As World Malaria Day approaches, more than 1 million children in Ghana, Kenya and Malawi have received one or more doses of the world’s first malaria vaccine, thanks to a pilot programme coordinated by WHO. The malaria vaccine pilots, first launched by the Government of Malawi in April 2019, have shown that the RTS,S/AS01 (RTS,S) vaccine is safe and feasible to deliver, and that it substantially reduces deadly severe malaria.
These findings paved the way for the historic October 2021 WHO recommendation for the expanded use of RTS,S among children living in settings with moderate to high malaria transmission. If widely deployed, WHO estimates that the vaccine could save the lives of an additional 40 000 to 80 000 African children each year.
More than US$ 155 million has been secured from Gavi, the Vaccine Alliance to support the introduction, procurement and delivery of the malaria vaccine for Gavi-eligible countries in sub-Saharan Africa. WHO guidance is available to countries as they consider whether and how to adopt RTS,S as an additional tool to reduce child illness and deaths from malaria.
“As a malaria researcher in my early career, I dreamed of the day we would have an effective vaccine against this devastating disease,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This vaccine is not just a scientific breakthrough, it’s life-changing for families across Africa. It demonstrates the power of science and innovation for health. Even so, there is an urgent need to develop more and better tools to save lives and drive progress towards a malaria-free world.”Prospects for new interventions
RTS,S is a first-generation vaccine that could be complemented in the future by other vaccines with similar or higher efficacy. WHO welcomes progress in the development of R21/Matrix-M and other malaria vaccine candidates in early clinical development. The successful completion of clinical trials for these vaccines will be important to assess their safety and efficacy profiles. WHO also welcomes the news from BioNTech, manufacturer of the Pfizer-BioNTech COVID-19 vaccine, that it aims to develop a malaria vaccine using mRNA technology.
In the field of vector control, a number of new tools and technologies have been submitted to WHO for evaluation. Should they demonstrate efficacy in controlling the disease, WHO will formulate new recommendations or amend existing ones to support their deployment. These include, for example, new types of insecticide-treated nets, spatial mosquito repellents, gene-drive approaches and sugar baits designed to attract and kill Anopheles mosquitoes.
There are also new medicines in the pipeline. WHO welcomes the recent approval by the Australian Therapeutic Goods Administration of dispersible tablets of single-dose tafenoquine for the prevention of P. vivax malaria among children. Tafenoquine has also been approved for use in adults by the US Federal Drug Administration and by drug regulatory bodies in other countries, including Brazil, Peru and Thailand. As a single dose, tafenoquine is expected to support patient adherence to treatment. The current standard of care requires a 7- or 14-day course of medication.
A number other antimalarial medicines with new modes of action are being developed for the treatment of uncomplicated and severe malaria. Ganaplacide-Lumefantrine, currently in a Phase II clinical trial, is the first non-artemisinin combination therapy and could be an asset in fight against emerging drug-resistant malaria in Africa.
In addition to drug resistance, WHO has reported other pressing threats in the fight against malaria, such as mosquito resistance to insecticides, an invasive malaria vector that thrives in urban and rural areas, and the emergence and spread of mutated P. falciparum parasites that are undermining the effectiveness of rapid diagnostic tests. Innovation in tools and strategies will be critical to contain these threats, together with a more strategic use of the tools that are available today.More investment needed
According to the 2021 World malaria report, global progress in reducing malaria cases and deaths has slowed or stalled in recent years, particularly in countries hardest hit by the disease. The report notes the need for continued innovation in the research and development of new tools if the world is to achieve the 2030 targets of the WHO malaria strategy.
Funding for malaria-related research and development reached just over US$ 619 million in 2020. An average annual R&D investment of US$ 851 million will be needed in the period 2021–2030.Making better use of the tools we have now
Reaching global malaria targets will also require innovations in the way that currently available tools are deployed. Through the “ High burden to high impact” approach, launched by WHO and the RBM Partnership to End Malaria in 2018, countries hardest hit by malaria have been collecting and analysing malaria data to better understand the geographical spread of the disease.
Instead of applying the same approach to malaria control everywhere, they are considering the potential impact of tailored packages of interventions informed by local data and the local disease setting. These analyses will enable countries to use available funds in a more effective, efficient and equitable way.Note to the editor:
For more information on the WHO World Malaria Day campaign, visit: https://www.who.int/campaigns/world-malaria-day/2022More on the RTS,S malaria vaccine and the pilot programme
WHO guidance is now available to countries as they consider whether and how to adopt the RTS,S vaccine into their national malaria control strategies. The WHO recommendation for the vaccine was recently added to WHO’s consolidated malaria guidelines, and WHO has also published an updated position paper on the vaccine.
To date, in routine use, the vaccine has been well accepted by African communities. Demand for the vaccine is expected to outstrip supply in the near to medium term; current vaccine production capacity stands at a maximum of 15 million doses per year, while demand is estimated to exceed 80 million doses annually.
WHO is working with partners to increase supply through increased manufacturing capacity of RTS,S and by facilitating the development of other first-generation and next-generation malaria vaccines. To guide where initial doses of the vaccine will be deployed, WHO is coordinating the development of a framework for the allocation of limited malaria vaccine supply; the aim is to prioritize areas of greatest need and highest malaria burden until supply meets demand.
The RTS,S pilot programme is made possible by an unprecedented collaboration between in-country and international partners, including Ministries of Health of Ghana, Kenya and Malawi; in-country evaluation partners; PATH, GSK, UNICEF and others; and the funding bodies of Gavi, the Global Fund and Unitaid.
The RTS,S malaria vaccine is the result of 30 years of research and development by GSK and through a partnership with PATH, with support from a network of African research centres.
General Assembly adopts consensus resolution welcoming 2022 World Cup football championship hosted by Qatar as first to be held in Middle East
The U.N. General Assembly passed a resolution welcoming the 2022 FIFA World Cup Qatar football championship and hailed the promotion of the tournament as a public health benchmark for other nations hosting future mega sporting events.
By the terms of the resolution (document A/76/L.48), which was passed on 8 April, the 193-member Assembly also expressed its support for the launch of “Healthy 2022 World Cup — Creating Legacy for Sport and Health”, a multi-year collaboration
among the International Federation of Association Football, the World Health Organization (WHO) and Qatar, which aims to make the 2022 World Cup a beacon for the promotion of healthy lives, physical and mental health and psychosocial well-being.
The project goals are very closely tied to WHO’s #HealthForAll campaign, which underscores that noncommunicable diseases such as cancer, diabetes, chronic respiratory diseases can be prevented by reducing risk factors such as tobacco use, unhealthy
diets and physical inactivity. After the World Cup ends, the project will be evaluated in an effort to build a legacy aimed at developing and implementing an outreach plan for WHO to identify new opportunities to apply the benchmarks set by Qatar
during the World Cup.
The World Cup is scheduled to be held in Qatar from 21 November to 18 December and will be the first World Cup held in the Middle East. Qatar’s representative, introducing the draft, said the text welcomes her country for hosting the first World Cup in the Middle East, and stresses the importance of community health. Qatar is ready to offer an exceptional event that no one will forget, with authentic hospitality.Read full twitter
Ukraine has joined the growing list of countries that will receive support from the global WHO mRNA technology transfer hub in South Africa. The manufacturer, Darnitsa, was evaluated by WHO and found to have the potential to be able to absorb the mRNA technology to produce vaccines and potentially other health products.
So far, there are 15 selected recipients of the mRNA technology through the WHO hub.
WHO and partners will work with these countries’ governments and with the technology recipients to develop a roadmap and put in place the necessary training and support to enable the technology transfer as effectively as possible.
WHO continues to review applications and to engage with local governments to fulfil the hub’s mission of expanding manufacturing capacity for mRNA vaccines to boost access to these tools in underserved areas.
See full list of mRNA technology recipients through the WHO hub.
Statement on the eleventh meeting of the International Health Regulations (2005) Emergency Committee regarding the coronavirus disease (COVID-19) pandemic
The eleventh meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (2005) (IHR) regarding the coronavirus disease (COVID-19) pandemic took place on Monday 11 April 2022 from 12:00 to 16:30 Geneva time (CEST).Proceedings of the meeting
Members and Advisors of the Emergency Committee were convened by videoconference.
The Director-General welcomed the Committee members and advisers. The Director-General explained that the world has tools to limit transmission, save lives, and protect health systems. He expressed hope in the current epidemiological situation, noting that the world is currently experiencing the lowest number of reported deaths in two years. However, the unpredictable behavior of the SARS-CoV-2 virus and insufficient national responses are contributing to the continued global pandemic context. The Director-General emphasized the importance of States Parties using available medical countermeasures and public health and social measures (PHSM). He highlighted the publication of the updated Strategic Preparedness, Readiness, and Response Plan which provides a roadmap for how the world can end the COVID-19 emergency in 2022 and prepare for future events.
Representatives of the Office of Legal Counsel (LEG) and the Department of Compliance, Risk Management, and Ethics (CRE) briefed the members on their roles and responsibilities. The Ethics Officer from CRE provided the members and advisers with an overview of the WHO Declaration of Interests process. The members and advisers were made aware of 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. They were additionally reminded of their duty to maintain the confidentiality of the meeting discussions and the work of the Committee. Each member who was present was surveyed. No conflicts of interest were identified.
The Secretariat turned the meeting over to the Chair, Professor Didier Houssin, who reviewed the objectives and agenda of the meeting.
The Secretariat presented on the current status of the COVID-19 pandemic and a vision for how to optimize the ongoing response to the COVID-19 pandemic for 2022. The presentation focused on:
- the global epidemiological context and factors that continue to drive transmission;
- updates on international traffic as well as COVID-19 proof of vaccination and test result certificates;
- the status of COVID-19 vaccination; and
- the strategic objectives for countries to incorporate in their COVID-19 response.
The Committee discussed key issues including SARS-CoV-2 variants; use and equitable access to antivirals; vaccine protection and global shifts in the supply and demand for COVID-19 vaccines; hybrid immunity; potential future scenarios for SARS-CoV-2 transmission and challenges posed by concurrent health emergencies; and how Member States are responding to the COVID-19 pandemic. The Committee also noted with concern the growing fatigue among communities worldwide in response to the COVID-19 pandemic and challenges posed by the lack of trust in scientific guidance and governments.
The Committee recognized that SARS-CoV-2 is a novel respiratory pathogen that has not yet established its ecological niche. SARS-CoV-2 continues to have unpredictable viral evolution, which is compounded by its wide-spread circulation and intense transmission in humans, as well as widespread introduction of infection to a range of animal species with potential for animal reservoirs to be established. SARS-COV-2 is continuing to cause high levels of morbidity and mortality, particularly among vulnerable human populations. In this context, the Committee raised concerns that the inappropriate use of antivirals may lead to the emergence of drug-resistant variants. In addition, Committee members acknowledged national, regional, and global capacities to respond to the COVID-19 pandemic context, but noted with concern that some States Parties have relaxed PHSM and reduced testing, impacting thus the global ability to monitor evolution of the virus. The Committee also noted with concern the inconsistency of global COVID-19 requirements for international travel and the negative impact that inappropriate measures may have on all forms of international travel. In this context, the Committee noted that offering vaccination to high-risk groups of international travelers on arrival could be considered a means to mitigate the risk of severe disease or death due to COVID-19 among these individuals.
The Committee stressed the importance of maintaining PHSM to protect vulnerable populations, and maintaining the capacity to scale up PHSM if the epidemiological situation changes. States Parties are advised to regularly adjust their response strategies by monitoring their epidemiological situation (including through use of rapid tests), assessing their health system capacity, and considering the adherence to and attributable impact of individual and combined PHSM.
In addition, the Committee reinforced the continued need for international cooperation and coordination for surveillance, as well as for robust and timely reporting to global systems (such as the Global Influenza Surveillance and Response System) to inform national, regional, and global response efforts. Surveillance activities require coordination between the human and animal sectors and more global attention on the detection of animal infections and possible reservoirs among domestic and wild animals. Timely and systematic monitoring and data sharing on SARS-CoV-2 infection, transmission and evolution in humans and animals will assist global understanding of the virus epidemiology and ecology, the emergence of new variants, their timely identification, and assessment of their public health risks. Continued provision of technical support and guidance from all three levels of the WHO can enable States Parties’ adjustment of COVID-19 surveillance and its integration into respiratory pathogen surveillance systems.
The Committee acknowledged that COVID-19 vaccination is a key tool to reduce morbidity and mortality and reinforced the importance of vaccination (primary series and booster doses, including through heterologous vaccine schedules). The Committee expressed appreciation for WHO and partners’ work to enhance global vaccine supply and distribution. Committee members highlighted the challenges posed by limited vaccination protection, particularly in low-income countries, as well as by waning population-level immunity. As outlined in the SAGE roadmap, vaccination should be prioritized for high-risk groups such as health workers, older adults, and immune-compromised populations, refugees, and migrants. To enhance vaccine uptake, States Parties are encouraged to address national and sub-national barriers for vaccine deployment and to ensure COVID-19 response measures align with and strengthen immunization activities and primary health services.
In addition, the Committee noted the continued importance of WHO’s provision of guidance, training, and tools to support States Parties’ recovery planning process from the COVID-19 pandemic and future respiratory pathogen pandemic preparedness planning.
The Committee unanimously agreed that the COVID-19 pandemic still constitutes an extraordinary event that continues to adversely affect the health of populations around the world, poses an ongoing risk of international spread and interference with international traffic, and requires a coordinated international response. The Committee stressed the importance for States Parties to prepare for future scenarios with the assistance of WHO and to continue robust use of the essential tools (e.g. vaccines, therapeutics, and diagnostics). The Committee concurred that the COVID-19 pandemic remains a PHEIC and offered its advice to the Director-General.
The Director-General determined that the COVID-19 pandemic continues to constitute a PHEIC. He accepted the advice of the Committee and issued the Committee’s advice to States Parties as Temporary Recommendations under the IHR.
The Emergency Committee will be reconvened within three months or earlier, at the discretion of the Director-General. The Director-General thanked the Committee for its work.
Temporary Recommendations to States Parties
The Committee identified the following actions as critical for all countries:
- NEW: 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 and Response Plan (SPRP). States Parties should conduct assessments (e.g. intra action and after action reviews) to inform current and future response and preparedness efforts. WHO Strategic Preparedness and Response Plan (SPRP)
- MODIFIED: Achieve national COVID-19 vaccination targets in line with global WHO recommendations of at least 70% of all countries’ populations vaccinated by the start of July 2022. States Parties are requested to support global equitable access to vaccines and to prioritize vaccination of high-risk populations through a primary series and booster schedule. These populations include health workers, older people, people with underlying conditions, immune-compromised, refugees, migrants, people living in fragile settings, and individuals with insufficient access to treatment. States Parties should continually assess their vaccine coverage and epidemiological situation in relation to the COVID-19 pandemic and modify their national responses accordingly. WHO SAGE Prioritization Roadmap
- MODIFIED: Continue to use evidence-informed and risk-based PHSM. State Parties should be prepared to scale up PHSM rapidly in response to changes in the virus and the population immunity, if COVID-19 hospitalizations, intensive care admissions, and fatalities increase and compromise the health system’s capacity. States Parties are advised to continue the risk-based use of basic PHSM (e.g. wearing masks, staying home when sick, increased hand washing, and improving ventilation of indoor spaces, even in periods of low circulation of SARS-CoV-2). Considerations for implementing and adjusting public health and social measures in the context of COVID-19
- 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 when conducting this risk assessment and planning events, in line with WHO guidance. Key planning recommendations for mass gatherings in the context of COVID-19
- MODIFIED: Adjust COVID-19 surveillance to focus on the burden and impact 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, and deaths). States Parties should integrate respiratory disease surveillance 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, such as use of wastewater surveillance; 3) monitor severity in vulnerable groups; and 4) enhance genomic surveillance to detect 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
- MODIFIED: Ensure availability of 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 and young adults. 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
- MODIFIED: Lift international traffic bans and continue to adjust travel measures, based on risk assessments. The failure of travel bans introduced after the detection and reporting of Omicron variant to limit international spread of Omicron demonstrates the ineffectiveness of such measures over time. The implementation of travel measures (such as vaccination, screening, including via testing, isolation/quarantine of travelers) should be based on risk assessments and should avoid placing the financial burden on international travelers, in accordance with Article 40 of the IHR. WHO advice for international traffic in relation to the SARS-CoV-2 Omicron variant
- MODIFIED: 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
- MODIFIED: Address risk communications and community engagement challenges, proactively counter misinformation and disinformation, and include communities in decision making. To re-build trust and address pandemic fatigue, States Parties should explain clearly and transparently changes to their response strategy. WHO risk communications resources
- MODIFIED: Support timely uptake of WHO recommended therapeutics. Local production and technology transfer should be encouraged and supported as increased production capacity can contribute to global equitable access to therapeutics. States Parties should provide access to COVID-19 treatments for vulnerable populations, particularly immunosuppressed people as this can also reduce the likelihood of new variants’ emergence. Therapeutics and COVID-19: living guideline
- MODIFIED: 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 faciliate 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
WHO, Ghana and Norway agree to accelerate actions to save lives in first International Strategic Dialogue on Noncommunicable Diseases and the Sustainable Development Goals
WHO welcomes the establishment of a new Heads of State and Government Group to accelerate progress towards the SDG target for noncommunicable diseases ̶ a one-third reduction in “premature” deaths from diseases like diabetes, cancer, heart and lung disease and the promotion of mental health and well-being.
The decision was taken at the inaugural International Strategic Dialogue on Noncommunicable Diseases (NCDs) and the Sustainable Development Goals, held today in Accra, Ghana, where a new Global Compact on NCDs was launched. The dialogue was co-hosted by WHO, together with the Governments of Ghana and Norway.
Heads of State highlighted the urgency of the NCD pandemic, which kills 7 out of 10 people globally from risk factors like tobacco, alcohol, unhealthy diet, physical inactivity, and air pollution.
NCDs are largely preventable and treatable, nearly 7 million lives could be saved for just US$ 0.84 per person per year from now until 2030. This investment would realize more than US$ 230 billion in economic and societal benefits and avert nearly 10 million heart attacks and strokes globally by 2030.
The Heads of States and Governments Group announced that it will gather countries championing the NCD agenda and will convene annually at the UN General Assembly. The first meeting is expected to take place in September 2022.
The NCD Compact will focus on five key areas of commitment:
- saving, by 2030, the lives of 50 million people from dying prematurely of NCDs by implementing the most cost-effective measures to prevent and control NCDs;
- protecting 1.7 billion people living with NCDs by ensuring that they have access to the medicines and care they need during humanitarian emergencies;
- integrating NCDs within primary health care and universal health coverage;
- comprehensive NCD surveillance and monitoring; and
- meaningfully engaging 1.7 billion people living with NCDs and mental health conditions in policy-making and programming.
The economic, as well as the health, benefits of investing in NCDs was a clear theme at the Dialogue. Norway has been a frontrunner in investment in the fight against NCDs, investing internationally, becoming the first donor country to include NCDs in its international development strategy.
Mr Nana Addo Dankwa Afuko-Addo, President of Ghana, outlined the successes of Ghana in implementing tobacco demand-reduction measures and introducing guidelines for NCD management, but also highlighted the challenges for lower-income countries in accelerating action.
Statements from the meeting:
Mr Nana Addo Dankwa Afuko-Addo, President of Ghana:
“Tacking the phenomenon of NCDs requires leadership to provide visibility to NCD issues. I ask my Heads of State colleagues to join hands with me as we establish a Presidential Group (non-binding), and as we find solutions to NCDs with a roadmap of universal health coverage and the Sustainable Development Goals. In our time, this will be our legacy”.
Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization:
“Apart from the lives they take, NCDs take a heavy toll on economies, cutting down people in their most productive years. Overcoming this challenge requires technical, financial, and above all, political commitment. I thank the Governments of Norway and Ghana for establishing the first Global Heads of State and Government Group on NCDs, and launching the Global NCD Compact 2020-2030.”
Mr Jonas Gahr Støre, Prime Minister of Norway:
"Investing in stronger health systems, service delivery and the prevention of NCDs will make vulnerable populations more resilient to COVID-19 and future pandemics. This is also vital for promoting universal health coverage. NCD prevention, and access to treatment and medicine must be a core component in the efforts to enhance pandemic preparedness and response, and in building back better in the post-pandemic recovery."
Dr Matshidiso Moeti, WHO Regional Director for Africa:
“Noncommunicable diseases account for nearly a third of deaths in Africa, where they not only pose a grave threat to health and well-being, but also blunt socioeconomic development. The commitment reached today marks a crucial step in speeding up the progress against these diseases and their risk factors as well as the suffering and deaths they cause.”