Global health highs and lows in 2019

MANILA — Global health organizations faced immense challenges in 2019. Ebola remains a concern in the Democratic Republic of the Congo, and health authorities across the globe struggled to contain multiple disease outbreaks, including those that could have been easily prevented with vaccines.

Amid the challenges, there were also quite a few bright spots, from disease eradication to successful replenishments.

Here are some of the biggest global health events of 2019. Which one grabbed your attention?

1. Ebola, a global public health emergency

After months of deliberations, on July 17, the World Health Organization finally declared the Ebola outbreak in DRC a public health emergency of international concern. By November, a significant reduction in cases raised hopes that the outbreak was near containment, but that was crushed with the resurgence of violence in Beni in late November.

The violence caused disruption in the response, some staff relocations, and the deaths of three Ebola responders. Following the violence, WHO again saw an uptick in cases, with 27 new confirmed cases from Dec. 4 to 10, compared to an average of seven cases in previous weeks.

2. Large-scale HIV infection of children in Pakistan 

In April, a town in Sindh Province, Pakistan, captured the world’s attention with a jump in reports of HIV cases among children in Larkana district. Mass screenings later confirmed widespread infection that experts traced to questionable health practices in the area, such as rampant reuse of syringes, unscreened blood transfusions, and high numbers of unqualified medical personnel. A study published in The Lancet on Dec. 19 revealed a total of 930 people tested positive for HIV in the screenings between April and July — 79% of whom were children aged 5 years or younger.

3. Disease outbreaks

While Ebola in DRC remains the biggest health emergency, there were also a number of disease outbreaks health authorities and aid agencies raced to contain during the year, including dengue, yellow fever, polio, and measles. There was an increase in polio cases in 2019, including vaccine-derived polio cases types 1 and 2. The Philippines continues to deal with an ongoing vaccine-derived polio outbreak that started in September. Measles outbreaks also continue to be a concern, with 413,308 confirmed cases from 187 WHO member states in 2019.

The situation reached unprecedented levels in Samoa, where measles-related deaths have reached 76 as of Dec. 18 and the number of cases amounted to more than 5,000 — leading the government to declare a state of emergency.

4. Global Fund replenishment 

The Global Fund to Fight AIDS, Tuberculosis and Malaria secured $14.02 billion in pledges at its replenishment conference in October, after months of campaigning, with advocates making the case for why donors should invest in the multilateral funder. That total included $100 million that French President Emmanuel Macron, Bill Gates, and Bono promised to secure for the fund to meet its replenishment target. The replenishment is seen as a success and evidence of strong donor trust in the fund, which is a major resource of external funding for many countries fighting HIV/AIDS, TB, and malaria.

5. Global Fund’s return to North Korea 

In September, the Global Fund board approved a proposed $41.7 million TB and malaria grant for North Korea, and discussions are currently underway with the government regarding implementation. “The Global Fund is ready to launch a new grant for tuberculosis and malaria in DPRK and can proceed when the DPRK government agrees that UNICEF can sign the grant,” said a Global Fund spokesman.

For months before the Global Fund decision, advocates questioned and called on the multilateral funder to resume grants in the country where thousands of TB patients rely on its financing for their treatment. The Global Fund closed its grants in North Korea in 2018 because the unique operating environment in the country had prevented it from “achieving the required level of assurance on the deployment of resources and the effectiveness of grants,” said Seth Faison, the fund’s director of communications.

Speaking to Devex in July, advocates called on the fund to immediately resume its grants and place orders for TB medicines as early as September 2019 to avoid drug stock outs in 2020. They said remaining stocks of TB drugs are expected to run out by June 2020, but it takes 9 to 10 months for items to arrive in North Korea, due to U.N. sanctions.

6. UN high-level meeting on UHC 

Universal health coverage got its first official moment in the spotlight this year during the U.N. General Assembly in September. The high-level meeting was a chance for governments to commit to guaranteeing health care for all — something that about half the world's population currently lack.

Governments signed the agreement, which many experts considered ambitious in scope, but hard financing and monitoring of commitments are still lacking. An estimated $176 billion is needed by 2030 for the 54 lowest-income countries to provide affordable health services, according to the World Bank.

But financing is only one part of the challenge. There are countries, such as the United States, which have invested in health care systems, but still have yet to see the results of improving indicators on maternal mortality, for example. What's most important now is how individual countries will interpret the UHC agreement and implement their own plans. And in different countries, the results are bound to take on their own forms.

7.  Renewed call for malaria eradication 

The Lancet Commission on malaria eradication made a bold statement in its report in September: The world can be malaria-free by 2050 — if certain measures are put in place. Some members of the malaria community have been cautious about putting a timeline on eradication, given past failed eradication attempts that resulted in donor fatigue and disengagement in the effort. Richard Feachem, head of the commission, said they considered these concerns, but believed that setting an aggressive timeline and showing commitment to malaria can actually encourage donors and inspire national governments.

8. Eradication of wild poliovirus type 3

On Oct. 24, the Global Commission for the Certification of the Eradication of Poliomyelitis announced another global health milestone: wild poliovirus type 3 has been eradicated worldwide. This follows the eradication of wild poliovirus type 2 in 2015, leaving only the wild poliovirus type 1 in circulation.

However, vaccine-derived polio outbreaks continue to pose challenges to polio eradication efforts and detract resources away from Pakistan and Afghanistan, where wild poliovirus type 1 remains endemic. Efforts are underway to develop a novel oral poliovirus type 2 vaccine — that advocates hope to be available in 2020 — to prevent the emergence of circulating vaccine-derived poliovirus type 2 in the future.

Polio advocates have warned against complacency in the fight against the disease and have called on donors to be steadfast in their commitment until polio is globally eradicated. Several donors showed their continued commitment during the Global Polio Eradication Initiative’s replenishment in November in Abu Dhabi, although the $2.6 billion pledged amount at the event didn’t yet meet the GPEI’s overall requirement of $3.27 billion to implement its current strategy through 2023.

9. First WHO global report on vision

The importance of eye health is often overlooked, but WHO’s first world report on vision in October sought to draw attention to the issue. There are at least 2.2 billion people suffering from a form of visual impairment or blindness globally, and that number is expected to increase even more, according to the report.

Access to eye care services is an issue, and most of the time patients pay out of pocket for eye care, as it’s not often covered in health insurance schemes or coverage is limited. The report underlined the importance for countries to integrate eye care in their national health plans and care packages.

10. WHO restructuring 

In March, WHO Director-General Tedros Adhanom Ghebreyesus announced one of the biggest changes in his transformation agenda — a revamp of WHO’s senior management structure. The revamp welcomed new officials in key senior posts. Some members of his existing senior leadership team were given new roles, while others were not included. The restructuring saw the creation of new divisions, and in May at the 72nd World Health Assembly, Tedros announced the creation of a WHO Foundation.

11. Investigations

Some cases that were brought up in 2018 came to a close this year, while others continue. Here are three significant cases:

WHO continues to investigate concerns related to its operations in Yemen. Former WHO officials and staff allegedly engaged in corruption and nepotism using aid money meant to alleviate people’s suffering in Yemen, according to an AP investigation published in August. Yemen is currently the world’s largest and worst humanitarian crisis, according to the U.N., with millions of children suffering from unprecedented levels of hunger and malnutrition.  

UNAIDS whistleblower Martina Brostrom, who in 2018 accused a senior UNAIDS official of sexual assault and whose case eventually paved the way for an independent investigation into UNAIDS culture, was fired this month. The dismissal was due to a separate investigation that concluded that Brostrom, and another staff member, misused UNAIDS resources and committed sexual misconduct. The other UNAIDS staff was also fired. Brostrom plans to appeal her dismissal, calling it an act of retaliation for reporting about the sexual assault, according to the AP.

Thomas Frieden, former director of the U.S. Centers for Disease Control and Prevention, and current president and CEO of Resolve to Save Lives, in June settled a case linked to his 2018 arrest after a woman accused him of sexual misconduct. Frieden pleaded not guilty to the woman’s accusations, but pleaded guilty to disorderly conduct, a lesser violation, according to STAT News.

Amy Lieberman contributed reporting to this article.