WHO Director-General’s opening remarks at the Regional Committee side event on Fighting Substandard and Falsified Medicines in Africa: A Collaborative and Integrative Approach – 23 August 2022

Your Excellency, Minister Mijiyawa,

Your Excellency, Minister Mainassara,

Your Excellency, Minister Ngamije,

Directeur-General Amalvy,

Excellencies, dear colleagues and friends,

Bonsoir, cher collègues et amis,

I thank the Government of Togo for hosting this important event, and for your leadership in addressing the threat of substandard and falsified medicines.

The magnitude of this problem, and its damage to both lives and to economies, is immense.

At best, these medicines fail to treat or prevent disease, wasting precious resources and exploiting the hopes and fears of vulnerable people.

At worst, they kill, and fan the flames of drug resistance, putting all of us at risk.

WHO estimates that more than one in ten medicines in low- and middle-income countries is either substandard or falsified.

We estimate that substandard or falsified antibiotics to treat pneumonia in children under five-years-old result in anywhere from 72,000 to 169,00 deaths each year.

Similarly, bad antimalarials are estimated to lead to anywhere from 31,000 to 116,000 deaths in sub-Saharan Africa each year.

Other examples include falsified cholera vaccines, leukaemia drugs that contain simply paracetamol, and faulty diabetes medicines that cause patients to suffer hypoglycaemia.

At the same time, low- and middle-income countries are estimated to spend more than 30 billion US dollars annually on substandard and falsified medicines.

This is not only public money that is being thrown away, it is being used on products that cause harm to the populations they are supposed to help.

Substandard and falsified medical products can be found in illegal street markets, via unregulated websites, and even in pharmacies, clinics and hospitals.

The WHO Global surveillance and monitoring system, which has been in place since 2013, has issued more than 70 global alerts to date.

Many of these alerts have been issued in Africa.

Last year alone, we issued eleven alerts, including five for COVID-19 products.

How can countries prevent, prepare for, and respond to public health emergencies if they cannot trust their own medicines and medical supplies?

There are several reasons for the proliferation of substandard and falsified medicines.

First, a lack of access to affordable efficacious and safe medicines forces desperate people to buy medicines from unreliable sources.

Second, a lack of good governance allows corruption to penetrate health systems and leaves loopholes for criminal groups to exploit.

Third, a lack of technical capacity undermines the integrity of supply chains and limits the ability of countries to safeguard the health of their people.

Stopping the scourge of falsified and substandard medical products requires working across sectors locally, nationally and internationally, and working closely with the private sector.

Law enforcement, through regulatory oversight by mature national regulatory authorities, and international cooperation are indispensable to stopping the flow of these faulty products, which undermine public health.

The COVID-19 pandemic highlights the importance of sharing information and collaboration within global supply chains, including the false information spread by criminal organizations.

WHO has been working to combat substandard and falsified medicines for many years.

Together with our Member States, WHO has developed a comprehensive strategy to prevent, detect and respond to substandard and falsified medical products.

This strategy includes 12 actions, from education to border control, from supply chain integrity to transparent legal processes.

This is complimented by the Lomé Initiative, in which African leaders committed to put falsified and substandard medicines on the highest political agenda.

WHO works closely with countries in Africa to strengthen national regulatory authorities and support local production of quality medical products, to prevent the use of falsified and substandard medicines.

The sharing of data from national regulatory authorities is critical to our joint efforts to stop the trade in these illicit, dangerous products.

We must change the common mindset that reporting on these bad medical products reflects negatively on countries.

We cannot stop this problem if we hide it, or pretend it’s not there.

WHO supports our Member States to shift this paradigm, so that high-levels of reporting are seen not as a failing, but as an indicator of an efficient response to the problem.

The Brazzaville Foundation is making an important contribution to this effort by auditing existing legislation related to substandard and falsified medical products.

Such strategic intelligence will inform our work in promoting appropriate legal tools and public health interventions.

As you know, WHO does not have a mandate to enforce criminal penalties, but we welcome collaboration with national institutions that can bring legal action against the producers and distributors of these damaging products.

With the Lomé Declaration and our continued work today, African leaders have sent a clear message that they will fight falsified and substandard medicines aggressively and urgently.

But remember, our biggest challenge is ensuring people have access to high-quality, affordable medicines.

After all, substandard and falsified medical products only exist because access to quality and affordable medicines does not.

By taking focused, concerted action, we can remove the market opportunity for substandard and falsified medicines. The new African Medicines Agency, which will be hosted in Rwanda, will play a critical role in this effort.

Thank you all once again for your attention and commitment to this serious public health threat.

Our sisters and brothers on this continent deserve nothing less than the highest quality medical products, and that is what we must work towards.

Working together, we can build a healthier, safer, and more prosperous Africa for all.

I thank you. Merci beaucoup.

Source: World Health Organization

Joint statement on the attacks in Al Hasakeh and Al Bab

Source: Damascus, 20 August 2022 – The United Nations Resident Coordinator and Humanitarian Coordinator for Syria, Mr. Imran Riza, the Regional Humanitarian Coordinator for Syria, Mr. Muhannad Hadi and the UNICEF Regional Director for the Middle East and North Africa, Ms. Adele Khodr express their deep concern about the continuing escalation of hostilities in northern Syria.

The attack on 18 August in Al Hasakeh claimed the lives of four women and girls and injured 11. On 19 August, the attack on a market in Al Bab city reportedly killed 13 civilians, including four boys and one girl, and injured a further 38 people, including nine children.

These terrible tragedies once again show that civilians, many of them women and children, continue to suffer the effects of ongoing hostilities in parts of Syria. We urge all parties to take all feasible measures to minimize harm to civilians and abide by their obligations to protect civilians. The UN in Syria offers its sincere condolences to the families of the victims and wishes the injured a speedy recovery.

The UN is committed to work with all stakeholders towards a peaceful and prosperous Syria, including advocating for a sustainable political solution for all Syrians. Ensuring the protection of civilians is paramount for a future where Syrians can rebuild their lives and live without fear of violence.

Source: UN Children’s Fund

African Union and WHO urge swift action against childhood tuberculosis

Lomé, 24 August 2022 – The African Union and the World Health Organization (WHO) today called for immediate and comprehensive measures to end the significant toll of tuberculosis among children in Africa. The appeal was made jointly with the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) and the Stop TB Partnership on the side-lines of the Seventy-second session of the WHO Regional Committee for Africa in Lomé, Togo.

The African region is home to 17 of the 30 countries with the highest tuberculosis burden globally and accounts for around 322 000 children and young adolescents (aged 0—15 years) or a third of tuberculosis cases among those under 15 years of age worldwide. Of particular concern is that two-thirds of children in the region are unreported or undiagnosed for the disease, leading to an increased risk of rapid disease progression and mortality, especially in younger children. Among children under five just around a third (32%) are diagnosed – the smallest proportion globally.

The low detection of tuberculosis arises from challenges in specimen collection as well as bacteriological confirmation of the disease among children who can display non-specific clinical symptoms that overlap those of other common childhood diseases. Additionally, children and young adolescents usually access primary health care or child health services in facilities where the capacity to diagnose for tuberculosis is often limited.

Worsening the impact of tuberculosis is malnutrition. Globally,19% of all tuberculosis cases are associated with malnutrition.

“Childhood tuberculosis doubled with malnutrition poses major health challenges in the ‎African Union Member States,” said H.E Minata Samate Cessouma, Commissioner for Health, Humanitarian Affairs and Social ‎Development, African Union Commission. “Undernourished children with tuberculosis are susceptible to developing ‎extensive and severe complications. There is an urgent need for innovative interventions to integrate ‎tuberculosis diagnosis in nutrition programmes to identify the disease ‎in children quickly.”

“The epidemic of tuberculosis among children in Africa has been occurring in the shadows and has until now been largely ignored. We hope this call will galvanize action and ensure no child in Africa is lost to a disease which in many parts of the world is now history,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “Strong political leadership, accountability, financial support and global solidarity are critically needed to increase access to effective diagnostics, medications, vaccines and other tools for tuberculosis control.”‎

At the side event, Towards political leadership to end childhood tuberculosis by 2030, the African Union, WHO, EGPAF and Stop TB Partnership also called for swift measures to accelerate recovery from the impact of COVID-19 and urged countries to facilitate the scale-up of child-friendly tuberculosis diagnosis, treatment and care.

“One child dies of tuberculosis somewhere in the world every two minutes even though tuberculosis is curable and preventable. Children with tuberculosis are almost never spreading the disease and are always infected by an adult, so their suffering is a metric of our failures to diagnose and treat tuberculosis in children,” said Dr Lucica Ditiu, Executive Director of Stop TB Partnership. “We call on all our partners to be committed, united and learn from our achievements and mistakes to ensure that an airborne disease hundreds of years old like TB is not a threat for the generations to come,”

Under the WHO End TB Strategy, countries should aim to reduce TB cases by 80% and cut deaths by 90% by 2030 compared with 2015. The strategy also sets key milestones that countries should cross by 2020 and 2025 if they are to end the disease.

The 2020 milestone sought a 35% reduction in tuberculosis deaths and 20% decline in cases. Only six countries with high tuberculosis burden met the 2020 case reduction milestone and just six achieved the target to reduce deaths by 35%.

“Ensuring we meaningfully invest in the tools and technologies needed to respond to the tuberculosis pandemic, guarantees that the global health community can save the lives of thousands of people living with or at risk for tuberculosis infection. However, should we fail to prioritize children and adolescents in these efforts, we will ultimately fail at achieving our goal of realizing a future free from tuberculosis,” said Chip Lyons, President and Chief Executive Officer of EGPAF.

The partners called on African countries to prioritize funding for tuberculosis prevention and control and allocate sufficient financial, technical and human resources to accelerate progress towards ending the disease in children and adolescents. Currently, investment and funding for tuberculosis control in Africa remains low, jeopardizing the efforts to meet the global target of ending the disease by 2030. The African region requires at least US$ 1.3 billion for tuberculosis prevention and treatment every year, yet countries contribute 22% of the needed budget while external funding accounts for 34%. The rest of the budget remains unfunded.

Source: World Health Organization

Horn of Africa Drought: Regional Humanitarian Overview & Call to Action | Revised 24 August 2022

The Horn of Africa is Facing its Worst Drought in More than Four Decades

Communities in the Horn of Africa are facing the threat of starvation following four consecutive failed rainy seasons in parts of Ethiopia, Kenya and Somalia, a climatic event not seen in at least 40 years. The October-December 2020, March-May 2021, October-December 2021 and March-May 2022 seasons were all marred by below-average rainfall, leaving large swathes of Somalia, southern and south-eastern Ethiopia, and northern and eastern Kenya facing the most prolonged drought in recent history. The March-May 2022 rainy season was the driest on record in the last 70 years—making the 2020-2022 surpass the horrific droughts in both 2010-2011 and 2016-2017 in duration and severity—and forecasts indicate that the October-December 2022 rainy season is also likely to fail.

An Unprecedented Emergency is Ravaging Drought-Affected Communities

Across the Horn of Africa, at least 36.1 million people have now been affected by the drought which began in October 2020, including 24.1 million in Ethiopia, 7.8 million in Somalia and 4.2 million in Kenya. This represents a significant increase from July 2022 (when an estimated 19.4 million people were affected), reflecting the impact of the drought in additional geographic areas of Ethiopia, as well as the rising needs in Somalia.

At least 20.5 million people are already waking each day to high levels of acute food insecurity and rising malnutrition across Ethiopia, Kenya and Somalia, and this figure could increase to between 23 and 26 million by September 2022, according to the Food Security and Nutrition Working Group (FSNWG). In Somalia, 7.1 million people are now acutely food insecure—including over 213,000 people in Catastrophe (IPC Phase 5)—and eight areas of the country are at risk of famine between now and September 2022, with Bay and Bakool regions of particular concern. About 9.9 million people in Ethiopia and some 3.5 million people in Kenya are severely food insecure due to the drought.

Over 8.9 million livestock—which pastoralist families rely upon for sustenance and livelihoods—have died across the region, including 3.5 million in Ethiopia, 2.4 million in Kenya and over 3 million in Somalia, according to the latest FSNWG Drought Special Report. Consequently, children have less access to milk, negatively affecting their nutrition. Across the three countries, malnutrition rates are alarming: about 4.6 million children are acutely malnourished, including about 1.3 million who are severely acutely malnourished. In Ethiopia, nearly 2.2 million children under age 5 are acutely malnourished, including nearly 705,000 who are severely malnourished. In Kenya, about 942,500 children aged 6-59 months are affected by acute malnutrition and need treatment, including 229,000 severely malnourished, and in Somalia, an estimated 1.5 million children under age 5 face acute malnutrition, including 386,400 who are likely to be severely malnourished, according to IPC.

Food prices are spiking in many drought-affected areas, due to a combination of macro-economic challenges, below-average harvests and rising prices for food and fuel on international markets, including as a result of the war in Ukraine. In Somalia, staple food prices in drought-hit areas have surpassed the levels recorded during the 2017 drought and the 2011 famine, according to WFP’s price monitoring. In Ethiopia, the cost of the local food basket increased by more than 33 per cent between January and June 2022, according to WFP. Soaring prices are leaving families unable to afford even basic items and forcing them to sell their hard-earned properties and assets in exchange for food and other lifesaving items. There are also repercussions for food for refugee programmes, which are already impacted by reduced rations due to lack of funding support.

More than 16.2 million people cannot access enough water for drinking, cooking and cleaning across the Horn of Africa, including 8.2 million in Ethiopia, 3.9 million in Somalia and 4.1 million in Kenya, according to UNICEF. Many water points have dried up or diminished in quality, heightening the risk of water-borne diseases and increasing the risk of skin and eye infections as families are forced to ration their water use and prioritize drinking and cooking over hygiene. Existing water deficits have been exacerbated by very high temperatures, which are forecast to continue until at least September 2022. In some of the worst affected areas in Somalia, water prices have spiked by up to 72 per cent since November 2021. Women and girls are having to walk longer distances to access water—in many instances up to double or triple the distances they would have to walk during a regular dry season—exacerbating their potential exposure to gender-based violence and dehydration. Water shortages are also impacting infection prevention and control in health facilities and schools. In Ethiopia and Kenya, there are already reports of an increase in pregnant women being exposed to infections—the worst of which have resulted in death—following deliveries both at home and at health facilities due to the limited availability of water.

An Unprecedented Emergency Is Ravaging Drought-Affected Communities “My livestock perished from lack of water and pasture, and could not survive the harsh drought anymore. It is painful”

Zeinaba, speaking with a UN team in Ethiopia.

Source: UN Office for the Coordination of Humanitarian Affairs

Children suffering dire drought across parts of Africa are ‘one disease away from catastrophe’ – warns UNICEF [EN/AR]

NEW YORK/NAIROBI/DAKAR, 23 August 2022 – Children in the Horn of Africa and the Sahel could die in devastating numbers unless urgent support is provided, as severe malnutrition and the risk of water-borne disease collide – UNICEF warns during World Water Week.

“History shows that when high levels of severe acute malnutrition in children combine with deadly outbreaks of diseases like cholera or diarrhoea, child mortality rises dramatically – and tragically. When water either isn’t available or is unsafe, the risks to children multiply exponentially,” said UNICEF Executive Director Catherine Russell. “Across the Horn of Africa and the Sahel, millions of children are just one disease away from catastrophe.”

The number of drought-hit people in Ethiopia, Kenya and Somalia without reliable access to safe water rose from 9.5 million in February to 16.2 million in July, putting children and their families in increased danger of contracting illnesses like cholera and diarrhoea1.

In Burkina Faso, Chad, Mali, Niger and Nigeria, drought, conflict and insecurity are driving water insecurity, with 40 million children facing high to extremely high levels of water vulnerability2. Already more children die as a result of unsafe water and sanitation in the Sahel than in any other part of the world, according to the latest WHO data.

Most people in the Horn of Africa rely on water delivered by vendors on trucks or donkey carts. In areas worst hit by drought, water is no longer affordable for many families.

In Kenya, 23 counties have seen significant price hikes topped by Mandera at 400 per cent and Garissa by 260 per cent compared to January 2021.

In Ethiopia, the cost of water in June this year has doubled in Oromia and increased by 50 per cent in Somali compared to the onset of the drought in October 2021.

In Somalia, average water prices climbed 85 per cent in South-Mudug, and 55 and 75 per cent respectively in Buurhakaba and Ceel Berde, compared to prices in January 2022.

More than 2.8 million children across both regions are already suffering from severe acute malnutrition, which means they are up to 11 times more at risk of dying from water-borne diseases than well-nourished children.

In Somalia, outbreaks of acute watery diarrhoea and cholera have been reported in almost all drought-affected districts, with the 8,200 cases reported between January and June, more than double the number of cases reported during the same period last year.

Almost two-thirds of those affected are children under the age of five. Between June 2021 and June 2022, UNICEF and partners treated more than 1.2 million cases of diarrhoea in children under the age of five in the worst drought-hit regions of Ethiopia – Afar, Somalia, SNNP and Oromia. In Kenya, over 90 per cent of open water sources – such as ponds and open wells – in drought-affected areas are either depleted or dried up, posing serious risk of disease outbreak.

Across the Sahel, water availability has also dropped by more than 40 per cent in the last 20 years due to climate change and complex factors such as conflict, putting millions of children and families at increased risk of waterborne diseases. Just last year, West and Central Africa marked the region’s worst cholera outbreak in the last six years, including 5,610 cases and 170 deaths in Central Sahel.

UNICEF is providing life-saving aid and resilient multisectoral services to children and their families in dire need across the Horn of Africa and the Sahel, including improving access to climate-resilient water, sanitation and hygiene services, drilling for reliable sources of groundwater and developing the use of solar systems, identifying and treating children with malnutrition, and scaling up prevention services.

UNICEF’s appeal to improve families’ long-term resilience in the Horn of Africa region – and stop drought devastating lives for years to come – is currently just 3 per cent funded. Of that, almost no money has been received for the section devoted to water, sanitation and climate resilience. The appeal for the Central Sahel region to meet the needs of vulnerable children and families with water, sanitation, and hygiene programmes is only 22 per cent funded.

“Imagine having to choose between buying bread or buying water for a hungry, thirsty child who is already sick, or between watching your child suffer from extreme thirst or letting them drink contaminated water that can cause killer diseases,” said Russell. “Families across drought-impacted regions are being forced into impossible choices. The only way to stop this crisis is for governments, donors, and the international community to step up funding to meet children’s most acute needs, and provide long-term flexible support to break the cycle of crisis.”

Notes to editors:

Water security capacity of a population to safeguard sustainable access to adequate quantities of and acceptable quality water for sustaining livelihoods, human well-being, and socioeconomic development, for ensuring protection against waterborne pollution and water-related disasters, and for preserving ecosystems in a climate of peace and political stability. Water insecurity occurs when any or all of these needs cannot be met.

Water vulnerability relates to physical water scarcity risks (baseline water stress; inter and seasonal variability; groundwater decline and droughts) and the water service level.

Sources include WASH cluster reports, vendors, and anecdotal evidence from affected communities.

Source: UN Children’s Fund

UNESCO Rallies Teacher Trainers to champion Peace Education and Prevent Violent Extremism in Teacher Education

The Ministry of Education and Sports (MoES) in Uganda is implementing the Peace Education and Prevention of Violent Extremism project with support from UNESCO’s International Institute for Capacity Building in Africa (IICBA) titled, “Youth Empowerment for Peace and Resilience Building and Prevention of Violent Extremism in African Countries through Teacher Development”. This project has been supported by the Government of Japan to support the infusion of peace education in teacher education, train teachers and teacher educators to nurture young people to become agents of peace and to make schools safe learning environments.

In pursuance of the above, a one-day workshop was organized for stakeholder engagement in Kampala on July 29, 2022, intended to share experiences on peace education and prevention of violent extremism in selected teacher training institutions in Uganda, drawing over 40 participants. The workshop was intended to;

disseminate the baseline results of a study on peace education and prevention of violent extremism in selected teacher training institutions

discuss the proposed workplan on mainstreaming peace education and prevention of violent extremism by Muni University and Muni NTC, and

share experiences of peace education and prevention of violent extremism in teacher education

This initiative is relevant in the context that the Horn of Africa region where Uganda lies suffers much from ongoing and violent conflicts caused by a variety of factors that has resulted in immense suffering and destructions to both properties and lives. Some of these conflicts have stemmed from skirmish over resources, ethnic-identify stereotyping, marginalization, exclusion and acts of violent extremism, with many of these manifestations still evident and present in this day and age. The guide on transformative pedagogy for peace building (an innovative pedagogical approach that empowers learners to critically examine their attitude and beliefs) developed by UNESCO IICBA therefore provides an anchor for this intervention.

The Chief Guest at the workshop Ms. Annet Kajura, the Assistant Commissioner TETD at MoES advised the teacher trainers to be role models and messengers of peace. She revealed that, “the teaching profession is one which can transform all other professions and you therefore have an extra responsibility to play as agents of peace and role models to younger generation.”

Mr. Charles Draecabo the National Projects Coordinator in his address to the teacher educators emphasized the need to integrate the promising practices documented in the report and use it to model program content that promote peace in the minds of learners. Mr. Draecabo added, “without peace, any efforts that you would like to do, will be in futility.”

Ms Victoria Kisaakye, the Senior Programmes Coordinator for Capacity Development for Education at IICBA in her remarks highlighted that the Institute focuses on improving the quality of learners through effective teaching in an environment that fosters peace. She stated that, “schools can be hubs for peace building in the communities where they are situated and the role of education in peace and resilience building remains very critical because it plays a transformative role.” She together with Ms Eyerusalem Azmeraw, shared several training materials developed by IICBA and introduced a virtual campus on peace education for teacher educators that want to undertake an online course.

The workshop recommended the need to scale up the training on the prevention of violence to all the teacher training institutions and universities as well as developing a module targeting teacher educators’ personal wellbeing and Psychosocial support where they are facing challenges that are impacting on their lives. The other request will be for UNESCO to support more youth-based training for university students to prevent violence in the colleges that has become rampant.

Source: UN Educational, Scientific and Cultural Organization