Juul to Pay Nearly $440M to Settle US States’ Teen Vaping Probe

Electronic cigarette maker Juul Labs has agreed to pay nearly $440 million to settle a two-year investigation by 33 U.S. states into the marketing of its high-nicotine vaping products, which have long been blamed for sparking a national surge in teen vaping. Connecticut Attorney General William Tong announced the deal Tuesday on behalf of the states plus Puerto Rico, which joined together in 2020 to probe Juul’s early promotions and claims about the benefits of its technology as a smoking alternative. The settlement, which includes numerous restrictions on how Juul can market its products, resolves one of the biggest legal threats facing the beleaguered company, which still faces nine separate lawsuits from other states. Additionally, Juul faces hundreds of personal lawsuits brought on behalf of teenagers and others who say they became addicted to the company’s vaping products. The states’ investigation found that Juul marketed its e-cigarettes to underage teens with launch parties, product giveaways and ads and social media posts using youthful models, according to a statement. “We think that this will go a long way in stemming the flow of youth vaping,” Tong said at a news conference at his Hartford office. “I’m under no illusions and cannot claim that it will stop youth vaping,” he said. “It continues to be an epidemic. It continues to be a huge problem. But we have essentially taken a big chunk out of what was once a market leader, and by their conduct, a major offender.” The $438.5 million will be …

Zimbabwe’s Measles Outbreak Claims Nearly 700 Lives

Zimbabwe is struggling to contain a measles outbreak that has killed nearly 700 people, most of them children and young people. Zimbabwe’s government said Tuesday thousands of people have been infected with measles since an April outbreak and 698 people have died, most of them children. Zimbabwe’s health ministry blames some religious sects for the outbreak. It says some religious groups and traditional leaders preach against getting vaccinations. Health authorities have since been struggling to contain the infectious viral disease, which causes a rash, cough, and high fever, and can be fatal for unvaccinated children. “Measles is a very contagious, infectious disease that spreads when a number of unvaccinated children rises beyond critical thresholds,” said Alex Gasarira, the World Health Organization’s representative in Zimbabwe. “So, what we have in Zimbabwe right now is because the number of unvaccinated children has risen because of several factors: Community who are not comfortable to have their children vaccinated, disruption [of] vaccination services because of the recent COVID-19 pandemic.” The rising death toll is fueling calls in Zimbabwe for mandatory shots to halt the virus, but experts says the effort has to be well organized. “Compulsory immunization has to be well planned, and it has to cover every child in this country,” said Tinashe Mundawarara of the Zimbabwe Health Law and Policy Consortium. “That would ensure that the best interest of the child is really considered.” Zimbabwe’s health authorities have not yet made the measles vaccination mandatory and were not immediately available for comment. …

Zimbabwe Says Measles Outbreak Has Killed 700 Children

The death toll from a measles outbreak in Zimbabwe has risen to almost 700 children, the country’s health ministry has said. Some are calling for the enactment of legislation to make vaccination mandatory in a country where anti-modern medicine religious sects hold sway on large swathes of the population of 15 million people. The southern African country’s health ministry announced at the weekend that 698 children have died from measles since the outbreak started in April. The ministry said 37 of the deaths occurred on a single day on Sept. 1. The health ministry said it had recorded 6,291 cases by Sept. 4. The latest figures are more than four times the number of deaths announced about two weeks ago when the ministry said 157 children, most of whom were unvaccinated due to their family’s religious beliefs, had succumbed to the disease. Dr. Johannes Marisa, the president of the Medical and Dental Private Practitioners of Zimbabwe Association, told The Associated Press on Monday that the government should escalate an ongoing mass vaccination campaign and embark on awareness programs targeted especially at anti-vaccine religious groups. “Because of the resistance, education may not be enough so the government should also consider using coercive measures to ensure that no one is allowed to refuse vaccination for their children,” said Marisa. He urged the government to “consider enacting legislation that makes vaccination against killer diseases such as measles mandatory.” UNICEF on Monday said it “is deeply concerned” with the number of cases and deaths …

Argentine Ministry Links 4 Deaths to Legionnaires’ Disease

Argentine health officials said Saturday that four people in a clinic in northwestern Tucuman province had died of Legionnaires’ disease, a relatively rare bacterial infection of the lungs. Health Minister Carla Vizzotti told reporters that Legionnaires’ had been identified as the underlying cause of double pneumonia in the four, who had suffered high fevers, body aches and trouble breathing. The deaths, all since Monday, occurred in a single clinic in the city of San Miguel de Tucuman. The latest, on Saturday morning, was that of a 48-year-old man with underlying health problems. A 70-year-old woman who had undergone surgery in the clinic was also a victim. Seven other symptomatic cases have been identified, all from the same establishment and nearly all involving clinic personnel, provincial officials said. Of those seven, “four remain hospitalized, three of them under respiratory assistance, and three are under home surveillance, with less complicated clinical symptoms,” said provincial health minister Luis Medina Ruiz on Saturday. The disease, which first appeared at a 1976 meeting of the American Legion veterans group in the U.S. city of Philadelphia, has been linked to contaminated water or unclean air-conditioning systems. When the outbreak in Tucuman was first detected, doctors tested the afflicted for COVID-19, flu and hantavirus, but ruled all of them out. Samples were then sent to the prestigious Malbran Institute in Buenos Aires. Tests there pointed to Legionnaires’. Vizzotti said authorities are working to ensure the clinic is safe for patients and staff. Hector Sale, president of the …

UK to Begin Rollout of New COVID-19 Vaccination Campaign

The U.K. will begin its autumn COVID-19 vaccination campaign in the coming weeks after authorizing booster shots made by Pfizer and Moderna that have been modified to target both the original virus and the widely circulating omicron variant. The Medicines and Healthcare products Regulatory Agency said Saturday that it had approved the Pfizer vaccine for use in people aged 12 and older after finding it was both safe and effective. The agency authorized the Moderna vaccine last month. The government will offer the vaccine to everyone age 50 and over, as well as front-line health care workers and other groups considered to be particularly at risk of serious illness as the National Health Service prepares for a surge in infections this winter. “These innovative vaccines will broaden immunity and strengthen our defenses against what remains a life-threatening virus,” Health Secretary Steve Barclay said in a statement. “If eligible, please come forward for a booster jab as soon as you are contacted by the NHS.” Previous COVID-19 vaccines targeted the initial strain, even as mutants emerged. In the new “bivalent” boosters, half of the shot targets the original vaccine and half offers protection against the newest omicron variants. …

Protest in India Over HIV Drug Shortage Ends After 42 Days

A protest by a group of HIV-positive people in New Delhi, demanding a regular supply of life-saving antiretroviral therapy drugs across the country, ended this week, after 42 days, as the government has reportedly resumed the interrupted supply of the drugs.  Around 2.3 million people are infected with HIV in India. Since 2004, the government has been providing free antiviral therapy, known as ART, to HIV-positive people in India.  The therapy stops replication of the virus, helping patients live longer and cutting the risk of transmission of the virus to others. Around 1.5 million HIV patients depend on the free government-supplied ART drugs. The demonstration, at the central office of the Health Ministry’s National AIDS Control Organization, or NACO, which manages HIV and AIDS prevention and control programs in India, began in July, after activists claimed the supply of the drugs became irregular, with many medicines no longer available in centers. The activists said many HIV-positive people were only getting drugs for three, four, or five days and others were not getting the drugs at all.  HIV activist Hari Shankar, a leader of the Delhi protest, said this week after withdrawing from the protest that the authorities had resumed the supply of ART drugs to each patient for a month, after a gap of three or four months. “Our network informed us this week that the ART centers across the country have begun handing out at least one month’s supply of drugs to each patient. They have fulfilled our main …

WHO Monitors Pneumonia Cases of Unknown Origin in Argentina

The World Health Organization is monitoring a cluster of 10 cases of pneumonia from an unknown cause in an outbreak in Argentina that so far has included three deaths. The cases are linked to a single private clinic in the city of San Miguel de Tucumán, located in the northwest part of the country, according to the Pan American Health Organization (PAHO), the regional office of the WHO. An initial report Tuesday included five health care workers and a patient who was treated in the intensive care ward of the clinic, with symptoms emerging Aug. 18-22. On Thursday, local health officials reported another three cases, bringing the total to nine, including three deaths. All three people who died had other health conditions. On Friday, Argentina reported an additional case. Symptoms have included fever, muscle and abdominal pain and shortness of breath. Several patients had pneumonia in both lungs. Tests for known respiratory viruses and other viral, bacterial and fungal agents were all negative, PAHO said. Biological samples have been sent to Argentina’s National Administration of Laboratories and Health Institutes for additional testing, which will include an analysis for the presence of toxins. Dr. Michael Osterholm, an infectious disease expert at the University of Minnesota, said given that the lungs are heavily involved, the cause is likely something the patients inhaled. He first suspected Legionnaires’ disease, which is caused by inhaling droplets of water containing Legionella bacteria, but tests have ruled that out. PAHO and the WHO are monitoring the outbreak …

Treatment Improves Cognition in Down Syndrome Patients

A new hormone treatment improved the cognitive function of six men with Down syndrome by 10% to 30%, scientists said this week, adding the “promising” results may raise hopes of improving patients’ quality of life. However, the scientists emphasized the small study did not point toward a cure for the cognitive disorders of people with Down syndrome and that far more research is needed. “The experiment is very satisfactory, even if we remain cautious,” Nelly Pitteloud of Switzerland’s Lausanne University Hospital, co-author of a new study in the journal Science, said Thursday. Down syndrome is the most common genetic form of intellectual disability, occurring in about one in 1,000 people, according to the World Health Organization. Yet previous research has failed to significantly improve cognition when applied to people with the condition, which is why the latest findings are “particularly important,” the study said. Recent discoveries have suggested that how the gonadotropin-releasing hormone (GnRH) is produced in the brain can affect cognitive functioning such as memory, language and learning. GnRH hormones regulate how much testosterone and estrogen are produced, and increased levels of it help spur puberty. “We wondered if this hormone could play any role in establishing the symptoms of people with Down syndrome,” said Vincent Prevot, study co-author and head of neuroscience research at France’s INSERM institute. Research on mice The team first established that five strands of microRNA regulating the production of GnRH were dysfunctional in mice specifically engineered for Down syndrome research. They then demonstrated that …

E-Commerce Company Jumia Launches Drone Deliveries in Ghana

Africa’s largest e-commerce company, Jumia, launched the first commercial drone delivery service on the continent this week, offering delivery of products across Ghana. After more than three months of testing in the town of Omenaku, Jumia and California-based instant-delivery service Zipline have started delivering products to homes. The service is available nationwide in the West African country. Jumia says it has made 100 delivery flights so far. “Today, we believe it’s a great enabler for service for far-flung areas in Africa, very quickly in good speed and also with a great amount of sustainability and safety,” said Apoorva Kumar, Jumia’s chief operations officer. A March 2022 Forbes report shows that Africa lags in access to energy and road networks, but the continent has made significant strides in internet penetration, which is estimated at 70%. So digital entrepreneurs are using technology to solve problems that are typically reserved for more traditional forms of infrastructure. However, economists such as Ken Gichinga say that poor addressing systems for homes are still a major obstacle to drone delivery. “Droning, if it is marked well with geo-mapping, can open up the industry in terms of delivery, but for good delivery we need to have a proper addressing system,” Gichinga said. “We don’t have them like in the west, proper addressing systems.” According to the United Nations conference on trade and development, Africa also is lagging in key aspects of e-trade because of connectivity issues, lack of payment systems, and various government policies. Less than 40% …

South Africa Reaches Deal With India to Boost Domestic Vaccine Production

The Serum Institute of India signed a deal this week with South Africa’s Aspen Pharmacare to make four vaccines used in Africa. The deal has been hailed as saving local vaccine production, which was at risk of shutting down after receiving no orders for a COVID vaccine. But medical aid group Doctors Without Borders says more efforts are needed for vaccines to be fully produced in Africa for Africans. Four routine pediatric vaccines — pneumococcal vaccine, rotavirus vaccine, polyvalent meningococcal vaccine and hexavalent vaccine — will be made in South Africa with products from bulk drug substances supplied by India’s Serum Institute. In addition to the 10-year agreement, South Africa’s Aspen Pharmacare also anticipates receiving grant funding from the Bill & Melinda Gates Foundation and the Coalition for Epidemic Preparedness Innovations, CEPI. “The partnership represents an important step for preventing the kinds of gross inequities of access to life-saving vaccines that emerged during the COVID pandemic,” said CEPI’s chief executive officer, Richard Hatchett. “We are proud to be part of an effort that will secure critically needed vaccine manufacturing capacity in Africa, for Africa so that it can be ready when it faces future epidemic or pandemic threats.” But Candice Sehoma with Doctors Without Borders’ Access Campaign in South Africa is calling for more than just fill-and-finish deals. “I think it’s a great step towards realizing the improvements in the African continent’s manufacturing capacity, particularly looking at vaccines. And actually looking into routine vaccines. I think that, for me, is …

Older Tennis Fans Take Heart In Serena’s Success

Imagine if they could bottle a potion called “Just Serena.” That was Serena Williams’ succinct, smiling explanation for how she’d managed — at nearly 41, and match-rusty — to defeat the world’s second-ranked player and advance Wednesday to the third round of a U.S. Open that so far, doesn’t feel much like a farewell. “I’m just Serena,” she said to roaring fans. Clearly there’s only one Serena. But as superhuman as many found her achievement, some older fans in particular — middle-aged, or beyond — said they saw in Williams’ latest run a very human and relatable takeaway, too. Namely the idea that they, also, could perform better and longer than they once thought possible — through fitness, practice and grit. “It makes me feel good about what I’m doing still at my age,” said Bess Brodsky Goldstein, 63, a lifelong tennis enthusiast who was attending the Open on Thursday, the day after Williams’ triumph over 26-year-old Anett Kontaveit. Yet Goldstein, like any athlete, suffers her share of aches and injuries, like a recent knee issue that set her back a few weeks. Watching Williams, she said, shows ordinary folks that injuries — or, in Williams’ case, a life-threatening childbirth experience five years ago — can be overcome. “She gives you inspiration that you can achieve your best, even in your early 60s,” said Goldstein, who also had high praise for Venus Williams, Serena’s older sister, competing this year at 42. Evelyn David was also watching tennis at the Open …

Studies Show COVID’s Negative Impact on US Education and Life Expectancy

A pair of reports issued this week have combined to illustrate the deep and lasting impact that the COVID-19 pandemic has had on the United States, documenting both declining educational outcomes for young students and a sharp decline in life expectancy for Americans in general. A special assessment by the National Assessment of Educational Progress (NAEP) focused on a nationally representative sample of 9-year-olds. It documented the sharpest ever drop in reading achievement between 2019, the year before the pandemic, and the early months of 2022. It also documented the first-ever decline in achievement in mathematics over the same time period. A separate report from the Centers for Disease Control and Prevention (CDC) documented a further decline in life expectancy in the U.S., first identified in 2021. According to the findings, the average American’s life expectancy fell by nearly a year from 2020 to 2021, and by 2.7 years between 2019 and 2021. As the country heads toward its third winter of the pandemic, the two studies demonstrate that even as Americans have, to some degree or another, returned to normal life despite the pandemic, its effects will continue to play out over the months and years to come. Students struggling Educators have been concerned about the impact that the transition to virtual learning had on students, as many schools were closed to in-person classes for much of 2020 and 2021. This prompted the National Center for Education Statistics to undertake its special assessment of 9-year-olds. “We have all been …

Australia Eases More COVID-19 Restrictions

Australia has had some of the world’s strictest disease-control measures. Some of those last remaining COVID-19 restrictions now are being eased. At the height of the pandemic, millions of people were forced into protracted lockdowns, masks were mandatory and many front-line workers, including medical staff and teachers, were told be vaccinated or face losing their jobs. Australia banned most foreign nationals after closing its borders in March 2020, and Australians needed government permission to leave the country. Tens of thousands of Australian citizens were trapped overseas, some unable to return home for months because of border restrictions and a lack of flights. Australia’s COVID fortress has been dismantled and its borders have reopened with few, if any, restrictions. Other pandemic measures have persisted, but they are now being wound back. Apart from workers in hospitals and nursing homes, the mandatory isolation period for people infected with the virus will be cut from seven to five days, if they do not have any symptoms. Masks will no longer be required on domestic flights. The measures will come into effect Sept. 9. However, public health experts warn the restrictions could trigger another wave of infections. They believe about a third of COVID-19 patients are still potentially infectious on day six and seven after they contract the virus. “We will be watching very closely at how this plays out in terms of pressure on hospitals, and we will be calling on the government to revise that if we find that things are getting …

US Advisers Endorse Updated COVID Shots for Fall Boosters

U.S. health advisers on Thursday endorsed new COVID-19 boosters that target today’s most common omicron strains, saying if enough people roll up their sleeves, the updated shots could blunt a winter surge.  The tweaked shots made by Pfizer and Moderna promise Americans a chance at their most up-to-date protection at yet another critical period in the pandemic. They’re combination or “bivalent” shots, half the original vaccine and half protection against the BA.4 and BA.5 omicron versions now causing nearly all COVID-19 infections.  Advisers to the Centers for Disease Control and Prevention struggled with who should get the new booster and when, because only a similarly tweaked vaccine, not the exact recipe, has been studied in people so far.  But ultimately, the panel deemed it the best option considering the U.S. still is experiencing tens of thousands of COVID-19 cases and about 500 deaths every day — even before an expected new winter wave.  “I think they’re going to be an effective tool for disease prevention this fall and into the winter,” said CDC adviser Dr. Matthew Daley of Kaiser Permanente Colorado.  Comparing the tweak that has been studied in people and the one the U.S. actually will use, “it is the same scaffolding, part of the same roof. We’re just putting in some dormers and windows,” said Dr. Sarah Long of Drexel University.  The CDC is expected to adopt that recommendation soon, the last step before shots can begin. Millions of doses are expected to reach vaccination sites nationwide by …

Tropical Storm Forming in Atlantic Forecast to Become Season’s First Hurricane

The U.S. National Hurricane Center reported Thursday that Tropical Storm Danielle has formed in the Atlantic Ocean and is expected to become the first hurricane of what has been an unusually quiet storm season, but one that is predicted to become busier than average.  Forecasters at the hurricane center say that as Danielle hovers over an area of warmer-than-average ocean waters in the mid- to north Atlantic, atmospheric conditions are forecast to be favorable for it to strengthen into a hurricane in two days, and peak in intensity in about four days.  But they also forecast it will stay in the middle of the ocean until it weakens back into a tropical depression.  What makes the storm noteworthy is its status as the first hurricane of the season, the fourth named storm, and the first named storm since July 3. There were no named storms during the entire month of August.   The hurricane center reports it’s the first August in 25 years without a named storm. And Colorado State University hurricane researcher Phil Klotzbach told The Associated Press it is the first time since 1941 the Atlantic has gone from July 3 until the end of August with no named storm.  In a separate interview, the head of Indiana University’s Environmental Resilience Institute, Professor Gabriel Filippelli, told the AP two factors have contributed to the quiet season up to this point. First, exceptionally dry air masses in the Atlantic have stripped the atmosphere of the moisture needed for hurricanes …

NASA: Mars Rover Produces Significant Amount of Oxygen

An instrument on the U.S. space agency NASA’s Mars rover, Perseverance, has been reliably producing oxygen from the planet’s thin atmosphere for more than a year, a finding that bodes well for extended future missions to the planet. A study published Wednesday in the journal Science Advances and led by researchers from the Massachusetts Institute of Technology studied the work of the Mars Oxygen In-Situ Resource Utilization Experiment, known as MOXIE. The study shows that since it was activated in April 2021 — two months after Perseverance landed on Mars — MOXIE was able to produce oxygen on seven experimental runs, in a variety of atmospheric conditions, including during the day and night, and through different Martian seasons. In each run, the instrument reached its target of producing six grams of oxygen per hour — about the rate of a modest tree on Earth. The researchers, along with NASA scientists and planners, envision that a scaled-up version of MOXIE could be sent to Mars ahead of a human mission to continuously produce oxygen at the rate equal to several hundred trees. The system should generate enough oxygen to both sustain humans once they arrive and fuel a rocket for returning astronauts back to Earth. The principal investigator for the study, MIT’s Dr. Michael Hecht, said in a press release the steady output that MOXIE has demonstrated is a promising first step toward those goals. Hecht said the instrument’s performance producing oxygen on Mars also represents the first demonstration of in-situ, …

Twitter Tests Long-Awaited Edit Button, Will Roll Out to Paid Subscribers

Twitter is internally testing a widely requested edit button, a feature that will be rolled out to paid subscribers in the coming weeks, the social media company said Thursday. For years, Twitter users have demanded the ability to edit their tweets after publishing in order to fix errors like typos. Those requests have led to jokes online that Twitter would rather introduce any other product, such as newsletters, before giving users their top-requested feature. Soon, those demands will be met. Users will be able to edit their tweets “a few times” within 30 minutes of publication, Twitter said in a blog post. Edited tweets will have an icon and timestamp to display when the post was last edited. Users will be able to click on the label of an edited tweet to view the edit history and previous versions of the post. Twitter has experimented with versions of an edit button. Subscribers of Twitter Blue, the company’s paid subscription product, currently have access to a feature that holds tweets for up to one minute, allowing users to review the tweet and “undo” it before the post is published. …

Taiwan Pilots, Cabin Crews Bemoan Stringent COVID Restrictions 

The flight crews at one of Taiwan’s main airline carriers have voiced frustration about continued COVID-19 policies that require them to adhere to some of the strictest quarantine and testing requirements in the world.  The policies remain in place even as other parts of the world loosen pandemic restrictions and adapt to a “new normal.”  Upon arrival at destinations overseas, pilots and cabin crews from China Airlines must be taken directly to their hotel rooms and provided with room key cards that work only once — when they leave and embark on their next flights.    One pilot for China Airlines, who wished to remain anonymous, told VOA he was “frustrated” with the current conditions.    “It’s really affected [me]. Whenever I went to work, I felt so frustrated … it means I can’t go home for a period of time, and [I’m] also very tired, because I need to continuously [go] back and forth to Taipei and the U.S. or Europe. So, I have to adjust myself, try to sleep more and be more positive. [Being] stuck in a tiny room for long is really uncomfortable, but I still have to get used to it,” he said.    The first officer has worked for the airline for nearly eight years, and he flies both long- and short-haul trips each month. He said the restrictions were worse in the beginning of the pandemic, as pilots were forced to wear goggles, gloves and face masks while on duty, as well as …

UN Weather Agency Predicts Rare ‘Triple-dip’ La Nina in 2022

The U.N. weather agency is predicting that the phenomenon known as La Nina is poised to last through the end of this year, a mysterious “triple dip” — the first this century — caused by three straight years of its effect on climate patterns like drought and flooding worldwide. The World Meteorological Organization on Wednesday said La Nina conditions, which involve a large-scale cooling of ocean surface temperatures, have strengthened in the eastern and central equatorial Pacific with an increase in trade winds in recent weeks. The agency’s top official was quick to caution that the “triple dip” doesn’t mean global warming is easing. “It is exceptional to have three consecutive years with a La Nina event. Its cooling influence is temporarily slowing the rise in global temperatures, but it will not halt or reverse the long-term warming trend,” WMO Secretary-General Petteri Taalas said. La Nina is a natural and cyclical cooling of parts of the equatorial Pacific that changes weather patterns worldwide, as opposed to warming caused by the better-known El Nino — an opposite phenomenon. La Nina often leads to more Atlantic hurricanes, less rain and more wildfires in the western United States, and agricultural losses in the central U.S. Studies have shown La Nina is more expensive to the United States than the El Nino. Together El Nino, La Nina and the neutral condition are called ENSO, which stands for El Nino Southern Oscillation, and they have one of the largest natural effects on climate, at times …

Half of the World’s Health Care Facilities are Unhygienic and Infection Incubators

A World Health Organization-UNICEF global study of health care facilities finds half lack basic hygiene services, putting around 3.85 billion people at risk of infection and death. The study is based on data from 40 countries representing 35% of the world’s population. It presents an alarming picture of health facilities that lack water and soap for handwashing, have dirty toilets, and are unable to manage health care waste. It says the lack of safe water, sanitation, and basic hygiene services, known as WASH, in health care facilities can lead to many preventable deaths. Rick Johnston is WHO lead WHO-UNICEF Joint Monitoring Program for WASH. He says sepsis, a major cause of mortality globally, could be prevented by improving WASH services in health care. “It causes about 11 million avoidable deaths each year. And we know that in health care settings, sepsis mortality is linked to poor quality of care, including inadequate WASH… Still today, 670,000 neo-natal deaths occur due to sepsis. So, there is a huge burden that could be improved right there,” he said. Data show the situation tends to be better in hospitals than in smaller health care facilities. The WHO reports the 46 least developed countries lag most behind in hygiene services, with only 32% of health care facilities providing WASH services. Johnston says sub-Saharan Africa is the geographic region with the lowest coverage of basic services, about a third lower than globally. “I mentioned hand hygiene services at 51% globally. It is only 38% in sub-Saharan …