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The World Health Organization (WHO) is releasing new guidelines on abortion care today, in a bid to protect the health of women and girls and help prevent over 25 million unsafe abortions that currently occur each year.

“Being able to obtain safe abortion is a crucial part of health care,” said Craig Lissner, acting Director for Sexual and Reproductive Health and Research at WHO. “Nearly every death and injury that results from unsafe abortion is entirely preventable. That’s why we recommend women and girls can access abortion and family planning services when they need them.”

Based on the latest scientific evidence, these consolidated guidelines bring together over 50 recommendations spanning clinical practice, health service delivery, and legal and policy interventions to support quality abortion care.

New recommendations to improve access to high quality, person-centred services

When abortion is carried out using a method recommended by WHO, appropriate to the duration of the pregnancy and assisted by someone with the necessary information or skills, it is a simple and extremely safe procedure.

Tragically, however, only around half of all abortions take place under such conditions, with unsafe abortions causing around 39 000 deaths every year and resulting in millions more women hospitalized with complications. Most of these deaths are concentrated in lower-income countries – with over 60% in Africa and 30% in Asia – and among those living in the most vulnerable situations. 

The guideline includes recommendations on many simple primary care level interventions that improve the quality of abortion care provided to women and girls. These include task sharing by a wider range of health workers; ensuring access to medical abortion pills, which mean more women can obtain safe abortion services, and making sure that accurate information on care is available to all those who need it. 

For the first time, the guidelines also include recommendations for use where appropriate of telemedicine, which helped support access to abortion and family planning services during the COVID-19 pandemic.

Removing unnecessary policy barriers facilitates safe abortion access

Alongside the clinical and service delivery recommendations, the guidelines recommend removing medically unnecessary policy barriers to safe abortion, such as criminalization, mandatory waiting times, the requirement that approval must be given by other people (e.g., partners or family members) or institutions, and limits on when during pregnancy an abortion can take place. Such barriers can lead to critical delays in accessing treatment and put women and girls at greater risk of unsafe abortion, stigmatization, and health complications, while increasing disruptions to education and their ability to work.

While most countries permit abortion under specified circumstances, about 20 countries provide no legal grounds for abortion. More than 3 in 4 countries have legal penalties for abortion, which can include lengthy prison sentences or heavy fines for people having or assisting with the procedure. 

“It’s vital that an abortion is safe in medical terms,” said Dr Bela Ganatra, Head of WHO’s Prevention of Unsafe Abortion Unit. “But that’s not enough on its own. As with any other health services, abortion care needs to respect the decisions and needs of women and girls, ensuring that they are treated with dignity and without stigma or judgement. No one should be exposed to abuse or harms like being reported to the police or put in jail because they have sought or provided abortion care." 

Evidence shows that restricting access to abortions does not reduce the number of abortions that take place. In fact, restrictions are more likely to drive women and girls towards unsafe procedures. In countries where abortion is most restricted, only 1 in 4 abortions are safe, compared to nearly 9 in 10 in countries where the procedure is broadly legal. 

“The evidence is clear – if you want to prevent unintended pregnancies and unsafe abortions, you need to provide women and girls with a comprehensive package of sexuality education, accurate family planning information and services, and access to quality abortion care,” Dr Ganatra added.

Following the launch of the guidelines, WHO will support interested countries to implement these new guidelines and strengthen national policies and programmes related to contraception, family planning and abortion services, helping them provide the highest standard of care for women and girls.

Notes

Quality abortion care is care that is effective – delivered by health workers with the right skills, resources, and information; safe; accessible to all those that need it; timely, and respectful of women and girls’ needs and rights.

The WHO abortion care guideline updates the former edition, released in 2012, and consolidates existing and new recommendations. The digital version is available at https://srhr.org/abortioncare 

An interactive online database containing comprehensive information on the abortion laws, policies, health standards and guidelines for all countries is available at https://abortion-policies.srhr.org.

Persons fleeing from Ukraine may be vulnerable to developing certain infectious diseases as a result of their living conditions and the situation they face during displacement.

Key messages:

• The TAG-CO-VAC is reviewing available data to optimize vaccine mediated protection against prevalent circulating variants. The TAG-CO-VAC strongly supports urgent and broad access to current COVID-19 vaccines for primary series and booster doses, particularly for groups at risk of developing severe disease, given that current COVID-19 vaccines continue to provide high levels of protection against severe disease and death, even in the context of the circulation of Omicron.
• However, to ensure COVID-19 vaccines provide optimal protection into the future, they may need to be updated as new, antigenically distinct variants emerge. The updated vaccines may be monovalent targeting the predominant circulating variant, or multivalent based on different variants.
• Ideally, COVID-19 vaccines will prevent infection and transmission, in addition to providing protection against severe disease and death. The development of pan SARS-CoV-2 or pansarbecovirus vaccines, as well as the development of vaccines that are able to elicit mucosal immunity, may be desirable options, but the timeframe for their development and production is uncertain. 
• The TAG-CO-VAC continues to encourage COVID-19 vaccine manufacturers to generate and provide data to WHO on performance of current and variant-specific COVID-19 vaccines so that they can be considered as part of a broad decision-making framework on COVID-19 vaccine composition, allowing the TAG-CO-VAC to issue more specific advice to WHO on adjustments needed to COVID-19 vaccine strain composition.

 

The World Health Organization, with the support of the Technical Advisory Group on COVID-19 Vaccine Composition (TAG-CO-VAC), continues to review and assess the public health implications of emerging SARS-CoV-2 Variants of Concern (VOC) on the performance of COVID-19 vaccines. Since the publication of the interim statement on COVID-19 vaccines on 11 January 2022, Omicron has become the dominant VOC globally, rapidly replacing other circulating variants. This statement highlights the global epidemiological situation, challenges of updating vaccine composition and provides the current position of the TAG-CO-VAC.  

Epidemiological situation

The current global epidemiological situation is characterized by rapid and relatively synchronous dominance of Omicron variant in all six WHO regions. While global cases are declining, there are reduced testing resources and capacities in some areas and the epidemiological situation remains heterogeneous, with a number of regions and countries reporting increases in new weekly cases, while others are now reporting declines.

Omicron is comprised of several genetically related sublineages, including BA.1, BA.2 and BA.3, each of which is being monitored by WHO and partners. At a global level, BA.1 has been the predominant Omicron lineage, however, the proportion of reported sequences designated as BA.2 has been increasing relative to BA.1 in recent weeks, and is the predominant Omicron lineage in several countries. BA.1 and BA.2 have some genetic differences, which may make them antigenically distinct. Reinfection with BA.2 following infection with BA.1 has been documented, however, initial data from population-level studies suggest that infection with BA.1 provides substantial protection against reinfection with BA.2, at least for the limited period for which data are available. For more details on the Omicron sublineages, please refer to the statement by WHO on the Omicron sublineage BA.2 , published on 22 February 2022.

Updating current COVID-19 vaccines

The public health goal of COVID-19 vaccination prioritizes protection against severe disease and death. Current vaccines appear to confer high levels of protection against severe disease outcomes associated with Omicron infection. The TAG-CO-VAC therefore strongly supports urgent and broad access to current COVID-19 vaccines for primary series and booster doses, particularly for groups at risk of developing severe disease. The near- and medium-term supply of the available vaccines has increased substantially, however, vaccine equity remains an important challenge and all efforts to address such inequities are strongly encouraged.

The first interim statement from the TAG-CO-VAC highlighted the need for the development of vaccines that provide protection against infection and prevent transmission, in addition to the protection from severe disease and death, as a means to achieve a greater public health impact from COVID-19 vaccination. In this context, vaccines that are able to elicit mucosal immunity, in addition to systemic immunity, are an important goal. One of the options proposed in the first statement was the development of pan SARS-CoV-2 or pansarbecovirus vaccines. Such vaccines would provide protection that would effectively be variant-proof, and work in this area should be accelerated.  

Current vaccines are based on the virus that circulated early in the pandemic (ancestral virus e.g. GISAID: hCoV-19/Wuhan/WIV04/2019). Since then, there has been continuous and substantial virus evolution and it is likely that this evolution will continue, resulting in the emergence of new variants. The composition of current COVID-19 vaccines may therefore need to be updated. Any update to current COVID-19 vaccine composition would aim to, at a minimum, retain protection against severe disease and death, while ensuring the breadth of the immune response against circulating and emerging variants, which may be antigenically distinct.  

The TAG-CO-VAC considered a number of issues, all of which are important in any decision on COVID-19 vaccine composition:

• There are heterogeneous levels of population immunity between countries due to different waves of VOCs and different types, levels and timing of vaccination, but robust data on the global immunologic landscape are limited. The performance of any updated vaccine(s) may vary depending on the nature and magnitude of previously acquired immunity.
• When updated vaccines become available, a substantial proportion of the global population will have been exposed to SARS-CoV-2, either as a result of vaccination and/or prior infection. As above, the performance of any updated vaccine(s) may vary depending on the nature and magnitude of previously acquired immunity.
• There are also considerable uncertainties as to how the virus will continue to evolve and the antigenic characteristics of future variants. Given widespread transmission of Omicron globally, the possibility of its continued evolution is high and a new variant may emerge before an updated vaccine can be produced and delivered at scale.
• WHO is tracking lineages under the ‘umbrella’ of Omicron, including BA.1 and BA.2. Though data are emerging, additional antigenic and virologic characterization of these lineages is needed both independently and in comparison, to the other lineages.
• While the body of evidence on the immune response to Omicron following infection is rapidly growing, data on breadth, magnitude, and durability of humoral and cell-mediated immune responses to variants from variant-specific candidate vaccines using different vaccine platforms remain limited.
• In addition to the current COVID-19 vaccines, there are many other COVID-19 vaccines in various stages of clinical and preclinical development. Any decision from the TAG-CO-VAC on COVID-19 vaccine composition would apply primarily to current COVID-19 vaccines.

Position of the TAG-CO-VAC

The TAG-CO-VAC welcomes, where feasible, the development and initiation of clinical trials on variant-specific candidate vaccines against WHO-designated VOCs, including Omicron. In this context, the TAG-CO-VAC is seeking evidence of robust homologous immune responses in primed and unprimed individuals and cross-reactivity data in primed individuals. The TAG-CO-VAC encourages collection of data following one and two doses of any modified vaccine across a variety of relevant vaccine platforms.

The TAG-CO-VAC continues to encourage COVID-19 vaccine manufacturers to generate and provide data to WHO on the performance of current and variant-specific candidate COVID-19 vaccines, including the breadth, magnitude, and durability of humoral and cell-mediated immune responses to variants through monovalent and/or multivalent vaccines. The TAG-CO-VAC will carefully consider these data as part of a broader decision-making framework on COVID-19 vaccine composition, allowing the TAG-CO-VAC to issue more specific advice on any adjustments that may be needed to COVID-19 vaccine strain composition, developed either as a monovalent vaccine targeting the predominant circulating variant(s) or a multivalent vaccine derived from different variants.

The TAG-CO-VAC recognizes the independent role and procedures of relevant regulatory authorities in establishing the necessary requirements for evaluation under the currently established regulatory pathways, and the role of WHO in ensuring alignment, collaboration and a continuous exchange of information between WHO and its expert groups, the TAG-CO-VAC, regulatory authorities, and COVID-19 vaccine manufacturers.

The statement reflects the current vaccine performance and landscape of vaccine development. The statement will therefore be updated as data become available.

 

 

As heads of the United Nations Network on Migration’s Executive Committee, the International Committee of the Red Cross, the International Federation of Red Cross and Red Crescent Societies and the International Commission on Missing Persons, we call on States to urgently assume collective responsibility to save lives and prevent migrants from going missing or dying along migration routes and to search for and identify those who have gone missing and to assist their families.

The heads of the International Monetary Fund, World Bank Group, World Health Organization, and World Trade Organization held high-level consultations with UNICEF, Gavi, the Vaccine Alliance, the Global Lead Coordinator for the COVID-19 Vaccine Country Readiness and Delivery and the CEOs of leading vaccine manufacturers on 1 March 2022 aimed at ensuring the rapid delivery of vaccines to where they are needed the most and putting those vaccines into arms.

The Multilateral Leaders Task Force issued the following statement:

"In the past few months, we have seen unprecedented levels of disease transmission across the world due to the Omicron variant. Still, unequal access to COVID-19 vaccines, tests and treatments is rampant, prolonging the pandemic. 23 countries are yet to fully vaccinate 10% of their populations, 73 countries are yet to achieve 40% coverage and many more are projected to miss the 70% target by middle of this year.

The biggest challenges are in low-income countries (LICs), which are concentrated in Africa. Only 7% of people in LICs have been fully vaccinated, compared with 73% in high-income countries. Safeguarding the health of people living in the world’s poorest countries in the face of a changing pandemic is a key priority. We must and can ensure that these countries have the access, the means, and the capacity to vaccinate their populations, especially those who are most at risk.

Despite the challenges, there has been progress. The vaccine supply constraints from last year have eased, and export restrictions are not currently an issue. Our efforts must now focus on supporting countries to increase vaccination rates. There is no "one-size-fits-all" approach as each country faces different political, administrative, and capacity challenges.

Insufficient health care infrastructure, including warehouses, cold chain capacity; lack of trained vaccinators; complexities associated with the management of multiple vaccines; lack of data systems to support vaccination campaigns; and misinformation and vaccine hesitancy are common hurdles that governments must confront. But we have good lessons to draw on from countries around the world that have managed to overcome obstacles and rollout vaccination campaigns, including from low-income countries.

Sustained investment in geographically diversified manufacturing capacity and new technologies for vaccines, therapeutics, and diagnostics is key for ensuring more equitable, affordable, and timely access to tools for developing countries. In this context, we welcome the work of the leading vaccine manufacturers in exploring and undertaking new partnerships and call for them to work closely with international organizations (IOs) and countries to capitalize on practical solutions, sharing licenses, technology and know-how.

A top priority to end the pandemic is deploying financing quickly to accelerate the development, production, and equitable access to COVID-19 tests, treatments and vaccines in low- and middle-income countries. Fully funding the Access to COVID-19 Tools (ACT) Accelerator is critical.

As vaccine supply increases in 2022, close coordination among all stakeholders will be crucial to aligning supply with demand, reducing supply fragmentation, and deploying vaccines in the most effective way. We must adjust to constantly evolving challenges and keep working together. As the late Dr Paul Farmer said: "Any time there's a new tool developed – whether they are vaccines or therapeutics – there must also be a delivery plan."

Let us acknowledge the importance of delivery, as this is where lives are saved, families are kept whole, children continue their education, communities stay strong, and economies grow."

 

About the Multilateral Leaders Task Force

This joint initiative of the International Monetary Fund, World Bank Group, World Health Organization, and World Trade Organization aims to support the roll out of COVID-19 tools by leveraging multilateral finance and trade solutions, particularly for low and middle-income countries. It supports the goals of the ACT-Accelerator and complementary initiatives in the delivery of COVID-19 diagnostics, vaccines, therapeutics, and PPE.

 

 

 

As we enter the third year of the pandemic, SARS-CoV-2, the virus that causes COVID-19, is spreading between people at an intense  level globally.  There are many factors that are driving transmission. One of these is the emergence of highly transmissible variants of concern, the latest being Omicron.  The virus continues to evolve and the risk of future emergence of variants is high.

Although the COVID-19 pandemic is driven by human-to-human transmission, the SARS-CoV-2 virus is also known to infect animal species. Current knowledge indicates that wildlife does not play a significant role in the spread of SARS-CoV-2 in humans, but spread in animal populations can affect the health of these populations and may facilitate the emergence of new virus variants.

In addition to domestic animals, free-ranging, captive or farmed wild animals such as big cats, minks, ferrets, North American white-tailed deer and great apes have thus far been observed to be infected with SARS-CoV-2. To date, farmed mink and pet hamsters have been shown to be capable of infecting humans with the SARS-CoV-2 virus and a potential case of transmission between white-tailed deer and a human is currently under review.

The introduction of SARS-CoV-2 to wildlife could result in the establishment of animal reservoirs. For example, it has been reported that, approximately one-third of wild white-tailed deer in the United States of America have been infected with SARS-CoV-2, initially via several human-to-deer transmission events. The SARS-CoV-2 lineages detected in white-tailed deer have also been circulating in close-by human populations. White-tailed deer have been shown to shed virus and transmit it between each other.

FAO, OIE and WHO call on all countries to take steps to reduce the risk of SARS-CoV-2 transmission between humans and wildlife with the aim of reducing the risk of variant emergence and for protecting both humans and wildlife. We urge authorities to adopt relevant regulations and disseminate previously released recommendations by FAO, OIE and WHO to (1) people working in close contact with or handling wildlife, including hunters and butchers; and (2) the public.

Personnel working closely with wildlife should be trained to implement measures that reduce the risk of transmission between people and between people and animals, using WHO advice on how to protect oneself and prevent the spread of COVID-19, and OIE and FAO guidelines on the use of personal protective equipment (PPE) and good hygiene practices around animals, including good hygiene practices for hunters and butchers.

Current evidence suggests that humans are not infected with the SARS-CoV-2 virus by eating meat. However, hunters should not track animals that appear sick or harvest those that are found dead. Appropriate butchering and food preparing techniques, including proper hygiene practices, can limit transmission of coronaviruses, including SARS-CoV-2, and other zoonotic pathogens.

FAO, OIE and WHO stress that the public should be educated about contact with wildlife. Some wild animals may come close to human settlements and residential areas. As a general precaution, people should not approach or feed wild animals or touch or eat those that are orphaned, sick or found dead (including road kills). Instead, they should contact local wildlife authorities or a wildlife health professional.

It is also crucial to safely dispose of uneaten food, masks, tissues, and any other human waste to avoid attracting wildlife, especially to urban areas and, if possible, keep domestic animals away from wildlife and their droppings.

We furthermore encourage countries’ national animal and human health services to adopt the following measures:

• Encourage collaboration between national veterinary services and national wildlife authorities, whose partnership is key to promoting animal health and safeguarding human and environmental health.
• Promote monitoring of wildlife and encourage sampling of wild animals known to be potentially susceptible to SARS-CoV-2.
• Share all genetic sequence data from animal surveillance studies through publicly available databases.
• Report confirmed animal cases of SARS-CoV-2 to the OIE through the World Animal Health Information System (OIE-WAHIS).
• Craft messages about SARS-CoV-2 in animals with care so that inaccurate public perceptions do not negatively impact conservation efforts. No animal found to be infected with SARS-CoV-2 should be abandoned, rejected, or killed without providing justification from a country- or event-specific risk assessment.

OIE and WHO also recommend countries to suspend the sale of captured live wild mammals in food markets as an emergency measure. 

Our organizations emphasize the importance of monitoring mammalian wildlife populations for SARS-CoV-2 infection, reporting results to National Veterinary Services (who report these findings to the OIE) and sharing genomic sequencing data on publicly available databases. Countries should also adopt precautions to reduce the risk of establishment of animal reservoirs and potential acceleration of virus evolution in novel hosts, which could lead to the emergence of new SARS-CoV-2 variants. Such measures will preserve the health of precious wildlife as well as humans.

We invite governments and other stakeholders to bring the contents of this joint statement to the attention of competent authorities and all parties concerned.

Note: This statement was originally published on 7 March 2022. An update was made on 21 March 2022.

 

 

CDC is aggressively responding to the global outbreak of COVID-19 and preparing for the potential of community spread in the United States.

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