Noma
Umar, an eight-year-old noma patient from Kano Sstate, Nigeria, and Adamu, a 15-year-old noma patient from Kebbi State, stand at the entrance of the post-operative ward at the Sokoto Noma Hospital. The two boys are looking forward to going outside.

Twenty years ago, 16-year-old Mulikat Okanlawan embarked on a 1000-kilometer journey from her home in the Nigerian capital of Lagos to the Northwestern city of Sokoto in a bid to change her life.

She is a survivor of noma, a little-known bacterial disease that attacks cells in facial tissue and bones. On paper, Okanlawan had been lucky. Noma is fatal in 90% of cases, often taking the life of those infected within mere days.

Mulikat, a 33-year-old former patient originally from the south of Nigeria, moved to Sokoto 17 years ago to undergo facial reconstructive surgery. She now works in the hospital.

But survivors, mostly children between the ages of 2 and 6 at the time of infection, are left with severe facial deformities that follow them long after the acute phase of noma subsides. These can make it hard to eat, speak, see or breathe, and often lead to discrimination against survivors in their own communities.

“It left a deadly mark on my face that hindered me from associating with people in the community,” Okanlawan said. “Imagine a life where people are running away from you because of your condition. I used to cry every day. I was alone.”

Noma results from deadly synergy between bacterial pathogens that causes ulcers to develop in the mouth, followed by the destruction of cells in the tissues and bones of the face. Often referred to as “the face of poverty,” its key risk factors include malnutrition, lack of basic hygiene, contaminated drinking water, immunodeficiencies, and recent illness, especially from malaria or measles.

Okanlawan has since received several reconstructive facial surgeries at the Sokoto Noma Children’s Hospital, the only specialised noma hospital in Nigeria since its founding in 1999. Little by little, Okanlawan found a new lease on life.

“I began to admire myself,” she said. “I began to relate with people in the community.”

After returning to school to complete her education, Okinlawan returned to Sokoto, where she now works as a hygiene officer and helps patients recover from the trauma of disfiguration.

WHO decision due in 2023

Despite years of campaigning from medical organizations and national governments, noma has yet to be included in the World Health Organization’s neglected tropical diseases list, an omission Médecins Sans Frontières (MSF) health advisor for Nigeria Mark Sherlock says makes noma “the most neglected of the neglected diseases.”

But this may be about to change. In late January, the Federal Ministry of Health of Nigeria, supported by 30 member states from five WHO regions, submitted a dossier on noma requesting the formal recognition of noma as a neglected tropical disease (NTD).

The request is a follow-up to the resolution on oral health passed by WHO at the 74th World Health Assembly in 2021, which recommended that “noma should be considered for inclusion in the NTD portfolio as soon as the list is reviewed in 2023.”

The latest WHO statistics – updated in 1998 – estimate 140,000 people are affected by noma every year. No systematic study of its disease burden has been conducted in the intervening 25 years.

The WHO’s Strategic and Technical Advisory Group for Neglected Tropical Diseases is supposed to make a final decision on whether to add noma to its list of neglected tropical diseases this year, but a date for the meeting has not yet been published.

Not a “silver bullet”, but noma belongs on the list

Amina, an 18-year-old noma patient from Yobe state, visited the Sokoto Noma Hospital for the first time in November 2016 with her mother. She has been disfigured since early childhood, and has a habit, like many noma survivors, of hiding her scars behind a veil. (MSF, Sokoto, Nigeria.) 
18 October, 2017.

Despite its omission from the official WHO list, Noma is the quintessential neglected disease.

It disproportionately affects people living in extreme poverty, is generally neglected by research, affects populations in tropical and sub-tropical areas of Africa, Asia, and Latin America, and incurs significant socio-economic costs on the communities it affects.

Its high mortality rate can also be attributed to neglect and lack of awareness education among the public and medical communities due to the highly treatable and preventable nature of the disease.

“Due to extreme poverty and lack of awareness, unfortunately, a lot of children die at home without even making it to the hospital,” said Dr Shafiu Isah, Chief Medical Director at the Sokoto Noma Children’s Hospital. “This disease is still not very well known in our communities, including among health care workers, who often mistake it for cancer or other illnesses.”

Doctors, researchers and activists recognize that the inclusion of noma on the WHO list would not change the situation of patients on the ground overnight, but say recognition of its neglected status would shine a much needed spotlight on a disease in dire need of renewed resources and attention.

“Whilst not a silver bullet, noma’s inclusion on the WHO list will draw attention to the disease and those at risk of or experiencing it, attract funding for research, prevention, and treatment, and integrate noma in existing protocols of disease-monitoring,” said Dr Ioana Cismas, co-lead of the research collective The Noma Project.

“Those who have lived experience of this disease are calling for national and international action.”

Read more: Noma Survivors Demand that WHO List the Disease as a Neglected Tropical Disease

Image Credits: Claire Jeantet – Fabrice Catérini / Inediz’.

Assistant Director-General Dr Tereza Kasaeva, WHO’s interim head of NCDs

Higher taxes and warning labels on unhealthy food, cigarettes and alcohol, and better screening for cancers, are on the World Health Organization’s (WHO) updated list of “best buys” to address non-communicable diseases (NCD) discussed by member states at the body’s Executive Board meeting on Thursday.

The list was updated in response to the lack of progress to reduce NCDs, with not a single country on track to achieve the 2025 global targets set by the World Health Assembly back in 2013, and the declaration by the UN General Assembly High-Level Meeting on NCDs in 2018.

The new list now recommends 112 interventions and enabling actions – up from 88 when it was last updated in 2017, and the global body has also worked out which are the most cost-effective.

There was wide support for the new list from member states. However, civil society representatives criticised its silence on kidney disease, dementia, obesity co-morbidities, as well as a lack of attention to older people more likely to have NCDs.

Lack of progress

In his report on progress made to address NCDs, WHO Director-General Dr Tedros Adhanom Ghebreyesus noted that health systems were failing to prevent and control these diseases.

“The [COVID-19 pandemic] has highlighted the urgent need to strengthen health systems through a radical reorientation towards primary health care as the foundation for progress towards universal health coverage, as well as to ensure health security and achieve health and well-being for all,” said Tedros. 

“The prevention and control of NCDs and the promotion, protection and care of mental health are integral to this reorientation.”

The cost of implementing the interventions in 76 low and lower-middle-income countries is less than US$ 1 per person per year, and together these actions could save seven million lives per country, according to the WHO.

However, Botswana, on behalf of the Africa region, requested that more affordable treatments are developed to assist lower-income countries.

Mental health remains neglected

“Between now and 2030, the economic gains from implementing the cost-effective NCD interventions could amount to more than $230 billion in lower-middle income countries when individual, economic and social benefits are factored in,” according to Tedros, who noted that almost three-quarters of deaths were caused by NCDs.

Almost a billion people globally lived with a mental disorder. A massive 283 million people had alcohol use disorders in 2016 and 36 million with drug use disorders in 2019, yet less than a third of member states had mental health policies and plans and only 2% of health budgets go to mental health. 

Denmark, on behalf of the European Union, called on the WHO to “strengthen the efforts for mental health and have a greater focus on information sharing and de-stigmatization efforts”.

Deputy Director-General Dr Zsuzsanna Jakab told the EB at a session on Thursday night that the best buys would “invigorate implementation of both the global action plan and relevant regional frameworks”.

‘We know these approaches work. In Southeast Asia for example, we have seen a rapid decline in tobacco use. Smoking prevalence among men in the region declined from 50% in 2000 to 25% in 2020,” said Jakab.

Assistant Director-General Dr Tereza Kasaeva, WHO’s interim head of NCDs, recommended that member states “define the list of priorities that are considered good value for money according to their national context”, and WHO would support them to implement these.

The list will continue to be updated as more evidence became available, added Kasaeva.

World Health Organization
The World Health Organization celebrates its 75th anniversary.

The world has changed since the World Health Organization (WHO) was founded 75 years ago. Established as the specialized health agency of the United Nations in 1948, WHO has played a critical role in addressing global health challenges, disease control, and providing health services to neglected populations ever since. 

This week, global health leaders gathered for a panel alongside the agency’s 152nd Executive Board meeting to discuss the future direction. Vast advances in medical science mean that the challenges the WHO faces today are different from those in its past, but not any less numerous. From climate change to growing global economic inequalities, to pandemics like COVID-19, global health is under attack on all fronts. 

Between technological advancements in artificial intelligence, medical science, and digital health systems and the threats of climate change, growing economic inequalities and future pandemics, the global health picture for the coming 25 years is as menacing as it is hopeful. 

“By 2050, the future of health will be significantly different,” WHO Director-General Dr Tedros Adhanom Ghebreyesus said. “Robots in the operating room – I think initially was science fiction – but that happened in 1998, and now is very common,” he added, highlighting the exponential pace of scientific advancement. 

“But it’s not the last 75 years that matter now, it’s the next 75 years,” Tedros said. “All roads must lead to universal health coverage. So the question is, how do we create a future that will bring health to everybody?”

Too slow to adapt: WHO must modernize

The United Nations, World Bank, and International Monetary Fund have come under fire in recent years for their inability to modernize.

Like its sister United Nations agencies and the multilateral development banks created to underpin the post-war international order, WHO has been slow to adapt to the ever-increasing pace of change in the modern world. 

“WHO was established 75 years ago. Its processes, its structures, and most importantly its mindset are stuck in the time 75 years ago when it was established,” said Bruce Aylward, Tedros’s Senior Advisor on Organizational Change. 

Achim Steiner, head of the UN Development Programme, echoed Aylward, saying the UN and its agencies must pivot away from being products of “post-Second World War realities” and towards 21st-century opportunities. 

Despite the slow pace of institutional change, WHO has achieved some historic victories. The eradication of smallpox in 1980, a virus estimated to have killed over 300 million people since 1900 alone, is justly seen as a medical miracle.

Efforts by WHO and partners also spearheaded the global campaign against polio, leading to a 99% decline in cases since the launch of the Global Polio Eradication Initiative in 1988, and led the charge in the fight against HIV/AIDS, providing technical and financial support to affected countries and working to improve access to treatment, care and prevention services.

But it has also faced its share of criticisms. Recent examples include its slow response to the 2014 outbreak of Ebola on the African continent and its handling of the early stages of the COVID-19 pandemic in 2020, when many argued that WHO was too slow to declare a global health emergency and coordinate a global response.

The agency is also chronically underfunded. With a budget of just $6 billion for the 2022-2023 period, the agency’s vast mandate often clashes with tight financial restrictions limiting what it can accomplish. A lack of trust in WHO within the communities it works with has also been a major obstacle to achieving its goals.

“If we had the trust of the communities we were working with, Ebola would have stopped way fast. COVID would have been managed way better,” Aylward said. “So we’ve got to be trusted in a way we aren’t today. We’re going to have to earn that.”

Civil society and younger generations need to be more involved

The WHO Youth Council held its inaugural meeting this week.

Part of the modernisation programme undertaken by WHO under Tedros’s leadership is the creation of the Youth Council, a network of youth representatives from health and non-health organizations aiming to leverage the “expertise, energy and ideas” of younger generations to assist WHO decision-making. 

“If you want to do something for young people, you have to involve young people,” said Dr Kerstin Vesna Petrič, chair of the WHO Executive Board. “The same is true if you want to do something for the most vulnerable, or for society in general: you have to involve civil society.”

The Youth Council met for the first time just four days ago, nearly 75 years after the agency’s establishment. Two other bodies – the Science Council, a research division, and the Innovation Hub, an accelerator programme – were established in April and May 2021 respectively. 

That these bodies are new reveals the historically insular nature of WHO, but also reflects a wider shift within the organization to expand its horizons beyond the bubble of the health world. 

“We have to move away from being a sectoral organization to a much broader one,” Aylward said. “It should be self-evident at this point: civil society has part of the answers, and the private sector has a big part of the answers.”

Nanjira Sambuli, a researcher and policy analyst at the civil society group Digital Impact Alliance, noted how long it has taken international institutions to engage with communities and stakeholders beyond Geneva.

“Multilateralism over the last 25 years has not really been a system accustomed to working with outsiders,” she said. “But I’m convinced that at the very least if we can leave behind systems and institutions that have done the groundwork, this generation that is inheriting these complexities lead the charge.”

UN agencies working as one

In an era of overlapping crises, WHO and its sister UN agencies have realized the need to deepen collaboration – a shift UN Development Programme director Achim Steiner said must continue. 

“We need integrated approaches. Health is as much dependent on addressing poverty as poverty is a way in which we have to look at the impact of climate change, and the need for adaptation,” Steiner said. 

An example of this kind of integrated approach is the WHO’s One Health Initiative, which launched its first joint plan of action at the World Health Summit in Berlin in October last year. 

The plan – a collaborative effort with the Food and Agriculture Organization of the United Nations (FAO), the United Nations Environment Programme (UNEP), and the World Organisation for Animal Health (WOAH) – aims to break down the silos that have historically separated the work of these agencies to address threats to both health and the environment.

“We have to believe in interdependence,” Tedros said.

Digitization does not fix inequality

As the health systems in rich countries speed into the digital age, nearly one billion people are still treated in health facilities without reliable electricity, or none at all.

One of the inescapable forces driving changes to health systems is digitization. The potential for digitization to accelerate the progress of healthcare systems, improve in quality of care, and assist the world in achieving the Sustainable Development Goal of universal health coverage is enormous.  

But the speed of digitization, and the infrastructure needed to benefit from it, threatens to leave some of the world behind – and create new inequalities.

“Digital technologies will amplify what already exists,” said Nanjira Sambuli, a researcher and policy analyst at the civil society group Digital Impact Alliance. “We must not fall into the trap of imagining that poorly functioning public health systems can merely leapfrog ahead into the digital age.”

As developed countries enter a new era of digitized health systems, nearly one billion people in low- and middle-income countries lack access to health facilities with reliable electricity, with over 430 million people served by facilities with no electricity at all.

“Digital public infrastructure and a deep commitment to equitable access are fundamental,” Steiner said. “At the end of the day, much of what happens in our world is ultimately premised on either the ability to invest, to buy, or to afford to pay for a service.”

‘The World Happiness Organization’

As the panel drew to a close, a final question was raised: should the WHO consider a change in name to reflect the new scope of the organization’s definition of health – perhaps to “The World Happiness Organization”, the moderator mused.

Tedros said he saw no need to change the acronym – after all, as long as human beings are around, there will be health issues to contend with – suggesting instead that the world’s defence ministries that shift their mission towards happiness, and away from war.

“Two trillion US dollars a year are being spent on defence, to kill each other,” Tedros said.  “Then when we say we need more money for health, it doesn’t exist.”

The budget of the WHO is currently $6 billion, 0.3% of what the world spends on defence.  

Image Credits: United States Mission Geneva, John Samuel.

12 African leaders pledge to end HIV in children by 2030

DAR ES SALAAM, Tanzania – Twelve African nations pledged on Wednesday to end AIDS in children by 2030, focusing on ensuring that life-saving antiretroviral (ARV) medication reaches children.

The pledge – known as the Dar es Salaam Declaration – was adopted at the first ministerial meeting of the Global Alliance to end AIDS in Children. The Alliance was formed during the International AIDS Conference in Canada last July.

Speaking during the meeting, Winnie Byanyima, Executive Director of UNAIDS said that the meeting had given her hope: “An inequality that breaks my heart is that against children living with HIV, and leaders today have set out their commitment to the determined action needed to put it right.”

According to her, today’s advanced medical science dictates no baby needs to be born with HIV let alone get infected during breastfeeding and no child living with HIV needs to be without treatment.

The work will centre on four pillars: early testing and treatment; ensuring  that pregnant and breastfeeding women do not pass the virus on to their babies; preventing new HIV infections among pregnant and breastfeeding adolescent girls and women; and “addressing rights, gender equality and the social and structural barriers that hinder access to services”.

Death every five minutes

Currently, around the world, a child dies from AIDS-related causes every five minutes, UNAIDS said in a statement.

Only 52% of children living with HIV are on ARVs in comparison to 76% adults are receiving antiretrovirals, something that the World Health Organisation(WHO) has described as “one of the most glaring disparities in the AIDS response”.

In 2021,160 000 children were infected with HIV. Although children comprise just 4% of people living with HIV, they account for 15% of all AIDS-related deaths, according to UNAIDS Global AIDS updates 2022.

Tanzania is among 12 countries with a high HIV burden that have since joined the alliance.

Others are Angola, Cameroon, Côte d’Ivoire, the Democratic Republic of the Congo (DRC), Kenya, Mozambique, Nigeria, South Africa, Uganda, Zambia, and Zimbabwe.

Tanzania’s Health minister Ummy Mwalimu (centre) welcomes Vice President Philip Mpango

Three UN agencies — UNAIDS, UNICEF and the World Health Organization (WHO) — are behind the initiative, along with the Global Network of People Living with HIV (GNP+), the Global Fund to Fight AIDS, Tuberculosis and Malaria and the U.S. President’s Emergency Plan For AIDS Relief (PEPFAR).

Tanzania’s Vice-President, Philip Mpango, called upon nations to “commit to moving forward as a collective whole”. 

“All of us in our capacities must have a role to play to end AIDS in children. The Global Alliance is the right direction, and we must not remain complacent as 2030 is at our doorstep,” he said.

Zimbabwean Vice-President Constantine Chiwenga said that governments worldwide had lost ground in the fight against HIV/AIDS because of the COVID-19 pandemic, and he urged global health leaders to continue the fight.

“We got affected, just like any other country, when the COVID-19 pandemic hit us,” he said.

Zimbabweans “completely forgot” about HIV/AIDS as they grappled with COVID-19, and as a result, the country’s mother-to-child HIV transmission rate had increased to 8.9%.

“Let us come up with concrete measures which will make sure the spread of HIV/AIDS is brought to a halt,” he said. 

First Lady of Namibia Monica Geingos said that “this gathering of leaders is uniting in a solemn vow – and a clear plan of action – to end AIDS in children once and for all. There is no higher priority than this.” 

UNAIDS believes that progress is possible as 16 countries and territories have already been certified for validation of limiting mother-to-child transmission of HIV and or syphilis.     

While HIV and other infections can be transmitted during pregnancy or breastfeeding, prompt treatment, or pre-exposure prophylaxis (PrEP) for at-risk mothers, can interrupt the process.  

Last year, Botswana became the first African country with high HIV prevalence to be validated as being on the path to eliminating vertical transmission of HIV, meaning the country had fewer than 500 new HIV infections among babies per 100,000 births. The vertical transmission rate in Botswana is now 2% from 10% a decade ago

Women of reproductive age in sub-Sahara Africa are disproportionately affected by HIV/AIDS, Dr Assery Mchomvu, a senior obstetric and gynaecologist at Dar es Salaam’s Mission Mikocheni Hospital, told Health Policy Watch.

“HIV positive women now have a greater opportunity to pursue childbearing goals, with fewer consequences,” said Mchomvu.

But he said that the fight against HIV/AIDS can only be won if there was a coordinated global response to curb new infections and unlimited access to treatment for those already affected.

Wide support

In 2021, 65,000 people died from AIDS-related illnesses, and 1.5 million people were infected with the deadly virus, according to UNAIDS data. And although deaths are down over the last decade, the number of new infections has essentially reached a plateau.

The UN Children’s Fund (UNICEF) welcomed the leaders’ commitments and pledged the agency’s full support. “Every child has the right to a healthy and hopeful future, but for more than half of children living with HIV, that future is threatened,” said UNICEF Associate Director Anurita Bains.

 Peter Sands, Executive Director of The Global Fund, said no child should be born with HIV in 2023 and no child should die from AIDS-related illness. “Let’s seize this opportunity to work in partnership to make sure action plans endorsed today are translated into concrete steps,” said Sands.

“With our country-led partnership model, we provide funding for HIV programmes in over 100 countries. The Global Fund supports HIV prevention and treatment programmes for children and adolescents, including access to early infant diagnosis, innovative testing approaches and family-focused service delivery.”  

Dr John Nkengasong, head of the US President’s Emergency Plan for AIDS Relief (PEPFAR), said that closing the treatment gap for children requires “laser focus and a steadfast commitment to hold governments, and other partners accountable for results”.

“PEPFAR commits to elevate the HIV/AIDS children’s agenda to the highest political level within and across countries to mobilize the necessary support needed to address rights, gender equality and the social and structural barriers that hinder access to prevention and treatment services for children and their families,” said Nkengasong.

“We have ensured that human rights, community engagement and gender equality are pillars of the alliance,” said Lilian Mworeko, Executive Director of the International Community of Women living with HIV in Eastern Africa. “We believe a women-led response is key to ending AIDS in children.”

Image Credits: Peter Mgongo.

A doctor provides health services to children in a refugee camp in northwest Syria during the COVID-19 pandemic.

The World Health Organization (WHO)’s  ‘zero-draft’ of a pandemic treaty proposes that 20% of pandemic-related products – vaccines, diagnostics, personal protective equipment and therapeutics – should be allocated to the global body, which will then ensure their equitable distribution.

The draft, which has been seen by Health Policy Watch, was sent to the WHO’s 194 member states this week, officially opening the door for negotiations on how the world should behave in future pandemics.

According to the draft, half of the pandemic products allocated to WHO (10% of total global production) should be donated while the other half would be bought for an “accessible” price.

No less than 11 of the draft’s 49-clause preamble deal in one way or another with intellectual property rights, signalling the key battleground for upcoming negotiations.

These clauses recognise that “protection of intellectual property rights is important for the development of new medical products”, but highlight their impact on price and access.

‘Use IP waivers’

In the text itself, member states are directed to “take appropriate measures to support time-bound waivers of intellectual property rights that can accelerate or scale up manufacturing of pandemic-related products during a pandemic, to the extent necessary to increase the availability and adequacy of affordable pandemic-related products”.

In addition, parties (member states) are encouraged to “apply the full use of the flexibilities provided in the TRIPS Agreement” and encourage all patent-holders of pandemic-related products to “waive, or manage as appropriate, payment of royalties by developing country manufacturers”.

Manufacturers that get significant public financing will also be encouraged to waive royalties on the continued use of their technology for the production of pandemic-related products. 

Health activist Jamie Love, director of Knowledge Ecology International (KEI), described the draft as being “surprisingly strong on several topics” including intellectual property.

The pandemic treaty is being developed in reaction to what the draft describes as “the catastrophic failure of the international community in showing solidarity and equity in response to the coronavirus disease”. 

Put together by the intergovernmental negotiating body (INB) bureau, the draft will be negotiated in this body – and it is unlikely to survive in its current form given the strong pharmaceutical lobby, particularly in the European Union.

The next meeting of the INB is on 27 February, with the final version of the accord expected to be tabled at the WHO’s 2024 World Health Assembly.

‘Nothing agreed’

The zero draft states it has been developed “without prejudice to the position of any delegation and following the principle that ‘nothing is agreed until everything is agreed’. “

While the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) was still analysing the draft, it described its release as “an important milestone in the negotiation process of the WHO Accord”.

“The innovative pharmaceutical industry has been at the forefront of the response to the current pandemic and as a result is uniquely positioned to contribute to future pandemic preparedness discussions,” according to the IFPMA. 

“We will continue to constructively engage in these negotiations, by emphasizing the lessons learned from the COVID-19 pandemic, and bringing proactive solutions to the table, such as Berlin Declaration.”

Building from the ‘bottom up’

Meanwhile, Dr Mike Ryan, WHO’s executive director of health emergencies, told the WHO’s executive board (EB) on Wednesday morning that the conditions conducive for pandemics – war, hunger, epidemics and natural disasters – were “converging with unprecedented frequency and intensity”.

“Currently, WHO is responding to 55 graded emergencies around the world, which is unprecedented,” said Ryan. “Last year, we supported member states in response to over 75 different health emergencies around the world.

“Over 339 million people are now in need of direct humanitarian assistance, and within those countries affected by fragility and conflict, we’re seeing 80% of the world’s major epidemics occurring.”

Ryan urged countries to build their national action plans for public health security alongside the INB negotiations, stressing that “global health security builds from the bottom up”.

Image Credits: Flickr – Trinity Care Foundation, International Rescue Committee.

Dr Tedros reporting on WHO efforts to root out sexual misconduct

A special unit to address sexual ‘misconduct’, a fund to support survivors in the Democratic Republic of Congo (DRC) and training for all staff are some of the steps taken by the World Health Organization (WHO) to rid itself of exploitative behaviour.

This follows the scandal that played out during the Ebola outbreaks in the DRC between 2018 and 2020, during which 83 women were sexually exploited and abused by WHO staff and allied agencies.

WHO Director-General told the global body’s Executive Board (EB) meeting on Tuesday that 90% of the 150 activities identified by the management response plan to address sexual “misconduct” – the catch-all phrase adopted by WHO – had been completed.

A $2 million fund has been set up to support 83 women in the DRC, some 20 of whom had given birth after their ordeals. Of the 83 women, 23 are “survivors of alleged sexual misconduct by WHO personnel and the other 60 are survivors of alleged sexual misconduct by employees of other agencies,” said Tedros, adding that the WHO was the only UN agency to have set up such a mechanism. 

“In DRC, we have worked with local organisations to reach more than 30,000 at-risk communities. We’re also offering free legal aid to survivors so they can pursue legal action,” he added.

Discrepancies between WHO and UN reports

However, Tedros said that there were a number of discrepancies between the WHO’s report and that of the UN Office of International Oversight Services (OIOS), which had also been investigating allegations of sexual misconduct during the Ebola outbreak in DRC.

According to Tedros, the OIOS had investigated the managerial mishandling of sexual misconduct in DRC and found “that the allegations of managerial misconduct against the three staff members identified by the independent commission were unsubstantiated”. 

“Those staff, who are on administrative leave, are returning to active service,” added Tedros, adding that the WHO has asked its independent external oversight advisory committee to help it to address these discrepancies with OIOS.

In relation to allegations of sexual misconduct by a WHO staff member during the World Health Summit in Berlin last October, Tedros said that the investigation team had completed its report and the case has advanced to the Global Advisory Committee.

“Once that Committee’s review is completed and if the allegations are substantiated disciplinary action will be taken,” said Tedros, who expressed regret that the media had identified the alleged perpetrator.

Dr Temo Waqanivalu, who heads WHO’s work on integrated delivery of noncommunicable disease services, was named by AP as the staff member who is reportedly the focus of a WHO investigation into the Berlin incident. A prior complaint had been made against Waqanivalu in 2017, but the WHO officials did little about it, according to the AP.

“Media reports indicating that at least one individual working in WHO recently alleged to have engaged in misconduct, and having had a record of prior accusations, really needs to be addressed by WHO,” said Loyce Pace, US Assistant Secretary of State for Global Public Affairs, at the EB.

“It’s important to many of us who have faced this personally, in our experience working in the global health and development space, and not just in terms of earlier in our careers, but even now, as seasoned global health professionals,” said Pace.

“There are many of us who stand with survivors and stand with those who identify as victims and are truly committed but also frustrated by where things have stood to date, and hope that we can all come together to do right by people like me, who have these stories to tell,” added Pace.

Loyce Pace, US Assistant Secretary of State for Global Public Affairs.

Zero tolerance

Some 90% of WHO staff had completed UN courses on sexual misconduct, while training had also been run for implementing partners and communities, according to Tedros.

As part of its reform of the policies, systems, structures and culture of WHO “to make zero tolerance a reality, not just a slogan”, all regional offices now have dedicated teams to work on sexual misconduct, he added.

Each of the 340 country offices had a focal person for sexual misconduct in all country offices, and all are being trained, while the head office’s department for the prevention of and response to sexual misconduct is “now fully staffed and coordinating our organisation-wide efforts”.

Tedros described reform of the Department of Internal Oversight Services (IOS) and the establishment of dedicated capacity for investigation of sexual misconduct as “one of the central and most impactful parts of our work in 2022”.

“The changes we have made have increased confidence and trust in our systems, as evidenced by tripling in the number of people coming forward with complaints from 166 in 2021 to 491 in 2022,” said Tedros.

“As promised, we cleared the backlog of sexual misconduct allegations by May of last year. The investigation team is now working on cases in real time because justice delayed is justice denied. We have set and have met a target of 120 days in which to complete investigations into allegations of sexual misconduct.”

spend
WHO EB 2023

One by one, countries demanded the World Health Organization (WHO) spend more on their countries’ needs while debating a proposal to shore up the U.N. health agency’s finances through a replenishment fund, that would be filled by periodic donor drives.

The discussion, which centred around demands to shift spending from WHO’s Geneva headquarters to budget-strapped WHO offices in over 100 low- and middle-income countries  dominated Tuesday’s morning session of its Executive Board (EB) meeting.

For the first time, more than half of WHO’s 2024-25 budget is earmarked for country offices. Despite an overall budget shortfall, African delegations want this increased to 75%. Historically, the region which bears the world’s biggest burden of many diseases, has also suffered from the biggest lack of resources. 

“The uneven funding of this biennium seems to be a repeat of the uneven funding from the previous biennium,” said Mahlet Hailu Guadey, Ethiopia’s Deputy United Nations Ambassador in Geneva, representing the African Union.

Guadey called for the WHO’s Secretariat to review what she described as uneven funding amongst priorities and regions.

The United States, one of WHO’s biggest financial backers, also repeated its conditional approval for increasing WHO’s assessed fees to countries, as long as those increases are  accompanied by new processes ensuring more internal controls and accountability.

Other nations, however, such as Poland, tried to put the brakes on more spending given the financial drain of global crises and conflicts, ranging from the COVID-19 pandemic to Russia’s war in Ukraine.

Flexible funding

Tuesday morning’s EB session was dominated by debate over a plan by WHO’s Programme, Budget and Administration Committee (PBAC) to support a ‘replenishment fund’ for urgently needed flexible funding. The fund would be modelled on the successful funds managed by agencies like The Global Fund and Gavi, the Vaccine Alliance, which succeed in raising billions of dollars through high-profile pledging events, staged every three to four years. 

While expressing support for WHO’s overall goals, EB delegates criticized a system they characterized as a top-heavy bureaucracy that spends too much money on its own divisions and processes instead of in-country programmes.

The EB’s chair, Slovenia’s Dr Kerstin Vesna Petrič, noted the prevailing sentiment to support the use of a replenishment fund filled by voluntary donations from both member states and philanthropies at high-profile events.

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EB’s chair, Slovenia’s Dr Kerstin Vesna Petrič

“I can see we all agree that more money should be given to the member states, but by this, we should all bear in mind that more responsibility will be given to the member states,” Petrič told the meeting.

Put on the defensive, Raul Thomas, WHO’s Assistant Director-General for Business Operations, told delegates that “every $1 invested in the World Health Organization results in a $35 return on investment” and asserted “this is the most heavily consulted budget ever.”

WHO’s Director-General Dr Tedros Adhanom Ghebreyesus tried a bit of diplomacy to bridge the gap between the main funders and those feeling their needs were not getting met. He began by agreeing with the general assertion that countries must be the main focus.

“I think if we’re going to raise the capacity of our programs it will depend on the strength of our country offices,” he said. “We have to equip them with everything.”

Tedros outlined a funding strategy ranging from an immediate focus for the next 100 days to more mid- and long-term planning, with the ultimate goal of turning country office heads into true leaders.

“We cannot use them as messengers, which very often happens,” he said. “Resource allocation is at the center; it’s one of the areas where we said we must make significant progress. And it will be a game changer.”

Tedros explained, as he often has in the past, that WHO’s income comes from two principal sources. One is assessed contributions, which comprised only around 14% of the last budget. These are the annual, compulsory dues that 194 member nations pay, using a formula based on each nation’s GDP.

Members’ dues provide a stable, predictable source, and the funds can be used as needed for global health priorities.

The other 86% of the budget comes from voluntary contributions by member nations, philanthropic foundations and other donors, and usually covers only short-term projects meaning that funding is less flexible because it’s earmarked and is also not guaranteed.

“What we’re saying now cannot happen if we’re going to rely on 86% of contributions from voluntary and earmarked where it should be spent,” Tedros told the EB. “This is a very opportune time but it’s also a crossroads.”

Only 14% of budget covered by members’ dues

The proposed 2024-25 budget being considered by the EB emphasizes the need for sustainable financing.

“The pandemic highlighted WHO’s longstanding challenge of sustainable financing. The organization’s ability to make an impact is limited by a funding model in which only 14% of WHO’s funding is fully flexible and predictable (while the remaining funds are dependent on generous donors, heavily earmarked and arrive at unpredictable times),” the budget says.

In May 2022, it notes, WHO’s member nations made a landmark decision to increase assessed contributions to represent 50% of the base programme budget by 2030–2031.

The draft proposed programme budget for 2024–2025 “benefits from this decision – it has been developed on the expectation of a 20% increase of assessed contributions (from the approved levels of 2022–2023), marking a historic move towards a more empowered and independent WHO,” it says. “This development reflects the increased trust in WHO to serve its member states.”

Rather than complaining about WHO’s funding, nations can make recommendations for fixing the system by engaging in efforts to “help us see whether the formula we’re using is wrong or not,” Tedros suggested. “If the formula – the allocation mechanism – is faulty, then definitely the sharing will not be right and you will not have a right to complain.”

The EB is expected to discuss the PBAC proposal further this week, before deciding whether to pass the initiative to a vote by the World Health Assembly in May.

Currently, member state assessments cover only about 16% of WHO’s budget needs. At last year’s World Health Assembly, nations agreed to cover half of WHO’s core budget through assessed contributions from member states by the year 2030, with an initial stepwise increase of 20% for this budget year.  That, however, still leaves a major shortfall in the agency’s annual budget of about $3 billion annually, underlining the need for a replenishment fund, proponents say.

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Youth masked up as COVID-19 pandemic hit the world.

A new study found COVID-19 has emerged as a leading cause of death in children and young people in the US, ranking eighth overall between August 2021 and July 2022.

The Oxford University study determined that COVID-19 was the underlying cause of death for more than 940,000 people in the US, including over 1,300 deaths among children and young people up to 19 years of age.

Until now, the study concluded, it had been unclear how the burden of deaths from COVID-19 compared with other leading causes of deaths in this age group.

Using data from the US Centers for Disease Control and Prevention (US CDC), researchers found that infants aged less than a year were the most vulnerable with a mortality rate of four per 100,000. Deaths in children and infants were particularly high during the Delta and Omicron waves of COVID-19.

Among the studied group of children and young people, COVID-19 ranked first in deaths caused by infectious or respiratory diseases. In the category of disease-related causes of death, COVID-19 ranked fifth overall. Among all causes of death, it ranked eighth.

COVID-19 also was the underlying cause for 2% of deaths in children and youth in the US, putting it ahead of influenza and pneumonia as a factor in mortality. 

“These results demonstrate that while it’s rare for kids and teens to die in the US, COVID-19 is now the leading underlying cause of death from infectious disease for this age group,” said Dr Seth Flaxman, the study’s lead author.

“Many of the 82 million American children and young people were infected during the big Delta and Omicron waves,” he said, “and as a result, more than 1,300 children and young people have died from COVID-19 during the pandemic, most in the last two years.”

Explaining the seriousness of the issue, Dr Robbie M. Parks, a co-author of the study, said that the deaths in children and youths due to COVID-19 is higher than the deaths caused by a few other diseases before vaccines became available. 

“If you look at infectious diseases in children in the US historically, in the period before vaccines became available, hepatitis A, rotavirus, rubella, and measles were all major causes of death,” said Parks

“But when we compared those diseases to COVID-19, we found that COVID-19 caused substantially more deaths in children and young people than those other diseases did before vaccines became available,” he said. “This demonstrates how seriously we need to take COVID-19 prevention and mitigation measures for the youngest age groups in the US and worldwide.”

Image Credits: Photo by Carlynn Alarid on Unsplash.

‘Cautioning that the Secretariat not to get ahead of member states:’ Loyce Pace, US Assistant Secretary of State for Global Affairs in debate over WHO reform proposal.

A new 10-point proposal by the World Health Organization’s Director General Dr Tedros Adhanom Ghebreyesus for improving preparedness and response to health emergencies received mixed reviews from WHO member states in Monday’s opening session of this week’s Executive Board (EB) meeting, the agency’s 34-member governing body. 

It was the first substantive issue to be tackled in the eight-day long EB meeting packed with an agenda of over 50 draft proposals and resolutions on items ranging from emergency pareparedness and response to non-communicable diseases. Charged management issues, ranging from sustainable finance to the organization’s handline of recent sexual harrassment claims will also be taken up by the EB.

The Director General’s 10-point proposal on “strengthening the global architecture for health emergency preparedness, response and resilience” calls for the creation of a new WHO Global Health Emergency Council, which would aim to liaise more efficiently between WHO’s Secretariat and its Member states in health emergencies and outbreaks, and meet during the World Health Assembly. 

The proposal also calls for massively expanding the size and scope of a  WHO Contingency Fund for Emergencies (CFE) to include broad support to member states’  “including deployments through the health emergency workforce and emergency supply chain” of medical products.

And the initiative calls for scaling up a system of member state peer reviews of emergency preparedness to increase “transparency”.  

The WHO proposal synthesizes more than 300 recommendations of several independent panels that reviewed WHO and member state response to the COVID pandemic, the report stated.

Initiative raises fears of ‘duplication’, moving ahead of member state negotiations

While member states gave positive reviews to the WHO proposal’s overall aims  – ensuring more fair, equitable and transparent management of crises – they stressed that concrete reforms are already the focus of two member state fora – and that’s where the discussion should focus. Those include the Intergovernmental Negotiating Board (INB) due to issue a zero draft for a proposed pandemic treaty later this week, as well as another member state working group that will look at more targeted revisions to the circa 2005 International Health Regulations (IHR), the rules currently governing emergency response.   

Japan joins the UK, USA and China in rare accord that member states should hold reins of emergencies reform wheel at the WHO Executive Board meeting Monday.

In a moment of rare agreement between often rival nations – the United Kingdom, China and Japan all expressed hesitations over the creation of a new WHO “Global Health Emergencies Council”, proposed by Tedros, ad meeting during the annual member state World Health Assembly. 

The UK said it “echoed China’s concerns about being careful about creating new institutions and mechanisms” which might duplicate the work of other bodies. 

“I think the risk is that there are multiple mechanisms already,” the UK’s EB delegate said, asking. “Do adding new mechanisms add, or do they actually make it more complicated to navigate?”

Japan, meanwhile, asked whether it was feasible to create yet another body that convenes during the already packed week-long session of the WHA “unless we have a clear idea of what will be discussed and decided by the council.

“Who will be preparing the materials for discussion?” Japan’s EB delegate asked wondering “whether a schedule [of meetings during the WHA] is feasible since we already have Committees A and B?” He was referring to the two main WHA sub-committees in which proposals are debated and decided during the WHA session.  

Meanwhile, the USA warned against the WHO administration “getting ahead” of member states’ own negotiations over a new Pandemic Treaty, or accord. Those discussions, led by the INB, are already taking up most of the same topics that the WHO Secretariat paper covers, said Loyce Pace, US Assistant Secretary of State for Global Public Affairs.  A ‘Zero Draft’ of the pandemic treaty framework is due to be published on Wednesday.  

“We’re grateful that they have a proposal that draws attention to those negotiations. But we’re still cautioning that the Secretariat not to get ahead of member states in terms of putting forth an architecture that hasn’t yet been agreed, and that would arguably require approval from member states and buy-in from relevant international institutions so they could be operationalized,” Pace said. 

Ensuring equity as a cross-cutting principle 

Echoing Brazil Peru says ‘fairness’ needs to be the foundation of reforms.

Brazil, likewise, said that the essence of proposals brought forward in document by Tedros and the WHO adminisration is already being debated in the INB and the IHR working groups.   

“The difference is that this process has been developed in a much more transparent and inclusive way, with clear participation by non-state actors,” said the Brazilian delegate. 

“Both of these work streams are entering a critical phase this year. Now it’s the time to concentrate our effort to have meaningful debates within those two mechanisms in order to come up with innovative, game changing norms.”

He called for the WHO administration proposal to be referred to the IHR and pandemic treaty negotiating bodies “where they can be discussed and fully developed.”

Brazil also said that proposals to change the way global emergency response unfolds need to include equitable access to medical countermeasures as a cross-cutting theme, along with “respect and promotion of human rights and racial and gender equity.”

Echoing Brazil, Peru added that, “one of the pillars of global architecture when it comes to preparedness and resilience in the face of future health emergencies has to be the principle of fairness.”

Revisions to the existing International Health Regulations as well as a new pandemic accord should “allow for a universal universal access to measures such as vaccines, without any privileges or discrimination, and will face challenge questions related to R&D, intellectual property technology transfers, and expanding the manufacturing capacities at the local level …in the context of emergencies,” added the Peruvian EB delegate. 

African Group – more WHO and donor support to countries   

Equitable access to health products and more support for WHO country offices – Ethiopia speaks on behalf of the African group of 47 countries at the 152nd session of the WHO Executive Board

Meanwhile, Ethiopia, speaking on behalf of the African group of 47 states stressed that in a time when many countries in the region are facing a complex array of climate-related and infectious disease health emergencies, “less than 10% of African countries have adequate human resources with technical emergency know how to prepare, detect and respond to emergencies.” 

There is also a “large reliance on international funding due to limited capacity to mobilize sustainable and predictable resources domestically.”

She called for “stronger support of the WHO country offices in strengthening the IHR capacities,” as part of the solution as well as underlining the importance of “greater coordination across the funding landscape to ensure that existing funding flows are ….targeted to the most critical gaps at the global regional and national level. And that this role should be augmented by additional catalytic gap funding.

She also called for a greater role for African representation in the new World Bank -managed pandemic fund, and other governance mechanisms. 

“We would also appreciate a greater focus on equitable access to health products, technologies and know-how, and as such, funding and capacity incentives for states to report information to the international community to be further explored. 

Dr Tedros opens the WHO executive board meeting.

Supporting 100 million tobacco users to quit, increasing exclusive breastfeeding for babies under six months to 48% globally, and helping 63 countries to build climate-resilient health systems are some of the recent successes of the World Health Organization (WHO), said Director General Dr Tedros Adhanom Ghebreyesus.

Addressing the opening of the WHO’s executive board (EB) meeting on Monday, Tedros said that the global body was focused on “promoting, providing, protecting, powering and performing for health”.

The 152nd session of the Executive Board, which runs until 7 February, has a very heavy agenda – ranging from a series of initiatives to improve global emergency response to an updated menu of WHO-recommended “best buys” to fight non-communicable diseases. The EB’s approval of draft resolutions and decisions is a prerequisite to bringing most proposals before the World Health Assembly (WHA) in May.  The EB also plays a watchdog role, vis a vis the 9000-member WHO’s finance and budet planning, advising on strategic directions for the global body’s work.

Protecting health during conflicts and humanitarian crises constituted a huge part of the WHO’s work in 2022 as it responded to 72 graded emergencies last year, “including three public health emergencies of international concern, outbreaks of Ebola and cholera, conflicts in Ethiopia, Syria, Ukraine and Yemen, and humanitarian crises in the greater Horn of Africa, the Sahel and much more”, said Tedros. 

“Thanks to the generosity of donors to the Contingency Fund for Emergencies, we were able to release more than $87 million immediately to support rapid response, and we delivered essential health supplies to 90 countries from our Dubai logistics hub in the United Arab Emirates,” said Tedros.

Africa demands an increase in country allocations

However, in reaction to the speech, Botswana for African Union called on the WHO to strengthen the African region, and particularly strengthen the region’s WHO country offices, which are historically under-resourced and staffed, so that they can better support national ministries responding to health crises.

“We call on the WHO to enhance capacity at the regional and national levels in order to accelerate progress. Currently, the regional office needs both technical and financial support in order to effectively address and support country needs,” said Botswana.

While for the first time, over one-half of WHO’s 2024-25 budget has been earmarked for country offices, Botswana called for this to be increased to 75% to “address the budget and funding imbalances”, declaring that this was “a precondition for the increase in assessed contributions” from member states.

For many member states’ reacting to Tedros’s speech, Russia’s war in Ukraine loomed large as a huge impediment to global well-being.

Demark condemns Russia’s aggression in Ukraine.

Russia’s war in Ukraine

Denmark, representing the 27 European Union member states and seven aligned countries, said that “nearly 750 attacks on health care have been verified in Ukraine” while the Office of the UN High Commissioner for Human Rights has reported a total of 17,023 casualties in Ukraine”. 

“Russia’s military aggression has triggered energy and food supply challenges, exacerbating existing food system vulnerabilities that have already been weakened by the effect of climate change and the COVID-19 pandemic. The huge impact of conflict on health and well being of people and societies is the case in all ongoing conflicts across the world.”

Canada, the US, the UK and Japan also condemned Russian aggression and its impact on the people of Ukraine and food security.

However, in response, Russia warned that “the politicisation of the WHO agenda is unacceptable and this will simply lead to increased inequality and a deterioration of the situation in developing states”.

US warning on sexual and reproductive rights

US assistant secretary of state for global public affairs Loyce Pace

Meanwhile, both the US and Brazil indicated that they would oppose any attacks on sexual and reproductive health and rights.

Loyce Pace, US assistant secretary of state for global public affairs, said that the US “prioritises efforts to promote universal health coverage through strengthening primary health care and protecting people from catastrophic spending”.

In addition, said Pace, US is focused on “ensuring the health and rights of lesbian, gay, bisexual, transgender, queer and intersex individuals and communities because we will not accept intolerance or discrimination of any people. We look forward to the EB’s discussions in this area”.

Last year’s World Health Assembly stalled for hours over the inclusion of phrases such as men who have sex with men in a technical document on HIV, facing significant opposition from countries form the Mediterranean and North Africa (MENA) region of WHO.

Brazil backed the US, saying that it too will “work with all the partners to improve the respect for human rights, in particular when it comes to gender and racial equality, sexual and reproductive health and rights”.

“We will fight discrimination based on sexual orientation and gender identity and promote the rights of people with disabilities and indigenous peoples. In this regard, I would like to announce our intention to put forward the resolution on the health of indigenous peoples a topic never addressed directly before by the World Health Assembly with the objective of ensuring the right to health according to their own requirements and under their own administration,” said Brazil’s representative.