INB co-chair Precious Matsoso briefs the media on Friday night.

Despite the huge human and economic cost of  COVID-19, over two years of negotiations and substantial diplomatic pressure, the World Health Organization’s (WHO) Intergovernmental Negotiating Body (INB) failed to reach consensus on a pandemic agreement by Friday (10 May), the last scheduled day of negotiations before the upcoming  77th World Health Assembly (WHA).

But the exhausted INB delegates have resolved to solider on with talks right up to the eve of the WHA, which begins on 27 May.

Briefing a handful of media left at the Geneva headquarters on Friday night, co-chairs Roland Driece and Precious Matsoso said the negotiations had finally started to make progress in the past two weeks.

“The closer you get to the endpoint, the more willingness there is to move. We worked very hard and deep into the night, but there’s just so much so many issues that we need to agree upon and which are sometimes very technical or political,” said Driece.

“I think this is the last mile,” said Matsoso, adding that One Health, pathogen access and benefit-sharing (PABS), intellectual property and human resources had preoccupied delegates – although the human resources article was almost entirely “yellowed”, which meant it had been agreed by the working group.

The INB has developed a schedule of work based on significant areas that still lacked convergence, she added.

“Of course PABS is one… But once you get that, the rest is history,” said Matsoso. “You may ask  why we have given PABS so much attention. It’s because they all say it’s the heart, so if it doesn’t go with the instrument, it means there will be no heartbeat.”

She added that there would be one or two days’ work interspersed with breaks in the next two weeks, but that the actual dates still had to be agreed on.

Earlier, some delegates told Health Policy Watch there was simply was not enough time to attend to the outstanding issues. Others, notably Eswatini, remained more hopeful saying that if INB reconvened in the week before the WHA, scheduled to start on 27 May, many of the outstanding gaps could potentially be closed. 

“If we can work intelligently and with dedication, I think we can deliver a stronger outcome at the World Health Assembly,” the delegate said.

INB’s mandate

“Our mandate is to report to the WHA on the outcome of the process, and that is what we will do,” said Driece. “And the outcome will be where we will be a day before the WHA. We do hope if we put all the efforts in that it’s going to be with the final agreements. But if not, we just report on where we are at that moment.”

If no agreement is reached in the next two weeks, other options include an extended WHA running into June, a WHA Special Session in November or December or – the least popular option – postponing the deadline until the next WHA in May 2025.

Whatever happens in the next two weeks, the INB is obliged to report an outcome at the WHA, including sharing the latest draft of the agreement so far, including all of the bracketed, green and yellow text, WHO’s legal department has reportedly told delegates on Friday.  The INB will also recommend a way forward on final negotiations, with the WHA making the final decision.  

WHO chief legal officer Steven Solomon told the media briefing that “the INB wants to provide the assembly with a basis to consider their two and a half years of work. They want to meet their mandate to give the assembly a basis to consider their work.”

Solomon added that there is confusion about what adoption by the WHA means.

“Adoption doesn’t mean the treaty applies to any country. It’s the start of a process by which countries go back and consider whether this instrument makes sense for them. They would consider, at the domestic level, whether they should ratify the agreement.

“What I’ve seen in the press, and in, particularly social media, is the view that if it’s adopted, then it applies. You all know that’s not the case, but it’s not necessarily clear.

“And I guess the other thing I’d say is that every negotiation of every international agreement, begins as a marathon and finishes with a sprint. Member states have been running this marathon for two and a half years, and they’re in the sprint phase now. That shows their commitment to to achieving a result that delivers both global health equity and global health security, and is effective at preventing future pandemics and responding to them.”

Important progress

However, WHO officials, INB members and stakeholders stressed that the agreements, even in principle, on key points regarding equity, benefit sharing and technology transfer that have been reached so far are important for advancing equitable access to medicines and vaccines.

Provided there is no backsliding in subsequent rounds of negotiations, these would represent important, albeit imperfect, advances in preparing for and responding to the next pandemic. 

Draft text from late Thursday reflected the still large areas of disagreement with a number of critical articles still to be discussed. 

The text is still a mess of green (agreed on in plenary), yellow (agreed on by working group) and brackets

Friday morning’s session did not return to disputed articles but discussed various definitions. This is important for amendments to the International Health Regulations (IHR), due to be finalised in the coming week, which are supposed to use common definitions.

Knowledge Ecology International’s James Love told Health Policy Watch that, while the current text did not go far enough in many aspects to ensure equitable access to pandemic medicines and vaccines, there were important advances.

In Article 12, which deals with pathogen access and benefit sharing (PABS), “every version has some amount of vaccines that will be available to the WHO for free and affordable prices”, said Love. 

“Some people would like, more some people would like less, but no one is arguing it would be zero. So if that succeeds, it will definitely expand access.”

The current draft has two versions – either “up to” or “at least” 20% of health-related pandemic health products being allocated to the WHO for distribution. 

Love also said that a number of the articles also established new norms – such as on public money invested in research and development (R&D), technology transfer and global supply chains.

Putting an obligation on countries that fund R&D of pandemic products to “look after the access conditions” of whatever medicines and vaccines are produced as a result of their investment, not only in their own countries but worldwide, particularly in developing countries, is “something brand new”, said Love. 

While much of the language on technology transfer (Article 7) is not binding, the text does mandate countries and the WHO to move ahead on this, ditto with the establishment of global supply chains.

The progress achieved by those who believe in a multilateral approach to pandemic prevention could, however, be viewed as a setback by ultra-nationalists that would rather go it alone even in a pandemic, sources here warned.

For instance, parts of the media in the United Kingdom have been claiming, somewhat hysterically, that an agreement on benefit sharing would mean the UK would have to give up 25% of its vaccines in future pandemics.  But this is a distortion of the agreement, WHO officials have pointed out. 

Like any international instrument, the proposed agreement would be subject to ratification and countries’ sovereign laws – even though pathogens know no boundaries.

Families flee Rafah to seek safe shelter in central Gaza, 7 May 2024.

With Gaza’s Rafah crossing into Egypt closed by an advancing Israeli incursion, and Israel’s Kerem Shalom crossing shut since last Sunday’s Hamas missile attack, Gaza hospitals have only about three days left of fuel and medical supplies, said WHO Director General Dr Tedros Adhanom Ghebreyesus Wednesday.    

The global health agency is making contingency plans for a full-scale Israeli invasion of Gaza in the wake of an impasse in Israel-Hamas talks over a cease-fire, including release of Israeli hostages. But such preparations would only be a “drop in the ocean” of human need that would follow the death and injuries incurred in such an operation, added Dr. Rick Peeperkorn, head of WHO’s office in the Occupied Palestinian Territories at the press briefing. 

“WHO has pre-positioned some supplies in warehouses and hospitals, but without more aid flowing into Gaza, we cannot sustain our lifesaving support to hospitals,” Tedros said.

Meanwhile, one third of Sudan’s population is facing acute hunger and  70% of hospitals in conflict affected areas are not functioning, Tedros noted – calling for a cease-fire in the African country wracked by a year-long civil war as well as in the war between Israel and Hamas.    

Rafah’s population fleeing and hospitals shutting down

Dr Rick Peeperkorn, head of WHO’s Jerusalem-based office of the Occupied Palestinian Territories (OPT) speaking at a WHO press briefing Wednesday

In war-torn Gaza, tens of thousands of people left Rafah’s eastern outskirts, as Israeli tanks moved in Tuesday and Wednesday through a narrow wedge of land between the city and its crossing into Egypt, taking full control of the strategic entry point for the first time since Israel’s withdrawal from Gaza in 2005.

More people were packing up and leaving by the hour, local media reported, showing scenes of advancing Israeli tanks, artillery explosions, and families pulling up tents and loading belongings onto tractors and donkeys.   

Despite the evacuations, some 1.4 million Gaza Palestinians remain in the densely populated Rafah area and “at risk”, including about 600,000 children, said Tedros. Areas designated by the Israeli military as safe zones, such as the Muwasi district westwards, near the Mediterranean Sea, are already packed with displaced Palesitnians, and lack infrastructure to accommodate tens of thousands more people, added Peeperkorn. 

Israeli evacuation order Sunday to Gazans – telling them to leave neighborhoods on the edge of Rafah (marked in red) for Khan Younis and Muwasi, skirting the Mediterranean sea, marked in yellow and beige.

One Rafah hospital, An-Najjar, has already been forced shut down since the Israeli incursion into the southernmost area of the Gaza strip overnight Tuesday – and the city’s other two hospitals are threatened with closure should the military advance further into the city core, said Peeperkorn, speaking by video from Jerusalem. 

Efforts are now being made to shift critical supplies and operations to hospitals further north, such as Nasser Medical Complex in Khan Younis and other hospitals in Gaza’s ‘Middle region’, Peeperkorn and Tedros said. Nasser hospital has recently been reopened after undergoing extensive repairs following damage in earlier phases of the seven months of war, and even just opened a dialysis center. 

Only three days of fuel left 

WHO Director General Dr Tedros Adhanom Ghebreyesus

However, if the Israeli advance continues, and key entry points remain cut off, then hospitals will have no more fuel or supplies with which to operate, Tedros warned. 

“Fuel that we expected to be allowed in today has not been allowed in, meaning we only have enough fuel to run health services in the south for three more days,” he said.

Already, WHO has had to suspend a number of medical missions to northern Gaza due to a lack of fuel to move EMTs, added Peeperkorn.  Israel has promised the United States that the Kerem Shalom entry from Israel would reopen Wednesday, but as of late afternoon that hadn’t happened, Peeperkorn said.

“There were discussions that fuel will come in through Kerem Shalom, but the current state is that just that there’s no fuel coming in today. So anyone with influence, it’s the biggest item that is needed. I’m not only talking about food distribution, I’m talking about fuel for bakeries, fuel for hospitals, fuel for any operations.

The WHO remarks were echoed by the UN Office for the Coordination of Humanitarian Affairs (OCHA) in a statement Wednesday: “An average of 48 trucks and more than 160,000 litres of fuel entered Gaza via the Rafah crossing between 1 and 5 May. We need that fuel to sustain our humanitarian operations.

“We are engaging with all involved on the resumption of the entry of goods, including fuel, and so that we can again begin managing incoming supplies. However, the situation remains extremely fluid, and we continue to confront a range of challenges, amid active hostilities.

“We count on cooperation and facilitation to get these crossings operational again, since stocks of critical supplies – including fuel – are being depleted by the hour.” 

‘WHO has no intention of withdrawing’

Tedros said that WHO is coordinating the work of some 20 Emergency Medical Teams in Gaza, comprising 179 internationals and 800 local staff based in 10 hospitals and five field hospitals. 

“WHO has no intention of withdrawing from Rafah and will stay and deliver alongside our partners,” Tedros asserted. 

Sudan faces humanitarian disaster after year of fighting

WHO team member providing nutrition support to internally displaced children in Gedaref state, Sudan, in August 2023 during the ongoing civil war.

As for Sudan, some 15 million people – nearly one-third of the population –  are in urgent need of humanitarian assistance and almost nine million people are displaced, Tedros said.  And even in areas where there is no active combat going on, one-half of the hospitals are not functioning.

“Those that are functioning are overwhelmed by people seeking care, many of whom are internally displaced,” he said. “Health facilities, ambulances, health workers and patients continue to be attacked, depriving entire communities of essential health services. Just last week, two of our colleagues from the International Committee of the Red Cross were killed in South Darfur.”

“The conflict has led to a devastating deterioration in food security. More than one-third of the population is facing acute hunger, and there is a risk of famine in Darfur and Khartoum. Humanitarian partners have released a famine prevention plan,” he added.

“WHO’s priority is to ensure continuity of health services to prevent and respond to outbreaks, and to provide care for those most in need, including pregnant and breastfeeding women and children under five,” he said.

Late last year, WHO launched a $US 178 million appeal for an emergency health response in Sudan.  But the agency has said little recently about efforts underway to support hospital capacity in the war-torn country. Although it does have a major nutrition stabilization effort underway, the last detailed report to Geneva media was in late February.

And Tedros didn’t provide any added details at Wednesday’s briefing, saying only: “It is imperative that all sides to the conflict provide unhindered humanitarian access to those in need, including through cross-border routes.

“Most of all, we call for a ceasefire and a comprehensive peace process for Sudan. It is time to silence the guns and raise the volume for peace. The best medicine is peace.”

Image Credits: OCHA/Olga Cherevko. , Twitter/@IDF, WHO.

Insulin supplementation is the daily reality for diabetes patients. Lower prices for insulin pens could make their everyday reality easier.

Insulin pens are more affordable and preferred by diabetics but they are available almost exclusively in high-income countries due to gross overpricing, according to a report by Médecins Sans Frontières (MSF) and T1International, a British NGO fighting for equal treatment access for people with diabetes type 1.

The research was presented on Wednesday, ahead of the fourth Symposium on Diabetes in Humanitarian Crises happening in Athens late this week, which is hosted by the International Alliance for Diabetes Action (IADA).

“In Lebanon, offering pens to people with diabetes in our care has had a significant and positive impact on their quality of life, especially for children who are more likely to stick to their treatment schedule with the easier-to-use and less painful pens,” said Dr Sawsan Yaacoub, Paediatrician for MSF in Lebanon, where insulin pens were implemented instead of the traditional treatment administering with syringes and vials of insulin.

Numerous benefits of using insulin pens instead of the traditional syringe and vial make it a preferred choice for a vast majority of patients

The pens offered many advantages, especially to young patients, MSF evaluated. They make it easier to inject insulin, calculate doses and they induce less pain during the procedure, they are also more practical in terms of transport and stocking. Thanks to their advantages, children and adolescents participating in MSF’s programme in Lebanon were more likely to stick to the prescribed injection schedule.

Growing burden

Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin produced. 

Type 1 diabetes (insulin-dependent) is a deficient insulin production of the organism and requires daily administration of insulin.

There were 529 million people living with diabetes worldwide in 2021, as a Lancet study found. According to WHO, the number increased five-fold, from 108 million, in the four last decades.

The disease and accompanying conditions are a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation. Diabetes and kidney disease alone accounted for two million deaths in 2019.

Inaccessible

The diabetes burden is increasing for low- and middle-income countries, but, as MSF pointed out, the treatment options offered there are limited and old-fashioned.

MSF and T1International’s survey found that 82% of over 400 respondents in 38 countries preferred insulin pens when compared with injecting insulin with a syringe.

The pens could also be a more affordable option. “We have shown that it could be more affordable to use insulin pens instead of the old-fashioned vials and syringes,” said Dr Helen Bygrave, a Non-communicable Diseases Advisor for MSF.

MSF’s research into the cost of production shows that analogue insulin pens, offering more durable insulin without having to keep it refrigerated, could be sold at a profit for $111 per patient per year, including insulin cartridge and the pen itself. 

This technology is widely used in high-income countries, contrary to the human insulin administered with syringes, which is the standard in low-income settings as it is sold for a lower price.

MSF argues that the production of analogue insulin and insulin pens is 30% cheaper than the alternative. It is the selling prices that make insulin pens inaccessible. Each long-acting analogue insulin pen costs $2.98 in South Africa, $7.88 in India and $28.40 in the US, compared to the cost-based price of $1.30.

“No matter where a person lives in the world, they should be able to have equal access to their preferred diabetes care option,” Bygrave added.

The situation is similar to that of new diabetes drugs, GLP-1 agonists, which increase the feeling of satiety, helping patients to curb obesity. 

Semaglutide, a commonly used diabetes drug, could be sold at a profit for just $0.89 per month – a daunting difference from its cost in a pharmacy: $115 per month in South Africa, $230 in Latvia, and $353 or more in the US, which is 400,000% higher than the estimated generic price.

Near-monopoly dictates prices

The main manufacturer of GLP-1 drugs, Novo Nordisk, has recently faced a hearing in the US Senate about the gigantic markup it imposes on the market.

Due to intellectual property rights restraints, only three firms are currently providing insulin: Sanofi, Novo Nordisk and Elly Lily. The two latter ones are the only producers of GLP-1 medicine.

Price comparison and the difference between the sales prices and the ones based on production costs, according to MSF’s estimates.

Numerous benefits of using insulin pens instead of the traditional syringe and vial make it a preferred choice for a vast majority of patients

Despite their limited capacity making it difficult for them to meet the demand worldwide, the firms is still blocking generic manufacturers from entering the market.

“Pharmaceutical corporations Eli Lilly, Novo Nordisk and Sanofi must drop their insulin pen prices now, and at the same time, humanitarian agencies need to start procuring insulin pens and more systematically integrating them into the diabetes care they provide,” said Bygrave. 

As gross overpricing stands on the way to improved diabetic care, the new report shows clearly the production costs are not the reason behind it.

 “There is really no excuse for today’s double standard in diabetes care to continue,” Bygrave added.

“We firmly believe that every person with diabetes should have affordable access to the insulin and delivery device that is best for their body,” Elizabeth Pfiester, T1International’s Founder said.

Image Credits: WHO, MSF.

Philanthropists gather to commit $300 million for global health research
Leading global health philanthropists gather near Copenhagen to commit $300 million for global health. From left: Mads Krogsgaard Thomsen (Novo Nordisk), Bill Gates (Gates Foundation), Catherine Kyobutungi (African Population and Health), Ismahane Elouafi (CGIAR) and John-Arne Røttingen (Wellcome).

The Novo Nordisk Foundation, Bill & Melinda Gates Foundation, and Wellcome Trust have announced a new partnership, committing $300 million over three years to stimulate innovative research in developing countries into three of the world’s most critical global health challenges and their interlinkages – including climate change, infectious diseases and antimicrobial resistance (AMR).

An additional funding stream would aim to support research for greater understanding of the interplay between nutrition, immunity, infectious and non-communicable (NCDs), and developmental outcomes. 

All of the challenges disproportionately affect people in low-and-middle income countries (LMICs).  Consequently, funding will be directed mainly to LMIC countries and communities to strengthen research and development capacities and scale “equitable access to existing tools and technologies,” the partners said. 

The announcement by the world’s biggest health philanthropy heavyweights also aims to signal the urgency of making bigger global health investments more broadly to face new and emerging threats. 

“We face huge challenges to protecting and improving physical and mental health, compounded by vast inequities globally,” said John-Arne Røttingen, CEO of Wellcome, speaking at a two-day “Global Science Summit” in Helsingør, Denmark, where the initiative was announced. 

The most effective solutions to pressing challenges often emerge from the very communities they affect,” said Dr. Catherine Kyobutungi, executive director of the African Population and Health Research Center, one of the scientific research institutions that will collaborate in the new effort. “I’m encouraged that this new partnership seeks to unlock novel ideas and support the scientists working directly with the communities that stand to benefit the most.”

Climate change, infectious disease, and nutrition-disease interactions

Girl receives oral polio vaccine, funded by Gates Foundation philanthropy
The philanthropic partnership will fund additional scientific research and vaccine development into emerging and persistent health threats.

The initiative will support interdisciplinary initiatives that advance, for instance, better collection and use of climate data, innovation in more sustainable agriculture and resilient food systems, and other measures protecting  people from climate change, according to a press release by the Bill and Melinda Gates Foundation. 

“We’re on the cusp of so many scientific breakthroughs in agriculture, health, and nutrition, and with the right support these innovations will save and improve lives around the world,” said Mark Suzman, Gates CEO. “Every sector has a critical role to play, and we hope this collaboration opens the door for other funders and partners to contribute to scaling up existing innovations and developing the tools of tomorrow.”

“Many of these challenges are overlapping and intersecting, with profound impacts on human health,” said Dr Tedros Adhanom Ghebreyesus in remarks at the two-day summit, hosted by Novo Nordisk Foundation, which ended Tuesday.  

Since the late 1990s, NCDs have overtaken infectious diseases as the world’s leading cause of premature mortality on every continent, except Africa, Tedros noted, while big gains against HIV, malaria and TB have plateaued recently. 

“NCDs can weaken the immune system, making people more vulnerable to infectious diseases. In turn, infectious diseases can exacerbate the progression of NCDs and cause complications. And the climate crisis exacerbates both of them.”

More equitable use of available tools also are needed

WHO Director General Dr Tedros Adhanom Ghebreyesus – innovation is an engine of global health improvements, but available health tools and strategies also are not being used well enough.

But while research and innovation have always been the “engine of improvements in public health”, Tedros also reminded his audience of donors and philanthropists that available solutions to NCDs, infectious disease and climate change also are not being harnessed. 

“The health challenges we face globally are not fundamentally scientific challenges; they are largely political, economic and social challenges,” the WHO DG asserted. “Of course, we need more technologies, but using the existing ones to the maximum is important.

“Many NCDs can be prevented through healthier diets, physical activity or by stopping smoking. Premature deaths from NCDs can be prevented with the right diagnosis and treatment.

“Most cases and deaths from infectious diseases can be prevented with vaccines, prophylaxis, bed nets or other tools to prevent exposure.

“And climate change can be reversed, and its impacts mitigated, by weaning ourselves off our addiction to fossil fuels.

“The problem is not that we don’t have the tools or the knowledge to address these threats; the problem is that those tools are not equally available, for multiple reasons.”

Emphasis on AMR

The partnership will also channel funding to infectious disease research, with an emphasis on addressing AMR, advancing disease surveillance, and developing vaccines for respiratory infections. 

Supporting new advances in detection and the development of vaccines and other tools should  help “reduce the burden of disease in LMICs and prevent outbreaks from turning into global crises,” the partners said. 

An overarching aim of the initiative is to “break down barriers between often isolated areas of work—between cardiometabolic and infectious diseases, or between scientific discovery and delivery of solutions, for example,” said Mads Krogsgaard Thomsen, CEO of the Danish-based Novo Nordisk Foundation.

Both over and under-nutrition continue to burden countries in both the global North and South. In that context, the partnership aims to support advances in nutritional science and the microbiome – the trillions of micro-organisms that co-exist in our bodies – as an avenue to tackle nutrition-related diseases. 

“It’s kind of mind-blowing how little research was going into understanding malnourishment,” remarked Bill Gates. “In some cases, for things like the microbiome, we had to fund scientific research because it was just an ignored area.” 

Faltering global health investments

Wellcome Trust CEO speaks at Copenhagen global health forum
John-Arne Røttingen, Wellcome Trust CEO, speaks the Novo Nordisk Foundation Global Science Summit in Denmark

The new initiative aims to signal that renewed global health investments are all the more important in the current post-pandemic context. 

“We have a challenging macroeconomic situation,” said John-Arne Røttingen, Chief Executive Officer at Wellcome. “We also see that the major part of global health financing is really not for science and innovation.”

After the surge in funding during the COVID-19 pandemic, national investments in health have since faltered. Governments face competing budgetary priorities in the wake of inflation and debt crises.

A recent World Health Organization (WHO) analysis of global health expenditures found that most governments fail to meet the global targets for spending of 5% of GDP and 15% of national budgets on health care. Meeting those two benchmarks indicates if a country is on track to achieve universal health coverage. Many low-and-middle income countries spend even less on health today than they did  in 2000. 

“Funding and attention for global health and development is faltering, putting progress at risk. Debt crises are forcing governments to cut funding for essential health programs; climate change and conflict are shattering communities; and progress to protect lives from diseases known and unknown is under threat. Across all of these challenges, it is the world’s poorest who are most affected,” said the Gates Foundation announcement.

New obesity drugs filling Novo Nordisk philanthropy’s coffers  

The Novo Nordisk Foundation contributed $100 million for a new global health partnership along with Gates Foundation and the Wellcome Trust

Ironically, the Novo Nordisk Foundation’s participation in the new partnership comes on the heels of the recent landslide success of the pharmaceutical firm Novo Nordisk A/S – which  Novo Nordisk Foundation controls – with the sale of two new drugs Ozempic® and Wegovy® to control obesity..

“The booming market for weight-loss drugs has pushed the assets of the Novo foundation to more than double those of the Gates foundation,” noted Bloomberg Law in a recent article.  

“In turn, the Danish organization is broadening its giving and its footprint outside its home market. The Novo foundation already backs 27% of Danish medical research, awarding a record $1.3 billion to projects related to innovation and science last year.

The partnership may be extended beyond the initial three years if successful, Novo Nordisk Foundation CEO Thomsen was quoted as saying. “To be honest, three years is a short time for making a change on global climate, agri-food systems, human health.” 

If early results are positive, he said, “the most natural thing is to continue such a relationship, of course.” 

Image Credits: CDC.

Some of the areas covered by the WHO Results Report

“The world is off track to reach most of the Triple Billion targets and the health-related Sustainable Development Goals,” said World Health Organization (WHO) Director General  Dr Tedros Adhanom Ghebreyesus. 

His comments were part of the WHO Results Report 2023 released on Tuesday.

The triple billion targets involve one billion more people benefitting from universal health coverage, one billion more people better protected from health emergencies, and one billion more people enjoying better health and well-being by 2025. 

Using data from 174 countries, the report shows some progress towards the 46 targets, however.

One billion enjoying better health? Yes

The current trajectory indicates that the target of 1 billion more people enjoying better health and well-being will likely be met by 2025, driven primarily by improvements in air quality and access to water, sanitation and hygiene measures, according to the summary.  

But the progress will be insufficient to reach all the health-related targets of the Sustainable Development Goals (SDGs) by 2030, with only one target on tobacco use likely to be met.

Tobacco use is declining in 150 countries, 56 of which are on track to achieve the global target of reducing tobacco use by 2025. There are 19 million fewer current tobacco users globally than there were two years ago.

Forty-five countries also reduced their road traffic deaths by 30% or more.

But adult obesity continues to rise in all WHO regions, with no immediate sign of reversal. Ambient air pollution continues to be a challenge in many areas of the world. 

One billion access to universal health coverage? No

The world is off track to meet the target of one billion more people benefiting from universal health coverage by 2025. However, 30% of countries have made progress on both the coverage of essential health services and the provision of financial protection. 

But “the overall measures of progress are largely driven by increased HIV service coverage”, according to the WHO. 

Over three-quarters of people living with HIV globally are receiving antiretroviral therapy and almost all of those who are receiving treatment are achieving viral suppression, which means that they cannot infect others. 

Global HIV services are the beneficiary of the US President’s Emergency Plan for AIDS Relief (PEPFAR), which has strengthened health systems in many countries, particularly in Africa.

However, the COVID-19 pandemic disrupted progress on childhood vaccination and tuberculosis and service coverage for malaria, non-communicable diseases and preventive services continue to lag.  

But the world’s first malaria vaccine, RTS,S/AS01, was administered to more than two million children in Ghana, Kenya, and Malawi during the biennium, reducing mortality by 13% among children eligible for vaccination. WHO’s prequalification of a second vaccine, R21/Matrix-M, is expected to further boost malaria control efforts. 

Indicators for financial hardship has worsened with 13.5% of households spending 10% or more of their income on health services (vs 13% in 2017).

Management of diabetes has also worsened. 

One billion better protected from health emergencies? No

Although the coverage of vaccinations for high-priority pathogens shows improvement since the pandemic-related disruptions in 2020–2021, it has not yet returned to pre-pandemic levels. 

But there has been a 62% increase (from 103 to 167) in the proportion of member states with genomic sequencing capability for SARS-CoV-2 between February 2021 and December 2023. Angola, Bahamas, Central African Republic, Dominican Republic, Honduras, Maldives and Sudan are among the countries that have gained a sequencing capacity.

The Pandemic Fund made its first round of $338 million disbursements to 37 countries in 2023 to assist them to bolster systems to prevent and respond to pandemics and outbreaks.

However, the Intergovernmental Negotiating Body (INB) still has not come up with a pandemic agreement, while the Working Group on Amendments to the International Health Regulations (2005) seems close to agreement on amendments to present to the Seventy-seventh World Health Assembly which starts on 27 May.

“With concrete and concerted action to accelerate progress, we could still achieve a substantial subset of [the targets]. Our goal is to invest even more resources where they matter most—at the country level—while ensuring sustainable and flexible financing to support our mission,” said Tedros.

Mechanical milking machines may be facilitating the fast spread of H5N1 avian flu in dairy cows in the US.

Although cows have been infected with avian influenza subtype H5N1 for the first time and viral remnants have been found in milk, the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC) characterise its current risk to humans as “low”.

The risk for people exposed to infected birds and other animals is low to moderate, they add.

So far, there have been no cases of avian flu being transmitted from person to person in the current outbreak – only from infected birds and animals to humans.

The last human-to-human transmission of avian flu was detected in 2017 and involved infections between a small group of health workers.

Only one person has been infected in the current outbreak in US dairy herds, a man working on a Texas dairy farm who developed conjunctivitis. Swabs of the man’s throat and eye tested positive for H5N1, but he had mild symptoms and did not infect anyone in his household.

Meanwhile, some 220 workers who work at the 36 US dairies affected by the H5N1 outbreak have been screened, but none has been infected with the virus, according to the US CDC’s Dr Todd Davis, speaking at a WHO Information Network for Epidemics (EPI-WIN) briefing on Monday.

“After sequencing several hundred viruses from cattle, we don’t see any molecular changes that would indicate increased possibilities of infection or transmission from person to person,” said Davis. 

“So we still consider this public health risks to be quite low. I think some of the exceptions may be prolonged unprotected exposure to infected dairy cattle, so there are some likely risk associated with occupational exposure.”

US CDC’s Todd Davis

Milk and meat risks

About 20% of milk samples collected by the US Food and Drug Administration (FDA) tested positive for H5N1 viral RNA, said Dr Richard Webby, director of the WHO’s Collaborating Centre for studies on the ecology of influenza in animals and birds.

Meanwhile, a smaller sample set targeted at the states where outbreaks had occurred found  40% of the milk products contained viral remnants,  added Webby, who is based at St Jude Children’s Research Hospital in Memphis in the US.

“There has been a relatively large number of samples tested, but so far from a safety perspective, it does look like the pasteurisation process is removing viable virus from those samples,” added Webby.

Dr Moez Sanaa, head of the WHO’s Standard and Scientific Advice on Food Nutrition, confirmed that while viral RNA has been found in pasteurised milk, none of this was live virus “suggesting that the pasteurisation process effectively inactivates H5N1,” said 

“Preliminary results [of ongoing studies] indicate that virus is inactivated by heat treatment similar to pasteurisation,” said Sanaa, but added that more studies of milk with higher viral loads was still needed. He warned people to avoid raw milk.

Meanwhile, last week the USDA’s Food Safety and Inspection Service (FSIS) announced that all 30 samples of ground beef from retail outlets in the states with infected dairy cattle herds tested negative for H5N1. These results reaffirm that the meat supply is safe.

Webby’s group has also tested eggs and found them to be free of H5N1.

Richard Webby, Director of the WHO’s Collaborating Centre for studies on the ecology of influenza in animals and birds

Cow transmission: mechanical?

From the genomic analysis, it appears that the outbreak in the dairy farms stemmed from “a single introduction” but that “the moving of dairy cattle has spread that to multiple farms and different locations”, according to Dr David Swayne, a US influenza veterinarian.

Swayne added that as transmission seemed to occur “in the unique environment of a dairy parlour”, there were two leading hypotheses about how the rapid transmission was taking place.

One was that there was “mechanical transmission” with infections being spread via milking machines, for example.

The other was that transmission occurred during the “continual cleaning” in dairies that enabled viral spread through “large droplets produced from that washing down process”. 

Meanwhile, Dr Aspen Hammond from WHO’s Global Immunization Programme (GIP) said that H5N1 had been found in other animals near the affected dairy cattle herd, including cats, raccoons and wild and domestic birds nearby.

‘One Health in action’

Dr Maria van Kerkhove, the WHO’s acting head of Epidemic and Pandemic Prevention and Preparedness (EPP), described the outbreak as “one Health in action”.

“You cannot look at human health risk without looking at the risk in animals,” said Van Kerkhove, stressing that partnerships with bodies in the animal health field were essential.

“Right now, there’s a lot of focus on the US but we are seeing a global epizootic of avian influenza, and we’ve seen H5N1 infection in wild birds and poultry and marine mammals and land mammals,” she said.

“But what is concerning is that we are seeing new species that are being infected… We need much stronger surveillance in animals globally, not just in the US, looking at the species that we know can be infected with H5N1, but also in humans at the animal-human interface. “

She urged those doing surveillance to continue to sequence and share those sequences to enable regular assessments of the viruses as well as “what any changes in these viruses mean, in terms of transmissibility in terms of severity.”

Van Kerkhove also stressed that occupationally exposed people needed to be protected from infection, including by using personal protective equipment and washing hands frequently, “because prevention is key”. 

She also said that, while it was not yet necessary, the current H5N1 flu was covered by the candidate vaccines in the influenza prevention pipeline.

Image Credits: pxfuel, Charyse Reinfelder.

Steve Solomon, WHO Principal Legal Officer, co-chairs Precious Matsoso and Roland Driece, and  Jaouad Mahjour, Head of WHO Secretariat to intergovernmental negotiating body.

“Get this done” – and if you disagree, don’t block consensus, was the heartfelt plea made by World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyessus to member states negotiating a pandemic agreement on Friday (3 May).

Tedros was addressing the ‘stocktake’ in the middle of the final 10-day meeting of the intergovernmental negotiating body (INB), and it was clear that member states were nowhere close to the finish.

“You are here for the same reason this organisation was created in the first place – because global threats demand a global response,” said Tedros.

“I appreciate that all of you are making compromises you did not want to make. I appreciate that, article-by-article, paragraph-by-paragraph, word-by-word, you are converging on a consensus, although you’re not there yet.

“I also appreciate that consensus does not mean unanimity. I recognise that there may be delegations who, despite their good faith efforts, may not be in a position to join a consensus, but they have a choice. They can choose not to block consensus.”

Evoking “the people of the world”, including future generations, those struggling to survive and those mourning family members who died during COVID-19, Tedros said: “Please, get this done, for them.”

Pandemic Agreement negotiations status (3 May).

At the stocktake, INB co-chairs told stakeholders that revised text has been circulated for Articles 4, 6, 10 and 19, and there is broad agreement on parts of Articles 4, 6 and 10.

New text for Articles 13, 13bis, 14, 17 and 20 still need to be circulated. Meanwhile,  Chapter 1 (definitions) and Chapter 3 have not yet been discussed.

However, at a media briefing later on Friday INB co-chairs said that agreement had been reached on Article 18, an innocuous article on communication. However, they were cagey about giving any specifics on the negotiations, stressing that countries “are trying to find each other”

“Nothing is agreed yet, but also nothing has been taken out yet,” said co-chair Roland Driece, adding that negotiations became complex when trade issues became involved.

“It’s not uncommon, actually is quite normal, that everything should come together almost in the last couple of days,” he added. “It’s standard negotiation practice that countries will only give up on what’s important for them when they see the whole picture.”

Driece added: “In the situation that we would not find consensus by the end of the week, we will report that to the World Health Assembly and it’s up to the World Health Assembly then to decide what should be happening next.” 

Matsoso concluded the briefing by warning: “The window of opportunity is closing, and once it closes, it will be a missed opportunity intergenerationally because there are new priorities and we cannot afford to miss this.  We can only but encourage countries to work towards finalising the agreement.”

Member states will be meeting in working groups on contentious articles over most of the weekend, then the 12-hour daily schedule resumes officially on Monday.

The programme for next week involves finalising all text. Working groups will meet in mornings to discuss and “yellow” text, indicating which areas are ready to be put up for discussion. Plenary sessions will be held in the afternoons to read and “green” this text. There is also time for breakouts and working groups in evenings.

Image Credits: WHO, Nina Schwalbe.

Surgeons in Burkina Faso operate on a patient after undergoing surgical training at the Geneva University Hospitals (HUG) as part of an international collaboration.

In the universe of Geneva’s global health hub, which includes dozens of international NGOs and WHO as the brightest star in the solar system, a parallel universe of locally-grown health and humanitarian collaborations have also developed around the University of Geneva and Geneva University Hospitals.

GENEVA – Ten years ago, two medical professionals from Madagascar met up with Dr Alexandra Calmy, a leading infectious disease expert at the Geneva University Hospitals (HUG in French) at the Geneva Health Forum to tell her about the bane of TB-meningitis that they were confronting in their country among people with HIV or weakened immunity – a disease that has a 40% mortality rate. 

“They told me ‘we are really in trouble in Madagascar with TB-Meningitis – we don’t know what to do and we have no way to diagnose and treat them efficiently,” recalled Calmy.  

That chance meeting proved to be the beginning of a major collaboration between the HUG and a hospital in Madagascar that introduced, firstly, more accurate GeneXpert diagnostics for earlier intervention, and later, two alternative treatment options for TB-meningitis. 

That eventually led to a grant from the European Union’s EDCTP, and a randomized, multi-country trial of the new treatments  in Madagascar as well as three other African countries – Ivory Coast, South Africa and Uganda (INTENSE-TBM), now underway. 

International Geneva’s ‘global health hub’ 

A training session in Mali for health professionals about therapeutic patient education and diabetes co-organized by the Malian Ministry of Health, HUG and the NGO, Santé Diabète

The story is one of dozens of examples of research innovations and health and international development success stories that have emerged out of a unique ecosystem of the University of Geneva and its university hospital affiliate, working in partnership with the city’s many NGOs and international aid organizations, all part of the constellation known as “International Geneva”.  

Others call it the Geneva ‘Global Health Hub’- with the World Health Organization as the center of the solar system –  around which dozens of other planets and satellites revolve.  

The projects stimulated by the University-HUG collaborations, per se, range from new medicine regimes like the one being tested for TB, to new, easy-to-use diagnostic tools for conditions such as cervical cancer, long-neglected in developing regions. 

They also span an enormous range of initiatives to actually introduce innovations into health systems and build the capacity of medical professionals. Examples of the latter include educating nurses to provide diabetes control information and training community health workers in refugee settings.   

In fact, the labyrinth of collaborations, particularly in the health and humanitarian arena, is so extensive and complex that it is difficult to map and describe. At the core are the HUG, the University of Geneva Faculty of Medicine and the University’s Geneva Centre of Humanitarian Studies.  

Around these, are a satellite array of collaborations and partnerships with WHO, ICRC, Médecins Sans Frontières and other, smaller, but influential Swiss-based NGOs, such as Terre des Hommes. The Geneva Health Forum, convening this year on 27-29 May, historically has played a key role as a platform to showcase many of the initiatives and bring stakeholders together.  

And finally, the ‘State’ of Geneva, and its “Service of International Solidarity” stand as the backbone behind all of these efforts – funding directly and indirectly over CHF 40 million in international health and development projects in the name of the “State of Geneva” – a title reflecting the influence it wields. And that is in addition to financial support from the Swiss national government’s department of Development and Cooperation (DDC)

HUG equalization fund ‘kickstarts’ innovative projects

The HUG has funded or partially funded nearly 100 health and humanitarian collaborations across the globe over the past six years.

A report on the HUG’s collaborations cites a total of 97 international health projects, entirely or partly funded by the Hospital, in the most vulnerable countries of sub-Saharan Africa and the world, over the past six years for a total of more than 3 million CHF, says Calmy. Some 43 projects are currently ongoing, with 20 new projects approved in 2023, she adds.  

The HUG finances start-up projects based on a “Fond de Péréquation” capitalized by doctors’ income from private patient visits to the hospital, Calmy notes. (The English translation is “Equalization Fund” – with all that implies). 

The fund enables HUG-affiliated staff to propose and launch innovative projects from the grassroots in their areas of expertise, notes Calmy, providing a unique laboratory for creative collaborations. Proposals can be submitted by any health professional – from doctors and  nurses to psychologists and dieticians.

“We are here to provide the kickstart,” added Calmy who is co-chair of the HUG Commission of Humanitarian Affairs and International Cooperation, that administers the medical facility’s programme – in collaboration with a parallel Commission at the University of Geneva. 

“You want to do cervical cancer detection in Cameroon.  You have to map what is going on there, what is the expertise, who are your contacts.  So we’ll give you the money to kickstart – after that you can go to the Canton, the ICRC, the Confederation for help in obtaining larger grants for research and implementation.”  

A nurse-led project launched in education about chronic diseases is one such example that she cites. A noteworthy feature of the HUG approach is its eclectic sponsorship of a very diverse portfolio, she adds.  

“We are well aware that we are funding diverse projects, there is no line in terms of themes, countries, or types of projects. Anyone in this hospital that has expertise, identified partners, and wants to do a project, can make a proposal,” she said. 

Seeking coherence amidst diversity

Alexandra Calmy, HUG Vice-Dean for Clinical Research and co-chair of the Medical Faculty’s Commisson for Humanitarian Affairs at the HUG-University  Humanitarian Conference “Assises de l’Humanitaire”, 9 October 2023

At the same time, there is growing recognition that more coherence and coordination amongst a wide array of initiatives would be useful – to share lessons learned and ensure maximum impact. 

That plethora of programmes and projects led all of the partners to hold a first-ever stocktaking event in October 2023, to seek a common direction and way forward. 

Called simply the Assises de L’Humanitaire (Humanitarian Conference)” the one-day encounter brought together stakeholders from the HUG and University system, along with the Swiss Confederation, Geneva State, WHO, ICRC and a wide array of other international organizations working with the Geneva-based institutions.

Now, six months later, a report on the findings and recommendations for a way forward is soon to be published. 

“I think the conclusion was that ours is still a good approach. But we wanted to explore new ways of doing things better,” said Blanchet.  

Key themes that emerged as recommendations include an increased focus on facilitating south-south along with north-south collaborations, and in-country partnerships that emphasize the education and training of local actors to ensure sustainability and scale up of projects. 

“But we want to remain a laboratory of ideas,” Calmly said.

‘Assises de l’Humanitaire was the triangle’  

The day was particularly important in terms of helping the University and the HUG share experiences between themselves and better align, said Karl Blanchet, who is the director of the university’s Geneva Centre for Humanitarian Studies. 

“The Assises de l’humanitaire was this triangle of the Geneva Centre, the Faculty of Medicine and the HUG. There were two objectives to all meet and all be aware to make sure that we are aware of what we do in different parts of the world,” he said.

“The next step is to formalize relationships and contribution to these programmes,” he added, noting the wide range of UN and NGO actors, like MSF and ICRC involved in individual projects.

The same network of collaborations underpins many of the events featured in the Geneva Health Forum, co-founded by the HUG, the University of Geneva and its Faculty of Medicine in 2006. 

This year’s GHF takes place 27-29 May, and coincides with the kickoff of the 77th World Health Assembly.  Health and Environment, Migration Health and Equity and Malaria Elimination are the key themes.  But a day-long session on  “International Hospital Collaborations” is also taking place on 29 May. Held in French, it will look even more deeply at some of the topics discussed at the conference last October.   

“The aim of the seminar is to collectively question the way partnerships between hospitals in the global north and global south are designed, and how to promote ethics and sustainable solutions within the frame of these partnerships,” said Bruno Lab, head of Humanitarian and International Cooperation Affairs at the HUG. 

“It’s a dive into the specific domain of long-term technical assistance projects. Through multi-year collaborations, the objectives are set around capacity building, teaching and research.”

Karl Blanchet, head of the University of Geneva’s Centre for Humanitarian Affairs

Many HUG staff also have joint appointments in the University of Geneva’s Medical Faculty, which also hosts an array of international health research initiatives, under the research portfolios of various departments. 

The Centre for Humanitarian Studies, therefore, collaborates with both institutions, and others, in a range of health and humanitarian research and education projects, says Blanchet. 

Examples of the former include a research study on reducing the impact of attacks on healthcare, as well as a five-university initiative on re-imagining the future of global health, he adds

But there are also collaborations in field settings on priorities like teaching doctors how to perform war surgery or a new programme in community health for refugees. 

The latter, targeting long-time refugees in Jordan and Kenya, provides students with a basic education that allows them to gain employment as health workers, as well as to qualify for further university training in their host countries, Blanchet says. 

The end result is better integration into local communities and health systems after decades as refugees.  

“During the COVID pandemic, the first settings that were closed in lockdown were in refugee camps,” Blanchet recalls. “”So we created a course not only to help refugees deal with health issues in their community, but to be able to get jobs.

“It’s the first advanced course on community health accredited by a University Faculty of Medicine, for students and refugees who cannot demonstrate their level of studies.  If they finish the certificate, they can go onto national university,” he said. 

University ‘open to the world’

Blanchet himself has a strong public health background. He came to the centre as an academic from the London School of Tropical Hygiene and Medicine.

He found the pace much faster and topical than the usual university ivory tower.    

“I can’t tell you how amazing this environment is,” he said. “When I arrived at this new post, where we are grappling with some of the most challenging environments, people would tell me, over and over, ‘just tell me what you need.’

That led to initiatives such as a website publishing briefs on the latest scientific knowledge about  COVID in Ukrainian after  the 2022 Russian invasion; as well as the hosting of leading Afghan health experts in the Centre, including the former minister of health, following the Taliban’s takeover of Kabul. 

The centre is likewise involved in an initiative to help medical students in conflict-ridden regions such as Gaza, Iran, Pakistan and Afghanistan to complete their studies in host countries abroad.  And there are now plans now in the works to host an international symposium soon on the rebuilding of Gaza’s health system, he confides.  

“These are all examples of the agility of the teams and the faculty,” he said. “The University of Geneva is so anchored in the news and what is going on – and they want to make sure that they can contribute, not only to research but as a university open to the world.” 

Paula Dupraz-Dubois contributed reporting to this story

Image Credits: Hopitaux Universitaires de Genève, Hopitaux Universitaires de Genève, Geneva University Hospitals , Paula Dupraz-Dubois.

Milking a cow in Texas. H5N1 Avian influenza is spreading among US cattle herds, most probably during the time of milking.

Most H5N1 infections spreading through US dairy cattle and other animal populations are likely going undetected despite stepped up surveillance by the US Department of Agriculture, Michael Osterholm, director of the Centre for Infectious Disease Research and Policy (CIDRAP), told Health Policy Watch on Wednesday.

Osterholm spoke as a growing number of infectious experts were sounding alarm bells about the expanding spread of the deadly virus to mammalian populations – and especially dairy cattle in the United States, where some 36 herds have so far been infected, according to the latest US Centers for Disease Control and Prevention (CDC) update April 30. Sanitation gaps and lax surveillance in industrial dairy operations are facilitating H5N1 transmission, experts now suggest. 

Total number of H5N1 cases in different animals in the US. Infection spread in dairy cattle, the newest ‘terrain’ for the virus, is causing the most concern.

And “most” infections are likely going undetected due to farmer reluctance to have cattle and employees tested for avian flu, warned Osterholm, an internationally-known expert. 

“We need much more extensive follow up, serology studies and close monitoring of mixing vessel animal species, e.g. pigs,” Osterholm stressed in emailed remarks. 

He noted that pig infections, for example, constitute a “mixing vessel animal species” because they can become co-infected with both animal and human forms of avian influenza, increasing the risks of spread to humans of a virus that has a greater than 50% fatality rate.

On the positive side, Osterholm added that it was “very unlikely” pasteurized milk could transmit the infection if pasteurization “is done properly.”

Policymakers have taken their ‘eye off the ball’ of ‘One Health’ principles

“Policymakers have again taken their eyes off the ball in efforts to protect humanity from new pandemics,” stated Dr Nigel Sizer, an Executive Director of the non-profit Preventing Pandemics at the Source (PPATS), as part of a stiff warning  issued Tuesday by half a dozen international experts on the wave of H5N1 infections.

“In this case, it is hard not to point the finger at lax monitoring and regulation of animal agriculture in the United States and elsewhere,” Sizer said.

Colorized transmission electron micrograph of Avian influenza A H5N1 viruses (seen in gold) grown in MDCK cells (seen in green).

The expanding outbreak takes place as WHO member states are in the throes of finalizing a draft Pandemic Accord agreement, where a commitment to stronger “One Health” measures for preventing spillovers of animal pathogens to humans remains a sticking point for some countries in the Global South. 

But in the case of the USA, a dearth of surveillance is also a hallmark of the rapidly expanding avian flu outbreak in the Global North, other experts also pointed out.  

“The situation with avian influenza across the United States exemplifies the inherent hypocrisy and vested economic interests around Pandemic Prevention, Preparedness, and Response,” said Dr. Christian Walzer, Executive Director of Health at the Wildlife Conservation Society, and a professor at the University of Veterinary Medicine in Vienna, Austria, in the PPATS statement of experts.

“As one hundred ninety-four member states of the World Health Organization (WHO) are negotiating perceived responsibilities and equity around a new Pathogen Access and Benefits-Sharing [PABS] Mechanism – while the Global North is demanding transparent and rapid access to pathogen data from the Global South to develop diagnostics, vaccines, and therapeutics, it seems unwilling to share such information with the world,” Walzer said.

Spread through milking machines

Among dairy cows, H5N1 appears to be transmitting rapidly through their mammary glands via virus contaminated milking machines, Stat News reported on Tuesday. The milking equipment is typically not sanitized between sessions with individual animals, becoming an obvious transmission path to infection by more and more cows from the herd.

Experts such as Jared Taylor, a professor of veterinary pathobiology at Oklahoma State University, noted that the H5N1 infections in cattle herds reported so far have been  limited to lactating dairy cows. And the ones who produce most milk – and therefore spend more time on the milking machines – have the highest disease incidence.

Even more worrisome is the potential presence of the virus in raw milk – which some consumers in the USA as well as in Europe prefer as a more ‘natural’ alternative.

US states where H1N5 has been detected in cattle

There also have been virus remnants found in pasteurised milk. “The role of pasteurization in inactivation of the virus […] is currently being investigated,” states a 23 April assessment by the WHO, issued jointly with the UN Food and Agriculture Organization (FAO) and the World Organisation for Animal Health (WOAH).

Infection with H5N1 from pasteurised milk is, however, “very unlikely, if [the pasteurisation is] done properly,” Osterholm said.

As compared with consumers, farm workers who have everyday contact with cattle are, however, at a far higher risk of infection. And the one case of human infection reported in March, does not reflect the scale of the disease spread to people, experts say because farmers have been reluctant to allow testing of cattle or employees, and such testing remains voluntary. 

That’s why “most” cases likely go undetected, Osterholm told Health Policy Watch.

Avian influenza as symptom of world’s failure to apply ‘One Health’ measures

Virus spillovers to more and more species are a direct effect of the poor animal management practices in the  intensive livestock production conditions that are common throughout the developed world today, said Sizer in the statement on April 30.

“Improved animal husbandry conditions, more rigorous inspection standards, as well as better reporting and sharing of animal health information could reduce the risk of these outbreaks as well as improve the welfare of the animals we consume,” he asserted. “We must question for how much longer consumers will have to worry that the price of a cheap sausage or steak is the risk of another global pandemic.”

One Health principles recognize the interlinkages between ecosystems, animal and human health, and call for enhanced collaboration between sectors to prevent zoonotic spillover into human populations. 

“This outbreak highlights the need for One Health approaches for preventing spillovers and interventions to reduce risk of such threats ‘at source’,” argued Dr. Malik Peiris, Professor of Virology at the School of Public Health at The University of Hong Kong, and a leading H5N1 expert.

Pigs are an important possible intermediary host for avian influenza.

“There is still a widespread philosophy of aiming for maximum profit in meat production, when it should be about optimizing food security, food safety, animal welfare and ecological sustainability,” added Dr. Dirk Pfeiffer, Professor of One Health at City University of Hong Kong, in the same statement, adding: 

 “Global investors who see opportunities in making money out of meat production should be aware that ‘growing cattle, pigs or chickens’ is not the same as making parts for mobile telephones.”

WHO still ranks human health risks as low or low-to moderate

In its 23 April assessment, WHO ranked avian influenza risks to humans as low generally insofar as human-to-human transmission has never been documented, and low-to-moderate for those “with exposure to infected birds or animals or contaminated environments.”

Only one human case connected with the US outbreak has been reported, a cattle worker from Texas.

Since 2003, WHO reported only rare instances of human infections all from close contact with animals. Even so, the mortality was “extraordinarily high,” according to WHO Chief Scientist Jeremy Farrar. He was referring to the 52% mortality rate registered amongst the 889 human cases of H5N1 reported to WHO between 2003 and 1 April 2024.

Jeremy Farrar, WHO Chief Scientist, during a press briefing April 18

“Being one of the few people around the world who have actually treated patients with H5N1 […] this remains I think an enormous concern,” Farrar stressed at an April 18 media briefing in Geneva. From 1996 until 2013, Farrar was Director of the Oxford University Clinical Research Unit in Ho Chi Minh City, where he and a Vietnamese colleague identified the re-emergence of the deadly bird flu, or H5N1, in humans in 2004. 

What worries experts the most is the virus’s expanding host range. Naturally found in wild birds, avian influenza has developed a limited ability to infect other species, including mammals. The recent joint assessment by WHO, FAO and WOAH reports mentions the virus as the probable source of infection in sea mammals, multiple fur animal farms and ferret-to-ferret infections, according to some studies.

The list of infected animals is getting longer: cats, dogs, goat kids or polar bears, already known to suffer from the disease were recently joined by a walrus, as The Guardian reported.

“The great concern, of course, is […] that that virus now evolves and develops the ability to infect humans. And then critically, the ability to go from human-to-human transmission,” Farrar told the media briefing.

Reassurance, but… 

Other WHO officials have still sought to issue a more reassuring note.

Speaking at another WHO press briefing on April 24, Dr. Maria Van Kerkhove, a WHO epidemiologist, asserted that appropriate surveillance systems are working well.

“We are concerned about this particular virus because we know influenza has the potential to cause epidemics that have the potential to cause pandemics,” she said. “And that’s why we have a global system in place to monitor, detect, and to rapidly do risk assessments to look at viruses that could potentially be used in vaccines as we go forward. There’s a lot of work in place right now,” she said.

Since the beginning of 2021, 28 detections of H5N1 in humans have been reported to WHO, with all nine cases reported in Europe or North America being assymptomatic or mild cases, notes the WHO/FAO/WOAH joint assessment. Still the three agencies also recommended tougher monitoring – calling on national authorities to  use “active case finding and serologic methods, as well as work with national agencies to understand the exposure and risk from milk and milk products.”

Osterholm, like other experts doubts that US authorities have the situation under control. What’s needed is, among others, a “much more extensive follow up,” said Osterholm. 

He also advises a close monitoring of pigs, which have “influenza virus receptors for both avian and human influenza viruses.

“If they get coinfected with both viruses simultaneously then viral reassortment can occur and a new human virus emerge, like what happened in 2009 with the new H1N1 [strain] that emerged in swine in Mexico.” 

With editing and reporting contributions by Elaine Ruth Fletcher 

Image Credits: Josh Kelahan, US CDC, CDC/ Courtesy of Cynthia Goldsmith, Flickr: Dutchairplaneshooter.

On the final day of INC-4, delegates held talks until the early hours of the morning trying to find a way forward

The fourth session of the UN intergovernmental negotiating committee (INC) to develop an international legally binding instrument on plastic pollution ended in Ottawa on Tuesday with “an advanced draft text of the instrument and agreement on inter-sessional work ahead”, according to the UN Environment Programme (UNEP).

Delegates engaged in text-based discussion on the revised draft for the first time, but there were major sticking points – especially on limiting plastic production. The European Union (EU) proposed extending the meeting but delegates failed to agree on the proposal, according to the Earth Negotiation Bulletin.

Other issues on the table related to emissions and releases; product design; waste management; problematic and avoidable plastics; financing, and a just transition.

The INC members agreement to hold inter-sessional work – expert meetings between the official INC sessions –  to work on “convergence on key issues” ahead of the next negotiating session, INC5, will take place in Busan, Korea, in November.

The inter-sessional groups will look at financing to achieve the objectives of the instrument and approaches to address  plastic pollution and chemicals of concern in plastic products and product design, focusing on products that can be recycled and reused. 

Long road to agreement

INC5 is supposed to adopt an agreement, but there is still a long road ahead as “meetings to discuss the technical elements of the text diverged on almost all points of discussion, from problematic and avoidable plastics to product design, composition and performance,” according to the Earth Negotiation Bulletin..

“We came to Ottawa to advance the text and with the hope that members would agree on the intersessional work required to make even greater progress ahead of INC-5. We leave Ottawa having achieved both goals and a clear path to landing an ambitious deal in Busan ahead of us,” said Inger Andersen, UNEP executive director.

 “The work, however, is far from over. The plastic pollution crisis continues to engulf the world and we have just a few months left before the end of year deadline agreed upon in 2022. I urge members to show continued commitment and flexibility to achieve maximum ambition.”

However, several NGOs that attending as observers were unhappy with the influence of member states with significant fossil fuel industries. Most plastics are made from oil and gas derivatives.

“Despite hearing people from polluted communities around the world give sensible proposals to curb the lifecycle harms of plastics, fossil fuel and petrochemical interests are still shamelessly blocking progress and focusing on utterly inadequate plastic waste management,” said Julie Teel Simmonds, a senior attorney at the Center for Biological Diversity (CBD).

While Rwanda and Peru, part of the high-ambition coalition, proposed production reductions,  a coalition of fossil fuel–aligned countries, including Russia, China, and Saudi Arabia, objected to treaty measures to address plastic production, according to the CBD. 

Not ‘if ‘but ‘how’

“Canada is committed to reaching a final agreement at INC-5 in the Republic of Korea before year end. We are no longer talking about ‘if’ we can get there, but ‘how.’ Together we can land one of the most significant environmental decisions since the Paris Agreement and the Kunming Montreal Global Biodiversity Framework,” said Steven Guilbeault, Canada’s Minister of Environment and Climate Change, who hosted INC4. 

“We are doing everything we can to raise the international profile of the plastic pollution crisis so that the agreement gets the global attention it deserves to cross the finish line.”

INC chairperson Ambassador Luis Vayas said that “some common ground” had been found and “I firmly believe that we can carry this same spirit forth to Busan to deliver on our mandate.” Delegates accepted Vayas’ proposal for a legal drafting group to ensure legal clarity in the text of the future agreement.

Jyoti Mathur-Filipp, executive secretary of the INC secretariat,  said that “compromise and commitment remains strong at this advanced stage of the negotiations”.

“Members should arrive in Busan ready to deliver on their mandate and agree a final text of the instrument. This is more than a process – it is the fulfilment of your commitment to saving future generations from the global scourge of plastic pollution.”

Image Credits: Kiara Worth/IISD.