Lisa McClennon, incoming WHO internal auditor, addresses the Executive Board.

Lisa McClennon has been appointed Director of Internal Oversight Services (IOS), the office in charge of investigating all misconduct including sexual abuse and fraud, at the World Health Organization (WHO), the global body’s Executive Board heard on Wednesday.

McClennon has been IOS Head of Investigations since November 2021, and led investigations into the sex abuse scandal in the Democratic Republic of Congo (DRC) during the Ebola outbreak in 2018.

Prior to joining the WHO, she worked at the US Agency for International Development, where she was Deputy Assistant Inspector General for Investigations for six years.

Announcing the appointment, WHO Director-General Dr Tedros Adhanom Gebreyesus said McClennon would assume her new position – generally referred to as the Internal Auditor –  on 1 July, taking over from David Webb, who is due to retire in December.

“Lisa, in her previous capacity, has done an excellent job in investigations, leading our efforts to fast-track and clear the backlog,” said Tedros. “We’re happy to see her transition to this role, and confident her leadership will be critical to driving results.”

In a brief address, McClennon thanked the Executive Board for its support and confidence in her leadership.

“While the road ahead of us is long, the good news is that we are on it together. You have my commitment to be focused, to be collaborative, transparent, and results-oriented,” she told the board.

US board representative Loyce Pace welcomed the appointment: “This is exciting, late-breaking news for today for us because of course this this role is just so critically important,” said Pace. “We’re confident in her ability to do this work.”

Hot seat

McClennon has already faced some heat about the length of time WHO takes to investigate sexual abuse investigations following foot-dragging claims in relation to UK doctor Dr Rosie James’s sexual harassment by Dr Temo Waqanivalu at the World Health Summit in Berlin last October.

“We are fast, we’re rigorous, we’re thorough. We take a contemporary and survivor-centric approach to the matters that are referred to us in this effort,” she told Health Policy Watch in a recent interview. 

“This increased effort and focus in increased resources towards this matter began over a year ago, and we have been able to clear up several cases that had perhaps languished in the past.”

Over the past few months, several employees have been fired in sexual harassment cases.

Loyce Pace, Assistant Secretary in the Office of Global Affairs for the U.S. Department of Health & Human Services.

Earlier in the meeting, US representative Pace had appealed to the WHO to address any claims of harassment and bullying within its ranks. 

“I want to take the time to highlight not only the sexual misconduct cases and what we expect to be cleared from among those that have increased in number, but we want to be sure that we’re also focused on harassment and other forms of abuse like bullying that happens at all levels of the organisation, and we continue to hear those cases,” said Pace.

“Of course, those cases arguably come forward because WHO is doing a better job creating space for staff and others to report on those, but let’s be sure we continue to address the issue and not just identify the issue moving forward.”

Lack of swift action is a persistent problem 

Meanwhile, a report of the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme released ahead of the World Health Assembly, which concluded on Tuesday, had raised concerns about delays in disciplinary action, noting, “delays in post-investigation disciplinary actions have generated frustration and marred confidence in the system.”

The committee had asked the WHO to provide the Human Resources department with additional expertise and capacity so they could act swiftly.

Apart from the allegations of sexual misconduct during the management of Ebola crisis in the DRC, the committee is also monitoring an investigation taking place in Syria that it was briefed about in November 2022. 

The committee “recommended that the investigation be conducted in collaboration with other UN entities, as relevant and findings be carefully communicated to donors.” 

But the oversight committee’s report also noted the seniority of the perpetrators. “The Committee was struck by the number of males in D-1 and P-5 leadership roles that are included on the dashboard as perpetrators. The IOAC is deeply concerned that the seniority of the perpetrators combined with a lack of swift disciplinary action is indicative of an ongoing culture of impunity across the Organization,” it said in its report. 

Need to include more women in WHO

While member states applauded the rising number of women at the WHO, they called for more efforts to improve inclusivity.

“We should have a zero tolerance when it comes to harassment, both sexual and at work, and that we need to maintain a perspective of greater inclusion through the participation of the women in the WHO,” Peru said.

The Executive Board finished its business on Wednesday and will not meet tomorrow as scheduled.

Indigenous Peoples
The 76th World Health Assembly approved a milestone decision on the health of indigenous populations, but a global plan will not be presented until year.

In a milestone decision at the 76th World Health Assembly (WHA76), a resolution aimed at addressing health challenges faced by indigenous peoples worldwide has been approved. With it, the Director-General of the WHO has been directed to develop a comprehensive global action plan dedicated to improving their health outcomes by 2026.

Indigenous peoples, encompassing a rich tapestry of diverse population groups and communities around the world, have long endured significant disparities in health compared to non-indigenous populations, WHO says. 

They face lower life expectancy rates and a higher prevalence of various diseases and adverse health conditions, including diabetes, maternal and infant mortality, and malnutrition, cardiovascular illnesses, HIV/AIDS and others. Disability rates are sometimes 20-33% higher than those of the general population, the WHA resolution notes.

In the United States, indigenous populations reportedly have higher rates of asthma, heart disease, diabetes, obesity, and dementia than the general U.S. population and these chronic medical conditions put individuals at more risk for illness and injury as the climate changes.

Calls for ethical engagement with indigenous communities

Rural Amazonia communities at risk in Peru (MMV/Damien Schumann).

The WHA resolution calls on countries and other actors to ensure “full, effective and equal participation of Indigenous Peoples” in the development of strategies and action plans concerning their communities. 

The same principles hold for WHO’s development of a Global Plan of Action for the Health of Indigenous Peoples, the resolution states. It should include consultation with “Member States, Indigenous Peoples, relevant United Nations and multilateral system agencies, as well as civil society, academia and other stakeholders.”

In addition, the resolution also mandates the WHO to extend support to Member States, upon their request, with respect to efforts to enhance indigenous health.  Such support may include sharing expertise, resources, and best practices to facilitate the implementation of national health plans, strategies, or other measures tailored specifically for indigenous population, the resolution states. 

The resolution also recommended the integration of improvement of indigenous peoples’ health within the framework of the WHO’s next five year work plan, or the 14th WHO General Programme of Work, 2024-2029.

Member States also are asked to actively develop knowledge about the health situation of indigenous peoples, following the principles of free, prior, and informed consent. The resolution notes that by engaging with indigenous communities respectfully and ethically, countries can gain a deeper understanding of their unique health challenges, paving the way for more targeted interventions and policies.

And the resolution encourages WHO Member States to “invest in and implement national health plans, strategies, or measures” that specifically address the health needs of indigenous populations. This includes “attraction, training, recruitment, and retention of indigenous peoples as health workers,” recognizing and valuing their traditional knowledge and practices. 

A significant milestone

The resolution was co-sponsored by an eclectic collection of 15 developed and developing nations with large indigenous populations, along with the European Union. They included: Australia, Bolivia, Brazil, Canada, Cuba, New Zealand, Vanuatu, Mexico, Colombia and Ecuador, along with several other Latin American nations. 

During their deliberations, WHO member states described the resolution as a significant milestone in the global pursuit of health equity and the protection of indigenous rights. 

Countries also shared their experiences to date, in efforts to improve the health of indigenous communities. “Our institutions are trying to adapt it to the specific needs of healthcare for indigenous peoples through amending legislation, through providing better health programs, and through ensuring that indigenous health is a cross-cutting issue in all our policies,” Chile told the WHA.

In another remark, the United Nations Population Fund (UNFPA) delegate told the committee that sexual and reproductive health needs and rights of indigenous peoples must be upheld. 

Addressing structural racism, sexism and discrimination, ensuring access to disaggregated data and working in partnership with civil society, are also key to advancing the rights of Indigenous Peoples, the UNFPA delegate said.

Image Credits: (MMV/Damien Schumann).

WHA
WHO Director General Dr Tedros Adhanom Ghebreyesus travels with health workers in the Democratic Republic of Congo.

In one of its last decisions before concluding, the World Health Assembly Tuesday asked WHO’s Director General to continue developing a draft roadmap for WHO’s new  Global Health and Peace initiative – but stopped short of adopting the proposed plan after some member states balked over elements of the strategy. Instead the Assembly agreed to “take note” of the roadmap and ask WHO’s Director General to report back next year on “progress made on strengthening the roadmap as a living document” through consultations with member states and other stakeholders.  

The Global Health and Peace Initiative was launched jointly by Oman and Switzerland in 2019 and primarily aims to use health as an entry point to build peace, following on from a proposal by Director General Dr Tedros Adhanom Ghebreyesus, who saw it as a centrepiece of his leadership.  

The initiative’s objective is to “strengthen the role of WHO and the health sector as contributors to improving the prospects for peace.” It also aims to strengthen resilience to the impact of armed conflict or violence, while empowering communities. 

However, the language of the draft has proven to be contentious with many countries reacting to what some delegates fear might be too much WHO encroachment into the humanitarian sector, and what others saw as potential interference into the business of states waging war in, or supporting, dozens of regional conflicts around the globe. 

Brazil, South Africa and India express reservations 

Health for peace
Brazil’s joint statement along with India and South Africa requested more discussion on the roadmap – but countries emerged from a closed session with agreement on the draft.

“Although its main focus is health and health workers, it borders on the most delicate subject: peace and security, peace, nation and state sovereignty,” said Brazil which made a joint statement on behalf of South Africa, India as well. 

“The seriousness is such that we should not rush into taking decisions unless everyone is truly comfortable with the roadmap,” Brazil’s delegate added in a session on Tuesday, WHA’s closing day. After huddling in a closed door session for nearly an nour, member states finally agreed to “take note” of the roadmap draft and ask for its continued development – without endorsing it per se.  

Two-pronged objective for WHO

The published version of the draft roadmap, etches a two-pronged objective for WHO:

  • “Ensure that health programs are “peace and conflict sensitive”. This means they are designed and implemented in a way that proactively seeks to mitigate the risks of inadvertently exacerbating social tensions, contributing to conflict, or undermining factors of social cohesion in a given society or community (also known as ‘do no harm’ principle). 
  • Where the context, capacities and risks allow, design and implement health programs that are “peace responsive” – meaning, that seek to improve the prospects for peace by, for example, strengthening social cohesion, equity, inclusivity, dialogue, or community resilience to the impact of armed conflict or all forms of violence.    

The roadmap also spells out the possible contribution that WHO can make alongside other UN agencies. It also refers to the role of non-State actors in conflict settings – although it does not spell that out in detail. 

While some may fear WHO’s encroachment in the business of states or other international actors, the initiative notes that: “The Global Health and Peace Initiative is grounded in WHO’s foundational documents. 

“The WHO Constitution recognizes that “the health of all peoples is fundamental to the attainment of peace and security and is dependent upon the fullest cooperation of individuals and States,” while resolution WHA 34.38 (1981) highlights the health sector’s role in promoting “peace as the most significant factor for the attainment of health for all.”

Regional conflicts and instability, together with climate change, have put more people on the move around the world than ever before – leading to increased WHO interest in supporting fragile states – before a crisis peaks.  

WHO estimates that roughly 80% of its humanitarian caseload, as well as 70% of disease outbreaks to which it responds occur in fragile, conflict-affected and vulnerable settings.

The current session of WHA also saw multiple geopolitical eruptions between member states, including over a resolution against Russia on its invasion of Ukraine; Chinese objections to Taiwan’s participation as an observer; the health status of Palestinians in Israeli occupied territories; and on Tuesday, at the closing plenary, between Azerbaijan and Armenia. 

  • Correction: an earlier version of this text reported that the health and peace roadmap had been “adopted”. In fact the decision adopted by the WHA was to continue developing the roadmap, with a report from the director-general  due to be made at the WHA in 2024 on progress made. 

Image Credits: WHO/L.Mackenzie, WHO.

India describes its candidacy for the post of WHO external auditor – WHA approved despite the steep price hike attached.

The World Health Assembly has re-elected India to serve as WHO’s external auditor for the next four years – but there was a steep price tag attached to this year’s appointment.

WHO will pay nearly $1 million for India’s services over the coming three-year term of 2024-2027  – amounting to US$ 2.268 million, according to India’s bid, disclosed in an annex of audit “fees” that accompanied the appointment documents. 

That is as compared to $1.35 million ($450,000 annually) that India received for performing the same audit service between 2020-2023 – for a difference of $918,000, according to the same report by the WHO Director General.

Three competing offers were all much cheaper

India’s bid was also by far the most expensive for the audit service. In an era when member states have talked constantly about the need for WHO to streamline and economize, competing offers for audit services by Egypt ($1.708 million; Kenya (1.862 million) and Tanzania, ($1.8million), would have saved the Organization $500,000 or even more – had any of them been accepted.

But in a secret ballot by WHA member states, India prevailed over all of the other candidates – garnering  114 votes against 42 for Tanzania – amongst the 156 member states that voted. 

India’s offer was by far the most expensive among the candidates

European Union and United States calls for more scrutiny

Following India’s reelection, Sweden on behalf of the European Union (EU) called on the external auditor to be more proactive in its role – monitoring efforts to make WHO more efficient, transparent and accountable in its use of the public funds provided by member states.

“We call on the newly elected external auditor to actively monitor these activities and work with the Secretariat and the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme [IOAC] in order to develop the necessary corporate practices in these areas and ensure implementation,” the EU noted.

Recent IOAC reports have highlighted the importance of the external auditing role, describing it as relevant to ensure in-depth knowledge and understanding of the work of the WHO. The report’s findings should be taken into account in the finalization of the formal arrangements that will follow the election, Sweden added. 

In its remarks, the United States called for further elaboration of WHO appointment procedures. It noted that the UN inspection unit has long recommended that a subsidiary committee of an organization’s governing body should screen external auditor candidates against established criteria and requirements as a requisite stage in the appointment process. 

“We understand this is also a best practice used across UN system organizations now,” the United States told WHA’s Committee B, which deals with WHO administrative matters..

It suggested the WHO Executive Board’s Programme, Budget and Administration Committee (PBAC) as an appropriate subsidiary body to screen and help guide the health assembly on making efficient and formed external auditor appointments in the future.

“We would also recommend in this regard that the Secretariat propose amendments to its relevant financial regulations and external auditor Terms of Reference as necessary to clarify and formalize such a role for the PBAC in future external auditor appointments,” the US added.

Stefan Anderson contributed to the reporting on this story.

Image Credits: WHO.

Protests against Uganda anti-homosexuality bill

There has been swift and widespread reaction to Uganda’s Anti-Homosexuality Act, which introduces severe punishment for homosexuality including the death penalty, being signed into law by that country’s president on Monday.

US President Joe Biden called for its “immediate repeal”, describing it as “a tragic violation of universal human rights—one that is not worthy of the Ugandan people, and one that jeopardizes the prospects of critical economic growth for the entire country”. 

 

EU High Representative Josep Borrell warned that “the Ugandan government has an obligation to protect all of its citizens and uphold their basic rights. Failure to do so will undermine relationships with international partners.”

“This law is contrary to international human rights law and to Uganda’s obligations under the African Charter on Human and People’s Rights, including commitments on dignity and non-discrimination, and the prohibition of cruel, inhuman or degrading punishment,” added Borrell.

The Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund), UNAIDS, and the US President’s Emergency Plan for AIDS Relief (PEPFAR) issued a joint statement calling for the law to be reconsidered as it was harmful and jeopardised Uganda’s progress to stop HIV.

“Trust, confidentiality, and stigma-free engagement are essential for anyone seeking health care. LGBTQI+ people in Uganda increasingly fear for their safety and security, and increasing numbers of people are being discouraged from seeking vital health services for fear of attack, punishment and further marginalization,” said the organisations.

Previously, UN High Commissioner for Human Rights Volker Türk described the law as “probably among the worst of its kind in the world”.

“The Bill confuses consensual and non-consensual relations – the former should never be criminalized, whereas the latter requires evidence-based measures to end sexual violence in all its forms – including against children, no matter the gender or sexual orientation of the perpetrator,” said Türk.

Unconstitutional?

Despite a warning by Ugandan  Deputy Attorney General (DAG) Kaafuzi Jackson Kargaba  that the law was open to a number of legal challenges, particularly with the inclusion of the death penalty in a country that has effectively ended the use of capital punishment, Ugandan President Yoweri Museveni went ahead and made it law.

Museveni sent the Bill back to Parliament for its reconsideration in early May, but MPs voted to retain the death penalty for “aggravated homosexuality” – defined as sex with a child or disabled person or while living with HIV. The law also makes provision for a 20-year prison sentence for “knowingly promoting homosexuality”.

The Bill had the support of all but one of the MPs, many of whom have persistently equated homosexuals with paedophiles.

During the sitting, Speaker Anita Among took issue with Kargaba for pointing out the flaws in the earlier Bill and when he tried to explain his position in Parliament, she refused to allow him to speak.

“We have a culture to protect. The Western world will not come to rule Uganda,” said Among.

Ironically, however, US conservative Christian groups have been pushing for the legislation since 2014 when a “kill the gays” Bill was passed but never implemented after being overturned in a legal challenge, and Among has been part of the high-level government officials meeting with these groups, including the Arizona-based Family Watch International.

Ugandan gay activist Frank Mugisha, previously told Reuters that if the Act becomes law, he will challenge it in court on grounds that it was unconstitutional and violated various international treaties to which Uganda is a signatory. 

However, Mugisha also said that he feared mob violence and the mass arrest of LGBTQ people, adding that his community would be too afraid to seek treatment at health centres and warned of the mental health damage, including an increased risk of suicide.

“This legislation… is here to erase the entire existence of an LGBTQ person in Uganda, but also it radicalizes Ugandans into hatred of the LGBTQ community,” LGBTQ activist Frank Mugisha told MSNBC’s Rachel Maddow in a recent interview.

Since Parliament passed the Bill, hate crimes and violence against LGBTQ people have risen sharply, according to the Human Rights and Awareness and Promotion Forum (HRAPF), a legal aid organisation. In addition, police have arrested people on suspicion of being LGBTQ, according to HRAPF.

 

Digital health
At a session on Saturday, WHO, member states and other stakeholders assess the progress, realities, challenges and odds stacked against an ambitious global strategy on digital health.

On Saturday at the World Health Assembly, the World Health Organization (WHO) laid out the current realities of its digital health agenda as contained in the 2020-2025 global strategy on digital health.

WHO member states see digital health as an important vehicle for accelerating progress towards WHO’s ‘triple billion’ targets of universal health coverage, health emergencies response and healthier populations.

Even though the strategy was launched just before the COVID-19 pandemic began, the pandemic response demonstrated that countries’ investments in digital health also strengthened the resilience and responsiveness of health systems, the Director of the Department of Digital Health and Innovation, Alain Labrique, told the WHA.

An ambitious strategy

Digital health
A summary of the WHO’s strategic action plan on digital health.

The development of a global strategy on digital health underwent a two-year co-creation journey before its adoption at the 73rd World Health Assembly (WHA). The initial draft of the strategy document was drafted and disseminated for comments through an internal consultation in early 2019, followed by a series of global and regional consultations. The strategy aims to improve health for everyone, everywhere by accelerating the development and adoption of “appropriate, accessible, affordable, scalable and sustainable person-centric digital health solutions to prevent, detect and respond to epidemics and pandemics”.

The strategy also aims to develop infrastructure and applications that enable countries to use health data routinely to  achieve WHO and UN Sustainable Development Goals. 

It argues that the value and uptake of digital health solutions is  contingent upon a range of l factors including: accessibility, efficiency and sustainability; affordability; and versatility with respect to different health applications  Applications also need to maintain patient privacy and data security. 

To achieve “radical improvements” in health outcomes, the strategy called for investment in governance, institutional capacity, workforce training, planning, and management. 

“By aligning with national strategies for digitizing the health sector, WHO believes digital health can enhance efficiency, cost-effectiveness, and potentially introduce new business models for service delivery. 

Accomplishments so far less clear 

Presently, WHO is working to ensure that member states have the capacity, guidance, and tools necessary to undertake digital transformation, Labrique told member states on Saturday. Although he said the WHO is enabling member states with “the necessary interoperability architecture to enable domestic, regional, and global digital health goals,” he did not provide specific details on how this is being done.

Moreover, WHO said is facilitating the development of competency-based frameworks to enable the training of digitally enabled health workers of today and of the future. “We are working collaboratively with multiple stakeholders to address the digital divide and enable equitable, safe, and ethical access to life-saving technologies for all.”

Just what that really means in countries, however, is much less clear, critiques say. Observers say that WHO’s rollout of its strategy has been lackluster with leadership ill-equipped for the task, to date. 

Most recently, for instance, WHO created briefing notes for countries, donors and on a  new WHO “Digital Health Clearinghouse”  that “assesses, curates and catalogs digital solutions that meet minimum requirements in the delivery of digital health interventions at the primary health care level.”

But while the clearinghouse was supposed to commence work in early 2023, with “solutions for specific health domains in early 2023, starting with Digital Documentation of COVID-19 Certificates (DDCC),” there is as of yet, no online address for the effort on WHO’s Digital Health page.

The digital health effort is housed in WHO’s Science division. Translating the high hopes of the strategy into results will therefore be a challenge facing new WHO Chief Scientist Jeremy Farrar, former director of Wellcome Trust.

A planned WHO data portal, Data.who.int, being developed in another WHO division, Data Analytics and Delivery for Impact (DDI) is supposed to consolidate WHO’s own wealth of digital health data assets, and provide greater interactivity between WHO headquarters, regions and country offices. It also has yet to get off the ground. 

Countries making progress

Many member states have already earmarked digital health for more investment – after the Pandemic served as a wake-up call. 

In its remarks, the government of Indonesia, which currently holds the G20 Presidency, affirmed its commitment to strengthening global and regional digital health systems  – along with the  national investments it is making now. 

“Indonesia has included digital health as one of our health transformation agenda priorities. Through the formation of digital transformation offerings of health, we aim to build an integrated system that ensures all processes run effectively and provides the best health care services to all to ensure a single national health data which is integrated and safely stored,” the country’s delegate stated. 

UK calls for ‘more work’ by WHO on digital health  

Meanwhile, the UK government, while acknowledging WHO’s current efforts, said that the agency needs to do more.  

“While there has been significant progress on digital transformation, [way] more work is needed to unlock its benefits in health and social care, said the UK delegate. 

“WHO’s leadership is vital in bringing together governments and other key stakeholders to advance the digital health agenda and address shared challenges such as data governance, interoperability, and incentivizing innovation,” he stated.

The UK also urged the WHO to focus on “aligning and harmonizing” digital health standards and ensuring that more detailed updates on progress are included in future WHA reports. 

In its submission, the International Pharmaceutical Students Association called on WHO and member states to empower young health care professionals to bridge the digital literacy gap in the community by including digital health and formal healthcare education curricula. 

The association also called for the creation of an enabling environment for young innovators by establishing clear funding and mentorship mechanisms. It also recommended the implementation of a harmonized digital strategy that includes community pharmacies.

Image Credits: WHO.

chemical pollution
The WHA resolution coincided with the start of a second round of international negotiations on a treaty to curb plastic pollution in Paris on Monday morning. / Photo: Factory smoke laced with chemical pollution.

The World Health Assembly (WHA) approved a landmark resolution on Monday calling on the World Health Organization (WHO) to scale up its efforts to fight the impact of chemicals, waste and plastic pollution on human health and produce the data to back it up.

The non-binding commitment spearheaded by Peru is the first time ever that the health effects of chemicals and plastic pollution have been directly addressed at the WHO’s member state assembly. The watershed moment for the UN health body follows years of collaboration with the UN Environment Programme (UNEP) on the safe management of chemicals and air pollution. 

The resolution passed with near-unanimous support, with 40 countries including Canada, Mexico, the European Union and its member states signing on as co-sponsors. 

“This is an environmental topic”

The success of the Peruvian effort to elevate the issue to the WHO’s agenda was far from certain when negotiators sat down in Geneva last week to kick off the WHA. In fact, the resolution seemed like a long shot.

“It was not easy,” Bernardo Roca-Rey, a member of the Peruvian team who wrote the resolution, told Health Policy Watch. “When we launched the negotiations on the very first draft, several delegations were still reluctant because they were saying this is an environmental topic, not human health.” 

Previous WHA sessions would likely have dismissed Peru’s proposal outright, veterans of the organization observed. 

“Years ago, it was difficult to bring all these [environmental] topics to health ministers,” Maria Neira, the director of Environment, Climate Change and Health at the WHO said at a side event discussing the resolution last Thursday. “They thought, well maybe this is important, but we have to deal with malaria, we have to focus on tuberculosis – we focus on diseases.”

Peru led the charge on the resolution 

Spatial view of large-scale illegal gold mining in the Madre de Dios region in the Southeastern Peruvian Amazon.

Peru had a week of negotiations and a wealth of knowledge about the issues to make its case. 

The country’s experience with illegal gold mining in the Peruvian Amazon meant its team was intimately aware of the consequences of dismissing the health effects of environmental crises. Peru’s rainforests are home to the highest levels of atmospheric mercury on earth, endangering the lives of miners, indigenous communities and wildlife exposed to its water and air.

“New chemicals are being developed every day, the demand and production of new chemicals continue to grow every day, and there is more and more evidence of the impact this is having on biodiversity, the environment and human health,” Roca-Rey said. “This is not only an environmental problem, it is also a human health problem.”

Generate more data on the health impacts of plastics pollution

Large data gaps continue to limit our understanding of the health impacts caused by plastic pollution.

The Peruvian delegation also highlighted the critical need for organizations like WHO to generate more data on the health effects of plastic pollution. 

The limited evidence base that exists suggests that microplastics can interfere with the function of cells in internal organs, block endocrine receptors that affect the behaviour of hormones, and find their way into breast milk, raising fears over their potential impact on the health of babies.

The resolution asks WHO Director-General Dr Tedros Adhanom Ghebreyesus to prepare a report on the “human health implications of chemicals, waste and pollution” and identify “existing data gaps” limiting scientific understanding of the health impacts caused by plastic pollution. 

“We know we have microplastics in our food, but we are still not actually aware of the extent that this is impacting human health,” Roca-Rey said. “We just found out less than two years ago that we have microplastics in our bloodstream. I don’t think we are fully aware of the extent of the issue.”

Multiple pathways exist for microplastics to enter the body. Widespread incineration of plastic waste is a major contributor to air pollution, particularly in developing countries. Other pathways include the ingestion of fish and wildlife, contaminated water, and the contamination of food and beverages with microplastics from plastic containers and utensils.

A WHO report would also have huge impacts in the wider plastics debate, Roca-Rey said. 

“More and more research is happening, but the problem is that this research doesn’t necessarily have the certification of an international organization checking that the information is reliable,” he said. “Members states are sometimes reluctant to accept this evidence.”

The success of Peru’s arguments in gaining WHA support for the resolution point to the ongoing shift in attitudes across WHO and other UN agencies towards the understanding that threats to the environment, health, climate and biodiversity must be seen as intertwined rather than isolated – a pivot known internally as the “One Health” approach.

“This is really a milestone,” Roca-Rey said. “It has put the topic fully on the WHO agenda.”

Image Credits: UNEP, Coordenação-Geral de Observação da Terra.

Access
Dr Tedros Adhanom Ghebreyesus, WHO Director-General speaks about WHO initiatives to extend universal healthcare access to another billion people.

The World Health Assembly (WHA) on Monday greenlit a slew of decisions and resolutions that aim to bring another one billion people under the coverage of universal health coverage (UHC), as the 76th WHA session drew closer to its end. 

The plan is the bedrock of WHO’s vision to deliver on so-called “triple billion targets” WHO Director General Dr Tedros Adhanom Ghebreyesus set as a goal in 2018. The targets, that aim to ensure stronger emergency response, access to UHC and beter health and well-being for 1 billion people each, form the backbone around which this year’s discussions have taken place. 

A core focus of the UHC target is the expansion and strengthening of primary healthcare access – viewed as a key means of bringing  more people closer to vital health services. 

“Strong primary health care is especially vital for delivering life saving services, maternal and child health, including routine immunization,” stressed Tedros in his opening remarks at the WHA last Sunday.  Countries definitely agreed, stressing over and over in comments Saturday and Monday the relevance of primary health care services. 

Landmark resolution on harmful chemicals, including plastics 

In terms of WHO’s pillar of work on better health and well-being, WHA also approved a landmark resolution calling for countries to scale-up work addressing harmful chemicals. The resolution refers to the need for countries to explore emerging linkages between plastic pollution and human health.

The resolution, spearheaded by Peru, is the first time ever that WHA has addressed the plastics issue – already widely acknowledged to be a growing environmental blight

Racing to catch up after last week was dominated by protracted debates over divisive topics like Ukraine and Palestine, WHA delegates settled into a routine of long statements and rapid approval of the wide range of technical items remaining on their agenda for this year’s session, which ends Tuesday.   See related story:

Landmark Resolution on Chemical Pollution Passes World Health Assembly

New thrust on fake medicines and rehabilitation services 

Among other key action-points addressed on Monday was a decision aiming to strengthen countries’ control over substandard and falsified medical products, as well as a resolution committing countries to boost rehabilitation services, to meet growing demands as non-communicable diseases rise. 

As part of the substandard medicines initiative, the Assembly’s Committee A, which reviews programmatic work items, OK’d the establishment of an independent evaluation to monitor the member states performance. 

In their comments, countries stressed that substandard diagnostics and medical devices are a problem along with fake and substandard medicines, per se; all are targeted in this week’s decision. 

“The lack of access to affordable, appropriate, good quality and safe medical devices is a major public health issue,” said Botswana, speaking on behalf of 47 countries in the Africa region. “African member states calls for resources to ensure availability of skilled human personnel, and to meet maintenance needs for the medical devices.”

With regards to rehabilitation, the resolution, led by Israel, aims to bolster services to the billions of people who suffer from disabilities or chronic disease that impairs their physical, mental or social functionality.

In 2019 around 2.4 billion individuals had conditions that would have benefited from rehabilitation, WHO estimates – a 63% increase over the past three decades.  And since then, COVID-19, conflicts and other humanitarian crises are also adding significantly to the demand for such services.

Many individuals simply do not receive the rehabilitation they require, despite the high cost. “A majority of those with unmet needs live in low- and middle-income countries, where as much as 50% of people do not receive the rehabilitation they need,” the background text for the resolution states.  WHO is already providing assistance to 35 countries to gather data, develop national plans and strengthen the rehabilitation workforce.

The resolution urges member states to build national rehabilitation programmes – particularly at primary health care level, and to “ensure the integrated and coordinated provision of high-quality, affordable,
accessible, gender sensitive, appropriate and evidence-based interventions for rehabilitation along the continuum of care.”

It also calls upon WHO to develop a global rehabilitation baseline report by 2026, as well as global health system rehabilitation targets and indicators “for effective coverage” for 2030.

“Best Buys’’ to combat NCDs

Last week, WHA delegates approved WHO recommendations for an expanded set of “Best Buys” that countries should use to prevent and control NCDs. These include stronger taxes and warning labels on unhealthy foods, so as to combat non-communicable diseases that now constitute 70% of deaths.  

Non-communicable diseases have been a major focus during this year’s WHA discussions.  

“As the global population is growing. People are living longer, and the emergence of non-communicable diseases, the need for rehabilitation services is on the increase. A recent WHO report suggests that 2.4 billion people are in need of rehabilitation services, and to meet this huge demand the importance for promoting, and investing in community-based rehabilitation (CBR) has never been more urgent,” said Malawi. 

Support for disability inclusion

The WHA also endorsed a new WHO strategy to strengthen disability inclusion within countries and health ministries. While the strategy found widespread support, WHA member states raised questions about steps WHO, as an agency, is also taking to include people with disabilities and stakeholder groups into the work of the organization.

“We would like to know what the plans are to ensure that organizations of people with disabilities are systematically included in the technical work of the organization as is stated in the strategy,” Mexico asked. 

“This would help us to ensure that disability is really incorporated in the work of the WHO for issues on recruitment, and to adapt a physical and digital infrastructure through the universal design and reasonable adjustments for different tools.”   

Other countries highlighted the lack of data on people with disabilities as well as intersectional issues, such as the challenges pregnant women living with disability face in accessing healthcare.  

Visa restrictions limit participation by global south in professional events

Access
Denmark underscored the need to improve trust in public health communication.

After the experience of the pandemic in which public behaviour was a key determinant in the uptake of vaccines, WHA members also expressed support for a new strategy to  mainstream behavioural sciences in the work of the global health agency.

“We saw how trust is a core aspect of a successful pandemic response, vertically as trust between citizen and state, and horizontally as trust in your fellow citizen,” said the WHA delegate from Denmark. 

“Low public trust is a worldwide public health concern. It needs a stronger global collaboration, and it needs global initiatives.” 

“However, building sustainable trust in authorities and among communities does not happen overnight. It requires some deep insight, structural approaches, and it can be a slow process,” he added. 

But as WHA drew to a close, countries also brought up a range of other concerns around the WHA’s policies and recommendations.

Universal health care
Jamaican representative alludes to inequity in conferences and workshops in global health, while speaking at the World Health Assembly.

For instance, developing countries face visa restrictions in trying to share knowledge around topics like health and behavioural sciences, the delegate from Jamaica suggested – referring to a “gap” faced by participants from the global south in getting to professional meetings and conferences.  

“We appreciate and support the priority placed in the report on fostering dialogue with academic institutions and practitioners to help reduce the gap,” the delegate said.

Image Credits: WHO, WHO .

WHO staff Dr Simon Ssentamu verifies the oxygen cylinder supply at a health facility in Cox’s Bazar, Bangladesh during the COVID-19 pandemic.

GENEVA – The global will to ensure that COVID-19 is a “never-again” pandemic is dissipating fast, according to many delegates attending the World Health Assembly (WHA) and its plethora of side events – threatening initiatives such as local manufacturing of vaccines.

Jeremy Farrar, the newly appointed Chief Scientist at the World Health Organization (WHO), reminded a forum on mRNA vaccines that, in previous outbreaks, the global health community had “made a promise of ‘never again’, but interest waned over time and it will pass again”.

“If we don’t invest in the whole global R&D ecosystem in the next year, there won’t be local vaccine production by the next pandemic,” Farrar warned delegates gathered in a white marquee on the lawns of the French Mission attending a event organised by the Medicines Patent Pool (MPP).

But it’s not just vaccine production. It is also diagnostic tests and treatments – and ensuring that countries’ health systems are able to offer services to all citizens, regardless of their ability to pay.

Timely testing

On Friday, the WHA passed a resolution to strengthen countries’ diagnostic testing capacity, stressing support for the local production of diagnostic tools and tests in low- and middle-income countries (LMICs).

COVID-19 tests were scarce in many parts of Africa, leading to a misconception that the continent had not suffered that much from the virus. Meanwhile, Tanzania struggled to identify a deadly Marburg outbreak recently because of a lack of access to laboratories and testing.

“Timely access to the right testing tools is one of the most critical parts of any medical intervention to curb an outbreak and save lives, so it’s encouraging to see access to testing being discussed at a global level,” said Dr Salha Issoufou, Director of Operations for Médecins sans Frontieres (West and Central Africa) in response to the resolution.

“We urge all governments to make sure everyone has access to lifesaving tests by swiftly adopting WHO guidelines in national policies, developing national essential diagnostics lists (EDL), and ensuring nationwide access to essential tests for all diseases relevant to the local context, including neglected diseases, and beyond pandemics alone.”

Keeping vaccine factories ‘warm’ outside pandemics

During COVID-19, vaccine delivery to Africa – which imports 99% of its vaccines – was frozen for months after India slapped an export ban on vaccines being made by the Serum Institute of India to deal with its own infection crisis.

The months’ long delay underscored the need for regions to be able to make their own vaccines. But ensuring this is expensive.

 “mRNA is a buzzword at the moment, but how do we keep the factories warm when there isn’t a pandemic?” asked Morena Makhoana, CEO of the South African company, Biovac, which is involved in vaccine production.

His own company faced a crisis recently when the South African government opted to switch its order of the pneumococcal vaccine from Biovac to India’s Cipla, which was producing it far cheaper.

Martin Friede, WHO’s head of vaccine research, recounted at the mRNA event how factories set up to produce influenza vaccine had closed one by one as governments’ support dried up once the threat of H1N1 had passed.

Seth Berkley, CEO of Gavi, the world’s biggest purchaser of vaccines, said that Gavi was committed to giving priority to regional manufacturers, and was currently working with 33 companies.

However, he warned that these vaccines will cost more and would need to be subsidised, not just by donors but by countries where manufacturers are based.

Dr Jean Kaseya, the new head of Africa CDC, told an event at the WHA that his continent has a potential market of 1.3 billion people – and that regional manufacturing of vaccines and medicines is a key pillar of Africa’s New Public Health Order. 

Africa CDC has set a bold target of purchasing 60% of the vaccines it needs from African producers by 2040 – an almost impossible task without massive investment and political will.

Even the recently formed Pandemic Fund has shied away from regional production in its first call for proposals because of the cost, said Priya Basu, executive lead of the fund’s secretariat.

The World Bank estimates LMICs need to invest $30 billion a year for the next five years to pandemic-proof themselves, said Basu.

Regulatory hiccups and pathogen sharing

A key component of regional production also rests on medicines and vaccines being passed by regulatory authorities – and in Africa’s case, each of the 55 countries has different regulatory authorities. The Africa Medicines Agency (AMA) is being set up to streamline this.

IFPMA’s Thomas Cueni (centre) flanked by Jayashree Iyer, CEO of Access to Medicines Foundation (left)  and WHO’s John Rheeder.

But Thomas Cueni, the plain-speaking Director-General of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), described the AMA as “a bit of a mess at the moment”, particularly as the main countries on the continent have not yet ratified it.

Cueni also said there was a huge gap between “the political rhetoric and reality on the ground” in relation to regional manufacturing, and it was “toxic” to expect that the North would always pay.

The IFPMA also wants the rapid sharing of pathogens without strings attached – such as access benefit-sharing agreements – one of the points of disagreement in the current pandemic accord negotiations.

“The rapid sharing of SARS-COV-2’s sequencing enabled the pharmaceutical industry to start developing vaccines, treatments and diagnostics in record time. The first vaccine was approved 326 days after the virus sequence was known. This sharing of data and information mustn’t be jeopardized in the future, and the principle needs to be kept in any solutions for pandemic preparedness,” said Grega Kumer, the IFPMA’s Deputy Director of Government Relations.

He added there had been cases where access to pathogens was either blocked or delayed because of access benefit-sharing agreements derived from the Nagoya Protocol, which led to delays in vaccine production. For instance, this has been the case for seasonal influenza, Ebola or Zika.

Pandemic-proofing humans and health systems

People also need to be pandemic-proofed. COVID-19 also showed that humanity is extremely unhealthy – with NCDs in particular whittling away resistance to infection. Those with co-morbidities, particularly obesity and diabetes, were far more likely to die from the virus.

Thus the WHO’s updated guidelines on tackling NCDs that were adopted by the assembly are extremely timely.

Member states at the WHA also expressed alarm that over a billion people cannot access health services because there is no universal health coverage (UHC) where they live, and they cannot afford to pay for healthcare. 

“In a transformative policy shift, member states across high-, middle- and low-income countries expressed a strong commitment to reorient their health systems based on primary health care (PHC) as a foundation for achieving health for all and reaching the furthest left behind first,” said the WHO after the adoption of a resolution to this effect.

“About 90% of UHC interventions can be delivered using a PHC approach; from health promotion to prevention, treatment, rehabilitation and palliative care, potentially saving 60 million lives by 2030.

UHC will also be discussed at a United Nations High-Level Meeting in September, where a political declaration is expected to commit all countries to UHC.

Are politicians out of the loop?

Joy Phumaphi (left) former Minister of Health of Botswana and co-chair of the Global Preparedness Monitoring Board, Terrence Deyalsingh, Health Minister of Trinidad and Tobago, and Precious Matsoso, co-chair of the pandemic accord negotiations.

Two processes are currently underway at the WHO to sharpen up the governance of future pandemics: negotiations for a pandemic accord to provide guidelines for how countries should behave during pandemics, and the amendment of the International Health Regulations, the only binding global rules for health emergencies.

But at an event on pandemic leadership, the Health Minister of Trinidad and Tobago, Terrence Deyalsingh, warned that politicians had to deal with a host of post-pandemic issues – particularly economic woes – and preparing for the next pandemic was no longer a priority.

A similar point was made by eSwatini’s Health Minister, Lizzie Nkosi, who questioned whether politicians were aware of pandemic accord negotiations – let alone preparing for new pandemics: “Are Ministers of Health in countries able to follow the processes in the negotiations and take the issues to their teams?”

Global health leaders are pinning their hopes on the United Nations High-Level Meeting on Pandemic Prevention, Preparedness and Response in September to reignite the political will seen at the height of the COVID-19 pandemic.

Michael Kazatchkine, a member of the Independent Panel for Pandemic Preparedness, is part of a lobby for the establishment of a high-level Global Health Threats Council to keep the issue alive. 

“This is very much a debated issue here in Geneva everywhere. Clearly, we need more work on this to make sure that we’re all on the same page, but what is certain is that saying ‘never again’ with regard to pandemics will remain just words unless we ensure that sustained high-level political engagement,” said Kazatchkine.

Meanwhile, a new pandemic lurks

A researcher explores evidence around the wildlife trade, possibility the source of the next pandemic.

Yet scientists warn that another pandemic is lurking, and is even more likely to erupt as humans encroach more on animals’ territory and the world gets heats up. 

The Intergovernmental Panel on Climate Change (IPCC) warned in its report last March that, without swift climate action, we will see an escalation of infectious diseases such the vector-borne dengue, Zika and malaria, and water-borne typhoid and cholera.

Chadia Wannous, One Health co-ordinator for the World Organization of Animal Health (WOAH), stressed at a number of panels during the past week that primary prevention of pandemics has to focus on “zoonotic spillover” – the messy interface between humans and animals as shown at the Huanan Market in Wuhan, the likely ground zero for the COVID-19 pandemic, where all kinds of wild animals were caged in poor conditions. 

At the opening of the WHA, WHO Director-General Dr Tedros Adhanom Ghebreyesus warned that an even worse pathogen than SARS-COV-2 might be ahead, while Maria van Kerkhove, WHO’s lead on COVID-19, also warned that while the emergency may be over, COVID-19 is not yet done killing humans.

Total R&D ecosystem overhaul?

Meanwhile, Wellcome Trust, one of the biggest private donors of infectious disease response, kicked off a global conversation about what needs to be done in a discussion paper released a few days back that declares: “The R&D infrastructure ecosystem for infectious disease is unfit for purpose and requires ambitions overhaul.”

At the heart of the discussion paper is this wish: “We want to see progress towards an infectious disease R&D ecosystem that efficiently and sustainably develops and brings to the market the range of vaccines, diagnostics and treatments required to address the growing threat posed by infections. At its heart, this ecosystem should be structured to provide appropriate products to the people that need them, wherever they live in the world, at an affordable price and in a timely way.”

Wellcome’s four-point vision for transforming infectious diseases R&D.

Wellcome points out that “resources are not allocated to research activities efficiently or equitably with whole fields suffering long-term neglect”. Key problems include “empty pipelines” for major infectious disease threats, especially affecting low-resource settings, barriers to registration, and lack of access.

“Individuals’ ability to access lifesaving products often depends more on economics and geography than on need,” the Trust points out.

Between now and the end of the year, Wellcome will engage key stakeholders on how to change four key areas around establishing health priorities, streamlined clinical trials and regulatory approaches, the strategic scale-up of geographically diverse and sustainable manufacturing capacity and how to both “centre access and affordability while incentivising innovation”.

Factor in three UN high-level meetings – on UHC, pandemic preparedness and tuberculosis – in September. Plus the two pandemic negotiations – on the pandemic accord and how to amend the International Health Regulations (IHR) to make them fit for the next pandemic – that are due to be concluded by the next WHA in May 2024.

It’s going to be a busy  12 months.

Image Credits: WHO/Fabeha Monir , Wildlife Conservation Society.

Digital health
(L-R) Dr Conrad Tankou, Yifan Zhou, Sarah Tuytschaever, Joseline Carias Galeano, Sameer Pujari, and Dr Ilona Kickbusch at the event.

Achieving universal health coverage by 2030, as resolved by the World Health Assembly this week, should ideally bring along with it a bouquet of possibilities through digital technologies. 

Digital health technologies have improved the delivery of healthcare services by improving access to COVID-19 vaccination in Canada, and by improving access to breast and cervical cancer screening in Cameroon. 

A nuanced panel discussion organized by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) and the International Pharmaceutical Students’ Federation (IPSF), and the commission, Governing Health Futures 2030: Growing up in a Digital World, at the sidelines of the World Health Assembly in Geneva deliberated on how to harness digital technology in service of global health.

Digital health must benefit vulnerable people

The COVID-19 pandemic disrupted the functioning of health systems around the world by cutting off access to much-needed regular medical care for millions of people. Not only did the pandemic push back the progress the world made in tackling diseases like HIV and tuberculosis, it also complicated people’s access to COVID-19 vaccines. 

Setting up an electronic documentation and information system at a clinic that provides care to vulnerable populations in Canada was one of the ways in which digital health worked wonders. 

As a member of a student group that worked closely with such clinics in Canada, Yifan Zhou, the chairperson of external relations at the IPSF, said that they focussed on not leaving behind vulnerable groups when designing digital solutions to solve healthcare problems. 

The student group also helped set up a digital model that provides appointments for vaccinations at clinics instead of walk-ins, which served as a preventative measure around COVID-19. 

“It’s important that digital solutions are designed for the communities that they serve. They don’t have to be really fancy, they just need to be practical to solve a problem,” Zhou pointed out. 

Dr Conrad Tankou, an Africa Young Innovators for Health awardee and medical doctor, added that while there is ample potential to combine the power of digital technology in healthcare, especially with the involvement of young people, there are difficulties in acquiring adequate resources to make it happen. 

“Clearly you need resources to be able to build the solution. And then you stumble on another situation where you need resources to carry pilots (projects). You need resources to carry out clinical trials, then you stumble on other resources, be able to get regulatory approvals and then bring it to the market,” he explained. “How do you as a young person navigate all of this?” 

As a possible solution to these burning questions, Tankou set up the Global Innovation and Creative space (GIC) in Africa, which brings together young professionals to collaborate on co-creating digital solutions to address healthcare problems. 

“The idea was to build a solution where women in remote areas can have access to screening and diagnosis [for cervical and breast cancer],” he said, adding that over time, this tool integrated other hardware technologies which enabled these women to access healthcare services from specialized healthcare service providers in cities, from their remote regions, based on their diagnosis.  

 Legal and ethical questions

Any conversation about leveraging digital technologies comes with legal and ethical concerns. Establishing governance principles rooted in the human rights of the patients and people these technologies serve is essential to take the idea forward, said Joseline Carias Galeano, general manager at RECAINSA. 

“We believe that in order to have digital health solutions, we need to have strong legal regulations that can secure the rights of the people.” 

This highlights the need for close collaborations between different sectors like academia, industry, governance, and technology. 

“I always feel like everyone has a piece of the puzzle,” said Sarah Tuytschaever, the digital care transformation lead at UCB. 

“It sounds much easier than it is, but how do we align all the incentives of these different factors and actually form that partnership?…And then when it comes to implementation, what we are always forgetting is we focus on the patient outcome.”

‘Cautiously optimistic’

While digital health is the buzzword in global health circles in the recent past, it is important to remain cautiously optimistic about its potential, said Sameer Pujari, lead for AI and digital frontier ecosystems at the World Health Organization (WHO). 

Highlighting the importance of scalability of the technologies used in improving healthcare and the incoming evidence even in food fortification aspects of global health, Pujari said, “There’s a lot of opportunities.. make sure that everyone who’s working on AI is cautiously optimistic and we use AI in a responsible fashion. I think that’s most important.” 

As the health sector evolves to include more digital tools to enhance quality, efficiency and reduce costs, it is equally crucial to ensure that it is not only gender-neutral but also demographically neutral, thus bringing in more men in healthcare delivery, which is currently dominated by women. 

“I urge young people to help us and to take the lead to rethink health systems and what health systems you want,” said Dr Ilona Kickbusch, senior distinguished fellow at the Geneva Graduate Institute. She added that seasoned global health leaders must consciously involve young professionals in co-designing digital health systems. 

“If we manage to develop a footprint for sustainable and equitable digital-first health systems, then we’ll have done our job. And we need that sooner rather than later.”

Image Credits: Twitter/Governing Health Futures 2030.