“Handwashing is one of the most effective ways to prevent the spread of COVID-19 and other infectious diseases, yet millions of people across the world lack access to a reliable, safe supply of water”, said WHO Director-General Tedros Adhanom Ghebreyesus. 

Progress made 

The Joint Monitoring Programme report, Progress on household drinking water, sanitation and hygiene 2000 – 2020, did, however, offer some good news on universal access to water, sanitation and hygiene services (or WASH for short). 

Between 2016 and 2020, it showed that access to safely managed drinking water at home, increased from 70 to 74 per cent; sanitation services went from 47 to 54 per cent; and handwashing facilities with soap and water, rose from 67 to 71 per cent. 

And rather than sewer connections, last year for the first time, more people used pit latrines, septic tanks and other improved on-site sanitation to effectively contain and treat waste.  

“Despite our impressive progress to date, to scale-up these lifesaving services, the alarming and growing needs continue to outstrip our ability to respond”, said UNICEF Executive Director Henrietta Fore. 

To maintain progress, the two UN agencies underscored the need for governments to adequately support safely managed on-site sanitation, including faecal sludge. 

The study also made clear that if current trends persist, by 2030 billions of children and families would be left without life-saving WASH services. 

It notes that still only 81 per cent of the world’s population would have access to safe drinking water at home, leaving 1.6 billion without; just 67 per cent would have safe sanitation services, leaving 2.8 billion in the lurch; and only 78 per cent would have basic handwashing facilities, leaving 1.9 billion adrift. 

“Investment in water, sanitation and hygiene must be a global priority if we are to end this pandemic and build more resilient health systems”, Tedros stressed. 

Inequalities prevail 

The report also noted vast inequalities – with vulnerable children and families suffering the most.  

At the current rate of progress, for least developed countries (LDCs) to access safely managed drinking water by 2030, the study spelled out that there would need to be a ten-fold increase. 

“Even before the pandemic, millions of children and families were suffering without clean water, safe sanitation, and a place to wash their hands”, said the UNICEF chief. “The time has come to dramatically accelerate our efforts to provide every child and family with the most basic needs for their health and well-being, including fighting off infectious diseases like COVID-19.” 

Spotlighting women 

For the first time, the report also presented emerging national data on menstrual health. 

In many countries, it showed a significant proportion of women and girls are unable to meet their menstrual health needs. 

And disparities are significant among vulnerable groups, such as the poor and those with disabilities.

WHO experts warned on Thursday that the numbers have increased for six consecutive weeks, up by 25% last week, reaching 202,000 positive cases. Deaths also rose by 15% across 38 African countries, to nearly 3,000.

Young adults hit

The Delta variant, initially identified in India, is now dominant in South Africa, which accounted for more than half of Africa´s cases last week. Moreover, the variant was detected in 97% of the samples sequenced in Uganda and 79% of those sequenced in the Democratic Republic of the Congo.

The variant also seems to be fueling illness among young adults. According to WHO experts. In Uganda for example, 66% of severe illness in people younger than 45, is attributed to Delta.

“The speed and scale of Africa’s third wave is like nothing we’ve seen before. The rampant spread of more contagious variants pushes the threat to Africa up to a whole new level. More transmission means more serious illness and more deaths, so everyone must act now and boost prevention measures to stop an emergency becoming a tragedy,” said Dr. Matshidiso Moeti, WHO´s regional director for Africa.

Alpha and Beta

The Alpha and Beta variants have been also reported in 32 and 27 countries respectively. Alpha has been detected in most countries in north, west and central Africa, while Beta is more widespread in the south. Both are considerably more transmissible than the original virus.

With rising case numbers and hospitalizations across the continent, WHO estimates that oxygen demand in Africa is now 50% greater than for the first wave peak, one year ago.

Lack of shots

Eight vaccines have been approved for the WHO emergency use listing, however, shipments to Africa have, in effect, dried up.

“While supply challenges grind on, dose sharing can help plug the gap. We are grateful for the pledges made by our international partners, but we need urgent action on allocations. Africa must not be left languishing in the throes of its worst wave yet,” added Dr. Moeti.

Only 15 million people – a mere 1.2% of the African population – are fully vaccinated.

IMF Photo/Jeff Moore

A masked man walking in London’s West End

Delta dominant in Europe ‘by August’

Meanwhile in Europe, a ten-week decline in the number of COVID-19 cases in the 53 countries that the WHO analyses, has come to an end.

The regional director for the UN health agency, Hans Kluge, informed on Thursday that last week the number of cases rose by 10%, driven by increased mixing, travel, gatherings, and easing of social restrictions.

“This is taking place in the context of a rapidly evolving situation – a new variant of concern, the Delta variant – and in a region where despite tremendous efforts by Member States, millions remain unvaccinated”, he explained.

Mr. Kluge said that the Delta variant overtakes alpha very quickly through multiple and repeated introductions and is already translating into increased hospitalizations and deaths.

“By August, the WHO European Region will be Delta dominant”, the expert underscored.

New wave of deaths

However, by August, Europe will not be sufficiently immunized, with 63% of people currently still waiting for their first jab, and the region will still be mostly loosening restrictions, with increasing travel and gatherings, Dr. Kluge warned.

“The three conditions for a new wave of excess hospitalizations and deaths before the autumn are therefore in place: new variants, (a) deficit in vaccine uptake, increased social mixing; and there will be a new wave in the WHO European Region unless we remained disciplined”, he said.

Vaccines are effective

Mr. Kluge reminded that vaccines are effective against the Delta variant: “not one dose but two doses”,

He added that delays in getting vaccinated cost lives and the economies, and the slower vaccination programmes are, the more variants will emerge.

“We see many countries doing well, but the truth is that the average vaccine coverage in the region is 24% only, and more serious, half of our elders and 40% of our health care workers are still unprotected. That’s unacceptable”, the expert said, explaining that with these figures, the pandemic is nowhere over.

“And it would be very wrong for anyone – citizens and policymakers – to assume that it is”.

Last July, UNCTAD estimated that the standstill in international tourism would cost the global economy between $1.2 trillion and $3.3 trillion. 

The steep drop in tourist arrivals worldwide in 2020 resulted in a $2.4 trillion economic hit, the report said, and a similar figure is expected this year depending on the uptake in COVID-19 vaccines. 

Global vaccination plan crucial 

“The world needs a global vaccination effort that will protect workers, mitigate adverse social effects and make strategic decisions regarding tourism, taking potential structural changes into account,” said Isabelle Durant, the UNCTAD Acting Secretary-General. 

“Tourism is a lifeline for millions, and advancing vaccination to protect communities and support tourism’s safe restart is critical to the recovery of jobs and generation of much-needed resources, especially in developing countries, many of which are highly dependent on international tourism,” the UNWTO Secretary-General Zurab Pololikashvili added. 

Developing countries hit hard 

International tourist arrivals declined by about 1 billion, or 73 per cent, last year, while in the first quarter of 2021 the drop was around 88 per cent, the report said. 

Developing countries have borne the brunt of the pandemic’s impact on tourism, with estimated reductions in arrivals of between 60 per cent and 80 per cent. 

They have also been hurt by vaccine inequity.  The agencies said the “asymmetric roll-out” of COVID-19 vaccines has magnified the economic blow to the tourism sector in these nations, as they could account for up to 60 per cent of global GDP losses. 

Rebound amid losses 

It is expected that tourism will recover faster in countries with high vaccination rates, such as France, Germany, the United Kingdom and the United States. 

However, international tourist arrivals will not return to pre-pandemic levels until 2023 or later, due to barriers such as travel restrictions, slow containment of the virus, low traveller confidence and a poor economic environment.  

While a tourism rebound is anticipated in the second half of this year, the report expects a loss of between $1.7 trillion and $2.4 trillion in 2021, based on simulations which exclude stimulation programmes and similar policies. 

Likely outcomes 

The authors outline three possible scenarios for the tourism sector this year, with the most pessimistic reflecting a 75 per cent reduction in international arrivals. 

This scenario sees a drop in global tourist receipts of nearly $950 billion, which would cause a loss in real GDP of $2.4 trillion, while the second reflects a 63 per cent reduction in international tourist arrivals. 

The third considers varying rates of domestic and regional tourism.  It assumes a 75 per cent reduction in tourism in countries where vaccine rates are low, and 37 per cent reduction in countries with relatively high vaccination levels, mainly developed countries and some smaller economies.

To regulate and govern AI, WHO published new guidance that provides six principles to limit the risks and maximize the opportunities intrinsic to AI for health. 

Governing AI 

WHO’s Ethics and governance of artificial intelligence for health report points out that AI can be and, in some wealthy countries is already being, used to improve the speed and accuracy of diagnosis and screening for diseases; assist with clinical care; strengthen health research and drug development; and support diverse public health interventions, including outbreak response and health systems management. 

AI could also empower patients to take greater control of their own health care and enable resource-poor countries to bridge health service access gaps. 

However, the report cautions against overestimating its benefits for health, especially at the expense of core investments and strategies required to achieve universal health coverage. 

Challenges abide 

WHO’s new report points out that opportunities and risks are linked and cautions about unethical collection and use of health data, biases encoded in algorithms, and risks to patient safety, cybersecurity and the environment.   

Moreover, it warns that systems trained primarily on data collected from individuals in high-income countries may not perform well for individuals in low- and middle-income settings.  

Against this backdrop, WHO upholds that AI systems must be carefully designed to reflect the diversity of socio-economic and health-care settings and be accompanied by digital skills training and community engagement. 

This is especially important for healthcare workers requiring digital literacy or retraining to contend with machines that could challenge the decision-making and autonomy of providers and patients. 

Guiding principles 

Because people must remain in control of health-care systems and medical decisions, the first guiding principle is to protect human autonomy. 

Secondly, AI designers should safeguard privacy and confidentiality by providing patients with valid informed consent through appropriate legal frameworks. 

To promote human well-being and public interest, the third principle calls for AI designers to ensure regulatory requirements for safety, accuracy and efficacy, including measures of quality control. 

As part of transparency and understanding, the fourth principle requires information to be published or documented before the AI technology is designed or deployed.  

Although AI technologies perform specific tasks, they must be used responsibly, under suitable conditions by appropriately trained people, which is the fourth principle.  

The fifth is to ensure inclusiveness and equity so that AI for health is accessible to the widest possible number of people, irrespective of age, gender, ethnicity or other characteristics protected under human rights codes. 

The final principle urges designers, developers and users to transparently assess applications during actual use to determine whether AI responds adequately and appropriately to expectations and requirements.