General Science & Health

WHO is deeply concerned that a full-scale military operation in Rafah could lead to a bloodbath. More than 1.2 million people are currently sheltering in the area, many unable to move anywhere else.   

A new wave of displacement would exacerbate overcrowding, further limiting access to food, water, health and sanitation services, leading to increased disease outbreaks, worsening levels of hunger, and additional loss of lives.  

Only 33% of Gaza’s 36 hospitals and 30% of primary health care centers are functional in some capacity amid repeated attacks and shortages of vital medical supplies, fuel, and staff.

As part of contingency efforts, WHO and partners are urgently working to restore and resuscitate health services, including through expansion of services and pre-positioning of supplies, but the broken health system would not be able to cope with a surge in casualties and deaths that a Rafah incursion would cause.   

The three hospitals (Al-Najjar, Al-Helal Al-Emarati and Kuwait hospitals) currently partially operational in Rafah will become unsafe to be reached by patients, staff, ambulance, and humanitarians when hostilities intensify in their vicinity and, as a result quickly become nonfunctional.  The European Gaza Hospital in east Khan Younis, which is currently functioning as the third-level referral hospital for critical patients, is also vulnerable as it could become isolated and unreachable during the incursion. Given this, the south will be left with six field hospitals and Al-Aqsa Hospital in the Middle Area, serving as the only referral hospital.  

As part of ongoing contingency efforts, WHO, partners and hospital staff have completed the first phase of restoration of Nasser Medical Complex, including cleaning and ensuring essential equipment is functioning. The emergency ward, nine operating theaters, intensive care unit, maternity ward, neonatal intensive care unit and the outpatient department are now partly functional, and national staff alongside emergency medical teams are working there. 

To alleviate the burden on hospitals, WHO and partners are establishing additional primary health centers and medical points in Khan Younis, Middle Area, and northern Gaza as well as pre-positioning medical supplies to enable these facilities to detect and treat communicable and non-communicable diseases and manage wounds.  A new field hospital is being set up in Al Mawasi in Rafah.    

A large WHO warehouse has been established in Deir al Bala and a sizable volume of medical supplies has been shifted there from WHO warehouses in Rafah as they could become unreachable during the incursion. These measures will help to ensure the rapid movement of supplies to Khan Younis, Middle Area and northern Gaza when needed. 

In the north, WHO and partners are scaling up efforts to resupply and expand services at Kamal Adwan, Al-Ahli, and Al-Awda hospitals, along with supporting the transfer of very ill patients to hospitals where they can get the treatment they need to survive. Plans are also underway to support the restoration of Patients’ Friendly Hospital, focusing on pediatric services.  

Despite the contingency plans and efforts, WHO warns that substantial additional mortality and morbidity is expected when the military incursion takes place. 

WHO calls for an immediate and lasting ceasefire and the removal of the obstacles to the delivery of urgent humanitarian assistance into and across Gaza, at the scale that is required.  

WHO additionally calls for the sanctity of health care to be respected. Parties to the conflict have the coordinates of health facilities: it is imperative they are actively protected and remain accessible to patients, health workers and partners. The safety of health and humanitarian workers must be guaranteed. Those striving to save lives should not have to endanger their own.  

In the eighth meeting of the Working Group on Amendments to the International Health Regulations (WGIHR), which was suspended yesterday until 16 May, State Parties to the IHR took a major step towards agreeing on the package of amendments which will be put forward to the World Health Assembly, which takes place from 27 May–1 June.

The amendments, proposed by IHR State Parties in the wake of the COVID-19 pandemic to strengthen the international community’s ability to detect and respond to pandemic threats, will be further discussed at the resumed eighth meeting on 16-17 May with a view to finalizing an agreed package for submission to the World Health Assembly in May for its consideration and, if agreed, formal adoption.

“The International Health Regulations have been the cornerstone of global health security for decades, but the COVID-19 pandemic showed the need to strengthen them in some areas to make them fit for purpose,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Countries are grasping this historic opportunity to protect future generations from the impact of epidemics and pandemics, with a commitment to equity and solidarity.”

This eighth meeting of the Working Group on Amendments to the IHR (WGIHR) started on 22 April and suspended today. Whilst the process is being held alongside negotiations of the world’s first pandemic agreement to strengthen global collaboration among governments to prepare for, prevent and respond to pandemics, it was proposed in WGIHR8 that two separate Resolutions on the two processes be submitted to the World Health Assembly in May. Negotiations resume on the pandemic agreement on 29 April and continue until 10 May.

During the eighth meeting of the WGIHR, substantial progress on finalizing the package of amendments was made as State Parties reached agreement in critical areas.

WGIHR Co-Chair Dr Ashley Bloomfield said: “The work to bolster our global defenses against public health emergencies and risks, through agreeing a stronger set of International Health Regulations, reflects both the risks our highly interconnected world faces today, and the recognition and readiness of countries to ensure their citizens are better protected.”

Fellow WGIHR Co-Chair, Dr Abdullah Assiri, said the proposed amendments to the IHR are readily implementable and recognize the importance of equity in ensuring effective global response.

“The COVID-19 pandemic showed the world that viruses of pandemic potential do not respect national borders,” Dr Assiri said. “Amending the International Health Regulations reflects the critical need to bolster our collective defenses against current and future public health risks so people’s health, societies and economies can be better protected, all whilst firmly respecting and adhering to the principle of national sovereignty.”

The eighth meeting of the WGHIR will resume in a two-day final session 16-17 May to continue and conclude the work of the Working Group according to its mandate from the Health Assembly

The IHR have 196 State Parties, comprising all 194 WHO Member States plus Liechtenstein and the Holy See. These Parties have led the process to amend the IHR. The Regulations have been negotiated under Article 21 of the WHO Constitution. Any amendment will come into force for all States Parties, after a set period, except for those that notify the WHO Director-General of a rejection or reservation.

Key points

• SARS-CoV-2 continues to circulate and evolve with important genetic and antigenic evolution of the spike protein.
• The objective of an update to COVID-19 vaccine antigen composition is to enhance vaccine-induced immune responses to circulating SARS-CoV-2 variants.
• As the virus is expected to continue to evolve from JN.1, the TAG-CO-VAC advises the use of a monovalent JN.1 lineage as the antigen in future formulations of COVID-19 vaccines.
• In accordance with WHO SAGE policy, vaccination programmes should continue to use any of the WHO emergency-use listed or prequalified COVID-19 vaccines and vaccination should not be delayed in anticipation of access to vaccines with an updated composition.

The WHO Technical Advisory Group on COVID-19 Vaccine Composition (TAG-CO-VAC) meets regularly to assess the impact of SARS-CoV-2 evolution on the performance of approved COVID-19 vaccines. This includes meeting in person approximately every six months to determine the implications of SARS-CoV-2 evolution on COVID-19 vaccine antigen composition and to advise WHO on whether changes are needed to the antigen composition of future COVID-19 vaccines. The twice-yearly evidence review by the TAG-CO-VAC is based on the need for continued monitoring of the evolution of SARS-CoV-2 and the kinetics and protection of vaccine-derived immunity.

In May 2023, the TAG-CO-VAC recommended the use of a monovalent XBB.1 descendent lineage, such as XBB.1.5, as the vaccine antigen. In December 2023, the TAG-CO-VAC advised retaining the use of a monovalent XBB.1 descendent lineage, such as XBB.1.5, as the vaccine antigen. Several manufacturers (using mRNA, protein-based and viral vector vaccine platforms) have developed COVID-19 vaccines with a monovalent XBB.1.5 formulation which have been approved for use by regulatory authorities and introduced into COVID-19 vaccination programmes in some countries. Previous statements from the TAG-CO-VAC can be found on the WHO website.

The TAG-CO-VAC reconvened on 15-16 April 2024 to review the genetic and antigenic evolution of SARS-CoV-2; immune responses to SARS-CoV-2 infection and/or COVID-19 vaccination; the performance of currently approved vaccines against circulating SARS-CoV-2 variants; and the implications for COVID-19 vaccine antigen composition.

Evidence reviewed

The published and unpublished evidence reviewed by the TAG-CO-VAC included: (1) SARS-CoV-2 genetic evolution with support from the WHO Technical Advisory Group on SARS-CoV-2 Virus Evolution (TAG-VE); (2) Antigenic characterization of previous and emerging SARS-CoV-2 variants using virus neutralization tests with animal antisera or human sera and further analysis of antigenic relationships using antigenic cartography; (3) Immunogenicity data on the breadth of neutralizing antibody responses elicited by currently approved vaccine antigens against circulating SARS-CoV-2 variants using animal and human sera, including modelling data; (4) Vaccine effectiveness estimates (VE) of currently approved vaccines during periods of circulation of XBB.1 and JN.1 lineages; (5) Preliminary immunogenicity data on immune responses following infection with circulating SARS-CoV-2 variants; and (6) Preliminary preclinical and clinical immunogenicity data on the performance of candidate vaccines with updated antigens shared confidentially by vaccine manufacturers with TAG-CO-VAC. Further details on the publicly available data reviewed by the TAG-CO-VAC can be found in the accompanying data annex. Unpublished and/or confidential data reviewed by the TAG-CO-VAC are not shown.

Summary of available evidence

• SARS-CoV-2 continues to circulate and evolve; there are genetic changes in important regions of the spike protein of SARS-CoV-2.
• As of April 2024, nearly all (>94%) SARS-CoV-2 genetic sequences in publicly available databases are derived from JN.1, and these variants continue to displace existing XBB lineage variants (e.g. EG.5). This displacement indicates greater fitness of JN.1 derived variants as compared to other circulating SARS-CoV-2 variants in the human population.
• Several JN.1 derived variants (e.g. JN1.13.1, JN.1.11.1, KP.2) have independently evolved changes in the spike protein at epitopes involving amino acid residues 346 and/or 456. Substitutions at these amino acid residues have been identified in previous SARS-CoV-2 variants (e.g. R346T in BQ.1 and XBB; F456L in EG.5 and HK.3) and are within epitopes known to be targeted by neutralizing antibodies.
• Given the displacement of XBB lineage variants by JN.1 derived variants, it is likely that, in the near-term, circulating SARS-CoV-2 variants will be derived from JN.1.
• In immunologically naïve animal and human sera, XBB.1.5 and JN.1 are antigenically distinct SARS-CoV-2 variants. In non-naïve animals and humans, post-monovalent XBB.1.5 vaccination sera, with or without recent prior infection, neutralize XBB.1.5 and its derivatives including EG.5, HK.3, HV.1, as well as BA.2.86 and JN.1. However, neutralization titres against JN.1 in published and unpublished studies were typically lower (2-5-fold) than those against the homologous XBB.1.5 immunizing antigen. There are further reductions in cross neutralization of JN.1 variants with F456L and/or R346T substitutions.
• Secondary analysis of published immunogenicity data demonstrates that an additional vaccine dose with an updated vaccine antigen results in an average 40% increase in neutralizing antibodies to that variant as compared to vaccines with a previous vaccine antigen. Using statistical modeling, the predicted additional effectiveness of a vaccine dose with an updated vaccine antigen may be approximately 23-33% against severe disease as compared to a previous vaccine antigen and 11-25% against symptomatic disease.
• In a context of high infection- and vaccine-derived immunity in the population, contemporary vaccine effectiveness (VE) estimates are mostly relative (rVE), rather than absolute (comparing vaccinated to unvaccinated individuals), and demonstrate the added protection of recent vaccination over and above pre-existing infection- and vaccine-derived immunity:
  • Bivalent (index virus and BA.1- or BA.4/5) mRNA vaccines and a Beta-based protein vaccine continue to offer protection against severe disease during periods of XBB descendent lineage circulation. Protection against symptomatic disease and infection is lower and wanes more rapidly over several months.
  • Monovalent XBB.1.5 vaccines were introduced into some vaccination programmes in the last quarter of 2023. Protection against severe disease during periods of XBB descendent lineage circulation is high during the first three months after vaccination, but protection against symptomatic disease is lower.
  • There are fewer studies estimating rVE for the monovalent XBB.1.5 vaccines during periods of JN.1 descendent lineage circulation. These initial studies show some additional protection offered during the first three months after vaccination, but point towards a slight reduction in VE against JN.1, as compared to XBB.1 lineage variants, for protection against severe and symptomatic disease. These observations are consistent with reductions in neutralizing antibody titres observed in preclinical and clinical immunogenicity studies of monovalent XBB.1.5 vaccinee sera against JN.1 derived variants.
• Preclinical data shared confidentially with the TAG-CO-VAC by vaccine manufacturers show that immunization of naïve mice, as well as mice previously immunized with SARS-CoV-2 variants, with monovalent JN.1-containing vaccine candidates elicits higher neutralizing antibody responses to JN.1 and its emerging descendent variants, as compared to responses elicited by currently approved vaccines. A single immunogenicity study in humans of a monovalent JN.1-containing vaccine candidate suggests that a JN.1 vaccine antigen is likely to produce higher neutralising antibodies to co-circulating JN.1 variants (e.g., KP.2) than an XBB.1.5 or related vaccine antigen.

The TAG-CO-VAC acknowledges several limitations of the available data:

• There are persistent and increasing gaps in genetic/genomic surveillance of SARS-CoV-2 globally, including low numbers of samples sequenced and limited geographic diversity. The TAG-CO-VAC strongly supports the establishment of the WHO Coronavirus Network (CoViNet) to help address this information gap.
• The trajectory of further SARS-CoV-2 evolution indicates that JN.1 will likely be the progenitor of SARS-CoV-2 variants, in the near term. However, the timing, specific mutations and antigenic characteristics, and the potential public health impact of newly emerged (e.g. KP.2) and future variants remain unknown. The TAG-CO-VAC strongly supports the ongoing work of the TAG-VE.
• Although neutralizing antibody titres have been shown to be important correlates of protection from SARS-CoV-2 infection and of estimates of vaccine effectiveness, there are multiple components of immune protection elicited by infection and/or vaccination. Data on the immune responses following XBB or JN.1 descendent lineage infection or XBB.1.5 vaccination are largely restricted to neutralizing antibodies and data on other aspects of the immune response, including cellular immunity, are limited.
• Immunogenicity data against currently circulating SARS-CoV-2 variants are not available for all COVID-19 vaccines.
• Estimates of rVE against recently circulating SARS-CoV-2 variants, including XBB or JN.1 descendent lineages, are limited in terms of the number of studies, geographic diversity, vaccine platforms evaluated, populations assessed, duration of follow-up and comparative estimates for monovalent XBB.1.5 vaccines versus other formulations delivered during the same time period.

Recommendations for COVID-19 vaccine antigen composition

As of April 2024, nearly all circulating SARS-CoV-2 variants reported in publicly available databases are JN.1 derived variants. As virus evolution is expected to continue from JN.1, future formulations of COVID-19 vaccines should aim to induce enhanced neutralizing antibody responses to JN.1 and its descendent lineages. One approach recommended by TAG-CO-VAC is the use of a monovalent JN.1 lineage (GISAID: EPI_ISL_19096142, WHO Biohub: 2024-WHO-LS-001) antigen in vaccines.

The continued use of the current monovalent XBB.1.5 formulation will offer protection given the neutralizing antibody responses to early JN.1 descendent lineages, and the evidence from early rVE studies against JN.1. However, it is expected that the ability for XBB.1.5 vaccination to protect against symptomatic disease may be less robust as SARS-CoV-2 evolution continues from JN.1. Other formulations and/or platforms that achieve robust neutralizing antibody responses against currently circulating variants, particularly JN.1 descendent lineages, can also be considered.

In accordance with WHO SAGE policy, vaccination programmes should continue to use any of the WHO emergency-use listed or prequalified COVID-19 vaccines and vaccination should not be delayed in anticipation of access to vaccines with an updated composition. WHO stresses the importance of access to and equity in the use of all available COVID-19 vaccines.

Further data requirements and considerations

Given the limitations of the evidence upon which the recommendations above are derived and the anticipated continued evolution of the virus, the TAG-CO-VAC strongly encourages generation of data on immune responses and clinical endpoints (i.e. VE) on the performance of all currently approved COVID-19 vaccines against emerging SARS-CoV-2 variants, and candidate vaccines with an updated antigen over time.

As previously stated, the TAG-CO-VAC continues to encourage the further development of vaccines that may improve protection against infection and reduce transmission of SARS-CoV-2. 

Note to editors:

On 7 May 2024, the following text in this statement:

"One approach recommended by TAG-CO-VAC is the use of a monovalent JN.1 lineage (GenBank: OY817255.1, GISAID: EPI_ISL_18538117, WHO Biohub: 2024-WHO-LS-001) antigen in vaccines."

was replaced with:

"One approach recommended by TAG-CO-VAC is the use of a monovalent JN.1 lineage (GISAID: EPI_ISL_19096142, WHO Biohub: 2024-WHO-LS-001) antigen in vaccines."

The GenBank and GISAID accession numbers of the virus sequence given as an example JN.1 lineage in the version of the statement published on 26 April 2024 lacked an insertion in the spike N-terminal domain (i.e. ins16MPLF) that is usually present in JN.1 and its descendent lineages. This is the result of a known technical issue associated with the bioinformatic analysis (Rothstein A et al. bioRxiv (preprint server). 2023; doi: 10.1101/2023.09.08.556912), rather than the lack of the above mentioned insertion in the isolate.

WHO welcomed Mr Javier Padilla Bernáldez, Spain’s Secretary of State for Health and his delegation on 23 and 24 April 2024 to discuss joint global health priorities. Amongst others, Spain's focus is on universal health coverage and health systems strengthening; pandemic response and emergency medical teams; organ and tissue transplantation; malaria and other tropical diseases; and polio.

During the visit, participants focused on plans and on-going work across a number of areas, including WHO’s Transplantation Program to increase availability; ethical access and oversight of transplantation of human cells; tissues and organs. They also discussed social determinants of health; tobacco and alcohol control; primary health care; access to medicines; universal health coverage; ensuring healthy lives at all ages; nutrition and food safety; health workforce; and emergencies.

Mr Javier Padilla was accompanied by Ms Paola Cannata Molero, Director of the Cabinet of the Secretary of State for Health, Mr Jacobo Fernández Álvarez, Technical Secretary General, Mr Héctor Tejero Franco, Advisor in the Cabinet of the Minister of Health and Responsible for Health and Climate Change, and Mr Roberto Carro Vázquez, Senior Technician of the Office of the Secretary of State for Health. The delegation also had representatives of Spain’s Permanent Mission to the United Nations Office and Other International Organizations in Geneva, including H.E. Ambassador Ms A. Díaz-Rato Revuelta, H.E. Ambassador Ms Clara Cabrera Brasero, and Counsellor Ms María del Carmen Martínez de la Peña.

The Spanish delegation met with Dr Ailan Li, Assistant Director General (ADG) for Universal Health Coverage, Healthier Populations, Dr Catharina Boehme, ADG for External Relations and Governance, Dr Yukiko Nakatani, ADG for Access to Medicines and Health products and ADG for Antimicrobial Resistance ad interim, Dr Michael Ryan, Deputy Director-General and Executive Director for WHO Health Health Emergencies Programme.

^{Left to right: Dr Maria Neira, Director, Environment, Climate Change and Health, H.E. Ambassador Aurora Díaz-Rato Revuelta, Dr Javier Padilla Bernáldez, Secretary of State for Health, Michael Ryan, Deputy Director-General and Executive Director, WHO Health Emergencies Programme. Credit: WHO/Chris Black}

WHO’s Management and their teams thanked Spain for their financial and technical support over the years. Spain’s support was instrumental in the last biennium in improving access to quality essential health services and medicines; addressing climate change and healthier environments; and strengthening country capacity in both data and innovation. Spain continues to be a champion of the Global Polio Eradication Initiative.

Spain also contributes to WHO’s work in tackling malaria and neglected and other tropical diseases, and has helped the Organization strengthen countries’ preparedness, readiness, prevention and response for health emergencies, epidemics and pandemics. Spain’s contribution to WHO’s Health Emergency Appeal has helped to protect health in humanitarian emergencies to break the cycles of poverty.

As a world leader in the field of organ and tissue transplantation, Spain plays a key role in WHO’s efforts through its Ministry of Health to improve the safety, quality, efficacy and access to transplants. WHO appreciates and acknowledges Spain as a partner who is not only leading and sharing expertise in support of countries’ development of sustainable, self-sufficient organ transplant systems, but also more generally, a key partner to WHO in health for all.

A major landmark study to be published by The Lancet reveals that global immunization efforts have saved an estimated 154 million lives – or the equivalent of 6 lives every minute of every year – over the past 50 years. The vast majority of lives saved – 101 million – were those of infants.

The study, led by the World Health Organization (WHO), shows that immunization is the single greatest contribution of any health intervention to ensuring babies not only see their first birthdays but continue leading healthy lives into adulthood.

Of the vaccines included in the study, the measles vaccination had the most significant impact on reducing infant mortality, accounting for 60% of the lives saved due to immunization. This vaccine will likely remain the top contributor to preventing deaths in the future.

Over the past 50 years, vaccination against 14 diseases (diphtheria, Haemophilus influenzae type B, hepatitis B, Japanese encephalitis, measles, meningitis A, pertussis, invasive pneumococcal disease, polio, rotavirus, rubella, tetanus, tuberculosis, and yellow fever) has directly contributed to reducing infant deaths by 40% globally, and by more than 50% in the African Region.

"Vaccines are among the most powerful inventions in history, making once-feared diseases preventable,” said WHO Director-General, Dr Tedros Adhanom Ghebreyesus. “Thanks to vaccines, smallpox has been eradicated, polio is on the brink, and with the more recent development of vaccines against diseases like malaria and cervical cancer, we are pushing back the frontiers of disease. With continued research, investment and collaboration, we can save millions more lives today and in the next 50 years.”

The study found that for each life saved through immunization, an average of 66 years of full health were gained – with a total of 10.2 billion full health years gained over the five decades. As the result of vaccination against polio more than 20 million people are able to walk today who would otherwise have been paralysed, and the world is on the verge of eradicating polio, once and for all.

These gains in childhood survival highlight the importance of protecting immunization progress in every country of the world and accelerating efforts to reach the 67 million children who missed out on one or more vaccines during the pandemic years.

Monumental efforts to increase access to vaccination over five decades

Released ahead of the 50^th anniversary of the Expanded Programme on Immunization (EPI) to take place in May 2024, the study is the most comprehensive analysis of the programme’s global and regional health impact over the past five decades.

Founded in 1974 by the World Health Assembly, EPI's original goal was to vaccinate all children against diphtheria, measles, pertussis, polio, tetanus, tuberculosis, as well as smallpox, the only human disease ever eradicated. Today, the programme, now referred to as the Essential Programme on Immunization, includes universal recommendations to vaccinate against 13 diseases, and context-specific recommendations for another 17 diseases, extending the reach of immunization beyond children, to adolescent and adults.

The study highlights that fewer than 5% of infants globally had access to routine immunization when EPI was launched. Today, 84% of infants are protected with 3 doses of the vaccine against diphtheria, tetanus and pertussis (DTP) – the global marker for immunization coverage.

Nearly 94 million of the estimated 154 million lives saved since 1974, were a result of protection by measles vaccines. Yet, there were still 33 million children who missed a measles vaccine dose in 2022: nearly 22 million missed their first dose and an additional 11 million missed their second dose.

Coverage of 95% or greater with 2 doses of measles-containing vaccine is needed to protect communities from outbreaks. Currently, the global coverage rate of the first dose of measles vaccine is 83% and the second dose is 74%, contributing to a very high number of outbreaks across the world.

To increase immunization coverage, UNICEF, as one of the largest buyers of vaccines in the world, procures more than 2 billion doses every year on behalf of countries and partners for reaching almost half of the world’s children. It also works to distribute vaccines to the last mile, ensuring that even remote and underserved communities have access to immunization services.

“Thanks to vaccinations, more children now survive and thrive past their fifth birthday than at any other point in history,” said UNICEF Executive Director Catherine Russell. “This massive achievement is a credit to the collective efforts of governments, partners, scientists, healthcare workers, civil society, volunteers and parents themselves, all pulling in the same direction of keeping children safe from deadly diseases. We must build on the momentum and ensure that every child, everywhere, has access to life-saving immunizations.”

In 2000, Gavi, the Vaccine Alliance, which includes WHO, UNICEF and the Bill & Melinda Gates Foundation (BMGF) as core founding members, was created to expand the impact of EPI and help the poorest countries in the world increase coverage, benefit from new, life-saving vaccines and expand the breadth of protection against an increasing number of vaccine-preventable diseases. This intensified effort in the most vulnerable parts of the world has helped to save more lives and further promote vaccine equity. Today, Gavi has helped protect a whole generation of children and now provides vaccines against 20 infectious diseases, including the HPV vaccine and vaccines for outbreaks of measles, cholera, yellow fever, Ebola and meningitis.

“Gavi was established to build on the partnership and progress made possible by EPI, intensifying focus on protecting the most vulnerable around the world,” said Dr Sania Nishtar, CEO of Gavi, the Vaccine Alliance. “In a little over two decades we have seen incredible progress – protecting more than a billion children, helping halve childhood mortality in these countries, and providing billions in economic benefits. Vaccines are truly the best investment we can make in ensuring everyone, no matter where they are born, has an equal right to a healthy future: we must ensure these efforts are fully funded to protect the progress made and help countries address current challenges of their immunization programmes.”

Immunization programmes have become the bedrock of primary health services in communities and countries due to their far reach and wide coverage. They provide not only an opportunity for vaccination but also enable other life-saving care to be provided, including nutritional support, maternal tetanus prevention, illness screenings and bed net distribution to protect families from diseases like malaria.

Since the study only covers the health impact of vaccination against 14 diseases, the number of lives saved due to vaccination is a conservative estimate and not a full account of the life-saving impact of vaccines. Societal, economic or educational impacts to health and well-being over the 50 years have also contributed to further reductions in mortality. Today, there are vaccines to protect against more than 30 life-threatening diseases.

While the HPV vaccine, which protects against cervical cancer in adults, was not included in the study, it is expected to prevent a high number of future deaths as countries work towards increasing immunization targets aimed at eliminating cervical cancer by 2030. New vaccine introductions, such as those for malaria, COVID-19, respiratory syncytial virus (RSV) and meningitis, as well as cholera and Ebola vaccines used during outbreaks, will further save lives in the next 50 years.

Saving millions more is “Humanly Possible”

Global immunization programmes have shown what is humanly possible when many stakeholders, including heads of state, regional and global health agencies, scientists, charities, aid agencies, businesses, and communities work together.

Today, WHO, UNICEF, Gavi, and BMGF are unveiling “Humanly Possible”, a joint campaign, marking the annual World Immunization Week, 24-30 April 2024. The worldwide communication campaign calls on world leaders to advocate, support and fund vaccines and the immunization programmes that deliver these lifesaving products – reaffirming their commitment to public health, while celebrating one of humanity’s greatest achievements. The next 50 years of EPI will require not only reaching the children missing out on vaccines, but protecting grandparents from influenza, mothers from tetanus, adolescents from HPV and everyone from TB, and many other infectious diseases.

“It's inspiring to see what vaccines have made possible over the last fifty years, thanks to the tireless efforts of governments, global partners and health workers to make them more accessible to more people,” said Dr Chris Elias, president of Global Development at the Bill & Melinda Gates Foundation. “We cannot let this incredible progress falter. By continuing to invest in immunization, we can ensure that every child – and every person – has the chance to live a healthy and productive life.”

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Notes to editors

For more information on WHO World Immunization Week 2024 campaign, visit World Immunization Week 2024 (who.int) and Humanly Possible campaign, http://itshumanlypossible.org.

Access photos and broll on immunization here.

About the data
WHO led the analysis of the impact of the Expanded Programme on Immunization from 1974 to 2024 with input from researchers from University of Basel, Safinea Ltd., University of Washington, KidRisk Inc., Penn State University, London School of Hygiene & Tropical Medicine, University of Cape Town, Imperial College London, the Vaccine Impact Modelling Consortium, and Institute for Health Metrics and Evaluation. The analysis covers the global and regional health impact of vaccination against 14 diseases: diphtheria, Haemophilus influenzae type B, hepatitis B, Japanese encephalitis, measles, meningitis A, pertussis, invasive pneumococcal disease, polio, rotavirus, rubella, tetanus, tuberculosis, and yellow fever.

About WHO
Dedicated to the health and well-being of all people and guided by science, the World Health Organization leads and champions global efforts to give everyone, everywhere, an equal chance at a safe and healthy life. We are the UN agency for health that connects nations, partners and people on the front lines in 150+ locations – leading the world’s response to health emergencies, preventing disease, addressing the root causes of health issues and expanding access to medicines and health care. Our mission is to promote health, keep the world safe and serve the vulnerable. www.who.int

About UNICEF
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. For more information about UNICEF and its work, visit: www.unicef.org. Follow UNICEF on Twitter, Facebook, Instagram and YouTube

About Gavi, the Vaccine Alliance
Gavi, the Vaccine Alliance is a public-private partnership that helps vaccinate more than half the world’s children against some of the world’s deadliest diseases. Since its inception in 2000, Gavi has helped to immunize a whole generation – over 1 billion children – and prevented more than 17.3 million future deaths, helping to halve child mortality in 78 lower-income countries. Gavi also plays a key role in improving global health security by supporting health systems as well as funding global stockpiles for Ebola, cholera, meningococcal and yellow fever vaccines. After two decades of progress, Gavi is now focused on protecting the next generation, above all the zero-dose children who have not received even a single vaccine shot. The Vaccine Alliance employs innovative finance and the latest technology – from drones to biometrics – to save lives, prevent outbreaks before they can spread and help countries on the road to self-sufficiency. Learn more at www.gavi.org and connect with us on Facebook and Twitter.

About the Bill & Melinda Gates Foundation
Guided by the belief that every life has equal value, the Bill & Melinda Gates Foundation works to help all people lead healthy, productive lives. In developing countries, it focuses on improving people’s health and giving them the chance to lift themselves out of hunger and extreme poverty. In the United States, it seeks to ensure that all people—especially those with the fewest resources—have access to the opportunities they need to succeed in school and life. Based in Seattle, Washington, the foundation is led by CEO Mark Suzman, under the direction of Co-chairs Bill Gates and Melinda French Gates and the board of trustees.

A new oral vaccine for cholera has received prequalification by the World Health Organization (WHO) on 12 April. The inactivated oral vaccine Euvichol-S has a similar efficacy to existing vaccines but a simplified formulation, allowing opportunities to rapidly increase production capacity.

“The new vaccine is the third product of the same family of vaccines we have for cholera in our WHO prequalification list,” said Dr Rogerio Gaspar, Director of the WHO Department for Regulation and Prequalification. “The new prequalification is hoped to enable a rapid increase in production and supply which many communities battling with cholera outbreaks urgently need.”

WHO prequalification list already includes Euvichol and Euvichol-Plus inactivated oral cholera vaccines produced by EuBiologicals Co., Ltd, Republic of Korea, which also produces the new vaccine Euvichol-S.  

Vaccines provide the fastest intervention to prevent, limit and control cholera outbreaks but supplies have been at the lowest point amidst countries facing dire shortcomings in other areas of cholera prevention and management such as safe water, hygiene and sanitation. 

There were 473 000 cholera cases reported to WHO in 2022 -- double the number from 2021. Further increase of cases by 700 000 was estimated for 2023. Currently, 23 countries are reporting cholera outbreaks with most severe impacts seen in the Comoros, Democratic Republic of the Congo, Ethiopia, Mozambique, Somalia, Zambia and Zimbabwe.

In a historic move, Nigeria has become the first country in the world to roll out a new vaccine (called Men5CV) recommended by the World Health Organization (WHO), which protects people against five strains of the meningococcus bacteria. The vaccine and emergency vaccination activities are funded by Gavi, the Vaccine Alliance, which funds the global meningitis vaccine stockpile, and supports lower-income countries with routine vaccination against meningitis.  

Nigeria is one of the 26 meningitis hyper-endemic countries of Africa, situated in the area known as the African Meningitis Belt. Last year, there was a 50% jump in annual meningitis cases reported across Africa.

In Nigeria, an outbreak of Neisseria meningitidis (meningococcus) serogroup C outbreak led to 1742 suspected meningitis cases, including 101 confirmed cases and 153 deaths in seven of 36 Nigerian states (Adamawa, Bauchi, Gombe, Jigawa, Katsina, Yobe, Zamfara) between 1 October 2023 and 11 March 2024. To quell the deadly outbreak, a vaccination campaign has been undertaken on 25--28 March 2024 to initially reach more than one million people aged 1-29 years.

Meningitis is a serious infection that leads to the inflammation of the membranes (meninges) that surround and protect the brain and spinal cord. There are multiple causes of meningitis, including viral, bacterial, fungal and parasitic pathogens. Symptoms often include headache, fever and stiff neck. Bacterial meningitis is the most serious, can also result in septicaemia (blood poisoning), and can seriously disable or kill within 24 hours those that contract it.  

“Meningitis is an old and deadly foe, but this new vaccine holds the potential to change the trajectory of the disease, preventing future outbreaks and saving many lives,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Nigeria’s rollout brings us one step closer to our goal to eliminate meningitis by 2030.”

The revolutionary new vaccine offers a powerful shield against the five major strains of the meningococcal bacteria (A, C, W, Y and X) in a single shot. All five strains cause meningitis and blood poisoning. This provides broader protection than the current vaccine used in much of Africa, which is only effective against the A strain.

The new vaccine has the potential to significantly reduce meningitis cases and advance progress in defeating meningitis. This is especially important for countries like Nigeria where multiple serogroups are prevalent. The new vaccine uses the same technology as the meningitis A conjugate vaccine (MenAfriVac®), which wiped out meningococcal A epidemics in Nigeria.

“Northern Nigeria, particularly the states of Jigawa, Bauchi and Yobe were badly hit by the deadly outbreak of meningitis, and this vaccine provides health workers with a new tool to both stop this outbreak but also put the country on a path to elimination,” said Prof. Muhammad Ali Pate of the Nigerian Ministry of Health and Social Welfare. “We’ve done a lot of work preparing health workers and the health system for the rollout of this new vaccine. We got an invaluable support from our populations despite this fasting period and from our community leaders especially the Emir of Gumel in Jigawa state who personally launched the vaccination campaign in the state. We’ll be monitoring progress closely and hopefully expanding the immunization in the coming months and years to accelerate progress.”

This new multivalent conjugate vaccine was 13 years in the making and was based on a partnership between PATH and the Serum Institute of India. Financing from the UK government’s Foreign, Commonwealth and Development Office was critical to its development.

In July 2023, WHO prequalified the new Men5CV vaccine (which has brand name MenFive®) and in October 2023 issued an official recommendation to countries to introduce the new vaccine. Gavi allocated resources for the Men5CV rollout in December 2023, which is currently available for outbreak response through the emergency stockpile managed by the International Coordinating Group (ICG) on Vaccine Provision, while roll-out through mass preventive campaigns is expected to start in 2025 across countries of the Meningitis Belt. 

“The rollout of one million vaccines in northern Nigeria will help save lives, prevent long-term illness and boost our goal of defeating meningitis globally by 2030,” said Andrew Mitchell, UK Minister for Development and Africa. “This is exactly the kind of scientific innovation, supported by the UK, which I hope is replicated in years to come to help us drive further breakthroughs, including wiping out other diseases.”

WHO has been supporting the Nigeria Centre for Disease Control and Prevention (NCDC) in responding to the meningitis outbreak in the country. This includes disease surveillance, active case finding, sample testing, and case management. WHO and partners have also played a vital role in supporting Nigeria to prepare for the rollout of the new vaccine and training health workers.

“Year after year, meningococcal meningitis has tormented countries across Africa,” said Dr Nanthalile Mugala, PATH's Chief of Africa Region. “The introduction of MenFive® in Nigeria heralds a transformative era in the fight against meningococcal meningitis in Africa. Building on the legacy of previous vaccination efforts, this milestone reflects over a decade of unwavering, innovative partnerships. The promise of MenFive® lies not just in its immediate impact but in the countless lives it stands to protect in the years to come, moving us closer to a future free from the threat of this disease.”

In 2019, WHO and partners launched the global roadmap to defeating meningitis by 2030.  The roadmap sets a comprehensive vision towards a world free of meningitis, and has three goals:

“With outbreaks of infectious diseases on the rise worldwide, new innovations such as MenFive® are critical in helping us fight back," said Aurélia Nguyen, Chief Programme Officer at Gavi, the Vaccine Alliance, which funds the global stockpile as well as vaccine rollout in lower-income countries. "This first shipment signals the start of Gavi support for a multivalent meningococcal conjugate vaccine (MMCV) program, which, with the required donor funding for our next five years of work, will see pentavalent meningococcal conjugate vaccines rolled out in high-risk countries. Thanks to vaccines, we have eliminated large and disruptive outbreaks of meningitis A in Africa: now we have a tool to respond to other serogroups that still cause large outbreaks resulting in long-term disability and deaths." 

Following Nigeria’s meningitis vaccine campaign, a major milestone on the road to defeat meningitis is the international summit on meningitis taking place in Paris in April 2024 where leaders will come together to celebrate progress, identify challenges and assess next steps. It is also an opportunity for country leaders and key partners to commit politically and financially to accelerate progress towards eliminating meningitis as a public health problem by 2030. 

^{WHO and Netherlands Strategic Dialogue in The Hague, Netherlands 10 April 2024. Credit: Michel Mees Photography}

The WHO and the Netherlands convened in The Hague on 10 April 2024, to discuss joint priorities and alignment between the Dutch Global Health Strategy and WHO’s key strategic goals, marking a new milestone in their longstanding partnership.

Rooted in the Netherlands' unwavering commitment to global health, human rights, and universal access to comprehensive health services, the collaboration between the WHO and the Netherlands is instrumental in addressing global health challenges and fostering health and well-being, worldwide and in the country.

Against the backdrop of ongoing conflicts, disasters, and the escalating impact of climate change, and the interconnectedness of the Dutch public health landscape in the Netherlands with global health challenges, this year’s Strategic Dialogue emerged as a critical platform for reflecting on this partnership’s long-term vision.

“In this Strategic Dialogue, throughout all sessions, WHO and the Netherlands showed a commitment to cooperation and to deepening their partnership based on the strong alignment between their respective priorities and objectives”, said Ms Marjolijn Sonnema, Director General for Public Health at the Netherlands’ Ministry of Health, Welfare and Sport.

A key outcome of the Strategic Dialogue was the recognition of the alignment between the Dutch Global Health Strategy and the WHO's forthcoming 14th General Programme of Work, paving the way for synergies in areas such as health system strengthening, pandemic preparedness, climate change and health, anti-microbial resistance (AMR) and mental health support.

"At a time when inequity in health and in access to essential health services and financial protection is increasing, disproportionately impacting the poor and most vulnerable, the Netherlands stands as a global health leader and trusted WHO partner. With shared priorities and commitment to sexual and reproductive rights, gender equity, health systems, security, climate resilience, and mental health, we look forward to strengthening our partnership to enhance the health and well-being of all, globally and in the Netherlands", said Dr Bruce Aylward, WHO Assistant Director-General, Universal Health Coverage, Life Course.

WHO acknowledged the Netherlands' global leadership as a flexible donor, with an agreement around the imperative to ensure WHO's financing is more sustainable, through the inaugural WHO Investment Round. This WHO initiative aims to mobilize predictable, sustainable and flexible resources essential for the WHO to respond swiftly and effectively to global health challenges and improve health outcomes, particularly for vulnerable populations.

Addressing contemporary challenges such as geopolitical tensions while seizing opportunities for advancing global health objectives were also on the table during the dialogue. Both parties stressed the importance of sustained collaboration to address pressing health issues comprehensively.

The outcomes of the 2024 dialogue will inform future collaboration between the Netherlands and the WHO, so that efforts are aligned, and the optimal use of resources is helps achieve improved health outcomes worldwide. The enduring partnership between the Netherlands and the WHO stands as a cornerstone in the global health landscape, reflecting a shared commitment to advancing health and well-being globally.

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The Netherlands is a key supporter and strategic partner of the WHO.

In 2022- 2023, the Netherlands was one of the top five flexible WHO contributors with nearly US$ 19 million in core voluntary contributions. Overall, the Netherlands contributed more than US$ 106 million to the WHO in 2022 - 2023, of which US$ 93 million, nearly 90%, was voluntary funding.

The Netherlands also supports the WHO's technical expertise through secondments of staff and helps boost young people's careers in public health via the WHO's Junior Professional Officer Programme.

This demonstrates the Netherlands' commitment through its Ministry of Foreign Affairs and Ministry of Health, Welfare and Sport to the WHO’s central role in the global health architecture.

Through this support, the Netherlands contributes to crucial activities in the areas of sexual and reproductive health, water and sanitation, mental health in emergencies, emergency preparedness, tuberculosis, One Health, primary health care, antimicrobial resistance, while facilitating cooperation with top Dutch institutions.

See more information on the partnership between Netherlands and WHO.

A WHO-led multi-agency mission accessed Al-Shifa Hospital in north Gaza on 5 April to conduct a preliminary assessment of the extent of destruction and identify needs to guide future efforts to restore the facility. The highly complex mission was conducted in close partnership with the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), United Nations Mine Action Service (UNMAS), United Nations Department for Safety and Security (UNDSS), and in collaboration with the acting Hospital Director.

Prior to the mission, WHO’s efforts to reach the hospital to medically evacuate patients and staff and conduct an assessment were denied, delayed or impeded 6 times between 25 March and 1 April.

Like the majority of the north, Al-Shifa Hospital ­– once the largest and most important referral hospital in Gaza – is now an empty shell after the latest siege. No patients remain at the facility. Most of the buildings are extensively damaged or destroyed and the majority of equipment is unusable or reduced to ashes. The WHO team said that the scale of devastation has left the facility completely non-functional, further reducing access to life-saving health care in Gaza. Restoring even minimal functionality in the short term seems implausible and will require substantial efforts to assess and clear the grounds for unexploded ordnance to ensure safety and accessibility for partners to bring in equipment and supplies.

The hospital’s emergency department, surgical, and maternity ward buildings are extensively damaged due to explosives and fire. The western wall of the emergency department and northern wall of the neonatal intensive care department (NICU) have been torn down. At least 115 beds in what once was the emergency department have been burnt and 14 incubators in the NICU destroyed, among other assets. An in-depth assessment by a team of engineers is needed to determine if these buildings are safe for future use.

The hospital's oxygen plant has been destroyed, leaving Kamal Adwan Hospital as the only source of medical oxygen production in the north. Further comprehensive assessment is essential to evaluate the functionality of vital equipment such as CT scanners, ventilators, sterilization devices, and surgical equipment, including surgical tools and anaesthesia devices. The current situation has left north Gaza without CT scanning capabilities and significantly diminished laboratory capacity, severely compromising effective diagnosis, which will increase avoidable deaths. 

Numerous shallow graves have been dug just outside the emergency department, and the administrative and surgical buildings. In the same area, many dead bodies were partially buried with their limbs visible. During the visit, WHO staff witnessed at least 5 bodies lying partially covered on the ground, exposed to the heat. The team reported a pungent smell of decomposing bodies engulfing the hospital compound. Safeguarding dignity, even in death, is an indispensable act of humanity.

According to the acting Hospital Director, patients were held in abysmal conditions during the siege. They endured severe lack of food, water, health care, hygiene and sanitation, and were forced to relocate between buildings at gun point. At least 20 patients have reportedly died due to the lack of access to care and limited movement authorized for health personnel.

Despite deconfliction, yesterday’s mission faced significant delays at the military checkpoint en route to Al-Shifa Hospital. On the same day, another WHO-led mission bound for Al-Awda and Kamal Adwan hospitals in northern Gaza – to deliver medical supplies, fuel, deploy emergency medical teams, and support referral of critical patients – encountered unnecessary delays, including the detention of a supply truck driver who was part of the convoy. He was detained for over an hour at a separate location, out of view of the mission team. Eventually this mission was aborted due to safety concerns as the delays left insufficient time for safe completion and return before nightfall.

Between mid-October and end March, over half of all WHO missions have been denied, delayed, impeded or postponed. As health needs soar, the lack of a functional deconfliction system is a major obstacle in delivering humanitarian aid – including medical supplies, fuel, food and water to hospitals – anywhere close to the scale needed. 

Six months – half a year – into the war, the destruction of Al-Shifa Hospital and Nasser Medical Complex has broken the backbone of the already ailing health system. Prior to the latest siege, WHO and partners had supported the revival of basic services at Al-Shifa Hospital, and Nasser Medical Complex was regularly supplied to continue serving as the main hospital in south Gaza. These efforts are now lost.

As WHO marks World Health Day tomorrow, under the theme “My health, my right”, this basic right is utterly out of reach for the civilians of Gaza. Access to health care in Gaza has become totally inadequate, and the ability of WHO and partners to help is constantly disrupted and impeded.

Of the 36 main hospitals that used to serve over 2 million Gazans, only 10 remain somewhat functional, with severe limitations on the types of services they can deliver. The proposed military incursion into Rafah can only result in further diminution of access to health care and would have unimaginable health consequences.  The systematic dismantling of health care must end.

WHO repeats its calls for the protection of patients, health and humanitarian workers, health infrastructure, and civilians. Hospitals must not be militarized, misused, or attacked. WHO demands an effective, transparent and workable deconfliction mechanism, and safety guarantees, ensuring that the movement of aid within Gaza, including through checkpoints, is safe, predictable and expedited. WHO calls for additional land crossings to allow access into and across Gaza more safely and directly.

As famine looms, disease outbreaks spread, and traumatic injuries increase, WHO calls for unimpeded access of humanitarian aid into and across the Gaza Strip, and a lasting ceasefire.