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The ceasefire and the cessation of hostilities took effect on 27 November, offering temporary relief for the millions of civilians caught in the conflict in Lebanon. But Lebanon’s suffering did not end amid staggering unmet health needs. Bordering Syria and Israel, Lebanon’s overburdened health system is reeling from the impacts of an economic crisis, political deadlock, refugee crisis and now war.
The country is host to 1.5 million Syrian refugees: inevitably, events in Syria impact Lebanon and WHO operations. Syrian nationals are entering Lebanon at the same time as Syrian refugees are returning to Syria from Lebanon.
"An already decimated health system remarkably withstood this latest storm, but it has been further weakened. The challenges are complex and call for specialized, sustained support," said WHO Representative to Lebanon Dr Abdinasir Abubakar.
The road ahead for Lebanon‘s health system is rocky and the future uncertain.
Lebanon’s cumulative real GDP has shrunk by 38% since 2019, according to the World Bank, with the war being the latest of many blows. As of today, more than 1 million people displaced by hostilities have returned to southern Lebanon where the physical and health infrastructure is in tatters. Several health facilities remain closed and most hospitals are running below capacity due to financial restraints and shortages of staff, long-standing challenges in Lebanon.
More than 530 health workers and patients have been killed or injured in attacks on health care and thousands of health workers have been displaced or have emigrated leaving the hospitals and the health centres grappling to meet the health needs of the populations. In order to keep hospitals running, the need for health workers is dire.
Water and sanitation systems have been severely disrupted, compounding the risk of disease outbreaks. With nearly 7% of buildings in ruins in the two southern governorates that were hardest hit, thousands remain on the move and won’t be able to return home anytime soon. Those who have returned face the risks posed by explosive remnants of war, as well as greater overall health risks.
Since 8 October 2023, more than 4000 people were killed and 17 000 injured in Lebanon alone. Since the ceasefire took hold and conflict-impacted areas have become more accessible, the death toll continued climbing as more bodies are found in the 16 000 buildings that have been partially or completely destroyed, leaving an estimated 8 million tonnes of debris.
"The physical destruction is similar to what you see after an earthquake – and that has resulted in complex injuries, open wounds and fractures. And since the treatment provided during the war was often not optimal, the injured end up needing multiple surgeries to prevent complications and disabilities, " said Dr Ahmad Alchaikh Hassan, WHO Trauma Technical Officer.
One in 4 people with life-changing injuries will need long-term rehabilitation and, in some cases, assistive technologies and prosthetics. Specialized support will be required as the technical capacities in Lebanon cannot cope with the increasing numbers of people in need for these services and commodities.
"This need for specialized health care will persist for months and years to come. Lebanon needs reconstructive surgeons to treat the severely injured, eye doctors to treat the thousands of people injured in the pager attack, physiotherapists to start rehabilitating amputees and prosthetists to assist users of assistive devices," said WHO Representative Dr Abubakar.
Ensuring a sufficient number of trained health workers with expertise in war-related trauma and plastic reconstructive surgery is a priority.
Three weeks into an 8-week ceasefire, WHO and the Ministry of Public Health are working on replenishing medical supplies and restoring health services country-wide.
"WHO and national health authorities have carried out several mass casualty management trainings across Lebanon – resulting in stronger, more life-saving assertive responses. Without these timely interventions, the outcomes would be unconscionable," said Dr Hassan, WHO's Trauma Technical Officer.
The ongoing WHO operations include scaling up trauma care capacity, training surgeons on specialized trauma care in conflict areas, providing mental health trainings to health workers, capacity building for rehabilitation in post-conflict settings, replacing damaged equipment, identifying gaps in health coverage, and preparing for future scenarios and the subsequent health impact.
WHO also provided 5000 contingency blood bags and reagents to blood banks and developed awareness material on unexploded ordinances and other health risks for first responders and civilians. WHO and the Ministry of Public Health run strong country-wide surveillance for disease outbreaks which pose a heightened risk in post-conflict settings.
"The road to recovery will be long and windy. Our aim is to assist the health system to bounce back, and be resilient and prepared. We are grateful to our many partners who have supported this response but this is not the end of it. This is the start and the need for technical and financial support has never been greater," concluded WHO Representative Dr Abubakar.
The 2024 Global Heath Expenditure Report by the World Health Organization (WHO) shows that the average per capita government spending on health in all country income groups fell in 2022 from 2021 after a surge in the early pandemic years. The report entitled, “Global spending on health Emerging from the pandemic” has been published in alignment with the Universal Health Coverage (UHC) Day campaign marked annually on 12 December. The campaign’s focus for 2024 is on improving financial protection for people everywhere to access health services they need.
Government spending on health is crucial to delivering UHC. Its deprioritization can have dire consequences in a context where 4.5 billion people worldwide lack access to basic health services and 2 billion people face financial hardship due to health costs.
“While access to health services has been improving globally, using those services is driving more and more people into financial hardship or poverty. Universal Health Coverage Day is a reminder that health for all means everyone can access the health services they need, without financial hardship,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.
Protecting people from financial hardship due to out-of-pocket health costs is fundamental to achieving health for all. Yet, WHO’s report shows that out-of-pocket spending remained the main source of health financing in 30 low- and lower middle-income countries. In 20 of these countries, more than half of total health spending in the country was paid for by patients out of their pocket, which contributes to the cycle of poverty and vulnerability.
The challenges posed by the lack of financial protection for health are not limited to lower-income countries. Even in high-income countries, out-of-pocket payments lead to financial hardship and unmet need, particularly among the poorest households. Most recent health accounts data show that in over a third of high-income countries, more than 20% of total health spending was paid out-of-pocket.
On the occasion of UHC Day, WHO is calling on leaders to make UHC a national priority and eliminate impoverishment due to health-related expenses by 2030. Effective strategies to strengthen financial protection include minimizing or removing user charges for those most in need, including people with low incomes or chronic conditions, adopting legislation to protect people from impoverishing health costs and establishing health financing mechanisms through public funding to cover the full population.
Public funding needs to budget for an affordable package of essential health services – from health promotion to prevention, treatment, rehabilitation and palliative care – using a primary health care approach.
During the COVID-19 pandemic in 2020–2022, public spending on health – mainly via government health budgets –enabled health systems to respond quickly to the emergency. This reflects the advantage of government budgets in financing public health functions, in particular population-based public health interventions, versus other health financing schemes, during times of health emergencies. Government funding ensured that more people were protected and more lives were saved.
Emerging from the pandemic, countries are at a crossroads. Governments face difficult decisions as they work to strengthen the resilience of health systems against future health threats while addressing their populations' healthcare needs in a challenging economic environment.
The key to making better choices on future health investments is timely and reliable evidence on the level and pattern of health spending. For 25 years the WHO Health Expenditure Tracking programme has had a major influence on how critical information on health spending is compiled and reported at the country level and globally.
Among its most notable achievements are the establishment of the Global Health Expenditure Database – the world’s richest source of health expenditure data covering more than 190 countries since 2000--and the Global Health Expenditure Report, which has been published annually since 2017. These global public goods drive informed policymaking, transparency and accountability worldwide.
This year’s UHC Day also provides a platform for a milestone discussion in WHO’s efforts to advance support and collaboration with countries in reorienting their health systems to advance UHC and achieve health security in countries, regions and globally. From 11–13 December, national health representatives, heads of WHO country offices, and health policy advisers from over 125 countries are meeting in Lyon, France to take stock of progress and challenges, agree on priority areas and working methods, and set the agenda for the next phase of the UHC Partnership from 2025-2027.
The UHC Partnership is WHO’s flagship initiative on international cooperation for UHC, which brings WHO and partners together to support concrete actions to achieve UHC. It is funded by the European Union, Belgium, Canada, the French Ministry for Europe and Foreign Affairs, Germany, Irish Aid, the Government of Japan, and the United Kingdom - Foreign, Commonwealth & Development Office.
Around 846 million people aged between 15 and 49 are living with genital herpes infections – more than 1 in 5 of this age-group globally – according to new estimates released today. At least 1 person each second – 42 million people annually – is estimated to acquire a new genital herpes infection.
Most of the time, these infections cause no or few symptoms. However, for some people they lead to painful genital sores and blisters that can recur throughout life, causing significant discomfort and often requiring multiple healthcare visits. According to the estimates, more than 200 million people aged 15 to 49 suffered at least one such symptomatic episode in 2020.
The authors of the study, published in the journal Sexually Transmitted Infections, say that new treatments and vaccines are needed to reduce adverse health effects of the herpes virus and control its spread.
“While most people with a genital herpes infection experience few symptoms, with so many infections genital herpes still causes pain and distress for millions globally and strains already overburdened health systems,” said Dr Meg Doherty, Director of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes at WHO. “Better prevention and treatment options are urgently needed to reduce herpes transmission and will also contribute to reducing the transmission of HIV.”
Currently, there is no cure for herpes, although treatments can relieve symptoms. In addition to sores, genital herpes can also on occasion lead to serious complications, including neonatal herpes – a rare condition most likely to occur when a mother acquires the infection for the first time in late pregnancy and then transmits the virus to her baby during childbirth.
There are two types of the herpes simplex virus (HSV), known as HSV-1 and HSV-2, both of which can lead to genital herpes. According to the estimates, 520 million people in 2020 had genital HSV-2, which is transmitted during sexual activity. From a public health perspective, genital HSV-2 is more serious since it is substantially more likely to cause recurrent outbreaks, accounts for around 90% of symptomatic episodes, and is linked to a three-fold increased risk of getting HIV.
Unlike HSV-2, HSV-1 primarily spreads during childhood through saliva or skin to skin contact around the mouth to cause oral herpes, with cold sores or mouth ulcers the most common symptoms. In those without previous infection, however, HSV-1 can be acquired through sexual contact to cause genital infection in adolescence or adulthood. Some 376 million people are estimated to have had genital HSV-1 infections in 2020. Of these, 50 million are estimated also to have HSV-2 as it is possible to have both types at the same time.
While the 2020 estimates show virtually no difference in the prevalence of genital HSV-2 compared to 2016, estimated genital HSV-1 infections are higher. Over recent years, several countries have observed changing patterns of transmission in HSV-1, with adult genital infections increasing as childhood oral infections decline. Reduced oral spread during childhood may be linked to factors like less crowded living conditions and improved hygiene, which then increases susceptibility to the virus at older ages. The authors note that these increases may also partially reflect changes in methods and additional data sources.
“Stigma around genital herpes means it has been discussed too little, despite affecting millions of people globally. Not enough has been done to address this common infection,” said Dr Sami Gottlieb, an author of the report and Medical Officer within WHO’s Department of Sexual and Reproductive Health and Research including the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP). “Expanded research and investment in developing new herpes vaccines and therapies, and their equitable use, could play a critical role in improving quality of life for people around the world.”
While they are not fully effective at stopping its spread, correct and consistent use of condoms reduces risks of herpes transmission. People with active symptoms should avoid sexual contact with other people, since herpes is most contagious when sores are present. WHO recommends that people with symptoms of genital herpes should be offered HIV testing and if needed, pre-exposure prophylaxis for HIV prevention.
In line with its Global Health Sector Strategy on HIV, viral hepatitis and sexually transmitted infections for 2022-2030, WHO works to increase awareness about genital herpes infections and related symptoms, improve access to antiviral medications, and promote related HIV prevention efforts. It is also working to advance research and development of new tools for the prevention and control of herpes infections, such as vaccines, treatments and topical microbicides.
Earlier this year, a new study showed that genital herpes infections not only cause significant health impacts but also major economic costs – amounting to an estimated US $35 billion a year worldwide – through health care expenditures and productivity loss.
The study, Estimated global and regional incidence and prevalence of herpes simplex virus infections and genital ulcer disease in 2020: Mathematical modeling analyses, updates the 2012 and 2016 WHO estimates. It was authored by experts from WHO, HRP, the WHO Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections and Viral Hepatitis at Weill Cornell Medicine-Qatar as well as the University of Bristol.
Based on comprehensive regional systematic reviews and meta-analyses of HSV-1 and HSV-2 prevalence for all WHO regions, the study estimates the prevalence and incidence of genital HSV infection and HSV related genital ulcer disease in 2020 globally and by region.
The World Health Organization (WHO) has granted prequalification to the molecular diagnostic test for tuberculosis (TB) called Xpert® MTB/RIF Ultra. It is the first test for TB diagnosis and antibiotic susceptibility testing that meets WHO's prequalification standards.
Tuberculosis is one of the world’s leading infectious disease killers, causing over a million deaths annually and imposing immense socioeconomic burdens, especially in low- and middle-income countries. Accurate and early detection of TB, especially drug-resistant strains, remains a critical and challenging global health priority.
“This first prequalification of a diagnostic test for tuberculosis marks a critical milestone in WHO’s efforts to support countries in scaling up and accelerating access to high-quality TB assays that meet both WHO recommendations and its stringent quality, safety and performance standards,” said Dr Yukiko Nakatani, WHO Assistant Director-General for Access to Medicines and Health Products. “It underscores the importance of such groundbreaking diagnostic tools in addressing one of the world's deadliest infectious diseases.”
WHO prequalification of this test is expected to assure quality of diagnostic tests used to improve access to early diagnosis and treatment. It complements WHO’s endorsement approach, which is grounded in emerging evidence, diagnostic accuracy, and patient outcomes alongside considerations for accessibility and equity, with prequalification requirements on quality, safety, and performance.
WHO’s assessment for prequalification is based on information submitted by the manufacturer, Cepheid Inc., and the review by Singapore’s Health Sciences Authority (HSA), the regulatory agency of record for this product.
Designed for use on the GeneXpert® Instrument System, this nucleic acid amplification test (NAAT) Xpert® MTB/RIF Ultra detects the genetic material of Mycobacterium tuberculosis, the bacterium that causes TB, in sputum samples, and provides accurate results within hours. Simultaneously, the test identifies mutations associated with rifampicin resistance, a key indicator of multidrug-resistant TB.
It is intended for patients who screen positive for pulmonary TB and who have either not started anti-tuberculosis treatment or received less than three days of therapy in the past six months.
“High-quality diagnostic tests are the cornerstone of effective TB care and prevention,” said Dr Rogerio Gaspar, WHO Director for Regulation and Prequalification. “Prequalification paves the way for equitable access to cutting-edge technologies, empowering countries to address the dual burden of TB and drug-resistant TB.”
In a joint effort by WHO Global TB Programme and the Department of Regulation and Prequalification to improve access to quality-assured TB tests and expand diagnostic options for countries, WHO is currently assessing seven additional TB tests.
The Director-General of the World Health Organization (WHO) is hereby transmitting the report of the second meeting of the International Health Regulations (2005) (IHR) Emergency Committee (Committee) regarding the upsurge of mpox 2024, held on Friday 22 November 2024, from 12:00 to 17:00 CET.
Notwithstanding some progress towards controlling the spread of mpox resulting from national and international response efforts, the Committee noted the rising number and continuing geographic spread of mpox cases, especially those due to monkeypox virus clade Ib infection; the operational challenges in the field in need of stronger national commitments; as well as the need to mount and sustain a cohesive response across countries and partners. The Committee advised that the event continues to meet the criteria of a public health emergency of international concern (PHEIC) and provided its views regarding the proposed temporary recommendations.
The WHO Director-General expresses his most sincere gratitude to the Chair, Members, and Advisors of the Committee. The WHO Director-General concurs with the advice of the Committee that the event continues to constitute a PHEIC for the reasons detailed in the proceedings of the meeting below, and issues revised temporary recommendations in relation to this PHEIC, which are presented at the end of this document.
Proceedings of the meeting
Sixteen (16) Members of, and two Advisors to, the International Health Regulations (2005) (IHR) Emergency Committee (Committee) were convened by teleconference, via Zoom, on Friday, 22 November 2024, from 12:00 to 17:00 CET. Thirteen (13) of the 16 Committee Members, and one of the two Advisors to the Committee participated in the meeting.
The Director-General of the World Health Organization (WHO) delegated the WHO Deputy Director-General to welcome the Committee Members and Advisors, and invited Government Officials designated to present to the Committee on behalf of the five invited States Parties – Burundi, the Democratic Republic of the Congo (DRC), Kenya, Rwanda and Uganda.
The WHO Deputy Director-General recalled that the determination of the public health emergency of international concern (PHEIC), on 14 August 2024, was a call for national authorities to invest energetically to prevent and control the transmission of monkeypox virus (MPXV) with particular focus on clade Ib, to reduce the risk of international spread of mpox, and for the international community to act cohesively and intensely with all the tools and resources available for the prevention and control of mpox.
Highlighting the evolution of mpox globally (see details under the heading “Session open to representatives of States Parties invited to present their views), the WHO Deputy Director-General stressed that, since the Committee last met in August 2024, the situation has become more complex and continues to require a coordinated international response, including in all countries and especially in those with limited number of mpox cases before wider spread of disease may occur. He outlined the constructive collaborations and efforts of WHO and numerous partners, including the Africa Centres for Disease Control and Prevention (Africa CDC), to scale up the response at regional, national and sub-national levels; and the establishment, by WHO and partners, of the Access and Allocation Mechanism (AAM) as part of the interim Medical Countermeasures Network endorsed by WHO Member States, to support the equitable allocation and distribution of vaccines, therapeutics and diagnostics. The WHO Deputy Director-General outlined a number of challenges States Parties are facing to interrupt the transmission of mpox, including a number of concurrent health emergencies and competing health priorities, hence requiring political commitment and resources to further scale up targeted and integrated interventions at local levels.
The Representative of the Office of Legal Counsel briefed the Members and Advisors on their roles and responsibilities and identified the mandate of the Committee under the relevant articles of the IHR. The Ethics Officer from the Department of Compliance, Risk Management, and Ethics provided the Members and Advisors with an overview of the WHO Declaration of Interests process. The Members and Advisors were made aware of their individual responsibility to disclose to WHO, in a timely manner, any interests of a personal, professional, financial, intellectual or commercial nature that may give rise to a perceived or actual conflict of interest. They were additionally reminded of their duty to maintain the confidentiality of the meeting discussions and the work of the Committee. Each Member and Advisor was surveyed, with no conflicts of interest identified.
The meeting was handed over to the Chair who introduced the objectives of the meeting, which were to provide views to the WHO Director-General on whether the event continues to constitute a PHEIC, and if so, to provide views on the potential proposed temporary recommendations.
Session open to representatives of States Parties invited to present their views
The WHO Secretariat presented an overview of the global epidemiological situation of mpox, all MPXV clades included, highlighting that, since the Committee last met in August 2024, MPXV transmission has been reported in all six WHO Regions. While the WHO African Region represents the largest contributor to the global increase of mpox cases due to clades Ia, Ib and IIa, mpox in the WHO Western Pacific Region has been increasing due to an MPXV clade IIb outbreak among men who have sex with men reported from Australia.
With regards to the spread of MPXV clade Ib in the WHO African Region, since the Committee last met, the WHO Secretariat presented that the foci of transmission are in the DRC, with clade Ib now detected in six provinces, including in the urban area of the capital Kinshasa. MPXV clade Ib has also spread in neighbouring countries, including in Burundi (2,083 mpox cases, growing in the urban areas of Bujumbura and Gitega) and Uganda (582 mpox cases, growing in the capital Kampala) with established sustained community transmission; and Kenya (17 mpox cases) and Rwanda (37 mpox cases) with clusters of mpox cases (data reported as of 19 November 2024).
Additionally, travel-related cases of MPXV clade Ib infection, mostly epidemiologically linked to the above-mentioned countries, have been detected in eight countries in the following WHO Regions – African Region (Zambia and Zimbabwe); Americas Region (United States of America); European Region (Germany, Sweden, and the United Kingdom. In the United Kingdom, transmission within the household of the case occurred); and South-East Asian Region (India and Thailand).
Available data from the sub-national level in the DRC shows that the observed dynamics of transmission of MPXV clade Ib are changing over time and are diverse across affected health zones. Since MPXV clade Ib was first detected in September 2023 in South Kivu province in the health zone of Kamituga, the most affected age group has shifted from adults, where transmission was first observed and appears to have been sustained by contact within commercial sexual networks, to younger age groups, including children, and sustained by household and likely broader community transmission through close physical contact.
The same epidemiological characteristics are being observed in the capital Kinshasa, where the outbreak is largely driven by transmission between adults, but where steadily more children are being reported as a result of close physical contact within households and/or the community. It is worth noting that, regardless of the circulating MPXV clades, adults of 50 years of age or older are less affected, likely due to the immunity conferred by prior vaccination against smallpox.
The WHO Secretariat indicated that information about mortality in confirmed cases of mpox, regardless of the MPXV clade, is limited. In the DRC, based on routine syndromic surveillance data, deaths attributed to mpox are predominant in rural areas known to be endemic for MPXV clade Ia – with variable case fatality rates observed across those areas, but being consistently higher in children under 5 years of age.
Outside the DRC, deaths associated with MPXV clade Ib infection have been reported in Burundi (1), Uganda (2) and Kenya (1).
The WHO Secretariat presented the assessed risk by MPXV clades and further expressed in terms of overall public health risk where any given clade/s is/are circulating, and risk of national and international spread, as: Clade Ib – high public health risk and high risk of national/international spread; Clade Ia – high public health risk and moderate risk of national/international spread; Clade II – moderate public health risk and moderate risk of national/international spread.
The WHO Secretariat subsequently provided an update on actions WHO has taken, with States Parties and partners, following the issuance of the temporary recommendations on 19 August 2024, the extension of the standing recommendations for mpox, and the WHO appeal: mpox public health emergency 2024, and based on the WHO Mpox global strategic preparedness and response plan, September 2024-February 2025; the Africa CDC-WHO Mpox Continental Preparedness and Response Plan for Africa, September 2024-February 2025; A coordinated research roadmap – Mpox virus - Immediate research next steps to contribute to control the outbreak (2024).
In addition to the overview provided by the WHO Deputy Director-General, the WHO Secretariat provided detailed updates on progress and challenges related to the following areas of the response, including: collaborative surveillance, safe and scalable clinical care, community protection, access to countermeasures, including diagnostics and vaccines (over 1.1 million doses of MVA-BN vaccine allocated to date), operations (deployment of human resources, dispatch of personal protective equipment, diagnostic tests, etc. to the field), funding (of the 87.4 million USD needed as per WHO appeal, 40.6 million USD were received or pledged; 3.5 million USD were released from the WHO's Contingency Funds for Emergencies), and coordination with partners.
Representatives of Burundi, the DRC, Kenya, Rwanda and Uganda updated the Committee on the mpox epidemiological situation in their countries and their current response efforts, needs and challenges. Mpox vaccine is currently being used in the DRC and Rwanda, and there are plans to use it in Kenya and Uganda, whereas vaccination against mpox is currently not encompassed by the response strategy of Burundi.
Members of, and the Advisor to, the Committee then engaged in questions and answers with the WHO Secretariat and invited Government Officials, on the issues and challenges presented.
The determination that the upsurge of mpox constitutes a PHEIC in August 2024 was regarded by States Parties attending the meeting as having boosted domestic response efforts and the mobilization of international resource to support those efforts.
However, the lack of information at national and local levels, including the suboptimal implementation of response interventions, was regarded as an obstacle to progress in controlling and interrupting MPXV transmission. Examples to that effect related to the proportion of suspected mpox cases tested; the time from diagnosis to subsequent isolation of mpox cases; the trend of mpox test positivity rate; the proportion of contacts that have completed the follow-up period; the proportion of mpox cases with an unknown epidemiological link, and trend thereof; and challenges with mpox vaccination implementation. Challenges with vaccination implementation include: the current vaccination coverage in countries with mpox vaccines, including in targeted at risk groups; the proportion of contacts that have received mpox vaccine; the time elapsed between the last exposure of an unvaccinated contact; and the administration of mpox vaccine.
The observed multifaceted dynamics of the spread of MPXV was discussed at length in terms of (a) the expansion of transmission from within known commercial sexual networks, and subsequently within households, and to the wider community with sustained transmission; (b) opportunities to refine the risk assessment approach, considering lower geographical levels and vulnerable subsets of population; and (c) the potential for predictive mathematical modeling approaches to anticipate MPXV spread both within countries and internationally.
Aspects related to the use of mpox vaccines as part of the response were discussed, including, but not limited to, (a) progress with global and domestic regulatory issues; (b) challenges for use of mpox vaccines in infants, children, adolescents, and immunocompromised persons (as per WHO vaccine position paper, August 2024); (c) need to implement vaccination as part of an integrated targeted response to interrupt MPXV transmission in hotspots at the local level, as opposed to a broader geographical use of the vaccine; (d) uncertainties related to the effectiveness of post-exposure use of the vaccine; (e) possible inclusion of studies to assess vaccine effectiveness in vaccine deployment plans; and (f) approaches to overcome vaccine hesitancy.
The coordination between Africa CDC and WHO in supporting States Parties’ response efforts in implementing the Africa CDC-WHO Mpox Continental Preparedness and Response Plan for Africa, September 2024-February 2025 was reported as collaborative, constructive and progressive. WHO and Africa CDC have a joint continental incident management team based in Kinshasa, DRC. A significant achievement of this coordination is the alignment of the vaccine allocation process and the AAM with the Technical Review Committee and the vaccination group within the Continental IMST.
Deliberative session
Following the session open to invited States Parties, the Committee reconvened in a closed session to examine the questions in relation to whether the event constitutes a PHEIC or not, and if so, to consider the temporary recommendations drafted by the WHO Secretariat in accordance with IHR provisions.
The Chair reminded the Committee Members of their mandate and recalled that a PHEIC is defined in the IHR as an “extraordinary event, which constitutes a public health risk to other States through the international spread of disease, and potentially requires a coordinated international response”.
The Committee was unanimous in expressing the views that the ongoing upsurge of mpox still meets the criteria of a PHEIC and that the Director-General be advised accordingly.
The overarching consideration underpinning the advice of the Committee is the limited effectiveness and efficiency of the response implemented at local level, particularly in Burundi and the DRC, to interrupt MPXV transmission – specifically in terms of surveillance, laboratory diagnostics, contact tracing, and community education and engagement. If duly and systematically implemented early on, such interventions could substantially contribute to the interruption of transmission both locally and globally, especially considering that access to mpox vaccine is often challenging, and the strategic use of vaccine has yet to be fully implemented.
On that basis, and further elaborating upon issues addressed during the question and answers session, the Committee considered that:
The event is “extraordinary” because of (a) the increased number of mpox cases and geographical expansion of foci of MPXV clade Ib transmission within States Parties; (b) the evolving dynamics of MPXV clade Ib transmission – from within known commercial sexual networks, to within households, to the wider community – resulting in the infection of broader age-groups, and/or vulnerable population groups, and/or co-infection and co-circulation with other MPXV clades and/or pathogens, and, hence, generating uncertainties and unknowns in terms of morbidity and mortality, and, consequently, leading to new response challenges, including regarding clinical care; (c) the risk of MPVX clade Ib mutations in the context of sustained community transmission, resulting in new dynamics of transmission and/or associated with new morbidity and mortality patterns (e.g. changes of transmissibility and/or virulence); (d) the ongoing prevalence of MPXV clade Ia infections in DRC with new foci of sexual network disease transmission in the capital Kinshasa.
The event “constitutes a public health risk to other States through the international spread of disease” because of (a) the documented recent exportation of MPVX clade Ib cases from States Parties where that clade is circulating to others within the WHO African Region and at least three additional WHO Regions; (b) the epidemiological link of exported MPVX clade Ib cases in the areas where exposure occurred is not known; (c) the risk that MPXV, and clade Ib in particular, is introduced in States Parties that may not comply with reporting requirement to WHO under IHR provisions, and/or may not have the capacities to implement response interventions.
The event “requires a coordinated international response” through (a) intensified engagement of international partners with national authorities to (i) raise the profile of mpox as public health priority, and (ii) strengthen prevention and response operations at the local level through the deployment of dedicated human resources and supplies; (b) mobilization of financial resources and their effective and efficient use; (c) the facilitation of equitable access to mpox including vaccines and diagnostics, including with the view to build capacity for the local and/or regional production of vaccine in the mid- to longer term.
The Committee indicated the need to start elaborating on the considerations that would inform their future advice to terminate the PHEIC while assessing the three criteria defining a PHEIC.
The Committee subsequently considered the draft of the temporary recommendations proposed by the WHO Secretariat.
Notwithstanding that temporary recommendations constitute non-binding advice to States Parties, and noting that it was the first time that a set of temporary recommendations included one related to reporting on the implementation thereof, the WHO Secretariat presented the structure and outcome of the survey to that effect administered to, and completed online by the five States Parties to which the temporary recommendations issued on 19 August 2024 were directed to (Burundi, the DRC, Kenya, Rwanda and Uganda). Provided that the Director-General would determine that the event still constitutes a PHEIC, and issue temporary recommendations accordingly, the Committee formulated suggestions to the WHO Secretariat to improve the survey by encompassing the local dimension of the response, and to use the outcome of the survey for shaping the proposed temporary recommendations.
The Committee then considered the revised set of temporary recommendations proposed by the WHO Secretariat, should the Director-Generals determine that the event still constitutes a PHEIC. The Committee had received the proposed set ahead of the meeting and, noting the proposal to extend most of the temporary recommendations issued on 19 August 2024, the Committee formulated suggestions regarding the definition of “hotspot”, referred to in some of the recommendations.
The Committee indicated that it would be giving further consideration to the proposed temporary recommendations while finalizing the report of the meeting.
Conclusion
The Committee reiterated its concern regarding the continuing spread of MPXV and uncertainties ensuing, and the effectiveness and efficiency of the response at the local level. The Committee underscored the need for the sustained commitment by national authorities in focusing efforts and resources at the local level to interrupt MPXV transmission, as well as the role of coordinated international cooperation in supporting and complementing such efforts in a synergistic manner. Therefore, the Committee considers that the determination by the WHO Director-General that the upsurge of mpox still constitutes a PHEIC would be warranted.
The WHO Deputy Director-General expressed his gratitude to the Committee’s Officers, its Members and Advisor and closed the meeting.
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These temporary recommendations are issued to States Parties experiencing the transmission of monkeypox virus (MPXV), including, but not limited to, those where there is sustained community transmission, and where there are clusters of cases or sporadic travel-related cases of MPXV clade Ib.[1]
They are intended to be implemented by those States Parties in addition to the current standing recommendations for mpox, which will be extended until 20 August 2025.
In the context of the global efforts to prevent and control the spread of mpox disease outlined in the WHO Strategic framework for enhancing prevention and control of mpox- 2024-2027, the aforementioned standing recommendations apply to all States Parties.
All current WHO interim technical guidance can be accessed on this page of the WHO website. WHO evidence-based guidance has been and will continue to be updated in line with the evolving situation, updated scientific evidence, and WHO risk assessment to support States Parties in the implementation of the WHO Strategic Framework for enhancing mpox prevention and control.
Pursuant to Article 3 Principle of the International Health Regulations (2005) (IHR), the implementation of these temporary recommendations, as well as the standing recommendations for mpox, by States Parties shall be with full respect for the dignity, human rights and fundamental freedoms of persons, in line with the principles set out in Article 3 of the IHR.
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[1] Note: The text in backets next to each temporary recommendation indicates the status with respect to the set of temporary recommendations issued on 19 August 2024. The following temporary recommendation issued on that occasion was terminated – “Prepare for the introduction of mpox vaccine for emergency response through convening of national immunization technical advisory groups, briefing of national regulatory authorities, preparing national policy mechanisms to apply for vaccines through available mechanisms”.
Emergency coordination
Collaborative surveillance and laboratory diagnostics
Safe and scalable clinical care
Vaccination
Community protection (MODIFIED)
The World Health Organization (WHO) and partners announced 10 projects that will receive almost US$ 2 million in grants to improve capacities in pathogen genomic surveillance.
The catalytic grant fund was established by the International Pathogen Surveillance Network (IPSN) to support partners from low- and middle-income countries to build their capacities in pathogen genomic analysis. This technology analyses the genetic code of viruses, bacteria and other disease-causing organisms to understand, in conjunction with other data, how easily they spread, and how sick they can make people. This data allows scientists and public health teams to track and respond to infectious disease threats, supports the development of vaccines and treatments and empowers countries to take faster decisions.
The fund is hosted by the United Nations Foundation and supported by the Bill & Melinda Gates Foundation, The Rockefeller Foundation and Wellcome.
“The IPSN catalytic grant fund has incredible potential to expand pathogen genomic surveillance for all, which we are already seeing through the first round of grantmaking,” said Sara Hersey, Director of Collaborative Intelligence at the WHO Hub for Pandemic and Epidemic Intelligence. “We are eager to support this work, which plays a key role in pandemic and epidemic prevention worldwide.”
“The IPSN catalytic grant fund recipients will accelerate the benefits of pathogen genomic surveillance in low- and middle-income settings, as well as explore new applications for genomic surveillance, such as wastewater surveillance,” said Manisha Bhinge, Vice President of the Health Initiative at The Rockefeller Foundation. “Pandemics and epidemics continue to be a global threat, further amplified by climate change. There is urgent need for equitable access to these tools and capabilities to protect lives in vulnerable communities.”
One of the recipients, the American University of Beirut, will use wastewater surveillance to study how diseases spread in refugee populations, helping to ensure that people can quickly receive the care and support they need in migration settings. Another grantee, the Pasteur Institute of Laos, will use the funding to develop new methods to track avian flu in live-bird markets, a setting that is often overlooked but vital to millions of people worldwide.
“If we are to protect vulnerable populations from the devastating impacts of disease, we first need to better understand how these pathogens spread, evolve and cause illness. These projects, developed in-country and tailored to local priorities, will generate new insights, knowledge and evidence that will help track global pathogen trends and inform evidence-based decisions to implement effective interventions” said Titus Divala, Interim Head of Epidemics and Epidemiology at Wellcome.
The Federal University of Rio de Janeiro in Brazil will use the funding to develop an open-source bioinformatics tool that can be used to conduct offline analyses. The tool will be piloted in Latin America with potential for global use, especially in low-resource settings.
"SARS-CoV-2 and subsequent regional disease outbreaks have underscored the importance of access to genomic surveillance tools in all countries. The IPSN's catalytic investments will generate data and innovative methods to support the much-needed scale-up in LMICs," said Simon Harris of the Gates Foundation.
The grantees were announced at the IPSN Global Partners Forum held in Bangkok, Thailand, from 21–22 November. The event was co-hosted by the WHO Regional Offices for South-East Asia and the Western Pacific and the Centre for Pathogen Genomics at the Doherty Institute in Australia.
A second round of catalytic grant funds will be made available to IPSN members in 2025.
Background on the IPSN
The IPSN is a new global network of pathogen genomic actors, brought together by the WHO Pandemic Hub, to accelerate progress on the deployment of pathogen genomics, and improve public health decision-making. The IPSN envisions a world where every country has equitable access to sustained capacity for genomic sequencing and analytics as part of its public health surveillance system. It sets out to create a mutually supportive global network of genomic surveillance actors that amplifies and accelerates the work of its members to improve access and equity.
More information about the network can be found here: www.who.int/initiatives/international-pathogen-surveillance-network.
Background on the WHO Hub for Pandemic and Epidemic Intelligence
Forming part of the WHO Health Emergencies Programme, the WHO Hub for Pandemic and Epidemic Intelligence (the WHO Pandemic Hub), facilitates a global collaboration of partners from multiple sectors that supports countries and stakeholders to address future pandemic and epidemic risks with better access to data, better analytical capacities, and better tools and insights for decision-making. With support from the Government of the Federal Republic of Germany, the WHO Pandemic Hub was established in September 2021 in Berlin, in response to the COVID-19 pandemic, which demonstrated weaknesses around the world in how countries detect, monitor and manage public health threats.
More information about the WHO Pandemic Hub can be found here: https://pandemichub.who.int
Background on the Centre for Pathogen Genomics
The Centre for Pathogen Genomics at the Doherty Institute, University of Melbourne is an academic and training hub that supports new collaboration for translational research, genomics-informed infectious disease surveillance, and capacity building and training across the Asia-Pacific region. The Centre is underpinned by a portfolio of world-leading experts across pathogen genomics, public health, surveillance, bioinformatics, research, and capacity building and training, with years of experience in using cutting-edge technologies to address infectious diseases of national and global importance.
Full list of the first IPSN catalytic grantees:
National Institute for Health Research (Angola) - “Metagenomic surveillance for epidemic prevention in the DRC-Angola cross-border (FEEVIR Project)”
Federal University of Rio de Janeiro (Brazil) - “Development of an offline-capable computational framework for decentralised real-time untargeted pathogen genomic surveillance”
National Public Health Laboratory (Cameroon) - “Integrating surveillance of malaria parasites into the National Public Health Laboratory genomics platform in Cameroon”
Evangelical University of Africa (Democratic Republic of Congo) - “Generating genomic surveillance data of pathogens in Democratic Republic of Congo by extending the Mini-Lab with a Nanopore MinION sequencer”
Noguchi Memorial Institute for Medical Research, University of Ghana (Ghana) - “Air Sampling Surveillance for Antimicrobial Resistance Monitoring and Pathogens of Public Health Interest”
Ashoka University, International Foundation for Research and Education, Council of Scientific and Industrial Research (India) - “Quantitative mapping of environmental to clinical AMR via DNA barcoding”
Pasteur Institute of Laos (Laos) - “Environmental genomic surveillance of avian Influenza A viruses in high-risk live-bird markets in Laos: an innovative sequencing approach”
American University of Beirut (Lebanon) - “Wastewater Genomic Surveillance of Underestimated Viral Diarrheal Diseases among Vulnerable and Refugee Populations in Lebanon”
Rwanda Biomedical Centre (Rwanda) - “Establishing a Rwandan One Health genomic surveillance network for endemic and emerging viral hemorrhagic fevers”
Medical Research Institute Colombo (Sri Lanka) - “Piloting the application of pathogen genomics for public health and surveillance of foodborne disease”
Delegations from over 110 countries are coming together to produce national roadmaps and negotiate a joint declaration on oral health at the first-ever global oral health meeting organized by the World Health Organization (WHO). The declaration is expected to outline collective commitments from Member States to accelerate the implementation of the Global strategy and action plan on oral health 2023–2030.
Oral diseases are the most common noncommunicable diseases (NCDs) worldwide, affecting an estimated 3.5 billion people. Oral health is often misunderstood as just dental health, overlooking its broader importance. Oral diseases include dental caries or cavities, gum disease, tooth loss, oral cancer, noma and birth defects, affecting the mouth, teeth and facial structures that are essential for eating, breathing and speaking.
"Oral health is an important part of well-being, yet millions of people lack access to the services they need to protect and promote their oral health,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “WHO calls on all countries to prioritize prevention and expand access to affordable oral health services as part of their journey towards universal health coverage.”
This groundbreaking event, hosted by the Government of the Kingdom of Thailand, is part of the preparatory process for the fourth UN High-Level Meeting on NCDs (4th UN HLM on NCDs) in 2025. It aims to accelerate progress towards UHC, reaffirm political commitments made by Member States, and promote the implementation of the Global strategy and action plan on oral health 2023–2030.
“Oral health is a crucial aspect of overall health, and Thailand is proud to host this landmark global meeting,” said H.E. Mr Somsak Thepsutin, Minister of Public Health in Thailand. “Our commitment to universal health coverage includes ensuring that all citizens have access to quality oral health services and promoting prevention through our communities, reinforcing our dedication to improving health outcomes for everyone."
Key outcomes of the meeting – the Bangkok declaration on oral health – will inform the WHO Director-General’s report for the 4th UN HLM on NCDs in 2025, ensuring better recognition and integration of oral diseases in the future global NCD agenda.
The Declaration seeks to guarantee oral health as a fundamental human right. It recognizes that improving access to affordable oral health care cannot be achieved without integrating it into primary health care and UHC packages.
During the meeting, it is expected a new global coalition on oral health will be announced, aiming to foster partnerships to enhance the reach and effectiveness of oral health initiatives worldwide.
The WHO first global oral health meeting is being attended by delegations from Member States, UN agencies, international organizations, philanthropic foundations, civil society organizations and other stakeholders dedicated to advancing oral health, NCDs and UHC programmes.
Note to editors:
The Global strategy and action plan on oral health 2023–2030 provides a framework to address challenges in preventing and controlling oral diseases, promoting oral health within the NCD agenda and ensuring that essential services are accessible without financial strain as part of UHC initiative. It outlines six strategic objectives, 100 actions and 11 global targets aimed at reducing the burden of oral diseases, which contribute significantly to the global NCD crisis.
For more information and to watch the meeting, please visit WHO global oral health meeting event webpage.
Since 7 October 2023, 47% of attacks on health care – 65 out of 137 – have proven fatal to at least one health worker or patient in Lebanon, as of 21 November 2024.
This is a higher percentage than in any active conflict today across the globe – with nearly half of all attacks on health causing the death of a health worker.
In comparison, the global average is 13.3%, based on the SSA’s figures from 13 countries or territories that reported attacks in the same period, 7 October 2023–18 November 2024 – among them Ukraine, Sudan and the occupied Palestinian territory (oPt). In the case of oPt, 9.6% of the total number of incidents has resulted in the death of at least one medical professional or patient.
According to the SSA, 226 health workers and patients were killed in Lebanon and 199 injured between 7 October 2023 and 18 November 2024.
In the same period, the SSA registered a combined total of 1401 attacks on health in oPt, Lebanon and Israel – 1196 in oPt, 137 in Lebanon and 68 in Israel.
Civilian health care has special protection
“These figures reveal yet again an extremely worrying pattern. It’s unequivocal – depriving civilians of access to lifesaving care and targeting health providers is a breach of international humanitarian law. The law prohibits the use of health facilities for military purposes – and even if that is the case, stringent conditions to taking action against them apply, including a duty to warn and to wait after warning,” said WHO Representative in Lebanon Dr Abdinasir Abubakar.
International humanitarian law states that health workers and facilities should always be protected in armed conflicts and never attacked. Health facilities must not be used for military purposes, and there should be accountability for the misuse of health facilities.
“There need to be consequences for not abiding by international law, and the principles of precaution, distinction and proportionality should always be adhered to. It’s been said before, indiscriminate attacks on health care are a violation of human rights and international law that cannot become the new normal, not in Gaza, not in Lebanon, nowhere,” said WHO Regional Director for the Eastern Mediterranean Dr Hanan Balkhy.
The majority of incidents in Lebanon impact health workers
The majority (68%) of incidents in Lebanon registered by the SSA impacted health personnel, a pattern seen repeatedly in the last few years, including in Gaza in the past year. In Lebanon, roughly 63% affected health transport and 26% affected health facilities.
Attacks on health care hit twice. First, when health workers lose their lives or when a health centre is obliterated, and again in the following weeks and months when the injured can’t be treated, those who are dependent on regular care don’t receive it and when children can’t be immunized.
“Casualty numbers among health workers of this scope would debilitate any country, not just Lebanon. But what the numbers alone cannot convey is the long-term impact, the treatments for health conditions missed, women and girls prevented from accessing maternal, sexual and reproductive health services, undiagnosed treatable diseases and, ultimately, the lives lost because of the absence of health care. That is the impact that’s hard to quantify,” said Dr Abubakar.
1 in 10 hospitals in Lebanon directly impacted
The greater the blow to the health workforce, the weaker the longer-term ability of a country to recover from a crisis and deliver health care in a post-conflict setting
Lebanon is a lower middle-income country with a fairly advanced health system that’s been hit hard by multiple crises in recent years. After hostilities in Lebanon escalated in September 2024, the growing number of attacks on health have caused further strain on an already over-burdened system.
Today, the country’s health system is under extreme duress, with 15 out of 153 hospitals having ceased to operate, or only partially functioning. Nabatieh, as an example, one of Lebanon’s 8 governorates, has lost 40% of its hospital bed capacity.
“Attacks on health care of this scale cripple a health system when those whose lives depend on it need it the most. Beyond the loss of life, the death of health workers is a loss of years of investment and a crucial resource to a fragile country going forward,” Dr Balkhy concluded.
So far this year, between 1 January 2024 and 18 November 2024, a total of 1246 attacks on health care were registered globally, in 13 countries or territories, killing 730 health workers and patients and injuring 1255.
Note to editors
The Surveillance System for Attacks on Health Care (SSA), established in 2017 by the World Health Organization, is an independent global monitoring mechanism whose goal is to collect reliable data on attacks on health care and to then identify patterns of violence that inform risk reduction and resilience measures so that health care is protected. The SSA also provides an evidence base for advocacy against attacks on health care.