A maternity and children´s hospital in the southern Ukranian city of Mariupol was bombed Wednesday, reportedly injuring 17 people, while WHO warned that Ukrainians who manage to escape direct injury in Russian bombings and shellings face hypothermia, frostbite and respiratory diseases, as well as conflict-related trauma – while the lack of access to treatment for cardiovascular disease, cancer and mental health is exacerbating chronic health conditions. 

Infectious diseases such as measles, tuberculosis, COVID-19 and even polio also are expected to increase as millions of people flee the Russian bombing of their towns and communities, WHO officials told a media briefing.  Cities like the southern Ukranian city of Mariupol remain cut off from adequate food, water and sanitation services, furtherin increasing infectious disease risks. Two million people have fled the country so far, while relief workers say that the number may double shortly. 

Mariupol shelling

In Wednesday’s shelling of the maternity hospital, including a children’s ward, in Mariupol, the Black Sea port city under siege by Russian troops, the region’s governor said 17 people were wounded, including women in labour.

A video circulated by Ukranian authorities showed a heavily damaged three-storey building, in a large compound also devastated by mangled glass, steel and wood outside. Much of the front of the building had been ripped away. BBC later released what it described as verified pictures of the Russian strike on the hospital.

“WHO is aware of disturbing news reports about an attack on a maternity hospital in Mariupol, Ukraine,” said Director General Dr Tedros Adhanom Ghebreyesus, in a Twitter post on Wednesday evening, condemning the ongoing violence, including the attacks on health facilities. As of Tuesday, WHO had verified 16 other Russian attacks on health facilities.

Fears of radiation accident

Meanwhile, there are growing fears of nuclear incidents in Ukraine after Russia seized control of both the Zaporizhzhya and Chernobyl nuclear power plants, after bombing Zaporizhzhya and causing a fire that burnt for almost five hours.

The Union of Concerned Scientists’ director of nuclear safety, Ed Lyman, warned on Tuesday that if the nuclear plants’ cooling systems are interrupted, it could result in the release of radioactive material.

The loss of power reported at Chernobyl on Wednesday “violates a key safety pillar on ensuring uninterrupted power supply”, according to the International Atomic Energy Agency (IAEA), but added “ in this case IAEA sees no critical impact on safety”.

According to the IAEA “the heat load of the spent fuel storage pool and the volume of cooling water contained in the pool is sufficient to maintain effective heat removal without the need for electrical supply”.

“The Zaporizhzhia plant is just one of four Ukrainian nuclear facilities whose 15 reactors provide more than half of the country’s electricity. None of the reactors was built to withstand a military assault,” said Lyman.

“Although there is no way to know if Russia intentionally targeted Zaporizhzhia, all of the plants are also vulnerable to indirect fire that could damage critical support systems and surrounding infrastructure, potentially resulting in a fuel meltdown and a radiological release that could contaminate thousands of square miles of terrain,” added Lyman.

While the IAEA was taking the lead on managing the nuclear risk, all countries have preparedness plans for nuclear events, said WHO’s head of emergency response, Dr Mike Ryan.

“Given the risks that have been risen in terms of an accidental event occurring, governments are well-advised to ensure that their preparedness plans and their supply chains are in place,” he added.

The WHO has raised the issues of chemical and bio-radio safety since the start of the conflict and ensured that any “high threat pathogens” in Ukraine had been autoclaved and destroyed,” added Ryan.

Dr Mike Ryan

Rising risk of infectious diseases

“We are tracking the risk of the emergence and spread of infectious diseases, such as measles, polio, and COVID-19,” said Dr Adelheid Marschang, WHO senior emergency officer. 

“Due to population movements and disruptions, we will have to look very, very carefully at that. We have further health risks related to mental health, psychosocial health. People are very, very stressed.”

Marschang added that the most vulnerable people “are those that cannot move because they have a chronic disease” and don’t have access to their usual treatment.

“There is increased risk of gender-based violence as women, children and the elderly travel, stay at reception centres or apartments or remain alone,” she added.

Adelheid Marschang

“The only real solution to this situation is peace, and WHO continues to call on the Russian Federation to commit to a peaceful resolution to this crisis, and to allow safe, unimpeded access to humanitarian assistance for those in need,” said Dr Tedros.

“The WHO has delivered 81 metric tonnes of supplies and is establishing a pipeline of supplies for health facilities throughout Ukraine, especially in the most affected areas,” added Tedros.

Supplies delivered to Kyiv include surgical care for 150 trauma patients and a month’s supply of medical supplies for a range of health conditions for 45,000 people, he added.

A further 400 cubic metres of supplies were waiting to be transported for Ukraine from the WHO’s logistics hub in Dubai, added Tedros.

Although the health sector had been remarkably resilient, about 1000 health facilities are either on frontlines are within 10 kilometres of the frontline of conflict and were becoming “engulfed” in it, said Ryan.

Dr Maria van Kerkhove

Second anniversary of COVID-19 

Friday marks the second anniversary of the declaration of COVID-19 spread as a pandemic, and over six million people had since died, said Tedros.

But although reported cases and deaths are declining globally, “countries in Asia and the Pacific are facing surges of cases and as the virus continues to evolve, and we continue to face major obstacles in distributing vaccines, tests and treatments everywhere they are needed,” said Tedros.

He expressed concern that countries were reducing testing, and said that the WHO was recommending that self-testing for COVID-19 should be offered in addition to professionally administered testing services.

“This recommendation is based on evidence that shows users can reliably and accurately self-test and that self-testing may reduce inequalities in testing access,” said Tedros.

COVID-19 Delta-Omicron ‘recombinant’ in Europe

Meanwhile, Dr Maria van Kerkhove, WHO’s COVID-19 lead, said that a COVID-19 “recombinant” made up of “Delta AY.4 and Omicron VA.1” had been identified in France, the Netherlands and Denmark.

“The recombinant is something that is expected given the intense amount of circulation that we saw with both Omicron and Delta”, and that both were circulating at high levels in Europe at the same time, said Van Kerkhove.

“There’s very good surveillance in many countries right now. And given the sheer number of changes and mutations within Omicron, it was much easier for researchers, scientists, public health professionals, people who are studying the genome to be able to detect these recombinants.

“We have not seen any change in the epidemiology with this recombinant. We haven’t seen any change in severity. But there are many studies that are underway.”

 

Image Credits: Gayatri Malhotra/ Unsplash.

Pro-abortion demonstrators in the US

The World Health Organization (WHO) released new guidelines on abortion care on Wednesday, that include recommendations on telemedicine for the first time.

Telemedicine has helped support access to abortion and family planning services during the COVID-19 pandemic, and is also being used in places where abortion access is limited.

Over 25 million unsafe abortions occur each year, causing around 39,000 deaths and millions more women being hospitalized with complications, according to the WHO. 

Most of these deaths are concentrated in lower-income countries – with over 60 percent in Africa and 30 percent in Asia – and among those living in the most vulnerable situations., according to the WHO.

“Being able to obtain safe abortion is a crucial part of health care,” said Craig Lissner, acting Director for Sexual and Reproductive Health and Research at WHO. “Nearly every death and injury that results from unsafe abortion is entirely preventable. That’s why we recommend women and girls can access abortion and family planning services when they need them.”

The guideline includes recommendations on many simple primary care level interventions that improve the quality of abortion care provided to women and girls. These include task sharing by a wider range of health workers; ensuring access to medical abortion pills, and making sure that accurate information on care is available to all those who need it.

Remove legal barriers

Alongside the clinical and service delivery recommendations, the guidelines recommend removing medically unnecessary policy barriers to safe abortion, such as criminalization, mandatory waiting times, the requirement that approval must be given by other people (e.g., partners or family members) or institutions, and limits on when during pregnancy an abortion can take place. 

While most countries permit abortion under specified circumstances, about 20 countries provide no legal grounds for abortion. Around three-quarters of countries have legal penalties for abortion, which can include lengthy prison sentences or heavy fines for people having or assisting with the procedure.

“It’s vital that an abortion is safe in medical terms,” said Dr Bela Ganatra, Head of WHO’s Prevention of Unsafe Abortion Unit. “But that’s not enough on its own. As with any other health services, abortion care needs to respect the decisions and needs of women and girls, ensuring that they are treated with dignity and without stigma or judgement. No one should be exposed to abuse or harms like being reported to the police or put in jail because they have sought or provided abortion care.”

Evidence shows that restricting access to abortions does not reduce the number of abortions that take place. In fact, restrictions are more likely to drive women and girls towards unsafe procedures. In countries where abortion is most restricted, only 1 in 4 abortions are safe, compared to nearly 9 in 10 in countries where the procedure is broadly legal.

“The evidence is clear – if you want to prevent unintended pregnancies and unsafe abortions, you need to provide women and girls with a comprehensive package of sexuality education, accurate family planning information and services, and access to quality abortion care,” Dr Ganatra added.

Following the launch of the guidelines, WHO will support interested countries to implement these new guidelines and strengthen national policies and programmes related to contraception, family planning and abortion services, helping them provide the highest standard of care for women and girls.

Image Credits: Gayatri Malhotra/ Unsplash.

NATAN Worldwide Disaster Relief organization volunteers, including Dr Dorit Nitzan
Former WHO/Europan Emergencies Director Dorit Nitzan (centre), now a front-line volunteer on the Polish-Ukraine border.

The Ukrainian refugees are crossing the border with only their coats on their backs. The women are holding their children’s hands. The children’s eyes are wide and their jaws clenched in fear.

“They come here exhausted and cold,” said Dr Dorit Nitzan, former Health Emergencies Coordinator for the World Health Organization´s European region.

Nitzan only retired from WHO within the last two months and already she has returned to the field.  But this time she is not a visiting high-level official to a humanitarian crisis zone, but a front-line volunteer sleeping on a mattress in a mall with hundreds of other refugees.

Nitzan is part of a team of first responders offering critical medical care to Ukranian refugees just inside the Polish-Ukranian border – after having finally managed to flee to safety from war torn communities in Ukraine.

According to the latest United Nations High Commissioner for Refugees (UNHCR), more than two million people, the vast majority of whom are women and children, have left Ukraine since 24 February, the day that the war started.

“The needs are immense, and we are doing our best in a small clinic,” Nitzan said this week on a call with Health Policy Watch – a call that was interrupted more than once by a sick person in need of care or an emergency.

Nitzan arrived in Poland last week with a delegation of physicians, nurses and social workers affilated with the all-volunteer NATAN Worldwide Disaster Relief organization, an Israeli-based network. Working closely with the Red Cross of Poland, the US-based Operation Blessing, the Mexican CADENA and WHO, Nitzan’s team has taken over a shopping mall in Medica, where it is serving some 3000 refugees.

Nitzan said they are expected to stay in the field for at least two months, with volunteers rotating in and out of the country every couple of weeks. The volunteers sleep on mattresses in the mall just like the refugees.

“We live with the people,” Nitzan said. “We aim to be wherever we are needed for as long as we are needed.”

Although Nitzan recently left WHO after reaching the mandatory retirement age of 65, she told Health Policy Watch that she still feels a part of the organization.

Secured a top job – then left for a war zone

Nitzan had only just returned to her home country in Israel and secured a top job at Ben-Gurion University, when the war broke out. She felt particularly compelled to respond – having also served in Ukraine on behalf of WHO from 2012 to 2016. That was during the last period of major conflict in which Russia occupied Crimea, and then supported the establishment of two pro-Russian breakaway enclaves in eastern Ukraine.

“I know Ukraine and I know the Ukrainians,” she said. “We were hoping Ukraine was marching towards a better future and this is a big slap. It really hurts me. It is extremely hard to see.”

A paediatrician, Nizan has been helping the refugee children. “I loved my job in the high chair and at the table, but here, with kids around me, I love it – I feel fulfilled,” she told Health Policy Watch.

A NATAN volunteer assists a Ukrainian refugee child at a clinic in Poland.
A NATAN volunteer assists a Ukrainian refugee child at a clinic in Poland.

More supplies are on the way

Nitzan has been in touch with the Polish branch of WHO, and through NATAN continues to stay abreast of WHO’s efforts in the region.

WHO Europe’s regional director, Dr Hans Kluge, told a press briefing on Tuesday that WHO was working to ensure the safe passage of critical medical supplies into Ukraine.


“Lifesaving essential medicines, such as oxygen and insulin, personal protective equipment, surgical supplies, anesthetics, and safe blood products, are in short supply,” Kluge said. “So far, two shipments totalling 76 tonnes of trauma and emergency health supplies, as well as freezers, refrigerators, ice packs and cool boxes are in transit in Ukraine. We have further shipments of 500 oxygen concentrators and more supplies are on their way.”

WHO is also supplying infrastructure and support to border countries and the clinics that have opened up in them, like the one in which Nitzan is operating. Kluge said that expert WHO teams have been sent to Hungary, Poland, the Republic of Moldova and Romania.

“We are working with UNHCR and coordinating closely with the relevant governments, local authorities and partners to assess the needs of incoming refugees upon entry at the border, build health system capacity to accommodate large numbers of refugees and ensure access to services,” he noted.

Next week, a meeting is planned on refugee and migrant health in Turkey where current events will be addressed by health ministers, representatives of refugee and migrant groups, partner organizations and the WHO African and Eastern Mediterranean regions.

“Continuity of care for those with long-term health needs is a major challenge because broken supply lines are affecting the treatment of conditions such as diabetes and hypertension, as well as for cancer,” Kluge said. “According to [the United Nations Population Fund] UNFPA, an estimated 80,000 women will give birth in the next three months without access to critical maternal care. Re-establishing and maintaining vaccination programs and continuing treatment for people living with TB and HIV, are priorities, as is the provision of mental health services.”

Nitzan explained that WHO also serves as a watchdog for attacks on healthcare and health workforce during the work, “which is not permitted at any time. Any attack we need to report,” she added.

To date, according to Kluge, there have been 16 confirmed reports of attacks on health facilities in Ukraine. However, on Wednesday, a Russian attack on a large maternity and children´s hospital in the beseiged city of Mariupol left at least 17 people injured, Ukranian authorities said.  WHO said it was aware of the reports and investigating that latest incident.

The day after: conflict, COVID-19 sap ‘ability to cope’

Nitzan said that while the doctors and other medical staff are now working in emergency mode, she worries for the day after the war. With so many refugees fleeing to other parts of Europe, there will be a “brain drain” in Ukraine.

“The strongest people left,” she said. “The people left behind will be the sick, the elderly and poor.”

And it will cost the country and the world a steep price to rebuild Ukraine, which could detract from other global health priorities, though she was not specific.

Dr Dorit Nitzan with a partner volunteer at the NATAN Worldwide Disaster Relief organization healthcare clinic in Medica.
Dr Dorit Nitzan (right) with another volunteer from the NATAN Worldwide Disaster Relief organization.

Over the last six or seven years, WHO worked closely with Ukraine to improve its health system, including offering universal health coverage and improving hospital care. The country had stocked medicine warehouses and was more prepared than expected, she said.

“The conflict, together with COVID, has left Ukraine with no ability to cope,” Nitzan said. “The margins are so thin, and everything is so fragile.

“I am afraid that whatever was achieved from 2015 until now and so much more will have to be rebuilt.”

Image Credits: NATAN Worldwide Disaster Relief organization, NATAN Worldwide Disaster Relief organization .

Women make up 75% of the global health workforce but hold only 25% of senior positions.

Commercialising the health sector and leaving healthcare up to the markets is “dangerous” and “really amoral” the World Health Organization’s (WHO) Director-General Dr Tedros Adhanom Ghebreyesus told the launch of a brief on measuring value in the economy on Tuesday. 

The policy brief, produced by the WHO Council on the Economics of Health for All, proposes a new system of value and measurement based on valuing planetary health, diverse social foundations and activities that promote equity, rather than Gross Domestic Product (GDP).

The panellists at the brief launch.

Value the right things to take right actions

The use of GDP as a “monolithic monetary measurement metric” of value for health was condemned by panellists at the launch. Instead, they proposed that the world should move toward a more holistic data measure that abandons purely monetary indices. 

“It’s all about ensuring that we value the right things because we need to take the right actions. And sometimes a focus on GDP, on increasing economic activity at all costs, leads us away from valuing those rights actions,” said economics professor Jayati Ghosh, from the University of Massachusetts in US.

“We need this holistic approach because Health for All has all these different dimensions…Governments have to move away from the single-minded focus on economic activity as the resolution of all the other problems.”

Jayati Ghosh said that a focus on GDP on increasing economic activity at all costs, leads us away from valuing those rights actions

Value women’s work

Using GDP as a metric of development also does not take into account the value of care and unpaid labour – work that is mainly done by women, who spend two and a half hours per day more than men on unpaid work, according to the brief.

The brief thus proposes the inclusion of new metrics that value goods and services that remain unaccounted for, such as growing food, cooking, cleaning, childcare and other unpaid household and community activities including environmental conservation – all predominantly performed by women.

“The contribution that women around the world make to sustaining human and planetary health is constantly undervalued. The most meaningful celebration of International Women’s Day would be to initiate a radical re-evaluation of these contributions, and drive economic policies that benefit communities, families and individuals,” said Tedros.

The gender gap in unpaid work in 23 low-and middle-income and 23 high-income countries, 2005-2013 (latest available year)

The brief talks about the creation of a dashboard instead of using GDP to measure the multifaceted health system. Panellists also brought to light the need to have a dashboard.

Professor Mariana Mazzucato, chair of the WHO Council on the Economics of Health for All, pointed out that countries’ GDP cannot be interpreted as a good sign.

“When we go to war, things have to be produced to go to war and that increases GDP. When we pollute, GDP goes up, because someone has to go and clean it up,” Mazzucato said. 

Governments invested 40 times more in war than health, while attempts to re-imagine GDP were marginal and insufficient for the radical change needed to achieve Health for All, according to the brief.

Lessons in pandemic preparedness

A business-as-usual approach to health, implying that the health sector can single handedly tackle a pandemic, would be “a catastrophic mistake – and a missed opportunity – that would leave the world once more unprepared for the next health crisis,” the brief said, advocating for investing in long-term preparedness. 

Reasons for lack of access to essential health services by country-income group, available data 2021, WHO

“By measuring the wrong things or by not measuring certain things at all, we are actually endangering our response, and we are endangering our livelihood,” said Professor Ilona Kickbusch,  Chair of the Global Health Centre at the Graduate Institute of International and Development Studies in Geneva.

“Our understanding of social determinants of health has actually expanded through the pandemic. And we neglected the one factor that turned out to be in short supply: Trust.

“We don’t measure and value what actually keeps our societies running,” she added. “And what was it during the pandemic that kept our societies running? Women’s work; women’s work in the healthcare sector…and at home.” 

Image Credits: WHO, Aishwarya , WHO Council on Economic Health For All .

CEPI Chairpseron Jane Halton

The Coalition for Epidemic Preparedness Innovations (CEPI) raised over $1.5 billion to develop vaccines against emerging diseases in as little as 100 days over the past two days at a pandemic preparedness summit co-hosted by the UK government.

CEPI’s total budgetary ask is for $3.5 billion to implement its five-year plan to prepare and protect against “Disease X”, the unknown pathogen that will cause the next pandemic.

It has developed a roadmap to compress vaccine development to 100 days, develop a broadly protective vaccine against COVID-19 and other Betacoronaviruses, and create a “library” of vaccine candidates for use against known and unknown pathogens. 

As part of this, CEPI announced on Tuesday that it will partner with UK-based DIOSynVax – a biotech company linked to the University of Cambridge that specialises in the development of broadly protective, multi-virus vaccine antigen payloads (VAPs).

Betacoronavirus vaccine candidate

DIOSynVax will assist to develop a vaccine candidate based upon “intelligent computational design” against existing and future variants of SARS-CoV-2 and other major sub-genera of Betacoronaviruses including those that cause SARS and MERS.

The idea of a 100-day mission came from a commitment made by leaders at the G7 meeting in June last year to “support science in a mission to shorten the cycle for the development of safe and effective vaccines, treatments and tests from 300 to 100 days”.

“CEPI’s five-year strategy aims to make the development of vaccines against emerging pathogens within 100 days a reality, because the quicker a safe, effective and globally accessible vaccine is developed and deployed, the quicker an incipient pandemic can be contained and controlled,” the organisation said in a statement on Tuesday.

“Achieving the 100 Day Mission, through CEPI’s innovative programme of access-focused R&D, would give the world a fighting chance of defusing the threat of future pathogens with pandemic potential.”

International pandemic accord

Addressing the summit in support of CEPI, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus said that CEPI had to be part of the new “enhanced global health architecture for pandemic prevention, preparedness and response”.

Negotiations on an international pandemic accord were beginning in order “to establish the rules of the road for a more cohesive and harmonised global response to future epidemics and pandemics – including the equitable sharing of countermeasures”, he added.

Dr Tedros said that the pandemic has taught the world “the incredible power of surveillance, genomics, diagnostics, vaccines and therapeutics” – but it had also exposed gaps and weaknesses in the global ecosystem.

“WHO is working with our Member States and partners to fill some of those gaps, including through the new WHO Hub for Epidemic and Pandemic Intelligence in Berlin, the WHO BioHub System for sharing pathogens in Geneva, and the soon-to-be-launched Global Genomics Surveillance strategy for pathogens with pandemic and epidemic potential,” said Tedros.

“But it’s clear that we also need to strengthen efforts to develop, evaluate and distribute vaccines, tests and treatments as rapidly and equitably as possible when a new pathogen emerges,” he added.

Over the past two days, health ministers, pharmaceutical company executives and other partners met in London and made a number of pledges to protect the world against future threats.

The UK Government has committed to delivering a research and development network, accessible to industry, to speed up the development and delivery of novel vaccines. 

Meanwhile,  associations representing vaccine manufacturers, as well as the broader biotech and biopharmaceutical industry and the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA) committed to investing in R&D aimed at “target pathogens with epidemic and pandemic potential and to build a portfolio of promising candidate vaccines, treatments and technologies”. 

Commitment to speed

They also committed to speeding up vaccine manufacturing and capacity, as well as clinical trials.

“The faster an effective vaccine is developed and deployed, the faster an incipient pandemic can be contained and controlled,” according to CEPI.

“In the case of COVID-19, a 100-day timeline would have seen a vaccine ready to use in mid-April instead of December 2020. This could have saved millions of lives and trillions of dollars. Achieving the 100-day goal would give the world a fighting chance of containing an outbreak before it spreads globally and becomes a pandemic.”

“COVID-19 has taught the global healthcare community hard but important lessons. Let’s use them to make our defences against the next pandemic more nimble, more robust, and – above all – more equitable,” said IFPMA Director General Thomas Cueni.

“We have seen the strength of a strong innovation ecosystem leading to the rapid development of multiple solutions, acting to expand partnerships, knowledge-sharing, and technology transfer in unprecedented ways,” he added, commending CEPI for bringing people across the innovation ecosystem to address COVID-19.

Moderna has committed to permanently waiving its COVID-19 patents in 92 low- and middle-income countries, and is pursuing vaccines for 15 diseases identified as the world’s biggest public health risk, including ebola, tuberculosis and malaria.

The company has also offered outside researchers access to its mRNA technology to pursue research on emerging and neglected infectious diseases, it announced on Monday evening.

However, Moderna will not share its COVID-19 vaccine technology with the mRNA hub that the World Health Organization (WHO) has established in South Africa that has already made a copy of Moderna’s vaccine.

This prompted French virologist Marie-Paule Kieny, who chairs the hub and the Medicines Patent Pool, to appeal for “more” from the company.

Instead, it is setting up a $500-million vaccine manufacturing facility in Kenya, and has signed a Memorandum of Understanding with that government.

Moderna CEO Stephane Bancel said that it was “not a good use of our time” to work with the mRNA hub.

The company aims to have clinical trials for some of the 15 priority pathogens by 2025. Moderna is expanding its patent pledge to never enforce COVID-19 patents in the 92 low and middle-income countries identified for support by COVAX.

Earlier, it had pledged not to enforce patents during the emergency phase of the pandemic, which is why the South African mRNA hub opted to make its vaccine.

Image Credits: Gavi .

Ukrainian child with his dog -displaced by war, in a refugee camp on the Moldova-Ukranian border

The World Health Organization (WHO) has managed to get five tonnes of surgical supplies into the besieged Ukrainian capital of Kyiv – although it did not want to disclose how it did so.

WHO spokesperson Tarik Jasarevic, who is in Lviv in western Ukraine, said the global body had received confirmation that the medical supplies had arrived in Kyiv overnight.

“Medical authorities there will dispatch them further. Without specifying precise details, we are looking into all possible modalities to do that,” Jasarevic told a media briefing hosted by the WHO Europe on Tuesday.

“So far, two shipments totalling 76 tonnes of trauma and emergency health supplies, as well as freezers, refrigerators, ice packs, and cool boxes are in transit in Ukraine,” said WHO regional director for Europe, Dr Hans Kluge. “We have further shipments of 500 oxygen concentrators and more supplies are on their way.”

“By hook and by crook, we need to get whatever we can already to the affected areas,” added Kluge. “We know from previous conflicts when doors are being closed, health diplomacy becomes key. Our principle is ‘Health for All’ and the top priority is to get life-saving humanitarian medical supplies to the people in need, wherever.”

Kluge added that the WHO was keeping the communication lines open to “both parties”, and it would also help vulnerable Russians if the western economic blockade disrupted the supply of, for example, cancer medicine or insulin for children.

Meanwhile, the situation of Ukrainians trapped in besieged cities such as Mariupol is worsening, with no access to water, food or power.

Earlier on Tuesday, a number of civilians including foreign students from China, India and other countries, were allowed to leave the southern port of Sumy by bus and in private cars during a Russian-agreed ceasefire.

However, there were reports of Russians firing on those evacuating as well as reports that a proposed evacuation route from Mariupol had been closed by Russian fire.

Addressing a meeting in London, WHO Director-General Dr Tedros Adhanom Ghebreyesus mentioned Russia for the first time since its invasion, describing events in Ukraine as “beyond heart-breaking”, and calling on “the Russian Federation to commit to a peaceful resolution of this crisis, and to allow unhindered access to humanitarian assistance for those in need”.

Worst refugee crisis in 75 years

Two million people, the vast majority women and children, have managed to flee Ukraine since 24 February, according to the UN High Commission on Refugees (UNHCR) on Tuesday, while Kluge said this number was expected to reach four million by July – the worst refugee crisis in Europe in over 75 years.

WHO Europe is hosting a long-planned meeting on refugee and migrant health is taking place next week in Turkey that will bring together health ministers, representatives of refugee and migrant groups, partner organizations as well as the WHO African and Eastern Mediterranean region.

“This meeting will be an opportunity to take account of current needs in a longer-term context, recognising the potential of migration to contribute to thriving, healthy populations and to ensure an economy of well-being for all,” said Kluge.

He spoke out sharply against reports of discrimination and racism against non-Ukrainian refugees, saying that any differentiated treatment of refugees would not be tolerated.

The principle of all refugees being treated equally would be written into the final outcome document of the meeting in Turkey, he added.

Women are especially vulnerable 

An estimated 80,000 Ukrainian women are expected to give birth in the next three months, and UN agencies anticipate that 1000 women will give birth every week as refugees by July.

Women have already experienced high levels of violence in the eastern Ukrainian areas of Donetsk and Lugansk, where the military and separatists have clashed.

“Past conflicts have shown us that adolescent girls, women with disabilities and elderly women are in the most vulnerable situation,” said Kluge. “They face an increased risk of suffering attacks by people outside the home and by armed groups, as well as intimate partner violence and sexual abuse and exploitation.”

Meanwhile, WHO Europe’s incident manager, Dr Catherine Smallwood, said that there had been 16 confirmed attacks on health facilities, including direct attacks on health facilities and the commandeering of ambulances. However, she added that the WHO did not want to name the facilities in case of reprisals against health workers that had reported them.

https://twitter.com/WHO/status/1500887174442536966?s=20&t=G_ixkh-MxGUOa3j3ZRHgeQ

Image Credits: UNICEF/UN0599222/Moldovan.

Up to 17 million mink are to be culled in Denmark following the discovery of a COVID-19 mutation
Up to 17 million minks were reportedly culled in Denmark following the discovery of a COVID-19 mutation

Countries need to prevent more SARS-CoV2 infections in wildlife, as this could result in the establishment of animal reservoirs, according to a joint statement by the World Health Organisation, Food and Agriculture Organisation (FAO), and the World Organisation for Animal Health (OIE).  

So far domestic animals, free-ranging, captive or farmed wild animals such as big cats, minks, ferrets, North American white-tailed deer and great apes have been observed to be infected with SARS-COV2. 

The statement noted that while the COVID-19 pandemic was caused by human-to-human transmission, animals are equally susceptible to the virus.

The only known instances so far of animal-to-human transmission of the SARS-COV2 have been from farmed mink and pet hamsters while a potential case of SARS-COV2 to a human through a white-tailed deer is under review.

Hong Kong recently ordered the culling of over 2,000 pet hamsters and other small animals due to its zero-COVID strategy in the face of a case of transmission of the virus at a pet shop. In November 2020, Denmark reportedly culled up to 17 million minks amid coronavirus fears. 

The organisations called for countries to adopt relevant regulations especially when it comes to people working in close proximity to wildlife, and the public. It also warns that people should avoid approaching, touching, feeding or eating wild animals in close wild proximity, especially those that are orphaned, sick or are dead.

While the transmission of the virus is not very common from animals to humans, a January 2021 report by WHO, FAO and OIE shows that the transmission of SARS-CoV-2 from fur farm animals to domestic animals and susceptible wildlife populations is the highest in Europe, likely because it has a high number of fur farms. Such a kind of transmission through fur farms is mild in Africa, while it is moderate in America and Asia.  

Countries are encouraged to monitor and sample wild animals susceptible to SARS-COV2 and report confirmed cases of the virus in animals to OIE through the World Animal Health Information System (OIE-WAHIS), and to suspend the sale of captured live wild mammals in food markets.

This statement comes after three pre-print papers published in February strengthened the case for the theory that SARS-COV2 first spread among people via infected animals sold and slaughtered at the Hunan wildlife market in Wuhan. 

Image Credits: Nettverk for dyrs frihet / Net. for Animal Freedom.

A Ukrainian refugee family with 11 children entered Romania at the Isaccea border crossing.

The World Health Organization (WHO) has managed to get the 36 metric  tonnes of medical supplies it flew into Poland late last week into the western Ukrainian town of Lviv, some 80 km from the Polish border. 

However, major Russian targets such as Kyiv and Mariopul are over 540km and 1200 kms away respectively, prospects so far appeared dim that the Russians will open up a humanitarian corridor to enable medical supplies to reach the capital for those unable to leave.

Speaking with Health Policy Watch from Lviv, Ukraine, WHO spokesperson Tarik Jaresevic said that WHO was liaising with the Ukranian Ministry of Health on where and how the supplies could be distributed so that they would reach those most in need throughout the country.  

“WHO has set up a warehouse in Lviv… we are working with the Ministry of Health on where it is going to be sent and how,” he said.  He said that most of the supplies were intended for trauma injuries: “It’s mainly surgical kits with a few emergency kits, and some essential medical supplies.  We hope they will go to where they are most needed.”

From its base in Lviv, WHO will also be coordinating the “health cluster” of international aid response, to provide a single address to the Ukrainian Ministry of Health, said Jaresevic.  He added that he expected another WHO aid shipment to arrive in the city shortly.

How the supplies will get from Lviv to other areas of the country that are desperately in need of aid, and in some cases also under shell fire and lacking electricity or water, is another question. 

Attacks on health facilities have skyrocketed, with WHO having verified a total of 16 attacks involving health facilities, in which nine people were killed and 16 were wounded.  That, as Russia steps up its attacks on Ukraine’s civilian infrastructure, including city centres, residential and commercial areas.

“Additional reports are being investigated,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus on Twitter Sunday. “Attacks on healthcare facilities or workers breach medical neutrality and are violations of international humanitarian law.”

WHO’s Kyiv staff moved to safer locations  

WHO maintains a large storehouse of supplies in Kyiv, but it remains unclear if access to that is available either, as Russia continues to tighten its noose around the city. In a press briefing, March 2, Mike Ryan, WHO Executive Director of Health Emergencies said access to Kyiv’s stores was largely “blocked” by the constant bombardments.  

Some of WHO’s Ukrainian national staff also have had to be relocated to safer locations outside of Kyiv – although the WHO spokesperson said “they are continuing working to support the health system.” 

Throughout Monday continued Russian shelling of evacuation routes from major cities was continuing, making entry or exit all the more dangerous.  This after a Russian military strike hit an evacuation crossing point in a Kyiv suburb Sunday, killing a family with two children and other civilians, and another shell attack in Hostomel killed the village mayor.  

Further attempts to create humanitarian access corridors continued to founder after Russia said that it would only allow people to evacuate to Russia or Belarus. 

UNICEF and UNHCR appeal for protection for child refugees 

On Monday, UNICEF and the UN High Commission for Refugees (UNHCR) appealed to Ukraine’s neighbours to help document and protect Ukrainian child refugees, especially those without parents.

In the past week, around 1.2 million refugees have fled Ukraine, and about half are estimated to be children, including those who are either unaccompanied or have been separated from their parents and family members.

“Children without parental care are at a heightened risk of violence, abuse and exploitation. When these children are moved across borders, the risks are multiplied. The risk of trafficking also soars in emergencies,” said UNICEF Executive Director Catherine Russell and United Nations High Commissioner for Refugees Filippo Grandi in a statement on Monday.

“UNICEF and UNHCR urge all neighbouring and impacted countries to ensure the immediate identification and registration of unaccompanied and separated children fleeing from Ukraine, after allowing them access to their territory,” they added.

Russell and Grandi have appealed to neighbouring states to link the child refugees to their national child protection systems, including with “screened caregivers” such as temporary foster or other community-based care, and critical child protection services and family tracing and reunification mechanisms.

Around 100,000 Ukrainian children, half of them with disabilities, live in institutional care and boarding schools in Ukraine. 

“Those legally responsible for children in institutions in Ukraine must ensure that evacuations are done in line with national authorities’ instructions. Movements must be reported to competent authorities in Ukraine and neighbouring countries immediately upon crossing the border, and as far as possible, children should be evacuated with their identification papers and case files,” according to the statement.

 

Meanwhile, an estimated 80,000 Ukrainian women are due to give birth in the next three months and many have already had to do so in underground train stations and temporary bomb shelters.

Exhausted Ukrainians continue to flee across the borders to seek refuge in Poland, Moldova and other countries to escape from Russia’s bombing.

Polish nurse Dominika Janas works in a makeshift clinic at the Rzeszów train station, in Poland. She told the WHO that the facility was seeing 50 to 100 refugees a day, mostly children who are cold, hungry, dehydrated and exhausted. However, Janas said what worries her the most was their mental health.

https://twitter.com/WHO/status/1500821976788742149

Image Credits: UNICEF.

A child receives an oral polio vaccine in India.

A four-year-old girl from Jerusalem has been diagnosed with polio, Israel’s Health Ministry said Sunday – the first case in the country since 1989.

The source of the girl’s infection is vaccine-derived polio virus, according to Israel’s head of Public Services Dr Sharon Alroy-Preis, speaking to reporters on Monday evening.

“We are not talking about wild polio,” Alroy-Preis stressed. “This is polio from the weakened live vaccine that changed over time.”

Neither the child nor any of her family members – all part of an ultra-Orthodox Jewish sect in the city – had been vaccinated against the disease. The ministry believes the child could be just one of dozens of others who have been exposed to a mutant strain of the virus, Alroy-Preis said. That is a particular concern since among some communities in Jerusalem, vaccination rates are less than 50%.

Alroy-Preis said that officials are in touch with 10 family members who were in close contact with the child, another 20 children in her preschool and staff. The city is working to get the necessary permissions to screen the children for the disease.

Jerusalem health officials will notify anyone else who might have come into close contact with the four-year-old and provide specific instructions, the ministry said. Based on the findings of the investigation, further recommendations will be made.

Others could have been exposed

Routine vaccination rates tend to be lower among ultra-Orthodox Jews in Israel, partially because of ideological reasons and a lack of trust in the government and its systems, and partially for technical reasons. Ultra-Orthodox families tend to be large and parents may struggle to adhere to each child’s vaccination calendar, Alroy-Preis said.

To help immediately increase polio vaccination rates, the Health Ministry has launched a dedicated communications campaign and is working to recruit nurses to offer vaccines during off hours and in non-traditional locations.

Israel is a member of the World Health Organization’s European Region, which was declared polio-free in 2002, according to the European Centre for Disease Prevention and Control.

Israel regularly monitors for the virus through a dedicated sewage surveillance program and in health clinics. In 2013, traces of polio were detected through the sewage program but no one was diagnosed with the virus.

Israel administers four doses of the polio vaccine between the ages of two and seven: two injections of the inactivated virus vaccine and two doses of the oral polio vaccine containing live attentuated virus, given as liquid drops. The live virus protects the digestive tract where polio is contracted.

Polio is a highly infectious disease that is transmitted person-to-person, especially in children. It enters through the mouth and is excreted in the faeces. There are usually no signs of illness, though one in about a thousand unvaccinated people can develop severe symptoms, including paralysis.

“The main concern is that we have a virus that can harm children – not only children, but mostly children – with a preventable illness,” Alroy-Preis said. “Even if it harms only a small number of children, the disease can be severe and irreversible.”

Case discovered two weeks ago

The case was discovered almost two weeks ago, Alroy-Preis said.

The child was admitted to Jerusalem’s Hadassah Medical Center, the hospital said. She was suffering from severe weakness in her leg muscles as well as other polio-like symptoms. Tests with the involvement of a paediatric neurologist confirmed the polio diagnosis.

The child was treated at the hospital for a week and with an improvement in her condition she has been transferred for further rehabilitation, the hospital added.

The Jerusalem District Health Bureau has opened an epidemiological investigation.

Last month, a child in Malawi was diagnosed with wild poliovirus (WPV type-1) linked to the strain in Pakistan. Neither the three-year-old Malawian girl, diagnosed after she experienced an onset of paralysis, nor any of her family members had recently travelled to Pakistan, meaning that she became infected locally.

Alroy-Preis said authorities had no way of knowing if the vaccine-derived virus was imported or developed locally.

Image Credits: Jean-Marc Giboux/Rotary International.