During humanitarian crises millions of people struggle to manage a range of non-communicable diseases (NCDs).

The United Nations estimates that 363 million people are currently impacted by humanitarian crises driven by increasing fragility and conflict, the climate crisis and widening inequality. Around 108.4 million people were forced to flee their homes in 2022, meaning one in every 74 persons globally.

Humanitarian crises, such as those occurring in Ukraine, Gaza, Libya, Somalia and Sudan may vary in nature and scale but they all share population displacement, the destruction of infrastructure and the disruption of supply chains and services.

Health is one of the first casualties. Increasingly, healthcare facilities and supply chains are directly targeted in conflict. Restricted or impeded access to hospitals, health services and staff and life-saving medicines and technologies, as well as food and water shortages, make life precarious.

Much media attention during crises understandably tends to focus on overwhelmed hospitals and what that means for women giving birth, vulnerable newborns and war-wounded people needing life-saving surgery.

Access to medication in crises

Outbreaks of infectious diseases such as measles and cholera also make the headlines. Yet the parallel reality is that during humanitarian crises millions of people struggle to manage a range of non-communicable diseases (NCDs) such as diabetes, hypertension or cardiovascular illness. Access to their essential medications and health professionals may be non-existent.

Policymakers are now being forced to take an ‘all hazards approach’ to emergency planning and response, together with an inclusive health and humanitarian response that leaves no one behind.

There are plenty of factors to consider: increasing fragility, widening inequality, uneven economic growth, a fragmented geopolitical landscape, inadequate financing, the potential for new pandemics, and climate crisis encroaching on and shifting the way societies produce, eat and live.

Of course, the degree to which countries are able to respond to health emergencies will depend on the scale of the crisis they face at any given time, the financial situation, preparedness, and how resilient the health system is.

Many low- and middle-income countries have fragile health infrastructures to begin with, and when faced with crises, they are much more vulnerable. But the success of an emergency response is more likely if established models of care and strong partnerships between government and civil society are already in place.

The International Committee of the Red Cross headquarters in Geneva, Switzerland.

Collaboration to deliver better NCD care

Partnering for Change – a collaboration between humanitarian organisations, the International Committee of the Red Cross (ICRC) and the Danish Red Cross (DRC), and the private sector company, Novo Nordisk – was launched to identify best practice to support people living with diabetes and hypertension in humanitarian crises. They have partnered with academia, the London School of Hygiene and Tropical Medicine (LSHTM) in research initiatives to design, evaluate and improve models of care.

Since 2020, the ICRC has supported a primary health care service run by the local NGO Chabab Al Ataa Al Jazeel Association (CAJA) in Bireh in Northern Lebanon. Initial research from P4C with patients, caregivers and service providers highlighted patients’ multiple care needs and the huge burden families faced in navigating a fragmented care system.

Improving the patient-centeredness of care by integrating cardio-metabolic disease management with mental health and physical rehabilitation services with defined referral pathways, and a joint patient management system was seen as a potential solution. An adapted integrated model was developed and is currently being implemented. In parallel, an evaluation is being conducted for a better understanding on how to implement, sustain and scale up this type of integrated model for NCD care in humanitarian settings.

Outside of Partnering for Change, the Danish Red Cross is supporting the Somali Red Crescent Society, one of the biggest health care providers in Somalia, in its efforts to integrate screening and management of diabetes, hypertension and asthma as well as mental health and psycho-social support into already existing health programmes.

They have until now mostly focused on maternal and child care but decided to include NCD care and prevention based on needs assessments. As well, Somali Red Crescent Society are seeking to include focus on health-promoting behaviour, NCD prevention and awareness of risk factors through community engagement and community health committees.

Trucks carrying humanitarian aid wait to cross into Gaza from Egypt through the Rafah border point.

Integrate care in humanitarian settings

A recent report on the financing of NCD care in humanitarian settings has pointed to the essential role of community-engagement in reaching people early, before conditions become serious and require costly hospital-level care.

These kinds of interventions are hopefully a window into the future, further building on what already exists. The idea of integrated care across the non-communicable and infectious disease spectrum has slowly been gaining traction: both the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund now include NCDs in their HIV and tuberculosis financing portfolios.

Yet more evidence is still needed to adequately demonstrate that integration is cost-effective. To address this gap, a recent report has looked into how integrated NCD care can save resources for both patients and health systems. Patients benefit the most – about 85 per cent of the total savings. From a health-system perspective, the extra cost to integrate these programmes are relatively small compared to the positive health outcomes they generate.

While delivering these integrated care services in humanitarian settings logistically still remains a leap into the unknown, the rationale for financing them is clear – if we are to achieve Universal Health Coverage, NCD services must be integrated into community services and primary healthcare facilities to ensure that people living with these chronic diseases have access to quality services across the continuum of care and during disruptions in care from disasters or conflict.

We’ve heard the growing calls for health services to be protected during conflicts. We’ve seen first-hand the growing alignment of climate change and health agendas at the recent COP 28 meeting. Now, we need to see political will that better responds to an uncertain future for the growing number of people living with NCDs and that guarantees their right to health.

Micaela Serafini is head of the health unit at the International Committee of the Red Cross.

Katie Dain is CEO of the NCD Alliance.

Nicolai Haugaard is Vice President and Global Head of Health Equity, Novo Nordisk

Image Credits: Unsplash, Flickr – US Mission Geneva, © UN Photo/Eskinder Debebe.

Patients undergoing chemotherapy for cancer.

New cancer cases are projected to increase by a massive 77% between 2022 and 2050 – mainly as a result of tobacco, alcohol, obesity and air pollution.

Ageing and population growth are also factors pushing new cases from 20 million in 2022 to an expected 35 million in 2050, according to the Global Cancer Observatory  released by the International Agency for Research on Cancer (IARC) on Thursday.

The IARC research, published every two years, covers 185 countries and 36 cancers with data drawn from countries themselves.

Lung cancer was both the most common cancer and the leading cause of cancer deaths in 2022 – likely because of “persistent tobacco use in Asia”, according to the IARC, which is the World Health Organization (WHO)’s cancer agency .

There were 2.5 million new lung cancer cases (12.4% of total cases) and 1.8 million deaths (18.7% of total) in 2022 – with men being more likely to succumb than women.

Breast cancer ranked second (2.3 million cases, 11.6%), followed by colorectal cancer (1.9 million cases, 9.6%), prostate cancer (1.5 million cases, 7.3%), and stomach cancer (970 000 cases, 4.9%).

However, colorectal cancer was the second biggest killer (900 000 deaths, 9.3%), followed by liver cancer (760 000 deaths, 7.8%). Breast cancer, which is the biggest killer of women, was the third highest cause of cancer mortality with 670 000 deaths (6.9%), closely followed by stomach cancer (660 000 deaths, 6.8%). 

Absolute numbers of cancers per continent in 2022

Low-income countries face doubling of deaths

In terms of the absolute burden, wealthier countries with a high human development index (HDI) – a measure of life expectancy, education rates and income – are expected to experience the greatest absolute increase in incidence, with an additional 4.8 million new cases by 2050 compared. 

Yet the increase in incidence is most striking in low HDI countries, which face a projected 142% increase, and in medium HDI countries (99%). Cancer deaths are projected to almost double in 2050.

“Those who have the fewest resources to manage their cancer burdens will bear the brunt of the global cancer burden,” says Dr Freddie Bray, IARC’s head of the cancer surveillance told a media briefing this week. 

Bray also called for better cancer data, as a number of countries do not have cancer registries.

Global cancer burden 2022

 

The Global Cancer Observatory was released alongside a WHO survey on cancer care on the eve of World Cancer Day on 4 February.

Only 39% of 115 countries surveyed covered the basics of cancer management as part of their financed core health services for all – ‘health benefit packages’ (HBP) – according to the WHO survey.

People living in poorer countries had much worse outcomes thanks to later diagnosis and often unaffordable treatment

In countries with a very high HDI, one in 12 women will be diagnosed with breast cancer in their lifetime and one in 71 women die of it.  But in countries with a low HDI, only one in 27 women will be diagnosed and one in 48 women will die from it.

“Women in lower HDI countries are 50% less likely to be diagnosed with breast cancer than women in high HDI countries, yet they are at a much higher risk of dying of the disease due to late diagnosis and inadequate access to quality treatment,” explains Dr Isabelle Soerjomataram, IARC’s deputy head of cancer surveillance.

Meanwhile, cervical cancer was the eighth most commonly occurring cancer globally and the ninth leading cause of cancer death. It is the most common cancer in African women with significant mortality although it can be eliminated as a public health problem through the scale-up of the WHO Cervical Cancer Elimination Initiative.

Female cancer mortality: Africa compared to Europe

“Despite the progress that has been made in the early detection of cancers and the treatment and care of cancer patients, significant disparities in cancer treatment outcomes exist not only between high and low-income regions of the world, but also within countries,” says Dr Cary Adams, head of the Union for International Cancer Control.

“Where someone lives should not determine whether they live. Tools exist to enable governments to prioritise cancer care, and to ensure that everyone has access to affordable, quality services. This is not just a resource issue but a matter of political will.”

Unaffordable treatment

WHO’s global survey of health benefit packages also revealed significant global inequities in cancer services. 

Lung cancer-related services were four to seven times more likely to be included in standard health benefits in high-income than lower-income countries. On average, there was a four-fold greater likelihood of radiation services being covered in a HBP of a high-income than a lower-income country. The widest disparity for any service was stem-cell transplantation, which was 12 times more likely to be included in a HBP of a high-income than a lower-income country.

“WHO’s new global survey sheds light on major inequalities and lack of financial protection for cancer around the world, with populations, especially in lower income countries, unable to access the basics of cancer care,” said Dr Bente Mikkelsen, WHO’s Director of Noncommunicable Diseases (NCDs). 

“WHO, including through its cancer initiatives, is working intensively with more than 75 governments to develop, finance and implement policies to promote cancer care for all. To expand on this work, major investments are urgently needed to address global inequities in cancer outcomes.”

Image Credits: Roche.

Gaza man walks across a pile of rubble.

The World Health Organization (WHO) was able to get medical supplies to Nasser Hospital in southern Gaza on Monday but trucks attempting to deliver food were delayed near the checkpoint then were raided “by crowds who are also desperate for food”, said Dr Tedros Adhanom Ghebreyesus, the global body’s Director-General.

Despite challenges including heavy fighting in the vicinity, Nasser Hospital – the main hospital serving the south – continues to offer health services but at a “reduced capacity”, he added.

“The hospital is operating with a single ambulance. Donkey carts are being used for transporting patients,” Tedros told the WHO’s weekly press conference on Wednesday.

“WHO continues to face extreme challenges in supporting the health system and health workers. As of today, over 100,000 Gazans are either dead, injured, or missing and presumed dead,” he added.

Tedros warned that the risk of famine in Gaza is “high and increasing each day with persistent hostilities and restricted humanitarian access”.

Dr Tedros Adhanom Ghebreyesus

He also described the decision by various countries to freeze aid to the United Nations Relief and Works Agency for Palestinian refugees (UNRWA) as “catastrophic”.

“No other entity has the capacity to deliver the scale and breadth of assistance that 2.2 million people in Gaza urgently need,” added Tedros, echoing a statement released earlier in the day from the Inter-Agency Standing Committee that coordinates humanitarian aid amongst the United Nations agencies, including the WHO. 

Israel has claimed that UNRWA staff members were involved in, or assisted, the Hamas attack on Israel on 7 October. The UN has launched an  investigation and some staff members have already been fired.

However, the WHO’s executive director of health emergencies, Dr Mike Ryan, dismissed a claim by an Israeli diplomat that the WHO was “colluding” with Hamas.

“We cooperate with NGOs but collude with no one,” Ryan told the press conference, adding that such a claim endangers WHO staff in the field.

Ryan described the environment for health workers as “frantic” and “terrorising”, as they tried to  do more and more with less and less, while Tedros said that both health workers and patients were surviving on one meal a day.

“The humanitarian space is is very constrained,” said Ryan. “Every aspect of what the agencies and NGOs are trying to do is constrained. We are constrained in bringing assistance in across the border. We’re constrained in how we store it. We’re constrained in  how we can distribute it, with so many distribution plans being denied or being impeded.

We’re constrained in the number of health facilities that are operational.”

Towards Zero Leprosy

Yohei Sasakawa, WHO Goodwill Ambassador for Leprosy

Meanwhile, Tedros also addressed leprosy, one of the world’s neglected tropical diseases (NTDs), a day after global NTD Day and three days after international Leprosy Day.

“One of the oldest and most misunderstood diseases in the world is leprosy,” said Tedros.

“The world has made great progress against leprosy. 

“The number of reported cases has dropped from an estimated five million a year in the mid-1980s to about 200,000 cases a year now. Although it has now been curable for more than 40 years, it still has the power to stigmatise. Stigma contributes to hesitancy to seek treatment, putting people at risk of disabilities and contributing ongoing transmission,” said Tedros.

Yohei Sasakawa, the WHO Goodwill Ambassador for Leprosy, appealed for assistance to spread the message globally about leprosy’s symptoms and treatment in order to achieve “zero leprosy”.

Massive stigma

Sasakawa said that the disease still existed in 100 countries.

“Over the past 50 years, I have visited leprosy endemic areas in over 120 countries,” said Sasakawa. “Everywhere, I met with countless numbers of people who have been abandoned, not only by society, but even by their own families and are living in despair and in solitude.”

He said that many people ignored initial signs of the disease – discoloured patches on their skin – because it was initially painless.

“We need to carry out extensive work to do our [Zero Leprosy] campaign to find the hidden cases, now that the drugs are available free of charge worldwide,” he stressed.

“I believe it is an opportune time to give another strong push to achieve zero leprosy by strengthening active case detection and prompt treatment.”

Image Credits: Care International .

 

 

 

Amina, an 18-year-old noma patient from Yobe state, has been disfigured since early childhood, and has a habit, like many noma survivors, of hiding her scars behind a veil.

A milestone World Health Organization (WHO) decision to recognise noma (cancrum oris or gangrenous stomatitis) as a neglected tropical disease (NTD) is the result of a longstanding campaign waged for over a decade by global health researchers and advocates in Geneva and beyond. Proponents believe that inclusion can offer noma’s victims the hope of new investments and eventually treatments for one of the world’s least understood diseases.

The WHO decision in December 2023, came shortly ahead of the fifth annual World NTD Day, observed on Tuesday (30 January).

Noma is a severe gangrene disease in the oral and facial regions that predominantly afflicts undernourished young children, typically between the ages of two and six, usually residing in areas marked by extreme poverty. It starts as inflammation of the gums but progresses rapidly, damaging facial tissues and bones if not promptly addressed.

Some 140,000 people – most in sub-Saharan Africa – are diagnosed with the disease a year, according to Dr Maria Guevara, International Medical Secretary for Médecins Sans Frontières (MSF), speaking at a May 2022 event on the margins of the World Health Assembly. The disease currently has a 90% fatality rate, she said. It is most prevalent in West Africa, parts of Central Africa and Sudan, although there are also cases in Asia and South America.

What explicitly causes noma is still unknown, but doctors believe it is the result of a bacterial infection that attacks children who have weakened immune systems as the result of a previous illness, such as measles or tuberculosis.

“Noma’s inclusion on the NTD list is the result of a campaign that has lasted over 10 years,” according to Dr Eric Comte, director of the Geneva Health Forum, which has been active in promoting awareness around the disease over the past months and years. “Several organisations and personalities were involved in this campaign.”

International Society for Neglected Tropical Diseases (ISNTD) and MSF hosted a Geneva Press Club event in May 2023, coinciding with the 76th World Health Assembly, to advocate for its inclusion and helped facilitate networking amongst noma stakeholders.

Noma recognition: impact

The WHO decision was lauded by these stakeholders, who now have very high expectations that the move could lead to several benefits and significant changes in visibility and awareness.

The inclusion on the NTD list “can stimulate research on the disease, particularly on its causes, treatment, and prevention, as researchers may be more inclined to focus on disease recognised by the WHO,” explained Marlyse Morard, director of Sentinelles, a Lausanne-based NGO fighting noma in the field. “The allocation of financial resources is likely to increase.”

Morard said they also expected improvement in prevention and control, mainly through training healthcare staff and epidemiological surveillance.

“Large-scale public awareness campaigns remain essential, as early detection of the disease reduces its impact and saves lives,” she said.

“The creation of awareness programs requires meticulous planning to ensure that they are effective. Improved coordination between public and private stakeholders is crucial, especially when it comes to fighting diseases like noma, which can lead to the stigmatisation of affected people.

“Awareness-raising is a powerful tool to promote a better understanding of the disease,” she continued. “Also, a disease recognised by WHO as a neglected tropical disease can benefit from increased political commitment and the creation of national disease control programs for countries that do not have them.”

She said the expectation included facilitated access to healthcare and reconstructive surgery, as well.

An individual with Noma
An individual with Noma

Noma challenges ahead

However, Morard noted that it was unlikely that these expectations would be met too quickly, as they would depend on each country’s legislation and their commitment to international guidelines.

“It is important to note that the fight against noma is complex and requires the long-term commitment of multiple stakeholders, including affected communities, governments, non-governmental organisations, political and religious leaders and international health agencies,” she said.

Comte expressed similar sentiments, noting that including noma on the NTD “is good news, but it is only a first step. We must now mobilise to establish an action plan and a roadmap against noma through collaborations between WHO Geneva, WHO Afro, the ministries of health of the countries concerned and civil society, which implements actions on the ground.”

WHO has said that there are multiple risk factors associated with this disease, including:

  • poor oral hygiene;
  • malnutrition;
  • weakened immune systems;
  • infections;
  • and extreme poverty.

Although the disease is not contagious, it tends to strike people when their body’s defences are down.

To help halt noma, countries need to run early detection programs for gingivitis, facilitate access to vaccinations, strengthen their clean drinking water systems, improve sanitary facilities, and enhance food support programs, Morard said.

Treatment generally involves antibiotics, improving oral hygiene with disinfectant mouthwash and nutritional supplements.

“If diagnosed during the early stages of the disease, treatment can lead to proper wound healing without long-term consequences,” Morard said.

Survivors face severe social impact

“In severe cases, though, surgery may be necessary. Children who survive the gangrenous stage of the disease are likely to suffer severe facial disfigurement, have difficulty eating and speaking, face social stigma and isolation, and need reconstructive surgery.”

Noma survivor Mulikat Okanlawon, an advocate and hygiene officer at the Noma Hospital in Sokoto, Nigeria, described the effects of noma on her life as follows: “I recovered from the disease, but it left a deadly mark on my face, which stopped me from interacting with people and being a part of the community. I could not go out. I could not go anywhere. I could not even look at myself in the mirror like other children.”

“I always cried… I often wished that I had not survived,” she added, speaking at one recent global health event.

Morard said, “It is truly tragic that noma continues to exist because it is a preventable and treatable disease. Those most severely affected will bear the burden for their entire lives due to late diagnoses or inadequate treatments. The persistence of noma serves as a poignant reminder of health inequalities around the world and underscores the importance of collective action to combat diseases linked, among other factors, to poverty.”

Eradicating noma, she continued, “represents a true challenge and requires strong willpower.”

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

Recent NTD achievements

There have been successes. For example, Sentinelles, Morard’s organisation, has been operating in Niger for the past 30 years, including running awareness-raising activities in coordination with the National Noma Control Program and health authorities. Working with local hospitals has helped ensure noma patients to access reconstructive surgery. Sentinelles also provides support and training for residents and medical staff, which has helped prevent the disease.

Some 1.34% of children aged 1-6 in Niger developed noma – some seven to 14 cases for every 10,000 children aged 0-6, according to an article published in the peer-reviewed journal Health in April 2023. The scientists said this was higher than the incidence of the whole sub-Saharan region.

Last week, at the WHO Executive Board meeting, a representative of the WHO Africa region shared some NTD successes in general, noting that between 2021 and 2023, 10 countries were certified to have eliminated at least one NTD: Lymphatic filariasis (elephantiasis) was eliminated Moreover, some 42 countries have been certified free of guinea worm disease.

WHO’s Dr Jérôme Salomon (center) provides an update on NTDs, including noma’s inclusion in the WHO list, at the WHO Executive Board meeting 22-28 January.

Noma was the first disease to be added to the WHO NTD list in over five years. Scabies and snakebite envenoming were added in 2017. There are currently 21 diseases or groups on the WHO NTD list.

At the Executive Board meeting, WHO Director-General Tedros Adhanom Ghebreyesus updated the delegates on the progress since the WHA73(33) road map for neglected tropical diseases was adopted at the World Health Assembly in November 2020. He shared the following statistics:

  • There was a 25% reduction in people requiring interventions against neglected tropical diseases between 2010 and 2021.
  • The Southeast Asian region had the highest proportion of people requiring intervention against NTDs in 2021 at 52%, followed by the African region (35%). All other areas made up less than 5%.
  • Some 14.5 million disability-adjusted life years were lost to NTDs in 2019, compared to 16.3 million in 2015.

However, the report showed that NTD programs were “severely impacted” by the COVID-19 pandemic and have not yet recovered.

“Much remains to be done to overcome the devastating impact caused by a restriction of movement, disrupted supplies of medicines and other health products, and repurposing of health staff in response to the pandemic,” the report said. “Today, financial support is still far less than before the pandemic and remains limited at all levels, thus jeopardising activities in countries, hampering meaningful planning, and preventing effective coordination at global and regional levels.”

A Global Health Council NGO representative responded to the report by highlighting the inextricable ties between poverty and inequality and NTDs. The representative also noted significant gaps in research and development tools needed to control and eliminate these diseases.

“We call on member states to sustain and expand investments to accelerate R&D of safe and affordable treatments for NTDs and improved diagnostics, particularly for NTDs with specific unmet needs for use in primary health care settings,” the representative said. “We urge WHO member states to collaborate to explore regulatory and manufacturing pathways to facilitate simultaneous or aligned pre-qualification and regulatory approval processes of in vitro diagnostics to accelerate market access.”

Germany, too, emphasized R&D, while Russia focused on the need for increased surveillance.

Others, such as the United States, urged WHO “to undertake the necessary internal reforms to strengthen the functions and operations of the program to support member states in reaching NTD goals, including by reinforcing WHO leadership through accountability, transparency, predictability and equity; filling normative gaps; and ensuring strong data systems enabling reliable surveillance, monitoring and evaluation.

“We also call for well-aligned leadership within the WHO neglected tropical diseases department with the ability to work effectively across sectors,” the US representative said.

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

Pandemic
A healthcare worker wearing PPE disinfecting a street in the early days of the COVID-19 pandemic.lder

World leaders have a duty to deliver “an effective, legally-binding pandemic accord” by May to prevent the devastation wrought by COVID-19, according to a group of influential leaders and organisations.

The call came in an open letter issued on Tuesday, the fourth anniversary of COVID-19 being declared a global emergency, and was signed by The Elders, The Global Preparedness Monitoring Board, The Independent Panel for Pandemic Preparedness and Response, Pandemic Action Network, The Panel for a Global Public Health Convention, and Spark Street Advisors.

Signatories include former presidents, prime ministers, health ministers and academics.

The accord needs to ensure that “all countries have the capacity to detect, alert, and contain pandemic threats, and the tools and means required to protect people’s health and economic and social well being”, according to the letter.

To succeed, the accord needs three key ingredients, they assert.

The first is equity, ensuring that “every region must have the capacities to research, develop, manufacture, and distribute lifesaving tools like vaccines, tests, and treatments”. 

Second, the accord needs to map out a “pathway to sustained financing for pandemic preparedness and response”, including “the additional $10.5 billion per annum needed for the Pandemic Fund to fill basic gaps in low and middle-income countries’ pandemic preparedness funding”. 

Thirdly, countries need to be “held accountable for the commitments they make via the accord”, including via independent monitoring and a regular Conference of Parties. 

The World Health Organization (WHO) is hosting the pandemic accord negotiations, with the deadline the World Health Assembly (WHA) in May. However, there are still a multitude of disagreements between countries.

Delay proposed

Last Thursday, during the WHO’s executive board meeting, Poland suggested that it might be better to delay the pandemic accord to ensure an “ambitious, clear and consistent” agreement.  

“It’s very important, especially in reference to a future pandemic treaty, to have an ambitious, clear and consistent document, which will really contribute to the prevention of future crises,” said the Polish delegate.  

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

However, Norway, the UK and others  rejected Poland’s suggestion. 

But WHO Director General Dr Tedros Adhanom Ghebreyesus also expressed his concern at the start of the executive board about the gulf between countries on a range of issues at the intergovernmental negotiating body (INB).

Tedros also condemned the global misinformation campaign that is pushing the “lie” that a pandemic agreement will “cede sovereignty to WHO and give the WHO Secretariat the power to impose lockdowns or vaccine mandates on countries”.

“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 [International Health Regulations] will not, and cannot, cede sovereignty to WHO and that it belongs to the member states,” said Tedros.

Image Credits: Photo by Maksym Kaharlytskyi on Unsplash.

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

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

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

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

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

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

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

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

Appeal for flexible funds

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

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

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

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

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

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

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

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

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

Injecting new urgency into the fight against AMR

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

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

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

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

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

Second UN high-level meeting on AMR

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

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

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

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

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

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

Problems with national AMR plans

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

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

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

 

Immunisation progress is uneven across regions and countries.

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

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

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

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

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

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

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

 

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

Access and cost continue to be barriers

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

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

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

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

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

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

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

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

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

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

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

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

Countries prepare for HPV rollout

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

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

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

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

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

Image Credits: Unsplash, WHO, WHO.

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

No. 1: Halt circulation in Afghanistan, Pakistan

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

No. 2: Surveillance, campaigns, community engagement

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

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

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

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

No. 3: Alignment of eradication, containment efforts

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

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

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

No. 4: Immunisation

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

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

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

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

Tackling persistent challenges

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

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

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

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

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

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

Challenges in the Eastern Mediterranean region

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

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

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

African region’s concerns and call to action

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

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

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

The world’s only public health emergency of international concern

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

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

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

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

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

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

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

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

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

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

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

Focus for 2024 and beyond

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

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

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

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

Image Credits: Screenshot.

WHO 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.