A researcher working on an mRNA vaccine at Afrigen, South Africa’s mRNA hub.

The best way to pandemic-proof the world is through ‘last-mile innovation’ based on strong regional and subregional research and development (R&D) hubs that can tackle disease outbreaks before they become pandemics.

These hubs should be led by local scientists and have the capacity to adapt established technologies without intellectual property restrictions to produce vaccines, treatments and diagnostics to address threatening pathogens.

This is the argument put forward by a group of health experts in a paper published this week in The Lancet amid three separate global negotiations aimed at improving the world’s response to future pandemics.

They assert that there has been too much focus on building new vaccine manufacturing facilities in developing regions and argue that the Pandemic Fund and development banks could finance “R&D for the common good rather than just vaccine manufacture and distribution through a market approach”. 

“As we have seen again during COVID-19, a system that largely relies on market dynamics to drive the research, manufacture and marketing, results in highly inequitable access and preventable deaths, particularly in developing countries,” said co-author Dr Soumya Swaminathan, former Chief Scientist, World Health Organization (WHO).

“Our proposal, which centres on equity from the start, would give researchers from developing countries greater ability to quickly and collectively contribute to solutions to infectious outbreaks in their regions. When each region has that ability, all of the world is better protected from pandemic threats, which are only going to increase due to climate change.”  

Speed is essential

“Time and again, developing countries are left waiting for tools like vaccines developed by others, while wealthier countries produce and access them first,” said Helen Clark, one of the authors and former co-chair of The Independent Panel for Pandemic Preparedness and Response. 

“The deadly lessons from COVID-19 demand transformative change, starting with action to ensure that all regions have the technology and capacities required to develop products that stop outbreaks before they spread worldwide. That’s not only equitable, it’s strategic.”

Dr Els Torreele, the lead author, explained that “in outbreak control, speed and versatility are of the essence, so having the ability to rapidly adapt the most suitable existing technology to local needs is critical”.

“The opportunity for ‘last-mile innovation’ will let researchers develop and produce products people can use, where they live, for the outbreaks in their regions,” added Torreele.

Dr Amadou Sall, Director of the Institut Pasteur de Dakar in Senegal, added that “given available technologies and in the wake of a pandemic that has led to some 24 million excess deaths, there should be no question that we need a new model – one that fully empowers all regions to be self-reliant”.

“Many of these technologies have been available for decades now, and others have been developed with public funds. It’s time to make them available in Africa and on other continents,” said Sall, who is also a co-author.  

Sharing mRNA technology

Professor Petro Terblanche, who heads the WHO’s mRNA technology development and transfer programme in South Africa, explains that if, for example, mRNA technology is made accessible, “researchers can innovate and develop vaccines that address local or regional health needs and are suited to optimal delivery into local and regional health care systems”.

The authors also make a strong case for a common goods approach to R&D, in which the ownership and control over technologies that are critical for public health are governed collectively and in the public interest.  

They cite the CERN research facility in Europe, which is jointly funded by 23 countries, as an example of a sub-regional R&D hub. 

“The public sector is already investing billions in research, which is then often sold or handed out to the private sector who decide whether or not to develop products based on profit potential,” said Dr Joanne Liu, a Canadian paediatrician, former International President of Medecins sans Frontieres (MSF) and member of The Independent Panel.

“We’re saying, tools to protect lives and stop outbreaks from crossing borders must be common goods – and must and can be funded with that mindset.” 

Timely intervention

The authors’ call comes as the Intergovernmental Negotiating Body (INB) working on a pandemic accord is set to meet in Geneva next week to continue negotiations. Issues of equitable access to pandemic countermeasures are being negotiated in specific articles on research and development and on technology sharing and co-development, and are considered some one of the most difficult areas to solve. 

The G20 Health Ministers also recognised the need for “sustainable global and regional research and development networks to facilitate better access to VTDs (vaccines, treatments and diagnostics) globally, especially in developing countries” at its meeting last week.

Meanwhile, the United Nations High-Level Meeting on pandemics is set for 20 September in New York, and will adopt a political declaration mapping out how to address future pandemics.

Image Credits: Rodger Bosch for MPP/WHO, Kerry Cullinan.

WHO Director-General Dr Tedros Adhanom Ghebreyesus arriving at the 73rd meeting of the WHO Africa region.

After a two-week hiatus in negotiations, United Nations (UN) member states this week received a third draft of the Political Declaration being developed for the High-Level Meeting on Pandemic Prevention, Preparedness and Response on 20 September.

The declaration was supposed to have been finalised by early August and put under silence procedure but member states failed to agree on a number of clauses and negotiations were interrupted by the northern hemisphere summer holidays.

Last week, bilateral meetings resumed and sources told Health Policy Watch that member states finally received an amended draft this week.

Slow pandemic accord talks

Meanwhile, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus expressed concern this week about the slow pace of negotiations on the pandemic accord, warning that it may not be completed by the May 2024 deadline.

“I’m concerned that negotiations are moving slowly and that the accord may not be agreed in time for next year’s World Health Assembly (WHA). I urge all member states to work with a sense of urgency with a particular focus on resolving the most difficult and contentious issues,” Tedros told WHO Africa’s regional meeting at its opening on Monday.

“This is a unique opportunity that we must not miss to put in place a comprehensive accord that addresses all of the lessons learnt during the pandemic with a particular emphasis on equity. This region has more to gain from a strong accord than any other so I urge you to continue engaging actively in the negotiations to make sure the needs and expectations of Africa are heard,” added Tedros.

The Intergovernmental Negotiating Body (INB) in charge of developing the accord to present to the WHA is set to meet again on 4-6 September.

Tedros also referred to the negotiations to amend the International Health Regulations (IHR) currently underway, describing the IHR as the “cornerstone of detecting and responding to disease spread internationally”.

“But as the COVID-19 pandemic laid bare, there are serious gaps in compliance and implementation which must be addressed. We need an IHR that’s fit for purpose,” said Tedros.

“The proposed amendments now being discussed by member states address many crucial areas including compliance, cooperation, and more efficient communication. We must learn the lesson of COVID-19, which is that global threats require a global response that is based on coherence and mechanisms for cooperation, rooted in solidarity and equity.”

The Working Group on IHR meets again on 2-6 October for the fifth time and is expected to debate the definition of a pandemic, amongst other issues.

“Crucially, the new global architecture cannot be designed, built or managed by those with the most power, money and influence. It must be designed, built and managed by all member states and partners in a truly inclusive process,” Tedros urged.

Dr Tedros addressing the opening of the 73rd WHO Africa regional meeting

Botswana’s approach to health is an example to the African continent, with strong leadership, investment in research and development and universal health services available for a nominal charge, said Dr Jean Kaseya, head of the Africa Centres for Disease Control and Prevention (Africa CDC).

Kaseya was speaking on Monday at the opening of the World Health Organization (WHO) Africa regional committee meeting being held in Botswana’s capital, Gaborone.

“Botswana was the first African country to achieve 70% coverage of COVID-19 vaccines because of the strong leadership of the president and the allocation of adequate resources to procure vaccines,” said Kaseya.

“Its investment of 1-2% of its GDP to research and development is why Botswana is one of the leaders in the development of vaccines for animals. Knowing that the next pandemic will be a zoonotic one, it means that Botswana will play a key role in addressing this issue in Africa,” he added.

Africa CDC head Dr Jean Kaseya

Kaseya added that he was surprised to learn that Botswana’s citizens were able to “access to all the healthcare that they need” by only paying a 15-cent contribution for every dollar charged.

Kaseya said that Africa needed to prepare for the next pandemic by pushing local manufacturing of vaccines and medicines and ensuring there was “enough funding for pandemic prevention, preparedness and response”.

The African region had failed to submit a regional application to the Pandemic Fund, unlike the Caribbean, Asia and Latin America and needed to ensure it made an application during the next call for proposals to fund a joint emergency action plan, he added.

The WHO Africa region excludes some of the countries in the far north of the continent that associate more closely with Arab states and are part of the Eastern Mediterranean Region (EMRO).

HIV laboratory declared WHO centre of excellence

Meanwhile, WHO Director-General Dr Tedros Adhanom Ghebreyusus told the meeting that Botswana’s National HIV Reference Laboratory has been designated as a WHO Collaborating Centre of Excellence “in recognition of the laboratory’s excellence in the field of HIV diagnosis and the potential of deeper collaboration with WHO in advancing the health and well-being of people living with HIV”.

“In 2021, WHO certified Botswana for reaching the silver tier on the path to eliminating mother-to-child transmission of HIV. And in 2022, Botswana reached the 95-95-95 targets for testing, treatment and viral suppression of HIV, one of only five countries to do so,” said Tedros, referring to the targets of 95% for testing all people, putting 95% of those with HIV on treatment, and achieving viral suppression in 95% of people living with HIV.

“Botswana is a model to show anything is possible, added Tedros. Peace is possible. Stability is possible. Democracy is possible. Growth is possible, even to an upper middle-income country or even even higher. Africa can grow. Africa can be stable, Africa can be peaceful. Africa can be a democratic continent,” added Tedros.

Botswana has a small population of 2.6 million people and has made its wealth from minerals.

Urgency of universal health coverage

Matshidiso Moeti

WHO Africa Regional Director Dr Matshidiso Moeti, who hails from Botswana, also expressed pride in her country’s health milestones. 

“It is one of the countries where direct payments for healthcare is almost non-existent,” said Moeti. “With a minimal nominal contribution, people have access to everything that is available in the country and transferred outside of it [for other treatment]. It is an example of how to make sure that payments are not a burden to the customer. I’m very proud of this.

“We could take many examples and I’ll just cite a couple. For example, the mother-to-child transmission of HIV has been reduced to less than 5%, and Botswana has been the first high-burden country in the world to achieve this milestone.

“HIV transmission rates have fallen from 40% of the sexually active age group in 1999 to below 1% this year. What an achievement for a nation that once had the highest HIV prevalence rate in the world.”

In contrast to Botswana, Moeti pointed out that “public spending on health is low in the majority of our countries, and Africa is home to two of the three poorest people who pay directly out of pocket for their health care.” 

Meanwhile, Tedros said that every WHO member state needed to “radically reorient health systems towards primary health care as the foundation of universal health coverage”.

“Nowhere is more important than here in our continent. Across the region, hundreds of millions of people lack access to essential services or are pushed into poverty by catastrophe out-of-pocket spending. Closing these gaps must be top of the to-do list for every member state,” urged Tedros.

Climate change threat

Moeti and Tedros both urged African member states to take measures to mitigate the effects of climate change on their citizens’ health.

“We have seen Europe burn literally over the past few months. Here in our region, prolonged drought in the Sahel, and also in the greater Horn of Africa and cyclones in southern Africa have increased morbidity, mortality and human suffering,” said Moeti.

“These phenomena are taking a heavy toll on health services. We are working with partners to support our member states in their efforts to provide essential health and nutrition services to affected countries and communities.”

She said that an African regional initiative to combat the health consequences of climate change on the continent had been launched in May on the sidelines of the World Health Summit, while the Climate-Health Africa Network for Collaboration and Engagement (CHANCE) had been formed in 2021 to assist countries in southern and east Africa to address climate change.

Meanwhile, Tedros encouraged all African member states to participate actively at COP28 in the United Arab Emirates, which will feature a day dedicated to health for the first time.

“Health systems are increasingly dealing with the consequences of climate change in terms of communicable and non-communicable diseases, and the impacts of more frequent and more severe extreme weather events,” said Tedros.

WHO's New Leadership Team
The World Health Organisation is losing track of the evolution of COVID-19 as governments lose interest in reporting data about the virus.

Fewer than 20 countries worldwide still report COVID-19 hospitalization and ICU data to the World Health Organization (WHO), leaving the UN health body blind to the impact and evolution of the virus in most of the world, agency leaders said Friday.

The decline in data reporting is a major setback for the WHO’s efforts to track the pandemic. Without reliable data, the WHO cannot accurately assess the burden of disease, identify new variants, or target its resources where they are most needed.

“We don’t have good visibility of the impact of COVID-19 around the world,” said Dr. Maria Van Kerkhove, who leads the WHO’s COVID-19 task force. “It is really important that surveillance continues, and this is on the shoulders of governments right now.”

Out of the 243 countries and territories party to the WHO, the UN health body has data on cases for just 103 of those. Only 19 countries and territories continue to report hospitalization data, while just 17 report data on cases that end in the ICU. The number of countries reporting COVID-19 deaths has fallen to 54.

“While we are certainly not in the same situation that we were in a year ago or two years ago, SARS-Cov-2 circulates in all countries right now,” said Van Kerkhove. “It is still causing a large number of infections, hospitalizations, admissions to the ICU and deaths.”

The current set of dominant COVID-19 variants can still cause the “full spectrum” of disease, from asymptomatic infections to severe disease and death, Kerkhove said.

The continued circulation of the virus also puts individuals at risk of joining the millions of people around the world suffering from the effects of long COVID. Research into the prevalence of long COVID worldwide estimates the number of people affected as high as 65 million — likely a vast underestimate.

“COVID remains a global health threat, and data available to WHO continues to decline,” WHO Director-General Dr Tedros Adhanom Ghebreyesus said at a media briefing on Friday. “We continue to call on all countries to strengthen surveillance, sequencing and reporting so we can assess the risk of new variants.”

Image Credits: Guilhem Vellut.

A health worker provides treatment to a malnourished child in Yemen.

For most people, electing the regional director – or chief health officer – for the Eastern Mediterranean Region (EMRO) of the World Health Organization (WHO) will not set the pulse racing.  Is this just another shuffling of chairs around the world’s bureaucratic table? Even among global health nerds, it will trigger just a faint tremor.

Yet the role matters to 22 countries spanning the Arab World from Morocco to the Gulf and extending across West Asia to Pakistan. They come together as the Regional Committee for the Eastern Mediterranean to select a new regional director on 10 October to helm the health aspirations of over 700 million hopeful people.

EMRO is one of six regional offices, the directors of which have almost complete authority for executing WHO’s health policies and programmes under its decentralised constitution.  

EMRO’s regional director election comes at a time of health’s increased geopolitical importance due to unpleasant global competition around the COVID-19 pandemic.  Today’s heavily securitised world has also realised that the might of nations is measured not just by guns. Healthy people make content, creative citizens and, ultimately, stronger nations.

EMRO’s life-and-death lottery

WHO EMRO is made up of 22 countries that differ vastly in income and health expenditure.

How is EMRO doing? Its people live 71.4 years, a little under the global average of 73 years. But this hides grave inequalities from Qatar’s 80 years to Somalia’s 55.4 years. Five other nations don’t make it past 66 years.  It is similar with maternal mortality: 620 Afghan women lose their lives for every 100,000 live births, compared to 223 globally. Kuwait does best with seven mothers’ deaths while seven countries are way off the SDG target of 70 maternal deaths per 100,000 live births by 2030.

Why does the region’s heath lag so far behind?  The main cause is that this is the world’s most conflict-torn corner, with two-thirds of its people directly and indirectly affected. Furthermore,  healthcare is brutally instrumentalised with facilities and workers attacked in Yemen, Syria, Iraq, Afghanistan and Pakistan.  Food has been denied in several conflicts with Sudan and Somalia generating starvation headlines and stratospheric malnutrition rates. 

Furthermore, glaring socio-economic gaps hallmark the region. Some of the world’s richest countries – Qatar, the United Arab Emirates (UAE), Saudi Arabia, Bahrain, Kuwait and Oman – are in the same administrative group as Pakistan, Palestine and Egypt, which barely get into the middle-income category, while others like Afghanistan and Yemen remain mired in abysmal poverty.   

This life-and-death lottery is detailed in WHO’s own health observatory, EMRO expends $669 per capita on health – half of the average global spending.  That is skewed further by profligate nations spending $1500-2500, masking other countries that spend less than $150 per person. 

Thousands of Somalis escaping drought and conflict are living in sprawling settlements on the outskirts of towns, like this one in Baidoa in south-central Somalia.

The new regional director needs courage

In such a diverse and divided region, the new regional director will have their work cut out. For starters, they must go courageously where others fear to tread and defend humanity by speaking out without fear or favour. But they must also be astute in walking the fine line between promoting health as a bridge for peace and over-politicising health’s humanitarian mission.

It is our human tendency to get de-sensitised to long-standing suffering and inequalities. Therefore, the incoming regional director will have to be super-human. They must feel stronger outrage about unfairness and injustice, possess greater compassion for misery, burn more intensely with urgency,  be smarter at delving into root causes and shine a brighter light on the path ahead.

Of course, these virtues are nowhere to be found in the sober language of the regional director’s job description. But they should be core considerations for EMRO member states. Can they rise above their usual politicking to unite for the collective good, knowing that the massive health risks they face know no boundaries?

They have six impressive candidates with a range of qualifications and experiences to choose from. Iraq has nominated pharmacologist Najim Abbas Jabir Al-Awwadi and Morocco has proposed former health minister Anass Doukkali. Pakistan has suggested health systems expert Abdul Ghaffar and Iran has put forward health policy professor Ali Akbari Sari. Sudan has nominated its goodwill health ambassador Ahmed Farah Shadoul and Saudi Arabia has proposed the sole woman, clinical and public health specialist Hanan Hassan Balkhy.  If elected, she would be EMRO’s first-ever female regional director, other WHO regions having passed that milestone earlier.

 Consolidation or change?

Whoever is elected, it is not too early to consider their desired legacy from a potential  5-10 years in office. Will they be a transformer or consolidator of business-as-usual?

The business-as-usual approach will see the incumbent – however technically proficient and managerially efficient  – see illusionary progress while presiding over strategic decline. To elaborate: even if the WHO/EMRO leadership does little, health indicators will continue to improve in most countries. Because, thanks to external stimuli, especially the private sector, they will get richer, stabilise some conflicts, improve governance here and there, expand key health capacities, and roll out new technologies wherever they prove useful. 

But such gains are threatened by bigger vulnerabilities. Climate change is heating the Mediterranean and the Middle East at twice the global average with devastating environmental and health impacts. Five of the 10 biggest disasters over the past two years were spawned here, including massive floods, droughts and earthquakes. 

In August 2022, massive floods in Pakistan displaced some 33 million people.

Some 127 million people – 37% of the world’s humanitarian caseload – come from this one region due to a combination of disasters, conflicts, and displacement. WHO’s middling performance on humanitarian assistance in this region needs urgent augmentation.

Concurrently, as the region ages, the burden from non-communicable diseases (particularly diabetes, cardiovascular and lung conditions and cancers) increases. Already 70-80% of deaths occur from NCDs. Other conditions such as substance abuse are surging.

Thus,  business-as-usual in EMRO implies regression. We already see this with continuing neglected tropical diseases such as leishmaniasis, and the emergence of new pandemic-potential agents such as MERS, or the re-emergence of old conditions such as tuberculosis and polio.  

Health systems are struggling in the Middle East and West Asia where health professionals are scarce in poor countries and, although sufficient in the rich ones, skewed towards specialised hospitals. Universal health coverage (UHC), the aspiration that all should receive quality healthcare without personal financial hardship, is still a dream when nearly half the population don’t access 16 essential services.

Healthcare demand will always outstrip provision and traditional health system mantras can never catch up. Will WHO EMRO’s new leader be capable of thinking outside the box? It means breaking old moulds and casting new ones – causing discomfort within WHO and member states. Will they have the guts for that?

Look inwards first for resources

Even if the incoming regional director goes down the egg-breaking, omelette-making track to transform healthcare, they can’t do it on their own. They must build partnerships and garner significant additional resources.

This must start internally inside WHO where its over-staffed headquarters operates out of Geneva, the world’s third most expensive city. Fortunately, WHO Director General Dr Tedros is committed to decentralisation, and although he faces resistance to pushing that through, the incoming regional director should hold him to that pledge. Meanwhile, they must do their utmost to radically reshape EMRO’s regional and country offices to make them investment-worthy.

The new regional director should resist holding out the begging bowl to traditional OECD (mostly Western) donors. The pennies received are not worth the self-respect expended. Multilateral development banks should be pushed to do more. But the real resourcing transformation must be within the region. After all, generosity towards the needy and suffering is an integral part of the region’s dominant religion and culture.

Gulf states are already giving more: $ 9.2 billion in official development assistance in 2022 led by Saudi Arabia ($6.2 billion) and UAE  ($1.4 billion). But such aid tends to be volatile and skewed towards emergency relief and the health sector’s share is small. The regional director must be politically skilled at changing that and establishing long-term health investment – and not donor-recipient – relationships.

Is all this too much to ask from the new WHO EMRO regional director?  No – because it is do-able. Anything less is a betrayal of trust and a missed opportunity to better the lives of people who deserve better.

Mukesh Kapila is a physician and public health specialist who has worked in 120 countries, including as a former United Nations (UN) Resident and Humanitarian Coordinator in Sudan and a UN Special Adviser in Afghanistan.

 

Image Credits: WHO Yemen, Mercy Corp/ TNH, Rahul Rajput.

Amidst the vibrant rhythms of Africa, a less audible rhythm beats – an alarming rise in cardiovascular diseases (CVDs) and non-communicable diseases (NCDs). Between 50% and 88% of deaths in at least seven African countries are due to NCDs, according to the 2022 World Health Organization (WHO) Noncommunicable Disease Progress Monitor. Yet, the realm of research has yet to fully recognize the magnitude of this symphony. 

The cacophony of these diseases is not confined to developed nations; Africa bears witness to their increasing impact, largely unseen by the global research community. Against this backdrop, we stand resolute in our commitment to shifting the focus to the African narrative in cardiovascular medicine.

Closing research disparities: Unravelling the findings 

We are two young cardiologists, both graduates of Egypt’s esteemed medical schools. One of us went on to pursue his career in the United States, where he is now a rising researcher at the Department of Internal Medicine at Yale School of Medicine in New Haven, Connecticut. The other, determined to make a difference in his country, dedicated himself to the demanding work of a physician-scientist in Egypt.

Our paths converged when we decided to address the striking lack of randomized clinical trials (RCTs) in Africa. This scarcity robs the continent of vital disease-specific and population-specific data, which stalls progress in clinical outcomes. This deficiency has global implications, as it dampens cardiology research on a global scale by preventing researchers from tapping into a vast, diverse, and treatment-naive population.

Our journey led us to a comprehensive evaluation of African-led clinical trials in cardiovascular medicine over the past three decades. We recently published our findings in a research letter in the journal Circulation: Cardiovascular Quality and Outcomes.

About 80% of RCTs came from 3 countries (Egypt, Nigeria, and South Africa). Yet, 37 African countries didn’t produce a single RCT.

Our analysis revealed a stark reality: only approximately 2% of published and registered clinical trials in cardiovascular medicine originated from Africa. However, within this fraction, we found a tale of perseverance and determination.

We examined a total of 179 trials from African countries from 1990 to 2019. Egypt, South Africa and Nigeria were the most notable contributors, with Egypt leading the way. The number of African-led trials surged over the past decade, with 2010 to 2019 witnessing a remarkable increase.

The primary outcomes assessed in the trials included biochemical and cardio-metabolic markers, hemodynamic outcomes, clinical events, and patient-related outcomes. African trials often had small sample sizes, few participating centers and short follow-up periods.

The impact of published trials from different countries was measured using the H-index, a metric that gauges the impact of scientific research by tracking how many times a published paper is cited by other researchers. South African publications had the highest impact score, followed by Egypt and Nigeria. A significant number of trials were not published as open access, and risk of bias assessment showed that a significant number of studies had unclear or high risks of bias.

It is estimated that only 2000 cardiologists practice in Africa (≈1 cardiologist for 600,000 individuals)

Collaborations transcended borders, as African centres actively participated in 45 multinational trials, contributing valuable insights to global research endeavors. On the issue of funding, the researchers noted that 91 trials did not disclose their funding sources, while 20 disclosed no external funding. Of the remaining 68 trials, 35.7% had funding from private sources, 28.6% from academic sources, 28.6% from governmental sources, and 7.1% from non-governmental sources.

Our research letter underscores several critical points. First, there is a need for increased investment in training cardiovascular researchers, beyond just cardiologists, to strengthen the research workforce in Africa. Second, it is important to allocate more resources for research and development in African countries, in line with the local disease burden and international recommendations.

Third, initiatives like the Clinical Trials Community platform and the Pan-African Clinical Trials Registry have the potential to improve research infrastructure and collaboration. Lastly, there is a need for multifaceted interventions to address barriers to clinical research in Africa, including regulatory frameworks, electronic medical records adoption, and institutional partnerships.

Forging a new path: Towards inclusivity and impact

Of the 179 trials included, 54 (30.2%) were performed in collaboration with another African (n=42) or non-African center (n=33), most commonly in Europe and the USA.

Together, we can overcome the disparities impeding Africa’s research progress. Our findings have revealed challenges that, once addressed, could amplify the continent’s contributions. Trials across the continent often have limited sample sizes, are conducted at a small number of participating centres, and have short follow-up periods. The intricate dance of collaboration also extended beyond African borders, with European and North American centers partnering to enhance the scope and impact of research.

To unleash the true potential of African-led clinical trials, key changes are needed. Increased investment in training for cardiovascular researchers, beyond just cardiologists, would enrich the research landscape. Clinical research is a cornerstone of sustainable progress, and local governments must invest more in it.

A symphony of change 

As the curtain falls on our story, the call for change echoes. To harmonise Africa’s cardiovascular research and amplify its impact on the world, we need multifaceted interventions. Expanding clinical research sites, standardising regulatory frameworks, and widely adopting electronic medical records will strengthen Africa’s research infrastructure.

Open-access publishing and robust institutional partnerships are our allies in the journey towards progress. The song of African science, once muted, now crescendos as we work to break down barriers and illuminate a path toward equitable cardiovascular knowledge. In this rhythm of change, we are architects of transformation, orchestrating a symphony of research that resonates far beyond the boundaries of continents and borders.

Dr Ahmed Bendary is Associate Professor in the Cardiology Department at Benha University, a member of the Egyptian Society of Cardiology and a Fellow of the European Society of Cardiology (FESC). He also serves on the Board of the Egyptian Association of Vascular Biology and Atherosclerosis (EAVA), is part of the abstract reviewing committee for the European Society of Cardiology (ESC) Congress and serves as associate editor for The Egyptian Heart Journal (TEHJ).

Dr Abdelrahman Abushouk is an Internal Medicine Resident at Yale-New Haven Hospital. He earned his medical degree from Ain Shams University.

Image Credits: CC.

climate emissions
Fossil fuel combustion is a leading source of global warming and harmful air pollution.

Almost 50 organisations have written to the head of the upcoming United Nations climate change meeting, Conference of the Parties (COP) 28, calling for substantive progress against air pollution, which they describe as “the nexus of climate and health”.

With 100 days to go until COP28 in the United Arab Emirates, the groups organised by the Clean Air Fund, have written to president-designate Dr Ahmed Al Jaber, asking him to “put air pollution firmly on the agenda and to catalyse national commitments and international funding to improve air quality”.

“Air pollution is a pervasive public health crisis and an accelerator of climate change,” the letter notes.

The letter anticipates that the global stocktake process to evaluate progress towards meeting the goals of the Paris Climate Change Agreement, which concludes at COP28, “will be a devastating reality check, showing that countries are massively off track from their commitments”.

“Ninety-nine percent of the world’s population breathes air that fails to meet WHO guidelines. The main drivers of air pollution are also sources of greenhouse gases, the largest culprit being the combustion of fossil fuels. 

“This interconnectedness means that a full stop to burning fossil fuels is essential to unlock the enormous co-benefits of clean air. We emphasise that clean air cannot be solely achieved by carbon capture technologies, which do not address all toxic pollutants and particulates, such as black carbon which also accelerates warming. Only measures which result in better air quality will deliver the public health co-benefits of climate action.”

The letter reaffirms the Global Alliance on Health and Pollution’s most effective interventions to reduce fine particulate matter (PM2.5) and carbon dioxide emissions to improve heath involve replacing coal with renewable sources of energy for total power production; replacing diesel and gasoline-powered vehicles with electric vehicles; eliminating uncontrolled diesel emissions and preventing crop burning and forest fires.

It adds a further demand for “comprehensive air quality monitoring to demonstrate progress towards WHO Air Quality Guideline levels and campaigns to demonstrate the benefits of clean air to health, families, and communities to further build public support for climate action”.

“COP28 must deliver tangible progress to end all fossil fuel subsidies, as a way to unlock progress across the negotiations,” the signatories state.

A recent report from the World Health Organization noted that the global high emissions trajectory continues, nine million people per year will die annually from climate-related causes by the end of the century.

 

Image Credits: Ella Ivanescu/ Unsplash, Chris LeBoutillier.

WHO Traditional Medicine Summit 2023

PUNE, India – The World Health Organization’s (WHO) two-day summit on traditional medicine, held last week in the Indian city of Gandhinagar, was an attempt to start a dialogue about how to integrate evidence-based traditional medicine into modern medicine – but many were disconcerted about social media posts from the global health body that appeared to offer support for unproven treatments.

In addition, with India as summit co-host, Indian officials and programmes that have made controversial, unscientific claims were also given prominence.

At the start of the summit, WHO Director-General Dr Tedros Adhanom Ghebreyesus urged delegates to “use this meeting as the starting point for a global movement to unlock the power of traditional medicine through science and innovation”.

“I urge you all to identify specific, evidence-based and actionable recommendations that can inform the next WHO traditional medicine global strategy,” said Tedros, adding that countries should commit to examining the best way to include traditional, complementary and integrative medicine (TCIM) into their national health systems.

Dr Bruce Aylward, WHO’s Assistant Director-General, Universal Health Coverage, also highlighted the need for a “stronger evidence base” that could enable countries to “develop appropriate regulations and policies around traditional, complementary, and integrative medicine.”

Despite WHO officials’ stress on evidence-based treatment, some of its social media messaging appeared to endorse contentious medical systems such as homeopathy. One such Twitter post (see below) had over 5.3 million views, and provoked thousands of comments.

Many critics said the post appeared to be promoting untested treatments. Timothy Caulfield, a Canadian professor of health law and science policy, said that he found the WHO tweet “frustrating”, and asked how naturopathy, homeopathy and osteopathy  could be considered “traditional”., and warned against “legitimizing harmful pseudoscience” such as homeopathy.

“The WHO social media posts are, after all, an extension of the organisation and might be seen as an official position of the organisation,” Dr Anant Bhan, a global public health and bioethics researcher based in Bhopal, told Health Policy Watch. 

“You cannot detract from your core messaging which is around evidence-based medicine and the need to support it, including for public health policy. Once that starts happening, it will cause confusion,” said Bhan, adding that many people would not be able to discern the finer details of the WHO tweet.

The WHO late conceded that its tweet “could have been better articulated” but did not remove it.

 

Controversial Indian officials and programmes

The summit also allowed co-host India to promote controversial officials at press conferences – most notably, joint secretary of the Ministry of Health and Family Welfare (MoHFW) Lav Agarwal. During the COVID-19 pandemic, Agarwal repeatedly linked rising COVID-19 cases to a meeting held by a Muslim group, driving misinformation and stigmatization in an already charged religious environment in the country. 

Lav Agarwal (second from left), a senior health official in the Indian government who has been a prominent presence in the run-up to the traditional health summit was responsible for misinformation and stigmatization in the early weeks of the pandemic.

India’s Ministry of Ayurveda, Yoga, and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) also announced at the summit that it is in discussions with Malaysia about how to cooperate on traditional medicine and homeopathy. The official inclusion of homeopathy in the Ministry of AYUSH has long been a subject of controversy in India. 

Integration opportunities and challenges

While this is the first global summit on traditional medicine, the WHO has made attempts to include traditional medicine since 2014 when the first global 10-year strategy for traditional medicine was approved, and Tedros told delegates that the summit is likely to be a regular event.

There is clearly a demand for such summits. Preliminary findings from the WHO Global Survey on Traditional Medicine 2023, which were shared at the summit, indicate that around 100 countries have TCIM-related national policies and strategies.  

“In many WHO member states, TCIM treatments are part of the essential medicine lists, essential health service packages, and are covered by national health insurance schemes.  A large majority of people seek traditional, complementary and integrative medicine interventions for treatment, prevention and management of non-communicable diseases, palliative care and rehabilitation,” the WHO noted in a media release after the summit, which ended last Friday.

The WHO envisions a complementary role for traditional medicine, one in which it can be used alongside modern medicine in preventive healthcare as well as rehabilitation. 

For example, Professor Stefano Masiero, who chairs the rehabilitation unit at the Padua University-General Hospital in Italy, told the summit that the integration of traditional and complementary medicine could create a comprehensive rehabilitation experience. 

Meanwhile, Dr Hans Kluge, WHO Regional Director for Europe, told delegates at the close of the summit that they have “gently shaken up the status quo that has, for far too long, separated different approaches to medicine and health.” 

“By taking aim at silos, we are saying we will collaborate all the more to find optimal ways to bring traditional, complementary and integrative medicine well under the umbrella of primary health care and universal health coverage,” said Kluge, urging the need for “better evidence on the effectiveness, safety and quality of traditional and complementary medicine”.

But Dr Shyama Kuruvilla, lead for the WHO Traditional Medicine Global Centre, said “we have a long journey ahead in using science to further understand, develop and deliver the full potential of TCIM approaches to improve people’s health and well-being in harmony with the planet that sustains us.”

India currently holds the presidency of the G20 group of countries and the Traditional Medicine Global Summit coincided with the meeting of the health ministers of the G20 countries, who represent around two-thirds of the world’s population.

Image Credits: WHO, Ministry of AYUSH, India.

Two-thirds of US adults say either they or a family member have been addicted to alcohol or drugs – but the impact of alcohol still substantially out-paces that of drugs, despite the country’s massive opioid epidemic.

This is the finding from a survey of a representative sample of US adults conducted last month by KFF, which was released this week.

More than half of those (54%) polled said someone in their family had been addicted to alcohol, and 13% reported that they may have been addicted to alcohol.

Slightly over a quarter reported family members who were addicted to an illegal drug (27%) or prescription painkillers (24%) while 5% said they may have been addicted to prescription painkillers, and 4% reported a possible addiction to illegal drugs.

Opioid impact

US overdose deaths reached record levels in 2022, with almost 110,000 people dying – mostly as a result of fentanyl overdoses.

In the survey, 42% of people reported they or a family member have experienced opioid addiction in comparison to 30%  in suburban and 23% in urban areas. 

More Whites (33%) than Hispanics (28%) or Blacks (23%) report personal or familial experience with opioid addiction. 

Among those who say they or a family member experienced addiction to prescription painkillers, alcohol, or any illegal drug, less than half (46%) report they or their family member got treatment for the addiction. 

However, more Whites (51%), than Blacks (35%) or Hispanics (35%) received treatment. 

“Experiences with addiction and overdose are widespread, with large shares across income groups, education, race and ethnicity, age, and urbanicity all reporting some experience, though some groups report higher incidence than others,” notes KFF. 

“Overall, one in five adults (19%) say they have personally been addicted to drugs or alcohol, had a drug overdose requiring an ER visit or hospitalization, or experienced homelessness because of an addiction.

“The share increases to a quarter (25%) among adults with a household income of under $40,000 a year.”

This KFF Health Tracking Poll was designed and analyzed by public opinion researchers at KFF. The survey was conducted between 11-19  July online and by telephone among a nationally representative sample of 1,327 US. adults in English and Spanish.

Image Credits: Chuttersnap/ Unsplash.

A mural appeals for South Africans to get vaccinated against COVID-19.

The South African High Court has ordered the country’s health department to hand copies of all its COVID-19 vaccine procurement contracts, negotiations and agreements to a non-governmental organisation, Health Justice Initiative (HJI).

The Pretoria High Court ruling on Thursday comes in response to a court application by HJI for access to the contracts, arguing that the government had a constitutional requirement to be transparent and adding that it wanted to assess the legality and cost-effectiveness of the contracts.

The health department has 10 days to provide HJI with copies of all its COVID-19  vaccine procurement contracts, memoranda of understanding and agreements relating to a wide range of pharmaceutical companies and vaccine procurement groups.

These include Pfizer, Janssen/ Johnson & Johnson, Serum Institute of India, local generic company Aspen, China’s Sinovac, as well as the African Union Vaccine Access Task Team (AU AVATT) and COVAX.

Judge Anthony Millar said that the contracts were in the public interest as more than 30 million vaccines had been administered in South Africa with a budget of R10 billion (around $530 million) being allocated to cover this in 2021 alone, according to GroundUp.

Inflated prices, onerous terms

“This is a massive victory for transparency and accountability,” said HJI in a media release on Thursday.

“The contracts concern substantial public funds, and the contracting process has been marred by allegations that the government procured vaccines at differential, comparatively inflated prices and that the agreements may contain onerous and inequitable terms including broad indemnification clauses, export restrictions, and non-refundability clauses.”

In 2021, the South African health department itself complained about the onerous indemnity requirements that Pfizer had tried to extract in exchange for vaccines.

Then health minister Zweli Mkhize had told parliament that Pfizer had demanded that it be indemnified against civil claims from citizens with adverse vaccine effects and that the government put up sovereign assets as collateral to settle such cases, as reported by the Bureau of Investigative Journalism.

After a public outcry, Pfizer backed down on its demand for government assets as collateral but was still believed to have been indemnified against claims in many countries.

In fact, the global vaccine access platform, COVAX, established a No-Fault Compensation Program for Advance Market Commitment (AMC) Eligible Economies to ensure that people who experienced serious adverse effects from COVID-19 vaccines in poorer countries could receive compensation.

South Africa and other low- and middle-income countries were unable to procure vaccines for some months after they were available in Western countries as they had relied on COVAX. COVAX had ordered vaccines from the Serum Institute of India (SII). However, the Indian government banned SII from exporting its COVID-19 vaccines in April 2021 during the height of that country’s pandemic.

The collapse of the COVAX-SII deal forced South Africa to scramble to procure vaccines directly from pharmaceutical companies, paying a suspected premium for these.

Noting increasing reports of corruption within the healthcare sector, HJI added that “we cannot have a healthcare system shrouded in secrecy.  Procurement must be held in check, as it will involve powerful multinational companies, particularly from the pharmaceutical industry.”

During the pandemic, Health Minister Mkhize himself was forced to resign after it emerged that his family had benefitted from a COVID-19 communication contract the health department had awarded to a company run by a close friend.

Precedent for pandemic accord negotiations?

The HJI added that the judgement would assist in bolstering “provisions on transparency and accountability” in the current pandemic accord negotiations “where worrying attempts are being made to water down transparency”.

HJI had previously tried to get access to the contracts via the Promotion of Access to Information Act (PAIA), but the health department had refused to release the information, describing it as “confidential”.

Meanwhile, the judgement has been hailed by the People’s Vaccine Alliance.

“Pharmaceutical companies should never be allowed to operate without public scrutiny, particularly in a pandemic. But in South Africa and many other countries, governments were forced to sign up to strict secrecy clauses for their populations to access lifesaving vaccines and medicines,” said Mohga Kamal-Yanni, policy co-lead for the People’s Vaccine Alliance.

“This landmark decision shows that the public can take on powerful pharmaceutical companies and win. We hope to see more cases like this around the world.”

Noting that “transparency and equity must be at the heart of the world’s response to health crises”, Kamal-Yanni added that “people have a right to know how much pharmaceutical companies are charging them for lifesaving vaccines and medicines, and that right must be enshrined in the pandemic accord and the International Health Regulations.”

The South African Department of Health said that it “will study the judgement and respond in due course”.

Image Credits: Medecins sans Frontieres.