Dr Hans Kluge, WHO Regional Director for Europe.

Dr Hans Kluge, regional director of the World Health Organization (WHO) in Europe,  has warned member countries to maintain their COVID-19 infrastructure and genomic surveillance amid a “gradual increase in cases, including hospitalizations, in some European countries”. 

“COVID has not gone away. While its impact currently isn’t as severe as earlier, millions, especially the most vulnerable, remain unprotected in the WHO Europe Region. Worryingly, barely 11% of people across Europe & Central Asia have gotten their second booster shot,” Kluge noted in a media release.

Kluge cited infrastructure such as early warning systems, variant tracking and vaccine boosters for at-risk groups. 

“Key to reducing the risk of COVID-19 & other respiratory viruses is better ventilation in our buildings. That’s why WHO Europe is facilitating our region’s first-ever indoor air conference in Bern on 20 September 20, with the Geneva Health Forum,” said Kluge.

Globally, nearly 1.5 million new COVID-19 cases and over 2500 deaths were reported in the last 28 days (10 July to 6 August 2023), an increase of 80% and a decrease of 57%, respectively, compared to the previous 28 days, according to the WHO’s latest weekly COVID-19 report. 

While five WHO regions have reported decreases in the number of both cases and deaths, the Western Pacific Region has reported an increase in cases and a decrease in deaths. As of 6 August 2023, over 769 million confirmed cases and over 6.9 million deaths have been reported globally. 

 

Image Credits: WHO.

Pharmacy in Kenya; more consistent regulatory rules across the African continent can also expedite access to new medicines and formulations.

Three more countries, Kenya, Cape Verde and Democratic Republic of Congo, have ratified the African Medicines Agency (AMA) Treaty recently – and Kenya’s ratification now means that most major East African countries are on board with the treaty.

Twenty-six countries have now fully ratified the treaty, one of the steps required for the establishment of the specialised agency of the African Union (AU) dedicated to improving access to quality, safe and efficacious medical products in Africa.

Countries are required to both sign and officially ratify the AMA Treaty in their parliaments in order for it to become applicable in their country.

As of August 2023, 37 countries have formally supported the AMA treaty, including 26 ratifications, the latest by Kenya, Cape Verde and the Democratic Republic of Congo.

“Specifically, Kenya’s signing and ratification is a huge milestone in the journey to regulatory harmonisation being that this is one of the biggest economies in our region. AMA needs more support from the big economies,” Maureen Okoth, project coordinator for the Coalition for Health Research and Development (CHReaD), told Health Policy Watch.

In terms of what it takes to bring the “big countries” on board, Okoth said that one of the gaps experienced when engaging with different countries is the fact that AMA needs to be demystified over and over, “We need to demonstrate practically what and how the different countries will benefit from AMA.

Strengthening advocacy efforts

“This is exciting… We continue to strengthen our advocacy efforts so that we have more ratifications being done. We’re doing advocacy to ensure that we really talk to the member states that have ratified and those that haven’t,” said Chimwemwe Chamdimba, head of the Africa Medicines Regulation Harmonization (AMRH) programme, during a webinar on the next steps in operationalisation of AMA.

Chamdimba said that a lot of advocacy was underway with member states to encourage those that have not signed to do so, as well as to encourage those that have signed but not ratified the treaty to take that final step.

While the process of countries’ signing and ratification, which began in 2019, may seem prolonged, the AMA Treaty has received more support, faster, than almost any other treaty in AU history, Chamdimba noted. 

“It just tells you why everybody realised that we need this, especially after the COVID pandemic,” she added.

Chimwemwe Chamdimba, head of the Africa Medicines Regulation Harmonization (AMRH) programme

The approval process has been outpaced only by the treaty approving a continent-wide free trade area that was launched on 30 May 2019.

However, Okoth observed that details of AMA operationalization need to be shared more widely – including the cost implications to build confidence and enable countries to make informed choices. 

AMRH expects that the AMA will help Africa to access quality, safe products and leverage pharmaceutical markets.

Operationalising the AMA 

In a wide-ranging discussion, Chamdimba and other participants also discussed the next steps in AMA operationalisation, including the division of work between the AMA and national regulatory authorities, the appointment of AMA’s Executive Director and how to include patient voices.  

AMRH revealed that the Rwandan government has provided a fully furnished building with a space to expand for AMA. The Rwandan government won the bid to host AMA in 2022. Uganda, Algeria, Egypt, Morocco, Tanzania and Zimbabwe also submitted expressions of interest but did not succeed.

Administratively, the secretariat is setting up systems and structures and systems – including human resources, finances, procurement – that are required for the organisation to function. 

The AMA Treaty mandates the AU Commission to drive the operationalization of AMA. 

AMA will pick up from what the AMRH has been doing over the years, ensuring that it is now done within an organisation that is more sustainable and systematic for the continent.

Currently, Chamdimba says, there is an AU task team on AMA formed by the different entities of the AU, including the AU Commission to guide AMA’s operationalization.

“We also have the Conference of State Parties, which has been meeting in the last two years to provide leadership in setting up the structures of the AMA. The Conference of State Parties is composed of ministers of health from countries that are parties to the treaty,” Chamdimba said.

Appointment of AMA board and staff

Currently, AMRH is in the process of setting up the AMA Board. Nominations from the different regions have been received, and the board is expected to be functional in the next two months.

The board will take up the responsibility of recruiting AMA’s Director General (DG). The terms of reference have been finalised but are currently waiting for the Board to be set up so that it can provide oversight on the DG recruitment. The DG will then be responsible for the recruitment of the rest of the staff, dealing with AMA structural and administrative issues, according to AMRH.

Aside from its continental operations, AMA will also operate at the national level, where a member state’s national regulator will make decisions and at the regional level, where the regional economic communities will build their capacity to support and implement AMA decisions.

“AMA will not deal with 55 countries alone but depend on already available country capacities… So we look at these three levels being able to be interlinked, interrelated, sharing information and working together,” Chamdimba said.

AMA is also not expected to deal with all medical products, but “provide support where there’s limited capacity” – such as providing guidance on traditional medicine and responding to emergencies. 

But some products will be dealt with by member states and regional economic communities.

Patient involvement

During the webinar, International Alliance of Patient’s Organisations CEO Kawaldip Sehmi, asked how the AMA framework will provide for meaningful engagement with patients and academia in Africa.

Chamdimba assured Sehmi, who has passed away since the webinar, that patient groups and non-governmental organisations will be involved in AMA operationalisation.

“It would be a missed opportunity if we don’t even consult on the set-up terms. So when we have a draft ready, we would like to open for comments. We will ensure to reach out for input so that patients are effectively represented,” she said.

“[Patients’] lived condition can effectively contribute to setting the AMA systems. Whatever decisions made may directly impact on them.”

AMRH has been working on harmonised standards and regulations in the regional economic communities namely the East African community, Southern African Development Community (SADC), the Economic Community of West African States (ECOWAS), and the Economic Community of Central African States.

“We have tested harmonisation systems in the regional economic communities. They’re working. But we realise that there’s also a need for cross-leveraging and cross-harmonisation so that we look at Africa as a whole. Then move from the regional economic communities to one continent, especially when it comes to sharing of capacities across the regions,” said Chambimba.

To assist with the preparation of AMA, an Africa Regulatory Conference is being held from 12-15 September with the theme ‘Together for patients – Transforming the regulatory ecosystem in Africa’.

The AMA Treaty was adopted by the AU Assembly on 11 February 2019 and a minimum of 15 member states needed to ratify the AMA Treaty in their national parliaments for AMA to come into force.

Image Credits: Marco Verch/Flickr, Luigi Guarino .

 How history influences women’s health advocacy

How does the past tie into current health policy? At a time when women’s health and reproductive rights are being debated globally, it is important to examine how historic policies impact the world today.

In the latest episode of the Global Health Matters podcast, host Garry Aslanyan spoke with two sexual and reproductive health advocates.

Carmen Barroso, a lifetime advocate, researcher and implementer for sexual and reproductive health, talked about the importance of using history as a tool for current activists. “I think it’s crucial that current and future leaders look at history and learn the lessons, both from the mistakes and from what was achieved,” Barroso said. “What we’ve learned from sexual and reproductive health in the past is fundamental because it’s an area that always faced a lot of opposition.”

Now 78 years old, Barroso has worked with many campaigns and organizations throughout her life. In 1990, Barroso became Director of the Population and Reproductive Health Program of the MacArthur Foundation, where she provided support for women’s organizations in Latin America, Africa and Asia. Although retired now, she still participates in advocacy work.

Dakshitha Wickremarathne agreed on the great significance of past activists’ work, like Barroso, on the current public health climate. “When you look particularly at sexual and reproductive health and rights, there are a lot of old challenges historically coming up in our conversations which are also currently relevant,” Wickremarathne said.

Wickremarathne is a senior technical lead overseeing the implementation of FP2030’s Asia Pacific Hub at the UN Foundation, a global movement working to advance access to reproductive health services.

Aslanyan brought up the value of certain policies over the past few decades, specifically the Alma-Ata Declaration of 1978 and the 1994 Cairo Conference.

Both Barroso and Wickremarathne stressed the impact of the conferences on shaping the way sexual and reproductive health issues are framed — not just as a medical issue, but as a human rights issue.

“Women then became right-holders,” Barroso said. “They were no longer seen as just the uterus. They were human beings with multiple needs, responsibilities and rights. They had the right to decide.”

Policy is not the only influence on women’s health rights. Social factors change constantly, and it is important to look at surrounding issues in relation to sexual and reproductive health. “I think many other social movements and external factors, such as the racial justice movement, LGBTIQ rights movement, have also influenced the way we look at health,” Wickremarathne explained. “Not just from a very siloed approach, but from a very inclusive and intersectional approach.”

While some factors have remained prevalent throughout recent history, such as funding for sexual and reproductive health services, Wickremarathne also brought up facets unique to today which impact sexual and reproductive health policy, such as climate change, migration and refugee crises and technological and digital advances.

“So within this context, with all the old and new challenges, there is a lot for us to learn from the historical context and events and influences of global health,” Wickremarathne noted.

Although there is still a great deal of work to be done in women’s health rights, Barroso feels encouraged by how far the world has come in the past few decades. “If we only see the tremendous obstacles that are real and continue to exist, we lose perspective and we lose hope, and without hope, we don’t do anything.”

Read about and listen to more episodes on Health Policy Watch.

This article is part of our TDR Supported Series.

Image Credits: TDR.

DRC President Félix Tshisekedi (left) welcomed the appointment of the DRC’s Dr Jean Kaseya (right) as head of the Africa CDC.

Controversy continues to surround Dr Jean Kaseya, the new Director-General of the Africa Centres for Disease Control and Prevention (Africa CDC), although the organisation described the allegations as “unverified and baseless” over the weekend.

Last Friday, online platform Devex reported on a letter from a group of Africa CDC staff to the head of the African Union (AU) sent on 26 July accusing Kaseya of harassment, intimidation and “unlawful termination of staff contracts based on personal ego and interest”.

The anonymous group, calling itself the AU Leadership Focus Group, also alleged that Kaseya had requested irregular payments, was abusive to staff, failed to provide leadership and was trying to replace current staff with his “allies”.

Fall-out with former employer

This followed a report by Devex in June about Kaseya’s acrimonious fall-out with his former employer, the Clinton Health Access Initiative (CHAI) after it decided not to renew his contract as senior country director in the Democratic Republic of Congo (DRC). 

The Africa CDC’s 16-member senior management team issued its own letter last week in response to the staff allegations, describing them as “unsubstantiated”, calling on staff to use the centre’s grievance procedures and “institutional governance mechanism and control measures” to address their problems.

Over the weekend, the Africa CDC also issued a statement in which they described the allegations against Kaseya as “baseless” and questioned the motives of those making them.

“Unfortunately, over the past 100 days since the Director General took office, Africa CDC has noted a repetitive, deliberate and ill-intent smear campaign by a well-identified media house linked to anonymous entities, whose aim seems to destabilise the organisation by disseminating unverified and baseless allegations directed towards the leadership and staff of the organisation,” said the Africa CDC.

“The Africa CDC strongly condemns the smear campaigns and assures all staff, AU Member States, the AU family and our valued partners that the institution remains strong and focused on delivering on its mandate. Be assured, that the asserted crusades will never distract nor deter Africa CDC leadership and its staff from meeting its mandate in health security on the continent,” it added.

Controversial from the start

However, Kaseya’s four-year appointment has been dogged by controversy since he was appointed ahead of Dr Magda Robalo, the former health minister of Guinea-Bissau with extensive global health experience, who had been widely expected to succeed Dr John Nkengasong.

Kaseya was appointed by African Heads of State following an election that took place on the sidelines of the 36th session of the African Union, which was held in Addis Ababa, Ethiopia, 18-19 February. While a total of 180 candidates vied for the position, Kaseya and Robalo were the finalists for the position. 

In early March, Rwanda’s President Paul Kagame wrote a letter to the AU chairperson condemning the fact that, at the AU summit where Kaseya had been appointed, “no debate was allowed on the appointment of the Director General of Africa CDC, even though three member states had requested to speak”.

Writing in his capacity as leader of the AU institutional reform process, Kagame noted that this agenda item was the only one in which discussion was “forbidden”.

“Moreover, the report given by the legal counsel on the deliberations of the committee of the heads of state and government on the Africa CDC gave no indication for why the first ranked candidate, a woman, was not selected,” added Kagame, whose government has a tense relationship with the DRC.

“More troubling, besides yourself, no heads of state or government took part in the committee meeting, and delegated officials were mostly below ministerial level,” he added.

After Kaseya was appointed, a statement by DRC’s presidency described it as “an epilogue of a long, secret diplomatic battle waged for six months by President Félix Tshisekedi”.

DRC President Félix Tshisekedi congratulates the new Director General of the Africa CDC, DRC’s Dr Jean Kaseya.

Image Credits: DRC Presidency, Presidency, DRC.

The number of Sudanese facing hunger has doubled over the past year.

The number of people facing hunger in Sudan has doubled over the past year, with nearly over 42% of the country’s 46 million people facing high levels of food insecurity, a senior Food and Agriculture Organization (FAO) representative in the country said Friday.

“The food situation in the country is deeply alarming,” Adam Yao, FAO deputy representative in Sudan, told a press briefing in Geneva.

According to the latest IPC [Integrated food security report] the July-September 2023 projection is nearly double the number of food insecure people compared to the last analysis conducted in May 2022, said Yao, speaking remotely from Port Sudan after a tour of the affected regions.

“That means 20.3 million people in Sudan face a high level of acute food insecurity, making this one of the most food insecure countries on the planet.”

Some 14 million people, or 29% of the population, are at a food “crisis” level, he added, while more than 6.2 million people are a few steps away from famine.

In some south and western states, including parts of Darfur, more than half of the population is facing acute hunger, he said. “The situation is critical….  Families are facing unimaginable suffering and I’ve seen this with my own eyes.  They are destitute; they need help.”

Adam Yao, FAO deputy representative in Sudan, speaking to a Geneva UN press briefing from Port Sudan.

Emergency access ‘increasingly complex’ 

Since the conflict between rebel and government forces began in April, roughly 1.6 million people across Sudan have received World Food Programme assistance, with roughly 150,000 people on the outskirts of Khartoum currently receiving aid.

But access everywhere remains challenging. Getting emergency food supplies to people trapped in conflict-ridden rural regions is becoming “increasingly complex,” said Eddie Rowe, Country Director of the World Food Programme (WFP) for Sudan, also speaking from Port Sudan.

He described the situation around Darfur as “catastrophic” with women and children, abandoned by husbands and fathers who had been killed, injured or gone missing, too scared to flee to safer areas. Only last week, WFP reached West Darfur for the first time and assisted over 15,000 people, via a route from Chad, he said.

Supporting small farmers

On the brighter side, FAO had nearly completed its ambitious goal of distributing emergency crop seed to an estimated one million farmers. “With over 650,000 farmers reached, the 2023 November harvest is well positioned to meet the cereal needs of millions of people across Sudan,” Yao said. Beyond the current campaign, FAO aims to reach 1.3 million pastoralists with livestock services and inputs to strengthen the nutrition and food security of 6.5 million people.

The success of the campaign is a reminder of the importance of agriculture as a cost-efficient frontline humanitarian intervention to reduce vulnerability and strengthen food and nutrition security, Yao stressed. It also underscored the importance of localised solutions to hunger and food insecurity.

Image Credits: World Food Programme.

Preparation of herbal prescriptions at a traditional Chinese medicine clinic in Simao, Yunnan Province, China

PUNE, India – The first global summit to explore the role of traditional, complementary, and integrative medicine in addressing health challenges is being convened in India next week by the World Health Organization (WHO).

The WHO Traditional Medicine Global Summit will be co-hosted by the Indian government in Gandhinagar on 17 and 18 August.

“Advancing science in traditional medicine should be held to the same rigorous standards as in other fields of health,” said Dr John Reeder, WHO’s Research Director and Director of the Special Programme for Research and Training in Tropical Diseases, at a press briefing about the summit on Thursday.

“This may require new thinking on the methodologies to address these more holistic, contextual approaches and provide evidence that is sufficiently conclusive and robust to lead to policy recommendations,” added Reeder.

He said that there was already a lot of evidence of the efficacy of some traditional medicine: “This is the heart of it; we need to treat traditional interventions with the same respect we give to other more Western medical interventions and that means examining them closely and critically and scientifically in the same way.”

Around 40% of pharmaceutical products are drawn from nature and traditional knowledge, including landmark drugs such as aspirin, artemisinin, and childhood cancer treatments. The scientists behind them used traditional knowledge to achieve their breakthrough discoveries, WHO said in a press statement.

Dr Shyama Kuruvilla, WHO lead for the Global Traditional Medicine Centre

Demand from member states

“Bringing traditional medicine into the mainstream of health care – appropriately, effectively, and above all, safely based on the latest scientific evidence – can help bridge access gaps for millions of people around the world.  It would be an important step toward people-centred and holistic approaches to health and well-being,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus in a statement on Thursday.

Meanwhile, Dr Shyama Kuruvilla, WHO lead for the Global Traditional Medicine Centre, told the media briefing that the summit aimed to ” support member states to support populations who want to learn and use evidence-based safe, effective traditional medicine for their health and well-being”.

She added that the demand for the summit came from the member states, and 170 of WHO’s 194 member states have reported that their citizens use traditional treatments including herbal medicines, acupuncture, yoga and indigenous therapies.

In many places, traditional medicine represents a significant part of the health sector’s economy. For millions living in remote and rural areas, traditional medicine is often the only culturally acceptable, available and affordable care, and countries have taken steps to integrate the practices, products and practitioners into their national healthcare systems.

Complementary roles

Dr Kim Sungchol, head of the WHO’s Traditional, Complementary and Integrative Medicine Unit said that the summit will help WHO understand the needs of the member states and guide policy.

“Many systems of traditional medicine have a more holistic approach (than modern medicine). That’s why they are much more advanced in health promotion and disease prevention, particularly lifestyle-related non-communicable disease,” Sungchol said.

Reeder added that the WHO wanted to develop methodologies to examine traditional medicine and practices to “produce robust evidence” about what works and what doesn’t.

WHO has been working on traditional medicine since 1976, responding to requests from countries for evidence and data to inform policies and practices and to set global standards and regulations to ensure safety and quality.

Results from the WHO’s third global survey on traditional medicine will be released during the summit.

Heads of State and governments at the 2019 UN high-level meeting on universal health coverage acknowledged the need to include evidence-based traditional and complementary medicine services, particularly in primary health care.

Participants at next week’s summit will include WHO Director-General Dr Tedros Adhanom Ghebreyesus and regional directors, health ministers of the G20 countries; scientists, practitioners of traditional medicine, health workers and members of civil society organisations.

Image Credits: Simon Lim/ WHO-TDR.

Informal neighbourhood on the periphery of Lima, Peru during a heat wave in April 2022. Vast areas of concrete and tin roofs exacerbate the urban heat island effect.

Mayors and other municipal officials should develop “urban heat maps” to identify and protect those most vulnerable to high temperatures, World Health Organization (WHO) official Maria Neira urged on Wednesday.

Many people in urban areas stifling under heat waves cannot afford cooling systems while conditions for outdoor workers not protected by legislation have become dangerous, added Neira, WHO Director of Public Health, Environmental and Social Determinants of Health.

She told the WHO’s weekly media briefing that people needed to be educated to recognize the signs of heat exhaustion and heat stroke.

Dr Maria Neira, director, Climate, Health & Environment.

Fulfilling early predictions, July has now been confirmed as the hottest month on record globally. It was 0.33°C warmer than the warmest month previously recorded in July 2019 and 0.72°C warmer than the 1991-2020 average for July, according to the European Commission’s Copernicus Climate Change Service.

While both urban and rural dwellers are affected by heat waves, typically, temperatures in cities can be 5-8° C higher than those in surrounding rural areas due to the . 

El Niño to heat world further

Surface air temperature anomaly for July 2023 relative to the July average for the period 1991-2020.

Meanwhile, the confirmation of an El Niño weather event by the World Meteorological Organization (WMO) last Friday is expected to further exacerbate the earth’s climate-change-related heating.

El Niño is a naturally occurring climate pattern that happens roughly every seven years when the warming of the ocean’s surface in the central and eastern tropical Pacific causes disruptive weather in far flung regions of the world.

“The onset of El Niño will greatly increase the likelihood of breaking temperature records and triggering more extreme heat in many parts of the world and in the ocean,” Petteri Taalas, WMO’s Secretary-General, said in a statement last Friday. 

“The declaration of an El Niño by WMO is the signal to governments around the world to mobilize preparations to limit the impacts on our health, our ecosystems and our economies,” Talaas warned. 

“Early warnings and anticipatory action of extreme weather events associated with this major climate phenomenon are vital to save lives and livelihoods.”

Mosquito-borne illnesses

Dengue virus, one of the best-known arboviruses, has resurged in the past several decades, becoming a major risk factor in cities, where infected mosquitoes breed in containers of stagnant water.

The increase in temperature and shifting rainfall has already seen a change in disease patterns – with extremely high rates of mosquito-borne dengue in the Americas – as well as warnings of  a  risk of possible dengue cases in Europe.

The warmer temperatures are allowing the Aedis aegypti mosquito, which transmits dengue, to thrive for longer periods and extend their mating season, allowing the mosquitoes to reproduce in greater numbers. 

However, Mike Ryan, the WHO’s executive director of health emergencies, warned that the behaviour of the Aedes aegypti mosquito and the Anopheles mosquito, which is a leading vector of malaria, are different and needed to be tackled differently.

The Aedes mosquito, which also transmits yellow fever and chikungunya, is active during the day whereas the Anopheles mosquito is active in the evening.

Mike Ryan, executive director of WHO Health Emergencies.

“The intervention we have in place for preventing malaria in kids is very often bed nets, but it doesn’t work as effectively when the mosquito transmitting the virus is biting during the day,” said Ryan, adding that Aedes aegypti breed in still water rather than rivers.

“Climate change is changing the zones in which these mosquitoes can survive and breed. Its changing characteristics are associated with the virus itself”, Ryan added 

“It’s changing human behaviour. It’s changing human migration. So what climate is doing is driving all of those factors in a way that’s very unpredictable and the outcomes we can’t predict very well,” he said.

Addressing the causes of climate change

Expansion of extremely hot regions in a business-as-usual climate scenario. Black and hashed areas represent unliveable hot zones. Absent migration, that area would be home to 3.5 billion people in 2070.

Meanwhile, the WHO’s COVID-19 lead, Maria van Kerkhove, stressed that countries need to use the systems developed over the past three years during the pandemic to address climate-related health challenges.

“Countries have worked incredibly hard to build those systems and strengthen systems for COVID. But those could also be used for other diseases,” she said, also speaking at the briefing. 

And Sylvie Briand, WHO’s Director of Epidemic and Pandemic Preparedness and Prevention, added that member states should use the Health Emergency Preparedness and Response Framework to address emerging diseases and new threats.

The framework was based on “the five C’s”, added Briand.These are collaborative surveillance, community protection, clinical care, access to countermeasures, and coordination.

Ahead of the upcoming UN Climate Change Conference (COP28) to be held in Dubai in December, Neira said the international community needs to focus more on preparing health systems to cope and adapt. “In addition, we need to look at mitigating the causes of climate change.” 

She said health and finance ministers will be invited to COP28 to discuss resources that will be required  “to be better prepared to cope with issues such as an increase of 35% in the population at risk of dengue in Southeast Asia, or at risk of malaria in places where we didn’t see it before.

“We [also] need to protect against the horrible consequences of air pollution ,which is killing seven million people every year; more sustainable…food systems, and of course better planning at the urban level,” she said warning:

“Climate change is already here.”

Image Credits: Paula Dupraz-Dobias, Copernicus Climate Change Service/ECMWF, PNAS.

Transgender rights
International events in solidarity with the Ugandan LGBTI community have been held across the world.

The World Bank’s decision to suspend new public loans to Uganda after the country passed its Anti-Homosexuality Act in March should serve as a warning to other countries contemplating passing similar discriminatory laws, according to human rights activists. 

“Other countries considering similarly discriminatory laws should take notice of the World Bank’s decision and the negative economic impact on their economies. Open and inclusive societies are better for business and better for economic growth,” said Clare Byarugaba, a local activist from the civil liberties group Chapter Four Uganda.

The Kenyan and Ghanaian parliaments are currently considering anti-homosexuality laws, while the governments of Tanzania and Ethiopia are clamping down on LGBTQ people.

The World Bank’s decision “is an important step by the international financial institution to respond to the pernicious impacts of the Act,” added Byarugaba, who is also co-convenor of the Convening For Equality Coalition (CFE), an alliance of LGBTIQ+ members and allies working for equality in Uganda.

The World Bank noted in a statement released on Tuesday that Uganda’s Anti-Homosexuality Act “fundamentally contradicts” its values, adding: “We believe our vision to eradicate poverty on a livable planet can only succeed if it includes everyone irrespective of race, gender, or sexuality.”

The World Bank sent a team to Uganda to review its portfolio of loans after the Act was passed to decide whether “determined additional measures are necessary to ensure projects are implemented in alignment with our environmental and social standards”.

“Our goal is to protect sexual and gender minorities from discrimination and exclusion in the projects we finance. These measures are currently under discussion with the authorities,” the bank stated. “No new public financing to Uganda will be presented to our Board of Executive Directors until the efficacy of the additional measures has been tested.” 

But Frank Mugisha of Sexual Minorities Uganda (SMUG) and the other CFE co-convenor, said that “there are no ‘additional measures’ which can make this law acceptable”.

Violation of patient confidentiality

On Tuesday, Uganda’s Ministry of Health issued a press statement noting that the country’s Constitution recognises that access to health is a “fundamental right” and that the Ministry is mandated to provide health services without discrimination.

It “reiterated” that health workers could not deny health services to anyone, had to deliver these without stigma or discrimination – including for sexual orientation, and respect patient confidentiality.

However, the Anti-Homosexuality Act specifies that everyone has a duty to report “acts of homosexuality” to the Ugandan police and that those usually “prevented by privilege” from making disclosures without consent shall be “immune from any actions” arising from their report – thus dispensing with patient confidentiality, as well as attorney-client privilege.

Extract from Uganda’s Anti-Homosexuality Act, which indemnified health workers who break patient confidentiality.

Mugisha dismissed the Health Ministry’s reassurance “to international funders of a commitment to non-discrimination in healthcare”, saying that “the lived reality for LGBTIQ Ugandans living under this law tells a very different story – one filled with discrimination, fear and violence because of this law and those who support it”. 

“The only way forward is for Uganda’s courts to stand up for the principle of non-discrimination, already enshrined in our Constitution, and rule that the law is unconstitutional as soon as possible,” said Mugisha.

Uganda’s $500 million grant from the US President’s Emergency Plan to Fight AIDS (PEPFAR) has also been suspended – although it is likely to go ahead, albeit with some changes. Over 90% of Ugandans with HIV rely on PEPFAR-sponsored anti-retroviral treatment.

Meanwhile, the World Health Organization’s (WHO) Dr Mike Ryan, executive director of health emergencies, expressed his solidarity with Ugandans.

Ryan, who told a media briefing on Wednesday that he wears a rainbow-coloured lanyard every day in solidarity with people facing discrimination on the basis of their sexual orientation or gender, was emphatic that the Anti-Homosexuality Act would impact health service delivery.

Mike Ryan says he wears a rainbow-coloured lanyard in solidarity with “all people in the WHO, UN system and everywhere” who face discrimination on the basis of their sexual orientation or gender.

“Any law that criminalises the behaviour, or criminalises a sexual preference or orientation, must ultimately end in the lack of access to health care or decreased access to health care, and WHO condemns that form of discrimination,” said Ryan.

“We act in solidarity with all those who lack access to health services all over the world for so many different reasons. And in particular, we want to assure our solidarity,” he said. “We stand as one with with with people in Uganda and any other country who are discriminated against for reasons of their sexual preference.”

Image Credits: Peter Tatchwell Foundation, Alisdare Hickson/Flickr.

Professor Preban Aavitsland, head of the review committee that advised WHO on the standing recommendations.

The World Health Organization (WHO) has issued new standing recommendations for COVID-19 for member states, now that the virus outbreak is no longer classified as a pandemic.

The recommendations are seven-fold, WHO Director-General Dr Tedros Adhanom Ghebreysus told a media briefing on Wednesday.

“First, all countries should update their national COVID-19 programmes using the WHO preparedness and response plan to move towards longer-term sustained management of COVID-19,” said Tedros.

“Second, we urge all countries to sustain collaborative surveillance for COVID-19 to detect significant changes in the virus, as well as trends in disease severity and population immunity.

“Third, all countries should report COVID-19 data to WHO or in open sources, especially on death and severe disease, genetic sequences and data on vaccine effectiveness.”

Only 25% of countries are still reporting deaths to the WHO, while just 11% continue to report on hospitalisations to the UN health body.

The remaining points request that countries continue to offer COVID-19 vaccinations; conduct research to generate evidence for COVID-19 prevention and control; deliver optimal clinical care for COVID-19; and ensure “equitable access to safe, effective and quality assured vaccines, tests and treatments for COVID-19”.

“The main approach, moving forward, involves immunising those who are most vulnerable to severe outcomes and providing effective treatment for those who become infected,” said Professor Preban Aavitsland, head of the review committee that advised WHO on the standing recommendations.

“Repeated infections among low-risk individuals will contribute to maintaining population immunity, although new waves of infection are possible, due to waning immunity and evolution of new variants,” said Aavitsland, who heads the Department of Global Public Health and Primary Health Care at the University of Bergen in Norway.

“Most people, however, remain at a very small risk of severe COVID-19 disease,” he said. 

One sample of Cold Out cough syrup was found to have unacceptable amount of DEG, as per WHO alert.

Adding to the spate of contaminated medicines linked back to India, the World Health Organization (WHO) has flagged another cough syrup for the presence of contaminants. 

This is the fifth medical product alert for an Indian formulation issued by the WHO since October 2022. 

“A sample of the Cold Out Syrup was obtained from one location in Iraq and submitted for laboratory analysis. The sample was found to contain unacceptable amounts of diethylene glycol (0.25%) and ethylene glycol (2.1%) as contaminants,” the WHO medical product alert issued on 7 August said. The acceptable amounts of both substances in cough syrups is up to 0.10%. 

The syrup is generally used in Iraq to treat and relieve symptoms of common cold and allergy. The WHO tested a sample from a specific batch of the syrup after it received a report on 10 July about possible contamination. The cough syrup was manufactured by Fourrts  Laboratories (India), on behalf of another Indian company, Dabilife Pharma, the WHO added. 

Since October 2022, the WHO has issued four medical product alerts concerning at least eight liquid medical formulations manufactured in India. In October 2022, the WHO reported that at least 66 children in the Gambia died after consuming cough syrups manufactured in India. 

Most recently, WHO’s Africa region reported that cough syrup laced with high amounts of Diethylene glycol (DEG) – as much as 28.6% – were found in samples of NATURCOLD sold in Cameroon.

While the product alert stated that the agency is unclear about the real manufacturer of the product, Reimann Labs, an Indian pharmaceutical company that was allegedly the manufacturer of the tainted product found in Cameroon, was ordered to shut down production by the Indian drug regulators. 

When cough syrup is manufactured, it needs a solvent to dissolve all its active ingredients, add sweetness, and act as a lubricant. Either glycerine or propylene glycol are usually used, with Glycerine Indian Pharmacopoeia (IP) the grade used in drugs and medicines. 

The cheaper industrial glycerine, which can contain DEG and ethylene glycol, is supposed to be used only in chemicals and cosmetics, according to the good manufacturing practice framed by the WHO. 

While many generic medicines are made in India, the country generally lacks the capacity to conduct rigorous checking of much of the medicine that is produced.

Image Credits: WHO.