Five global health topics to watch

As the World Health Organization Executive Board is meeting this week, the world is grappling with increasing humanitarian crises, rising health costs and competing financial priorities.

Triple D dynamics

Dynamics of Decarbonization", Demographics and Deglobalization are altering market structures and increasing the risk of macro-economic shocks. A report developed for WHO Executive Board highlighted countries’ slow progress towards achieving the goals of Universal Health Coverage, with many of them seeing stagnation or deterioration in service coverage or financial protection.?

As the context of multiple crises persists, it will be critical for countries and partners to focus on essential health interventions, especially those in which progress can be made and positive health outcomes can be maximised.

Five areas offer unique opportunities to transform people’s health in 2024 despite the ongoing macro challenges faced by countries.?

One: A new Pandemic Agreement??

Led by an Intergovernmental Negotiating Body (INB) hosted by WHO, Member States are negotiating a Pandemic Accord to deal with future pandemics. The INB has now released three drafts of the proposed Pandemic Agreement and negotiations are still ongoing. The agreement is to be finally adopted in May 2024, two years after the process was launched, and Member States are intensifying negotiations to reach this tight deadline. The Pandemic Agreement negotiations carry the promise of transforming how the world responds to future pandemics, especially on the imperative of prioritizing equity in their prevention, preparedness and response. Proposals of reserving a fixed percentage of medical countermeasures (i.e., vaccines, diagnostics, medicines) to developing countries have the potential of shifting the structural inequities that play out when countries need to urgently deal with health threats. Four months are left for the negotiators in Geneva (and their counterparts in capitals) to produce a historic agreement that will make a difference for countries, for health institutions and, most importantly, for their own people.?

Two: Climate and health?

At the end of 2023, the United Nations Climate Change Conference COP28 UAE closed with an agreement signalling the “beginning of the end” of the fossil fuel era by laying the ground for a swift, just and equitable transition, underpinned by deep emissions cuts and scaled-up finance.

Building on the unprecedented political momentum created by the hosting of the first health day at COP28, countries also adopted a first-ever Declaration on Climate and Health which covers a range of action areas at the nexus of climate and health, including building more climate-resilient health systems, strengthening cross-sectoral collaboration to reduce emissions, and increasing finance for climate and health solutions.

While the declaration is welcome, countries must continue the work they started in Dubai to incorporate public health measures in National Adaptation Plans (NAPs), to strengthen surveillance and vulnerability assessments of climate-sensitive diseases, and to decarbonise health supply chains and procurement as part of the broader effort to build climate resilient, low-carbon, and sustainable health systems.

Immunisation has been hardly ever considered in climate and health discussions, yet vaccines can prevent several climate-sensitive diseases. If anything, the upcoming World Health Assembly in May provides a critical opportunity for countries to update their commitments and translate them into concrete actions.?

Three: Antimicrobial resistance?

Antimicrobial resistance is an urgent global health and socioeconomic crisis that threatens the core of modern medicine. The upcoming High-level Meeting on Antimicrobial Resistance (AMR) at the UN General Assembly in September 2024 will be a critical opportunity for countries to renew political momentum and commitment towards addressing antibiotic resistance.

The true value and potential of vaccines in preventing AMR has long been under-recognized and the vast majority of national AMR plans do not include immunisation as a tool for preventing and reducing AMR. This is despite the fact that vaccines are considered one of the most cost-effective ways of preventing morbidity and mortality and are an important tool in tackling AMR.

Vaccination helps to prevent AMR in three ways:

Firstly, certain vaccines can prevent bacterial infections commonly acquired by the general population. This helps by protecting individuals and their communities from diseases while reducing the need for antibiotics, decreasing opportunities for bacteria to develop resistance and the transmission of antibiotic resistant bacteria.

Secondly, vaccines help to prevent bacterial infections commonly acquired in hospitals and other health settings.

Thirdly, vaccines help to prevent viral infections. This is important as a large proportion of unnecessary antibiotic prescriptions occur for patients who have viral infections.

It is high time to prioritise the strengthening of vaccination programs within national AMR plans as a preventative measure.?

Four: Child survival?

With only six years remaining until the Sustainable Development Goals target in 2030, many countries are still not on track to achieve the targets of reducing neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births.

While the recent uptick in coverage for the third dose of diphtheria, tetanus, and pertussis-containing vaccine (DTP3) and reduction in the number of zero-dose children (those who never received a single dose of vaccine) has been celebrated as a positive step, we are still far from pre-pandemic levels, where global DTP3 coverage stood at 86%.

We also know that lowest income countries have shown slower recovery trends in 2022. If countries are to achieve the Sustainable Development Goals, more needs to be done to reach unvaccinated children and scale up coverage of vaccines that prevent major causes of child mortality.

The good news is that twenty countries across different regions in Africa are set to receive 18 million doses of the first-ever malaria vaccine over the next two years. The roll out is a critical step forward in the fight against one of the leading causes of death in the continent. In view of their increased availability, the introduction of malaria vaccines in endemic countries, as part of comprehensive malaria control plans, could be a game changer to improve child survival in lower income countries.??

Five: Adolescent Health?

Adolescents are not simply old children or young adults. According to a World Health Organization definition , adolescence is a unique stage of human development and an important time for laying the foundations of good health.

This is particularly true in the context of health prevention and promotion. The prevention of cervical cancer, a major cause of death for women, through HPV vaccination of adolescents, especially adolescent girls, is a clear illustration of how this preventive approach can save lives.

In 2020, cervical cancer caused more than 342,000 deaths, 90% of which occurred in low- and middle-income countries. The HPV vaccine has among the highest impact of vaccines and helps to protect the future of adolescent girls across the world. After significant global supply constraints during the COVID-19 pandemic, combined with the unique challenges of reaching adolescent girls with the HPV vaccine due to misinformation and gender-related barriers, many countries saw a clear setback.

Now that supply limitations are lifted, the world has an incredible opportunity to hamper efforts to build and improve coverage as well as reach more adolescents, especially girls in lower income countries, with this life-saving preventative intervention. Gavi, the Vaccine Alliance has committed to support countries to reach 86 million adolescent girls by 2025 with the HPV vaccine.??

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