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Massive proportion of world’s population are living with herpes infection

Virus causing genital herpes may put millions of people at greater risk of infection with HIV

About half a billion people worldwide are living with genital herpes, and several billion have an oral herpes infection, new estimates show.

Authored by staff at the University of Bristol, World Health Organization (WHO), and Weill Cornell Medical College-Qatar, and published in the Bulletin of the World Health Organization,
the new study estimates the global infection prevalence and incidence of herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) in 2016.

“Herpes infection affects millions of people across the globe and can have far-reaching health effects. We need more investment and commitment to develop better treatment and prevention tools for this infection.” says Dr Sami Gottlieb, Medical
Officer at WHO and an author of the study.

Prevalence and incidence

An estimated 491.5 million people were living with HSV-2 infection in 2016, equivalent to 13.2% of the world’s population aged 15 to 49 years. HSV-2 is almost exclusively sexually transmitted, causing infection in the genital or anal area (genital
herpes).

An estimated 3.7 billion people had HSV-1 infection during the same year – around 66.6% of the world’s population aged 0 to 49. HSV-1 is mainly transmitted by oral to oral contact to cause infection in or around the mouth (oral herpes). However,
HSV-1 can also be transmitted to the genital area through oral-genital contact – during oral sex – to cause genital herpes. Most HSV-1 infections were oral; however, between 122 million to 192 million people were estimated to have genital
HSV-1 infection, depending on the assumptions used in the estimation model.

Because herpes is a lifelong infection, estimated prevalence increased with age; HSV-2 prevalence was also higher among women and in the WHO African Region.

Health and social impacts

Most people living with herpes, caused by either HSV-1 or 2, are unaware they have the infection.

When symptoms do occur however, oral herpes infection can lead to painful sores around the mouth (“cold sores”). Genital herpes infection can cause recurring, often painful, genital sores, often referred to as genital ulcer disease.

WHO and partners published a study in March 2020 estimating that around 5% of the world’s population (187 million people) suffered from at least one episode of herpes-related genital ulcer disease in 2016 (1). Most of these episodes were due to
HSV-2, which can recur frequently over many years.

Recurrent symptoms of genital herpes can lead to stigma and psychological distress, and can have an important impact on quality of life and sexual relationships. However, in time, most people with herpes adjust to living with the infection.

“Genital herpes is a substantial health concern worldwide – beyond the potential pain and discomfort suffered by people living with the infection, the associated social consequences can have a profound effect on sexual and reproductive health”
says Dr Ian Askew, Director of the Department of Sexual and Reproductive Health and Research at WHO.

Herpes and HIV

A strong association exists between HSV-2 infection and HIV infection. In 2019, WHO commissioned a modeling study to estimate how much HSV-2 infection might contribute to HIV incidence. The study estimated that almost 30% of new sexually acquired HIV
infections in 2016 worldwide were likely attributable to HSV-2 infection (2).

Evidence shows that people with HSV-2 infection are at least three times more likely to become infected with HIV, if exposed. HSV-2 leads to inflammation and small breaks in the genital and anal skin that can make it easier for HIV to cause infection.
In addition, people with both HIV and HSV-2 infection are more likely to spread HIV to others.

Women have higher biologic susceptibility to both HSV-2 and HIV. Women living in the WHO Africa Region have the highest HSV-2 prevalence and exposure to HIV – putting them at greatest risk of HIV infection, with negative implications for their health
and well-being.

For people living with HIV (or who are living with other conditions that compromise their immune systems) as well as HSV-2, the symptoms of herpes can be more severe and more frequent.

Neonatal herpes

Neonatal herpes can occur when an infant is exposed to HSV in the genital tract during delivery. This is a rare condition, occurring in an estimated 10 out of every 100,000 births globally, but can lead to lasting neurologic disability or death. The risk
for neonatal herpes is greatest when a mother acquires HSV infection for the first time in late pregnancy. Women who have genital herpes before they become pregnant are at very low risk of transmitting HSV to their infants.

No cure – better treatment and prevention needed

There is no cure for herpes. At present, antiviral medications, such as acyclovir, famciclovir, and valacyclovir, can help to reduce the severity and frequency of symptoms but cannot cure the infection.

As well as increasing awareness about HSV infection and its symptoms, improved access to antiviral medications and heightened HIV prevention efforts for those with genital HSV symptoms are needed globally.

In addition, development of better treatment and prevention interventions is needed, particularly HSV vaccines. WHO and partners are working to accelerate research to develop new strategies for prevention and control of HSV infections. Such research includes
the development of HSV vaccines and topical microbicides. Several candidate vaccines and microbicides are currently being studied.

“A vaccine against HSV infection would not only help to promote and protect the health and well-being of millions of people, particularly women, worldwide – it could also potentially have an impact on slowing the spread of HIV, if developed
and provided alongside other HIV prevention strategies” says Dr Meg Doherty, Director of the WHO Department of Global HIV, Hepatitis, and STI Programmes.

Related publications

WHO guidelines for the treatment of Genital Herpes Simplex Virus

WHO preferred product characteristics for herpes simplex virus vaccines

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(1) Looker KJ, Johnston C, Welton NJ, et al. The global and regional burden of genital ulcer disease due to herpes simplex virus: a natural history modelling study. BMJ Glob Health. 2020;5(3):e001875. doi: 10.1136/bmjgh-2019- 001875.

(2) Looker KJ, Welton NJ, Sabin KM, et al.Global and regional estimates of the contribution of herpes simplex virus type 2 infection to HIV incidence: a population attributable fraction analysis using published epidemiological data. Lancet Infect Dis.2020;20(2):240-249. doi: 10.1016/S1473-3099(19)30470-0.

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May 9, 2020
Indonesia firmly committed to eliminating lymphatic filariasis as a public health problem

Indonesia recently completed the last of its annual large-scale treatment for lymphatic filariasis (also known as elephantiasis or Penyakit Kaki Gajah) in Malaka District located in its southernmost province, East Nusa Tenggara. Unprecedented
progress by the National Lymphatic Filariasis Elimination Programme has strongly placed the country on the path to achieving the elimination of lymphatic filariasis as a public health problem.

“We reached an estimated number of 40.7 million people living in the 118 high-risk districts during this month-long treatment campaign in October 2019” said Dr Anung Sugihantono, who recently retired as Director General of Diseases
Prevention and Control, Ministry of Health Indonesia. “Single doses of diethylcarbamazine citrate and albendazole facilitated by WHO were delivered to all eligible populations.”

In 2010, an estimated 125 million Indonesians were still at risk of the disease and required treatment.

But things changed considerably in 2015 when Indonesia mounted an annual national campaign to resolutely address transmission of the disease and to tackle the morbidity and disability associated with it. The results were apparent as early as 2017, with
remarkable progress.

In Indonesia, LF is considered a significant public health concern. In 2009, risk mapping identified a population of 124.5 million people needing treatment for LF. The country initiated a national level LF elimination campaign in 2015, addressing both
disease prevention and management.

“In 2017 and in just two years we managed to achieve 100% geographical coverage of all people requiring treatment” said Dr Sugihantono. “It meant achieving more than 78% epidemiological coverage – much higher than the generally recommended 65% to stop transmission.”

Transmission of lymphatic filariasis can be stopped through large-scale treatment (or mass drug administration – MDA) of entire at- risk communities with recommended medicines once a year. These medicines kill the microfilariae in an infected patient’s
blood preventing mosquitoes to transmit¹ the disease to others. Through mass treatment, the aim is to reduce the reservoir of microfilariae in the blood to a level insufficient to maintain transmission by the mosquito vector.

This strategy to interrupt transmission is the corner-stone of the World Health Organization’s (WHO) Global Program to Eliminate Lymphatic Filariasis (GPELF). Indonesia has been using the GPELF’s strategy since 2002 using a district or city
as its implementation unit.

In 2005, it listed the elimination of LF as a national priority for controlling infectious diseases and the medicines it has been using in large-scale treatment programmes are diethylcarbamazine citrate (DEC) and albendazole² which are
largely distributed by volunteer community health workers³.

“Community health volunteers are themselves members of the community and know how to reach people effectively to improve compliance” said Dr. Stefanus Bria Seran, the Regent of Malaka District, one of LF endemic district in Indonesia. “Besides ensuring every single person ingests the medicine given to them, these community workers help in disseminating information well before a large-scale treatment campaign and also assist in reporting activities related to each treatment campaign”.

Indonesia’s efforts to eliminate lymphatic filariasis began in the 1970s but faced numerous challenges including programme coordination in the many inhabited islands, conducting information, education and awareness programmes, lack of capacity and
insufficient medicines.

Furthermore, the situation in Indonesia is unusual than in many other countries endemic for lymphatic filariasis as the country is endemic for all three species of thread-like filarial worms – Brugia malayi, Brugia timori, and Wuchereria bancrofti –
that cause the disease. Most of the infections in Indonesia, however, are caused by B. malayi.

In the past, some of the factors that prevented access to the medicines (DEC and albendazole) were social stigmatization linked to the disease, the vast geography of the territory and challenges in reaching remote populations.

With an estimated population of 242 million, Indonesia is the world’s largest island nation and consists of approximately 17,000 islands, of which 5,000–6,000 are inhabited. It is the fourth most populated nation behind China, India, and the United
States.

Indonesia is endemic for many other neglected tropical diseases and an estimated 110 million Indonesians are believed to suffer from at least one neglected tropical disease (NTD), including lymphatic filariasis and soil-transmitted helminth infections.
Leptospirosis (not classified as NTD) is also widespread.

Indonesia is the only country of WHO’s South East Asia Region with endemic schistosomiasis. Like many other countries of the Region, it also faces recurrent threats of dengue outbreaks.

Global progress

The world has made significant progress towards the elimination of lymphatic filariasis as a public health problem.

Sixteen countries⁴ and one territory are now acknowledged by WHO to have achieved elimination of lymphatic filariasis as a public health problem.

Seven additional countries have successfully implemented recommended strategies, stopped large-scale treatment and are under surveillance to demonstrate that elimination has been achieved.

The disease

Lymphatic filariasis is caused by infection with parasitic worms living in the lymphatic system. The larval stages of the parasite (microfilaria) circulate in the blood and are transmitted from person to person by mosquitoes.

Infection involves asymptomatic, acute, and chronic conditions. Most infections are asymptomatic, showing no external signs while contributing to transmission of the parasite. Although asymptomatic, these infections still cause damage to the lymphatic
system and the kidneys and alter the body’s immune system.

When lymphatic filariasis develops into chronic conditions it leads to lymphoedema (tissue swelling) or elephantiasis (skin/tissue thickening) of limbs and hydrocele (scrotal swelling). Involvement of breasts and genital organs are common.

Manifestation of the disease after infection takes time and can result in an altered lymphatic system, causing abnormal enlargement of body parts, and leading to severe disability and social stigmatization of those affected.

¹Lymphatic filariasis is transmitted by different types of mosquitoes – e.g the Culex mosquito which widespread across urban and semi-urban areas; Anopheles, mainly found in rural areas; and, Aedes, mainly
in endemic islands in the Pacific.

²In 2017, WHO recommended an alternative three drug treatment to accelerate the global elimination of lymphatic filariasis. The treatment, known as IDA, involves a combination of ivermectin, diethylcarbamazine citrate and albendazole.
It is recommended annually in settings where its use is expected to have the greatest impact.

³Community health workers, also called ‘cadres’, are volunteers who form part of the communities they serve and work with local
communities to educate families. Their contribution in promoting health has been significant in the country.

⁴Cambodia, The Cook Islands, Egypt, Kiribati, Maldives, Marshall Islands, Niue, Palau, Sri Lanka, Thailand, Togo, Tonga, Vanuatu, Viet Nam, Wallis and Futuna, and Yemen

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May 9, 2020
New estimates highlight need to step up the response to hepatitis D

Lyon, France, 29 April 2020 – In a study published in the Journal of Hepatology,¹ Professor Anna Maria Geretti and Dr Alexander Stockdale from the University of Liverpool (United Kingdom), in collaboration with researchers
from the World Health Organization (WHO) and the International Agency for Research on Cancer (IARC), estimate that worldwide, hepatitis D virus (HDV) affects nearly 5% of people who have a chronic infection with hepatitis B virus (HBV) and that HDV
co-infection could explain about 1 in 5 cases of liver disease and liver cancer in people with HBV infection..

To map the epidemiology of HDV infection in the world, Professor Geretti and Dr Stockdale joined forces with the WHO Global Hepatitis Programme and IARC, alongside investigators in Germany, Malawi, and the United Kingdom. “Infection with HDV occurs
in about 1 in 22 cases of chronic HBV infection in the world,” Dr Stockdale says. “More high-quality data are needed, but we have identified several geographical hotspots of high prevalence of HDV infection: in Mongolia, the Republic of
Moldova, and countries in Western and Middle Africa.”

“Although it is less common than hepatitis B, hepatitis D is a serious disease that often affects underprivileged and vulnerable populations,” says Dr Meg Doherty, Director of the WHO Global Hepatitis Programme. Those who are more likely to
have HBV and HDV co-infection include people who inject drugs and people with hepatitis C virus or HIV infection. The risk of co-infection also appears to be higher in recipients of haemodialysis, men who have sex with men, and commercial sex workers.
Dr Doherty points out, “This information helps in identifying the groups with HBV among whom we should be looking for HDV.”

HDV (formerly known as the Delta agent) is a small virus – one of the smallest that is known to cause disease in humans – and can replicate only in the presence of HBV, from which HDV borrows some of its structures. Compared with people with
HBV infection alone, those who have a chronic infection with both HBV and HDV have a much higher risk of developing disease in the form of cirrhosis and liver cancer. “HDV is a significant contributor to severe liver disease and liver cancer,”
says IARC scientist Dr Catherine de Martel. “The findings from this study inform our work on the association between viral infections and cancer, which is focused on developing improved prevention strategies.”

Professor Geretti concludes, “HDV has long been neglected, because for decades the prevalence of infection remained uncertain and effective treatment was lacking. Mapping the epidemiology of the infection is just the first step. More efforts are
needed to reduce the global burden of chronic hepatitis B and develop medicines that are safe and effective against hepatitis D and are affordable enough to be deployed on a large scale to those who are most in need.”

¹ Stockdale AJ, Kreuels B, Henrion MYR, Giorgi E, Kyomuhangi I, de Martel C, Hutin Y, Geretti AM (2020). The global prevalence of hepatitis D virus infection: systematic review and meta-analysis. J Hepatol. Published online 23 April 2020;
https://doi.org/10.1016/j.jhep.2020.04.008

For more information, please contact

Véronique Terrasse, Communications Group, at +33 (0)6 45 28 49 52 or terrassev@iarc.fr or IARC Communications, at com@iarc.fr

The International Agency for Research on Cancer (IARC) is part of the World Health Organization. Its mission is to coordinate and conduct research on the causes of human cancer, the mechanisms of carcinogenesis, and to develop scientific strategies for
cancer control. The Agency is involved in both epidemiological and laboratory research and disseminates scientific information through publications, meetings, courses, and fellowships. If you wish your name to be removed from our press release emailing
list, please write to com@iarc.fr.

About University of Liverpool

Founded in 1881 as the original ‘red brick’, the University of Liverpool is one of the UK’s leading research-intensive higher education institutions. Consistently ranked in the top 200 universities worldwide, we are a member of the prestigious
Russell Group and have a global reach and influence that reflects our academic heritage as one of the country’s largest civic institutions. For more information please visit us at www.liverpool.ac.uk

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May 9, 2020
Commitment and call to action: Global collaboration to accelerate new COVID-19 health technologies
Our Vision and Mission

Grounded in a vision of a planet protected from human suffering
and the devastating social and economic consequences of
COVID-19, we, an initial group of global health actors (BMGF,
CEPI, Gavi, Global Fund, UNITAID, Wellcome Trust, WHO) and
private sector partners and other stakeholders, are launching
a landmark, global and time-limited collaboration to accelerate the
development, production and equitable global access to new COVID-19 essential health technologies.

We know that as long as anyone is at risk from this virus, the entire
world is at risk – every single person on the planet needs to be
protected from this disease.

We agree that alongside evidence-based public health measures,
innovative COVID-19 diagnostics, therapeutics and vaccines are
needed – in record time and at record scale and access – to save
millions of lives and countless trillions of dollars, and to return
the world to a sense of ‘normalcy’.

We recognize the significant amount of critical work, investment
and initiatives already ongoing around the world to expedite
the development and deployment of innovative COVID-19 related
products and interventions.

We appreciate that while development and deployment of
innovative products is essential, it will not be enough. We must
simultaneously and urgently accelerate the strengthening of
sustainable health systems and capacities to enable delivery of
the new COVID-19 tools to those who need them and to mitigate
the knock-on impact on other diseases.

We remember lessons from the past, which have shown that even
when effective tools are available to the world, too often some
are protected, while others are not. This inequity is unacceptable –
all tools to address COVID-19 must be available to all. In the fight
against COVID-19, no one should be left behind.

We understand we cannot do this alone, and that we need to
work together in unprecedented and inclusive partnership with all
stakeholders – political leaders, public and private sector partners,
civil society, academia, and all other stakeholders across society
– jointly leveraging our comparative strengths and respective
voices to drive towards collective solutions, an accelerated path,
and access for all. We are stronger, faster and more effective
working together.

Our Mission is not only accelerated development and availability
of new COVID-19 tools – it is to accelerate equitable global access
to safe, quality, effective, and affordable COVID-19 diagnostics,
therapeutics and vaccines, and thus to ensure that in the fight
against COVID-19, no one is left behind.

Our Commitment
1. We commit to the shared aim of equitable global
  access to innovative tools for COVID-19 for all.
2. We commit to an unprecedented level of partnership
  – proactively engaging stakeholders, aligning and
  coordinating efforts, building on existing collaborations, collectively devising solutions, and grounding
  our partnership in transparency, and science.
3. We commit to create a strong unified voice to
  maximize impact, recognizing this is not about
  singular decision-making authority, but rather
  collective problem-solving, interconnectedness and
  inclusivity, where all stakeholders can connect and
  benefit from the expertise, knowledge and activities
  of this shared action-oriented platform.
4. We commit to build on past experiences towards
  achieving this objective, including ensuring that
  every activity we undertake is executed through the
  lens of equitable global access, and that the voices
  of the communities most affected are heard.
5. We commit to be accountable to the world, to
  communities, and to one another. We are coming
  together in the spirit of solidarity, and in the service
  of humanity, to achieve our mission and vision.
Our Call

We ask the global community and political leaders to
support this landmark collaboration, and for donors to
provide the necessary resources to accelerate achievement
of the objectives of this global collaboration, capitalizing
on the opportunity provided by the rolling pledging
campaign that will start on 4 May 2020.

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May 9, 2020
New Ebola case confirmed in the Democratic Republic of the Congo

A new case of Ebola virus disease was confirmed today in the city of Beni in the Democratic Republic of the Congo (DRC).

“While not welcome news, this is an event we anticipated. We kept response teams in Beni and other high risk areas for precisely this reason,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

As part of the active Ebola surveillance system in place to respond to this ongoing outbreak in DRC, thousands of alerts are still being investigated every day. An alert is a person who has symptoms that could be due to Ebola, or any death in a high risk area that could have been as result of Ebola.

As with all confirmed cases, efforts are already underway to find everyone who may have been in contact with the person in order to offer them the vaccine and monitor their health status.

“WHO has worked side by side with health responders from the DRC for over 18 months and our teams are right now supporting the investigation into this latest case,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “Although the ongoing COVID-19 pandemic adds challenges, we will continue this joint effort until we can declare the end of this Ebola outbreak together.”

The news of the confirmed case came minutes after the conclusion of a meeting of the International Health Regulations Emergency Committee on Ebola in DRC. The Emergency Committee will reconvene next week in order to re-evaluate their recommendations in light of this new information.

Prior to this, the last person who was confirmed to have Ebola in DRC tested negative twice and was discharged from a treatment centre on 3 March 2020.

As of 10 April 2020, 3456 confirmed and probable cases and 2276 deaths have occurred as a result of the outbreak.

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April 11, 2020
WhatsApp tightens sharing limits to curb virus misinformation

SAN FRANCISCO: WhatsApp on Tuesday placed new limits on message forwarding as part of an effort to curb the spread of misinformation about the coronavirus pandemic.

The new policy limits users to forwarding certain messages to one “chat” at a time, aiming to limit the rapid propagation of content that is provocative but likely to be false.

The Facebook-owned messaging platform said it took the action to enable people to concentrate on personal and private communications during the health crisis.

In recent weeks, “we’ve seen a significant increase in the amount of forwarding which users have told us can feel overwhelming and can contribute to the spread of misinformation,“ WhatsApp said in a blog post.

“We believe it’s important to slow the spread of these messages down to keep WhatsApp a place for personal conversation.”

Last year, WhatsApp set limits on forwarded messages to five chats at a time, “to constrain virality,“ responding to events in India where the rapid proliferation of unverified information led to mob violence.

The new policy applies to messages forwarded “many times” and marked with a double-arrow, indicating that it did not originate from a close contact, according to WhatsApp.

“In effect, these messages are less personal compared to typical messages sent on WhatsApp,“ the blog said.

“We are now introducing a limit so that these messages can only be forwarded to one chat at a time.”

Damian Collins, a British member of parliament and co-founder of the Infotagion fact-check blog, called the move “a timely intervention,“ noting that WhatsApp was being used to spread recent hoaxes that 5G wireless networks were spreading the virus.

“The online conspiracy theories about #5G exposed last week, and their real-life consequences, are a clear call to fight disinformation about #COVID19,“ Collins tweeted.

“A lot of the false content sent to us at @infotagion came from @WhatsApp.”

Scrambling to stop hoaxes

WhatsApp along with its parent Facebook have been scrambling to curb an explosion of rumors and hoaxes about the coronavirus and at the same time seeking to promote verified content.

With more than a billion users worldwide, WhatsApp has become a key source of information and communication during the pandemic.

Facebook said last month it has nearly doubled server capacity to power WhatsApp as people in isolation place more voice and video calls using the popular messaging service.

But WhatsApp has also been used to spread inaccurate information about the Covid-19 outbreak including about untested treatments.

Irish Prime Minister Leo Varadkar last month warned people against sharing unverified coronavirus information on the messaging platform.

“These messages are scaring and confusing people and causing real damage. Please get your info from official, trusted sources,“ the leader tweeted.

One problem faced by the messaging service is that the encrypted information is seen only by the sender and recipient, making it harder for fact-checkers to debunk.

WhatsApp said that as part of its efforts to fight the spread of false information, it was working with the World Health Organization and some 20 national health ministries, “to help connect people with accurate information.”

The platform has been funding fact checking organizations and created a Coronavirus Information Hub within the app. – AFP

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April 10, 2020
A meeting on digital innovations, TB and implementation research organised by WHO and the European Respiratory Society

WHO’s Global Tuberculosis Programme (WHO/GTB) and the European Respiratory Society convened a technical meeting on digital innovations, TB and implementation research, in Geneva on 7 February 2020. This meeting brought together funders,
partners, representatives of national TB programmes, civil society and scientists to discuss the challenges and opportunities when evaluating, integrating and scaling up digital technologies under programmatic settings. Specifically, this meeting
sought to receive input on the elements of a toolkit on implementation research that is currently being developed by WHO/GTB and the Special Programme for Research and Training in Tropical Diseases (TDR) to support evidence-informed use of
digital technologies under programmatic settings. Th etoolkit will be launched in mid-2020. Considering that several countries are updating their national TB strategic plans and preparing funding proposals for submission to the Global Fund, this meeting
also sought to create mutual understanding on the importance of resourcing implementation science to bridge the divide between research and practice.

This present meeting, is the latest in a series of efforts by WHO/GTB to facilitate the meaningful use of digital technologies for TB prevention and care. It
was preceded by a one-day workshop on 6 February held at the same venue for partner agencies of the ASCENT project. ASCENT is a UNITAID-funded project that started in 2019 with the aim of increasing demand and adoption of affordable digital technologies for TB medication adherence. The project is led by KNCV in partnership with Aurum Institute for Health
Research, PATH and the London School of Hygiene and Tropical Medicine. Activities are running in Ethiopia, the Philippines, South Africa, Ukraine and Tanzania UR. This was the first in a series of annual meetings that will be coordinated by the WHO/GTB
to assess progress in implementation of country activities and results from the interventions.

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April 10, 2020
Strengthening accountability to end TB
WHO today released a Checklist to enable Member States and their partners to assess the status of work at the national level to strengthen accountability to End TB, principally: national commitments made, actions taken on those commitments, monitoring & reporting approaches, and the nature of any high-level review mechanisms. The Checklist has been developed in response to requests from Member States, regions, civil society and partners as a tool to support the adaptation and implementation of the WHO Multisectoral Accountability Framework (MAF-TB) released in 2019. It responds also to the UN General Assembly request to WHO to ensure implementation of the Framework.

There are four components of the MAF-TB that form a cycle for strengthening accountability: Commitments, Actions, Monitoring and Reporting, and Review, that were released during the World Health Assembly in May, 2019. In the political declaration of the first UN high-level meeting on TB, world leaders called for WHO to finalize the framework and ensure its implementation in 2019.

After its publication in May, 2019, WHO began work with pathfinding country counterparts who were seeking to move ahead on key elements including, among others: formal adoption of country-specific targets for 2022 for increased TB case detection and treatment in line with the global targets in the political declaration; updating or development of new national TB strategic plans based on 2022 and 2030 targets and other new commitments; coordination platforms across sectors and stakeholders; formalizing engagement with civil society across End TB efforts; producing robust performance reports; and, using those reports to inform high-level review bodies that will assess and drive faster progress. Based on the MAF-TB document, relevant country experiences, and specific requests from countries and partners, WHO developed the MAF-TB Checklist. The Checklist is especially relevant for high TB burden countries, but has content relevant to all countries. The appropriateness of different approaches may vary, according to national constitutional, legal and/or regulatory frameworks or other relevant factors.

The MAF-TB Checklist has three annexes on:
1. engagement across government ministries and bodies;
2. engagement of civil society and affected communities; and,
3. adoption and implementation of WHO TB guidance.
In releasing this MAF-TB Checklist today, Dr Tereza Kasaeva, Director of the WHO Global TB Programme noted, “At this enormously difficult time, all countries and partners are focused on the COVID-19 pandemic. Lessons learnt from ongoing TB programmes are helping the response. Likewise, TB efforts will benefit from learning underway on collaboration, innovation and accountability in confronting the virus.”

WHO will be helping Ministries of Health and partners to use the Checklist, hold related consultations and move forward with more effective collaboration and review mechanisms. The WHO Civil Society Task Force on TB also will support countries and civil society partners, using the Checklist. Progress in strengthening accountability will be assessed in the 2020 Report of the UN Secretary-General on progress since the 2018 TB UN high-level meeting, as well as in the WHO Global TB Report 2020.

The WHO TB Civil Society Task Force, National TB Programme Managers and other country officials, WHO staff at all levels, consultants working with WHO and The Global Fund, and staff of partner agencies, contributed content to, and/or provided feedback on, the MAF-TB Checklist during its development. Access the Checklist and 3 annexes.

An online form of the checklist will be available shortly here, along with additional information.

Translations of the Checklist and annexes, as soon as available in Arabic, Chinese, French, Russian and Spanish, will be posted at the above link as well. Kindly contact gtb programme@who.int if you have questions regarding the MAF-TB Checklist or to request versions in MS Word format if needed.

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April 10, 2020
COVID-19 And Nigeria’s Pathetic Leadership Deficit By Ugochukwu Ejinkeonye

There is no better warning about the growing confusion that seems to be gradually beclouding the federal government’s response to the coronavirus challenge than the belief it betrayed last week that, perhaps, all it needs to calm the fears and apprehensions of Nigerians about its ability to halt the spread of the virus is to reel out a catalogue of activities President Buhari was said to have undertaken so far concerning the pestilence, whether the people felt their impact or not.

Now, if your family is starving badly, do you solve the rumbling signs of biting hunger in their stomach with some wild tales of the efforts deployed by you so far to feed them, or just keep quiet, give them food, and they will see and feel for themselves that you have played your role responsively and effectively? Or if you must talk, tell them something you have done whose benefits they can readily verify and identify with.

Indeed, some Nigerians are beginning to achieve the conviction that there must be something about being in government in this country that seems to diminish the reasoning ability of people once they get in there and deprives them of the capacity to realize when they have stopped making sense or even become downright annoying. This is very pathetic.

And so, last week, presidential spokesperson, Mr. Femi Adesina, issued a document entitled: “COVID-19: What President Buhari Has Done And Is Doing.” And, I suppose that with the release of that handout, the virus immediately received a deadly blow and vanished from the country! Aren’t we so blessed? Why then are Nigerians not on the streets celebrating the unprecedented feat?

A prominent item on Mr. Adesina’s list is the president’s March 29 broadcast. And what exactly did the broadcast achieve? The two things I can readily remember now is that Gen Buhari had announced the continuation of the school feeding programme for pupils who are all at home now due to the closure of schools as part of the efforts to contain the spread of the coronavirus. Probably, nobody remembered to inform him and his speech writers that school children were on compulsory holidays, or are they going to send the food to them in their homes? Or, perhaps, somebody is trying to find a justification for the billions of naira we will be informed later was spent on the exercise?

Also, the president proclaimed the lockdown of Lagos and Ogun states and the Federal Capital Territory (FCT). And when he was through, he returned to his hideout – where only a few privileged eyes and ears see and hear from him, and then come out to tell us what they think he has said or done.

Now, what exactly was the lockdown meant to achieve? Okay, as social interactions are reduced, the chances of spreading the virus decrease. Yes, but what else? Has anyone seen any evidence that there were any plans to use the stay-at-home period to access the people and step up medical tests to determine how many people have become infected with the virus and how they could be attended to?

The government that was boasting that it was “adequately prepared” to tackle the virus was later to prove when the virus eventually arrived that it was only making empty claims as usual. A country of 200 million people has yet to demonstrate any capacity to test even a reasonable fraction of one percent of her population. And somebody is publishing a document to tell us what the president was supposed to have done or is doing. As if such boring tales will remove the cloud of gloom hovering over Nigeria?

Again, in a country where electric power is just an unaffordable luxury for many, how can a leader just lock down some states and return to his hideout to continue his “vacation” that was rudely interrupted by the loud, persistent and widespread demands that he should address his country even though some other presidents were doing daily briefings and leading the war against the virus from the front? As the markets closed and movements became restricted, how are those who could afford to buy and stock food items at home preserve them without electric power?

What of the greater population which depend on daily earnings for their survival? What is the government’s plan for them? Okay, we are hearing of palliatives that have been extended to this category of people and the billions of naira that have already been transferred to their accounts? Now, who has encountered the happy recipients of the twenty thousand naira (N20, 000) said to have been given to each of them? Are there really existing data showing the social and economic status of every Nigerian which is in the possession of the authorities? So, all the “poor and vulnerable” Nigerians now have bank accounts whose details are known to the government? So, why then are too many Nigerians very suspicious of these claims as shown in their social media comments? And why is such a rare display of kindness by this government not being celebrated? Or have the funds (if indeed any were shared) ended up in the hands of the same people who have more than enough to need them while those who are genuinely deprived remain terribly famished?

Already, the biting hunger out there is forcing a growing number of people to defy the no-movement decree and soon, the whole effort might be defeated, and the country will return to square one. Information Minister, Mr. Lai Mohammed, is threatening that the lockdown may be extended if Nigerians fail to behave themselves. But what he should rather have done is to hasten to school himself to realize that there is always a price to pay when leaders leave the country they claim to be governing in great disarray only to suddenly wake up when there is an emergency to grope for fix-quick solutions.

A few days after the president’s broadcast (that is, Tuesday, March 31), Daily Independent carried a front page lead story about 26 Americans who came into the country through the Murtala Mohammed International Airport and headed to Calabar without being screened. Now, who cleared their trip to the country and why were there no health officials available to screen them and ensure they were quarantined for 14 days before being allowed to fly to Calabar? Is it because they are Americans or clients of the Nigerian National Petroleum Corporation (NNPC) or both? Does that automatically exempt any of them from being a carrier of the virus which is presently ravaging their own country? What kind of government claims to be fighting a virus with one hand and using the other hand to be undermining the efforts being deployed to contain it?

Okay, the Minister of Health, Dr. Osagie Ehanire, has just announced that an 18-man Chinese team of medical “experts” will soon arrive the country to “assist” Nigeria in the fight against the coronavirus. Now, is it the federal government that asked China for help or was it China that volunteered their assistance? Indeed many Nigerians are vehemently opposed to this gesture at this time. Our own local medical experts have not shown any signs of being overburdened by the work, so what difference are these 18 Chinese doctors and nurses going to make? Will they, like the 26 privileged Americans, also be given express entry into the country or will they be isolated for 14 days as should be the case, before they would be allowed to start rendering their “assistance”?

Do we really need this Chinese gift now or is it that the government lacks the liver to politely decline their offer of help, despite the widespread apprehension among the citizenry about their involvement (since many Nigerians, habour strong fears that the gesture might turn out a Greek gift)? Even the umbrella body of Nigerian doctors, the Nigerian Medical Association (NMA), has come out to strongly oppose the coming of the Chinese medical team. Is it that our government is too intimidated to say NO to China’s offer probably because it has yoked itself so much with crushing debts due to its excessive borrowings from them – debts, whose positive effects on Nigerian lives many are yet to see?

I raise these points because, although, Nigeria has recorded one of the lowest deaths from coronavirus, it was the stubborn refusal of the government to close our borders when it became very necessary and urgent (and despite calls from well-meaning Nigerians) that led to the explosion in the number of confirmed cases that the country has recorded today. In saner climes, the government should have profusely apologized for that terrible miscalculation that is costing the nation so much now.

But it now has another opportunity now to gratify the yearning of Nigerians and reject the Chinese offer even if it is well-meaning and the fears about it are misplaced.

Now, what lessons is the government taking away from the scourge of coronavirus? Will they see the need to equip our hospitals this time and upgrade at least few of them to world standard now that they have realized the folly of always waiting to use public funds to send themselves and their families abroad to treat even minor ailments? For the first time in Nigeria, the naïve and largely misguided Nigerian leaders have found out that it is not always safe to seek solutions for health challenges outside the country and that there is afterall no place like home. This is hoping that the lesson will endure and be redemptive.

*Ugochukwu Ejinkeonye, is a Nigerian journalist and writer. (scruples2006@yahoo.com)

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April 9, 2020
Assuaging Plight Of The Poor In This Perilous Time By Okechukwu Nwanguma

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Rule of Law and Accountability Advocacy Centre has been monitoring and receiving information on public compliance with the Federal Government ordered lockdown in Abuja, Lagos and Ogun states, which contain measures to contain the ravaging Covid-19 pandemic.

Our monitoring of the compliance with the lockdown and stay-at-home orders in Lagos, Abuja and few other states indicate that most people are finding it difficult to effectively comply for various reasons.

First, there are those, who still don’t believe that Covid-19 is a real life-threatening pandemic and that precautionary measures such as social distancing, personal hygiene and other outlined measures can prevent its infection and spread.

In fact some have been made to believe that the lockdown is a deception by government to achieve other ulterior motives. Those, who promote this narrative are mainly the apocalyptic Pentecostal ‘Men of God’, who push arguments linking Covid-19 to 5G mobile technology, which they argue is a part of the biblically ordained designs of the Anti-Christ.

Second, some Nigerians are simply lawless or lack discipline, just like when passengers are asked to switch off their phones prior to flight take off and you still find some people, seemingly ladies and gentlemen, fiddling with their phones.

To illustrate, a relative of mine called me yesterday to complain that he was arrested by the police somewhere in Lagos when he drove out to buy pap for his baby. I asked him whether he knew about the lockdown order and whether there was nowhere around his neighbourhood he could walk down to buy the pap. He said ‘but other vehicles are on the road’. I told him that he had broken the law as much as those other people. Everybody may not be arrested at once.

He wanted me to talk to the police officers, who arrested him and ordered him to drive to their station. I asked him what he wanted me to tell them.

Third, and most significantly, there are yet others, who are forced out of their homes by want and hunger. They can’t stand the site of their tender children crying for hunger.

As I said elsewhere, majority of the population fall within the poor and vulnerable category. Usually, many feed themselves and their dependents on their daily earnings. They live from hand to mouth.

Under the prevailing difficult and uncertain situation, many families and individuals are already suffering and starving, just one week into the lockdown, with one more week left to go, with the probability of an extension.

The Federal Government’s Social Intervention Policy, the so-called conditional cash transfer is not yet addressing mass poverty, deprivation and hunger. The billions, which government announced that it has released and made available for conditional cash transfer to the poor and vulnerable in communities are not reaching the targets. There are still cries of woe and anguish in most communities.

We have seen videos of caricature of the ‘social intervention’, of food items shared to some communities. In one video, we saw a street in Lagos of over 30 families, who said they were given two loaves of bread and few cups of rice and garri and few condiments (tomato paste sachets) to share. And we see members of the community lamenting and asking how a whole street of over 30 families could be given such quantity of food items not enough to serve one family for two days to share!

Corruption has become our national culture. A seemingly intractable challenge to our progress and development. Most of our politicians and public office holders are unscrupulously avaricious.

Given our past experiences where public funds meant for and released to assuage the sufferings of poor and vulnerable communities were either unconscionably used to ‘cut grasses’ or inexplicably got ‘swallowed by snakes’, we call for transparent and community-based approaches to the management and disbursement of social intervention funds.

Considering complaints by many local communities about not benefiting from the released billions of naira announced and meant to alleviate poverty and hardship, especially during this difficult and uncertain period, we call for a transparent and effective investigation of the management of the funds so far allocated. Efforts must be put in place to ensure that the funds are not diverted as usual.

Independent community committees must receive these funds and be charged with identifying those in their midst, who qualify to benefit.

The management of the funds should be monitored by a multi-stakeholder committee including government and community representatives as well as credible media and civil society representatives.

Government must put effective measures in place to check corrupt public officials, who want to steal or divert funds meant to relieve the sufferings of the poor and vulnerable people in this perilous times.

This is the only way to help the people comply with the law and stay at home for now!

Finally, since government has been announcing huge numbers of beneficiaries of cash transfer program running into millions and claiming to have paid billions, can the government make the system transparent by publishing the names and addresses of the beneficiaries on an electronic portal so that Nigerians can do the verification?

Okechukwu Nwanguma is the Executive Director of Rule of Law and Accountability Advocacy Centre

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April 9, 2020