WHO executive board members take an exercise break.

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

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

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

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

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

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

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

Organ transplants

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

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

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

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

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

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

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

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

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

Test tube rack stocked with electronic cigarettes.

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

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

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

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

WHO Director-General Dr Tedros Adhanom Ghebreyesus

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

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

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

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

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

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

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

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

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

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

En route COP10

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

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

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

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

Image Credits: Unsplash.

WHO Executive Board discusses Universal Health Coverage.

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

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

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

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

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

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

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

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

Delivering UHC requires countries to invest more in primary healthcare.

High debt burden is stunting progress 

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

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

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

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

Pressure placed by conflicts

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

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

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

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

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

Syrian refugee camp

Lessons from countries with UHC

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

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

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

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

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

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

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

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

Shortage and safety of healthcare workers

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

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

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

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

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

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

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

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

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

A lack of investment in vaccine and therapeutics R&D is undermining global pandemic preparedness.

There is a global lack of preparedness and reactive responses when confronted with emerging epidemic threats, a concerning lack of investment in the R&D vaccine and therapeutics pipeline, and signs of waning focus on pandemic preparedness, according to a new report by the International Pandemic Preparedness Secretariat (IPPS).

The IPPS launched its third annual report on the 100 Days Mission (100DM) for pandemic preparedness at the Accademia dei Lincei in Rome on Wednesday.

The report assesses how much progress has been made toward ensuring the global availability of diagnostics, therapeutics, and vaccines (DTVs) within the first 100 days of a pandemic threat. It also evaluates progress toward 100 Days Mission target of two antiviral therapies for each high-risk viral family, ready for Phase II/III clinical trials by 2026.

“In 2021, a group of G7 scientific advisors and experts came together to set out the recommendations that would form the basis of the 100DM,” explained 100DM outgoing chair Sir Patrick Vallance in the report’s introduction.

“Since then, the world has changed. We are no longer in the throes of a global pandemic; world leaders are dealing with multiple competing crises, and the global health landscape appears increasingly complex as organisations grapple with optimally prioritising limited funds and contend with multiple needs and threats. But we know that future epidemics and pandemics are not just likely; they are inevitable.”

He said IPPS’ annual reports are an opportunity to reflect on progress made the year before and set priorities for the following year.

What happened in 2023?

In 2023, progress was made in several areas, the report highlighted, including the first US Food and Drug Administration-approved Chikungunya vaccine and Phase 1 trials for Crimean-Congo Haemorrhagic Fever (CCHF) vaccines. Moreover, the report showed solid political support for the 100DM from the G7 and G20.

“2023 saw strong progress in epidemic and pandemic vaccine research in support of the 100 Days Mission, including investments to advance the next-generation of mRNA and thermostable technologies, a groundswell of support for regionalised manufacturing and the growing use of artificial intelligence to accelerate vaccine design,” said Dr Richard Hatchett, CEO of the Coalition for Epidemic Preparedness Innovations (CEPI).

Therapeutics Roadmap & Scorecard

Two other publications were launched alongside the report on Tuesday: The 100DM Therapeutics Roadmap and the 100DM Mission Scorecard.

The roadmap was developed with advisors and partners, including the INTREPID Alliance, Unitaid, the Drugs for Neglected Diseases Initiative (DNDi), the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), the Medicines Patent Pool (MPP) and the Rapidly Emerging Antiviral Drug Development Initiative (READDI).

“The roadmap marks the start of a more coordinated approach to pandemic therapeutics development,” IPPS explained. “It aims to provide a springboard for action and collaboration, with a headline goal of developing at least two ‘Phase 2 ready’ therapeutic candidates for each of the top 10 WHO priority pathogen families, while also focusing on the optimisation of monoclonal antibodies and the promotion of new, disruptive technologies.”

The scorecard aims to evaluate the pipeline thoroughly concerning WHO R&D Blueprint pathogens with pandemic potential. Policy Cures Research’s analysis reveals a scarcity of approved products beyond COVID-19 and the Ebola virus Zaire strain. Furthermore, it underscores a worldwide demand for increased funding for WHO Blueprint pathogens, excluding COVID-19.

From 2019 to 2022, COVID-19 witnessed an investment of US $14.5 billion, a figure eight times higher than the combined investment in the other nine pathogens, the scorecard showed. This stark contrast underscores the imperative for more diversified funding sources, emphasising a potential risk to global preparedness.

Reactive funding

The scorecard showed that funding for epidemic diseases is also highly reactive.

“We have not yet adopted a preparedness approach for Research and Development,” the scorecard said.

Most of the available funding is generally provided by public funders, mainly the United States, which makes this funding vulnerable to political shifts. Moreover, regarding funding, vaccine R&D is the most advanced space. There is also more product R&D and WHO Target Product Profiles (TPPs) for nearly all pathogens.

In contrast, the scorecard showed that therapeutics R&D lags with few approved products, clinical candidates, and only one WHO TPP. The analysts indicate this is likely because of a lack of unified leadership around therapeutics, such as CEPI providing vaccines and FIND providing diagnostics.

Pathogens with more significant outbreaks and perceived as a greater risk to national biosecurity have more mature pipelines. In addition, funding for platform technologies to support “Disease X” has grown since 2019, and these are being used to develop products for eight priority pathogens.

“These should benefit R&D for other pathogens, but this is not yet routine,” according to the scorecard.

“The 100 Days Mission is a welcome complement to WHO’s work with partners on the diseases that pose the greatest pandemic risk, for which there are no or insufficient countermeasures,” noted Sir Jeremy Farrar, Chief Scientist at the World Health Organization (WHO). “To rapidly and equitably prepare for and respond to outbreaks of pathogens with pandemic potential, we must now sustainably invest, particularly in basic science, R&D and distributed manufacturing, including the neglected areas of pandemic therapeutics and diagnostics, as well as vaccines.”

What’s next?

The 100DM team will urge the G7 and G20 to catalyse coordinated international action and will call for political commitment to building virtual prototype libraries of pandemic therapeutics, diagnostics, and vaccines. It will also push the need to work with the private and philanthropic sectors.

The IPPS identified four goals for 2024:

  • Greater coordination and investment in the therapeutics pipeline to operationalise the 100DM Therapeutics Roadmap due to the need for more funding and coordination. The report asserts that a coalition is growing around the 100DM Therapeutics Roadmap, which sets out an end-to-end plan and investment case of what is needed to reach the updated goal of at least two ‘Phase 2 ready’ therapeutic candidates for the top 10 priority pathogen families.
  • Sufficient funding to implement the 100DM diagnostics framework, including supporting FIND’s initial ask of US $80-100 million. There are only four WHO priority pathogens for which they are approved diagnostics, and funding is waning.
  • Greater regulatory alignment and adoption of preparatory regulatory approaches. The world would start collecting data on the safety and efficacy of prototype pandemic countermeasures when a pandemic is declared.
  • Strengthening of sustainable regional and global clinical trial infrastructure to enable the rapid testing of products in humans during an outbreak.

“In 2024, under WHO leadership, practical discussions on pre-agreeing master trial protocols for emergency use should take place alongside support for regional authorities to maintain sustainable clinical trial capacity with joint ethics reviews,” according to IPPS.

“We hope that by the end of 2024, each of the four areas will have a clear overall lead, a credible plan, and the funding necessary to make progress,” Vallance said.

“Infectious diseases are one of the greatest health challenges of our time, causing around a quarter of all deaths around the world and particularly impacting vulnerable populations in low-income countries,” added Dr John-Arne Røttingen, CEO of Wellcome.

“It’s vital that pandemic preparedness stays on the agenda in 2024, with governments, industry, and philanthropy stepping up to invest in the development of new diagnostics, treatments, and vaccines.”

“Today’s report should act as a clarion call for global leaders, who must now urgently refocus on the practical steps needed to better prepare for the next pandemic, concluded Thomas Cueni, IFPMA Director General.

“Science and innovation delivered at record speed and scale against COVID-19. We must preserve what made this possible whilst taking practical steps to address the inequity we saw in the rollout of vaccines and treatments if we are going to meet the ambitious goals set out by the 100 Days Mission.

“Pharmaceutical companies have backed the ambition of the Mission since it was set out in 2021. It’s becoming increasingly clear that governments must learn the right lessons from our collective response to the COVID pandemic if we are going to achieve this shared goal.”

Image Credits: Nana Kofi Acquah.

WHO Director-General Dr Tedros Adhanom Ghebreyesus with Hanan Balkhy of Saudi Arabia, taking the oath as the new WHO Eastern Mediterranean Regional Director.

The World Health Organization’s (WHO) executive board confirmed the appointment of three new regional directors on Tuesday, which are both controversial and historic.

The election of Saima Wazed,  the daughter of Bangladesh’s prime minister, to lead the South-East Asia region has already been mired in allegations of nepotism.

Tonga’s Dr Saia Ma’u Piukala steps into his role as the head of the Western Pacific office, following his predecessor’s dismissal for alleged racism. He has his work cut out in the region with many small-island nations weathering climate impacts, and the added pressure to restore trust among the staff in the regional offices.

The Eastern Mediterranean has its first female leader in Hanan Balkhy of Saudi Arabia. Balkhy takes charge as the region is experiencing a staggering humanitarian crisis in Gaza which has left over 25,000 dead, and in Sudan where an estimated 11 million people are in need of urgent healthcare.

The three regions are home to around 60% of the world’s population and face a range of health challenges from climate change to infectious disease as well as conflict, making the appointments critical in the delivery of healthcare.

WHO Director-General Tedros Dr Tedros Adhanom Ghebreyesus remarked that it was the first time a high-profile post was being transferred from one woman to another, as Wazed took over from India’s Poonam Khetrapal, who was the first woman in the post of South-East Asia’s Regional Director.

“The success of this organization depends on close collaboration, co-operation, co-ordination, and trust between headquarters and the regional offices and country offices,” Tedros said, assuring the new directors all the support they needed from him as well as the colleagues in the WHO offices.

While the elections for the regional directors were conducted last year, the appointments were confirmed at the ongoing 154th executive board meeting of the world health body that will continue until Saturday.

The new appointees spell out priority areas

All three appointees spelt out their priority areas for their region reflecting the health challenges the countries in their region face, as they took charge.

Balkhy said her region had a large number of displaced populations, with both strong and fragile economies. “We aim to enhance end-to-end supply chains, ensuring essential medicines and supplies reach all populations, not an easy task for many in the region. Additionally, we will foster collaborations to build skilled and sufficient health workforce to serve diverse populations across the regions,” she said.

Wazed highlighted improving mental health awareness and services as one of her key priority areas, along with women and children. “I look forward to devising and implementing specific interventions for women and children, including pregnant women. This will be created with education, empowerment and prevention in mind, structured with the life course approach,” she said.

In his emotional speech, Piukala said that his journey from a small island to his current role showed that everyone can have something to contribute. He listed strengthening primary healthcare as a key priority area as well as bringing more people in the region under the ambit of universal healthcare.

“In recent years, our region accounted for 80% of the total global new displacement related to disasters, becoming the world’s most climate-vulnerable region. Critically, every person deserves access to basic preventive care,” he said.

Dr Tedros with Dr Saia Ma’u Piukala, the new Western Pacific Regional Director. Piukala is the first Pacific Islander to be appointed to the post.

Conflict of interest

The WHO election in South-East Asia region has been mired in controversy, with Bangladesh allegedly using its political clout to get Wazed elected. Unlike in other regions, she only had one other competitor, Shambhu Prasad Acharya, a WHO and public health veteran.

Wazed is now tasked with providing WHO policy advice to her mother’s government, but the WHO has not addressed the potential conflict of interest.

Within the public health community concerns were raised about the lack of transparency in the elections and there have been a call for reforms. Medical journal The Lancet also carried an editorial on the need to protect the integrity of WHO’s regional offices.

New South-East Asia Regional Director Saima Wazed and WHO. Director-General Tedros Dr Tedros Adhanom Ghebreyesus.

In her first speech on appointment, Wazed paid tribute to her mother. “I’d like to express my big thanks to Prime Minister Sheikh Hasina, not only for the leadership she has demonstrated over the decades of governance in our country and in our region, but also as my mother for teaching me how to lead with compassion and care,” she said.

Image Credits: WHO, WHO, WHO.

Canada expressed concern that the EB might be over-prescriptive.

Variation between the six regions of the World Health Organization (WHO) on how their regional directors are nominated – and whether these should be standardised – generated substantial discussion at the body’s executive board (EB) meeting on Tuesday.

A report from the WHO’s legal counsel on regional nominations noted key areas where a  lack of alignment between the regions could be addressed, including on the scrutiny of candidates and transparency of procedures.

For example, criteria for the assessment of candidates are inconsistent, with some not specifying educational qualifications, professional experience or managerial skills. The Africa region is alone in specifying “a medical background”.

The Pan American Health Organization (PAHO) does not have a code of conduct for the nomination process, aimed at promoting an open, fair, equitable and transparent nomination process.

South-East Asia Region does not specify the shortlisting of five candidates if there are more than five candidates for the position, or how this would take place.

All regions provide for the interviews of candidates with the exception of the European Region, where the interviews take place at a private meeting of the Regional Committee. 

Only PAHO and Europe hold a live candidates’ forum, comprising an oral presentation and a question-and-answer session between candidates and members of the region.

All regions except Europe and the Western Pacific Region explicitly limit nominations to people from the region.

Too prescriptive

However, Canada contended that “a minimum common standard beyond the current direction from the EB regarding criteria might be found to be too prescriptive or limiting” and “would also represent a considerable extension of the board’s authority over these processes”. 

Instead, it proposed that the EB put forward “a menu of best practices that regions can draw on from as appropriate”.

Australia contended that any minimum common standard “should be supported by accepted best practice” and also “protect autonomy to account for regional contexts”.

It supported the proposal for the WHO Secretariat to prepare documents for regional committees on “ways to enhance transparency, accountability and integrity of the election process”.

Meanwhile, Comores on behalf of the 47 African members, rejected a “single approach which will be to the benefit of some regions but not necessarily to the benefit of all”. 

Later, the Africa region represented by Ethiopia said it would support “measures to enhance transparency, accountability and integrity of the election process” for the WHO Director General. Ethiopia previously contested the reappointment of Dr Tedros Adhanom Ghebreyesus.

The board deferred any decision on regional director election processes at the request of Denmark, which asked for more time to achieve consensus. 

Wide support for measures to stop sexual exploitation 

The Director-General’s report on the implementation of measures to prevent and respond to sexual misconduct was also discussed on Tuesday, receiving appreciation and support from a wide range of EB members.

The implementation plan focuses on a range of issues including accountability, policies, investigation capacity, training, dedicated human resources, victim- and survivor-centred support and culture change. 

“The Secretariat is ensuring alignment and consistency between the implementation plan and the three-year strategy on preventing and responding to sexual misconduct, 2023 to 2025,” according to the report.

Commending the WHO secretariat’s efforts to root out sexual exploitation, the EB’s programme, budget and administration committee (PBAC) proposed “a comprehensive stocktaking review no later than January 2025 to assess whether the key actions and the reforms contained in the three-year strategy had led to the intended results”.

German’s Björn Kümmel has a key driver of the investment round proposal.

By hosting a high-level “investor round” to raise flexible funding for its operations, the World Health Organization (WHO) will address one of its “greatest overall risks, namely dependency on the very few number of donors”.

This is according to Germany’s Björn Kümmel, chair of the WHO Working Group on Sustainable Financing, who told the WHO’s executive board meeting on Monday that there is “completely fragmented resource mobilisation” throughout the global body.

Executive board members supported the proposal for an investor round – likely to be held in November – with uncharacteristic enthusiasm on Monday.

The idea of a WHO investment jamboree similar to those hosted by the Global Fund and Gavi, was accepted in principle by last year’s World Health Assembly, but it charged the WHO Director-General with investigating how it would operate, including costs versus potential income.

Dr Tedros Adhanom Ghebreyesus reported back to the board that the “expected benefits outweigh the additional costs of the investment round”.

WHO finances is largely earmarked

Currently, the majority of WHO funding comes from donors for earmarked projects which can distort the global programme of work.

To correct this distortion, the WHA resolved that member states need to increase their  “assessed contributions” – currently barely covering 16% of WHO’s budget – and the WHO needs to raise more flexible donor funding.

Not sustainable

“The average length of a grant in WHO is 13 months. This is everything else but predictable,” Kümmel told the board.

“There are 3,300 grants in this organisation with individual reporting requirements with the consequence that the technical staff, that needs to provide norms and standards for the world, is raising earmarked funds for their units in order to be paid and to be able to run the programmes. This is not effective, and this is certainly not sustainable,” added Kümmel, whose working group has been working on reforming WHO’s financing since 2021.

Meanwhile, Tedros told the board that he was embarrassed by the fact that the many WHO staff members were on 60-day rolling contracts due to financial restraints, which made them vulnerable and undermined stability.

“If you talk about motivated and fit-for-purpose workforce, retaining and attracting talent without sustainable financing is impossible,” said Tedros.

 Kümmel asserted that the investment round has the potential to be “truly catalytic” for all reforms that the board is pushing, and  has the potential to introduce more flexible and predictable financing.

The WHO Working Group on Sustainable Financing’s report to the 2023 WHA highlighted that WHO’s budget is “up to 86 % dependent on generous donors and that only roughly 14 % of WHO’s finances are truly predictable”.

“This situation has put WHO at severe risk, including its independence, its integrity, its agility and certainly also its mandated role to be the world’s leading and coordinating authority in global health,” said the report.

While board members accepted the proposal for an investor round, they want input on the investor case due to be developed by May, and urged that the case should be closely linked to the WHO’s 14th global programme of work (GPW), which was also discussed on Monday.

WHO investment round timeline

Image Credits: WHO.

INB co-chairs Precious Matsoso and Roland Driece brief the WHO executive board meeting.

Misinformation, waning interest and entrenched positions threaten the World Health Organization’s (WHO) two pandemic-related negotiations aimed at strengthening future pandemic responses, according to a briefing given to the WHO executive board meeting on Monday.

Draft agreements from the two processes – to establish a pandemic accord and to update the International Health Regulations (IHR) – are due to be presented to the World Health Assembly in May.

But agreement will only be reached if member states are prepared to compromise and push back against “fake news, lies and conspiracy theories”, said WHO Director General Dr Tedros Adhanom Ghebreyesus.

A global misinformation campaign is pushing the notion that the pandemic agreement and changes to the IHR will “cede sovereignty to WHO and give the WHO Secretariat the power to impose lockdowns or vaccine mandates on countries”, said Tedros. 

“We cannot allow this milestone in global health to be sabotaged by those who spread lies, either deliberately or unknowingly. We need your support to counter these lies by speaking up at home and telling your citizens that this agreement and an amended IHR will not, and cannot, cede sovereignty to WHO and that it belongs to the member states,” he insisted.

Right-wing politicians and conspiracy theorists have been pushing an anti-WHO agenda using the pandemic negotiations for some time (see example below).

Dr Ashley Bloomfield, co-chair of the Working Group on IHR Amendments (WGIHR), called on member states to counter the “nonsense” that the pandemic negotiations are WHO power grabs rather than member state driven processes.

“It is essential that member states reiterate this point domestically and also fully support the DG and his efforts,” said Bloomfield.

He also stressed that member states need to meet the deadline “as it will take a further 18 months for any amendments to come into force”.

Mandates and flexibility

Dr Ashley Bloomfield (R) briefs the WHO executive board.

Noting that the WGIHR only had two more meetings before the May deadline, Bloomfield also urged member states “to make sure that your negotiators have both the mandate and the flexibility to achieve consensus during these last two meetings, so that we end up with changes that truly strengthen the IHR and enable more equitable and pandemic prevention preparedness and response”.

Meanwhile, the Intergovernmental Negotiating Body (INB) negotiating the pandemic accord also has two more meetings including a mammoth two-week meeting in February, and INB co-chair Precious Matsoso said that the INB planned to update member states much more regularly about progress and problems during the next few months.

Her co-chair, Roland Driece, added that the world had learnt “the hard way.. that we were not ready to face a pandemic collectively”.

“We’re only as strong as the weakest link. It’s a cliché, but it’s true and that’s why we need to work together, help each other getting where we want to be and be as strong as possible when it comes to preparing for responding to and acting on pandemics,” said Driece.

Meanwhile, Tedros urged member states to compromise and find a middle ground as  “everyone will have to give something or no one will get anything”, said Tedros.

However, Tedros also expressed concern that there was very little time before the May deadline, and that impetus to achieve pandemic-related agreements was waning.

‘Get it done’

Dr Tedros and Dr Mike Ryan brief the WHO executive board.

Communities experienced three years of “horror” during the COVID pandemic, alongside regional horrors such as outbreaks of Lassa fever, Ebola, yellow fever and cholera, said Dr Mike Ryan, WHO Executive Director of Health Emergencies.

“Communities are struggling to deal with the constant pressure of health emergencies and,  on top of that, the fear of another pandemic,” said Ryan.

“This pandemic didn’t just affect the health sector. It ripped apart our social, economic and political systems and has become a multi-trillion-dollar problem for the world.”

The pandemic agreements need to “reduce the impact of inconsistency and incoherence between member states”. 

“Even in the midst of geopolitical disagreements over so many things around the world at the moment, I think this is one thing the world agrees on,” said Ryan.

“We just disagree on how to get there and the means. But we have one chance. This is the one opportunity we have under the leadership of the World Health Assembly to come to an agreement and I would plead with you on behalf of the health workers of the world and the communities that they serve: Get it done. Do not waste this opportunity.”

Up to 20 African countries are gearing up to rollout WHO-recommended malaria vaccines in 2024.

The Central African country of Cameroon became the first country globally to implement routine malaria vaccinations on Monday, marking a significant stride in the fight against the deadly disease that claims over half a million lives annually, primarily affecting children under five in Africa.

According to Aurélia Nguyen, Chief Programme Officer of Gavi the Vaccine Alliance, the RTS,S vaccine will be administered in 42 districts across the nation, targeting children over the age of 5 months, in areas with the highest risk of malaria.

The moment marks the historic start of routine malaria vaccinations in African countries for the first time ever, said WHO and Gavi, the Vaccine Alliance in simultaneous announcements on Monday.  Over 30 African countries have expressed interest in introducing the vaccine, with 20 aiming to introduce it in 2024, said Gavi in an press briefing last Friday, which was embargoed until Monday.  The aim is to reach approximately 6.6 million children with the malaria vaccine through 2024 and 2025.

Cameroon, the first country to participate in the rollout, has been grappling with rising malaria cases and deaths since 2017, with nearly 30% of all hospital consultations attributed to the mosquito-borne illness. The vaccine rollout is expected to bring about a substantial reduction in both cases and fatalities, providing relief to affected families and alleviating strain on the country’s healthcare system.

More than 331, 000 doses of malaria vaccine landed in Yaoundé on Tuesday 22nd November, to support the kick-off of the vaccination campaign.

Several other countries have already received shipments of vaccine doses as well, and are gearing up for launch. Others are waiting for delivery a second WHO-approved malaria vaccine, the R21/Matrix-M,  which is to be produced by the Serum Institute of India in even larger quantities than the RTS,S, WHO and Gavi said in the press briefing.

Why it matters

Gavi emphasised the historical significance of this moment. Having invested in studies and urged manufacturers to expedite the vaccine’s development, the vaccine alliance said it is now delivering approved vaccines to those in need. It also described collaborations with partners to ensure that vaccination is integrated into essential interventions like the distribution of bed nets.

Dr Mohammed Abdulaziz, Head of Disease Control and Prevention at Africa Centres for Disease Control and Prevention, noted that the vaccine has been validated through trials in several African countries to have a significant impact on reducing clinical cases, particularly in high-burden areas.

He described the integration of the malaria vaccine into routine immunisation in African countries as a strategic shift to address insecticide and drug resistance, as well as the effects of climate change on malaria.

Beyond medical benefits, he said the vaccine has the potential to improve educational outcomes and cognitive abilities, breaking the cycle of adversity for future generations. He added that the partnerships involved in the vaccine implementation suggest that there would be equitable distribution of doses which in return could result in a decrease in malaria morbidity and mortality among children. Beyond adopting strategies, he urged all African Union member states to take up the vaccine for better health outcomes.

A vaccine that is already saving lives

The vaccine has already reached more than two million children and Kate O’Brien, the World Health Organization’s (WHO) Director of Immunisation, Vaccines and Biologicals, said the vaccine’s safety and life-saving efficacy, demonstrated in successful pilot programs, have prompted a broader rollout across Africa as part of routine services.

It has already been implemented in large-scale programs in Ghana, Kenya, and Malawi, reaching over two million children, leading to a 13% reduction in deaths among eligible children and a significant decrease in severe malaria hospitalizations, said O’Brien, speaking at Friday’s press briefing.

“The malaria vaccines have been shown to reduce clinical malaria cases by more than half in the year after vaccination. And that level of efficacy goes up when the vaccine is provided seasonally,” said O’Brien.

“In that case, that prevents about three quarters or 75% of malaria cases. So if we think about the 250 million in malaria cases that occur every year, a childhood vaccine with this level of efficacy can result in major reductions in malaria illness and death.”

She added that the coordinated pilot programs demonstrated high demand for the malaria vaccine without compromising other preventive measures, and expressed gratitude to scientists, African researchers, health workers, international partners, and donors for their collaborative efforts in achieving this progress, marking a significant step toward improving child health in Africa.

While acknowledging the long road of development for malaria vaccines, Andrew Jones, Principal Advisor for UNICEF’s Supply Division’s Vaccine Centre, described the imminent mass introductions as a reflection of progress in ensuring every child at risk of malaria receives the vaccine.

This, he said, is a giant step forward in collective efforts to save children’s lives and reduce the malaria burden. While celebrating the achievement, he anticipated ongoing innovation, and said he is looking forward to the development and rollout of even more effective and user-friendly next-generation vaccines.

The four-dose quagmire

To achieve the best outcomes from the vaccine, every child should receive four doses, which Jones described as unusual for routine childhood immunisation vaccines and noted that it could pose an additional challenge to some countries.

Dr Dorothy Achu, malaria adviser for WHO’s African Regional Office, noted that it will be important to communicate to parents that getting all the doses gives their children a higher chance of celebrating lots of birthdays. She also expressed WHO Africa’s preparedness to support countries to roll out the vaccine.

Dr Dorothy Achu, regional malaria adviser for WHO Africa

“We want to congratulate countries that have taken this bold step after the pilot phase and we encourage all endemic countries, and especially the high-burden countries to this vaccine and to deploy them. We are also committed to supporting them as we have been doing already – preparing the countries to roll out the vaccine,” she said.

Working with local partners

One of the lessons from the COVID-19 vaccination experience in Africa has been the need to involve local partners and for the malaria vaccination rollout in Cameroon, said Mbianke Livancliff, Senior Immunization Officer, Value Health Africa, an NGO improving community health in Cameroon, is one of the local partners involved in the rollout.

Livancliff said the timing of the vaccine arrival in the country is timely and highlighted the excitement within communities in Cameroon, recalling the positive response to the first vaccine shipment.

He said the organisation has been actively engaging with communities to understand dynamics, expectations, and concerns, addressing potential rumours and dispelling myths. He added that discussions are being held with community leaders, religious leaders, and various groups to educate them on the vaccine’s effectiveness. He said feedback from these engagements will inform the national policy for the vaccine introduction.

“The communities understand that this is not something that is just happening now. This has been in development over the years, going through rigorous processes to ensure the vaccines are safe and effective for children. Like with every vaccine, there are conspiracies, rumours, and myths. Understanding those dynamics within communities will help in the acceptance of these vaccines,” he said.

Image Credits: WHO.

Davos Alzheimer’s Collaborative Founding Chairman George Vradenburg
Davos Alzheimer’s Collaborative Founding Chairman George Vradenburg

There will be close to 10 billion people in the world by 2050, and if the World Health Organization estimates are correct, as many as 22% of them – or 22 billion people – will be over 60.

A separate study by American doctors found that by that same year, the number of people living with dementia could be as high as 132 million – three times the current number.

The Organisation for Economic Co-operation and Development (OECD) estimates that impaired brain health drains as much as $8.5 trillion a year from the global economy in lost productivity. This number will increase as the population ages.

“We must better understand the brain and provide access to tools and information to help people nurture brain health as part of One Health in every community, country and health system,” according to the Davos Alzheimer’s Collaborative (DAC), a Swiss-based foundation and a US 501c3 initiated by The World Economic Forum (WEF) and The Global CEO Initiative on Alzheimer’s Disease (CEOi).

The DAC held a round-table discussion at Davos to discuss the need to prioritise brain health globally, especially given brain health’s impact on human and societal well-being, productivity, and resilience.

The discussion brought together leaders representing international organisations, scientists, experts from the healthcare industry, policymakers, and forward-thinking visionaries spanning both private and public sectors. Their collective aim was to delve into the significance of brain health as a crucial economic imperative, underscore the pressing requirement for ongoing global collaboration, and emphasise the essential role of fortifying health systems to ensure the well-being of populations with all levels of resources.

Moderated by George Vradenburg, founding chairman of the DAC, the discussion encompassed a range of critical topics, such as advancing the development of immunotherapies and vaccines, expediting interventions through the lens of patients’ groups, evaluating the effectiveness of public-private partnerships, intensifying efforts in risk reduction and prevention education, spotlighting the disproportionate impact on women, and emphasising the imperative for strengthened initiatives in data-sharing.

The event also kicked off a new network of global “Brain Health Ambassadors,” who will commit to promoting the inclusion of brain health at the primary care level and the international prevention of Alzheimer’s and related dementias. His Excellency Luis Gallegos, Chairman of the Board of UNITAR and former Minister of Foreign Affairs of Ecuador, became the first inaugural Brain Health Ambassador.

His Excellency Luis Gallegos, Chairman of the Board of UNITAR and former Minister of Foreign Affairs of Ecuador
His Excellency Luis Gallegos, Chairman of the Board of UNITAR and former Minister of Foreign Affairs of Ecuador

The Brain Health Imperative

“There is no question that we are all living longer, and that is good news,” Vradenburg said.

He emphasised that prolonged life spans contribute positively to society and the economy as individuals work for an extended period. Yet, he noted a potential oversight: “Rarely do you hear people talking about your brain span equaling your health span.”

Vradenburg expressed concern about the prevalence of individuals spending the last decade of their lives enduring some form of dementia.

“The prevalence of this disease is huge – nearly 50 million people around the world,” Vradenburg said. “But the disease starts 25 years or so before you get symptoms. So, this estimate of 50 million people diagnosed worldwide needs to be multiplied by a factor of eight to get the total number of people actually experiencing the disease.”

The silver lining is that today, doctors and scientists better understand what enables brain resilience and what can prevent Alzheimer’s, Vradenburg said. Moreover, as innovation accelerates and populations age, more countries and leaders see brain health as an economic, societal, and policy imperative.

“Governments, businesses, international organisations, and the scientific and advocacy communities everywhere are paying attention like never before. We have reached a critical inflexion point for action,” according to Vradenburg. He reminded that “2023 was a pretty good year” for people with Alzheimer’s, as the first disease-modifying drug was fully approved by the American Food and Drug Administration and covered by Medicare.

“For the patient community, this is excellent news,” he said. However, he admitted that the drug only has a moderate benefit – reducing the rate of decline by up to 27%, that it has side effects, and that it is expensive.

Prof Miia Kivipelto from the Karolinska Institute highlighted the current abundance of information regarding the factors influencing Alzheimer’s, particularly genetics, and the preventive measures available.

According to her, adopting a healthy lifestyle is pivotal, such as maintaining a balanced diet, participating in regular physical activity, practising relaxation techniques, effectively managing stress, and engaging in cognitive stimulation. She emphasized that the indicators for optimal cardiovascular health align with those crucial for maintaining brain health, including blood pressure regulation, cholesterol management, prevention of obesity, and controlling diabetes.

“What is good for the heart is good for the brain,” Kivipelto said.

Cognitive Reserve Strategies

Neuroplasticity is also crucial, noted Prof Murali Doraiswamy of Duke University.

“The important thing is that the brain is plastic throughout our lifetime,” he said.

Consider infants—they employ multiple senses, biting, smelling, and even testing the rebound of objects, Doraiswamy said. Participating in such multisensory activities is instrumental in shaping the networks within the brain. These networks, in turn, play a pivotal role in forming memories and experiences.

Prof Murali Doraiswamy of Duke University
Prof Murali Doraiswamy of Duke University

Doraiswamy highlighted the enduring presence of neuroplasticity even in the later stages of life and said researchers have explored various electrical and chemical stimuli in rodent models to augment neuroplasticity. While cautioning that these methods haven’t been applied to humans yet, he suggested the possibility of their future application.

Additionally, Doraiswamy introduced the concept of “cognitive reserve.”

“Cognitive reserve can simply be thought of as how many excess networks you have built up in your brain over a lifetime of experiences,” he said. “That reserve capacity is what protects you from decline if you suffer from a neurodegenerative disease. So, think of it as having access to cell phone towers and the more cell phone towers, you have a couple of get knocked out, you still have power.

“So it’s crucial for us to learn how to develop and monitor cognitive reserve.”

He said that physicians can evaluate an individual’s brain and cognitive reserve using state-of-the-art digital tools, including those accessible through smartphones.

“I think in addition to all of the pharmacotherapies that pioneers are developing, we need also to develop non-pharmacological ways,” Doraiswamy continued. “Now, with digital tools such as smartphone apps, it’s possible to create a closed-loop system where you can do cognitive self-testing at home in the comfort and convenience of your home. You can also send those reports to your doctor. And you can also decide to train what parts of your abilities are below normal for five minutes a day using these tools.”

Global Brain Health Initiatives

Drew Holzapfel, executive director of CEOi, said some programs are already underway and working. For example, this year, his organisation is collaborating with eight flagship sites in five countries to improve how Alzheimer’s disease is diagnosed. His organisation funded 19 programs in 12 countries in 2023.

“We’re trying to speed up the time from detection to diagnosis so that we can get care to the people who need it as fast as possible,” Holzapfel said.

His organisation’s second focus is creating collaborations to scale Alzheimer’s and brain health longitudinal clinical trial research. In India, for example, a group of high-volume clinics is looking at AI’s role in brain health. In another example, they work with ophthalmologists there to help detect cognitive impairment early and get those people into the health system.

The group has also started to look at how brain health and climate change are interconnected with partners in Kenya, Slovenia, and Chile.

Finally, he said, they are working on finding ways to engage governments.

“There have been a lot of governments and international organisations that have made commitments to Alzheimer’s. And so we’re committed to working with these governments to ensure we bring those commitments forward,” Holzapfel said.

Dr Noémie Le Pertel, a senior fellow and founding chair for the Economics of Well-being and Global Human Flourishing Working Group at the Human Flourishing Network, housed at Harvard University’s Institute for Quantitative Social Science, said her team is currently undertaking the world’s most comprehensive study on mental health, physical well-being, and various childhood predictors, encompassing the entire lifespan.

Le Pertel said: “The call to action that I wanted to put forward was really for leaders in the room who are working in organisations, what can we do and how can we join forces to seize the opportunity to work in the workforce to upskill people to understand the role of their brain health, and how it impacts not only organisation, society, the economy, but the future of our society?”

Image Credits: Courtesy of the Davos Alzheimer’s Collaborative, Courtesy of the Davos Alzheimer's Collaborative, Courtesy of the Davos Alzheimer's Collaborative.