WHO

10 April 2019, Maputo – The Ministry of Health in Mozambique has concluded a successful six-day emergency cholera vaccination campaign that reached more than 800 000 people in four districts affected by Cyclone Idai.

The campaign was supported by around 1200 community volunteers and partners including the World Health Organization (WHO), UNICEF, Médecins Sans Frontières (MSF), International Federation of the Red Cross and Red Crescent Societies (IFRC) and Save the Children.

“From start to finish, this campaign was one of the fastest ever, thanks to experienced people at the Ministry of Health, who knew there was a high risk of a cholera outbreak and made a rapid request for the vaccines as soon as the cyclone hit,” says Dr Djamila Cabral, Head of the WHO office in Mozambique. “The Ministry did an excellent job organizing the campaign and reaching so many people in such a short time. The oral cholera vaccine is one of the vital measures that can help save lives and stop the spread of this terrible disease during an outbreak.”

The oral cholera vaccines, donated by Gavi from the Global Cholera Vaccine Stockpile, arrived in Beira on Tuesday 2 April and, within 24 hours, began reaching people in need.

The vaccines were given to communities identified by the Government at highest risk – those without access to safe water and sanitation – in Beira, Dondo, Nhamatanda and Buzi districts.

Vaccine uptake has been very high and the campaign has been well received by the communities. Remaining vaccines will be used for other at-risk communities that were not reached by the initial campaign.

People develop protection against cholera approximately 7 days after receiving the vaccine. One dose of this oral vaccine provides around 85% protection against cholera for 6 months.

“Controlling cholera in these areas will reduce the risk to the rest of the population because fewer people will be taking it back and forth into the wider community,” says WHO cholera vaccination expert, Kate Alberti, who was deployed to Beira to support the Ministry of Health to organize the campaign.

Dr Nazira Abdula, Minister of Health of Mozambique, acknowledged the great support of WHO and partners for the vaccination campaign. “It’s very difficult to roll out a campaign of this scope in only three days,” she says.

WHO’s Dr Cabral adds: “This campaign would not have been possible without the strong engagement of the local authorities and the communities themselves. The number of volunteers is impressive and, wherever they go, there has been very strong uptake of the vaccine. Everyone is very keen to make this a success to stop cholera in its tracks.”

Since Cyclone Idai struck Mozambique on 14 March, hundreds of thousands of people have been living in temporary settlements without access to safe water and sanitation. The Ministry of Health declared a cholera outbreak on 27 March and, as of 8 April, had reported more than 3577 cases and 6 deaths.

The cholera vaccine is just one tool for the outbreak response. Currently 12 cholera treatment centres, with 500-bed capacity, have been set up by the national authorities and international partners to serve the affected communities. Partners are also supporting the local authorities to provide access to safe water and sanitation in settlements and communities across Sofala Province.

Cholera is endemic in several parts of Sofala province and the cholera outbreak that developed post-Cyclone Idai acts as a reminder that sustainable access to safe water, sanitation, and hygiene (WASH) is the long-term solution to controlling cholera. Acknowledging that every case of cholera is preventable, the Global Task Force on Cholera Control is implementing a Cholera Global Roadmap to 2030, which calls upon development partners and donors to support countries to reduce cholera deaths by 90% by 2030.

WHO

WHO launches new global influenza strategy

NYT

“……The World Health Organization …..announced a long-awaited restructuring intended to streamline the agency — and strongly hinted that it intended to shake up some staffers’ resistance to change.

The announcement, made in a lengthy and mostly cheerful speech delivered jointly by the organization’s director general, Tedros Adhanom Ghebreyesus, and the directors of the agency’s six regional offices, aims to serve the W.H.O.’s new targets: to get affordable health care to the world’s poorest 1 billion people; to better protect them against epidemics; and to help them enjoy better health, including protection from noncommunicable diseases like cancer…..”

WHO

WHO unveils sweeping reforms in drive towards “triple billion” targets

WHO

What is WHO’s role in emergencies?

WHO is committed to saving lives and reducing suffering during times of crisis – whether caused by conflict, disease outbreak or a disaster. The new WHO Health Emergencies Programme addresses the full risk management cycle, meaning it works with countries to address emergencies before they happen by working on prevention and preparedness, helps in the response to the emergency, and also, once the initial event has passed, on recovery. The new Programme builds on WHO’s years of experience working with countries in emergencies.

What is the new WHO Health Emergencies Programme?

Requested and approved by Member States, the new WHO Health Emergencies Programme is a profound change for WHO, adding operational capabilities to our traditional technical and normative roles. The Programme works with countries and partners to prepare for, prevent, respond to and recover from all hazards that create health emergencies, including disasters, disease outbreaks and conflicts. The Programme will also lead and coordinate the international health response to contain disease outbreaks and provide effective relief and recovery to affected people.

Why is the WHO Health Emergencies Programme needed?

Worldwide, a record 130 million people are in need of humanitarian assistance, and disease outbreaks are a constant global threat.

To meet the immediate health needs of crisis-affected populations at the same time as addressing the underlying causes of their vulnerability, WHO must be part of a broader change in the way the international community prevents, prepares for, and responds to crises.

What are some of the key changes and achievements within the Programme so far?

Since 1 August 2016, WHO has operated under new emergency-management processes for risk assessment, grading of emergencies and incident management. Recent emergency responses have seen the Programme continually tested and adjusted. Significant progress has been made in areas such as risk assessment and grading, coordination of WHO’s response at headquarters, regional offices and country offices through an Incident Management System, and the rapid release of funds from the WHO Contingency Fund for Emergencies. Lessons are being applied to adapt and improve the processes.

Hurricane Matthew in Haiti

In response to Hurricane Matthew in Haiti, WHO/PAHO quickly established 2 new field offices, deployed multinational teams of experts to support the government’s efforts to provide health services to affected areas, and sent essential supplies and medicines. Anticipating increased numbers of cholera outbreaks, WHO/PAHO prepositioned cholera supplies in at-risk areas. WHO/PAHO also evaluated health structures and services in Haiti to prioritize needs.

Yellow fever outbreak in Africa

WHO and partners supported the vaccination of at least 17 million people this year in response to the yellow fever outbreak in Angola and the Democratic Republic of the Congo, in complex campaigns that came together in a matter of weeks.

Response to Zika virus

Within 10 days of the declaration of Zika and its associated complications being declared a Public Health Emergency of International Concern, WHO worked with 23 agencies to develop a common strategic and operational plan. WHO’s Contingency Fund for Emergencies was used for rapid initial cash disbursement. WHO developed and rapidly distributed guidance to help countries in all aspects of the Zika response, from caring for affected infants, to eliminating mosquitoes, to strengthening health services for pregnant women living in affected areas.

Conflict in north eastern Nigeria

In north eastern Nigeria, within 6 weeks of scaling up its emergency operations, WHO supported setting up a disease alert system in 160 health facilities which serve 85% of the 1.6 million displaced people in Borno state.

How does WHO work with partners in emergencies?

The Health Emergencies Programme works with its partners to protect and save people’s lives in all health emergencies. During a crisis, WHO works with the local ministry of health and partners to identify where health needs are greatest and to coordinate the efforts of partner organizations to ensure that these areas are covered by both medical supplies and personnel.

No organization can act alone in emergencies. WHO regularly collaborates with partner networks to leverage and coordinate the expertise of hundreds of partner agencies:

• Global Health Cluster: More than 300 partners responding in 24 crisis-affected countries.
• Emergency Medical Teams: More than 60 teams from 25 countries classified by WHO to provide clinical care in wake of emergencies, with the number expected to rise to 200 soon.
• Global Outbreak Alert and Response Network (GOARN): Since 2000, approximately 2 500 health personnel in response to over 130 public health emergencies in 80 countries.
• Standby partners: In 2015, WHO’s Standby Partners deployed 207 months of personnel support to 18 countries.
• Inter-Agency Standing Committee (IASC): WHO is an active member of IASC, the primary mechanism for inter-agency coordination relating to humanitarian assistance in response to complex and major emergencies under the leadership of the Emergency Relief Coordinator.

How does WHO’s Health Emergencies Programme support countries?

WHO’s Health Emergencies Programme provides the following services to countries:

• support of the assessment of country health emergency preparedness and development of national plans to address critical capacity gaps;
• development of strategies and capacities to prevent and control high-threat infectious hazards; and
• monitoring of new and ongoing public health events to assess, communicate and recommend action for public health risks.

In addition, WHO will work with countries and partners to:

• ensure readiness to diminish public health risks in countries with high vulnerability; and
• provide life-saving health services to affected populations in countries with ongoing emergencies.

What is the structure of the new Programme?

The Programme has a common structure across the organization, in country offices, regional offices and headquarters. This is 1 Emergencies Programme, with

• 1 workforce
• 1 budget
• 1 line of accountability
• 1 set of processes/systems
• 1 set of benchmarks.

The Programme’s structure reflects WHO’s major functions and responsibilities in health emergency risk assessment and management. This structure and related results expected are the same in headquarters and in regional offices and country offices.

The Programme is made up of 5 technical and operational departments. Their titles and specific outcomes are:

• Infectious hazards management: ensure strategies and capacities are established for priority high-threat infectious hazards.
• Country health emergency preparedness and the International Health Regulations (2005): ensure country capacities are established for all-hazards emergency risk management.
• Health emergency information and risk assessments: provide timely and authoritative situation analysis, risk assessment and response monitoring for all major health threats and events.
• Emergency operations: ensure emergency-affected populations have access to an essential package of life-saving health services.
• Emergency core services: ensure WHO emergency operations are rapidly and sustainably financed and staffed.

The Programme will dedicate more than 1000 core WHO staff to work on emergencies. It will harness WHO’s experience and technical expertise on all health hazards at all levels of the Organization to coordinate the international responses to health emergencies worldwide.

How much funding is required for the new Programme?

Financing the work of the new WHO Health Emergencies Programme will require a combination of core financing for baseline staff and activities at the 3 levels of the Programme, financing of the WHO Contingency Fund for Emergencies, and financing for ongoing activities in acute and protracted emergencies through appeals guided by humanitarian response plans.

The core budget is the funding WHO needs to implement the normative, technical, and operations-management capacities and activities reflected in the new results framework for the Health Emergencies Programme. To implement the core activities of the new Health Emergencies Programme WHO must raise US$ 485 million in 2016–2017: at present a gap of 44% remains.

Funding for the core budget comes from 3 sources:

• Assessed contributions: The annual quotas paid by Member States to support the work of the Organization.
• Core voluntary contributions: Flexible contributions made by Member States and other donors that the Director-General may allocate at her discretion and according to need.
• Earmarked contributions: Voluntary contributions earmarked for the core budget of the WHO Health Emergencies Programme or specific activities within it.

Appeals linked to Humanitarian Response Plans (HRPs) currently have a funding gap of 66% of the total requirement of US$ 656 million.

The third basket of funding, the WHO Contingency Fund for Emergencies (CFE), a replenishable fund which facilitates cash flow in the initial 3 months of response to an emergency (before donor funding arrives), has raised US$ 31.5 million of its US$ 100 million target.

What is the Joint External Evaluation?

The Joint External Evaluation (JEE) was developed to assist in evaluating a country’s capacity under International Health Regulations (2005) to prevent, detect, and respond to high-threat infectious hazards. The tool is arranged according to the following core elements:

• preventing and reducing the likelihood of outbreaks and other public health hazards and events defined by International Health Regulations (2005) is essential;
• detecting threats early can save lives; and
• rapid, effective response requires multi-sectoral, national and international coordination and communication.

Country participation in the JEE process is voluntary, and it takes into account a multisectoral approach by both the external teams and the host countries, with an emphasis on transparency and openness of data, information sharing, and the public release of reports.

The JEE incorporates the targets and indicators of the “Global Health Security Agenda” and additional elements needed to fully cover the International Health Regulations (2005) core capacities. Countries are supported in measuring their progress in achieving the targets of the International Health Regulations (2005), ensuring any improvements can be sustained, and identifying the most urgent needs within their health security system, to prioritize opportunities for enhanced preparedness, response and action. The JEE also provides a basis for countries to engage with current and prospective donors and partners, to target resources effectively.

Who will monitor the success of the Programme?

On 29 March 2016, the Director-General established the Independent Oversight and Advisory Committee to provide oversight and monitoring of the development and performance of the WHO Health Emergencies Programme, guide the Programme’s activities, and report findings through the Executive Board to the Health Assembly. Reports of the Committee will be shared with the United Nations Secretary-General and the Inter-Agency Standing Committee.

These are the main functions of the Independent Oversight and Advisory Committee:

• Assess the performance of the Programme’s key functions in health emergencies (including all 5 pillars of the work of the Programme, for example, including both emergency operations and core services).
• Determine the appropriateness and adequacy of the Programme’s financing and resourcing.
• Provide advice to the Director-General.
• Review the Programme’s reports on WHO’s actions in health emergencies.
• Review reports on the state of health security developed by the Director-General for submission to the World Health Assembly through the Executive Board and to the United Nations General Assembly.
• Prepare an annual report on its activities, conclusions, recommendations, and, where necessary, interim reports, for submission by the Chair of the Committee to the World Health Assembly through the WHO Executive Board.

The Committee consists of 8 members drawn from national governments, nongovernmental organizations, and the UN system, with extensive experience in broad range of disciplines, including public health, infectious disease, humanitarian crises, public administration, emergency management, community engagement, partnerships and development. Members serve in their personal capacity and will exercise their responsibilities with full regard for the paramount importance of independence.

The Committee will regularly meet and engage with the Programme management team to help guide its work. They will also assess and influence the work of the programme through engagement with member states.

WHO

Copenhagen, Geneva, 21 January 2019

Migrants and refugees are likely to have good general health, but they can be at risk of falling sick in transition or while staying in receiving countries due to poor living conditions or adjustments in their lifestyle. This is the main conclusion of the first “Report on the health of refugees and migrants in the WHO European Region”, released by the WHO Regional Office for Europe today.

“Today, political and social systems are struggling to rise to the challenge of responding to displacement and migration in a humane and positive way. This report is the first of its kind, and gives us a snapshot of the health of refugees and migrants in the WHO European Region, at a time when the migration phenomenon is expanding across the world,” says Dr Zsuzsanna Jakab, WHO Regional Director for Europe.

The report summarizes the latest available evidence on the health of refugees and migrants in the WHO European Region – from a review of more than 13 000 documents – and the progress countries have made to promote their health. It was developed in partnership with the Italian National Institute for Health, Migration and Poverty (INMP).

Vulnerability to noncommunicable and communicable diseases

Refugees and migrants appear to be less affected than their host populations by many noncommunicable diseases on arrival; however, if they are in conditions of poverty, the duration of their stay in host countries increases their risk for cardiovascular diseases, stroke or cancer. As migrants and refugees are likely to change their lifestyle to engage in less physical activity and consume less healthy food, they are also more prone to risk factors for chronic diseases.

The displacement processes itself can make refugees and migrants more vulnerable to infectious diseases. Yet the report underlines that, for instance, the proportion of refugees and migrants among a host country’s tuberculosis (TB) cases varies broadly depending on the TB prevalence in the host population; and that a significant proportion of migrants and refugees who are HIV positive acquired the infection after they arrived in Europe. Despite the widespread assumption to the contrary, there is only a very low risk of refugees and migrants transmitting communicable diseases to their host population.

“The new report provides insight into what must be done to meet the health needs of both migrants and refugees and the host population. As migrants and refugees become more vulnerable than the host population to the risk of developing both noncommunicable and communicable diseases, it is necessary that they receive timely access to quality health services, as everyone else. This is the best way to save lives and cut treatment costs, as well as protect the health of the resident citizens,” stresses Dr Jakab.

Key findings and myths exposed

• International migrants make up only 10% (90.7 million) of the total population in the WHO European Region. Less than 7.4% of these are refugees. In some European countries, citizens estimate that there are 3 or 4 times more migrants than there really are.
• While communicable diseases are commonly linked with displacement and migration, there is a growing awareness that a range of acute and chronic conditions also require attention.
• Refugees and migrants are at lower risk for all forms of cancer, except cervical cancer. However, cancer in refugees and migrants is more likely to be diagnosed at an advanced stage, which can lead to considerably worse health outcomes than those of the host population.
• Depression and anxiety tend to affect refugees and migrants more than host populations. However, variation by migrant group and in the methods used to assess prevalence make it hard to draw firm conclusions.
• In general, refugees and migrants have a higher incidence, prevalence and mortality rate for diabetes than the host population, with higher rates in women.
• Refugees and migrants are potentially at greater risk of developing infectious diseases because of their exposure to infections, lack of access to health care, interrupted care and poor living conditions during the migration process. It is therefore necessary to protect them and to ensure that health-care workers on the front line understand the risks.
• While refugees and migrants may arrive in Europe with incomplete or interrupted immunization, vaccination uptake is likely to increase with the duration of their stay. The immediate response to new arrivals is to ensure that they receive basic vaccines based on the schedule of the host country.
• *Access to social and health services varies across the WHO European Region, with legal status, language barriers and discrimination generally being influential factors.
• *Unaccompanied minors are vulnerable to sexual exploitation and experience higher rates of depression and symptoms of post-traumatic stress disorder.
• *Male migrants experience significantly more work-related injuries than non-migrant workers.

A series of guidance documents was also developed to translate the report’s findings into practice. Each addresses a specific aspect of the health of refugees and migrants by providing tools, case studies and evidence to inform practices and policies to improve health. They focus on the areas of maternal and newborn health, children’s health, health promotion, mental health and healthy ageing. The documents were produced with financial support from the European Commission.

Towards refugee- and migrant-friendly health systems

Countries in the WHO European Region are making progress in implementing the Strategy and action plan for refugee and migrant health, adopted in 2016 by the WHO Regional Committee for Europe to guide progress on the health aspects of population movement. However, more needs to be done to progress towards refugee- and migrant-friendly health systems, including:

• providing quality and affordable health coverage as well as social protection for all refugees and migrants regardless of their legal status;
• making health systems culturally and linguistically sensitive to address communication barriers;
• ensuring health-care workers are well equipped and experienced to diagnose and manage common infectious and noninfectious diseases;
• enhancing multisectoral action on refugee and migrant health; and
• improving systematic and routine collection of comparable data on refugee and migrant health.

The WHO Regional Office for Europe and partners will continue to support the implementation of the Strategy and action plan, and to assist countries in filling potential gaps in health service delivery. This includes training health-care staff, providing technical assistance, carrying out joint public health and health system assessment missions, and providing policy recommendations using the WHO toolkit to prepare for large influxes of refugees and migrants.

Manila Post

“….The WHO said that “two falsified vaccines have so far been discovered.” It said that Verorab vaccines with batch number NIE35 and H1833 are counterfeit.….”

WHO

The WHO Humanitarian Response Plans for 2018 are based on rigorous assessment and analysis of need in 26 countries. The plans include an overview of the situation, WHO’s objectives to address the health aspects of the crisis, and the funds that will be required to do so. They form part of the overall humanitarian response plans developed by partners in the wider humanitarian response.

Reviewing 2017 • In 2017, humanitarian agencies reached more people in need than ever before: tens of millions of them, saving millions of lives; • Donors provided record levels of funding to Humanitarian Response Plans—nearly $13 billion by the end of November; • Humanitarian agencies helped stave off famines in South Sudan, Somalia, north-east Nigeria and Yemen, through effective scale-up and the rapid release of funds by donors; • Agencies stepped up to provide rapid assistance to refugees fleeing violence in Myanmar; and • Mobilized to support countries in the Caribbean to prepare for and respond to successive hurricanes of a ferocity rarely seen before. • Despite conflict and other constraints complicating the provision of assistance, plans were implemented effectively, with costs averaging approximately $230 a year per person for essential needs.

In 2018 • Conflict will continue to be the main driver of humanitarian needs. • Protracted violence will force people to flee from their homes, deny them access to enough food, and rob them of their means of making a living. • Droughts, floods, hurricanes and other natural disasters will also create humanitarian needs. Although the risk of El Niño or La Niña is low next year, some scientists forecast an increased risk of earthquakes in 2018. • In a number of countries, humanitarian needs will fall, but still remain significant, including Afghanistan, Ethiopia, Iraq, Mali, and Ukraine. • However, needs are rising substantially in Burundi, Cameroon, Central African Republic, the Democratic Republic of the Congo, Libya, Somalia and Sudan. • And needs will remain at exceptionally high levels in Nigeria, South Sudan, the Syria region, and Yemen, which is likely to remain the world’s worst humanitarian crisis. • Overall, 136 million people across the world will need humanitarian assistance and protection. • UN-coordinated response plans costed at $22.5 billion can help 91 million. • The overall number of people in need is more than 5% higher than in the 2017 GHO. The cost of the response plans sets a new record, about 1% higher than at the start of 2017. • Humanitarian agencies will become more effective, efficient and cost-effective. They will respond faster to crises, in a way more attuned to the needs of those they are trying to help. They will undertake more comprehensive, cross-sectoral and impartial needs assessments. They will also contribute more to long-term solutions by working more closely with development agencies. • Larger country-based pooled funds will improve the agility and prioritised use of funds in the places where they operate. An expanded Central Emergency Response Fund will better support the least-funded major crises.
PEOPLE IN NEED PEOPLE TO RECEIVE AID 135.7M 90.9M
FINANCIAL REQUIREMENTS $22.5B

WHO

WHO

Grade 3 emergencies

• Bangladesh – Rohingya crisis
• Democratic Republic of the Congo
• Myanmar
• Nigeria
• Somalia
• South Sudan
• Syrian Arab Republic
• Yemen

Grade 3: a single or multiple country event with substantial public health consequences that requires a substantial WCO response and/or substantial international WHO response. Organizational and/or external support required by the WCO is substantial. An Emergency Support Team, run out of the regional office, coordinates the provision of support to the WCO.

Grade 2 emergencies

• Brazil (in Portugese)
• Cameroon
• Central African Republic
• Ethiopia
• Hurricane Irma and Maria in the Caribbean
• Iraq
• Libya
• MERS-CoV
• Niger
• occupied Palestinian territory
• Sao Tome and Principe Necrotizing Cellulitis (2017)
• Sudan
• Ukraine
• Zimbabwe

Grade 2: a single or multiple country event with moderate public health consequences that requires a moderate WCO response and/or moderate international WHO response. Organizational and/or external support required by the WCO is moderate. An Emergency Support Team, run out of the regional office (the Emergency Support Team is only run out of HQ if multiple regions are affected), coordinates the provision of support to the WCO.

Grade 1 emergencies

• Afghanistan
• Chad
• Indonesia – Sulawesi earthquake 2018
• Kenya
• Lao People’s Democratic Republic
• Mali
• Namibia – viral hepatitis
• Peru
• Philippines – Tyhpoon Mangkhut
• Tanzania

Grade 1: a single or multiple country event with minimal public health consequences that requires a minimal WCO response or a minimal international WHO response. Organizational and/or external support required by the WCO is minimal. The provision of support to the WCO is coordinated by a focal point in the regional office.