Shoppers wear masks in Guangzhou, China.

Unusual outbreaks of respiratory illness and pneumonia in Chinese children have prompted the World Health Organization (WHO) to ask the country for detailed information. 

Children’s hospitals in Beijing and Liaoning Province, some 800km apart, are “overwhelmed with sick children, and schools and classes were on the verge of suspension”,  according to local Chinese media, as reported by ProMed International Society for Infectious Diseases.

Beijing Children’s Hospital was overcrowded with parents and children with pneumonia, according to ProMed.

 “Many, many are hospitalized. They don’t cough and have no symptoms. They just have a high temperature (fever) and many develop pulmonary nodules,” according to a resident quoted in the report.

The lobby of Dalian Children’s Hospital in Liaoning Province is full of sick children receiving intravenous drips, according to ProMed.

Meanwhile, local authorities in Shandong Province in north-eastern China have advised people to wear masks and get influenza vaccinations, according to Nikkei Asia.

At a press conference on 13 November 2023, the Chinese National Health Commission reported an increase in the incidence of respiratory diseases in China at a media briefing on 13 November, according to the WHO.

They attributed this to “the lifting of COVID-19 restrictions and the circulation of known pathogens such as influenza, mycoplasma pneumoniae (a common bacterial infection which typically affects younger children), respiratory syncytial virus (RSV), and SARS-CoV-2 (the virus that causes COVID-19)”.

On Wednesday, the WHO “requested additional epidemiologic and clinical information, as well as laboratory results from these reported clusters among children, through the International Health Regulations mechanism”, said the WHO in a statement.  

Influenza-like

“We have also requested further information about recent trends in the circulation of known pathogens including influenza, SARS-CoV-2, RSV and mycoplasma pneumoniae, and the current burden on health care systems. WHO is also in contact with clinicians and scientists through our existing technical partnerships and networks in China.”

The WHO also notes that since October, northern China has reported an increase in influenza-like illness compared to the same period in the previous three years. 

“While WHO seeks this additional information, we recommend that people in China follow measures to reduce the risk of respiratory illness, which include recommended vaccination; keeping distance from people who are ill; staying home when ill; getting tested and medical care as needed; wearing masks as appropriate; ensuring good ventilation; and regular hand-washing,” said the WHO.

The first cases of COVID-19 were detected in Wuhan in central China in December 2019, and by March 2020, the WHO declared a pandemic. That was caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which originated in bats.

Image Credits: China News Service／中国新闻网, Flickr: ZhiZhou Deng.

One-third of people in 14 countries in the Western Balkans, the Caucasus and Central Asia used antibiotics without a medical prescription, according to a survey released on Wednesday by the World Health Organization’s (WHO) European Region.

The survey involved 8221 participants, half of whom reported taking oral antibiotics in the past 12 months. 

Participants came from Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Georgia, Kazakhstan, Kyrgyzstan, Montenegro, North Macedonia, Moldova, Tajikistan, Türkiye and Uzbekistan. 

The most common reasons cited for taking the antibiotics were colds (24%), flu-like symptoms (16%), sore throat (21%) and cough (18%). These are often caused by viruses unaffected by antibiotics. 

Across the 14 countries, a third (33%) of respondents consumed antibiotics without a medical prescription, in contrast to 8% of residents in the European Union polled in a similar survey in 2022.

In some countries, more than 40% of the antibiotics were obtained without medical advice.

“Medical expertise is essential to make a correct diagnosis and determine whether antibiotics are the right course of treatment,” WHO Europe stressed.

For some years, the WHO has urged cautious use of antibiotics as pathogens are increasingly developing resistance to them, known as antimicrobial resistance (AMR).

This week is Global AMR Awareness Week. AMR causes an estimated five million deaths annually, with more than half a million deaths occurring in the WHO European Region, which comprises 53 Member States in Europe and Central Asia.  

Different types of antimicrobials – such as antibiotics for bacteria, antivirals for viruses and antifungals for fungi – target specific types of microorganisms. While AMR is a natural phenomenon, the development and spread of superbugs are being accelerated by the misuse of antimicrobials, rendering infections more challenging to treat effectively.  

“The alarming reality is that, without immediate intervention, AMR could result in up to 10 million deaths a year by 2050. Moreover, this burden falls disproportionately on low- and middle-income countries, exacerbating global health inequalities,” according to WHO Europe.

“This research clearly shows the need for education and awareness raising,” said Robb Butler, Director of WHO Europe’s Division of Communicable Diseases, Environment and Health. “All countries in our region have regulations in place to protect precious antibiotics from misuse, for example, preventing over-the-counter sales without a prescription. Enforcing these regulations would solve most antibiotic misuse among humans.”

Image Credits: AMR Industry Alliance.

Pregnant women, newborns and young children are uniquely vulnerable to the effects of climate change.

If government subsidies for fossil fuel were removed and redirected to addressing the impact of climate change on health, this would free up some $6 trillion or 75% of what is spent on health annually, said Agnes Soucat from the French Development Agency.

Soucat also called for scrutiny of agricultural subsidies “and how they contribute to our food system, and how this contributes to biodiversity loss and health impacts, such as impact on diabetes and cardiovascular diseases”.

Governments should eliminate the “harmful subsidy mechanism to reduce or suppress the adverse effect on the environment, animal and human health”, and substitute it with “smart environment and health taxation for one sustainable planetary health”, such as taxes on fossil fuel andcarbon, she proposed.

Soucat also pointed out there there are over 500 public investment banks worldwide with  $2.5 trillion of public investments. If only 10% was “mobilised” for investment in health, this would represent 10 times what is currently available in development aid.

Agnes Soucat from the French Development Agency (AFD).

Soucat was addressing Tuesday’s launch of a Call for Action for policies and action to protect pregnant women, babies and children from climate-related health risks, by United Nations (UN) agencies ahead of the global Conference of the Parties (COP28) negotiations on climate change in Dubai.

According to the Call, climate response policies should prioritise pregnant women, newborns and children, who are particularly vulnerable.

Babies more at risk from air pollution

UNICEF’s Abheet Solomon pointed out that babies “breathe more rapidly than adults while their lungs are still developing”, and this puts them at a greater risk of developing respiratory illnesses when exposed to air pollution.

“This is why, every day 1000 newborns die, simply because of air pollution-related risks,” said Solomon.

“Infants are less able than adults to regulate body temperatures and have a higher metabolic rate, meaning that they’re more susceptible to the effects of extreme heat,” he added. UNICEF estimates that one in three children are currently “highly exposed to heat waves”.

Children’s under-developed immune systems also put them at greater risk of infectious diseases, including malaria and dengue. Meanwhile, children are also vulnerable to natural disasters – one-third of deaths in the recent floods in Pakistan were children.

“When pregnant and lactating mothers are exposed to climate shocks and stresses, the negative effects not only affect their health, but also foetal development,” said Solomon.

UNFPA’s Wllibald Zeck stressed the importance of protecting vulnerable women and girls in the poorest countries who were heavily affected but contributed the least to climate change.UNFPA was also concerned about disruptions to sexual and reproductive health services.

“Climate change is affecting the health of all of us – infectious diseases, non-communicable diseases mental health, of course, heat waves, malnutrition, displacement – everything,” said Maria Neria, the World Health Organization’s (WHO) director of environment.

“It took us at least 10 years to make sure that we have a health day at COP,” added Neria, in reference to 3 December being set aside at COP28 to discuss health and climate.

After this, “no country has an excuse for saying they didn’t know” about the effects of climate on health, said Neria. She  added that the WHO was also pushing for governments to ensure that their health systems are climate-resilient and to mobilise finances to respond to the climate “shock”.

“The causes of climate change and the causes of air pollution, which is killing seven million people every year, are overlapping and relate to the combustion of fossil fuels,” said Neria. “This dependence on fossil fuels needs to stop.” 

The Call to Action was released by WHO, UNICEF and UNFPA alongside an advocacy brief by the Partnership for Maternal, Newborn and Child Health (PMNCH).

The PMNCH advocacy brief reinforces the Call to Action by outlining specific recommendations for different stakeholders – including governments, global financing mechanisms, donors and foundations, private sector and civil society – for ensuring that the health needs of women, children and adolescents are better addressed in climate policies, financing, and programmes.

Image Credits: Michael Duff/ UNFPA.

People seeking shelter at a refugee near the Chad border with Sudan. 

Following seven months of fighting in Sudan, there are outbreaks of cholera, measles, malaria and dengue in the country.

An estimated 6.2 million people – about one in eight – have been forced to flee from their homes since the fighting between the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF) started in mid-April, according to the UN Office for the Coordination of Humanitarian Affairs (OCHA).

About three million of the displaced people are children, the largest child displacement crisis in the world.

The Office of the High Commission for Human Rights OHCHR has also raised concerns about women and girls being abducted, forcibly married and held for ransom.

“Disease outbreaks are increasing due to the disruption of basic public health services, including disease surveillance, functioning public health laboratories and rapid response teams,” said OCHA in its latest update released on Sunday.

“In addition, insecurity, displacement, limited access to medicines, medical supplies, electricity, and water continue to pose enormous challenges to delivering health care across the country.”

No healthcare services

OCHA estimated that 65-70% of the population lacks access to healthcare, while 70-80%  of hospitals in conflict-affected areas are no longer functional. 

Meanwhile, almost 3,000 suspected cases of cholera, including 95 deaths, have been reported from seven states as of 12 November, according to the Federal Ministry of Health and the World Health Organization (WHO). Other disease outbreaks are ongoing in several states, including measles, malaria and dengue.

Almost 3,000 suspected cases of cholera, including 95 deaths, have been reported from seven states by 12 November, according to the Federal Ministry of Health (FMoH) and the World Health Organization (WHO). Other disease outbreaks are ongoing in several states, including measles, malaria and dengue.

Twenty million people face hunger

Meanwhile, the World Food Programme (WFP) has warned that “over 42% of Sudan’s population – more than 20 million people – face hunger. This is the highest number ever recorded in the country”.

“In addition to conflict, increasing food and fuel prices, the pre-existing economic crisis, protracted displacement, poor harvests and climate shocks, such as floods and droughts, are the main drivers of food insecurity,” reports the WFP, noting that 2023 food prices are 29% higher than last year and 228% higher than two years ago.

UN agencies and NGO partners in the country report that they have only received one-third of the funding that they need to implement the 2023 Sudan Humanitarian Response Plan – $856.2 million of the required US$2.6 billion. 

An estimated 18.1 million people need assistance but humanitarian organisations have reached about 4.5 million people with multi-sectoral life-saving assistance and 5.5 million people with livelihood support since the start of the conflict. 

 

Image Credits: World Food Programme.

Emission
“Present trends are racing our planet down a dead-end 3C temperature rise,” UN Secretary-General Antonio Guterres said on Monday.

The world is on a trajectory to heat up by nearly 3°C this century unless governments take “relentless” action to cut greenhouse gas emissions, according to a new report released Monday by the United Nations Environment Programme (UNEP).

The Emissions Gap report, an annual assessment by UNEP that measures the difference between government pledges to combat climate change and the emissions reductions scientists say are necessary to avert planetary catastrophe, found that current policies are leading to between 2.5°C and 2.9°C of warming above pre-industrial levels by 2100. 

A 3-degree Celsius warming scenario would unleash a cascade of catastrophic consequences, including the displacement of over a billion people, the collapse of ice caps leading to uncontrollable sea level rise, widespread biodiversity loss, frequent and devastating extreme weather events, and the endangerment of critical carbon sinks like the Amazon and Congo Basin rainforests.

The average daily global temperature surpassed 2°C above pre-industrial levels for the first time ever on Friday, marking a historic milestone in the escalating climate crisis as world leaders prepare to gather in Dubai for the annual UN climate summit later this month. 

The 2.06°C average global temperature recorded by the European Union’s Copernicus climate change service on November 17.

“Humanity is breaking all the wrong records when it comes to climate change,” said Inger Andersen, Executive Director of UNEP. “The world must change track, or we will be saying the same thing next year — and the year after, and the year after, like a broken record.” 

The report determined that projected 2030 emissions must be slashed by at least 28-42% compared to current policy scenarios to align with the 2°C and 1.5°C goals of the Paris Agreement, respectively. Even if governments were to fully implement their Nationally Determined Commitments (NDCs) under the Paris Agreement – a big if – warming would still reach 2.9°C, according to the report. 

The current emissions trajectory will see the world exceed the emissions threshold required to meet the 1.5C target by around 22 gigatonnes in 2030 – roughly equivalent to the combined emissions of the United States, China and the European Union. 

“The emissions gap is more like an emissions canyon — a canyon littered with broken promises and broken lives,” UN Secretary-General Antonio Guterres said in a media briefing on Monday. “All this is a failure of leadership and a betrayal of the vulnerable.”

Global GHG emissions under different scenarios and the emissions gap in 2030 and 2035.

Anne Olhoff, the report’s lead scientific editor, stated that the findings remain “essentially unchanged” from last year’s report. The 2022 edition found “no credible pathway” to 1.5°C and concluded that “inadequate progress on climate actions means the rapid transformation of societies is the only option.”

“The only way to maintain a possibility of achieving the temperature goal of the Paris Agreement is to relentlessly strengthen mitigation actions this decade,” said Olhoff. “All countries must urgently accelerate economy-wide low carbon transformations and the transformation of global energy systems.”

With the window of opportunity to avert the worst effects of climate change rapidly narrowing, the reduction targets outlined in the report currently appear far out of reach. In 2022, global greenhouse gas emissions rose by 1.2%, setting a new record of 57.4 Gigatonnes in the planet’s atmosphere. Current projections indicate a mere 2% decline in global emissions from 2019 levels over the same period.

Governments worldwide are planning to produce 110% more fossil fuels in 2030 than is compatible with the 1.5°C target, while the top 20 oil and gas companies alone plan to produce emissions 173% above the 1.5°C target in 2040, according to recent reports by the UN and medical journal The Lancet.

This surge in coal, oil, and gas extraction by governments and private sector fossil fuel companies is set to unleash over 3.5 times the carbon emissions allowed under the 1.5°C warming limit and nearly exhaust the entire carbon budget for 2°C, according to UNEP.

Committed CO2 emissions from existing fossil fuel infrastructure, compared with carbon budgets reflecting the long-term temperature goal of the Paris Agreement.

“Governments can’t keep pledging to cut emissions under the Paris Agreement and then greenlight huge fossil fuel projects,” said Andersen. “It is throwing the global energy transition and humanity’s future into question.”

When the Paris Agreement was ratified in 2015, the probability of global average annual temperatures temporarily surpassing 1.5°C was close to zero. Today, those odds have ballooned to 50% for the 2022-2026 period, according to the World Meteorological Organization (WMO). 

The most optimistic emissions scenario outlined in the Emissions Gap report puts the chance of keeping annual global temperatures below 1.5°C at a mere 14%. The worst-case emissions scenario presented an upper limit of 3.8°C of warming, more than doubling the 1.5°C target set by the Paris Agreement.

“We know it is still possible to make the 1.5°C limit a reality, and we know how to get there,” said Guterres. “We have roadmaps from the International Energy Agency and the IPCC — and it requires tearing out the poison root of the climate crisis: fossil fuels.”

Global greenhouse gas emissions hit a new record of 57.4 Gigatonnes in the planet’s atmosphere in 2022.

A single pyrrhic victory is hidden beneath the gloomy findings of the UNEP report: the Paris Agreement has spurred some, albeit wholly insufficient, action on climate change.

Global greenhouse gas emissions, which were projected to rise by around 16% by 2030 at the time of the Paris Agreement, are now on track to increase by just 3% compared to 2015 levels. Since 2015, a total of 149 signatory countries to the agreement have updated their climate commitments, with nine countries doing so since COP27 in Egypt last year.

These nine countries’ commitments will lead to a reduction of around 0.1 Gigatonnes of emissions. However, to achieve the 2°C pathway, the world must reduce emissions by 18 Gigatonnes, while a 29 Gigatonne decrease is necessary to stay on track for 1.5°C.

Despite the Paris Agreement’s modest progress, the world continues to fall behind on climate action, and records are being broken at an almost monthly rate.

In September 2023, global average temperatures reached 1.8°C above pre-industrial levels, surpassing the previous record by an unprecedented 0.5°C. According to the European Union’s Copernicus Climate Change Service, this year is almost certain to be the warmest on record.

“Leaders cannot delay any longer; we are out of road. COP28 must set us on a path to immediate and dramatic climate action,” said Guterres. “The crucial aspect is our addiction to fossil fuels. It is time to establish a clear phase-out with a time limit linked to 1.5°C.”

Image Credits: UNEP.

A doctor in the DRC examines a patient. Working conditions for doctors are extremely challenging in many African countries.

As the Global North poaches African doctors, healthcare falls to overworked and unmentored interns, some of whom learn medical procedures from YouTube.

Fifteen of the world’s (fiscally) richest countries have over 55,000 African doctors in their health systems, a new data analysis by The Continent shows. These are doctors who qualified before entering those countries. 

The United Kingdom is the top culprit, followed by the United States, France, Canada, Germany and Ireland, in that order. 

Of the African countries being drained of doctors, an analysis of the latest data from the Organisation for Economic Cooperation and Development shows that Egypt has lost the most, followed by Nigeria, South Africa, Algeria and Sudan. 

These countries have consequently paid a significant price in the quality of healthcare they can offer their own residents. 

Egypt, for example, has the lowest doctor-to-patient ratio of its north African neighbours. In many of the drained countries, there are so few trained doctors left that the bulk of healthcare falls to doctors in training: medical interns. 

‘Treated like we are nobody’

Research in Uganda and Kenya details the cost to those interns. The study titled “We were treated like we are nobody” was published this month in the British Medical Journal for Global Health and is based on data on more than 700 medical interns in the two countries, as well as interviews with 54 junior doctors and 14 consultant physicians.

It found that medical interns are suffering from burnout and stress because they are working unreasonable hours and frequently don’t have superiors to train and supervise them. Their working conditions continue to have the same challenges that drive more experienced doctors to seek greener pastures. 

The research found that the lack of support and supervision also “threatened individuals’ well-being and the quality of care being delivered”. 

“Many reported working unreasonable hours – as long as 72 hours – due to staff shortage,” according to Yingxi Zhao, one of the researchers. 

“Sometimes interns were the only staff managing the wards or had to perform certain procedures unsupervised. These included cases where interns had to learn how to perform Caesarean sections from YouTube.” 

Threat to patients’ and doctors’ lives

Such conditions threaten not just the lives of patients but the trainee doctors too. Research by the World Health Organization (WHO) found that people who work 55 or more hours a week had a 35% higher risk of suffering a stroke and a 17% higher risk of dying from ischemic heart disease, compared to those who worked 35-40 hours. 

The Kenya and Uganda findings echo those of a Nigeria study published in May in the Public Library of Science journal. 

Researchers interviewed 628 early career doctors and nearly 40% said they felt overwhelmed by their work. About 16% said they wanted to quit the profession and twice as many said they experienced anxiety. 

The researchers in both studies recommend capping the hours that medical interns and junior doctors work. But limited training facilities and continuing brain drain make the doctor-to-patient ratio so low that reducing working hours is all but impossible. 

By a large margin, the best doctor-to-patient ratios are in Libya and Algeria – 22 and 17 doctors for every 10,000 residents respectively. But even Libya and Algeria compare poorly to the top importers of African doctors, the UK and US, which have between 32 and 37 doctors for every 10,000 people. 

To a doctor looking for a liveable work-life balance, going to the Global North is a no-brainer. 

Lucy Nyokabi, a medical trainee at a Nairobi hospital, says her workload is overwhelming and she often doesn’t have safety equipment or the supplies to do the job properly, like oxygen masks.

“My family supports me in getting the things that I need for the job. I have to remind myself that I need this training to excel at the actual job,” she says.

This makes leaving attractive: “We all hope to work outside the country. I believe the conditions are better out there.” 

First published in The Continent. Subscribe to this free weekly newspaper by emailing read@thecontinent.org

Image Credits: DNDi.

Nearly one million Somalians were affected by flooding in 2020, as the effects of climate change intensify.

With the annual United Nations (UN) climate conference, COP28, due to start at the end of the month, climate-vulnerable countries have reiterated that wealthy countries should cut down their carbon emissions, provide finance to vulnerable countries, and help with technology transfer so all countries can transition to a greener economy faster. 

Meanwhile, recent meetings between the world’s superpowers and biggest polluters, the US and China, offer a glimmer of hope that there might be some progress on reducing greenhouse gas emissions.

“From our perspective, we first of all call for a truthful global stocktake, truthful to our successes and also failures so all countries can face the truth that we in the vulnerable countries already know,” said Tony La Viña, associate director for Climate Policy and International Relations at the Manila Observatory in the Philippines. 

He was addressing a press conference convened last Thursday by Allied for Climate Transformation By 2025 (ACT2025), a coalition that represents voices and expertise from all over the world committed to understanding and amplifying the climate priorities of vulnerable countries and ensuring they are heard at UN climate negotiations. 

Roughly half of the world’s population lives in countries that are vulnerable to the changing climate, according to climate scientists, and ACT25 representatives called for COP28 to be the place where the rich countries to deliver on climate finance and up their climate ambitions.

ACT25 members expressed alarm at the latest data from the World Meteorological Organization’s (WMO) November bulletin shows that greenhouse gas levels in the atmosphere have reached record levels, and will continue to trap heat and drive climate change for many years.

 

Climate and health

Chukwumerije Okereke, director of the Center for Climate Change and Development at Nigeria’s Alex-Ekwueme Federal University Ndufu-Alike, called for more attention to be paid to the connection between climate and health

“I come from the part of Nigeria that has begun to see more incidence of malaria as a result of the changes in weather patterns,” he said. “There are quite a range of different health issues. Flooding is one of the biggest challenges faced in Nigeria. And after each flood, we see an escalation of cholera and other health-related challenges.”

For the first time, a day has been set aside at COP28 to do precisely that.

The World Health Organization estimates that the direct damage costs to health is estimated to be between US$ 2–4 billion per year by 2030. Reducing emissions of greenhouse gases could result in very large gains for health, particularly through reduced air pollution.

China-US pledge

Earlier this month, US and China’s climate envoys met and reaffirmed their commitment to working together to address the climate crisis according to the Sunnylands statement released after the meeting.

The two envoys expressed commitment to implementing previous agreements, including “the effective implementation of the UNFCCC and the Paris Agreement, reflecting equity and the principle of common but differentiated responsibilities and respective capabilities, in light of different national circumstances, to achieve the Paris Agreement’s aim in accordance with its Article 2 to hold the global average temperature increase to well below 2 degrees C and to pursue efforts to limit it to 1.5 degrees C, including efforts to keep 1.5 degrees C within reach.”

Meanwhile, according to the White House statement following last week’s meeting between US President Joe Biden and China’s President Xi Jingping, the two leaders “welcomed recent positive discussions between their respective special envoys for climate, including on national actions to reduce emissions in the 2020s, on common approaches toward a successful COP28, and on operationalising the Working Group on Enhancing Climate Action in the 2020s to accelerate concrete climate actions.

The US is ready to work with China to address “transnational challenges, such as health security and debt and climate finance in developing countries and emerging markets,” it added.

ACT25 members welcomed the recent US-China energy deal that aims to triple renewable energy globally by 2030 and deliver a meaningful reduction in carbon emissions in the power sector by the end of this decade. This is significant given the two countries are among the top two carbon emitters. 

G20 countries, a group of some of the world’s largest economies that are together responsible for over 80% of the global carbon emissions made a similar pledge in September this year during their meeting in New Delhi, India to expand renewable energy.

Mark Bynoe, assistant executive director of the Caribbean Community Climate Change Centre

But Mark Bynoe, assistant executive director of the Caribbean Community Climate Change Centre, said: “It seems like, rather than scaling back, we are continuing to experience and to see that we are investing more in oil and gas. 

“Countries that would have said we need to take a conscious decision of moving away are now investing in oil and gas. The subsidies that we need to cut back on is now increasing towards oil and gas,” added Bynoe.

The International Monetary Fund has estimated that the subsidies given to fossil fuels have surged to $7 trillion. 

Demand rising for private finance

However, vulnerable countries do not expect any radical change at COP28, with the meetings not delivering much gains, year after year. But they also haven’t written off the process, as it is the only global place for global climate negotiations.

“Largely, as we have recognized, most of these agreements are gentleman’s agreements. They are not binding and as a result, it is difficult to hold the country to something that they would have pledged to,” said Bynoe.

The ACT25 members are now also beginning to talk about private finance to address the gaps in climate finance – mainly stemming from wealthy countries not providing the resources necessary to assist low- and middle-income countries to mitigate climate change.

“We need from the corporate, the financial, the private sector, greater involvement, greater transparency and a commitment to make sure that the resources are mobilised towards the global south, towards those most in need,” Maria Laura Rojas Vallejo, executive director of Transforma in Colombia.

Image Credits: AP.

Healthcare workers treat a patient with drug-resistant TB in Myanmar,.

Clinical trial results presented at the Union World Conference on Lung Health in Paris on Wednesday provided evidence to support the use of four new, improved regimens to treat multi-drug resistant tuberculosis or rifampicin-resistant tuberculosis (MDR/RR-TB). 

The endTB clinical trial found three new drug regimens that can deliver similar efficacy and safety to conventional treatments while reducing treatment time by up to two-thirds. It also found a fourth regimen that can be used as an alternative for people who cannot tolerate bedaquiline or linezolid, staples in current World Health Organization (WHO) -recommended regimens for MDR-TB.  

The endTB consortium, made up of Médecins Sans Frontières (MSF), Partners In Health (PIH), and Interactive Research and Development (IRD), began this Phase III randomized controlled trial in 2017.

A diverse group of 754 patients from Georgia, India, Kazakhstan, Lesotho, Pakistan, Peru, and South Africa were enrolled and included teenagers and people with comorbidities like substance-use disorders.

It evaluated five nine-month treatment regimens against the standard of care, with three of the drugs showing favourable outcomes in 85-90% of participants. 

“We stand on the cusp of a significant breakthrough in the battle against MDR, a disease that disproportionately affects impoverished populations around the globe,” said Professor Carole Mitnick, co-principal investigator of the study. 

“But the cost of some drugs remains a barrier. One example is delamanid which is still priced at 12-40 times higher than it should be according to an independently estimated cost to produce the drug,” said Mitnick, Professor of Global Health and Social Medicine at Harvard Medical School.  

MDR/RR-TB is caused by a TB bacterium that is resistant to rifampicin, one of the most powerful first-line antibiotics, and also sometimes resistance to isoniazid as well. Roughly half a million people fall sick with MDR/RR-TB each year, and many die from it. 

Although a range of MDR-TB regimens are now in use around the world, many people are still treated with conventional treatments that take up to 24 months, are ineffective (only 59% treatment success in 2018), and often cause terrible side effects, including acute psychosis and permanent deafness.

All-oral treatments

“For far too long, MDR-TB has loomed as a formidable threat with limited, poorly tolerated treatment options, but today, we unveil evidence for multiple innovative all-oral, shortened regimens that will allow patient-centred, individualized treatment of MDR-TB,” said MSF’s Dr Lorenzo Guglielmetti, co-principal investigator.

“What makes these results even more remarkable is the diversity, and resulting generalizability, of this Phase III randomized controlled trial.”

The trial was funded by Unitaid, whose executive director, Dr Philippe Duneton, praised the “gold-standard research”.

“The drugs are already available where they are needed. If recommended, this high-quality evidence could quickly translate into better treatment options suitable for all people with drug-resistant tuberculosis.” 

Image Credits: The Global Fund / John Rae.

Geothermal
Steam rises from Africa’s first geothermal power plant, which generates electricity from heat in the depths of the earth. Many more such renewable energy projects are necessary, says a new UN report on countries’ climate commitments.

With a fortnight to go before the start of the annual global climate conference, COP28, countries have – by their own admission – made insufficient progress in reducing carbon emissions.

This is according to a report on countries’ nationally determined contributions (NDCs) or goals they’ve set for themselves, released this week by the UN Framework Convention on Climate Change – now being referred to as UN Climate Change. 

A second UN Climate Change report on long-term low-emission targets, also released this week, is slightly more optimistic – saying that by 2050 CO2 emissions could be reduced by two-thirds in comparison to 2019 – but only if countries meet their climate commitments.

Simon Stiell, Executive Secretary of UN Climate Change, said that governments are taking “baby steps” to avert the climate crisis. But they need bolder action to get the world on track to limit global warming to 1.5° C by the end of this century. 

To meet the 2030 goal for slashing climate emissions so as to stick to the Paris Agreement target of 1.5° C , the world needs to cut emissions of carbon dioxide or its equivalent by 43% of the 2019 levels, he said in a press statement. 

But if countries implement their current climate action promises, including conditional ones, the report calculates there will only be a 5.3% reduction in emissions. If the conditional commitments aren’t met, emissions could instead rise by 1.4%.

“COP28 must be a clear turning point. Governments must not only agree on what stronger climate actions will be taken but also start showing exactly how to deliver them,” said Stiell in a media release.

Almost stagnant climate action                           

Oil fields in Bakersfield, California – the USA, Canada, Australia and Norway account for 51% of planned new oil and gas extraction by 2050. COP host UAE is bossting oil production by 1 million barrels per day by 2027.

Even when incorporating the latest commitments made by countries by the end of September, and just ahead COP28, the aggregate effect of the NDCs is “almost stagnant” over the last year.

“A significant increase in the level of ambition of climate action” is needed by countries Stiell said.  

COP28 President Designate, the United Arab Emirates (UAE)’s Sultan Al Jaber, says, “There is simply no time left for delays”, adding that the NDCs report “underscores the need for us to act with greater ambition and urgency to meet the goals of the Paris Agreement”. 

But UAE, COP28’s host, plans to boost its oil production by one million barrels per day by 2027 and triple its natural gas production over the next five years by its national oil company, ADNOC, and Al Jaber is the oil company’s president and CEO.

It’s not just the UAE. The United Nations Environment Programme (UNEP) reported last week that governments are planning to produce 110% more fossil fuels in 2030 than compatible with the 1.5°C limit. 

The US,  Canada, Australia, Norway and the United Kingdom account for 51% of planned new oil and gas extraction by 2050. 

Meanwhile, India, Saudi Arabia, and Russia are leading the global surge for coal, oil and gas, the UNEP report showed last week. 

The Indian government on Monday stated that it would be increasing coal production by 2030 to 1,577 million tonnes, that’s up three-fourths from the current 893 MT. India is the third largest emitter but ranks 126th in per capita emissions, unlike, say, the US which is the second largest emitter and ranked 15th in per capita emissions. 

Long-term plans

Solar panel field in Egypt.

The second report released by UN Climate Change looks at countries’ plans to transition to net-zero emissions by or around 2050. 

It shows that these countries’ greenhouse gas emissions could be roughly 63% lower in 2050 than in 2019, but only if all the long-term strategies are fully implemented on time. 

It looked at the long-term climate action strategies of 75 parties to the Paris Agreement (which recognised the importance of limiting global warming to under 1.5°C). These are among the world’s biggest economies and populations. Today’s report optimistically says, “This is a strong signal that the world is starting to aim for net-zero emissions.”

Stiell stressed that the conclusion of the first global stocktake at COP28 is where nations can regain momentum to scale up their efforts across all areas and get on track with meeting the goals of the Paris Agreement. The stocktake is intended to inform the next round of climate action plans under the Paris Agreement (known as nationally determined contributions, or ‘NDCs’) to be put forward by 2025, paving the way for accelerated action.

“The Global Stocktake report released by UN Climate Change this year clearly shows where progress is too slow. But it also lays out the vast array of tools and solutions put forward by countries. Billions of people expect to see their governments pick up this toolbox and put it to work,” Stiell said.  

WMO’s sobering greenhouse gases report

Another UN body, the World Meteorological Organisation (WMO) put out its Greenhouse Gas (GHG) Bulletin to “inform” COP28, and it makes for bleak reading. 

Emissions of three important GHGs continued to rise in 2022. Carbon dioxide, the biggest chunk, was 50% above the pre-industrial level for the first time, WMO said. Methane, which accounts for about 19% of the warming effect of long-lived greenhouse gases, also grew. 

But the biggest year-on-year jump on record was seen in nitrous oxide from 2021 to 2022. N2O is both a powerful greenhouse gas and ozone-depleting chemical and accounts for about 7% of the warming effect by long-lived greenhouse gases. About 60% is emitted from natural sources and the rest from sources like biomass burning, fertilizer use, and industrial processes, as well as healthcare use of the gas for anesthesia, and so on.

The WMO’s report laments there is no end in sight to the rising trend of GHG emissions. The last time the Earth experienced a comparable concentration of CO2 was 3-5 million years ago, when the temperature was 2-3°C warmer and sea level was 10-20 meters higher than now, it says. 

Frustration is palpable as carbon clock counts down

After three decades of global climate meetings to reduce greenhouse gases, emissions are forecast to increase 55.2% by 2025 over 1990. 

“Despite decades of warnings from the scientific community, thousands of pages of reports and dozens of climate conferences, we are still heading in the wrong direction,” says WMO Secretary-General Prof Petteri Taalas.

Appealing for rapid change Stiell says, “It’s time to show the massive benefits now of bolder climate action: more jobs, higher wages, economic growth, opportunity and stability, less pollution and better health. We can make COP28 a game-changer.”

Image Credits: IRENA, Babette Plana/Flickr.

Two-thirds of countries no longer criminalise consensual same-sex sex, a “remarkable reversal” since the start of the AIDS pandemic that has enabled global progress against the spread of HIV.

This is a key finding of Progress and the Peril, a report on HIV and decriminalisation released this week by Georgetown University’s Global HIV Policy Lab.

While 129 out of the world’s 194 countries, a further 24 countries don’t enforce their criminalising laws, said Professor Matthew Kavanagh, Director of the Center for Global Health Policy & Politics at the university’s O’Neill Institute.

“The reason why we’re talking about the decriminalisation of LGBTQ people around the world is because it has a clear link to HIV outcomes,” Kavanagh said at the launch of the report.

The trend towards decriminalisation has accelerated since 2017, with 13 countries representing 7% of the world, removing criminalising laws. The most progress was made in  2022 when Singapore, Barbados, St. Kitts and Nevis, and Antigua and Barbudan decriminalised consensual same-sex acts. In 2023, the Cook Islands and Mauritius joined them, with Venezuela removing its criminalising military law. 

“Knowledge of HIV status and viral suppression among the whole population is significantly higher where decriminalisation has happened,” added Kavanagh.

Professor Matthew Kavanagh, Director of the Center for Global Health Policy & Politics at the university’s O’Neill Institute.

Not a ‘Western agenda’

“This report shows how the world is increasingly rejecting the criminalisation of LGBTQ people,” said Winnie Byanyima, UNAIDS Executive Director. “Instead of sending a message of condemnation and fear, these governments are encouraging their people to come into the health system and get what they need for their well-being.”

Byanyima noted that progress had accelerated since the United Nations decision two and a half years ago to close the inequalities driving AIDS.

“That included creating enabling legal environments with a goal that, by 2025, less than 10% of countries in the world would have punitive laws standing in the way of ending the AIDS pandemic,” she added.

“There are some who say that this is a Western agenda. But no, look at this report – India, Botswana, Angola, Gabon, Barbados, Venezuela, and just a few weeks ago Mauritius. That is a South. The South is moving,” stressed Byanyima, who is Ugandan.

The Caribbean is the region that’s decriminalising at the fastest rate, she added.

UNAIDS Executive Director Winne Byanyima

Perils in some countries

But the report also warns of the perils, with recent prosecutions of LGBTQ people reported in 41 countries and “recent or pending legislation in several of these countries that make penalties more extreme”.

In May, Uganda passed an Anti-Homosexuality Act (AHA), which is one of the harshest anti-LGBTQ laws ever passed globally. Ghana passed a similar law in July.

“There is a concerted campaign [and] US organisations that are pushing the deepening of criminalisation,” warned Kavanagh, who described this as a well-financed, well-coordinated “neocolonial push”.

Florence Riako Anam, co-executive director of the Global Network of People Living with HIV (GNP+),  expressed deep concern that some countries are “continuing to deepen criminalisation and persecution against the LGBTQ communities”. 

“I’m speaking as a Kenyan and I can share how deeply worried I am about the coordinated efforts that are happening in East Africa to replicate the laws and condone violence and discrimination that we are seeing in Uganda,” said Anam. Kenya’s parliament is considering a Bill that is similar to Uganda’s AHA.

Florence Riako Anam, co-executive director of the Global Network of People Living with HIV (GNP+),

‘Step up and catch up’

Mandeep Dhaliwal, the United National Development Programme (UNDP) director for HIV and Health, said that homophobia and punitive laws cost the world more than $126 billion per year – largely calculated in lost productivity and increased health costs.

“People living with HIV in criminalising countries have 11% lower knowledge of their HIV status and 8% lower viral suppression rates,” said Dhaliwal.

Meanwhile, Byanyima called for the leaders of the one-third of countries that still criminalise to “step up and catch up”.  

“Those who are pushing in the opposite direction, sadly such as my own country, Uganda, towards direct criminalisation, are on the wrong side of public health, on the wrong side of economic growth, and on the wrong side of history,” she stressed.

“Politicians usually make this argument that [being LGBTQ] is unAfrican, really, with the purpose of disenfranchising LGBTQ people from society. Once they put them in the category of not citizens of Africa, then they are denied all their rights. I totally don’t respect it. I am a proud African and I support and promote and respect and cherish LGBTQ people.”

Mandeep Dhaliwal, the United National Development Programme (UNDP) director for HIV and Health,

Anam said that programmes and interventions for people living with HIV would not work “if some of us are not able to come into the room and share what their needs are,” she added, noting that this was a human rights issue that should not be confined to HIV.

“The struggle for our rights and dignity and quality of life has reached fervent urgency now more than ever,” said Anam. “Repressive laws institutionalising the criminalisation, prejudice, and violence against our communities – particularly those based on sexual orientation and gender identities – do not serve us. 

“They cause harm. They lead to the death of friends or getting harmed. All of us people living with HIV must access treatment, get undetectable and achieve quality of life.”

Vivek Divan, Head and Coordinator, Centre for Health Equity, Law & Policy

Vivek Divan, head of the Centre for Health Equity, Law & Policy, said that the effort to decriminalise in India had taken two decades.

“The litigation that led to the decriminalisation of queer people in India was filed in 2001 to an HIV NGO. It had many ups and downs being dismissed on the grounds of local standby in 2004, reinstated in 2005 by the Supreme Court and finally heard in 2008 with a positive decision being adjudicated in 2009 – all by the Delhi High Court,” said Divan.

Dhaliwal noted that progress against criminalisation “is not an accident”. 

“It is the result of the courageous leadership of LGBTQI communities, people living with HIV and other key populations working together with enlightened institutions and allies towards decriminalisation and anti-discrimination. We need much more of this kind of solidarity in a world that is suffering from a solidarity deficit,” said Dhaliwal

Image Credits: Stavrialena Gontzou/ Unsplash.