Albert Bourla, CEO of Pfizer.

Pfizer will provide all of its current and future patent-protected medicines and vaccines available in the United States and the European Union on a not-for-profit basis to 45 lower-income countries where some 1.5 billion people live.

However, critics have questioned whether the announcement has been timed to undermine a possible waiver on intellectual property for COVID-19 vaccines due to be discussed at the World Trade Organization (WTO) next month.

The Pfizer initiative, an ‘Accord for a Healthier World’, was announced at the World Economic Forum in Davos on Wednesday.

Under the Accord, Pfizer said it would initially provide 23 medicines and vaccines that treat infectious diseases, certain cancers, and rare and inflammatory diseases. 

Making these medicines and vaccines more readily available has the potential to treat non-communicable and infectious diseases that claim the lives of nearly one million people each year in these countries and chronic diseases that significantly impact quality of life for at least half a million more. 

Rwanda, Ghana, Malawi, Senegal and Uganda are the first five countries to commit to join the Accord. Health officials in these countries will help identify and resolve hurdles beyond supply to inform the roll-out in all 45 lower-income countries.

“As we learned in the global COVID-19 vaccine rollout, supply is only the first step to helping patients. We will work closely with global health leaders to make improvements in diagnosis, education, infrastructure, storage and more. Only when all the obstacles are overcome can we end healthcare inequities and deliver for all patients,” said Pfizer Chairman and Chief Executive Officer Albert Bourla.

The Accord countries include 27 of the world´s lowest-income countries as well as 18 lower-middle-income countries that have transitioned from low to lower-middle-income classification in the last ten years. 

Distraction from TRIPS waiver?

However, Julia Kosgei, policy advisor to the People’s Vaccine Alliance, described the accord as an attempt by Pfizer to improve its reputation.

“It’s right that some countries will not have to pay Pfizer’s rip-off prices for certain vaccines and treatments. But Pfizer is once again gate-keeping who can and can’t manufacture and access these lifesaving vaccines and medicines. Many lower-middle and middle-income countries will continue to pay through the nose for lifesaving drugs they can’t afford,” said Kosgei.

“We are weeks away from an important vote on pharma intellectual property at the World Trade Organization [TRIPS waiver]. And Pfizer has calculated that this move will ease the heat generated by its appalling conduct over the last two years.”

Meanwhile, James Love of Knowledge Ecology International (KEI) said that while the deal drew attention to the need for expanded access to medicines, “there are so many questions about what the initiative really is and is not”. 

He also questioned the timing of the announcement.

“What I would like to see would be: all the agreements and program details made public; an independent evaluation of what constitutes a ‘non-profit’ price, and annual, truly independent and transparent evaluations of what actually happens,” said Love.

“For most companies, these announcements are primarily offered to serve public relations objectives with very little follow-through, very little transparency and no evaluations on what actually happens.”  

Cancer Coalition

Meanwhile, the Access to Oncology Medicines (ATOM) coalition was launched this week, and announced that AstraZeneca, BeiGene, Bristol Myers Squibb, Gilead Sciences, Novartis, Roche, Sanofi and Teva had joined the partnership to improve access to essential cancer medicines in poorer nations.

 

Image Credits: Flickr – World Economic Forum.

World Health Assembly Thursday 26 May just after votes on competing resolutions on the health crisis in Ukraine.

The World Health Assembly on Thursday approved a resolution condemning Russia’s invasion of Ukraine by 88 votes to 12 – but the 53 abstentions reflected the discomfort of many member states with a debate that polarised the global health body. 

Russia’s counter-resolution only garnered 15 votes including those of Belarus, Burundi and Eritrea, with 66 countries voting against – but this time, a massive 70 countries abstained.

Most African nations abstained during both votes, as did many Middle Eastern nations, India and Pakistan. Some indicated discomfort with voting on a political issues, while others alluded to support received from Russia during COVID-19.

Most of Europe, the United States, Oceania and many Latin American countries supported the Ukrainian-backed resolution, which condemns “in the strongest terms, Russian Federation’s military aggression against Ukraine, including attacks on health care facilities”.

Unlike most of the African region, Ghana also supported the resolution, which also expresses “grave concerns over the ongoing health emergency in Ukraine and refugee receiving and hosting countries, triggered by the Russian Federation’s aggression against Ukraine”  and  calls for an increase in contributions to the WHO Emergency Appeal for Ukraine.

The  Russian-sponsored resolution, backed by Syria, omits any reference to who began the war or Russia’s attacks on health facilities. But it called for the rules of war to be respected around medical and humanitarian relief, and safe passage of medical supplies and personnel, along with support for WHO emergency relief efforts.

Ukraine delegation describes vote as a victory 

Ukraine
Ukraine´s representative to the UN Mission in Geneva, Ambassador Yevheniia Filipenko just after vote tally on WHA resolution condemning Russia´s invasion of Ukraine.

As much as the vote itself, the diverse reactions to the dual resolutions underlined the sharply divided perceptions over the war, and the role of WHO in responding to politically-laden conflicts between its member states.

The United Kingdom, one of the Ukraine resolution´s co-sponsors, described it as a vote ¨against war, against the lies, for peace and for health.¨ 

The US Mission to the UN in Geneva’s Ambassador Bathsheba Nell Crocker noted that “not even maternity hospitals have been spared” by Russia’s onslaught in Ukraine. “And the devastation is not limited to Ukraine. Impacts are being felt across the world. What is the impact of this war if not a health crisis?” she added.

Speaking just after the count was tallied, Ukraine´s representative to the UN Mission in Geneva, Ambassador Yevheniia Filipenko, representative thanked the WHA saying, ¨This is exactly the document which Ukraine was expecting from the World Health Organization to comprehensively address the health emergency caused by the Russian Federation. 

“This resolution sends a clear signal to the Russian Federation, stop your war against Ukraine, stop attacks on health facilities, respect international humanitarian and human rights law. 

“In voting down Russia´s draft, the World Health Assembly confirms that the responsibility for the health crisis in Ukraine rests exclusively with the Russian Federation… It is only through collective efforts that we will be able to address the health emergency in Ukraine and elsewhere in the world, in realizing the vision of health for peace and peace for health,” Filipenko concluded in remarks greeted by a round of applause from WHA delegates.

“We cannot ignore the abstentions but it´s good that we got 88 votes against and only 15 opposed,” Laremenko Oleksii, a member of the Ukraine delegation, told Health Policy Watch, adding that he believed the resolution would also boost donations to WHO´s  emergency aid effort. 

“It’s about depriving [Russia] of a platform for their propaganda,” another Ukrainian delegate to the Assembly added. 

Ongoing dialogue

Kenya’s delegate appealed for ongoing dialogue, while abstaining in both votes.

However, a number of leading developing countries, including Brazil and China, expressed concern that the WHO was being “politicised” and forced into “taking sides” over the war raging in Europe.

“WHO is not the right place for us to discuss” the war in Ukraine, China’s envoy asserted.

Kenya, which abstained on both votes, called for the “cessation of hostilities, and condemns all attacks on health care which are clear violations of international humanitarian law and human rights”. It also called for “continued dialogue and concerted efforts of all players within the multilateral setting”.

“We have observed with extreme distress how the war has had a ripple effect across the world, and we remain deeply concerned about the escalating food, energy and financial crisis, which has particularly dramatic impacts on developing countries,” added Kenya, raising a fear haunting most African countries.

Most countries, including those abstaining, expressed support for the efforts of the WHO to provide humanitarian health assistance to Ukraine and its neighbours assisting refugees. 

Ukraine and Russia exchange harsh words

Deputy Ambassador Alexander Alimov from the Russian UN Mission in Geneva called the Ukrainian resolution is “politicized,” “one-sided,” and “biased.”

“They are trying to transform WHO into a forum for score-settling and political debates,” he said of proponents of the competing resolution. By contrast, he said, Russia’s resolution “is constructive, it is not politicized, and it seeks to bring about the most rapid resolution to this crisis.”

But Crocker countered that: ¨This isn´t about politicization¨ adding that ¨Russia is asking you to look away” from the reality of the war’s impacts.

Before the vote, Filipenko, blasted Russia’s resolution as diplomatic double speak: “This is not just shamefully dishonest. It is also a cynical attempt to dupe this assembly. We urge you not to fall for this subterfuge,” she said.

The politically charged vote in the global health body comes at a pivotal moment in the grinding war in the Ukraine, with Russia now concentrating troops and firepower in the country´s eastern Donbas region. Full conquest of the Donbas is now the most immediate target for Moscow, keen to show some kind of decisive victory after abandoning its earlier aim of a quick and easy conquest of the capital Kiev, and overthrow of President Volodymyr Zelensky.

Elaine Ruth Fletcher contributed to this story.

Image Credits: Health Policy Watch .

World Health Assembly on Thursday morning, as member states launch debate over Russia’s invasion of Ukraine.

GENEVA –Russia’s war in Ukraine grabbed centre stage at the World Health Assembly Thursday as delegates prepared to take up competing draft resolutions on Ukraine’s health emergency: one denouncing Russia and supported by Turkey, Ukraine, the United States and all European Union members except for Hungary; the other co-sponsored only by Russia and Syria.

Although the resolutions – which address health conditions in Ukraine and neighbouring refugee-hosting countries – were only due to come to the Assembly’s floor in the afternoon, delegates began trading charges over the war in the morning while discussing a World Health Organization report on the Ukraine emergency as well as a broader report from WHO’s Independent Oversight & Advisory Committee of the Health Emergency Programme (IOAC) on the agency’s responses to global emergencies. 

Ukranian backed resolution calls for immediate halt to attacks on health facilities

Mapping of the co-sponsors of the Ukraine-backed and Russian resolution on Russia’s invasion of Ukraine in the World Health Assembly. The Russian city-enclave of Kaliningrad, sandwiched between Poland and Lithuania is also etched in red on the maa.

The Ukrainian-backed resolution condemns “in the strongest terms, Russian Federation’s military aggression against Ukraine, including attacks on health care facilities.”

It further expresses “grave concerns over the ongoing health emergency in Ukraine and refugee receiving and hosting countries, triggered by the Russian Federation’s aggression against Ukraine.”  And it causes for an increase in contributions to the WHO Emergency Appeal for Ukraine. 

Co-sponsors include Albania, Andorra, Australia, Austria, Belgium, Bosnia and Herzegovina, Bulgaria, Canada, Colombia, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Georgia, Germany, Greece, Guatemala, Iceland, Ireland, Italy, Japan, Latvia, Lithuania, Luxemburg, Malta, Moldova, Montenegro, Netherlands, New Zealand, North Macedonia, Norway, Peru, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Turkey, United Kingdom and United States.

The competing Russian-sponsored resolution, backed by Syria, omits any reference to who began the war or Russia’s attacks on health facilities. But it calls for the rules of war around medical and humanitarian relief, safe passage of medical supplies and personnel to be respected, and support for WHO emergency relief efforts.

Ukraine describes “catastrophic health crisis”

Ukraine’s UN Geneva Mission First Secretary Taras Popelniuk said Russia’s invasion on February 24 is causing a “catastrophic health crisis” that extends well beyond the many deaths, injuries and trauma inflicted on civilians. He cited damage to hundreds of health care facilities and services, causing disruptions in acute and chronic treatments, less access to medicine and added mental health burdens “so huge that they need additional assessment.”

He said that over 100 health facilities had been destroyed and 500 damaged.

As the delegates spoke, the latest figures from the Office of the United Nations High Commissioner for Human Rights (OHCHR) showed 8,628 civilian casualties were recorded in Ukraine, including 3,974 killed and 4,654 injured. Among those, 259 children were killed and 402 children were injured. OHCHR said it believes the actual figures are considerably higher.

Already in April, WHO reported the “grim milestone” of 103 verified attacks aimed at health care providers since the start of the war – attacks that killed 73 people and injured 51 others. Of those attacks, 89 directed against health facilities and 13 targeted ambulances and other health transport providers.

France’s U.N. Ambassador in Geneva Jérôme Bonnafont said Russia, one of the five permanent, veto-wielding members of the powerful 15-nation UN Security Council, was “clearly violating” the principles of the UN Charter. The opposition to Russia’s invasion of Ukraine – and its proposed resolution – was widespread among Europe’s delegates, particularly ones with shared borders.

“Let’s be honest. What we are witnessing in Ukraine is genocide,” said Poland’s U.N. Ambassador Zbigniew Czech. “This draft is only a cynical attempt to complicate our work.”

WHO Emergencies work will be strengthed by more stable finance

While many delegates veered into the emotional Ukraine crisis, others also took time to focus on the broader issues WHO is facing in strengthening its own health emergencies response.

That is the focus of the report of the IOAC committee, chaired by Felicity Harvey, which describes the challenges faced internally by the global health agency in its emergency response.

“The World Health Emergency program continues to be overstretched and understaffed,” said Germany’s Bjorn Kummel, summing up key conclusions of the IOAC review.  “The HR management with high level of short term contracts is a concern and must be adequately addressed. Given the circumstances the program does a great job despite occasional unacceptable derailing moments such as in the DRC,” he added, referring to the ongoing investigation of sexual misconduct and abuse by WHO staff and consultants during the 2018-2020 Ebola crisis.

He also pointed out to mental health challenges faced by staff, noting that “The IOC speaks of intolerable level of toxicity and incivility on social media against WHO and its staff members and we appreciate that the IOAC is drawing attention to this issue.

“Many of the problems resigned from the chronic underfunding. We fully agree with the IOAC that the solutions formulated by the Working Group on Sustainable Financing will be the single most important contribution to the improvement of the program,” Kummel concluded referring to the successful passage Tuesday of a new WHA resolution that would increase fixed member state contributions to 50% of WHO’s core budget by 2029-30 in an effort to stabilise budget planning.

“Not surprisingly, Germany believes that WHO should play a central role not only in the global health architecture for pandemic preparedness and response, but also the discussions on this topic,” Kummel added, referring to a recent WHO White Paper on global health institutional reform. Related to that, he stressed that WHO needs to play a “central role” in the new FIF (Financial Intermediary Fund) for emergency relief that has been proposed by global health leaders, to be hosted at the World Bank.

Image Credits: John Heilprin , Konrad Adenauer Stiftung .

An advertisement from the Healthy Caribbean Alliance advocating front-of-package warning labels.

Barbados recently imposed a 20% tax on sugary drinks, while Mexico, Chile and Uruguay, have introduced warning labels on food packaging to curb unhealthy eating – a key driver of obesity, diabetes and other non-communicable diseases (NCDs).

Mexico also has restricted the marketing of junk food to children, including sports sponsorships as it battles one of the highest rates of obesity in the world.

But interference from industries that produce unhealthy ultra-processed food and sugary drinks is undermining countries’ efforts to control food, according to speakers at a side event on curbing NCDs through healthier diets at the World Health Assembly in Geneva.

Ian Gooding-Edghill, the Barbados Minister of Health and Wellness, told the event his country had first imposed a 10% tax on sugary drinks, but that had only reduced consumption by 4.3%.

 “This was, in our opinion, far from what was required to have a significant impact,” said Gooding-Edghill, whose country now has one of the highest taxation rates in the world.

“The prevalence of diabetes is approximately 18% of the country and the obesity prevalence rate for those persons who are 25 years and older, is 33.8%.”

The Caribbean region, which imports a lot of packaged goods, is also tackling warning labels as a region.

Ian Gooding-Edghill, the Barbados Minister of Health and Wellness

Junk food kills more than tobacco

Jordan’s Princess Dina Mired, who is the NCD Ambassador for Vital Strategies, told the gathering that “junk food now claims more lives than tobacco”.

“In the decades since ultra-processed foods appeared on supermarket shelves, they have been aggressively promoted and marketed around the world, displacing traditional and healthier foods and diets,” she added.

“There is even some debate about whether ultra-processed foods can be called food at all. They do not resemble anything you can prepare in a kitchen. Made from ingredients that use industrial processes, these harmful products are appealing as they are preserved, packaged, convenient and ready to eat,” said Princess Dina.

“Ultra-processed products are exposing billions of people to a higher risk of Type 2 diabetes, heart disease, stroke and obesity. Obesity has nearly tripled since 1975— today, 2 billion people are overweight or obese.”

She criticised the World Health Organization’s (WHO) “best buys” to address NCDs for not going far enough in regard to “making the link between rising NCD rates and ultra-processed foods”.

Vital Strategies’ Nandita Murukutla

Meanwhile, Nandita Murukutla, vice-president of global policy and research at Vital Strategies, said that industry interference was preventing countries from acting against ultra-processed food and drink.

She highlighted a paper that was published in The Lancet in 2021 that found only a third of the WHO’s recommended policies to address NCDs were being implemented by member states. 

“Policies on tobacco control, except for graphic health warnings, junk foods and alcohol marketing were among the least well implemented,” said Murukutla, adding that “conflict of interest and industry interference, were the chief contributors in delays in implementation”. Latin America has one of the highest obesity rates in the world, and ultra-processed beverages are often more accessible than clean water or fresh food and other healthy options. 

Simon Barquera, executive director of the Nutrition and Health Research Center at Mexico’s National Institute of Public Health.

Simon Barquera, executive director of the Nutrition and Health Research Center at Mexico’s National Institute of Public Health, said that more than 80% of deaths in Mexico are due to NCDs. 

“More than 100,000 deaths every year are due to diabetes, and more than 40,000 deaths per year are a consequence of a sugar, sugary drink consumption,” added Barquera.

“And we’re one of the countries with the highest ultra-processed food consumption.”

Mexico has been trying to “modify” this food environment for more than 20 years, but “it has been very hard”, he acknowledged. 

“The soda tax took us 14 years of developing evidence and doing attempts at the Congress with the President in the Ministry of Health. The front-of-pack labels took us about 11 years.”

Mexico had successfully curbed marketing to children through an alliance of civil society, academia and government officials. But much of this marketing was now digital – which made international collaboration essential, said Barquera.

“Companies don’t like tweets that are international, exposing what these multinational companies are doing in our countries.”

The event was organised by NCD Alliance, Vital Strategies, World Obesity Federation, and the Ministry of Health and Wellness of Barbados.

Loyce Pace, Assistant Secretary for Global Affairs at the United States Department of Health and Human Services (HHS).

GENEVA – Despite pushback Monday from many WHO member states, including the 47-member ‘Africa Group’, Loyce Pace, US Assistant Secretary for Global Affairs at the Department of Health and Human Services remains “hopeful we may reach consensus” on reforming international health emergency rules at the World Health Assembly this week. 

The proposal backed by Australia, Colombia, the European Union, the United Kingdom, Japan and the United States, is perhaps the only concrete measure that the WHA can take in its current session to address the international rulebook for emergencies that largely failed the world in the COVID-19 pandemic – and was described by the widely-acclaimed Independent Panel review  as an “analogue” system in a digital age. 

While a much broader reform proposal backed only by the US also is technically on the table, it is the much narrower, process-based resolution,  A75/A/CONF./7, that has the only real chance of passage this year.  

Responding to a question from Health Policy Watch at a small media briefing Wednesday at the US Mission to the UN in Geneva, Pace spoke with diplomatic tact about the resistance that has been encountered to making any changes in the rules: 

“It’s obvious each country or government has a prerogative to express any concerns or reservations at any time, and it’s our job to listen, frankly.” 

But she added, “We are hopeful, I am hopeful we will reach consensus…. It is our hope…   to at least be able to move forward on this process point.” 

Process for changing a process 

WHA75 is meeting at the Palais des Nations, Geneva.

Under the process proposed by A75/A/CONF./7, countries would submit and negotiate proposals for more substantive IHR amendments over the coming two years.  An amendment to Article 59 of the IHR, would also create an abridged one-year framework in which any future amendments would actually take force – as compared to the two-year time frame that now exists.  

“It’s really how we just get that ball rolling, and ensuring that we have some method whereby we can at least bring into force these various amendments at a faster pace,” said Pace of the issue at stake.

Time frame for IHR changes too tight? 

Botswana, on behalf of the African group, expressed reservations over a US-backed initiative to expedite the process for amending the International Health Reservations, on Tuesday, 24 May

But ostensibly modest moves to expedite the timeline for future changes in the IHR ran into resistance in an initial debate on Tuesday, led by China and Iran, which complained that the time-frame for making amendments was too tight – although any process begun now would still take until 2025 to complete. 

While those objections may have been expected in light of the current state of geopolitical tensions, reservations by the WHA’s Africa bloc of 47 states took the resolution’s co-sponsors more by surprise.   

Led by Botswana, African countries expressed concerns about the nature of more substantive amendments lying in wait down the road – should they open the door to changes now.

“The amendments need to be considered as a holistic package,” Botswana’s Moses Keetile, a deputy permanent secretary in its health ministry, said on behalf of the African delegation to the Assembly. 

Admittedly the proposal tabled by the US early in 2022 sets out a more ambitious agenda for very substantive IHR revisions. Those include much clearer and tougher time frames for countries to report to WHO on suspected outbreaks as well language about responsibilities to rapidly share the “gene sequences” of pathogens, when available.  

Country comfort with pace of change 

But establishing tighter time frames for reporting on outbreaks could be difficult for low- and middle-income countries with few resources to muster for reporting at all, some African member states complained at Monday’s session. 

And there is a complex, brewing controversy over rules that would mandate sharing of the DNA sequences of new or emerging pathogens – which some low- and middle-income countries feel should be accompanied by guarantees that they would receive certain “benefits” from medicines or vaccines developed as a result.  

In the interest of transparency, the US has been forthright about the kinds of changes it would ultimately like to see in the IHR rules, Pace said.

However, she added that Washington is also keen to build a consensus with the African group and others uncertain about how next to proceed.   

“I think what we are keeping an ear out for is countries’ comfort with the pace at which things are happening and understanding of the scope of what is included in amendments,” she said.

“I think the President’s been clear about our commitment to international cooperation and dialogues…doing so with not only a sense of leadership but a sense of humility.  We’re still working to ensure that everyone is comfortable with where we are, and that we can move forward and that the very least on this process issue.”

Pace added that the US was “open to any sort of questions or conversations” and that “conversations have been ongoing, which I think is a good sign in terms of us reaching some consensus this week”.

“If it doesn’t happen this week, we’re not going to stop, we’re going to keep working to that end,” she added.

Need to keep up momentum even as pandemic urgency wanes

At the same time, there is still momentum for reforming emergency rules right now, and beyond that, discussing a broader pandemic convention or legal instrument, which could be lost if the discussion drags on, and the memory of the recent crisis fades.  

“You get to another phase of COVID or even get beyond COVID, hopefully, and it might be very hard to get this on the agenda or as high up on the agenda, as we put it off,” Pace said. 

“And so countries have really commented on the importance or the value of putting it on the agenda, keeping it on the agenda… not just in principle we should look at the IHRs, but practically, here’s some specific pragmatic changes we can make. In a way that can make a difference right now.

“Everyone acknowledges that this has been a nightmare that we’ve lived through, but if we don’t do anything about it, then what are we here for ultimately? 

“So that’s really our goal with this Article [IHR Article 59]. And I think that other countries … understand that as well and share that goal, which is you have to be taking steps, meaningful steps, tangible steps to demonstrate to our countries that … when we come together, we truly are taking action and we really are making progress.”

IHR not about sovereignty 

Pace also rebutted the claims being made in some US media channels as well as in some circles abroad – that a stronger set of global health emergency rules mean a loss of sovereignty for the US or any other nation.

Whether such claims originate in ”valid confusion or deliberate disinformation”, global inaction could put more lives at risk, she stressed.     

“The IHRs are not about sovereignty. They’re about public health. And they’re about ensuring that we all do – countries around the world, member states of WHO and WHO itself, do everything we can to protect the global community from anything like this ever again,” she said. .

“We’ve had over a million Americans who have lost their lives. Over 6 million people around the world lost their lives. WHO estimates even more than 15 million associated deaths with those are real numbers. And they’re real people,” Pace said.  

“And what we tried to do in a bureaucratic way, certainly, but in an important way, is to really show up with solutions to that problem – because we never should have been in a situation where we’ve lost so many to this.“

“ I think what happens when we see everything from… valid confusion to deliberate disinformation, is an undermining of those efforts to save lives in the future. And that’s never where we want to be. 

“What it is we are here to do is to protect all Americans and global citizens.” 

 

Director-General Dr Tedros Adhanom Ghebreyesus addresses the agency’s failings on sexual exploitation and abuse by WHO staff and contractors

GENEVA – Faced with a chorus of demands for accountability from member nations, Dr Tedros Adhanom Ghebreyesus again pledged greater efforts by the World Health Organization’s (WHO) leadership to eliminate sexual exploitation and abuse by its staff and contractors at the World Health Assembly on Wednesday. 

The discussion followed the recent publication of a letter sent to Tedros in March 2022 by three UN Special Rapporteurs regarding the “inadequate response” by the WHO to allegations of sexual exploitation and abuses during the Ebola response in the Democratic Republic of the Congo (DRC) from August 2018 to June 2020.

A number of weaknesses may have “prevented a fair and thorough investigation of crimes of sexual harassment, exploitation, and abuse” and “weakened the accountability for these crimes allowing perpetrators of these crimes to go unpunished”, according to the letter signed by Rapporteurs on violence against women, the right to the highest attainable standard of physical and mental health, and the Working Group on discrimination against women and girls, Reem Alsalem, Tlaleng Mofokeng, and Melissa Upreti.

The Rapporteurs also criticised the WHO for failing to explain how it would ensure criminal accountability for any sexual abuse committed by WHO personnel, beyond stating its existing policy of “referring cases that constitute a crime to national authorities for criminal investigation”, and committing to providing “support for legal action through the UN and national stakeholders”.

The Rapporteurs, who had information about 125 women, girls and men, also said the WHO had not adequately protected the identities of those abused.

An independent commission set up by the WHO found that 83 emergency responders in the DRC’s 2018-2020 Ebola outbreak, including 21 WHO employees and consultants, had raped nine women and likely abused dozens of women and men, obtaining sex in exchange for promises of jobs.

Member states want more action

During a discussion on the issue at the WHA on Wednesday, the African region represented by Cameroon, called on the WHO to establish a sub-committee within its health emergency programme “to consider how the organization’s current policies and procedures on prevention of and response to sexual exploitation and abuse and harassment could be improved”. 

The Africa group also welcomed the appointment of a regional coordinator on the prevention of sexual exploitation, abuse and harassment, who started work in March 2022 and called for adequate funds “to ensure capacity”.  

Meanwhile, the Geneva Group of Friends to Eliminate Sexual Harassment, made up of 56 member states and the EU, noted with concern that the Rapporteurs’ correspondence “was made public only this week”. Netherlands, on behalf of the group, called for regular updates from the WHO leadership and ongoing exchanges between the WHO and other UN organisations to strengthen the “zero tolerance” approach for sexual exploitation, abuse and sexual harassment. 

Netherlands, speaking on behalf of Geneva Group of Friends to Eliminate Sexual Harassment.

Norway also referred to the Rapporteurs’ concerns and said that these needed to be reflected in WHO’s management response plans.

“We stress the importance of providing the UN Office of Internal Oversight Services (OIOS) with unhindered access to all information and staff throughout its investigations,” said Norway.

Waiting for UN  investigation

In a response to the Special Rapporteur, dated 20 May, WHO said that the investigation of the allegations currently underway by the UN’s OIOS need to be completed before it takes further action against any of the WHO staff or former staff alleged to have committed the sexual exploitation and harassment. 

“All investigations related to the 10th Ebola outbreak in the Democratic Republic of the Congo are investigated by UN OIOS, not WHO,” said the WHO in an eight-point response to the Rapporteurs signed by Gaya Gamhewage, WHO’s director of prevention and response to sexual misconduct.   

It added that any criminal charges filed with the DRC government authorities would have to be filed with the consent of the victims – and so far that hadn’t been received. 

“WHO takes a victim- and survivor-centred approach and prioritizes their protection, wishes and needs. This requires obtaining consent from the survivor to share their personal information. As this has not yet been received, WHO has asked UN Investigators to seek such consent.” 

Speaking to Health Policy Watch, outside of the chambers, Gamhewage added that WHO had also offered 25 women in the DRC who were victims of abuse financial support for any cases that they wished to pursue in local courts there. 

‘Long. long way to go’

“We appreciate the attention you have given this,” Dr Tedros said in soft tones to delegates seated in one of the 194-nation World Health Assembly’s round chambers.

He acknowledged the criticism of bureaucratic delays, multi-year backlogs in investigations and concerns about the quality of WHO’s work, acknowledging that “we have a long, long way to go”.

Despite the hurdles, Tedros sought to highlight some progress WHO has made in creating a culture of zero tolerance for sexual abuse, exploitation and harassment. This includes holding weekly meetings, discussing possible actions and taking steps to put greater focus on prevention and care for the victims and survivors. 

He said WHO is sensitive to complaints about its investigation backlogs — and delays in delivering justice.

“And they are right, because some of the investigations have taken two years, three years, four years, five years, even more. I know some of the investigations that came after seven or eight years. So that’s why the backlog is now being finished,” he said, adding that WHO set a new 120-day deadline for all such investigations to be completed. 

“This is the first time we’re trying it in the UN system and we see advantages to it because it brings accountability,” Tedros said. “Of course, there are some concerns from some colleagues about the quality of it. But I assure you that quality will not be compromised, because quality will be at the centre.”

However, it took Tedros more than two months to respond to the Rapporteurs’ letter. In the WHO reply of 20 May, Tedros apologized for the delay, which he blamed on an “administrative error.” 

He assured Alsalem nonetheless that he feels a “profound, personal commitment to addressing the issues of sexual exploitation and abuse, and violence and discrimination against women and girls in all its forms.”

Also responding to the Rapporteurs in the WHO letter, Gamhewage said that the UN system is still working to find agreement on how best to focus its efforts around victims and survivors.

“I want to assure you that we are working with women-led organizations trusted by communities to support victims, but also to get their voices into the strategy that we’re developing,” she said.

The World Health Organization (WHO) doesn’t fully know what is driving the latest monkeypox outbreaks; it doesn’t know the virus’ animal reservoir nor knows what the future holds for the disease.

A session at the 75th World Health Assembly that was aimed at enlightening member countries ended up highlighting the existence of knowledge gaps and uncertainties regarding the future of monkeypox virus disease that has now been reported in about 20 countries just 17 days after the UK reported its first case.

On 7 May 2022, the UK Health Security Agency (UKHSA) announced an individual was diagnosed with monkeypox in England. According to the agency, The patient had a recent travel history from Nigeria where they believed the patient contracted the infection before traveling to the UK. Seventeen days after the announcement, monkeypox was discussed at the World Health Assembly on a day that the UK reported its 71st case. Cases have also been reported in a number of countries in Europe and beyond.

According to the UKHSA, a notable proportion of the cases identified to date have been among people who are gay, bisexual and men who have sex with men. And despite further cases being detected, it said the risk to the UK population remains low.

“We are continuing to promptly identify further monkeypox cases in England through our extensive surveillance and contact tracing networks, our vigilant NHS services and thanks to people coming forward with symptoms,” said Dr Susan Hopkins, UKHSA’s Chief Medical Adviser.

Multiple transmissions

At a WHA75 Committee session on Tuesday, WHO executive director of Health Emergencies Programme, Dr Mike Ryan, described monkeypox as “an emerging zoonosis that has once again reached a species barrier, and is now transmitting in multiple countries but is a containable event nonetheless”.

Dr Sylvie Briand, WHO director for Global Infectious Hazard Preparedness, said the global health body has been monitoring the outbreak of the disease for several years, especially in a number of African countries in which it is endemic. 

“We have localized epidemics every year, sometimes they’re higher, sometimes they’re lower every year, but that’s why we’ve been monitoring the outbreak of this disease for several years,” she said. 

She added the WHO had always been concerned that monkeypox would replace variola virus (the virus that causes smallpox) which was eradicated in 1980 — three years after the last wild case was reported in 1977, among human populations.

For several years, she said monkeypox was exported by travellers, but the cases had remained extremely isolated and have not become major outbreaks in countries which imported the virus.

‘Current situation is not normal’

In sharp contrast to previous epidemiological trends for monkeypox, WHO described the current outlook of the disease as not normal with 131 confirmed and 106 suspected cases now reported in 19 countries between 7-23 May.

“We’re currently facing a very unusual situation. We haven’t seen this type of situation in previous years. In a few days, we’ve had a high number of cases in many countries and that raises a number of questions and it’s unusual,” she said.

The initial suspicion was a mutation in the virus genome, but WHO said while more data is still needed, initial genomic studies suggested the virus hasn’t changed or mutated. What is considered more likely is a change in the pattern of human behaviour and this could explain the numerous transmissions in different areas of the world.

She noted that after two and a half years of the Coronavirus pandemic where there were a number of restrictions on human contact and large events, the global health body is suspecting that individuals are now more interested in getting out to events. In the same vein, they may be taking advantage of the fact that COVID-19 restrictions have now been lifted. 

“That means that they’re having, for example, more human contact or there are larger assemblies of people together, which means that there has been a facilitated transmission of this disease,” she added.

Unknowns and uncertainties

WHO however admitted that the outbreaks are still plagued with several unknowns and uncertainties about the future. These include the extent of the current disease spread in non-endemic countries.

“Are we just seeing the very tip of the iceberg or have we already passed the spike in transmission communities?” Briand asked. She added that the animal reservoir of the monkeypox virus is still unknown.

According to her, more research is needed on the modes of transmission to better understand what has generated the current unusual situation. She however encouraged countries to increase the surveillance of monkeypox in order to know the levels of virus transmission and to understand the outbreak progression in countries.

She added that while there are available medical countermeasures, they are extremely limited in quantity and some of them are not yet fully licensed to be put on the market.

Going forward, the WHO recommends targeting containment of the disease in countries where monkeypox is non-endemic. 

“We believe that it is still containable. It is possible to cut the transmission chain by first of all increasing awareness, and early recognition in our populations. Also, detecting cases, enhancing clinical recognition of the disease to ensure early detection of cases and isolation of patients to make sure that these patients do not transmit to their countries or their loved ones,” Briand added.

Intensified surveillance through cluster investigation and contact tracing are also being recommended by the WHO to stop chain transmission while contacting sexual partners would ensure that there is no sexual transmission of the disease. 

Ryan added that the monkeypox outbreak is the latest in the cycle of disease emergence, amplification and dissemination that the entire world needs to face together.

“We are clearly making progress in our capacities to work together in the face of these emerging threats,” Ryan concluded.

An individual with Noma
An individual with Noma

A team of health professionals and Noma survivors called on the World Health Organization on Tuesday to list the deadly infection of the mouth and face as a neglected tropical disease (NTD) so that it can receive the attention it needs to be eradicated.

“We hope that we can bring global attention to this disease and work toward the elimination of Noma,” said Nigeria’s health minister Dr E. Osagie Ehanire. He was speaking at the Geneva Press Club ahead of a screening Wednesday evening of a new documentary film on Noma, Restoring Dignity by the filmmaker Claire Jeantet, followed by a panel discussion at the Geneva Graduate Institute’s Global Health Centre.

Noma is a progressive and usually fatal infection of the mouth and face that affects some 140,000 people a year – most in sub-Saharan Africa, predominantly young children between the ages of two and five years old, living in poverty. It has a 90% fatality rate.

Although the exact cause is still unknown, Noma is likely the result of a bacterial infection that attacks children who have weakened immune systems as the result of a previous illness, such as measles or tuberculosis.

“There is nothing that talks more about you than your face,” said Ehanire. “If your face is damaged, imagine the psychological and mental consequences.”

The 52-minute documentary film follows the stories of several Noma survivors from Nigeria who have also come to Geneva this week to stimulate awareness about the disease on the margins of the World Health Assembly.

For survivors – facial scars and stigma

Among them is Mulikat Okanlawon, an advocate and hygiene officer at the Noma Hospital in Sokoto, Nigeria, who shared her personal story about contracting the disease as a child. While around 90% of people who get Noma die, she survived.

“I recovered from the disease, but it left a deadly mark on my face, which stopped me from interacting with people and being a part of the community. I could not go out. I could not go anywhere. I could not even look at myself in the mirror like other children,” she said Tuesday. “I always cried… I often wished that I had not survived.”

Another survivor, Fidel Strub – now an advocate and president of Noma-Aid Switzerland – explained that Noma is not a disease a person gets as a child and then moves on. Recovery, he said, is a life-long fight and “takes a lot of energy, self-motivation” and money.

Noma survivor Fidel Strub

Dr Isah Shafi’u has been working at the Noma Hospital in Sokoto for the past decade and said he has treated around 2,000 patients with Noma. He described how children are brought to the hospital in a struggle between life and death and it is his job to bring them back to life.

“To bring back a smile to those children is really amazing,” he said. “It is the most wonderful feeling.”

“We do not want to leave anyone behind,” added Ehanire, noting that he had recruited several countries to co-sponsor a petition to WHO to include Noma on its list of NTDs.

More than 90% of the children who get Noma die

Noma is preventable, but only if there is early diagnosis and treatment, explained Dr Maria Guevara, International Medical Secretary for Médecins Sans Frontières (MSF). She said that good nutrition, proper oral hygiene and access to healthcare – including childhood vaccinations – all prevent Noma.

“More than 90% of the children who get Noma die in the first two weeks if they do not get the treatment they need,” Guevara stressed. While an estimated 140,000 children are infected with Noma each year, those statistics were last collected in the 1980s.

“The data has not been updated for more than 25 years, showing just how neglected the disease and its survivors are,” she added. “Neglect should not be the case for a disease that could be eliminated.

“I am here today to add my voice to the call for Noma to be listed as an NTD,” Guevara continued. “Let’s make it a disease of the past and no longer the face of poverty.”

Prof. Dr. Bertrand Piccard
Prof. Dr. Bertrand Piccard

Guevara’s words were echoed in closing by Prof. Dr. Bertrand Piccard, chairman of the Solar Impulse Foundation, in a video message.

“WHO needs to put Noma on the list of tropical neglected diseases,” he said. “If this does not happen, Noma will continue.”

He praised the hospitals and nonprofits working to raise awareness about and treat Noma, but said they will not succeed without WHO’s attention.

“Only WHO can do what we have not been able to do, only WHO – by putting Noma on the list of NTDs – can put a stop to this unacceptable situation in our world today.”

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REMINDER: GETTING NOMA OUT OF NEGLECT

Film screening and panel discussion
25 May 2022, 15:00 – 16:30
Auditorium Ivan Pictet, Maison de la paix, Geneva
Learn more >>

Image Credits: Wikimedia Commons, Screenshot.

Björn Kümmel (left) and Dr Tedros (right) at a WHA event moderated by Folly Bah Thibault.

In a groundbreaking decision on financing reform, the World Health Assembly (WHA) resolved on Tuesday that half of the world body’s budget will be derived from members’ fees by 2030.

That will reduce the World Health Organization’s (WHO) massive reliance on donors. But there was less enthusiasm for revising the International Health Regulations (IHR).

The Assembly adopted in full the recommendations for financing reform made by the Sustainable Financing Working Group chaired by Germany’s Björn Kümmel, which also include proposals to increase the body’s efficiency.

“When it was approved, I have to admit I had a tear in my eye,” Kümmel told Health Policy Watch on Tuesday night. “I’ve been covering WHO for ten years and I always thought the financial situation was unsustainable.”

Kümmel, deputy head of the global health division at Germany’s Ministry of Health, said he was “told that it was un-doable” when he was asked to lead the process on financing reform a year and a half ago. “This is a success of multilateralism,” he said.

Incremental increases to member states’ fees (known as assessed contributions), starting with an increase to 20% in next year’s budget, is the group’s key recommendation. 

The WHO currently derives 84% of its budget from donors and voluntary contributions, making it beholden to donor priorities and inflexible funding that is earmarked for particular projects and cannot be redirected to health emergencies.

A task group of member states will be set up to work with the WHO Secretariat to strengthen the body’s “transparency, efficiency, accountability and compliance.”

The WHO is also mandated to investigate a replenishment model for additional funds.

Member states, particularly the US, have been adamant that if they are to pay more fees, they want financing reform that leads to a more efficient WHO.

Welcoming the decision, WHO Director-General Dr Tedros Adhanom Ghebreyesus said that it  “addresses head-on the decades-long challenge WHO has faced on predictable, flexible and sustainable funding”. 

“WHO’s current financing model has been identified by many experts as posing a risk to the integrity and independence of its work,” the WHO said in a statement on Tuesday night.

“WHO’s over-reliance on voluntary contributions, with a large proportion earmarked for specific areas of work,” it said, “results in an ongoing misalignment between organizational priorities and the ability to finance them.”

As financing reform gains support, IHR reform hits opposition

However, proposals to revise the IHR did not go so smoothly at the assembly on Tuesday.

The IHR are binding laws that govern countries’ obligations to report and respond to pathogens that could result in cross-border disease outbreaks public health emergencies.

The IHR were last revised in 2005 and the Independent Panel on Pandemic Preparedness and other bodies have pointed out a number of inadequacies in the light of COVID-19.

This has led to calls for the IHR to be revised, alongside the negotiation of an international pandemic instrument or treaty to better prepare the world for future pandemics.

But on Tuesday, a group of mainly African nations pushed back on both the process and substance contained in several proposals for revising the IHR.

Among the sticking points on financing reform were issues around national sovereignty and the speed raised in proposals before delegates at the WHA.

One proposal to shorten the process for effectively reforming the IHR was put forward by Australia, Bosnia and Herzegovina, Colombia, the EU Japan, Monaco, Korea, the UK and the US – and one with more far-reaching changes was offered by the US.

While the first one is more procedural, the US proposal would strengthen the WHO’s ability to gather and share information among nations with disease outbreaks that could put global public health at risk. 

But African nations led by Botswana voiced unease, dimming hopes for the one concrete action the Assembly might be expected to take on pandemic reform. 

The US proposal suggests 13 reforms including strict timetables for reporting outbreaks and introducing language on gene sequence sharing, forming a new compliance committee to monitor nations’ implementation, and authorizing expert teams to be sent to outbreak and contamination sites.

Holistic package

Iran also objected to the US proposal’s technical measures for changing IHR Article 59, saying Tehran “deems it premature to decide to reduce the time entry into force.” 

The US proposal would shorten the timeframe for amendments to take effect to one year, down from its current two-year period. That would also limit the time that member nations have to meet, analyze and raise objections.

“The amendments need to be considered as a holistic package,” Botswana’s Moses Keetile, a deputy permanent secretary in its health ministry, said on behalf of the African delegation to the Assembly. 

A US delegate said its proposals are meant to encourage a process that is “more agile and responsive to technological” considerations, and that “it is essential that states’ parties comply” because “there is no greater duty for governments” than to look after the public health of their citizens. 

A Danish diplomat, however, expressed a preference for more “targeted amendments,” while Norway’s envoy said “much can be done without altering the regulations, and there is an urgency in doing so.”

Singapore’s Health Minister Ong Ye Kung said overall the “foundation of our response is not lockdowns but vaccinations” in responding to pandemics.

The US in January submitted its draft WHA proposal for a series of pinpoint amendments to the 17-year-old IHR.

But final agreement on any IHR amendments is now likely to be put off until 2023, with resistance growing to any attempt to “fast track” the process of amending the IHR.

The Assembly had been expected to agree only to a process for making new IHR amendments by inviting all member states to propose their own reform proposals by the end of September.

Rightwing clamour

Meanwhile, outside the WHA there has been a clamour of rightwing opposition to reforms to the IHR and to a pandemic treaty on the basis that these will cede national sovereignty to the WHO.

This has been voiced by conservative leaders including Fox News’s Tucker Carlson, US former congresswoman Michele Bachmann, and Christine Anderson, a Member of the European Parliament from the German right-wing, anti-immigrant Alternative für Deutschland.

Some of the claims appear to be part of an overall disinformation campaign against the WHO by anti-vaxxers.

That was demonstrated by a petition against the IHR changes signed by a number of prominent anti-COVID-19 vaccine conspiracy theorists.

However, the WHO does not have the power to enforce or police the IHR – which was violated by a number of member states during the current pandemic.

Meanwhile, negotiations on a pandemic instrument or treaty only started this year with a proposal on its form only likely at next year’s WHA at the earliest.

Tedros
Djibouti Health Minister and World Health Assembly President Dr Ahmed Robleh Abdilleh and WHO Director-General Dr Tedros Adhanom Ghebreyesus sign a new contract for the second term

World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus has been re-elected unopposed to spend another five years at the helm of the UN health agency, after receiving the World Health Assembly’s overwhelming endorsement as a health diplomat fluent in war and a pandemic.

Tedros, a former Ethiopian health minister and the first African to lead WHO, ran unopposed for a second term. He was re-elected in a secret ballot vote in accord with Assembly procedures that required at least two-thirds of its 194 member nations to endorse him. A key donor nation, the United States, expressed support in February.

Although it initially appeared that all regions had endorsed his nomination, an indignant Ethiopia berated Botswana after it had delivered a message of support for Tedros on behalf of the Africa region. Neither Ethiopia nor Eritrea support Tedros as he has been outspoken about their blockage of Tigray, his home territory in Ethiopia. After Tedros’s re-election, Botswana then delivered a message of support on behalf of 45 African states – not 47.

Tedros began his first five-year term on July 1, 2017, and since 2020 he has been the public face of the world’s response to the COVID-19 pandemic, including its delays and failures at vaccine equity. 

Immediately after the secret ballot vote, which lasted without explanation for a couple hours longer than had been scheduled, Tedros entered the Assembly hall to a rock star’s welcome, surrounded by delegates, well-wishers and photographers on his way to the podium. 

“The Health Assembly has just decided to appoint you,” Djibouti Health Minister and World Health Assembly President Dr Ahmed Robleh Abdilleh said. “In congratulating you, the Health Assembly fully acknowledges the challenges ahead of you.” Immediately afterward, Tedros took a brief oath of office and, also in front of the Assembly, signed a new contract that runs from 16 August, 2022 to 15 August, 2027.

“This is overwhelming. I’m really grateful and very humbled for your confidence and trust. It was not just today. During my nomination, all regions have nominated me,” he told the Assembly. “This is for the whole team.” Tedros laid out his previously established main priorities for his second term, ranging from primary care to pandemic preparedness to accountability. 

He became teary-eyed recalling being a seven-year-old boy living in Ethiopia in a poor family when his younger brother died of a disease later suspected to be measles, a preventable condition, and it could have just as easily been him. 

“So I hope peace will come,” he said. “Let peace and understanding be the antidote to war.”

Dr Tedros visited Kyiv in Ukraine earlier this month.

Vaccine equity

He has repeatedly called out wealthy nations for taking first dibs on most of the world’s vaccine supplies, leaving poorer nations years behind in getting their first shots. Amid the media focus on Ukraine, he has kept reminding people of the suffering in Afghanistan, Syria, Tigray, Yemen and other conflict zones. 

Throughout his first term, the 57-year-old Tedros projected empathy. In his opening remarks to the Assembly, he spoke of his visits to see first-hand the effects of conflict.

“In both Yemen and Ukraine, and in other countries I have visited in between during my first term, I saw the profound consequences of conflict for health systems and the people they serve. More even than pandemics, war shakes and shatters the foundations on which previously stable societies stood,” Tedros said.

“And it leaves psychological scars that can take years or decades to heal. For me, this is not hypothetical or abstract; it’s real, and it’s personal. I am a child of war,” he recalled. 

“The sound of gunfire and shells whistling through the air; the smell of smoke after they struck; tracer bullets in the night sky; the fear; the pain; the loss – these things have stayed with me throughout my life, because I was in the middle of war when I was very young.  … Not only a child of war, but following me throughout. But my story is not unique.”

He also has been harshly criticized for his agency’s dealings with China soon after COVID-19 was first discovered, and for early statements against mask-wearing. And, under his tenure, WHO has also been criticized for failing to hold its staff accountable for sexual abuse and other misconduct.

Trump challenges

Perhaps his stiffest challenge came from former US President Donald Trump, who withdrew the US from the WHO after numerous broadsides about the body’s capabilities – a decision that was swiftly reversed by President Joe Biden.

As the ninth director-general of WHO, Tedros is the only one since the agency’s creation in 1948 to not hold a medical degree. Instead, he has a doctorate in philosophy. 

In his second term, Tedros will continue to have to deal with the global response to the pandemic and new health threats such as monkeypox and hepatitis. He said he had been humbled by the Executive Board’s decision to nominate him for a second term, and, as he reflected on the past five years, realized they have been “bookended” by two visits to war zones.

 

“I made my first trip as Director-General to Yemen in July 2017, a country which was, and remains, mired in civil war. While I was there, I met a mother and her malnourished child who had travelled for hours to reach the health centre I was visiting in Sana’a,” he recalled. 

“Then two weeks ago, I was in Ukraine, visiting bombed hospitals and meeting health workers. I visited a reception center for refugees in Poland, where I met another mother, from the Mariupol area, who told me that when the shelling began, her young daughter was very scared. … I met people who have lost loved ones; lost their homes; lost their sense of security – and yet somehow, have not lost hope.”

 

 

Image Credits: WHO.