Staff Association President Catherine Kororei Corsini

Shortcomings and failures in the World Health Organization’s internal justice system  –  laid bare during revelations of sexual abuse and exploitation in DR Congo –  require more systematic reform to make the system transparent, fair and equitable, the head of WHO’s Staff Association told WHO’s Executive Board governing body on Wednesday.  

“Delays in responding to allegations of wrongdoings still affect the work environment of too many WHO personnel,”  said Staff Association President Catherine Kororei Corsini, delivering both oral remarks and a written statement to the EB. 

While the DRC cases have received wide media attention, broader issues need to be resolved, she noted. Among those, she said that the Organization had yet to “revise and share its investigation policy, and to establish time targets and indicators for monitoring investigations.” 

“We need an internal justice system that is well functional and able to deliver in a timely manner. We need a system that all staff have confidence in. We have on several occasions said that justice delayed is indeed justice denied.” 

In a written statement that went further, the Staff Association added that staff members who feel that they have been wrongly accused remain on an “unequal footing” with the organization – when forced to take on expensive appeals of their cases beyond WHO internal channels – to the broader UN tribunal, of the International Labour Organization (ILOTA).  

“Today, many staff members are not able to exercise their right to an appeal process because they cannot afford the legal fees,” statement by Staff Associations representing some 9000 people employed in WHO’s global organization as well as UNAIDs. “Staff members who feel they are victims of wrong-doing by the Organization are in a disadvantaged situation vis-à-vis the Organization in terms of means for the defence of their case. In particular, staff members must personally spend considerable amounts of money from their salaries or savings to pay for a lawyer. 

“That is the case even when they benefit from the limited insurance coverage provided by the staff associations, a benefit that staff in regions do not have. Some staff are even obliged to take out a private financial loan to be able to afford the appeal process. The staff member is thus on an unequal footing with the Organization in the face of litigation.

“We need an internal justice system that is well functional and able to deliver in a timely manner. We need a system that all staff have confidence in. We have on several occasions said that justice delayed is indeed justice denied.” 

Comments Follow Reports of Sexual Abuse Scandals in DR Congo

A series of media reports have recently come to light about extensive sexual abuse scandals in DR Congo

The comments came on the heels of a lengthy discussion by WHO member states at last week’s World Health Assembly about a series of recent media reports  of extensive sexual abuse and exploitation of Congolese women by WHO aid workers supporting DRC response to the 2018-2021 Ebola epidemic. 

Coinciding with those debates, some 54 member states and the European Union signed a joint statement voicing concerns over the allegations of sexual exploitation and abuse – and even more critically – the possibility that “WHO management knew” – but failed to report about some allegations or even acted to “suppress the cases.”  

“We expressed alarm at the suggestions in the media that WHO management knew of reported cases of sexual exploitation and abuse, and sexual harassment and had failed to report them, as required by UN and WHO protocol, as well as at allegations that WHO staff acted to suppress the cases,” said the joint statement. 

 

In remarks to the EB, the Staff Association President expressed the dismay of WHO staff over the reports and the way in which they had first been publicized by the media, but also pointed to the wider gaps and shortcomings this  had revealed in the internal justice system:    

“When misconduct on the part of members of the WHO workforce goes unaddressed. And this is not dealt with swiftly, transparently and rapidly, the reputation of the organization is damaged,” she noted in her presentation, which called for the implementation of a long-delayed  “360 degree” performance review system to address current shortcomings. 

Added the written statement: “With the required resources in place, like funding, Human Resources tracking and accountability systems, etc, incidents such as this would have been rapidly investigated, and more importantly, support would have been provided immediately to the women and children affected.”  

The statement laid out a six point plan for: “a more transparent and global approach” to WHO’s internal justice system; “fair and adequate access to justice mechanisms”; more “solutions-oriented” WHO administrative management of appeals; as well as more “transparent global reporting” and a “review of reporting lines” for review and judgment of staff cases. 

WHO Steps Addressing on Internal Justice 

In his remarks before the Executive Board, WHO Director General Dr Tedros Adhanom Ghebreyesus noted that he had created an open door policy in the Director General’s Office – where staff issues and complaints could also be aired with him directly during designated hours. He said he was encouraging managers at other levels of the organization to do the same thing.

“Frequent dialogue helps to address issues,” he said. 

He added that WHO is beginning to pilot a 350 degree performance system – which has received broad endorsement from WHO member states at the EB meeting. 

Although he noted that there remain disagreements with staff about where those pilots should begin – with senior management – or with more rank-and-file staff , “we will continue the discussion and finalize as soon as possible.”  

Tedros also said that WHO’s Internal Oversight Services (IOS) department, which manages the first two steps of internal justice review, is receiving extra funds to clear its backlog of cases. 

“They have now designed a proposal to address the backlogs and focus on the fresh investigations that they need to do. We will continue to support them. The support we gave them this year is based on their proposal, we haven’t even reduced any penny from what they proposed to have in order to close the backlogs,” the Director General said.  “As the president said, justice delayed is justice denied.”

Tackling Sexual Abuse & Exploitation 

who
Dr Tedros addressed WHO staff today at the organisation’s 149th Executive Board meeting

Speaking last week at the WHA as well as a special strategic meeting on the Assembly’s margins,  Tedros also announced a series of new initiatives to tackle sexual harassment at all levels of the WHO. 

This effort involves the creation of an Independent Commission, based in Goma, DRC, supported by a “mass of inspectors” to prioritise investigations in at least eight countries.

“We have decided to adopt new ways of doing it by appointing an independent commission. And also, by letting the Independent Commission to hire an external firm  to investigate. 

“Doing things the same way again and again will not get us a different result. That’s why we’re doing it differently so we can get a different result with regard to identifying perpetrators and also identifying the systemic problems,”  Tedros said.

The sex-for-jobs scandal has been focused in the Democratic Republic of Congo (DRC), where dozens of workers alleged abuse by WHO employees during their work as responders in the 2018-2021 Ebola outbreak. One nursing assistant had charged that a WHO doctor offered her a double salary in exchange for sex, one of multiple misconduct cases WHO allegedly knew about but failed to act on.

Independent Commission Inquiry Interrupted by Volcanic Explosion 

Goma residents flee city night of 22 May after volcanic eruption

 

However, the work of the Goma-based Independent Commission had only just begun when it was interrupted. 

The Commission’s contractor Justice Rapid Response (JRR) began its field investigations in Goma on 3 May.   Then on 22 May, the eruption of the Mount Nyiragongo volcano nearby, followed by constant earthquakes and tremors in the region, led to the suspension of activities. The ongoing risks of further eruptions, earthquakes, and the possible release of dangerous methane gas buried in adjacent Lake Kivu, has since led to the displacement of some 400,000 people, creating a massive humanitarian emergency.

“As you can imagine, the situation on the ground is very challenging starting from the security problems that exist in North Kivu, with disruptions to the Goma area caused by the volcanic eruption over the past week,” the WHO DG said last week. 

Over 50 Member States Express Concerns About Sexual Abuse & Exploitation In WHO

Stephanie Psaki, Senior Advisor on Human Rights and Gender Equity, HHS Office of Global Affairs, speaks out on sexual abuse issues at World Health Assembly

Speaking at the Assembly, Stephanie Psaki, Senior Advisor on Human Rights and Gender Equity in the US Office of Global Affairs, Department of Health and Human Services, said that member states needed to hold WHO to the highest standards of protection from sexual exploitation and abuse.

“We must work together to ensure that perpetrators face the full measure of accountability for sexual exploitation, harassment  and abuse of authority,” she said.

“Regular collaborative attention to these issues, especially in terms of ensuring locally appropriate prevention and risk mitigation measures, is necessary for decisively responding to these issues. We look forward to making tangible progress on this issue so accountability and healing can begin,” she concluded.

The focus of future inquiries should not be limited to DRC, noted Ghana’s delegate to the WHA, Iddrisu Yakubu.

“Moral grandstanding and tactic attempts to associate the problem with a particular WHO country or region, by fixating on a media report from a particular country while ignoring similar reports from other regions will not solve the problem of sexual exploitation and abuse, which as we all know, is a real danger in many countries and organizations. The WHO needs our support to address what is essentially a structural problem afflicting many of our own national institutions,” he said.

Image Credits: WHO, WHO, @GuerchomNdebo, WHO .

The United States representative to the Executive Board on Wednesday – speaks out sharply about Syrian and Belarus health and human rights violations.  

United States charges against Syria and Belarus for human rights abuses, including reference to a “ruthless Assad regime”, were a major theme at Wednesday’s World Health Organization (WHO) Executive Board meeting – in what may also be a signal by Washington to Russia ahead of a high profile “Geneva Summit” that the US is going to take a harder tact on human rights.    

US President Joe Biden and Russia’s Valdimir Putin are set to meet on June 16 in Geneva for the first time since Biden became president.  The meeting follows four years in which US President Donald Trump was perceived by many critics as often courting Putin’s favor while sidestepping divisive issues such as the human rights record of Russia and its proxies.  

The US statements may also be a signal to WHO member states – that if the global health forum is going to remain a place where Taiwan is sidelined and politically-charged debates on health conditions in the Occupied Palestinian Territories regularly take place – then Washington will have its say on issues that concern it, as well. 

Last week the Israeli-Palestinian conflict took centre stage for a full day at the World Health Assembly gathering of all 194 WHO member states during a debate on a WHA resolution decrying “Health conditions in the occupied Palestinian territory, including east Jerusalem and the occupied Syrian Golan”. The prolonged discussion drew protests not only from the US delegate, but also from the United Kingdom and other allies that noted the WHA accords no comparable amount of attention to health conditions specific to other conflict zones and humanitarian settings.  

Election of New Executive Board Members 

The debate over Syria and Belarus occurred as both countries were elected to represent their respective regions in the WHO Governing Board  – the 34-member state steering committee that is supposed to guide and watchdog the activities of WHO at close range. 

Palestine and Taiwan excepting, member states usually try to avoid direct attacks on other members. They even more rarely criticize the selections of countries from other regions to the governing body, per se.  But in today’s session, the criticism was sharp and repeated – beginning with protests by the United States, as an outgoing EB member concluding its own three-year term.   

“We know that members of the Executive Board are expected to uphold universal values and human rights. Unfortunately, we have grave concerns that the governments of two new board members, Belarus and Syria do not share these values as demonstrated by their respective human rights violations and abuses against their own citizens – as overwhelmingly condemned by the international community,” said the US representative to the EB in a statement. 

Added the US, “In particular, we know Syria’s track record of conducting chemical weapons attacks, harming civilians and striking medical facilities, as well as first responders. The United States takes this opportunity to reinforce the expectations of members of the Executive Board, and call on the governments of both Belarus and and Syria to respect human rights. We also call on Syria to allow for the unimpeded access of life saving humanitarian aid, including medical supplies, regardless of where those in need are located.”

Syria and Belarus Reply 

Syria decries “politicization” of WHO forum.

The US comments brought swift and sharp replies from Syria and Belarus, also supported by Russia – which accused the United States of, in Syria’s words, “politicization of the WHO”    

Protesting the allegations of chemical weapons use and bombings of health facilities, Syria’s representative accused the US of “an effort to destabilize our countries by supporting terrorism, as well as aggression and occupation…. That destroy the quality of life in our countries.”

As the language became even more heated, Syrian charged that the US allegations of chemical weapons use by Damascus were “part of fake news campaigns that have no justification,” adding that “the United States actually creates humanitarian crises by pillaging human and economic resources, supporting militias and terrorist groups.”

The debate would better be consigned to the UN Human Rights Council, Belarus added, saying: “When we think about the flagrant violations of human rights in the US, we’re thinking about things like racism, violation of the right to peaceful process. We have seen also that millions of people in the United States are deprived of their right to medical care in many cases. I do hope that in the future such discussion will be held only in the Human Rights Council – and not here at the Executive Board –  and we would hope that a similar approach would be taken by other countries, our partners here within the WHO Executive Board.” 

US Comes Back Again 

Belarus lashes back at US record on racism and civil rights.

At the EB’s afternoon session, however, the United States came back to the Syrian issue again – focusing, in particular, on the destruction of health facilities by the “ruthless Assad regime”. 

The comments were a clear reference to the pattern of Syrian bombings and artillery fire aimed at hospitals and clinics located in areas held by Kurdish or other opposition forces – although the opposition groups were not cited by name.  

“We condemn in the strongest terms the repeated attacks impacting health and other civilian facilities throughout the conflict in Syria,” said the US.   

“We do believe issues raised by my government are within the purview of the UN. In fact, the evidence compiled by the UN’s Board of Inquiry clearly supports what we have known throughout this conflict:  the ruthless Assad regime and its allies have destroyed, hospitals, schools, and civilian infrastructure. 

In addition, Washington added, the US sanctions against the Syrian regime, “generally do not target provision of humanitarian goods including medicine, medical supplies and food to Syria. 

“The Syrian sanctions program provides authorizations, exemptions and general licenses for humanitarian aid and medical supplies to reach the Syrian people, including US-funded humanitarian aid to regime-held areas. 

“The regime is the one obstructing the access to humanitarian and medical assistance to all Syrians in need.” 

As for Belarus, the United States said the government had a demonstrated record of “human rights violations condemned by the international community; in particular the regime continues to deploy mass detentions, police brutality, and other abuses against peaceful protesters journalists and other members of civil society.”

In one note of irony, Turkey sided with the United States with regards to its criticism of Syria.  Said the Turkish representative attending the EB meeting as an observer: “Turkey would like to note its concern that in light of the Syrian regime’s record in targeting civilian healthcare facilities and health workers, its representation at the board is regrettable.”

gavi
Left to Right, clockwise – Olly Cann, Michael Froman, Seth Berkley, Marie-Ange Saraka-Yao

The WHO-sponsored COVAX facility raised another US $2.4 billion on Wednesday from donors to fund more COVID vaccines for low- and middle-income countries – exceeding their total funding target and bringing the total pledged to the COVAX AMC to US $9.6 billion, following a GAVI COVAX AMC Summit “One World Protected” virtual event.

But the 54 million donations in vaccines that were also offered by rich countries at the event – still fall far short of the 1 billion doses that WHO and other global health leaders say are needed by 1 September to fill immediate needs for fighting the pandemic.

The summit, hosted by the government of Japan and Gavi, the Vaccine Alliance, garnered donations from nearly 40 governments, the private sector, and foundations.

The donations will enable COVAX to secure 1.8 billion fully subsidized doses of COVID-19 vaccines for delivery to LMICs participating in the COVAX facility.

The vaccines, to be delivered in 2021 and early 2022, will protect almost 30% of the adult population against COVID-19 in these 91 participating countries. 

“Thanks to all our donors, we can now protect not only healthcare workers, the elderly and other vulnerable people but broader sections of the population, increasing our chances further of bringing the pandemic under control,” said Gavi Board Chair Jose Manuel Barroso. 

Donations Bring Hope in Overcoming COVID-19

Japan’s Prime Minister Suga Yoshihide

Gavi has received tremendous support in particular from Japan, which has pledged US $800 million at the summit, making their total contribution to the COVAX AMC US $1 billion. 

“Delivering more vaccines through the Gavi COVAX AMC Facility is the key to overcoming this pandemic. Today’s summit has brought hope to the world in both overcoming COVID-19 and building back better,” said Japan’s Prime Minister Suga Yoshihide.

The United States, which hosted the launch of the Gavi COVAX AMC Investment Opportunity in April, reaffirmed its support as a Gavi partner on Wednesday, committing US $4 billion for procurement and delivery of COVID-19 vaccines.    

The European Investment Bank (EIB) has also stepped up to support African Union countries with EUR 300 million financing to access vaccines via COVAX. 

According to Marie-Ange Saraka-Yao, Gavi Managing Director of Resource Mobilization and Private Partnerships, Gavi is working with the EIB to leverage access to domestic resources for vaccine doses.

“The key here is that financial innovation needs to continue,” said Saraka-Yao. 

Dose Sharing Boosted, but More Vaccines Needed To Prevent Deadly Mutations

The first shipment of vaccine doses by the international COVAX facility reached Ghana in February

Alongside financial pledges, first dose sharing donations were announced by Belgium, Denmark, and Japan, as well as additional pledges from Spain and Sweden, boosting short-term supplies by over 54 million vaccine doses.  

However, Gavi remains “deeply concerned about the short-term disruptions we face,” said Gavi CEO Seth Berkley, citing the second wave in India that has deeply impacted early secured supply and consumed all of the country’s production, leading to a shortfall of 190 million doses. 

“We need all countries that have doses to share a portion of them with COVAX now, so that we can get them into the hands of those who are most at risk of the virus and help prevent the emergence of more deadly mutants,” said Gavi CEO Seth Berkley. 

The WHO had appealed for vaccine donations last month in the midst of the shortfall, with manufacturers that have reached agreements with the facility – Moderna, Novavax, and Johnson and Johnson, only able to deliver later in the year or in 2022. 

Bilateral Agreements May Undermine Equitable Access

Gavi also addressed the potential that bilateral agreements for donations may undermine COVAX. 

“If we want to get equitable access, the problem is that if countries are picking their favorites, there will be countries that will not be the favorites,” said Berkley. 

“Despite a massive effort to scale up and produce billions of vaccine doses, COVID-19 vaccines currently are not reaching all priority populations worldwide,” said Director General of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) Thomas Cueni, during the summit. 

Gavi does not take into account bilateral donations, so one of the advantages of going through COVAX, is that [doses] can be adjusted to be part of equitable allocation, added Berkley.   

Gavi is currently looking for doses from manufacturers with long shelf-lives and are pre-qualified for use. 

“Speed is the critical issue here and that’s why we’re trying to have a systematic process,” said Berkley, noting the difficulties of getting vaccines without a complex regulatory mechanism.  

Private Sector Crucial in Running Biggest Immunisation Campaign

The private sector is crucial to COVAX’s vaccination campaign.

In addition to government and foundation donors, Gavi emphasized the importance of its private sector partnerships in mobilizing resources towards vaccine equity.  

“The private sector really is in Gavi’s DNA. Of course, there’s funding, there’s reserving, there’s building capacity, but there’s also the process of vaccinating, and then we need the expertise of the private sector,” said Saraka-Yao. 

“This will be critical in running the largest immunization campaign ever.”

Mastercard, alongside existing partners such as Google.org, the Visa Foundation, has increased their financial donations. 

The company has pledged US $28 million in a new commitment.  

“We’re not a pharmaceutical company but it’s obvious to us that we thrive when economies around the world thrive, and our business is healthier when people are healthier,” said Vice Chairman and President of Mastercard Michael Froman. 

Image Credits: WHO, Gavi, Jose Manuel Barroso/Twitter, WHO Ghana, Eric Fiegl-Ding/Twitter.

Humans can typically be exposed to bird flu at live poultry markets like this one in Xining, China.

The World Health Organization(WHO) is working with Chinese authorities to assess the circumstances around the first documented case of human infection with a rare strain bird flu known as H10N3.

This is after a 41-year-old man in China’s eastern province of Jiangsu, located northwest of Shanghai, tested positive for H10N3 on May 28 – a month after he was hospitalised in an intensive care unit on 28 April.

The China’s National Health Commission (NHC) alerted WHO on Tuesday of the detection of human infection with avian influenza. No other cases of human infection with H10N3 have been reported globally, it added.

The Chinese authorities, however, provided no details on how the man was infected.

Although this is the first case of infection with the H10N3 strain, other bird flu strains have been found to have high mortality rates in humans – thus the heightened concerns over human infection with any new strain of the virus.

While there are instances of human-to-human infection with other deadly bird flu strains, they have been rare.

“WHO, through the Global Influenza Surveillance and Response System (GISRS) continuously monitors influenza viruses, including those with pandemic potential, and conducts risk assessments,” WHO said in response to a query from Health Policy Watch.

The Chinese NHC said it has instructed Jiangsu Province to carry out prevention and control measures in accordance with relevant plans, and that it has organised expert risk assessments.

“Experts assessed that the whole gene analysis of the virus showed that the H 10 N 3 virus was of avian origin and did not have the ability to effectively infect humans, the NHC asserted. 

No human cases of H10N3 have been reported globally , and the H10N3 virus among poultry is low pathogenic to poultry.

No Published WHO Alert So Far

While acknowledging China’s report, WHO said that it had not yet posted any information about the incident on its website.

However, in its response, WHO stressed that it was not merely relying on reports from Chinese authorities, but was also using its International Health Regulations (IHR) and the Epidemic Intelligence from Open Sources (EIOS) to monitor and investigate the matter.

“Under the IHR, there is the possibility for WHO to take into account reports from sources other than notifications or consultations,” said WHO.

It said the GISRS, through its various surveillance, monitoring and alert systems,  is in place to protect people from the threat of influenza.

The Chinese man is now in a stable condition and he is ready to be discharged.  Emergency surveillance of the local population found no other cases, the Chinese reports stated.

Avian influenza Type A viruses infect the respiratory and gastrointestinal tracts of birds and have been found in more than 100 different species of wild birds around the world, according to the U.S. Centers for Disease Control and Prevention (CDC).

While these viruses don’t normally infect humans, birds can shed virus in their saliva, mucous and faeces, the CDC says. Human infections can occur if enough virus gets into a person’s eyes, nose, or mouth.

Experts suggest that the public should avoid contact with sick or dead poultry , try to avoid direct contact with live birds, pay attention to food hygiene , and improve self-protection awareness. It urged the public to seek medical help if they experience flu-like symptoms and respiratory problems.

Symptoms of avian influenza A virus infections can be accompanied by nausea, abdominal pain, diarrhoea, vomiting and severe respiratory illness, according to the CDC. 

Image Credits: Wikimedia Commons.

IMF Managing Director Kristalina Georgieva

A $50-billion plan to end the COVID-19 pandemic developed by the International Monetary Fund (IMF), would generate an additional $9 trillion in global economic returns by 2025, said IMF Managing Director Kristalina Georgieva on Tuesday.

The plan is supported by the World Bank Group, World Health Organization (WHO) and the World Trade Organization (WTO), and their leaders joined Georgieva at a media briefing convened by the WHO.

The first element of the IMF’s three-point plan involves vaccinating “at least 40% of the population in all countries by end 2021 and at least 60% by the first half of 2022”, Georgieva told the briefing. 

“This requires additional upfront grants to COVAX, donating surplus doses and free cross-border flows of raw materials and finished vaccines,” she said.

“Second, insuring against downside risks, such as new variants,” said Georgieva. “This would involve investing in additional vaccine production capacity by 1 billion doses, diversifying production and scaling up surveillance, and contingency plans to handle virus mutations or supply shocks.”

The third element involves managing the “interim period” in countries with limited vaccine supply through the tried-and-tested public health measures including masks, widespread testing and contact tracing.

“Vaccine policy is economic policy,” Georgieva stressed, referring to the growing divergence between countries with rapid vaccinations that are coming out of the pandemic crisis fast, and those with low vaccination rates, that are falling further behind. 

“That is dangerous for everyone because it holds the global recovery back, and we are creating a breeding ground for mutations,” she added.

World Bank Offers Vaccine Finance

World Bank President David Malpass

Counting the $22 billion recently pledged by G20 member to the Access to COVID-19 Tools (ACT) Accelerator that manages COVAX, Georgieva said that an additional $13 billion could come from grant finance and $15 billion from national governments, supported by “concessional financing” from the World Bank and other development banks.

World Bank President David Malpass told the briefing that the bank has $12 billion in vaccine financing available to help countries buy and distribute COVID-19 vaccines, and encourage vaccinations. 

“By the end of June, we will have approved vaccination operations in over 50 countries. These countries can immediately use vaccines from COVAX, from manufacturers and from donor countries themselves as soon as they are made available,” said Malgass.

WTO Director-General Dr Ngozi Okonjo-Iweala

WTO Director-General Dr Ngozi Okonjo-Iweala stressed that trade policy can help with vaccine scale-up by freeing supply chains for raw materials and finished vaccines, and working with manufacturers to maximise existing production facilities and building new manufacturing capacity. 

“We know that there’s the TRIPS waiver debate going on at the WTO and while I cannot take sides, we need to get to a conclusion on this debate, promote technology transfer and know-how to get lasting increases in production capacity,” said Okonjo-Iweala.

WHO Director-General Tedros Adhanom Ghebreyesus said that the leaders’ calls for the $50 billion rapid investment would “fund the equitable distribution of vaccines, and other crucial health tools”, and the “majority of the new funding would be made available quickly through grants, including to fill the ACT Accelerator  funding gap”. 

The IMF, WBG, WHO and WTO leaders issued their joint statement as a round of G7 meetings were set to start, beginning with a meeting of finance ministers later this week.

Tedros Welcomes Sinovac Approval 

Tedros also welcomed the WHO decision on Tuesday to grant emergency use listing (EUL) to the Chinese COVID-19 vaccine, Sinovac (also called CoronaVac) – the eighth vaccine to get this listing, a prerequisite for it to be used by COVAX.

The vaccine was “found to be safe, effective, and quality assured following two doses”, said Tedros, adding that it’s easy storage requirements “make it very suitable for low resource settings”. 

“Vaccine efficacy results showed that the vaccine prevented symptomatic disease in 51% of those vaccinated and prevented severe COVID-19 and hospitalization in 100% of the studied population,” according to a WHO statement based on the recommendation of its Strategic Advisory Group of Experts on Immunization (SAGE)

“Few older adults (over 60 years) were enrolled in clinical trials, so efficacy could not be estimated in this age group,” said the WHO.

However, it is not recommending an upper age limit for the vaccine “because data collected during subsequent use in multiple countries and supportive immunogenicity data suggest the vaccine is likely to have a protective effect in older persons,” said the global body. 

 

 

 

Target Malaria Project

Researchers engaged in mosquito gene drive technologies are optimistic that new World Health Organization (WHO) guidance on best research practices will ensure that their work is safe and ethical. Such guidance also helps research results advance from laboratories to be used in the field,  the researchers told Health Policy Watch.

Due to limiting regulatory frameworks, most African countries doing research on genetically modified mosquitoes have been accused of carrying out unethical research. Some confine their work to laboratories because regulations mostly focus on handling plant-based genetically modified organisms.

The WHO recently released essential standards for the study and evaluation of genetically modified mosquitoes so use of this public health tool can be ethical, effective, and affordable. Malaria kills more than 400,000 people a year worldwide.

“Genetically modified mosquitoes are one of a number of promising new tools that could help speed the pace of progress against malaria and other vector-borne diseases,” WHO Global Malaria Programme Director Dr Pedro Alonso said. 

Dr Michael Santos, GeneConvene Global Collaborative director, said that “like any new public health intervention, genetically modified mosquitoes raise new questions for researchers, affected communities and other stakeholders.  

“The updated guidance framework aims to answer these questions and help ensure that testing of genetically modified mosquitoes is as rigorous as it is for other public health products – and that it generates quality results to guide decisions about if and how these technologies are used,” Santos said.

The WHO guidance was developed in partnership with the Special Programme for Research and Training in Tropical Diseases (TDR) and the GeneConvene Global Collaborative, supported by the Foundation for the US National Institutes of Health.

“We believe that this guidance framework will be valuable both for researchers of genetically modified mosquitoes and for stakeholders to understand expectations for how research should be conducted,” said Santos. For example, the guidance specifies that studies should progress in a step-wise fashion, generating evidence along the way to make decisions about further research. Other chapters on ethics and regulatory frameworks will enlighten readers about relevant research standards and governance, he said. 

New Guidance Will Set Clearer Testing Procedures

Ernest Tambo, an independent consultant in public health and disease surveillance, welcomed the “important” guidance. “[This] will help policy-makers in Africa to buy in and promote adoption and adaptation of gene drive technology.” 

The guidance builds on a 2014 document by the Special Programme for Research and Training in Tropical Diseases (TDR) and the Foundation for the National Health Institutes of Health. It is updated with regards to genetic modification of mosquitoes and other issues such as safety and ethics. Topics include implications of genetically modified mosquitoes for human and animal health and the environment as well as effective risk assessment and stakeholder engagement strategies. 

The new set of tools were also praised for setting clearer criteria for projects to proceed from one testing phase to the next. This describes the steps needed to safely and responsibly take genetically modified mosquitoes into the field, including those incorporating gene drive.

Dr Abdoulaye Diabaté, Entomology and Parasitology head at Burkina Faso’s Research Institute in Health Sciences, said the guidelines show WHO values this new vector control approach along with current intervention tools. He said the guidelines contain “all the important ingredients that can guarantee a responsible and safe use of this technology including the technical challenges, the legal and ethical issues, the risk assessment, to the public engagement”.

“It delineates a pathway that will help scientists,” said Diabaté, who also serves as Target Malaria team leader in Burkina Faso.

Civil society organizations in Africa have expressed concerns about genetically modified mosquitoes, saying most countries have no published environmental risk assessment, as well as no genuine independent public consultation apart from “public engagement” activities.

mosquito
Target Malaria Project

In the case of the Target Malaria project’s work, which released mosquitoes in Burkina Faso, activists said there was no full informed consent from relevant communities.

The ETC Group –  an advocacy group monitors impacts from emerging technologies and corporate strategies on biodiversity, agriculture and human rights –  made a documentary, A Question of Consent: Exterminator Mosquitoes in Burkina Faso.  The documentary said Target Malaria lacked sufficient consent from communities where mosquitoes were to be released, and that residents were apprehensive about potential effects.

Barbara Ntambirweki, a researcher for Advocates Coalition for Development and Environment (ACODE), said: “This technology is still underdeveloped and presents serious regulatory gaps, environmental concerns, and inadequate public participation mechanisms.” 

Speaking for the environmental civil society organization, Ntambirweki said such technologies require risk assessment, but that this is difficult for African countries as most do not have infrastructure to solve problems that may arise from new technologies.

Countries Experience Regulatory Challenges

Countries participating in the project are also experiencing regulatory problems that require reforms and present the need to meet high public expectations,  researchers said. Uganda, Mali, Burkina Faso, and Ghana are carrying out research on genetically modified mosquitoes under the Target Malaria project.

“In Uganda, it is actually at the ‘field trial’ level where we need regulatory reform so that the research is moved from containment level,” said Target Malaria Uganda Principal Investigator Jonathan Kayondo during a Tuesday online meeting on health transformative technologies.

“Uganda as a country has the necessary guidelines at the containment level. The regulatory gap will only be felt at the time of field release trials. However, the genetic engineering regulatory Bill (2019) is in parliament and might address this gap,” Kayondo said. 

Makerere University malaria researcher Chris Opesen said: “The National Environment Management Authority is also working to close this gap by developing workable guidelines.” For work under the Target Malaria project, only Burkina Faso and Mali have obtained “contained use permits” from regulatory bodies. 

Karen Logan, Target Malaria senior project manager and network coordinator, said that Uganda has not requested importation of genetically modified mosquitoes yet, and that Ghana has no plans to do so under current transgenic work projects. 

She clarified that there have been no gene drive releases in Burkina Faso, Mali, Uganda, or Ghana yet. The mosquitoes released in Burkina Faso were of the genetically modified sterile mosquito line.

Logan told Health Policy Watch that Target Malaria welcomes such guidance, especially when it comes from WHO.  

Diabate said, “Though it is wise to say that gene drive research should be considered in a case-by-case manner, I would recommend that all the technology developers take time to read and digest this document and use it as needed. Gene drive can curb the malaria burden in Africa, and it is important to adopt a responsible code of conduct to give chance to the technology to achieve its full potential.”

Image Credits: Target Malaria Project.

Empty streets in downtown Medellin, Colombia after people were urged to stay home in March 2019. Physical distancing measures to control COVID-19 can lead to greater isolation and the deterioration of mental health.

“Mass trauma” from COVID-19 has worsened mental health worldwide, WHO officials said at the 74th World Health Assembly (WHA) on Monday. The long neglected issue received special attention on the Assembly’s closing day, with member states expressing broad support for more action – after a year that saw new mental health issues emerge even while mainstream mental health services were disrupted. 

“I think [mental health] has been a hugely under-recognized and under-responded-to element of this epidemic, as it is in all health emergencies,” said Dr Mike Ryan, WHO Director of Health Emergencies.  

“We’ve seen the terrible toll taken on mental health and psychological well-being in communities, among health workers and others,” Ryan said. 

Public health measures to control COVID-19 have caused isolation and disrupted daily activities. These changes heightened distress in many people, particularly healthcare workers and those with pre-existing mental health conditions, WHO experts and member states agreed.

Malaysian Prime Minister Muhyiddin Yassin told delegates at the closing of the 74th WHA: “There is nothing natural about self-isolation and the toll it takes on our global citizens, young and old [with] disruptions to education, work and social norms. It will require us to endure a healing process that will take time.” 

Tan Sri Muhyiddin Yassin, the Malaysian Prime Minister, at the 74th World Health Assembly on Monday.

Speakers noted how the pandemic contributed to various adversities – unemployment, financial instability, missed education, social isolation, domestic violence, fear of a life-threatening disease, and loss of loved ones. All of these put individuals at greater risk of developing short- or long-term mental health disorders.

“One day this pandemic will be over – but many of the psychological scars linked to the pandemic will stay with us for a long, long time,” said Dr Tedros Adhanom Ghebreyesus, WHO Director General. 

“The impact of this pandemic on mental health is very palpable; paying attention to mental health will be very central. Please, let’s give mental health a serious priority,” Tedros urged.

Mental Health Action Plan

A proposal to extend WHO’s 2013-2020 Mental Health Action Plan for another decade, but including updated indicators and targets, received wide support among member states at the WHA, where they adopted a draft decision endorsing the updated Action Plan.

The updated Action Plan will include a greater focus on: suicide prevention, workplace mental health, universal health coverage, mental health of children, mental health across the life course, and the involvement of people with lived experience of mental health conditions. 

New global targets for 2030 also include:  

  • 80% of countries developing or updating their policy for mental health by 2030;
  • Mental health integrated into primary health care services by 80% of countries – and increased mental health service coverage by 50%;
  • 80% of countries with at least two national mental health promotion and prevention programmes;
  • Reducing the rate of suicide by one third;
  • 80% of countries with a system for mental health and psychosocial preparedness for emergencies;
  • Doubling the output on global research on mental health.

“It is crucial to prioritize the actions to minimize mental health consequences of the pandemic and incorporate these actions into emergency and disaster risk management strategies,” said Asim Ahmed, Permanent Representative at the Permanent Mission of the Maldives to the UN in Geneva.

“We welcome the work done by WHO in the area of mental health resulting in the updated Mental Health Action Plan 2013-2030,” the European Union said in a statement on Friday. “This plan is an essential tool for strengthening mental health and psychosocial support and preparedness at country level, for current and future public health emergencies.” 

“We support the review of the action plan on mental health 2013-2030 to make sure that it is better integrated and that it provides us with the tools that are necessary to become more resilient at the international level,” said Isabel Padilla de Stenvold, Counsellor at the Permanent Mission of the Dominican Republic to the UN in Geneva.

Isabel Padilla de Stenvold, Counsellor at the Permanent Mission of the Dominican Republic to the UN in Geneva

Responding to the Mental Health Impacts of COVID-19

In the short term, the WHO Secretariat plans to support countries to strengthen community-based psychosocial services for those experiencing pandemic-related adversity, address the needs of at-risk populations, including health workers, and increase access to affordable care for mental health conditions.

The WHO Europe Regional Office has established a technical advisory group to evaluate mental health service development and system strengthening as a component of the COVID-19 recovery. The findings will be used to develop a new European framework for mental health.

In addition, the Pan European Mental Health Coalition will be launched in October to “break barriers and advocate for mental health rights,” announced Dr Hans Kluge, WHO Regional Director for Europe.

Dr Hans Kluge, WHO Regional Director for Europe.

“A silver lining of the crisis is the opportunity to forge a new pathway for mental health promotion and care,” said Kluge. “Now is the chance to drastically transform mental health care. Let’s grasp it.”

Rise in Mental Health Symptoms

Symptoms of anxiety, post-traumatic stress disorder, depression and psychological distress have been among the most common reported among the general populations of several countries during the pandemic, according to WHO’s report on Mental Health Preparedness and Response published in January. 

A US-based study published in February found that the proportion of adults who reported symptoms of anxiety or depressive disorder increased from one in ten from January to June 2019 to four in ten in January 2021. 

Throughout the pandemic, symptoms of anxiety, depression, sleep disruptions, and thoughts of suicide increased for many young adults in the US, according to a survey of 8,943 individuals aged 18-24. 

A study from late 2020 conducted by European researchers found 50% of respondents across 78 countries had only moderate mental health during the first year of the pandemic, and around 10% had low levels of mental health.

Disruptions in Mental Health Services

Mental health services were among the health services worst-hit by the pandemic, partly due to lack of mental health funding nationally.

According to a WHO survey, 120 out of 130 countries reported significant service disruptions for mental, neurological and substance use disorders in 2020. And while 89% of countries surveyed incorporated mental health and psychosocial support into their COVID-19 response plans, only 17% fully funded these mental health response plans. 

“COVID-19 exposed the limited investment in mental health preparedness and infrastructure in all countries before the pandemic,” said Dr Ren Minghui, WHO assistant director-general for Universal Health Coverage and Communicable and Noncommunicable Diseases.

Dr Ren Minghui, WHO Assistant Director General for Universal Health Coverage and Communicable and Noncommunicable Diseases.

WHO responded to service disruption reports by deploying experts in 12 instances to help coordinate psychosocial support in the context of COVID-19. The organization also developed operational guidance on continuing essential services that address mental, neurological, and substance use disorders. A Global Forum on Neurology and COVID-19 is documenting neurological conditions associated with COVID-19 to enhance clinical practices.

“We will continue to work with donors and partners to ensure that the WHO technical capacity, particularly in the regional and country levels, could be strengthened in order to better provide technical support to the member states [and to assist in] integrating evidence based primary and community mental health services and psychosocial support in COVID-19 responses,” Ren said.

Image Credits: Flickr: Nicola, Diego Zapata , WHO.

Dr Tedros Adhanom Ghebreyesus, WHO Director General, giving his closing remarks at the 74th World Health Assembly.

The 74th World Health Assembly (WHA) closed on Monday with appeals for vaccine equity, more resources for the World Health Organization (WHO) and support for a “pandemic treaty” to combat future pathogens.

WHO Director General Dr Tedros Adhanom Ghebreyesus devoted much of his concluding speech to the global body’s dearth of finances and the importance of the proposed pandemic treaty to put more teeth into international health rules around outbreak responses. Member states agreed at the WHA session that the proposed treaty would be discussed in detail at a special WHA session at the end of November.

Despite member countries’ praise for the global body’s support, Tedros said bluntly:  “We cannot pay people with praise”, adding that many of their experts were on short contracts as the WHO struggled to maintain its current level of pandemic response.

“The message that a strong WHO needs to be properly financed has been amplified by all the expert reviews that reported to this Assembly,” said Tedros, adding that the WHO Working Group on Sustainable Finance was charting a way forward to address this.

“The one recommendation that I believe will do the most to strengthen both WHO and global health security is the recommendation for a treaty on pandemic preparedness and response,” said Tedros. “That could also improve the relationship between member states, and foster cooperation.”

For Tedros, such a treaty would be a “a generational commitment that outlives budgetary cycles, election cycles and media cycles”.

Pathogens have More Power than WHO – And Globe has a “Temperature”

The current pandemic had been characterised by a lack of sharing and a lack of global accountability, he added.

“At present, pathogens have greater power than WHO. They are emerging more frequently in a planet out of balance. They exploit our interconnectedness and expose our inequities and divisions,” Tedros stressed.

“A treaty would foster improved sharing, trust and accountability, and provide the solid foundation on which to build other mechanisms for global health security,” said Tedros, including research and innovation, early warning, stockpiling and production of pandemic supplies – and equitable access to vaccines, tests and treatments.

Referring to a visit Saturday to WHO by a group of health and climate activists DoctorsXR   the WHO Director General also noted how the climate crisis has become interwoven with the pandemic as another risk to humanity whose signals need to be heeded now. 

“Our human health is very much similar to Planet health,” he noted,  “As you know, in human health, 37 ℃ is healthy. If you add 2 degrees, which is 39 ℃, you’re sick. If you add another 2 ℃, then you are at 41, and in  danger. And then if you add more and it’s 37 ℃ plus 5℃, that’s too late. 

“And for the planet it’s the same thing.  So we need to take care of ourselves and our planet. And the recommendations they have made are: 1)  focus on preventive rather than curative care; 2) promote a more sober and equitable medicine; 3) develop environmentally-friendly healthy structures, and 4) focus on community based care and support.

“Five, respect the natural environment; 6) organize information and education, and 7)  involve the population and patients in strategic decisions. And in all that leadership is key and this is a message to you which they asked me to pass to all member states.”

Debates over TRIPS Waiver, Virus Origins Investigation and Pandemic Treaty End in Whispers  

The WHA had the longest agenda in its history, and adopted over 30 resolutions, including new initiatives to promote local production of medicines; prevent and reduce non-communicable diseases;  expand access to services for the treatment of diabetes, disabilities and eye care.

It also considered reports from three different bodies – the Independent Oversight and Advisory Committee (IAOC), the Independent Panel for Pandemic Preparedness and Response (IPPR), and the International Health Regulations Review Committee (IHRC) – which revealed the WHO weaknesses in dealing COVID-19 and how to address these.

Despite the roaring debates that occurred on the Assembly’s margins, member states clearly sought to end the packed 8-day long meeting on a note of accord – if not exactly consensus. 

Disagreements over an IP waiver to spur vaccine protection or the future direction of the WHO-led investigation into the SARS-CoV-2 origins did not break out again onto the plenary floor, as could have occurred in the closing hours of the assembly.  

Rather, member states seemed happy to let the IP waiver debate move back to its natural arena in the World Trade Organization forum, which is set to meet on the issue once more next Monday – although chances for progress remain dim in light of continued European opposition.  

A key resolution of this WHA, “Strengthening WHO Preparedness for and Response to Health Emergencies, received final approval on Monday without objections – even though scientific critics and member states had complained that the already nuanced text touching on the investigation into the SARS-CoV2 origins had been weakened further during the course of negotiations. 

A terse statement by one of the leading critics of the investigation so far, the United States, seemed to throw the ball back into the court of Dr Tedros once more.  

“We call for a timely, transparent, evidence-based, and expert-led Phase 2 study, including in the People’s Republic of China,” said the US statement.

“It is critical that China provides independent experts full access to complete, original data and samples relevant to understanding the source of the virus and the early stages of the pandemic. We appreciate the WHO’s stated commitment to move forward with Phase 2 of the COVID-19 origins study, and look forward to an update from Director General Tedros.”

But President Joe Biden was not taking any chances either.  As the WHA session was in full swing, Biden announced the launch of a US investigation into one key element of the controversy –  whether the virus more likely first infected humans via contact with the pathogen in a wild animal or food-borne source – or via a biosafety accident at the Wuhan Virology Institute, that was studying bat-borne coronaviruses at the time the Wuhan outbreak first began.  

Member States Describe Pandemic Challenges and Successes 

Malaysian Prime Minister Tan Sri Muhyiddin Yassin

Instead of touching on those sensitive nerves, leaders of member states addressing the closing plenary talked about the struggles that they still faced to contain the pandemic – as well as the qualified successes that some countries had seen. 

Malaysian Prime Minister Tan Sri Muhyiddin Yassin said his country was experiencing another surge in infections – but it had only secured 6% of the 53 million vaccines it needed to protect its citizens.

“Vaccine equity is still a major issue and we cannot win this war against the virus unless everyone has equal and rapid access to vaccines,” said Yassin, expressing his country’s support for the proposed TRIPS waiver of intellectual property on COVID-19 related products.

Argentina’s President Alberto Fernández said that his country was “going through very, very difficult times… the worst time of the pandemic”.

“We’ve got, say, a dozen countries who can produce vaccines and have managed not only to produce but to purchase about 90% of them. Everyone else has had to go searching for the vaccines in order to try and get sufficient quantities to vaccinate our people. Solidarity there has been fairly non-existent,” he said.

Fernández described the ongoing economic blockade of Cuba and Venezuela during the pandemic as “obscene”, and called for it to be lifted alongside the lifting of patents on vaccines. Cuba is reportedly in advanced stages of R&D into an indigenous COVID-19 vaccine which could be relevant for its Latin American neighbours unable to readily access sufficient supplies from the big producers in US, Europe, India, China or Rusia. 

Bhutan’s Success Mitigated by Vaccine Scarcity 

Bhutan’s Prime Minister, Lotay Tshering

On a brighter side, Azerbaijan President Iham Aliyer said that the country had vaccinated two million people – 20% of its population – mostly using the Sinovac vaccine, and would be removing most pandemic restrictions by 1 June. 

Buthan’s Prime Minister, Lotay Tshering, talked about how the tiny country had been able to vaccine 90% of its population thanks to AstraZeneca vaccines donated by India – and that had, in turn, kept the pandemic at bay.

But he expressed doubts about “how long” the reprieve would last, if Bhutan is unable to get people their second doses because of the huge surge seen in Indian cases since. 

Afghanistan President Mohammed Ashraf Gani was meanwhile critical of “UN agencies” which had neither been able to deliver the oxygen they had promised nor “offer us timely policy advice”.

In contrast, he said, “India showed us exceptional solidarity by giving us 650,000 vaccine doses” which had enabled the country, currently in its third wave, to vaccinate its most vulnerable people.

  • Elaine Ruth Fletcher contributed to this story.

 

 

Image Credits: WHO.

Polio workers protest against WHO retrenchments.

ISLAMABAD – Despite the 18-month COVID-19 pandemic, Pakistan and Afghanistan have observed a sharp decline in polio cases which the health authorities attribute to their effective back-to-back anti-polio drives.

Officials leading the polio eradication programme believe that the decline occurred due to uninterrupted polio vaccination campaigns, improved security and the polio field teams’ accessibility to the population in high-risk areas.

However, despite a remarkable decline in poliovirus cases, officials believe that ‘vaccine refusal and hesitancy’ by parents remains a bigger challenge than COVID in completely eradicating the virus.

Pakistan and Afghanistan, both members of the World Health Organization’s (WHO) Eastern Mediterranean Region, are the only two countries in the world still fighting to eradicate wild polio virus as a cause of the crippling disease.    

In August 2020, Nigeria achieved zero wild poliovirus cases, leaving Africa to be certified by WHO as a free of the wild poliovirus. 

However, some 16 countries in Africa are still experiencing periodic outbreaks of vaccine-derived polio cases (cVDPV2). While rare, vaccine-derived polioviruses cases can occur when the weakened live virus in the oral polio vaccine passes among under-immunized populations and, over time, changes to a form that can cause acute disease.  If a population is adequately immunized with polio vaccines, it will be protected from both wild polio and circulating vaccine-derived polioviruses.

A WHO report on the global battle to eradicate polio was the subject of a wide-ranging discussion Saturday at the World Health Assembly – with WHO and other member states commending Pakistan and Afghanistan and Africa on the progress seen – while also highlighting the uphill battle still faced to completely eradicate both wild and vaccine-derived forms of the disease. Member states also called upon WHO to remain committed to polio eradication – including building the capacity of national health teams to gradually take over the roles of the WHO-supported Global Polio Eradication initiative.

“We are accountable to children,” said WHO Polio Director Aidan O’Leary, in describing the challenges still faced to eradicate the last remaining cases of wild poliovirus – along with tackling vaccine derived cases that continue to circulate not only in Africa and Asia, but other regions as well.

‘Last Mile’ in Pakistan ? 

On both sides of the shared 2,640 kilometer border, Pakistan and Afghanistan are focused on both forms of the virus – working alongside about dozen international health and donor agencies.

Speaking to Health Policy Watch ahead of the WHA, key Pakistani health officials expressed hope that the wild poliovirus could soon be eradicated altogether in that country.

“This is our last mile and hopefully we will achieve zero cases in 2022,” said National Coordinator Dr. Shehzad Baig.  He told  Health Policy Watch that the last three anti-polio campaigns had been very effective reaching 90 to 95% of targets in  eradicating the virus from the country – and if that track record can be maintained then the eradication target can be met.

He said that the silver lining of the COVID-19 pandemic’s lockdown rules meant that children had been easier to reach: “Mostly children in high-risk areas remained at home and were accessible to polio teams for vaccination,” said Baig.

Stability in Pakistan’s security situation since last year also contributed to effective anti-polio drives, he said adding: “Since November, there was no security challenge for 286,000 field polio workers accessing areas for polio drives in security risk regions,” he said.

A WHO report submitted to the World Health Assembly (WHA) on Saturday, stated that WPV transmission is ongoing in traditional reservoirs in the northern corridor (Peshawar/Khyber), Karachi and the southern corridor (Quetta block, Balochistan), with expansion of virus to previously polio-free areas (Punjab and Sindh), and detection of virus across the country.

It also said that circulating vaccine-derived poliovirus type 2 continues to spread geographically, notably in Khyber Pakhtunkhwa, with ongoing breakthrough transmission complicated by a large nationwide accumulation of populations susceptible to type 2 poliovirus. 

Afghanistan also Sees Progress – But Poor Reporting May be Factor 

In Afghanistan, reports of polio virus cases were also on the decline this year as compared to 2020 – although surveillance remains an issue, particularly in areas where the reach of the central government is weak, officials cautioned.

Just one wild polio virus case has been reported so far in Afghanistan so far in 2021, as compared to 56 in 2020, according to the Independent Monitoring Board, an international body monitoring the performance of the polio programs by the countrie. And only 38 cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) had been reported in Afghanistan, in contrast to 308 cases in 2020. 

In the wake of three WPV cases in November 2020, some 54 cross-border teams and 288 permanent transit teams (PTTs) were deployed across Afghanistan, the IMB said. The teams vaccinated 79,489 adults and 538,674 children.  Wild Polio Virus type 1 is endemic to the southern and eastern regions of Afghanistan, but  WPV, along with more vaccine derived cases, can encroach previously polio-free areas in the north and west of the country in the absence of containment vaccine campaigns. And those had been suspended in the first six months of the pandemic.    

In Pakistan, cases so far in 2021 have declined even more dramatically.  According to the official data of Pakistan Polio Eradication Program (PPEP), the country saw 84 Wild Polio Virus (WPV) cases and 83 circulating vaccine-derived poliovirus type 2 (cVDPV2) virus cases in 2020 (the IMB says the number of vaccine derived cases in 2020 was even higher – 135). 

This year, there has been just one WPV case reported so far, and no cVDPV2 cases.

Speaking at the WHA, the Afghan representative said, however, that still 3.5 million children are missing from the country’s vaccination campaigns. Afghanistan also urged the global community for more financial support to expand the immunization campaigns in the security risk areas.

Setbacks at Start of Pandemic Followed by Renewed Vaccine Drives  

In both countries, campaigns were initially suspended for the first six months of the year.  For instance in Pakistan,  after the first surge of COVID-19 pandemic, the country’s polio programme had to suspend its scheduled April National Immunization Drive (NID) –  which meant that around 40 million children missed the polio drops.

That followed on interruptions in vaccine drives in 2019, as well, after attacks on polio teams occurred in the country’s southern and western regions.  As a result, around 250,000 children missed the polio drops as a result leading to 134 polio cases reported in 2019.

However, after the decline of the first COVID-19 wave, Pakistan’s polio programme, led by Dr Rana Muhammad Safdar, then National Coordinator on Polio Program now the Director General of Pakistan’s Health Ministry, rebounded. It conducted two national and three sub-national anti-polio drives between July and December  2020 to cover the immunity gaps. Then, in 2021 the country conducted another national drive to vaccine 40 million children with polio drops.

Impact of CIA’s Fake Polio Campaign

Pakistani efforts to eliminate polio were seriously undermined a decade ago when the US Central Investigation Agency (CIA) conducted a widely-criticized fake polio campaign as part of its intelligence gathering operations on the whereabouts of Osama Bin Laden in Abottabad; the al-Qaeda leader was finally ambushed and killed by US troops in his compound on 2 May 2011.

Following the disclosure of the CIA mission, the Taliban also launched an intense anti-vaccine propaganda campaign on both sides of the Pakistani-Afghan border. Polio teams were attacked in both countries by the militants, and several field workers were killed.

It is likely that these factors eroded parental confidence in vaccines and health workers and declines in vaccination rates. 

Cross Border Transmission and Vaccine Hesitancy    

To this day, parental refusal remains a bigger challenge in both Afghanistan and Pakistan than cross border transmission of the virus, said Baig.

He said that the ratio of parents’ refusal from polio drops fluctuates between 2% and 5% in different areas of Pakistan.

Meanwhile, Dr Faisal Sult, the Special Assistant to the Prime Minister (SAPM) on health, warned, however, that “we have been close before and lowered our guard and polio surged back, so rather than congratulate ourselves on efforts to date, we need to double our efforts and drive harder than ever if we are to truly protect Pakistan’s, and the world’s children from this devastating disease.”

He also stressed the need for a coordinated whole of government approach encompassing nutrition, primary health care and water and sanitation.

Risk of Resurgence

Despite the sharp decline in the polio cases in Pakistan, polio officer Anil Kumar from Sindh province believes that the risk of resurgence remains as dedicated polio vaccine teams are gradually reduced or reassigned – in Pakistan as well as worldwide.

Kumar criticized the recent WHO moves to abolish around 850 posts of national polio officers – even while the virus lingers in the country.

The cutbacks have come as part of a gradual WHO move to phase out its huge and costly ground support for the polio elimination programme – with an eye to the day when the world reaches polio eradication.

However, the strategy has been controversial among countries which have relied heavily upon the polio teams to conduc other vaccine drives too. And indeed, over the past several years, WHO has shifted gradually from talking about outright staff cuts to a more gradual integation of WHO-supported polio teams with other national immunization efforts – as part of developing stronger national immunization capacity.

In the wake of COVID, which saw national polio teams also supporting COVID  testing, tracking and containment followed by a groundswell of needs for vaccine teams generally, that approach has been validated.

But even so, countries like Pakistan say that the reality on the ground doesn’t always match the rhetoric in Geneva.

In Sindh province, one key at-risk region, the Deputy Commissioner (DC) of the Umerkot district wrote a letter to the WHO team lead in the province appealing for the retention of its lost polio officers.

In March 2021, polio workers staged a protest outside WHO’s Pakistan country office, demanding a restoration of the 850 cancelled posts. But the head of WHO’s Pakistan country office, Dr Palitha Mahipala, turned down their demand.

Warned Kumar, “some of the posts have been abolished in high-risk areas where there is still a chance of resurgence of the virus.” 

 

 

 

 

Image Credits: Pakistan Polio Eradication Program.

US delegate Colin Mclff urged bold action.

The World Health Assembly (WHA) passed a resolution on preventing violence against women and girls at Monday’s plenary – but only after heated discussion on Saturday resulted in a watered-down version with no reference to “sexuality education”. 

However, during the plenary session after the resolution had been adopted, Argentina’s representative, María Jimena Schiaffino, expressed disappointment on behalf of over 30 countries at the compromise that had been adopted “in order to not break consensus on voting on technical issues”.

“We have remained disappointed that similarly the long-standing practice of this association was not employed by objecting member states,” added Schiaffino. 

Comprehensive Sexuality Education ‘Agreed On’ in UN

“We want to take this opportunity today to again reiterate our support for comprehensive sexuality education for children to realise their health, well-being and to learn how to build relationships. For real communication, self-protection and risk-reduction skills are a fundamental part of efforts to prevent, recognise or respond to violence against children,” she said.

She added that “the term comprehensive sexuality education is based on already agreed consensus language use in other UN fora” and that the WHA  needs discussions to evolve its language to support “this evidence-based standard for the benefit of all children everywhere”.

The resolution is aimed at strengthening the health sector’s capacity to prevent and respond to violence against children. Every year around a billion children are affected by physical, sexual or emotional violence. 

During Saturday’s committee meeting on the draft resolution, US delegate Colin Mclff called for member states to “be bold” in order to “move forward with our shared goal of ending violence against children”, emphasizing that “sexuality education” would allow for a pathway to tolerance leading to “acceptance, inclusivity and empowerment”.

Countries like New Zealand also drew attention to the intersectionality of violence against children with their race, gender and other identities. 

Heated discussion over language

However, a number of countries including Kenya, Syria, Egypt, Bahrain and Iran disagreed with the language of the draft resolution, particularly with the inclusion of the term “sexuality education” over “sex education” for children. 

The push for bold language that would recognise multiple gender identities came from co-sponsor countries including the United States, Canada, the European Union, Oman and Paraguay, among others.  

Eventually, in an effort to pass the resolution with consensus, Monaco, Australia and Japan suggested a compromise that would drop the contentious paragraph:

“To provide accessible gender-sensitive, free from gender stereotypes, evidence-based and appropriate to age and evolving capacities sexuality education to children, and with appropriate direction and guidance from parents and legal guardians, with the best interests of the child as their basic concern to empower and enable them to realize their health well-being and dignity, build communication, self-protection and risk reduction skills, as a fundamental part of the efforts to prevent, recognize and respond to violence against children”

While countries agreed to the compromise, F Mamdouhi of Iran said his country disassociates itself from the parts of the resolution “that may imply in any manner whatsoever, recognition, protection, or promotion of those behaviours that are unethical under its legal system, or socio-cultural norms or which may contradict its world, and religious values accordingly.”

There were also discussions on protecting children from the growing challenge of online bullying.

Resolution on violence against women

The resolution also included suggestions to take a multi-sectoral approach to interpersonal violence as well as that in particular against women and children. While both boys and girls are at equal risk of physical and emotional abuse and neglect, girls are at a greater risk of sexual abuse. 

There was consensus on considering violence against women an issue of public health concern. 

The WHO will support their member states to train their frontline healthcare workers to respond better to violence against women and girls. Around 60 countries have already adopted or used WHO guidelines to inform their national protocols. 

While there was consensus on the need to prevent violence against women, Zimbabwe reminded the Assembly that violence against boys and men must not be ignored. 

“It is important to take particular attention not to sideline the boy child who also suffers from sexual violence in all forms of violence, including physical, inside of the ruling,” said J Chimedza of Zimbabwe. 

Image Credits: WHO.