Vaccination Is the Best Bet Against Drug-Resistant Superbugs — Experts

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Experts encourage parents to vaccinate their children against typhoid to ensure that the child has access to clean drinking water. Credit: Zofeen Ebrahim/IPS

Experts encourage parents to vaccinate their children against typhoid to ensure that the child has access to clean drinking water. Credit: Zofeen Ebrahim/IPS

By Zofeen Ebrahim
KARACHI, Jul 6 2023 (IPS)

The first thing you notice about eight-month-old Manahil Zeeshan is how tiny she looks on the adult-size hospital bed at the government-run Sindh Institute of Child Health and Neonatology (SICHN) in Korangi, a neighbourhood in Karachi.

Her right foot is taped with a cannula, and she whimpers incessantly. “I have been in and out of the hospital for the last seven days,” said Uzma Mohammad, Zeeshan’s mom, with worry lines on her forehead. “High fever that refused to come down, severe cough for days and breathlessness,” were some of the symptoms Mohammad described. She was convinced someone had “put a spell” on her daughter.

The doctors, however, suspected she had typhoid.

Salmonella Typhi bacteria cause typhoid fever, and Salmonella Paratyphi bacteria cause paratyphoid fever. According to the US-based public health agency, Centers for Disease Control and Prevention, along with a fever that can be as high as 103 to 104°F (39 to 40°C), the sick person can have weakness, stomach pain, headache, diarrhoea or constipation, cough, and loss of appetite. Some people have a rash of flat, rose-coloured spots.  Internal bleeding and death can occur but are rare. It affects between 11 and 20 million people each year, leading to 128,000 to 161,000 deaths, according to the World Health Organization (WHO). The highest fatality rates are reported in children under four years of age.

While Zeeshan’s blood culture report had yet to come to ascertain the cause of her sickness, she needed urgent medical care, said Dr Shabita Bai, who had admitted her.

“We could not wait for five days for the blood culture report as she was not doing well. And because she had already been given an antibiotic (a medicine used to kill bacteria) from outside, our chances of finding if the baby had typhoid for sure were slim, and we had to rely on the history,” justified Bai.

Decisions had to be made. Based on her condition, symptoms, and clinical diagnosis, the baby was given Ceftriaxone, an intravenous antibiotic, but she showed no improvement. The doctors then administered the stronger Meropeneme intravenously, a last-resort antibiotic.

Manahil Zeeshan's foot has a drip in an effort to bring her temperature down and fight suspected typhoid. Credit: Zofeen Ebrahim/IPS

Manahil Zeeshan’s foot has a drip in an effort to bring her temperature down and fight suspected typhoid. Credit: Zofeen Ebrahim/IPS

Battling the Superbug

But even if she had typhoid, the bacteria in her body had taken on the form of a superbug — the extensively drug-resistant (XDR) typhoid and the current antimicrobials had become ineffective, said paediatrician Dr Jamal Raza, the executive director of the SICHN.

According to a Lancet study published in 2022, multidrug-resistant (MDR) typhoid has been seen in Pakistan, while typhoid bacteria resistant to the widely-used antibiotic azithromycin have been found in Bangladesh, Nepal and India. “Our analysis revealed a declining trend of MDR typhoid in south Asia, except for Pakistan, where XDR S Typhi emerged in 2016 and rapidly replaced less-resistant strains,” stated the study, which researchers claim is the largest ever examination of the S.Typhi bacterium.

The reason why antibiotics are losing their punch against some types of bacteria, said Raza, was the “indiscriminate use of antibiotics” that health practitioners prescribe to provide immediate relief. Another big problem was self-medication by people. “I know people often use an old prescription by a doctor to get the same medicine if they feel they have the same symptoms, thinking they do not need to visit the doctor.”

But he pointed out viruses, which are also small germs like bacteria, are causing bacteria-like infections, like a cold or the flu.

“Taking an antibiotic for the latter does not treat the disease; it only leads to antibiotic resistance,” said Raza.

A study conducted by researchers from three medical institutions, namely, the Aga Khan University (AKU) in Karachi, the Armed Forces Institute of Pathology (AFIP) in Rawalpindi, and the Shaukat Khanum Memorial Cancer Hospital & Research Center (SKH) in Lahore in 2018, found indiscriminate use of antibiotics to be causing new drug-resistant “superbugs.”

It found a high prevalence of multidrug and fluoroquinolone resistance for both S.Typhi and S. Paratyphi strains of typhoid bacteria. From 20% in 1992, the resistance was found to have increased to around 50% in 2015. The stubborn bacteria were resistant to antibiotics like ampicillin, chloramphenicol (and co-trimoxazole), as well as fluoroquinolone (ciprofloxacin and/or ofloxacin).

“The situation is quite grim,” said Dr Mashal Khan, chairperson of the government-run paediatric medicine department at Karachi’s National Institute of Child Health, referring to the increase in the number of children developing resistance to typhoid drugs. His worry is not that the bacteria has spread; his concern is the bacteria has mutated and become resistant to the drug.

“We’re running out of new antibiotics to treat bacterial infections; Meropeneme is the last one, and a very expensive one too,” he said resignedly, adding: “Although the development of newer antibiotics is the need of the day, I must emphasise the rational use of the ones being used is more urgent.”

Developing new drugs is challenging, and antibiotics more so, as the science is tricky.

“Antibiotics are not the most lucrative drugs to develop for pharmaceuticals as their utility is limited in the future due to the bacteria developing the ability to resist them,” said Infectious Diseases specialist and epidemiologist Dr Faisal Mahmood at the Aga Khan University Hospital in Karachi. “A lot of money goes into developing new drugs, and since most of the funding is from the global north, they prefer to work on infections which concern them directly. Typhoid is unfortunately endemic in the low and middle-income countries in the South, which have poorer water quality and have warmer, more humid climates.”

And that is why the only sure-shot way of reducing the disease burden of typhoid is to vaccinate the children.

In 2019, Pakistan became the first country to get the World Health Organization (WHO)-recommended single-dose typhoid conjugate vaccine (TCV) injected intramuscularly, added to its routine immunisation (RI) regime. This is given to babies at nine months, alongside measles-rubella vaccinations, without impacting either vaccine.

“Childhood vaccination complemented with clean drinking water and improved hygiene practices is the much more cost-effective way of eradicating typhoid than pumping antibiotics in a child,” said Raza. Meropenem costs as much as Rs. 30,000 (USD 105) for a 10-day course, and if hospitalisation is included, it can go up to Rs 100,000 ($349), said the doctor. Being in a government hospital, Zeeshan is treated free of cost.

Eight-month-old Manahil Zeeshan is treated for typhoid at the government-run Sindh Institute of Child Health and Neonatology (SICHN) in Korangi, a neighbourhood in Karachi. Credit: Zofeen Ebrahim/IPS

Eight-month-old Manahil Zeeshan is treated for typhoid at the government-run Sindh Institute of Child Health and Neonatology (SICHN) in Korangi, a neighbourhood in Karachi. Credit: Zofeen Ebrahim/IPS

Typhoid Vaccine Launch Hits a Snag as Covid-19 Surfaces

The 2019 TCV campaign was first launched in the two cities of Sindh – Karachi and Hyderabad (children up to 15 years of age were also given a shot), which reported the highest number of typhoid cases among children. There was a pause when Covid-19 hit the world. But by 2022, TCV had been launched across Pakistan, and 35.5 million children were vaccinated, after which it was added to the government-run Expanded Programme on Immunisation (EPI) programme.

“Many parents do not know that the TCV is a more effective vaccine but only available at government vaccination centres, and not at private clinics and hospitals as Gavi has only given it to the government of Pakistan,” said paediatrician Dr D.S. Akram.

“There is another typhoid vaccine available in the private sector (typhoid polysaccharide vaccine), but it can only be given to children over two years of age, and it needs boosters every three years. My advice to parents is to vaccinate their kids against typhoid bacteria at nine months,” she said.

But it is still a drop in the ocean, and the fight against typhoid and other childhood diseases continues. The WHO places Pakistan among the ten countries that account for almost two-thirds of the world’s unimmunised children.

When Covid-19 hit the country’s already crumbling health system, it also brought the country’s immunisation programme to a halt too. An estimated 1.5 million children across Pakistan missed out on basic vaccines from March to May 2020, according to Gavi.

For Pakistan, which already has low immunisation coverage (the percentage of fully immunised children aged 12-23 months is just 66%), it meant a further dip in coverage which led to an unprecedented rise in the number of zero-dose children (those that have not received any routine vaccine). Add to these were the almost 19,000 new births every day. But when the lockdown eased and vaccinators returned to work, there was less demand for vaccination, having been replaced by fear of the new virus.

While Pakistan has yet to reach the optimal immunisation coverage of 90%, during Covid-19, Pakistan’s EPI received plaudits internationally for taking both vaccine coverage and the number of zero-dose children close to pre-pandemic levels in 2021. “What Pakistan achieved needs to be celebrated. In fact, Pakistan and Chad are used as examples internationally of how to get it right in an emergency,” said Huma Khawar, an immunisation and child health advocate working closely with EPI.

“Despite a year’s delay due to Covid-19, which was unforeseen, I think it is the best thing that the government has done for its country’s children,” said Khawar. She credited the RI programme that bounced back to the pre-pandemic level in 2021.

Clean water, Good Hygiene Key to Preventing typhoid

While immunisation can protect children from getting infected, clean drinking water and improved hygiene practices can reduce the risk of catching the disease to a great extent.

“Vaccines provide immunity when there is exposure to the bacteria,” agreed Dr Jai Das, assistant director at the Institute for Global Health and Development at the Aga Khan University and one of the co-authors of the 2018 report on typhoid, but emphasised the need for improved water and sanitation, a situation that continues to remain dismal and compromised in Pakistan.

The same study not only found a strong correlation between water and sanitation but to literacy levels as well. In addition, it stressed improving the country’s food safety protocols and implementing regulations.

While Mohammad believes that her daughter is under a curse, one reason could be that the unpasteurised cow’s milk she gives her daughter may not be properly boiled at home. “I was unable to breastfeed her,” she said. Further, she confessed to diluting it with unboiled tap water to make it last longer.

Doctors say giving Pakistani babies a lease of life is simple and costs nothing. “Exclusive breastfeeding up to at least six months of age (right now it is only 43%), attaining 90% coverage of RI across Pakistan and improving water and sanitation quality,” according to Dr Akram.

Bacteria Don’t Respect Geographic Borders

The XDR typhoid bacteria propagating in Pakistan has crossed borders and reached as far as the UK, Canada and the US. Earlier this year, a team of Pakistani and US researchers published their findings in the American Journal of Tropical Medicine and Hygiene, stating that with numerous typhoid bacteria variants circulating in Pakistan have also been identified in Southeast Asia and Eastern and Southern Africa and have been introduced into the United Kingdom, Canada, and the United States by travellers.

The Lancet study said strains from South Asia had spread 200 times to other countries since 1990. When these superbugs grow and spread, they can cause infections that are hard to treat. Sometimes they can even spread the resistance to other bacteria they meet.

The future looks frightening. While the need for improving water and sanitation cannot be overemphasised, along with the need for vaccinating children, newer and stronger antibiotics need to be developed and fast as typhoid may surface in deadlier ways than now since very few antibiotics remain effective against the bacteria.

Note: This story was supported by the Sabin Vaccine Institute and Internews

IPS UN Bureau Report

 


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Excerpt:

Childhood vaccination, complemented with clean drinking water and improved hygiene practices, are the key to eradication of typhoid XDR, not indiscriminate use of antibiotics, say Pakistan health experts. Source

Global Community Celebrates Medical Innovations and Milestones Since Defining Leprosy Discovery 150 Years Ago

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Yohei Sasakawa, WHO’s Goodwill Ambassador for Leprosy Elimination, speaks at the two-day Bergen International Conference on Hansen’s Disease. The conference coincided with the 150th anniversary of the discovery of Mycobacterium leprae by Norwegian doctor Gerhard Armauer Hansen. Credit: Thor Brødreskift/Sasakawa Leprosy (Hansen’s Disease) Initiative

Yohei Sasakawa, WHO’s Goodwill Ambassador for Leprosy Elimination, speaks at the two-day Bergen International Conference on Hansen’s Disease. The conference coincided with the 150th anniversary of the discovery of Mycobacterium leprae by Norwegian doctor Gerhard Armauer Hansen. Credit: Thor Brødreskift/Sasakawa Leprosy (Hansen’s Disease) Initiative

By Joyce Chimbi
NAIROBI, Jun 22 2023 (IPS)

The 1873 discovery of Mycobacterium leprae, the causative agent of leprosy by Norwegian doctor Gerhard Armauer Hansen, remains one of the greatest paradigm shifts in medical history, a true revolution.

“Before the great discovery, even in the days when communication and transportation technologies were not as developed as today, leprosy was detested by the entire world. Leprosy was believed to be a divine punishment or a hereditary disease; once affected, patients were segregated to remote areas and islands for life,” says Yohei Sasakawa, WHO’s Goodwill Ambassador for Leprosy Elimination.

Sasakawa, who also serves as chairperson of The Nippon Foundation, spoke during a two-day conference in Bergen, Norway, to commemorate the 1873 discovery. In attendance were over 200 people, including medical, human rights, and historical preservation experts, researchers, NGOs, and organizations of persons affected by the disease.

The Bergen International Conference on Hansen’s Disease, held on June 21 and 22, 2023, was organized by the Sasakawa Leprosy (Hansen’s Disease) Initiative and the University of Bergen. It focused on medical efforts against leprosy, human rights, and dignity issues and preserving the history of leprosy for the lessons it can teach future generations. All three are pillars of the Sasakawa Leprosy (Hansen’s Disease) Initiative’s activities for a world free of leprosy and the discrimination it causes, in line with the UN’s Resolution on Elimination of discrimination against persons affected by leprosy and their family members.

In his speech to delegates, Sasakawa acknowledged the extraordinary advances made by medical professionals since Dr Hansen’s discovery that leprosy was neither a curse nor a punishment from God but a chronic disease caused by a bacillus.

With the 1873 discovery, leprosy went from being a mythological divine disease shrouded in mystery to something one could observe and explain—although it would take more than half a century before a cure was found.

Delegates at the Bergen International Conference on Hansen’s Disease held on June 21 and 22, 2023. The conference was organized by Sasakawa Leprosy (Hansen’s Disease) Initiative and the University of Bergen. Credit: Thor Brødreskift/Sasakawa Leprosy (Hansen’s Disease) Initiative

Delegates at the Bergen International Conference on Hansen’s Disease held on June 21 and 22, 2023. The conference was organized by the Sasakawa Leprosy (Hansen’s Disease) Initiative and the University of Bergen. Credit: Thor Brødreskift/Sasakawa Leprosy (Hansen’s Disease) Initiative

Margareth Hagen, Rector, University of Bergen, said there was a clear shift in the scientific discourse about leprosy before and after the discovery.

Sasakawa said the journey towards a cure started with a single anti-leprosy drug to more effective drug regimens and, ultimately, a recommendation from WHO’s medical team that leprosy patients receive drug regimens consisting of multiple drugs.

“A single anti-leprosy drug tended to increase drug resistance. Since the development of multi-drug therapy, with early detection and treatment, leprosy has become totally curable. About 60 million patients have been cured over the last 40 years,” he said.

Abbi Patrix, the great-grandson of Dr Hansen, now responsible for his great grandfather’s history, spoke about the man behind the science in a session titled, ‘My grandfather, my mother, the documents and me.’

Patrix, a European performance storyteller, talked about the day his mother, the only direct descendant of Dr Hansen at the time, learned that leprosy was named Hansen’s disease after her grandfather.

She was moved and wondered why? His mother was informed that Dr Hansen’s discovery had put a name to a disease that had confounded scientists and society alike and that labeling it ‘Hansen’s disease’ meant freedom for those afflicted because a cure could now be found.

The conference venue was, therefore, a recognition of his renowned great-grandfather because he was born in Bergen, and this was the site for his landmark 1873 discovery at only 32 years of age.

WHO Director-General Dr Tedros Adhanom Ghebreyesus told the audience: “WHO was born halfway between 1873 and today, 75 years ago. Much progress has been made since the two major milestones in the fight against leprosy. But much remains to be done toward our shared goals of zero disease, zero disability, and zero discrimination. Cases of leprosy have decreased significantly in recent decades, but more effort is needed to recover from the health system disruptions of the COVID-19 pandemic and move further ahead.”

Ghebreyesus said the WHO was committed to supporting countries in their bid to eliminate leprosy in line with the roadmap for neglected tropical disease for 2021 to 2030.

“So far, 49 countries have eliminated at least one neglected tropical disease, including Human African trypanosomiasis, rabies, and trachoma. With your support and those of our global partners, we can achieve that goal for leprosy too.”

Other dignitaries who spoke at the conference include United Nations High Commissioner for Human Rights Volker Türk, who said the conference celebrated medical innovations over the last 150 years.

“But when leprosy was eliminated as a global public health problem in 2000, it did not mean that the disease disappeared. Over 250,000 people suffer from leprosy every year, 15,000 of them are children. The actual figures are likely far higher,” he emphasized.

“Around three to four million people who have already been cured still bear varying degrees of impairment. The burden of leprosy is heaviest in countries with the greatest inequality, poverty, and marginalization.”

Türk further said that to better the lives of people affected by leprosy, “We need to address the physical symptoms, but we also need social and behavioral measures to address stigma and discrimination. We need comprehensive strategies with access to quality care, education, and social protection,” and told participants that “together we can make a real difference in ending leprosy, which causes immense preventable and unjustifiable suffering for thousands of people.”

Against this backdrop, Sasakawa stressed that further action is needed to combat stigma and discrimination, pointing out that as many as 130 discriminatory laws against leprosy are still in place in more than 20 countries.

“When respect for human rights is a must, it is unacceptable to leave such a large-scale and serious human rights violation unaddressed,” he said.

As the curtain fell on the Bergen conference of a remarkable journey to end leprosy over the last 150 years, Dr Takahiro Nanri, executive director of Sasakawa Health Foundation, noted that this was the third international conference that the foundation has helped to organize since launching its “Don’t Forget Leprosy” campaign in 2021 to help to ensure that the disease and those affected by it are not overlooked amid the coronavirus pandemic.

“Our purpose in organizing these conferences is to make the world aware that there are still many people who have Hansen’s disease and its consequences; to build momentum for collaboration toward the realization of a leprosy-free world; and to provide a setting for both formal and informal exchanges that can be a catalyst for innovative solutions that we as a foundation are ready to support,” he said.

IPS UN Bureau Report

 


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Human Rights Defenders in Exile Safety Imperiled by Host Countries’ Declining Civil Rights

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Irene Grace says human rights defenders hiding in Kenya fear harassment and intimidation due to a decline in civic rights. Credit: Joyce Chimbi/IPS

Irene Grace says human rights defenders hiding in Kenya fear harassment and intimidation due to a decline in civic rights. Credit: Joyce Chimbi/IPS

By Joyce Chimbi
NAIROBI, Jun 20 2023 (IPS)

While leaving one’s country and becoming a refugee is a last resort, it is a decision that many, like Steve Kitsa, have had to make. As conflict becomes increasingly protracted in many African countries, many others will take this step.

“In a matter of life and death, I fled the Democratic Republic of Congo (DRC) five years ago and left my elderly mother behind. One day we were seated in a group of young men, chatting and enjoying the morning sun, when a lone gunman in uniform approached us and started firing away unprovoked. Such incidences had become too common in the eastern region, and some of my friends were killed,” Kitsa tells IPS.

Kenya hosts one of the largest refugee populations in Africa. Kitsa is one of more than 520,000 registered refugees and asylum seekers. But human rights defender Irene Grace, who fled Uganda two years ago, says the number is much higher because borders are porous.

Nevertheless, official records show that about 287,000 refugees come from Somalia, 142,000 from South Sudan, 50,000 from DRC, and 32,000 from Ethiopia; many live in Dadaab and Kakuma camps.

Others, like Kitsa, have found their way into the urban centers of Nairobi, Kisumu, Mombasa, and Eldoret. Outdated statistics from 2017 indicate that more than 67,267 refugees live in Nairobi.

“There is a lot of exploitation because we need the locals to survive. Along the highways, you will find many young men hawking peanuts. You can tell they are from DRC because of the kind of Swahili they speak. They sell these peanuts under the hot sun, all day, every day, in exchange for a plate of food and somewhere to sleep as the profits go to the host. Most of us are desperate to go to France,” he explains.

Irene Grace fled Uganda for promoting the rights of the LGBTQI community as the country clamped down on their rights. As the government-endorsed crackdown against the community intensified, so did threats against her life.

“The issue of human rights defenders in exile is one aspect of the refugee situation that is hardly ever talked about. The risk is very high because you are under an alias in a foreign country, and if murdered, you are likely to remain unidentified for a long time, and it might take years to connect the dots. The question of who bears the duty of protection for us remains unanswered,” Grace says.

Her fears and concerns reflect the 2022 report findings by the global civil society alliance, CIVICUS, and the Kenya Human Rights Commission (KHRC), highlighting the decline in civil rights in Kenya. According to the report, the government was using excessive force to quieten dissent.

Kenya was placed on the CIVICUS Monitor’s human rights ‘Watchlist’ in June 2022. The Watchlist highlights countries with a recent and steady decline in civic freedoms, including the rights of free speech and peaceful assembly.

Kenya was rated Obstructed by the CIVICUS Monitor. There are 42 countries in the world with this rating. The rating is typically given to countries where power holders heavily contest civic space and impose a combination of legal and practical constraints on the full enjoyment of fundamental rights.

In 2021, Front Line Defenders released a report accusing the governments of Uganda and Kenya of giving the South Sudanese National Security Service (NSS) intelligence agency the freedom to target refugee human rights workers who fled the country.

“It is very difficult to continue with activism in such a hostile environment, on top of the many other challenges confronting us, such as a lack of documentation and access to services. Some of us left our families behind, exposed and unprotected. Over the eight years, I have lived in Kenya, I have received many threatening calls from South Sudan, but I know the information of my whereabouts came from within this country,” Deng G, an activist from South Sudan, tells IPS.

“Our situation worsens when local activists are targeted. In exile, you must connect with local networks to survive and continue with your activism. I am aware of activists in Kenya currently being held without trial for protesting against the high cost of living.”

KHRC continues to express concerns over the misuse of laws to undermine peaceful protest and recently responded with speed when five activists from the Social Justice Center, a Nairobi-based grassroots group, were arrested during a peaceful protest against the controversial Finance Bill 2023.

A pre-independence Public Order Act requires activists to notify authorities of protests at least three days in advance. Police have mistakenly understood the provision as a requirement for protests to be approved or denied, using it as an excuse to deem protests ‘unpermitted.’ Even though the right to peaceful assembly is guaranteed in Kenya’s constitution, it is continually undermined, says CIVICUS and KHRC.

Irene Grace says ongoing hostilities have derailed efforts to promote the safety and security of LGBTQI asylum seekers and refugees in the Kakuma Refugee Camp complex in northwestern Kenya whose lives are at risk. She says they are experiencing discrimination, and physical and sexual violence, among other forms of human rights violations.

“I am unable to travel there to determine how we can mobilize and improve their safety, working hand in hand with grassroots activists in Kenya. There are corrupt security officers, and once they discover you are hiding in the country, you become a target. They want you to pay them to turn a blind eye as you go on with your activities,” she says.

Kitsa says the issue of bribes is a most pressing challenge for many refugees seeking to integrate with the locals.

“They usually threaten to send you to the refugee camps despite having refugee documentation allowing you to live among the locals. They can create many problems for you.”

Against this backdrop, Irene Grace says activism is being suppressed from multiple angles, and human rights activists, local and those operating from exile, must now go back to the drawing board to find safer, impactful ways to speak truth to power and take the powers that be head-on.
IPS UN Bureau Report

 


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Excerpt:

Home Away From Home is the theme of World Refugee Day 2023. However, for many, including human rights activists who have fled their homes, a decline in civil rights in their host countries means their lives are often endangered and their activism curtailed. Source

Parliamentarians Ask G7 Hiroshima Summit to Support Human Security and Vulnerable Communities

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Parliamentarians attending the Global Conference of Parliamentarians on Population and Development Toward the 2023 G7 Hiroshima Summit. Credit: APDA

Parliamentarians attending the Global Conference of Parliamentarians on Population and Development Toward the 2023 G7 Hiroshima Summit. Credit: APDA

By Cecilia Russell
JOHANNESBURG, May 9 2023 (IPS)

Parliamentarians from more than 30 countries agreed to send a strong message to the G7 Hiroshima Summit in Japan later this year, focusing on human security and support of vulnerable communities, including women, girls, youth, aging people, migrants, and indigenous people, among others.

The wide-ranging declaration also called on governments to support active political and economic participation for women and girls, enhancing and implementing legislation that addresses gender-based violence (GBV) and eradicating harmful practices like child, early, and forced marriages. During discussions and in the declaration, a clear message emerged that budgetary requirements for Universal Health Care (UHC) should be prioritized and the exceptional work done by health workers during the pandemic be recognized.

In his keynote address, Japan’s Prime Minister Kishida Fumio reminded delegates that Covid-19 had exposed the “fragility of the global health architecture and underscored the need for UHC.”

Kishida said that the central vision of the G7 Hiroshima Summit was to emphasize the importance of addressing human security – through building global health architecture, including the “governance for prevention, preparedness, and response to public health crises, including finance. We believe it is important for the G7 to actively and constructively contribute to efforts to improve international governance, secure sustainable financing and strengthen international norms.”

Apart from contributing to resilient, equitable, and sustainable UHC, health innovation was needed to promote a “more effective global ecosystem to enable rapid research and development and equitable access to infectious disease crisis medicines … and to support aging society,” Kishida said.

Former Prime Minister of Japan Fukuda Yasuo, Chair of APDA, and Honorary Chair of JPFP said this conference and its declaration would follow in a tradition of delivering strong messages to the G7 that improving reproductive health was crucial to the development and the future of a planet which now had 8 million people living on it.

“International Community is becoming increasingly confrontational and divided, and there is the emergence of a national leader who is threatening the use of nuclear weapons. No nuclear weapons have been used in the nearly 80 years since Hiroshima and Nagasaki. We must work together to prevent the use of nuclear weapons, which can take many precious lives and people’s daily lives. In this instance, I would like you to search for the path toward appeasement and not division. We must keep all channels of dialogue open so as to ease tension,” Fukuda asked of the conference.

While calling on parliamentarians to work together to address challenges, Fukuda also expressed concern about the widening inequities caused by Covid-19 and climate change and noted: “This network of parliamentarians on population and development has been a vital resource for parliamentarians who share the same concern for not only their own countries but for the entire planet and future generations.”

Kamikawa Yoko, MP Japan, Chair of JPFP, said that with a world population of 8 billion, it was essential to “realize a society where no one is left behind … and Japan would share its experiences of being on the frontlines of an aging society with declining birth rates. “We are living in an aging society … and given these challenges in Japan, we will try to share with you our experience and lessons through our diplomacy while trying to deepen our discussions and exchanges to seek solutions.”

Japan’s Foreign Affairs Minister Hayashi Yoshimasa said it was essential for all to cooperate during the “Anthropocene era, when human activities have promised to have a major impact on the global environment, global issues that transcend national borders, such as climate change, and the spread of infectious diseases, including Covid-19 are becoming more and more prevalent.”

He reminded the delegates that at the center of Japan’s economic growth post World War II was mainly through health promotion and employment policies.

Delegates of the Global Conference of Parliamentarians on Population and Development Toward the 2023 G7 Hiroshima Summit agreed to send a strong message on human security to the Summit. Credit: APDA

Delegates of the Global Conference of Parliamentarians on Population and Development Toward the 2023 G7 Hiroshima Summit agreed to send a strong message on human security to the Summit. Credit: APDA

Director of the Division for Communications and Strategic Partnerships of UNFPA, Ian McFarlane, said it was not about the “numbers of people but the rights of the people that matter. It’s not about whether we are too many or too few, but whether women and girls can decide if, when, and how many children to have.”

A recent UNFPA report indicated that nearly half of the women across the globe could not exercise their rights and choices, their bodily autonomy, and expressed hope that policies in the future continue to focus on humanity and universal human rights.

Despite being close to the 30th anniversary of the International Conference on Population and Development (ICPD), the conference heard that much still needed to be done regarding women’s rights.

New Zealand MP and co-chair of AFPPD Standing Committee on Gender Equality and Women Empowerment, Angela Warren-Clark, reminded the audience that women still only held 26 percent of parliamentarian seats globally. While women make up 70 percent of the workforce in the health sector, only 25 percent have senior leadership positions.

“It is women in this pandemic who bore the increased burden of unpaid work at home as schools were closed, and it is girls and the poorest families who were taken out of school and forced into early marriages … We believe that if women had an equal say in decision-making during the pandemic, some of these mistakes would have been avoided.”

Baroness Elizabeth Barker, MP from the United Kingdom, told parliamentarians their role was to ensure that “no person on earth, from the head of G7 country to a poor person in a village, can say that they do not know what gender equality is. And they do not know what gender violence is.”

Barker suggested they use international standards, like the Istanbul Convention on Violence Against Women, to compare countries. “And you know that if your country doesn’t come out very well, they really don’t like it.”

She pointed to two successes in the UK, including stopping virginity testing and tackling the practice of forced marriages. She also warned the delegates that there was a right-wing campaign aimed at destroying human rights gained, and they chose different battlegrounds. The overturning of abortion rights in the United States in the Roe vs. Wade case was an example, as was the anti-LGBTQ legislation in Uganda.

Hassan Omar, MP from Djibouti, gave a host of achievements in his country, including ensuring that women occupy 25 percent roles in politics and the state administration and the growing literacy of women numbers in his country.

Risa Hontiveros, MP Philippines, painted a bleak picture of the impact of Covid in her country.

Hontiveros said GBV increased during Covid and extended to the digital space.

“The Internet has become a breeding ground for predators and cyber criminals to prey on children, especially young women, and girls. The online sexual abuse and exploitation of children … has become so prevalent in the Philippines that we have been tagged as the global hotspot.”

In a desperate attempt to provide for their families, even parents produced “exploitative material of their own children and sold them online to pedophiles abroad.”

To address these, she filed a gender-responsive and inclusive Emergency Management Act bill, which seeks to address the gender-differentiated needs of women and girls, because they were “disproportionately affected in times of emergencies.”

Former MP from Afghanistan Khadija Elham’s testimony united many in the conference and even resulted in proposals from the floor to include a condemnation of the Taliban’s women’s policies.

Elham said GBV had increased since the Taliban took over – women were forced to wear a burqa in public, they were not allowed to work, and those who wish to “learn science or (get an) education are forced to continue their studies and hidden places like basements.”

If their secret schools are exposed, they face torture and imprisonment. During the last two months, 260 people, including 50 women, were publicly whipped – a clear violation of their human rights. Women’s representation in political life has been banned, and women are no longer allowed to work in NGOs – and it has been “550 days since women could attend high schools and universities.”

She called on the international community, the United Nations, to pressure the Taliban to restore women’s work and education rights.

Nakayama Maho, Director of the Peacebuilding Program at the Sasakawa Peace Foundation, announced new research on factors contributing to men’s propensity to GBV. The research found that the higher a man’s educational attainment, the lower the level of violence. There were also lower levels of violence with “positive” masculinity – such as a man being employed, married, and capable of protecting his family. Men who experienced violence during times of conflict tended to support violence to instill discipline, or protect women and communities.

Dr Roopa Dhatt, Executive Director of Women in Global Health, summed up this critical session by saying, “Equal leadership for women in all fields is a game changer, particularly in politics and health.”

Japan’s Health, Labour and Welfare Minister, Kato Katsunobu, noted during his closing address that the G7 countries “share the recognition that investment in people is not an expense, but an investment… and as you invest in people you can create a virtuous cycle between workers well-being and social and economic activities.”

He said Japan had a lot to offer concerning aging populations.

“Japan has been promoting the establishment of a comprehensive community-based care system so that people can continue to live in their own way in their own neighborhood until the end of their lives and is in the position to provide knowledge to the G7 countries and other countries who will be facing (an aging population) in the future.”

Dr Alvaro Bermejo, Director-General of IPPF, commended the conference and said he was “thankful” that the conference declaration would tell G7 governments to set an example. “Marginalized and excluded populations are at the heart of human security and can only be achieved in solidarity, and that message from this conference is clear.”

Professor Takemi Keizo, MP Japan, Chair of AFPPD, summed up the proceeding by saying that parliamentarians as representatives of the electorate were vital to creating a “positive momentum in this global community and overcoming so many difficult issues.”

Takemi elaborated on some issues facing the world now, including climate change and military conflicts, but as parliamentarians, there was the opportunity to “build up the new basis of the global governance, which can be very beneficial.”

NOTE: Global Conference of Parliamentarians on Population and Development Toward the 2023 G7 Hiroshima Summit was organized by the Asian Population and Development Association (APDA), the Asian Forum of Parliamentarians on Population and Development (AFPPD), and the Japan Parliamentarians Federation for Population (JPFP).

It was supported by the Ministry of Foreign Affairs of Japan (MOFA), United Nations Population Fund (UNFPA), Japan Trust Fund (JTF), and Keidanren-Japan Business Federation in cooperation with the International Planned Parenthood Federation (IPPF).

IPS UN Bureau Report

 


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CIVICUS Report Exposes a Civil Society Under Attack

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The State of Civil Society report from CIVICUS, the global civil society alliance which was officially launched on March 30, 2023, exposes the gross violations of civic space. Credit CIVICUS

The State of Civil Society report from CIVICUS, the global civil society alliance which was officially launched on March 30, 2023, exposes the gross violations of civic space. Credit CIVICUS

By Joyce Chimbi
NAIROBI, Mar 31 2023 (IPS)

As conflict and crises escalate to create human emergencies that have displaced over 100 million people worldwide, civil society’s vital role of advocating for victims and monitoring human rights cannot be over-emphasised.

The 2022 Nobel Peace Prize award to activists and organisations in Belarus, Russia and Ukraine for working to uphold human rights in the thick of conflict underpins this role.

Yet this has not stopped gross violations of civic space as exposed by the State of Civil Society report from CIVICUS, the global civil society alliance, which was officially launched on March 30, 2023.

“This year’s report is the 12th in its annual published series, and it is a critical look back on 2022. Exploring trends in civil society action, at every level and in every arena, from struggles for democracy, inclusion, and climate justice to demands for global governance reform,” said Ines Pousadela from CIVICUS.

The report particularly highlights the many ways civil society comes under attack, caught in the crossfire and or deliberately targeted. For instance, the Russian award winner, the human rights organisation Memorial, was ordered to close in the run-up to the war. The laureate from Belarus, Ales Bialiatski, received a 10-year jail sentence.

Mandeep Tiwana stressed that the repression of civic voices and actions is far from unique. In Ethiopia, “activists have been detained by the state. In Mali, the ruling military junta has banned activities of CSOs that receive funding from France, hampering humanitarian support to those affected by conflict. In Italy, civil society groups face trial for rescuing migrants at sea.”

Ines Pousadela at the launch of the CIVICUS State of Civil Society Report. Credit: Joyce Chimbi/IPS

Ines Pousadela at the launch of the CIVICUS State of Civil Society Report. Credit: Joyce Chimbi/IPS

Spanning over six chapters titled responding to conflict and crisis, mobilising for economic justice, defending democracy, advancing women’s and LGBTQI+ rights, sounding the alarm on the climate emergency and urging global governance reform, the analysis presented by the report draws from an ongoing analysis initiative, CIVICUS Lens.

On responding to conflict and crisis, Oleksandra Matviichuk from the Center for Civil Liberties in Ukraine spoke about the Russian invasion and the subsequent “unprecedented levels of war crimes against civilians such as torture and rape. And, a lack of accountability despite documented evidence of crimes against civilians.”

Bhavani Fonseka, from the Centre for Policy Alternatives, Sri Lanka, addressed the issue of mobilising for economic justice and how Sri Lanka captured the world’s attention one year ago through protests that start small in neighbourhoods and ultimately led to the President fleeing the country.

Launched in January 2022, CIVICUS Lens is directly informed by the voices of civil society affected by and responding to the major issues and challenges of the day.

Through this lens, a civil society perspective of the world as it stands in early 2023 has emerged: one plagued by conflict and crises, including democratic values and institutions, but in which civil society continues to strive to make a crucial difference in people’s lives.

On defending democracy, Amine Ghali of the Al Kawakibi Democracy Transition Center in Tunisia spoke about the challenge of removing authoritarian regimes, making significant progress in levels of democracy only for the country to regress to authoritarianism.

“It starts with the narrative that democracy is not delivering; let me have all the power so that I can deliver for you. But they do not deliver. All they do is consolidate power. A government with democratic legitimacy demolishing democracy is where we are in Tunisia,” he said.

Erika Venadero from the National Network of Diverse Youth, Mexico, spoke about the country’s journey that started in the 1960s towards egalitarian marriages. Today, same-sex marriages are provided for in the law.

On global governance reforms, Ben Donaldson from UNA-UK spoke about global governance institutional failure and the need to improve what is working and reform what is not, with a special focus on the UN Security Council.

“It is useful to talk about Ukraine and the shortcomings of the UN Security Council. A member of the UN State Council is unable to hold one of its members accountable. There are, therefore, tensions at the heart of the UN. The President of Ukraine and many others ask, what is the UN for if it cannot stop the Ukraine invasion?”

Baraka, a youthful climate activist and sustainability consultant in Uganda, spoke about ongoing efforts to stop a planned major pipeline project which will exacerbate the ongoing climate crisis, affecting lives and livelihoods.

His concerns and actions are in line with the report findings that “civil society continues to be the force sounding the alarm on the triple threat of climate change, pollution and biodiversity loss. Urging action using every tactic available, from street protest and direct action to litigation and advocacy in national and global arenas.”

But in the context of pressures on civic space and huge challenges, the report further finds that “civil society is growing, diversifying and widening its repertoire of tactics.”

Moving forward, the report highlights 10 ideas, including an urgent need for a broad-based campaign to win recognition of civil society’s vital role in conflict and crisis response as well as greater emphasis by civil society and supportive states on protecting freedom of peaceful assembly.

Additionally, the need for civil society to work with supportive states to take forward plans for UN Security Council reform and proposals to open up the UN and other international institutions to much greater public participation and scrutiny.

In all, strengthening and enhancing the membership and reach of transnational civil society networks to enable the rapid deployment of solidarity and support when rights come under attack was also strongly encouraged.

IPS UN Bureau Report

 


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The Need for a Strong Legal Treaty on Business & Human Rights

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The open-ended intergovernmental working group on transnational corporations and other business enterprises with respect to human rights was established in 2014 in response to Human Rights Council resolution 26/9 with a mandate to elaborate an international legally binding instrument to regulate, in international human rights law, the activities of transnational corporations and other business enterprises.

By Simone Galimberti
KATHMANDU, Nepal, Mar 31 2023 (IPS)

The ongoing discussions on an internationally treaty, described as a “legally binding instrument” on business and human rights, remains one of the most neglected issues that should instead command the attention of the public.

Such a legal tool would bind companies to uphold high standards and most importantly, it would entail mandatory guarantees for accessible and inclusive remedy and therefore, clear liabilities for victims of alleged abuses perpetrated by companies.

It all started in 2014 when two nations of the South, Ecuador and South Africa successfully pushed for a resolution at the UN Human Rights Council on the establishment of a so called “international legally binding instrument on transnational corporations and other business enterprises with respect to human rights”.

By reading the title of the resolution you can immediately realize that one of the conundrums being discussed is the overarching scope of such treaty especially in the reference of the nature of the companies being subject to it.

In practice, would only multinational or also national private corporations come under its jurisdiction?

Interestingly, at the Intergovernmental Working Group (IGWG) created to draft the text of the treaty, many developing nations, for example, like Indonesia, were strongly advocating for only multinationals to be included.

This is a position of convenience that would exclude local major operators involved in the plantations business from coming under scrutiny of the treaty.

Other complex issues are centered on the liability especially in relation to instances where a corporation is “only” directly linked to the harm rather than cause.

As explained by Tara Van Ho, a lecturer at the University of Essex School of Law and Human Rights Centre, if “a business is only “directly linked to” the harm, it does not need to provide remedies but can instead use its “leverage” to affect change in its business partners.”

The difference between causing or contributing to harm and instead being only liked to it can be subtle and remain an exclusive debate among scholars, but its repercussions could or could not ensure justice to millions of people victims of corporate abuses.

Another point of attrition is the complex issue of the statutes of limitations and the role of domestic jurisdiction over the future treaty.

With all these challenges, after 8 years of negotiations, the drafting is moving in slow motion amid a general disinterest among state parties, as explained by Elodie Aba for Business & Human Rights Resource Centre

An issue that should capture global attention has instead become a realm of technical discussions among governments, academicians and civil society members without generating mass awareness about it.

The need for a treaty related to abuses of corporations is almost self-evident, considering the gigantic proofs that have been emerging both in the North and South.

Despite nice words and token initiatives, the private sector has been more than often keen to close its eyes before abuses occurring through its direct actions or throughout its supply chains.

Amid weak legislations, especially in developing countries, the hard job of trying to keep companies accountable, until now, has depended on a set of non-binding, voluntary procedures formally known as the Guiding Principles on Business and Human Rights.

The Principles, prepared by late Harvard Professor John G. Ruggie in his capacity as UN Special Representative on Business and Human Rights, proved to be a useful but at the same time inadequate tool.

It has been useful because it was instrumental in raising the issue of human rights within the corporate sector, something that was for too long and till recently, a taboo.

In order to further mainstream it, for example, a UN Working Group on Business and Human Rights has been established as a special procedure within UN Human Rights.

Along the years, this independent group, composed by pro bono academicians, has carried out considerable work to strengthen both the understanding of and the adherence to the Principles.

There is no doubt that there have been attempts at going deeper, especially from the legal point of view on the Principles, especially on their articles related to right to remedy, the thorniest issue.

In this regard, the Accountability and Remedy Project have been providing a whole set of insights through multiple consultations and discussions, a process that still ongoing with the overall purpose of making a stronger cases on “the right to remedy, a core tenet of the international human rights system”.

Yet principles, UN Global Compact, are toothless tool and showed considerable limitations, starting from the most obvious element, the fact that they are not binding.

In the meantime, in 2021 the UN Working Group on Business and Human Rights, on occasion of their 10th anniversary of the Principles, launched road map for the next 10 years.

It is actions, despite their intrinsic limitations due to the nature of the Principles, should be supported but more financial resources are indispensable. Yet finding the financial resources or better the political will to do so remains an issue.

A recommendation from late Prof. Ruggie to create a Voluntary Fund for Business and Human Rights did not go anywhere.

“The Fund would provide a mechanism for supporting projects developed at local and national levels that would increase the capacity of governments to fulfill their obligations in this area as well as strengthen efforts by business enterprises and associations, trade unions, non-governmental organizations and others seeking to advance implementation of the Guiding Principles”.

Even more worrisome is the fact that till now a new Special Representative for Business and Human Rights has not been appointed yet.

Having an authoritative figure, especially a former head of state rather than an academician, could help bring more visibility to the ongoing “behind the curtain” discussions related to the need for a strong Treaty.

Such a political figure could not only command a stronger attention on the issue but also provide “cover” to the delicate work of the UN Working Group on Business and Human Rights, complementing and strengthening its mandate.

Engagement with the education sector, law and business schools, as advocated by a report published by Business and Human Rights Asia, a UNDP Program, can be essential.

Together with a stronger media coverage, students and academicians can help elevate the issue of human rights and its linkages with the private sector.

We could imagine competitions among students at national and international levels on how the principles can be better implemented as a “bridge” tool towards a binding legal mechanism.

Students could also have a major say on the opaque drafting process of this treaty.

At the end of the day, there will be compromises and shortcomings, but with a bigger bottom-up approach, a strong Treaty could become a “global” Escazu’, the first ever binding environment agreement in Latin America and the Caribbean.

UNDP with its Business and Human Rights Asia unit that recently organized in Kathmandu an excellent 4th UN South Asia Forum on Business and Human Rights. But it could also be bolder.

The forum did a great job at giving voice to indigenous people, one of the key stakeholders in the global negotiations for the treaty.

A lot of discussions were rightly held on the impact of issues like climate change and migration and their links with businesses’ attitudes and behaviors towards local populations.

Yet, there was no conversation nor on the treaty nor on the future evolution of the principles. It might certainly be an issue of a limited “mandate” but UNDP could, together with UN Human Rights, be a neutral enabler on a global discussion on the treaty and on how the Principles can further evolve while we wait for such a legal tool.

The Principles should also be better linked with the UN Compact, creating more synergies and coordination between the two.

The fact that nations like France, Germany and the Netherlands have been stepping up with new vigorous legislations in the field of business and human rights is extremely positive.

Equally important is the commitment of the EU to come up with Corporate Sustainability Due Diligence Directive (CSDDD) or the OECD to revise its Guidelines on Responsible Business Conduct but the nations behind these initiatives must commit to the drafting process of the Treaty.

Otherwise, we run the risk that discussions will continue without anyone caring about them. Such an unfortunate situation must truly be “remedied’ with the right smart mix, political will, starting from the Secretary General and a powerful alliance of progressive nations in the both South and North driving the process and involving other peer nations.

Ultimately civil society must also step up beyond their technical and legal recommendations and truly engage the people.

Simone Galimberti is the co-founder of ENGAGE and of the Good Leadership, Good for You & Good for the Society.

Opinions expressed are personal.

IPS UN Bureau

 


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