News Flash 561: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

White seabream (Diplodus sargus sargus)

News Flash 561

Weekly Snapshot of Public Health Challenges



No Ceasefire Gaza Threatens Humanitarian Aid, Raises the Palestinian Question

People’s Health Dispatch Bulletin #70: Will it be possible to build peace through global health?

Opinion: Aid can no longer be dictated by foreign policy or geopolitics

SDGs in Asia – mind the widening gap

What to look out for in the Pandemic Accord: Intellectual Property Rights

What to look out for in the Pandemic Accord: Transparency

What to look out for in the Pandemic Accord: Stockpiling

Webinar registration: mRNA 4th Scientific Colloquium: on establishing R&D consortia in South-East Asia to advance mRNA vaccine development up to proof of concept Mar 18, 2024

Brazil Tries New Vaccine as ‘Exponential’ Rise in Dengue Cases Plagues the Americas

Collateral effects of the COVID pandemic on the vulnerable in Nigeria and their coping strategies

Wavering Sexuality During Covid Pandemic  by Subhash Hira and Rajiv Hira

US Measles Outbreak Coincides With Lowest Child Immunisation Rate in 10 Years

Child Diarrhea Has a Cheap and Easy Fix—Why Isn’t It Reaching Patients?

Kenyan scientists test AI app to diagnose tuberculosis


Clinical surveillance systems obscure the true cholera infection burden in an endemic region

Inclusion of noncommunicable disease care in response to humanitarian emergencies will help save more lives

The PASTEUR Act is not the way for the US government to address antimicrobial resistance

The Economics of Antibiotic Resistance

Keeping antimicrobial resistance high on the agenda

The quality of medicines for the prevention and management of hypertensive disorders of pregnancy: A systematic review

Patients betrayed as FDA refuses to enforce clinical trial reporting law


New Zealand moves to abolish Maori health authority despite protests

Ghana’s Parliament Passes Draconian Law With Prison Terms for People Who ‘Identify’ as LGBTIQ

Sunak’s asylum laws trapping 55,000 people in ‘perma-backlog’, says UK thinktank

Female Genital Mutilation Continues Amid Sudan’s Conflict and Forced Displacement

Cancer risk factors and access to cancer prevention services for people experiencing homelessness

UN Environment Assembly Focusses on Multilateral Solutions to Climate Crises

EU carbon border tax will do little to cut emissions, ADB study says

Why aren’t we there yet? Understanding and addressing donor barriers to localisation in climate adaptation




Wavering Sexuality During Covid Pandemic

Editor's Note

An exhaustive overview here on sexuality multifaceted flux during recent COVID pandemic, whereby attention is paid to aspects including sexual desires, virtual intimacy, dynamics of isolation, sexual health services, among other relevant issues.  

As the Authors maintain, this essay …serves as a reminder of our collective strength, adaptability, and our ever-present desire to connect, even when the world feels fractured. It is an exploration that celebrates the resilience of humankind, fostering a deeper understanding of our own desires while providing solace in the pursuit of intimacy…

…Fragmented by the disruptive forces of the COVID-19 pandemic, this exploration of human sexuality is both a reflection of our collective experiences and an unyielding search for connection in a time of isolation.

By Subhash Hira, MD, MPH

Professor of Global Health, University of Washington, Seattle, USA

and Rajiv Hira, MD, MPH

Former Assistant Professor, Intervention Radiology, LTMG Medical College Hospital, Mumbai, India

Wavering Sexuality During Covid Pandemic



In an era of Covid-19 pandemic where physical connection became elusive and intimacy got transformed, this essay on human sexuality emerges as a testament to our resilience, adaptability, and the enduring quest for a deeper understanding of our own sexual desires. Fragmented by the disruptive forces of the COVID-19 pandemic, this exploration of human sexuality is both a reflection of our collective experiences and an unyielding search for connection in a time of isolation.

Human sexuality is a complex and multifaceted topic that has evolved over billions of years. While the study of human sexuality began relatively recently in comparison, say around the late 19th and early 20th centuries, it is essential to understand the broader context of sexual evolution and behavior throughout history. During prehistoric times when human beings were evolving, say approximately 4 to 6 million years ago, our ancestors exhibited sexual behaviors that were primarily aimed at reproduction and ensuring the survival of the species. While precise details are scarce due to the limited evidence, it is believed that early humans engaged in heterosexual mating patterns, similar to other primates. Later, with ancient civilizations and cultures such as Mesopotamia, ancient Egypt, and the Indus Valley’s ancient site called ‘Mohenjo-Daro’ witnessed the development of more complex social structures and belief systems. These societies often associated sexuality with religious and cultural practices. While information on sexual behavior during these eras is mostly derived from artwork, it suggests that the ancient Egyptians celebrated sexual pleasure and fertility, while the Mesopotamians and Indus Valley believed in fertility rituals and sexual equality.

During the Classical Period, the ancient Greeks and Romans were well-known for their diverse perspectives on human sexuality. In ancient Greece, sexual relationships between men were common, alongside with heterosexual relationships for procreation. This phenomenon is known as pederasty, which typically involved an older man mentoring a younger adolescent. Ancient Roman society also exhibited a more open attitude towards sexuality, with practices such as bisexuality and orgies. With the advent of Middle Ages, and the rise of Christianity in Europe, the Middle Ages witnessed a shift in sexual attitudes. The Church played a significant role in shaping sexual morality and emphasized the necessity of procreation within the confines of marriage. Extra-marital sexual activities were condemned and considered sinful. This period also saw the rise of ‘courtly love’, an idealized form of love, romance, flirting, dancing that was illicit but that influenced how people viewed relationships and sexuality. However, during the Renaissance and Enlightenment periods, a more nuanced understanding of human sexuality began to emerge. Scholars explored various aspects of sexuality, often challenging and critiquing the Christian teachings. Figures like Leonardo da Vinci and Michelangelo explored the male form in their artwork, while philosophers like John Locke and Jean-Jacques Rousseau questioned prevailing societal norms. Sexual sculptures and carvings in ancient temples and caves of India, Thailand, Indonesia were used to document sexual postures of ‘Kamasutra’ for teaching and learnings for adolescents.

The field of sexology emerged during the late 19th and early 20th centuries, marking a shift towards scientific study and understanding of human sexuality. Figures like Sigmund Freud, Havelock Ellis, and Alfred Kinsey made significant contributions, revolutionizing the understanding of sexual orientation, gender identity, and sexual behaviors. This period saw the beginning of exploring and understanding diverse sexual orientations, such as homosexuality and bisexuality. Lately contemporary times starting with the mid-20th century, more liberal attitudes towards human sexuality have continued to evolve. The sexual revolution of the 1960s and 1970s challenged traditional norms and brought discussions surrounding contraception, reproductive rights, and sexual freedom with multiple sex partners to the forefront. The ongoing fight for LGBTQ+ rights, gender equality, and sexual education has further shaped modern attitudes and understanding of human sexuality. The knowledge accumulated over years was deflected back into the sexual practice itself in order to shape it as though it came from within and amplify its effect. In this way sexual partners were counselled that knowledge must remain secret, not because an element of infamy that might be attached to it but because of the need to hold it in great reserve for future generations. According to tradition, it was taught that sexual knowledge will lose its effectiveness and its virtue by being divulged. Consequently, relationship with the master who holds the secrets was of paramount importance. The norm ‘to keep this knowledge secret’ is now broken because there is a need felt by the state to understand more about transmission of infections in order to control pandemics. In conclusion, the history of human sexuality spans billions of years, reflecting the complex interplay between biology, culture, and societal norms. It is a continuously evolving field of study that remains a crucial aspect of human existence and shows no signs of diminishing in significance.

There are a variety of reasons why young adults may engage in multiple sex partners. It is important to note that not all young adults engage in this behavior, and individual motivations also vary greatly. However, some potential reasons may include:

  1. Exploration and curiosity: Young adulthood is typically a time of self-discovery and exploration, including exploring one’s own sexuality. Engaging in multiple sexual partners can be a way for some individuals to satisfy their curiosity and learn more about their own desires and preferences.
  2. Lack of commitment: Young adulthood is often a period of transition, exploration, and personal growth. Some individuals may prioritize personal and career goals over committed relationships. Engaging in multiple sex partners may offer a sense of freedom and avoid the perceived commitment and responsibilities of a monogamous relationship.
  3. Social and peer pressures: Social norms and peer influence can play a significant role in shaping sexual behavior. Some young adults may feel pressured to conform to societal expectations or the actions of their peers, which may include having multiple sexual partners.
  4. Desire for variety and excitement: Some young adults may value novelty and variety in their sexual experiences. Engaging in multiple sex partners can offer a sense of excitement, newness, and exploration in their intimate relationships.
  5. Emotional fulfilment: Some individuals may seek emotional connection and validation through sexual encounters. Engaging in multiple sexual relationships allows for the potential to fulfil emotional needs with multiple partners.
  6. Concerns about long-term commitment: Past experiences, personal beliefs, or a fear of commitment may lead some young adults to prefer non-monogamous relationships. Engaging in multiple sex partners can provide a sense of freedom and avoid the potential pressures and expectations of a long-term commitment.

It is vital to remember that everyone’s motivations and experiences are unique, and the decision to have multiple sex partners should always be consensual and based on personal preference, mutual respect, and safe practices.

There could be several reasons why some elderly individuals opt for multiple sex partners:

  1. Increased life expectancy: With advancements in healthcare and better overall quality of life, people are living longer. For example, the average life expectancy of female-to-male in Japan is 87:82 years; in Europe is 83:78; in North America is 79:73; in India is 69:66, in Africa is 64:57 years, respectively. As a result, they may have more opportunities and desires for sexual experiences.
  2. Freedom and liberation: Some elderly individuals may feel freer to explore their sexuality later in life, as varied societal norms and expectations around sexuality have evolved. They may no longer have familial responsibilities or societal pressures, allowing them to embrace their desires and seek multiple partners.
  3. Desire for companionship and intimacy: Loneliness is a common issue among the elderly, especially those who may have lost a long-term partner or experienced significant life changes. Seeking multiple sex partners can be a way to fulfil their need for companionship, intimacy, and human connection.
  4. Increased confidence and better self-image: As people age, they may develop a stronger sense of self and increased self-assurance, which can positively impact their sexual behavior. This newfound confidence may lead them to seek out multiple sex partners.
  5. Sexual fulfilment and pleasure: Sexual desire and pleasure do not diminish with age; in fact, some studies suggest that older individuals may experience increased sexual satisfaction due to decreased performance anxiety and enhanced self-acceptance. Seeking multiple sex partners can help fulfil their sexual desires and provide a source of pleasure.

Regardless of these reasons, it’s important to remember that individual preferences and choices vary greatly, and not all elderly individuals opt for multiple sex partners. It is essential for everyone, regardless of age, to engage in consensual and safe sexual practices.

During Covid-19 pandemic, the following important areas of human sexuality were affected: sexual desires,

1: Defining Sexual Desires

In a world that suddenly closed down and turned inward, the first chapter delves into the complexities of desires, attempting to untangle its intricate web. From the profound longing for physical touch to the exploration of newfound pleasures within the confines of our homes, we examine the shifting landscape of human sexuality, navigating through the fragments of restrained intimacy to avoid Corona virus transmission.

The anatomy and physiology of sexual desire refers to the biological components and processes that contribute to the desire or interest in engaging in sexual activity that ranged between foreplay to penetrative sex.

Anatomy: The anatomical aspects of sexual desire involve various structures and organs in the human body that play a role in the experience of sexual desire. These include:

  1. Brain: The brain is a crucial organ that regulates sexual desire. Certain regions, such as the hypothalamus and limbic system, are particularly involved in processing sexual stimuli and generating sexual desire.
  2. Hormones: Hormones, such as testosterone in males and oestrogen/ progesterone in females, play a key role in sexual desire. These hormones are secreted by the reproductive organs and affect the brain regions involved in sexual motivation. Dopamine and oxytocin from the Pituitary gland in the brain, also known as happy hormones, stimulate and control sexual desire.
  3. Genitalia: Sexual desire involves activation of specific genital structures, such as the penis and clitoris, which have rich nerve endings that enhance sexual pleasure.

Physiology: The physiological processes related to sexual desire encompass various mechanisms and events that occur in the body during sexual arousal. These include:

  1. Neuro-transmitters: Neurotransmitters, such as dopamine and serotonin, are involved in regulating sexual desire. They act on the brain’s reward and pleasure frontal centers, contributing to the feeling of desire and excitement.
  2. Blood flow: Sexual desire leads to increased blood flow to the genital region, resulting in engorgement and erection of the penis in males and clitoral swelling in females. This increased blood flow is facilitated by the dilation of blood vessels, ensuring adequate oxygenation and promoting sexual response.
  3. Nerve signalling: Nerves play a critical role in transmitting signals from the genital area to the brain, and vice versa. Sensory nerve endings in the genitalia detect sensations and send signals to the brain, triggering sexual desire. Any damage or slowing of nerve conduction due to diabetes or neuropathies cause loss of sexual desire, also known in lay terms as libido.
  4. Psychological factors: While the focus is primarily on anatomy and physiology, it’s important to note that psychological factors, such as emotions, thoughts, and experiences, also influence sexual desire. Psychological arousal and context can affect the physiology of sexual desire, amplifying or inhibiting sexual motivation. Thus, understanding the anatomy and physiology of sexual desire can help shed light on the complex interplay between the body, brain, and psychological factors that contribute to human sexuality. 

2: Virtual Intimacy

The pandemic propelled us into an unprecedented digital realm, where internet-empowered screens and computers became the conduits of human connection. Here, as we dipped into the domain of virtual intimacy, exploring the intricacies of online dating, sexting, and the surge of virtual platforms that expanded the boundaries of sexual exploration. Despite the restricted continuity of physical proximity due to the pandemic, these fragments of intimacy thrived amidst the personal, economic, health, social, and environmental chaos unleashed by Covid-19.

During the pandemic, virtual intimacy served as a means to maintain and foster connections with friends, relatives, jobs, and loved ones while practicing social distancing. Here are some ways virtual intimacy was used during such times:

  1. Video calls: Platforms like Zoom, FaceTime, or Skype allowed people to have face-to-face conversations with their loved ones. This helped maintain a sense of connection and intimacy, overcoming physical barriers.
  2. Online dating: Virtual dating platforms provided opportunities for individuals to establish new relationships or maintain existing ones during the pandemic. Video chats, messaging, and other virtual tools helped facilitate getting to know someone and fostering emotional bonds.
  3. Online support groups and psychotherapy: Many individuals relied on support groups and psychotherapy to cope with difficulties during the pandemic. Virtual platforms offered an effective way to access these services, providing a sense of emotional intimacy and support through sharing experiences and seeking professional guidance.
  4. Online gaming: Playing multiplayer games online provided an avenue for social interaction and intimacy during pandemics. Collaborative gameplay allowed individuals to connect, communicate, and build relationships with fellow gamers, fostering a sense of camaraderie.
  5. Virtual events and gatherings: Organizing virtual parties, reunions, or celebrations allowed people to connect and celebrate special occasions together while maintaining social distancing. Virtual platforms offered options for group video calls, shared activities, and interactive experiences, simulating real-life social gatherings.
  6. Long-distance relationships: Virtual intimacy became crucial for couples in long-distance relationships during the pandemic. Regular communication through video calls, messages, and virtual date nights helped maintain emotional and hormonal closeness and preserved the romantic connection despite physical separation.
  7. Sharing personal moments online: Social media platforms was used to share personal stories, photos, or videos, allowing individuals to feel connected and involved in each other’s lives. This helps overcome the absence of physical interactions and fostered a sense of intimacy with a wider network. Virtual intimacy during pandemic, while it did not fully replace physical intimacy, served as an essential tool to mitigate the effects of isolation, loneliness, and uncertainty. It acted as a bridge, providing moments of emotional connection, support, and social interactions, helping individuals navigate challenging times while staying safe from infections.

3: The Dynamics of Isolation

Human sexuality is intricately intertwined with our social fabric, and the isolation imposed by COVID-19 interrupted these delicate threads of our social life. Chapter three examines the profound impact of social distancing, exploring the human longing for touch, hug, kiss, fondling etc and the challenges of maintaining relationships at a distance. Instead, the novel virtual ways in which individuals adapted to sustain emotional and sexual connections.

The dynamics of isolation during COVID-19 restrictions were complex and varied among individuals and communities. It’s important to note that the dynamics of isolation varied across regions depending on the severity and duration of COVID-19 restrictions, as well as the effectiveness of government measures and community adherence to guidelines. Here are some key points:

  1. Social distancing, masking, and hand hygiene: Governments worldwide implemented social distancing guidelines of minimum distance of 6 feet. A variety of face masks, including those made of cotton cloth having a layer of satin and frequent use of hand sanitisers were recommended but these received limited compliance. These led to reduced physical interactions, limiting social gatherings, and increasing isolation.
  2. Quarantine by local health authorities versus self-isolation: Individuals who tested positive for COVID-19 or had been exposed to someone with the virus were required to self-isolate or quarantine for periods ranging between 7-14 days. This involved staying at home and avoiding contact with others, leading to extended periods of solitude and separation.
  3. Workplace and school closures: Many workplaces and educational institutions were temporarily closed or shifted to remote work and online learning. This disruption to daily routines contributed to isolation, as people were physically separated from their co-workers, classmates, and friends.
  4. Restricted travel and border closures: International and domestic travel restrictions were implemented to prevent the spread of the virus. This led to isolation not only within countries but also globally, as people were unable to visit or be visited by their loved ones living in other regions or countries.
  5. Mental health impact: The extended periods of isolation resulted in increased feelings of loneliness, depression, irritability, and anxiety for many individuals. Lack of social support and limited access to mental health services further exacerbated mental health challenges.
  6. Technology and virtual connections: The use of technology played a crucial role in mitigating the effects of isolation. Virtual platforms and social media allowed people to stay connected with friends and family, work remotely, and attend online to social and cultural events.
  7. Economic impact: COVID-19 restrictions and subsequent job losses or reduced working hours impacted many individuals economically. Financial stress and uncertainty contributed to increased social isolation as people faced challenges in maintaining social connections and participating in activities.

4: Redefining sexual relationships based on sexual pandemics

The pandemic forced us to re-evaluate the very foundation of our relationships and necessitated a redefinition of love, commitment, and companionship. Fragmented by the mental, emotional, and physical constraints of COVID-19, chapter four delves into the various forms of relationships that emerged – from the vitality of long-distance love to navigating the complexities of polyamory (desire for romantic relationships with more than one partner at the same time, mostly considered as illicit) during times marked by physical separation.

  1. Lack of sexual education: One of the crucial lessons learned from the HIV/AIDS and STI pandemics is the importance of comprehensive sexual education. Many individuals did not have access to adequate information about safe sex practices, leading to the rapid spread of these diseases. Proper education programs can help individuals make informed decisions about their desires, frequency, and sexual health, reducing the risk of disease transmission.
  2. Stigma and discrimination: The pandemics highlighted the harmful impact of stigma and discrimination on individuals living with HIV/AIDS and other STIs. This not only created barriers for people to seek testing and treatment but also contributed to the spread of these diseases by driving people underground and making it harder to access preventative measures.
  3. Importance of prevention methods: The HIV/AIDS and STI pandemics highlighted the urgent need for effective prevention methods, such as condoms, pre-exposure prophylaxis, and vaccinations (where available). These prevention measures, when widely accessible and utilized, can significantly reduce the transmission rates of these diseases.
  4. Global collaboration and awareness: The pandemics emphasized the importance of international collaboration and awareness campaigns. Joint efforts by governments, non-profit organizations, and healthcare providers have been crucial in raising awareness about safe sex practices, reducing stigma, and ensuring access to testing and treatment for all individuals.
  5. Holistic approach to healthcare: The HIV/AIDS and STI pandemics highlighted the significance of a holistic approach to healthcare, including integrating sexual healthcare into primary healthcare systems. By recognizing sexual health as an integral part of overall well-being, individuals are more likely to seek timely testing, treatment, and follow-up care.
  6. Access to healthcare services: Another important lesson learned during Covid pandemic was the need for accessible and affordable healthcare services. Lack of access to healthcare, especially for marginalized populations, has contributed to the spread of HIV/AIDS and STIs. Addressing structural barriers to healthcare access is essential in preventing and controlling future pandemics.
  7. Research and development: The pandemics have underscored the importance of ongoing research and development efforts to improve diagnostic tools, treatment options, coping skills, and potential vaccines. Continued investment in science and research is crucial in developing effective strategies to combat future pandemics related to sexual transmission.
  8. Communication and information dissemination: The pandemics taught us the importance of effective communication and information dissemination. Clear and accurate messaging, targeted outreach efforts, and community engagement are essential in spreading awareness about sexual health, prevention measures, and available resources. Overall, the lessons learned from the HIV/AIDS and STI pandemics of the 20th century highlight the need for comprehensive sexual education, prevention methods, global collaboration, accessible healthcare services, and ongoing research to control and prevent the spread of sexually transmitted infections.

5: Sexual Health Services during the pandemic

As the world grappled with a devastating Corona virus, attention to sexual health and safety became pivotal, but paradoxically, more complex. This chapter unravels the fragmented landscape of sexual health services during the pandemic, examining the impact on reproductive rights, the rise of telemedicine, and the unique challenges faced by marginalized communities. The case study presented here highlights many issues of personal relationship that became challenging to individuals in Mumbai in 2021.

A young married couple was trying to cope with their social and sexual needs during the Covid pandemic. Husband was working as a plumber in northern suburb of Mumbai and lived in a rented shack. His wife worked as a secretary in a small garment company in a nearby suburb. In April 2020, the national unemployment rate had reached a record high of 23.52% during the national Covid lockdown and both were rendered without jobs. But the second wave delivered another hit to the job market in April and May 2021. Almost for a year, they spent increasing time together! The usual complaint of many families to counsellors was that had to adjust to spending more time together at home due to lockdowns and social distancing measures. While this has provided opportunities for quality family time, it has also posed challenges in terms of maintaining work-life balance and dealing with potential conflicts arising from increased togetherness. Their sexual frequency had reduced from once or twice a week to once a fortnight. Their relationships with identical families in neighbouring shacks became more intimate and they got introduced to consensual partner swapping. In a way, what each partner was otherwise doing individually in terms of multi-partner sex outside the home before the Covid pandemic changed its character to consensual partner exchange; more of a barter system than exchange of scarce cash outside the home. Their episodes of respiratory infections and genital illnesses appeared almost twice a month and counselling on phone as to how to avoid face-to-face sex and use of condoms with casual partners did not get their acceptance. (Posture figure of CDC was shared with the couple on social media) Their bartering of partners in the neighbourhood continued unabated till early 2022 when the couple gradually went back to their workplaces but continued their old and new patterns of sexuality. Again, they ignored compliance with Covid posture and mask, and HIV/AIDS/STI prevention with condom use (sexual tree). They continued to ignore testing and insisted on taking antibiotics whenever infections set in.

6: Healing and reconnection with receding pandemic

Amidst the chaos and fragmentation of psychosexual fabric of communities, humans possess an innate ability to heal and reconnect. The final chapter explores the transformative power of resilience and offers guidance on navigating the fragments of intimacy left behind by the pandemic. From self-exploration to erotic imaginations, we delve into the diverse ways individuals work towards reclaiming and rebuilding their sexual selves.

Despite the uncertainty and unpredictability of COVID-19, our innate human sexuality persistently shines amidst the fragments. This essay serves as a reminder of our collective strength, adaptability, and our ever-present desire to connect, even when the world feels fractured. It is an exploration that celebrates the resilience of humankind, fostering a deeper understanding of our own desires while providing solace in the pursuit of intimacy. Finally, for solace and healing we involved sexual counselling that helped to embrace fragments.

Sexual counselling for responsible sex can encompass a range of topics and approaches, depending on the specific needs and concerns of individuals or couples seeking guidance. Here are some key areas that sexual counselling for responsible sex should focus on:

  1. Education and information: Sexual counsellors provide accurate and reliable information about sexual health, contraception, sexually transmitted infections (STIs), respiratory infection, and safe sex practices. This helped individuals make informed choices and reduced the risk of infections.
  2. Consent and communication: Counselling helped individuals and couples develop effective communication skills and understand the importance of consent in sexual relationships. This included learning how to discuss desires, boundaries, and expectations openly and respectfully with partners.
  3. Safer sex practices: Sexual counselling helped individuals or couples explore various methods of planned parenthood, pregnancy control, and understand sexual practices. Counsellors also addressed the importance of regular STI testing and how to reduce the risk of transmission.
  4. Sexual pleasure and satisfaction: Responsible sex involves mutual pleasure and satisfaction for all individuals involved. Counsellors supported clients in exploring and understanding their own sexual desires, needs, and preferences, as well as those of their partners. They provided guidance on enhancing intimacy, exploring different sexual activities and postures, managing love performance anxiety, and addressing concerns related to sexual dysfunctions.
  5. Relationship dynamics: Sexual counselling also addressed broader relationship dynamics that impact responsible sex practices, such as trust, emotional intimacy, conflict resolution, and overall relationship satisfaction. This involved exploring how relationship issues affect sexual experiences and vice versa.
  6. Consent in the digital age: With the growing role of technology in intimate relationships, sexual counselling covered topics related to responsible online sexual activity. This included discussing consent in sexting, sharing explicit media clips such as Kamasutra etc, or engaging in virtual sexual encounters. Overall, sexual counselling for responsible sex aims to support individuals and couples in developing a healthy sexual life while prioritizing communication, consent, safety, and mutual satisfaction. Counsellors provided a non-judgmental and confidential space for clients to explore their concerns, ask questions, and receive appropriate guidance.
The Kama Sutra, an ancient Indian text, does contain information about sexual positions and techniques. While the text does mention group sexual encounters, it primarily focuses on positions for two partners. It is essential to approach such activities with respect, consent, and the well-being of everyone involved. If you are considering exploring sexual activities involving penetrative sex, it is recommended to have open and honest conversations with all parties involved, as well as to educate yourself about safe sex practices, emotional well-being, and always be consensual and safe for all involved parties. 


References / Recommended reading

These are just a few examples of the multitude of articles and books published on sexuality in the past 50 years. The field of sexuality research and discourse has expanded greatly during this time, providing diverse perspectives and knowledge on this important aspect of human life. Here are some significant and influential ones:

  1. “Sexual behavior in the Human Female” by Alfred C. Kinsey et al. (1953): This study was one of the first comprehensive works on human sexual behavior, challenging cultural norms and providing empirical evidence on various aspects of sexuality.
  2. “The Hite Report: A Nationwide Study of Female Sexuality” by Shere Hite (1976): This groundbreaking publication challenged prevailing notions of female sexuality and highlighted women’s experiences and desires.
  3. “Human Sexual Response” by William H. Masters and Virginia E. Johnson (1966): This pioneering work examined the physiological and psychological aspects of sexual response, providing a scientific approach to the understanding of human sexual function.
  4. “The Joy of Sex” by Alex Comfort (1972): This popular and widely read book discussed various aspects of human sexuality, including sexual technique, contraceptive methods, and sexual satisfaction.
  5. “The History of Sexuality” by Michel Foucault (1976-1984): This influential series of books explored the social and cultural construction of sexuality, challenging conventional ideas about sexuality as a natural and essential aspect of human identity.
  6. “Sexual Fluidity: Understanding Women’s Love and Desire” by Lisa Diamond (2008): This research-based book challenged the notion that sexual orientation is fixed and explored the concept of sexual fluidity, particularly in women.
  7. “Sex at Dawn: How We Mate, Why We Stray, and What It Means for Modern Relationships” by Christopher Ryan and Cacilda Jetha (2010): This book presented an alternative perspective on human sexuality and questioned conventional narratives about monogamy and sexual behavior.
  8. “Come as You Are: The Surprising New Science that Will Transform Your Sex Life” by Emily Nagoski (2015): This book provided an in-depth exploration of female sexuality and how understanding the science behind it can lead to improved sexual well-being.
  9. “The Ethical Slut: A Guide to Infinite Sexual Possibilities” by Dossie Easton and Janet Hardy (1997): This book challenged societal norms around monogamy and explored the concept of ethical non-monogamy, promoting consensual and responsible open relationships.
  10. “Savage Love” by Dan Savage (1991-present): This advice column-turned-book addressed various aspects of sexuality and relationships, exploring topics such as sexual orientation, kink, and communication.


News Flash 560: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Cleaver wrasse (Xyrichtys novacula)

News Flash 560

Weekly Snapshot of Public Health Challenges


Statement by Principals of the Inter-Agency Standing Committee (IASC): Civilians in Gaza in extreme peril while the world watches on

Webinar registration: High-level dialogue between the WHO Director-General and the UN High Commissioner for Human Rights: ‘Realizing the Right to Health in a world in turmoil’ Mar 6, 2024 

Ethiopia: How Persistent Unemployment and Low Motivation Affect Health Workers and the Healthcare System  by Melaku Kebede 

Advancing primary health care in Africa through capacity building, advocacy, and partnership: the International Institute for Primary Health Care in Ethiopia 

AidWatch 2022 | 1 euro in every 6 not going towards those left furthest behind

Using Law To Advance Population Health Planning

Many efforts yet few achievements: Where should healthcare quality improvement policies focus in LMICs?

Children’s lives threatened by rising malnutrition in the Gaza Strip

In eastern Chad, people fleeing Sudan continue to face unmet needs amid limited response

Advocating for a sleep-friendly hospital status

Launch of new HMA-EMA catalogues of real-world data sources and studies

Shortage of Cholera Vaccines Spurs Africa CDC’s Quest for Local Manufacturing of Medical Products

Defining Disease X

COVID Rebound Can Happen Whether or Not You Take Paxlovid

149 experts call to find all TB to stop TB

Multi-agency report highlights importance of reducing antibiotic use

The EU must continue to support development of drugs for neglected infectious diseases in Framework Programme 10

The AU plans to pool resources to unify $50B pharma market

MSF welcomes Indian government standing strong against EFTA trade deal’s harmful intellectual property provisions

Medicines Law & Policy Intervention at the WHO Pandemic Accord Negotiations

Can telemedicine bridge Africa’s healthcare divide?

Africa programme launches ‘A Continent in Conversation’ series at AU summit

Blended Finance Is (Still) a Mess

Blended finance can perpetuate climate colonialism

UN agriculture fund bets big on innovation to improve food security

Innovation ‘imperative’ for securing rice production

Experts Fear Nigeria’s Food Inflation Could Worsen Hunger Crisis

Climate change-driven pests silently devastate Indian farms

Phasing out from Fossil Fuels: An Imperative for Climate Justice

When It Comes to Climate and Development, Worry Less about Finance and More about People

EU deal on improved air quality fails to align with WHO standards

Why Should Climate Change and Biodiversity Loss Be Tackled Together?










Ethiopia: How Persistent Unemployment and Low Motivation Affect Health Workers and the Healthcare System

Editor's Note

A first hand outburst&complaint snapshot here about the perceived motivational and salary gaps inside the public healthcare system in Ethiopia, whereby feelings of irony and paradox arise in the Author from still critical shortages of health workers in key areas coupling with many doctors being unable to find public employment

By Dr. Melaku Kebede

Public Health Advocate

Head of Pediatrics Department at Olenchiti Hospital


Ethiopia: How Persistent Unemployment and Low Motivation Affect Health Workers and the Healthcare System


Ethiopia has made some strides in improving its healthcare system, but it still faces many challenges, particularly in rural areas where access to quality care is limited by scarce resources. Health workers, who are essential for delivering health services, suffer from low morale due to poor working conditions and inadequate compensation.

I, a medical doctor, can paint a bleak picture of the situation. Healthcare professionals battle diseases and a dysfunctional system, lacking essential supplies and basic amenities. According to a survey conducted by the World Health Organization (WHO), only 1% of the health facilities assessed in Ethiopia had all the basic amenities, such as water, electricity, sanitation, and waste management. I want to emphasize the effect of these constraints on health workers’ motivation, saying that they drive many of them to look for alternative careers that do not involve direct patient care or to join the private sector, which offers better pay and working environment.

The Ministry of Health recognizes the difficulties faced by the health sector, including low availability of medicines and high turnover of staff. It has made commitments to improve the situation, but many doctors remain dissatisfied with their financial situation, as expressed by the fact that it’s impossible to fulfill basic needs with current salaries.

The irony is that while many doctors are unable to find employment, there are still critical shortages of health workers in key areas, such as maternal and child health, infectious diseases, and emergency care.

This unemployment paradox reflects the need for increased investment in the healthcare sector and the need for health professionals to explore alternative career paths amidst limited opportunities in the private sector.


News Flash 559: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Common octopus (Octopus vulgaris)

News Flash 559

Weekly Snapshot of Public Health Challenges


Global Health Centre Side Events during the 77th World Health Assembly, 2024 CALL FOR PROPOSALS Deadline 6 March 2024, 23:45 CET

Meeting registration: Resilient and scalable MCM ecosystem: CSOs engagement forum for advancing timely and equitable access to medical countermeasures against pandemic threats 22 February 2024 14:00 – 17:00

EXCLUSIVE: Read Latest Pandemic Agreement Draft Ahead of Monday’s Negotiations

Without Ensuring Swift Access to Pathogens, Pandemic Accord Risks Failure

Advanced HIV as a Neglected Disease

Southern Africa Losing Battle Against Cholera Outbreaks?

Is ‘silent’ outcome switching in clinical trials research misconduct?

WHO FCTC Conference of Parties Adopts New Decision on Curbing Tobacco’s Environmental Impacts, but Sidesteps E-Cigarettes

Reductions in smoking due to ratification of the Framework Convention for Tobacco Control in 171 countries

Govt departments split as trade talks with European pharma firms hit last lap, patent key issue

Billion-dollar exposure: Investor-state dispute settlement in Mozambique’s fossil fuel sector

India Pushes Back To Protect Patient Access to Generic Medicines

Millions of peoples’ access to affordable medicines at risk if India-EFTA trade deal finalised as is

Medicine Across Borders: Exploration of Grey Zones

To achieve fair pricing: Ensure cooperation and transparency, build enforcement capacity, and engage civil society

More equal access to medicines needed, says EU Pharmaceutical roundtable

What Is It Like to Live in Ecuador, One of the Most Violent Countries?

Lessons From Ecuador: A One Health Perspective  by Laura H. Kahn

People’s Health Dispatch Bulletin #69: Dehumanization of healthcare in Palestine a prelude to ethnic cleansing

From childhood to adulthood: examining the long-term effects of racial discrimination on mental and physical health

Advancing primary health care in Africa through capacity building, advocacy, and partnership: the International Institute for Primary Health Care in Ethiopia

Do Half of the World’s Poor Really Live in Fragile States?

Record number of migrants died or went missing off Tunisia in 2023


Independent Thinking: Can the UN’s first cybercrime treaty protect us?

The Strategic Dialogue on the Future of Agriculture must consider public health interests

How the response to hunger crises has changed since Ethiopia’s famine

Destroying Gaza’s Health Care System Is a War Crime

Biosolutions – the hi-tech ecosystem accelerating Europe’s Green Deal

First-ever UN report on migratory species reveals complex threats

The Socioeconomic Impact of Climate Change in Developing Countries in the Next Decades

The Moral Imperative for Climate Finance

If Trump wins, Africa will spiral into climate hell






Lessons From Ecuador: A One Health Perspective

Editor's note
By One Health critical lens of examination, this extremely documented masterful article turns the spotlight on the challenges and threats to health currently being perceived in the Ecuadorian areas of Amazon rainforest and Galapagos islands. At a time when consensus has gained traction that humans, animals, plants, and the whole ecosystems are intimately enmeshed and mutually dependent as for individual and global health, this article strongly recommends that a One Health vision shaping the human policies, strategies and practices should be embraced by all policy leaders and decision makers. As a matter of fact, closer collaboration under One Health umbrella would definitely add strength towards global health security and ecosystems integrity achievements

By Laura H. Kahn, MD, MPH, MPP

Co-Founder, One Health Initiative

Lessons From Ecuador

A One Health Perspective



A One Health Overview 

One Health is the concept that human, animal, plant, environmental, and ecosystem health are linked. It’s a relatively new term but an ancient concept understood by indigenous peoples around the world. In her book Braiding Sweetgrass, Robin Wall Kimmerer, a Professor of Environmental Biology at the State University of New York (SUNY), Syracuse and a Citizen Potawatomi Nation tribal member describes how indigenous peoples consider plants and other animals as ‘kin’ and not as objects to own or exploit. Indigenous peoples value the teachings of their kin—the plants and animals—for their health and well-being.

Western cultures do not emphasize how nature sustains us. But we literally incorporate nature into our bodies every day. From the air we breathe, to the plants and animals we eat, to the water we drink, our health and well-being depend on a healthy planet. The One Health concept acknowledges that we are a part of nature, not superior or separate from it. Unfortunately, our hubris and a sense of invulnerability to nature’s limits jeopardizes our future and the future of all species.

There are many ways to visualize the One Health concept. The Tripartite (World Health Organization, Food and Agriculture Organization, World Organization for Animal Health) and UN Environment Programme depict One Health in a complex way using multiple intersecting circles involving humans, animals, environments, and societies. The US Centers for Disease Control and Prevention (CDC) promotes One Health as intersecting circles involving Coordinating, Communicating, and Collaborating between human, animal, and environmental health professionals.

One Health can also be visualized as a Rubik’s cube representing three intersecting dimensions that form a matrix: a One Health dimension, a Complexity dimension, and a Political, Social, and Economic dimension.

The One Health dimension represents the linkages between humans, animals, plants, environments, and ecosystems. Environments are defined as the abiotic (e.g., soil, water, air) aspects of a defined geographic area. Ecosystems are defined as the biotic (e.g., microbes, flora, fauna) aspects of a defined geographic area. The Complexity dimension provides scale at the microbial/cellular, individual, and population levels. The Political, Social, and Economic dimension can be represented as political borders at local/regional, national, or international levels. This third dimension represents the important social determinants of health and the need to consider health in all policies. Time (e.g., days, months, years) can be a fourth dimension but will not be visualized or discussed in this paper.  The intersecting dimensions can be used in whole or in part to provide a systematic, comprehensive, and concise framework to analyze a wide variety of complex, multidisciplinary health-related challenges including those affecting the equitable access to health.

For example, intact forests provide extremely important environmental and ecosystem services such as carbon storage, erosion prevention, climate and water regulation, timber, and non-timber products, as well as food, shelter, and income for indigenous peoples. Forests depend on their environment to supply fresh water for their survival. Andean tropical glaciers deliver essential melt waters to the rainforest and to the indigenous peoples and animals living in the region. Unfortunately, these Andean glaciers are rapidly melting because of climate change, threatening the future of the delicate ecosystems.

In this brief article, the One Health matrix will be used to examine the geographically diverse nation of Ecuador which includes the biodiverse Amazon rainforest and the biosparse Galapagos Islands. With a total area of slightly more than 283 thousand square kilometers, Ecuador is a relatively small nation located on the equator on the west coast of South America. It has a total population of approximately 18 million people. In this paper, the Complexity dimension will focus on the population level.

One Health dimensions of the Amazon Rainforest

While Ecuador possesses only 2 percent of the total Amazon basin, its biodiversity is immense, possessing around 10 percent of Earth’s plants and 8 percent of its animals. Ten out of 14 indigenous tribes in Ecuador live in the tropical rainforest and depend on its natural resources to live. Not surprisingly, the indigenous peoples are important stewards of the land and fight for the forest’s and their own survival. For decades, one of their greatest challenges has been the aggressive presence of large-scale oil drilling that has been causing deforestation and environmental degradation in their territories that threatens their lives. This deforestation taking place in Ecuador is different than in Brazil which has been largely due to intensive agricultural purposes. From 1985 to 2022,  Ecuador lost almost 3 million acres of natural land cover, much of it in the Amazon rainforest. Oil extraction has led to multiple spills, emissions, and heavy metal contamination of the region adversely impacting human, animal, and plant health.

Despite their efforts to improve their rights and to protect their ancestral lands by establishing the Confederation of Indigenous Nationalities of Ecuador (CONAIE), the indigenous peoples of Ecuador continue to experience ongoing injustices including serious health threats. Oil drilling is known to contaminate environments and create health risks especially for children. While few quality health studies have been done in the Ecuadorian rainforest, there is evidence to suggest that living near oil production facilities jeopardizes the health of indigenous peoples including increased cancer rates of the colorectum, skin, and kidneys in adults and leukemia in children. One analysis published almost 15 years ago found that indigenous populations had a 30 percent higher mortality rate and a 63 percent higher all-cause morbidity rate compared to non-indigenous colonists living and working in nearby areas. The indigenous peoples particularly suffered from chronic as well as gastrointestinal and vector borne diseases. Many seek traditional medicine from shamans rather than care from Western clinics and hospitals. The Jambi Huasi clinic is attempting to integrate both traditional and Western medicine to meet the cultural demands and health needs of the indigenous peoples.

Data on wildlife health in the Ecuadorian Amazon rainforest is limited. The Wildlife Conservation Society (WCS) has been conducting conservation-based research on wildlife in South America including the LlanganatesYasuni landscape in Ecuador. A search of the WCS publications database on “Ecuador” yielded 40 unique records, ranging in dates from 2005 to 2020. The publications included census studies of Andean condors, bears, primates, mammals, and birds as well as identifying conservation threats to wildlife such as trafficking and other human activities.

While it’s illegal to possess, buy, or sell wildlife in Ecuador, illegal activity does occur. Private individuals and groups have established centers to protect injured or captured wildlife. For example, in 1993, a small group of individuals established a non-governmental organization (NGO) called amaZOOnico that has received, rehabilitated, and reintroduced thousands of wild animals confiscated from illegal activities. In its 31-year history, it has become one of the largest animal rescue establishments in Ecuador, relying on volunteers and donations for its efforts. Another animal welfare and rehabilitation center established by a private family has been caring for wildlife injured by habitat destruction and illegal trapping for 18 years.

Several non-government organizations exist to protect the Amazon rainforest, although not necessarily only in Ecuador. For example, the Rainforest Alliance fights deforestation and climate change and works to improve the human rights of the indigenous peoples. The Amazon Conservation Team works to protect the rainforest and the indigenous peoples living there, and Amazon Conservation is another one. Like the indigenous peoples of the Amazon, their efforts are in conflict with financial interests.

In August 2023, eight Amazonian nations met and agreed to create an alliance to protect the Amazon rainforest.  Unfortunately, they could not agree on a common goal to end deforestation. Instead, they decided to let each nation develop its own deforestation and conservation goals. They agreed that indigenous people’s rights should be considered as well.

One Health dimensions of the Galapagos Islands

In contrast to the Amazon rainforest, the Galapagos Islands are an isolated volcanic archipelago located about 1000 kilometers off the Ecuadorian coast. Discovered in 1535, the islands remained largely uninhabited because of the paucity of fresh water and the dry, inhospitable environment. In the 1920s, Europeans and North Americans began settling there. Today, four (i.e., Santa Cruz, San Cristobal, Isabela, and Floreana) of the 19 largest islands are inhabited by approximately 25-30,000 year-round residents. The population has been growing at a rate of about 6.4 percent per year, but these inhabited areas constitute only about 3 percent of the total area of the islands. In 1959, ninety-seven percent of the islands were designated as a national park which is visited by 170,000-220,000 tourists each year.

The Galapagos Islands were made famous by Charles Darwin’s 1835 visit on board the HMS Beagle which inspired him to develop his theory of “natural selection.” Because the islands are so remote, most species arrived either by flying, being blown by wind, swimming, or floating on a raft. As a result, the wildlife populations on the islands are unique. There are very few native mammals, no native amphibians, a variety of terrestrial and marine birds, and many reptiles. Plant seeds arrived by the wind, or if saltwater tolerant, by sea. The sparce biodiversity created open ecosystem niches that facilitated species to evolve to fill them.

Humans introduced invasive species such as rats to the islands. For example, in the 17th or 18th centuries, the black rat (Rattus rattus) was introduced by whalers and/or pirates. In the 1980s, the brown rat (Rattus norvegicus) was introduced to several islands. Rodents disrupted the delicate ecosystems, and rodent eradication programs have been ongoing.

The people who live in the Galapagos Islands reportedly depend upon imported food for their sustenance and have some of the highest rates of obesity, diabetes, and other chronic diseases in Ecuador. One study published in 2020 found that poor water quality and unhealthy diets consisting of primarily highly processed food contributed to the high disease burden even though the standard of living on the islands compared to the mainland was relatively high. Contaminated tap water led to a reliance on bottled water and sweetened beverages. The authors concluded that rapid population growth, expanding urbanization, food and water insecurity, and tourism contributed to the disease burden.

In June 2022, the Galapagos Science Center (GSC) hosted the World Summit on Island Sustainability on San Cristobal Island. While “One Health” wasn’t the title of the summit, the agenda covered the islands’ ecosystems, environments, animals, and humans. However, Dr. Enrique Teran, a professor at the University San Francisco de Quito, presented his research titled, “One Health Approach to Understanding Human Health on Galapagos Island.” In 2014, he conducted a hospital survey on San Cristobal Island and found that 30 percent of the population was diagnosed with gastrointestinal infections, and many also suffered with urinary tract infections. Poor water quality contaminated with coliforms was a major contributing factor to the infections. Another contributing factor was low socioeconomic status and the ownership of companion animals sick with parasitic infections. In 2019, he found that almost 31 percent of the residents owning companion animals reported that the animals received regular veterinary care, but around 13 percent of the animals had been recently ill. Risk of parasitic illness was higher for humans of lower socioeconomic status (SES) with sick companion animals compared to those with higher SES.

Wildlife and ecosystem health in the Galapagos Islands receive extensive attention and study given the global interest in the islands. For example, since 2016, the GSC has been hosting annual international summits for scientists to share their research on island conservation efforts, the restoration of Galapagos Island marine and terrestrial ecosystems, and the socio-economic issues and health of the island’s human population. The World Wildlife Service (WWS) established a Galapagos Animal Doctors project to treat both wild and domestic animals living on the islands. The Galapagos Conservancy is a U.S. based non-profit organization dedicated to protecting and restoring the Galapagos Islands.

One Health Lessons 

From a One Health perspective, human health relies on sanitation and hygiene as well as on healthy animals, plants, environments, and ecosystems. But the indigenous peoples of Ecuador live without sanitation or clean water, and many get sick and die from waterborne diseases. In the Galapagos Islands, only the affluent can afford bottled water.

In Ecuador, the lessons from the Industrial Revolution on the importance of sanitation, clean water, and health are slowly being learned. While the situation has improved over the past decade, the availability of quality drinking water and coverage of sanitation services remains insufficient for the public’s needs particularly in rural areas. In general, wastewater treatment is virtually nonexistent in South America. Most wastewater is dumped into rivers and oceans leading to environmental and ecosystem contamination as well as contributing to water-borne diseases.  The indigenous peoples of Ecuador had the highest burden of getting sick and dying from waterborne diseases compared to other ethnic groups in the country.

Unlike the Galapagos Islands which are stringently protected, the Amazon rainforest in Ecuador is not despite having parts of it designated as a UNESCO Biosphere Reserve. The challenge is to convince the political leaders that having an intact rainforest and healthy indigenous peoples is economically beneficial for the country.

Efforts such as the Natural Capital Project seek to quantify the economic value of intact ecosystems. For example, Ecuador is one of the countries working with the Natural Capital Project and the Inter-American Development Bank to design and inform finance and policy decisions. However, surpassing the income generated from oil reserves that would allow the rainforest to remain intact would be a challenge. From a One Health perspective, the world’s leaders should make the health of the rainforest and its indigenous caretakers a priority for the future of humanity and for all other species on the planet. 


A Brief Historical Aside: Political leaders must be convinced that improving health is beneficial for their nation’s economy. There is historical precedence for this observation. The French Revolution in the late 18th century created fertile ground for French pioneers such as Drs. Louis-Rene Villerme, a pioneer in social epidemiology, and Alexandre Parent-Duchatelet, a leader in the French hygienic movement to improve health. But it wasn’t until Jeremy Bentham, a British social reformer, lawyer, and poor relief advocate, who helped pass a set of “Poor Laws” through Parliament, that actual efforts began to help the working class and poor. Edwin Chadwick, an investigative journalist and lawyer, was hired by Bentham to enquire into the effectiveness of the poor laws.

Bottom line: The poor laws did nothing

Chadwick’s investigation led to the publication of The Report from the Poor Law Commissioners on an Inquiry into the Sanitary Conditions of the Laboring Population of Great Britain. This famous report detailed the wretched environmental and social conditions of Britain’s working class and poor during the beginning of the Industrial Revolution. People lived in slums without sanitation, clean water, pure air, or healthy food. Diseases were rampant. The report planted the seeds for a nascent public health movement. However, only after a deadly cholera epidemic in 1848 did advocacy efforts intensify leading to Parliament to approve a Public Health Act that established a General Board of Health, but it had limited powers and no money. Over the next 50 years, the law was amended to give more power to local boards of health. Ultimately, the political leaders had to be convinced that having healthy workers living in healthy environments benefited the economy.  Efforts to improve the equitable access to health for poor, working class, and indigenous peoples, must take this political reality into consideration.




News Flash 558: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Bluespotted cornetfish (Fistularia commersonii)

News Flash 558

Weekly Snapshot of Public Health Challenges


Global health inequities: more challenges, some solutions

The Responsibility of My Country in an Unjust Global System: Do No Harm

Stop taking the Global South for granted

WHO and Health & Environment: Need to Rethink Role of Civil Society  by Raymond Saner

Health policy implications of corporate social responsibility provisions in international investment agreements

EXCLUSIVE: Reject Drug Procurement Secrecy, Civil Society Urges ‘Big Five’ Buyers

Forum Discusses High Drug Prices in Wealthy Countries and Access to Medicines in Conflicts

Much Ado About Nothing: Why ‘March-In’ Rights Won’t Lower Drug Prices

Measuring The Health Of Primary Care: Lessons From US And Global Scorecards

Meeting registration: „„EB TODAY – EB154 Review (continued) on 13 February 2024“ verwalten  

Developing an agenda for the decolonization of global health

About 13 children die each day at a camp in Sudan for displaced people, medical charity MSF says

Addressing health inequalities in gender diverse people

Putting survivors at the forefront of the global movement to end female genital mutilation

Female Genital Mutilation and Cutting in Asia Remain a Neglected Problem

Envisioning an End to FGM/C

Colombia takes significant next step to expand people’s access to affordable HIV treatment, and moves forward with compulsory license for HIV medicine dolutegravir

Polio Eradication Strategies and Challenges: Navigating Hidden Risks  by Muhammad Noman

Pakistan Pushes Towards Polio Eradication – Can Elections Help Pave the Way? 

Taking the neglect out of neglected tropical diseases

Neglected Tropical Diseases Persist in the World’s Poorest Places

South American cities release mosquitoes to stem disease

Southern African Govts Tackle Cholera at Extraordinary Summit

WHO and MPP announce technology transfer license to enable greater patient access to multiple essential diagnostics

Tobacco COP10 to Address New Products and Industry Interference

Shrimp farms threaten livelihoods of small-scale fishers


Climate risks in urban areas

Burning e-waste contaminating breast milk in Ghana

‘A deeply troubling discovery’: Earth may have already passed the crucial 1.5°C warming limit

Recommendations for 2040 targets to reach climate neutrality by 2050

EU Commission chief to withdraw the contested pesticide regulation






Polio Eradication Strategies and Challenges: Navigating Hidden Risks

 Author's note
An opinion short paper based on my extensive field experience, exploring the strategies and challenges in the quest to eradicate polio. The paper delves into hidden risks, including missed populations, refusals, and inaccessible groups, hindering complete eradication despite progress. Emphasizing the importance of Inactivated Poliovirus Vaccine (IPV), the author discusses issues such as environmental sample alerts, population movement, malnutrition, refusals, fake vaccination practices, and monitoring gaps. The paper advocates for community engagement, mobile vaccination units, global health security collaboration, and a shift towards quality-focused campaigns. It underscores the significance of surveillance, genetic sequencing, cross-border collaboration, routine immunization strengthening, and environmental surveillance intensification. The conclusion emphasizes the need for a multifaceted approach, strengthened alliances, and unwavering commitment to overcoming persistent hurdles in the pursuit of a polio-free world

By Muhammad Noman

Healthcare System, CHIP Training and Consulting

Quetta, Balochistan Pakistan

Polio Eradication Strategies and Challenges

               Navigating Hidden Risks               



Polio eradication campaigns have made remarkable progress, yet challenges persist, hindering the goal of complete eradication. Despite successful mass campaigns and widespread efforts, certain segments remain vulnerable. Hidden children, missed from Oral Polio Vaccine (OPV) programs, persist, along with refusals and inaccessible populations. Malnourished children face compromised immunity, and the movement of populations poses a substantial risk.

Amidst these challenges, the emphasis on Inactivated Poliovirus Vaccine (IPV) administration for children under 2 years old is crucial. While quality mass campaigns have effectively targeted zero-dose populations, more focus is needed on defaulted individuals. A key concern involves the administration of inadequate Polio vaccine doses, which can potentially render the vaccine less effective.

Mass Campaigns and Hidden Challenges

While commendable efforts have been made through quality mass campaigns, the focus needs to shift towards children who have defaulted from Oral Polio Vaccine (OPV) and are yet to be reached. The emergence of hidden children poses a risk, coupled with the challenges of refusals and the inaccessibility of certain populations. Malnutrition exacerbates the vulnerability of children, compromising their immunity and putting them at higher risk.

Environmental Sample Alerts

Recent environmental samples have detected the Type-1 Wild Poliovirus, emphasizing the urgency of addressing gaps in vaccination strategies. Positive samples in various districts raise concerns, signalling the need for a comprehensive, adaptive approach to tackle the evolving landscape of the polio virus.

The Menace of Population Movement

The movement of populations, a dynamic aspect of modern society, poses a substantial threat to polio eradication efforts. The challenge lies not only in reaching transient populations but also in maintaining consistent vaccination coverage as people move from one place to another. This fluidity introduces an element of unpredictability that demands innovative solutions.

Malnutrition and Immunity Compromise

Malnutrition compromises the immunity of children, making them more susceptible to poliovirus infections. Prioritizing malnutrition-prone areas in vaccination campaigns can enhance overall effectiveness.

Refusals and Unavailability

Refusals pose a significant hurdle, impacting not only the vaccinated but also exposing the community to potential outbreaks. Identifying and addressing the reasons behind refusals is crucial for overcoming this challenge.

Fake Vaccination Practices

Fake vaccination practices are a significant concern, driven by factors such as the pressure to meet numeric targets, community demands, and inadequate monitoring. The study reveals that teams, caught between social influences and program pressures, resort to shortcuts like fake finger marking, creating a delicate balance to appease both sides.

Monitoring and Programmatic Gaps

The research highlights ineffective monitoring, with area supervisors often unaware of fake vaccination practices. Limited incentives and job security, coupled with social unacceptance of NGO work, create demotivating factors for frontline workers. The crucial aspect of enforced vaccination and its impact on community trust remains a focal point for discussion.

Community Engagement and Trust Building

Cultivating trust within communities is paramount. Engaging with local leaders, addressing concerns, and dispelling misconceptions can contribute to increased participation in vaccination programs.

Mobile Vaccination Units

To counter the challenge of population movement, deploying mobile vaccination units that can adapt to changing locations and timings is essential. Collaboration with transportation authorities can facilitate vaccinations during travel.

Global Health Security Collaboration

Recognizing that the movement of people transcends borders, collaborating with neighbouring countries is imperative. Synchronizing efforts and sharing information can create a cohesive front against the poliovirus.

Quality vs. Quantity: Focusing on IPV

While quantity-focused campaigns have been successful in reaching a vast number of children, the emphasis must shift toward quality. Zero-dose cases demand increased attention, and defaulted cases should be the new focal point. Prioritizing Inactivated Polio Vaccine (IPV) administration in the under-2 age group can contribute significantly to long-term immunity.

Surveillance and Response

Strengthening disease surveillance systems is critical for detecting and responding to new cases promptly. Timely responses, such as supplementary immunization activities, are essential to contain outbreaks in regions with positive samples.

Genetic Sequencing and Analysis

Utilizing genetic sequencing provides valuable insights into the origin and transmission patterns of the virus. Analyzing genetic links between samples informs targeted interventions and enhances the understanding of the virus’s evolution.

Community Engagement

Engaging communities is essential to address vaccine hesitancy and refusal challenges. Collaboration with local leaders and influencers can play a pivotal role in advocating for the importance of immunization.

Cross-Border Collaboration

Collaborating with neighbouring countries is crucial to prevent the cross-border spread of the virus. Sharing information and coordinating vaccination efforts help create a unified front against polio.

Routine Immunization Strengthening

Reinforcing routine immunization programs ensures that children receive timely and complete vaccinations. Focusing on underserved populations is crucial for improving vaccine coverage.

Environmental Surveillance Intensification

Increasing the frequency and coverage of environmental surveillance helps promptly detect the presence of the virus in sewage samples, contributing to more effective intervention strategies.

Conclusion: Bridging Gaps and Forging Alliances

In conclusion, the battle against polio demands a multifaceted approach. Addressing hidden children, refining strategies for population movement, and unmasking and countering fake vaccination practices are imperative. Quality mass campaigns are undeniably impactful, yet they must adapt to the evolving challenges. The alliance between communities and frontline workers must be strengthened, dispelling mistrust and fostering a shared commitment to polio eradication.

As we stand at the intersection of progress and persistent hurdles, the resolve to eradicate polio remains unwavering. The road ahead requires continued collaboration, innovation, and an unwavering commitment to leaving no child behind in the quest for a polio-free world.


By the same Author on PEAH 

The Gray Houses Polio Eradication Initiative: A Case Study on Identifying and Vaccinating Hidden Children 

Balochistan Primary Healthcare: What Has Been Done and What Needs to Improve?

Decision Makers’ Perception of the Performance and Salary of UC Polio Officers in Pakistan

Polio Eradication Programme in Pakistan: Critical Analysis from 1999 to 2023 


WHO and Health & Environment: Need to Rethink Role of Civil Society

Editor's note

By putting governments and WHO under critical lens as for current positions to counteract climate change-tied health & environment deterioration, this article condemns the ongoing exclusion of civil society (CSOs e NGOs) from far-reaching relevant decisions.  Under these circumstances, solutions to secure factual cohesion with civil society organisations are envisaged. As the Author maintains ‘…The Health & Environment nexus requires a real multi-stakeholder approach, not some unnamed heads of government that claim to represent the peoples of the world. The only sustainable approach is that of separate constituencies/stakeholders who develop solutions within their stakeholder group, and once they have formulated their own position, then to reach out to the other stakeholders. It does not make sense to have Civil Society be amalgamated into a government position nor be controlled and absorbed by an International Organisation… 

…Concretely, in light of the fact that CSOs and NGOs do not have co-decision power at the WHO, it would be best to create an independent voice regrouping CSOs and NGOs who can speak with credibility on health and environment issues…’

By Raymond Saner, Ph.D.

Director, Centre for Socio-Eco-Nomic Development-CSEND

Geneva, Switzerland

WHO and Health & Environment

Need to Rethink Role of Civil Society


 Health and Environment are determinants of human life.  Extreme weather events such as floods and droughts are having detrimental impacts on our societies and climate change-induced vector-borne diseases, like cholera and malaria, require urgent attention at global levels. Concerned citizens and government officials are calling for measures to enhance the resilience of healthcare systems.

Current initiatives are undertaken by Government groups, WHO, and NGO groups.

  1. Governments

A group of like-minded countries, all members of WHO,  have drafted a resolution on Climate and Health that is intended for consideration at the World Health Assembly in May 2024. The collective effort is led by the Kingdom of the Netherlands in collaboration with Peru, Fiji, Barbados, Kenya, and the United Kingdom. The final negotiation of the resolution will be up to the assembly of the 194 member countries. The initiative of the six countries is a much-welcomed first step towards an international agreement on Health & Environment.

As clarified by Ambassador Lars Tummers of the Netherlands during an informal meeting at the Palais des Nations in Geneva on 2nd November 2023, the objective of the resolution is to “galvanize the World Health Organization, member states, and other stakeholders into tangible action within the confines of our current shared points of agreements”. The drafting and later text negotiations is the prerogative of governments no matter how competent they might be in regard to the Health & Environment nexus and no matter whether they represent democratic, autocratic or authoritarian régimes who have different preferences in regard to health and environment policies and international agreements.

  1. WHO secretariat

In reaction to the call by some governments, health experts and civil society,  the Director General has published a report on Climate Change and Health (Document EB 154/25) on 20th December 2023 ( and the Draft WHO Fourteenth General Programme of Work (Document EB154/28) lists six strategic objectives, the first one being “ To promote health by responding to climate change, the greatest health threat of the 21st century”
(, page 18)

The WHO secretariat published a document titled “The alliance for transformative action on climate and health (ATACH)” on 18th August 2022 ( which lists the following key objectives:

  • Support Member States to develop health systems that are adapted and resilient to the impacts of climate change and that are low-carbon and sustainable, contributing to national net zero goals.
  • Encourage Member States to make commitments on ‘climate resilient and sustainable’ health systems and to build on those commitments for increased ambition.
  • Elevate the climate and health agenda in both climate and health spaces by identifying and advocating for innovative solutions to global constraints thereby achieving resilient and sustainable systems.
  • Identify, disseminate, strengthen and advocate for evidence and knowledge on best practices relating to emerging issues and health argument for climate change action to support implementation of the commitments and encourage global progress in addressing the climate and health nexus.

The ATACH website states that “Alliance” works to realize the ambition set at COP26 to build climate resilient and sustainable health systems, using the collective power of WHO Member States (“Member States”) and other stakeholders to drive this agenda forward at pace and scale; and promote the integration of climate change and health nexus into respective national, regional, and global plans. Five thematic working groups work to address common issues: Enhancing the Health Commitments on Climate Resilient and Sustainable Low Carbon Health Systems; Climate Resilient Health Systems; Low Carbon Sustainable Health Systems; Supply Chains and Climate Action and Nutrition.

The WHO secretariat’s initiative is addressing important aspects of the Health & Environment nexus and at the same time has created a bureaucratic maze. It invites opportunities to participate to the following participant categories:  Government Institutions with a mandate for Climate Change and Health; Intergovernmental organizations, Nongovernmental organizations (including civil society groups); Private-sector entities, represented through international business associations, Philanthropic foundations and Academic institutions.

At the same time, the Secretariat determines with amazing detail over 5 pages the many criteria for qualifications of the participants and equally detailed states that this ATACH “shall in all respects be administered by the WHO Constitution and General Programme of Work, WHO’s Financial and Staff Regulations and Rules, WHO’s manual provisions, and WHO rules, policies, procedures, and practices”.

The ATACH is a timely initiative by the WHO secretariat however because the WHO secretariat has to comply with member governments’ wishes and decisions, the outcome of the voluntary group is unsure and in light of possible blocking maneuvers of some government intent to control and limit ATACH’s deliberations, the creation of an ATACH WATCH organization by civil society organization is called for.

  1. Civil Society and NGOs

The Geneva Global Health Hub (G2H2) organized a series of webinars of public briefings and policy debates in anticipation of the WHO EB.

The webinar on 15 January 2024 was titled “Putting climate and health at the centre of the next WHO strategy: What does this mean? What does it need for WHO to walk the talk?”

The cover information pertaining to this webinar stated:

Over the last few months, and at the COP28 UN Climate Conference, the interrelatedness of climate and health justice has, finally, received the attention it deserves, and some political traction at the highest political level. In 2024, climate change and health will be prominently on the agenda of the WHO governing bodies, with a resolution proposed by the WHO member states Core Group Climate Change and Health, and with the WHO secretariat’s proposal to put the “response to climate change, the greatest health threat of the 21st century” at the centre of its draft strategy (GPW14) for the next years, as one of six strategic objectives. On this background, the policy briefing and debate explored, in a conversation between civil society organizations, WHO members states and the WHO Secretariat, how this strategic focus of the World Health Organization on climate change and health, if approved by the Governing Bodies, will be transformed into political leadership for the promotion of climate and health justice within and beyond the health sector, and what support by member states, what capacities and financial means are needed for WHO to walk the talk.

Participants were also provided with Documentation and references such as the Draft WHO Fourteenth General Programme of Work.  Document EB154/28, the Climate Change and Health. Report by the Director General. Document EB154/25, Climate change and health. A review of WHO’s commitment to ‘safeguarding the health of the planet’, Climate Change and Health Resolution: draft text of WHA77 resolution for negotiation dated 14 November 2023, The project of a WHA77 Resolution on Climate Change and Health: State of the process, civil society narrative, and how to engage., the documentation of a discussion meeting in August 2023 hosted by the MMI Community of Practice on Climate Change and Health, the WHO and COP28 (In November 2023, WHO co-hosted the first-ever Health Day at the COP28).  UN Climate Conference on which more than 40 million health professionals from around the globe joined a call to action issued by WHO and civil society organizations, to prioritize health in climate negotiations. In a historic milestone global leaders united in endorsing a health and climate change declaration, sounding the alarm on the severe health implications of climate change. At COP28, WHO committed itself to strengthening its climate change and health portfolio by integrating climate change as a priority for all WHO programmes through its core functions of leadership, evidence and, most importantly, country implementation.

The webinar session was organized by Medicus Mundi International Network, CoP Climate and Health Justice and Global Climate and Health Alliance (GCHA).

My comments were as follows:

  1. As was reiterated during the 2nd November meeting at the UN in Geneva, the resolution is a matter for governments to negotiate and decide. Non-stake actors are not part of the process. (Neither private sector nor CSOs).
  2. In view of the urgency of the Climate change risks and the many years of the inability of governments to come up with binding agreements on how to stop or at the minimum reduce GHG, the expectations of a meaningful resolution are very limited
  3. Reducing Climate Change requires participation and contributions by the private sector (reduction of GHG industrial production and pesticide-fertilizer overuse in agriculture) and civil society (changing of life styles, making high CO2 consumption costlier or outlawed, e.g. through the tougher implementation of the MEAs)
  4. From my perspective, it would be good to clearly distinguish between symptoms and causes. Remedial health actions are needed to combat health problems caused by environmental pollution, e.g. polluted water, air, food, or dumping of toxic waste. Health Care is needed to combat symptoms of environmental pollution, especially in DCs and LDCs.
  5. What is equally if not even more important is to reduce or eliminate the causes of environmental health problems e.g. caused by industrial pollution, waste from extensive farming dropped into water systems, and overfishing of small ocean fish to feed land-based aquafarms.
  6. For the reasons listed above, it would be very useful to have a shadow resolution written by CSO organizations. This would generate a CSO proposal in contrast to the government-negotiated resolution which will be a weak agreement due to the resistance of some countries to agree to structural changes in our industry, agriculture, and lifestyles.
  7. I notice that countries that participate in the WHO resolution are the USA and Australia, two main causes of high CO2 emissions and hence of high-risk climate change. What will these two countries commit to that would be anything else than what they have proposed at COP28?
  8. Countries absent from the WHO resolutions are China and India, two large contributors to GHG and CO2. The WHO resolution will not mention this but a CSO shadow resolution could.
  9. and finally, the resolution should highlight and give examples of SDG policy trade-offs and policy synergies since such constructive SDG development strategies would reduce harmful environmental practices and instead strengthen investments in constructive and sustainable environmental practices which would have much lower negative health implications.   
  1. CSEND position on Health & Environment

The Health & Environment nexus is crucial for the future of all countries and citizens. Because of its important impact, it is necessary to ensure a multi-stakeholder approach to the analysis and solution elaborations. Statements given in the Chapeau of the zero draft of the Pact for the Future (28 January 2024) are unacceptable examples how the world community supposedly should cope with global challenges be that the global sustainable development or the Health & Environment Nexus.

The chapeau states:

We, the Heads of State and Government, representing the peoples of the world, have gathered at United Nations Headquarters to take action to safeguard the future for present and coming generations. (Page 1, italic added)

The Health & Environment nexus requires a real multi-stakeholder approach, not some unnamed heads of government that claim to represent the peoples of the world. The only sustainable approach is that of separate constituencies/stakeholders who develop solutions within their stakeholder group, and once they have formulated their own position, then to reach out to the other stakeholders. It does not make sense to have Civil Society be amalgamated into a government position nor be controlled and absorbed by an International Organisation.

Concretely, in light of the fact that CSOs and NGOs do not have co-decision power at the WHO, it would be best to create an independent voice regrouping CSOs and NGOs who can speak with credibility on health and environment issues. This could for instance include: 

For the Health CSO Community:

Community Health Organizations, Medical Professional Associations; Research Institutes and Think Tanks;   Patient Advocacy Groups, Public Health NGOs (epidemiology, sanitation, hygiene, and disease surveillance); Global Health Organizations (infectious diseases, health equity, and access to essential medicines): Health Policy and Governance NGOs (health policies, governance structures, and healthcare systems) and Special Health Interest groups (children, elderly, people with disabilities, cancer, HIV/AIDS, diabetes).

For the environment CSO community:

Regarding environmental issues, CSO – NGO organizations are also not included in the negotiation process such as Conservation Protection NGOs (habitat restoration, species protection, and land conservation); Research and Educational Institutions (reduction of greenhouse gas emissions, promotion of renewable energy adoption; Community-Based Organizations (CBOs) (clean water, sustainable agriculture, renewable energy, and waste management)

Other truly CSO organizations competent in these two sectors could jointly draft a shadow report on the WHO Health & Environment report thereby making clear what voice and responsibility the governments and the private sector have in contrast to Civil Society regarding the analysis, solution generation, and implementation of solutions about the Health & Environment nexus.



Saner, R, Yiu, L; (2017) “Negotiation and Health Diplomacy: The Case of Tobacco”, in Matlin S. & Kickbusch, I. (eds.) “Pathways to Global Health: Case Studies in Global Health Diplomacy (Volume 2)”, Global Health Diplomacy, vol. 5, p.171-210.

Ashley Warren, Stephen Browne, Roberto Cordon , Raymond Saner, Lichia Yiu, Shufang Zhang , Michaela Told , Don de Savigny , Ilona Kickbusch , Marcel Tanner; (2019) “Private Financial Assistance for Health and Principles of Aid Effectiveness: Development Partner Perceptions in Chad, Ghana, Mozambique, and Tanzania; SNIS study, 2012-2015;

Saner, R. (2021) “PPPs and SDGs, the Missing Stakeholder Is Civil Society ”in A. Farazmand (ed.), Global Encyclopedia of Public Administration, Public Policy, and Governance, pp 1-10, Springer Nature Switzerland AG 2021;


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