This is an important week for Pandemic Prevention, Preparedness and Response and for the broader health agenda as world leaders have gathered at the United Nations General Assembly (UNGA) in New York to discuss a range of health issues including preparing for the next pandemic. A Coalition of Advocates for Global Health and Pandemic Preparedness who aim “to ensure increased and meaningful involvement of civil society and communities in the development and decision-making of these initiatives and to advocate for an integrated and holistic approach to pandemic preparedness that emphasizes equity, diversity, inclusion, global solidarity, and synergies of multiple existing global health programs” charge world leaders at the UNGA to step up and deliver a meaningful Political Declaration on Pandemic Prevention, Preparedness, and Response. They write in a guest essay in The Geneva Files (Switzerland): “Building on what we have, centering equity, diversity, and meaningful inclusion in our global and country-level PPPR architecture, strengthening community engagement, and sustainably financing global health are crucial to the world’s success. With a more equitable, inclusive, integrated, and well-funded system we can prevent outbreaks, prepare for inevitable threats, respond to pandemics, and work to end the epidemics of today.”
 
If You Are in a Hurry
 

• Read an opinion on PLOS Speaking of Health Blog that calls out the failure to integrate the three health-related UN political declarations.
• Read an important study in BMJ Global Health (UK) about the relationship between income inequality and HIV, AIDS, and COVID-19.
• Read a Lancet editorial that calls for breaking down health silos at the UNGA and notes an important TB prevention study.
• Read Michael Marmot in The Guardian on financing pandemic preparedness and response and other critical interventions.
• Read AP on efforts to link climate change and health issues.
• Read Bhekisisia on the promise of South Africa’s mRNA hub.
• Read The Lancet on what happened to the mpox pandemic and then read Reuters on how China plans to manage its growing mpox outbreak.
• Read Undark on why we should leave the bats alone.

 
More on the UNGA
 
In an opinion on PLOS Speaking of Health Blog, a group of global health experts write that the failure to integrate the UN political declarations — Universal Health Coverage (UHC), Pandemic Preparedness, Prevention and Response (PPPR) and Tuberculosis (TB) – is a missed opportunity. “Breaking down siloes requires more substantive and direct connections between policies and the lived experience of individuals and communities. The UNGA must offer a clear and feasible way forward to make the collective goals under the political declarations more attainable. Yet, the language of the high-level political declarations remains vague. This is a pivotal moment. The political declarations must connect the concepts of resilience, equity, and the common sense of well-equipped PHC systems directly to tangible resources and actionable steps. Saving lives requires political leaders to deliver on the high-level declarations and remain accountable to global communities. If they do not seize this opportunity, the effects will ripple for decades to come.”
 
Health Policy Watch (Switzerland) reports, “Despite the weaknesses of the political declaration on Pandemic Prevention, Preparedness, and Response (PPPR) expected to be adopted by the United Nations (UN) High-Level Meeting (HLM) on Wednesday, some world leaders believe that the UN is a more appropriate forum to thrash out the global pandemic response than the World Health Organization (WHO). Juan Manuel Santos, former President of Colombia and a member of The Elders, believes that the UN may be the better forum as “pandemic preparedness encompasses far more than health”.
 
Jeffrey Sachs and Henry B Perry write in The Lancet (UK), “The Political Declaration of the High-level Meeting on Universal Health Coverage, scheduled for Sept 21, 2023 at the UN, is high-minded and admirable. Nations will recommit to universal health coverage (UHC) as called for by Sustainable Development goal. However, the declaration will not mean much without a plan and financing to back it up. That's the real test ahead…. At a time when the world is in despair over great power conflict and tensions, the UN member states might just surprise themselves and a world in need by rising to the challenge of UHC. A few heads of state could mobilise their colleagues in all parts of the world to do the right thing at the upcoming UHC meeting. If so, they would surely look back on their success as among their finest moments.”
 
A Lancet (UK) editorial on the TB portion of the HLM notes, “There is little sense that these meetings are coordinated. Not only does this risk creating silos when cohesion is needed, but any calls to action on tuberculosis are likely to be lost among the clamour.” The editorial takes note of the RATIONS study, which “showed how providing a pack of food rations to household contacts of patients with tuberculosis in India can reduce incidence by 39–48%. Undernutrition is well established as a risk factor for tuberculosis, but nevertheless, this is a stunning result.” The Lancet editors conclude, “Provision of food is simple, cheap, and potentially beneficial for a range of outcomes beyond tuberculosis. RATIONS represents a different way of doing things that—if its lessons can be applied—gives some reason for hope in making progress on tuberculosis.”
 
Epidemiologist and co-chair of the Global Council on Inequality, Aids and Pandemics, Michael Marmot writes in The Guardian, “Financing pandemic preparedness and response is a key factor in a world where countries have highly unequal resources, whether for buying tests and vaccines or for the upgrades in health infrastructure that can deliver them to people. We are in a world in which lower-income countries, already in deep economic crisis from the pandemic, could be even less prepared for the next, with no plan to address their levels of debt, let alone access more funds to strengthen their health systems and tackle Aids and tuberculosis. Two serious efforts are needed: a clear commitment to a pandemic response fund that would be triggered when a pandemic is declared; and a major effort to address unequal access to financing – in the short term to remove the massive debt burden hampering many countries’ ability to invest in preparedness and in the long term so that lower-income countries have equal access to affordable credit in times of crisis.”
 
Read the Council Chairs’ Summary on Discussions of Pandemic Prevention, Preparedness and Response and the proposed Accord.
 
Linking Climate Change and Health
 
AP (US) reports, Trying to lessen climate change’s sweeping impact, experts are hoping that attempts to improve the sputtering global public health system and sometimes-stalled efforts to curb global warming through collaboration can combine — and create a better system for handling the problem along the way. Leaders of both the World Health Organization and the upcoming climate negotiations said Monday that for the first time, they are going to devote a day during December climate talks to public health issues. By concentrating on how climate change is causing death and disease, they hope, nations may act more on the root cause: carbon pollution.
 
The Promise of South Africa’s mRNA Vaccine Hub
 
As World leaders hash out the political response to pandemic preparedness, Bhekisisia (South Africa) notes world leaders “will today have one more chance to put measures in place to prevent the catastrophes that played out during the COVID-19 pandemic from being repeated…. The document, and also a more controversial and binding World Health Organisation (WHO) accord, which is still outstanding, tries to find ways to ensure medicines such as vaccines are distributed more equally between rich and poor countries.  One such way is for middle- and low-income countries to get help to start making their own medicines — which is exactly what the WHO’s mRNA hub in Cape Town is doing.”
 
BNN Network (Canada) reports on the annual meeting of the Developing Countries Vaccine Manufacturers Network. The meeting “was a significant step towards achieving the goal of equitable vaccine access through sustainable regional vaccine manufacturing. As the global community continues to grapple with the COVID-19 pandemic, efforts like these are critical to ensure that every country has the capacity and resources to protect its population from this and future health crises.”
 
SABC News (South Africa) reports on a speech by the South African Deputy President Paul Mashatile to the Developing Countries Vaccine Manufacturers Network. Mashatile said, “’The COVID-19 pandemic has shaken the foundations of our world, exposing vulnerabilities in our healthcare systems and the global vaccine supply chain. We have witnessed the devastating impact of this virus on our lives, our economies, and our communities. It has been a stark reminder of how inter-connected we are that and no one is safe until everyone is safe.’ Mashatile said as a continent, Africa has taken bold and decisive steps towards self-sufficiency in vaccine manufacturing and pandemic preparedness.”
 
What Happened to the Mpox Pandemic?
 
The Lancet (UK) looks at the state of the mpox pandemic, noting that “Mpox has not disappeared, neither from the high-income countries where the 2022 outbreak occurred, nor the African countries where the disease was and remains endemic. Multiple countries have had recent pockets of infection, but the numbers of weekly cases have usually been in single digits.” Researcher Marc Shamier is quoted, among other experts, on why mpox numbers are down. “Reflecting on the past year, the mpox epidemic has underscored the significance of open discussions about sexual health, particularly among groups with heightened sexual activity. The combination of awareness, willingness to alter sexual behaviours, uptake of vaccination, and seeking testing upon symptoms has undeniably played a pivotal role in combatting the outbreak.”
 
Reuters (UK) reports, “China plans to manage mpox in the same way it handles infectious diseases such as COVID-19 starting from Sept. 20, health authorities said on Friday, after detecting around 500 cases of the viral infection last month. Mpox will be managed under Category B protocols, the National Health Commission (NHC) said in a statement. Under this category, China could take emergency measures such as restricting gatherings, suspending work and school or sealing off areas when there is an outbreak of a disease. Category B infectious diseases currently include COVID-19, AIDS and SARS.”
 
Measles and Child Deaths in Sudan
 
Business Day (South Africa) reports, “More than 1,200 children have died of suspected measles and malnutrition in Sudan refugee camps, while many thousands more, including newborns, are at risk of death before year-end, UN agencies said on Tuesday…. Separately, some 3,100 suspected measles cases and 500 cholera cases have been reported across the country in the same period, along with outbreaks of dengue and malaria.…”
 
Dengue on the Rise in Central America and the Caribbean
 
CIDRAP (US) reports, The Pan American Health Organization (PAHO) recently posted an epidemiologic alert about a rise in dengue cases in Central America and the Caribbean regions, urging countries to review their response plans and step up surveillance ahead of the Southern Hemisphere's summer season. So far this year, about 3.4 million dengue cases have been reported in the Americas, exceeding the record 3.1 million cases recorded in 2019. Brazil by far has been the hardest-hit country in 2023, followed by Peru and Bolivia. Brazil has also reported the highest number of severe cases, followed by Colombia, Peru, Bolivia, and Mexico. So far this year, 1,612 dengue deaths have been reported in the Americas, putting the case-fatality rate at 0.05%.
 
Income Inequality and Pandemics
 
A study in BMJ Global Health (UK) looked at “the relationship between income inequality and HIV incidence, AIDS mortality and COVID-19 mortality.” The study concluded, “COVID-19 excess deaths, HIV incidence and AIDS mortality are significantly associated with income inequality globally—more unequal countries have a higher HIV incidence, AIDS mortality and COVID-19 excess deaths than their more equal counterparts. Income inequality undercuts effective pandemic response. There is an urgent need for concerted efforts to tackle income inequality and to build pandemic preparedness and responses that are adapted and responsive to highly unequal societies, prioritising income inequality among other social determinants of health.”
 
Endemic COVID-19
 
Dhruv Khullar writes in a comment in The New Yorker (US), “We can’t give up on education, communication, and persuasion—the essential tools of public health—but, for the time being, spending our limited political and financial capital on biomedical advances may be the surest path forward. The swift arrival of covid vaccines saved countless lives during the pandemic—a feat possible only because of the decades of research and development that preceded it. A rapid response to an emergency depends on the investments we make before it arrives; a smooth return to normal life requires sustaining them after it passes.”
 
Gain of Function Research Recommendations
 
CIDRAP reports, “The American Society of Microbiology (AMS) today released consensus recommendations on gain-of-function research into infectious agents with pandemic potential. The recommendations include internationally accepted definitions of terminology, greater transparency with the public, and stronger biorisk-management systems and oversight…. The report acknowledges that future pandemics of natural origin are inevitable. ‘Science is a key defense mechanism to protect us against and respond to pandemics,’ it concluded. ‘In the end, although the workshop did not discuss exactly what oversight is needed, it highlighted helpful recommendations for the scientific community and society to consider going forward.’"
 
Leave the Bats Alone
 
An opinion piece by two wildlife experts in Undark (US) references their recent publication in The Lancet Planetary Health in which they argue, “for a global taboo whereby humanity agrees to leave bats alone. People should not fear bats, and not try to chase them away or cull them; such actions would only serve to disperse them and increase the odds of zoonotic spillover. Based on the available science, we strongly believe that humanity simply needs to let bats have the habitats they need and live undisturbed…. This would not only lower the chances of another pandemic but would allow the world’s diverse bat species… to continue to provide a range of incredibly important benefits.”