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Updated: 2 hours 48 min ago

Monkeypox: experts give virus variants new names

Sat, 08/13/2022 - 00:57
A group of global experts convened by WHO has agreed on new names for monkeypox virus variants, as part of ongoing efforts to align the names of the monkeypox disease, virus and variants—or clades—with current best practices.

WHO launches appeal to respond to urgent health needs in the greater Horn of Africa

Tue, 08/02/2022 - 22:25

The health and lives of people in the greater Horn of Africa are threatened as the region faces an unprecedented food crisis. In order to carry out urgent, life-saving work, WHO is today launching a funding appeal for US$ 123.7 million.

Over 80 million people in the 7 countries spanning the region – Djibouti, Ethiopia, Kenya, Somalia, South Sudan, Sudan and Uganda – are estimated to be food insecure, with upwards of 37.5 million people classified as being in IPC phase 3, a stage of crisis where people have to sell their possessions in order to feed themselves and their families, and where malnutrition is rife.

Driven by conflict, changes in climate and the COVID-19 pandemic, this region has become a hunger hotspot with disastrous consequences for the health and lives of its people.

“Hunger is a direct threat to the health and survival of millions of people in the greater Horn of Africa, but it also weakens the body’s defences and opens the door to disease,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “WHO is looking to the international community to support our work on the ground responding to this dual threat, providing treatment for malnourished people, and defending them against infectious diseases.”

The funds will go towards urgent measures to protect lives, including shoring up the capacity of countries to detect and respond to disease outbreaks, procuring and ensuring the supply of life-saving medicines and equipment, identifying and filling gaps in health care provisions, and providing treatment to sick and severely malnourished children.

With the upcoming rainy season expected to fail, the situation is worsening. There are already reports of avoidable deaths among children and women in childbirth. The risk of trauma and injuries is high as violence, including gender-based violence, is on the rise. There are outbreaks of measles in 6 of the 7 countries, against a background of low vaccination coverage. Countries are simultaneously fighting cholera and meningitis outbreaks as hygiene conditions have deteriorated, with clean water becoming scarce and people leaving home on foot to find food, water and pasture for their animals.

The region already has an estimated 4.2 million refugees and asylum seekers, with this number expected to increase as more people are forced to leave their homes. When on the road, communities find it harder to access health care, a service already in short supply following years of underinvestment and conflict.

“Ensuring people have enough to eat is central. Ensuring that they have safe water is central. But in situations like these, access to basic health services is also central,” said Dr Michael Ryan, Executive Director of WHO’s Health Emergencies Programme. “Services like therapeutic feeding programmes, primary health care, immunization, safe deliveries and mother and child services can be the difference between life and death for those caught up in these awful circumstances.”

WHO has already released US$ 16.5 million from its Contingency Fund for Emergencies to ensure people have access to health services, to treat sick children with severe malnutrition and to prevent, detect and respond to infectious disease outbreaks.

WHO thanks its donors who make it possible to carry out this life-saving work.

 

New global alliance launched to end AIDS in children by 2030

Mon, 08/01/2022 - 16:00

Globally, only half (52%) of children living with HIV are on life-saving treatment, far behind adults where three quarters (76%) are receiving antiretrovirals, according to the data that has just been released in the UNAIDS Global AIDS Update 2022. Concerned by the stalling of progress for children, and the widening gap between children and adults, UNAIDS, UNICEF, WHO and partners have brought together a global alliance to ensure that no child living with HIV is denied treatment by the end of the decade and to prevent new infant HIV infections.

The new Global Alliance for Ending AIDS in Children by 2030 was announced by leading figures at the International AIDS Conference taking place in Montreal, Canada.

In addition to the United Nations agencies, the alliance includes civil society movements, including the Global Network of People living with HIV, national governments in the most affected countries, and international partners, including PEPFAR and the Global Fund. Twelve countries have joined the alliance in the first phase: Angola, Cameroon, Côte d'Ivoire, the Democratic Republic of the Congo (DRC), Kenya, Mozambique, Nigeria, South Africa, Uganda, the United Republic of Tanzania, Zambia, and Zimbabwe.

Consultations by the alliance have identified four pillars for collective action:

  1. closing the treatment gap for pregnant and breastfeeding adolescent girls and women living with HIV and optimizing continuity of treatment;
  2. preventing and detecting new HIV infections among pregnant and breastfeeding adolescent girls and women;
  3. accessible testing, optimized treatment, and comprehensive care for infants, children, and adolescents exposed to and living with HIV; and
  4. addressing rights, gender equality, and the social and structural barriers that hinder access to services. 

Addressing the International AIDS Conference, Limpho Nteko from Lesotho shared how she had discovered she was HIV positive at age 21 while pregnant with her first child. This led her on a journey where she now works for the pioneering women-led mothers2mothers programme. Enabling community leadership, she highlighted, is key to an effective response.

“We must all sprint together to end AIDS in children by 2030,” said Ms Nteko. “To succeed, we need a healthy, informed generation of young people who feel free to talk about HIV, and to get the services and support they need to protect themselves and their children from HIV. mothers2mothers has achieved virtual elimination of mother-to-child transmission of HIV for our enrolled clients for eight consecutive years—showing what is possible when we let women and communities create solutions tailored to their realities.” 

The alliance will run for the next eight years until 2030, aiming to fix one of the most glaring disparities in the AIDS response. Alliance members are united in the assessment that the challenge is surmountable through partnership.

“The wide gap in treatment coverage between children and adults is an outrage,” said UNAIDS Executive Director Winnie Byanyima. “Through this alliance, we will channel that outrage into action. By bringing together new improved medicines, new political commitment, and the determined activism of communities, we can be the generation who end AIDS in children. We can win this – but we can only win together.”

"Despite progress to reduce vertical transmission, increase testing and treatment, and expand access to information, children around the world are still far less likely than adults to have access to HIV prevention, care, and treatment services," said UNICEF Executive Director Catherine Russell. "The launch of the Global Alliance to End AIDS in Children is an important step forwardand UNICEF is committed to working alongside all of our partners to achieve an AIDS-free future."

“No child should be born with or grow up with HIV, and no child with HIV should go without treatment,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “The fact that only half of children with HIV receive antiretrovirals is a scandal, and a stain on our collective conscience. The Global Alliance to End AIDS in Children is an opportunity to renew our commitment to children and their families to unite, to speak and to act with purpose and in solidarity with all mothers, children and adolescents.”

Dr Osagie Ehanire, Minister of Health of Nigeria, pledged to “change the lives of children left behind” by putting in place the systems needed to ensure that health services meet the needs of children living with HIV.

Nigeria, Dr Ehanire announced, will host the alliance’s political launch in Africa at a Ministerial meeting in October 2022.

About UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

About UNICEF

UNICEF works in some of the world’s toughest places, to reach the world’s most disadvantaged children. Across more than 190 countries and territories, we work for every child, everywhere, to build a better world for everyone. Follow UNICEF on Twitter and Facebook.

About WHO

Dedicated to the well-being of all people and guided by science, the World Health Organization leads and champions global efforts to give everyone, everywhere an equal chance at a safe and healthy life. We are the UN agency for health that connects nations, partners and people on the front lines in 150+ locations – leading the world’s response to health emergencies, preventing disease, addressing the root causes of health issues, and expanding access to medicines and health care. Our mission is to promote health, keep the world safe and serve the vulnerable. Learn more at www.who.int and follow WHO on Twitter, Facebook, Instagram, LinkedIn, TikTok, Pinterest, Snapchat, YouTube, and Twitch.




 

WHO recommends long-acting cabotegravir for HIV prevention

Mon, 07/25/2022 - 22:07
WHO today released new guidelines for the use of long-acting injectable cabotegravir (CAB-LA) as pre-exposure prophylaxis (PrEP) for HIV and called for countries to consider this safe and highly effective prevention option for people at substantial risk of HIV infection.

WHO calls on global community to “do one thing” to save lives on World Drowning Prevention Day

Mon, 07/25/2022 - 09:42

Today, the World Health Organization (WHO) issued a call for people around the world to “do one thing” to prevent drowning. As one of the leading causes of death globally for children and young people ages 1–24, and the third leading cause of injury-related deaths overall, drowning tragically claims more than 236 000 lives each year. To galvanize action and mark World Drowning Prevention Day, the Jet d’Eau in Geneva will be illuminated in blue this evening, accompanied by similar actions in other cities around the world.

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More than 90% of drowning deaths occur in low- and middle-income countries, with children under the age of 5 being at highest risk. These deaths are frequently linked to daily, routine activities, such as bathing, collecting water for domestic use, travelling over water on boats or ferries, and fishing. The impacts of seasonal or extreme weather events – including monsoons – are also a frequent cause of drowning and these impacts are largely preventable through a number of interventions.

“Every year, around the world, hundreds of thousands of people drown. Most of these deaths are preventable through evidence-based, low-cost solutions,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Today, cities around the world are lighting up their monuments in blue light as a call to action for each of us to do our part to prevent drowning. Let’s put a stop to drowning.”

“Drowning is a global public health challenge, and at Bloomberg Philanthropies, we’re focused on implementing solutions to prevent it. Today, we’re joining our partners around the world in recognizing World Drowning Prevention Day and taking action,” said Michael R. Bloomberg, founder of Bloomberg Philanthropies and WHO Global Ambassador for Noncommunicable Diseases and Injuries. “In many cases, we know what works to prevent drowning. We’ve developed tools and guidance to help governments implement solutions – and if we do more together, we really can save thousands of lives.”

WHO recommends 6 evidence-based measures to prevent drowning, including installing barriers controlling access to water; training bystanders in safe rescue and resuscitation; teaching school-aged children basic swimming and water safety skills; providing supervised day care for children; setting and enforcing safe boating, shipping and ferry regulations; and improving flood risk management.

This year, the theme of World Drowning Prevention Day invites the global community to “do one thing” to prevent drowning. Examples of actions that can be taken are as follows:

  • Individuals can share drowning prevention and water safety advice with their families, friends and colleagues, sign up for swimming or water safety lessons, or support local drowning prevention charities and groups.
  • Groups can host public events to share water safety information, launch water safety campaigns, or commit to developing or delivering new drowning prevention programmes using recommended best practice interventions.
  • Governments can develop or announce new drowning prevention policies, strategies, legislation or investment, convene multisectoral roundtables or parliamentary discussions on drowning burden and solutions, and introduce or commit to supporting drowning prevention programming domestically or internationally.

Many countries in the world have committed to drowning prevention programmes. Bangladesh has started a 3-year program to reduce drowning among children throughout the country. As part of the program, the government will take over the 2500 daycares established and funded by Bloomberg Philanthropies since 2012, and will expand the program by adding an additional 5500 daycares to provide supervision to 200 000 children ages 1–5 years. 

Notes to Editors:

WHO works with partners including Bloomberg Philanthropies, the Royal National Lifeboat Institution (RNLI) and the Global Health Advocacy Incubator as well as other UN agencies to raise awareness on drowning prevention.

Together, we are supporting Member States to design and implement drowning prevention initiatives based on published guidance documents. With Bloomberg Philanthropies’ support, Bangladesh and Vietnam have identified and scaled up cost-effective approaches to drowning prevention among children, and Ghana and Uganda are receiving support to study the circumstances of drowning.

WHO has published a growing library of drowning prevention assessments and guidance documents. The 2014 Global Report on Downing: Preventing a leading killer. In May 2022, WHO published its latest guidance on best practice recommendations for three of these interventions: the provision of day-care for children, basic swimming and water safety skills, and safe rescue and resuscitation training.

The Bloomberg Philanthropies Initiative to Prevent Drowning supports drowning-prevention activities in Bangladesh, Uganda and Viet Nam, including supervision of young children in daycare, survival swimming instruction to children ages 6–15, and enhanced data collection.

In 2021, the first UN General Assembly resolution was adopted on drowning prevention. The resolution asks WHO to coordinate drowning prevention actions within the UN System and lead preparations for World Drowning Prevention Day.

Global virtual webinar event:

To mark World Drowning Prevention Day 2022, WHO and international partners will host a global virtual webinar event on 27 July (12:00 – 13:30 CEST), to discuss approaches to working across the UN system to prevent drowning and showcase the “one thing” partners from around the world have committed to for preventing drowning in their communities. https://who.zoom.us/meeting/register/tJ0ldeiorzMpG9EQR-6AlBABlSQKCWQhUZ9w

 

 

WHO publishes new guidelines on HIV, hepatitis and STIs for key populations

Sun, 07/24/2022 - 19:21
Today, 29 July 2022, WHO published new Consolidated guidelines on HIV, viral hepatitis and sexually transmitted infections (STIs) prevention, diagnosis, treatment and care for key populations. The guidelines outline a public health response for 5 key populations (men who have sex with men, trans and gender diverse people, sex workers, people who inject drugs and people in prisons and other closed settings). WHO promotes an evidence and rights based approach to addressing these health issues which puts key populations at the centre of the response.

Second meeting of the International Health Regulations (2005) (IHR) Emergency Committee regarding the multi-country outbreak of monkeypox

Sat, 07/23/2022 - 17:00

The WHO Director-General is hereby transmitting the Report of the second meeting of the International Health Regulations (2005) (IHR) Emergency Committee regarding the multi-country outbreak of monkeypox, held on Thursday, 21 July 2022, from 12:00 to 19:00 CEST.

The WHO Director-General expresses his sincere gratitude to the Chair, Members, and Advisors for their careful consideration of the issues regarding this outbreak, as well as for providing invaluable input for his consideration. The Committee Members did not reach a consensus regarding their advice on determination of a Public Health Emergency of International Concern (PHEIC) for this event.

The WHO Director-General recognizes the complexities and uncertainties associated with this public health event. Having considered the views of Committee Members and Advisors as well as other factors in line with the International Health Regulations, the Director-General has determined that the multi-country outbreak of monkeypox constitutes a Public Health Emergency of International Concern.  

The WHO Director-General also considered the views of the Committee in issuing the set of Temporary Recommendations presented below.

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Temporary Recommendations issued by the WHO Director-General in relation to the multi-country outbreak of monkeypox

These Temporary Recommendations apply to different groups of States Parties, based on their epidemiological situation, patterns of transmission and capacities. Each State Party, at any given point in time, falls either under Group 1 or under Group 2. Some State Parties may also fall under Group 3 and/or Group 4.

All Temporary Recommendations are expected to be implemented in full respect of established principles of human rights, inclusion and the dignity of all individuals and communities.

Group 1: States Parties, with no history of monkeypox in the human population or not having detected a case of monkeypox for over 21 days

1.a. Activate or establish health and multi-sectoral coordination mechanisms to strengthen all aspects of readiness for responding to monkeypox and stop human to human transmission.

1.b. Plan for, and/or implement, interventions to avoid the stigmatization and discrimination against any individual or population group that may be affected by monkeypox, with the goal of preventing further undetected transmission of monkeypox virus. The focus of these interventions should be: to promote voluntary self-reporting and care seeking behaviour; to facilitate timely access to quality clinical care; to protect the human rights, privacy and dignity of affected individuals and their contacts across all communities.

1.c. Establish and intensify epidemiological disease surveillance, including access to reliable, affordable and accurate diagnostic tests, for illness compatible with monkeypox as part of existing national surveillance systems. For disease surveillance purposes, case definitions for suspected, probable and confirmed cases of monkeypox should be adopted.

1.d. Intensify the detection capacity by raising awareness and training health workers, including those in primary care, genitourinary and sexual health clinics, urgent care/emergency departments, dental practices, dermatology, paediatrics, HIV services, infectious diseases, maternity services, obstetrics and gynaecology, and other acute care facilities.

1.e. Raise awareness about monkeypox virus transmission, related prevention and protective measures, and symptoms and signs of monkeypox among communities that are currently affected elsewhere in this multi-country outbreak (e.g., importantly, but not exclusively, gay, bisexual and other men who have sex with men (MSM) or individuals with multiple sexual partners) as well as among other population groups that may be at risk (e.g., sex workers, transgender people).

1.f. Engage key community-based groups, sexual health and civil society networks to increase the provision of reliable and factual information about monkeypox and its potential transmission to and within populations or communities that may be at increased risk of infection.

1.g. Focus risk communication and community support efforts on settings and venues where intimate encounters take place (e.g., gatherings focused on MSM, sex-on-premises venues). This includes engaging with and supporting the organizers of large and smaller scale events, as well as with owners and managers of sex on premises venues to promote personal protective measures and risk-reducing behaviour.

1.h. Immediately report to WHO, through channels established under the provision of the IHR, probable and confirmed cases of monkeypox, including using the minimum data set contained in the WHO Case Report Form (CRF).

1.i. Implement all actions necessary so as to be ready to apply or continue applying the set of Temporary Recommendations enumerated for Group 2 below in the event of first-time or renewed detection of one or more suspected, probable or confirmed cases of monkeypox.

Group 2: States Parties, with recently imported cases of monkeypox in the human population and/or otherwise experiencing human-to-human transmission of monkeypox virus, including in key population groups and communities at high risk of exposure

2.a. Implementing coordinated response

2.a.i. Implement response actions with the goal of stopping human-to-human transmission of monkeypox virus, with a priority focus on communities at high risk of exposure, which may differ according to context and include gay, bisexual and other men who have sex with men (MSM). Those actions include: targeted risk communication and community engagement, case detection, supported isolation of cases and treatment, contact tracing, and targeted immunization for persons at high risk of exposure for monkeypox.

2.a.ii. Empower affected communities and enable and support their leadership in devising, contributing actively to, and monitoring the response to the health risk they are confronting. Extend technical, financial and human resources to the extent possible and maintain mutual accountability on the actions of the affected communities.

2.a.iii. Implement response actions with the goal of protecting vulnerable groups (immunosuppressed individuals, children, pregnant women) who may be at risk of severe monkeypox disease. Those actions include: targeted risk communication and community engagement, case detection, supported isolation of cases and treatment, contact tracing. These may also include targeted immunization which takes into careful consideration the risks and benefits for the individual in a shared clinical decision-making.

2.b. Engaging and protecting communities

2.b.i. Raise awareness about monkeypox virus transmission, actions to reduce the risk of onward transmission to others and clinical presentation in communities affected by the outbreak, which may vary by context, and promote the uptake and appropriate use of prevention measures and adoption of informed risk mitigation measures. In different contexts this would include limiting skin to skin contact or other forms of close contact with others while symptomatic, may include promoting the reduction of the number of sexual partners where relevant including with respect to events with venues for sex on premises, use of personal protective measures and practices, including during, and related to, small or large gatherings of communities at high risk of exposure.

2.b.ii Engage with organizers of gatherings (large and small), including those likely to be conducive for encounters of intimate sexual nature or that may include venues for sex-on-premises, to promote personal protective measures and behaviours, encourage organizers to apply a risk-based approach to the holding of such events and discuss the possibility of postponing events for which risk measures cannot be put in place. All necessary information should be provided for risk communication on personal choices and for infection prevention and control including regular cleaning of event venues and premises.

2.b.iii. Develop and target risk communication and community engagement interventions, including on the basis of systematic social listening (e.g., through digital platforms) for emerging perceptions, concerns, and spreading of misinformation that might hamper response actions.

2.b.iv. Engage with representatives of affected communities, non-government organizations, elected officials and civil society, and behavioural scientists to advise on approaches and strategies to avoid the stigmatization of any individual or population groups in the implementation of appropriate interventions, so that care seeking behaviour, testing and access to preventive measures and clinical care is timely, and to prevent undetected transmission of monkeypox virus.

2.c. Surveillance and public health measures

2.c.i. Intensify surveillance for illness compatible with monkeypox as part of existing national surveillance schemes, including access to reliable, affordable and accurate diagnostic tests.

2.c.ii. Report to WHO, on a weekly basis and through channels established under the provision of the IHR, probable and confirmed cases of monkeypox, including using the minimum data set contained in the WHO Case Report Form (CRF).

2.c.iii. Strengthen laboratory capacity, and international specimens referral capacities as needed, for the diagnosis of monkeypox virus infection, and related surveillance, based on the use of nucleic acid amplification testing (NAAT), such as real time or conventional polymerase chain reaction (PCR).

2.c.iv. Strengthen genomic sequencing capacities, and international specimens referral capacities as needed, building on existing sequencing capacities worldwide, to determine circulating virus clades and their evolution, and share genetic sequence data through publicly accessible databases.

2.c.v. Isolate cases for the duration of the infectious period. Policies related to the isolation of cases should encompass health, psychological, material and essential support to adequate living. Any adjustment of isolation policies late in the isolation period would entail the mitigation of any residual public health risk.

2.c.vi. During the isolation period, cases should be advised on how to minimise the risk of onward transmission.

2.c.vii. Conduct contact tracing among individuals in contact with anyone who may be a suspected, probable, or confirmed case of monkeypox, including: contact identification (protected by confidentiality), management, and follow-up for 21 days through health monitoring which may be self-directed or supported by public health officers. Policies related to the management of contacts should encompass health, psychological, material and essential support to adequate living.

2.c.viii. Consider the targeted use of second- or third-generation smallpox or monkeypox vaccines (hereafter referred to as vaccine(s)) for post-exposure prophylaxis in contacts, including household, sexual and other contacts of community cases and health workers where there may have been a breach of personal protective equipment (PPE).

2.c.ix. Consider the targeted use of vaccines for pre-exposure prophylaxis in persons at risk of exposure; this may include health workers at high risk of exposure, laboratory personnel working with orthopoxviruses, clinical laboratory personnel performing diagnostic testing for monkeypox and communities at high risk of exposure or with high risk behaviours, such as persons who have multiple sexual partners.

2.c.x. Convene the National Immunization Technical Advisory Group (NITAG) for any decision about immunization policy and the use of vaccines. These should be informed by risks-benefits analysis. In all circumstances, vaccinees should be informed of the time required for protective immunity potentially offered by vaccination to be effective.

2.c.xi. Engage the communities at high risk of exposure in the decision-making process regarding any vaccine roll out.

2.d. Clinical management and infection prevention and control

2.d.i. Establish and use recommended clinical care pathways and protocols for the screening, triage, isolation, testing, and clinical assessment of suspected cases of persons with monkeypox; provide training to health care providers accordingly, and monitor the implementation of those protocols.

2.d.ii. Establish and implement protocols related to infection prevention and control (IPC) measures, encompassing engineering and administrative and the use of PPE; provide training to health care providers accordingly, and monitor the implementation of those protocols.

2.d.iii Provide health and laboratory workers with adequate PPE, as appropriate for health facility and laboratory settings, and provide all personnel with training in the use of PPE.

2.d.iv. Establish, update, and implement clinical care protocols for management of patients with uncomplicated monkeypox disease (e.g., keeping lesions clean, pain control, and maintaining adequate hydration and nutrition); with severe symptoms; acute complications; as well as for the monitoring and management of mid- or long-term sequelae.

2.d.v. Harmonise data collection and report clinical outcomes, using the WHO Global Clinical Platform for Monkeypox.

2.e. Medical countermeasures research

2.e.i. Make all efforts to use existing or new vaccines against monkeypox within a framework of collaborative clinical efficacy studies, using standardized design methods and data collection tools for clinical and outcome data, to rapidly increase evidence generation on efficacy and safety, collect data on effectiveness of vaccines (e.g., such as comparison of one or two dose vaccine regimens), and conduct vaccine effectiveness studies. 

2.e.ii. Make all efforts to use existing or new therapeutics and antiviral agents for the treatment of monkeypox cases within a framework of collaborative clinical efficacy studies, using standardized design methods and data collection tools for clinical and outcome data, to rapidly increase evidence generation on efficacy and safety.

2.e.iii. When the use of vaccines and antivirals for monkeypox in the context of a collaborative research framework is not possible, use under expanded access protocols can be considered, such as the Monitored Emergency Use of Unregistered and Investigational Interventions (MEURI), under certain circumstances, using harmonized data collection for clinical outcomes (such as the WHO Global Clinical Platform for Monkeypox).

2.f. International travel

2.f.i. Adopt and apply the following measures:

  • Any individual:
    • With signs and symptoms compatible with monkeypox virus infection; or being considered a suspect, probable, or confirmed case of monkeypox by jurisdictional health authorities; or
    • Who has been identified as a contact of a monkeypox case and, therefore, is subject to health monitoring,

    should avoid undertaking any travel, including international, until they are determined as no longer constituting a public health risk. Exemptions include any individual who need to undertake travel to seek urgent medical care or flee from life-threatening situations, such as conflict or natural disasters; and contacts for whom pre-departure arrangements to ensure the continuity of health monitoring are agreed upon by sub-national health authorities concerned, or, in the case of international travel, by national health authorities;

  • Cross-border workers, who are identified as contacts of a monkeypox case, and, hence, under health monitoring, can continue their routine daily activities provided that health monitoring is duly coordinated by the jurisdictional health authorities from both/all sides of the border.

2.f.ii. Establish operational channels between health authorities, transportation authorities, and conveyances and points of entry operators to:

  • Facilitate international contact tracing in relation to individuals who have developed signs and symptoms compatible with monkeypox virus infection during travel or upon return;
  • Provide communication materials at points of entry on signs and symptoms consistent with monkeypox; infection prevention and control; and on how to seek medical care at the place of destination;

WHO advises against any additional general or targeted international travel-related measures other than those specified in paragraphs 2.f.i and 2.f.ii.

Group 3: States Parties, with known or suspected zoonotic transmission of monkeypox, including those where zoonotic transmission of monkeypox is known to occur or has been reported in the past, those where presence of monkeypoxvirus has been documented in any animal species, and those where infection of animal species in countries may be suspected including in newly affected countries

3.a. Establish or activate collaborative One Health coordination or other mechanisms at federal, national, subnational and/or local level, as relevant, between public health, veterinary, and wildlife authorities for understanding, monitoring and managing the risk of animal-to-human and human-to-animal transmission in natural habitats, forested and other wild or managed environments, wildlife reserves, domestic and peri-domestic settings, zoos, pet shops, animal shelters and any settings where animals may come into contact with domestic waste.

3.b. Undertake detailed case investigations and studies to characterize transmission patterns, including suspected or documented spillovers from, and spillback, to animals. In all settings, case investigation forms should be updated and adapted to elicit information on the full range of possible exposures and modes of both zoonotic and human-to-human transmission. Share the findings of these endeavours including ongoing case reporting with WHO.

Group 4: States Parties with manufacturing capacity for medical countermeasures

4.a. States Parties who have manufacturing capacity for smallpox and monkeypox diagnostics, vaccines or therapeutics should raise production and availability of medical countermeasures.

4.b. States Parties and manufacturers should work with WHO to ensure diagnostics, vaccines, therapeutics, and other necessary supplies are made available based on public health needs, solidarity and at reasonable cost to countries where they are most needed to support efforts to stop the onward spread of monkeypox.

Proceedings of the meeting

The second meeting of the IHR Emergency Committee on the multi-country outbreak of monkeypox was convened by Zoom, with the Chair and Vice-Chair being present in person on the premises of WHO headquarters, Geneva, Switzerland.

Members and Advisers joined by videoconference. Overall, 15 of the 16 Committee’s Members and all 10 Advisers to the Committee participated in the meeting.

The WHO Director-General welcomed the Committee, noting that he had reconvened them to assess the immediate and medium-term public health implications of the evolution of the multi-country monkeypox outbreak and provide their views on whether the event constitutes a public health emergency of international concern.

The WHO Director-General expressed concern about the number of cases, in an increasing number of countries, that have been reported to WHO and highlighted the challenges presented due to the complexity of transmission patterns in different Regions. He additionally stressed his awareness that determination of a Public Health Emergency of International Concern (PHEIC) involves the consideration of multiple factors, with the ultimate goal of protecting public health.

The Representative of the Office of Legal Counsel briefed the Members and Advisors on their roles and responsibilities and the mandate of the Emergency Committee under the relevant articles of the IHR.

The Ethics Officer from the Department of Compliance, Risk Management, and Ethics briefed Members and Advisers on their roles and responsibilities. Members and Advisers were also reminded of their duty of confidentiality as to the meeting discussions and the work of the Committee, as well as their individual responsibility to disclose to WHO, in a timely manner, any interests of a personal, professional, financial, intellectual or commercial nature that may give rise to a perceived or direct conflict of interest. Each Member and Adviser who was present was surveyed. No conflicts of interest were identified.

The meeting was handed over to the Chair of the Emergency Committee, Dr Jean-Marie Okwo-Bele who introduced the objectives of the meeting: to provide views to the WHO Director-General on whether the multi-country outbreak of monkeypox constitutes a PHEIC, and, if so, to review the proposed temporary recommendations to States Parties.

Presentations 

The WHO Secretariat presented the global epidemiological situation, highlighting that between 1 January 2022 and 20 July 2022, 14,533 probable and laboratory-confirmed cases (including 3 deaths in Nigeria and 2 in the Central African Republic) were reported to WHO from 72 countries across all six WHO Regions; up from 3,040 cases in 47 countries at the beginning of May 2022.

Transmission is occurring in many countries that had not previously reported cases of monkeypox, and the highest numbers of cases are currently reported from countries in the WHO European Region and the Region of the Americas.

The majority of reported cases of monkeypox currently are in males, and most of these cases occur among males who identified themselves as gay, bisexual and other men who have sex with men (MSM), in urban areas, and are clustered in social and sexual networks. Early reports of children affected include a few with no known epidemiological link to other cases.

There has also been a significant rise in the number of cases in countries in West and Central Africa, with an apparent difference in the demographic profile maintained than that observed in Europe and the Americas, with more women and children amongst the cases.

Mathematical models estimate the basic reproduction number (R0) to be above 1 in MSM populations, and below 1 in other settings. For example, in Spain, the estimated R0 is 1.8, in the United Kingdom 1.6, and in Portugal 1.4.

The clinical presentation of monkeypox occurring in outbreaks outside Africa is generally that of a self-limited disease, often atypical to cases described in previous outbreaks, with rash lesions localized to the genital, perineal/perianal or peri-oral area, that often do not spread further, and appears prior to the development of lymphadenopathy, fever, malaise, and pain associated with lesions.

The mean incubation period among cases reported is estimated at 7.6 to 9.2 days (based on surveillance data from the Netherlands, the United Kingdom of Great Britain and Northern Ireland (United Kingdom), and the United States of America (United States). The mean serial interval is estimated at 9.8 days (95% CI 5.9-21.4 day, based on 17 case-contact pairs in the United Kingdom).

A small number of cases have been reported among health workers. Investigations so far have not identified cases of occupational transmission, although investigations are ongoing.

The Secretariat noted that, although the number of cases and countries experiencing outbreaks of monkeypox appear to be rising, the WHO risk assessment has not changed since the first meeting of the Committee on 23 June 2022, and the risk is considered to be “moderate” at global level and in all six WHO Regions, except for European region, where it is considered to be “high”.

Modelling work conducted by the European Centre for Disease Prevention and Control (ECDC) and the European Commission’s Health Emergency Preparedness and Response Authority (HERA) suggests that isolation of cases and contact tracing could be effective in bringing the outbreak under control. However, the operational experience gained to date in responding to this event, indicates that the implementation of such interventions in practice is extremely challenging – the identification of cases is hampered by barriers to access diagnostic testing; the isolation of cases for 21 days is difficult in the current COVID-19 pandemic-related post-lockdowns context; and contact tracing is difficult as contacts are often multiple and may be anonymous. The modelling by ECDC and HERA is suggesting that the addition of vaccination-related interventions can increase the chances of controlling the outbreak, with pre-exposure prophylaxis of individuals at high-risk of exposure appearing to be the most effective strategy to use vaccines when contact tracing is less effective, or impracticable. However, the limited data on vaccine effectiveness against monkeypox constitutes one of the limitations of the modelling work conducted. Additionally, the operationalization of such vaccination strategy presents challenges, including those related to vaccine access.

The genome sequence of the virus obtained in several countries shows some divergence from the West African clade. Work is ongoing to understand whether the observed genomic changes lead to phenotypic changes such as enhanced transmissibility, virulence, immune escape, resistance to antivirals, or reduced impact of countermeasures.

Although many species of animals are known to be susceptible to the monkeypox virus in the natural setting (e.g., rope squirrels, tree squirrels, Gambian pouched rats, dormice, non-human primates), there is the potential for spillback of the virus from humans to other susceptible animal species in different settings. To date, there is currently no documented evidence of instances of anthropozoonotic transmission available to the WHO Secretariat or its One Health partners the Food and Agriculture Organization (FAO) and the World Organisation for Animal Health (WOAH).

The WHO Secretariat also outlined the WHO response so far, and the ongoing work to develop the WHO Strategic Readiness and Response Plan for monkeypox, with its overall goal being to stop human-to-human transmission.

Representatives of Spain, the United Kingdom, the United States, Canada and Nigeria updated the Committee (in this order) on the epidemiological situation in their countries and their current response efforts. With the exception of Nigeria, the remaining four countries reported that 99% of cases were occurring in MSM, and mainly among those with multiple partners.

In Spain, cases have been decreasing over the past few weeks, but it is likely the data are incomplete because of delays in reporting. Most cases have been reported in major urban areas, with very few reports of cases among females and children who had epidemiological links to MSM. Pre-exposure prophylaxis with vaccination is being offered to health workers, contacts and people living with HIV, but vaccine supplies are low.  

The United Kingdom reported on a few severe cases of monkeypox (including encephalitis), and it is also planning to modify its case definition for monkeypox, to include newly recognized conditions such as proctitis. Environmental investigations have identified monkeypox virus DNA (presumed to be infectious because of moderate Ct values) on surfaces in hospitals and households. The vaccine strategy is targeted and aims to interrupt transmission through post-exposure prophylaxis and pre-exposure prophylaxis among MSM at highest risk.

In the United States, cases of monkeypox are widely distributed across the country, although most cases are concentrated in three large cities. While a few cases have occurred in children and a pregnant woman, 99% are related to male-to-male sexual contact.

In Canada, 99% of cases have occurred among MSM, and the country is taking a broad approach to pre-exposure prophylaxis, given the challenges with contact tracing; and is strongly focused on engagement with community-led organizations supporting key affected populations groups.

Nigeria recorded a little over 800 cases of monkeypox between September 2017 and 10 July 2022 and has seen at 3% case fatality ratio among confirmed cases. Cases are predominantly in men aged 31 to 40 years; there was no evidence of sexual transmission presented. The highest number of annually reported cases since 2017 has been observed in 2022.

Following the presentations, the Committee Members and Advisers proceeded with a questions and answers session for both the Secretariat and the presenting countries.

The Committee continues to be concerned about a broad range of issues, including the following: the need for further understanding of transmission dynamics; the impact of the fear of stigma on health-seeking behaviour among MSM; the potential implications on rights-based delivery of care by Ministries of Health and other authorities; the challenges related to the use of public health and social measures to stop onward transmission, including isolation, access to testing and contact tracing, particularly because of multiple anonymous contacts; planned large local and international gatherings focused on MSM and associated public and private satellite events, conducive for increased opportunities for exposure through intimate sexual encounters and subsequent amplification of the outbreak; the need for continuous evaluation of interventions that may have an impact on transmission (e.g., one-dose versus two-dose vaccination regimens and vaccine effectiveness in general, given the apparent permucosal exposures that are causing infection in some cases); and the identification of key activities for targeted risk communications and community engagement, working in close partnership with affected communities, and providing the necessary support for community-led organizations to play their important role in the response to the outbreak.

There was particular concern about how vaccines and antivirals would be priced and distributed in the near future and made available in an equitable manner.

Deliberative session

The Committee reconvened in a closed meeting to examine the questions in relation to whether the event constitutes a PHEIC or not, and if so, to consider the Temporary Recommendations, drafted by the WHO Secretariat in accordance with IHR provisions.

At the request of the Chair, the WHO Secretariat reminded the Committee Members of their mandate and recalled the definition of a PHEIC under the IHR: an extraordinary event, which constitutes a public health risk to other States through international spread, and which potentially requires a coordinated international response.

The Committee reviewed evidence gathered by the Secretariat against the considerations proposed during its first meeting for re-assessing the outbreak.  The Committee noted the generally moderate level of confidence in the available data to make any informed determination on these considerations.

Of the nine considerations put forward, based on currently available data, two of them have seen a significant change since the previous meeting – an increased number of countries reporting the first case(s) of monkeypox, and an increase of the number of cases in some West and Central African countries.  There was evidence of a small increase of the overall growth rate associated with the outbreak. While cases among health workers have been reported, most reported community exposure. A limited number of cases among sex workers has been reported from case reports and social media listening. Secondary transmission to some children and women was reported. Limited transmission was reported to have been observed among vulnerable groups (immunosuppressed individuals, pregnant women, or children, although a small number of children were reported not to have an epidemiological link to another case. While cases experiencing severe pain continue to be reported, with some hospitalizations required to manage pain or secondary infection, and while clinical severity of cases overall remained generally unchanged since the previous meeting, a few severe cases, two ICU admissions and five deaths have been reported. At the present time, there is no data currently available about potential spillback from humans to animals. With regards to the potential changes in the virus genome, investigations are ongoing in relation to the reports of changes that may affect features of the virus. There has to date not been any reported circulation of the virus clade normally present in Central Africa outside of the usual settings.

Conclusions

Committee Members expressed a range of views on the considerations before them. They were unable to reach consensus regarding advice to the WHO Director-General on whether the multi-country outbreak of monkeypox should or should not be determined to constitute a Public Health Emergency of International Concern (PHEIC). Supportive elements regarding the views expressed by the Members of the Committee in favour or not in favour of such a determination are summarized below. Such views reflected:

Committee Members’ views in support of the prospective determination of a PHEIC

  • The multi-country outbreak of monkeypox meets all the three criteria defining a PHEIC contained in Article 1 of the Regulations ([...] an extraordinary event […] (i) constitut[ing] a public health risk to other States through the international spread of disease and (ii) which may potentially require a coordinated international response);
  • The moral duty to deploy all means and tools available to respond to the event, as highlighted by leaders of the LGBTI+ communities from several countries, bearing in mind that the community currently most affected outside Africa is the same initially reported to be affected in the early stages of HIV/AIDS pandemic;
  • The observed rising trends in the number of cases reported globally, in an increasing number of countries, and, yet, likely to reflect an underestimation of the actual magnitude of the outbreak(s);
  • The cases of monkeypox reported in children and pregnant women, which are reminiscent of the initial phases of the HIV pandemic;
  • Future waves of monkeypox cases are expected as the monkeypox virus is introduced in additional susceptible populations;
  • The modes of transmission sustaining the current outbreak are not fully understood;
  • The changes in the clinical presentation of cases of monkeypox currently observed with respect to the clinical picture known to date;
  • The need to generate further evidence related to the effectiveness of the use of both pharmaceutical and non-pharmaceutical measures in controlling the outbreak;
  • The significant morbidity associated with the monkeypox outbreak(s);
  • The potential future implications on public health and health services if the disease were to establish itself in the human population across the world, particularly for an orthopoxvirus causing human disease, as global immunity has greatly declined after smallpox was eradicated;
  • The perceived benefits associated with the prospective determination of a PHEIC include:
    • Maintaining a heightened level of awareness and alert, which would increase the probability of stopping human-to-human transmission of monkeypox virus;
    • Boosting political commitment towards response efforts; Increasing opportunities for funds to be released for response, and research purposes, as well as for the mitigation of the socioeconomic impact of the disease;
    • Boosting international coordination of response efforts, in particular to secure equitable access to vaccines and antivirals;
    • The possible stigmatization, marginalization, and discrimination that may result from the prospective determination of a PHEIC should not be regarded as deterrent to do so, and would need to be addressed.

 

Committee Members’ views NOT in support of the prospective determination of a PHEIC

  • The overall global risk assessment presented by the WHO Secretariat remained unchanged with respect to that presented to the Committee on 23 June 2022;
  • The greatest burden of the outbreak is currently reported in 12 countries in Europe and in the Americas, with no indications, based on currently available data, of an exponential increase in the number of cases in any of those countries, and early signs of stabilization or declining trends observed in some countries;
  • The vast majority of cases are observed among MSM with multiple partners, and, despite the operational challenges, there is the opportunity to stop ongoing transmission with interventions targeted to this segment of the population. Cases observed beyond this population group, including among health workers are, to date, limited;
  • The severity of the disease is perceived to be low;
  • The epidemic is gaining maturity, with future waves expected, and clearer indications about the effectiveness of policies and interventions are being generated;
  • The potential risks of hampering response efforts through the prospective determination of a PHEIC are perceived as outweighing the benefits of the latter for the following reasons:
    • The stigma, marginalization, and discrimination that a determination of a PHEIC may generate against the currently affected communities, especially in countries where homosexuality is criminalized, LGBTI+ communities are not well established and engaged in a dialogue with governments. Communities in some countries have reportedly indicated that minimizing stigma associated with monkeypox – which unlike HIV infection may be a visible condition– requires developing novel approaches, which could be challenging in the context of a PHEIC;
    • Action taken by the WHO Secretariat since May 2022 to raise the alert in relation to the unfolding monkeypox outbreak, including convening the Committee, appear to be effective, in triggering immediate response efforts in many countries in the northern hemisphere;
    • Technical guidance issued by the Secretariat to inform national response efforts is regarded as adequate and comprehensive, with no identified impediments preventing its implementation worldwide;
    • For West and Central African countries, where capacity building for surveillance, laboratory, and response is needed, the determination of a PHEIC may not be regarded as a tool for triggering nor for boosting such efforts;
    • The determination of a PHEIC would unnecessarily and artificially increase the perception of the risk of the disease in the general public, which, in its turn, would translate into generating demand for vaccines, which should be used wisely;
    • Not determining a PHEIC would not mean “business as usual”. The communication of the WHO Director-General decision would still be an opportunity to convey the needed continuity of the full range of necessary public health actions, beyond a mere high visibility determination.

 

Following the deliberations, Committee Members provided input to the proposed Temporary Recommendations previously outlined, should the WHO Director-General determine that the Multi-country outbreak of monkeypox constitutes a PHEIC.

===

WHO releases global COVID-19 vaccination strategy update to reach unprotected

Fri, 07/22/2022 - 14:10
  • The global COVID-19 vaccination rollout is the biggest and fastest in history but many of those at greatest risk remain unprotected – only 28% of older people and 37% of health care workers in low-income countries have received their primary course of vaccines and most have not received booster doses.
  • Health care workers, over 60s and other at-risk groups must be reached as priorities on the way to reaching the 70% coverage target. 
  • WHO’s strategy update elevates the targets of vaccinating 100% of health care workers and 100% of the highest risk populations with both primary and booster doses, with the aim of reducing deaths, keeping societies open and ensuring economies function as transmission continues.
  • While vaccines have saved countless lives, they have not substantially reduced the spread of COVID-19. Innovation is needed to develop new vaccines that substantially reduce transmission, are easier to administer and give broader and longer-lasting protection.

 

WHO published an update to the Global COVID-19 Vaccination Strategy today, in response to the spread of Omicron subvariants, advances in vaccine evidence, and lessons from the global vaccination program.

In the first year of rollouts, COVID-19 vaccines are estimated to have saved 19.8 million lives. Through unprecedently large and rapid rollouts worldwide, over 12 billion doses have been administered globally, in nearly every country in the world, resulting in countries reaching 60% of their populations on average. 

Yet only 28% of older populations and 37% of health care workers in low-income countries have been vaccinated with their primary series. 27 of WHO's Member States have not yet started a booster or additional dose program, 11 of which are low-income countries.

The strategy aims to use primary and booster doses to reduce deaths and severe disease, in order to protect health systems, societies and economies. On the way to reaching the 70% vaccination target, countries should prioritize achieving the underpinning targets of vaccinating 100% of health care workers and 100% of the most vulnerable groups, including older populations (over 60s) and those who are immunocompromised or have underlying conditions.

“Even where 70% vaccination coverage is achieved, if significant numbers of health workers, older people and other at-risk groups remain unvaccinated, deaths will continue, health systems will remain under pressure and the global recovery will be at risk,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Vaccinating all those most at risk is the single best way to save lives, protect health systems and keep societies and economies open.” 

To ensure vaccines reach the highest priority groups, the strategy emphasizes the need for measuring progress in vaccinating these groups and developing targeted approaches to reach them. Approaches include using local data and engaging communities to sustain demand for vaccines, building systems for vaccinating adults, and reaching more displaced people through humanitarian response.

The strategy also has the goal of accelerating development and ensuring equitable access to improved vaccines to substantially reduce transmission as the top priority but also to achieve durable, broadly protective immunity.

Current vaccines were designed to prevent serious illness and death, which they have succeeded in doing, saving millions of lives. However, they have not substantially reduced transmission. As the virus continues to circulate widely, new and dangerous variants are emerging, including some which reduce the efficacy of vaccines. It is fundamental to continue investing in research and development to make more effective, easier to administer vaccines, such as nasal spray products.

Other vital actions to take include: equitably distributing manufacturing facilities across regions and supporting strong vaccine delivery programs. WHO will continue to collaborate with COVAX and COVID-19 Vaccine Delivery Partnership (CoVDP) partners to support countries with rollouts, such as through packaging COVID-19 vaccination with other health interventions.

Note to editors: 

The Global COVID-19 Vaccination Strategy in a Changing World: July 2022 update can be read in its entirety here.

 

 

Pandemic instrument should be legally binding, INB meeting concludes

Fri, 07/22/2022 - 11:47
  • INB members agreed that a new international instrument on pandemic prevention should be legally binding
  • Any final decision on the new instrument will be made by the World Health Assembly under Article 19 of WHO Constitution
  • The INB will meet next in December 2022 and will deliver a progress report to the World Health Assembly in May 2023.
  • As with all international instruments, governments themselves will determine actions under the accord while considering their own national laws and regulations.

 

2ND meeting of the INB to draft and negotiate a WHO convention, agreement or other international instrument on pandemic prevention, preparedness and response concludes, with agreement that the new instrument should be legally binding 

The Intergovernmental Negotiating Body (INB) to draft and negotiate a WHO convention, agreement or other international instrument on pandemic prevention, preparedness and response held its second meeting in Geneva from 18-21 July 2022. 

The INB’s work aims to ensure better preparedness and equitable response for future pandemics, and to advance the principles of equity, solidarity and health for all. The INB is a subdivision of the World Health Assembly, the decision-making body of WHO,  and is comprised of WHO’s 194 Member States, Associate Members, and regional economic integration organizations.

This week, INB members agreed, through consensus, that they will work to conclude a new, legally-binding international pandemic agreement.  They are working to conclude this agreement in May 2024.

The next meeting of the INB will be held in December 2022, and the INB will deliver a progress report to the 76th World Health Assembly in 2023.

As with all international instruments, any new agreement, if and when agreed by Member States, is drafted and negotiated by governments themselves, who will take any action in line with their sovereignty. 

Several sessions of the INB2 were publicly webcast, including the session that addressed the potential substance of the future agreement, recorded and accessible here

The INB process is broad and inclusive with strong engagement open to all 194 WHO Member States, as well as relevant stakeholders from around the world, including UN Agencies, intergovernmental organizations and non-State actors in official relations with WHO.

The WHO Secretariat is also conducting global public hearings to support the work of the INB; the first round of hearings took place in April 2022 and a second round is expected to take place in September this year. 

Dr Tedros Adhanom Ghebreyesus, WHO’s Director-General, addressed the INB members and welcomed this historic step forward to safeguard families and communities everywhere from the threat of future pandemics. He thanked all Member States and relevant stakeholders for the commitment and engagement in the process so far. “The importance of a legally binding instrument cannot be overstated: it will be our collective legacy for future generations,” he said.

The INB acknowledged the work towards the amendments of the International Health Regulations (2005) and the need for coherence and complementarity between the two workstreams.    

The Co-Chair of the INB, Ms Precious Matsoso, from South Africa, said: “The decision today is a first important step of our critical work together. But we still have many hills to climb. It is a journey that will require all of us to stand together. We, as Co-Chairs of the Intergovernmental Negotiating Body, are grateful to count on committed Member States and resolute Members of the Bureau to reach success in our collective work.”  

 

      Solutions journalism boosts road safety in Tanzania

      Thu, 07/21/2022 - 12:51
      Before 2016, many Tanzanian journalists thought it wasn’t worth the trouble to produce stories on road safety. Yet the WHO road safety media fellowship, undertaken as part of the Bloomberg Initiative for Global Road Safety, has helped change the narrative for good.

      WHO report shows poorer health outcomes for many vulnerable refugees and migrants

      Wed, 07/20/2022 - 11:59

      Around the world, millions of refugees and migrants in vulnerable situations, such as low-skilled migrant workers, face poorer health outcomes than their host communities, especially where living and working conditions are sub-standard, according to the first WHO World report on the health of refugees and migrants. This has dire consequences for the probability that the world will not achieve the health-related Sustainable Development Goals for these populations.

      “Today there are some one billion migrants globally, about one in eight people. The experience of migration is a key determinant of health and wellbeing, and refugees and migrants remain among the most vulnerable and neglected members of many societies,” said Dr Tedros. “This report is the first to offer a global review of refugee and migrant health; it calls for urgent and collective action to ensure they can access health care services that are sensitive to their needs. It also illustrates the pressing need to address the root causes of ill health and to radically reorient health systems to respond to a world increasingly in motion.”

      Based on an extensive review of literature from around the world, the report demonstrates that refugees and migrants are not inherently less healthy than host populations. It is, rather, the impact of the various suboptimal health determinants, such as education, income, housing, access to services, compounded by linguistic, cultural, legal and other barriers and the interaction of these during the life course, that are behind poor health outcomes.

      The report reiterates that the experience of migration and displacement is a key factor in a person’s health and wellbeing, especially when combined with other determinants. For example, a recent meta-analysis of more than 17 million participants from 16 countries across five WHO regions found that, compared with non-migrant workers, migrant workers were less likely to use health services and more likely to have an occupational injury. Evidence also showed that a significant number of the 169 million migrant workers globally are engaged in dirty, dangerous, and demanding jobs and are at greater risk of occupational accidents, injuries, and work-related health problems than their non-migrant counterparts, conditions exacerbated by their often limited or restricted access to and use of health services.

      The Report demonstrated critical gaps in data and health information systems regarding the health of refugees and migrants – while data and evidence are plentiful, they are fragmented and not comparable across countries and over time. Although these mobile populations are sometimes identifiable in global datasets used for SDG monitoring, health data are often missing from migration statistics and migratory status variables are often missing from health statistics. This makes it difficult to determine and track progress for refugees and migrants towards the health-related SDGs.

      “It is imperative that we do more on refugees and migrants’ health but if we want to change the status quo, we need urgent investments to improve the quality, relevance and completeness of health data on refugees and migrants. We need sound data collection and monitoring systems that truly represent the diversity of the world population and the experience that refugees and migrants face the world over and that can guide more effective policies and interventions,” said Dr Zsuzsanna Jakab, WHO’s Deputy Director-General.   

      While lack of comparable data on the health of refugees and migrants across countries and over time often impedes good policy development towards health equity, policies and frameworks do exist that address and respond to the health needs of refugees and migrants. However, disparities in health outcomes remain and the report shows that they are mainly due to a lack of meaningful and effective implementation of policies.

      “Health does not begin or end at a country’s border. Migratory status should therefore not be a discriminatory factor but a policy driver on which to build and strengthen healthcare and social and financial protection. We must reorient existing health systems into integrated and inclusive health services for refugees and migrants, in line with the principles of primary health care and universal health coverage,” said Dr Santino Severoni, Director of WHO’s Health and Migration Programme. 

      Refugees and migrants can introduce innovative ideas that drive economic and social transformation. The Report highlights the extraordinary contributions of refugee and migrant healthcare workers to the COVID-19 frontline response. One of the most notable was the contributions of migrants in several countries of the Organisation for Economic Co-operation and Development (OECD), which were particularly significant when in some countries as many as half of doctors or nurses are foreign born.

      Implementing inclusive health systems that conform to the principle of right to health for all and universal health coverage would permit individuals in need of health services to be identified and supported early, before many problems become acute. Health systems are only as strong as their weakest link. The inclusion of refugees and migrants is a worthwhile investment for the development and wellbeing of societies around the world. 

       

      Note to Editors:  

      Signatories to the world report are quoted here:  

      “Recognizing that migration and displacement have an impact on the health of the billion people on the move, this Report marks a welcome advance in thinking of migration and displacement through one clarifying glass. The lens is universal health coverage and the idea that everyone has a right to ‘complete physical, mental and social well-being and not merely the absence of disease or infirmity’, as stated in the WHO Constitution in 1946.”

      Ban Ki-moon, Chairman of Ban Ki-moon Foundation for a Better Future, 8th Secretary-General of the United Nations

      “The physical, economic and psychological challenges posed by migration and displacement, and integration in host communities, are often misheard, overlooked or misperceived. I welcome how this Report assembles available global evidence on the health of people on the move – international migrants and those forcibly displaced – in a single authoritative document.”

      Abdulrazak Gurnah, Novelist and Professor, Nobel Prize in Literature (2021)  

      “This Report demonstrates that the most efficient way to meet the health needs of refugees and migrants in the short, medium and long term is by integrated health systems and by including refugees and migrants within systems that serve the host communities. In spite of the significant resources and technical improvements this may require, a more inclusive health system has proven to be hugely beneficial for all, refugees, migrants and host communities alike.”

      Midori de Habich, Former Minister of Health, Peru

      France and WHO commit to work further together to improve the global health architecture

      Mon, 07/18/2022 - 19:43

      On 18 July 2022, Dr Tedros Adhanom Ghebreyesus, WHO Director-General, was in Paris to meet with high-level French officials and share views on the future directions of the France –  WHO collaboration.

      In a discussion with President Macron, Dr Tedros stressed France’s central role as a champion for global investment in the health sector. Dr Tedros saluted President Macron for his personal commitment to ACT-A. They recognized what has worked and deliberated on what could be improved from an equity lens, outlining options for the future of the ACT-A mechanism. The partners confirmed the importance of the WHO Academy for training the worldwide workforce, as reinforced French support for the Academy turns it into an essential vector for health action at country level. WHO also thanked the Government of France for its support for the WHO Lyon Office. France plays a leading role in shaping a stronger and more inclusive health emergency preparedness, response, and resilience architecture. France confirmed its support for developing a global accord on pandemic prevention, preparedness and response.

      Dr Braun, Minister of Health and Prevention, appreciated Dr Tedros' recognition of French leadership on emergency preparedness and response. They also talked about alignment between national and global efforts to reshape health systems centred on primary health care (PHC), with a focus on health promotion and disease prevention. The country and WHO share a vision for strengthening health systems that would have better capacities to prepare for and respond to health emergencies, based on equity, solidarity and effectiveness supported by a consistent One Health approach.

      In his conversation with Dr Zacharopoulou, Secretary of State to the Minister for Europe and Foreign Affairs, in charge of Development, Francophonie and International Partnerships, Dr Tedros engaged in a lively debate about the way forward for women health and a new strong collaboration on women health and rights. They recognized access and innovation as key drivers for investment in global health, in close collaboration with UNITAID. They exchanged on how France and WHO can to better deliver jointly and with other global health stakeholders at country level with reference to the Global Action Plan for SDG3, and to the One Health approach.

      ***

      Over the recent years, France has expanded its already strong support to multilateralism through:

      • France contributed US$ 148.7 million in 20-21 including US$ 105.8 million in voluntary contributions (VC) – doubling its support compared with 2018-2019. France increased the flexibility of its allocation with 50% of its VC dedicated to thematic funding for the Strategic Preparedness Response Plan (SPRP) and US$ 7.2 million in core voluntary contributions account (CVCA);
      • France’s commitment to the WHO Academy will reach €120 million over five years, enabling the construction of its headquarter, recruitment of team and creation of content;
      • A new €50 million in support to Health Systems & Response Connector was announced in February 2022.


       

      COVID-19 pandemic fuels largest continued backslide in vaccinations in three decades

      Fri, 07/15/2022 - 01:01

      The largest sustained decline in childhood vaccinations in approximately 30 years has been recorded in official data published today by WHO and UNICEF.

      The percentage of children who received three doses of the vaccine against diphtheria, tetanus and pertussis (DTP3) – a marker for immunization coverage within and across countries – fell 5 percentage points between 2019 and 2021 to 81 per cent.

      As a result, 25 million children missed out on one or more doses of DTP through routine immunization services in 2021 alone. This is 2 million more than those who missed out in 2020 and 6 million more than in 2019, highlighting the growing number of children at risk from devastating but preventable diseases. The decline was due to many factors including an increased number of children living in conflict and fragile settings where immunization access is often challenging, increased misinformation and COVID-19 related issues such as service and supply chain disruptions, resource diversion to response efforts, and containment measures that limited immunization service access and availability.

      “This is a red alert for child health. We are witnessing the largest sustained drop in childhood immunization in a generation. The consequences will be measured in lives,” said Catherine Russell, UNICEF Executive Director. “While a pandemic hangover was expected last year as a result of COVID-19 disruptions and lockdowns, what we are seeing now is a continued decline. COVID-19 is not an excuse. We need immunization catch-ups for the missing millions or we will inevitably witness more outbreaks, more sick children and greater pressure on already strained health systems.”

      18 million of the 25 million children did not receive a single dose of DTP during the year, the vast majority of whom live in low- and middle-income countries, with India, Nigeria, Indonesia, Ethiopia and the Philippines recording the highest numbers. Among countries1 with the largest relative increases in the number of children who did not receive a single vaccine between 2019 and 2021 are Myanmar and Mozambique.

      Globally, over a quarter of the coverage of HPV vaccines that was achieved in 2019 has been lost. This has grave consequences for the health of women and girls, as global coverage of the first dose of human papillomavirus (HPV) vaccine is only 15%, despite the first vaccines being licensed over 15 years ago.

      It was hoped that 2021 would be a year of recovery during which strained immunization programmes would rebuild and the cohort of children missed in 2020 would be caught-up. Instead, DTP3 coverage was set back to its lowest level since 2008 which, along with declines in coverage for other basic vaccines, pushed the world off-track to meet global goals, including the immunization indicator for the Sustainable Development Goals.

      This historic backsliding in rates of immunization is happening against a backdrop of rapidly rising rates of severe acute malnutrition. A malnourished child already has weakened immunity and missed vaccinations can mean common childhood illnesses quickly become lethal to them. The convergence of a hunger crisis with a growing immunization gap threatens to create the conditions for a child survival crisis. 

      Vaccine coverage dropped in every region, with the East Asia and Pacific region recording the steepest reversal in DTP3 coverage, falling nine percentage points in just two years.

      “Planning and tackling COVID-19 should also go hand-in-hand with vaccinating for killer diseases like measles, pneumonia and diarrhea,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “It’s not a question of either/or, it’s possible to do both”.

      Some countries notably held off declines. Uganda maintained high levels of coverage in routine immunization programmes, whilst rolling out a targeted COVID-19 vaccination programme to protect priority populations, including health workers. Similarly, Pakistan returned to pre-pandemic levels of coverage thanks to high-level government commitment and significant catch-up immunization efforts. To achieve this in the midst of a pandemic, when healthcare systems and health workers were under significant strain, should be applauded.

      Monumental efforts will be required to reach universal levels of coverage and to prevent outbreaks. Inadequate coverage levels have already resulted in avoidable outbreaks of measles and polio in the past 12 months, underscoring the vital role of immunization in keeping children, adolescents, adults, and societies healthy.

      First dose measles coverage dropped to 81 per cent in 2021, also the lowest level since 2008. This meant 24.7 million children missed their first measles dose in 2021, 5.3 million more than in 2019. A further 14.7 million did not receive their needed second dose. Similarly, compared to 2019, 6.7 million more children missed the third dose of polio vaccine and 3.5 million missed the first dose of the HPV vaccine- which protects girls against cervical cancer later in life.

      The sharp two-year decline follows almost a decade of stalled progress, underscoring the need to not only address pandemic-related disruptions but also systemic immunization challenges to ensure every child and adolescent is reached.

      WHO and UNICEF are working with Gavi, the Vaccine Alliance and other partners to deliver the global Immunization Agenda 2030 (IA2030), a strategy for all countries and relevant global partners to achieve set goals on preventing diseases through immunization and delivering vaccines to everyone, everywhere, at every age.

      “It’s heart-breaking to see more children losing out on protection from preventable diseases for a second year in a row. The priority of the Alliance must be to help countries to maintain, restore and strengthen routine immunization alongside executing ambitious COVID-19 vaccination plans, not just through vaccines but also tailored structural support for the health systems that will administer them,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance.

      The IA2030 partners call on governments and relevant actors to:

      • Intensify efforts for catch-up vaccination to address backsliding on routine immunization, and expand outreach services in underserved areas to reach missed children and implement campaigns to prevent outbreaks;
      • Implement evidence-based, people-centred, and tailored strategies to build trust in vaccines and immunization, counter misinformation and increase vaccine uptake particularly among vulnerable communities;
      • Ensure current pandemic preparedness and response and the global health architecture strengthening efforts lead to investment in primary health care (PHC) services, with explicit support to strengthen and sustain essential immunization;
      • Ensure political commitment from national governments and increase domestic resource allocation to strengthen and sustain immunization within PHC;
      • Prioritize health information and disease surveillance systems strengthening to provide the data and monitoring needed for programmes to have maximum impact; and
      • Leverage and increase investment in research to develop and improve new and existing vaccines and immunization services that can achieve community needs and deliver on IA2030 goals.

      1 Of countries with at least 10,000 zero-dose children in 2021

       

      #####

      Notes for editors:

      Access the UNICEF dataset (data will be updated to reflect the new WUENIC release once embargo lifts): Overview page, Full datasets, Data visualisation, Country profiles

      Access the WHO dataset (data will be updated to reflect the new WUENIC release once embargo lifts): Global dashboard, Full datasets, information page

      Download content: photo gallery and  social media contentimmunization page, coverage fact sheet and WUENIC Q&A, UNICEF multimedia and  immunization page

      Read the Guiding Principles for recovering, building resiliency, and strengthening of immunization in 2022 and beyond here

      About the data
      Based on country-reported data, the official WHO and UNICEF estimates of national immunization coverage (WUENIC) provide the world’s largest and most comprehensive data-set on immunization trends for vaccinations against 13 diseases given through regular health systems - normally at clinics, community centres, outreach services, or health worker visits. For 2021, data were provided from 177 countries.

      About WHO
      Dedicated to the well-being of all people and guided by science, the World Health Organization leads and champions global efforts to give everyone, everywhere an equal chance at a safe and healthy life. We are the UN agency for health that connects nations, partners and people on the front lines in 150+ locations – leading the world’s response to health emergencies, preventing disease, addressing the root causes of health issues and expanding access to medicines and health care. Our mission is to promote health, keep the world safe and serve the vulnerable.

      For more information about WHO and its work, visit: www.who.int 
      Follow WHO on Twitter, Facebook, Instagram, LinkedIn, TikTok, Pinterest, Snapchat, and YouTube

      About UNICEF
      UNICEF works in some of the world’s toughest places, to reach the world’s most disadvantaged children. Across more than 190 countries and territories, we work for every child, everywhere, to build a better world for everyone. For more information about UNICEF and its work, visit: www.unicef.org
      Follow UNICEF on Twitter, Facebook, Instagram and YouTube

      About Immunization Agenda 2030:

      The Immunization Agenda 2030 (IA2030) is an ambitious global strategy to maximize the lifesaving impact of vaccines -one of the most successful and cost-effective public health interventions of all time. IA2030 aims to reduce by half the number of children who still miss out on essential vaccines, achieve 500 introductions of new or under-used vaccines in low- and middle-income countries, and achieve 90 per cent coverage for key life-saving vaccines. Achieving these goals would avert over 50 million deaths and help build healthcare systems that can withstand the impact of pandemics and deliver rapid vaccination response. The strategy was endorsed by all countries through the 73rd World Health Assembly and is a commitment of IA2030 partners comprised of UN agencies, global health initiatives (such as Gavi, the Vaccine Alliance, the Global Polio Eradication Initiative, the Measles & Rubella Initiative), non-governmental organizations, civil society organizations, faith-based organizations and academia. For more information on IA2030 partners, please visit the partners commitment page.

      Statement on the twelfth meeting of the International Health Regulations (2005) Emergency Committee regarding the coronavirus disease (COVID-19) pandemic

      Tue, 07/12/2022 - 16:02

      The WHO Director-General has the pleasure of transmitting the Report of the twelfth meeting of the International Health Regulations (2005) (IHR) Emergency Committee regarding the coronavirus disease (COVID-19) pandemic, held on Friday, 8 July 2022, from 12:00 to 15:30 CEST.

      The WHO Director-General concurs with the advice offered by the Committee regarding the ongoing COVID-19 pandemic and determines that the event continues to constitute a Public Health Emergency of International Concern (PHEIC).

      The WHO Director-General considered the advice provided by the Committee regarding the proposed Temporary Recommendations. The set of Temporary Recommendations issued by the WHO Director-General is presented at the end of this statement.

      The WHO Director-General is taking the opportunity to express his sincere gratitude to the Chair, and Members of the Committee, as well as to its Advisors.

      ===

      Proceedings of the meeting

      On behalf of the WHO Director-General, the Executive Director of the WHO Health Emergencies Programme, Dr Michael J. Ryan, welcomed Members and Advisors of the Emergency Committee, all of whom were convened by videoconference.

      Dr Ryan expressed concern regarding the current global COVID-19 epidemiological situation. Cases of COVID-19 reported to WHO had increased by 30% in the last two weeks, largely driven by Omicron BA.4, BA.5 and other descendent lineages and the lifting of public health and social measures (PHSM). This increase in cases was translating into pressure on health systems in a number of WHO regions. Dr Ryan highlighted additional challenges to the ongoing COVID-19 response: recent changes in testing policies that hinder the detection of cases and the monitoring of virus evolution; inequities in access to testing, sequencing, vaccines and therapeutics, including new antivirals; waning of natural and vaccine-derived protection; and the global burden of Post COVID-19 condition.

      The Ethics Officer from the Department of Compliance, Risk Management, and Ethics briefed Members and Advisers on their roles and responsibilities. Members and Advisors were also reminded of their duty of confidentiality as to the meeting discussions and the work of the Committee, as well as their individual responsibility to disclose to WHO, in a timely manner, any interests of a personal, professional, financial, intellectual or commercial nature that may give rise to a perceived or direct conflict of interest. Each Member and Advisor who was present was surveyed. No conflicts of interest were identified.

      The Representative of the Office of Legal Counsel briefed the Members and Advisors on their roles and responsibilities and the mandate of the Emergency Committee under the relevant articles of the IHR.

      The meeting was handed over to the Chair of the Emergency Committee regarding the COVID-19 pandemic, Professor Didier Houssin. The Chair introduced the objectives of the meeting: to provide views to the WHO Director-General on whether the COVID-19 pandemic continues to constitute a PHEIC, and to review temporary recommendations to States Parties. 

      The WHO Secretariat presented a global overview of current status of the COVID-19 pandemic, and highlighted a number of challenges to the ongoing response. The presentation focused on: the global COVID-19 epidemiological situation; the evolution of the virus and the impact of SARS-CoV-2 variants of concern; an update on international travel-related measures; the current status of COVID-19 vaccination and progress towards WHO vaccination targets; and the 2022 WHO Strategic preparedness, readiness and response plan.

      Deliberative session

      The Committee discussed the following issues: the impact of SARS-CoV-2 virus evolution on the public health response and capacities of health services; progress towards increasing COVID-19 vaccination coverage; changes in testing and surveillance strategies; societal and political risk perception and community engagement; equity and access to countermeasures, vaccines and therapeutics; and maintaining political engagement while balancing the need to respond to other public health priorities and emergencies. The Committee discussed that SARS-CoV-2 virus had not yet established its ecological niche and that the implications of a pandemic caused by a novel respiratory virus may not be fully understood. Consequently, given the current shape and unpredictable dynamics of the COVID-19 pandemic, the Committee emphasized the need to reduce the transmission of SARS-CoV-2 virus. This requires the responsible, consistent, and continued use of individual-level protective measures, to the benefit of communities as a whole; as well as the continued adjustments of community-wide PHSM, to overcome the “all or nothing” binary approaches.

      The Committee expressed concern as to the ongoing changes observed in States Parties with respect to steep reductions in testing, resulting in reduced coverage and quality of surveillance as fewer cases are being detected and reported to WHO; and fewer genomic sequences being submitted to open access platforms – resulting in a lack of representativeness of genomic sequences from all WHO regions. This impedes assessments of currently circulating and emerging variants of the virus, including the generation and analysis of phenotypic data. The above is translating into the increasing inability to interpret trends in transmission, and consequently to properly inform the adjustments of PHSM.

      The epidemiology of SARS-CoV-2 virus infection remains unpredictable as the virus continues to evolve, through sustained transmission in the human population and in domestic, farmed, and wild animals in which the virus was newly introduced.

      The Committee noted that both the trajectory of viral evolution and the characteristics of emerging variants of the virus remain uncertain and unpredictable, and, in the absence of the adoption of PHSM aiming at reducing transmission, the resulting selective pressure on the virus increases the probability of new, fitter variants emerging, with different degrees of virulence, transmissibility, and immune escape potential.

      For these reasons, the Committee highlighted the need for all States Parties to continue to apply PHSM proportionate to their epidemiological situation, stressing the continued use of effective, individual-level protective measures to reduce transmission. The Committee acknowledged the ongoing challenges faced by States Parties in adjusting and implementing PHSM. The Committee acknowledged WHO’s advice to States Parties to regularly assess the epidemiological situation at sub-national levels and adjust PHSM proportionately. PHSM should be adjusted based on estimates of disease prevalence and population protection from infection and vaccination, as well as the capacities of the local health system (already challenged, inter alia, by staff shortages due to COVID-19 related burn-out).

      The Committee highlighted the need to improve surveillance, by broadening and developing an array of approaches and tools aiming at achieving global situational population- based and geographic representativeness. These include, but are not limited to, the integration of self-testing results and sentinel surveillance approaches into national and global surveillance schemes, and aggregate sampling strategies with Nucleic Acid Amplification Test-based tools and detailed deep genome sequence probing. Novel surveillance approaches would enhance better assessment of trends in epidemiology of infection, disease, and viral evolution, as well as trends in health system capacity, and support agility and timely adjustments of PHSM. The Committee acknowledged the need to expedite integration of COVID-19 surveillance into routine systems, for instance by integrating COVID-19 surveillance with the surveillance of other respiratory pathogens; and recognized the potential value of supplementing surveillance with wastewater surveillance. In addition, access to timely and accurate testing, with linkage to clinical care and therapeutics, needs to be maintained.

      The Committee recognised the continued work of WHO and partners in increasing vaccination coverage in all six WHO regions, with focus in achieving the highest possible vaccination coverage among persons at highest risk of severe disease outcomes and among persons at highest risk of exposure; as well as assessing and addressing barriers to vaccine uptake. However, given the persistent vaccine inequities, the Committee reinforced the need for ensuring that the highest priority groups are vaccinated in every country, with a primary series and booster dose, in accordance with WHO global vaccination strategy and the updated WHO SAGE Roadmap for prioritizing uses of COVID-19 vaccines. The Committee expressed concern over the lack of data shared with WHO on vaccination coverage in the high priority groups for 30% of the countries. The Committee acknowledged the disruption the pandemic continues to have on routine immunization activities, which is resulting in outbreaks of vaccine-preventable diseases in areas of low coverage.

      The Committee highlighted that immediate efforts are warranted to promote access for Low and Middle Income Countries to therapeutics that reduce disease severity in both ambulant and hospitalised patients. The Committee warned that the lack of equitable access that occurred with vaccines should not be repeated with therapeutics. The Committee also highlighted the continued need for further research and development for COVID-19 in the areas of epidemiology and variants, diagnostics, clinical care including care for Post COVID-19 condition, and additional COVID-19 vaccines.

      Given the general public’s perception that the pandemic may be over, the Committee also highlighted the ongoing challenges in communicating, particularly to communities that continue to experience high levels of transmission, that the mitigation of the impact of the ongoing COVID-19 pandemic, in the immediate and longer terms, depends on the use of PHSM. The Committee emphasised the importance of using learning from the last two and a half years to nuance the implementation of PHSM in individual communities. The Committee acknowledged that any risk communication and community engagement effort should hinge on consistent and synchronized political will, policies, and a concert of community influencers to shift the course of risk perception.

      Status of the Public Health Emergency of International Concern

      The Committee recognized an overall decoupling of incident cases from severe disease, deaths, and pressure on health systems in the context of increased population immunity.

      However, the Committee unanimously agreed that the COVID-19 pandemic still meets the criteria of an extraordinary event that continues to adversely impact the health of the world’s population, and that the emergence and international spread of new SARS-CoV-2 variants may present an even greater health impact.

      The Committee explicitly indicated the following reasons underpinning their advice to the WHO Director-General as to the event continuing to constitute a PHEIC.

      Firstly, the recent increase in the growth rate of cases in many States Parties in different WHO regions.

      Secondly, the continuing and substantial evolution of SARS-CoV-2 virus, which, while inherent to all viruses, is expected to continue in an unpredictable manner. Yet the ability to assess the impact of variants on transmission, disease characteristics, or countermeasures, including diagnostics, therapeutics and vaccines, is becoming increasingly difficult as a result of the inadequacy of current surveillance, including the reductions in testing and genomic sequencing. Additionally, there are uncertainties surrounding the level of readiness of already overburdened health systems, across all WHO regions, to respond to future COVID-19 pandemic waves.

      Thirdly, public health and health planning tools to reduce transmission and disease burden (including hospitalisations and admissions to intensive care units of severe cases, and the impact of post COVID-19 condition) are not being implemented in proportion to local transmission levels or health system capacities.

      Finally, there are inadequacies in risk communication and community engagement related to the need for the implementation or adjustment of PHSM, as well as a disconnect in the perception of risk posed by COVID-19 between scientific communities, political leaders and the general public.

      For these reasons, continued coordination of the international response is necessary to reconsider approaches allowing for the accurate and reliable monitoring of the evolution of the COVID-19 pandemic and triggering of adjustments to PHSM. Coordination is also still necessary to intensify and sustain development and research efforts related to effective and equitably available countermeasures and to develop further risk communication and community engagement approaches.

      The Committee considered the Temporary Recommendations proposed by the WHO Secretariat and provided its advice.

      ===

      Temporary Recommendations issued by the WHO Director-General to all States Parties

      1. MODIFIED: Strengthen national response to the COVID-19 pandemic by updating national preparedness and response plans in line with the priorities and potential scenarios outlined in the 2022 WHO Strategic Preparedness, Readiness and Response Plan. States Parties should regularly conduct assessments (including e.g. intra action and after action reviews) to inform current and future response, readiness and preparedness efforts, so that future challenges are rapidly identified and managed, including with tools and approaches different from those adopted in the context of the current shape of the pandemic. (WHO Strategic preparedness, readiness and response plan to end the global COVID-19 emergency in 2022)

      2. MODIFIED: Address risk communications and community engagement challenges and the need to address divergent perceptions in risk between scientific communities, political leaders and the general public. Proactively counter misinformation and disinformation, and include communities in decision making. To re-build trust and to address pandemic fatigue and risk perceptions, States Parties should explain clearly and transparently changes in the implementation of PHSM, as well as the uncertainties related to the evolution of the virus and related potential scenarios. Risk communication and community engagement efforts can only be effective in altering the course of current individual behaviours if underpinned by consistent strategies, policies and the political will to manage the COVID-19 pandemic, and concurrent public health risks, within and among States Parties. (WHO risk communications resources)

      3. MODIFIED: Achieve national COVID-19 vaccination targets in accordance with global WHO vaccination targets and the updated WHO SAGE Roadmap for prioritizing uses of COVID-19 vaccines. States Parties should determine and close the vaccination gap among high-risk populations to achieve the highest possible vaccination coverage among persons at highest risk of severe disease outcomes and among persons at highest risk of exposure, health workers, the elderly and other priority groups. This includes a primary series and booster dose as per WHO SAGE recommendations. In addition, States Parties must continue to support global equitable access to vaccines to achieve national coverage targets on the way to the WHO global COVID-19 vaccination targets, which includes 70% population coverage in every State Party for further disease reduction and protection against future risks. States Parties with less than 20% vaccination coverage should develop strategies and/or receive assistance to improve their status. States Parties need to ensure that routine immunization activities continue and may consider integrating COVID-19 vaccination into routine immunization services, such as the co-administration of COVID-19 vaccine and an inactivated seasonal influenza vaccine, as warranted. (WHO SAGE Prioritization Roadmap; Interim statement on the use of additional booster doses of Emergency Use Listed mRNA vaccines against COVID-19; Coadministration of seasonal inactivated influenza and COVID-19 vaccines

      4. MODIFIED:. Continue to promote the use of effective, individual-level protective measures to reduce transmission (e.g. wearing of well-fitted masks, distancing, staying home when sick, frequent hand washing, avoiding closed spaces with poor ventilation, crowded places, improving and investing in ventilation of indoor spaces) in order to reduce transmission and slow down viral evolution. States Parties should be prepared to scale up PHSM rapidly in response to changes in the virus and the population immunity, as COVID-19 continues to have the potential to stretch the capacity of public health and health services, with hospitalizations, intensive care admissions, fatalities, management of the Post COVID-19 condition, and thus compromise the health system’s capacity not only to deliver COVID-19 related care, but also the care for other acute and chronic conditions (Considerations for implementing and adjusting PHSM in the context of COVID-19)

      5. MODIFIED: Take a risk-based approach to mass gathering events by evaluating, mitigating, and communicating risks. Recognizing that there are different drivers and risk tolerance for mass gatherings, it is critical to consider the epidemiological context (including the prevalence of variants of concern and the intensity of transmission), surveillance, contact tracing and testing capacity, as well as adherence to PHSM to reduce transmission risk of SARS-CoV-2 (e.g. request attendees wear well-fitted masks, provide outdoor spaces where attendees can eat and drink, reduce crowding, improve indoor ventilation) when conducting this risk assessment and planning events, in line with WHO guidance. (WHO mass gathering COVID-19 risk assessment tool: generic events)

      6. MODIFIED: Adjust COVID-19 surveillance to focus on the burden of COVID-19, its impact on health and public health services; and prepare for sustainable integration with other surveillance systems. States Parties should collect and publicly share indicators to monitor the burden of COVID-19 (e.g. new hospitalizations, admissions to intensive care units, deaths, and Post COVID-19 condition). States Parties should integrate respiratory disease surveillance, for instance by leveraging and enhancing the Global Influenza Surveillance and Response System (GISRS). States Parties should be encouraged to 1) maintain representative testing strategies; 2) focus on early warning and trend monitoring, including through the progressive development and introduction of environmental surveillance schemes (e.g., wastewater surveillance); 3) monitor severity in vulnerable groups; and 4) enhance laboratory surveillance to detect, track and characterize potential new variants and monitor the evolution of SARS-COV-2. (Guidance for surveillance of SARS-CoV-2 variants; WHO global genomic surveillance strategy for pathogens with pandemic and epidemic potential 2022–2032)

      7. MODIFIED: Make available essential health, social, and education services. States Parties should enhance access to health, including through the restoration of health services at all levels and strengthening of social systems to cope with the impacts of the pandemic, especially on children, young adults, and individuals with Post COVID-19 condition. Within this context, States Parties should maintain educational services by keeping schools fully open with in-person learning. In addition, essential health services, including COVID-19 vaccination, should be provided to migrants and other vulnerable populations as a priority. (Building health systems resilience for universal health coverage and health security during the COVID-19 pandemic and beyond: WHO position paper; The State of the Global Education Crisis | UNICEF; Clinical management of COVID-19: Living guideline)

      8. MODIFIED: Continue to adjust international travel-related measures, based on risk assessments. The implementation of travel measures (such as vaccination, screening, including via testing, isolation/quarantine of travelers) should be proportionate (based on risk assessments) and should avoid placing the financial burden on international travelers, in accordance with Article 40 of the IHR. (Policy considerations for implementing a risk-based approach to international travel in the context of COVID-19)

      9. EXTENDED: Do NOT require proof of vaccination against COVID-19 for international travel as the only pathway or condition permitting international travel. States Parties should consider a risk-based approach to the facilitation of international travel. (Interim position paper: considerations regarding proof of COVID-19 vaccination for international travelers; Policy considerations for implementing a risk-based approach to international travel in the context of COVID-19)

      10. MODIFIED: Support timely uptake of accurate and timely SARS-CoV-2 testing, linked to WHO recommended therapeutics. States Parties should provide access to COVID-19 treatments for vulnerable populations, particularly immunosuppressed people, and improve access to specific early treatments for patients at higher risk for severe disease outcomes. Local production and technology transfer related to vaccines, other therapeutics and diagnostics should be encouraged and supported as increased production capacity can contribute to global equitable access to therapeutics. (Therapeutics and COVID-19: living guideline; COVID-19 Clinical Care Pathway)

      11. EXTENDED: Conduct epidemiological investigations of SARS-CoV-2 transmission at the human-animal interface and targeted surveillance on potential animal hosts and reservoirs. Investigations at the human animal interface should use a One Health approach and involve all relevant stakeholders, including national veterinary services, wildlife authorities, public health services, and the environment sector. To facilitate international transparency, and in line with international reporting obligations, findings from joint investigations should be reported publicly. (Statement from the Advisory Group on SARS-CoV-2 Evolution in Animals; Joint statement on the prioritization of monitoring SARS-CoV-2 infection in wildlife and preventing the formation of animal reservoirs)

      WHO’s Science Council launches report calling for equitable expansion of genomics

      Tue, 07/12/2022 - 15:23

      WHO’s Science Council of experts has issued its first report, on accelerating access to genomics for global health. The report argues that it is not justifiable ethically or scientifically for less-resourced countries to gain access to such technologies long after rich countries do.

      The field of genomics uses methods from biochemistry, genetics, and molecular biology to understand and use biological information in DNA and RNA, with benefits for medicine and public health – especially during the COVID-19 pandemic – as well as agriculture, biological research and more. The report calls for expanding access to genomic technologies, particularly in low- and middle-income countries (LMICs), by addressing shortfalls in financing, laboratory infrastructure, materials, and highly trained personnel. 

      While the costs of establishing and expanding genomic technologies are declining – making it increasingly feasible for all countries to pursue – they can and should be further lowered. A range of tools to make genomic technologies more affordable for LMICs have been developed, including tiered pricing; sharing of intellectual property rights for low-cost versions; and cross-subsidization, whereby profits in one area are used to fund another. 

      "Genomic technologies are driving some of the most ground-breaking research happening today. Yet the benefits of these tools will not be fully realized unless they are deployed worldwide. Only through equity can science reach its full potential impact and improve health for everyone, everywhere,” said Dr Soumya Swaminathan, WHO Chief Scientist. “Through convening and coordinating the world’s leading minds, as we do through our Science Council, WHO acts as a global engine for analysis to address the world’s most pressing health challenges.”

      Comprised of 9 leading scientists and public health experts from around the world, the Science Council was established in April 2021 by WHO Director-General Dr Tedros Adhanom Ghebreyesus to advise him on high-priority issues and advances in science and technology that could directly improve global health. The Science Council identified genomics as the focus of its first study, given the significant implications for public health; its many successful uses in confronting infectious diseases, cancers, and other chronic diseases; and the new opportunities for implementing expensive technologies, even in LMICs.  

      "It is already clear that genomics can make enormous contributions to human health, from surveying populations for infectious agents, such as the virus that causes COVID-19, to predicting and treating a wide variety of diseases, such as cancers and developmental disorders. Attention to equity in deploying these technologies is essential for achieving the immense potential benefits to human health," said the Council’s Chair, Professor Harold Varmus, a Nobel Laureate and former Director of the U.S. National Institutes of Health.

      To promote the adoption or expanded use of genomics, the report’s recommendations address four themes: advocacy, implementation, collaboration, and associated ethical, legal and social issues: 

      • Advocacy for genomics is needed to persuade governments, as well as commercial and non-commercial organizations, academic institutions, and others, of the medical, scientific, and economic benefits of genomic technologies.
      • Overcoming obstacles to implementation will require local planning, financing, expanded training of essential personnel, and the low-cost provision of instruments, materials, and computational infrastructure. 
      • Government ministries, funding agencies, and scientific organizations in academia and industry should collaborate to establish plans on how to use genomics and build and expand technical capacity. They should also look to pool resources through regional programmes if appropriate. 
      • Effective oversight – coupled with national and international rules and standards – is key to promoting ethical, legal, equitable use and responsible sharing of information obtained with genomic methods. 

      To take forward the recommendations and to monitor their applications across all four main areas, the report also recommends WHO create a Genomics Committee. A key responsibility proposed for the Genomics Committee is convening commercial organizations to develop and implement ways of making their products and technologies affordable in LMICs. 

      The report follows the release of WHO’s 10-year strategy for genomic surveillance of pathogens. Genomic surveillance has played a crucial role in the global COVID-19 response, with countries like South Africa able to make crucial contributions in detecting variants, due to their capacities in this area. Recent data from WHO shows that the percentage of countries able to conduct genomic surveillance increased from 54% to 68% between March 2021 and January 2022, due to major investments made during the COVID-19 pandemic. 

      Urgent call for better use of existing vaccines and development of new vaccines to tackle AMR

      Tue, 07/12/2022 - 14:57
      WHO today released the first-ever report on the pipeline of the vaccines currently in development to prevent infections caused by antimicrobial-resistant (AMR) bacterial pathogens.

      WHO and I-DAIR to partner for inclusive, impactful, and responsible international research in artificial intelligence (AI) and digital health

      Thu, 07/07/2022 - 15:01

      The World Health Organization (WHO) and the International Digital Health and AI Research Collaborative (I-DAIR) have signed a Memorandum of Understanding (MoU) outlining their joint efforts to advance the use of digital technologies for personal and public health globally.

      Through this agreement, WHO and I-DAIR will work together to harness the digital revolution towards urgent health challenges, while emphasizing equity and greater participation from Low and Middle-Income Countries (LMIC) in the research and development and governance of the digital health and AI space, with particular focus on the inclusion of young researchers and entrepreneurs.

      The partnership will focus on achieving these common goals through a multi-faceted approach focusing on promoting scientific cross-domain/cross-border collaboration and implementing innovative digital health long-term solutions, consistent with WHO recommendations and interoperability standards.

      The joint activities include inter alia the promotion and the development of new norms and guidelines for the governance of health data as a public good, the building of evidence cases for thoughtful investments in digital health globally, and the strengthening of stakeholders’ capacities - for instance via the common elaboration of the WHO digital health competency framework.

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      I-DAIR is a multi-stakeholder platform for enabling global research collaborations on digital health and for convening stakeholders to develop global public goods aimed at solving issues around the inclusive, equitable, and responsible deployment of data and AI for health. For more information about our projects, we invite you to visit our website.

       

      UN Report: Global hunger numbers rose to as many as 828 million in 2021

      Wed, 07/06/2022 - 16:57

      The number of people affected by hunger globally rose to as many as 828 million in 2021, an increase of about 46 million since 2020 and 150 million since the outbreak of the COVID-19 pandemic (1), according to a United Nations report that provides fresh evidence that the world is moving further away from its goal of ending hunger, food insecurity and malnutrition in all its forms by 2030. 

      The 2022 edition of The State of Food Security and Nutrition in the World (SOFI) report presents updates on the food security and nutrition situation around the world, including the latest estimates of the cost and affordability of a healthy diet. The report also looks at ways in which governments can repurpose their current support to agriculture to reduce the cost of healthy diets, mindful of the limited public resources available in many parts of the world.

      The report was jointly published today by the Food and Agriculture Organization of the United Nations (FAO), the International Fund for Agricultural Development (IFAD), the United Nations Children's Fund (UNICEF), the UN World Food Programme (WFP) and the World Health Organization (WHO). 

      The numbers paint a grim picture:

      • As many as 828 million people were affected by hunger in 2021 – 46 million people more from a year earlier and 150 million more from 2019.
      • After remaining relatively unchanged since 2015, the proportion of people affected by hunger jumped in 2020 and continued to rise in 2021, to 9.8% of the world population. This compares with 8% in 2019 and 9.3% in 2020.
      • Around 2.3 billion people in the world (29.3%) were moderately or severely food insecure in 2021 – 350 million more compared to before the outbreak of the COVID‑19 pandemic. Nearly 924 million people (11.7% of the global population) faced food insecurity at severe levels, an increase of 207 million in two years.
      • The gender gap in food insecurity continued to rise in 2021 - 31.9% of women in the world were moderately or severely food insecure, compared to 27.6% of men – a gap of more than 4 percentage points, compared with 3 percentage points in 2020.
      • Almost 3.1 billion people could not afford a healthy diet in 2020, up 112 million from 2019, reflecting the effects of inflation in consumer food prices stemming from the economic impacts of the COVID-19 pandemic and the measures put in place to contain it. 
      • An estimated 45 million children under the age of five were suffering from wasting, the deadliest form of malnutrition, which increases children’s risk of death by up to 12 times. Furthermore, 149 million children under the age of five had stunted growth and development due to a chronic lack of essential nutrients in their diets, while 39 million were overweight. 
      • Progress is being made on exclusive breastfeeding, with nearly 44% of infants under 6 months of age being exclusively breastfed worldwide in 2020. This is still short of the 50% target by 2030. Of great concern, 2 in 3 children are not fed the minimum diverse diet they need to grow and develop to their full potential.
      • Looking forward, projections are that nearly 670 million people (8% of the world population) will still be facing hunger in 2030 – even if a global economic recovery is taken into consideration. This is a similar number to 2015, when the goal of ending hunger, food insecurity and malnutrition by the end of this decade was launched under the 2030 Agenda for Sustainable Development.

      As this report is being published, the ongoing war in Ukraine, involving two of the biggest global producers of staple cereals, oilseeds and fertilizer, is disrupting international supply chains and pushing up the prices of grain, fertilizer, energy, as well as ready-to-use therapeutic food for children with severe malnutrition. This comes as supply chains are already being adversely affected by increasingly frequent extreme climate events, especially in low-income countries, and has potentially sobering implications for global food security and nutrition.

      “This report repeatedly highlights the intensification of these major drivers of food insecurity and malnutrition: conflict, climate extremes and economic shocks, combined with growing inequalities,” the heads of the five UN agencies (2) wrote in this year's Foreword. “The issue at stake is not whether adversities will continue to occur or not, but how we must take bolder action to build resilience against future shocks.”

      Repurposing agricultural policies

      The report notes as striking that worldwide support for the food and agricultural sector averaged almost US$ 630 billion a year between 2013 and 2018. The lion's share of it goes to individual farmers, through trade and market policies and fiscal subsidies. However, not only is much of this support market-distorting, but it is not reaching many farmers, hurts the environment and does not promote the production of nutritious foods that make up a healthy diet. That's in part because subsidies often target the production of staple foods, dairy and other animal source foods, especially in high- and upper-middle-income countries. Rice, sugar and meats of various types are most incentivized food items worldwide, while fruits and vegetables are relatively less supported, particularly in some low-income countries.

      With the threats of a global recession looming, and the implications this has on public revenues and expenditures, a way to support economic recovery involves the repurposing of food and agricultural support to target nutritious foods where per capita consumption does not yet match the recommended levels for healthy diets.

      The evidence suggests that if governments repurpose the resources they are using to incentivize the production, supply and consumption of nutritious foods, they will contribute to making healthy diets less costly, more affordable and equitably for all.

      Finally, the report also points out that governments could do more to reduce trade barriers for nutritious foods, such as fruits, vegetables and pulses.

      (1) It is estimated that between 702 and 828 million people were affected by hunger in 2021. The estimate is presented as a range to reflect the added uncertainty in data collection due to the COVID-19 pandemic and related restrictions. The increases are measured with reference to the middle of the projected range (768 million).

      (2) For FAO - QU Dongyu, Director-General; for IFAD - Gilbert F. Houngbo, President; for UNICEF - Catherine Russell, Executive Director; for WFP - David Beasley, Executive Director; for WHO - Tedros Adhanom Ghebreyesus, Director-General.

      What they said

      FAO Director-General QU Dongyu: “Low-income countries, where agriculture is key to the economy, jobs and rural livelihoods, have little public resources to repurpose. FAO is committed to continue working together with these countries to explore opportunities for increasing the provision of public services for all actors across agrifood systems.”

      IFAD President Gilbert F. Houngbo: “These are depressing figures for humanity. We continue to move away from our goal of ending hunger by 2030. The ripple effects of the global food crisis will most likely worsen the outcome again next year. We need a more intense approach to end hunger and IFAD stands ready to do its part by scaling up its operations and impact. We look forward to having everyone's support.”

      UNICEF Executive Director Catherine Russell: “The unprecedented scale of the malnutrition crisis demands an unprecedented response. We must double our efforts to ensure that the most vulnerable children have access to nutritious, safe, and affordable diets -- and services for the early prevention, detection and treatment of malnutrition. With so many children’s lives and futures at stake, this is the time to step up our ambition for child nutrition – and we have no time to waste.”

      WFP Executive Director David Beasley: “There is a real danger these numbers will climb even higher in the months ahead. The global price spikes in food, fuel and fertilizers that we are seeing as a result of the crisis in Ukraine threaten to push countries around the world into famine. The result will be global destabilization, starvation, and mass migration on an unprecedented scale. We have to act today to avert this looming catastrophe.”

      WHO Director-General Tedros Adhanom Ghebreyesus: “Every year, 11 million people die due to unhealthy diets. Rising food prices mean this will only get worse.  WHO supports countries’ efforts to improve food systems through taxing unhealthy foods and subsidising healthy options, protecting children from harmful marketing, and ensuring clear nutrition labels. We must work together to achieve the 2030 global nutrition targets, to fight hunger and malnutrition, and to ensure that food is a source of health for all.”
       

      GLOSSARY

      Acute food insecurity: food insecurity found in a specified area at a specific point in time and of a severity that threatens lives or livelihoods, or both, regardless of the causes, context or duration. Has relevance in providing strategic guidance to actions that focus on short-term objectives to prevent, mitigate or decrease severe food insecurity. 

      Hunger: an uncomfortable or painful sensation caused by insufficient energy from diet. Food deprivation. In this report, the term hunger is synonymous with chronic undernourishment and is measured by the prevalence of undernourishment (PoU). 

      Malnutrition: an abnormal physiological condition caused by inadequate, unbalanced or excessive intake of macronutrients and/or micronutrients. Malnutrition includes undernutrition (child stunting and wasting, and vitamin and mineral deficiencies) as well as overweight and obesity. 

      Moderate food insecurity: a level of severity of food insecurity at which people face uncertainties about their ability to obtain food and have been forced to reduce, at times during the year, the quality and/or quantity of food they consume due to lack of money or other resources. It refers to a lack of consistent access to food, which diminishes dietary quality and disrupts normal eating patterns. Measured based on the Food Insecurity Experience Scale. 

      Severe food insecurity: a level of severity of food insecurity at which, at some time during the year, people have run out of food, experienced hunger and at the most extreme, gone without food for a day or more. Measured based on the Food Insecurity Experience Scale. 

      Undernourishment: a condition in which an individual’s habitual food consumption is insufficient to provide the amount of dietary energy required to maintain a normal, active, healthy life. The prevalence of undernourishment is used to measure hunger (SDG indicator 2.1.1).

       

      High-level meeting of the UN General Assembly on Road Safety

      Wed, 07/06/2022 - 09:05
      Assistant Director-General, WHO Office at the UN (ADG WUN), Stewart Simonson, represented WHO Director-General, Dr Tedros, at the High-Level Meeting (HLM) on Improving Global Road Safety, convened by the President of the UN General Assembly (PGA), on 30 June and 1 July, on the overall theme of “The 2030 horizon for road safety: securing a decade of action and delivery”.

      WHO Director-General welcomes ACT-Accelerator fair share contributions from Norway and Sweden

      Mon, 07/04/2022 - 15:49

      WHO Director-General Dr Tedros Adhanom Ghebreyesus has welcomed contributions from Norway and Sweden to the ACT-Accelerator, which have taken both countries over their ‘fair share’ allocation.

      Contributions of US$ 340 million from Norway and US$ 300 million from Sweden will accelerate efforts to get vaccines into arms, facilitate access to new treatments and ensure health systems can meet the challenges of the COVID-19 pandemic.

      Norway and Sweden join Germany in having exceeded their fair share for ACT-A’s 2021/22 budget, with Canada pledging to do the same. ‘Fair share’ calculations are based on the size of a country’s national economy and what they would gain from a faster recovery of the global economy and trade.

      In February 2022, President Ramaphosa of South Africa and Prime Minister Støre of Norway – in their roles as co-chairs of the ACT-Accelerator Facilitation Council - made a call to 55 countries to jointly support global efforts to end the COVID-19 crisis and contribute their ‘fair share’ to the ACT-Accelerator agencies’ urgent needs.

      These contributions from Norway and Sweden reinforce the strong support that both countries have provided to the ACT-Accelerator since its inception in 2020.

      The ACT-Accelerator now faces a funding gap of US$ 11.2 billion, having received contributions totaling US$ 5.6 billion for the 2021/22 budget.

      WHO Director-General Dr Tedros Adhanom Ghebreyesus said: “I wish to commend Norway and Sweden for their commitment towards the vital work of the ACT-Accelerator. We call on other countries to follow their lead in contributing their fair share, and get COVID-19 vaccines, tests and treatments to those who need them most. We have made tremendous progress in reducing mortality and transmission. But cases are still on the rise in 110 countries. Our job is not over. We must ensure that all countries are equipped to fight future waves of COVID-19.”

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