Global Health Updates. Issue 7.
Global Health Updates. Issue 7. Vol2
?Summary
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?Summary
In a special issue of Paediatric and Perinatal Epidemiology, the editors. Amelia K. Wesselink and?Gregory A. Wellenius (2022) presented eight manuscripts, and three accompanying commentaries specifically focused on the potential role of climate hazards in shaping the health of pregnant women, foetuses, newborns and children.
The world remains off-track to meeting Health-related Sustainable Development Goals. Data gaps remain a severe challenge to child mortality estimation and monitoring. Almost two-thirds of low and middle-income countries (97 out of 135) have no reliable mortality data in the past three years.
The UN General assembly adopted a resolution on Addressing the challenges of persons living with rare diseases. According to the US Food and Drug Administration, a rare disease or disorder is anyone that affects 200,000 or fewer people. Diagnostic delays, lack of available treatments, difficulty in finding the appropriate health services are some of the issues they face. Families feel isolated, under-supported and often face economic hardship.
WHO identified?Ten critical issues in 2021. They are innovations and persistent inequities in the COVID-19 response. Emergencies emerge and persist, Tackling health service challenges, Greater contributions by – and challenges for – women in health care services, Malaria vaccine a beacon of hope, New boost to the fight against diabetes, Tobacco use fell, Alarm about dementia challenge, Health argument for climate action and the need to strengthen?WHO.
?Editors. Amelia K. Wesselink, Gregory A. Wellenius (2022) Special Issue: Climate Change and Reproductive, Perinatal, and Paediatric Health. Paediatric and Perinatal Epidemiology Volume 36, Issue 1 p. 1-3. Pages: i-iv, 1-168. January 2022
?A great deal is already known about the impacts of climate change on health and disease. However, relatively little is known about the potential for climate-relevant hazards to impact babies health.
In a special issue of Paediatric and Perinatal Epidemiology, the editors. Amelia K. Wesselink and ?Gregory A. Wellenius (2022) presented eight manuscripts, and three accompanying commentaries specifically focused on the potential role of climate hazards in shaping the health of pregnant women, foetuses, newborns and children.
These manuscripts address a wide range of outcomes, from preconception events to health during childhood,?health with chronic or acute underpinnings,?methodologic advances on well studied exposure-outcome associations, and novel outcomes related to climate hazards.
Substantial gaps in knowledge remain, including identifying critical windows of exposure and susceptible subpopulations. However, preterm birth is a common and essential adverse pregnancy outcome, and a growing body of evidence indicates that exposure to extreme heat, hurricanes and wildfire smoke can increase the risk of preterm birth.
Concerning high ambient temperature, a recent meta-analysis documented that the odds of preterm birth rose by 5% for each 1°C increase in ambient temperature and was 16% higher during heatwaves.
Jegasothy and colleagues examined the association between ambient temperature and spontaneous preterm birth for all births (2004– 2015) in the temperate region of New South Wales, Australia. They found that cumulative mean daily temperature >95th percentile (25°C) compared with the median (17°C) during the seven days before birth was associated with 16% (95% confidence interval [CI] 8, 25) higher risk of spontaneous preterm birth. Notably, associations were stronger for pregnant individuals with co-morbidities (defined as any chronic illness, diabetes or hypertension) or who smoked during pregnancy.?
?These results can be used to identify pregnant individuals who are potentially more vulnerable to the perinatal health effects of heat due to medical co-morbidities.
Cushing and colleagues also assessed the association between ambient heat and spontaneous preterm birth in the hot climate of Harris County, Texas. They examined births during 2007– 2011, during which there was an extreme heatwave. They reported that the risk of spontaneous preterm birth was 1.15 (95% CI 1.01, 1.30) times higher following days with apparent temperature ≥40°C compared with <20°C.
?Over a quarter of pregnancies were exposed to these high ambient temperatures. The association was stronger when the data were censored at 28, 32 or 36 weeks gestation (rather than 37) and was particularly strong for individuals living in neighbourhoods with high levels of economic deprivation.
These results have essential environmental justice implications and demonstrate that community-level interventions to mitigate the health consequences of extreme heat could have significant effects on population health.
Maternal exposure to higher temperatures has been associated with lower birth weight, but the adverse effects of early-life exposure to extreme heat may extend beyond birth.
Dionicio and colleagues examined the association between exposure to ambient heat in the first year of life and rapid infant weight gain, associated with obesity in childhood, adolescence and adulthood. Using data from maternal and child health clinics in Israel, the authors report that exposure to minimum temperature in the highest (≥6.7°C) compared with the middle (3.8– 5.2°C) quintile was associated with 5% (95% CI: 3, 7) more significant risk of rapid weight gain during the first year of life.
The manuscript by Niu and colleagues demonstrates that the adverse health effects of heat extend even beyond the first year of life. Using data from emergency department visits and hospitalisations among children age 0– 18??years in New York City during 2005–???2011, a ~7.2°C increase in maximum daily temperature (the interquartile range in the population) was associated with a 1.6% higher rate of paediatric emergency department visits and a 1.2% higher rate of paediatric hospitalisations.
Cause-specific analyses demonstrated that the increase in emergency department visits was driven by heart-specific symptoms, general symptoms and in-jury diagnostic codes.
The authors speculate that the susceptibility of paediatric populations to heat largely stems from differential risk behaviours, and they offer several policy recommendations related to outdoor physical activity and city planning to protect children from extreme heat.?
In the western United States, the frequency and intensity of wildfires have increased dramatically over the past two decades. The manuscript by Park and colleagues links wildfire exposure to foetal Gastroschisis, an abdominal wall defect that is rare but increasing in prevalence. In addition, Gastroschisis has been associated with air pollution in some but not all previous studies.
The authors used data on California births between 2007 and 2010. They reported that pregnant individuals living within 15 miles of a wildfire during preconception or the first trimester had 2.17 and 1.28 times the risk of foetal Gastroschisis, respectively, compared with individuals living farther from wildfires. Further research with spatially and temporally refined exposure assessment is needed, but these preliminary data highlight the potential for wildfire exposure to affect early foetal development.
Ambient air pollution from the burning of fossil fuels not only contributes to continued climate change it may also have immediate adverse impacts on reproductive processes.
Animal and epidemiological evidence demonstrates that air pollution may influence fertility. Wesselink and colleagues8 add to this literature using data from a large preconception cohort of Danish couples trying to conceive during 2007– 2018. They found that increasing residential ambient concentrations of particulate matter <2.5 μm (PM2.5) and <10 μm (PM10) were associated with reduced fecundability, the per-cycle probability of conception. Moreover, these associations occurred at pollution levels that largely met the current European Union air quality standards.
?These results highlight that even low levels of air pollution can be harmful to human health and emphasise the importance of the new World Health Organization air quality guidelines for reducing air pollution-related morbidity and mortality. The association between air pollution and preterm birth is well documented. A systematic review from 2020 reported that PM2.5 and ozone concentrations were associated with a higher risk of preterm birth in 19 of 24 studies, with stronger associations among individuals with asthma and marginalised populations, particularly Black individuals.
Costello and colleagues focus on air pollution and its impact on preterm birth. They analysed 2.7 million births to California residents (2011– 2017). They found that road proximity metrics (including distance to major roads, central road density within 500??meters, and significant road density-weighted by truck volume) were not appreciably associated with preterm birth. In contrast, more refined estimates of pollution (census tract level PM2.5 and diesel PM) were associated with preterm birth. This article highlights the need to consider exposure assessment in studies of air pollution and perinatal outcomes, particularly over large geographical areas.
Most research on air pollution and preterm birth has focused on long-term exposures (during pregnancy or trimester-specific exposure). However, ha and colleagues used a case-crossover design to measure the extent to which acute air pollution exposure triggers preterm birth. This study design allows for identifying the health effects of acute exposures and inherently controls for time-invariant confounding, as each participant with the outcome is compared with themselves at different time points.
They conducted their study in California's San Joaquin Valley, an agricultural region with some of the highest air pollution levels in the United States. They found that an IQR increase in ozone concentration in the warm months (May- October) was associated with 9– 11% higher odds of delivering very preterm (<34 weeks' gestation) within seven days post-exposure, after controlling for PM2.5, temperature and humidity. PM2.5 exposure during the cold season (November- April) was associated with a 6% increased odds of very preterm birth. These results indicate that acute air pollution exposure may trigger preterm birth. The evidence is clear: climate hazards, particularly heat and air pollution, adversely impact a wide range of reproductive, perinatal and paediatric health outcomes.
However,?the more urgent issue for public health is the development of interventions that protect pregnant individuals, neonates and children from present-day climate hazards. Some individual-level interventions may be effective, at least in some population segments. For instance, obstetrician-gynaecologists could advise patients to avoid spending time outside on hot days.
?However, the efficacy of such interventions is highly dependent on the patient's relative privilege, such as their access to air conditioning, how they travel throughout their day and the type of job(s) they hold. Because marginalised populations are simultaneously at higher risk of exposure to climate hazards and potentially less resilient to the effects of these exposures due to systematic oppression, structural or population-level interventions are needed to ensure equitable protection from climate hazards.
Although the need for equitable climate adaptation at the local level is clear, there is a paucity of evidence of which interventions are most effective or cost-effective to achieve these goals. Nevertheless, the expected pace of continued climate change and resulting impacts on our physical and mental health and wellbeing calls for decisive and immediate action on adaptation. This is because our climate has already changed profoundly due to human activity and these changes are broadly harmful to our health, with some communities and individuals affected much more than others.
Failure to urgently address climate change's reproductive, perinatal and paediatric health impacts will perpetuate and worsen reproductive injustices, wherein the most marginalised populations will be deprived of their ability to procreate and safely parent their children.
United Nations Inter-Agency Group for Child Mortality Estimation (UN IGME), Report. Levels and trends in child mortality. December 2021. https://data.unicef.org/resources/levels-and-trends-in-child-mortality/#
The world remains off-track to meeting Health-related Sustainable Development Goals. (SDG3). The report by the UN IGME reveals an urgent need to invest in strengthening data systems to track newborn and child health and mortality in low- and middle-income countries, two-thirds of which have had no reliable mortality data in the past three years. More than 5 million children died before reaching their fifth birthday in 2020. Almost half of those deaths, 2.4 million, occurred among newborns. However, data gaps remain a severe challenge to child mortality estimation and monitoring. Almost two-thirds of low and middle-income countries (97 out of 135) have no reliable mortality data in the past three years. Moreover, just 40 countries had high-quality national data for 2020 included in the estimation model, though national or subnational data were available for more than 80 countries or areas to help analyse excess mortality due to COVID-19.
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Resolution adopted by the UN General Assembly on 16 December 2021
https://undocs.org/en/A/RES/76/132
According to the US Food and Drug Administration, a rare disease or disorder is anyone that affects 200,000 or fewer people.
Recognising the need to promote and protect the human rights of all persons, the ?UN General Assembly, on 16 December 2021, adopted a resolution. An estimated 300 million persons live with a rare disease worldwide, many of whom are children, by ensuring equal opportunities to achieve their optimal potential development and fully, equally, and meaningfully participate in society.
Diagnostic delays, lack of available treatments, difficulty in finding the appropriate health services are some of the issues they face. Families feel isolated, under-supported and often face economic hardship.
It has been a year of colossal efforts in global health. Countries battled COVID-19, which claimed more lives in 2021 than in 2020 while struggling to keep other health services running. Health and care workers have borne the lion's share of these efforts but often received little recognition or reward. According to WHO??Life-saving COVID-19, vaccines, tests and treatments were rolled out, but overwhelmingly in the wealthiest countries, leaving many populations unprotected, especially in lower-income countries.??Across other health areas, from diabetes to dementia, there have been both setbacks and hard-won successes.??Here are ten global highlights from 2021, including a few issues you might have missed:?
?Innovation and inequities in the COVID-19 response
Emergencies emerge and persist
Tackling health service challenges
More extraordinary contributions by – and challenges for – women
The malaria vaccine is a beacon of hope in the fight against a range of infectious diseases
New boost to the fight against diabetes
Tobacco use fell
Alarm about dementia challenge
Health argument for climate action
Need to strengthen?WHO
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?Ten key global health moments from 2021
WHO 20 December 2021
It has been a year of colossal efforts in global health. Countries battled COVID-19, which claimed more lives in 2021 than in 2020 while struggling to keep other health services running. Health and care workers have borne the lion's share of these efforts but often received little recognition or reward.???
Life-saving COVID-19 vaccines, tests and treatments were rolled out, but overwhelmingly in the wealthiest countries, leaving many populations unprotected, especially in lower-income countries.?
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Across other health areas, from diabetes to dementia, there have been both setbacks and hard-won successes. Here are ten global highlights from 2021, including a few issues you might have missed: ?
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This year, inequalities in access to health tools came into an even sharper focus. Over 8 billion COVID-19 vaccine doses have been administered worldwide, but only 1 in 4 African health workers was fully vaccinated by the end of November. Moreover, a mere 0.4% of tests globally have been carried out in low-income countries.
Driving efforts to end the COVID-19 pandemic, WHO has led the charge for equity. We have set global vaccination targets and emphasised that the priority in every country, and globally, should be protecting those most at-risk, such as health workers and older people. As a result, as of 20 December 2021, we have validated 10 COVID-19 vaccines as safe, effective and high-quality and continually updated our therapeutics guidelines, reflecting the latest clinical insights.
Collaboration is key to WHO's COVID-19 response. The world's best scientific brains came together to ask and answer the critical research questions needed to tackle COVID-19 under WHO's Research and Development Blueprint. The ACT-Accelerator halved the cost of COVID-19 rapid tests for low and lower-middle-income countries and procured over 148 million tests. Its vaccines arm, COVAX, delivered over three-quarters of a billion doses globally, despite substantial challenges, such as vaccine hoarding and insufficient transparency from manufacturers. We partnered closely with countries to prepare for rollouts throughout this uncertain year.
WHO also launched an mRNA technology transfer hub initiative and supports a South African manufacturer in bringing the know-how, data and technology together to develop production capacity to serve the region.
Providing a great example of a transparent, global, non-exclusive agreement, the COVID-19 Technology Access Pool announced its first licence, which will allow all countries to manufacture a serological test developed by the Spanish National Research Council.
As our COVID-19 response continues apace, make our preparedness efforts for future outbreaks. We opened a Hub for Pandemic and Epidemic Intelligence in Berlin with Germany. With Switzerland, we launched the first facility in our global BioHub system for rapidly and safely sharing pathogens, which will help assess risks and enhance global preparedness.
Globally, there have been over 100 Intra-Action Reviews by countries that have used this tool to evaluate their COVID-19 responses and strengthen them in real-time. In parallel, the pilot rollout of Universal Health and Preparedness Reviews has successfully recruited countries to learn from each other in assessing their readiness for the next pandemic while providing for and promoting the overall health of their populations.
Emergencies emerge and persist
As the pandemic raged on, WHO and partners continued helping communities caught up in protracted humanitarian crises, such as Yemen and Syria, while responding to emerging ones in Afghanistan and Northern Ethiopia.
In Yemen, COVID-19 has further strained a health system already beset by conflict and other disease outbreaks, where only half of the country's healthcare facilities are reported as functional. WHO has helped millions by supporting essential health services and therapeutic feeding centres to treat children with acute malnutrition. In response to the pandemic, WHO worked on constructing oxygen production stations, capacity-building for health care workers, provision of medical and protective equipment and bolstering laboratory and testing capacity.
After more than a decade of crisis, needs in Syria are greater than ever. So WHO stepped up with deliveries of medical supplies and by working with partners to provide mental health support.
Currently, the world's largest humanitarian emergency, Afghanistan is contending not only with COVID-19 but also acute watery diarrhoea, dengue, measles, polio and malaria. WHO has shipped over 414 metric tonnes of life-saving medical supplies since 15 August 2021 and, with partners, vaccinated 8.5 million children against polio through a November campaign.
Severe hardships — including a lack of fuel, food and medicine — also afflicted people in Northern Ethiopia. WHO provided over 367 metric tonnes of humanitarian cargo to Ethiopia to date, to provide relief to hundreds of thousands of families. Together with partners, we also launched a campaign to vaccinate 2 million people against cholera in Tigray region. We also supported mobile health and nutrition teams to deliver services to internally displaced people in conflict-affected Afar, Amhara and Tigray regions.
Tackling health service challenges
once-in-a-generation crises have outsized ripple effects. The pandemic is likely to halt two decades of global progress towards universal health coverage (UHC), having triggered the worst economic crisis since the 1930s and badly disrupted health services.
According to new data launched this year, 23 million children missed out on routine vaccines in 2020, the largest number in over a decade – increasing risks from preventable diseases like measles and polio. Over half of the countries WHO surveyed between June and October 2021 reported disruptions to services for diabetes, cancer screening and treatment, and hypertension management.
As we navigate these challenges, UHC remains WHO's North Star. Yet even before COVID-19, the world was falling short of our target to see 1 billion more people benefiting from UHC, as half a billion people were pushed (or pushed still further) into extreme poverty because of payments they had to make for health care. The situation will only be worse as a result of the pandemic, so we must redouble our efforts and make 'Health For All' the rallying cry of the recovery.
COVID-19 has exposed the limits of the resilience of health systems, underscoring the need to build them up to better deliver on both universal health coverage and health security. All countries should invest in primary health care, the health and care workforce, health infrastructure, medicines and other health products, and strengthening social protection mechanisms.
For its part, WHO is bolstering health services at this pivotal moment, for example, through our collaboration with partners on achieving the Immunization Agenda 2030 strategy. We are also facilitating big picture thinking on the way forward, by convening experts to look at how to fund health for all and ensure that medical breakthroughs serve the common good. Shortly after UHC Day, we marked the agreement of the Geneva Charter for Well-being, which signals the need for a paradigm shift towards prevention and equipping people to take control of their own health.
?Greater contributions by – and challenges for – women
If health systems and services have weathered the storm of the past two years, it is in no small part due to the huge sacrifices of the women who represent 70% of the health and social workforce. WHO's Year of Health and Care Workers campaign has called for protecting them and investing in their work environments and education; the WHO Academy represents a major investment in the latter area.
Women also played a leading role in driving scientific breakthroughs. WHO is committed to dismantling barriers to women's participation in science, so more can participate in pushing the boundaries of knowledge and safeguarding public health. Committed to championing women as decision-makers and leaders, we signed an MoU with the Women in Global Health network and made multiple commitments to women's empowerment and equality at the Generation Equality Forum.
We have also moved to rectify past injustices, awarding a posthumous award to Henrietta Lacks, who in 1951 had tumour samples taken without her consent during her treatment for cervical cancer. Lacks's life was cut short at the age of 31 but her legacy lives on. Her cells have contributed to nearly 75 000 studies, paving the way for advancements from HPV and polio vaccines to medications for HIV/AIDS and breakthroughs, including in vitro fertilisation.
But women and girls are facing new or heightened health challenges, as the COVID-19 pandemic has exacerbated existing inequalities and disrupted access to vital health and support services.
The largest ever study on the prevalence of violence against women shows that almost 1 in 3 women globally have been subjected to physical or sexual violence by an intimate partner or sexual violence from a non-partner. Exposure to violence at home likely increased during the pandemic. WHO resources aim to help health workers better support survivors, while new research highlights the urgent need for policies that prioritise violence against women as a public health threat.
To address health challenges that particularly affect women, WHO is working to help countries eliminate cervical cancer, releasing new guidelines on cervical screenings and pushing for equity in access to vaccines, screening and treatment. We also launched a groundbreaking initiative to tackle breast cancer – aiming to significantly reduce deaths from the disease.
Malaria vaccine a beacon of hope in the fight against a range of infectious diseases
Just as health workers have been guiding lights in these difficult times, so has the transformative potential of science. WHO's recommendation of the widespread use of a malaria vaccine for children at risk, particularly in sub-Saharan Africa, marked a milestone moment for child health and malaria control.
The recommendation was based on results from an ongoing pilot programme of the RTS,S vaccine in Ghana, Kenya and Malawi that has reached more than 800 000 children since 2019.
The vaccine has reinvigorated the fight against malaria, which claimed the lives of over 600 000 people in Africa in 2020. Children under the age of 5 represented 80% of these deaths. Even before the pandemic struck, there were signs that after years of phenomenal gains, progress was stalling.
Other major achievements relating to immunisation include the introduction of a licensed Ebola vaccine and launch of a landmark new global plan to tackle meningitis.??????
Meanwhile, we released new evidence that more countries are following WHO's advice on the steps to take when HIV drug resistance reaches critical thresholds. This is an important step forward in the global fight against antimicrobial resistance, about which WHO continues to raise the Alarm, calling for action on innovation and within the food system.?
New boost to the fight against diabetes
With 2021 marking the 100th anniversary of the discovery of insulin, WHO launched a Global Diabetes Compact to speed up action on the prevention and treatment of diabetes.
Bringing together people living with diabetes, academia, civil society, the business community and more, the Compact aims to reduce the risk of diabetes and ensure that all people diagnosed with the condition have access to affordable, good quality care.
A new report published in November highlighted that insulin, a life-saving diabetes medicine, remains out of reach for a high proportion of the people who need it. WHO is working on a number of fronts to increase access to insulin and related products, with the priority to ensure uninterrupted production and supply of human insulin. The inclusion of insulin analogues on WHO's Essential List of Medicines opens the door to their prequalification, which could increase competition and potentially reduce prices.
Our work on diabetes is just one part of our comprehensive efforts on noncommunicable diseases (NCDs) and mental health. This is no small undertaking, given that NCDs claim the lives of 41 million people each year, equivalent to 71% of all deaths globally; depression alone constitutes a leading cause of disability worldwide.
?Tobacco use fell
As to fateful choices for health and preventing NCDs, impressive numbers of people are deciding to stop smoking. Between 2000 and 2020, the number of people using tobacco dropped by 69 million — from around one third of the global population to under a quarter.
Two years ago, only 32 countries were on track to lower tobacco use by 30% between 2010 and 2025. Now, 60 countries are on course to achieve the target reduction.
Progress is fragile however, with the tobacco industry having exploited the COVID-19 pandemic to build influence with governments in many countries. The Conference of the Parties (COP9) to the WHO Framework Convention on Tobacco Control (FCTC) endorsed a declaration on recovery from the COVID-19 pandemic and also established a funding mechanism to strengthen global tobacco control measures.
Tobacco users who would like to quit can draw on resources shared via WHO's Commit to Quit campaign, including the 'Quitters' Diaries', charting personal journeys in stepping away from tobacco.
?Dementia
WHO signals Alarm about dementia challenge
Individuals can do a lot themselves to stay healthy but they can't do it all on their own. WHO released its first report on the global status of the public health response to dementia, showing that only a quarter of countries worldwide have a national policy, strategy or plan for supporting people with dementia and their families.
These gaps are increasingly concerning, as the number of people living with dementia is growing. WHO estimates that more than 55 million people (8.1% of women and 5.4% of men over 65 years) are living with dementia. As life expectancy increases worldwide, this number is estimated to rise to 78 million by 2030 and to 139 million by 2050.
To drive change, the report highlights the urgent need to strengthen support at national level, for both people with dementia and those who care for them. Many countries lack earmarked funding in national health budgets, leaving significant gaps in treatment and care, and do not comprehensively involve people with dementia and their carers and families in developing policies. These are among the areas for change.?
WHO is also developing a Dementia Research Blueprint, to structure research efforts and stimulate new initiatives, helping to overcome challenges related to past unsuccessful clinical trials for treatments and the high costs of research and development.
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Health argument for climate action
Whether managing irreparable damage to someone's memory or to our planet, WHO aims to rise to existential threats, from the personal to systemic.
Launched in September, WHO's Global Air Quality Guidelines equipped the global community with clear evidence of the damage air pollution inflicts on human health, at even lower concentrations than previously known.
In the lead-up to the UN COP26 climate conference in Glasgow, WHO's team lead on climate change, Dr Diarmid Campbell-Lendrum, cycled from Geneva to London — the first stretch in transporting two key documents to the global convening: WHO and partners' 'Health Argument for climate action' report and an open letter signed by organisations representing two-thirds of the global health workforce.
The Glasgow Climate Pact has left climate action at a critical point. It provides entry points on key issues such as financing as well as the fate of coal and fossil fuel subsidies – but they remain either unresolved or with caveats.
WHO will urgently work with partners to provide technical and financial support to the 50 countries that signed commitments to increase health sector resilience to climate change and reduce carbon emissions produced by the health sector.
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A stronger WHO
Increasing global health security requires strengthening, empowering and sustainably financing WHO at the centre of the global health architecture.
Two major developments closed out 2021. Countries made an historic decision to embark on the process of drafting and negotiating a new convention, agreement or other international instrument on pandemic prevention, preparedness and response, informed by an active working group of Member States. The spirit of solidarity underpinning this process will not only prevent and mitigate the impact of future pandemics, but end this one.
Composed of Member States, the Working Group on Sustainable Financing has been developing concrete recommendations towards more sustainable financing of WHO. Proposals for increasing the flexibility and predictability of funds were discussed, including considering a step change in assessed contributions, which are calculated based on each country's GDP. Member States agreed that more time was needed to reach full consensus and their draft report will go to WHO's Executive Board in January 2022.
In 2021, WHO also embarked on an urgent journey to strengthen safeguards against sexual exploitation and abuse in our work with communities and better protect our own staff against sexual harassment.
An important milestone was the publication of the Implementation Plan, which lays the foundation for zero tolerance for sexual exploitation, abuse and harassment — and for inaction against it. We are adopting a survivor-centred approach, ensuring all our personnel know and are accountable for upholding standards, and reforming structures, cultures and practice. This work is integral to our mission to promote health, keep the world safe and serve the vulnerable.
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