Pandemic
A healthcare worker wearing PPE disinfecting a street in the early days of the COVID-19 pandemic.lder

World leaders have a duty to deliver “an effective, legally-binding pandemic accord” by May to prevent the devastation wrought by COVID-19, according to a group of influential leaders and organisations.

The call came in an open letter issued on Tuesday, the fourth anniversary of COVID-19 being declared a global emergency, and was signed by The Elders, The Global Preparedness Monitoring Board, The Independent Panel for Pandemic Preparedness and Response, Pandemic Action Network, The Panel for a Global Public Health Convention, and Spark Street Advisors.

Signatories include former presidents, prime ministers, health ministers and academics.

The accord needs to ensure that “all countries have the capacity to detect, alert, and contain pandemic threats, and the tools and means required to protect people’s health and economic and social well being”, according to the letter.

To succeed, the accord needs three key ingredients, they assert.

The first is equity, ensuring that “every region must have the capacities to research, develop, manufacture, and distribute lifesaving tools like vaccines, tests, and treatments”. 

Second, the accord needs to map out a “pathway to sustained financing for pandemic preparedness and response”, including “the additional $10.5 billion per annum needed for the Pandemic Fund to fill basic gaps in low and middle-income countries’ pandemic preparedness funding”. 

Thirdly, countries need to be “held accountable for the commitments they make via the accord”, including via independent monitoring and a regular Conference of Parties. 

The World Health Organization (WHO) is hosting the pandemic accord negotiations, with the deadline the World Health Assembly (WHA) in May. However, there are still a multitude of disagreements between countries.

Delay proposed

Last Thursday, during the WHO’s executive board meeting, Poland suggested that it might be better to delay the pandemic accord to ensure an “ambitious, clear and consistent” agreement.  

“It’s very important, especially in reference to a future pandemic treaty, to have an ambitious, clear and consistent document, which will really contribute to the prevention of future crises,” said the Polish delegate.  

“And here I would like to share with you our concern that it would not be beneficial if time pressure leads to a weakening of our ambition, and the quality of the final document.  It is time to ask if we will be ready to present an agreement on a draft pandemic treaty by May 2024?” 

However, Norway, the UK and others  rejected Poland’s suggestion. 

But WHO Director General Dr Tedros Adhanom Ghebreyesus also expressed his concern at the start of the executive board about the gulf between countries on a range of issues at the intergovernmental negotiating body (INB).

Tedros also condemned the global misinformation campaign that is pushing the “lie” that a pandemic agreement will “cede sovereignty to WHO and give the WHO Secretariat the power to impose lockdowns or vaccine mandates on countries”.

“We cannot allow this milestone in global health to be sabotaged by those who spread lies, either deliberately or unknowingly. We need your support to counter these lies by speaking up at home and telling your citizens that this agreement and an amended IHR [International Health Regulations] will not, and cannot, cede sovereignty to WHO and that it belongs to the member states,” said Tedros.

Image Credits: Photo by Maksym Kaharlytskyi on Unsplash.

A gas-fired grill being used in place of a traditional coal-fired one to cook kebabs in Delhi. Burning coal is banned for much of winter as a pollution control measure.

Ten years ago, India’s appalling air pollution made headlines. But $1 billion dollars of investment, new policies and a health crisis have done little to address this situation. Is there still hope? 

If you have a fever, you measure your temperature. If there’s a storm,  you measure the wind and rain. If there’s a stock market crash or boom, you can accurately measure your pennies. It’s the same with the air you breathe. ‘Measure what you treasure’ is the axiom and this needs to be embraced far more whole-heartedly in India’s battle against high air pollution. 

Air pollution is a debilitating global crisis linked to more than 8 million deaths globally, including more than 2 million deaths in India every year as well as losses for the Indian economy estimated at $95 billion. 

It is also a cloud over an ascendant India’s image. As a recent Economic Times editorial pointed out: “Air pollution in Indian cities is real and needs cleaning for both optics and spiration.”

The extent of the country’s air pollution was revealed by recent data published on the completion of five years of an ambitious and landmark government plan, the National Clean Air Programme (NCAP). 

In the last five years, over $1 billion of government funding (INR 96 billion Indian Rupees) has been released to well over a hundred cities to cut air pollution. But only about 60% has been spent, and only 16 cities managed to meet the targeted cuts as per a recent analysis. More and better data can arguably improve policy responses and local interventions. 

The NCAP was launched in January 2019, initially to cut pollution by 20% to 30%. Two years ago, this target was increased to a 40% cut by 2026. 

The programme has also introduced improvements including speedy policy interventions such as shutting schools and banning construction vehicles and old vehicles – most commonly implemented in Delhi. 

The backbone of any such policy intervention is data and in this case air quality monitors. In India, where over four deaths every minute annually are linked to air pollution-related cardiovascular and lung diseases as well as cancers, this backbone needs strengthening. 

The government’s air monitors have increased from 134 five years ago to almost 550 today. These are continuous and real-time. It’s a vast improvement, not just in numbers but geographical spread. Before 2019, Delhi – often in the headlines for its terrible air quality – had far more monitors than massive and populous states like Uttar Pradesh and Maharashtra, roughly the size of the United Kingdom and Italy. 

Since 2022, the number of monitors in Mumbai has shot up by 50% to 30, providing better ground-level reporting that helps to identify local pollution sources. But its air pollution levels are also up 38% since 2019, possibly due to much more post-pandemic construction. 

However, these monitors are simply not enough as most are in the cities and as vast areas are not covered. Some estimates put the number required at 4,000.  An analysis of satellite data recently showed the geographical extent of worsening air pollution across two decades. 

 

Need for more real-time AQ monitors

Real-time or continuous ambient air quality monitoring stations (CAAQMS) have proven to be the most useful in cutting pollution in other countries. Under NCAP, however, about two-thirds of the almost 1,500 monitors are manual. This is not ideal, something that’s been acknowledged by the government itself. 

While the real-time monitors can report air pollution on a minute-to-minute basis, the manual ones are meant to report data only twice a week. 

CAAQMS data is automated, while the manual system is prone to human error, and real-time data is useful for quick policy interventions versus a slow process based on manual monitoring. Some states have addressed this gap of insufficient real-time monitors by using low-cost sensors, especially for rural areas. 

Need for greater data transparency

Pollution in Delhi  typically peaks in late autumn when drifting emissions from crop burning exacerbate the usual urban household, traffic and industrial sources

There is a far larger network monitoring emissions, both air and water, at source, which several categories of heavily polluting industries must also maintain by law. The monitors are known as online continuous emissions/affluent monitoring systems (OCEMS). There are about 3,700 of these. 

The government states the data is open to the public but in most cases, it is not accessible. According to government officials responding to questions in Parliament on 19 September 2020, the reason for this is that much of the data is “reported by industries on self-monitoring and reporting purposes and not owned or generated by the CPCB [Central Pollution Control Board, the main agency responsible], hence not shared in the public domain.” 

This is not only an issue of transparency but also concerns public health and tax-payers money that funds the CPCB, which in turn hosts this data on its central portal. More data and better data with greater transparency can only help improve policy action.

Are funds being used effectively?

So-called ”smog towers” have been a popular political bandaid – but they don’t reduce air pollution.

Perhaps the greatest challenge in reducing air pollution is revealed in the funding and spending, with 40% of the budget allocated to cities unspent as per recent government data. 

It’s a complex issue as a lot depends on local factors ranging from implementation to meteorological issues. For instance, both Greater Mumbai and Kolkata spent over INR 6 billion. But PM 2.5 levels rose 38% in the former and fell 16.7% in the latter. 

Varanasi spent only about a third of its INR 2.29 billion but improved the most, cutting air pollution by 72%. 

Delhi, despite being the most polluted, received only about INR 380 million as per this data, which is less than 51 other cities listed, and it spent only about Rs 10 crores. More research is required to understand how funds are allocated and if they are being used effectively. 

China’s precedent – billions invested in air pollution solutions

China, which had terrible air pollution for years, has spent close to  $3 billion spanning a decade from the time it held the 2008 Olympics. About $1 billion came in loans from the World Bank with funds being disbursed based on achieved deliverables. A study shows that from 2013 to 2022, the annual average concentrations of major air pollutants decreased significantly: PM2.5 decreased 66.5%; SO2 decreased 88.7%, a result of banning coal in and around Beijing; NO2 decreased 58.9% and PM10 decreased 50%.4.

The air pollution action, apart from the ban on domestic coal burning, included new rules and regulations, identifying accountable parties, and public education for behavioural and lifestyle changes.

While India and China’s political systems are fundamentally different – multi-party democracy with free and fair elections vs. single-party rule. a somewhat similar path has been followed in the sub-continent.  In December, the Indian government released a detailed roundup of funds released and actions supported in some 131 Indian cities, reflecting increased attention to the problem. 

There are new rules, there is increased monitoring, there are many studies and research papers and most notably a new, empowered agency, the Commission for Air Quality Management (CAQM), whose jurisdiction is limited to Delhi and the surrounding region. However, accountability and implementation are yet to deliver widespread and deep cuts in India’s pollution.

About a decade ago both Delhi and Beijing were alternatively the most polluted cities in the world. Last year, Delhi was ninth and Beijing was the 489th most polluted globally. 

At least 92 Indian cities exceed WHO’s standard, Delhi most polluted

Back to the NCAP analysis, Delhi’s pollution has only seen a marginal dip of under 6% since 2019, although there have been some successes like the 2023 Diwali, which was the least polluted festival period in the past six years. Fireworks are widely used during the festival and usually send pollution levels soaring. 

The new data shows Delhi to be the most polluted city in India last year, with PM 2.5 averaging 102 micrograms/cubic metre. That’s over 20 times the WHO’s safe standard of five micrograms. In all, 92 Indian cities exceeded the WHO’s guidelines – although for the other 39 cities of the 131 that have received support for air pollution reductions, there is insufficient data to draw conclusions.

More roads and parking lots being built in Delhi – against expert advice

Accepting and following the science is one of the most helpful things officials can do. Offering a glimmer of hope in that direction, Delhi pollution control officials conceded last year that smog towers don’t work – something that scientists and experts have long contended. But political optics won the day and a central Delhi tower was reopened (only to be shut down again over non-payment of salaries.) 

In Ghaziabad, bordering Delhi, the air quality has shown improvement but there were reports of controversial ways allegedly used to ensure lower pollution levels measured, including spraying water at a monitoring site and relocating a monitor from a crowded place to a greener one. These may well be aberrations, but such doubts need to be addressed speedily by officials. 

In Delhi, road dust is removed by vacuums mounted on trucks, and run on polluting diesel generators. A low-hanging fruit could involve switching the fleet of diesel-run air pollution control machines to electric ones. 

Much more pragmatism, however could be shown in promoting clean public transit over gasoline and diesel vehicles – a major factor in fossil fuel emissions. Officials, especially in Delhi and its neighbouring areas, have long neglected bus and pedestrian transit – although there is an excellent metro network. The latter could also provide the backbone for a much broader shift away from private vehicles to urban transit and non-motorized transport. Reducing fossil fuel emissions, of which vehicles are a major component, would reduce air pollution levels in Southeast Asia by more than 65% according to The BMJ assessment. On a global level, some 5.13 million of the estimated total 8.34 million deaths from air pollution annually are from fossil fuel emissions, The BMJ estimates.

Huge air quality gains would be seen from a 50% reduction in fossil fuel emissions in Southeast Asia.

Huge air quality gains from a 50% reduction in fossil fuel emissions – including shifts to clean public and non-motorized transport.Instead, despite recent, high-level policy advice from a Delhi government commission, which advocated for better public transit, more roads and parking are constantly being built for private vehicles in the capital. Vehicles are a significant source of pollution, about 40% in Delhi. So in the very short term, slashing metro fares as pollution rises bears immediate results in reducing ambient pollution. This can be funded by an existing environmental levy on petrol and diesel – about INR 7.8 billion is lying unused. 

Some lifestyle changes are also required both at a policy and community level. For instance, the government’s cooking gas scheme, Ujjwala, has helped about 80 million beneficiaries switch from burning biomass. 

Delhi’s famous kebabs have been traditionally cooked using coal. Coal for cooking is banned for much of winter, as are wood-fired pizza ovens. One solution is a gas-fired grill. But the owner of such a kebab joint can’t wait to start using coal again, insisting that “the taste is better”. Ditching coal-fired kebabs or polluting private vehicles for cleaner options is still a challenge, as the foul air we breathe appears to be insufficient motivation, at least for now. 

Image Credits: Chetan Bhattacharji, Flickr, Care for Air India, The BMJ.

The executive board meeting was wracked by political and ideological conflicts.

An alliance of conservative World Health Organization (WHO) member states and right-wing US organisations has halted the process of granting a reproductive health organisation “official relations” with the global body.

Meanwhile, a similar member state grouping objected to the use of “WHO LGBTQI+ community” in a routine human resources report that the Director-General tabled at the WHO executive board (EB) meeting on Saturday.

These actions have compromised the WHO secretariat’s “technical, science-based approach to health” and independence, according to other member states at the EB, as the “culture wars” once again polarised and paralysed the global health body.

‘Routine’ discussion erupts

Discussion at last week’s EB on an apparently routine agenda item – relations with non-state actors (NSAs) – was initially deferred amid rumours that Russia objected to the WHO secretariat’s proposal to grant official relations to the Center for Reproductive Rights (CRR).

The EB can grant “official relations” to groups with “sustained and systematic engagement in the interest of the WHO,” according to a report to the EB by the Director General.

Official relations are based on a collaboration plan between the WHO and the NSA that is “structured in accordance with the General Programme of Work and Programme budget and is consistent with the Framework of Engagement with Non-State Actors (FENSA)”.

However, an intense discussion finally erupted at the EB on Friday night over the WHO secretariat’s proposal that the CRR be granted official relations. 

Threatening letter from US right-wingers

By that stage, a letter from leading US right-wing groups, fronted by the Center for Family and Human Rights (C-Fam), had also been sent to EB members objecting to relations with the CRR – and bizarrely using misinformation to press their point.

 Extract from Pro-Life Letter on CRR WHO Status

“Giving special status to the Center for Reproductive Rights will further fuel the culture wars undermining the WHO’s mission to tackle health issues. It confirms fears that WHO’s new accord on pandemic preparedness will be used to undermine national laws related to abortion,” they claimed.

This is precisely the argument being used by global conspiracy theorists, many with links to anti-vaccine groups, that are trying to undermine the WHO as it seeks to better equip the world to address the next pandemic.

The US group, which includes organisations with zero connection to health such as the Center for Military Readiness and iRapture, also threatened that CRR recognition would “expose WHO to loss of funding under future pro-life US presidential administrations”.

C-Fam has also led a campaign to prevent the renewal of the US President’s Emergency Plan for AIDS Relief (PEPFAR), endangering the lives of thousands of people, particularly in Africa, who are dependent on PEPFAR for their antiretroviral medication.

‘Incompatible’ rights

The CRR works in the US, Africa, Asia and Latin America to advance women’s and girls’ access to reproductive health services, including abortion in countries where that is permitted.

The WHO, which has already worked with CRR, envisioned that the CRR would support its work on “promoting and disseminating WHO guidance, statements, tools and strategies on sexual and reproductive health and human rights, as and when appropriate, at global, regional and national levels”. 

Yemen kicked off objections to the Center for Reproductive Rights.

Objections to WHO relations with CRR were voiced first by Yemen, speaking on behalf of the East Mediterranean Region (EMRO). 

It claimed that the “efforts” of non-state actors in relations with WHO must “be in line with national laws”, and that the CRR “has principles that run counter to our regional principles”.

Russia concurred, speaking on behalf of several conservative member states where women’s rights and access to reproductive health are restricted – namely  Algeria, Bangladesh, Egypt, Indonesia, Iran, Iraq, Nigeria, Pakistan, Palestine, Saudi Arabia and Sudan.

“States are responsible to their citizens for the activities taken at the side of WHO,” said Russia.

“Taking into account that the Center for Reproductive Health and Rights (sic) is promoting the sexual rights of girls which do not exist on an international level, are fundamentally incompatible with universal recognised human rights and are legally unacceptable in at least half of the WHO member states and are illegal in a number of countries, we are expecting a further sharp reaction from the citizens and organisations of these countries,” added Russia, apparently alluding to the US letter.

“WHO mandate does not provide ground for work promoting sexual rights,” it added.

Meanwhile, Cameroon on behalf of the 47 African member states, expressed “concern about entry into official relations of non-state actors that do not respect the culture and the values of the member states. We would like therefore, to delay the admission process in order to better understand the implications of this decision.”

‘Undermining the secretariat’

The decision on the CRR status at WHO has been referred back to the WHO’s Programme, Budget and Administration Committee (PBAC)

However, a wide range of member states including the US, Canada, Brazil and the European Union, supported the CRR’s application.

Furthermore, Mexico on behalf of 25 member states – largely European and Latin American – warned that the WHO secretariat’s “neutrality and authority to fulfil its functions, as requested by member states through FENSA, is being undermined”, accusing the member states who were objecting of “politicising routine decisions that we should trust the secretariat to make in the framework of its mandate”.

“The strength of WHO lies in its technical, normative and science-based work. We call on all member states, and in particular EB members, to safeguard WHO’s technical, normative and independent role,” Mexico added.

The decision has since been deferred to the EB’s Programme, Budget and Administration Committee (PBAC) meeting in May – but it is hard to predict how the WHO will decide on this polarising issue.

LGBTIQ+ ‘unrecognised concept’

Meanwhile, on Saturday afternoon another controversy emerged over what would normally have been a mundane report – the Director General’s report of the International Civil Service Commission that covers issues related to staff relations, pay scales and benefits. This mentioned the “WHO LGBTIQ+ community” in a section on “diversity, equity and inclusion”.

“We have the use of terminology which spreads concepts which are not recognised by everyone and which are in contradiction with the values and religious beliefs of quite a large number of countries,” said Russia.

Meanwhile, Syria not only asked for the sentence to be removed but urged the WHO “to refrain from including references of this nature and future reports and official documents”.

Conversely, nearly three dozen other countries, including the US, Canada, Europe and a number of Latin America countries,  expressed support for the Director General’s commitment to diversity equity and inclusion, and gender equality in the workforce. 

“We support the efforts of the secretariat to promote a decent working environment for all staff regardless of the community to which they belong, including those belonging to the LGBTIQ+  community,”  said Denmark, on behalf of the 32 nations. 

Ultimately, the EB agreed with the chair’s proposal to “note” the report along with the “divergence of views that exist on the board as a whole”.

Additional reporting by Elaine Fletcher.

Qatar’s Dr Hanan Al Kuwari, chair of the WHO executive board.

The African region is accelerating the implementation of the global roadmap for neglected tropical diseases (NTDs), and 10 countries have eliminated at least one NTD since 2021, Dr Matshidiso Moeti, World Health Organization (WHO) regional director for Africa told the body’s executive board last week.

Togo eliminated four NTD, while Egypt eliminated lymphatic filariasis and trachoma has ceased to be a public health problem in Morocco. Moreover, 42 countries in the region will also be certified free of guinea worm disease before 2025, said Moeti.

The countries were guided both by the WHO global framework and using the Africa region’s Framework for the Integrated Control, Elimination and Eradication of Tropical and Vector-borne Diseases in the African Region  for 2022 to 2030.

“The strides made by the WHO African region and other WHO regions result from strong country leadership and effective partnerships,” said Moeti. 

She emphasised the role of the expanded special project for the elimination of neglected tropical diseases (ESPEN), which enabled countries to pool resources and work closely with the global NTDs community. She urged the board to sustain ESPEN’s funding in order to expand its successes as the region moves to the last miles of NTD elimination. 

“We must maintain and accelerate our progress by sustaining political commitment, enhancing multisectoral actions through effective partnerships and mobilising additional domestic and international funding to achieve the NTD roadmap goals,” Moeti concluded.

The roadmap sets global targets and milestones to prevent, control, eliminate or eradicate 20 diseases and disease groups as well as cross-cutting targets aligned with the Sustainable Development Goals. It is based on three foundational pillars: accelerated programmatic action, intensified cross-cutting approaches, and changing operating models and culture to facilitate country ownership.

Appeal for flexible funds

Senegal expressed its commitment to align with the roadmap “to speed up efforts in prevention, control, and elimination of NTDs”, and urged the WHO to increase flexible funding for NTDs within Universal Health Coverage (UHC) efforts, emphasising the need for collaboration and domestic funding.

Cameroon, aligning with previous statements, praised the WHO’s roadmap and emphasised its commitment to national plans for NTDs. The country outlined specific goals for 2024-2028, including the interruption of Guinea worm disease and leprosy transmission. Cameroon highlighted the need for cross-sectoral collaboration, calling for mobilisation of human resources and domestic financing.

Meanwhile, Germany reiterated its dedication to the fight against NTDs, emphasising the Kigali Declaration on NTDs. Germany dwelt on improving access to quality health services, expanding water, sanitation, and hygiene initiatives, and investing in social security. 

The United States called for internal reforms within WHO to strengthen NTD programs and ensure accountability, transparency, and equity.

Non-state actor the Global Health Council (GHC) called for improved access to new drugs for NTD and better diagnosis ,as central to accelerating progress and meeting the goals of the roadmap.

“We call on member states to sustain and expand investments to accelerate R&D of safe and affordable treatments for NTDs and improved diagnostics, particularly for NTDs with specific unmet needs for use in primary healthcare settings,” the GHC said.

To accelerate market access for diagnostics, it recommended the exploration of regulatory and manufacturing pathways by the WHO and member states, to facilitate simultaneous or aligned prequalification and regulatory approval processes.

While highlighting the inextricable link of NTDs to poverty and inequality, it noted that the increased attention in recent years has brought new resources to the fight against NTDs and fuelled research breakthroughs.

“Yet very significant gaps remain in the arsenal of tools needed to control and eliminate these diseases, underscoring the need for research and development (R&D) of new tools,” it noted. 

Injecting new urgency into the fight against AMR

Member States also discussed antimicrobial resistance (AMR), which they framed as a growing and existential threat that hasn’t seen the sustained political attention it demands. 

The need for new actions is further supported by the WHO’s global action plan on antimicrobial resistance which is coming to an end in 2025.

Germany expressed its support for the WHO’s global AMR initiative and emphasised collaboration with academia, the private sector, and civil society. They asked that attention be on increasing investment and innovation in quality-assured, priority,  new and improved antimicrobials, novel compounds, diagnostics, vaccines, and other health technologies to fight AMR.

Morocco, speaking on behalf of the Eastern Mediterranean region, emphasised the diverse challenges faced by countries in the region. The representative stressed the importance of adapting responses to the varied contexts, emphasising the need for a coordinated, cross-cutting approach. They advocated for strengthening health systems, particularly in vulnerable and conflict-affected areas, and urged action beyond hospitals to include primary care, emergency, and public health programs.

“We believe that in our region, we have a very diverse picture. Therefore, in our response to AMR, we have to ensure that it is adapted to these different contexts if it is to be effective,” said the Moroccan representative.

Second UN high-level meeting on AMR

The US supported the continuation of AMR as a priority for the WHO, especially as the world prepares for the second UN General Assembly high-level meeting on AMR in September.

“We urge WHO to be fully inclusive of all partners, including Taiwan, and support Taiwan’s participation as an observer to the World Health Assembly, truly embodying the meaning of health for all,” said the U.S. representative.

Japan emphasised the importance of political momentum in addressing AMR and called for strategic allocation of resources at the national level. The Japanese representative highlighted the need for international collaboration, citing the example of Taiwan’s significant public health achievements. Japan pledged support for the implementation of National Action Plans on AMR in collaboration with the WHO and member states.

“In the September second UN high-level meeting on AMR, we have a good opportunity to increase the political momentum for countermeasures. The Government of Japan would like to contribute to promoting the implementation of the National Action Plan on AMR,” stated the Japanese representative.

Rwanda, speaking on behalf of the WHO Africa region, emphasised the urgent need to accelerate the implementation of national action plans on AMR and acknowledged progress made by member states in developing these plans.

“We take note of the report and call for effective implementation of all strategic and operational priorities by all members and stakeholders,” said the African region representative.

Problems with national AMR plans

According to the WHO DG’s report on AMR, while 178 countries had developed multi-sectoral national action plans on AMR as at November 2023, only 27% of countries reported implementing their national action plans effectively and only 11% had allocated national budgets to do so. He also fragmented implementation of national action plans in the human health sector, which he observed is often limited to hospitals, despite the vast majority of antibiotic use being outside hospitals. 

“Capacity to prevent, diagnose and treat bacterial infections and drug resistance, and the evidence base for policy development, are very limited in low- and middle-income countries. The integration of antimicrobial resistance interventions in health systems, and inter-dependencies with other health systems capacities and priorities, are often not recognized in strategies for universal health coverage or health emergencies,” the DG reported.

He proposed three urgent strategic priorities for a comprehensive public health response to antimicrobial resistance in the human health sector, notably surveillance of both antimicrobial resistance and antimicrobial consumption; the development of new vaccines, diagnostics and antimicrobial agents; and measures to make these accessible and affordable.

 

Somalia is leading development of new WHA decision that aims to tackle persistently high rates of maternal, newborn and early childhood mortality.

WHO’s director general says the battle against maternal mortality has stalled; Somalia calls for a new WHA resolution committing to stepped-up action on maternal and child deaths, a leading global health inequality. 

The battle against maternal mortality has stagnated and high rates of deaths continue to plague sub-Saharan Africa, as well as other low- and middle-income nations, said World Health Organization (WHO) Director-General Dr. Tedros Adhanom Ghebreyesus on Friday. 

“Progress has stalled, and still, a woman dies every two minutes,” he stated.

He was referring to a bleak report from February 2023 showing the world is far off track for achieving Sustainable Development Goal (SDG) target 3.1 for reducing maternal deaths to less than 70 per 100,000 live births. 

As of 2020, there was an average of 223 deaths of mothers per live births and in sub-Saharan Africa the death rate was 536 per 100,000 live births, according to the UN inter-agency report.

Friday’s debate at the WHO Executive Board meeting revolved around a draft World Health Assembly (WHA) decision led by Somalia for consideration at the upcoming WHA in May (WHA77). It is aimed at addressing the stark global disparities in maternal, newborn and child health that persist, falling far short of the targets set out in the 2030 Sustainable Development Goal targets on reducing maternal mortality (SDG 3.1) and ending preventable deaths of newborns and children under five years of age ( SDG 3.2). 

Opening the discussion, Somalia's representative painted a vivid picture of the leading factors, which are deeply rooted in health inequalities between high- and low-income countries. 

"The tragedy of this statistic is that most of these deaths in mothers and their children are preventable or treatable with known effective interventions," he lamented.

“We know that 70% of maternal deaths are due to direct obstetric causes,” he said, reciting a list of factors including hypertension, sepsis, abortion and embolism.  

Health system bottlenecks, including cost and capacity constraints, are responsible for an estimated 30% of deaths, he said.

 “We are deeply concerned by these preventable tragedies," he added. “The intent of the resolution is to galvanise action on the direct costs of maternal and child mortality, and also to propose interventions to address the root causes.”   

Adding to the discussion, Afghanistan's representative highlighted the unprecedented challenges faced by the nation. Political turmoil, economic collapse and restrictive Taliban policies have created barriers to essential healthcare services, particularly affecting women.

"The lives and well-being of millions of Afghan women and children hang in the balance. We cannot remain passive observers in the face of such a humanitarian crisis," urged Afghanistan's representative.

Many countries are off track

A draft decision was proposed by Egypt, Ethiopia, Paraguay, Somalia, South Africa and United Republic of Tanzania to accelerate progress towards reducing maternal, newborn and child mortality in order to achieve SDG target 3.1 and SDG target 3.2 after data was shared that showed it is likley that more than four out of five countries (80%) will not achieve their national maternal mortality targets, 63 countries will miss their neonatal mortality targets and 54 countries will miss the under-five mortality target by 2030.

The draft decision called for focused, urgent and coordinated course-correcting, and country-led action for maternal, newborn and child survival.

According to the DG’s report, there is ample evidence on effective interventions to monitor and improve the health and well-being of women and children. He noted that multiple strategies have been developed that incorporate this evidence so as to support countries in identifying the high-impact interventions that should be included in their national health sector plans. 

These strategies include the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016−2030); Ending Preventable Maternal Mortality; Every Newborn Action Plan; the Roadmap to Combat Postpartum Haemorrhage between 2023 and 2030; the Child Survival Action call; and the Global Accelerated Action for the Health of Adolescents initiative. 

He noted that countries that are off track from reaching 2030 maternal and child mortality targets could accelerate progress toward national and global health targets by adopting such strategies and implementing them at scale.

Global Support and Urgency

A wide range of countries, from the United States to Ethiopia, speaking on behalf of the WHO African Region, voiced strong support.

 The United States voiced its unwavering support for the resolution, emphasising strategic approaches to reduce preventable maternal, newborn and child deaths. 

"We recognize that ending preventable maternal newborn and child deaths is critical to achieving universal health coverage and the promise of the SDGs," stated the U.S. representative. 

“There is strong consensus among many member states around several strategic approaches to accelerate progress by expanding coverage and equitable access to an integrated package of:  

  • High quality essential health and nutrition services for women and children. These approaches include first, reinvigorating country leadership and commitment to accelerate progress on this crucial unfinished agenda.
  • Second, adopting a multi pronged approach to maximize investing resources and attract reclaiming and third, aligning and reorienting our investments to strengthen primary healthcare delivery capacity.
  • Finally, prioritizing the hardest to reach the poorest remotest and historically marginalized communities."

Other member states echoed those messages, calling for intensified technical assistance to catch up after years of progress lost, including during the COVID pandemic.

“We are extremely alarmed about being off track with targets,” said Ethiopia, on behalf of the African Region of the WHO, which includes 47 Sub-Saharan African member states. Countries in the regions are also “still struggling” with the legacy of the COVID-19 pandemic, including a present-day shortage of healthcare workers and a socio-economic crises. 

Gender equality and universal access to sexual and reproductive health services

Germany, Norway and others call for universal access to reproductive and sexual health services as key to reductions in maternal mortality.

While the proposed resolution, designed to galvanise global action, could be adopted during the next WHA, some key portions of the draft text, remains in [brackets] - signaling a lack of member state agreement. Notably, these paragraphs revolve around gender equality; empowerment of women and girls; and access to sexual and reproductive health services  - reflecting their political sensitivity for many member states.   

Even so, Germany, Norway and Australia, as well as a range of non-state actors, underlined the importance of women and girls' education as well as "universal" access to sexual and reproductive health services as critical to reducing maternal mortality. 

“Access to sexual and reproductive health and rights including access to free and safe abortion is crucial. Women's rights to bodily autonomy is an essential part of achieving maternal health,” said Norway. “We find it encouraging that levels of adolescent pregnancy and childbearing have declined, but the fact that that 1.5 out of 1,000 young girls give birth before their 15th birthday is still far too many.” 

WHO commends decries stark statistics

WHO's Bruce Aylward decries the stark disparities between rich and poor countries in maternal, newborn and child mortality at WHO EB 154

Dr Bruce Aylward, Assistant Director-General, Universal Health Coverage, Life Course, commended Somalia for reigniting the conversation about a crucial yet alarming global issue, but he expressed concern for the challenges ahead.

"We keep talking about this as these are preventable deaths, and indeed they are, but sometimes that sounds like well, this is an easy problem to solve," Aylward said. "And again, as we've heard, this is a very difficult problem to solve."

He noted the uphill battle against systemic challenges like workforce shortages, out-of-pocket payments, and inadequate infrastructure.

Tedros - ‘stay hopeful’ 

"While there are huge barriers, there has been some very rapid progress in countries where the political will was actually there, both to reorient their systems toward a primary health care approach, and to make the reduction of maternal mortality a national priority," Aylward stated. 

Tedros stressed the need for tailored measures: "The progress is not there, and the recent report from February 2023 is showing that we are off track, and chances to achieve the SDGs are actually dwindling. But still, I think we need to stay hopeful and we should believe that we can achieve it, especially if we do the right things," he asserted.

He called for political will and commitment from every country: "But as we have said when we presented the DPW 14 maternal and child health, that will be one of the top priorities, and we hope together to make a difference and achieve the SDGs by 2030."

As the session concluded, Dr. Tedros highlighted the board's readiness to proceed with the report and draft decision, signifying the collective acknowledgment of the urgent need to accelerate progress in reducing maternal, newborn and child mortality.

Image Credits: UN, World Bank .

New WHO initiatives on climate and plastics follow on from a first-ever Health Day at a UN climate summit (COP28) in December 2023 in Dubai.

A first-ever WHO initiative to join global negotiations on a plastics treaty, as well as the first WHO decision on climate and health since 2008, are set to come before the World Health Assembly in May, following a strong show of member state support for both measures on the closing day of this week’s Executive Board meeting in Geneva. 

The draft decision on climate change and health, led by eight member states, including Peru, Kenya, the United Arab Emirates and the United Kingdom, reflects the wealth of new evidence on the linkages between climate and health that have come to light over the past 16 years. The draft includes an estimated 5% contribution of the health sector to climate emissions, although that data also remains bracketed leaving in question if it will be included in the final draft. 

With regards to a treaty on plastics pollution, currently being negotiated under the leadership of the UN Environment Programme (UNEP), WHO told EB members that it wants to address health aspects of that long-neglected agenda in the context of the plastic treaty negotiations.  

Plastic waste is contaminating air, land and water resources, and the food chain, with potential health harms, experts have warned.

It proposes that the agency provide formal health-related inputs into the new treaty instrument, including about particularly hazardous plastics or polymers that should be phased out, as well as playing an active role in a UN science-policy panel on plastics pollution. 

Both the climate and the plastics initiatives appeared to garner wide support from the 34-member Executive Board, as well as member states observing the proceedings from across the Americas, Europe, Asia and Africa.

“We support the WHO to take a more active role in global chemicals management to protect human health,” including inputs to the plastics treaty now being negotiated on “the importance of the issue of plastic pollution, chemicals and microplastics and potential harmful implications” to health,” said  Switzerland, speaking on behalf of nine member states, including Canada, Colombia, Costa Rica, Excuador, El Salvador, Mexico,Panama and Norway. 

One member state, Russia, however, voiced strong objections to the twin initiatives. Climate change is already a part of WHO’s programmes; addressing the health issues related to plastics pollution goes beyond WHO’s mandate, Russia’s representative to the EB said. 

Civil society complains about lack of reference to fossil fuels  

Maldives delegate links tobacco and plastics pollution.

At the same time, a range of non-state actors rapped the WHO member states for failing to even refer to “fossil fuels” as a driver of climate change in the draft climate and health decision, with one NGO suggesting that WHO should treat fossil fuels like tobacco.

“We urge member states to take a stand against the fossil fuel industry and its influence as done with the tobacco industry,” said one NGO, Public Services International. The agency’s remarks were echoed by at least three other civil society groups but by few member states.

The NCD Alliance asked member states to incorporate language in the draft decision “calling for reductions in fossil fuel use as the most significant driver of climate change and air pollution.” 

Responding to those remarks, WHO Director General Dr Tedros Adhanom Ghebreyesus, described fossil fuel phase out as “crucial.”  But he stopped short of explicitly asking that such a reference be included in the draft decision being negotiated.  

“What was agreed during the COP28, the phase out of fossil fuels is very, very crucial,” Tedros said. “And that’s not without reason, because fossil fuels contribute more than 70% of greenhouse gas emissions – fossil fuels, meaning oil, natural gas and coal. 

“So that’s where the focus should be in order to get the 1.5 degrees centigrade [ceiling of global warming]. That was already agreed. So thank you so much for underlining the importance of focusing on fossil fuels, and as many of you have rightly said, there is a good reason to do that.” 

With respect to tobacco and fossil fuels, the Maldives highlighted the inter-linkages between the issues in more than just rhetoric. 

“The huge amount of plastic waste produced by the tobacco industry, some of which are disposed with their deadly chemical content, must be addressed in this treaty in a way that does not allow the tobacco industry to greenwash their tactics.” stated the Maldives delegate, commending WHO for its “comprehensive and … focused approach in supporting vulnerable nations” on both climate and plastics pollution. 

Tame, but still urging a more proactive stance  

 

Dr Tedros Adhanom Ghebreyesus has strong words about fossil fuel phase-out but member states avoid issue in draft WHA decision.

Indeed, the new WHA initiatives create a much broader scope for action on interlinked climate and plastic pollution issues, even if the framing and terms used reflect delicate balance of member state interests and the organization’s inherent political conservative. 

Some 20% of fossil fuels production eventually winds up as plastics products, highlighting the synergies that exist between unsustainable energy production and unsustainable  consumption and disposal of plastics products.  

WHO’s 2008 resolution on climate and health focused only on a very brief, discrete set of issues related largely to health “vulnerability” to climate change and “adaptation” measures the health sector could promote. The new draft decision carves out new territory, even if hesitantly, urging health actors and health systems to play a more proactive role in the climate policy arena. 

That includes not only active initiatives to reduce health sector emissions, but public awareness-raising about the “interdependence between climate change and health,” as well as intersectoral  “engagement in the development of climate and health policies, fostering recognition of health co-benefits and sustainable behaviour…” that address “ the root causes of climate change.” 

Finally, the draft document calls upon WHO to clean up its own house by “firmly integrating climate across the technical work of the WHO at all three levels” and develop a “Roadmap to Net Zero by 2030 for the WHO Secretariat, in line with the UN Global Roadmap.” That will be a big lift for an agency whose pre-pandemic carbon footprint was one of the largest in the UN family – from air travel to routine procurement of heavy-duty diesel vehicles for regional and country offices. 

“We’re not talking about the future. It’s about now,”  declared Tedros with respect to the initiatives, saying that, “both mitigation and adaptation is key.”

He said: “We need to push while saying that, by the way, the health sector also contributes 5% [of GHGs]. And that’s why we should start from the health sector as well.”

Greening health systems 

Map of ATACH members- green shading shows states committed to “low carbon and sustainable” health systems.

Indeed, the boldest feature of the draft WHA decision is the explicit request to WHO to support member states’ development of “decarbonization” of “health systems, facilities and supply chains.” 

That “request” also refers in detail to the long chain of climate impacts associated with the enormous quantities of water, energy, food, medical equipment, drugs and chemicals that modern health facilities consume, and the waste and emissions they produce.  

The draft promotes further development of an “Alliance for Transformative Action on Climate and Health (ATACH),” a new WHO-led platform on development of sustainable health systems.

ATACH, launched in June 2022, has gained further traction since WHO helped lead the first-ever Health Day in December 2023 at the UN Climate Conference in Dubai. Some 75 countries are now committed to creating “low-carbon health systems” and 29 countries even setting net zero targets for sometime between 2030 and 2050.   

But limiting GHG emissions of health systems should only be promoted “when doing so does not compromise health care provision and quality, in line with relevant WHO guidance,” the draft decision recommends. 

The draft text also remains full of brackets, suggesting continued member state disagreements on the fine points of language linking climate action to factors like “healthy environments … more sustainable life choices” and “air quality,” and even to longstanding legal agreements like the United Nations Framework Agreement on Climate Change and the 2015 Paris Climate Agreement.  

More attention to noncommunicable diseases 

Norway, the US, and a number of non-state actors also underlined the importance of climate impacts on non-communicable disease, particularly with regards to extreme heat, with the NCD Alliance calling on member states to include reference to NCDs, as well as to fossil fuels, in the new WHA climate decision. 

 

Image Credits: AfricaNews, WHO , WHO .

Immunisation progress is uneven across regions and countries.

Global levels for routine immunisations are still lagging behind pre-pandemic rates, with uneven progress in different countries, World Health Organization (WHO) officials said at a session of the Executive Board on Friday.

In its report to the EB, the WHO has documented that the current progress is not enough to meet the WHO’s Immunization Agenda for 2030.

Childhood vaccinations have been amongst the worst-hit, member states agreed. The number of zero-dose children who did not receive any DTP (Diphtheria, tetanus, and pertussis) vaccine doses in 2022 stood at 14.3 million, well above the 2019 level of 12.9 million children.

“In the African region, the number of zero-dose children increased from 7.64 million in 2021 to 7.78 million in 2022 − a 25% increase since baseline year 2019,” the WHO report stated.

On the positive side, many countries are preparing to roll out the HPV vaccine for protection against cervical cancer – the fourth most common cancer amongst women that killed an estimated 342,000 in 2020.

“Despite initial signs of recovering global coverage rates of DPT vaccines still hovered below pre-COVID-19 pandemic rates,” a representative of Gavi, The Global Vaccine Alliance, told member state participants at the meeting.

The Gavi representative described WHO’s target of reducing the number of zero-dose vaccine children by 50% by 2030 as “ambitious and urgent.” The Gavi delegate also encouraged countries to include the new malaria vaccine and HPV vaccines in their national immunisation programmes.

 

Vaccine roll-outs globally have been lower than the targets due to the pandemic-related disruptions.

Access and cost continue to be barriers

Several countries in Africa are reporting outbreaks of measles as one in five children do not have access to vaccines.

Cameroon, speaking on behalf of 47 countries in WHO’s African Region, said that Africa needs more financing mechanisms like Gavi, transition grants, debt swaps, and development bank loans.

“It is undeniable that immunisation is worth investing in, both as core primary service as well as a key measure for pandemic preparedness and response,” the representative said.

Not just low-income countries but middle-income countries, as well, spoke of the cost of vaccinations as a major financial burden.

“The rising costs of new vaccines present a significant hurdle, impeding their seamless integration into national immunisation programs, especially in middle-income countries,” Malaysia’s representative said. “It remains critical for global partners to explore avenues that enable the provision of more affordable vaccine supplies within these regions.”

Day five of the 154th session of WHO’s Executive Board.

14% of Yemeni children under the age of one have received no vaccinations at all

Apart from the immunisation stalled by the pandemic, raging conflicts have meant that children are going without routine immunisation. In Gaza, there is no functioning healthcare system to speak of at the moment, as Health Policy Watch reported from an earlier session.

In Yemen, around 80% of the population and one-third of the country is controlled by the Houthis, a rebel group.

“We face several challenges,” the representative of Yemen told the board. “Fourteen percent of children under one have received no vaccine doses whatsoever in the northern region, which are not under the control of the legitimate government.

“The Houthis [rebel group] are not putting in place national vaccine campaigns, and this will have serious consequences on the children of Yemen, as well as on neighbouring countries and the world in the future.”

Backed by Iran, Houthi rebels are fighting to overthrow the recognised government in Sanaa, and now control significant swathes of the country. The group has in the past called COVID-19 vaccines “biological warfare.”

Countries prepare for HPV rollout

Several countries described their plans to roll out the HPV vaccine for adolescent girls and young women. Timor-Leste said that it plans to launch HPV vaccination later this year.

Along with Gavi, the European Society for Medical Oncology (ESMO) also made a statement supporting the ambitious HPV rollout.

“Given that prevention offers the most cost-effective, long-term strategy for cancer control, ESMO urges the WHO member states to include the routine vaccination of girls and boys against human papillomaviruses in their national programmes,” ESMO’s representative said.

While Thailand appreciated the global push, the representative from the country offered a note of caution.

“Too much confidence in the HPV vaccine can be harmful as the protection rate against cervical cancer is only 70%. Cervical cancer screening and avoiding unprotected multiple sex partners are still crucial,” the representative from Thailand said.

Image Credits: Unsplash, WHO, WHO.

The United States described a four-pronged strategy to accelerate the eradication of polio globally at the WHO Executive Board session on poliomyelitis on Thursday.

No. 1: Halt circulation in Afghanistan, Pakistan

The first action, the U.S. representative said, would be the intensification of efforts to halt the circulation of the wild poliovirus in Afghanistan and Pakistan by the end of December 2024. Synchronised campaigns across borders would be imperative, with the representative noting, “Decisive action now can pave the way for a polio-free future.”

No. 2: Surveillance, campaigns, community engagement

The second action would be closing surveillance gaps, conducting high-quality campaigns and community engagement in the African region, where there continues to be persistent variant polioviruses.

“These are not just strategies; they are indispensable keys to our success in eradicating polio globally,” the representative said.

The U.S. also urged member states to support incremental measures for rebuilding capacity in high-risk countries. The representative highlighted the unique challenges faced by these countries, calling for solidarity and support to rebuild health infrastructure.

The United States speaks at the World Health Organizations Executive Board meeting in a session on eradicating poliomyelitis.
The United States speaks at the World Health Organizations Executive Board meeting in a session on eradicating poliomyelitis.

No. 3: Alignment of eradication, containment efforts

The third pillar calls for alignment of eradication and containment efforts.

“Eradication and containment must go hand-in-hand,” the representative said.

All member states were urged to intensify actions to speed up the progress of poliovirus containment and certification.

No. 4: Immunisation

Lastly, the U.S. underscored the importance of integrating polio eradication efforts with routine immunisation activities.

Recognising the challenges of reaching communities not responsive to standalone polio campaigns, the representative said, “Integration with routine immunisation is crucial to reaching every child, even in the most remote areas.”

Reiterating support for a comprehensive approach, the U.S. urged donors to expedite and increase their contributions to polio eradication.

“Continued investments are not just essential; they are the lifeline that ensures we reach all children, multiple times, and ultimately end the polio scourge globally,” she said.

Tackling persistent challenges

WHO member states stressed the global commitment to fighting the spread of polio.

The Afghan representative addressed the specific challenges his country faces in eradicating the disease from the country. He said that despite some successes, the country faces several impediments to implementing crucial house-to-house campaigns, an important component of any polio eradication strategy.

“The inability to conduct these campaigns jeopardises the effectiveness and efficiency of our collective effort to eliminate polio on the ground,” the representative said.

He added that there was a negative impact from not being able to reach vulnerable children specifically. And he stressed the need for national ownership over the polio eradication program and collaboration with international institutions, as well.

Afghanistan speaks at the World Health Organizations Executive Board meeting in a session on eradicating poliomyelitis.
Afghanistan speaks at the World Health Organizations Executive Board meeting in a session on eradicating poliomyelitis.

The Afghan representative also called for investments in human capital, highlighting the pivotal role that the right professionals can play in eradicating the disease and ensuring it remains eradicated. The representative also noted that technology could revolutionise the program, making data collection, monitoring, and response strategies more efficient.

Challenges in the Eastern Mediterranean region

Yemen, speaking on behalf of the member states of the Eastern Mediterranean region, acknowledged the progress made in reducing poliovirus circulation in 2023. However, challenges persist, the representative said, particularly in preventing the virus from gaining a foothold in previously identified reservoirs.

The representative stressed, “We must reach all children with polio vaccines and strive to prevent other vaccine-preventable diseases.”

The call for global solidarity and action was reinforced, urging the WHO to provide financial assistance to countries facing internal and external obstacles, including those managing refugee influxes. The importance of routine immunisation and vaccination campaigns against polio was emphasised, particularly in regions like Yemen.

African region’s concerns and call to action

Representatives from the African region expressed gratitude for poliomyelitis being placed on the WHO Executive Board agenda, highlighting the collective efforts to end polio circulation. Concerns were raised about the persistent circulation in specific regions of the Democratic Republic of the Congo. Delays in introducing the polio vaccine and challenges in the move to the novel oral polio vaccine were also noted.

Comoros speaks at the World Health Organizations Executive Board meeting in a session on eradicating poliomyelitis.
Comoros speaks at the World Health Organizations Executive Board meeting in a session on eradicating poliomyelitis.

Comoros, speaking on behalf of the African region, urged countries to act on recommendations, improve information campaigns, and ensure vaccination coverage, especially for low or zero-dose children. The increased risk of a major epidemic outbreak due to a drop in immunity across the continent was described as a significant concern. The representatives called for further mobilisation of resources to implement strategies preventing cross-border and international transmission.

The world’s only public health emergency of international concern

Aidan O’Leary, director of Polio Eradication at WHO, while commending member states and partners for their commitment and support, highlighted the significance of the ongoing efforts.

“Polio is the only public health emergency of international concern in the world as we speak today,” O’Leary said.

He emphasised the collaborative nature of the fight against polio, noting the vaccination of over 800 million children globally in 2023.

The director also stressed the importance of vigilance in surveillance in the face of emerging variants concentrated in specific regions. He reiterated the challenge of reaching zero-dose children and the necessity of maximising coverage through innovative delivery modalities. O’Leary also emphasised the ongoing innovation at every level, citing the prequalification of the novel oral polio vaccine as a significant milestone.

“We are committed to making every effort [in] … 2024,” O’Leary said.

Meanwhile, WHO Director-General Dr. Tedros Adhanom Ghebreyesus described the final leg of the polio eradication journey as the most challenging.

Despite the difficulty, he conveyed optimism, stating, “The finish line is within reach.”

WHO Director-General Dr. Tedros Adhanom Ghebreyesus reveals the WHO report on poliomyelitis eradication at the Executive Board meeting on January 25, 2024.
WHO Director-General Dr. Tedros Adhanom Ghebreyesus reveals the WHO report on poliomyelitis eradication at the Executive Board meeting on January 25, 2024.

In his report on poliomyelitis eradication, Tedros called for the implementation of risk mitigation strategies in highest-risk polio-free areas, notably in the Afghan city of Kandahar. He also revealed the ongoing conflict in Sudan “continues to hamper the response to the new outbreak of circulating vaccine-derived poliovirus type 2, detected in 2023.”

To direct future polio transition efforts, Tedros’ report revealed a post-2023 strategic framework for polio transition is already being developed, and it is based on a theory of change and will build upon lessons learned from the strategic action plan on polio transition (2018–2023).

“The operationalisation of the framework will begin in 2024; it will be closely aligned with evolving epidemiology and polio eradication timelines, and will address the recommendations of the Polio Transition Independent Monitoring Board outlined in its most recent report published in July 2023. This work is essential to ensure that the eradication gains once made are sustained,” the report stated.

Focus for 2024 and beyond

In 2024, the report revealed the focus of the WHO will be on updating the polio post-certification strategy, with the aim of “aligning it with updated eradication timelines and reflecting new developments in post-certification policy, strategy and research.”

The strategy will also be aligned with the post-2023 strategic framework for polio transition.

“Working groups have been established for each key thematic area. During this process, efforts will be made to identify and apply lessons learnt from the 2016 switch from trivalent oral polio vaccine to bivalent oral polio vaccine in routine immunisation programmes, in support of preparations for the eventual cessation of all oral polio vaccine use from routine immunisation programmes,” the report stated.

Following the successful eradication of wild polioviruses globally, the report revealed that the use of all remaining oral polio vaccines in routine immunisation programmes will end. The aim of this action, the DG reported, is to eliminate the risk of vaccine-derived polioviruses.

Image Credits: Screenshot.

WHO Director General Dr Tedros Adhanom Ghebreyesus  choked back tears at end of lengthy EB session, during appeal for peace in Gaza.

Poland on Thursday suggested that it might be better to delay the approval of a new World Health Organization (WHO) pandemic accord, beyond the planned May 2024 deadline – so as to get to an “ambitious, clear and consistent” agreement.  

The Polish trial balloon seemed to break ranks with the drumbeat of recent statements by WHO and other member states that negotiations should conclude this year – even if the present pathway to rapid agreement seems strewn with obstacles – including only a few more planned meetings of WHO  member state negotiating teams.   

Poland’s comment came during a marathon 12-hour WHO Executive Board meeting Thursday that veered sharply from topics such as pandemic preparedness and biosafety to the Gaza and Ukraine war, with the latter dominating most of the day’s session. 

‘Lies’ and Entrenched Positions Undermine WHO Pandemic Negotiations

“It’s very important, especially in reference to a future pandemic treaty, to have an ambitious, clear and consistent document, which will really contribute to the prevention of future crises,” said the Polish delegate in remarks about the member state negotiations over a new pandemic accord and revisions in the International Health Regulations (IHR), which are supposed to be completed by May 2024.  

“And here I would like to share with you our concern that it would not be beneficial if time pressure leads to a weakening of our ambition, and the quality of the final document.  It is time to ask if we will be ready to present an agreement on a draft pandemic treaty by May 2024?” 

Norway, however, appeared to push back against Poland’s suggestion that the deadline for conclusion of a pandemic accord be delayed. 

“The deadline for INB and IHR negotiations must be used as a historic opportunity to ensure the world is better able to prevent and respond to pandemics,” said the Norwegian delegate. 

Other countries reaffirmed their commitment to reaching an accord without stating a date. 

“On the pandemic accord, the United Kingdom remains committed to reaching agreements with other member states,” stated the UK. 

Palestine accuses Israel of genocide; Israel charges WHO of ‘collusion’ with Hamas

Gaza and Ukraine are only two amongst the more than dozen Grade 3 health emergencies related to conflict, climate and disease outbreaks that the organisation is coping with right now.   The EB discussions reflected the deep demands now being generated by conflicts – as compared to a virus – on the time of the WHO governing bodies, as well as the technical work of the global health agency.  

And the sharp geopolitical rifts that seem to have plagued the global body even more severely since the winding down of the COVID pandemic were again plainly evident Thursday.

Listing of WHO Grade 3 Emergencies as of September 2023, before the outbreak of the Hamas-Israel war

In the EB debate over Gaza, Palestine, a WHO observer state, accused Israel of carrying out deliberate attacks on civilian populations and health facilities during its invasion of Gaza in military actions amounting to “genocide” – an issue now before the International Court of Justice in The Hague. On Friday, the ICJH issued an interim ruling that Israel must take more active measures to prevent indiscriminate killing and ensure basic services and humanitarian reaches Gaza Palestinians – although the court stopped short of ordering Israel to halt its military campaign.

Israel, meanwhile, accused WHO of  “collusion” with Hamas, turning a blind eye to the use of hospital infrastructure for military aims and concealment of Israeli hostages.  

Neither WHO Health Emergencies Director Mike Ryan nor Director General Dr Tedros Adhanom Ghebreyesus responded to the Israeli charges against the global health agency at the EB session, although Tedros on Friday issued a denial on X (Twitter). 

“No one and nowhere is safe in Gaza. So far around 26,000 people have died, 8000 are missing, and close to 64,000 are injured in the conflict, and 1.7 million people are displaced,” said Tedros, repeating calls for a cease fire.

“If we look for a solution, it’s always possible. It’s only the will that’s required, and I’m a true believer because of my own experience that war doesn’t bring solutions – except more war, more hatred, more destruction.

Fighting back tears at the reference to his own childhood in a war-torn region of Ethiopia, now in Eritrea, he pleaded: “So let’s choose peace. Let’s resolve this issue politically.”

Gaza humanitarian crisis 

France calls for “immediate and sustainable cease-fire” in Gaza.

Discussions on Gaza focused on WHO’s latest report on Health Conditions in the Occupied Palestinian Territories, describing barely functioning Gaza hospitals, and a civilian population trapped by war, hunger, thirst and displacement. A slight technical revision to an EB resolution on more humanitarian aid to Gaza, already approved in a special EB session in December, was approved. 

A large bloc of Islamic and Middle Eastern countries, supported by the African Region, and Cuba, Colombia, Nicaragua and Venezuela, blasted Israel’s conduct of the war, with some, such as Cuba and Colombia, also describing Israel’s actions in Gaza as tantamount to war crimes. 

The United States, Germany and most other European nations focused on the urgency of getting more humanitarian aid into Gaza. They also called for Hamas to release the more than 100 Israeli and foreign hostages still held in Gaza, after a November cease-fire broke down. Around 240 hostages were taken by Hamas in its bloody 7 October incursion into Israeli border communities, which killed 1,200 people and triggered Israel’s military invasion. 

France called for an “immediate, sustainable cease fire” while the United Kingdom spoke in terms of an “immediate humanitarian pause as a vital step towards building a sustainable, permanent cease-fire.” 

A few states, notably Germany, Belgium and New Zealand denounced Hamas actions, directly or indirectly.  

“We reiterate our condemnation of Hamas terrorist attacks, including the systematic use of sexual violence and the abuse of hospitals and civilians as human shield,” stated Germany, which also referenced “the right of Israel to defend itself in line with international humanitarian law.”

“Medical facilities must never be used for military purposes, and must never be the object of attack,’’ added New Zealand’s delegate.  

Gazans have no health or human dignity 

Ryad Awaja Aouadja, Consul at the Palestinian Mission to the UN in Geneva

For their part, both Israeli and Palestinian delegates described the impacts of the war-time violence in highly emotive terms.  

Palestinian delegate, Ryad Awaja Aouadja, described the how a young female double amputee had to be carted to a makeshift toilet in a refugee camp by her parents.

“I have no words to describe what is happening in the occupied Palestinian territories,” said Aouadja.  

“The whole world knows about the humanitarian disaster there, the catastrophic health situation in the Gaza Strip. And we’re still hearing pretexts, justifications, supposedly for the occupation, justifications for the destruction committed by the occupying power,” he said. 

“How can we accept this devastation, this genocide, the total destruction of health establishments and facilities?

“How can you talk about health and human dignity when what you are seeing is a situation where the rights of Palestinian women and girls to get sanitary napkins to get nappies are being denied?…. And you have so many dead, most of them women and civilians? 

“Where is health? Where is hygiene? Where’s dignity when you have a young girl who’s had to have her legs amputated and be carried by her parents to some kind of toilet? … We have 1.5 million people who’ve had to leave their homes because their homes have been destroyed by the occupying powers and they’ve had to go and live in overcrowded refugee camps,

“We know that for 75 years now, we’ve had the occupation going on there,” added Aouadja, referring to the 1948 Arab-Israeli war that followed the UN partition of Palestine and the creation of the state of Israel.

“…Talking about self defense no longer makes any sense. We’re just talking here about collective punishment about vengeance, about genocide against the Palestinian people,” Aouadja added.

“If you look anywhere on the internet, you can see that that is the case…. I therefore call on the international community to shoulder its humanitarian, ethical and moral responsibility to put an end to this military aggression to put an end to this violence,” he concluded, drawing applause from several dozen EB participants at the end of his comments. 

Israel – WHO ‘collusion’ with Hamas 

Waleed Gadban, Consul at the Israeli UN Mission in Geneva

Israel’s ambassador, Meirav Eilon Shahar, quoted testimony by former Israeli hostage Moran Stela Yanai, who described being taken to a Gaza hospital on 7 October, after being beaten and abducted from a music festival – where she was examined by a Gazan physician who “knew I was kidnapped and did not do anything.”

Shahar also cited Israeli military reports of Hamas tunnels, munitions and weaponry found in and under at least five major Gazan hospitals, including Shifa and the Indonesian Hospital, where corpses of five Israeli hostages also were found. “Every single hospital that the IDF searched in Gaza, it found evidence of Hamas’ military use,” charged Shahar. “Hamas has militarised the entire civilian area of the Gaza Strip, as a matter of premeditated strategy.”

View interactive compilation of Hamas abuse of hospitals >> 

“These are undeniable facts that WHO chooses to ignore time and time again. This is not incompetence; it is collusion. The WHO knew hostages were held in hospitals and that terrorists operated within. “Even when presented with concrete evidence of what was happening below ground and above ground, about the weapons, the headquarters, the closed rooms, WHO chooses to turn a blind eye, jeopardising those they are meant to protect,” she said. 

Her comments were refuted by Tedros in an X post on Friday – sparking yet another round of exchanges.  

At the conclusion of Thursday’s session on Gaza, Israeli delegate Waleed Gadban, described the EB debate on Gaza as a “masquerade with no limits.” 

“Syria bombarded more than half of its own civilian population and Israel facilitated access to more than 10,000 trucks into Gaza and no one has mentioned that,” said Gadban, an Israeli Druze who delivered his closing remarks in Arabic.

“In Yemen, people are suffering from famine… We need to call a spade a spade. Iran launched a humanitarian appeal for the people in Gaza. I can tell you that the people in Gaza would be better off if Iran didn’t furnish weapons to terrorists.”  

Russia and Ukraine 

Ukraine’s delegate to the WHO Executive Board

Later Thursday, a WHO update on the health and humanitarian situation in Ukraine, following on from  2022 and 2023 World Health Assembly resolutions denouncing Russia’s 2022 invasion, served as the focus for yet another politicized debate over health as a casualty of war during the Thursday session. 

Russia blasted the WHO follow-up  report as unnecessary and “politically motivated” by NATO allies.

In his closing remarks, Tedros told the Russian Federation that WHO had maintained “strict neutrality” in its follow-up on the Ukraine health and humanitarian situation.  

The WHO report details some 1,300 Russian attacks on health care facilities in Ukraine, since the start of the conflict. However, the health system, while damaged, remains functional with “92% of all health facilities intact,” said WHO’s Ryan. He noted that over $72 million worth of medical supplies has been delivered to health facilities and another $51 million is in the pipeline, with nearly 200 aid convoys and 100 WHO missions since the conflict began.  

“This represents one of the most intense,  one of the most sustained, comprehensive responses to any humanitarian crisis. I believe that WHO has ever been able to mount,” he said. 

Both Moldova and Denmark expressed concerns about the safety of Ukraine’s Zaporizhzhia  nuclear reactor in the wake of Russia’s purported destruction of the Kakhovka dam in June, 2023, which lowered water levels in a reservoir around the nuclear power plant that supplies cooling water for the reactor and its spent fuel. 

Denmark, speaking on behalf of Ukraine, the European Union and about dozen other non-EU European states, noted that over the past weeks, Russia has intensified its attacks in Ukraine “As a consequence, Ukraine’s health system and access to critical health care services, medicines and treatment are severely compromised.” 

Other European countries denounced the ongoing conflict, with Poland describing it as an “illegal and unprovoked” war perpetrated by Russia.

Slovakia, however, also called on the international community for renewed efforts at peace negotiations in a war-weary region “to support the end of this conflict which is putting at high risk of death or certainty, unsafe environment for the house the development of children and adolescent and promoting the health of families that are divided and experiencing poverty due to social determinants, and worsening mental health.” 

Russia denounces WHO report as ‘politically motivated’  

Russia denounces the EB debate as politically motivated.

The Russian Federation, meanwhile, denounced the WHO report and debate as indulgence in “anti-Russian propaganda” saying that “representatives of NATO countries for the second year in a row are insisting on the inclusion of this item on our agenda, with only one purpose, that of getting airtime to allow them to recite a litany of baseless allegations against Russia. 

“Their governments at the same time, are supplying Ukraine with lethal weaponry that is being used against civilians in peaceful towns, and also against health infrastructure,” said the delegate to the EB. 

“The fact is that in accordance with data from the International Statistical Institute, in the world, in 2023, there were 183 regional conflicts, apart from Ukraine. Judging by the WHO classification, there are 16 acute and protracted emergencies that are grade three for emergencies.

“Just a little earlier, countries were obliged to cram into three minutes, their position on all these emergencies, on the work of WHO, and also on the pandemic agreement and amendments to the IHR [international health regulations]. And now they have another three minutes on Ukraine alone,” said Russia’s delegate.  

Board makes only fleeting reference to health crises triggered by other global conflicts

Dr W. Majrooh, Afghan delegate to the EB

Meanwhile, amongst the nearly dozen conflict-related Grade 3 emergencies cited in the WHO report, only fleeting reference was made by Board delegates to other global hotspots, such as Sudan, Syria, Afghanistan, Yemen and Haiti at the EB session on health emergencies that continued for hours throughout Thursday.     

“It seems that Afghanistan has dropped off the map,” complained Dr W. Majrooh, the delegate of Afghan’s government in exile, at one point. He noted that Afghanistan continues to face “historical susceptibility in both man-made and natural disasters.” 

Majrooh urged WHO to “not only keep the health emergency preparedness and response capacity in Afghanistan, as it is top priority but to actively engage with the current leadership to make them realise the significance of this matter.”  

  • Updated on 27 January with references to official quotes and news developments on Friday.
Swiss global health ambassador Nora Kronig Romero speaks about the Health and Peace initiative at the WHO Executive Board meeting Thursday.

WHO Executive Board delegates on Thursday gave the green light to a draft proposal by Switzerland cementing the framework for a new WHO “Health for Peace” initiative.

The move marked a bright spot in a day otherwise marked by heated debates over regional conflicts, including Gaza and  Ukraine. 

The Health and Peace initiative was first proposed in 2020 by WHO’s Director General, who grew up in a war-torn region of Ethiopia, now in Eritrea, whose remarks then – “there can be no health without peace and no peace without health” – became a slogan for the initiative. 

A “roadmap” for rolling out the initiative came before the World Health Assembly in May 2023, and was “noted” by the member state body.

The draft decision, which provides a more framework for the WHO approach to the issue, would represent a more formal seal of approval by member states, should it get the go-ahead in May.

And that approval has been slow in coming due to member state fears that such an initiative could be politicised and overlap with the work of other UN agencies.

“Our Constitution, your constitution, says the health of all peoples is fundamental to peace and security. Therein lies the mandate for this activity,” WHO’s Executive Director for Health Emergencies Mike Ryan told the EB, summarising the rationale for the initiative. 

“Health can build trust, helps prevent conflict. Health can sustain peace.” 

WHO Executive Director of Health Emergencies, Michael Ryan

In his remarks, Ryan pledged that the initiative would build locally-relevant programs that support peace-building while avoiding further politicisation of the health sector and its role. However, some countries were still not convinced.  

China, while not directly opposing the initiative, reflected some of still lingering reservations amongst some member states, stating,  “We should follow the principle of the member states-driven respect to national sovereignty, non- interference in internal affairs and the member states consensus. 

“We should have respect for different national conditions,” said the Chinese delegate, urging further clarification of “specific goals…content and outcome evaluation indicators,” as well as analysis of the “division of labor of other UN agencies and global health organizations, to avoid duplication by WHO and resource waste. 

Brazil expressed hesitations as well, saying:  “Let me reiterate the concern of my country with the securitization of the health agenda. 

“We have seen in our debate on the previous item. How issues of health continue to be used by some members to advance political speeches, the same members that selectively complain about the politicization of the EB agenda and say it needs to be streamlined. 

“Health is not and shall not be a security issue, but instead should be considered as a core part of the sustainable development agenda.” 

The decision, which still must go before the full World Health Assembly in May, received strong support from many other diverse quarters ranging from the Maldives to the United States and Afghanistan. 

“As we have heard repeatedly throughout the interventions in the preceding agenda items today, the importance of global peace and its intricate correlation to help cannot be overstated. The roadmap would pave the way for the creation of health programs that are both conflict sensitive, to focus on young persons’ awareness and capacity building in mainstream directions are important,” stated the Maldives delegate to the EB. 

“We find ourselves at a historical juncture where the world is stuck in unprecedented global disorder,” said  Dr W. Majrooh, representative of Afghanistan’s government in exile, “A mess created by politicians – in this climate the only community that spans from the village to the international level and is still fairly trusted, is the health community. It is not just a privilege but a historical responsibility.

“I implore you to recognize the untapped potential within our healthcare community, from the frontline campaigns to the institutional capacity of the World Health Organization. 

“Now more than ever, we must step out of our comfort zones, fill the gaps left by violence and politicians and  become the bridge to the real advocates of health and  peace.”

Image Credits: WHO/Sean Hawkey .