World Report
2019: a year in review
Epidemics and emergencies, human rights and hope. Farhat Yaqub looks back at medicine and
health in 2019.
Vaping and lung injury
This year, the USA had an outbreak of
e-cigarette, or vaping, product use-
associated lung injury (EVALI), which is
characterised by respiratory (eg, cough,
shortness of breath, and chest pain),
gastrointestinal (eg, abdominal pain,
diarrhoea, nausea, and vomiting), or
constitutional symp­toms (eg, fever,
chills, and weight loss). According to
the US Centers for Disease Control and
Prevention (CDC), 2409 patients with
EVALI have been admitted to hospital
in the USA as of Dec 10, with 52 deaths
(median age 52 years) confirmed. The US
Food and Drug Administration (FDA)
found 80% of 70 cases were connected
to tetrahydrocannabinol-containing
products; the CDC identified vitamin
E acetate, a thickening agent in tetra­
hydrocannabinol-containing products,
as a chemical of concern. Both the
CDC and the FDA recommend that
people do not use e-cigarette or
vaping products that contain tetra­
hydrocannabinol. President Donald
Trump announced in September that
he would ban flavoured e-cigarettes,
but a ban has not yet been enforced.
Ebola, a PHEIC
Control of the ongoing Ebola
outbreak, declared on Aug 1, 2018,
in DR Congo has been hindered by
community mistrust of the public
health response, attacks on health-
care workers and Ebola treatment
centres, and insecurity from the
fighting between the army and
armed groups. 3200 confirmed cases
and 2207 deaths have been reported
from DR Congo, as of Dec 4, 2019.
Three members of a family from
DR Congo who had crossed the
border to Uganda died from Ebola in
June. On July 17, because of concern
about further spread of Ebola, WHO
Director-General Tedros Adhanom
www.thelancet.com Vol 394 December 21/28, 2019 2215
Ghebreyesus declared the outbreak
a Public Health Emergency of
International Concern—only the fifth
in WHO’s history.
Climate emergency
This year, excess deaths occurred during
a heatwave in Europe; Australia and
California had wildfires; and severe
Atlantic hurricanes and storms reaped
“...climate change activism is on
the rise, with Greta Thunberg,
Extinction Rebellion, and many
other campaigners inspiring
people of all ages to care about
our planet.“
death and destruction in places such
as the Bahamas (61 deaths as of
Oct 11) and Bermuda (>27 000 people
[80% of the island] left without
power). According to the EAT–Lancet
Commission, global food production by
humans is threatening local ecosystems
and the stability of the Earth system.
And the National Institute for Space
Research estimated the deforestation
rate in the Brazilian Legal Amazon to
be 9762 km² from August, 2018, to
July, 2019—a 29·54% increase since
2017–18.
Some politicians were still not
deterred, however, from putting profit
above planet. Because of President
Jair Bolsonaro’s deforestation policies,
Brazil is unlikely to achieve the Paris
Agreement target of zero illegal
deforestation by 2030. The Trump
administration submitted a formal
request to the UN on Nov 4, 2019,
to withdraw the USA from the Paris
Agreement in 2020.
In response, climate change activism
is on the rise, with Greta Thunberg,
Extinction Rebellion, and many other
campaigners inspiring people of all
ages to care about our planet. In
November, the Lancet Countdown For more on EVALI from the
reported that the reduction in air CDC see https://www.cdc.gov/
tobacco/basic_
pollution in Europe from 2015 to information/e-cigarettes/severe-
2016, if maintained throughout a lung-disease.html
lifetime, could lead to a decrease, For more on EVALI from the
worth €5·2 billion per year, in the years FDA see https://www.fda.gov/
news-events/public-health-
of life lost. focus/lung-illnesses-associated-
use-vaping-products
US migrant crisis For more on Donald Trump and
According to Human Rights Watch, e-cigarettes see World Report
Lancet 2018; 394: 1977–78
the Mexican Government does not
have a proper system in place to For more on the Ebola outbreak
see World Report Lancet 2018;
screen and identify asylum seekers 394: 287–88
with disabilities and chronic health For the EAT–Lancet Commission
problems. Furthermore, the shelters see The Lancet Commissions
Lancet 2019; 393: 447–92
in Mexico do not accommodate the
For the Lancet Countdown
medical, dietary, and access needs of
report see Review Lancet 2019;
these individuals. Also, the US border 394: 1836–78
agents are inconsistent in identifying For more on China see Review
individuals with disabilities and Lancet 2019; 394: 1192–204
whether to exclude them from being For the UNAIDS Independent
returned. The USA has sent back more Expert Panel report see
https://www.unaids.org/sites/
than 55 000 asylum seekers, including default/files/media_asset/report-
at least 16 000 children, to Mexico iep_en.pdf
since the Migrant Protection Protocols
(Remain in Mexico) were implemented
on Jan 24. In November, Save the
Children and Save the Children Action
Network urged the US Congress to
repeal the policy. A repeal would let
children and families stay in the USA
REUTERS/Goran Tomasevic
until their cases are heard. On Nov 8,
at the second annual meeting of the
Comprehensive Regional Protection
and Solutions Framework, in Mexico
City, the participating countries (Belize,
Costa Rica, El Salvador, Guatemala,
Honduras, Mexico, and Panama) com­
mitted to promoting coordinated
responses to address and mitigate the
humanitarian consequences of internal
displacement and increase protection
and help for displaced people.
Measles worldwide
UN Photo/Loey Felipe
Measles cases have surged in 2019,
a consequence of poor vaccination
coverage. More than 413 000 cases
 World Report
were reported globally by mid-
November, with 250  000 cases
reported through DR Congo’s national
Witthaya Prasongsin/EyeEm/Getty Images
system alone.
More than 58 000 cases were
registered in Ukraine, as of Nov 6—the
highest number in Europe. Madagascar
and the Philippines also had large
outbreaks. In Samoa, a state of emer­
gency was declared on Nov 16 and
vaccination was made mandatory
(coverage had declined from >70%
in 2013 to 28% in 2018, but it needs
to be ≥95% with two doses of the
vaccine to protect populations).
Albin Lohr-Jones/Pacific Press/LightRocket/Getty Images
2437 confirmed cases and 32 associated
deaths were reported as of Nov 26.
The USA reported 1276 cases during
Jan 1–Dec 5, 2019—its highest number
since 1992.
WHO announced this year that
Albania, Czech Republic, Greece, and
the UK had lost their elimination
status in 2018. On Nov 14, Germany
passed a bill to make measles
vaccination mandatory for all children
attending school or nursery.
Healthy China
China celebrated the 70th anniversary
of the founding of the People’s Republic
on Oct 1. 2019 also marked 10 years
since the launch of its health system
reform. China has made progress in
providing equal access to basic health
UN Photo/Loey Felipe
care and financial risk protection for its
citizens; however, with a 2020 deadline
for the completion of this reform, China
still has a lot to achieve, including
control of non-communicable diseases,
quality of care, public satisfaction, and
health expenditure control. This reform
provides a foundation on which to build
Healthy China 2030, a national policy
to improve the overall health of the
population between 2016 and 2030.
Michel Sidibé and UNAIDS
Michel Sidibé, the executive director for
UNAIDS, stepped down after 10 years
CDC/Science Photo Library
in the role on May 8, months before
his term was due to end. UNAIDS
announced Sidibé’s new appointment
“with immediate effect” as the Minister
2216 www.thelancet.com Vol 394 December 21/28, 2019
of Health and Social Affairs for Mali. His
resignation came after the publication
of the UNAIDS Independent Expert
Panel report in December, 2018, which
“The number of cases in the
Americas in 2019 was the
highest recorded in the history
of dengue in the region...“
stated that “a change in leadership
has become necessary” after his
failure to prevent or properly respond
to allegations that included sexual
harassment, bullying, and abuse of
power at UNAIDS. Gunilla Carlsson, the
UNAIDS deputy executive director for
Management and Governance, stepped
up ad interim before Winnie Byanyima
joined UNAIDS as the new executive
director on Nov 1.
US opioid payouts
More than 32 600 deaths have been
attributed to people overdosing
on synthetic opioids (other than
methadone) in the year ending in
February, 2019. In August, a civil court
ordered Johnson & Johnson to pay
US$572 million to Oklahoma for its
role in causing opioid addiction and
deaths through false claims; and in
October, the company agreed to pay
$20 million to two counties (Cuyahoga
and Summit) in Ohio to avoid federal
trials to determine liability for the
opioid crisis. Teva Pharmaceuticals and
drug distributors AmerisourceBergen,
Cardinal Health, and McKesson also
agreed to pay a total of $260 million to
the two counties. These payouts might
not be the last.
UN high-level meeting on UHC
On Sept 23, the first UN High-Level
Meeting on universal health coverage
(UHC) was hosted in New York, NY,
USA, with the theme moving together
to build a healthier world. The final
set of six key asks from the UHC
Movement was launched on April 1
for the meeting. Two of the key asks
were uphold quality of care (deliver
coverage of quality essential health
services to 1 billion additional people)
and leave no one behind.
Dengue resurgence
The number of cases in the Americas
in 2019 was the highest recorded
in the history of dengue in the
region, with more than 2·8 million
suspected and confirmed cases,
including 1256 deaths, reported as of
Nov 19. The highest incidences were
in Brazil (73%), Belize, Honduras,
and Nicaragua. In 2019, versus the
number of cases reported in the same
period in 2018, Bangladesh had an
increase of roughly ten times, as of
Nov 17; Cambodia had an increase
o­­­­f eight times, as of Nov 7; and the
Philippines had twice the number, as
of Oct 19. Nepal also had an increase in
the number of cases this year.
In September, two cases of labo­
ratory-confirmed sexually transmitted
dengue were reported for the first time
between men who have sex with men
in Madrid, Spain.
Nairobi Summit on ICPD25
The Nairobi Summit on ICPD25, the
25th anniversary of the International
Conference on Population and
Development, was held in Kenya, on
Nov 12–14, to review the progress
of the ICPD Programme of Action,
which was set out in Cairo, Egypt, in
1994, to empower women and girls
for their sake, and for the benefit
of their families, communities, and
nations. Delegates from more than
170 countries took part in the ICPD25.
The Nairobi Summit was hailed a
success, with partners committing
to achieving three zeros by 2030:
maternal deaths; unmet need for family
planning; and gender-based violence
and harmful practices against women
and girls. The estimated total cost to
achieve these results is $264 billion.
Country governments and the private
sector together pledged a total of
$9 billion at the Nairobi Summit. And
there is to be no ICPD50.
Farhat Yaqub