After a total of 12.5 hours of consultations in five informal meetings, a bloc of countries led by Thailand won WHO Executive Board approval for a landmark decision to develop a new ten year-action plan to reduce the harmful use of alcohol.

Representatives of Norway and the European Union joined as co-sponsors in a compromise decision, which nonetheless saw an earlier reference to the possible development of an international legal instrument removed.

Civil society actors who had lobbied hard for the new action plan, described it as a “historic moment” but lamented that the “overarching need” for more binding international measures to limit alcohol marketing and advertising, particularly to youths, had not been answered.

However, the compromise text asked WHO to prepare a technical report on the harmful use of alcohol related to cross-border advertising, including marketing targeted towards youth.

The compromise also greatly softened a reference to WHO’s own internal policies, which generally tolerate alcohol consumption in office cafeterias and official events, including at the Geneva Headquarters.  An earlier draft had asked WHO to exercise of “global leadership” by refraining from providing or selling alcohol on all WHO-campuses and at WHO-sponsored events. The amended text simply acknowledges that some WHO offices do not offer alcohol as a practice.

Thailand expressed that the text was amended “in the spirit of compromise to move this very important agenda forward.”

Still, the Thailand delegation urged WHO to take action outside of the Executive Board framework and consider an “alcohol-free” policy for the Organization in the coming months.

In a win for the bloc of sponsors, the revised text retained a reference to alcohol’s carcinogenic properties, which had been opposed initially by the United States.

“Cancer is one of the diseases linked causally to alcohol, “ said Germany, on behalf of the EU. The delegate also expressed concern about the “cross-border “digital marketing” of alcohol towards minors.

“We have to do better,” Germany concluded. The reduction of the harmful use of alcohol “cannot be addressed effectively without cross-border collaboration.”

Norway, the second co-sponsor added to the resolution last night, has also made harmful alcohol use reduction a key cornerstone of a new development aid policy that focuses on non-communicable disease prevention and control.

In a statement, the NCD Alliance lauded the action by member states, saying, “Today’s decision, adopted by consensus, will ensure alcohol harm will be given greater time and attention….We are particularly pleased to see the EU co-sponsor the decision and call on all EU member states to walk the talk by tackling alcohol as a carcinogen in the EU cancer plan announced earlier this week on World Cancer Day. The EU Cancer Plan which so far overlooks alcohol as a major risk factor for premature death, in the heaviest alcohol drinking region in the world.

“The proposed new Action Plan holds great potential to provide a stronger whole-of-government and inter-agency framework for accelerated action, accountability and impact. It is also an opportunity to address barriers to progress, such as by ensuring a robust monitoring and accountability framework and providing guidance on managing alcohol industry conflict of interest and interference.

“It is important that the Action Plan addresses industry interference as a barrier to alcohol policy progress, as it has been acutely apparent that throughout recent months and days, the alcohol industry were actively lobbying Member States in efforts to dilute existing evidence based recommendations policies which are known to reduce alcohol harm, as well as undermining efforts by Member States to secure a stronger global response to alcohol,” he addded.

“We are also very pleased to see that attention will be given to the impact of cross-border alcohol marketing, particularly its impact on youth and adolescents. Marketing of health harming products such as alcohol and unhealthy food and drinks is insidious and inadequately regulated. The evolving marketing and sponsorship landscape demands far greater scrutiny and regulation to protect the health and wellbeing of people across the life-course.”

Maik Duennbier, director of Strategy and Advocacy at Movendi International, an alcohol abuse NGO, told Health Policy Watch that the EB action follows a decade of inertia. “It has taken 10 years for a substantive discussion of the global alcohol burden and the necessary policy response at the WHO governing bodies. Thanks to today’s decision, this will change: the issue will be on the agenda more often and more regularly,”

“But what this week of debating the response to alcohol harm has shown is: while we are where we need to be yet…  the action plan needs to be filled with bold targets and actions to turn the tide on alcohol harm. The overarching need is still a global binding treaty on alcohol to effectively protect the human right to health.”

Updating the WHO alcohol strategy was a key element of this year’s EB decisions on combatting NCDs. The EB recommendations also prioritize global action on cervical cancer control and stronger prevention and early detection services at the primary health care level.  A menu of treatment options for mental health is also under development along with a package of interventions for reducing air pollution risks and disease.

EB Members Urge WHO To Accelerate Roll Out Of New Polio Vaccine, Ensure Supply

Meanwhile the Executive Board also approved a recommendation urging WHO to accelerate the roll-out of a novel oral polio vaccine that could help reduce incidence of vaccine-derived polio virus – which was the cause of several polio outbreaks in Africa in 2019, according to WHO.

The new polio type II vaccine is expected to be available by mid-2020, Michel Zaffran, head of WHO’s Polio Eradication efforts, told the governing board.

The draft decision adopted Friday by the Board requested WHO to: accelerate the assessment and roll-out of the novel oral polio vaccine type 2, including through the “WHO Emergency Use Listing” procedure; and to initiate a process for prioritizing the “equitable allocation of limited supplies” of the novel vaccine.

The EB also urged WHO member states to expedite the processes for authorizing the importation and use of polio vaccines, including the novel vaccine on the basis of its emergency use listing, as well as stepping up domestic funding for vaccination.

Gabon, speaking on behalf of African states, said the decision represents a “major undertaking for the African region.”

Zaffran acknowledged that 2019 was “a very difficult year” for polio eradication, with wild virus outbreaks in Afghanistan and Pakistan as well. He underlined the need for stronger outbreak strategies in countries as well as stronger domestic resource allocation.

US Blocks Request for Report on Digital Marketing of Breastmilk Substitutes

In other EB action on Friday, Bangladesh requested the WHO to “collect data and prepare a comprehensive report to address digital marketing and promotion of breastmilk substitutes,” in line with the WHO Code of Marketing for Breast-milk Substitutes. However, the United States expressed concerns about the “resources involved” in conducting the study, ultimately leading to the request being tabled for further discussion.

The Bangladesh request was proposed as an amendment under an EB agenda item on “maternal, infant, and young child nutrition.” WHO and UNICEF both currently recommend exclusive breastfeeding until 6 months of age, with sustained breastfeeding up to 2 years. The Code of Marketing for Breast-milk Substitutes serves as strict guidance for marketing infant formula – which WHO called a “major factor in undermining efforts to improve breastfeeding rates” in a 2018 report.

Several countries supported Bangladesh’s request, including Benin on behalf of the Who AFRO region, and several countries of the PAHO region such as Guatemala and Chile.

The US, home to some of the largest infant-formula companies in the world such as Abbott, said that nutrition initiatives should “include the private sector” and initially declined to comment on Bangladesh’s proposed amendment.

However, once the decision on the amendment was brought to the floor, the US expressed concerns regarding the “implications of the amendment,” including reporting requirements from WHO Member states and other “resources” that would need to be involved.

“We respectfully ask for more time… We would be happy to continue the discussion into May,” said the US delegate.

Ultimately, the Chair of the EB proposed a compromise to suspend a decision on Bangladesh’s  request until Saturday, asking the WHO Secretariat to “facilitate discussions” on the matter.

Wider WHO guidance around nutrition and health was requested by several states – including a request from Austria asking for further guidance on how to measure childhood obesity in kindergarten and a plea from Sudan on behalf of the Eastern Mediterranean region to consider “conflict-affected countries” facing food insecurity and undernutrition. The discussion set the stage for the December 2020 Nutrition for Growth Summit in Tokyo, which will precede the release of new WHO Nutrition guidelines for 2021, including a specific roadmap for closing gaps for specific country needs.

EB Debates IP Protection, Access to Medicines

The Executive Board also approved a GSPOA that aims to balance access to medicines with innovation needs – but not without debate around intellectual property protection. The decision, which will now go to the May World Health Assembly for final approval, asks countries and the WHO to proceed swiftly on the implementation of recommendations approved by the 2018 World Health Assembly (WHA) on next steps for the 2008 Global Strategy and Plan of Action on Public Health, Innovation and Intellectual property. The European Union joined as a co-sponsor of the decision

Brazil, leading the charge on the draft decision, explained that the document is meant to renew the political push given by World Health Assembly in 2018 and 2019 on greater frameworks for discussions about medicines prices and the R&D costs of developing them. Germany, which fought alongside the United Kingdom during the last WHA against a resolution on price transparency of medicines markets, spoke for the European Union, co-sponsor of the draft decision. The German delegate, while acknowledging that millions of people have no access to medicines, said the issue should be tackled in a holistic manner, reflecting the complexity of the problem and considering the entire life cycle of medicines.

Still, the final decision left out more explicit language asking Member States to support disclosure of R&D costs; more explicit identification of supply shortages; and national commitments to allocate at least 0.01% of national gross domestic product to research “relevant to the health needs of developing countries.”

Instead, after five rounds of discussions, the final resolution simply left the door open to member states to consider such issues in the framework of national policies on patents and intellectual property rights. Low-income countries are accorded some flexibilities allowing them to override patents on certain medicines so as to increase access to generics and biosimilars, under the World Trade Organization’s (WTO) agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS).

The EB text also requests the WHO Director-General to report back by 2021 on the results of an informal consultation on drug price transparency, medicines shortages, and investments in research, including R&D costs.

Members of the EB were clearly reluctant to suggest more explicit language that might somehow impinge on intellectual property rights that protect medicines patents, which industry leaders are an important driver to R&D for new health products. The United States said intellectual property is “the corner stone of medical innovation,” while Switzerland said the protection of IP rights should be discussed at the World Trade Organization and at the World Intellectual Property Organization (WIPO). WHO’s discussions, the Swiss delegate said, should be focused on price transparency and on efforts to stop shortages.

Even so, the decision was largely seen as a step forward by civil society actors on an oft-polarized issue.

Jamie Love, director of Knowledge Ecology International, told Health Policy Watch, “This decision strengthens the mandate for the WHO to work on transparency of medicine prices.” We hope the member states will also spend some time looking at the R&D Observatory, which has failed to have much of an impact so far, at the WHA.”

Mariângela Simão, WHO assistant director-general of Access to Medicines and Health Products said the WHO has made substantive progress in response to some member states’ reticence to address the issue. The sheer number of recommendations in the first 2008 Global Strategy and Plan of Action (108) was paralysing, she said, and when in 2018, the recommendations were pared down to just 33 it became much more manageable.

Simão added that WHO, along with the WTO and WIPO, were working on the latest update to a trilateral study on “Promoting Access to Medical Technologies and Innovation: Intersections between public health, intellectual property and trade.” The report is due to be launched just before the WHA in May.

Israeli Proposal on Removal of Special Item on Palestine Knocked Down

Also at the Executive Board, Israel submitted once again a request to change the status of a WHA agenda item on health conditions in the occupied Palestinian territories and Golan Heights, where the matter is discussed every year, separately from other health and humanitarian emergencies. But the request was denied by the EB in a 15-7 vote.

“We heard many times that WHO is engaged in international emergencies and assisting people around the world… yet none of these programmes is presented by the Secretariat in a standalone item, and none receive the attention they deserve in the limited time in the Assembly,” said Israel’s delegate, protesting the singling out of the Israeli-Palestine issue at every WHA.

The Secretariat’s report could still be presented “without opportunity for political attack against one Member State,” added the delegate. The Israel delegation also expressed disappointment over the withdrawal of a draft WHO report that had included details of Israeli health and humanitarian support to Syrians, which was supposedly suppressed by the Syrian government.

Syria quickly shot back, “once again, Israel is trying to misuse its membership in this technical forum to achieve political gains by returning to proposals that this board has rejected last year.”

Palestine, a permanent observer to the EB proceedings, joined in and added that they did not find “any justification” for Israel’s request to move the agenda item from WHA’s Committee B to Committee A, which effectively would give the matter less attention at the Assembly.

“Health for all is and remains our goal… as the DG has said, we have to show solidarity and cooperate,” said the Palestine delegate. “We shouldn’t be referring to purely political matters… in order to deal with a draft decision to deal with moving an item from Committee B to Committee A, especially when we know this is an issue we’ve been debating for years… at committee B.”

The Israel proposal was then brought to the table and shut down in a 15-7 vote against amending the agenda, with 10 abstentions by EB voting members.

Updated on 8 February 2020

Image Credits: Flickr/Steven Miller.

WHO member states were locked away in late-night negotiations over the shape of a proposed new WHO roadmap for reducing harmful alcohol consumption.

A group of member states, led by Bangladesh, Indonesia, Iran, Sri Lanka and Thailand, have been pressing the WHO Executive Board (EB) to support the rapid development of a tough new WHO approach to a health risk that claims 3 million lives a year – to replace the failed strategy of a decade ago.

The member states, supported by civil society groups combatting alcohol abuse and non-communicable diseases, want to see WHO embrace the development of binding “international instruments”, such as measures to reduce digital and cross-border marketing of alcohol products to adolescents.

A copy of the initial draft EB decision circulating among member states, and obtained by Health Policy Watch, also asks WHO to “exercise global leadership” by banning the sale and consumption of alcohol on WHO premises.

Finally, proponents want to highlight the fact that alcohol is a Group 1 carcinogen, according to  WHO’s own International Agency for Research on Cancer.

However, such measures have met with stiff opposition from a cluster of countries that have big alcohol industry lobbies, including Japan and the United States.

Civil society groups note that harmful alcohol consumption claims as may as 3 million lives a year, either directly through cancer, liver disease, heart attack and stroke, or indirectly, through alcohol-induced violence and traffic injuries.

And with a few striking exceptions, most notably Russia, the last decade has seen a worldwide increase in harmful alcohol consumption, particularly in low- and middle-income countries, said Nina Renshaw, of the NCD Alliance.

She spoke out on the alcohol issue at Wednesday’s EB debate, on behalf of the Union for International Cancer Control, Vital Strategies and the World Cancer Research Fund International.

Alcohol consumption and related deaths in different regions of the world

The group has called upon member states to: establish a new ten-year Global Action Plan on Alcohol, with a view to gaining World Health Assembly endorsement of the new plan no later than 2022.

The group also called upon member states to create an expert working group to come up with a roadmap for “delivering dramatic reductions in alcohol harm by 2030, including consideration of internationally binding instruments.”

Interviewed by Health Policy Watch, Renshaw said that member states’ Geneva missions had been subject to “harassment” by alcohol industry representatives over the past few months leading up to the EB discussion, which was to evaluate the old strategy and explore a way forward.

“Recognising the intense pressure applied by the alcohol industry to governments and Missions, we call on WHO to case bi-lateral dialogues with alcohol industry actors and call on Member States to publish public records of any engagement,” Renshaw stated in her formal message to the EB on behalf of the other NGO groups.

While the civil society groups are optimistic that a compromise formula can be reached on a draft EB decision before the EB governing board meeting ends on Saturday – it remains to be seen if the decision will lay the foundation for a strategy that can really reverse current trends in alcohol-related deaths and disease.

Image Credits: WHO, WHO .

As the number of novel coronavirus infections rose again on Thursday – to 28,060 confirmed cases in China and 225 abroad – a US Centers for Disease Control official raised the possible spectre that the epidemic could become a global “pandemic” – if countries fail to take assertive action now.

“While unclear how the situation will evolve, we are preparing as if it were the next pandemic – while hoping that it is not,” said Barbara Marston, head of the International Coronavirus Task Force, speaking at a US State Department teleconference for foreign press about the epidemic currently raging in Hubei Province, China.

Her remarks followed a statement Wednesday by US Senator Chuck Grassley, who said that while “not yet a pandemic, there are signs that it could develop into a worldwide threat.” Grassley spoke after receiving a classified briefing by the Department of Health and Human Services.

US Calls For WHO Technical Guidance On Travel Restrictions – WHO To Convene Global Research Forum 

In Geneva, the US meanwhile called upon the World Health Organization to provide more advice to countries about protective measures countries could take to protect themselves from new cases of virus arriving with travelers from China.

WHO Executive Board discussion on coronavirus outbreak, led by Deputy Director General Zsuzsanna Jakab and Emergencies Head Mike Ryan

Speaking at WHO’s Executive Board meeting Thursday, the US representative asked WHO to “provide technical advice to member states as to how they can implement appropriate travel restrictions consistent with the International Health Regulations (IHR) to minimize the spread, and complement the travel restrictions that China has put in place.”

WHO has generally opposed travel restrictions by countries outside of China – saying that the disease first needs to be attacked at its source in Wuhan and Hubei province, where tens of millions of people remain under lockdown.

Even so, some 22 countries have put in place measures ranging from cancellation of flights and visas to the temporary quarantine or barring of entry to people arriving from China.

In an afternoon press briefing WHO’s Emergencies Head Mike Ryan responded saying that, “Under the IHR, where countries have exceeded or appear to have exceeded those recommendations, we are bound to ask the country for the rationale,” he said, speaking in an afternoon press briefing. “The IHR does not deny or prevent a country from taking measures, but requires to justify the risk assessment. This is a very important balance.

(Left-right) Mike Ryan, Tedros Adhanom Ghebreyesus, Maria Van Kerkhove

“All risk assessment is local, so local dynamics and local capacity are important. Sometimes you have a limited toolkit and you have to use it in a certain way.  Sometimes you have to make decisions based on communities’ perceptions of fear.

But he added that travel measures such as quarantine, are generally too expensive and complex for low-income countries to undertake, and investments would better be spent in preparing clinicians and laboratories to handle the virus.

As compared to travel restrictions, he said WHO’s outreach has been focused on preparing health systems in low income countries to detect and diagnose the disease, if and when cases arrive, as well as to take appropriate infection control measures.

“High-impact quarantine measures are some of the most expensive measures to implement. Low-income countries have choices to make, and the real point of entry to a country [for a new infection] is a poorly equipped emergency room or  doctors’ clinic.

“We do support screening [at point of entry], but to have disease arriving to untrained health workers and unprepared in a clinical setting thats the worst thing. And we are focusing on weaker countries with weaker health systems to support the key parts of their health system… the last thing we need is the front-line health workers becoming victims.

“Where countries have more resources they can put in place more expensive measures.  You can argue about the value.. we want to extract the most from every dollar invested.”

Against the more dire predictions of a possible pandemic, Ryan also voiced one cautious note of optimism.

He noted that the overnight increase in new cases in China between Wednesday and Thursday of 3,697 confirmed infections had been slightly less than the whopping 3925 new cases recorded between Tuesday and Wednesday.

“Today is the first day that overall new confirmed cases dropped,” said Ryan, noting that the large 24-hour increase nonetheless remained a cause for significant concern.  The epidemic has so far claimed 564 lives in China, while there has been only 1 death abroad, officials also note, an indication that infection spread to other countries is so far being contained.

WHO To Sponsor Research Forum On Coronavirus Next Week

Meanwhile, WHO Director General Dr Tedros Adhanom Ghebreyesus said that the Organization would convene a global research and innovation forum next week, 11-12 February, to respond to the novel coronavirus (2019-nCoV).

He noted that currently there are no effective treatment tools or vaccines for the virus – and with tens of thousands of people ill, those are desperately needed.

“We don’t know the source of the outbreak. We don’t know what its natural reservoir is, and we don’t properly understand its transmissibility or severity. We have no vaccine to prevent infections and no therapeutics to treat them,” said Dr Tedros, at the Thursday press briefing.

“We are shadow boxing, we need to bring this virus out into the light so we can attack it properly.  So on February 11 and 12, we are convening a global research forum.  This will be a meeting of scientists from all over the world, including China, both in person and virtually. The aim of the meeting is to fast track development of effective diagnostic tests, vaccines and medicines.”

“A lot of donors want to help, but we need to direct them to support agreed priorities, rather than going off in different directions,” he added.  “I have said we need to be led be facts not fear, and science not rumours. That’s exactly what we’re doing. We are letting science lead.”
WHO Director General also said that he had convened a teleconference on Thursday with more than 200 United Nations Country representatives to brief them on the risks posed by the new virus, following a briefing Wednesday with senior UN leadership. “We are also mobilizing the full power of the UN system,” he said.

Human Rights Watch Protests Wuhan Lockdown

Meanwhile, Kenneth Roth, Executive Director of Human Right Watch, an advocacy group, took China to task over its handling of the coronavirus epidemic- on both public health and rights grounds, and noted apart from its welcomed prompt public genetic sequencing of the virus, China’s reaction has been a cover-up.

The criticism came just as one of the first doctors to sound the alarm about the new disease, 35-year old ophthalmologist Li Wenliang, tragically passed away from a battle with the novel coronavirus on Thursday night. Li was detained by police and asked to sign a statement swearing he would “not spread rumors” after he tried to warn members in a group chat about cases of a potential “SARS-like” illness in December. Li is survived by his pregnant wife and young child, according to tributes to the doctor circulating on Weibo, China’s Twitter equivalent.

“It may be good for political self-preservation but its a disaster for trying to contain the epidemic,” Roth told reporters at a news conference in Geneva Thursday.

Kenneth Roth, Executive Director, Human Rights Watch, during press conference with UN correspondents in Geneva, 6 February 2020.

Asked about China’s handling of the information surrounding the outbreak, especially on social media, the veteran HRW chief said, “There has been an enormous amount of information put out on social media but there’s also an active government effort to suppress it. The government does seem determined to limit the flow of information about the coronavirus outbreak. Particularly, criticism of its response to that.”

Roth, a harsh critic of China’s rights record, argued, “When push comes to shove, do you allow open information, open debate, and indeed criticism of governmental conduct in the face of something threatening the Chinese public, or do you try to cover it up to preserve the power of Beijing. It’s always official power that is the priority.”

Turning to China’s massive quarantine efforts- to try and contain the spread of the virus- Roth declared: “There are major questions about this, besides the nature of the quarantine. A quarantine of this sort, and magnitude, has never been attempted. Only an autocratic government, like China, could try that. Quarantines of this sort, normally do not work.”

He critically observed the quarantines that public health officials advocate, are much more targeted.”They’re aimed at people who have been identified as having the virus, and they’re put in a place where they can receive treatment, as well as food and housing, and then that is a way of avoiding infecting others.”

Roth said the idea of a quarantine of Hubei province – a region of 60 million – has never before happened and pondered ” it’s utterly unclear whether it’s going to be effective. People need to be housed, they need to get treatment, and there are huge gaps in the Chinese government’s response to individual needs.”

“So, this is not a rights-oriented approach to public health. This is treating public health with a sledgehammer, and public health officials will tell you this is not an effective way to proceed…” he added.

Concerning the large number of countries that have notified the WHO of the restrictive measures they’ve taken – which appear to go against the grain of WHO’s recommendations – and some countries, such as the U.S., holding classified briefings on the outbreak, Roth said, “There’s no place for secrecy in fighting an epidemic.”

” I think it’s broadly understood that you need total and complete transparency to effectively fight an epidemic. You need to know where it’s breaking out, you need to know in real-time where medical energies have to be focused. And so, this is not a time for secrecy, it’s not a time to suppress criticism of governments’ reaction. It’s a time for total transparency, even if it’s embarrassing. ”

Executive Board Raises Concerns About WHO Emergencies Contingency Fund & Staffing

In a morning discussion on Emergency Preparedness at WHO’s Executive Board, Japan asked whether WHO’s emergency contingency fund had assurance of sustainable funding, while Germany, speaking on behalf of the European Union, underlined the need for WHO to support countries in measures to guarantee the safety and security of health workers and health facilities – to create “resilient health systems able to withhold the shock of health emergencies.”

Singapore stressed the need to examine more deeply the increased global health risks faced due to increased urbanization, more and more densely populated cities, where viruses can be easily transmitted in crowded spaces, both public and private.

China, meanwhile, called on the global community to react in a “rational manner” to the crises and “refrain from panic.”  But it also asked WHO why some 30% of posts in the Organization’s Health Emergencies Department were vacant, as of November 2019.

Ryan, in response to the query, said that vacancies were largely due to budget shortages.

 

Image Credits: HPW/Catherine Saez, Fletcher/HPW, John Zarocostas.

The World Health Organization Executive Board unanimously adopted two decisions that began to set the stage for global vaccine policy in the next decade – a draft resolution on “strengthening global immunization efforts to leave no one behind” and another on “eliminating meningitis by 2030,” after reviewing a report prepared by the Director-General on lessons learned from the Global Vaccine Action Plan (GVAP) 2011-2020.

The two decisions outlined key concerns for the architects of the global strategies to consider as they finalize the drafts for the “Immunization Agenda 2030” and “Meningitis Elimination by 2030” strategy for approval at this year’s World Health Assembly.

Health worker vaccinates young child against measles

According to the DG’s review, although more than 116 million children are now vaccinated annually, global vaccination coverage has plateaued at 85% in the past few years. Several members of the EB pointed out that the world is unlikely to eliminate measles and rubella – two recurring threats that have caused outbreaks worldwide.

The EB recognized the “unfinished agenda,” so dubbed by WHO Head of Vaccines and Biologicals Kate O’Brien, of stalling and backsliding vaccine coverage for measles, failure to achieve polio eradication, and the lack of improvement in reaching so-called “zero-dose” children – kids who have never received the first dose of the most common infant vaccine, DTaP.

Along with these standing items, new challenges such as vaccine hesitancy, urbanization and migration, climate change, and the difficulties of vaccinating in fragile, conflict-affected settings emerged as new challenges for the next decade, added O’Brien.

All of these issues, O’Brien said, are “being addressed” as the next iteration of the Global Vaccination Action Plan is being drafted.

Vaccine hesitancy, first recognized by WHO as a major threat to global health in 2019, was of particular interest to many members and observers. Indeed, the somber prophecy was fulfilled as refusal to vaccinate or delays in vaccinating played parts in causing four European countries to lose measles elimination status in 2019, and were factors in a deadly measles outbreak in Samoa that infected over 5,000 people.

“As infectious diseases decrease, public attention shifts from the dangers of diseases to the dangers of vaccines,” said the delegate of Singapore. “Misinformation is amplified by social media.” Australia, Iran, Germany on behalf of the European Union, the United States, Mexico, and Brazil also echoed these concerns.

But other delegates brought up that misinformation and vaccine hesitancy were only one part of the puzzle. Indonesia added that outside of “sociocultural” factors related to vaccine refusal, “lack of support from stakeholders, communications strategies, and geographical concerns,” along with “affordable access” are still preventing the final 15% of unvaccinated and under vaccinated children from being reached.

China, home to a strong emerging vaccine manufacturing industry, urged WHO to support “local vaccine production” and “proprietary research” in countries struggling to eliminate measles. Brazil, another large host of vaccines producers, added that the next GVAP should consider “diversification of vaccine manufacturers.”

Observers were in less agreement on the timeline of measles elimination. Norway asked WHO to “postpone a time-bound measles goal until elimination is in sight,” while Russia followed up by asserting that “global eradication of measles and rubella… are topical and achievable aims of the next decade.”

Meningitis Elimination by 2030

Along with concerns around the long-standing goal of measles elimination, the focus was pointed towards a deadlier vaccine-preventable disease – meningitis.

However, many countries expressed they would have preferred a separate discussion completely on the disease, rather than have the discussion on meningitis under the larger agenda item of immunization.

A young girl receives a meningitis vaccine.

Burkina Faso, backed up by a previous comment from Germany on behalf of the EU, expressed that “many countries” felt that “more than vaccination” was needed to address the disease.

“In Africa… we say you can only count the total number of your children when the meningitis outbreak has passed,” the delegate from Burkina Faso expressed. “That is how serious it is. I think to a certain extent you have to have suffered from this problem to know how grave it is.”

Germany, on behalf of the EU, stated that they were concerned about the governance structure of the current meningitis strategy.

As the clock ticked towards dinner, the Chair of the EB proposed a compromise on the decision – the resolution itself would be supported with an added request to the secretariat to “make an extensive effort to strengthen governance.”

Meningitis is an infection of the brain and spinal cord lining causes epidemics across the world, but most often in the so-called “meningitis belt” – a region of sub-Saharan Africa that stretches from Senegal to Ethiopia.

Gavi-Transitioning Countries Concerned

Tanzania, along with other countries receiving support from Gavi, the public-private partnership that has helped multiple low- and middle-income countries rapidly increase the number of vaccines in their national immunization programmes, urged the international community to continue supporting such efforts.

“We are worried about the ‘post-Gavi’ era,” said the delegate for Tanzania.

“Under the GVAP 2011-2020, Tanzania has introduced a record number of new vaccines… however we are worried… to sustain gains and introduce new vaccines. We plead for continued support, especially for measles, mumps, and rubella vaccines, across the regions.”

The United Kingdom, a founding member of Gavi, followed up with an appeal to support the partnership’s fifth replenishment this year, which will be hosted in London in June 2020.

Image Credits: WHO, WHO/John Kisimir.

WHO issued a call to the global community to come forward with US$ 675 million in funding to help some 60 low- and middle-income countries that are at significant risk of infection with the novel coronavirus that originated in Wuhan China prepare for possible outbreaks.

The call was issued by WHO Director General Dr. Tedros Adhanom Ghebreyesus at an afternoon press briefing on the virus, held on the margins of this week’s bi-annual WHO Executive Board meeting in Geneva.

(Left-Right) Mike Ryan, Tedros Adhanom Ghebreyesus, Sylvie Briand

The WHO Director General made the call as the case count in China continued to skyrocket to 24,554 cases confirmed globally, with 3925 cases of the pneumonia-like virus recorded overnight. As of 5 February, the virus had claimed 561 lives.

That was the largest single 24-hour increase since the outbreak began. That includes 24,363 cases in China, as well as 191 confirmed cases abroad, according to the latest WHO report.

“We are launching a strategic preparedness plan to support countries to detect and respond to cases,” said Dr Tedros.  “We are requesting US$ 675 million to fund the plan for the next three months, including US$ 60 million to fund WHO operations. The rest is for countries at risk.

“Our message to the international community is invest today or pay more later,” he said, noting that the Bill and Melinda Gates Foundation had already stepped up with a US$ 100 million contribution to the plan, for research and evaluation of new diagnostics, medicines and vaccines for the novel virus, dubbed 2019-nCoV.

While weaker countries need to prepare for the possible arrival of the virus, Dr Tedros continued to protest what he described as the imposition of unecessary travel and trade measures against travelers arriving to other nations from China.  Some 22 countries have imposed restrictions or quarantine requirements, while multiple US and European airlines have cancelled flights.

“People are considering China as if the problem is the same in all provinces,” Dr Tedros said. “‘80% of the cases are in Hubei province, so that blanket approach may not help.”

But his message came against the backdrop of burgeoning limitations on travel – including an announcement by Hong Kong’s administration that it would begin to quarantine for 14 days anyone arriving from mainland China. Hong Kong is also holding a cruise ship offshore with 1,800 people aboard, due to suspicions that some passengers might have contracted the virus. Another cruise ship of 3,600 people is reportedly being held by Japan off the coast of Tokyo, where 10 cases of the coronavirus have reportedly been confirmed.

Sylvie Briand, WHO Director of Epidemic and Pandemic Diseases said that WHO was holding talks with the travel and tourism industry to discuss real and perceived threats from the virus, and measures that could be put in place to reassure worried customers and employees.

WHO Coordinates Massive Laboratory Training and Distributes Masks  

At the briefing, WHO’s Head of Emergencies Mike Ryan said that scale up of capacity for countries to detect the virus was happening rapidly.

“As of 3 February only two countries in Africa had the capacity to diagnose 2019-nCoV,” he said.  As of 7 February [Friday], most countries will have the capacity to diagnose.”  This is following a WHO-organized training for laboratory technicians from 24 countries at the Institut Pasteur In Senegal, which is going on this week.

Scott Pendergast said,  “there are around 60 countries globally with weaker health systems at high risk of imported cases; within Africa that includes 25 countries.”

In contrast, in Latin America, Ryan said that laboratory networks are stronger as are the public health systems, “so we hae more confidence, and there are fewer countries that directly need operational assistane.  Although there are some that have suffered recent shocks.”

In addition half a million surgical masks, 250,000 pairs of gloves, as well as thousands of respirators had been sent to countries around Africa, using WHO contingency supplies and funds, Dr. Tedros said.

Do International Health Regulations Need Updating? Legal Experts Consider the Question 

Meanwhile, just opposite the sprawling WHO campus in Geneva, a panel of legal experts discussed whether the 2005 International Health Regulations (IHR), a binding legal convention that guides WHO and member state responses to health emergencies, needed a brush-up, in light of the unfolding coronavirus emergency.

In the face of criticism over the WHO delay in declaring an international health emergency, under the provisions of the IHR, Dr Tedros recently suggested that the system should not just include a “red and green light, but also a yellow one”  – to warn countries of budding crises, even if an outbreak had not yet exploded outright.

Gian Luca Burci,  Adjunct Professor at the Geneva Graduate Institute (IHEID) and former senior legal counsel at WHO, seemed to agree.

Speaking at the expert session, Burci said that there are gaps and weaknesses in the current IHR system. “We are testing IHR again. Even as we are [not completely finished] addressing Ebola, the IHR system is again being put to test with the outbreak of the novel coronavirus.”

(Left-right) UNAIDS’ Luisa Cabal, WHO’s Mariangela Simão, and Gian Luca Burci (IHEID) at Lancet Commission Health and Law panel. (Photo: T. Balasubramanian.)

There is a need to look at the design and politics behind the law, not only how the existing law is being implemented,” added Burci at the session, held as part of a Geneva event focusing on issues raised in a Lancet Commission report on Harnessing the Power of Law for Global Health, published in 2019.

Burci noted that in the most recent iteration of the International Health Regulations occurred under pressure, in response to the 2002-03 epidemic of Severe Acute Respiratory Syndrome (SARS).

“The IHR themselves were thoroughly revised within a very short period of time between January 2004 to May 2005. So there was a rush then, in the aftermath of the outbreak of Severe Acute Respiratory Syndrome (SARS). This may explain some of the flaws we are witnessing, and perhaps there is a need to take a step back and rethink the design of the IHR with an open mind,” he said.

“What we have now is a very rigid binary framework around declaring a Public Health Emergency of International Concern (PHEIC); either there is an emergency or there is nothing.

“Reality is more complex than that, and it may be time to consider introducing a more nuanced system of alert. The declaration of a PHEIC is a highly symbolic act but its legal consequences, as well as those of the temporary recommendations that the WHO DG can issue after declaring an emergency, are unclear. People are asking questions on what is the legal effectiveness of the current framework, and related questions on accountability given that the compliance with this framework is inconsistent.”

Priti Patnaik contributed to this story.

 

 

 

 

Image Credits: Fletcher/HPW, WHO .

The elements are all in place for expanding universal health coverage – what’s missing is more action at the country level, World Health Organization Director General Tedros Adhanom Ghebreyesus told the WHO Executive Board on Wednesday.

“All the political work is actually done now,” Dr. Tedros said.

He was reporting on WHO action since the  September 2019 Political Declaration of the United Nations High-Level Meeting on Universal Health Coverage, which followed up on the 2018 Astana Declaration on Primary Health Care.

The Executive Board report outlined the next steps WHO will be taking to help member states expand access to quality health services, despite the  many infrastructure and funding challenges that exist at national level.

One cornerstone of efforts will be the creation of a WHO Special Programme on Primary Health Care as a “one-stop” mechanism for providing support to member states on the scale-up of the most critical layer of health systems, which is regarded as a cornerstone of UHC.

The Special Programme will be run by a new WHO director, Suraya Dalil, former Afghanistan Minister of Health.

“It will put into action the operational framework for primary health care, once it is approved, which outlines 14 levers,” according to the Director General’s report to the EB.

Other next steps would include supporting countries to:

  • Scale up access to various forms of health insurance or financial protection, with an emphasis on reaching groups left furthest behind;
  • Better coordination with other UN and global health partners on programmes and services;
  • Strengthened accountability and monitoring.

Access to Health Coverage Gradually Increasing – But Costs Also Rising

According to the 2019 WHO Global Monitoring Report, released in September 2019, the proportion of people with health coverage has increased from an average of 45% in 2000 to 66% in 2017.

Universal Health Coverage Index in 2017, Global Monitoring Report (WHO,2019)

However, this was accompanied by a sharp rise in out-of-pocket spending. Between 2000 and 2015, the number of people with out-of-pocket health spending exceeding 10% of their household budget increased to about 930 million worldwide. Those with out-of-pocket spending exceeding 25 percent of household budgets, increased by about 210 million people.

The report called for government to increase spending on primary health care by at least 1 percent of their GPD in order to achieve health targets by 2030. The report projected that investing an additional US$ 200 billion a year on scaling up primary health care across low- and middle-income countries could save 60 million lives, and increase average life expectancy by 3.7 years by 2030.

Most countries can raise the necessary funding from domestic resources by increasing public spending on health, and reallocating spending towards primary health care, the report pointed out, adding that countries with the lowest incomes, will continue to require external assistance.

EB Members Agree Funding Needs To Be Increased

A group of prominent EB members, led by Indonesia, called on fellow member states to step up sustainable funding for health systems. Indonesia made the call on behalf of the Foreign Policy and Global Health Initiative composed of Brazil, France, Indonesia, Norway, Senegal, South Africa, and Thailand.

Their calls were supported by other WHO member states, such as Thailand and Bolivia, while Nigeria asked WHO to step up its assistance to developing countries on sustainable financing for primary health care.

Norway highlighted the fact that while international support remains important for some countries, national governments need to do more to close the domestic investment gap in health services.

Barbados, however, noted that demands to increase health budgets compete with other needs such as security and environment, while “UHC is not a low-cost endeavour.”

Delegates also underlined the need to improve global availability and access to affordable medicines, vaccines and other health products.

The United States expressed concern for health workers’ safety, and called on the WHO to focus more attention on the issue globally. In order to achieve UHC, countries will need to recruit and train some 18 million health workers globally in the next decade.

Another group of countries, led by Sri Lanka, and including Burkina Faso, Japan, France, the Netherlands, Sweden, and Tonga stressed the large economic burden imposed by poor oral health care, noting that this issue should be integrated more deeply in UHC. Poor oral health can contribute to diabetes, cancer and cardiovascular diseases. Sri Lanka’s delegate proposed that a global strategy on oral health be considered as a Board agenda item in 2021.

 

Image Credits: WHO Global Monitoring report .

The World Health Organization’s Executive Board tackled two big issues today – primary health care, a cornerstone of WHO’s Universal Health Coverage platform, and cancer, the world’s second leading cause of premature deaths.

In a comprehensive report released on World Cancer Day, WHO outlined an action plan that could save 7 million lives from cancer in the next decade – a framework that includes recommendations on prevention policies, expansion of screening and early treatment services at the primary care level, and guidance on financing cancer interventions and price transparency for cancer therapeutics.

The 149-page report, launched in parallel with a whopping 613-page companion report by the International Agency for Research on Cancer (IARC), was launched Tuesday. Shortly afterward, the WHO Executive Board reviewed and tacitly endorsed a new WHO operational plan for dramatically scaling up Primary Health Care services in countries worldwide.

Cancer Action Plan Could Save 7 Milion Lives

“At least 7 million lives could be saved over the next decade, by identifying the most appropriate science for each country situation, by basing strong cancer responses on universal health coverage, and by mobilizing different stakeholders to work together,” said Dr Tedros Adhanom Ghebreyesus, director-general of WHO in a press release on the cancer action plan.

The report warns that if current trends continue, there will be a 60% increase in cancer cases over the next two decades, the report warns. Low-income countries with limited health resources will be hardest hit – some 81% of the new cases are projected to occur in those countries where survival rates are also the lowest.

In terms of cancer death prevention, the report highlights measures that can be taken to prevent and cure cervical cancer, the fourth most common cause of cancer in women, as “a global priority.” It underscores that most effective cervical cancer interventions – vaccination, screening, and early diagnosis and treatment – can be provided at the primary care level – where health services can be inexpensively provided.

Just a day later, the WHO EB unanimously recommended that the first draft strategy for the elimination of cervical cancer be adopted by the 73rd World Health Assembly in May.

Primary Health Care – Requires Political Will

Yet in many countries, investing in primary health care where many such services can be provided, is an uphill political battle, “like going against the wind, because politicians advocate for hospital beds,” warned Dr Tedros on the second day of 146th Session of the Executive Board. “During elections, even communities want to see something visible like… a big hospital.”

But he added, if we are going to make “a dent in noncommunicable disease and communicable diseases, primary health care is the answer – that goes for high-income countries and low-income countries as well… If we really believe in primary health care we need to stand against the wind.”

At the same time, awareness of the importance primary health care plays as a building block of health systems is growing, said Zsuzsanna Jakab, deputy-director of the WHO, and there is now “an unprecedented political movement to move forward… it has to be at the center of the functional health system.”

The new operational framework outlines 14 operational “levers” that “comprise all the components of primary health care,” said Jakab, who introduced the framework details to Executive Board members.

“Essential components” like multi-sectoral action, community engagement, policy and government frameworks, and funding must be “integrated” with public health functions like “immunization surveillance, prevention, promotion, and protection” to address “all the determinants of health.”

Expansion of primary health care services is one of the key accelerators of health-related Sustainable Development Goals, endorsed by both WHO and UNICEF, she added.

A WHO Special Programme for Primary Health Care will provide differentiated support to countries that aim to expand such services, focusing on fragile health systems, said Jakob.

The framework was widely welcomed by members and observers at the EB session, although the absence of a strong reference to nutrition and special consideration to the needs of small island states battered by climate change effects were issues raised by Bangladesh, the United Kingdom, and Tonga.

In its response to the plan, Eswatini called on countries to “avoid erecting economic or political boundaries… and to promote healthy partnerships,” a jab at yesterday’s showdown on Taiwan’s political status. Guatemala also thanked Taiwan for “generous support.”

Firing back, China’s EB delegate said that the “Taiwan region is part of China and concern’s China’s internal affairs,” and called on countries to stop hijacking “the so-called Taiwan issue.”

Six Target Actions for Cancer Control

Along with cervical cancer – the WHO Report on Cancer details trends in other most common and deadly cancers – including lung, breast, colorectal, prostate, and stomach cancers. Cancer caused 9.8 million deaths in 2018 alone, the report notes. Lung cancer remained the world’s most common cause of new cancer cases and deaths, with  2.1 million new cases and 1.8 million deaths in 2018. Breast cancer followed at a close second, with 2.1 million new cases and 627,000 deaths in 2018.

Estimated rise in the global burden of cancer based on United Nations population projections.

With limited health resources focused on combatting infectious diseases and improving maternal and child health, health systems in many low-income countries are ill-equipped to prevent, diagnose, and treat cancers. According to the report, in 2019 less than 15% of low-income countries had comprehensive cancer treatment  available in the public health system, compared to 90% of high income countries.

“The past 50 years have seen tremendous advances in research on cancer prevention and treatment,” says Dr Elisabete Weiderpass, director of IARC.

She added that while “deaths from cancer have been reduced,” the improvements have mostly been seen in high-income countries.

In rich countries, “prevention, early diagnosis and screening programmes…together with better treatment, have contributed to an estimated 20% reduction in the probability of premature mortality between 2000 and 2015, but low-income countries only saw a reduction of 5%,” Weiderpass said.

Ultimately, she added, “we need to see everyone benefitting equally.”

“This is a wake-up call to all of us to tackle the unacceptable inequalities between cancer services in rich and poor countries,” added Ren Minghui, assistant director-general of the Division of Universal Health Coverage/ Communicable and Noncommunicable Diseases at WHO.

The solution is two-pronged – strengthen health care services for cancer, particularly at the primary care level, and scale up proven interventions for cancer prevention. The report lists six high-yield priorities for prevention and early treatment:

  • Control tobacco use – responsible for an estimated 25% of all cancers;
  • Reach 90+% vaccination coverage against hepatitis B and human papillomavirus, respectively responsible for a majority of liver and cervical cancers;
  • Screen for cervical cancer with 70+% participation rate;
  • Focus on early diagnosis and treatment for so-called “curable cancers” – such as many childhood cancers – that have proven, effective treatments;
  • Scale-up capacity to manage 200 million cancer cases in the next decade;
  • Provide palliative care for all cancer patients.

Actions that reduce air pollution, promote active lifestyles and increase healthy eating can also reduce cancer rates, while having a broader effect on the reduction of non-communicable diseases such as diabetes as well, the report notes.

Financing Cancer Services

Scaling up expensive treatments for cancers may be more complex, the report admits. In low- and middle-income countries, donor support and budgets allocated for cancer services, and non-communicable diseases (NCD) more broadly, are limited in comparison to spending on other health priorities.

An analysis of spending patterns in 40 low- and middle-income countries showed that NCD spending has grown, now averaging about a quarter of domestic budgets, but international aid for NCDs still lagged at about 2% of total health-related assistance.

Recommending a “progressive” approach to expand cancer services, the report stated that countries should  “incrementally” increase resources to cover “ever larger segments of the population,” mobilizing “innovative financing mechanisms” such as airline levies, tobacco taxes, or other sources of non-traditional revenue. 

Price Transparency of Medicines Can Increase Affordability

But the report also touches on the thorny issue of price transparency – particularly relevant in the case of expensive, new cancer therapies. It recommends that governments “enforce price caps on medicines, with or without progressive reduction of prices over time; create competition among therapeutically similar medicines, including generic and biosimilars; and use voluntary license agreements, applying the flexibility of TRIPS for patented medicines, where appropriate.”

The report recommends that “health systems should disclose the net transaction prices of cancer medicines to relevant stakeholders in order to strengthen the governance of procurement” and “countries should disclose and control prices along the supply chain to avoid excessive mark-ups” are an endorsement of price transparency for cancer treatments. Pooled procurement mechanisms – which allow small countries with little market power to collectively bargain on treatment prices – “should extend their scope to include cancer medicines and related health products… when relevant and feasible.”

The recommendations align with WHO’s steps over the past year to increase competition in the cancer treatment arena. Recently WHO  created a channel for pharma manufacturers to gain WHO’s quality seal of approval for biosimilar versions of a breast cancer drug, Trastuzumab, through the WHO Prequalification Programme.

“If people have access to primary care and referral systems then cancer can be detected early, treated effectively and cured. Cancer should not be a death sentence for anyone, anywhere,” said Minghui.

This story was updated 5 February 2020

Image Credits: WHO, WHO Report On Cancer.

A crisis management cell at the United Nations Secretariat level is being created to support global management of the novel coronavirus outbreak, World Health Organization officials said this evening.

In a late evening briefing Tuesday to WHO member states attending this week’s 146th Session of the Executive Board, WHO officials laid out their war plan for combatting the virus that originated a month ago in Wuhan, China – and which now includes 20,471 confirmed infections and 23,314 suspected cases inside China – but only 176 cases abroad.

“99% of the cases are in China, while in the rest of the world we have only 176,” underlined Dr Tedros Adhanom Ghebreyesus, in the briefing. “That doesn’t mean it won’t get worse, but for sure we have a window of opportunity.

“Concern and worry should be supplemented by action now while we have a window of opportunity… because of the measures that China is taking at the source.”

The WHO Director General said that WHO had sent 250,000 tests for identifying the new virus to more than 70 reference laboratories globally. Masks and gowns, as well as other basic equipment for creating isolation wards, are also being shipped from WHO warehouses in places such as Accra, Ghana – closer to countries that may need the most WHO support.

Laboratories in low income countries are also being trained in the conduct of rapid tests, WHO officials said.

“As of Friday, countries will have the capacity and the training to test and make the diagnosis in less than a week,” said WHO head of emergencies Mike Ryan, noting that the actions were underway in coordination with regional bodies such as Africa CDC. “We are not helpless and it is not hopeless,” he added.

Epidemic Response Cost Likely To Be High 

However, fighting the epidemic will come with a high price tag, the WHO officials warned.

The unit cost of responding for three months to just 10 imported cases from China could be an estimated US $ 1.5 million, while 100 cases involving some local transmission would cost about US $ 10 million, and 1000 cases of community transmission would cost over US $ 53 million, said Scott Pendergast, Director, Strategic Planning & Partnerships in WHO Health Emergencies.

Anticipated capacity for testing (green) and transporting (red) suspected 2019-nCoV specimens in the WHO Africa Region

He estimated that the overall cost of scaling up epidemic response in low income settings for the coming months would be about US $ 675 million, while WHO has immediate needs of about US $61.5 million.

Ryan said that WHO was exploring with the World Bank and other partners how to release global emergency and pandemic funds to low-income countries and fragile states for their response.

“We are looking at how that can be activated as well,” said Ryan. “We have our own contingency on epidemics and we have been using that to set up regional platforms. But if we need to go to scale with multiple countries having a thousand cases the cost of this will escalate rapidly.”

“Many, many countries in Africa are experiencing similar epidemics.. the addition of another novel coronavirus is another burden and a great worry,” Ryan said.

To help countries cope, WHO on Tuesday held a briefing with all 150 WHO country offices worldwide, Dr Tedros said.  From now on, the agency will also conduct daily media briefings about new developments in the emergency.

He said that he was also writing to all ministers of health worldwide to request faster sharing of data about exported cases.

“Of the 170 cases reported outside of China so far, only 38% have been fully reported,” he said, “and some of the high-income countries are behind in sharing this data with WHO.

“Without better data, it is very hard for WHO to assess how this outbreak is evolving or what impact it could have.  The commitment to global solidarity starts from sharing information.”

Travel and Trade Restrictions

Some 22 countries have now imposed travel and trade restrictions on the entry of people who recently were in China, the WHO Director General also said. But he said that such restrictions can also increase fear and stigma, which could even impede response efforts.

“We call on countries not to impose restrictions contrary to the International Health Regulations,” he said, referring to the binding treaty between WHO member states that governs emergency response efforts. “Where restrictions are created, we request that they are short in duration,” he said.

Said Pendergast, WHO was developing a public health strategy to help countries to prepare for and control the outbreak. It would focus on so called “high risk countries – low income countries.

“What we are mostly concerned is countries at the lower end of the preparedness scale where there are countries at a high risk of imported cases, but cases are not being detected and reported.”

Infection Transmission & Severity

So far, about 14% of the cases of the novel coronavirus, dubbed 2019-nCoV,  have been severe, and an additional 2% being fatal, said Maria Van Kerkhove, head of emerging diseases at WHO. Most of the fatal cases have been in people who are 60 years or older, or have pre-existing conditions, she said.

She said that the upper limit of the incubation period was 14 days, and that the virus is transmitted via droplets from an infected person, or touching surfaces contaminated by such droplets.

She said that WHO had created guidance on management of the virus, and would soon be updating that with advice on the use of protective masks in the community, during home care and in health care settings.

 

 

Image Credits: Flickr: Lei Han, WHO dashboard for 2019-nCoV, WHO.

World Health Organization Director General Dr Tedros Adhanom Ghebreyesus called for “solidarity, solidarity and solidarity” amongst WHO member states to meet the new challenge of a novel coronavirus epidemic – at Monday’s opening of a week-long meeting of WHO’s Executive Board in Geneva.

“The rule of the game is solidarity, solidarity, solidarity. But we see this missing in many corners, and that has to be addressed,” he said, speaking before the 34-member governing board.

The WHO Director General also stressed that “there is no reason for measures that unnecessarily interfere with travel or trade” – despite the widespread curbs that many countries have imposed on travel to or from China.

Dr Tedros gives his annual report at the 146th Meeting of the WHO Executive Board

WHO is tracking countries that impose travel and trade restrictions, and some of those imposing limits have been asked to justify their policies on public health grounds, a WHO official told Health Policy Watch. The official declined to indicate which countries might be called to account. A global WHO roundup of such measures is reported to Member States on a weekly basis. But that won’t be made public until the World Health Assembly in May, the official added.

Under the provisions of the International Health Regulations, a binding treaty among WHO member states, countries are supposed to refrain from unnecessary travel and trade restrictions when health emergencies occur.

But as the case load of the novel virus soared to over 17,341 people worldwide and 361 deaths reported on Monday, what might be a  “necessary” or “unnecessary” restriction has varied widely in different corners of the world. Countries across Europe, Asia and North America have severely tightened travel restrictions, also imposing mandatory quarantine measures on travelers returning from China. African countries, such as Nigeria, however, said the doors would remain open.

It remained unclear exactly what measures WHO was recommending that countries outside of China do take to meet the challenge of the spiraling outbreak-turned-epidemic, which some observers now warn could even become a “pandemic.”

Speaking Monday morning, the WHO Director-General called on countries “to implement decisions that are evidence-based and consistent,” adding that WHO stood ready “to provide advice to any country that is considering which measures to take.”

He said that universal measures should include policies to:

  • combat the spread of rumours and misinformation;
  • review preparedness plans, identify gaps and evaluating the resources needed to identify, isolate and care for cases, and prevent transmission;
  • sharing data, sequences, knowledge and experience with WHO and the world.

The world must also “support countries with weaker health systems,” as well as “accelerate the development of vaccines, therapeutics and diagnostics” to combat the new virus, he said.

Dr Tedros praised China’s response to the outbreak, and the “personal leadership” and “commitment” of President Xi Jinping, saying that China’s actions were protecting other countries around the world.

Medical workers conduct temperature checks of passengers at a subway station in Beijing.

“If we invest in fighting at the epicentre, at the source, then the spread to other countries is minimal and also slow.  If it’s minimal and slow, that is going outside can also be controlled easily,” Dr Tedros said. “So it can be managed – when I say this, don’t make a mistake, it can get even worse. But if we give it our best, the outcome could be even better.”

Dr Tedros added: “The only way we will defeat this outbreak is for all countries to work together in a spirit of solidarity and cooperation. We are all in this together, and we can only stop it together.

“The rule of the game is solidarity, solidarity, solidarity. But we see this missing in many corners, and that has to be addressed.”

While most EB board members followed Tedros example in praising China’s response to the outbreak, stories about delays in the initial Chinese government response were multiplying in global media.

Valuable time was thus lost to contain the mushrooming epidemic, critics said. One expert, Anthony S. Fauci, director of the US National Institute of Allergy and Infectious Diseases, told the New York Times, “It’s very, very transmissible, and it almost certainly is going to be a pandemic… some epidemiological models indicated that there could actually be 100,000 or more cases.”

Spat over Taiwan Status in Emergency Response  

Solidarity was singularly absent in a subsequent EB debate over the treatment of Taiwan – which in WHO terms, falls under the jurisdiction of the mainland government in Beijing.

Complaining of “political conflicts” that hinder outbreak response, Eswatini’s representative complained that “The Republic of China Taiwan has limited access, if any, to the WHO IHR (International Health Regulations) processes.

“Taiwan’s technical experts are denied participation in technical meetings of the WHO. This unfortunately leaves over 23 million people in Taiwan vulnerable to such epidemics, yet we know that Taiwan has cutting-edge expertise that will benefit all of us. A case in point is the management of the current novel coronavirus outbreak where inaccurate info enlisting what lead to unfortunately misplaced decisions impacting the people of Taiwan.”

China’s EB representative hotly denied the claims, saying that Taiwan had been fully informed of cases involving Taiwanese on the mainland, and that Taiwanese specialists had even visited the mainland and Hubei province to learn about containment measures being taken.

“There does not exist a so called gap in the epidemic preparedness system as a consequence of Taiwan’s inattendance at the WHA,” said China’s EB representative. “Instead it is just the lies and excuses of the Taiwanese authorities made in an attempt to participate in the WHA [World Health Assembly].”

Year In Review – Unprecedented Challenges, Achievements & Transformation

While the coronavirus outbreak has dominated headlines in early 2020, the threat posed by the deadly outbreak of Ebola in the Democratic Republic of Congo, has now been virtually squashed, the WHO Director-General reminded the EB – in remarks that also included a wide-ranging review of the challenges and accomplishments of 2019.

Paying homage to the health workers who lost their lives combating both the Ebola virus as well as DRC armed groups that frequently attacked health responders, Dr Tedros said their determination is the reason: “Why Ebola is almost zero, the last 16 days are almost done. We had one case again yesterday, but I hope we will finish it as soon as possible. For the Ebola situation to be what it is now, we paid in lives.. we have to give them due respect.”

Fighting the Ebola outbreak, he said, was just one example of how, “2019 was a year of unprecedented challenges, unprecedented achievements and unprecedented transformation. We touched every corner of the organization while fighting emergencies and launching new initiatives.”

New WHO Focus on “Healthy Populations”  

The year also saw a new emphasis on health promotion and illness prevention, Dr Tedros noted, with the foundation of a WHO division on “Healthy Populations” as well as a new department on Social Determinants of Health.

An agreement was reached with the  International Food and Beverage Association to eliminate cancer-causing “transfats” from processed foods by 2023.

More than 80 cities in more than 50 countries committed to reaching WHO air quality guidelines, and WHO also began implementing a new initiative on climate and health in Small Island States – countries threatened with virtual extinction by rising seas and climate change.

“The urgency of this challenge was brought home to me during my trip to my trip to Tahiti, Tonga, Tuvalu and Fiji last year,” said Dr Tedros. “In Tonga, I planted a mangrove in an area which used to be a rugby field, where Tonga and Fiji played each other in 1924, but it’s now fully consumed by saltwater.”

In terms of preventing non-communicable diseases that cause 70% of the world’s deaths, the WHO Director-General noted that:

  • Countries are scaling up hypertension control – only 200 million of the 1.2 billion people with hypertension currently use control measures. Another effort aims to dramatically expand diabetes diagnosis and treatment.
  • The number of men using tobacco is finally starting to decline…. on the other hand the threat of e-cigarettes is rising.
  • Global initiatives were launched on mental health – aiming to increase access to services for 100 million more people as well as to combat childhood cancer.
  • Global standards were published for safe use of personal audio devices to reducing hearing loss.
  • A draft strategy for eliminating cervical cancer, now mostly preventable through vaccines and screening, has been developed; it is to be considered at this week’s Executive Board.
Universal Health Coverage

In terms of progress on Universal Health Coverage (UHC), South Africa and The Philippines passed new laws for UHC, while Greece, India and Kenya rolled out “ambitious programmes to expand coverage”, Dr Tedros said.

The WHO flagship initiative that aims to expand affordable, accessible health care to the entire world by 2030 was also the focus of a high-level UN declaration in September 2019.

In line with the UHC drive, the WHO Director General said that “access to health services expanded in all regions of the world and across all income groups in 2019. But that comes with a big caveat – we are going backwards on financial protection.”

“In 2015, 930 million people spent 10% or more of their household consumption on health, and we know that number is growing every year… The world spends almost 10% of global GDP on health,” Dr Tedros said, adding that “too many countries spend too much of their health budgets on managing disease, instead of promoting health and preventing disease, which is far more cost-effective.”

He repeated a longstanding WHO call for countries to increase public spending on primary health care by at least 1% of their GDP: “As you have heard me say many times, health is a political choice. But it’s a choice we see more and more countries making.”

Executive Board members and observers rise for a moment of silence in memory of Peter Salama, WHO Executive Director of Universal Health Coverage, who died suddenly in late January.
Access To Medicines

In another historic moment last year, WHO signed a memorandum of understanding with the African Union to establish an African Medicines Agency. The new agency is expected to speed approval and rollout of new medicines across the continent – overcoming the complexities of national approvals. Last year, WHO also launched new initiatives to approve through WHO “pre-qualification” channels, new manufacturers for an expensive breast cancer treatment as well as for human insulin, which is often too pricey for the poor to afford.

The moves are expected to foster more competition in the production of life-saving drugs that are now often too expensive now for low- and even middle-income countries.

“We expect to prequalify more and more of these very effective but very expensive medicines in the coming years,” said Dr Tedros.

Infectious diseases – Egypt Leading in Hepatitis C Elimination

Egypt, which has one the world’s highest burden of hepatitis C (HCV) infections, is now on track to be one of the first countries to eliminate the disease, noted Dr Tedros.

The national elimination strategy has included access to screening for 60 million people, and treatment for 3.7 million found to be infected. HCV screening has been combined with screening and treatment of hypertension and diabetes, as well as cervical and breast cancer – at primary health care level. “This is a truly stunning achievement, which could be a good lesson for other countries,” declared the WHO Director General.

Australia, France, Georgia and Mongolia are also moving towards Hepatitis C elimination, enabled by dramatic reductions in the price of direct-acting antivirals that offer 95% or greater cure rates. In terms of other leading infectious diseases, the Director General noted progress on the following:

  • HIV/AIDS – By the end of 2019, 77 countries had national policies that support HIV self-testing, helping to reach people at higher risk from HIV, including those who are most marginalized and not accessing health services.
  • Malaria – a pilot programme for the world’s first malaria vaccine was launched in Ghana, Malawi and Kenya. Argentina and Algeria were certified as malaria-free. And a WHO Strategic Advisory Group on Malaria Eradication and the Lancet Commission on Malaria Eradication both published milestone reports on what the world needs to do to eliminate malaria.  “Despite these gains, we continue to see more than 200 million cases of malaria annually. More than 400,000 people die each year from this preventable and treatable disease,” he said. In response, WHO and the RBM Partnership to End Malaria launched a new initiative to accelerate action on malaria in the 11 countries of Sub-Saharan Africa that are responsible for 70% of the global malaria burden.
  • Tuberculosis – 7 million people were diagnosed and treated for TB in 2018, up from 6.4 million in 2017. WHO’s aim for 2020 is 8 million.WHO has also developed new policies and guidelines to ensure better outcomes for those affected, including strong recommendations for the first time for fully oral regimens for the treatment of multi-drug resistant TB.
  • Polio – WHO certified the global eradication of wild poliovirus type 3, and launched a new Global Polio Eradication strategy with US $2.6 billion pledged by donors. Despite 173 cases of another wild polio virus type in 2019, as well as many outbreaks of vaccine devised outbreaks, mostly in Africa, the WHO Director General said he was “confident we are on our way to realizing our vision of a polio-free world.”
  • Neglected Tropical Diseases – Yemen and Kiribati eliminated lymphatic filariasis, and Mexico eliminated rabies. And for the first time, the number of human African sleeping sickness cases reported globally fell below 1000.
Antimicrobial Resistance – Drug Resistant Pathogens

WHO has strengthened collaboration with the Food and Agriculture Organization (FAO) as well as the World Organization For Animal Health (OIE) to make more rational use in agriculture and animal husbandry of antibiotics critical to  human health.

To stimulate research and development into new and much-needed medicines, WHO is working with the European Investment Bank on a new investment fund – “we will have more news about that in the coming months,” said Dr Tedros. “At the same time, we’re striving to protect the antibiotics we have by working with countries to strengthen infection prevention, stewardship, hygiene and water and sanitation. As part of that:

  • Some 135 countries have developed national action plans to combat drug resistant germs.
  • Some 90 countries have enrolled in the WHO global surveillance platform (GLASS) that will monitor how well countries are doing in fighting AMR, as part of a new Sustainable Development Goals indicator.
  • With support from the Governments of the Netherlands and Sweden WHO launched the Multi-Partner Trust Fund on AMR, to catalyse action in countries.

 

Image Credits: Wikimedia Commons: Pau Colominas, Twitter: @WHO, Twitter: @WHO.

This week’s Executive Board meeting features a heavy agenda of topics, including a review of progress in WHO’s flagship Universal Health Coverage (UHC) initiative; steps taken to confront the burgeoning coronavirus health emergency; and review of a first-ever WHO strategy to eliminate cervical cancer. Debates over the long-term challenges posed by drug resistant pathogens and access to medicines among the world’s poorest populations are also on the docket. Here is a rundown of the key items on the agenda, and what to watch:

Universal health coverage, with a focus on non-communicable disease prevention and management, is high on the priority list following the high-level political declaration on UHC signed at the United Nations General Assembly in October 2019.

Dr Tedros giving the “Report of the Director-General” at the 146th Meeting of the WHO EB

The EB is to review a progress reports on the implementation of the political declaration and provided guidance on a menu of policy options and interventions to promote mental health and well-being, reduce premature deaths from air-pollution related NCDs, and reduce the harmful use of alcohol. The EB will also be weighing on draft proposals for the first ever WHO strategy on cervical cancer elimination and an action plan for a “Decade of Healthy Aging.”

As the world teeters on the edge of a global epidemic due to a novel coronavirus that emerged late last year from Wuhan, China, the EB is also set to review work on public health preparedness and response. Influenza preparedness, polio eradication, and cholera control are main items up for discussion on the health emergencies agenda, but observers say the agenda may change with ongoing outbreak of the novel coronavirus, 2019-nCoV, which was just declared a “public health emergency of international concern” last week.

The EB will also recommend that a draft strategy for tuberculosis research and innovation be endorsed by the WHA in May, and will be providing guidance on the next iteration of a global strategies for immunization and combatting neglected tropical diseases.

Lastly, the EB will be debating access to medicines – focusing on the thorny issues surrounding innovation and intellectual property. Specifically, the EB will provide further comments on a global action plan for 2020 – 2022, which will be finalized for endorsement by the WHA. In related items, the EB will review a proposed workplan for the implementation of the Nagoya Protocol – an international agreement that provides guidance on sharing of genetic information – and approve the first ever strategy on digital health for 2020-2024.

The EB will also comment on the final methods of measuring outputs of 13th General Program of Work, and assess existing collaborations and a list of applications under the Framework of Engagement with Non-State Actors.

Appointment of Regional Directors For Europe and Africa

Dr Tedros welcoming Kluge into his new role as WHO Regional Director for Europe.

In actions taken on Monday, the EB opening day, Dr Hans Kluge was appointed as the new WHO Regional Director for Europe today, following former Regional Director Zsuzsanna Jakab’s promotion to Deputy-Director General of the WHO. Kluge, who previously directed the Division of Health Systems and Public Health at the WHO European Regional Office, explained that his platform would focus on “applying the best data and evidence, demanding increasing investment in health, strengthening health systems around people’s needs, and extending inclusive and non-discriminatory access to health care to all” in a WHO press release.

“Every child, every woman and every man in our beautiful and diverse Region has the right to health. I am committed to delivering united action for better health,” Kluge vowed.

Dr Tedros congratulates Matshidiso Moeti on her re-election as WHO Regional Director for Africa.

Dr Matshidiso Moeti was re-elected to a second term as the WHO Regional Director for Africa. Moeti’s platform will focus on “accelerating action” towards universal health coverage to increase access to healthcare “without financial hardship.”

Serving since 2015, Moeti said that she was “greatly honored” by WHO’s decision to reappoint her “as Africa increasingly faces the double burden of disease.”

Moeti added, “Thank you for the trust you have shown…The next five years in public health will be crucial in laying a strong foundation to reverse this burden.”

Image Credits: Twitter: @WHO, Twitter: @WHO.