Healthcare Professional Preparedness Checklist For Transport and Arrival of Patients With Confirmed or Possible COVID-19
The emergence of variants of SARS-CoV-2, the virus that causes COVID-19, serve as a powerful reminder that viruses by their very nature mutate, and that the scientific response may need to adapt if they are to remain effective against them.
In light of recent news stories regarding the preliminary data on minimal effectiveness of the AstraZeneca/Oxford vaccine at preventing mild to moderate COVID-19 disease caused by the viral variant B.1.351, it is important to note that primary analysis of data from Phase III trials has so far shown – in the context of viral settings without this variant – that the AstraZeneca/Oxford vaccine offers protection against severe disease, hospitalisation and death. This means it is vitally important now to determine the vaccine’s effectiveness when it comes to preventing more severe illness caused by the B.1.351 variant.
Additional studies will also allow us to confirm the optimal vaccination schedule and its impact on vaccine efficacy. CEPI has announced funding for additional clinical research to optimize and extend the use of existing vaccines, which could include "mix-and-match" studies of different vaccines used in combinations that may improve the quality and strength of the immune response. Such studies could be useful in optimizing the use of available vaccines, including the AstraZeneca/Oxford vaccine.
The WHO Strategic Advisory Group of Experts on Immunization (SAGE) convened today to review evidence on the AstraZeneca/Oxford vaccine, including emerging evidence on performance against viral variants, and to consider the demonstrated impact of the product and the risk-benefit assessment for use cases with limited data. These recommendations for use of the AstraZeneca product are being finalised and will be presented to the WHO Director-General on 9 Feb 2021.
Even though this recent news on effectiveness of the AstraZeneca/Oxford vaccine against the B.1.351 variant is based on a limited study size which focused on low-risk participants and used interval doses that were not optimized for immunogenicity, these results confirm we must do everything possible to reduce the circulation of the virus, prevent infections and reduce the opportunities for the SARS-CoV-2 to evolve resulting in mutations that may reduce the efficacy of existing vaccines. This means that additionally:
- Manufacturers must be prepared to adjust to the SARS-CoV-2 viral evolution, including potentially providing future booster shots and adapted vaccines, if found to be scientifically necessary.
- Trials must be designed and maintained to allow any changes in efficacy to be assessed, and to be of sufficient scale and diversity to enable clear interpretation of results.
- Enhanced genomic surveillance must be backed by rapid sharing of genetic and meta-data to allow for global coordination and response.
- Priority should be given to vaccinating high-risk groups everywhere in order to ensure maximum global protection against new strains and minimize the risk of transmission.
- Governments and donors, as well as development banks, should further support COVAX in order to ensure equitable access and delivery, as well as meet ongoing research and development costs for next-generation vaccines.
- WHO is enhancing an existing mechanism for tracking and evaluating variants that may affect vaccine composition and expanding that mechanism to provide guidance to manufacturers and countries on changes that may be needed for vaccines.
COVAX was set up to ensure global equitable access to safe and effective COVID-19 vaccines. With the world’s largest actively managed portfolio of COVID-19 vaccine candidates, the COVAX Facility offers its self-financing participants and those eligible for support through the Gavi COVAX Advance Market Commitment access to a diverse range of vaccine candidates, suitable for a broad range of contexts and settings. The ability to deploy vaccines globally to address the evolving pandemic is more critical than ever, as is the importance of coordination to ensure we do not put the impact and value of vaccines at risk. If new vaccines are required, ensuring global access to these is even more essential, as we continue to see that we are all safe only if everyone is safe.
With regards to the AstraZeneca/Oxford vaccine, COVAX has signed advance purchase agreements with AstraZeneca and Serum Institute of India and has published plans to distribute nearly 350 million doses in the first half of the year. We expect a decision this month from WHO on whether the vaccines will be granted emergency use listing (EUL) as well as a SAGE recommendation on its optimal use. Should EUL be forthcoming, we expect the vaccine to play a key role in our effort to protect high risk persons and to help end the acute phase of the pandemic.
Representatives from the Government of France and the Lyon Metropolis, and representatives of WHO gathered for the annual Statutory meeting of partners of the WHO Lyon Office, held virtually this year. The main objectives of the meeting were to take stock
of achievements in 2020 and review the vision and strategic directions of the office in the context of the COVID-19 pandemic and beyond, discuss on-going and future collaboration with local and national partners in the local scientific environment;
and collaboration with the WHO Academy, the innovative centre for delivering advanced digital and classroom training to health workers and others around the world.
This year the WHO Lyon Office marks 20 years since its opening in February 2001. “The Government of France and the French partners of the WHO Lyon Office recognized the importance of global health security 20 years ago when they played an instrumental role in the establishment of the Lyon Office,” said Dr Michael Ryan, Executive Director of the WHO Health Emergencies Programme. “WHO is extremely grateful to France not only for its longstanding financial and technical support but also for its strategic partnership that is based on a shared vision for better health outcomes for all people around the world,” added Dr Ryan.
The Lyon office was established in 2001 to support national laboratory and surveillance systems for epidemic preparedness and response, after an agreement between WHO, the French government, the Metropolis of Lyon (“la Metropole”) and the Merieux Foundation. The scope of the office was broadened in 2005 with the revision of the International Health Regulations (IHR) and the creation of a new team in charge of health security at ports, airports and ground crossings. The office is now part of the Emergency Preparedness Division, Country Readiness Strengthening department, with three units in charge of Public Health Laboratory Strengthening, Border Health Risk Dissemination and Learning and Training Solutions. Its expertise is fully mobilized to provide support to COVID-19 preparedness and response.
Global health security preparedness and IHR implementation are one the French global health priorities and mentioned as one of the five France-WHO areas of collaboration in the 2020-2025 WHO-France framework agreement signed in 2019.
Moreover, in light of the COVID-19 pandemic, France has contributed 10M EUR to support implementation of the strategic preparedness and response plan, and the Access to COVID-19 Tools (ACT) Accelerator, a unique global partnership that brings together health organizations, scientists, businesses, civil society, and philanthropists to accelerate the development, production and equitable access to COVID-19 tests, treatments and vaccines. The ACT-A was set up in response to a call from G20 Leaders in March 2020 and launched by the WHO, European Commission, France and The Bill & Melinda Gates Foundation in April 2020.
The WHO Guidelines for malaria, launched today, bring together the Organization’s most up-to-date recommendations for malaria in one user-friendly and easy-to-navigate online platform. They are designed to support malaria-affected countries in their efforts to reduce and, ultimately, eliminate a disease that continues to claim more than 400 000 lives each year.
Through the new platform, MAGICapp, users will find:
All official WHO recommendations for malaria prevention (vector control and preventive chemotherapies) and case management (diagnosis and treatment). Recommendations for elimination settings are in development.
Links to other resources, such as guidance on the strategic use of information to drive impact; surveillance, monitoring and evaluation; operational manuals, handbooks, and frameworks; and a glossary of key terms and definitions.
Users can access the evidence that underpins each WHO recommendation through the new web-based platform. There is a feedback tab to help identify recommendations that may need an update or further clarification, and inputs from stakeholders are also welcome by email (firstname.lastname@example.org).Delivering timely, evidence-informed guidance
“These consolidated guidelines represent an important step in our efforts to deliver timely, evidence-based guidance to malaria-endemic countries,” said Dr Pedro Alonso, Director of the WHO Global Malaria Programme. “They will soon become a living resource that is updated periodically as new evidence becomes available, and as WHO guideline development groups bring forward proposals for new or revised recommendations,” he added.
The first version of the Guidelines for malaria – available online only – is a compilation of existing WHO recommendations on malaria and supersedes 2 previous WHO publications: the Guidelines for the treatment of malaria, third edition and the Guidelines for malaria vector control. Four WHO guideline development groups focused on vector control, chemoprevention, treatment and elimination are currently convening to develop new or updated recommendations, and other groups will convene this year to address additional relevant topics.
Recommendations on malaria will continue to be reviewed and, where appropriate, updated based on the latest available evidence through WHO’s transparent and rigorous guidelines review process. Any updated recommendations will always display the date of the most recent revision in the MAGICapp platform. With each update, a new PDF version of the consolidated guidelines will also be available for download
on the WHO website.
Clear, evidence-informed WHO recommendations guide managers of national malaria programmes as they develop polices and strategic plans to combat the disease tailored to the local context; they support decisions around “what to do”. WHO also develops implementation guidance – such as operational and field manuals – to advise countries on “how to” deliver the recommended tools and strategies.
The consolidation of WHO’s malaria guidelines is one of a number of actions the Organization has undertaken in recent years to make its guidance more accessible to end users in malaria-endemic countries. The overall aim is to deliver timely, high quality recommendations through processes that are more transparent, consistent, efficient and predictable.Key definitions
A WHO guideline is defined broadly as any information product developed by WHO that contains recommendations for clinical practice or public health policy.
A recommendation tells the intended end-user
of a guideline what he or she can or should do in specific situations to achieve the best health outcomes possible, individually or collectively. It offers a choice among different interventions or measures having an anticipated positive impact on health
and implications for the use of resources.
The critical concentrations for culture-based phenotypic drug susceptibility testing (DST) to first-line anti-TB drugs have been revised by the the World Health Organization (WHO). Critical concentrations for rifampicin have been lowered while those for isoniazid have been maintained at the present level. This update helps address the discordance observed between phenotypic and molecular methods to detect rifampicin resistance and improves the accuracy of DST. As a result patients with TB will have a more accurate diagnosis.
The revision was the outcome of a Technical Expert Group meeting convened by WHO in 2020 to assess the results of a systematic review of published literature on critical concentrations for DST of the most important first-line anti-TB drugs, isoniazid and the rifamycins (rifampicin, rifabutin and rifapentine). New evidence showed that critical concentrations used for phenotypic methods to detect rifampicin resistance may incorrectly classify strains with certain mutations. The following media were considered: Löwenstein-Jensen (LJ), Middlebrook 7H10 (7H10), Middlebrook 7H11 (7H11) and BACTEC™ Mycobacterial Growth Indicator Tube™ 960 (MGIT).
Guidance has been provided to resolve discordance between genotypic and phenotypic results for these drugs and areas for further research have been highlighted. The full report is available here.
DST methods continue to have a very important role to identify resistance not detected by molecular assays and to support the interpretation of molecular assays results. However, they require sophisticated laboratory infrastructure, qualified staff and strict quality assurance procedures.
The Clinical Management of Patients with COVID-19 course series is developed for healthcare workers during the COVID-19 pandemic. It provides crucial knowledge necessary to provide safe, effective quality patient care. Presentations address all aspects of clinical management, including facility preparation and surge planning; health worker infection prevention and control; interfacility transfer; clinical management of mild, moderate, and severely ill patients with COVID-19; special considerations for geriatric, pregnant, and pediatric patients with COVID-19; rehabilitation; and ethics and palliative care.
The course series consists of 6 courses, which include video lectures and downloadable presentations that have been updated with the latest guidance and evidence. Each course contains 5-8 modules, and each module includes a quiz to evaluate knowledge acquisition.
The sixth course of the Clinical Management of Patients with COVID-19 course series is devoted to the rehabilitation of patients with COVID-19. The seven course modules address the manifold and varied rehabilitation needs of patients recovering from COVID-19, including patients with cognitive impairment, physical deconditioning and weakness, respiratory impairment, swallow impairment, communication impairment and challenges in completing Activities of Daily Living (ADLs). Techniques for rehabilitation also are addressed.- Access the course