COVAX, the multilateral mechanism for equitable global access to COVID-19 vaccines launched in 2020, will draw to a close on 31 December. Jointly led by the Coalition for Epidemic Preparedness Innovations (CEPI), Gavi, the Vaccine Alliance (Gavi), UNICEF and the World Health Organization (WHO), COVAX has so far supplied nearly 2 billion COVID-19 vaccine doses and safe injection devices to 146 economies. Its efforts are estimated to have helped avert the deaths of at least 2.7 million people in the COVAX Advance Market Commitment (AMC) low- and lower middle-income participating economies (lower-income economies) that received free doses through the mechanism, alongside nearly US$ 2 billion in critical support to turn vaccines into vaccinations.
These 92 lower-income economies that were eligible to participate in the programme with support from the financing mechanism known as the Gavi COVAX Advance Market Commitment (COVAX AMC) will continue to have the option to receive COVID-19 vaccine doses and delivery support through Gavi’s regular programmes. So far, 58 lower-income economies have requested a total of 83 million doses in 2024, with plans to focus on the continued protection of priority groups, including health care workers, community workers and older adults.
Drawing on the lessons of the H1N1 pandemic, when the majority of countries missed out on vaccines, COVAX partners advocated from the earliest stages of the COVID-19 emergency that “no one is safe until everyone is safe” – urging the world to place vaccine equity at the heart of the global response, and calling for every country to have at least enough doses to protect those most at risk. By the end of 2020, 190 economies of all income levels had signed agreements to participate in COVAX, making it one of the most significant multilateral partnerships of the 21st century. By November 2020, it had raised US$ 2 billion towards vaccine procurement; and in January 2021, 39 days after the first vaccine administration in a high-income country, the first COVAX-supplied doses were administered in a lower-income country.
COVAX was designed as an end-to-end coordination mechanism encompassing R&D and manufacturing, policy guidance, vaccine portfolio development, regulatory systems, supply allocation and country readiness assessments, transport logistics, vaccine storage and administration, and monitoring country coverage and absorption rates. However, as an emergency solution launched in the midst of the pandemic, COVAX faced many challenges. Without having any cash reserves up front, it was initially limited in its ability to sign early contracts with manufacturers, and while it was able to ship doses to 100 economies in the first six weeks of global roll-out, export bans and other factors meant that large-volume deliveries were only received in the third quarter of 2021.
While COVAX was unable to completely overcome the tragic vaccine inequity that characterized the global response, it made a significant contribution to alleviating the suffering caused by COVID-19 in the Global South. Today, the initiative has supplied 74% of all COVID-19 vaccine doses supplied to low-income countries (LICs) during the pandemic; and in total, 52 of the 92 AMC-eligible economies relied on COVAX for more than half of their COVID-19 vaccine supply. Thanks to the tireless efforts of national governments, health and frontline workers, civil society organisations and others, those doses, delivered free of charge and combined with nearly US$2 billion in delivery support, helped to lift primary series coverage among the 92 AMC-eligible economies to 57%, compared to a global average of 67%. Two-dose coverage of health care workers, those most critical to saving lives and keeping health systems running, stands at 84% in lower-income economies.
COVAX also deployed 2.5 million doses to protect the most vulnerable in humanitarian and conflict settings through a first-of-its kind mechanism called the Humanitarian Buffer, co-designed with international humanitarian organisations, and set up as a last resort to reach those who are not easily reached through government programmes. Attempting to deliver novel products through non-governmental channels proved to be incredibly difficult, but the effort provided deep insight into the systemic barriers that are exacerbated by a global emergency situation. Governments, humanitarian institutions, global health organisations and others are now working to apply these lessons towards ongoing programmes, and advocating for how we can better protect the most vulnerable populations in a future pandemic.
COVAX’s successes and challenges in the bid to overcome inequity have underscored the clear need for the world to be better prepared the next time a viral threat with pandemic potential emerges. The plethora of learnings from COVAX’s unique effort must be considered in the development of future global pandemic preparedness and response architecture. These include strengthening existing capacity by designing, investing in and implementing an end-to-end solution to equitable access ahead of time, one that centres on the needs of the most vulnerable; recognising that vaccine nationalism will persist in future pandemics and putting in place mechanisms to mitigate it – including by diversifying vaccine manufacturing so all regions have access to supply; and accepting the need to take financial risks to avoid potentially deadly delays to the development, procurement and delivery of medical countermeasures.
With collaboration from manufacturers, all of COVAX’s advance purchase supply agreements will have been completed or terminated by the end of 2023, with the exception of one, where a modest volume of supply will continue into the first half of 2024 in support of the new COVID-19 routine immunization programme.
Thanks in large part due to the savings gained through the successful renegotiation of supply contracts, some COVAX AMC funds remain in the contingency mechanism known as the Pandemic Vaccine Pool, and these can now be reinvested into translating the lessons from COVAX Facility into concrete actions. This includes the establishing of an African Vaccine Manufacturing Accelerator (AVMA), a result of our learnings from the pandemic where Africa was left vulnerable to supply restrictions. Investment in AVMA will make up to US$ 1 billion available to support vaccine manufacturing on the African continent. In addition, a First Response Fund will be established to ensure financing for a vaccine response is immediately available in the event of a future pandemic. It also includes funding “The Big Catch-up” effort designed to fill the gaps in immunization resulting from the pandemic which are now causing outbreaks of vaccine-preventable diseases around the world and threatening the achievement of Immunization Agenda 2030 goals.
“Millions of people are alive today who would not have been here without COVAX. Those averted deaths mean mothers can continue to nurture their children, and grandparents can enjoy watching future generations flourish,” said Jane Halton, Chair of the Board of CEPI. “Despite being built and funded from scratch amid the deadliest pandemic the world has seen in more than a century, COVAX’s life-saving accomplishments were considerable. It should take its place in history and be proud of what it was able to accomplish but also serve as a reminder to us all that we can and must do better next time.”
“COVID-19 has been the greatest health challenge of our time, and it was met with innovation and partnership on an equally unprecedented scale,” said José Manuel Barroso, Chair of the Board of Gavi, the Vaccine Alliance. “COVAX’s impact has been historic, as are the insights it has generated on how, concretely, the world can do better next time. As we transition COVID-19 into Gavi’s routine programming, we do so with deep gratitude for the passion, dedication and sacrifice of so many around the globe who fought tirelessly for three years to try and create a more equitable world – and with an unwavering commitment to improve by transforming learnings into tangible action.”
“The joint efforts of all partners to ensure an equitable response to the pandemic helped protect the futures of millions of children in vulnerable communities,” said UNICEF Executive Director Catherine Russell. “This huge and historic undertaking is something we can be collectively proud of and build on. UNICEF will continue to deliver vaccines to the world's youngest to stop the spread of all preventable diseases and build strong health systems for the future.”
"We knew that market forces alone would not deliver equitable access to vaccines and other tools," said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. "The creation of ACT-A and COVAX gave millions of people around the world access to vaccines, tests, treatments and other tools who would otherwise have missed out. COVAX has taught us valuable lessons that will help us to be better prepared for future epidemics and pandemics."
COVAX, the vaccines pillar of the Access to COVID-19 Tools (ACT) Accelerator, was co-convened by the Coalition for Epidemic Preparedness Innovations (CEPI), Gavi, the Vaccine Alliance (Gavi), UNICEF and the World Health Organization (WHO) – working in partnership with countries, donors, developed and developing country vaccine manufacturers, the World Bank, and others. Its efforts focused on ensuring all countries could access COVID-19 vaccines, regardless of income level.
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, 12 December 2023-- On Universal Health Coverage (UHC) Day, WHO is calling on governments to prioritize investments in building resilient health systems to safeguard the health and well-being of all people, everywhere.
In an increasingly turbulent world, climate change, emergencies and other shocks will take an even greater toll on health systems and the people who need them most. Over 40% of people in the world already live in areas highly susceptible to climate change. Over a quarter of the global population live in settings affected by protracted conflict, poverty and lack of access to basic health services.
Global humanitarian needs have reached record levels with 360 million people in need worldwide. At the same time, half the world’s population is not fully covered by essential health services and 2 billion people face financial hardship or are impoverished due to out-of-pocket health spending. Without urgent action, these gaps will only widen.
“WHO was born 75 years ago on the conviction that health is a human right. And the best way to realize that right is universal health coverage,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Investing in resilient health systems, based on strong primary health care, is the most inclusive, equitable and cost-effective path towards universal health coverage.”
Health systems that can respond to shocks and withstand pressures are crucial to effectively reduce the world’s disease burden and avert the millions of additional deaths each year that are expected as a result of the climate crisis, avoidable environmental risks and complex health emergencies.
WHO is working with countries to reorient health systems towards a primary health care (PHC)—an approach that can help deliver 90% of essential health services while saving 60 million lives by 2030—to accelerate progress towards UHC.
WHO and partners also held a series of events dedicated to UHC Day on 11 December.
A 100-day youth-led advocacy campaign to engage parliamentarians to deliver on the promise of Health for All kicked off at a town hall meeting hosted by the WHO Youth Council, UHC2030 and the Inter-Parliamentary Union. The event provided an opportunity for young people to pose questions about UHC reforms to a panel of parliamentarians from around the world, and to share perspectives on what is needed to drive action toward UHC in countries.
In 2019, the Inter-Parliamentary Union adopted a historic resolution, calling on lawmakers to accelerate action towards UHC.
WHO launched a new Global Health Expenditure Report and database which shed new light on the evolution of global health spending at the height of the COVID-19 pandemic and what lessons can be learnt to future-proof health systems.
The report reveals that in 2021 global spending on health reached a new high of US$ 9.8 trillion or 10.3% of global gross domestic product (GDP). Nevertheless, the distribution of spending remained grossly unequal. In 2021, about 11% of the world's population lived in countries that spent less than US$50 per person per year, while the average per capita spending on health was around US$ 4000 in high-income countries. Low-income countries accounted for only 0.24% of the global health expenditure, despite having an 8% share of the world’s population.
WHO, the World Bank and the British Medical Journal (BMJ) launched a new collection of articles on quality of healthcare. The collection emphasizes that health service quality must be a priority, not an afterthought, including during emergencies. The authors share experiences and proven solutions, and call for greater investment and political attention to quality issues–not just access—as a cornerstone of universal health coverage.
Universal health coverage means that all people can access the health services they need, without financial hardship. Through a new political declaration on UHC in September 2023, world leaders committed to redouble their efforts to achieve UHC by 2030. These commitments must now be turned into investments in resilient health systems.
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 1 November 2023, the International Health Regulations (IHR) National Focal Point of Zambia notified WHO of an anthrax outbreak in humans. The first human cases were reported from the Dengeza Health Post in the Sinazongwe District of the Southern Province on 5 May 2023. Around the same time period, domestic (cattle and goats) and wild animals (hippopotami) were reportedly dying from an unknown cause in the surrounding areas. In June 2023, human and animal cases were reported in the Kanchindu and Siameja veterinary camps of Sinazongwe District. Twenty-six human cases developed sores on their face, arms, and fingers after consuming meat from three wild hippopotamus carcasses. The first human case was reported on 16 June 2023 and laboratory confirmed by culture at the Lusaka Central Veterinary Research Institute (CVRI). As of 20 November 2023, 684 suspected human cases, including four deaths, a Case Fatality Ratio (CFR)of 0.6%, were reported from 44 out of 116 districts in nine of Zambia’s 10 provinces. Sinazongwe district is the epicenter, accounting for 287 cases (42% of total 684 cases) and two deaths (50% of total the four deaths). The most affected provinces are the Southern (370 cases; 54 %), Western (88; 13%), Lusaka (82; 12%), Eastern (66; 10%) and Muchinga (47; 7 %) Provinces. The majority of symptomatic cases were epidemiologically linked to confirmed cases and not tested.
This unprecedented outbreak marks the first major occurrence spanning nine out of 10 country provinces. The latest large-scale outbreak reported in Zambia occurred in 2011 with a total of 511 suspected cases. Response activities have been taken from both human and animal sides, such as active surveillance, case management, laboratory diagnosis, health promotion, and Risk Communication and Community Engagement (RCCE), meat inspection and livestock vaccination.
Anthrax is a zoonotic disease caused by a bacteria called Bacillus anthracis that typically affects ruminants (such as cows, sheep, and goats). The bacteria produce extremely potent toxins which are responsible for the symptoms, causing a high lethality rate in the pulmonary form. Humans can develop the disease from infected animals or through contaminated animal products. Hospitalization is required for all human cases identified. Vaccines are available for livestock and humans in limited supply.
The risk of the event spreading within Zambia is assessed to be high due to the unrestricted animal movement and carcasses within and between provinces. The risk at the regional level is also considered high due to the frequent movement of both animals and people between Zambia and its neighbouring countries (such as Angola, Botswana, the Democratic Republic of the Congo, Malawi, Mozambique, Namibia, Tanzania, Uganda and Zimbabwe).
On 1 November 2023, the IHR National Focal Point of Zambia notified WHO of an anthrax outbreak in humans. The first human cases were reported from the Dengeza Health Post in the Sinazongwe District of the Southern Province on 5 May 2023. Around the same period, domestic (cattle and goats) and wild animals (hippopotami) were reportedly dying from an unknown cause in the surrounding areas. While Zambia typically reports sporadic cases of anthrax annually, the investigation revealed that from September 2022 to January 2023, 42 suspected cases of anthrax in humans had been recorded at the Dengeza Health Post. All the cases presented at health facilities with skin sores and ulcers, and some of them developed nonspecific symptoms (e.g., nausea, vomiting, difficulty in breathing). Human specimens were collected during the investigation and sent to the Lusaka Central Veterinary Research Institute (CVRI) for testing. The initial samples collected and tested by culture returned negative for anthrax.
In June 2023, human and animal cases were reported in the Kanchindu and Siameja veterinary camps of Sinazongwe district. Twenty-six human cases developed sores on their face, arms, and fingers after consuming meat from three wild hippopotamus carcasses. The first human case was reported on 16 June 2023 and laboratory confirmed by culture at the Lusaka CVRI. On the animal side, 13 domestic animals including cattle (10) and goats (3) out of Sinazongwe district susceptible population of 65 000 (30 000 cattle and 35 000 goats), under free range extensive traditional management, died of suspected anthrax. Cattle and goat specimens tested by culture at the Lusaka CVRI returned positive for anthrax on 17 July 2023. Until 1 November, anthrax outbreaks affecting animals and humans were reported in other Southern, Northwestern, and Western provinces.
As of 20 November 2023, 684 suspected human cases, including four deaths (CFR 0.6%) were reported from 44 out of 116 districts in nine of Zambia’s 10 provinces. Sinazongwe district is the epicenter, accounting for 287 cases (42% of total 684 cases) and two deaths (50% of total the four deaths). The most affected provinces are the Southern (370 cases; 54 %), Western (84; 12%), Lusaka (82; 12%), Eastern (66; 10%) and Muchinga (47; 7 %) Provinces. The majority of symptomatic cases were epidemiologically linked to confirmed cases and not tested.
On the animal side, as of 21 November 2023, 568 domestic and wild animal cases were reported across 11 districts in Eastern, Southern, and Western provinces, with (344; 61%) occurring in the Southern province, (132; 23%) in the Muchinga province and (62, 11%) in the Western Province. Cases in wildlife, primarily hippos, were reported in the Eastern and Southern provinces.
This outbreak marks the first major occurrence spanning nine out of 10 country provinces. Previous outbreaks were confined to Northwest and Western provinces, with sporadic cases over the years. Of note, Zambia reported anthrax outbreaks in both human and animals in Western Province in 2017 and in Eastern Province in 2016 and 2011.
Anthrax is a disease caused by a spore-forming bacteria called Bacillus anthracis. It is a zoonosis (disease transmissible from animals to humans) that affects ruminants (such as cows, sheep, and goats). Anthrax does not typically spread from animal to animal or human to human. When anthrax spores are ingested from contaminated animal products, inhaled, or enter the body through skin abrasions or cuts, they can germinate, multiply and produce toxins.
Depending on the type of exposure, within a few hours to three weeks, individuals may present one of the three clinical presentations of anthrax.
Cutaneous or skin anthrax is the most common presenting with an itchy bump in the exposed area that rapidly develops into a black sore. Some people then develop headaches, muscle aches, fever, and vomiting.
Gastrointestinal anthrax causes initial symptoms similar to food poisoning, but can worsen to produce severe abdominal pain, vomiting of blood and severe diarrhoea.
Pulmonary anthrax, the most severe presentation, has initial symptomatology of a common cold but can rapidly progress to severe breathing difficulties and shock.
Diagnosis can be made through polychrome methylene blue-stained blood smears, polymerase chain reaction (PCR) or enzyme-linked immunosorbent assay (ELISA).
Hospitalization is required for all human cases identified. Individuals exposed may receive prophylactic treatment. Antibiotics, particularly penicillin, are effective against this disease. Prompt treatment can reduce case-fatality rate to <1%. Vaccines are also available for livestock and humans in limited supply. Human vaccines are limited to those with possible occupational exposure.
Response activities have been taken from both human and animal sides.
With the support of the Food and Agriculture Organization of the United Nations (FAO), livestock vaccination is ongoing. In total 338 000 doses of anthrax vaccine have been distributed up to 19 November 2023. Vaccination campaigns have been initiated at the outbreak epicentre, Sinazongwe district, and is extended to other affected districts. A joint One Health task force comprising the Ministry of Health and the Ministry of Local Government has been conducting case finding in animals and humans. Meat inspection is enhanced by the veterinary department. Additionally, the Department of Wildlife and Parks has been actively involved, conducting patrols to monitor illegal animal movements and ensuring proper disposal of carcasses. WHO is working closely with FAO and the Ministry of Agriculture on animal health activities like vaccination.
WHO is supporting and working closely with the Ministry of Health in the following activities:
For case management, health workers have undergone orientation to enhance their capacities to identify potential cases early on. Efforts have been made to strengthen event-based surveillance (EBS) and early detection mechanisms. Provision of essential medical supplies has been prioritized, in addition to public sensitization. Active surveillance is ongoing across healthcare facilities and within communities, including contact tracing.
Meat inspections are being conducted in abattoirs and butcher shops. Preparedness plans are in place, including the mobilization of additional healthcare personnel to districts, foreseeing a potential surge in anthrax cases. Moreover, specialized training sessions for provincial practitioners aim to improve case management proficiency in the provinces.
The laboratory continues to operate under a unified One Health approach for diagnostics. Procurement efforts for laboratory reagents are underway due to shortages. Strict protocols for disinfection and decontamination remain ongoing to ensure safety.
Extensive health promotion and Risk Communication and Community Engagement (RCCE) activities are ongoing, including press briefings by Ministry of Health, social media campaigns, radio broadcasts, and the distribution of informative brochures and posters.
Anthrax is endemic in Zambia, usually occurring between May and January, with a peak toward the end of the dry season (between October and November). Although sporadic cases are reported yearly in animals and humans across the country, a large-scale outbreak like the current one has not been reported since 2011, when there were 511 suspected human cases.
The epidemic is spreading along the provinces located along the basin of the Zambezi, Kafue, and Luangwa rivers, which is an additional problem because these rivers also flow into Lake Kariba in Zimbabwe, Kahora Bassa in Mozambique and Lake Malawi, and the risk of anthrax transmission to neighbouring countries is increased.
Other affected districts and provinces of Zambia have reported sporadic suspected cases and deaths since June 2023. In addition, the Bacillus anthracis bacteria can form highly resistant spores that survive in the environment for decades.
The risk for human health is high given the known population’s multiple exposures from handling the carcasses of animals that had died suddenly and eating meat from infected animals with resultant associated cutaneous and gastrointestinal anthrax.
The risk of the event spreading within Zambia has increased due to the unrestricted animal movement and carcasses within and between provinces. Since September 2023, there has been a significant rise in the number of affected districts. Moreover, a low index of suspicion, socio-cultural norms, community resistance, limited community knowledge regarding anthrax transmission, high levels of poverty and food insecurity, a shortage of available vaccines and laboratory reagents, inadequate carcass disposal and decontamination practices significantly contribute to hampering the containment of the anthrax outbreak.
There is an absence of robust engagement with local communities involved in breeding and handling cattle and livestock, including farmers, heads of cattle markets, and butchers. Among these communities, the fear of losing livelihoods often outweighs concerns about contracting anthrax. The risk of insufficient control capacities is considered high in Zambia due to concurrent public health emergencies in the country (cholera, measles, COVID-19) that limit the country’s human and financial capacities to respond to the current anthrax outbreak adequately.
The risk at the regional level is also considered high due to the frequent movement of both animals and people between Zambia and its neighbouring countries (such as Angola, Botswana, the Democratic Republic of the Congo, Malawi, Mozambique, Namibia, Tanzania, Uganda and Zimbabwe). This is compounded by the confirmed cases of anthrax spreading in provinces located along the basin of the Zambezi, Kafue, and Luangwa rivers. These rivers ultimately flow into Lake Kariba in Zimbabwe, the Kahora Bassa lake in Mozambique, and Lake Malawi.
Unburied carcasses of wild animals that float on the river increase the risk of international spread to neighbouring countries. They can spread the bacterium and infections to other regions, including neighbouring countries, and be eaten by other animals, which can further perpetuate the spread.
Humans usually acquire the infection after exposure to infected animals, carcasses, or animal products. More than 95% of human anthrax cases take the cutaneous form and result from handling infected carcasses or hides, hair, meat or bones from such carcasses. The public should avoid handling and consumption of meat from animals that died suddenly, meat obtained via emergency slaughter, and meat of uncertain origin. Anthrax can also be an occupational hazard for veterinarians, agriculture and wildlife workers, or workers who butcher animals or process meat, hides, hair, and wool and should wear preventive clothing and gloves or personal protection equipment (PPE).
In health-care settings, it is crucial to enhance screening procedures specifically in areas where there is a known epidemiological risk of anthrax. It is imperative to anticipate and implement infection prevention and control measures promptly when cases are suspected. When caring for patients with draining anthrax lesions, implementing contact precautions is vital. This includes placing the patient in a private room and the use of PPE (such as examination gloves and a fluid resistant gown). Additionally, dressings may be used to contain drainage and reduce the risk of environmental contamination. These dressings should be disposed of as infectious waste after use. The WHO’s 5 Moments for hand hygiene should be practiced using soap and water when caring for suspected and confirmed cases, as alcohol-based hand rub has weakened effect against spores. For areas where patients with suspected or confirmed exposure to anthrax spores are being cared for, it is recommended to implement enhanced cleaning and disinfection protocols.
Individuals potentially exposed to anthrax spores should receive prophylactic treatment. Anthrax responds well to antibiotics, which need to be prescribed by a medical professional. Strict adherence to the full course of treatment is vital. Human vaccines are in limited supply and used primarily for the protection of selected individuals with possible occupational exposure to anthrax.
International travelers to anthrax endemic countries should be aware of regulations concerning the importation of prohibited animal products, trophies, and souvenirs.
Anthrax is controlled through animal vaccination programs, rapid detection and reporting, quarantine, treatment of sub clinically affected animals (postexposure prophylaxis) and burning or burial of suspect and confirmed animal cases. The carcass should not be opened since exposure to oxygen will allow the bacteria to form spores. The general public and at-risk individuals should immediately report instances of sick or unexpected deaths in animals to veterinary authorities. Veterinary vaccines are used for control of anthrax in livestock. Vaccination protocols for livestock should be strictly followed to curb anthrax spread. Preventing the disease in animals will protect human health.
WHO advises against implementing any travel or trade restrictions based on the current information available on this 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.
Once again, nowhere is safe in Gaza. WHO is gravely concerned about the resumption of hostilities, including heavy bombardment in Gaza, and reiterates its appeal to Israel to take every possible measure to protect civilians and civilian infrastructure, including hospitals, as per the laws of war.
We have seen what happened in northern Gaza. This cannot be the blueprint for the south. Gaza cannot afford to lose another hospital as health needs continue to soar.
As more civilians in southern Gaza receive immediate evacuation orders and are forced to move, more people are being concentrated into smaller areas, while the remaining hospitals in those areas run without sufficient fuel, medicines, food, water, or protection of health workers.
WHO and other partners are less able to provide support, given dwindling access to our supplies or any assurance of safety when we move supplies or staff.
This morning WHO was contacted with advice to move as many medical supplies as possible from a warehouse in Gaza, situated in an area ordered to be evacuated. Access to storage could become challenging over the coming days due to ground operations.
Intensifying military ground operations in southern Gaza, particularly in Khan Younis, are likely to cut thousands off from health care – especially from accessing Nasser Medical Complex and European Gaza Hospital, the two main hospitals in southern Gaza – as the number of wounded and sick increases.
Lack of access would also limit WHO’s ability to deliver aid to these hospitals.
About 1.9 million people, nearly 80% of Gaza's population, are estimated to be internally displaced. Recent evacuation orders cover 20% of Khan Younis and localities east of Khan Younis, which prior to the hostilities were home to nearly 117 000 and 352 000 people, respectively.
In less than 60 days, the number of functioning hospitals has dropped from 36 to 18. Of these, three are only providing basic first aid, while the remaining hospitals are delivering only partial services. Those able to admit patients are delivering services well over their intended capacities, with some treating two to three times as many patients as they were designed for. The 12 hospitals that are still operational in the south are now the backbone of the health system.
On a recent visit to Nasser Medical Complex in Khan Younis, the WHO team described the situation inside as catastrophic, with the building and hospital grounds grossly overcrowded with patients and displaced people seeking shelter. The emergency ward is overflowing with patients. There is a shortage of health workers compared to the overwhelming needs. Those who are available have been working non-stop and are exhausted. Many patients are being treated on the floor. Bed capacity has been overwhelmed. Patients and families sheltering at the hospital are scared for their security.
Disease surveillance systems are hampered, but syndromic surveillance has noted increases in infectious diseases, including acute respiratory infections, scabies, jaundice, diarrhoea, and bloody diarrhoea. Shelters in the south are also reporting cases of acute jaundice syndrome, a worrisome signal of hepatitis.
From 7 October to 28 November, WHO recorded an unprecedented number of attacks on health care: 203 attacks on hospitals, ambulances, medical supplies, and the detention of health-care workers. This is unacceptable. There are means to protect civilians and civilian infrastructure, and they should be instituted.
The only viable solution is a sustained ceasefire.
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.
Earlier today, a joint UN humanitarian assessment team, led by WHO accessed Al-Shifa Hospital in northern Gaza to assess the situation on the ground and conduct a rapid situational analysis, assess medical priorities, and establish logistics options for further missions. The team included public health experts, logistics officers, and security staff from OCHA, UNDSS, UNMAS/UNOPS, UNRWA and WHO.
The mission was deconflicted with the Israel Defense Forces (IDF) to ensure safe passage along the agreed route. However, this was a high-risk operation in an active conflict zone, with heavy fighting ongoing in close proximity to the hospital.
Earlier in the day, the IDF had issued evacuation orders to the remaining 2,500 internally displaced people who had been seeking refuge on the hospital grounds. They, along with a number of mobile patients and hospital staff, had already vacated the facility by the time of the team's arrival.
Due to time limits associated with the security situation, the team was able to spend only one hour inside the hospital, which they described as a “death zone,” and the situation as “desperate.” Signs of shelling and gunfire were evident. The team saw a mass grave at the entrance of the hospital and were told more than 80 people were buried there.
Lack of clean water, fuel, medicines, food and other essential aid over the last six weeks have caused Al-Shifa Hospital—once the largest, most advanced, and best equipped referral hospital in Gaza—to essentially stop functioning as a medical facility. The team observed that due to the security situation, it has been impossible for the staff to carry out effective of waste management in the hospital. Corridors and the hospital grounds were filled with medical and solid waste, increasing the risk of infection. Patients and health staff with whom they spoke were terrified for their safety and health, and pleaded for evacuation. Al-Shifa Hospital can no longer admit patients, with the injured and sick now being directed to the seriously overwhelmed and barely functioning Indonesian Hospital.
There are 25 health workers and 291 patients remaining in Al-Shifa, with several patient deaths having occurred over the previous 2 to 3 days due to the shutting down of medical services. Patients include 32 babies in extremely critical condition, two people in intensive care without ventilation, and 22 dialysis patients whose access to life-saving treatment has been severely compromised. The vast majority of patients are victims of war trauma, including many with complex fractures and amputations, head injuries, burns, chest and abdominal trauma, and 29 patients with serious spinal injuries who are unable to move without medical assistance. Many trauma patients have severely infected wounds due to lack of infection control measures in the hospital and unavailability of antibiotics.
Given the current state of the hospital, which is no longer operational or admitting new patients, the team was requested to evacuate health workers and patients to other facilities. WHO and partners are urgently developing plans for the immediate evacuation of the remaining patients, staff and their families. Over the next 24–72 hours, pending guarantees of safe passage by parties to the conflict, additional missions are being arranged to urgently transport patients from Al-Shifa to Nasser Medical Complex and European Gaza Hospital in the south of Gaza. However, these hospitals are already working beyond capacity, and new referrals from Al-Shifa Hospital will further strain overburdened health staff and resources.
WHO is deeply concerned about the safety and health needs of patients, health workers and internally displaced people sheltering at the few remaining partially functional hospitals in the north, which are facing risk of closure due lack of fuel, water, medical supplies, food, and the intense hostilities. Immediate efforts must be made to restore the functionality of Al-Shifa and all other hospitals to provide urgently needed health services in Gaza.
WHO reiterates its plea for collective efforts to bring an end to the hostilities and humanitarian catastrophe in Gaza. We call for an immediate ceasefire, the sustained flow of humanitarian assistance at scale, unhindered humanitarian access to all of those in need, the unconditional release of all hostages, and the cessation of attacks on health care and other vital infrastructure. The extreme suffering of the people of Gaza demands that we respond immediately and concretely with humanity and compassion.
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.
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HBV is a viral infection that attacks the liver and can cause both acute and chronic disease.1 It is the most common type of viral hepatitis affecting people of all ages, posing a significant burden on people and healthcare systems globally.1 In 2019, WHO estimated that 296 million people were living with chronic hepatitis B infection, with 1.5 million new infections each year. In this same year, hepatitis B resulted in an estimated 820,000 deaths, mostly from cirrhosis and hepatocellular carcinoma (primary liver cancer). The virus is most commonly transmitted from mother to child during birth and delivery, as well as through contact with blood or other body fluids during sex with an infected partner, unsafe injections or exposures to sharp instruments.1 While a vaccine exists to prevent HBV, there is currently no cure for patients who have been diagnosed with the infection.
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The World Health Organization (WHO), today, officially launches the "Stop the lies" campaign as a vital initiative to protect young people from the tobacco industry and their deadly products, by calling for an end to tobacco industry interference in health policy.
This campaign is supported by new evidence from “The Global Tobacco Industry Interference Index 2023”, published by STOP and the Global Center for Good Governance in Tobacco Control, which shows that efforts to protect health policy from increased tobacco industry interference have deteriorated around the world.
WHO’s campaign aims to amplify youth voices, expose tobacco industry tactics and increase public awareness on the need to defend health policies and protect the health of future generations.
Youth groups around the world called on countries to “...adopt decisions that shield us from the manipulative practices of tobacco and related industries.”
“WHO stands with young people globally who have demanded governments protect them against a deadly industry that targets them with new harmful products while outright lying about the health impacts. We call on all countries to safeguard health policies from this deadly industry by not letting them have a seat at the policy-making table,” said Dr Ruediger Krech, Director of Health Promotion, WHO.
The tobacco industry tries to interfere with countries’ right to protect people’s health by taking governments to court, or offering financial and in-kind incentives to be able to influence tobacco control policies, even at the upcoming WHO FCTC Conference of Parties. WHO supports countries in defending evidenced based tobacco control measures in the face of industry interference.
The tobacco industry continues to lie to the public, using different ways to spread misinformation, including through:
Recognizing the tobacco industry’s relentless efforts to market its products to vulnerable groups, especially young people, WHO is committed to expose the industry's attempts to weaken health policies and call on policy makers to stand firm against tobacco industry influence. There are 183 Parties to the Framework Convention on Tobacco Control that have committed to do this under the global health treaty.
The tobacco industry has a long history of lying to the public, even insisting that smoking does not cause lung cancer. Today we know that tobacco causes 25% of all cancers and kills over 8 million people each year, but the industry persists with marketing what they call ‘new’ and ‘safer’ products that we know are harmful to health, while still producing trillions of cigarettes each year.
With half of all tobacco users dying prematurely, the maintenance of the tobacco and nicotine market relies heavily on recruiting new, young users, and tobacco companies employ multiple tactics to gain the trust and interest of young people at an early age.
Menthol and flavoured cigarettes and candy-flavored e-cigarettes with eye-catching designs have further contributed to the popularization of these products among the young generation, all while leaving many consumers largely unaware of the negative effects on their health.
The tobacco industry invests enormous amounts of money in lobbying against tobacco control policies and funds organizations that promote its interests.
These tobacco tactics, when left unchecked, inflict immeasurable harm on public health. Moreover, the production and use of tobacco and nicotine products have a cascading damaging effect on other critical issues such as the environment, mental health, and child labor.
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.
WHO has lost communication with its contacts in Al-Shifa Hospital in northern Gaza. As horrifying reports of the hospital facing repeated attacks continue to emerge, we assume our contacts joined tens of thousands of displaced people who had sought shelter on the hospital grounds and are fleeing the area. There are reports that some people who fled the hospital have been shot at, wounded and even killed.
Over the past 48 hours, Al-Shifa Hospital--which is the largest medical complex in Gaza--has been reportedly attacked multiple times, leaving several people dead and many others injured. The intensive care unit suffered damage from bombardment, while areas of the hospital where displaced people were sheltering have also been damaged. An intubated patient reportedly died when electricity was at one point cut.
The last reports said that the hospital was surrounded by tanks. Staff reported lack of clean water and risk of the last remaining critical functions, including ICUs, ventilators and incubators, soon shutting down due to lack of fuel, putting the lives of patients at immediate risk.
WHO has grave concerns for the safety of the health workers, hundreds of sick and injured patients, including babies on life support and displaced people who remain inside the hospital. The number of inpatients is reportedly almost double its capacity, even after restricting services to lifesaving emergency care.
Patients seeking health care should never be exposed to fear, and health workers who have taken an oath to treat them should never be forced to risk their own lives to provide care.
WHO calls again for an immediate ceasefire in Gaza as the only way to save lives and reduce the horrific levels of suffering. Hospitals, patients, health staff, and persons sheltering in health facilities are protected under the Geneva Conventions and International Humanitarian Law.
WHO also calls for the sustained, orderly, unimpeded and safe medical evacuations of critically injured and sick patients into Egypt through the Rafah Border Crossing.
All hostages should receive appropriate medical care and be released unconditionally.
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) 2023 Global tuberculosis (TB) report underscores a significant worldwide recovery in the scale-up of TB diagnosis and treatment services in 2022. It shows an encouraging trend starting to reverse the detrimental effects of COVID- 19 disruptions on TB services.
Featuring data from 192 countries and areas, the report shows that 7.5 million people were diagnosed with TB in 2022, making it the highest figure recorded since WHO began global TB monitoring in 1995.
The increase is attributed to good recovery in access to and provision of health services in many countries. India, Indonesia and the Philippines, which together accounted for over 60% of the global reductions in the number of people newly diagnosed with TB in 2020 and 2021, all recovered to beyond 2019 levels in 2022.
“For millennia, our ancestors suffered and died with tuberculosis, without knowing what it was, what caused it, or how to stop it,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Today, we have knowledge and tools they could only have dreamed of. We have political commitment, and we have an opportunity that no generation in the history of humanity has had: the opportunity to write the final chapter in the story of TB.”
Globally, an estimated 10.6 million people fell ill with TB in 2022, up from 10.3 million in 2021. Geographically, in 2022, most people who developed TB were in the WHO Regions of South-East Asia (46%), Africa (23%) and the Western Pacific (18%), with smaller proportions in the Eastern Mediterranean (8.1%), the Americas (3.1%) and Europe (2.2%).
The total number of TB-related deaths (including those among people with HIV) was 1.3 million in 2022, down from 1.4 million in 2021. However, during the 2020-2022 period, COVID-19 disruptions resulted in nearly half a million more deaths from TB. TB continues to be the leading killer among people with HIV.
Multidrug-resistant TB (MDR-TB) remains a public health crisis. While an estimated 410 000 people developed multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB) in 2022, only about two in five people accessed treatment.
There is some progress in the development of new TB diagnostics, drugs and vaccines. However, this is constrained by the overall level of investment in these areas.
WHO reports that global efforts to combat TB have saved over 75 million lives since the year 2000. However, even more efforts are needed as TB remained the world’s second leading infectious killer in 2022.
Despite significant recovery in 2022, progress was insufficient to meet global TB targets set in 2018 with disruptions caused by the pandemic and ongoing conflicts being major contributing factors:
· the net decrease in TB-related deaths from 2015 to 2022 was 19%, falling far short of the WHO End TB Strategy milestone of a 75% reduction by 2025;
· the cumulative reduction in the TB incidence rate from 2015 to 2022 was 8.7%, far from the WHO End TB Strategy milestone of a 50% reduction by 2025;
· about 50% of TB patients and their households face total costs that are catastrophic (direct medical expenditures, non-medical expenditures and indirect costs such as income losses that amount to more than 20% of total household income), far from the WHO End TB Strategy target of zero;
· the targets set for 2018-2022 in the political declaration of the first UN High-Level Meeting on TB were not met, with only 84% of the 40 million people targeted for TB treatment reached; and only 52% of the 30 million people targeted for TB preventive treatment accessing it; and
· less than half of the funding targeted for TB service delivery and research was mobilized.
The 2023 UN General Assembly High-Level Meeting on TB reinforced the 2018 commitments and targets, setting out new targets for the period of 2023-2027. The new targets include reaching 90% of people in need with TB prevention and care services; using a WHO-recommended rapid test as the first method of diagnosing TB; providing a health and social benefit package to all people with TB; ensuring the availability of at least one new TB vaccine that is safe and effective; and closing funding gaps for TB implementation and research by 2027.
“We have strong commitments with concrete targets made by world leaders in the political declaration of the second UN High-Level Meeting on TB, that provides a strong impetus to accelerate the TB response,” said Dr Tereza Kasaeva, Director of WHO’s Global TB Programme. “This report provides key data and evidence on the status of the TB epidemic and a review of progress, that serves to inform the translation of these targets and commitments into action in countries. We need all hands on deck to make the vision of ending TB a reality.”
The report additionally stresses the importance of concerted action across the health and other sectors to address the social, environmental and economic determinants of TB and consequences of inaction. WHO continues to support the engagement of other sectors in the TB response, through its Multisectoral Accountability Framework. In 2022, outside of the health sector, education was the most engaged sector in TB advocacy and information-sharing, followed by the defence sector and justice sector, for TB prevention and care services, and the social development sector for patient support, including provision of economic, social and nutritional benefits.
The report emphasizes that ending the global TB epidemic requires translating the commitments made at the 2023 UN High-Level meeting on TB into real action, changing the lives and livelihoods in communities.
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) welcomes Egypt’s decision to accept 81 injured and sick people from the Gaza Strip for treatment.
WHO has been working to support the Egyptian Ministry of Health and Population in planning and establishing a comprehensive triage, stabilization, and medical evacuation system, by providing ongoing training for health care staff. WHO is also working with the Egyptian Red Crescent Society to ensure that psychological trauma support services are available to patients.
Our experts have visited Al-Arish, visited medical evacuation facilities and met with medical staff and ambulance paramedics who received advanced life support training. There are 65 ambulances equipped with full resuscitation and life support capabilities. Thirteen of the ambulance teams include trained emergency doctors in addition to paramedics with advanced life support training.
Al-Arish Hospital will be the main first referral hospital. It has fully equipped resuscitation and intensive care facilities, and a range of surgical teams to manage severe injuries, including major trauma and burns. Onward referral arrangements to second-line hospitals in Egypt are also in place.
Thousands more people inside the Gaza Strip continue to need access to urgent and essential health services amid shortages of medicines, health supplies and other aid such as fuel, water and food. Those in serious need include thousands of seriously injured civilians (many of them children); more than 1000 people who need kidney dialysis to stay alive; more than 2000 patients on cancer therapy; 45 000 people with cardiovascular diseases; and more than 60 000 people with diabetes. These patients must be able to have sustained access to health care inside Gaza. Hospitals and other health facilities must be protected from bombardment and military use.
Before 7 October 2023, around 100 patients each day needed to access specialized health care services outside the Gaza Strip because of the lack of needed, specialized health services inside Gaza.
WHO calls for urgent, accelerated access for humanitarian aid – including fuel, water, food and medical supplies – into and throughout the Gaza Strip, and access for patients to referral services outside Gaza. Ultimately, WHO calls for a humanitarian ceasefire to prevent further loss and suffering.
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 published its first-ever Global research agenda on health, migration and displacement to guide research efforts to understand and address the health needs of migrants, refugees, and all forcibly displaced populations and shape responsive policies and practices worldwide.
There are one billion people currently leaving their homes by choice or force due to various factors such as wars, conflicts, income inequalities, economic shifts, urbanization, and climate change. It is essential to develop evidence-based policies that ensure no one is left behind. However, there is a lack of comprehensive knowledge about what works to better support the health of people on the move. This gap in knowledge impacts people’s well-being, and it slows down global progress towards universal health coverage (UHC) and Sustainable Development Goals (SDGs).
During the year-long consultative process of the Global research agenda with over 180 key stakeholders from all regions representing expertise from diverse backgrounds and migration and displacement contexts, five priority research themes were agreed that require greater investment:
Ways to scale up access to services and achieve inclusive universal health coverage, especially: evidence on effective health financing models and how health systems can better respond to the diverse needs of people on the move.
Actions to make health emergency preparedness more responsive to the needs of migrants and those forcibly displaced, particularly: effective and sustainable health care models in humanitarian settings in low- and middle-income countries and models of UHC in protracted displacement contexts.
Better understanding of the determinants of health and ways to address them, particularly on: the impact of living and working conditions as well as restrictive immigration policies on the health of migrants, refugees, and other displaced people.
More visibility for under-researched groups of migrants and forcibly displaced populations, for example: children, people in immigration detention, or people who are internally displaced.
New ways to collaborate in research and translate research into policy and practice.
"The first WHO Global research agenda on health, migration and displacement is an important step in our efforts to drive evidence-informed policies and practices," said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. "By bridging the knowledge gap on the health needs of some of the world’s most vulnerable populations, the report will help us navigate a world that is increasingly on the move."
The priorities outlined in the agenda are relevant to all areas of global public health and policy development and can be applied to varying geographical regions and migration contexts. If translated into action, they will improve research on the health of migrants, refugees and all forcibly displaced populations, support countries to develop health systems that are more responsive to current and future population movement and protect and promote the health of all people on the move and their receiving communities worldwide. It will encourage progress by supporting leaders at all levels to make inclusive, evidence-informed health care policies.
“In today's interdependent and interconnected world and with the many ongoing severe acute and protracted crisis around the world, migration and displacement cannot be considered separate issues from other efforts in global health," said Dr Jeremy Farrar, WHO's Chief Scientist. "The Global research agenda on health, migration and displacement is a call to action and an alarm bell to expand global knowledge on the health needs of migrants and forcibly displaced. We need to know more about their access to health services, their inclusion in health systems, the best ways to respond to their needs during health emergencies and turn all of this evidence into tangible impact.”
The Global research agenda will also serve as a foundation for developing regional and national research agendas to turn the global themes identified into context-specific research questions. An implementation guide and toolkit is contained within the Global research agenda, which will support policy-makers, civil society and non-governmental organizations, and other United Nations agencies to apply the research agenda to their various migration contexts and organizational needs.
An interactive dataset exploring the global research funding landscape in the field of health, migration and displacement will be used as part of the monitoring and evaluation process for the Global research agenda. This dashboard, hosted by the WHO Science Division on the WHO Global Observatory on Health Research and Development, demonstrates that the current research funding in this field at the global level is not enough to meet the urgent research gaps identified in the Global research agenda.
"The global research agenda will catalyze high-quality context-specific knowledge on the health of migrants, refugees, and other displaced populations globally," said Dr Santino Severoni, Director of the WHO's Department of Health and Migration. "By understanding the health of people on the move we can create equitable policies, programmes, and interventions that improve the health of all society and make progress towards attaining the SDGs."
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.