Total Uganda: the French Supreme Court recognizes the jurisdiction of the civil court

Press Release

The Court of Cassation (French Supreme Court) issued its ruling on the case against the oil giant Total, led by six French and Ugandan civil society organizations (CSOs) - Friends of the Earth France, Survie, AFIEGO, CRED, NAPE and NAVODAThis is the first legal action based on the law on the duty of vigilance of transnational corporations. 

Putting an end to a nearly two years long procedural battle, the Supreme Court ruled in favor of the CSOs, rejecting the jurisdiction of the commercial courts (1). As the violations continue and intensify in Uganda and Tanzania, the case will now return to the civil court of first instance, which will finally examine it on the merits.

After a ruling by the Nanterre civil court in January 2020, which considered that this dispute fell under the jurisdiction of the commercial court, and which was upheld in December 2020 by the Versailles Court of Appeal (2), Friends of the Earth France, Survie and their four Ugandan partners had decided in early 2021 to file an appeal to the Supreme Court. 

On this question of jurisdiction they were supported by three other civil society organizations - ActionAid France, CCFD-Terre Solidaire, Collectif Éthique sur l'étiquette -, and one trade union - CFDT. For the claimants, today's ruling by the Court of Cassation, giving jurisdiction to the civil court, is an important victory. The Court ruled in favor of the civil society organizations by recognizing the "right to choose" (‘droit d’option’) that they enjoy as non-commercial claimants (3). 

By entrusting the case to the civil court, this decision makes it possible to fulfil the objectives of the law on duty of vigilance. The purpose of this law is to hold companies liable for the impacts of their activities on third parties, such as employees of subsidiaries, suppliers and subcontractors, local communities and the environment.

While the commercial courts draw their legitimacy from their knowledge of the business world, cases brought under the duty of vigilance law relate to the protection of human rights and the planet, and cannot therefore be reduced to a purely commercial dispute.

Moreover, this decision is coherent with the provision recently adopted by French Parliament in a new, soon to be enacted procedural law, which gives jurisdiction to the Paris civil court for all cases based on the duty of vigilance law (4).

For Juliette Renaud, of Friends of the Earth France, "We are relieved by this decision of the Court of Cassation, which finally closes nearly two long years of procedural battle. However, we are very concerned about the impact of the delays this procedural issue has caused: in the meantime, according to our investigations, more than 100 000 people are still totally or partially deprived of their land and livelihoods in Uganda and Tanzania (5). Action is urgently needed, and we hope that the upcoming decision on the merits of the case will order Total to finally take concrete measures to stop these violations”.

For Thomas Bart of Survie, "This decision is a first victory in the long legal battle we have launched against this transnational corporation. We will finally be able to focus on the substance of the case. Despite repeated warnings from civil society, the project continues at full speed without any concern for the repression of people on the ground: our partners and community members who dare to raise their voices against this oil megaproject are subject to increasing intimidation, and arbitrary arrests are multiplying (6)”.

This ruling of the Court of Cassation sends back the case to the civil court of Nanterre, where a hearing, finally dealing with the merits of the case, should be held in the coming months.

REF :

1. (1)  The decision of the Court of Cassation  .

2. (2)  See our press release from December 10, 2020 : "Total Uganda case: the Versailles Court of Appeal remands the case to commercial court". To learn more about the previous steps of this lawsuit, read the briefing from Friends of the Earth France and Survie (October 2020): Total Uganda – A first lawsuit under the duty of vigilance law: An update.

3. (3)  According to the right to choose (‘droit d’option’), if the claimants are a non-commercial entity, as is the case for our organizations, they can choose to bring a dispute against a commercial entity before either the civil court or the commercial court. In November 2020, this principle was reaffirmed by the Court of Cassation in the "Uber" ruling (available here in French only), even in a case where the subject matter of the dispute has a direct link with the company’s internal management. This decision was relied upon by the Nanterre court in the "Total climate" case, also based on the law on the duty of vigilance.

4. (4)  See our press release from October 21, 2021: Attribution de la compétence à un tribunal judiciaire : les parlementaires sauvent l’esprit de la loi sur le devoir de vigilance !

5. (5)  See Friends of the Earth France and Survie report (October 2020): A nightmare named Total - An alarming rise in human rights violations in Uganda and Tanzania

6. (6)  See the news report by Le Monde, published on November 26, 2021: "En Ouganda, le pétrole de Total impose le silence et la peur" (In Uganda, Total's oil imposes silence and fear)

Tanzania kids edutainment 'Akili and Me' wins TZ 19 Million Prize

Ubongo, a Tanzania-based nonprofit social enterprise and Africa’s leading producer of kids’ edutainment, is this year’s winner of the prestigious Rotman Innovation of the Year Award, worth $10,000 Canadian dollars (approximately 19 million Tanzanian shillings)

Ubongo was recognized for its transformative innovation of offering evidence-based programming that improves developmental outcomes for children, while using broadcast technology to reach a wide breadth of children across Sub-Saharan Africa.

The accolade is presented annually by Grand Challenges Canada, a Canadian not-for-profit organization that invests in local innovations that address critical global health, humanitarian and Indigenous community challenges in Canada and low-resource countries.

Ubongo’s flagship Akili and Me programming is currently translated in nine languages. Since receiving Grand Challenges Canada support in 2018, more than 1.37 million children (pre-primary and primary school) across Tanzania, Kenya, Rwanda, Nigeria, Uganda and Ghana have benefitted from watching Akili and Me. 

The multimedia platform—the first in Africa to integrate resource caregivers and other stakeholders—is easily accessible through television, radio and mobile phones.

According to a study, exposure to Ubongo’s Akili and Me program for 30 minutes per day for a month led to significantly improved child development scores, compared to those in the control group, including counting (24%); English skills (12.5%); number recognition (11.7%); shape knowledge (9.7%); and drawing skills (8.2%).

The project aims to positively impact the development, learning and life trajectory of over 100 million kids in Africa by 2030.

The Rotman Innovation of the Year Award was created in honour of the late Joseph Rotman, Founding Chair of Grand Challenges Canada, and his family, in recognition of their unfailing support for global health innovation. The Award honours innovation that has had the largest sustainable increase in lives saved or lives improved over the past year.

Ubongo Co-Founder and Chief Executive Nisha Ligon, who leads a strong, women-led team said the prize money will help with their goal of adapting content to more languages and contexts; the organization is determined to broadcast programming across Africa. 

“We are so honoured to receive this award. GCC’s support over the past three years has enabled us to expand our reach into many new markets and languages to reach millions of more kids. They have challenged us to think critically and strategically about our growth and have been essential in enabling Ubongo’s success,” she said.

“My father’s firm belief was that business has a critical role to play in building a better society. His vision is well embodied in Ubongo’s exceptional approach: the coordinated application of science and entrepreneurialism for the benefit of children. The Rotman Family congratulates Ubongo on being named the second annual winner of the Award,”Janis Rotman, President of the Rotman Family Foundation.

“Ubongo has brought a science-backed Early Childhood Development model into homes of children, many of whom otherwise don’t have access to quality education, through fun, localised and multi-platform educational content," said Jocelyn Mackie, the Grand Challenges Canada Co-CEO.

"To date, we have proudly financed Ubongo for a total of 1 million Canadian dollars under our Saving Brains program (with funding provided by Global Affairs Canada). Leveraging the reach of broadcast media, Ubongo has the largest breadth of impact in our Saving Brains portfolio.” 

“This very unique and successful idea that uses media for child development is helping to change the lives of the next generation of Africans, especially girls, so that they can live healthier lives, realize their potential, and prepare for active involvement in their communities,"said Her Excellency Pamela O’Donnell, High Commissioner for Canada in Tanzania.

The Government of Canada is investing in organizations, like Grand Challenges Canada, that support innovative solutions to save and improve the lives of people in low- and middle-income countries. "More than ever, we need new, creative solutions to build a sustainable future that leaves no one behind,”said O’Donnell. 

Last year, the inaugural Rotman Innovation of the Year Award, created as part of Grand Challenges Canada’s 10th anniversary, went to Hewatele, a Kenyan-owned social enterprise with a mission to address the lack of access to medical grade oxygen for rural and regional healthcare facilities by producing, delivering and servicing an eco-friendly, low-cost, safe and reliable oxygen solution.

£500,000 Hydrogen Training Academy to fight against climate change

A revolutionary project based in Ballymena, has received more than half-a-million-pounds of funding (£511,000) from the UK Government’s Community Renewal Fund (CRF) to start a new Hydrogen Training Academy, which they say will help in the fight against climate change.

With hydrogen emerging as a leading sustainable energy solution, the first-of-its-kind project for Northern Ireland will enable and develop a dynamic, skilled workforce that can take full advantage of hydrogen and clean tech opportunities.

The Hydrogen Training Academy is one of 31 projects across Northern Ireland set to benefit from a total of £12million CRF funding – all focusing on skills, education, local business and employment.

Led by Mid and East Antrim Borough Council, the Academy will be driven by a public-private partnership that includes Queen’s University, Ulster University, the University of Birmingham, Northern Regional College and Belfast Metropolitan College.

A consortium of key industry players also involved already includes Wrightbus, Energia, Translink, Firmus and EPUK with opportunities for other partners to come on-board as the project develops.

Professor David Rooney, Dean of Internationalisation and Reputation in the Faculty of Engineering and Physical Science at Queen’s University, comments:

“With COP26 taking place, sustainability is very much at the forefront of all of our minds. At Queen’s, we have been prioritising this as an area of research for many years and our world class experts have been working on many initiatives in the fight against climate change.

“Working in partnership with other institutions we will continue to use our expertise to develop cutting edge research and technology to drive forward change. I am also pleased that we will play an integral role in training our future leaders and the next generation of experts in the hydrogen economy.”

The development of the academy began earlier this year with the formal procurement of a new state-of-the-art training pod to support the practical training through the Hydrogen Training Academy. The training pod is being built by BSH Limited and will be delivered early in 2022.

The Mayor of Mid and East Antrim, Councillor William McCaughey, commented: “As all eyes around the world turn to COP26 and the urgent focus on environmental sustainability continues to gather pace, news of this funding really is very timely and very welcome indeed.

“Mid and East Antrim is uniquely placed in Northern Ireland in terms of the key strengths and assets we boast in energy and cleantech that align with zero carbon targets. Through this revolutionary Hydrogen Training Academy, our Borough will continue to build upon its reputation as centre of excellence and the main focal point of the emerging Northern Ireland wide hydrogen economy.

“I commend Council’s Elected Members and officers who, in collaboration with our public and private sector partners, have invested a huge amount of time and effort in bringing the project to this stage. I very much look forward to seeing the plans come to fruition in the coming months and witnessing the longer-term economic impact the Academy will undoubtedly have in the coming years.”

Graham Whitehurst MBE, Chair of Mid and East Antrim’s Manufacturing Task Force, explained how the Academy will play a “critical role” in training and upskilling both existing employees and new trainees to a recognised professional competence standard required for the hydrogen sector.

“The Hydrogen Training Academy will deliver a range of crucial entry-level introductory training for industry across a number of sectors, including energy, transport, gas, manufacturing and engineering,” he said.

“This training will be delivered via a combination of online, classroom and practical training with initial focus on two key areas of hydrogen – hydrogen gas basics and safety and hydrogen production.”

According to Mr Whitehurst, an initial pilot phase at the Academy will see 30 participants take part in a ‘Train the Trainer’ course, delivered by academics from the University of Birmingham, who have already successfully delivered their ‘KnowHy Training’ to over 1,000 participants.

Queen’s University and Ulster University will collaborate to develop a Level 7 postgraduate certificate in Hydrogen Power. Northern Regional College and Belfast Metropolitan College will draw upon the learning from participation on the Train the Trainer Programme to develop and accredit two Level 3 courses for delivery to young people and employees across the hydrogen industry.

“This Hydrogen Training Academy has been developed using a unique partnership approach involving Council, Further Education, Higher Education and industry. Their contribution has been, and will remain, critical to the overall success of the project and the future commercialisation of activity for the clean growth sector in Northern Ireland,” said Mr Whitehurst.



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Africa’s death rates from COVID-19 infections are significantly higher in patients with diabetes

By World Health Organisation

Africa’s sharp increase in diabetes is clashing with the COVID-19 pandemic and poor access to vaccines. Africa’s death rates from COVID-19 infections are significantly higher in patients with diabetes, according to a preliminary analysis which the World Health Organization (WHO) presented today in advance of the World Diabetes Day on 14 November.

“COVID-19 is delivering a clear message: fighting the diabetes epidemic in Africa is in many ways as critical as the battle against the current pandemic,” said Dr Matshidiso Moeti, WHO Regional Director for Africa.

“The COVID-19 pandemic will eventually subside, but Africa is projected in the coming years to experience the highest increase in diabetes globally. We must act now to prevent new cases, vaccinate people who have this condition and, equally importantly, identify and support the millions of Africans unaware they are suffering from this silent killer.”

Diabetes impairs the body’s ability to produce or process insulin, a substance essential to counteracting a dangerous rise in blood sugar. The disease causes inflammation and poor blood circulation, both of which increase the risk of complications, including death, from COVID-19.

A recent WHO analysis evaluated data from 13 countries on underlying conditions or comorbidities in Africans who tested positive for COVID-19 revealed a 10.2% case fatality rate in patients with diabetes, compared with 2.5% for COVID-19 patients overall. 

The case fatality rate for people with diabetes was also twice as high as the fatality rate among patients suffering any comorbidity. In addition to people with diabetes, the three most frequent underlying conditions included patients with HIV and hypertension.

The countries contributing data to the analysis were Burkina Faso, Chad, Cote d’Ivoire, Democratic Republic of the Congo, Eswatini, Guinea, Namibia, Niger, Rwanda, Senegal, Seychelles, Sao Tome and Principe and Uganda.

An estimated 24 million people are living with diabetes in Africa in 2021 according to the International Diabetes Federation and the continent is expected to experience the highest increase in diabetes globally, with the number of Africans suffering from the disease predicted to rise to 55 million by 2045, an increase of 134% compared with 2021. 

Africa is the region with the highest number of people who do not know their diagnosis – an estimated 70% of people with diabetes do not know they have the disease.

“Health officials in Africa should take advantage of the growing availability of low-cost rapid diagnostic tests to routinely test patients in diabetes centres to ensure early detection and proper care,” said Dr Benido Impouma, Director, Communicable and Noncommunicable Diseases Cluster at WHO Regional Office for Africa. “These centres also can be key venues for vaccination.”

Since the early days of the pandemic, people with diabetes in countries around the world have been prioritized to receive COVID-19 vaccinations. Africa has faced challenges in this strategy.

Access to vaccines remains poor. Thus far, only 6.6% of the African population is fully vaccinated against COVID-19, compared with about 40% globally. Data from 37 countries indicates that since March 2021, over 6.5 million COVID-19 vaccine doses have gone to Africans with comorbidities, representing 14% of all doses administered so far. 

Efforts to prioritize people with comorbidities, like diabetes, are accelerating with about half of those 6.5 million doses administered in just the last couple of months. However, there is still a lot more work to be done to ensure people at high risk receive the vaccines they need.

“Nine months since COVID-19 vaccination campaigns began in Africa, we are still nowhere near where we need to be with protecting our most vulnerable,” Dr Moeti said. “There is an urgent need to step up vaccination and other key services to people at high risk, including those with diabetes.”

There are two main types of diabetes: type 1 caused by a condition early in life that damages the pancreas and impairs insulin production; and type 2—which is linked to poor diet, obesity and lack of exercise—where the body struggles to process insulin. 

About 90% of diabetes cases globally, and the vast majority in Africa, are type 2, with rising rates in Africa attributed to the same poor diets and sedentary lifestyles causing a surge in type 2 diabetes around the world. 

In addition to COVID-19 risks, diabetes can also increase risk of heart attack, stroke, kidney failure, lower limb amputation, visual impairment, blindness and nerve damage, including erectile dysfunction.

“All Africans at risk of diabetes must have access to testing,” Dr Moeti said. “We can also stop diabetes from claiming more lives by promoting healthy, affordable diets and regular exercise.”

During the COVID-19 pandemic, access to diabetes care has been severely disrupted in the African Region. Lockdowns to limit the spread of COVID-19, for example, have impeded access to health care and the basic elements of proper disease management, such as routine glucose monitoring and eating a healthy diet.

To improve equitable access to quality diabetes care, WHO launched the Global Diabetes Compact in April 2021. This builds on work in recent years to rollout the WHO Package of Essential Noncommunicable Disease (WHO PEN) interventions for primary health care in low-resource settings. 

So far 21 African countries have started using this package. Benin, Eritrea, Eswatini, Lesotho and Togo have achieved national expansion covering all primary health care facilities.

WHO held a virtual press conference facilitated by APO Group. Dr Impouma was joined by Professor Maïmouna Ndour Mbaye, Head of the Internal Medicine unit, Cheikh Anta Diop University of Dakar and Director, National Diabetes Centre, Senegal, and Mr Greg Tracz, Chief Executive Officer, Diabetes Africa.

Also on hand to respond to questions were Dr Phionah Atuhebwe, New Vaccines Introduction Officer, WHO Regional Office for Africa, Dr Thierno Balde, Regional COVID-19 Incident Manager, WHO Regional Office for Africa, and Dr Jean-Marie Dangou, Coordinator, Noncommunicable Diseases Programme, WHO Regional Office for Africa.



(END)

55 million Africans predicted to suffer from diabetes by 2045

By World Health Organisation

Africa is expected to experience the highest increase in diabetes globally. The number of people suffering from the disease is predicted to rise to 55 million by 2045—a 134% spike compared with 2021. 

At 70%, the continent also has the world’s highest number of people who do not know they have diabetes.

Dr Bernadette Adeyileka-Tracz, Founder and Chief Operating Officer of Diabetes Africa, a non-profit organization working to improve the health of Africans living with diabetes, explains the challenges in diabetes prevention and care in the continent.

What are the challenges a person living with diabetes faces in Africa? 

 

The number one challenge for a person living with type 1 or type 2 diabetes in Africa is diagnosis: people living with diabetes may not know they have the condition until serious complications develop. That’s because “looking healthy” is not the same as “being healthy.” 

People with excess blood sugar, particularly in the case of type 2 diabetes, can live without experiencing complications for a long time. However, when these complications do manifest, they present huge problems to livelihoods and add to the burden of already-strained health systems. Blindness, amputation, heart emergencies are not light complications.

In many places across the continent, this challenge is compounded by a lack of testing facilities or training among health workers that would enable them to identify risks early on. The earlier Type 2 diabetes or pre-diabetes can be diagnosed and treated, the better for the person and for the community at large.

The cost and access to medication is of course an acute challenge in Africa. We can add that managing blood glucose levels requires testing blood sugar levels regularly, and this presents challenges on its own: people living with diabetes should receive adequate training on the topic, but also be able to afford it: how can we expect people to test regularly if they must choose between feeding their families and buying test strips?

Diagnosis and testing are the first of a series of cascading challenges. Experts often use what they call the “rule of halves” to describe them: of 100 people living with diabetes, only 50 of them will have been diagnosed. The rest will live with the condition and its consequences without being aware of it. Of the 50 that have been diagnosed, 25 will receive care. 

The others are unable to seek care, for personal or economic reasons. Finally, among the 25 who receive adequate care, only 12 or 13 will meet their targets in terms of readings or measurements. But in the end, only six of them will have a positive health outcome.

This shows the scale of the challenge in front of us. It’s also possible that in remote and rural areas in Africa a rule of thirds or a rule of fourths applies.

How has COVID-19 made their situation worse? 

 

COVID-19 has certainly increased risks for people living with diabetes. People living with diabetes are more likely to have more severe symptoms of COVID-19. Research is still ongoing, but anecdotal evidence coming from Africa tends to corroborate research done in the United Kingdom and in the United States of America. 

In the Democratic Republic of the Congo, for example, the analysis of a small sample of 215 people who died of COVID-19 showed that 30% of them had diabetes.

The public response to the pandemic has also had an impact on people living with diabetes. An initial reaction to the pandemic has been to encourage people to stay at home and reduce visits to the hospital. People living with diabetes also chose to stay at home for fear of catching the virus. With the pandemic stretching into 2021, this did not prove to be a sustainable solution.

The sudden global focus on health may have encouraged some people to control their diabetes better and make an extra effort, but in general, COVID-19 and its associated restrictions has meant that people became more sedentary, experienced stress and anxiety and had more difficulties keeping a healthy diet and controlling their diabetes.

Luckily, in most instances, hospitals and healthcare providers acknowledged these challenges and made a special effort to allow people living with chronic conditions to receive face-to-face care. Telemedicine has helped in countries where phone calls and video calls were a workable option, for example in Nigeria and Kenya. However, in other countries, such as Uganda for example, the cost and technical challenges of telemedicine were often prohibitive.

COVID-19 has also been the catalyst for positive changes. Civil society organizations have had an active role in encouraging governments to tackle non-communicable diseases like diabetes to lighten the burden on health systems. In Kenya, the Noncommunicable Diseases Alliance has been actively advocating for essential diabetes medicines to be covered by the National Health Insurance Fund.

 

How can countries innovate and manage diabetes in a low-resource setting? 

 

It’s difficult to look at diabetes in isolation and ask how we could do more with less. Adequate healthcare demands a basic level of resources and given their impact on the overall system, noncommunicable diseases such as diabetes remain largely underfunded.

This is regrettable because managing health in a low-resource setting would benefit from actions that reduce costly complications, such as early diagnosis and prevention of diabetes. People who stay in the hospital with COVID-19 often have comorbidities. Can we not address these comorbidities at the source?

One of the greatest innovations in a low-resource setting would be to change mindsets: consider investing in keeping people healthy, rather than fixing problems. There will always be emergencies and costly operations that cannot be avoided. But diabetes need not be the cause of them.

This involves an effort to train healthcare professionals, inform and train people who may be at risk, sharing knowledge at a much greater scale, which is what Diabetes Africa aims to do. This would also entail working with commercial organizations, in particular in the food and beverage industry to label products and help people make informed decisions.

Study: Access to a simple breathing monitor could prevent 11,000 fatal anaesthetic accidents per year in sub-Saharan Africa

A study, the Global Capnography Project (GCAP), published 26 September 2018, in the journal Anaesthesia, clearly identified the need for middle and low-income countries to have access to a simple and life-saving method of monitoring a patient’s breathing, called capnography, in operating theatres and in intensive care units.

Capnography is an essential monitor for safe anaesthesia and is widely used in high-income countries as part of major improvements in the safety of anaesthesia care. 

The study called: ‘Global Capnography Project (GCAP): implementation of capnography in Malawi - an international anaesthesia quality improvement project’ and will be published in the journal Anaesthesia in September 2018 https://www.onlinelibrary.wiley.com/doi/10.1111/anae.14426 

A landmark study in 2011, the 4th National Audit Project (NAP4), further confirmed the importance of capnography both in the operating theatre and especially in the intensive care unit. Despite this, the device is hardly ever available in low-income countries.

The GCAP team set out to measure the availability of capnography and determine whether its introduction was feasible and could improve patient care in a low-income country. 

A pilot site was identified in Malawi and forty capnographs were donated by Medtronic to eight hospitals in the southern part of the country. In addition, thirty-two anaesthesia providers at these hospitals received a one-day capnography training course.

Prior to the pilot project, there was only one capnograph in the southern region of Malawi, across eight hospitals. During the six-month pilot, 699 episodes of monitoring with the capnographs were recorded and 90% of the anaesthesia providers trained believed that the use of capnography had saved lives. They reported that a minimum of 57 lives had been saved during the six months of use. 

Oesophageal intubation (accidently placing a tracheal tube in the patient’s oesophagus) and breathing circuit disconnections are two of the most important incidents in operating theatres and intensive care units that capnography monitoring can detect. Both of these can lead to significant patient harm and mortality if not identified early and corrected quickly.

During the six-month pilot, 44 oesophageal intubations were detected by capnography. From this, the GCAP team made an estimation that with a population of 7.5 million in Southern Malawi there is a rate of 11.7 oesophageal intubations per million population per year.

Assuming Southern Malawi is representative of sub-Saharan Africa as a whole (with a population of 1,022 million), the team then went on to estimate that over 11,000 oesophageal intubations could occur per year in the region.

These incidents pose a very significant patient safety risk that could be prevented by access to capnography. The GCAP team estimated that there are at least 70,000 operating theatres in the world
without Capnography.

Prof Ellen O’Sullivan from GCAP Team, said: “We believe that this is one of the most important projects in anaesthesia safety in the last decade. Our research clearly shows that lives are at risk in low-income countries due to an absence of a simple method of monitoring breathing, called capnography. 

This is despite international standards recommending its use. We are calling for the development of an international project to make global capnography to become a reality, so that like pulse oximetry, it can be included the World Health Organisation (WHO) surgical safety checklist to help improve patient safety worldwide All relevant organisations should consider taking this forward.”

 “These results show that capnography is desperately needed to help save patients’ lives in our operating theatres and ICUs. We found the equipment robust and easy to use. We plead with the international anaesthesia community to support the dissemination of the GCAP project throughout Malawi and other sub-Saharan African countries,”Dr Delia Mabedi from Zomba Hospital, Malawi commented.

"Medtronic is grateful for the opportunity to participate in the GCAP project that demonstrated the major clinical benefits of monitoring patients breathing with capnography. We look forward to working with the clinical community to address the global need for this technology and to keep patients safe worldwide,” said Vafa Jamali, senior vice president and president of Respiratory, Gastrointestinal and Informatics, which is part of the Minimally Invasive Therapies Group at Medtronic.

-Ends-
REF: https://www.onlinelibrary.wiley.com/doi/10.1111/anae.14426

Study finds blocking or hiding facial movement can affect sharing of emotions and social interaction

Hiding the bottom half of the face with a mask could have a detrimental effect on our ability to socially interact and share other people’s emotions, new research suggests.

A study, which was led by Cardiff University and involved researchers from Queen’s University Belfast, found that people with facial paralysis, people seeing others who wear face masks, or even children sucking on dummies, could struggle to show empathy or detect positive social cues.

The research is published in the journal Cognitive, Affective, and Behavioral Neuroscience.

Lead author Dr Ross Vanderwert, from Cardiff University’s School of Psychology, says: “People tend to automatically imitate others’ facial expressions of emotion when looking at them, whether that be a smile, a frown, or a smirk. 

This facial mimicry – where the brain recreates and mirrors the emotional experience of the other person – affects how we empathise with others and interact socially.

“Our study suggests that when the movements of the lower part of the face are disrupted or hidden, this can be problematic, particularly for positive social interactions and the ability to share emotions.

“Wearing a face mask continues to be vital to protect ourselves and others during the COVID-19 pandemic – but our research suggests this may have important implications for the way we communicate and interact.”

Dr Magdalena Rychlowska, from Queen’s University Belfast’s School of Psychology, was second author on the paper. She comments: “Our findings suggest that processing faces is a very challenging task and that the brain may need more support from, and rely more heavily on, our own faces to support the visual system for understanding others' emotions.

“This mirroring or simulation of another person’s emotions may enable empathy; however, up until now the neural mechanisms that underline this kind of emotion communication have been unclear.”

The scientists recorded the brain activity of 38 individuals via an electroencephalogram whilst they watched videos of fearful, happy, and angry expressions, as well as a collection of inanimate everyday objects, as a control.

Study participants were asked to watch the videos whilst holding a pen between their teeth for half the videos and without the pen for the remaining videos.

The researchers were investigating, for the first time, the effect this had on a process known as neural mirroring – activity in the motor system for our own actions that is also active observing other’s actions. Neural mirroring facilitates simple tasks such as hand-eye coordination and more complex tasks like understanding the emotions of others.

The results revealed that participants who could freely move their face showed significant neural mirroring when observing the emotional expressions, but not the everyday objects.

While the pen was held in their teeth, no neural mirroring was observed when looking at the happy and angry expressions – but it did show neural mirroring when looking at fearful expressions.

Dr Rychlowska adds: “For emotions that are more heavily expressed by the eyes, for example fear, blocking the information provided by the mouth doesn’t seem to affect our brain’s response to those emotions. But for expressions that depend on the mouth, like a friendly smile, the blocking had more of an effect.”

Cervical cancer rates reduced by 87% in women vaccinated against HPV, English study confirms

Cervical cancer rates are 87% lower in women who were offered vaccination against human papillomavirus (HPV) when they were between the ages of 12-13 than in previous generations confirms a new study published in The Lancet. 

The researchers also found reductions in cervical cancer rates of 62% in women offered vaccination between the ages of 14-16, and 34% in women aged of 16-18 when vaccination was introduced. This is the first direct evidence of prevention of cervical cancer using the bivalent vaccine, Cervarix.

HPV vaccination has been introduced in 100 countries as part of efforts by the World Health Organization (WHO) to eliminate cervical cancer. England initially used a bivalent vaccine which protects against the two most common types of HPV, responsible for approximately 70-80% of all cervical cancers. 

The English HPV vaccination programme was introduced in 2008, with vaccines given to women between 12-13 years old and “catch-up” vaccinations offered to older age groups up to the age of 18.

“Although previous studies have shown the usefulness of HPV vaccination in preventing HPV infection in England, direct evidence on cervical cancer prevention was limited,” says Professor Peter Sasieni, King’s College London, one of the authors of the paper “Early modelling studies suggested that the impact of the vaccination programme on cervical cancer rates would be substantial in women aged 20-29 by the end of 2019. Our new study aims to quantify this early impact. The observed impact is even greater than the models predicted.”

The study looked at population-based cancer registry data between January 2006 and June 2019 for seven cohorts of women who were between the ages of 20-64 at the end of 2019. Three of these cohorts formed the vaccinated population, where women were vaccinated with Cervarix between the ages of 12-13, 14-16 and 16-18 respectively. Incidences of cervical cancer and non-invasive cervical carcinoma (CIN3) in the seven populations were recorded separately.

During the study period, 28,000 diagnoses of cervical cancer and 300,000 diagnoses of CIN3 were recorded in England. In the three vaccinated cohorts there were around 450 fewer cases of cervical cancers and 17,200 fewer cases of CIN3 than expected in a non-vaccinated population. 

The research found reductions in cervical cancer rates of 87% (with a confidence interval of 72-94%) in women targeted between the ages of 12-13 (89% of whom received at least one dose of the HPV vaccine and 85% of whom had received three jabs and were fully vaccinated), 62% (CI: 52-71%) in women potentially vaccinated between the ages of 14-16, and 34% (CI: 25-41%) in those eligible for vaccination between the ages of 16-18 (60% of whom received at least one dose and 45% of whom were fully vaccinated). 

The corresponding reductions in CIN3 rates were 97% in women vaccinated between the ages of 12-13, 75% in women vaccinated between the ages of 14-16 and 39% in women vaccinated between the ages of 16-18.

“This study provides the first direct evidence of the impact of the UK HPV vaccination campaign on cervical cancer incidence, showing a large reduction in cervical cancer rates in vaccinated cohorts. As expected, vaccination against HPV was most effective in the cohorts vaccinated at ages 12-13 amongst whom the uptake was greatest and prior infection least likely,” says Dr Kate Soldan from the UK Health Security Agency and co-author. 

“This represents an important step forwards in cervical cancer prevention. We hope that these new results encourage uptake as the success of the vaccination programme relies not only on the efficacy of the vaccine but also the proportion of the population vaccinated.”

Lucy Elliss-Brookes, Associate Director for Data Curation at NHS Digital and one of the authors of the paper said: “The findings of this study are hugely important in encouraging those eligible to take up the vaccine, but also in demonstrating the power of data [2] in helping medical researchers and the NHS to understand what causes cancer and how best to diagnose, prevent and treat it.”

The authors acknowledge some limitations with the study, principally that cervical cancer diagnosis is rare in young women. In addition, the number of registered cases of cervical cancer is impacted by the age at which women are screened; most of the follow-up for women in vaccinated cohorts occurred under the age of 25 and small differences in the age of first screening can have a large impact on registered cervical cancer cases in women below this age. 

Because the vaccinated populations are still young, the authors stress that this means that it is still too early to assess the full impact of HPV immunisation on cervical cancer rates. However, it is important to note that the two most common HPV infections which the bivalent vaccine protects against are present in as many as 92% of women diagnosed with cervical cancer before the age of 30.

It should also be noted that the bivalent vaccine Cervarix used in the UK from 2008-2012. Since September 2012, the quadrivalent vaccine Gardasil has been used instead.

Writing in a linked comment, Professor Maggie Cruickshank from the University of Aberdeen (UK), who was not involved in the study, says: “The scale of HPV vaccination effect reported by this study should stimulate vaccination programmes in low and middle-income countries where the problem of cervical cancer is a far greater public health issue than those with well-established systems of vaccination and screening."

"The most important issue, besides the availability of the vaccine (related to the decision-makers in the health policy), is the education of the population to accept the vaccination, as an increase in the rate of immunization is a key element of success.”

Infertility Treatments Raise No Insurmountable Theological or Legal Problems for Muslim Scholars, says WISH 2020 Report

By Esther Nakkazi

Women and men who are infertile and fail to have children face discrimination, stigma, and ostracism in many cultures worldwide and Assisted Reproductive Technologies (ARTs), more commonly known as fertility treatments are often morally questioned. 

In the Islamic world moral tradition is characterized by diversity of opinions on many of the questions raised by ARTs. 

This gives healthcare professionals, their patients, and policymakers greater freedom in formulating governing policies, regulations, and in drafting laws says a report released during the 2020 World Innovation Summit for Health (WISH) is collaborating with the Research Center for Islamic Legislation & Ethics (CILE) at the College of Islamic Studies, Hamad Bin Khalifa University (HBKU).

Infertility affects around 10-15% of couples globally. ARTs have provided solutions that have benefited many couples and while the biomedical scientists have been working to improve the safety and efficacy of these new technologies, ethicists and religious experts have simultaneously been studying the related moral issues. 

This is so couples that undergo treatment do not compromise their moral or religious values and principles. The observation is pertinent for Qatar and other Muslim-majority countries, where a legal vacuum in this field persists.

The research report Islamic Ethics and Infertility Treatment presented at the WISH 2020 biennial conference provided healthcare professionals and policymakers, with informative and practical guide to better understanding how ARTs intersect with the moral world in the Islamic tradition.

Maha El Akoum, Head of Content at WISH and a contributor to the report, said a meeting of religious and biomedical scholars on this subject is crucial, and this seminal report is an extension of WISH’s long-term interest in examining the interplay between biomedical sciences and Islamic ethics.

"It is an honor to be drawing on the widely-respected scholarship of CIS’ research center at HBKU, to provide informed and evidence-based policy recommendations from the perspective of Islamic ethics.”

But miscarriage prevention remains a low public health priority in many low- and middle-income countries, where there are many competing health care priorities and services for women can be especially limited.

There needs to be a minimum service available globally for women with recurrent miscarriage, and in low- and middle-income countries this service should include tests to check for diabetes, anaemia, thyroid abnormalities, and antiphospholipid syndrome when indicated, with appropriate treatment based on the results. 

There also needs to be a focus on providing pre-pregnancy counselling and psychological support to women with repeated miscarriages. This will require investment in early pregnancy care in low- and middle-income countries, and we recommend increasing provision of medication and equipment, training in scanning and surgical procedures, and creating dedicated early pregnancy units to ensure high-quality care. Awareness-raising programmes to encourage women to seek care is also needed.” [1]

QF’s global health initiative collaborates with HBKU’s College of Islamic Studies ahead of 2020 health summit this November.

Qatar launched its first IVF center in April 1993, and the Assisted Reproductive Center (ARC) established at HMC, the country’s largest governmental healthcare provider, currently performs over 1,500 cycles a year for female and male infertility, with a success rate comparable to that of international centers.

Maha El Akoum, Head of Content at WISH and a contributor to the report, said: “Infertility affects around 10-15% of couples globally. ARTs have provided solutions that have benefited many couples and while the biomedical scientists have been working to improve the safety and efficacy of these new technologies, ethicists and religious experts have simultaneously been studying the related moral issues. This is so couples that undergo treatment do not compromise their moral or religious values and principles.

Some of those issues revolve around the risks of such therapies, while others focus on the definitions of what constitutes a marriage or family. The financial aspect is another cause of ethical concern, particularly around the inequitable access to care, given the high-cost of these therapies. Government-aided funding for ART varies widely among different countries.

In responding to the complex and multidimensional questions arising from the use of ARTs, Muslim religious scholars have sometimes formally collaborated with biomedical scientists to understand some of the scientific and biomedical aspects of ARTs. 

As explained in previous studies published by WISH, the collaboration between religious scholars and biomedical scientists was facilitated through the mechanism of collective religio-moral reasoning.

The World Innovation Summit for Health (WISH) is a global healthcare community dedicated to capturing and disseminating the best evidence-based ideas and practices. WISH is an initiative of Qatar Foundation for Education, Science and Community Development (QF) and is under the patronage of Her Highness Sheikha Moza bint Nasser, its Chairperson.

The inaugural WISH Summit took place in Doha in 2013 and convened more than 1,000 global healthcare leaders. Through international summits and a range of ongoing initiatives, WISH is creating a global community of leading innovators in healthcare policy, research, and industry.

Together, they are harnessing the power of innovation to overcome the world’s most urgent healthcare challenges and inspire other stakeholders to action.

Qatar Foundation for Education, Science and Community Development (QF) is a non-profit organization that supports Qatar on its journey to becoming a diversified and sustainable economy. QF strives to serve the people of Qatar and beyond by providing specialized programs across its innovation-focused ecosystem of education, science and research, and community development.

QF was founded in 1995 by His Highness Sheikh Hamad bin Khalifa Al Thani, the Father Emir, and Her Highness Sheikha Moza bint Nasser, who shared the vision to provide Qatar with quality education. Today, QF’s world-class education system offers lifelong learning opportunities to community members as young as six months through to doctoral level, enabling graduates to thrive in a global environment and contribute to the nation’s development.

QF is also creating a multidisciplinary innovation hub in Qatar, where homegrown researchers are working to address local and global challenges. By promoting a culture of lifelong learning and fostering social engagement through programs that embody Qatari culture, QF is committed to empowering the local community and contributing to a better world for all.

New study: How UNESCO's World Heritage forests play a vital role in mitigating climate change

Paris, 28 October – The first ever scientific assessment of the amounts of greenhouse gases emitted from and absorbed by forests in UNESCO World Heritage sites has found that forests in World Heritage sites play a vital role in mitigating climate change by absorbing 190 million tons of CO2 from the atmosphere each year. However, ten forestsreleased more carbon than they sequestered due to pressure from human activity and climate change, which is alarming.

World Heritage forests absorb 190m tons of CO2 each year

By combining satellite-derived data with monitoring information at the site level, researchers at UNESCO, World Resources Institute (WRI) and the International Union for Conservation of Nature (IUCN) were able to estimate the gross and net carbon absorbed and emitted by UNESCO World Heritage forests between 2001 and 2020 and determine the causes of some emissions.

The research found that, as a whole, UNESCO World Heritage forests in 257 separate sites, absorbed the equivalent of approximately 190 million tons of CO2 from the atmosphere each year, comparable to roughly half the United Kingdom’s annual CO2 emissions from fossil fuels. “We now have the most detailed picture to date of the vital role that forests in World Heritage sites play in mitigating climate change,” said Tales Carvalho Resende, from UNESCO who co-authored the report.

World Heritage forests, whose combined area of 69 million hectares is roughly twice the size of Germany, are biodiversity-rich ecosystems. In addition to absorbing CO2 from the atmosphere they also store substantial amounts of carbon. Carbon sequestration by these forests over long periods has led to total carbon storage of approximately 13 billion tons of carbon, which is more than the carbon in Kuwait’s proven oil reserves. If all this stored carbon were to be released into the atmosphere as CO2, it would be akin to emitting 1.3 times the world’s total annual CO2 emissions from fossil fuels.

Findings from 10 World Heritage forests are cause for concern

However, given that World Heritage sites are highly prized and protected, the fact that 10 of 257 forests emitted more carbon than they captured between 2001 and 2020 due to different anthropogenic disturbances and pressures is alarming.

At some sites the clearance of land for agriculture caused emissions to be greater than sequestration. The increasing scale and severity of wildfires, often linked to severe periods of drought, is also a predominant factor in several cases. Other extreme weather phenomena, such as hurricanes, contributed at certain sites.

“All forests should be assets in the fight against climate change. Our report’s finding that even some of the most iconic and best protected forests such as those found in World Heritage sites can actually contribute to climate change is alarming and brings to light evidence of the severity of this climate emergency”, said Tales Carvalho Resende.

In the coming years, ongoing sequestration and carbon sinks are likely to be affected at a growing number of sites worldwide as a result of increasingly fragmented and degraded landscapes, and more frequent and intense climate-related events.

Better management of sites can yield results

The report urges strong and sustained protection of UNESCO World Heritage sites and their surrounding landscapes to ensure their forests can continue to act as strong carbon sinks and stores for future generations. To achieve this, the report recommends rapidly responding to climate-related events, as well as maintaining and strengthening ecological connectivity through improved landscape management.

For example, in Indonesia, government agencies have been using near real-time fire alert systems to significantly reduce their average fire response time. Rapid response is integral to preventing fires from developing into destructive conflagrations that produce extensive CO2 emissions.

At the Sangha Trinational World Heritage site, located within Cameroon, the Central African Republic and the Republic of Congo, the creation of a buffer zone around the site has kept some human activity farther from this important carbon sink.

The report also recommends integrating the continued protection of UNESCO World Heritage sites into international, national and local climate, biodiversity and sustainable development strategies in line with the Paris climate agreement, the Post-2020 Global Biodiversity Framework and the Sustainable Development Goals.

“This analysis of iconic World Heritage sites shows that combining satellite data with on-the-ground information can improve local decision-making and strengthen accountability, thereby helping forests, climate, and people,” said David Gibbs, WRI Research Associate and co-author of the report.

“Protecting World Heritage sites from increasing fragmentation and escalating threats will be central to our collective ability to address climate change and biodiversity loss,” added Tim Badman, Director of IUCN’s World Heritage Programme.

New biotech firm launched to develop ‘revolutionary’ treatment for one of world’s rarest neurodegenerative diseases

A new biotech business SynaptixBio has been launched to tackle one of the world’s rarest neurodegenerative diseases.

SynaptixBio is working to develop the world’s first disease-modifying treatment for TUBB4a leukodystrophy, including H-ABC - a debilitating and potentially life-limiting condition.

Founded by a worldwide team of leading medical and pharmaceutical experts, the Oxford-based research company has entered into a sponsored research agreement with Children’s Hospital of Philadelphia (CHOP) in the US related to a new method for treating TUBB4a leukodystrophy.

SynaptixBio also has an option to exclusively license CHOP research related to this project. Antisense Oligonucleotides (ASOs) therapy, which has previously been used to treat conditions such as Duchenne muscular dystrophy and spinal muscular atrophy, is also hoped to dramatically improve the quality of - and extend – the lives of leukodystrophy patients.

Dr Dan Willams, CEO and co-founder of SynaptixBio, said the treatment had the potential to “modify the disease, increase survival and significantly improve motor skills development.

“The new approach provides the potential to stabilise, improve quality of life and extend life expectancy in children suffering from the condition.“Successful prevention of leukodystrophy progression would be a revolutionary life-saving and life-enriching treatment.”

TUBB4a leukodystrophy causes hypomyelination in the brain, which can lead to developmental delays in motor skills such as walking, sitting, speaking and swallowing; learning difficulties, seizures, paralysis and an early death.

Research has already begun, with the firm aiming to launch clinical trials in 2024.“This project will change people’s lives,” Williams said. “The research and development of a clinically-proven treatment for TUBB4a would be a real game-changer for patients and their families.

“There is a real chance to improve the lives of leukodystrophy sufferers. We want to ensure that dream becomes a reality.”

COVID-19 and Children

By Dr. Sabrina Kitaka 

I have had the opportunity to interact with hundreds of parents throughout the COVID-19 pandemic. One of their most common questions has been, “Doctor, do you think my baby could have COVID-19?”

During the most recent wave, children are affected by COVID-19 in roughly equal numbers as adults. However, infected children typically don’t become as sick as adults, and some do not show any symptoms at all.

While children are less likely to become seriously ill, there are risks that we should all be aware of and some steps you can take to keep you and your family safe.

Which children are most at risk from COVID-19?

The children most at risk from COVID-19 have pre-existing comorbidities like cancer, congenital heart disease, sickle cell disease, and chronic renal failure. Children with underlying conditions like obesity, diabetes, and asthma are also at higher risk of serious illness from COVID-19.

Children with any of these conditions need to be protected from exposure to COVID-19 as much as possible. If your child does not have any of these conditions, their risk of serious illness is relatively low.

However, children can be a potential driver of infection rates because they are more likely to have mild symptoms and be asymptomatic virus carriers. The possibility of children spreading the virus is the primary justification for keeping them away from crowded places like schools to slow the infection rate (flattening the curve).

During lockdowns and school closures, it is vital that we all, as parents, care for our children’s physical, mental, and emotional health. We can do this by encouraging them to continue school activities, engage in physical exercise, and practice maximum levels of hygiene like handwashing.

Why do children react differently to COVID-19?

The answer is not yet clear. Some experts think that children might not be as severely affected by COVID-19 because they often get common colds caused by other coronaviruses. Their immune systems might therefore be primed to fight off COVID-19 infection. It is also possible that children’s immune systems interact differently with the virus than adult immune systems, but research on this question is still ongoing.

In Africa, our children are more regularly exposed to various microbiomes. Presumably, they have an expanded load of gut microbiota as a result. African children may thus have an even more robust immune system to combat COVID-19 infection. However, research on this topic is still limited.

What can I do to protect myself and my children from COVID-19?

The Pfizer/BioNTech COVID-19 vaccine is available and approved for children aged 12 and older. Several other companies have started enrolling children as young as 12 in vaccine clinical trials. Studies with even younger children will also begin soon. The list of vaccines approved for children will likely grow in the months ahead.

Besides vaccination, the best thing you can do to protect your children is to follow existing public health guidelines. These guidelines include washing your hands often, practicing social distancing, cleaning and disinfecting your home, and wearing a cloth face mask in public.

It’s also essential to stay on top of your child’s immunization schedule. Don’t allow fear of the virus to prevent your child from getting their vaccines to prevent other serious illnesses, which in turn would increase their risk from COVID-19.

By Sabrina Bakeera-Kitaka

Department of Paediatrics, Makerere University College of Health Sciences, Fellow of the Uganda National Academy of Sciences (UNAS).

sabrinakitaka@gmail.com

COVID-19 has given African scientists a new momentum for sharing science advice with governments

By Esther Nakkazi 

For the last 18 months of COVID-19, governments have made science the centre of decision making and science advice and policy recommendations by scientists have presented an opportunity to deal with the pandemic. 

Delegates attending the virtual International Conference on Science Advice to Governments  in Montreal, Canada, from August 30 to September 2, heard that as policymaking will likely change, as governments learn new lessons from the pandemic in terms of science advice and science diplomacy. 

The conference was seeking to come up with some kind of blueprint for science advice at a global level because science is at the center of advising government and governments.

Salim Abdool Karim, the Director of the Center for the AIDS program of research in South Africa said he and other scientists have been quite struck at the profile of science during this pandemic. 

“I've been involved in giving scientific advice over many years, and I'm used to it being a backroom activity with those receiving it taking off what they wish. During COVID, science advice became very much front and center, because people were being directly affected and in the midst of so much uncertainty, they would much rather that the scientists were providing the guidance rather than ideology or different vested interests,” said Karim.

“The pandemic has given us the possibility to have a new momentum for science advice and to build bridges between science advices and there's an opportunity for us to position the work of science and in support to policy. So there is an opportunity for approaches, and bringing together different branches of science in support to the policy response to the pandemic,” said Stephen Quest, the Director General of the European Commission’s Joint Research Centre (JRC). 

In South Africa, as in many other countries, very early in the pandemic, governments decided to create committees of scientists to give them advice. 

“Part of our responsibility was to take the evidence that was available, little as it was and to give advice,” said Karim who was part of the 21 member scientific advisory committee. “So we saw that and a whole different way of doing things, not usually done in our governments and in that way I think that's that was impressive.”

But without the luxury of time and clear evidence, science advice for governments on the actions to be taken to control the pandemic did not go through the normal consensus and sometimes was difficult.    

“I remember the day we were trying to decide whether to institute lockdowns. When I got asked this question, I went and did a search. I went through Google looking for what is known about lockdowns, as a public health measure,” said Karim. 

He found only three documents on Google, - one was the Chinese handbook on behavior lockdown for COVID, the other in Mexico for swine flu, and a city was locked down in Sierra Leone for Ebola, that was it. “That's the sum total on evidence about lockdowns, it doesn't even feature in the two most important textbooks on public health,” he said.

With limited data to back up the advice it became apparent that countries had to collect routine information or data as part of surveillance against the pressure of time to inform the science advice and policy for their governments. 

Projects and universities have put up global panel datasets to track government policy responses to COVID-19 in almost all countries, built vaccine indicators to enable health researchers and policymakers to understand why and what is happening on the ground. 

Some researchers even had to work with mobile phone companies to track mobility patterns of citizens and map that against providing some quite useful insights in terms of the way the viruses is spreading. 

“It's all under pressure and the scientific community to find this balance between speed and quality of science. The challenge of finding comparable data remains high on the list and ensuring coordination and connection between different systems,” said Yuxi Zhang, a research fellow at the University of Oxford. 

But just as the issue of data collection is important, data protection and privacy is very important too. The pandemic has enabled collection of a lot of data for scientific work but largely this also requires a need to respect the right to privacy and to protect people's data.

In some places like within the European Union framework where strict data protection, regulatory framework is by law, the compliance is high but in other areas it is a different story.

“So for us, within the European Space it's an absolute, we have to comply with those requirements and we have to ensure that our data collection or data use or data reuse are compatible with the regulations which at times makes life complicated for the scientists, but it's a tradeoff that I think is necessary if we're going to have the trust of citizens,” said Quest.

Will science advice change after the COVID-19 pandemic: 

Scientists are optimistic that they can maintain this momentum and take some of the lessons learned but it will take resolute action on the part of the scientific community and the policy community to lock in and anchor these benefits going forward. 

“It's hard to imagine that it's going to go back to how it used to be because I think the public is very used to this idea now of scientists always talking to them, sharing science with transparency,” said Karim.

There is also a potential downside risk which is that although science is in the spotlight and people increasingly want science to give instant answers, and there's a real tradeoff between speed and quality, which requires maintaining the integrity of science, scientific excellence and being responsible. 

“I think as we have grown with this epidemic now in science advice. We've learned the art of conveying information, with its uncertainty, but in a confident way that the public can take away a clear message that doesn't leave them wondering what what's going on but they have some idea, and I think that that's, that's been happening and I've been seeing how government advisors across the world are conveying information in such a clear way now,” said Karim.

“So it is our task to combine different science based advice, and, and this one could say, balance also the different interests that are at stake. In the beginning it was purely a health related issue, but it evolved to become much broader and what we do see is that it is really difficult to have the government use science based advice on in other domains,” said Corien Prins, the Chair of the Netherlands Scientific Council for Government Policy (WRR). 

“We need to do is leverage what we've learned through the pandemic, to be better prepared for the future to have more anticipated culture. To ensure this connectivity between science and policy to ensure that we have these multi-disciplinary approaches that we really root this in to our way of doing policy in the future,” said Karim.

Ends.

 

My First Hackathon

By Esther Nakkazi

The first Hack-a-thon I attended ever was at Mbarara University of Science and Technology (MUST) in August 22nd-24th 2014. For curiosity sake, I never knew what happens at a Hack-a-thon but I was told teams made up of engineers, entrepreneurs, professors, clinicians come up with innovations that impact on global health to save millions of lives in just 48 hours!

After the opening speeches on the first day, as if to clear their heads, in the evening, everyone took to the dance floor, dancing, hands up in the air, swinging and jumping to African drum beats as if there was no work the next day. But the programme was clear, teams had 48 hours to come up with innovations and prototypes.

At this Hack-a-thon, four continents were represented; America, Europe, Asia, Africa so you can imagine the dancing strokes each of them pulled out. Then it started getting dark, then it started raining, the beer river ever flowing and they kept on dancing almost until dawn including Dr. David Bangsberg, Director at Mass General Hospital (MGH)’s Centre for Global Health and his team.

The music from the big speakers could be heard reverberating loudly across the University campus bouncing to other hills around, Mbarara being a hilly area. Looking at them, dancing away, maybe the visitors were thinking ‘the locals think we came with the rain, let us dance to it,’ while the locals thought; ‘these are great visitors, they have come with the rain! Let us drink and dance to the blessing.’

But for sure, the next morning the second annual medical technology Hack-a-thon in Uganda started promptly at 8.30 am. The winning team came up with an idea of a neonate hydraulic mechanical baby scale. They won $1,000, a seed fund to move the idea forward but five other teams won cash too.

“It is novel and can be tested,” said Dr. Bangsberg to the young enthusiastic students while announcing the winning team. “We have never had these many ideas. You have all won in the area of rapid innovations,” he added.

Most of the ideas and prototypes presented for the day were to address road safety while others were towards new born and maternal survival. Software applications for efficiency in health facilities were made but ultimately all efforts were geared towards saving more lives around the world.

This time 29 projects were presented up from 23 projects last year when the first Hack-a-thon was held at MUST and at least 200 clinicians, engineers and entrepreneurs came up with functional ideas and viable business models to commercialise their innovations that have the potential to transform health in Uganda and around the world.

It was organised by the Consortium for Affordable Medical Technologies (CAMTech) Uganda and MUST in partnership with MGH’s Centre for Global Health. Other participating groups were the Massachusetts Institute of Technology (MIT), Harvard Medical School and Vellore Institute of Technology (VIT) in India.

Hack-a-thons are a new way of coming up with innovations, they can be a messy process that generates ideas, which offer health care solutions that are commercially viable. 

Most of the participants at the MUST Hack-a-thon were students from the various Universities in Uganda most of them supported by Uganda Communications Commission (UCC) and this time round more local companies supported the event.

Events like Hack-a-thons ‘emancipate fear from young people who also become better thinkers,” said Professor Frederick Kayanja, the Vice Chancellor, MUST. He also recognised that innovations raise the profile of a University just as they are crucial to solving Africa’s problems because ‘the beneficiaries are all those who will be patients at one time or another’ which is all of us at some point.

For students ‘it changes the mindset about their education. People who did not think they were innovators become innovators,’ explains the director CAMTech, Elizabeth Bailey. And entrepreneurship skills are learnt because teams create viable business plans, she added.

In this game, failure is totally acceptable. “We believe in ‘failing fast’ nobody wants to put time and energy into something that will not work. It also offers a neutral space where people do not fear failure,” says Bailey who was so enthusiastic about the business models from all the projects.

Earlier in the day, the Mbarara University of Science and Technology co-creation laboratory was opened. Dr. Data Santorino, a lecturer at MUST and the country director CAMTech Uganda said the laboratory would give the students exposure to clinicians, entrepreneurs and offer technology support as well as basic materials like timber, mortars and electronic devices to produce functional prototypes.

Kristian Olson from Medical Director of CAMTech, was impressed that almost all teams this time round at the second Hack-a-thon made a prototype. Some used used disposable cups, straws, empty tins etc “The fact that there is so much drive and to see that many people want to solve their own problems is intangible,”said Olson.

“In time the co-creation lab gives the students a chance to learn from failures as they pivot towards success,” said Dr. Santorino.

With these kinds of events the two professors (Bangsberg and Kayanja) concurred that Mbarara University for Science and Technology could be the next Silicon Valley because it has all the right ingredients; clinicians, entrepreneurs, engineers and solid partnerships from India and the United States.

“Innovation is not a one person affair. As African innovators we need partnerships that support our weak areas. There is a lot we can contribute to Global Health because we understand global health problems better,” said Dr. Santorino.

“My dream is to see an ecosystem where an innovator can take an idea, find the right expertise to ideate it, test it, move it with small seed capital, scale it with cooperate sponsorship,” said Bangsberg.
ends-

World Bank funded shoddy renovations of COVID-19 isolation Centre rejected

By Esther Nakkazi

Renovation works at Entebbe National Isolation Centre project funded by the World Bank which would enable a regional referral hospital to have additional space for COVID-19 patients have failed to meet required standards and this could fuel spread of the pandemic.

The isolation centre funded by the World Bank to the tune of UGX 3 billion is meant to provide more space for Entebbe regional referral hospital which is grappling with limited space due to the high number of COVID-19 patients but the contractor BMK Uganda Ltd presented shoddy work according to the Ministry of Health.

During the pre-hand over inspection of the isolation centre conducted by a team of engineers and architects from the health ministry led by Eng. George Otim, the commissioner of health infrastructure, Dennis Kiberu, an Architect and Engineer Paul Kalanzi, a Mechanical Engineer mechanical and electrical engineering faults as well as carpentry and joinery defects were identified and the contractor was directed by the contractor to fix them within ten days.

The contractor was tasked to replace lights, taps, toilet pans and hand washing basins that do not meet the specifications in the bill of quantities. 

It turned out the approved samples before installation were not what was installed and although the work was slated to be completed within two months the contractor failed to meet his obligations citing lock down and mobility constraints. 

It was noted that the worktops in the kitchen and pantries, particularly in the remodeled former TB ward (Block D) should be reworked to provide space for cookers. He directed that the long neck taps be replaced because they are too high from the level of the handwashing basins and will result in spills. "People will wet their clothes while medics will wet their scrubs while washing hands," Kiberu noted.

MOH contracted BMK Uganda Ltd to refurbish the isolation and complete the works by April this year. However, due to delays in approving plans for remodeling the Tuberculosis ward, the completion date was pushed to May. The contractor was expected to hand over the site on June 11. 

Ministry of Health officials lamented that when they ask the contractor to fix the shoddy work they complain of being harassed. By June 11, the contractor had not yet completed plumbing and electrical works in some of the buildings and former TB ward. 

The ministry has revised the company's terms and wants shoddy work fixed and handed over within ten days as the isolation centre should be in use by next month. 

MOH has already started equipping the isolation centre with beds in the wards and fixed freezers in the mortuary.

Kiberu also noted that the worktops in the kitchen and pantries, particularly in the remodeled former TB ward (Block D) should be reworked to provide space for cookers. 

He directed that the long neck taps be replaced because they are too high from the level of the handwashing basins and will result in spills. "People will wet their clothes while medics will wet their scrubs while washing hands," Kiberu noted.

MOH contracted BMK Uganda Ltd to refurbish the isolation and complete the works by April this year. However, due to delays in approving plans for remodeling the Tuberculosis ward, the completion date was pushed to May. The contractor was expected to hand over the site on June 11.

However, by then, the contractor had not yet completed plumbing and electrical works in some of the buildings and former TB ward. As a result, the ministry gave the company a week to complete the works and hand over the site.

From September, renovation works stalled after the ministry cancelled the contract of Synergy Enterprises Ltd for alleged incompetence and lack of capacity to finance works. 

The work resumed in January 2021 after the World Bank and the Solicitor General approved the award of the contract to BMK Uganda Ltd for completion of the project.

The isolation centre was constructed in 2009 for infectious disease control such as SARS and Ebola. The World Bank and MOH decided to renovate the centre to create more space for intensive care, separate rooms for suspects and patients, laboratories and separate entry and exit points for the public and health workers.

Uganda registers improvement in Tuberculosis treatment success

By Esther Nakkazi

Uganda was in the for a celebratory World Tuberculosis day last month after the country recorded improved treatment success and increased TB diagnosis capacity.

Treatment success is about 82 percent of the TB patients in Uganda from 75 percent in 2018 although public health experts want a 90 percent treatment success and advise that to get to that all regions should be at the same level.

The Karamoja region in North Eastern Uganda is one of the high burden regions with a TB prevalence rate ten times higher than the national average. The treatment success rate in the Karamoja region was below 50% until an emergency response was declared in 2019. 

“Even in Karamoja sub-region 80 percent of all people treated for TB were cured in the last reporting period, up from 52 percent successfully treated at the start of 2020,” said USAID Uganda Mission Director Richard Nelson at Uganda’s World TB Day National Commemoration event in Moroto. 

TB is the world's deadliest infectious disease, infecting about 10 million people and killing 1.5 million globally each year. Uganda is among the 30 high burden TB and HIV countries in the world.

As dangerous as TB is, it is treatable and curable but in Uganda TB disease still causes illness in about 90,000 Ugandans annually including 1,500 people who get infected with drug-resistant TB. And in Uganda, about 15,600 people died from TB in Uganda in 2019.

Furthermore, in 2019, of the estimated 1,500 multidrug-resistant TB (MDR-TB) cases, only 559 were diagnosed and notified to the National TB and Leprosy Program (NTLP)

“The treatment coverage rate has improved in Karamoja improving the national rate and ending deaths due to TB has improved,” said Dr. Jane Ruth Aceng, the Minister of Health during the National World TB & Leprosy Day events held in Moroto District found in Karamoja region.

The region also became the home of the U.S. government's Accelerated Control of TB in Karamoja program or PACT Karamoja supported by the United States Agency for International Development (USAID) launched last year.

USAID's PACT Karamoja program is a $7.5 million agreement (2020-2025) that aims to address the Karamoja Region’s high TB prevalence and low treatment success rates by supporting locally generated solutions to mobilize health facilities, village health teams, and community members for accelerated screening, testing, identification, and successful treatment and prevention of TB.

In 2018, the U.S. launched the Global Accelerator to End TB to support countries in reaching the ambitious global targets of diagnosing and enrolling 40 million people on TB treatment and enrolling 30 million on TB preventive therapy by 2022.

“Everyone who is sick should get treatment. This will minimize the risk of passing the infection to others and reduce deaths in the community due to TB,” said Dr. Stavia Turyahabwe, the Assistant Commissioner for the Tuberculosis Leprosy Control Unit at the Ministry of Health.

While there is progress many people who are sick are unaware and deaths from TB are an estimate as most of the cases are not followed up. In 2019, 65,897 TB cases were diagnosed and notified to the NTLP (75 percent); this means that approximately 25,000 cases were either not diagnosed or diagnosed and not notified to the NTLP.

The government has decided to step up awareness and improve TB treatment-seeking behavior. According to the Ministry of Health in Uganda, only 46% of the population is aware of TB and about 40% of the people with signs and symptoms of TB do not seek care for TB services.

“We are instituting mortality TB audits. Although we cannot stop death completely, we can save some lives by understanding the circumstances around death,” said Dr. Turyahabwe.

She said death is occurring in the first few days of initiation of treatment but this is due to delayed diagnosis, limited awareness of the disease and not completing treatment.

“We are also encouraging our facilities that have big numbers of patients to have clinic days so that patients come on appointment and are seen on specific days and share information among themselves,” said Dr. Turyahabwe. This will improve adherence and reduce stigma.

Supported by USAID and other development partners, Uganda has also made milestones in the Treatment Success Rate of Multidrug-Resistant TB (MDR-TB) treatment due to increased roll-out of GeneXpert machines, decentralization of MDR-TB care to regional referral hospitals, and improvements made to the specimen transport system.

Uganda also has the national TB Supranational reference laboratory which is responsible for testing samples that are suspected to be MDR of those that are supposed to have sensitivity for different drugs. The Supranational reference laboratory receives samples from over 22 countries across Africa and is a regional center of excellence, receiving samples for reference testing. 

“We have expanded diagnostics like GeneXpert technology from less than 50 machines to over 280 GeneXpert instruments. Although we continue to use our conventional methods of smear microscopy for follow-up with patients on TB treatment, the GeneXpert technology has eased so much in this finding of tuberculosis,” said Dr. Diana Atwine, the permanent secretary at the Ministry of Health.

However, the Ministry acknowledged that an increased rollout of GeneXpert instruments is required and strengthening of the specimen transport system is required as well as increasing access to X-Ray and radiology services in the country including making the services available at the community level through targeted outreach programs would create better outcomes.

Among the challenges, Uganda is facing is increasing mortality among TB/HIV co-infected patients.
About 8,500 people died of TB/HIV in 2019. The ministry of health intends to improve case finding and treatment of people co-infected with TB/HIV and reduce deaths.

Dr. Atwine said they have introduced testing for TB using urine for people living with HIV who are severely ill and unable to produce sputum which too has eased the diagnosis.

In the Karamoja region, while officiating at the World TB day, Dr. Aceng urged community leaders to support the TB program for sustainability. The Ministry of Health which she heads also wants more community engagement and has implemented a National TB Civil Society Organization (CSO) Engagement strategy as well as approved the National Community TB Operational Guidelines in 2019.

With the engagement of community actors studies have demonstrated that these can contribute to increased TB case-finding, TB Preventive Therapy (TPT) uptake, TB treatment support and retention, and awareness about TB. For example, in 2019, 25 percent of TB cases notified in three USAID-supported districts were referred by community actors.

“As individuals, raise awareness about TB, encourage people to seek help early, and support those in care to complete treatment. Support every person with TB to complete treatment for TB,” said U.S. Centers for Disease Control and Prevention (CDC) country director for Uganda Lisa Nelson speaking at the event in Moroto.

Over the last 12 months, there was a 43 percent increase in the number of TB cases identified and a more than doubling in the number of cases successfully treated compared to the prior year. 

This is an important milestone to achieve during the first year of PACT Karamoja implementation amidst COVID-19 in a region with a high burden and past low performance, said Nelson. 

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