Health workers rollout immunization campaign aiming to reach one million
In a historic move, Nigeria has become the first country in the world to roll out a new vaccine (called Men5CV) recommended by the World Health Organization (WHO), which protects people against five strains of the meningococcus bacteria. The vaccine and emergency vaccination activities are funded by Gavi, the Vaccine Alliance, which funds the global meningitis vaccine stockpile, and supports lower-income countries with routine vaccination against meningitis.
Nigeria is one of the 26 meningitis hyper-endemic countries of Africa, situated in the area known as the African Meningitis Belt. Last year, there was a 50% jump in annual meningitis cases reported across Africa.
In Nigeria, an outbreak of Neisseria meningitidis (meningococcus) serogroup C outbreak led to 1742 suspected meningitis cases, including 101 confirmed cases and 153 deaths in seven of 36 Nigerian states (Adamawa, Bauchi, Gombe, Jigawa, Katsina, Yobe, Zamfara) between 1 October 2023 and 11 March 2024. To quell the deadly outbreak, a vaccination campaign has been undertaken on 25--28 March 2024 to initially reach more than one million people aged 1-29 years.
Meningitis is a serious infection that leads to the inflammation of the membranes (meninges) that surround and protect the brain and spinal cord. There are multiple causes of meningitis, including viral, bacterial, fungal and parasitic pathogens. Symptoms often include headache, fever and stiff neck. Bacterial meningitis is the most serious, can also result in septicaemia (blood poisoning), and can seriously disable or kill within 24 hours those that contract it.
“Meningitis is an old and deadly foe, but this new vaccine holds the potential to change the trajectory of the disease, preventing future outbreaks and saving many lives,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Nigeria’s rollout brings us one step closer to our goal to eliminate meningitis by 2030.”
The revolutionary new vaccine offers a powerful shield against the five major strains of the meningococcal bacteria (A, C, W, Y and X) in a single shot. All five strains cause meningitis and blood poisoning. This provides broader protection than the current vaccine used in much of Africa, which is only effective against the A strain.
The new vaccine has the potential to significantly reduce meningitis cases and advance progress in defeating meningitis. This is especially important for countries like Nigeria where multiple serogroups are prevalent. The new vaccine uses the same technology as the meningitis A conjugate vaccine (MenAfriVac®), which wiped out meningococcal A epidemics in Nigeria.
“Northern Nigeria, particularly the states of Jigawa, Bauchi and Yobe were badly hit by the deadly outbreak of meningitis, and this vaccine provides health workers with a new tool to both stop this outbreak but also put the country on a path to elimination,” said Prof. Muhammad Ali Pate of the Nigerian Ministry of Health and Social Welfare. “We’ve done a lot of work preparing health workers and the health system for the rollout of this new vaccine. We got an invaluable support from our populations despite this fasting period and from our community leaders especially the Emir of Gumel in Jigawa state who personally launched the vaccination campaign in the state. We’ll be monitoring progress closely and hopefully expanding the immunization in the coming months and years to accelerate progress.”
This new multivalent conjugate vaccine was 13 years in the making and was based on a partnership between PATH and the Serum Institute of India. Financing from the UK government’s Foreign, Commonwealth and Development Office was critical to its development.
In July 2023, WHO prequalified the new Men5CV vaccine (which has brand name MenFive®) and in October 2023 issued an official recommendation to countries to introduce the new vaccine. Gavi allocated resources for the Men5CV rollout in December 2023, which is currently available for outbreak response through the emergency stockpile managed by the International Coordinating Group (ICG) on Vaccine Provision, while roll-out through mass preventive campaigns is expected to start in 2025 across countries of the Meningitis Belt.
“The rollout of one million vaccines in northern Nigeria will help save lives, prevent long-term illness and boost our goal of defeating meningitis globally by 2030,” said Andrew Mitchell, UK Minister for Development and Africa. “This is exactly the kind of scientific innovation, supported by the UK, which I hope is replicated in years to come to help us drive further breakthroughs, including wiping out other diseases.”
WHO has been supporting the Nigeria Centre for Disease Control and Prevention (NCDC) in responding to the meningitis outbreak in the country. This includes disease surveillance, active case finding, sample testing, and case management. WHO and partners have also played a vital role in supporting Nigeria to prepare for the rollout of the new vaccine and training health workers.
“Year after year, meningococcal meningitis has tormented countries across Africa,” said Dr Nanthalile Mugala, PATH's Chief of Africa Region. “The introduction of MenFive® in Nigeria heralds a transformative era in the fight against meningococcal meningitis in Africa. Building on the legacy of previous vaccination efforts, this milestone reflects over a decade of unwavering, innovative partnerships. The promise of MenFive® lies not just in its immediate impact but in the countless lives it stands to protect in the years to come, moving us closer to a future free from the threat of this disease.”
In 2019, WHO and partners launched the global roadmap to defeating meningitis by 2030. The roadmap sets a comprehensive vision towards a world free of meningitis, and has three goals:
- elimination of bacterial meningitis epidemics;
- reduction of cases of vaccine-preventable bacterial meningitis by 50% and deaths by 70%; and
- reduction of disability and improvement of quality of life after meningitis due to any cause.
“With outbreaks of infectious diseases on the rise worldwide, new innovations such as MenFive® are critical in helping us fight back," said Aurélia Nguyen, Chief Programme Officer at Gavi, the Vaccine Alliance, which funds the global stockpile as well as vaccine rollout in lower-income countries. "This first shipment signals the start of Gavi support for a multivalent meningococcal conjugate vaccine (MMCV) program, which, with the required donor funding for our next five years of work, will see pentavalent meningococcal conjugate vaccines rolled out in high-risk countries. Thanks to vaccines, we have eliminated large and disruptive outbreaks of meningitis A in Africa: now we have a tool to respond to other serogroups that still cause large outbreaks resulting in long-term disability and deaths."
Following Nigeria’s meningitis vaccine campaign, a major milestone on the road to defeat meningitis is the international summit on meningitis taking place in Paris in April 2024 where leaders will come together to celebrate progress, identify challenges and assess next steps. It is also an opportunity for country leaders and key partners to commit politically and financially to accelerate progress towards eliminating meningitis as a public health problem by 2030.
The World Health Organization provides global leadership in public health within the United Nations system. Founded in 1948, WHO works with 194 Member States, across six regions and from more than 150 offices, to promote health, keep the world safe and serve the vulnerable. Our goal for 2019-2023 is to ensure that a billion more people have universal health coverage, to protect a billion more people from health emergencies, and provide a further billion people with better health and wellbeing.
Following consultation with public health agencies and experts, the World Health Organization (WHO) publishes a global technical consultation report introducing updated terminology for pathogens that transmit through the air. The pathogens covered include those that cause respiratory infections, e.g. COVID-19, influenza, measles, Middle East respiratory syndrome (MERS), severe acute respiratory syndrome (SARS), and tuberculosis, among others.
The publication, entitled “Global technical consultation report on proposed terminology for pathogens that transmit through the air”, is the result of an extensive, multi-year, collaborative effort and reflects shared agreement on terminology between WHO, experts and four major public health agencies: Africa Centres for Disease Control and Prevention; Chinese Center for Disease Control and Prevention; European Centre for Disease Prevention and Control; and United States Centers for Disease Control and Prevention. This agreement underlines the collective commitment of public health agencies to move forward together on this matter.
The wide-ranging consultation was conducted in multiple steps in 2021-2023 and addressed a lack of common terminology to describe the transmission of pathogens through the air across scientific disciplines. The challenge became particularly evident during the COVID-19 pandemic as experts from various sectors were required to provide scientific and policy guidance. Varying terminologies highlighted gaps in common understanding and contributed to challenges in public communication and efforts to curb the transmission of the pathogen.
Together with a very diverse range of leading public health agencies and experts across multiple disciplines, we are pleased to have been able to address this complex and timely issue and reach a consensus,” said Dr Jeremy Farrar, WHO Chief Scientist. “The agreed terminology for pathogens that transmit through the air will help set a new path for research agendas and implementation of public health interventions to identify, communicate and respond to existing and new pathogens.”
The extensive consultation resulted in the introduction of the following common descriptors to characterize the transmission of pathogens through the air (under typical circumstances):
Individuals infected with a respiratory pathogen can generate and expel infectious particles containing the pathogen, through their mouth or nose by breathing, talking, singing, spitting, coughing or sneezing. These particles should be described with the term ‘infectious respiratory particles’ or IRPs.
IRPs exist on a continuous spectrum of sizes, and no single cut off points should be applied to distinguish smaller from larger particles. This facilitates moving away from the dichotomy of previously used terms: ‘aerosols’ (generally smaller particles) and ‘droplets’ (generally larger particles).
The descriptor ‘through the air’ can be used in a general way to characterize an infectious disease where the main mode of transmission involves the pathogen travelling through the air or being suspended in the air. Under the umbrella of ‘through the air transmission’, two descriptors can be used:
1. Airborne transmission or inhalation, for cases when IRPs are expelled into the air and inhaled by another person. Airborne transmission or inhalation can occur at a short or long distance from the infectious person and distance depends on various factors (airflow, humidity, temperature, ventilation etc). IRPs can theoretically enter the body at any point along the human respiratory tract, but preferred sites of entry may be pathogen-specific.
2. Direct deposition, for cases when IRPs are expelled into the air from an infectious person, and are then directly deposited on the exposed mouth, nose or eyes of another person nearby, then entering the human respiratory system and potentially causing infection.
“This global technical consultation process was a concerted effort of many influential and experienced experts,” said Dr Gagandeep Kang, Christian Medical College, Vellore, India who is a Co-Chair of the WHO Technical Working Group. “Reaching consensus on these terminologies bringing stakeholders in an unprecedented way was no small feat. Completing this consultation gives us a new opportunity and starting point to move forward with a better understanding and agreed principles for diseases that transmit through the air,” added Dr Yuguo Li from the University of Hong Kong, Hong Kong SAR (China), who also co-chaired the Technical Working Group.
This consultation was the first phase of global scientific discussions led by WHO. Next steps include further technical and multidisciplinary research and exploration of the wider implementation implications of the updated descriptors.
The World Health Organization provides global leadership in public health within the United Nations system. Founded in 1948, WHO works with 194 Member States, across six regions and from more than 150 offices, to promote health, keep the world safe and serve the vulnerable. Our goal for 2019-2023 is to ensure that a billion more people have universal health coverage, to protect a billion more people from health emergencies, and provide a further billion people with better health and wellbeing.
On the anniversary of its founding, the Organization urges countries to invest, tackle discrimination and intolerance, and expand equitable access to quality health services
5 April 2024 - To mark World Health Day (7 April), the World Health Organization (WHO) is running the “My health, my right” campaign to champion the right to health of everyone, everywhere.
The campaign advocates for ensuring universal access to quality health services, education, and information, as well as safe drinking water, clean air, good nutrition, quality housing, decent working and environmental conditions, and freedom from discrimination.
All around the world, the core challenges consistently compromising the right to health are political inaction coupled with a lack of accountability and funding, compounded by intolerance, discrimination and stigma. Populations facing marginalization or vulnerability suffer the most, such as people who live in poverty, are displaced, are older or live with disabilities.
While inaction and injustice are the major drivers of the global failure to deliver on the right to health, current crises are leading to especially egregious violations of this right. Conflicts are leaving trails of devastation, mental and physical distress, and death.
The burning of fossil fuels is simultaneously driving the climate crisis and violating our right to breathe clean air. The climate crisis is in turn causing extreme weather events that threaten health and well-being across the planet and strain access to services to meet basic needs.
Everyone deserves access to quality, timely and appropriate health services, without being subjected to discrimination or financial hardship. Yet, in 2021, 4.5 billion people, more than half of the world’s population, were not covered by essential health services, leaving them vulnerable to diseases and disasters. Even those who do access care often suffer economically for it, with about 2 billion people facing financial hardship due to health costs, a situation that has been worsening for two decades.
To expand coverage, an additional US$ 200–328 billion a year is needed globally to scale up primary health care in low- and middle-income countries (i.e. 3.3% of national forecast GDP). Progress has shown to be possible where there is political will. Since 2000, 42 countries, representing all regions and income levels, succeeded in improving both health service coverage and protection against catastrophic health spending.
“Realizing the right to health requires governments to pass and implement laws, invest, address discrimination and be held accountable by their populations,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “WHO is working with governments, partners and communities to ensure the highest attainable standard of health, as a fundamental right for all people, everywhere.”
The right to health is enshrined within the WHO Constitution, and at least 140 countries recognize the right to health in their national constitutions. But recognition alone is not enough, which is why WHO supports countries to legislate the right to health across sectors and integrate human rights into health policies and programmes. The aim of this support is to make health services available, accessible and responsive to the needs of the populations they serve and to increase community participation in health decision-making.
On this World Health Day and beyond, WHO is calling for governments to make meaningful investments to scale up primary health care; to ensure transparency and accountability; and to meaningfully involve individuals and communities in decision-making around health. Recognizing the interdependence between the right to health and other fundamental rights, the campaign includes calls to action on finance, agriculture, environment, justice, transport, labour and social affairs.
Individuals, communities and civil society have long defended their right to health, improving access to health care services by breaking down barriers and advocating for equity. WHO urges the public to know, protect and promote their health rights, including those related to safe and quality care, zero discrimination, privacy and confidentiality, information, bodily autonomy, and decision-making.
The World Health Organization provides global leadership in public health within the United Nations system. Founded in 1948, WHO works with 194 Member States, across six regions and from more than 150 offices, to promote health, keep the world safe and serve the vulnerable. Our goal for 2019-2023 is to ensure that a billion more people have universal health coverage, to protect a billion more people from health emergencies, and provide a further billion people with better health and wellbeing.
Kyiv, Ukraine, 4 April 2024 - A concerning new trend has emerged from the WHO Surveillance System for Attacks on Health Care (SSA) in Ukraine: Ambulance workers and other personnel servicing health transport face a risk of injury and death 3 times higher than that of other health-care service workers.
“Many emergency teams come under fire either on the way to a call or at their bases. 4 of our employees have already been killed and 12 people were injured and hospitalized,” said Halyna Saldan, Head of the Centre for Emergency Medical Care and Disaster Medicine of Kherson Regional State Administration.
Out of the 68 attacks verified by WHO during the first quarter of 2024, some 12 of them – almost 20% – targeted Emergency Medical Services, including 9 attacks targeting emergency medical aid base stations, 7 attacks resulting in damage to ambulances, and 6 attacks affecting assets and emergency medical aid equipment.
In 3 of these 12 attacks, 4 health workers were injured and 2 health professionals were killed, marking a casualty rate nearly 3 times higher than in other health-care services during the same period.
The attacks pose significant dangers to both health-care workers and patients. “This is a horrifying pattern,” acknowledged Dr Emanuele Bruni, WHO Incident Manager in Ukraine. “Emergency health-care workers and services are dedicated to helping people in critical situations and must be protected in all circumstances. These attacks threaten their safety and further devastate communities that have been living under constant shelling for more than 2 years.”
The first months of 2024 have witnessed a concerning escalation in the number of attacks, with nearly 1 attack per day in the months of January and March, mostly with the use of heavy weaponry.
“This grim number underscores the pressure on the Ukrainian health-care system,” stated Dr Jarno Habicht, WHO Representative in Ukraine. “WHO urgently reiterates its calls for the protection of health-care workers and patients, as well as the uninterrupted delivery of essential health services.”
Since the invasion by the Russian Federation in February 2022, WHO has verified 1682 attacks on health care in Ukraine, resulting in 128 deaths and 288 injuries of medical personnel and patients. WHO defines an attack on health care as any act of verbal or physical violence, obstruction or threat of violence that interferes with the availability, access and delivery of curative and/or preventive health services during emergencies. This can range from harm caused by heavy weapons to psychosocial threats and intimidation that affect access to health care for those in need.
The World Health Organization provides global leadership in public health within the United Nations system. Founded in 1948, WHO works with 194 Member States, across six regions and from more than 150 offices, to promote health, keep the world safe and serve the vulnerable. Our goal for 2019-2023 is to ensure that a billion more people have universal health coverage, to protect a billion more people from health emergencies, and provide a further billion people with better health and wellbeing.
Geneva, 28 March 2024-- WHO Member States agreed to resume negotiations aimed at finalizing a pandemic agreement during 29 April to 10 May. The decision came at today’s end of two weeks of intensive country-led discussions on critical subjects aimed at making all countries of the world better prepared for, and able to effectively and equitably respond to, future pandemics.
This ninth meeting of the Intergovernmental Negotiating Body (INB9) started on 18 March and ended today. Government negotiators discussed all articles from the draft agreement, including adequate financing for pandemic preparedness, equitable access to medical countermeasures needed during pandemics and health workforce strengthening.
“Our Member States are fully aware of how important the pandemic agreement is for protecting future generations from the suffering we endured through the COVID-19 pandemic,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “I thank them for their clear commitment to finding common ground and finalizing this historic agreement in time for the World Health Assembly.”
Next month’s resumption of INB9 will be a critical milestone ahead of the Seventy-seventh World Health Assembly, starting 27 May 2024, at which Member States are scheduled to consider the proposed text of the world’s first pandemic agreement for adoption.
Dr Precious Matsoso, Co-Chair of the INB Bureau, said: “There is clear recognition from governments that the goal of a pandemic agreement is to prepare the world for preventing and responding to future pandemics, built on consensus, solidarity and equity. These goals must remain our North Star as we move toward the finalization of this historic, pressing commitment for the world. We know that if we fail, we will be failing humanity, including all those who suffered from COVID-19, and those at risk of future pandemics.”
Fellow INB Bureau Co-Chair, Mr Roland Driece, said: “Governments said clearly we cannot fail to reach an agreement at the next World Health Assembly to make the world healthier, fairer and safer from pandemics. We are at the finishing line and we are committed to maximizing the remaining negotiations to reach the result the entire world needs.”
In December 2021, the World Health Assembly met in a Special Session, the second-ever since WHO’s founding in 1948, and decided to establish the INB to draft and negotiate a WHO convention, agreement, or other international instrument on pandemic prevention, preparedness and response. The process has involved participation of other United Nations system bodies, non-state actors, other relevant stakeholders, and the public.
The World Health Organization provides global leadership in public health within the United Nations system. Founded in 1948, WHO works with 194 Member States, across six regions and from more than 150 offices, to promote health, keep the world safe and serve the vulnerable. Our goal for 2019-2023 is to ensure that a billion more people have universal health coverage, to protect a billion more people from health emergencies, and provide a further billion people with better health and wellbeing.
Geneva, 27 March 2024 -- WHO has launched a new network for coronaviruses, CoViNet, to facilitate and coordinate global expertise and capacities for early and accurate detection, monitoring and assessment of SARS-CoV-2, MERS-CoV and novel coronaviruses of public health importance.
CoViNet expands on the WHO COVID-19 reference laboratory network established during the early days of the pandemic. Initially, the lab network was focused on SARS-CoV-2, the virus that causes COVID-19, but will now address a broader range of coronaviruses, including MERS-CoV and potential new coronaviruses. CoViNet is a network of global laboratories with expertise in human, animal and environmental coronavirus surveillance.
The network currently includes 36 laboratories from 21 countries in all 6 WHO regions.
Representatives of the laboratories met in Geneva on 26 – 27 March to finalize an action plan for 2024-2025 so that WHO Member States are better equipped for early detection, risk assessment, and response to coronavirus-related health challenges.
The CoViNet meeting brings together global experts in human, animal, and environmental health, embracing a comprehensive One Health approach to monitor and assess coronavirus evolution and spread. The collaboration underscores the importance of enhanced surveillance, laboratory capacity, sequencing, and data integration to inform WHO policies and support decision-making.
“Coronaviruses have time and again demonstrated their epidemic and pandemic risk. We thank our partners from around the world who are working to better understand high threat coronaviruses like SARS, MERS and COVID-19 and to detect novel coronaviruses,” said Dr Maria Van Kerkhove, acting Director of WHO’s Department of Epidemic and Pandemic Preparedness and Prevention. “This new global network for coronaviruses will ensure timely detection, monitoring and assessment of coronaviruses of public health importance.”
Data generated through CoViNet's efforts will guide the work of WHO's Technical Advisory Groups on Viral Evolution (TAG-VE) and Vaccine Composition (TAG-CO-VAC) and others, ensuring global health policies and tools are based on the latest scientific information.
The World Health Organization provides global leadership in public health within the United Nations system. Founded in 1948, WHO works with 194 Member States, across six regions and from more than 150 offices, to promote health, keep the world safe and serve the vulnerable. Our goal for 2019-2023 is to ensure that a billion more people have universal health coverage, to protect a billion more people from health emergencies, and provide a further billion people with better health and wellbeing.
World Health Organization (WHO) has today published a new, comprehensive diagnostic manual for mental, behavioural, and neurodevelopmental disorders: “The clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders (ICD-11 CDDR)”.
The manual has been developed using the latest available scientific evidence and best clinical practices and is designed to support qualified mental health and other health professionals to identify and diagnose mental, behavioural and neurodevelopmental disorders in clinical settings.
“An accurate diagnosis is often the first critical step towards receiving appropriate care and treatment. By supporting clinicians to identify and diagnose mental, behavioural and neurodevelopmental disorders, this new ICD-11 diagnostic manual will ensure more people are able to access the quality care and treatment they need” said Dévora Kestel, Director, Mental Health and Substance Use Department, World Health Organization.
The new diagnostic guidance, reflecting the updates to the ICD-11, includes the following features:
Guidance on diagnosis for several new categories added in ICD-11, including complex post-traumatic stress disorder, gaming disorder and prolonged grief disorder. This enables improved support to health professionals to better recognize distinct clinical features of these disorders, which may previously have been undiagnosed and untreated.
The adoption of a lifespan approach to mental, behavioural and neurological disorders, including attention to how disorders appear in childhood, adolescence, and older adults.
The provision of culture-related guidance for each disorder, including how disorder presentations may differ systematically by cultural background. The incorporation of dimensional approaches, for example in personality disorders, recognizing that many symptoms and disorders exist on a continuum with typical functioning.
The ICD-11 CDDR are aimed at mental health professionals and qualified non-specialist health professionals such as primary care physicians responsible for assigning these diagnoses in clinical settings as well as other health professionals in clinical and non-clinical roles, such as nurses, occupational therapists and social workers, who need to understand the nature and symptoms of mental, behavioural and neurodevelopmental disorders even if they do not personally assign diagnoses.
The ICD-11 CDDR were developed and field-tested through a rigorous, multi-disciplinary and participatory approach involving hundreds of experts and thousands of clinicians from around the world.
The World Health Organization provides global leadership in public health within the United Nations system. Founded in 1948, WHO works with 194 Member States, across six regions and from more than 150 offices, to promote health, keep the world safe and serve the vulnerable. Our goal for 2019-2023 is to ensure that a billion more people have universal health coverage, to protect a billion more people from health emergencies, and provide a further billion people with better health and wellbeing.
New country, policy and program commitments, plus nearly US$600 million in new funding, at first-ever global forum offer a chance to save hundreds of thousands of lives by 2030.
Cartagena de Indias, Colombia, 5 March 2024 – Governments, donors, multilateral institutions, and partners today announced major new policy, programmatic and financial commitments, including nearly US$600 million in new funding, to eliminate cervical cancer. If these ambitions to expand vaccine coverage and strengthen screening and treatment programs are fully realized, the world could eliminate a cancer for the first time.
These commitments were made at the first-ever Global Cervical Cancer Elimination Forum: Advancing the Call to Action in Cartagena de Indias, Colombia, to catalyze national and global momentum to end this preventable disease.
Every two minutes, a woman dies from cervical cancer, although the knowledge and the tools to prevent and even eliminate this disease already exist. Vaccination against human papillomavirus (HPV) — the leading cause of cervical cancer — can prevent the vast majority of cases and, combined with screening and treatment, provides a path to elimination.
Cervical cancer is the fourth most common cancer in women worldwide, and continues to disproportionately impact women and their families in low- and middle-income countries (LMICs). In an important shift, the World Health Organization (WHO)’s 2022 global recommendation for one-dose HPV vaccine schedules significantly reduced barriers to scaling up vaccination programs. It was reinforced by a similar recommendation in the Americas Region in 2023. The WHO’s Regional Office for Africa has just followed suit with its own recommendation for countries in the region to adopt the single-dose vaccination schedule. To date, 37 countries have reported switching or an intent to switch to a one-dose regimen.
The commitments announced at the forum mark a watershed moment to accelerate progress on a promise made in 2020, when 194 countries adopted WHO’s global strategy to eliminate cervical cancer.
“We have the knowledge and the tools to make cervical cancer history, but vaccination, screening and treatment programmes are still not reaching the scale required,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This first global forum is an important opportunity for governments and partners to invest in the global elimination strategy and addressing the inequities that deny women and girls’ access to the life-saving tools they need.”
In addition to a re-commitment by Indonesia to its National Action Plan 2023, other country commitments include:
Democratic Republic of Congo commits to start introducing the HPV vaccine as early as possible using the WHO-recommended single-dose schedule. It also commits to do everything to get, as early as possible, to the cervical cancer elimination strategy immunization’s coverage target for girls aged 9 to 14 years.
Ethiopia commits to implement a robust vaccine delivery strategy across the country, targeting at least 95% coverage in 2024 for all 14-year old girls, regardless of their socioeconomic status, whether in school or out of school. The country also commits to screen 1 million eligible women every year for cervical cancer and to treat 90% of those screened, who present with positive precancerous lesions. Further, HPV single dose has been approved to be introduced this year and scaled up as part of the country’s Expanded Program on Immunization plans.
Nigeria launched its HPV vaccine national program this year, adopting the single-dose schedule for girls 9 to 14 years old, and now commits to achieving at least 80% vaccine coverage of girls. They are committed to continuing to increase coverage of the HPV vaccine through a robust delivery strategy that will meet the girls where they are. For girls who are in school, they will concentrate on school-based delivery; for girls that are not in school, they will commit to implementing outreach activities at key moments in the year, with the target of at least 80% coverage of girls targeted by 2026.
The nearly US$600 million in new funding includes US$180 million from the Bill & Melinda Gates Foundation, US$10 million from UNICEF, and US$400 million from the World Bank. A full list and description of commitments can be found here and will be updated throughout the forum.
There are many challenges on the path to elimination. Due to supply constraints, delivery challenges, and the COVID-19 pandemic, just one in five eligible adolescent girls were vaccinated in 2022. And while there are cost-effective and evidence-based tools for screening and treatment, fewer than 5% of women in many LMICs are ever screened for cervical cancer. Health system constraints, costs, logistical issues, and lack of political will are obstacles to implementing comprehensive programs for cervical cancer prevention and treatment.
These barriers have led to deep inequity: of the estimated 348,000 cervical cancer deaths in 2022, over 90% took place in LMICs. With governments and partners recommitting urgently to the global agenda, it is possible to reverse the tide and prevent annual deaths from rising to 410,000 by 2030, as currently estimated.
“For the Government of Colombia, in its commitment to guaranteeing the rights of women in their diversities, it is imperative to advance in the elimination of cervical cancer; a disease that affects millions of girls and women. Therefore, we are pleased to host the first Global Forum for the Elimination of Cervical Cancer. This is an opportunity that will allow the country, and the world, to exchange experiences and knowledge that will contribute to eliminating barriers to care, increasing vaccination against HPV and facilitating capacity development so that countries and partners continue adding actions for elimination of cervical cancer.”
For the Spanish government, "Cervical cancer is a public health problem for which there are already prevention, detection, and treatment tools," as stated by the Minister of Foreign Affairs, European Union, and Cooperation, José Manuel Albares, who is convinced that "with political will, we can address it. We are confident that, from this first forum, commitments and support will emerge from countries, international organizations, global initiatives, philanthropic entities, and civil society to boost government action and commitment to achieving the goals of the WHO strategy. In coherence with its feminist foreign and cooperation policy, Spain is ready to undertake significant commitments to achieve this."
This milestone forum is co-sponsored by the Governments of Colombia and Spain in partnership with the Pan American Health Organization (PAHO); World Health Organization (WHO); UNICEF; the Bill & Melinda Gates Foundation; Unitaid; the Global Financing Facility for Women, Children and Adolescents (GFF); Gavi, the Vaccine Alliance; the United States Agency for International Development (USAID); and the World Bank.
The World Health Organization provides global leadership in public health within the United Nations system. Founded in 1948, WHO works with 194 Member States, across six regions and from more than 150 offices, to promote health, keep the world safe and serve the vulnerable. Our goal for 2019-2023 is to ensure that a billion more people have universal health coverage, to protect a billion more people from health emergencies, and provide a further billion people with better health and wellbeing.
The World Health Organization’s (WHO) latest HIV Drug Resistance (HIVDR) Report tells us where drug resistance is growing and offers recommendations for countries to monitor and respond to the potential challenges.
The report shares some good news and some concerning news. It highlights high levels of HIV viral load suppression (>90%) in populations receiving dolutegravir (DTG)-containing antiretroviral therapy (ART). However, observational and country-generated survey data indicate that levels of HIVDR to DTG are exceeding levels observed in clinical trials.
Since 2018, WHO has recommended use of dolutegravir as the preferred first- and second-line HIV treatment for all population groups. It is more effective, easier to take, and has fewer side effects than other drugs currently in use. It also has a high genetic barrier to developing drug resistance.
However, among the four surveys reported, levels of resistance to dolutegravir ranged from 3.9% to 8.6%, and reached 19.6% among people experienced with treatment and transitioned to a DTG-containing ART while having high HIV viral loads. To date, only a few countries have reported survey data to WHO.
“The worrying evidence of resistance in individuals with unsuppressed viral load despite dolutegravir treatment underscores the necessity for increased vigilance and intensified efforts to optimize the quality of HIV care delivery,” said Dr Meg Doherty, Director, WHO Department of the Global HIV, Hepatitis and STI Programmes. “Standardized surveillance of HIV drug resistance is essential for effectively preventing, monitoring, and responding to these challenges”.
Haiti was the only country to report data from a survey of HIVDR among ART naïve infants or infants starting ART for the first time. One infant, whose mother had received DTG-based ART, was found to have DTG resistance. Effective management of high viral loads among pregnant and breastfeeding women is critical to prevent transmitting HIV to infants. Increasing routine surveillance for HIVDR among infants newly diagnosed with HIV not yet taking HIV treatment will be important to guide appropriate ART options for the future.
In 2022, more than 75% of the 39 million people living with HIV globally were receiving HIV treatment. Countries have implemented the WHO recommendations with 116 of 127 having adopted WHO preferred first-line DTG-based treatment for adults and adolescents, and 74% of reporting low- and middle-income countries adopted viral load monitoring for adults and adolescents.
But progress towards the SDG targets has stalled as there were still an estimated 1.3 million new HIV infections and 630 000 deaths from HIV-related causes. Between 2017 and 2022, for most countries reporting through the Global AIDS Monitoring (GAM) system, programmatic quality indicators for HIV treatment did not achieve established global targets, which further highlights the need to proactively improve the quality of HIV treatment and care services.
In 2022, only 12 of 45 WHO focus countries reported conducting surveys or had integrated the monitoring of HIVDR early warning indicators into routine monitoring and evaluation systems. Many countries continue to miss the mark when it comes to optimizing retention in care, population-level viral load suppression, and switching people with virological failure to different regimens. Additionally, antiretroviral drug stock-outs continue to happen which may negatively impact patient treatment adherence.
WHO recommends that countries routinely implement standardized surveillance of HIVDR to follow the prevalence and patterns of resistance among people not achieving suppressed viral load. This is critical, as information and data from surveys influence the development of treatment guidelines and inform the quality of treatment programmes.
The report also documents cases of resistance to integrase-strand transfer inhibitors (INSTIs) after recent exposure to cabotegravir (CAB-LA). Delayed detection and confirmation of HIV infection can increase the risk of developing resistance to INSTIs. Since 2022, WHO has recommended the use of long-acting injectable CAB-LA as an additional HIV prevention option for people at substantial risk of HIV infection.
Despite the possible risk, WHO recommends the roll-out of CAB-LA for pre-exposure prophylaxis (PrEP) and calls for the scale-up of PrEP to be accompanied by standardized surveillance of drug resistance among people testing positive for HIV while receiving PrEP.
Routine monitoring of quality-of-care indicators at both clinic and national levels, followed by addressing any suboptimal performance, remains a cornerstone for the success of ART programmes. Key quality-of-care indicators include on-time ART pick-up, retention on ART, viral load testing coverage, timely second-viral load test, ARV drug stock-outs and timely switch to second-line ART.
The new HIVDR report emphasizes the importance of strengthening data reporting systems so that countries can effectively monitor and report quality-of-care indicators. It underscores the active engagement by ART clinics and programmes in use of indicator data to develop locally appropriate and sustainable solutions. These efforts are crucial for optimizing service delivery quality, thereby reducing the emergence of drug-resistant HIV.
Minimizing the spread of HIV drug resistance is a crucial part of the broader global response to antimicrobial resistance that needs coordinated action across all government sectors and levels of society.
The World Health Organization provides global leadership in public health within the United Nations system. Founded in 1948, WHO works with 194 Member States, across six regions and from more than 150 offices, to promote health, keep the world safe and serve the vulnerable. Our goal for 2019-2023 is to ensure that a billion more people have universal health coverage, to protect a billion more people from health emergencies, and provide a further billion people with better health and wellbeing.
In February 2024, Austria, Denmark, Germany, Sweden and The Netherlands reported through the Early Warning and Response System (EWRS) of the European Union, an increase in psittacosis cases observed in 2023 and at the beginning of 2024, particularly marked since November-December 2023. Five deaths were also reported. Exposure to wild and/or domestic birds was reported in most of the cases. Psittacosis is a respiratory infection caused by Chlamydophila psittaci (C. psittaci), a bacteria that often infects birds. Human infections occur mainly through contact with secretions from infected birds and are mostly associated with those who work with pet birds, poultry workers, veterinarians, pet bird owners, and gardeners in areas where C. psittaci is epizootic in the native bird population. The concerned countries have implemented epidemiological investigations to identify potential exposures and clusters of cases. Additionally, implemented measures include the analysis of samples from wild birds submitted for avian influenza testing to verify the prevalence of C. psittaci among wild birds. The World Health Organization continues to monitor the situation and, based on the available information, assesses the risk posed by this event as low.
Austria
In Austria, 14 confirmed cases of psittacosis were reported from five of the nine federal states in 2023, compared to the median of two cases (range: 1-4) per year in the previous eight years. In 2024, there have been four cases of psittacosis reported as of 4 March 2024, with the earliest onset date of 24 January 2024. None of these unrelated cases notified in 2023 or 2024 have reported travel abroad and wild birds have not been mentioned as a source of infection.
In Austria, suspected and confirmed psittacosis cases, as well as deaths due to psittacosis are notifiable. The country did not report changes in diagnostic procedures (currently reverse transcription polymerase chain reaction (RT-PCR) is used) that could explain this increase in reported psittacosis cases.
Denmark
Denmark reported a marked increase in psittacosis cases from late 2023 to mid-January 2024. As of 27 February 2024, 23 individuals tested positive for C. psittaci via RT-PCR. Most of the cases were reported from the North Denmark Region, Zealand Region, and the Capital Region. Seventeen cases (74%) were hospitalized, of whom 15 had pneumonia and four died.
From the epidemiological investigations, one case has been linked to domestic birds that tested positive for C. psittaci. Of the 15 other cases with exposure information available, 12 (80%) have indicated contact with wild birds (primarily via bird feeders). For three cases there is no information available on bird exposures, and for the remaining four cases, no direct bird contact has been reported. Transmission from chickens has been ruled out by testing of suspected birds in two of the cases with reported bird contact.
Over the past five years, Denmark has reported between 15 to 30 human cases annually, most of which have been linked to exposure to domestic birds (e.g. parrots, parakeets, hobby birds such as racing pigeons) and ducks handled during hunting; however, each year several cases report no direct contact with birds, which suggests potential environmental exposure. There is no indication of increased testing or change in testing procedures in Denmark that could explain the current increase in psittacosis cases.
The National Health Institute of Denmark, Statens Serum Institute, suspects that infections are primarily associated with wild birds through the inhalation of airborne particles from the dried droppings of infected birds. The prevalence of C. psittaci among wild birds in Denmark is currently unknown, and plans are underway to examine samples from wild birds submitted for avian influenza testing to clarify this. It is assumed that the actual number of individuals infected with C. psittaci is much higher than reported. Some cases may be associated with exposure to domesticated psittacines (including parrots) or other birds that can carry the bacteria asymptomatically.
Germany
Germany reported an increase in individuals who tested positive for C. psittaci in December 2023 with five confirmed cases, making a total of 14 confirmed cases in 2023. In 2024, as of 20 February, another five confirmed cases of psittacosis were notified. There are no reports of a geographical cluster, except with an accumulation of cases around the city of Hannover over the last year. Almost all cases had pneumonia (18/19), 16 of whom were hospitalized.
Among the 19 cases notified from 1 January 2023 to 19 February 2024, none had information on exposure to wild birds, although 26% (5/19) of cases reported exposure to domesticated birds such as parrots, chickens, or breeding pigeons.
Over the past five years, Germany has reported an average of 15 cases per year, with the highest number of cases in 2022 (19 cases) and the lowest number in 2019 (11 cases). Usually, around zero to two cases per month are reported. Around 72% (56/78) of the cases in the last five years were confirmed by antibody testing. Information on bird exposure is often missing.
Sweden
Sweden reported an unusually high number of cases of psittacosis in late November 2023 and early December 2023, with seven cases reported in November 2023 and 19 cases reported in December 2023. This represents a doubling of the number of cases compared to respective months in the previous five years.
In 2024, however, ten cases were reported in January and three cases in February, which is lower than the average number of cases reported in the same period in the previous five years. Overall, Sweden reported an increase in the number of reported cases of psittacosis from 2017 onwards.
Geographically, cases reported as of early November 2023, are distributed between eight of the 21 regions of Sweden, all located in the southernmost third of the country. Reported cases have been in contact with droppings from small birds, mainly via feeders, and a few are thought to have been infected via domestic birds (hens or cockatoos).
Changes in diagnostic practices have likely contributed to this increase, as it has become increasingly common to use RT-PCR panels for screening.
The Netherlands
The Netherlands observed an increase of confirmed psittacosis cases since late December 2023, with 21 individuals reported as positive for C. psittaci as of 29 February 2024, which is twice as many cases as the same period in previous years. Over the past ten years, there has been an average of nine cases reported during the same period.
Recent cases have been geographically spread throughout the country with no common source of infection being identified. The cases had an average age of 67 (range: 37-86 years), of whom 16 were men (76%). All recent cases were hospitalized and one case died. Six of the 21 cases reported since late December 2023 have noted contact with droppings of wild birds, seven had contact with droppings of domestic birds, and eight cases did not report any contact with birds.
Testing procedures have not changed in recent years in the Netherlands. Since 2018, more than 95% of the notifications are based on RT-PCR testing.
Chlamydophila psittaci is a bacterium that causes the zoonotic disease of psittacosis in humans. Human infections are generally associated with those who work with pet birds, poultry workers, veterinarians, pet bird owners, and gardeners in areas where C. psittaci is epizootic in the native bird population.
C. psittaci is associated with more than 450 avian species and has also been found in various mammalian species, including dogs, cats, horses, large and small ruminants, swine, and reptiles. However, birds, especially pet birds (psittacine birds, finches, canaries, and pigeons), are most frequently involved in causing human psittacosis. Disease transmission to humans occurs mainly through inhalation of airborne particles from respiratory secretions, dried faeces, or feather dust. Direct contact with birds is not required for infection to occur.
In general, psittacosis is a mild illness, with symptoms including fever and chills, headache, muscle aches and dry cough. Most people begin developing signs and symptoms within 5 to 14 days after exposure to the bacteria. Prompt antibiotic treatment is effective and allows avoiding complications such as pneumonia. With appropriate antibiotic treatment, psittacosis rarely (less than 1 in 100 cases) results in death.
Human psittacosis is a notifiable disease in the concerned countries. Epidemiological investigations were implemented to identify potential exposure and clusters of cases.
National surveillance systems are closely monitoring the situation, including laboratory analysis of samples from wild birds submitted for avian influenza testing to verify the prevalence of C. psittaci among wild birds.
Overall, five countries in the WHO European region reported an unusual and unexpected increase in reports of cases of C. psittaci. Some of the reported cases developed pneumonia and resulted in hospitalization, and fatal cases were also reported.
Sweden has reported a general increase in psittacosis cases since 2017, which could be associated with the increased use of more sensitive polymerase chain reaction (PCR) panels. The increase in reported psittacosis cases across all countries requires additional investigation to determine whether it is a true increase in cases or an increase due to more sensitive surveillance or diagnostic techniques.
While birds that carry this disease could be crossing international borders, there is currently no indication of this disease being spread by humans nationally or internationally. Generally, people do not spread the bacteria that causes psittacosis to other people, so there is a low likelihood of further human-to-human transmission of the disease. If correctly diagnosed, this pathogen is treatable by antibiotics.
WHO continues to monitor the situation, and based on the available information, assesses the risk posed by this event as low.
WHO recommends the following measures for the prevention and control of psittacosis:
increasing the awareness of clinicians to test suspected cases of C. psittaci for diagnosis using RT-PCR.
increasing awareness among caged or domestic bird owners, especially psittacines, that the pathogen can be carried without apparent illness.
quarantining newly acquired birds. If any bird is sick, contact the veterinarian for an examination and treatment.
conducting surveillance of C. psittaci in wild birds, potentially including existing specimens collected for other reasons.
encouraging people with pet birds to keep cages clean, position cages so that droppings cannot spread among them and avoid over-crowded cages.
promoting good hygiene, including frequent hand washing, when handling birds, their faeces, and their environments.
standard infection-control practices and droplet transmission precautions should be implemented for hospitalized patients.
The World Health Organization provides global leadership in public health within the United Nations system. Founded in 1948, WHO works with 194 Member States, across six regions and from more than 150 offices, to promote health, keep the world safe and serve the vulnerable. Our goal for 2019-2023 is to ensure that a billion more people have universal health coverage, to protect a billion more people from health emergencies, and provide a further billion people with better health and wellbeing.