UN agencies have vaccinated more than 187,000 children against polio in central Gaza over the past three days, which was more than expected, The World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus told a media briefing on Wednesday.

The vaccination drive, aimed at children up to 10 years of age, continues in southern Gaza on Thursday.

“Together, we are helping to prevent the spread of polio in Gaza, but other health needs remain immense,” said Tedros.

“We acknowledge that the humanitarian pause has been respected to allow the vaccination campaign to be conducted safely and successfully. We ask not only for that to remain the case, but also for a ceasefire,” added Tedros.

However, the WHO’s Dr Rik Peeperkorn

A critical #polio vaccination campaign is underway in #Gaza. WHO, UNICEF, UNRWA and other partners are supporting the health workers to deliver the vaccination campaign. Despite the difficult circumstances, parents are showing up eagerly to ensure their children are safe from… pic.twitter.com/Nxqx5x32AU

— World Health Organization (WHO) (@WHO) September 3, 2024

Dr Rik Peeperkorn, joining the briefing from the WHO’s office in Gaza, said that UN agencies still needed a further three days at least to complete the polio vaccination campaign in southern Gaza before heading to the north of the territory.

“I’m deeply concerned about the overall health situation,” added Peeperkorn, explaining that only 16 out of 36 hospitals were partially operational, while less than a third of  the 152 primary health care centres were partially functional.

“We’ve seen an enormous spread in infectious diseases – more than 600,000 cases of diarrhoea, more than 510,000 cases of hepatitis, a huge number of acute respiratory infection; dismal, horrible water and sanitary conditions etcetera.”

DRC to start weekend mpox vaccinations

Mpox vaccines donated by the European Commission’s Health Emergency Preparedness and Response Authority (Hera) will arrive in the Democratic Republic of Congo (DRC) on Thursday and the country’s health ministry plans to start vaccinations over the week, said Tedros.

“WHO is working with our partners to coordinate vaccine demand, share information on doses available and ensure those doses are directed to areas where they can contribute to controlling the outbreak,” he added.

While up to 60% of the DRC’s mpox cases are children, the donated vaccine – Bavarian Nordic’s Jynneos (also called MVA-BN) is not yet registered for use in children.

However, the WHO’s head of R&D, Dr Ana-Maria Restrepo, said that the DRC could use the vaccine off label for children, and that there were a number of studies – including clinical studies – that had established its effectiveness in children.
“Vaccines alone will not stop these outbreaks,” Tedros stressed. “We’re also working to strengthen surveillance, risk communication, community engagement, clinical and home care and coordination between partners at every level.”

The WHO’s Dr Maria van Kerkhove added that the WHO was “deeply concerned” about the spread of mpox Clade 1b in Burundi, the site of the second largest outbreak after the DRC.

“What’s concerning about Burundi is that the cases are dispersed through the country, so we aren’t seeing these small pockets of outbreaks. This indicates that there’s more transmission, there’s more circulation that’s happening,” said Van Kerkhove.

Surge in cholera deaths

The WHO also published global cholera statistics for 2023 on Wednesday, showing a 71% increase deaths and a 13% increase in cases in 2023 in comparison to 2022.

“Over 4000 people died last year from a disease that is preventable and easily treatable,” said Tedros.

“Conflict, climate change, unsafe water and sanitation, poverty and displacement all contributed to the rise in cholera outbreaks last year,” he added, flagging that the geographical distribution of the disease had changed significantly, with cases from the Middle East and Asia declining by a third while cases in Africa more than doubled. 

Cholera is an acute intestinal infection spread through contaminated food and water. Communities with limited access to sanitation are most affected.

“Afghanistan, the DRC, Malawi and Somalia continue to report large outbreaks of over 10,000 suspected or confirmed cases, with Ethiopia, Haiti, Mozambique and Zimbabwe adding to the tally in 2023,” according to the WHO report.

The WHO’s Dr Philippe Barbosa said some technical surveillance issues that influenced the increase in mortality, many people died before they had reached health facilities.

“The very large cholera outbreaks are deadlier,” said Barbosa. “But treatment is simple and cheap. It is immoral that people do not have access to treatment, safe water and hygiene.”

Understanding pathogen origin

On Wednesday, the WHO also published a global framework to help member states to investigate the origins of new and re-emerging pathogens, with the guidance of its Scientific Advisory Group for the Origins of Novel Pathogens (SAGO).

“We still don’t know how the COVID-19 pandemic began, and unfortunately, the work to understand its origins remains unfinished,” said Tedros.

“As I have said many times, including to senior Chinese leaders, China’s cooperation is absolutely critical to that process. That includes sharing information on the Huanan Seafood Market, the earliest known and suspected cases of COVID-19, and the work done at laboratories in Wuhan, China.

“Without this information, none of us are able to rule any hypothesis out. Until or unless China shares this data, the origins of COVID-19 will largely remain unknown.”

The WHO framework outlines six areas in which scientific investigations are needed to identify the origins of outbreaks: early investigations; human studies; animal-human interface studies; environmental and ecological studies; genomic and phylogenetic studies; and laboratory biosafety and biosecurity assessments.