The World Health Organization Just Declared War on Trans Fats

The World Health Organization has announced a comprehensive plan to eliminate industrially produced trans-fatty acids from the global food supply by 2023. It’s a good idea—but the five-year plan may be overly ambitious.

The plan, called REPLACE, urges global governments to eliminate the use of industrially produced trans fats, also known as partially hydrogenated oils (PHOs), within the next five years. It’s a logical next step given that many jurisdictions, particularly those in wealthier countries, have already taken similar measures—but the challenge now will be in getting low- and middle-income countries to follow suit, a more difficult task owing to weaker food and safety controls.

Trans fats, which are produced when vegetable oil hardens in a process called hydrogenation, can be found in margarine, ghee, and shortening products like Crisco. Margarine was super popular in the 1970s, as it was touted as a healthier alternative to butter back when saturated fats were, perhaps unfairly, linked to heart disease. Trans fats are also used in some deep frying, and can often be found in baked and processed snack foods.

The consumption of trans fats increases a person’s risk of heart disease by 21 percent and premature death by 28 percent, according to the WHO. Partially hydrogenated oils also lead to increased inflammation and endothelial dysfunction, a condition that precedes atherosclerosis and clogging of arteries. Globally, around 500,000 people die each year due to trans fat-induced cardiovascular disease. The CDC says a reduction of trans fat consumption would prevent between 10,000 to 20,000 heart attacks each year, and 3,000 to 7,000 coronary heart disease deaths annually, in the United States.

Manufacturers say PHOs extend the shelf life of foods, and that they are cheaper than the alternatives, but the WHO contests both of these claims.

“WHO calls on governments to use the REPLACE action package to eliminate industrially-produced trans-fatty acids from the food supply,” said WHO Director-General Tedros Adhanom Ghebreyesus in a statement. “Implementing the six strategic actions in the REPLACE package will help achieve the elimination of trans fat, and represent a major victory in the global fight against cardiovascular disease.”

These six strategic actions are designed to ensure the “prompt, complete, and sustained elimination” of industrially produced trans fats from the global food supply:

REview dietary sources of industrially-produced trans fats and the landscape for required policy change.

Promote the replacement of industrially-produced trans fats with healthier fats and oils.

Legislate or enact regulatory actions to eliminate industrially-produced trans fats.

Assess and monitor trans fats content in the food supply and changes in trans fat consumption in the population.

Create awareness of the negative health impact of trans fats among policy makers, producers, suppliers, and the public.

Enforce compliance of policies and regulations.

Speaking to reporters, Ghebreyesus said today’s announcement marks the first time that WHO has called for the elimination of a significant lifestyle factor responsible for a non-communicable disease.

As noted, some countries have practically eliminated industrially produced trans-fatty acids by enforcing limits on the amount that can be added to packaged foods. Some countries and jurisdictions have even taken the step of imposing bans on PHOs—the main source of industrially produced trans-fatty acids. Denmark was the first country to impose restrictions on trans fat over a decade ago, and in 2015, the US Food and Drug Administration took steps to eliminate PHOs from the American food supply by this year. New York City enacted restrictions 10 years ago, and studies suggest the move is already paying dividends in the form of reduced rates of cardiovascular disease—a claim that remains controversial.

“Banning trans fats in New York City helped reduce the number of heart attacks without changing the taste or cost of food, and eliminating their use around the world can save millions of lives,” Michael R. Bloomberg, a three-term mayor and WHO Global Ambassador for Noncommunicable Diseases, said in a statement today. “A comprehensive approach to tobacco control allowed us to make more progress globally over the last decade than almost anyone thought possible—now, a similar approach to trans fat can help us make that kind of progress against cardiovascular disease, another of the world’s leading causes of preventable death.”

Trans fats seem to be unhealthy because they increase levels of low-density lipoprotein (LDL, or “bad”) cholesterol, which has been linked to cardiovascular disease, stroke, and type 2 diabetes. At the same time, trans fats decreases high-density lipoprotein (HDL, or “good”) cholesterol, which has the beneficial effect of transporting cholesterol from the arteries to the liver for processing. Meanwhile, eating unsaturated fatty acids lowers a person’s risk of heart disease by offsetting the negative effects of PHOs on blood lipids—the fatty substances found in the blood, including cholesterol and triglycerides.

In its guidelines, the WHO recommends that people reduce their total trans fat consumption to less than 1 percent of their total daily energy intake. So for a 2,000 calorie per day diet, that’s no more than 2.2 grams of trans fats a day.

The WHO’s recommendations are exactly that: recommendations. As Walter Willett, a professor of epidemiology and nutrition at Harvard T.H. Chan School of Public Health, told CNN, the WHO has no enforcement capacity, so national and local governments will have to do the heavy lifting in this regard.

“The food industry is not monolithic. Some parts of the industry eliminated trans fat proactively once the evidence became clear that this was harmful, but other parts of the industry are likely to resist unless they are legally forced to remove trans fat from their products,” Willett told CNN. “In the long run, I’m confident that industrial trans fat will be eliminated.”

Eliminating all industrial-manufactured trans fats from the global food supply by 2023 is an ambitious, perhaps unrealistic goal. It’s also important to point out that naturally occurring trans fats from cud-chewing mammals like cows and sheep will continue to appear in food products, such as milk, butter, and yogurt. But a deadline is good, as it imparts urgency. As the WHO rightly points out, there’s no excuse to keep using trans fats in products. The issue now is one of will.




'Serious Challenge': World Health Officials Rushing to Stop Another Ebola Outbreak After 18 Deaths

The World Health Organization said Friday they are working to prevent an outbreak of the Ebola in the Democratic Republic of the Congo.

In the past five weeks, at least 34 cases of the fatal hemorrhagic fever have been reported, with 18 deaths and 14 suspected cases, the WHO said. Three health workers have also been infected.

“WHO staff were in the team that first identified the outbreak. I myself am on my way to the DRC to assess the needs first-hand,” said WHO director-general Dr. Tedros Adhanom Ghebreyesus in a statement. “I’m in contact with the Minister of Health and have assured him that we’re ready to do all that’s needed to stop the spread of Ebola quickly. We are working with our partners to send more staff, equipment and supplies to the area.”

“It is too early to judge the extent of this outbreak,” added Dr. Peter Salama, WHO deputy director-general for Emergency Preparedness and Response. “However, early signs including the infection of three health workers, the geographical extent of the outbreak, the proximity to transport routes and population centres, and the number of suspected cases indicate that stopping this outbreak will be a serious challenge. This will be tough and it will be costly. We need to be prepared for all scenarios.”

This is the DRC’s ninth outbreak of Ebola.

The WHO is teaming with the government there on their response plan. Right now, that plan includes contact tracing, infection prevention, community engagement and the use of ring vaccinations and antivirals.

During the 2014-15 Ebola outbreak, 11,310 people died and 28,616 were infected across West Africa, the Centers for Disease Control and Prevention reported.




Taiwan accuses World Health Organisation of bowing to Beijing over invitation to top health meeting

Taipei again fails to gain entry to the WHO’s main international gathering of the year

Taiwan has accused the World Health Organisation of succumbing to political pressure from mainland China after the island failed to receive an invitation to a major international meeting.

Beijing sees self-governing democratic Taiwan as part of its territory awaiting reunification and has used its clout to diminish the island’s presence on the world stage since Beijing-sceptic President Tsai Ing-wen took power in May 2016.

Last year was the first time in eight years that Taiwan was not granted access to the World Health Assembly (WHA), the WHO’s main meeting.

This year’s assembly is to be held in Geneva from May 21-26 and the online registration deadline lapsed on Monday without Taipei receiving an invite.

“We believe the WHO is a non-political organisation pursuing the highest health standards for humanity and should not solely serve Beijing’s political will,” Taiwan’s Mainland Affairs Council said in a statement.

Taiwan’s foreign ministry said on Tuesday it “regretted” that it had not been invited to the assembly.

“Health is a basic human right, as well as a universal value regardless of differences in race, religion, political beliefs, economic or social situations,” the ministry said in a statement.

It added that under the WHO charter, Taiwan should be allowed “equal participation” in all WHO events.

The WHO did not immediately respond to a request for confirmation it would not invite Taipei to this year’s assembly.

In Beijing on Monday, foreign ministry spokesman Geng Shuang the island was only able to attend the assembly from 2009-2016 because the previous Taiwan government had a consensus with Beijing that there is only “one China”.

While the former administration touted the agreement as enabling cross-strait relations to flourish without compromising Taiwan’s sovereignty, Beijing saw it as meaning that Taiwan and the mainland are part of a single China.

Tsai and her independence-leaning Democratic Progressive Party have refused to acknowledge the principle which Beijing sees as the bedrock for relations.

“This damaged the political foundation for Taiwan’s participation,” Geng said.

Beijing has also been trying to exert pressure on international companies to list Taiwan as a Chinese province on their websites, rather than as a separate entity.

The White House said on Saturday that China’s aviation authorities had sent letters to 36 foreign airlines including US firms demanding they refer to Taiwan, Hong Kong, and Macau as Chinese territories.

“This is Orwellian nonsense and part of a growing trend by the Chinese Communist Party to impose its political views on American citizens and private companies,” the White House said.



World Malaria Day 2018: We are ready to beat malaria

25 April 2018, Cairo - On World Malaria Day 2018, the World Health Organization (WHO) and its partners are calling on all concerned parties to be ready to end malaria - a disease which can be fatal and which affects millions of people, claiming many lives annually.

This year’s World Malaria Day coincides with activities to commemorate the 70th anniversary of WHO. Over the last 7 decades, WHO has been providing support to countries to fight malaria. “Ready to beat malaria” is the theme of this year’s day. The theme underscores the collective energy and commitment of the global malaria community in uniting around the common goal of achieving a malaria-free world.

Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. It is a preventable and curable disease and yet the global burden of this disease is very high. According to the latest “World Malaria Report”, released in November 2017, there were 216 million cases of malaria in 2016, up from 211 million cases in 2015. The estimated number of malaria deaths stood at 445 000 in 2016, a similar number to the previous year (446 000).

In areas with high transmission of malaria, children under 5 are particularly susceptible to infection, illness and death; more than two thirds (70%) of all malaria deaths occur in this age group. The number of under-5 malaria deaths has declined from 440 000 in 2010 to 285 000 in 2016. However, malaria remains a major killer of children under 5, taking the life of a child every 2 minutes.

In the Eastern Mediterranean Region, the number of malaria cases increased from 3.9 million in 2015 to 4.3 million in 2016with 8200 deaths.

Ninety-five percent (95%) of confirmed malaria cases are reported from 4 countries in the Region and 6 countries are at high risk of malaria but are at the stage of burden reduction.

On the occasion of World Malaria Day 2018, Dr Jaouad Mahjour, acting WHO Regional Director for the Eastern Mediterranean, said that, “Although coverage of main interventions in endemic countries is increasing it falls short of universal health coverage targets. Humanitarian emergencies taking place in some countries are decreasing the capacity of malaria programmes and insufficient resources in high-burden countries are among the main challenges.”

Over the past few years, the Region has made some achievements towards eliminating malaria. The Islamic Republic of Iran and Saudi Arabia are at the stage of malaria elimination.

Fourteen countries in the Region are free from indigenous malaria transmission and are at the stage of prevention of establishment of local malaria transmission.

Increasing insecticide resistance in many malaria-endemic countries of the Region is a threat for vector control as the main preventive measure for malaria.

Together with diagnosis and treatment, WHO recommends a package of proven prevention approaches, including insecticide treated nets, spraying indoor walls with insecticides, and preventive medicines for the most vulnerable groups: pregnant women, under 5s and infants.

Without urgent action, the major gains in the fight against malaria are under threat. On this World Malaria Day, WHO continues to call for greater investment from national resources and also donors from the Region and expanded coverage of proven tools to prevent, diagnose and treat malaria.



Prescreening necessary before dengue vaccine use, says WHO expert advisory group

MANILA — The World Health Organization’s expert advisory group on immunization, or SAGE, is not halting the use of the dengue vaccine Dengvaxia. But they stress the need for prescreen tests before its administration for safety reasons.

The group made the new recommendations following their two-day meeting last week.

While the new recommendation by SAGE is meant to maximize the public health benefits of the vaccine while minimizing risks, it poses limitations in terms of the vaccine’s widespread use. There are currently no rapid diagnostic tests at point of care available to know whether patients have previously been infected with the dengue virus.

“There are tests available, but these are not point of care tests, so their implementation would be cumbersome, and require that the person returns,” Dr. Joachim Hombach, SAGE’s executive secretary, said in a press conference.

“We see indeed a significant obstacle in using this vaccine that way. On the other hand, we are confident that this also spurs the development of rapid diagnostic tests that then could be readily used.”

There are several rapid diagnostic tests available in the market, but none have been validated or licensed when it comes to determining an individual’s dengue serostatus.

“Various ELISA-based assays exist such as the dengue IgG ELISA, and many countries actually have access to these diagnostic tests. The disadvantage of such laboratory assays are that they cannot be used at the point of care as blood sample needs to be taken, then it takes 1-3 days to receive the results, sometimes even longer,” Hayatee Hasan, WHO technical officer for Immunization, Vaccines and Biologicals in Geneva, told Devex.

Asked whether the onerous recommendations could limit the vaccine’s long-term existence, the group said that’s something the manufacturer has to deal with.

“Whether this has repercussions on the manufacturer is something which is secondary. For us, it is very important that we signal in which way we think this vaccine could be used, even if ... the options for using it may not be available immediately. But maybe for the medium term. This is for the company to decide in terms of how they cope with this,” Hombach said.

Dengvaxia is currently the only vaccine licensed against dengue.

The vaccine came under scrutiny after Sanofi Pasteur, its manufacturer, revealed in late 2017 of the potential severe effects of the vaccine in seronegative individuals, or essentially those who’ve not been previously infected with the dengue virus.

The issue caused widespread uproar in the Philippines, in particular, where over 800,000 schoolchildren have already received the vaccine. A senate inquiry commenced after reports emerged that 14 children reportedly died from the vaccine. The Department of Health formed a panel of experts to probe this. Initial findings by the panel showed three of the cases have “causal association” to the vaccine, but they stressed the need for further tests before they can arrive to a final conclusion.

“The results of this evaluation are to be forwarded to the Pharmacovigilance Team of the DOH for further investigation and/or signal detection for possible new causal association. Only then can the investigation of these cases be completed and the results considered final,” it said in the report.

Following the controversies, the Philippine Department of Health has decided to suspend its dengue immunization program.

The WHO will be aligning its position on the use of the dengue vaccine with the SAGE recommendations, said Hasan. The U.N. body’s revised position paper on the subject will be published in September 2018.



World Health Organisation warns against dengue vaccine risks

Fresh concerns about the efficacy of the world’s first ever Dengue vaccine has come to light as the World Health Organisation (WHO) noted that there is an urgent need to describe the potential risks of the vaccine.

Therefore, it has advised the countries planning to use the vaccine to screen the population before vaccination. It has strictly directed the countries to vaccinate only seropositive (tested positive for dengue) individuals.

Dengvaxia (CYD-TDV), the vaccine in question is produced by the Pharmaceutical giant Sanofi Pasteur. The Strategic Advisory Group of Experts (SAGE) formulated by WHO is examining the concerns caused by the vaccine.

“Furthermore, although the efficacy against dengue infections in seropositive individuals is high, it is still not complete. Hence, the limitations of CYD-TDV will need to be clearly communicated to populations offered vaccination,” warned WHO.

SAGE also looked at the population seroprevalence criteria (percentage of population affected by dengue) to ensure that only those affected by dengue get the jab.

“SAGE noted that the evidence of the absence of a safety issue in seronegative individuals aged 9 and above was based on the limited data set of 10%-20% of the trial population, and highlighted the urgent need to better describe the long-term benefit-risk ratio of CYD-TDV in seronegative individuals,” said a spokesperson.


Face of Defense: Doctor Builds Partnerships Through Global Health Engagement

Air Force Lt. Col. (Dr.) Elizabeth Erickson’s experiences in military health outreach around the world allows her to build strong partnerships, and her position as a female officer and physician has given her the unique opportunity to work with and learn from inspiring women around the globe.

The Air Force Medical Service participates in international medical outreach efforts, called global health engagements, to strengthen relationships with partner nations that bear fruit diplomatically and medically.

Building Strong Relationships With Allies, Partners

GHEs include a broad range of international medical activities undertaken by the U.S. military. These activities help to build strong relationships with allies and partners, increase military medical interoperability between nations and build global capacity to address health security threats.

“For example, we work with some partner nations on biosurveillance in order to better detect and respond to outbreaks, so they do not become larger health security crises,” Erickson said.

Erickson, a family physician and currently a preventive medicine resident at the Uniformed Services University of the Health Sciences in Bethesda, Maryland, always had an interest in working and studying abroad. Before joining the Air Force, she studied and volunteered in India and Africa.

In the Air Force, after assignments in Turkey and Germany and a deployment to Afghanistan, she was an international health specialist at Pacific Air Forces and U.S. Pacific Command.

“I was always interested in having a global perspective on care, so I gravitated towards these unique opportunities,” Erickson said. “As an international health specialist, I planned and executed GHEs, coordinated Department of Defense health activities across the Indo-Asia-Pacific region, and developed strategies to use health engagements to achieve national security objectives.”

Service in Afghanistan

Erickson’s GHE experiences allow her to apply and expand intercultural, medical and military skills. As a female officer, she had opportunities to support the health and empowerment of women in multiple countries, specifically in Afghanistan.

From July 2009 to March 2010, Erickson served as senior medical officer and director of Women’s Affairs on the Zabul Provincial Reconstruction Team in Afghanistan. She and her team executed programs that supported the local government and improved the health and well-being of the local population, especially women and children. The team engaged with the local Ministry for Women’s Affairs representatives, female health care providers at local hospitals and the province’s only girls’ school.

“It was a priority for our commander to find sustainable ways to improve the lives of Afghan women,” Erickson said. “One project provided women with solar stoves. We found that women were inhaling harmful smoke while cooking with charcoal and wood, and we wanted to provide an alternative cooking method that would ultimately improve their health.”

The three medical Air Force women on the PRT met regularly with local female health care providers.

“We developed strong relationships with them and learned about their challenges,” Erickson said. “We conducted training on basic life support in obstetrics to help them recognize potentially life-threatening events that happen during childbirth and prepared them to manage those events.”

International Women’s Day Event

While in Afghanistan, Erickson participated in an International Women’s Day event. Local women -- including the female nurses and physicians she had worked with so closely -- gave speeches, performed music and recited poetry.

“It was special to see our friends, these women we became so close with, share their hopes for peace and stability in Afghanistan,” Erickson said.

Erickson’s experiences serve as an important reminder that female military leaders and medical personnel are vital for full-spectrum global health engagement, and she encourages other female medical airmen to pursue opportunities in GHE.

“There are some really inspiring women in our partner nations, and it was a rewarding experience to meet and work with them,” Erickson said. “Many times, my female counterparts and I built a special bond and we worked together to move health cooperation between our militaries forward.”

She added, “We should encourage more women to become leaders on both sides of the GHE community to improve our engagements with our partner nations and the global military medical community.”



Australia to join global health and climate change initiative

The Lancet Countdown report on health and climate change was published in October 2017 by The Lancet and will be updated annually through to 2030.

It tracks progress on health and climate change across 40 indicators divided into five categories: climate change impacts, exposures and vulnerability; adaptation planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement.

Dr Ying Zhang, a senior lecturer in the University of Sydney's School of Public Health, and Associate Professor Paul Beggs, from Macquarie University, wrote in the MJA that, from an Australian perspective, "with our high level of carbon emissions per capita, it will be important to reflect on our progress and how it compares with that of other countries, especially high-income countries".

"A group of Australian experts from multiple disciplines is commencing work on our first national countdown report," Zhang and Beggs wrote.

"The project recognises the importance of the climate change challenge in Australia, including its relevance to human health, and also the unique breadth and depth of the Australian expertise in climate change and human health.

"The Australian countdown will mirror the five domain sections of the Lancet Countdown, adopt the indicators used--where feasible and relevant to Australia--and include any useful additional indicators.

"The inaugural Australian report is planned for release in late 2018 and is expected to be updated annually. We hope to raise awareness of health issues related to climate change among Australian medical professionals, who play a key role in reducing their risks," the authors concluded.

"The Australian countdown is also envisioned as a timely endeavour that will accelerate the Australian government response to climate change and its recognition of the health benefits of urgent climate action."


The University of Sydney appointed Dr Tony Capon as the world's first professor of planetary health in 2016. Learn more about the mission and activities of the University of Sydney's Planetary Health Platform.