ACT-Accelerator partnership welcomes leadership and commitments at US COVID Summit to ending COVID-19 pandemic through equitable access to tests, treatments, and vaccines
- President Biden and global leaders agreed ambitious targets, aligned with the ACT-Accelerator, to end the COVID-19 pandemic
- Collective accountability for world leaders, industry and partners emphasized, as global response now turns to implementation of these targets
- Concrete action must now follow this summit to deliver and deploy tests, treatments, and vaccines immediately, to prevent further unnecessary loss of life
Global leaders attending the US-hosted Global COVID-19 Summit on 22 September re-affirmed their commitment to ending the acute phase of the pandemic, and the goals of the ACT-Accelerator, by agreeing targets to provide equitable access to COVID-19 tests, treatments, and vaccines.
Global targets agreed at the Summit include vaccinating 40% of the world’s population in 2021 and 70% of the population in 2022; achieving testing rates of one per 1,000 people per day in all countries by the end of 2021; and for all facilities treating patients with severe COVID-19 to have sufficient oxygen supplies, quality-assured treatments and PPE.
Currently the world is facing a two-track pandemic, where public health measures are starting to lift among highly vaccinated populations, while those in low and middle-income countries are still grappling with lockdowns, high death rates and insufficient tools to fight the virus. The economic case could not be clearer. Research from the International Chamber of Commerce shows that vaccine nationalism could cost rich countries US$4.5 trillion.
The ACT-Accelerator partnership welcomes President Biden’s political leadership and new commitments in support of these goals, including additional financing, dose donations, and the establishment of an EU-US taskforce to work toward vaccination objectives. These targets have come at a crucial time ahead of the G20 in Rome in October, and as the ACT-Accelerator prepares to launch its new Strategy and Budget.
Carl Bildt, WHO Special Envoy for the ACT-Accelerator and former Prime Minister of Sweden, said: “President Biden’s COVID-19 Summit should be the tipping point to ending the pandemic. We saw significant commitments from global leaders towards the goals of the ACT-Accelerator and agreement on what needs to be done to defeat the pandemic. In the next month, we must see concrete progress towards the fulfilment of these ambitious goals.
“Right now, 1.5 billion doses of vaccine are being produced every month, but most of the world doesn’t have access to any of them. Sick people need oxygen now. Doctors and nurses need PPE. Without widespread testing we risk being blindsided by the next variant. Manufacturers need to deliver their promised doses to COVAX and AVAT. Rich countries need to honour their promises to global access and make space at the front of the queue. All countries need to step up, because we cannot afford to go through the full Greek alphabet of variants.”
The ACT-Accelerator is the only integrated, end-to-end solution to the pandemic everywhere. The partnership is committed to making sure that the targets agreed become a reality. In order to achieve this, the global response - estimated at $50bn by the IMF - needs to be fully funded. Compared to the trillions spent by G20 countries mitigating the consequences of the pandemic, and the trillions more that will be spent if it continues, that is an unbeatable return on investment.
The Access to COVID-19 Tools Accelerator (ACT-Accelerator) is a global coalition of organizations developing and deploying the new diagnostics, treatments and vaccines needed to end the acute phase of the pandemic. Pooling the expertise of its many partners, the ACT-Accelerator has quickly ushered in rapid, affordable tests and effective medicines, and established the COVAX facility for the equitable procurement and distribution of vaccines in low- and middle-income countries.
The ACT Accelerator’s work is more vital than ever as new variants of the virus threaten to resist current COVID-19 tools, posing the risk of more death, illness, and social and economic harm. The ACT-Accelerator has four areas of work, or pillars:
- A diagnostics pillar, led by the Global Fund and FIND
- A therapeutics pillar, led by UNITAID and Wellcome
- A vaccines pillar, led by CEPI, Gavi and WHO and implementing partner UNICEF
- A health systems connector, led by the World Bank and the Global Fund and implementing partner Global Financing Facility
UNICEF is a cross-cutting partner of the ACT-Accelerator, providing programmatic support and procurement of supplies for countries across all Pillars. A workstream on access and allocation of COVID-19 products, hosted by WHO, cuts across the four pillars.
The ACT-Accelerator partnership was formed at the onset of the pandemic in response to a call from G20 leaders, and was launched by WHO, the European Commission, France and the Bill & Melinda Gates Foundation. Critical funding for the effort comes from an unprecedented mobilization of donors, including countries, the private sector, philanthropists and multilateral partners. It has supported the fastest, most coordinated, and successful global effort in history to develop tools to fight a disease.
The Independent Allocation Vaccine Group (IAVG) was established by the WHO in January 2021 and is composed of 12 members who serve in their personal, independent capacities to review and assess Vaccine Allocation Decision (VAD) proposals generated by the COVAX Facility Joint Allocation Taskforce (JAT) on the volumes of vaccines that should be allocated to each participant under COVAX within a given time frame.
The IAVG continues to be very concerned about the evolution of the pandemic, and its health, social and economic impacts, and offers its full support to COVAX Partners to ensure that critical messages are channelled to the relevant fora to raise the awareness of governments, manufacturers and stakeholders of challenges in access to COVID-19 vaccines.
The IAVG is concerned about the 25% reduction in supply forecast for the fourth quarter of 2021. It is also concerned about the prioritization of bilateral deals over international collaboration and solidarity, export restrictions and decisions by some countries to administer booster doses to their adult populations.
During its last meeting on 17 September, the IAVG revisited issues previously raised pertaining to vaccine supply, vaccine allocation, and vaccine administration and offers the following perspectives:Vaccine supply
The IAVG continues to be concerned by the low supply of vaccines to COVAX, and reiterates the need for manufacturers, vaccine producing and high-coverage countries to prioritize vaccine equity and transparency, the sharing of information about manufacturing capacity and supply schedules to COVAX, as well as vaccine access plans. While recognizing the need for additional doses to protect certain vulnerable, immune-compromised populations, the IAVG suggests countries collect and review more evidence before implementing policies regarding the administration of booster doses to their populations.Vaccine allocation
The recent exceptional allocation round at which the recommendation was made that the October COVAX supply be fully dedicated to those countries with a low population coverage, after accounting for all sources of vaccines, is a step forward in achieving equitable access. The IAVG supports the decision of prioritizing COVAX supply for those countries most likely relying solely on COVAX for access to COVID-19 vaccines and supports the continuation of this approach in future rounds.
The IAVG notes that so far only three manufacturers have waived indemnification and liability for use in humanitarian settings, and none have been waived for use at country level. This has consequences for vaccines allocated to the humanitarian buffer, as well as potentially setting precedents for future use.Vaccine administration
The IAVG has considered the information and data on absorptive capacity in countries with low total population coverage and brings the following issues to the attention of the COVAX Partners for further consideration:
- Continued advocacy for equity is needed in international and regional fora to address the lack of political will in several settings that is blocking the implementation of equitable access and the development of well-resourced vaccination programmes at country level.
- Countries must be able to access funding for vaccine implementation. Continued awareness of the need for such funding as well as the provision of technical support to countries to develop requests for assistance must be prioritized, especially by the World Bank and other multilateral development banks. Funding should also be considered for third party actors (NGOs and civil society) willing to support countries in vaccine implementation.
- Donations to COVAX are an important source of vaccine supply; however, these should complement rather than replace vaccine procurement by COVAX given the high transaction burden and costs in managing these donations. Additionally, IAVG strongly encourages high-coverage countries to swap their delivery schedules with those of COVAX so that COVAX contracts can be prioritized by manufacturers.
- The IAVG reiterates the need for countries which are sharing doses with COVAX to reduce/remove all earmarking and ensure the donated vaccines have an adequate remaining shelf life to allow for their use.
- Several programmes have been put in place to increase confidence in COVID-19 vaccines and address vaccination hesitancy. These must be tailored to local contexts and the engagement of local communities and civil society is critical to ensuring their effectiveness.
- Some regions and/or countries are experiencing civil unrest, conflicts and natural disasters that are impeding or slowing the implementation of vaccination programmes. Global solidarity and cooperation are needed to ensure they are supported in such critical situations.
COVAX remains the main global access mechanism able to serve all countries and ensure equitable access. The IAVG stands strongly behind this initiative.
 The IAVG (https://www.who.int/groups/iavg) acknowledges that the role of the WHO within COVAX is to provide guidance on vaccine policy, regulation, safety, research and development, vaccine allocation, and country readiness and delivery, in partnership with UNICEF. As of today, the IAVG has validated allocation through COVAX for a total of 362.8 million doses of vaccines.
News release of the Inter-Agency Standing Committee Reference Group on Mental Health and Psychosocial Support in Emergency Settings
A new book published today aims to help children stay hopeful and positive during the COVID-19 pandemic. The story is a sequel to ‘My Hero is You: how kids can fight COVID-19!’, published in April 2020.
Both books have been released by a collaboration of 60 organizations working in the humanitarian sector, including the World Health Organization, UNICEF, the United Nations High Commissioner for Refugees, the International Federation of Red Cross and Red Crescent Societies and the MHPSS Collaborative for Children & Families in Adversity.
‘My Hero is You 2021: how kids can hope with COVID-19!’ draws on the daily realities of millions of children since the beginning of the pandemic. For many, the pandemic continues to disrupt their education, recreation, and time with friends, family and teachers.
The story – aimed primarily at children aged 6-11 years – sees the return of Ario, a fantasy creature who travels the world helping children to find hope in the future and joy in simple pleasures. Together with old and new friends, Ario addresses the fears, frustrations and concerns children are facing in the current phase of the pandemic, and explores the various coping mechanisms that they can use when faced with difficult emotions like fear, grief, anger and sadness.
The new story drew from responses to a survey of more than 5000 children, parents, caregivers and teachers from around the world who described the challenges they continue to face in the second year of the pandemic.Reaching children everywhere
The book is currently available in Arabic, Bengali, Chinese, English, French, Portuguese, Russian, Spanish and Swahili. Its predecessor is now available in more than 140 languages, including sign language and Braille, and in more than 50 adaptations, in animated video, read-aloud, theatre, activity books and audio formats. Examples include an adaptation for Native Americans, a colouring book for children in Syria, and an animation developed by a team led by Stanford Medicine in the USA.
Since April 2020, governments, universities, nongovernmental organizations, media outlets and celebrities have joined forces with the United Nations to facilitate a truly global distribution of the first book in the series. Initiatives include the roll-out of audio versions and workshops relating to the book among refugees in Cox’s Bazar, Bangladesh; the broadcasting of an animated version on Mongolian national television; and the inclusion of the book as a free supplement with a national newspaper in Greece.
The new storybook can be used by parents and teachers in conjunction with a guide entitled ‘Actions for Heroes’, released by the same group in February 2021. Already available in more than a dozen languages, the guide advises parents, caregivers and teachers on how to create the right conditions for children to openly share their feelings and worries related to the pandemic and includes activities based on the books in the series.Note for editors:
The ‘My Hero is You’ series is a project of the Inter-Agency Standing Committee Reference Group on Mental Health and Psychosocial Support in Emergency Settings, a unique collaboration of United Nations agencies, national and international nongovernmental organizations and international agencies providing mental health and psychosocial support in emergency settings. Co-chaired by the World Health Organization and the International Federation of Red Cross and Red Crescent Societies, the group has released multiple resources since the start of the COVID-19 pandemic to help governments, partner organizations and individuals manage the mental health consequences of the pandemic.Quotes
Mr Martin Griffiths, Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, United Nations:
“Addressing the consequences of the pandemic on the mental health of young people is crucial to help them recover faster from the COVID-19 crisis. This new storybook is one of the tools to help them do so.”
Dr Tedros Adhanom Ghebreyesus Director-General of the World Health Organization:
“As we collectively weather the COVID-19 crisis and find our own ways to cope, we must strive to safeguard the mental health and well-being of children who continue to grapple with disrupted childhoods. The ‘My Hero is You’ storybooks help us to do just that. I encourage parents, teachers and caregivers everywhere to share the sequel to the immensely popular original to help the children in their care build resilience and hang on to a sense of hope for the future.”
Henrietta Fore, UNICEF Executive Director:
“Almost two years into the pandemic, millions of children are still seeing their lives and routines disrupted. The ‘My Hero is You’ series is an essential and wonderful tool for parents and teachers to help children understand today’s new world and cope with their changing emotions.”
Filippo Grandi, UN High Commissioner for Refugees
“The pandemic has profoundly impacted the life and well-being of millions of children around the world, including many living in situations of forced displacement as a result of conflict, violence and persecution. In this period of fear, losses and uncertainties for so many children and their caregivers, initiatives such as the ‘My Hero is You’ series can play a crucial role in helping them cope, heal and maintain hope for the future.”
Audrey Azoulay, UNESCO Director-General:
“COVID-19 has separated millions of children from friends, teachers and schools, with devastating socio-emotional consequences. UNESCO fully supports the My Hero is You initiative, which uses the universal magic of storytelling and reading to open children’s hearts to hope – a top priority in the educational recovery.”
Leaders pledge financing, dose donations, support for country readiness and delivery and scale up of global manufacturing, to enable equitable access to COVID-19 vaccines
To improve access for lower-income economies, the United States will contribute an additional 500 million doses of Pfizer vaccine to be delivered through COVAX, beginning in 2022, and Sweden will provide an additional SEK 2.1 billion (approximately US$243 million) through 2021 and 2022
New dose commitments from the European Union, including Italy and Spain, as well as Sweden, Denmark, and Japan mean further doses will be available to COVAX participants in 2021 and 2022
Global leaders attending the Global COVID-19 Summit hosted by the United States have again underlined their commitment to ensuring equitable access to COVID-19 vaccines for all countries through COVAX – noting that equitable access is essential to end the acute stage of the pandemic. Building on the momentum and global solidarity generated over the past eighteen months by various commitments including at summits organised by the European Commission, the G20 under the Saudi and Italian presidencies, the United Kingdom (UK), including the G7 under the UK presidency, the United States, and the Prime Minister of Japan, yesterday’s Summit saw further pledges made to COVAX and equitable access.
As the host of the Summit, the United States presented a target to vaccinate the world and as part of its commitment, pledged an additional 500 million doses of Pfizer vaccine to be delivered to low- and lower-middle-income countries through COVAX. These doses are in addition the deal for 500 million Pfizer doses facilitated by the United States, announced in June, and more than 90 million surplus doses shared through COVAX, bringing the US total doses to be provided through COVAX to nearly 1.1 billion doses. With deliveries of previously pledged doses underway, these additional doses will be made available beginning in January 2022. In addition, the US International Development Finance Corporation (DFC) will provide more than $383 million in political risk insurance to Gavi, the Vaccine Alliance (Gavi) to facilitate shipments around the world.
The United States and the European Union announced a joint agenda for combatting the global pandemic, reemphasising commitments to share doses with COVAX and support critical readiness activities, and calling on other nations to do the same – particularly emphasising the importance of predictable and effective dose-sharing to maximize sustainability of the process and minimize wastage of doses. Building on previous pledges, Team Europe committed to share 500 million doses by mid-2022.
Emphasising the close partnership between the African Union / AVAT and COVAX in delivering doses to African countries, South African President Cyril Ramaphosa called on higher-income countries to trade places in production queues and to support the AU and COVAX in their shared goal of increasing coverage across the African continent.
In addition to the US$ 285 million Sweden has already pledged to the Gavi COVAX Advance Market Commitment (AMC), the financing mechanism which enables access to fully donor-funded doses for 92 lower-income economies, Sweden announced that a new pledge of SEK 2.1 billion (approximately US$ 243 million) in cash contributions and dose donations, will be made available to support equitable access to COVID-19 vaccines to AMC-eligible economies through 2021 and 2022.
Alongside these commitments, several countries pledged additional dose donations to be made available to countries around the world, including through COVAX, with Spain pledging an additional 7.5 million doses, Italy pledging an additional 30 million doses to be made available by the end of the year, and Japan, which hosted the “One World Protected” Gavi COVAX AMC Summit in June 2021, pledging approximately 60 million doses. In addition, Denmark announced during the United Nations General Assembly this week that it would be doubling its dose donation commitment, bringing the total to 6 million doses pledged to be shared.
José Manuel Barroso, Chair of the Gavi Board, said: “This Summit marks a major step forward in the global response against COVID-19 and a major step forward for multilateralism. I would like to thank President Biden and all leaders for their commitment to global access to vaccines and urge all partners and stakeholders to increase their support of COVAX, so that we can meet our objective of ending the acute phase of this pandemic as quickly as possible.”
Dr Richard Hatchett, CEO of the Coalition for Epidemic Preparedness Innovations (CEPI) “Science has made huge progress in the fight to save lives, restore the global economy, and end the pandemic. Now we must redress the central moral failing of the world’s response to the pandemic, which is the lack of equitable access to the life-saving tools we have developed. This will require continued investment in R&D so we are able to deploy more vaccines, more effectively and create equity between countries of all income levels with regard to access to these life-saving vaccines.”
Dr Tedros Adhanom Ghebreyesus, WHO Director-General, said: “I am grateful to President Biden and world leaders for the commitment they have shown to vaccinate the world. However, what we need to succeed is truly sustainable, ironclad support that gets delivered now – not in 6 months or 12 months time. If we are to meet the targets we have set of vaccinating 10% of the population of all countries by the end of this month, 40% by the end of 2021 and 70% by mid next-year, we need to drastically scale up access to vaccines now.”
UNICEF Executive Director Henrietta Fore said: “We welcome world leaders’ renewed commitment to provide vaccine doses to low-income countries. We laud the US pledge of 500 million additional doses next year, as well as the announcements made by the European Union, Denmark, Japan, Italy and Spain, and hope to see these promises fulfilled urgently. With only 12 per cent of the pledges made earlier this year turning into actual doses, low-income countries can no longer wait. We urge dose-sharing countries to accelerate their donation plans.”
Dr Seth Berkley, CEO of Gavi, said: “With the rise of variants and the current gap in equitable access to COVID-19 vaccines we must urgently vaccinate those most at risk everywhere in the world. We cannot afford further delays in getting vaccines to the most vulnerable – to do so will mean a continuation of this pandemic and its impact on all of our lives.”
COVAX has recently published an updated supply forecast, which indicates that while COVAX deliveries to countries are accelerating and will continue to ramp up dramatically through the end of year, significant risks remain.
As a result COVAX partners have issued an urgent call to action – for the lifting of all export restrictions, for manufacturers to deliver on their commitments to COVAX and provide transparency on delivery schedules and queues. COVAX also calls for countries who are ahead in manufacturers’ queues and have already achieved high coverage to give up their place in the queue to COVAX and the low and middle-income participants it supports, and for the expansion, acceleration and systemization of dose donations to provide greater volumes, lead times, and shelf lives, allowing countries to better prepare for rollouts.
So far COVAX has delivered more than 300 million doses to 142 economies, and according to the latest forecast, a total of approximately 1.2 billion doses will be available for the lower income economies supported by the COVAX Advance Market Commitment (AMC) by the end of 2021. This is enough to protect 20% of the population, or 40% of all adults, in all 92 AMC economies with the exception of India. The key COVAX milestone of two billion doses released for delivery is now expected to be reached in the first quarter of 2022.Notes to editors
COVAX, the vaccines pillar of the Access to COVID-19 Tools (ACT) Accelerator, is co-convened by the Coalition for Epidemic Preparedness Innovations (CEPI), Gavi, the Vaccine Alliance Gavi) and the World Health Organization (WHO) – working in partnership with UNICEF as key implementing partner, developed and developing country vaccine manufacturers, the World Bank, and others. It is the only global initiative that is working with governments and manufacturers to ensure COVID-19 vaccines are available worldwide to both higher-income and lower-income countries.
CEPI’s role in COVAX
CEPI is leading on the COVAX vaccine research and development portfolio, investing in R&D across a variety of promising candidates, with the goal to support development of three safe and effective vaccines which can be made available to countries participating in the COVAX Facility. As part of this work, CEPI has secured first right of refusal to potentially over one billion doses for the COVAX Facility to a number of candidates, and made strategic investments in vaccine manufacturing, which includes reserving capacity to manufacture doses of COVAX vaccines at a network of facilities, and securing glass vials to hold 2 billion doses of vaccine. CEPI is also investing in the ‘next generation’ of vaccine candidates, which will give the world additional options to control COVID-19 in the future.
Gavi’s role in COVAX
Gavi leads on procurement and delivery at scale for COVAX: designing and managing the COVAX Facility and the Gavi COVAX AMC and working with its traditional Alliance partners UNICEF and WHO, along with governments, on country readiness and delivery. As part of this role, Gavi hosts the Office of the COVAX Facility to coordinate the operation and governance of the mechanism as a whole, holds financial and legal relationships with 193 Facility participants, and manages the COVAX Facility deals portfolio: negotiating advance purchase agreements with manufacturers of promising vaccine candidates to secure doses on behalf of all COVAX Facility participants. Gavi also coordinates design, operationalisation and fundraising for the Gavi COVAX AMC, the mechanism that provides access to donor-funded doses of vaccine to 92 lower-income economies. As part of this work, Gavi provides funding and oversight for UNICEF procurement and delivery of vaccines to all AMC participants – operationalising the advance purchase agreements between Gavi and manufacturers – as well as support for partners’ and governments work on readiness and delivery. This includes tailored support to governments, UNICEF, WHO and other partners for cold chain equipment, technical assistance, syringes, vehicles, and other aspects of the vastly complex logistical operation for delivery. Gavi also co-designed, raises funds for and supports the operationalisation of the AMC’s no fault compensation mechanism as well as the COVAX Humanitarian Buffer.
WHO’s role in COVAX
WHO has multiple roles within COVAX: It provides normative guidance on vaccine policy, regulation, safety, R&D, allocation, and country readiness and delivery. Its Strategic Advisory Group of Experts (SAGE) on Immunization develops evidence-based immunization policy recommendations. Its Emergency Use Listing (EUL) / prequalification programmes ensure harmonized review and authorization across member states. It provides global coordination and member state support on vaccine safety monitoring. It developed the target product profiles for COVID-19 vaccines and provides R&D technical coordination. WHO leads, together with UNICEF, the Country Readiness and Delivery workstream, which provides support to countries as they prepare to receive and administer vaccines. Along with Gavi and numerous other partners working at the global, regional, and country-level, the CRD workstream provides tools, guidance, monitoring, and on the ground technical assistance for the planning and roll-out of the vaccines. Along with COVAX partners, WHO has developed a no-fault compensation scheme as part of the time-limited indemnification and liability commitments.
UNICEF’s role in COVAX
UNICEF is leveraging its experience as the largest single vaccine buyer in the world and working with manufacturers and partners on the procurement of COVID-19 vaccine doses, as well as freight, logistics and storage. UNICEF already procures more than 2 billion doses of vaccines annually for routine immunisation and outbreak response on behalf of nearly 100 countries. In collaboration with the PAHO Revolving Fund, UNICEF is leading efforts to procure and supply doses of COVID-19 vaccines for COVAX. In addition, UNICEF, Gavi and WHO are working with governments around the clock to ensure that countries are ready to receive the vaccines, with appropriate cold chain equipment in place and health workers trained to dispense them. UNICEF is also playing a lead role in efforts to foster trust in vaccines, delivering vaccine confidence communications and tracking and addressing misinformation around the world.
The Access to COVID-19 Tools ACT-Accelerator, is a new, ground-breaking global collaboration to accelerate the development, production, and equitable access to COVID-19 tests, treatments, and vaccines. It was set up in response to a call from G20 leaders in March and launched by the WHO, European Commission, France and The Bill & Melinda Gates Foundation in April 2020.
The ACT-Accelerator is not a decision-making body or a new organisation, but works to speed up collaborative efforts among existing organisations to end the pandemic. It is a framework for collaboration that has been designed to bring key players around the table with the goal of ending the pandemic as quickly as possible through the accelerated development, equitable allocation, and scaled up delivery of tests, treatments and vaccines, thereby protecting health systems and restoring societies and economies in the near term. It draws on the experience of leading global health organisations which are tackling the world’s toughest health challenges, and who, by working together, are able to unlock new and more ambitious results against COVID-19. Its members share a commitment to ensure all people have access to all the tools needed to defeat COVID-19 and to work with unprecedented levels of partnership to achieve it.
The ACT-Accelerator has four areas of work: diagnostics, therapeutics, vaccines and the health system connector. Cross-cutting all of these is the workstream on Access & Allocation.
On new recommendation for treatment of COVID-19 patients: WHO calls for equitable access to casirivimab and imdevimab for COVID-19
We recently completed a high level mission to Kabul, Afghanistan, where we met with senior members of the Taliban leadership, UN partners, health care workers and patients, and WHO staff.
Afghanistan’s health system is on the brink of collapse. Unless urgent action is taken, the country faces an imminent humanitarian catastrophe. Our visit allowed us to witness the immediate needs of the Afghan people firsthand and meet with stakeholders to define ways to urgently scale up our health response.
Acting on the UN principles of neutrality and independence, we engaged in constructive dialogue to address differences and find solutions that will allow us to continue our life-saving work for millions of innocent Afghans affected by decades of conflict.
Throughout our visit, we focused on a number of priority health issues that need immediate attention, as well as the need to invest in achieving longer-term development goals.
Cuts in donor support to the country’s largest health project, Sehetmandi, has left thousands of health facilities without funding for medical supplies and salaries for health staff. Many of these facilities have now reduced operations or shut down, forcing health providers to make hard decisions on who to save and who to let die.
Only 17% of all Sehatmandi health facilities are now fully functional. This breakdown in health services is having a rippling effect on the availability of basic and essential health care, as well as on emergency response, polio eradication, and COVID-19 vaccination efforts.
Nine of 37 COVID-19 hospitals have already closed, and all aspects of the COVID-19 response have dropped, including surveillance, testing, and vaccination. Prior to August this year, 2.2 million people had been vaccinated against COVID-19. In recent weeks, vaccination rates have decreased rapidly while 1.8 million COVID-19 vaccine doses in country remain unused. Swift action is needed to use these doses in the coming weeks and work towards reaching the goal of vaccinating at least 20% of the population by the end of the year based on national targets.
Afghanistan is one of two countries in the world where polio remains endemic. With only one case of wild poliovirus reported so far this year, compared to 56 in 2020, there has never been a better time to eradicate polio. However, the polio programme will struggle to respond if the basic immunization infrastructure begins to collapse around it. Measles outbreaks are also spreading. With access to all communities no longer impeded, WHO and partners are ready to begin a country-wide house-to-house polio vaccination campaign and include measles and COVID vaccination in an integrated campaign.
WHO particularly emphasizes the need for women to maintain access to education, health care, and to the health workforce. With fewer health facilities operational and less female health workers reporting to work, female patients are hesitant to seek care. We are committed to working with partners to invest in the health education of girls and women, as well as continue training female health workers.
WHO also continues to support an extensive trauma programme that includes training, supplies and equipment for 130 hospitals and 67 blood banks.
We reiterate WHO’s long-term commitment to advancing the health of all Afghans and remind all stakeholders of our collective obligations today and in the months and years ahead.
WHO is playing a leading role coordinating health actors in Afghanistan, including the Ministry of Public Health and more than 50 organizations. We were the first humanitarian agency to deliver medicines and medical supplies in August 2021. To date, eight separate shipments of almost 170 metric tonnes of life-saving medical supplies have been delivered with the support of Qatar, Pakistan, the United Arab Emirates, and the World Food Programme.
New WHO Global Air Quality Guidelines (AQGs) provide clear evidence of the damage air pollution inflicts on human health, at even lower concentrations than previously understood. The guidelines recommend new air quality levels to protect the health of populations, by reducing levels of key air pollutants, some of which also contribute to climate change.
Since WHO’s last 2005 global update, there has been a marked increase of evidence that shows how air pollution affects different aspects of health. For that reason, and after a systematic review of the accumulated evidence, WHO has adjusted almost all the AQGs levels downwards, warning that exceeding the new air quality guideline levels is associated with significant risks to health. At the same time, however, adhering to them could save millions of lives.
Every year, exposure to air pollution is estimated to cause 7 million premature deaths and result in the loss of millions more healthy years of life. In children, this could include reduced lung growth and function, respiratory infections and aggravated asthma. In adults, ischaemic heart disease and stroke are the most common causes of premature death attributable to outdoor air pollution, and evidence is also emerging of other effects such as diabetes and neurodegenerative conditions. This puts the burden of disease attributable to air pollution on a par with other major global health risks such as unhealthy diet and tobacco smoking.
Air pollution is one of the biggest environmental threats to human health, alongside climate change. Improving air quality can enhance climate change mitigation efforts, while reducing emissions will in turn improve air quality. By striving to achieve these guideline levels, countries will be both protecting health as well as mitigating global climate change.
WHO’s new guidelines recommend air quality levels for 6 pollutants, where evidence has advanced the most on health effects from exposure. When action is taken on these so-called classical pollutants – particulate matter (PM), ozone (O₃), nitrogen dioxide (NO₂) sulfur dioxide (SO₂) and carbon monoxide (CO), it also has an impact on other damaging pollutants.
The health risks associated with particulate matter equal or smaller than 10 and 2.5 microns (µm) in diameter (PM₁₀ and PM₂.₅, respectively) are of particular public health relevance. Both PM₂.₅ and PM₁₀ are capable of penetrating deep into the lungs but PM₂.₅ can even enter the bloodstream, primarily resulting in cardiovascular and respiratory impacts, and also affecting other organs. PM is primarily generated by fuel combustion in different sectors, including transport, energy, households, industry, and from agriculture. In 2013, outdoor air pollution and particulate matter were classified as carcinogenic by WHO’s International Agency for Research on Cancer (IARC).
The guidelines also highlight good practices for the management of certain types of particulate matter (for example, black carbon/elemental carbon, ultrafine particles, particles originating from sand and dust storms) for which there is currently insufficient quantitative evidence to set air quality guideline levels. They are applicable to both outdoor and indoor environments globally, and cover all settings.
“Air pollution is a threat to health in all countries, but it hits people in low- and middle-income countries the hardest,” said WHO Director-General, Dr Tedros Adhanom Ghebreyesus. “WHO’s new Air Quality Guidelines are an evidence-based and practical tool for improving the quality of the air on which all life depends. I urge all countries and all those fighting to protect our environment to put them to use to reduce suffering and save lives.”
Disparities in air pollution exposure are increasing worldwide, particularly as low- and middle-income countries are experiencing growing levels of air pollution because of large-scale urbanization and economic development that has largely relied on the burning of fossil fuels.
“Annually, WHO estimates that millions of deaths are caused by the effects of air pollution, mainly from noncommunicable diseases. Clean air should be a fundamental human right and a necessary condition for healthy and productive societies. However, despite some improvements in air quality over the past three decades, millions of people continue to die prematurely, often affecting the most vulnerable and marginalized populations,” said WHO Regional Director for Europe, Dr Hans Henri P. Kluge. “We know the magnitude of the problem and we know how to solve it. These updated guidelines give policy-makers solid evidence and the necessary tool to tackle this long-term health burden.”
Global assessments of ambient air pollution alone suggest hundreds of millions of healthy life years of life lost, with the greatest attributable disease burden seen in low and middle-income countries. The more exposed to air pollution they are, the greater the health impact, particularly on individuals with chronic conditions (such as asthma, chronic obstructive pulmonary disease, and heart disease), as well as older people, children and pregnant women.
In 2019, more than 90% of the global population lived in areas where concentrations exceeded the 2005 WHO air quality guideline for long term exposure to PM₂.₅. Countries with strong policy-driven improvements in air quality have often seen marked reduction in air pollution, whereas declines over the past 30 years were less noticeable in regions with already good air quality.
The goal of the guideline is for all countries to achieve recommended air quality levels. Conscious that this will be a difficult task for many countries and regions struggling with high air pollution levels, WHO has proposed interim targets to facilitate stepwise improvement in air quality and thus gradual, but meaningful, health benefits for the population.
Almost 80% of deaths related to PM₂.₅ could be avoided in the world if the current air pollution levels were reduced to those proposed in the updated guideline, according to a rapid scenario analysis performed by WHO. At the same time, the achievement of interim targets would result in reducing the burden of disease, of which the greatest benefit would be observed in countries with high concentrations of fine particulates (PM₂.₅) and large populations.
Whilst not legally-binding, like all WHO guidelines, AQGs are an evidence-informed tool for policy-makers to guide legislation and policies, in order to reduce levels of air pollutants and decrease the burden of disease that results from exposure to air pollution worldwide. Their development has adhered to a rigorously defined methodology, implemented by a guideline development group. It was based on evidence obtained from six systematic reviews that considered more than 500 papers. The development of these global AQGs was overseen by a steering group led by the WHO European Centre for Environment and Health.