Since 13 May 2022, monkeypox has been reported to WHO from 23 Member States that are not endemic for monkeypox virus, across four WHO regions. Epidemiological investigations are ongoing. The vast majority of reported cases so far have no established travel links to an endemic area and have presented through primary care or sexual health services. The identification of confirmed and suspected cases of monkeypox with no direct travel links to an endemic area is atypical. Early epidemiology of initial cases notified to WHO by countries shows that cases have been mainly reported amongst men who have sex with men (MSM). One case of monkeypox in a non-endemic country is considered an outbreak. The sudden appearance of monkeypox simultaneously in several non-endemic countries suggests that there may have been undetected transmission for some time as well as recent amplifying events.
The current publication of Disease Outbreak News is an update to the previously published Disease Outbreak News of 21 May. This edition provides information on recently published WHO guidance for the outbreak. The background information, such as the description of the epidemiology of the disease, remains mostly unchanged.
As of 26 May, a cumulative total of 257 laboratory confirmed cases and around 120 suspected cases have been reported to WHO. No deaths have been reported.
The situation is evolving rapidly and WHO expects that there will be more cases identified as surveillance expands in non-endemic countries, as well as in countries known to be endemic who have not recently been reporting cases.
Immediate actions should focus on the following:
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.
Today, at the 75th World Health Assembly, Member States agreed to adopt a landmark decision to improve the World Health Organization’s financing model.
The decision adopted, in full, the recommendations of a Sustainable Financing Working Group made up of WHO’s Member States, which was set up in January 2021 and chaired by Björn Kümmel, from Germany.
In one of the key recommendations in the Working Group’s report to the Health Assembly, Member States target a gradual increase of their assessed contributions (membership dues) to represent 50% of WHO’s core budget by the 2030-2031 budget cycle, at the latest. In the last budget biennium, 2020-2021, assessed contributions represented only 16% of the approved programme budget.
The report includes other recommendations, such as exploring the feasibility of a replenishment mechanism to broaden the financing base. It also asks the WHO Secretariat to work with a Member States task group to strengthen WHO's governance, which will make recommendations on transparency, efficiency, accountability and compliance. The task group’s work will help ensure that increases to Member States’ assessed contributions will be accompanied by further reforms to the way the Organization operates.
WHO's current financing model has been identified by many experts as posing a risk to the integrity and independence of its work. WHO’s over-reliance on voluntary contributions, with a large proportion earmarked for specific areas of work, results in an ongoing misalignment between organizational priorities and the ability to finance them. The recommendations today are designed to substantially address these shortcomings.
It is intended that the gradual increase to assessed contributions will start with WHO’s 2024-25 budget, with a proposed 20% increase over the assessed contributions in the approved 2022-23 base budget. The aim is to reach 50% of WHO’s budget by 2028-2029 if possible, and by 2030-31 at the latest, up from the current 16% in 2020-21. This would mean that by 2028-2029, WHO would see an increase of roughly US$ 600 million a year in the part of its income that comes from the most sustainable and predictable sources.
More predictable and sustainable funding for WHO makes economic sense for the Organization’s contributors, with its new investment case ‘A Healthy Return’ showing that every US dollar invested in WHO delivers a return on investment of at least 35 US dollars. Sustainable financing will better equip WHO to deliver more effectively for all its Member States and their populations, for example through longer-term programming in countries and attracting and retaining expertise.
WHO Director-General Dr Tedros Adhanom Ghebreyesus said, “This decision addresses head-on the decades-long challenge WHO has faced on predictable, flexible and sustainable funding. Delivering on the target they have agreed today will mean our Member States are empowering WHO to meet their expectations and truly fulfill our mandate as the world’s leading global health authority.” “Coming on the day I am re-elected, this decision gives all of us at WHO renewed confidence as we face the future,” he added.
Björn Kümmel, deputy head of the global health division at Germany’s Federal Ministry of Health and chair of WHO’s Working Group on Sustainable Funding, said. “This decision is about nothing less than the future role of WHO in global health. Even beyond that, it is about what we envisage for the global health architecture: a less fragmented, better coordinated, more efficient and truly inclusive global health governance with a fundamentally strengthened WHO at its centre as the enabled leading and coordinating authority.”
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.
I want to start today by looking back, to where we have been over the past five years. The WHO Results Report for 2020-21 provides a detailed and interactive presentation of our work over the past two years against each of the “triple billion” targets. I commend it to you. Progress isn’t always fast or easy to measure. But in ways small and large, seen and unseen, I am proud to say that this Organization is making a difference.
Underpinning all of these achievements is the transformation journey that we have been on for five years. There have been many calls for WHO to change. And there is no question that more change is needed.
We still face many challenges. So we must look down, to see where we are now. As I said yesterday, the pandemic is far from over. And even as we continue to fight it, we face the task of restoring essential health services, with 90% of Member States reporting disruption to one or more essential health services.
Allow me now to look forward, to where I believe we need to go in the next five years. At the meeting of the Executive Board in January -- thank you to our chair of the board, Dr Amoth -- I outlined my five priorities for the next five years. We are calling on every government to put the health of its people at the centre of its plans for development and growth.
The pandemic has demonstrated why the world needs WHO, but also why the world needs a stronger, empowered and sustainably financed WHO. I welcome the recommendation of the Working Group on Sustainable Financing to increase assessed contributions to 50% of the core budget over the next decade. I also welcome the recommendation to consider a replenishment model, to broaden our financing base, and to provide more flexible funding for the programme budget. Your Excellency Ahmed Robleh Abdilleh, Minister of Health of Djibouti and President of the 75th World Health Assembly,
Excellencies, Ministers, heads of delegation, dear colleagues and friends,
Good morning. Bonjour.
Yesterday, I made my remarks on the theme of health for peace and peace for health, which Member States will discuss in the general debate.
I want to start today by looking back, to where we have been over the past five years.
You elected me five short years ago, with an ambitious agenda for universal health coverage; health emergencies; women's, children's and adolescents' health; the health impacts of climate and environmental change; and a transformed WHO.
Those priorities evolved into the 13th General Programme of Work and the “triple billion” targets, which the Health Assembly adopted in 2018.
The WHO Results Report for 2020-21 provides a detailed and interactive presentation of our work over the past two years against each of the “triple billion” targets. I commend it to you.
But I also want to reflect on everything we have achieved together over the past five years.
Progress isn’t always fast or easy to measure. But in ways small and large, seen and unseen, I am proud to say that this Organization is making a difference.
Let me start with our efforts to see 1 billion people enjoying better health and well-being.
Our projection is that we will almost reach this target by 2023, but progress is only about one quarter of what is required to reach the relevant SDG targets.
Still, there are encouraging trends and successes to celebrate.
In addressing the risk factors for noncommunicable diseases, many countries are making progress by reducing the use of health-harming products.
Tobacco use continues to decline. Since 2018, the number of countries on track to meet the target of a 30% reduction in tobacco use between 2010 and 2025 almost doubled, from 32 to 60 countries.
We also see encouraging progress against our target to eliminate industrially-produced trans fat from the global food supply by 2023.
Since we launched our REPLACE initiative in 2018, mandatory policies prohibiting the use of industrially-produced trans fat have been introduced in 58 countries accounting for 40% of the world’s population.
And in the past five years, more than two-thirds of Member States have either introduced or increased excise taxes on at least one health-harming product, such as tobacco, alcohol or sugary drinks.
At the same time, WHO has supported countries to create the environment and living conditions in which health can flourish.
At COP26 last year, more than 50 countries agreed to take concrete steps to develop climate-resilient, low-carbon health systems.
We issued new air pollution guidelines, setting new limits for air quality based on mounting evidence of the harms to health of air pollution at even lower concentrations than previously thought.
71 countries are now using WHO guidelines or tools on the health response to violence against women.
Road deaths have stabilized, despite a continued rise in the number of cars.
And the Global Network for Age-friendly Cities and Communities was expanded, supporting more than 1300 cities in 52 countries to become better places in which to live and age.
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Now to our efforts to see 1 billion more people benefitting from universal health coverage by 2023.
We are far behind, and progress is less than one quarter of what is required to reach the “triple billion” target.
Even before the pandemic, we estimated that only 270 million more people would be covered by 2023 – a shortfall of 730 million people against the target of 1 billion.
Disruptions to health services during the pandemic have sent us backwards, and we estimate the shortfall could reach 840 million.
Nevertheless, we have many achievements to be proud of over the past five years in our work to strengthen health systems and respond to communicable and noncommunicable diseases.
At the political level, we saw two major commitments, with the Astana Declaration on Primary Health Care in 2018, and the political declaration on universal health coverage at the UN General Assembly in 2019.
WHO’s Special Programme on Primary Health Care is now supporting 115 countries, compared with 30 five years ago.
Since 2015, 95% of these countries have made progress towards increased service coverage.
We have also seen encouraging trends in our work to strengthen the global health workforce.
Between 2013 and 2020, the number of health workers globally increased by 29%.
Previously, we projected a global shortage of 18 million health workers by 2030. That projected shortage has now shrunk to 15 million – but it is still a massive shortage.
In the past five years, we have also made significant progress in expanding access to medicines and other essential health products.
We have prequalified 53 vaccines, 50 in-vitro diagnostics and 288 medicines, including important new therapies for HIV, hepatitis, TB, malaria, NTDs and COVID-19.
We also prequalified two biosimilar cancer medicines and launched a pilot programme to prequalify human insulin, to make these life-saving but expensive therapies more affordable and accessible.
During the pandemic, we gave Emergency Use Listing to 12 COVID-19 vaccines and 28 in-vitro diagnostics.
Within 15 days of Emergency Use Listing of vaccines, 101 countries issued their own regulatory authorization, illustrating the weight that these countries place on WHO’s stamp of approval.
We have assessed regulatory systems in 80 countries, and supported 10 new countries to develop to higher regulatory levels, including four in Africa: Egypt, Ghana, Nigeria and Tanzania.
Recognizing that almost 90% of Member States report the use of traditional medicine, just last month we established the Global Centre for Traditional Medicine in India, to create a reliable body of evidence and data for practices and products that many millions of people use.
On communicable diseases, WHO guidelines have supported major gains in HIV testing and treatment, resulting in a 32% decline in HIV mortality since 2016.
We have validated 15 countries for the elimination of mother-to-child transmission of HIV and/or syphilis.
The SDG target on hepatitis B has been met, and since 2015 the number of people who have received treatment for hepatitis C has increased 9-fold to 9.4 million, reversing the trend of increasing mortality for the first time.
On TB, 33 countries have reached the target for a 35% reduction in TB deaths since 2015, and 86 have achieved a 20% reduction in incidence.
Since 2012, nine more countries have been certified as malaria free, and cases in the Greater Mekong have dropped by almost 90%.
And for the first time, we have a malaria vaccine. More than one million children in Ghana, Kenya and Malawi have now received at least one dose.
Widespread use of this vaccine, as WHO recommended last year, could save tens of thousands of young lives, especially in Africa, every year.
In the past five years, 14 additional countries and territories eliminated at least one neglected tropical disease.
Cases of African trypanosomiasis have declined by 90% in ten years.
And only 15 cases of Guinea worm disease were reported last year, compared with 3.5 million in the mid-1980s. Just two cases have been reported so far this year.
Our dream of a polio-free world is tantalisingly close, with four cases of wild poliovirus reported so far this year in Afghanistan and Pakistan – although two new cases in Malawi and Mozambique are a setback.
Since 2017, WHO and our partners in the Global Polio Eradication Initiative have provided 1.4 billion doses of polio vaccines to Member States at no cost.
Our investments in polio will not end when polio ends. The infrastructure and expertise we have built is already being used to deliver other vaccines and health services, including for COVID-19.
And we have made significant progress in our response to antimicrobial resistance.
High-level political leadership is essential to address the threat of AMR, which is why we established Global Leaders Group for AMR, chaired by Prime Minister Mia Mottley of Barbados and Prime Minister Hasina of Bangladesh.
Through WHO’s GLASS surveillance system, the number of countries collecting and sharing data on AMR has tripled, and we have seen a six-fold increase in the number of samples collected and analysed globally.
The AMR Multi-Partner Trust Fund was established, and is now supporting 11 countries to implement their national action plans.
And in 2020, the AMR Action Fund was set up to overcome funding barriers for antibiotic development. This year it made its first investments in the development of two antibacterials.
On noncommunicable diseases, over the past five years WHO has supported 36 countries to integrate services to prevent, detect and treat NCDs into primary health care programmes, and we have supported 25 countries with rehabilitation services.
More than 3 million people in 18 countries have gained access to treatment for hypertension, with increasing use of the WHO HEARTS package of interventions.
More than 30 countries have developed policies or programmes to improve access to childhood cancer care.
We’ve supported more than 40 countries to introduce HPV vaccines for the first time, as part of the Cervical Cancer Elimination Initiative.
And we have supported 31 more countries to integrate mental health services into primary health care.
Child survival has improved dramatically over the past 20 years, although 54 countries are off track to meet the SDG child survival targets.
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Now to our work on emergencies.
It’s clear that the world was – and remains – unprepared for a pandemic.
Every month, WHO processes more than 9 million pieces of information, screens 43000signals, reviews 4500 events, and verifies an average of 30 events.
In the past five years, WHO has responded to more than 120 emergencies – cyclones, volcanoes, earthquakes, outbreaks, wars – and a pandemic. Some last a few months; some last for years.
As we speak, my colleagues are responding to more than 50 emergencies around the world. In many cases, WHO is the first to arrive and the last to leave.
Since 2017, we have shipped more than US$1.6 billion worth of medical supplies all over the world, working with partners to support critical health emergency supply chains.
The WHO Logistics Hub in Dubai has expanded 10-fold.
Through the ACT Accelerator, WHO and our partners have delivered more than 1.5 billion vaccine doses, enabling 40 countries to begin their COVID-19 vaccination campaigns, as well as 159 million tests and US$222 million worth of therapeutics.
For the first time, we established a Division of Emergency Preparedness, which supported countries to prepare for thousands of mass gatherings, from the Olympic and Winter Olympic Games, to COP26 and the Dubai Expo.
We have introduced the Universal Health and Preparedness Review, which has now been tested successfully in four Member States: Central African Republic, Iraq, Thailand and Portgual, with support from a further 21 Member States.
And just last year, we created the Division for Health Emergency Intelligence and Surveillance, which has created the WHO Hub for Pandemic and Epidemic Intelligence, in Berlin.
This will build on our existing work by harnessing cutting-edge technologies and innovations in data science, and by fostering greater sharing of data and information between countries with a “collaborative intelligence” approach.
The Secretariat remains committed to supporting all Member States technically, operationally and logistically to continue responding to this pandemic, and to prepare for future health emergencies.
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All of these achievements, across the “triple billion” targets, have been supported by the new Divisions of Science and Data and Delivery for Impact, which we created in 2019.
The Science Division has supported the development of hundreds of guidelines and other normative products.
During the pandemic, WHO introduced a “living guidelines” approach, which cut the average time to production of guidance from as much as nine months to as little as five weeks.
WHO also established the mRNA technology transfer programme in South Africa to support countries to build local manufacturing capacity, using cutting edge technology.
The Division of Data and Delivery for Impact has supported countries to improve their data systems through WHO’s SCORE technical package, and consolidated data in the World Health Data Hub.
Last year, we broke ground on the WHO Academy in Lyon. Already the Academy is offering several training courses, attracting strong interest.
For instance, the Academy's Mass Casualty Management Program has now been successfully delivered in 14 countries, reaching more than 100 hospitals.
The Global Action Plan for Healthy Lives and Well-being for All has helped strengthen collaboration among 13 multilateral agencies on primary health care and other areas in more than 50 countries.
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Underpinning all of these achievements is the transformation journey that we have been on for five years.
There have been many calls for WHO to change. And there is no question that more change is needed.
But this is an Organization that has changed, and is still changing, introducing the concept of continuous improvement.
We have built a new strategy, moving from a focus on outputs to outcomes;
New processes, to make us more effective, efficient and agile;
A new operating model, moving from a fragmented organization to one that is more integrated, aligned and agile;
A new approach to partnerships, moving from risk aversity to risk management;
A new approach to financing, towards more sustainability and predictability;
And a new culture, based on shared values of service, professionalism, integrity, collaboration and compassion.
The pandemic has put our transformation to the test. It has shown the value of the changes we have made, and areas where we must continue to improve.
We have more work to do to deliver the results, the efficiency, the accountability, and the transparency that you, our Member States, expect – including being an Organization with zero tolerance for sexual exploitation, abuse and harassment, and zero tolerance for inaction against it.
I provide regular and full updates on our PRSEAH work to Member States regularly, and a detailed report on our Management Response Plan is in my report to this Assembly.
Be assured of my complete personal commitment to this issue. We are implementing wide-ranging changes to our Organization, which you will hear more about in my report on this issue later this week.
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Looking back, we have achieved so much together over the past five years. We have many reasons to be proud.
But we still face many challenges.
So we must look down, to see where we are now.
As I said yesterday, the pandemic is far from over.
And even as we continue to fight it, we face the task of restoring essential health services, with 90% of Member States reporting disruption to one or more essential health services.
One of the most common is immunization.
The number of children receiving no doses of DTP vaccine has barely changed for a decade, until 2020, when it jumped by more than 25%, taking us back to the 2005 level.
Progress on sexual and reproductive health, including maternal mortality, remains slow.
One in 3 women will suffer physical or sexual violence in their lifetime;
Hypertension causes one-third of all deaths, but only half of cases are diagnosed, and less than half of those are treated;
The pandemic has led to a massive increase of 28% in depression and 26% in anxiety disorders globally.
Malaria-related deaths have been increasing since 2015, and TB deaths rose last year for the first time in a decade;
In 2020, the number of people receiving treatment for a neglected tropical disease fell by 25% as a result of health service disruptions caused by the pandemic.
Only 20% of national AMR action plans are fully-funded, most in higher income countries.
Since 2000, the number of people globally who face financial hardship because of out-of-pocket health spending has increased by 75%, to close to 2 billion people.
I could go on. You get the picture.
The needs of our world remain daunting and complex.
But none of these challenges are insurmountable. For every challenge, there are solutions. If there is a will, there is a way.
So how will we harness those solutions to overcome the challenges we face, and accelerate progress towards the “triple billion” targets and the Sustainable Development Goals?
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We have looked back, to where we’ve come from; we have looked down, at where we are.
Allow me now to look forward, to where I believe we need to go in the next five years.
At the meeting of the Executive Board in January – thank you to our chair of the board, Dr Amoth – I outlined my five priorities for the next five years.
Since then, the Secretariat has been further developing how we will work with Member States to deliver on these priorities, which we are now describing as follows:
Promoting health – by addressing the root causes of disease and creating the conditions for good health and well-being;
Providing health services – by reorienting health systems towards primary health care as the foundation of universal health coverage;
Protecting health – by strengthening the global architecture for health emergency preparedness, response and resilience;
Powering progress – by harnessing science, research, innovation, data, and digital technologies;
And performing – by building a stronger WHO that delivers results, and is reinforced to play its leading role in global health.
First, promoting health.
Realising our vision for the highest attainable standard of health starts not in the clinic or the hospital, but in schools, streets, supermarkets, households and suburbs.
Much of the work that you do as Ministries of Health is dealing with the consequences of poor diets, polluted environments, unsafe roads and workplaces, inadequate health literacy, and the aggressive marketing of products that harm health.
We need an urgent paradigm shift, towards promoting health and well-being and preventing disease by addressing its root causes.
Globally, only 3 percent of health budgets are spent on promotion and prevention. And yet increased investment in these areas could reduce the global disease burden by half, generating massive returns for individuals, families, communities and nations.
We are calling on every government to put the health of its people at the centre of its plans for development and growth.
In the next five years, WHO is committed to supporting all Member States to focus attention on the highest-impact transformations:
To decarbonize your health sectors;
To implement air quality standards;
To reduce car dependence and promote public transport;
To ensure all health facilities have electricity, and safe water and sanitation;
To improve diet, nutrition and food safety; and in particular to stop the rise in obesity in 24 high-burden countries by 2025;
And to reduce consumption of health-harming products.
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The second priority is providing health services – by reorienting health systems towards primary health care as the foundation of universal health coverage.
At present, health spending in most countries is imbalanced towards secondary and tertiary care, with huge amounts spent on expensive equipment and medicines that often deliver modest health gains.
By contrast, 90% of essential health services can be delivered through primary health care;
And we estimate that investing in primary health care could increase global life expectancy by as much as 6.7 years by 2030.
We need a radical shift to accelerate progress towards universal health coverage, with a significant increase in investments in primary health care in all countries – high, middle, low income. We have seen globally that the weakness is in primary health care.
Crucially, we call on all Member States to ensure that seeking health care is never a source of financial hardship.
The Secretariat’s proposed target therefore is to support 25 countries to halt the rise in financial hardship caused by out-of-pocket health spending by 2025.
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The third priority is protecting health – by strengthening the global architecture for health emergency preparedness, response and resilience.
In response to the request from the Executive Board, and in consultation with Member States, the Secretariat has prepared a proposal for a more equitable, inclusive and coherent global architecture.
This proposal synthesizes and builds on more than 300 recommendations from the various reviews of the global response to the pandemic.
The international accord, which Member States are now negotiating, will provide a vital overarching legal framework, under which we make 10 recommendations, in three key areas.
First, we need governance that is coherent, inclusive and accountable.
Second, we need stronger systems and tools to prevent, detect and respond rapidly to health emergencies.
And third, we need adequate and efficient financing, domestically and internationally.
Underpinning these proposals, we need a stronger and sustainably financed WHO at the centre of the global health security architecture. I will return to this in a few moments.
The Secretariat looks forward to your feedback on this proposed architecture, but more importantly, to building it with you.
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Our fourth strategic priority is powering progress – by harnessing science, research, innovation, data, and digital technologies.
Advances in science and research are constantly pushing back the boundaries of the unknown and the impossible, increasing our understanding, and opening new possibilities.
Innovations in health products and service delivery offer give us hope of overcoming challenges that once seemed insurmountable.
Developments in big data and machine learning are helping us to see who is being left behind, where the biggest gaps are, and to track progress against our targets.
And digital technologies offer huge potential for delivering health services in new ways, to more people, especially in hard-to-reach areas.
To pick up the pace towards the “triple billion” targets and the SDGs, we must pick up the pace and scale at which science, research, innovations and digital technologies are adopted and implemented.
Equity is key: the best science and innovations are those that make the biggest difference to people who are furthest behind.
This cannot be left to chance, goodwill or market forces.
The Secretariat’s proposal for the next five years is to support the scaling of at least five innovations that reach at least five million people each.
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The fifth priority is performing – by building a stronger WHO that delivers results, and is reinforced to play its leading role in global health.
The pandemic has demonstrated why the world needs WHO, but also why the world needs a stronger, empowered and sustainably financed WHO. Many of you have said it more eloquently – thank you so much.
I welcome the recommendation of the Working Group on Sustainable Financing to increase assessed contributions to 50% of the core budget over the next decade. I would like to use this opportunity to thank Björn Kümmel for his incredible leadership, all bureau members, and all Member States for your support.
I also welcome the recommendation to consider a replenishment model, to broaden our financing base, and to provide more flexible funding for the programme budget.
These recommendations could completely transform this Organization.
For many months I have said that fixing WHO’s financing was a case of now or never.
If adopted by this Health Assembly as I hope they will be, you will have given your answer. You have chosen now.
I thank all Member States for their commitment over the last year and their engagement in the negotiations. It has been tough, but you have made it.
We recognize and agree that with increased trust comes increased responsibility.
The Secretariat welcomes the Working Group’s recommendation to further strengthen governance, transparency, accountability, efficiency and compliance, and we look forward to working with the Member States task team to move this forward.
We will work day and night to deliver on these issues.
A key priority for the next five years is to further strengthen our work in our country offices. I assure you that all roads will lead ot the countries, based on country priorities.
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Mr President, Excellencies, dear colleagues and friends,
We have looked back, at where we have been.
We have looked down, at where we are.
And we have looked forward, to where we must go.
Now, I invite you to look up.
How will we overcome the many challenges we face, and reach the targets we set for ourselves?
It takes good data;
It takes good planning;
It takes good science;
It takes strong political commitment;
But more than anything else, it takes hope – the belief that things can be better.
As President Milanović of Croatia said yesterday, the President of the very first World Health Assembly, held in 1948, was a Croat, Dr Andrija Štampar.
Dr Štampar was a visionary, and one of the architects of the WHO Constitution, including its timeless preamble.
In his address to that first Health Assembly 74 years ago, Dr Štampar said this:
“It is obvious that we cannot proceed to the solution of health problems in the same way in all countries.
“Each country has its own peculiarities, and what may be good for one may not be so good for another.
“But one basic truth applies to all of them, and that is that every individual has a fundamental right to health.”
It is that right to health for which this Organization has been striving for three-quarters of a century.
And it is that right to health for which we will continue to strive;
For which I will continue personally to strive, because health is a fundamental human right. It’s an end in itself, and a means to development.
Thank you so much and I look forward to working with you. Thank you for your confidence and support.
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 13 May 2022, WHO was notified of two laboratory confirmed cases and one probable case of monkeypox, from the same household, in the United Kingdom. On 15 May, four additional laboratory confirmed cases have been reported amongst Sexual Health Services attendees presenting with a vesicular rash illness and in gay, bisexual, and other men who have sex with men (GBMSM).
As response measures, an incident team has been established to coordinate contact tracing efforts.
In contrast to sporadic cases with travel links to endemic countries (see Disease outbreak news on Monkeypox in the United Kingdom published on 16 May 2022), no source of infection has been confirmed yet. Based on currently available information, infection seems to have been locally acquired in the United Kingdom. The extent of local transmission is unclear at this stage and there is the possibility of identification of further cases.
On 13 May 2022, the United Kingdom notified WHO of two laboratory confirmed cases and one probable case of monkeypox to WHO. All three cases belong to the same family.
The probable case is epidemiologically linked to the two confirmed cases and has fully recovered. The first case identified (index case) developed a rash on 5 May and was admitted to hospital in London, the United Kingdom on 6 May. On 9 May, the case was transferred to a specialist infectious disease centre for ongoing care. Monkeypox was confirmed on 12 May. Another confirmed case developed a vesicular rash on 30 April, confirmed to have monkeypox on 13 May, and is in a stable condition.
The West African clade of monkeypox was identified in the two confirmed cases using reverse transcriptase polymerase chain reaction (RT PCR) on vesicle swabs on 12 May and 13 May.
On 15 May, WHO was notified of four additional laboratory confirmed cases, all identified among GBMSM attending Sexual Health Services and presenting with a vesicular rash. All four were confirmed to have the West African clade of the monkeypox virus.
Monkeypox is a sylvatic zoonosis with incidental human infections that usually occur in forested parts of Central and West Africa. It is caused by the monkeypox virus which belongs to the orthopoxvirus family. Monkeypox can be transmitted by droplet exposure via exhaled large droplets and by contact with infected skin lesions or contaminated materials. The incubation period of monkeypox is usually from 6 to 13 days but can range from 5 to 21 days. The disease is often self-limiting with symptoms usually resolving spontaneously within 14 to 21 days. Symptoms can be mild or severe, and lesions can be very itchy or painful. The animal reservoir remains unknown, although is likely to be among rodents. Contact with live and dead animals through hunting and consumption of wild game or bush meat are known risk factors.
There are two clades of monkeypox virus: the West African clade and Congo Basin (Central African) clade. Although the West African clade of monkeypox virus infection sometimes leads to severe illness in some individuals, disease is usually self-limiting. The case fatality ratio for the West African clade has been documented to be around 1%, whereas for the Congo Basin clade, it may be as high as 10%. Children are also at higher risk, and monkeypox during pregnancy may lead to complications, congenital monkeypox or stillbirth.
Milder cases of monkeypox may go undetected and represent a risk of person-to-person transmission. There is likely to be little immunity to the infection in those travelling or otherwise exposed, as endemic disease is normally geographically limited to parts of West and Central Africa. Historically, vaccination against smallpox was shown to be protective against monkeypox. While one vaccine (MVA-BN) and one specific treatment (tecovirimat) were approved for monkeypox, in 2019 and 2022 respectively, these countermeasures are not yet widely available, and populations worldwide under the age of 40 or 50 years no longer benefit from the protection afforded by prior smallpox vaccination programmes.
Health authorities in the United Kingdom have established an incident management team to coordinate the extensive contact tracing which is currently underway in health care settings and the community for those who have had contact with the confirmed cases. Contacts are being assessed based on their level of exposure and followed up through active or passive surveillance for 21 days from the date of last exposure to a case. Vaccination is being offered to higher risk contacts.
A detailed backwards contact tracing investigation is also being carried out to determine the likely route of acquisition and establish whether there are any further chains of transmission within the United Kingdom for all cases. Sexual contacts and venues visited (for example saunas, bars and clubs) are actively being investigated for the four GBMSM cases.
No source of infection has yet been confirmed for either the family or GBMSM clusters. Based on currently available information, infection seems to have been locally acquired in the United Kingdom. The extent of local transmission is unclear at this stage and there is the possibility of identification of further cases. However, once monkeypox was suspected, authorities in the United Kingdom promptly initiated appropriate public health measures, including isolation of the cases and extensive forward and backward contact tracing to enable source identification.
In the United Kingdom, there have been eight previous cases of monkeypox reported: all importations were related to a travel history to or from Nigeria. In 2021, there were also two separate human monkeypox cases imported from Nigeria reported by the United States of America. During an outbreak of monkeypox in humans in 2003 in the United States of America, exposure was traced to contact with pet prairie dogs that had been co-housed with monkeypoxvirus-infected small mammals imported from Ghana.
Intensive public health measures should continue in the United Kingdom. In addition to the ongoing forward and backward contact tracing and source tracing, case searching, and local rash-illness surveillance should be strengthened in the GBMSM and wider community, as well as in primary and secondary health care settings. Any patient with suspected monkeypox should be investigated and isolated with supportive care during the presumed and known infectious periods, that is, during the prodromal and rash stages of the illness, respectively. Timely contact tracing, surveillance measures and raising awareness among health care providers, including sexual health and dermatology clinics, are essential for preventing further secondary cases and effective management of the current outbreak. Additionally, deployment of pharmaceutical countermeasures under investigational protocols can be considered.
Health workers and other care givers caring for patients with suspected or confirmed monkeypox should implement standard, contact and droplet infection control precautions. Samples taken from people with suspected monkeypox or animals with suspected monkeypox virus infection should be safely handled by trained staff working in suitably equipped laboratories.
Any illness during travel or upon return from an endemic area should be reported to a health professional, including information about all recent travel and immunization history. Residents and travellers to endemic countries should avoid contact with sick animals (dead or alive) that could harbour monkeypox virus (rodents, marsupials, primates) and should refrain from eating or handling wild game (bush meat). The importance of hand hygiene by using soap and water or alcohol-based sanitizer should be emphasized.
International travel or trade: WHO does not recommend any restriction for travel to and trade with the United Kingdom based on available information at this time.
WHO continue to closely monitor as the situation is evolving rapidly.
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.
This statement acknowledges the growing body of evidence regarding the value of an additional booster dose for some population groups and highlights research gaps.
WHO with support of SAGE has reviewed the available data from seven studies published so far, which show some short-term benefit of an additional booster dose in the highest risk group (health workers, those over the age of 60 and immunocompromised persons).
However, the data is only available for the mRNA vaccines and there is limited data regarding the duration of protection and the benefits of an additional booster dose for healthy younger people.
More data is needed to evaluate the benefits of an additional booster dose for other population groups and vaccine platforms. When this is available, SAGE will update its recommendations accordingly.
Countries considering introducing a fourth additional booster dose should carefully weigh up the financial and programmatic challenges against the incremental benefits expected.
The World Health Organization, with the support of the Strategic Advisory Group of Experts (SAGE) on Immunization and its COVID-19 Vaccines Working Group, continues to review the emerging evidence on the need for and timing of additional booster doses for the currently available COVID-19 vaccines which have received Emergency Use Listing (EUL). The statements and conclusions in this document will be updated as new data become available.
The objective of this statement is to review the evidence on additional booster doses. In considering additional booster doses, there are two main scenarios to assess: 1) the use of additional booster doses in those who are not able to mount and sustain adequate immune responses and 2) considerations for additional booster doses to be administered in order to protect high risk populations and health workers in order to maintain the health system during periodic waves of disease surges.
(1) initial booster doses
Booster doses should be offered based on evidence that doing so would have substantial impact on reducing hospitalization, severe disease and death, and to protect health systems. The order of implementing booster doses to different population groups should follow that which has been laid out for the primary vaccination series – i.e., booster doses should be prioritized for higher priority-use groups before lower priority-use groups, unless there is adequate justification not to do so. Such justification may include programmatic constraints or acceptability obstacles to uptake in higher priority-use groups that would result in vaccine wastage. In such cases, strategies should be prioritized to improve vaccine delivery, community engagement, and social mobilization efforts to reach higher priority-use groups.
Within a given priority-use group, primary series vaccination will have greater impact per dose than additional doses. Across priority-use groups, the benefits of additional doses for higher priority-use groups versus primary series doses for lower priority-use groups depends on country conditions, including supply and roll-out timelines, past epidemic dynamics and infection-induced immunity, vaccine product, vaccine effectiveness, and waning of protection. When high primary series coverage rates have been achieved among subgroups at higher risk of severe disease and death (e.g., older adults), additional doses for these subgroups may yield greater reductions in severe disease and death than use of equivalent vaccine supply for primary series vaccination of lower priority-use groups.
The optimal interval between completion of a primary series and administration of additional doses has yet to be determined, and depends on epidemiological setting, vaccine product, targeted age groups, background seroprevalence, and circulation and frequency of specific variant of concerns (VoC). As a general principle, an interval of 4–6 months since completion of the primary series could be considered, especially in the context of Omicron.
Booster doses should be considered for all COVID-19 vaccines having received EUL as per WHO’s product specific interim recommendations.
(2) Additional doses in immunocompromised persons
Available data for WHO EUL COVID-19 vaccine products suggest that vaccine effectiveness and immunogenicity are lower in immunocompromised persons (ICPs), compared to persons without immunocompromising conditions. An additional dose included in an extended primary series enhances immune responses in some ICPs (2, 3). Given the significant risk of severe COVID-19 for ICPs, if infected, WHO has already issued a recommendation for an extended primary series (i.e. third dose) as well as a booster dose (i.e. fourth dose) for ICPs, for all COVID-19 vaccines (1, 4). Homologous (same vaccine platform) and heterologous (different vaccine platform) vaccines can be used for such booster doses (5).
Additional booster doses beyond the first booster dose are currently being offered by some countries (i.e. fourth dose to older adults and a fifth dose for immunocompromised persons). Data on the usefulness of these additional booster doses is sparse and especially limited on the duration of further protection. Data on additional booster doses as of May 2022 only exists for the mRNA vaccines, and not for other vaccine platforms. Hence, in the following we only focus on the evidence with regards to additional booster for mRNA vaccines, while encouraging more data to be accrued for all vaccine platforms.
Seven studies were available for review, six of which were from Israel (6-11) and one from Canada (12). All were conducted during a time when Omicron has been the predominant circulating strain globally. While the studies vary in their design and population investigated, most evaluated the relative effectiveness of a fourth dose 4 months after a 3rd dose of mRNA vaccine compared to those who received 3 doses. This relative vaccine effectiveness only provides evidence on the value of a fourth dose compared to individuals who already have some vaccine induced protection (3 dose recipients). The relative vaccine effectiveness depends upon the initial VE provided by 3 doses and how much subsequent waning has occurred. In contrast, earlier studies provide an absolute vaccine effectiveness comparing vaccinated versus unvaccinated individuals. The Canadian study is the only available study that provides data on absolute vaccine effectiveness (i.e., compares 4th dose schedule to those who are unvaccinated). Additionally, the maximum follow up in the available studies was short and ranged from two weeks to ten weeks after the fourth dose.
Of the seven studies that investigated the use of a 4th dose of mRNA COVID vaccine, two reported specifically on outcomes of infection and any symptomatic disease (10, 11). Both studies were conducted in Israel and included health workers (HWs) as their population of interest. One study showed an increased IgG antibodies against SARS-CoV-2 receptor-binding domain and neutralizing antibody titers by a factor of 9-10 measured after fourth dose of vaccine. This corresponded to antibody titers that were slightly higher than those achieved after the third dose, with no significant difference between the two mRNA vaccines (11). The second study investigated breakthrough infections in HWs who received 3 doses of BNT162b2 vaccine and provided a comparison to those who received a fourth dose of BNT162b2. In fourth dose recipients, there was a reduction in breakthrough infection rates compared to that observed after only a 3rd dose of mRNA vaccine (10).
Of the remaining five studies, all were conducted in individuals older than 60 years of age, excluding individuals who had previous SARS-Co-2 infection and specifically evaluated mRNA vaccines. Two of the studies were retrospective cohort studies using administrative data. The first study found that the relative vaccine effectiveness against severe disease to be 66% (95% CI, 57-72) 15 to 21 days after a fourth dose and 77% (95% CI, 62-86) 36-42 days after a fourth dose (6). The second retrospective cohort study reported on death as the outcome measure and found a relative vaccine effectiveness of 78% (95% CI 72-83) 7 or more days post fourth dose. The absolute risk reduction conferred by the fourth dose was 0.07% in the study (9). The third study used a test negative design and reported on severe disease. They found a relative vaccine effectiveness of 87% (95% CI 0-98) 49-69 days post fourth booster. This study reported that severe disease was a relatively rare event, occurring among <1% of both fourth dose and third dose only recipients (8). The fourth study reviewed was a target trial (application of trial design principles from RCTs to the analysis of observational data(13)) that provided outcome data for hospitalization, severe disease and death. They found a relative vaccine effectiveness of 62% (95% CI, 50 to 74) against severe COVID-19, and 74% (95% CI, 50 to 90) against COVID-19 related death comparing 3 dose recipients to 4 dose recipients. A further analysis of the risk of severe COVID-19 from 7 days to 30 days post fourth dose was 42.1 events per 100,000 persons, as compared with 110.8 events per 100,000 persons in the 3 dose recipient control group. This corresponds to a difference in risk of 68.8 cases per 100,000 persons (95% CI, 48.5 to 91.9)(7).
The final study, conducted in Canada, investigated not only the relative vaccine effectiveness but also the absolute vaccine effectiveness when compared to unvaccinated individuals, two dose recipients as well as three dose recipients. This study found that with each additional dose, VE increased for severe disease. Absolute VE was 82% (95%CI 75-88%) as measured more than 84 days after third dose, and 92% (95%CI 87-95%) for fourth dose recipients at greater than 7 days after the fourth dose (12).
Taken together, these studies show some short-term benefit of an additional booster dose of mRNA vaccine in health workers, those over 60 years of age or with immunocompromising conditions. Data to support an additional dose for healthy younger populations are limited; preliminary data suggest that in younger people, the benefit is minimal. Moreover, follow-up time after the additional booster dose was limited, thereby precluding conclusions about duration of protection after this dose. Therefore, there is a lack of data to guide some important questions for making policy decisions. The limited available data suggest that for highest risk groups there is a benefit that supports the administration of an additional booster dose.
Administering an additional booster dose likely comes with considerable programmatic challenges in terms of vaccine delivery in many settings. The financial and opportunity cost of such programmes must also be carefully weighed against the limited incremental benefit of an additional booster dose. In those most at risk for severe disease or death (i.e. adults above the age of 60 years, or those who are not able to mount a full immune response), the additional benefit of an additional booster dose of mRNA vaccine might be warranted.
For longer-term considerations, there are significant uncertainties related to the evolution of the virus and the characteristics of future variants. Given widespread transmission of Omicron globally, continued viral evolution with the emergence of new variants or sub lineages as is already being seen. Development of a pan-SARS-CoV-2 or pan-sarbecovirus vaccines are needed, but the timeframe for their development is uncertain (14). Meanwhile, the composition of the currently available COVID-19 vaccines may need to be updated to offer better protection against new VOCs which may be antigenically distinct (14). Current vaccines based on the index virus appear to maintain high VE against severe disease also in the context of current variants of concerns, but VE estimates against infection and symptomatic diseases are lower against Omicron. Any update to vaccine composition would aim to elicit greater breadth in the immune response against circulating and emerging variants, in addition to retaining protection against severe disease and death. The performance of any updated vaccine(s) may vary depending on the nature and magnitude of previously acquired immunity, recognizing that this immunity will be dependent upon different VOCs, different types of vaccines and their timing of administration.
While seasonality is not yet fully established for SARS-COV-2, evidence from the past two years support the notion of more substantial transmission during the winter season. Therefore, for countries with either a Northern or Southern Hemisphere winter season, plans for catch-up to improve primary series coverage and boosting for those at highest risk, campaigns should take seasonality into account. In addition, in view of the uncertainty of the characteristics of new VOC, which may emerge rapidly, there may be value in establishing vaccine induced immunity using existing vaccines (i.e. index virus) complemented by a booster dose of variant vaccine to broaden the immunological response. The Technical Advisory Group on COVID-19 Vaccine Composition will provide advice on updated vaccine composition when data is available.
To that end, in order to make sound policy decisions, data will need to be generated on the performance of current and variant-specific candidate COVID-19 vaccines, including the VE, immunogenicity and safety of an additional booster dose over time and by disease outcome and priority use groups. More research is needed on the breadth, magnitude, and durability of humoral and cell-mediated immune responses to variants. Also needed is evidence to address other gaps in the evidence regarding the need for additional booster doses, which includes the duration of VE of inactivated, subunit and viral vectored vaccines over time and by disease outcome. Finally, an understanding of the vaccine correlates of protection and correlates of durability of protection in persons with and without previous COVID-19 infection would assist policy makers in creating sound programmatic decisions.
SAGE as well as the Technical Advisory Group on COVID-19 Vaccine Composition (TAG-CO-VAC) continue to monitor the situation carefully and the WHO position will be updated accordingly.
The World Health Organization provides global leadership in public health within the United Nations system. Founded in 1948, WHO works with 194 Member States, across six regions and from more than 150 offices, to promote health, keep the world safe and serve the vulnerable. Our goal for 2019-2023 is to ensure that a billion more people have universal health coverage, to protect a billion more people from health emergencies, and provide a further billion people with better health and wellbeing.
In a world threatened by conflict, inequities, the climate crisis and pandemics, the Seventy-fifth session of the World Health Assembly will stress the importance of building a healthy and peaceful planet by harnessing science, data, technology and innovation.
This year’s session of the Health Assembly will focus on the theme of “Health for Peace, Peace for Health” and will run from the 22nd until the 28th of May at the Palais des Nations in Geneva. It will include the appointment of the next WHO Director-General.
“The pandemic has undermined progress towards the health-related targets in Sustainable Development Goals and laid bare inequities within and between countries,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Sustained recovery will require more than ‘getting back on track’ and reinvesting in existing services and systems. We need a new approach, which means shifting priorities and focusing on the highest-impact interventions.”
The Seventy-fifth World Health Assembly will kick off with a high-level segment on 22 May with speeches from the elected Health Assembly President, Heads of State, special guests, an address by the WHO Director-General and the presentation of the Director-General’s Health Awards. The Director-General’s speech will set out WHO’s five priorities going forward, expanding from the vision delivered at the Executive Board meeting held in January 2022.
Ahead of the Health Assembly, on 20 May, WHO will publish the latest set of World Health Statistics, its annual compilation of health statistics for WHO’s 194 Member States. The latest edition summarizes trends in life expectancy and causes of death and reports on progress towards global health/development goals for 2020.
The 2020-2021 Results Report, also published before WHA, summarizes the Organization's achievements and challenges in implementing the programme budget.
The Health Assembly will discuss global strategies on food safety, oral health, and tuberculosis research and innovation. It will also discuss the report of the Working Group on WHO Sustainable financing.
Strengthening WHO preparedness for and response to health emergencies
An implementation road map 2023–2030 for the global action plan for the prevention and control of non-communicable diseases
Intersectoral Global Action Plan on epilepsy and other neurological disorders 2022-2031
Prevention of sexual exploitation, abuse and harassment
Poliomyelitis
Global Health for Peace Initiative
Agenda items will be discussed in Committee A, which deals with predominantly programme and budget matters, and Committee B, which deals mainly with administrative, financial and legal matters. Details can be found in the provisional agenda. The venues at the Palais des Nations are: Plenary -- room XIX; Committee A -- room XX; and Committee B -- room XVII.
Assembly delegates, partner agencies, representatives of civil society and WHO experts will also discuss priorities for public health in a series of strategic roundtables. Discussions can be followed online here.
The Health Assembly is WHO’s highest decision-making body, setting out the Organization’s policy and approving its budget. WHA is attended by delegations from all WHO 194 Member States. The Health Assembly’s agenda is prepared by the Programme, Budget and Administration Committee of the Executive Board, which will meet on 18-20 May, 2022.
The Health Assembly is open to Member States, Associate Members, Observers, invited representatives of the UN and other participating inter-governmental organizations and non-State actors.
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.
Expressing concern at the COVID-19 outbreak in DPR Korea, the World Health Organization today reiterated its commitment to support the country respond to the pandemic.
“WHO is concerned and ready to support the government and the people of DPR Korea to respond to the pandemic and save lives,” said Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia, taking note of reports by KCNA, official DPRK news agency, about deaths and a large number of people with fever.
WHO is awaiting information from the national focal person for International Health Regulations (IHR) about the outbreak.
“We stand committed to assist our Member country, as needed, by providing technical support to scale up testing, strengthen case management, implement situation specific public health and social measures, and provide essential medical supplies and medicines,” the Regional Director said.
WHO had supported the country develop its national strategic preparedness and response plan for COVID-19.
“With the country yet to initiate COVID-19 vaccination, there is risk that the virus may spread rapidly among the masses unless curtailed with immediate and appropriate measures,” Dr Khetrapal Singh said.
It is important for all countries, irrespective of their COVID-19 transmission status, to roll out COVID-19 vaccination, which protects against severe disease and death, she said.
WHO continues to work with the national authorities by providing them with necessary information on COVID-19 vaccines available through COVAX.
WHO had supported DPR Korea develop a COVID-19 vaccine deployment plan along with partner organizations - UNICEF and GAVI. The plan was reviewed and approved by a multi-partner body at the regional level, making DPR Korea eligible to receive COVID-19 vaccines through COVAX.
“The pandemic is far from over. Every country must implement tailored public health and social measures and protect its population with COVID-19 vaccines, prioritizing the vulnerable population such as health workers, the elderly and those with underlying conditions that puts them at risk of severe disease and death from COVID-19,” the Regional Director said.
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 7 May 2022, WHO was informed of a confirmed case of monkeypox in an individual who travelled from the United Kingdom to Nigeria.
The case developed a rash on 29 April 2022 and returned to the United Kingdom on 4 May. Monkeypox was suspected and the case was immediately isolated. As of 11 May, extensive contact tracing has been undertaken to identify exposed contacts in healthcare settings, the community and the international flight. These individuals are being followed up for 21 days from the date of last exposure with the case. None has reported compatible symptoms so far.
Since the case was immediately isolated and contact tracing was performed, the risk of onward transmission related to this case in the United Kingdom is minimal. However, as the source of infection in Nigeria is not known, there remains a risk of ongoing transmission in this country.
On 7 May 2022, the National IHR Focal Point for the United Kingdom notified WHO of a confirmed case of monkeypox in an individual who travelled from United Kingdom to Nigeria from late April to early May 2022 and stayed in Lagos and Delta States in Nigeria. The case developed a rash on 29 April and returned to the United Kingdom, arriving on 4 May. On the same day (4 May), the case presented to hospital. Based on the travel history and rash illness, monkeypox was suspected at an early stage and the case was isolated immediately. Appropriate use of personal protective equipment was ensured during hospitalization. Monkeypox (West African clade) was laboratory confirmed by reverse transcriptase polymerase chain reaction (RT-PCR) on a vesicular swab on 6 May by the United Kingdom Health Security Agency (UKHSA) Rare and Imported Pathogens Laboratory.
Monkeypox is a sylvatic zoonosis with incidental human infections that usually occur sporadically in forested parts of Central and West Africa. It is caused by the monkeypox virus which belongs to the orthopoxvirus family. Monkeypox can be transmitted by contact and droplet exposure via exhaled large droplets. The incubation period of monkeypox is usually from 6 to 13 days but can range from 5 to 21 days. The disease is often self-limiting with symptoms usually resolving spontaneously within 14 to 21 days. Symptoms can be mild or severe, and lesions can be very itchy or painful. The animal reservoir remains unknown, although is likely to be among rodents. Contact with live and dead animals through hunting and consumption of wild game or bush meat are known risk factors.
There are two clades of monkeypox virus, the West African clade and Congo Basin (Central African) clade. Although the West African clade of monkeypox virus infection sometimes leads to severe illness in some individuals, disease is usually self-limiting. The case fatality ratio for the West African clade has been documented to be around 1%, whereas for the Congo Basin clade, it may be as high as 10%. Children are also at higher risk, and monkeypox during pregnancy may lead to complications, congenital monkeypox or stillbirth.
Milder cases of monkeypox may go undetected and represent a risk of person-to-person transmission. There is likely to be little immunity to the infection in those travelling and exposed as endemic disease is geographically limited to parts of West and Central Africa. While a vaccine has been approved for prevention of monkeypox, and traditional smallpox vaccine also provides protection, these vaccines are not widely available and populations worldwide under the age of 40 or 50 years no longer benefit from the protection afforded by prior smallpox vaccination programmes.
• Health authorities in the United Kingdom have set up an incident management team to coordinate identification and management of contacts.
• As of 11 May, extensive contact tracing has identified exposed contacts in the community, the healthcare setting and on the international flight. None has reported compatible symptoms so far.
• All identified contacts have been assessed and classified based on their exposure to the case and are being followed up accordingly through either active or passive surveillance for 21 days after their last exposure to the case. Post-exposure prophylaxis with vaccination is being offered to the higher risk contacts.
• Nigerian authorities were informed about this case and travel history in Nigeria on 7 May. The case did not report contact with anyone with a rash illness or known monkeypox in Nigeria. Details of travel and contacts within Nigeria have been shared with authorities in Nigeria for follow up as necessary.
In the United Kingdom, there have been seven cases of monkeypox previously reported; all importations were related to a travel history to or from Nigeria. In 2021, there were also two separate human monkeypox cases imported from Nigeria reported by the United States of America.
Since September 2017, Nigeria has continued to report cases of monkeypox. From September 2017 to 30 April 2022, a total of 558 suspected cases have been reported from 32 states in the country. Of these, 241 were confirmed cases, and among these there were eight deaths recorded (Case Fatality Ratio: 3.3%). From 1 January to 30 April 2022, 46 suspected cases have been reported of which 15 were confirmed from seven states - Adamawa (three cases), Lagos (three cases), Cross River (two cases), Federal Capital Territory (FCT) (two cases), Kano (two cases), Delta (two cases) and Imo (one case). No death has been recorded in 2022.
In the present case, the source of infection is currently unknown and the risk of further transmission in Nigeria cannot be excluded. Once monkeypox was suspected in the United Kingdom, authorities promptly initiated appropriate public health measures, including isolation of the case and contact tracing. The risk of potential onward spread related to this case in the United Kingdom is therefore minimal. As the source of infection in Nigeria is not known, there remains a risk of further transmission in Nigeria.
Importations of monkeypox from an endemic country to another country has been documented on eight previous occasions. In this instance, the confirmed case has a history of travel from Delta state in Nigeria, where monkeypox is endemic.
Any illness during travel or upon return from an endemic area should be reported to a health professional, including information about all recent travel and immunization history. Residents and travelers to endemic countries should avoid contact with sick animals (dead or alive) that could harbour monkeypox virus (rodents, marsupials, primates) and should refrain from eating or handling wild game (bush meat). The importance of hand hygiene using soap and water, or alcohol-based sanitizer should be emphasized. While a vaccine and specific treatment have recently been approved for monkeypox, in 2019 and 2022 respectively, these countermeasures are not yet widely available.
A patient with monkeypox should be isolated and provided with supportive care during the presumed and known infectious periods, that is during the prodromal (early signs) and rash stages of the illness, respectively. Timely contact tracing, surveillance measures and raising awareness of imported emerging diseases among health care providers are essential for preventing further secondary cases and effective management of monkeypox outbreaks.
Health workers caring for patients with suspected or confirmed monkeypox should implement standard, contact and droplet infection control precautions. This includes all workers such as cleaners and laundry personnel who may be exposed to the patient care setting, bedding, towels, or personal belongings. Samples taken from people with suspected monkeypox or animals with suspected monkeypox virus infection should be handled by trained staff working in suitably equipped laboratories.
International travel and trade: WHO does not recommend any restriction for travel to and trade with Nigeria or the United Kingdom based on available information at this time.
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.
Despite the the COVID-19 pandemic, the World Health Organization’s 2020-2021 Results Report tracks WHO’s significant achievements across the global health spectrum. Released ahead of the World Health Assembly next week, the report details such accomplishments as the delivery of more than 1.4 billion vaccine doses via the COVAX facility, the recommendation for broad use of the world’s first malaria vaccine and WHO’s response to some 87 health emergencies, including COVID-19.
During 2020-2021, WHO led the largest-ever global response to a health crisis, working with 1600 technical and operational partners, and helped galvanise the biggest, fastest and most complex vaccination drive in history. The Organization spent US$1.7 billion on essential supplies to the COVID-19 response.
“Even as WHO has responded to the most severe global health crisis in a century, we have continued to support our Member States in addressing many other threats to health, despite squeezed budgets and disrupted services,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.
“As the world continues to respond to and recover from the pandemic in the years ahead, WHO’s priority is to invest even more resources for our work in countries, where it matters most,” he continued. “Ensuring WHO has sustainable, predictable and flexible financing is essential for fulfilling our mission to promote health, keep the world safe and serve the vulnerable.”
The ACT-A partnership delivered over 1 billion COVID-19 vaccine doses by January 2022. The global rollout of crucial health materials included nearly US$500 million worth of personal protective equipment; US$ 187 million in oxygen supplies, US$4.8 million in treatments and 110 million diagnostic tests.
However, much remains to be done for the world to get on track for WHO’s target of each country vaccinating 70% of its population by July 2022.
he Results Report reveals noteworthy achievements beyond the pandemic. Mandatory policies prohibiting the use of trans fatty acids (a hazardous food compound linked to cardiovascular disease), are in effect for 3.2 billion people in 58 countries. Among these countries, 40 have best practice policies, including Brazil, Peru, Singapore, Turkey and the United Kingdom. WHO’s REPLACE initiative aims for a world free of trans-fats by the end of 2023.
Thanks to implementation of measures mandated by WHO's Framework Convention on Tobacco Control, tobacco use is decreasing in 150 countries, saving lives and livelihoods.
Due to efforts to scale up life-saving interventions guided by WHO guidelines, 15 countries have achieved elimination of mother-to-child transmission of HIV and/or syphilis.
And WHO’s recommendation of widespread use of the world’s first malaria vaccine (RTS,S) has been delivered to over 1 million children. It is expected to save 40 000 to 80 000 lives a year, when used with other malaria control interventions.
The report demonstrates WHO’s crucial role as the world’s global health guardian, speaking up for health equity in a world of widening inequalities.
The grave costs of the pandemic were felt everywhere. The report portrays a world which is clearly further off track to reach crucial global health goals. Due to myriad disruptions caused by the COVID-19 pandemic, countries have fallen behind on WHO’s “Triple Billion targets” that provide critical pathways to attain the Sustainable Development Goals (SDGs) by 2030.
Progress on Universal health coverage and healthier populations are at about one quarter or less the pace needed to reach the Sustainable Development Goals by 2030, and no country was fully prepared for a pandemic of such scale.
COVID-19 also caused huge disruptions to health services: 117 of 127 countries surveyed reported disruption to at least one essential health service because of COVID, whilst the average disruption across those countries was a staggering 45%.
Going forward, fulfilling the triple billion targets will be WHO’s overriding goal, as a measurable means of reducing health equity gaps.
The Results Report details WHO’s efforts towards transparency and accountability, providing details of expenditure. The WHO Programme Budget for 2020-2021 was $5 840.4 million. In fact, financing reached US $7 916 million, due to COVID-19 emergency operations. The surplus was thanks to the generosity of donors, including 12 Member States which contributed approximately 71% of the total financing.
Nonetheless, the largest share of WHO financing is earmarked by donors through specified voluntary contributions. Flexible funds constituted only 20% of total financing in 2020-2021.
If WHO is to play its full role in achieving the SDGs, delivering on universal health coverage, reducing the burden of ill health and protecting 1 billion more people from health emergencies, the share of regular, stable, predictable financing must increase.
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.
News release - Geneva -- A new report from the World Health Organization highlights the increasing use of sophisticated online marketing techniques for alcohol and the need for more effective regulation. It shows that young people and heavy drinkers are increasingly targeted by alcohol advertising, often to the detriment of their health.
Reducing the harm from alcohol – by regulating cross-border alcohol marketing, advertising and promotion is the first report from WHO to detail the full extent of the way that alcohol is today being marketed across national borders – often by digital means – and in many cases regardless of the social, economic or cultural environment in receiving countries.
Worldwide, 3 million people die each year as a result of harmful use of alcohol – one every 10 seconds – representing about 5% of all deaths. A disproportionate number of these alcohol--related deaths occur among younger people, with 13.5% of all deaths among those who are 20–39 years of age being alcohol-related.
“Alcohol robs young people, their families and societies of their lives and potential,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. “Yet despite the clear risks to health, controls on the marketing of alcohol are much weaker than for other psychoactive products. Better, well enforced and more consistent regulation of alcohol marketing would both save and improve young lives across the world.”
One of the biggest changes in recent years to alcohol marketing is the use of sophisticated online marketing. The collection and analysis of data on users’ habits and preferences by global Internet providers has created new and growing opportunities for alcohol marketers to target messages to specific groups across national borders. Targeted advertising on social media is especially effective at using such data, with its impact strengthened by social influencers and sharing of posts between social media users.
One data source quoted in the report calculated that over 70% of media spending of leading alcohol marketers based in the USA in 2019 was through promotions, product placement and online advertisements in social media.
“The rising importance of digital media means that alcohol marketing has become increasingly cross-border”, said Dag Rekve of the Alcohol, Drugs and Addictive Behaviours Unit at the World Health Organization. “This makes it more difficult for countries that are regulating alcohol marketing to effectively control it in their jurisdictions. More collaboration between countries in this area is needed.”
Sponsorship of major sporting events at global, regional and national levels is another key strategy used by transnational alcohol companies (which are gaining increasing dominance in the production and branding of alcohol beverages). Such sponsorship can significantly increase awareness of their brands to new audiences. In addition, alcohol producers engage in partnership with sports leagues and clubs to reach viewers and potential consumers in different parts of the world.
The increasing market of e-sports, including competitive gaming events, is another opportunity to sponsor events and increase brand recognition and international sales. So is product placement in movies and serials, many of which are streamed on international subscription channels. According to an analysis of the 100 highest-grossing box office U.S. movies between 1996 and 2015, branded alcohol was shown in almost half of them.
The lack of regulation to address cross-border marketing of alcohol is of particular concern for children and adolescents, women, and heavy drinkers.
Studies have shown that starting to drink alcohol at a young age is a predictor of hazardous drinking in young adulthood and beyond. Furthermore, teenage drinkers are more vulnerable to harm from alcohol consumption than older drinkers. Areas of the world with young and growing populations, such as Africa and Latin America, are being particularly targeted.
In addition, alcohol consumption among women is an important growth sector for alcohol production and sales. While three quarters of the alcohol that the world drinks is consumed by males, alcohol marketers tend to see the lower rate of women drinking as an opportunity to grow their market, often depicting drinking by women as a symbol of empowerment and equality. They organize corporate social responsibility initiatives, on topics such as breast cancer and domestic violence, and engage with women known for their success in areas such as sports or the arts to promote brands of alcohol.
Heavy and dependent drinkers are another target for marketing efforts, since in many countries just 20% of current drinkers drink well over half of all alcohol consumed. Alcohol-dependent people frequently report a stronger urge to drink alcohol when confronted with alcohol-related cues, yet they rarely have an effective way to avoid exposure to the content of the advertising or promotion.
While many countries have some form of restrictions on alcohol marketing in place, generally they tend to be relatively weak. In a WHO 2018 study, it was found that, while most countries have some form of regulation for alcohol marketing in traditional media, almost half have no regulation in place for Internet (48%) and social media (47%) marketing of alcohol.
Meanwhile, sustained attention and work by national governments, the public health community and WHO to limit the availability and promotion of tobacco products, with specific attention to the cross-border aspects of tobacco production and marketing, has led to life-saving reductions in global tobacco use and exposure.
The report concludes that national governments need to integrate comprehensive restrictions or bans of alcohol marketing, including its cross-border aspects, in public health strategies. It highlights key features and options for the regulation of cross-border marketing of alcohol and stresses the need for strong collaboration between states in this area.
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.