Tag: 2019

Statement of the Twenty-Fourth IHR Emergency Committee
The Twenty-fourth meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) on the international spread of poliovirus was convened by the Director General on 26 March 2020 with committee members only attending
via teleconference, supported by the WHO Secretariat. In order to ease the burden on affected State Parties in the exceptional situation following the determination of the COVID-19 outbreak as a Public Health Emergency of International Concern
(PHEIC) on 30 January 2020, characterized as a pandemic on 11 March 2020, the invited State Parties were asked to present their reports electronically only instead of attending via teleconference. Reports were received from Afghanistan, Burkina
Faso, Central African Republic, Cote d’Ivoire, Democratic Republic of Congo (DR Congo), Ethiopia, Ghana, Pakistan, and Philippines.

The Emergency Committee reviewed the data on wild poliovirus (WPV1) and circulating vaccine derived polioviruses (cVDPV). The WHO Secretariat presented a report of progress for affected IHR States Parties subject to Temporary Recommendations.

Wild poliovirus

The Committee remains gravely concerned by the significant increase in WPV1 cases globally in 2019 and 2020, with 175 cases in 2019 compared to 33 in 2018, and already 32 cases as at 17 March 2020, compared to six for the same period in 2019, with no
significant success yet in reversing this trend.

In Pakistan transmission continues to be widespread, as indicated by both acute flaccid paralysis (AFP) surveillance and environmental sampling. While the issues of vaccine hesitancy and refusals by individuals and communities and problems with management
of the national polio program are being addressed, these are yet to have impact on the current worrying epidemiology. The added pressure on the program due to detection of cVDPV2 and ongoing spread in several provinces (see below) has continued
into 2020.

In Afghanistan, the security situation remains very challenging. Inaccessibility and missed children particularly in the Southern Region have led to a large cohort of susceptible children in this part of Afghanistan. The risk of a major upsurge
of cases is growing, with other parts of the country that have been free of WPV1 for some time now at risk of outbreaks. This would again increase the risk of international spread.

The Committee noted that based on sequencing of viruses, there were recent instances of international spread of viruses from Pakistan to Afghanistan and also from Afghanistan to Pakistan. The recent increased frequency of WPV1 international
spread between the two countries suggests that rising transmission in Pakistan and Afghanistan correlates with increasing risk of WPV1 exportation beyond the single epidemiological block formed by the two countries.

The Committee noted the continued cooperation and coordination between Afghanistan and Pakistan, particularly in reaching high risk mobile populations that frequently cross the international border and welcomed the all-age vaccination now being taken
at key border points between the two countries.

Vaccine derived poliovirus (VDPV)

The multiple cirulating VDPV (cVDPV) outbreaks in four WHO regions (African, Eastern Mediterranean, South-east Asian and Western Pacific Regions) are very concerning, with two new countries reporting outbreaks since the last meeting (Malaysia and Burkina
Faso). Unlike historical experience, cross border spread of cVDPV2 has become quite common, with recent spread from Angola to DR Congo and Zambia, and from Chad and CAR to Cameroon, and from Ghana to Burkina Faso. In addition, local emergences
attributable to mOPV2 use have recently occurred in Togo, Chad and Ethiopia.

The Committee noted that the GPEI has published a strategy to address cVDPV2 outbreaks but was extremely concerned that the monovalent OPV2 stockpile was still depleted. The Committee strongly supports the development and proposed Emergency Use
Listing of the novel OPV2 vaccine which should become available mid-2020, and which it is hoped will result in no or very little seeding of further outbreaks.

Impact of COVID-19

The Committee noted the very recent policy guidance of the GPEI:
- GPEI recommendations for countries during the COVID-19 pandemic. This document summarizes the recommendations from the Polio Oversight Board meeting on 24 March 2020 which calls for postponement of both preventive and outbreak response campaigns,
  while ensuring surveillance and nOPV2 development and roll out plans continue in full.
- The COVID-19 Polio programme continuity plan. The operational guide was developed in collaboration with the regional polio eradication teams and the GPEI Partners to ensure essential GPEI functions continue, polio programme personnel and staff are
  kept safe, and to plan for a fast and effective resumption of polio eradication activities including supplementary immunization activities as soon as the public health situation with COVID-19 allows.
The Committee is extremely concerned about the impact of the COVID-19 pandemic on the risk of heightened transmission of polio and consequently the potential for international spread and significant reversal of polio eradication.

Conclusion

The Committee unanimously agreed that the risk of international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC) and recommended the extension of Temporary Recommendations for a further three months. However
noting that some if not many international borders are closed to prevent international spread of COVID-19, State Parties may not currently be able to enforce the Temporary Recommendations in all places. The Committee strongly urges countries
subject to these recommendations to maintain a high state of readiness to implement them as soon as possible ensuring the continued safety of travelers as well as health professionals . The Committee recognizes the concerns regarding the lengthy
duration of the polio PHEIC, but concludes that the current situation is extraordinary, with clear ongoing risk of international spread and ongoing need for coordinated international response. The Committee considered the following factors in reaching
this conclusion:
- Rising risk of WPV1 international spread: The progress made in recent years appears to have reversed, with the Committee’s assessment that the risk of international spread is at the highest point
  since 2014 when the PHEIC was declared. This risk assessment is based on the following:
  - the WPV1 exportation in 2019 from Pakistan to Iran and to Afghanistan, and more recently spread from Afghanistan to Pakistan;
  - ongoing rise in the number of WPV1 cases and positive environmental samples in Pakistan, and to a lesser extent Afghanistan;
  - the quickly increasing cohort of unvaccinated children in Afghanistan, with the risk of a major outbreak imminent if nothing is done to access these children;
  - the urgent need to overhaul the leadership and strategy of the program in Pakistan, which although already commenced, is likely take some time to lead to more effective control of transmission
    and ultimately eradication;
  - increasing community and individual resistance to the polio program.
- Rising risk of cVDPV international spread: The clearly documented increased spread in recent months of cVDPV2 demonstrate the unusual nature of the current situation, as international spread of cVDPV
  in the past has been very infrequent. The number of new emergences of cVDPV2 in Africa raises further concern. The risk of new outbreaks in new countries is considered extremely high, even probable.
- COVID-19: This new and unprecedented pandemic is likely to substantially negatively impact the polio eradication program and outbreak control efforts. There is a risk of exportation of both
  WPV1 and cVDPV to known high risk countries, to which it may take a lot of time and effort to adequately respond.
- Falling PV2 immunity: Global population mucosal immunity to type 2 polioviruses (PV2) continues to fall, as the cohort of children born after OPV2 withdrawal grows, exacerbated by poor coverage
  with IPV particularly in some of the cVDPV infected countries.
- Multiple outbreaks: The evolving and unusual epidemiology resulting in rapid emergence and evolution of cVDPV2 strains is extraordinary and not yet fully understood and represents an additional risk
  that is yet to be quantified.
- Weak routine immunization: Many countries have weak immunization systems that can be further impacted by various humanitarian emergencies including COVID19, and the number of countries in which immunization
  systems have been weakened or disrupted by conflict and complex emergencies poses a growing risk, leaving populations in these fragile states vulnerable to outbreaks of polio.
- Surveillance gaps: The appearance of highly diverged VDPVs in the Philippines, Somalia and Indonesia are examples of inadequate polio surveillance, heightening concerns that transmission could be missed
  in various countries. Furthermore, the missed transmission in China for a year illustrates that even countries with generally good surveillance can miss VDPV transmission. COVID-19 is likely to have a negative impact on polio surveillance
  also.
- Lack of access: Inaccessibility continues to be a major risk, particularly in several countries currently infected with WPV or cVDPV, i.e. Afghanistan, Nigeria, Niger, Somalia and Myanmar, which all
  have sizable populations that have been unreached with polio vaccine for prolonged periods.
- Population movement: The risk is amplified by population movement, whether for family, social, economic or cultural reasons, or in the context of populations displaced by insecurity and returning refugees.
  There is a need for international coordination to address these risks. A regional approach and strong crossborder cooperation is required to respond to these risks, as much international spread of polio occurs over land borders.
Risk categories

The Committee provided the Director-General with the following advice aimed at reducing the risk of international spread of WPV1 and cVDPVs, based on the risk stratification as follows:
- States infected with WPV1, cVDPV1 or cVDPV3, with potential risk of international spread.
- States infected with cVDPV2, with potential risk of international spread.
- States no longer infected by WPV1 or cVDPV, but which remain vulnerable to re-infection by WPV or cVDPV.
Criteria to assess States as no longer infected by WPV1 or cVDPV:
- Poliovirus Case: 12 months after the onset date of the most recent case PLUS one month to account for case detection, investigation, laboratory testing and reporting period OR when all reported AFP cases with onset within 12 months of last case have been tested for polio and excluded for WPV1 or cVDPV, and environmental or other samples collected within 12 months of the last case have also tested negative, whichever is the longer.
- Environmental or other isolation of WPV1 or cVDPV (no poliovirus case): 12 months after collection of the most recent positive environmental or other sample (such as from a healthy child) PLUS one month to account for the laboratory testing and reporting period
- These criteria may be varied for the endemic countries, where more rigorous assessment is needed in reference to surveillance gaps (e.g. Borno State, Nigeria)
Once a country meets these criteria as no longer infected, the country will be considered vulnerable for a further 12 months. After this period, the country will no longer be subject to Temporary Recommendations, unless the Committee has concerns based on the final report.

TEMPORARY RECOMMENDATIONS

States infected with WPV1, cVDPV1 or cVDPV3 with potential risk of international spread

WPV1

Afghanistan                               (most recent detection 25 February 2020)

Pakistan                                                (most recent detection 2 March 2020)

Nigeria                                      (most recent detection 27 Sept 2016)

cVDPV1

Malaysia                                     (most recent detection 26 October 2019)

Myanmar                                   (most recent detection 9 August 2019)

Philippines                                 (most recent detection 28 October 2019)

These countries should:
- Officially declare, if not already done, at the level of head of state or government, that the interruption of poliovirus transmission is a national public health emergency and implement all required measures to support polio eradication; where such declaration has already been made, this emergency status should be maintained as long as the response is required.
- Ensure that all residents and longterm visitors (i.e. > four weeks) of all ages, receive a dose of bivalent oral poliovirus vaccine (bOPV) or inactivated poliovirus vaccine (IPV) between four weeks and 12 months prior to international travel.
- Ensure that those undertaking urgent travel (i.e. within four weeks), who have not received a dose of bOPV or IPV in the previous four weeks to 12 months, receive a dose of polio vaccine at least by the time of departure as this will still provide benefit, particularly for frequent travelers.
- Ensure that such travelers are provided with an International Certificate of Vaccination or Prophylaxis in the form specified in Annex 6 of the IHR to record their polio vaccination and serve as proof of vaccination.
- Restrict at the point of departure the international travel of any resident lacking documentation of appropriate polio vaccination. These recommendations apply to international travelers from all points of departure, irrespective of the means of conveyance (e.g. road, air, sea).
- Further intensify crossborder efforts by significantly improving coordination at the national, regional and local levels to substantially increase vaccination coverage of travelers crossing the border and of high risk crossborder populations. Improved coordination of crossborder efforts should include closer supervision and monitoring of the quality of vaccination at border transit points, as well as tracking of the proportion of travelers that are identified as unvaccinated after they have crossed the border.
- Further intensify efforts to increase routine immunization coverage, including sharing coverage data, as high routine immunization coverage is an essential element of the polio eradication strategy, particularly as the world moves closer to eradication.
- Maintain these measures until the following criteria have been met: (i) at least six months have passed without new infections and (ii) there is documentation of full application of high quality eradication activities in all infected and high risk areas; in the absence of such documentation these measures should be maintained until the state meets the above assessment criteria for being no longer infected.
- Provide to the Director-General a regular report on the implementation of the Temporary Recommendations on international travel.
States infected with cVDPV2s, with potential or demonstrated risk of international spread

Afghanistan           (most recent detection 8 January 2020)

Angola                      (most recent detection 9 February 2020)

Benin                        (most recent detection 9 December 2020)

Burkina Faso          (most recent detection 11 January 2020)

Cameroon              (most recent detection 30 January 2020)

CAR                           (most recent detection 5 February 2020)

Chad                         (most recent detection 5 February 2020)

Cote d’Ivoire          (most recent detection 11 February 2020)

China                        (most recent detection 25 April 2019)

DR Congo                 (most recent detection 22 January 2020)

Ethiopia                (most recent detection 21 February 2020)

Ghana                      (most recent detection 28 January 2020)

Malaysia                 (most recent detection 18 January 2020)

Niger                         (most recent detection 3 April 2019)

Nigeria                  (most recent detection1 January 2020)

Pakistan                   (most recent detection 12 February 2020)

Philippines              (most recent detection 16 January 2020)

Somalia                    (most recent detection 4 February 2020)

Togo                          (most recent detection 10 January 2020)

Zambia                     (most recent detection 25 November 2019)

These countries should:
- Officially declare, if not already done, at the level of head of state or government, that the interruption of poliovirus transmission is a national public health emergency and implement all required measures to support polio eradication; where such declaration has already been made, this emergency status should be maintained.
- Noting the existence of a separate mechanism for responding to type 2 poliovirus infections, consider requesting vaccines from the global mOPV2 stockpile based on the recommendations of the Advisory Group on mOPV2.
- Encourage residents and longterm visitors to receive a dose of IPV four weeks to 12 months prior to international travel; those undertaking urgent travel (i.e. within four weeks) should be encouraged to receive a dose at least by the time of departure.
- Ensure that travelers who receive such vaccination have access to an appropriate document to record their polio vaccination status.
- Intensify regional cooperation and crossborder coordination to enhance surveillance for prompt detection of poliovirus, and vaccinate refugees, travelers and crossborder populations, according to the advice of the Advisory Group.
- Further intensify efforts to increase routine immunization coverage, including sharing coverage data, as high routine immunization coverage is an essential element of the polio eradication strategy, particularly as the world moves closer to eradication.
- Maintain these measures until the following criteria have been met: (i) at least six months have passed without the detection of circulation of VDPV2 in the country from any source, and (ii) there is documentation of full application of high quality eradication activities in all infected and high risk areas; in the absence of such documentation these measures should be maintained until the state meets the criteria of a ‘state no longer infected’.
- At the end of 12 months without evidence of transmission, provide a report to the Director-General on measures taken to implement the Temporary Recommendations.
States no longer infected by WPV1 or cVDPV, but which remain vulnerable to re-infection by WPV or cVDPV

WPV1
- none
  cVDPV
  - Kenya cVDPV2 (last env positive specimen 21 March 2018)
  - Mozambique cVDPV2 (last virus detected 17 December 2018)
  - PNG cVDPV1 (last environmental positive specimen 6 November 2018)
  - Indonesia cVDPV1 (last virus detected 13 February 2019)
These countries should:
- Urgently strengthen routine immunization to boost population immunity.
- Enhance surveillance quality, including considering introducing supplementary methods such as environmental surveillance, to reduce the risk of undetected WPV1 and cVDPV transmission, particularly among high risk mobile and vulnerable populations.
- Intensify efforts to ensure vaccination of mobile and crossborder populations, Internally Displaced Persons, refugees and other vulnerable groups.
- Enhance regional cooperation and cross border coordination to ensure prompt detection of WPV1 and cVDPV, and vaccination of high risk population groups.
- Maintain these measures with documentation of full application of high quality surveillance and vaccination activities.
- At the end of 12 months without evidence of reintroduction of WPV1 or new emergence and circulation of cVDPV, provide a report to the Director-General on measures taken to implement the Temporary Recommendations.
Additional considerations

Impact of COVID-19 on the polio program:
- The committee urges all countries, but particularly those at high risk of polio, to maintain a high level of polio surveillance throughout the pandemic period, noting that the postponement of polio immunization campaigns whether preventive or in response to outbreaks may lead to an increase in polio transmission including international spread. Maintainenance of access to laboratory diagnosis in the face of widespread transport and shipping disruption is critical.
- Secondly, countries affected by campaign postponement should strive to maintain a high degree of operational readiness in order that immunization activities, including border vaccination, can resume quickly adhering to principles of good hygiene and safety for the vaccinee as well as for the health professionals to prevent COVID-19 spread. This includes ensuring teams have access to appropriate personal protective equipment.
- Given the risk of international spread, countries need to ensure that they are ready to use appropriate vaccines, as recommended by the Strategic Advisory Group of Experts on Immunization, in response to new outbreaks.
- The committee urged countries to maximize the use of polio assets to synergistically address the COVID19 pandemic, noting that polio affected countries may be vulnerable to poorer outcomes in the pandemic due to health care system fragility and poorer health status of the population generally.
- Lastly the pandemic should serve as a reminder to high risk countries with poor immunization coverage that infectious disease outbreaks can lead to social and economic disruption as well as straining the health care system, and countries can increase their population resilience and recovery through prioiritising robust immunization programmes. This is relevant not only to polio, but to all other vaccine preventable diseases particularly measles.
Based on the current situation regarding WPV1 and cVDPV, and the reports provided by affected countries, the Director-General accepted the Committee’s assessment and on 7 April 2020 determined that the situation relating to poliovirus continues to constitute a PHEIC, with respect to WPV1 and cVDPV. The Director-General endorsed the Committee’s recommendations for countries meeting the definition for ‘States infected with WPV1, cVDPV1 or cVDPV3 with potential risk for international spread’, ‘States infected with cVDPV2 with potential risk for international spread’ and for ‘States no longer infected by WPV1 or cVDPV, but which remain vulnerable to re-infection by WPV or cVDPV’ and extended the Temporary Recommendations under the IHR to reduce the risk of the international spread of poliovirus, effective 7 April 2020.

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April 9, 2020
Armed Conflicts, State Repression Causing Human Rights Abuses In Africa, Says Amnesty International

Amnesty International has said that armed conflicts and state repression were causes of human rights abuses in Africa.

The organisation in its annual review of human rights in the region on Tuesday said rights defenders in Africa were persecuted and harassed for standing up and speaking out against governments.

According to the report, there are major developments from the past year, which include the deposition of Sudanese President Omar al-Bashir, Zimbabwean Government’s response to mass protests, and increasing attacks on civilians in Mozambique and Mali.

“In 2019, we saw incredible people power in mass protests which swept across Sub-Saharan Africa. From Sudan to Zimbabwe, and Democratic Republic of Congo to Guinea, people braved brutal crackdowns to stand up for their rights,” said Deprose Muchena, Amnesty International’s East and Southern Africa Director.

“In some cases, these protests led to major changes, following the toppling of Sudan’s long-time leader, Omar al-Bashir, the new authorities promised human rights friendly reforms and following protest a raft package of human rights reforms was introduced by the Ethiopian Government.

“Sadly, other changes needed are being blocked by repressive governments, who continue to carry out violations with impunity.

“In Sudan’s Darfur region, government forces continued to commit possible war crimes and other serious human rights violations including unlawful killings, sexual violence, systematic looting and forced displacement.

“In DRC, dozens of local and foreign armed groups together with the country’s security forces continued to carry out human rights abuses resulting in more than 2000 civilian deaths and at least one million were forcibly displaced in the course of 2019.

“In Somalia, civilians continued to live with attacks from the armed group Al-Shabaab, while government and allied international forces failed to take sufficient precautions to spare civilians from their attacks targeted at Al-Shabaab.

“Armed groups carried out attacks directed against civilians in Cameroon, Central African Republic and Burkina Faso, while governments failed to protect civilians,” he added.

The organisation said access to healthcare remains a major concern for people across the region, with underfunded health budgets leading to shortages of beds and drugs in hospitals.

It said, “Governments from Angola to Zimbabwe, Burundi to Cameroon have failed to respect the right to health, and conflicts have exacerbated the situation.

“With the COVID-19 pandemic looming, there is no time to waste in addressing the inequalities and human rights violations which make healthcare inaccessible for so many.”

The organisation also condemned the persecution and harassment of human rights defenders for standing up and speaking out against governments.

It said Burundi, Malawi, Mozambique, Eswatini, Zambia and Equatorial Guinea all saw surging crackdowns on activism in 2019.

“In 17 countries across sub-Saharan Africa, journalists were arbitrarily arrested and detained in 2019. In Nigeria for example, 19 cases of assault, arbitrary arrest, and detention of journalists were recorded, with many facing trumped up charges.

“In Burundi, authorities continued to crack down on the work of human rights defenders and civil society organisations including by subjecting them to prosecution and lengthy prison terms.

“Human rights violations forced hundreds of thousands of people in the region to flee their homes in search of protection. There were about 600,000 internally displaced people in CAR; more than 222,000 people in Chad, and over half a million in Burkina Faso,” the report added.

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April 8, 2020
Making available free paediatric medicine can accelerate elimination of congenital Chagas disease
The donation of an essential antiparasitic medicine can potentially accelerate the elimination of Chagas disease infection in children. A pediatric presentation of benznidazole with accurate dosage and will soon be made available freely to address
a long-standing gap in the treatment of congenital infections of Chagas disease.

The donation, by the Mundo Sano Foundation¹ and INSud Pharma² group to the World Health Organization (WHO), is expected to become effective soon.

“Making benznidazole freely available for the treatment of newborns and children until the age of 19 will be a game-changer in the fight against Chagas disease” said Dr Mwelecele Ntuli Malecela, Director, WHO Department of Control
of Neglected Tropical Diseases. “This can save future generations from developing life-threatening and fatal complications and also boost up diagnosis and treatment contributing to congenital Chagas disease elimination.”

The three-year agreement will make available 108 000 tablets of benznidazole³ – one of the two antiparasitic medicines against Chagas disease. Treatment⁴ with benznidazole in the early stages of infection can cure Chagas
disease, prevent or curb disease progression and prevent congenital transmission in pregnant women.

“We have now added the systematic detection and treatment of all newborns and children under 19 which was not part of our recent switch from control to elimination of congenital Chagas disease” said Dr Pedro Albajar
Vinas, Medical Officer, WHO Department of Control of Neglected Tropical Diseases. “In addition, screening of pregnant women at risk of infection who have not had past antiparasitic treatment provides an excellent opportunity for prevention of posterior transmission throughout pregnancy and birth.”

Each year, an estimated 15 000 children are born from infected mothers.

The agreement

The donation by Mundo Sano Foundation for the duration of the agreement comprises benznidazole:
- 105,000 tablets of 100mg
- 3,000 tablets of 12.5mg
Furthermore, the Foundation may donate funds to support activities associated with distribution of medicines and is ready to consider extending this agreement beyond the specified duration of three years.

The disease

Chagas disease, also known as American trypanosomiasis, is a potentially life-threatening illness caused by the protozoan parasite Trypanosoma cruzi (T. cruzi).

Although considerable progress has been achieved, particularly in reducing vector transmission and screening of blood and organ supply, reaching, diagnosing and providing healthcare for people most affected has been a challenge.

Currently, under-diagnosis of Chagas disease cases is as high as 90% and under-diagnosis of congenital and paediatric cases is believed not to be lower.

Globally, an estimated 6-7 million people are infected with T. cruzi.

The disease is found mainly in endemic areas of 21 continental Latin American countries⁵. But movement of people to urban areas and to other continents has expanded its transmission through non vectorial routes, such as blood transfusion,
congenital transmission, organ transplants and oral transmission through food contamination.

Considering that neglected tropical disease as a growing public health problem in many countries, the World Health Assembly – WHO’s decision-making body – decided in May 2019 to commemorate World Chagas Disease Day on 14 April.

The inaugural celebration happens this year.

¹Mundo Sano is a nonprofit international foundation working with the public and private sectors, academia, and other international organizations to provide solutions to the affected communities and generate scientific knowledge.
In 2012, it led a public-private consortium in 2012 to produce benznidazole in Argentina.

²Insud Pharma (formerly known as Chemo Group) specializes in research, development, manufacture, sale and marketing of active pharmaceutical ingredients and medicinal products for human and veterinary use.

³In 2017, the United States Food and Drug Administration (FDA) approved benznidazole for the treatment of children aged 2–12, making it the first treatment approved in the United States for Chagas disease.

⁴Nifurtimox is also 100% effective in curing Chagas disease if given soon after onset of infection, including cases of congenital infection. It is donated by Bayer who pledged more than 7.5 million tablets for the period 2012-2021.

⁵Argentina, Belize, Bolivia (Plurinational State of), Brazil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, French Guiana, Guatemala, Guyana, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Suriname, Uruguay, and Venezuela
(Bolivarian Republic of).

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April 8, 2020
Nigeria’s Unhealthy Healthcare In Eye Of Coronavirus By Runcie C.W. Chidebe

Coronavirus (COVID-19) is right here to show us a lesson; I hope we be taught. Nigeria’s healthcare is unhealthy. But as an alternative of fixing it our rulers have been busy flying up and down to profit from different nation’s productive well being system. With Coronavirus, actuality is upon us. No extra operating abroad for medical trip. Our rulers can’t journey to the United Kingdom, United States of America or India anymore for medical care. These nations are additionally hanging on their final breath, battling to outlive the COVID-19 pandemic.

In 2017, President Muhammadu Buhari spent 103 days in London receiving medical therapy for an undisclosed sickness, spending taxpayers’ cash as an alternative of investing within the nation’s healthcare. Thousands of Nigerians died in the identical interval from totally different sicknesses. More than 3,000 girls died of breast most cancers, greater than 2,000 girls died of cervical most cancers and greater than 1,500 males died of prostate most cancers, in line with World Health Organization (WHO) figures on annual most cancers mortality.

I had hoped that on his return to Nigeria, President Buhari would declare a state of emergency within the nation’s well being sector. Painfully, nothing of such occurred. Nigeria’s funds allocation to healthcare has remained lower than 5% of the whole funds for the previous 5 years. Simply put, in 2020 the federal authorities budgeted N2,000 (£4.2) for every Nigerian with a complete of N427.Three billion as funds allocation to the well being sector whereas the United Kingdom budgeted £2,159.6 for every citizen with a complete well being funds of £143.4billion. It is similar dismal story within the states throughout Nigeria. Healthcare isn’t a precedence. In some states in Nigeria, a hospital is a 20-minute boat journey and an hour-long automobile journey. Because many poor Nigerians don’t personal boats, a girl in labour may bleed to loss of life earlier than she reaches the hospital.

On March 22, 2018, Bill Gates, founding father of Microsoft and the Bill & Melinda Gates Foundation, criticized Nigerian authorities’s poor funding of healthcare within the nation. In his phrases, “One in three children is chronically malnourished.” This tragedy has large implications for the economic system. According to the World Bank, addressing the stunting disaster in Nigeria would add virtually $30 billion to Nigeria’s GDP. It is painful that regardless of Mr. Gates assertion, nothing has modified. Nigeria has remained one of many nations on this planet with the worst healthcare system with over 60 deaths per 1000 stay births. Nigeria has one of many worst most cancers survival charges on this planet, with solely 2 to three most cancers radiotherapy machines working at any time and fewer than 70 oncologists for a inhabitants of over 200 million.

COVID-19 is exposing the insensitivity of our leaders to issues that matter most to us. That Nigerians are disobeying the federal government’s security recommendation on COVID-19 is a transparent reflection of residents’ distrust for his or her leaders. Many Nigerians belief their non secular leaders greater than they belief our political leaders. Successive governments have failed the nation, and it doesn’t appear like factor will change anytime quickly.

Nigeria is a rustic the place our rulers make legal guidelines as we speak and break the identical legal guidelines tomorrow. The Nigeria Centre for Diseases Control (NCDC) adopted the World Health Organization (WHO) guideline and strongly inspired all Nigerians coming from sure nations to self-isolate and monitor themselves, as a method to comprise or to delay the unfold of COVID-19. The president’s Chief of Staff, Abba Kyari, returned from Germany and as an alternative of isolating himself he was leaping from one state to a different, attending occasions and conferences with totally different folks, breaching the federal government’s personal advice and inserting the lives of different Nigerians in danger!

Now that COVID-19 is in Nigeria we have to face it with all that we’ve. But can we? The Nigeria Centre for Disease Control (NCDC) is now the nation’s solely perceived hope. Many Nigerians have been calling NCDC scorching traces, criticizing NCDC for not testing sufficient folks. But we must always face the music and never the dancer. NCDC is crippled and never effectively outfitted to guard Nigerians from the illness.

In 2016, NCDC budgeted N3.7m for its recurrent and N248m for capital allocations. That is a complete of N251.7m. Out of this, solely N155m was launched to the centre. In the identical 12 months, 1,166 Nigerians died of Cerebrospinal Meningitis. In 2017, the NCDC had a funds of N1.5b. Only N782m was launched. In the identical 12 months, greater than 120 Nigerians contracted Monkeypox and 7 folks died from the illness. That identical 12 months, the Presidency budgeted N77m for Aso Rock lease, N1b for journeys and sitting allowances, and N94m for meals. In 2018, the NCDC had a funds of N1.9b. Only N654m was launched. In the identical 12 months, N7.2b was proposed for Presidential Air Fleet. N440m was proposed for necessary improve and set up of stay TV and web service within the presidential aircrafts, N375m for brand spanking new cabin administration, N418m for the touchdown gears. In whole, over N1b was budgeted for the presidential aircrafts which is used for medical tourism and frequent journeys overseas.

On November 12, 2018, the NCDC institution invoice was signed by President Muhammadu Buhari, because of the efforts of Senator Mao Ohuabunwa, the then Chair, Senate Committee on Primary Healthcare and Communicable Diseases. On this premise, the NCDC was empowered with a laws for its work in stopping and making ready for outbreaks of infectious illnesses. Interestingly, the NCDC acquired the worst funds in 2019, the 12 months following the passage of the NCDC Act. The Centre had a funds of N1.4b, however solely N224m was launched. In the identical 12 months, over 472 Nigerians have been identified with Lassa fever and over 110 folks died from this viral hemorrhagic fever. Clearly, NCDC can’t carry out magic. They need assistance. Nigeria is grossly under-testing for COVID-19, the laboratories usually are not sufficient, and NCDC and its affiliate businesses wouldn’t have sufficient manpower and sources.

Months in the past, being unwell evoked empathy; as we speak being unwell evokes concern. The concern of COVID-19? No! It is the concern of not gaining access to the care that you just want, the concern of absence of ventilators, the concern of a damaged well being system. It is the concern of loss of life. Our political leaders have stolen from the sick by corruption. Many Nigerian governors construct non-functional hospitals of their states. Usually, after the commissioning of those hospitals, all of the CT Scan, Magnetic Resonance Imaging (MRI) and different medical machines—a few of them faux—are returned to the place they have been bought or left to rot.

Hospitals in Nigeria are among the worst on this planet. Our educating hospitals at the moment are museums the place lower than 5% of medical trial and analysis is occurring due to poor laboratory. Medical tourism has due to this fact grow to be the norm. Dubai hospitals, Saudi Arabian hospitals, and so on., are promoting in Abuja and Lagos for Nigerian sufferers. They are recruiting Nigerian docs, together with consultants. Nigeria isn’t solely going through “brain drain,” we’re additionally going through “patient drain.” Our docs and nurses work within the worst situations. Hazard allowance for well being staff is about N5,000 whereas wardrobe allowance for members of the National Assembly runs into hundreds of thousands.

Now is the time for Nigeria to confront its healthcare disaster. The Nigerian authorities should settle for its failure. Our political leaders should brace as much as their duty and critically replicate on the issue their greed has delivered to Nigeria. This is the time to put money into a result-oriented healthcare system. Health is wealth because the saying goes. healthcare system is the muse of any nation.

If we survive COVID-19, we have to contemplate a legislation to limit all public officers from searching for medical care overseas. It could also be perceived as strict, however it can save future generations since we don’t know which pandemic would come subsequent and when.

Let’s give each Nigerian an area to stay and a not probability to die.

Runcie C.W. Chidebe is Executive Director, Project PINK BLUE. He is at the moment a Commonwealth Scholar on Transforming and Leading in Health Care at Birmingham City University, United Kingdom. He tweets @runciecwc

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April 4, 2020
Chagas disease: providing free paediatric medicine can enhance diagnosis and treatment
Documentation resulting in the donation of an important antiparasitic medicine for the treatment of Chagas illness to the World Health Organization (WHO) is within the ultimate stage of preparation.

A 3-year settlement, between the Mundo Sano Foundation¹ (Brazil) and WHO, is anticipated to make obtainable 108 000 tablets of the paediatric formulation of benznidazole² – a first-line medicine towards Chagas illness. Treatment³ with benznidazole within the early levels of an infection can treatment Chagas illness.

“Making benznidazole freely obtainable for the treatment of newborns till the age of 18 might be a game-changer within the battle towards Chagas illness” mentioned Dr Mwelece Ntuli Malecela, Director, WHO Department of Control of Neglected Tropical
Diseases. “This is not going to solely save future generations from growing life-threatening and deadly issues however can even increase up diagnosis and treatment.”

Each yr, an estimated 15 000 youngsters are born from contaminated moms. A freely obtainable paediatric presentation of benznidazole with correct dosage is essentially anticipated to contribute to deal with congenital infections.

“Treating newborns and youngsters was the lacking hyperlink, as we transfer decisively to advocate for the mixing of diagnosis of an infection amongst pregnant ladies and women of child-bearing age into different surveillance programmes, together with HIV and syphilis” mentioned Dr Pedro Albajar Vinas, Medical Officer with WHO’s Department of Control of Neglected Tropical Diseases. “Diagnosing and treating ladies of this age group earlier than being pregnant can increase successfully stop congenital transmission.”

The settlement

The donation by Mundo Sano Foundation at some point of the settlement includes benznidazole:
- 105,000 tablets of 100mg
- 3,000 tablets of 12.5mg
Furthermore, the Foundation might donate funds of as much as US$100 000 at some point of the settlement to help actions related to distribution of medicines and conferences. The Foundation additionally makes provision for an extension of this settlement past
the required length of three years.

The illness

Chagas illness, often known as American trypanosomiasis, is a doubtlessly life-threatening sickness brought on by the protozoan parasite Trypanosoma cruzi (T. cruzi).

Although appreciable progress has been achieved, significantly in decreasing vector transmission and screening of blood and organ provide, reaching and diagnosing individuals most affected has been a problem.

Currently, under-diagnosis of Chagas illness instances is as excessive as 90% and under-diagnosis of congenital transmission is believed to be even greater.

Globally, an estimated 6-7 million individuals are contaminated with T. cruzi.

The illness is discovered primarily in endemic areas of 21 continental Latin American international locations⁴. But motion of individuals to city areas and to different continents has expanded its transmission by means of non vectorial routes, akin to blood transfusion, congenital
transmission, organ transplants and oral meals contamination.

Considering the illness as a rising public well being drawback in lots of international locations, the World Health Assembly – WHO’s decision-making physique – determined in May 2019 to commemorate World Chagas Disease Day on 14 April.

The inaugural celebration occurs this yr.

¹Mundo Sano is a nonprofit worldwide basis working with the general public and personal sectors, academia, and different worldwide organizations to supply options to the affected communities and generate scientific information. In 2012, it led a public-private consortium in 2012 to provide benznidazole in Argentina.

²In 2017, the United States Food and Drug Administration (FDA) accepted benznidazole for the treatment of kids aged 2–12, making it the primary treatment accepted within the United States for Chagas illness.

³ Nifurtimox can be 100% efficient in curing Chagas illness if given quickly after onset of an infection, together with instances of congenital an infection. It is donated by Bayer who pledged greater than 7.5 million tablets for the interval 2012-2021.

⁴ Argentina, Belize, Bolivia (Plurinational State of), Brazil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, French Guiana, Guatemala, Guyana, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Suriname, Uruguay, and Venezuela
(Bolivarian Republic of).

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April 3, 2020
WHO to continue support for Chagas disease programme that promotes patient self-care
The World Health Organization (WHO) and the Catalan Ministry of Health say they’ll collectively support the dissemination of a programme that gives support to sufferers affected by Chagas disease to handle their very own well being and promote self-care.

The Catalonian ‘Expert Patient Programme on Chagas disease’ includes interplay and sharing of knowledge amongst individuals affected by the disease and is performed by an knowledgeable patient. The programme is taken into account to have completed very properly because it was first initiated in 2017.

“Over the previous few years we now have seen exceptional improve in consciousness and confidence amongst sufferers to pursue medical care and follow-up with physicians” stated Dr Pedro Albajar Vinas, who’s accountable for WHO’s Chagas disease programme. “When sufferers discuss to each other there may be higher deal with general perceptions of well being, life-style, bettering shallowness, self-care and particular person satisfaction.”

The programme additionally encourages self-responsibility and features as a part of the Chronic Disease Prevention and Care Programme of the Government of Catalonia. It is predicated on three key approaches:
- support supplied by sufferers and observing professionals to these in power part of the disease;
- promote interplay in teams by 9 fastidiously deliberate periods;
- consider efficiency of previous periods by questionnaires earlier than a brand new session begins.
Many individuals who attended the programme over time say they might suggest it to household and associates because it vastly helps to enhance information about disease.

Initiators of the programme are assured that the methodology used, and classes discovered can type a part of a broader technique to push for complete care for a disease that continues to be largely uncared for. For instance, regardless of the efforts of the previous decade, the worldwide detection fee for Chagas disease is lower than 10%.

Through this settlement, WHO will present support in facilitating the interpretation of supplies and paperwork in languages utilized in its Member States in addition to help within the improvement of any mobile-based software if the necessity arises. The Government of Catalonia will print and distribute for advocacy functions.

To promote international advocacy for the disease, the World Health Assembly – WHO’s decision-making physique – in 2019 adopted a call to have a good time World Chagas Disease Day on 14 April.

The disease

Chagas disease was as soon as confined to rural areas of Latin American international locations the place the primary route of transmission is vectorial transmission.

But over the previous many years, the disease has been more and more reported in lots of international locations exterior Latin America primarily due to motion of populations and migration.

According to WHO estimates, round 6-7 million individuals are contaminated with Trypanosoma cruzi – the protozoan parasite that causes Chagas disease.

Vectorial transmission happens when people are available in contact with the faeces or urine of triatomine bugs (referred to as ‘kissing bugs’, amongst many different native names).

These bugs – the vectors that carry the parasites – reside within the wall or roof cracks of properties – the place they disguise in the course of the day and lively at evening after they feed on human blood. They often chew an uncovered space of pores and skin such because the face (therefore its widespread identify ‘kissing bug’).

Right after a chew, the bug defecates/urinates shut to the chew space. The parasites enter the physique when the particular person instinctively reacts to the chew and smears the bug faeces or urine into the chew, the eyes, the mouth, or into any pores and skin break.

The parasite may also be transmitted by:
- consumption of meals contaminated with T. cruzi by, for instance, contact with faeces or urine of contaminated triatomine bugs or marsupials (this type of transmission sometimes causes outbreaks with extra extreme morbidity and better mortality – infecting teams of individuals concurrently with extra frequent instances of extreme disease and better variety of deaths);
- blood or blood product transfusion from contaminated donors;
- passage from an contaminated mom to her new child throughout being pregnant or childbirth;
- some organ transplants utilizing organs from contaminated donors; and
- laboratory accidents.
There is not any vaccine in opposition to Chagas disease. Domiciliary vectorial management and transfusional management, along with congenital transmission, stay the simplest strategies of stopping transmission in Latin America.

Chagas disease was named after Carlos Ribeiro Justiniano Chagas, a Brazilian doctor and researcher who found the disease in 1909.

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April 3, 2020
Medical Product Alert N°2/2020
This Medical Product Alert relates to a confirmed falsified human immunodeficiency virus (HIV) in vitro diagnostic medical device (IVD) that has been identified circulating in Guyana and Kenya.

Through its Global Surveillance and Monitoring System (GSMS) for substandard/falsified medical products,
WHO was informed that at least 8,240 falsified rapid diagnostic tests to detect HIV-1/2 have been distributed in Guyana at end-user level. The product is Uni-Gold™ HIV and claims to be manufactured by
Trinity Biotech plc. Subsequent reports
revealed that the same falsified product is also circulating in Kenya.

Uni-Gold™ HIV is a single-use rapid diagnostic test – an immunoassay for the qualitative detection of antibodies to HIV-1 and HIV-2 in serum, plasma and whole blood. Uni-Gold™ HIV is intended for use in point of care settings as an aid
in diagnosis of HIV-1 and HIV-2 infection.

The WHO testing strategy recommends three HIV reactive test results to confirm an HIV-positive status in a
patient. The use of this falsified Uni-Gold™ HIV, subject of WHO medical product alert n°2 of 2020, is likely to lead to delayed diagnosis of HIV status.

Table 1: Specific details of the falsified product Uni-Gold™ HIV, subject of WHO Medical Product Alert n°2 of 2020

Product Name

Uni-Gold™ HIV

Lot Number

HIV7120026

Expiry Date

5 DEC 2020

Stated manufacturer

Trinity Biotech

The packaging of this falsified HIV test kit is in English.

The genuine manufacturer (Trinity Biotech plc) has confirmed that:
- They did not manufacture the falsified product in Table 1.
- Genuine lot HIV7120026 was made by Trinity Biotech plc and expired in 2019.
- The expiry date is incorrect and does not correspond with their batch manufacturing records.
Photographs and advice to the public are available below.

Figure 1 – Falsified Uni-Gold™ HIV, lot number HIV7120026, displaying falsified expiry date

Figure 2 – Falsified Uni-Gold™ HIV, displaying labelling inconsistencies

Advice on action to be taken by end-users:
- Please check to see if any Uni-Gold™ HIV test kits in your facility have lot number HIV7120026.
- If you are in possession of these falsified test kits with lot number HIV7120026:
1. Please do not use.
2. Please immediately contact the organization that supplied you with the product (either your HIV testing programme, nongovernmental organization or local distributor).
3. Please contact Trinity Biotech plc
Phone : +353 1 276 9800

E-mail : hiv@trinitybiotech.com
1. Please contact your national health authorities
All medical products must be obtained from authentic and reliable sources. Their authenticity and condition should be carefully checked.

Advice on action to be taken by national health authorities:

WHO requests increased scrutiny within the supply chains of all countries, particularly at testing sites (health facilities, community-based), clinical laboratories, medical stores/warehouses, and at the facilities of relevant economic operators (agents,
authorized representatives, distributors, wholesalers, etc.).

If these falsified test kits with lot number HIV7120026 are discovered, please do not use.

National health authorities are asked to immediately inform WHO, if these falsified products are discovered in their country using the WHO IVD complaint form.

If you have any information concerning the manufacture, distribution, or supply of this product, please contact rapidalert@who.int

WHO Global Surveillance and Monitoring System for Substandard and Falsified Medical Products

For further information, please visit our website: https://www.who.int/medicines/regulation/ssffc/en/

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April 1, 2020
WHO releases guidelines to help countries maintain essential health services during the COVID-19 pandemic

The COVID-19 pandemic is straining health systems worldwide. The rapidly increasing demand on health facilities and health care workers threatens to leave some health systems overstretched and unable to operate effectively.

Previous outbreaks have demonstrated that when health systems are overwhelmed, mortality from vaccine-preventable and other treatable conditions can also increase dramatically. During the 2014-2015 Ebola outbreak, the increased number of deaths caused
by measles, malaria, HIV/AIDS, and tuberculosis attributable to health system failures exceeded deaths from Ebola
^[1,2].

“The best defense against any outbreak is a
strong health system,” stressed WHO Director-General Tedros Adhanom Ghebreyesus.
“COVID-19 is revealing how fragile many of the world’s health systems and
services are, forcing countries to make difficult choices on how to best meet
the needs of their people.”

To help countries navigate through these challenges, the World Health Organization (WHO) has updated operational planning guidelines in balancing the demands of responding directly to COVID-19 while maintaining essential health service delivery, and mitigating
the risk of system collapse. This includes a set of targeted immediate actions that countries should consider at national, regional, and local level to reorganize and maintain access to high-quality essential health services for all.

Countries should identify essential services that will be prioritized in their efforts to maintain continuity of service delivery and make strategic shifts to ensure that increasingly limited resources provide maximum benefit for the population. They
also need to comply with the highest standard in precautions, especially in hygiene practices, and the provision of adequate supplies including personal protective equipment This requires robust planning and coordinated actions between governments
and health facilities and their managers.

Some examples of essential services include: routine vaccination; reproductive health services including care during pregnancy and childbirth; care of young infants and older adults; management of mental health conditions as well as noncommunicable diseases
and infectious diseases like HIV, malaria and TB; critical inpatient therapies; management of emergency health conditions; auxiliary services like basic diagnostic imaging, laboratory services, and blood bank services, among others.

Well-organized and prepared health systems can continue to provide equitable access to essential service delivery throughout an emergency, limiting direct mortality and avoiding increased indirect mortality.

The guidelines stress the importance of keeping up-to-date information. This requires frequent transparent communications with the public, and strong community engagements so the public can maintain trust in the system to safely meet their
essential needs and to control infection risk in health facilities. This will help ensure that people continue to seek care when appropriate, and adhere to public health advice.

1. Elston, J. W. T., Cartwright, C., Ndumbi, P., & Wright, J. (2017). The health impact of the 2014–15 Ebola outbreak. Public Health, 143, 60-70.

2. Parpia, A. S., Ndeffo-Mbah, M. L., Wenzel, N. S., & Galvani, A. P. (2016). Effects of response to 2014–2015 Ebola outbreak on deaths from malaria, HIV/AIDS, and tuberculosis, West Africa. Emerging infectious diseases, 22(3), 433.

For interviews please contact: Tarik Jasarevic

To access the full guidance please visit: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/maintaining-essential-health-services-and-systems

For further information and guidance on COVID-19 please visit: https://www.who.int/emergencies/diseases/novel-coronavirus-2019

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March 31, 2020
Information sharing on COVID-19
WHO’s focus at all times is to ensure that all areas of the globe have the information they need to manage the health of their people. In a recent interview, the WHO official who headed the joint international mission to China, did not answer a question on Taiwan’s response to the COVID-19 outbreak.

The question of Taiwanese membership in WHO is up to WHO Member States, not WHO staff. However, WHO is working closely with all health authorities who are facing the current coronavirus pandemic, including Taiwanese health experts.

The Taiwanese caseload is low relative to population. We continue to follow developments closely. WHO is taking lessons learned from all areas, including Taiwanese health authorities, to share best practices globally.

With respect to the COVID-19 outbreak, the WHO Secretariat works with Taiwanese health experts and authorities, following established procedures, to facilitate a fast and effective response and ensure connection and information flow.
- There is a Taiwanese International Health Regulations Point of Contact, who receives IHR (2005) communications and has access to the Event Information Site (EIS) Platform (a password-protected database and information exchange mechanism supporting the IHR (2005)).
- The Taiwanese Field Epidemiology Training Program is a member of the Training Programs in Epidemiology and Public Health Interventions Network (also known as “TEPHINET”). WHO shares Global Outbreak Alert and Response Network alerts and requests for assistance with TEPHINET, and those messages are cascaded to the TEPHINET members.
- Two Taiwanese public health experts participated in the Global Research and Innovation Forum organized by WHO on 11-12 February 2020, thus contributing, alongside other world scientists, including from mainland China, to critical research questions and to finding ways to work together to advance the response.
  WHO staff work around the world to respond to this pandemic with the best evidence-based guidance and operational support available for all people, based on public health needs. Membership in WHO and status issues are decided by Member States and the rules they set at WHO’s governing body, the World Health Assembly.
  
  Information about COVID-19 can be found here: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
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March 30, 2020
Vanguard CEO Tim Buckley to become Chairman in 2019

On January 1, 2019, Vanguard President and CEO Tim Buckley will assume the role as Chairman of Vanguard.

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March 29, 2020

*Product Name*	Uni-Gold™ HIV
Lot Number	HIV7120026
Expiry Date	5 DEC 2020
Stated manufacturer	Trinity Biotech

Tag: 2019

The agreement

The disease

The settlement

The illness

The disease