“Containment” remains the main objective of the battle against the coronavirus, said WHO’s Director General Dr Tedros Adhanom Ghebreyesus on Monday, following a weekend where reports of new virus clusters in the United Kingdom and France raised fresh concerns about the virus capacity to spread rapidly beyond China’s borders.

The WHO Director General spoke to press after a weekend uptick of freshly reported cases of the mysterious new virus (2019-nCoV) in China as well as abroad.

In China, there were 42,359 confirmed cases and 1012 deaths as of Monday night – passing the watershed mark of the nearly 800 deaths recorded in the SARS epidemic of 2003-2003. Outside of China there are now 319 cases in 24 countries, with one death, WHO reported.

The new cases abroad included 5 adults and a child in France and 5 more people in the UK and Spain. All contracted the virus from the same so-called “superspreader,” a British man who had attended a sales conference in Singapore, also attended by an infected man from the virus epicentre in Wuhan, China. The British man had then hopped to a ski holiday in France, staying at a rented chalet that he shared with friends, before returning home to Britain.

WHO Director General at Monday press briefing

“In recent days we have seen some concerning instances of onward transmission from people with no travel history to China, like the cases reported in France yesterday and the UK today,” said Dr Tedros at the press briefing. “The detection of this small number of cases could be the spark that becomes a bigger fire. But for now, it’s only a spark. Our objective remains containment. We call on all countries to use the window of opportunity we have to prevent a bigger fire….We should work hard as one human race to fight this virus before it gets out of control.”

At least eight other cases of the coronavirus among Singaporeans, Koreans and Malaysians have been linked to the private Singapore conference event, according to Bloomberg News reports on those who fell ill. However WHO emergencies head, Mike Ryan, said that it was “too early to consider the Singapore conference cluster as a superspreader event.”

Despite new reports of conference cancellations in Singapore, which has the largest number of cases reported outside of China, Ryan said that WHO isn’t recommending that mass meetings be called off.

“Certainly it’s a concern when people come together and move apart,” Ryan said. “But you can’t shut down the world here. We cant say that we are going to cancel every event. Where is the limit to this?  We need to remain calm and measured, ask what are the risks and how can those risks be minimized?”

Global Research Forum Starts Tuesday – WHO Team In China

Meanwhile, a hastily-convened Global Research and Innovation Forum was due to kick off a meeting at WHO headquarters in Geneva on Tuesday, in a quest to find more answers on treatments for the mysterious virus.

The meeting, involving member states, the private sector, other UN agencies and global research institutions, will review existing knowledge about the nature of the virus, clinical symptoms and its transmission; infection prevention and control, particularly in health care settings; potential drug treatments; and prospects for the rapid development of vaccines.

The aim is to identify target product profiles for new treatments, and then ensure that there is both institutional support as well as financing to roll them out as soon as possible, said Dr Tedros at the press briefing.

“This is an amazing initiative to centralize our knowledge.. to identify the gaps, what are the specific research priorities and how do we accelerate action o n the most needed medical technologies and vaccines.  How are these priorities going to be turned into product profiles? How will those be financed? How are we going to ensure accessibility to the products? This is not just a scientific discourse.. we need to ensure the broader outcomes of that process so that the results are available to all.”

Dr Tedros said he hoped that the forum would serve as a “leapfrog moment, in terms of coherence and priority setting, setting that roadmap so we all travel together in coming months.

Simultaneously a small WHO advance team arrived Monday in Beijing to lay the groundwork for the arrival of a larger group of international researchers, to support the Chinese research and disease control effort.

Ryan said that the international team was planned to include about 10-15 experts, representing “the best of China and the world.” The team would be “fully-empowered” to explore the challenges posed by the virus and opportunities for bringing the epidemic more rapidly under control.  “We need to give them time to interact, to step back and let the scientists do the work and see what they come up with,” said Ryan.

Thirteen African Countries & Iran Equipped with Laboratory Tests for Coronavirus

Meanwhile, thirteen African countries, as well as Iran, have now been specially equipped by WHO with laboratory tests to identify the novel virus.  Those countries included Cameroon, Cote d’Ivoire, the Democratic Republic of Congo, Egypt, Ethiopia, Gabon, Ghana, Kenya, Morocco, Nigeria, Tunisia, Uganda and Zambia.

Another shipment of 150,000 tests is being assembled in Berlin this week, to be sent to more than 80 labs worldwide. These are among the 168 labs globally that have been identified as having the right technology to use the tests, WHO said. Last week the African Centers for Disease Control conducted a training in Senegal with lab technicians from 12 countries on use of the diagnostic tests. Another training will take place in South Africa next week.

“Without vital diagnostic capacity, countries are in the dark as to how far and wide the virus has spread – and who has coronavirus or another disease with similar symptoms,” said Dr. Tedros.

Latest WHO dashboard showing coronavirus epidemic distribution as of Sunday evening. Cases reported as of Monday morning bring the total up to 40,554 worldwide.

Image Credits: WHO .

Governments are falling behind in the battle against a “global epidemic” of noncommunicable diseases (NCDs), say two new reports by the World Health Organization and the NCD Alliance, launched on the first day of a Global NCD Alliance Forum in Sharjah, United Arab Emirates.

Many countries are stalled in implementing basic prevention policies, such as reducing tobacco and harmful alcohol consumption; promoting health eating and physical activity; and strengthening early NCD detection and treatment in primary health care systems, according to the WHO NCD Progress Monitor 2020 report, released Monday. Such policies are among the so-called WHO “Best Buys” for NCD prevention.

Only 19% of 194 countries surveyed have fully implemented tobacco taxes; just 20% are meeting targets for salt-reduction, and one-third of countries are providing basic NCD health services such as drug therapy and counseling.  And less than half of the 194 countries surveyed met at least two of the ten targets that would reflect progress against NCDs – a “grim sign” as the report calls it.

Speakers of the opening plenary at the Global NCD Alliance Forum

“Countries are still failing to meet basic indicators. If they continue on this path then millions of people will die needlessly from heart attacks, stroke, diabetes, cancers, and respiratory disease.” said Ren Minghui, assistant director-general for Universal Health Coverage, Communicable & Noncommunicable Diseases at WHO in a joint press release, issued with the NCD Alliance at the Global NCD Forum.

According to the WHO report, about a quarter of all countries also do not have a national NCD plan in place, and one-third of all countries lack time-bound national targets to drive and monitor progress in the overall Sustainable Development Goal of reducing deaths from NCDs by one-third by 2030.

Data from the second report, the NCD Alliance’s Bridging the Gap backs up this stark reality. The report, based on surveys of national and regional NCD alliances, found that only 20 percent of members believed that their country is on track to meet global NCD targets. Some 82% of members did not believe their country had sufficient accountability mechanisms to ensure NCD targets were being met.

“This report confirms what we’ve long suspected – that the United Nations targets aimed at reducing NCDs are not bearing fruit on the ground,” said CEO of the NCD Alliance Katie Dain. “Unless the gaps in the response are addressed, we’ll be faced in 2030 with a tsunami of disease-related impacts, both human and economic, that could have been avoided.“

NCDs account for over 70% of all deaths worldwide. An estimated 41 million people die from NCDs such as cardiovascular disease, cancer, stroke, diabetes and respiratory illnesses every year.

5 Major Gaps Impeding Progress

The Bridging the Gap report points to gaps in five major areas that are impeding progress – political leadership, investment, care, community engagement, and accountability.

The report found that political commitment to NCDs at the country level is low – only Brazil and Turkey have implemented all five of the tobacco demand reductions measures from the Framework Convention on Tobacco Control for example. Additionally, while domestic financing in NCD control is increasing in some places, international funding for NCDs remains a paltry 2% of total multilateral aid for health.

Only about a third of all countries provide drug therapy and counseling to prevent heart attacks and strokes, and just 40% of countries provide palliative care in primary healthcare or in the community.

““We know what works — primary health care, with its emphasis on promoting health and preventing disease, is the most inclusive, effective and efficient way to reduce premature mortality from NCDs and promote mental health and well-being,” said Minghui.

The report also finds that countries are lagging in engaging communities of people affected by NCDs, and creating independent, civil-society led accountability mechanisms for monitoring progress on reducing NCDs. These measures, the report says, are crucial to push forward action on political promises for NCD control.

“The evidence before us is indicating that we need to move well beyond the health sector to really make a dent in the epidemic. We need to address the root causes of NCDs, in the food we eat, the water we drink, the air we breathe and the conditions in which people live, work and play,” said Minghui.

Image Credits: NCD Alliance/Gilberto Lontro, NCD Alliance.

[STAT News]

As China struggles to contain an epidemic caused by a new coronavirus, science is racing to develop vaccines to blunt the outbreak’s impact. Central to the effort is CEPI — the Oslo, Norway-based Coalition for Epidemic Preparedness Innovations — a global partnership created to spearhead development of vaccines in just this type of emergency.

Two weeks after China announced on 7 January that a new coronavirus had ignited a fast-growing outbreak of pneumonia cases in the city of Wuhan, CEPI announced funding for three efforts to develop a vaccine to protect against the virus, currently known as 2019-nCoV. A week later, it added a fourth. Just days after that, it announced major vaccine manufacturer GSK would allow its proprietary adjuvants — compounds that boost the effectiveness of vaccines — to be used in the response.

But to date, most of the CEPI-funded efforts are focused on partners that don’t have the production facilities to make a commercial product in bulk. They include Inovio, a partnership between Moderna and the National Institute of Allergy and Infectious Diseases; CureVac; as well as the University of Queensland, in Australia. All use innovative approaches that offer the promise of unprecedented speed to the development of a vaccine candidate. But none of the companies has yet licensed a vaccine.

Read the full interview on STAT News.

Image Credits: CEPI/University of Queensland.

The world is facing a “severe disruption” in stocks of personal protective equipment vital for health workers to fight the novel coronavirus  raging through China’s Hubei Province and threatening other countries worldwide, said WHO Director-General Dr Tedros Adhanom Ghebreyesus at a Friday press briefing.

The Director-General spoke as cases of the new (2019-nCoV) virus continued to rise inside China to 31,211 confirmed infections on Friday. Abroad some 270 cases were confirmed. However, for the second day running, the 24-hour increase in new cases was slightly lower, Dr Tedros noted.

Nurse wearing a specialized mask, cap, gown and gloves measures the body temperature of a coronavirus patient in Hubei TCM Hospital. Such gear is vital to protect health workers from infection.

“Fewer new infections have been registered in the last two days, which is good news, but to be taken with caution,” Dr Tedros said. Overnight Tuesday, there were 3,925 new cases in China, as compared to 3,697 overnight Wednesday and 3,151 overnight Thursday to Friday morning.

However the number of new cases reported elsewhere in the world was still increasing every day, with a total of 54 new cases recorded overnight Thursday in 24 countries. That included cases on a cruise ship quarantined in Tokyo’s harbor, where some 61 people among over 3,000 passengers have now been confirmed to be infected with the virus.

In the face of worldwide public fears over infection, demand for specialized masks with N-95 or other high-quality filters and other personal protective gear usually worn by health care professionals is “100 times greater” than normal, said Dr Tedros, and that has depleted stockpiles, created a backlog of orders while sending prices through the roof.

(left-right) Mike Ryan, Dr Tedros, Maria Van Kerkhove

He said he had convened a teleconference with equipment manufacturers on Friday, to asking them to avoid hoarding materials and ensure a more targeted release of stocks to front-line workers in China and elsewhere that need the materials the most.

“When there is a shortage, there can be hoarding to sell at higher prices. There is a moral issue here. That is why we had a discussion with manufacturers,” said Dr Tedros. “It’s really important that we prioritize this for people who need it most, health workers and people caring for their families.”

Added Mike Ryan, WHO’s head of emergencies, “At every stage of the supply chain there is a possibility for disruption, for profiteering. We need the public and the private sector, the wholesalers and retailers” to come together, he added.

Studies Provide Initial Profile Of Seriously Ill Patients

Meanwhile, new a study that analysed the profile of 138 patients hospitalized in Wuhan for the virus between 1-28 January, found that the median age of those seriously ill was 56 years old – with the range between 22 and 92 years of age. Some 54% were men.

The most common symptoms at onset of illness were fever, fatigue, dry cough (82), muscle pain (34.8%), and breathing difficulties (31.2%), according to the study published in JAMA, the Journal of the American Medical Association. Less common symptoms were headache, dizziness, abdominal pain, diarrhea, nausea, and vomiting. A total of 14 patients (10.1%) initially presented with diarrhea and nausea 1 to 2 days prior to development of fever and other symptoms.

Of the patients admitted, 36 (26.1%) were admitted and transferred to an intensive care unit, (ICU) because of the development of organ dysfunction. The median durations from first symptoms to hospital admission, and acute respiratory distress syndrome was about 5 days. Of the 138 patients, 64 (46.4%) had 1 or more coexisting medical conditions, including hypertension, diabetes, cardiovascular disease, or cancer.  As of 3 February, 34% of those patients had been discharged, after an average stay of 10 days. Among those hospitalized, 4.3% had died.

Among the entire population of those infected, some 82% of have only mild cases, while some 15% are severely ill, and another 2% have died, said Maria Van Kerkhove, a WHO emergencies expert in Friday’s briefing.

New Research Suggests Pangolin, Scaly Mammal Used In Traditional Medicines, May Be Coronavirus Source

Meanwhile, a report published in Nature suggested that the Pangolin, a scaly mammal that is an endangered species in Africa and Asia, but still popular for its meat as well as uses in traditional Chinese medicine, may have been the source of the coronavirus that infected humans in Wuhan.

Two researchers at South China Agricultural University in Guangzhou, Shen Yongyi and Xiao Lihua, announced the preliminary finding in a press conference on Friday, based on a genetic analysis of coronaviruses that the mammals carry, which are 99% similar to that of the 2019-nCoV virus circulating in human populations.  The United Nations Environment Programme and World Wildlife Fund WWF have been waging campaigns to save the world’s only scaly mammal, often described as “the most trafficked” on the plant.  The eight pangolin species living in Africa as well as in Asia, are protected by international and national laws, but they are threatened with extinction by illegal wildlife poaching and trade.

Scientists have previously suggested that the coronavirus first originated in bats. But it is also likely that the virus was transmitted to humans by another animal on sale at a wild animal market in Wuhan, China, where the outbreak first occured. If the scientists are proved correct, it would be the second time that a coronavirus that causes severe acute respiratory disesase spread from a traditional Chinese food market to trigger a major global disease outbreak.  Severe Acute Respiratory Syndrome, or SARS, which caused the 2002-03 outbreak, originally spread from bats to civet cats to humans.

 

WHO Executive Board Acts On Emergency Preparedness – Travel Restrictions Skyrocket

Meanwhile, on Saturday, the final day of a week long meeting of WHO’s Executive Board, the governing body approved a draft World Health Assembly resolution on “Strengthening Preparedness for Health Emergencies; Implementation of International Health Regulations“. 

The United States dissassociated from one provision that referred to the need to deliver “sexual and reproductive health, and maternal, newborn and child health services” during health emergencies. 

The final text of the disputed paragrah recognizes “the need to involve women, youth, people with disabilities, and older people in planning and decision-making, and the need to ensure that during health emergencies, health systems ensure the delivery of and the universal access to health-care [services, including strong routine immunization, mental health and psycho–social support, trauma recovery, sexual and reproductive health, and maternal, newborn and child health].”

The resolution, which will go before the WHA for final approval, sets out a detailed list of measures that the UN, global community and member states should take to improve international coordination as well as national preparedness for emergencies.

The resolution also calls on member states to adhere more diligently to the WHO International Health Regulations, a binding convention that governs international and national health responses to emergencies such as the coronavirus epidemic.

Friday’s WHO outbreak situation report noted that 72 out of 194 member states have now implemented some form of travel restrictions as a result of the epidemic. That included 10 more countries that had applied restrictions in just the past 24 hours, the report stated,

Among the countries that had imposed restrictions, however, only 23 had filed official reports with WHO regarding the measures taken and their public health rationale, as they are required to do under the IHR.

Updated 8 February 2020

Image Credits: China News Service.

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 .