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This week in health: a battered healthcare situation in Gaza, NMC’s contested new logo and how India can fight AIDS stigma.

December 06, 2023 10:04 am | Updated December 07, 2023 10:00 am IST

Image for representational purpose only.

Image for representational purpose only. | Photo Credit: AP

(In the weekly Health Matters newsletter, Ramya Kannan writes about getting to good health, and staying thereYou can subscribe here to get the newsletter in your inbox.)

Something really significant for health care happened at the biggest climate conference this weekend. For the first time, a COP meeting had a designated Health Day, on December 3, when over 120 countries endorsed the COP28 Declaration on Climate and Health. The effects of air pollution on the population are becoming more apparent, in recent times. A recent BMJ study indicated that air pollution causes over 2 million deaths annually in India, putting the country second only to China. Heat stress. Lung damage from wildfire smoke. The spread of disease-carrying mosquitoes into new regions as temperatures rise. From 2030, experts expect that just four of these threats are making the world a sicker place - malnutrition, malaria and dengue, diarrhoea, and heat stress - will push global death tolls up by 2,50,000 per year, according to the World Health Organisation (WHO).

Members of the International Federation of Medical Students Associations hold placards during a protest demanding an end to fossil fuels at COP28 World Climate Summit, in Dubai, United Arab Emirates, December 3, 2023.

Members of the International Federation of Medical Students Associations hold placards during a protest demanding an end to fossil fuels at COP28 World Climate Summit, in Dubai, United Arab Emirates, December 3, 2023. | Photo Credit: Reuters

The Declaration read thus: “We, on the occasion of the first Health Day at the 28th UN Climate Change Conference (COP28), express our grave concern about the negative impacts of climate change on health. We stress the importance of addressing the interactions between climate change and human health and well-being in the context of the UNFCCC and the Paris Agreement, as the primary international, intergovernmental for the global response to climate change.” The signatories recognised the urgency of taking action on climate change, noting the benefits for health from deep, rapid, and sustained reductions in greenhouse gas emissions, including just transitions, lower air pollution, active mobility, and shifts to sustainable healthy diets. “In this year of the first Global Stocktake, and given the lessons learned from the COVID-19 pandemic, which strained all health systems and further widened inequities and vulnerabilities within and among countries, regions and populations, we are committed to the advancement of climate-resilient development, the strengthening of health systems, and the building of resilient and thriving communities, for the benefit of present and future generations,” the declaration further read.

As disasters, floods and famines, occur at a breathless place in the world around us, it is very important to factor health in as we write out our actions to stop climate change. Health, however has been no stranger to the COP, says Saumya Kalia. The United Nations Framework Convention on Climate Change (UNFCCC) recognises the health impacts of climate change; the 2016 Paris Agreement acknowledged the right to health; last year’s COP27 mentioned the human right to a clean, healthy and sustainable environment in its cover decision. “Health events have been held at COP for several years, including at the WHO Health Pavillion, but this is the first time there has been an official ‘Health Day’,” says Jess Beagley, policy lead at the Global Climate and Health Alliance (GCHA). Most G20 countries — including wealthy industrialised nations responsible for the majority of historic greenhouse gas emissions — have failed to centre health in their climate action, as per a 2023 analysis by the Global Climate and Health Alliance. Low- and middle-income countries like Burundi and Congo were found to be better at engaging with health concerns in their NDCs and meeting their health targets. 

From one global health crisis to another. Roshin Mary George writes about how fraternal ties and humanitarian gestures go hand in hand for the UAE in support of Gaza. On November 18, the first plane carrying 15 Palestinians including children and their guardians – most often one parent, with the other staying behind to tend to their remaining children – and medical volunteers landed at Abu Dhabi International Airport from Al Arish airport in Egypt. Pregnant women as well as children in need of urgent medical assistance, such as those suffering from severe injuries, burns and cancer, had reached Arish through the Rafah crossing in an operation that takes 15 hours. The second and third flights landed on November 21 and 28 respectively, and more such missions are on the anvil.

The UAE President also ordered the establishment of an integrated field hospital and three desalination plants in Gaza as part of the “Gallant Knight 3” operation. The 150-bed hospital, to be built in stages, will include the departments of general surgery, orthopaedics, paediatrics, dentistry, psychiatry and gynaecology, in addition to anaesthesia and intensive care units for both children and adults. Moreover, 31 premature babies shifted from Al Shifa Hospital in Gaza are being cared for at the UAE-run Al Helal Emirati Maternity Hospital in Rafah. 

Disease could be a bigger killer than bombs in Gaza, apparently. More people could die from disease than from bombings in the Gaza Strip if its health system is not repaired, a World Health Organization spokesperson said last week, warning of a surge in infectious diseases and diarrhoea in children. “Eventually we will see more people dying from disease than we are even seeing from the bombardment if we are not able to put back (together) this health system,” said the WHO’s Margaret Harris at a U.N. briefing in Geneva. She repeated concerns about a rise in outbreaks of infectious diseases, particularly diarrhoea in children, with cases for those aged five and older surging to more than 100 times normal levels by early November.

Sometimes, one is just glad to pass on to yet another former health crisis – HIV/AIDS. On the occasion of World AIDS Day, there was a rash of reportage about HIV, an issue that used to dominate the headlines in the late 1990s and early 2000s. For someone used to all those hectic parleys and media blitz on HIV itself, it seems that the sector is rather dull these days. A sterling example of where the people living with HIV/AIDS forced the course of care and treatment, the world over, there are many lessons still from the way health systems geared up to meet the rather extraordinary situation, which still has ‘no cure.’ It was rather reassuring to read from an expert expressing hope again.

N. Kumarasamy who has years of experience in HIV treatment and has helmed crucial and extensive research, wrote that AIDS can be stopped with science-backed tools. Today we have effective antiretroviral medications available to prevent the multiplication of HIV, he says. People with HIV who are on these antiretroviral medications can lead a normal, healthy lifestyle without developing opportunistic infections. Results from clinical trials recommend starting Antiretroviral Therapy (ART) soon after diagnosis. He adds: We have effective biomedical prevention tools in preexposure prophylaxis (PrEP) medications. These oral medications are very effective in preventing HIV acquisition if a person with high risk of HIV takes them correctly without fail.” Adherence, of course, very difficult to enforce is very important.

There is a need to scale up HIV response for those at higher risk, experts also said on the occasion of HIV Day. While the HIV prevalence in prisoners is 1.9%, the coverage of antiretroviral therapy is only 28.7% in prisoners. “If current trends continue, more than 1.2 million persons will be newly infected with HIV in 2025. Pre-exposure prophylaxis (PrEP) can prevent HIV acquisition but is still not implemented widely in India. Efforts should be made for the accessibility of PrEP medications for the communities,” the article said.

With hectic activity across the country, each State made appropriate gestures on December 1. About 91% of the affected people contracted the virus due to engaging in unsafe sex. This indicates that while the incidence of HIV/AIDS has come down over the years, challenges still persist in eradicating the disease, officials in Andhra Pradesh said.     

Afshan Yasmeen recorded that at 0.29%, Karnataka’s HIV prevalence rate is higher than the national average. While Nagaland tops the list of States with the highest prevalence (1.61%), Karnataka is in the ninth position, according to data from the National AIDS Control Organisation (NACO). Nagaland is followed by Mizoram (1.13%), Meghalaya (0.58%), Delhi (0.41%), Tripura and Chandigarh (0.38% each), Andhra Pradesh (0.37%), Manipur (0.33%), and Karnataka (0.29%). There was also this side of the picture: HIV cases on a gradual decline in Dakshina Kannada. Karnataka Chief Minister Siddaramaiah said that the country and Karnataka should target zero transmission of HIV/AIDs in the next five years. Clearly, he’s not the only one with the idea: Kerala’s Health dept. has resolved to launch a campaign to end AIDS by 2025. And Hyderabad is in the picture as well, Siddharth Kumar Singh writes that Hyderabad leads the charge in fighting AIDS stigma through collaborative initiatives.

Moving on to a domestic crisis, it came as a relief to medicos when the National Medical Commission (NMC) announced relief for displaced students of four medical colleges in Manipur. Following an appeal by the Manipur Government and discussions with them, the NMC has decided that all displaced students from four medical colleges in violence-hit areas of the State will be allowed to have online classes or on hybrid mode at Churachandpur Medical College (CMC), reports Bindu Shajan Perappadan.

But the Indian Medical Association is scarcely impressed with the NMC, now, she further says. The Commission earlier this week unveiled a new logo depicting the Hindu deity Dhanwantari with the words Bharat added to it. The IMA, the nation’s largest non-government organisation of allopathic doctors, on December 3, expressed its strong objection and disapproval of the new logo, emphasising that it should be religion neutral, and not contradict the Hippocratic oath, by seeming to align with one community.

In 2022, India accounted for 66% of malaria cases in WHO South-East Asia Region, the World Malaria Report said last week. It added that almost 46% of all cases in the region were due to Plasmodium vivax, which is a protozoal parasite and a human pathogen, which is the most frequent and widely distributed cause of recurring malaria. While acknowledging the ever-expanding access to tools to keep mosquitoes at bay, there is still concern about improving this access. “The changing climate poses a substantial risk to progress against malaria, particularly in vulnerable regions,” said Tedros Adhanom Ghebreyesus, WHO Director-General, adding that a substantial pivot in the fight against malaria is needed, with increased resourcing, strengthened political commitment, data-driven strategies and innovative tools.

We seem to have arrived at our infectious diseases alcove, for the week, so here goes: R. Prasad writes about the BCG revaccination study in high-risk adults that is to begin in 23 States, to evaluate the effectiveness of the vaccine in reducing TB disease incidence. Two clinical investigation studies (2019 and 2023) by St. John’s Research Institute, Bengaluru have found BCG revaccination in adults to be significantly immunogenic, and this study holds out a lot of hope as of now.

Dr. Rajeev Jayadevan brings to us yet another angle related to COVID-19 that might have missed our attention otherwise. He begins by asking: Did vaccination reduce COVID-related preterm births? The study tracked vaccine rollout in California, and divided the State into five zones based on vaccination coverage. The apparent adverse impact of COVID-19 on preterm births diminished quickly in places where vaccines were widely accepted. The difference persisted for almost another year in areas that had low vaccine acceptance. The impact eventually vanished in January 2022, which coincided with the arrival of Omicron and widespread population immunity. Based on these observations, the authors state that vaccination prevented a large number of preterm births during the pandemic. He adds a note of caution that pre-term births are caused by multiple factors and the issue is rather complicated. 

In these days where AI is traded happily over the counter, the medical sector seems to have employed it gainfully in multiple aspects of the health spectrum. We have been hearing about AI X-rays that will be able to identify abnormal results and then scale it up. Here is another: Swaasa, an AI platform, which analyses cough sounds to assess risks and identify respiratory diseases, has reportedly become the world’s first company, to get a licence for the device, which uses cough as a marker. The founder of Swaasa claimed that the validations of the app were done in Andhra Medical College, Christian Medical College at Vellore, and AIIMS in New Delhi.

Meanwhile, amid ICU bed shortage, care-at-home services are gaining ground in some parts of the country. Care-at-home services revolve around two core principles - reducing hospital stays and establishing essential infrastructure at home to support medical care when individuals require assistance. Currently, in India, the services include nursing support, doctor visits, home-based support systems, mobile ventilators, etc., which are tailored to the specific nature of the illness. These are expanding beyond the big cities, apparently.

At least if you have the reach, it might be within your grasp.

Tailpiece

In a strange turn of events, the World Bank recalled a paper on the decline in toilet usage in India, sending it flushing down, perhaps, after it was launched. Weeks after the World Bank published a departmental working paper titled “Progress on Sanitation in Rural India: Reconciling Diverse Evidence” in September this year, highlighting the “most concerning” trend of toilet usage declining in rural India since 2018 despite early gains of the Swachh Bharat Mission - Gramin, it has recalled this paper and two others, pending an “internal review”, while insisting that the papers had not gone through the required approvals internally before being published on the website. One would think the WHO would do due diligence, but as it is, this one must be filed under scatological humour.

From the Health page

Sridhar Sivasubbu and Vinod Scaria write on the transformative benefits of population-level genome sequencing. 

Ayurveda serves global need for equitable healthcare system, says Vice President.

Ishita Mishra, who followed the Silkyara tunnel rescue, reports that workers rescued from the tunnel are undergoing check-ups in in AIIMS.

Experts stress on preventing complications due to diabetes.

Japan begins trials to sell over-the-counter pills for emergency contraception.

U.S. FDA approves Granules copy of pulmonary arterial hypertension drug.

Meanwhile, do check our rather wide coverage of regional content, presented over the week, across our bureaus:

Andhra Pradesh

Now help just a click away for visually challenged and hearing impaired in Visakhapatnam.

Harish Gilai writes that many students in Andhra Pradesh’s Paderu found to be anaemic during survey by Health Department.

Awareness of dementia is key to understanding patients and supporting them, say speakers at a workshop.

Phase-II of Arogya Suraksha will begin on January 1, says Andhra Pradesh CM.

Delhi

Government hospitals to screen children amid pneumonia outbreak in China.

Gujarat

More than 1,000 people died of heart attack in Gujarat in six months, says Minister Kuber Dindor.

Jharkhand

Jharkhand puts hospitals on alert amid pneumonia outbreak in China.

Karnataka

Pneumonia precautions: Karnataka Health Department issues circular and advisory to public.

Karnataka Health Department rolled out 262 new ambulances under ‘108 services’.

Health Minister opened surgery, physiotherapy and laboratory units at Govt. AYUSH Hospital in Mangaluru.

ASHAs take out protest march in Karnataka’s Haveri.

Dialysis patients in Karnataka hit as staff of government units launch indefinite strike.         

Dialysis workers’ protest: Technician hospitalised after he attempts to end life.  

Five-month-old infant in Bengaluru diagnosed with a rare congenital disorder undergoes life-saving bone marrow transplantation.

Kerala

Kerala Governor signs health Bill and reserves seven for Presidential consideration.

In a first, Kerala to host Transplant Games.

H1N1 fever case reported in Kerala’s Alappuzha.     

Puducherry

Preparedness ramped up in Puducherry for any surge in respiratory ailments.   

Tamil Nadu

Tamil Nadu’s ‘Innuyir Kappom’ scheme has helped two lakh people.

60,000 stamps with awareness messages on childhood cancer released in Chennai.

Conference on ‘One Health’ approach to virus research gets under way in Tiruchi.

World AIDS Day observed in Tiruchi, Pudukottai districts.

As always, do put us on your radar, as we bring more health content your way. Get more of The Hindu’s health coverage here.  

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