. 

“Research indicates that 80% of the world’s roads fail to meet pedestrian safety standards and just 0.2% have cycle lanes, leaving these road users dangerously exposed. And while nine in 10 people surveyed identify as pedestrians, just a quarter of countries have policies to promote walking, cycling and public transport,” according to WHO.

The report also reveals an alarming lack of progress in advancing laws and safety standards. Only six countries have laws that meet WHO best practice for all risk factors, namely speeding, drunk driving, compulsory motorcycle helmets, seatbelts and child restraints.

The global motor vehicle fleet is set to double by 2030, but only 35 countries – less than a fifth of UN Member States – legislate on all key vehicle safety features, while only a quarter require vehicle safety inspections that cover all road users.

“Our mission at Bloomberg Philanthropies is to save and improve as many lives as possible, and one of the best ways to do that is to make more of the world’s roads safe for all,” said Michael R. Bloomberg, founder of  Bloomberg Philanthropies, which supports a substantial global road safety programme.

“For more than a decade now, we’ve made encouraging progress together with the WHO and our partners. Still, as this new report makes clear, road safety demands stronger commitments from governments worldwide – and we’ll continue to urge more leaders to take lifesaving action,” added Bloomberg, who is the WHO’s Global Ambassador for Noncommunicable Diseases and Injuries.

Image Credits: tph567/Flickr, Flickr/ M M.

The outsized effect of climate change on young children represents an “intergenerational injustice”, according to experts speaking at a side event on maternal and child health at COP28 in Dubai. 

“Nearly 90% of the global burden of disease associated with climate change is borne by children under the age of five,” according to UNICEF. 

“Climate change has already had an impact on heat-related child mortality in sub-Saharan Africa. The annual average heat-related child mortality for the period from 2005 to 2014 was approximately under 20% higher than would have been observed without climate change. This so-called ‘climate penalty’ will be worse over the coming years,” said Veronique Filippi, Professor at the London School of Hygiene and Tropical Medicine. 

There is also compelling evidence that heat can increase the risk of preterm births, stillbirths, hypertension as well as preeclampsia, she said.

“There are no physiological reasons why pregnant women or newborns are more vulnerable to the health impact of environmental disasters,” emphasized Filippi. “The main reason for vulnerability is the position of women in society, their limited agency and mobility.” 

Dr Anshu Banerjee, Director of Maternal, Newborn, Child and Adolescent Health and Ageing at the World Health Organization (WHO) said that while global carbon emissions have to be reduced, health facilities also have to be equipped with solar power and cooling facilities for patients. 

“For every climate-related project proposal, we should make sure that it has a maternal, child, adolescent health impact lens as well,” he said. 

WHO’s Dr Anshu Banerjee.

Evidence gaps

While there is growing evidence of the different ways climate change affects pregnant women and young children, there continue to be gaps which affect the response.

“Most of the evidence is related to the effects of air pollution, followed by temperature and the effect of disasters, food insecurity, and water access,” Filippi said. 

Angela Baschieri, UNFPA’s Technical Lead on Climate Change, reiterated that it was important to generate “evidence that helps us to inform how we design program as well as the evidence that we need to ensure that we are targeting and we are reaching those who are left behind or may be more exposed”. 

Only 23 national climate action plans out of 119 reviewed by UNFPA have made some reference to maternal and newborn health. These responses have largely been community-led interventions, Baschieri said.
Improving basics like water and sanitation, as well as involving community healthcare workers emerged as some of the key responses that experts said are known to deliver results.

Improve basics like water access

Nobel Prize-winning economist Michael Kremer from the University of Chicago said ensuring communities have basics like clean drinking water can go a long way in responding to worsening climate impacts.

“First, cyclones, floods and heavy rains spread pathogens into drinking water sources causing disease spikes,” he said. “Second, droughts can force people to move to less safe water sources. Finally, increased temperatures can accelerate the growth of pathogens and water,” he explained, elaborating on the climate change and poor water quality link. 

Kremer said water treatment provides a proven safe and cost-effective solution and could prevent a quarter of children’s deaths.

“Water treatment can save more lives than virtually any other health intervention,” he said. Kremer pointed out gains countries like India, Rwanda and Malawi have policies and pilot projects to improve the delivery of safe drinking water to populations. 

“Water treatment has historically been neglected because it falls between the health sector and the water sector. And as many people emphasize, we need to move beyond the silos, particularly as climate change increases threats to water safety and health,” Kremer said.

Working with community-based health workers to improve healthcare delivery is a direct way to provide relief to pregnant women and children.

Nobel Prize-winning economist Michael Kremer

Community-based response

In 2022, when extreme rainfall worsened by climate change caused devastating floods in Pakistan,  over 100,000 pregnant women were affected, primarily because they could not access services.

“The breakdown that had happened in continuity of care led to so many adverse outcomes in maternal health,” said Neha Mankani, a midwife and project lead at the International Confederation of Midwives. 

“They did not have a safe place to give birth. There were abortion care services that they weren’t able to get, and there were newborn feeding issues that were happening,” she said, adding that community-based healthcare workers were a solution in times of crisis.

Neha Mankani, a midwife and a Project Lead at the International Confederation of Midwives

“We should look at climate change through a rights and human capital development lens and ensure that meaningful engagement of the most vulnerable. Women and children need to be engaged in setting policies because they are the ones who know how it affects them,” said Banerjee.

Image Credits: Guillaume de Germain/ Unsplash.