For many, access to assistive technology can enable independent everyday life.

Only one in five of the people in need of hearing aids and prostheses worldwide can access them, according to a new report by ATscale, a global partnership for assistive technologies and the Clinton Health Access Initiative (CHAI).

Assistive technology (AT) is any device and related systems that can help with everyday activities, improving or restoring the capabilities of a person’s body, ranging from eyeglasses, access ramps, prostheses or smartphones for functionalities such as the text-to-speech option.

The report, issued on the first-ever Day for Assistive Technology, aims to make assistive technology markets more transparent and easier to navigate for the public sector and producers. 

The hope is that comprehensive information will facilitate the choice of quality products, especially for governments in low- and middle-income countries, and encourage companies to expand their reach to new regions of operation, explained Pascal Bijleveld, CEO of ATscale in an interview for Health Policy Watch.

“It’s really about addressing one of the bottlenecks to access, which is the lack of transparency in the markets about what products are available, what are the price ranges, what’s the quality, and so on and so forth,” Bijleveld said.

Many governments lack the capacity to analyse and understand each of the markets and may make sub-optimal product choices.

It is also essential to raise awareness about the benefits of assistive technology and to start public and private initiatives to ensure more people, especially in low-income countries, can attain the AT they need. 

Large gap in access

Getting a AT of need is often the key to a more independent, full life for people with disabilities, unlocking a possibility to live independently, meet with family and friends, study, or work.

Globally, 2.5 billion people need at least one assistive product with the number expected to reach 3.5 billion by 2050 as the world population ages, WHO’s and UNICEF’s report shows. Even though 90% of people in need of an AT in high-income countries can access it, the number drops drastically to only 10% in low- and middle-income countries.

There is a nine-to-one return on investment from providing AT, thanks to unlocked educational outcomes, better paid employment and lower longer-term healthcare costs, an ATscale study from 2022 highlights.

The report systematically analyses markets for several most popular technologies: wheelchairs, glasses, augmentative communication, screen readers, and smartphones. 

Hearing aids, glasses and other assistive technologies can be prohibitively expensive. Taken for granted in wealthy countries, these simple technologies are out of reach for millions globally.

It lists the product types available, describes market specifics and enumerates some of the most important features. For hearing aids, for example, approximately 20 million units are sold annually, with the main market drivers being the ageing population. 

When picking the right device, it’s important to consider its ability to manage background noise and acoustic loops, its resilience against mild shocks, dust or rain, volume control and overall design. Those and other features are tested by several control agencies; to help navigate the market, the report provides a comprehensive list of producers and certificates held by their devices.

The report is only the first step, Bijleveld said and will be changed over the next couple of months into “a web-based platform that will be continuously updated”.

 Producers themselves will want to keep this interactive source of information up to date as a potential advertisement for their products and a guide to the overall market situation.

Raising awareness about the benefits of ATs is on the top of ATscale’s agenda. ”People need to get the word out there,” Bijleveld stressed.

Image Credits: CC.

Drug-resistant bacteria have developed from years of over-prescription of antibiotics.

With less than four months to the United Nations High-Level Meeting (HLM) on Antimicrobial Resistance (AMR), global leaders have proposed a variety of measures to address the growing threat of pathogens that are resistant to antibiotics.

The recently published zero draft of the political declaration for the meeting aims to reduce global deaths caused by bacterial AMR by 10% by 2030 (using 2019 as the baseline).

Mia Mottley, Prime Minister of Barbados and chairperson of the Global Leaders Group on AMR, called for “adequate, predictable and sustainable financing” to address the problem,  including financing for research and development for new antibiotics and the implementation of national action plans on AMR, especially in low- and middle-income countries. 

“Fundamentally, we must focus on prevention across all sectors – clean water, safe and effective sanitation, food security, infection prevention and control in all settings,” Mottley told a lunchtime roundtable during last week’s World Health Assembly.

Prime Minister of Barbados Mia Mottley, who chairs the Global Leaders Group on AMR

“I believe that we should establish an independent panel to monitor and report on the science and the evidence to facilitate collaborative and coordinated action against AMR,” She also called for the quadripartite joint secretariat on AMR to be formalised and adequately resourced. This is made up of the World Health Organization (WHO), the UN Food and Agriculture Organisation (FAO), UN Environment Programme (UNEP), and the World Organisation for Animal Health (WOAH).

The agricultural sector is responsible for the vast majority of antibiotic overuse, leading to drug resistance. 

Threatens to ‘unwind century of medical progress’

“In 2019, 1.3 million deaths resulted directly from bacterial AMR, more than two every minute,” WHO Director-General Dr Tedros Adhanom Ghebreyesus told the meeting.

“AMR threatens to unwind the century of medical progress and also threatens animal health, global food production, food security, and the environment.”

Dr Jean Kaseya, Director-General of Africa CDC, noted over one million deaths in Africa were associated with AMR and 250,000 caused by ARM. 

“Only 1.3% of our labs in Africa are able to perform bacterial resistance testing. It means this data that I’m sharing with you is an underrepresentation of the reality in Africa,” said Kaseya.

Four years ago, the African Union Assembly established a task force to control AMR and recommended that all member states implement national action plans.

“But less than 10% of a member states have national action plans that are fully funded and implemented,” he added.

Kaseya appealed to The Global Fund to expand its mandate from HIV, TB, and malaria to include AMR.

Professor Sally Davies, UK Special Envoy on AMR

Professor Sally Davies, the UK Special Envoy on AMR and a member of the Global Leaders Group, called for the high-level meeting to “truly address the needs of the most vulnerable communities, offering clear support to low and middle-income countries” that carry the greatest burden of this antibiotic emergency and need fair and equitable access to antibiotics and diagnostics.

Surviving AMR

Vanessa Carter developed a drug-resistant infection after a car crash cost her an eye.

South African Vanessa Carter, chair of WHO Taskforce of AMR Survivors, shared her nightmare of being unable to shake an infection after being seriously injured in a car crash in Johannesburg and losing her right eye. 

The infection turned out to be the drug-resistant Methicillin-resistant Staphylococcus aureus (MRSA). Hospital patients, people with wounds, and those who have surgery and medical devices implanted in their bodies are particularly at risk of MRSA.

Carter, who spent a month in hospital, had a prosthetic eye inserted and a number of surgeries.

“In my sixth year of surgeries, and my fourth prosthetic [eye], I went out shopping one day, I came back to the car and I felt moisture on my face. When I pulled down the rearview mirror, I saw this pus seeping out of the cheek of the prosthetic,” Carter told the roundtable meeting.

Her doctor told her she needed emergency surgery, but two weeks’ later the infection came back again.

“I was under the care of different types of specialists, an ENT surgeon, ophthalmologist, plastic surgeon, maxillofacial surgeon, each of them prescribing antibiotics during surgeries,” she added.

After almost a year of continued infections, doctors removed the prosthetic eye and sent it for testing and it was found to be contaminated with MRSA. What followed was a long and harrowing process during which the infection got into Carter’s bones before she was finally cured.

“I’ve been an advocate for the last 11 years and, most recently, we’ve established the WHO Task Force of AMR Survivors,” said Carter.

“Our biggest objective is to bring the human impact. When policy makers and members of the public understand exactly what it is, we can we can empower them. One of the documents we have worked on is a strategic technical guidance document for meaningful patient involvement. I would encourage you to go take a look at it.”

Votes to move to a secret ballot broke down along almost the same geopolitical lines – with 14 opponents (voting here) versus 17 supporters.

The World Health Organization (WHO) Executive Board on Tuesday voted to recognize the US-based Center for Reproductive Rights (CRR) as a non-state actor “in official relations” with it, in a motion carried by a narrow 17-13 margin, with four abstentions.

After multiple rounds of voting, the final vote was by way of a secret ballot.

The decision to grant WHO recognition to the Center, which supports access to sexual and reproductive health services, including abortion, was a hard-won victory for European, Asian and Latin American countries.  But the victory may be  short-lived.

Egypt, backed by a coalition of Middle Eastern and Islamic nations, as well as the 47-member WHO African Group, pledged to  “escalate” the issue to the World Health Assembly (WHA), a promise that it reaffirmed shortly after the vote in the WHO governing body, calling the vote a “politicization” of the global health body.

Egypt’s delegate to the EB (back left) pledges “to pursue” the controversial issue at the World Health Assembly.

“We would like to repeat what we have mentioned yesterday,” said Egypt’s delegate. “That we will pursue reopening of the discussions on this agenda item within the wider quorum of the organization during the upcoming WHA”.

He added that, at the national level, the decision ” is of no weight…  we will not abide by it, and will not consider it in any means”.

“Also, we will join the Russian Federation on their query, which is ‘how could we avoid the repetition of such unpleasant situation?’.. We need the good offices of the WHO in order to avoid the politicization of this organization as it has been experienced frequently in the past few days. “

“The text that was adopted today will not be implemented in Senegal, unless it is compatible with our laws, traditions and values,” said Senegal’s delegate, echoing sentiments expressed by Yemen, Kuwait, Somalia, and other member states in the post-vote discussion. 

National context still prevails

The Netherlands: WHO recognition of non-state actors does not commit member states where, “the national context prevails.”

Member states that supported the move by the 34-member governing body noted that other nations are in no way obliged to cooperate with the Center, or with any other non-state actor, which they oppose.

They stressed that the recognition was being extended solely by the WHO Secretariat, which maintains a wide network of official relations with over 200 non-state actors from civil society, industry federations and professional associations in line with a Framework for Engagement with Non-State Actors (FENSA) approved by the World Health Assembly in 2016.

The vote also awarded WHO recognition to a second non-state actor, Rare Diseases International, whose candidacy was never opposed by member states.

“The Framework of Engagement with Non State Actors (FENSA) is one of WHO normative guidelines, which has been negotiated and agreed by all member states,” The Netherlands pointed out.  “Questioning any non-state actor about its eligibility for admission into an official relationship with WHO after the organization passed the Secretariat’s criteria, undermines a great procedure and sets a harmful precedent for the future agreements.

However “the national context prevails over WHO engagements with non state actors,” she emphasized. 

FENSA framework is supposed to be neutral

The FENSA framework sets out a set of generic criteria for organizations “in official relations” to engage in collaborations with WHO, serve on technical groups and be recognized as “observers” with the right to speak at the annual WHA.

The aim of FENSA, which took years to negotiate and approve, was to create an even playing field in the much-coveted “official relations” designation that would side-step vested interests, particularly of industry or lobbying groups, that contravened WHO aims and priniciples.

Since the approval of FENSA, the handful of recommendations made by WHO each year to the Executive Board, to approve new NSA’s in official relations with WHA, or renew the terms of others, are usually just a matter of protocol, following WHO review and due diligence.

But there is growing pressure on the UN from socially conservative nations to roll back its activities on sexual and reproductive health in a period where many conservative nations still ban abortions, limit access to contraceptives and  criminalize the LGBTQI community.

Proposed WHO Recognition of Center for Reproductive Rights Provokes Storm at WHO Executive Board

As member states pointed out, the CRR has long been recognized by the UN’s Economic and Social Council (ECOSOC),  highlighting how the controversy over its recognition by WHO is a sign of the times, with intensive pushback not only in major powers such as the US and Russia, but also in international forums against the recognition of reproductive health rights long taken for granted in many societies.

Multiple votes are worrisome precedent for WHO governing body

Poland pledges to uphold the “consensus” around the FENSA framework for engagement with non-state actors.

For the EB members, themselves, the repeated votes, including by secret ballot, was yet another worrisome sign of the growing fracture between WHO member states in Europe, the Americas and Asia, which tend to identify themselves as socially and politically liberal, and developing nations in Africa as well as Russia, and the Middle East – where more conservative worldviews prevail.

The result, most member states agree, is the creeping “politicization” of global health agendas and issues. And while everyone also has a different point of view about what is political, it’s clear that it is leading to fewer decisions by consensus and more by lengthy, and often bitter, rounds of votes.

“After a record number of votes in the last week, we are alarmed by the notion that this is now becoming the default way to solve difficult issue,” said Poland’s delegate. “We would like to remind everyone that we adopted the FENSA by consensus, and we should respect it subtle equilibrium for the sake of our collective interests.

Matthew Wilson (center): “What you did was democracy”

“It is essential to preserve the independent, transparent, technical and evidence based role of the World Health Organization. We highly appreciate the efforts of the direct chair and other member states in trying to find a solution we could have all subscribed to. Poland remains committed to decision-making by consensus in this organization, and rejects the notion that the voting is now mainstream. We will spare no effort in supporting effective multilateralism and fostering consensus – with all due respect for different contexts of different countries.”

New EB Chair, Matthew Wilson, who sought to strike a more consensual note after the vote, declared: “What you did was democracy, and that’s not a bad thing.”

A baby gets vaccinated against polio thanks to su

With the first-ever malaria vaccines rolling out across Africa and a next-generation tuberculosis (TB) vaccine in testing, scientific advances are driving an unparalleled expansion of vaccine development. But vaccines in development don’t become immunizations that protect our health without concerted efforts by global initiatives like Gavi, the vaccine alliance, that help bring these life-saving products to the world’s poorest countries.

Next month, Gavi will kick-off a campaign to raise several billion dollars to deliver on its new strategy. The stakes are high: falling short of its target could delay delivery of vaccines to those most in need.

But amidst a rapidly changing global landscape, Gavi’s leadership and board must look inwards and seize the opportunity to reform by adjusting its operational model, addressing how it delivers vaccines in humanitarian and conflict settings, sustaining the impact of its investments, and aligning with other global health initiatives to respond to country priorities.

By Gavi’s own count, it has helped immunize more than a billion children since its launch in 2000. But underlying this remarkable impact is a stark reality: millions of women and children continue to miss out on vaccines. Perhaps most staggering is the fact that close to 15 million children around the world still do not receive basic childhood vaccines, leaving the poorest and most vulnerable susceptible to preventable diseases.

Significant gaps in accessing newer vaccines also exist. Only 20% of girls worldwide have received the human papillomavirus (HPV) vaccine, which protects against the leading cause of cervical cancer.

As Gavi’s leadership and board finalize a new strategy that will cement its priorities over the next five years, we urge attention to three areas to ensure that every child, everywhere, has access to vaccines. 

Rethink criteria for selecting countries

First, Gavi should update how it deems which countries receive support. Since its early days, Gavi has channeled financial support for immunization, based on national income per capita, to the poorest countries that also showed the biggest gaps in immunization access. The model is simple: if national income per capita is below the eligibility line, a country can receive full Gavi support; if it is above the line, then no support is given. But almost 25 years later, it’s time to refine how this works. 

 As a growing number of countries face economic headwinds and stagnating vaccination rates in the post-COVID era, Gavi needs to better match support with a country’s ability to pay for vaccines. And as new vaccines – including for TB – become available, Gavi’s model needs to align with the burden of leading infectious killers. 

As one case in point: four of the highest TB burden countries – India, Indonesia, China, and the Philippines – are no longer or were never eligible for Gavi support. But ironically, they are eligible for financial support for TB diagnosis and treatment from Gavi’s sister organization, The Global Fund for AIDS, TB, and Malaria. This policy mismatch could limit the impact of a new vaccine against a major infectious killer.

Invest more in vaccine delivery innovation

Second, Gavi should play a bigger role in scaling innovations to address the barriers that deter vaccine delivery. COVID-19 laid bare just how critical health systems infrastructure is to stopping disease outbreaks in their tracks. It also proved how useful innovations like digital immunization records can be in boosting vaccine uptake.

 With dedicated resources, Gavi can support partner countries to scale proven innovations for immunization systems they want and need. This could include solar panels for electrification of health clinics, unmanned drones for vaccine delivery, and digital immunization records.

While each of these innovations has been proven to work, Gavi’s investments would fill a critical gap in providing financing to scale, thereby leveraging at-risk early funding by other partners. Gavi’s track record in innovation, including financing mechanisms to scale new vaccine introductions, makes it well placed to do so.

Pilot new financing to ensure country control

Lastly, Gavi should pilot new ways to channel financing to partner countries that puts them in the driver’s seat and respond to national priorities. This is especially timely amidst growing calls to shift the center of gravity for decision-making to countries. 

How can this be achieved? One idea is for Gavi to test a new approach that provides a consolidated envelope of resources to each country, scaled to specific criteria including population size.

One portion could be dedicated to vaccine purchasing, enabling countries to base decisions on their own priorities. The second portion could be carved out for technical support and grants for health systems strengthening. With the 2030 deadline of the Sustainable Development Goals in sight, now is the time to experiment. 

Our collective ability to end the scourge of vaccine-preventable diseases is within reach. And Gavi – provided it is able to reform – remains one of our best bets to get there. At this crucial juncture, its leadership, board, and donors must ensure that Gavi has a fit-for-purpose model with adequate resources to deliver on the unfinished immunization agenda in a shifting global landscape.

Janeen Madan Keller is deputy director of the Global Health Policy Program and a Policy Fellow at the Center for Global Development (CGD), where she leads policy-oriented research focused on the economics of global health challenges. 

Orin Levine has worked to accelerate the introduction of, and access to, vaccines and other proven health interventions in low- and middle-income countries for the past 30 years. He served as a member of Gavi’s board for almost nine years, representing the Bill & Melinda Gates Foundation. He currently serves as a member of the Board on Global Health for the US National Academy of Medicine, and on the Board of Directors for the National Foundation for Infectious Diseases.

 

 

Image Credits: Gavi/Karel Prinsloo 2017, Gavi, the Vaccine Alliance.

WGIHR co-chairs Dr Ashley Bloomfield and Dr Abdullah Asiri and INB co-chair Precious Matsoso.

After two years of intensive negotiations – including long nights this week – the World Health Assembly (WHA) finally passed amendments to the International Health Regulations (IHR)  and committed to completing pandemic agreement talks within a year. 

After failing to agree on the amendments before WHA opened on Monday, member states have been racing to the finish in a drafting committee during this week in meetings that often went into the early hours.

“Tonight we have all won and the world has won. You have made the world safer,” said a hoarse WHO Director-General Dr Tedros Adhanom Ghebreyesus, who lost his voice during the late-night sessions.

The IHR is a legally binding international instrument aimed at preventing the international spread of disease, and requires countries to conduct surveillance for potential international health threats of all kinds and report those to WHO.

The COVID-19 pandemic showed weaknesses in the IHR, including that it did not mention “pandemic”. Member states submitted over 300 proposed amendments to the Working Group on Amendments to the IHR (WGIHR), chaired by New Zealand’s Dr Ashley Bloomfield and Dr Abdullah Asiri of Saudi Arabia.

“The amendments to the International Health Regulations will bolster countries’ ability to detect and respond to future outbreaks and pandemics by strengthening their own national capacities, and coordination between fellow states, on disease surveillance, information sharing and response,” said Tedros. 

WHI Director-General Dr Tedros Adhanom Ghebreyesus: Hoarse but happy

New ‘pandemic emergency’ defined

The amendments include the definition of a “pandemic emergency” – the highest level of alarm – that will trigger more effective international collaboration in response to a disease outbreak that may become a pandemic. 

“Solidarity and equity on strengthening access to medical products and financing” will be strengthened by a “coordinating financial mechanism” to help to “equitably address the needs and priorities of developing countries” to prevent, prepare and respond to pandemics

A States Parties Committee will be set up to facilitate the effective implementation of the amended Regulations, including the creation of National IHR Authorities to improve coordination of implementation of the Regulations within and among countries.

WHA President Dr Edwin Dikoloti strikes the gavel to indicate the passing of the IHR amendments and extension of the INB’s mandate.

“The experience of epidemics and pandemics, from Ebola and Zika to COVID-19 and mpox, showed us where we needed better public health surveillance, response and preparedness mechanisms around the world,” said Bloomfield, who also co-chaired the drafting group.

Countries also agreed to extend the mandate of the Intergovernmental Negotiating Body (INB) established in December 2021, to finish its work to negotiate a pandemic agreement by the World Health Assembly in 2025, or earlier if possible at a special session of the Health Assembly in 2024.

“There was a clear consensus amongst all member states on the need for a further instrument to help the world better fight a full-blown pandemic,” said Precious Matsoso of South Africa, co-chair of the INB and drafting group.

Credit to multilateralism

Member states generally expressed satisfaction with the final agreement, with the European Union and China describing it as proof of the success of multilateralism.

Ethiopian Health Minister Mekdes Daba, on behalf of Africa group, supports the IHR amendments and urges speedy adoption of pandemic agreement

However, Ethiopia’s Health Minister, Mekdes Daba – representing the 47 African member states and Egypt – urged all countries to use the momentum from the adoption of the IHR amendments to propel agreement on the pandemic accord. The INB meets again in July.

When parallel negotiations on a new pandemic agreement sailed into heavy water, there was a risk that the IHR amendments might become a casualty in the bargaining process – particularly from African member states pursuing equitable access to health products in the pandemic agreement.

They feared that the powerful Western countries pushing for the IHR to be passed – the US, European Union, Japan and the UK – would be less inclined to continue negotiating in good faith on the pandemic agreement once the IHR amendments have been passed. 

Meanwhile, Slovakia dissociated itself from the resolution, and Russia and Argentina said they reserved the right to implement amendments – or not – according to their national sovereignty. Costa Rica also expressed reservations about the extension of the INB’s mandate.

Reactions to amendments

Former Prime Minister of New Zealand Helen Clark, who chaired the Independent Panel for Pandemic Preparedness and Response, welcomed the adoption of the amendments.

“These amended International Health Regulations, if fully implemented, can result in a system that can better detect health threats and stop them before they become international emergencies,” said Clark.

“I congratulate WHO member states for agreeing to regulations intended to improve information-sharing about outbreaks, and action to ensure that countries have access to health products to contain outbreaks, including to the financing required. It’s excellent that a pandemic emergency is now defined in the IHRs.

“The world must now urgently make the investments needed to implement them, including in low- and middle-income countries, with the objective of stopping pandemic threats in their tracks.”

However, Nina Schwalbe, CEO of Spark Street Advisors and an independent observer of the pandemic negotiations, expressed “deep disappointment” that all references to compliance have been dropped in the IHR.

“The amendments do not include any provisions for a compliance mechanism. How can countries be held accountable to their commitments with a compliance mechanism?”

This story was edited to add reactions.

Civil society observers Yassen Tcholakov, MSF’s YuanQiong Hu, and KEI’s Thiru Balasubramaniam and Jamie Love outside the negotiating room

GENEVA – There were claps and cheers from inside Room XXVI of the UN’s Palais des Nations as World Health Organization (WHO) member states finally agreed on amendments to the International Health Regulations (IHR) after over two years of negotiations.

After failing to reach an agreement on the amendments before Monday’s start of the World Health Assembly (WHA), member states agreed to try to race to the finish during this week.

A drafting committee has been in intensive talks ever since, and its co-chair, Dr Ashley Bloomfield, told Health Policy Watch on Saturday that he had barely slept for the past few  days.

The IHR is a legally binding international instrument aimed at preventing the international spread of disease, and require countries to conduct surveillance for potential international health threats of all kinds and report those to WHO.

The COVID-19 pandemic showed weaknesses in the IHR, including that it did not mention “pandemic”. Member states submitted over 300 proposed amendments to the Working Group on Amendments to the IHR (WGIHR), chaired by New Zealand’s Bloomfield and Dr Abdullah Asiri of Saudi Arabia.

When parallel negotiations on a new pandemic agreement sailed into heavy water, there was a risk that the IHR amendments might become a casualty in the bargaining process – particularly from African member states pursuing equitable access to health products in the pandemic agreement.

They fear that the powerful Western countries pushing for the IHR to be passed – the US, European Union, Japan and the UK – will be less inclined to continue negotiating in good faith on the pandemic agreement once the IHR amendments have been passed. 

It is much harder for wealthy nations to buy into an agreement that involves compelling pharmaceutical companies to share their products – and the know-how about to make these – with companies and countries in the global south.

At the time of publication, the WHO still had to outline the process to conclude the pandemic agreement negotiations, but this is expected before the WHA closes at midnight on Saturday.

The fight against malaria is facing a new and urgent challenge as climate change and extreme weather events threaten to undermine decades of progress, according to warnings from several countries at the 77th World Health Assembly this week.

“Recent extreme weather events such as flooding in Malawi and other countries have intensified malaria transmission, disproportionately affecting vulnerable populations,” Dr. Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization, told the assembly on Thursday.

France, a leader in the fight against malaria, expressed concern over the lack of funding for malaria response and called for integrating anti-malaria efforts into national health plans, emphasizing that the need for funding has become more urgent as climate change is “increasingly impacting health systems and making them more fragile.”

“We wish to highlight the importance of the One Health approach and the key role of community health workers in local surveillance and awareness of malaria,” the delegation said.

The introduction of new malaria-causing parasite species due to climate change is also putting populations at risk, particularly transitory migrant groups, Costa Rica warned. “We believe it’s essential for international bodies to take these variables into account when allocating resources, both for dealing with public health problems and regional and extra-regional migration,” the country’s delegation said.

Colombia echoed those concerns, noting that “rapidly changing ecosystems are increasing vulnerability and giving rise to new malaria transmission dynamics,” a problem compounded by “increasing migration patterns.”

Eliminating Malaria

Despite the challenges, several countries, including Egypt, Ecuador and Malawi, renewed their commitment to eliminating the disease. Papua New Guinea said partnerships had been crucial to its malaria control initiatives, which focus on prevention, diagnosis, treatment and community engagement.

Malawi is implementing a plan to eliminate malaria by 2030, while Cabo Verde recently became malaria-free, joining just 43 countries worldwide to achieve the milestone and be recognized with this certification by the WHO.

The WHO is adopting a multi-faceted strategy to fight malaria, including new guidelines for countries to prioritize interventions in resource-limited settings and a focus on emerging threats like drug resistance, Dr. Jérôme Salomon, the organization’s assistant director-general for universal health coverage, communicable and non-communicable diseases, said Thursday.

Salomon, reflecting on the achievements of malaria-free countries, stated that key strategies to accelerate progress include introducing new tools like a malaria vaccine and ensuring wider access to existing ones.

“Recent extreme weather events such as flooding in Malawi and other countries have intensified malaria transmission, disproportionately affecting vulnerable populations,” Salomon said, emphasizing the urgency of addressing climate change through proactive mitigation, adaptation, and research.

Investments in primary health care are fundamental, he added, as are efforts to address various factors impacting malaria transmission, including inequities, conflicts, migration, the Covid-19 pandemic and climate change.

Although new tools are becoming available to fight malaria, several challenges are limiting their use, especially in Africa, said a representative from Chad, speaking on behalf of the 47 member states of the WHO’s African region. Chief among them, the delegate said, are shortfalls in funding.

In a joint statement, African countries pressed for greater political commitment and self-reliance in the fight against malaria, appealing for more predictable international aid that aligns with their national policies.

Sudan stressed the importance of tackling security issues to enable far-reaching malaria interventions, while Guinea urged partners to keep supporting immunization efforts and help end repeated malaria outbreaks.

Image Credits: WHO.

Rüdiger Krech, Director of Health Promotion at WHO showing examples of nicotine products with toy-like designs created to attract children.

The tobacco industry is deliberately targeting children with nicotine products, using targeted marketing to lure the younger generation into smoking while publicly promoting e-cigarettes as a less harmful alternative for smokers, according to a new report by the World Health Organization (WHO) and STOP, a tobacco industry watchdog.

The report, released ahead of World No-Tobacco Day on May 31, analyzes ways in which tobacco and nicotine companies design products, implement digital marketing campaigns, and shape policy environments to help them addict youth globally.

“The industry is peddling a narrative that denies or underplays youth addiction,” Jorge Alday, Director of STOP at Vital Strategies, told Health Policy Watch. “If we don’t establish a comprehensive approach and work across agencies, the industry will exploit any loophole or any new opportunity to reach young audiences.”

The report accuses the tobacco industry of targeting children and young people with over 16,000 e-cigarette flavours, employing colourful branding, influencer partnerships, and innovative digital marketing tactics, including the Metaverse.

“The Metaverse could eventually become a virtual shop window like physical or e-commerce stores,” Alday told Health Policy Watch about how the tobacco industry is using new digital forms of marketing.

The tobacco industry is attempting to “replace tobacco users lost to death and disease with a fresh wave of users trapped in addiction,” said Rüdiger Krech, WHO’s Director of Health Promotion, during the report’s launch press conference.

“We see tobacco products taking the shape of chocolates and sweets, candy, taking the form of toys,” Given Kapolyo, the global youth ambassador of the year and an anti-tobacco activist, told reporters. “They’re going out of their way to ensure that they make this product seem very cool.”

The tobacco industry bombards youth with branding, Kapolyo added, targeting areas close to schools, along routes used by young people, and in the digital space.

“These industries are actively targeting schools, children and young people with new products that are essentially a candy-flavoured trap,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General, commenting on the youth-targeting strategies of tobacco firms. “How can they talk about harm reduction when they are marketing these dangerous, highly addictive products to children?”

Fewer smokers, more vapes

Christian Lindmeier, WHO’s Spokesperson and Rüdiger Krech, Director of WHO Health Promotion during a press conference launching a report on tobacco firms targeting children in their marketing

While the global number of smokers is declining, with one in five adults smoking in 2020 compared to one in three in 2000, eight million people still die annually because of tobacco use.

The number of e-cigarette users, meanwhile, is growing, especially among the youngest generation. Globally, 37 million children aged 13–15 years use tobacco, and in many countries, vaping is more popular than traditional cigarettes among adolescents. In the WHO European Region, one in five 15-year-olds surveyed reported using e-cigarettes in the past month.

The tobacco industry often frames vaping as a way to reduce the harmful health effects of carcinogenic substances present in cigarettes, but research shows e-cigarette use actually increases conventional cigarette use nearly three times, according to the WHO.

The US Food and Drug Administration says that nicotine-mimicking substances used in vapes to avoid product regulation can be even more addictive than normal nicotine, Reuters reported.

Curbing the industry’s influence

Introducing tobacco taxes in New Zealand successfully lowered the cigarette consumption, also among the youth

Controlling marketing strategies, including digital ones, is an important way to limit tobacco firms’ influence on youth, the report’s authors said.

“How we define terms like advertising, promotion and sponsorship set the stage for what can be regulated now and in the future. This means that regulators should update rules to cover any and all platforms – physical and virtual,” Alday told Health Policy Watch.

Alday cited the recent example of Nigeria, which announced new regulations that will require health warnings for films that contain tobacco imagery. The regulation covers movies, music videos and skits produced in Nollywood, one of the world’s biggest movie industries, Alday said.

The WHO recommends not only a ban on marketing, advertising, and promotion but also creating 100% smoke-free indoor public places, banning flavoured e-cigarettes, and imposing higher taxes, among other strategies.

The latter strategy has shown significant results, as Vital Strategies’ Jeffrey Drope, co-author of the Tobacco Atlas, demonstrated during the State of Tobacco Control press briefing on May 21.

“Raising taxes [is] arguably the most effective and most straightforward solution,” said Drope. With higher prices, “young people don’t start to use tobacco products [and] people who already smoke or use tobacco stop, or cut down.”

New Zealand’s tax policy effectively drove down youth smoking prevalence as prices doubled between 2009 and 2019. It was also able to make a step towards bridging societal gaps between the general and Maori smoking populations.

The UK’s total ban on cigarettes for people born after 2009 is another example of an ambitious health policy, aiming to gradually raise the minimum age required for buying cigarettes until eventually, they become illegal. The regulation law passed its second reading in April, but has been postponed until after the general elections, BBC reported.  The bill has support from the opposition Labour party, a likely winner of the vote, which gives it much chance to be passed in the next term.

“This really has an enormous effect on consumption,” Drope said.

In their closing remarks, speakers at the press conference emphasized the essential role of youth leaders in shaping the future of global tobacco consumption and policy. “Youth leaders have a key role to play in communicating their reality to policymakers, that use of nicotine products is growing rapidly and these products are harming youth, now,” Alday told Health Policy Watch.

“What young people have is … they have each other,” Kapolyo added. “When young voices unite, even governments listen.”

Gavi, the Vaccine Alliance, addresses countries at the 77th World Health Assembly.

At the 77th World Health Assembly, Gavi, The Vaccine Alliance, urged nations to prioritize vaccinating “zero-dose” children, particularly those in regions affected by humanitarian crises and complex emergencies. These children have not received any shots, putting them at a higher risk of preventable diseases.

“We are scaling up routine immunization and reaching the estimated 14.3 million zero-dose children worldwide, recognizing that most polio cases are in subnational areas with the highest proportion of unvaccinated and under-vaccinated children,” Gavi representatives told the assembly.

Gavi’s 2021-2025 strategy focuses on reaching zero-dose children and missed communities who have not received any vaccinations. The organization aims to reduce the number of zero-dose children by 25% by 2025 and by 50% by 2030.

The World Health Organization reported a decline in the number of zero-dose children from 18.1 million in 2021 to 14.3 million in 2022, nearing the pre-pandemic level of 12.9 million in 2019. The percentage of children receiving their first dose of the measles vaccine increased from 81% in 2021 to 83% in 2022, still falling short of the 86% achieved in 2019.

During Committee A’s discussion on poliomyelitis, Gavi called on member states to integrate polio funding into existing national health systems to promote and accelerate essential polio and broader immunization functions.

Progress and challenges in the Eastern Mediterranean

Dr Hanan Balkhy, WHO Regional Director for the Eastern Mediterranean, highlighted the region’s progress in ending poliovirus transmission but noted that the poliovirus persists in mobile, border, and migrant populations.

“To end polio, we must reach all children, keep strengthening surveillance, address community resistance and disinformation, and continue leveraging polio resources as we build a resilient health workforce across our region,” Balkhy said.

Iraq and Libya have taken full financial responsibility for sustaining polio essential functions, demonstrating what can be achieved when countries commit to transition. In Yemen, the WHO is negotiating with northern authorities to stop outbreaks of polio and other vaccine-preventable diseases this year.

Global efforts and country commitments

Australia pledged $43.5 million to bolster the Polio Eradication Strategy (2022-2026), underscoring the urgency to ramp up efforts to halt vaccine-derived transmission and concentrate on critical regions. The nation also backed routine immunization, emphasizing the importance of partnering with WHO, UNICEF, and Gavi to expedite advancements in achieving the Immunization Agenda 2030 objectives.

Countries spanning the globe, from Sudan and Chad to Guinea, Senegal, Pakistan, India, the Philippines, Kenya, Bangladesh, and Morocco, shared their initiatives, obstacles, and advancements in the fight against polio. All stressed the importance of integrated strategies, community involvement, targeting zero-dose children, and fortifying immunization systems.

African member states, having ended the wild poliovirus outbreak, remain uneasy about polio’s persistent status as a public health emergency of international concern. avi noted that “the 47 countries remain concerned by the ongoing transmission of circulatory poliovirus and by the low level of vaccination in areas that are difficult to access.” Vaccine supply problems and financial limitations were partly to blame for the type two poliomyelitis outbreaks.

African nations have started transition planning for poliomyelitis and post-certification activities, prioritizing indicators for monitoring and evaluation to uphold program quality. However, unstable health systems, coupled with political and economic challenges, may slow down several countries in the region from assuming complete technical and financial responsibility for all polio eradication functions.

United for Self-Care Coalition hosts a WHA side-event in Geneva.
United for Self-Care Coalition hosts a WHA side-event in Geneva.

Costa Rica’s and Malawi’s ministers of health, along with global health and policy experts, gathered in Geneva to discuss self-care.

At an event organized by the Global Self-Care Federation (GSCF), participants advocated for a World Health Organization (WHO) resolution on self-care. Costa Rica, Egypt, and Malawi, the three countries that co-hosted the event, are working to elevate self-care.

Ministerial representatives from Guatemala, Belize, Panama and El Salvador were also in attendance.

“The potentials for self-care are enormous,” Iain Chapple, Professor of Periodontology at the University of Birmingham and one of the summit’s panelists, told Health Policy Watch. However, he said the approach “needs to be multidimensional,” with collaboration from different fields.

“We need self-care embedded in public health policy,” said GSCF Director-General, Judy Stenmark. She explained that a WHO resolution “could lead to meaningful policy change” and cost-savings for healthcare systems.

“We want to save time and money for individuals, healthcare professionals and healthcare systems, and we have the evidence and data that demonstrates that self-care can do all that,” Stenmark said.

According to a policy brief published by the United for Self-Care Coalition, implementing self-care protocols can generate as much as $119 billion annually in savings for health systems.

The WHO estimates that there will be a global shortage of 18 million health workers by 2030. In 2022, WHO said at least 400 million people worldwide lacked access to the most essential health services. The organization put self-care among “the most promising and exciting approaches to improve health and well-being.”

One key aspect of the conversation this week was making self-care accessible to all. Every year, 100 million people are plunged into poverty because of high healthcare expenses, WHO has said.

“A comprehensive approach to self-care should encompass cultural sensitivities, holistic practices and community engagement,” said Wendy Olayiwola, president of the Nigerian Nurses Association UK and Professional Midwifery Advocate.

Self-care can complement other public health services by being integrated into general health coverage plans, especially for people who “fall through the cracks” of the system, said Dr Manjulaa Narasimhan, WHO’s Sexual and Reproductive Health and Research Unit head.

She said that making menstrual products more available across different contexts is a powerful example of self-care implementation.

“Self-care is about how people lead their lives and can care for themselves,” Narasimhan said.

Dr Mary Munive Angermüller, Vice President of Costa Rica and Minister of Health added: “Self-care is not an individual action, it requires a confluence of different circumstances from health literacy to public health policy, in order to realise its potential.”

Putting People at the Center

Another “concrete” benefit of self-care is that “patients take an active role in their health,” said another summit panelist, Ellos Lodzeni, Chair of the International Alliance of Patients’ Organisation. He said patients also make more informed decisions.

“When we put people in the center of healthcare, self-care is inherent,” added Narasimhan.

A big focus of the Global Self-Care Federation’s efforts is education.

Educating people about ways to take care of their health and new tools that can help them with it brings many advantages, said Chapple, who spoke with Health Policy Watch.

Moreover, Narasimhan said that education about where to find accurate health information is essential. She said that sometimes people can find false information online, for example. She said it would be better to provide “good education on self-care, starting from the very beginning.” This means across the life course from the prenatal stage to older adulthood.

Benefits of Self-Care

Various benefits of improved self-care enumerated in the WHO guidelines
Various benefits of improved self-care enumerated in the WHO guidelines

“Self-care can also be discussed in the context of health insurance,” said Dr Mariam Jashi, Chair of the Eastern Europe and Central Asia chapters of UNITE, an international consortium of present and ex-parliamentarians.

She spoke to Health Policy Watch. She said she sees much potential for policy-making regarding health coverage and prevention as essential components of self-care. Screening, for instance, for breast cancer, is “a classic example of self-care. It makes it possible to identify potentially deadly diseases with timely detection [and] increase the chance of survival and quality of life.”

Yet Jashi said we need to agree, “specifically on the international level,” about defining self-care. The summit was an excellent start, Jashi said, “but more work is needed for better framing.”

To find out more about self-care and the work of the United Self-Care Coalition, visit www.unitedforselfcare.org.

Image Credits: Zuzanna Stawiska, World Health Organization.