Devex CheckUp: A year into war in Ukraine, the health crisis worsens

This is my last edition of CheckUp. For the 130-odd weeks since my colleague Jenny Lei Ravelo and I launched this newsletter, I have had the honor to learn about global health and the organizations and people who work to make it more efficient, accessible, and equitable — and the opportunity to write about the times when that doesn’t happen. For this and the community that gives us constant feedback and encouragement, I am thankful. As I move on, I’m reassured that the newsletter will be in the able hands of Jenny, Sara Jerving, and Andrew Green, who has been a regular contributor to our global health coverage and from whom you’ll hear more in the coming weeks. I will remain a loyal subscriber and a fan of this team’s incredible reporting. I wish I could end my stint on a positive note about the state of global health, but unfortunately, this week marks a year of Russia’s war in Ukraine and as we take stock, we are reminded of a growing health crisis. Even in liberated areas of the country, about 1 in 3 people can no longer afford to buy medicines, and 44% are seeking care for chronic conditions such as kidney and heart disease. Added to this are continued attacks on health care in the country. Since the war started, the World Health Organization has recorded more than 800 attacks on health care facilities, including hospitals and pharmacies. Dr. Hans Kluge, WHO regional director for Europe, tells Jenny that since the war began, the health response’s focus has changed — from an emphasis on vaccines and communicable diseases to mental health and chronic conditions such as diabetes, which affects a huge percentage of the population. In occupied areas, basic humanitarian access continues to be a challenge. According to Kluge, informal reports indicate that there are about 15,000 HIV/AIDS patients in Mariupol and Donbas who are running out of antiretroviral therapies. While WHO has launched a $160 million appeal for Ukraine, donor fatigue is a real concern. But Kluge says, “this is not the time to let fatigue win, because we expect a worsening of the situation.” Read: WHO warns of worsening health situation in Ukraine + Catch up on all our coverage of the humanitarian response to the war in Ukraine. Kaseya what? Jean Kaseya, a Congolese medical doctor with over two decades of experience in public health, has been named the first director general of the Africa Centres for Disease Control and Prevention. Sources tell Sara the final decision was down to Kaseya and Dr. Magda Robalo from Guinea-Bissau. And according to the president's office of the Democratic Republic of Congo, there were 180 candidates for the role. “This is the epilogue of a long, secret diplomatic battle waged for six months by President Félix Tshisekedi,” an announcement said. Kaseya’s overarching task is to lead the agency in its quest to ensure global health security for populations across Africa. This includes strengthening disease surveillance, working with countries to strengthen health systems, and responding to health emergencies. To find out all about Kaseya’s manifesto, read Sara’s story on Africa CDC's new director general. Related op-ed: Africa is better prepared for future pandemics Battle royale After the Taliban came back into power in Afghanistan in August 2021, the country's health system — which was mostly aid-funded — was left without any support. No foreign funding could go to the Taliban, which is not an internationally recognized government. Now a group of organizations including United Nations agencies, multilateral donors, and international NGOs are trying to create a strategy that will be sustainable. The catch? The Taliban wants to have a say over the strategy and control who will implement it on the ground. “The Taliban has repeatedly emphasized that they would like to be engaged and to have ownership [over health programs] and to have even a stewardship, which is not something that we have been in full agreement with,” WHO director Awad Mataria tells me. Right now, all the interested parties are reviewing the draft of the strategy. In early March, it will be circulated to a wider group, after which U.N. agencies hope donors will fund its implementation. But not everyone agrees it’s the right way forward. The international community simply does not have the money to spend billions of dollars to create a parallel system, and donors will have to work with the Taliban to ensure sustainability, says Crisis Group's Senior Consultant Graeme Smith. “Because otherwise, these systems will collapse.” Read: The battle to revive Afghanistan's failing health system Usual suspects My colleague Adva Saldinger has the rundown of who in the U.S. Congress will take charge of foreign aid this year. Still chairing the Senate Foreign Relations Committee will be Sen. Bob Menendez, a Democrat from New Jersey with lots of health-related priorities: He’s a co-sponsor of the End Tuberculosis Now Act, a bipartisan bill to make eliminating TB a U.S. foreign assistance priority, and recently called on the State Department and the U.S. Agency for International Development to guarantee access to health care services for women employees abroad. Read: Congress who's who for foreign aid in 2023 (Pro) + Start your 15-day free trial of Devex Pro today to read the piece. Up next At a leading HIV conference this week, one researcher called long-acting cabotegravir, or CAB-LA — essentially a long-term form of pre-exposure prophylaxis, or PrEP — “one of the most revolutionary breakthroughs in HIV prevention.” While current forms of PrEP require a pill taken daily, CAB-LA means patients need injections four or eight weeks apart. But there are concerns about ensuring that the long-acting injectable will reach the communities that might benefit most from it. This follows lower uptake of pill-form PrEP than officials had hoped. Look out for Andrew’s story on the Conference on Retroviruses and Opportunistic Infections, where researchers looked to lessons from PrEP’s rollout to ensure wider availability and acceptance of the new preventative. What we’re reading Sri Lankans are delaying nonessential surgeries as the country struggles to procure medicines due to the financial crisis. [Tamil Guardian] Researchers in Kenya have detected an invasive mosquito that can transmit malaria in different climates. [VOA] Mpox is more deadly for advanced HIV patients, scientists warn. [The Telegraph] Andrew Green contributed to this edition of Devex CheckUp.