Impact of US funding cuts on global HIV/AIDS fight by UNAIDS, agencies   24 Mar. 2025   UN agency warns of ‘surge’ in AIDS deaths without US funding. (UN News)   Amid continuing uncertainty about the impact of deep US funding cuts to humanitarian work worldwide, the head of the UN agency coordinating the fight against HIV-AIDS warned that an additional 6.3 million people will die in the next four years, unless support is reinstated.   “We will see a …real surge in this disease - we will see it come back, and we see people dying the way we saw them in the 90s and in 2000s,” said UNAIDS Executive Director Winnie Byanyima who noted a “tenfold increase” from the 600,000 AIDS-related deaths recorded globally in 2023.   “We also expect an additional 8.7 million new infections. At the last count, there were 1.3 million new infections globally in 2023”.   Byanyima noted that the funding freeze announced by the White House on 20 January was due to end next month, after a 90-day review.   “We have not heard of other governments pledging to fill the gap,” she told journalists.   Already, drop-in centres where HIV patients can pick up the anti-retroviral medicines they need are not reopening, “for fear that this might not be consistent with the new guidelines”, she maintained.   “This sudden withdrawal of US funding has led to the closure of many clinics, laying off of thousands of health workers. These are nurses, doctors, lab technicians, pharmacy workers…it's a lot.”   Focusing on Africa – where the eastern and southern regions bear 53 per cent of the global HIV burden – Ms. Byanyima warned that closing drop-in centers for girls and young women without notice would be disastrous. She emphasized that more than 60 per cent of new infections on the continent are among girls and young women.   Speaking to UN News earlier this month, Susan Kasedde, head of the UNAIDS office in the Democratic Republic of the Congo (DRC), highlighted major uncertainties regarding the extent and scope of cuts to PEPFAR-led programmes. This initiative, launched over two decades ago by former US President George W. Bush to prevent and contain HIV infections, is estimated to have saved around 26 million lives.   There are currently around 520,000 people living with HIV in the DRC, including 300,000 women and 50,000 children. The epidemic continues to grow, as the number of new infections is almost double the number of deaths linked to the disease.   PEPFAR's expected contribution for the 2025 fiscal year was due to be $105 million, and it aims to provide treatment to half of the population living with HIV in the DRC – some 209,000 people.   “This means that we currently have 440,000 people living with HIV who are on treatment. Thanks to this treatment, they are alive”, said Ms. Kasedde.   Several other UN agencies that are heavily reliant on US funding have also warned that the cut in support – in addition to chronic under-investment in humanitarian work globally – is already having a serious impact on the communities they serve.   On Friday, the UN refugee agency, UNHCR, said that thousands have been left without lifesaving aid in the war-torn eastern DRC.   The UN International Organization for Migration (IOM) also announced that funding cuts have severe repercussions for vulnerable migrant communities, exacerbating humanitarian crises and undermining essential support systems for displaced populations.   Together with IOM, the UN Children’s Fund (UNICEF) warned last Friday that that the liquidity crunch has jeopardized lifesaving work, including progress in reducing child mortality, which has fallen by 60 per cent since 1990.   “It is reasonable for the United States to want to reduce its funding - over time. But the sudden withdrawal of lifesaving support is having a devastating impact across countries, particularly Africa, but even in Asia and Latin America,” said UNAIDS’ Ms. Byanyima. “We urge for a reconsideration and an urgent restoration of services – life-saving services.”   According to UNAIDS, approximately 40 million people globally live with HIV, based on 2023 data. Of this number, some 1.3 million became newly infected with HIV in the same year and 630,000 people died from AIDS-related illnesses.   http://news.un.org/en/story/2025/03/1161416   7 Feb. 2025   Impact of US funding cuts on global HIV/AIDS fight. (UN News)   Christine Stegling, Deputy Executive Director of UNAIDS, stated that the sudden pause to US foreign assistance was a shockwave to the AIDS response and the global health infrastructure.   While the Emergency Humanitarian Waiver issued by the US Secretary of State was welcome, there was still a lot of confusion. The waiver should mean that 20 million people living with HIV that depended on US aid for their treatment could continue to receive their medication during the 90-day assessment. There were still ten million HIV-positive people in the world living without treatment, reminded Ms. Stegling.   Many services that supported the delivery of treatment had stopped, such as counselling services or the community delivery of medication. The biggest impact would be on community health services, which were at the heart of UNAIDS’s successful drive against HIV/AIDS.   UNAIDS estimated that if US President's Emergency Plan for AIDS Relief (PEPFAR) was not reauthorized between 2025 and 2029, and other resources were not found for the HIV response, there would be a 400 percent increase in AIDS deaths, or 6.3 million AIDS-related deaths.   Ms. Stegling quoted Richard Lusimbo, Director of the Ugandan Key Populations Consortium, who said that foreign aid had been more than financial support in the fight against HIV/AIDS, discrimination, and systemic inequalities; it had been a lifeline.   Ms. Stegling reminded that the US had been a huge supporter of global health and UNAIDS was hopeful that it would stay present. The biggest danger was losing the hard-won gains and abandoning human rights protection for the most marginalized.   She concluded by stressing that the world was at a critical moment in the AIDS response, as in 2024, long-acting medicines for HIV prevention and treatment had proven over 95 percent effective in stopping new HIV infections. This could be a game changing moment but only if there was global solidarity and a true global commitment to end AIDS by 2030.   Responding to questions from the media, Ms. Stegling said it was becoming gradually clear what the US waiver would cover, but everyone was still analyzing and seeking guidance.   UNAIDS was doing live monitoring with country offices to see where bottlenecks might be. UNAIDS was concerned about the long-term impact of HIV prevention, as well as treatment interruption, which would lead to an increase in new HIV infections.   Ms. Stegling specified that in Ethiopia, 5,000 public health workers’ contracts funded by US assistance from all regions had been terminated; 10,000 data clerks had also been let go. It was hoped that the US would continue its critical aid, which had been provided over the decades, with bipartisan support. The global community had to come together, with national governments, to see how best to fill in the gaps at the community health level.   There were many ongoing conflicts in the world right now, reminded Ms. Stegling, which already adversely affected provision of HIV prevention and treatment services.   On another question, Ms. Stegling explained that in 2024, UNAIDS had been USD 8 billion short on global HIV/AIDS response. Current donors ought to step up and new donors were needed to step in, she stressed.   http://www.unaids.org/en/impact-US-funding-cuts   5 Feb. 2025   Foreign Aid Freeze Leaves Millions Without H.I.V. Treatment. (New York Times)   Two weeks into President Trump’s sweeping freeze on foreign aid, H.I.V. groups abroad have not received any funding, jeopardizing the health of more than 20 million people, including 500,000 children.   Subsequent waivers from the State Department have clarified that the work can continue, but the funds and legal paperwork to do so are still missing.   With the near closure of the American aid agency known as U.S.A.I.D. and its recall of officers posted abroad, there is little hope that the situation will resolve quickly, experts warned.   H.I.V. treatment and services were funded through the President’s Emergency Plan for AIDS Relief, or PEPFAR, a $7.5 billion program that was frozen along with all foreign aid on Mr. Trump’s first day in office.   Since its start in 2003 during the George W. Bush administration, PEPFAR has delivered lifesaving treatment to as many as 25 million people in 54 countries and had enjoyed bipartisan support. The program was due for a five-year reauthorization in 2023; it survived an effort by some House Republicans to end it and was renewed for one year.   Without treatment, millions of people with H.I.V. would be at risk of severe illness and premature death. The loss of treatment also threatens to reverse the dramatic progress made against H.I.V. in recent years and could spur the emergence of drug-resistant strains of H.I.V.; both outcomes could have a global impact, including in the United States.   The pause on aid and the stripping down of U.S.A.I.D. have delivered a “system shock,” said Christine Stegling, a deputy executive director at UNAIDS, the United Nations’ H.I.V. division.   On Jan. 28, Secretary of State Marco Rubio issued a waiver for lifesaving medicines and medical services, ostensibly allowing for the distribution of H.I.V. medicines. But the waiver did not name PEPFAR, leaving recipient organizations awaiting clarity.   On Sunday, another State Department waiver said more explicitly that it would cover H.I.V. testing and treatment as well as prevention and treatment of opportunistic infections such as tuberculosis, according to a memo viewed by The New York Times. The memo did not include H.I.V. prevention — except for pregnant and breastfeeding women — or support for orphaned and vulnerable children.   Although PEPFAR is funded by the State Department, roughly two-thirds of its grants are implemented through U.S.A.I.D. and the Centers for Disease Control and Prevention. Neither organization has released funds to grantees since the freeze was initiated.   In an interview with The Washington Post, Mr. Rubio appeared to blame the recipient organizations for not acting on the waiver.   But experts familiar with PEPFAR’s requirements said his comments belied the complexity of its system of approvals.   “The messaging and guidance from the State Department expose an ignorance of how these programs function — and an alarming lack of compassion for the millions of lives at risk,” said Jirair Ratevosian, who served as chief of staff for PEPFAR in the Biden administration.   For instance, the stop-work orders compelled each program to cease immediately. The organizations are now legally required to wait for equally explicit instructions and cannot proceed on the basis of a general memo, according to a senior official at a large global health organization that receives PEPFAR funds.   “We have to wait till we get individual letters on each project that tell us not only we can start work, but tell us which work we can start up and with how much money,” the official said. The official asked not to be named for fear of retaliation; 90 percent of the organization’s money comes from PEPFAR.   The freeze is also disrupting the network of smaller organizations that deliver H.I.V. treatment and services in low-income nations.   In a survey of 275 organizations in 11 sub-Saharan countries conducted over the past week, all reported that their programs or services had shut down or were turning people away, said Dr. Stellah Bosire, executive director of the Africa Center for Health Systems and Gender Justice.   At least 70 organizations reported disruptions in H.I.V. prevention, testing and treatment services, and 41 said that some programs had closed. “Without immediate intervention, these funding suspensions could lead to devastating reversals in public health progress,” Dr. Bosire said in an email.   In Kenya, 40,000 doctors, nurses and other health workers have been affected by the freeze, according to Mackenzie Knowles-Coursin, who was deputy chief of communications at the American mission in Nairobi until Monday. In South Africa, the halt in funding will affect the salaries of more than 15,000 health workers and operations across the country, the nation’s health minister, Aaron Motsoaledi, said during a televised news conference last week.   Some organizations rely on a patchwork of grants, with a stream of funding from one donor applied to purchasing medications and another stream applied to paying staff. Interruption of even one source can hobble the clinics, leaving them without medications to dispense or workers to dispense them.   The Uganda Key Populations Consortium, an umbrella organization that provides H.I.V. treatment and other services, has lost 70 percent of its funding. It has shuttered 30 of the 54 drop-in centers around the country that dispense medications, and it terminated the contracts of 28 of its 35 staff members.   On Tuesday night, the Trump administration put nearly all of U.S.A.I.D.’s global work force on leave and recalled those posted abroad to return to the United States within 30 days.   Without U.S.A.I.D. staff to process waiver applications, organizations fear they will not see funds anytime soon. Even large global health organizations are struggling to stay afloat; some have already cut programs and staff.   Even if the funds were to return quickly, it may not be easy to restart programs and return to something resembling normalcy, said Ms. Dunn-Georgiou the president of Global Health Council, a membership organization of health groups. “It costs a lot to restart something, so I don’t think we really know yet if that’s even possible,” she said.   http://news.un.org/en/story/2025/02/1159901 http://www.ungeneva.org/en/news-media/press-briefing/2025/02/un-geneva-press-briefing-0 http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2025/february/20250201_us-funding http://news.un.org/en/story/2025/02/1160081 http://www.ipsnews.net/2025/02/tanzanians-with-hiv-left-in-crisis-as-u-s-aid-ends/ http://www.msf.org/uncertainty-around-pepfar-programme-puts-millions-people-risk http://www.gatesfoundation.org/ideas/media-center/press-releases/2025/01/pepfar-us-international-aid http://www.nytimes.com/2025/02/05/health/trump-usaid-pepfar.html http://frontlineaids.org/urgent-action-needed-to-safeguard-hiv-response-from-trump-administration-freeze/ http://www.unaids.org/en/resources/presscentre/featurestories/2025/march/20250320_debt-crisis Visit the related web page
	The health of one depends on the health of all by MSF, WHO, GI-ESCR, The Lancet, agencies   Jan. 2025   Pandemic prevention, preparedness and response: Proposals for action form The Elders.   The science is clear. The next pandemic threat is a matter of when, not if. There is a significant chance that a future pandemic could be some combination of more infectious, more likely to mutate and more fatal than COVID-19.   As we mark the 5th anniversary of COVID-19's declaration as a public health emergency, it is evident that lessons have not been learnt and most recommendations from independent expert panels have not been implemented.   This is a collective problem. We learned from COVID-19 that none of us are safe unless all of us are safe. Yet, humanity is struggling to put aside individual and national interests and act in our common interest. Some people and governments are actively turning against actions that would significantly reduce risks. How can we break through this impasse?   This paper examines six critical themes requiring action on the global pandemic reform agenda and concludes with targeted recommendations for each:   International attention and global leadership; A whole of society approach to pandemics; Equity, human rights and global solidarity; Sustainable financing; Disinformation and politicisation; The threats and opportunities of new technologies   Implementing these measures would significantly help break the cycle of panic and neglect while mitigating the impact of future infectious disease outbreaks.   These are not easy asks. They require a step change in prioritisation and financing and, above all, will require bold political leadership. But if leaders make the right decisions, the impact on the world’s pandemic preparedness will be momentous. That is what current and future generations demand of us.   http://theelders.org/PandemicPolicy   Aug. 2024   Recommitting to pandemic preparedness, by Gro Harlem Brundtland. (IPS Journal, agencies)   Four years ago, at the height of the Covid-19 pandemic, governments were scrambling to protect their populations and prevent an economic meltdown. No one would dispute that addressing this existential threat was the top political priority back then.   As a former prime minister and director-general of the World Health Organization, I was impressed by the coordinated international response to Covid-19. To be sure, there were large inequalities within and between countries, resulting in society’s most vulnerable paying too high a price, especially when it came to vaccine access.   But I saw reason to hope that the pandemic’s devastating impact would prompt a political sea change and lead to a greater commitment to future preparedness, prevention and response.   I was wrong. It is depressingly obvious that the lessons of Covid-19 are being forgotten. The world remains stuck in the familiar cycle of panic and neglect that has characterised this past pandemic.   Political leaders are largely ignoring current threats, including Covid-19 (which has not been consigned to the history books, despite no longer being a public-health emergency), H5N1 bird flu and dengue fever.   And new pandemics with potentially catastrophic outcomes will almost surely occur, especially as climate change and environmental degradation worsen.   Mpox and a new phase of neglect   These are not hypothetical risks. Exactly one week ago, WHO Director-General Tedros Adhanom Ghebreyesus declared the latest outbreak of mpox in East Africa a ‘public-health emergency of international concern’.   Not only must the international community now rally behind affected African countries and those at highest risk; it must also prepare itself for potential spread into more countries and across the globe.   Even before Covid-19 hit, I had been warning that our failure to break this vicious cycle was putting us at grave risk. In September 2019, the Global Preparedness Monitoring Board (which I co-chair) issued a report highlighting the acute risk of a devastating global epidemic or pandemic. Little did we know how prescient our warnings were.   And now we find ourselves in a new phase of neglect, which can only be understood as a failure of political will. For all the pious words uttered in the Covid-19 era, heads of state and governments are failing to address the inequalities that stymied recovery efforts.   It is unacceptable that rich countries have done so little to make the next pandemic response more equitable — and therefore more effective.   In June, for example, the 77th World Health Assembly failed to finalise a new pandemic accord, even though the Intergovernmental Negotiating Body (INB) had been working on the global pact, which aims to prevent a repeat of Covid-19, for two years. Member states have extended talks for up to 12 months.   But, crucially, they still seem unwilling to provide negotiators with the political support needed to agree on measures that can address inequities in pandemic readiness, response, and recovery.   The failure to find consensus on substantive matters is symptomatic of the growing trust deficit between advanced and emerging economies and of the ineffectiveness of the multilateral system in an era of deepening geopolitical tensions. But this cannot be an excuse to delay action on one of the biggest threats of our time.   The INB needs a new approach that enables maximum engagement from independent experts and civil-society organisations, while ensuring that member states stay focused on improving – instead of just paying lip service to – global equity.   Moreover, if the past four years have taught us anything, it is that WHO-led processes alone are not enough to tackle the existential threat of pandemics. Other multilateral institutions should take up the cause of improving preparedness.   The United Nations’ Summit of the Future in September, as well as the upcoming meetings of the G7 and the G20, must highlight the urgency of this challenge and encourage world leaders to act. More visible advocacy for global health security in these fora could be crucial in securing the political leadership and financing needed to bring about meaningful change.   To that end, the group of former political leaders known as The Elders support the adoption of an emergency platform – a set of protocols that would allow UN leaders to respond quickly to global shocks – at the Summit of the Future.   World Trade Organization members should also agree to review, as proposed by Colombia, the implementation of the agreement on ‘Trade-Related Aspects of Intellectual Property Rights’. The TRIPS agreement governs patent protection for vaccines and treatments and thus plays a key role in pandemic-response efforts.   Recommitting to pandemic preparedness is essential. But it also should be part of a broader revival of multilateralism. Only through compromise and collaboration can we confront humanity’s gravest challenges. © Project Syndicate   http://www.ips-journal.eu/topics/foreign-and-security-policy/recommitting-to-pandemic-preparedness-7721/ http://www.hrw.org/news/2024/09/09/who-pandemic-pact-risks-repeating-covid-19-failures http://www.msfaccess.org/pandemic-agreement-msfs-comments-selected-provisions-november-2024-draft http://www.msfaccess.org/pandemic-prevention-preparedness-and-response http://www.nature.com/articles/d41586-024-01658-5 http://tinyurl.com/7pb24ey5 http://www.oxfam.org/en/press-releases/oxfam-reaction-who-member-states-not-reaching-agreement-pandemic-treaty http://www.oxfam.org/en/research/open-statement-stop-spending-development-funds-profit-private-healthcare-providers   Mar. 2024   The Pandemic Treaty: shameful and unjust. (The Lancet)   The Intergovernmental Negotiating Body (INB), which is tasked under WHO with drawing up an international instrument on pandemic prevention, preparedness, and response, will sit for the 9th and final time from March 18–29. In the 2 years since it first met, hundreds of hours and unknown costs have been spent, but the political impetus has died.   The convention is now at a critical juncture: the final text for countries to ratify is due to be presented at the World Health Assembly in May. With only limited days of negotiation left and a long way to go to secure a meaningful agreement, it is now or never for a treaty that can make the world a safer place.   It is hard to remember sometimes, among the highly diplomatic and technical negotiations, but that is what this treaty is trying to do: to protect all people, in all countries, no matter how rich or poor, from harm.   As The Lancet went to press, a new publicly available draft text was awaited, but judging from the most recently available version, from October, 2023, the treaty will fail in this aim. Much of the language is greatly weakened from the initial ambition, filled with platitudes, caveats, and the term “where appropriate”.   A key recommendation from the Independent Panel for Pandemic Preparedness and Response, met with widespread support, was the need for a treaty that would “address gaps in international response, clarify responsibilities between States and international organisations, and establish and reinforce legal obligations and norms”.   At the heart of this recommendation was the need to ensure that high-income countries and private companies behave fairly, that they do not stockpile millions of excess doses of vaccine or refuse to share life-saving knowledge and products, and that there are mechanisms to ensure that countries work together rather than against each other.   These issues still represent the broad sticking points in current negotiations: access and benefit sharing (who gets what, how much, and when) and governance and accountability (to what degree are countries made to do something).   The word equity appears nine times in the October negotiating text, including as a guiding principle of the whole treaty. But in reality, Article 12 stipulates that WHO would have access to only 20% of “pandemic-related products for distribution based on public health risks and needs”.   The other 80%—whether vaccines, treatments, or diagnostics—would be prey to the international scramble seen in COVID-19 that saw vital health technologies sold to the highest bidder. Most of the world's peoples live in countries that might not be able to afford these products, but 20% seems to be all that high-income countries were willing to agree to.   This is not only shameful, unjust, and inequitable, it is also ignorant. Creating and signing up to a strong and truly equitable set of terms on access and benefit sharing is not an act of kindness or charity. It is an act of science, an act of security, and an act of self-interest. There is still time to correct this misjudgment.   Even the anaemic commitments of the agreement are in jeopardy. Independent monitoring of whether countries are complying with their commitments is essential for the efficacy and longevity of the treaty. Yet, as colleagues have pointed out, all indications suggest that the governance and accountability mechanisms of the treaty are being further undermined.   There is little in the way of clear enforceable obligations to prevent zoonotic disease outbreaks, implement One Health principles, strengthen health systems, or counter disinformation. Heads of states and the INB might not see pandemic governance as a priority now, but it is fundamental to the success of any agreement.   Creating a global convention acceptable to all is undoubtedly a challenge. The aims for a pandemic treaty are easy to articulate but many are difficult to enact and agree to. The INB might be doing its best, but ultimately it is the politicians of G7 countries who must put aside vested industry interests and finally understand that in a pandemic it is not possible to protect only your own citizens: the health of one depends on the health of all.   Millions of lives that could have been saved during the COVID-19 pandemic were not. Far from making amends, a handful of powerful countries are sabotaging the best chance to translate the lessons from the COVID-19 pandemic into legally binding commitments that will protect us all. The treaty is an opportunity that must not be squandered.   http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00410-0/fulltext http://www.thelancet.com/commissions/health-and-human-rights http://peoplesvaccine.org/resources/media-releases/pandemic-accord-hoax-highlights-hypocrisy/ http://peoplesvaccine.org/resources/media-releases http://www.msfaccess.org/what-look-out-pandemic-accord-intellectual-property-rights http://publicservices.international/resources/news/a-pandemic-treaty-is-empty-without-its-health-and-care-workforce?id=14887&lang=en http://www.icj.org/principles-and-guidelines-on-human-rights-and-public-health-emergencies-featured-in-new-documentary-film-and-blog-symposium http://www.icj.org/icj-and-other-human-rights-groups-draft-pandemic-treaty-fails-to-comply-with-human-rights/ http://www.ohchr.org/en/press-releases/2023/08/global-north-states-persistent-refusal-waive-covid-19-vaccine-intellectual   * The Global Initiative for Economic, Social and Cultural Rights (GI-ESCR) publishes a new policy brief entitled: ‘Transformative Policies to Realise Universal Access to Medicines. Why we Need Knowledge Commons and Public Options for Pharmaceuticals to Realise the Rights to Health and Science.’   The research frames universal access to medicines as a fundamental component of several human rights, including the rights to life, health, and science. However, as exemplified by stark inequalities in accessing COVID-19 vaccines, progress towards universal access to life-saving medicines is staggering. In this context, the policy brief argues that commercial models for researching, developing, manufacturing, and delivering medicines are limited when it comes to meet human rights goals:   http://gi-escr.org/en/resources/publications/transformative-policies-to-realise-universal-access-to-medicines-pub   Sep. 2023   Billions left behind on the path to Universal Health Coverage   The World Health Organization (WHO) has published the 2023 Universal Health Coverage (UHC) Global Monitoring Report, revealing an alarming stagnation in the progress towards providing people everywhere with quality, affordable, and accessible health care.   The report exposes a stark reality based on the latest available evidence – more than half of the world’s population is still not covered by essential health services. Two billion people face severe financial hardship when paying out-of-pocket for the services and products they needed.   "The COVID-19 pandemic was a reminder that healthy societies and economies depend on healthy people," said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.   "The fact that so many people cannot benefit from affordable, quality, essential health services not only puts their own health at risk, it also puts the stability of communities, societies and economies at risk. We urgently need stronger political will, more aggressive investments in health, and a decisive shift to transform health systems based on primary health care."   The 2023 report found that, over the past two decades, less than a third of countries have improved health service coverage and reduced catastrophic out-of-pocket health spending. Moreover, most countries for which data are available on both UHC dimensions (96 out of 138) are off-track in either service coverage, financial protection, or both.   “We know that achieving Universal Health Coverage is a critical step in helping people escape and stay out of poverty, yet there continues to be increased financial hardship, especially for the poorest and most vulnerable people,” said Dr Tedros Adhanom Ghebreyesus.   In 2021, about 4.5 billion people, more than half of the global population, were not fully covered by essential health services. And this estimate does not yet reflect the potential long-term impacts of the COVID-19 pandemic.   Catastrophic out-of-pocket health spending, defined as exceeding 10% of a household budget, continues to rise. More than one billion people, about 14% of the global population, experienced such large out-of-pocket payments relative to their budgets. But even small expenditures in absolute terms can be devastating for low-income families; approximately 1.3 billion individuals were pushed or further pushed into poverty by such payments, including 300 million people who were already living in extreme poverty.   Out-of-pocket health payments can also cause individuals to forego essential care and force families to choose between paying for a visit to the doctor, buying food and water, or sending their children to school. Such trade-offs can spell the difference between the early treatment of a preventable disease and, at a later stage, suffering severe illness or even death. Addressing this problem requires progressive health financing policies that exempt those with limited ability to pay for health services.   Achieving Universal Health Coverage by 2030 is crucial for realizing the fundamental human right to health.   To reach the goal of UHC, substantial public sector investment and accelerated action by governments and development partners are essential. Key actions include a radical reorientation of health systems towards a primary health care approach, advancing equity in health-care access and financial protection, and investing in robust health information systems.   http://www.who.int/news/item/18-09-2023-billions-left-behind-on-the-path-to-universal-health-coverage   Sep. 2023   Universal Health Coverage targets leave behind the most vulnerable, reports Medecins Sans Frontieres, Doctors Without Borders   UN member states have committed to achieving Universal Health Coverage (UHC) by 2030. This is defined as, “all people have access to the full range of quality health services they need, when and where they need them, without financial hardship”.   We speak to Dr Mit Philips, Medecins Sans Frontieres (MSF) senior advisor on health policies, to learn if these commitments are on track to becoming a reality.   How do you judge progress towards the UHC goal?   “Access to essential care today varies widely depending on where a person lives, who this person is, and what is his or her health need. A citizen in a well-equipped city has a completely different experience to someone from a vulnerable background when they need lifesaving surgery, prenatal care, a reliable supply of medicine for HIV or malaria; or when they need to pay for drugs for diabetes.   In that sense, health coverage today is nowhere near universal. MSF teams witness every day human tragedies caused by a lack of access to healthcare.   People living in vulnerable circumstances today face the most acute barriers in accessing care: people who cannot afford to pay for essential care, people facing a crisis situation, people excluded or discriminated because they’re migrants, refugees or socially marginalised people.   There is little attention being given to the most vulnerable in the current UHC agenda and country plans. The focus is on long-term plans and system change, but the crucial link to the direct response to patients’ health needs is missing. UHC needs to focus on measures that aid the most vulnerable people, who cannot afford to wait for theoretical plans to bear fruit.”   A patient in Port-au-Prince, Haiti: "I didn’t come to the hospital because there was fighting in the neighbourhood. The gangs didn’t allow anyone to pass. I contacted a nurse to have my wounds treated, but it was expensive... and I didn’t have money."   Universal Health Coverage means people should not suffer financial hardship to access healthcare. Has there been improvement in that regard?   “There are more people today at risk of falling into poverty because they have to pay for health services than in the year 2000. Poor and vulnerable households are more exposed to so-called ‘catastrophic health expenditure’.   In order to access healthcare, they have to sell goods, borrow money or reduce other important expenses for their family, such as food or education. This does not even account for the people who are forced to renounce seeking care because they know they simply cannot afford it. Too many people have to choose between illness or even death versus their family’s economic survival.   We have already pointed to the increased burden of user fees. Today, patients are forced to pay fees before they can get care, exemptions from payments are strongly limited, and in the UHC agenda there is still no concrete action proposed to make sure that those who need it most can access healthcare free of charge.   Grandmother of a patient in Lankien, South Sudan:   “We walked for five hours by foot to reach the closest place that offers hospital care. The people here only take their children to the hospital when they are extremely sick. The hospital is far, so many of them cannot even reach the hospital.”   Most UHC plans rely heavily on domestic resource mobilisation. But countries with the weakest health systems also tend to have the smallest tax bases. In most contexts where MSF works, public budgets for health have been undermined and suffer from austerity measures since the COVID-19 pandemic and the global economic crisis.   Patients already face gaps in essential medical supplies and services. At the same time, there is a reduction of international funding for health, with strong cuts in countries like South Sudan, Sierra Leone, etc.   This undermines strategies to ensure essential care free of charge. How can countries with crippling staff shortages and stock outs of essential medicines hope to provide UHC to their people?   To compensate for the losses in healthcare coverage and the increased precariousness of people, UHC plans need to urgently address financial access barriers. User fees should be abolished for essential care.”   Mother of a patient in Herat, Afghanistan:   "When my child was sick... the public clinic did not give us all the medication we needed. It was difficult to pay for transport to the city, that’s why we went to private clinics. Now my child is worse, and we owe a lot of money."   UHC is a pillar of the Sustainable Development Goal. Is the underlying promise to “leave no one behind” on track?   “Most country UHC-plans don’t just neglect the needs and vulnerabilities of migrants, asylum seekers, non-residents, or marginalised people; they often deliberately exclude these people from social protection schemes.   In some provinces in South Africa, migrant women and children are required to pay out-of-pocket for essential services, when paperwork cannot be shown immediately. In Belgium, asylum seekers are excluded from timely lifesaving hepatitis C treatment. Most European countries fail to provide preventive care such as vaccinations, and now epidemic outbreaks of vaccine-preventable illnesses are spreading among asylum seekers.   Secondly, the aspiring narrative of UHC is not translated and adapted to respond effectively to the needs of people affected by emergency situations. For example, even when increased funding is provided by international donors, the requirement to suspend user fees or to take measures to reduce other out-of-pocket expenses is missing.   It’s difficult to mobilise additional frontline workers and support them adequately. Bureaucratic hurdles block the rapid supply of medical items. We recommend that each UHC-country plan includes a specific chapter on what adaptations and extra interventions will be applied during crisis or emergency situations to ensure effective access to care.”   http://www.msf.org/universal-health-coverage-targets-leave-behind-most-vulnerable http://www.msf.org/urgent-measures-needed-address-gaps-universal-health-coverage-targets   * Marking The Lancet Medical Journal's 200th anniversary, this special issue features critical issues impacting health globally: http://www.thelancet.com/lancet-200   Sep. 2023   UN High-Level meeting on Pandemic Prevention, Preparedness and Response. (Reuters)   Health officials from around the world will gather to discuss a treaty addressing pandemic prevention in Geneva next week. The meeting is part of ongoing negotiations by the decision-making body of the World Health Organization to tackle pandemic threats in a legally binding accord. Representatives from as many as 194 member countries are planned to take part.   Ongoing discussions include access to funding to manage the costs of measures meant to address the risk of pathogens emerging from wildlife. Risk factors, many of which disproportionately affect the developing world, include deforestation, climate change, rapid urbanization and the wildlife trade.   Previous discussions on the proposed treaty, which began two years ago, have centered on preparedness of health systems. The discussions next week, by contrast, are meant to focus on prevention. Many health experts say that finding ways to stop potential pandemics before they can emerge is as crucial as any amount of readiness for when they do.   “We will see more pandemics and we will see more severe outbreaks if we don’t act on prevention,” said Chadia Wannous, a global coordinator at the World Organisation for Animal Health, a France-based intergovernmental body involved in the treaty discussions.   In May, Reuters published a global analysis of environmental risk factors associated with zoonotic spillover, the term used by scientists to describe a leap by a pathogen from animals into humans. Spillovers are the leading source of infectious diseases in humans. The pathogens that cause COVID-19, Ebola, Nipah and other deadly illnesses are caused by or closely related to viruses found in the wild, particularly among some tropical bats.   Reuters’ analysis found that the number of people living in areas at high risk for spillover, mostly tropical locales and undergoing rapid urbanization, grew by 57% in the two decades ending in 2020. Nearly 1.8 billion people, or one of every five on the planet, now live in these areas.   Since early in the COVID-19 pandemic, global health officials have sought to create a “pandemic treaty” to better prepare for future outbreaks. The governing body of the World Health Organization chose delegates from each of its six administrative regions worldwide to lead the negotiations. The delegates have met with representatives of member countries and are tasked with forging an agreement by May 2024.   But governments remain divided, failing to agree on some of the basics needed to strengthen health systems worldwide. Those basics, all issues that hindered a coordinated global response to the COVID-19 outbreak, include the sharing of information, costs and vaccines.   The divisions arose anew in June, when the European Union negotiated new agreements with pharmaceutical companies to reserve vaccines for future pandemics. The agreements led critics to accuse the bloc of “vaccine apartheid.”   “The trust between higher and low-income countries has plummeted,” said Lawrence Gostin, who is director of the WHO Collaborating Center on National and Global Health Law and involved in treaty discussions.   The disparity between rich and poor countries at present is noted in the very first paragraph of the proposed treaty to be discussed in Geneva. The draft cites “the catastrophic failure of the international community in showing solidarity and equity in response to the coronavirus disease.”   Despite broad consensus on the need for pandemic prevention, negotiators remain divided when it comes to specifics. Ahead of the meeting, according to officials interviewed by Reuters, the biggest sticking point remains financing for poor countries.   Already struggling for resources to strengthen their public health systems, governments of developing nations need more funds if they are to invest in prevention. That could include measures like improved surveillance for emerging diseases, efforts to combat deforestation and more oversight of development in areas that could be prone to new spillover.   At present, such measures are proposed in the treaty through a concept known as “One Health,” outlined by the WHO and other international agencies in a 2022 “ plan of action.” The concept links human wellbeing to that of animals and the environment. The United States and the European Union have both said they support the inclusion of “One Health” provisions in a pandemic treaty.   “Lower income countries don’t want to make obligations unless they get funding,” Gostin, of the WHO global health law center, told Reuters. “Higher income countries are resistant to guaranteeing funds.”   Nearly all of the highest-risk areas identified by the Reuters spillover analysis are in low- and middle-income countries across Asia, Africa and Latin America. But much of the deforestation and development in these areas is driven by demand for minerals, food and other raw materials among wealthier countries. The shared responsibility – not to mention the shared consequences – should mean shared expenditures, officials argue.   “It should be in everyone’s combined interest to find solutions, for it not just to be the problems or financial problems for low income countries,” said Maria Van Kerkhove, an infectious disease epidemiologist who is the head of the WHO’s emerging diseases unit. “We live in this interconnected world and any pathogen that emerges on one part of the planet could be in another within 24 to 48 hours.”   Sep. 2023   Lawrence Gostin’s Statement at UN High-Level Meeting on Pandemic Prevention, Preparedness and Response:   The “call to action” States make today in the Political Declaration are laudable, but aspirational, even empty in terms of hard commitments, funding, and action. The Political Declaration will be of little value if States fail to follow through with concrete mechanisms to promote solidarity and secure compliance.   What is most urgent is achieving a fairer, more equitable world, where lifesaving medical resources are affordable, available, and accessible everywhere. Fourteen million lives were lost to COVID-19. What we decide today, and in the negotiations for the Pandemic Accord and revised IHR, will determine whether we allow the same in the next pandemic.   During COVID-19, the lack of investment in health care systems and pandemic preparedness left health systems overwhelmed, and wealthier nations buying out the limited global supplies of lifesaving countermeasures.   Lower income nations were left reliant on charitable donations and aid, a model that proved unworkable and entirely inequitable. This was especially true in sharing vaccines and the knowledge and resources needed to produce vaccines.   States failed to comply with the even minimal obligations set out through the IHR, as well as with the recommendations set by the World Health Organization. It did little good to have well-intended norms that were not enforceable.   Today, the O’Neill Institute, a WHO Collaborating Center, makes three recommendations for States to maintain political momentum and solidarity for Pandemic Prevention, Preparedness and Response.   First, financing. We urge Heads of State and Government to sustainably and adequately fund pandemic preparedness and response with concrete pledges and targets. This requires full financial, political and technical support for new mechanisms for equitable access to lifesaving countermeasures.   Second, equity must be operationalized. Commitments to pandemic prevention, preparedness, and response should be universal but also cognizant of States’ varying resources and capacities. Lower-income countries, which often face compliance challenges, should be guaranteed financial, technical and other assistance.   Third, compliance with international law. States must agree on robust, transparent mechanisms for compliance and accountability. Heads of State and Government should provide full support for peer review mechanisms, and for an independent mechanism for monitoring the implementation of States’ commitments.   These mechanisms need not be punitive. Accountability mechanisms could identify compliance gaps, and link unmet obligations with financial and technical assistance. To build trust and transparency, accountability mechanisms could offer a formal role for civil society, and be located in the public domain.   If we fail to meet this historic moment through watered-down promises, and without bold commitments, it could be many decades before we regain the opportunity to make the world more secure from pandemics, for ourselves and for future generations. We have a great responsibility, and I urge us all to rise together to meet it.   http://oneill.law.georgetown.edu/publications/lawrence-gostins-statement-at-un-high-level-meeting-on-pandemic-prevention-preparedness-and-response/ http://www.ilo.org/secsoc/press-and-media-centre/news/WCMS_898190/lang--en/index.htm http://peoplesvaccine.org/resources/media-releases/ http://www.hrw.org/news/2023/10/31/covid-19-showcased-failed-global-cooperation http://www.project-syndicate.org/commentary/pandemic-prepardendess-response-un-agreement-lacking-concrete-solutions-by-joseph-e-stiglitz-2023-10   http://www.theguardian.com/society/2024/jan/21/arctic-zombie-viruses-in-siberia-could-spark-terrifying-new-pandemic-scientists-warn http://theindependentpanel.org/a-joint-letter-to-all-who-member-states-now-is-the-time-to-agree-on-a-pandemic-accord-which-safeguards-everyone-from-pandemic-threats/ http://www.gpmb.org/annual-reports/annual-report-2023 http://www.business-humanrights.org/en/latest-news/global-south-health-experts-call-for-uk-india-trade-deal-to-protect-access-to-medicines/ http://www.citizen.org/news/pfizer-spikes-paxlovid-prices-to-100-times-cost-of-production/ http://gi-escr.org/en/our-work/on-the-ground/un-continues-to-raise-concerns-on-private-actors-in-healthcare http://www.ohchr.org/en/press-releases/2023/08/global-north-states-persistent-refusal-waive-covid-19-vaccine-intellectual
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