Correspondence
Governance of health standing body including heads of state Non-communicable
and other global leaders.3 Heads of
emergencies state already dealing with enormously
diseases in Afghanistan:
There have been many analyses complex responsibilities are not a silent tsunami
of the COVID-19 pandemic but likely to fully engage outside times of
little discussion of the governance emergency, and the council might also Afghanistan is experiencing an
failures, especially the need for overlap with the work of a heads of untypical humanitarian crisis resulting
cross-government, multisectoral government CoP of the new treaty. from a chronic 40-year conflict and
engagement, and leadership by heads The UN’s Secretary-General has political upheavals. This crisis has led
of state and governments at both proposed an emergency platform, to a rapid economic collapse, inflation,
national and global levels. which would not be a standing drastic rises in poverty, hunger, and
Governance is already being discussed body but a set of protocols triggered risk of malnutrition.1 Afghanistan is
within the health context. WHO automatically by a crisis of sufficient suffering from the double burden of
member states are engaged in two scale and magnitude—for example a communicable and non-communi
historic negotiations of international pandemic.4 The UN’s Secretary-General cable diseases. Outbreaks of many
treaties: a new pandemic convention, would convene leaders from countries, communicable diseases such as acute
agreement, or other instrument the UN system, international financial watery diarrhoea, measles, dengue
(WHO CA+)1 and the revision of the institutions, and subject experts fever, pertussis, and Crimean–Congo
International Health Regulations.2 The including civil society, industry, and haemorrhagic fever in addition to
WHO CA+ would establish a Conference research bodies. We strongly support COVID-19 have worsened the situation.
of the Parties (CoP) comprising heads this approach as the best means to Non-communicable diseases (NCDs)
of government to oversee the treaty’s bring the world together to act at account for almost 50% of mortality in
implementation. As the treaty is the time when a global coordinated the country with a transition towards
likely to be adopted under Article 19 response to a pandemic is needed the a heavier burden by 2030. If these
of the WHO constitution, only states most. diseases are not addressed by context-
that have ratified the treaty would be We declare no competing interests. We write as the based interventions, they will cause
members of the CoP. The International Panel for a Global Public Health Convention. more than 70% of years lived with
Health Regulations revision under Barbara Stocking, Lawrence Gostin, disability in a country with a population
Article 21 is expected to have near Jane Halton, Jorge Saavedra, of 48 million by 2030 and more than
universal membership. Patricia Garcia, Ricardo Baptiste Leite, 60% of mortality mainly among
Although all countries must be Jemilah Mahmood, Winnie Mpanju, women by 2030.2
included in governance to ensure Angel Gurria, *Elil Renganathan NCDs are a neglected issue in the
worldwide coordination, only countries elil@[Link] Afghanistan humanitarian context.
that have ratified a convention can Panel for a Global Public Health Convention, Sunway NCD services are mostly only available
be members of the CoP and oversee University, Bandar Sunway 47500, Malaysia at the tertiary-care level and through
the treaty itself. We propose two 1 WHO. The world together: establishment of an the private sector, which makes
intergovernmental negotiating body to
separate committees: one committee strengthen pandemic prevention,
accessing the services challenging for
comprising only the CoP with other preparedness, and response. Dec 1, 2021. patients. Given that services for NCDs
countries acting as observers, and a [Link] are expensive, these services, including
WHASSA2/SSA2(5)-[Link] (accessed
second committee with representatives May 18, 2023). medicines, might not be available in
of all countries supported by a common 2 WHO. Strengthening WHO preparedness for those facilities that should provide
and response to health emergencies.
secretariat for both committees and a May 27, 2022. [Link]
them at the public primary health-care
common chair. Furthermore, there has pdf_files/WHA75/A75(9)-[Link] (accessed level. A national assessment on the
to be coherence and complementarity May 18, 2023). provision and use of essential health
3 Sirleaf E, Clark H. Losing time: end this
between the new convention and pandemic and secure the future. 2021. https:// services in 2022 showed that NCDs
the revised International Health [Link]/wp-content/ were the most disrupted services and an
uploads/2021/11/COVID-19-Losing-Time_
Regulations, with compliance measures [Link] (accessed April 27, 2023).
unmet need of the Afghan population
that cover both. 4 UN. Our common agenda policy brief 2: during the COVID-19 pandemic.
Solutions have been proposed for strengthening the international response to This study showed that people need
complex global shocks–an emergency
multisectoral global governance. platform. 2023. [Link] diagnostic tests and medication for the
The Independent Panel on Pandemic [Link]/files/our-common-agenda-policy- treatment of chronic diseases.3 Submissions should be
[Link] (accessed made via our electronic
Preparedness and Response proposed April 27, 2023).
Afghanistan’s health system is submission system at
a Global Health Threats Council estab highly dependent on financial donors. [Link]
lished by the UN General Assembly as a To provide NCD management as thelancet/
[Link] Vol 401 June 17, 2023 2035
Correspondence
routine health care to the Afghan 3 Neyazi N, Lindan C, Perdes S, Ibrahimi AG, to produce a well-distributed cohort
Horemans D, Al Afsoor D. The provision and
population, the Ministry of Public utilization of essential health services in
of literature. Similarly, countries
Health has designed the Integrated Afghanistan during COVID-19 pandemic. responsible for high emissions need
Package of Essential Health Services, Front Public Health 2023; 10: 1097680. to be made accountable to support
4 Safi N, Singh LS, Naseri S, Anwari P.
which is an integration of two existing An alternative model for health service delivery nations affected by the consequences
packages, the Basic Package of Health in Afghanistan. Lancet 2021; 398: 1481–82. of their emissions. Otherwise, climate
Services and the Essential Package of 5 Bausch FJ, Beran D, Hering H, et al. Operational change will remain a predator–prey
considerations for the management of non-
Hospital Services.4 However, the new communicable diseases in humanitarian relationship with some countries
package has never been implemented emergencies. Confl Health 2021; 15: 9. benefiting at the cost of others.
due to high costs and because NCDs We declare no competing interests.
have not been the priority for donors
*Muhammad Abbas Abid,
and many humanitarian actors in the Climate change justice Muhammad Bilal Abid
country.
To control this silent tsunami in
goes beyond authorship [Link]@[Link]
Afghanistan, humanitarian actors equity Department of Pathology & Laboratory Medicine,
The Aga Khan University, Karachi 74800, Pakistan
should integrate NCD care into their (MAA); Division of Hematology and Oncology and
activities and allocate specific budgets Mehr Muhammad Adeel Riaz and Division of Infectious Diseases, BMT and Cellular
Therapy Program, Department of Medicine, Medical
for harmonising and enhancing NCD colleagues commented on the poor College of Wisconsin, Milwaukee, WI, USA (MBA)
management in humanitarian crises. global authorship equity in the 2022 1 Riaz MMA, Wangari MC, Mugambi JK.
The key points to be considered report of The Lancet Countdown on No climate change justice in lieu of global
are training of health workers on health and climate change.1 This letter authorship equity. Lancet 2023; 401: 1074.
2 Climate Trade. Climate Change News. Which
the identification of NCDs, access not only describes the inequity in countries are the world’s biggest carbon
to treatment, continuity of care reporting but also enlightens the need polluters? [Link]
countries-are-the-worlds-biggest-carbon-
through the referral pathways, patient to dissect climate change in detail to polluters/ (accessed April 7, 2023).
self-management and education, truly understand cause and effect. 3 MIT Technology Review. Climate Change.
health promotion, and community The countries responsible for the These three charts show who is most to blame
for climate change. [Link]
engagement. This approach has been highest carbon emissions are China, [Link]/2022/11/18/1063443/
developed by WHO in the Package of the USA, India, Russia, Japan, Germany, responsible-climate-change-charts/ (accessed
April 7, 2023).
Essential Non-Communicable Diseases Iran, South Korea, Saudi Arabia, and
4 Klingelhöfer D, Müller R, Braun M, Brüggmann D,
that can be piloted and implemented Indonesia.2 The first five countries in Groneberg DA. Climate change: does
in Afghanistan. Only a collaborative the list, along with the EU, account for international research fulfill global demands and
necessities? Environ Sci Eur 2020; 32: 137.
approach by all actors will address 70% of total global carbon emissions.3 5 Concern Worldwide. 10 of the countries most
the needs of people affected by NCDs The countries that published the most affected by climate change. [Link]
during this humanitarian crisis.5 scientific articles on climate change [Link]/news/countries-most-affected-
by-climate-change (accessed April 7, 2023).
We declare no competing interests. are the USA, the UK, China, Australia,
Germany, Canada, France, Netherlands,
*Narges Neyazi,
Ali Mohammad Mosadeghrad, Spain, and India.4 One cannot help but Essential role of staff
notice the overlap between the two
Alaa AbouZeid
lists. None of the top ten countries
development in
neyazinarges@[Link]
Health System Development Department (NN) and
most affected by climate change are addressing structural
Health Emergencies Department (AA), World Health on the list. These countries include racism
Organization, Kabul 1001, Afghanistan; School of Afghanistan, Bangladesh, Chad,
Public Health, Tehran University of Medical Sciences, Haiti, Kenya, Malawi, Niger, Pakistan, After the recent Comment 1 by
Tehran, Iran (AMM); Department of Public Health,
Faculty of Medicine, Cairo University, Cairo, Egypt Somalia, and Sudan;5 their contribution Saleem Razack and Thirusha Naidu, we
(AA) to the global emissions is miniscule yet thought it essential to emphasise the
1 UN Office for the Coordination of they face the harshest consequences. importance of faculty development. As
Humanitarian Affairs. Afghanistan Hence, there is more literature on medical educators, we must role-model
humanitarian needs overview 2023.
Jan 23, 2023. [Link] cause and little on effects of climate the behaviours and attitudes we expect
afghanistan/afghanistan-humanitarian- change, with a sharp demographic of our students, including the critical
needs-overview-2023-january-2023 (accessed
March 28, 2023). contrast. It is the obligation of high- consciousness mentioned, but also an
2 Neyazi N, Mosadeghrad AM, Tajvar M, Safi N. income countries to take the lead awareness of structural racism and its
Trend analysis of non-communicable diseases in building capacity and developing effects on students, patients, and staff.
and their risk factors in Afghanistan.
Chronic Dis Transl Med 2023; published online collaborations with low-income We are concerned that too much of the
March 7. [Link] and low-middle income countries focus in recent years has been on the
2036 [Link] Vol 401 June 17, 2023
