Outbreaks of Cholera and Ebola as Race for WHO Chief Gets Nasty

Candidates for the next WHO director-general: David Nabarro, Sania Nishtar and Tedros Adhanom


May 16, 2017 – Next week delegates will gather for the World Health Assembly and vote for a new director-general of the World Health Organization.

The election comes at a time when WHO are dealing with a cholera outbreak in Yemen that risks spreading quickly due to the dire humanitarian crisis there already and the reemergence of Ebola in the Democratic Republic of Congo.

Pakistan’s Sania Nishtar, UK’s David Nabarro and Ethiopia’s Tedros Anhanom are the three vying for the post and this week the race hardened with accusations that Nabarro is running a smear campaign and is also using UN and WHO staff on his campaign, contravening the code of conduct for WHO’s election process.

The charge comes from Mukesh Kapila, a professor of global health at the University of Manchester in England. Kapila tweeted photos of what he says are leaked communications from Nabarro’s team. One of the recipients in a January email from Nabarro to his “Support Team” is Laurence Gostin, a professor of global health at Georgetown University in Washington DC.

The spark for Kapila to make the charge against Nabarro and his team is that Gostin was quoted as the source for an article in the New York Times this week accusing Tedros of covering up cholera outbreaks when he was Ethiopia’s health minister.

Gostin told the paper he went public to protect WHO and that his intervention was not authorized by Nabarro, who also said he did not authorize the release of the accusations.

Kapila has also retweeted several tweets supportive of Tedros’s campaign.

The new director-general will take the reins on July 1 when current DG, China’s Margaret Chan, steps down.

– Denis Fitzgerald
On Twitter @denisfitz

Related: Replacing Vaerie Amos: Political Appointment or Merit Based?

Cuba First Country to Eliminate Mother to Child HIV Transmission

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June 30, 2015 – The Caribbean region has the second highest incidence of HIV after sub-Saharan African but has made steady progress over the past decade in reducing new infections and on Tuesday Cuba achieved a feat that has so far evaded the rest of the world.

The World Health Organization announced that the island nation has become the first country to eliminate mother-to-child transmission of HIV. The most recent figures from WHO show that 240,000 children globally were born with HIV in 2013, down from 400,000 in 2009.

“Eliminating transmission of the virus is one of the greatest public health achievements possible,” WHO Executive-Director Margaret Chan said in a statement. “This is a celebration for Cuba and a celebration for children and families everywhere.”

An estimated 1.4 million women living with HIV become pregnant annually and, unless treated with anti-retrovirals, have a 15-45 percent chance of transmitting the virus during pregnancy, labor or through breastfeeding. If both mother and child receive antiretroviral treatment during these crucial stages then the risk of transmission is lowered to about 1 percent, according to WHO.

The Caribbean nation has also eliminated mother-to-child transmission of syphilis. Some 1 million pregnant women are infected with the disease annually and it results in early miscarriage and stillbirth, newborn death, low-birth-weight and other serious infection in newborns.

The WHO guidelines for validating elimination of mother-to-child transmission of HIV and syphilis notes that as treatment is not 100 percent effective, elimination is defined as a reduction to such a low-level that it no longer constitutes a public health concern. Among the indicators are new HIV infections among infants are less than 50 cases per 100,000 live births or less than 5 percent for women living with HIV who are breastfeeding. These targets must be met for two consecutive years.

In 2013, only two babies in Cuba were born with HIV and only five with syphilis.

– Denis Fitzgerald 
On Twitter @denisfitz

UN Investigators Find Numerous Flaws With WHO’s Ebola Response


May 11, 2015 – The World Health Organization is ill prepared to respond to international health emergencies and poorly managed the initial response to last year’s Ebola outbreak in West Africa, an independent team of investigators appointed by the UN has concluded.

The esteemed panel of investigators, in an interim report, said the WHO did not seek support early enough from other United Nations agencies that have experience in emergency response, did not engage with local communities early enough on changing behaviors that spread the disease, and its authoritative status was undermined by a combination of the above as well as fluffed communications including belatedly declaring Ebola a Public Health Emergency of International Concern.

“At present, WHO does not have the operational capacity or culture to deliver a full emergency public health response,” the investigators concluded. Among their recommendations are establishing a new agency for emergency health response or reforming WHO.

The latter is preferable, the investigators said, because “establishing a new agency would take time to put in place and substantial new resources would be required to establish its basic administrative systems, and operational response capacity.”

“A new agency would, in any case, have to rely on and coordinate with WHO for public health and technical resources, creating an unnecessary interface,” the report says. “A WHO that is capable of adequately responding to public health emergencies requires deep and substantial organizational change.”

Although WHO leads the health response cluster during humanitarian emergencies, the investigators write that “it is unclear…how a public health emergency fits into the wider humanitarian system and at what point an outbreak becomes a humanitarian emergency that requires a broader United Nations-wide response.”

They add that “one of the difficulties is that the risk assessment of public health emergencies and so-called humanitarian emergencies differs, because of uncertainty in assessing the likelihood of disease spread.”

Among other recommendations are that WHO should have used medical anthropologists for developing communications strategies for changing traditional burial and funeral practices that contributed to the spread of Ebola and that UN member states should increase their contributions to WHO so that it can effectively respond to public health emergencies.

“Now is the historic political moment for world leaders to give WHO new relevance and empower it to lead in global health,” the report concludes. “In response, the (WHO) Secretariat needs to take serious steps to earn this leadership role in relation to outbreaks and emergency response and to regain the trust of the international community.”

Full report is below.

Denis Fitzgerald
On Twitter @denisfitz


Ebola Interim Report on WHO Response

UN Agencies Pin Hopes on Kuwait Pledging Conference for Syria Funds

An example of a World Food Program package delivered to Syrians in need.

An example of a World Food Program package provided to Syrians in need.

Kuwait City, March 29, 2015 – Representatives from UN agencies started gathering in Kuwait over the weekend ahead of the Third International Pledging Conference for Syria with hopes that donors will stump up much needed funds for the at least 12 million Syrians in need.

A combined total of almost $4 billion was pledged at the previous two donor conferences – $1.5 billon in 2013 and 2.4 billion last year – but almost double that amount is needed at the March 31st gathering to meet basic needs for the remainder of the year.

The World Food Program requires $30 million weekly to feed six million Syrians inside and outside the country while the World Health Organization’s (WHO) requirements to provide life-saving medicines and services for 2015 is over $1 billion.

The WHO’s Tarik Jasarevic told UN Tribune that new crises continue to emerge and with the warmer season approaching the risk of cholera increases.

A crisis that continues to worsen is the decreasing amount of medical facilities and professionals in the country. Barely half the hospitals in Syria are fully functioning while more than half of the country’s doctors and health staff have left the country due to insecurity.

Procuring essential medicines is another growing challenge. While Syria once produced 90 percent of the drugs it needed in in the country, that figure is now less than 30 percent.

A hidden crisis is emerging in the mental health sector with a lack of facilities and a lack of medicine. Syrians with chronic diseases, including an estimated 10,000 children with cancer, are also at risk due to diminishing availability of life-saving treatment while a lack of dialysis treatment for diabetes sufferers is yet another growing crisis.

The UN Children’s Agency (UNICEF) requires $903 billion for 2015. Two years ago, 2.5 million Syrian children needed help, the agency’s Juliette Touma told UN Tribune, but that figure has increased three-fold to 8.5 million, including 2.6 million children who are not in school.

Another UN agency hoping for a big response in Kuwait is UNRWA, the agency responsible for Palestinian refugees, including more than 500,000 residing in camps in Syria. UNRWA spokesman Chris Gunness said it urgently needs $415 million as 95 percent of Palestinian refugees in Syria cannot meet their daily needs.

Some 78 governments and more than 40 aid agencies are expected in Kuwait for the pledging conference on Tuesday which Ban Ki-moon will chair.

– Denis Fitzgerald
On Twitter @denisfitz

Ethiopia Among Countries to Meet MDG Hunger Target

A fruit and vegetable market in Ethiopian capital, Addis Ababa. (credit: wikimedia)

Dec. 1, 2014 – Fifteen developing countries in 2014 have met the MDG 1 hunger goal of reducing by half the number of undernourished people from 1990 levels.

Ethiopia, the 13th most populous nation in the world and Africa’s second most populous behind Nigeria, is among the 15 to reach the target this year. The UN Food and Agriculture Organization said on Sunday that the prevalence of undernourishment in the country has decreased from 74.8 percent in 1990-92, to 35 percent in 2012-14.

But there are still some 33 million Ethiopians without enough food each day, almost one-third of the country’s 96 million people.

Brazil, Cameroon, Iran and Mexico were also among the fifteen countries this year to meet the hunger goal. The prevalence of undernourishment in these countries was much lower than in Ethiopia with Brazil reducing hunger from 14.8 percent of its population in 1990-92, to 1.7 percent in 2012-14, while the number of hungry in Cameroon declined to 2.3 million people compared with 4.7 million in 1990.

Globally, there are some 805 million people who do not have enough food to eat each day. In China, which met the hunger goal in June this year, 10.6 percent of the population are undernourished while in India, which has not yet met the target, 15.2 percent of people are undernourished. Combined, these two countries account for 340 million of the world’s undernourished people, 40 percent of the overall total.

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Hunger is the biggest public health threat globally, according to the World Health Organization and is a contributory factor in the death of 3.1 million children under five every year.

While progress is being made in the fight against hunger, conflict is driving food insecurity in a number of places including Yemen, Sudan, South Sudan, Iraq, Gaza and Syria. On Monday, the World Food Program announced it was suspending a food aid scheme for 1.7 million Syrian refugees due to a lack of funding. The agency said it needs $64 million in December to resume its voucher scheme in Egypt, Iraq, Jordan, Turkey and Lebanon.

The Millennium Development Goals are set to expire in December 2015 and will be replaced by a new set of post-2015 goals.

– Denis Fitzgerald
On Twitter @denisfitz

538 MERS Cases in 18 Countries

May 12, 2014 – Lebanon has recorded its first case of the Middle East Respiratory Syndrome (MERS) as the US Center for Disease Control announced on Monday that it is investigating a second case in Florida.

The amount of new infections has more than doubled in the past month with the majority of new cases in Saudi Arabia where 290 new infections have been diagnosed since late March.

MERS can cause severe respiratory illness and has a fatality rate of about 30 percent.

It originated in Saudi Arabia in 2012 and has since spread to Jordan, Kuwait, Lebanon, Oman, Qatar, United Arab Emirates and Yemen in the Middle East; Egypt and Tunisia in Africa; France, Germany, Greece, Italy and the UK in Europe; Malaysia and the Philippines in Asia; and the United States in North America.

All cases outside of the Middle East are among individuals who recently travelled to the region. Camels are suspected as the primary source of infection for humans with the World Health Organization reporting that the case from Yemen had no recent history of travel outside of Yemen, but had made weekly visits to a camel farm where he reported drinking fresh camel milk.

The majority of cases are in men, 65 percent, and the median age for infection is 49.

– Denis Fitzgerald
On Twitter @denisfitz

Ten Countries Infected by Polio Virus as WHO Declare Emergency

May 5, 2014 –  Cameroon, Pakistan and Syria pose the greatest risk for exporting the polio virus that was on the verge of eradication a couple of years ago.

The vaccine-preventable disease has already spread across the borders of these three countries with neighboring Equatorial Guinea, Afghanistan and Iraq also infected.

Declaring the situation a public health emergency of international concern, the World Health Organization on Monday said “the consequences of further international spread are particularly acute today given the large number of polio-free but conflict-torn and fragile States” where vaccination programs have been interrupted because of fighting.

Ethiopia, Israel, Somalia as well as Nigeria have also recorded cases of polio in the past year whereas prior to 2013 only three countries – Afghanistan, Nigeria and Pakistan – were considered endemic countries. The number of cases had decreased from some 350,000 in 1988 to 223 in 2012 as it seemed that the virus would join smallpox and rinderpest as the only diseases ever eradicated.

There were 417 polio cases last year, according to the Global Eradication Initiative.

Central African Republic, Chad, Democratic Republic of Congo, Sudan, and Lebanon are at high risk of becoming infected countries due to their proximity to currently infected countries and the risk of conflict interrupting vaccination campaigns there.

– Denis Fitzgerald
On Twitter @denisfitz

UN: Cancer Rates Will Worsen With Poorest Hit Hardest

Feb. 5, 2014 –  Cancer rates globally are predicted to increase by about 70 percent in the next two decades and lower-income countries will be hit hardest.

Late diagnoses and the high cost of treatment place an undue burden on poorer patients and population growth, ageing and the spread of risk factors such as tobacco use will result in the situation worsening, according to the 2014 World Cancer Report, published by WHO.

“This divide between the experiences of individual cancer patients will only increase,” the report says. “Taken in isolation, this is a dark prediction.”

The report calls for much greater emphasis on cancer prevention as it is “implausible to treat our way out of cancer.” On a positive note, it says that there is enough information available to prevent 50 percent of cancers if prevention strategies are implemented.

It states that the decades-old perception of cancer as a disease of affluence is false as high-risk factors such as tobacco use, obesity, alcohol abuse, less exercise, sun exposure and pollution are not unique to rich countries.

More than 60 percent of cancer cases occur in Africa, Asia, Central and South America and these regions account for 70 percent of cancer deaths.

There were 14 million new cancer cases and 8 million cancer-related deaths in 2012, according to the report.

The five most common cancers for Women are: 1. Breast 25.2%; 2. Colorectum 9.2%; 3. Lung 8.7%; 4. Cervix  7.9%; 5. Stomach 4.8%, and for Men: 1. Lung 16.7%; 2. Prostate 15%; 3. Colorectum 10%; 4. Stomach 8.5%; 5. Liver 7.5%.

Lung, stomach and liver cancer have the highest mortality rates for men. Breast cancer, which has a survival rate of about 65 percent, still accounts for 14.7 percent of cancer deaths in women – because of its high prevalence – followed by lung cancer at 13.2 percent.

– Denis Fitzgerald
On Twitter @denisfitz

Preliminary Evidence Suggests Polio in Syria Came from Pakistan


Nov 10, 2013 – Foreign fighters appear to be the source of the outbreak of polio in Syria that risks infecting hundreds of thousands of children in the region.

Initial tests indicate that the poliovirus detected in Syria is of Pakistani origin, according to UNICEF and the World Health Organization.

Pakistan is one of only three countries – along with Afghanistan and Nigeria – where the virus remains endemic. The BBC reported in July that the Pakistan Taliban had set up a base inside Syria to join the fight against the Assad regime.

Syria had been polio free for fourteen years prior to the outbreak and the virus had not been detected in neighboring countries in the past decade but so far this year has been found in sewage samples in Egypt, Israel, the West Bank and Gaza.

Polio affects the nervous system and can cause paralysis within hours. It usually affects children under five and is typically spread through contact with contaminated feces.

Children usually require four doses of the polio vaccine before school-age to provide lifelong protection against the virus.

As a result of the conflict, immunization rates have plummeted from 92 percent before the conflict to 67 percent as of 2012, according to UNICEF.

WHO and UNICEF aim to vaccinate 20 million children in Syria and neighboring countries in the coming months to prevent an epidemic.

– Denis Fitzgerald
On Twitter: @denisfitz

photo/UN Photo

Annual World Health Assembly Highlights Global Health Burden

May 20, 2013 – The annual meeting of the World Health Assembly, the governing body of the World Health Organization, which opened in Geneva on Monday provides an interesting overview of the current global health situation and priorities for the years ahead.

The proposed $3.9 billion budget for the 2014-15 biennium includes an eight percent reduction in the budget for communicable diseases, with cuts in the HIV/Aids and Tuberculosis budgets, and a 20 percent increase in the budget to tackle non-communicable diseases (NCDs), aimed reducing the prevalence of cancer, cardio-vascular diseases and substance abuse.

The reduction in the HIV/Aids budget reflects the significant progress made in reducing new infections – a 20 percent overall decrease since 2003, including a 40 percent decrease in new infections among children over that period. Anti-retroviral drugs now reach eight million people living with HIV, up from two million in 2006.

The increase in the NCDs budget is indicative of the growing burden on health systems and the related increase in mortality: some two-thirds of the estimated 60 million deaths annually are a result of non-communicable diseases.

Among the primary aims of the increased NCDs budget is reducing harmful alcohol use, reducing tobacco use, and increasing mental health awareness and treatment – particularly in low-income countries. WHO’s mental health action plan notes that almost half the world’s population lives in countries where there is just one psychiatrist for 200,000 or more people.

Some facts and figures from documents and resolutions that will be discussed and voted on at the WHA over the next week:

– Close to 900,000 people commit suicide each year

– Between 76 precent and 85 percent of people with severe mental disorders receive no treatment for their in low-income and middle-income countries

– Between 2000 and 2011 the reported incidence of measles decreased globally by 65 percent, in tandem with more vaccinations

30 percent of married women in the West Bank and 51 percent of married women in the Gaza Strip had experienced violence from their husbands in the preceding 12 months

– As of Feb. 14 2013 the numbers of both cases of polio and countries experiencing cases were at their lowest-ever recorded levels: Globally, 222 cases had been reported in 2012, a 66% decline compared with 2011. Five countries reported cases in 2012 compared with 16 in 2011

– About 16 million adolescent girls between 15 years and 19 years give birth each year. Babies born to adolescent mothers account for roughly 11% of all births worldwide

– Denis Fitzgerald