A pharmacy in Kenya: Inconsistent regulation across Africa impedes access to new medicines and formulations.

Strengthening Africa’s medicines regulatory framework is key to achieving the “bold goal” of having 60% of the continent’s vaccines produced locally by 2040, said Margareth Ndomondo-Sigonda, head of health at the African Union’s development agency, AUDA-NEPAD.

But only 7% of African country’s national medicines regulatory agencies (NMRA) have “moderately developed capacity”, and more than 90% of the agencies have “either minimal or no capacity at all”, Ndomondo-Sigonda told the opening of a conference on regulation strengthening hosted by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA on Tuesday.

However, she mentioned a number of hopeful signs: five NMRAs have attained World Health Organization (WHO)  Maturity Level Three, which “essentially is a sign of having a robust regulatory system.

In addition, stronger NMRAs such as in South Africa and Egypt have started to work together. 

Regional regulatory bodies have also been set up in west, east and southern Africa 

But real change will happen once a sizeable number of the continent’s 55 countries have signed and ratified the African Medicines Agency (AMA), which aims to harmonise the regulation of medicines on the continent. So far, while some 37 countries have formally supported the treaty, only 26 countries have actually ratified the treaty. While big swingers like Kenya have recently ratified, other leading countries like South Africa and Nigeria have not yet moved to approve the treaty. 

 

Catching up after COVID

“We are all aware of the fact that the continent was sidelined in the global rush for vaccines in 2021 and 2022 and currently we have fewer than half of the African population that has been fully vaccinated [against COVID-19],” said Ndomondo-Sigonda.

Stung by its exclusion, AU Heads of State and the Africa Centres for Disease Control and Prevention adopted a New Public Health Order in September 2022, with institutional strengthening and local medicine manufacturing making up two of its five pillars.

The Partnership for African Vaccine Manufacturing (PAVM), also established during the pandemic, is overseeing the local production of vaccines with the assistance of Nepad-AUDA’s African Medicines Regulatory Harmonisation Initiative.

Once the AMA is operational – it is in the process of being set up in Rwanda – it will take on the responsibility of ensuring coordinating regulatory systems strengthening, explained Ndomondo-Sigonda.

She expressed concern that countries such as Nigeria, Tanzania and South Africa have yet to ratify the AMA and depose their instrument of ratification –  formal notification that their governance structures have ratified the treaty.

“What is very, very important is for all the stakeholders to see that they have a responsibility to advocate for the ratification of AMA and I think it’s also very important to note the fact that as strong AMA will be based on strong NMRAs,” she added.

She also challenged the pharmaceutical sector, which “has access to politicians”, to advocate for all African countries to fully ratified the AMA.

Currently, 37 countries have taken some action to recognise the AMA – but only 21 of these have fully ratified it.

Image Credits: Luigi Guarino .

Thousands of people and hundreds of civil society organisations are expected to march in New York City this weekend to call on US President Joe Biden to use his executive powers to stop the expansion of fossil fuel projects in the country.

The march is one of over 400 marches, rallies and protests worldwide coordinated by the Global Fight to End Fossil Fuels ahead of the Climate Ambition Summit at United Nations (UN) headquarters in New York next week.

More than 600 civil society organisations and some 10,000 people from across the country are expected to attend the march in front of the UN in New York City, according to the organisers.

The Climate Ambition Summit, convened by UN Secretary-General Antonio Guterres, hopes to extract commitments from world leaders to shorten national timelines to phase out fossil fuels.

The summit follows the release of the UN global stocktake report on progress towards the 2015 Paris Agreement targets last week.

The technical report, which will be a key reference document at the UN climate summit in Dubai in November, found that the world is drastically off track in limiting global warming to the 1.5C degrees target set in Paris eight years ago.

The report warned that the rapid scale-up of renewable energy and phase-out of fossil fuels are “indispensable” to correcting course towards the Paris Agreement targets.

Profits bolster the resilience of fossil fuel extraction

World leaders who received invitations to the UN climate summit last month were told that only countries that have demonstrated significant commitment to climate action will be allowed to participate.

The invitation, which was sent by the UN Secretary-General, António Guterres, said that net-zero commitments not backed by action would not be sufficient to participate, according to reporting by the Guardian. Countries that did not meet the standards of climate policy ambition set by the UN can still observe the summit.

British Prime Minister Rishi Sunak reportedly will not attend the UN climate summit out of fear of being excluded from the meeting due to the expansion of his government’s oil drilling in the North Sea.

However, the US is the world’s largest fossil fuel producer, but Biden is expected to attend the summit. However, the Inflation Reduction Act passed by the Biden administration has made nearly $400 billion in incentives and funding available for green projects in the country, creating a windfall of green investment.

“The more oil, gas and coal we burn, the more toxic air we breathe; the more heatwaves, fires, and floods we face, all while wealthy fossil fuels CEOs rake in record profits,” march organizers said in a press release.

“President Biden has the power to stop them by putting an end to the expansion of fossil fuels – ensuring that we all have clean air and water, and better health and safety for our communities,” said the march organizers.

The Biden administration has been under fire from environmental groups for not taking action on seven oil and gas leases in Alaska’s Arctic National Wildlife Refuge issued in the waning days of the Trump administration. However, the US Interior Department this week cancelled the leases, saying they were legally flawed.

US oil giants Exxon Mobil and Chevron, meanwhile, have rebuffed calls to scale down fossil fuel production, electing to go in the opposite direction.

The Russian invasion of Ukraine caused a surge in profits for the world’s largest oil companies. Exxon Mobil announced in February that it made $56 billion in profits in 2022. The $6.3 million in profits made each hour is the most a Western oil company has ever earned in one year.

“July 2023 was the hottest month in recorded climate history. The unparalleled, deadly climate disasters sweeping the world seem to leave polluters unfazed,” said Tesneem Essop, Executive Director of the Climate Action Network. “Historical emitters like Norway, the UK and the USA are announcing new fossil fuel projects even as floods, fires and heatwaves take over our lives.”

The global movement against fossil fuels grows

The march at UN headquarters is part of a growing global movement to demand an end to fossil fuels. In recent months, there have been large-scale protests in countries around the world, including the United Kingdom, the Netherlands and Australia.

More than 2,400 climate protestors were arrested this week during a three-day blockade of a major highway outside of the Hague in the Netherlands.

The protest was organized by the Scientist’s Rebellion, a group led by academics urging an end to the estimated $37 billion in fossil fuel subsidies provided by the Dutch government each year.

In the United States, climate scientist Rose Abramoff and five other women were arrested this week for chaining themselves to a fracked gas pipeline in West Virginia. The arrest makes Abramoff the first climate scientist to face criminal civil disobedience charges for a climate protest in the United States.

“My greatest fear is the world we’re creating for future generations,” Abramoff told the climate newsletter HEATED. “That outweighs the fear I have of the personal consequences that I might suffer.”

Image Credits: The Lancet Countdown.

A mother and her newborn baby at a health centre in the Patna district of Bihar, India.

Ahead of next week’s United Nations Summit on the Social Development Goals, a new report asserts that a few simple measures could slash the deaths of mothers and babies

A series of relatively simple interventions could save the lives of millions of mothers and babies and put the world on course to achieve the Sustainable Development Goals (SDG) related to child deaths and maternal mortality.

This is according to the Bill & Melinda Gates Foundation’s (BMGF) Goalkeepers 2023 report, which was released on Tuesday.

The COVID-19 pandemic seriously disrupted the SDGs’ progress, including the goals of ending all preventable child deaths, cutting child deaths to 12 per 1000 live births, and cutting the maternal mortality rate to less than 70 deaths per 100,000 births by 2030. 

The United Nations has convened a special SDG summit in New York on Monday and Tuesday next week to review progress and accelerate the implementation of the 2030 Agenda for Sustainable Development.

The draft political declaration for the summit concedes that the achievement of the 17 SDGs “is in peril”, declaring that progress is “either moving much too slowly or has regressed below the 2015 baseline”. 

Every year, five million children die before they turn five – three-quarters of these deaths in the child’s first year – while almost two million babies are stillborn. 

The SDG for cutting newborn deaths to 12 per 1000 births is far from being achieved.

“For new mothers, progress has hit a brick wall. Globally, maternal mortality rates have remained stubbornly static over the past eight years, and in some countries, from the United States to Venezuela, they have risen,” according to the Goalkeepers report.

This is not just a problem for low and middle-income countries. In the United Kingdom and the United States, the death rates for Black mothers have doubled since 1999.

“For nearly all of human history, we simply didn’t know enough about preventing or treating the common childbirth complications that lead to death, such as postpartum haemorrhage or infection,” according to Melinda French Gates, BMGF co-chair.

“Today, we know a great deal. Yet, as is so often the case in global health, new breakthroughs aren’t making their way to the people who need them most: women in low-income countries like Malawi, as well as Black and Indigenous women in high-income countries like the United States, who are dying at three times the rate of white women, even when holding for economic and education levels.”

According to the report, in the 2010s doctors “uncovered revolutionary information about maternal and child health—everything from the exact diseases that are killing children; to the role anaemia can play in increasing blood loss during childbirth; to previously unknown ways in which a baby’s health is linked to their mother’s”. 

By applying this information, the BMGF estimates that nearly 1,000 mothers and babies could be saved every day to the end of the decade – a total of two million lives. 

SDGs maternal mortality

Postpartum haemorrhaging

The first intervention involves addressing postpartum haemorrhage, the number-one cause of maternal death. 

The World Health Organization (WHO) defines postpartum haemorrhage as losing more than half a litre of blood within 24 hours of childbirth, something that kills 70,000 women annually, primarily in low-income countries, and leaves many others with disabling heart or kidney failure. 

Research conducted in four African countries by Dr Hadiza Galadanci, a Nigerian obstetrician, found that many healthcare workers struggled to recognise how much blood loss is too much – and over half the women who experienced it were never diagnosed.

“There is a simple, low-cost way to identify when blood loss is dangerously excessive: a drape that looks like a V-shaped plastic bag. When this calibrated obstetric drape is hung at the edge of the bed collected blood rises like mercury in a thermometer. And in a busy hospital ward, that visual gauge tells providers which patients are in danger in just a single glance,” according to French Gates.

Five treatments are conventionally used to stop the bleeding – uterine massage, oxytocic drugs, tranexamic acid, IV fluids, and genital tract examination. 

“But those interventions were being delivered sequentially—and far too slowly,” according to the report.

So Galadanci’s researchers asked healthcare providers to administer all five at once and this, combined with the use of the V-shaped blood bags, decreased severe bleeding by 60%. 

Anaemia affecting pregnancies

A common cause of haemorrhaging is anaemia, or severe iron deficiency, which affects 37% of pregnant women around the world – and in some places in South Asia, is as high as 80%. “Every pregnant woman should have access to maternal micronutrient supplements – high-quality prenatal vitamins that include iron—which can prevent most mild maternal anaemia cases,” according to the report.

Screening for anaemia during antenatal care is important – but some women dislike the unpleasant side effects of taking iron.

Nigerian obstetrician Dr Bosede Afolabi is working on a one-off, 15-minute intravenous infusion of iron to replenish women’s iron reserves during pregnancy.

Preventing infections, boosting nutrients

Another leading cause of maternal death and disability is an infection that leads to sepsis, something that can easily be treated by a common antibiotic, azithromycin.

When given during labour, azithromycin reduces maternal infections, and during a trial across sub-Saharan Africa, it reduced sepsis cases by a third, according to the report.

“It could also be a game-changer in the US, where 23% of maternal deaths are from sepsis,” according to French Gates. “The United States has some of the most abysmal—and most inequitable—maternal mortality rates among high-income countries.”

“American women are more than three times more likely to die from childbirth than women in almost every other wealthy country,” she added, and the “biggest crisis is among Black and Indigenous women”. 

Recalling tennis star Serena Williams’s account of how close she came to dying after giving birth and the death in April of Olympic track and field star Tori Bowie from treatable childbirth complications in her home, French Gates said that “azithromycin has the potential to address the cause of nearly a quarter of American maternal deaths”.

The report also advocates for giving Bifidobacteria (B. Infantis), a new probiotic supplement to infants at risk of malnutrition alongside breastmilk and multiple micronutrient supplements for breastfeeding mothers to replenish their nutrient stores in pregnant women and ensuring those vital nutrients are transferred to the baby 

In addition, the report proposes giving antenatal corticosteroids (ACS)  to women who will give birth prematurely to accelerate foetal lung growth, and AI-enabled portable ultrasounds to enable nurses to monitor high-risk pregnancies in low-resource settings.

“Of course, these interventions aren’t silver bullets on their own—they require countries to keep recruiting, training, and fairly compensating health care workers, especially midwives, and building more resilient health care systems. But together, they can save the lives of thousands of women every year,” asserted French Gates.

Innovations to prevent maternal mortality.

Causes of babies’ death

Meanwhile, BMGF co-chair Bill Gates spoke of the importance of data about the causes of babies’ deaths, recalling how the BMGF supported the Child Health and Mortality Prevention Surveillance (CHAMPS) initiative since 2015. 

“Even 10 years ago, public health officials had only the vaguest information about why babies were dying,” said Gates.”Back then, any record of a child’s death would generally list one of the four most common causes: diarrhoea, malnutrition, pneumonia, or premature birth. But each was a vast ocean of different illnesses, each with scores of different causes and cures. Pneumonia, for example, is linked to more than 200 types of pathogens.”

The Foundation funded three studies to fill in the gaps – CHAMPs to uncover the most inscrutable causes of death, PERCH, which examined the causes of childhood pneumonia, and GEMS which looked at diarrhoeal diseases. 

Innovations to save babies

“As doctors compiled and compared case after case, a clearer, and often surprising, picture of child death emerged. For instance, some pathogens were less likely than was expected, like pertussis which causes whooping cough, but others were more likely than we expected, like Klebsiella which can be harder to treat,” said Gates.

“Over the past eight years, the field of child health has moved faster and farther than I thought I’d see in my lifetime. And if our delivery can keep pace with our learning – if researchers can keep developing new innovations and health workers can get them to every mother and child that needs them – then doctors could all but guarantee a baby would survive their crucial first days,” he added.

However, the report asserts that lives will only be saved “if all mothers and babies have access to both quality healthcare services and [these] innovations”.

“We need policy changes, political will, more investment into women’s health, and health care workers – including midwives.”

Image Credits: BMGF.

Hong Kong experienced its worst flooding since 1884 last week (8 September 2023)

Much more action, ambition and trillions of dollars are needed to limit global heating to 1.5ºC above pre-industrial levels as agreed by the Paris Agreement, according to a global stocktake report released on Friday by the United Nations Framework Convention on Climate Change (UNFCCC).

While the 46-page report with 17 key findings is delivered in technical language, its key message is unambiguous and chilling: There is “a rapidly narrowing window” to confine global warming to 1.5 °C. 

The stocktake was released during a week that saw unprecedented floods in places as diverse as Hong Kong, Brazil, Spain, Venezuela, Pakistan, Greece and Nigeria.

It calls for “much more ambition in action and support” and “more ambitious targets” by countries – called nationally determined contributions (NDC).

The challenge is dauntingly huge: global greenhouse gas (GHG) emissions need to be cut by 43% by 2030 and further by 60% by 2035 (compared with 2019 levels) and reach net zero CO2 emissions by 2050.

The key to achieving this is phasing out all unabated fossil fuels – which in turn rests on massively scaling up renewable energy. Doing so needs “systems transformations” in industry, transport, buildings and other sectors.

Reversing deforestation by 2030 and restoring natural ecosystems will “result in large-scale CO2 absorption and co-benefits” – but achieving this rests on intensifying sustainable agriculture without further land expansion.

‘Redeploy trillions of dollars’

Some of the paths to achieving this include economic diversification and “strategically deploying international public finance” to support climate action in developing countries.

“It is essential to unlock and redeploy trillions of dollars to meet global investment needs, including by rapidly shifting finance flows globally to support a pathway towards low GHG emissions and climate-resilient development,” asserts the stocktake.

“More than 137 non-Party stakeholders submitted input on their actions and support for the Paris Agreement goals, in total over 170,000 pages of written submissions were received, and we had over 252 hours of meetings and discussions over the three meetings of the technical dialogue – in plenaries, roundtables and world café formats,” said co-facilitator Harald Winkler, a professor from the University of Cape Town in South Africa.

“Much more is needed now, on all fronts and by all actors to meet the long-term goals of the Paris Agreement.”

The stocktake will be discussed at the 28th UN climate negotiations, the Conference of the Parties (COP28), hosted in the United Arab Emirates from 30 November.

Simon Stiell, Executive Secretary of UN Climate Change, urged all governments to “carefully study the findings of the report and ultimately understand what it means for them and the ambitious action they must take next”. 

“While the catalytic role of the Paris Agreement and the multilateral process will remain vital in the coming years, the global stocktake is a critical moment for greater ambition and accelerating action,” Stiell added.

Accra, Ghana: Traffic, waste burning and desert dust all combine to make air pollution a burgeoning problem in this fast-growing city.

The World Health Organization (WHO) will host a summit on air pollution in Accra, Ghana in 2024, the organization announced on Thursday. The summit will be the second ever to address air pollution, which is responsible for millions of premature deaths each year, and the first to be held in Africa.

The announcement was made on Thursday by Dr Maria Neira, Director of the Public Health, Environment and Social Determinants of Health Department at WHO. The UN health agency considers air pollution “one of the biggest public health emergencies” facing the world, said Neira. 

“Every single day we have news, scientific evidence and papers published demonstrating even more damage caused by exposure to air pollution,” said Neira. “In addition to the death, which is already horribly dramatic, we need to keep in mind that we are talking about chronic diseases… [that] take away quality of life and bring costs for health systems.” 

The announcement of the summit was made on the International Day of Clean Air and Blue Skies, established by the UN General Assembly in 2019 to raise awareness of the health risks of air pollution. 

Air pollution is responsible for nearly 7 million premature deaths each year.

The high-level meeting planned for Accra reflects the growing global recognition that air pollution, once seen as an environmental issue, is now a serious health concern. The summit is expected to be attended by government representatives, businesses, civil society organizations and other stakeholders from around the world.

“Every year, air pollution is killing more people than COVID killed,” Dr Ardvind Kumar, a lung specialist based in New Delhi and founder of the Lung Care Foundation, told a World Bank Panel on Thursday. “COVID caused death immediately, directly. Air pollution causes slow, indirect death, and hence does not get the attention.” 

“The world needs to respond to air pollution in the same that that we responded to COVID,” said Kumar. 

Air pollution will be high on the agenda at the upcoming UN climate summit in Dubai, which will kick off in November. The summit will be the first UN climate negotiation to directly consider health as a factor in the climate crisis. 

G20 to tackle air pollution

A thick layer of smog hangs over the Indian capital, New Delhi, which will be the site of the G20 summit that begins on Saturday.

Air pollution is also expected to be a topic of discussion at the G20 summit in New Dehli which will take place this weekend.

Ten Indian cities are in the world’s top 15 cities with the highest levels of air pollution, according to IQ Air, an air quality platform based on official and crowdsourced data. The health effects on Indian citizens have become a critical political issue in the host country as it grapples with reducing pollution in its cities. 

“Thirty years back when I started as a lung cancer surgeon, I would see 95% smokers,” said Kumar. “But today, 50% of my patients are ‘so-called’ non-smokers. I use the words ‘so-called’ because I believe that in a polluted country, there is no true non-smoker.”

The WHO estimates that 99% of people globally breathe unsafe air. South Asia faces the world’s heaviest health toll from air pollution. This cuts the life expectancy of the average South Asian by about five years, leading to annual costs estimated at more than 10% of regional GDP.

“Everyone has a right to live in a clean and healthy environment, and air pollution violates this right for 99% of the world’s population,” said UN Environment Programme Director Inger Andersen. 

The air shared by countries in the Indo-Gangetic Plain and Himalayan foothills – including India, Pakistan, Nepal and Bangladesh – is the most harmful worldwide, according to the World Bank. In some of the region’s most populated cities, air pollution is up to 20 times the WHO guideline.

“In Delhi, a nebulizer has become ubiquitous in every household,” Kumar told the World Bank panel. “I never heard this term when I was a child. But today, when they start getting breathless, every child says to themselves, ‘Oh, I’m going to get the nebulizer’.”

PM2.5, the primary harmful form of air pollution, is generated from a variety of sources, including car emissions, forest fires, and industrial activity. It can enter the lungs and bloodstream, causing a range of health problems, including respiratory infections, heart disease, and cancer.

Global air pollution heat map published by Swiss air quality technology company IQAir.

Black carbon, another major type of air pollution made up of soot and other particles that can enter the lungs and bloodstream, is produced by the incomplete combustion of fossil fuels such as coal, oil and wood.

“We’ve tended to express health impacts through the number of premature deaths. But our day-to-day quality of life is affected, too,” said Martina Otto, who leads the Climate and Clean Air Coalition convened by the UN Environment Programme. “Exposure at any level can have health implications that impair quality of life and come with costs for the individual, our societies and our economies.”  

Air pollution disproportionately impacts women, children and the elderly. Low- and middle-income countries also suffer the highest exposures. 

The air pollution crisis affects everyone – even children who have not yet entered the world, said Kumar. 

“The bad effects of air pollution do not wait for us to be born, it actually starts even before we are born,” said Kumar. “Pregnant mothers who are in polluted cities, when they breathe polluted air, the pollutants go through to the foetus through the placenta.

“Newborns start smoking, figuratively, from the very first breath of their life,” he said. 

Nairobi kicks off World Clean Air Day with a new wall mural by local artist @bankslaveone highlighting the importance of clean transport and improved air quality for children’s health.

Image Credits: WHO/Blink Media, Nana Kofi Acquah, Jean-Etienne Minh-Duy, Clean Air Fund/@bankslaveone.

The WHO has fired Maurizio Barbeschi (left) for sexual misconduct.

The World Health Organization (WHO) has dismissed Dr Maurizio Barbeschi, former head of its Health Security Unit, for sexual misconduct after a three-year investigation that started in January 2020, according to The Telegraph.

Barbeschi had been on administrative leave since late 2021 as the global body investigated complaints against him, including that he removed his trousers during a meeting with a female colleague in a hotel room.

The Italian national and biosecurity expert has worked for WHO for the past 20 years and is also an adjunct professor in the Faculty of Medicine of Flinders University in Adelaide, Australia, according to his LinkedIn profile, which still reflects that he works for the WHO.

Earlier in the year, The Telegraph broke the story about the complaints against Maurizio after speaking to some of the women involved as well as some of his colleagues.

Allegations include that Maurizio “rested his hand on women’s thighs if they sat next to him in meetings”, tried to kiss a WHO consultant and urged women to “go and put their bikinis on” during a meeting.

WHO spokesperson Marcia Poole confirmed Maurizio’s dismissal “following findings of sexual misconduct against him and corresponding disciplinary process”.

“He was informed of the decision yesterday (6 September),” Poole told Health Policy Watch via email.

She added that perpetrators of sexual misconduct are entered into the UN “ClearCheck” screening database “as a matter of standard process to avoid their hiring or re-hiring by UN agencies”.

“Sexual misconduct of any kind by anyone working for WHO – be it as staff, consultant, partner – is unacceptable. Over the past two years WHO has been implementing a comprehensive programme of reform across the entire organisation to prevent sexual misconduct and ensure that there is no impunity if it happens,” said Poole, and encouraged anyone who may have been affected by sexual misconduct to “come forward through our confidential reporting mechanisms”.

Dr Gaya Gamhewage, Director of the WHO’s Prevention & Response to Sexual Exploitation, Abuse and Harassment.

More decisive action

The WHO has been trying to deal more decisively with sexual misconduct allegations within its staff following a huge sexual abuse scandal in the Democratic Republic of Congo (DRC) during the 2018-2020 Ebola outbreak.

A WHO independent commission concluded that 83 emergency responders, including 21 WHO employees and consultants, had likely abused dozens of Congolese women, obtaining sex in exchange for promises of jobs – also raping nine women outright. 

In the wake of that scandal, the WHO appointed Dr Gaya Gamhewage as its director of Prevention and Response to Sexual Misconduct and it has since hired more investigators for its Internal Oversight Services (IOS) department.

Earlier this year, Gamhewage told Health Policy Watch that her unit had terminated the contracts of four staff or consultants as a result of sexual misconduct allegations in the last quarter of 2022 – the most of any year so far. The contracts of a further three people were terminated between January and March.

New sexual misconduct policy

WHO’s new policy on Preventing and Addressing Sexual Misconduct (PASM) came into effect on 8 March this year, with the aim of enhancing WHO’s legal and accountability frameworks “for achieving zero tolerance for sexual misconduct and inaction against it”.

In April, the WHO dismissed a senior manager at its Geneva Headquarters, Temo Waqanivalu, on charges of sexual misconduct. This followed a six-month investigation into allegations that Waqanivalu, who was in the running to be the Western Pacific’s regional director, had harassed a British doctor at the World Health Summit in Berlin last October. 

“In the last year, our investigation team acted on not just the cases that were highlighted in the media, but have completed 120 investigations into sexual misconduct, and 72 other investigations are ongoing,” Gamhewage told a media briefing in April.

In May, the global body dismissed scientist Peter Ben Embarek, one of the leaders of the independent team of scientists sent to Wuhan to investigate the origins of COVID-19.

He was dismissed “following findings of sexual misconduct against him and corresponding disciplinary process,” said WHO spokeswoman Marcia Poole told Associated Press.“The findings concern allegations relating to 2015 and 2017 that were first received by the WHO investigations team in 2018.”

Image Credits: United Nations, Israel in Geneva/ Nathan Chicheportiche.

Kenyan President William Ruto announced the adoption of the Nairobi Declaration.

Over 20 African countries unanimously adopted the Nairobi Declaration on Wednesday, a document that sets out the continent’s demands for climate finance and debt relief ahead of the United Nations climate negotiations in Dubai later this year. 

The declaration calls for a global carbon tax on the use and trade of fossil fuels, low-interest loans for green energy projects in Africa, and reform of the world financial system that forces debt-laden African countries to pay more to borrow money and hampers foreign investment on the continent. 

The AU declaration circulated in Nairobi hours after the summit ended has not yet been made available online, raising concerns about possible revisions.

Kenyan President William Ruto, who hosted the summit and presided over Wednesday’s high-level proceedings, said that $23 billion in green investments was secured during the three-day event. This included hundreds of millions of dollars for African carbon credits, which Ruto and US climate envoy John Kerry highlighted as key to addressing the continent’s massive climate finance gap.

Africa will need at least $2.8 trillion to meet its climate targets by 2030, according to a joint African Union Commission and UN Economic Commission for Africa report released on the opening day of the summit.

Meanwhile, African governments currently spend almost as much on debt payments as they receive in energy investments, the International Energy Agency said on Monday. 

Debt crisis looms over Africa’s energy transition

Debt servicing costs were just 20% lower than total energy investment in Africa between 2014 and 2022, according to the IAEA.

More than 30 of the world’s most indebted countries are in Africa. With debt repayment levels at a 25-year high – the world’s poorest countries spend 16% of government revenue on debt – Africa is heavily reliant on investment from the private sector and foreign governments to build momentum for its energy transition. 

The paradox, as African leaders see it, is that debt is cited by private and multinational lenders – alongside concerns of instability, conflict and government corruption – as creating a risky environment for investment. As a result, the cost of capital in Africa is up to eight times higher than elsewhere, limiting the continent’s ability to attract much-needed investment, said Ruto. 

At the summit’s closing ceremony, Ruto criticized the “unjust configuration of multilateral institutional frameworks that perpetually place African nations on the back foot.”

Africa’s ability to respond and adapt to the climate crisis is hamstrung by this “costly financing which plunges our economies into debt traps and denies them resources needed to mitigate and adapt,” said Ruto. 

Exorbitant borrowing costs hamper clean energy investments in Africa

Around 30,000 delegates attended the inaugural Africa Climate Summit, the first-ever held by African leaders to address climate change.

Exorbitant borrowing costs have limited green energy investment in Africa to just 2% of the global total. In many cases, no money is available at all.

More than 80% of green investments in developed countries, where borrowing costs are low, are funded by private finance. In developing countries, that figure falls to 14%.

“The stock of public debt in sub-Saharan Africa at the end of 2022 was estimated at 1,140 billion dollars,” said African Union Commission President Moussa Faki Mahmat. “In light of these staggering figures and many others, it is clear that there can be no relevant global intervention in favour of Africa without a credible solution to the crippling debt challenge.” 

Some of Africa’s largest economies were notably absent from the inaugural summit in Nairobi, with the heads of state of Nigeria, South Africa, Ethiopia, and Egypt failing to attend. 

China, the world’s largest emitter of greenhouse gases, Africa’s largest trade partner, and one of its largest creditors, declined to make a public statement at the conference, although senior Chinese officials were in attendance.

The declaration also called on the world’s biggest emitters to meet their $100 billion pledge in annual climate finance to developing countries, which has gone unfulfilled since its announcement 14 years ago.

Critics question focus on carbon credits

“Kenya and Africa look forward to a successful COP 28 that is a turning point in the Climate Change conversation,” said Ruto.

Hundreds of millions of dollars for African carbon credits were announced at the summit, including a $450 million commitment by the United Arab Emirates (UAE).

The UAE, one of the world’s largest oil producers, is leading a campaign to reframe its image as a leader in green energy ahead of the UN climate summit in Dubai in November. It committed an additional $4 billion to green investments in Africa, albeit in the form of a “non-binding letter of intent”.

The focus on carbon credits at the Nairobi summit was met with criticism from environmentalists and African politicians who view them as an excuse for major polluters to continue polluting.

African carbon credits are already widely sold to Western companies and governments, such as airlines and energy companies. Critics of carbon markets say that their voluntary nature makes them an easy way for companies and countries to offset their emissions without actually reducing them.

However, carbon credits could help to lower the cost of capital standing in the way of green investment in Africa by providing an additional financial incentive to unlock private sector interest.

Ruto described the African carbon market as “an unparalleled economic gold mine”, adding: “GDP is about capitalising what you have. We have the carbon sinks that serve the world.”

The African carbon market, where a ton of carbon is worth less than $10 compared to over $100 in wealthier nations, is seen by critics as an easy dumping ground for countries and companies seeking to offset their emissions.

The IAEA estimates that African carbon credit sales to governments – similar to the deal agreed by Ghana and Switzerland in 2022 – could raise even more money than sales to private companies.

‘Agents of change’ – recasting Africa’s role in the energy transition 

The Nairobi declaration seeks to recast Africa’s population of 1.3 billion people – set to double by 2050 – as agents of change in the global climate fight, rather than helpless victims. 

“[Africa] is more than ever called upon to rely first and foremost on its own efforts, on its own genius,” said Mahmat.

Africa is home to 60% of the world’s renewable energy potential and 30% of the critical minerals needed for low-carbon technologies, said Ruto. Despite this, over 600 million people do not have access to electricity.

“It’s becoming increasingly difficult to explain to our people, particularly to our youth, the contradiction: resource-rich continent and poor people,” said Ethiopian President Sahle-Work Zewde. “Africa cannot be nature-rich and cash-poor.”

Involving youth, health sector

Health sector leaders, however, expressed dismay that health was not more prominent in the Summit proceedings and outcomes – particularly in light of the huge toll fossil fuel emissions and climate change are taking in terms of more heat-related illnesses; drought, flooding and food insecurity; and poor urban air quality.  An appeal for a greater focus on  health-related climate issues was circulated at the Summit by WHO and a number of development partners earlier this week.

But in the final declaration, “health” was only mentioned once – in reference to the disproportionate impacts of climate change on the continent on “economies, health, education, peace and security, among other risks.”

“Sadly, the organisers seem to have overlooked the urgency of this health crisis, as it remains conspicuously absent from the summit’s agenda,” CEO of Amref Health Africa Githinji Gitahi was quoted as saying. “This isn’t merely an oversight; it’s a haunting omission that risks squandering a golden opportunity to amplify Africa’s voice on a global stage, especially with the 78th Session of the United Nations General Assembly and COP28 looming on the horizon.”

Ruto, in his remarks, also emphasized the importance of involving Africa’s youth in climate discussions. Africa is the world’s youngest continent, with 40% of its population under the age of 15. 

“We are the last frontier of untapped potential in the form of hundreds of millions of young men and women who are educated, skilled, motivated, innovative, ready and willing to drive the enterprises and industries that will unlock the possibilities promised by our immense endowments of natural assets, mineral resources, and green energy potential in order to unleash opportunities and prosperity for Africa and the world on an unprecedented scale,” said Ruto.

“If the voice of the youth is missing, our efforts to achieve prosperity will not succeed.”

Dr Tedros Adhanom Ghebreyesus.

There are “concerning trends for COVID-19 ahead of the winter season in the northern hemisphere”, including increased ICU admissions and hospitalisation in Europe, and case increases in the Middle East and Asia, according to World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus.

However, the WHO’s ability to assess the threat of new COVID-19 variants is hamstrung by member countries’ lack of monitoring of the virus, Tedros told a global media briefing on Wednesday.

“Only 43 countries, less than a quarter of WHO member states, are reporting [COVID-19 cases] to WHO and only 20 provide information on hospitalizations globally,” Tedros noted.

“The increase in hospitalizations and deaths shows that COVID is here to stay and that we will continue to need tools to fight it,” he added.

Meanwhile, Dr Maria van Kerkhove, WHO’s COVID-19 lead, said that while the data was limited ‘hospitalisations are increasing in the Americas and Europe in what we call our southeast Asia region”.

“That is a worry given that, when we get to colder months in some countries, people tend to spend more time indoors aggregated together and viruses that transmit through the air like COVID will take advantage of that.”

She added that only 11 countries had shared information with the WHO’s technical advisory group for virus evolution (TAG VE) about BA.2.86, the latest “variant under monitoring”.

“Given that BA.2.86 has been detected in 11 countries since late July, that indicates to us that it is circulating,” added Van Kerkhove, but added that there were three other “variants of interests” – EG.5 (also called Eris) and two sub-lineages of XBB, which itself developed from Omicron.

Dr Maria van Kerkhove

“EG.5 accounts for about 30% of global sequences that are globally and was not out-competing any of the variants of interest or other variants that are in circulation,” she added.

“It is quite a complex picture globally in terms of how these variants behave because different variants circulated in different countries at different times. So what we’re trying to do is look at transmissibility. Right now we have very limited information, but we’re also looking at immune escape,” said Van Kerkhove.

Van Kerkhove added that the global influenza monitoring system is “pretty incredible”, and it was also assisting in keeping tabs on SARS-CoV2, the virus that causes COVID-19. In addition, some countries were also using wastewater monitoring for SARS-CoV2.

“What we are working on right now in this transition period of COVID is where can we integrate the systems for surveillance, integrate systems for clinical care and clinical care pathways and what needs to be standalone,” she said.

“That’s what countries are working on right now. We can’t keep up the same systems with a COVID lens only COVID needs to be dealt with in the context of all of these other circulating pathogens including flu.”

Health workers in Cape Town, South Africa, getting vaccinated against COVID-19 in March 2021.

Pharmaceutical giant Janssen/Johnson & Johnson (J&J) and generic manufacturer Serum Institute of India (SII) charged the South African government more than the European Union for COVID-19 vaccines – and South Africa assumed all the risk in ‘take-it-or-leave-it’ contracts with Pfizer, J&J and SII.

This is according to an analysis of the contracts led by Health Justice Initiative (HJI), a South African NGO that won a court challenge last month to get access to all South Africa’s COVID-19 vaccine contracts.

J&J charged South Africa $10 a dose, 15% more than the company charged the European Union (EU), and the government was required to pay a non-refundable down payment of $27.5 million.

Pfizer also charged $10 a dose, which is 32.5% more than the $6.75 “cost price” it reportedly charged the African Union. South Africa was required to pay $40 million in advance, only half of which was refundable.

SII was to have charged South Africa $5.35 a dose for Covishield, its generic version of  AstraZeneca – which was 2.5 times more than it charged the EU. However, South Africa suspended its order over safety concerns related to the vaccine.

This is according to a media release issued on Tuesday by HJI and a group of medicines access advocates that analysed the first batch of contracts given to HJI since the court judgment.

Meanwhile, the exact price of vaccines supplied via the global COVID-19 vaccine access programme, COVAX, administered by Gavi, was “unclear” according to the group, but COVAX’s “all-inclusive weighted average estimated cost per dose” was $10.55.

In total, South Africa would have been liable for $734 million for COVID-19 vaccines including advance payments of $ 94 million.

‘Ransom negotiations’

HJI director Fatima Hassan

“The terms and conditions in these contracts and agreements are so one-sided, and so in favour of multinational corporations that they beggar belief,” said HJI director Fatima Hassan at a media briefing on Tuesday. 

“[The contracts] has placed governments, including South Africa and other countries in the Global South, in the unenviable position of having to secure scarce supplies in a global emergency in a manner which basically can only be described as a set of ransom negotiations,” added Hassan. 

“There was so much secrecy, no transparency, and very little leverage against late or no delivery of supplies when South Africa was really waiting for supplies and needing them.”

Vague delivery terms for J&J 

Jay Kruuse, director of South Africa’s Public Service Accountability Monitor (PSAM), said that the J&J vaccine contracts – which also involved Belgian company Janssen – were characterised by “very vague delivery terms”, which meant that South Africa had “very little leverage over the arrival time of doses”.

In addition, there were “extensive confidentiality conditions” and indemnity clauses, said Kruuse. 

The J&J vaccines were the first vaccines South Africa was able to buy and were prioritised for health workers and delivered via a mass clinical trial before the vaccine was authorised in the country.

Jay Kruuse, director of the Public Service Accountability Monitor (PSAM) in South Africa.

Pfizer’s ‘sweeping indemnity provisions’

Addressing the Pfizer contract, Canadian professor Mathew Herder said that the provisions “shift virtually all of the risk, all of the cost, and all of the burden onto the South African government, which at the time this deal was struck back in early 2021 had virtually no vaccines for the country’s people”.

Herder, who directs the Health Law Institute at Dalhousie University, described some of the contract’s provisions as “extreme” and “far more in Pfizer’s favour compared to some of the other deals I’m familiar with”.

“The contract does not guarantee that Pfizer will actually deliver any vaccines to South Africa and in the event that they don’t actually deliver, the most the South African government can recoup is 50% of the advance payment they were required to make under the contract,” said Herder. 

The contract refers to Pfizer making “commercially reasonable efforts” to deliver the vaccine whereas EU agreements refer to “best reasonable standard”, which is a higher standard to be met. 

“Why? Because the commercially reasonable thing to do is the most profitable thing to do so if it generates more returns to deliver elsewhere first, that is perfectly fine under the Pfizer-SA contract,” said Herder.

Mathew Herder, director of the Health Law Institute at Dalhousie University in Canada.

“Sweeping indemnification provisions” required the South African government to hold Pfizer ‘harmless of any and all claims against it’ and to “bear the costs of any product recalls if that needed to happen down the road”, said Herder. 

Pfizer also required the South African government to “set up a vaccine injury compensation programme as a condition precedent for delivering any of the vaccines that were contracted for”, he added. 

“These provisions shift virtually all of the risk all of the cost all of the burden onto the South African government, which at the time this deal was struck back in early 2021. had virtually no vaccines for the country’s people. So that certainly feeds into this very strong impression we have from reading the contract says as a group, that it was a very one-sided endeavour in the company’s favour.

COVAX ‘failed’ South Africa

“The COVAX programme was set up to equalise access and to be equal it needed to be both timely and in sufficient quantity. And if we look at what happened with Gavi’s COVAX programme, we would say that, particularly in South Africa, it failed in virtually every respect,” said US professor Brook Baker from Northeastern University School of Law, and  senior policy analyst at Health GAP Global Access Project.

“South Africa was one of the first countries to recognise the urgency and even promoted the TRIPS waiver proposal at the WTO to try to expand the number of manufacturers and overcome the monopoly barriers that companies had on products,” he added.

Brook Baker

“That urgency was met with protracted delay. Gavi had promised or at least projected – I guess we should say projected because Gavi never really made wholly committed promises –  to supply 20 million doses by the end of 2021, and it fell far, far short. At the end of the day, South Africa got somewhat over a million doses from COVAX. That was all that it was actually able to deliver.”

Challenge for pandemic accord negotiations

Nic Dearden, director of the UK-based Global Justice Now, said that had global COVID-19 vaccine negotiations been conducted openly and the terms of contracts been disclosed, such inequitable terms “would not have happened”.

“How can it possibly have been that South Africa was charged two and a half times what my country, the UK, and many European governments were paying for what was effectively the same AstraZeneca Serum Institute dose? That cannot be right, it shouldn’t have been allowed to happen,” said Dearden.

The group stressed that the problem of one-sided contracts favouring pharmaceutical companies requires a regional and global solution.

’Unless acted upon with clear, legally binding international agreement, we will arrive at the next pandemic with little more to enforce fair terms than platitudes and scathing press statements from the [health] minister and president in South Africa and other world leaders in the Global South,” the group asserted.

“This must be deliberated upon in pandemic accord negotiations and revisions of the International Health Regulations currently underway and at the upcoming United Nations General Assembly (UNGA).”

Meanwhile, Baker added that, if equitable access to vaccines and other pandemic-related medicines is to be achieved in future, the terms of contracts with pharmaceutical companies have to change.

Currently, “we give intellectual property monopolies to companies that maximise their commercial interests and profiteer to the maximum”, said Baker.

“It gives them the right to artificially control supplies because they don’t share the technology with other producers. We let them unilaterally set prices and different prices for different countries – sometimes more advantageous to some and less advantageous to others, and they get to decide who they distribute to and when.

Baker added that “when you invest all of their power over essential public goods in the hands of private companies, with no governments, other multi-stakeholders or international institutions that can override those commercial decisions,  you get exactly what we got in this pandemic”.

“Unless the pandemic accord is willing to address intellectual property monopolies and power over the supply price and distribution, we will have exactly the same thing in the future,” he added.

Lives were saved

The South African Department of Health responded to the HJI analysis saying it had “entered into these agreements to secure vaccine doses to protect the lives of South Africans against the deadly virus which claimed more than 100,000 lives in South Africa, and almost seven million globally”.

“There is no argument that low and middle-income countries around the world, including South Africa, had limited bargaining power to secure vaccine doses and negotiate the price of vaccines due to a number of reasons including the limited number of manufacturers and vaccine hoarding and nationalism by high and upper middle-income countries. The unequal distribution of vaccines has undoubtedly contributed to more deaths which could have been prevented.

“Given the uncertain circumstances at the time, the government took a difficult decision and prioritised saving the lives of the citizens. There is no doubt that this decision to make vaccines available despite the difficulties has saved lives.”

The department added that South Africa had recently deliberated with a number of local and global organisations – including the Africa Centre for Disease Control and Prevention – “on a potential African Union and BRICS framework of cooperation for pandemic, preparedness, prevention, resource and recovery” to address future inequity of access and distribution of pandemic products.

This story was updated to include the response from the South African Department of Health.

Image Credits: Western Cape government.

“All countries and virtually all children” are affected by substantially heightened risks brought on by climate change, the UN Children’s Fund said.

The health, development and safety of children in 98% of African countries are severely threatened by the effects of climate change, according to a new report by UNICEF. 

The report, published ahead of the start of the Africa Climate Summit in Nairobi on Monday, found that children in 48 of the 49 African countries for which data is available are at “high” or “extremely high” risk from the extreme weather, illnesses, pollution, and environmental degradation caused by climate change. 

Children living in the Central African Republic, Chad, Nigeria, Guinea, Somalia and Guinea-Bissau face the highest threat, according to the report. In Somalia, over 20,000 children under the age of five died last year amid the extended drought in the country, according to UN estimates. In Chad, nearly 40% of children under five are stunted, according to the World Food Programme. 

The countries most at risk from climate change also have weak health, nutrition, and water, sanitation, and hygiene (WASH) services, according to the report. This makes children in these countries even more vulnerable to the effects of climate change, as they are less able to access basic services such as safe drinking water, education, and protective services during extreme weather events.

“It is clear that the youngest members of African society are bearing the brunt of the harsh effects of climate change,” said Lieke van de Wiel, Deputy Director of UNICEF’s Eastern and Southern Africa region. “They are the least able to cope, due to physiological vulnerability and poor access to essential social services.” 

The report follows revelations made by the Children’s Environmental Rights Initiative, which includes UNICEF, in June, which found that just 2.4% of investments by multilateral climate funds (MCFs) in Africa directly support children.

UNICEF estimates that one billion children globally are at “extremely high” risk of suffering from the impacts of the climate crisis, which the organization has called a “children’s rights crisis”.

Weather extremes threaten children from all sides 

Overall Children Climate Risk Index (CCR) score by country in Africa.

Children are disproportionately vulnerable to the impacts of climate change, as their developing immune systems, behavioural characteristics and developmental needs make them more susceptible to diseases, food insecurity, water scarcity and air pollution. 

In the northern part of Africa, children are more exposed to risks related to water scarcity and air pollution, according to the report. In the western and eastern parts of the continent, children are more exposed to risks related to vector-borne diseases, heatwaves and riverine flooding.

Water and soil pollution, meanwhile, affects children across the entire continent. The risks of tropical cyclones and coastal flooding, however, are concentrated in specific coastal regions, the report said.

Climate change is also driving child labour, child marriage, extremism and forced migration, which can expose children to human trafficking, gender-based violence, abuse and exploitation, the report said. 

“Children and their families hit by one crisis may be able to absorb the shock provided the crisis is not too severe,” said UNICEF. “However, when they are hit by a second, a third and other subsequent shocks within a short span of time their coping mechanisms can become exhausted.”

A UN Development Programme report published earlier this year found that the promise of economic opportunity, not religious ideology, is the leading driver of violent extremist groups in Sub-Saharan Africa. Climate change is accelerating the expansion of these groups, with devastating impacts on the rights and security of women and children.

Extreme weather has destroyed crops and fish populations around Lake Chad, pushing young men in the region to turn to extremist groups like Boko Haram in search of income to feed themselves and their families.

The lake, which straddles the borders of Nigeria, Niger, Chad and Cameroon, has shrunk by more than 90% in the past 40 years due to climate change, overfishing and pollution. This has led to widespread food insecurity and poverty in the region.

“Present and future generations of children will bear the brunt of the intensifying effects of the climate crisis over the course of their lifetime,” said UNICEF. “These impacts are already occurring.”

Children must be heard in the climate conversation

The right of children to participate in climate decisions that will affect their future is enshrined in the UN Declaration on the Rights of the Child.

Africa has contributed very little to the carbon emissions that are at the root of the climate crisis. As of 2022, Africa as a whole has emitted just under 50 billion metric tons of CO2, less than 3% of the 1.73 trillion metric tons emitted since the turn of the twentieth century.

This is especially true of the continent’s children: around 40% of Africa’s population was under the age of 15 in 2022, making it the world’s youngest continent. Another 20% of Africa’s population is under the age of 25.

This youth is Africa’s “greatest natural resource” in the fight against climate change, according to UNICEF. The agency added that the right of children to participate in decision-making that affects their future is recognised under the UN Convention on the Rights of the Child.

“Children are not only victims,” said UNICEF. “Despite this, children’s voices and perspectives are rarely heard or considered in the decision-making processes fundamentally shaping their future.”

“Their ideas, creativity, and skills need to be taken seriously and become integral parts of the solutions, including policy and financing,” the agency said. “The time to act is now.”

Chance for action in Nairobi at the inaugural Africa Climate Summit

African leaders will have a chance to act on UNICEF’s findings at the inaugural Africa Climate Summit, which opened Monday in Nairobi, Kenya, under the auspices of the African Union.

Over 20 African heads of state are expected to attend the summit, Kenyan Environment Cabinet Secretary Soipan Tuya told Al Jazeera. The summit, which is running in parallel to Africa Climate Week, expects around 30,000 delegates to be in attendance.

Kenyan President William Ruto billed the summit as a chance for Africa to define its position on the ways “humanity should engage in effective action to save this planet from a climate catastrophe” and “lift hundreds of millions out of poverty.”

Ruto said he hopes to rally African leaders around the Nairobi Declaration on Green Growth and Climate Finance, which is set to be the key outcome of the summit. The declaration is a blueprint for a “new green industrial age” in Africa based on an “ambitious green growth agenda and climate finance solutions”.

Securing new financial commitments from wealthy nations and holding them to their $100 billion climate finance goal set out in 2009 at COP15 in Copenhagen will be a major focus of the summit.

The list of high-profile attendees of the Africa Climate Summit includes UN Secretary-General Antonio Guterres, US climate envoy John Kerry, COP28 Director-General Majid Al Suwaidi, and COP28 President Sultan Al Jaber.

“Climate action is not a Global North issue or a Global South issue,” said Ruto. “It is our collective challenge, and it affects all of us.”

Image Credits: UNICEF.