Category: Medical

The World Health Organization is urgently appealing for $123.7 million to provide emergency aid for millions of people facing an unprecedented food and health crisis in the Horn of Africa.

U.N. aid agencies report more than 80 million people in the greater Horn of Africa are facing a level of hunger not seen in decades. They warn up to 20 million people, about half children, already are on the verge of starvation across Somalia, Ethiopia, and Kenya.

WHO assistant director-general for emergencies response, Ibrahima Soce Fall says this acute food insecurity crisis also has triggered a health crisis in the region. He says malnutrition is soaring and disease outbreaks, including measles and cholera are increasing.

Speaking on a line from Dakar, Senegal, Fall says the important role health plays in the response to famine crises often goes underrecognized. Consequently, he says health care is less available just when people need it most.

“It is very unfortunate that people’s access to healthcare is more restricted because they are on the move in search of food, water, and pasture and they may also have to make hard choices like between buying food and going to see a doctor.”

Fall says WHO’s multi-million-dollar appeal will be used to prop up the healthcare systems in seven affected countries: Djibouti, Ethiopia, Kenya, Somalia, South Sudan, Sudan and Uganda.

He says a focus of the appeal is to make sure severely malnourished children who are sick get the care they need.

“The level of vaccination has dropped off because of the insecurity, the displaced population. And, of course, the disruption of vaccination during the COVID pandemic. So, more children are at risk and are already dying. We are already in a health crisis. It is not only a nutrition crisis…The number of children dying from diseases. So, the situation is already catastrophic, and we need to act now.”

Fall notes the competition for dwindling resources has become more intense since war broke out in Ukraine in February. However, he says it is not conscionable for international donors to just fund the crisis in Ukraine and not act to prevent people from dying from hunger and disease in the Horn of Africa.

Source: Voice of America

Global health agencies say a voluntary licensing agreement has been reached to allow for the generic production of the first and only long-acting injectable HIV-prevention drug.

Until recently, Cabotegravir, the HIV-prevention medication, was available only in pill form and had to be taken daily, or in some cases before and after sex. The injectable form can provide two months of continuous protection against HIV infection through a single intramuscular injection.

Herve Verhoosel is spokesman for UNITAID, the global health initiative that spearheaded the agreement. He says the price of the injectable drug is prohibitive, noting a year’s supply in the United States costs $20,000.

“That is a lot of money. That is why the product cannot be used today in low-and-middle-income countries," Verhoosel said. "This license will, in fact, give the option to three different generic manufacturers to develop the product on a generic base … Of course, that will help to win the price of the generic version down.”

Data from UNAIDS, the United Nations program on HIV/AIDS, finds 1.5 million people were newly infected with HIV last year, including some 650,000 deaths.

Verhoosel says cabotegravir will be available to people at high risk in the least developed, low-income, lower-middle income, and sub-Saharan African countries. He says people with high rates of infection will benefit most from this medication. They include men who have sex with men, sex workers, transgender women, adolescent girls, and young women.

“And I would like to insist on the importance of protecting adolescent girls and young women," Verhoosel said. "In sub-Saharan Africa, the epicenter of the epidemic, the HIV infection rate of adolescent girls aged 15 to 19 is six times that of their male peers. It is six times greater.”

Verhoosel says the agreement will give selected manufacturers the opportunity to develop and supply generic versions of cabotegravir in 90 countries, where more than 70 percent of all new HIV infections have occurred.

He notes it might take two or more years to develop the generic product. He says the price, which is not yet known, will likely be determined then.

Source: Voice of America

The spread of monkeypox in the U.S. could represent the dawn of a new sexually transmitted disease, though some health officials say the virus that causes pimple-like bumps might yet be contained before it gets firmly established.

Experts don't agree on the likely path of the disease, with some fearing that it is becoming so widespread that it is on the verge of becoming an entrenched STD — like gonorrhea, herpes and HIV.

But no one's really sure, and some say testing and vaccines can still stop the outbreak from taking root.

So far, more than 2,400 U.S. cases have been reported as part of an international outbreak that emerged two months ago.

Health officials are not sure how fast the virus has spread. They have only limited information about people who have been diagnosed, and they don't know how many infected people might be spreading it unknowingly.

They also don't know how well vaccines and treatments are working. One impediment: Federal health officials do not have the authority to collect and connect data on who has been infected and who has been vaccinated.

With such huge question marks, predictions about how big the U.S. outbreak will get this summer vary widely, from 13,000 to perhaps more than 10 times that number.

Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, said the government's response is growing stronger every day and vaccine supplies will soon surge.

"I think we still have an opportunity to contain this," Walensky told The Associated Press.

Monkeypox is endemic in parts of Africa, where people have been infected through bites from rodents or small animals. It does not usually spread easily among people.

But this year more than 15,000 cases have been reported in countries that historically don't see the disease. In the U.S. and Europe, the vast majority of infections have happened in men who have sex with men, though health officials have stressed that anyone can catch the virus.

It spreads mainly through skin-to-skin contact, but it can also be transmitted through linens used by someone with monkeypox. Although it's been moving through the population like a sexually transmitted disease, officials have been watching for other types of spread that could expand the outbreak.

Symptoms include fever, body aches, chills, fatigue and bumps on parts of the body. The illness has been relatively mild in many men, and no one has died in the U.S. But people can be contagious for weeks, and the lesions can be extremely painful.

When monkeypox emerged, there was reason to believe that public health officials could control it.

The tell-tale bumps should have made infections easy to identify. And because the virus spreads through close personal contact, officials thought they could reliably trace its spread by interviewing infected people and asking who they had been intimate with.

It didn't turn out to be that easy.

With monkeypox so rare in the U.S., many infected men — and their doctors — may have attributed their rashes to some other cause.

Contact tracing was often stymied by infected men who said they did not know the names of all the people they had sex with. Some reported having multiple sexual interactions with strangers.

It didn't help that local health departments, already burdened with COVID-19 and scores of other diseases, now had to find the resources to do intensive contact-tracing work on monkeypox, too.

Indeed, some local health officials have given up expecting much from contact tracing.

There was another reason to be optimistic: The U.S. government already had a vaccine. The two-dose regimen called Jynneos was licensed in the U.S. in 2019 and recommended last year as a tool against monkeypox.

When the outbreak was first identified in May, U.S. officials had only about 2,000 doses available. The government distributed them but limited the shots to people who were identified through public health investigations as being recently exposed to the virus.

Late last month, as more doses became available, the CDC began recommending that shots be offered to those who realize on their own that they could have been infected.

Demand has exceeded supply, with clinics in some cities rapidly running out of vaccine doses and health officials across the country saying said they don't have enough.

That's changing, Walensky said. As of this week, the government has distributed more than 191,000 doses, and it has 160,000 more ready to send. As many as 780,000 doses will become available as early as next week.

Once current demand is satisfied, the government will look at expanding vaccination efforts.

The CDC believes that 1.5 million U.S. men are considered at high risk for the infection.

Testing has also expanded. More than 70,000 people can be tested each week, far more than current demand, Walensky said. The government has also embarked on a campaign to educate doctors and gay and bisexual men about the disease, she added.

Donal Bisanzio, a researcher at RTI International, believes U.S. health officials will be able to contain the outbreak before it becomes endemic.

But he also said that won't be the end of it. New bursts of cases will probably emerge as Americans become infected by people in other countries where monkeypox keeps circulating.

Walensky agrees that such a scenario is likely. "If it's not contained all over the world, we are always at risk of having flare-ups" from travelers, she said.

Shawn Kiernan, of the Fairfax County Health Department in Virginia, said there is reason to be tentatively optimistic because so far the outbreak is concentrated in one group of people — men who have sex with men.

Spread of the virus into heterosexual people would be a "tipping point" that may occur before it's widely recognized, said Kiernan, chief of the department's communicable disease section.

Spillover into heterosexuals is just a matter of time, said Dr. Edward Hook III, emeritus professor of infectious diseases at the University of Alabama at Birmingham.

If monkeypox becomes an endemic sexually transmitted disease, it will be yet another challenge for health departments and doctors already struggling to keep up with existing STDs.

Such work has long been underfunded and understaffed, and a lot of it was simply put on hold during the pandemic. Kiernan said HIV and syphilis were prioritized, but work on common infections like chlamydia and gonorrhea amounted to "counting cases and that's about it."

For years, gonorrhea, chlamydia and syphilis cases have been rising.

"By and large," Hook said, doctors "do a crummy job of taking sexual histories, of inquiring about and acknowledging their patients are sexual beings."

Source: Voice of America

From January 1 to July 7, 2022, 7,892 confirmed cases, including three deaths, were reported in 63 Member States from five World Health Organization (WHO) Regions. The 3 fatal cases were reported from Nigeria (1) and the Central African Republic (2).

As of July 7, 2022, 82% (6,496 cases in 34 countries) of the confirmed cases were registered in the European Region; 15% (1,184 cases in 14 countries) in the Region of the Americas, 2% (173 cases in 8 countries) in the African Region, <1% (24 cases in 4 countries) in the Western Pacific Region, and <1 % (15 cases in 3 countries) in the Eastern Mediterranean Region.

During the last seven days, a 41.6% increase in the number of cases reported globally was observed. During the same period, in the African Region, the increase was 82%, in the Western Pacific Region 60%, in the Americas Region 57%, and in the European Region 38%.

78% of confirmed cases globally correspond to men between 18 and 44 years of age (7 cases have been registered in those under 18 years of age in countries of the African and European Regions). 98% of cases were identified as men who have sex with men (MSM) and of these 41% are HIV positive. 47% of the cases indicated that they had previous exposure to the disease during social events with sexual contact.

Of the 1,110 cases with available information, 113 are health workers. Whether the infection in these cases was caused by occupational exposure is under investigation.

Source: World Health Organization

Public revenues are the cornerstone of funding for governments’ response to health emergencies; as such, public financial management (PFM) – the rules and mechanisms governing the allocation, execution and reporting of public funds – has been an integral part of the health response to the COVID-19 pandemic.

• This rapid review highlights the importance of PFM for health emergencies, by analysing various countries’ experiences of financing their national health response to COVID-19 and identifying some early lessons. This review can help countries to enhance their understanding of good practices, and key requirements for adjustments to their PFM systems.

• To be able to effectively adapt and quickly respond to health emergencies, PFM may need to be overhauled. Key PFM policy actions summarized in Table 1 include recommended adjustments for each phase of the budget cycle (formulation, spending, and reporting), to ensure health financing is more agile, flexible and responsive to emergency needs, while assuring transparency and accountability.

• One of the key PFM-related lessons emerging from the COVID-19 health response is the need to shift from budgeting by line items to budgeting based on programmes. Programme-based budgets are more readily structured to allow for more flexible allocations of public resources, and are thus more effective responses to health emergencies.

• The COVID-19 pandemic has shown the need to prepare expenditure management systems by updating emergency spending protocols and proactively empowering frontline providers to access, manage, and account for public funds in an agile way.

• The adoption of measures to balance speed and accountability is another key lesson. Better equipping financial management information systems to provide integrated reporting of emergency-related spending is a critical step to ensuring public trust for the response.

• Countries can better prepare for future health emergencies by strengthening their regular PFM mechanisms and capacities, while limiting the proliferation of parallel mechanisms which can exacerbate fragmentation of health financing and hinder alignment with national response plans. The use of extra-budgetary mechanisms without well-defined procedures is unlikely to result in the efficient use of public resources for health emergency response.

Introduction: why PFM matters for the response to health emergencies

Public revenues are the cornerstone of funding for the response to health emergencies. While private financing can contribute to a country’s response, public sources make up the largest share of the funding available for this purpose. This has been exhibited during the current pandemic, with the health response to COVID-19 predominantly funded from public sources, even in countries facing revenue constraints [1,2]. For example, in Ghana, COVID-19-related health spending in 2020 was mostly funded through domestic government funds (83%) with external and private funding representing 10% and 7% of the total, and in Burkina Faso, domestic public funding represented 53% [2]. The predominance of public funding promotes consistency, efficiency and equity in the response [3].

Given the importance of public finances, the ongoing COVID-19 pandemic has also shown that public financial management (PFM) should be an integral part of the response. Effectiveness in financing the health response depends not only on the level of funding but also on the way public funds are allocated and spent. This is determined by the PFM rules that guide how public funding is allocated, executed, and reported, and in turn how money flows to health service providers [4,5]. Early assessments have shown that PFM systems ranged from being a fundamental enabler to acting as a roadblock in the COVID-19 health response [6,7].

When the crisis hit, many countries’ domestic PFM systems were not ready or agile enough to support an effective emergency response. Challenges commonly faced by countries include [6,8-10]:

i) estimating and formulating budget provisions to align with response needs;

ii) tailoring spending modalities to ensure funds are quickly available for service delivery units and disbursed flexibly and on time;

iii) adjusting tracking and reporting systems to ensure public funds for emergency response are accounted for effectively and transparently.

While problems in service delivery have been extensively documented [11], the underlying PFM mechanisms of the response also merit attention. To highlight the importance of PFM in health emergency contexts, this policy brief analyses various country PFM experiences and identifies early lessons emerging from the financing of the health response to COVID-19. The policy brief is focused on documenting lessons from the budgeting and spending mechanisms and processes; it does not discuss the sources of funding, nor the content of fiscal policies in response to COVID-19, which are covered extensively elsewhere [12]. The assessment is done by stages of the budget cycle: budget allocation, budget execution, and budget oversight. Identifying lessons from PFM modalities used to finance the health response to COVID-19 is fundamental both for health policy-makers and for finance authorities, to enhance PFM system preparedness to respond effectively to future health emergencies. It can help to enhance understanding of good practices, as well as key requirements for future system adjustments.

The assessment is built on a non-systematic review of several activities initiated by WHO in 2020 to monitor countries’ health response from a PFM perspective (see Table 2). The evidence reviewed included a desk-based survey initiated in March 2020, which analysed budgeting, spending, and accounting modalities in financing of the health response in 183 countries. Technical consultations were conducted in 17 countries (Argentina, Australia, Brazil, Chile, China, Costa Rica, Dominican Republic, Ecuador, Indonesia, Lao People’s Democratic Republic, Malawi, Mexico, Mongolia, Peru, Philippines, South Africa, Ukraine) between June and September 2020 by WHO to further the understanding of PFM modalities. Complementary analyses conducted in 2021 to unpack specific PFM aspects of the health response, including an analysis of 40 extra-budgetary funds used to channel resources for the response [13], a mapping of PFM issues related to COVID-19 vaccine roll-out [7], and an in-depth assessment of PFM modalities in selected countries, including Argentina, the Philippines and South Africa [14,15] were also reviewed. In late 2021, the emerging findings in this paper were further explored and validated during the 5th Meeting of the Montreux Collaborative, a virtual meeting that gathered over 900 participants and 50 speakers over 5 days to explore policy options to help countries rebuild and strengthen health financing and PFM systems to make them more responsive to future shocks and able to sustain efforts towards universal health coverage (UHC). Finally, in early 2022, to gather the latest information on the response, another non-systematic review of published literature and publicly available audit reports on COVID-19-related expenditures was conducted to complement the understanding of the opportunities and risks associated with the use of emergency procedures.

Source: World Health Organization