Sixty-fourth World Health Assembly concludes: Summary

The Sixty-fourth World Health Assembly (16–24 May 2011) concluded in Geneva. Member States adopted 28 resolutions and three decisions during the Assembly, summarized here:

We excerpt selection sections from the summary below [full text]:

Improving global preparedness for future pandemics
In another agenda item aimed to improve global preparedness for future pandemics, delegates approved a framework for pandemic influenza preparedness, the culmination of four years of negotiation between WHO’s Member States. The framework will improve influenza virus sharing and access to vaccines and other benefits. Member States agreed the framework lays the groundwork for better preparedness and better access to tools and knowledge. The next phase is to ensure the implementation of the agreement.

Resolutions and reports support health-related MDGs
Health-related MDGs received support with resolutions and reports on immunization strategy, infant and young child nutrition, child injury prevention, youth health risks, malaria, and the presentation of the final report of the Commission on Information and Accountability for Women’s and Children’s Health.

The progress report on the global immunization vision and strategy was widely supported. Delegates highlighted their country’s achievements in increasing immunization coverage, reducing vaccine-preventable deaths and implementing advocacy events such as the regional immunization weeks. But they also recognized that several challenges remain, including mobilizing more resources to strengthen national immunization programmes; ensuring a balanced approach in strengthening immunization systems; introducing new vaccines; preventing a resurgence of measles through high vaccination coverage; and facilitating vaccine technology transfer to developing countries. The work outlined in the strategy will contribute to overcoming these challenges.
Member States commend WHO’s leadership and collaboration with UNICEF, the Bill & Melinda Gates Foundation, and other partners on the Decade of Vaccines — a vision for using the next 10 years to achieve immunization goals and reach important milestones in vaccine research, development, financing and public support…

…The Health Assembly adopted a resolution on malaria calling on Member States to keep malaria high on the political and development agendas in order to sustain the tremendous gains made during the past decade, and calling on international partners to ensure adequate and predictable funding so that global malaria targets for 2015 can be met. The resolution highlighted the need for continued universal coverage with malaria vector control for at-risk persons, expanded access to diagnostic testing for suspected malaria and treatment for confirmed cases, and strengthened malaria surveillance systems. The need to implement the WHO Global Plan for Artemisinin Resistance Containment, and to develop a global plan for insecticide resistance management in malaria vectors, were also emphasized.

Reaffirmed that the remaining stock of smallpox virus should be destroyed
The Health Assembly strongly reaffirmed the decision of previous Assemblies that the remaining stock of smallpox (variola) virus should be destroyed when crucial research based on the virus has been completed. The state of variola virus research will be reviewed at the 67th World Health Assembly in 2014 and in light of that, determining a date for destruction of the remaining virus stocks will be discussed.

Annual report on the eradication guinea-worm disease
The delegates adopted a resolution paving the way for an annual report on the eradication of dracunculiasis (more commonly known as guinea-worm disease) to be presented every year beginning with the next Health Assembly. Dracunculiasis is the second disease which is approaching eradication (the first being smallpox) and it occurs only after people drink contaminated water. Previously it was responsible for millions of infections across Africa and Asia. The disease mainly occurs in remote poverty-stricken areas, with limited or no access to safe drinking water.

Strong commitment to polio eradication
The global health community sent a sign of strong commitment to polio eradication with discussion focusing on the ‘significant advances’ since the launch of a new strategic plan and new, bivalent oral poliovirus vaccine in 2010. In India and Nigeria — the source of all importations of wild poliovirus into previously polio-free countries in recent years — polio cases declined by 95% between 2009 and 2010; during the same period polio cases due to the type 3 virus declined by 92% globally. Delegates called for strong national and subnational leadership by political authorities for the implementation of polio eradication strategies and highlighted the need for countries to significantly strengthen routine immunization. Delegates expressed particular concern over the funding gap of US$ 665 million to fully carry out polio eradication activities in 2011 and 2012. Delegates requested WHO to provide additional technical support to countries with ongoing, re-established polio transmission (Angola, Chad, Democratic Republic of the Congo), to continue to pursue research for post-eradication risk management and to help countries maintain high-quality surveillance and population immunity until eradication is complete globally.

WHO Media Center documentation on the overall WHA available here:

64th WHA: Margaret Chan Closing Remarks

    WHO Director-General Dr Margaret Chan, in closing remarks at the Sixty-fourth World Health Assembly, discussed historic agreements reached by Member States. Full text here:

The following excerpts are relevant to vaccines, immunization an related themes:

“…Mr. Bill Gates reminded us that we in public health have one of the hardest jobs in the world, but also one of the most rewarding jobs. He also reminded us that work done by these Health Assemblies is having a tremendous impact on the health of this world.

Having seen his teenage dream of putting a computer in every home well under way, he is now committed to devoting his time, talent, and wealth to getting vaccines in every child.

Through the Decade of Vaccines, launched with a $10 billion pledge, he is using his wealth to spur innovation and to work with industry to get the prices of existing vaccines down.

His devotion to polio eradication is unwavering, and public health in many other areas has benefitted greatly from the generosity of the Bill and Melinda Gates Foundation. He reminded us of the absolutely critical importance of leadership and accountability in getting things done…”

“…Committee A experienced true euphoria when the item on pandemic influenza preparedness was discussed, based on the framework agreed in April.

I can summarize the significance of this agreed framework by quoting the words used by delegates during their interventions: a milestone, an historical agreement, a landmark, a momentous and remarkable achievement, and a proof of the democratic decision-making dynamics we see at WHO. Many delegates commended the strong collaboration of the pharmaceutical industry and the very useful perspectives provided by civil society organizations.

I will add my own comment. This agreed framework is a triumph for health diplomacy, under the superb leadership of chairs and co-chairs, as well as a triumph for public health. It is a tribute to the principles of equity, fairness, and solidarity that underpin everything we try to do at WHO.

The resolution on this matter was adopted, as amended, by consensus. As you know, this was the culmination of four years of very hard work which at times faced issues that appeared hopelessly deadlocked.

This was a high point for all of us, and especially, for the health security of the world. It vastly improves the world’s capacity to prepare for the next influenza pandemic through better surveillance and risk assessment, and to distribute the benefits of vaccines, antiviral medicines, and diagnostic tests more equitably.

With consensus now reached, delegates asked me to maintain close oversight of the framework’s implementation, working hand-in-hand with the Advisory Group, and to give particular attention to building the requisite capacities, skills, and know-how, including through technology transfer….”

“…The item on the Global immunization and vision strategy deserves special mention as an exciting contribution to the achievement of the MDG set for reducing child mortality. Well over 50 delegates and representatives of civil society organizations took the floor.

As we enter this Decade of Vaccines, we heard high praise for support from WHO and UNICEF, but especially for the GAVI Alliance. With GAVI support, vaccines that prevent pneumonia and diarrhoea, the two biggest childhood killers, are now being rolled out in a number of countries.

We heard first-hand accounts of what the new meningitis vaccine means for Africa and its people. Many countries have also added yellow fever and hepatitis B vaccines to routine immunization programmes.

I hardly need to remind you of what these efforts contribute to the attainment of MDG 4. But as I have said, and you agree, achievement of this goal also depends on some very basic and cost-effective measures best delivered through primary health care.

You gave us an extremely clear message. The achievement of ambitious, yet fully agreed goals, such as expanded immunization coverage, the introduction of new vaccines, polio eradication, and measles elimination is directly tied to funds.

We heard compelling pleas to fully replenish GAVI funds so that this spectacular recent progress, supported by strong country ownership, does not lose its momentum.

As I have heard on many occasions, a vaccine that is too expensive for the developing world is worse than no vaccine at all.

Many asked the international community to seek ways to reduce the costs of vaccines, especially the newer ones. Let me assure you. WHO, UNICEF, several other partners and, of course, the Bill and Melinda Gates Foundation are working on this right now.

You will see the results you so greatly need to maintain the current momentum. And I know you want this to happen. You strongly endorsed WHO plans for the development of a global vaccine action plan.

You referred to the need for technology transfer and skills training to enable local manufacturing of vaccines, especially in Africa. Some of you described WHO’s key role in achieving exactly this objective for the local manufacturing of pandemic influenza vaccines.

This is a decade with a vision, and vision always feeds that perennial optimism of public health that keeps us going despite the many obstacles and setbacks thrown our way by policies and events beyond our control.

This decade will help realize the full power of immunization to prevent morbidity and mortality, and the young lives saved from death or life-long disability will be numbered in the millions.

Several delegates mentioned the need for communication strategies that address public fears about the safety of vaccines, especially as these fears are responsible for several recent outbreaks that really should not have happened.

WHO was not proactive on social media during the influenza pandemic, and I believe that this allowed some unfounded criticisms to flourish and contributed to the decision of some groups, including members of the medical profession, to refuse vaccination as unsafe and unnecessary.

But we did use Twitter extensively during this Assembly, and our tweets about events over the past several days, on topics ranging from the reform agenda for WHO to pandemic influenza preparedness, reached more than three million people…”

G8 Summit, Deauville: Declaration – vaccines, GAVI, Global Fund, Muskoka, polio

 The G2—G8 Summit of Deauville, held 26-27 May 2011, included the following summary declaration: G8 DECLARATION: RENEWED COMMITMENT FOR FREEDOM AND DEMOCRACY The excerpts below reference vaccines, immunization and related themes:

57. We remain strongly committed to meeting our commitments and to tracking their implementation in a fully transparent and consistent manner. We endorse the Deauville Accountability Report: “G8 Commitments on Health and Food Security: State of Delivery and Results” which documents G8 action on health and food security, and mobilisation of financial resources including 85% of all commitments to the L’Aquila Food Security Initiative, 78% of the overall resources of the Global Fund to fight AIDS, Tuberculosis and Malaria, 44% of funding for the Global Polio Eradication Initiative, and $1.8 billion to the GAVI Alliance through direct contributions and innovative financing mechanisms. We will continue to improve the rigour of G8 accounting for progress in meeting its non-financial commitments and will follow-up on the report’s recommendations.

60. The G8 has catalysed significant action on health and food security and we are ready to further work with other stakeholders. In this regard:
a. We will continue to support the Global Fund to Fight AIDS, Tuberculosis and Malaria. We welcome the commitment of the Global Fund Board to implement a reform agenda to improve oversight, accountability and effectiveness in using its resources. Based on these reforms, traditional donors will be enabled to meet their respective pledges to the Global Fund. We encourage non-traditional donors and the private sector to provide resources to the Global Fund.

b. We reaffirm our commitment to improving maternal health and reducing child mortality, most notably through the Muskoka Initiative for Maternal, Newborn and Child Health launched in 2010. We are delivering our Muskoka commitments. We will continue to monitor their implementation in coordination with all partners, including stakeholders in the Global Strategy for Women’s and Children’s Health. We support the recommendations of the Commission on Information and Accountability for Women’s and Children’s Health established by the WHO at the request of the UN Secretary General. We will implement them, and urge others to do so.

c. We recognise the impact of the GAVI Alliance and strongly welcome its efforts to expand access to new and under-used life-saving vaccines in the poorest countries including through tiered pricing and innovative mechanisms such as the International Finance Facility for Immunisation. We call for a successful completion of the first pledging conference of GAVI in June in London, involving all relevant actors. We also welcome the development of the Advanced Market Commitments and notably the pilot project on pneumococcal vaccines.

d. We stress our continuing commitment to the eradication of polio which is a reachable objective. Our past support has contributed to the 99% decrease of polio cases in the developing countries. We flag the need for a special focus on this issue and renewed momentum. To this end, we will continue to support the Global Polio Eradication Initiative.

e. We will work, together with major bilateral donors, global health programmes and country coordination initiatives, to improve these funds’ implementation of aid effectiveness.

U.S., Russia pledge continued efforts for polio eradication

Presidents Obama and Medvedev, speaking at the G20-G8 Summit in Deauville, “recognized the collaborative efforts already underway between the United States and Russia to eradicate polio globally, and pledged to continue that cooperative until the eradication objective is finally achieved.” USAID noted that in January, 2011, the U.S. government and the government of the Russian Federation, through the U.S. Agency for International Development (USAID), the U.S. Department of Health and Human Services (HHS), and the Ministry of Health and Social Development of the Russian Federation (MOHSD), signed a Protocol of Intent on Cooperation for the Global Eradication of Polio.

Areas of collaboration include “providing technical assistance for polio surveillance; participating in and monitoring of polio immunization campaigns; providing technical assistance on polio clinical diagnoses, case management and rehabilitation; and advocacy and resource mobilization.”  The U.S. noted that it is the largest bilateral donor to the Global Polio Eradication Initiative. Polio eradication “is part of USAID’s more comprehensive effort to reduce morbidity, mortality and disability due to vaccine-preventable diseases.”

Germany increases GAVI support commitment

GAVI reported that Germany will contribute €30 million to the GAVI Alliance in 2012, up from €20 million in 2011. The announcement from Germany’s Ministry of Economic Cooperation and Development (BMZ) was made ahead of the G8 summit and is part of a plan to implement last year’s G8 commitment to the Muskoka initiative for maternal and child health. In a media release, Gudrun Kopp, Parliamentary Secretary to the Minister of Economic Cooperation and Development, said, “An important part of the G8 Muskoka implementation is to work more closely with the Global Alliance for Vaccines and Immunisation, GAVI…GAVI is doing an excellent job and has financed the immunisation of more than 280 million children in the last decade. We have therefore increased our contributions to €20 million in 2011, a fivefold increase compared with previous years. I am happy to announce that we are planning another increase to €30 million in 2012.”

The Bill & Melinda Gates Foundation has offered to match the 2011 and 2012 increases with a €24 million contribution of its own.

GAVI: 2010 Progress Report

GAVI released its 2010 Progress Report, marking its first decade of operation. GAVI’s summary of the report notes: “By the end of 2010, over 5 million future deaths had been prevented and over 288 million additional children had been immunised with support from GAVI and its partners. With sufficient funding GAVI can address the main childhood killers, pneumonia and diarrhoea, as well as other diseases that place a huge burden on developing countries, and prevent another 3.9 million future deaths by 2015.” The report includes “a summary of GAVI’s new strategy and business plan, success stories, facts and figures, country information and an overview of how the GAVI Alliance is governed.” download the full report (PDF – 4.7MB).