Global & Disaster Medicine

Archive for the ‘WHO’ Category

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:


Signaling a major change to its Essential Medicines List (EML), the World Health Organization (WHO) today grouped antibiotics into three categories—access, watch, and reserve—and included recommendations when each should be used to treat 21 common infections.

WHO

WHO updates Essential Medicines List with new advice on use of antibiotics, and adds medicines for hepatitis C, HIV, tuberculosis and cancer

News release

New advice on which antibiotics to use for common infections and which to preserve for the most serious circumstances is among the additions to the WHO Model list of essential medicines for 2017. Other additions include medicines for HIV, hepatitis C, tuberculosis and leukaemia.

The updated list adds 30 medicines for adults and 25 for children, and specifies new uses for 9 already-listed products, bringing the total to 433 drugs deemed essential for addressing the most important public health needs. The WHO Essential Medicines List (EML) is used by many countries to increase access to medicines and guide decisions about which products they ensure are available for their populations.

“Safe and effective medicines are an essential part of any health system,” said Dr Marie-Paule Kieny, WHO Assistant Director-General for Health Systems and Innovation. “Making sure all people can access the medicines they need, when and where they need them, is vital to countries’ progress towards universal health coverage.”

New advice: 3 categories of antibiotic

In the biggest revision of the antibiotics section in the EML’s 40-year history, WHO experts have grouped antibiotics into three categories – ACCESS, WATCH and RESERVE – with recommendations on when each category should be used. Initially, the new categories apply only to antibiotics used to treat 21 of the most common general infections. If shown to be useful, it could be broadened in future versions of the EML to apply to drugs to treat other infections.

The change aims to ensure that antibiotics are available when needed, and that the right antibiotics are prescribed for the right infections. It should enhance treatment outcomes, reduce the development of drug-resistant bacteria, and preserve the effectiveness of “last resort” antibiotics that are needed when all others fail. These changes support WHO’s Global action plan on antimicrobial resistance, which aims to fight the development of drug resistance by ensuring the best use of antibiotics.

WHO recommends that antibiotics in the ACCESS group be available at all times as treatments for a wide range of common infections. For example, it includes amoxicillin, a widely-used antibiotic to treat infections such as pneumonia.

The WATCH group includes antibiotics that are recommended as first- or second-choice treatments for a small number of infections. For example, the use of ciprofloxacin, used to treat cystitis (a type of urinary tract infection) and upper respiratory tract infections (such as bacterial sinusitis and bacterial bronchitis), should be dramatically reduced to avoid further development of resistance.

The third group, RESERVE, includes antibiotics such as colistin and some cephalosporins that should be considered last-resort options, and used only in the most severe circumstances when all other alternatives have failed, such as for life-threatening infections due to multidrug-resistant bacteria.

WHO experts have added 10 antibiotics to the list for adults, and 12 for children.

“The rise in antibiotic resistance stems from how we are using – and misusing – these medicines,” said Dr Suzanne Hill, Director of Essential Medicines and Health Products. “The new WHO list should help health system planners and prescribers ensure people who need antibiotics have access to them, and ensure they get the right one, so that the problem of resistance doesn’t get worse.”

Other additions

The updated EML also includes several new drugs, such as two oral cancer treatments, a new pill for hepatitis C that combines two medicines, a more effective treatment for HIV as well as an older drug that can be taken to prevent HIV infection in people at high risk, new paediatric formulations of medicines for tuberculosis, and pain relievers. These medicines are:

  • two oral cancer medicines (dasatinib and nilotinib) for the treatment of chronic myeloid leukaemia that has become resistant to standard treatment. In clinical trials, one in two patients taking these medicines achieved a complete and durable remission from the disease;
  • sofosbuvir + velpatasvir as the first combination therapy to treat all six types of hepatitis C (WHO is currently updating its treatment recommendations for hepatitis C);
  • dolutegravir for treatment of HIV infection, in response to the most recent evidence showing the medicine’s safety, efficacy, and high barrier to resistance;
  • pre-exposure prophylaxis (PrEP) with tenofovir alone, or in combination with emtricitabine or lamivudine, to prevent HIV infection;
  • delamanid for the treatment of children and adolescents with multidrug-resistant tuberculosis (MDR-TB) and clofazimine for children and adults with MDR-TB;
  • child-friendly fixed-dose combination formulations of isoniazid, rifampicin, ethambutol and pyrazinamide for treating paediatric tuberculosis; and
  • fentanyl skin patches and methadone for pain relief in cancer patients with the aim of increasing access to medicines for end-of-life care.

Note to Editors

The WHO Model list of essential medicines was launched in 1977, coinciding with the endorsement by governments at the World Health Assembly of “Health for all” as the guiding principle for WHO and countries’ health policies.

Many countries have adopted the concept of essential medicines and have developed lists of their own, using the EML as a guide. The EML is updated and revised every two years by the WHO Expert Committee on the Selection and Use of Essential Medicines.

The meeting of the 21st Expert Committee was held 27–31 March 2017 at WHO Headquarters. The Committee considered 92 applications for about 100 medicines and added 55 to the EML (30 to the general EML and 25 to the children’s EML).

For more information, please contact:

Simeon Bennett
WHO Department of Communications
Telephone: +41 22 791 4621
Mobile: +41 79 472 7429
Email: simeonb@who.int

Tarik Jašarević
WHO Department of Communications
Telephone: +41 22 791 5099
Mobile: +41 79 367 6214
Email: jasarevict@who.int


WHO: New vector control response seen as game-changer

WHO

The call came from the WHO Director-General in May 2016 for a renewed attack on the global spread of vector-borne diseases.

“What we are seeing now looks more and more like a dramatic resurgence of the threat from emerging and re-emerging infectious diseases,” Dr Margaret Chan told Member States at the Sixty-ninth World Health Assembly. “The world is not prepared to cope.”

Dr Chan noted that the spread of Zika virus disease, the resurgence of dengue, and the emerging threat from chikungunya were the result of weak mosquito control policies from the 1970s. It was during that decade that funding and efforts for vector control were greatly reduced.

‘Vector control has not been a priority’

Dr Ana Carolina Silva Santelli has witnessed this first-hand. As former head of the programme for malaria, dengue, Zika and chikungunya with Brazil’s Ministry of Health, she saw vector-control efforts wane over her 13 years there. Equipment such as spraying machines, supplies such as insecticides and personnel such as entomologists were not replaced as needed. “Vector control has not been a priority,” she said.

Today more than 80% of the world’s population is at risk of vector-borne disease, with half at risk of two or more diseases. Mosquitoes can transmit, among other diseases, malaria, lymphatic filariasis, Japanese encephalitis and West Nile; flies can transmit onchocerciasis, leishmaniasis and human African trypanosomiasis (sleeping sickness); and bugs or ticks can transmit Chagas disease, Lyme disease and encephalitis.

Together, the major vector-borne diseases kill more than 700 000 people each year, with populations in poverty-stricken tropical and subtropical areas at highest risk. Other vector-borne diseases, such as tick-borne encephalitis, are of increasing concern in temperate regions.

Rapid unplanned urbanization, massive increases in international travel and trade, altered agricultural practices and other environmental changes are fuelling the spread of vectors worldwide, putting more and more people at risk. Malnourished people and those with weakened immunity are especially susceptible.

A new approach

Over the past year, WHO has spearheaded a new strategic approach to reprioritize vector control. The Global Malaria Programme and the Department of Control of Neglected Tropical Diseases – along with the Special Programme for Research and Training in Tropical Diseases, have led a broad consultation tapping into the experience of ministries of health and technical experts. The process was steered by a group of eminent scientists and public health experts led by Dr Santelli and Professor Thomas Scott from the Department of Entomology and Nematology at the University of California, Davis and resulted in the Global Vector Control Response (GVCR) 2017–2030.

At its Seventieth session, the World Health Assembly unanimously welcomed the proposed response.

The GVCR outlines key areas of activity that will radically change the control of vector-borne diseases:

  • Aligning action across sectors, since vector control is more than just spraying insecticides or delivering nets. That might mean ministries of health working with city planners to eradicate breeding sites used by mosquitoes;
  • Engaging and mobilizing communities to protect themselves and build resilience against future disease outbreaks;
  • Enhancing surveillance to trigger early responses to increases in disease or vector populations, and to identify when and why interventions are not working as expected; and
  • Scaling-up vector-control tools and using them in combination to maximize impact on disease while minimizing impact on the environment.

Specifically, the new integrated approach calls for national programmes to be realigned so that public health workers can focus on the complete spectrum of relevant vectors and thereby control all of the diseases they cause.

Recognizing that efforts must be adapted to local needs and sustained, the success of the response will depend on the ability of countries to strengthen their vector-control programmes with financial resources and staff.

A call to pursue novel interventions aggressively

The GVCR also calls for the aggressive pursuit of promising novel interventions such as devising new insecticides; creating spatial repellents and odour-baited traps; improving house screening; pursuing development of a common bacterium that stops viruses from replicating inside mosquitoes; and modifying the genes of male mosquitoes so that their offspring die early.

Economic development also brings solutions. “If people lived in houses that had solid floors and windows with screens or air conditioning, they wouldn’t need a bednet,” said Professor Scott. “So, by improving people’s standard of living, we would significantly reduce these diseases.”

An entomologist inserts live mosquitoes in wall of a mud house in Kisumu, Kenya

An entomologist inserts live mosquitoes into a standard ‘cone bioassay’. After 30 minutes he will see how many have been killed – this will measure if the insecticide was sprayed properly on the walls, and constitutes intervention monitoring.
WHO/S. Torfinn

The call for a more coherent and holistic approach to vector control does not diminish the considerable advances made against individual vector-borne diseases.

Malaria is a prime example. Over the past 15 years, its incidence in sub-Saharan Africa has been cut by 45% – primarily due to the massive use of insecticide-treated bed nets and spraying of residual insecticides inside houses.

But that success has had a down side.

“We’ve been so successful, in some ways, with our control that we reduced the number of public health entomologists – the people who can do this stuff well,” said Professor Steve Lindsay, a public health entomologist at Durham University in Britain. “We’re a disappearing breed.”

The GVCR calls for countries to invest in a vector-control workforce trained in public health entomology and empowered in health care responses.

“We now need more nuanced control – not one-size-fits-all, but to tailor control to local conditions,” Professor Lindsay said. This is needed to tackle new and emerging diseases, but also to push towards elimination of others such as malaria, he said.

Dr Lindsay noted that, under the new strategic approach, individual diseases such as Zika, dengue and chikungunya will no longer be considered as separate threats. “What this represents is not three different diseases, but one mosquito – Aedes aegypti,” said Professor Lindsay.

GVCR dovetails with Sustainable Development Goals

The GVCR will also help countries achieve at least 6 of the 17 Sustainable Development Goals. Of direct relevance are goal 3 on good health and well-being, goal 6 on clean water and sanitation, and goal 11 on sustainable cities and communities.

The GVCR goals are ambitious – to reduce mortality from vector-borne diseases by at least 75% and incidence by at least 60% by 2030 – and to prevent epidemics in all countries.

The annual price tag is US$ 330 million globally, or about 5 cents per person – for workforce, coordination and surveillance costs. This is a modest additional investment in relation to insecticide-treated nets, indoor sprays and community-based activities, which usually exceed US$ 1 per person protected per year.

It also represents less than 10% of what is currently spent each year on strategies to control vectors that spread malaria, dengue and Chagas disease alone. Ultimately, the shift in focus to integrated and locally adapted vector control will save money.

‘A call for action’

Dr Santelli expressed optimism that the GVCR will help ministries of health around the world gain support from their governments for a renewed focus on vector control.

“Most of all, this document is a call for action,” said Dr Santelli, who now serves as deputy director for epidemiology in the Brasilia office of the U.S. Centers for Disease Control and Prevention.

It will not be easy, she predicts. The work to integrate vector-control efforts across different diseases will require more equipment, more people and more money as well as a change in mentality. “The risk of inaction is greater,” said Dr Santelli, “given the growing number of emerging disease threats.” The potential impact of the GVCR is immense: to put in place new strategies that will reduce overall burden and, in some places, even eliminate these diseases once and for all.


For the first time in its seventy-year history, the World Health Organization (WHO) will, effective July 1, be led by a nonphysician, an African, and a person from the global South: Tedros Adhanom Ghebreyesus of Ethiopia

Council on Foreign Relations

“……Tedros has a PhD in community health and has served as his nation’s minister of health and of foreign affairs, as well as a central committee member of the ruling Ethiopian People’s Revolutionary Democratic Front party.

Despite Ethiopia’s dismal human rights record, when campaigning for the position started in 2016, U.S. President Barack Obama’s administration backed Tedros, admiring his track record as minister of health. He is credited with leading a dramatic re-envisioning of health, in which forty thousand community health workers were trained to provide basic services at the village level and hundreds of clinics were built across the large, diverse nation. These steps resulted in sharp reductions in the rates of infectious diseases like malaria and HIV, and a decrease in the number of women dying during childbirth. The United States also appreciated Tedros’s transformative role as chair of the Global Fund to Fight AIDS, Tuberculosis and Malaria, bringing reform to an institution that had been fraught with fraud and “missing money.”….”

Image result for \dr tedros adhanom ghebreyesus


WHO: Attacks on health care questions and answers

WHO

Health care is under attack

We witness with alarming frequency a lack of respect for the sanctity of health care and for international humanitarian law: patients are shot in their hospital beds; medical personnel are threatened, intimidated or attacked; vaccinators are shot; hospitals are bombed.

What are attacks on health care?

We consider attacks on health care to be any act of verbal or physical violence or obstruction or threat of violence that interferes with the availability, access and delivery of curative and/or preventive health services during emergencies.

Attacks on health can include bombings, explosions, looting, robbery, hijacking, shooting, gunfire, forced closure of facilities, violent search of facilities, fire, arson, military use, military takeover, chemical attack, cyberattack, abduction of health care workers, denial or delay of health services, assault, forcing staff to act against their ethics, execution, torture, violent demonstrations, administrative harassment, obstruction, sexual violence, psychological violence and threat of violence.

What are the consequences of attacks on health care?

Every attack on health care has a domino effect. Such attacks not only endanger health care providers; they also deprive people of urgently needed care when they need it most. And while the consequences of such attacks are as yet largely undocumented, they are presumed to be significant – negatively affecting short-term health care delivery as well as the longer-term health and well-being of affected populations, health systems, the health workforce, and ultimately our global public health goals.

Think of the years of education and experience lost with the early and tragic death of each health care worker. Think about the time and resources and dedication it takes to develop one doctor. Think of the resources required to rebuild one hospital. We cannot accept these losses as normal.

What information do we have on attacks on health care?

There is no publicly available source of consolidated information on attacks on health care in emergencies. For 2014 and 2015, WHO consolidated available data on individual attacks from open sources and found:

  • 594 reported attacks in 19 countries facing emergencies
  • 959 deaths, 1561 injuries
  • 63% against health care facilities; and 26% against health care workers
  • 62% of the attacks intentionally targeted health care.

While we recognize that these numbers are not comprehensive, they are a first attempt to provide a consolidated global view of attacks on health care in emergency settings and they serve to highlight the alarming frequency of attacks over the past two year.

Is there sufficient reporting of attacks on health care?

We believe there is considerable under reporting–most likely due to limited awareness of the possibility, means and use of reporting, perceptions of the usefulness of reporting, limited resources and time, fear of reporting, complexity and limitations of existing reporting systems, lack of standardized definitions for use in data collection, and cultural perceptions of violence.

What additional information do we need?

We need a more standardized approach to gathering and sharing information on attacks on health care and their consequences to health service delivery so that the information that is being collected is comparable. The most significant knowledge gap is the consequences of attacks on health care delivery, on the health of affected populations, on health systems, on the health workforce, and on longer-term public health. This is a priority for data collection moving forward.

Quantitative and qualitative information would help us. A combination of quantitative and qualitative information will help us to understand the extent and nature of the problem and to identify and implement concrete actions to reduce the risk and impact of attacks during emergencies.

Where is WHO with developing methods for data collection as per WHA Resolution 65.20?

WHO has developed and tested a new method in some locations; however it is not yet ready for publication. WHO aims to collect and share data on attacks on health care in emergency settings as part of its standard package of information collection and analysis within the new emergency programme. This will depend largely on the resources and capacities available to WHO going forward.

What can be done to stop attacks on health care?

Priority actions include the following:

  • Gather and consolidate comparable data; establish national registries
  • Document the consequences of attacks to health care delivery and public health
  • Establish national legislation to uphold International Humanitarian Law
  • Implement risk reduction measures, including through WHO’s Safe Hospitals Programme
  • Engage communities in protecting health care
  • Inform emergency response plans with security risk analysis
  • Document and apply good practices, including the recommendations of ICRC’s Health Care in Danger (HCiD) project
  • Promote and apply ethical principles in health care delivery
  • Speak out and advocate with zero-tolerance

What about the new Security Council Resolution 2286?

The Security Council 2286 that was unanimously adopted on May 3rd sends a strong message around the world that health care must be protected during conflict.

At the same time, we must remember that this is only part of the solution. We must remember that violence to health care is not only in conflict settings. Remember the health care workers who have been killed while working to eradicate the crippling disease of polio, or those who died from violence during the Ebola response. We also must think beyond the “wounded and sick” to all those who need health care—women giving birth and children needing vaccinations.

What is WHO doing about attacks on health care?

WHO is gathering and sharing information; advocating to build momentum for change; and helping to identify and promote good practice to reduce the risk of attacks.


Categories

Recent Posts

Archives

Admin