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Statement on the third meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of coronavirus disease (COVID-19)
The third meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (2005) (IHR) regarding the coronavirus disease (COVID-19), took place on Thursday, 30 April 2020, from 12:00 to 17:45 Geneva
time (CEST).

Proceedings of the meeting

Members and advisors of the Emergency Committee were convened by teleconference. Membership of the Emergency Committee was expanded
to reflect the nature of the pandemic and the need to include additional areas of expertise.

The Director-General welcomed the Committee, thanked them for their commitment to enhancing global public health, and provided an overview of the major achievements in the COVID-19 response since the last Emergency Committee meeting on 30 January 2020.
Representatives of the legal department and the Department of Compliance, Risk Management, and Ethics (CRE) briefed the members on their roles and responsibilities.

The Ethics Officer from CRE provided the members and advisers with an overview of the WHO Declaration of Interest process. The members and advisers were made aware of their individual responsibility to disclose to WHO, in a timely manner, any interests
of a personal, professional, financial, intellectual or commercial nature that may give rise to a perceived or direct conflict of interest. They were additionally reminded of their duty to maintain the confidentiality of the meeting discussions and
the work of the committee. Only those committee members and advisers who were not considered to have any perceived or direct conflict of interest participated in the meeting.

The Secretariat turned the meeting over to the Chair, Professor Houssin. He also welcomed the Committee and reviewed the objectives and agenda of the meeting.

The WHO Regional Emergency Directors and the Executive Director of the WHO Health Emergencies Programme (WHE) provided regional and the global situation overview. After ensuing discussion, the Committee unanimously agreed that the outbreak still constitutes
a public health emergency of international concern (PHEIC) and offered advice to the Director-General.

The Director-General declared that the outbreak of COVID-19 continues to constitute a PHEIC. He accepted the advice of the Committee to WHO and issued the Committee’s advice to States Parties as Temporary Recommendations under the IHR.

The Emergency Committee will be reconvened within three months or earlier, at the discretion of the Director-General. The Director-General thanked the Committee for its work.

Advice to WHO

Coordination, planning, and monitoring
- Continue to lead and coordinate the global response to the COVID-19 pandemic in collaboration with countries, the United Nations (UN), and other partners.
- Work with fragile states and vulnerable countries that require additional technical, logistical and commodity support.
- Establish mechanisms to compile lessons learned from country and partner experiences and WHO missions and share the best practices and updated recommendations.
- Provide further guidance to countries about adjusting public health measures, taking into account the different epidemiological situations of the pandemic.
- Promote the inclusion of all interested countries, including low- and middle-income countries from all regions, in the Solidarity clinical trials for therapeutics and vaccines.
- Continue efforts with partners to obtain equitable access to personal protective equipment, diagnostics, and biomedical equipment essential to the pandemic COVID-19 response.
- Continue to coordinate global expert networks in epidemiology, laboratory, vaccines, clinical care, infection prevention and control, social sciences, and operational research; modelling; and other technical support.
One Health
- Work with the World Organisation for Animal Health (OIE), the Food and Agriculture Organization of the United Nations (FAO), and countries to identify the zoonotic source of the virus and the route of introduction to the human population, including
  the possible role of intermediate hosts. This should be accomplished through efforts such as scientific and collaborative field missions, which will enable targeted interventions and a research agenda to reduce the risk of similar events.
- Work closely with OIE and FAO to provide guidance on how to prevent SARS-CoV-2 infections in animals and humans and prevent the establishment of new zoonotic reservoirs.
- Work with partner organizations and countries to strengthen the global food supply chain, protect food workers, properly manage food markets, and mitigate possible disruptions to the food supply.
Essential Health Services
- Support countries to assess and manage the unintended consequences of public health measures implemented to control the COVID-19 pandemic, including gender-based violence and child neglect.
- Support countries to monitor their ability to provide and strengthen essential health services throughout a likely extended COVID-19 response. This should include, but is not limited to, essential prevention for communicable diseases, particularly
  vaccination; services related to reproductive health, including care during pregnancy and childbirth; care of vulnerable populations, such as young infants and older adults; provision of medications and supplies for the ongoing management of chronic
  diseases, including mental health conditions; continuity of critical inpatient therapies; management of emergency health conditions and common acute presentations that require time-sensitive intervention; and auxiliary services, such as basic
  diagnostic imaging, laboratory services, and blood bank services.
- Support countries to address shortages of essential medicines and health products, personal protective equipment, and other medical supplies and to establish sustainable risk management practices to prevent future shortages.
Risk communication and community engagement
- Continue risk communications and community engagement activities through the WHO Information Network for Epidemics (EPI-WIN) and other platforms to counter rumours and misinformation.
- Continue to regularly communicate clear messages, guidance, and advice about the evolution of the COVID-19 pandemic, how to reduce transmission, and save lives.
- Work with partners and countries to articulate potential long-term consequences of COVID-19 pandemic, emphasizing the need for strengthened cross-sectoral preparedness, transparency and global coordination.
Surveillance
- Clarify the testing strategy, support countries to increase testing capacity, and aim to provide equitable access to diagnostic tests and supplies in light of market failures and global shortages.
- Continue to provide guidance on monitoring disease trends using Severe Acute Respiratory Infections (SARI) and Influenza Like Illness (ILI) surveillance systems in anticipation of the co-circulation of influenza viruses.
- Develop qualitative and quantitative indicators that countries can use to assess and monitor SARS-CoV-2 transmission at all levels of public health response.
- Continue to support countries and partners by providing technical and operational guidance, training platforms, and tools such as Go.Data,to enhance case identification and contact tracing capacity, strengthen the public health workforce, and engage
  communities for contact tracing.
- Provide clear qualitative and quantitative indicators to monitor SARS-CoV-2 transmission to inform the adjustment of public health and social measures.
Travel and Trade
- Continue working with countries and partners to enable essential travel needed for pandemic response, humanitarian relief, repatriation, and cargo operations.
- Develop strategic guidance with partners for the gradual return to normal operations of passenger travel in a coordinated manner that provides appropriate protection when physical distancing is not feasible.
- Update recommendations on appropriate travel measures and analyze their effects on international transmission of COVID-19, with consideration of the balance between benefits and unintended consequences, including entry and exit screening, education
  of travelers on responsible travel behaviour, case finding, contact tracing, isolation, and quarantine, by incorporating evidence on the potential role of pre-symptomatic and asymptomatic transmission.
To all States Parties

Coordination and Collaboration
- Support WHO leadership and continue to collaborate with WHO at all levels of the organization and with other countries to enable effective global COVID-19 pandemic preparedness and response.
- Participate in global solidarity efforts to enable access to essential supplies for all.
- Document and share lessons learned from efforts to control the pandemic, including the timing, pace, and sequencing of the application and lifting of public health measures.
Preparedness
- Strengthen preparedness for health emergencies, and build resilient health systems, incorporating lessons learned during different stages of the pandemic, and sharing experiences with other countries.
Surveillance
- Work with WHO and multisectoral partners to interrupt transmission by maintaining robust surveillance systems; enhancing capacities for case detection, testing, isolation of cases, contact tracing, quarantine of contacts, and rapid response; strengthening
  the public health workforce; and actively engaging communities for contact tracing, with a particular focus on high risk areas.
- In settings where testing a large proportion of suspected cases is not possible, monitor overall trends; undertake early detection through laboratory confirmation of a limited number of cases with a focus on health workers; and rapidly implement
  public health measures.
- Share with WHO all data necessary to conduct global risk assessments through data platforms, such as the Global Influenza Surveillance and Response System and the IHR mechanism. These data should include SARI and ILI where available.
- Use the WHO qualitative and quantitative indicators to assess and monitor SARS-CoV-2 transmission at all levels of public health response.
Additional Health Measures
- Avoid restrictions on international transport of food, medical and other essential supplies and permit the safe movement of essential personnel required for an effective pandemic response.
- Implement appropriate travel measures with consideration of their public health benefits, including entry and exit screening, education of travelers on responsible travel behaviour, case finding, contact tracing, isolation, and quarantine, by
  incorporating evidence on the potential role of pre-symptomatic and asymptomatic transmission.
- Implement and monitor case finding and contact tracing of travellers, using digital tools where appropriate.
- Continue to review travel and trade measures based on regular risk assessments, transmission patterns at origin and destination, cost-benefit analysis, evolution of the pandemic, and new knowledge of COVID-19.
- Engage in global efforts to respond to the challenges of COVID-19 in managing maritime vessels.
- Do not implement trade restrictions beyond those considered to be of public health importance in accordance with relevant international agreements.
- Continue to provide appropriate public health rationale to WHO for additional health measures in accordance with IHR.
Health Workers
- Prioritize the protection of the health workforce through access to training and provision of personal protective equipment, infection prevention and control measures, improved working conditions, application of WHO recommended testing strategies,
  and prevention of stigma and attacks on health workers.
Food Security
- Work with WHO and partners to strengthen the global food supply chain, protect food workers, properly manage food markets, and mitigate possible disruptions to the food supply, especially for vulnerable populations.
One Health
- Promote sound practices to manage risks of trade of live animals in food markets and regulate trade of exotic wildlife.
Risk Communications and Community Engagement
- Continue to engage communities to address rumours and misinformation and keep the public informed, with a focus on vulnerable populations.
Research and development
- Address research gaps such as: routes of transmission, including the role of asymptomatic and pre-symptomatic infection droplet, contact, fomite and aerosol transmission; and viral shedding; and animal source and intermediate hosts, in collaboration
  with partners.
- Continue to support and conduct COVID-19 research, in line with the WHO Research and Development Blueprint, and the road map for COVID-19 vaccines, diagnostics, and therapeutics.
- Continue sharing full genome sequences to increase global understanding of virus evolution and phylogenetics and their application to public health practices.
Essential Health Services
- Maintain essential health services throughout a likely extended COVID-19 response. This should include essential prevention for communicable diseases, particularly vaccination; services related to reproductive health, including care during pregnancy
  and childbirth; care of vulnerable populations, such as young infants and older adults; provision of medications and supplies for the ongoing management of chronic diseases, including mental health conditions; continuity of critical inpatient
  therapies; management of emergency health conditions and common acute presentations that require time-sensitive intervention; and auxiliary services, such as basic diagnostic imaging, laboratory services, and blood bank services.
- Continue to track and document the impact of COVID-19 on essential health services.
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May 9, 2020
WHO calls for healthy, safe and decent working conditions for all health workers, amidst COVID-19 pandemic
On World Day for Safety and Health at Work, the World Health Organization calls upon all governments, employers and workers organizations and the global community to take urgent measures for strengthen countries’ capacities to protect occupational health and safety of health workers and emergency responders respect their rights to decent working conditions, and develop national programmes for occupational health of health workers and to provide them with occupational health services. Amidst the COVID-19 pandemic, ILO has dedicated World Day for Safety and Health at Work 2020 in addressing the outbreak of infectious diseases at work, in particular, on the COVID-19 pandemic.

Health workers are at the front line of the COVID-19 outbreak response and as such are exposed to hazards that put them at risk of infection. Hazards include pathogen exposure, long working hours, psychological distress, fatigue, occupational burnout, stigma, and physical and psychological violence.

Infections with COVID-19, insufficient measures for infection prevention and control, occupational safety and health, mental health and psychosocial support for health workers result in high rates of absenteeism and deplete the health workforce – the most precision resources for stopping the COVID outbreak.

Key Messages and Facts

COVID-19 infections among health workers:
- As of 21 April 2020 countries reported to WHO that over 35, 000 health workers were infected with COVID19. This number is significantly higher because of underreporting.
- The major occupational risks for COVID19 infection among health workers are: late recognition or suspicion of COVID-19 in patients, working in a higher-risk department, longer duty hours, sub-optimal adherence to infection prevention and control measures, such as hand hygiene practices, and lack of or improper use of personal protective equipment (PPE). Other factors have also been documented, such as inadequate or insufficient IPC training for respiratory pathogens, including the COVID-19 virus, as well as long exposure in areas in healthcare facilities where large numbers of COVID-19 patients were being cared for.
- The prevention of infections requires the use of appropriate infection prevention and control measures by all health workers, with a special focus on the adherence to hand hygiene and personal protective equipment when caring for COVID-19 patients, as well as a combination of environmental and administrative controls
- Health workers infected with COVID-19 following exposure in the workplace should have the right to employment injury benefits for occupational disease, including compensation, rehabilitation, and curative services.
Violence and stigma against health workers:
- Health workers are at high risk of violence all over the world. Between 8% and 38% of health workers suffer physical violence at some point in their careers. Many more are threatened or exposed to verbal aggression and social stigma because of their work.
- In the COVID19 crisis, shortage of staff and resources and increasing social tensions result in increased level of violence against health workers and even attacks against health care facilities. Doctors, nurses, security personnel and those who are assisting in testing, tracing contacts and enforcing physical distancing measures to stop COVID-19 experience threats and aggression.
- WHO calls upon governments, employers and workers organizations to institute measures for zero-tolerance to violence against health workers at the workplace and at the way to and from their workplace, and for intensifying social support and respect for health workers and their families.
Long working hours and psychosocial hazards for health workers:
- Many health workers have to work longer or irregular hours because of the increasing demand for health services. In addition, many countries experience shortage of health workers, or junior staff are working in demanding new roles.
- Health workers face psychosocial hazards, which are exacerbated during emergencies where demands increase and they have to experience risk of infection witness higher suffering or mortality.
- Long working hours, shift work, high workload and other psychosocial hazards can lead to fatigue, occupational burnout, increased psychological distress or declining mental health – affecting the health of health workers, and the quality and safety of care delivered.
- WHO calls for adequate staffing levels and clinical rotation in healthcare facilities, measures to minimize psychosocial hazards, and provision of access to mental health and psychosocial support for health workers.
The annual World Day for Safety and Health at Work on 28 April promotes the prevention of occupational accidents and diseases globally. It is an awareness-raising campaign intended to focus international attention on the magnitude of the problem and on how promoting and creating a safety and health culture can help reduce the number of work-related deaths and injuries.

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May 9, 2020
Network Interference: A Legal Guide

Social media is a revolution in the way in which corporations communicate with consumers. This White Paper will help you to maximize the huge potential benefits of this revolution and protect against the inherent legal risks surrounding this phenomenon. In this document, you will find practical, action-oriented guidelines as to the state of law in the following areas: Advertising & Marketing; Commercial Litigation; Data Privacy & Security; Employment Practices; Government Contracts & Investigations;
Insurance Recovery; Litigation, Evidence & Privilege; Product Liability; Securities; and Trademarks.

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http://www.associationofmarketing.org/whitepapers/view.php?whitepaper_id=78

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April 11, 2020
Social Media Marketing GPS

It had to happen?an entire book, one tweet a time, and yet it is a real book that will help you understand what SM is about.

SMGPS will tell you the why & how of using social media, 1 tweet at a time. You?ll learn essentials in digestible little spoonfuls.

The book will explain why old-school broadcast practices are waning and new conversational methods are on the rise.

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http://www.associationofmarketing.org/whitepapers/view.php?whitepaper_id=79

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April 11, 2020
Marketing Strategy & Planning: The Road Map

Many small to medium sized businesses face a common struggle; a balancing act of plans, strategies, departments and decisions. All of the elements are present, all of the gears in working condition, but business isn’t exactly booming at the pace it had anticipated or forecasted for. What exactly does this growth and sustainability require? In a turbulent economy teeming with congested airwaves and aggressive business practices, it’s about standing out from the crowd. And surprisingly, your marketing strategy has a lot more to do with it than you might realize.

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http://www.associationofmarketing.org/articles/view.php?article_id=5335

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April 10, 2020
Growing Your List with Email Append

Is the success of your email marketing program limited by the size of your subscriber list? Email append, the
process of adding email addresses to a postal customer database, is a quick and affordable way to expand the size of your email list. If you haven?t considered it in the past, it?s time to take a look.

Perceptions about email append and the methods for doing it have matured over the past few years, and it?s now a predictable and reliable email list growth tactic. This white paper provides guidelines and best practices for consumer email appending.

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http://www.associationofmarketing.org/whitepapers/view.php?whitepaper_id=68

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April 10, 2020
Search Engine Optimization and Pay-Per-Click: A Holistic Approach

Far too often, online marketers separate natural search engine optimization practices from pay-per-click (also known as PPC or paid search).

Clearly, they both involve very distinct disciplines, but they may have a common landing page or potentially keyword and traffic data that can be shared to make initiatives more powerful and efficient.

In this guide, we?ll take a look at how the two facets of search engine marketing can work together. In addition, we?ll provide insights about how to make the most of SEO and PPC in their own right.

Paid search involves the sponsored listings at the top and to the right of the natural results that dominate the top search engine results pages (also known as SERPs).

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http://www.associationofmarketing.org/whitepapers/view.php?whitepaper_id=69

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April 10, 2020
With Humans In Hiding, Animals Take Back The World

Gulf states have tightened lockdown measures in large cities, and with Dubai’s shops closed and almost no people on the streets, peacocks that normally live in nearby gardens ventured out to explore other areas of the Middle Eastern city.

A flock of geese searched for food inside a temple in Nagaon, in India’s state of Assam, on April 3. Many temples and shrines across the country have closed during the nationwide lockdown.

On April 5, two cows strolled on a Corsican beach usually popular with tourists. It was the 20th day of a strict shutdown in France.

A young puma walked the streets of Santiago on March 24 after the government ordered confinement measures in some areas of the Chilean capital.

Mountain goats roamed the streets of Llandudno, in Wales, on March 31, one week after U.K. Prime Minister Boris Johnson issued a stay-at-home order.

Sika deer wandered over to a sushi restaurant in Nara, Japan, on March 12. When Prime Minister Shinzo Abe declared a state of emergency for Tokyo and its surrounding regions, the number of visitors to the city of Nara dropped significantly

Macaques searched for food around the closed stalls of the Johari Bazar in Jaipur, India, on March 26. After Prime Minister Narendra Modi declared a nationwide lockdown, the marketplace was deserted.

Since Italy’s countrywide lockdown was imposed, the water in Venice’s canals have cleared, and residents have noticed more birds appearing.

On March 30, ducks ventured across the street in the heart of Paris, which is typically bustling with traffic.

Goats sauntered on abandoned streets in Jaipur on March 24

A baby rabbit crossed a main road in Christchurch on April 1. New Zealand entered its strictest state of lockdown on March 25.

A wild fox roamed the empty streets of London on the night of March 28.

On April 1, cattle looked for food in Palu, Central Sulawesi, in Indonesia, where the government is recommending that people avoid public spaces.

A coyote stood outside Dodger Stadium in Los Angeles on April 3, weeks after Major League Baseball suspended all play.

The movie theater was closed in Westbury, N.Y., on March 20, leaving the parking lot empty for Canadian geese to roam.

Gulf states have tightened lockdown measures in large cities, and with Dubai’s shops closed and almost no people on the streets, peacocks that normally live in nearby gardens ventured out to explore other areas of the Middle Eastern city.

Karim Sahib/AFP via Getty Images

It took just a few days of lockdown for baby rabbits to dare to cross once-bustling roads in Christchurch, New Zealand, and less than a week for a puma to descend from the Andes Mountains into Santiago, one of South America’s busiest capitals. In Barcelona, wild boar, a familiar sight for citizens on the city’s outskirts, have made their way into Diagonal Avenue, an eight-lane thoroughfare.

It’s surprising and strange, yes, but also meaningful. Research suggests that ecosystems can rebound with speed once human intervention subsides. A review published last week determined that damaged ecosystems and wildlife can be rebuilt if the right conditions are achieved. Marine ecosystems in particular can substantially recover by 2050, according to the study, led by Carlos Duarte at the Red Sea Research Center in Saudi Arabia.

Of course, a deadly pandemic that brings about a sudden economic collapse is no way to sustainably restore threatened ecosystems. Yet it’s a clear reminder of how quickly the wild world responds when humans take a step back.

Scientists have tracked this pattern for decades. The number of humpback whales migrating from Antarctica to eastern Australia has been increasing each year, from a few hundred animals in 1968, when commercial whaling was banned, to more than 40,000 today. In 1880 only 20 breeding northern elephant seals had survived decades of hunting, and today there are more than 200,000.

Hunting bans, habitat restoration, and the reduction of water pollution are all linked to the recovery of marine species. The continuation of these practices—and, most of all, working to mitigate the effects of climate change—would contribute to oceans recovering significantly by 2050, the researchers said.

It’s more difficult for land ecosystems to bounce back because both the scale of extinction and the scale of human presence are so large there, said Duarte, a marine science professor. But these differences don’t mean the return of wildlife to deserted city streets isn’t significant, he said: “I believe our own confinement, and the release of wildlife from confinement, should bring some empathy between humans and wildlife moving forward.”

A flock of geese searched for food inside a temple in Nagaon, in India’s state of Assam, on April 3. Many temples and shrines across the country have closed during the nationwide lockdown.

Anuwar Ali Hazarika/Barcroft Media via Getty Images

On April 5, two cows strolled on a Corsican beach usually popular with tourists. It was the 20th day of a strict shutdown in France.

Pascal Pochard-Casabianca/AFP via Getty Images

A young puma walked the streets of Santiago on March 24 after the government ordered confinement measures in some areas of the Chilean capital.

Andrews Pina/Aton Chile/AFP via Getty Images

Mountain goats roamed the streets of Llandudno, in Wales, on March 31, one week after U.K. Prime Minister Boris Johnson issued a stay-at-home order.

Christopher Furlong/Getty Images

Sika deer wandered over to a sushi restaurant in Nara, Japan, on March 12. When Prime Minister Shinzo Abe declared a state of emergency for Tokyo and its surrounding regions, the number of visitors to the city of Nara dropped significantly

Tomohiro Ohsumi/Getty Images

Macaques searched for food around the closed stalls of the Johari Bazar in Jaipur, India, on March 26. After Prime Minister Narendra Modi declared a nationwide lockdown, the marketplace was deserted.

Vishal Bhatnagar/NurPhoto via Getty Images

Since Italy’s countrywide lockdown was imposed, the water in Venice’s canals have cleared, and residents have noticed more birds appearing.

Andrea Pattaro/AFP via Getty Images

On March 30, ducks ventured across the street in the heart of Paris, which is typically bustling with traffic.

Mehdi Taamallah/NurPhoto via Getty Images

Goats sauntered on abandoned streets in Jaipur on March 24

Vishal Bhatnagar/NurPhoto via Getty Images

A baby rabbit crossed a main road in Christchurch on April 1. New Zealand entered its strictest state of lockdown on March 25.

Sanka Vidanagama/NurPhoto via Getty Images

A wild fox roamed the empty streets of London on the night of March 28.

Sanka Vidanagama/NurPhoto via Getty Images

On April 1, cattle looked for food in Palu, Central Sulawesi, in Indonesia, where the government is recommending that people avoid public spaces.

Basri Marzuki/NurPhoto via Getty Images

A coyote stood outside Dodger Stadium in Los Angeles on April 3, weeks after Major League Baseball suspended all play.

Keith Birmingham/Pasadena Star-News via Getty Images

The movie theater was closed in Westbury, N.Y., on March 20, leaving the parking lot empty for Canadian geese to roam.

Bruce Bennett/Getty Images

Credits: Bloomberg

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April 9, 2020
Lawan, Gbajabiamila Fault Social Investment Programme Implementation, Want Scheme Backed By Law

The leadership of the National Assembly has faulted the way the Social Investment Programme of the Nigerian Government was being implemented and called for an enabling legislation in line with global best practices.

President of the Senate, Ahmad Lawan, and the Speaker of the House of Representatives, Femi Gbajabiamila, made their reservations about the scheme at a meeting on Tuesday with Minister of Humanitarian Affairs, Disaster Management and Social Development, Hajia Sadiya Umar Farouq, and top officials of the ministry.

Lawan and Gbajabiamila made it clear that the Social Investment Programme established in 2016 under the Presidency but which is now under the Ministry of Humanitarian Affairs, needed a reform to make it more efficient and effective.

In his opening remarks, Lawan said the National Assembly was interested in the current Intervention initiatives of the ministry particularly with respect to the disbursement aimed at assuaging the plight of poor Nigerians against COVID-19.

He said, “We feel that we need to work together with you to ensure that there is effectiveness, there is efficiency, that those who are supposed to benefit, benefit directly.

“I want to tell you that the majority of those who are supposed to benefit have no access to power. They have no access to Internet. They have no bank account, so no BVN.

“In fact, many of them don’t even have phones and these are the poorest of the poor. Yet, some of the conditions or guidelines which you set inadvertently leave them out.

“We believe that when we work together, the executive side of government and the National Assembly as representatives of the people, we will be able to reach more of these people who are in serious distress even before Coronavirus.”

Adding his voice to the issue, Gbajabiamila urged the minister to talk with the relevant committees and the National Assembly leadership on the best way to codify the scheme.

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April 8, 2020
WHO and partners call for urgent investment in nurses
The Covid-19 pandemic underscores the urgent need to strengthen the global health workforce. A new report, The State of the World’s Nursing 2020, provides an in-depth look at the largest component of the health workforce. Findings identify important gaps in the nursing workforce and priority areas for investment in nursing education, jobs, and leadership to strengthen nursing around the world and improve health for all. Nurses account for more than half of all the world’s health workers, providing vital services throughout the health system. Historically, as well as today, nurses are at the forefront of fighting epidemics and pandemics that threaten health across the globe. Around the world they are demonstrating their compassion, bravery and courage as they respond to the COVID-19 pandemic: never before has their value been more clearly demonstrated.

‘Nurses are the backbone of any health system. Today, many nurses find themselves on the frontline in the battle against Covid-19,’ said Dr Tedros Adhanom Ghebreyesus, WHO Director General. ‘This report is a stark reminder of the unique role they play, and a wakeup call to ensure they get the support they need to keep the world healthy.’

The report, by the World Health Organization (WHO) in partnership with the International Council of Nurses (ICN) and Nursing Now, reveals that today, there are just under 28 million nurses worldwide. Between 2013 and 2018, nursing numbers increased by 4.7 million. But this still leaves a global shortfall of 5.9 million – with the greatest gaps found in countries in Africa, South East Asia and the WHO Eastern Mediterranean region as well as some parts of Latin America.

Revealingly, more than 80 per cent of the world’s nurses work in countries that are home to half of the world’s population. And one in every eight nurses practices in a country other than the one where they were born or trained. Ageing also threatens the nursing workforce: one out of six of the world’s nurses are expected to retire in the next 10 years.

To avert the global shortage, the report estimates that countries experiencing shortages need to increase the total number of nurse graduates by on average 8% per year, along with improved ability to be employed and retained in the health system. This would cost roughly USD 10 per capita (population) per year.

“Politicians understand the cost of educating and maintaining a professional nursing workforce, but only now are many of them recognizing their true value,” said ICN President Annette Kennedy. “Every penny invested in nursing raises the wellbeing of people and families in tangible ways that are clear for everyone to see. This report highlights the nursing contribution and confirms that investment in the nursing profession is a benefit to society, not a cost. The world needs millions more nurses, and we are calling on governments to do the right thing, invest in this wonderful profession and watch their populations benefit from the amazing work that only nurses can do.”

About 90 per cent of all nurses are female, yet few nurses are found in senior health leadership positions– the bulk of those positions are held by men. But when countries enable nurses to take a leadership role, for example by having a government chief nursing officer (or equivalent), and nursing leadership programmes, conditions for nurses improve.

“This report places much-needed data and evidence behind calls to strengthen nursing leadership, advance nursing practice, and educate the nursing workforce for the future,” said Lord Nigel Crisp, Co-Chair of Nursing Now. “The policy options reflect actions we believe all countries can take over the next ten years to ensure there are enough nurses in all countries, and that nurses use of the full extent of their education, training, and professional scope to enhance primary health care delivery and respond to health emergencies such as COVID-19. This must start with broad and intersectoral dialogue which positions the nursing evidence in the context of a country’s health system, health workforce, and health priorities.”

To equip the world with the nursing workforce it needs, WHO and its partners recommend that all countries:
- increase funding to educate and employ more nurses;
- strengthen capacity to collect, analyze and act on data about the health workforce;
- monitor nurse mobility and migration and manage it responsibly and ethically;
- educate and train nurses in the scientific, technological and sociological skills they need to drive progress in primary health care;
- establish leadership positions including a government chief nurse and support leadership development among young nurses;
- ensure that nurses in primary health care teams work to their full potential, for example in preventing and managing noncommunicable diseases;
- improve working conditions including through safe staffing levels, fair salaries, and respecting rights to occupational health and safety;
- implement gender-sensitive nursing workforce policies;
- modernize professional nursing regulation by harmonizing education and practice standards and using systems that can recognize and process nurses’ credentials globally; and
- strengthen the role of nurses in care teams by bringing different sectors (health, education, immigration, finance and labour) together with nursing stakeholders for policy dialogue and workforce planning.
The report’s message is clear: governments need to invest in a massive acceleration of nursing education, creation of nursing jobs, and leadership. Without nurses, midwives, and other health workers, countries cannot win the battle against outbreaks,
or achieve universal health coverage and the Sustainable Development Goals.

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April 8, 2020