Uganda’s Speaker of Parliament, Anita Among, during the passing of the Act.

The United Nations (UN) High Commissioner for Human Rights Volker Türk has called on Uganda’s President Yoweri Museveni not to promulgate the Anti-Homosexuality Act his country’s Parliament passed on Tuesday night.

Describing the Act as “probably among the worst of its kind in the world”, Türk said that, “if signed into law by the president, it will render lesbian, gay and bisexual people in Uganda criminals simply for existing, for being who they are”. 

Meanwhile, US Secretary of State Antony Blinken said that the Act would “undermine fundamental human rights of all Ugandans and could reverse gains in the fight against HIV/AIDS”, and urged the Ugandan government to “strongly reconsider the implementation of this legislation”.

The Act introduces “the offence of homosexuality”, with a potential life sentence for a same-sex “sexual act”. It also criminalises a person who “holds out as a lesbian, gay, transgender, a queer or any other sexual or gender identity that is contrary to the binary categories of male and female”.

It also proposes the death penalty for “aggravated homosexuality”, including sex acts with children, disabled people or those drugged against their will, or committed by people living with HIV. 

Landlords face prison sentences for renting premises to homosexuals, journalists face 20-year sentences for “promoting homosexuality” and even lawyers may face fines for representing gay clients.

The Act was proposed by Asuman Basalirwa from Bugiri and had the near-unanimous support of MPs.

Ugandan gay activist Frank Mugisha, told Reuters that if the Act becomes law, he will challenge it in court on grounds that it was unconstitutional and violated various international treaties to which Uganda is a signatory. 

However, Mugisha also said that he feared mob violence and the mass arrest of LGBTQ people, adding that his community would be too afraid to seek treatment at health centres and warned of the mental health damage, including an increased risk of suicide.

“The Bill confuses consensual and non-consensual relations – the former should never be criminalized, whereas the latter require evidence-based measures to end sexual violence in all its forms – including against children, no matter the gender or sexual orientation of the perpetrator. This bill will be a massive distraction from taking the necessary action to end sexual violence,” the UN High Commissioner said.

Rise in anti-LGBTQ activity

“Not only does it conflict with Uganda’s own constitutional provisions stipulating equality and non-discrimination for all – it also runs counter to the country’s international legal obligations on human rights and political commitments on sustainable development, and actively puts people­’s rights, health and safety at grave risk,” he added.

There has been a rise in homophobic sentiments, particularly among politicians and religious leaders in Uganda and neighbouring Kenya over the past few months

The OHCHR said that,  according to a report from a civil society group, in February alone more than 110 LGBTQI+ people “reported incidents, including arrests, sexual violence, evictions and public stripping”.

“Let us be clear: this is not about ‘values’. Promoting violence and discrimination against people for who they are and who they love is wrong and any disingenuous attempts to justify this on the basis of ‘values’ should be called out and condemned,” Türk said.

Meanwhile, UNAIDS has warned that, if the Act becomes law, it will curtail “the human rights of people living with HIV and some of the most vulnerable people of Uganda to access life-saving services”. 

“If enacted, this law will undermine Uganda’s efforts to end AIDS by 2030, by violating fundamental human rights including the right to health and the very right to life,” said UNAIDS East and Southern Africa Director Anne Githuku-Shongwe.  

“Research in sub-Saharan Africa shows that, in countries which criminalize homosexuality, HIV prevalence is five times higher among men who have sex with men than it is in countries without such laws,” said UNAIDS, calling on Museveni not to enact the Bill as it will  “cost lives and it will drive up new HIV infections”. 

“The harmful Act stands in marked contrast to a positive wave of decriminalization taking place in Africa and across the world, in which harmful punitive colonial legislation is being removed in country after country. Decriminalisation saves lives and benefits everyone.”

Describing the Act as “an extreme violation of human rights”, International AIDS Society (IAS) warned that it “threatens to reverse the country’s progress in the HIV response”. “Criminalizing LGBTQ+ people is wholly incompatible with an effective HIV response,” said the IAS.

In opposition to HIV response

“While Uganda has made considerable gains in reducing the impact of HIV, gay men and other men who have sex with men, trans people and sex workers continue to be less likely than the general population to access HIV treatment, prevention and care services and will be further threatened by this legislation.

“In 2021, key populations (gay men and other men who have sex with men, people who inject drugs, trans people, and sex workers) and their sexual partners accounted for 51% of new HIV acquisitions in central, eastern, southern and western Africa. This underscores the urgent need for governments in the region to work with, not against, communities most vulnerable to HIV.”

The IAS also noted that the Act is also “completely in opposition to President Museveni’s stated support for the HIV response. UNAIDS and others lauded the President when he launched The Presidential Fast-track Initiative on ending HIV & AIDS in Uganda by 2030, the first such initiative globally.”

Plastic
Most plastics that are produced end up in landfills in poorer countries.

Human health is in grave danger because of plastics across their entire lifecycle, a new study has found. The study, conducted by an international consortium of scientists, has pointed out that from production to disposal, plastics are bad news. 

The team of scientists, led by the Boston College Observatory on Planetary Health, Australia’s Minderoo Foundation and the Centre Scientifique de Monaco, called for a strong and comprehensive global plastics treaty to be adopted as soon as possible, to put the world on track to end plastic pollution by 2040. 

The study, published in the journal Annals of Global Public Health on Tuesday, stated that the current patterns of producing, using and disposing of plastics are leading to snowballing impacts on health from the womb to old age.  

“It is now clear that current patterns of plastic production, use, and disposal are not sustainable and are responsible for significant harms to human health, the environment, and the economy as well as for deep societal injustices”, stated an editorial accompanying the report. 

Along with pushing for the expedited adoption of a global plastics treaty, the study also recommends that a Permanent Science Policy Advisory Body be created to guide the implementation of the treaty. 

“The main priorities of this body would be to guide member states and other stakeholders in evaluating which solutions are most effective in reducing plastic consumption, enhancing plastic waste recovery and recycling, and curbing the generation of plastic waste,” the study’s authors added. 

Impacts on health from cradle to grave

That plastics cause harm to the planet is not news. However, this is the first study to look in detail into the dangers to human health from plastics at every stage of production, use and disposal. Among the key findings:  

  • Of the more than 10,000 materials used in plastics production, some 1,254 pose high health concerns. Those include toxic, mutagenic and carcinogenic monomers – of which PVC is perhaps best known, but there are many others.
  • At the use stage, some 63 of the more than 90 chemicals associated with plastics packaging rank in the highest category for human health. Many of the chemicals used in food packaging can leach out onto food, leading to human exposures.
  • Finally, at disposal stage, those same chemical components or additives can be released or leached out during recycling and recovery processes, the report found.  And most of the world’s plastics are not recovered at all – they are simply dumped into landfills, incincerated or shipped elsewhere – contaminating soils, fresh water aquifers, oceans and fisheries – with further ecosystem and health impacts.

“This is the first analysis to look at hazards to human health caused by plastics across their entire life cycle – cradle to grave – beginning with the extraction of the coal, oil and gas from which nearly all plastics are made, through production and use, and on to the point where plastic wastes are thrown into landfills, dumped into the ocean or shipped overseas,” Dr Philip Landrigan, director of the Program on Global Public Health and the Common Good at the Boston College Observatory on Planetary Health and the study’s lead author explained in a press release. 

Plastic
A range of chemicals are used, present and released throughout the life cycle of plastics.

Occupational health hazards, premature births and birth defects

Workers involved in plastics production suffer higher mortality from a range of causes from traumatic injury to lung cancer to interstitial lung disease. They are also highly likely to contract diseases like mesothelioma, angiosarcoma, breast cancer and decreased fertility. 

But plastics also cause a variety of health impacts across the population, from pregnancy and early childhood to older ages.  

“Because of the exquisite sensitivity of early development to hazardous chemicals and children’s unique patterns of exposure, plastic-associated exposures are linked to increased risks of prematurity, stillbirth, low birth weight, birth defects of the reproductive organs, neurodevelopmental impairment, impaired lung growth, and childhood cancer,” the study pointed out.  

“Early-life exposures to plastic-associated chemicals also increase the risk of multiple non-communicable diseases later in life.”

Massive adverse enviornmental, economic and social justice impacts

Elaborating on the production cycle of plastics, the scientists also summed up the massive adverse environmental, economic, human health and social justice impact that prolonged plastic use creates. 

Plastics are produced from coal, oil or gas, in an energy intensive process. The current modes of plastic disposal are highly inefficient. 

Plastic
A wall made of plastic waste in Singapore.

“Plastic disposal is highly inefficient, with recovery and recycling rates below 10% globally,” the study pointed out. “The result is that an estimated 22 megatonnes of plastic waste enters the environment each year, much of it single-use plastic and are added to the more than 6 gigatons of plastic waste that have accumulated since 1950.”

Apart from causing widespread pollution across terrestrial, aquatic and atmospheric environments globally, the reckless use of plastics causes significant economic costs. 

“We estimate that, in 2015, the health-related costs of plastic production exceeded $250 billion globally, and that in the USA alone the health costs of disease and disability caused by the plastic-associated chemicals PBDE, BPA and DEHP exceeded $920 billion”.

Around 90% of the plastics produced are not recycled or reused, and often end up in landfills in poorer countries. This adversely affects people who are already vulnerable and had nothing to do with creating the plastics crisis and lack the power and resources needed to address it. 

“Plastics’ harmful impacts across its life cycle are most keenly felt in the Global South, in small island states, and in disenfranchised areas in the Global North,” the study said. “Social and environmental justice principles require reversal of these inequitable burdens to ensure that no group bears a disproportionate share of plastics’ negative impacts and that those who benefit economically from plastic bear their fair share of its currently externalized costs”. 

Global Plastics Treaty

Plastic
The adoption of the resolution receives a standing ovation from the delegates present in Nairobi, Kenya, in 2022.

In 2022, Heads of State, Ministers of environment and other representatives from UN Member States at the fifth United Nations Environment Assembly in Nairobi, Kenya, approved a resolution to draft a Global Plastics Treaty by the end of 2024. This agreement on addressing the pollution caused by plastics would be internationally binding. 

“And as we embark on this journey, let us be clear that the agreement will only truly count if it has clear provisions that are legally binding, as the resolution states,” Inger Andersen, the executive director of the United Nations Environment Programme (UNEP) remarked after the resolution was passed. According to UNEP, plastics will account for 20% of oil and gas consumption by 2050. 

“It will only count if it adopts a full life-cycle approach – stretching from design to production to circularity to reducing, managing and preventing waste.”

Switzerland and Ecuador reiterated the importance of a global plastics treaty in Davos in January 2023, in the world’s journey to end plastic pollution. 

While the treaty is currently under negotiations, it is expected that the powerful oil and gas producers will oppose the creation of a comprehensive treaty with teeth. 

The first session of the Intergovernmental Negotiating Committee (INC) took place from 28 November to 2 December, 2022 in Uruguay. The second session of the INC is scheduled to take place in Paris from 29 May, 2023 to 2 June, 2023. 

“Our report is intended to inform the Treaty negotiations. The Global Plastics Treaty is still two to three years away. But it will resonate with other treaties, including the agreement reached earlier this month known as the Oceans Treaty,” Landrigan said. 

The Permanent Science Policy Advisory Board, recommended by the study, will aim to inform the work of the treaty by arming the negotiators and participants with scientific evidence. 

“All big global agreements, or treaties, need scientific support. They need access to individuals with expertise to make sure the treaty reflects the most recent science. These treaties are never static, they must continually be updated to reflect the best current knowledge”. 

Image Credits: Photo by Hermes Rivera on Unsplash, The Minderoo-Monaco Commission on Plastics and Human Health, Photo by Nick Fewings on Unsplash, UNEP.

During the COVID-19 pandemic, people living with cancer, heart diseases, chronic respiratory diseases, diabetes and other non-communicable diseases (NCDs) experienced difficulties in accessing their routine medicines, according to a new report released by the World Health Organization on Wednesday.

While 21% of WHO member states reported stockouts of the five many medicines for people with NCDs, only 4% of high-income countries were affected whereas a third of low-and middle-income countries were affected.

“The COVID-19 pandemic has exacerbated the challenges that people living with NCDs face in accessing essential medicines,” said Dr Bente Mikkelsen, the WHO’s NCD Director.

“Many have had their treatment disrupted, which can lead to serious health consequences. It is therefore very important not only that treatment and care for people living with NCDs are included in national responses and preparedness plans, but that innovative ways are found to implement those plans.”

Numerous pharmaceutical supply chains were affected, according to the WHO, which called for improvement of “the transparency of the overall pharmaceutical information ecology as a foundation for pandemic planning and response”.

“If we are unable to identify weaknesses in the global NCD supply chain, we cannot hope to mend them,” the WHO noted in a statement on Wednesday.

“Without effective monitoring and transparent data, it is difficult to identify weaknesses in the global NCD supply chain. This requires countries to look at their supply chain, strengthen and expand medicine shortage notification systems, build in flexibility in their regulatory measures and minimize barriers to trade.”

Globally, more is spent on medicines for NCDs than any other therapeutic class. 

Although a few short-term interventions were adopted to respond to pandemic needs, the WHO wants “a longer-term strategy to strengthen access and delivery mechanisms during emergencies and mitigate future outbreaks”.

 “Let’s not forget: COVID-19 may be out of sight, but access to NCD medicines is still out of reach for many,” said Mikkelsen.

Co-chairs of the UN Water Conference, President Emomali Rahmon of Tajikistan and King Willem of Netherlands, at the opening ceremony.

“We are draining humanity’s lifeblood through vampiric overconsumption and unsustainable use and evaporating it through global heating,” United Nations Secretary-General António Guterres told the start of the UN 2023 Water Conference. which also coincided with World Water Day.

At the conference, national governments and stakeholders from all levels of society will collaborate to make voluntary commitments to accelerating progress on Social Development Goal Six, to promote access to safe water, sanitation and hygiene.

These voluntary commitments will form the Water Action Agenda, designed to deliver rapid, transformative change in the remainder of this decade.

“We’ve broken the water cycle, destroyed ecosystems and contaminated groundwater,” Gutteres added.

“Nearly three out of four natural disasters are linked to water. One in four people lives without safely managed water services or clean drinking water. And over 1.7 billion people lack basic sanitation. Half a billion practice open ablutions. And millions of women and girls spend hours every day fetching water.”

In addition, 1.4 million people die annually and 74 million will have their lives shortened by diseases related to poor water, sanitation and hygiene, according to the World Health Organization (WHO).

Global water demand is projected to increase by 55% by 2050. 

 

Is the raccoon dog the elusive “animal X” that passed SARS-CoV2 from bats to humans?

Raccoon dogs, lab leaks and Chinese secrecy have made for high drama as scientists who think they may have found the elusive “Animal X” that passed SARS-CoV2 were excluded from a data-sharing platform for “scooping” Chinese scientists.

Nineteen scientists, including world-renowned figures such as Dr Michael Worobey and Dr Angela Rasmussen – have published a report detailing how they had been scolded and falsely accused of rules violations by the data-sharing platform, GISAID, after reporting that they had found genetic material of wild animals intermingled with environmental samples collected by the Chinese Center for Disease Control in January and February of 2020 from the Huanan Seafood Wholesale Market in Wuhan – ground zero of the COVID-19 outbreak.

This co-mingling of SARS-CoV-2 virus and animal RNA/ DNA from five animal species “identifies these species, particularly the common raccoon dog, as the most likely conduits for the emergence of SARS-CoV-2 in late 2019”, the authors concluded in their study, published on the pre-print research server base Zenodo on Monday. 

This is the first time that scientists have proposed that the elusive “animal X” responsible for virus spillover from animals to humans might have been found.

Later on Tuesday, it appeared that GISAID had removed all the authors’ access to its platform. The platform is a public-private partnership that is hosted by the German government that allows scientists to share data about infectious diseases.

Report co-author and French evolutionary biologist Florence Débarre accidentally found the Chinese Center for Disease Control and Prevention (CCDC) environmental samples on the GISAID infectious diseases database on 4 March 2023.

The samples had apparently been posted to support a CCDC preprint article published on 25 February by a group of Chinese scientists affiliated with CCDC and other governmental resaerch institutions.

In the preprint article, the Chinese authors asserted that of the 1,380 samples collected from the environment and the animals in the market in early 2020, “No virus was detected in the animal swabs covering 18 species of animals in the market” – exactly the opposite of what Worobey and his colleagues said they have found.

Of the environmental samples taken from the marketplace in the early days of the pandemic, only 73 tested positive for SARS-CoV-2 and three live viruses were successfully isolated – which 99.9% related to the genetic forms of virus strains circulating among humans in those early days, according to the Chinese authors.  

Genetic footprints of ‘multiple animal species’ co-mingling in SARS-CoV2 environmental samples 

In contrast, the Worobey-led research group, in their analysis of the same GSAID data, said they found genetic evidence of “multiple animal species” co-mingling among the SARS-CoV-2 positive environmental samples collected at the marketplace.

In particular, they identified mitochondrial genomes for the common raccoon dog; Malayan porcupine; Amur hedgehog; masked palm civet; and hoary bamboo rat “from wildlife stalls positive for SARS-CoV-2”. 

This is important, they assert, because although live mammals had been observed in the market in late 2019, an area where many COVID-19 patients with the earliest-known onset of symptoms worked, the animals’ presence and “exact locations were not conclusively known” at the time when SARS-CoV2 first surfaced in the marketplace.

The most recent data posted on GSAID, therefore, raises the likelihood that wild animals kept caged in the market could have been a conduit for passing the coronavirus, which originates amongst bats, to humans, the authors state. 

In another explosive finding, some of the animals they identified – such as the fox-like raccoon dogs – are known to be susceptible to  SARS-CoV-2 but “were not included in the list of live or dead animals tested at the Huanan market, as reported in the 2021 WHO-China joint report on the origin of the COVID-19 pandemic”, the authors state. 

The fox-like raccoon dog is susceptible to SARS-CoV-2.

Even more crucially, in some cases, there was more animal genetic material than human material “consistent with the presence of SARS-CoV-2 in these samples being due to animal infections”, say the authors.

In 2021, an international team assembled by the World Health Organization (WHO) to investigate the origins of SARS-CoV-2 identified animal transmission – through an elusive ‘Animal X’ – as the most likely route of infection in their report. But the theory stalled due to a lack of actual evidence in the WHO report about the exposure of wild animals in the marketplace at the time to the virus. 

Chinese secrecy – data withdrawn

The controversy around the data, and its implications, has been heightened by the fact that it has now been withdrawn from the GSAID site.

This happened shortly after the scientists said that they had contacted one of the Chinese preprint authors, on 9 March, and were told they could conduct an independent analysis of the CCDC data.

But on 11 March,  a day after the Worobey group told the Chinese colleague that they had found animal genetic material in the samples, the data was pulled from the site “at the request of the submitter”. 

Not only that, but the GISAID Secretariat sent emails to the scientists “admonishing us to comply with the GISAID terms of use, or in some cases falsely accusing us of having breached the GISAID terms of use”, wrote the Worobey group. 

“We are well aware of these terms of use, have not breached them, and have no intention of breaching them,” they wrote.

While the GISAID website makes no mention of a secretariat, its business affairs are run by the executive board of the Friends of GISAID, the members of which are not named, and advised by an 11-person scientific advisory council that includes US, Chinese, European, Japanese and Singaporean representatives.

However, GISAID released a statement on Tuesday accusing the Worobey group of “scooping” the Chinese group by using its data and publishing it before the Chinese scientists had done so.

“Unfortunately, GISAID learned that select users published an analysis report in direct contravention of the terms they agreed to as a condition to accessing the data, and despite having knowledge that the data generators are undergoing peer review assessment of their own publication,” according to the statement.

GISAID said it had asked the Chinese researchers whether “best efforts to collaborate have been made in this case”, and were told the Worobey group had communicated “only their intent to publish their analysis of the generators’ data. As such, the best efforts requirement has not been met”.

“GISAID’s goal is to incentivize timely and transparent data sharing by providing a trusted place for data contributors to see their rights respected.  It should be apparent to everyone that the data generators [Chinese researchers] are the ones most familiar with the details surrounding their submitted data and the context in which it was collected,” added the platform, stressing that the Chinese research should have been published first.

WHO involvement

However, it is unclear whether the international scientific community will agree, as China has long been accused of withholding data and access to Wuhan sites.

The WHO confirmed late last week that it had been informed both about the findings and the CCDC’s actions on 12 March, and it reached out to its Scientific Advisory Group for the Origins on Novel Pathogens (SAGO) and the CCDC.

After calls between SAGO and the CCDC, the CCDC confirmed that “DNA from wild raccoon dogs, Malaysian porcupine, and bamboo rats among others” had been found “in SARS-CoV-2 positive environmental samples”, according to a SAGO statement released last Friday.

“These results provide potential leads to identifying intermediate hosts of SARS-CoV-2 and potential sources of human infections in the market,” according to SAGO.

This is despite the CCDC’s assertions to the contrary, which mention 18 animals, none of which are raccoon dogs.

But, said SAGO, “the presence of high levels of raccoon dog mitochondrial DNA in the metagenomics data from environmental samples identified in the new analysis, suggest that raccoon dog and other animals may have been present before the market was cleaned as part of the public health intervention”.

Late on Friday afternoon, WHO Director-General Dr Tedros Adhanom Ghebreysus did not mince his words at a media briefing when he appealed to China for transparency, adding that these samples could have been shared three years ago.

China has consistently refused to accept that COVID-19 might have originated on its shores, and has asserted that the virus could have been spread from imported frozen fish sold at the market – the frozen food chain hypothesis.

However, the independent origins group report stated that “there is no conclusive evidence for foodborne transmission of SARS-CoV-2 and the probability of cold-chain contamination with the virus from a reservoir is very low”. 

Lab leak revival

Dr Robert Redfield, ex-CDC head, testifies at the hearing in favour of the lab leak theory.

In early March, the Republican-dominated US House Subcommittee on the Coronavirus Pandemic convened its first hearing to examine COVID-19’s origins, focusing almost entirely on the theory that COVID-19 originated from a laboratory “leak” at the Wuhan facility studying coronaviruses. 

Dr Robert Redfield, former head of the US CDC, told the hearing that he found it implausible that a virus could jump from animals in the Wuhan wet market to humans.

The lab leak theory was initially pushed by then-US president Donald Trump and his allies in 2020.

The impetus for the lab leak theory has grown this year, particularly as the US ramps up its anti-China rhetoric – and China’s secrecy and refusal to share data has fueled it.

“The FBI has for quite some time now assessed that the origins of the pandemic are most likely a potential lab incident in Wuhan,” Christopher Wray, the head of the US Federal Bureau of Investigation (FBI) told Fox News in late February.

The Trump-appointed Wray added that “we’re talking about a potential leak from a Chinese- government-controlled lab that killed millions of Americans”.

However, the origins report described this hypothesis as “extremely unlikely”, saying that “the deliberate bioengineering of SARS-CoV-2 for release has been ruled out by other scientists following analyses of the genome”. In addition, the SARS-CoV-2 from bats and pangolin that were being studied at the Wuhan lab “are evolutionarily distant from SARS-CoV-2 in humans”. 

Meanwhile, recent polls show that roughly two-thirds of Americans believe that Covid probably started in a lab, according to the New York Times.

Image Credits: Bernd Schwabe/ Wikipedia, Ryzhkov-Sergey/ Wikipedia, CSPAN.

As the impact of drought worsens, there is a growing risk of famine in Somalia. Some 4.5 million Somalis are directly affected by the drought, and about 700,000 people have been displaced.

The worsening drought in Somalia is likely to have caused 43,000 excess deaths in 2022, of which around 21,500 are children under the age of five, according to a new report released on Monday.

“We are racing against time to prevent deaths and save lives that are avoidable. We have seen, deaths and diseases thrive when hunger and food crises prolong. We will see more people dying from disease than from hunger and malnutrition combined if we do not act now,” Dr Mamunur Rahman Malik, the World Health Organization (WHO) representative for Eastern Mediterranean region (EMRO) said. 

“The cost of our inaction will mean that children, women and other vulnerable people will pay with their lives while we hopelessly, helplessly, witness the tragedy unfold”.

The Horn of Africa, particularly southeast Ethiopia, northern Kenya and Somalia, has been experiencing one its worst hunger crisis in 70 years. Along with the

failure of six consecutive monsoon seasons, Somalia is also struggling with the effects of climate change-induced weather events, political instability, ethnic tensions, food insecurity and rising prices. The COVID-19 pandemic only exacerbated an already grim situation.  

The study was commissioned by UNICEF and the WHO and was carried out by the London School of Hygiene and Tropical Medicine and the Imperial College, London. The study involved a statistical mode, which retrospectively estimated that the crude death rate across Somalia increased from 0.33 to 0.38 deaths per 10,000 person-days between January 2022 and December 2022. 

The death rate in children younger than five years was almost double these levels. The researchers used data from 238 mortality surveys carried out by the Food Security and Nutrition Analysis Unit for Somalia to arrive at these estimates. 

“Our findings suggest that tens of thousands of Somalis lost their life in 2022 due to drought conditions, with this toll set to increase in 2023. This is in spite of Somalis’ own resilience, support by Somali civil society within and outside the country and a large-scale international response,” said Dr Francesco Checchi, co-author and professor of epidemiology and international health at the London School of Hygiene and Tropical Medicine. “Far from being scaled back, humanitarian support to Somalia must if anything be increased as the year progresses, and sustained until Somalia exits this latest crisis.”

For the year 2023, the crude death rate is forecasted to increase to 0.42 deaths per 10,000 person-days by June 2023. 

The highest death rates were estimated in south-central Somalia, around the areas of Bay, Bakool and Banadir regions, the center of the current drought. 

“We continue to be concerned about the level and scale of the public health impact of this deepening and protracted food crisis in Somalia,” said Somalia’s Health Minister, Dr Ali Hadji Adam Abubakar.

“At the same time, we are optimistic that if we can sustain our ongoing and scaled-up health and nutrition actions and humanitarian response to save lives and protect the health of our vulnerable, we can push back the risk of famine forever, else those vulnerable and marginalized will pay the price of this crisis with their lives.”

Image Credits: UN-Water/Twitter .

Some of the co-authors confer with IPCC Vice-Chair Ko Barrett (centre) before the adoption of the report over the weekend.

The world will heat up by at least 1.5ºC by the 2030s – and our best hope is that global warming does not “go blasting” way beyond this point, according to scientists from the United Nations Intergovernmental Panel on Climate Change (IPCC).

The IPCC released its sixth synthesis report on climate change in Interlaken in Switzerland on Monday after a two-day extension of its four-day meeting – largely because of disagreements from various UN member states about how to frame the temperature increases.

“Emissions should be decreasing by now and will need to be cut by almost half by 2030 if warming is to be limited to 1.5°C,” the report warns, referring to the temperature target adopted by most countries in the Paris Agreement in 2015.

But global greenhouse emissions have increased by 54% between 1990 and 2019, and the world is already 1.1ºC warmer now than it was in the pre-industrial era (1850-1900). 

In the past year, the world emitted more carbon dioxide than in any other year on records dating to 1900. One of the reasons was the Russia-Ukraine war, which caused a resurgence in coal use by Western nations to replace Russian gas.

The world’s two biggest polluters, the US and China, show few signs of slowing emissions. The US recently approved a massive new oil drilling project in Alaska called Willow that will produce 260 million tons of carbon dioxide,  equal to the annual output of 66 American coal plants. Meanwhile, China has approved over one hundred new coal plants.

“Keeping warming to 1.5°C above pre-industrial levels requires deep, rapid and sustained greenhouse gas emissions reductions in all sectors,” warned IPCC chair Hoesung Lee.

Political will and public support will determine whether the world reduces global warming, Lee added, but warned that “we are walking when we should be sprinting”.

IPCC chairperson Hoesung Lee

Co-author Dr Peter Thorne said that “almost irrespective of our emissions choices in the near term, we will probably reach I.5ºC in the first half of the next decade”. 

“The real question is whether our will to reduce emissions quickly means we reach 1.5ºC, maybe go a little bit over, but then come back down or whether we go blasting through 1.5ºC, go through even 2ºC and keep on going, so the future really is in our hands,” warned Thorne.

“We will, in all probability, reach around 1.5ºC early next decade, but after that, it really is our choice. This is why this the rest of this decade is key. The rest of this decade is whether we can apply the brakes and stop the warming at that level.”

Wrong direction

Petteri Taalas, Secretary-General of the World Meteorological Organisation, warned that all indicators were “going in the wrong direction” – temperature, ocean warming, melting ice and rising sea level.

Taalas urged countries to invest in early warning services, describing them as “one of the best ways to mitigate climate risk.

Meanwhile, UN Secretary-General Antonio Guterres appealed to countries to stop expanding their coal, oil and gas projects, saying that limiting global warming to 1.5ºC would require a “quantum leap in climate action”. 

Three to six times the current spending on climate adaptation and mitigation is needed to achieve targets, said Indian economist Dr Dipak Dasgupta, one of the report’s co-authors.

“Governments can do more with the public finances,” said Dasgupta. “And the financial system itself – the banks, the central banks or regulators themselves – have to start recognising the urgency and pricing in the risks.”

Another co-author, Dr Aditi Mukherji, also warned that once the world reached a certain temperature, it would be less possible for countries and communities to adapt.

IPCC report co-author, Dr Aditi Mukherji (left).

“Almost half of the world’s population lives in regions that are highly vulnerable to climate change. In the last decade, deaths from floods, droughts and storms were 15 times higher in highly vulnerable regions,“ she stressed.

Inger Andersen, Executive Director of the UN Environment Agency, said that the report tells us “we are very, very close to 1.5 degree limit and that even this limit is not safe for people and for planet”. 

“Climate change is throwing its hardest punches at the most vulnerable communities who  bear the least responsibility, as we just saw with Cyclone Freddy in Malawi, Mozambique and Madagascar, and as we saw with flash floods in Turkey just recently,” said Andersen.

 “We must turn down the heat. We must help vulnerable communities to adapt to those impacts of climate change that are already here.”

Climate-resilient development

The report proposes “climate-resilient development” as the solution, including clean energy,  low-carbon electrification, and walking and cycling as preferred methods of public transport to enhance air quality and improve health.

Lee added that there is “a great deal of room for improvement in the energy efficiencies”, and energy consumption can be reduced by 40 to 70% in some sectors over the next two decades”. 

But “climate-resilient development becomes progressively more challenging with every increment of warming”, warns the report.

“The greatest gains in wellbeing could come from prioritizing climate risk reduction for low-income and marginalised communities, including people living in informal settlements,” said Christopher Trisos, one of the report’s authors. “Accelerated climate action will only come about if there is a many-fold increase in finance. Insufficient and misaligned finance is holding back progress.”

UNEP Executive Director Inger Andersen

Meanwhile, UNEP’s Andersen said that the global community already has the solutions: “Renewable energy instead of fossil fuels, energy efficiency, green transport, green urban infrastructure, halting deforestation, ecosystem restoration, sustainable food systems,  including reduced food loss and waste.”  i

“Investing in these areas will help to stabilise our climate, reduce nature and biodiversity loss and pollution and waste,” she stressed.

Image Credits: Anastasia Rodopoulou IISD/ ENB .

Caged animals held for sale and slaughter in unsanitary conditions at Wuhan’s Huanan Seafood Market, prior to the outbreak of COVID-19, from top left: (a) King rat snake  (b) Chinese bamboo rat (c) Amur hedgehog (d) Raccoon dog (e) Marmot and (f) Hog badger.

New evidence indicating that raccoon dogs from the Huanan Seafood Market in Wuhan may have been infected with SARS CoV2 in January 2020 was published on a shared database by China’s Centers for Disease Control and Prevention in January  – but removed recently after scientists started asking questions.

This was revealed at a media briefing on Friday by World Health Organization’s (WHO) Director-General Dr Tedros Adhanom Ghebreyusus.

“This data could have, and should have, been shared three years ago,” Tedros chastised, as he appealed to China to “be transparent” in sharing data about the origins of the COVID-19 pandemic.

WHO had only become aware of the data last Sunday from China CDC relating to samples taken at the Huanan market in Wuhan in 2020, said Tedros – although this had been published on a shared GSAID online database in late January, but “taken down again recently”. 

While the data was online, scientists from a number of countries downloaded that data and analysed it, and their findings were reported earlier this week by The Atlantic.

“A new analysis of genetic sequences collected from the market shows that raccoon dogs being illegally sold at the venue could have been carrying and possibly shedding the virus at the end of 2019,” according to the publication.

Positive swabs

This evidence came from swabs of the market that had tested positive for SARS-CoV2, which also included genetic material from raccoon dogs.

The international team that had assembled the analysis consisted of “virologists, genomicists, and evolutionary biologists”, according to The Atlantic.

The evidence may finally point to the “Animal X” vector that scientists examining the orgins of the virus believe was the most likely conduit for SARS-CoV2 between carrier bats and humans – rather than the laboratory accident theory that has gained currency recently.

“As soon as we became aware of this data, we contacted the Chinese CDC and urged them to share it with WHO and the international scientific community so it can be analysed,” said Tedros. 

The WHO also convened the Scientific Advisory Group on the Origins of Novel Pathogens (SAGO) on Tuesday and asked both the scientists who had analysed the data and China CDC  to present their analysis of the data to the group.

“This data do not provide a definitive answer to the question of how the pandemic began, but every piece of data is important in moving us closer to that answer, and every piece of data relating to studying the origins of COVID-19 needs to be shared with the international community immediately,” said Tedros.

“We continue to call on China to be transparent in sharing data and to conduct the necessary investigations and share the results. 

“Understanding how the pandemic began remains both a moral and scientific imperative.”

Seafood and fresh food market in Wuhan, Hubei, China, where live mammals, including raccoon dogs, were also caged and kept for slaughter.

Molecular evidence

Dr Maria van Kerkhove, WHO lead on COVID-19, said that the scientists had told SAGO this week that there was “molecular evidence” that some of the animals sold at the Huanan Market, including raccoon dogs, “were susceptible to SARS CoV2” – evidence that had been missing until now.

“We need to make clear that the virus has not been identified in an animal in the market or in animal samples from the market, nor have we actually found the animals that infected humans,” stressed Van Kerkhove.

“What this does is provides clues to help us understand what may have happened. One of the big pieces of information that we do not have at the present time is the source of where these animals came from. Where these animals traded? Were they the wild animals or domestic animals where they farmed, where were they farmed?”

China CDC needs to explain

“The big issue right now is that this data exists and that it is not readily available to the international community,” she said.

She said that China CDC needed to explain why it had taken down the data, as all the WHO knew was that it had been uploaded to the site as part of their work and in writing a publication, a pre-print of which was available.

“I don’t know the situation or the circumstances in which the data was released and taken down,” she added.

“Unfortunately, this doesn’t give us the answer of how the pandemic began, but it does provide more clues,” said Van Kerkhove, who reiterated that there are many more studies that need to be carried out. 

“Right now, there are several hypotheses that need to be examined, including how the virus entered the human population, either from a bat through an intermediate host, or through a biosecurity breach from a lab and we don’t have a definitive answer of how the pandemic began,” she said.

Earlier evidence of links to raccoon dogs

This is not the first time, by any means, that infected racoon dogs have been linked to the early stages of the SARS-CoV2 outbreak. In July 2022, Health Policy Watch reported on research led by the University of Arizona’s Michael Worobey, that suggested that mammals in the Wuhan market place, including racoon dogs, were carrying the infection in early 2020.

The Science Magazine study found that SARS-CoV2 susceptible mammals, such as red foxes, hog badgers, and common racoon dogs, were sold at the market in late 2019 and that SARS-CoV2 environmental samples were  found in cages which had previously housed the racoon dogs, as well as other equipment used around the mammals and vendors selling those live mammals in early 2020.

The clusters of early cases around the market also occured at a frequency that was far higher than could be expected in comparison to the volumes and frequency of visitors to other major commercial locations in the city, Worobey’s study found.

The researchers also found that both early lineages of SARS-CoV-2, dubbed A and B were “geographically associated” with the market: “Until a report in a recent preprint, only lineage B sequences had been sampled at the Huanan market,” the researchers added.

“If SARS-CoV2 did not emerge at the Huanan market, how surprised should we be at the coincidence of finding the first cluster of a new respiratory virus at – of all places – one of a handful of markets in a city of 11 million,” said Michael Worobey of the University of Arizona and one of the authors of the study, said in a tweet on the study.

Image Credits: Nature , Arend Kuester/Flickr.

A child getting an oral polio vaccination.

Health authorities in Burundi have declared a national public health emergency response to an outbreak of circulating poliovirus type 2.

The World Health Organization’s (WHO) Africa region announced on Friday that polio had been detected in an unvaccinated four-year-old boy in Isale district in western Burundi and two other children who had been in contact with the child. 

Five samples from wastewater surveillance confirmed the presence of the circulating poliovirus type 2. 

Circulating vaccine-derived poliovirus are variant polioviruses that can emerge if the weakened live virus contained in oral polio vaccine, shed by vaccinated children, is allowed to circulate in under-immunized populations for long enough to genetically revert to a version that causes paralysis.

The Burundian government plans to implement a vaccination campaign to combat polio in the coming weeks, aiming at protecting all eligible children under the age of eight against the virus.

Meanwhile, the Global Polio Eradication Initiative (GPEI) announced on Thursday that a further six cases of circulating poliovirus type 2 had been detected in children in the DRC’s eastern Tanganyika and South Kivu provinces.

“The detection of the circulating poliovirus type 2 shows the effectiveness of the country’s disease surveillance. Polio is highly infectious and timely action is critical in protecting children through effective vaccination,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “We are supporting the national efforts to ramp up polio vaccination to ensure that no child is missed and faces no risk of polio’s debilitating impact.”

According to WHO, circulating poliovirus type 2 is the most prevalent form of polio in Africa and outbreaks of this type of poliovirus are the highest reported in the region, with more than 400 cases reported in 14 countries in 2022. 

These are the first instances of circulating poliovirus type 2 that are linked with novel oral polio vaccine type 2 (nOPV2) since roll-out of the vaccine began in March 2021. 

“While detection of these outbreaks is a tragedy for the families and communities affected, it is not unexpected with wider use of the vaccine,” according to GPEI.

“All available clinical and field evidence continues to demonstrate that nOPV2 is safe and effective and has a significantly lower risk of reverting to a form that cause paralysis in low immunity settings when compared to monovalent oral polio vaccine type 2 (mOPV2),” it added.

“To date, close to 600 million doses of nOPV2 have been administered across 28 countries globally, and the majority of countries have seen no further transmission of cVDPV2 after two immunization rounds.”

Equatorial Guinea’s Marburg testing conundrum

Dr Ahmed Ouma, acting director of the Africa CDC

Meanwhile, in mid-February, health authorities in Equatorial Guinea confirmed the country’s first ever case of Marburg virus disease in the western Kie Ntem province with concerns that cases may be undetected as the country has limited testing capacity. 

Over one month later, 12 cases — one confirmed case and 11 probable – and 12 deaths have been reported. The Africa CDC on Thursday attributed the inability to confirm the suspected cases to limited testing capacity in Equatorial Guinea.

According to the US Centers for Disease Control and Prevention (CDC), the polymerase chain reaction (PCR) test is one of the methods for diagnosing Marburg virus disease. 

While noting that Equatorial Guinea and several other African countries acquired and expanded their PCR testing network during the COVID-19 pandemic, Dr Ahmed Ouma, acting director of the Africa CDC, told Health Policy Watch that availability of the infrastructure for testing is just one of the several elements required for testing for the disease. 

In addition, he said there is also the need for manpower (laboratory scientists) and reagents. These three, he said, need to be at the same place for an effective diagnosis strategy.

“In the beginning, there was no capacity within Equatorial Guinea. That capacity has now been made available. Training is ongoing, and we expect that the situation of not being able to get laboratory diagnosis out quickly is going to change,” Ouma said.

Noting the variation in testing capacity on the continent, Ouma added that access to the affected population was a challenge in some areas, as the required equipment may not be easily deployable in rural areas affected by Marburg.

“We have a situation here where it was a very rural community that was affected and we are working around the clock with the government of Equatorial Guinea to ensure that laboratory capacity is on the ground,” he added.

Despite the challenges of diagnosis, Ouma revealed available knowledge regarding clinical diagnosis and management are being deployed in responding to the outbreak. This includes quarantining and managing cases that present like human hemorrhagic fever — monitoring individuals with such symptoms “so that they are not a danger to themselves and the rest of the community”.

Cyclone Freddy linked waterborne disease outbreaks

On 12 March, Malawi experienced landfall of Cyclone Freddy that has caused flooding, displacement of people and massive destruction of sanitation facilities now impeding current response efforts. Other countries affected by the cyclone are Madagascar and Mozambique. 

“The second passage of Cyclone Freddy has displaced 87,603 people and caused 238 deaths in Madagascar, Malawi and Mozambique. This is a 111% increase in the number of new displaced persons and a 1,685% increase in the number of new deaths. Cumulatively 70,014 displaced persons and 132 deaths have been reported from three AU Member States,” Ouma said.

Regarding the health impacts of the cyclone, Ouma said Africa CDC is working with several agencies including the World Food Programme (WFP), particularly focusing on mitigation initiatives to ensure that those who have been displaced are in an environment that has decent and acceptable sanitary facilities.

“We are ensuring that we avoid any outbreak of waterborne diseases and we are also working with the government to provide health facilities where they can be able to access health whenever they need it. Other arms of governments in the affected countries and other partners are actually also working very hard to provide water, food and transportation to safer ground and mitigate the possibilities of unhealthy and unsanitary living conditions. This is how we reduce or completely stop the outbreak,” Ouma said.

Image Credits: Sanofi Pastuer/Flickr.

A genetic revolution is coming. It’s time the medical community and policymakers discuss it.

As technology advances and the price for genetic testing decreases, it is likely that within the next five years, DNA sequence information will be part of a patient’s medical records. Such a move would revolutionize the way doctors diagnose and treat medical conditions while at the same time raising complicated ethical questions.

By allowing access to a patient’s complete DNA sequence, doctors could more accurately diagnose various medical conditions, including genetic disorders. In addition, it would help doctors to better decide which medical tests are needed to establish a diagnosis and better understand how a patient’s genetics may affect the results of those tests.

At the same time, doctors could preempt the risk for certain medical conditions, at a different level of certainty, from cardiovascular disease to Alzheimer’s, Huntington’s disease to breast cancer.

Taking cardiovascular disease as an example, if doctors could see that a particular patient has a strong predisposition to it, they could tailor a personalized treatment plan designed to prevent or mitigate the condition. Of course, the plan would not only be based on genetics but would include historical information and a current medical workup. However, the patient’s genetic information would be the catalyst for the prevention and treatment plans.

 Another aspect would be the impact on treatment allocation, whereby doctors could start prescribing medication according to genetic characteristics, improving many of today’s anguishing patient journeys. Instead of testing medications until the right drug is discovered, doctors could match the most suitable medication to each patient right away. That would be a considerable leap in the quality of care.

Barriers to integration

 The increased availability of direct-to-consumer genetic testing has spawned the shift toward integrating DNA into medical records. These tests provide people access to their genetic information without involving a healthcare provider or health insurance company.

However, when people receive the results, they often bring them directly to their physician, who then must deal with whatever has been discovered. 

For example, a woman concerned she might have the BRCA gene that puts her at much higher risk of developing breast cancer or ovarian cancer, could send a saliva sample to the US and find out if she is BRCA positive within a few weeks. Then, if she is, she will most likely approach her physician concerned, asking for additional tests, such as an annual MRI or information about surgical preventive measures.

Financial burden

However, as a physician can only address results from a high-quality, clinically validated laboratory, they will have to explain that a second genetic test, and likely a more expensive one, is first needed. 

Of course, insufficiently reliable direct-to-consumer genetic testing can have a high emotional cost and uncertainty during the interim period prior to validating the results. 

Moreover, this information would inevitably increase the financial burden on the health system. While early detection undoubtedly saves lives, when insufficiently reliable or inconclusive in terms of the results or what can be done with them, can also lead to a lifetime of excessive testing and medical consultations and follow-ups.

An additional barrier would be the need to re-educate a large number of healthcare practitioners, as many doctors and other medical professionals will need to learn how to read and interpret genetic information.

Ethical questions arise

However, the most significant barrier to implementation should be the multitude of ethical questions that must be addressed before DNA sequencing is available to almost everyone. The medical community and policy makers must develop new regulations for managing personalized genetic data.

 For example, there are significant risks of invasion of privacy if a person’s genetic information gets out. There is also a possibility that this genetic information could be misused by an insurance company, which could raise rates due to a ‘high risk’ marker to develop a future medical condition found in a person’s genetic makeup. 

A more liberal stance is to provide the patient with their full genetic workup. An alternative is to provide him or her access to solely genetically actionable genes (ie. genetic findings that have defined and known medical consequences and treatment recommendations).

However, ‘actionable’ is a dynamic concept, whereby as research develops, and our knowledge increases exponentially – and what is not actionable today, might be actionable in a year. Should the physician be responsible to constantly re-check the patient’s genetic makeup and notify them? 

Should patients have to opt-in or sign a consent to see their DNA sequence? Or should they opt out if they do not want to see it?

The future standard of care will include the integration of genetic information into the medical decision process. This calls on medical professionals and policy advisors to be prepared and address ethical, legal and regulatory issues – today.

Dr Tal Patalon is Head of KSM Research and Innovation Center, which helps to develop tech-based medical solutions to inform global health policies and enhance healthcare services. She also oversees the Tipa Biobank Project, the largest Israeli biosample repository. She is also an active clinician, specializing in family and emergency medicine. 

Image Credits: Sangharsh Lohakare/ Unsplash.