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

Pathogen genomic surveillance, the ability to track changes in the genetic makeup of viruses, bacteria, and other microbes has become an indispensable tool in modern public health. While high-income countries have long used this technology to detect outbreaks, trace transmission chains, and guide interventions, many low- and middle-income countries (LMICs) have struggled to adopt it due to high costs, complex technical requirements, and limited bioinformatics capacity.

Prior to COVID-19, Pakistan had no in-country genomic sequencing capacity for public health purposes. The pandemic changed everything. It was not only a wake-up call but also a catalyst for a sweeping transformation. In response to the crisis, Pakistan rapidly established its first national genomic surveillance infrastructure at the National Institute of Health (NIH) enabling real-time tracking of SARS-CoV-2 variants for the first time in our history.

This blog reflects on how genomics reshaped Pakistan’s pandemic response, how we continue using it for emerging threats like Mpox and why embedding it in national policy is essential for future epidemic preparedness.

COVID-19: The Catalyst for Genomic Self-Reliance

Before 2020, genetic sequencing in Pakistan was largely confined to research institutions, with limited use in public health. The Virology Department at NIH had basic Sanger sequencing capacity, but this older technology lacked the throughput and speed needed for real-time surveillance of evolving pathogens. In many cases, clinical samples had to be shipped abroad causing delays, incurring costs, and raising biosecurity concerns.

The COVID-19 pandemic exposed this gap dramatically.

Recognizing the urgent need, NIH with technical support from the U.S. Centers for Disease Control and Prevention (CDC) established Pakistan’s first Next-Generation Sequencing (NGS) facility for public health in May 2020. I was fortunate to be part of the capacity-building journey, receiving training and helping operationalize this breakthrough.

The impact was immediate. In June 2020, the newly operational NGS facility detected the D614G mutation, an early indication of variant-driven transmission during Pakistan’s first COVID-19 wave. By the time the Alpha variant (B.1.1.7) emerged, our capacity had matured. Although national case numbers were declining, our sequencing data showed a sharp rise in Alpha cases. This early warning, reported to the National Command and Operation Centre (NCOC), allowed Pakistan to anticipate rather than simply react to the pandemic’s third wave.

This marked a turning point: for the first time, genomic evidence was shaping national policy in real time.

4. Bridging science and policy: Our scientific community must learn to translate genomic data into actionable public health intelligence. Sustainability will depend not just on technology, but on the ability to influence decisions and protect lives.

The Way Forward: Institutionalizing Genomic Surveillance

We now stand at a crossroads.

Pakistan must evolve its pandemic-driven investments into permanent public health assets. This includes:

• Establishing a national pathogen genomics framework
• Investing in infrastructure, workforce development, and bioinformatics
• Integrating genomics with One Health, antimicrobial resistance (AMR), and disease elimination programs
• Leveraging platforms like IPSN, WHO Technical Working Groups, and South-South collaboration

“Pakistan’s pandemic investments must now evolve into a permanent public health asset.”

Conclusion: From Pandemic to Preparedness

Pakistan’s journey from zero capacity to regional leadership in genomic surveillance is nothing short of remarkable. But the work is far from over.

Genomics is not just a laboratory tool, it is a core public health strategy. As threats evolve, so must our systems. By embedding genomics into national health security and policy reform, Pakistan can ensure it is not only ready for the next pandemic, but also better equipped to protect its people from ongoing threats.

The path from crisis to capacity has been challenging—but it has shown us what’s possible when science, leadership, and collective urgency converge to build resilient public health systems.

By ISID Emerging Leader, Dr. Massab Umair

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.

New research suggests that getting your booster shot in the same arm as your first jab could help your immune system gear up faster and stronger. This simple trick could speed up protection, especially during outbreaks of fast-changing viruses like COVID-19.

Why does the arm matter?
When you get a vaccine, immune cells take the viral or bacterial antigens to the closest lymph nodes - those little immune command centers near the injection site. There, memory B cells hang out, ready to spring into action if they see the pathogen again.

The research discovered that certain immune cells such as macrophages get “primed” after the first shot and help rally the memory B cells when a booster arrives - but only if it’s in the same place ⁽¹⁾.

In a human trial, 30 volunteers got the Pfizer COVID-19 vaccine booster—20 in the same arm, and 10 in the opposite arm ⁽²⁾. Guess what? Those who stuck to the same arm produced protective antibodies faster - within just one week after the booster!

Faster antibodies = faster protection
The antibodies from the “same-arm” group were not only quicker but also better at tackling variants like Delta and Omicron. While the difference faded by week four, that early immune boost could be a game changer during outbreaks.

What’s next?
If scientists can harness this local immune magic, future vaccines might need fewer boosters—saving time, doses, and hassle.

So next time you get a jab, remember: The same arm might just be your immune system’s favourite sidekick!

References

1. Dhenni R, Hoppé AC, Reynaldi A, Kyaw W, Handoko NT, Grootveld AK, et al. Macrophages direct location-dependent recall of B cell memory to vaccination. Cell [Internet]. 2025 Apr 29 [cited 2025 Jun 3]; Available from: https://www.sciencedirect.com/science/article/pii/S0092867425004076
2. Left arm, or right? The simple choice that might influence your response to vaccines [Internet]. [cited 2025 Jun 14]. Available from: https://www.gavi.org/vaccineswork/de-left-arm-or-right-simple-choice-might-influence-your-response-vaccines

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

Scientific breakthroughs in pathogen genomics can transform public health responses—if policymakers understand and act on them. The COVID-19 pandemic demonstrated this potential on an unprecedented scale. More than 16.8 million SARS-CoV-2 genome sequences have been submitted to GISAID—far exceeding the total submissions for all pathogens combined from 2000 to 2019 in both GISAID and NCBI. The genomics expertise and facilities developed during the pandemic are now being leveraged for the surveillance of other pathogens, strengthening public health preparedness. The key challenge now is: how can we effectively translate such complex data into compelling evidence that drives policy decisions?

Having briefed national policymakers in Pakistan during critical outbreaks, including COVID-19 and Mpox, I have learned that the impact of genomic surveillance depends not just on data generation but also on how well it is communicated. This article explores key strategies to bridge the gap between genomics and decision-making, ensuring that scientific evidence informs timely and effective public health interventions.

Know Your Audience

One of the biggest mistakes scientists make when communicating genomic data is neglecting their audience. Policymakers, often from non-technical backgrounds, may struggle to grasp the complexities of pathogen genomics. Early in the COVID-19 pandemic, I made this mistake while briefing Pakistan’s National Command and Operation Center (NCOC), where key decision-makers included a planning minister and a military general—both unfamiliar with genomic data. Even the Special Assistant to the Prime Minister on Health, an infectious disease expert, found genomics to be uncharted territory. My key takeaway? Always tailor your message to your audience. Before presenting, take time to understand their background—whether they are non-specialists or technical experts with decision-making authority. This simple step can make your insights far more impactful.

Avoid Jargon and Simplify Complex Information

Another common mistake scientists make is using excessive jargon—technical terms that can confuse non-experts. In pathogen genomics, a simple example is replacing the word mutation with change to make the concept more accessible. I learned this lesson when, during an NCOC briefing, a member interrupted me and asked me to simplify my message. I had been using SARS-CoV-2 lineage names (such as B.1.1.7 instead of Alpha variant), which meant little to my audience. Once I switched to commonly recognized names like Alpha, Beta, and Omicron, the discussion became far more engaging. Pathogen genomics offers powerful insights, but if the message isn’t clear, it risks being misunderstood—or worse, ignored. Clarity and simplicity don’t dilute science; they make it actionable.

Connect Data to Policy Actions

To maximize the impact of genomic surveillance, scientists must clearly link genomic findings to policy decisions such as travel restrictions, vaccine rollouts, and public health messaging. An example from Pakistan underscores this point. In February 2021, COVID-19 case numbers were declining after the second wave. However, our genomic data at the National Institute of Health (NIH) showed that the Alpha variant (then known as the UK variant) was increasing exponentially. We reported this trend to the NCOC in a timely manner. The result? Almost one and a half months later, the third wave began, driven by the Alpha variant. Sharing our genomic data early gave policymakers time to prepare for a possible new wave of infections.

This experience was a turning point, as it demonstrated to policymakers the importance of genomic surveillance. At NIH, we successfully used SARS-CoV-2 genomic surveillance data to detect the emergence and spread of the Delta variant before the fourth wave and Omicron and its subvariants before the fifth and sixth waves. By consistently providing timely genomic insights, we strengthened national preparedness and response efforts, ensuring that scientific evidence informed public health decisions.

Be Clear and Confident in Your Recommendations

Policymakers need clear, actionable insights—not uncertainty. Most of the time, they seek straightforward solutions—a yes or no response to critical questions. Using confident language helps instill trust in scientific findings. Instead of saying "The data suggests...," use "The data shows..." when evidence is strong.

I saw the importance of clear communication when the World Health Organization (WHO) declared Mpox a Public Health Emergency of International Concern (PHEIC) in July 2022. The declaration caused significant anxiety among health authorities in Pakistan. Misinformation and fear led to unnecessary measures, such as screening passengers at airports and collecting respiratory swabs—neither of which were appropriate for Mpox (lesion swabs are recommended). Our virology department at NIH received an influx of improper samples, leading to wasted resources and confusion.

Recognizing this issue, I provided a concise briefing to clarify key differences between Mpox and SARS-CoV-2. I explained that unlike SARS-CoV-2, which spreads primarily through respiratory transmission, Mpox is mainly transmitted through direct contact with infected individuals. I also emphasized the genetic distinction between the two viruses—Mpox, being a DNA virus, mutates far less frequently than the RNA-based SARS-CoV-2. Moreover, I provided clear guidance on patient selection, emphasizing the need to test only those with characteristic skin lesions rather than asymptomatic individuals. I also outlined proper sample collection techniques, highlighting that lesion swabs—not respiratory samples—are essential for accurate diagnosis. Additionally, I explained the recommended laboratory diagnostic methods, including real-time PCR for detecting Mpox virus DNA, ensuring that health authorities understood the best approach for reliable case confirmation. This short yet targeted intervention had a significant impact. It not only alleviated fear but also corrected the response strategy, ensuring that valuable resources were directed toward appropriate diagnostic and containment measures.

Use Visuals to Enhance Understanding

Policymakers process visual information much faster than raw data, making clear and intuitive visuals essential for effective communication. Instead of overwhelming them with intricate genetic details, use simplified figures, graphs, and infographics that highlight key findings in a clear and actionable way.

I experienced this firsthand while briefing Pakistan’s National Command and Operation Center (NCOC) during the COVID-19 pandemic. I initially presented a figure showcasing specific mutations detected through PCR to identify the Alpha variant. However, the technical nature of the figure—featuring genetic targets and mutation sites—proved challenging for non-scientific decision-makers to interpret. Midway through my presentation, the NCOC chairman interrupted and said, "This is too technical—just tell us what it means for our response."

Recognizing this, I later adopted a more visual approach, presenting a straightforward trendline that showed the Alpha variant's rise over time and its correlation with case surges. This shift in presentation made the data immediately understandable, allowing policymakers to grasp the significance of genomic surveillance in real time.

The lesson? A well-designed visual does more than simplify complexity—it transforms genomic insights into clear, actionable intelligence, ensuring that scientific evidence effectively informs public health responses.

Conclusion

Effectively communicating pathogen genomics to policymakers is essential for ensuring that genomic surveillance translates into meaningful public health actions. By tailoring messages to the audience, simplifying technical language, using confident and actionable recommendations, and leveraging clear visuals, scientists can bridge the gap between genomic data and policy decisions. The ultimate goal is to make genomics a cornerstone of public health strategy, ensuring that scientific advancements lead to timely interventions that save lives.

By ISID Emerging Leader, Dr. Massab Umair

The author is a virologist and public health expert with a focus on disease surveillance and health systems strengthening (massab.umair@yahoo.com).

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

Rotavirus - A Major Culprit: The discovery of rotavirus in 1973 filled a significant diagnostic gap in childhood diarrhea, revealing it as the cause of 40–50% of severe acute diarrhea cases in young children worldwide ⁽¹⁾. It most commonly affects those between 6 and 24 months old, with nearly every child experiencing at least one infection by the age of five ⁽²⁾. In 2016 alone, rotavirus was responsible for an estimated 128,500 deaths and over 258 million episodes of diarrhea in children under five, with 90% of global diarrheal deaths occurring in sub-Saharan Africa ⁽³⁾.

A Shot at Prevention - The Global Rollout of Rotavirus Vaccines

The introduction of rotavirus vaccines has been a significant milestone in reducing diarrheal morbidity and mortality. As of now, 123 countries have incorporated the rotavirus vaccine into their national immunization programs, leading to a global reduction of approximately 40% diarrheal admissions among children ⁽⁴⁾.

Challenges with oral rotavirus vaccines:  Despite the progress in rotavirus vaccination, several challenges hinder its widespread impact. By the end of 2023, rotavirus vaccines had achieved approximately 55% global coverage, yet nearly 40% of countries in sub-Saharan Africa had not adopted the vaccine, highlighting significant regional disparities in access ⁽⁵⁾. These vaccines have shown higher efficacy in high-income countries, while their impact in low-income nations, where the disease burden is greatest, is still substantial. Passive transfer of maternal rotavirus antibodies, co-administration with oral polio vaccine, malnutrition, environmental enteropathy, and HIV are major factors compromising rotavirus vaccine efficacy in low-income settings ^(6,7).

Ongoing efforts to Tackle Diarrheal Diseases: To improve the efficacy of oral rotavirus vaccines, ongoing research is exploring alternate dosing schedules, such as neonatal administration and booster doses, as well as micro supplementation with zinc and probiotics ⁽⁷⁾. Injectable rotavirus vaccines also hold promise, as they may overcome the challenges associated with the lower effectiveness of oral vaccines in low-income settings. Combination vaccines targeting multiple pathogens, such as rotavirus and norovirus, are also in the pipeline, aiming to provide broader protection. These innovations, alongside improved water, sanitation, and hygiene (WASH) programs, offer hope for significantly lowering the global burden of diarrheal diseases, particularly in low-resource settings where they remain a major threat to child health.

With each vaccine dose, we move closer to a future where no child suffers or loses their life to preventable diarrheal diseases.

By ISID Emerging Leader, Dr. Tintu Varghese, MD, DTM&H

References

1. Bishop R. Discovery of rotavirus: Implications for child health. J Gastroenterol Hepatol. 2009 Oct;24 Suppl 3:S81-85.
2. Parashar UD, Hummelman EG, Bresee JS, Miller MA, Glass RI. Global Illness and Deaths Caused by Rotavirus Disease in Children. Emerg Infect Dis. 2003 May;9(5):565–72.
3. Troeger C, Khalil IA, Rao PC, Cao S, Blacker BF, Ahmed T, et al. Rotavirus Vaccination and the Global Burden of Rotavirus Diarrhea Among Children Younger Than 5 Years. JAMA Pediatr. 2018 Oct 1;172(10):958.
4. Aliabadi N, Antoni S, Mwenda JM, Weldegebriel G, Biey JNM, Cheikh D, et al. Global Impact of Rotavirus Vaccine Introduction on Rotavirus Hospitalisations Among Children Under 5 Years of Age, 2008–16: Findings from the Global Rotavirus Surveillance Network. Lancet Glob Health. 2019 Jul;7(7):e893–903.
5. Burnett E, Parashar UD, Tate JE. Global impact of rotavirus vaccination on diarrhea hospitalizations and deaths among children <5 years old: 2006–2019. J Infect Dis. 2020 Oct 13;222(10):1731–9.
6. Velasquez DE, Parashar U, Jiang B. Decreased performance of live attenuated, oral rotavirus vaccines in low-income settings: causes and contributing factors. Expert Review of Vaccines. 2018 Feb 1;17(2):145–61.
7. Steele AD, Victor JC, Carey ME, Tate JE, Atherly DE, Pecenka C, et al. Experiences with rotavirus vaccines: can we improve rotavirus vaccine impact in developing countries? Hum Vaccin Immunother. 2019 Feb 8;15(6):1215–27.

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*

The launch of the National Zero Measles-Rubella (MR) Elimination Campaign 2025-26 during World Immunization Week is a pivotal moment in India’s public health journey ². The campaign targets 100% immunization coverage by administering two doses of the MR vaccine to every child, ensuring no child is left behind and promoting both individual and community health.

Milestones to Celebrate: Significant Progress So Far

By early 2025, 332 districts reported zero Measles cases and 487 districts reported zero Rubella cases between January and March, highlighting the success of vaccination efforts and progress toward elimination ².

Powerful Tools Driving Success: Key Government Initiatives ¹

• Mission Indradhanush (2014): Targets children missed by the UIP with focused vaccination drives in low-coverage areas.
• Intensified Mission Indradhanush (IMI): Accelerates vaccination in high-priority districts and urban slums with mobile vans and real-time monitoring.
• eVIN (Electronic Vaccine Intelligence Network) : Tracks vaccine stocks and prevents wastage, ensuring safe storage and delivery.

The Roadmap to Eliminate Measles and Rubella: India’s Strategic Plan

India’s MR elimination strategy includes:

1. Immunization Coverage: Achieving 95% vaccine coverage in every district. As of the 2024-25 Health Management Information System (HMIS) data, the country has achieved a 93.7% coverage for the first dose and 92.2% for the second dose². This marks a significant achievement but also highlights the remaining gaps to achieve complete coverage.
2. Enhanced Surveillance: A robust surveillance system is essential for detecting any outbreaks early and responding quickly. India’s efforts to strengthen surveillance mechanisms will ensure that no case goes undetected, facilitating a swift public health response when necessary
3. Outbreak Preparedness: Preparing for potential outbreaks is another key strategy. India’s experience with Polio and Maternal and Neonatal Tetanus elimination provides valuable insights into how coordinated efforts and quick responses can prevent widespread outbreaks and protect vulnerable populations.
4. Demand Generation: Addressing vaccine hesitancy remains a critical challenge. India is conducting focused mass awareness campaigns to dispel myths, provide accurate information about the MR vaccine, and build community trust.
5. Inclusive Participation: The success of the MR elimination campaign relies on the collective efforts of all stakeholders, from health professionals and local government officials to community leaders and frontline workers. By working with local authorities and engaging in community-based awareness programs, India is ensuring that vaccination efforts reach even the most marginalized populations.

India’s comprehensive approach to Measles and Rubella elimination sets a strong foundation for achieving complete eradication by 2026, ensuring a healthier future for its children.

By ISID Emerging Leader, Dr. Tintu Varghese, MD, DTM&H

References

1. National Health Mission. (n.d.). Data on immunization and health initiatives. National Health Mission, Ministry of Health and Family Welfare, Government of India. Retrieved April 28, 2025, from https://nhm.gov.in/index1.php?lang=1&level=2&sublinkid=824&lid=220
2. Press Information Bureau. (2025, April 24). Union Health Minister launches National Zero Measles-Rubella Elimination Campaign on World Immunization Week. Ministry of Health and Family Welfare, Government of India. Retrieved April 28, 2025, from https://pib.gov.in/PressReleasePage.aspx?PRID=2124032

When COVID-19 first hit Pakistan in early 2020, the nation stood at a crossroads. With a fragmented healthcare system and governance challenges stemming from the 18^th Amendment, which devolved health responsibilities to the provinces, a coordinated response seemed nearly impossible. Yet, against all odds, Pakistan emerged as one of the few countries that managed to navigate the crisis with remarkable efficiency. The secret weapon? The National Command and Operation Center.

As the nerve center of Pakistan’s pandemic response, the NCOC became a beacon of centralized decision-making and data-driven governance. It transformed what could have been a chaotic, disjointed effort into a streamlined and effective national strategy. And now, as Pakistan grapples with a looming threat in the form of Mpox (formerly monkeypox), the NCOC’s legacy continues to shape the country's response.

A Blueprint for Crisis Management

When COVID-19 struck, developed nations with robust healthcare infrastructures faltered. Pakistan, despite its resource limitations, took a different approach: it established a unified command. Using constitutional provisions to bypass bureaucratic bottlenecks, the federal government created the NCOC in April 2020. This body did what few expected—it brought all provinces, health agencies, and security forces onto the same page.

Led by the Minister of Planning and Development, with military leadership providing operational expertise, the NCOC crafted policies that balanced public health and economic stability. Unlike blanket lockdowns that paralyzed many economies worldwide, Pakistan introduced smart lockdowns—a targeted strategy that restricted only high-risk areas. This approach not only curbed the virus’s spread but also kept businesses afloat, mitigating economic devastation.

The NCOC’s achievements were staggering. COVID-19 testing capacity skyrocketed from just four laboratories to over 170 nationwide. Daily testing rose from 500 to an impressive 65,000. The “Test, Trace, and Quarantine” strategy helped contain outbreaks, while aggressive vaccination campaigns, backed by real-time data analysis, ensured effective immunization coverage. One of the hallmarks of the NCOC during the COVID-19 pandemic was its ability to make quick

decisions. I remember advocating for genomic surveillance and the need to strengthen next- generation sequencing (NGS) facilities at NIH. Given the high costs of NGS technology, securing funding seemed unlikely. However, to my surprise, the proposal was swiftly approved by the Special Assistant to the Prime Minister (SAPM) on Health—who, being an infectious disease expert, recognized its critical importance. With these funds, NIH was able to report variants and their spread in real time to the NCOC, significantly aiding data-driven decision-making. Additionally, the NCOC played a key role in shaping public behavior through strategic communication. Initially, many citizens underestimated COVID-19’s severity, but by mid-2020, the NCOC’s multi-platform messaging—through media campaigns and mobile phone alerts— helped drive compliance with mask-wearing and social distancing. By the time the NCOC wound down operations in April 2022, it had successfully steered Pakistan through six waves of the pandemic.

NCOC 2.0: Taking on Mpox

While many saw the NCOC’s closure as the end of an era, its operational framework proved too valuable to retire completely. In 2024, as Mpox cases surfaced worldwide, Pakistan was quick to react. The NCOC was reactivated (this time led by National Institute of Health (NIH), leveraging its pandemic-tested model to preempt a full-blown crisis.

Despite initial WHO recommendations against screening travelers at entry points, Pakistan took a proactive stance. Border Health Services, under NCOC directives, implemented early screenings, leading to the timely detection of imported Mpox cases. Public health laboratories across the country, in collaboration with the NIH, ramped up diagnostic capacities, while the polio environmental surveillance network was repurposed to track Mpox outbreaks. These measures allowed Pakistan to detect and contain 14 cases as of March 2025—before the virus could spiral into an uncontrollable epidemic.

Genomic surveillance, another NCOC hallmark, has played a crucial role in tracking Mpox mutations. Scientists at NIH have successfully sequenced and identified imported viral strains, helping public health officials anticipate transmission patterns. Meanwhile, isolation protocols and containment strategies, similar to those deployed during COVID-19, are ensuring that Pakistan stays ahead of the curve.

Lessons for the World

Pakistan’s handling of COVID-19 and now Mpox underscores an invaluable lesson: centralized coordination works. The NCOC model—grounded in data, rapid decision-making, and inter- agency collaboration—has proven that even countries with limited resources can effectively manage global health crises.

While international recognition has poured in, with WHO commending Pakistan’s pandemic response, the real victory lies in the blueprint it offers for future public health emergencies. Whether it’s a resurgence of COVID-19, another viral outbreak, or an unforeseen health crisis, Pakistan now possesses a tested and scalable mechanism to respond.

As global health threats continue to evolve, perhaps it’s time for other nations to take a page from Pakistan’s playbook. The NCOC didn’t just help Pakistan survive a pandemic—it set a precedent for how nations can turn adversity into opportunity through strategic, science-backed governance.

Dr. Massab Umair Presenting Genomic Surveillance Data on SARS-CoV-2 at NCOC: Informing Pakistan’s Pandemic Response.

By ISID Emerging Leader, Dr. Massab Umair

The author is a virologist and public health expert with a focus on disease surveillance and health systems strengthening (massab.umair@yahoo.com).

Embracing Digital Transformation in Health

Pakistan has taken bold strides toward digitalizing its health infrastructure, recognizing technology's transformative potential in improving service delivery, continuity of care, and patient safety. Furthering these efforts, the country piloted Electronic Medical Records (EMR) and a one-patient-one-ID system in the Islamabad Capital Territory (ICT), setting a foundation for nationwide integration.

Looking ahead, Pakistan envisions a digitally integrated healthcare system that includes the nationwide rollout of Electronic Medical Records (EMR) to digitize health records and streamline information management. Implementing a "One Patient, One ID" model is expected to enhance care continuity and reduce fragmentation across various health system levels. Also, establishing hospital bed registries and structured referral systems will improve coordination between primary and tertiary care facilities. Ensuring the availability of essential diagnostics and medicines at the point of care remains a top priority to enhance service delivery and meet patients' needs efficiently.

Reinventing Primary Health Care

Pakistan firmly believes that primary health care is the cornerstone of UHC. Strengthening PHC supports routine services and acts as a first line of defense in maternal and child health, disease surveillance, and emergency preparedness. To realize this vision, Pakistan has developed a contextualized Essential Package of Health Services (EPHS) that is being rolled out at the community level, primarily through its vast Lady Health Workers (LHWs) Program. Lady Health Workers Program: is a Community-Based Backbone launched in 1994; the LHWP has grown into one of the most extensive community-based health programs in the world. With approximately 90,000 LHWs, they deliver services to around 115 million women and children, serving as key links between communities and health systems, providing Family planning and contraceptive use education, Antenatal, natal, and postnatal care. Nutrition and hygiene promotion, Immunization support (including polio, malaria, TB, and routine under-five immunization), Disease prevention, and public health awareness.

To support their role in delivering EPHS, the LHW curriculum has been revised to align with UHC goals, and regular training modules are implemented to ensure updated knowledge and practices. Counseling cards cover 22 family care practices from conception to 8 years of age, emphasizing men's involvement in child development and care.

Tackling the Nutrition Crisis

Nutrition remains a significant public health challenge in Pakistan. An estimated 3% of GDP is lost annually due to malnutrition. Nearly half of Pakistan's children and mothers suffer from undernutrition, impeding human development and progress toward the Sustainable Development Goals (SDGs).

Pakistan has initiated a comprehensive package of nutrition interventions:

• Multiple Micronutrient Supplementation (MMS) integrated into antenatal care
• Fortification of staple foods
• Wheat flour with iron and folic acid
• Edible oils with vitamins A and D
• Vitamin A supplementation campaigns for children aged 6–59 months
• Promotion of Infant and Young Child Feeding (IYCF) practices
• Community-Based Management of Acute Malnutrition (CMAM)
• Strengthening nutrition data through integration into the District Health Information System (DHIS)

Strengthening Governance and Policy Frameworks

Digital transformation and efforts to achieve Universal Health Coverage (UHC) require strong policies and safeguards to ensure long-term success and equity. In this regard, Pakistan is actively working toward establishing comprehensive national and provincial digital health policies that foster innovation and uphold essential principles such as data privacy, ethical standards, and the protection of health workers' rights. These policies aim to guarantee equitable access to health services across all segments of society, including marginalized and vulnerable populations. Simultaneously, the government is focusing on coordinating health investments across federal and provincial levels, expanding healthcare coverage to underserved and remote areas, and building resilient health infrastructure capable of effectively responding to emergencies and outbreaks.

The Path Forward: A Collective Commitment

On World Health Day 2025, Pakistan reaffirms its commitment to building a future where health systems are proactive, prepared, and centered around the needs of people. The country envisions a healthcare landscape where technology is a powerful enabler, empowering healthcare providers and recipients to deliver and access more efficient, informed, and equitable care. Strengthening primary health care remains at the core of this vision, serving as the frontline defense against disease, health disparities, and public health threats. Pakistan is determined to ensure that every citizen—regardless of geography, income, or background—has access to safe, high-quality, and affordable healthcare, leaving no one behind in pursuing health and well-being.

Our Commitment to Health and Equity

Let us move forward with a shared resolve to #Empower communities #Embrace innovation #Strengthen health systems #Protect every health worker and citizen.

Stay healthy. Stay empowered. Let's build a digitally advanced, community-centered, and healthier Pakistan together.

Acknowledgement: Author would like to acknowledge the support received from Director General Health.

By ISID Emerging Leader, Dr. Nadia Noreen

Author is a medical graduate, Public Health specialist, and Epidemiologist with focus on international health regulations, global health security disease surveillance, and health systems strengthening.

For years, global efforts to reduce childhood undernutrition have focused on the idea that “what you are is what you eat.” This approach has led to initiatives like promoting exclusive breastfeeding and improving sanitation and hygiene, backed by organizations like the World Health Organization (WHO). However, despite these efforts, the rates of childhood undernutrition worldwide have not dropped as expected^[1]. This shows that we need new, innovative ways to strengthen existing programs and better support children’s health.

One major reason why childhood undernutrition remains a problem is due to enteric infections—infections that affect the intestines. Diarrhoea is one of the most common consequences of enteric infections, and it often leads to a cycle where children lose nutrients, feel less hungry, and cannot absorb nutrients properly, resulting in malnutrition^[2]. In areas with poor sanitation and hygiene, children are also exposed to harmful microbes, which can cause a condition called environmental enteric dysfunction. This condition, which can be acquired as early as 12 weeks of age, damages the intestines, making it harder for children to digest and absorb nutrients^[3].

Gut Health: The key to prevention

To prevent both enteric infections and undernutrition, we need to keep the intestines healthy. Interestingly, scientists are now looking at how probiotics (beneficial bacteria) and prebiotics (compounds that feed beneficial bacteria) can play a role in improving gut health and preventing infections. Probiotics are live microorganisms, often bacteria, that, when consumed in adequate amounts, can have a positive effect on health. Prebiotics, usually types of fibre, act as food for these good bacteria. Synbiotics combine both probiotics and prebiotics to support gut health.

In high-income countries, probiotics have been used for years to treat and prevent various childhood conditions, like diarrhoea and premature birth complications^[4]. These beneficial bacteria work by improving the gut microbiota—the community of microbes living in our intestines. When we consume probiotics, they help increase the number of good bacteria, which compete with harmful pathogens for space in the gut. They also help digest food and produce acids that fight off bad bacteria, boost the growth of healthy intestinal cells, and support the immune system.

The future of gut health in fighting undernutrition

Most research so far on probiotics has focused on children who are already sick or older children. However, there is a growing interest in using probiotics from early childhood to help build a stronger, healthier gut from the start. Early studies, particularly in sub-Saharan Africa, are exploring whether giving probiotics to infants can improve their growth, development, and overall health. These studies suggest that the health of our intestines is just as important as the food we eat when it comes to fighting undernutrition^[5].

In short, for children to fully process and utilize the nutrients in the food they eat, their intestines must always be strong and healthy. By improving gut health through probiotics, we could help children grow stronger, fight infections more effectively, and ultimately reduce the rates of childhood undernutrition.

By ISID Emerging Leaders, Benjamin Kadia and Tintu Varghese

References

1. Scott N, Delport D, Hainsworth S, Pearson R, Morgan C, Huang S, et al. Ending malnutrition in all its forms requires scaling up proven nutrition interventions and much more: a 129-country analysis. BMC Med. 2020;18(1):356.
2. Rodriguez L, Cervantes E, Ortiz R. Malnutrition and gastrointestinal and respiratory infections in children: a public health problem. Int J Environ Res Public Health. 2011;8(4):1174-205.
3. Naylor C, Lu M, Haque R, Mondal D, Buonomo E, Nayak U, et al. Environmental Enteropathy, Oral Vaccine Failure and Growth Faltering in Infants in Bangladesh. EBioMedicine. 2015;2(11):1759-66.
4. Alcon-Giner C. Microbiota Supplementation with Bifidobacterium and Lactobacillus Modifies the Preterm Infant Gut Microbiota and Metabolome: An Observational Study. Cell Reports Medicine 2020.
5. Momo Kadia B, Otiti MI, Ramsteijn AS, Sow D, Faye B, Heffernan C, et al. Modulating the early-life gut microbiota using pro-, pre-, and synbiotics to improve gut health, child development, and growth. Nutr Rev. 2023.

Despite having one of the world’s most extensive surveillance networks and a history of rigorous vaccination campaigns, Pakistan’s polio resurgence raises pressing concerns. Experts point to several key factors behind this resurgence:

1. Low Routine Immunization Coverage: Shockingly, more than half of polio cases in 2024 occurred in children who had never received a single routine vaccine. Another 14% of cases were in children over five years old, indicating a significant immunity gap. While mass immunization campaigns have been effective in reaching millions, they cannot fully replace robust routine immunization programs.
2. Vaccine Hesitancy and Misinformation: Misinformation surrounding polio vaccines continues to fuel resistance, particularly in Balochistan and KP. Conspiracy theories spread through social media, distrust in health authorities, and religious misconceptions have led many parents to refuse vaccination for their children, leaving entire communities vulnerable.
3. Conflict and Accessibility Challenges: Certain areas, particularly in Balochistan and KP, remain hard to reach due to insecurity, militancy, and geographical barriers. Vaccination teams often face hostility, and in some cases, life-threatening violence. Without improved access to these high-risk areas, polio will continue to thrive in these pockets of vulnerability.
4. Cross-Border Transmission: Genomic sequencing of WPV1 cases in Pakistan has revealed strong links to poliovirus strains circulating in Afghanistan. The frequent movement of people between the two countries, combined with uncoordinated immunization efforts, has allowed the virus to persist and spread.

A Call to Action

Polio eradication in Pakistan requires an urgent, multi-faceted approach. Routine immunization must be prioritized alongside supplementary vaccination campaigns. Health authorities must counter vaccine hesitancy through community engagement, involving religious leaders and local influencers to combat misinformation. Insecurity issues need immediate government intervention to protect frontline workers. Furthermore, Pakistan and Afghanistan must synchronize vaccination efforts to cut off cross-border transmission routes.Pakistan has proven before that progress against polio is possible, but the current resurgence demands immediate, decisive action. Without it, the country risks not only prolonging its own polio crisis but also jeopardizing global eradication goals. The world is watching—will Pakistan rise to the challenge?

The Sudan strain of Ebola, responsible for the current outbreak, is particularly concerning due to the absence of an approved vaccine. Unlike the Zaire strain, for which vaccines exist, the Sudan strain necessitates alternative containment strategies. In response, Ugandan health authorities have initiated a clinical trial for a vaccine targeting this specific strain. Developed by the International AIDS Vaccine Initiative (IAVI), the trial is being conducted by the Makerere Lung Institute, which has received approximately 2,460 doses. The primary focus is on vaccinating contacts of confirmed cases to curb further transmission [2].

The risk of Ebola spreading in Uganda is exacerbated by several factors. Kampala, the capital city, is densely populated and serves as a major travel hub, increasing the likelihood of rapid virus transmission. The mobility of the city's 4 million residents poses significant challenges for contact tracing and containment efforts. Health officials have identified 44 contacts associated with the deceased nurse, including 30 health workers, highlighting the critical need for effective monitoring and intervention strategies [3].

Key Drivers of the Outbreak

• Delays in Seeking Medical Care – Fear, stigma, and lack of awareness led many infected individuals to avoid seeking timely medical attention, allowing the virus to spread within communities.
• Traditional Burial Practices – Cultural rituals involving direct contact with the deceased significantly contributed to the transmission of the virus.
• Mistrust in Health Authorities – Some community members were skeptical of government interventions, leading to reluctance in following containment measures such as quarantine and contact tracing.
• Mobility and Trade Routes – High population movement, particularly along trade corridors, facilitated the spread of the virus beyond the initial outbreak areas.
• Healthcare Worker Exposure – Inadequate personal protective equipment (PPE) and delayed case detection led to nosocomial transmission among healthcare workers, increasing the outbreak's severity.

These findings highlight the urgent need for community engagement, improved surveillance, and culturally sensitive public health interventions to mitigate the spread of Ebola and enhance outbreak response efforts.

Conclusion

The current Ebola outbreak in Uganda underscores the critical importance of swift and coordinated public health responses. While the initiation of vaccine trials offers hope, the absence of an approved vaccine for the Sudan strain necessitates reliance on traditional containment measures, including contact tracing, community engagement, and strict adherence to infection prevention protocols.

In your opinion, how can addressing the root causes of transmission, particularly delays in seeking care, traditional burial practices, and mistrust in health authorities be mitigated to prevent the spread of this current outbreak?

By ISID Scientific Manager, Aisha Abubakar

References

1. Associated Press. Uganda nurse dies of Ebola, first fatal case in two years [Internet]. 2025 [cited 2025 Feb 4]. Available from: https://apnews.com/article/762d73117fda1220f9907ad54295f1ef
2. Reuters. Ebola vaccination trial launched in Uganda, WHO says [Internet]. 2025 [cited 2025 Feb 4]. Available from: https://www.reuters.com/business/healthcare-pharmaceuticals/ebola-vaccination-trial-launched-uganda-who-says-2025-02-03/
3. Associated Press. Uganda health workers exposed to Ebola after nurse’s death [Internet]. 2025 [cited 2025 Feb 4]. Available from: https://apnews.com/article/fc33af48307c911c7771db825c159333
4. Ssali M, et al. Transmission dynamics of the 2022 Ebola outbreak in Uganda: a mathematical modeling approach. J Infect Dis [Internet]. 2023 [cited 2025 Feb 4];228(5):678–85. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11413514/
5. Chowell G, Hengartner NW, Castillo-Chavez C, Fenimore PW, Hyman JM. The basic reproductive number of Ebola and the effects of public health measures: the cases of Congo and Uganda. J Theor Biol [Internet]. 2005 [cited 2025 Feb 4];229(1):119-26. Available from: https://arxiv.org/abs/q-bio/0503006
6. Nanyonjo A, et al. Perceived drivers of Ebola outbreak in Uganda’s Mubende and Kassanda districts: insights from a qualitative study. BMJ Public Health [Internet]. 2023 [cited 2025 Feb 4];2(2):e001267. Available from: https://bmjpublichealth.bmj.com/content/2/2/e001267  
7. Kupferschmidt K. Uganda’s Ebola outbreak underscores need for Sudan strain vaccine. Nature [Internet]. 2022 [cited 2025 Feb 4]. Available from: https://www.nature.com/articles/d41586-022-03192-8
8. Gostin LO, Hodge JG. The global response to Ebola in Uganda: legal and ethical challenges. BMJ Glob Health [Internet]. 2022 [cited 2025 Feb 4];7(12):e010982. Available from: https://gh.bmj.com/content/7/12/e010982
9. Bell BP, Damon IK, Jernigan DB, Nichol ST. Overview, control strategies, and lessons learned in past Ebola outbreaks. N Engl J Med [Internet]. 2020 [cited 2025 Feb 4];382(4):393-403. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6831630/
10. Bausch DG, Towner JS, Dowell SF, Kaducu F, Lukwiya M, Nichol ST, et al. Assessment of the risk of human-to-human transmission of Ebola virus in healthcare settings. J Travel Med [Internet]. 2024 [cited 2025 Feb 4];31(5):taae079. Available from: https://academic.oup.com/jtm/article/31/5/taae079/7691187

Antimicrobial Resistance (AMR) has been identified as a global health and developmental challenge. The Global Research on Antimicrobial Resistance (GRAM) project findings for 2019 estimated 4.95 million deaths due to drug-resistant bacterial infection, with a higher burden on low-resource settings (1). 

The 79th United Nations General Assembly (UNGA) High-Level Meeting on AMR was held in September 2024, and global leaders committed to reducing the AMR death rate annually by 10% (2). While new drug development can be challenging, various new drugs show promising antibacterial activity. However, access to these drugs is still predominantly only in high-income countries. While it is important that Low- and middle-income countries (LMIC) also have access to these antibiotics, there is the dilemma of managing access without excess use of antibiotics (3).

Understanding the socio-economic drivers of AMR, such as gender, living conditions, access to healthcare and climate change, can help develop sustainable interventions for mitigating AMR (4). These social determinants of health intersect and interact with one another to shape an individual’s societal experiences. Such interactions can be better understood by adopting an intersectional lens. Understanding the experiences of AMR from individuals differently impacted by AMR due to these social determinants of health contributes to building culture-sensitive and responsible interventions against AMR (5).

LMICs also face challenges around access to clean water, sanitation, and health (WASH), which contributes to their high infectious disease burden. This issue is more prominent in the rural areas and marginalized populations, including women and girls, of these countries (6). Women and girls also have inadequate access to healthcare. They are more exposed to drug-resistant infections due to their role in food production, caregiving, and water collection and a higher rate of sexual violence. Women also constitute 70% of the healthcare workforce, which contributes to their exposure to drug-resistant infections (7).

In LMICs like India, the caste system poses a challenge to ensuring equitable access to healthcare. The caste system represents a hierarchy of social roles that hold inherent characteristics. The status attached to one’s caste has been passed down over the generations, changing it from a social role to a hereditary role (8). People who belong to the lower castes, such as Dalits, are limited to occupations such as domestic laborers, scavengers, and sweepers and have lower access to education and healthcare in addition to facing social discrimination in society (9). In many other parts of the world, race also affects health-seeking and health-providing behaviors. These social constructs can also influence their access to education and income levels.

The use of intersectional research in health care is gaining momentum now. Intersectional research can be conducted by using various qualitative, quantitative, and mixed methods, amongst which qualitative methods like ethnography are the most common. When conducting such studies, researchers must know how their biases, shaped by their social constructs, can influence their research work. Although it may not be possible to eliminate such biases, cultivating this self-awareness enables researchers to consciously avoid letting personal judgments distort their findings. In the Wellcome Trust funded the PROTEA study that we are currently undertaking, which investigates the intersection of socio-economic and cultural drivers on AMR and its health-seeking and health-providing behaviors, potential researcher biases will be addressed through reflexivity, methodological and analytical triangulation, and working closely with research participants and collaborators (10).

It is also important that these cultural drivers are considered in AMR policies. In a review of National Actional Plans, it was found that there is little to no recognition of addressing the cultural drivers of health-seeking and health-providing behaviors (11). It is important that AMR interventions include an intersectional approach and are contextually fit and culturally sensitive. Multisectoral collaboration is also key in tackling AMR. Healthcare professionals, researchers, community members, activists, policymakers, environmentalists, veterinarians, climate change experts should join hands to develop interventions against AMR from a One Health perspective.

By ISID Emerging Leader, Vrinda Nampoothiri

References

1. Global Research on Antimicrobial Resistance. Global burden of bacterial AMR. https://www.tropicalmedicine.ox.ac.uk/gram/research/global-burden-of-bacterial antimicrobial-resistance
2. World leaders commit to decisive action on antimicrobial resistance. https://www.unep.org/news-and-stories/press-release/world-leaders-commit-decisive-action-antimicrobial-resistance
3. Patel TS, Sati H, Lessa FC, Patel PK, Srinivasan A, Hicks LA, et al. Defining access without excess: expanding appropriate use of antibiotics targeting multidrug-resistant organisms. The Lancet Microbe. 2024 Jan 1;5(1):e93–8.
4. Anderson M, Ljungqvist G, van Kessel R, Saint V, Mossialos E. The socioeconomic drivers and impacts of Antimicrobial Resistance: Implications for policy and research. Copenhagen: European Observatory on Health Systems and Policies, WHO Regional Office for Europe; 2024
5. Charani E, Mendelson M, Ashiru-Oredope D, Hutchinson E, Kaur M, McKee M, et al. Navigating sociocultural disparities in relation to infection and antibiotic resistance-the need for an intersectional approach. JAC Antimicrob Resist. 2021 Oct 1;3(4):dlab123. doi: 10.1093/jacamr/dlab123.
6. Biswas S, Adhikary M, Alam A, Islam N, Roy R. Disparities in access to water, sanitation, and hygiene (WASH) services and the status of SDG-6 implementation across districts and states in India. Heliyon. 2024 Sep 30;10(18):e37646.
7. WHO releases guidance on gender inequalities and antimicrobial resistance. https://www.who.int/news/item/16-09-2024-who-releases-guidance-on-gender-inequalities-and-antimicrobial-resistance
8. Sankaran S, Sekerdej M, von Hecker U. The Role of Indian Caste Identity and Caste Inconsistent Norms on Status Representation. Front Psychol. 2017 Mar 31;8:487. doi: 10.3389/fpsyg.2017.00487. PMID: 28408896; PMCID: PMC5374864.
9. Thapa R, Teijlingen E van, Regmi PR, Heaslip V. Caste Exclusion and Health Discrimination in South Asia: A Systematic Review. Asia-Pacific Journal of Public Health. 2021 May 24;33(8):828.
10. Charani E, Dlamini S, Koch A, Singh S, Hodes R, Laxminarayan R, et al. Power Relations in Optimisation of Therapies and Equity in Access to Antibiotics (PROTEA) Study: investigating the intersection of socio-economic and cultural drivers on antimicrobial resistance (AMR) and its influence on healthcare access and health-providing behaviours in India and South Africa. Wellcome Open Res. 2024 Jul 24;9:400.
11. Charani E, Mendelson M, Pallett SJC, Ahmad R, Mpundu M, Mbamalu O, et al. An analysis of existing national action plans for antimicrobial resistance-gaps and opportunities in strategies optimising antibiotic use in human populations. Lancet Glob Health. 2023 Mar;11(3):e466-e474. doi: 10.1016/S2214-109X(23)00019-0.

On the 3rd of November 2024, the One Health Day was celebrated globally. This reminds us that the intersection of health, climate, and resistance demands cohesive, global action, a goal achievable only through a shared commitment to our interconnected world.

Climate overshoot is a reality, carrying significant ecological, health, and socioeconomic consequences. While “climate change” encompasses a range of long-term shifts in temperature, weather patterns, and atmospheric conditions largely driven by human activities, “climate overshoot” refers to temporary but severe breaches of temperature limits that may prompt irreversible environmental damage.

Countries agreed to pursue efforts to limit global warming to below 1.5 - 2°C at the 2015 Paris Climate Agreement. According to the Climate Overshoot Commission, “climate overshoot” refers to crossing the 1.5 °C threshold. One of the less discussed aspects of climate overshoot is its impact on health systems, particularly with respect to antimicrobial resistance. Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi, and parasites adapt and become resistant to medications that successfully treat these infections, is a global public health emergency. Climate change and AMR are linked through several mechanisms.

• Agricultural Pressures: Climate impacts on agriculture, such as altered rainfall patterns and drought, may drive a higher reliance on antibiotics to prevent infections in stressed animals, intensifying antibiotic use and resistance. In regions with weak regulatory oversight, this can lead to unchecked AMR spread, impacting local and global health.
• Changing Ecosystems and Disease Vectors: Rising temperatures can broaden the habitat of disease-causing organisms and their carriers, such as ticks and mosquitoes, leading to increased disease exposure. For example, warmer climates can expand the range of vector-borne diseases (such as malaria or dengue), increase respiratory illnesses due to pollution and wildfires, and lead to waterborne disease outbreaks after floods. This expansion of infectious diseases could increase antibiotic usage, consequently hastening the development of antibiotic resistance.
• Human Migration and Overcrowding: Climate overshoot may trigger human migration and displacement due to extreme weather events or sea-level rise, leading to overcrowded living conditions and increased risk of infection. A high population density often coincides with increased antimicrobial use and poor sanitation, both facilitating the spread of AMR.

It is clear that human health is intricately tied to the health of animals and the environment, and the links between climate change, AMR, and health outcomes are undeniable. Ongoing global health initiatives recognise the need for integrated solutions. The Paris Agreement focuses on reducing emissions to maintain global temperatures below critical thresholds. Although primarily aimed at climate mitigation, the agreement also supports climate adaptation strategies to help buffer health systems against the consequences of overshoot scenarios, including AMR. The WHO’s Global Action Plan on AMR highlights a One Health

approach, stressing collaboration across the human, animal, and environmental health sectors. This plan acknowledges that climatic factors play a role in the spread of AMR, particularly in agriculture and other ecosystems. The One Health High-Level Expert Panel (OHHLEP) emphasises the importance of integrated approaches in addressing AMR and climate health impacts. OHHLEP helps governments align climate and AMR strategies by advocating for the One Health approach, fostering health resilience across sectors.

The impact of climate overshoot on AMR highlights the need for unified action. It is important that we need to reinforce policies that bridge health, environment, and

Agriculture by:

• Reducing Antibiotic Pollution: Strengthening regulations regarding antibiotic use in agriculture and promoting clean water access can protect the environment from antibiotic residues, thus slowing the spread of AMR.
• Supporting Sustainable Agriculture: Climate-resilient crops and livestock practices help to reduce the need for antibiotics. Investing in climate-smart agriculture can mitigate climate impact and limit AMR.
• Investing in Climate-Resilient Health Systems: This refers to building health healthcare systems equipped to handle the increased disease burden and health challenges triggered by climate overshoot. Climate changes can lead to increased occurrence of outbreaks. There is a need to deploy improved health data monitoring systems, especially genomic epidemiology for infectious diseases, improve access to healthcare services and institute community-driven preventive strategies (vaccination, health promotion).

Climate change, health, resistant infections, and antimicrobial use are all entwined within our ecosystem. By investing in sustainable climate-smart healthcare practices, One Health policy, and eco-friendly practices in agriculture, we can truly state that we are committed to a future where the health of people, animals, and the planet is protected for generations to come.

Written by ISID Emerging Leader, Abiodun Egwuenu

References

1. IPCC. (2023). Climate Change 2023: Synthesis Report Summary for Policymakers.
2.  World Health Organization. (2015). Global Action Plan on Antimicrobial Resistance.
3. Murray, C. J., Ikuta, K. S., Sharara, F., Swetschinski, L., Aguilar, G. R., Gray, A., & Han, C. (2022). Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis. The Lancet, 399(10325), 629-655.
4. United Nations. (2015). Paris Agreement.

Meningitis is a deadly and debilitating infectious disease that can be caused by bacteria, viruses, fungi, and parasites. Meningitis affects people of all ages across the globe, but mainly young children. The disease causes an inflammation of the membranes that envelop the brain and spinal cord (meninges), and the symptoms start quickly. Although meningitis can be caused by several microbes, bacterial meningitis is the most dangerous form of the disease. Most bacterial meningitis cases are caused by four pathogens: Neisseria meningitidis (meningococcus), Haemophilus influenzae, Streptococcus pneumoniae (pneumococcus) and Streptococcus agalactiae (Group B Streptococcus, GBS). It is estimated that 1 in 6 people who get bacterial meningitis will die and 1 in 5 people who survive will have long-lasting disabilities like deafness, epilepsy, paralysis, and cognitive impairment. In 2019, bacterial meningitis accounted for 16.3 million disability-adjusted life years (DALYs) and low- and middle-income countries (LMIC) were the most affected regions (>95%). Thus, populations with low socioeconomic status are more likely to die from meningitis or suffer from its long-lasting disabilities.

Although meningitis is considered a global health problem, the highest burden of the disease is found in LMIC, especially the “meningitis belt” of sub-Saharan Africa. The meningitis belt encompasses 26 countries and is known for the high frequency of severe meningitis epidemics reported in the region. Meningitis epidemics have also been reported in other regions, including Latin America and Asia, and demand huge financial resources from the healthcare system to afford patients’ treatment, rehabilitation regimens, and other required control and prevention measures. Considering the economic and social scenario of LMIC, meningitis reinforces and amplifies the inequity that already exists in these countries and highlights the lack of access to health care systems experienced by vulnerable populations.

Safe and effective vaccines to prevent meningitis caused by N. meningitis, H. influenzae, and S. pneumoniae are available, and vaccines against GBS are in advanced development. The meningitis vaccines already available have been successful in decreasing the disease burden, as demonstrated by the eradication of epidemics by Meningococcus serogroup A in the meningitis belt and the reduction in the global meningitis burden due to the implementation of vaccines against H. influenzae type b (Hib) and pneumococcal conjugate vaccines (PCV). These vaccines confer protection not only to the vaccinated people but to the entire population (herd effect) and impact other infectious diseases caused by these pathogens, like pneumonia and sepsis. However, the vaccines against pneumococcus and meningococcus prevent the major but not all serotypes and serogroups able to cause meningitis, and they were not implemented by all LMIC – greatest gaps are observed in middle-income countries. 

Additionally, the reduction rate on the meningitis burden (2000-2019 – meningitis deaths reduced by 39%) was lower than the reduction observed for other vaccine-

preventable diseases (2000-2019 – deaths due to tetanus and measles reduced by 77% and 86%, respectively).

In 2021, the World Health Organization (WHO) together with partners (governments, global health organizations, academia, private sector, among others),

launched a global roadmap to defeat meningitis as a public health threat - DEFEATING MENINGITIS BY 2030 - A GLOBAL ROAD MAP. The roadmap focuses on the four major agents of bacterial meningitis and is based on three visionary goals: to eliminate bacterial meningitis epidemics, reduce cases of vaccine-preventable bacterial meningitis by 50% and deaths by 70%, and reduce disability and improve the quality of life after meningitis due to any cause. These goals will be achieved by integrated actions organized in five pillars, which are prevention and epidemic control, diagnosis and treatment, disease surveillance, care and support, and advocacy and engagement. The global road map is already in course, and it is expected that the achievement of the visionary goals will avert 2,750,000 meningitis cases and 920 000 deaths by 2030. In addition, the global road map will have an impact on reducing the burden of other serious infectious diseases (pneumonia, sepsis), tackling antimicrobial resistance spread, and reducing health-care costs and social inequalities.

The WHO and its partners have taken the lead in the fight against meningitis, but the civil society is also an important ally in this war. It is critical to raise awareness of meningitis and its health and socioeconomic impacts among the global population. The World Meningitis Day, celebrated on October 5th, is a unique moment in the year dedicated to uniting people across the world to fight against meningitis and help save lives. This global movement started in 2009 by a community of people affected by meningitis and is supported by the Confederation of Meningitis Organisations (CoMO) and the Meningitis Research Foundation. The World Meningitis Day involves an active campaign via a dedicated website and social media to share people’s previous experience with meningitis and inform the population across the globe about how to prevent and defeat the disease. Everyone can take action in the campaign and help raise awareness of meningitis by either telling their own story, using the social media toolkit, contacting local politicians, or making a donation. The path towards a world free of meningitis is challenging, but with united action from all sectors (global health organizations, private sector, governments, civil society, academia), we can achieve this ultimate goal and make a lasting impact on global health.

Written by ISID Emerging Leader Laura Oliveira

References

Investing to defeat meningitis and beyond – World Health Organization (WHO)

Defeating meningitis by 2030: a global road map – World Health Organization (WHO)

Introducing World Meningitis Day: 5th October – Meningitis Research Foundation

Under the theme "All for Health, Health for All” WHO convened this year's World Health Assembly (WHA) covering a wide range of topics, including universal health coverage, influenza preparedness, reducing public health risks from live wild animal markets, and the impact of climate change and pollution on health. 

An agreement on a package of critical amendments to the International Health Regulation (IHR) was passed as critical actions are needed to ensure that comprehensive, robust systems are in place to protect the health and safety of all people from the risk of future outbreaks and pandemics.

The new amendments to the IHR included: a) Introducing a definition of a pandemic emergency, b) A commitment to solidarity and equity on strengthening access to medical products and financing, c) Creation of National IHR Authorities to improve coordination of implementation of the Regulations within and among countries.

Other resolutions during this WHA included: a) Recognizing climate change as an imminent threat to global health and emphasizing the urgent need for collective action to protect both human health and the planet;  b) Accelerating national and global responses to AMR, within a One Health approach to address the causes and consequences of AMR for the health of people, animals and the environment; c) A new Global action plan and monitoring framework for infection prevention and control (IPC) for 2024–2030.

Let us know what you think regarding these global initiatives as different challenges and pitfalls may arise.

Official WHO site: 

https://www.who.int/about/accountability/governance/world-health-assembly/seventy-seventh

Resources:

1. https://www.nature.com/articles/d41586-024-01256-5
2. https://www.nature.com/articles/d41586-024-01036-1
3. https://www.paho.org/en/topics/avian-influenza

In six African countries, DRC (Nigeria, Liberia, Sierra Leone, Cote d’Ivoire, and Cameroon), 59 human infections were recorded between 1970 and 19808. From 1980 to 1986, over 400 cases were reported in Central and West Africa, all found in tropical rainforest locations. However, between 1972 and 1981, the instances in Congo where mpox was first reported vastly outnumbered those reported from any other country, increasing significantly from 1982 to 19847. Most recorded cases of mpox in Africa are said to have been transmitted by animals, which include rodents and less through human–human transmission. The possibility of transmission through the respiratory or mucocutaneos and inoculation or percutaneous routes or both were recorded.

The first case of Mpox in Nigeria was recorded in 1971. Until the outbreak in 1996, the most common mode of virus transmission was contact with small animals in the rainforest. A study of etiology and the sequencing of genomes; however, revealed several cases of human–human transmission in Nigeria. Human mpox cases have been recorded in 11 African countries: the DRC, Benin, the Central African Republic, Cameroon, Nigeria, the Republic of Congo, Ivory Coast, Liberia, Sierra Leone, Gabon, and South Sudan. The first incidence of the MPXV outside of Africa was during an epidemic in the United States in 2003, which was traced back to imported West African rodents. Mpox infection cases in the United Kingdom in 2018 and 2019, Israel in 2019, and Singapore in 2019 were all traced back to travelers from Nigeria.

The most severe virus outbreak in West Africa occurred in Nigeria between September and November 2017. Data collected in 2017 showed that 88 cases were confirmed, and since then, Nigeria has been reporting new cases of mpox. From its re-emergence in September 2017 to August 2018, the South-South region reported the highest number of cases. Nigeria recorded 262 suspected and 113 confirmed cases in 26 states and seven deaths in 16 states. Eight to 49 human mpox cases were recorded annually between 2019 and 2021. In the mpox outbreak, the subject matter experts for mpox at treatment centers raised the possibility of sexual transmission of mpox. Nigeria had its lowest number of reported cases in 2020 since the outbreak in 2017, with only eight recorded cases. In the spring of 2022, the disease outbreak was detected in people outside the African Continent instead of sporadic cases from travelers from endemic areas in Africa for the first time in a multi-country outbreak.

Since December 2023, there has been another outbreak of mpox in the Democratic Republic of the Congo. Tthere has been a large increase in the number of mpox cases reported in the Democratic Republic of the Congo (DRC). Since 2023 and as of 29 March 2024, DRC reported a total of 18 922 suspected mpox cases including 1,007 deaths. In 2024, and as of March 29, 4 488 cases have been reported, of which 319 have been confirmed. A total of 279 deaths have been reported in the country in 2024 (CFR: 6.7%). Mpox cases have been reported in 23 of 26 provinces of the DRC.

Currently, WHO considers the following risks for the population accordingly:

• For the general population in countries newly affected in 2022-23 or not affected mpox risk is assessed as low.
• For the general population in countries with historical mpox transmission and their neighboring countries mpox risk is assessed as moderate.
• The overall global risk for men who have sex with men and sex workers is assessed as moderate.

In March 2024, WHO published the “Surveillance, case investigation and contact tracing for mpox ‎‎(monkeypox)‎: Interim guidance”, including a new chapter on mpox reinfection, providing case definitions for suspected, probable and confirmed reinfection; also adapting more considerations relevant to endemic contexts in the African region.

With the current outbreak in the DRC, do you foresee any risk of a global spread of mpox in the near future? What measures do you suggest should be put in place to curb the outbreak in the DRC?

Resources:

1. https://www.who.int/publications/i/item/WHO-MPX-Surveillance-2024.1
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10406091/
3. https://www.ecdc.europa.eu/en/news-events/outbreak-mpox-caused-monkeypox-virus-clade-i-democratic-republic-congo