Seventieth World Health Assembly update

Please see below for highlights on the Seventieth World Health Assembly:

24th May --  25th May -- 26th May -- 29th May

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Delegates at the World Health Assembly today approved the Organization’s proposed programme budget of US$ 4421.5 million for the biennium, which includes a 3% (or US$ 28 million) increase in Member State assessed contributions for 2018–2019.

This approved budget sets out the Organization’s priorities in line with the Sustainable Development Goals. It includes increased investments in the new WHO Health Emergencies Programme (US$ 69.1 million) and combating antimicrobial resistance (US$ 23.2 million).

WHO’s programme budgets are financed through a combination of assessed and voluntary contributions, with the latter coming from State- and non-State contributors. In the early decades of WHO’s existence, assessed contributions constituted almost all the Organization’s funding. But as the Organization’s total budget has increased, voluntary contributions have overtaken assessed contributions in providing the majority of its income. Assessed contributions had remained largely stable prior to today’s increase.

The World Health Assembly today made decisions relating to polio, the Pandemic Influenza Preparedness Framework, and the health workforce.

Polio

Delegates paid tribute to ongoing efforts to end polio transmission in the last three endemic countries - Afghanistan, Nigeria and Pakistan. They expressed concern about the continued shortage of inactivated poliovirus vaccine, and noted the urgent need to contain polioviruses in safe facilities, destroy unneeded materials, and appropriately contain resources that can be used for research or other purposes. This has become particularly important since the eradication of type 2 of the wild poliovirus in 2015.

The Global Polio Eradication Initiative (GPEI) was launched in 1988, following the adoption for a resolution for the worldwide eradication of polio at the Forty-first World Health Assembly. Since then, the number of polio cases has fallen by over 99.9%. The initiative has also strengthened countries’ capacities to tackle other health issues, for example through better disease surveillance; immunization and health systems strengthening; early warning, emergency and outbreak response.

Delegates also addressed the challenge of scaling down the global polio response as eradication becomes closer, acknowledging the importance of developing a strategy to define the critical functions needed to sustain a polio-free world, as well as the global structures and financial requirements to support them. The development of this Post-eradication Certification Strategy is ongoing, and will be presented to the Executive Board and World Health Assembly next year.

Delegates welcomed efforts to plan for a post-polio world, including WHO’s organization-wide work to identify the key programmatic, financial, human resources and organizational risks associated with the eventual closure of the global polio eradication effort. They requested the Director-General to consider polio transition planning an urgent organizational priority and highlighted the need to ensure that polio transition needs are fully incorporated into the development of the next WHO budget and planning cycle.

Pandemic Influenza Preparedness Framework

Delegates reaffirmed the critical role played by the Pandemic Influenza Preparedness Framework’s (PIP) as a specialized international instrument that facilitates expeditious access to influenza viruses of human pandemic potential, risk analysis and the expeditious, fair and equitable sharing of vaccines and other benefits.

They emphasized the importance of prioritizing and supporting global pandemic influenza preparedness and response, including through the strengthening of domestic seasonal influenza virus surveillance, manufacturing and regulatory capacities and international coordination and collaboration through the Global Influenza Surveillance and Response System (GISRS) to identify and share influenza viruses with pandemic potential rapidly.

The Health Assembly agreed that the WHO secretariat should comprehensively analyse, in consultation with Member States and relevant stakeholders, including the GISRS, the implications of amending the definition of PIP biological materials to include genetic sequence data and expanding the PIP Framework to include seasonal influenza. The delegates further agreed that the PIP Framework model has potential to be used for other pathogens.

The PIP Framework was set up in 2011 to introduce greater equity and solidarity among nations when the next pandemic strikes. The PIP Framework provides WHO with real-time access to approximately 10% of global vaccine production, enabling the Organization to send life-saving doses to developing countries in need.

Health Workforce

The Health Assembly agreed to a five-year action plan under which WHO will collaborate with the International Labour Organization, and the Organization for Economic Cooperation and Development in working with governments and key stakeholders to address the global health and social workforce shortfall and contribute to international efforts to achieve the Sustainable Development Goals.

The plan calls on countries to view the health and social workforce as an investment, rather than a cost, and take advantage of the economic benefits of growth in the health and social sector. It outlines how ILO, OECD and WHO will take intersectoral action on five fronts: galvanizing political support; strengthening data and evidence; transforming and scaling up the education, skills and decent jobs of health and social workers; increasing resources to build the health and social workforces; and maximizing the multiple benefits that can be obtained from international health worker mobility.

It also focuses on maximizing women’s economic empowerment and participation. It addresses occupational health and safety, protection and security of the health and social workforce in all settings. It also covers the reform of service models towards the efficient provision of care, particularly in underserved areas.

The action plan supports the WHO Global Strategy on Human Resources for Health: Workforce 2030. It will facilitate implementation of the recommendations of the United Nations Secretary General’s High-Level Commission on Health Employment and Economic Growth, which found that, as populations grow and change, the global demand for health workers will double by 2030.

 

Today’s decisions at the World Health Assembly focused on implementation of the International Health Regulations, and improving the prevention, diagnosis and treatment of sepsis.

International Health Regulations

Delegates emphasized the urgent need to achieve full implementation of the International Health Regulations (2005) – the international legal instrument designed to help the global community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide.

The Regulations, which entered into force on 15 June 2007, require countries to report certain disease outbreaks and public health events to WHO. They define the rights and obligations of countries to report public health events, and establish a number of procedures that WHO must follow in its work to uphold global public health security.

Delegates requested the Director-General to work with Member States to develop a five-year global strategic plan for public health preparedness and response and submit it to the World Health Assembly in 2018. The strategic plan is to be based on guiding principles including consultation, country ownership, WHO leadership, broad partnerships, community involvement, regional integration, and results and accountability. The strategic plan is to focus on using an intersectoral approach; integration with the health system; focus on fragile contexts; domestic financing for sustainability; balance between legally binding and voluntary elements; with a guiding focus on monitoring.

Delegates also requested the Director-General to pursue and strengthen efforts to support Member States in full implementation of the Regulations, including through building their core public health capacities.

Sepsis

Delegates also agreed on a resolution to improve the prevention, diagnosis and treatment of sepsis.

Sepsis occurs when a person has an infection and the body’s reaction injures tissues and organs. Sepsis can be triggered by infections caused by bacteria, viruses, fungi, and parasites. Bacterial infections are the most common triggers. Early recognition of sepsis is crucial to treating patients before their condition worsens and becomes fatal. Antimicrobial resistance makes it much more difficult to treat infections and stop them evolving into sepsis. Antimicrobial resistance occurs when bacteria and other microbes change to resist the effects of antibiotics and other antimicrobial medicine. Most infections can be avoided by improving hygiene, access to vaccinations and other infection prevention measures.

The resolution urges governments to strengthen policies and processes related to sepsis, especially to prevent infections and the further spread of antimicrobial resistance. It emphasizes the importance of reinforcing health worker training to recognize and deal effectively with the condition, improve tracking and reporting of cases, and promote research to develop more tools for sepsis diagnosis and treatment.

Further, the resolution requests that WHO develop a report on sepsis and guidance for its prevention and management. In addition, the resolution directs the Organization to help countries develop the necessary infrastructure, laboratory capacity, strategies and tools to reduce the burden of sepsis. It also asks WHO to work with partners to help developing countries gain access to quality, safe, efficacious and affordable sepsis treatments and tools for infection prevention and control, including immunization.

 

Delegates at the World Health Assembly have reached new agreements on dementia; immunization; refugee and migrant health; substandard and falsified medical products, and the world drug problem.

Dementia

Delegates at the World Health Assembly today endorsed a global action plan on the public health response to dementia 2017-2025 and committed to developing ambitious national strategies and implementation plans. The global plan aims to improve the lives of people with dementia, their families and the people who care for them, while decreasing the impact of dementia on communities and countries. Areas for action include: reducing the risk of dementia; diagnosis, treatment and care; research and innovative technologies; and development of supportive environments for carers.

They called on the WHO Secretariat to offer technical support, tools and guidance to Member States as they develop national and subnational plans and to draw up a global research agenda for dementia. Delegates recognized the importance of WHO’s Global Dementia Observatory as a system for monitoring progress both within countries and at the global level.

Delegates emphasized the need to integrate health and social care approaches, and to align actions to tackle dementia with those for other aspects of mental health, as well as noncommunicable diseases and ageing. They also highlighted the importance of ensuring respect for the human rights of people living with dementia, both when developing plans and when implementing them.

Worldwide, around 47 million people have dementia, with nearly 9.9 million new cases each year. Nearly 60% of people with dementia live in low- and middle-income countries.

Immunization

Delegates agreed to strengthen immunization to achieve the goals of the Global Vaccine Action Plan (GVAP). In 2012, the Health Assembly endorsed GVAP, a commitment to ensure that no one misses out on vital immunization by 2020. However, progress towards the targets laid out in that plan is off track. Halfway through the decade covered by the plan, more than 19 million children were still missing out on basic immunizations.

Today’s resolution urges Member States to strengthen the governance and leadership of national immunization programmes. It also calls on them to improve monitoring and surveillance systems to ensure that up-to-date data guides policy and programmatic decisions to optimize performance and impact. It calls on countries to expand immunization services beyond infancy; mobilize domestic financing, and strengthen international cooperation to achieve GVAP goals. It requests the WHO Secretariat to continue supporting countries to achieve regional and global vaccination goals. It recommends scaling up advocacy efforts to improve understanding of the value of vaccines and of the urgent need to meet the GVAP goals. The Secretariat will report back in 2020 and 2022 on achievements against the 2020 goals and targets.

Immunization averts an estimated 2 to 3 million deaths every year from diphtheria, tetanus, pertussis (whooping cough), and measles. An additional 1.5 million deaths could be avoided if global vaccination coverage were improved.

Refugee and migrant health

Delegates asked the Director-General to provide advice to countries in order to promote the health of refugees and migrants, and to gather evidence that will contribute to a draft global action to be considered at the 72nd World Health Assembly in 2019. They also encouraged Member States to use the framework of priorities and guiding principles to promote the health of refugees and migrants developed by WHO, in collaboration with IOM and UNHCR, to inform discussions among Member States and partners engaged in the development of the UN global compact on refugees and the UN global compact for safe, orderly and regular migration.

There are an estimated 1 billion migrants in the world – one in seven of the world’s population. This rapid increase of population movement has important public health implications, and requires an adequate response from the health sector. International human rights standards and conventions exist to protect the rights of migrants and refugees, including their right to health. But many refugees and migrants often lack access to health services and financial protection for health.

Health problems faced by newly-arrived refuges and migrants can include accidental injuries, hypothermia, burns, cardiovascular events, pregnancy and delivery-related complications. Women and girls frequently face specific challenges, particularly in maternal, newborn and child health, sexual and reproductive health, and violence. Children are prone to acute infections such as respiratory infections and diarrhoea because of poor living conditions and deprivation during migration and forced displacement. Lack of hygiene can lead to skin infections.

Refugees and migrants are also at risk of psychosocial disorders, drug abuse, nutrition disorders, alcoholism and exposure to violence. Those with noncommunicable diseases (NCDs) can also suffer interruption of care, due either to lack of access or to the decimation of health care systems and providers.

Substandard and falsified medical products

“Substandard” medical products (also called “out of specification”) are authorized by national regulatory authorities, but fail to meet either national or international quality standards or specifications – or in some cases, both. “Falsified” medical products deliberately or fraudulently misrepresent their identity, composition or source.

The Assembly also agreed a definition of “unregistered or unlicensed medical products”. These have not been assessed or approved by the relevant national or regional regulatory authority for the market in which they are marketed, distributed or used.

The new terminology aims to establish a common understanding of what is meant by substandard and falsified medical products and to facilitate a more thorough and accurate comparison and analysis of data. It focuses solely on the public health implications of substandard and falsified products, and does not cover the protection of intellectual property rights.

Substandard and falsified medical products can harm patients and fail to treat the diseases for which they were intended. They lead to loss of confidence in medicines, healthcare providers and health systems, and affect every region of the world. Anti-malarials and antibiotics are amongst the most commonly reported substandard and falsified medical products, but all types of medicines can be substandard and falsified. They can be found in illegal street markets, via unregulated websites, and in pharmacies, clinics and hospitals.

Delegates agreed to adopt the new name of “substandard and falsified” (SF) medical products for what have until now been known as “substandard/spurious/falsely-labelled/falsified/counterfeit (SSFFC)” medical products.

The world drug problem and public health

Delegates agreed on the need for intensified efforts to help Member States address the world drug problem. They asked the WHO Secretariat to strengthen its collaboration with the United Nations Office on Drugs and Crime and the International Narcotics Control Board to implement the health-related recommendations of in the outcome document of the 2016 Special Session of the United Nations General Assembly on the world drug problem (UNGASS).

It has been 26 years since the Health Assembly made a decision on this topic. The Secretariat is asked to report back on progress in 2018, 2020 and 2022.

According to WHO’s latest estimates, psychoactive drug use is responsible for more than 450 000 deaths each year. The drug-attributable disease burden accounts for about 1.5% of the global burden of disease. Furthermore, injecting drug use accounts for an estimated 30% of new HIV infections outside sub-Saharan Africa and contributes significantly to hepatitis B and C epidemics in all regions.

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