Health Issues in Africa

Health Issues in Africa

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EU putting weight behind Ethiopia’s Tedros for a second term in WHO DG role

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Tedros 2.0?

German government sources told Reuters on 23 September that Berlin would officially nominate Tedros as the Director General (DG) of the World Health Organization (WHO) for the second time around and was seeking support from other European Union (EU) member states.

Geneva, Switzerland, 2020. World health organization (WHO) landing page & emblem. Specialized agency of United Nations responsible for public health

At least 17 EU states have said they would also submit his name for nomination, a Western diplomat said, adding: “I understand he is being nominated by other regions.”

As the deadline for nominations elapsed, diplomats said that they were unaware of any other names being put forward, suggesting that Tedros could stand unopposed in the May (2022) election.

Dr Tedros Adhanom Ghebreyesus, a former health and foreign minister of Ethiopia, elected as WHO’s first African DG in May 2017, has led the global fight against the seemingly relentless COVID-19 pandemic.

He has been shunned by his native Ethiopia due to friction over the Tigray conflict, making it necessary for other countries to step into the breach and submit his name for a second five-year term.

African countries broadly support Tedros who has championed their access to vaccines, but have not wanted to break ranks with Ethiopia, diplomats said. However, it is unlikely that they will desert his cause in the ultimate analysis, ending up being seen to have let down Africa’s first WHO chief.

Notably Dr Tedros has steered the UN agency through attacks on its handling of the crisis, which was sparked by COVID-19 that emerged in China in late 2019 and that has killed 4.75 million people so far.

While the Trump administration in the US accused Tedros of being “China-centric” all of last year, relations warmed with the Biden administration, especially after Tedros publicly said that further investigations were needed into the origins of the virus, including audits of China’s laboratories, diplomats said.

The United States has not opposed a fresh term for him, they add.

However, under the WHO process, envelopes are to remain sealed until after October 29, meaning it cannot be ruled out that a country might nominate another candidate. This is designed to limit campaigning too early.

The DG is the WHO’s chief technical and administrative officer.  The appointment of the next DG will take place at the Seventy-fifth World Health Assembly (WHA75) in May 2022. 

The election process began in April when the WHO secretariat invited the 194 member states to submit proposals for candidates for the DG’s position. The deadline for proposals was 23 September 2021. (www.who.int/about/governance/election)

Information on candidates, including the curricula vitae and other particulars of their qualifications and experience as received from member states, will be published following the closure of the last regional committee meeting of the year, shortly after 29 October 2021.

If there is more than one candidate, a second forum will be convened in March 2022, prior to WHA75 to allow for an interactive panel discussion between the candidates and member states.

At WHA75, the World Health Assembly will appoint the next DG by secret ballot.

A DG can be re-elected once. Therefore the incumbent (Tedros) is eligible to be proposed for a second term of five years. (510)

Upping the ante

The Director of the US Centers for Disease Control and Prevention (CDC) has set the proverbial cat among pigeons, reversing a recommendation of her panel of experts on COVID-19 booster shots. The Director, Dr Rochelle Walensky, went along with the experts endorsing booster shots for millions of older or otherwise vulnerable Americans, opening a major new phase in the US vaccination drive against COVID-19. However, she decided to make one recommendation that the panel had rejected. The panel on Thursday (23 September) voted against booster jabs to the 18-64 age group who are health care workers or have other jobs that puts them at increased risk of being exposed to the virus. (https://www.npr.org/2021/09/24/1040348413/cdc-director-backs-covid-booster-plan-and-makes-an-additional-recommendation?)

Walensky disagreed and put that recommendation back in, noting that such a move aligns with an FDA booster authorization decision earlier this week. “As CDC Director, it is my job to recognize where our actions can have the greatest impact,” Walensky said in a statement late Thursday night.

Experts say getting the unvaccinated their first shots remains the top priority, and the panel wrestled with whether the booster debate was distracting from that goal.

All three of the COVID-19 vaccines used in the US offer considerable protection against severe illness, hospitalization and death, even with the spread of the extra-contagious Delta variant. But only about 182 million Americans are fully vaccinated, just 55% of the population and hospitals are full because people are not vaccinated.

Thursday’s decision represented a dramatic scaling back of the Biden administration plan announced last month to dispense boosters to nearly everyone to shore up their protection.

The booster plan marks an important shift in the nation’s vaccination drive. Britain and Israel are already giving a third round of shots over strong objections from the WHO that poor countries don’t have enough for their initial doses.

The CDC advisers expressed concern over the millions of Americans who received the Moderna or Johnson & Johnson shots early in the vaccine rollout. The government still hasn’t considered boosters for those brands and has no data on whether it is safe or effective to mix-and-match and give those people a Pfizer shot.

About 26 million Americans got their last Pfizer dose at least six months ago, about half of whom are 65 or older. It’s not clear how many more would meet the CDC panel’s booster qualifications.

CDC data show the vaccines still offer strong protection against serious illness for all ages, but there is a slight drop among the oldest adults. And immunity against milder infection appears to be waning months after people’s initial immunization.

An Indian Rebound?

And now here’s what could be a real role reversal with Indians coming to the aid of the Cowboys! There could be some consolation for vast swathes of unvaccinated people the world over amidst what seems to be vaccine profligacy on the part of the US and other countries plugging booster doses. Back in the reckoning after a crushing second COVID-19 wave that left thousands dead and hundreds of thousands of others seriously ill earlier this year, India says its vaccine manufacturers will resume exporting COVID-19 shots in October, potentially eliminating a major roadblock for global vaccine equity. Indian officials said the country’s producers could churn out one billion more coronavirus vaccine doses by the end of the year, but did not specify how many would be exported. (https://www.science.org/content/article/news-glance-india-s-covid-19-vaccine-exports?

The Serum Institute of India and other local producers had stopped exports at the government’s behest in the spring, when only about 2% of India’s population had been fully vaccinated and daily reported cases in the country soared to nearly 400,000. That deprived the COVID-19 Vaccines Global Access Facility of hundreds of millions of doses it had planned to distribute in lower and middle-income countries. (So far, India has exported fewer than 70 million doses.) Now some 15% of India’s population has become fully vaccinated, and daily new cases have fallen to about 30,000.

Pandemic preparedness: better late than never

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Billion-dollar plan 

Almost as if to make up for the lost Trump year during the pandemic, the White House has put together an ambitious new plan with a $65.3 billion price tag that could transform the way the United States responds to pandemics by vastly accelerating vaccine development, testing, and production. But is the plan big enough? 

A mortuary stretcher left sat outside a mobile mortuary vehicle

Announced on 03 September, the scheme hopes to launch with $15 billion set aside in a budget reconciliation bill now before Congress (but not certain to pass). It asks Congress to provide the rest of the funding over the next decade. It calls for an Apollo-like “mission control” centre to coordinate the many branches of government already involved with pandemic preparedness. Nearly 40% of the money would go towards vaccines, followed by just under 20% for treatments. The rest will support new diagnostics, early warning systems, improved public health and biosafety measures, and global health efforts. 

Combining science with security, the 27-page plan has been signed by Eric S. Lander, Assistant to the President for Science and Tech and Jacob J. Sullivan, Assistant to the President for National Security Affairs. The security angle obviously comes into play because of lurking suspicions that anything of biological origin can be manufactured in laboratories for nefarious purposes.  

(American Pandemic Preparedness: Transforming Our Capabilities)  

Almost military-like in approach, the proposal envisages work organized across five pillars

  1. Transforming medical defences
  2. Ensuring situational awareness
  3. Strengthening public health systems
  4. Building core capabilities
  5. Managing the mission

For vaccines, it calls for more research on 26 families of viruses known to infect humans. It will also lay the groundwork to develop, test, and approve vaccines against new emerging pathogens within 100 days—three times faster than COVID-19 shots—and produce enough vaccine for the United States within 130 days and for the world by 200 days. Vaccine-makers will be funded to maintain excess production capacity at their existing plants.  

A clinical trials network will be at the ready, set up to enrol 100,000 participants within a few weeks, which will lead to answers more quickly than the 30,000-person studies staged for existing COVID-19 vaccines. New technologies such as skin patches or nasal sprays would simplify providing vaccines, and more effort will be made to develop animal models for all potential viral families. 

The plan stresses that the cost of the COVID-19 pandemic to the United States alone has been an estimated $16 trillion, which makes  $65.3 billion seem like bus fare.  

The current pandemic has illustrated the seriousness of biological threats. As of mid-August 2021, COVID-19 has killed over 4.3 million globally, with excess mortality estimates suggesting a death toll exceeding 10 million. In the United States, the number of deaths directly attributed to COVID-19 has surpassed 623,000.  

As devastating as the COVID-19 pandemic is, there is a reasonable likelihood that another serious pandemic will occur soon—possibly within the next decade—and maybe worse than COVID-19.  

SARS-CoV-2, the virus responsible for COVID-19 disease, was relatively mild in certain respects. It is far less lethal than the 1918 influenza virus. It also belongs to a well-understood family: coronaviruses. It was possible to design vaccines within days of ascertaining the virus’s genetic code because nearly 20 years of federally-funded fundamental scientific research, spurred by the emergence of SARS and MERS had provided detailed knowledge about coronaviruses. Unfortunately, most of the 26 families of viruses that infect humans are less well understood or harder to control than coronaviruses. The plan document goes on to say: “While there are important lessons to be learned from COVID-19, we must not fall into the trap of preparing for yesterday’s war.” 

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Covax – unprecedented achievements but not quite enough 

The haves vs have-nots saga continues apace on the availability and distribution of COVID-19 vaccines for poorer countries with the rich ones being accused of hogging the show. The major bone of contention for the last couple of months has been booster vaccine doses being given or contemplated by the developed world for people who have already had two doses at least 8 months ago.  

COVAX logo with the four alliance members

Meanwhile, a year after it was launched, the COVAX scheme has not yet reached its target of protecting at least 20% of the adult population in the less privileged world. It’s a year since the innovative scheme was born. “ Yet, the global picture of access to Covid-19 vaccines is unacceptable,” according to a UN statement released on 08 September. https://news.un.org/en/story/2021/09/1099422 

“In the critical months during which COVAX was created, signed on participants, pooled demand, and raised enough money to make advance purchases of vaccines, much of the early global supply had already been bought by wealthy nations,” the statement went on to say, adding that “COVAX’s ability to protect the most vulnerable people in the world continues to be hampered by export bans, the prioritisation of bilateral deals by manufacturers and countries, ongoing challenges in scaling up production by some key producers, and delays in filing for regulatory approval.”  

It’s not that COVAX has been standing still and doing nothing. It has risen to the challenge of organising the most complex vaccine rollout in human history: “…more than $10 billion has been raised; legally-binding commitments for up to 4.5 billion doses of vaccine (secured); 240 million doses have been delivered to 139 countries in just six months”, said the UN statement.  

But according to its latest Supply Forecast, COVAX expects to have access to around 1.2 billion doses of vaccine for lower-income economies in 2021.  This is enough to protect 20% of the population, or 40% of all adults, in all 92 AMC economies, with the exception of India. However, the key milestone of two billion doses released for delivery is now expected to be reached only in the first quarter of 2022, late by several months. COVAX is now calling on donors and manufacturers to “prevent further delays to equitable access”, by ensuring that the following basic steps take place:  

  • That where countries are ahead of COVAX in manufacturer queues, and already have achieved high coverage, those nations give up their place in the queue to COVAX.  
  • That nations “expand, accelerate, and systematize dose donations from countries that are already well advanced in their vaccination programmes”, ensuring that doses are available in larger and more predictable volumes, with longer shelf lives – reducing the burden on countries trying to prepare for deliveries.  

In a news briefing in Geneva, WHO Director-General, Tedros Adhanom Ghebreyesus, reminded journalists of his call, a month ago, for a global moratorium on booster doses, at least until the end of September, in order to prioritise the vaccination of the most at-risk people around the world who are yet to receive their first dose.  

“There has been little change in the global situation since then, so today I am calling for an extension of the moratorium until at least the end of the year, to enable every country to vaccinate at least 40 percent of its population,” he explained.    

Rich countries with large supplies of coronavirus vaccines should refrain from offering booster shots through the end of the year and make the doses available for poorer countries, Dr Tedros said last week, doubling down on an earlier appeal for a “moratorium” on boosters that have largely been ignored. https://globalhealthnow.us14.list-manage.com/track/click?u=eb20503b111da8623142751ea&id=0d29081ba0&e=5504a12b0d 

The WHO chief who has so far remained silent on seeking a second and last term, also said he was “appalled” after hearing comments from a top association of pharmaceutical manufacturers that there are enough vaccine supplies to allow for both booster shots for people in well-supplied countries and first jabs in poorer countries that face shortages. The deadline for the declaration of candidature for the WHO DG’s position ends this month. Tedros has failed to explain why he was so “appalled”.  

Cancer in Africa: The untold tale

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Scenes from AMISOM’s work to promote breast cancer awareness in Somali. Image credit: AMISOM Public Information, CC0, via Wikimedia Commons

Cancer in Africa is an increasing health issue, which must be handled effectively to limit rising incidences and fatality rates. It has been predicted that because of population increase and ageing, there would be a seventy percent influx of new cancer diagnoses by 2030.

In Africa, this daunting condition has co-existed with newly found contagious diseases like COVID-19, Ebola, Malaria, and HIV/AIDS. Even though cancer mortality rates have exceeded malaria, tuberculosis, and AIDS altogether, there is still a lack of dedication in Africa to battling cancer. Indeed, most emphasis is focused on infectious diseases, whereas several non-communicable diseases, like cancer, pose significant concerns. The rising cancer death rates in Africa are particularly because care is costly and there are inadequate resources. In the next two decades, cancer mortality rates in Africa are expected to outstrip the worldwide norm by thirty percent.  

Cancer is a genetic illness, which reacts with other risk factors to establish a person’s susceptibility – three of these corresponding risk variables highlight why African countries should prioritise cancer diagnosis and care. The first is about improved health care. According to World Bank data, Africans’ life expectancy has risen greater than the worldwide median and is presently estimated to be around 60 years across the region. As cancer diagnoses and death rates rise with ageing, these advancements in life expectancy consequently increase cancer incidences. The second is a result of Africa’s development and lifestyle changes. Some of the most notable changes include but are not limited to: rapid urbanisation, the introduction of new pollutants, unhealthy dietary modifications, and increased substance abuse. Research shows that these adjustments cause a heightened risk of cancer, as well as contact with carcinogens. 

Finally, Africa is home to a wide range of sub-populations and ethnicities, all of which are affected by various genetically linked cancers that impact various groups more than others. The most prevalent including breast, cervix, and prostate cancer. As other health hazards recede, these group-dependent cancer illnesses will be even more evident and wreak a greater toll on the healthcare systems in Africa.

Ebola makes a comeback in Côte d’Ivoire

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Created by GC microbiologist Cynthia Goldsmith, this colourised transmission electron micrograph (TEM) revealed some of the ultrastructural morphology displayed by an Ebola virus virion. Image credit: CDC/Cynthia Goldsmith, Public domain, via Wikimedia Commons

The Ebola virus arrested headlines earlier this year following an outbreak in the Democratic Republic of the Congo. Now, it’s back in the news with Côte d’Ivoire detecting its first case in more than 25 years.

The country’s Ministry of Health confirmed the news, after samples collected from an individual who had arrived from Guinea. This marks the first case of Ebola in Côte d’Ivoire since 1994. The individual in question – an eighteen-year-old girl – travelled to Côte d’Ivoire from Guinea, arriving in the country’s economic capital and largest city Abidjan on August 12th. The Pasteur Institute (Institut Pasteur) confirmed the case, with the patient receiving treatment in hospital. 

That the case was detected in a capital city is of concern, as World Health Organization (WHO) Regional Director for Africa Dr Matshidiso Moeti pointed out. “It is of immense concern that this outbreak has been declared in Abidjan, a metropolis of more than four million people,” she said. Nonetheless, she emphasised that “much of the world’s expertise in tackling Ebola is here on the continent and Côte d’Ivoire can tap into this experience and bring the response to full speed. The country is one of the six that WHO has supported recently to beef up their Ebola readiness and this quick diagnosis shows preparedness is paying off.”

The DRC experienced an outbreak of the Ebola virus earlier this year in its North Kivu province – its fourth in three years and twelfth overall. The outbreak was declared over on May 3rd, with WHO Director-General Dr Tedros Adhanom Ghebreyesus affirming the WHO’s commitment to “helping national and local authorities, and the people of North Kivu, [to] prevent the return of this deadly virus and to promote the overall health and well-being of all at-risk communities.” The outbreak witnessed eleven confirmed cases, one probable case, and six fatalities. 

A situation map of the Ebola virus epidemic in West Africa in 2014-16, as of November 30th, 2014. Notably, Côte d’Ivoire did not experience cases despite being a neighbouring country of Guinea, Liberia, and Sierra Leone which all experienced widespread transmission. Image credit: Mikael Häggström. Also updated by BrianGroen. Esperanto version included in separate layer by Piet-c., CC0, via Wikimedia Commons

Guinea also experienced an Ebola outbreak this year. “The Ministry of Health of the Republic of Guinea announced an outbreak of Ebola virus disease on 14 February 2021 after a cluster of cases was reported in the sub-prefecture of Gouécké, Nzérékoré Region,” the WHO said. “This was the first time the disease was reported in Guinea since the previous outbreak ended in 2016.” The outbreak was declared over on June 19th, following twelve confirmed cases and seven probable cases as well as twelve fatalities. 

Guinea was the epicentre of the 2014-16 Ebola outbreak in West Africa, which the WHO declared a public health emergency of international concern (PHEIC) on August 8th, 2014 – a designation which applies to “events with a risk of potential international spread or that require a coordinated international response” as the Centers for Disease Control and Prevention (CDC) explains. 

Widespread Ebola transmission occurred in Guinea, Liberia, and Sierra Leone. Italy, Mali, Nigeria, Senegal, Spain, the United Kingdom, and the United States also saw infections, with Italy, Mali, Nigeria, and the United States also experiencing instances of secondary infection. The WHO rescinded the PHEIC designation on March 29th, 2016. 

An infection control official teaches hygiene measures as part of Ebola control in Guinea. against Image credit: Lindsey Horton, CC BY 2.0 https://creativecommons.org/licenses/by/2.0, via Wikimedia Commons

It is as yet unclear as to whether the Côte d’Ivoire outbreak is linked to the outbreak in Guinea. Genome sequencing is underway as part of investigations into the origin of the new case and whether there is a link. In the interim, the WHO says it “is helping to coordinate cross-border Ebola response activities and 5000 Ebola vaccines doses which the organization helped secure to fight the outbreak in Guinea are now being transferred to Côte d’Ivoire, following an agreement between the ministries of health of Côte d’Ivoire and Guinea. An aircraft is departing Abidjan soon to collect the vaccines which will be used to vaccinate people at high risk, including health workers, first responders and contacts of confirmed cases. 

“WHO staff based in Côte d’Ivoire are supporting the investigation into the case. In addition, a multidisciplinary team of WHO experts covering all key response areas will be deployed rapidly to the field. They will help with ramping up infection prevention and control of health facilities, diagnostics, contact tracing, treatment and reaching out to communities to ensure they take a key role in the response.” Earlier this year, the International Coordinating Group (ICG) on Vaccine Provision, which includes the World Health Organization (WHO), UNICEF, the International Federation of Red Cross and Red Crescent Societies (IFRC), and Médecins Sans Frontières (MSF, or Doctors Without Border), announced a global Ebola vaccine stockpile to enable countries affected by outbreaks to vaccinate their populations in a timely manner should the need arise.

The Ebola virus is rare, but deadly. Symptoms include fever, aches, fatigue, a sore throat, loss of appetite, gastrointestinal issues, and unexplained bleeding or bruising. Preventative measures include vaccination, avoiding contact with bodily fluids of those who are sick or items which they have had contact with, and avoiding contact with the meat and bodily fluids of animals which are known vectors for the Ebola virus such as bats, forest antelopes, and nonhuman primates (such as monkeys and chimpanzees).

How a Malawi Village is Fighting Malaria and Saving Lives

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Malawi had nearly 7 million malaria cases last year, more than a third of the population, with 2,500 lives lost to the mosquito-borne disease. However, one village – Mwikala village in Machinga district – has become a model for how to eradicate malaria and in June was honoured as the first-ever to have zero malaria cases for a whole year. In June of this year, Malawi’s president, Lazarus Chakwera, honoured the village’s chief for reducing malaria infection and for recording zero cases since 2017. The village chief augmented the campaign by creating laws requiring villagers to use mosquito nets.

Mosquito Net for Protection against Malaria

“I have introduced the bylaws to prevent people from abusing mosquito nets,” said Yasin Mustapha, a senior chief for Mwikala village. “Some people would sell the free mosquito nets to fishermen. So, anyone disobeying the bylaws would pay a fine of $6. I use the money (to) buy a mosquito net, and I give it to those who don’t have (one).”

The village is fighting malaria and saving lives

For years, health experts and global health partners have been trying to help Malawi eliminate malaria. But after being on the list of the country’s top ten most affected districts for over 30 years, the numbers have plateaued. In 2012, a new plan, including a very powerful tool – applying high-volume insecticide-treated mosquito nets – seemed to be working. However, a drop in aid from the global health community meant that these nets weren’t being used on the scale to close the gap. And then in 2016, the country’s new president, Peter Mutharika, appeared to cut the budget for fighting malaria and the international NGOs funding efforts were threatened with suspension.

Why Malawi?

Malawi has an average of 24 malaria cases and deaths per every 100,000 people. Making a real difference Mwikala is a village of fewer than 3,000 people. Ninety per cent of the community lives in homes without a solid roof, the majority built of mud and sticks. And for the most part, malaria was a fact of life. “Everyone had it,” remembers Rejoice Ngolongoliwa, a local health worker who is also a grandmother of seven and a mother of five. “Especially during the rainy season, when the water from the hills comes into our villages, we had to be careful. When the mosquitoes came, that was when we began to get sick.

What makes this village so successful?

The village is small, but its inhabitants take pride in how their living conditions are so different from those of the rest of the country. “It’s a blessing to live here. We have good sanitation, food and water, everything is okay and we are friendly with each other. The ward councillor helps us in the village,” 50-year-old resident Sakhina Sango says. Sango is among those in Mwikala that know how to protect themselves against the disease and does everything she can to keep mosquitoes away. And they do this using very simple and cheap measures. “We can also use leafy branches and a few sticks to cover the windows in our houses,” she says, proudly. “They are effective in controlling mosquitoes.

The future

In a large number of tropical diseases, eradication and prevention are key to not only protecting human health but restoring the ecosystems upon which our livelihoods depend. Cured, reduced, or limited geographic areas of disease with high rates of infection like malaria prove that there is much more to eradicating these diseases than simply killing parasites in the environment. A healthy ecosystem is necessary for human health and when malaria is cut off, the ecosystem becomes less habitable and makes it much harder for humans to live healthy, productive lives.