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96 Global Health NOW: Lebanese Hospitals on Alert; Malaria Becomes ‘Ancient History’ in Egypt; and Switching Sides on the Tobacco Fight October 23, 2024 Lebanese forces take security measures around Rafik Hariri University Hospital in Beirut on October 22, after an Israeli attack near the area. Houssam Shbaro/Anadolu via Getty Lebanese Hospitals on Alert as Strikes Intensify 
  UN officials are urging protections for health care facilities in Lebanon after an Israeli airstrike Tuesday near the Rafik Hariri University Hospital—迟丑别 largest public hospital in Lebanon—led to “significant damage,” .

Another hospital, the Al-Sahel Hospital in Dahiyeh, was evacuated amid “horror and tears” after Israel claimed that Hezbollah is stockpiling cash and gold in a bunker under the hospital, increasing fears that Lebanon’s health sector could face the same destruction as Gaza’s, .

Other mounting health risks: 400,000+ displaced Lebanese children face growing risk of cholera, scabies, and waterborne diseases due to unsanitary conditions in shelters, .

• Last week, health authorities Northern Lebanon’s first case of cholera. 

Meanwhile in Gaza: Escalating violence across northern Gaza has forced the postponement of the polio vaccination campaign’s final phase, .

• And the WHO led a “high risk” in northern Gaza to transfer patients to Gaza City this week amid intense hostilities and the denial of deliveries of critical medical supplies, blood, and fuel.

GLOBAL HEALTH VOICES The Latest One-Liners   New stroke prevention guidelines from the American Stroke Association for the first time call out specific risks faced by women and gender-diverse individuals taking the hormone estrogen; also call for screening for and addressing social determinants of health.

Girls and young women may be more susceptible to the clade Ib mpox subvariant, that found a higher percentage of cases and a much earlier average age of infection—6 years—among girls, compared with 17.5 years for boys.
 
An E. coli outbreak linked to McDonald’s Quarter Pounder hamburgers has sickened at least 49 people in 10 U.S. states, leading to one death and 10 hospitalizations, the yesterday; investigators are focused on onions and beef as potential sources of contamination.

The U.S. Department of Agriculture weakened its bird flu emergency order last spring in response to pushback from state and industry officials—potentially contributing to disease transmission across state lines, records show. GOOD NEWS Malaria Becomes ‘Ancient History’ in Egypt   
After three years of interruption to the transmission chain in Egypt, the country malaria-free.

• The country had a prevalence of ~40% in 1930—but public health officials made strides over the last century, . 

How they did it, :

• Free diagnosis and treatment, regardless of legal status. 


• Malaria detection training for health professionals.


• Malaria screenings provided at the country’s borders. 

Vigilance to continue: The health ministry pledges to guard its malaria-free status through surveillance, integrated vector management, and rapid response to imported cases.
 
The Quote: "Malaria is as old as Egyptian civilization itself, but the disease that plagued pharaohs now belongs to its history,” said WHO chief Tedros Adhanom Ghebreyesus. GLOBAL HEALTH VOICES BIG TOBACCO Switching Sides on the Tobacco Fight 
As the FDA fights an “epic struggle” against the tobacco industry over next-generation nicotine products, the agency is contending with a particularly galling dynamic: lawyers who have shifted alliances. 

Nearly two dozen FDA lawyers have left the FDA’s tobacco regulation arm to advise, litigate for, or work with the tobacco and vaping industry over the last 15 years, according to a review by The Examination.

Insider advantage: The lawyers often helped craft and defend the same regulations the industry is fighting—giving them a powerful upper hand in litigation.

• “It seems like every time we get sued in the tobacco industry, a former FDA lawyer is leading the lawsuit,” FDA Commissioner Robert Califf told an oversight organization last year. 

CLIMATE CRISIS Climate Change’s Psychological Toll
Climate-related changes threaten more than people’s physical safety and livelihoods. These changes also act as a “threat multiplier,” increasing risks for mental health problems. 

• Survivors of California’s 2018 Camp wildfire were diagnosed with PTSD at a rate comparable to war veterans.


• Slower-onset changes like drought, land cover change, rising sea levels, etc., can cause stress over time that erupts into violence like 2019’s Ogossagou massacre in Mali.

A hefty price tag: Mental disorders due to climate, pollution, and environment-related causes could cost the global economy $47 billion annually by 2030. 

To address these issues, researchers are pushing for mental health to be a focus in climate policy and interventions, such as in countries’ Paris Accord climate action plans.

OPPORTUNITY QUICK HITS Polio Anywhere is a Threat Everywhere: Why the UK Must Act –

Dengue fever: with a record 12.4m cases in 2024 so far, what is driving the world’s largest outbreak? –

Ukraine: Population drops by 10 million since Russia invaded in 2014, UNFPA reports –

Elderly Americans with dementia have become some of the GOP’s top donors without even realizing it –

Beyond Longevity: The Critical Role of Mental Health in Japan’s Well-Being –

How one woman set up a mental health helpline for the whole of South Africa –

How does the brain react to birth control? A researcher scanned herself 75 times to find out –

Coke, Twinkies, Skittles, and … Whole-Grain Bread? – Issue No. 2802
Global Health NOW is an initiative of Johns Hopkins Bloomberg School of Public Health.

Contributors include Brian W. Simpson, MPH, Dayna Kerecman Myers, Annalies Winny, Morgan Coulson, Kate Belz, Melissa Hartman, Jackie Powder, Aliza Rosen, and Rin Swann. Write us: dkerecm1@jhu.edu, like us on and follow us on Instagram and X .

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96 Global Health NOW: The Push to Prevent Drownings in Uganda; Switching Sides on the Tobacco Fight; and Heeding Africa’s Hearing Loss October 22, 2024 GHN EXCLUSIVE Bystanders watch rescuers search the site of a capsized cruise boat on Lake Victoria near Mutima village, south of Kampala, Uganda. November 25, 2018. Isaac Kasamani/AFP/Getty The Push to Prevent Drownings in Uganda
KAMPALA, Uganda—Every year, —people like Owen Ntanda, an 18-year-old boat operator who drowned in the lake last summer, despite being a good swimmer—giving the lake a reputation as one of the “” in the world.

• by researchers at Makerere University and the CDC estimated Uganda’s drowning death rate to be 8.5 per 100,000 population per year—~2,942 drowning deaths a year. 


• Worldwide, . But in Uganda, young adults aged 20–39 years are most affected, —and men in Uganda are 3X more likely to drown than women. 

Behind Uganda’s high drowning rate:

• A lack of safety gear like life jackets—most of which are substandard.


• Overloaded cargo boats—which are not well-policed.


• Supercharged floods fueled by climate change.

Steps toward change:

• Uganda will become one of the first countries to implement a national drowning intervention strategy—expected to launch this fall—giving each stakeholder ministry a mandate and drowning prevention activities.

• The Ministry of Health has established emergency response services focused on water emergencies, boosting first aid training, and procuring water boat ambulances.

Ed. Note: This article is part of , made possible through the generous support of loyal GHN readers. Kyra Guy of USC’s Keck School of Medicine won an honorable mention for entering the idea for this story in the 2024 Untold Global Health Stories contest, co-sponsored by GHN and CUGH, which is now accepting nominations for the 2025 round. ! GLOBAL HEALTH VOICES The Latest One-Liners   A large proportion of sub-Saharan African teens with severe asthma are missing out on diagnosis and treatment, of 27,000 students from urban areas in Malawi, South Africa, Zimbabwe, Uganda, Ghana, and Nigeria; of ~3,000+ reporting symptoms, just ~600 had a formal diagnosis.

School administrators in Mexico have six months to implement a government-sponsored ban on junk foods like sugary fruit drinks and chips or face heavy fines between $545 and $5,450, which could double for a second offense.

Washington state its first suspected avian flu infections in people—four agricultural workers who tested positive after working with infected poultry at a facility that culled ~800,000 birds that tested positive for avian flu last week.

U.S. infant mortality was higher than expected in the months following the Supreme Court decision that eliminated federal abortion protections, , corresponding with a 7% absolute increase in infant mortality overall, representing 247 excess deaths. DATA POINT VIOLENCE A Public Health Approach to Political Violence 
As political rhetoric grows more incendiary leading up to the first U.S. presidential election since the January 6, 2021 insurrection, the at the University of California at Davis has begun to study the threat of political violence in earnest. 

A key goal of their research: Identify risk factors and interventions that could deescalate potential unrest before it arises. 

“Openness to change”: According to a from the program released last month, just 3.7% respondents said it was “very likely” that they would participate as a combatant in a large-scale civil conflict—but ~44% said they would be “not likely” to join if they were dissuaded by family members, and ~30% said they could be deterred from participating if a respected religious leader urged them not to.

Such findings can “guide prevention efforts,” the survey concluded.

HEALTH DISPARITIES Heeding Africa’s Hearing Loss
54 million people in Africa are facing hearing loss by 2030, due to factors including a shortage of hearing specialists and a limited budget for ear and hearing care (EHC).

• Up to 75% of child hearing loss in LMICs is preventable.

• Only 10% of the 33 million people who need hearing aids have access and can afford them. 

• Hearing loss costs Africa an estimated $27 billion per year, in terms of the impact on human lives and economies. 

Solutions: pushes for EHC policies and implementation—urging more dedicated funding, better-equipped facilities, and exploration of public-private partnerships. 
 
OPPORTUNITY QUICK HITS Committee reviewing euthanasia in Canada finds some deaths driven by homelessness fears, isolation –

A Maine Law Could Have Forced the Lewiston Mass Shooter Into Mental Health Treatment. Why Wasn’t It Used? –  

China unveils first diagnosis guidelines to battle escalating obesity crisis –

Medicaid will cover traditional healing practices for Native Americans in 4 states –

Ending “domestic helicopter research” –

As Ukraine's birth rate plunges, here's what one doctor is doing to reverse the trend –

The Perverse Consequences of Tuition-Free Medical School – Issue No. 2801
Global Health NOW is an initiative of Johns Hopkins Bloomberg School of Public Health.

Contributors include Brian W. Simpson, MPH, Dayna Kerecman Myers, Annalies Winny, Morgan Coulson, Kate Belz, Melissa Hartman, Jackie Powder, Aliza Rosen, and Rin Swann. Write us: dkerecm1@jhu.edu, like us on and follow us on Instagram and X .

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96 Global Health NOW: Barriers to Polio Vaccination; The Overdose Vaccine ‘Moon Shot’ and Where Early Education is Enshrined October 21, 2024 A child looks on before receiving a vaccination for polio in Khan Yunis, in the southern Gaza Strip, on September 5. Bashar Taleb/AFP via Getty Barriers to Polio Vaccination ‘Leaving Children Vulnerable’
While health workers in Pakistan battle a growing polio outbreak, polio vaccination teams in Gaza are also contending with widening obstacles.

In Pakistan: Health officials have confirmed six more cases of wild poliovirus type 1, bringing the total number of infected children this year to 39—after just six cases last year, .  

• Vaccine hesitancy and attacks against vaccination teams have increased as hardline clerics and militants spread misinformation about the vaccine’s safety, “leading to missed opportunities for immunization and leaving children vulnerable,” said Melissa Corkum, chief of UNICEF’s polio team in Pakistan. 


• Pakistan will launch a nationwide vaccination campaign next week to vaccinate 45 million+ children. 

In Gaza: Today the UN and WHO launched the second round of a widespread polio vaccination campaign in Gaza, targeting 590,000 children with booster doses, .

• But conditions have deteriorated in the enclave since the first round of vaccinations—making it more difficult for families to travel to vaccination sites amid destroyed infrastructure and increased safety concerns. 


• And health workers are concerned polio vaccines won’t reach Gaza’s northern communities because of ongoing fighting and fears for health workers’ safety, .

GLOBAL HEALTH VOICES The Latest One-Liners   The global oral cholera vaccine stockpile has been depleted, the WHO said Friday, jeopardizing outbreak response amid a 126% rise in cholera mortality from January 1 to September 29 across five WHO regions.

Whooping cough cases in the U.S. have hit their highest number—18,506—since 2014; outbreaks of the disease, which can be prevented by vaccination, are hitting mostly older kids and teens.

Women seeking pain relief at emergency departments can wait 30 minutes longer than men, per a published in PNAS that assessed 22,000 discharge notes from emergency departments in the U.S. and Israel.

Over-the-counter contraceptives could be required to be covered by U.S. health insurers without cost-sharing, according to a new proposal the Biden administration unveiled today. OPIOID CRISIS The Overdose Vaccine ‘Moon Shot’ 
Efforts to prevent opioid overdose with a vaccine have largely been fruitless—until now. A number of opioid overdose vaccines are currently being tested, all relying on the same basic strategy:

• Stimulate the immune system to protect against an opioid’s ability to overwhelm the brain and shut down the breathing process.

How it works: Portions of the fentanyl molecule are linked to proteins the body recognizes in order to trigger an immune response.

Also underway: The first fentanyl monoclonal antibody is undergoing human trials, with initial published in Nature Communications showing that monkeys treated with the antibody survived a lethal dose of fentanyl.

The Quote: “It’s a moon shot, but a moon shot is what the country needs right now,” said JR Rhan, co-founder of startup Ovax, which is developing an opioid overdose vaccine.

GLOBAL HEALTH VOICES WEST NILE VIRUS Ukraine’s Viral Threat
West Nile virus has killed 11 people and sickened 88 in Ukraine over the last three months—marking a “serious” new threat to the country that will likely become more common with climate change, said Ukraine's Deputy Health Minister.

• “We probably have to get used to the fact that this fever will be in even greater numbers in Ukraine,” Ihor Kuzin said.

Growing hotspot: Outbreaks are typically found on bird migratory routes, and Ukraine is a stop along several such flight paths, explained Kuzin.

CHILD & ADOLESCENT HEALTH Where Early Education is Enshrined 
In Norway, the “intrinsic value” of childhood is upheld in the 63-page Kindergarten Act of 2006, a law guaranteeing every child’s right to attend kindergarten.

These schools, serving children 5 and under, are seen “as an investment for society and the child,” said Kristin Aasta Morken, a program leader in Oslo.

As such, Norwegian kindergartens are:

• Publicly funded: National funds cover 85% of operating costs.


• Inclusive: Children with disabilities are not segregated, and non-Norwegian speakers are given communication aids.


• Embracing nature: Children spend 70% of their kindergarten time outside, in all weather—in keeping with the Norwegian saying: “There is no bad weather, just bad clothes.”

RESOURCE QUICK HITS ‘One-man anti-abortion army’: shadow of US global gag rule looms over Nepal’s family planning services –

China ends international adoption. Reactions range from shock to relief –

Under a L.A. Freeway, a Psychiatric Rescue Mission –

Tobacco Sponsorship of F1 Could Put Children on a Fast Track to Addiction –

Nut bans little help to allergic air passengers –

Life-saving spongelike 'bandage' rapidly stops hemorrhaging and mitigates risk of infection – Issue No. 2800
Global Health NOW is an initiative of Johns Hopkins Bloomberg School of Public Health.

Contributors include Brian W. Simpson, MPH, Dayna Kerecman Myers, Annalies Winny, Morgan Coulson, Kate Belz, Melissa Hartman, Jackie Powder, Aliza Rosen, and Rin Swann. Write us: dkerecm1@jhu.edu, like us on and follow us on Instagram and X .

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96 Global Health NOW: Rwanda’s Marburg Vaccine Quandary; War-Torn Sudan’s Medical Training Nightmare; and A ‘Conker’-Versial Victory October 17, 2024 Sabin Vaccine Institute delivered 700 doses of its Marburg vaccine to Rwanda on Oct. 5.
Photo Courtesy of the Sabin Vaccine Institute Rwanda’s Marburg Vaccine Quandary 
As Rwanda rushes to contain the third biggest outbreak of the fatal Marburg virus ever, it has quickly greenlit experimental vaccines and treatments.

But officials have taken divergent routes in deploying those, approving the first-ever clinical trial for a Marburg treatment, while rejecting a similar trial for vaccines, . 

This reflects an “agonizingly difficult” debate:

• Marburg outbreaks are rare and small—Rwanda has confirmed 62 cases and 15 deaths—meaning there are few opportunities to test vaccine efficacy.


• Yet the virus is lethal, with ~80% of cases affecting health care workers, which “weakens the area’s overall health infrastructure,” virologist Kari Debbink explained to “Public Health on Call.”

Ultimately, the government elected to “move fast to protect the front-line workers” by rejecting the trial and giving them access to the vaccine—but some public health leaders see this as a missed opportunity in overall vaccine development.

The vaccine: Rwanda has received 1,700 doses of an experimental vaccine from the Sabin Vaccine Institute, and ~700 people have been vaccinated—primarily health care workers and contacts of those infected.

The therapy trial: The Rwandan government has agreed to proceed with a WHO-led randomized clinical trial to test the antiviral drug remdesivir and a monoclonal antibody against Marburg, . GLOBAL HEALTH VOICES The Latest One-Liners  

The U.S. FDA put a hold on Novavax’s application to advance its combination COVID-19 and influenza vaccine after a trial participant reported a serious adverse event—a form of nerve damage—last month; the patient received the combination shot in a phase two trial that finished in July last year.

 
Italy has criminalized surrogacy overseas, levying jail time and steep fines for citizens who go abroad to have children via surrogate in a move opponents described as “medieval” and discriminatory to same-sex couples.

Breast cancer risk is “slightly higher” for women with hormonal IUDs, finds a large study published in ; the findings align with similar risks tied to taking long-term hormonal birth control pills.

Western Pacific nations are failing to meet UN targets to reduce premature deaths from lifestyle-related diseases like cancer and diabetes by 2030, —largely due to a slow decline in tobacco and alcohol consumption. GHN EXCLUSIVE COMMENTARY Doctors consult with patients in a clinic in a camp for internally displaced people in South Kordofan, Sudan, on June 17. Guy Peterson / AFP via Getty War-Torn Sudan’s Medical Training Nightmare   The ongoing conflict in Sudan has not only pushed public services beyond the point of collapse, it has disrupted medical training and licensing, with lasting consequences for the country’s health care workforce, write three Sudanese medical professionals in an .

• Medical education in much of the country has halted because of the destruction of medical schools and hospitals.


• Medical students and interns have emigrated—worsening the long-standing brain drain of medical professionals.

Remarkable resilience:

• Physicians are still training interns and students.


• Displaced physicians are establishing specialty units in neurosurgery and orthopedics, for example, in remote hospitals.

But:

• Disruptions in medical training have compromised the national public health infrastructure, exacerbating the country’s overwhelming health needs.


• Broken health systems will continue to undermine public health even after the war ceases.

What needs to happen now:

• International agencies and organizations need to join now with Sudanese partners to revitalize medical training in the country.


• Sudan must act as soon as possible to avoid future physician shortages by facilitating resident transfers to other in-country residency programs with better security and additional capacity.

GLOBAL HEALTH VOICES CLIMATE CRISIS Disparities in South Africa Extend to Heat Impacts
In a country with income inequality, a recent temperature-mapping study found that heat also impacts neighborhoods very differently: Overall, townships were 6?C (42.8?F) hotter than wealthier suburbs.

Environmental factors: Under the hot sun, tree cover allows for evaporative cooling. The suburb of Waterkloof has 54.1% tree cover—compared to only 2.6% in the neighboring township of Mamelodi.

Structural inequality: Township residents often live in makeshift steel shacks that trap heat and can reach up to 48.5?C (119?F) inside.

Extreme heat can cause heat stroke, dehydration, and heat exhaustion, and exacerbate respiratory problems.

ALMOST FRIDAY DIVERSION A ‘Conker’-Versial Victory  
An English town—and chestnut enthusiasts everywhere—has been roiled by a spot of scandal after the winner of the World Conker Championships was accused of cheating.
 
The beloved autumn tradition in the village of Southwick involves stringing up chestnuts and hurling them at one another until one competitor is obliterated. But this year, “King Conker”—82-year-old David Jakins—was caught with a steel conker in his pocket after winning the contest.

• According to , Jakins’ opponent claimed that his own conker “disintegrated in one hit" when he faced Jakins. “That doesn’t just happen.”

• The case will be a tough nut to crack: Jakins claims he carries the steel conker as a joke. That old chestnut…

But if he is indeed a chestnut cheater, Jakins is more than welcome in the conker battle royale of South London—a lawless, “anything-goes” competition where cheating is actively encouraged, . QUICK HITS Imperial modelling shows 100 Days Mission could have saved 8 million lives –

Six people sought new organs. They ended up with HIV. –

Kidney transplantation between donors and recipients with HIV is safe –

War’s Public Health Impacts Are Vast. Tallying Them Is Difficult. –

People are catching avian flu from wild birds, study suggests –

South Australia’s upper house narrowly rejects ‘Trumpian’ bill to wind back abortion care –

CDC issues interim recommendations to prevent sexual Oropouche virus spread –

‘Smart’ insulin prevents diabetic highs — and deadly lows –

6 Things to Eat to Reduce Your Cancer Risk – Issue No. 2799
Global Health NOW is an initiative of Johns Hopkins Bloomberg School of Public Health.

Contributors include Brian W. Simpson, MPH, Dayna Kerecman Myers, Annalies Winny, Morgan Coulson, Kate Belz, Melissa Hartman, Jackie Powder, Aliza Rosen, and Rin Swann. Write us: dkerecm1@jhu.edu, like us on and follow us on Instagram and X .

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96 Global Health NOW: Halving Premature Mortality Rates; Thalassemia’s Strain on Blood Supplies; and Enter the Untold Global Health Stories Contest! October 16, 2024 A Sudanese patient with kidney failure undergoing dialysis at the Soba Hospital in southern Khartoum. June 3, 2023. AFP via Getty Halving Premature Mortality Rates: ‘A Prize Within Reach’
All countries—even those afflicted by poverty and conflict—can cut their premature death rates in half by 2050 through a series of policy priorities, posits a new Lancet presented at the closing of the in Berlin.

The roadmap, dubbed “50 by 50,” argues that steady focus on 15 “priority conditions”—including infectious diseases like tuberculosis, noncommunicable diseases, and other issues such as accidents and suicide—is the key to dramatically improved mortality rates.

• “It’s a prize within reach,” said the report’s lead author, Gavin Yamey of the .

Other high-impact efforts:

• Tackling tobacco: High tobacco taxes are “by far” the most crucial policy tool for reducing premature deaths.


• Improving medical access: Subsidizing essential medicines and vaccines and expanding childhood immunizations can lead to “significant gains.”

If the global goal is met, a person born in 2050 would have a 15% chance of dying before age 70—down from 31% for someone born in 2019, “meaning dramatic improvements for billions,” . GLOBAL HEALTH VOICES The Latest One-Liners   23 attacks on hospitals and health workers in Lebanon have led to 72 deaths and 43 injuries among health workers and patients since mid-September—putting health facilities “under massive strain.”

Five new suspected human cases of bird flu have been , adding to six confirmed cases in the state, the U.S.’s largest dairy supplier.

Novo Nordisk is halting its insulin pen production, the company told governments and nonprofit organizations—a move critics say was made to scale up the production of more profitable injectable weight-loss drugs.

Vaccine-derived poliovirus type 3 has been detected in wastewater samples in French Guiana, per a that urged nearby countries to keep vaccination levels above 95% to minimize the risk of outbreaks. GHN EXCLUSIVE OPPORTUNITY Workers collect freshly picked marigold flowers to sell. August 13, Qujing, China. Wang Yong/VCG via Getty Send Us Your Story Ideas! 
Do you know of a global health story that the media is overlooking? The , co-sponsored by the Consortium of Universities for Global Health and GHN, is open and ready for your entries!
 
How it works:

• you feel deserves urgent attention, describing the story and why it deserves more coverage and support in 150 words or less.


• The best nominations focus on a specific issue in a specific location (i.e., not global chronic disease) and include available data, evidence, and contact information.

The win-win: If we choose your issue, we’ll provide a platform to expand the audience for your issue in GHN and through CUGH’s network.
 
Bonus: The grand-prize winner will receive a free registration to CUGH’s annual meeting in February in Atlanta.

Deadline: Enter by November 15, 2024, at 11:59 p.m. EST. BLOOD DISORDERS Thalassemia’s Strain on Blood Supplies
  People with the genetic blood disorder thalassemia are not able to produce a sufficient amount of hemoglobin and require regular blood transfusions to prevent debilitating anemia. 

In Southeast Asia, the condition is so prevalent that more than a third of blood supplies go toward such transfusions.

• In Thailand and Laos, 30%–40% of donated blood is used to treat thalassemia patients. 

“We need blood banks for accidents, for childbirth, for dengue fever, hemodialysis, cancer and other diseases. But treating thalassemia is the single biggest use,” said Chanthala Souksakhone, head of the National Blood Institute at the Lao Red Cross.

GLOBAL HEALTH VOICES CLIMATE CRISIS In Defense of Biodiversity
Zoonotic diseases—caused by pathogens that spill over from animals to humans, like Ebola, mpox, and Lyme—sicken 2.5 billion people and kill 2.7 million every year. As global temperatures rise and humans disrupt ecosystems, the risk of these diseases is expected to rise.

• Deforestation, for instance, increases human encounters with animals acting as disease reservoirs, while climate change makes new regions hospitable to disease vectors like mosquitoes and ticks.

Natural barriers: Diverse ecosystems safeguard humans against a panoply of zoonotic illnesses by diluting the intensity of pathogen transmission among many species.

“We need to appreciate the value that the natural world offers to humanity, from an infectious disease-mitigation standpoint,” says University of Notre Dame professor Jason Rohr.

QUICK HITS Female Genital Mutilation Happens in America, Too – Thanks for the tip, Chiara Jaffe!

Millions of aging Americans are facing dementia by themselves –

France's Airports Report Increased Odyssean Malaria Cases –

State supreme court races could determine abortion access in several states –

Employers should be fined for unhealthy workplaces, says think tank –

Ukraine: Time to recognise ‘tremendous potential’ of demining –

Using genomics to find solutions to malaria –

A new way to support grandparents raising kids affected by the addiction epidemic – ?? Issue No. 2798
Global Health NOW is an initiative of Johns Hopkins Bloomberg School of Public Health.

Contributors include Brian W. Simpson, MPH, Dayna Kerecman Myers, Annalies Winny, Morgan Coulson, Kate Belz, Melissa Hartman, Jackie Powder, Aliza Rosen, and Rin Swann. Write us: dkerecm1@jhu.edu, like us on and follow us on Instagram and X .

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96 Global Health NOW: Russian Propaganda Targets Anti-Malaria Efforts; South Africa’s Femicide Crisis; and How DEI Hostility Affects Health Research October 15, 2024 Russian Propaganda Takes Aim at West African Anti-Malaria Programs
Pro-Russian propagandists are targeting Western-funded health care programs in Africa, spreading disinformation aimed at undermining scientists fighting malaria and other infectious diseases on the continent. 

A must-read New York Times report details a chilling example: Egountchi Behanzin, a French-Togolese activist, claimed on social media that malaria and dengue fever cases increased in Bana, Burkina Faso, after Target Malaria—a Gates Foundation-backed nonprofit—released genetically modified mosquitoes in the village in 2019.

• Village elders say they were consulted on the experiment, designed to create a species of mosquito that is unable to transmit malaria—and that malaria cases have actually fallen since the study’s launch.


• Behanzin—who denies receiving Russian funding, but often posts pro-Russian content—couldn’t provide any evidence to support his claims.

Part of a pattern: According to the U.S. State Department, Kremlin-paid African influencers and news outlets and Russian state-controlled media amplify each other—capitalizing on weakened trust in the West while silencing independent journalists.

• Russia has sponsored 80 documented disinformation campaigns in 22 African countries since 2022, per the Africa Center for Strategic Studies.

Lives at stake: “Any claims that our initiatives contribute to the spread of diseases are unfounded and detract from the critical goal of saving lives,” says Paulin Basinga, the Gates Foundation’s director for Africa.

GLOBAL HEALTH VOICES The Latest One-Liners   Nearly two million severely malnourished children are at risk of dying due to therapeutic food shortages in 12 hard-hit countries: Mali, Nigeria, Niger, and Chad have already run out of the high-protein ready-to-use food, or will soon; 8 more countries including Sudan, South Sudan, and DRC could run out by mid-2025.

Massive regional flooding has kept ~10 million children across Nigeria, Mali, Niger, and the DRC out of school this fall; the floods have displaced nearly one million people.

10 million pounds of ready-to-eat meat and poultry products made at an Oklahoma plant have been recalled by the company BrucePac of Oregon, after routine testing by U.S. Agriculture Department officials detected listeria bacteria, which can cause illness and death.

Adolescents between 12 and 18 with obesity given GLP1R treatments had a 33% lower risk of suicidal ideation or attempts compared to those treated with behavioral interventions in a study of 6,912 young people in Israel. DATA POINT VIOLENCE South Africa’s Femicide Crisis 
South Africa continues to have some of the highest femicide rates in the world—with intimate partner violence continuing to take a “devastating” toll, according to findings from the South African Medical Research Council’s new on femicide and intimate partner violence.

By the numbers:

• South Africa’s rate for intimate partner femicide is at 5.5 — almost 5X higher than in the rest of the world. 


• 60% of women murdered in 2020-2021 were killed by an intimate partner. 


• The Eastern Cape province has the highest rates for femicide, at almost 2X the country’s overall rate. 

No justice: The study also found “significant gaps” in convictions for such killings.

GHN EXCLUSIVE: TRANSLATED A statue to remember the victims in Bhopal, India. August 25, 2022. Pallava Bagla/Corbis via Getty Read “Bhopal: A Tale of Two Tragedies” in Chinese
We’re pleased to share another installment of GHN articles translated into Chinese, courtesy of our collaboration with the translation program at Queen’s University Belfast.
 
of Pranab Chatterjee’s piece, Bhopal: A Tale of Two Tragedies, on February 28, 2024.

Special thanks to: Chen-En (Ted) Ho, FHEA, senior lecturer at the Centre for Translation and Interpreting; Queen’s University Belfast translators Xinchen Li and Zhiwen Liu (翻译：李昕辰、刘至文); and reviewers: Yingren Wang and Yifan Wang (审校：王英人、王怡凡). GLOBAL HEALTH VOICES RACISM How DEI Hostility Affects Health Research 
U.S. institutes and initiatives created to research racism’s effects on health have increasingly found themselves under attack as the conservative backlash to DEI efforts leads to lawsuits, threats, and imperiled funding. 

Among the impacts:

• Researchers and instructors have found themselves on right wing “watchlists” for teaching on racism and public health.

• Some grant-making organizations are now asking some researchers to stop using the word “racism” when investigating public health inequities. 

• State lawmakers have introduced at least 85 anti-DEI bills since 2023.

• The Medical Board of California has been sued for requiring continuing medical education courses to include implicit-bias training.

“It’s very taxing. This anti-DEI movement creates a climate of fear,” said Chandra L. Ford, founding director of the Center for the Study of Racism, Social Justice & Health.

QUICK HITS US$ 1 billion in new and reaffirmed funding commitments announced for WHO’s ongoing Investment Round –

130,000 U.S. cancer cases went undiagnosed in Covid pandemic, study finds –

Hurricanes set new normal for hospital disaster prep –

CDC details 2023 trichinellosis outbreak linked to undercooked bear meat –

How Overdose Prevention Centers Became Political Scapegoats –

AI scans RNA ‘dark matter’ and uncovers 70,000 new viruses –

From Hurricane Milton to world hunger: How to make your donations count –

Public Health Has a Blueberry-Banana Problem – Issue No. 2797
Global Health NOW is an initiative of Johns Hopkins Bloomberg School of Public Health.

Contributors include Brian W. Simpson, MPH, Dayna Kerecman Myers, Annalies Winny, Morgan Coulson, Kate Belz, Melissa Hartman, Jackie Powder, Aliza Rosen, and Rin Swann. Write us: dkerecm1@jhu.edu, like us on and follow us on Instagram and X .

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96 Global Health NOW: ‘War Is Everywhere’ in Sudan; Gangs Infiltrate the Amazon Basin; and Tapping Into Traditional Wells October 14, 2024 ‘War Is Everywhere’ in Sudan 
Escalating violence in Sudan’s North Darfur region has forced Médecins Sans Frontières to suspend its work in a major camp for displaced people—putting thousands of malnourished children at risk of death, .

• MSF was forced to halt work at the Zamzam camp—where 300,000 people live—following supply blockades and a new wave of violence between Rapid Support Forces (RSF) and the Sudanese army around the city of Al Fasher. 


• “We’re not talking about an emergency anymore. We’re talking about a nightmare,” said MSF coordinator Claire San Filippo, who described no escape for people in the region, where “war is everywhere,” .

Born into war: 2 million+ babies are estimated to have been born amidst the conflict, according to by Save the Children—and all face “dangerous and irreversible consequences” of famine and a collapsing health system, . 

Women’s acute, unmet needs: Millions of Sudanese women are suffering from a lack of sexual and reproductive health services, even as sexual violence continues to be widespread, . 

Spillover to South Sudan: The number of Sudanese refugees in South Sudan has now surpassed half a million, . GLOBAL HEALTH VOICES The Latest One-Liners   Recoveries are outpacing fatalities in Rwanda’s Marburg outbreak, the health ministry reported yesterday; the toll has reached 61 infections, 14 deaths, 18 recoveries, and 29 cases still under treatment, while 620 vaccine doses have been administered to frontline workers.
 
Four countries reported new polio cases last week, including Pakistan (wild poliovirus cases) and Angola, Nigeria, and South Sudan (vaccine-derived cases), ; Spain and French Guiana also reported positive environmental samples of vaccine-derived polio—a first for both countries.

A third of oral cancer cases worldwide have been linked to smokeless tobacco products, per a major published in Lancet Oncology.

Climate-crisis health impacts will receive more focus at medical schools across Europe, with future doctors undergoing more training on mosquito-borne diseases, heatstroke, and asthma management. VIOLENCE Gangs Infiltrate the Amazon Basin
Drug syndicates that have driven Brazil’s growing homicide surge in cities are extending their reach to the Amazon Basin, creating a public security crisis as gangs try to control local markets.

• In 2023, the homicide rate in the rainforest region hit 34 per 100,000 people, compared to 22.8 per 100,000 nationwide.

• Four of Brazil’s 15 most dangerous cities are in the Amazon region as armed robbery, kidnapping, extortion, and murder—notably femicide—have proliferated. 

Overcrowded prisons: In packed and dysfunctional prison systems, criminal groups conduct recruitment and orchestrate violence both behind bars and outside the gates.

• “We cannot ensure public safety unless we have a secure prison system,” said José Lima, Amapá State Secretary of Justice and Public Security. 

GLOBAL HEALTH VOICES CLIMATE CRISIS SOLUTIONS Tapping Into Traditional Wells 
As India’s infrastructure expands to keep pace with its rapid population growth, finding innovative water solutions remains critical. 

But sometimes innovation means revisiting old ways—like the traditional well. 

In the megacity of Bengaluru, which frequently faces water shortages, Biome Environmental Trust has restored ~280,000 traditional wells over the past decade, tapping into shallow aquifers that had been overlooked as the region shifted to deeper drilling and piping water in from rivers. 

The wells, less than 100 feet deep, are energy-efficient and eco-friendly. And they allow the city to diversify its water options in a crisis.

“Truly, it’s a low, shallow-hanging fruit,” said urban planner Vishwanath Srikantiah.



Related: Climate change: A growing threat to emergency response – OPPORTUNITY QUICK HITS WHO approves Bavarian Nordic's mpox vaccine for adolescents –

Ethiopia: Children disproportionately affected by weapon contamination –

Better-prepared emergency departments could save kids’ lives cost-effectively, Stanford Medicine-led study finds –

Missing immune cells may explain why COVID-19 vaccine protection quickly wanes –

Almost 40% of the world’s anti-HIV pill users live in SA –

Uptake of self-injectable contraceptive soars among young women –

Milton spares Daytona Beach, Florida, factory that’s a critical supplier of IV fluids ??–

AI-supported dermatology: Now for darker skin tones too, thanks to a new data set –

The Cutting-Edge Hearing Aids That You May Already Own – Issue No. 2796
Global Health NOW is an initiative of Johns Hopkins Bloomberg School of Public Health.

Contributors include Brian W. Simpson, MPH, Dayna Kerecman Myers, Annalies Winny, Morgan Coulson, Kate Belz, Melissa Hartman, Jackie Powder, Aliza Rosen, and Rin Swann. Write us: dkerecm1@jhu.edu, like us on and follow us on Instagram and X .

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96 Global Health NOW: Milton’s Might; AI in Public Health: Gaps, Disparities, and Remarkable Potential; and Mammoth Mama Bear Clinches Fat Bear Week October 10, 2024 A downed crane blocks a street after crashing into the the Tampa Bay Times offices after the arrival of Hurricane Milton. October 10, St. Petersburg, Florida. Spencer Platt/Getty Milton’s Might 
Hurricane Milton slammed into Florida early this morning, spawning an onslaught of tornadoes, bringing a deluge of rain, and lashing the Tampa Bay area with 120 mph winds that left 3 million+ customers without power as the state ramps up search and rescue missions and begins to assess damage, .

• At least 19 tornadoes have been confirmed, destroying homes in multiple counties.


• Winds shredded the roof of Tropicana Field, a Major League Baseball stadium staged to serve as a shelter for 10,000 first responders and essential workers, .


• At least four fatalities were reported at a St. Lucie County retirement community, .


• Operations were underway to rescue people trapped in an assisted living facility and hotel in Hillsborough County, and at an apartment building in Clearwater. 

17 inches of rain fell across areas of Tampa Bay in only six hours, —marking a “1-in-1000 year” rainfall event that spurred flash flood warnings which remain in place this morning: “It’s not over,” Tampa Mayor Jane Castor said. GLOBAL HEALTH VOICES The Latest One-Liners   Cholera cases in Sudan have climbed to 21,806, including 632 deaths, the Sudanese Health Ministry said yesterday; meanwhile dengue fever cases reached 1,329, with four deaths.

A travel ban instituted in Rwanda to suppress the spread of Marburg prohibits anyone who has been exposed to Marburg virus from leaving the country until 21 days after exposure.

The tickborne disease babesiosis increased by 9% per year in the U.S. between 2015 to 2022, according to a published in Open Forum Infectious Diseases.

Eating less can boost longevity, a ; but factors like immune health and genetics play key roles along with the metabolic effects of caloric restriction. GHN EXCLUSIVE REPORT Biostatistician Elizabeth Stuart (in purple) makes a point to HHS assistant secretary Micky Tripathi; other AI event panelists (l to r): Alison Snyder, John Auerbach, and Jesse Ehrenfeld. Poulomi Banerjee AI in Public Health: Gaps, Disparities, and Remarkable Potential   Public health experts extolled the promise of AI to solve longstanding health problems in a , but also raised concerns about its potential for exacerbating inequity.
 
AI Wins:

• Chicago’s health department has used AI to make outbreak predictions for diseases such as , said Micky Tripathi, acting chief AI officer for the U.S. Department of Health and Human Services.


• Uses include vaccine and drug development, medical diagnostics, and disease screening.


• AI could help small public health departments by streamlining tasks like filling out forms or deciding which restaurants to inspect, said John Auerbach, senior vice president at the global consulting firm ICF.

AI Challenges:

• It’s difficult for many local public health departments—especially smaller ones—to access the power of AI.


• Much of AI development and use suffers from a lack of transparency.


• AI continues to draw on limited data sets, said Elizabeth Stuart, Biostatistics chair at the Johns Hopkins Bloomberg School of Public Health. “We need to be really conscious of who is not in the data … and then the implications of that,” she said.

Another obstacle: The U.S. federal system (with significant power resting with states) drives the lack of a standardized, national policy on AI.
 

 
Ed Note: The panel “Making AI a Lifesaver” was held at the Hopkins Bloomberg Center in Washington, D.C., and was cosponsored by , , and . DATA POINT POPULATIONS Latin America’s Demographic Overhaul
Population shifts are reshaping the economies and cultural family structures across Latin America and the Caribbean, as fertility rates continue to drop and life expectancy climbs.

• Fertility rates in the region plunged from 5.8 children per woman in 1950 to 1.8 in 2024.


• Meanwhile, life expectancy rose from 49 years in 1950 to 76 years in 2024.


• Household size shrank from 4.3 in 2000 to 3.4 in 2022.

Another factor: Migration—particularly away from Cuba and Venezuela—is also driving major demographic shifts. 

ALMOST FRIDAY DIVERSION Mammoth Mama Bear Clinches Fat Bear Week
In this highly consequential election season, many are watching the polls. We’ve also been watching the rolls … on the brown bears of Katmai National Park.

“,” the chunky incumbent 128 Grazer once again claimed victory in Fat Bear Week, The mammoth mama bear is a “” feared by many—but she may not be the fattest of them all.

Grazer is a relatively svelte 700-800 pounds compared to runner-up Chunk’s 1,200+, but this competition is about popularity as much as portliness. Tens of thousands of voters joined Grazer’s bid to exact revenge on Chunk, who killed one of Grazer’s cubs in July.

While fatness isn’t the only factor, brown bears must eat to compete—so let’s not forget the unsung MVPs of this beloved contest: “Thanks again to the salmon,” Katmai National Park . QUICK HITS ‘I trekked pregnant through the jungle to get paracetamol’ –

Study links COVID infection to heart attacks, strokes –

Climate change-fueled heat is especially deadly when mixed with meth in the summer months –

A vaginal ring could soon offer women 3 months of HIV protection –

What’s at Stake for Public Health in the 2024 U.S. Election? –

Chris Beyrer Receives Desmond Tutu Award for HIV Research –

Mali’s traditional theater gives psychiatric patients the stage – Issue No. 2795
Global Health NOW is an initiative of Johns Hopkins Bloomberg School of Public Health.

Contributors include Brian W. Simpson, MPH, Dayna Kerecman Myers, Annalies Winny, Morgan Coulson, Kate Belz, Melissa Hartman, Jackie Powder, Aliza Rosen, and Rin Swann. Write us: dkerecm1@jhu.edu, like us on and follow us on Instagram and X .

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96 Global Health NOW: Health Care in a Hurricane; Politics in Leprosy Elimination; and Fixing the Women’s Health Funding Disparity October 9, 2024 Health Care in a Hurricane 
  Health care workers in Florida are bracing for the potentially brutal effects of a from Hurricane Helene followed by the “monstrous” Hurricane Milton, .

• “There is no doubt that they are weary, given the back-to-back storms,” said Mary C. Mayhew, president and CEO of the Florida Hospital Association, adding that Helene increased vulnerabilities for hospitals statewide. 

Battening down the hatches: Hospitals across the region are preparing backup power, water, and food sources, while also deploying flood protections, .

• Tampa General Hospital withstood Helene’s record-breaking storm surge because of a flood barrier called an AquaFence; but Milton poses an even greater threat, . 

Transporting patients: The state’s “largest evacuation ever” includes 300 health facilities, mainly long-term care facilities. Ten hospitals have also reported evacuations. 

Meanwhile in Western North Carolina: Running water remains unavailable to ~136,000 people as critically damaged water systems require significant repairs, .

• The ongoing crisis has created a “public health emergency” in the region, , with the region’s largest hospital depending on 40 continuously pumping water tankers, .

GLOBAL HEALTH VOICES The Latest One-Liners   Live Oropouche virus was detected in semen 16 days after symptom onset, suggesting risk of sexual transmission of the virus, a published yesterday in Emerging Infectious Diseases has found.

LGBTQ+ women face “substantial” health disparities, mental illness, and barriers to care, finds a National Center for Lesbian Rights that analyzed a national survey of 5,000 respondents.

A series of lawsuits against TikTok were filed yesterday by more than a dozen states and the District of Columbia, each alleging the app’s algorithm is designed to be addictive to kids and is harming youth mental health.

Nearly 50% of researchers quit science within a decade of starting their careers, with women more likely than men to stop publishing, a large published in Higher Education finds. NEGLECTED DISEASES Politics in Leprosy Elimination  
A campaign in India promises to eliminate leprosy by 2027, three years ahead of the WHO’s target—but advocates warn that the campaign is under-resourced and based more on political “grandstanding” than “genuine commitment.”

• Leprosy—one of the world’s most stigmatized diseases—is fully curable.


• 60% of the 200,000 new cases reported annually are in India. 

Challenges:

• India’s medical schools have not taught leprosy treatment and diagnosis for the last 20 years.


• COVID-19 stalled a previous vaccination rollout.


• Awareness campaigns have yet to be implemented, leading to worries that cases may be undercounted to meet goals.  

GLOBAL HEALTH VOICES RESEARCH Expanding Biobanks
Increasingly, researchers and physicians rely on genetic data to tailor treatments to patients, in a field known as precision medicine. 

Glaring data gaps: Genetic information represented in biobanks used to guide treatment decisions is disproportionately focused on European ancestry—limiting critical insights and options for other populations.

• In particular, Indigenous groups in Latin America are underrepresented in these banks—a significant obstacle for researchers developing targeted treatments.

Drilling down: Efforts are gaining in Latin America and elsewhere to collect far more detailed genetic data to expand diversity in biobanks.

WOMEN'S HEALTH Fixing the Funding Disparity
Women and girls make up half of the population—yet organizations dedicated to them receive less than 2% of all charitable giving in the U.S., reveals.
 
Philanthropist Melinda French Gates—who has long focused on the lack of investment in women and girls—announced a new effort today to help address the disparity, inviting grant applications to her organization, Pivotal, through an .

• Applicants should address issues relating to women’s mental and physical health in the U.S. and around the world.

• The new program allocates $250 million, through grants of $1 million to $5 million each, adding to French Gates’ pledge to donate $1 billion to women and girls over the next two years.

The goal: To identify women’s health nonprofits in need of new funding streams—especially those that historically might not have been eligible.

Related: The ‘huge disadvantage’ women behind femtech phenomenon face – OPPORTUNITY QUICK HITS Stigma adds to Burundi's challenges in mpox fight –

The end of smallpox was ... the beginning for mpox –

Loiasis: bringing an end to neglect –

Severe Covid infections can inflame brain’s ‘control centre’, research says –

A Boy’s Bicycling Death Haunts a Black Neighborhood. 35 Years Later, There’s Still No Sidewalk. –

The Supreme Court appears to have found a gun regulation it actually likes –

Scientists discover a secret to regulating our body clock, offering new approach to end jet lag –

The next lifesaving antibiotic might be a virus on your toothbrush – Issue No. 2794
Global Health NOW is an initiative of Johns Hopkins Bloomberg School of Public Health.

Contributors include Brian W. Simpson, MPH, Dayna Kerecman Myers, Annalies Winny, Morgan Coulson, Kate Belz, Melissa Hartman, Jackie Powder, Aliza Rosen, and Rin Swann. Write us: dkerecm1@jhu.edu, like us on and follow us on Instagram and X .

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96 Global Health NOW: Transportation Justice in Music City; The New Fight Against Fistula; and Health Workers Traumatized With Nowhere to Turn October 8, 2024 GHN EXCLUSIVE REPORT Many of the historic buildings, shops, bars, and clubs along Broadway in Nashville, Tennessee. Cheryl A. Austin/Wikimedia Commons Transportation Justice in Music City   NASHVILLE, Tenn.— to “reverse the effects of environmental racism.” His engine of choice: transportation infrastructure. 
 
The challenges:

• Time spent in traffic congestion increased to in 2023 from in 2022.


• It has America’s,, with long drive times and a lack of walkability, bikeability, and public transportation.


• Pollution from traffic snaking through the city’s urban core disproportionately impacts communities that have been historically marginalized because of the racist practice of .

O’Connell wants to establish economic equity and reduce pollution-related health threats by:

• Replacing two-thirds of the city’s traffic lights with capable of adjusting traffic flows on demand while reducing commute times and stop-and-go fuel emissions.


• Constructing bike lanes, 86 miles of new , and 12 new transit centers with 24-hour bus service.


• Planting by 2050 and seeding citywide. 

The catch: Much of O’Connell’s goals depend upon passage of a referendum next month that would impose a temporary sales tax surcharge that would help the city access federal funds from the .
 
GLOBAL HEALTH VOICES The Latest One-Liners   Junior doctors in West Bengal, India, launched a hunger strike demanding improved security for hospitals following the alleged rape and murder of a young female doctor last August.
 
Hospitals are urging the White House to help shore up supplies of IV bags after the North Carolina factory that produces 60% of the nation’s supply was shuttered temporarily by Hurricane Helene.
 
The U.S. Supreme Court declined to intervene in a Texas emergency abortion case, leaving in place a lower court ruling that exempts doctors in Texas from performing emergency abortions that conflict with the state’s abortion ban—rejecting a Biden Administration appeal that the Texas ban violates federal law.
 
20th-century gains in human life expectancy are slowing down—rising only six and a half years since 1990, of 10 wealthy countries, hinting that the human lifespan is reaching a limit. SURGERY The New Fight Against Fistula
  In Nepal, fistula—a debilitating condition caused by a hole in the bladder—is more and more brought on by botched surgeries, not obstructed and prolonged labor.

• The devastating condition, which leaves women incontinent and leaking urine, affects at least 4,500 women in Nepal.

The growing proportion of fistulas caused by botched hysterectomies or C-sections signals broader issues in the health system, such as surgeons who struggle to admit they aren’t qualified to do certain procedures.

The Quote: “Latrogenic fistula [caused by a surgical error] is a sentinel indicator, it’s saying something about the quality of surgical care on offer,” says Carrie Ngongo, a health systems specialist at the Research Triangle Institute.

  GLOBAL HEALTH VOICES HEALTH WORKERS Traumatized With Nowhere to Turn
In 2020 the Soldiers’ Home in Holyoke, Massachusetts, had one of the deadliest COVID-19 outbreaks to occur at a long-term nursing facility.

• The outbreak, in which dozens of veterans died, prompted a top-to-bottom overhaul of the facility and its leadership and a $56 million settlement for veterans and families. 

But many nursing assistants who worked on the front lines at the facility and remain traumatized by the effects of the ordeal—including depression and PTSD—have received little relief.  
 
The situation is a vivid example of “how labor conditions can jeopardize the health of employees”—and for lower-paid staff with limited power and resources at work, a lack of agency adds to the stress, reports Amy Maxmen.
 
OPPORTUNITY QUICK HITS Tragic statistics show African roads are among world's deadliest –

CDC: 35% flu vaccine efficacy in South America may predict similar for US season –

US CDC to issue second-highest travel alert for Rwanda on Marburg outbreak –

Q&A: How California, now an epicenter for bird flu in dairy cattle, is monitoring the virus –  

Biden sets a 10-year deadline for US cities to replace lead pipes and make drinking water safer –

Tiny brain, big deal: fruit fly diagram could transform neuroscience – Thanks for the tip, Xiaodong Cai!

Why So Many Hungarians Are Staying Child-Free –

Turning AI's Hype into a Realistic Hope for Global Healthcare –  

8 ways to make the future brighter: from battling misinformation to honoring grandmas –

Another Reason to Hate Ticks – Issue No. 2793
Global Health NOW is an initiative of Johns Hopkins Bloomberg School of Public Health.

Contributors include Brian W. Simpson, MPH, Dayna Kerecman Myers, Annalies Winny, Morgan Coulson, Kate Belz, Melissa Hartman, Jackie Powder, Aliza Rosen, and Rin Swann. Write us: dkerecm1@jhu.edu, like us on and follow us on Instagram and X .

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96 Global Health NOW: September Recap October 7, 2024 People participate in a Tashlich ritual organized by Jewish Voice for Peace to mark the one-year anniversary of Hamas’ attack on Israel and calling for a ceasefire. October 6, Los Angeles. Apu Gomes/AFP via Getty A Year of ‘Unrelenting Tragedy’
The year that has passed since Hamas launched the deadliest attack in Israel’s history has been one of “unimaginable suffering” across the region, .

• “It has been 12 months of unrelenting tragedy—this must end,” said Joyce Msuya, the UN’s acting under-secretary-general and emergency relief coordinator.

The mounting toll, per OCHA and :

• 1,500+ Israelis have been killed, mostly during Hamas’ Oct. 7 attacks; ~5,500 have been injured; and ~250 others were abducted. ~100 hostages remain in captivity, denied humanitarian assistance and subjected to inhumane treatment—including sexual violence. 


• 41,600+ Palestinians have been killed in Israel’s counterattacks, while ~96,600 have been injured. “Nearly the entire population of Gaza has been displaced, many of them multiple times, with no safe place to go,” and civilians face “extreme deprivation” with no access to food, electricity, or health care. 

An altered world: In a to mark one year since the Oct. 7 attacks, UN Secretary-General António Guterres called on the international community to condemn the “abhorrent acts” that triggered the ever-widening conflict—which has no end in sight. GLOBAL HEALTH VOICES The Latest One-Liners   Cholera death rates in Sudan and Nigeria have surged to up to 3X the global average as conflict and flooding continue to disrupt treatment.
 
Rwanda launched a Marburg vaccine clinical trial yesterday to curb the outbreak, which has killed at least 12 people; those most at risk—including health workers and patients’ contacts—will be first in line for the 700 doses received for the study.

Mpox vaccinations were kicked off in the DRC over the weekend after the country received 265,000 doses; priority is being given to health workers, frontline responders, contacts of confirmed cases, and other at-risk groups.

Swarms of yellow jackets disturbed by Hurricane Helene in North Carolina have led to a spike in requests for Benadryl and epinephrine injections at pharmacies and hospitals, state health officials and relief groups report. SEPTEMBER’S MUST-READS The Sharp Bite of Inequity  
Marking International Snakebite Awareness Day (September 19), —from the likelihood of encountering a venomous snake and being bitten to having protection like basic shoes and adequate shelter to access to treatment.
  
There’s an ambitious plan to help—迟丑别 —but it is still grossly underfunded. Support from the , one of the few funding sources, is set to end soon, and no new donors have stepped up.

Everyday Poisoning in Afghanistan  
Researchers trying to understand why Afghanistan has one of the world’s highest rates of lead exposure—especially as Afghan refugee children arriving in the U.S. showed “dramatically elevated blood lead levels”—zeroed in on a culprit: aluminum cooking pots; one “leached sufficient lead to exceed the childhood limit by 650-fold.”

Compounding Crisis in the Darién Gap  
The dense rainforest of the Darién Gap has long been considered inaccessible, shielding Indigenous communities and the region’s rich biodiversity from outside impact. But the surge of migration through the region over the last five years has brought unprecedented pollution to the rainforest—threatening the local ecosystem and the health of people who depend on it, community leaders say. GHN’s SEPTEMBER EXCLUSIVES Local Reporting Initiative:

• By Scovian Lillian

• By Adeel Saeed

Q&A:

• By Morgan Coulson

Commentaries:

• Zipporah Gathuya:

• Niranjan Konduri:

• Benjamin Mason Meier, Neha Saggi, Muhammad Jawad Noon, and Xinshu She:

GLOBAL HEALTH VOICES SEPTEMBER’S BEST NEWS Pesticide Bans Slow Suicides in Nepal
A few years ago, pesticides—or “plant medicines,” as the locals called them—were used in roughly a third of Nepal’s suicides.
 
“What if the pesticide had not been on the market?” wondered one doctor, Rakesh Ghimire, recognizing that most suicides are impulsive and that the chemicals were too easily available. He helped ban the sale and import of eight pesticides in 2019, and deaths fell—by as much as 30% by 2023.
 


More good news:
Hope to fight rising heroin use: A Pretoria, South Africa program is replacing the rehab model with drop-in centers offering methadone and counseling, with excellent patient retention stats.

Shining a light on noma: The addition of the devastating gangrenous disease to WHO’s list of neglected tropical diseases is already leading to substantive research funding boosts and a stigma-busting effect.

Trees as treatment: Adding to tree planting’s climate benefits, University of Louisville researchers are documenting human health benefits of “greened” neighborhoods, too. QUICK HITS At least 78 dead and dozens missing after ferry disaster in DR Congo –

WHO approves first mpox test for quick diagnosis –

H5N1 infects second farm worker in California as feds bolster vaccine supply –

Is there hope for changes to the NHI Act? –

Catholic hospital offered a bucket and towels to woman it denied abortion, California AG says –

The activists working to abolish IVF –

Pharma eyes male birth control pill for Gen Z – September 2024 Monthly Recap
Global Health NOW is an initiative of Johns Hopkins Bloomberg School of Public Health.

Contributors include Brian W. Simpson, MPH, Dayna Kerecman Myers, Annalies Winny, Morgan Coulson, Kate Belz, Melissa Hartman, Jackie Powder, Aliza Rosen, and Rin Swann. Write us: dkerecm1@jhu.edu, like us on and follow us on Instagram and X .

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96 Global Health NOW: A Year of ‘Unrelenting Tragedy’; and Your September Recap October 7, 2024 People participate in a Tashlich ritual organized by Jewish Voice for Peace to mark the one-year anniversary of Hamas’ attack on Israel and calling for a ceasefire. October 6, Los Angeles. Apu Gomes/AFP via Getty A Year of ‘Unrelenting Tragedy’
The year that has passed since Hamas launched the deadliest attack in Israel’s history has been one of “unimaginable suffering” across the region, .

• “It has been 12 months of unrelenting tragedy—this must end,” said Joyce Msuya, the UN’s acting under-secretary-general and emergency relief coordinator.

The mounting toll, per OCHA and :

• 1,500+ Israelis have been killed, mostly during Hamas’ Oct. 7 attacks; ~5,500 have been injured; and ~250 others were abducted. ~100 hostages remain in captivity, denied humanitarian assistance and subjected to inhumane treatment—including sexual violence. 


• 41,600+ Palestinians have been killed in Israel’s counterattacks, while ~96,600 have been injured. “Nearly the entire population of Gaza has been displaced, many of them multiple times, with no safe place to go,” and civilians face “extreme deprivation” with no access to food, electricity, or health care. 

An altered world: In a to mark one year since the Oct. 7 attacks, UN Secretary-General António Guterres called on the international community to condemn the “abhorrent acts” that triggered the ever-widening conflict—which has no end in sight. GLOBAL HEALTH VOICES The Latest One-Liners   Cholera death rates in Sudan and Nigeria have surged to up to 3X the global average as conflict and flooding continue to disrupt treatment.
 
Rwanda launched a Marburg vaccine clinical trial yesterday to curb the outbreak, which has killed at least 12 people; those most at risk—including health workers and patients’ contacts—will be first in line for the 700 doses received for the study.

Mpox vaccinations were kicked off in the DRC over the weekend after the country received 265,000 doses; priority is being given to health workers, frontline responders, contacts of confirmed cases, and other at-risk groups.

Swarms of yellow jackets disturbed by Hurricane Helene in North Carolina have led to a spike in requests for Benadryl and epinephrine injections at pharmacies and hospitals, state health officials and relief groups report. SEPTEMBER’S MUST-READS The Sharp Bite of Inequity  
Marking International Snakebite Awareness Day (September 19), —from the likelihood of encountering a venomous snake and being bitten to having protection like basic shoes and adequate shelter to access to treatment.
  
There’s an ambitious plan to help—迟丑别 —but it is still grossly underfunded. Support from the , one of the few funding sources, is set to end soon, and no new donors have stepped up.

Everyday Poisoning in Afghanistan  
Researchers trying to understand why Afghanistan has one of the world’s highest rates of lead exposure—especially as Afghan refugee children arriving in the U.S. showed “dramatically elevated blood lead levels”—zeroed in on a culprit: aluminum cooking pots; one “leached sufficient lead to exceed the childhood limit by 650-fold.”

Compounding Crisis in the Darién Gap  
The dense rainforest of the Darién Gap has long been considered inaccessible, shielding Indigenous communities and the region’s rich biodiversity from outside impact. But the surge of migration through the region over the last five years has brought unprecedented pollution to the rainforest—threatening the local ecosystem and the health of people who depend on it, community leaders say. GHN’s SEPTEMBER EXCLUSIVES Local Reporting Initiative:

• By Scovian Lillian

• By Adeel Saeed

Q&A:

• By Morgan Coulson

Commentaries:

• Zipporah Gathuya:

• Niranjan Konduri:

• Benjamin Mason Meier, Neha Saggi, Muhammad Jawad Noon, and Xinshu She:

GLOBAL HEALTH VOICES SEPTEMBER’S BEST NEWS Pesticide Bans Slow Suicides in Nepal
A few years ago, pesticides—or “plant medicines,” as the locals called them—were used in roughly a third of Nepal’s suicides.
 
“What if the pesticide had not been on the market?” wondered one doctor, Rakesh Ghimire, recognizing that most suicides are impulsive and that the chemicals were too easily available. He helped ban the sale and import of eight pesticides in 2019, and deaths fell—by as much as 30% by 2023.
 


More good news:
Hope to fight rising heroin use: A Pretoria, South Africa program is replacing the rehab model with drop-in centers offering methadone and counseling, with excellent patient retention stats.

Shining a light on noma: The addition of the devastating gangrenous disease to WHO’s list of neglected tropical diseases is already leading to substantive research funding boosts and a stigma-busting effect.

Trees as treatment: Adding to tree planting’s climate benefits, University of Louisville researchers are documenting human health benefits of “greened” neighborhoods, too. QUICK HITS At least 78 dead and dozens missing after ferry disaster in DR Congo –

WHO approves first mpox test for quick diagnosis –

H5N1 infects second farm worker in California as feds bolster vaccine supply –

Is there hope for changes to the NHI Act? –

Catholic hospital offered a bucket and towels to woman it denied abortion, California AG says –

The activists working to abolish IVF –

Pharma eyes male birth control pill for Gen Z – Issue No. 2792
Global Health NOW is an initiative of Johns Hopkins Bloomberg School of Public Health.

Contributors include Brian W. Simpson, MPH, Dayna Kerecman Myers, Annalies Winny, Morgan Coulson, Kate Belz, Melissa Hartman, Jackie Powder, Aliza Rosen, and Rin Swann. Write us: dkerecm1@jhu.edu, like us on and follow us on Instagram and X .

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96 Global Health NOW: The Hidden Health Burden of Hurricane Helene; Leveraging Technology to Bridge Health System Gaps; and Say It With Cats October 3, 2024 An aerial view of damaged houses after Hurricane Helene made landfall in Horseshoe Beach, Florida, on September 28. Chandan Khanna/AFP via Getty The Hidden Health Burden of Hurricane Helene  
Hurricane Helene’s rampage across the U.S. Southeast this week killed more than 160 people—already making it one of the country’s deadliest hurricanes in a century, second only to Hurricane Katrina, .
 
And the danger hasn’t passed. shows that tropical storms have a long-term impact on public health—contributing to elevated mortality long after the clean-up.

• The analysis of 501 U.S. tropical storms from 1930 to 2015 found that the average tropical storm or hurricane “indirectly accelerated the death” of an additional 7,000–11,000 people over the next 15 years, .


• Tropical storms contributed to more U.S. deaths—3.6 to 5.2 million—during the study period than automobile crashes, infectious diseases, and combat. 

What’s going on: It isn’t just the obvious, direct causes of death tied to the storms, such as drowning in flood water; “disasters trigger complex cascades of events that ultimately may cause additional future mortality,” Axios notes.

• Post-storm stress may worsen cancer, heart disease, and other chronic conditions.


• The high cost of hurricane recovery and home repairs can have severe economic repercussions, reducing their health care spending for years to come.

Behind the research: The researchers looked at typical mortality patterns and isolated anomalies that only the variable under study—a sizable storm—could have caused, . Previously, that technique helped improve understanding of excess deaths caused by COVID-19 and heat waves. GLOBAL HEALTH VOICES The Latest One-Liners   The WHO reported a new human case of MERS-CoV in Saudi Arabia yesterday; the man, who was admitted to a hospital on August 31 and has since recovered, had no history of contact with camels and is not a health worker.

U.S. kindergarten vaccination rates slipped last year, translating to ~80,000 fewer kids covered with MMR, DTaP, polio, and chickenpox immunizations—and exemptions rose to an all-time high of 3.3%, shared yesterday.

The FDA missed its September 30 deadline to release new suggested best practices for pulse oximeters to increase the accuracy of blood oxygen readings in people of color; researchers in 2020 found that the devices often miss low blood oxygen levels in patients with darker skin.

Global spending to fight lead poisoning has doubled thanks to a USAID and UNICEF initiative, Partnership for a Lead-Free Future, backed with $150 million in initial funding from USAID, the Gates Foundation, Open Philanthropy, and other sources. GHN EXCLUSIVE COMMENTARY A health care worker connects with callers from the community using Chipatala Cha Pa Foni (Health Center by Phone). Lilongwe, Malawi in 2016. Paul Joseph Brown Leveraging Technology to Bridge Health System Gaps
In the quest to restore global immunization to pre-pandemic levels, some important data points are known: “We know where these children are (mostly in fragile and conflict-affected countries), and which vaccines they missed (measles vaccines, among others),” .
 
What’s missing: An understanding of community preferences and perspectives on when, where, and how people receive immunizations and other health care services; African populations, in particular, are severely underrepresented in available data.
 
Tech can “close the loop”: Mobile health apps, health hotlines, digital avatars, chatbots, and other tools can help underreached communities share feedback consistently and discreetly.
 
Success stories:

• A health hotline in Malawi helps disseminate—and collect—health information, the spread of misinformation and flagging early signs of outbreaks.


• uses machine learning to analyze radio content in Uganda, gleaning insights that inform outbreak tracking.

Clearing obstacles: The authors map out what’s needed to address the digital divide—inequitable access to the internet and digital devices—describing their as a model for community-centered health programs built on community feedback.

DATA POINT REPRODUCTIVE HEALTH RIGHTS Abortion Pills Under Lock and Key in Louisiana 
Abortion pills are now considered “controlled dangerous substances” in Louisiana under a first-of-its-kind law that took effect Tuesday, criminalizing possession without a prescription,
 
Mifepristone and misoprostol are used for medication abortions and in routine miscarriage management. Misoprostol is also used to stop dangerous bleeding after childbirth.

• The new law requires that the pills be kept in a locked box in hospitals, raising fears that physicians will not be able to access the drugs quickly in emergency situations, .

• The pills are now in the same category as opioids, antidepressants, and other potentially addictive substances, .

Stage set for tighter restrictions in other states? “This new law sets a dangerous precedent by mischaracterizing safe medications that are neither addictive nor dangerous, but rather are standard of care for a variety of women’s health and other conditions,” said Jennifer Avegno, director of the New Orleans Health Department.  ALMOST FRIDAY DIVERSION Do you ever wonder how people communicated before cat memes?  
They used cat postcards! The global postcard craze of the early 20th century was the social media of yesteryear, complete with concerns about privacy (no envelope!) and whether the short-form medium was making people dumber.
 
Nevertheless, Edwardian mail bags felt the weight of the cat craze as does today’s internet, stuffed with postcards of “cats just being cats”—or dressed up as humans, doing day jobs. 

Even the Suffragettes harnessed the power of the feline, deploying images of cats in jaunty hats, campaigning for women’s right to vote. Suffice to say, their efforts paid off!
 
QUICK HITS US breast cancer rate rising sharply even as deaths fall: study –

Brazil eliminates lymphatic filariasis as a public health problem –
 
Was Missouri’s bird flu case a one-off or something more? Quest for answers faces testing delay –

Most accurate ultrasound test could detect 96% of women with ovarian cancer –

Condoms aren’t a fact of life for young Americans. They’re an afterthought –

Opinion: Want People to Embrace Public Health? Make It More Like Weather Forecasting. –

Can flashing lights stall Alzheimer’s? What the science shows – Issue No. 2791
Global Health NOW is an initiative of Johns Hopkins Bloomberg School of Public Health.

Contributors include Brian W. Simpson, MPH, Dayna Kerecman Myers, Annalies Winny, Morgan Coulson, Kate Belz, Melissa Hartman, Jackie Powder, Aliza Rosen, and Rin Swann. Write us: dkerecm1@jhu.edu, like us on and follow us on Instagram and X .

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96 Global Health NOW: Rwanda’s Simmering Marburg Outbreak; Mpox Epicenter; and No Medical Code? No Money Back The WHO warns that mpox could spread outside of Rwanda. October 2, 2024 Colorized scanning electron micrograph of Marburg virus particles (yellow) both budding and attached to an infected VERO E6 cell (blue). NIAID via Flickr/Creative Commons License Rwanda’s Simmering Marburg Outbreak  
Concerns about the Marburg outbreak in Rwanda are rising as more than two dozen cases have been confirmed and the WHO has warned of the risk of the disease spreading to neighboring countries and beyond.
 
The latest:

• Confirmed cases have reached 29—10 of which have been fatal, .


• Possible cases have been reported in districts that border the DRC, Tanzania, and Uganda.


• A contact of a confirmed case traveled to Belgium but has completed 21 days of monitoring and is not considered a risk to public health.

Vax race: Currently, no therapies or vaccines against the viral hemorrhagic fever are approved, . But Rwandan scientists have been appointed to run potential trials and may work with Marburg virus vaccine consortium scientists.

• At least one vaccine trial will be launched if the outbreak continues.


• The trial would follow the ring vaccination strategy that involves immunization of an infected individual’s contacts.

Simmering outbreak: The large number of Marburg cases—Rwanda’s outbreak is one of the largest ever—indicates the virus has been circulating for a few weeks, the CDC’s Jennifer McQuiston told , adding that it takes up to 21 days post-exposure for symptoms to appear. GLOBAL HEALTH VOICES The Latest One-Liners   An “extremely concerning malaria surge” has overtaken Ethiopia with 5.9 million cases reported by the WHO this year as of Sept. 22—far above the 4.5 million cases reported in all of 2023; cases in Ethiopia have increased every year since 2018.
 
South Africa has pulled Top Score Instant Porridge from shelves after three children in Eastern Cape province who ate the porridge died; the cause is not known.

U.S. women with sickle cell disease were more likely to undergo tubal sterilization post-delivery than people without the condition—8.8% compared to 6.7%, ; the contrast is more extreme in certain states, including Alabama, Mississippi, Kentucky, and Tennessee.

The WHO validated the elimination of trachoma as a public health problem in Pakistan, crediting the country’s use of the for reducing transmission of the disease, which can result in irreversible blindness; Pakistan is the 19th country to reach the milestone. MPOX Sex Workers—and Miners—at the Epicenter  
In Kamituga, a DRC mining town, sex work is flourishing—and so is mpox.
 
Sex workers and their clients—mostly miners—are key to blocking the spread of the virus’s dangerous new variant, per health authorities.

• Many of the town's estimated 40,000 sex workers—some 13% of the population—are single mothers with few job alternatives. 

Health workers say the government should shutter nightclubs and mines—and compensate sex workers. Local officials counter that strategy exceeds their budget—and their responsibility.
 
Protection tools in short supply: 

• It’s unclear when any of Congo’s ~250,000 vaccines will make it to Kamituga’s sex workers and miners.

• Until then, advocates are emphasizing education, as well as condoms—which they say are underused, but sex workers say are too expensive.

Miners are major: Mpox awareness campaigns are needed in the mines, where conditions are often unsanitary and not all miners are taking the virus seriously.
 

  
Related:
 
11 new cases of monkeypox reported in Argentina –
 
WHO’s Slow Mpox Response Calls For a Rethink –
 
Think *Your* Job Sucks? Epidemiologists Study Mpox By Collecting Used Condoms – GLOBAL HEALTH VOICES INSURANCE No Medical Code? Big Problem
Years of youth sports took a toll on 17-year-old Preston Nafz’s body, leaving him in chronic pain that physical therapy and anti-inflammatory drugs didn’t help.

Ultimately, a doctor recommended Nafz undergo a to mend damaged tissue in his pelvis. 

Missing code: Unfortunately, the procedure had no medical billing or “CPT” code—which insurers identify from provider claim forms to determine the amount of reimbursement.

The cost: As is often the case for procedures that lack codes, Nafz’s insurer denied the claim, forcing his father to pay more than $7,000 upfront for the surgery. 

• With extra documentation, he was eventually reimbursed—for $620.26.

WEBINAR Tomorrow: Planetary Health, Education, and the Earth Crisis
The unprecedented crises of Earth’s systems brought about by human activity require a planetary health approach that addresses pollution, water scarcity, extreme weather, changing patterns of disease transmission, and other threats.
 
Join a free webinar by the American Public Health Association and the Planetary Health Alliance to learn about the vital connections between ecological systems and human health.
 
Speakers will share educational materials and practical tools for educators and learners.
 
Details:

• Thursday, October 3 at 2 p.m. EDT

QUICK HITS 'People are hopeless here': Sudan's sick, starving and injured spill into camps across its borders –

Finding help to get sober is hard. In Kentucky, it's even harder as a mom. –

WHO calls for urgent transformation of care and support systems for older people –

Radon, even at levels below EPA guideline for mitigation, is linked to childhood leukemia –

New advisory body needed to guide U.S. biomedical research policy, panel says –

The huge toll of PhDs on mental health: data reveal stark effects –

Three Effective Ways to Use Routinely Collected Data to Evaluate Health Programs — Insights from Rwanda’s Mass Drug Administration Program – Issue No. 2790
Global Health NOW is an initiative of Johns Hopkins Bloomberg School of Public Health.

Contributors include Brian W. Simpson, MPH, Dayna Kerecman Myers, Annalies Winny, Morgan Coulson, Kate Belz, Melissa Hartman, Jackie Powder, Aliza Rosen, and Rin Swann. Write us: dkerecm1@jhu.edu, like us on and follow us on Instagram and X .

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96 Global Health NOW: Pakistan’s Trans Community Especially Vulnerable to Climate Crises; Narrowing HIV Education Gaps; and Lifesaving Snakebite Software October 1, 2024 On a hot and humid afternoon in Peshawar, Pakistan, Gulalai gets ready for a dance performance; the nearby fan is not working due to electrical outages. July 22. Adeel Saeed GLOBAL HEALTH NOW EXCLUSIVE Pakistan’s Trans Community Especially Vulnerable to Climate Crises   PESHAWAR, Pakistan—, her clothes soaked in sweat, while trying to get home after performing at a wedding celebration.
 
Timely rescue and medical care helped Shama, a transgender person, recover from severe dehydration. Still, the health threats from climate extremes persist, exacerbated for trans people by a pervasive stigma that pushes people like Sharma to the margins of society. 

• Many trans people are disowned by their families, limiting education, work, and housing options—and often forcing them to live in temporary shelters that can withstand neither increasingly erratic storms, nor sizzling heat.


• “We spend restless days and sleepless nights subjected to unbearably scorching heat,” Shama says—often with no respite from fans or air conditioners.

Legal hurdles: Family estrangement makes it hard for trans people to obtain national identity cards needed to access welfare and disaster relief assistance.
 
Easing of obstacles: Government officials say they’re advancing gender-sensitive policies—relaxing documentation required for identity cards, for example, and working to include trans people in disaster management guidelines.
 
Transgender advocates say, however, that gender-inclusive policies should be a compulsory component of planning for climate-induced disasters.
 
Ed. Note: This article by Adeel Saeed, a Pakistan-based journalist, is part of , made possible through the generous support of loyal GHN readers.  GLOBAL HEALTH VOICES The Latest One-Liners   Some 5.4 million Haitians—nearly half the country’s population—are in a hunger crisis, with close to 6,000 people starving; gang violence is a key contributor, as people fear leaving their homes and food transportation is hampered.

Lebanon’s health system is being stretched thin following Israeli attacks; three hospitals have been evacuated, 37 out of 317 health centers have been shut down, and staff shortages are rising as displacement increases.
 
A 65-year-old Minnesota resident died of rabies after coming into contact with a bat last July, the state health department reported late last week.
 
Gun laws banning the sale of high-capacity magazines were tied to a 91% drop in pediatric deaths associated with mass shootings, according to a database analysis of 178 mass shootings in the U.S. from 2009 to 2020. Rwanda's Marburg Outbreak Rwanda: Death Toll From Marburg Virus Reaches Nine –

Rwanda limits funeral sizes due to Marburg virus outbreak – 

Marburg virus outbreak in Rwanda draws concern over possibility of international spread –

What is Marburg virus, the infectious and deadly Ebola-like disease breaking out in Rwanda? –  HIV/AIDS Narrowing the Access and Education Gap  
In Dallas, HIV prevention advocates are promoting medical access and education in the Hispanic community. 
 
Resources include clinics that proudly wave pride flags or are disguised as thrift stores, social media posts of LGBTQ stories, and robust support systems—all to combat stigma and encourage people to get tested.

• In 2021, new HIV cases for Dallas men increased by 30%. 


• 35% of cases affected Hispanic/Latino people. 

Information gap: 86% of Americans mistakenly believe that HIV primarily affects members of the LGBTQ community. In the Latino community, limited conversations about sex education bring additional challenges.
 


Related: 'America's Nobel' goes to a power couple who made a startling discovery about HIV – GLOBAL HEALTH VOICES TECH & INNOVATION Snakebite Software Could Save Lives
Treating snakebite patients in time to save them may have just gotten easier, thanks to artificial intelligence software capable of identifying venomous species of snakes. 

Two Médecins Sans Frontières hospitals are piloting the AI app in South Sudan, where the number of people taken to hospital with snakebites is high. 

• Between January and July 2024, more than 300 snakebite patients were treated in MSF medical facilities across the country.

The app’s database contains 380,000 pictures of snakes, allowing for quick and accurate species identification and ensuring the correct use of rare and expensive antivenoms.



Related: ‘I’ve seen venom disintegrate a foot’: What snakebite does to the body – QUICK HITS Climate change likely to increase diarrheal disease hospitalizations in Dhaka by 2100s, study suggests –

WHO recommends maternal shot and antibody therapy to prevent RSV in infants – 

The pipeline of deadly fentanyl into the U.S. may be drying up, experts say – 

Abortion in Georgia can resume up to 22 weeks of pregnancy after court ruling –

Pooled Analysis of Physical Activity, Sedentary Behavior, and Sleep Among Children From 33 Countries – 

In the Fight to Decide the Fate of US Steel, Climate and Public Health Take a Backseat to Politics –

Rwanda unveils its new National Oxygen Strategy –

Here are the high schoolers tracking the bird flu virus in New York City – Issue No. 2789
Global Health NOW is an initiative of Johns Hopkins Bloomberg School of Public Health.

Contributors include Brian W. Simpson, MPH, Dayna Kerecman Myers, Annalies Winny, Morgan Coulson, Kate Belz, Melissa Hartman, Jackie Powder, Aliza Rosen, and Rin Swann. Write us: dkerecm1@jhu.edu, like us on and follow us on Instagram and X .

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96 Global Health NOW: Countries Pledge to Reduce AMR Deaths; Marburg Outbreak Hits Rwanda; and Shining a Light on Noma September 30, 2024 Barbados Prime Minister Mia Mottley speaks during the UN General Assembly in New York on September 27. Jeenah Moon/Bloomberg via Getty Countries Pledge to Reduce AMR Deaths
National leaders committed last week at the UN General Assembly to reducing deaths from antimicrobial resistance (AMR) by 10% by 2030.
 
The , which was passed by 193 member states on Sept. 26, reflects growing international concern about the growing threat of AMR:

• 1.27 million deaths in 2019 were caused by bacterial antimicrobial resistance.

Persistent problems: While countries have made strides against AMR since a 2016 , underlying issues that aid AMR remain, including “excessive use of antibiotics in livestock and on fish farms” and unnecessary antibiotics prescriptions for patients, .

• At least 28% of antibiotic prescriptions in the U.S. are unnecessary, .

Action items: The declaration called on countries to increase efforts across sectors, including farming, pharmaceutical manufacture, environmental protection, and health care, .  
 
The Quote: “This is a press conference not for us with grey hair so much, but for the young people of the world, because they’re the ones who will have to face the possible threat of a reversal of a century of medical progress in what we dub the silent, slow-motion pandemic,” said Barbados Prime Minister Mia Mottley at a media event before the declaration’s passage.
 
Related:
 
Tedros Adhanom Ghebreyesus: World leaders commit to radically scale-up efforts to fight the superbug threat –
 
Why the world can afford the intimidating sums needed to beat superbugs –
 
Cargill cows contaminated with vital antibiotics –
 
‘Superbugs’ could devastate livestock globally – GLOBAL HEALTH VOICES The Latest One-Liners   Twin Russian drone strikes hit a hospital in the city of Sumy in northeastern Ukraine yesterday, killing at least nine and injuring several more; the second strike incapacitated first responders.

Four more health workers developed respiratory symptoms after caring for a Missouri patient who was hospitalized with bird flu, raising to six the number of health workers affected; CDC and the state’s health department are conducting blood tests of those affected to look for antibodies to the H5 virus linked to outbreaks in cattle and poultry.

COVID-19 vaccination during pregnancy protects newborns too young to be vaccinated from hospitalization, ; ~90% of babies hospitalized for COVID-19 had mothers who did not receive the shots while pregnant.
 
A novel drug for schizophrenia secured U.S. approval Friday; in trials, KarXT, designed to activate muscarinic receptors in the brain, relieved symptoms while causing fewer side effects, offering a promising alternative to traditional antipsychotics. ETHICS RADAR Marburg Outbreak Hits Rwanda  
Rwanda is battling an outbreak of Marburg virus—迟丑别 country’s first—and, while confirmed just last Friday, it’s already the world’s fourth-largest recorded outbreak, .

• Rwanda’s Ministry of Health confirmed eight fatalities and 26 cases as of yesterday, ; ~300 people potentially exposed to the viral hemorrhagic fever are being monitored.


• Most of the victims are health workers, .

Marburg, which is initially transmitted to people via fruit bats, has a fatality rate of up to 88%—and there are no licensed vaccines or specific treatments, The Telegraph notes.

The response:

• The WHO is deploying experts and equipment to Rwanda and coordinating cross-border containment efforts with neighbors; emergency medical supplies are expected to land in Kigali in the coming days.


• Rwandan authorities are urging people to stay calm but vigilant, wash their hands with soap and clean water, and report all suspected cases.

GLOBAL HEALTH VOICES NEGLECTED DISEASES Shining a Light on Noma
  It has not even been a year since noma was added to the WHO’s list of neglected tropical diseases.

But already the designation has buoyed researchers and doctors hoping to turn the tide against the devastating gangrenous disease, which destroys tissues of the mouth and face.

• “The inclusion of noma on WHO’s NTD list has already been felt here,” said Abdala Atumane, who leads the oral health department at the provincial health service of Zambezia in Mozambique. 

Encouraging research: The NTD designation “translates into substantive increases in funding” for research into the disease’s cause, as well as potential therapies. 

Fighting stigma: Public health workers say the formal attention to the disease is crucial in their efforts to screen for the disease and locate stigmatized patients who have been hidden by their families. 

QUICK HITS Sudan humanitarian crisis has catastrophic impact for women and girls, with two-fold increase of gender-based violence –

Stem cells reverse woman’s diabetes — a world first –

Whooping cough rebounds to pre-pandemic levels –

Why Thousands Of Kosovars Are On Hospital Waiting Lists For Years  –

Players, coaches and teams: Here’s how men could help SA score an HIV goal –

Interview: How Michigan Targeted Avian Influenza in Dairy Cattle –

What are Brazilian butt lifts, and should they be banned? – Issue No. 2788
Global Health NOW is an initiative of Johns Hopkins Bloomberg School of Public Health.

Contributors include Brian W. Simpson, MPH, Dayna Kerecman Myers, Annalies Winny, Morgan Coulson, Kate Belz, Melissa Hartman, Jackie Powder, Aliza Rosen, and Rin Swann. Write us: dkerecm1@jhu.edu, like us on and follow us on Instagram and X .

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96 Global Health NOW: Bird Flu Control Strategies Aren’t Working; U.S. Elections: An Existential Crossroads for Global Health Policy; and Cone of Acclaim September 26, 2024 Dairy farm workers at Fairvue Farms, in Woodstock, Connecticut, on July 9. Suzanne Kreiter/The Boston Globe via Getty Bird Flu Control Strategies Aren’t Working
  A comprehensive review of avian flu outbreaks in European fur farms, South American marine mammals, and U.S. dairy cattle point to a spillover turning point, .
 
U.K. Pirbright Institute virologists evaluated H5N1’s molecular evolution in wild and domestic birds and pathways for the virus’s spread to mammals, and called out “a reluctance to pursue modern vaccine and surveillance technologies,” , identifying serious control gaps:
 
Dearth of data: Months of missing data from U.S. dairy farms “leaves researchers, veterinarians, and policymakers in the dark,” researchers write.
 
Limited testing: Very few states conduct proactive, “bulk-tank” milk testing; H5N1 cattle testing is limited to lactating cattle moved over state lines.
 
Wildlife testing gap: Testing live animals, not just carcases, could boost detection.
 
New control strategies needed: Stocks of H5 vaccine related to currently circulating viruses are available; if H5N1 begins spreading in humans, the vaccine could be produced at scale.
 
The Quote: “What keeps scientists up at night is the possibility of unseen chains of transmission silently spreading through farm worker barracks, swine barns, or developing countries, evolving under the radar because testing criteria are narrow, government authorities are feared, or resources are thin,” the study authors .
 
Related: H5N1 clade 2.3.4.4b dynamics in experimentally infected calves and cows – GLOBAL HEALTH VOICES The Latest One-Liners   The obesity drugs Ozempic and Wegovy, known as GLP-1s, could be linked to a drop in opioid overdoses, according to a new ; researchers analyzed anonymized EHRs to identify overdose risk of patients taking GLP-1s with semaglutide compared to patients taking other diabetic medications.

At least three Canadian provinces are exploring options to expand involuntary treatment of people with substance use disorders, against the advice of some health experts who warn involuntary care for drug use can be ineffective and harmful.

Almost a quarter of U.K. Black men surveyed report being refused a prostate cancer test by their doctor—despite having 2X the risk of developing the disease than the overall adult male population.
 
Sexual behavior modification and natural immunity following infection were the driving forces in curbing the 2022–2023 mpox outbreak in Europe and the U.S., per a ; ~50% of the participants said they changed their sexual behavior during the outbreak. GHN EXCLUSIVE COMMENTARY A man holds up a sticker on the first day of Virginia's in-person early voting at Long Bridge Park Aquatics and Fitness Center. Arlington, Virginia, September 20. Andrew Harnik/Getty U.S. Elections: An Existential Crossroads for Global Health Policy   The 2024 U.S. elections will shape the future of global health policy, determining whether America will continue to provide crucial leadership to advance global health, of CUGH’s Advocacy and Communications Committee.
 
Backstory: The U.S. has long played a leading role in global health governance, from the WHO’s establishment in 1948 to the launch of PEPFAR in 2003.

• But that changed after the 2016 election, write Benjamin Mason Meier, Neha Saggi, Muhammad Jawad Noon, and Xinshu She in a GHN commentary.

Elections’ impact:

• The Trump Administration , , and, during the COVID-19 pandemic, sought to .


• Subsequently, the Biden Administration walked back those decisions, seeking to .

High stakes: The future of the nation’s leadership in global health hangs in the balance of this election—and global health stakeholders should raise awareness of candidates’ global health positions for voters, argue the authors.  
 
GLOBAL HEALTH VOICES INDIGENOUS PEOPLE An Apology for Medical Mistreatment of Indigenous Peoples
Last week, the Canadian Medical Association apologized to the country’s Indigenous Peoples for the organization’s role in medical abuse and racial injustices committed against them. It outlined specific cases of wrongdoing and how it plans to reconcile them.

“Ripple effects on future generations”: 150+ years of racism and neglect in medicine and research has had widespread consequences for Indigenous peoples—shorter life expectancies, higher rates of chronic illnesses, and deep mistrust of the medical system, to name a few.

In its apology, the CMA committed to focused on education, inclusion, and advancing Indigenous health and well-being.

ALMOST FRIDAY DIVERSION Cone of Acclaim
To see a dog wearing a “cone of shame” is to feel instant pity. The wide collars may be a loving way to keep dogs from licking wounds—but they just look humiliating. 

But to photographer Winnie Au, a dog in a cone is a —which has now been captured in her new coffee table book, Cone of Shame, .

• It features 60 dignified doggos flaunting customized collars, transforming the demoralizing device into something “beautiful and majestic,” explains Au. 


• A portion of the proceeds goes to Animal Haven’s Recovery Road Fund, which covers medical care for rescue dogs.

Ruffs worth ruffing about: Au teamed up with designer to craft cones from ranging from to to . 

Don’t call it a catwalk: The dogs could be quite the divas, per behind-the-scenes gossip including . Treats? Mandatory. And drool? Inescapable, says Au: “So most of the retouching in the book went into drool removal.” QUICK HITS Sudanese refugees fled to Chad with hope. What they found is a bitter irony –

Race to combat mpox misinformation as vaccine rollout in DRC begins –

US suicides held steady in 2023 — at a very high level –

The cancer moonshot goes global –

10th death announced in listeria outbreak linked with Boar’s Head deli meat recall –

Healthier rice variety could counter rise in diabetes, Philippine scientists say –

‘We are embarrassed’: Scientific rigor proponents retract paper on benefits of scientific rigor –

Get your Narcan! Old newspaper boxes are being used to distribute overdose reversal drug – Issue No. 2787
Global Health NOW is an initiative of Johns Hopkins Bloomberg School of Public Health.

Contributors include Brian W. Simpson, MPH, Dayna Kerecman Myers, Annalies Winny, Morgan Coulson, Kate Belz, Melissa Hartman, Jackie Powder, Aliza Rosen, and Rin Swann. Write us: dkerecm1@jhu.edu, like us on and follow us on Instagram and X .

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  Copyright 2024 Johns Hopkins Bloomberg School of Public Health. All Rights Reserved. Views and opinions expressed in Global Health NOW do not necessarily reflect those of the Johns Hopkins Bloomberg School of Public Health or Johns Hopkins University.


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96 Global Health NOW: Revisiting Stockpiles as Mpox Spreads; The Power of the Promotoras Model; and DIY Injections September 25, 2024 Health workers walk between wards at the mpox treatment center at Nyiragongo General Referral Hospital, north of Goma, on August 17. Guerchom Ndebo/AFP via Getty Revisiting Stockpiles as Mpox Spreads
  The WHO is urging wealthy countries with smallpox vaccine stockpiles to give some of those doses to African countries that are still battling mpox empty-handed, .

• Smallpox vaccines have been shown effective against mpox, and an estimated hundreds of millions are in global stockpiles. They could help fight the outbreak as efforts to get mpox vaccines to the region continue to stall. 


• “Right now we have an immediate need,” said the WHO’s Maria Van Kerkhove. 

Closer to home: In addition to the need for international aid, empowering African leadership is critical right now, wrote a group of African authors in a .

• “Ultimately, successfully eliminating human-to-human transmission of mpox in Africa will come down to local public health action,” the group wrote. 

Gaining traction: Meanwhile, there are worrying signs that mpox is making inroads in Kinshasa, the DRC’s capital city of 17 million, after a sharp uptick in cases—leading scientists to warn of a larger outbreak, .

And in India: Health officials confirmed the country’s first case of clade 1b mpox in a 38-year-old man who had recently traveled to Dubai, . 

Related: CDC Alerts on Mpox Prevention for Patients Heading to Areas With Clade I Outbreaks – GLOBAL HEALTH VOICES The Latest One-Liners   At least 210 women were charged with pregnancy-related crimes since Roe v. Wade was overturned in 2022—more than in any other 12-month period since 1973, ; in most of the cases, women were accused not of violating abortion bans, but of child abuse, neglect, or fetus endangerment.

More than 1 in 3 children around the world are shortsighted, that points to excessive screen time and too little time outdoors; Asian children were most affected, with a prevalence rate of 85% in Japan and 73% in South Korea, versus 1% in Paraguay and Uganda.
 
Many hospitalized COVID-19 patients show worse cognitive function more than a year after their illness compared with those who weren't hospitalized, published in Nature Medicine.

Outbreak detection efforts in South and Southeast Asia remain “under-resourced”—with only about half the countries studied currently including genomic surveillance initiatives in their national plans, published in Nature Microbiology. REPRODUCTIVE HEALTH The Power of the Promotoras Model
The landscape of reproductive rights in the U.S. is already byzantine—but for newly arrived immigrants, it is even more confounding.

• For example: A recent community survey in New Jersey found that nearly 70% of Latinx immigrants did not know that abortion was legal in the state.

That is why more advocates are encouraging a public health outreach model for Latinx immigrants based on the “promotora de salud”—or community health worker.

• In the promotoras model, developed in Latin America in the 1960s, local residents serve as “trusted messengers” to share and gather health information. 

In New Jersey, the state’s Abortion Justice Committee has begun training and deploying promotoras to help provide immigrant communities information about reproductive and sexual health services. 

GLOBAL HEALTH VOICES TECH AND INNOVATIONS DIY Injections
In some regions where people struggle to access critical medicines, the problem is not a lack of drugs—but the lack of medical providers to dispense them. 

That’s why new attention is focusing on medication delivery, and in particular: the syringe. 

Breakthrough delivery: Marc Koska, who invented the single-use auto-disable syringe in 1987, hopes to take that creation to the next level in the form of self-injectable syringes, preloaded with the exact dose of medication.

• “We need to get to the point where people can say ‘all right, I can do this myself,’” said Koska. 

Optimizing for access: While self-injectable syringes are already used for some medications like Ozempic, they are difficult to produce—and only economically viable in the West. Koska’s model takes a different manufacturing tack to make the process more cost-effective. 

QUICK HITS ‘We are not testing enough’: new US bird flu cases stoke fears over poor response –

Will the UNGA meeting on AMR deliver results for the global south? –

A lead poisoning mystery: How 2 detectives fingered a surprising culprit –

Senate chairman demands answers from emergency rooms that denied care to pregnant patients –

Ozempic maker's CEO blames insurance companies for weight-loss drug prices –

Top Chinese vape firms research nicotine alternatives –

These Maternity Homes Offer Sanctuary, but It Can Feel Oppressive –

1 in 7 scientific papers is fake, suggests study that author calls ‘wildly nonsystematic’ –

Health warning over face-slap fighting – Issue No. 2786
Global Health NOW is an initiative of Johns Hopkins Bloomberg School of Public Health.

Contributors include Brian W. Simpson, MPH, Dayna Kerecman Myers, Annalies Winny, Morgan Coulson, Kate Belz, Melissa Hartman, Jackie Powder, Aliza Rosen, and Rin Swann. Write us: dkerecm1@jhu.edu, like us on and follow us on Instagram and X .

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96 Global Health NOW: Holding the Polio Eradication Effort Hostage; Cancer Care Inequities Are Costing Kids' Lives; and A Refuge from Relentless Threats September 24, 2024 Holding the Polio Eradication Effort Hostage  
In northwestern Pakistan, village leaders frustrated by government neglect are boycotting polio immunization campaigns—allowing vaccinations only in exchange for services like electricity, water, paved roads, health care, or jobs—unwinding Pakistan’s progress against the virus.

• Two years ago, Pakistan appeared close to defeating polio, with no cases for over a year; this year so far, the country has identified 18 cases.

Global eradication effort at risk: The boycotters are aware of international pressure on Pakistan—one of the last two countries where the disease is still endemic—to wipe out the disease. But it’s a misconception that some of the money spent on polio could be allocated to address other problems, says Abdul Sattar, a doctor who has worked on the polio campaign.
 
The Quote: “We do care for our children, but we also know that the government concedes to our demands only when we stay away from polio drops,” says Zeeshan Ali, a Kuki Khel tribesman who participated in a polio boycott that secured a government promise to repatriate people displaced by war.
 
GLOBAL HEALTH VOICES The Latest One-Liners   The Biden Administration plans to announce a donation today of 1 million mpox vaccine doses and at least $500 million to African countries in a bid to halt the spread.  

California cow herds infected with H5N1 bird flu doubled last weekend—going from 17 last Thursday to 34 yesterday morning, making California second only to Colorado, which has confirmed 64 infected herds, among all affected states.
 
African countries’ longer life expectancies—and the fastest growing senior population in the world—herald a sharp increase in dementia cases in coming decades; challenges include outdated detection technologies, insufficient research, and inadequate data.

The U.S. obesity rate is “high and holding steady” at ~40%, per a of ~6,000 people, but the proportion of Americans with severe obesity has ticked up from a decade ago—from ~8% to ~10%—with women nearly 2X as likely as men to be affected. GHN EXCLUSIVE Q&A A boy who has cancer sits on a bed as he receives treatment at the Oncology Centre in Sanaa, Yemen, on November 10, 2020. Hani Al-Ansi/picture alliance via Getty Cancer Care Inequities Are Costing Kids Their Lives
An estimated 400,000 children and adolescents worldwide develop cancer each year. But only half are ever diagnosed—and . More than 80% of children with cancer in high-income countries are cured, compared to less than 30% in many LMICs, . 

Compared to children in wealthier nations, kids in LMICs are more likely to experience:

• Delays in diagnosis.


• Lack of access to imaging, diagnostic testing, and medications.


• A scarcity of high-volume centers—impeding access to specialized oncology, surgery, and radiotherapy expertise.


• Inadequate support services.

“All of these barriers negatively impact survival rates,” Andrew Kung, chair of the Department of Pediatrics at Memorial Sloan Kettering (MSK), says in a GHN exclusive Q&A.

Overcoming them requires global health care collaboration, adds Andreas Dracopoulos, co-president of the Stavros Niarchos Foundation (SNF). 

Looking forward: Kung and Dracopoulos are currently working with the , an MSK Cancer Center and SNF initiative, that aims “to optimize outcomes for young patients globally by expanding clinical care expertise, educational and specialized training, and collaborative translational research,” says Kung. DATA POINT MENTAL HEALTH A Refuge from Relentless Threats
Across Latin America, Indigenous environmental advocates seeking to protect ancestral lands from outside industries have faced ruthless repercussions: intimidation, incarceration, assassinations, or forced disappearances. 

“Invisible traumas”: But targeted advocates also face profound mental suffering under such constant duress, including insomnia, panic attacks, depression, and suicidal ideation.

Places of healing: In response, a network of safe houses and temporary shelters is being created by groups of psychologists, social workers, and lawyers to support advocates’ mental health.

• The havens use different forms of therapy, arts and crafts, and educational workshops to help residents “breathe, sleep and rest”—and build resilience. 

Thanks for the tip, Cecilia Meisner! GLOBAL HEALTH VOICES VACCINES Lessons from Louisville  
Louisville, Kentucky, has been held up as a vaccination success by offering vaccinations through school clinics and raising vaccination rates 4% for kindergartners during the 2022–2023 school year. 
 
But numbers have slipped once again—and remain below the national threshold, part of a growing trend.

• 40% of American parents said vaccinating their child was “extremely important”—18% less than 2018. 

Louisville’s approach: Local officials believe they can get to herd immunity thresholds, citing support from the local health department, nursing schools, and city leaders—but they have to overcome challenges including tight funding, misinformation, and bureaucratic rules that hamper doctors providing vaccines.



Thanks for the tip, Dave Cundiff! QUICK HITS The mosquito-bourne virus that's spreading without a cure –

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Surrogates face higher risk of pregnancy complications, study finds –

Why climate change means more blood shortages: Q&A with HHS’ Rachel Levine –

The Secret to Getting Men to Wear Hearing Aids – Issue No. 2785
Global Health NOW is an initiative of Johns Hopkins Bloomberg School of Public Health.

Contributors include Brian W. Simpson, MPH, Dayna Kerecman Myers, Annalies Winny, Morgan Coulson, Kate Belz, Melissa Hartman, Jackie Powder, Aliza Rosen, and Rin Swann. Write us: dkerecm1@jhu.edu, like us on and follow us on Instagram and X .

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96 Global Health NOW: The Toll of Traumatic Injuries in Gaza; Strengthening Systems to Ready for a Pandemic Agreement; and Intelligent Infrastructure September 23, 2024 The Toll of Traumatic Injuries in Gaza
Life-changing injuries to people in Gaza are being severely undertreated, —leaving them vulnerable to further physical and mental deterioration as the war there continues. 

A found that ~22,500 people are likely to have “acute and ongoing rehabilitation needs” that include extremity injuries, amputations, spinal cord injuries, and burns.

• But rehabilitation services “do not come close to meeting the enormous surge in needs,” the report found.


• Meanwhile, MSF estimates ~4,000 people in Gaza need reconstructive surgery. The organization has been able to treat only a fraction of those people in its specialized hospital in Amman. 

And yet: ~60% of requests for medical evacuations from Gaza are turned down, per the WHO—including requests to evacuate wounded children. 

Adolescents are especially vulnerable to the “acute stress” from injuries they have suffered and will require long-term psychotherapy.

• “This is a huge, tormenting catastrophe, and psychologically their minds are unable to bear all of this stress,” said Ahmad Mahmoud Al Salem, an MSF psychiatrist in Amman. 

Related: 

‘Fear of war’ causing speech problems in Gaza –

UN to add nutrients to second round of Gaza polio vaccinations – GLOBAL HEALTH VOICES The Latest One-Liners   Whooping cough is surging in the U.S., which has reported over 4X as many cases compared with last year; unvaccinated teens and tweens are driving the surge in many states.

A second Missouri health worker who had contact with a hospitalized avian flu patient developed “mild respiratory symptoms” but was not tested for the virus, U.S. officials have reported.

U.S. trade regulators have sued the three largest pharmacy benefit managers for allegedly engaging in “anticompetitive practices” that boosted profits while inflating the list price of insulin.

A nasal spray flu vaccine will be available for home use starting next fall after the FDA expanded its approval of AstraZeneca’s FluMist; it will be the first flu vaccine that doesn't need to be administered by a health provider and will be sold direct to consumers. GHN EXCLUSIVE COMMENTARY A woman enters a pharmacy damaged in a Russian drone attack in Kharkiv, Ukraine, on January 31. Ivan Samoilov / Gwara Media / Global Images Ukraine via Getty Pandemic Agreement May Happen Eventually ... But Is the World Ready?    After the latest round of pandemic accord discussions wrapped up last week, —including in research and development, regulatory systems strengthening, and pandemic prevention and technology. Discussions will resume in November.
 
But countries don’t need to wait until WHO member states reach consensus to begin the essential, though perhaps less exciting, behind-the-scenes system-strengthening work to prepare for the accord’s implementation, .
 
He offers three ways that global health professionals and donors can help strengthen LMIC pharmaceutical systems now:

• Ensure adequate financing of national medicines regulatory authorities (NMRAs) tasked with ensuring new product safety.


• Strengthen pharmaceutical supply chains with an eye to long-term resilience.
  
  Example: Ukraine’s supply chain program for HIV and TB drugs that uses a network of local, private-sector logistics providers has been twice repurposed: for vaccine delivery during COVID, and again to move emergency medical supplies during the invasion.


• Establish pharmacovigilance to ensure newly introduced products remain safe.
  
  Example: A few years ago, Bangladesh’s NMRA established a web-based surveillance system to monitor the safety of a novel TB treatment, which is now used to monitor adverse reactions for all medical products.

GLOBAL HEALTH VOICES COVID-19: ORIGINS A Closer Look at Wuhan Market’s Wildlife 
Newly published research explores the possibility that wild animals brought to the Wuhan market were at the “epicenter” of the COVID-19 pandemic. 

The , published last week in Cell, traces “with unprecedented granularity” how SARS-CoV-2 was present at a specific part of the market where wildlife—including raccoon dogs, palm civets, Himalayan marmots, and other creatures—were kept and sold.

The genetic data used for the analysis were drawn from swabs taken at the market by Chinese scientists on Jan. 1 and Jan. 12, 2020, as the market was shut down. 

Ongoing controversy: Critics say the analysis depends on flawed and biased data, as “Chinese scientists were preferentially collecting data” from areas where live animals were sold. 

ROAD SAFETY Intelligent Infrastructure
In the global quest to reduce traffic deaths, safety advocates are increasingly looking beyond driver behavior—with more focus on cars and roads. 

Reactive roadways: One big-picture tool getting more attention is wireless technology known as “vehicle to everything,” or V2X, which allows vehicles to transmit information about speed, road conditions, and emergencies—prompting traffic signals to adapt accordingly to improve safety and flow.

• The goal: “Extending a car’s perception … through communication with traffic infrastructure and other vehicles.”

The challenge: Implementing the tech requires a “substantial” number of cars and infrastructure to be equipped with V2X for it to work effectively. 



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Global Health NOW is an initiative of Johns Hopkins Bloomberg School of Public Health.

Contributors include Brian W. Simpson, MPH, Dayna Kerecman Myers, Annalies Winny, Morgan Coulson, Kate Belz, Melissa Hartman, Jackie Powder, Aliza Rosen, and Rin Swann. Write us: dkerecm1@jhu.edu, like us on and follow us on Instagram and X .

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