WHO’s 10 calls for climate action to assure sustained recovery from COVID-19

8 Oct

Countries must set ambitious national climate commitments if they are to sustain a healthy and green recovery from the COVID-19 pandemic.

The WHO COP26 Special Report on Climate Change and Health, launched today, in the lead-up to the United Nations Climate Change Conference (COP26) in Glasgow, Scotland, spells out the global health community’s prescription for climate action based on a growing body of research that establishes the many and inseparable links between climate and health.

“The COVID-19 pandemic has shone a light on the intimate and delicate links between humans, animals and our environment,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “The same unsustainable choices that are killing our planet are killing people. WHO calls on all countries to commit to decisive action at COP26 to limit global warming to 1.5°C – not just because it’s the right thing to do, but because it’s in our own interests. WHO’s new report highlights 10 priorities for safeguarding the health of people and the planet that sustains us.”

The WHO report is launched at the same time as an open letter, signed by over two thirds of the global health workforce - 300 organizations representing at least 45 million doctors and health professionals worldwide, calling for national leaders and COP26 country delegations to step up climate action.

“Wherever we deliver care, in our hospitals, clinics and communities around the world, we are already responding to the health harms caused by climate change,” the letter from health professionals reads. “We call on the leaders of every country and their representatives at COP26 to avert the impending health catastrophe by limiting global warming to 1.5°C, and to make human health and equity central to all climate change mitigation and adaptation actions.”

The report and open letter come as unprecedented extreme weather events and other climate impacts are taking a rising toll on people’s lives and health. Increasingly frequent extreme weather events, such as heatwaves, storms and floods, kill thousands and disrupt millions of lives, while threatening healthcare systems and facilities when they are needed most. Changes in weather and climate are threatening food security and driving up food-, water- and vector-borne diseases, such as malaria, while climate impacts are also negatively affecting mental health. 

The WHO report states: “The burning of fossil fuels is killing us. Climate change is the single biggest health threat facing humanity. While no one is safe from the health impacts of climate change, they are disproportionately felt by the most vulnerable and disadvantaged.”

Meanwhile, air pollution, primarily the result of burning fossil fuels, which also drives climate change, causes 13 deaths per minute worldwide.

The report concludes that protecting people’s health requires transformational action in every sector, including on energy, transport, nature, food systems and finance. And it states clearly that the public health benefits from implementing ambitious climate actions far outweigh the costs.

“It has never been clearer that the climate crisis is one of the most urgent health emergencies we all face,” said Dr Maria Neira, WHO Director of Environment, Climate Change and Health. “Bringing down air pollution to WHO guideline levels, for example, would reduce the total number of global deaths from air pollution by 80% while dramatically reducing the greenhouse gas emissions that fuel climate change. A shift to more nutritious, plant-based diets in line with WHO recommendations, as another example, could reduce global emissions significantly, ensure more resilient food systems, and avoid up to 5.1 million diet-related deaths a year by 2050.”

Achieving the goals of the Paris Agreement would save millions of lives every year due to improvements in air quality, diet, and physical activity, among other benefits. However, most climate decision-making processes currently do not account for these health co-benefits and their economic valuation.   

 

Notes to editors:

WHO’s COP26 Special Report on Climate Change and Health, The Health Argument for Climate Action, provides 10 recommendations for governments on how to maximize the health benefits of tackling climate change in a variety of sectors, and avoid the worst health impacts of the climate crisis.

The recommendations are the result of extensive consultations with health professionals, organizations and stakeholders worldwide, and represent a broad consensus statement from the global health community on the priority actions governments need to take to tackle the climate crisis, restore biodiversity, and protect health.

Climate and Health Recommendations

The COP26 report includes ten recommendations that highlight the urgent need and numerous opportunities for governments to prioritize health and equity in the international climate regime and sustainable development agenda.

  1. Commit to a healthy recovery. Commit to a healthy, green and just recovery from COVID-19.
  2. Our health is not negotiable. Place health and social justice at the heart of the UN climate talks.
  3. Harness the health benefits of climate action. Prioritize those climate interventions with the largest health-, social- and economic gains.
  4. Build health resilience to climate risks. Build climate resilient and environmentally sustainable health systems and facilities, and support health adaptation and resilience across sectors.
  5. Create energy systems that protect and improve climate and health. Guide a just and inclusive transition to renewable energy to save lives from air pollution, particularly from coal combustion. End energy poverty in households and health care facilities.
  6. Reimagine urban environments, transport and mobility. Promote sustainable, healthy urban design and transport systems, with improved land-use, access to green and blue public space, and priority for walking, cycling and public transport.
  7. Protect and restore nature as the foundation of our health. Protect and restore natural systems, the foundations for healthy lives, sustainable food systems and livelihoods.
  8. Promote healthy, sustainable and resilient food systems. Promote sustainable and resilient food production and more affordable, nutritious diets that deliver on both climate and health outcomes.
  9. Finance a healthier, fairer and greener future to save lives. Transition towards a wellbeing economy.
  10. Listen to the health community and prescribe urgent climate action. Mobilize and support the health community on climate action.

Open Letter – Healthy Climate Prescription

The health community around the world (300 organizations representing at least 45 million doctors and health professionals) signed an open letter to national leaders and COP26 country delegations, calling for real action to address the climate crisis.

The letter states the following demands:

  • “We call on all nations to update their national climate commitments under the Paris Agreement to commit to their fair share of limiting warming to 1.5°C; and we call on them to build health into those plans;
  • We call on all nations to deliver a rapid and just transition away from fossil fuels, starting with immediately cutting all related permits, subsidies and financing for fossil fuels, and to completely shift current financing into development of clean energy;
  • We call on high income countries to make larger cuts to greenhouse gas emissions, in line with a 1.5°C temperature goal;
  • We call on high income countries to also provide the promised transfer of funds to low-income countries to help achieve the necessary mitigation and adaptation measures;
  • We call on governments to build climate resilient, low-carbon, sustainable health systems; and
  • We call on governments to also ensure that pandemic recovery investments support climate action and reduce social and health inequities.”

WHO report highlights global shortfall in investment in mental health

8 Oct

The World Health Organization’s new Mental Health Atlas paints a disappointing picture of a worldwide failure to provide people with the mental health services they need, at a time when the COVID-19 pandemic is highlighting a growing need for mental health support.

The latest edition of the Atlas, which includes data from 171 countries, provides a clear indication that the increased attention given to mental health in recent years has yet to result in a scale-up of quality mental services that is aligned with needs. 

Issued every three years, the Atlas is a compilation of data provided by countries around the world on mental health policies, legislation, financing, human resources, availability and utilization of services and data collection systems. It is also the mechanism for monitoring progress towards meeting the targets in WHO’s Comprehensive Mental Health Action Plan.

“It is extremely concerning that, despite the evident and increasing need for mental health services, which has become even more acute during the COVID-19 pandemic, good intentions are not being met with investment,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. “We must heed and act on this wake-up call and dramatically accelerate the scale-up of investment in mental health, because there is no health without mental health.”

Lack of progress in leadership, governance and financing

None of the targets for effective leadership and governance for mental health, provision of mental health services in community-based settings, mental health promotion and prevention, and strengthening of information systems, were close to being achieved.

In 2020, just 51% of WHO’s 194 Member States reported that their mental health policy or plan was in line with international and regional human rights instruments, way short of the 80% target. And only 52% of countries met the target relating to mental health promotion and prevention programmes, also well below the 80% target. The only 2020 target met was a reduction in the rate of suicide by 10%, but even then, only 35 countries said they had a stand-alone prevention strategy, policy or plan.

Steady progress was evident, however, in the adoption of mental health policies, plans and laws, as well as in improvements in capacity to report on a set of core mental health indicators. However, the percentage of government health budgets spent on mental health has scarcely changed during the last years, still hovering around 2%. Moreover, even when policies and plans included estimates of required human and financial resources, just 39% of responding countries indicated that the necessary human resources had been allocated and 34% that the required financial resources had been provided.

Transfer of care to the community is slow

While the systematic decentralization of mental health care to community settings has long been recommended by WHO, only 25% of responding countries met all the criteria for integration of mental health into primary care. While progress has been made in training and supervision in most countries, the supply of medicines for mental health conditions and psychosocial care in primary health-care services remains limited.

This is also reflected in the way that government funds to mental health are allocated, highlighting the urgent need for deinstitutionalization. More than 70% of total government expenditure on mental health was allocated to mental hospitals in middle-income countries, compared with 35% in high-income countries. This indicates that centralized mental hospitals and institutional inpatient care still receive more funds than services provided in general hospitals and primary health-care centres in many countries. 

There was, however, an increase in the percentage of countries reporting that treatment of people with specific mental health conditions (psychosis, bipolar disorder and depression) is included in national health insurance or reimbursement schemes – from 73% in 2017 to 80% (or 55% of Member States) in 2020.

Global estimates of people receiving care for specific mental health conditions (used as a proxy for mental health care as a whole) remained less than 50%, with a global median of 40% of people with depression and just 29% of people with psychosis receiving care.

Increase in mental health promotion, but effectiveness questionable

More encouraging was the increase in countries reporting mental health promotion and prevention programmes, from 41% of Member States in 2014 to 52% in 2020. However, 31% of total reported programmes did not have dedicated human and financial resources, 27% did not have a defined plan, and 39% had no documented evidence of progress and/or impact.

Slight increase in the mental health workforce

The global median number of mental health workers per 100 000 population has increased slightly from nine workers in 2014 to 13 workers per 100 000 population in 2020. However, there was a very high variation between countries of different income levels, with the number of mental health workers in high-income countries more than 40 times higher than in low-income countries.

New targets for 2030

The global targets reported on in the Mental Health Atlas are from WHO’s Comprehensive Mental Health Action Plan, which contained targets for 2020 endorsed by the World Health Assembly in 2013. This Plan has now been extended to 2030 and includes new targets for the inclusion of mental health and psychosocial support in emergency preparedness plans, the integration of mental health into primary health care, and research on mental health.

“The new data from the Mental Health Atlas shows us that we still have a very long way to go in making sure that everyone, everywhere, has access to quality mental health care,” said Dévora Kestel, Director of the Department of Mental Health and Substance Use at WHO. “But I am encouraged by the renewed vigour that we saw from governments as the new targets for 2030 were discussed and agreed and am confident that together we can do what is necessary to move from baby steps to giant leaps forward in the next 10 years.”

 

Note for editors:

The Atlas is being released in the lead-up to World Mental Health Day on 10 October, for which the focus this year is scaling up access to quality mental health care.

 

WHO, UN set out steps to meet world COVID vaccination targets

7 Oct
  • Working with COVAX, African Vaccine Acquisition Trust and other partners – world can and must meet WHO targets to vaccinate 40% of the population of all countries by the end-2021 and 70% by mid-2022
  • Vaccine supply gaps to COVAX must be closed immediately for countries to reach the 40% year end target
  • United Nations Secretary-General and WHO Director-General call on countries and  manufacturers to make good on their commitments without further delays 

The World Health Organization has today launched the Strategy to Achieve Global Covid-19 Vaccination by mid-2022 (the Strategy) to help bring an end to what has become a two-track pandemic:  people in poorer countries continue to be at risk while those in richer countries with high vaccination rates enjoy much greater protection.

WHO had set a target to vaccinate 10% of every country, economy and territory by the end of September but by that date 56 countries had not been able to do so, the vast majority of these are countries in Africa and the Middle East.

The new strategy outlines a plan for achieving WHO’s targets to vaccinate 40% of the population of every country by the end of this year and 70% by mid-2022.

“Science has played its part by delivering powerful, life-saving tools faster than for any outbreak in history,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “But the concentration of those tools in the hands of a few countries and companies has led to a global catastrophe, with the rich protected while the poor remain exposed to a deadly virus. We can still achieve the targets for this year and next, but it will take a level of political commitment, action and cooperation, beyond what we have seen to date.”

“This is a costed, coordinated and credible path out of the COVID-19 pandemic for everyone, everywhere,” said United Nations Secretary-General Antonio Guterres. “Without a coordinated, equitable approach, a reduction of cases in any one country will not be sustained over time. For everyone’s sake, we must urgently bring all countries to a high level of vaccination coverage.”

To achieve the global vaccination targets, there should be a three-step approach to vaccination, with all older adults, health workers, and high-risk groups of all ages, in every country vaccinated first, followed by the full adult age group in every country and lastly extended vaccination of adolescents.

Vaccinating 70% of the global population requires at least 11 billion vaccine doses.   By the end of September, just over 6 billion doses had already been administered worldwide.  With global vaccine production now at nearly 1.5 billion doses per month, there is sufficient vaccine from a supply perspective to achieve the global vaccination targets provided that there is equitable distribution of those doses. 

Substantial financing has already been invested to procure most of the required vaccine doses for low- and lower-middle-income countries through COVAX, the African Vaccine Acquisition Trust (AVAT) and bilateral contracts.  There needs to be additional investment to secure the remaining vaccine doses for these countries as well as investment to support in-country delivery.  

The Strategy outlines the priority actions needed from the different actors to achieve the targets.

All Countries must:

  • Establish updated national COVID-19 vaccine targets and plans defining dose requirements to guide manufacturing investment and vaccine redistribution, and financial and programmatic resource needs to guide internal planning and external support;
  • Monitor vaccine demand and uptake carefully to rapidly adapt services and ensure continuity of vaccine supplies;
  • Commit to equitable distribution of vaccines in line with the WHO three-step approach;
  • Revise national vaccination strategies, policies and prioritization as needed to harness emerging evidence to maximize the impact of existing, modified and new vaccines.

Countries with high vaccine coverage must:

  • Swap vaccine delivery schedules, with COVAX and AVAT to enhance coverage in countries in need;
  • Fulfil and accelerate vaccine dose-sharing and donation commitments to COVAX in the near term, for those with existing pledges;
  • Establish new dose-sharing commitments to facilitate progress toward the 70% coverage target in every country.


Vaccine-producing countries must:

  • Allow the free cross-border flow of finished vaccines and raw materials;
  • Enable diversified vaccine production, both geographically and technologically, including through non-exclusive, and transparent licensing and sharing of know-how to allow transfer of technology and scale-up of manufacturing.  


COVID-19 vaccine manufacturers must:

  • Prioritize and fulfil COVAX and AVAT contracts as a matter of urgency;
  • Provide full transparency on the overall monthly production of COVID-19 vaccines and clear monthly schedules for supplies to COVAX, AVAT and low and low-middle income countries, to enable proper global and national-level planning and optimal use of scarce supplies;
  • Actively engage and work with countries that have high coverage and that have contracted high volumes of vaccines to allow the prioritization of COVAX and AVAT contracts, including through delivery schedule swaps, and facilitate rapid and early dose-sharing;
  • Commit to share know-how more rapidly, facilitate technology transfer and provide transparent non-exclusive voluntary licenses, to ensure that future vaccine supply is reliable, affordable, available, and deployed to every country in volumes and timing that achieves equitable access.


Civil society, community organizations, and the private sector must:

  • Advocate locally, nationally and internationally for equitable access to COVID-19 vaccines, tests and treatments, calling for and monitoring in particular the specific actions required of manufacturers, governments and multilateral actors;
  • Mobilize and empower communities, including through social media and community networks, to generate strong vaccine demand and address misinformation and misperceptions that contribute to vaccine hesitancy;
  • Provide support to the in-country delivery of vaccination programmes and services.


Global and regional multilateral development banks and institutions must:

  • Enable countries to more rapidly access the capital and external support needed for in-country vaccine delivery, prioritizing low-income settings and especially targeting support to the technical, logistics and human resources required;
  • Engage fully with COVAX/ACT-Accelerator and AVAT, with integrated operations and real-time sharing of information to truly support equitable access;
  • Support international procurement and allocation mechanisms to enable all countries to equitably, efficiently and rapidly achieve the COVID-19 vaccine targets;
  • Support vaccine distribution plans and a campaign to convey the life-saving importance of approved COVID-19 vaccinations.


For their part, WHO, Gavi, UNICEF and CEPI must work in close collaboration with World Bank, World Trade Organization, International Monetary Fund, Africa CDC, AVAT, and other key partners to monitor progress, identify changes needed to resolve bottlenecks, coordinate information and prioritize actions; continue to co-lead and manage the COVAX Pillar of ACT-Accelerator; support the equitable allocation of available vaccines, particularly to low-, lower-middle-income and lagging countries; directly support countries to develop and sustain rapid, effective, high-quality COVID-19 vaccine delivery programmes that can achieve the global targets; address key research, policy, safety and regulatory issues that will optimize vaccine impact including effective supply, dosing and vaccine schedules, mixing and matching of products, protection against variants, and other issues; and monitor and report monthly on progress towards the global COVID-19 vaccination goals.

Note to Editors:

The Strategy to Achieve Global Covid-19 Vaccination by mid-2022 can be read in its entirety here

See also:

The Global COVID-19 Vaccination – Strategic Vision for 2022 Technical Document

Slide deck on the Strategy to Achieve Global Covid-19 Vaccination by mid-2022

Following the WHO declaration of novel coronavirus as a public health emergency of international concern on 30 January 2020, the main global immunization partners developed a global COVID-19 vaccination strategy through the Access to COVID-19 Tools Accelerator (ACT-A) Vaccines Pillar (COVAX). The ACT-A prioritized strategy and budget can be read here. The 2022 Global Vaccination Strategy is intended to complement that strategy.

 The immediate goal of the global COVID-19 vaccination strategy is to minimize deaths, severe disease and overall disease burden; curtail the health system impact; fully resume socio-economic activity, and reduce the risk of new variants.

The 2022 Global COVID-19 Vaccination Strategy is based on a technical analysis that established a Conceptual COVID-19 Goal Framework which specifies a sequence of socio-economic and health goals, which could be achieved with various levels of vaccination scope and other interventions. The Conceptual Goal Framework structures the technical analyses of vaccination requirements to achieve ever broader health, social and economic goals and builds upon WHO’s broader COVID-19 Strategic Preparedness and Response Plan (SPRP) first published in 2020 and subsequently updated in 2021. The SPRP’s strategic objectives inform and align with the health and socioeconomic dimensions of the Global COVID-19 Vaccine Strategic Vision Goal Framework.

WHO recommends groundbreaking malaria vaccine for children at risk

6 Oct

The World Health Organization (WHO) is recommending widespread use of the RTS,S/AS01 (RTS,S) malaria vaccine among children in sub-Saharan Africa and in other regions with moderate to high P. falciparum malaria transmission. The recommendation is based on results from an ongoing pilot programme in Ghana, Kenya and Malawi that has reached more than 800 000 children since 2019.

“This is a historic moment. The long-awaited malaria vaccine for children is a breakthrough for science, child health and malaria control,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Using this vaccine on top of existing  tools to prevent malaria could save tens of thousands of young lives each year.”

Malaria remains a primary cause of childhood illness and death in sub-Saharan Africa. More than 260 000 African children under the age of five die from malaria annually.

In recent years, WHO and its partners have been reporting a stagnation in progress against the deadly disease.

"For centuries, malaria has stalked sub-Saharan Africa, causing immense personal suffering,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “We have long hoped for an effective malaria vaccine and now for the first time ever, we have such a vaccine recommended for widespread use. Today’s recommendation offers a glimmer of hope for the continent which shoulders the heaviest burden of the disease and we expect many more African children to be protected from malaria and grow into healthy adults.”

WHO recommendation for the RTS,S malaria vaccine

Based on the advice of two WHO global advisory bodies, one for immunization and the other for malaria, the Organization recommends that:

WHO recommends that in the context of comprehensive malaria control the RTS,S/AS01 malaria vaccine be used for the prevention of P. falciparum malaria in children living in regions with moderate to high transmission as defined by WHO.  RTS,S/AS01 malaria vaccine should be provided in a schedule of 4 doses in children from 5 months of age for the reduction of malaria disease and burden.

Summary of key findings of the malaria vaccine pilots

Key findings of the pilots informed the recommendation based on data and insights generated from two years of vaccination in child health clinics in the three pilot countries, implemented under the leadership of the Ministries of Health of Ghana, Kenya and Malawi. Findings include:

  • Feasible to deliver: Vaccine introduction is feasible, improves health and saves lives, with good and equitable coverage of RTS,S seen through routine immunization systems. This occurred even in the context of the COVID-19 pandemic.
  • Reaching the unreached: RTS,S increases equity in access to malaria prevention.
    • Data from the pilot programme showed that more than two-thirds of children in the 3 countries who are not sleeping under a bednet are benefitting from the RTS,S vaccine.
    • Layering the tools results in over 90% of children benefitting from at least one preventive intervention (insecticide treated bednets or the malaria vaccine).

  • Strong safety profile: To date, more than 2.3 million doses of the vaccine have been administered in 3 African countries – the vaccine has a favorable safety profile. 
  • No negative impact on uptake of bednets, other childhood vaccinations, or health seeking behavior for febrile illness. In areas where the vaccine has been introduced, there has been no decrease in the use of insecticide-treated nets, uptake of other childhood vaccinations or health seeking behavior for febrile illness.
  • High impact in real-life childhood vaccination settings: Significant reduction (30%) in deadly severe malaria, even when introduced in areas where insecticide-treated nets are widely used and there is good access to diagnosis and treatment.
  • Highly cost-effective: Modelling estimates that the vaccine is cost effective in areas of moderate to high malaria transmission.


Next steps for the WHO-recommended malaria vaccine will include funding decisions from the global health community for broader rollout, and country decision-making on whether to adopt the vaccine as part of national malaria control strategies.

Financial support

Financing for the pilot programme has been mobilized through an unprecedented collaboration among three key global health funding bodies: Gavi, the Vaccine Alliance; the Global Fund to Fight AIDS, Tuberculosis and Malaria; and Unitaid.

Note to editors:

  • The malaria vaccine, RTS,S, acts against P. falciparum, the most deadly malaria parasite globally, and the most prevalent in Africa.
  • The Malaria Vaccine Implementation Programme is generating evidence and experience on the feasibility, impact and safety of the RTS,S malaria vaccine in real-life, routine settings in selected areas of Ghana, Kenya and Malawi.
  • Pilot malaria vaccine introductions are led by the Ministries of Health of Ghana, Kenya and Malawi.
  • The pilot programme will continue in the 3 pilot countries to understand the added value of the 4th vaccine dose, and to measure longer-term impact on child deaths.
  • The Malaria Vaccine Implementation Programme is coordinated by WHO and supported by in-country and international partners, including PATH, UNICEF and GSK, which is donating up to 10 million doses of the vaccine for the pilot.
  • 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.
  • The Bill & Melinda Gates Foundation provided catalytic funding for late-stage development of RTS,S between 2001 and 2015.

Case study: Pilot implementation in Nigeria and Zambia, SBI COVID-19 data collection tool

1 Oct

An effective response to the coronavirus (COVID-19) pandemic requires the understanding and use of social and behavioural data alongside biomedical data. Recognizing this need, the Behavioural Insights and Sciences Unit of the World Health Organization (WHO) and the WHO Regional Office for Africa (AFRO) designed a survey tool tailored to Africa, to make it easier for countries to collect context-specific social and behavioural data. The objective was to inform the COVID-19 response at the country level while also allowing regional comparisons. This case study describes how the tool was adapted and used in a pilot study in Nigeria and Zambia and complements the WHO guidance on how to use the tool.

WHO prioritizes access to diabetes and cancer treatments in new Essential Medicines Lists

29 Sep

WHO today published the new edition of its Model Lists of Essential Medicines and Essential Medicines for Children, which include new treatments for various cancers, insulin analogues and new oral medicines for diabetes, new medicines to assist people who want to stop smoking, and new antimicrobials to treat serious bacterial and fungal infections.

The listings aim to address global health priorities, identifying the medicines that provide the greatest benefits, and which should be available and affordable for all. However, high prices for both new, patented medicines and older medicines, like insulin, continue to keep some essential medicines out of reach for many patients.

“Diabetes is on the rise globally, and rising faster in low- and middle-income countries,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Too many people who need insulin encounter financial hardship in accessing it or go without it and lose their lives. Including insulin analogues in the Essential Medicines List, coupled with efforts to ensure affordable access to all insulin products and expand use of biosimilars, is a vital step towards ensuring everyone who needs this life-saving product can access it.”

Medicines for diabetes

Insulin was discovered as a treatment for diabetes 100 years ago and human insulin has been on WHO’s List of Essential Medicines since it was first published in 1977. Unfortunately, limited insulin supply and high prices in several low- and middle-income countries are currently a significant barrier to treatment. For example, in Ghana’s capital, Accra, the amount of insulin needed for a month would cost a worker the equivalent of 5.5 days of pay per month. Insulin production is concentrated in a small number of manufacturing facilities, and three manufacturers control most of the global market, with the lack of competition resulting in high prices that are prohibitive for many people and health systems.

The move to list long-acting insulin analogues (insulin degludec, detemir and glargine) and their biosimilars, along with human insulin, is intended to increase access to diabetes treatment by expanding the choice of treatment. Inclusion in the List means that biosimilar insulin analogues can be eligible for WHO’s prequalification programme; WHO prequalification can result in more quality-assured biosimilars entering the international market, creating competition to bring prices down and giving countries a greater choice of products.

Long-acting insulin analogues offer some extra clinical benefits for patients through their prolonged duration of action, which ensures that blood glucose levels can be controlled over longer periods of time without needing a booster dose. They offer particular benefit for patients who experience dangerously low blood glucose levels with human insulin. The greater flexibility in timing and dosing of insulin analogues has been shown to improve quality of life for patients living with diabetes. However, human insulin remains a staple in the treatment of diabetes and access to this life-saving medicine must continue to be supported through better availability and affordability.

The list also includes Sodium-Glucose Co-transporter-2 (SGLT2) inhibitors empagliflozin, canagliflozin and dapagliflozin as second line therapy in adults with type 2 diabetes. These orally administered medicines have been shown to offer several benefits, including a lower risk of death, kidney failure and cardiovascular events. Because SGLT2 inhibitors are still patented and high-priced, their inclusion in the list comes with the recommendation that WHO work with the Medicines Patent Pool to promote access through potential licencing agreements with the patent-holders to allow generic manufacturing and supply in low- and middle-income countries.

Improving access to diabetes medicines including insulin and SGLT2 inhibitors is one of the workstreams of the Global Diabetes Compact, launched by WHO in April 2021, and a key topic under discussion with manufacturers of diabetes medicines and health technologies.

Cancer medicines

Cancers are among the leading causes of illness and death worldwide, accounting for nearly 10 million deaths in 2020, with seven out of 10 occurring in low- and middle-income countries. New breakthroughs have been made in cancer treatment in the last years, such as medicines that target specific molecular characteristics of the tumour, some of which offer much better outcomes than “traditional” chemotherapy for many types of cancer. Four new medicines for cancer treatment were added to the Model Lists:

  • Enzalutamide, as an alternative to abiraterone, for prostate cancer;
  • Everolimus, for subependymal giant cell astrocytoma (SEGA), a type of brain tumour in children;
  • Ibrutinib, a targeted medicine for chronic lymphocytic leukaemia; and
  • Rasburicase, for tumour lysis syndrome, a serious complication of some cancer treatments.

The listing for imatinib was extended to include targeted treatment of leukaemia. New childhood cancer indications were added for 16 medicines already listed, including for low-grade glioma, the most common form of brain tumour in children.

A group of antibodies that enhance the immune response to tumour cells, called PD-1 / PD-L1 immune-checkpoint inhibitors, were not recommended for listing for the treatment of a number of lung cancers, despite being effective, mainly because of their exceedingly high price and concerns that they are difficult to manage in low-resourced health systems. Other cancer medicines were not recommended for listing due to uncertain additional clinical benefit compared with already listed medicines, high price, and management issues in low-resource settings. These included osimertinib for lung cancer, daratumumab for multiple myeloma, and three types of treatment (CDK4/6 inhibitors, fulvestrant and pertuzumab) for breast cancer.

Other developments

Infectious diseases - New medicines listed include cefiderocol, a ‘Reserve’ group antibiotic effective against multi-drug resistant bacteria, echinocandin antifungals for severe fungal infections and monoclonal antibodies for rabies prevention – the first monoclonal antibodies against an infectious disease to be included on the Model Lists. The updated lists also see new formulations of medicines for common bacterial infections, hepatitis C, HIV and tuberculosis, to better meet dosing and administration needs of both children and adults. An additional 81 antibiotics were classified as Access, Watch or Reserve under the AWaRe framework, to support antimicrobial stewardship and surveillance of antibiotic use worldwide.

Smoking cessation – Two non-nicotine-based medicines – bupropion and varenicline – join nicotine-replacement therapy on the Model List, providing alternative treatment options for people who want to stop smoking. Listing aims to support the race to reach WHO’s ‘ Commit to Quit’ campaign goal that would see 100 million people worldwide quitting smoking over the coming year.

Note to Editors

The meeting of the 23rd Expert Committee on the Selection and Use of Essential Medicines was held virtually from 21 June to 2 July. The Expert Committee considered 88 applications for medicines to be added to the 21st WHO Model List of Essential Medicines (EML) and the 7th WHO Model List of Essential Medicines for Children (EMLc). WHO technical departments were involved and consulted with regard to applications relating to their disease areas.

The updated Essential Medicines Lists include 20 new medicines for adults and 17 for children and specify new uses for 28 already-listed medicines. The changes recommended by the Expert Committee bring the number of medicines deemed essential to address key public health needs to 479 on the EML and 350 on the EMLc. While these numbers may seem high, they are only a small proportion of the total number of medicines available on the market.

Governments and institutions around the world continue to use the WHO Model Lists to guide the development of their own essential medicines lists, because they know that every medicine listed has been vetted for efficacy and safety and delivers value for money for the health outcomes they produce.

The Model Lists are updated every two years by an Expert Committee, made up of recognized specialists from academia, research and the medical and pharmaceutical professions. This year, the Committee underscored the urgent need to take action to promote equitable and affordable access to essential medicines through the list and complementary measures such as voluntary licensing mechanisms, pooled procurement, and price negotiation.

WHO and partners call for urgent action on meningitis

28 Sep

Today, the World Health Organization (WHO) and partners launched the first ever global strategy to defeat meningitis - a debilitating disease that kills hundreds of thousands of people each year.

By 2030, the goals are to eliminate epidemics of bacterial meningitis – the most deadly form of the disease – and to reduce deaths by 70% and halve the number of cases. The organizations estimate that in total, the strategy could save more than 200,000 lives annually and significantly reduce disability caused by the disease.

This strategy, the Global Roadmap to Defeat Meningitis by 2030, was launched by a broad coalition of partners involved in meningitis prevention and control at a virtual event, hosted by WHO in Geneva. Its focus is on preventing infections and improving care and diagnosis for those affected.

“Wherever it occurs, meningitis can be deadly and debilitating; it strikes quickly, has serious health, economic and social consequences, and causes devastating outbreaks,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “It is time to tackle meningitis globally once and for all –by urgently expanding access to existing tools like vaccines, spearheading new research and innovation to prevent, detecting and treating the various causes of the disease, and improving rehabilitation for those affected.”

Meningitis is a dangerous inflammation of the membranes that surround the brain and spinal cord, predominantly caused by infection with bacteria and viruses.

Meningitis that is caused by bacterial infection tends to be the most serious – leading to around 250,000 deaths a year - and can cause fast-spreading epidemics. It kills 1 in 10 of those infected – mostly children and young people - and leaves 1 in 5 with long-lasting disability, such as seizures, hearing and vision loss, neurological damage, and cognitive impairment.

Over the last ten years, meningitis epidemics have occurred in all regions of the world, though most commonly in the ‘Meningitis Belt,’ which spans 26 countries across Sub-Saharan Africa. These epidemics are unpredictable, can severely disrupt health systems, and create poverty - generating catastrophic expenditures for households and communities.

“More than half a billion Africans are at risk of seasonal meningitis outbreaks but the disease has been off the radar for too long,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “This shift away from firefighting outbreaks to strategic response can’t come soon enough. This roadmap will help protect the health and lives of hundreds of thousands of families who every year fear this disease.”

Several vaccines protect against meningitis, including meningococcal, Haemophilus influenzae type b and pneumococcal vaccines. However, not all communities have access to these lifesaving vaccines, and many countries are yet to introduce them into their national programmes.

While research is underway to develop vaccines for other causes of meningitis, such as Group B Strep bacteria, there remains an urgent need for innovation, funding and research to develop more meningitis-preventive vaccines. Efforts are also needed to strengthen early diagnosis, treatment and rehabilitation for all those who need it after contracting the disease.

“This roadmap is the embodiment of the ambition of people and families affected around the world who have called for its creation. It's their experience and passion that has driven a whole community of interest to get this far,” said Vinny Smith, Chief Executive Officer of the Meningitis Research Foundation and the Confederation of Meningitis Organisations (CoMO), an international membership organization of patient advocacy groups for meningitis. “We celebrate together the common goal of defeating meningitis and will be led by their inspiration to make it happen.”

The new Roadmap details the following priorities for meningitis response and prevention:

  • Achievement of high immunization coverage, development of new affordable vaccines, and improved prevention strategies and outbreak response;
  • Speedy diagnosis and optimal treatment for patients;
  • Good data to guide prevention and control efforts;
  • Care and support for those affected, focusing on early recognition and improved access to care and support for after-effects, and
  • Advocacy and engagement, to ensure high awareness of meningitis, accountability for national plans, and affirmation of the right to prevention, care and after-care services.

 WHO and partners are providing support to countries to implement the Roadmap, including through the development of regional and national frameworks that will help countries achieve its ambitious goals.

Partner quotes

“The Global Roadmap to Defeat Meningitis demonstrates what can be accomplished when a global need is met with global action,” said Nikolaj Gilbert, President and CEO of PATH. “Progress against meningitis has lagged for too long; by working together, we can overcome the disease that has cost so many lives in countries around the world. PATH is proud to have been a part of the roadmap’s development and is committed to advancing affordable and equitable vaccine solutions to defeat meningitis.”

“We must be united in our efforts to end all preventable childhood diseases, including bacterial meningitis,” said Dr. Aboubacar Kampo, Director of Health Programmes at UNICEF. “UNICEF has been supporting governments for decades, facilitating the delivery of life-saving meningitis vaccines. Still, far too many children are succumbing to this and other preventable diseases – and the situation is only worsening as a result of the pandemic. We need to act decisively to strengthen primary health care and get routine immunization back on track, before more children face adverse health outcomes – or loss of life - inflicted by meningitis and other preventable infectious diseases.”

“Although the main burden of meningitis is in poor countries, acute bacterial meningitis is a global problem with no country being spared its devastating impact,” said Professor Sir Brian Greenwood, Professor of Clinical Tropical Medicine at the London School of Hygiene & Tropical Medicine and co-chair of the Task Force supporting the implementation of the roadmap. “Thus, containing this serious group of infections needs a global response. This is what the roadmap sets out to achieve, bringing together – under the umbrella of WHO – health professionals from across the world to bring this condition under control by 2030.”

“The Meningitis Roadmap provides a clear blueprint for defeating this devastating disease,” said Professor Robert Heyderman, Head of the Research Department of Infection at University College London. “Crucially it identifies the gaps in our knowledge and the tools required. To achieve the Road Map’s ambitious goals, a team approach will bring together countries, global policymakers, civil society, funders, researchers, public health specialists, healthcare workers and industry to generate and implement innovative new strategies.”


Notes

Today’s launch event was supported by a large network of organizations and individual experts involved in meningitis prevention and control, including the United States Centers for Disease Control and Prevention, the London School of Hygiene and Tropical Medicine, Médecins Sans Frontières, Epicentre, the Meningitis Research Foundation, PATH, UNICEF, the Gates Foundation and CoMO. Additional acknowledgements go to all partners involved in the development of the Roadmap

The Roadmap is the result of the first ever resolution on meningitis, passed by the World Health Assembly and endorsed unanimously by WHO member states in 2020.

As one of the first tangible outputs from this Roadmap, WHO and the London School of Hygiene and Tropical Medicine will be launching a global evidence-based report on November 3rd about identifying and preventing deaths due to Group B strep, also known as streptococcal bacteria, the major cause of neonatal and infant meningitis.

 

WHO Academy Groundbreaking Ceremony Expanding Access to Critical Learning

24 Sep

Emmanuel Macron, President of the French Republic, and Dr Tedros Adhanom Ghebreyesus, WHO Director-General, today broke ground for the WHO Academy’s campus in the French city of Lyon.

The event marks a milestone in fulfilling a previous commitment by the two leaders to establish a WHO Academy in Lyon’s bio-medical district to meet the needs of WHO Member States and a growing global health workforce for expanded access to life-long learning, health guidance and competency-building.

The quickening pace of scientific discovery and advancement of technology is making it more difficult for health workers, policy makers and other public health practitioners to keep up with evidence-based health practice and policy. As a result, it often takes more than a decade to put important life-saving guidelines into practice. 

This is a key reason why no country is currently on track to achieve all of the health targets of Sustainable Development Goals (SDGs). The COVID-19 pandemic has also disrupted life-long learning systems, generating growing demand for digital learning.

“The ambitions of the WHO Academy are not modest: to transform lifelong learning in health globally,” said Dr Tedros. “The COVID-19 pandemic is a powerful demonstration of the value of health workers, and why they need the most up-to-date information, competencies and tools to keep their communities healthy and safe.

He added: “The WHO Academy is an investment in health, education, knowledge and technology, but ultimately it’s an investment in people, and in a healthier, safer, fairer future.”

From its campus in Lyon, the Academy will provide millions of people around the world with rapid access to the highest quality life-long learning in health. It will offer multilingual, personalized learning programmes in digital, in-person and blended formats, deploying the latest evidence-based health guidance, state-of-the-art learning technologies and advancements in the science of adult learning.

“The quality of the health workforce is the key to resilience during a health crisis”, said President Macron. “Investing in health systems is the best way to prepare for future pandemics. Success requires unprecedented coordination of all actors. WHO is, of course, a key player and its Academy will be an essential platform for disseminating learning”.

The Academy aims to expand access to critical learning to health workers, managers, public health officials, educators, researchers, policy makers and people who provide care in their own homes and communities, as well as to WHO’s own workforce throughout the world. The vast majority will use online means to access the Academy’s programmes, which will be made available via desktop and mobile devices and in low-bandwidth settings, thereby ensuring an equitable, global and diverse cohort of learners.

Additionally, the WHO Academy will:

  • Harness the capabilities of new, high-impact technologies such as virtual reality, augmented reality, artificial intelligence and serious educational games to deliver health learning for maximum impact.
  • Formally recognize the competencies gained by learners through “digital credentials” that they can show to employers and regulatory agencies to help advance their careers.
  • Offer more than 100 major learning programmes by 2023, with flagship credentialed programmes for COVID-19 Vaccine Equity, Universal Health Coverage, Health Emergencies and Healthier Lives. The Academy will also offer its learners streamlined access to WHO’s full breadth of hundreds of e-learning programmes currently spread over 20 digital learning platforms as well as access to high quality learning programmes developed by others. 

When it opens in 2024, the WHO Academy campus in Lyon will have high-tech and people-centred spaces designed for collaborative learning, educational research and innovation.  It will also host a world-class health emergencies simulation centre that will use high-fidelity technologies to enable health workers to sharpen their competencies amid realistic scenarios including mass casualties and disease outbreaks.

During today’s event at Lyon’s Cité Internationale, President Macron and Dr Tedros reviewed an architectural model of the building and  talked via video-link with health workers who have participated in the Academy’s Mass Casualty Management programme, which is already operating in several countries including France, Greece, Afghanistan, Ethiopia and Somalia.

WHO also used the occasion to announce the appointment, which became effective on 16 August 2021, of Dr Agnès Buzyn as the Academy’s Executive Director. She has been serving since January as the WHO Director-General’s Envoy for Multilateral Affairs, during which time she has also supervised the Academy project.

As a WHO Member State and a key actor in global health, France is the lead investor in the Academy’s development, having committed more than 120 million euros to support its establishment and infrastructure. This achievement is possible thanks to the collective actions, commitment and financial support of the City of Lyon and the Lyon Metropole, as well as from the Auvergne-Rhône-Alpes region, which contributed 25 million euros of the total investment. The region will own the campus and lease it to WHO.

More information: English, French 

 

ACT-Accelerator partnership welcomes leadership and commitments at US COVID Summit to ending COVID-19 pandemic through equitable access to tests, treatments, and vaccines

24 Sep
  • President Biden and global leaders agreed ambitious targets, aligned with the ACT-Accelerator, to end the COVID-19 pandemic
  • Collective accountability for world leaders, industry and partners emphasized, as global response now turns to implementation of these targets
  • Concrete action must now follow this summit to deliver and deploy tests, treatments, and vaccines immediately, to prevent further unnecessary loss of life

Global leaders attending the US-hosted Global COVID-19 Summit on 22 September re-affirmed their commitment to ending the acute phase of the pandemic, and the goals of the ACT-Accelerator, by agreeing targets to provide equitable access to COVID-19 tests, treatments, and vaccines.

Global targets agreed at the Summit include vaccinating 40% of the world’s population in 2021 and 70% of the population in 2022; achieving testing rates of one per 1,000 people per day in all countries by the end of 2021; and for all facilities treating patients with severe COVID-19 to have sufficient oxygen supplies, quality-assured treatments and PPE.

Currently the world is facing a two-track pandemic, where public health measures are starting to lift among highly vaccinated populations, while those in low and middle-income countries are still grappling with lockdowns, high death rates and insufficient tools to fight the virus. The economic case could not be clearer. Research from the International Chamber of Commerce shows that vaccine nationalism could cost rich countries US$4.5 trillion.

The ACT-Accelerator partnership welcomes President Biden’s political leadership and new commitments in support of these goals, including additional financing, dose donations, and the establishment of an EU-US taskforce to work toward vaccination objectives. These targets have come at a crucial time ahead of the G20 in Rome in October, and as the ACT-Accelerator prepares to launch its new Strategy and Budget.

Carl Bildt, WHO Special Envoy for the ACT-Accelerator and former Prime Minister of Sweden, said: “President Biden’s COVID-19 Summit should be the tipping point to ending the pandemic. We saw significant commitments from global leaders towards the goals of the ACT-Accelerator and agreement on what needs to be done to defeat the pandemic. In the next month, we must see concrete progress towards the fulfilment of these ambitious goals.

“Right now, 1.5 billion doses of vaccine are being produced every month, but most of the world doesn’t have access to any of them. Sick people need oxygen now. Doctors and nurses need PPE. Without widespread testing we risk being blindsided by the next variant. Manufacturers need to deliver their promised doses to COVAX and AVAT. Rich countries need to honour their promises to global access and make space at the front of the queue. All countries need to step up, because we cannot afford to go through the full Greek alphabet of variants.”

The ACT-Accelerator is the only integrated, end-to-end solution to the pandemic everywhere. The partnership is committed to making sure that the targets agreed become a reality. In order to achieve this, the global response - estimated at $50bn by the IMF - needs to be fully funded. Compared to the trillions spent by G20 countries mitigating the consequences of the pandemic, and the trillions more that will be spent if it continues, that is an unbeatable return on investment.

Background

The Access to COVID-19 Tools Accelerator (ACT-Accelerator) is a global coalition of organizations developing and deploying the new diagnostics, treatments and vaccines needed to end the acute phase of the pandemic. Pooling the expertise of its many partners, the ACT-Accelerator has quickly ushered in rapid, affordable tests and effective medicines, and established the COVAX facility for the equitable procurement and distribution of vaccines in low- and middle-income countries.

The ACT Accelerator’s work is more vital than ever as new variants of the virus threaten to resist current COVID-19 tools, posing the risk of more death, illness, and social and economic harm. The ACT-Accelerator has four areas of work, or pillars:


UNICEF is a cross-cutting partner of the ACT-Accelerator, providing programmatic support and procurement of supplies for countries across all Pillars. A workstream on access and allocation of COVID-19 products, hosted by WHO, cuts across the four pillars.

The ACT-Accelerator partnership was formed at the onset of the pandemic in response to a call from G20 leaders, and was launched by WHO, the European Commission, France and the Bill & Melinda Gates Foundation. Critical funding for the effort comes from an unprecedented mobilization of donors, including countries, the private sector, philanthropists and multilateral partners. It has supported the fastest, most coordinated, and successful global effort in history to develop tools to fight a disease.

What Needs to Change to Enhance Covid-19 Vaccine Access

24 Sep

The Independent Allocation Vaccine Group (IAVG) was established by the WHO in January 2021 and is composed of 12 members who serve in their personal, independent capacities to review and assess Vaccine Allocation Decision (VAD) proposals generated by the COVAX Facility Joint Allocation Taskforce (JAT) on the volumes of vaccines that should be allocated to each participant under COVAX within a given time frame[1].

The IAVG continues to be very concerned about the evolution of the pandemic, and its health, social and economic impacts, and offers its full support to COVAX Partners to ensure that critical messages are channelled to the relevant fora to raise the awareness of governments, manufacturers and stakeholders of challenges in access to COVID-19 vaccines. 

The IAVG is concerned about the 25% reduction in supply forecast for the fourth quarter of 2021. It is also concerned about the prioritization of bilateral deals over international collaboration and solidarity, export restrictions and decisions by some countries to administer booster doses to their adult populations.

During its last meeting on 17 September, the IAVG revisited issues previously raised pertaining to vaccine supply, vaccine allocation, and vaccine administration and offers the following perspectives:   

Vaccine supply

The IAVG continues to be concerned by the low supply of vaccines to COVAX, and reiterates the need for manufacturers, vaccine producing and high-coverage countries to prioritize vaccine equity and transparency, the sharing of information about manufacturing capacity and supply schedules to COVAX, as well as vaccine access plans.  While recognizing the need for additional doses to protect certain vulnerable, immune-compromised populations, the IAVG suggests countries collect and review more evidence before implementing policies regarding the administration of booster doses to their populations.

Vaccine allocation

The recent exceptional allocation round at which the recommendation was made that the October COVAX supply be fully dedicated to those countries with a low population coverage, after accounting for all sources of vaccines, is a step forward in achieving equitable access. The IAVG supports the decision of prioritizing COVAX supply for those countries most likely relying solely on COVAX for access to COVID-19 vaccines and supports the continuation of this approach in future rounds.

The IAVG notes that so far only three manufacturers have waived indemnification and liability for use in humanitarian settings, and none have been waived for use at country level. This has consequences for vaccines allocated to the humanitarian buffer, as well as potentially setting precedents for future use.

Vaccine administration

The IAVG has considered the information and data on absorptive capacity in countries with low total population coverage and brings the following issues to the attention of the COVAX Partners for further consideration: 

  • Continued advocacy for equity is needed in international and regional fora to address the lack of political will in several settings that is blocking the implementation of equitable access and the development of well-resourced vaccination programmes at country level.
  • Countries must be able to access funding for vaccine implementation.   Continued awareness of the need for such funding as well as the provision of technical support to countries to develop requests for assistance must be prioritized, especially by the World Bank and other multilateral development banks. Funding should also be considered for third party actors (NGOs and civil society) willing to support countries in vaccine implementation.
  • Donations to COVAX are an important source of vaccine supply; however, these should complement rather than replace vaccine procurement by COVAX given the high transaction burden and costs in managing these donations.  Additionally, IAVG strongly encourages high-coverage countries to swap their delivery schedules with those of COVAX so that COVAX contracts can be prioritized by manufacturers.
  • The IAVG reiterates the need for countries which are sharing doses with COVAX to reduce/remove all earmarking and ensure the donated vaccines have an adequate remaining shelf life to allow for their use.
  • Several programmes have been put in place to increase confidence in COVID-19 vaccines and address vaccination hesitancy.  These must be tailored to local contexts and the engagement of local communities and civil society is critical to ensuring their effectiveness.
  • Some regions and/or countries are experiencing civil unrest, conflicts and natural disasters that are impeding or slowing the implementation of vaccination programmes.  Global solidarity and cooperation are needed to ensure they are supported in such critical situations.

COVAX remains the main global access mechanism able to serve all countries and ensure equitable access. The IAVG stands strongly behind this initiative.

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[1] The IAVG (https://www.who.int/groups/iavg) acknowledges that the role of the WHO within COVAX is to provide guidance on vaccine policy, regulation, safety, research and development, vaccine allocation, and country readiness and delivery, in partnership with UNICEF.  As of today, the IAVG has validated allocation through COVAX for a total of 362.8 million doses of vaccines.