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.

In the wake of a World Health Organization declaration Thursday of an international public health emergency, there is growing uncertainty among disease control experts over whether even the drastic measures now being taken will be too little too late to contain the outbreak.

The concerns came as the reported case count of 9811 exceeded that of the 2002-03 SARS outbreak, and the fatalities rose to 213 dead. The United States and eight other countries issued stiff advisories against travel to China, while other countries and territories closed or restricted border entries, suspended visa authorizations, and cancelled flights.

However, such measures seemed to pale in the face of reports such as one published Friday by researchers from the University of Hong Kong, in The Lancet, which estimated that up to 75,800 individuals could be infected with the virus in the epicentre of Wuhan, a city of 10 million where the 2019-nCoV coronavirus first emerged in December 2019.

A medical team from Beijing’s Tsinghua (清华) University is sent to Wuhan to help fight the outbreak.

“In a manner of 3-5 weeks, countries around the world are going to be seeing outbreaks not that dissimilar to what we’ve been seeing in China,” Michael Osterholm, director of the Center for Infectious Disease Research and Policy (CIDRAP), told Health Policy Watch.

He warned that the dynamics of the outbreak were moving into “uncharted territory,” with the virus looking as infectious as the seasonal flu, and the current case-fatality approaching the alarming death rate seen in the 1918 Spanish Flu pandemic, which killed an estimated 50 million people worldwide.

The virus is also spreading silently among people with asymptomatic or mild infections who may not require or seek medical attention, reported the New England Journal of Medicine, in a letter Thursday. The letter, signed by over a dozen doctors from Munich’s University Hospital described the case of a 33-year old German businessman who fell ill with the virus and infected three other co-workers, shortly after meeting a Chinese business partner from Shanghai – who appeared healthy at the time, but became ill on her return flight home.

“The fact that asymptomatic persons are potential sources of 2019-nCoV infection may warrant a reassessment of transmission dynamics of the current outbreak,” said the authors. Osterholm added that although it’s suspected asymptomatic patient are less infectious than those showing symptoms, experts are still determining how often asymptomatic transmission happens.

Although WHO’s Director General Dr Tedros Adhanom Ghebreyesus had said Thursday, during his announcement of the international public health emergency (PHEIC) that WHO did not recommend restrictions in trade or travel – which can cause “more harm than good” by hindering information-sharing and medical supply chains – his advice was being widely ignored.

The United States State Department Thursday issued a level-4 “do not travel” advisory for China – the highest level of travel restriction advisory. Canada, The United Kingdom, France, India, New Zealand, Finland, Australia, and Germany also have recommended against travel to China and particularly Hubei Province.

Egypt, Hong Kong, Russia, Malaysia, and Singapore took even more drastic measures to limit travel to and from China – including cutting flights, temporarily suspending visas, and even closing borders to the mainland – especially targeting travelers to and from Hubei.

On Friday, the Chinese Mission to the United Nations protested the increased travel restrictions in a Twitter post that said: “There is no reason for measures that unnecessarily interfere with international travel and trade. WHO doesn’t recommend limiting trade and movement.”

As for other measures governments should be taking to protect against 2019-nCoV, Osterholm told HPW that countries should be “preparing their health systems as much as they can” with an eye towards “protecting their healthcare workers.”

“Many hospitals in China that are reporting cases in healthcare workers do not have adequate protective equipment because they’ve run out,” said Osterholm.

He added that other countries should prepare for “a major increase in patients with respiratory disease like this who are not only going to need a bed, but some form of isolation so that they don’t transmit the virus to others. And that includes protecting healthcare workers.”

China Blamed For Cracking Down On Medical Reports Of New Virus in Early December

While the WHO Director General repeatedly praised China for its fast and efficient response, other media reports criticized the Chinese government for covering up details of the new virus in its early days in December – and hauling doctors who reported the initial emergence of the novel infections before police for punishment.

“In late Dec a Wuhan doctor said in a WeChat group that there were 7 cases of SARS connected to the seafood market. He was then scolded by the party disciplinary office, and made to sign a “I’m wrong” statement with police. He’s still in critical condition [from the disease],” reported Yaxue Cao, founder and editor of the respected ChinaChange.org website, which reports on Chinese civil society and the rule of law, in a Twitter thread that was circulating widely among Chinese and abroad.

“From the same report, we learned that Wuhan health authorities were having overnight meetings about the new “SARS” at end of Dec. Earlier today the Wuhan mayor said he was not “authorized” to publicize the epidemic until Jan 20. Q[uestion] is, “what went on during the 3 weeks in between?” said Cao.

Li Wenliang, doctor at Central Hospital of Wuhan, was one of the 8 people reprimanded by police for spreading “rumors” about the new viral disease.

“The first known coronavirus infections in the city of Wuhan presented symptoms beginning on December 1 and by 8 December, there was alarm in Wuhan’s medical circles. That would have been the moment for the authorities to act decisively. And act decisively they did – not against the virus but against whistle-blowers who were trying to call attention to the public health threat,” said New York Times journalist Nicholas Kristof, in an 30 January Op-Ed that related the authorities’ detention of a group of Wuhan medical doctors’ who had reported the emergence of an unidentified SARS-like virus on WeChat social media. One doctor who was among the group detained in January later posted his story and photo online, and is currently recovering from the disease himself.

Other reports have also confirmed that China was busy cracking down on journalists and social media about the virus in early and mid-January – at a time when more information might have strengthened the early response effort.  A Hong Kong news station said its reporters were approached by police during an interview in a Wuhan hospital in mid-January, and forced to delete their interviews and photographs.

Shanghai sources reached by Health Policy Watch also confirmed that the “government told Chinese citizens not to talk about the outbreak on social media” a couple of weeks ago.

Virus May Have Spread Too Far To Be Squashed Like SARS – Africa At Risk

Speculation was now growing over whether the virus could in fact be contained and effectively eliminated, as was the case with SARS in the 2002-2003 outbreak, or if it might enter permanently into the global chain of viral transmission – at least until a vaccine could be developed.

Already, the number of reported cases has outnumbered those of SARS, which reached 8,000, and also appears to be more insidiously infectious – although SARS still had a higher fatality rate.

And that is not including the asymptomatic cases, which may number as high as 75,000 in Wuhan alone, according to a study published Friday in The Lancet.

African countries, which have a deep and embedded network of links with China may be particularly at risk. Even though so far, no cases had been reported on the continent, several individuals suspected of infections had been quarantined. And asymptomatic cases could be slipping through borders undetected, experts feared.

It was the need to bolster response in low-income countries with weaker health systems and fewer resources was a key consideration in the WHO declaration of a PHEIC on Thursday, Dr Tedros repeatedly emphasized.

Already earlier this week, senior officials from African Union (AU) said screening and surveillance was being enhanced across the continent.

John Nkengasong, the director of African Centre for Diseases Control and Prevention warned that the continent stood at “risk” given its existing links with China at the moment.

“It is very possible that we have cases, but not recognised,” Nkengasong told reporters at the African Union (AU) headquarters in Addis Ababa.

Airports across the continent have increased screening for passengers, even as carriers announced flight cancellations. Kenya Airways halted flights to Guangzhou, backtracking on earlier statements that it would continue to monitor the situation. Ethiopian Airlines has also suspended its flights.

Some African countries were considering evacuating their citizens from the Chinese province – although only Morocco said it would actually evacuate 100 nationals. An estimated 4,600 African students are residing in Hubei Province, ground zero for the rapidly spreading virus.

As the virus struck just before the Chinese Lunar New Year, some students had already travelled back home to Africa before Wuhan and the Hubei region were placed under lockdown. But a large number of students still remain trapped in Hubei.

However so far, no cases have been reported among the returning students. Kenya’s Health Cabinet Secretary, Cecily Kariuki, Ministry of Health confirmed that a student who had been quarantined at Kenyatta National Hospital in Nairobi after returning to Kenya from Wuhan on 28 January was virus-free. Zweli Mkhize, South Africa’s Minister for Health said the country had screened 55 frequent travelers to China at points of entry, all who were found to be virus-free.

“We have remained vigilant on the development regarding the movement and behaviour of the viral infection across the world and we continue to engage with the international academic fraternity to better understand how the virus behaves,” Mkhize told News24.

However, with the climbing reports of confirmed cases, models suggesting tens of thousands more in China, and reports of asymptomatic carriers able to infect others within days, the chances of any country remaining virus-free for much longer were rapidly diminishing.

“Trying to control transmission of a virus like this, an influenza-like virus, is virtually impossible. So you can try to keep it out or minimize its arrival into your area into a very limited degree, but generally it’s going to make its way,” Osterholm told Health Policy Watch.

“In terms of what actions countries and governments can take right now, it’s really preparing their health systems as much as they can. And one of the things to prepare in fact is protection for their healthcare workers.”

Further Actions To Speed Vaccine Trials Announced

Meanwhile, as public health experts looked towards a new vaccine as a potential solution, the Oslo-based Coalition for Epidemic Preparedness (CEPI), announced its fifth collaboration in just a few weeks – to accelerate development of a vaccine against the new coronavirus.

CEPI said that it had signed a collaboration with CureVac AG, a biopharmaceutical company pioneering the field of mRNA-based drugs, aims to “safely advance vaccine candidates into clinical testing as quickly as possible, and would include US $8.3 million from CEPI to fund accelerated vaccine development, manufacturing and clinical tests,” according to a press release.

Rendering of the novel coronavirus, 2019-nCoV, created by the US CDC.

The coronavirus is made up of a single RNA chain enclosed in a spiky, spherical envelope.

Yesterday CEPI also launched a new call for proposals to rapidly develop and manufacture already proven vaccine technology that can be used against the new coronavirus. The call is rolling and open for two weeks.

CEPI also has three other collaborations underway with the Pharma company Inovio, The University of Queensland (Australia) as well as a third partnership involving Moderna, Inc. and the US National Institute of Allergy and Infectious diseases.

Grace Ren and Fredrick Nzwili contributed to this story

Image Credits: Twitter: @Tsinghua_Uni, Nandu News, US Centers for Disease Control and Prevention.

In the face of an escalating crisis over the spread of a novel coronavirus in China, WHO declared an international public health emergency Thursday evening, signalling a new stage in global efforts to contain and control the escalating outbreak.

The announcement came after a week of waiting and debating, which saw the case load of the new virus (2019-nCoV), first discovered in Wuhan, escalate to 7834 victims by Thursday evening, according to numbers released at an evening press conference, including 7736 cases in China and other cases scattered across 18 more countries.  Some 170 of those infected have died and about 20 percent are seriously ill, according to other WHO reports.

WHO Director General Dr Tedros Adhanom Gehebreyesus (left) and Didier Houssin, (right) chair of the WHO Emergency Committee.

In announcing the move, WHO Director General Dr Tedros Adhanom Ghebreyesus, said that China has “already done incredible things to limit the spread of the virus to other countries.” But he said that in countries with “weaker health systems” more support was needed, which a formal WHO declaration of a “public health emergency of international concern” (PHEIC), would help unlock.

“In the past few weeks we have witnessed the emergence of a previously unknown pathogen, which has escalated into an unprecedented outbreak and has been met by an unprecedented response,” said the WHO Director General told journalists.

Dr Tedros commended China for its “extraordinary measures” it has taken to contain the outbreak, saying, “we would have seen many more cases outside of China by now, if it were not for the government efforts, and the progress that they have made to protect their own people and the people of the world.”

“However, we don’t know what sort of damage this virus could do if it were to spread to a country with a weaker health system,” he cautioned. “We must act now to help countries prepare for that possibility.

“The main reason for this declaration is not what is happening in China, but what is happening in other countries; our greatest concern is the potential of the virus to spread to countries with weaker health systems, which are ill prepared to deal with it.”

The WHO Director-General spoke shortly after Finland, India and The Philippines reported their first cases as the virus continued its relentless march across borders – defiant of the draconian lockdown measures imposed by China over 50 million people in the Wuhan epicentre and the wider Hubei province.

Signs of mounting international concern were also evident in moves by countries such as Russia, which closed its eastern border with China, as announced by Prime Minister Mikhail Mishustin, over government-controlled media. A cruise ship with 7,000 people aboard was being held off the shore of Italy after one woman from the autonomous Chinese region of Macao, came down with a suspected case, ABC News reported.  And the US Centres for Disease Control announced the first US case of human-to-human transmission in Chicago.

Despite such moves, as well as the widening array of airlines canceling flights in and out of China, Dr Tedros said that WHO was not recommending further international travel and trade restrictions as a response to the outbreak. “WHO doesn’t recommending trade and movement,” he said.

Didier Houssin, head of the Emergency Committee of expert advisors, said that the expert committee “almost unanimously” recommended that WHO declare a Public Health Emergency of International Concern (PHEIC) over the novel coronavirus under provisions of the WHO International Health Regulations (IHR) at Thursday’s meeting, the third one in a week.

Houssin said that the PHEIC was deemed justified due to the increased number of cases seen in China; the increase in the numbers of countries affected with cases; as well as the fact that “some countries have taken questionable measures against travellers.”

“Thanks to the IHR, our main international health treaty, declaring a Public Health Emergency of International Concern is likely to facilitate a WHO leadership role for public health measures; holding countries to account concerning additional measures they may take regarding travel, trade, quarantine or screening; research efforts; global coordination; anticipation of economic impacts, support to vulnerable states,” said Houssin.

Researchers Race to Develop Vaccine

Meanwhile, researchers were racing to develop a vaccine against the novel virus, dubbed 2019-nCoV – whose spread will soon outpace the 8,000 cases seen in the 2002-03 SARS epidemic.  While less deadly than SARS, so far, the virus had still claimed 170 victims as of Thursday evening, according to a WHO disease outbreak news.

Researchers are racing to find a vaccine for the novel coronavirus, 2019-nCoV; this rendering was created by the US CDC.

At the frontlines of the research effort was the new Oslo-based Coalition for Epidemic Preparedness Innovations (CEPI) – an initiative founded in 2016 in Davos by the governments of Norway and India, the Bill & Melinda Gates Foundation, the Wellcome Trust, and the World Economic Forum.

CEPI had announced last week during the 2020 World Economic Forum that it was funding three different initiatives to develop vaccines against the novel coronavirus. The programmes are in partnership with the Pharma company Inovio, The University of Queensland (Australia) as well as a third partnership involving Moderna, Inc. and the US National Institute of Allergy and Infectious diseases.

A joint WHO-World Bank statement thrust the CEPI efforts once more into the spotlight Thursday. The statement by the Global Preparedness Monitoring Board called upon CEPI and private sector pharma to “use the vaccine research they are supporting for other coronaviruses, such a MERS-CoV, for exploring the development of vaccines against 2019-nCoV.”

Dr. Tedros said Thursday evening that WHO had “invited partners” to discuss the vaccine further and there had already been “progress” that would be discussed further.

Observers say that the novel coronavirus will be the first real-time test case for the Norwegian-based international non-profit initiative, which has recruited US $750 million to prepare vaccines that can counter the threat of new disease outbreaks and pandemics.

CEPI’s CEO Richard Hatchett told the Financial Times that he aims to begin clinical trials on a vaccine for the 2019-nCoV virus within 16 weeks. Hatchett, a former director of the U.S. Biomedical Advanced Research and Development Authority (BARDA), served on the White House Homeland Security Council under President George W. Bush and was a member of the White House National Security Staff under President Barack Obama.

Image Credits: Twitter: @WHO, US Centers for Disease Control and Prevention.

Funding to develop new drugs for some of the world’s leading infectious disease killers, such as HIV/AIDS, TB and malaria, reached a record high of US $4 billion in 2018, with private sector investment driving much of the increase, according to the 2019 G-FINDER Report, which tracks such investments globally.

However, investments in neglected tropical diseases (NTDs) – a subset of debilitating but lesser-known parasitic, viral and bacterial infections – have plateaued in the past two years, and even declined by US $34 million over the last decade, according to the findings in the report, launched today by Australian Policy Cures Research group.

That was sobering news as the global health community celebrated the first-ever World NTD Day, to mark the need for more attention to 20 of the world’s most neglected diseases that affect over 1.5 billion of the world’s poorest and most vulnerable people.

Mixed Signals In Global Trends  

The G-FINDER report is the most comprehensive annual review of trends in investments in neglected disease research, and it is used widely by national governments, industry, civil society, and the World Health Organization to identify gaps in progress and areas where investments need to be increased.

Reactions to the news were mixed, in line with the good and bad news that the report contains.

“Great to see continued donor commitment to malaria R&D—critical, if we are to accelerate progress,” said David Reddy, CEO of Medicines for Malaria Venture (MMV). Malaria along with tuberculosis and HIV/AIDS are among the biggest so-called “neglected diseases.”

But the report also reflects the comparatively low priority that NTDs are receiving, said Nathalie Strub-Wourgaft, director of NTDs at the Drugs for Neglected Diseases Initiative (DNDi). This is despite the fact that such NTDs include some major global health threats such as dengue disease, transmitted by mosquitoes, as well as infections such as leishmaniasis and Chagas that are a cause of debilitating chronic illness and death among the world’s poorest.

“Flatlined funding for NTDs is proof that the world is not paying enough attention to the biomedical needs of the most vulnerable,” Strub-Wourgaft said. “It will be impossible to alleviate poverty, or achieve gender equity, quality universal health coverage, or any of the other Sustainable Development Goals (SDGs) without urgent course correction, and increased, sustained investment in R&D for NTDs.”

A man with symptoms of the deadly NTD, African trypanosomiasis (sleeping sickness), is examined by Dr Victor Kande in the Democratic Republic of Congo (DRC). Kande was principle investigator for clinical trials of fexinidazole, the first oral treatment approved by the European Medicines Agency (EMA) in 2018. Developed by DNDi,  it is being rolled out in  DRC.

The G-FINDER report tracks investments across 36 diseases including HIV/AIDS, tuberculosis, and malaria – which together represent the world’s biggest infectious disease killers. The so-called “big three” received a whopping US $2.7 billion in R&D investments in 2018, representing more than two-thirds of the total investments in neglected diseases.

The latter third of R&D investment was split between the remaining 33 diseases. Funding for the 20 diseases categorized by the World Health Organization as NTDs plateaued or even fell. Investment in disfiguring and painful skin diseases such as leprosy, cryptococcal meningitis, and Buruli ulcer dropped “across-the-board.” Trachoma, the leading cause of blindness caused by the common bacteria Chlamydia trachomatis, also saw decreases in R&D funding, along with cryptococcal meningitis, leptospirosis, and rheumatic fever.

Dengue, a WHO-categorized NTD listed as one of the top ten threats to global health in 2019, saw a funding drop of $3.6 million in 2018 – once again the largest decrease in funding for a single disease for at least two years in a row.

Overall, the report notes “the extremely small quantum of funding these diseases receive” overall. It states that “there is little chance of meaningful progress in developing missing tools – especially drugs and vaccines – when total global investment in some of these diseases is just $2 million annually.”

On a brighter note, while NTD research financing remains dominated by public sector sources, industry investments seem to be slowly increasing. According to the report, some US $57 million of the growth in multinational pharma companies’ investments went to diseases outside of the “big three.”

“I am pleased to see that investment by multinational pharmaceutical companies reached its highest-ever level last year. However, we are far from having all the tools we need to control and eliminate NTDs,” said Thomas Cueni, director general of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), in a press release.

“‘Collaboration” is the watchword: cross-sectoral cooperation and public-private partnerships are more important than ever if we want to further catalyze innovation, harness the power of science and technology, and help unlock new ways of reaching a world free of NTDs,” Cueni said.

Funding trends for neglected diseases and NTDs, as reported by G-Finder

Late Stage R&D Also Gets More Funding   

Investment by public and philanthropic, as well as the private sector, all reached record highs in 2018, according to the report, although contributions varied by country and organization.

Particularly significant was the positive trend in investments for critical late-stage drug development, including clinical trials and post-registration studies, filling a historical gap in the last steps that are usually required to bring novel treatments to patients.

Funding for clinical development and post-registration studies reached a record high of US $1.4 billion in 2018, increasing by US $198 million. Much of the progress was driven by industry investment, which reached a record high of US $694 million in 2018.

High-income countries represented the lion’s share of the US $2.6 billion in funding reported by the public sector, with all three of the largest public donors moderately increasing their investments. The United States made the biggest investment in R&D at US $1.78 billion, although the recorded increase in funding was also partly attributable to improved reporting by the US National Institutes of Health. The second largest donors were, once again, the United Kingdom and the European Commission, providing some US $230 million and US $134 million respectively.

Japan, Australia, and Brazil also upped their financing for neglected diseases, although France and The Netherlands both reduced funding by about US $9.1 million. Two of the largest lower-middle income donors – India and South Africa – also reduced their contributions by US $9.4 million and US $1.9 million respectively.

Philanthropic funding for neglected disease R&D totaled US $760 million in 2018, an increase of US $43 million, reaching its highest level in a decade. The two historically largest donors – The Bill and Melinda Gates Foundation and The Wellcome Trust – jointly accounted for 93% of such contributions. Both organizations also increased their funding in 2018: the Gates Foundation by US $36 million and the Wellcome Trust by US $11 million.

World NTD Day 

Meanwhile, more than 250 public and private sector groups marked 30 January as the first World NTD Day, devoted to raising awareness of the world’s most neglected diseases.

While important new treatments have recently come on line for some NTDs, such as sleeping sickness, as well as Chagas disease and leishmaniasis, NTDs continue to be responsible for thousands of preventable deaths each year.

NTDs also cause physical impairments that perpetuate the cycle of poverty by keeping millions of adults out of work and children out of school, costing developing economies billions of dollars each year, organizers of NTD events, led by Abu Dhabi, noted in a press release. Despite their prevalence, NTDs have not always been at the top of public health priorities, advocates say. World NTD Day aims to engage the general public in the effort to ensure people at risk for NTDs no longer remain “neglected”.

“World NTD Day will raise awareness and rally the general public behind the urgent need to end NTDs, helping to keep the issue high on the global agenda. Our commitment to ending NTDs is not just about disease elimination. By removing the barrier of disease, we can help alleviate poverty and uplift entire generations,” said Mohamed Mubarak Al Mazrouei, Undersecretary of the Crown Prince Court of Abu Dhabi, which sponsored the first-ever World NTD events, in the press release.

The date of January 30th was chosen for the first-ever global event, as it is also the anniversary of a landmark 2012 London Declaration on NTDs, which unified partners, countries and disease communities to push for greater action on ten of the highest-priority NTDs. Organizers say that 2020 will be a decisive year for the advancement of NTD eradication. This year, the World Health Organisation is expected to launch a new NTD strategy, including roadmap and goals for 2030.

 

Image Credits: DNDi, G-Finder .

With some 4.2 million deaths worldwide from outdoor air pollution, and many or most cities in low- and middle-income countries failing to meet World Health Organization air quality guidelines, it’s clear that reducing air pollution’s huge death toll needs rapid action by urban centers. But officials and administrators of fast-growing municipalities often lack the right tools for tackling air pollution.

A new guide, “Accelerating City Progress on Clean Air: Innovation and Action Guide,” aims to fill that gap – fast-tracking strategies and solutions. The guide was launched Wednesday at the World Sustainable Development Summit in New Delhi, by the Delhi-based Energy and Resources Institute (TERI), Bloomberg Philanthropies and Vital Strategies.

The publication provides a step-by-step approach for city governments to take action on air quality beginning with effectively monitoring air quality, assessing emissions and sources; expanding data access and use; and engaging governments and partners to develop and implement action plans.

Smog over the city of Delhi

The launch of the report in Delhi was particularly significant, in light of the air pollution emergency experienced in the city last month, said Dr Sarath Guttikunda, a lead contributor to the guide and head of the Indian-based non-profit group, urbanemissions.info, a leading repository of air quality information in India and the region.

He was referring to the period when the city was covered with haze created by a combination of emissions from regional crop burning, industry, transport and waste-burning, which became trapped in the city due to seasonal weather conditions. At times, the city’s air pollution levels exceeded what monitoring equipment could record.

“Unless India urgently adopts long-term strategies to address air pollution effectively, we are doomed to repeat the associated health crisis of this past season year after year,” Guttikunda said. “This guide identifies recent data and resources that each city can use to address their challenges, both shared and unique, and make rapid progress. Poor air quality shouldn’t drive us indoors, depriving us of a full life of opportunity, productivity and health. This is a solvable problem, and I urge cities to use this guide to commit to action today.”

The guide is focused around four stages of activity deemed critical to identifying air pollution sources and addressing them. These include:

  • Monitoring air quality, including with the use innovative low-cost approaches;
  • Assessing emissions and leading sources – which typically include transport, power production, industry, waste and biomass burning – but may vary in priority from city to city;
  • Creating and using open data sources about air pollution emissions;
  • Catalyzing action by government and other stakeholders.

The guide draws on lessons learned from successful urban clean air initiatives including New York City, Beijing, Bangkok and Hong Kong. For example, interventions by New York City and the New York state government saw a 70% reduction in sulphur dioxide levels in just five years.

Best practices and progress from cities in early phases of developing air quality management plans, such as Battambang, Cambodia and Accra, Ghana are also highlighted. In addition, the guide addresses the roles of cities in regional, state and national policy and implementation.

Ambient PM2.5 concentrations (left) and mortality attributable to ambient PM2.5 (right) by region

“Cities, centers of creative governance, intellectual and civic life, are also home to growing civil society movements pressing for clean air and other environmental improvements,” said Daniel Kass, Senior Vice President for Environmental Health at Vital Strategies, which has a growing programme on air pollution and health. “The guide can help local governments respond to these demands with good science, logical planning and inclusive and transparent action. Each year, air pollution takes a huge public health toll and more children experience harm that can affect their future health and productivity. City governments can be powerful agents of change that speeds progress towards clean and healthy air for all.”

“Air pollution has constant, adverse repercussions on communities around the globe, and we must act now to mitigate its effects,” said Ailun Yang, head of global air pollution programs at Bloomberg Philanthropies. “By helping cities identify feasible, near-term solutions, this guide will empower governments to quickly build more sustainable, comprehensive clean air management plans at the local, national and regional level. Cities are hubs of innovation and ingenuity, and by making faster progress on clean air goals, they can lead the way in improving lives.”

 

 

Image Credits: Flickr/Jean-Etienne Minh-Duy Poirrier, Accelerating City Progress on Clean Air: Innovation and Action Guide/Vital Strategies.

The World Health Organization is set to reconsider a declaration of an international public health emergency over the novel coronavirus discovered in Wuhan – as the number of confirmed cases soared to 6086, the death toll to 132, and infections were reported in 15 other countries.

WHO announced that it would reconvene its Emergency Committee on Thursday to reconsider an announcement of a “Public Health Emergency of International Concern” (PHEIC) over the outbreak– just a few days after experts had deferred such a move saying “it was too soon.”

Momentum was clearly building towards a PHEIC announcement now, as the case load approached that of the 2002-2003 SARS epidemic. While not as deadly as SARS, the new coronavirus, dubbed 2019-nCoV, appears capable of being transmitted between people even before symptoms appear.

Citizens of Wuhan lining up outside a drugstore to buy masks

“Not sure what @WHO is waiting for….not acting now will not age well,” tweeted Florian Krammer, a professor of microbiology at Mount Sinai School of Medicine in New York City. “This is a PHEIC. We are all China at this moment.”

“It’s PHEIC time,” tweeted Ian Mackay, another respected infectious disease researcher.

“@WHO is monitoring the new #coronavirus outbreak every moment of every day…. We will have more news following tomorrow’s Emergency Committee meeting,” tweeted Dr Tedros Adhanom Ghebreyesus after returning from Beijing today with the head of WHO’s Emergencies Department, Mike Ryan.

“The decision to reconvene the committee is based on the evidence of the increasing number of cases, [and] human to human transmission that has occurred outside of China,” said Ryan,  in a press conference convened Wednesday evening. Ryan described the outbreak as one “of grave concern”  but also praised China for “doing the right things” and said that the outbreak has “spurred countries to action.”

“The whole world must be on alert right now,” said Ryan.

Dr Tedros, however, added that the Emergency Committee was also considering a new “traffic-light” approach for declaring a PHEIC in the wake of the advisory committee’s 50-50 stalemate last week over whether to declare an emergency over the outbreak at that point.

“Right now the PHEIC declaration is either ‘yes’ or ‘no’ – green or red,” Dr Tedros told journalists. “It would be good to have the green, the yellow, or the red. We need to have something in between; we are considering that. I think the traffic light approach will help, so the yellow would be a warning, something that shows that it is quite serious, but not totally red.”

There has also been speculation, however, that WHO has been reluctant to declare an emergency as long as Chinese authorities, who want to be seen as in control of the emergency response, were opposed to such a move.

Latest Developments

However, while the case load remains heavily concentrated in China, the novel virus was also increasingly spilling over international borders. According to confirmed reports, the new virus, believed to have jumped from an infected wild animal to people visiting, or working in, a Wuhan market, has now spread to 15 countries in Asia, Europe, North America and the Middle East. Most of those infected, however, had recently returned from Wuhan, and no deaths have been reported among the victims abroad.

Confirmed cases were highest in Thailand (14), Singapore (10), Malaysia, Japan and Australia (7 each); followed by the United States (5); France, Korea and Germany (4 each); and including Japan Korea, Thailand and Singapore in Asia; Canada (3) Vietnam (2) and Nepal, Cambodia, Sri Lanka and the United Arab Emirates (1 each).

Novel Coronavirus (2019-nCoV) Global Cases as of 28 January 2020 at 11pm EST, collected by Johns Hopkins Center for Systems Science and Engineering

While exacting a lower fatality rate than the infamous SARS epidemic of 2002-2003,  the coronavirus appeared to be leaving about 17% of peple with confirmed cases seriously ill, according to the latest official Chinese government case data.

Unlike SARS, however, the virus may be infectious even before people began showing symptoms – and thus with great potential to spread silently to unknowing contacts. But it is too early to determine whether so-called “asymptomatic transmission” is a large risk in this outbreak, Ryan told reporters at Wednesday’s press conference.

Maria Van Kerkhove, WHO’s head of Emerging Diseases, said that there was evidence of so-called “fourth generation” infections inside Wuhan, a city of 10 million people, where the outbreak first began around the beginning of January. This means that a person originally infected by an animal source transmitted the virus to another person, who passed it on to another person, who then infected someone else.

Van Kerkhove added that second generation infections had been seen elsewhere in China, and in limited cases outside of the country as well.

Approximately 99% of the cases remain concentrated in China, along with all 132 deaths, with the majority  majority concentrated in Hubei Province.

Dr Tedros said disease control efforts thus need to focus “on the epicentre” in Wuhan and the province of Hubei – as the “most effective” way to quash an outbreak.

Like Ryan, he praised the response of Chinese authorities so far, saying, “the fact that we have only seen 68 cases outside of China has shown… its actions have helped prevent it from spreading to the rest of the world.”

Still, the few reports of human-to-human transmission in other countries including in Germany and Japan, clearly have disease control experts worried.

The greatest fear is that human to human transmission of the virus might be sustained in a country with a “weaker” health system, with less capacity to enact strict public health and infection prevention measures, the WHO officials said.

Ryan emphasized the importance of reinforcing countries’ “preparedness” efforts, saying those with “fragile” health systems, may also need help containing the transmission of the virus.

“We don’t see many media coming to press conferences about preparedness,” Ryan quipped. “Maybe that’s part of the problem.”

Countries Evacuate Ex-Pats & Airlines Suspend Flights as Wuhan Digs in for Seige

Multiple airlines had, meanwhile, suspended flights in and out of mainland China; foreign nationals evacuated from the epidemic’s epicentre were being placed in isolation, and Wuhan was laying down the foundations of two new hospitals to deal with the overwhelming influx of coronavirus patients.

Three carriers, British Air, Lufthansa and United, announced Wednesday that they were temporarily suspending flights into the mainland, although flights in and out of Hong Kong continued. American Airlines canceled some flights to mainland China.

Multiple countries were in the process of evacuating their foreign nationals. California-bound American passengers were being rerouted to Anchorage, Alaska for health checks, before landing at an air base in California, ABC News reported. British officials said that evacuated nations should be “safely isolated” for 14 days, The Guardian reported.

Australia is taking precautions one step further, quarantining evacuees offshore on Christmas Island for 14 days before allowing Australian ex-pats to return to the mainland. Japan, South Korea, the Philippines are among the other countries planning to evacuate expats.

In Wuhan, meanwhile, social media reports from citizens were lamenting the overwhelmed hospital systems. One Wuhan reporter tweeted that patients were waiting hours in the hospital for diagnosis due to a shortage of testing kits.

Two makeshift hospitals with a total capacity about 2,600 beds were frantically under construction. Some 1905 are reported ill in the capital of Hubei province, with more infections expected to be reported daily. The first, the Huoshenshan hospital, with an area of 25,000 square meters and capacity for 700 to 1,000 beds, is expected to be put into use by next Monday.  The second hospital, Leishenshan is expected to be operating by next Wednesday. Chinese social media was rife with livestream reports of the rapid hospital construction, which Chinese authorities see as a test of their capacity to combat the disease.

US Secretary of Health and Human Services Alex Azar told journalists that the US had offered to send a group of experts to China to support the response, although China had not so far responded. “We’re urging China: More cooperation and transparency are the most important steps you can take for a more effective response,” Azar told the press conference.

Meanwhile, WHO will assemble an international team of “the best minds in the world” to explore different dimensions of the response effort along with Chinese experts, Dr Tedros told journalists Wednesday evening.  And that is apparently an offer that Beijing will not refuse.

 

Grace Ren contributed to this story

Image Credits: China News Service／中国新闻网, John's Hopkins CSSE.

Cases of the novel coronavirus first discovered in Wuhan, China nearly doubled again in a day jumping from 2585 confirmed cases Monday to 4515 cases and 106 deaths as of Tuesday morning. As the numbers climbed, countries around the world planned to evacuate citizens in the quarantined city of Wuhan – the epicentre of the outbreak.

The alarming surge in numbers reported by the Chinese National Health Commission (NHC) echoed Chinese Minister of the NHC Ma Xiaowei’s warning in a press conference Sunday that the world had likely “not yet seen the peak of the epidemic,” just days after the World Health Organization’s Emergency Committee decided not to declare the outbreak a “public health emergency of international concern.”

Dr Tedros (left) and Xi Jinping

Following a meeting with Chinese President Xi Jinping Monday, the World Health Organization’s Director-General Dr Tedros Adhanom Ghebreyesus said that “stopping the spread of this virus both in China and globally is WHO’s highest priority.”

WHO praised China’s swift public health response and agreed on further collaboration, but did mention whether the Emergency Committee will reconvene in the near future in the press release.

Meanwhile, as China expanded its travel restrictions and the Lunar New Year holiday in an effort to contain the outbreak, a number of countries have mobilized to evacuate expats stuck in Wuhan. The European Commission is sending two planes to repatriate citizens from the Wuhan area to Europe, following a request from France that activated the EU Civil Protection Mechanism. Other countries such as the United States, Japan, and South Korea, have also announced plans to evacuate citizens from Wuhan in the coming days.

Most of the countries that have announced intentions to evacuate citizens from Wuhan will also be requesting evacuees to then quarantine themselves at home for up to 14 days – the suspected maximum incubation period of the virus. Researchers in China and at the World Health Organization have confirmed that the disease can spread from person-to-person through a respiratory route – likely through droplets sprayed by sneezes or coughs. WHO Scientist Maria Van Kerkhove said in a Live:Q&A that there had also been rare case reports of people transmitting the virus before showing symptoms of the disease themselves.

Despite strong evidence of human-to-human transmission in China, only one confirmed case of person-to-person infection has occurred outside of China so far, in Viet Nam. The other 36 confirmed cases outside China all had travel history to Wuhan.

Van Kerkhove said that those most at risk are family and friends in close contact with an infected person. The exact reproductive number – or the number of susceptible people one infected person is likely to infect – is still unknown, although researchers have given estimates ranging between 2.0 – 6.0.

Most of the infections have been in adults, although cases have been recorded in children as young as 2 years old. Those at highest risk of infection and severe disease are elderly people with pre-existing health conditions as stated by WHO. The current case-fatality rate remains around 2-3%, less deadly than other viruses in the same family such as severe acute respiratory syndrome (SARS) and Middle-Eastern respiratory syndrome (MERS).