Health for All is a biding for all nations under the Alma Ata Declaration, the provision of quality healthcare services to the people of Pakistan, Pakistan is struggling with a double burden of disease, which means that the country is facing a significant burden of infectious diseases alongside an increasing epidemic of non-communicable diseases. Hepatitis C is a significant public health concern in Pakistan, with the prevalence rate currently standing at 7.5% with 10 million infected cases, out of 60 million hepatitis C cases globally. The impact of the disease on the population is significant, and it poses a serious challenge to the nation's healthcare system. Viral Hepatitis, though infectious, can also transition into chronic illness. i.e. liver cancers, increasing the financial burden on both our public and health systems. However, the Government of Pakistan, with the highest political will has launched an ambitious initiative to eliminate Hepatitis C infection in the country. This initiative aims to screen, test, and treat at least 50% of the eligible population, a step towards significantly reducing the burden of Hepatitis C in Pakistan.

Pakistan has the highest prevalence of Hepatitis-C in the world, surpassing Egypt, which successfully eliminated the disease through a concerted national effort. "Our goal is to replicate Egypt's success by ensuring mass screening, awareness, and access to effective three-month oral treatments."

Government of Pakistan has taken a crucial step by investing in the hepatitis C program which will help avert significant morbidity and mortality due to complications as well as financial burden on the health systems Hepatitis C Elimination Program as Public Sector Development Programme (PSDP) project in collaboration with all four provinces. Timely screening and treatment are essential in preventing liver failure and liver cancer among affected individuals.

This initiative aims to ensure early detection through widespread screening, PCR testing, and treatment - all provided free of cost.

The project is set to run from July 2024 to June 2027 with domestic funding as a PSDP project covering all four provinces, ICT and federating regions. The initiative targets a substantial portion of Pakistan’s population, focusing on individuals aged 12 years and above, with a goal to screen and treat 50% of the eligible population (approximately 82.5 million people).

The success of this initiative hinges on a well-coordinated effort between the federal and provincial governments. The federal government will play a pivotal role by providing essential commodities for the program. This includes 100% of the Rapid Diagnostic Test (RDT) kits for screening, 30% of the testing (PCR), and 50% of the medicines required for treatment. Additionally, the federal government will establish a Project Management Unit (PMU) to oversee the implementation of the program, ensuring that key performance indicators (KPIs) are met and providing the necessary support to the provinces.

The provincial governments will strengthen health facilities to enable effective screening, testing, and treatment. They will be responsible for training the necessary healthcare workforce, including doctors, nurses, laboratory technicians, and data entry officers. Provinces will also take the lead in raising public awareness about Hepatitis C, ensuring that communication strategies are in place to promote prevention, control, and treatment. The provinces will be tasked with deploying human resources where needed and covering the treatment costs for 50% of positive cases.

Since the devolution of health services in 2011, provincial governments have been managing hepatitis control programs. These programs are already operational and have made strides in addressing Hepatitis C and B. Key initiatives include:

• Free screening, testing, and treatment services for the general population
• Hepatitis B vaccination (except for infants and children under five years of age)
• Awareness campaigns aimed at the prevention and control of viral hepatitis

The provinces, including Punjab, Sindh, Khyber Pakhtunkhwa (KP), and Balochistan, have established hepatitis clinics across various healthcare facilities, such as district and teaching hospitals, rural health centers, and dispensaries. These clinics offer screening, PCR testing, and treatment. For example, Punjab alone has 243 hepatitis clinics in place. Additionally, waste management systems have been set up at hospitals, and vaccination and treatment camps are organized to reach underserved areas, including prisons and refugee camps.

Federal and Provincial Collaboration for Success

A crucial aspect of this program is the coordination between federal and provincial authorities. The Prime Minister will chair a National Task Force (NTF) to ensure that the Hepatitis C elimination initiative stays on track. The Technical Committee, led by experts Prof. Saeed Akhtar and the highest level leadership from MONHSRC, will provide strategic oversight and guidance on program implementation. A well-defined procurement and implementation plan will ensure that the program is executed effectively, with ongoing monitoring and evaluation to track progress.

The development of a National Electronic Medical Records (EMR) system for Hepatitis C is a significant innovation that will facilitate better management and reporting of patient data, ensuring that the program is not only comprehensive but also efficient and transparent.

Challenges and Solutions

One of the primary challenges in addressing Hepatitis C in Pakistan is the need to expand screening, testing, and treatment services, especially in remote areas. Additionally, tackling stigma and misinformation about Hepatitis C is a key component of the public health strategy. The collaboration between federal and provincial governments, supported by robust funding, training, and awareness efforts, will be crucial in overcoming these challenges.

The provision of free screening and treatment, combined with a strong communication campaign, will help to ensure that a larger portion of the population is reached. Further, engaging the private sector and ensuring that healthcare workers are well-trained and equipped with the necessary resources will contribute to the program's overall success.

Recently program has been successfully piloted in two districts of Gilgit Baltistan District Shigar - UC Markunja District Diamer - UC MC ChilasThe Hepatitis C elimination initiative in Pakistan marks a significant step forward in the country’s battle against viral hepatitis. With a well-coordinated effort, sufficient funding, and the active involvement of both federal and provincial governments, the goal of eliminating Hepatitis C in the country by 2027 is achievable. By reaching out to vulnerable populations, improving healthcare infrastructure, and promoting awareness, this initiative has the potential to reduce the prevalence of Hepatitis C and improve the health outcomes of millions of Pakistanis.

Early detection can save lives.

Acknowledgement:

Director General Health (PD) and DD program I MONHSRC.

By ISID Emerging Leader, Dr. Nadia Noreen

Meningitis is a life-threatening infectious disease that can affect all age groups, but especially neonates and children less than 5 years old. Bacterial meningitis can be caused by several pathogens, but among neonates, Group B Streptococcus (GBS, Streptococcus agalactiae) stands out as the leading causative agent of meningitis. The greatest meningitis burden worldwide is reported in children, with 112,000 deaths and 1.28 million cases in 2019. Considering the etiology of neonatal meningitis, viruses are responsible for 37.1% of total cases, followed by GBS (20.4% of total cases) and Neisseria meningitis (9.7% of total cases). GBS can colonize the lower reproductive tract of up to 40% of pregnant women worldwide and is associated with both vertical and horizontal modes of transmission. According to the World Health Organization (WHO), 21.7 million pregnant women are colonized by GBS each year, which leads to 390,000 cases of GBS infection, 91,000 neonatal deaths, more than 46,000 stillbirths, and 518,000 preterm births. Moreover, around 40,000 children who survive GBS infection show neurodevelopmental impairment.

GBS Meningitis

GBS is an opportunistic pathogen that can colonize asymptomatically the gastrointestinal and genital tracts of healthy adults, being part of the intestinal and vaginal microbiomes. The neonatal invasive infections caused by GBS can be classified into early- and late-onset disease according to the timing of symptoms’ onset and mode of transmission. The early-onset GBS disease (EOGBS) is characterized by the onset of symptoms within 7 days after birth and vertical intrapartum transmission due to aspiration of contaminated amniotic or vaginal secretions during labor. The late-onset GBS disease (LOGBS), in turn, is characterized by the beginning of symptoms between 7 and 90 days after birth and horizontal postpartum transmission (hospital environment, the mother or other caregivers, or breastfeeding). Additionally, GBS can ascend from the lower genital tract into the uterus during pregnancy and infect the fetus, causing stillbirths, preterm birth, and miscarriage (prenatal-onset GBS disease). EOGBS and LOGBS differ in their clinical manifestations. Usually, EOD is associated with sepsis and pneumonia and less frequently with meningitis, while LOGBS commonly presents with sepsis and meningitis. Although viruses are the causative agents of most cases of neonatal meningitis, GBS accounts for the highest mortality rates. In 2019, GBS accounted for the highest burden of neonatal deaths due to meningitis (22.8%), followed by Klebsiella pneumoniae (17.1%) and viruses (15.3%). Most of this burden is in low- and middle-income countries, especially in Africa and Asia. GBS can also cause meningitis in adults with underlying conditions (e.g., diabetes, heart disease, cancer, immunocompromising conditions), although the frequency of GBS meningitis in that group is lower. The GBS population is composed of several lineages, but one in specific, the hypervirulent clone CC17 associated with serotype III, is recognized as the major clone causing LOGBS and meningitis. Currently, universal GBS screening of pregnant women in late pregnancy (36-37 weeks of pregnancy) and intrapartum antibiotic prophylaxis (IAP) are recommended to prevent GBS disease. The screening involves taking swab samples from the vagina and rectum, and the pregnant women who test positive for GBS should receive antibiotics during labor (IAP). Penicillin is the drug of choice for IAP, and cefazolin, clindamycin, and vancomycin are options for women with penicillin allergies. However, IAP is effective only to prevent EOGBS but does not prevent the occurrence of LOGBS and prenatal-onset GBS disease. A maternal vaccine is considered the most promising approach to prevent all forms of disease caused by GBS, including meningitis.

Antimicrobial Resistance and GBS

Antimicrobial resistance is a topic of concern for GBS. Penicillin is the drug of choice to treat GBS infections, but penicillin-resistant strains were already detected in Japan, Europe, Canada, and the USA. Clindamycin and erythromycin are recommended to treat patients allergic to penicillin. However, the circulation of GBS strains resistant to clindamycin and erythromycin is a reality, with rates reaching nearly 50% in some regions. Considering this scenario, penicillin-resistant GBS, clindamycin-resistant GBS, and erythromycin-resistant GBS are included in the lists of pathogens that pose a threat to the public health published by the Centers for Disease Control and Prevention (CDC) and the WHO and are targets for the actions taken to tackle antimicrobial resistance.

GBS Can Be Considered a Zoonotic Pathogen?

A foodborne outbreak of invasive disease caused by GBS was reported for the first time in Singapore in 2015. The outbreak was caused by the consumption of farmed freshwater fish contaminated with GBS and affected non-pregnant and younger adults. Septic arthritis and meningitis were the predominant clinical manifestations (146 cases and 5 deaths), and the outbreak was caused by the GBS clone ST283 serotype III. GBS ST283 is a widespread clone in Southeast Asia, but it was already detected in other geographic regions, like Brazil. It causes an infectious disease in fish called streptococcosis and economic losses in aquaculture. This episode highlights the zoonotic role of GBS and its public health importance beyond the neonatal infectious diseases.

The Path Towards a Maternal GBS Vaccine

The WHO, together with many partners, defined a global strategy to tackle bacterial meningitis globally, but especially in LMICs. The global roadmap Defeating Meningitis by 2030 has the vision "Towards a world free of meningitis" and aims to tackle the main causes of bacterial meningitis worldwide. Regarding GBS meningitis, the road map fosters the development of an effective and affordable maternal vaccine, implementation of GBS surveillance strategies, and effective, accessible diagnosis and treatment. In addition, the WHO also published the document “Group B Streptococcus vaccine: full value of vaccine assessment", which describes the global public health rationale for developing GBS vaccines for maternal immunization and informs decision makers and stakeholders. Currently, the vaccine proposals in development are based on two approaches: a multivalent capsular polysaccharide (CPS)-protein conjugate vaccine and protein subunit vaccines. The CPS-based vaccine proposals cover between three and six capsular types, targeting the serotypes most associated with disease. The protein subunit proposals target proteins conserved across all GBS serotypes. A maternal GBS vaccine has not been licensed yet, but there are promising approaches in clinical trials, and it is expected that at least one GBS vaccine will be licensed for maternal immunization very soon.

International GBS Awareness Month

July is recognized as the International GBS Awareness Month, and this is a month dedicated to raising awareness about GBS disease, including GBS neonatal meningitis, among the lay public. The campaign aims to provide information and educate healthcare professionals, the public, parents, and decision-makers about GBS and the risks this pathogen can pose to the health of neonates and their mothers. Usually, nonprofit organizations like Group B Strep International (https://www.groupbstrepinternational.org/) and Group B Strep Support (https://gbsaw.gbss.org.uk/) take the lead in the campaign, but everyone can be involved and make a difference to prevent and tackle GBS meningitis!

By ISID Emerging Leader, Laura Oliveira

References

1. Costa NS, Oliveira LMA, Meštrović T, Obiero CW, Lee SS, Pinto TCA. The urgent need to recognize and properly address prenatal-onset group B Streptococcus disease. Int J Infect Dis. 2022 Nov;124:168-170. doi: 10.1016/j.ijid.2022.10.016.
2. GBD 2019 Meningitis Antimicrobial Resistance Collaborators. Global, regional, and national burden of meningitis and its aetiologies, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2023 Aug;22(8):685-711. doi: 10.1016/S1474-4422(23)00195-3.
3. Tavares T, Pinho L, Bonifácio Andrade E. Group B Streptococcal Neonatal Meningitis. Clin Microbiol Rev. 2022 Apr 20;35(2):e0007921. doi: 10.1128/cmr.00079-21.
4. van Kassel MN, van Haeringen KJ, Brouwer MC, Bijlsma MW, van de Beek D. Community-acquired group B streptococcal meningitis in adults. J Infect. 2020 Mar;80(3):255-260. doi: 10.1016/j.jinf.2019.12.002.
5. Seale AC, Bianchi-Jassir F, Russell NJ, Kohli-Lynch M, Tann CJ, Hall J, Madrid L, Blencowe H, Cousens S, Baker CJ, Bartlett L, Cutland C, Gravett MG, Heath PT, Ip M, Le Doare K, Madhi SA, Rubens CE, Saha SK, Schrag SJ, Sobanjo-Ter Meulen A, Vekemans J, Lawn JE. Estimates of the Burden of Group B Streptococcal Disease Worldwide for Pregnant Women, Stillbirths, and Children. Clin Infect Dis. 2017 Nov 6;65(suppl_2):S200-S219. doi: 10.1093/cid/cix664.
6. Kalimuddin S, Chen SL, Lim CTK, Koh TH, Tan TY, Kam M, Wong CW, Mehershahi KS, Chau ML, Ng LC, Tang WY, Badaruddin H, Teo J, Apisarnthanarak A, Suwantarat N, Ip M, Holden MTG, Hsu LY, Barkham T; Singapore Group B Streptococcus Consortium. 2015 Epidemic of Severe Streptococcus agalactiae Sequence Type 283 Infections in Singapore Associated With the Consumption of Raw Freshwater Fish: A Detailed Analysis of Clinical, Epidemiological, and Bacterial Sequencing Data. Clin Infect Dis. 2017 May 15;64(suppl_2):S145-S152. doi: 10.1093/cid/cix021.
7. CDC. Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019. DOI: http://dx.doi.org/10.15620/cdc:82532.
8.  Prevention of Group B Streptococcal Early-Onset Disease in Newborns. Pediatrics. 2019 Aug;144(2):e20191882. doi: 10.1542/peds.2019-1882.
9. Sati H, Carrara E, Savoldi A, Hansen P, Garlasco J, Campagnaro E, Boccia S, Castillo-Polo JA, Magrini E, Garcia-Vello P, Wool E, Gigante V, Duffy E, Cassini A, Huttner B, Pardo PR, Naghavi M, Mirzayev F, Zignol M, Cameron A, Tacconelli E; WHO Bacterial Priority Pathogens List Advisory Group. The WHO Bacterial Priority Pathogens List 2024: a prioritisation study to guide research, development, and public health strategies against antimicrobial resistance. Lancet Infect Dis. 2025 Apr 11:S1473-3099(25)00118-5. doi: 10.1016/S1473-3099(25)00118-5.

July 6, recognised as World Zoonoses Day, commemorates the historic achievement of Louis Pasteur, who administered the first successful rabies vaccine in 1885. While this milestone marks a triumph in medical science, the real significance of zoonotic diseases reaches far beyond. Zoonoses—diseases transmitted between animals and humans—are not isolated events. They are shaped by the way we interact with animals, ecosystems, and each other. This day invites us not only to reflect on past victories but also to examine the deeper drivers, consequences, and inequities associated with the emergence of zoonotic diseases.

What Makes a Disease Zoonotic?

A zoonosis is any infectious disease that can be naturally transmitted between vertebrate animals and humans, caused by a wide range of pathogens: viruses (e.g., SARS-CoV-2, Ebola, CCHF, Avian Influenza), bacteria (e.g., Salmonella enterica, Brucella spp., Bacillus anthracis), parasites (Toxoplasma spp., Trichinella spp.), fungi (Cryptococcus neoformans, Aspergillus spp.), and even prions (Bovine Spongiform Encephalopathy (BSE) also known as mad cow disease). Some zoonoses, like rabies or anthrax, are well-known and deadly. Others, like Hepatitis E, are underestimated but globally widespread. According to the WHO, over 60% of known human pathogens are zoonotic, and 75% of emerging infectious diseases have an animal origin. HIV itself was once zoonotic—before adapting to human-to-human transmission.

Transmission Routes and Everyday Risks

Zoonotic pathogens reach humans through various channels:

• Direct contact with animal secretions, blood, or excreta
• Indirect contact with contaminated surfaces (e.g., barns, soil, cages)
• Vector-borne transmission via mosquitoes, ticks, or fleas
• Foodborne infections via undercooked meat, raw dairy, or unwashed produce
• Waterborne transmission from contaminated water supplies

Even domestic animals can serve as silent reservoirs for zoonotic pathogens. Companion animals such as cats and dogs have been linked to the transmission of Toxoplasma gondii, Giardia lamblia, and Bartonella henselae. On a broader scale, wildlife markets, hunting practices, bushmeat consumption, and the exotic animal trade—especially involving primates, rodents, or bats—create high-risk interfaces for zoonotic spillovers.

Environmental Disruption and the Rise of Spillovers

Spillover—when a pathogen jumps from an animal host to a human—is not a rare anomaly, but a predictable outcome of ecological disruption. Zoonoses are not random accidents; they are symptoms of a planet under pressure. Deforestation, climate change, industrial livestock farming, and the wildlife trade are major contributors. A 2020 UNEP report linked increased zoonotic pandemics to the anthropogenic (human-caused) destruction of ecosystems and the rise in global meat demand. Encroachment into wild habitats and reduced biodiversity create new interfaces for disease transmission, especially in tropical regions where species are forced to coexist unnaturally due to ecological stress.

The problem is escalating: spillover events have tripled since the 1980s, and up to 850,000 unknown viruses in birds and mammals could theoretically infect humans. These risks are no longer hypothetical—they are ecological feedback loops, exposing deep flaws in global food systems, land use policies, and trade patterns.

Beyond Biology: Inequities and Invisible Burdens

Zoonotic diseases disproportionately affect low- and middle-income countries, where veterinary services, diagnostics, and outbreak surveillance are limited. Within societies, smallholder farmers, migrant labourers, and women in caregiving and food roles are more exposed but underprotected. While many zoonoses originate in animal reservoirs, the social determinants of exposure, vulnerability, and care are profoundly unequal.

Veterinarians and frontline public health workers are at high occupational risk, especially in contexts with limited PPE or training. Yet their knowledge and lived experiences are often marginalised in global health policy. Tackling zoonoses means elevating local expertise, community perspectives, and culturally embedded practices—not just imposing biomedical models from above.

Zoonoses and Antimicrobial Resistance (AMR): A Dangerous Intersection

Industrial livestock farming doesn’t just drive zoonoses—it fuels antimicrobial resistance (AMR). The prophylactic use of antibiotics in animals leads to resistant pathogens that enter the human population through food, water, or direct contact. Without strict regulation, improved biosecurity, and universal access to diagnostics, the dual threat of zoonoses and AMR will only intensify. These are not separate crises—they are intersecting syndemics, demanding integrated solutions.

One Health: From Framework to Global Action

The One Health concept acknowledges that human, animal, and environmental health are inseparably linked. But turning this into action requires more than inter-ministerial coordination. It demands:

• Joint surveillance systems across sectors
• Genomic technologies to detect early spillovers
• Cross-border data sharing and transparency
• Community-led education and behaviour change
• Reforms to global trade, agriculture, and wildlife governance

And most importantly, it requires rethinking development itself—shifting from extraction to regeneration, from inequality to inclusion, from crisis response to resilience building.

Final Thought: Zoonoses Are Warnings

On World Zoonoses Day 2025, we must see zoonotic diseases not merely as biological phenomena but as biopolitical signals—indicators of unsustainable systems, eroded habitats, and neglected communities. These diseases are not emerging from nature’s cruelty, but from our failure to coexist with nature responsibly. They reveal how extractive economies, deforestation, industrial farming, and global inequality converge to create environments where pathogens can leap from animals to humans with alarming ease.

Each outbreak is more than a health crisis; it is an ecological message—urgent and unheeded. With every spillover, the Earth warns us. These warnings are not random, nor are they isolated. They are part of a pattern driven by our collective actions and inactions. The question is not only how we can prevent the next pandemic, but whether we are willing to confront and transform the systems that continue to generate them. Without shifting the underlying drivers—be it land use, wildlife exploitation, or global trade—we will remain vulnerable.

The deeper we look into zoonoses, the clearer it becomes: our health depends on the health of all living things. Protecting biodiversity, strengthening equitable health systems, and promoting One Health principles are not optional—they are essential pillars of global survival. On this day, let us recommit not only to science but also to justice, sustainability, and a renewed sense of shared responsibility with the living world.

By ISID Emerging Leader, Dr Gültekin Ünal

Select References

1. Taylor, L. H., Latham, S. M., & Woolhouse, M. E. (2001). Risk factors for human disease emergence. Philosophical Transactions of the Royal Society B: Biological Sciences, 356(1411), 983–989. https://doi.org/10.1098/rstb.2001.0888
2. World Health Organization. (2023). Zoonoses. https://www.who.int/news-room/fact-sheets/detail/zoonoses
3. Grange, Z. L., Goldstein, T., Johnson, C. K., Anthony, S., Gilardi, K., Daszak, P., ... & Mazet, J. A. K. (2021). Ranking the risk of animal-to-human spillover for newly discovered viruses. Proceedings of the National Academy of Sciences, 118(15), e2002324118. https://doi.org/10.1073/pnas.2002324118
4. Beyer, R. M., Manica, A., & Mora, C. (2021). Shifts in global bat diversity suggest a possible role of climate change in the emergence of SARS‑CoV‑1 and SARS‑CoV‑2. Science of the Total Environment, 767, Article 145413. https://doi.org/10.1016/j.scitotenv.2021.145413
5. Centers for Disease Control and Prevention. (2024). Zoonotic diseases.
6. Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES). (2020). Workshop report on biodiversity and pandemics. https://ipbes.net/pandemics
7. United Nations Environment Programme (UNEP), & International Livestock Research Institute (ILRI). (2020). Preventing the next pandemic: Zoonotic diseases and how to break the chain of transmission. https://www.unep.org/resources/report/preventing-future-zoonotic-disease-outbreaks-protecting-environment-animals-and

Every year on May 18, I take a moment not just to reflect—but to reignite a shared belief that a world free of HIV is within reach. World AIDS Vaccine Day, also known as HIV Vaccine Awareness Day, is more than a date on the calendar—it’s a global reminder of how far we’ve come, how much remains to be done, and how essential our collective commitment is. As an epidemiologist and public health advocate, I remain deeply committed to equity, innovation, and community empowerment. And today, with renewed conviction, I can say: we’re closer than ever to achieving the impossible—but the journey continues.

Why May 18 Still Matters

World AIDS Vaccine Day was inspired by a powerful call to action delivered by President Bill Clinton in 1997, urging the world to dedicate resources and energy toward developing a preventive HIV vaccine. Since then, this day has evolved into a symbol of hope and determination—for scientists, health workers, clinical trial participants, and advocates like myself. It’s not just a day of remembrance. It’s a day of action.

The Global HIV Landscape: Progress and Persistent Gaps

HIV continues to be a major public health challenge. Sub-Saharan Africa carries the greatest

burden—with countries like:

• Eswatini (27.5%)
• Lesotho (20.5%)
• Botswana (19.7%)

These rates reflect the urgent need for continued innovation and intervention. In South Africa, over 7.7 million people are living with HIV—making it the highest number globally. By contrast, countries like Cuba (0.07%) and Timor-Leste (under 0.2%) have achieved exceptionally low prevalence thanks to robust public health policies and education campaigns.

As of the end of 2023, an estimated 39.9 million people were living with HIV worldwide. While antiretroviral therapy (ART) has revolutionized treatment, turning HIV into a manageable condition, disparities remain:

• High Burden: Sub-Saharan Africa – ~3.4% prevalence among adults 15–49
• Low Burden: Middle East and North Africa – mostly under 0.1%
• Lives Lost: Over 630,000 AIDS-related deaths reported in 2023
  

Breakthroughs in HIV Vaccine Research: Hope on the Horizon

• There is reason for optimism. Scientific advances have brought new hope to the field:
• mRNA Vaccines: Building on COVID-19 success, mRNA platforms (e.g., Moderna) are now being tested for HIV—offering precision and adaptability.
• Broadly Neutralizing Antibodies (bNAbs): These powerful antibodies target multiple HIV strains and are being studied for prevention and treatment.
• Mosaic Vaccines: Designed to tackle HIV’s global diversity, these vaccines stimulate broader immune responses.
• VRC01 and AMP Trials: Though they didn’t produce a standalone vaccine, these trials gave us valuable data on antibody behavior and immune response.

Each step forward builds on years of effort—this is science in motion, not standing still.

But Let’s Be Honest—Challenges Remain

Despite progress, we’re still facing major hurdles:

• HIV’s Complexity: It mutates rapidly and exists in many strains—making vaccine design incredibly difficult.
• Funding Shortfalls: HIV doesn’t always command the same urgency or investment as newer pandemics like COVID-19.
• Stigma & Misinformation: Myths, fear, and marginalization hinder vaccine trust—especially in underserved communities.
• Access & Equity: Once a vaccine exists, will the people who need it most be the first to receive it? That depends on global cooperation and local engagement.

This Is Bigger Than Health—It’s a Justice Issue

Developing and delivering an HIV vaccine supports more than medical outcomes—it aligns with global development and human rights:

• SDG 3 – Good Health and Well-being
• SDG 10 – Reduced Inequalities
• SDG 17 – Partnerships for the Goals

Ending HIV is not only about medicine—it’s about addressing poverty, gender inequality, education gaps, and systemic injustice.

What Can We Do—Together?

• Champion Science: Support trusted institutions like AVAC, IAVI, and NIAID. Stay informed, and if you’re eligible and safe to do so—consider participating in trials.
• Build Vaccine Literacy: Talk about vaccines. Explain how they work. Tackle misinformation, especially in communities with limited access to accurate health information.
• Push for People-Centered Policies: Let’s advocate for frameworks that prioritize vulnerable populations and include them in planning and decision-making.
• Empower Young Leaders: Youth aren’t just future change-makers—they’re already leading. Let’s support school programs, youth-led campaigns, and digital literacy.
• Celebrate the Unsung Heroes: From lab researchers to community mobilizers to trial volunteers—these individuals are the heartbeat of progress. Let’s uplift them.

A Vaccine of Hope, A World of Possibility

World AIDS Vaccine Day is a powerful reminder of what can happen when science, solidarity, and humanity come together. As someone who has worked across HIV, TB, and socio-economic health systems, I believe in the dream of an HIV vaccine—not as a fantasy, but as a future we are building together. Let’s stay committed. Let’s stay informed. Let’s keep going with courage, compassion, and determination.

In Solidarity and Purpose,

ISID Emerging Leader, Nelisiwe Lynneth Mhlabane

Epidemiologist | Public Health Specialist | Implementation Advisor

Pretoria, South Africa

nellytsetse@gmail.com | +27 73725 9422

References

1. AVAC (AIDS Vaccine Advocacy Coalition): https://avac.org/
2. IAVI (International AIDS Vaccine Initiative): https://www.iavi.org/media-and-resources/iavi-report/
3. NIAID (National Institute of Allergy and Infectious Diseases): https://www.niaid.nih.gov/
4. WHO HIV Data and Statistics: https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hiv/strategic-information/hiv-data-and-statistics
5. mRNA Vaccines for HIV Study: https://www.biorxiv.org/content/10.1101/2025.01.24.634423v1
6. Broadly Neutralizing Antibodies (bNAbs) Research: https://aidsrestherapy.biomedcentral.com/articles/10.1186/s12981-017-0178-3
7. Mosaic Vaccines Study: https://www.mdpi.com/2076-393X/11/7/1143

Each year on May 5, World Hand Hygiene Day is observed globally. It is spearheaded by the World Health Organization (WHO) to highlight the vital importance of hand hygiene in preventing infections and strengthening infection prevention and control (IPC) practices.

The WHO Framework for Action 2024-2030 emphasizes the importance of universal access to safe WASH and effective waste management as essential components of quality healthcare. It calls for integrating WASH and waste considerations into all aspects of health system planning, implementation, financing, and monitoring areas that can be strengthened through infection prevention and control (IPC) initiatives.

The theme for this year, "It might be gloves. It’s always hand hygiene,” underscores the fundamental importance of hand hygiene as a key measure in protecting health, especially within healthcare environments, regardless of glove use. Hand hygiene is a crucial pillar of SDG 3—ensuring good health and well-being for all.

By promoting universal access to clean water and sanitation (SDG 6), we protect communities from infections and strengthen global health resilience.

The Science Behind Hand Hygiene

Hands are the most common vector for pathogen transmission. Numerous studies confirm that hand hygiene is the single most effective practice to reduce the spread of infections, including healthcare-associated infections (HAIs), which affect millions of patients annually and contribute to antimicrobial resistance (AMR).

Key scientific facts:

• According to estimates by the Centers for Disease Control and Prevention (CDC), approximately 80% of common infectious illnesses are spread through hand contact.
• Proper hand hygiene can reduce diarrheal diseases by up to 40% and respiratory infections by 21% in the general population. (CDC)
• Effective hand hygiene disrupts the transmission of bacteria (e.g., MRSA, E. coli), viruses (e.g., influenza, norovirus, SARS-CoV-2), and fungal pathogens.

Global Situation and Gaps

Despite its proven efficacy, hand hygiene compliance remains low, especially in low- and middle-income countries (LMICs):

• Less than 40% of healthcare workers in LMICs adhere to recommended hand hygiene practices.
• More than one-third of healthcare facilities worldwide do not have sufficient handwashing stations available at the point of care.
• Many public and private healthcare facilities lack adequate water, sanitation, and hygiene (WASH) infrastructure.
• IPC breakdowns

These gaps not only compromise patient safety but also facilitate the spread of emerging and re-emerging infectious diseases, such as COVID-19, Mpox, and multidrug-resistant pathogens.

It takes just 5 moments to change the world. Clean your hands, stop the spread of drug-resistant germs! To standardize and enhance compliance, WHO introduced the “5 Moments” approach, targeting:

1. Before touching a patient
2. Before clean/aseptic procedures
3. After body fluid exposure/risk
4. After touching a patient
5. After touching the patient’s surroundings

This framework provides a science-based, context-sensitive guide to minimize infection risk at critical points during care delivery.

Innovation and Behavioral Change

 Recent advancements in promoting hand hygiene practiced in the COVID-19 pandemic globally include:

•  Alcohol-based hand Rub (60%) formulations are recommended by WHO.
•  Sensor-based hand hygiene monitoring systems in hospitals.
•  Behavioral change prompts and Communication material, such as visual cues and leadership modeling, significantly improve hand hygiene adherence.

AI & Generation Hand Hygiene Innovations

With AI adoption across the world, the healthcare industry has accelerated, through the introduction of exciting scientific Innovations that guide how we approach hand hygiene in the healthcare system:

• AI-Powered Hygiene Monitoring smart sensors- which improves compliance and infection control with real-time feedback
• Advanced AI-driven sensor technology transforming healthcare environments.
• Sustainable, Waterless Hygiene Solutions
• With global water scarcity rising, waterless hand hygiene innovations—like biodegradable alcohol- based formulations and antimicrobial dry hand wipes
• UV-Based Hand Disinfection machines which kills bacteria and viruses
• Smart Dispensers & Internet of Things (IoT) Hygiene Compliance accessories which track sanitization rates amongst health care personnel.

• Still, health facilities lack continuous access to hand hygiene stations.
• The national IPC project is launched covering 100 private hospitals.
• Integration of hand hygiene into infection prevention and control (IPC) policies is ongoing but needs stronger enforcement and surveillance.

The Way Forward

• Policy Strengthening: National IPC guidelines should prioritize hand hygiene as a mandatory performance indicator.
• Infrastructure Investment: Ensuring continuous availability of ABHR, soap, and water at all healthcare and public facilities.
• Capacity Building: Regular IPC training and refresher courses for healthcare workers.
• Community Engagement: Public campaigns, especially in areas with maximum exposure like schools, malls, and transport hubs, to instill lifelong hand hygiene habits.
• Monitoring and Evaluation: Establish hand hygiene auditing systems at national and sub-national levels with clear benchmarks.

World Hand Hygiene Day goes beyond symbolic recognition. It serves as a call to implement evidence-based action. Clean hands save lives, reduce disease burden, and protect healthcare systems. In a world facing increasing biosecurity threats, hand hygiene remains our first line of defense. *Let’s commit together to clean care for all*