WHO calls for access to health and humanitarian assistance on fourth day of conflict in Israel and the occupied Palestinian territory
The World Health Organization (WHO) repeats its call for an end to the hostilities that are causing untold suffering in Israel and the Gaza Strip. Over 1000 people have died and many more injured following horrific acts of violence by Hamas and others on Saturday in Israel. Nine hundred people have died and many more injured in days of bombing by Israel in Gaza. The pain of so many families must be unbearable.
WHO has offered assistance to health officials in both Israel and the occupied Palestinian territory.
On 9 October, WHO Director-General Dr Tedros Adhanom Ghebreyesus met with the Egyptian President Abdel Fattah El-Sisi, who agreed to a WHO request to facilitate the delivery of health and other humanitarian supplies from WHO to Gaza via the Rafah crossing. Such humanitarian corridors must be protected.
In the Gaza Strip, hospitals are running on back-up generators with fuel likely to run out in the coming days. They have exhausted the supplies WHO pre-positioned before the escalation. The life-saving health response is now dependent on getting new supplies and fuel to health care facilities as fast as possible.
WHO is urgently working to procure medical supplies locally to meet demand, and preparing supplies from its Global Medical Logistics Hub in Dubai, UAE.WHO is also gravely concerned about the health and well-being of hostages, including elderly civilians, seized from Israel by Hamas in attacks on 7 October. The hostages’ health and medical needs must be addressed immediately, and we call for their safe release.
New funding to ensure 370 million children receive polio vaccinations and to boost health innovation in low-income countries
Team of experts from ECDC, EFSA, EC and EU Member States conduct visit to Kosovo on One Health approaches against AMR
WHO/Europe, EC and ECDC urge eligible groups to get vaccinated or boosted to save lives this autumn and winter
Governments make progress towards agreeing amendments to the International Health Regulations (2005)
Progress was made this week on many of the over-300 proposed amendments to the International Health Regulations 2005 (IHR). In this fifth round of intensive discussions, taking place under the aegis of the Working Group on Amendments to the IHR (WGIHR) – which includes the 196 States Parties to the IHR, the European Union and the Observer Delegation of Palestine – participants discussed proposed amendments including those in the areas of:
- Points Of Entry
- Public Health Measures
- Health Documents
- General Provisions
- Final Provisions
- Definitions, Purpose and Scope, Principles and Responsible Authorities
- The Emergency Committee
- Decision Instrument for The Assessment and Notification of Events.
The Working Group also discussed a consolidated proposal by the proponent States Parties of proposed amendments to Article 13A Equitable Access to Health Products, Technologies and Know-How for Public Health Response, as well as Article 8 Consultation.
It was agreed that efforts should continue during the intersessional period (before the next meeting of the WGIHR in December), including:
- discussions between proponents of various proposed amendments, with a view to presentation of any outcomes for the consideration of the drafting group;
- intersessional briefings and facilitated intersessional consultations covering Articles, Annexes and topics discussed during this and previous meetings of the WGIHR, including those that have been the subject of intersessional work. This includes also work on financing for public health emergencies and IHR implementation, and the Public Health Alert – PHEIC – pandemic continuum, including definitions, criteria and the process for determining each. The outcomes of facilitated intersessional consultations will not constitute agreed text and will be made available in advance of the next WGIHR meeting in December 2023; and
- preparation, as relevant, by the Bureau with the assistance of the Secretariat, of draft text proposals based on the discussions so far, for consideration by the Working Group at the Sixth Meeting.
"We will continue work on a range of issues in the intersessional period before WGIHR6, as well as in early 2024. We are confident that we will be able to deliver on our mandate by the 77th World Health Assembly. The will is there,” said WGIHR Co-Chair Dr Abdullah Assiri of Saudi Arabia.
“We have a very strong shared focus on our mandate to deliver a package of targeted amendments to the IHR and ensure that equity is reflected in the IHR. It would be easy to make the IHR worse. It will be hard to make them better. We will focus on the hard task, making them better,” said WGIHR Co-Chair Dr Ashley Bloomfield of New Zealand.
The Co-Chairs noted that, in reference to Decision WHA75(9), it appeared unlikely that the package of amendments would be ready by January 2024. In this regard, the Working Group agreed to continue its work between January and May 2024. The Director-General will submit to the 77th Health Assembly the package of amendments agreed by the Working Group.
The original International Sanitary Regulations were adopted in 1951 under the WHO Constitution to set out agreed approaches and obligations for countries to prepare for, and respond to, disease outbreaks and other acute public health events with risk of international spread. The original International Sanitary Regulations were revised three times – in 1969 (when they became International Health Regulations), in 1981, and in 2005.
The IHR are an instrument of international law that is legally-binding on 196 State Parties, including the 194 WHO Member States. The IHR, in their version adopted in 2005, have been amended twice – in 2014 and 2022 (the most-recent amendments will come into force in May 2024). The newest proposed amendments come in response to the challenges posed by the COVID-19 pandemic.
(1) Liechtenstein and the Holy See are State Parties to the IHR but not Member States of WHO.
Sweden’s advice-making process on schools during the COVID-19 pandemic: Good practices and lessons learnt
The World Health Organization (WHO) has recommended a new vaccine, R21/Matrix-M, for the prevention of malaria in children. The recommendation follows advice from the WHO: Strategic Advisory Group of Experts on Immunization (SAGE) and the Malaria Policy Advisory Group (MPAG) and was endorsed by the WHO Director-General following its regular biannual meeting held on 25-29 September.
WHO also issued recommendations on the advice of SAGE for new vaccines for dengue and meningitis, along with immunization schedule and product recommendations for COVID-19. WHO also issued key immunization programmatic recommendations on polio, IA2030 and recovering the immunization programme.
The R21 vaccine is the second malaria vaccine recommended by WHO, following the RTS,S/AS01 vaccine, which received a WHO recommendation in 2021. Both vaccines are shown to be safe and effective in preventing malaria in children and, when implemented broadly, are expected to have high public health impact. Malaria, a mosquito-borne disease, places a particularly high burden on children in the African Region, where nearly half a million children die from the disease each year.
Demand for malaria vaccines is unprecedented; however, available supply of RTS,S is limited. The addition of R21 to the list of WHO-recommended malaria vaccines is expected to result in sufficient vaccine supply to benefit all children living in areas where malaria is a public health risk.
“As a malaria researcher, I used to dream of the day we would have a safe and effective vaccine against malaria. Now we have two,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Demand for the RTS,S vaccine far exceeds supply, so this second vaccine is a vital additional tool to protect more children faster, and to bring us closer to our vision of a malaria-free future.”
Dr Matshidiso Moeti, WHO Regional Director for Africa, emphasized the importance of this recommendation for the continent, saying: “This second vaccine holds real potential to close the huge demand-and-supply gap. Delivered to scale and rolled out widely, the two vaccines can help bolster malaria prevention and control efforts and save hundreds of thousands of young lives in Africa from this deadly disease.”
Key features of the R21 malaria vaccine:
The updated WHO malaria vaccine recommendation is informed by evidence from an ongoing R21 vaccine clinical trial and other studies, which showed:
- High efficacy when given just before the high transmission season: In areas with highly seasonal malaria transmission (where malaria transmission is largely limited to 4 or 5 months per year), the R21 vaccine was shown to reduce symptomatic cases of malaria by 75% during the 12 months following a 3-dose series. A fourth dose given a year after the third maintained efficacy. This high efficacy is similar to the efficacy demonstrated when RTS,S is given seasonally.
- Good efficacy when given in an age-based schedule: The vaccine showed good efficacy (66%) during the 12 months following the first 3 doses. A fourth dose a year after the third maintained efficacy.
- High impact: Mathematical modelling estimates indicate the public health impact of the R21 vaccine is expected to be high in a wide range of malaria transmission settings, including low transmission settings.
- Cost effectiveness: At prices of US$ 2 – US$ 4 per dose, the cost-effectiveness of the R21 vaccine would be comparable with other recommended malaria interventions and other childhood vaccines.
- Similarity of R21 and RTS,S vaccines: The two WHO-recommended vaccines, R21 and RTS,S, have not been tested in a head-to-head trial. There is no evidence to date showing one vaccine performs better than the other. The choice of product to be used in a country should be based on programmatic characteristics, vaccine supply, and vaccine affordability
- Safety: The R21 vaccine was shown to be safe in clinical trials. As with other new vaccines, safety monitoring will continue.
Next steps for the second recommended malaria vaccine, R21/Matrix-M, include completing the ongoing WHO prequalification which would enable international procurement of the vaccine for broader rollout.
At least 28 countries in Africa plan to introduce a WHO-recommended malaria vaccine as part of their national immunization programmes. Gavi, the Vaccine Alliance has approved providing technical and financial support to roll out malaria vaccines to 18 countries. The RTS,S vaccine will be rolled out in some African countries in early 2024, and the R21 malaria vaccine is expected to become available to countries mid-2024. ;
Recommendations on dengue
- Dengue poses a significant public health burden in endemic countries and is poised to increase further both in terms of incidence and geographic expansion, due to climate change and urbanization.
- The live-attenuated quadrivalent dengue vaccine developed by Takeda (TAK-003) has demonstrated efficacy against all four serotypes of the virus in baseline seropositive children (4-16 years) in endemic countries and against serotypes 1 and 2 in baseline seronegative children.
- SAGE recommended that the vaccine be considered for introduction in settings with high dengue disease burden and high transmission intensity to maximize the public health impact and minimize any potential risk in seronegative persons.
- SAGE recommended that the vaccine be introduced to children aged 6 to 16 years of age. Within this age range, the vaccine should be introduced about 1-2 years prior to the age-specific peak incidence of dengue-related hospitalizations. The vaccine should be administered in a 2-dose schedule with a 3-month interval between doses.
- SAGE recommended that vaccine introduction should be accompanied by a well-designed communication strategy and community engagement.
Recommendations on meningitis
- SAGE recommended that all countries in the African meningitis belt introduce the novel pentavalent meningococcal conjugate vaccine targeting serogroups A, C, Y, W and X (Men5CV) into their routine immunization programmes in a single-dose schedule at 9 to 18 months of age.
- In high-risk countries, and countries with high-risk districts, a catch-up campaign should also be conducted at the time of the introduction of Men5CV, targeting all individuals aged 1 to 19 years.
Recommendations on COVID-19
- SAGE was presented with updated data on the epidemiology of COVID-19, including death rates among priority-use groups; vaccine effectiveness data during Omicron XBB sub-lineages circulation; and pre-clinical and clinical data on novel monovalent XBB vaccines.
- Based on the data reviewed, SAGE recommended a simplified single-dose regime for primary immunization for most COVID-19 vaccines which would improve acceptance and uptake and provide adequate protection at a time when most people have had at least one prior infection.
- Available data suggest the monovalent Omicron XBB vaccines provide modestly enhanced protection compared to bivalent variant-containing vaccines and monovalent index virus vaccines.
- When monovalent XBB vaccines are not available, any available WHO emergency-use listed or prequalified vaccine, bivalent variant-containing or monovalent index virus vaccines, may be used since they continue to provide benefits against severe disease in high-risk groups.
- Progress against the IA2030 indicators was stalled due to the impact of the COVID-19 pandemic and was off-track for six of the seven impact goal targets; progress against the target for the introduction of new vaccines is on track driven by the introduction of new vaccines in low-income countries in 2022.
- While there are promising signs of recovery, it is uneven; recovery is especially slow in low-income countries and vulnerable populations living in fragile and conflict-affected settings.
- Low coverage of measles-containing vaccines has increased the risk of large, disruptive outbreaks.
- A shared action agenda for 2023-2024 that sets out a series of short-term and high-level priorities to align the efforts of countries, regions, global partners, and other stakeholders has been developed.
- The action agenda has six trajectories, which are catch-up and strengthening of immunization programmes, equity promotion, regaining control of measles, making the case for investment into immunization, accelerating the introduction of WHO-recommended vaccines, and advancing vaccination in adolescence.
Recommended composition of influenza virus vaccines for use in the 2024 southern hemisphere influenza season
The World Health Organization (WHO) today announced the recommendations for the viral composition of influenza vaccines for the 2024 influenza season in the southern hemisphere. The announcement was made at an information session at the end of a 4-day meeting on the Composition of Influenza Virus Vaccines, a meeting that is held twice annually.
WHO organizes these consultations with an advisory group of experts gathered from WHO Collaborating Centres and WHO Essential Regulatory Laboratories to analyse influenza virus surveillance data generated by the WHO Global Influenza Surveillance and Response System (GISRS). The recommendations issued are used by the national vaccine regulatory agencies and pharmaceutical companies to develop, produce, and license influenza vaccines for the following influenza season.
The periodic update of viruses contained in influenza vaccines is necessary for the vaccines to be effective due to the constant evolving nature of influenza viruses, including those circulating and infecting humans.
The WHO recommends that trivalent vaccines for use in the 2024 southern hemisphere influenza season contain the following:
- an A/Victoria/4897/2022 (H1N1)pdm09-like virus;
- an A/Thailand/8/2022 (H3N2)-like virus; and
- a B/Austria/1359417/2021 (B/Victoria lineage)-like virus.
Cell culture- or recombinant-based vaccines
- an A/Wisconsin/67/2022 (H1N1)pdm09-like virus;
- an A/Massachusetts/18/2022 (H3N2)-like virus; and
- a B/Austria/1359417/2021 (B/Victoria lineage)-like virus.
For quadrivalent egg- or cell culture-based or recombinant vaccines for use in 2024 southern hemisphere influenza season, the WHO recommends inclusion of the following B/Yamagata lineage component:
a B/Phuket/3073/2013 (B/Yamagata lineage)-like virus.
Top donor Germany signs major contribution to WHO for health emergencies; signs host agreement for WHO pandemic hub
Germany deepened its longstanding engagement with WHO on Thursday with two new agreements: one to contribute a further €40 million to WHO’s work in health emergencies, and a second to host the Berlin-based WHO Hub for Pandemic and Epidemic Intelligence.
With the new contribution, Germany has provided €53.5 million so far this year to support WHO’s response to more than 50 active health emergencies.
“This is important because climate disasters, conflicts, and the ongoing pandemic demand urgent action,” said Susanne Baumann, State Secretary of the Federal Foreign Office for Germany (GFFO), whose delegation met with WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Our support is flexible and vital for saving lives around the globe.”
Through the GFFO, the country provides substantial funding to humanitarian crises in Afghanistan, Libya, Ukraine, Yemen, and to Ebola responses in Africa.
Germany is an all-time top donor to WHO’s Contingency Fund for Emergencies (CFE), having contributed €115 million since the CFE’s inception in 2015. The contributions have made a significant impact on the health of people caught up in humanitarian crises; this year alone, CFE funding allowed WHO to bring immediate, lifesaving support to victims of floods in Libya, conflict in Sudan, cholera and diphtheria outbreaks, and earthquakes in Türkiye and Syria.
Of the new €40 million contribution, €20 million goes to the WHO Health Emergencies Appeal 2023, €10 million to the Ukraine emergency, €10 million for emergencies in Africa.
Thursday’s meeting also featured the signing of a host agreement for the WHO Hub for Pandemic and Epidemic Intelligence. The Hub was established with Germany’s support in Berlin in September 2021 to provide the world with better data, analytics and decisions to detect and respond to health emergencies.
Coinciding with the signing of the host agreement in Geneva, the German government held in Berlin a high-level forum “Pandemics: no time for neglect,” which focused on political priorities and actions on pandemic prevention, preparedness, and response, along with financing for resilient health systems. WHO’s Chief Scientist, Dr Jeremy Farrar, and Dr Chikwe Ihekweazu, WHO’s Assistant Director-General for Health Emergency Intelligence and Surveillance Systems, addressed the Forum.
“After last week’s historic political declaration at the UN General Assembly committing to stronger collaboration, investments, and governance to prevent, prepare, and respond to future pandemics, I am appreciative of Germany’s leadership leveraging the political momentum to host this high-level forum,” Dr Tedros said. “We must continue the dialogue to align on strengthening and financing health systems.”
In the coming weeks, Germany will join with WHO in two more Berlin-based events:
- Breaking Barriers: Advancing the One Health Agenda with a Focus on Environment (12-13 October).
- The World Health Summit 2023 (15-17 October) will gather stakeholders from more than 100 countries under the theme: “A Defining Year for Global Health Action.”
In a whole-of-government investment approach, Germany commits funds from its federal ministries: the Ministry of Health, the Ministry of Foreign Affairs, the Ministry for Economic Cooperation and Development, as well as the German Agency for International Cooperation (GIZ), the German Development Bank (KfW), the Ministry of Food and Agriculture, and the Ministry for the Environment.