Geneva, Lyon, 1 February 2024 -- Ahead of World Cancer Day, the World Health Organization (WHO)’s cancer agency, the International Agency for Research on Cancer (IARC), released the latest estimates of the global burden of cancer. WHO also published survey results from 115 countries, showing a majority of countries do not adequately finance priority cancer and palliative care services, as part of universal health coverage (UHC). The IARC estimates, based on the best sources of data available in countries in 2022, highlight the growing burden of cancer, the disproportionate impact on underserved populations, and the urgent need to address cancer inequities worldwide.
In 2022, there were an estimated 20 million new cancer cases and 9.7 million deaths. The estimated number of people who were alive within 5 years following a cancer diagnosis was 53.5 million. About 1 in 5 people develop cancer in their lifetime, approximately 1 in 9 men and 1 in 12 women die from the disease.
The global WHO survey on UHC and cancer shows that only 39% of participating countries covered the basics of cancer management as part of their financed core health services for all citizens, ‘health benefit packages’ (HBP). Only 28% of participating countries additionally covered care for people who require palliative care, including pain relief in general, and not just linked to cancer.
The new estimates available on IARC’s Global Cancer Observatory show that 10 types of cancer collectively comprised around two-thirds of new cases and deaths globally in 2022. Data covers 185 countries and 36 cancers.
Lung cancer was the most commonly occurring cancer worldwide with 2.5 million new cases accounting for 12.4% of the total new cases. Female breast cancer ranked second (2.3 million cases, 11.6%), followed by colorectal cancer (1.9 million cases, 9.6%), prostate cancer (1.5 million cases, 7.3%), and stomach cancer (970 000 cases, 4.9%).
Lung cancer was the leading cause of cancer death (1.8 million deaths, 18.7% of the total cancer deaths) followed by colorectal cancer (900 000 deaths, 9.3%), liver cancer (760 000 deaths, 7.8%), breast cancer (670 000 deaths, 6.9%) and stomach cancer (660 000 deaths, 6.8%). Lung cancer’s re-emergence as the most common cancer is likely related to persistent tobacco use in Asia.
There were some differences by sex in incidence and mortality from the global total for both sexes. For women, the most commonly diagnosed cancer and leading cause of cancer death was breast cancer, whereas it was lung cancer for men. Breast cancer was the most common cancer in women in the vast majority of countries (157 of 185).
For men, prostate and colorectal cancers were the second and third most commonly occurring cancers, while liver and colorectal cancers were the second and third most common causes of cancer death. For women, lung and colorectal cancer were second and third for both the number of new cases and of deaths.
Cervical cancer was the eighth most commonly occurring cancer globally and the ninth leading cause of cancer death, accounting for 661 044 new cases and 348 186 deaths. It is the most common cancer in women in 25 countries, many of which are in sub-Saharan Africa. Even while recognizing varying incidence levels, cervical cancer can be eliminated as a public health problem, through the scale-up of the WHO Cervical Cancer Elimination Initiative.
Global estimates reveal striking inequities in the cancer burden according to human development. This is particularly true for breast cancer. In countries with a very high HDI, 1 in 12 women will be diagnosed with breast cancer in their lifetime and 1 in 71 women die of it. By contrast, in countries with a low HDI; while only one in 27 women is diagnosed with breast cancer in their lifetime, one in 48 women will die from it.
“Women in lower HDI countries are 50% less likely to be diagnosed with breast cancer than women in high HDI countries, yet they are at a much higher risk of dying of the disease due to late diagnosis and inadequate access to quality treatment,” explains Dr Isabelle Soerjomataram, Deputy Head of the Cancer Surveillance Branch at IARC.
WHO’s global survey of HBPs also revealed significant global inequities in cancer services. Lung cancer-related services were reportedly 4–7 times more likely to be included in a HBP in a high-income than a lower-income country. On average, there was a four-fold greater likelihood of radiation services being covered in a HBP of a high-income than a lower-income country. The widest disparity for any service was stem-cell transplantation, which was 12 times more likely to be included in a HBP of a high-income than a lower-income country.
“WHO’s new global survey sheds light on major inequalities and lack of financial protection for cancer around the world, with populations, especially in lower income countries, unable to access the basics of cancer care,” said Dr Bente Mikkelsen, Director of the Department of Noncommunicable Diseases at WHO. “WHO, including through its cancer initiatives, is working intensively with more than 75 governments to develop, finance and implement policies to promote cancer care for all. To expand on this work, major investments are urgently needed to address global inequities in cancer outcomes.”
Over 35 million new cancer cases are predicted in 2050, a 77% increase from the estimated 20 million cases in 2022. The rapidly growing global cancer burden reflects both population ageing and growth, as well as changes to people’s exposure to risk factors, several of which are associated with socioeconomic development. Tobacco, alcohol and obesity are key factors behind the increasing incidence of cancer, with air pollution still a key driver of environmental risk factors.
In terms of the absolute burden, high HDI countries are expected to experience the greatest absolute increase in incidence, with an additional 4.8 million new cases predicted in 2050 compared with 2022 estimates. Yet the proportional increase in incidence is most striking in low HDI countries (142% increase) and in medium HDI countries (99%). Likewise, cancer mortality in these countries is projected to almost double in 2050.
“The impact of this increase will not be felt evenly across countries of different HDI levels. Those who have the fewest resources to manage their cancer burdens will bear the brunt of the global cancer burden,” says Dr Freddie Bray, Head of the Cancer Surveillance Branch at IARC.
“Despite the progress that has been made in the early detection of cancers and the treatment and care of cancer patients–significant disparities in cancer treatment outcomes exist not only between high and low-income regions of the world, but also within countries. Where someone lives should not determine whether they live. Tools exist to enable governments to prioritise cancer care, and to ensure that everyone has access to affordable, quality services. This is not just a resource issue but a matter of political will,” says Dr Cary Adams, head of UICC - Union for International Cancer Control.
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, 29 January 2024 -- WHO has awarded its first-ever certificates validating progress in eliminating industrially produced trans fatty-acids to five countries. Denmark, Lithuania, Poland, Saudi Arabia, and Thailand have each demonstrated they have a best practice policy for industrially produced trans-fatty acids (iTFA) elimination in effect, supported by adequate monitoring and enforcement systems. WHO also released results from the first five years of its REPLACE initiative to eliminate iTFA.
While the ambitious target set by WHO in 2018—to fully eliminate iTFA from the global food supply by the end of 2023—was not met, there has been remarkable progress made towards this goal in every region of the world. In 2023 alone, new best-practice policies became effective in 7 countries (Egypt, Mexico, Moldova, Nigeria, North Macedonia, Philippines, and Ukraine).
Trans-fatty acids (TFA) are semisolid to solid fats that occur in two forms: industrially produced and naturally occurring. Intake of TFA is associated with increased risk of heart attacks and death from heart disease. TFA have no known health benefits, and foods high in iTFA (e.g. fried foods, cakes and ready meals) are often high in sugar, fat and salt.
A total of 53 countries have now best practice policies in effect for tackling iTFA in food, vastly improving the food environment for 3.7 billion people, or 46% of the world’s population, as compared to 6% just 5 years ago. These policies are expected to save approximately 183 000 lives a year.
“Trans fat has no known health benefit, but huge health risks,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “We are very pleased that so many countries have introduced policies banning or limiting trans fat in food. But introducing a policy is one thing; implementing it is another. I congratulate Denmark, Lithuania, Poland, Saudi Arabia and Thailand, who are leading the world in monitoring and enforcing their trans fat policies. We urge other countries to follow their lead.”
Accelerating efforts to achieving best-practice policies in just 8 countries with the highest needs would eliminate 90% of the global iTFA burden, representing a unique opportunity to see in our lifetime a world free from deaths attributable to iTFA.
The WHO validation programme for iTFA elimination recognizes those countries which went beyond introducing best practice policies by ensuring rigorous monitoring and enforcement systems in place. Monitoring and enforcing compliance with policies is critical to maximizing and sustaining the health benefits of iTFA elimination.
Best practices in iTFA elimination policies follow WHO criteria and limit iTFA use in all settings. There are two best-practice policy options: 1) mandatory national limit of 2 grams of iTFA per 100 grams of total fat in all foods; and 2) mandatory national ban on the production or use of partially hydrogenated oils (a major source of trans fat) as an ingredient in all foods. For some countries, an optimal programme would implement both policies, due to the sources of trans fat.
“Trans fat elimination is economically, politically, and technically feasible and saves lives at virtually no cost to governments or consumers. This harmful compound is unnecessary, and no one misses it when it’s gone,” said Dr Tom Frieden, President and CEO of Resolve to Save Lives. "We are winning the battle against trans fat, but countries without regulations are at risk of becoming dumping grounds for TFA products. Governments and the food industry have a responsibility to ensure that doesn’t happen."
WHO also encourages food manufacturers—the producers of raw materials and final food products—to eliminate iTFA from their products. The food industry has made good progress so far, as presented in a November 2023 WHO report.
Despite recent successes in eliminating iTFA from food globally, over half of the world's population remain unprotected from its harmful impacts, thus putting them at a potential risk of increasing heart disease.
While countries should continue to strive for total elimination of iTFA, based on what has been achieved in the 5 years since the global call for elimination, WHO proposes a revised new target for virtual elimination of iTFA globally by 2025. The target includes:
best-practice elimination policies are passed in countries that account for at least 90% of the total global iTFA burden.
best practice policies are passed in countries that account for at least 70% of the total burden within regions.
Eliminating iTFA is a powerful way to prevent heart disease and the high costs to individuals and economies in medical treatment and lost productivity. WHO remains committed to supporting countries in their efforts and celebrating their achievements.
The next application cycle for the iTFA elimination validation programme will open in March 2024 and applications will be received on a continued basis.
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.
Rome / Geneva / New York, 15 January 2024 – As the risk of famine grows, and more people are exposed to deadly disease outbreaks, a fundamental step change in the flow of humanitarian aid into Gaza is urgently needed, United Nations agencies warned today. The heads of the World Food Programme (WFP), UNICEF and the World Health Organization (WHO) say that getting enough supplies into and across Gaza now depends on: the opening of new entry routes; more trucks being allowed through border checks each day; fewer restrictions on the movement of humanitarian workers; and guarantees of safety for people accessing and distributing aid.
Without the ability to produce or import food, the entire population of Gaza relies on aid to survive. But humanitarian aid alone cannot meet the essential needs of the Gaza people. The United Nations, international aid agencies and non-governmental organizations have so far managed to deliver limited humanitarian assistance in Gaza, despite extraordinarily difficult conditions, but the quantities fall far short of what is needed to prevent a deadly combination of hunger, malnutrition, and disease. The shortage of food, clean water, and medical assistance is particularly severe in the northern areas.
Humanitarian action is seriously limited by the closure of all but two border crossings in the south and the multi-layered vetting process for trucks coming into Gaza. Once inside, efforts to set up service points for people in need are hampered by bombardments and constantly shifting battle fronts, which endanger the lives of ordinary Gazans and the UN and other humanitarian personnel striving to help them.
“People in Gaza risk dying of hunger just miles from trucks filled with food,” said WFP Executive Director Cindy McCain. “Every hour lost puts countless lives at risk. We can keep famine at bay but only if we can deliver sufficient supplies and have safe access to everyone in need, wherever they are.”
The latest Integrated Food Security and Nutrition Phase Classification (IPC) report found devastating levels of food insecurity in Gaza and confirmed that the entire population of Gaza – roughly 2.2 million people – are in crisis or worse levels of acute food insecurity. Virtually all Palestinians in Gaza are skipping meals every day while many adults go hungry so children can eat, and the report warned of famine, if current conditions persist.
WFP has been providing food to people inside Gaza every day since 7 October and reached more than 900 000 people with food assistance in December. This has required pivoting to new ways of operating with local partners, including finding safe sites for distributions, channeling wheat flour into bakeries so that they can resume production, and distributing special food supplements to help children fight off malnutrition. On Thursday, WFP’s first food convoy to North Gaza since the humanitarian pause delivered food supplies for around 8000 people.
The conflict has also damaged or destroyed essential water, sanitation and health infrastructure and services and limited capacity to treat severe malnutrition and infectious disease outbreaks. With Gaza’s 335 000 children under 5 years of age especially vulnerable, UNICEF projects that, in the next few weeks, child wasting, the most life-threatening form of malnutrition in children, could increase from pre-crisis conditions by nearly 30 per cent, affecting up to 10 000 children.
“Children at high risk of dying from malnutrition and disease desperately need medical treatment, clean water and sanitation services, but the conditions on the ground do not allow us to safely reach children and families in need,” said UNICEF Executive Director Catherine Russell. “Some of the material we desperately need to repair and increase water supply remain restricted from entering Gaza. The lives of children and their families are hanging in the balance. Every minute counts.”
UNICEF has been warning since November that children in southern Gaza are accessing only 1.5 to 2 litres of water per day, well below the recommended requirements for survival. To address this, UNICEF and partners have provided safe drinking water to over 1.3 million people, but much more is needed to address the desperate conditions. UNICEF has also provided medical supplies, including 600 000 doses of vaccine, nutritional supplements and vitamins to children and pregnant women, and humanitarian cash transfers to over 500 000 households.
Since the start of the hostilities, WHO and partners have been supporting the health system in Gaza with deliveries of medical equipment and supplies, medicines, fuel, coordination of emergency medical teams, and disease surveillance. There have been more than a dozen high-risk missions to deliver supplies to hospitals in northern and southern Gaza. WHO and partners helped establish two kitchens at Al-Shifa hospital, now serving 1200 meals a day and delivered medical supplies to support treatment for up to 1250 children with severe acute malnutrition, and the establishment of therapeutic feeding centres.
“People in Gaza are suffering from a lack of food, water, medicines and adequate healthcare. Famine will make an already terrible situation catastrophic because sick people are more likely to succumb to starvation and starving people are more vulnerable to disease”, said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “We need unimpeded, safe access to deliver aid and a humanitarian ceasefire to prevent further death and suffering.”
Israeli authorization to use a working port close to the Gaza Strip and border crossing points into the north is critically needed by aid agencies. Access to Ashdod port, roughly 40 km to the north, would enable significantly larger quantities of aid to be shipped in and then trucked directly to the badly affected northern regions of Gaza, which few convoys have managed to reach.
“The flow of aid has been a trickle in comparison to a sea of humanitarian needs,” said Phillipe Lazzarini, Commissioner General for the UN Palestine Refugee Agency (UNRWA). “Humanitarian aid will not be enough to reverse the worsening hunger among the population. Commercial supplies are a must to allow the markets and private sector to re-open and provide an alternative to food accessibility.”
The agency heads emphasize the urgent need to lift the barriers and restrictions on aid delivery to and within Gaza, and for commercial traffic to resume. They reiterated the call for a humanitarian ceasefire to enable this vitally important roll-out of a massive, multi-agency humanitarian operation.
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.
A total of 43 countries and 1 territory have now been certified as malaria-free
Cabo Verde, 12 January 2024 – The World Health Organization (WHO) has certified Cabo Verde as a malaria-free country, marking a significant achievement in global health. With this announcement, Cabo Verde joins the ranks of 43 countries and 1 territory that WHO has awarded this certification.
Cabo Verde is the third country to be certified in the WHO African region, joining Mauritius and Algeria which were certified in 1973 and 2019 respectively. Malaria burden is the highest on the African continent, which accounted for approximately 95% of global malaria cases and 96% of related deaths in 2021.
Certification of malaria elimination will drive positive development on many fronts for Cabo Verde. Systems and structures built for malaria elimination have strengthened the health system and will be used to fight other mosquito-borne diseases such as dengue fever. Travellers from non-malaria endemic regions can now travel to the islands of Cabo Verde without fear of local malaria infections and the potential inconvenience of preventive treatment measures. This has the potential to attract more visitors and boost socio-economic activities in a country where tourism accounts for approximately 25 per cent of GDP.
“I salute the government and people of Cabo Verde for their unwavering commitment and resilience in their journey to eliminating malaria,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “WHO’s certification of Cabo Verde being malaria-free is testament to the power of strategic public health planning, collaboration, and sustained effort to protect and promote health. Cabo Verde's success is the latest in the global fight against malaria, and gives us hope that with existing tools, as well as new ones including vaccines, we can dare to dream of a malaria-free world.”
Certification of malaria elimination is the official recognition by WHO of a country’s malaria-free status. The certification is granted when a country has shown – with rigorous, credible evidence – that the chain of indigenous malaria transmission by Anopheles mosquitoes has been interrupted nationwide for at least the past three consecutive years. A country must also demonstrate the capacity to prevent the re-establishment of transmission.
“The certification as a malaria-free country has a huge impact, and it's taken a long time to get to this point. In terms of the country's external image, this is very good, both for tourism and for everyone else. The challenge that Cabo Verde has overcome in the health system is being recognised”, said the Cabo Verde´s Prime Minister, Ulisses Correia e Silva.
Cabo Verde, an archipelago of 10 islands in the Central Atlantic Ocean, has faced significant malaria challenges. Before the 1950s, all islands were affected by malaria. Severe epidemics were regular occurrences in the most densely populated areas until targeted interventions were implemented. Through the targeted use of insecticide spraying, the country eliminated malaria twice: in 1967 and 1983. However, subsequent lapses in vector control led to a return of the disease. Since the last peak of malaria cases in the late 1980s, malaria in Cabo Verde has been confined to two islands: Santiago and Boa Vista, which have now both been malaria-free since 2017.
“Cabo Verde’s achievement is a beacon of hope for the African Region and beyond. It demonstrates that with strong political will, effective policies, community engagement and multisectoral collaboration, malaria elimination is an achievable goal,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “The attainment of this milestone by Cabo Verde is an inspiring example for other nations to follow.”
Cabo Verde's journey to malaria elimination has been long and received a boost with the inclusion of this objective in its national health policy in 2007. A strategic malaria plan from 2009 to 2013 laid the groundwork for success, focusing on expanded diagnosis, early and effective treatment, and the reporting and investigating all cases. To stem the tide of imported cases from mainland Africa, diagnosis and treatment were provided free of charge to international travellers and migrants.
In 2017 the country turned an outbreak into an opportunity. Cabo Verde identified problems and made improvements, leading to zero indigenous cases for three consecutive years.
During the ongoing COVID-19 pandemic, the country safeguarded progress; efforts focused on improving the quality and sustainability of vector control and malaria diagnosis, strengthening malaria surveillance - especially at ports, airports, in the capital city and areas with a risk of malaria re-establishment.
Collaboration between the Ministry of Health and various government departments focused on the environment, agriculture, transportation, tourism, and more, played a pivotal role in Cabo Verde's success. The inter-ministerial commission for vector control, chaired by the Prime Minister was key to elimination. The collaborative effort and the commitment of community-based organizations and NGOs demonstrate the importance of a holistic approach to public health.
As Cabo Verde celebrates this monumental achievement, the global community commends its leaders, healthcare professionals, and citizens for their dedication to eliminating malaria and creating a healthier future for all.
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, 11 January 2024 -- Preliminary data from Member States indicate that the number of cholera cases reported in 2023 as of 15 December has surpassed that of 2022, with over 667 000 cases and 4000 deaths. These figures must be interpreted with caution given the varying surveillance systems and capacity across countries, which means that 2023 data are not directly comparable to reports from previous years.
Since the publication of the last situation report on the multi-country outbreak of cholera on 7 December 2023 (which included data up to 15 November), and as of 15 December 2023, one new country (Togo) has reported an outbreak of cholera or acute watery diarrhoea (AWD). In total, at least 30 countries have reported cases since 1 January 2023.
Nearly a year has passed since WHO classified the global resurgence of cholera as a grade 3 emergency, the highest internal level for a health emergency requiring a comprehensive response at the three levels of the organization. WHO is currently reviewing its response to cholera globally to identify key lessons and make evidence-based adjustments where needed to better coordinate activities in the coming months.
Based on the large number of outbreaks and their geographic expansion, alongside the shortage of vaccines and other resources, WHO continues to assess the risk at global level as very high.
Cholera is an acute intestinal infection that spreads through food and water contaminated with the bacterium Vibrio cholerae, often from faeces. With safe water and sanitation, cholera can be prevented. It can kill within hours when not treated, but immediate access to treatment saves lives.
While the triggers for cholera outbreaks—like poverty and conflict—are enduring, climate change and conflict are now compounding the problem. Extreme climate events like floods, cyclones and droughts reduce access to clean water and create an ideal environment for cholera to thrive.
This increase in outbreaks and cases is stretching the global capacity to respond. There is a shortage of cholera tools, including vaccines.
WHO is responding with urgency to reduce deaths and contain outbreaks in countries 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.
A high-level meeting took place on 30 December between WHO and China about the current surge in COVID-19 cases, to seek further information on the situation, and to offer WHO's expertise and further support.
High-level officials from China's National Health Commission and the National Disease Control and Prevention Administration briefed WHO on China's evolving strategy and actions in the areas of epidemiology, monitoring of variants, vaccination, clinical care, communication and R&D.
WHO again asked for regular sharing of specific and real-time data on the epidemiological situation—including more genetic sequencing data, data on disease impact including hospitalisations, ICU admissions and deaths—and data on vaccinations delivered and vaccination status, especially in vulnerable people and those over 60 years old. WHO reiterated the importance of vaccination and boosters to protect against severe disease and death for people at higher risk.
WHO called on China to strengthen viral sequencing, clinical management, and impact assessment, and expressed willingness to provide support on these areas, as well as on risk communications on vaccination to counter hesitancy. Chinese scientists are invited to engage more closely in WHO-led COVID-19 expert networks including the COVID-19 clinical management network. WHO has invited Chinese scientists to present detailed data on viral sequencing at a meeting of the Technical Advisory Group on SARS-CoV-2 Virus Evolution on 3 January.
WHO stressed the importance of monitoring and the timely publication of data to help China and the global community to formulate accurate risk assessments and to inform effective responses.
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 (WHO) has added the R21/Matrix-M malaria vaccine to the list of prequalified vaccines. In October 2023, WHO recommended its use for the prevention of malaria in children following the advice of the WHO Strategic Advisory Group of Experts (SAGE) on Immunization and the Malaria Policy Advisory Group. The prequalification means larger access to vaccines as a key tool to prevent malaria in children with it being a prerequisite for vaccine procurement by UNICEF and funding support for deployment by Gavi, the Vaccine Alliance.
The R21 vaccine is the second malaria vaccine prequalified by WHO, following the RTS,S/AS01 vaccine which obtained prequalification status in July 2022. Both vaccines are shown to be safe and effective in clinical trials, for preventing malaria in children. When implemented broadly, along with other recommended malaria control interventions, they are expected to have a high public health impact. Malaria, a mosquito-borne disease, places a particularly high burden on children in the African Region, where nearly half a million children die from the disease each year. Globally, in 2022, there were an estimated 249 million malaria cases and 608,000 malaria deaths across 85 countries.
The prequalification of the world’s second malaria vaccine, developed by Oxford University and manufactured by Serum Institute of India, is poised to expand access to malaria prevention through vaccination. Demand for malaria vaccines is high but the supply has thus far been limited. The availability of two WHO recommended and prequalified malaria vaccines is expected to increase supply to meet the high demand from African countries and result in sufficient vaccine doses to benefit all children living in areas where malaria is a significant public health risk.
Dr Rogério Gaspar, Director of the Department of Regulation and Prequalification, WHO said "Achieving WHO vaccine prequalification ensures that vaccines used in global immunization programmes are safe and effective within their conditions of use in the targeted health systems. WHO evaluates multiple products for prequalification each year and core to this work is ensuring greater access to safe, effective and quality health products".
Dr Kate O’Brien, Director of the Department of Immunization, Vaccines and Biologicals, said "Today marks a huge stride in global health as we welcome the prequalification of R21/Matrix-M, the second malaria vaccine recommended for children in malaria endemic areas. This achievement underscores our relentless commitment to wiping out malaria which remains a formidable foe causing child suffering and death. This is another step toward ensuring a healthier, more resilient future for those who have lived for too long in fear of what malaria could do to their children. Together with our partners, we are united in the pursuit of a malaria-free future, where every life is shielded from the threat of this disease.”
As part of the prequalification process, WHO applies international standards to comprehensively evaluate and determine whether vaccines are safe, effective and manufactured to international standards. WHO also ensures the continued safety and efficacy of prequalified vaccines through, for example, regular re-evaluation, site inspection and targeted testing. Prequalification supports the specific needs of national immunization programmes with regards to vaccine characteristics such as potency, thermostability, presentation, labelling and shipping conditions.
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 a new position paper published last week, WHO has updated its recommendations for the human papillomavirus (HPV) vaccine. Of particular note, the paper states that a single-dose schedule, referred to as an alternative, off-label single–dose schedule can provide a comparable efficacy and durability of protection to a two-dose regimen. The recommendation for alternative single-dose scheduling was initially made by WHO’s independent expert advisory group, SAGE in April 2022.
The position paper is timely in the context of a deeply concerning decline in HPV vaccination coverage globally. Between 2019 and 2021, coverage of the first dose of HPV vaccination fell by 25% to 15%. This means 3.5 million more girls missed out on HPV vaccination in 2021 compared to 2019.
The optimization of the HPV schedule is expected to improve access to the vaccine, offering countries the opportunity to expand the number of girls who can be vaccinated and alleviating the burden of the often complicated and costly follow-up required to complete the vaccination series. It’s vital that countries strengthen their HPV vaccination programmes, expedite implementation and reverse the declines in coverage.
A one or two-dose schedule for girls aged 9-14 years
A one or two-dose schedule for girls and women aged 15-20 years
Two doses with a 6-month interval for women older than 21 years
The position paper underscores the importance of vaccinating as a priority immunocompromised people, or those living with HIV. Immunocompromised individuals should receive at a minimum two doses and where possible three doses.
The primary target of vaccination is girls aged 9-14, prior to the start of sexual activity. The vaccination of secondary targets such as boys and older females is recommended where feasible and affordable.
Cervical cancer is the fourth most common type of cancer in women, and more than 95% of cervical cancer is caused by sexually transmitted HPV. Averting the development of cervical cancer by increasing access to effective vaccines is a highly significant step in alleviating unnecessary illness and death.
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 12 November 2022, Indonesia’s Ministry of Health notified WHO of a confirmed case of circulating vaccine-derived poliovirus type 2 (cVDPV2) with acute flaccid paralysis (AFP) from Pidie district in Aceh province. Field investigations were immediately launched by local and national public health authorities, with support from partners of the Global Polio Eradication Initiative. On 28 November, the Ministry of Health launched an immunization campaign for children under the age of 13 years in the affected areas.
On 12 November 2022, Indonesia’s Ministry of Health notified WHO of a confirmed case of VDPV2. The case was a 7-year-old boy from Pidie district in Aceh province, who developed AFP on 9 October 2022. The case had not received oral polio vaccine (OPV) or inactivated polio vaccine (IPV) and had no travel history or contact with those who had traveled. On 25 November 2022, three more genetically related isolates of cVDPV2 were reported based on the laboratory results of stool samples taken from three healthy children who were in the same community but not close contacts of the confirmed case. Sequencing results from Biofarma lab showed 25 nucleotide changes for the AFP case and 25 to 26 nucleotide changes for the three asymptomatic children. These results are evidence of transmission of the virus and meets the criteria to be classified as circulating VDPV2 (cVDPV2). In the past in Indonesia, a cVDPV type 1 outbreak was reported in Papua province in 2019.
Aceh province has very low polio vaccination coverage in the routine immunization programme; however, coverage is also low in several other provinces in Indonesia, including three provinces nearby Aceh (North Sumatera, West Sumatera and Riau). In 2021, in Aceh province, bivalent oral polio vaccine (OPV3) coverage was 50.9%, and IPV 28.2%. and for Pidie district the coverage was 17.7% for OPV3 and 0.5% for IPV. There is low population immunity against all polioviruses but primarily type 2 in children born after the switch from the trivalent to bivalent OPV in April 2016.
Polio is a highly infectious disease that largely affects children under five years of age, causing permanent paralysis (approximately 1 in 200 infections) or death (2-10% of those paralyzed).
The virus is transmitted by person-to-person, mainly through the fecal-oral route or, less frequently, by a common vehicle (e.g., contaminated water or food) and multiplies in the intestine, from where it can invade the nervous system and cause paralysis.
The incubation period is usually 7–10 days but can range from 4–35 days. Up to 90% of those infected are either asymptomatic or experience mild symptoms and the disease usually goes unrecognized.
Vaccine-derived poliovirus is a well-documented strain of poliovirus mutated from the strain originally contained in OPV. OPV contains a live, weakened form of poliovirus that replicates in the intestine for a limited period, thereby developing immunity by building up antibodies. On rare occasions, when replicating in the gastrointestinal tract, OPV strains genetically change and may spread in communities that are not fully vaccinated against polio, especially in areas where there is poor hygiene, poor sanitation, or overcrowding. The lower the population immunity, the longer this virus survives and the more genetic changes it undergoes.
In very rare instances, the vaccine-derived virus can genetically change into a form that can cause paralysis as does the wild poliovirus – this is what is known as a vaccine-derived poliovirus (VDPV). The detection of VDPV in at least two different sources and at least two months apart, that are genetically linked, showing evidence of transmission in the community, should be classified as ‘circulating’ vaccine-derived poliovirus type 2 (cVDPV2). Circulating vaccine-derived poliovirus type 2 continues to affect different areas of the world, notably in the African Region.
The Ministry of Health has publicly announced the outbreak, and on 28 November, immunization campaigns were launched for 1.2 million children under the age of 13 years in the province of Aceh.
Risk assessment and field investigations were immediately launched and are still ongoing by the local and national public health authorities, with support from the Global Polio Eradication Initiative (GPEI) partners, including a more detailed assessment of the origin of the isolated viruses.
The Ministry of Health, with support from WHO, UNICEF and other partners, is undertaking strong measures to stop the transmission. Measures include enhanced surveillance- active search for AFP cases at health facilities and communities, assessment of OPV/IPV coverage through a rapid community survey in a sample of 200 households, and training on the surveillance guidelines for the use of novel oral polio vaccine type 2 (nOPV2).
The WHO Director General approved the release of the nOPV2 for rapid response on 25 November 2022 and a rapid vaccination response was initiated on 28 November in Pidie district (the affected district) with approximately 95 603 children aged under 13 years to be vaccinated.
A rapid response vaccination campaign was launched in Aceh province for those aged zero to 12 years on 5 December 2022. Large-scale supplementary immunization activities (SIAs) with nOPV2 are proposed for those aged zero to 12 years in Aceh and zero to four years in North Sumatera, West Sumatra, and Riau in the first week of January 2023 and the first week of February 2023.
Advocacy campaigns, risk communication messaging, and social mobilization have been implemented.
WHO assesses the risk to be high at the national level due to low polio vaccination coverage in Aceh and other provinces in Indonesia, the susceptibility of the population to poliovirus type 2 after switching from trivalent oral polio vaccine (tOVP) to bOPV in April 2016 combined with low uptake of inactivated polio vaccine (IPV), sub-optimal surveillance capacity, and vaccine hesitancy among the at-risk population.
The detection of cVDPVs highlights the importance of maintaining high levels of routine vaccination coverage everywhere to minimize the risk and consequences of the circulation of any poliovirus, as well as the need to ensure quality surveillance for early detection of any poliovirus.
It is important that all countries, in particular those with frequent travel and contacts with polio-affected countries and areas, strengthen surveillance for AFP cases and commence any planned expansion of environmental surveillance in order to rapidly detect any new virus importation and to facilitate a rapid response. Countries, territories and areas should also maintain uniformly high routine immunization coverage at the district level to minimize the consequences of any new virus introduction.
WHO’s International travel and health recommends that all travellers to polio-affected areas be fully vaccinated against polio.
As per the advice of the Emergency Committee convened under the International Health Regulations (2005) on the international spread of poliovirus, countries affected by poliovirus transmission are subject to Temporary Recommendations. To comply with the Temporary Recommendations issued under the PHEIC, any country that have had an importation of cVDPV2 with local transmission should (i) declare the outbreak as a national public health emergency (ii) encourage residents and long-term visitors to receive a dose of IPV four weeks to 12 months prior to international travel, (iii) ensure that travellers who receive such vaccination have access to an appropriate document to record their polio vaccination status, (iv) further intensify efforts to increase IPV immunization coverage, including sharing coverage data, and (v) intensify regional cooperation and cross border coordination to enhance surveillance for prompt detection of poliovirus, and vaccinate refugees, travellers and cross border populations, according to the advice of the Advisory Group.
WHO does not recommend any travel and/or trade restrictions to Indonesia based on the information available for this current event.
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, 19 December 2023 -- Due to its rapidly increasing spread, WHO is classifying the variant JN.1 as a separate variant of interest (VOI) from the parent lineage BA.2.86. It was previously classified as VOI as part of BA.2.86 sublineages.
Based on the available evidence, the additional global public health risk posed by JN.1 is currently evaluated as low. Despite this, with the onset of winter in the Northern Hemisphere, JN.1 could increase the burden of respiratory infections in many countries.
All viruses, including SARS-CoV-2, the virus that causes COVID-19, change over time. Most changes have little to no impact on the virus’s properties. However, some changes may affect the virus’s properties, such as how easily it spreads, the associated disease severity, or the performance of vaccines, therapeutic medicines, diagnostic tools, or other public health and social measures.
In June 2020, the WHO Virus Evolution Working Group was established with a specific focus on SARS-CoV-2 variants, their phenotype and their impact on countermeasures. This later became the Technical Advisory Group on SARS-CoV-2 Virus Evolution. In late 2020, the emergence of variants that posed an increased risk to global public health prompted WHO to characterize some as variants of interest (VOIs) and variants of concern (VOCs) in order to prioritize global monitoring and research, and to inform and adjust the COVID-19 response. From May 2021 onwards, WHO began assigning simple, easy-to-say labels for key variants.
Considerable progress has been made in establishing and strengthening a global system to detect signals of potential VOIs or VOCs and rapidly assess the risk posed by SARS-CoV-2 variants to public health. It remains critical that these systems are maintained, and data are shared, according to good principles and in a timely fashion, as SARS-CoV-2 continues to circulate at high levels around the world. While monitoring the circulation of SARS-CoV-2 globally, it also remains essential to monitor their spread in animal populations and chronically infected individuals, which are crucial aspects of the global strategy to reduce the occurrence of mutations that have negative public health implications. In March 2023, WHO updated its tracking system and working definitions for variants of concern, variants of interest and variants under monitoring. WHO is continuously monitoring the evidence and will update the JN.1 risk evaluation as needed.
Current vaccines continue to protect against severe disease and death from JN.1 and other circulating variants of SARS-CoV-2, the virus that causes COVID-19.
COVID-19 is not the only respiratory disease circulating. Influenza, RSV and common childhood pneumonia are on the rise.
WHO advises people to take measures to prevent infections and severe disease using all available tools. These include:
-Wear a mask when in crowded, enclosed, or poorly ventilated areas, and keep a safe distance from others, as feasible
-Improve ventilation
-Practise respiratory etiquette - covering coughs and sneezes
-Clean your hands regularly
-Stay up to date with vaccinations against COVID-19 and influenza, especially if you are at high risk for severe disease
-Stay home if you are sick
-Get tested if you have symptoms, or if you might have been exposed to someone with COVID-19 or influenza
For health workers and health facilities, WHO advises:
-Universal masking in health facilities, as well as appropriate masking, respirators and other PPE for health workers caring for suspected and confirmed COVID-19 patients.
-Improve ventilation in health facilities
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.