Leaders of the US conservative Christian group Family Watch International travelled to Uganda and met with Uganda’s first lady, Janet Museveni and other government officials to encourage the passing of the Bill.

Uganda’s Parliament passed a revised Anti-Homosexuality Bill on Tuesday, retaining executions for certain same-sex activity and introducing harsher penalties for some categories of ‘offences’.

Ugandan President Yoweri Museveni had declined to sign into law an earlier version of the Bill after the Deputy Attorney General (DAG) had advised him that it would be open to various legal challenges, sending it back to Parliament to be tightened up.

The inclusion of the death penalty in particular would leave the bill open to legal challenge in a country that has effectively ended the use of capital punishment, wrote DAG Kaafuzi Jackson Kargaba in a letter to the president.

However, Parliament has voted to retain the death penalty for “aggravated homosexuality” – defined as sex with a child or disabled person or while living with HIV. A 20-year prison sentence for “knowingly promoting homosexuality” has also been retained.

However, the Bill no longer makes it a crime to simply identify as LGBTQ and people are only obliged to report homosexual activity if a child is involved.

The Bill had the support of all but one of the MPs, many of whom have persistently equated homosexuals with paedophiles.

Speaker Anita Among took issue with Kargaba for pointing out the flaws in the earlier Bill and when he tried to explain his position, she refused to allow him to speak.

“Today Parliament has once again gone into the history books of Uganda, Africa and the world and clearly brought up the issue of homosexuality, the moral question, the future of of children and protecting families,” said Among.

“We have a culture to protect. The Western world will not come to rule Uganda,” she added.

Ironically, however, US conservative Christian groups have been pushing for the legislation since 2014 when a “kill the gays” Bill was passed but never implemented after being overturned in a legal challenge, and Among has been part of the high-level government officials meeting with these groups, including the Arizona-based Family Watch International.

“This legislation… is here to erase the entire existence of an LGBTQ person in Uganda, but also it radicalizes Ugandans into hatred of the LGBTQ community,” LGBTQ activist Frank Mugisha told MSNBC’s Rachel Maddow in an interview on Monday.

Since the previous Bill was passed a month ago, hate crimes and violence against LGBTQ people have risen sharply, according to the Human Rights and Awareness and Promotion Forum (HRAPF), a legal aid organisation.

In addition, police have arrested people on suspicion of being LGBTQ, according to HRAPF.

The Bill goes back to the president to be signed into law amid intense pressure for him not to from the US and European Union in particular.

pandemic
Countries across the world show first signs of significant recovery of health systems after the pandemic.

Three years after the COVID-19 pandemic began, health systems across the world are showing signs of recovery from its negative impact, with fewer countries reporting on scaling back delivery of essential health services as compared with 2020-21.  

Disruptions to the delivery of essential health services had almost halved by the end of 2022 when compared with the same period in 2021.

The interim report of the fourth Global Pulse survey on the continuity of essential health services during the COVID-19 pandemic released by the World Health Organization (WHO) on Tuesday stated: “The key informant survey results indicate that while essential health service disruptions persist in almost all countries across the globe, health systems are showing the first notable signs of recovery and transition beyond the acute phases of the pandemic”. 

This round of the survey covered responses from 125 countries and concluded that an average of 23% health service types (“tracers”) were disrupted in the last quarter of 2022 (October to December). Taking into account 84 countries that participated in all four rounds of the pulse survey, the service disruption decreased from 56% in the third quarter of 2020 to 23% in the fourth quarter of 2022.

Health services
Level of service disruption across 27 tracer services in 84 countries submitting responses to all four survey rounds

Some of these tracers include 24-hour emergency care, emergency surgeries, rehabilitative services, family planning and contraception, antenatal care, and routine facility-based immunization services. 

While an overall reduction in disruption to the delivery of health services is evident, countries still reported disruptions to around 25% of the tracer items covered through the survey. 

Dr Rudi Eggers, WHO Director for Integrated Health Services, acknowledged the recovery in delivery of health services and added, “But we need to ensure that all countries continue to close this gap to recover health services, and apply lessons learnt to build more prepared and resilient health systems for the future”.

Significant recovery since 2021

The data collected and presented in Tuesday’s report shows a significant positive change from the previous editions. 

The third Global Pulse survey report published in February 2022 stated that over 90% of the countries faced ongoing disruptions in delivering essential health services to its people due to the pandemic.  

In the third edition, healthcare workforce issues emerged as one of the major barriers to delivering essential services in over 35% of the countries that responded to the survey. Additionally, around 53% of the countries reported disruptions in delivering primary health care services and 38% of the countries reported disruptions in the delivery of community care services. 

The disruption in the delivery of primary health care services decreased to 26% in the latest edition of the report and the disruption in providing emergency life-saving care decreased to 16% in the latest edition. 

In the latest report, over 70% of the countries reported that they have successfully budgeted for and integrated COVID-19 services including case management, vaccines and diagnostics in their health systems. However, when it comes to managing post-COVID-19 conditions, only 60% of the surveyed countries stated having budgets and integration strategies for it. 

Around 80% of the countries still reported having at least one challenge in increasing access to one or more essential COVID-19 tool. 

Health services
Bottlenecks to scaling up access to essential COVID-19 tools (n=83)

Countries eye long-term preparedness and resilience

The report also poins out that countries have institutionalized some of the innovative practices that were born out of necessity during the COVID-19 pandemic, like telehealth consultations. 

Around 75% of the countries also reported an increase in their budget allocation towards bolstering and preparing their health systems for the long term. 

Image Credits: MSH, World Health Organization (WHO).

South Sudan’s Minster of Health, Elizabeth Chuei, being vaccinated at Juba Teaching Hospital with a vaccine delivered by COVAX.

By the end of 2022, COVID-19 vaccines delivered by the global vaccine access initiative, COVAX,  helped to avert 2.7 million deaths across 92 lower-income countries, according a new report based on modelling by researchers from Imperial College London.

COVAX’s biggest success was in low-income countries, where its vaccines were responsible for three-quarters of all deaths averted, with 73% of COVID deaths averted in Africa from COVAX vaccines. 

Between January 2021 and December 2022, COVAX delivered 1.9 billion vaccine doses to countries supported by the Advance Market Commitment (AMC), a financing mechanism where doses were largely funded by donor governments to countries that could not afford them.

By the end of 2022, over half the populations in AMC countries had received their full primary vaccines, according to the report, which was released on Tuesday by the global vaccine alliance, Gavi, one of the four key COVAX partners.

The report was released at the start of a two-day “global stocktake” of COVID-19 vaccine delivery, being held in Ethiopia. One of the aims of this meeting is to ensure that COVID-19 services are integrated into primary healthcare.

The modelling is an extension of earlier research published in The Lancet by researchers from Imperial College’s MRC Centre for Global Infectious Disease Analysis.

They explain their methodology thus: “A mathematical model of COVID-19 transmission and vaccination was separately fit to reported COVID-19 mortality and all-cause excess mortality in 185 countries and territories.

“The impact of COVID-19 vaccination programmes was determined by estimating the additional lives lost if no vaccines had been distributed.” 

COVAX vaccines offloaded in Abuja, Nigeria.

India vaccine export ban

COVAX’s vaccine supply was sharply curtailed in April 2021 when India, battling a severe COVID-19 outbreak, prevented the Serum Institute of India (SII) from exporting any of its vaccines. SII was to have been COVAX’s main supplier.

As a result, by the end of 2021, COVAX vaccines had contributed to a quarter of vaccine doses in the AMC countries, averting around 857,000 deaths averted – or 13%.

In a collosal understatement, the report acknowledges that “arguably more deaths could have been averted had access to doses not been hindered and had countries received them at scale earlier”.

However, while COVAX’s global market suffered from the export ban, the SII vaccines “contributed significantly to India’s coverage gains that year, which saw more than 850 million people receive at least one dose, with 617 million receiving the complete primary series in 2021”.

India conducted the world’s largest domestic COVID-19 vaccination campaign, and the SII vaccines – 80% of which had been destined for COVAX – averted “an estimated 3.6 million deaths in 2021 alone”, according to the report.

‘A ship built as it set sail’

Describing COVAX as “a ship that was built as it set sail”, the report identifies ”key learnings” in how equitable vaccine access can be achieved as fast as possible for low-income countries and African economies.

To avoid delivery delays, COVAX advocates for: 

  • Increased regional supply resilience and manufacturing capacity of life-saving interventions, such as vaccines, particularly across Africa. 
  • Transparency by manufacturers regarding their order books so that when delays occur or supplies are limited, it is possible to determine when countries that are unable to afford doses are in danger of disproportionally missing out. 
  • Contingency funding and surge capacity to enable global and regional health agencies to pivot during a global health crisis and mount a rapid global response.
  • Mechanisms for equitable access to pandemic products like vaccines, therapeutics and diagnostics to be in place before “disaster strikes”.
  • Global mapping of existing health solutions, mechanisms, networks, expertise, policies, frameworks and tools, including those created during COVID. It lists the Emergency Use Listing of health, indemnification and liability agreements and the No-Fault Compensation Scheme as examples.
Gavi’s Aurelia Nguyen

“When COVID-19 hit us, there was no playbook to handle what would become the deadliest global health emergency in 100 years,” said Aurélia Nguyen, Gavi Chief Programme Strategy Officer, and former COVAX managing director.

“The rapid actions of COVAX, which by the end of 2022 had averted 2.7 million deaths, show us how essential a coordinated, multilateral global response is. It also shows the importance of ensuring equitable access to vaccines is built in from the very beginning in any future effort, as many more lives would have been saved if vaccines had reached vulnerable populations earlier.” 

COVAX is the vaccines pillar of the Access to COVID-19 Tools (ACT) Accelerator, set up to accelerate the development, production, and equitable access to COVID-19 tests, treatments, and vaccines.

COVAX is co-led by the Coalition for Epidemic Preparedness Innovations (CEPI), Gavi and the World Health Organization (WHO), with UNICEF as the key delivery partner for the vaccines.

Image Credits: UNICEF, NPHCDA.

About 30% of Tanzania’s artisanal gold miners are women.

GEITA, TANZANIA—As the morning breeze sweeps across a rugged mining site at Tanzania’s northwest Sabora village, Judith Nyakeke sits under a huge acacia tree, briskly sorting pieces of rock with her bare hands ready to wash.

“This is a tough job but it can be quite rewarding,” she says.

The 39-year-old mother of four, who has been working as a miner for 13 years, adeptly shaking a giant mesh sieve to filter sand from the crushed ore. 

She then wades into a muddy stream to wash the silt encrusted with gold in the water.

Then she goes to her home to mix it with mercury to get a hardened amalgam which she burns on an open flame to distil the mercury and get purer gold ready to sell.

As the amalgam is sizzling on a heated pan, it emits toxic fumes, that waft past Nyakeke’s 12-year-old daughter, Jane, who squats nearby to look.

“People say mercury is a dangerous substance, but I have been using it for many years without any harm,” says Nyakeke, who has a slight stammer.

 Nyakeke’s quest for survival has taken her to the hazardous depth of artisanal gold mining in Tanzania’s northwestern Geita region where men, women and children are jostling to eke out a living.

“I don’t worry too much about health problems. My focus is to put food on my family’s table and educate my children. Other things, God will take care of them,” she adds.

Toxic substance

Mercury is a toxic substance that attacks the central nervous system. Exposure to the shiny liquid metal may cause neurological problems, including impaired coordination, slurred speech, memory loss, and life-long disability, medical experts say.

The toxic substance can cripple the cardiovascular and immune systems, attack kidneys and affect the gastrointestinal tract and lungs.

Mercury poisoning, with symptoms that include twitching, tremors and blurred vision, may also reduce women’s fertility and cause miscarriages, according to doctors at Tanzania’s Muhimbili National Hospital.

Mercury poisoning, which the doctors call “the invisible epidemic”, is hard to detect and can be potentially harmful to children.

In Sabora village, some female miners strap their small children onto their backs when mixing or burning mercury, not knowing that they are exposing them to toxic fumes.

Across Tanzania, hundreds of men women and children are toiling in hazardous goldmines,  exposing themselves to grave health risks.

Although small-scale gold mining is a vital source of income for rural communities in Tanzania – Africa’s fourth largest gold producer – experts say it is hazardous because miners use toxic substances to obtain gold.

A Health Policy Watch investigation in Geita shows that the miners who touch mercury with their bare hands are oblivious to the grave health risks.

Labour-intensive work

Up on the hill at the impoverished Sabora Village, half a dozen men with flashlights strapped on their foreheads emerge from a ground pit, carrying buckets filled with rocks.

Armed with heavy-duty chisels, the miners say they spent six hours crushing the rock to get fist-sized pieces. Then they pass it on to female colleagues who sort and wash them in the river.

Dressed in a dazzling African Kitenge outfit meticulously patterned with blue and yellow marks, Nyakeke and other women crush the ore into smaller fine particles, sort grade and wash them.

Judith Nyakeke right, and her colleague washing crushed rocks encrusted with gold.

The use of mercury in these makeshift goldmines also has a devastating effect on the environment as it seeps into the food chain, causing birth defects, neurological disorders even death, according to Nasra Semgomba, an environmental health expert at Tanzania’s Ministry of Health.

The unsafe disposal of mercury in Tanzania has created a toxic mix in the country’s river system exposing people downstream to serious health risks due to water and fish contamination, she added.

“Small-scale miners should not at all use mercury for processing gold, it is  pretty dangerous for their health,” Semgomba said.

Despite her warning, Health Policy Watch saw artisanal miners in Geita cutting trees, diverting waterways and reshaping the land in their desperate search for gold. While the miners are struggling to eke out a living, they are also disposing mercury through the air, water, and soil. 

Wider problem

Artisanal miners sieving gold encrusted rocks

Across Africa, men, women and children work in labour-intensive artisanal gold mines to eke out a living. Approximately 12% of gold production worldwide comes from artisanal mining. Globally there are 15 million artisanal gold miners, working in 70 countries.

Pushed by sheer poverty, artisanal gold miners in the east African nation often suffer chronic intoxication.

The investigations conducted by Health Policy Watch in Tanzania’s northern Geita region and in the southern highlands of Mbeya shows the miners routinely burn mercury-gold nuggets at their homes, exposing themselves and their families to hazardous fumes.

Some of the miners in Geita told Health Policy Watch that they know the risk involved but believe they are immune to the adverse effects of the liquid metal as they have been using it for a long time without feeling any side effects.

“This is my 11th year as a miner. I have been using mercury without any harm,” said Martin Kulwa, a small-scale miner in Geita.

The miners use mercury for gold extraction because it is cheap and can easily be obtained. While developed nations have adopted safe, cleaner alternatives for gold extractions and have enforced tougher rules for mercury use, African authorities often turn a blind eye to the health risks posed by mercury, citing low capacity and a lack of expertise to deter its use.

Despite efforts to ban mercury use for gold extraction, the toxic liquid is still being widely used by small-scale miners in Tanzania.

“I don’t think there is political will to ban the use of mercury since it is a big business in this country despite its harmful effects,” said Rubera Mato, Professor of Environmental Engineering at Ardhi University in Dar es Salaam.

Child labour

In its 2013 report, “Toxic Toil: Child Labour and Mercury Exposure in Tanzania’s Small-Scale Gold Mines,” Human Rights Watch revealed shocking details of children working in unlicensed small-scale gold mines in Tanzania, risking their lives due to exposure to mercury.

The global rights watchdog said young children are lured to work in the gold mines in the hope of a better life but often end up in the vicious circle of danger and despair.

Tanzania has long been criticised by environmental and civil society groups for its lax regulations to deter child labour.

“Our policies on health and environment are in shambles. We need clearcut policies and laws to deter environmental hazards” said  Zuhra Ahmed, an environmental Activist at Tanzania’s Youth Biodiversity Network 

Estimates of mercury usage vary from between 13.2 and 214.4 tonnes in Tanzania every year, with the approximately 1.2 million artisanal miners being the largest number of users. Between 10% and 20%  of all the gold produced in Tanzania is produced by small scale miners, about 30% of whom are women, according to government data.

Global treaty

Globally the Minamata Convention, a global treaty to protect human health and the environment from the effects of mercury that came into effect in 2017, requires countries to develop national action plans to reduce and eliminate mercury use in artisanal and small-scale gold mines.

But unlike other nations, Tanzania has done almost nothing to regulate the import or use of mercury which causes birth defects, neurological problems even deaths as people consume tainted fish, Ahmed said.

Dotto Benjamin, Chief Mine Inspector in Tanzania’s Vice President’s office (environment) denied the allegations, saying the government has been working to eliminate the worst practices, particularly the open burning of amalgam and processing of mercury-contaminated tailings with cyanide to recover gold, as well as raising awareness on the effect of mercury and promoting alternative technologies.

“A national action plan has been developed to meet the requirement of the Minamata Convention and serves as a national framework for fostering sound management of mercury use and where possible eliminate its use,” Benjamin said. 

United Nations human rights experts in Geneva recently reiterated their call for an end to the trade in mercury and its use in small-scale gold mining.

Marcos Orellana, UN Special Rapporteur on toxics and human rights, recently urged nations to address human rights violations related to the use of mercury in small-scale gold mines and protect the environment by prohibiting its trade and use in such mining.

“In most parts of the world where mercury is used in small-scale gold mining, the human rights of miners, their families and communities, often living in abject poverty, are increasingly threatened by mercury contamination,” he said.

Maria Kemilembe, left, preparing a gold-mercury amalgam before it burning

Indigenous peoples are particularly affected by the destruction and pollution of their territories, deforestation, loss of biodiversity and contamination of their food sources, according to Orellana.

“In order to more effectively combat human rights violations related to the use of mercury in small-scale gold mining and protect the environment, states and the Convention should prohibit the use and trade of mercury in such mining. This will be an essential step towards strengthening other elements of the Convention and making them more effective,” he said.

Asha Kisena, a resident of Nyang’wale village in Tanzania’s Geita region looks older than her 43 years. Her sun-parched skin and the repairs to her tattered dress declare her poverty.

Kisena has been working as a miner for many years, but recently her husband, George, noticed she was sick.

When she showed up at a district hospital in Geita in March, she couldn’t walk, her speech was slurred and she couldn’t walk and was not able to feel her hands.

Shortly after being admitted, Kisena fainted and was hospitalised for many weeks.

Her husband said doctors discovered that his wife’s desperate condition was caused by mercury poisoning.

“She is still sick and we don’t have much hope that her condition will improve,” George said.

But for Nyakeke, there is little choice: “This is my livelihood, I am under no illusion I can quit my job anytime soon,” she said

Image Credits: Kizito Makoye.

Childhood Pneumonia
Health officials from Francophone African countries speaking on at the 2nd Global Forum on Childhood Pneumonia.

Four more African countries will be introducing pneumococcal conjugate vaccine (PCV) into their routine immunization schedules – as other countries across Africa said they would ramp up and revitalize childhood vaccination programmes that were hit hard by the COVID pandemic. 

In commitments announced this week at the 2nd Global Forum on Childhood Pneumonia in Madrid Spain, officials of Chad, Guinea, Somalia and South Sudan announced their readiness to start administering the vaccines routinely by 2024. They said that they would apply for support to Gavi, The Vaccine Alliance to support rollout. 

Burkina Faso, the Democratic Republic of Congo (DRC), Ethiopia, Mozambique and Nigeria also pledged to increase the coverage of PCV and other vaccines to pre-pandemic levels. Specifically, health authorities in Burkina Faso said they would restore PCV coverage to above 90% by working with the Zero-Dose Immunization Programme (ZIP) while also reaching zero-children with vaccines against measles, rotavirus, ​​diphtheria, tetanus and pertussis (DTP).

‘Zero dose children’ are those who have not vaccinated at all – reaching those pockets of children is critical to the ambition to end preventable deaths of newborns and children under 5 years of age by 2030, a health  target of the Sustainable Development Goals (SDG 3.2).

‘Unjust burden’ on Sub-Saharan Africa and South Asia 

Attendees at the 2nd Global Forum on Childhood Pneumonia in Madrid, Spain.

Every day, pneumonia kills 2,000 children globally – one of the leading causes of deaths of under-fives. Nearly all of those deaths are preventable, however, with vaccination, equitable access to quality primary health care, and a reduction of other key risk factors such as undernutrition, household air pollution, and a lack of access to safe water, sanitation and hygiene. 

Sub-Saharan Africa and Southern Asia are the worst affected, accounting for four of every five child pneumonia deaths worldwide Partners at the forum declared the childhood pneumonia indices as an unjust burden requiring attention, prioritization, and urgent action.

“This is an unjust burden requiring our attention, prioritization, and urgent action… Fast action to reduce child pneumonia deaths can make the difference and will impact overall child mortality by strengthening health systems to deliver integrated child health services,” the forum’s official declaration stated.

In addition to the pneumococcal vaccine which is used to protect infants, young children and adults against pneumonia caused by the bacterium Streptococcus pneumoniae, health authorities in Guinea and South Sudan also want to introduce the rotavirus vaccine while Somalia is also adding rotavirus and measles-rubella vaccines into routine childhood vaccination in 2023.

Strengthening access to oxygen therapies 

A number of countries also pledged to strengthen access to pulse oximetry and oxygen therapies – critical to diagnosing and treating children hospitalized with pneumonia.

“The Ministry will ensure all relevant child health policies, guidelines, and essential medicines lists include pulse oximetry and oxygen and that health facilities and pediatric wards are equipped with pulse oximeters and oxygen and trained staff to diagnose and treat sick children,” the Burkina Faso Health Ministry declared. 

To help finance these efforts, the government said it is seeking support to acquire and train health workers in using pulse oximetry and oxygen support, as well as better access to doses of  child-friendly amoxicillin from The Global Fund; it is also aiming to co-invest in strengthening the community health workforce by working with the Global Financing Facility and the Community Health Roadmap Catalytic Fund.

Tackling child mortality by targeting zero-dose children

Keith Klugman, Director, Pneumonia and Pandemic Preparedness at the Bill & Melinda Gates Foundation addresses the forum.

While progress is being recorded in many countries, 54 are not on track to achieve the SDG target 3.2 for child survival by 2030 – whose indicator is less than 25 deaths among children under five per 1,000 live births. 

At the conference, experts argued that fast action to reduce child pneumonia deaths can make the difference and will also reduce overall child mortality by strengthening health systems to deliver more integrated child health services.

On the sidelines of the forum, Dr Keith Klugman, Director, Pneumonia and Pandemic Preparedness at the Bill & Melinda Gates Foundation told Health Policy Watch that targeting zero-dose children to tackle child mortality is a smart goal for African countries but they need to have adequate knowledge regarding vaccination in their countries in other to effectively reach groups of children who have not been vaccinated at all.

“In my view, it’s quite clear. The first is to develop the process to have a clearer idea of who’s being vaccinated and who isn’t. And then to set targets and then to make it a term of national pride, that they’re able to meet those targets. We know how to do this. This is not rocket science,” Klugman told Health Policy Watch.

Commitments by DRC, Ethiopia, Guinea and Mozambique

The DRC pledged to rapidly accelerate the decline in child mortality and progress towards SDG 3.2 by reducing the number of zero-dose children by 30% in 11 provinces by 2025. 

Ethiopia’s “ambitious plan” entails targeting the country’s estimated 1.1 million zero-dose children and reaching those living far from health services to address the currently very low rates of care seeking for children with pneumonia symptoms. This it said will address the currently very low rates of care seeking for children with pneumonia symptoms.

The ministry noted that child pneumonia and other deaths can be reduced by restoring PCV, pentavalent, rotavirus, and measles coverage to pre-pandemic levels of above 90%; by increasing the supply of vaccines and antibiotics through more local medicines manufacturing, and by increasing access to pulse oximetry and oxygen therapies for newborns and children. 

“The Ministry will ensure that COVID-19 pulse oximetry and oxygen supplies are redeployed to benefit sick children,” it added.

In Guinea where there are an estimated 192,000 zero-dose children, the country’s ministry of health committed to reducing the figure by 50% with key roles being played by the finalization of the country’s National Immunization Strategy and strengthening the capacity of health care workers to diagnose pneumonia, especially in remote areas. “Special efforts will also be made to ensure that mothers understand the risks of pneumonia and can seek quality healthcare quickly for a sick child,” the ministry declared.

Mozambique also made a similar pledge to target the country’s estimated 330,000 zero-dose children. In addition, it also pledged to prioritize increasing coverage of routine vaccines to over 90% by 2030 as a way to accelerate progress towards SDG 3.2. 

“Mozambique will [also] continue to implement actions to sensitize and raise awareness in communities about the dangers of pneumonia in children in parallel with other causes of child morbidity and mortality, especially malaria and HIV/AIDS,” the ministry announced.

Cervical cancer

Gavi, the Vaccine Alliance has pledged $142 million in additional funds to expand global coverage of the human papillomavirus (HPV) vaccine, increasing its total investment to $600 million by the end of 2025, the organization has announced. Gavi said it expects its new investment to help reach 86 million adolescent girls by 2025, preventing over 1.4 million future deaths from cervical cancer.

The pledge marks a renewed commitment to advance the World Health Organization’s Global Strategy to Accelerate the Elimination of Cervical Cancer approved by the World Health Assembly in 2020 – the first-ever global commitment to eradicate a cancer.

“[Vaccines] can prevent up to 90% of all cervical cancer cases,” Gavi said in its statement Thursday on the new initiative. “It is the key intervention towards achieving elimination of cervical cancer.”

While the HPV vaccine is readily available in Gavi’s portfolio, supply bottlenecks and pandemic era disruptions of routine immunization programmes have hamstrung global efforts to increase vaccine coverage, especially in low- and middle-income countries where access to screening and treatment is limited.

Over 100 million adolescent girls received at least one dose of the HPV vaccine between 2006 and 2017 – but 95% of them were in high-income countries, leading to a staggering nine in ten cervical cancer deaths occurring in low-and middle-income countries in that same period. Overall HPV vaccine coverage was just 12% by the end of 2021.

“There are still millions of adolescent girls at risk of contracting cervical cancer – a life-threatening yet vaccine-preventable disease that disproportionately kills women in lower-income countries,” said Aurélia Nguyen, chief programme strategy officer at Gavi. “Taking urgent action to ensure no girl is left behind is imperative from a gender and equity perspective.”

New push to assist countries to introduce the HPV vaccine into routine immunization

Over the next three years, the revitalized push by Gavi and partner organisations like the WHO and UNICEF will focus on providing assistance to primary health care systems to introduce the HPV vaccine into routine immunization schedules and helping to catch up on vaccinations missed during the COVID-19 pandemic. HPV vaccination rates, which rely heavily on delivery through schools, were hit particularly hard by the lockdowns caused by the pandemic.

The additional funding announced on Thursday includes $33 million for enchanced technical assistance for the planning and implementation of HPV vaccine integration into regular immunization schedules, $40 million for strengthening delivery of the HPV vaccine and strengthening health systems, and $69 million in cash support for new introductions. Key countries that will receive support in the coming year include Bangladesh, Cambodia, Ethiopia, Indonesia, Kenya, Nigeria, Togo, and Zambian, Gavi said.

“The COVID-19 pandemic and school closures have also hit hard and set back vital progress,” Nguyen said. “The HPV vaccine has amongst the highest impact of all Gavi-supported vaccines, saving millions of lives and helping to protect the future of adolescent girls across the world.”

Gavi’s financial commitment comes days after a powerful global coalition of global health institutions, including Gavi, announced a partnership to halt the global backsliding in childhood vaccination rates caused by COVID-19, which was criticized for not including any new funds to support its goals.

Global momentum to tackle cervical cancer continues to grow

Momentum to tackle cervical cancer deaths has been building since the World Health Organization launched the Global Strategy to Accelerate the Elimination of Cervical Cancer in 2020 – the first-ever global commitment to eradicate a cancer.

WHO estimates the successful eradication of cervical cancer can avert 62 million deaths by 2040. Left unchecked, cervical cancer deaths will rise by nearly 50%, the UN health body said.

“Elimination is within the reach of all countries,” WHO director general Tedros Adhanom Ghebreyesus said in announcing the launch of the eradication roadmap in November 2020. “Girls who are born today will live to see a world free of this disease.”

However, shortly after that, the COVID pandemic enveloped the world – and while the elimination strategy was approved by the World Health Assembly in May 2020 – it was consigned to a backburner as countries battled the SARS-CoV2 virus.

A woman is estimated to die every two minutes from cervical cancer, despite the disease being preventable, treatable, detectable, and curable. HPV is the root cause of over 95% of global cervical cancer cases, and causes nearly half of female cancer deaths in sub-Saharan African countries.

Cervical cancer ranks as the fourth most prevalent cancer among women globally, with approximately 570,000 new cases and 311,000 deaths reported worldwide in 2018. The highest incidence and mortality rates are prevalent in Africa, where the rates are 7 to 10 times higher compared to the western world.

The prevalence of cervical cancer is reflective of inequalities among different populations, which depend on access to a national vaccination program, population-based cervical cancer screening, and quality treatment. These resources are not equally available to all, resulting in disproportionate deaths due to the disease.

WHO’s one-vaccine recommendation raises eradication hopes

WHO’s Dr Kate O’Brien and SAGE chairperson Dr Alejandro Cravioto announcing updated guidelines for the HPV vaccine.

In April 2022, the WHO’s Strategic Advisory Group of Experts on Immunization (SAGE) finalised an extensive evidence review on the HPV vaccine which concluded that a single shot was enough to prevent HPV in girls and women between the ages of nine and 20.

While women above the age of 21 are still required the traditional two dose schedule, SAGE’s updated guidance raised hopes that the additional doses freed up by the new assessment could provide a shot in the arm to global vaccination efforts. The WHO described the development as “game-changer”.

“This has been an important step towards vaccinating and protecting more women and girls,” said Dr Kate O’Brien, Director, Department of Immunization, Vaccines and Biologicals, World Health Organization. “With new evidence available on vaccine performance, WHO updated its recommendations in 2022 to give countries the option of a one-dose schedule of the HPV vaccine.”

“Girls are our future scientists, writers, sports champions, and innovators,” she said. “We want to see every girl and woman protected from cervical cancer throughout her lifetime.”

Image Credits: Creative Commons, WHO.

Panellists Pedro Villarreal, Hélène de Pooter, Elisa Morgera, Daniel Warner and moderator Gian Luca Burci.

As the current US Senate is unlikely to ratify a pandemic accord, it might make more sense for World Health Organization (WHO) member states to invest more effort in ensuring that the International Health Regulations (IHR) are adapted to respond to the next pandemic.

So suggested Daniel Warner, Assistant Director for International Affairs at the Geneva Centre for the Democratic Control of Armed Forces (DCAF) at an event hosted by the Geneva Graduate Institute’s Global Health Centre.

The IHR are the only global regulations to prevent the international spread of disease and contain certain binding obligations on member states.

“Any treaty must be ratified by the United States Senate, and especially in today’s Senate, it would be difficult to get any multilateral treaty passed, as opposed to changes in the IHR that don’t need Senate approval and they are covered within the WHO constitution,” said Warner.

IHR ‘more a priority’

He added that it would make sense for amendments to the IHR to be “more of a priority within the American position as opposed to some kind of treaty”. 

The US was one of the first countries to propose IHR amendments after weaknesses emerged during the COVID-19 pandemic and member states have proposed over 300 amendments.

However, given that the IHR are the world’s only legally binding protection against the spread of diseases, it is essential that they are protected from “a political dimension and from political division”, warned fellow panellist Hélène de Pooter, a senior law lecturer at the University of Franche-Comté.

Negotiations are taking place during “very difficult times for multilateralism”, De Pooter said. “The success of the ongoing negotiations at the WHO cannot be taken for granted, so the challenge for states’ representatives or diplomats is to keep health and health cooperation safe from the global disturbances that we are witnessing nowadays.” 

She added that it was “remarkable” that the IHR are not subjected to the traditional ratification process but enter into force automatically”.

As regulations are “not political instruments” but “technical and procedural tools designed for the sake of efficient cooperation and coordination in the health sector”.

As such, they should be “beneficial for all states, and for health cooperation, regardless of political party cleavages and specific national interests”. 

Universal, regardless of politics

For this reason, she appealed for the IHR to be universal in appeal to ensure that they had wide appeal and support.

The two were speaking on a panel on the concurrent negotiations on the pandemic accord and changes to the IHR, with drafts of both due to be presented at the 2024 World Health Assembly – and how to avoid a “collision” between the two processes.

Pedro Villarreal, Senior Research Fellow at the German Institute for International and Security Affairs, said that a pandemic accord might take a long time to come into being as each member state would need to ratify it.

Should a pandemic be declared soon after an accord had been passed by the World Health Assembly, only a few states might have ratified it.

“What will happen in such a situation where a pandemic is declared and it turns out that obligations are applicable to some states but not others?” Villarreal asked.

 “We will have a jigsaw puzzle of fragmented obligations, where the future pandemic response might go different ways, similar to what we saw during the COVID-19 pandemic.”

To make negotiations more efficient and fit to tackle the next pandemic, Villarreal suggested two negotiation processes could be combined.

“There could be an agreement on where to put which provisions and in which instrument each provision would be located,” he proposed.

“So why not negotiate everything together and then decide what goes where? Because first, it’s about knowing whether there is consensus at all.”

However, he acknowledged that this was “quite a tall order” as it required the mandates for negotiating each would need to be changed.

The final speaker, Elisa Morgera, Professor of Global Environmental Law at Strathclyde University Law School in the UK, said there were “several international multilateral beneficiary mechanisms” that could provide lessons for the current pandemic negotiations.

“What has then come out after decades of studying fair and equitable benefit-sharing mechanisms in international environmental law is that, fundamentally, we’re looking at enhanced international cooperation,” said Morgera, who is also Director of the One Ocean Hub.

“For research, we’re really looking at the research capacities in different states to be able to realise global objectives, and that fairness and equity boil down to: ‘what can we do in international law? What are the state obligations? What are the international mechanisms that we can devise to support fair research partnerships now in the Global North and global South countries where researchers are at very different stages in their capacities to contribute to the objectives?”

She appealed for the creation of a system that supported both the sharing and flow of global benefits and “specific benefits for specific beneficiaries”. 

“We have those important references to human rights in the draft preamble of the pandemic instrument and I think this is a crucial lens under the UN Charter for any new international law development that has to do with health and, really, human survival and flourishing.”

WHO’s Gaya Gamhewage on a visit to the Congolese city of Goma in November 2022, one of the hotspots of the 2018-2020 Ebola outbreak, where she committed to supporting the survivors of sexual assault and their families.

Gaya Gamhewage, the agency’s lead official in prevention and response to sexual misconduct, describes WHO’s recent moves to bring justice to DRC’s victims. 

In a long-awaited move, the World Health Organization (WHO) is preparing to share files with the Congolese courts on the sexual exploitation and abuse complaints of 13 women who are pursuing criminal cases in local courts against WHO-linked Ebola responders that they say exploited and abused them.

The abuse is alleged to have happened during the 2018-2020 Ebola outbreak in the Democratic Republic of the Congo (DRC). 

In a wide-ranging interview with Health Policy Watch, Gaya Gamhewage, WHO’s new director of Prevention and Response to Sexual Misconduct, spoke about WHO’s new initiatives to root out sexual misconduct from the Organization, also rebutting recent media reports that WHO has been foot-dragging on the pursuit of offenders in the DRC and had failed to liaise with DRC officials.  

Failings in WHO and other UN systems for preventing and managing sexual misconduct complaints have emerged as a major issue following revelations in 2020  by The New Humanitarian that dozens of women in the DRC has been sexually exploited, and even raped, by WHO, UN and other responders during the 2018-2020 Ebola outbreak, leaving behind a trail of victims, at least 20 of whom later bore children.

A scathing report by WHO established the Independent Commission in September 2021 found that 21 out of the 83 identified perpetrators were linked to WHO. The report also found major shortcomings in WHO’s processes for preventing, reporting and managing cases. It called for investigations against alleged perpetrators and managers and “disciplinary sanctions” for those found culpable.  

But WHO was unable to take action in DRC courts against the alleged perpetrators until the victims of abuse themselves decided to act, explained Gamhewage, who took over in 2021 as acting director of WHO’s newly formed Department for the  Prevention and Response to Sexual Misconduct at the height of the scandal. 

This is what just 13 women finally did, by accessing legal aid services by a local women-led NGO contracted by WHO and granting WHO permission to share their confidential information with local courts. 

Women pursuing cases are part of a larger group

Ebola responders raise awareness about the deadly disease in Beni, DRC, at the height of the 2018-2020 pandemic.

The 13 women are part of the larger group that testified in 2021 to the Independent Commission about the widespread patterns of abuse by men, who took advantage of UN, WHO staff or consultancy positions to obtain sex in exchange for money or jobs, in some cases raping local women as well.  

“Those [files] are being transferred directly to the courts that have asked us to provide them,” Gamhewage said. “Our WHO Legal Department received a letter from the courts that are prosecuting these cases, and now, because we’ve just received the victim’s consent, we are in the process of transfer.”  

Files from the ongoing investigation by the UN Office of Internal Oversight Services (UN OIOS), which is investigating all 83 DRC victims’ claims, will also be shared by WHO in relation to the same 13 survivors who have granted their permission, but those investigations are yet to be completed, she added.    

Gamhewage also noted that WHO has been providing medical, social and legal support to all identified victims of abuse, regardless of whether their alleged perpetrators were in fact affiliated with WHO or other agencies that responded the Ebola outbreak.

As the lead agency in health emergencies, WHO has borne the brunt of media attention in the scandal but only a quarter of the actual claims were linked to WHO staff or consultants.

“The total number of victims/ survivors identified by the Independent Commission is 83. Of those, 21 were associated with WHO at the time and the rest were perpetrators allegedly from other agencies,” Gamhewage said.

Seven WHO consultants were already dismissed 

Ebola responders at the height of the DRC outbreak in full protective gear.

The legal action being pursued locally in DRC is only one element in the spectrum of organizational disciplinary actions, Gamhewage also stressed.  

Seven WHO consultants were dismissed in the immediate aftermath of the Independent Commission report.

“Where there was enough evidence, we were able to terminate the contracts of consultants who were accused,” she said. “And when the UN OIOS investigation reports are provided to WHO, we will take disciplinary action against our personnel in every [other] case in which allegations of SEA are substantiated,” she pledged.

In addition, the names of 14 former WHO staff or consultants identified as alleged perpetrators by the Independent Commission were posted on the UN ClearCheck database. 

Through the database, some 33 UN entities share information about individuals who have “established allegations” related to sexual harassment, sexual exploitation and sexual abuse, with the aim of preventing their re-employment in the UN system. 

WHO is liaising with DRC government  

Meanwhile, WHO also has been liaising with DRC government officials on the handling of the cases, Gamhewage asserted.

She contested recent media reports  that the DRC government was uninformed, noting that she had personally traveled to the DRC in mid-March to brief officials and meet local NGOs to review the package of support that had been provided so far, and discuss options for more extended support to the survivors.  

However, on 24 March, just  days after her visit, a sudden DRC Cabinet reshuffle occurred, and that meant the process had to start all over again.  

“In just the previous week, I was with the Health Minister, I sat in his office and I briefed him. And we had a very good agreement on how to move forward,” recalled Gamhewage. “But then the government changed, so of course now we have to have a new conversation. I hope to have an opportunity to brief them again very soon.”

‘We realized we had to do something’ 

When Gamhewage took over her new role in 2021, she had a three-pronged aim: to find ways to support DRC victims; build WHO’s internal SEAH investigative capacity; and stimulate more effective outreach and education to prevent sexual misconduct from occurring.    

The painstaking work on the ground to support the DRC abuse victims took over a year, Gamhewage said. It involved reaching women in remote parts of conflict-ridden DRC, explaining to them their options, and connecting them with local support groups,

In early 2022, WHO engaged a DRC legal aid organization to advise women who wished to pursue legal claims. In parallel it struck a deal with HEAL Africa, a health foundation based in the eastern DRC city of Goma, to provide emotional, physical or social support to women who wished to have such services.  

“All in all, WHO provided victim and survivor support – medical, psychosocial, legal and income generation support to 115 survivors who claimed they had experienced SEA regardless of which agency the alleged perpetrator belonged to,” she underlined.

Regarding legal action, “in November 2021, and January 2022, we realized we had to do something while we were waiting for the [UN OIOS] investigation, so we transferred money to the UNFPA, to HEAL Africa, and to a women-led NGO that provides legal aid. And 13 of the survivors have now started pursuing justice through the legal aid NGO we hired in [local] legal systems,” she said. 

WHO’s Survivor Assistance Fund is unique in the UN system 

WHO’s Survivor Assistance Fund, established in September 2021 just after the Independent Commission report was published, covered the costs. She notes that the new fund is unique in the UN system insofar as it disperses funds directly – thus enabling “the fast allocation of funds to support victims and survivors of sexual misconduct” regardless of where they live.  

“The UN has a Trust Fund that supports United Nations and non-United Nations entities and organizations that provide victim assistance and support services and provides grants to NGOs that provide services to SEA survivors,” she observes. “But WHO is the only agency that has a fund for direct support, which can be accessed by individual survivors.”

‘When the UNIOS reports are provided, we will take disciplinary action’   

She stressed, however, that the victims’ consent to share information with local courts was essential for any local legal action – and that also took time.  

“When the survivors were initially interviewed [by the Independent Commission], they only gave consent for the information to be shared with WHO, not with the national authorities,” Gamhewage pointed out.  

 “So now, what we are doing is that we are collaborating on those 13 cases because we have consent. And as soon as we have the UN OIOS reports, we’ll hand those over too. 

“Our plan is whenever we get a victim’s consent for their information to be shared with the government, we will hand that over through the proper channels.  

Victim-centered approach  

“WHO is committed to transparency in its zero tolerance approach to sexual misconduct,” the UN’s health body said.

Gamhewage rebutted claims that its response to sexual abuse victims in the DRC had been different than its treatment of claims in headquarters. 

Just last Monday, WHO announced the dismissal of the senior official Temo Waqanivalu, accused of sexually harassing the young British doctor, Rosie James, at the World Health Summit in Berlin last October.

A decision on that case was issued within a period of just six months – the organization’s new benchmark for resolving claims.  

The process in DRC has taken much longer, she admits. In terms of the investigative process, WHO has little control since the high-profile DRC cases, uniquely, were turned over to the New York City-based UN OIOS, operating under the auspices of the UN Secretary General .

But more generally, Gamhewage also contends that in the case of DRC, any outreach to victims that was not carefully planned in advance could also have boomeranged: “It wouldn’t be victim-centered, and they could be put in danger.  

“Even when we gave victim support, to identify these women in the villages, we had to be very careful and the case managers had to be very careful not to stigmatize them.

“So, it’s actually a balance between protecting their rights, their wishes, but also their safety. And you know, survivors are, in a very, very tough area characterized by armed conflict, population displacement and extreme vulnerability and hardship.” 

‘If you take shortcuts, everybody loses’ 

Gaya Gamhewage at a UN press conference on March 3, 2023, describing WHO’s moves to better prevent and respond to sexual misconduct.

“Obviously if you are a survivor, you want this over as soon as possible, but these cases unfortunately take a long time.… It is from a victim/survivor point of view, very long.  

“But investigations also have to be robust; they have to be done properly. So if you take shortcuts, then everybody loses. What we aim for is a solid process that does not take too long, is fair and protects the rights and due process for all parties. Only by doing that will disciplinary action not be overturned on internal or external appeal.

“And do you know how difficult it is to access people, even for survivor support?  Sometimes it took five days [of local travel] to reach a community where the survivor was.” 

Even so, she concedes that before the recent changes in the system were made, “like most agencies, we took far too long for any investigation. We conducted an external audit to understand the real picture and took action to strengthen our investigation capacity.  But we set an ambitious benchmark, and we tested it.

The new six-month benchmark for the investigation of sexual abuse and exploitation cases from start to finish applies “wherever they occur in the world,” she asserts, rejecting the suggestion of a double standard. 

That time frame includes 120 days for investigation in sexual misconduct cases and another 60-80 days for a final decision on disciplinary action.

“In fact we’re [now] the only UN agency to set a benchmark of 120 days.”   

Broader overhaul of programme to prevent and respond

The DRC cases, meanwhile, have triggered a much broader overhaul of WHO’s system for preventing and responding to cases of sexual misconduct, she argues, echoing points made by WHO’s Director General Dr Tedros Adhanom Ghebreyesus at WHO’s Executive Board meeting in late January.  

The Organization hired more investigators for its Internal Oversight Services (IOS) department – and accelerated investigations clearing a backlog of sexual misconduct cases – not including the DRC complaints being handled by the wider UN OIOS team. 

As for critics who contend that some of the new WHO investigators are inexperienced, and only working as short-term consultants, she said: “It takes time to create posts, approve organigrams. But in the interim, what did we do?  Because of the urgency, we hired qualified consultants as ‘surge’ capacity. They are a multi-disciplinary team experienced in trauma-informed, survivor-centered approaches to investigating sexual misconduct and other abusive conduct.”

But over the long term, she maintains, WHO is developing a core team of permanent staff investigators specialized in sexual misconduct cases, who can be “supplemented if we need with surge capacity in the form of consultants.”  

“So we are now transitioning into a more stable way of moving forward. This, you can see in the confidence in the system by the number of people coming forward to a system that they didn’t trust before. 

“And of course, it can get better, and we would love to learn and improve, but the proof is that people are coming forward, compared to the past when they thought it was futile to raise a complaint,” she says, with reference to the gradual rise in the numbers of new complaints over the past year – including sharp rises in the African and Eastern Mediterranean regions.  

Meanwhile, the backlog of sexual misconduct cases that existed previously has been eliminated, she says. Although as the WHO dashboard on investigations reflects, there remains a backlog in WHO investigations into other forms of abusive conduct, in terms of sexual misconduct “we are working the cases in real time, and they are coming in mostly under 120 days. 

And excluding the DRC cases, WHO has dismissed eight personnel for sexual misconduct over the past seven months – more than ever before for a comparable period, Gamhewage pointed out.

Investments in education and training – online and in countries 

WHO Director General Dr Tedros Adhanom Ghebreyesus speaks at the 152nd Executive Board meeting, 31 January about WHO’s reforms in prevention and response to sexual misconduct cases.

WHO Director-General Dr Tedros Adhanom Ghebreyesus has publicly committed to a budget of $25 million a year for prevention and response to sexual misconduct, she adds. So far, that has included funding for the hiring of 20 full-time staff – along with the appointment and training of some 350 part-time focal points in 127 WHO country offices.  

A new policy on preventing and responding to sexual misconduct was issued in March 2023.  That policy clearly places not only direct WHO beneficiaries of aid, but also members of the wider public who are abused or exploited by a WHO staff member or consultant, as within its scope.  

“All WHO country offices are now mandated to complete at least one risk assessment for sexual exploitation, abuse and harassment every year, and all personnel must take mandatory training and be subject to screening in the UN ClearCheck database that aims to prevent the re-hiring of sexual misconduct offenders.

“And new standards and requirements have been set for health emergencies as the risk of sexual misconduct is high in humanitarian settings,” she says.

Finally, the WHO has also invested in new public education programmes for prevention of sexual misconduct – an area of work that was just a “box to check” during the 2018-2020 Ebola response, according to DRC responders who spoke with Health Policy Watch after initial revelations of the abuse. 

More than 30,000 participants have already engaged in WHO’s  live webinar series  #NoExcuse, through the OpenWHO.org online learning platform – which targets not only WHO and UN staff but also the broader audiences of civil society and health workers engaged in emergency response. 

“This is a platform where people can learn as well as ask tough questions about the system and policies openly,” said Gamhewage. “It is supplemented by country-level training and visits.”  

‘I cannot accept that we who are privileged…can also be the ones that harm’

Community advocates raise awareness about Ebolavirus on the outskirts of Beni, DRC in 2019 – an area wracked by poverty as well as armed conflict.

Gamhewage, who is leading the entire effort since July 2021, built her own reputation over two  decades at WHO as a skilled corporate coach, communicator and educator – teaching scientists and other staff to speak to the media, each other, and stakeholders about complex health topics in clear and understandable language.  

During the early days of the COVID pandemic, she was drafted to lead vital training and capacity building activities for the WHO Health Emergencies team, including the OpenWHO platform, followed by strategic development of online WHO Academy. The latter is now the world’s largest free open-source public health learning platform, offering some 200 public health courses, and with 7.5 million subscribers. 

A Sri Lankan born medical doctor and a public health professional, who has a reputation in WHO for frankly speaking her mind, she previously worked for Save the Children in her home country, as well as leading community health work in more than 15,000 communities for a large national NGO.

In terms of her latest mission, many challenges remain: 

“While WHO gets its own house in order, we have to work better as the UN and humanitarian systems to address persisting problems – lack of effective community-based complaints mechanisms, poor or absent victim and survivor services and last but not least, inadequate collaboration or poor engagement with governments in countries where we operate,” sayd Gamhewage.  

“We are just at the start of a long, hard journey. I did not ever expect that I would have to do this job but now that I have that responsibility, I am fully committed to doing everything I can to change our systems, our culture and anything else that is required. Like most WHO colleagues, I cannot accept that we who are privileged to serve people can also be the ones that harm them.”

Image Credits: Naomi Nolte IFRC emergency communication coordinator, WHO, Twitter/@OMSDRCONGO, World Bank Group/ V.Tremeau.

The new head of the Africa Centres for Disease Control and Prevention, Dr Jean Kaseya

The new head of the Africa Centres for Disease Control and Prevention (Africa CDC), Dr Jean Kaseya, wants to introduce a tax on all airline passengers on the continent to help finance health.

Days into the start of his term, the Congolese medical doctor revealed his manifesto for his four-year term at a media briefing on Thursday, his first public engagement since he was appointed to the post in February.

His manifesto is synced with the pillars of Africa CDC’s New Public Health Order, said Kaseya, focusing on the health workforce, financing Africa’s health systems, building partnerships, reinforcing local and regional organizations to respond to all health issues, and boosting local manufacturing capacities on the continent for diagnostics, therapeutics and vaccines.

Kaseya’s proposes actions meant to make Africa CDC to be more autonomous such as an African Air Tax to be paid by airline passengers with the proceeds going to financing Africa CDC’s health support to countries. 

Addressing journalists on Thursday, Kaseya said the tax is a way of extending Africa CDC’s autonomy from administrative autonomy to financial sustainability.

“We have some ideas we are discussing with key people and our member states. Financial sustainability will give us the opportunity not only to sit respectfully with our partners to meet the needs of African people, it also gives us some flexibility to support responses during different occurrences,” he added.

“By 2040, I will be 70 years old. I want to say to my children and grandchildren that I and my colleagues made Africa more independent by learning from what COVID-19 gave us as lessons,” Kaseya said.

He noted that the agency now has “a very strong political mandate” because it is engaging directly with Africa’s heads of state and, as such, it must be properly aligned to ensure true representation of the respective countries’ health priorities. 

“We have with this power, the convening power, we are the umbrella of all health efforts on the continent. This means our strategic plan must reflect the agenda of the majority of countries in Africa,” he added.

The continent also aims to increase its local vaccine production from the current 1% of vaccines to up to 60% by 2040.

Challenges ahead

When Kaseya’s election was announced, a number of several clear challenges emerged including getting all the countries on the continent to work together and in fulfilling the goals of the agency’s new public health order.

Dr Javier Guzman, Director of Global Health Policy at the Center for Global Development, said that Kaseya will face a formidable series of challenges in advancing the Africa CDC strategy. Moreover, there is also the challenge of finding new ways to make the agency and its public health priorities stand out in the post-COVID era – amongst the multiple other challenges that Africa faces in trade, finance, climate change and diplomacy.

But COVID-19 is no longer the priority that it used to be, Guzman noted.  Instead, many countries are now preoccupied with a burgeoning fiscal and debt crisis, as well as multiple other competing priorities.  These include accelerating the African Continental Free Trade Area, the main agenda item at the 36th AU Assembly, as well as confronting the growing effects of climate change and the war in Ukraine on food security, and beyond. 

“Dr Kaseya needs to bring a clear and focused vision to Africa CDC’s agenda, secure financial sustainability and build efficient operations, proactively reset the continental/regional balance, and secure the place of Africa CDC within a changing global health architecture. He will have the challenging job of maintaining the status of Africa CDC as the leading public health institution for the continent and delivering on the promise of an autonomous public health agency, a status granted by the African Union Assembly in February 2022,” Guzman said.

Kaseya has over two decades of experience in public health in international institutions and the government of the Democratic Republic of Congo, revealed his priorities and strategic vision for the autonomous health agency.

WHO
Dr Gaya Gamhewage, Director, Prevention of Sexual Misconduct, WHO.

Four World Health Organization (WHO) staff or consultants had their contracts terminated as a result of sexual misconduct allegations in the last quarter of 2022 – the most of any year so far. 

The contracts of another three people had already been terminated between January and March of this year, Dr Gaya Gamhewage, WHO’s Director of Prevention and Response to Sexual misconduct, told the media on Wednesday. 

The revelations came on the heels of news on Monday that WHO had dismissed senior manager Temo Waqanivalu following the conclusion of a high-profile investigation of sexual misconduct charges, first brought by a British doctor who had attended the World Health Summit last October in Berlin. 

“In the last year, our investigation team acted on not just the cases that were highlighted in the media, but have completed 120 investigations into sexual misconduct,” Gamhewage said in the briefing, adding that “72 other investigations are ongoing.”

Gamhewage’s report was the most complete, in terms of numbers to date, of WHO actions since the agency WHO undertook a major revamp of its programmes for preventing and responding to allegations of sexual misconduct – including a major expansion of its investigations team. 

WHO overhaul came in wake of DRC sex scandal

The WHO overhaul came in the wake of media revelations of widespread sexual exploitation, abuse and harassment, including cases of rape, by dozens of WHO and other UN responders to the 2018-2020 Ebola outbreak. 

In 2021, after a scathing report by a WHO-mandated Independent Commission investigation pointing to major shortcomings in the agency’s  SEAH management,  WHO announced worldwide reforms in both its investigative and prevention policies. 

However while the Independent Commission report also called for “disciplinary sanctions” against the alleged DRC perpetrators found culpable, Gamhewage’s report on Wednesday did not include the outcomes of their cases. 

That’s because the UN’s Office of Internal Oversight Services (UN OIOS) – and not WHO – are managing those cases separately and have yet to deliver their final reports, she said. 

“We are not investigating the DRC cases. They are all with UN OIS,” Gamhewage told Health Policy Watch in response to a follow-up question. “We can only take action once we receive their reports.”    

WHO changed ‘how we work, our structures, our culture’

But she asserted that WHO’s overhaul of its own internal systems was significant. 

“WHO started changing how we work, our structures, our culture, our processes over the last 18 months,” she said. 

“Because of the many changes we’ve made..having much stronger investigations capacity that is benchmarked, that’s fast and fair…providing better victim support …are having a cumulative effect that is changing our organization.” 

While acknowledging the role played by the media in breaking some of the taboos around addressing sexual misconduct, Gamhewage insisted that WHO also is “making changes with or without media spotlight.”

And she issued a warning to media who have been covering the trail of sexual misconduct cases at the organisation saying that some stories risked violating the rights of victims and alleged perpetrators. 

“I want to caution that the media spotlight should not harm the due process that is owed to everybody involved,” she said, referring to the right of confidentiality of both victims and survivors. 

“It’s only when we protect these things will the disciplinary action that we take a stand. Otherwise, it can be appealed and nobody will win,” she said. 

Her remarks were echoed by WHO Director-General Dr Tedros Adhanom Ghebreyesus who added: “On the one hand, media helps; it’s the eyes and ears of the so keep doing that, we appreciate your work. On the other hand, I would like to stress that …. we see a lack of balance. In some of the reporting [there are] factual errors. And when we try to correct …  there is refusal from some of the media outlets even to correct the factual errors.” 

“So we believe that you are helping us, but at the same time, I would urge you to… really make journalism balanced.  And any factual issue you bring, we will take it seriously,” he promised.