Global & Disaster Medicine

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WHO: An estimated 1 in 10 medical products circulating in low- and middle-income countries is either substandard or falsified

WHO

1 in 10 medical products in developing countries is substandard or falsified

WHO urges governments to take action

News release

An estimated 1 in 10 medical products circulating in low- and middle-income countries is either substandard or falsified, according to new research from WHO.

This means that people are taking medicines that fail to treat or prevent disease. Not only is this a waste of money for individuals and health systems that purchase these products, but substandard or falsified medical products can cause serious illness or even death.

“Substandard and falsified medicines particularly affect the most vulnerable communities,” says Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Imagine a mother who gives up food or other basic needs to pay for her child’s treatment, unaware that the medicines are substandard or falsified, and then that treatment causes her child to die. This is unacceptable. Countries have agreed on measures at the global level – it is time to translate them into tangible action.”

Since 2013, WHO has received 1500 reports of cases of substandard or falsified products. Of these, antimalarials and antibiotics are the most commonly reported. Most of the reports (42%) come from the WHO African Region, 21% from the WHO Region of the Americas, and 21% from the WHO European Region.

This is likely just a small fraction of the total problem and many cases may be going unreported. For example, only 8% of reports of substandard or falsified products to WHO came from the WHO Western Pacific Region, 6% from the WHO Eastern Mediterranean Region, and just 2% from the WHO South-East Asia Region.

“Many of these products, like antibiotics, are vital for people’s survival and wellbeing,” says Dr Mariângela Simão, Assistant Director-General for Access to Medicines, Vaccines and Pharmaceuticals at WHO. “Substandard or falsified medicines not only have a tragic impact on individual patients and their families, but also are a threat to antimicrobial resistance, adding to the worrying trend of medicines losing their power to treat”.

Prior to 2013, there was no global reporting of this information. Since WHO established the Global Surveillance and Monitoring System for substandard and falsified products, many countries are now active in reporting suspicious medicines, vaccines and medical devices. WHO has trained 550 regulators from 141 countries to detect and respond to this issue. As more people are trained, more cases are reported to WHO.

WHO has received reports of substandard or falsified medical products ranging from cancer treatment to contraception. They are not confined to high-value medicines or well-known brand names and are split almost evenly between generic and patented products.

In conjunction with the first report from the Global Surveillance and Monitoring System published today, WHO is publishing research that estimates a 10.5% failure rate in all medical products used in low- and middle-income countries.

This study was based on more than 100 published research papers on medicine quality surveys done in 88 low- and middle-income countries involving 48 000 samples of medicines. Lack of accurate data means that these estimates are just an indication of the scale of the problem. More research is needed to more accurately estimate the threat posed by substandard and falsified medical products.

Based on 10% estimates of substandard and falsified medicines, a modelling exercise developed by the University of Edinburgh estimates that 72 000 to 169 000 children may be dying each year from pneumonia due to substandard and falsified antibiotics. A second model done by the London School of Hygiene and Tropical Medicine estimates that 116 000 (64 000 – 158 000) additional deaths from malaria could be caused every year by substandard and falsified antimalarials in sub-Saharan Africa, with a cost of US$ 38.5 million (21.4 million – 52.4 million) to patients and health providers for further care due to failure of treatment.

Substandard medical products reach patients when the tools and technical capacity to enforce quality standards in manufacturing, supply and distribution are limited. Falsified products, on the other hand, tend to circulate where inadequate regulation and governance are compounded by unethical practice by wholesalers, distributors, retailers and health care workers. A high proportion of cases reported to WHO occur in countries with constrained access to medical products.

Modern purchasing models such as online pharmacies can easily circumvent regulatory oversight. These are especially popular in high-income countries, but more research is needed to determine the proportion and impact of sales of substandard or falsified medical products.

Globalization is making it harder to regulate medical products. Many falsifiers manufacture and print packaging in different countries, shipping components to a final destination where they are assembled and distributed. Sometimes, offshore companies and bank accounts have been used to facilitate the sale of falsified medicines.

“The bottom line is that this is a global problem,” says Dr Simão. “Countries need to assess the extent of the problem at home and cooperate regionally and globally to prevent the traffic of these products and improve detection and response.”

Note to editors

WHO is publishing two reports today:

  • WHO launched its Global Surveillance and Monitoring System for substandard and falsified medicines, vaccines and in-vitro diagnostic tests in July 2013. This first report is based on data collected during the first 4 years of operation up to 30 June 2017.
  • A study on the public health and socioeconomic impact of substandard or falsified medical products conducted by WHO and the Member State Mechanism.

This study is based on 100 literature reviews and two peer-reviewed models developed by the University of Edinburgh and The London School of Hygiene and Tropical Medicine. The 100 papers reviewed provide data for more than 48 000 samples of medicines from 88 countries. Because only 178 samples were taken in high-income countries, prevalence estimates of substandard or falsified medical products were limited to low- and middle-income countries.

Despite these limitations, these two reports represent the most comprehensive compilation to date of data related to substandard and falsified medical products and are a first step towards better understanding their public health and socioeconomic impact.

For more information, please contact:

Daniela Bagozzi
Senior Information/Communications Manager
Telephone: +41 22 791 1990
Mobile: +41 79 603 7281
E-mail: bagozzid@who.int

Christian Lindmeier
Communications Officer
Telephone: +41 22 791 1948
Mobile: +41 79 500 6552
E-mail: lindmeierch@who.int


WHO: Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities

WHO 

Focus on AMR – evidence, guidelines and publications

Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities

The eight recommendations are:

  • Adopt multipart strategies to prevent and control CRE, CRAB, or CRPsA infection or colonization that includes at least hand hygiene, surveillance (especially for CRE), contact precautions, patient isolation (single room or cohorting), and environmental cleaning
  • Implement hand hygiene best practices spelled out in earlier WHO guidance
  • Conduct surveillance for CRE-CRAB-CRPsA infection and colonization, especially targeting those with previous CRE colonization, contacts of CRE patients, or those with a history of recent hospitalization in CRE-endemic settings
  • Implement contact precautions when caring for infected or colonized patients
  • Isolate infected or colonized patients, either in a single room or with others who have the same pathogen
  • Comply with environmental cleaning protocols in the “patient zone” of infected or colonized patients, though the optimal cleaning agent was not identified
  • Take surveillance cultures of the environment to detect contamination
  • Monitor the impact of the interventions

Carbapenem-resistant gram-negative bacteria, namely, carbapenem-resistant Enterobacteriaceae (CRE), Acinetobacter baumannii (CRAB) and Pseudomonas aeruginosa (CRPsA), are an emerging cause of health-care acquired infection that pose a significant threat to public health. The first ever global guidelines for the prevention and control of CRE-CRAB-CRPsA in health care facilities were published on 14 November 2017. They include 8 recommendations distilled by the world’s leading experts from a review of the latest evidence. They are designed to provide evidence-based recommendations on the early recognition and specific required infection prevention and control practices (IPC) and procedures to effectively prevent the occurrence and control the spread of CRE-CRAB-CRPsA colonization and/or infection in acute health care facilities. They provide an evidence-based framework to help inform the development and/or strengthening of national and facility IPC policies and programmes to control the transmission of CRE-CRAB-CRPsA in a variety of health care settings. The recommendations included in these guidelines build upon the overarching standards set by the WHO publication Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level.



These guidelines are intended to support IPC improvement at the facility level, targeting infection prevention leads, senior managers, other health care professionals and patients alike. They are also relevant to policy makers, regulatory and professional bodies at the national level, among others. We encourage you all to use and promote these guidelines.


Teleclass: Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities

President Robert Mugabe as WHO Goodwill Ambassador for Noncommunicable Diseases in Africa? What was I thinking?

WHO

Director-General rescinds Goodwill Ambassador appointment

WHO statement
22 October 2017

Over the last few days, I have reflected on my appointment of H.E. President Robert Mugabe as WHO Goodwill Ambassador for Noncommunicable Diseases in Africa. As a result I have decided to rescind the appointment.

I have listened carefully to all who have expressed their concerns, and heard the different issues that they have raised. I have also consulted with the Government of Zimbabwe and we have concluded that this decision is in the best interests of the World Health Organization.

It is my aim to build a worldwide movement for global health. This movement must work for everyone and include everyone.

For me, what is important is to build political leadership and create unity around bringing health to all, based on WHO’s core values.

I remain firmly committed to working with all countries and their leaders to ensure that every one has access to the health care they need.

We must build bridges that bring us together and help us move forward in our quest to achieve universal health coverage.

I thank everyone who has voiced their concerns and shared their thoughts. I depend on constructive debate to help and inform the work I have been elected to do.

 


WHO’s Tedros starts storm of controversy over Mugabe as “goodwill ambassador”

CNN

“…..Mugabe has long been criticized for corruption and abuse of power, and the decision to name him a goodwill ambassador for WHO stunned health experts and rights activists……

More than 25 global health organizations that attended a conference in Uruguay, where Mugabe was named a global ambassador Wednesday, signed a joint statement expressing shock and concern.
The organizations acknowledged that Mugabe has made commitments to fight noncommunicable diseases as a priority in his country but noted he has a long track record of human rights violations…..”

More than a million doses of antibiotics have been delivered by the World Health Organization to fight an outbreak of plague in Madagascar which has killed at least 33 people.

BBC

 


WHO: To combat cholera in South Sudan

WHO

10 July 2017

Cholera contributes substantially to the disease burden in South Sudan, where outbreaks have been confirmed every year since 2014. Thus, cholera is endemic in South Sudan and requires an integrated and comprehensive approach that entails surveillance, patient care, optimal access to safe drinking water, sanitation, and hygiene (WASH); social mobilization and complementary use of oral cholera vaccines.

During the week ending 2 July 2017, a total of 304 new cholera cases and 0 deaths (Case Fatality Rate –CFR 0%) were reported across South Sudan. As of 2 July 2017, the cumulative total number of cases since the start of the current outbreak on 18 June 2016 is 17, 242 cases and 320 deaths (CFR 1.8%). The counties with active cholera transmission include Tonj East, Juba, Lankien, Pieri, Panyijar, Yirol East, Yirol West, Kapoeta East, Kapoeta South, and Kapoeta North. Suspect cholera cases are being investigated in Torit and Terekeka.

The integrated and comprehensive approach is core to the current cholera response in South Sudan. The cholera response strategy in South Sudan includes; case management, improving access to safe drinking water and sanitation; health promotion, risk communication, and community engagement; surveillance; patient care; and complementary use of oral cholera vaccines.

As a result, cholera transmission in Bor, Mingkaman, Duk, Ayod, Bentiu, Leer, Aburoc, Malakal Town, and several other areas has been controlled. The National cholera taskforce chaired by the Ministry of Health and co-chaired by WHO is leading the current response through its coordination, surveillance, case management, WASH, and social mobilization working groups.

Coordination

Overall coordination of the cholera response at the national level is coordinated by the National cholera taskforce.

At the sub-national level, cholera taskforce committees are coordinating the cholera response in locations with active transmission including Yirol East and Yirol West, Bor, Duk, Tonj East, Kapoeta South, Kapoeta North, and Kapoeta East. Other non-affected states have also initiated cholera preparedness meetings in Aweil, Torit, Wau, Yambio, and Rumbek.

Health cluster support in coordination with the humanitarian partners responding to cholera outbreak and donors to fund cholera response in different locations.

Case Management

At least 50 cholera treatment facilities including cholera treatment centers and units; and oral rehydration points are currently operational in the areas with active cholera transmission. The cholera case management working group is coordinating patient care activities that are driven by the need to ensure timely access to rehydration at household level and at designated cholera treatment facilities. Ministry of Health-led and WHO supported rapid response teams have been deployed to support the cholera response in Kapoeta, Tonj, Jonglei, Eastern Lakes, and Northern Upper Nile states. The teams are evaluating transmission dynamics among the nomadic migratory communities in Kapoeta and devising appropriate epidemiological structures to break the chain and pattern of cholera transmission in this group. WHO, UNICEF, and health cluster partners have delivered cholera kits for patient care in areas with active transmission.

Water, Sanitation and Hygiene (WASH)

The WASH response is led by the WASH cluster and its partners and with interventions delivered as part of the integrated comprehensive approach in affected and at-risk areas. Point of use water treatment using PuR and water treatment tablets, hygiene promotion, distribution of other WASH NFIs, and repair of hand pumps are core to the current emergency WASH response in affected and high-risk areas. WHO is enhancing WASH capacities in cholera treatment facilities through training, deployment of public health officers, and water quality surveillance in affected and at-risk areas. Arrangements have been finalized for an intercountry planning meeting between South Sudan, Uganda, and Kenya to mitigate the risk of cross-border cholera spread.

Surveillance

With support from WHO, the Ministry of Health has rolled out electronic and mobile reporting of cholera alerts as well as cholera case based line listing in all affected locations. This has enhanced the transmission and accuracy, analysis, and dissemination of cholera situation reports to inform the response. Rapid response teams have been activated and supported with cholera investigation kits to facilitate timely verification and investigation of suspect cholera cases. Out of the 624 cholera samples tested by the National Public Health Laboratory, 247 (39.6%) have been confirmed by culture since 18 June 2016.

Social Mobilization

Partners have supported the Ministry of Health to intensify Social mobilization in the affected communities through community social mobilizers, and use of educational materials. WHO in collaboration with UNICEF and MOH has reactivated Cholera hotline (1144) Vivacell Telecom hotline to respond to calls, inquiries, alerts and as well as provide education on cholera prevention and control.

Oral cholera vaccination

As part of the ongoing cholera response, cholera vaccines have been deployed in Leer, Bor PoC, Malakal Town, Bentiu PoC, Mingkaman IDP settlement, Aburoc IDPs, Bentiu/Rubkona Town, Ayod (Pagil, Tar, Jiech, Karmun, Padek, and Kandak), and Juba (Don Bosco IDPs). Out of the 544 140 doses secured by WHO in 2017, a total of 384 971 doses have been deployed. There are no cholera cases reported from any of the sites where the oral cholera vaccines have been deployed in 2017.

An additional two million doses of oral cholera vaccines are required to mitigate the risk of cholera in high risk areas and to interrupt transmission in the areas with ongoing transmission. WHO is in the final stages of securing these additional doses to complement the ongoing cholera response.

WHO’s contribution to the cholera response

WHO provides overall technical guidance to MOH and health partners towards the cholera response. We also support to surveillance and cholera investigation as well as case management by deployment of Rapid Response Teams (RRTs), Clinicians, and support to WASH in Cholera Treatment Centers (CTCs) and monitoring standards of care.

WHO and partners conducting an assessment at Don Bosco Gumbo Oral Rehydration Point
WHO and partners conducting an assessment at Don Bosco Gumbo Oral Rehydration Point

WHO: Some 3 in 10 people worldwide, or 2.1 billion, lack access to safe, readily available water at home, and 6 in 10, or 4.5 billion, lack safely managed sanitation

WHO

Global-water-sanitation-graphic_2017

2.1 billion people lack safe drinking water at home, more than twice as many lack safe sanitation
News release
12 July 2017 | GENEVA | NEW YORK – Some 3 in 10 people worldwide, or 2.1 billion, lack access to safe, readily available water at home, and 6 in 10, or 4.5 billion, lack safely managed sanitation, according to a new report by WHO and UNICEF.

The Joint Monitoring Programme (JMP) report, Progress on drinking water, sanitation and hygiene: 2017 update and Sustainable Development Goal baselines, presents the first global assessment of “safely managed” drinking water and sanitation services. The overriding conclusion is that too many people still lack access, particularly in rural areas.

“Safe water, sanitation and hygiene at home should not be a privilege of only those who are rich or live in urban centres,” says Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “These are some of the most basic requirements for human health, and all countries have a responsibility to ensure that everyone can access them.”

Billions of people have gained access to basic drinking water and sanitation services since 2000, but these services do not necessarily provide safe water and sanitation. Many homes, healthcare facilities and schools also still lack soap and water for handwashing. This puts the health of all people – but especially young children – at risk for diseases, such as diarrhoea.

As a result, every year, 361 000 children under 5 years of age die due to diarrhoea. Poor sanitation and contaminated water are also linked to transmission of diseases such as cholera, dysentery, hepatitis A, and typhoid.

“Safe water, effective sanitation and hygiene are critical to the health of every child and every community – and thus are essential to building stronger, healthier, and more equitable societies,” said UNICEF Executive Director Anthony Lake. “As we improve these services in the most disadvantaged communities and for the most disadvantaged children today, we give them a fairer chance at a better tomorrow.”

Significant inequalities persist
In order to decrease global inequalities, the new Sustainable Development Goals (SDGs) call for ending open defecation and achieving universal access to basic services by 2030.

Of the 2.1 billion people who do not have safely managed water, 844 million do not have even a basic drinking water service. This includes 263 million people who have to spend over 30 minutes per trip collecting water from sources outside the home, and 159 million who still drink untreated water from surface water sources, such as streams or lakes.

In 90 countries, progress towards basic sanitation is too slow, meaning they will not reach universal coverage by 2030.

Of the 4.5 billion people who do not have safely managed sanitation, 2.3 billion still do not have basic sanitation services. This includes 600 million people who share a toilet or latrine with other households, and 892 million people – mostly in rural areas – who defecate in the open. Due to population growth, open defecation is increasing in sub-Saharan Africa and Oceania.

Good hygiene is one of the simplest and most effective ways to prevent the spread of disease. For the first time, the SDGs are monitoring the percentage of people who have facilities to wash their hands at home with soap and water. According to the new report, access to water and soap for handwashing varies immensely in the 70 countries with available data, from 15 per cent of the population in sub-Saharan Africa to 76 per cent in western Asia and northern Africa.

Additional key findings from the report include:

Many countries lack data on the quality of water and sanitation services. The report includes estimates for 96 countries on safely managed drinking water and 84 countries on safely managed sanitation.
In countries experiencing conflict or unrest, children are 4 times less likely to use basic water services, and 2 times less likely to use basic sanitation services than children in other countries.
There are big gaps in service between urban and rural areas. Two out of three people with safely managed drinking water and three out of five people with safely managed sanitation services live in urban areas. Of the 161 million people using untreated surface water (from lakes, rivers or irrigation channels), 150 million live in rural areas.
Note to editors
Safely managed drinking water and sanitation services means drinking water free of contamination that is available at home when needed, and toilets whereby excreta are treated and disposed of safely.

Basic services mean having a protected drinking water source that takes less than thirty minutes to collect water from, using an improved toilet or latrine that does not have to be shared with other households, and having handwashing facilities with soap and water in the home.

Sustainable Development Goal 6 is to ensure availability and sustainable management of water and sanitation for all. The JMP monitors progress on the following two targets:

Target 6.1: By 2030, achieve universal and equitable access to safe water and sanitation for all.
Target 6.2 By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations.
The JMP also contributes to monitoring of SDG 1 “to end poverty in all its forms everywhere”, and “to SDG 4 to ensure inclusive and equitable quality education and promote lifelong learning opportunities for all” by contributing data on basic water, sanitation and hygiene for the following targets:

Target 1.4: By 2030, ensure that all men and women, in particular the poor and the vulnerable, have equal rights to economic resources, as well as access to basic services.
Target 4.a: Build and upgrade education facilities that are child, disability and gender sensitive and provide safe, non-violent, inclusive and effective learning environments for all.
Safe water, sanitation and hygiene are also essential to SDG 3 “Ensuring healthy lives and promote wellbeing for all at all ages”. Under SDG target 3.9, countries are working to substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination by 2030. Additionally, safe water, sanitation and hygiene are needed to reduce maternal mortality and to end preventable deaths of newborns and children as called for in SDG targets 3.1 and 3.2.

UNICEF media package
About the Joint Monitoring Programme
The WHO/UNICEF Joint Monitoring Programme (JMP) for Water Supply, Sanitation and Hygiene is the official United Nations mechanism tasked with monitoring country, regional and global progress, and especially towards the targets of the Sustainable Development Goals relating to universal and equitable access to drinking water, sanitation and hygiene. Thanks to the globally supported household surveys, JMP analysis helps draw connections between use of basic water and sanitation facilities and quality of life, and serves as an authoritative reference to make policy decisions and resource allocations, especially at the international level.

For more information, please contact:
Geneva
Nada Osseiran
World Health Organization
Tel: +41 22 791 4475
Mobile: +41 79 445 1624
Email: osseirann@who.int

Kim Chriscaden
World Health Organization
Tel: +41 22 791 2885
Mobile: +41 79 603 1891
Email: chriscadenk@who.int

New York
Yemi Lufadeju
UNICEF
Tel: +1 212 326 7029
Mobile: +1 917-213-4034
Email: glufadeju@unicef.org

Christopher Tidey
UNICEF
Mobile: +1 917 340 3017
Email: ctidey@unicef.org


The new Director-General of the World Health Organization speaks…….

WHO

Director-General Dr Tedros takes the helm of WHO: address to WHO staff

Dr Tedros Adhanom Ghebreyesus
Director-General of the World Health Organization

Geneva, Switzerland
3 July 2017

Today it is my pleasure and privilege to join and stand before you as the new Director-General of the World Health Organization. Our World Health Organization.

Let me start with the moral centre of our work, with this simple but crucial statement: WHO’s work is about serving people, about serving humanity. It’s about serving people regardless of where they live, be it in developing or developed countries, small islands or big nations, urban or rural settings. It’s about serving people regardless of who they are. Poor or rich, displaced or disabled, elderly or the youth. Most importantly, it’s about fighting to ensure the health of people as a basic human right. Health is a basic human right, that you fully understand.

It’s about a child who gets to see adulthood or about a parent who watches their child survive and thrive. It’s about a community living disease-free or an entire country or region that’s better prepared for health emergencies or for climate change.

Without health, people have nothing. Without health, we have nothing as humanity.

That’s why our work here at the World Health Organization is so important. WHO’s work is about helping people to protect and to improve their health. This is our collective vision: a world where everyone can achieve healthy and productive lives no matter who they are or where they live.

My transition, as you know, has been very short, just over four weeks, but also very busy. I have been listening intensely and appreciated all the advice I have received from you and others.

Let me outline, for today, three areas that I will focus on.

  • Implementing leadership priorities and measuring results.
  • Delivering results, value for money, efficiency and earning trust.
  • Reinforcing a talented, motivated and engaged staff.

I’ll start with number one: implementing leadership priorities and measuring results.

During the transition, I met with the United Nations Secretary-General António Guterres who emphasized WHO’s opportunity and responsibility to lead on health and the Sustainable Development Goals. As you know, I ran with four clear substantive priorities plus a promise to transform WHO. These priorities came from WHO Member States. I was elected with an overwhelming mandate. I feel obliged by this clear mandate to implement the priorities.

These priorities are:

  • universal health coverage
  • health emergencies
  • women’s, children’s and adolescents’ health
  • health impacts of climate and environmental change

Of this, universal health coverage is at the centre.

I have said many times during the campaign that all roads lead to universal health coverage. For me, the key question of universal health coverage is an ethical one. Do we want our fellow citizens to die because they are poor? Universal health coverage, as I said earlier, is a human rights issue. And the responsibility of national governments. It’s not only a technical matter but even more so a political one. Countries should compare their results to their peers and learn from each other.

About 400 million people have no access, as you know, to even basic health care. Many more have access but will endure financial hardship. During the coming weeks, we will be looking at how best to implement the relevant Sustainable Development Goal, achieving universal health coverage, including financial risk protection, access to quality essential health care services, and access to safe, effective, quality and affordable essential medicines and vaccines for all.

Health emergencies will also be the litmus test for WHO. This topic is also closely related to universal health coverage because our goal is to prevent outbreaks from becoming epidemics at their roots. And this happens at the country level, based on strong health systems which robustly implement the International Health Regulations. Universal health coverage and health emergencies are cousins, two sides of the same coin.

We learned important lessons from Ebola. The task is now to make sure these lessons are effectively implemented. The next outbreak can occur tomorrow and WHO needs to be prepared. We have a new programme in health emergencies which is integrated into headquarters and the regions and country offices. I had the chance to observe the recent Ebola response in the Democratic Republic of the Congo and gained confidence that WHO is implementing its reforms. But we need to do more. If you read the report of the Independent Oversight and Advisory Committee prepared for the World Health Assembly, you will see that they think WHO has made progress in implementing reforms, but they also think that it’s not fast enough. We mustn’t let this happen. I have met with the leaders of the Health Emergencies Programme and I am committed to making sure the world is prepared for the next epidemic.

Women, children and adolescents are a central focus for universal health coverage and also the most vulnerable and at risk in health emergencies. Did you know that about half of the deaths of women and children are in a humanitarian context? WHO is fully committed to Every Woman Every Child and its areas of focus, including early child development, adolescent health and well-being. Quality, equity and dignity in services as well. Plus, sexual and reproductive health and rights, empowerment of women, girls and communities. And also, of course, humanitarian and fragile settings. While health emergencies hit quickly, climate change is a slow-motion disaster. WHO must play a strategic and decisive role not only in adaptation but also in mitigation.

Finally, for WHO to be effective in supporting countries, we need to have technical expertise in health challenges countries face: communicable diseases including polio, HIV, TB, malaria, hepatitis and neglected tropical diseases and noncommunicable diseases, including cardiovascular diseases, chronic pulmonary diseases, cancer, diabetes, mental health, addictions, accidents and injuries, you name it.

To single out just one vital example, this year, to date, we have had only 6 polio cases in the world. During my tenure, and together, we hope to meet the very last polio victim.

However, countries want holistic offerings from universal health care coverage that can be flexible to their needs. These individual areas of expertise are like the players on a football team. Each needs to be strong to win. But without teamwork, we will not win. Our team needs to work as one. Our team needs a captain. And universal health coverage is the captain of the team.

And the second of what I wanted to say today is on delivering results, value for money, efficiency and earning trust.

I said many times during my campaign that WHO must deliver value for money. This requires first and foremost that we develop a culture of results. We are very fortunate to have the Sustainable Development Goals. These indicators are the agreed results, the framework for the world, especially at the country level.

A key priority for me is to enhance our approach to resource mobilization among donors, old and new. And that has to start by building confidence among partners, that WHO will deliver results and impact. I want WHO to be synonymous with results. And that is doable. At the same time, we must recognize that WHO is the world’s platform for global health. It’s the only venue where all governments, along with other stakeholders, come together to discuss and decide fundamental issues in global health. If the platform did not exist, we would need to create it. This global governance function is the infrastructure of global health and the global public good.

WHO has a rightful role and is an undisputed leader in global health. When I met with the UN Secretary-General, he reinforced this role. However, I also want WHO to work with any partner, public or private, who can help improve health. We want to be the partner of choice and this has to go beyond our WHO brand to how we actually work together to improve outcomes for the poor.

I also fully understand from my experience that results happen at the country and local level. So I will be looking for ways to increase our emphasis on country level work in concert with the regions to meet the needs of countries and to optimize our results. We have to strengthen our country offices and need to ensure that heads of country offices are equipped not only with super technical capacity but also with political leadership and resource mobilization skills. In order to ensure our resources and efficiency, we need to have cohesion across all levels of the Organization: country offices, regional offices and headquarters. That’s why I will continue building upon the Global Policy Group in order to have shared vision and accountability at all levels.

We also need to become more efficient in our operations. Let me give you two examples that came to my attention during my interactions with WHO management and other stakeholders after my election. First, I was extremely surprised to learn that there are over 3000 separate grants managed by the World Health Organization. Just think about the transaction costs. This is unacceptable. I faced a similar situation in Ethiopia and developed the one plan, one budget and one report concept. I am cognizant that we cannot go from 3000 grants to one. I understand that. But it does illustrate how we need to radically overhaul and harmonize WHO’s business model and resource mobilization.

My second example from my engagement is, among a lot actually, the recent uproar over travel costs. I am reviewing the situation thoroughly and will ensure that our resources are used efficiently. We have to be good stewards of our resources. But I think the commitment of all of us will be necessary, but including our partners.

I have already started consultations with Member States, donors and partners on how to harmonize and modernize our resource mobilization. This will be a critical area I will be focusing on and I will ensure that WHO is adequately and appropriately funded with emphasis on expanding the donor base. From what we discussed so far I see positive developments that will really transform the way we mobilize resources. I hope through concrete actions on results, value for money and efficiency, WHO will earn trust among Member States, partners and donors, old and new, who will want to step up and not only increase their contributions for our collective live-saving work, but also become champions of our common cause.

And the third issue I would like to talk about today is reinforcing a talented, motivated and engaged staff. During the transition, I have focused first and foremost on WHO staff. My first meeting was actually with the WHO Staff Association.

If WHO is not healthy internally, then it will not be able to interact effectively externally.

In my acceptance speech in May, I promised staff, that I value you, and I will listen to you. And that’s what I did for the last four weeks. We have a amazing and dedicated staff. I have seen this in the last four weeks. And I believe that staff are our greatest asset more than even ever before. We should take pride in serving humanity.

And as I said earlier, my very first meeting after my election was with the representatives of the WHO Headquarters Staff Association Committee and I will be meeting their counterparts in the regions as well. I told them I will always listen. My answer will not always be “yes” but when it’s “no” I will give my reasons and I will engage them in the decision. But the 10 issues they raised, on many of them, we have the same position. And I was really happy to see that. I also told them that I will act on their concerns and started acting swiftly. And that we have on most of the issues a common position.

During the transition, I met each of the Regional Directors individually and collectively. I also met headquarters assistant directors-general and directors on several occasions to listen to their great ideas. I also got ideas for change from heads of WHO country offices. I appreciated when directors and heads of country offices consulted with their staff for the ideas they sent to me.

As you all know this was a unique election and the transition was also unique. I listened to staff for their views and opinions. I am so energized by their feedback and input as well as passion, dedication and commitment that I have seen so far.

When I met directors and assistant directors-general, I told them that I would be accessible and gave them my mobile phone number so they could reach me any time. We have to continue this candid discussion because candour is the best medicine for any organization.

I promise you this dialogue with WHO staff and the Staff Association will continue on a regular basis because we belong to the same team and we need to engage on a regular basis in order to be a winning team. I will continue to listen to and act upon staff concerns and ideas. Any enduring change at WHO will come from the staff outwards.

Let me also emphasize that I do not believe in perpetual reform and I think WHO staff are reformed out. I do believe in continuous improvement, however. Because our greatest asset is people, one core item in continuous improvement is how performance reviews are conducted and what coaching people receive. I would like to tie this much more closely to the results we seek to achieve.

My friends, talent is global, but opportunity is not. We will continue to conduct open recruitment, based on merit. However, we will ensure merit is seen from global or geographic and gender perspectives and the recruitment is done fairly and on an even playing field.

My door will always be open to the staff. In fact, I will set a regular time to meet with staff who wish to meet with me and I call upon all leaders and managers of WHO at all levels, starting from headquarters to the regions and to the country offices, starting from team leaders to the Deputy Director-General to do the same. Listening to our staff is a bottom line and builds our teams.

As a way forward, I would like to tell you that this has been a very holistic election. I have been given a decisive mandate and my vision and priorities for WHO have been endorsed by Member States. I have spent the last four weeks listening and engaging staff and conversing with partners. What we focus on in the next phase is going to be clearly articulating measurable outcomes and swiftly moving to implementation with a sense of urgency.

As you can imagine, the very short transition window has not given me enough time to identify the best and appropriate senior leadership team. I hope to complete forming my team in the next few months. That’s why I have asked the existing senior management to stay on their positions for few more months until I appoint my leadership team. As you know, I have asked for recommendations from all levels of the Organization and have received many excellent ideas. I have formed a committee of WHO staff to study these recommendations, composed of directors, and to identify which are the most important ones that would lead to a major paradigm shift in our WHO. I will ensure the full engagement and participation of staff in any change.

Again, let me emphasize that enduring change comes from the bottom up. Only change that’s owned by staff will succeed. As Tom Peters said, I quote, “change is a door that can only be opened from the inside”. So in order to fundamentally change WHO, first of all, we all need to individually open our minds for change. Because the mind is opened from inside. And two, we all need to collectively work together to open our organizations for change.

My friends, we have a historic opportunity to make transformational improvement in world health. Let’s do it. Let us do it for every woman and child who died when they didn’t have to die. And for every child who failed to reach her full potential. For every victim felled by an outbreak, for every small islander who is faced with the threat of climate change. Let us dedicate ourselves to them. Let us stand together for a healthier world.

Thank you so much. Merci beaucoup.


Dr Tedros Adhanom takes office as Director-General of the World Health Organization

WHO

More about Dr. Tedros

 


WHO’s new list of neglected tropical diseases

 

WHO

Neglected tropical diseases (NTDs)– a diverse group of communicable diseases that prevail in tropical and subtropical conditions in 149 countries – affect more than one billion people and cost developing economies billions of dollars every year. Populations living in poverty, without adequate sanitation and in close contact with infectious vectors and domestic animals and livestock are those worst affected.

Effective control can be achieved when selected public health approaches are combined and delivered locally. Interventions are guided by the local epidemiology and the availability of appropriate measures to detect, prevent and control diseases. Implementation of appropriate measures with high coverage will contribute to achieving the targets of the WHO NTD Roadmap on neglected tropical diseases, resulting in the elimination of many and the eradication of at least two by 2020.

In May 2013, the 66th World Health Assembly resolved to intensify and integrate measures against neglected tropical diseases and to plan investments to improve the health and social well-being of affected populations. WHO is working with Member States to ensure the implementation of resolution WHA66.12.

In 2016, the 69th Assembly adopted resolution WHA69.21 on addressing the burden of mycetoma and requested WHO, through the Strategic and Technical Advisory for Neglected Tropical Diseases, “to define a systematic, technically-driven process for evaluation and potential inclusion of additional diseases among the ‘neglected tropical diseases’”.

Accordingly, in 2017 the 10th meeting of the Strategic and Technical Advisory Group for Neglected Tropical Diseases received proposals for the addition of diseases and, pursuant to the required procedures, chromoblastomycosis and other deep mycosesscabies and other ectoparasites and snakebite envenoming have been added to the NTD portfolio:


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