Focus on Climate & Health + so much more
H5N1, MSF Access Campaign Controversy & New MPOX strain
Dear Friend of Global Health Conversations,
A new week is (almost) upon us. And despite having plenty to talk about in the Fortnight in Resources below, the whacky weather in both the northern & southern hemispheres served as a reminder to me to highlight the urgency of addressing and acknowledging the role that climate change plays in health.
But first - how has your fortnight been? We’ve had the South African, Indian, UK, France (I learned a new French word this week: dédiabolisation), etc. elections and their respective fallouts. As well as the Euros. I found myself talking politics a lot. Defending my personal, fiscal positions on certain topics, and so on.
I also, rather controversially, supported both Switzerland and England, respectively, with the utmost vigour in their matches last weekend. Expectedly, it all came to a head this weekend when I had to make a choice: England vs Switzerland. It was a good game and I watched it in Geneva in the company of an international group of fun folks from global health, health tech & adjacent industries; all supporting Switzerland. Except me. I was for England all the way. (Just this once 😉)
It was all good fun and the conversation enthusiastically turned to local manufacturing of vaccines. So much has happened this fortnight - but I’ve focussed on three main issues below in the FiRs.
Finally, Friend, I would like to thank you wholeheartedly for reading and for being here with me this fortnight. I like to punctuate this letter portion with some lighthearted delights. Nevertheless, among those reading, there will be, inevitably, one or two reading this who don’t feel as though the fortnight has been delightful at all. In fact, in this moment, perhaps nothing feels terribly delightful. But for some reason you opened this email and have read through the ‘bantery bit’ to this point. For you, I have a song - Louis Armstrong. One that I listen to when I feel less than delightful. And my hope for you is that the morning will bring light.
Best,
Christiana
Why Addressing Climate Change is So Urgent for Health
Climate change is one of the biggest health threats facing humanity. It impacts health through air pollution, disease, extreme weather events, forced displacement, food insecurity, and mental health pressures. Environmental factors cause approximately 13 million deaths annually.
Increased Respiratory Conditions
Rising temperatures and air pollution levels exacerbate respiratory conditions, leading to higher incidences of asthma, bronchitis, and other respiratory illnesses due to increased ground-level ozone and particulate matter.
Expansion of Vector-Borne Diseases
Warmer temperatures and altered weather patterns create favourable conditions for vectors like mosquitoes, expanding the range and transmission of diseases such as malaria and dengue.
Impact of Extreme Weather Events
Hurricanes, floods, and droughts disrupt healthcare services, damage infrastructure, and increase the burden on emergency services.
Health Risks from Heatwaves
Heatwaves pose severe risks to vulnerable populations, leading to heat stress, dehydration, and exacerbation of some cardiovascular and respiratory diseases. These conditions disproportionately affect the elderly, children, and those with pre-existing health issues.
Waterborne Diseases and Sanitation Challenges
Climate change undermines access to clean water and sanitation, increasing the prevalence of waterborne diseases such as cholera. Extreme weather events further compromise clean, safe water quality and availability.
Food Security and Malnutrition
Climate change affects agricultural productivity, leading to food insecurity and malnutrition. Disruptions in food supply chains due to extreme weather events and shifting growing seasons heighten the risk of hunger and undernutrition. (Did you ever see this video from 2021? This project, called COVID Confessions, interviewed farmers in the US to learn their insights)
Economic Burden of Climate-Induced Health Problems
The economic impacts of climate-induced health issues include increased healthcare costs, loss of productivity, and long-term economic instability. For instance, air pollution from fossil fuels resulted in $2.9 trillion in health and economic costs in 2018.
Health Benefits of Climate Action
Meeting the Paris Agreement goals is projected to be able to potentially save approximately one million lives per year by 2050 through reduced air pollution. Preventing the worst climate impacts could avert 250,000 additional deaths per year from malnutrition, malaria, diarrhoea, and heat stress between 2030 and 2050.
Impact of Carbon Emissions from Transportation
Transportation accounts for about 20% of global carbon emissions. Alternatives like walking and cycling can be beneficial - reducing emissions and offering health benefits such as reducing the risk of chronic diseases and improving mental health. But remember, we need to be realistic and make sure that urban infrastructure can accommodate this appropriately. Not only traditional physical infrastructure but we need to realise that almost all women do not and cannot feel entirely safe walking or cycling after certain hours. A reality of life.
Impact of Food System sustainability
Food production, packaging, and distribution generate one-third of greenhouse gas emissions. Sustainable agricultural practices can mitigate climate impacts, support healthier diets, and prevent up to 11 million premature deaths annually.
Global Health Inequities
Climate change disproportionately affects LMICs, exacerbating health inequities. These regions face higher vulnerability, oftentimes weaker health systems especially in the case of LICs, and greater exposure to climate-related health risks.
Urgency of Immediate Action
Immediate action is necessary to prevent further health crises, reduce mortality and morbidity, protect vulnerable populations, and avoid overwhelming healthcare systems. The longer we delay addressing climate change, the more severe and irreversible the health impacts will be.
(Read more: here, here, here, here too, and here, this is a good one from Lancet Climate & Health, this too but from 2022, (I consulted many sources) including this as well from WHO - nice roundup & e-mail me if you’d like more)
This is the meat and gravy part of this newsletter. And I encourage you to give it a good skim.
1. H5N1 - Bird Flu update: Cases, Causes, Risks & Fatalities
Listen to this great podcast I heard this week wherein Dr Rick Bright discusses the dangers, nuances and risks of H5N1. Dr Rick Bright (requiring no introduction tbh) is someone who I respect a great deal, a virologist specialised in this particular disease, the former director of BARDA and someone I feel very privileged to have met and worked with in a professional capacity on a handful of occasions. I cannot think of anyone better, therefore, to outline this topic. But I’ll give it a go now 🙂.
As of this Friday, H5N1 continues to circulate primarily in avian populations, but sporadic human infections underscore the zoonotic potential of the virus. In Cambodia, a three-year-old boy was recently diagnosed with H5N1, marking the sixth human case in the country this year. The boy had direct contact with dead poultry, a common risk factor for transmission in affected regions. (Where in the US, contact with widely affected livestock seems to be the primary mode of exposure and transmission.) Of the six cases in Cambodia, five involved children, and one case resulted in a fatality. The virus has high pathogenicity and it is evolving rapidly - even in just one generation.
In the United States, the fourth human case of H5N1 in 2024 was reported in a Colorado dairy worker, who exhibited only ocular symptoms and has since recovered following antiviral treatment. This case is part of a broader outbreak affecting dairy cattle in the region, with significant implications for both animal and public health. Monitoring efforts have been intensified, with over 780 individuals screened for symptoms and 53 tested for the virus.
A major challenge in controlling H5N1 continues to be the lack of specific, commercially available diagnostic tests. Current testing capabilities are limited, relying on general influenza diagnostics that cannot distinguish H5N1 from other subtypes. This is an important and unfortunate diagnostic gap. Nucleic acid-based tests remain the gold standard for detecting influenza viruses due to their sensitivity. However, these require significant laboratory infrastructure, which is not easily available everywhere. And there are numerous reasons and economic forces that can make both employers and patients reluctant to carry out regular tests. Rapid antigen-based tests, while useful for broader influenza surveillance, lack the specificity needed for H5N1 detection. We urgently need to develop and deploy specific, scalable diagnostic tools for H5N1. This is the heart of the R&D for pandemic preparedness discussion. We cannot continue to wait until the very last moment to develop appropriate therapeutics, diagnostics and vaccines. (And there are many orgs working on this critical R&D side of pandemic preparedness to make this possible in ways we can discuss at length another day. But they, too, need to be funded appropriately. And the further we get from COVID and our collective memory of what could happen, my concern is that this funding will ultimately be insufficient for global needs.)
In response to H5N1, various agencies are ramping up their preparedness efforts. The U.S. has entered into a $176 million contract with Moderna to develop mRNA-based vaccines for H5N1, with trials expected to begin in 2025. Additionally, 4.8 million doses of another H5N1 vaccine are anticipated to be ready by mid-July 2024, pending FDA approval. Now, do you remember a few fortnights back when I broke down the Q1 pharma financials across the sector? The tanking of BioNTech and Moderna was pretty predictable. But Moderna are doing something interesting at present that brings me back to thinking about the role of the absolutely vital role of the private sector as part of ensuring and securing global health outcomes where appropriate incentives are in place. As a slight aside, Moderna are developing a combination vaccine against influenza and SARS-CoV-2. Moderna’s Phase 3 trial of mRNA-1083 showed higher immune responses in adults 50+ than existing vaccines. I just feel that if industry is sufficiently incentivised (alongside everyone else, including academia) we can move faster in making sure that appropriate treatments, diagnostics and vaccines are available, full stop. Not in every case, but in many.
Enhanced surveillance and biosecurity measures are being implemented, particularly in high-risk sectors such as poultry and dairy farming. These measures include stricter controls on farm access, improved hygiene protocols, and increased testing of both animal and human populations at risk of exposure. But experts have remarked that these are not enough. With a 56% mortality rate according to WHO, I am not saying we ought to be afraid, far from it - I am just saying that we need to be both active and very concerned.
(Read more: here (FIND), here (CDC), here & here (Guardian))
2. Controversy brews: MSF’s Access Campaign Closes
There are controversies and there are Controversies. At the present moment, this is a Controversy. But I believe enough in the power, unity, priorities and goodwill of the sector at large to feel that this will eventually, and hopefully meet a positive outcome. Whatever that might be. :) For now - here’s the story.
On June 30, 2024, Médecins Sans Frontières (MSF) officially ended its Access Campaign, sparking a flurry of controversy and debate within the global health community. The decision has been met with a mix of disappointment, criticism, and concern, particularly from those who have long admired the campaign’s tireless efforts to improve access to essential medicines, vaccines, and diagnostic tools in low- and middle-income countries.
The MSF Access Campaign, launched in 1999, was established with a clear mission: to push for access to, and the development of, life-saving and life-prolonging medicines, diagnostics, and vaccines for patients in MSF programs and beyond.
(Image source: MSF)
Personally, my interactions with MSF have always shown their clear position strongly in favour of access. I hope that no-one will take exception to my remarking that their dedication to access sometimes positions them as so radically pro-access and willing to express this to industry in ways that many orgs don’t always do. I think this is so necessary and admirable within the Global Health Landscape.
The decision to close the Access Campaign has been described by critics as short-sighted and detrimental to global health equity. MSF plans to replace the campaign with a new unit focused more narrowly on the direct needs of its field operations, rather than broader policy advocacy. This shift, according to MSF leadership, aims to better align with the organization's primary humanitarian mission.
The announcement has prompted a robust response. An open letter from TAG expressed shock and grief, emphasizing the Access Campaign's pivotal role in reshaping global and national health policies to overcome systemic barriers to access. Similarly, a letter from FIND, a global alliance for diagnostics, underscored the Access Campaign's importance in advocating for the health needs of vulnerable populations and supporting regional manufacturing capabilities for diagnostics. FIND urged MSF to reconsider its decision, stressing the ongoing critical need for the campaign's expertise and advocacy in achieving universal health coverage and pandemic preparedness. Medicines Law & Policy, an advocacy group, also condemned the closure, noting that it would result in a significant loss of institutional knowledge and expertise. Dr. Mariângela Simão, former WHO Assistant Director-General for Access to Medicines, and former New Zealand Prime Minister Helen Clark, among other prominent figures, have joined the call for MSF to maintain its Access Campaign.
The decision has also faced internal criticism within MSF. Former leaders of the organization, including past international presidents and executive directors, have expressed their opposition. They argue that the closure represents a shift towards a more technocratic and inward-focused MSF, neglecting the broader political and systemic issues that influence access to healthcare. Critics fear that this move will weaken the organization's ability to advocate effectively for global health equity and hold pharmaceutical companies accountable
MSF has defended the decision, stating that the new structure will better support their medical humanitarian operations by focusing on the immediate needs of the communities they serve. They argue that this reorganization will enable more effective and tangible improvements in access to healthcare products. However, critics remain unconvinced, citing the lack of a clear strategic plan for the new unit and concerns over the potential loss of the campaign's broader advocacy role.
There is a lot more I could say about MSF here. Positive things from the fortnight like this RE South Africa & J&J (long time readers will remember this saga) and this. But this has been long. I’ll say this: you know you’ve been doing good work when such a backlash emerges in response to ceasing those good works. (shrugs)
(Read here: Open letters from the Treatment Action Group, FIND, Medicines Law & Policy, External criticism, Internal criticism as well as the organisation’s justification for their decision. (And yes, I briefly consulted the Lancet for good measure))
3. This one: New strain of Mpox - death toll, threats & more
A lot of my background data came from South Africa. In part, perhaps because I’m partial to my country and the algorithm knows it. But perhaps also because globally, South Africa is particularly good at publishing and sharing data (pathogen data, genomic sequence data, public health data, etc etc.) Despite being inadvertently slapped on the wrist for this practice in the past. Nevertheless, I wrote this based on international sources.
V. Alarming IMO. The new strain of the mpox virus, designated Clade Ib, has emerged in the DRC, posing significant health risks and raising alarms internationally. The strain, identified in April 2024, has shown increased transmissibility and virulence compared to previous strains, leading to higher mortality rates and widespread concern among global health officials. Like H5N1, the Mpox virus is rapidly mutating.
The outbreak has been particularly severe in the eastern DRC. In the mining town of Kamituga, hundreds of cases have been reported, including infections among sex workers, schoolchildren, and healthcare workers. This town is believed to be the epicentre of the outbreak, with the first cases traced back to September 2023.
Mpox is a viral infection causing flu-like symptoms and characteristic pus-filled lesions. This strain has also been linked to high rates of miscarriages among infected pregnant women. The virus is spreading through both sexual and non-sexual contact.
The World Health Organization (WHO) has reported nearly 8,000 cases in the DRC this year, with 384 deaths, half of which were among children under 15. The potential for international spread is significant.
In the DRC in particular, some issues around limited access in the relevant regions outside the capital has exacerbatesd the crisis. Researchers and health officials are urgently calling for increased surveillance, contact tracing, and potential deployment of smallpox vaccines among high-risk groups, despite uncertainties about their effectiveness against the new strain.
Cases of mpox have made it to South Africa, too. There are currently 20 cases and the death toll since May 2024 has reached three. Of the 20 reported cases in SA, 15 individuals have recovered, while five remain hospitalized. Some of these hospitalizations are due to severe health complications exacerbated by underlying conditions and co-morbidities such as HIV.
The global health community should remain on high alert. It is vital to emphasize the need for swift and coordinated action to prevent the new Mpox strain from becoming another widespread health crisis. In my mind, it echoes fears and recollections of HIV in the early 2000s. Undoubtedly, there are cases of Mpox in other regions too. Not all of which might be recorded in data. The DRC is geographically very, very far from South Africa. Particularly from KZN, Cape Town, Joburg and Pretoria where this fortunately very small number of cases have been detected. It is no secret that the world took HIV particularly seriously when it came to affect populations in the US - despite the slightly marginalised nature, at the time, of the population of Americans and Europeans affected. Mpox is a different beast. I might be taking liberties here; but I feel strongly that as a global community across Pharma, Biotech and Global health; we need to take this new strain of Mpox very seriously; as some quarters fortunately already are. Let’s talk about Mpox, bring it up in meetings, bring it up to policy makers and remember the fact that this rapidly mutating virus will continue to mutate. Likely faster than we are able to develop more specific and appropriate therapeutics for it.
(Read more: here (Guardian), here (Economist), here (BBC) & here)
Behind the scenes:
Despite my lovely fortnight: watching the games, having a delightful girl dinner with a friend, spending some time back in Lausanne and attending a wonderful birthday celebration of a dear friend in a gorgeous converted abbey north of Lausanne with a fantastic vegetarian menu; this issue was far too long to include a postcard. So I have something else this fortnight. :)
Some off-topic ‘Wee Wins of the Week’:
Listened to this great podcast episode: Dr Rick Bright discussing H5N1 (recommended)
I filed my taxes (on time!) 🙈
Past Episode - In case you missed it! 💃🏾
Back in March, I spoke to Dr Ema Prohić about oral health as a public health issue. Discussing system challenges, incentivisation and disincentivasation, dental caries as the most common infectious disease, bacteria and the use of antibiotics. I was particularly surprised by the extent to which antibiotic use in the dental sector has an impact on excess use of antibiotics and; by extrapolation, the rise of antimicrobial resistance. It was a very interesting conversation and I recorded a little Behind the Scenes video during our call (below).
If you missed the episodes; here they are: Part 1 & Part 2.
This is another great and informative edition Christiana! Thanks so much for sharing and pulling such useful information together. Always enjoy receiving this - they're so well researched and written. Louis Armstrong also a nice touch - always loved this song!