Qatar’s Dr Hanan Al Kuwari, chair of the WHO executive board.

The African region is accelerating the implementation of the global roadmap for neglected tropical diseases (NTDs), and 10 countries have eliminated at least one NTD since 2021, Dr Matshidiso Moeti, World Health Organization (WHO) regional director for Africa told the body’s executive board last week.

Togo eliminated four NTD, while Egypt eliminated lymphatic filariasis and trachoma has ceased to be a public health problem in Morocco. Moreover, 42 countries in the region will also be certified free of guinea worm disease before 2025, said Moeti.

The countries were guided both by the WHO global framework and using the Africa region’s Framework for the Integrated Control, Elimination and Eradication of Tropical and Vector-borne Diseases in the African Region  for 2022 to 2030.

“The strides made by the WHO African region and other WHO regions result from strong country leadership and effective partnerships,” said Moeti. 

She emphasised the role of the expanded special project for the elimination of neglected tropical diseases (ESPEN), which enabled countries to pool resources and work closely with the global NTDs community. She urged the board to sustain ESPEN’s funding in order to expand its successes as the region moves to the last miles of NTD elimination. 

“We must maintain and accelerate our progress by sustaining political commitment, enhancing multisectoral actions through effective partnerships and mobilising additional domestic and international funding to achieve the NTD roadmap goals,” Moeti concluded.

The roadmap sets global targets and milestones to prevent, control, eliminate or eradicate 20 diseases and disease groups as well as cross-cutting targets aligned with the Sustainable Development Goals. It is based on three foundational pillars: accelerated programmatic action, intensified cross-cutting approaches, and changing operating models and culture to facilitate country ownership.

Appeal for flexible funds

Senegal expressed its commitment to align with the roadmap “to speed up efforts in prevention, control, and elimination of NTDs”, and urged the WHO to increase flexible funding for NTDs within Universal Health Coverage (UHC) efforts, emphasising the need for collaboration and domestic funding.

Cameroon, aligning with previous statements, praised the WHO’s roadmap and emphasised its commitment to national plans for NTDs. The country outlined specific goals for 2024-2028, including the interruption of Guinea worm disease and leprosy transmission. Cameroon highlighted the need for cross-sectoral collaboration, calling for mobilisation of human resources and domestic financing.

Meanwhile, Germany reiterated its dedication to the fight against NTDs, emphasising the Kigali Declaration on NTDs. Germany dwelt on improving access to quality health services, expanding water, sanitation, and hygiene initiatives, and investing in social security. 

The United States called for internal reforms within WHO to strengthen NTD programs and ensure accountability, transparency, and equity.

Non-state actor the Global Health Council (GHC) called for improved access to new drugs for NTD and better diagnosis ,as central to accelerating progress and meeting the goals of the roadmap.

“We call on member states to sustain and expand investments to accelerate R&D of safe and affordable treatments for NTDs and improved diagnostics, particularly for NTDs with specific unmet needs for use in primary healthcare settings,” the GHC said.

To accelerate market access for diagnostics, it recommended the exploration of regulatory and manufacturing pathways by the WHO and member states, to facilitate simultaneous or aligned prequalification and regulatory approval processes.

While highlighting the inextricable link of NTDs to poverty and inequality, it noted that the increased attention in recent years has brought new resources to the fight against NTDs and fuelled research breakthroughs.

“Yet very significant gaps remain in the arsenal of tools needed to control and eliminate these diseases, underscoring the need for research and development (R&D) of new tools,” it noted. 

Injecting new urgency into the fight against AMR

Member States also discussed antimicrobial resistance (AMR), which they framed as a growing and existential threat that hasn’t seen the sustained political attention it demands. 

The need for new actions is further supported by the WHO’s global action plan on antimicrobial resistance which is coming to an end in 2025.

Germany expressed its support for the WHO’s global AMR initiative and emphasised collaboration with academia, the private sector, and civil society. They asked that attention be on increasing investment and innovation in quality-assured, priority,  new and improved antimicrobials, novel compounds, diagnostics, vaccines, and other health technologies to fight AMR.

Morocco, speaking on behalf of the Eastern Mediterranean region, emphasised the diverse challenges faced by countries in the region. The representative stressed the importance of adapting responses to the varied contexts, emphasising the need for a coordinated, cross-cutting approach. They advocated for strengthening health systems, particularly in vulnerable and conflict-affected areas, and urged action beyond hospitals to include primary care, emergency, and public health programs.

“We believe that in our region, we have a very diverse picture. Therefore, in our response to AMR, we have to ensure that it is adapted to these different contexts if it is to be effective,” said the Moroccan representative.

Second UN high-level meeting on AMR

The US supported the continuation of AMR as a priority for the WHO, especially as the world prepares for the second UN General Assembly high-level meeting on AMR in September.

“We urge WHO to be fully inclusive of all partners, including Taiwan, and support Taiwan’s participation as an observer to the World Health Assembly, truly embodying the meaning of health for all,” said the U.S. representative.

Japan emphasised the importance of political momentum in addressing AMR and called for strategic allocation of resources at the national level. The Japanese representative highlighted the need for international collaboration, citing the example of Taiwan’s significant public health achievements. Japan pledged support for the implementation of National Action Plans on AMR in collaboration with the WHO and member states.

“In the September second UN high-level meeting on AMR, we have a good opportunity to increase the political momentum for countermeasures. The Government of Japan would like to contribute to promoting the implementation of the National Action Plan on AMR,” stated the Japanese representative.

Rwanda, speaking on behalf of the WHO Africa region, emphasised the urgent need to accelerate the implementation of national action plans on AMR and acknowledged progress made by member states in developing these plans.

“We take note of the report and call for effective implementation of all strategic and operational priorities by all members and stakeholders,” said the African region representative.

Problems with national AMR plans

According to the WHO DG’s report on AMR, while 178 countries had developed multi-sectoral national action plans on AMR as at November 2023, only 27% of countries reported implementing their national action plans effectively and only 11% had allocated national budgets to do so. He also fragmented implementation of national action plans in the human health sector, which he observed is often limited to hospitals, despite the vast majority of antibiotic use being outside hospitals. 

“Capacity to prevent, diagnose and treat bacterial infections and drug resistance, and the evidence base for policy development, are very limited in low- and middle-income countries. The integration of antimicrobial resistance interventions in health systems, and inter-dependencies with other health systems capacities and priorities, are often not recognized in strategies for universal health coverage or health emergencies,” the DG reported.

He proposed three urgent strategic priorities for a comprehensive public health response to antimicrobial resistance in the human health sector, notably surveillance of both antimicrobial resistance and antimicrobial consumption; the development of new vaccines, diagnostics and antimicrobial agents; and measures to make these accessible and affordable.

 

Somalia is leading development of new WHA decision that aims to tackle persistently high rates of maternal, newborn and early childhood mortality.

WHO’s director general says the battle against maternal mortality has stalled; Somalia calls for a new WHA resolution committing to stepped-up action on maternal and child deaths, a leading global health inequality. 

The battle against maternal mortality has stagnated and high rates of deaths continue to plague sub-Saharan Africa, as well as other low- and middle-income nations, said World Health Organization (WHO) Director-General Dr. Tedros Adhanom Ghebreyesus on Friday. 

“Progress has stalled, and still, a woman dies every two minutes,” he stated.

He was referring to a bleak report from February 2023 showing the world is far off track for achieving Sustainable Development Goal (SDG) target 3.1 for reducing maternal deaths to less than 70 per 100,000 live births. 

As of 2020, there was an average of 223 deaths of mothers per live births and in sub-Saharan Africa the death rate was 536 per 100,000 live births, according to the UN inter-agency report.

Friday’s debate at the WHO Executive Board meeting revolved around a draft World Health Assembly (WHA) decision led by Somalia for consideration at the upcoming WHA in May (WHA77). It is aimed at addressing the stark global disparities in maternal, newborn and child health that persist, falling far short of the targets set out in the 2030 Sustainable Development Goal targets on reducing maternal mortality (SDG 3.1) and ending preventable deaths of newborns and children under five years of age ( SDG 3.2). 

Opening the discussion, Somalia's representative painted a vivid picture of the leading factors, which are deeply rooted in health inequalities between high- and low-income countries. 

"The tragedy of this statistic is that most of these deaths in mothers and their children are preventable or treatable with known effective interventions," he lamented.

“We know that 70% of maternal deaths are due to direct obstetric causes,” he said, reciting a list of factors including hypertension, sepsis, abortion and embolism.  

Health system bottlenecks, including cost and capacity constraints, are responsible for an estimated 30% of deaths, he said.

 “We are deeply concerned by these preventable tragedies," he added. “The intent of the resolution is to galvanise action on the direct costs of maternal and child mortality, and also to propose interventions to address the root causes.”   

Adding to the discussion, Afghanistan's representative highlighted the unprecedented challenges faced by the nation. Political turmoil, economic collapse and restrictive Taliban policies have created barriers to essential healthcare services, particularly affecting women.

"The lives and well-being of millions of Afghan women and children hang in the balance. We cannot remain passive observers in the face of such a humanitarian crisis," urged Afghanistan's representative.

Many countries are off track

A draft decision was proposed by Egypt, Ethiopia, Paraguay, Somalia, South Africa and United Republic of Tanzania to accelerate progress towards reducing maternal, newborn and child mortality in order to achieve SDG target 3.1 and SDG target 3.2 after data was shared that showed it is likley that more than four out of five countries (80%) will not achieve their national maternal mortality targets, 63 countries will miss their neonatal mortality targets and 54 countries will miss the under-five mortality target by 2030.

The draft decision called for focused, urgent and coordinated course-correcting, and country-led action for maternal, newborn and child survival.

According to the DG’s report, there is ample evidence on effective interventions to monitor and improve the health and well-being of women and children. He noted that multiple strategies have been developed that incorporate this evidence so as to support countries in identifying the high-impact interventions that should be included in their national health sector plans. 

These strategies include the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016−2030); Ending Preventable Maternal Mortality; Every Newborn Action Plan; the Roadmap to Combat Postpartum Haemorrhage between 2023 and 2030; the Child Survival Action call; and the Global Accelerated Action for the Health of Adolescents initiative. 

He noted that countries that are off track from reaching 2030 maternal and child mortality targets could accelerate progress toward national and global health targets by adopting such strategies and implementing them at scale.

Global Support and Urgency

A wide range of countries, from the United States to Ethiopia, speaking on behalf of the WHO African Region, voiced strong support.

 The United States voiced its unwavering support for the resolution, emphasising strategic approaches to reduce preventable maternal, newborn and child deaths. 

"We recognize that ending preventable maternal newborn and child deaths is critical to achieving universal health coverage and the promise of the SDGs," stated the U.S. representative. 

“There is strong consensus among many member states around several strategic approaches to accelerate progress by expanding coverage and equitable access to an integrated package of:  

  • High quality essential health and nutrition services for women and children. These approaches include first, reinvigorating country leadership and commitment to accelerate progress on this crucial unfinished agenda.
  • Second, adopting a multi pronged approach to maximize investing resources and attract reclaiming and third, aligning and reorienting our investments to strengthen primary healthcare delivery capacity.
  • Finally, prioritizing the hardest to reach the poorest remotest and historically marginalized communities."

Other member states echoed those messages, calling for intensified technical assistance to catch up after years of progress lost, including during the COVID pandemic.

“We are extremely alarmed about being off track with targets,” said Ethiopia, on behalf of the African Region of the WHO, which includes 47 Sub-Saharan African member states. Countries in the regions are also “still struggling” with the legacy of the COVID-19 pandemic, including a present-day shortage of healthcare workers and a socio-economic crises. 

Gender equality and universal access to sexual and reproductive health services

Germany, Norway and others call for universal access to reproductive and sexual health services as key to reductions in maternal mortality.

While the proposed resolution, designed to galvanise global action, could be adopted during the next WHA, some key portions of the draft text, remains in [brackets] - signaling a lack of member state agreement. Notably, these paragraphs revolve around gender equality; empowerment of women and girls; and access to sexual and reproductive health services  - reflecting their political sensitivity for many member states.   

Even so, Germany, Norway and Australia, as well as a range of non-state actors, underlined the importance of women and girls' education as well as "universal" access to sexual and reproductive health services as critical to reducing maternal mortality. 

“Access to sexual and reproductive health and rights including access to free and safe abortion is crucial. Women's rights to bodily autonomy is an essential part of achieving maternal health,” said Norway. “We find it encouraging that levels of adolescent pregnancy and childbearing have declined, but the fact that that 1.5 out of 1,000 young girls give birth before their 15th birthday is still far too many.” 

WHO commends decries stark statistics

WHO's Bruce Aylward decries the stark disparities between rich and poor countries in maternal, newborn and child mortality at WHO EB 154

Dr Bruce Aylward, Assistant Director-General, Universal Health Coverage, Life Course, commended Somalia for reigniting the conversation about a crucial yet alarming global issue, but he expressed concern for the challenges ahead.

"We keep talking about this as these are preventable deaths, and indeed they are, but sometimes that sounds like well, this is an easy problem to solve," Aylward said. "And again, as we've heard, this is a very difficult problem to solve."

He noted the uphill battle against systemic challenges like workforce shortages, out-of-pocket payments, and inadequate infrastructure.

Tedros - ‘stay hopeful’ 

"While there are huge barriers, there has been some very rapid progress in countries where the political will was actually there, both to reorient their systems toward a primary health care approach, and to make the reduction of maternal mortality a national priority," Aylward stated. 

Tedros stressed the need for tailored measures: "The progress is not there, and the recent report from February 2023 is showing that we are off track, and chances to achieve the SDGs are actually dwindling. But still, I think we need to stay hopeful and we should believe that we can achieve it, especially if we do the right things," he asserted.

He called for political will and commitment from every country: "But as we have said when we presented the DPW 14 maternal and child health, that will be one of the top priorities, and we hope together to make a difference and achieve the SDGs by 2030."

As the session concluded, Dr. Tedros highlighted the board's readiness to proceed with the report and draft decision, signifying the collective acknowledgment of the urgent need to accelerate progress in reducing maternal, newborn and child mortality.

Image Credits: UN, World Bank .

New WHO initiatives on climate and plastics follow on from a first-ever Health Day at a UN climate summit (COP28) in December 2023 in Dubai.

A first-ever WHO initiative to join global negotiations on a plastics treaty, as well as the first WHO decision on climate and health since 2008, are set to come before the World Health Assembly in May, following a strong show of member state support for both measures on the closing day of this week’s Executive Board meeting in Geneva. 

The draft decision on climate change and health, led by eight member states, including Peru, Kenya, the United Arab Emirates and the United Kingdom, reflects the wealth of new evidence on the linkages between climate and health that have come to light over the past 16 years. The draft includes an estimated 5% contribution of the health sector to climate emissions, although that data also remains bracketed leaving in question if it will be included in the final draft. 

With regards to a treaty on plastics pollution, currently being negotiated under the leadership of the UN Environment Programme (UNEP), WHO told EB members that it wants to address health aspects of that long-neglected agenda in the context of the plastic treaty negotiations.  

Plastic waste is contaminating air, land and water resources, and the food chain, with potential health harms, experts have warned.

It proposes that the agency provide formal health-related inputs into the new treaty instrument, including about particularly hazardous plastics or polymers that should be phased out, as well as playing an active role in a UN science-policy panel on plastics pollution. 

Both the climate and the plastics initiatives appeared to garner wide support from the 34-member Executive Board, as well as member states observing the proceedings from across the Americas, Europe, Asia and Africa.

“We support the WHO to take a more active role in global chemicals management to protect human health,” including inputs to the plastics treaty now being negotiated on “the importance of the issue of plastic pollution, chemicals and microplastics and potential harmful implications” to health,” said  Switzerland, speaking on behalf of nine member states, including Canada, Colombia, Costa Rica, Excuador, El Salvador, Mexico,Panama and Norway. 

One member state, Russia, however, voiced strong objections to the twin initiatives. Climate change is already a part of WHO’s programmes; addressing the health issues related to plastics pollution goes beyond WHO’s mandate, Russia’s representative to the EB said. 

Civil society complains about lack of reference to fossil fuels  

Maldives delegate links tobacco and plastics pollution.

At the same time, a range of non-state actors rapped the WHO member states for failing to even refer to “fossil fuels” as a driver of climate change in the draft climate and health decision, with one NGO suggesting that WHO should treat fossil fuels like tobacco.

“We urge member states to take a stand against the fossil fuel industry and its influence as done with the tobacco industry,” said one NGO, Public Services International. The agency’s remarks were echoed by at least three other civil society groups but by few member states.

The NCD Alliance asked member states to incorporate language in the draft decision “calling for reductions in fossil fuel use as the most significant driver of climate change and air pollution.” 

Responding to those remarks, WHO Director General Dr Tedros Adhanom Ghebreyesus, described fossil fuel phase out as “crucial.”  But he stopped short of explicitly asking that such a reference be included in the draft decision being negotiated.  

“What was agreed during the COP28, the phase out of fossil fuels is very, very crucial,” Tedros said. “And that’s not without reason, because fossil fuels contribute more than 70% of greenhouse gas emissions – fossil fuels, meaning oil, natural gas and coal. 

“So that’s where the focus should be in order to get the 1.5 degrees centigrade [ceiling of global warming]. That was already agreed. So thank you so much for underlining the importance of focusing on fossil fuels, and as many of you have rightly said, there is a good reason to do that.” 

With respect to tobacco and fossil fuels, the Maldives highlighted the inter-linkages between the issues in more than just rhetoric. 

“The huge amount of plastic waste produced by the tobacco industry, some of which are disposed with their deadly chemical content, must be addressed in this treaty in a way that does not allow the tobacco industry to greenwash their tactics.” stated the Maldives delegate, commending WHO for its “comprehensive and … focused approach in supporting vulnerable nations” on both climate and plastics pollution. 

Tame, but still urging a more proactive stance  

 

Dr Tedros Adhanom Ghebreyesus has strong words about fossil fuel phase-out but member states avoid issue in draft WHA decision.

Indeed, the new WHA initiatives create a much broader scope for action on interlinked climate and plastic pollution issues, even if the framing and terms used reflect delicate balance of member state interests and the organization’s inherent political conservative. 

Some 20% of fossil fuels production eventually winds up as plastics products, highlighting the synergies that exist between unsustainable energy production and unsustainable  consumption and disposal of plastics products.  

WHO’s 2008 resolution on climate and health focused only on a very brief, discrete set of issues related largely to health “vulnerability” to climate change and “adaptation” measures the health sector could promote. The new draft decision carves out new territory, even if hesitantly, urging health actors and health systems to play a more proactive role in the climate policy arena. 

That includes not only active initiatives to reduce health sector emissions, but public awareness-raising about the “interdependence between climate change and health,” as well as intersectoral  “engagement in the development of climate and health policies, fostering recognition of health co-benefits and sustainable behaviour…” that address “ the root causes of climate change.” 

Finally, the draft document calls upon WHO to clean up its own house by “firmly integrating climate across the technical work of the WHO at all three levels” and develop a “Roadmap to Net Zero by 2030 for the WHO Secretariat, in line with the UN Global Roadmap.” That will be a big lift for an agency whose pre-pandemic carbon footprint was one of the largest in the UN family – from air travel to routine procurement of heavy-duty diesel vehicles for regional and country offices. 

“We’re not talking about the future. It’s about now,”  declared Tedros with respect to the initiatives, saying that, “both mitigation and adaptation is key.”

He said: “We need to push while saying that, by the way, the health sector also contributes 5% [of GHGs]. And that’s why we should start from the health sector as well.”

Greening health systems 

Map of ATACH members- green shading shows states committed to “low carbon and sustainable” health systems.

Indeed, the boldest feature of the draft WHA decision is the explicit request to WHO to support member states’ development of “decarbonization” of “health systems, facilities and supply chains.” 

That “request” also refers in detail to the long chain of climate impacts associated with the enormous quantities of water, energy, food, medical equipment, drugs and chemicals that modern health facilities consume, and the waste and emissions they produce.  

The draft promotes further development of an “Alliance for Transformative Action on Climate and Health (ATACH),” a new WHO-led platform on development of sustainable health systems.

ATACH, launched in June 2022, has gained further traction since WHO helped lead the first-ever Health Day in December 2023 at the UN Climate Conference in Dubai. Some 75 countries are now committed to creating “low-carbon health systems” and 29 countries even setting net zero targets for sometime between 2030 and 2050.   

But limiting GHG emissions of health systems should only be promoted “when doing so does not compromise health care provision and quality, in line with relevant WHO guidance,” the draft decision recommends. 

The draft text also remains full of brackets, suggesting continued member state disagreements on the fine points of language linking climate action to factors like “healthy environments … more sustainable life choices” and “air quality,” and even to longstanding legal agreements like the United Nations Framework Agreement on Climate Change and the 2015 Paris Climate Agreement.  

More attention to noncommunicable diseases 

Norway, the US, and a number of non-state actors also underlined the importance of climate impacts on non-communicable disease, particularly with regards to extreme heat, with the NCD Alliance calling on member states to include reference to NCDs, as well as to fossil fuels, in the new WHA climate decision. 

 

Image Credits: AfricaNews, WHO , WHO .

Immunisation progress is uneven across regions and countries.

Global levels for routine immunisations are still lagging behind pre-pandemic rates, with uneven progress in different countries, World Health Organization (WHO) officials said at a session of the Executive Board on Friday.

In its report to the EB, the WHO has documented that the current progress is not enough to meet the WHO’s Immunization Agenda for 2030.

Childhood vaccinations have been amongst the worst-hit, member states agreed. The number of zero-dose children who did not receive any DTP (Diphtheria, tetanus, and pertussis) vaccine doses in 2022 stood at 14.3 million, well above the 2019 level of 12.9 million children.

“In the African region, the number of zero-dose children increased from 7.64 million in 2021 to 7.78 million in 2022 − a 25% increase since baseline year 2019,” the WHO report stated.

On the positive side, many countries are preparing to roll out the HPV vaccine for protection against cervical cancer – the fourth most common cancer amongst women that killed an estimated 342,000 in 2020.

“Despite initial signs of recovering global coverage rates of DPT vaccines still hovered below pre-COVID-19 pandemic rates,” a representative of Gavi, The Global Vaccine Alliance, told member state participants at the meeting.

The Gavi representative described WHO’s target of reducing the number of zero-dose vaccine children by 50% by 2030 as “ambitious and urgent.” The Gavi delegate also encouraged countries to include the new malaria vaccine and HPV vaccines in their national immunisation programmes.

 

Vaccine roll-outs globally have been lower than the targets due to the pandemic-related disruptions.

Access and cost continue to be barriers

Several countries in Africa are reporting outbreaks of measles as one in five children do not have access to vaccines.

Cameroon, speaking on behalf of 47 countries in WHO’s African Region, said that Africa needs more financing mechanisms like Gavi, transition grants, debt swaps, and development bank loans.

“It is undeniable that immunisation is worth investing in, both as core primary service as well as a key measure for pandemic preparedness and response,” the representative said.

Not just low-income countries but middle-income countries, as well, spoke of the cost of vaccinations as a major financial burden.

“The rising costs of new vaccines present a significant hurdle, impeding their seamless integration into national immunisation programs, especially in middle-income countries,” Malaysia’s representative said. “It remains critical for global partners to explore avenues that enable the provision of more affordable vaccine supplies within these regions.”

Day five of the 154th session of WHO’s Executive Board.

14% of Yemeni children under the age of one have received no vaccinations at all

Apart from the immunisation stalled by the pandemic, raging conflicts have meant that children are going without routine immunisation. In Gaza, there is no functioning healthcare system to speak of at the moment, as Health Policy Watch reported from an earlier session.

In Yemen, around 80% of the population and one-third of the country is controlled by the Houthis, a rebel group.

“We face several challenges,” the representative of Yemen told the board. “Fourteen percent of children under one have received no vaccine doses whatsoever in the northern region, which are not under the control of the legitimate government.

“The Houthis [rebel group] are not putting in place national vaccine campaigns, and this will have serious consequences on the children of Yemen, as well as on neighbouring countries and the world in the future.”

Backed by Iran, Houthi rebels are fighting to overthrow the recognised government in Sanaa, and now control significant swathes of the country. The group has in the past called COVID-19 vaccines “biological warfare.”

Countries prepare for HPV rollout

Several countries described their plans to roll out the HPV vaccine for adolescent girls and young women. Timor-Leste said that it plans to launch HPV vaccination later this year.

Along with Gavi, the European Society for Medical Oncology (ESMO) also made a statement supporting the ambitious HPV rollout.

“Given that prevention offers the most cost-effective, long-term strategy for cancer control, ESMO urges the WHO member states to include the routine vaccination of girls and boys against human papillomaviruses in their national programmes,” ESMO’s representative said.

While Thailand appreciated the global push, the representative from the country offered a note of caution.

“Too much confidence in the HPV vaccine can be harmful as the protection rate against cervical cancer is only 70%. Cervical cancer screening and avoiding unprotected multiple sex partners are still crucial,” the representative from Thailand said.

Image Credits: Unsplash, WHO, WHO.

The United States described a four-pronged strategy to accelerate the eradication of polio globally at the WHO Executive Board session on poliomyelitis on Thursday.

No. 1: Halt circulation in Afghanistan, Pakistan

The first action, the U.S. representative said, would be the intensification of efforts to halt the circulation of the wild poliovirus in Afghanistan and Pakistan by the end of December 2024. Synchronised campaigns across borders would be imperative, with the representative noting, “Decisive action now can pave the way for a polio-free future.”

No. 2: Surveillance, campaigns, community engagement

The second action would be closing surveillance gaps, conducting high-quality campaigns and community engagement in the African region, where there continues to be persistent variant polioviruses.

“These are not just strategies; they are indispensable keys to our success in eradicating polio globally,” the representative said.

The U.S. also urged member states to support incremental measures for rebuilding capacity in high-risk countries. The representative highlighted the unique challenges faced by these countries, calling for solidarity and support to rebuild health infrastructure.

The United States speaks at the World Health Organizations Executive Board meeting in a session on eradicating poliomyelitis.
The United States speaks at the World Health Organizations Executive Board meeting in a session on eradicating poliomyelitis.

No. 3: Alignment of eradication, containment efforts

The third pillar calls for alignment of eradication and containment efforts.

“Eradication and containment must go hand-in-hand,” the representative said.

All member states were urged to intensify actions to speed up the progress of poliovirus containment and certification.

No. 4: Immunisation

Lastly, the U.S. underscored the importance of integrating polio eradication efforts with routine immunisation activities.

Recognising the challenges of reaching communities not responsive to standalone polio campaigns, the representative said, “Integration with routine immunisation is crucial to reaching every child, even in the most remote areas.”

Reiterating support for a comprehensive approach, the U.S. urged donors to expedite and increase their contributions to polio eradication.

“Continued investments are not just essential; they are the lifeline that ensures we reach all children, multiple times, and ultimately end the polio scourge globally,” she said.

Tackling persistent challenges

WHO member states stressed the global commitment to fighting the spread of polio.

The Afghan representative addressed the specific challenges his country faces in eradicating the disease from the country. He said that despite some successes, the country faces several impediments to implementing crucial house-to-house campaigns, an important component of any polio eradication strategy.

“The inability to conduct these campaigns jeopardises the effectiveness and efficiency of our collective effort to eliminate polio on the ground,” the representative said.

He added that there was a negative impact from not being able to reach vulnerable children specifically. And he stressed the need for national ownership over the polio eradication program and collaboration with international institutions, as well.

Afghanistan speaks at the World Health Organizations Executive Board meeting in a session on eradicating poliomyelitis.
Afghanistan speaks at the World Health Organizations Executive Board meeting in a session on eradicating poliomyelitis.

The Afghan representative also called for investments in human capital, highlighting the pivotal role that the right professionals can play in eradicating the disease and ensuring it remains eradicated. The representative also noted that technology could revolutionise the program, making data collection, monitoring, and response strategies more efficient.

Challenges in the Eastern Mediterranean region

Yemen, speaking on behalf of the member states of the Eastern Mediterranean region, acknowledged the progress made in reducing poliovirus circulation in 2023. However, challenges persist, the representative said, particularly in preventing the virus from gaining a foothold in previously identified reservoirs.

The representative stressed, “We must reach all children with polio vaccines and strive to prevent other vaccine-preventable diseases.”

The call for global solidarity and action was reinforced, urging the WHO to provide financial assistance to countries facing internal and external obstacles, including those managing refugee influxes. The importance of routine immunisation and vaccination campaigns against polio was emphasised, particularly in regions like Yemen.

African region’s concerns and call to action

Representatives from the African region expressed gratitude for poliomyelitis being placed on the WHO Executive Board agenda, highlighting the collective efforts to end polio circulation. Concerns were raised about the persistent circulation in specific regions of the Democratic Republic of the Congo. Delays in introducing the polio vaccine and challenges in the move to the novel oral polio vaccine were also noted.

Comoros speaks at the World Health Organizations Executive Board meeting in a session on eradicating poliomyelitis.
Comoros speaks at the World Health Organizations Executive Board meeting in a session on eradicating poliomyelitis.

Comoros, speaking on behalf of the African region, urged countries to act on recommendations, improve information campaigns, and ensure vaccination coverage, especially for low or zero-dose children. The increased risk of a major epidemic outbreak due to a drop in immunity across the continent was described as a significant concern. The representatives called for further mobilisation of resources to implement strategies preventing cross-border and international transmission.

The world’s only public health emergency of international concern

Aidan O’Leary, director of Polio Eradication at WHO, while commending member states and partners for their commitment and support, highlighted the significance of the ongoing efforts.

“Polio is the only public health emergency of international concern in the world as we speak today,” O’Leary said.

He emphasised the collaborative nature of the fight against polio, noting the vaccination of over 800 million children globally in 2023.

The director also stressed the importance of vigilance in surveillance in the face of emerging variants concentrated in specific regions. He reiterated the challenge of reaching zero-dose children and the necessity of maximising coverage through innovative delivery modalities. O’Leary also emphasised the ongoing innovation at every level, citing the prequalification of the novel oral polio vaccine as a significant milestone.

“We are committed to making every effort [in] … 2024,” O’Leary said.

Meanwhile, WHO Director-General Dr. Tedros Adhanom Ghebreyesus described the final leg of the polio eradication journey as the most challenging.

Despite the difficulty, he conveyed optimism, stating, “The finish line is within reach.”

WHO Director-General Dr. Tedros Adhanom Ghebreyesus reveals the WHO report on poliomyelitis eradication at the Executive Board meeting on January 25, 2024.
WHO Director-General Dr. Tedros Adhanom Ghebreyesus reveals the WHO report on poliomyelitis eradication at the Executive Board meeting on January 25, 2024.

In his report on poliomyelitis eradication, Tedros called for the implementation of risk mitigation strategies in highest-risk polio-free areas, notably in the Afghan city of Kandahar. He also revealed the ongoing conflict in Sudan “continues to hamper the response to the new outbreak of circulating vaccine-derived poliovirus type 2, detected in 2023.”

To direct future polio transition efforts, Tedros’ report revealed a post-2023 strategic framework for polio transition is already being developed, and it is based on a theory of change and will build upon lessons learned from the strategic action plan on polio transition (2018–2023).

“The operationalisation of the framework will begin in 2024; it will be closely aligned with evolving epidemiology and polio eradication timelines, and will address the recommendations of the Polio Transition Independent Monitoring Board outlined in its most recent report published in July 2023. This work is essential to ensure that the eradication gains once made are sustained,” the report stated.

Focus for 2024 and beyond

In 2024, the report revealed the focus of the WHO will be on updating the polio post-certification strategy, with the aim of “aligning it with updated eradication timelines and reflecting new developments in post-certification policy, strategy and research.”

The strategy will also be aligned with the post-2023 strategic framework for polio transition.

“Working groups have been established for each key thematic area. During this process, efforts will be made to identify and apply lessons learnt from the 2016 switch from trivalent oral polio vaccine to bivalent oral polio vaccine in routine immunisation programmes, in support of preparations for the eventual cessation of all oral polio vaccine use from routine immunisation programmes,” the report stated.

Following the successful eradication of wild polioviruses globally, the report revealed that the use of all remaining oral polio vaccines in routine immunisation programmes will end. The aim of this action, the DG reported, is to eliminate the risk of vaccine-derived polioviruses.

Image Credits: Screenshot.

WHO Director General Dr Tedros Adhanom Ghebreyesus  choked back tears at end of lengthy EB session, during appeal for peace in Gaza.

Poland on Thursday suggested that it might be better to delay the approval of a new World Health Organization (WHO) pandemic accord, beyond the planned May 2024 deadline – so as to get to an “ambitious, clear and consistent” agreement.  

The Polish trial balloon seemed to break ranks with the drumbeat of recent statements by WHO and other member states that negotiations should conclude this year – even if the present pathway to rapid agreement seems strewn with obstacles – including only a few more planned meetings of WHO  member state negotiating teams.   

Poland’s comment came during a marathon 12-hour WHO Executive Board meeting Thursday that veered sharply from topics such as pandemic preparedness and biosafety to the Gaza and Ukraine war, with the latter dominating most of the day’s session. 

‘Lies’ and Entrenched Positions Undermine WHO Pandemic Negotiations

“It’s very important, especially in reference to a future pandemic treaty, to have an ambitious, clear and consistent document, which will really contribute to the prevention of future crises,” said the Polish delegate in remarks about the member state negotiations over a new pandemic accord and revisions in the International Health Regulations (IHR), which are supposed to be completed by May 2024.  

“And here I would like to share with you our concern that it would not be beneficial if time pressure leads to a weakening of our ambition, and the quality of the final document.  It is time to ask if we will be ready to present an agreement on a draft pandemic treaty by May 2024?” 

Norway, however, appeared to push back against Poland’s suggestion that the deadline for conclusion of a pandemic accord be delayed. 

“The deadline for INB and IHR negotiations must be used as a historic opportunity to ensure the world is better able to prevent and respond to pandemics,” said the Norwegian delegate. 

Other countries reaffirmed their commitment to reaching an accord without stating a date. 

“On the pandemic accord, the United Kingdom remains committed to reaching agreements with other member states,” stated the UK. 

Palestine accuses Israel of genocide; Israel charges WHO of ‘collusion’ with Hamas

Gaza and Ukraine are only two amongst the more than dozen Grade 3 health emergencies related to conflict, climate and disease outbreaks that the organisation is coping with right now.   The EB discussions reflected the deep demands now being generated by conflicts – as compared to a virus – on the time of the WHO governing bodies, as well as the technical work of the global health agency.  

And the sharp geopolitical rifts that seem to have plagued the global body even more severely since the winding down of the COVID pandemic were again plainly evident Thursday.

Listing of WHO Grade 3 Emergencies as of September 2023, before the outbreak of the Hamas-Israel war

In the EB debate over Gaza, Palestine, a WHO observer state, accused Israel of carrying out deliberate attacks on civilian populations and health facilities during its invasion of Gaza in military actions amounting to “genocide” – an issue now before the International Court of Justice in The Hague. On Friday, the ICJH issued an interim ruling that Israel must take more active measures to prevent indiscriminate killing and ensure basic services and humanitarian reaches Gaza Palestinians – although the court stopped short of ordering Israel to halt its military campaign.

Israel, meanwhile, accused WHO of  “collusion” with Hamas, turning a blind eye to the use of hospital infrastructure for military aims and concealment of Israeli hostages.  

Neither WHO Health Emergencies Director Mike Ryan nor Director General Dr Tedros Adhanom Ghebreyesus responded to the Israeli charges against the global health agency at the EB session, although Tedros on Friday issued a denial on X (Twitter). 

“No one and nowhere is safe in Gaza. So far around 26,000 people have died, 8000 are missing, and close to 64,000 are injured in the conflict, and 1.7 million people are displaced,” said Tedros, repeating calls for a cease fire.

“If we look for a solution, it’s always possible. It’s only the will that’s required, and I’m a true believer because of my own experience that war doesn’t bring solutions – except more war, more hatred, more destruction.

Fighting back tears at the reference to his own childhood in a war-torn region of Ethiopia, now in Eritrea, he pleaded: “So let’s choose peace. Let’s resolve this issue politically.”

Gaza humanitarian crisis 

France calls for “immediate and sustainable cease-fire” in Gaza.

Discussions on Gaza focused on WHO’s latest report on Health Conditions in the Occupied Palestinian Territories, describing barely functioning Gaza hospitals, and a civilian population trapped by war, hunger, thirst and displacement. A slight technical revision to an EB resolution on more humanitarian aid to Gaza, already approved in a special EB session in December, was approved. 

A large bloc of Islamic and Middle Eastern countries, supported by the African Region, and Cuba, Colombia, Nicaragua and Venezuela, blasted Israel’s conduct of the war, with some, such as Cuba and Colombia, also describing Israel’s actions in Gaza as tantamount to war crimes. 

The United States, Germany and most other European nations focused on the urgency of getting more humanitarian aid into Gaza. They also called for Hamas to release the more than 100 Israeli and foreign hostages still held in Gaza, after a November cease-fire broke down. Around 240 hostages were taken by Hamas in its bloody 7 October incursion into Israeli border communities, which killed 1,200 people and triggered Israel’s military invasion. 

France called for an “immediate, sustainable cease fire” while the United Kingdom spoke in terms of an “immediate humanitarian pause as a vital step towards building a sustainable, permanent cease-fire.” 

A few states, notably Germany, Belgium and New Zealand denounced Hamas actions, directly or indirectly.  

“We reiterate our condemnation of Hamas terrorist attacks, including the systematic use of sexual violence and the abuse of hospitals and civilians as human shield,” stated Germany, which also referenced “the right of Israel to defend itself in line with international humanitarian law.”

“Medical facilities must never be used for military purposes, and must never be the object of attack,’’ added New Zealand’s delegate.  

Gazans have no health or human dignity 

Ryad Awaja Aouadja, Consul at the Palestinian Mission to the UN in Geneva

For their part, both Israeli and Palestinian delegates described the impacts of the war-time violence in highly emotive terms.  

Palestinian delegate, Ryad Awaja Aouadja, described the how a young female double amputee had to be carted to a makeshift toilet in a refugee camp by her parents.

“I have no words to describe what is happening in the occupied Palestinian territories,” said Aouadja.  

“The whole world knows about the humanitarian disaster there, the catastrophic health situation in the Gaza Strip. And we’re still hearing pretexts, justifications, supposedly for the occupation, justifications for the destruction committed by the occupying power,” he said. 

“How can we accept this devastation, this genocide, the total destruction of health establishments and facilities?

“How can you talk about health and human dignity when what you are seeing is a situation where the rights of Palestinian women and girls to get sanitary napkins to get nappies are being denied?…. And you have so many dead, most of them women and civilians? 

“Where is health? Where is hygiene? Where’s dignity when you have a young girl who’s had to have her legs amputated and be carried by her parents to some kind of toilet? … We have 1.5 million people who’ve had to leave their homes because their homes have been destroyed by the occupying powers and they’ve had to go and live in overcrowded refugee camps,

“We know that for 75 years now, we’ve had the occupation going on there,” added Aouadja, referring to the 1948 Arab-Israeli war that followed the UN partition of Palestine and the creation of the state of Israel.

“…Talking about self defense no longer makes any sense. We’re just talking here about collective punishment about vengeance, about genocide against the Palestinian people,” Aouadja added.

“If you look anywhere on the internet, you can see that that is the case…. I therefore call on the international community to shoulder its humanitarian, ethical and moral responsibility to put an end to this military aggression to put an end to this violence,” he concluded, drawing applause from several dozen EB participants at the end of his comments. 

Israel – WHO ‘collusion’ with Hamas 

Waleed Gadban, Consul at the Israeli UN Mission in Geneva

Israel’s ambassador, Meirav Eilon Shahar, quoted testimony by former Israeli hostage Moran Stela Yanai, who described being taken to a Gaza hospital on 7 October, after being beaten and abducted from a music festival – where she was examined by a Gazan physician who “knew I was kidnapped and did not do anything.”

Shahar also cited Israeli military reports of Hamas tunnels, munitions and weaponry found in and under at least five major Gazan hospitals, including Shifa and the Indonesian Hospital, where corpses of five Israeli hostages also were found. “Every single hospital that the IDF searched in Gaza, it found evidence of Hamas’ military use,” charged Shahar. “Hamas has militarised the entire civilian area of the Gaza Strip, as a matter of premeditated strategy.”

View interactive compilation of Hamas abuse of hospitals >> 

“These are undeniable facts that WHO chooses to ignore time and time again. This is not incompetence; it is collusion. The WHO knew hostages were held in hospitals and that terrorists operated within. “Even when presented with concrete evidence of what was happening below ground and above ground, about the weapons, the headquarters, the closed rooms, WHO chooses to turn a blind eye, jeopardising those they are meant to protect,” she said. 

Her comments were refuted by Tedros in an X post on Friday – sparking yet another round of exchanges.  

At the conclusion of Thursday’s session on Gaza, Israeli delegate Waleed Gadban, described the EB debate on Gaza as a “masquerade with no limits.” 

“Syria bombarded more than half of its own civilian population and Israel facilitated access to more than 10,000 trucks into Gaza and no one has mentioned that,” said Gadban, an Israeli Druze who delivered his closing remarks in Arabic.

“In Yemen, people are suffering from famine… We need to call a spade a spade. Iran launched a humanitarian appeal for the people in Gaza. I can tell you that the people in Gaza would be better off if Iran didn’t furnish weapons to terrorists.”  

Russia and Ukraine 

Ukraine’s delegate to the WHO Executive Board

Later Thursday, a WHO update on the health and humanitarian situation in Ukraine, following on from  2022 and 2023 World Health Assembly resolutions denouncing Russia’s 2022 invasion, served as the focus for yet another politicized debate over health as a casualty of war during the Thursday session. 

Russia blasted the WHO follow-up  report as unnecessary and “politically motivated” by NATO allies.

In his closing remarks, Tedros told the Russian Federation that WHO had maintained “strict neutrality” in its follow-up on the Ukraine health and humanitarian situation.  

The WHO report details some 1,300 Russian attacks on health care facilities in Ukraine, since the start of the conflict. However, the health system, while damaged, remains functional with “92% of all health facilities intact,” said WHO’s Ryan. He noted that over $72 million worth of medical supplies has been delivered to health facilities and another $51 million is in the pipeline, with nearly 200 aid convoys and 100 WHO missions since the conflict began.  

“This represents one of the most intense,  one of the most sustained, comprehensive responses to any humanitarian crisis. I believe that WHO has ever been able to mount,” he said. 

Both Moldova and Denmark expressed concerns about the safety of Ukraine’s Zaporizhzhia  nuclear reactor in the wake of Russia’s purported destruction of the Kakhovka dam in June, 2023, which lowered water levels in a reservoir around the nuclear power plant that supplies cooling water for the reactor and its spent fuel. 

Denmark, speaking on behalf of Ukraine, the European Union and about dozen other non-EU European states, noted that over the past weeks, Russia has intensified its attacks in Ukraine “As a consequence, Ukraine’s health system and access to critical health care services, medicines and treatment are severely compromised.” 

Other European countries denounced the ongoing conflict, with Poland describing it as an “illegal and unprovoked” war perpetrated by Russia.

Slovakia, however, also called on the international community for renewed efforts at peace negotiations in a war-weary region “to support the end of this conflict which is putting at high risk of death or certainty, unsafe environment for the house the development of children and adolescent and promoting the health of families that are divided and experiencing poverty due to social determinants, and worsening mental health.” 

Russia denounces WHO report as ‘politically motivated’  

Russia denounces the EB debate as politically motivated.

The Russian Federation, meanwhile, denounced the WHO report and debate as indulgence in “anti-Russian propaganda” saying that “representatives of NATO countries for the second year in a row are insisting on the inclusion of this item on our agenda, with only one purpose, that of getting airtime to allow them to recite a litany of baseless allegations against Russia. 

“Their governments at the same time, are supplying Ukraine with lethal weaponry that is being used against civilians in peaceful towns, and also against health infrastructure,” said the delegate to the EB. 

“The fact is that in accordance with data from the International Statistical Institute, in the world, in 2023, there were 183 regional conflicts, apart from Ukraine. Judging by the WHO classification, there are 16 acute and protracted emergencies that are grade three for emergencies.

“Just a little earlier, countries were obliged to cram into three minutes, their position on all these emergencies, on the work of WHO, and also on the pandemic agreement and amendments to the IHR [international health regulations]. And now they have another three minutes on Ukraine alone,” said Russia’s delegate.  

Board makes only fleeting reference to health crises triggered by other global conflicts

Dr W. Majrooh, Afghan delegate to the EB

Meanwhile, amongst the nearly dozen conflict-related Grade 3 emergencies cited in the WHO report, only fleeting reference was made by Board delegates to other global hotspots, such as Sudan, Syria, Afghanistan, Yemen and Haiti at the EB session on health emergencies that continued for hours throughout Thursday.     

“It seems that Afghanistan has dropped off the map,” complained Dr W. Majrooh, the delegate of Afghan’s government in exile, at one point. He noted that Afghanistan continues to face “historical susceptibility in both man-made and natural disasters.” 

Majrooh urged WHO to “not only keep the health emergency preparedness and response capacity in Afghanistan, as it is top priority but to actively engage with the current leadership to make them realise the significance of this matter.”  

  • Updated on 27 January with references to official quotes and news developments on Friday.
Swiss global health ambassador Nora Kronig Romero speaks about the Health and Peace initiative at the WHO Executive Board meeting Thursday.

WHO Executive Board delegates on Thursday gave the green light to a draft proposal by Switzerland cementing the framework for a new WHO “Health for Peace” initiative.

The move marked a bright spot in a day otherwise marked by heated debates over regional conflicts, including Gaza and  Ukraine. 

The Health and Peace initiative was first proposed in 2020 by WHO’s Director General, who grew up in a war-torn region of Ethiopia, now in Eritrea, whose remarks then – “there can be no health without peace and no peace without health” – became a slogan for the initiative. 

A “roadmap” for rolling out the initiative came before the World Health Assembly in May 2023, and was “noted” by the member state body.

The draft decision, which provides a more framework for the WHO approach to the issue, would represent a more formal seal of approval by member states, should it get the go-ahead in May.

And that approval has been slow in coming due to member state fears that such an initiative could be politicised and overlap with the work of other UN agencies.

“Our Constitution, your constitution, says the health of all peoples is fundamental to peace and security. Therein lies the mandate for this activity,” WHO’s Executive Director for Health Emergencies Mike Ryan told the EB, summarising the rationale for the initiative. 

“Health can build trust, helps prevent conflict. Health can sustain peace.” 

WHO Executive Director of Health Emergencies, Michael Ryan

In his remarks, Ryan pledged that the initiative would build locally-relevant programs that support peace-building while avoiding further politicisation of the health sector and its role. However, some countries were still not convinced.  

China, while not directly opposing the initiative, reflected some of still lingering reservations amongst some member states, stating,  “We should follow the principle of the member states-driven respect to national sovereignty, non- interference in internal affairs and the member states consensus. 

“We should have respect for different national conditions,” said the Chinese delegate, urging further clarification of “specific goals…content and outcome evaluation indicators,” as well as analysis of the “division of labor of other UN agencies and global health organizations, to avoid duplication by WHO and resource waste. 

Brazil expressed hesitations as well, saying:  “Let me reiterate the concern of my country with the securitization of the health agenda. 

“We have seen in our debate on the previous item. How issues of health continue to be used by some members to advance political speeches, the same members that selectively complain about the politicization of the EB agenda and say it needs to be streamlined. 

“Health is not and shall not be a security issue, but instead should be considered as a core part of the sustainable development agenda.” 

The decision, which still must go before the full World Health Assembly in May, received strong support from many other diverse quarters ranging from the Maldives to the United States and Afghanistan. 

“As we have heard repeatedly throughout the interventions in the preceding agenda items today, the importance of global peace and its intricate correlation to help cannot be overstated. The roadmap would pave the way for the creation of health programs that are both conflict sensitive, to focus on young persons’ awareness and capacity building in mainstream directions are important,” stated the Maldives delegate to the EB. 

“We find ourselves at a historical juncture where the world is stuck in unprecedented global disorder,” said  Dr W. Majrooh, representative of Afghanistan’s government in exile, “A mess created by politicians – in this climate the only community that spans from the village to the international level and is still fairly trusted, is the health community. It is not just a privilege but a historical responsibility.

“I implore you to recognize the untapped potential within our healthcare community, from the frontline campaigns to the institutional capacity of the World Health Organization. 

“Now more than ever, we must step out of our comfort zones, fill the gaps left by violence and politicians and  become the bridge to the real advocates of health and  peace.”

Image Credits: WHO/Sean Hawkey .

WHO executive board members take an exercise break.

Discussion about non-communicable diseases (NCDs) opened a Pandora’s Box of problems at the World Health Organization’s (WHO) executive board meeting on Wednesday.

Not a single country is on track to achieve all nine voluntary global NCD targets for 2025, according to the Director-General’s report, which appealed to member countries for input on how they can accelerate progress towards reducing premature mortality from NCDs by one-third by 2030 (Sustainable Development Goal target 3.4).

New proposals to improve measures to protect mental health in armed conflicts, and increasing the availability of organ transplants in global NCD measures were also presented for further discussion.

“The mental health and psychological needs of people affected by armed conflict. natural and human caused disasters and other emergencies require actions beyond those identified by the WHO comprehensive mental health action plan 2013-2030,” said Ukraine, which has proposed a new resolution, supported by the Netherlands, which will be tabled at the World Health Assembly (WHA) in May.

However, most member states acknowledged that efforts to address mental health in everyday life was inadequate.

“Mental health conditions encompass a multitude of illnesses that need to be recognised, diagnosed and treated,” noted Denmark, which urged WHO to work to “better ensure that mental health is recognised in its own right as a key global health agenda”. 

“Mental health is essential but constantly constantly challenged by stigma, discrimination, conflict and dynamics and natural hazards. We owe it to our children and young people to take this seriously,” Denmark concluded, thanking WHO for it’s recommendation to decriminalise suicide.

Organ transplants

Spain, supported by Brazil and China, co-sponsored a recommendation to “increase the availability, ethical access and oversight of transplantation of human cells, tissues and organs”. 

Spain told the EB that only around 10% of transplant needs were met globally, and that expanded access could reduce NCD mortality.The resolution, which has consensus, will be tabled at the WHA.

A plethora of other concerns were raised by countries, including lack of access to oral care globally, inadequate targets for dementia.

Many countries also focused on how to address key NCD drivers more efficiently – tobacco, alcohol, poor diet and lack of exercise.

While many countries have been successful in reducing tobacco consumption, less progress has been made against alcohol consumption and poor diet.

Senegal, for the 47 Africa region members, called for support to collect data on NCDs “so that policies can be based on under scientific evidence”.

It also called for  “more financial resources to promote health and prevent these conditions through strengthening innovative financing mechanisms including tobacco taxation, and the taxation of sugary drinks and alcohol and indeed, developing public-private partnerships,” noted Senegal.

Japan pointed out that targets in the dementia global action plan for diagnosis and treatment would be missed in 2025, and  requested that the plan be extended after 2025. 

A fourth United Nations high-level meeting on NCDs has been planned for September 2025, and the current WHO decisions on NCDs will feed into this.

Test tube rack stocked with electronic cigarettes.

World Health Organization’s (WHO) Director-General, Dr Tedros Adhanom Ghebreyesus lauded the success of tobacco control measures at the Wednesday evening session of the Executive Board meeting, but expressed concerns about the growing use of harmful products like e-cigarettes among youth.

He urged member states, “to take swift action to counter this emerging threat” of children being targeted and potentially being made to be customers of the tobacco industry for life.

“Children as young as 10-14 years are vaping because it’s fashionable and it comes in different flavours and colours,” he said, adding that peer pressure was driving this trend – as it had driven cigarette smoking.

“History is repeating itself — the same nicotine but in a different form, a different packaging. And the sad part is this: the industry is saying it’s harm reduction but what has harm reduction got to do with children? To call it harm reduction and deliberately recruit children and use schools as a battleground is dishonest,” he added.

WHO Director-General Dr Tedros Adhanom Ghebreyesus

China showcased its commitment to combating Non-Communicable Diseases (NCDs), placing particular emphasis on tobacco use.

“China has established a sound mechanism for the comprehensive prevention and treatment of chronic diseases,” said the Chinese representative. They highlighted efforts in “improving monitoring systems, early screening, and comprehensive interventions for major health concerns.”

Although progress continues to be recorded in declining the use of tobacco, member states called for strengthened regulations around tobacco and nicotine products, considering that the efforts are crucial for the health of future generations.

Denmark, meanwhile, threw its full support behind the European Union’s focus on tobacco control and mental health.

The country highlighted a recent political agreement aimed at reducing the consumption of alcohol, nicotine products, and tobacco among children and adolescents. Denmark emphasized the importance of addressing risk factors like tobacco use, with a representative stating, “Ambitious control policies, especially concerning emerging tobacco products, are essential to protect the health of our younger population.”

Maldives also expressed its commitment to addressing tobacco use. The Maldives representative highlighted the nation’s national high-level coordination mechanism, recognizing the challenges faced by small island states in tackling commercial determinants of NCDs.

“Often, we are helpless in addressing the determinants of NCDs, particularly those commercial determinants,” said the Maldives representative, urging WHO to work closely with small island states.

According to the DG’s report on the prevention and management of non-communicable diseases, promotion of mental health and well-being, and treatment and care of mental health conditions, reducing exposure to risk factors in the population is essential for the cost-effective reduction of NCD burden and mortality.

Even though the report stated that 56 countries are currently on track to meeting the voluntary global target of a 30% relative reduction in tobacco use between 2010 and 2025, the DG noted that the rate of decline in the prevalence of tobacco use in all WHO regions and globally is insufficient to meet the voluntary global target for 2025, especially among men. Of around 1.3 billion people still using tobacco, 82% (1.1 billion) are males.

WHO’s Executive Board discusses the prevention and control of non-communicable diseases.

En route COP10

Meanwhile, country representatives are gearing up for the upcoming Conference of the Parties (COP10) in Panama, where discussions around cigarette regulations will be at the forefront. The focus is expected to be on the accountability of tobacco companies and the detrimental impacts of extensive lobbying by the tobacco industry.

Sabina Timco Lacazzi, WHO’s Legal Officer, emphasized that “Tobacco is and continues to be a threat” not only to human life and health but also to the planet.

The meeting will take place from 5 – 15 February, bringing parties together for the tenth time to oversee the implementation of the WHO Framework Convention on Tobacco Control (FCTC) and its special protocol on illicit tobacco trade.

Over a fifth of the world’s population, with the majority in low- and middle-income countries, uses tobacco, leading to over eight million deaths annually, according to the WHO. Despite a decline in the number of tobacco users, the industry’s lobbying efforts often hinder regulatory measures and information campaigns.

Image Credits: Unsplash.

WHO Executive Board discusses Universal Health Coverage.

The World Health Organization’s (WHO) executive board discussed ways to deliver Universal Health Coverage (UHC) on Wednesday, and while most member states expressed support for UHC, they highlighted bottlenecks of lack of finance and  trained healthcare workers for being off track with its implementation.

In its report to the board, the WHO estimated that over half of the world’s population is not covered by essential health services, and a quarter face financial hardship due to out-of-pocket health spending.

In the past two decades, due to a combination of conflicts and the impact of the COVID-19 pandemic, financial availability for health has worsened, the discussions revealed.

Small island nations, developing countries, countries with high levels of migration of health workers as well as those with ongoing conflicts, voiced a range of challenges that they face, and need support to address.

“In 2019, 1.3 billion people incurred impoverishing health spending at the relative poverty line, and 344 million people faced impoverishing out-of-pocket health spending at the extreme poverty line of $2.15 a day in 2017 purchasing power parity,” the WHO report noted.

For UHC to be implemented, there needs to be an increase in health funding, it needs to be used efficiently and equitably, the health and care workforce needs to be strengthened, and primary healthcare (PHC) needs to be expanded, according to WHO.

“Investment in health is actually on the decline now, and many governments are shifting towards other sectors,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “It is the continued investment in health that can help us in preventing the next pandemic. And it’s the continued investment in health and in UHC that will help us to respond,” he said.

Tedros reiterated that both low-income and high-income countries need to focus on strengthening PHC.

Delivering UHC requires countries to invest more in primary healthcare.

High debt burden is stunting progress 

WHO has found that the current expenditure on health is not adequate. “Emerging evidence shows increased financial hardship, especially among the poorest, with an uneven recovery post-2020/2021. A notable concern is the higher public spending on national debt over health in developing countries,” the report said.

Rwanda, speaking on behalf of the 47 countries in the WHO African region, drew attention to the burden of debt repayments on poor countries.

“The African neighbour states also note with great concern that, as noted by the UN Secretary-General, many countries are forced to spend more on servicing debt than on health and education. In this regard, the IMF has reported that the average debt ratio in Sub-Saharan Africa has doubled in the decades from 30% of GDP at the end of 2013 to almost 60% of GDP by the end of 2022,” he said.

Meanwhile, Yemen’s representative said that 70% of health expenses in his country are borne by individuals and they face tremendous financial hardship as a result.

Pressure placed by conflicts

Palestine, which is currently facing intense and deadly aggression from Israel, said that it has no functional public health system left. “We are facing several challenges and obstacles to maintain the primary healthcare and minimum services using the available resources,” the representative of Palestine said, adding that any discussion on UHC can only be had after their destroyed health system is rebuilt.

Yemen, which has seen several years of conflict, spoke of the additional pressure placed by people displaced by war: “There are a great many displaced persons in our country…internally displaced, in particular, approximately three million of them. We are also facing an influx of refugees and migrants, which is of course a tremendous burden for our health system and makes it more difficult for us to achieve UHC.”

Afghanistan also spoke of the resource crunch and the lack of female healthcare workers. The representative bravely asked member countries for help in advocating for women’s rights and access to education, which has been severely restricted under Taliban rule in the country.

Conflict-ridden Syria said it was aware of the challenges its citizens were facing in accessing healthcare but expressed an inability to do more.

“Because of the conflict that has been raging in our country for more than 12 years now, the work of our health ministry has been made much more difficult. And we now have to give top priority to emergency response rather than UHC because of the war,” the country’s representative said, while asking for support from the global community.

Syrian refugee camp

Lessons from countries with UHC

On the other hand, countries that have achieved UHC fell into two buckets: those who are looking to build on the progress and those struggling to keep the level of progress up.

The expansion of UHC was a key issue for the elections of the new Regional Directors taking place in three new regions last year, as the new appointees needed to have enough knowledge on how to help countries expand access to healthcare, and the different models that can be employed to reach there.

The new Regional Director of the Western Pacific region Dr Saia Ma’u Piukala also said that expanding UHC access would be one of his key priority areas, as Health Policy Watch reported earlier.

Malaysia that achieved UHC in the 1980s said it planned to further, “expand coverage to quality health services through primary healthcare [by] increasing funding, improving the distributions of primary healthcare facilities, ensuring adequately trained human resources for health and facilitating Public Private Partnership moving forward”.

Small-island nations who are at the forefront of climate change are struggling with the rising extreme weather events that have increased pressure on health systems, while simultaneously also damaging the economy.

Maldives spoke of the challenges of continuing the high level of investment on healthcare as climate change and global conflicts hit its two main sources of income – tourism and fishing.

“Therefore Maldives is taking a two-pronged approach. One is to further strengthen PHC with low-cost intervention, including multi-tasking multi-discipline health workforce, early detection for NCDs and timely reference. The other is investing more in health promotion, including digital health literacy and promoting a healthy lifestyle in healthcare settings,” the country’s representative said.

Healthcare workers
Several countries suffered during the COVID-19 pandemic due to shortage of healthcare workers.

Shortage and safety of healthcare workers

A key challenge for many countries in the developing world, and those at the forefront of facing climate impacts, is the shortage of healthcare workers, as well as threats to their safety.

“Barbados continues to grapple with a shortage of nursing personnel and allied professionals. The country currently makes up for this by recruiting nurses from Ghana and Cuba, but a long-term solution is required to ensure sustainability,” the representative from the island nation said.

In addition, retaining the workforce in rural areas is a challenge. “The most willing to leave the health system is the medical staff in primary care, especially in rural areas. Being a difficult speciality, family medicine became almost completely feminized,” said the representative from Moldova.

Increases in resources and infrastructure improvement could help with some of these challenges, with Ethiopia stressing that it is crucial to ensure the safety and security of health and care workers.

The Philippines too said that out migration of healthcare workers has hit its ability to deliver UHC hard and that destination countries needed to play a role in supporting the source country’s health systems through investments.

Tedros acknowledged this in his remarks by pointing out that while migration cannot be stopped as it is human to want to migrate, more health professionals can be trained to handle this shortage.

Denmark, speaking on behalf of the European Union, expressed concerns over the lack of consensus on several issues, and Germany reiterated that comprehensive sexual and reproductive health and rights are an essential part of UHC.

“While many of the member states have highlighted the bleak situation globally in terms of half the world’s population not having access [to essential health services] and another quarter suffering financial hardship, I think we should remember as well [that] 30% of the countries for which we have data, have been able to make progress on both of those indicators,” said Dr Bruce Aylward, WHO’s Assistant Director-General of UHC, as the report was noted by the executive board.

Image Credits: WHO, WHO, Mercy Corps, Photo by Carlos Magno on Unsplash.