Article by Lalita Panicker, Consulting Editor, Views and Editor, Insight, Hindustan Times, New Delhi
More than 100 low- and middle-income countries have put in early bids for at least $5.5 billion from a fund that initially has only $300 million to spend to help them better prepare for pandemics. https://www.reuters.com/world/pandemic-fund-vastly-oversubscribed-more-money-needed-world-bank-2023-03-07/
The demand is a sign that pandemic prevention, preparedness and response needs more money and attention, the head of the fund’s secretariat at the World Bank, Priya Basu, told Reuters.
The fund is one of a host of global initiatives being set up to help prevent a COVID-19 rerun, alongside a binding agreement being drafted by World Health Organization (WHO) member-states and plans to speed up vaccine manufacturing.
However, almost all of the efforts remain under-funded.
The World Bank’s pandemic fund has raised around $1.6 billion in total so far, much less than the $10 billion annual funding gap for pandemic preparedness, as estimated by the WHO and the bank.
The fund has $300 million available for its first round of financing, and in February received 650 early expressions of interest from countries, regional bodies and global health organisations for the money.
Parties now have until May 19 to draft formal proposals for the first phase, which prioritises surveillance, laboratory systems and the health workforce.
The bank has said that the aim is for its first round to be a “proof of concept” and it hopes other sources of funding, for example from other global health bodies, can also be made available.
Excessive sodium intake is one of the main culprits of death and disease globally, the World Health Organisation (WHO) declared in its first report on sodium intake reduction. The report shows that the world is “off-track” in its efforts to achieve the global target of reducing sodium intake by 30 per cent by 2025. https://www.indiatoday.in/health/story/excessive-sodium-intake-leading-cause-of-death-and-disease-globally-who-2344838-2023-03-10
Sodium is one of the most essential nutrients for the body but the excess of it could increase the risk of heart disease, stroke and premature death. While table salt is the main source of sodium (sodium chloride), this nutrient is also contained in other food ingredients such as sodium glutamate.
WHO’s global report states that implementing cost-effective sodium reduction policies could save 7 million lives in the world by 2030. However, only nine countries – Brazil, Chile, Czech Republic, Lithuania, Malaysia, Mexico, Saudi Arabia, Spain and Uruguay – have a comprehensive package of recommended policies to reduce sodium intake.
The global average salt intake is estimated to be 10.8 grams per day, which is more than double the WHO recommendation of less than 5 grams of salt per day (one teaspoon).
WHO Director-General Dr Tedros Adhanom Ghebreyesus said, “Unhealthy diets are a leading cause of death and disease globally, and excessive sodium intake is one of the main culprits. This report shows that most countries are yet to adopt any mandatory sodium reduction policies, leaving their people at risk of heart attack, stroke, and other health problems. The WHO calls on all countries to implement the ‘Best Buys’ for sodium reduction, and on manufacturers to implement the WHO benchmarks for sodium content in food.”
The health agency’s four “best buy” interventions to reduce sodium, which could contribute to preventing noncommunicable diseases are:
- Reformulating foods to contain less salt, and setting targets for the amount of sodium in foods and meals
- Establishing public food procurement policies to limit salt or sodium rich foods in public institutions such as hospitals, schools, workplaces and nursing homes
- Front-of-package labelling that helps consumers select products lower in sodium
- Behaviour change communication and mass media campaigns to reduce salt/sodium consumption
More evidence has emerged linking high sodium intake with increased risk of other health conditions such as gastric cancer, obesity, osteoporosis and kidney disease.
A new type of drug is generating excitement among the rich and the beautiful. Just a jab a week, and the weight falls off. Elon Musk swears by it and influencers sing its praises on TikTok. But the latest weight-loss drugs are no mere cosmetic enhancements. Their biggest beneficiaries will be not celebrities in Los Angeles or Miami but billions of ordinary people around the world whose weight has made them unhealthy.
Treatments for weight loss have long ranged from the well-meaning and ineffective to the downright dodgy. The history of weight-loss medication is a sorry tale. In 1934 as many as 100,000 Americans were using dinitrophenol to shed excess pounds. It is toxic, causing cataracts and, occasionally, deaths. By one estimate 25,000 people were blinded by the drug; it was banned as a drug for human use in 1938 but deaths continue to this day as people are still enticed to buy it online. Next amphetamines became popular—until the risk of addiction and other side-effects became apparent. Ephedra, a herbal medication which in 1977 was taken by an estimated 70,000 people, was also banned in America after it led to deaths. Two other weight-loss drugs, rimonabant and sibutramine, were withdrawn from sale because of safety concerns.
The new class of drugs, called glp-1 receptor agonists, seems actually to work. Semaglutide, developed by Novo Nordisk, a Danish pharmaceutical firm, has been shown in clinical trials to lead to weight loss of about 15%. It is already being sold under the brand name Wegovy in America, Denmark and Norway and will soon be available in other countries; Ozempic, a lower-dose version, is a diabetes drug that is also being used “off label” for weight loss. A rival glp-1 drug, made by Eli Lilly, an American firm, is due to come on sale later this year and is more effective still. Analysts think the market for glp-1 drugs could reach $150bn by 2031, not far off the market for cancer drugs today. Some think they could become as common as beta blockers or statins.
The drugs could not have arrived at a better time. In 2020 two-fifths of the world’s population were overweight or obese. By 2035, says the World Obesity Federation, an NGO, that figure could swell to more than half, with a staggering 4bn people overweight or obese. People everywhere are getting fatter. The populations putting on pounds the fastest are not in the rich West but in countries like Egypt, Mexico and Saudi Arabia.
These trends are alarming because obesity causes a host of health problems, including diabetes, heart disease and high blood pressure, as well as dozens of illnesses such as stroke, gout and various cancers. Carrying extra weight made people more likely to die of covid-19. And then there is the misery that comes from the stigma associated with being fat, which affects children in schools and playgrounds most cruelly of all.
The consequences of obesity for the public purse and the wider economy are large. According to modelling by academics the annual cost to the world economy of excess weight could reach $4trn by 2035 (2.9% of global GDP, up from 2.2% in 2019).
The world’s expanding waistlines are not a sign of the moral failure of the billions who are overweight, but the result of biology. The genes that were vital to helping humans survive winters and famine still help the body cling on to its weight today. Once the fat is on, the body fights any attempt to diet away more than a little of its total weight. Despite the $250bn that consumers around the world spent on dieting and weight loss last year, the battle to get slim was largely being lost.
The new obesity drugs arrived by serendipity, after treatments meant for diabetics were observed to cause weight loss. Semaglutide mimics the release of hormones that stimulate a feeling of fullness and reduce the appetite. They also switch off the powerful urge to eat that lurks inside the brain, waiting to ambush even the keenest dieter.
The drugs use short chains of amino acids to mimic the hormones produced naturally by the body after a meal, but which diabetics sometimes produce in insufficient quantities.
The drugs semaglutide (sold as Wegovy) and tirzepatide (to be sold as Mounjaro) imitate the action of glucagon-like peptide-1 (glp-1), one such hormone. This increases the production of insulin (which transports blood sugar into body cells) and reduces the production of glucagon (which releases sugar into the bloodstream from the liver). It also slows down the rate at which the stomach empties, creating a feeling of fullness that reduces appetite. In addition, the drug may increase energy expenditure by changing fat tissue into brown adipose tissue, which is more likely to be burned at rest. These effects not only help diabetics, but also promote weight loss.
Consider safety first. The newness of these drugs means that their long-term consequences are not yet known. For the lower-dose forms prescribed for diabetes, the side-effects, such as vomiting and diarrhoea, have been mild. But others could crop up as the drugs are used more widely and at higher doses. Animal studies have shown a higher incidence of thyroid cancer, and semaglutide is associated with a rare pancreatitis. Little is known about the effects of using them during or just before pregnancy. All this will require careful analysis through controlled longitudinal studies.
Understanding these risks will be important, because many patients who take the drugs may need them for the rest of their lives. As with ditching a diet, stopping a high dose of semaglutide is associated with much of the lost weight piling back on. Some people even gain more weight than they lost in the first place.
Another preoccupation for policymakers is cost. In America the bill for Wegovy runs at around $1,300 a month; for Ozempic about $900. Judged by such prices, lifelong prescriptions look forbiddingly expensive. The longer view, however, is more encouraging. In time, companies may strike deals with governments and health providers to cover the whole population, ensuring high volumes in return for low prices. The prospect of profits is already luring competition and spurring innovation. Amgen, AstraZeneca and Pfizer are all working on rival drugs; Novo Nordisk has a full pipeline of follow-on drugs. Further ahead still, patents will expire, enabling the development of lower-priced generics.
What to do in the meantime? Governments must ensure that those who most need the drugs get them, leaving those taking them for cosmetic purposes to pay out of their own pockets. The long-term effects must be carefully studied. States should keep pressing other anti-obesity measures, such as exercise, healthy eating and better food labelling, which may help prevent people from getting fat in the first place. But spare a moment to celebrate, too. These new drugs mean that the world’s fight against flab may eventually be won.