Save Hands for Girls campaigns against female genital mutilation in The Gambia by working with schools, parents and organisations.

Global health and parliamentary leaders have offered to support The Gambia to maintain its  ban on female genital mutilation (FGM), expressing “profound concern” over a recent attempt to reverse the ban. 

The business committee of Gambia’s parliament is currently contemplating whether to allow the passage of a Private Members Bill which aims to reverse the landmark Women’s (Amendment) Act of 2015, which outlawed FGM.

The Bill was introduced by Almameh Gibba, an MP from the Alliance for the Patriotic Reorientation and Construction (APRC), with the support of Imam Abdoulie Fatty, a notorious proponent of FGM. The process involves the partial of total removal of external female genitalia – supposedly to “control” women’s sexuality – and is usually performed on girls under the age of 15.

But this attempt to reintroduce FGM has been condemned by the leadership of both the Partnership for Maternal, Newborn & Child Health (PMNCH), the world’s largest alliance for women’s, children’s, and adolescent’s health and well-being, which is hosted by World Health Organization (WHO), and the Inter-Parliamentary Union (IPU), the global organisation of national parliaments.

They urge the Members of the National Assembly to continue to protect the “hard-won” ban on FGM, warning in a statement issued over the weekend that repealing the ban “would not only undermine this progress but also perpetuate a cycle of discrimination and violence against women and girls”.

Despite the banning of FGM nine years ago, almost three-quarters of Gambian women are estimated to have been subjected to the practice, and almost half were cut before their 15th birthday.

There has only been one FGM-related conviction in the past nine years involving three women for cutting babies aged four to 12 months old, according to women’s rights activist Jama Jack. They received fines which were paid by Fatty via a public fundraising campaign, added Jack.

‘All possible support’

“We pledge all possible support to The Gambia in strengthening its efforts to prevent and address this harmful practice through multi-sectoral actions. This includes ensuring robust enforcement mechanisms, increasing access to quality healthcare services, and promoting gender equality and women’s empowerment initiatives,” according to the statement, which is signed by PMNCH leaders Helen Clark, Joy Phumaphi, Githinji Gitahi and Flavia Bustreo, and IPU Secretary General Martin Chungong.

“FGM is a grave violation of human rights and a harmful practice with severe health consequences, including physical, psychological, and reproductive and sexual health complications,” they add.

“FGM is associated with increased risks of postpartum hemorrhage, perinatal death, as well as urinary tract infections, menstrual difficulties and mental health conditions over the life course of women and girls.”

The PMNCH and the IPU emphasise the importance of upholding international human rights standards and commitments to protect women and girls from all forms of violence and discrimination.

“As a signatory to various international instruments, including the Convention on the Rights of the Child (CRC), Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), the African Charter on the Rights and Welfare of the Child (ACRWC) and the Protocol to the African Charter on Human and People’s Rights on the Rights of Women in Africa (Maputo Protocol), The Gambia has a duty to uphold its obligations to its people and prioritize the health and rights of its population,” they remind the country.

Domino effect?

“Combatting FGM requires partnership at all levels. Parliamentarians can develop and uphold comprehensive legal frameworks; opinion leaders, including faith leaders, are needed to speak out firmly against the practice; community members, including health workers, can carry out powerful awareness campaigns based on lived experience, ensuring that care and support for survivors are integrated into sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH) services.”

Meanwhile, Bustreo, who chairs PMNCH’s governance and ethics committee, said that her organisation was concerned about potential copycat moves.

“The concern lies in the potential for a domino effect if an anti-FGM law is repealed, signaling to others that similar regressive steps are acceptable,” Bustreo told Health Policy Watch.

“This isn’t merely about changing legislation; it’s about preserving the progress made in safeguarding the rights and well-being of women and girls. Repealing such laws threatens to erase years of dedicated advocacy and community engagement.” 

Around 90% of women in Somalia, Guinea and Djibouti are subjected to FGM, and a range of organisations fear that The Gambia’s reversal will encourage other countries in West Africa to follow suit.

Over 230 million girls and women alive today have undergone female genital mutilation (FGM), according to a report from the UN children’s agency, UNICEF, released earlier this month. This is a 15% increase since eight years ago.

Image Credits: Safe Hands for Girls.

CoViNet – The new network includes nearly 3 dozen research laboratories across the world with an expanded mandate.

The World Health Organization (WHO) has launched a new network, CoViNet, aimed at identifying, monitoring, and evaluating SARS-CoV-2, MERS-CoV, and emerging coronaviruses that pose significant public health risks.

The program expands on the WHO COVID-19 reference laboratory network, established in January 2020, in the early days of the pandemic.

Originally, the network’s primary goal was to offer confirmatory testing to countries lacking the capacity for testing SARS-CoV-2, including new variants. Over time, the requirements related to SARS-CoV-2 have changed. As such, CoViNet, with its “enhanced epidemiological and laboratory capacities,” according to WHO, will focus on tracking the virus’s evolution and the spread of variants and evaluating how these variants affect public health. The network brings together experts in animal health and environmental surveillance, other existing coronaviruses, and the identification of novel coronaviruses that could negatively affect human health. 

One Health focus 

The network will emphasize the significance of adopting a “OneHealth” strategy, the agency also added in a press release. The COVID-19 pandemic underscored the need for a comprehensive health approach that considers interactions among various species. The virus likely originated from a bat and was transmitted to humans through infected mammals kept and processed under unhygienic conditions at a market in Wuhan, China.

Finally, CoViNet will contribute to shaping WHO policies regarding public health and medical interventions. The data collected by CoViNet will inform the decisions of WHO’s Technical Advisory Groups on Viral Evolution and Vaccine Composition, among others. This will help ensure global health strategies and tools are grounded in the most up-to-date scientific insights.

“Coronaviruses have time and again demonstrated their epidemic and pandemic risk. We thank our partners from around the world who are working to better understand high-threat coronaviruses like SARS, MERS, and COVID-19 and to detect novel coronaviruses,” said Dr Maria Van Kerkhove, acting Director of WHO’s Department of Epidemic and Pandemic Preparedness and Prevention. “This new global network for coronaviruses will ensure timely detection, monitoring, and assessment of coronaviruses of public health importance.”

So far, 36 laboratories from 21 countries are involved in the network – from FIOCRUZ in Brazil to Geneva University Hospitals, Institut Pasteur in Dakar, Senegal, and Pakistan’s National Institute of Health.  Representatives from the labs met last week in Geneva to finalize an action plan for the next 12 months.

WHO has reported 6,932,591 coronavirus deaths and 766,440,796 cases since the pandemic began – although the real number of deaths worldwide is presumed to have been far higher. The pandemic was declared over last year, while the number of people dying from the disease has declined since the Omicron variant first detected in the fall of 2021 in southern Africa became dominant.  But WHO has continued to encourage countries to report weekly aggregate indicators of COVID-19 morbidity and mortality and variant surveillance data, warning that new variants of the virus, or other related emerging viruses could still pose a global health risk. 

Image Credits: WHO .

INB co-chairs Roland Driece and Precious Matsoso.

The fractious pandemic agreement talks – supposed to end with an agreement on Thursday (28 March) – have limped into extra time, with World Health Organization (WHO) member states resolving to hold an additional intergovernmental negotiating body (INB) meeting from 29 April to 10 May.

The World Health Assembly (WHA), which begins on 27 May, is supposed to adopt the agreement, intended to be a global guide on how to prevent, prepare for, and respond to, pandemics.

But the best case scenario is for the WHA to adopt an “instrument of essentials”, a bare-bones text that will be fleshed out over the next 12 to 24 months in advance of the proposed Conference of Parties, according to people close to the talks.

At the briefing at the end of Thursday’s talks, which started almost four hours later than scheduled, INB co-chair Roland Driece said that “there is no champagne”.

“We had long intensive discussions, but we have not succeeded in concluding this meeting,” added Driece. 

Consensus text

Instead, the INB Bureau would get a revised text to member states by no later than 18 April.

However, this text would be different from the previous one as it would aim to draw out consensus points rather than provide a shopping list of issues.

“That text will be building on the current one but also be different in focus and in level of detail, like we discussed before, but still trying to operationalise equity as much as we can,” said Driece. “We will build on the consensus already identified. Consensus is an important word.”

Extract from the INB 9 reportback

The INB drafting group will focus on “agreeing text”, and member states were also urged to “provide the Bureau with any convergence text resulting from informal consultations, as soon as possible”.

Meanwhile, when the INB resumes, there will be space for “structured informal meetings or working groups, as needed, to progress the work”.

At the start of the two-week negotiations, a number of member states had complained that their proposals and agreements reached in sub-groups had not been reflected in the Bureau’s draft text.

The focus on consensus appeared to cheer delegates, including Switzerland which said there was “a clear way forward”. Switzerland had refused to accept the draft text at the start of the talks.

Meanwhile, WHO Director General Dr Tedros Adhanom Ghebreyesus implored delegates to draw on the “spirit of Geneva” to conclude the talks.

“Let the spirit of Geneva – the spirit of cooperation, mutual respect, and shared responsibility – guide your deliberations as you work towards finalising the agreement by the set deadline in May this year,” said a visibly tired Tedros.

“Together let us reaffirm our commitment to global health security, to solidarity in times of crisis and to a future where no one is left behind by operationalising equity with international law,” added Tedros.

WHO Director General Dr Tedros, flanked by WHO head of health emergencies, Dr Mike Ryan, at INB 9.

Putting on a brave face?

Finding consensus points may be hard in the coming days as many countries appear to have lost patience with one another, and with the INB Bureau and WHO Secretariat members who have been steering the process.

Countries across the political spectrum accused one another of refusing to make compromises, and criticised the Bureau for failing to provide direction.

However, the geopolitical reality is that some of the 194 member states are at war, while others are long-term trade enemies. This was never going to be easy, despite the recent trauma of COVID-19.

In the past two weeks, so much text has been added to the 31-page draft that the meeting started with that it had swollen to a completely unwieldy 100-page draft by Tuesday 26 March with multiple opposing clauses contained in brackets.

For example, by last Saturday (23 March), 50 countries had submitted at least one bracketed suggestion for Article 11, which deals with technology transfer, according to Knowledge Ecology International (KEI), which had two observers at the meeting.

However, the now notorious Article 12, which deals with pathogen access and benefit-sharing (PABS), remains the biggest obstacle.

The European Union believes that there is a place for intellectual property rights in PABS. However, this has been rejected by the Group on Equity – an alliance of 34 countries  – and the Africa region.

But the Group on Equity, which includes countries with large generic medicine producers such as India, Brazil and Indonesia, has also been accused of trying to secure advantages for these companies but taking a hard line on technology transfer.

Meanwhile, Colombia blamed the lack of progress in the past two weeks on “changing modalities, which were sometimes unclear, but also because we’re facing a highly complex document”.

“We support the Bureau in producing a streamline text and one which can achieve consensus but it will have to have substantive provisions which will take us beyond the status quo. The agreement that we will reach must be clearly based on the principles of equity and solidarity that tragic experiences that we live through during the COVID 19 pandemic.

Additional reporting by Elaine Ruth Fletcher

Women over the age of 60 and women with disabilities, face a higher risk of abuse yet their experiences are largely hidden in most data, according to two new publications released today by the World Health Organization (WHO).

Where there is data, these groups face high prevalence, with one systematic review finding greater risks of intimate partner violence for women with disabilities and another finding higher rates of sexual violence. 

“Older women and women with disabilities are under-represented in much of the available research on violence against women, which undermines the ability of programmes to meet their particular needs,” said Dr Lynnmarie Sardinha, Technical Officer at WHO and the UN Special Programme on Human Reproduction (HRP) for Violence against Women Data and Measurement.

Sardinha is one of the authors of two new WHO briefs on measuring violence against older women and against women with disabilities. These briefs are the first in a series on neglected forms of violence by the UN Women-WHO Joint Programme on Violence against Women Data. 

“Understanding how diverse women and girls are differently affected, and if and how they are accessing services, is critical to ending violence in all its forms,” said Sardinha.

According to the WHO, one in three women worldwide experience physical and/or sexual violence in their lifetime, whether from their intimate partners or from others. The prevalence of violence ranges from 20% in the WHO’s Western Pacific region, to 22% in Europe, and as high as 31- 33% in the Africa, Eastern Mediterranean and South-East Asia regions.

Additional risks

But older women and women with disabilities also face specific risks and additional forms of abuse, sometimes at the hands of caregivers or health care professionals. These include coercive and controlling behaviours such as withholding of medicines, assistive devices or other aspects of care, and financial abuse.

In older age, intimate partner violence tends to change from physical to psychological abuse, including threats of abandonment, although more research is needed to understand how power dynamics shift in older age.

Older women and women with disabilities can be extremely isolated when violence occurs, making it more difficult for them to escape and report the abuse. Stigma and discrimination can further reduce access to services or information, or result in their accounts of violence being dismissed by responders.

“Gender-based violence is rooted in unequal power and control over women,” said Dr Avni Amin, Head of the Rights and Equality across the Life Course Unit at WHO and HRP. 

“For older women and women with disabilities, their dependency and isolation are further exploited by perpetrators, increasing their risk of abuse. Services must be responsive to their needs and identify appropriate contacts through the health and care systems, so that all women experiencing violence can access empathetic, survivor-centered care.”

Noting that older women are currently represented in only about 10% of data on violence against women, the WHO recommends extending the age limit for survey participation and incorporating questions relating to different types of violence, encompassing a broad spectrum of disabilities.

They also advocate for user-friendly formats such as Braille or EasyRead to enhance the accessibility and participation of some disabled women.

Image Credits: UN Women.

Bats captured from the Kitaka mine in Uganda were discovered to be the source of a Marburg virus outbreak in July 2007.

As World Health Organization (WHO) member states bang heads in Geneva over a pandemic agreement to keep the world safe, a group of scientists has challenged global decision-makers to pay far more attention to humans’ relationship with animals.

“Although preparedness and response have received significant focus, prevention, especially the prevention of zoonotic spillover, remains largely absent from global conversations,” write the 24 scientists from a range of different global institutions in an article in Nature Communications published on Tuesday (26 March).

Using bats as their case study, they show how environmental changes exacerbate zoonotic spillover – and identify the “ecological interventions that can disrupt these spillover mechanisms”.

Primary prevention of zoonotic spillover

Their ecological countermeasures focus on bats because a number of major epidemics and pandemics” – SARS-CoV-2, Ebola, SARS-CoV-1, MERS-CoV, and Nipah virus –  have an evolutionary origin in bats.

Certain bat species also host four of the nine diseases identified by the WHO as having the potential to generate epidemics that pose a great risk to public health.

So what does an ecological approach look like when applied to bats? The authors propose three measures to prevent zoonotic spillover from bats to humans.

The first involves protecting where bats eat, which involves numerous interventions including preserving and restoring vegetation diversity and structural complexity in bat foraging habitats.

In subtropical Australia, for example, Pteropus species bats (which carry the deadly Hendra virus) feed on nectar in winter-flowering forests. But in some areas, over 90% of these forests have been destroyed.

“Replanting winter habitats would be a sustainable, scalable, and effective strategy to reduce the risk of spillover of not just Hendra virus, but other viruses carried by Pteropus species bats,” they argue.

Preventing zoonotic spillover involves protecting bats where they eat and roost and protecting people wo interact with them.

The second measure involves protecting where bats roost.

“Roosts are locations where bats sleep, shelter, mate, socialise, and raise their young. With few exceptions, bats cannot construct shelters and must roost in pre-existing natural (eg, caves, rock crevices, tree cavities, and tree foliage) or human-made (eg, buildings, bridges, mines) structures,” the authors state.

The third measure involves protecting people and their livestock who come into contact with bats. This can be done by reducing livestock’s interactions with bats and bat excreta and providing personal protective equipment for peoplein contact with bats or their excreta.

In Malaysia, for example, “a regulation requiring fruit trees to be planted at a distance from pig sties may explain the lack of subsequent Nipah virus spillovers”, the authors note.

Integrating ecological and biomedical approaches

“Recognising that pandemics originate in ecological systems, we advocate for integrating ecological approaches alongside biomedical approaches in a comprehensive and balanced pandemic prevention strategy,” they argue.

Pandemics almost always start with a microbe infecting a wild animal in a natural environment, but when a wild animal then infects a human, this is often triggered by “human-caused land-use change”. The more land use changes, the greater the risk of zoonotic spillover.

“Designing land management and conservation strategies to explicitly limit spillover is central to meeting the challenge of pandemic prevention at a global scale,” they argue.

“In our view, the most effective strategy to reduce the probability of another pandemic is to preserve intact ecosystems and bolster their resilience through restoration and the creation of buffer zones.

“Our primary emphasis should be on maintaining and enhancing the integrity and resilience of still-intact landscapes to prevent new interfaces that could enable the emergence of Disease X.”

Pandemic agreement and One Health

Article 5 of the draft pandemic agreement is devoted to One Health, which it defines as “an integrated, unifying approach that aims to sustainably balance and optimise the health of people, animals and ecosystems. It recognizes that the health of humans, domestic and wild animals, plants and the wider environment (including ecosystems) is closely linked and interdependent”.

According to the draft agreement, parties will commit to a One Health approach for pandemic prevention, preparedness and response that is “coherent, comprehensive, integrated, coordinated and collaborative among relevant actors and sectors”.

Proposed measures include engaging communities to prevent, detect and respond to zoonotic outbreaks; workforce training; updating international standards and guidelines, and developing multilateral mechanisms to help developing countries to adopt a One Health approach.

Image Credits: Chris Black/WHO.

A convention of the Polish Left party, one of leading advocates for legalizing abortion.

Poland’s right-wing Law and Justice (PiS) party, which championed the country’s restrictive abortion laws, was voted out of power last October, but the path to improving access to abortion is not fast or straight forward.

“First of all, we need accessible abortions and we need, which is extremely important, the decriminalisation of abortion support,” activist Agata Adamczuk told Health Policy Watch. She is from Dziewuchy Dziewuchom (Gals Help Gals) Foundation, a Polish feminist NGO providing information on safe abortions. 

Yet, Parliamentary Speaker Szymon Hołownia says it’s not a good time to introduce abortion reform, the Polish Press Agency reports. According to Hołownia, parliamentarians may vote against any abortion reforms if they are placed on the agenda before the local government elections on 7 April, fearing reactions of more conservative voters.

“If we proceed after the [local] elections, the chances will be much greater. Talks and declarations about supporting the draft bills in the first reading will start,” said Hołownia, adding that discussion on a draft abortion reform Bill was set down for 11 April.

Coalition politics

Hołownia is leader of Polska 2050, a new Christian Democrat party,  and one of the three parties that make up the ruling coalition. The group is ambiguous in their stance towards reproductive rights, whereas the other two parties in ruling coalition, the New Left and Prime Minister Donald Tusk’s Civic Platform, have made abortion on demand up to the 12th week of pregnancy one of their priorities.

“It’s a good first step, in the right direction, but it’s not enough,” Adamczuk highlighted.

Even if there is a law granting abortion on demand until the 12th week of pregnancy, in practice it likely won’t be respected “because we’ve already faced such situations”, she adds.

Last year, demonstrations were held in 60 cities in protest against the unnecessary deaths of women because hospitals were reluctant to abort pregnancies that endangered their lives, even though performing them would have been legal, Newsweek Poland reported.

However, the Civic Platform and the New Left remain optimistic that abortion rights are a necessary and realistic goal for the current term of the parliament.

“We have the right to and we want the draft bill on abortion to be finally proceeded in the Sejm,” said Anna Maria Żukowska, a leader of the New Left, during the party’s summit.

Yet a new Bill to make abortion access less restrictive is likely to face opposition of some parties in the Catholic country, including the possibility that President Andrzej Duda, who is aligned to PiS, may veto it. He has been quoted as saying that advocating abortion access is “demanding the right to kill”.

Abortion mostly forbidden – but still happening

Poland’s abortion laws are the second most restrictive in Europe, with only Malta reaching a lower score on legality and accessibility, according to the Abortion Policies Atlas.

A comparison of abortion-related policies in Europe. Poland with considerably more restrictive laws than most countries.

Performing the procedure is now legal only in cases of rape and where there is serious risk to the mother’s health. Even then, doctors are permitted conscientious objection to performing abortions, which further limits access to abortion.

In 2020, the politicised Constitutional Tribunal ruled that it was against the Polish Constitution to allow abortion if there was a serious deformation of the foetus.

As a result of this ruling, the number of legal abortions decreased tenfold, amounting to only about a hundred cases per year since 2020, according to Statista.

Yet the total annual number of abortions is estimated to be between 80,000 and 93,000. Numerous NGOs help provide information and organisational support for ordering abortion pills online or assisting women to schedule a surgical abortion abroad.

Lack of education 

Women’s protests following the Constitutional Tribunal’s ruling are credited with helping to unseat the PiS party in the last parliamentary elections. The ruling coalition has made abortion on demand until the 12th week of pregnancy one of their top priorities.

Women’s Strike protests in Warsaw, 2020, against the constitutional tribunal sentence dramatically limiting access to abortions.

Even if the relaxation of abortion laws happens, it will do little to improve reproductive rights in Poland, according to Adamczuk. 

“Politicians should acknowledge the fact that simply changing the law will not automatically mean changing the situation for abortion accessibility. We need a more holistic revolution there,” she said.

“What we need is to do work at the ground level, to fight abortion stigma,” she stresses, pointing out that Polish medical circles are reluctant to provide abortion. 

The recent Polish Gynaecologists Association guidelines, for instance, say all other options should be tried before performing the procedure on a patient whose mental health is likely to suffer if they give birth.

Another crucial element is medical education: right now, no classes on abortion care are included in the gynaecologists’ curricula, Adamczuk says. 

Some sources highlight the causal link between the lack of education and the lack of accessibility. 

“If doctors receive the message that abortion is not a normal medical procedure during their studies, they will be more likely to carry on that opinion,” the activist added. “Performing abortions is almost exclusively our burden, of us activists, and most probably that won’t change in the nearest future.”

Decriminalising help

“We simply cannot be penalised for doing the job of the state,” Adamczuk highlighted, pointing out that decriminalising abortion help is one of the most urgent changes that need to happen. 

Last year, Polish abortion activist Justyna Wydrzyńska was found guilty of facilitating abortion and sentenced to eight months of community service. 

Although she declared that the court’s decision won’t stop her from continuing her work, such cases may have had a chilling effect on abortion access.

However, Wydrzyńska’s trial might have inspired another draft Bill currently waiting to be proceeded on decriminalising abortion support. 

The New Left has also proposed other Bills to advance women’s rights, including a change to the definition of rape and more favourable rules for maternity leave.

“We’re glad that abortion is the talk of the town right now, that there’s discussion about it,” says Adamczuk. “But just discussing is far too little.”

Image Credits: Lewica, Abortion Policies Atlas, Greenpeace Polska.

UN Security Council approves a first-ever resolution calling for a cease-fire in Gaza

WHO Director General Dr Tedros Adhanom Ghebreyesus on Monday welcomed a UN Security Council resolution calling for a ceasefire and the assurance of humanitarian aid in Gaza, and the immediate release of all hostages. 

The resolution, which passed with a vote of 14 in favor and the United States abstaining, was the first resolution to pass the body since the 7 October attack by Hamas-led gunmen on Israeli communities that left 1,200 Israelis dead, and triggered Israel’s massive invasion of Gaza in a war that so far has resulted in the deaths of over 32,000 Palestinians, according to Gaza’s Hamas-run health ministry.  

Fighting continues in Shifa and raging around two more Gaza hospitals

Gaza’s Al Shifa hospital during a WHO visit on Friday 1 March – was only just getting back into service after months of siege, officials say.

The director-general’s comments came as fierce fighting continued to rage in and around three strategically placed Gazan hospitals – Al Shifa in the north, and Nasser and Al Amal Hospitals in Khan Younis. 

Israel claims to have killed over 170 Hamas militants in battles at Shifa over the past week, including Hamas chief of internal security, Faiq Mabhouh, along with detaining around 800 people on the hospital grounds. 

Hamas and Islamic Jihad gunmen continued to barricade themselves inside parts of the facility Monday night, Israel said.  The claims were denied by Hamas, which said that over a dozen patients had died during the operation, the most prolonged in a health facility since the war began.   

Patients and health workers who managed to leave the compound described harrowing scenes, with a shortage of food and water, and bodies piling up on the hospital grounds. 

Dr. Tayseer al-Tanna, 54, a vascular surgeon, told the New York Times that Israeli forces had gathered doctors and patients together in parts of the hospital, while they swept the grounds outside.

“The Israeli military didn’t treat us violently,” Dr. Al-Tanna was quoted as saying. “But we had almost no food and water.”   

He declined to comment on whether Palestinian fighters had fortified themselves in parts of the medical complex.

On Monday evening, Israel’s military spokesman claimed that Hamas and Islamic Jihad forces were still positioned inside the hospital’s emergency room, the maternity ward and a burn ward, were firing at Israeli forces, and throwing mortar shells from their positions.  

Following its first incursion into the hospital in November, Israel exposed video footage of Israeli hostages being brought into Shifa on 7 October. It also displayed caches of arms, ammunition and a tunnel dug underneath the compound. But experts later disputed the army’s claims that the hospital had been a major Hamas command and control centre.  On Monday, 17 March, Israel said that it had moved back into the hospital during an overnight operation, after it discovered leading Hamas military operatives regrouping there.

The hospital was only just getting back into service after weeks of siege in northern Gaza, in which medical supply deliveries were largely blocked, said Rick Peeperkorn speaking at a WHO press conference last Thursday.

“Shifa hospital was bouncing back and providing minimal services,” he said. But then a planned WHO mission to the hospital last week was cancelled by Israel. 

“It was cancelled due to the ongoing insecurity in the region. And this is, again, I think we’ve raised so often, what is needed is an effective and a transparent, workable deconfliction mechanism,” Peeperkorn said. 

The northern Gaza area is desperately in need of emergency malnutrition measures to stave off looming famine, he assserted. Hospitals also need to play a key role in this, he said, acting as “nutrition stabilisation centres” while northern Gaza, the area most at risk, is flooded “with ready-to-use therapeutic foods,” followed by a return to local food production as soon as possible.

Al Amal and Nasser Hospitals also now under siege 

Meanwhile, two other hospitals in the southern Gaza city of Khan Younis, Al Amal and Al Nasser, also came under siege by Israeli troops over the weekend, as fierce fighting raged in surrounding neighbourhoods.   

In separate statements, both Hamas officials in Gaza and the Palestinian Authority in the West Bank claimed that Israel had launched assaults on the hospitals, resulting in a number of casualties. Israel denied its forces had entered the hospitals, but said they had been cordoned off during fighting in the area.  

“@WHO and @ochaopt are extremely worried about the safety of the patients, companions, and the few health workers remaining at the hospital. We urgently need safe access to ensure patients can be provided with life-saving care,” stated an X post by WHO’s Office for the Occupied Palestinian Territories. 

“Our team was not given clearance to proceed to the hospital for assessment and facilitating patient transfer this evening but was able to assist nine health workers who walked from Al-Amal to south #Gaza with water and first aid.

“International law is clear: patients, health workers, and civilians must be protected. We urge parties to the conflict to respect their obligations.”

Image Credits: UN News , WHO.

mpox virus
Both Clade I and II strains of mpox are circulating in outbreak stricken DRC

WHO officials said that they are trying to expedite delivery of mpox vaccines to outbreak-stricken DR Congo through talks with the world’s only two mpox vaccine manufacturers, as well as appeals for vaccine donations and negotiations with DRC officials.

But speaking at a press briefing on Thursday, WHO’s Dr Mike Ryan, Executive Director of Health Emergencies, and technical lead Maria Van Kerkhove were unable to provide concrete details as to when significant quantities of vaccines could be rolled out – and how many, in light of the global shortage of supplies.  

Despite two years of millions of doses of global mpox vaccine rollout, there has been no mass administration of the vaccines so far in DRC or other west African countries. This is despite the fact that the region, and DRC in particular, is now the epicenter of the largest and deadliest mpox outbreak to date. 

The problems are multiple – ranging from global supply lines to local regulatory hurdles, stigma around mpox and vaccine hesitancy. 

Mpox lesions

At the global level, the production line of Bavarian Nordic, the Belgium-based manufacturer of one the world’s two available mpox vaccines, MVA-BN, halted its production for months in 2022 due to building renovations.  

Then in August, 2023, it received a $120 million contract from the US Biomedical Advanced Research and Development Authority (BARDA) to manufacture new mpox vaccine product in bulk.  But that has only partly restored the depleted US stockpile – believed to be the world’s largest.  

At the same time, stigma around the disease, which can be sexually transmitted, as well as around vaccines more generally has also held back progress in the DRC – one of the most vaccine-hesitant countries in Africa. 

An attempt to donate doses of mpox vaccine was stalled for more than a year, Bavarian Nordic Chief Executive Paul Chaplin said in a statement to Reuters, in December 2023. National regulatory approval of vaccines and medicines has thus inched forward at snail’s pace. 

Taking gloves off to join in partnership

Dr Mike Ryan mpox press conference
Dr Mike Ryan, WHO Executive Director of Health Emergencies at a recent press conference

“We know that production capacity of the manufacturers is closely held proprietary information sometimes, but we have an idea of production,” Ryan said, adding. “I think Bavarian Nordic has been very open to discussing how they could scale up production. 

“And I do know that GAVI and others are willing to engage around how the existing vaccines beyond donations could also be procured.  

“So we are taking the gloves off to join hands in partnership – not to beat anyone around on the head,” Ryan said. 

The MVA-BN vaccine as well as a second vaccine, LC16 KMB, produced by the Japanese firm KM Biologics, both present technical challenges in terms of their administration as well, Ryan pointed out. The MVA-BN requires two jabs – a challenge in settings like DRC wracked by conflict and insecurity.  

The LC16 vaccine, on the other hand, requires intradermal administration – a relatively simple skin jab, but still a procedure requiring training for the health workers unfamiliar with the technique.  

In addition, Ryan added, neither vaccine has yet been formally approved for use in children – and amongst the 250 deaths seen so far in DRC this year, most victims have been children under the age of 15. 

Targeting vaccines due to limited supplies 

“Given limited supply, limited availability of vaccines need to really be able to use those vaccines in a targeted way to reach those who are most at risk,” Van Kerkhove said. 

“We’re currently looking at a number of different ways the vaccines could enter into the country, led by our country office, the Ministry of Health and their partners. We’re looking at bilateral donations, at the use of vaccines as part of a response strategy – at a number of different options apply, but we’re also looking at supply,” she stressed, adding:  “We’re looking at how many doses could be available. And then of course the strategies in which those vaccines can be used in outbreak situations.”

Still trying to understand the epidemiology ’

While the barriers remain, virus transmission continues to expand within communities and geographies. 

“In 2024 alone there have been more than 3000 suspected cases and about 250 deaths with a crude case fatality ratio around 7.8%,” said Van Kerkhove, of the outbreak, the largest ever seen by the DRC to date.  

The high fatality rate is due to the fact that most cases seen so far in the DRC have been of the Clade I mpox virus, which very deadly. 

In contrast, it was the much milder Clade II virus that triggered WHO’s declaration of a global health emergency in 2022 – which it began circulating widely outside of Africa, primarily among men who have sex with men. The emergency  was declared to be over in 2023, after the successful rollout of millions of vaccines among at-risk groups in high and middle income countries.  

As well as being more deadly, the patterns of transmission of the Clade I virus in DRC and West Africa, also appear to be much more varied – although sexual transmission is a factor, it is not the only one.

DRC and global health officials are thus struggling to “better understand the epidemiology,” of the outbreak, which is happening amongs a wide variety of communities and populations – from children to sex workers.  

“There are clearly different outbreaks that are happening, some are happening among sex workers, some are zoonotic transmission and some family clusters,” Van Kerkhove said. 

“We’re working with our country office in DRC, our regional office and many different partners to look at the types of interventions that can prevent infections, but also stop transmission,” Van Kerkhove said. “And one of those interventions is vaccines.”  

“We had a big partnership meeting yesterday. A lot of people are now actively engaged. But let’s be real here.  We do have to look at the different types of scenarios and be realistic about how much vaccine is available, how quickly the vaccines can be used, and how they can optimally be used in different parts of DRC and beyond. To have the biggest impact in stopping human-to-human transmission.”

Image Credits: National Foundation for Infectious Diseases , Tessa Davis/Twitter , WHO.

What actions and strategies are required for countries and communities to have more agency in their health?

This is the topic of the latest episode of the Global Health Matters “Dialogues” podcast series, in which host Dr. Garry Aslanyan tries to “blow up some of the echo chambers that exist in global health.”

In this episode, he talks with Olusoji Adeyi, a seasoned Nigerian global health practitioner who has held many prominent leadership positions, about overhauling the existing power dynamics in global health.

Dr. Garry Aslanyan (left) and Olusoji (Soji) Adeyi
Dr. Garry Aslanyan (left) and Olusoji (Soji) Adeyi

“Aid is still used as a lever to exert power over nations at times,” Aslanyan said.

Adeyi proposed six essential changes to turn the situation around.

No. 1—Have clarity of purpose.

No. 2—Consider the needs, realities, and interests of recipient countries as the starting point for any deliberation.

No. 3—Emphasise learning.

“All too often, it’s almost as if principal actors in global health resist learning because such learning might threaten the status quo,” said Adeyi. “When it threatens the status quo, it threatens the current imbalance. And so it’s shut down or suffocated.”

No. 4—Overhaul the legacy foreign aid paradigm, including ending aid for basic health services and commodities and goods.

“This is not a call for an abrupt cessation today,” Adeyi stressed, “but it ought to be done, say by the year 2030, that’s a six to seven-year period so that there’s a finite date in sight and there is a transition out of it, with exceptions only for say countries at war, because then we’re talking about humanitarian purposes or countries that have suffered sudden and devastating natural disasters. Those would be sensible exceptions there.”

No. 5—End the current practice of technical assistance so that the aid given via technical assistance is no longer tied to the source of financing for that technical assistance.

No. 6—Developing/improving/supporting mission-critical institutions in low- and lower-middle-income countries.

Systemic Flaws in Vaccine Distribution

Adeyi highlighted the vaccine distribution process during the COVID-19 pandemic as a prime illustration of systemic flaws. He told Aslanyan that during the pandemic’s peak, “a few individuals convened at Davos and hastily drafted what would essentially become global policy for distributing COVID-19 vaccines and related technologies to low- and middle-income nations.”

Those initial sketches materialized into ACT-A for accelerated access to COVID technologies and COVAX, managed by Gavi. Consequently, during the pandemic’s peak, high-income nations stockpiled vaccines, leaving African countries in a predicament where even those countries that wanted to buy vaccines had to rely on donations rather than purchase vaccines themselves.

“If you go to buy a car, a computer, or a pair of shoes, you are empowered as the buyer,” Adeyi explained. “But if you are waiting for somebody to donate a car, a pair of shoes, or a computer to you, you are disempowered, and you are at the mercy of the donor. And, of course, COVID did not live up to the hype.

“If you had accountable leadership, they would acknowledge that failure and find ways to do better,” he continued. “But the leadership of Gavi did the exact opposite by claiming they had established a blueprint for how to get vaccines to poor people in an emergency, which was just the exact opposite of what had happened.”

Adeyi said that this illustrates how significant power imbalances result in policies, decisions, and practices that counter the interests of those intended to benefit.

Previous “Dialogues” episode: A Conversation with Daisy Hernández.

Listen to previous episodes of Global Health Matters on Health Policy Watch.

Image Credits: Screenshot, Global Health Matters Podcast.

Routine testing for tuberculosis in Lima, Peru.

Tuberculosis has long been the neglected stepchild of global health – but new diagnostic tools and treatments, artificial intelligence (AI) and debt swaps to help countries meet their targets have come into play and are making a difference. 

“There is fresh momentum,” says Dr Jamie Tonsing, Senior TB advisor at the Global Fund, in a wide-ranging interview with Health Policy Watch.

“I’ve just come back from a meeting in Manila, where the discussion was all around AI for TB,” she adds.

One of these involves an AI tool that can read chest X-rays and predict whether a person is likely to have TB.

“The chest X-ray goes into the computer and the image is read by software and gives you a threshold above which a person is likely to have TB,” explains Tonsing.

“It’s a screening tool that needs to be followed by a proper molecular test. But this is very exciting because we don’t have radiologists everywhere, and TB is often in the most hard to reach, vulnerable population groups.”

Up to 50% of people with TB do not have the classical symptoms of TB, Tonsing adds.

“So the only way they will be diagnosed early and before they have symptoms is when they do a chest X-ray. And so that’s why we’re very excited by this new advance in technology.”

Jamie Tonsing, Senior TB advisor at the Global Fund,

Those with TB can be started on treatment immediately. Children under the age of five and people living with HIV who don’t have TB but have been exposed to someone with the disease, can be given TB preventive treatment to protect them.

Over three-quarters of international financing for TB comes from Global Fund, which also spends around $150 million per year to new digital tools. These are being used in places like Bangladesh, Paraguay and Indonesia to screen people in remote areas.

Bangladesh, is using digital X-rays with AI and telemedicine to rapidly screen people for TB, while health workers in Paraguay, are using portable X-ray machines and AI technology in prisons screen and diagnose people with TB fast, according to Dr Mohammed Yassi, the Global Fund’s TB advisor.

Cheaper testing for drug-resistance

GeneXpert diagnostics have become the gold standard for TB testing, particularly for drug-resistant TB (DR TB), which is difficult to diagnosis through the traditional sputum smear technologies or chest X-rays.  GeneXpert can rapidly detect rifampicin-resistant TB (a proxy for DR-TB diagnosis) along with drug-susceptible TB.  But the diagnostic machines need electricity and are expensive to operate.

Four years ago, the World Health Organization (WHO) endorsed another rapid molecular test called Truenat, which is also able to detect DR-TB – but is cheaper than GeneXpert and can run on batteries.

The Global Fund and Stop TB Partnership have signed an agreement with Truenat’s manufacturer, Molbio Diagnostics, to provide the machines at a reduced price in all countries that are supported by the two organisations and USAID.

In theory, results from these machines are supposed to be processed in two hours. But in practice, it usually takes clinics a few days to process.

“We need to find the people we are missing. So despite all the good progress, our global detection rate is 77% and we have said we need to get that up to 90%. So all the innovations are important, but what we also really need is point-of-care rapid tests like we have for malaria and HIV,” says Tonsing.

“In the past year, the Global Fund secured a 20% reduction in the price of the most commonly used molecular diagnostic test and a 55% reduction in the price of a key treatment for multidrug-resistant TB,” according to Peter Sands, executive director of the Global Fund.

Better treatment for DR TB

People with DR-TB used to spend 12 to 24 months in hospital, and take lots of pills and injections. But in May 2022, this changed dramatically when the WHO recommended an all-oral six-month regimen known as BPaLM –  a regimen of bedaquiline (B), pretomanid (Pa), linezolid (L) and moxifloxacin (M).

“The shorter duration, lower cost, lower pill burden and high efficacy of this novel regimen should enable much better treatment and treatment outcomes.. while also helping health systems to provide care for more people,” the WHO announced.

But the challenge is to ensure that countries adopt the new guidelines. Drug resistant TB is very high in the central region of Eastern Europe, but the management of TB is still  centralised with people still being admitted to hospital for months in many countries. 

The Global Fund is investing in BPalM, and encouraging countries to adopt the regimen, allow patients to stay at home and train staff and civil society organisations about how it works.

The older drug-resistant TB treatment (above) compared with new BPaL regimen (below).

Innovative financing

COVID has depleted many countries’ budgets, especially in the low-and middle-income countries most likely to be struggling with TB.

“Domestic budgets for TB are often not being increased commensurate with the need,” says Tonsing. “Every year, we get around $5 billion for the global TB response whereas the need is around $13 billion, so that gap is huge.”

Since 2017, the World Bank and the Global Fund have supported many countries by investing with blended finance transactions. For example, a loan buydown in India was tied to increased domestic financing for TB care and prevention. 

Debt2Health is an innovative financing mechanism designed to increase domestic financing in health by converting debt repayments into investments in public health programmes. Under individually negotiated “debt swap” agreements, a creditor nation forgoes repayment of a loan when the beneficiary nation agrees to invest all or part of the freed-up resources in a Global Fund-supported programme.

For example, in April 2021 Germany, Indonesia, and the Global Fund signed an agreement to  increase support to TB in Indonesia by converting €50 million of debt owed by Indonesia to Germany into investments in public health programmes supported by the Global Fund in Indonesia.

Still off track

“We have recovered from COVID-19 and in 2022, a record number of TB cases were identified – 7.3 million out of 10.6 million estimated cases. That’s a big new high and we  think, once we get the 2023 data, it will easily cross over eight million,” says Tonsing.

“So we’re getting back on track after being off track but but I don’t think we will be able to make it to the UN high level meeting, or even the 2030 SDG targets.”

Image Credits: Socios en Salud, Marc Bader/ The Global Fund, Dato Koridze .