Health experts have called on global leaders to tackle environmental issues affecting health and health systems.

A paradigm shift towards health systems and societies that emphasize health promotion, disease prevention and environmental protection could prevent and reduce 50% of the global disease burden worldwide, experts at an informal session on the margins of the 74th World Health Assembly  said on Thursday.

The COVID-19 pandemic has highlighted the inextricable relationships between environments and health while revealing health systems’ weaknesses, according to WHO director-general  Dr Tedros Adhanom Ghebreyesus at the event, Safe Societies and Environments for Health: The Path to Build Forward Better, Healthier and Greener.   

World leaders should hold a “Nature Summit” that would focus heads of state more squarely on delicate relationships between health, climaste and environment – and the “planetary” crisis facing ecosystems, said Inger Andersen, executive director of the United Nations Environment Programme (UNEP), in an apperance at the WHO forum. 

“There’s evidence that the more we fragment nature, the more we encroach into nature, the more we push biodiversity stress, by encroaching and destroying, then the greater likelihood of human pathogens developing out of contact with wildlife and wild diseases,“ said Andersen. 

Maria Neira, WHO director, Environment, Climate Change and Health shared Andersen’s sentiments: “We need to stop this war we are having with nature. We need to recover our relationship as it is the only way towards a safer world that is green and healthy.”

Maria Neira, WHO director, Environment, Climate Change and Health

The events coincided with a landmark decision by a court in the Netherlands, against the multinational fossil fuel giant Royal Dutch Shell – which was cheered by WHO climate and health advocates such as Neira.

The court in The Hague ordered Shell to reduce it’s CO2 emissions by 45% within the next 10 years in its response to a legal suit by Friends of the Earth Netherlands (Milieudefensie) together with 17,000 co-plaintiffs and six other organizations.  The ruling has far-reaching consequences for the rest of the fossil fuel industry worldwide – opening up the possibility of liability claims and suits in other countries against fossil fuel companies for the damage that they are wreaking on the health of the planet and its people.

WHO’s Green Manifesto

In May 2019, the 72nd WHA adopted a Global Strategy on Health, Environment and Climate Change. The WHO strategy aims to “provide a vision and way forward on how the world and its health community need to respond to environmental health risks and challenges up to 2030, and to ensure safe, enabling and equitable environments for health by transforming our way of living, working, producing, consuming and governing.”

The pandemic provides a unique opportunity to rebuild health systems while also tackling environmental issues affecting health, said Tedros at the session, while also lamenting the lack of sufficient investment today. . 

For instance, global health budgets allocate only 3% to addressing preventable causes of disease and to promoting and enabling healthier environments and lifestyle choices. Increased investment could reduce global disease burdens by half, Tedros said, and this would greatly benefit individuals, families, communities and nations.

That is despite the fact that  “preparation is not just better than cure — it’s cheaper”, he said. 

In fact, an investment of $US 1 per person per year in more disease prevention and health promotion could save 8.2 million lives and US$ 350 billion by 2023, Tedros said in his opening WHA remarks on Monday.

On Thursday he again emphasised the need for more investment. “For every dollar invested in basic sanitation, there is a return of $5.50 in terms of reduced waterborne disease … which is still one of the largest killers of children.”

“Safer air, food and roads, better nutrition, and reduced injuries and violence will save lives. But we’ll also save money by preventing health care costs and [by] contributing to employment, productivity, and inclusive economic growth. Healthy populations are also more resilient populations.”

WHO Director-General  Dr Tedros Adhanom Ghebreyesus

In May 2020, after the COVID pandemic laid bare the underlying vulnerabilities of global health, social and environmental systems, WHO issued a Green Manifesto for healthy and green recovery with several 80 action points for so-called “building back better.”

The manifesto also lists opportunities for actions to enhance the WHO global strategy, which is likewise embedded in WHO’s 2019-2023 workplan – encouraging more cross-sectoral actions on unhealthy urban environments, lifestyles, poor diets and unsustainable food systems – areas where the worst risks often hit hardest on the poor – exacerbating existing social inequalities. 

A Healthy Planet Makes Healthier People

That has been all the more vividly illustrated during the COVID pandemic, in which access to clean water and sanitation, clean air, and decent urban housing conditions have all been understood as critical to reducing disease risks and disease transmission. 

UNEP Director Andersen said the argument for climate action is at an “historic crossroads” due to the COVID-19 pandemic.

Pandemic-related policies thus need to also address climate, biodiversity, nature and pollution, because otherwise “We would just be in a systematic loop … We have been taking nature for granted.”

Although the world has for far too long assumed that climates and environments would remain stable, she said, “A healthy planet is a precondition for healthy lives.”

Referring to research pointing to vast potential losses of genetically diverse animal and plant species over the coming years, Andersen also called for more research into food systems. “Why does this affect us? Because nature is a finely-tuned ecosystem where each relies on the other. And that is what produces the food, the water, the air” that humankind relies upon for life and livelihoods.

Education to Promote Environmental Awareness

Along with high-level efforts like a summit, education also is a critical tool to raise environmental awareness and contribute to improved health, according to  Desmond Appiah, resilience and sustainability advisor in the city of Accra, Ghana. 

Appiah said there is a need to work across sectors and with communities from the ground up to address water, waste, sanitation and air pollution issues critical in developing and building healthy cities. For example, he said the city government and its partners in a WHO and UNEP co-sponsored “Urban Health Initiative,” visits local churches, faith-based organisations to educate them on  air pollution’s health impacts as well as contributing factors, from waste-burning to motor traffic and the dearth of walkable green spaces.  In line with those efforts, Accra in 2018 was also the first city in Africa to join the BreatheLife initiative, dedicated to building awareness and more local action around linked, health, environment and climate.   

In two decades of work on World Bank digital health initiatives, global health policy specialist Akiko Maeda found many fell short of their promises. She suggested these underperforming digital health initiatives focused too much on delivering hardware — but they failed to provide means to ensure stable electricity supplies, and similarly failed to provide adequate human resources to manage data, or to design initiatives that the most vulnerable groups could benefit from.

Akiko Maeda, health economist with over 30 years of experience in international development in over 40 countries

“It’s not just the infrastructure and the hardware, but how we design the software that goes with it,” Maeda said Thursday. She spoke at a World Health Assembly side event co-hosted by the Geneva Graduate Institute’s Global Health Centre, the Lancet & Financial Times Commission, and Digital Square, which is supported by USAID and the Bill and Melinda Gates Foundation. 

“Digital infrastructure is more than just a bunch of cables and devices,” said data literacy consultant Gulsen Guler, who is also co-chair of My Data Global, a civil advocacy group promoting equitable digital societies – adding that the stakes are high:

“Digital technologies can determine what the future of a child will look like…or even more, they can determine between life and death.”

Digital Health Saves Resources to Reach Universal Health Coverage 

Roger Kamba, Special Advisor to the Democratic Republic of the Congo (DRC), called digital technologies crucial in low-income countries. He said these tools can help countries reach universal health coverage and that digital health can help to meet Sustainable Development Goals. 

“Digital health is not an option, but rather a necessary step towards universal health coverage,” Kamba said. “I remain personally convinced that there can be no universal health coverage without a substantial contribution from digital health.”

However, he said that for that to happen, governments must prioritize digital transformation through a multi-sectoral approach that goes beyond the health ministry. 

In 2019, the DRC adopted its digital technology strategic plan, Kamba said. Implemented by a newly-created ministry, the plan engages all sectors, including health. “All governments need to take a systems approach to digital transformation. It’s not just the health ministry that needs to be working on health care anymore.”

An Epidemiological Nerve Centre – The Emergency Operations Centre

Kamba said existing digital health initiatives, notably the nation’s Emergency Operations Centre (EOC), have proven useful in quickly containing infectious disease outbreaks like Ebola. Set up two years ago by PATH, USAID, and the Bill and Melinda Gates Foundation in collaboration with the DRC Centers for Disease Control, the EOC acts as the country’s epidemiological nerve centre to coordinate efforts to prevent, detect, and rapidly respond to public health emergencies. 

“The center uses tools such as digital mapping, Geographic Information System (GIS) mapping, and mobile health technologies to produce layers of information that help reveal  patterns that enabled more effective interventions during the Ebola epidemic,” he said.

“Actionable surveillance data and digital epidemic maps made the response faster and more focused, and was the first time that response data was digitized and centralized”. Recently the EOC expanded its scope to investigate regional and local malaria trends; it also facilitates disease control strategies using advanced data analyses. 

Kamba warned that digital health initiatives depend on reliable and affordable electricity, which can be a challenge in low-income countries: “We’re talking here about the potential of digital solutions to help us overcome long standing infrastructure challenges in sub-Saharan Africa … Investments in digital health in DRC must be coupled with energy solutions at the national level.”

“These [digital] infrastructures are also faced with a fundamental financing gap,” said Ilona Kickbusch, Geneva Graduate Institute Global Health Centre co-founder and co-chair of the new Lancet & Financial Times Commission on Governing Health Futures 2030. “To really have sustainable financing that’s also reflected in the budgets of countries is a truly, truly big challenge.” 

Ilona Kickbusch, Geneva Graduate Institute Global Health Centre co-founder and co-chair of the new Lancet & Financial Times Commission on Governing Health Futures 2030.

Digital Health in Burkina Faso Improves Care Quality

Meanwhile in Burkina Faso, Swiss NGO Terre des Hommes (Tdh) has worked for over a decade with the Ministry of Health to develop Ieda – a digital job aid tool that enhances the clinical diagnosis of childhood diseases and improves health workers’ performance using artificial intelligence (AI) algorithms.

Ieda already is available in 80% of health-care facilities in the country and has helped with a whopping 10 million digital consultations. This generates savings of US$1.6 million every year, Tdh health programmes research head Riccardo Lampariello said. “Digital health solutions at scale bring financial savings for the authorities, of course after the initial national investment, of $1.6 million every year. Hence the importance of investing in digital health.”

Lampariello stressed that the bulk of digital health expenditure is not on infrastructure but on human resources required to build necessary technical and regulatory capacity. He noted that governments need to run local data centers, extract and analyze data, update software and fix data platforms when they crash.

Riccardo Lampariello, head of Tdh’s health programmes

“Digital health is human resource-intensive, and we should equally invest in infrastructure — which is not only tablets and solar power panels, it is also data centers, for example — and in human resources, including local authorities, including the government, the MOH, in technical skills … and also look to teach them the governance skills to regulate labor use.”

Thanks to this already-existing digital health infrastructure, when the coronavirus hit it took only a few weeks for Burkina Faso’s Ministry of Health to deploy digital tools to support training, awareness-raising and triage, and to reach vulnerable groups in remote and unsafe areas, Lampariello said.

But he warned that the digital health landscape is still fragmented in low-income countries, challenged by duplication, a lack of interoperability and waste of precious devices and electricity.

“Even before COVID, it wasn’t rare to pay a visit to a health-care facility in a very poor country, open a cupboard and find two or three tablets or smartphones [for] dealing with different platforms and databases. In a context of limited resources, this represents a lot of wasted tools,” Lampariello said. “And not to mention, for example, the additional unnecessary e-waste and energy consumption related to that.”

Speakers Ask For Well-Designed & Equitable Digital Health Initiatives

Digital health initiatives are likely to be more impactful if they designed to be equitable, added panelists on Thursday. In Japan, for example, vaccine uptake in older age groups was hampered by the country’s response plan failing to consider that booking vaccine appointments online can be a struggle for older people. “It’s a design issue, and it’s not a complex issue, but it was not adequately designed for the elderly, so there’s a huge problem going on right now in Japan,” said Maeda.

Ann Aerts, Head, Novartis Foundation

“Every solution, digital- or AI-driven, has to be human-centered,” said Novartis Foundation head Ann Aerts. “And that’s quite obvious, although it’s not always the case. The best way is to use a human-centered design with input from the people who will have to use a solution, and by thinking up-front how the solution will be integrated in the processes of the health workforce, or the workflow.”

According to a World Bank study, successful digital health initiatives tend to share characteristics like strong leadership and regulatory systems, substantial financial commitments to digitize health systems, and national frameworks to facilitate data flows between systems, added Aerts. 

Disability services should be incorporated into primary health care programmes at the community level, states a resolution adopted at the 74th WHA.

A new resolution adopted on Thursday by the 74th World Health Assembly aims to scale up access to services and treatment for people living with disabilities – using a more “gender-sensitive and inclusive” approach.

The resolution co-sponsored by Israel and Australia,  calls upon member states to ensure that disability services are incorporated into primary health care programmes at the community level – and that conversely disabled people also have full access to health services.

It also calls for special attention to be paid to the “unique vulnerabilities of those who may be living in care and congregated living settings in times of public health emergencies such as COVID-19, and for special protection against infections in particular for at-risk groups,” including more education for health care workers. 

And, the resolution calls upon WHO to etch out a global research agenda on disabilities, as well as to develop, by the end of 2022, a global report on disabilities, updating estimates on the numbers of disabled people worldwide, from a decade old World Report on Disability (2011).

Countries Said Community-based Interventions Are Key 

Israeli diplomat Nitzan Arny speaks about the resolution on persons with disability led by Israel.

One in seven persons worldwide experience some form of disability. The numbers are increasing due to factors such as ageing populations and widespread chronic health conditions. 

Many countries highlighted the roles community-based interventions can play in improving access – in reactions that warmly supported the initiative overall. 

The resolution broadly calls for collection of reliable data that allow for disaggregation by disability. It also advocates equal access to effective health services, protection during health emergencies, and access to cross-sectoral public health interventions. 

Persons with disabilities face inequality in social, economic, health and political spheres and are more likely to live in poverty than those without disabilities. They are also more likely to have risk factors for noncommunicable diseases and less likely to have access to essential health services.  

“Nothing about us without us’ is not just a catchphrase. Meaningfully involving persons with disabilities in decision-making processes is a precondition for ensuring disability inclusion,” said Israel’s delegate to the WHA,  Nitzan Arny, in presenting the initiative. 

Australia, the resolution’s co-sponsor said: “We recognize the importance of promoting disability inclusion in the health sector to ensure persons with a disability enjoy the highest sustainable highest attainable standard of health, including access to quality disability inclusive health services, information and education across their lifetimes.”

Israel, Australia, the United States, European Union, Kenya, Botswana, the United Kingdom, Japan, Mexico and a dozen other countries co-sponsored the resolution.

Meanwhile, the resolution gives new impetus for action, particularly in light of the fact that WHO’s current Global Disability Action Plan 2014–2021 is set to expire this year. 

New Zealand, however, said it supports extending the Global Disability Action Plan because “This would demonstrate continued international commitment to this goal, and provide guidance for how this can be achieved.” 

 

COVID’s Impacts on Persons With Disabilities 

The pandemic has harmed people with disabilities in various ways, yet few member states collect data that are disaggregated by disability.  

Women and girls living with disabilities face particular challenges. “Women, young women and girls who are disabled have a high risk of being marginalized and seriously discriminated against. That reduces their economic and social status, it increases the risk of sexual violence and sexist attitudes against and towards them and [of] limited access to justice,” Canada said. “These challenges have only increased during the COVID-19 pandemic, and disabled women and girls continue to fight for their rights for equality and for changes to the system.” 

The resolution highlighted the role of community health workers in advancing equitable access of persons with disabilities to safe, quality, accessible and inclusive health services.

Stress on Community-Based Rehabilitation

Among the stakeholders invited to collaborate under the resolution are organisations of persons with disabilities, private sector companies, scholars and teachers. 

“Community-based rehabilitation is a strategy to improve access to the services to persons living disabilities in middle-and low-income countries through the optimal use of local resources,” said Colombia. 

 Civil society organisations have welcomed the resolution. “We welcome that the resolution calls on governments to actively involve people living with disabilities in decision-making and programme design. This will ensure that health systems and responses to health emergencies can better deliver on the needs of the people most affected,” said Nina Renshaw of the NCD Alliance. “As we’ve seen in other fields of global health, such as HIV and TB, meaningful inclusion of lived experience is absolutely fundamental to catalyse overdue progress.”

Image Credits: PicPedia.

Mr Ma Bin, Consultant at the Health Emergency Response Office, China’s National Health Commission, read the statement for China at the session

China told the World Health Assembly on Wednesday it will continue to support developing countries’ access to affordable COVID-19 vaccines – but it stopped short of any commitment to supplying its recently-approved Sinopharm vaccine to the WHO co-sponsored Global COVAX vaccine facility. 

WHO officials had said they hoped China would join the COVAX facility, following WHO’s decision to grant the Chinese Sinopharm vaccine an Emergency Use Listing.  COVAX has been badly strapped for doses to send to over 100 low- and middle-income countries after its major supplier, the Serum Institute of India, announced it would have to redirect all of its vaccines to domestic needs following India’s huge COVID surge.  

But China’s WHA delegate said that the country had honored its commitment to provide vaccines as a global public good by providing bilateral vaccine assistance to more than 80 countries, along with exports to 43 more nations – for a total of 300 million vaccine doses. 

“China believes that promoting equitable distribution of and access to COVID-19 vaccines worldwide is crucial to the current pandemic prevention and control,” the delegate said. On the private market, the Sinopharm vaccine is the most expensive in the world – outstripping the cost of the highest-performing mRNA vaccines produced by Pfizer and Moderna.  

 

The Chinese representative also avoided taking a clear position on the proposed Pandemic Treaty. A draft agreement on taking at least the first steps towards a treaty was reached earlier this week among WHA delegates. The proposal – by 26 entities including the European Union, USA, UK and key countries from each WHO region – appeared to be gathering more momentum from other countries as well. 

However, China supports “the concept of building a One Health Surveillance System as well as a whole-of-government and whole-of-society response approach,” the Chinese delegate, Mr Ma Bin, stated. 

In a wide-ranging discussion at the Assembly’s morning sessions, most countries’s statements also stressed the pandemic’s damage to their societies and economies. 

“The emergence of new variants of the virus has overwhelmed the already overburdened health system,” said Ethiopia’s delegate, saying the pandemic had also resented unprecedented social challenges and put enormous strains on economies. 

Strategies to engage communities and communicate effectively with the public are pillars of the Ehiopian response aimed to reduce disease transmission, she said. The COVAX Initiative has meanwhile supported the vaccination of 1.7 million Ethiopian’s at high risk, she added. 

“However, due to the current global situation, our vaccination campaign is seriously challenged, severely hampering our response and management of the spread of COVID-19. This reality is being experienced by many developing countries,” she said. 

Her comments sidestepped any reference to the pandemic or wider health issues faced by Ethiopians in the country’s war-ravaged Tigray region, where UN officials have warned that famine now looms.  

vaccine
Hiwot Solomon, Director, Disease Prevention and Control, Ethiopia’s Ministry of Health: “The emergence of new variants of the virus has overwhelmed the already overburdened health system.”

Sudan’s representative, meanwhile, said that while the pandemic has shaken all health systems, it has widened health service delivery inequities particularly in Low and/or Middle Income Countries (LMICs).

“While Sudan is committed to playing its role in the global efforts for control and prevention of public health emergencies of international concern, challenges remain,” Sudan’s representative said. “This is observed in the difficulties to regularly evaluate legislation, regulations, and policies to facilitate full implementation as well as capacity for infection prevention and control.”

Sudan called for WHO technical support to establish public health laboratories in difficult spaces and to support LMICs with consumable supplies. Sudan said its particular needs include food safety surveillance systems and a poison control center.

COVID – One Among Many Outbreaks Africa Faces 

Dr Matshidiso Moeti, WHO Regional Director for Africa.

WHO Regional Office Director for Africa Dr Matshidiso Moeti described COVID-19 as just one among a number of outbreaks African countries face. She noted the region has endured humanitarian crises as well as outbreaks of Ebola, measles, yellow fever and other diseases.

Still, she said, African governments “have pushed to sustain hard-won health gains and to minimize the pandemic’s impact, and are taking actions to prevent and treat other diseases.”

The pandemic highlights the need to invest in preparedness and the importance of equity in order to protect the vulnerable, Moeti said. “Much needs to be done immediately and in significant quantities to make the difference.”

‘Last Pandemic’ Report Approved

The WHA morning session also formally accepted the report of the Independent Panel for Pandemic Preparedness and Response. This panel was created to provide evidence and historical context to ensure that countries and global institutions, specifically the WHO, will be able to address future pandemic threats.

See also: Sweeping Report on COVID Pandemic: Broken Global Emergency Alert System, Hesitant WHO & Patch Country Response 

Former Liberian President Ellen Johnson Sirleaf, who co-chaired the panel, repeated to the Assembly once more her mantra that actions need to be taken now – so that COVID-19 may be the last pandemic of its kind.

Ellen Johnson Sirleaf: “We identified shortcomings at all stages of the response at both the national and international levels.”

“We identified shortcomings at all stages of the response at both the national and international levels. We also identified successes, and we recognize the hard work and sacrifices made – especially by health workers across the world,” Sirleaf said.

The panel’s goal wasn’t to apportion blame, she said, but to identify the pandemic’s lessons “so that the world can move forward to end the current pandemic and make it the last”.

Former Prime Minister Helen Clark of New Zealand, the Independent Panel’s other co-chair, said that fully acting on these findings can address the current pandemic as well as prevent future outbreaks from becoming pandemics.

‘Two-tiered World’ of Vaccinated and Unvaccinated

Helen Clark, co-chair of the WHO’s Independent Panel for Pandemic Preparedness and Response (IPPR), and former Prime Minister of New Zealand.

As virus deaths continue in the thousands daily, she said, vaccines that provide hope also show development of a two-tier world of the vaccinated and unvaccinated. 

“Immediate action therefore is needed on vaccines,” Clark said. The panel has recommended that high income countries share their existing vaccine doses on a much more massive scale – to free up at least 1 billion doses by September for lower-income member states.  

“At the same time, we urge removing the barriers to manufacturing scale-up by sharing intellectual property and transferring knowledge and technology, and by fully funding the Access to COVID-19 Tools Accelerator (ACT-A),” Clark said. 

She was referring to the WHO co-sponsored initiative that includes COVAX as well as funding for medicines rollout and strengthening health systems. It remains US$ 18.5 billion short of funds needed for 2021, according to senior WHO adviser Bruce Aylward, speaking at the WHA Tuesday. 

Said Clark: “The return on investment would be enormous – both for people’s health and for economies.”

Image Credits: Paul Adepoju , Paul Adepoju.

World Health Assembly side event – COVID-19 and Cross-Border Health Measures, left to right – Apakrishnanarna Ananth, Lisa Forman, Karen Grepin, Catherine Worsnop, Roonjin Habibi, Diego Silva, Barbara von Tigerstrom, James Wiltshire

Controlling a disease outbreak requires cooperation both behind borders and between countries, experts said at a Wednesday event co-organised by the Geneva Graduate Institute’s Global Health Centre.  And one key, neglected area of international cooperation has been travel restrictions, where countries worldwide have created a cacophony of different measures to control COVID.  

“Travel measures are potentially necessary, but they’re not sufficient to control an outbreak. It’s not sufficient to just have strong travel measures in place,” said Karen Grepin, University of Hong Kong associate professor, during the World Health Assembly side event. “We also need a strong national response, a public health response to the pandemic. It can’t just be one or the other.” 

Panelists discussed the impacts of cross-border measures implemented in response to COVID-19. They also considered lessons learned regarding the strengths and weaknesses of the existing International Health Regulations (IHR), which govern country responses, as well as the broader global health ecosystem. 

Travel Measures Must Be Implemented at a Granular Level

travel
Travel measures must take into account local capacity, economic and social circumstance, and legal obligations of countries

These measures need implementation at a granular level, taking into account the “incredible diversity of local capacity, economic and social circumstances, and other legal obligations among member states,” said Barbara von Tigerstrom, Professor at the University of Saskatchewan.

She said experts are making efforts to adapt to a single uniform set of recommendations “when member states are so varied, and especially when things are moving quickly and we need to make quick decisions.” 

Regarding the IHR, von Tigerstrom suggested that evaluating a centralized recommendation or a single set of regulations is not necessary to evaluate what is legitimate or lawful: “If we’re going to use travel restrictions and have them be useful, [then] the more quickly the better.”

Grepin said travel measures also should be rethought in terms of effectiveness: “In the case of COVID, I can say without a doubt that travel measures have been effective in various contexts.” 

Karen Grepin, University of Hong Kong

These measures have been a critical component of national infectious disease response,  Grepin said, and many countries have effective border measures in place they are reluctant to discontinue. 

However, Grepin pointed out, “The reality is that we don’t need to respond like we have in this pandemic to all future threats. Context matters an enormous amount. Some places are more likely to benefit from [these measures] than others, so blanket measures that apply to all state parties are likely to be limited in what they can really [do].” 

James Wiltshire, International Air Transport Association assistant director, also called for a context-based approach for travel measure exit strategies: “There’s not a joined-up approach between measures at the border and measures behind the border.”  

Almost every country in the world has travel measures in place, but those measures are highly inconsistent.  And the IHR rules, which have few provisions about travel in the first place, provide even less guidance on how such measures should be relaxed or removed as the  pandemic is beaten back.

Said Wiltshire each country also faces different contexts, not in terms of disease transmission as well as social and economic pressures: This is a “complex pandemic, with many different countries in different states, so almost certainly a phased removal or relaxation of measures is needed. It is not realistic to expect something that’s prescriptive of the IHR to be followed to the letter of the law, given the range of different circumstances that countries have.” 

High-Income Countries Have ‘Moral Obligation’ Regarding Travel Regulations

Diego Silva, University of Sydney

University of Sydney health ethics lecturer Diego Silva said, “If we’re truly interested in global health, if we’re truly interested in taking seriously the ‘pan’ part of a pandemic, then we need to think through how we interact with each other.”

Silva discussed reciprocity between countries with different income levels. He said travel restrictions and border closures must be understood not just in the context in which they occurred, but also in relation to broader politics and policies. 

Using Australia as an example, Silva said its government is very hesitant on immigration from certain Asian countries, and that “[this] geopolitical reality shapes [Australia’s] border responses.” He said this idea of “state sovereignty used in a protectionist manner” may be “morally problematic, because of the global nature of the virus.” 

He advised that countries need to work on a regional level, at the very least, when it comes to border closures. High-income countries also have a “moral obligation” to work with LMICs on  international travel issues: “It’s not enough to act again in a unilateral manner.”

Potential Gap in IHR Compliance and Policy Implementation   

Catherine Worsnop, University of Maryland

Looking beyond potential IHR revisions and a potential pandemic treaty, University of Maryland Assistant Professor Catherine Worsnop said it’s critical to understand compliance behavior during an outbreak, as well as the potential drivers of variant spread. 

Worsnop found a potential gap between legally compliant behavior and implemented policy when evaluating country compliance in regards to Article 43 of the IHR. 

“Compliance and non-compliance does not capture the full extent of variation and policies that states were actually adopting at the border,” said Worsnop. Implemented policies were not necessarily aligned with the dual purposes of the IHR: to protect health and minimize interference with international traffic.

“We need better clarity on what the IHR are actually aiming to achieve when it comes to cross-border measures, and what counts as compliance really needs to be aligned with that aim going forward,” Worsnop said. 

Roojin Habibi of York University addressed legal considerations in the interpretation of Article 43. The precautionary principle has come up often, notably in reviews conducted by the Independent Panel for Pandemic Preparedness and Response (IPPR), the IHR Review Committee’s report, and the Independent Oversight and Advisory Committee’s report. Yet this “is nowhere written in the text of the IHR,” Habibi said. 

The principle asserts that positive actions, such as a ban on certain activities, may be implemented in order to protect the environment or public health before a risk is scientifically proven. “I would caution us, and would strongly urge us to think carefully about the precautionary principle,” Habibi said. “Doesn’t scientific evidence do the job well enough for us?” 

 

Image Credits: Sanshiro Kubota/Flikr, Global Health Centre/Twitter, Graduate Institute Geneva.

Palestinian medics attend to an young man injured during clashes with Israeli security forces in Jerusalem on 10 May, just before the eruption of violence between Israel and Gaza

A longstanding dispute over a perennial World Health Assembly resolution on the health situation in the Israeli-occupied Palestinian territories claimed a full day of WHA delegates’ attention – as countries on both sides of the bitter conflict battled over a draft decision in a prolonged debate, leading up to a painstaking virtual vote by roll call of all 194 WHO member states.  

Ultimately, Israel lost its bid to defeat the measure – to which it has long objected saying that it singles out the Palestinian issue at the WHA above any other health and humanitarian conflict today. 

A total of 83 WHO member states voted yes, 14 voted no and 39 abstained from the final, approved resolution on the “Health conditions in the occupied Palestinian territory, including east Jerusalem, and in the occupied Syrian Golan”. 

The resolution, its 27 co-sponsors led by Algeria, and including South Africa, Andorra and Indonesia and Venezuela alongside nearly two dozen other Arab and North African states, was backed by a detailed report focusing on shortcomings and barriers to the access of health services in Hamas-controlled Gaza and the West Bank, occupied by Israel. 

WHO Regional Director for EMRO Ahmed Al Muntari

The report covers a wide range of longstanding issues faced by Palestinians such as: the lack of access to specialist hospitals in Israeli-controlled Jerusalem; Israeli limitations on the movement of Palestinian emergency services; lack of Palestinian access to COVID vaccines, and an overall lower quality of health services.  The net result of those factors, compounded by chronic violence, poor housing, inadequate water and sanitation services, also leave Palestiniains with a shorter average life expectancy, pointed out WHO’s Ibrahima Socé Fall and Ahmed Al Mandhari, WHO Regional Director for the Eastern Mediterranean, who presented the report.   

The resolution, anchored upon the report, called mainly for the provision of  more WHO support to the Palestinian health sector, equitable Palestinian access to COVID-19 vaccines, and protection of health and humanitarian responders who have faced even greater challenges during the recent 11-spate of clashes between Israel and the Hamas-controlled Gaza Strip.  

However, Israel and its allies also have begun to object more and more vocally over the past year to the centrality the Palestinian measure receives aimed on the WHA stage – unlike that of any other country, humanitarian crisis or disputed territory.  

This year, in particular, sentiments were running at fever pitch – in light of the recent fierce fighting between Israel and the Hamas-controlled Gaza Strip. Those clashes saw 11 days of fiery exchanges of missiles and air power – leaving at least 243 Gaza Palestinians killed, including more than 100 women and children, according to Hamas  – although Israel disputes those figures saying that among the victims in Gaza were more than 150 Hamas fighters.  In Israel,13 people, including two children, died.  

In contrast, a brewing WHA debate over whether to credential Myanmar’s deposed civilian government of Aung San Suu Kyi, or the new military rulers who seized power in February and have since been accused of violently repressing and arresting protestors en masse, was buried by a WHA credentials committee. The committee, meeting behind closed doors Tuesday, kicked on the politically thorny decision to a latter date and the UN General Assembly.  That motion passed without a word of opposition from the WHA plenary on Wednesday. 

Even the normally contentious issue of Taiwan’s exclusion from the WHA passed with just a few remarks by member states in plenary and other meetings yesterday and today. 

Objections by Israel and Allies to “Standalone Item” Have Amplified 

The debates over the health conditions in occupied Palestinian territories and the Golan Heights have gradually became more and more prolonged over the past couple of years, after Israel began to insist on a roll-call vote over the  WHA resolution accompanying the report on health conditions. 

That constitutes Israeli pushback over the extra  attention the issue receives every year in the WHA forum – as compared to other similar reports on health conditions in humanitarian situations and conflict zones – which are either never discussed, or are confined to a footnote.    

A sustained Israeli diplomatic effort among sympathetic member states has gradually yielded some results – although not enough to overturn the vote.  

As the United Kingdom stated:  “We voted no, because we object to the addition of this standalone agenda item at the World Health Assembly, which as we all know is the only country-specific item proposed at this Assembly – and something which we believe needlessly politicizes the WHO and the WHA at a time when collaborative action between us is so needed.

“We supported the report, and the associated decision be considered alongside other WHO assistive programs. 

“We of course, like so many others who remain deeply concerned by the fragile health situation in the occupied Palestinian, especially in Gaza –  and the recent conflict and damage to health infrastructure has exacerbated the needs of the population at the same time that it faces the COVID pandemic. 

“However, we are considering that this Assembly does not scrutinize the other difficult health situations around the world in the same way as it scrutinizes the situation in the occupied Palestinian territories.  And this his item remains the only one of its kind. And we fail, we believe in our duty to serve people around the world who have vitally important health needs. If we allow the WHO become politicized in this way.

Palestine & Syria Retort – What is New?

Syrian delegate to the WHA

Retorted the delegate from Palestine, which represents the Palestinian Authority on the West Bank – and has observer status at the WHA: 

“It’s very sad to hear all of these excuses from some of my colleagues, all of those who spoke of the politicization, voted for this same draft a few years ago. Everyone was for this draft resolution. So what is new, that we have just discovered, that makes everyone believe that this is a politicization, no we’re against anything that makes things more political.” 

The Palestinian delegate also suggested that “if the bombing stops, and ief we have at least the opportunity to have eased access to distribute vaccines, then in that case, we wouldn’t even need a resolution” – adding that she hoped next year Palestine would also become a full member of the World Health Assembly. 

“What we are attempting is to establish responsibility, we do not want to harm anyone but this means of going forward is something that we reject. And it is a major hindrance for the health sector of Palestine, and it is not in conformity with the Geneva Conventions, I thank you very much for your kind attention.”

Added Syria, Israel’s allegations that the resolution politicized the work of the WHO, “is a sheer misleading campaign” saying it was a “technical text….  which is presented in the context of the mandate or who it confirms the determination of the international society, to provide protection and health care to the Palestinian people and the Syrians under occupation.”

The bitter dispute, as Syria noted, also extends to the Golan Heights, over which Israel has extended Israeli law – providing Syrian Druse communities living there with access to Israeli health and social security services –  as well as a pathway to citizenship. 

“This relates to Syrian citizens, who are under foreign occupation, and who are being referred to by the Israeli occupying power under misleading terms, to justify its illegal decisions to annex the Syrian Golan.”

Israel meanwhile said that member states who adopted the decision have allowed the Syrians to whitewash their political crimes – and allow the Palestinians to use this forum for their political goals, and adopt a decision that is far removed from reality. 

Meirav Eilon Shahar, Israel’s ambassador to the UN in Geneva

“Let’s stop the politicization of this forum, by deleting this  from the agenda,” said Meirav Eilon Shahar, Israel’s ambassador to the UN in Geneva. “Health can be a bridge to peace. This decision has become a ritual, its time to stop that. It’s time to build back better.” 

Image Credits: www.laprensalatina.com.

Ajoke Sobanjo-ter Meulen, Princess Nothemba (Nono) Simelela, Wiweka Kaszubska, Alwyn Mwinga, Jamie Nishi, Andrew Tuttle, Lisa Goërlitz (from top left to right)

Although gender is increasingly factored into health research, much remains to be done, experts reported at a Tuesday event co-organised by the Geneva Graduate Institute’s Global Health Centre.

But despite growing awareness, health research continues to conceptualize gender in binary terms. Very little research concerns those who identify as LGBTQ+, according to speakers at the event, which was co-sponsored by the Medicines for Malaria Venture, the Global Health Technologies Coalition, Deutsche Stiftung Weltbevölkerung (DSW International), and the International Geneva Global Health Platform. 

Panellists explained how diseases can have vastly different impacts on different genders because of social and economic factors. Women are under-represented in pre-clinical and clinical trial research, leading to limited data on risks and benefits of tested medicines and vaccines. Later impacts of this bias eventually may limit women’s therapeutic options.

Pregnant women are an especially vulnerable category, often left out of clinical trials altogether.  

Involve Communities, Improve Trust

Alwyn Mwinga, CEO, Zambart Project; Zambia DNDi Board Patient Representative said the key to involving more women in research is to improve trust.

Panellists repeatedly stressed the need to work closely with communities while designing solutions, as currently researchers have inadequate consultations with women.

“This element of trust actually underscores the importance of important community research, and this is more impactful,” said Alwyn Mwinga, Zambart Project CEO and Zambia DNDi Board Patient Representative.

She said the take-home message is that pregnant women are willing to participate in research, provided they are given sufficient information to make a considered decision. She added that while more women are included in recent clinical trials, a lot more needs to be done.  

Among the barriers to including more women in clinical trials were onerous paperwork involved in the consent process and cultural issues surrounding consent: if women must refer such decisions to a spouse or parents, this calls into question the process of informed consent. 

Neglected Diseases and Skewed Funding

Bias isn’t limited to gender issues — inequities also mark funding for research into various diseases. Some diseases get more funding than others, and those that concern women the most may be neglected.  

“In 2018 we saw $US 1.7 billion invested across these health issues … and, maybe unsurprisingly, the lion’s share of that — nearly 85% — went to HIV/AIDS,” said Andrew Tuttle, Policy Cures Research research director. Research is lacking about pregnancy-related conditions, and this slows development of drugs and technologies for pregnancy-related conditions.

Poverty-related neglected diseases are another neglected area. “The same disease might have different consequences on different genders or different sexes because of the role of women and girls in society or because of expectations towards different gender roles and so on,” said Lisa Goërlitz, DSW Brussels Office EU Advocacy Unit head.

She said there is almost no data on how these diseases affect LGBTQ+ community members.

Gender dimensions have significant impact on health outcomes depending on stigma and discrimination, as well as different financial and social outcomes.

Ajoke Sobanjo-ter Meulen, lead of Maternal Immunisation, Bill & Melinda Gates Foundation said that maternal immunisation can serve as an example for other health programmes

While stakeholders like manufacturers, policy-makers and communities can make a difference, women have made direct efforts to be included in research.
“Women’s autonomy and agency — I think that played a very important role. The Zika example and Ebola example are very critical here, because in both instances pregnant women demanded to be included in clinical trials, which initially did not happen,” said Ajoke Sobanjo-ter Meulen, maternal immunisation lead at the Bill & Melinda Gates Foundation.

Thanks to these milestones, subsequent outbreaks have seen pregnant women included in earlier stages of research.

Healthcare workers in Nigeria fight to maintain vaccination services during the COVID-19 pandemic.

 

Key World Health Organization (WHO) member states agreed to postpone a potentially polarising discussion on a ‘pandemic treaty’ until November, according to a World Health Assembly ‘draft decision’ published Tuesday.

The proposal – by 26 entities including the European Union, USA, UK and key countries from each WHO region – specifies that a special WHA session should be “dedicated to considering the benefits of developing a WHO convention, agreement or other international instrument on pandemic preparedness and response”.

This special WHA would establish “an intergovernmental process” to draft and negotiate this instrument, “taking into account the report of the Working Group on Strengthening WHO Preparedness and Response to Health Emergencies”. 

Previously, the US had advocated for a high-level ministerial meeting to consider the possibility of an international instrument or treaty.

Late Tuesday afternoon, Germany delivered a statement on behalf of 59 countries that now support the  special session of the WHA in November to discuss a possible pandemic treaty.

“In our view, a pandemic treaty under the roof of the WHO is the preferred way forward to strengthen the multilateral health architecture,” said Germany in the statement.

Mike Ryan, WHO Health Emergencies Programme Executive Director, appealed Tuesday for “the highest-level political commitment” to address the organisation’s weaknesses in the face of pandemics. 

Dr Mike Ryan, WHO Executive Director of Health Emergencies Programme.

Reciting a lengthy list of epidemics that had ended with unmet promises to fix global responses, Ryan said, “If I had a dollar for every recommendation made in this space, I would have a completely funded programme.”

“My personal view is that we need a political treaty that makes the highest-level commitment to the principles of global health security — and then we can get on with building the blocks on this foundation,” Ryan told a lunchtime briefing on pandemic preparedness.

Since November the European Union has advocated a pandemic treaty similar to the Framework Convention on Tobacco Control, but has faced opposition from the US, Russia and Brazil. (The tobacco convention provides signatories with evidence-based tobacco control strategies that they are obliged to implement, albeit incrementally.)

Russia’s WHA representative told Tuesday’s plenary that there was no need for additional requirements beyond the International Health Regulations, as these are binding global regulations to prevent the spread of disease.

US public utterances have been vague, although an earlier Health Policy Watch report indicated the US was trying to stall discussions by proposing various diplomatic measures such as a high-level ministerial meeting to consider setting up an “international instrument”.

US Health and Human Services Secretary Xavier Becerra

Addressing Tuesday’s plenary, US Health and Human Services Secretary Xavier Becerra called for “urgent action this year to strengthen health security and pandemic preparedness” by “improving global triggers.” 

Measures should include a “sustainable global health security financing mechanism” and developing “surge capacity” for global manufacturing of personal protective equipment, vaccines, therapeutics and diagnostics, said Becerra.

However, comments from various US officials during the Assembly indicate that the country is concerned about the financial responsibilities attached to any legal framework, which might be difficult to get domestic support for.

EU Upbeat About Pandemic Treaty

Meanwhile, the EU delegations to the United Nations in Geneva were positive about the draft decision.

“Ahead of the World Health Assembly, the EU and a group of countries from across all WHO regions built a large coalition to ensure that WHA74 would pave the way for establishing a process for a Framework Convention on Pandemic Preparedness and Response,” according to a statement from the EU delegations.

“The decision to be adopted today by the Assembly will set up a special session of the WHA in November 2021 to focus on this one issue with a view to starting the formal negotiation process immediately thereafter.”

Also Tuesday, Charles Michel, President of the European Council, reiterated the EU’s call for an international treaty to “foster a comprehensive approach to better predict, prevent and respond to pandemics, strengthen global capacity and resilience to ensure fair access to medical solutions, and bolster international alert systems that are sharing … cutting-edge medical research.”

Three Perspectives on WHO Inadequacies

Helen Clark, co-chair of the WHO’s Independent Panel for Pandemic Preparedness and Response (IPPR), and former Prime Minister of New Zealand.

Three key reports – from the Independent Oversight and Advisory Committee (IAOC), the Independent Panel for Pandemic Preparedness and Response (IPPR), and the International Health Regulations Review Committee (IHRC) – have laid bare various WHO failures in the face of COVID-19.

The IPPR presented its report to the WHA on Tuesday. This team was led by former New Zealand Prime Minister Helen Clark and former Liberian President Ellen Sirleaf. Clark told Tuesday’s technical briefing the panel “has recommended the adoption of a pandemic framework convention within six months, using powers under Article 19 of the WHO constitution”. 

“We see the convention as being complementary to the International Health Regulations,” Clark said. “We think its negotiation should be facilitated by the WHO, with involvement at the highest levels of that negotiation of governments, scientific experts and civil society.”

This convention would fill gaps in the current legal framework, clarify the responsibilities of states and international organisations, reinforce states’ pandemic-related measures and support WHO’s empowerment, she said. 

It also would set up principles and mechanisms for financing preparedness and early response, and for the “global public goods of vaccines, therapeutics, diagnostics, and essential supplies and technology transfer.”

More pointedly, Clark noted that “WHO needs to have unfettered access to the sites of an outbreak, and it shouldn’t need to go through a negotiated process to get there.”

IHR review co-chair Lucille Blumberg said her committee also supports a pandemic treaty to address regulatory gaps that “mostly concern detection, assessment, and alert provisions, as well as preparedness for core capacities. … There are other elements required for a comprehensive global architecture for emergency preparedness and response which seem to fall outside of the IHR. 

“This has made us consider there may be benefits in agreeing on a global legal mechanism that would outline such provisions while supporting and complementing IHR implementation — and this could be done through a pandemic treaty,” Blumberg said.

Image Credits: Twitter: @WHOAFRO, WHO.

Front line healthcare workers at Thailand Bamrasnaradura Infectious Disease Institute faced workforce shortages and had limited access to personal protective equipment as violence against healthcare workers worsened globally.

An unprecedented number of healthcare workers were seriously assaulted last year, even as health workers risked their lives on the front lines of the COVID-19 response. 

Over 412 COVID-related attacks on health workers, including kidnappings and murders, occurred between January and December 2020, experts reported at a World Health Assembly side event. The session Monday was co-organized by the Global Health Center; the Safeguarding Health in Conflict Coalition; the Swiss Confederation; and the Government of Spain. 

Panelists said that as most countries went into lockdown last year, public frustration, anger and anxiety fuelled violence against health workers worldwide. 

Violence against health care in the context of the COVID-19 pandemic in 2020. Reported COVID-19-related violence (in green) peaked in the early weeks of the pandemic and has since fallen.

The majority of perpetrators of pandemic-triggered violence were patients and their family members, or local community members. In 59% of cases, violence was triggered by opposition to COVID diagnostic testing or a decision to hospitalize a patient, said a “Threats and Violence against Health Care during the COVID-19 Pandemic” report by Insecurity Insight.

Healthcare workers faced abuse while traveling to and from work in 30% of cases. In 11% of incidents, health workers were threatened or injured for speaking out against challenges they experienced at work, including protests over the lack of personal protective equipment and masks. 

“Sadly, these violations in dozens of countries and situations of conflict are the new normal. And this normal is not acceptable,” said Susannah Sirkin, Director of Policy and Senior Advisor at Physicians for Human Rights. 

Susannah Sirkin, Director of Policy and Senior Advisor at Physicians for Human Rights.

“It is especially unconscionable during the time of a global health crisis, the COVID-19 pandemic, which compounds the situation of devastation from attacks on health in war and other situations of conflict,” Sirkin added

While generally there were fewer assaults in 2020 compared to previous years, the nature of the events became more severe, with an increase in the number of health workers killed and kidnapped. 

Assaults on Health in Conflict Situations

Beyond COVID-related attacks, deeply-entrenched patterns of violence against health workers in conflict-ridden countries also continued. 

This included attacks on health workers and destruction of health facilities associated with the ongoing conflicts in Libya and Yemen – which continued despite the UN Secretary’s call for a ceasefire due to the pandemic. 

The Central African Republic, plagued by armed conflict, social unrest and political instability, also has seen a high proportion of health facilities destroyed or rendered non-functional.

“Killings, assault, kidnapping, verbal threats and overt acts of intimidation against healthcare workers are commonplace,” said Minister of Health Pierre Somse. 

Pierre Somse, Minister of Health of the Central African Republic.

He said that in the country, the number of attacks against healthcare workers rose 79% from October 2020 to February 2021.

The Central African Republic has one of the world’s lowest physician-to-patient ratios and among the highest rates of maternal and infant mortality. 

In one district in the Central African Republic with high levels of violence against health personnel, tuberculosis vaccination rates also dropped to 45%, as compared to the national average of 81%. 

“Conflict and violence against healthcare workers is worsening inequality and inequities in access to health services,” said Somse. “Addressing all forms of violence against healthcare workers in conflict settings is an urgency. It is needed today more than ever, as we confront COVID-19.”

Trends in Violence Against Health Workers for 2021 

Over the past five years, a health facility in a conflict zone was destroyed or severely damaged every other day, on average. Every two days a health worker was kidnapped or injured, and every three days a health worker was killed. At least 600 health workers were killed and over 1000 health facilities were damaged. This violence was concentrated in Syria, Nigeria, Afghanistan and the Democratic Republic of Congo. 

“Where does this leave us for this year? I’m afraid the picture doesn’t look good,” said Christina Wille, Director of Insecurity Insight, a Geneva-based NGO. “I’m afraid we’ll probably be here next year again with a report that has a few little positive notes to report.”

In 2021, increasing attacks on healthcare workers were witnessed and reported in Tigray, Gaza, and in Myanmar. In Myanmar, there were over 500 arrest warrants issued against healthcare workers since the coup in February.

Barely a day has gone by without violence against health workers being reported in Myanmar. Some 19 health facilities were damaged in Gaza over the past two weeks, including its main COVID-19 laboratory. 

“It seems that whenever there’s violence, it’s accompanied by violence against healthcare,” said Leonard Rubenstein, Chair of the Safeguarding Health in Conflict Coalition. 

Leonard Rubenstein, Chair of the Safeguarding Health in Conflict Coalition.

The violence is sometimes the collateral damage associated with larger strategic objectives. Other times it is an end in itself, as in Afghanistan, where the Taliban forces closures of health facilities in order to exert their leverage over health services. Health workers are sometimes punished for providing care to enemy combatants, although occasionally the violence is a result of recklessness, said Rubenstein.

Actions Needed by States, the UN and WHO

This month marks five years since the United Nations Security Council adopted a resolution against attacks on health workers in situations of armed conflict. On this anniversary, little progress has been made on implementing the resolution and reducing violence. 

“A few states have demonstrated their commitments and followed through on them, but these unfortunately are exceptions,” said Rubenstein.

The resolution was prompted by the 2015 US bombing of the Kunduz Trauma Center in Afghanistan, operated by Médecins sans Frontières, which killed 42 patients and health-care workers. 

An operating room in the Kunduz Trauma Center in Afghanistan, operated by Médecins Sans Frontières, that was destroyed in a US airstrike in 2015.

“In the darkness of the night, my hospital was on fire and I was hearing the screams of patients, caretakers, and staff for help. No one could help them. And all of them, the ones who had been trapped inside, died,” said Masood Nasim, Deputy Medical Coordinator of Médecins sans Frontières in Afghanistan.

“I have seen terrible consequences of attacks on healthcare: patients and medical personnel directly killed and injured, and essential in life saving medical services lost for current and future patients,” said Nasim.

Masood Nasim, Deputy Medical Coordinator of Médecins sans Frontières in Afghanistan.

Calling for Five Concrete Steps by Global Community

“After five years of inaction, the international community must take a much more vigorous stance,” said Rubenstein.  He laid out five concrete steps to be taken by the international community:

  • A special representative of the UN Secretary General should be appointed to monitor and report on the compliance of states with the resolution;
  • Political leaders must demand that ministers of defense get involved in reforming operational procedures and protecting healthcare;
  • WHO should convene health ministers to address the issue of violence against health workers at the ongoing 74th World Health Assembly;
  • WHO must take action to address the underreporting of data collected on violence against healthcare;
  • States and the UN must stop taking actions that undermine protection and legitimize violence against healthcare.

Multiple times over the past five years, the Security Council has blocked referrals to the International Criminal Court. In response, the General Assembly should establish new tribunals to prosecute perpetrators. 

Additionally, member states that sell arms to perpetrators of violence against healthcare must start adhering to laws prohibiting such sales. 

“These five steps take commitment and political will,” said Rubenstein. “We don’t want to meet in another five years and have the same discussion.”

“We all have a role to play in preventing these terrible events, which continuously reduce and impair the capacity of the impact of healthcare systems around the world,” said Maciej Polkowski, Head of the Health Care in Danger Initiative at the International Committee of the Red Cross. 

“The very least we can ask is that people stop attacking medical facilities and healthcare workers who are trying to save human lives,” said Nasim. “It must stop.”

Image Credits: Global Health Center, UN Women Asia and the Pacific.

Keva Bain of the Bahamas and WHO Director General Tedros Adhanom Ghebreyesus

Strengthening the World Health Organization’s pandemic response is a key focus of the 74th World Health Assembly, which started on Monday – and WHO Director General Dr Tedros Adhanom Ghebreyesus has already secured agreements with powerful European member states to do just that.

WHA discussion on a report from the Independent Panel on Pandemic Preparedness is expected on Tuesday., which details the slow, antiquated pandemic response mechanisms of the under-resourced global body. 

To bolster international pandemic surveillance, Switzerland will provide a biosafety laboratory in Spiez for a WHO BioHub Facility. This laboratory will share pathogens with global laboratories and other partners, according to a WHO announcement Monday.

“The facility will serve as a centre for the safe receipt, sequencing, storage and preparation of biological materials for distribution to other laboratories, in order to inform risk assessments and sustain global preparedness against these pathogens,” the announcement said.

Swiss Health Minister Alain Berset addressed the WHA opening session, expressing support for “predictable, independent funding” for the WHO and a pandemic treaty to “enhance and strengthen the role of the WHO, and also to ensure better implementation of the International Health Regulations.”

Meanwhile, French President Emmanuel Macron announced that a WHO Academy to train health workers would open its doors in Lyon in 2023. Macron also stressed the importance of ensuring that the WHO’s funding  was “more sustainable, more predictable, and less dependent on several big donors”.

In addition, said Macron, WHO needs “rapid response missions” with access to all territories to investigate pathogens that might lead to a pandemic. This follows unhappiness with how long it took China to admit a WHO-led team into Wuhan to research the origin of SARS-CoV2.

German Chancellor Angela Merkel expressed her country’s support for a pandemic treaty as well as a Global Health Threats Council to monitor member states’ adherence to international health regulations. Earlier this month, Germany and the WHO announced the establishment of a global hub in Berlin to gather data on pandemics and epidemic intelligence.

German Chancellor Angela Merkel

Push to Vaccinate 10% by September

When Tedros addressed the assembly, he was characteristically frank: “There is no diplomatic way to say it: a small group of countries that make and buy the majority of the world’s vaccines control the fate of the rest of the world.

“The number of doses administered globally so far would have been enough to cover all health workers and older people, if they had been distributed equitably,” he added. “We could have been in a much better situation.”

He then appealed to all member states to “support a massive push to vaccinate at least 10% of the population of every country by September, and a drive to achieve our goal of vaccinating at least 30% by the end of the year.” 

United Nations Secretary-General Antonio Guterres described the COVID-19 pandemic as bringing a  “tsunami of suffering.” He noted the costs of 4 million lives, 500 million jobs and trillions of dollars in economic and industrial impacts.

Guterres reiterated his call made at Friday’s G20 Global Health Summit for a task force that “brings together all countries with vaccine production capacity, WHO, ACT Accelerator, its partners and essential financial institutions able to deal with the pharmaceutical companies”.

The aim, Gutteres added, would be to double global vaccine production by exploring “all options — from voluntary licences and technology transfers to patent pooling and flexibility for intellectual property rights”.

South African president Cyril Ramaphosa, who also co-chairs the ACT Accelerator, decried the “huge divide in the provision of COVID-19 vaccines… [M]illions of people in wealthier nations have been vaccinated while billions of people in poorer countries still wait & are vulnerable to infection.”

Ramaphosa also expressed support for a global health council to collaborate with WHO to support regional and national pandemic response mechanisms.

Appeal for Travel Restrictions to be Eased

Meanwhile, Prime Minister of Antigua and Barbuda Gaston Brown stressed how difficult it was for small island states that suffered massive economic losses to buy vaccines through COVAX because they were deemed middle-income countries. Brown appealed for access to COVAX vaccines to be relaxed, and for travel restrictions and access to be eased.

Reiterating Spain’s commitment to sharing vaccines with Latin American countries, the country’s Prime Minister, Pedro Sanchez, proposed a public-private partnership between airlines, governments and international organisations to facilitate vaccine distribution.

Dechen Wangmo, Minister of Health of Bhutan

Dechen Wangmo, Minister of Health of Bhutan, was elected president of the WHA, which is the main governing body of the WHO, and will steer the complex discussions until the assembly ends next Tuesday. 

Over 70 health issues are on the agenda, from COVID-19 response and preparedness to mental health; patient safety; non-communicable diseases; antimicrobial resistance; health workforces; laboratory biosafety; violence against women, girls and children; finances; and the health-related 2030 Sustainable Development Goals.