Addressing the crisis in antibiotic development

9 Jul

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. 

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UN Public Service Day

8 Jul

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.

The United Nations will 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.

A virtual event will bring together public servants and leaders to discuss the importance of the continuation of public service provision during times of pandemic. In doing so, it will examine the various approaches countries have taken during the crisis while looking at what measures they are undertaking to better mitigate such challenges in the future.

The event will also include an orchestral piece performed by the UN Orchestra and feature a video showcasing public servants in action developed from over 80 submissions received from public servants at national and local levels worldwide. 

Speakers include:

  • 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

  1. Link to event
  2. DG speech

 

 

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WHO experts to travel to China

7 Jul

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.

 

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

7 Jul

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.

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

6 Jul

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.

 

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WHO launches iSupport Lite

6 Jul

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. 

 

 

 

 

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

4 Jul

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.



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Statement of the twenty-fifth polio IHR Emergency Committee

3 Jul

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-19

The 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.  

Conclusion

The 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 categories

The 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 RECOMMENDATIONS

States 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)

cVDPV1
Malaysia          (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)
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)
  • China (most recent detection 25 April 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. 

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

1 Jul

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.

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

1 Jul

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

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