#EndTB Webinar: From Policy to Practice: Rolling out new WHO guidelines on rapid diagnostics and drug-resistant TB treatment

2 months 1 week ago
A special #EndTB Webinar organized by the World Health Organization (WHO) to provide key updates on recently released new WHO guidance on rapid diagnostics and drug-resistant TB treatment. The aim of the webinar is to facilitate better understanding of the guidance to enable its rapid uptake in countries by national programmes and other key stakeholders. This will translate to earlier access to quality diagnosis and treatment, and better outcomes for the millions affected by TB and drug-resistant TB.

WHO discontinues hydroxychloroquine and lopinavir/ritonavir treatment arms for COVID-19

2 months 1 week ago

WHO today accepted the recommendation from the Solidarity Trial’s International Steering Committee to discontinue the trial’s hydroxychloroquine and lopinavir/ritonavir arms. The Solidarity Trial was established by WHO to find an effective COVID-19 treatment for hospitalized patients.

The International Steering Committee formulated the recommendation in light of the evidence for hydroxychloroquine vs standard-of-care and for lopinavir/ritonavir vs standard-of-care from the Solidarity trial interim results, and from a review of the evidence from all trials presented at the 1-2 July WHO Summit on COVID-19 research and innovation. 

These interim trial results show that hydroxychloroquine and lopinavir/ritonavir produce little or no reduction in the mortality of hospitalized COVID-19 patients when compared to standard of care. Solidarity trial investigators will interrupt the trials with immediate effect. 

For each of the drugs, the interim results do not provide solid evidence of increased mortality. There were, however, some associated safety signals in the clinical laboratory findings of the add-on Discovery trial, a participant in the Solidarity trial. These will also be reported in the peer-reviewed publication. 

This decision applies only to the conduct of the Solidarity trial in hospitalized patients and does not affect the possible evaluation in other studies of hydroxychloroquine or lopinavir/ritonavir in non-hospitalized patients or as pre- or post-exposure prophylaxis for COVID-19. The interim Solidarity results are now being readied for peer-reviewed publication.



WHO: access to HIV medicines severely impacted by COVID-19 as AIDS response stalls

2 months 1 week ago

Seventy-three countries have warned that they are at risk of stock-outs of antiretroviral (ARV) medicines as a result of the COVID-19 pandemic, according to a new WHO survey conducted ahead of the International AIDS Society’s biannual conference. Twenty-four countries reported having either a critically low stock of ARVs or disruptions in the supply of these life-saving medicines. 

The survey follows a modelling exercise convened by WHO and UNAIDS in May which forecasted that a six-month disruption in access to ARVs could lead to a doubling in AIDS-related deaths in sub-Saharan Africa in 2020 alone.

In 2019, an estimated 8.3 million people were benefiting from ARVs in the 24 countries now experiencing supply shortages. This represents about one third (33%) of all people taking HIV treatment globally.  While there is no cure for HIV, ARVs can control the virus and prevent onward sexual transmission to other people.

A failure of suppliers to deliver ARVs on time and a shut-down of land and air transport services, coupled with limited access to health services within countries as a result of the pandemic, were among the causes cited for the disruptions in the survey.

The findings of this survey are deeply concerning,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Countries and their development partners must do all they can to ensure that people who need HIV treatment continue to access it. We cannot let the COVID-19 pandemic undo the hard-won gains in the global response to this disease.

Stalled progress

According to data released today from UNAIDS and WHO, new HIV infections fell by 39% between 2000 and 2019. HIV-related deaths fell by 51% over the same time period, and some 15 million lives were saved through the use of antiretroviral therapy.

However, progresstowards global targets is stalling. Over the last two years, the annual number of new HIV infections has plateaued at 1.7 million and there was only a modest reduction in HIV-related death, from 730 000 in 2018 to 690 000 in 2019.  Despite steady advances in scaling up treatment coverage – with more than 25 million people in need of ARVs receiving them in 2019 – key 2020 global targets will be missed.

HIV prevention and testing services are not reaching the groups that need them most. Improved targeting of proven prevention and testing services will be critical to reinvigorate the global response to HIV.

WHO guidance and country action

COVID-19 risks exacerbating the situation. WHO recently developed guidance for countries on how to safely maintain access to essential health services during the pandemic, including for all people living with or affected by HIV. The guidance encourages countries to limit disruptions in access to HIV treatment through “multi-month dispensing,” a policy whereby medicines are prescribed for longer periods of time – up to six months. To date, 129 countries have adopted this policy.

Countries are also mitigating the impact of the disruptions by working to maintain flights and supply chains, engaging communities in the delivery of HIV medicines, and working with manufacturers to overcome logistics challenges.

New opportunities to treat HIV in young children

At the IAS conference, WHO will highlight how global progress in reducing HIV-related deaths can be accelerated by stepping up support and services for populations disproportionately impacted by the epidemic, including young children. In 2019, there were an estimated 95 000 HIV-related deaths and 150 000 new infections among children. Only about half (53%) of children in need of antiretroviral therapy were receiving it.  A lack of optimal medicines with suitable pediatric formulations has been a longstanding barrier to improving health outcomes for children living with HIV.

Last month, WHO welcomed a decision by the U.S. Food and Drug Administration to approve a new 5mg formulation of dolutegravir (DTG) for infants and children older than 4 weeks and weighing more than 3 kg. This decision will ensure that all children have rapid access to an optimal drug that, to date, has only been available for adults, adolescents and older children. WHO is committed to fast-tracking the prequalification of DTG as a generic drug so that it can be used as soon as possible by countries to save lives. 

Through a collaboration of multiple partners, we are likely to see generic versions of dolutegravir for children by early 2021, allowing for a rapid reduction in the cost of this medicine,” said Dr Meg Doherty, Director of the Department of Global HIV, Hepatitis and STI Programmes at WHO. “This will give us another new tool to reach children living with HIV and keep them alive and healthy.”

Tackling opportunistic infections

Many HIV-related deaths result from infections that take advantage of an individual’s weakened immune system. These include bacterial infections, such as tuberculosis, viral infections like hepatitis and COVID-19, parasitic infections such as toxoplasmosis and fungal infections, including histoplasmosis.

Today, WHO is releasing new guidelines for the diagnosis and management of histoplasmosis, among people living with HIV. Histoplasmosis is highly prevalent in the WHO Region of the Americas, where as many as 15 600 new cases and 4500 deaths are reported each year among people living with HIV. Many of these deaths could be prevented through timely diagnosis and treatment of the disease.

In recent years, the development of highly sensitive diagnostic tests has allowed for a rapid and accurate confirmation of histoplasmosis and earlier initiation of treatment. However, innovative diagnostics and optimal treatments for this disease are not yet widely available in resource-limited settings.

 

As more go hungry and malnutrition persists, achieving Zero Hunger by 2030 in doubt, UN report warns

2 months 1 week ago

Rome – More people are going hungry, an annual study by the United Nations has found. Tens of millions have joined the ranks of the chronically undernourished over the past five years, and countries around the world continue to struggle with multiple forms of malnutrition.

The latest edition of the State of Food Security and Nutrition in the World, published today, estimates that almost 690 million people went hungry in 2019 – up by 10 million from 2018, and by nearly 60 million in five years. High costs and low affordability also mean billions cannot eat healthily or nutritiously. The hungry are most numerous in Asia but expanding fastest in Africa. Across the planet, the report forecasts, the COVID-19 pandemic could tip over 130 million more people into chronic hunger by the end of 2020. (Flare-ups of acute hunger in the pandemic context may see this number escalate further at times.)

The State of Food Security and Nutrition in the World is the most authoritative global study tracking progress towards ending hunger and malnutrition. It is produced jointly by the Food and Agriculture Organization of the United Nations (FAO), the International Fund for Agriculture (IFAD), the United Nations Children’s Fund (UNICEF), the UN World Food Programme (WFP) and the World Health Organization (WHO).

Writing in the foreword, the heads of the five agencies warn that “five years after the world committed to end hunger, food insecurity and all forms of malnutrition, we are still off-track to achieve this objective by 2030".

 

The hunger numbers explained

In this edition, critical data updates for China and other populous countriesii have led to a substantial cut in estimates of the global number of hungry people, to the current 690 million. Nevertheless, there has been no change in the trend. Revising the entire hunger series back to the year 2000 yields the same conclusion: after steadily diminishing for decades, chronic hunger slowly began to rise in 2014 and continues to do so.

Asia remains home to the greatest number of undernourished (381 million). Africa is second (250 million), followed by Latin America and the Caribbean (48 million). The global prevalence of undernourishment – or overall percentage of hungry people – has changed little at 8.9 percent, but the absolute numbers have been rising since 2014. This means that over the last five years, hunger has grown in step with the global population.

This, in turn, hides great regional disparities: in percentage terms, Africa is the hardest hit region and becoming more so, with 19.1 percent of its people undernourished. This is more than double the rate in Asia (8.3 percent) and in Latin America and the Caribbean (7.4 percent). On current trends, by 2030, Africa will be home to more than half of the world’s chronically hungry.

 

The pandemic’s toll

As progress in fighting hunger stalls, the COVID-19 pandemic is intensifying the vulnerabilities and inadequacies of global food systems – understood as all the activities and processes affecting the production, distribution and consumption of food. While it is too soon to assess the full impact of the lockdowns and other containment measures, the report estimates that at a minimum, another 83 million people, and possibly as many as 132 million, may go hungry in 2020 as a result of the economic recession triggered by COVID-19.iii The setback throws into further doubt the achievement of Sustainable Development Goal 2 (Zero Hunger).

 

Unhealthy diets, food insecurity and malnutrition

Overcoming hunger and malnutrition in all its forms (including undernutrition, micronutrient deficiencies, overweight and obesity) is about more than securing enough food to survive: what people eat – and especially what children eat – must also be nutritious. Yet a key obstacle is the high cost of nutritious foods and the low affordability of healthy diets for vast numbers of families.

The report presents evidence that a healthy diet costs far more than US$ 1.90/day, the international poverty threshold. It puts the price of even the least expensive healthy diet at five times the price of filling stomachs with starch only. Nutrient-rich dairy, fruits, vegetables and protein-rich foods (plant and animal-sourced) are the most expensive food groups globally.

The latest estimates are that a staggering 3 billion people or more cannot afford a healthy diet. In sub-Saharan Africa and southern Asia, this is the case for 57 percent of the population – though no region, including North America and Europe, is spared. Partly as a result, the race to end malnutrition appears compromised. According to the report, in 2019, between a quarter and a third of children under five (191 million) were stunted or wasted – too short or too thin. Another 38 million under-fives were overweight. Among adults, meanwhile, obesity has become a global pandemic in its own right.

 

A call to action

The report argues that once sustainability considerations are factored in, a global switch to healthy diets would help check the backslide into hunger while delivering enormous savings. It calculates that such a shift would allow the health costs associated with unhealthy diets, estimated to reach US$ 1.3 trillion a year in 2030, to be almost entirely offset; while the diet-related social cost of greenhouse gas emissions, estimated at US$ 1.7 trillion, could be cut by up to three-quarters.iv The report urges a transformation of food systems to reduce the cost of nutritious foods and increase the affordability of healthy diets. While the specific solutions will differ from country to country, and even within them, the overall answers lie with interventions along the entire food supply chain, in the food environment, and in the political economy that shapes trade, public expenditure and investment policies. The study calls on governments to mainstream nutrition in their approaches to agriculture; work to cut cost-escalating factors in the production, storage, transport, distribution and marketing of food – including by reducing inefficiencies and food loss and waste; support local small-scale producers to grow and sell more nutritious foods, and secure their access to markets; prioritize children’s nutrition as the category in greatest need; foster behaviour change through education and communication; and embed nutrition in national social protection systems and investment strategies.

The heads of the five UN agencies behind the State of Food Security and Nutrition in the World declare their commitment to support this momentous shift, ensuring that it unfolds “in a sustainable way, for people and the planet.”

 

Media contacts for interview requests (several languages are covered):

FAO – Andre VORNIC, +39 345 870 6985, [email protected]

IFAD – Antonia PARADELA, +34 605 398 109, [email protected]

UNICEF – Sabrina SIDHU, +1 917 476 1537, [email protected]

WFP – Martin PENNER, +39 345 614 2074, [email protected]

WHO – Fadela CHAIB, +41 79 475 5556, [email protected]

----------------------------------------

i For FAO – Qu Dongyu, Director-General; for IFAD – Gilbert F. Houngbo, President; for UNICEF – Henrietta H. Fore, Executive Director; for WFP – David Beasley, Executive Director; for WHO – Tedros Adhanom Ghebreyesus, Director-General.

ii Updates to a key parameter, which measures inequality in food consumption within societies, have been made for 13 countries whose combined population approaches 2.5 billion people: Bangladesh, China, Colombia, Ecuador, Ethiopia, Mexico, Mongolia, Mozambique, Nigeria, Pakistan, Peru, Sudan and Thailand. The size of China’s population, in particular, has had the single largest impact on global numbers.

iii This range corresponds to the most recent expectations of a 4.9 to 10 percent drop in global GDP.

iv The report analyses the “hidden costs” of unhealthy diets and models options involving four alternative diets: flexitarian, pescatarian, vegetarian and vegan. It also acknowledges that some poorer countries’ carbon emissions may initially need to rise to allow them to reach nutrition targets. (The opposite is true of richer countries.)

Poor quality medicines putting the lives of pregnant women at risk

2 months 1 week ago

 

Good-quality medicines, given at the right time, can save the lives of pregnant and recently pregnant women and their newborn babies. New evidence synthesis reveals however, that in many health-care settings across the world, women with life-threatening maternal complications are given poor quality medicines – putting their lives and well-being at grave risk.

The systematic review, authored by staff at WHO Department of Sexual and Reproductive Health and Research including HRP, and collaborators published in PLOS ONE, shows that in many low- and middle-income countries, low-quality medicines are used to manage life-threatening maternal conditions.

Maternal mortalityIt is both tragic and unacceptable that so many women, particularly those living in low- and middle-income countries continue to die from causes related to health complications related to pregnancy, childbirth and the postpartum period. The most recent estimates showed that every day in 2017, approximately 810 women died from preventable causes related to pregnancy and childbirth.  Preventable with the right treatmentFrequent life-threatening maternal complications include post-partum haemorrhage, pre-eclampsia/eclampsia, and sepsis. With timely and effective care and medications, any serious repercussions caused by these complications can often be avoided. Uterotonics (drugs used to stop bleeding, particularly for postpartum haemorrhage) such as oxytocin, are effective in preventing post-partum haemorrhage. Antibiotics administered during labour or after birth can prevent or treat sepsis for both women and their newborn babies. And magnesium sulphate can help to prevent and/ or treat eclampsia. These are medical options that are both affordable and effective. “Out of specification” and poor-quality drugsThere are growing concerns about the negative impact upon health of substandard and falsified medicines (also known as “out of specification” drugs) particularly in low- and middle-income countries. The new systematic review shows, however, that in many health-care settings in low- and middle-income countries, poor quality versions of these drugs are often provided. The findings suggest that this problem could contribute to the persistence of the high numbers of severe complications and deaths caused by pos partum haemorrhage, eclampsia, and sepsis in low- and middle- income countries. 

The new study showed that nearly half (48.9%) of all uterotonic drugs sampled failed quality assessments. 1 in 7 injectable antibiotic samples (13%) and 1 in 29 magnesium sulphate samples (3.4%) were of low quality.

Nearly half of the samples assessed were collected since 2011, indicating that this is an issue of current global concern that requires immediate attention. The study also looked at differences in quality of medicines between the private and public sector, and found that in general, higher failure rates were in the private sector. This finding underlines the crucial need for national procurement bodies or private providers to procure medications that adhere to WHO prequalification, or similar stringent requirements. Quality and dignityEvery woman has the right to quality care before, during and following pregnancy and childbirth. The informed provision of good quality medicines, at the right time, is crucial for ensuring high quality and dignified care for women and their newborn babies.

Health-care providers need also to be able to access good quality medicines in order to properly care for women. They should also receive proper training in how and when to administer these drugs. This is crucial as they work to uphold the Hippocratic oath of ‘do no harm’. Mariana Widmer, a Scientist at WHO and HRP, and an author of the paper reflects, “Health care workers need to be able to know they are truly caring for women, and treating any health complications of pregnancy and childbirth effectively. We need to ensure they receive training to provide medications, and that medications are always good quality.

WHO and partners to help more than 1 billion people quit tobacco to reduce risk of COVID-19

2 months 1 week ago

GENEVA — A new Access Initiative for Quitting Tobacco aims to help the world's 1.3 billion tobacco users quit. Stopping smoking is more important than ever as evidence reveals that smokers are more likely than non-smokers to have severe outcomes from COVID-19.

The project gives people free access to nicotine replacement therapy and to Florence, a digital health worker, based on artificial intelligence that dispels myths around COVID-19 and tobacco and helps people develop a personalized plan to quit tobacco. 

It is being led by the World Health Organization (WHO), together with the UN Interagency Task Force on Non-communicable Diseases, PATH and the Coalition for Access to NCD Medicines and Products, with support from the private sector.

The Secretariat of the WHO FCTC, salutes this initiative. The Head of the Convention Secretariat commented, “This will contribute to Parties’ implementation of Article 14 of the Convention, regarding measures concerning tobacco dependence and cessation. And, as previously said: there has never been a more appropriate time to support people in their efforts to quit tobacco use.”

Dr Ruediger Krech, Director of Health Promotion said that, "We welcome the support of pharmaceutical and tech companies to improve people's health and save lives during COVID-19. The partnership highlights what we can achieve when we work together both to end the pandemic and, moving forward, to build back better."

WHO received its first-ever donation of nicotine replacement therapies for the project from Johnson & Johnson Consumer Health. The manufacturer has donated 37,800 nicotine patches to help 5,400 people in Jordan quit smoking. These efforts will help WHO respond to the ongoing pandemic and improve health outcomes.

Florence was created with technology developed by San Francisco and New Zealand based Digital People company Soul Machines, with support from Amazon Web Services and Google Cloud.

Jordan, which has some of the highest tobacco use rates in the world, will be the first pilot country with additional companies and countries to join in discussion. HRH Princess Dina Mired of Jordan, President for the International Union of Cancer Control said, “I am pleased that Jordan is part of this initiative, which will help advocate for tobacco control and support civil society organizations in their continued efforts for a healthier smoke-free future for Jordan.”

Just last week the Government of Jordan adopted a ban on smoking and vaping indoors in public places. The link between smoking and COVID-19 make it essential for governments to pass comprehensive tobacco control laws that will protect the health of their people during this pandemic and beyond.

Although around 60% of tobacco users worldwide say they want to quit, only 30% of them have access to the tools that can help them do so The Access Initiative for Quitting Tobacco is designed to deliver tobacco cessation services that will help people overcome both physical and mental addictions to tobacco

Infographic

(click on image to download infographic in PDF)
AIQT_Infographic

Study estimates more than one million Indians died from snakebite envenoming over past two decades

2 months 1 week ago

 

India is among the countries most dramatically affected by snakebite and accounts for almost half the total number of annual deaths in the world. Authors of the article entitled Trends in snakebite mortality in India from 2000 to 2019 in a nationally representative mortality study’ analysed 2,833 snakebite deaths from 611,483 verbal autopsies from an earlier study1 and conducted a systematic literature review from 2000-2019 covering 87,590 snake bites.

The authors estimated that India had 1.2 million snakebite deaths (representing an average of 58,000 per year) from 2000 to 2019 with nearly half of the victims aged 30-69 and over a quarter being children under 15.

People living in densely populated low altitude agricultural areas in the states of Bihar, Jharkhand, Madhya Pradesh, Odisha, Uttar Pradesh, Andhra Pradesh (which includes Telangana, a recently defined state), Rajasthan and Gujarat, suffered 70% of deaths during the period 2001-2014, particularly during the rainy season when encounters between snakes and humans are more frequent at home and outdoors.

Russell’s viper (Daboia russelii) (Figure 1), kraits (Bungarus species) and cobras (Naja species; Figure 2) are among the most important biting snake species in India, yet other often unidentified species also represent a threat. 

           

 

Left: Russel's Viper (Photo:David Williams):   Right: Speckled Cobra in a field near an agricultural worker.
         (Photo: Ben Owens)

The World Health Organization (WHO) has set the target of reducing by half the number of deaths due to snakebite envenoming by 2030 and India’s efforts to prevent and control this disease will largely influence this global target.

 Since deaths are restricted mainly to lower altitude, intensely agricultural areas, during a single season of each year, this should make the annual epidemics easier to manage. India’s tremendous snakebite burden is staring us in the face and we need to act now” said Romulus Whitaker of the Centre for Herpetology/Madras Crocodile Bank. “Targeting these areas with education about simple methods, such as ‘snake-safe’ harvest practices, wearing rubber boots and gloves and using rechargeable torches (or mobile phone flashlights) could reduce the risk of snakebites.”

Need for more nationwide epidemiological studies in snakebite endemic countries

Additional nationally representative studies together with increasing mapping resolution and multi-sourced data granularity, including both hospital-based mortality and morbidity data including those collected at the community level, are needed for more targeted and effective public health interventions in other snakebite endemic countries.

The authors also noted that the Government of India’s official declaration of snakebite deaths in public hospitals during the period 2003 to 2015 was only 15,500, one tenth of the 154,000 snakebite deaths detected during this same period by the MDS from public and private hospitals.

Our study directly quantified and identified the populations most affected by fatal snakebites in India. We showed that the overall lifetime risk of being killed by snakebite is about 1 in 250, but in some areas, the lifetime risk reaches 1 in 100” said Prabhat Jha, Director of the Centre for Global Health Research at the University of Toronto, Canada. “Ongoing direct measurement of mortality at local levels is key to achieving WHO’s global roadmap.”

To repair this gross under-reporting, the authors recommend that the Government of India designate and enforce snakebite as a ‘Notifiable Disease’ within the Integrated Disease Surveillance Program. Accurate snakebite data are essential if the Government of India’s strategies to reduce snakebite deaths are to succeed.  

--------------------------------------

1Snakebite Mortality in India: A Nationally Representative Mortality Survey published in PLoS in 2011 and based on the Indian Million Death Study estimated 46,000 annual deaths caused by snakebite in India.

 

Addressing the crisis in antibiotic development

2 months 2 weeks ago

Today, more than 20 leading biopharmaceutical companies are announcing the launch of the AMR Action Fund that will invest in developing innovative antibacterial treatments. The Fund aims to bring 2-4 new treatments to patients by 2030. This initiative is a significant step towards addressing the current crisis in antibacterial treatment development.

“AMR is a slow tsunami that threatens to undo a century of medical progress” highlighted Dr Tedros, Director General of the WHO at the launch event in Berlin. “I very much welcome this new engagement of the private sector in the development of urgently-needed antibacterial treatments. WHO looks forward to working with the AMR Action Fund to accelerate research to address this public health crisis.”

The AMR Action Fund is the result of collaboration among major pharmaceutical companies, the European Investment Bank (EIB), Wellcome Trust and WHO. Since 2018, WHO and the EIB have been advancing an overall concept for an impact investment fund to support the development of antibacterial treatment for public health priorities. This concept was presented and discussed in several international fora including at the Biocom AMR Conference, the World Health Summit  in Berlin, and the World AMR Congress in Washington.

In 2019, a financial model was developed to assess the risks, success rates and the potential financial return of investment in new antibacterial treatments. WHO then played a catalytic role in bringing together the International Federation of Pharmaceutical Manufacturers & Associations, the EIB and Wellcome Trust, providing critical input on the public health priorities and the investment strategy of the AMR Action Fund.

Recent bankruptcies have shown how small antibiotics companies struggle to survive in the current market environment. The process of getting new drugs to market is cost intensive as new antibacterial treatments have to be underpinned with rigorous data that are derived from a series of complex and costly clinical trials to demonstrate their advantages over existing treatment regimens.

The AMR Action Fund will invest, through equity or debt, in small companies developing innovative antibacterial treatments that target existing public health priorities. The annual reviews conducted by WHO of both the preclinical and clinical antibiotic pipeline, together with the recently published target product profiles for missing treatments, will provide detailed guidance in this regard.

The WHO review of the clinical antibiotic pipeline identifies a number of potential investment candidates. Currently, there are only 32 antibacterial treatments, in clinical development, targeting the WHO’s list of priority pathogens and of these, only 6 fulfil at least one of the innovation criteria as defined by WHO.

The latest WHO review of the preclinical pipeline revealed that new and innovative approaches are emerging in the development of antibacterial agents; of the 252 antibacterial agents that were in preclinical development, over one-third were non-traditional products.  The next WHO clinical pipeline review will expand to include non-traditional products such as phages and other new innovative approaches to overcome antibacterial resistance.

 “Investment to ensure promising antibacterial treatments successfully move through to market is a critical step in tackling AMR,” said Dr Haileyesus Getahun, Director of the Department of Global Coordination and Partnership on AMR at WHO. ‘’WHO stands ready to support the AMR Action Fund in its focus on public health priorities and innovative new antibacterial treatments.’’

While the AMR Action Fund is an important step in addressing the challenge of AMR, it will only partly compensate for the rapidly diminishing flow of investment from the private sector and from public funding. Partnerships like the AMR Action Fund, CARB-X and the Global Antibiotic Research and Development Partnership (GARDP), bring together relevant stakeholders and play a crucial synergistic role in improving the current pipeline of antibacterial treatments. GARDP, a foundation that was set up by WHO and the Drugs for Neglected Diseases initiative (DNDi) to develop new treatments for drug-resistant infections posing the greatest threat to public health, is playing an important role in mobilizing more funding from both public and private sectors for public health priorities. GARDP recently partnered with a small company on an innovative beta-lactamase inhibitor that works against serious multidrug resistant bacterial infections.

The launch of the AMR Action Fund represents an important step towards revitalizing antibacterial drug development and also creates the opportunity to address the much needed reforms of the current procurement and reimbursement systems for new treatments. 

Independent evaluation of global COVID-19 response announced

2 months 2 weeks ago

WHO Director-General today announced the initiation of the Independent Panel for Pandemic Preparedness and Response (IPPR) to evaluate the world’s response to the COVID-19 pandemic.

In remarks to WHO Member States, Director-General Tedros Adhanom Ghebreyesus said the Panel will be co-chaired by former Prime Minister of New Zealand Helen Clark and former President of Liberia Ellen Johnson Sirleaf. Prime Minister Clark went to on lead the United Nations Development Programme and President Sirleaf is a recipient of the Nobel Peace Prize.

Operating independently, they will choose other Panel members as well as members of an independent secretariat to provide support. 

“Prime Minister Clark and President Sirleaf were selected through a process of broad consultation with Member States and world experts. I cannot imagine two more strong-minded, independent leaders to help guide us through this critical learning process.” said Dr. Tedros in his speech.

At the historic 73rd World Health Assembly in May, Member States adopted a landmark resolution that called on WHO to initiate an independent and comprehensive evaluation of the lessons learned from the international health response to COVID-19.

“This is a time for self-reflection, to look at the world we live in and to find ways to strengthen our collaboration as we work together to save lives and bring this pandemic under control,” said Dr Tedros. “The magnitude of this pandemic, which has touched virtually everyone in the world, clearly deserves a commensurate evaluation.”   

Dr Tedros proposed that a Special Session of the Executive Board be called in September to discuss the Panel’s progress. In November the Panel will present an interim report at the resumption of the World Health Assembly.

In January 2021, the Executive Board will hold its regular session, where the Panel’s work will be further discussed; and in May of next year, at the World Health Assembly, the panel will present its substantive report.

The Director-General noted that the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme will also continue its existing work.

“Even as we fight this pandemic, we must be readying ourselves for future global outbreaks and the many other challenges of our time such as antimicrobial resistance, inequality and the climate crisis,” said Dr Tedros. “COVID-19 has taken so much from us. But it is also giving us an opportunity to break with the past and build back better.” 

UN Public Service Day

2 months 2 weeks ago

Honouring the public servants who have been working on the frontlines of the COVID-19 pandemic.

Whether working in healthcare or delivering essential services in the areas of sanitation, social welfare, education, postal delivery, transport, law enforcement, and more, public servants globally have continued to work in the community as many people shelter at home, risking their lives to ensure ours can continue.

WHO Director-General joined a virtual high-level panel at the United Nations to mark Public Service Day on 23 June to honour the women and men who are risking their lives and health to deliver essential public services amid the ongoing COVID-19 pandemic.

The event brought together public servants and leaders to discuss the importance of the continuation of public service provision during times of the COVID-19 pandemic. It examined the various approaches countries are taking during the crisis and what measures they are undertaking to better mitigate such challenges in the future. The event also included an orchestral piece performed by the UN Orchestra and featured a video showcasing public servants in action, developed from over 80 submissions received from public servants at national and local levels worldwide. 

Speakers included:

  • Mr. António Guterres, Secretary-General of the United Nations (video statement)
  • Mr. Tijjani Muhammad-Bande, President of the General Assembly
  • H.E. Ms. Sahle-Work Zewde, President of Ethiopia
  • Dr. Tedros Adhanom Ghebreyesus, Director General, World Health Organization
  • Mr. Liu Zhenmin, United Nations Under Secretary-General for Economic and Social Affairs
  • H.E. Mr. Chin Young, Minister of Interior and Safety, Republic of Korea
  • Dr. In-Jae Lee, Deputy Minister of the Interior and Safety, Republic of Korea
  • H.E. Ms. K.K. Shailaja Teacher, Minister of Health of Kerala State, India
  • Mr. Jim Campbell, Director, Health Workforce Department World Health Organization
  • Ms. Annette Kennedy, President of International Council of Nurses
  • Rosa Pavenelli, General Secretary, Public Services International, 

Moderator: Ms. Odette Ramsingh, Executive Director: Human Resources, Sefako Makgatho Health Sciences University

How to watch

WHO experts to travel to China

2 months 2 weeks ago

WHO experts will travel to China to work together with their Chinese counterparts to prepare scientific plans for identifying the zoonotic source of the SARS-COV-2 virus. The experts will develop the scope and TOR for a WHO-led international mission. 

Identifying the origin of emerging viral disease has proven complex in past epidemics in different countries. A well planned series of scientific researches will advance the understanding of animal reservoirs and the route of transmission to humans. The process is an evolving endeavor which may lead to further international scientific research and collaboration globally.

 

Update from WHO and Pew Charitable Trusts: urgent action needed to accelerate antibiotic development

2 months 2 weeks ago

Just as the COVID-19 pandemic started taking the world by storm, The World Health Organization (WHO) and The Pew Charitable Trust (Pew) each released assessments of the global antibiotic pipeline. Both found there are still not enough antibacterial treatments in clinical development worldwide to fight the growing threat of drug-resistant bacterial infections. 

Essential medicines

Developing new, innovative antibiotics is resource-intensive and scientifically difficult. And, when more antibiotics are used the less effective they become, hence new antibiotics are often held in reserve to help preserve their potency. This is good for public health, but results in relatively low potential sales volume, making it challenging for companies to recoup their investment. As a result, major pharmaceutical companies have backed away from antibiotic development. The remaining small companies struggle to sustain their operations – with many facing bankruptcy even after successfully bringing a new antibiotic to market

Almost all antibiotics in our arsenal today are based on discoveries from more than 35 years ago. And only about 1 in 4 candidates currently in the development pipeline represent the truly new types of drugs needed to overcome resistance. Even more problematic is that historical data suggest that many candidates will fail in clinical trials, with just a small fraction obtaining regulatory approval.

COVID-19 has so poignantly reminded us that we need to build more resilient health systems that include access to effective antibiotics to better tackle future outbreaks. Antibiotic resistance is a looming public health crisis also requiring improved preparedness, including a robust clinical antibacterial development pipeline.  

Pew and WHO ask the following of policymakers, pharmaceutical companies, research funders and antibiotic innovation stakeholders:

  1. Increase public funding for early-stage research for innovative antibiotics to overcome the basic scientific challenges of antibiotic discovery.
  2. Ensure promising antibiotics successfully move through clinical development by increasing  push and pull incentives - this includes public-private partnerships such as CARB-X and GARDP.
  3. Identify innovative solutions for sufficient return on investment for new antibiotics while ensuring their appropriate use. This could include different reimbursement and procurement models to facilitate bringing urgently needed antibiotics to market.

These efforts must be robust and sustained in order to stabilize and revitalize the broken antibiotic development pipeline and market. As the threat of antibiotic resistance continues to grow, novel antibiotics are needed urgently – now more than ever. 

WHO_Antimicrobials_HWC_round_logo

The WHO is committed to shaping the public health R&D priority setting agenda to combat antimicrobial resistance and will continue to review the preclinical and clinical antibacterial pipeline on an annual basis as well as expanding to fungal pathogens of public health importance.

The Pew Charitable Trusts tracks the global antibiotic pipeline to shed light on the status of antibiotic development, to evaluate and advocate for public policies, and to bring researchers together to spur new drug discovery. Pew also works to reduce the inappropriate use of antibiotics in human medicine and animal agriculture that accelerates drug resistance.

WHO launches iSupport Lite

2 months 2 weeks ago

The recent COVID-19 pandemic and resulting breakdown of community-based services for people with dementia and their caregivers emphasized the importance of providing caregivers with accessible public health messages to reduce caregiver stress and improve their mental health and well-being.

WHO’s iSupport Lite consists of a set of practical support messages for caregivers of people with dementia extracted from iSupport, WHO’s knowledge and skills training programme.

iSupport Lite offers tips for caregivers of people with dementia that can be drawn upon when and as needed. For caregivers who have already completed the comprehensive iSupport programme, iSupport Lite will act as a refresher, reinforcing previously-acquired caregiving skills and knowledge. iSupport Lite is available as posters on the WHO website and through social media. 

 

 

 

 

Statement of the twenty-fifth polio IHR Emergency Committee

2 months 2 weeks ago

 

 

The twenty-fifth meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) on the international spread of poliovirus was convened and opened by the Director General on 23 June 2020 with committee members attending via teleconference, supported by the WHO Secretariat.  Dr Tedros in his opening remarks said that while there has been amazing progress on wild poliovirus in Africa, there is still much more work to do to end transmission in Pakistan and Afghanistan. Similarly, the significantly greater than expected number of circulating vaccine derived polio virus type-2 (cVDPV2) outbreaks are another major challenge.  The COVID-19 pandemic has had a significant impact on public health programs, including polio eradication.  As a result, the risk of the international spread of polio is likely to have increased considerably.  At the same time, the polio infrastructure that has been developped in Pakistan and Afghanistan has been used to assist with the tracking and tracing as part of the COVID-19 pandemic response.
He also remarked that the novel oral polio vaccine type-2, which will be made available under the Emergency Use Listing procedure (EUL), is expected to be an important new tool to stop the vicious cycle of using monovalent Sabin OPV2 to combat outbreaks, but in turn seeding new outbreaks of cVDPV2.  Dr Tedros thanked the committee for their commitment and said he looked forward to receiving their advice.
The Emergency Committee reviewed the data on wild poliovirus (WPV1) and circulating vaccine derived polioviruses (cVDPV).  The WHO Secretariat presented a report of progress for affected IHR States Parties subject to Temporary Recommendations.  The following IHR States Parties provided an update at the teleconference on the current situation and the implementation of the WHO Temporary Recommendations since the Committee last met on 26 March 2020: Afghanistan, Burkina Faso, Mali and Pakistan.   In order to ease the burden on affected  State Parties in the exceptional situation following the determination of the COVID-19 outbreak as a Public Health Emergency of International Concern (PHEIC) on 30 January 2020, the following invited State Parties were asked to present their reports electronically only instead of attending via teleconference: Chad, Cote d’Ivoire, Ethiopia, Ghana, Malaysia, Niger, Nigeria, Philippines, Philippines, and Togo.  All these States Parties have previously attended teleconferences of the committee to present their statements.
  Wild poliovirus
The global situation remains of great concern with the increased number of WPV1 cases that started in 2019 continuing in 2020.  This year there have been 70 WPV1 cases as at 16 June 2020, compared to 57 for the same period in 2019, with no significant success yet in reversing this upward trend.
In Pakistan transmission continues to be widespread, as indicated by both acute flaccid paralysis (AFP) surveillance and environmental sampling. WPV1 transmission continues to be widespread, with southern Khyber Pakhtunkhwa becoming a new WPV1 reservoir, and some areas such as Karachi and the Quetta block having uninterrupted transmission.  There has also been expansion of WPV1 to previously polio free areas in Sindh and Punjab. 
In Afghanistan, the security situation remains very challenging.  Inaccessibility and missed children particularly in the Southern Region have led to a large cohort of susceptible children in this part of Afghanistan.  The risk of a major upsurge of cases is growing, with other parts of the country that have been free of WPV1 for some time now at risk of outbreaks. The number of provinces reporting WPV1 has increased from three in 2019 to 11 in 2020.  This would again increase the risk of international spread.  
The  Committee noted that based on results from sequencing of WPV1, there were recent instances of international spread of viruses from Pakistan to Afghanistan and from Afghanistan to Pakistan.  The ongoing frequency of WPV1 international spread between the two countries and the increased vulnerability in other countries where routine immunization and polio prevention activities have both been adversely affected by the COVID-19 pandemic are two major factors that suggest the risk of international spread may be at the highest level since 2014.  While border closures and lockdowns may mitigate the risk in the short term while in force, this would be outweighed in the longer term by falling population immunity through disruption of vaccination and the resumption of normal population movements.
The Committee noted that at its meeting 15 – 17 June, the African Regional Certification Commission had accepted the evidence presented by Nigeria that it was now free of WPV1 infection, and commended this achievement by the Government of Nigeria and its partners.
Vaccine derived poliovirus (VDPV)The multiple cirulating VDPV (cVDPV) outbreaks in four WHO regions (African, Eastern Mediterranean, South-east Asian and Western Pacific Regions) are very concerning, with one new country reporting an outbreak since the last meeting (Mali).  Unlike historical experience, international spread of cVDPV2 has become quite common, with recent spread from Chad and CAR to Cameroon; Nigeria, Togo and Ghana to Cote d’Ivoire; Nigeria to Benin, Ghana to Burkina Faso, Nigeria to Mali, Togo to Niger, Ghana and Benin to Togo, Angola to DR Congo, and Pakistan to Afghanistan.  In addition, a new local emergence attributable to mOPV2 use has recently occurred in Ethiopia.
In 2020, West Africa and Ethiopia are experiencing high levels of transmission of cVDPV2, and due to the pandemic, outbreak response has been significantly hampered, with many areas that have reported cases recently not having had an immunization response.  The Committee repeated its strong support for the development and proposed Emergency Use Listing of the novel OPV2 vaccine which should become available mid-2020, and which it is hoped will result in no or very little seeding of further outbreaks.  
Impact of COVID-19The Committee noted that in many polio infected countries, the COVID-19 pandemic has disrupted polio surveillance to a varying extent, sometimes significantly, resulting in an unusual degree of uncertainty regarding the current true polio epidemiology.  All of the countries reported postponements of immunization responses to cases, further increasing risk.  In addition, routine immunisation has also been adversely affected by the pandemic in many countries.  There is evidence that in some polio infected countries, the pandemic may yet to have peaked.  As international travel begins to return, there is unknown risk of exportation of polioviruses.  There are many other challenges ahead, such as the effect of COVID-19 on community trust and support for immunization, the possibility of other epidemics such as measles, the risks to front-line workers and how these can be managed, and the risk of immunization activities being associated with COVID-19 outbreaks, either truly or spuriously.  
On a positive note, the contribution of polio infrastructure, such as the National Emergency Operation Centre in Pakistan, to pandemic control efforts was significant.  Going forward, the committee noted the opportunity to link polio eradication and pandemic response in positive ways.  
ConclusionThe Committee unanimously agreed that the risk of international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC) and recommended the extension of Temporary Recommendations for a further three months.  However noting that many international borders are closed to prevent  international spread of COVID-19, State Parties may not currently be able to enforce the Temporary Recommendations in all places. The Committee strongly urges countries subject to these recommendations to maintain a high state of readiness to implement them as soon as possible ensuring the continued safety of travelers as well as health professionals.  The Committee recognizes the concerns regarding the lengthy duration of the polio PHEIC, but concludes that the current situation is extraordinary, with clear ongoing and increasing risk of international spread and ongoing need for coordinated international response. The Committee considered the following factors in reaching this conclusion:
  • Rising risk of WPV1 international spread: The progress made in recent years appears to have reversed, with the Committee’s assessment that the risk of international spread is at the highest point since 2014 when the PHEIC was declared. This risk assessment is based on the following:

 

  • the ongoing WPV1 exportation from Pakistan to Afghanistan, and from Afghanistan to Pakistan;
  • ongoing rise in the number of WPV1 cases and positive environmental samples in both Pakistan and
    Afghanistan with formerly polio free areas within the countries reporting cases in 2020;
  • the quickly increasing cohort of inaccessible unvaccinated children in Afghanistan, with the risk of a major
    outbreak imminent if nothing is done to access them;
  • the urgent need to overhaul the leadership and strategy of the program in Pakistan, which although already commenced, is likely take some time to lead to more effective control of transmission and ultimately eradication;
  • increasing community and individual resistance to the polio program.

 

  • Rising risk of cVDPV international spread: The clearly documented increased spread in recent months of cVDPV2 demonstrate the unusual nature of the current situation, as international spread of cVDPV in the past has been very infrequent.  The number of new emergences of cVDPV2 in Africa raises further concern.  The risk of new outbreaks in new countries is considered very high.  
  • COVID-19:  This unprecedented pandemic is likely to continue to substantially negatively impact the polio eradication program and outbreak control efforts.  The need to take extra precautions to prevent COVID-19 transmission will probably have an impact on vaccination coverage, and also hamper polio surveillance activities leading to increased risk of missed transmission.  
  • Falling PV2 immunity:  Global population mucosal immunity to type 2 polioviruses (PV2) continues to fall, as the cohort of children born after OPV2 withdrawal grows, exacerbated by poor coverage with IPV particularly in some of the cVDPV infected countries.
  • Multiple outbreaks: The evolving and unusual epidemiology resulting in rapid emergence and evolution of cVDPV2 strains is extraordinary and not yet fully understood and represents an additional risk that is yet to be quantified.
  • Weak routine immunization: Many countries have weak immunization systems that can be further impacted by various humanitarian emergencies including COVID19, and the number of countries in which immunization systems have been weakened or disrupted by conflict and complex emergencies poses a growing risk, leaving populations in these fragile states vulnerable to outbreaks of polio. 
  • Lack of access: Inaccessibility continues to be a major risk, particularly in several countries currently infected with WPV or cVDPV, i.e. Afghanistan, Nigeria, Niger, Somalia and Myanmar, which all have sizable populations that have been unreached with polio vaccine for prolonged periods.
  • Population movement: While border closures may have mitigated the short term risk, conversely the risk once borders begin to be re-opened is likely to be higher.  

 

Risk categoriesThe Committee provided the Director-General with the following advice aimed at reducing the risk of international spread of WPV1 and cVDPVs, based on the risk stratification as follows:

  • States infected with WPV1, cVDPV1 or cVDPV3, with potential risk of international spread.
  • States infected with cVDPV2, with potential risk of international spread.
  • States no longer infected by WPV1 or cVDPV, but which remain vulnerable to re-infection by WPV or cVDPV.

Criteria to assess States as no longer infected by WPV1 or cVDPV:
  • Poliovirus Case: 12 months after the onset date of the most recent case PLUS one month to account for case detection, investigation, laboratory testing and reporting period OR when all reported AFP cases with onset within 12 months of last case have been tested for polio and excluded for WPV1 or cVDPV, and environmental or other samples collected within 12 months of the last case have also tested negative, whichever is the longer.
  • Environmental or other isolation of WPV1 or cVDPV (no poliovirus case): 12 months after collection of the most recent positive environmental or other sample (such as from a healthy child) PLUS one month to account for the laboratory testing and reporting period
  • These criteria may be varied for the endemic countries, where more rigorous assessment is needed in reference to surveillance gaps (e.g. Borno State, Nigeria)

Once a country meets these criteria as no longer infected, the country will be considered vulnerable for a further 12 months.  After this period, the country will no longer be subject to Temporary Recommendations, unless the Committee has concerns based on the final report. 
TEMPORARY RECOMMENDATIONSStates infected with WPV1, cVDPV1 or cVDPV3 with potential risk of international spread 
WPV1
Afghanistan     (most recent detection 27 May 2020) Pakistan           (most recent detection 8 June 2020)
cVDPV1Malaysia          (most recent detection 12 February 2020)Myanmar        (most recent detection 9 August 2019)Philippines      (most recent detection 28 November 2019)

These countries should:

  • Officially declare, if not already done, at the level of head of state or government, that the interruption of poliovirus transmission is a national public health emergency and implement all required measures to support polio eradication; where such declaration has already been made, this emergency status should be maintained as long as the response is required.
  • Ensure that all residents and long­term visitors (i.e. > four weeks) of all ages, receive a dose of bivalent oral poliovirus vaccine (bOPV) or inactivated poliovirus vaccine (IPV) between four weeks and 12 months prior to international travel.
  • Ensure that those undertaking urgent travel (i.e. within four weeks), who have not received a dose of bOPV or IPV in the previous four weeks to 12 months, receive a dose of polio vaccine at least by the time of departure as this will still provide benefit, particularly for frequent travelers.
  • Ensure that such travelers are provided with an International Certificate of Vaccination or Prophylaxis in the form specified in Annex 6 of the IHR to record their polio vaccination and serve as proof of vaccination.
  • Restrict at the point of departure the international travel of any resident lacking documentation of appropriate polio vaccination. These recommendations apply to international travelers from all points of departure, irrespective of the means of conveyance (e.g. road, air, sea).
  • Further intensify cross­ border efforts by significantly improving coordination at the national, regional and local levels to substantially increase vaccination coverage of travelers crossing the border and of high risk cross ­border populations. Improved coordination of cross ­border efforts should include closer supervision and monitoring of the quality of vaccination at border transit points, as well as tracking of the proportion of travelers that are identified as unvaccinated after they have crossed the border.
  • Further intensify efforts to increase routine immunization coverage, including sharing coverage data, as high routine immunization coverage is an essential element of the polio eradication strategy, particularly as the world moves closer to eradication.
  • Maintain these measures until the following criteria have been met: (i) at least six months have passed without new infections and (ii) there is documentation of full application of high quality eradication activities in all infected and high risk areas; in the absence of such documentation these measures should be maintained until the state meets the above assessment criteria for being no longer infected.
  • Provide to the Director-General a regular report on the implementation of the Temporary Recommendations on international travel.

 

States infected with cVDPV2s, with potential or demonstrated risk of international spread Afghanistan       (most recent detection 15 May 2020)Angola                (most recent detection 9 February 2020)Benin                  (most recent detection 16 January 2020)Burkina Faso     (most recent detection 30 March 2020)Cameroon         (most recent detection 5 May 2020)Central African Republic  (most recent detection 5 February 2020)
Chad                (most recent detection 9 May 2020)
China               (most recent detection 18 August 2019) 
Cote d’Ivoire     (most recent detection 9 May 2020)Democratic Republic of the Congo    (most recent detection 8 February 2020)Ethiopia            (most recent detection 16 March 2020)Ghana               (most recent detection 11 March 2020)Malaysia           (most recent detection 22 January 2020)Mali                   (most recent detection 6 February 2020)Niger                 (most recent detection15 March 2020)Nigeria              (most recent detection 1 January 2020)Pakistan            (most recent detection 2 May 2020)Philippines       (most recent detection 16 January 2020)Somalia            (most recent detection 8 May 2020)Togo                  (most recent detection 3 May 2020)Zambia             (most recent detection 25 November 2019)

These countries should:

  • Officially declare, if not already done, at the level of head of state or government, that the interruption of poliovirus transmission is a national public health emergency and implement all required measures to support polio eradication; where such declaration has already been made, this emergency status should be maintained.
  • Noting the existence of a separate mechanism for responding to type 2 poliovirus infections, consider requesting vaccines from the global mOPV2 stockpile based on the recommendations of the Advisory Group on mOPV2.
  • Encourage residents and long­term visitors to receive a dose of IPV four weeks to 12 months prior to international travel; those undertaking urgent travel (i.e. within four weeks) should be encouraged to receive a dose at least by the time of departure.
  • Ensure that travelers who receive such vaccination have access to an appropriate document to record their polio vaccination status.
  • Intensify regional cooperation and cross border coordination to enhance surveillance for prompt detection of poliovirus, and vaccinate refugees, travelers and cross border populations, according to the advice of the Advisory Group.
  • Further intensify efforts to increase routine immunization coverage, including sharing coverage data, as high routine immunization coverage is an essential element of the polio eradication strategy, particularly as the world moves closer to eradication.
  • Maintain these measures until the following criteria have been met: (i) at least six months have passed without the detection of circulation of VDPV2 in the country from any source, and (ii) there is documentation of full application of high quality eradication activities in all infected and high risk areas; in the absence of such documentation these measures should be maintained until the state meets the criteria of a ‘state no longer infected’.
  • At the end of 12 months without evidence of transmission, provide a report to the Director-General on measures taken to implement the Temporary Recommendations.

 

 







 States no longer infected by WPV1 or cVDPV, but which remain vulnerable to re-infection by WPV or cVDPV

WPV1

  • none

 

cVDPV
  • Mozambique cVDPV2 (most recent detection 17 December 2018)
  • PNG cVDPV1 (most recent detection 6 November 2018)
  • Indonesia cVDPV1 (most recent detection 13 February 2019)

 


These countries should:

  • Urgently strengthen routine immunization to boost population immunity.
  • Enhance surveillance quality, including considering introducing supplementary methods such as environmental surveillance, to reduce the risk of undetected WPV1 and cVDPV transmission, particularly among high risk mobile and vulnerable populations.
  • Intensify efforts to ensure vaccination of mobile and cross ­border populations, Internally Displaced Persons, refugees and other vulnerable groups.
  • Enhance regional cooperation and cross border coordination to ensure prompt detection of WPV1 and cVDPV, and vaccination of high risk population groups.
  • Maintain these measures with documentation of full application of high quality surveillance and vaccination activities.
  • At the end of 12 months without evidence of reintroduction of WPV1 or new emergence and circulation of cVDPV, provide a report to the Director-General on measures taken to implement the Temporary Recommendations.

 Additional considerations 

Impact of COVID-19 on the polio program:

  • The committee urges all countries, but particularly those at high risk of polio, to maintain a high level of polio surveillance throughout the ongoing pandemic, noting that the postponement of polio immunization campaigns whether preventive or in response to outbreaks may lead to an increase in polio transmission including international spread.  There may be opportunities to strengthen polio and COVID-19 surveillance synergistically.
  • Secondly, outbreak affected countries should resume immunization response campaigns as soon as feasibly possible.  The planning and implementation of the response should employ a flexible approach whereby some activities are put on hold as the transmission of COVID-19 intensifies and then resumed as the COVID-19 transmission reverses back from community transmission to the interruption of COVID-19 transmission.  Critically, campaigns should be planned and implemented in such a way that they protect front line polio workers and also the communities they serve so that COVID-19 transmission is not increased.  This includes ensuring teams have access to appropriate personal protective equipment, teams are selected so that high risk workers are not put on the front-line, and that the risks related to the pandemic are factored into the selection and planning of areas targeted  by polio campaigns.
  • Given the risk of international spread, countries need to ensure that they are ready to use appropriate polio vaccines, as recommended by the Strategic Advisory Group of Experts on Immunization, in response to new outbreaks.
  • The committee urged countries to maximize the use of polio assets to synergistically address the COVID19 pandemic, noting that polio affected countries may be vulnerable to poorer outcomes in the pandemic due to health care system fragility and poorer health status of the population generally.  
  • Lastly the pandemic should serve as a reminder to high risk countries with poor immunization coverage that infectious disease outbreaks can lead to social and economic disruption as well as straining the health care system, and countries can increase their population resilience and recovery through prioiritising  robust immunization programmes. This is relevant not only to polio, but to all other vaccine preventable diseases particularly measles.  In particular, countries whether eligible for Gavi support or not should plan to implement a second dose of IPV now being introduced to protect children from paralytic polio.

    Based on the current situation regarding WPV1 and cVDPV, and the reports provided by affected countries, the Director-General accepted the Committee’s assessment and on 3 July 2020 determined that the situation relating to poliovirus continues to constitute a PHEIC, with respect to WPV1 and cVDPV.  The Director-General endorsed the Committee’s recommendations for countries meeting the definition for ‘States infected with WPV1, cVDPV1 or cVDPV3 with potential risk for international spread’, ‘States infected with cVDPV2 with potential risk for international spread’ and for ‘States no longer infected by WPV1 or cVDPV, but which remain vulnerable to re-infection by WPV or cVDPV’ and extended the Temporary Recommendations under the IHR to reduce the risk of the international spread of poliovirus, effective 3 July 2020. 

     

     

     

Chemicals and COVID - Tuesday, 7July2020, 11AM-CEST

2 months 3 weeks ago

Dear Colleagues,

COVID-19 has changed our life: disinfectants, hand sanitizers, personal protective equipment (PPE) have become attributes of fighting against the virus transmission. Most of these products contain chemicals or are chemical in their nature. Their improper and unsafe use can lead to toxic effects in people that can be as dangerous as the virus itself.

Preliminary analysis of poisoning cases caused by non-intentional and intentional consumption of disinfectants and other relevant products, unsafe behaviours and actions, falsely considered preventive, confirm a need to pay more attention to precautionary measures to ensure their safe use. Environmental impacts of the increased use of disinfectants and other chemical products for COVID-19 require specific attention in a longer-term perspective.

These topics will be at a core of a webinar organized by the WHO European Centre for Environment and Health (ECEH), in cooperation with the WHO Headquarters on Tuesday, 7 July 2020 at 11:00 AM-12:30 PM CEST.

Invited speakers will share preliminary analysis of the situation on terms of chemical impact and COVID-19 and outline recommendations on how to ensure safety of chemical products applied to stop spreading of the virus.  

The webinar is open and you are welcome to participate. Please, mark it in your calendar and do not hesitate to share within your professional networks.

Please right to [email protected] for more information on how to join.

 

 

Introductory meeting of WHO’s Strategic and Technical Advisory Group for Tuberculosis

2 months 3 weeks ago

An introductory meeting of WHO’s Strategic and Technical Advisory Group for Tuberculosis (STAG-TB) was held on 24-25 June 2020. STAG-TB, which is comprised of 15 eminent experts from ministries of health, national TB programmes, academic and research institutions, civil society organizations, and communities and patients affected by TB. The group is led by Dr Ariel Pablos-Méndez as Chair,  and provides strategic advice to WHO's Director-General and the Global TB Programme on its TB response.

In his keynote address, WHO Director General Dr Tedros emphasized the important strategic role of STAG-TB in efforts to end TB especially in light of the current COVID-19 pandemic. He said, “Even at this difficult time, with COVID-19 threatening the world, WHO remains committed to meet the TB targets and driving high-level action and investment. Commitments must be kept to address all communicable disease threats, and reach the triple billion targets, despite the COVID-19 crisis. Doing so offers hope to end avoidable death and suffering for millions of people worldwide at risk from preventable and treatable diseases like TB.”

The meeting was opened by Dr Ren Minghui, WHO Assistant Director-General, Universal Health Coverage, Communicable and Noncommunicable Diseases Division. The first day focused on briefings from the WHO Global TB Programme secretariat on ongoing WHO efforts towards ending TB, preparations underway for the development of the 2020 progress report of the UN Secretary General on TB, and the impact of the COVID-19 pandemic on the TB response. The second day included a special session of STAG-TB members with WHO Director-General Dr Tedros Adhanom Ghebreyesus. Key partners – Stop TB Partnership, Global Fund and UNITAID also participated in this session.

Dr Ariel Pablos-Méndez, STAG-TB Chair highlighted the group’s commitment to guide WHO’s TB response. He emphasized, “We need to leverage existing synergies between TB and universal health coverage to save lives. This is especially critical in this time of crisis. STAG-TB is dedicated to providing strategic direction that will guide WHO in supporting countries to accelerate progress and investment to reach targets set by the UN High-level Meeting on TB.”

Dr Tereza Kasaeva, Director of WHO’s Global TB Programme appreciated the role of STAG-TB, she said, “The STAG-TB provides a critical contribution to WHO, and the world, in combatting TB. We look forward to receiving strategic advice from STAG-TB during this, and coming, years on how the world can meet commitments to end the TB epidemic especially in the face of new threats”.

The next meeting of the STAG-TB will be held in November 2020.

WHO announced as a Global Leader of the Generation Equality Action Coalition on ending gender-based violence

2 months 3 weeks ago

Generation equality logoThe  Generation Equality Forum—a global gathering for gender equality, convened by UN Women and co-hosted by the governments of Mexico and France in partnership with civil society—today announced the leaders of the Generation Equality Action Coalitions, to achieve gender equality and all women’s and girls’ human rights. WHO, together with The United Nations Entity for Gender Equality and the Empowerment of Women (UN Women) have been invited to co-lead the Action Coalition focusing on ending gender-based violence. 

The Action Coalitions will deliver concrete and transformative change for women and girls around the world in the coming five years. They will focus on six themes  that are critical for achieving gender equality. In addition to the coalition on gender-based violence there are five other coalitions on economic justice and rights, bodily autonomy and sexual and reproductive health and rights, feminist action for climate justice, technology and innovation for gender equality, and feminist movements and leadership. Adolescent girls and young women will be at the heart of each Action Coalition’s work.    

The 65 initial leaders of the Action Coalitions represent Member States, diverse feminist and women’s rights organizations, youth-led organizations, philanthropic entities, UN agencies and other international organizations ( full list here).  The Action Coalitions’ leaders bring deep commitment to and experience in advancing gender equality and women’s human rights and reflect the different experiences and identities of women and girls from around the world.    

Further appointments of the Action Coalitions’ leaders will be made in the next few months, including private sector companies and youth-led organizations, to ensure intersectional and intergenerational leadership.  

The Action Coalitions’ leaders were selected by the Generation Equality Forum Core Group, which includes France, Mexico, Civil Society and UN Women.  Five criteria  were followed to select the leaders, including evidence of leaders’ commitment and past record of achievement in the respective Action Coalitions’ themes.  

The Action Coalitions are one of the key outcomes of the Generation Equality Forum that will kick off in Mexico City, Mexico, and culminate in Paris, France, in the first half of 2021. The Generation Equality Forum, accelerated by the Action Coalitions, will mobilize urgent action to make irreversible progress towards gender equality and women’s and girls’ human rights globally.  

This announcement comes as the world responds to the impacts of COVID-19, which is exacerbating gender and other inequalities and disproportionally affecting women and girls in all countries. In this context of the pandemic, the Generation Equality Forum and Action Coalitions are important and urgently needed to get through this pandemic, to recover faster, and build a more just, inclusive, and equitable future for everyone. 

Next steps

The Action Coalitions’ leaders will come together in the coming months to co-design concrete, game-changing Blueprints for action to be implemented over the next five years.  

Beginning in September 2020, a set of virtual public conversations will mobilize and capture women’s and young people’s voices to inform the Action Coalitions.  

The Action Coalition Blueprints will then be refined at the Generation Equality Forum in Mexico City, during the first part of 2021, and officially launched at the Generation Equality Forum in Paris, later in 2021.  

The Action Coalitions aim to mobilize a broad support in addition to the leadership structure. A broad set of stakeholders will be involved in the design of the Action Coalitions during the next months and will be provided with opportunities to commit to transformative actions to advance gender equality and women’s rights. 

Violence against women is a major threat to global public health and human rights, cutting across boundaries of age, race, religion, ethnicity, disability, geography, culture and wealth. WHO is committed to working towards a world in which all women live their lives free of violence and discrimination. Dr Tedros Adhanom Ghebreyesus, Director-General, World Health Organization

 

10th Ebola outbreak in the Democratic Republic of the Congo declared over; vigilance against flare-ups and support for survivors must continue

2 months 3 weeks ago

Today marks the end of the 10th outbreak of Ebola virus disease in the Democratic Republic of the Congo (DRC). This long, complex and difficult outbreak has been overcome due to the leadership and commitment of the Government of the DRC, supported by the World Health Organization (WHO), a multitude of partners, donors, and above all, the efforts of the communities affected by the virus. 

WHO congratulates all those involved in the arduous and often dangerous work required to end the outbreak, but stresses the need for vigilance. Continuing to support survivors and maintaining strong surveillance and response systems in order to contain potential flare-ups is critical in the months to come.

"The outbreak took so much from all of us, especially from the people of DRC, but we came out of it with valuable lessons, and valuable tools. The world is now better-equipped to respond to Ebola. A vaccine has been licensed, and effective treatments identified,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus.

“We should celebrate this moment, but we must resist complacency. Viruses do not take breaks. Ultimately, the best defence against any outbreak is investing in a stronger health system as the foundation for universal health coverage.”

The outbreak, declared in North Kivu on 1 August 2018, was the second largest in the world, and was particularly challenging as it took place an active conflict zone. There were 3470 cases, 2287 deaths and 1171 survivors. 

Led by the DRC Government and the Ministry of Health and supported by WHO and partners, the more than 22-month-long response involved training thousands of health workers, registering 250 000 contacts, testing 220 000 samples, providing patients with equitable access to advanced therapeutics, vaccinating over 303 000 people with the highly effective rVSV-ZEBOV-GP vaccine, and offering care for all survivors after their recovery.

The response was bolstered by the engagement and leadership of the affected communities. Thanks to their efforts, this outbreak did not spread globally. More than 16 000 local frontline responders worked alongside the more than 1500 people deployed by WHO. Support from donors was essential, as was the work of UN partner agencies, national and international NGOs, research networks, and partners deployed through the Global Outbreak Alert and Response Network. Hard work to build up preparedness capacities in neighbouring countries also limited the risk of the outbreak expanding.

Work will continue to build on the gains made in this response to address other health challenges, including measles and COVID-19.

“During the almost two years we fought the Ebola virus, WHO and partners helped strengthen the capacity of local health authorities to manage outbreaks,” said Dr Matshidiso Moeti, WHO Regional Director for Africa.

“The DRC is now better, smarter and faster at responding to Ebola and this is an enduring legacy which is supporting the response to COVID-19 and other outbreaks.” 

As countries around the world face the COVID-19 pandemic, the DRC Ebola response provides valuable lessons. Many of the public health measures that have been successful in stopping Ebola are the same measures that are now essential for stopping COVID-19: finding, isolating, testing, and caring for every case and relentless contact tracing. 

In DRC, community workers were provided with training and a smartphone data collection app that enabled them to track contacts and report in real time rather than fill in laborious paper reports. Even when violence locked down cities, the community workers, many of them local women, continued to track and trace contacts using the application, something that was crucial for ending this outbreak.

While this 10th outbreak in DRC has ended, the fight against Ebola continues. On 1 June 2020, seven cases of Ebola were reported in Mbandaka city and neighbouring Bikoro Health Zone in Equateur Province and an 11th outbreak was declared. WHO is supporting the government-led response with more than 50 staff already deployed and more than 5000 vaccinations already administered.

WHO salutes the thousands of heroic responders who fought one of the world’s most dangerous viruses in one of the world’s most unstable regions. Some health workers, including WHO experts, paid the ultimate price and sacrificed their lives to the Ebola response. 

WHO thanks the many partners who supported the Government-led response

Note to Editors

WHO thanks the donors who provided funding to WHO for the Ebola response under the Strategic Response Plans: 

African Development Bank, Bill & Melinda Gates Foundation, Canada, China, Denmark, ECHO, European Commission/DEVCO, Gavi, the Vaccine Alliance, Germany, Ireland, Italy, Luxembourg, Norway, Paul Allen Foundation, Republic of Korea, Sweden, Switzerland, Susan T Buffett Foundation, UK DFID, UN CERF, USAID/OFDA, US CDC, Wellcome Trust, World Bank, World Bank Pandemic Emergency Financing Facility. 

Several donors also provided funding to the WHO Contingency Fund for Emergencies in recognition of the critical role the fund has played in responding to the Ebola outbreak.

WHO urges countries to expand access to rapid molecular tests for the detection of TB and drug-resistant TB

2 months 3 weeks ago

The World Health Organization (WHO) is urging countries to expand access to rapid molecular tests for the detection of TB and drug-resistant TB in updated consolidated guidelines, released today. The guidelines are accompanied by an operational handbook to facilitate rapid implementation and roll out of rapid molecular tests by national TB programmes, ministries of health and technical partners.

“The use of rapid molecular assays as the initial test to diagnose TB is recommended instead of sputum smear microscopy as they have high diagnostic accuracy and will lead to major improvements in the early detection of TB and drug-resistant TB,” said Dr Tereza Kasaeva, Director of WHO’s Global TB Programme.  “We now need to urgently ensure universal access to these rapid molecular tests. This will impact positively on reducing transmission and enabling faster access to accurate life-saving treatment that will lead to better outcomes for those affected.”

The consolidated guidelines and the associated operational handbook recommend key updates of the approaches to diagnose TB including:

  • The use of Xpert MTB/RIF assay, Xpert Ultra assay and Truenat assay as the initial test to diagnose pulmonary TB and to detect rifampicin resistance.  This replaces smear microscopy and culture.
  • The use of Xpert MTB/RIF assay and Xpert Ultra assay for improved diagnosis of TB and rifampicin resistance in children, in specific specimens such as sputum, stool, nasopharyngeal and gastric specimens
  • The use of Xpert MTB/RIF assay and Xpert Ultra assay for improved diagnosis of TB and rifampicin resistance in patients with broad range of extrapulmonary TB.

The Xpert MTB Rif assay has been used worldwide since 2010, while the Xpert Ultra assay and Truenat assay are new technologies.

The above updates were signaled in January 2020 through a Rapid Communication from WHO in advance of the publication of the updated guidelines. The purpose was to help national TB programmes and other stakeholders plan and prepare in advance for the rapid transition to new diagnostic tools at country level.

Globally, diagnosis of TB and drug-resistant TB remains a challenge with a third of people with TB and two-thirds of people with drug-resistant TB not being detected. Accelerated efforts to diagnose TB and drug-resistance are essential to end the global TB epidemic and achieve the targets of the political declaration of the UN high-level meeting, the WHO End TB Strategy, the UN Sustainable Development Goals, universal health coverage and the triple billion targets of WHO’s General Programme of Work.

Public call for data on diagnostic accuracy on nucleic acid amplification tests to detect TB and resistance to selected anti-TB agents

2 months 3 weeks ago

Nucleic acid amplification tests (NAAT) are promising technologies for the rapid and accurate detection of TB and resistance to selected anti-TB agents. In December 2020, the World Health Organization (WHO) will convene a Guidelines Development Group (GDG) meeting to update its diagnostic guidelines on the use of NAATs to detect TB and resistance to selected anti-TB agents. Ahead of this meeting, WHO will commission reviews of relevant evidence on diagnostic accuracy for several NAAT assays.

The following NAAT assays or classes of NAAT assays will be discussed by the GDG:

Centralized assays that present end-to-end solutions for detection of TB and resistance to rifampicin and isoniazid (cDST: Index test 1);

Cartridge-based technology for isoniazid and second-line drug resistance detection (XDR cartridge: Index test 2);

Hybridization-based technology for pyrazinamide resistance detection (PZA LPA: Index test 3).

To enable this process, WHO is issuing a public call for data, appealing to industry, researchers, national TB programmes and other agencies to provide suitable evidence for the performance of these technologies. The obtained data will be essential to facilitate the process of WHO policy updates.

Please send relevant data by 1st August 2020, to [email protected]. For more information on the parameters of the datasets, variables, and the process see below:

Annex 1: Data requirements

Index test 1: Centralized assays that present end-to-end solutions for detection of TB and resistance to rifampicin and isoniazid (cDST platforms).

Desirable characteristics of the test: (a) Sample preparation workflow included; (b) Automated DNA extraction; (c) Automated PCR preparation; (d) Automated result interpretation; (c) Capacity per run: ≥24 tests; (d) Time from sample to full MDR-TB diagnosis: <12 hours; (e) Minimal desirable drug resistance detection: at least to INH and RIF.

Study type: Clinical evaluation studies to confirm diagnostic performance on clinical samples.

Study population: Random sample of unselected patients with signs and symptoms of TB, requiring evaluation for TB and/or resistance to isoniazid and rifampicin in sites of intended use.

Reference standard: At a minimum, result of a single sputum culture and phenotypic DST, wherever applicable (liquid or solid, with speciation) should be included for each result of Index test 1. The use of a genotypic sequencing results where available will have an added value to confirm the presence of mutations in addition to phenotypic DST results.

Index test 2: Cartridge-based technology for isoniazid and second-line drug resistance detection (XDR cartridge);

Desirable characteristics of the test: (a) Automated real-time PCR; (b) Automated result interpretation; (b) Capacity per run: ≥ 4 tests; (c) Time test results: <4 hours; (d) Minimal desirable drug resistance detection: at least to INH and FQ.

Study type: (a) Analytical validation studies measuring accuracy, precision, and reproducibility of the test in contrived specimens or panels, covering all key mutations to isoniazid and second-line drugs. (b) Clinical evaluation studies to confirm diagnostic performance on clinical samples.

Study population: Patients with detected TB, requiring evaluation for resistance to isoniazid and second-line anti-TB agents in sites of intended use.

Reference standard: At a minimum, result of a single sputum phenotypic DST (liquid or solid, with speciation) should be included for each result of Index test 2. The use of a genotypic sequencing results where available will have an added value to confirm the presence of mutations in addition to phenotypic DST results.

Index test 3: Hybridization-based technology for pyrazinamide resistance detection (PZA LPA).

Desirable characteristics of the test: (a) Automated or manual hybridization methodology; (b) Automated or manual result interpretation (c) Time from sample to test results: <24 hours; (d) Minimal desirable drug resistance detection: at least to PZA.

Study type: (a) Analytical validation studies measuring accuracy, precision, and reproducibility of the test in contrived specimens or panels, covering all key mutations to pyrazinamide; (b) Clinical evaluation studies to confirm diagnostic performance on clinical samples;

Study population: Patients with detected TB and resistance to rifampicin, requiring evaluation for resistance to pyrazinamide in sites of intended use;

Reference standard: At a minimum, result of a single sputum phenotypic DST (liquid or solid, with speciation) should be included for each result of Index test 3. The use of a genotypic sequencing results where available will have an added value to confirm the presence of mutations in addition to phenotypic DST results.

Corporate news releases, statements, and notes for media issued by the World Health Organization.