Regional Committee opens in Turkey
Health ministers and senior officials from 51 Member States in the WHO European Region are in Çeşme Izmir, Turkey, on 16–19 September 2013 for the sixty-third session of the WHO Regional Committee for Europe.
The session is webcast in English and Russian, and covered on Twitter (#rc63izmir).
High-level meeting with selected Member States
WHO/Europe hosted discussions with delegates from Croatia, Kazakhstan, Kyrgyzstan, Montenegro, Republic of Moldova, Romania, Russian Federation, Tajikistan, the former Yugoslav Republic of Macedonia, Turkey, Ukraine and Uzbekistan, as well as representatives of the GAVI Alliance, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Joint United Nations Programme on HIV/AIDS (UNAIDS), the United Nations Children's Fund (UNICEF), Rotary International and WHO headquarters on 14–15 September. The meetings were organized to facilitate informal strategic discussions and to share experiences on specific issues including: immunization and vaccine-preventable diseases, the Consolidated Action Plan to Prevent and Combat Multidrug- and Extensively Drug-resistant Tuberculosis, the Global Action Plan for the Prevention and Control of Noncommunicable Diseases, a European mental health action plan, tobacco control, food and nutrition policy, Health 2020 and WHO reform.
Measles and rubella elimination
Occasional outbreaks of these diseases threaten the regional goal of elimination by 2015, and to address this a package for accelerated action will be presented at the Regional Committee. Measles is a seasonal disease, and its profile in the Region is changing: no longer just a childhood disease, cases are increasingly found in adolescents and young adults. Complacency, at political levels and among the public, as well as ensuring supplies of vaccine in some countries remain challenges. Participants referred to the WHO Region of the Americas for good practices, as this Region has achieved sustained elimination for more than 10 years. The Western Pacific Region is also close to its elimination goal, and key to its strategy has been targeting immunization campaigns at high-risk groups.
Polio “endgame” strategy
The WHO European Region has been certified polio-free for over a decade. As part of global efforts to eliminate the disease, WHO has developed a “polio endgame plan”. One of the implications of this plan for the Region is the move from using oral polio vaccines (a live vaccine) to inactivated polio vaccines (IPVs). With IPV the vaccine is not live and therefore cannot circulate or revert to become a wild virus. Many countries are already using IPVs only, and at least one dose must be introduced in every country in the Region by 2015. WHO will support countries in the process through guidance on planning and logistics, as well as support in procurement and to regulatory authorities for licensing the vaccines, and GAVI will provide supply assistance for some countries.
Global Vaccine Action Plan
Supporting the Global Plan, a regional action plan is to be developed through a consultative process with Member States, and presented a year from now. This regional plan will not increase Member States’ monitoring requirements, but emphasize the need for quality data reported in a timely manner. Participants expressed their support for the development of a regional plan, strengthening accountability, improving coverage, and taking account of differences across the Region.
Action Plan on Multidrug- and Extensively Drug-resistant Tuberculosis
Over 95% of patients with multidrug-resistant tuberculosis (TB) are in countries of the Commonwealth of Independent States. The treatment success rate for this form of TB is 45% on average, ranging from 18% to 80%. WHO has developed a compendium of best practices for TB prevention, control and care. Through a combination of local investment and political commitment, great progress has been made in some countries in the last two years. Participants emphasized the need for action across government, including the prison sector, and for strengthening primary health care to address this issue, and expressed their concerns about reforming current TB services, the availability of rapid testing, second-line drugs, and psychosocial care for those on treatment.
European Action Plan for HIV/AIDS
The WHO European Region is experiencing a “treatment gap”, with HIV infection rates increasing faster than treatment. WHO has recently introduced new consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. These new guidelines emphasize the need to get those most in need on treatment, but also recognize the benefits of introducing antiretroviral treatment at an earlier stage. WHO and UNAIDS have also established Treatment 2015, with the aim of increasing the numbers of those receiving treatment. This framework underlines that treatment is cost-effective, and could be cost-saving over time as it defers health care costs for those with HIV. Delegates agreed that a combination of prevention and treatment interventions are needed to tackle the HIV epidemic. Despite increasing infection rates, the Region is set to be the first to eliminate the mother-to-child transmission of HIV.
International Health Regulations
Having entered into force in 2007, the revised International Health Regulations (IHR) call for national capacity for surveillance and response systems and at points of entry (ports, airports and ground crossings) to be strengthened. The deadline for implementing the IHR was 2012, with the possibility for countries to extend implementation to 2014 based on a written request and plan submitted to WHO. Following discussions at the last World Health Assembly, WHO is seeking guidance from Member States on possible criteria to extend the implementation deadline beyond 2014.
Following the adoption of a European strategic action plan on antibiotic resistance in 2011, WHO/Europe has undertaken country assessments in several Member States, and has established the Central Asian and Eastern European Surveillance of Antimicrobial Resistance (CAESAR) Network. Work in this area is undertaken in close collaboration with many partners, notably the European Centre for Disease Prevention and Control (ECDC). Advocacy activities, highlighting the risks of antibiotic misuse for both the public and health care professionals, a greater focus on changing behaviours, and collaboration across sectors are integral to the work.
Action plan on mental health
A European mental health action plan will be put to the Regional Committee for adoption at this session. The plan emphasizes the right to mental well-being throughout life, the protection of human rights for those with mental health problems, the positive influence of community-based services, and everyone’s entitlement to respectful, safe and effective treatment. The need for community care tailored to local situations, and for trained health personnel was underlined by delegates in discussions.
Noncommunicable diseases (NCDs)
The Government of Turkmenistan will host the WHO European Ministerial Conference on the Prevention and Control of Noncommunicable Diseases in Ashgabat on 3–4 December 2013. This Conference will focus on three areas: NCDs in development and foreign policy, the endgame of tobacco and overcoming health system barriers. Mortality from cardiovascular diseases has fallen across the European Region over the past 30 years, and economic development is an important determinant for success. Discussions covered the issue of cancer screening, and the need to ensure that appropriate treatment is available once screening measures are in place, as well as the role of industry in addressing NCD risk factors.
This European policy framework for health and well-being was adopted at last year’s session of the Regional Committee. Now the focus is on implementing the strategy, and WHO/Europe is developing a package of tools and services to support countries on issues including governance and leadership, monitoring inequalities, and essential public health functions. The major findings of the report on social determinants of health and the health divide will be discussed at this year’s Regional Committee session. Delegates expressed their support for Health 2020 and the need for support in forging effective governance partnerships.
Monitoring framework and indicators for Health 2020
Following agreement last year to have six overarching targets for Health 2020, work over the past year has focused on identifying a series of indicators to measure these targets. Based on expert discussions and a consultation with Member States, a series of 20 core indicators and 17 additional indicators has been identified. The importance of using indicators that are available and already routinely reported by Member States, and that can be reported disaggregated according to age, gender and so on, was underlined in the development process. WHO will report the Region-wide averages of these indicators. Participants also emphasized the need for cross-sectoral reporting teams and reporting at the local level.
This process has three main pillars – programmes and priorities, governance and management reform. It was initiated because of a recognition that the organization’s funding mechanism was out of step with its needs and external realities. One recent development in this process has been the introduction of financing dialogues with donors and Member States, to make WHO funding more predictable. The first of these dialogues took place in June, and the next will be in November this year.
Signing of Biennial Collaborative Agreement (BCA) with the former Yugoslav Republic of Macedonia
On Sunday afternoon, Mr Nikola Todorov, Minister of Health of the former Yugoslav Republic of Macedonia, and Zsuzsanna Jakab, WHO Regional Director for Europe, signed the BCA covering areas of cooperation for the next two years. Key areas of joint work include technical support from WHO to develop a national operational health plan under the framework of Health 2020, and a new national multisectoral health plan on NCDs.
“WHO is the most credible source of expertise on health referred to by the Ministry of Health,” said Mr Todorov. He explained that the Ministry is setting up a unit to streamline WHO policies, guidelines and documents into national health settings. Speaking of other national developments, the Minister announced that the country had introduced an electronic referral and waiting-list system this year.
Ms Jakab thanked the Minister for the strong collaboration with WHO and in particular for the support given by the Government and the Ministry of Health in hosting the seat of the South-eastern Europe Health Network (SEEHN) secretariat in Skopje, which opened in March this year.
The former Yugoslav Republic of Macedonia is the first Member State in the European Region to sign a BCA with WHO/Europe for 2013–2014.
Briefing for nongovernmental organizations (NGOs)
Representatives of 26 NGOs met on Sunday to discuss the agenda and their participation at the Regional Committee session. Written statements by several NGOs are available online.
Standing Committee of the WHO Regional Committee for Europe
The Twentieth Standing Committee of the Regional Committee (SCRC) held its final session on Sunday 15 September 2013. It reviewed the provisional agenda and programme of the Regional Committee and other procedural matters in preparation for the session.
Highlights for Monday
- Address by Dr Mehmet Müezzinoğlu, Minister of Health of Turkey
- Opening address by WHO Regional Director for Europe, Zsuzsanna Jakab
- Discussion on WHO reform and implications for the WHO European Region