SINGAPORE: Singapore today confirmed 14 new cases of the novel coronavirus, its health ministry said, marking the biggest daily increase of the infection in the city-state.
Singapore has confirmed a total 226 cases of the virus so far, with 105 having fully recovered. Nine of the cases confirmed on Sunday are imported. — Reuters
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Twenty-five years ago, two global events – the International Conference on Population and Development and the Fourth World Conference on Women in Beijing – formally recognized that women’s health and reproductive choices cannot be separated from the social context of their lives.
Now, researchers have created a dataset which brings together national surveys from 74 countries, representing 3 million women. For the first time, it allows them to describe trends in demand/use of modern contraceptives alongside social and economic indicators.
The data is published in The Lancet Global Health and is authored by the London School of Hygiene & Tropical Medicine and the World Health Organization.
It shows that, over time, women are more likely to have their demand for modern contraception met in countries where gender equality and their educational opportunities improve.
Trends in sexual activity and demand for use and use of modern contraceptive methods in 74 countries: a retrospective analysis of nationally representative surveys finds that met need for modern contraception is strongly correlated with positive shifts in social structures.
For every 0.1-point increase in a country’s gender development index, it found a 6.7% rise in women who were sexually active and did not want to conceive. Of those women, an additional 13.5% used modern methods to prevent a pregnancy.
Expectations of every girl’s right to education also made a difference. Each extra year in schooling is linked to an increase of 2.3% in demand, and a 4.7% increase in use of modern contraceptive methods.
“This study shows how every woman must negotiate her reproductive autonomy within the social framework in which she lives, responding to barriers and opportunities as they emerge,” says Dr Lale Say, one of the authors of the study and Unit Head at WHO and HRP.
“Gender equality is both a precondition and a driving force for securing women’s reproductive health and rights – as well as the sustainable development targets, which are our best chance for delivering health and well-being for all.”
Overall, the data reinforce global trends: more time spent sexually-active and single, postponement of parenthood, and the near-universal desire for smaller families.
The study also highlights where action is needed at country-level to avoid family planning services falling behind demand.
Out of the 74 countries analyzed, 42 showed an increase in demand for contraception. Only 37 countries show an increase in use of a modern method to prevent pregnancy.
Although unmet need for contraception declined in 34 countries, it increased in 14 countries. Significantly more progress is needed, and faster, to ensure each girl and woman is able to access the sexual and reproductive health services she needs.
Gender equality can affect contraceptive use in many ways. From the personal and political degree to which women are free to choose their sexual activity, to accessing family planning services it can also shape any power imbalances within personal relationships. This study supports recent efforts by WHO to adopt a broader, integrated concept of sexual and reproductive health – and to translate it into a framework for policy and practice.
The authors argue that family planning targets in the 2030 Agenda for Sustainable Development will not be met without a profound shift: from focus on ‘access to contraception’, to broader aspects of sexual health and social context.
Since reproductive health and women’s empowerment are intertwined, trends in contraceptive use can also reveal progress towards another global target: progress towards gender equality.
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One of the most challenging tasks for drivers is parallel parking, which is why automatic parking systems are becoming a popular feature on some vehicles. However, the cost of designing and implementing such computing-intensive systems can significantly increase a vehicle’s price, creating a barrier to adding the feature in many models.
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The World Health Organization (WHO) today spells out the need to step up cancer services in low and middle-income countries. WHO warns that, if current trends continue, the world will see a 60% increase in cancer cases over the next two decades. The greatest increase (an estimated 81%) in new cases will occur in low- and middle-income countries, where survival rates are currently lowest.
This is largely because these countries have had to focus limited health resources on combating infectious diseases and improving maternal and child health, while health services are not equipped to prevent, diagnose and treat cancers. In 2019, more than 90% of high-income countries reported that comprehensive treatment services for cancer were available in the public health system compared to less than 15% of low-income countries.
“This is a wake-up call to all of us to tackle the unacceptable inequalities between cancer services in rich and poor countries,” says Dr Ren Minghui, Assistant Director-General, Universal Health Coverage/ Communicable and Noncommunicable Diseases, World Health Organization. “If people have access to primary care and referral systems then cancer can be detected early, treated effectively and cured. Cancer should not be a death sentence for anyone, anywhere.”
Yet, progress in poorer countries is achievable. WHO and the International Agency for Research on Cancer (IARC) are releasing two coordinated reports on World Cancer Day (4 February), in response to government calls for more research into the scope and potential policies and programmes to improve cancer control.
“At least 7 million lives could be saved over the next decade, by identifying the most appropriate science for each country situation, by basing strong cancer responses on universal health coverage, and by mobilizing different stakeholders to work together”, said Dr Tedros Adhanom Ghebreyesus, Director-General, WHO.
WHO highlights a wide range of proven interventions to prevent new cancer cases. These include controlling tobacco use (responsible for 25% of cancer deaths), vaccinating against hepatitis B to prevent liver cancer, eliminating cervical cancer by vaccinating against HPV, screening and treatment, implementing high-impact cancer management interventions that bring value for money and ensuring access to palliative care including pain relief.
“The past 50 years have seen tremendous advances in research on cancer prevention and treatment,” says Dr Elisabete Weiderpass, Director of IARC. “Deaths from cancer have been reduced. High-income countries have adopted prevention, early diagnosis and screening programmes, which together with better treatment, have contributed to an estimated 20% reduction in the probability of premature mortality between 2000 and 2015, but low-income countries only saw a reduction of 5%. We need to see everyone benefitting equally.” The challenge will be for countries to select treatments balancing considerations including cost, feasibility and effectiveness. Each government is tasked with choosing the appropriate innovative cancer therapies, while recognizing that established treatments, many of which are very effective and affordable, can provide benefits for cancer without causing financial hardship.
World Health Organization
Report on Cancer: Setting priorities, investing wisely and providing care for all
The report aims to set the global agenda on cancer, mobilize stakeholders and help countries set priorities for investing in cancer control and universal health coverage. It introduces the principles, tools and current priority cancer control interventions in the context of the current and future cancer burden and opportunities.
International Agency for Research on Cancer
World Cancer Report “Cancer research for cancer prevention”
The report focuses on prevention and offers the most comprehensive overview of relevant research available to date, ranging from descriptive etiology, cellular and molecular biology, toxicology and pathology through to behavioural and social science. Key chapters include discussions on the impact of inequalities in cancer, vaccination and screening, genomic individual susceptibility to cancer and the finer identification of those at risk, which may allow ‘precision cancer prevention’.
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In response to calls for action, WHO has provided guidelines, physical standards, training and technical support to improve blood product quality, safety and availability in WHO regions and in countries. Despite these actions, progress in blood availability and safety under effective regulation has been slow in many parts of the world.
For that reason, the WHO Action framework for blood products 2020-2023, proposes a renewed effort to scale up programme implementation to improve global adequacy of blood donation, and universal access to quality and safe blood and blood components for transfusion, and plasma derived medicinal products.
The Action Framework provides strategic direction to WHO’s work for the years 2020-2023. It identifies six strategic objectives: appropriately structured, well-coordinated and sustainably resourced national blood systems; regulatory capacity to ensure the quality and safety of blood; functioning and efficiently managed blood services; effective implementation of patient blood management to optimize transfusion practices, effective surveillance, haemovigilance and pharmacovigilance, supported by comprehensive and accurate data collection systems; and partnerships, collaboration and information exchange to achieve key priorities and jointly address challenges and emerging threats at global, regional and national levels.
The Action Framework will improve coordination and collaboration at all levels of WHO. The document will promote and strengthen new and existing partnerships, as areas for collaborative action are clearly identified. Moreover, it demonstrates the need for support to WHO (including sustainable funding) to coordinate the implementation of this ambitious plan. As a result, the Action Framework for blood products will allow WHO to more effectively carry out its mandate on blood, and to increase the impact of WHO activities to strengthen blood systems and blood regulation in countries and regions and eventually to ensure universal access to blood products worldwide.
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No single country is adequately protecting children’s health, their environment and their futures, finds a landmark report released today by a Commission of over 40 child and adolescent health experts from around the world. The Commission was convened by the World Health Organization (WHO), UNICEF and The Lancet.
The report, A Future for the World’s Children?, finds that the health and future of every child and adolescent worldwide is under immediate threat from ecological degradation, climate change and exploitative marketing practices that push heavily processed fast food, sugary drinks, alcohol and tobacco at children.
“Despite improvements in child and adolescent health over the past 20 years, progress has stalled, and is set to reverse,” said former Prime Minister of New Zealand and Co-Chair of the Commission, Helen Clark. “It has been estimated that around 250 million children under five years old in low- and middle-income countries are at risk of not reaching their developmental potential, based on proxy measures of stunting and poverty. But of even greater concern, every child worldwide now faces existential threats from climate change and commercial pressures.
“Countries need to overhaul their approach to child and adolescent health, to ensure that we not only look after our children today but protect the world they will inherit in the future,” she added.
The report includes a new global index of 180 countries, comparing performance on child flourishing, including measures of child survival and well-being, such as health, education, and nutrition; sustainability, with a proxy for greenhouse gas emissions, and equity, or income gaps. [Top & Bottom 10 countries; Full Global Index on pp. 35-38] [1]
According to the report, while the poorest countries need to do more to support their children’s ability to live healthy lives, excessive carbon emissions – disproportionately from wealthier countries – threaten the future of all children. If global warming exceeds 4°C by the year 2100 in line with current projections, this would lead to devastating health consequences for children, due to rising ocean levels, heatwaves, proliferation of diseases like malaria and dengue, and malnutrition.
The index shows that children in Norway, the Republic of Korea, and the Netherlands have the best chance at survival and well-being, while children in Central African Republic, Chad, Somalia, Niger and Mali face the worst odds. However, when authors took per capita CO2 emissions into account, the top countries trail behind: Norway ranked 156, the Republic of Korea 166, and the Netherlands 160. Each of the three emits 210% more CO2 per capita than their 2030 target. The United States of America (USA), Australia, and Saudi Arabia are among the ten worst emitters.
“More than 2 billion people live in countries where development is hampered by humanitarian crises, conflicts, and natural disasters, problems increasingly linked with climate change,” said Minister Awa Coll-Seck from Senegal, Co-Chair of the Commission. “While some of the poorest countries have among the lowest CO2 emissions, many are exposed to the harshest impacts of a rapidly changing climate. Promoting better conditions today for children to survive and thrive nationally does not have to come at the cost of eroding children’s futures globally.”
The only countries on track to beat CO2 emission per capita targets by 2030, while also performing fairly (within the top 70) on child flourishing measures are: Albania, Armenia, Grenada, Jordan, Moldova, Sri Lanka, Tunisia, Uruguay and Viet Nam.
The report also highlights the distinct threat posed to children from harmful marketing. Evidence suggests that children in some countries see as many as 30,000 advertisements on television alone in a single year, while youth exposure to vaping (e-cigarettes) advertisements increased by more than 250% in the USA over two years, reaching more than 24 million young people.
Professor Anthony Costello, one of the Commission’s authors, said: “Industry self-regulation has failed. Studies in Australia, Canada, Mexico, New Zealand and the USA – among many others – have shown that self-regulation has not hampered commercial ability to advertise to children. For example, despite industry signing up to self-regulation in Australia, children and adolescent viewers were still exposed to 51 million alcohol ads during just one year of televised football, cricket and rugby. And the reality could be much worse still: we have few facts and figures about the huge expansion of social media advertising and algorithms aimed at our children.”
Children’s exposure to commercial marketing of junk food and sugary beverages is associated with purchase of unhealthy foods and overweight and obesity, linking predatory marketing to the alarming rise in childhood obesity. The number of obese children and adolescents increased from 11 million in 1975 to 124 million in 2016 – an 11-fold increase, with dire individual and societal costs.
To protect children, the independent Commission authors call for a new global movement driven by and for children. Specific recommendations include:
Dr. Richard Horton, Editor-in-Chief of The Lancet family of journals, said: “The opportunity is great. The evidence is available. The tools are at hand. From heads-of-state to local government, from UN leaders to children themselves, this Commission
calls for the birth of a new era for child and adolescent health. It will take courage and commitment to deliver. It is the supreme test of our generation.”
“From the climate crisis to obesity and harmful commercial marketing, children around the world are having to contend with threats that were unimaginable just a few generations ago,” said Henrietta Fore, UNICEF Executive Director. “It
is time for a rethink on child health, one which places children at the top of every government’s development agenda and puts their well-being above all considerations.”
“This report shows that the world’s decision makers are, too often, failing today’s children and youth: failing to protect their health, failing to protect their rights, and failing to protect their planet,” Dr Tedros Adhanom Ghebreyesus,
Director-General of the World Health Organization said. “This must be a wakeup call for countries to invest in child health and development, ensure their voices are heard, protect their rights, and build a future that is fit for children.”
Notes to editors
[1] About the index; please see pp. 35-38 of the report, with technical details in the Annex, pp. 19-72
[2] This Commission was funded by the Bill & Melinda Gates Foundation.
For more information or to set up interviews with report authors, please contact any of the listed media contacts.
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The meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (IHR) (2005) to review the current Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo (DRC) took place on Wednesday, 12 February 2020, from 14:00 to 16:45 Geneva time (CEST).
Members and advisors of the Emergency Committee were convened by teleconference.
The Secretariat welcomed the Committee and thanked them for their support. The meeting was turned over to the Chair, Dr Robert Steffen.
Dr Steffen also welcomed the Committee and gave the floor back to the Secretariat.
Representatives of WHO’s legal department and the department of compliance, risk management, and ethics briefed the Committee members on their roles and responsibilities.
Committee members were reminded of their duty of confidentiality and their responsibility to disclose personal, financial, or professional connections that might be seen to constitute a conflict of interest. Each member who was present was surveyed and no conflicts of interest were judged to be relevant to the meeting.
The Chair then reviewed the agenda for the meeting and introduced the presenters.
Presentations were made by representatives of the Ministry of Health of the Democratic Republic of the Congo (DRC), the WHO Secretariat, and the UN Ebola Emergency Response Coordinator.
The current situation in the DRC was reviewed. As of 10 February 2020, there were a total of 3431 cases, of which 3308 were confirmed and 123 were probable. 2253 persons have died (66%). Between 3 and 9 February 2020, three new confirmed cases were reported in Beni Health Zone, North Kivu. These three cases were already registered as contacts and two were under surveillance at the time of detection. More than 2000 contacts are being followed. There has been an increase in the number of security incidents in recent months.
Challenges that remain include: strengthening of community acceptance for full commitment to response measures; protection of personnel at strategic health checkpoints; improvement of infection prevention and control practices in health facilities; strengthening of the local health system; and comprehensive treatment and support for patients in recovery.
The WHO Secretariat gave an overview of the epidemiological situation, which shows an overall encouraging trend in case incidence and geographic spread. It was noted that sustaining this progress depends on the security situation and control of the well-known drivers of transmission, particularly in traditional health facilities, and on continued trust and communication with the community.
A risk communication and community engagement programme has been developed, as has an EVD survivors programme. It is critical to ensure the long-term sustainability of these two initiatives.
The situation in countries neighbouring DRC was reviewed, as was preparedness in nonaffected areas of DRC. An EVD operational readiness standardized approach has been implemented in 9 priority countries. More than 2400 alerts have been investigated, and more than 14,600 health workers have been vaccinated.
The UN Ebola Emergency Response Coordinator gave a brief report on operational support, focused on security challenges and preparations for any resurgence of disease.
The Committee noted a great deal of progress in the situation since its last meeting and commended the response, under the leadership of the DRC Ministry of Health and the multisectoral coordination commission established in July 2019. Support provided by WHO, UN agencies, nongovernmental organizations and other partners has also contributed to limiting the spread and impact of this virus in a difficult context. An increase in the number of alerts was attributed to strong and proactive community surveillance.
It was the unanimous view of the Committee that this event still constitutes a public health emergency of international concern (PHEIC) under the IHR (2005).
The Committee acknowledged the revised risk assessment, which puts the risk now as high at national and regional levels, and low at the global level.
The Committee was concerned that withdrawing the PHEIC now might have adverse consequences for the response efforts through diminishing focus. Additionally, although the primary concern of the Committee is EVD, there are serious ongoing outbreaks of other diseases, including measles and cholera, in DRC. The country continues to need support to combat infectious diseases as well as to strengthen its health system. Further, there remains an urgent need to maintain international solidarity for the response.
The Committee noted the ongoing discussions about the interpretation in the text of the IHR (2005) of the terms international and regional spread, and about creating an intermediate level of response between the binary possibilities of PHEIC or no PHEIC, in a way that does not require reopening negotiations on the Regulations. The Committee supports these discussions, as an intermediate level would be as useful for gradually ending a PHEIC and for signaling the potential for one to be declared.
The Committee provided the following advice to the Director-General for his issuance as revised Temporary Recommendations under the IHR (2005).
For DRC:
For countries at risk:
For all countries:
The Committee emphasized the importance of continued support by WHO and other national and international partners towards the effective implementation and monitoring of these recommendations.
Based on this advice, the reports made by the affected State Party, and the currently available information, the Director-General accepted the Committee’s assessment and on 12 February 2020 maintained the Ebola outbreak in the Democratic Republic of the Congo as a Public Health Emergency of International Concern (PHEIC).
The Director-General endorsed the Committee’s advice and issued them as Temporary Recommendations under IHR (2005) to reduce the international spread of Ebola, effective 12 February 2020. The Director-General thanked the Committee Members and Advisors for their advice and requested their reassessment of this situation within two months or earlier if the situation requires.
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Good afternoon everyone and apologies for being late, and apologies too from Dr Tedros, who is just about to land in the Democratic Republic of the Congo where he is following up on important Ebola matters and meeting with President Tshisekdi and many others to look at the future post-Ebola of the health system in Congo.
I’m sure you’ll understand how important a task and mission that is given the last year-and-a-half in Congo and the ongoing struggles in that country to deliver effective healthcare and reduce suffering and mortality from infectious diseases.
Let me start by updating you on the latest numbers.
In the last 24 hours China has reported 1,820 laboratory-confirmed cases, bringing the total to 46,550.
In addition, China reported 13,332 clinically confirmed cases in Hubei province, and crucially, we understand that most of these cases relate to a period going back over days and weeks and are retrospectively reported as cases, sometimes back to the beginning of the outbreak itself.
So this increase that you’ve all seen in the last 24 hours is largely down to a change in how cases are being diagnosed and reported.
So, in other words, in Hubei province only, a trained medical professional can now classify a suspected case of COVID-19 as a clinically-confirmed case on the basis of chest imaging, rather than having to have a laboratory confirmation.
This allows clinicians to move and report cases more quickly, not having to wait for lab confirmation, ensuring that people get to clinical care more quickly, and also allows public health responses in terms of contact tracing and other important public health measures to be initiated.
As you’ve noticed with suspect cases, there have been some backlogs in testing and this is also going to help ensure that people get adequate care and adequate public health measures can be taken.
So we are not dealing, from what we understand, with a spike in cases of 14,000 on one day.
To an extent this is an artefact of the reporting and we are working with our colleagues in China, and our team there are working very hard to see exactly how many days and weeks and how those numbers are spread across those days and weeks.
In the rest of China and the rest of the world, laboratory confirmation for reporting is still required.
WHO will continue to track both laboratory and clinically-confirmed cases in Hubei province.
We’ve seen this spike in the number of cases reported in China, but this does not represent a significant change in the trajectory of the outbreak.
Outside China, there are 447 cases from 24 other countries, and now two deaths. In addition to the death in the Philippines, there is now one more death in Japan.
We have said consistently that we need to be cautious when drawing conclusions from daily reported numbers. I think we were having that discussion yesterday and I think the numbers today speak to that.
We need to be very careful when interpreting any extremes. Be it in incubation period, be it in daily numbers, we must take all numbers into account, we must look at all numbers seriously but we also must try and interpret what those numbers mean and not react directly to the number itself.
The number of countries reporting cases has still not changed and outside the cases on the Diamond Princess cruise ship, we’re not seeing a dramatic increase in transmission outside China.
That is the current picture. We’re still saying to governments around the world that we still have an opportunity to prepare for the potential spread of the virus.
Regarding the Diamond Princess cruise ship, which is currently quarantined in Yokohama, 218 passengers have tested positive for the virus, which does represent the largest cluster of COVID-19 cases outside China.
This morning, I briefed health ministers from the European Union, convened by Croatia, the presidency, about COVID-19 and our teams are working with governments and partners of the European Union to ensure that the latest information is disseminated, that preparations are made and there’s good coordination between ourselves and the European Union and our WHO Regional Office for Europe.
And we very much welcome the strong support from the European Union in supporting countries with weaker health systems and ensuring that other countries have the investment and support needed to prepare for the arrival of the virus.
In terms of the international mission, the advanced team and their Chinese counterparts have now finalized the scope of work and design of the mission and we expect the rest of the international team to start arriving in China over the weekend.
Thank you.
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