Member States Raise Concerns About Sustainability Of Funding For Polio & Antimicrobial Resistance Efforts
Dr Tedros Adhanom Ghebreyesus, WHO Director General, at Monday’s Executive Board session.

COVID-19 has led to the suspension of polio campaigns in more than 30 countries, and has underscored the importance of the mission to eradicate it, tackle antimicrobial resistance, and ensure the timely sharing of pathogens, said WHO member states at Monday’s Executive Board session. 

Throughout the morning and afternoon sessions, member states reviewed and discussed the Director General’s reports on poliomyelitis eradication, polio transition planning, antimicrobial resistance (AMR), and the public health implications of the implementation of the Nagoya Protocol

Afghanistan and Pakistan have already reported outbreaks of both types of polioviruses, making them the last two remaining polio endemic countries. Although polio outbreaks impacted three of WHO’s six regions in 2020, with almost 1,000 cases recorded, 30% of the emergencies were stopped during the year, demonstrating the ability to stop polio outbreaks even in the midst of a pandemic. The pandemic has also disrupted routine immunisation programmes, increasing outbreaks of both wild and vaccine-derived polioviruses.

“Polio is still considered an emergency, and rightly so, because it could become a major international problem again if we’re not careful,” said WHO Regional Director for the Eastern Mediterranean, Ahmed Al-Mandhari. “So we need the resources that are required to keep the public health situation under control and make sure that all countries of our region are doing what needs to be done as it needs to be done.

“This requires resource mobilisation across the region…We’ve got children at risk of being paralysed for life and we must save them from that. That means intensifying our efforts as we get close to the finishing line of efforts to eradicate poliomyelitis.” 

Despite the disruptions of efforts to combat vaccine-preventable diseases, along with projections that the African region could see a 200% increase in the number of districts with polio cases by the end of 2020, WHO officials highlighted the opportunities brought along by the SARS-CoV2 virus. This could particularly be the case for polio transition, which is the adaptation of polio infrastructure for disease surveillance, social mobilisation, vaccine delivery, and care for hard-to-reach populations to other programme areas. 

“Firstly, COVID-19 is accelerating programmatic integration…We are now leveraging the full technical expertise to align polio transition activities with other programmatic priorities and the planning processes,” said Zsuzsanna Jakab, WHO Deputy Director-General. “Secondly, COVID-19 has once again demonstrated the value of the polio network, especially at the community level…Thirdly, COVID-19 underlines the importance and the need for strong and resilient health systems. In countries where there is a strong polio footprint, the polio network is a core component of the essential public health workforce.”

Zsuzsanna Jakab, WHO Deputy Director-General.

The contributions of polio staff, networks, resources and expertise to COVID-19 actions assisted in the pandemic responses in over 50 countries. In the African region, two polio personnel at the national and district levels in country offices in the region are spending more than half of their time on the COVID-19 response. 

In addition, “polio colleagues are the main frontline workers [in the African region] responding to outbreaks of cholera, yellow fever, and meningitis,” said Matshidiso Moeti, WHO Regional Director for the African Region. 

Australia’s delegation echoed some of WHO’s messages, “acknowledg[ing] the ongoing role the GPEI [Global Polio Eradication Initiative] will have in supporting the delivery of COVID-19 health interventions, including vaccinations.”

Polio Eradication Efforts Face “Precarious Financing”

Meanwhile, member states expressed concern regarding the “precarious financing situation” of the Global Polio Eradication Initiative, a public-private partnership with six core partners – WHO, Rotary International, the US Centers for Disease Control and Prevention, UNICEF, the Gates Foundation, and GAVI. 

“We’re concerned at the slow pace with which polio transition plans are being finalised. Given current funding constraints, this work needs to be expedited now more than ever,” said the UK’s delegate. 

“We share concern with regard to the financial gap in GPEI’s budget this year. The way forward is looking for new financial resources, but also focusing on increasing efficiency,” said the delegate representing Germany. 

Burkina Faso, speaking on behalf of the 47 WHO member states of the African region, called upon stakeholders to strengthen the financial mechanisms to fight polio, particularly given the “fragile financial situation.”

Burkina Faso’s delegate at the Executive Board session on Monday.

With the announcement in the Director General’s report of the likely scaling back of resources and presence in countries where poliomyelitis is not endemic, the African region emphasised the need to “mobilise long term financing to allow the region to continue its elimination activities” and “ask[ed] WHO to add financing for poliomyelitis and put it in one of the priorities of the program budget for 2022-2023 and following budgets,” said Burkina Faso’s delegate. 

In an effort to reassure member states, Jakab recognised the need for long term financing to sustain polio assets. “We would like to assure [member states] that this remains a priority for WHO’s programme budget 2020-2023 and beyond.”

“The draft budget presented to the EB reflects our commitment to sustainable financing for the polio network and we are working closely with GPEI and other development partners to develop comprehensive resource mobilisation efforts for future financing,” she added. 

“I encourage partners and donors to continue to support WHO in order to sustain our core functions where polio infrastructure can make the most impact,” said Dr Tedros Adhanom Ghebreyesus, WHO Director General. “These functions are central to reaching the 13th General Programme of Work (GPW) goals of promoting health, keeping the world safe and serving the vulnerable.” 

Antimicrobial Resistance

Also on the Executive Board agenda was AMR, a growing global threat. Essential antimicrobial drugs used to treat common infections are becoming ineffective globally, but the highest rates of resistance are in low- and lower-middle-income countries, found WHO’s progress report on the implementation of the Global Action Plan on Antimicrobial Resistance. 

A risk assessment conducted by the Secretariat indicated that COVID-19 has disrupted planned and ongoing national AMR activities and has heightened the risk of resistance emerging due to the irrational use of antimicrobials to treat patients infected with SARS-CoV2. 

The EU and the Philippines laid out the interplay between COVID-19 and AMR, which included supply chain disruptions of antibiotics, interruptions in the delivery of routine immunisation services, and the misuse and overuse of antibiotics in managing COVID-19 patients. 

“These developments, if not addressed, can push back all the gains in our fight against infectious diseases,” said the delegate representing the Philippines. 

Philippines’ delegate at the Executive Board session on Monday.

“Within the context of the pandemic, implementing the relevant programmes to mitigate and control AMR, such as infection prevention, surveillance, antimicrobial stewardship, and WASH [water, sanitation, and hygiene] have become even more crucial,” said Dr Tedros. “As we continue to tackle the COVID-19 pandemic, we must simultaneously ensure that efforts to stop the spread of AMR are accelerated to control this silent tsunami together.” 

WHO Collaboration to Address AMR

Following the establishment of the Tripartite Joint Secretariat on AMR, a collaboration between WHO, the Food and Agriculture Organisation (FAO), and the World Organisation for Animal Health (OIE), the tripartite Antimicrobial Resistance Multi-Partner Trust Fund was launched in 2019 to support One Health action in low- and lower-middle-income countries.

“In Brazil’s view, the collaboration between WHO and other agencies within the United Nations system [such as through the Tripartite Joint Secretariat on AMR] will be as legitimate and successful as they perform their respective mandates and are accountable to their respective governing bodies,” said Brazil’s delegation. “We also see room for improvements in the way that AMR-related high level bodies connect their work, the wealth of needs and context to member states.”

The Trust Fund was supported by Zambia at the Executive Board session, as “this will ensure sufficient and sustainable AMR funding” through the utilization of multi-fund streams. 

“134 countries have established national plans [on AMR], but a lot of countries lack the necessary financing. As a result, plans won’t have a real impact. We can’t be successful if we don’t have the necessary financing in place to implement activities at the national, regional and local level,” said Professor Hanan H. Balkhy, WHO Assistant Director-General of Antimicrobial Resistance. 

Professor Hanan H. Balkhy, WHO Assistant Director-General of Antimicrobial Resistance.

“We call upon all member states to take the necessary measures to fight AMR by establishing these national action plans and establishing the financing so that they can be implemented in the context of Universal Health Coverage and primary health care,” she added. 

WHO and member states agree upon the need for a holistic and multi-sectoral approach – a One Health approach – to AMR and several announced their support for the One Health Global Leaders Group on Antimicrobial Resistance, a key global governance structure comprised of members states, civil society and the private sector. 

“We applaud the many initiatives that are putting the one health approach in practice at the global level….Germany welcomes the recent establishment of the One Health Leaders Group and is happy to be represented in this group,” said Germany’s delegate. “We trust that it will keep AMR high on the political agenda.”

Mechanisms for Pathogen Sharing in Health Emergencies

Subsequently, member state discussions on practices in the sharing of pathogens and genetic sequencing data commenced, largely focusing on actions taken in relation to the SARS-CoV2 virus and highlighting the importance of rapid pathogen sharing in the context of public health emergencies.

Austria, speaking on behalf of EU member states, underscored the “confusing situation” and legal uncertainty that surrounds the timely access to pathogens in health emergencies. This uncertainty “could cause delays in access to diagnostics, therapeutics and vaccines,” said the Austrian delegate.

Ambassador Elisabeth Tichy-Fisslberger, Permanent Representative of Austria to the United Nations Office at Geneva.

Current arrangements lack clarity, as the distinction between the sharing of biological pathogen samples and genetic sequences is blurry and the implementation of certain provisions of the Nagoya Protocol – an international legal agreement on the fair and equitable sharing of genetic resources – is limited, according to the Austrian delegation.

By contrast, India’s delegate recounted the benefits of the Protocol revealed by the pandemic. “[The Nagoya Protocol] facilitated the rapid sharing of information about the COVID-19 virus and helped in establishing a systematic, organised method of data exchange to prevent any potential breaches in the country’s jurisdiction related to sharing and use of biological data and resources,” said the delegate representing India.

The Chinese delegation recognised the urgent need to establish a fair and equitable benefit sharing mechanism and highlighted China’s efforts to fulfill its obligations to promote access to genetic data under the Nagoya Protocol.

Both China and the US delegations drew attention to the actions of their respective countries during COVID-19.

“Concerning the sharing of the SARS-CoV2 virus, since the outbreak, China immediately mobilised high level, biological security labs with leading experts to conduct a parallel testing for cases and samples. Within a record breaking time period, they identified SARS-CoV2 as the pathogen and immediately shared this genome sequencing,” said China’s delegate.

China’s WHO Executive Board delegate at the session on Monday.

“The genome sequencing shared immediately by China provided the world with important basic information to be used in clinical diagnostics,…vaccine research, origin tracing, [and] virus evolution studies,” he added.

In the US, “the National Institute of Allergy and Infectious Diseases has shared these [SARS-CoV2 virus samples] more than 4,500 times…with diverse stakeholders in at least 49 countries, including government scientists, academics, and private sector companies for any legitimate purpose required to study, rapidly detect, prepare for, and respond to COVID-19,” said the delegate from the US.

The discussion on pathogen sharing practices and pathways to increase the capacity for the sequencing and analysis of genomes globally will resume on Tuesday, prior to the closure of the 148th session of the Executive Board.

Image Credits: WHO / Christopher Black, WHO.

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