Bureau of Global Heath Security and Diplomacy
US Secretary of State Antony Blinken, Health Secretary Xavier Beccera, USAID head Samantha Power and new Bureau head John Nkengasong

The US has consolidated its efforts to address global health threats into a single structure, the Bureau of Global Heath Security and Diplomacy, which was launched on Monday.

Renowned Cameroonian health expert Dr John Nkengasong, appointed last year to lead the US President’s Emergency Plan for AIDS Relief (PEPFAR), leads the new structure and will report directly to US Secretary of State Antony Blinken. He also remains head of PEPFAR.

PEPFAR, the hugely successful HIV programme estimated to have saved 25 million lives over 20 years, will be incorporated into the new bureau alongside all other US efforts to address future pandemics and other health emergencies.

“We’re setting up a new bureau to focus fully on the need to drive both internal and international coordination and accelerate the State Department’s ongoing efforts to strengthen global health security so that the world can respond with immediacy and intention when the next health crisis emerges,” Blinken told the launch.

Blinked outlined three main functions for the Bureau, the first being to lead US diplomacy in  “strengthening the global health security architecture so that the world is better prepared to prevent, detect, control and respond to infectious diseases”. 

“That includes by working with partners to modernise existing organisations like the World Health Organization (WHO) so that they’re more fit for purpose and by shaping new structures like the Pandemic Fund,” said Blinken.

The second function is to “leverage US foreign assistance to strengthen public health systems, including laboratories and supply chains for vital medical counter-measures” to enable countries to be better prepared to address health threats.

The third is “to elevate health security as a core US foreign policy priority” through both international diplomatic engagement and health security policymaking across the US government.

Dr John Nkengasong leads the new structure.

Nkengasong said that some of the Bureau’s immediate priorities are to “strengthen the global health security architecture to ensure greater capacity, coordination and accountability”, including through the Pandemic Fund, amending the International Health Regulations and successfully negotiating a pandemic accord.

He also flagged the danger posed by antimicrobial resistance (AMR), which is projected to kill about 10 million people a year from 2050 if nothing is done to address it.

Describing PEPFAR as the US government’s most successful global health programme, Nkengasong said that the lessons learned from PEPFAR – particularly the importance of an “all of government response” – would be applied to the new Bureau. 

“We recognise that the frequency of the health threats has increased because of the greater connectivity, globalisation, climate change, population growth, food insecurity, and many others,” added Nkengasong, who headed the Africa Centre for Disease Control during the pandemic.

Samantha Power, Administrator of the US Agency for International Development, told the launch that the odds of living through another pandemic of similar severity as COVID-19 in our lifetimes was almost 40%.

“To give a sense of the need here, the WHO and the World Bank estimate that the annual funding gap in pandemic preparedness is $10 billion annually. This new bureau is going to play an absolutely vital role in coordinating with our partners to summon the global cooperation and the resource investments needed to keep us all safe,” said Power.

Rightwing threat to PEPFAR

Meanwhile, PEPFAR is facing a right-wing backlash based on misinformation, as reported recently by Health Policy Watch.

PEPFAR’s five-year budget is due for reauthorisation by the US Congress by 30 September, but there has been unprecedented right-wing mobilisation against it over the past few months by both US and African groups.

The US right-wing groups claimed in a recent letter sent to Senate and Congress leaders that PEPFAR grantees  “are using taxpayer funds to promote a radical sexual and reproductive health agenda”. Signatories include the Center for Family and Human Rights (C-FAM), Heritage Foundation and the Dr James Dobson Family Institute.

A similar letter was sent on 6 June to the same US Senate and Congress leaders by some African politicians and religious leaders claiming that PEPFAR “is supporting so-called family planning and reproductive health principles and practices, including abortion, that violate our core beliefs concerning life, family, and religion”.

US Representative Chris Smith, who co-sponsored PEPFAR’s refinancing in 2018, has also joined its critics by recently claiming that the programme is being used to “promote abortion on demand”.

Illegal for PEPFAR to fund abortion

However, it is illegal for PEPFAR to fund or support abortion, and abortion is illegal in most of the  African countries where it operates.

“PEPFAR has never, will not ever, use that platform in supporting abortion,” said Nkengasong, as reported by Devex.

One of the PEPFAR grantees that have been singled out is DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe), which targets teenage girls in 16 African countries.

Girls and young women are up to five times more likely to contract HIV than boys and men their age, and DREAMS offered HIV prevention services to 2.9 million adolescent girls and young women in 2022.

“These people are all playing with fire, and they’re playing with people’s lives, and there can only be one reason: political motivation to kill PEPFAR,” Mark Dybul, former US global AIDS coordinator, told Devex.

Moderna
Moderna mRNA vaccine is found to be the safest for older adults. 

Older adults vaccinated with Moderna’s COVID-19 vaccine were 15% less likely to be infected with COVID-19 than those vaccinated with Pfizer-BioNTech’s, according to a peer-reviewed study, published in JAMA Network on Wednesday.

The study was based on observational data from 6.3 million adults, almost 60% women and 86.5% White, with an average age of 76 years old and were inoculated with either of the two mRNA vaccines against COVID-19. 

The results showed Moderna’s COVID-19 vaccine was also marginally safer with fewer post-vaccine adverse events like pulmonary embolism and thromboembolic events reported among the said group.

“The results of this study can help public health experts weigh which mRNA vaccine might be preferred for older adults and older subgroups, such as those with increased frailty,” Dr Daniel Harris, epidemiologist and the lead author of the study said. 

His team, at the Center for Gerontology and Healthcare Research at the Brown University School of Public Health, observed two groups of older adults, one with Pfizer-BioNTech’s mRNA vaccine and the other with Moderna’s mRNA vaccine for 28 days after receiving their first doses of the vaccines. 

Overall, only 1% of all the adults who participated in the study reported adverse events. Of these, those who received Moderna’s vaccine were associated with a 4% lower risk of pulmonary embolism (sudden blockage in blood vessels) and a 2% lower risk of thromboembolic events (several conditions related to blood clotting). 

Harris stressed that the risk of adverse events from contracting COVID-19 were substantially higher than the risk of adverse events from being vaccinated by either of the two mRNA vaccines.

“But in an ideal world where we can have a choice between which vaccine product is used, we wanted to see whether one vaccine was associated with better performance for older adults and those with increased frailty,” said Harris.

Long COVID clinical trials begin recruitment

Meanwhile, the US National Institute of Health (NIH), on Tuesday, launched the second phase of clinical trials to evaluate at least four potential treatments for long COVID. As part of the RECOVER Initiative, a range of  treatments will be evaluated through these trials including drugs, biologics, and medical devices.   

“The trials are designed to evaluate multiple treatments simultaneously to identify more swiftly those that are effective,” said the NIH in a press release. 

Created to study the long-term effects of long COVID, the RECOVER Initiative is currently conducting research on how COVID-19 affects the different tissues and organs in the human body, using data from over 24,000 participants, 60 million electronic health records, and over 40 pathobiological studies. 

The information gained from these studies has been used to design the second phase in which the safety and efficacy of long COVID treatments will be studied in groups of 300-400 people. 

“Hundreds of RECOVER investigators and research participants are working hard to uncover the biologic causes of long COVID. The condition affects nearly all body systems and presents with more than 200 symptoms,” Dr Walter J. Koroshetz, director of the NIH’s National Institute of Neurological Disorders and Stroke, and co-lead of the RECOVER Initiative, added. 

“Recognizing that more than one solution is likely needed, we’ve taken the lessons learned from RECOVER participants to design rigorous clinical trial platforms that will identify treatments for persons with different symptom clusters to improve their function and well-being.”

Image Credits: Gavi .

African cancer patients receiving chemotherapy

Africa has one of the highest cancer death rates in the world, yet this could be markedly improved by better access to treatments already widely available in high-income countries for the continent’s biggest killers – breast, cervical, lung and prostate cancers and Kaposi sarcoma.

This is according to a recent study by the Botswana-Rutgers Partnership for Health, which researched which cancer treatments that are effective in other regions could have an impact in sub-Saharan Africa (SSA) – but are not available or hard to get.

Cancer is in the top three causes of premature death in the vast majority of countries in SSA. Without significant intervention, annual deaths are projected to nearly double between 2020 and 2030, reaching about one million by 2030.

In high-income countries “the rapid evolution of precision oncology therapies is increasingly transforming the length and quality of life for cancer patients”. But in SSA “basic levels of cancer care, treatment and palliation are limited”, the study notes.

As a result, Africa’s cancer patients have “poor survival outcomes across most malignancies”. In 2020, Africa’s cancer incidence made up 5.7% of global cases, but its cancer mortality was 7.2% of global deaths.

There is a 30% survival rate for children with cancer in low-income countries in comparison to over 90% for children in high-income countries, WHO Director-General Dr Tedros Adhanom Ghebreyesus noted recently.

Access to high-impact treatments

“Cancer is threatening sub-Saharan African populations to a degree that demands a large-scale response,” said Richard Marlink, the director of Rutgers Global Health Institute and a study author. 

“This guidance provides a framework for how to improve access to the life-saving and life-altering medications that are proven to work. The high-impact treatments available elsewhere are needed in this region of our world.”

While there is a dearth of accurate data about cancer in the region, the study used cancer registries and other studies to get a sketch of the cancer burden.

Cervical Cancer

Cervical cancer is the leading cause of cancer-related death in women in SSA. For patients with advanced cervical cancer, the standard of care is chemotherapy in conjunction with radiation therapy. 

But a study of 29 oncology treatment centres in 12 SSA countries found an inconsistent supply of cisplatin, a preferred chemotherapy drug as well as limited access to radiation therapy.

In addition, access to radiotherapy is limited access due to a lack of trained personnel and equipment and equipment maintenance.

Breast Cancer

Elisabeth Nyiramana (left) is a breast cancer survivor from Rwanda.

Data from cancer registries show that breast cancer incidence is rising in nine countries in SSA. For example, in Harare (Zimbabwe) there has been a 4.9% average annual increase in the incidence of breast cancer and a 4.5% increase in Kampala (Uganda).

Mortality rates in southern Africa are “among the world’s highest due to late-stage presentation and lack of screening programs”, according to the study.

In a population-based registry study of 834 patients in 11 countries in SSA, only one-third received chemotherapy.

Breast cancer patients are also not routinely tested to determine their specific hormonal profiles, which means that “treatment may not include precision targeting, which is available in high-income countries where profiling capabilities are more accessible”.

“Treatment for breast cancer greatly differs based on hormonal status and human epidermal growth factor (HER2) expression status,” the study notes.

HER2-positive breast cancer is one that tests positive for the protein HER2, which promotes the growth of cancer cells. Treatments that specifically target HER2 are very effective.

Hormonal therapy with the drug tamoxifen is recommended for HER2 tumours. Tamoxifen is inexpensive or even free in some countries, so it may be prescribed even if the patient’s hormonal profiling has not taken place. This could harm the patient and provide no therapeutic advantage.

But even when hormonal profiling is available, the medications that have proven to be most effective “may be cost-prohibitive to obtain” – such as trastuzumab, which targets HER2. 

“Another barrier is that immunotherapy, using drugs such as atezolizumab and pembrolizumab, requires specialized monitoring and management protocols that usually aren’t available in this region,” the study notes.

Prostate Cancer

A leading cause of cancer death among men is prostate cancer, particularly in southern Africa where there are approximately 66 cases per 100,000 (more than double the rate recorded in West and East Africa).

Prostate cancer is also increasing. For example, in Kampala, Uganda, an average annual percentage increase of 5.2% was found between 1991–2010.

Treatment with surgical castration to remove the testicles is widespread in sub-Saharan Africa, yet “newer generation oral hormone therapy may have an expanded role in the region”.

Abiraterone with prednisone therapy is an oral hormone therapy that can improve outcomes. This is included on the World Health Organization’s Essential Medicines List, and is “expected to be available through multiple generic options and that reduced pricing is in the foreseeable future”. 

Molecular profiling, which isn’t readily accessible in the region, could also assist to identify patients with metastatic castration-resistant prostate cancer and develop treatments appropriate for them. Androgen deprivation therapy can provide symptom relief and improve survival.

Kaposi sarcoma

While Kaposi sarcoma (KS) is relatively rare worldwide, it is more common in people with weakened immune systems and has increased 20-fold in SSA since the 1980s alongside the HIV/AIDS epidemic.

Antiretroviral treatment has reduced the incidence of AIDS-associated KS, but there is still “ongoing significant morbidity and mortality from KS in the region”, according to the study.

This cancer, caused by infection with human herpesvirus-8, manifests in patches of abnormal tissue growing in the body, especially under the skin, in the lining of the mouth, nose and throat; and in lymph nodes. 

Since most cases of KS are associated with HIV, the study notes that “it is imperative for all patients living with HIV to receive antiretroviral therapy”. 

The medicine, Paclitaxel, can be used to treat advanced KS and is “much more affordable and readily available in SSA” than other medicines.

The World Health Organization’s (WHO) updated Essential Medicines List (EML) released last week includes a new KS treatment, liposomal doxorubicin.

The study also notes the lack of interest in studying new therapies for KS, despite the significant burden of disease in the region. The first large clinical trial in more than a decade that compared chemotherapy drugs used to treat Kaposi sarcoma in SSA took place in 2020. 

Lung Cancer

Greater access to tobacco products in Africa is expected to increase lung cancer.

In high-income countries, molecular targeted therapies for lung cancer have achieved substantial survival benefits – but the equipment and trained personnel to do this are lacking in SSA.

Increased affordability and marketing of tobacco products in sub-Saharan Africa is expected to increase lung cancer. The researchers emphasised the need for more advanced pathology capabilities in the region to improve precision diagnostics and therapeutics. 

Improving access is a ‘moral need’

“We recognize that costs and cost-effectiveness concerns are important factors in realistically increasing availability of a broad range of oncology drug therapies in SSA,” the study notes.

“The moral need, however, to advance therapeutics and reduce the significantly high case-fatality rates from cancer in SSA remains an urgent global imperative.”

“High drug costs are a major challenge to bridging the stark inequities in access to cancer treatments,”  said lead author Kirthana Sharma.

“To optimize cancer treatment in this region, diagnostic and laboratory infrastructure also needs to be strengthened, and the oncology workforce needs to be further trained and developed.”

The Botswana-Rutgers Partnership for Health is a collaboration between Botswana’s Ministry of Health, the University of Botswana and Rutgers Global Health Institute. Botswana’s cancer mortality rate exceeds 63%, and the partnership is engaged in efforts to strengthen the country’s health systems and provide comprehensive, patient-centred oncology care.

Image Credits: Roche, Cecille Joan Avila / Partners In Health, Flickr: Marco Verch Professional Photographer and Speaker.

One Life, One Liver campaign launched on World Hepatitis Day

Viral hepatitis could become a more lethal killer than malaria, tuberculosis and HIV combined by 2040, if current trends in undetected infection and treatment continue, warned the World Health Organisation (WHO) on Friday, World Hepatitis Day. 

In observance of the day, WHO launched a call, under the title “One life, one liver”, to scale up testing and treatment for hepatitis, a group of five diseases which infect the liver, causing deadly liver damage and cancer.  Of those diseases, hepatitis B and C are the two viruses in this group which cause the most disease and death.

Over 400,000 people die of hepatitis C annually, while of the two billion people infected with hepatitis B, over 800,000 die every year.

For some time, it has seemed that the world was on track to reduce or even eliminate hepatitis, with increasing numbers of people receiving curative treatment for hepatitis C. A global target for reducing hepatitis B infections was reached by 2020, making it the only health-related Sustainable Development Goals on track, with a real possibility of elimination by 2030.

But testing remains inadequate, with only 21% of people infected with hepatitis C diagnosed – and of those, just 13% have been treated, WHO pointed out. The picture for Hepatitis B is even worse, with only 10% of people living with chronic hepatitis B having a diagnosis, and just 2% getting treatment.

And the increase in the numbers of people receiving treatment to cure hepatitis C is slowing, while many African countries do not have access to the vaccine for hepatitis B that is administered at birth, a key intervention. “SARS-CoV-2 pandemic’s detrimental impact on the health system slowed or even suspended HCV [hepatitis C virus] elimination programs” in many countries, noted a recently published paper, adding that “HCV testing and treatment fell, which increased morbidity and mortality.

“Millions of people are living with undiagnosed and untreated hepatitis worldwide, even though we have better tools than ever to prevent, diagnose and treat it,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “WHO remains committed to supporting countries to expand the use of those tools, including increasingly cost-effective curative medication, to save lives and end hepatitis.”

Vaccination, testing and treatment: the key to saving lives

New WHO guidance for countries to tackle hepatitis effectively, include a core set of recommendations to: 

  • ensure access to treatment for all pregnant women living with hepatitis B;
  • provide hepatitis B vaccines for their babies at birth;
  • diagnose 90% of people living with hepatitis B and/or hepatitis C;
  • provide treatment to 80% of all people diagnosed with hepatitis. 

Optimal blood transfusion, safe injections and harm reduction are additional measures countries can take in the fight against hepatitis.

The time is ripe for a renewed effort to reach the goal of reducing and/or eliminating hepatitis, as treatment prices have dropped significantly, WHO aded.

When the game-changing curative fourse for heptatis C was first introduced in high-income countries, its cost was over $90,000.  Today it is just $60 for the 12-week course in low-income countries. Treatment for those living with hepatitis B costs under $30 a year.

In addition, west and central African countries, where mother-to-child transmission of hepatitis B remains high, will benefit from Gavi’s Vaccine Investment Strategy 2018, which was recently restarted, and includes those interventions.

In a separate statement, the Africa Centre for Disease Control and Prevention said: “The World Hepatitis Day on 28th July gives us an opportunity to join all stakeholders such as the World Health Organization and the World Hepatitis Alliance to raise awareness on the public health importance of this silent killer and to call on member states to invest more in the fight against Hepatitis B and C in Africa to reach viral hepatitis elimination by 2030.”

Temperature around the Mediterranean Sea on 24 July.

July 2023 may have experienced temperatures last seen in prehistoric times, as climate scientists confirm that once rare heatwaves are now routine events. 

Record heatwaves have been seen this year from the US to India, and according to the latest analysis, this July may be the hottest ever recorded.  

Dr Karsten Haustein, a climate scientist at Leipzig University, says that July’s average global temperature is projected to be 1.3-1.7°C above the average July temperature experienced before humans began warming the planet by burning fossil fuels. This is hotter by 0.2°C than the previous record, set in July 2019.

“Not only will it be the warmest July, but the warmest month ever in terms of absolute global mean temperature. We may have to go back thousands, if not tens of thousands of years, to find similarly warm conditions on our planet,” Haustein said. 

European Union’s Earth Observation Programme, Copernicus, and UN’s World Meteorological Organization have also confirmed that the “first three weeks of July have been the warmest three-week period on record and the month is on track to be the hottest July, and the hottest month on record.”

Scientists attribute the record temperatures to the continued burning of coal, oil, gas and other human activities since the beginning of the industrial era. They are also clear that this is not the new norm: temperatures will continue to rise and extreme weather events will worsen until the world drastically cuts fossil fuel use and reaches net-zero emissions. 

Climate change makes heatwaves routine

Earlier this week an international team of scientists with the World Weather Attribution (WWA) released their analysis of the impact of climate change on this year’s multiple heatwaves spanning the Americas, Europe and Asia. 

Heatwaves hit parts of the US and Mexico, southern Europe and China this July. Both Death Valley in the US and northwest China saw temperatures exceed 50°C. In Europe, too, temperature records were broken in Spain. The analysis was clear: climate change is to blame for once rare heatwaves becoming routine occurrences now. And more is to come.  

The heatwave in China would have been about a one in 250-year event before accelerated heating, while maximum heat like that recorded in July 2023 would have been virtually impossible in the US-Mexico region, as well as in southern Europe, before human-made global heating set in, the WWA analysis found. 

“On the one hand, we really need to stop burning fossil fuels to stop these records from continuing to be broken. But we also need to adapt. We need to adapt because even when we stop burning fossil fuels tomorrow, we will not go back, it will not get cooler,” said Dr Friederike Otto, senior lecturer in Climate Science at Imperial College London.

“We have to live with these and make it possible for people to live with these extreme conditions in summer because they are not rare. And the later we stop burning fossil fuels, the more frequent they become.”

Heat impacts on health set to worsen

Heatwaves are known to be silent killers; in Europe alone, an estimated 62,862 heat-related deaths occurred in 2022, according to a study published in Nature this July.

“Since the inception of the Lancet Countdown eight years ago, we have consistently seen an increase in the health impacts of climate change through our heat-related indicators: heat-related deaths among the elderly are rising; productivity is decreasing globally because of the heat, affecting people’s livelihoods and wellbeing,” said Dr Marina Romanello, who is the executive director of the Lancet Countdown on Climate Change and Health.

This year, news reports in central India linked dozens of deaths to the heatwave but the toll is yet to be confirmed by the government. With most countries lacking high-quality death records, it is easy for deaths linked to heatwaves to be underreported or dismissed.

“These heatwaves and wildfires are another reminder of the urgent need to reduce greenhouse gas emissions and protect the planet on which all life depends,” World Health Organisation Director-General Dr Tedros Adhanom Ghebreyesus said of the ongoing extreme weather events in Europe. He called for immediate climate action. 

All eyes on COP28 negotiations

Later this year, world leaders will meet in Dubai at the annual climate conference, or Conference of the Parties (COP), now in its 28th year. This year’s COP has already come under intense criticism, as the negotiations will be chaired by Sultan al-Jaber, CEO of the Abu Dhabi National Oil Company. 

At a time when fossil fuels need to be phased out, and renewables ramped up at a record pace, the selection of an oil baron to head critical climate talks has evoked dismay among advocacy groups and climate activists. 

Stakeholders remain hopeful that the large-scale acceptance of renewable energy will receive financial support from governments and banks.  

“We are already seeing this exponential build-up of renewable energy happen. 2022 was a banner year for renewables and energy efficiency and we need to see that expanding and going even faster,” said Catherine Abreu, Executive Director of the advocacy group, Destination Zero. 

Image Credits: Copernicus, European Union, Karsten Haustein.

Health workers in Cape Town, South Africa, getting vaccinated against COVID-19 in March 2021. Vaccines only became available for health workers at the end of this study.

A single healthcare worker infected with COVID-19 cost the Kenyan economy over $33,000 – around 18 times the country’s per capita GDP.

This is according to a new report on the economic cost of COVID-19 infections among healthcare workers in Eswatini, Colombia, Kenya and South Africa (the provinces of KwaZulu-Natal and Western Cape) during the first year of the pandemic, which has been compiled by the World Bank and Resolve to Save Lives.

The estimated cost per health worker infection ranged from $10,105 in Colombia to $35,659 in Eswatini, with $34,226 in South Africa’s KwaZulu-Natal province and $33,781 in its Western Cape province.

These figures are based on three calculations: the direct cost of healthcare worker’s infection in terms of their healthcare costs and loss of productivity; the costs of infections transmitted by sick healthcare workers; and the disruptions to essential health services.  

The economic burden was highest in areas with the fewest health workers. In South Africa’s Western Cape, the total cost of health worker infections was equivalent to 8.38% of the total health budget. 

In Kenya, where maternal and child death rates were high before the pandemic, health care worker illness disrupted essential services for these vulnerable populations and caused a substantial increase in deaths. This was the biggest “expense” in that country’s calculations.

“Immunisation, chronic disease management, emergency services, and surgery were also severely disrupted, leading to increased non-Covid deaths,” according to the report.

No vaccines for African health workers

At a press conference on Wednesday to launch the report, Dr Keith Cloete, head of health in the Western Cape, South Africa, reminded the audience of the impact of vaccine inequity on health workers.

“Everybody knew that the most important thing was to vaccinate healthcare workers. Our delay in having access to vaccines meant that, in your study period from 1 March 2020 until 28 February 2021, we had vaccines for two weeks,” said Cloete. 

The first South African health worker was vaccinated on 17 February 2021; health workers only got access to vaccines via a clinical trial of Johnson and Johnson vaccines rather than as part of a vaccine rollout for the general population.

In the absence of vaccines, the Western Cape had to try to assuage health workers’ fear by ensuring that they had personal protective equipment (PPE), and by improving its occupational health and safety and employee wellbeing policies, added Cloete.

The province also invested in good data to enable it to predict COVID-19 waves and plan accordingly.

“At the height of the waves is when you have the most healthcare workers in quarantine and in isolation, so you’re going to have the lowest number of available staff. So that’s one of the first predictive models we did, and we then intentionally employed people on contract to cover these waves,” explained Cloete.

The COVID-19 incidence among HCWs was higher than in the general population in all study sites – almost 10 times higher in Kenya and seven to eight times higher in the two provinces of South Africa 

“The economic burden due to SARS-CoV-2 infection among HCWs makes a compelling investment case for pandemic preparedness, particularly the protection of HCWs, and resilient health systems going forward,” argues the report.

Juan Pablo Uribe, the World Bank’s Global Director for Health Nutrition and Population, warned that there was a projected shortage of 10 million health workers by the end of the decade and that health workers from low-income countries were moving to high-income countries, exacerbating shortages in poorer countries.

“Many of our health workers are still very much unsatisfied or frustrated in their workplaces. And more important, they’re facing incredible risks of infection, of disability and injuries and in many places, even of violence,” said Uribe.

Resolve CEO Dr Tom Frieden said that health workers needed to be protected during pandemics by policies, protective equipment, and data systems and information “to hold us all accountable for protecting people who protect and care for us so that they can be safer and healthier, and societies can be safer and healthier”. 

Image Credits: Western Cape government.

As the effects of climate change hit home for people and communities around the world, lawsuits are becoming a central tool in the fight for climate justice.

The number of climate cases taken to court has more than doubled in the last five years, as people and communities turn to the legal system to hold governments and corporations accountable for their inaction on climate change, according to a new Global Climate Litigation Report, published Thursday by the UN Environment Programme (UNEP) and the Sabin Center for Climate Change Law at Columbia University.

The latest data shows that over 2,300 climate-related legal cases have been filed since UNEP began tracking climate litigation in 2017.

“The challenge with climate litigation is that it needs to target each country individually,” said Maria Antonia Tigre, a senior fellow in climate litigation at Columbia’s Sabin Center, at a joint press briefing Tuesday, just ahead of the report’s release. “Lots of cases have to be filed to actually move the needle.”

The new UNEP report collates and analyzes data on some 2180 cases filed to end 2022, with Sabin Center’s online data base recording nearly 200 more cases filed since the start of 2023.

Current trajectory has temperature rising 2.7°C -2.8°C by 2100

That means that lawsuits are now becoming a central tool in the fight for climate justice as the world catapults above the 1.5°C global heating threshold set out by the 2015 Paris Agreement. The current climate emissions trajectory leaves the planet set to exceed pre-industrial temperatures by 2.7°C by 2100, according to a 2021 UN analysis of climate emissions and mitigation commitments.

The weak pledges made ahead of the 2022 COP27 meeting led to even more gloomy projections of a 2.8°C temperature rise by the end of the century.

As governments and corporations fail to adjust course on greenhouse gas emissions that may alter the global climate for generations, people are resorting to litigation to try to claw back control of their future.

“There is a distressingly growing gap between the level of greenhouse gas reductions the world needs to achieve in order to meet its temperature targets, and the actions that governments are actually taking to lower emissions,” said Michael Gerrard, the founder and director of the Sabin Center. “This inevitably will lead more people to resort to the courts.”

The United States continues to dominate global climate change case numbers.

The largest number of climate cases have been filed in the United States, which accounts for around 70% of the global total. Courts in Australia, the United Kingdom, European Union and the United Kingdom round out the top five climate litigators.

Even so, nearly 20% of cases have been filed in developing countries, the report said. For the first time, two developing countries – Mexico and Brazil – are in the top ten countries facing climate litigation.

The report comes a day ahead of the one-year anniversary of the United Nations General Assembly vote to recognize access to a clean, healthy and sustainable environment as a universal human right – a decision viewed as historic for explicitly linking human rights to climate change.

Inger Andersen, Executive Director of UNEP, declared that the resolution sent a message that “nobody can take nature, clean air and water, or a stable climate away from us – at least, not without a fight”.

A year of heatwaves, drought, floods and record temperatures has repeatedly challenged the ambitions set out in the non-binding resolution, pushing people, environments and ecosystems around the world to their limits.

As the current El Niño event develops over the coming months, global-mean air temperature are already expected to rise above pre-industrial levels by more than 1.5°C for extended periods. Average temperatures across the earth’s terrestial areas, which are typically warmer than the seas, have also risen above the threshold already.

“The climate crisis is getting worse, not better,” said Patricia Kameri-Mbote, who leads UNEP’s legal division. “People are increasingly turning to the courts for answers.”

A new field of climate law

The disruptive activities of climate activists around the world are increasingly being met with criminal charges – even as lawsuits over official climate inaction proliferate.

Lawsuits arguing that the right to a healthy and sustainable environment is inherent to existing national constitutional law and international human rights law is the most common category of litigation, the report said.

Plaintiffs also sued governments for not abiding by emissions targets set out in international agreements like the Paris Accords. They have challenged the construction of new fossil fuel extraction facilities in the courts, and attacked greenwashing in corporate marketing.

The growing number of cases and legal strategies for climate litigation is increasingly defining a new field of law, UN experts said.

“These cases are being seen across the world,” said Andy Raine, head of environmental law at UNEP. “[Precedents] have influence and impact that don’t always just stay within national borders.”

Youth climate activists have been a driving force in climate litigation, filing 34 cases on behalf of children, teens, and young adults.

Legal ‘backlash’ cases proliferate

The report also warned, however, of a growing number of legal “backlash” cases against climate activists and affected communities as corporations try to protect their fossil fuel assets. Criminal and civil cases that target the disruptive actions of climate activists are also increasing, Tigre said.

The legal costs associated with major climate litigation, however, also represent a high bar of entry that prevents many of the world’s most vulnerable from using it as an avenue for climate justice, the report said.

“Many cases are still not brought to the forefront as financial challenges, intimidation, lack of know-how and other barriers remain in place,” the report said. “These barriers are especially harmful for vulnerable groups including Indigenous Peoples, women and those from a lower socioeconomic status, the majority of whom are women.”

International courts yet to weigh in

The International Court of Justice’s advisory opinion on the responsibilities of states to respond to climate change to protect present and future generations is pending.

Climate cases are also working their way through international courts – although the process is slow and painstaking. In March, the UN General Assembly requested an advisory opinion from the International Court of Justice on the obligations of states to respond to climate change. The resolution also invited the court to give an opinion on these obligations with respect to future generations.

“The advantage of the ICJ advisory opinion is that we would hopefully have the highest court in the world clarifying what the legal obligations of states are,” said Tigre. “A big challenge often facing individuals in these systemic cases against governments will be surpassed … domestic courts will likely follow that interpretation.”

“Obviously, you won’t solve any problem in and of itself, because it’s an advisory opinion, but it would help for future litigation and hopefully also lead to certain changes from governments without the need for further litigation, as well,” Tigre added.

Criminal charges have also been sought in international courts. In 2021, a communication was filed with the International Criminal Court (ICC) requesting that former Brazilian President Jair Bolsonaro be investigated for crimes against humanity for his role in deforestation activities in the Amazon rainforest.

The communication argued that Bolsonaro actively promoted and facilitated attacks on the Amazon and the people who depend on it, which constitutes “a clear and extant threat to humanity itself”. If the ICC pursues the case, it would be the first time that environmental and climate harm formed the basis for charges of crimes against humanity.

Image Credits: Markus Spiske/ Unsplash, CC.

High cost has prevented some cancer drugs from being included in the World Health Organization’s (WHO) updated Essential Medicines List (EML) and Essential Medicines for List Children (EMLc) released on Wednesday.

These include “patented, highly-priced” treatments for lung and breast cancer.

“With the cancer medicines, we are facing now an issue where we have a very high burden of disease and very expensive, highly-priced medicines,” said Dr Benedikt Huttner, secretary of the expert committee that advises the WHO on the EML.

“For some of the medicines [cost] was one of the factors leading the expert committee not to recommend them currently,” Huttner told a WHO global press conference.

Among the new recommended EML cancer drugs are a treatment for Kaposi sarcoma and a medicine to stimulate the production of white blood cells to reduce the toxic effect of some cancer medicines on bone marrow, as well as the extension of some children’s cancer treatments to cover three additional cancers.  WHO’s essential medicines lists are widely used by countries in medicines procurement choices and decisions about what drugs to include in government subsidized medicines plans. 

Access to medicines a killer for cancer patients

Access to medicines remains a killer for cancer patients, and the 30% survival rate for children with cancer in low-income countries, in comparison to more than 90% for children in high-income countries, reflects this, said WHO Director-General Dr Tedros Adhanom Ghebreyesus.

“Every year, an estimated 350,000 children are diagnosed with cancer in low and middle-income countries (LMICs). Many of them cannot access the treatment they need,” noted Dr Tedros.

“Only 25% of low-income countries covered childhood cancer medicines in their health benefit packages. This subjects children and families to significant suffering and financial hardship or puts them at risk of receiving substandard and falsified medicines.”

James R Downing, CEO of St Jude Children’s Research Hospital

EML Pricing group still not formed

Despite several WHO mentions of the high cost of drugs excluded from the list, an EML sub-group on pricing, which was recommended by experts in 2021, still hasn’t been been launched.

At Wednesday’s press conference, Huttner reaffirmed it was going to be set up soon – even though it hasn’t begun its work yet.

“There is actually going to be also an advisory group advising WHO on how to deal with the issue of highly-priced medicines,” he stated.  The new working group is supposed to develop more systematic strategies for monitoring medicines prices and for assessing and making high-priced, but essential drugs more affordable, as part of WHO and EML processes.   

‘Where you live in the world’ is a major determinant for children’s cancer survival

A major determinant of survival for children with cancer is “where you live in the world”, James R Downing, CEO of New York City’s St Jude Children’s Research Hospital, told the press conference.

“In developed countries, we have made incredible progress against paediatric cancer with cure rates approaching 90% for many of the more common paediatric cancers. Yet the rest of the world has been left behind,” he added.

In 2021, St Jude Hospital announced that it would contribute $200 million over six years to improve access to cancer drugs for kids via the Global Platform for Access to Childhood Cancer Medicines, an initiative that it is running with the WHO.

The initiative aims to provide an uninterrupted supply of free, quality-assured cancer medicines to low- and middle-income countries – focusing first on six of the most common cancers that cause over half of childhood cancers. The aim is to raise survival rates to at least 60% in these countries by 2030.

Interruptions in medicines access a key factor undermining children’s survival

This followed earlier work between St Jude and the WHO via the Global Initiative for Childhood Cancer, which identified lack of access to medicine and interruptions in supply as key factors undermining the survival of children with cancer.

“Some 40-60% of children being treated for cancer will have disruptions in their access to chemotherapy, and that decreases their chance of cure,” said Downing. 

“In other countries, the quality of the drugs is not up to standards, and so they’re getting inferior drugs that are leading to inferior treatment.”

The platform is being piloted in six countries initially, with UNICEF as a collaborating partner.

“The idea is that we will set up a secretariat at the WHO that will manage this, and that we will have a procurement agency that will produce those drugs with generic drug producers,” Downing explained.

“We will know the market size because of the analytics that we have developed and then we will be able to ship those drugs into those countries. And we know their capacity to use those drugs effectively to treat children with cancer because they’re part of the St Jude Global Alliance and we have spent energy and time training them and putting forward to them the exact protocols they should be using to treat those children.”

Another challenge is the lack of diagnostic tools to diagnose cancer in LMICs, and St Jude is also working on a platform to develop and distribute cheaper diagnostics.

Children undergoing chemotherapy

Multiple sclerosis drugs included on EML for first time

In other new EML additions, medicines for the treatment of multiple sclerosis (MS) have been included on the essential medicines list for the first time ever, along with new treatments for cardiovascular conditions and infectious diseases.

Three medicines that can slow MS – cladribine, glatiramer acetate and rituximab – have been added. Multiple sclerosis is a chronic, debilitating disease of the nervous system affecting approximately 2.8 million people worldwide. 

Fixed-dose combinations of multiple medicines (commonly called ‘polypills’) for the prevention of diseases of the heart and blood vessels, have also been added to the EML for the first time.

“The list is an important tool for achieving universal health coverage, providing guidance to governments, health facilities and procurers on which medicines are the best value in terms of benefits for individuals and communities. The EML includes medicines only on the basis of solid evidence for safety and efficacy. Approved indications within national jurisdictions or the availability of on-label alternatives is not a decision criterion,” said Huttner. 

Other medicines for infectious diseases that have been listed in the new EML include:

  • ceftolozane + tazobactam, effective against multi-drug resistant bacteria, including difficult-to-treat infections caused by carbapenem-resistant Pseudomonas aeruginosa; the drug is a ‘reserve’ group antibiotic, under WHO’s three-tiered  “AWaRe” system for judicious antibiotic use, meaning it should only be used when other treatments have failed.
  • pretomanid to treat multidrug-resistant or rifampicin-resistant tuberculosis;
  • ravidasvir (to be used in combination with sofosbuvir) for the treatment of chronic hepatitis C virus infection in adults;
  • monoclonal antibodies for Ebola.

Altogether, the recommended changes bring the number of medicines on the WHO essential medicines list, which is updated every two years, to 502 drugs for adults and to 361 for the essential medicines list for children. 

But the WHO warned that “rising prices and supply chain disruptions mean that all countries now face increasing problems in ensuring consistent and equitable access to many quality-assured essential medicines”.

Image Credits: National Cancer Institute, National Cancer Institute, USA.

WHO's New Leadership TeamThe cases of drug-resistant gonorrhoea, a sexually transmitted disease, are on the rise in many parts of the world, the World Health Organization (WHO) has warned. 

The agency added that it considers Neisseria gonorrhoea a “priority microorganism” to be monitored for antimicrobial resistance. 

The new WHO guidance on sexually transmitted infections (STIs) requires countries to work towards improving access to better testing and diagnostic services. 

“Early testing and diagnosis are key in stopping the spread of STIs,” Dr Teodora Wi, the lead for sexually transmitted infections of the WHO’s Global HIV, Hepatitis and STIs programmes, said. “When left untreated, certain STIs can lead to long-term irreversible outcomes and some can be potentially fatal.”

Countries like Australia, Austria, Canada, Denmark, France, Ireland, the United Kingdom, and several countries in Asia including China, Japan, Singapore and Vietnam, have reported cases of Neisseria gonorrhoea, a pathogen that is highly resistant to the antibiotic medication ceftriaxone.

“The enhanced gonorrhoea AMR surveillance (EGASP) suggests high rates of resistance in gonorrhoea to current treatment options such as ceftriaxone, cefixime and azithromycin in Cambodia, for instance,” the WHO said in a press release. 

Eighty two million new cases of N.gonorrhoea are being reported around the world every year in people between the ages of 15 and 49. 

“In addition, antimicrobial resistance (AMR) in N. gonorrhoea is particularly problematic. With resistance to both cephalosporins, including third-generation extended-spectrum cephalosporins, and fluoroquinolones, N. gonorrhoea is a multidrug-resistant pathogen,” the WHO indicated, adding that the resistance observed in the pathogen outpaces the new antibiotics being developed for it. 

“WHO considers N. gonorrhoea to be a priority microorganism for AMR monitoring in the Global Antimicrobial Surveillance System and for drug development in the context of AMR.” 

The new guidance is also expected to help make STI testing more accessible and affordable to the masses, which will lead to better data collection, the WHO added. 

Image Credits: Flickr – Guilhem Vellut, Guilhem Vellut.

pandemic
Investment in strong health systems is key to pandemic-proofing the world.

Thirty-seven countries have received grants worth $338 million from the Pandemic Fund to boost their resilience to pandemics in the first round of the fund’s disbursements.

Three disbursements involve multi-country grants: to 12 Caribbean countries to strengthen their early warning surveillance, build laboratory systems and workforce development; to seven Latin American countries to engage communities and territories​ in pandemic response, and to five Central Asian countries to bolster their One Health response.

Single-country recipients include Burkino Faso, Ethiopia, Kazakhstan​, West Bank and Gaza, Yemen and Zambia.

The fund, which was launched at the G20 meeting in November 2022 to help low- and middle-income countries prepare for future pandemics, received 179 applications from 133 countries. 

“We are very pleased that the Pandemic Fund has been able to move forward so quickly to allocate funding to projects that represent a good balance across geographical regions, country income groups, and participating Implementing Entities,” said Pandemic Fund Board co-Chairs, Dr Chatib Basri, former Indonesian finance minister, and Dr Sabin Nsanzimana, Rwanda’s health minister.

Independent evaluation

“All proposals were independently reviewed and evaluated by the Technical Advisory Panel (TAP)and we are confident that the portfolio of projects selected by the board for funding will increase pandemic prevention, preparedness, and response (PPR) capacity and respond to the inequalities that COVID-19 further revealed to the world.”

The WHO’s head of health emergencies, Dr Mike Ryan, currently chairs the TAP, while the fund is hosted by the World Bank.

“In keeping with the Pandemic Fund’s mission to catalyse funding and promote coordination, the $338 million of grants awarded will mobilize over $2 billion in additional resources, adding $6 for each $1 coming from the Fund,” according to a media release from the Fund.

 Priya Basu, executive head of fund’s secretariat, said that the response to the first call was “eight times oversubscribed”. 

“This first round of funding was a learning exercise and we are committed to drawing lessons that will be reflected in how we do business in the future. We are excited to see the results and impact of our funding,” added Basu.

The fund’s second call for proposals is expected towards the end of 2023.

It has raised $2 billion in seed capital from 25 sovereign and philanthropic contributors but needs an estimated $10-billion a year for the next five years to pandemic-proof the world.

Image Credits: Tehran Heart Centre .