A child is vaccinated against Meningitis A in Chad; a new five-strain vaccine just introduced in Nigeria offers hope of eliminating meningitis as a public health problem, says WHO.

Immunisation has saved at least 154 million lives over the past 50 years, since the ​​World Health Organization (WHO) launched its Expanded Programme on Immunization (EPI) in 1974.

Of the lives saved, 146 million were children under five, and 101 million were babies.  Global infant deaths have reduced by 40%  and more than halved in Africa.

“That’s an average of more than 1000 a day and six every minute of every year for the past 50 years,” said WHO Director-General, Dr Tedros Adhanom Ghebreyesus, at a WHO press conference Wednesday that celebrated the program’s successes while warning of the setbacks to vaccination programmes from regional conflicts, the legacy of COVID and other risks. 

The measles vaccine has had the biggest impact on reducing infant mortality, accounting for 60% of the lives saved – 94 million.

This is according to a landmark WHO-led study, whose key findings were published on Wednesday to coincide with the start of World Immunisation Week (24-30 April).

The study used mathematical and statistical models to estimate the impact of 50 years of vaccination against EPI’s 14 priority pathogens. 

The 14 pathogens are diphtheria, Haemophilus influenzae type B, hepatitis B, Japanese encephalitis, measles, meningitis A, pertussis, invasive pneumococcal disease, polio, rotavirus, rubella, tetanus, tuberculosis, and yellow fever.

More children live to celebrate their fifth birthday

Dr Ephrem Lemango, UNICEF

 EPI –  now renamed the Essential Programme on Immunization – celebrates its 50th next month. When it was launched fewer than 5% of infants whereas today, 84% of infants are protected with three doses of the vaccine against diphtheria, tetanus and pertussis (DTP) – the global marker for immunization coverage.

“Today more children live to celebrate their fifth birthday than any moment in history,” said Dr Ephrem Lemango, UNICEF associate director and chief of immunization, at the press briefing.

“Vaccines are among the most powerful inventions in history, making once-feared diseases preventable,” said Dr Tedros. 

“Thanks to vaccines, smallpox has been eradicated, polio is on the brink, and with the more recent development of vaccines against diseases like malaria and cervical cancer, we are pushing back the frontiers of disease. With continued research, investment and collaboration, we can save millions more lives today and in the next 50 years.”

As the result of the polio vaccination, more than 20 million people are able to walk today who would otherwise have been paralysed, and the world is on the verge of eradicating polio.

More lives are expected to be saved in the next 50 years by additional vaccines, such as the new HPV vaccine that prevents most cases of cervical cancer, and vaccines against malaria, meningitis, dengue, COVID-19, respiratory syncytial virus (RSV).

Missing doses and rising vaccine hesitancy

Despite the successes, during the COVID-19 pandemic, 67 million children didn’t receive all the vaccinations they needed between 2020 and 2022, and nearly 49 million never received a single dose, according to the WHO.  

Coverage of at least 95% of children with two measles vaccines doses is needed to protect communities from outbreaks. 

Currently, the global coverage rate of the first dose of measles vaccine is only 83% and the second dose is just 74%. Reported measles cases increased by a staggering 84% in just one year between 2022-2023. 

A rise in anti-vaccine sentiment has also seen a decrease in immunisation against measles specifically, as well as vaccination more generally, in developed countries and particularly the US. For example, 28% of Americans  believe that parents should be able to decide not to vaccinate their children (up 12 points since 2019), according a 2023 survey by the Pew Research Center.

The decline in support for vaccine requirements for children has been driven by changing views among Republicans: 57% now support requiring children to be vaccinated to attend public schools, down from 79% in 2019, according to Pew.

UNICEF, Gavi and Gates Foundation as key drivers of the success

A baby is vaccinated at a UNICEF-supported health centre in Abidjan, Côte d’Ivoire.

UNICEF is one of the largest buyers of vaccines in the world, procuring more than two billion doses every year on behalf of countries and partners for reaching almost half of the world’s children. 

“This massive human achievement has only been possible through collective determination and effort led by governments and partners, with the help of scientists, healthcare workers, civil society and volunteers. Sustained cooperation and investment are essential to carry the achievements of the past half-century into the future,” said Catherine Russell, executive director of UNICEF.

In 2000, the vaccine alliance, Gavi, was created to help the poorest countries in the world increase immunisation coverage and benefit from new vaccines. 

Today Gavi has helped protect a whole generation of children and now provides vaccines against 20 infectious diseases, including HPV vaccine that protects against cervical cancer, and vaccines for outbreaks of measles, cholera, yellow fever, Ebola and meningitis. 

“Gavi was established to build on the partnership and progress made possible by EPI, intensifying focus on protecting the most vulnerable around the world,” said Gavi CEO Dr Sania Nishtar. 

“In a little over two decades we have seen incredible progress – protecting more than a billion children, helping halve childhood mortality in these countries, and providing billions in economic benefits. Vaccines are truly the best investment we can make in ensuring everyone, no matter where they are born, has an equal right to a healthy future: we must ensure these efforts are fully funded to protect the progress made and help countries address current challenges of their immunization programmes.”

New vaccine opportunities for meningitis, malaria and dengue

Dr Tedros Adhanom Ghebreyesus, WHO director general.

The rollout of a new vaccine for meningitis, which immunises against five bacterial strains at once, offers the first “real hope of being able to eliminate meningitis as a public health problem,” said Tedros. The vaccine was launched just last month by Nigeria in its northern states where officials aim to vaccinate 1 million people hit hard by meningitis recently.  He noted that he would be joining global health leaders in Paris Friday for a first-ever high level meeting on defeating meningitis.

“The defeating meningitis by 2030 roadmap requires an initial investment of 130 million US dollars,” said Tedros. “Which is frankly loose change compared to the return that investment will deliver as well as preventing over $900,000 and nearly 3 million cases of meningitis by 2030. He added that “defeating meningitis would save billions of dollars in health costs and lost productivity – and as part of an integrated primary health care program can also help to combat antimicrobial resistance (AMR).”

Two new malaria vaccines are also being rolled out in half a dozen African countries, with many more states planning to join the campaign, said Tedros.  Malaria vaccines, he said, could “save tens of thousands of young lives every year” in the case of a disease that now kills some 608,000 people annually.

Finally, vaccines are playing a novel role in the response to a widening dengue outbreak, including more than 5.2 million cases reported in the Americas over just the first quarter of 2024 – more than all of 2023 combined.

“Last year, WHO recommended use of a new dengue vaccine for children aged six to 16 in areas where Dengue is present,” said Tedros.  “Countries including Brazil are now using the vaccine are now using the vaccine – although the supplies constraints and costs are still releatiely high.”

DRC declares mpox a health emergency – finally setting stage for vaccine rollout

Dr Rosamund Lewis, WHO technical lead for mpox

Meanwhile, the Democratic Republic of Congo (DRC) two weeks ago declared its swelling mpox outbreak as a national health emergency – finally setting the stage for introduction of two novel mpox vaccines against a worrisome rise in deadly Clade 1 cases of the disease, particularly among children.

So far no vaccines have been used at all in the DRC outbreak – due to multiple hurdles ranging from global supply lines to bureaucratic barriers in a country wracked by armed conflicts, poverty and multiple disease challenges.

“Now that the government two weeks ago determined that the mpox outbreak in the country constitutes a health emergency, the Ministry of Health has a direction.  And they have issued their statement that they intend to introduce vaccines in the country,” said WHO’s Dr Rosamund Lewis. “So the next step is the vaccine assessment by the national regulatory authority of the two vaccines that the National Immunization Technical Advisory Group has recommended, and open immunization strategies.”

Those vaccines include a Japanese-made mpox vaccine,  LC16 KMB, which is approved for use in children, and the Bavarian Nordic’s MVA-BN vaccine, which has not yet been approved for child use and requires two jabs to be effective.

“I think it’s important to note that the MVA-BN vaccine is very similar to the vaccine for Ebola and that does have authorization for children. So we know a lot about the safety of these vaccines in children,” said Dr Kate O’Brien, director of WHO’s Immunization Programme. Even so, it will be important to conduct more studies simultaneously with rollout to determine how the vaccines can best be deployed among at-risk groups.

“It’s really important as the rollout of vaccine happens, that it’s done in such a way that the information is collected in a scientific way, so that we really strengthen the evidence that will lead to a better understanding of exactly how the vaccines can best be used,” O’Brien said.

‘Humanly possible’ campaign

Also on Wednesday, WHO, UNICEF, Gavi, and the Bill and Melinda Gates Foundation (BMGF) launched a worldwide communication campaign on Wednesday, Humanly Possible, which calls on world leaders to advocate, support and fund vaccines and the immunization programmes that deliver these lifesaving products.  The campaign follows on WHO’s announcement last year of The Big Catchup – a strategy that aims to recoup ground lost during the COVID pandemic, in terms of immunization coverage. 

“It’s inspiring to see what vaccines have made possible over the last 50 years, thanks to the tireless efforts of governments, global partners and health workers to make them more accessible to more people,” said Dr Chris Elias, BMGF president of Global Development 

“We cannot let this incredible progress falter. By continuing to invest in immunization, we can ensure that every child – and every person – has the chance to live a healthy and productive life.”

  • with reporting by Elaine Ruth Fletcher 

Image Credits: UNICEF, Gavi.

Woman with dementia (illustrative)
Woman with dementia (illustrative)

A team of researchers from the Nuffield Department of Clinical Neurosciences at the University of Oxford have identified diabetes, traffic-related air pollution exposures and alcohol use as the most harmful out of 15 modifiable risk factors for dementia.

Their paper, published last month in Nature Communications, examines how genetic traits and modifiable risk factors affect the vulnerability of the more fragile LIFO (“last in, first out”) brain network.

Fig. 1: Vulnerable ‘last in, first out’ (LIFO) network of higher-order brain regions that degenerate earlier and faster than the rest of the brain.
Fig. 1: Vulnerable ‘last in, first out’ (LIFO) network of higher-order brain regions that degenerate earlier and faster than the rest of the brain.

The researchers studied nearly 40,000 people from the United Kingdom Biobank who were over 45 and had brain scans. They assessed how the LIFO brain network is linked to 161 modifiable risk factors, classified according to 15 broad categories: blood pressure, cholesterol, diabetes, weight, alcohol consumption, smoking, depressive mood, inflammation, pollution exposures, hearing, sleep, socialisation, diet, physical activity and education.

They found that seven genetic clusters were significantly associated with the development of dementia. Amongst these clusters, two are found in the genes related to both male and female traits. These genes play a role in determining antigens in the XG blood system. Furthermore, the research showed that after accounting for age and sex effects, diabetes, exposure to traffic-related pollution, and frequency of alcohol consumption most negatively impact these genetic areas. In other words, these factors can make these “weak spots” in our genes more vulnerable.

Nitrogen dioxide assessed as a ‘proxy’ for traffic-related air polution

In terms of air pollution, exposure to nitrogen dioxide (NO2) was assessed – as a “proxy for traffic-related air pollution” the researchers stated.  Traffic emissions are one of the largest, but not the only, source of NO2 emissions worldwide – fossil fuel power plants are another leading source. A growing body of evidence has linked NO2 exposures, as well as ground level ozone (O3) for which it is a precursor, to asthma and other chronic and acute lung disorders.

In 2021, WHO slashed by 75% guideline levels for annual average NO2 exposures, while halving guideline limits for PM2.5 (small particulates).  But stricter emissions limits on gasoline and diesel vehicles have been less effective in reducing NO2 than other pollutants – leaving persistently high concentrations across some major cities in Europe and China and rising NO2 concentrations in parts of South Asia and the Middle East.

NASA satellite image (2018) reflects persistently high NO2 levels in China and parts of Europe, as well as growing levels in South Asia, as compared to 2005.

“The bottom line is that this study gives a biological basis to the risk factors and disease outcomes,” explained Dr Vaibhav Narayan, Executive Vice President and Head of Strategy and Innovation for the Davos Alzheimer’s Collaborative. “This is an important advancement and makes the whole area of prevention more science-based and could allow us to develop more targeted interventions.”

Vulnerability of Brain Regions to Aging and Disease

Previously, the researchers had pinpointed the LIFO network as a vulnerable area of the brain that matures later in adolescence but deteriorates earlier in old age. They also found that this specific brain network is especially susceptible to conditions like schizophrenia and Alzheimer’s disease.

“We know that a constellation of brain regions degenerate earlier in aging, and in this new study, we have shown that these specific parts of the brain are most vulnerable to diabetes, traffic-related air pollution − increasingly a major player in dementia − and alcohol, of all the common risk factors for dementia,” Prof Gwenaëlle Douaud, who led this study, said in a release. “We have found that several variations in the genome influence this brain network, and they are implicated in cardiovascular deaths, schizophrenia, Alzheimer’s and Parkinson’s diseases, as well as with the two antigens of a little-known blood group, the elusive XG antigen system, which was an entirely new and unexpected finding.”

A study published last year in the Lancet found that 12 modifiable factors, all included in this study, account for 40% of dementia cases worldwide. But this new study goes further in prioritizing what risk factors make the biggest contribution to brain degeneration.

Alzheimer's Disease and dementia can lead to loneliness in old age.
Alzheimer’s disease is the most common type of dementia found in elderly people.

“What makes this study special is that we examined the unique contribution of each modifiable risk factor by looking at all of them together to assess the resulting degeneration of this particular brain ‘weak spot,” added co-author Prof Anderson Winklerf from the National Institutes of Health and The University of Texas Rio Grande Valley in the United States. “It is with this kind of comprehensive, holistic approach − and once we had taken into account the effects of age and sex − that three emerged as the most harmful: diabetes, air pollution, and alcohol.”

Expanding Research Horizons: Inclusivity and Global Perspectives

Narayan said that the next step is to make similar studies more inclusive.

“This study is of a limited population in the United Kingdom—people with good higher education status and high levels of affluence—and it is quite possible that the relative importance of these risk factors varies across diverse populations worldwide.”

He said other factors such as pesticide use, extreme heat, indoor air pollution and climate change also could have comparatively larger impacts in different parts of the world.

“This deserves to be studied as much,” he concluded.

Image Credits: Pixabay, Nature Communications Screenshot, NASA , Photo by Steven HWG on Unsplash.

Planet well-being and human health are interconnected issues – one cannot be achieved without the other, according to Kinari Webb, an American medical doctor, public health innovator and thought leader interviewed on the most recent episode of the Global Health Matters podcast.

During the special “Dialogues” episode, Webb speaks with host Dr. Garry Aslanyan about her experiences in the rainforests that led her to establish the non-profit organisation Health in Harmony and write the book “Guardians of the Trees.” Webb and her team have developed a model that provides health care as an incentive to protect the environment.

“Without access to basic services … communities are often driven to destroy their local ecosystem, even when they really don’t want to do that,” Webb told Aslanyan. When these communities were asked what they would need so that they and the rainforests could thrive, “people said … they needed health care access. Sure enough, that came out straight. Without that, we cannot protect the forest, we cannot thrive, and we need organic farming training. They also wanted help with education for their kids.”

Webb and her team were able to work with these communities to help them implement incentives and other programs to achieve these goals. In Health in Harmony’s first sites, after 10 years, they saw a 90% drop in logging households, stabilisation of the loss of the primary forest, 52,000 acres of rainforest grew back, and a 67% drop in infant mortality, according to Webb.

Moreover, at Health in Harmony, they talk to the community about why issues exists and help them develop solutions rather than treating them from the outside. This can be seen, for example, in Madagascar, where they worked with the community to “design these comprehensive food systems that they just needed access to a little bit of education or certain kinds of seeds or a little bit of help with irrigation systems, things like that. Suddenly, they go from one rice crop a year to three.”

Webb said, “We are facing the end of civilisation. We don’t realise that even if we stopped 100% of all fossil fuel emissions and continue to lose rainforests at the rate that we are losing them, it would still be game over. Rainforests are absolute. They are the heart and the lungs of the world. We really need to think about that in that way. We can amputate an arm and still survive, not well, but we can survive. But without the heart and lungs, we won’t make it.”

What were the key lessons she wanted to share with other public health professionals:

1 – Radical listening

“Those closest to a problem understand it in its fullest depth and know the best solutions,” Webb said.

2 – Reciprocity

“We all have something to give; it’s about equal, loving respect and gift-giving mutually around the world,” she concluded.

Previous “Dialogues” episode: A conversation with Olusoji Adeyi.

Listen to previous episodes of Global Health Matters on Health Policy Watch.

Image Credits: Global Health Matters.

“Having taken up smoking at the age of 14, I was smoking 40 [cigarettes] a day by the age of 20. And as a 21st birthday present to myself I gave up. But today, 40 years later […] I still feel like a fag sometimes. That is how addictive smoking is,” said Andrea Leadsom, a Member of Parliament in the United Kingdom. She was addressing the lower chamber just before an ambitious tobacco regulation draft bill passed a second reading.

“This is not about freedom to choose; it is about freedom from addiction,” she highlighted.

On 16 April, the UK parliamentarians voted for a progressive ban on tobacco products which makes it illegal to ever sell cigarettes to people born after 1 January 2009. The legal age for buying tobacco products would increase by one year every year until it eventually covers the entire population.

The draft legislation will now be referred to a committee for detailed discussion and amendments. Once these have been dealt with, Parliament will vote again, and should it pass a third reading, it would go to the House of Lords for a final vote, possibly as soon as in mid-June.

Strictest in the world

Should the new law pass, it will be one of the strictest in the world. Similar legislation, aiming to create a smoke-free generation, was overturned in New Zealand with a change of government. In Malaysia, the proposed generational tobacco ban was abandoned due to industry pressure.

“We’re hopeful it will get to a point further than all the other policies in the world,” Jorge Alday, director of tobacco industry watchdog, STOP, part of the global public health organisation, Vital Strategies. However, he admitted uncertainty about the bill’s chances against the weight of the tobacco lobby’s influence.

Aside from gradually increasing the minimum age for legally buying cigarettes until it covers more and more people, the bill also proposes an additional fine on selling tobacco to underage smokers, a new tax on vaping, a ban on disposable e-cigarettes and restrictions on their content, flavours and packaging, according to the BBC.

According to the UK’s Office of National Statistics, 6.4 million people, or almost 13% of the country’s population, smoked cigarettes in 2022. There has been a significant decline in cigarette use in the last decade, contrary to the use of new tobacco products, which are on the rise. 

E-cigarettes, or vapes, were most popular among those aged 16 to 24 years, reaching 15.5% of that population in 2022, an increase of roughly a third from 2021. Amongst ex-smokers, e-cigarettes are also frequently used with traditional cigarettes or instead of them, among ex-smokers.

Smoking also creates a considerable burden on healthcare. In England alone, there were 474 400 smoking-related hospital admissions in 2015/16, costing almost £2m, according to Action for Smoking and Health.

Efficient policy

“We know that other age restriction policies work to reduce youth uptake,” says Alday. “Monitoring and surveillance would be needed to confirm the impact, but it doesn’t have to be a huge investment and the UK already has some good monitoring systems in place.”

Critics argue that it would be complicated to enforce the bill, ensuring the retailers aren’t selling to young people. That, some cigarette makers argue, also can create space for more illicit trade.

“I think it’s a false argument. Even if there was an increase it wouldn’t be to the extent the tobacco industry suggests,” Alday said, adding that “the tobacco industry makes this comment for any policy.”

He also doesn’t think that “subtracting cigarettes as an alternative necessarily makes vaping more attractive.”

Regulations that ensure young people never begin smoking, otherwise known as a ‘tobacco generational endgame,’ could be a particularly efficient way to reduce smoking prevalence, proponents say. 

Although no government has yet to see such a policy through to the end, that’s what the studies done so far suggest, according to STOP.

Notably, nine out of ten adults who smoke daily first try smoking by the age of 18 and only about 7,5% are successful in quitting, even though over a half of them try, according to the US Centre for Disease Control and Prevention (CDC). This makes policies targetting adolescents not using cigarettes as yet the most effective.

“At the end of the day we’re talking about young people who are not starting to smoke,” Alday concludes.

Image Credits: Zaya Odeesho/ Unsplash.

A new report from the World Meteorological Organisation (WMO) warns that the Asian continent is the world’s most disaster-prone region, and extreme heat is becoming more severe. 

The warming trend in Asia has nearly doubled over the last three decades, the UN’s meteorological agency reports. In its State of the Climate in Asia 2023, the WMO shows how this has happened largely in the north in places like Siberia, China and Japan. 

Despite the growing health risks posed by extreme heat, heat-related mortality is frequently not reported. While extreme heat is becoming more severe, the highest number of casualties and economic losses were caused by floods and storms. 

Warmer seas, heavier rainfall 

Warming of the upper ocean (0m–700m) is particularly strong in the North-Western Arabian Sea, the Philippine Sea and the seas east of Japan – more than three times faster than the global average. Warmer oceans tend to make cyclones more powerful and unpredictable. Cyclone Mocha, which hit Bangladesh and Myanmar last year, was the strongest cyclone in the Bay of Bengal in the last decade. It touched speeds of 280 km per hour and rapidly intensified in one day. 

While the number of named tropical cyclones, 17, over the western North Pacific Ocean and the South China Sea, was below average, the rainfall in China, Japan, the Philippines, and the Republic of Korea was record-breaking. Hong Kong recorded an hourly rainfall total of 158.1 mm on 7 September 2023, the highest since records began in 1884.

Several stations in Vietnam observed record-breaking daily rainfall amounts in October. In West Asia too there was heavy rainfall and flooding in Saudi Arabia, the United Arab Emirates, and Yemen. 

Of 79 disasters analysed, most were related to flood and storm events, with more than 2,000 fatalities and nine million people directly affected

“The report’s conclusions are sobering. Many countries in the region experienced their hottest year on record in 2023, along with a barrage of extreme conditions, from droughts and heatwaves to floods and storms. Climate change exacerbated the frequency and severity of such events, profoundly impacting societies, economies, and, most importantly, human lives and the environment that we live in,” said WMO Secretary-General Celeste Saulo.

The report covers a vast geographical expanse, from the Arabian desert to the Barents Sea in the Arctic Circle. This sea is identified as a climate change hotspot. Higher ocean temperature impacts the sea-ice cover which melts and in turn, increases temperatures further because darker sea surfaces can absorb more solar energy than the highly reflective sea-ice. The reduction in sea ice has led to controversial moves by several countries (Russia, Norway and others) to exploit the region particularly as it allows for easier shipping routes. 

Particularly high average temperatures were recorded from western Siberia to central Asia and from eastern China to Japan. Source: WMO State of the Climate in Asia 2023

Extreme heat becoming severe 

The heat, however, is a bigger challenge than water-related hazards. Overall, Asia’s annual mean, near-surface temperature last year was the second highest on record at 0.91°C above the 1991-2020 average, and 1.87° above the 1961-1990 average. The global average temperature last year was 1.45°C above the pre-industrial era, very close to the 1.5° threshold recognised by the Paris Agreement. However, for Asia, WMO doesn’t use that pre-Industrialisation baseline because of insufficient data. 

Many parts of Asia experienced extreme heat events and record-breaking heat in 2023. Japan experienced its hottest summer on record. China experienced 14 high-temperature events in summer, with six stations breaking their temperature records. In India, severe heatwaves in April and June resulted in about 110 reported fatalities due to heatstroke. However, this is likely to be an underestimation as heat-related deaths are frequently not reported. 

Tackle climate change and air pollution together

WMO’s report terms Asia the world’s most diaster-prone region. Making many communities here a lot more vulnerable is the high level of air pollution across the continent. In South Asia, Bangladesh, Pakistan, and India are the three most polluted countries in the world, and global warming and pollution is linked, officials say. 

“Air pollution and climate change are interrelated in that if you reduce greenhouse gas emissions, then you also help tackle air pollution. There is also a close link between heatwaves, ozone pollution and poor air quality. So the message is that we need to tackle both together,” a WMO spokesperson told Health Policy Watch. 

At the heart of Asia lies the largest volume of ice outside the polar regions. The Tibetan Plateau contains approximately 100,000 square kilometres of glaciers. Most have been retreating for decades and at an accelerating rate. Melting glaciers threaten future water security

Twenty out of 22 observed glaciers in the High Mountain Asia region showed continued mass loss. One of the glaciers, Urumqi Glacier No 1, in Eastern Tien Shan, recorded its second-highest negative mass balance during 2022-23 since measurements began in 1959.

Permafrost, which is soil that continuously remains below 0° for two or more years, is thawing rapidly across northern Asia. As it melts, it can release methane a greenhouse gas that traps more heat in the short term than carbon dioxide. 

Overview of reported disasters in 2023 associated with hydro-meteorological hazards in the Asia region. Source: WMO State of the Climate in Asia 2023

Call for urgent, tailored action

With emissions of greenhouse gases not being cut fast enough, the world is almost certainly going to cross the threshold of 1.5° above pre-industrial times. Beyond that limit, climate scientists project more intense, frequent, and unpredictable extreme weather events with devastating consequences on life. 

The WMO has flagged an “urgent” need for what it calls tailored support and services to effectively mitigate rising disaster risks. What this means is more than general weather forecasts, the spokesperson told HPW. An example would be a heat-health early warning aimed at health professionals, or an impact-based forecast not just of how much rainfall but what the impact will be in terms of flooding in an urban area.

WGIHR co-chairs Ashley Bloomfield, Abdullah Assiri and Dr Tedros

The penultimate meeting of a World Health Organization (WHO) working group to amend the International Health Regulations (IHR) began in Geneva on Monday amid stakeholder praise and criticism for the latest 64-page draft.

The IHR are legally binding and sets out countries’ rights and obligations in handling public health events and emergencies that have the potential to cross borders. But they were found lacking during the COVID-19 pandemic and the Working Group on Amendments to the IHR (WGIHR) has been considering over 300 amendments over the past two years.

WHO Director-General Dr Tedros Adhanom Ghebreyesus said that the draft “reflects the patience, flexibility and commitment” of the WGIHR.

He also expressed appreciation for the inclusion “pandemic emergency” within the process of declaring a Public Health Emergency of International Concern (PHEIC).  Amazingly, the current  IHR neither mention nor define a pandemic.

However, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) described the “pandemic emergency” along with several other new definitions as “excessively vague”,  which made it “very difficult for industry to assess the overall instrument”. 

Other terms condemned for vagueness include “early action alerts”, stages in the PHEIC process, and “references to health products”, said the IFPMA’s Grega Kumer.

The IFPMA also believes the process of declaring the early action alerts and PHEIC leaves room for “discretion and interpretation” instead of being “based on science and evidence-based criteria”. 

Article 13 attracts the most attention

The IHR’s amended  Article 13, dealing with the “public health response, including access to health products”, attracted the most attention from stakeholders.

Knowledge Ecology International (KEI) welcomed the” transparency mandate” contained in Article 13 (9C). 

This calls on state parties to publish “relevant terms of government-funded research agreements for health products needed to respond to a public health emergency of international concern as well as information where relevant on pricing policies regarding these products and technologies to support equitable access”, said KEI’s Thiru Balasubramaniam.

“Article 13.7 envisions that WHO plays a coordinating role among state parties during public health emergencies of international concern. This coordinating role involves the facilitation of equitable access to health products, including through technology transfer on mutually agreed terms,” added Balasubramaniam.

KEI suggested two options to encourage technology transfer and know-how to facilitate the development of drugs, vaccines and other countermeasures. 

One would “create incentives for parties to share some rights acquired from publicly funded R&D or procurements in a reciprocal manner with parties that also share”. The other would “provide money or other incentives to acquire rights to patented inventions, know-how and other inputs from private rights holders”.

The Coalition for Epidemic Preparedness Innovations (CEPI) described as “commendable” that Article 13 made provision for state parties to allocate sustainable financing, but added that “they should have the support of the WHO in building, strengthening and maintaining core capacities” and in public health emergency, this should extend to “local production capacity development”. 

“Equally, in this article, we would like to see broader requirements for embedding equitable access terms in public funding contracts, including data sharing, affordable and sustainable pricing, manufacturing scale-up and technology transfers,” said CEPI.

Third World Network (TWN), an alliance of non-profit organisations from the Global South, welcomed the proposed language on WHO’s role in equitable access to deliver health products, but said “specific methods for achieving this remain absent, particularly in Article 13.7.”

TWN also that Article 4.2 bis and 13.1 shift the “implementation burden to state parties, contradicting the common but differentiated responsibilities principle and abandoning support for developing countries”.

Health Action International’s Senior Policy Advisor, Jaume Vidal, condemned attempts by some countries to “water down and remove suggested amendments seeking to scale up production, diversify manufacturing and guarantee a steady supply of health technologies”.

The IFPMA said that some recommendations in Article 13 lack balance and pre-empt the outcome of the pandemic agreement negotiations, “in particular, the WHO-coordinated mechanisms and networks”.

Threat of avian flu

Although the WGIHR meeting is set to close on Friday to enable the intergovernmental negotiation body (INB) on the pandemic agreement to resume next week, Tedros encouraged the group to “take more sessions together if you need them”.

But WGIHR co-chair Dr Ashley Bloomfield urged member states to “work towards Friday this week as a firm deadline”. 

“We are all aware the INB process remains live with another two weeks of intense negotiations scheduled following this meeting,” said Bloomfield. “We continue to work closely with the INB co-chairs and the Bureau to ensure our work is aligned.

“One reason it is important for us to complete our work this week is so that there can be a full focus on the INB negotiations in the following two weeks to maximise the chance of success in that crucial process.”

Bloomfield added: “You will all be aware of the growing concern about the threat of H5N1 bird flu highlighted by the WHO just last week. We have the opportunity to ensure that the world is better prepared both individual countries and collectively to address that thread through strengthening core capacities in all states parties.”

World Bank president Ajay Banga (centre) addresses an event to announce the new focus. He is flanked by Shakuntala Santhiran and WHO’s Dr Tedros.

The World Bank aims to support countries to deliver “quality, affordable health services” to 1.5 billion people by 2030, it announced during its ‘spring’ meeting in Washington this week.

It will expand its current focus from maternal and child health to include “coverage throughout a person’s lifetime, including non-communicable diseases”; hard-to-reach areas, including remote villages, cities, and countries; and working with governments to “cut unnecessary fees and other financial barriers to health care”, the Bank announced on Thursday.

“The Bank has been working in 100 countries for a while on a maternal and neonatal effort to improve the delivery of care to women and young babies,” said World Bank president Ajay Banga at an event to announce the Bank’s new focus. 

“We want to widen our aperture to include the diseases across adults, adolescents and old age.”

Banga said that the Bank intended to “really reach them…  actually touching the person with a medical appointment, either physical or telehealth, working on this expanded range of noncommunicable diseases, that’s the effort we’re going to try and put in by now in 2030”. 

World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus said that around 4.5 billion people lacked adequate health coverage, while two billion face financial hardship trying to get health services, some “descending into poverty” as a result.

The task is complicated by what the Bank describes as “intertwined challenges, such as climate change, pandemics, conflicts, societal ageing, and a projected shortfall of 10 million healthcare workers by 2030”.

How will this be achieved?

“A lot of hard work, a lot of knowledge, a lot of financing, and a lot of partnerships,” is how the aim will be realised, said Banga.

“Financing is the obvious one. We’re a money bank and a knowledge bank. But even the money we can put to work will never be enough. We’re talking about putting to work 50% more money per year than what we used to spend on health care, pre- the pandemic,” he said.

But governments and the private sector would also have to invest in the effort.

Low-income countries spend an average of $21 per person, per year on health care. 

“That’s not going to get to health care workers in remote areas. So we have to give them share financing, concessional and grant financing,” said Banga.

Middle-income countries have more money available, but “may not have the right regulatory policies to create the multiplier that you want to create” – which could be done through private sector involvement.

“We can help with incentivizing them to create the right regulatory platforms and the right policies.”

This could involve private sector involvement in manufacturing essential medicines, or fortifying basic foods with vitamins.

Discussions with countries would involve identifying what they need to do to break through their barriers to deliver their share of the 1.5 billion – skills, infrastructure, medicines.

“We bring a diversification of knowledge. We understand water, we understand climate, we understand agriculture. We understand how those connect to health challenges.

“We can bring that knowledge as a partner, not just our financing, not just our ability to advise governments on regulatory policy, but our ability to help understand the intersections between these different causes of healthcare problems in the intertwined challenges that we are going through,” Banga concluded.

The World Health Organization (WHO) has published a new technical report including updated terminology to describe pathogens that are transmitted through the air, following “an extensive, multi-year, collaborative effort”.

It follows confusion and contestation between scientists during the COVID-19 pandemic because of the “varying terminologies” and  “gaps in common understanding”, said the WHO.

These “contributed to challenges in public communication and efforts to curb the transmission of the pathogen”.

However, a number of scientists called out the WHO itself for being slow to acknowledge that SARS-CoV2 could be transmitted in the air.

“Together with a very diverse range of leading public health agencies and experts across multiple disciplines, we are pleased to have been able to address this complex and timely issue and reach a consensus,” said Dr Jeremy Farrar, WHO’s Chief Scientist. 

“The agreed terminology for pathogens that transmit through the air will help set a new path for research agendas and implementation of public health interventions to identify, communicate and respond to existing and new pathogens.”

Experts and four major public health agencies – the Africa Centres for Disease Control Prevention, Chinese Center for Disease Control and Prevention, European Centre for Disease Prevention and Control and US Centers for Disease Control and Prevention – were consulted between 2021 and 2023.

Away with ‘aerosols’ and ‘droplets’

Instead of ‘aerosols’ and ‘droplets’, the report uses the new descriptor, ‘infectious respiratory particles’ (IRPs), describing these as existing “on a continuous spectrum of sizes, and no single cut-off points should be applied to distinguish smaller from larger particles”. 

This facilitates a “away from the dichotomy of previously used terms: ‘aerosols’ (generally smaller particles) and ‘droplets’ (generally larger particles)”.

These IRPs are transmitted by people infected by a respiratory pathogen “through their mouth or nose by breathing, talking, singing, spitting, coughing or sneezing”. 

‘Through the air’

Under the umbrella of ‘through the air’ transmission, the report advises the use of two descriptors. The first is “airborne transmission or inhalation” for cases when IRPs are expelled into the air and inhaled by another person, who could be at quite a distance from the infected person.

The second is “direct deposition” for cases when IRPs are expelled into the air from an infectious person, and are then directly deposited on the exposed mouth, nose or eyes of another person nearby.

The pathogens covered include those that cause respiratory infections, such as COVID-19, influenza, measles, Middle East respiratory syndrome (MERS), severe acute respiratory syndrome (SARS), and tuberculosis.

Image Credits: Towfiqu Barbhuiya/ Unsplash.

A resident of Ifakara tucked into a mosquito net

Bed nets treated with an additional insecticide are between 20% and 50% more effective in preventing malaria than those treated with the standard single pyrethroid insecticide, according to pilots in 17 sub-Saharan Africa. 

The New Nets Project successfully piloted nets impregnated with a new generation pyrrole insecticide in combination with pyrethroid in response to growing resistance by the malaria-carrying Anopheles mosquitoes to pyrethroid.

Between 2019 and 2022, the New Nets Project supported the deployment of 38.4 million nets across sub-Saharan Africa. 

In parallel, the Global Fund and US President’s Malaria Initiative (PMI) supported the deployment of millions of additional nets under an internal initiative. As a result, 56 million mosquito nets were introduced in 17 countries across sub-Saharan Africa. 

Two clinical trials and five pilot studies, delivered through the New Nets Project found the new nets could improve malaria control by approximately 20-50% in countries reporting insecticide resistance in sub-Saharan Africa, compared to standard nets. 

The intervention has the potential to avert about 13 million malaria cases and save 24,600 lives, according to its funders, Unitaid and the Global Fund, and the lead implementer, the Innovative Vector Control Consortium (IVCC).

The epidemiological evidence built throughout the project led the World Health Organization (WHO) to publish new recommendations supporting pyrethroid-chlorfenapyr nets instead of pyrethroid-only nets in countries facing pyrethroid resistance.

“We are delighted to see that the dual active ingredient insecticide-treated nets have demonstrated exceptional impact against malaria,” said Peter Sands, executive director of the Global Fund.

Unitaid’s executive director, Dr. Philippe Duneton, said “The New Nets Project has made a massive contribution to malaria control efforts, helping to accelerate the introduction of next-generation bed nets – a critically important tool for reducing malaria cases and deaths. “

Global burden of malaria. Most DALYs in Sub-Saharan Africa.

Malaria is a life-threatening infectious disease with an estimated 249 million cases and 608 000 deaths in 2022, according to the World Malaria Report. It is present in 85 countries, with 95% of cases in the African region. Children under the age of five account for as much as about 80% of malaria deaths.

While some malaria cases are mild, others prove deadly, progressing to severe illness and death within 24 hours. Symptoms range from fever, chills and headache to seizures, confusion and difficulty breathing.

As it is transmitted through mosquito bites, much of the malaria control efforts go into vector control, that is protection against mosquitoes through insecticide-treated bed nets and indoor residual spraying to prevent mosquitoes from staying on the house roof or walls.

Yet, as malaria-carrying mosquitoes adapt to insecticides, a new chemical is likely only a short-term solution. Malaria control requires broad action with multiple solutions implemented. Next to bed nets, many public and private actors concentrate on vaccines, treatments, preventive doses for risk groups and other measures.

 “The findings of the New Nets Project demonstrate the value of investments into state-of-the-art tools in the fight against malaria. We always say that there is no silver bullet to eliminating malaria and we cannot rely on single interventions but rather invest in a suite of tools, which when combined, will have the biggest impact on defeating this disease,” said Dr. Michael Charles, CEO of the RBM Partnership to End Malaria.

Image Credits: Peter Mgongo, IHME.

UNICEF screening for malnutrition in the River Nile state

A year into one of the most brutal conflicts in decades, the war in Sudan has triggered the world’s largest displacement crisis and left the country’s healthcare system in tatters.

Nearly 25 million people need immediate humanitarian assistance, according to the United Nations (UN) and over  18 million people face acute food insecurity, with the World Food Programme (WFP) warning that the situation could quickly slip into “catastrophic” food insecurity levels.

In light of this accelerating humanitarian crisis, governments, donors, and aid organizations met in Paris on the first anniversary of the war, aiming to “break the silence surrounding this conflict and mobilize the international community,” said French Foreign Minister Stéphane Séjourné said in his opening remarks. 

The Sudanese people have suffered not only from the catastrophe of war, but also from international “indifference,” said Séjourné, while international organizations struggled to meet key funding needs.

“The scale of this catastrophe far outstrips the international community’s attention,” said World Health Organization (WHO) director-general Dr. Tedros Adhanom Ghebreyesus.

The conflicts in Gaza and Ukraine have garnered most of the international community’s attention, and funding. Only 6% of the UN’s emergency funding appeal was met before the Paris conference. Similarly, only 7% of the $1.4 billion Regional Refugee Response Plan for the Sudan Crisis was funded.

Donors responded to pleas for humanitarian funding, pledging 2.13 billion in aid for Sudan. Top contributors were the European Union (EU), co-sponsors France and Germany, the US and the UK. 

“We can manage together to avoid a terrible famine catastrophe, but only if we get active together now,” German Foreign Minister Annalena Baerbock said, adding that, in the worst-case scenario, one million people could die of hunger this year.

Tedros echoed this sentiment, calling for access across borders and humanitarian corridors, the cease of attacks on healthcare facilities, funding for both health-related aid and for the UN in general: “This is a health crisis that could reverberate across generations.”

Heavy fighting persists

“People in Sudan are suffering immensely as heavy fighting persists, including bombardments, shelling and ground operations in residential urban areas and in villages, and the health system and basic services have largely collapsed or been damaged by the warring parties,” said Jean Stowell, Medecins sans Frontieres (MSF) head of Sudan mission. 

“Only 20-30% of health facilities remain functional in Sudan, meaning that there is extremely limited availability of health care for people across the country.”

The number of operational healthcare facilities has decreased even further since February 2024. Healthcare facilities themselves have been subject to attacks. The World Health Organization (WHO) reports 62 confirmed attacks, but notes that these numbers are most likely underestimates.

In the 12 months of conflict the warring sides repeatedly and intentionally blocked humanitarian and medical aid. 

A United Nations graphic of the humanitarian crisis in Sudan

The disruption of basic needs has meant that routine immunizations, care for pregnant women and babies, and chronic disease care has “dropped precipitously.” In the Darfur region alone, only 30% of children have received routine immunizations, according to the United Nations Children’s Fund (UNICEF.) The country has seen outbreaks of measles, malaria, dengue fever, cholera, and other water-borne illnesses.

Since March, the country has reported over 5,000 cases of measles and 106 deaths. While a nationwide “catch up” measles vaccination campaign was successfully conducted across seven Sudanese states in January 2024, the campaign was unable to cover the Darfur or Kordofan states. Both regions have seen some of the heaviest fighting; no immunizations have been possible since the conflict began. 

Children bear the brunt of these healthcare disruptions. “After 365 days of conflict, the children of Sudan remain at the sharp end of a horrific war,” said UNICEF Deputy Executive Director, Ted Chaiban this week.

“If immediate steps are not taken to halt the violence, facilitate humanitarian access and provide lifesaving aid to those in need, an even worse catastrophe is likely to impact children for many years to come.” 

The threat of malnutrition

Map of Sudan food insecurity
Acute food insecurity in Sudan have soared in the states of Khartoum, Aj Jazirah, and in the Darfur and Kordofan regions

Since violence erupted on 15 April 2023 between the Sudanese Armed Forces (SAF) and the paramilitary Rapid Support Forces (RSF), the country has experienced the highest levels of food insecurity in its history.

More than 710,000 children face severe acute malnutrition, “representing the highest number of people in need of nutrition assistance ever recorded in Sudan,” according to the WHO.

Without humanitarian assistance, the number could rise to 3.5 million children before the end of 2024. These levels surpass the WHO’s emergency thresholds for acute malnutrition, and raise concerns for an expected famine. 

For the first time since the crisis began, displacement in the Darfur states is now being driven by hunger rather than violence, according to the most recent WHO public health situation analysis.

This acceleration of widespread severe food insecurity is most prominent in rural households, where up to 59 percent face moderate or severe food insecurity. The states of West Kordofan, South Kordofan, and Blue Nile have seen the highest levels, according to a new study from United Nations Development Programme (UNDP) and the International Food Policy Research Institute (IFPRI). 

The study warns that a famine in Sudan is expected in 2024, particularly in the states of Khartoum, Aj Jazirah, and in the Darfur and Kordofan regions. 

Key food sources disrupted

Map of Sudan displacement
Food insecurity is now driving displacement in the Darfur states

The conflict has affected cereal production in particular, pushing more people into hunger, according to the Food and Agriculture Organization of the United Nations (FAO). 

The situation requires “urgent and at-scale agricultural support ahead of the planting season starting in June,” said Rein Paulsen, Director of the FAO Office of Emergencies and Resilience.

The production output of key cereal crops in 2023 decreased 46 percent from the previous year, and 40 percent below the average from the previous five years.

“This is a very practical manifestation of the impact of clashes, conflict and violence on food production. We clearly have a context that requires urgent and appropriate support. This is why FAO’s interventions are so incredibly important at this point in time,” said Paulsen, who is currently on a field mission to the country to evaluate the food security situation on the ground.

Preventing a looming famine requires an immediate ceasefire, unhindered humanitarian access, and increased support for humanitarian needs, concludes the report. 

Image Credits: UNICEF/UNI530171/Mohamdeen, Integrated Food Security Phase Classification, United Nations Office for the Coordination of Humanitarian Affairs (OCHA).