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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.


Tedros Adhanom Ghebreyesus from Ethiopia will be the next director general of the World Health Organization (WHO).

BBC

WHO

World Health Assembly elects Dr Tedros Adhanom Ghebreyesus as new WHO Director-General

News release

Today the Member States of WHO elected Dr Tedros Adhanom Ghebreyesus as the new Director-General of WHO.

Dr Tedros Adhanom Ghebreyesus was nominated by the Government of Ethiopia, and will begin his five-year term on 1 July 2017.

Prior to his election as WHO’s next Director-General, Dr Tedros Adhanom Ghebreyesus served as Minister of Foreign Affairs, Ethiopia from 2012–2016 and as Minister of Health, Ethiopia from 2005–2012. He has also served as chair of the Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria; as chair of the Roll Back Malaria (RBM) Partnership Board; and as co-chair of the Board of the Partnership for Maternal, Newborn and Child Health.

As Minister of Health, Ethiopia, Dr Tedros Adhanom Ghebreyesus led a comprehensive reform effort of the country’s health system, including the expansion of the country’s health infrastructure, creating 3500 health centres and 16 000 health posts; expanded the health workforce by 38 000 health extension workers; and initiated financing mechanisms to expand health insurance coverage. As Minister of Foreign Affairs, he led the effort to negotiate the Addis Ababa Action Agenda, in which 193 countries committed to the financing necessary to achieve the Sustainable Development Goals.

As Chair of the Global Fund and of RBM, Dr Tedros Adhanom Ghebreyesus secured record funding for the two organizations and created the Global Malaria Action Plan, which expanded RBM’s reach beyond Africa to Asia and Latin America.

Dr Tedros Adhanom Ghebreyesus will succeed Dr Margaret Chan, who has been WHO’s Director-General since 1 January 2007.

 BIO:

Prior to his election as WHO’s next Director-General, Dr Tedros Adhanom Ghebreyesus served as Minister of Foreign Affairs, Ethiopia from 2012-2016 and as Minister of Health, Ethiopia from 2005-2012. He has also served as chair of the Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria; as chair of the Roll Back Malaria (RBM) Partnership Board, and as co-chair of the Board of the Partnership for Maternal, Newborn and Child Health.

As Minister of Health, Ethiopia, Dr Tedros Adhanom Ghebreyesus led a comprehensive reform effort of the country’s health system, including the expansion of the country’s health infrastructure, creating 3,500 health centres and 16,000 health posts; expanded the health workforce by 38,000 health extension workers; and initiated financing mechanisms to expand health insurance coverage. As Minister of Foreign Affairs, he led the effort to negotiate the Addis Ababa Action Agenda, in which 193 countries committed to the financing necessary to achieve the Sustainable Development Goals.

As Chair of the Global Fund and of RBM, Dr Tedros Adhanom Ghebreyesus secured record funding for the two organizations and created the Global Malaria Action Plan, which expanded RBM’s reach beyond Africa to Asia and Latin America.

CV


WHO travel: Wastefully extravagant or appropriate?

WHO

WHO travel to support program work

News release

Travel is an essential aspect of WHO’s global health work – convening experts for collective decision-making on health interventions or traveling experts anywhere in the world that requires technical assistance for global health. WHO’s travel expenditure in calendar year 2015 was US$ 234 million, and in calendar year 2016 was US$ 200 million – a reduction of 14%.

Less than half of these costs are for staff travel – nearly 60% is spent on travel of external experts to support countries, and for representatives of Member States to travel to technical meetings and sessions of WHO governing bodies.

WHO staff travel covers a diverse range of activities: for example, assessing countries’ emergency preparedness, implementing vaccine campaigns, training Member States’ health care workforce, and strengthening Organizational management.

WHO has clear travel policies, recently strengthened by Director-General Margaret Chan’s request for a policy prohibiting first class travel for all of WHO, regardless of position or grade. Business class travel is permitted only for official travel over 9 hours. In addition, per diems for all WHO-funded travel conform to UN rates.

The Director-General strictly abides by WHO’s travel policies. She does not travel first class. She receives a standard per diem entitlement at UN rates. For example, on recent travel to Guinea, the Director-General’s overnight stay cost the same as all other WHO travellers – €212 – and well within UN per diem rates. On some visits, the Director-General is hosted by a Member State. In those cases; her accommodation is provided by the hosting nation at no cost to WHO. When that occurs, she receives no per diem.

WHO is always looking for ways to reduce travel costs. Overall compliance with WHO’s travel policy is high, and improving each year. As an example, to-date in 2017, only 20% of business class tickets were purchased less than 14 days before travel (emergency travel often requires booking within the 14 day rule, and can be permitted with appropriate review). This is a marked improvement on the 31% during the same period in 2016 and 39% in 2015.


Seventieth World Health Assembly opens in Geneva

WHO

News release

In her final opening address to the World Health Assembly as Director-General, Dr Margaret Chan offered some advice to delegates “as you continue to shape the future of this Organization”.

She called on the Health Assembly to make “reducing inequalities” a guiding ethical principle. “WHO stands for fairness,” she said. Countries should also work to improve collection of health data and make health strategies more accountable.

Protecting scientific evidence should form “the bedrock of policy”, said Dr Chan, citing vaccine refusal as one of the reasons that the “tremendous potential of vaccines is not yet fully realized”.

She stressed the importance of continued innovation, citing the research partnership between WHO and others to produce an effective and highly affordable meningitis A vaccine that has transformed the lives of millions of people in Africa. “Meeting the ambitious targets in the Sustainable Development Goals depends on innovation,” she said.

She then asked governments and partners to safeguard WHO’s integrity in all stakeholder engagements. “The Framework for engagement with non-state actors is a prime instrument for doing so,” and to “listen to civil society”: “Civil society organizations are best placed to hold governments and businesses, like the tobacco, food and alcohol industries, accountable. They are the ones who can give the people who suffer the most a face and a voice.”

In closing, Dr Chan asked government representatives to: “Remember the people…Behind every number is a person who defines our common humanity and deserves our compassion, especially when suffering or premature death can be prevented.”

New President of the Health Assembly

Earlier in the day, the Health Assembly elected Professor Veronica Skvortsova, Minister of Healthcare of the Russian Federation, as its new President. Five Vice-Presidents were also appointed from Cabo Verde, the Cook Islands, the Democratic People’s Republic of Korea, Somalia and Suriname.

Some 3500 delegates from WHO’s 194 Member States – including a large proportion of the world’s health ministers – are attending the Health Assembly, which ends on 31 May. They are currently debating ways to advance the 2030 agenda, focusing on building better systems for health.

Election of New Director-General

Tomorrow, Member States will elect a new Director-General, who will take office for a five-year term on 1 July 2017.

The three nominees for the position, Dr Tedros Adhanom Ghebreyesus of Ethiopia; Dr David Nabarro of the United Kingdom of Great Britain and Northern Ireland, and Dr Sania Nishtar of Pakistan, will each address the Health Assembly for 15 minutes tomorrow afternoon, starting at 14.00 (CET). Dr Tedros will speak first, followed by Dr Nabarro and then by Dr Nishtar. The three addresses will be webcast.

The election will take place by secret ballot and its result will be communicated once the process has been completed. The Director-General Elect will take the oath of office in a public ceremony, which will be webcast.

Topics covered during the Health Assembly

Over the next days, delegates will approve the Organization’s programme budget for 2018-19 and discuss a wide range of health-related issues. They will make decisions relating to WHO’s response to health emergencies, the International Health Regulations, and Pandemic Influenza Preparedness. Important discussions will take place relating to polio; antimicrobial resistance; access to medicines and vaccines; the health of refugees and migrants; improving vector control; adolescent health and chemicals management. The Health Assembly will also examine a number of topics relating to noncommunicable diseases, including dementia, cancer, and preparations for the UN General Assembly High-Level Meeting on NCDs to be held in September 2018.

A series of daily, webcast, technical briefings will start on Wednesday 24 May with a session on Reaching everyone, everywhere with life-saving vaccines. Subsequent briefings will focus on Universal Health Coverage: sustained commitment and concrete achievements (Thursday, 25 May) and Health and the environment, inheriting a sustainable world (Friday, 26 May).

Note to Editors

The World Health Assembly is attended by delegates from WHO Member States as well as representatives from many agencies, organizations, foundations and other groups that contribute to improving public health. Member States approve resolutions in committee before formally adopting them in the plenary session at the end of the Health Assembly.

For more information, please contact:

Gregory Härtl
WHO Department of Communications
Mobile: +41 79 203 67 15
Email: hartlg@who.int

Ms Fadéla Chaib
WHO Department of Communications
Mobile: +41 79 475 5556
Email: chaibf@who.int

Mr Tarik Jasarevic
WHO Department of Communications
Mobile: +41 79 367 6214
Email:jasarevict@who.int

Mr Christian Lindmeier
WHO Department of Communications
Mobile: +41 79 500 6552
Email: lindmeierch@who.int


WHO: The last keynote address from departing Director-General Margaret Chan, MD, MPH

WHO

Address to the Seventieth World Health Assembly

Dr. Margaret Chan
Director-General of the World Health Organization

Geneva, Switzerland
22 May 2017

Madame President, Excellencies, honourable ministers, ambassadors, distinguished delegates, friends and colleagues, ladies and gentlemen,

I thank Member States for the trust shown when you appointed me as your Director-General more than ten years ago. I promised to work tirelessly, and have done so, but never got tired of the job, in the best and worst of times.

When I took office, I also promised that I would hold myself accountable for the Organization’s performance. This month, I have issued a report tracking how public health evolved during the ten years of my administration.

The report sets out the facts and assesses the trends, but makes no effort to promote my administration. The report goes some way towards dispelling the frequent criticism that WHO has lost its relevance. The facts tell a different story.

The report covers setbacks as well as successes and some landmark events. Above all, it is a tribute to the power of partnerships and the capacity of public health to take solutions found for one problem and apply them to others.

As just one example, it took nearly a decade to get the prices for antiretroviral treatments for HIV down. In contrast, thanks to teamwork and collaboration, prices for the new drugs that cure hepatitis C plummeted within two years.

This is the culture of evidence-based learning that improves efficiency, gives health efforts their remarkable resilience, and keeps us irrepressibly optimistic.

We falter sometimes, but we never give up.

Excellencies, ladies, and gentlemen,

As I speak to you, the political and economic outlook is much less optimistic than it was when I took office in 2007.

That was before the 2008 financial crisis changed the economic outlook from prosperity to austerity almost overnight, with effects on economies and health budgets that are still being felt.

That was before acts of international terrorism and violent extremism became commonplace, before the word “mega-disaster” entered the humanitarian vocabulary, before seemingly endless armed conflicts caused the largest population displacements and flights of refugees seen since the end of World War II.

That was before the alarming frequency of attacks on health facilities and aid convoys made a mockery of international humanitarian law. We condemn all these attacks on health care facilities and workers. According to reports consolidated by WHO, more than 300 attacks on health care facilities occurred in 2016 in 20 countries, with the majority documented in the Syrian Arab Republic. We are also seeing how a world full of threats can toss out deadly combinations, like the dual threats from drought and armed conflict that have brought famine to parts of Africa and the Middle East on a scale never experienced since the United Nations was founded in 1945.

The world was fortunate that the 2009 influenza pandemic was so mild. The world is fortunate that the new viruses that emerged to cause MERS in 2012 and human cases of H7N9 avian influenza in 2013 are not yet spreading easily from person to person. But they have the potential to do so and we dare not let down our guard.

The world was less fortunate with Zika, an outbreak that WHO continues to monitor closely. The world was not at all fortunate with the 2014 Ebola outbreak that utterly devastated the populations of Guinea, Liberia, and Sierra Leone. This was West Africa’s first experience with Ebola, and the outbreak took everyone, including WHO, by surprise.

WHO was too slow to recognize that the virus, during its first appearance in West Africa, would behave very differently than during past outbreaks in central Africa, where the virus was rare but familiar and containment measures were well-rehearsed.

But WHO made quick course corrections, brought the three outbreaks under control, and gave the world its first Ebola vaccine that confers substantial protection. This happened on my watch, and I am personally accountable.

I saw it as my duty, as your Director-General, to do everything possible to ensure that a tragedy on this scale will not happen again. History will judge whether the new emergencies programme has given the world a stronger level of protection.

Ultimately, health systems with International Health Regulations core capacities must be strengthened in your countries to detect unexplained deaths much earlier. This is critical for improving global health security to protect our common vulnerability.

Last week, the Democratic Republic of Congo confirmed a new Ebola outbreak near the border with the Central African Republic. This is the country’s eighth Ebola outbreak. In its last outbreak, which coincided with the West Africa outbreak, DRC interrupted transmission within six weeks. Despite enormous logistical challenges, discussions engaging DRC continue about possible use of the new vaccine to augment the response.

The Ebola outbreak in West Africa had a number of spillover effects which can be judged more immediately. During the outbreak, WHO acquired extensive experience in facilitating R&D for new medical products, but poor coordination lost too much time. To speed things up, WHO and its partners finalized an R&D blueprint in 2016.

By setting up collaborative models, standardized protocols for clinical trials, and pathways for accelerated regulatory approval in advance, the blueprint cut the time needed to develop and manufacture candidate products from years to months.

The expert consultations that designed the blueprint led to the establishment of the Coalition for Epidemic Preparedness Innovations, announced in January 2017 with initial funding of nearly $500 million.

The Coalition is building a new system to develop affordable vaccines for priority pathogens, identified by WHO, as a head-start for responding to the next inevitable outbreak.

The world is better prepared but not nearly well enough.

Excellencies, ladies, and gentlemen,

The relevance of WHO’s work is demonstrated in many ways, some more visible than others.

The chronology of the HIV, tuberculosis, and malaria epidemics shows direct links between WHO changes in technical strategies and turning points in the disease situation.

WHO also made scientific breakthroughs more democratic by translating findings into a public health approach that works everywhere, even in extremely resource-constrained settings.

Relevance is readily apparent when WHO endorses a new medical product, and partners find ways to fund it, or issues a position paper on a new vaccine. Many national immunization programmes will not introduce a new vaccine until WHO has issued its formal seal of approval. Such approval triggers actions by Gavi, the Vaccine Alliance, to scale up access dramatically.

The prequalification programme is now firmly established as a mechanism for ensuring that the quality, safety, and efficacy of low-cost generic products match those of originator products. For example, by the end of 2016, WHO had prequalified more than 250 finished pharmaceutical products for treating HIV-related conditions. This stretches the impact of funding agencies, like the Global Fund, in significant ways.

The relevance of WHO was most dramatically demonstrated during last month’s global partners meeting on the neglected tropical diseases.

Participants assessed, and celebrated, ten years of record-breaking progress that promises to eliminate many of these ancient diseases in the very near future. This is one of the most effective global partnerships, also with industry, in the modern history of public health.

The fact that, in 2015, nearly one billion people received free treatments that protect them from diseases that blind, maim, deform, and debilitate has little impact on the world’s geopolitical situation.

The people being protected are among the poorest in the world. But judging from the massive amount of media coverage, which included entry into the Guinness World Records for the most medication donated, this was a success story that the world was hungry to hear.

Less visible relevance comes from the way WHO has built a safety net that encircles the globe in the form of thousands of laboratories specialized in the surveillance and diagnosis of priority pathogens, hundreds of collaborating centres, and a vast network of scientific boards and strategic advisory groups. I thank the scientific institutions in your countries for contributing to the work of WHO.

No other health agency has this degree of technical expertise ready-to-hand.

Excellencies,

The resolutions you adopt also shape the health situation, especially by raising the profile of neglected problems. For example, the comprehensive mental health action plan, adopted in 2013, definitively took mental health out of the shadows and into the spotlight.

Likewise, beginning in 2010, viral hepatitis appeared as a stand-alone agenda item at three sessions of the World Health Assembly, contributing greatly to the international priority now given to this disease.

But the strongest call for action comes from high-level political commitment. This happened in 2011, when the United Nations General Assembly adopted a political declaration on noncommunicable diseases and again in 2016, when a political declaration gave full attention to antimicrobial resistance.

Both political declarations responded to a crisis in ways that triggered broad-based urgent action to find solutions.

Excellencies, ladies, and gentlemen,

I regard the 2010 World Health Report, on Health systems financing: the path to universal coverage, as the most influential publication issued during my administration.

It launched what is now a movement towards universal health coverage and inspired the 2012 UN General Assembly resolution that paved the way for inclusion of UHC in the Sustainable Development Goals. Our actions under the 2030 Agenda for Sustainable Development must be guided by the 5 Ps: people, planet, peace, prosperity, and partnership.

The recommendations that I most want to see implemented are those made by the Commission on Ending Childhood Obesity.

Childhood obesity is the most visible, and arguably the most tragic, expression of the forces that are driving the rise of NCDs. It is the warning signal that bad trouble, in the form of more heart disease, cancer, and diabetes, is on its way.

The initiatives we all most want to succeed are those for the eradication of polio and guinea worm disease. For both, the world has never been so close. We must keep up our efforts to make eradication a reality.

The trend that most profoundly reshaped the mind-set of public health was the rise of chronic noncommunicable diseases. This shift in the disease burden called for a move away from the biomedical model of health and its emphasis on curing diseases to a much broader approach based on prevention.

I regard Every Woman Every Child as the most game-changing strategy during my administration.

Its adoption by the UN in 2010 captured financial support in the billions of dollars and launched a number of initiatives aimed at implementing its recommendations. Maternal and child deaths dropped dramatically.

The related WHO Commission on information and accountability for women’s and children’s health added greatly to the culture of measurement and accountability. As set out in this year’s World Health Statistics report, nearly half of all deaths worldwide now have a recorded cause of death. This is huge progress. I thank all countries that have made a special effort on this front.

The most contentious issue was access to medicines, especially when intellectual property and the patent system were perceived as barriers to both affordable prices and the development of new products for diseases of the poor.

The negotiations that led to the establishment of the Pandemic Influenza Preparedness Framework were tense, to say the least, but ultimately successful, as were those that led to the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property.

Fortunately, several new initiative and public-private partnerships are contributing to both objectives. One example is the new Global antibiotic research and development partnership, launched last year by WHO and the Drugs for neglected diseases initiative (DNDi).

This is a needs-driven R&D initiative initially focused on the development of new antibiotics for treating sepsis and sexually transmitted infections, most notably gonorrhoea. The partnership aims to promote access and to ensure that prices are affordable.

Earlier this month, WHO announced the launch of a pilot project for prequalifying biosimilar medicines, a step towards making expensive cancer treatments more widely available.

WHO is also working with partners on a model for the fair pricing of pharmaceuticals. The rationale is obvious: universal health coverage depends on affordable medicines. No country on this planet can hope to treat its way out of all the diseases affecting their populations.

Excellencies, ladies, and gentlemen,

I will conclude with some brief advice that you may wish to consider as you continue to shape the future of this Organization.

WHO stands for fairness. Continue to make reductions in inequalities a guiding ethical principle.

What gets measured gets done. Continue to strengthen systems for civil registration and vital statistics and continue to make accountability frameworks an integral part of global health strategies.

Scientific evidence is the bedrock of policy. Protect it. No one knows whether evidence will retain its persuasive power in what many now describe as a post-truth world.

Vaccine refusals are at least one reason why the tremendous potential of vaccines is not yet fully realized. The current measles outbreaks in Europe and North America should never have happened.

Push for innovation. Meeting the ambitious health targets in the Sustainable Development Goals depends on innovation. Innovation that uses country experiences can be frugal and transformative. For example, the R&D partnership that gave Africa its meningitis A vaccine has transformed the lives of millions of people.

Safeguard WHO’s integrity in all stakeholder engagements. The Framework for engagement with non-state actors is a prime instrument for doing so. Many other UN agencies are following WHO’s lead with this framework.

While ministries of health are our principle partners, the multiple determinants of health demand engagement with non-health sectors, communities, and partners, businesses, and civil society organizations.

Listen to civil society. Civil society organizations are society’s conscience. They are best placed to hold governments and businesses, like the tobacco, food, and alcohol industries, accountable. They are the ones who can give the people who suffer the most a face and a voice.

Above all, remember the people. Behind every number is a person who defines our common humanity and deserves our compassion, especially when suffering or premature death can be prevented.

Excellencies, ladies, and gentlemen,

This is the last time I will address the World Health Assembly. I thank Member States for the privilege and honour of serving this Organization. I have done so with humility, but also with great pride.

I thank my Regional Directors for their wise counsel and their support for WHO reform, and my wonderful staff at headquarters, in the regional offices, and in countries, where the impact of our work matters most.

Last but not least, I thank my husband, David, and my family for love and support. David, thank you for listening.

Thank you.

 


Liberia: WHO’s evidence suggests a mysterious illness that has sickened 28 people so far and killed 12 is linked to food or drink poisoning and is not a viral infection

The Guardian

  • The cases appeared tied to one funeral suggesting that an isolated poisoning was to blame
  • WHO and medical charity Doctors Without Borders have said the warning system put in place in Liberia after the Ebola crisis prompted fast action following the recent deaths.
  • The unexplained illness causes fever, vomiting, headaches and diarrhoea.

 


WHO Reports ‘Record-breaking’ Progress: About 1.5 billion people in 149 countries, down from 1.9 billion in 2010, are affected by neglected tropical diseases (NTD)

VOA

WHO

Unprecedented progress against neglected tropical diseases, WHO reports

WHO reports remarkable achievements in tackling neglected tropical diseases (NTDs) since 2007. An estimated 1 billion people received treatment in 2015 alone.

“WHO has observed record-breaking progress towards bringing ancient scourges like sleeping sickness and elephantiasis to their knees,” said WHO Director-General, Dr. Margaret Chan. “Over the past 10 years, millions of people have been rescued from disability and poverty, thanks to one of the most effective global partnerships in modern public health”.

The WHO report, Integrating neglected tropical diseases in global health and development, demonstrates how strong political support, generous donations of medicines, and improvements in living conditions have led to sustained expansion of disease control programs in countries where these diseases are most prevalent.

Since 2007, when a group of global partners met to agree to tackle NTDs together, a variety of local and international partners have worked alongside ministries of health in endemic countries to deliver quality-assured medicines, and provide people with care and long-term management.

In 2012, partners endorsed a WHO NTD roadmap, committing additional support and resources to eliminating 10 of the most common NTDs.

Key achievements include:

  • 1 billion people treated for at least one neglected tropical disease in 2015 alone.
  • 556 million people received preventive treatment for lymphatic filariasis (elephantiasis).
  • More than 114 million people received treatment for onchocerciasis (river blindness: 62% of those requiring it.
  • Only 25 human cases of Guinea-worm disease were reported in 2016, putting eradication within reach.
  • Cases of human African trypanosomiasis (sleeping sickness) have been reduced from 37 000 new cases in 1999 to well under 3000 cases in 2015.
  • Trachoma – the world’s leading infectious cause of blindness – has been eliminated as a public health problem in Mexico, Morocco, and Oman. More than 185 000 trachoma patients had surgery for trichiasis worldwide and more than 56 million people received antibiotics in 2015 alone.
  • Visceral leishmaniasis: in 2015 the target for elimination was achieved in 82% of sub-districts in India, 97% of sub-districts in Bangladesh, and in 100% of districts in Nepal.
  • Only 12 reported human deaths were attributable to rabies in the WHO Region of the Americas in 2015, bringing the region close to its target of eliminating rabies in humans by 2015.

However, the report highlights the need to further scale up action in other areas.

“Further gains in the fight against neglected tropical diseases will depend on wider progress towards the Sustainable Development Goals,” said Dr Dirk Engels, Director of the Department of Control of Neglected Tropical Diseases. Meeting global targets for water and sanitation will be key. WHO estimates that 2.4 billion people still lack basic sanitation facilities such as toilets and latrines, while more than 660 million continue to drink water from “unimproved” sources, such as surface water.

Meanwhile, global concern about the recent outbreaks of Zika virus disease, and its associated complications, has re-energized efforts to improve vector control. In May this year, the World Health Assembly will review proposals for a new Global vector control response. There are also brighter prospects to prioritize cross-sectoral collaboration to promote veterinary public health.

Global Partners’ Meeting

Integrating neglected tropical diseases in global health and development is being released at the Global Partners’ Meeting on Neglected Tropical Diseases (NTDs) in Geneva, on 19 April 2017.

The Meeting will celebrate efforts to “Collaborate. Accelerate. Eliminate”, and will be attended by health ministers, industry representatives, partners and a host of well-known personalities, including philanthropists, donors and stakeholders.

Besides celebrating 10 years of multi-stakeholder collaboration, the event will also mark the 5th anniversary of the WHO NTD Roadmap which established targets and milestones for the global control, elimination, and eradication of many of these diseases as well as that of the London Declaration.

Note to editors:

Neglected tropical diseases blind, maim, disfigure and debilitate hundreds of millions of people in urban slums and in the poorest parts of the world.

Once widely prevalent, these diseases are now restricted to tropical and sub-tropical regions with unsafe water, inadequate hygiene and sanitation, and poor housing conditions. Poor people living in remote, rural areas, urban slums, or conflict zones are most at risk.

More than 70% of countries and territories that report the presence of NTDs are low or lower-middle income economies.

 


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