Reporting back: COVID 19 and cancer medicines at WHO 148 Executive Board

This January, the WHO’s Executive Board (EB) met to reflect on global health in 2020 and to help shape the organisation’s work over 2021.
Dr Tedros, Director-General, WHO

A WHO PULSE survey in August 2020 found 55% of countries were experience partial or severe disruption of cancer diagnosis and treatment services as a result of the global pandemic. Looking more broadly across the broader swathe of NCDs, 69% of countries reported disruptions to essential diagnosis and treatment. At the same time, the global prevalence of NCDs has been worsening COVID mortality, with a recent commentary by the Editor-in-Chief of the Lancet, called on governments and stakeholders around the world to tackle the ‘syndemic’ nature of COVID-19.

In this context, the WHO EB met to monitor progress in the global COVID-19 pandemic and discuss a resolution on improving mental health services as a core part of the pandemic response. The report contains an update on how WHO has been working to combat the pandemic, including an online COVID-19 Strategic Preparedness and Response monitoring framework. The report also notes that the WHO is undertaking a second PULSE survey to monitor the impact on essential health services, which will provide us with further information on the disruption of cancer and NCD diagnosis and treatment around the world.

During the presentation from the WHO, Dr Mike Ryan shared the latest information on the global COVID-19 response including the available data on the impacts of co-morbidities like cancer:

 

During the discussion Member States raised several key points including:

  • The importance of strengthening health systems and ensuring that countries can continue to deliver strong primary health care and other essential services, in order to minimise disruptions to patients. Several countries, such as Malaysia and Kazakhstan, highlighted the work they have undertaken to ensure the delivery of essential services at different levels of the health system, including for cancer.
  • Calls for high-income countries to support the COVID facility to help ensure that low- and middle-income countries can access the vaccine, recognising that nobody is safe until everyone is safe. This echoed a call from WHO Director-General, Dr Tedros who warned that ’the world is on the brink of catastrophic moral failure’ due to high-income countries prioritising domestic vaccine roll-out over support for COVAX and the ACT Accelerator. 
  • A number of Member States, including the Philippines, highlighted that achieving equity will be critical to the successful roll-out of the COVID-19 vaccine and that all partners will need to support Member States to prioritise vulnerable groups, such as older adults, healthcare workers, refugees and those with underlying conditions like cancer around the world.

Looking ahead, Member States reiterated the importance of better global coordination and capacity building for health, the need to learn from mistakes in the global pandemic response, and the importance of investing in health and UHC to better protect countries from future pandemics. To help achieve this, the EU Member States put forward a proposal for a pandemic preparedness treaty which would be legally binding mechanism to support pandemic reporting and responses globally. A working group has been established to develop this and we anticipate it will be submitted to the World Health Assembly in May.   

Key documents:

Expanding access to cancer medicines has been a hot topic at the WHO EB since the 2017 cancer resolution and the 2019 resolution on improving transparency of markets for medicines, vaccines, and other health products. The report discussed during this session explored progress that WHO has made over the past four years including support to accelerate Hepatitis B and HPV vaccine programmes, the expansion of the WHO’s  prequalification programme, as well as strong support for the Fair Pricing Forum 2019 discussions on improving access and increasing transparency.

The discussions were wide ranging with a number of updates from Member States on national progress which highlighted several key points:

  • The high prices for new cancer treatments are a concern for low-, middle- and high-income countries alike as they are increasing the pressure on already strained national health budgets. The result in increasing financial hardship for individuals and may even be preventing people from accessing these life-saving therapies.
  • Improving the transparency of research and development alongside the price of medicines and technologies will be important. Transparency is a key component of good governance and accountability throughout the process of developing new medicines and technologies, maintain reliable supply chains and forecasting national needs to make effective and efficient investments.  
  • The need for capacity building and other support from WHO to support medicine and technology policies (including the use of TRIPs flexibilities), increase the rational selection of medicines and technologies (including quality-assured generics), improve regulatory capacities, scale-up local production, and improve local research and development capacities to ensure that health budgets are spent as efficiently as possible.
  • Recognition from different countries that while medicines are important, they are only effective where patients have access to accurate diagnosis, as well as other treatments like radiotherapy and surgery.
  • The need for increased investments which go beyond the current pandemic, to broader health system strengthening, health service delivery and health security capacity, including responses to any future outbreaks.

In addition to this discussion, Member States reviewed progress on the Global Strategy and Plan of Action in Intellectual Property (GSPoA). Discussions included a proped resolution to strengthen the local production of medicines and other health technologies, which calls for: 

  • Stronger national leadership and a whole-of-government approach to policy making to support the establishment or promotion of quality assured medicines and other health technologies
  • Alignment of regional and national policies and strategies to support local production, which leverage regional economic integration and coordination platforms
  • WHO to support Member States and provide leadership in promoting the strategic use of quality, accessible, afforable and sustainable local production, including technical support for policies, supporting partnerships (both between governments and non-State actors) and capacity building. 

There are a number of outstanding issues which will be taken forward in negotations including the use of TRIPS flexibilities, the role and use of pooled funds across different regions, and the role of WHO in supporting research and development and technologies transfers internationally.

Key documents

 

Antimicrobial resistance remains a key topic of concern amongst the global health community and the WHO prepared a report on its activities to support the global response. One of the key headlines is that 138 countries now have a national action plan on antimicrobial resistance and all WHO regions are working to raise awareness and providing training on AMR. 92 countries have enrolled in the Global Antimicrobial Resistance and Use Surveillance System (GLASS) and the GLASS team are begun to publish tools including a method to estimate the mortality from AMR bloodstream infections and guidance for national reference laboratories to identify resistant bacteria and other microbes.

The WHO has also recently published AMR stewardship programmes in health care facilities in low- and middle-income countries to share experiences and expertise and is working closely with other UN agencies as part of a Tripartite Joint Secretariat to support the global response.

Several key points emerged during the discussions which are relevant to the cancer community including:

  • The need for multi sectoral cooperation to reduce spread of AMR, this included a number of calls for a stronger ‘One Health’ approach and which provides a number of opportunities for the cancer community to engage nationally, regional and globally. 
  • Governments encouraged each other to sign up to the GLASS and provide data, as well as calling for the wider use of the Access, Watch, Reserve (AWaRe) classification of antibiotics and the development of national AMR plans. Within these discussions there were numerous calls from low- and middle-income countries for additional resources and support to implement these strategies.  
  • The importance of continuing to raise awareness of the current and future impacts of AMR on patients around the world, using opportunities like World Antimicrobial Awareness Week.
  • Stressed the need for better infection control across the health sector and engagement with different health professionals. 
  • Finally, there were numerous calls for countries to scale-up research and development support for new medicines, this will be important for the cancer community in order to preserve the effectiveness of things like surgery and chemotherapy.

Key documents

In 2018 during the 8th Conference of the Parties, Member states commissioned a report on tobacco products regulation, focusing particularly on novel and emerging products. The WHO Study Group on met to discuss several background papers focusing on heated tobacco products (HTPs), electronic nicotine delivery systems (ENDS) and electronic-non-nicotine delivery systems (ENNDS). The papers addressed toxicology issues, attractiveness and addictive potential of products, effects on perception, flavours, marketing, and barriers to regulation. The goal of this evidence-based report was to update the WHO’s Member States’ knowledge on these products and the report included a number of recommendations:

  • Accelerate the implementation of evidence-based measures to reduce tobacco use
  • Use existing regulations for tobacco products to regulate HTPs, including the device.
  • Ensure that the public is well informed about the risks associated with use of HTPs, correcting false perceptions of safety, and countering misinformation.
  • Utilise independent data free from tobacco industry interference or associated organisations, such as Foundation for a smoke-free world,
  • Ban all activities related to the marketing of those products which particularly target youth, including via social media, to ensure that products are not presented as ‘safe’ or ‘low risk’.

Key documents

Immunization Agenda 2030 sets out a goal of a “world where everyone, everywhere, at every age, fully benefits from vaccines to improve health and well-being”. Over the course of the COVID-19 pandemic, immunisation services have been some of the most heavily disrupted, which may have major implications for the success of cervical cancer elimination efforts and measures to reduce hepatitis B associated cancers.

This report tracks progress in how WHO is supporting governments to take ownership of national vaccinations, as well as developing accountability and monitoring frameworks globally, regionally and nationally. It makes clear calls for countries to set national targets and data baselines, use national and regional coordination mechanisms, and for civil society organisations to step-up support to rapid increase immunisation rates.

During the discussion Member States raised several key points including:

  • The importance of supporting the COVAX facility to roll out the vaccine equitably and ensure as much of the world as possible is protected, as early as possible to enable countries and health systems to return to normalcy.
  • While there has been a lot of progress in expanding access to vaccines, particularly in low- and middle-income countries, there is still a large unmet need for capacity build and financial support to continue adding new vaccines such as the Human Papillomavirus vaccine into national schedules and scaling up coverage. The UK and Thailand in particular emphasised the importance of vaccinations as part of strong primary health care.
  • There were repeated calls for further investment in research and development for new vaccines, drawing on the rapid development of the COVID-19 vaccine. A number of Member States called on WHO to take a more active role in research, including by facilitating cross-border collaborations.
  • Norway highlighted the importance of surveillance systems to be able to track he equitable roll-out of vaccines, and called on Member States to engage civil society organisations in this work. 

Key documents

This report provides a summary of the different actions and programmes that the WHO has been pursuing to reduce the global mortality from NCDs and help Member States make progress towards the 2025 NCD targets and SDG 3.4. The report notes the substantial impact that COVID-19 has had on NCD services globally, as well as alarming increases in the prevalence of alcohol use, obesity, and air pollution. WHO’s data suggests that the probability (risk) of premature death from any one of the four main NCDs decreased by 18% globally between 2000 and 2016. The most rapid decline was seen for chronic respiratory diseases (40% lower), followed by cardiovascular diseases and cancer (both 19% lower), and while this is an important step forwards the data masks significant inequities globally, regionally, and nationally.

Included in the report annexes were several key documents for the cancer community including:

  • Status update on the implementation of the 2017 cancer resolution
  • Report on physical activity
  • Biennial report on improving nutrition and meeting global commitments
  • Air pollution – including a update on WHO’s work to develop best buys
  • Mental health
  • People living with NCD in emergencies – where the WHO asked for further guidance
  • Proposal for a resolution on oral health and to explore a resolution on diabetes to mark the 100 anniversary of the discovery of insulin.

Also included was the mid-term evaluation of the WHO Global Action Plan for the prevention and control of NCDs, which has been extended through to 2030 and an evaluation of the WHO’s Global Coordination Mechanism on the prevention and control of NCDs.

Throughout the discussions several key themes emerged, including:

  • Importance of addressing NCDs as part of a connected and comprehensive approach to UHC, which ensures that cancer patients and others with NCDs can access the diagnostic, treatment and care services they need and protect them from catastrophic health spending.  
  • The ‘deadly interplay’ between NCDs and COVID-19 pandemic which has increased the cases of severe disease and mortality across populations. Oman called for countries to urgent restore NCD services as part of their national response, particularly recognising the global commitments to eliminate cervical cancer and reduce mortality from childhood cancers, while Spain highlighted the critical importance of maintaining access to surgery.
  • Several member states, including Norway, Zimbabwe, and Pakistan, highlighted the global shortfall in funding for NCDs, which account for 1-2% of all development funding, and the impact that small amounts of catalytic funding can have in jump-starting national NCD programmes. In the light of COVID-19 and the refocusing of many health services, there were serious concerns about the ability to continue delivering essential care.
  • Strong support for the oral health resolution, recognising that oral diseases including head and neck cancers are characterised by significant inequalities with the worst effects being felt by the poorest and most marginalised. In particular, the EU called out the importance of good oral health, highlighting that it is essential to improve the wellbeing and survival of patients with conditions like cancer and healthy ageing more broadly. Other member states, including Tonga on behalf of the Pacific Islands and Indonesia, called on countries to include oral health care in UHC packages.

In follow-up the WHO has been requested to develop an operational framework to implement the Global Action Plan on NCDS from 2023 to 2030.

Key documents

Following on from a recommendation by the Executive Board, the WHO developed a short report on the key social determinants of health (SDoH), which highlighted how COVID-19 has exacerbated health inequities. Accompanying the report was a resolution, which was proposed by Peru and supported by 10 Member States and the European Union (EU). The resolution put forward suggestions for Member States to strengthen the monitoring of SDoH ad for WHO to provide greater technical assistance to support the development of strategies, policies and monitoring systems, as well as facilitating the exchange of best practices and lessons learned.

During the discussions key themes emerged including:

  • Importance of better understanding the SDoH to identify and respond to the needs of vulnerable groups such as women, refugees. Portugal announced that, as President of the EU, the country will be holding a Social Summit in Porto in May 2021 to explore this issue further.
  • In the context of the COVID-19 pandemic, many Member States highlighted the impact of the crisis on the SDoH including the rise in aggressive marketing by tobacco, alcohol, and processed food industries, as well as rise in physical inactivity.
  • Recognising that as many of the SDoH lay outside of the control of the health sector, that Governments need to step up work to ensure that all policies positively contribute towards health, with several member states identifying the impact of environmental ad transport policies on health.

In follow-up the WHO has been requested to develop an operational framework to collect and analyse data on the social determinants of health by Member States.

Key documents

2020 presented new challenges for all stakeholders to engage in WHO meetings, and for the first time the WHO moved to hosting meetings on a virtual platform. This provided a new set of options as part of the ongoing discussions between WHO and its Member States around where, how, and when non-State actors (NSAs) (i.e., civil society organisations, business associations and philanthropic organisations) engage in meetings. One positive move was a suggestion by the WHO to organise a series of three three-hour meetings with the WHO technical teams and a further three meetings with WHO Member States to informally discuss topics at the WHO, this is a great step forward but will likely come too late in the process to really inform or shape discussions. Read UICC’s response and suggestions in our statement below.

Several common points and new suggestions emerged during the discussions:

  • A request to the WHO to provide further information on the goals and modalities for informal meetings
  • Requests to further engage NSAs in consultation on the proposals and in general, as NSAs provide valuable support to Member States both in countries and in Geneva.
  • Germany called for greater transparency and welcomed the proposals for online meetings to try and facilitate broader participation. The delegation also suggested that discussions with NSAs take place earlier in the process to make them more meaningful as documents and plans are developed.

Key documents

Last update

Thursday 12 January 2023

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