Highlights of RC64 day 4 – Ebola emergency update, food and nutrition action plan adopted, and six European progress reports discussed
Adoption of European Food and Nutrition Action Plan 2015–2020
The final day of the 64th session of the WHO Regional Committee for Europe (RC64) started with 3 additional Member States welcoming the Action Plan. One called for the redefinition of the concept of overweight and obesity.
Nongovernmental organizations (NGOs) called on all Member States to take strong measures to implement WHO’s recommendations on the marketing of foods and non-alcoholic beverages to children.
RC64 adopted the Action Plan.
Matters arising from resolutions from the World Health Assembly
Hepatitis and malaria
Dr Hiroki Nakatani, WHO Assistant Director-General, HIV/AIDS, TB, Malaria and Neglected Tropical Diseases, described the global challenge presented by hepatitis and WHO’s work to develop a strategy for 2016–2020 that identifies priorities and sets global targets for a coordinated global response. He also outlined the draft global malaria technical strategy for 2016–2030.
Dr Nedret Emiroglu, Deputy Director of the Division of Communicable Diseases, Health Security and Environment, described the burden of hepatitis on the European Region, particularly in eastern countries. WHO/Europe supported Member States in securing or sustaining their malaria-free status; only 37 cases had been reported by 2 countries in 2013.
The representative of Germany asked about the cost of hepatitis treatment and welcomed further guidance from WHO to Member States.
Outcomes of the United Nations General Assembly high-level meeting on noncommunicable diseases (NCDs)
Dr Oleg Chestnov, Assistant Director-General for Noncommunicable Diseases and Mental Health, described how governments had committed themselves at the high-level meeting to intensifying their efforts to secure a world free of the avoidable burden of NCDs. Dr Gauden Galea, Director of the Division of Noncommunicable Diseases and Life-course, noted that the European Region had agreed to consider setting national targets for NCDs and developing national multisectoral policies and plans by 2014, and to implement “best buys” to reduce NCD risk factors by 2016.
In the discussion that followed, a representative suggested changing the name NCDs to long-standing, preventable and manageable diseases. Dr Galea said that the current name comprised a recognizable brand, and suggested, “We need a term that keeps the brand, connects with mental health and captures the hope of finding a solution.” The debate could develop a cluster of additional terms to be used.
Update on the Ebola emergency
Through a video link with WHO headquarters, Dr Keiji Fukuda, Assistant Director-General for Health Security, described the situation in West Africa as having “evolved from an outbreak to a top-level regional and global health security challenge.” There had been over 5000 cases of Ebola virus disease, and 2600 deaths, mostly in five countries: Guinea, Liberia, Nigeria, Senegal and Sierra Leone. In addition to the health effects, the countries suffered from paralysed health systems, compromised food availability and severe damage to their economies. Recognition had grown that the emergency could not be addressed without empowering households, communities and community leaders. A new approach to stopping disease transmission had been suggested: setting up community-based Ebola care centres using trained local staff. The United Nations Security Council was discussing a proposed resolution on the Ebola emergency.
The representative of the United Kingdom highlighted a market failure: the lack of medicines or vaccines to address Ebola. A solution had to be found, not only for Ebola but also to fill the antibiotics pipeline and address antimicrobial resistance (AMR) and neglected tropical diseases.
International Health Regulations (IHR)
Dr Florence Fuchs, Coordinator, IHR Capacities at WHO headquarters, noted that 63 Member States globally had reported having the required core capacities to implement the IHR, while 75 (including only 8 European countries) had requested a second extension of the deadline for developing these capacities. The IHR review committee sought feedback from Member States on its proposals to accelerate implementation, including setting minimal standards for implementation and establishing a global body with regional representation, for verification. Consultation would continue until May 2015.
Dr Emiroglu highlighted the importance of the structure for information sharing between national focal points and WHO/Europe.
Member States fully agreed on the vital importance of IHR, and the need to strengthen and accelerate implementation. Several representatives called for any global body to be “flexible and agile”.
Development of a global action plan to combat AMR
The 2014 World Health Assembly’s resolution on AMR called for the development of a global action plan. Dr Charles Penn, from WHO headquarters, outlined some of the key elements of the draft plan, such as the inclusion of incremental targets for implementation and quantifiable objectives. WHO was developing the plan in cooperation with the Food and Agriculture Organization (FAO) and the World Organisation for Animal Health (OIE). Member States would be consulted on it in October.
Dr Emiroglu underlined the leadership of many European Member States in adopting and implementing the European strategic action plan on AMR, raising awareness and driving action. Major developments included the CAESAR (Central Asian and Eastern European Surveillance of Antimicrobial Resistance) network, which covered countries in the Region not belonging to the European Union (EU).
RC64 expressed strong support for the development of a global plan on AMR.
Implementation of the Polio Eradication and Endgame Strategic Plan 2013–2018
Endorsed in 2013, the Plan aimed to guide intensified global efforts to complete the eradication of all poliovirus and certify the remaining WHO regions polio free by the end of 2018. While no type 2 wild poliovirus had circulated since 1999, and no type 3 virus since 2012, poliomyelitis (polio) remained endemic in Afghanistan, Nigeria and Pakistan. Cases were declining in the first 2 countries, but rising in the third. In 2014, type 1 wild poliovirus had caused 171 reported cases of polio.
Owing to the striking increase in the international spread of poliovirus since April 2013, however, on 5 May 2014 the WHO Director-General declared it a public health emergency of international concern under the IHR and issued temporary recommendations for states currently exporting wild poliovirus and those infected with but not currently exporting wild poliovirus.
Dr Emiroglu noted that oral polio vaccine (OPV) had been withdrawn and inactivated polio vaccine (IPV) introduced. That would reduce the risks associated with type 2 OPV removal, facilitate outbreak control and interruption of polio transmission, and hasten eradication.
Technical briefing on women’s health
The briefing focused on improving sexual and reproductive health and preventing violence against women and girls. Dr Gunta Lazdane, Programme Manager for Sexual And Reproductive Health, called it an ideal opportunity to discuss the issues to be discussed at the world conference on women to be held in Beijing, China in September 2015.
Ms Peggy Maguire, Director-General of the European Institute of Women’s Health (EIWH) and President of European Public Health Alliance (EPHA) described the interaction between sex and gender, inequalities in health care, violence against women and sexual reproductive health. She recommended:
- investment in gender-sensitive research, prevention and care;
- inclusion of reproductive rights, sexual health and violence against women in health planning and programmes;
- reporting of discrimination in health care; and
- increased health literacy for women.
She praised the European child and adolescent health strategy adopted the previous day by RC64.
A panel including representatives of Italy and Tajikistan and the Executive Director for Women’s Health of the city of Vienna, Austria presented the work on women’s health in their countries.
Six progress reports were presented for discussion, on HIV/AIDS, antibiotic resistance, reducing the harmful use of alcohol, prevention of injuries, child and adolescent health and development and the environment and health process.
RC64 began with the implementation of the European Action Plan for HIV/AIDS 2012–2015, and the implementation of the European strategic action plan on antibiotic resistance. A representative of the AIDS Healthcare Foundation expressed concern about the continued epidemic in the eastern part of the Region and unequal access to diagnosis and treatment.
Professor Michel Kazatchkine, the United Nations Secretary-General's Special Envoy for AIDS in Eastern Europe, noted that the epidemic was increasing in the eastern part of the Region, while plateauing or decreasing in many other parts of the world. Access to prevention was poor, particularly for harm-reduction services.
Mr Vinay Saldanha, Regional Director for eastern Europe and Central Asia of the Joint United Nations Programme on HIV/AIDS (UNAIDS), commented that the global AIDS response was shrinking but in tough times one could deliver more with less.
Progress reports were made on the European action plan to reduce the harmful use of alcohol 2012–2020, the prevention of injuries in the Region, the European strategy for child and adolescent health and development, and the European environment and health process.
- Speaking on behalf of Denmark, Finland, Lithuania, Latvia, Norway, Sweden and Slovenia, the representative from Estonia, noted that alcohol use had declined and urged other Member States to submit timely data on alcohol.
- France commented that environment and health are intertwined and important to all health sectors.
Dr Gauden Galea, Director of the Division of Noncommunicable Diseases and Life-course, agreed that data were essential for advocacy, needs assessment and monitoring, although WHO tried to minimize the burden of reporting. He noted that, while alcohol consumption was declining across the Region, it remained very high.
Dates and places for forthcoming sessions of the WHO Regional Committee for Europe
RC65 would be held in Vilnius, Lithuania on 14–17 September 2015 and RC66 would take place in Copenhagen, Denmark in September 2016.
Closure of the session
Speaking on behalf of all participants, the representative of Portugal expressed appreciation for the useful debate and agreements reached by RC64, and described the nomination of Ms Zsuzsanna Jakab for a second term as WHO Regional Director for Europe as “magnifico!”
The Regional Director closed the session by thanking all for their active participation, and expressing her particular admiration for the action that countries had taken to implement Health 2020.
“It is clear that a lot has already been achieved. In my view this is linked to the participatory approach in which it was developed, which I believe means you feel stronger ownership of Health 2020,” she said.