WHO welcomes the overarching recommendations of The Lancet COVID-19 Commission’s report on “Lessons for the future from the COVID-19 pandemic,” which align with our commitment to stronger global, regional and national pandemic preparedness, prevention, readiness and response. At the same time, there are several key omissions and misinterpretations in the report, not least regarding the public health emergency of international concern (PHEIC) and the speed and scope of WHO’s actions.
WHO welcomes the Commission’s endorsement of a pandemic agreement, strengthening the International Health Regulations (IHR), and enhancing financing. These issues are core to the vision of WHO Director-General, Dr Tedros Adhanom Ghebreyesus, as distilled in the five priorities for his second term. WHO and its Member States are already enacting these recommendations. The World Health Assembly agreed a historic decision in May 2022 to sustainably finance WHO.This year will see two rounds of public hearings for a pandemic accord take place.
The Commission strongly endorses WHO’s central role in global health, arguing that “WHO should be strengthened” and that reforms “should include a substantial increase of its core budget.”
WHO echoes the Commission’s conclusions that COVID-19 exposed major global challenges, such as chronic under financing of the UN, rigid intellectual property regimes, a lack of sustainable financing for low- and middle-income countries, and “excessive nationalism,” which drove vaccine inequity.
The Organization also agrees with the focus on biosafety, as shown by the formalization of our Technical Advisory Group on biosafety, the publication of our Laboratory biosafety manual – now in its 4th edition – and the publication on 13 September this year of a life sciences framework to help mitigate bio risks and safely govern dual-use research.
WHO places similar emphasis on the importance of multilateralism, solidarity and cooperation when facing pandemics. We also welcome the recognition of the key role that countries themselves play.
Many of the Commission’s recommendations align with those received over the past two years from review bodies set up by WHO itself, such as the Independent Panel for Pandemic Preparedness and Response (IPPPR), the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme (IOAC) and the IHR Review Committee, as well as assessments from other entities. As we are a learning organization, we established a dashboard of recommendations from these initiatives and others to track their implementation by WHO and others.
The Commission does not, however, convey the full arc of WHO’s immediate, multi-year, life-saving response, detailed below:
On 30 December 2019, WHO received the first alerts of cases of pneumonia of unknown cause in Wuhan, China, and notified the IHR focal point, seeking further information from Chinese health authorities the next day.
On 1 January 2020, WHO activated its Incident Management System to manage daily action. The team, which includes focal points on clinical care, infection prevention and control, diagnostics, logistics, communications and more, met daily throughout 2020, into 2021 and continues to meet this year.
On 5 January 2020, WHO issued a global alert to all Member States through a formal IHR system – the Event Information System – based on our initial risk assessment of the situation in China. This alerted Member States and advised them to take measures to identify cases, care for patients, and prevent infection and onward human-to-human transmission for acute respiratory pathogens with epidemic and pandemic potential. This was WHO’s first global warning to take concrete measures for an unknown respiratory disease. WHO has consistently driven knowledge-sharing through dedicated briefings for countries, during which the critical experiences of early-affected countries were shared and the elements of WHO’s comprehensive response were outlined.
On 9 January 2020, WHO convened the first of many teleconferences with established global expert networks, to discuss all available information on the cluster reported from China. These networks enabled the real-time exchange of direct knowledge, experience and early study findings, which fed directly into WHO’s early advice and recommendations.
Between 10 and 12 January 2020, WHO published a comprehensive package of technical guidance for countries. This package covered how to test for a high threat respiratory coronavirus, treat patients for severe acute respiratory infection, inform the public to prevent infection and human- to-human transmission, and to prepare health systems to deal with more cases. On 13 January 2020, WHO published the first protocol to develop PCR tests to identify cases based on the release of the full genome sequence two days earlier. By 2 February 2020, WHO began shipping validated PCR assays to countries around the world.
On 22 and 23 January 2020, when there were nine cases and no deaths reported outside China, the Director-General convened the Emergency Committee (EC) under the IHR to meet, and advise whether the event constituted a public health emergency of international concern (PHEIC). The Committee advised that it did not. The Director-General said publicly: “Make no mistake. This is an emergency in China, but it has not yet become a global health emergency. It may yet become one”.
From 27 to 28 January, following the EC, the Director-General and senior staff travelled to China to meet with top government officials, gather information about the outbreak and seek cooperation.
On 30 January 2020, when there were 98 reported cases (and no deaths) in 18 countries outside China, the Director-General reconvened the Emergency Committee. It advised that the outbreak constituted a PHEIC. The DG took their advice and declared a PHEIC, issuing temporary recommendations for how countries could further prepare and respond.
On 4 February 2020, WHO’s Strategic Preparedness and Response Plan (SPRP) was published. It outlined comprehensive measures all countries needed to take to suppress transmission and save lives, using a package of interventions including early identification and isolation and care of cases, contact tracing and supported quarantine, use of medical masks, distancing, ventilation, infection prevention and control in health facilities, taking a risk-based approach to small and large gatherings, and for travel.
Following regular media briefings held in January, daily briefings began on 5 February 2020. Media briefings continue on a weekly basis, alongside regular live social media conversations with senior WHO experts, demonstrating the priority placed on communicating with leaders and the public.
From 11 to 12 February 2020, WHO led a Global Research and Innovation Forum on the new virus, convening nearly 900 experts and funders from more than 40 countries, to take stock of what was known about the novel coronavirus and to set the agenda going forward. A follow-up achievement was WHO’s Solidarity trial, which became one of the largest clinical trials for COVID-19 therapeutics, involving more than 30 countries, over 14 000 patients and nearly 500 hospitals at its peak.
A comprehensive and detailed list of actions taken by WHO during the COVID-19 response can be viewed in our interactive timeline.
From day one and to this day, WHO, together with our global expert networks and guideline development groups, regularly updates our guidance and strategies with the latest knowledge about the virus, including updates to the SPRP and the COVID-19 global vaccination strategy, and to the 11th version of WHO’s living guideline on COVID-19 therapeutics, which was published in July 2022.
WHO played, and continues to play, a vital role in getting COVID-19 tools to countries in need, not least through joint endeavours such as the ACT-Accelerator, Pandemic Supply Chain Network (PSCN) and UN COVID-19 Supply Chain Task Force. Lab testing capability in African nations rose dramatically over six months, thanks to support from WHO. Only two countries on the African continent had COVID-19 testing capacities at the start of 2020; by mid-year, all 54 countries had them. WHO has supported 18 countries globally to set up plants for medical oxygen.
Throughout the pandemic, the Director-General has repeatedly called for leaders to take actions to protect people and share tools equitably when addressing the world’s most important fora, such as the February Munich Security Conference; the extraordinary G20 Leaders Summit of March 2020; the G7 Summit of June 2021, where the 70% vaccination target was announced; and Global COVID-19 Summits co-hosted by the Biden Administration in September 2021 and May 2022.
Regarding the areas of WHO’s response focused on by the Commission, WHO would like also to highlight the many day-to-day steps, including the following:
WHO repeatedly warned of the potential of asymptomatic human-to-human transmission, particularly pre-symptomatic transmission, including in late January in updated surveillance guidance, in protocols for enhanced surveillance on 29 January (defining a contact as someone with exposure 1 day before symptom onset of a case) and 4 February (changing a contact to someone with exposure up to 4 days before symptom onset of a case), at its Executive Board on 4 February, in guidance documents from 23 and 28 February 2020, in its China mission report and media briefings. WHO issued guidance and enhanced surveillance protocols early in the pandemic to identify contacts among people prior to the development of symptoms.
The IHR recognize the sovereign rights of State Parties to introduce restrictions on travel. From the very beginning of the COVID-19 response, WHO recommended many measures countries should take, including screening at entry points.
At the beginning of the pandemic, dramatic global supply constraints saw health workers around the world scrambling to find basic supplies to protect themselves. WHO’s early priority was getting access to masks for those most at-risk around the world; we initially recommended the use of medical masks for anyone with symptoms, anyone caring for someone sick, and frontline health workers. Our logisticians and other UN partners were central in activating the pandemic supply chain and increasing global supplies.
WHO guidance published on 10 January 2020, outlined respiratory precautions – including airborne precautions – in health-care settings. WHO guidance addressing many forms of transmission including zoonotic, droplet, airborne, short- and long-range aerosol, fomite, and vertical transmission, along with specific recommendations to prevent such transmission in different settings (such as health facilities, schools, workplaces), was updated and expanded regularly throughout the pandemic based on emerging evidence. WHO is leading and coordinating a multi-agency, multidisciplinary, international technical consultation process to discuss and reach a consensus on pathogens that transmit through the air, with a wide range of global experts and international and national agencies.
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.
Good morning, good afternoon, and good evening.
First, to the COVID-19 pandemic.
The global decline in reported cases and deaths is continuing.
This is very encouraging. But there is no guarantee these trends will persist. The most dangerous thing is to assume they will.
The number of weekly reported deaths may have dropped by more than 80% since February, but even so, last week one person died with COVID-19 every 44 seconds.
Most of those deaths are avoidable.
You might be tired of hearing me say the pandemic is not over. But I will keep saying it until it is. This virus will not just fade away.
We understand that many governments are dealing with multiple challenges and competing priorities.
To support them, WHO will next week publish a set of six short policy briefs, outlining the essential actions that all governments can take to reduce transmission and save lives.
The briefs will cover the essential elements of testing, clinical management, vaccination, infection prevention and control, risk communication and community engagement, and managing the infodemic.
We hope countries will use these briefs to reassess and readjust their policies to protect those most at risk, treat those who need it and save lives.
The pandemic is always evolving, and so must the response, in every country.
Even as we continue to respond to the pandemic, work is progressing to put in place the measures to keep the world safer from future epidemics and pandemics.
In November last year, WHO’s Member States made a historic decision to negotiate a new international accord on pandemic preparedness and response.
Just as countries have come together before to agree treaties on the threats posed by tobacco, nuclear weapons and climate change, so now countries are coming together to agree on a common approach to the common threat of epidemics and pandemics.
The final outcome will be a legal instrument negotiated by sovereign states and implemented by sovereign states, in accordance with their own laws.
But this is not a discussion for governments alone.
Pandemics threaten every single person on earth, so it’s important that everyone can have their say on what this landmark international agreement looks like.
To enable that to happen, WHO is holding public hearings, to give as many people as people as possible the opportunity to have input into the negotiating process.
The first round of public hearings was in April, and the second round will be held later this month.
We invite everyone, everywhere to have their say, by submitting a video statement between the 9th and 13th of September, responding to this question:
“Based on your experience with the COVID-19 pandemic, what do you believe should be addressed at the international level to better protect against future pandemics?”
We look forward to receiving many suggestions and ideas, from as many countries as possible.
===
Now to monkeypox, where we are continuing to see a downward trend in Europe.
While reported cases from the Americas also declined last week, it’s harder to draw firm conclusions about the epidemic in that region.
Some countries in the Americas continue to report increasing numbers of cases, and in some there is likely to be under-reporting due to stigma and discrimination, or a lack of information for those who need it most.
But as I said earlier, a downward trend can be the most dangerous time, if it opens the door to complacency.
WHO continues to recommend that all countries persist with a tailored combination of public health measures, testing, research and targeted vaccination, where vaccines are available.
Community engagement is vital. Last week, WHO held a consultation with community leaders from all over the world to listen to their views and concerns, and to emphasize the importance of responding to monkeypox using existing services and infrastructure, including those for HIV and sexual health.
===
Now to Pakistan, where almost 1500 health facilities have been affected by flooding.
There are limited stocks of emergency medicines and other health supplies.
WHO has delivered medicines, water purification kits, tents and other supplies, and together with our partners we have set up more than 4500 medical camps to provide essential health services.
The challenge is huge.
===
Finally, we remain deeply concerned about the situation in the Sahel and the Greater Horn of Africa, and particularly in Somalia.
Parts of Somalia are projected to fall into famine in the very near future unless there is an urgent scale-up in humanitarian assistance.
Millions more people in other parts of the country are facing extreme hunger, and it is likely that many people have already starved to death.
A rapid scale-up in humanitarian assistance since early this year has saved many lives.
But the resources that WHO and our partners have to respond to the crisis are outstripped by the explosion in needs.
Somalia and its neighbours in the Greater Horn of Africa – as well as the countries of the Sahel region – need the world’s help, and they need it now.
Margaret, back to you.
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.
Good morning, good afternoon, and good evening.
First, to the COVID-19 pandemic.
The global decline in reported cases and deaths is continuing.
This is very encouraging. But there is no guarantee these trends will persist. The most dangerous thing is to assume they will.
The number of weekly reported deaths may have dropped by more than 80% since February, but even so, last week one person died with COVID-19 every 44 seconds.
Most of those deaths are avoidable.
You might be tired of hearing me say the pandemic is not over. But I will keep saying it until it is. This virus will not just fade away.
We understand that many governments are dealing with multiple challenges and competing priorities.
To support them, WHO will next week publish a set of six short policy briefs, outlining the essential actions that all governments can take to reduce transmission and save lives.
The briefs will cover the essential elements of testing, clinical management, vaccination, infection prevention and control, risk communication and community engagement, and managing the infodemic.
We hope countries will use these briefs to reassess and readjust their policies to protect those most at risk, treat those who need it and save lives.
The pandemic is always evolving, and so must the response, in every country.
Even as we continue to respond to the pandemic, work is progressing to put in place the measures to keep the world safer from future epidemics and pandemics.
In November last year, WHO’s Member States made a historic decision to negotiate a new international accord on pandemic preparedness and response.
Just as countries have come together before to agree treaties on the threats posed by tobacco, nuclear weapons and climate change, so now countries are coming together to agree on a common approach to the common threat of epidemics and pandemics.
The final outcome will be a legal instrument negotiated by sovereign states and implemented by sovereign states, in accordance with their own laws.
But this is not a discussion for governments alone.
Pandemics threaten every single person on earth, so it’s important that everyone can have their say on what this landmark international agreement looks like.
To enable that to happen, WHO is holding public hearings, to give as many people as people as possible the opportunity to have input into the negotiating process.
The first round of public hearings was in April, and the second round will be held later this month.
We invite everyone, everywhere to have their say, by submitting a video statement between the 9th and 13th of September, responding to this question:
“Based on your experience with the COVID-19 pandemic, what do you believe should be addressed at the international level to better protect against future pandemics?”
We look forward to receiving many suggestions and ideas, from as many countries as possible.
===
Now to monkeypox, where we are continuing to see a downward trend in Europe.
While reported cases from the Americas also declined last week, it’s harder to draw firm conclusions about the epidemic in that region.
Some countries in the Americas continue to report increasing numbers of cases, and in some there is likely to be under-reporting due to stigma and discrimination, or a lack of information for those who need it most.
But as I said earlier, a downward trend can be the most dangerous time, if it opens the door to complacency.
WHO continues to recommend that all countries persist with a tailored combination of public health measures, testing, research and targeted vaccination, where vaccines are available.
Community engagement is vital. Last week, WHO held a consultation with community leaders from all over the world to listen to their views and concerns, and to emphasize the importance of responding to monkeypox using existing services and infrastructure, including those for HIV and sexual health.
===
Now to Pakistan, where almost 1500 health facilities have been affected by flooding.
There are limited stocks of emergency medicines and other health supplies.
WHO has delivered medicines, water purification kits, tents and other supplies, and together with our partners we have set up more than 4500 medical camps to provide essential health services.
The challenge is huge.
===
Finally, we remain deeply concerned about the situation in the Sahel and the Greater Horn of Africa, and particularly in Somalia.
Parts of Somalia are projected to fall into famine in the very near future unless there is an urgent scale-up in humanitarian assistance.
Millions more people in other parts of the country are facing extreme hunger, and it is likely that many people have already starved to death.
A rapid scale-up in humanitarian assistance since early this year has saved many lives.
But the resources that WHO and our partners have to respond to the crisis are outstripped by the explosion in needs.
Somalia and its neighbours in the Greater Horn of Africa – as well as the countries of the Sahel region – need the world’s help, and they need it now.
Margaret, back to you.
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.
As of 3 September 2022, a cluster of 11 cases of severe pneumonia, including four deaths, have been reported in San Miguel de Tucumán city, Tucuman Province, Argentina. Legionella spp. was isolated in the samples from four cases. Legionellosis is a pneumonia-like illness that varies in severity from mild febrile illness to a serious and sometimes fatal form of pneumonia. Cases were initially reported as being pneumonia of unknown cause. Legionella bacteria was identified as the causative organism on 3 September. All cases presented with bilateral pneumonia, fever, myalgia, abdominal pain, and dyspnea between 18 and 25 August 2022 and are epidemiologically linked to one health facility. Of the 11 cases, eight are health workers of the facility; three are patients of the health facility. Three of the four deaths were among health workers.
Health authorities are coordinating cluster investigation activities, active case finding to identify additional cases, contact tracing and public health activities to limit further spread.
On 29 August 2022, WHO was notified by the Ministry of Health of Argentina of a report from the Ministry of Public Health of Tucumán Province, of a cluster of six cases of bilateral pneumonia without an etiological cause identified in San Miguel de Tucumán city, Tucuman Province, Argentina 1. All six cases were linked to one private health facility in the city of San Miguel de Tucumán, with the onset of symptoms between 18 and 22 August 2022. The six cases included five health workers and one patient who was admitted to the clinic for an unrelated condition and then subsequently to the intensive care unit after developing pneumonia. In addition to bilateral pneumonia, all cases presented with fever, myalgia, abdominal pain, and dyspnea.
On 1 September, three additional cases were identified through active case finding - all health workers from the same private health facility, aged 30 to 44 years - with similar signs and symptoms to the initial six cases identified 2. The onset of symptoms for these cases was between 20 and 25 August 2022.
Between 2 and 3 September, two additional cases were identified, an 81-year-old male and a 64-year-old male, both with comorbidities, who were hospitalized and presented similar clinical presentation as the previous cases 3.
As of 3 September 2022, 11 cases have been identified, four of whom have died (three health workers). Eight of the 11 reported cases are health workers of the same health facility. The median age of the cases is 45 years; seven are male. Ten cases had underlying conditions and/or risk factors for severe disease, including the four reported deaths. Four cases are still hospitalized as of 3 September. Contacts of the cases are under follow-up and, to date, none have developed symptoms.
Blood, respiratory and tissues samples were obtained from the 11 cases. Preliminary tests conducted at the local Public Health Laboratory were negative for respiratory viruses, and other viral, bacterial, and fungal agents. On 31 August, samples from the initial six cases were sent to the National Reference Laboratory - the Administration of National Laboratories and Health Institutes (Administración Nacional de Laboratorios e Institutos de Salud - ANLIS per its acronym in Spanish) - for additional testing 4 . As of 3 September 2022, negative results have been obtained for COVID-19 (RT-PCR), Influenza, detection of antibodies for Coxiella, urinary antigen for Legionella spp., panel of 12 respiratory viruses, hantavirus (Elisa IgM), histoplasma (RT-PCR), Yersinia pestis (PCR) and micro agglutination for leptospirosis.
Further analyses of two bronchoalveolar lavage samples by highly sensitive total DNA sequencing (metagenomics) found readings compatible with Legionella spp. On 3 September 2022, ANLIS reported that amplification products of the 16S ribosomal gene for Legionella spp. from the two samples of bronchoalveolar lavage sequenced by metagenomics and analyzed by four different bioinformatic methods, produced results compatible with Legionella pneumophila. Confirmation of these results is expected upon completion of the sequencing processes. This laboratory result supports evidence compatible with Legionnaires’ disease. Blood culture and seroconversion tests continue to be conducted to complement the diagnosis of Legionella infection.
Legionellosis is a generic term describing the pneumonic and non-pneumonic forms of infection with the Legionella species of bacteria. Legionellosis varies in severity from mild to serious and can sometimes be fatal.
Legionnaires’ disease, the pneumonic form, has an incubation period of 2 to 10 days (but up to 16 days have been recorded in some outbreaks). It is an important cause of community- and hospital-acquired pneumonia; and although uncommon, Legionnaires may cause outbreaks of public health significance. Initially, symptoms are fever, mild cough, loss of appetite, headache, malaise and lethargy, with some patients also experiencing muscle pain, diarrhoea and confusion. The severity of Legionnaires’ disease ranges from a mild cough to rapidly fatal pneumonia. Untreated Legionnaires’ disease usually worsens during the first week.
Mortality from Legionnaires’ disease depends on the severity of the disease, the use of antibiotic treatment, the setting where Legionella was acquired, and whether the patient has underlying conditions, including immunosuppression. The death rate may be as high as 40–80% in untreated immunosuppressed patients and can be reduced to 5–30% through appropriate case management, depending on the severity of the clinical signs and symptoms. Overall, the death rate is usually between 5–10%.
In response to the detection of the cluster of bilateral pneumonia, health authorities in Tucuman Province coordinated cluster investigation activities including the follow-up of cases, search for the source(s) of infection, active case finding to identify additional cases, and contact tracing. Preliminary investigations indicated no secondary cases were identified.
As Legionella spp. has been identified as the etiology of this outbreak, the following public health measures were implemented:
Risk assessment and suspension of healthcare activities in the health facility.
Enhanced surveillance including active and passive case finding.
Biological and environmental sampling, and laboratory testing, including bacteria isolation, and metagenomics.
Case isolation and clinical care of patients.
Contact identification, support and monitoring.
Risk communication
With the support of national health authorities, environmental samples are being collected to define the source of contamination and urgently implement prevention and control measures. The health authorities are also implementing internal and external communication strategies for health professionals and the community.
The Pan American Health Organization (PAHO)/WHO is providing technical support for the outbreak investigation, including advice on sampling, environmental assessment, clinical management, and Infection and Prevention Control (IPC) measures.
Legionellosis varies in severity from a mild febrile illness to a serious and sometimes fatal form of pneumonia and is caused by exposure to Legionella species found in contaminated water and potting mixes. The most common form of transmission of Legionellosis is inhalation of contaminated aerosols from contaminated water sources. Sources that have been linked to both the transmission of Legionella via aerosols and outbreaks of Legionellosis include air conditioning cooling towers or evaporative condensers associated with air conditioning and industrial cooling, hot and cold water systems, humidifiers, and whirlpool spas. Infection can also occur by aspiration of contaminated water or ice, particularly in susceptible hospital patients. To date, there is no reported direct human-to-human transmission.
Sporadic outbreaks of legionellosis pneumonia have been reported in Argentina before. There are robust surveillance activities being implemented in the affected health facility. Nonetheless, in the absence of an identified source of Legionella bacteria, the risk of developing Legionellosis for people working or hospitalized at the same health facility is currently moderate.
Countries with cases of Legionellosis reported after travel to Argentina should notify their regional IHR focal point.
WHO recommends the continuation of laboratory analyses, case identification and clinical care, contact tracing, outbreak investigation to identify the source(s), implementation of measures to prevent further infections and enhancement of Infection Prevention and Control (IPC) measures. IPC measures in health facilities have been enhanced during the COVID-19 pandemic and should be reinforced to prevent healthcare-associated transmission. Precautions that are recommended for COVID-19 should continue to be followed.
WHO does not recommend any specific different measures for travelers. In case of symptoms suggestive of respiratory illness either during or after travel, travelers are encouraged to seek medical attention and share their travel history with their healthcare provider.
WHO advises against the application of any travel or trade restrictions on Argentina 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.
Cairo – Islamabad, 30 August 2022 – As districts in Pakistan continue to be affected by massive monsoon rainfall and unprecedented levels of flooding, the World Health Organization (WHO) warns of significant public health threats facing affected populations, including the risk of further spread of water- and vector-borne diseases such as malaria and dengue fever.
The impact of the heavy monsoon rains, which began in mid-July 2022, is drastic, affecting 33 million people in 116 districts across the country, with 66 districts being hardest hit.
According to the Ministry of National Health Services, Regulations and Coordination, at least 1000 people have been killed and 1500 injured as a result of this natural disaster, and more than 161 000 people have been displaced to relief camps.
Around 888 health facilities have been damaged in the country, of which 180 are completely damaged, leaving millions of people lacking access to health care and medical treatment, as reported in many affected districts.
“According to a preliminary assessment conducted by WHO and humanitarian partners, the current level of devastation is much more severe than that caused by floods in Pakistan in previous years, including those that devastated the country in 2010,” said Dr Ahmed Al-Mandhari, WHO’s Regional Director for the Eastern Mediterranean. “WHO has initiated an immediate response to treat the injured, provide life-saving supplies to health facilities, support mobile health teams, and prevent the spread of infectious diseases.”
Ongoing disease outbreaks in Pakistan, including acute watery diarrhoea, dengue fever, malaria, polio, and COVID-19 are being further aggravated, particularly in camps and where water and sanitation facilities have been damaged. Even before the heavy rainfall and subsequent flooding, Pakistan had reported 4531 measles cases, and 15 cases of wild poliovirus in 2022. The rains and floods have disrupted the nationwide polio vaccination campaign in affected areas.
“WHO is working with health authorities to respond quickly and effectively on the ground. Our key priorities now are to ensure rapid access to essential health services to the flood-affected population strengthen and expand disease surveillance, outbreak prevention and control, and ensure robust health cluster coordination,” said Dr Palitha Mahipala, WHO Representative in Pakistan.
With projections that the floods will further worsen over the coming days, with an even greater humanitarian and public health impact, WHO’s immediate priorities are to rapidly expand access to essential health services to the flood-affected population, strengthen and expand disease surveillance, outbreak prevention and control, and ensure a well-coordinated response at national and subnational levels, including the involvement of all relevant partners.
The Government of Pakistan is leading the national response, including declaring a state of emergency in affected areas, establishing control rooms and medical camps at provincial and district level, organizing air evacuation operations, and conducting health awareness sessions for people who are now at increased risk of waterborne and vector-borne diseases, as well as other infectious disease such as COVID-19.
Working closely with the Ministry of National Health Services, Regulations and Coordination, WHO is increasing surveillance for acute watery diarrhoea, cholera, and other communicable diseases to avoid further spread, and is also providing essential medicines and medical supplies to functional health facilities treating affected communities. Prior to the flood, WHO and partners had undertaken vaccinations against cholera in response to the pre-existing outbreak. Pakistan is also one of the two remaining polio-endemic countries in the world, and polio teams in affected areas are expanding surveillance for both polio and other diseases. Polio workers are working closely with national authorities to support relief efforts, particularly in areas worst hit by the floods.
WHO has also diverted mobile medical camps, including those responding to COVID-19 teams, to affected districts, delivered 1 700 000 aqua tabs to ensure access to clean water, and provided sample collection kits to ensure clinical testing of samples to ensure early detection of infectious diseases.
While ensuring that essential medicines and equipment are available, WHO and partners are also conducting a broader immediate assessment of the health services impacted and identifying key priority areas requiring a response, including the delivery of routine and emergency health services. WHO’s Regional Office is also deploying a surge team of public health experts to scale up the country’s response capacity.
UNICEF works in some of the world’s toughest places, to reach the world’s most disadvantaged children. Across more than 190 countries and territories, we work for every child, everywhere, to build a better world for everyone.
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.
Newly established global estimate on hygiene reveals the risk of disease spread and infections to patients and health care providers
30 AUGUST 2022 | Geneva, New York – Half of health care facilities worldwide lack basic hygiene services with water and soap or alcohol-based hand rub where patients receive care and at toilets in these facilities, according to the latest Joint Monitoring Programme (JMP) report by WHO and UNICEF. Around 3.85 billion people use these facilities, putting them at greater risk of infection, including 688 million people who receive care at facilities with no hygiene services at all.
“Hygiene facilities and practices in health care settings are non-negotiable. Their improvement is essential to pandemic recovery, prevention and preparedness. Hygiene in health care facilities cannot be secured without increasing investments in basic measures, which include safe water, clean toilets, and safely managed health care waste,” said Dr Maria Neira, WHO Director, Department of Environment, Climate Change and Health. “I encourage Member States to step up their efforts to implement their 2019 World Health Assembly commitment to strengthen water, sanitation and hygiene (WASH) services in health care facilities, and to monitor these efforts.”
The latest report, “Progress on WASH in health care facilities 2000–2021: special focus on WASH and infection prevention and control”, has for the first time established this global baseline on hygiene services – which assessed access at points of care as well as toilets – as more countries than ever report on critical elements of WASH services in their hospitals and other health centres. For hygiene, data are now available for 40 countries, representing 35% of the world’s population, up from 21 countries in 2020 and 14 in 2019.
The newly established global estimate reveals a clearer and more alarming picture of the state of hygiene in health care facilities. Though 68% of health care facilities had hygiene facilities at points of care, and 65% had handwashing facilities with water and soap at toilets, only 51% had both and therefore met the criteria for basic hygiene services. Furthermore, 1 in 11 (9%) of health care facilities globally have neither.
“If health care providers don’t have access to a hygiene service, patients don’t have a health care facility,” said Kelly Ann Naylor, UNICEF Director of WASH and Climate, Environment, Energy, and Disaster Risk Reduction (CEED). “Hospitals and clinics without safe water and basic hygiene and sanitation services are a potential death trap for pregnant mothers, newborns, and children. Every year, around 670 000 newborns lose their lives to sepsis. This is a travesty – even more so as their deaths are preventable.”
The report notes that contaminated hands and environments play a significant role in pathogen transmission in health care facilities and the spread of antimicrobial resistance. Interventions to increase access to handwashing with water and soap and environmental cleaning form the cornerstone of infection prevention and control programmes and are crucial to providing quality care, particularly for safe childbirth.
Coverage of WASH facilities is still uneven across different regions and income groupings:
Facilities in sub-Saharan Africa are lagging on hygiene services. While three-quarters (73%) of health care facilities in the region overall have alcohol-based hand rub or water and soap at points of care, only one-third (37%) have handwashing facilities with water and soap at toilets. The vast majority (87%) of hospitals have hand hygiene facilities at points of care, compared to 68% of other healthcare facilities.
In the Least Developed Countries, only 53% of health care facilities have access on-premises to a protected water source. To compare, the global figure is 78% with hospitals (88%) doing better than smaller health care facilities (77%), and the figure for eastern and south-eastern Asia is 90%. Globally, around 3% of health care facilities in urban areas and 11% in rural areas had no water service.
Of the countries with available data, 1 in 10 health care facilities globally had no sanitation service. The proportion of health care facilities with no sanitation services ranged from 3% in Latin America and the Caribbean and in eastern and south-eastern Asia to 22% in sub-Saharan Africa. In the Least Developed Countries, just 1 in 5 (21%) had basic sanitation services in health care facilities.
The data further reveals that many health care facilities lack basic environmental cleaning and safe segregation and disposal of health care waste.
The report is being launched at World Water Week taking place in Stockholm, Sweden. The annual conference, which runs from 23 August to 1 September, explores new ways to tackle humanity’s greatest challenges: from food security and health to agriculture, technology, biodiversity and climate.
UNICEF works in some of the world’s toughest places, to reach the world’s most disadvantaged children. Across more than 190 countries and territories, we work for every child, everywhere, to build a better world for everyone.
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
Millions of lives are in peril, including children. US$ 123.7 million is needed for the health agency’s response until December 2022.
The World Health Organization (WHO) has published its first guideline for Ebola virus disease therapeutics, with new strong recommendations for the use of two monoclonal antibodies. WHO calls on the global community to increase access to these lifesaving medicines.
Ebola is a severe and too often fatal illness caused by the Ebola virus. Previous Ebola outbreaks and responses have shown that early diagnosis and treatment with optimized supportive care —with fluid and electrolyte repletion and treatment of symptoms—significantly improve survival. Now, following a systematic review and meta-analysis of randomized clinical trials of therapeutics for the disease, WHO has made strong recommendations for two monoclonal antibody treatments: mAb114 (Ansuvimab; Ebanga) and REGN-EB3 (Inmazeb).
Developed according to WHO standards and methods for guidelines, and published simultaneously in English and French, the guidelines will support health care providers caring for patients with Ebola, and policymakers involved in outbreak preparedness and response. The clinical trials were conducted during Ebola outbreaks, with the largest trial conducted in the Democratic Republic of the Congo, demonstrating that the highest level of scientific rigour can be applied even during Ebola outbreaks in difficult contexts.
The new guidance complements clinical care guidance that outlines the optimized supportive care Ebola patients should receive, from the relevant tests to administer, to managing pain, nutrition and co-infections, and other approaches that put the patient on the best path to recovery.
“This therapeutic guide is a critical tool to fight Ebola,” said Dr Richard Kojan, co-chair of the Guideline Development Group of experts selected by WHO and President of ALIMA, The Alliance for International Medical Action. “It will help reassure the communities, health care workers and patients, that this life-threatening disease can be treated thanks to effective drugs. From now on, people infected with the Ebola virus will have a greater chance of recovering if they seek care as early as possible. As with other infectious diseases, timeliness is key, and people should not hesitate to consult health workers as quickly as possible to ensure they receive the best care possible.”
The two recommended therapeutics have demonstrated clear benefits and therefore can be used for all patients confirmed positive for Ebola virus disease, including older people, pregnant and breastfeeding women, children and newborns born to mothers with confirmed Ebola within the first seven days after birth. Patients should receive recommended neutralizing monoclonal antibodies as soon as possible after laboratory confirmation of diagnosis.
There is also a recommendation on therapeutics that should not be used to treat patients: these include ZMapp and remdesivir.
All these recommendations only apply to Ebola virus disease caused by Ebola virus (EBOV; Zaire ebolavirus).
“Advances in supportive care and therapeutics over the past decade have revolutionized the treatment of Ebola. Ebola virus disease used to be perceived as a near certain killer. However, that is no longer the case,” said Dr Robert Fowler, University of Toronto, Canada and co-chair of the guideline development group. “Provision of best supportive medical care to patients, combined with monoclonal antibody treatment—MAb114 or REGN-EB3—now leads to recovery for the vast majority of people.”
Access to both these treatments remains challenging, especially in resource-poor areas. These drugs should be where patients need them the most: where there is an active Ebola outbreak, or where the threat of outbreaks is high or very likely. WHO is ready to support countries, manufacturers and partners to improve access to these treatments, and to support national and global efforts to increase affordability of biotherapeutics and their corresponding similar biotherapeutic products, WHO published the first invitation to manufacturers of therapeutics against Ebola virus disease to share their drugs for evaluation by the WHO Prequalification Unit, a crucial step to improve drug access for communities and countries affected by Ebola.
“We have seen incredible advances in both the quality and safety of clinical care during Ebola outbreaks,” said Dr Janet Diaz, lead of the clinical management unit in WHO’s Health Emergencies programme. “Doing the basics well, including early diagnosis, providing optimized supportive care with the evaluation of new therapeutics under clinical trials, has transformed what is possible during Ebola outbreaks. This is what has led to development of a new standard of care for patients. However, timely access to these lifesaving interventions has to be a priority.”
Although WHO was able to make strong recommendations for the use of two therapeutics, there is a need for further research and evaluation of clinical interventions, as many uncertainties remain. Further improvements could be made in supportive care, and in our understanding and characterization of Ebola virus disease and its longer-term consequences, and to ensure continued inclusion of vulnerable populations (pregnant women, newborns, children and older people) in future research.
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.
Globally, only half (52%) of children living with HIV are on life-saving treatment. UNAIDS, UNICEF, and WHO have brought together a new alliance to fix one of the most glaring disparities in the AIDS response.
Globally, only half (52%) of children living with HIV are on life-saving treatment, far behind adults where three quarters (76%) are receiving antiretrovirals, according to the data that has just been released in the UNAIDS Global AIDS Update 2022. Concerned by the stalling of progress for children, and the widening gap between children and adults, UNAIDS, UNICEF, WHO and partners have brought together a global alliance to ensure that no child living with HIV is denied treatment by the end of the decade and to prevent new infant HIV infections.
The new Global Alliance for Ending AIDS in Children by 2030 was announced by leading figures at the International AIDS Conference taking place in Montreal, Canada.
In addition to the United Nations agencies, the alliance includes civil society movements, including the Global Network of People living with HIV, national governments in the most affected countries, and international partners, including PEPFAR and the Global Fund. Twelve countries have joined the alliance in the first phase: Angola, Cameroon, Côte d'Ivoire, The Democratic Republic of the Congo (DRC), Kenya, Mozambique, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe.
Consultations by the alliance have identified four pillars for collective action:
1) Closing the treatment gap for pregnant and breastfeeding adolescent girls and women living with HIV and optimizing continuity of treatment;
2) Preventing and detecting new HIV infections among pregnant and breastfeeding adolescent girls and women;
3) Accessible testing, optimized treatment, and comprehensive care for infants, children, and adolescents exposed to and living with HIV;
4) Addressing rights, gender equality, and the social and structural barriers that hinder access to services.
Addressing the International AIDS Conference, Limpho Nteko from Lesotho shared how she had discovered she was HIV positive at age 21 while pregnant with her first child. This led her on a journey where she now works for the pioneering women-led mothers2mothers programme. Enabling community leadership, she highlighted, is key to an effective response.
“We must all sprint together to end AIDS in children by 2030,” said Ms. Nteko. “To succeed, we need a healthy, informed generation of young people who feel free to talk about HIV, and to get the services and support they need to protect themselves and their children from HIV. mothers2mothers has achieved virtual elimination of mother-to-child transmission of HIV for our enrolled clients for eight consecutive years—showing what is possible when we let women and communities create solutions tailored to their realities.”
The alliance will run for the next eight years until 2030, aiming to fix one of the most glaring disparities in the AIDS response. Alliance members are united in the assessment that the challenge is surmountable through partnership.
“The wide gap in treatment coverage between children and adults is an outrage,” said UNAIDS Executive Director Winnie Byanyima. “Through this alliance, we will channel that outrage into action. By bringing together new improved medicines, new political commitment, and the determined activism of communities, we can be the generation who end AIDS in children. We can win this – but we can only win together.”
"Despite progress to reduce vertical transmission, increase testing and treatment, and expand access to information, children around the world are still far less likely than adults to have access to HIV prevention, care, and treatment services," said UNICEF Executive Director Catherine Russell. "The launch of the Global Alliance to End AIDS in Children is an important step forward – and UNICEF is committed to working alongside all of our partners to achieve an AIDS-free future."
“No child should be born with or grow up with HIV, and no child with HIV should go without treatment,” said Dr Tedros Adhanom Gheberyesus, WHO Director-General. “The fact that only half of children with HIV receive antiretrovirals is a scandal, and a stain on our collective conscience. The Global Alliance to End AIDS in Children is an opportunity to renew our commitment to children and their families to unite, to speak and to act with purpose and in solidarity with all mothers, children and adolescents.”
Dr. Osagie Ehanire, Minister of Health of Nigeria, pledged to “change the lives of children left behind” by putting in place the systems needed to ensure that health services meet the needs of children living with HIV.
Nigeria, Dr Ehanire announced, will host the alliance’s political launch in Africa at a Ministerial meeting in October 2022.
The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals.
UNICEF works in some of the world’s toughest places, to reach the world’s most disadvantaged children. Across more than 190 countries and territories, we work for every child, everywhere, to build a better world for everyone.
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.
Millions of lives are in peril, including children. US$ 123.7 million is needed for the health agency’s response until December 2022.
Geneva/Nairobi, 2 August 2022 | The health and lives of people in the greater Horn of Africa are threatened as the region faces an unprecedented food crisis. In order to carry out urgent, life-saving work, WHO is today launching a funding appeal for US$ 123.7 million.
Over 80 million people in the 7 countries spanning the region – Djibouti, Ethiopia, Kenya, Somalia, South Sudan, Sudan and Uganda — are estimated to be food insecure, with upwards of 37.5 million people classified as being in IPC phase 3, a stage of crisis where people have to sell their possessions in order to feed themselves and their families, and where malnutrition is rife.
Driven by conflict, changes in climate and the COVID-19 pandemic, this region has become a hunger hotspot with disastrous consequences for the health and lives of its people.
“Hunger is a direct threat to the health and survival of millions of people in the greater Horn of Africa, but it also weakens the body’s defences and opens the door to disease,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “WHO is looking to the international community to support our work on the ground responding to this dual threat, providing treatment for malnourished people, and defending them against infectious diseases.”
The funds will go towards urgent measures to protect lives, including shoring up the capacity of countries to detect and respond to disease outbreaks, procuring and ensuring the supply of life-saving medicines and equipment, identifying and filling gaps in health care provisions, and providing treatment to sick and severely malnourished children.
With the upcoming rainy season expected to fail, the situation is worsening. There are already reports of avoidable deaths among children and women in childbirth. The risk of trauma and injuries is high as violence, including gender-based violence, is on the rise. There are outbreaks of measles in 6 of the 7 countries, against a background of low vaccination coverage. Countries are simultaneously fighting cholera and meningitis outbreaks as hygiene conditions have deteriorated, with clean water becoming scarce and people leaving home on foot to find food, water, and pasture for their animals.
The region already has an estimated 4.2 million refugees and asylum seekers, with this number expected to increase as more people are forced to leave their homes. When on the road, communities find it harder to access health care, a service already in short supply following years of underinvestment and conflict.
“Ensuring people have enough to eat is central. Ensuring that they have safe water is central. But in situations like these, access to basic health services is also central,” said Dr Michael Ryan, Executive Director of WHO’s Health Emergencies Programme. “Services like therapeutic feeding programmes, primary health care, immunization, safe deliveries and mother and child services can be the difference between life and death for those caught up in these awful circumstances.”
WHO has already released US$ 16.5 million from its Contingency Fund for Emergencies to ensure people have access to health services, to treat sick children with severe malnutrition and to prevent, detect, and respond to infectious disease outbreaks.
WHO thanks its donors who make it possible to carry out this life-saving work.
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.
As global crises continue to threaten the health and nutrition of millions of babies and children, the vital importance of breastfeeding as the best possible start in life is more critical than ever.
This World Breastfeeding Week, under its theme Step up for breastfeeding: Educate and Support, UNICEF and WHO are calling on governments to allocate increased resources to protect, promote, and support breastfeeding policies and programmes, especially for the most vulnerable families living in emergency settings.
During emergencies, including those in Afghanistan, Yemen, Ukraine, the Horn of Africa, and the Sahel, breastfeeding guarantees a safe, nutritious and accessible food source for babies and young children. It offers a powerful line of defense against disease and all forms of child malnutrition, including wasting.
Breastfeeding also acts as a baby’s first vaccine, protecting them from common childhood illnesses.
Yet the emotional distress, physical exhaustion, lack of space and privacy, and poor sanitation experienced by mothers in emergency settings mean that many babies are missing out on the benefits of breastfeeding to help them survive.
Fewer than half of all newborn babies are breastfed in the first hour of life, leaving them more vulnerable to disease and death. And only 44 per cent of infants are exclusively breastfed in the first six months of life, short of the World Health Assembly target of 50 per cent by 2025.
Protecting, promoting, and supporting breastfeeding is more important than ever, not just for protecting our planet as the ultimate natural, sustainable, first food system, but also for the survival, growth, and development of millions of infants.
That is why UNICEF and WHO are calling on governments, donors, civil society, and the private sector to step up efforts to:
· prioritize investing in breastfeeding support policies and programmes, especially in fragile and food insecure contexts;
· equip health and nutrition workers in facilities and communities with the skills they need to provide quality counselling and practical support to mothers to successfully breastfeed;
· protect caregivers and health-care workers from the unethical marketing influence of the formula industry by fully adopting and implementing the International Code of Marketing of Breast-Milk Substitutes, including in humanitarian settings; and
· implement family-friendly policies that provide mothers with the time, space, and support they need to breastfeed.
UNICEF works in some of the world’s toughest places, to reach the world’s most disadvantaged children. Across more than 190 countries and territories, we work for every child, everywhere, to build a better world for everyone.
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.