Comprehensive cholera statistics for 2022, published by WHO today, shed light on the scale and extent of the ongoing cholera upsurge.
While data for cholera remain inadequate, cases reported to WHO in 2022 were more than double those in 2021. Forty-four countries reported cases, a 25% increase from the 35 countries that reported cases in 2021.
Not only were there more outbreaks, but the outbreaks were larger. Seven countries –Afghanistan, Cameroon, Democratic Republic of the Congo, Malawi, Nigeria, Somalia, Syrian Arab Republic–have each reported over 10 000 suspected and confirmed cases. The larger the outbreak, the harder it typically is to control.
Cholera is an acute intestinal infection that spreads through food and water contaminated with faeces containing the bacterium Vibrio cholerae. It is closely linked to the lack of adequate safe water and sanitation, due to underdevelopment, poverty and conflict. Climate change too is playing a role in this upsurge as extreme climate events like floods, droughts and cyclones trigger new outbreaks and worsen existing ones.
Current data for 2023 suggest that this global upsurge is continuing. Twenty-four countries are currently reporting active outbreaks, with some countries in the midst of acute crises.
The increased demand for cholera materials has been a challenge for disease control efforts globally. Since October 2022, the International Coordinating Group (ICG)—the body which manages emergency supplies of vaccines—has suspended the standard two-dose vaccination regimen in cholera outbreak response campaigns, using instead a single-dose approach.
WHO is supporting countries to respond to cholera outbreaks on an emergency footing through the strengthening of public health surveillance, case management, and prevention measures; providing essential medical supplies; coordinating field deployments with partners; and supporting risk communication and community engagement.WHO has appealed for US$ 160.4 million to respond to cholera through the global strategic preparedness, readiness and response plan. US$ 16.6 million has been released from the WHO Contingency Fund for Emergencies for cholera response in 2022 and 2023.
World leaders at the United Nations General Assembly’s High-Level Meeting on Tuberculosis have approved a Political Declaration with ambitious new targets for the next five years to advance the global efforts towards ending the TB epidemic.
The targets include reaching 90% of people with TB prevention and care services, using a WHO-recommended rapid test as the first method of diagnosing TB; providing social benefit packages to all people with TB; licensing at least one new TB vaccine; and closing funding gaps for TB implementation and research by 2027.
“For millennia, our ancestors have suffered and died with tuberculosis, without knowing what it was, what caused it, or how to stop it,” said Dr Tedros Adhanom Ghebreyesus. “Today, we have knowledge and tools they could only have dreamed of. The political declaration countries approved today, and the targets they have set, are a commitment to use those tools, and develop new ones, to write the final chapter in the story of TB.”Progress made towards 2018 targets
Taking stock of progress towards targets set in 2018 for a five-year period, WHO reported that while global efforts to combat TB have saved over 75 million lives since the year 2000, they fell short of reaching the targets, mainly due to severe disruptions to TB services caused by the COVID-19 pandemic and ongoing conflicts. Only 34 million people of the intended 40 million people with TB were reached with treatment between 2018 and 2022. For TB preventive treatment, the situation was even more grim, with only 15.5 million of the 30 million people targeted to be reached with preventive treatment accessing it.
Funding for TB services in low- and middle-income countries fell from US$ 6.4 billion in 2018 to US$ 5.8 billion in in 2022, representing a 50% financing gap in implementing the required TB programmes. Annual funding for TB research ranged from US$ 0.9 billion to US$ 1.0 billion between 2018 and 2022, which is just half of the target set in 2018.
This has placed an even heavier burden on those affected, especially the most vulnerable. Today, TB remains one of the world’s top infectious killers: annually more than 10 million people fall sick, and over 1 million lose their lives to this preventable and curable disease. Drug-resistant TB continues to be a major contributor to antimicrobial resistance with close to half a million people developing drug-resistant TB every year.
“Uniting around the TB response by world leaders, for a second time, provides an opportunity to accelerate action and strengthen health systems capable of not only addressing the TB epidemic, but also protecting the broader health and well‑being of communities, strengthening pandemic preparedness and building on lessons learnt during the COVID-19 pandemic,” said Dr Tereza Kasaeva, Director of the WHO Global TB Programme. “Averting TB-related financial hardship and preventing the development of the disease in vulnerable groups will help diminish inequities within and between countries, contributing to the achievement of the Sustainable Development Goals.”
TB incidence and deaths have risen between 2020 and 2021 but coordinated efforts by countries, WHO and partners are resulting in a recovery of essential services.Launch of the TB vaccine accelerator council
In the lead-up to this historic meeting, WHO Director-General, Dr Tedros Adhanom Ghebreyesus, officially launched the TB vaccine accelerator council to facilitate the development, licensing and use of new TB vaccines. The Council, supported by the WHO secretariat, will be led by a ministerial board, consisting of nine members who will serve on a rotating basis, for a term of two years. The Council will also have subsidiary bodies to support its interaction and engagement with different sectors and stakeholders broadly, including the private sector, scientists, philanthropy, and civil society.
BCG is currently the only licensed TB vaccine. While it provides moderate efficacy in preventing severe forms of TB in infants and young children, it does not adequately protect adolescents and adults, who account for the majority (>90%) of TB transmission globally.
The Council aims to identify innovative sustainable financing, market solutions and partnerships across public, private, and philanthropic sectors. It will leverage platforms like the African Union, Association of Southeast Asian Nations (ASEAN), BRICS countries (Brazil, Russian Federation, India, China and South Africa), G20, G7 and others to strengthen commitment and actions for novel TB vaccine development and access.
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Dead bodies from natural disasters and conflict do not generally pose health risks, Red Cross and WHO say
Amid devastating loss of life due to disasters and conflict, there is often unfounded fear and misunderstanding concerning the dead. It is therefore important that communities have the tools and information they need to manage dead bodies safely and with dignity. This is in part to help survivors along the path to recovery, the International Federation of the Red Cross and Red Crescent Societies (IFRC), the International Committee of the Red Cross (ICRC) and the World Health Organization (WHO) said today.
When many people die in natural disasters or armed conflict, the presence of these bodies is distressing for affected communities. Some may move quickly to bury bodies, such as in mass graves, in part in an attempt to manage this distress, and sometimes because of the fear that these bodies pose a health threat. This approach can be detrimental to the population, the organizations said.
Though local authorities and communities can be under immense pressure to bury the dead quickly, the consequences of mismanagement of the dead include long lasting mental distress for family members as well as social and legal problems. Well managed burials include easily traceable and properly documented individual graves in demarcated burial sites. This should ensure that the exact location of each dead body, as well as the associated information and personal belongings, is known as outlined in guidance developed by the organizations, in particular the ICRC/IFRC/WHO Manual for the Management of the Dead After Disasters. Cremations should not take place before the body is positively identified.
In order to support better management of the dead, the organizations provide supplies and expertise to local authorities to help them manage the sometimes-overwhelming task of burying the dead. Today in Libya, Red Cross and WHO teams are working directly with authorities, communities and the Libyan Red Crescent Society, supporting them with guidance, materials, and training. The ICRC and WHO are both delivering body bags in Libya to help with the dignified treatment of the dead.
The bodies of people who have died following wounds sustained in a natural disaster or armed conflict almost never pose a health danger to communities. This is because victims who have died from trauma, drowning or fire do not normally harbour organisms that cause disease with common precautions. The exceptions are when deaths occur from infectious diseases such as Ebola or Marburg diseases or cholera, or when the disaster occurred in an area endemic for these infectious diseases.
Under any circumstance, dead bodies near or in water supplies can lead to health concerns, as the bodies may leak feces and contaminate water sources, leading to a risk of diarrheal or other illness. Bodies should not be left in contact with drinking water sources.
“The belief that dead bodies will cause epidemics is not supported by evidence. We see too many cases where media reports and even some medical professionals get this issue wrong,” said Pierre Guyomarch, the head of ICRC’s forensics unit. “Those who survive an event like a natural disaster are more likely to spread disease than dead bodies.”
“We urge authorities in communities touched by tragedy to not rush forward with mass burials or mass cremations. Dignified management of bodies is important for families and communities, and in the cases of conflict, is often an important component of bringing about a swifter end to the fighting,” said Dr Kazunobu Kojima, Medical Officer for biosafety and biosecurity in WHO’s Health Emergencies Programme.
“An unnecessary rush to dispose of bodies of those killed in disasters or conflict deprives families of the opportunity to identify and mourn their loved ones, while providing no public health benefit. Dignified treatment of the dead requires appropriate time to identify the deceased and mourn and perform funeral rites in accordance with local cultural and social norms,” said Gwen Eamer, IFRC’s Senior Officer for Public Health in Emergencies and Head of Emergency Operations, Morocco Earthquake Response.
The ICRC, IFRC and WHO wish to remind authorities and communities of the following:
- While it is distressing to see dead bodies, community leaders or authorities should not hastily bury bodies in mass graves or carry out mass cremations. Burial or cremation procedures must keep in mind cultural, religious, and family concerns.
- The bodies of those who die from natural disasters or armed conflict are generally not a source of disease.
- Unless the deceased has died from a highly infectious disease, the risk to the public is negligible. However, there is a risk of diarrhoea from drinking water contaminated by faecal material from dead bodies. Routine disinfection of drinking water is sufficient to prevent waterborne illness.
- Rapid, disrespectful mass burials or cremations, make identification of the dead and notification to family more difficult and sometimes impossible.
- The only time dead bodies pose a health risk of epidemics is when the deaths resulted from some infectious diseases or when a natural disaster occurs in an area where such a disease is endemic.
- Lime powder does not hasten decomposition, and since dead bodies in disaster or conflict are generally not an infectious risk, the disinfection of these bodies is not needed.
- After any contact with the deceased, hands should be washed with soap and water, or cleaned with alcohol-based hand rub if there is no visible soiling.
The ICRC, IFRC and WHO urge all parties to conflict, and responders in disasters, to follow established principles for the management of dead bodies, for the good of all of society, and have offered further support as needed.
The Drafting Group of the Intergovernmental Negotiating Body (INB) to draft and negotiate a WHO convention, agreement or other international instrument on pandemic prevention, preparedness and response (WHO CA+) held discussions and informal meetings from 4 – 6 September 2023 in order to advance work on a pandemic accord.
During the meeting, informal meetings of the INB Drafting Group discussed the following articles of the INB Bureau’s text: Article 4 (Pandemic prevention and public health surveillance) and Article 5 (Strengthening pandemic prevention and preparedness through a One Health approach) (jointly) co-facilitated by India, United Republic of Tanzania and the United Kingdom; Article 9 (Research and development) co-facilitated by Mexico and Norway; Article 11 (Co-development and transfer of technology and know-how) co-facilitated by Colombia, the Philippines and Saudi Arabia; Article 12 (Access and benefit-sharing) co-facilitated by Australia and Ethiopia; and Article 13 (Supply chain and logistics) co-facilitated by Indonesia and Pakistan.
The INB will hold additional co-facilitated informal meetings of the drafting group on Articles 4 and 5 (jointly), 11, and 12 by 22 September 2023, when the INB Drafting Group will resume its work to take stock of progress achieved through these informal meetings.
The INB Bureau will develop a proposal for negotiating text of the WHO CA+ for the consideration of the INB at its next meeting, based on the discussions of the INB from its fourth, fifth, and sixth meetings, as well as the meeting of the INB Drafting Group, including its informal meetings, and the reports of the co-facilitators of those informal meetings. It was agreed that the proposal for negotiating text would be without prejudice to the right of any Member State to present textual proposals and to the status of the compilation document.
It was decided that the seventh meeting of the INB will take place from 6-10 November and will resume from 4-6 December 2023, to allow the presentation and consideration of the negotiating text of the WHO CA+.