Health

• Suspect and Protect will highlight risks of concussion and provide educational resources for everyone involved at every level of football
• Knowing the signs and symptoms of suspected concussion and how to protect players can help to make the game safer for all
• Global campaign is launched in partnership with the World Health Organization (WHO) and supported by FIFA Member Associations

In line with the Strategic Objectives for the Global Game: 2023–2027 and following on from the announcement at the IFAB AGM in March 2024, FIFA is launching Suspect and Protect: No Match is Worth the Risk, a concussion awareness campaign, in partnership with the World Health Organization (WHO).

The campaign aims to raise awareness of the fact that concussion is a traumatic brain injury and is a risk to every player on the pitch. It has been endorsed by players, coaches and team doctors from around the world.

Developed through extensive consultation with FIFA Medical and WHO brain health experts, the Suspect and Protect campaign aims to increase sign and symptom recognition among players, coaches and medical staff, as well as the general public. The campaign highlights that symptoms may take up to 72 hours to appear and offers guidance on how to return to play safely following a suspected or confirmed concussion. These tailored resources are designed to empower national team stakeholders, professional clubs and leagues and grassroots and amateur communities.

Suspect and Protect will be delivered at a global level across FIFA channels, while toolkits are being distributed to the 211 FIFA Member Associations for delivery at a national, regional and local level.

“Concussion is a brain injury and should always be taken seriously. Playing football should be something enjoyed safely, by everyone, everywhere,” FIFA President Gianni Infantino said. “By knowing the signs of concussion, by being aware of the risks, and by treating a concussion correctly, you can help to put player safety first.

“A big thank you to FIFA’s member associations for their efforts in launching with us and for following the advice provided by our colleagues at the World Health Organization.”

“Concussion is a public health issue of concern at all levels of football, and many other sports, requiring greater levels of awareness and action,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “That is why WHO is proud to team up with FIFA on the Suspect and Protect campaign to promote ways to protect the brains of footballers, young and old, around the world from the risks of concussion.”

The campaign is built upon three main action points for audiences within national teams, professional clubs and leagues and amateur and grassroots communities.

BE AWARE: Whether a player, coach, team doctor, parent or carer, it is important to understand that concussion is a traumatic brain injury and should always be taken seriously. Everyone should know the common signs of concussion as well as when to seek urgent medical advice. 

SUSPECT: Anyone who sustains a direct or indirect impact to their head, face, neck or body, should be assessed for concussion symptoms. Symptoms may take up to 72 hours to present. They include headache or ‘pressure’ sensation, nausea or vomiting, problems with balance, dizziness or being unsteady on feet, distorted/blurry or double vision, sensitivity to light and/or noise, memory problems (difficulty recalling the traumatic event, and/or events before or after), feeling drowsy, confused or unable to focus, sleep problems.

PROTECT: Anyone presenting with one or more concussion symptoms should leave the pitch immediately. A doctor must be seen as soon as possible and within 24 hours. The symptoms of a concussion can change or evolve within the minutes, hours, days and even weeks after the traumatic event. Some symptoms require urgent medical attention. Players should follow medical guidance on return to play. No match is worth the risk.

Editor's notes

Suspect and Protect will be available through FIFA channels in Arabic, English, French, German, Portuguese (Brazilian) and Spanish and will be adapted by Member Associations in additional languages.

WHO's work on brain health: The WHO works with countries to promote optimal brain development and function, neurological health, and well-being across the life course. Key activities include strengthening policies, service delivery, health information systems, research and technology, with a focus on low- and middle-income countries; providing technical assistance to develop integrated and person-centred approaches to brain health that prioritize promotion, prevention, treatment, care, and rehabilitation; and promoting increased investment, inter-agency collaboration, and engagement across a range of sectors globally.

Recognizing the urgent need for a broad-based effort globally to reduce errors in medical diagnosis, the World Health Organization (WHO) is calling on all stakeholders to “Get it right, make it safe!” as part of the World Patient Safety Day campaign on 17 September. The theme ‘improving diagnosis for patient safety’ was selected in consultation with a wide range of stakeholders – from patients to policy-makers – to highlight how everyone has a vital role to play in reducing the risks and impact of errors in diagnosis.

“The right diagnosis, at the right time, is the basis of safe and effective health care. By contrast, diagnostic errors can lead to serious harm, and even death,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Reducing this risk takes collaboration between health workers and managers, policymakers and regulators, civil society and the private sector, and importantly, patients and their families.”

Each year, diagnostic errors account for an estimated 16% of preventable harm in health care, with tremendous human and economic consequences. Data suggest that most adults will experience at least one diagnostic error in their lifetime, which can result in prolonged ill health, increased health care costs, or even preventable death.

Diagnostic error is when a diagnosis is delayed, incorrect, missed, or miscommunicated and can occur at any stage of a patient’s journey. Targeted interventions by policy-makers, health care leaders, health workers, medical product regulators and manufacturers, with the active engagement of patients, their families and civil society can help reduce the risk of error.

Policy-makers should ensure appropriate national guidelines, protocols and regulations exist and are implemented, and necessary budget and resources are allocated. Health facility and programme managers should create safe and conducive working environments, promote continuous improvement, and ensure adequate systems, standards and processes are in place. Health facility and programme managers should also ensure that diagnostic tools and technologies are well-maintained, sharing user feedback with the manufacturer quickly to improve systems.

At the individual level, patients and their families should proactively participate in the diagnostic process by sharing their symptoms and full medical history, asking questions, raising concerns and following up on test results. Health workers should actively engage their patients while integrating excellence into every stage of the diagnostic process.

WHO is developing a model to support the implementation of diagnostic safety interventions. On 10–12 September the WHO-convened World Patient Safety 2024 Global Consultation brought together patients, patient advocates, health workers, health care facility managers, policy-makers, diagnostic safety experts, and academic and research institutions to provide input on the implementation model. Participants also discussed the progress and challenges in implementing the Global Patient Safety Action Plan (GPSAP) 2021–2030.  

The GPSAP serves as an action framework for stakeholders to work towards the goal of safe and high-quality health care for all patients. The recently published Global Patient Safety Report 2024 highlighted progress made by many countries towards the GPSAP goals, but also underscored the huge scope for further improvement. The implementation model for improving diagnostic safety will be released in 2025 as one of the range of WHO tools and practical resources to help stakeholders drive progress towards the goals set in the GPSAP.

World Patient Safety Day was established in 2019 to promote measures needed to improve patient safety globally. Each year a new theme is selected to highlight a priority area. More information about 2024 World Patient Safety Day Campaign can be found on the WHO website.

Around 560 000 children under ten years old were vaccinated against polio during the first round of an emergency vaccination campaign conducted in three phases from 1-12 September 2024 in the Gaza Strip.

The 12-day campaign provided novel oral polio vaccine type 2 (nOPV2) to 558 963 children, following meticulous planning and coordination. This involved the use of an extensive network of teams, vaccinating at selected fixed sites at health facilities and outreach posts. Mobile and transit teams actively reached out to families living in shelter homes, tents, and camps for the displaced, alongside community workers engaging families to raise awareness ahead of and during the campaign. For each phase, an area-specific humanitarian pause of nine hours daily was agreed to ensure the safety of communities and health workers, and enable vaccination efforts.

“Health and community workers have shown incredible resilience, carrying out this campaign at unprecedented scale and speed under the toughest conditions in Gaza. Swift action by the Global Polio Eradication Initiative—from the moment the virus was detected to the launch of the vaccination campaign—speaks to the effectiveness of the polio programme. In areas where humanitarian pauses took place, the campaign brought not just vaccines, but moments of calm. As we prepare for the next round in four weeks, we’re hopeful these pauses will hold, because this campaign has clearly shown the world what’s possible when peace is given a chance,” said Dr Richard Peeperkorn, WHO Representative for the occupied Palestinian territory (oPt).

“It was critical this ambitious campaign was carried out quickly, safely and effectively to protect children in the Gaza Strip and neighbouring countries from the life-altering poliovirus,” said Jean Gough, UNICEF Special Representative in the State of Palestine. “The progress made in this first round is encouraging, but the job is far from done. We are poised to finish the task and call on all involved to ensure we can do so in the next round in four weeks' time, for the sake of children everywhere.”

Partners at all levels recognize common operational challenges faced during these efforts, including devastated infrastructure, from health facilities to roads, limited trained healthcare workers, access issues due to insecurity, limited fuel for generators used to safely store vaccines and freeze ice packs, and constant population movements. However, these issues were addressed in a timely manner, with the key support of the Palestinian Ministry of Health and UNRWA, to enable planned vaccination activities.

Despite these challenges and the conditions that families in the Gaza Strip have endured over the past 11 months, families flocked to health facilities to get their children vaccinated. This can be attributed to traditionally positive health seeking behaviour among the Palestinian people and an impactful campaign to raise awareness and mobilize the public.

The original target for the campaign was 640 000 children, estimated in the absence of an accurate survey, which may have been an over-estimate, as the population continues to move from place to place, and people are fleeing and being killed due to the ongoing hostilities. During the campaign, trained monitoring teams were deployed to oversee vaccination efforts. As next steps, an additional 65 independent monitors are being deployed to cross-check the proportion of children vaccinated across the Gaza Strip to independently assess the level of coverage achieved in the first round. They need safe, unimpeded access so they can visit households, markets, transit points, and health facilities to check children for the prominent purple dye marked on their little finger when they are vaccinated. These efforts will provide an independent measure of the percentage of vaccination coverage achieved and reasons for any unvaccinated children.

A second round of the campaign will follow, ideally within four weeks, to provide a second dose of nOPV2 to children in Gaza to stop the outbreak and prevent its international spread.

To repeat this ambitious intervention, reach enough children, and successfully stop further transmission of the poliovirus, WHO, UNICEF and UNRWA are calling on all parties to the conflict to commit to  another round of humanitarian pauses, with unimpeded access to children in areas that need special coordination.

Ultimately, we need a long-lasting ceasefire as all families in the Gaza Strip need peace so they can begin to heal and rebuild their lives.

The campaign was implemented as part of an urgent and robust response to the confirmation of circulating variant poliovirus type 2 (cVDPV2) in Gaza, which was found in the environment in July 2024, and in a 10-month-old child in August 2024. It was conducted by the Palestinian Ministry of Health (MOH), in collaboration with the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), the United Nations Relief and Works Agency for Palestine Refugees (UNRWA) and partners. The Global Polio Eradication Initiative (GPEI) members, donors, WHO Member States and partners in oPt, including as part of the Health Cluster, played a key role in facilitating the campaign. 

The campaign kicked off using 473 teams, including 230 mobile teams, and 143 vaccination sites, in central Gaza, followed by 91 fixed sites, complemented by 384 mobile teams in southern Gaza. It concluded in northern Gaza, reaching children through 127 teams at fixed sites and 104 mobile teams. Fixed sites comprised hospitals, medical points, primary health centres, temporary learning spaces, schools, and food and water distribution points. Additionally, 749 social mobilizers were trained and deployed to engage communities, before and during the campaign to nudge families to vaccinate their children and address concerns.

Novel oral polio vaccine (nOPV2) is a polio vaccine being used to stop transmission of variant poliovirus type 2 (cVDPV2), currently the most prevalent form of the variant poliovirus. nOPV2 is safe and effective and offers protection against paralysis and community transmission. It is the vaccine globally recommended for variant type 2 poliovirus outbreaks – the type that has been found in Gaza.

WHO has updated its guidelines for the care of patients with influenza. The guidelines are designed primarily for health care providers who manage patients with influenza virus infection, and will also serve as a reference source for policymakers and others in efforts towards epidemic and pandemic preparedness.

Influenza is a viral disease. Seasonal influenza is common in all parts of the world. It is estimated that there are around a billion cases of seasonal influenza annually, including 3–5 million cases of severe respiratory illness. An estimated 290 000-650 000 deaths each year are due to seasonal influenza related respiratory disease, in addition to the deaths related to other influenza-related complications.

Along with seasonal influenza viruses, animal influenza viruses – most commonly avian and swine influenza viruses – can occasionally infect humans. They can cause disease ranging from mild conjunctivitis to severe pneumonia and even death. Current animal influenza viruses have not shown the capacity to transmit from person to person, but do pose a pandemic threat for the future.

These guidelines provide recommendations on the use of antiviral medications, and other treatments such as steroids for immune system regulation. This update applies to patients with seasonal influenza viruses, potential pandemic influenza viruses, and new influenza type A viruses that are known to cause severe illness in infected humans. 

A Guideline Development Group of content experts, clinicians, patients, ethicists and methodologists analysed available data and produced these recommendations following standards for trustworthy guideline development using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

The recommendations form part of WHO’s response to influenza, which includes the work of the Global Influenza Surveillance and Response System (GISRS), and the Pandemic Influenza Preparedness (PIP) framework which addresses gaps in access to effective medical therapies and other tools.

In coordination with Member States, the World Health Organization (WHO) and partners have established an access and allocation mechanism for mpox medical countermeasures including vaccines, treatments and diagnostic tests. The Access and Allocation Mechanism (AAM) will increase access to these tools for people at highest risk and ensure that the limited supplies are used effectively and equitably.   

This is part of the response to the public health emergency of international concern declared by WHO Director-General Dr Tedros Adhanom Ghebreyesus on 14 August 2024, following an upsurge of mpox in the Democratic Republic of the Congo and neighbouring countries. Fifteen countries in Africa have reported mpox this year. Recommendations issued on the advice of the International Health Regulations Emergency Committee asked States Parties to ensure "equitable access to safe, effective and quality-assured countermeasures for mpox.”  

“Alongside other public health interventions, vaccines, therapeutics and diagnostics are powerful tools for bringing the mpox outbreaks in Africa under control,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “The COVID-19 pandemic illustrated the need for international coordination to promote equitable access to these tools so they can be used most effectively where they are most needed. We urge countries with supplies of vaccines and other products to come forward with donations, to prevent infections, stop transmission and save lives.” 

The AAM was established as a part of the interim Medical Countermeasures Network (i-MCM-Net). The i-MCM-Net brings together partners from around the world, including UN and other international agencies, health organizations, civil society organizations, industry and private sector to build an effective ecosystem for the development, manufacturing, allocation and delivery of medical countermeasures. The network was endorsed by WHO Member States as a mechanism to operate in the interim, as negotiations continue towards a pandemic agreement. 

Along with WHO, the AAM for mpox includes members of the i-MCM-Net: the Africa Centres for Disease Control and Prevention, the Coalition for Epidemic Preparedness Innovations, the EU’s Health Emergency Preparedness and Response Authority, FIND, Gavi, the PAHO Revolving Fund, UNICEF, Unitaid and others. 

Over 3.6 million doses of vaccines have been pledged for the mpox response.  This includes 620 000 doses of the MVA-BN vaccine pledged to affected countries by the European Commission, Austria, Belgium, Croatia, Cyprus, France, Germany, Luxembourg, Malta, Poland, Spain, and the United States of America, as well as vaccine manufacturer Bavarian Nordic. Japan has pledged 3 million doses of the LC16 vaccine, the largest number of doses pledged so far.   

The recent surge in mpox cases, coupled with the limited availability of vaccines and other medical countermeasures, underscores the need for a collaborative and transparent process to distribute these critical resources fairly. The AAM is working to allocate the currently scarce supplies of vaccines and diagnostics for those at the highest risk of infection, including for vaccinating contacts of confirmed cases, and providing access to point of care diagnostics to countries with ongoing mpox outbreaks so that people who might be suspected cases can systematically be tested and cared for.  

The AAM will operate based on these guiding principles:  

• Preventing illness and death: Prioritize vaccination and other tools to interrupt transmission for those at greatest risk to prevent illness and death.  
• Mitigating inequity: Ensure equitable access to medical countermeasures for all people at risk, irrespective of socio-economic or demographic background.  
• Ensuring transparency and flexibility: Establish and maintain clear and open communication about allocation decisions and be ready to adapt strategies as new data emerge or situations change. 

“WHO and partners are supporting the government of the Democratic Republic of the Congo and other countries to implement an integrated approach to case detection, contact tracing, targeted vaccination, clinical and home care, infection prevention and control, community engagement and mobilization, and specialized logistical support,” said Dr Mike Ryan, Executive Director of WHO’s Health Emergencies Programme. “The AAM will provide a reliable pipeline of vaccines and other tools in order to ensure the success on the ground in interrupting transmission and reducing suffering.”  

The World Health Organization (WHO) has announced the MVA-BN vaccine as the first vaccine against mpox to be added to its prequalification list.

The prequalification approval is expected to facilitate timely and increased access to this vital product in communities with urgent need, to reduce transmission and help contain the outbreak. WHO’s assessment for prequalification is based on information submitted by the manufacturer, Bavarian Nordic A/S, and review by the European Medicines Agency, the regulatory agency of record for this vaccine.

“This first prequalification of a vaccine against mpox is an important step in our fight against the disease, both in the context of the current outbreaks in Africa, and in future,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “We now need urgent scale up in procurement, donations and rollout to ensure equitable access to vaccines where they are needed most, alongside other public health tools, to prevent infections, stop transmission and save lives.”

The MVA-BN vaccine can be administered in people over 18-years of age as a 2-dose injection given 4 weeks apart. After prior cold storage, the vaccine can be kept at 2–8°C for up to 8 weeks.

“The WHO prequalification of the MVA-BN vaccine will help accelerate ongoing procurement of the mpox vaccines by governments and international agencies such as Gavi and Unicef to help communities on the frontlines of the ongoing emergency in Africa and beyond,” said Dr Yukiko Nakatani, WHO Assistant Director-General for Access to Medicines and Health Products. “The decision can also help national regulatory authorities to fast-track approvals, ultimately increasing access to quality-assured mpox vaccine products.”

The WHO Strategic Advisory Group of Experts (SAGE) on Immunization reviewed all available evidence and recommended the use of MVA-BN vaccine in the context of an mpox outbreak for persons at high risk of exposure. While MVA-BN is currently not licensed for persons under 18 years of age, this vaccine may be used “off-label” in infants, children and adolescents, and in pregnant and immunocompromised people. This means vaccine use is recommended in outbreak settings where the benefits of vaccination outweigh the potential risks.

WHO also recommends single-dose use in supply-constrained outbreak situations. WHO emphasizes the need to collect further data on vaccine safety and effectiveness in these circumstances.

Available data shows that a single-dose MVA-BN vaccine given before exposure has an estimated 76% effectiveness in protecting people against mpox, with the 2-dose schedule achieving an estimated 82% effectiveness. Vaccination after exposure is less effective than pre-exposure vaccination.

Good safety profile and vaccine performance has been consistently demonstrated in clinical studies, as well as in real-world use during the ongoing global outbreak since 2022. In light of the changing epidemiology and emergence of new virus strains, it remains important to collect as much data as possible on vaccine safety and effectiveness in different contexts.

Since the triggering of the emergency use listing for mpox vaccines by WHO Director-General on 7 August 2024, WHO has conducted product and programmatic suitability assessments of MVA-BN vaccine.

“The findings of the assessments are particularly relevant in the context of the declaration of a public health emergency of international concern (PHEIC) related to the upsurge of mpox in Africa,” said Dr Rogerio Gaspar, WHO Director for Regulation and Prequalification. “We are progressing with prequalification and emergency use listing procedures with manufacturers of two other mpox vaccines: LC-16 and ACAM2000. We have also received 6 expressions of interest for mpox diagnostic products for emergency use listing so far.”

The escalating mpox outbreak in the Democratic Republic of the Congo and other countries was declared a PHEIC by the WHO Director-General on 14 August 2024. 

Over 120 countries have confirmed more than 103 000 cases of mpox since the onset of the global outbreak in 2022. In 2024 alone, there were 25 237 suspected and confirmed cases and 723 deaths from different outbreaks in 14 countries of the African Region (based on data from 8 September 2024).

WHO Prequalification (PQ) and Emergency Use Listing (EUL) are mechanisms used to evaluate quality, safety and efficacy of medical products, such as vaccines, diagnostics and medicines (optional: including biotherapeutics), and product suitability for use in an low- and middle-income country context. PQ or EUL listed products assist decision for international, regional and country procurement by UN and partner procurement agencies and member states. PQ is based on the review of full set of quality, safety and efficacy data on medical products, including risk management plan and programmatic suitability. EUL is a risk benefit assessment to address urgent demands during public health emergencies based on available limited data. Under EUL, the manufacturers are required to commit to continue generating missing information to fulfil prequalification requirements. Once this information becomes available, a PQ application should be submitted to complete the full process to achieve recommendation for international procurement in both emergency and non-emergency settings. 

At least one quarter or 22 500 of those injured in Gaza by 23 July are estimated to have life-changing injuries that require rehabilitation services  now and for years to come, according to a  World Health Organization (WHO) analysis of the types of injuries resulting from the ongoing conflict in Gaza: Estimating Trauma Rehabilitation Needs in Gaza using Injury Data from Emergency Medical Teams.  

The analysis found that severe limb injuries, estimated to be between 13 455 to 17 550, are the main driver of the need for rehabilitation. Many of those injured have more than one injury. According to the report, between 3105 and 4050 limb amputations have also occurred. Large surges in spinal cord injury, traumatic brain injury and major burn injuries all contribute to the overall number of life-changing injuries, which includes many thousands of women and children.

“The huge surge in rehabilitation needs occurs in parallel with the ongoing decimation of the health system,” said Dr Richard Peeperkorn, WHO Representative in the occupied Palestinian territory. “Patients can’t get the care they need. Acute rehabilitation services are severely disrupted and specialized care for complex injuries is not available, placing patients' lives at risk. Immediate and long-term support is urgently needed to address the enormous rehabilitation needs.” 

Currently, only 17 of 36 hospitals remain partially functional in Gaza, while primary health care and community-level services are frequently suspended or rendered inaccessible due to insecurity, attacks, and repeated evacuation orders. Gaza’s only limb reconstruction and rehabilitation center, located in Nasser Medical Complex and supported by WHO, became non-functional in December 2023 due to lack of supplies and specialized health workers being forced to leave in search of safety, and was later left damaged following a raid in February 2024. Tragically, much of the rehabilitation workforce in Gaza is now displaced. Reports indicate 39 physiotherapists have been killed as of 10 May. In-patient rehabilitation and prosthetic services are no longer available and the number of people with injuries requiring assistive products far exceeds the equipment available within Gaza. Partners report that stocks of essential assistive products such as wheelchairs and crutches have run out and it is difficult to replenish supplies due to the restricted flow of aid into Gaza.   

The analysis focuses solely on new injuries sustained since the escalation of hostilities in October 2023. However, tens of thousands of Palestinians in Gaza were already living with pre-existing chronic conditions and impairments before this, putting them at significant risk due to the lack of appropriate services. 

The estimates in the analysis will be used by WHO and partners to plan for a surge in rehabilitation-related services and contribute to long-term health planning and policymaking. 

Amidst the ongoing hostilities, it is critical to ensure access to all essential health services, including rehabilitation to prevent illness and death. WHO reiterates its call for a ceasefire, which is critical for rebuilding the health system to cope with escalating needs.