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.

Bjorn Kummel

Björn Kümmel, chair of the World Health Organization’s (WHO) working group on sustainable financing, wants to complete two marathons this year: an actual road race in Berlin – and the adoption of proposals to improve the WHO’s financing at the World Health Assembly (WHA) currently in session.

For 18 months, Germany’s Kümmel has steered discussions aimed at reforming the WHO’s finances as chair of the working group on sustainable financing. 

Only around 16% of the WHO budget is predictable, derived from member states’ fees, called “assessed contributions”. The other 84% comes from grants and voluntary contributions from members, skewing the global body’s programmes and making it hard to respond with speed and flexibility to health emergencies.

‘Severe risk’

“This situation has put WHO at severe risk, including its independence, its integrity, its agility and certainly also it’s mandated role to be the world’s leading and coordinating authority in global health,” Kümmel told the WHA’s meeting of Committee A on Monday.

He was reporting on the consensus reached by the working group last month on a package of measures, including that 50% of the WHO’s budget should come from assessed contributions by 2030, starting with an increase to 20% by next year’s WHA.

This is not a technical issue but a “gamechanger”, Kümmel told the committee. 

“It was clear for the working group that what we were discussing is nothing less than the future role of the WHO and global health and even beyond. Namely, the question, what kind of global health architecture do we envisage: a less fragmented, better coordinated, more efficient and truly inclusive global health governance with a fundamentally strengthened WHO at the centre as the enabled, leading and coordinating authority.”

 

WHO staff tied up with grant management

Earlier in the day, WHO Africa director Dr Matshidiso Moeti told a WHA roundtable meeting on WHO financing that the global body was managing around 3,000 grants.

“Many of our staff members are spending a disproportionate amount of their time processing these grants,” said Moeti. 

In addition, said Moeti, Africa was seen by donors as being “overwhelmed by communicable diseases” and this has resulted in a lack of funds for non-communicable diseases.

WHO Regional Director for Africa Dr Matshidiso Moeti.

If there was more flexibility in funding, the WHO could “address the health systems needs of the countries for preparedness, for providing essential health care services, for being resilient when we have to encounter such a problem as the pandemic we’re experiencing now”, she added.

She compared WHO’s funding model to that of “an average African country, which is highly dependent on donor funding” and “structured in this very vertical fragmented manner”.

This was inefficient, and made countries vulnerable rather than resilient to a pandemic, she said, appealing to member countries to support the changes being proposed by the working group.

Supporting her in the session, WHO Director-General Dr Tedros Adhanom Ghebreyesus said that it was “not about the money” as the WHO had received significant donations during the pandemic – but rather the flexibility to spend the money where it was most needed.

‘Constructive multilateralism’

Describing the process of reaching consensus in the working group as “constructive multilateralism”, Kummel told the WHA committee that “any substantive AC increase would need to be supported by concrete steps to ensure that agility of the WHO, therefore the working group on sustainable financing also recommends the establishment of an agile member states task group”.

This was well-received by member states, with unanimous support for the financial reforms – to the relief of Kummel who described the process as “a marathon run” at the roundtable event before the committee.

“But it was a good run because we ran as a team, and we are still running as a team. There are two things on my to-do list for this year. The one is the Berlin marathon that is in September. The other one is to get this over the finish line and we will have the chance to get this over the finish line, most likely this afternoon,” he told the roundtable.

The WHA will vote on a resolution based on the working group’s decision later in the week.

Image Credits: WHO.

France at the WHA75.

France led the call for a more integrated approach to ameliorating the global burdens of non-communicable diseases at the World Health Assembly (WHA) on Monday, appealing for climate change and environmental issues to be factored into the global response.

Speaking on behalf of some countries in the European Union at Monday’s WHA75 committee session to discuss the follow-up to the political declaration of the third high-level meeting on the prevention and control of NCDs, France said that NCDs were increasing and affecting more and more people of all ages around the world, in particular, the most vulnerable. 

“NCDs already place a large burden on future generations as well as the budgets of states. We must have efficient programs based on an integrated health approach,” the government of France told the WHA committee session.

It called for urgent action, financing and mobilization of stakeholders to be facilitated by the global coordination mechanism. While describing WHO’s roadmap as a basis to work on, it also called for the inclusion of climate change and environmental factors which it described as being of determining importance for NCDs.


Decrying the impacts of the COVID-19 pandemic on global and local initiatives to address NCDs, France said the interruption of prevention and treatment over the course of the pandemic has led to greater inequalities in health.

France then highlighted the importance of improved pandemic preparedness in order to intensify the efforts against NCDs. This, it said, should include promoting patient-focused health education; and policies that prioritize early detection, diagnostics and better treatment in the framework of continued treatment.

Shift to primary health 

In his opening address at WHA75, WHO DG revealed that over the past five years, the global health body has supported 36 countries to integrate services to prevent, detect and treat NCDs into primary health care programmes. He added that health systems are being reorientated towards primary health care as the foundation of universal health coverage.

He revealed that 90% of essential health services can be delivered through primary health care. And investing in primary health care could increase global life expectancy by as much as 6.7 years by 2030.

“We need a radical shift to accelerate progress towards universal health coverage, with a significant increase in investments in primary health care in all countries – high, middle, low income. We have seen globally that the weakness is in primary health care,” the Director-General said.

France agrees. It told the assembly that primary healthcare needs to be strengthened to be able to give people the means to better control their health and in containing the risk factors of NCDs such as the effects of alcohol, tobacco and other addictive substances, diets and sedentary lifestyles.

“Countries rely on the support of WHO and it’s essential that the preparedness and response to NCDs is also part of all emergency responses in order to allow essential healthcare services to be provided in a multi-sectoral way,” it added.

Insights from the war against diabetes 

Diabetes is one of the NCDs that its control could have far-reaching impacts on the global NCDs agenda considering its association with other health conditions and socioeconomic impacts. 

In January 2022, WHO Executive Board proposed several global targets including diagnosing 80% of people with diabetes, 80% of people with diagnosed diabetes have good control of glycaemia, 80% of people with diagnosed diabetes have good control of blood pressure, 60% of people with diabetes of 40 years or older receive statins, and 100% of people with type 1 diabetes have access to affordable insulin treatment (including devices for insulin delivery, such as syringes and needles) and blood glucose self-monitoring.

National diabetes policies and guidelines in Kenya, Mali and South Africa. Source: MSF Access Campaign.

But Dr Helen Bygrave, Chronic Diseases Advisor for Medicins Sans Frontieres (MSF) Access Campaign said while setting global targets for response is strongly supported, more investments will be required, especially in the areas of monitoring and surveillance.

“In countries where MSF works, we have witnessed the challenges faced by people with diabetes receiving care in the public health system, who often don’t have access to the bundle of insulin, medical supplies required to inject it, and tools to monitor their blood glucose levels. It is imperative that countries consider this ‘diabetes bundle’ and its price, when forecasting, budgeting and procuring,” Bygrave stated.

Pandemic
WHO DG Tedros Adhanom Ghebreyesus at 75th WHA

GENEVA – The world is still not ready to handle pandemics despite all of the international efforts to improve health care in recent years, Dr Tedros Adhanom Ghebreyesus warned in a wide-ranging opening address to the World Health Assembly’s 194 member nations.

The World Health Organization must respond to dozens of global emergencies — cyclones, volcanoes, earthquakes, outbreaks, wars – while handling the COVID-19 pandemic, and it created a new hub for pandemic and epidemic intelligence in Berlin earlier this year.

And yet it is not enough because “it’s clear that the world was – and remains — unprepared for a pandemic,” Tedros said. “The pandemic is far from over. And even as we continue to fight it, we face the task of restoring essential health services, with 90% of member states reporting disruption to one or more essential health services.”

More optimistically, Tedros said the world’s needs “remain daunting and complex. But none of these challenges are insurmountable. For every challenge, there are solutions. If there is a will, there is a way.”

His opening speech on the second day of the Assembly began with a look back at the UN health agency’s past five years, during which Tedros’ first term as director-general has been marked by “many calls for WHO to change,” he noted, in its work methods and culture.

“And there is no question that more change is needed,” said Tedros, who is widely expected to be appointed to a second five-year term. “Allow me now to look forward to where I believe we need to go in the next five years. … We are calling on every government to put the health of its people at the center of its plans for development and growth.”

Tedros said the pandemic shows not only why the world needs WHO but also why it needs to be “stronger, empowered and sustainably financed.” To that end, he welcomed a working group’s recommendation to raise assessed contributions to 50% of the core budget over the next decade. These fixed contributions only comprise 17% of WHO’s budget, leaving it to a few rich countries and philanthropies to voluntarily cover most of WHO’s costs.

“You elected me five short years ago, with an ambitious agenda for universal health coverage; health emergencies; women’s, children’s and adolescents’ health; the health impacts of climate and environmental change; and a transformed WHO,” he noted, adding those priorities evolved into the five-year plan for achieving its “triple billion” targets that the Assembly adopted in 2018.

They aim by 2023 to help 1 billion more people benefit from universal health coverage; 1 billion more people be better protected from health emergencies; and 1 billion more people enjoy better health and well-being.

Pandemics progress still slow

“Progress isn’t always fast or easy to measure. But in ways small and large, seen and unseen, I am proud to say that this organization is making a difference. Let me start with our efforts to see 1 billion people enjoying better health and well-being,” he said. “Our projection is that we will almost reach this target by 2023, but progress is only about one quarter of what is required to reach the relevant SDG [Sustainable Development Goals] targets.”

For examples of other global health progress, Tedros also pointed to declining tobacco use, less industrially-produced trans fat in the global food supply and more excise taxes on at least one health-harming product, such as tobacco, alcohol or sugary drinks.

He also cited new WHO limits for air quality “based on mounting evidence of the harms to health of air pollution at even lower concentrations than previously thought” and new WHO health guidelines or tools that 71 countries are using to respond to violence against women.

But on the universal health coverage goal, he said, the world is “far behind, and progress is less than one quarter of what is required” to reach the target.

“Even before the pandemic, we estimated that only 270 million more people would be covered by 2023, a shortfall of 730 million people against the target of 1 billion,” said Tedros. “Disruptions to health services during the pandemic have sent us backwards, and we estimate the shortfall could reach 840 million.”

But there has been a 29% global increase in the number of health workers between 2013 and 2020, he noted, in contrast to previous projections for a global shortage of 18 million health workers by 2030. “That projected shortage has now shrunk to 15 million but it is still a massive shortage,” he added.

Tedros said that in the past five years there has been “significant progress in expanding access to medicines and other essential health products” – such as 53 prequalified vaccines, 50 in-vitro diagnostics and 288 medicines, including new therapies for HIV, hepatitis, TB, malaria, NTDs and COVID-19 – and two prequalified biosimilar cancer medicines along with a pilot program to prequalify human insulin.

Since the start of the pandemic in March 2020, WHO approved emergency use listings for 12 COVID-19 vaccines and 28 in-vitro diagnostics. And within 15 days of those vaccine listings, he said, 101 countries were “illustrating the weight that these countries place on WHO’s stamp of approval” through their own regulatory authorizations of those vaccines.

He said the UN target on hepatitis B — part of the U.N.’s 17 SDGs that contain 169 targets – has been met, and since 2015 the number of people who got treatment for hepatitis C increased ninefold to 9.4 million, reversing the trend of increasing mortality for the first time. And for the first time, the world has a malaria vaccine, enabling more than 1 million children in Ghana, Kenya and Malawi to receive at least one of 4 doses recommended for them from 5 months of age. Each year more than 260,000 African children under five die of malaria.

And on non-communicable diseases, he said, WHO helped 36 countries over the past five years to integrate services to prevent, detect and treat NCDs – one or more chronic conditions, like obesity, heart or kidney disease, or cardiovascular diseases – into primary health care programs, and supported 25 countries with rehabilitation services. WHO also helped 31 more countries to integrate mental health services into primary health care. “Child survival has improved dramatically over the past 20 years,” he said, “although 54 countries are off track to meet the SDG child survival targets.”

Ukraine
Djibouti Health Minister and World Health Assembly President Dr Ahmed Robleh Abdilleh in action on Monday

GENEVA – Russia’s attacks on healthcare facilities amid its war in Ukraine took center stage on the first full day of the World Health Assembly (WHA), where 46 mostly European nations including Turkey, Ukraine, and the United States proposed a draft resolution “condemning in the strongest terms” Russia’s invasion and the attacks on health facilities, calling on all 194 of the World Health Organization’s (WHO) member nations to “maintain or increase support for the UN-led response” to the war in Europe.

The resolution emerged from WHO’s Regional Committee for Europe, which adopted it at a special session on 10 May. It calls on WHO’s Regional Director for Europe to consider temporarily closing Russia’s regional office and suspending all regional meetings in Russia, including technical and expert meetings. 

It also urges Russia “to fully respect and protect all medical personnel and humanitarian personnel exclusively engaged in medical duties, their means of transport and equipment” and to show “respect for and protection of the sick and wounded, including civilians, health and humanitarian aid workers, healthcare systems consistent with the Geneva Conventions and their additional protocols, and with broader international humanitarian law.”

The resolution also urges all WHO member nations to “adhere to international humanitarian law, international human rights law, and WHO norms and standards; to allow and facilitate safe, rapid and unhindered access to populations in need of assistance by staff deployed by the World Health Organization on the ground, and by all other medical and humanitarian personnel; [and] to ensure the free flow of essential medicines, medical equipment and other health technologies in all conflict and non-conflict areas.”

Ukraine war scarier than a pandemic

Ukraine’s First Lady, Olena Zelenska, told the Assembly that Ukraine and WHO have had years of “fruitful relations” and, at least until recently, nothing could have been scarier than a pandemic.

“But it turned out differently. Russia’s war has shown horrors we could not have imagined,” she said by videoconference. “WHO is committed to protecting the most crucial human rights – to life and health. Now they are both being violated in Ukraine. No Ukrainian, neither adults nor children, can be sure that they will wake up tomorrow, that a missile will not fly into their house. Doctors cannot be sure that their ambulances will not be bombed on the way to a patient.”

On the same day, her husband, President Volodymyr Zelensky, spoke by videoconference to the World Economic Forum in Davos and called for help to come “as fast as possible” to arm Ukraine for victory and help rebuild the country after the war.

The draft resolution put forward by Ukraine was co-sponsored by 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, Luxembourg, Malta, Moldova, Montenegro, Netherlands, New Zealand, North Macedonia, Norway, Peru, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Turkey, United Kingdom and United States.

Russia appeals for ‘non-politicized’ discussion

Among the holdouts from the co-sponsor list were Hungary – the only one missing from the 27-nation EU bloc – along with Israel and Switzerland.

Russia won some scattered applause in the Assembly when one of its diplomats urged colleagues not to allow WHO to become “politicized” – in keeping with the nations’ social media posts. 

Russia’s Mission in Geneva tweeted that “Russia looks forward to forging common solutions to the pressing global health challenges. We expect non-politicized, constructive and consensual deliverables of #WHA75, moving us towards a healthier planet.”

Separately, a Russian diplomat at Russia’ Mission in Geneva said he was resigning his position because he was ashamed of his government’s invasion of Ukraine. In a letter posted on his LinkedIn account, Boris Bondarev, a counselor for arms control, disarmament, nonproliferation and export control, said he resigned on Monday.

“Long overdue, but today I resign from civil service. Enough is enough,” he began. “For twenty years of my diplomatic career I have seen different turns of our foreign policy, but never have I been so ashamed of my country as on February 24 of this year. The aggressive war unleashed by [Russian President Vladimir] Putin against Ukraine, and in fact against the entire Western world, is not only a crime against the Ukrainian people, but also, perhaps, the most serious crime against the people of Russia, with a bold letter Z crossing out all hopes and prospects for a prosperous free society in our country.”

“Those who conceived this war want only one thing – to remain in power forever, live in pompous tasteless palaces, sail on yachts comparable in tonnage and cost to the entire Russian Navy, enjoying unlimited power and complete impunity,” he continued. “To achieve that they are willing to sacrifice as many lives as it takes. Thousands of Russians and Ukrainians have already died just for this.”

As the Assembly got underway, WHO said it verified 30 additional attacks on health care facilities in Ukraine. As of Monday, it said, 75 deaths and 59 injuries can be traced to 248 verified attacks on health care facilities in Ukraine from February 24, the day that Russia invaded, until May 19.

“It is a true catastrophe for millions of people. The World Health Assembly needs to discuss this,” Germany’s Health Minister Dr Karl Wilhelm Lauterbach urged colleagues.

“I call on everyone to support the resolution presented by Ukraine to this assembly.” Norway’s Health Minister Ingvild Kjerkol said her nation strongly supports Ukraine and WHO has a strong role to play in helping maintain peace. When nations stand together, she said, they are stronger and “that is what this time calls for.”

Child infected with monkeypox in Liberia – since smallpox vaccinations were discontinued children may be even more vulnerable

Fifteen non-endemic World Health Organisation(WHO) member states have reported 95 confirmed cases of monkeypox between 13-22 May – but the language and imagery used to report the outbreak has raised concerns over the reemergence of disease-related stigma against LGBTI and African members of society. 

Based on currently available information, the WHO said that cases have mainly but not exclusively been identified amongst men who have sex with men seeking care in primary care and sexual health clinics.

“While we’re seeing cases amongst men who have sex with men, this is not a gay disease, as some people on social media have attempted to label it. It is just not the case. Anybody can contract monkeypox through close contact,” said Andy Seale, Advisor at the WHO, in a live Q&A on Monday.

The Joint United Nations Programme on HIV/AIDS (UNAIDS) also raised concerns over the portrayal of LGBTI and African members in the commentary and reportage being circulated in the media. 

UNAIDS said that such language and imagery can reinforce racist and homophobic stigma. “Experience shows that stigmatizing rhetoric can quickly disable evidence-based response by stoking cycles of fear, driving people away from health services, impeding efforts to identify cases, and encouraging ineffective, punitive measures,” said Dr Matthew Kavanagh, UNAIDS Deputy Executive Director. 

The current images used to portray monkeypox rashes belong to members of the African community based on the documentation over the last decades on cases in the African region where this disease is endemic. 

Seale re-emphasised that communities are the WHO’s main concern and it was working on getting more accurate information to better understand and manage the health risks of this disease.

“There’s a lot of stigma and discrimination that surrounds many diseases. And I think the key thing we need to look out for is WHO working with our partners in communities and elsewhere, to make sure that their messaging is correct.” 

The WHO expects more cases of monkeypox to be identified as surveillance expands in non-endemic countries. As per available evidence, those who have had close physical contact with someone with monkeypox symptoms are the most susceptible to contracting the disease which is endemic to West Africa. 

US orders freeze-dried smallpox vaccines 

As the reportage and awareness of the outbreak gains momentum in Europe and North America, US President Joe Biden said the current scale of the disease was something “everyone should be concerned about.” “It is a concern that if it were to spread, it would be consequential,” he said.

The US has exercised its options under an agreement with the Copenhagen-based Bavarian Nordic company to order a freeze-dried version of JYNNEOS® smallpox vaccine. According to the company, the first doses of this vaccine version will be manufactured in 2023 and 2024 and will cost US$119 million.  

Bavarian Nordic said that additional options on the contract, valued at US$180 million, would support the conversion of up to a total of approximately 13 million freeze-dried doses of the vaccine that are expected to be manufactured in 2024 and 2025. “The majority of the bulk vaccine for these doses has already been manufactured and invoiced,” the company’s press release said. 

monkeypox
A table showing the recent outbreak of WHO between 13-22 May in non-endemic countries.

According to the US Centers for Disease Control and Prevention, the smallpox vaccine is at least 85% effective against monkeypox. It also said that the U.S has licensed two vaccines to prevent smallpox, with one being authorized specifically for monkeypox.

Vaccine efficacy, and access

This 85% vaccine effectiveness is attributed to the older version of the vaccine, said Dr Maria van Kerkhove, WHO Technical Lead on COVID-19.

“We now have new vaccines. Although smallpox was eradicated, research has continued for the last 40 years… [because] these viruses are closely related to each other and now we have the benefit of all those years of research diagnostics and treatments in vaccines,” she said. 

However, she warned that since these are relatively newly discovered products, they are not yet widely available. “They are available to some Ministries of Health and National stockpiles, but they’re not yet widely available commercially.”

This highlights the US decision to exercise its options in light of the scarcity of vaccines in even regions where monkeypox is endemic. 

According to a paper published in February 2022, the cessation of the smallpox vaccine in 1980s caused a minimum of 10-fold increase in cases in 2010-19 compared to the 1970s. The smallpox vaccines provided some cross-protection against monkeypox. The paper had warned at its time of publication that monkeypox is gradually evolving to become of global relevance and surveillance and detection programs are essential tools for understanding the continuously changing epidemiology of this resurging disease.

How worried should one be about contracting monkeypox? 

“Monkeypox and COVID-19 are not the same disease,” said Dr Rosamund Lewis, head of the Smallpox Secretariat at the WHO Emergencies Programme.

“Monkeypox spreads through close physical contact, which includes touching the rashes developed in this disease,” she said. 

While COVID-19 and monkeypox are zoonotic viruses, the latter is transmitted from one person to another by close contact with lesions, body fluids, respiratory droplets and contaminated materials such as bedding. The disease has symptoms that are similar to those seen in smallpox patients, although the former is clinically less severe and has an incubation period of 6 to 13 days. 

Dr Van Kerkhove said that the WHO has been working with Ministries of Health in countries to expand surveillance in order to look for people who have a rash. This means broadening the radius of alertness to dermatology clinics, emergency departments, infectious disease clinics, and sexual health clinics to effectively understand the extent of infection.  

She brought to light that the current outbreak seen in non-endemic countries is “a containable situation” but warned that “we can’t take our eye off the ball on what’s happening in Africa as well as in endemic countries”.

“So this gives us an opportunity to talk about what monkeypox is and what it isn’t, so you can be very well informed,” she added.

All you need to know about monkeypox 

There are currently 12 monkeypox endemic countries in the WHO Regional Office for Africa: Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Ghana (identified in animals only), Ivory Coast, Liberia, Nigeria, the Republic of the Congo, Sierra Leone, and South Sudan. 

If you are in a non-endemic country, the symptoms to watch out for are an acute rash with the combination of one or more of the following: headache, acute onset of fever, swollen lymph nodes, muscle and body ache, back pain, and weakness.

Image Credits: US Centres for Disease Control , WHO.

(On right): Magda Robalo, Global Managing Director at Women in Global Health outlines gender and sex abuse issues facing WHO, hours before the 75th World Health Assembly convened.

Over 20 babies have been born as a result of sexual exploitation and abuse by World Health Organization (WHO) staff and contractors in the Democratic Republic of Congo (DRC), and the global health body, cannot yet move on from the two-year-old scandal.

Addressing the WHO’s stained record of sexual exploitation abuse and harassment remains unfinished business for the global health body – in the wake of the scandal that plagued the World Health Organization’s (WHO) Ebola response in the Democratic Republic of Congo (DRC) between 2018 and 2020.

That was just one of a number of key messages to emerge from Sunday’s pre-World Health Assembly briefing, organized by the Geneva Graduate Institute’s Global Health Centre and the United Nations Foundation. 

Charting a path to the Triple Billion

Open Briefing to 75th WHA:  Agnes Soucat of the French Development Agency (center) and WHO’s Abdou Salam Gueye (right) discuss the global architecture for health emergencies response.

The briefing focused around WHO’s ‘Triple Billion targets’, looked at how the global health agency could achieve universal health coverage for 1 billion more people worldwide in coming years (Pillar 1); improved emergency response (Pillar 2); and better health and wellbeing (Pillar 3); with key speakers from WHO, donors, and civil society.

At the sessions, new modes of financing UHC access were explored by Kate O’Brien of WHO and Ghitnji Gitahi, of Amref Health Africa. WHO’s Abdou Salam Gueye and Agnes Soucat of Agence France du Developpement discussed a White Paper proposal by the WHO for reforms that would, among other things, support a new World Bank fund for ready finance of vaccines and treatments in low- and middle-income countries during future outbreaks and pandemics.

Gueye also stressed the need for more coordination between WHO’s Africa Regional Office and the African Centers for Disease Control to advance a wide range of agendas, from health systems strengthening to medicines access. He said that he recently visited Africa CDC at its Addis Ababa headquarters to discuss the possibility of a new coordination mechanism between the two groups.

“We said what we want to do and they said what they want to do. When we checked, it was so interesting and we could complement each other at many points. We need better streamlining in order to know what the other is doing, and where we can really put our forces together and succeed,” Gueye told the audience in Geneva. “What we need is just to have a coordination mechanism where what needs to be done will be clarified, and also people will work together in a complementary manner.”  

Meanwhile, WHO’s Ben McGrady and Mohammed Eissa, part of the student-driven International Federation of Medical Students Associations (IFSMA) talked about how to better integrate environmental factors driving ill health, such as air pollution, as well as commercial drivers, such as the aggressive marketing of tobacco, alcohol and sugary drinks, into WHO’s own agenda as well as country priorities.

Ensuring justice for DRC victims

Better WHO governance was a “fourth pillar” discussed at the briefing – including follow-up on the still outstanding questions around the investigation into the DRC victims of sexual abuse and exploitation by WHO staff and consultants during between 2018 and 2020. Some 75 Congolese women were reportedly sexually exploited, abused, and/or harassed by 25 WHO workers deployed to assist the DRC in its response to the Ebola outbreak that occurred in eastern DRC between 2018 and 2020.

Magda Robalo, Global Managing Director for Women in Global Health, noted that the WHA’s 75th session, which began Sunday, would need to review progress made so far to address the DRC scandal, and ensure that WHO investigations bring justice to the victims and prevent the abuse of vulnerable populations in the future. 

“The drama around sexual exploitation, abuse and harassment is one of the issues that we need to collectively work together on eliminating. When we say eliminating, we know we cannot eradicate it. The DRC Ebola case brought to light something that happens every single day in humanitarian emergency situations, but also in development contexts. There are other cases in other countries where this is happening,” said Robalo. 

“There is no justice for the victims. And that’s totally unfair.” 

sexual exploitation drc
The DRC sexual exploitation and abuse scandal occurred during the WHO’s response to the 2018 – 2020 Ebola outbreak.

The global health body has admitted to failures in its response to sex scandals following accusations of “common sexual exploitation and abuse”, leading to calls for reform of internal justice at the WHO. A final report by an Independent Oversight Advisory Committee (IOAC) of the WHO Health Emergencies Programme also advised the global health body to reform accountability systems to prevent sexual exploitation and abuse.

Robalo emphasised that the WHO and other development bodies needed to ensure that workers hired to protect vulnerable populations do not abuse them because they have power.

WHO quickly addressed  the DRC scandal

WHA75 which commenced Sunday afternoon, is expected to discuss sexual harrassment, abuse and exploitation, among other issues.

Once the sexual abuse came to light, the WHO “quickly developed a management response plan to address the situation”, according to Robalo, who reported on a town hall meeting addressed by WHO Director-General Tedros Adhanom Ghebreyesus a month earlier on progress made to address the issue and protect the populations that are at risk of becoming victims. 

“They established the department for preventing sexual exploitation, abuse and harassment with an interim director. We hope that there will be a permanent appointment so that the department can be staffed and work on these issues,” she said. 

Pressure to see justice for victims 

Even though the WHO can still do more, she observed that WHO’s member states also have a role to play. 

“Very often, when these cases are coming to light, you see a disconnect between the outcomes and recommendations from the reports and action from the Ministries of Justice and the structures in the countries where those victims are living, which needs to be taken on board by the government,” she added. 

Addressing this, she said, would require continuing working on ensuring that the right policies and right actions are in place to prevent sexual exploitation, abuse and harassment in humanitarian emergency settings, but also across the development world.

“We need to continue putting pressure, following up and demanding that action is taken until the response management plan is implemented, but also that we see justice for the victims. That’s very important for the survivors,” she concluded.

Image Credits: WHO AFRO.

WHO DG Tedros Adhanom Ghebreyesus at the 75th World Health Assemby in Geneva, Switzerland, in the Palais des Nations.

GENEVA – Opening the World Health Assembly under a “health for peace” banner that is this year’s theme, Dr Tedros Adhanom Ghebreyesus warned WHA member states that achieving ambitious global health goals – from snuffing out COVID-19 to expanding universal health coverage – will be virtually impossible if regional conflicts like ones ongoing in Ukraine, Yemen,  and elsewhere continue to smolder and burn. 

War was not far away, however, as the ceremonial session saw leaders such as French President Emmanuel Macron and Croatia’s President Zoran Milanović issue strong denunciations of Russia’s invasion of Ukraine.  

“France & the EU stand in full solidarity with Ukraine,” said Macron, one of a number of heads of state to make videotaped remarks. “We condemn in the strongest possible terms the military aggression committed by Russia by the complicity of Belarus.”

French President Emmanuel Macron speaking at the 75th World Health Assembly.

Even so, a more serious confrontation was avoided after Moscow remained silent over a move by WHO’s European member states to place Armenia, instead of Russia, on the powerful “General Committee” that will decide behind closed doors tonight on the finalized agenda of the week-long WHA meeting.  

“War is bad enough, but it’s made worse because it creates the conditions for disease to spread,” said Tedros, who has been WHO’s director-general since 2017 and whose remarks dwelt mostly on the continuing challenges of snuffing out the COVID-19 pandemic – while grappling with a worrisome new outbreak of monkeypox, which continues to spread.  

“In war, hunger and disease are old friends… Ultimately the one medicine that’s needed is one that WHO cannot deliver – peace.  Peace is a prerequisite for health,” said Tedros, who also spoke movingly of his own experiences growing up in the Tigrayan minority area of conflict-ridden Ethiopia “as a child of war … with the sound of gunfire and shells whistling … tracer bullets in the night sky, the fear, the pain, the loss.”

Meeting face to face for the first time since 2020

75th World Health Assemby at the Palais des Nations, Geneva, Switzerland.

For the first time since 2020, WHO’s annual meeting of its 194-nation governing body at Geneva’s Palais des Nations was once again a physical gathering, largely reflecting the unprecedented speed of vaccine development since WHO declared COVID-19 a pandemic in March 2020. 

Sunday morning, in the streets around the global gathering place, WHO sponsored a “Walk the Talk: Health For All Challenge” event where delegates and others began the day with exercises and ran or walked for several kilometers to emphasize the importance of physical activity and other measures for combating non-communicable diseases that are the cause of two-thirds of premature deaths today globally.

Yet the continuing catastrophic damage to health and economies of the COVID-19 pandemic, and the widening injustices and inequalities it has brought on, along with Russia’s invasion of Ukraine – is expected to dominate debate at the assembly’s seven-day meeting.

WHA Resolutions by both Ukraine and Russia circulating 

peace
Refugees leaving Ukraine. A resolution denouncing Russia’s aggression on Ukraine is expected to take considerable time during the 75th World Health Assemby.

A resolution denouncing Russia’s aggression on Ukraine, co-sponsored by Ukraine, Canada, the United States and the European Union is expected to take considerable time on the agenda later this week. And Russia was now also said to be circulating its own resolution among member states with its own narrative on the still-raging conflict. 

The opening of the WHA also coincided with Israel’s first reported case of monkeypox in a man who returned from overseas, in what apparently was the first case in the Middle East. WHO says it has identified about 92 cases around the world in nations such as Canada, Italy, Portugal, Spain, Sweden, the United Kingdom and the United States. 

Until now outbreaks of the virus had been confined largely amongst rural residents of central and western Africa where the virus circulates in rodents, monkeys and other non-human primates – with only isolated cases seen abroad in travelers arriving from endemic countries.  

Incremental progress on pandemic reform 

While there has been considerable media focus on the prospects for a new and potentially sweeping international pandemic treaty, delegates at this session are only expected to make incremental moves toward that long term goal – likely agreeing, first, to a process for amending the existing binding rules that govern health emergencies: the International Health Regulations (IHR).

A new WHO “White Paper” does, however, outline a vision for strengthening its emergency response with a 10-point plan submitted by Tedros calling for the establishment of a Global Health Emergency Council that would involve heads of state, under WHO’s auspices, as well as a World Bank-hosted Financial Intermediary Fund (FIF) to maintain a standing pool of resources for purchasing treatments and vaccines.  The aim is to avoid the kinds of delays and inequities that have occurred with the lagging distribution of COVID-19 vaccines to low- and middle-income countries.. 

And a draft resolution co-sponsored by the United Kingdom and Argentina calling for greater transparency in clinical trials reporting – with both negative and positive results – was reportedly now finalized after weeks of closed door discussions. Proponents have said that the resolution is critical for ensuring more harmonized reporting of clinical trial results so that there will be a faster uptake of new treatments, particularly during disease outbreaks and health crises.  

Along with those big ticket items, the Assembly will debate more than two dozen other issues such as polio eradication, cervical cancer elimination, a roadmap on reducing non-communicable diseases, how to better coordinate research priorities in clinical trials, eradicating polio, and cases of sexual exploitation by WHO staff.

See Friday’s full report on what to expect from the WHA here:

More Reliable Funding for WHO, Slow Progress on Pandemic Reform & Ukraine Controversy – What to Watch at the World Health Assembly

Increasing fixed member state contributions to WHO

Members of the WHO Working Group on Sustainable Finance hammer out the final agreement on increasing member state contributions, Germany’s Björn Kümmel on far left.

In another significant move, delegates are expected to approve a move to gradually increase the proportion of fixed assessments that member states must pay annually towards WHO’s budget. 

The assembly’s anticipated new formula for fixed contributions to WHO’s budget – which only covers 17% of its costs – is intended to raise its member nations’ annual “assessed” contributions to as much as 50% of its core budget by 2030. 

Most of the agency’s budget now is covered by a handful of wealthy “voluntary” donors: Germany, Japan, the United States, Korea, the European Commission, Australia, the COVID-19 Solidarity Fund, the GAVI Alliance, U.N. Development Program, the Bill & Melinda Gates Foundation, the United Kingdom and New Zealand.

Tedros and other WHO leaders have repeatedly asked for this move, saying that the agency’s long standing over-reliance on the voluntary funding it receives from countries and charitable donors makes the agency too dependant  upon the whims of donors.

A plea to continue fighting COVID

Yemen’s ruined health system struggles to cope with COVID alongside other diseases.

Tedros, who is expected to be re-elected for another term during this WHA session, set the stage for the weeklong discussions by acknowledging that the COVID-19 pandemic has “turned our world upside down” and continues along an unpredictable path still today. “Reported cases are increasing in almost 70 countries in all regions,” Tedros warned. “And this is in a world in which testing rates have plummeted and reported deaths are rising in my continent [Africa]. The continent with the least vaccination coverage. 

“This virus has surprised us at every turn – a storm that has torn through communities again and again. And we still can’t predict its path or its intensity. We lower our guard at our peril.”

More than 6 million COVID-19 deaths have been reported to WHO. Earlier this month, however, WHO provided new estimates showing the full death toll associated both directly and indirectly from the continuing pandemic was almost 15 million people in 2020 and 2021 alone. This also is a  dramatic illustration of the need for far greater investment in resilient healthcare systems, WHO officials say.

 “People have lost their lives, loved ones and livelihoods. Health systems have been strained to breaking point, and in some cases, beyond. Health workers have laboured under extreme circumstances. Some have paid the ultimate price, and we have lost others to stress and depression,” said Tedros.

“Communities have faced great disruptions to their lives, with schools and workplaces closed, and the burden of isolation and anxiety. And you, as governments, have been at the center of the storm, facing multiple challenges,” Tedros said. “I know that’s not the message you want to hear, and it’s definitely not the message I want to deliver,” he said. “There’s no question we have made progress, of course we have: 60% of the world’s population is vaccinated, helping to reduce hospitalizations and deaths, allowing health systems to cope, and societies to reopen. But it’s not over anywhere until it’s over everywhere.”

Image Credits: People in Need, Germany's UN Mission in Geneva , ReliefWeb.