Jun 13 2021

Will you also vaccinate your pets against COVID-19?

After the first vaccine against coronavirus in animals was registered in Russia in March, veterinary clinics in the country have started using the new preparation “Kornivak Kov”, Rosselkhoznadzor reports.

According to the BBC, the European Union, along with Japan, South Korea, and Argentina, have also expressed interest in similar vaccinations of pets and farm animals. These are dogs, cats, monkeys, and minks.

Although there is no real evidence that the virus is actively transmitted from farmed animals to humans, scientists say that infections have been confirmed in various animal species, which in turn favors the development of mutations.

Clinical trials of the Russian animal vaccine show that immunity lasts about 6 months after immunization with Kornivak Kov.

The American veterinary pharmaceutical company Zoetis, which is also working on another vaccine, has set a similar goal to protect its animals.

According to scientists, the vaccine would be used mainly on animal farms, as minks have been shown to be more susceptible to the virus. In most cases, the disease is severe and leads to many deaths. Some studies show that there is evidence that mink have transmitted a mutated version of the virus to humans.

EU rules make it easier to travel to another EU country (in this case the 27 EU countries + Norway) with your dog, cat, or ferret. These rules also cover travel to the EU from a country or territory outside the Union.

With a few exceptions, your pet may travel with you to another EU country or from a non-EU country to a country in the Union if it has:

a microchip (in accordance with the technical requirements of Annex II to the EU Pet Movement Regulation) or a clearly legible tattoo, if affixed before 3 July 2011.
rabies vaccination
treatment against tapeworm Echinococcus multilocularis, if necessary (not required for dogs traveling directly between Finland, Ireland, Malta, and Norway)
a valid European passport for pets when traveling to another EU country, or an EU veterinary health certificate when traveling from outside the Union.

Warning

EU rules on travel with pets apply to personal travel with pets where there is no change of owner or sale.

The European Pet Passport is a document that follows a standard EU model and is essential for travel between EU countries. It contains a description and details of your pet, including the code of its microchip or tattoo, as well as information about the rabies vaccination and contact details of the owner and veterinarian who issued the passport. You can obtain a European passport for your dog, cat, or ferret from any veterinarian who has permission from the relevant authorities to issue passports for pets. The pet passport is valid for life, provided that your pet’s rabies vaccination is up to date.

The EU Veterinary Health Certificate is another type of document that contains specific information about your pet (identity, health, rabies vaccines) and is based on a standard EU model.

If you are traveling from outside the EU or territory, your pet must have an EU veterinary health certificate approved by an official veterinarian in the country of departure no more than 10 days before the date of arrival of your pet in the EU. The certificate shall be valid for travel between the countries of the Union for a period of 4 months from that date or until the expiry of the rabies vaccination, whichever is the first.

In addition, you must complete and attach to your animal’s veterinary health certificate a written declaration stating that its movement is for non-commercial purposes. This declaration is also required if your pet is traveling with a person authorized by you. In this case, your pet should reach you within 5 days of changing your location.

European pet passports are issued only for dogs, cats, and ferrets. If you are traveling to another EU country with other pets, such as birds, ornamental aquatic animals, reptiles, rodents, or rabbits, check the national rules of the country you plan to visit for information on entry conditions.

If you travel to an EU country from Andorra, Switzerland, the Faroe Islands, Greenland, Iceland, Liechtenstein, Monaco, Norway, San Marino, the Vatican, your pet can also enter the Union with a passport issued in one of these countries.

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Jun 11 2021

The WHO seeks to end human rights violations in psychiatry

The mental health care services in Europe and globally in the main continues to be provided in psychiatric wards and hospitals. As The European Times is documenting human rights abuses and coercive practices in these facilities are common. The World Health Organization (WHO) in new guidance material released this week evidence that providing community-based mental health care that is both respectful of human rights and focused on recovery is proving successful and cost-effective.

Photo: Alan de la Cruz from Pixabay

Mental health care recommended in the new guidance by WHO should be located in the community and should not only encompass mental health care but also support for day-to-day living, such as facilitating access to accommodation and links with education and employment services.

WHO’s new “Guidance on community mental health services: promoting person-centred and rights-based approaches” further affirms that mental health care must be grounded in a human rights-based approach, as recommended by the WHO Comprehensive Mental Health Action Plan 2020-2030 endorsed by the World Health Assembly in May 2021.

Fast transition to redesigned mental health services required

“This comprehensive new guidance provides a strong argument for a much faster transition from mental health services that use coercion and focus almost exclusively on the use of medication to manage symptoms of mental health conditions, to a more holistic approach that takes into account the specific circumstances and wishes of the individual and offers a variety of approaches for treatment and support,” said Dr Michelle Funk of the Department of Mental Health and Substance Use, who led the development of the guidance.

Since the adoption of the United Nations’ Convention on the Rights of Persons with Disabilities (CRPD) in 2006, an increasing number of countries have sought to reform their laws, policies and services related to mental health care. All European countries have signed and ratified this Convention. However, to date, few countries have established the frameworks necessary to meet the far-reaching changes required by international human rights standards.

Reports from around the world highlight that severe human rights abuses and coercive practices are still far too common in countries of all income levels. Examples include forced admission and forced treatment; manual, physical and chemical restraint; unsanitary living conditions; and physical and verbal abuse.

The majority of government mental health budgets still goes to psychiatric hospitals

According to WHO’s latest estimates, governments spend less than 2% of their health budgets on mental health. Furthermore, the majority of reported expenditure on mental health is allocated to psychiatric hospitals, except in high-income countries where the figure is around 43%.

The new guidance, which is intended primarily for people with responsibility for organizing and managing mental health care, presents details of what is required in areas such as mental health law, policy and strategy, service delivery, financing, workforce development and civil society participation in order for mental health services to be compliant with the CRPD.

It includes examples from countries including Brazil, India, Kenya, Myanmar, New Zealand, Norway and the United Kingdom of community-based mental health services that have demonstrated good practices in respect of non-coercive practices, community inclusion, and respect of people’s legal capacity (i.e. the right to make decisions about their treatment and life).

Services include crisis support, mental health services provided within general hospitals, outreach services, supported living approaches and support provided by peer groups. Information about financing and results of evaluations of the services presented are included. Cost comparisons provided indicate that the community-based services showcased produce good outcomes, are preferred by service users and can be provided at comparable cost to mainstream mental health services.

“Transformation of mental health service provision must, however, be accompanied by significant changes in the social sector,” said Gerard Quinn, UN Special Rapporteur on the Rights of Persons with Disabilities. “Until that happens, the discrimination that prevents people with mental health conditions from leading full and productive lives will continue.”

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Jun 10 2021

With the pandemic far from over, we all need to practice #SummerSense

With lockdowns easing in many countries across the European Region, many are finding themselves tempted to begin booking foreign holidays, attending music festivals and sporting events, or possibly heading to popular beach resorts. Today, WHO/Europe launches the #SummerSense campaign, advising people on how to make the most of the warmer weather while staying protected from COVID-19.

“We know from bitter experience that easing public health and social measures too soon can lead to a surge in COVID-19 cases and in turn to further lockdowns, unnecessary deaths and economic repercussions”, says Dr Hans Henri P. Kluge, WHO Regional Director for Europe. “Although some of the population in the European Region have now been vaccinated, we are still far from vaccinating all eligible individuals and the situation this summer remains fragile with more transmissible variants spreading”.

Currently, more than 15% of people in the European Region have been fully vaccinated against COVID-19, with this figure rising all the time. However, it’s worth noting that being vaccinated does not automatically stop people from becoming ill or spreading the virus. Vaccination does, however, reduce the chance of becoming seriously sick or dying from COVID-19, so it’s important to encourage everyone to take up their offer of a vaccine when it comes.

Having fun while staying as safe as possible

Learning from last year’s situation when COVID-19 cases surged in the autumn following a relaxation in measures in the summer, WHO/Europe is launching its #SummerSense campaign together with UNICEF Europe and Central Asia. The campaign aims to ensure people can enjoy the warmer months and avoid getting infected with COVID-19, thus maintaining efforts to bring the pandemic to an end sooner.

The #SummerSense campaign focuses on four key areas:

Travel and tourism;
Sports events, such as the UEFA European Football Championship;
Life outside the home, including social gatherings, festivals, weddings and beach holidays;
Returning to education, when children and young people go back to schools, colleges, and universities towards the end of the summer.

Practicing #SummerSense

For individuals and families, #SummerSense means exercising common sense and being cautious:

rethinking the need to travel, to reduce the risk of getting and spreading COVID-19;
assessing risks of exposure to COVID-19 at every step, from leaving the house until returning home again;
taking precautions, such as cleaning hands frequently, keeping a safe distance and wearing a mask;
avoiding the three Cs; settings that are Closed, Confined or Crowded. Instead, people should consider meeting outdoors whenever possible, or in open, ventilated spaces.

WHO also urges governments, authorities and event organisers in the European Region to follow the #SummerSense advice by:

Rethinking the need for travel;
Using a risk-based approach to decide whether to hold, modify, postpone or cancel mass gatherings;
Enhancing public health and social measures if events do take place, not just in venues, but also outside in places and on transport used by spectators, participants and local communities.

Even though more people are getting vaccinated, and some public health measures are easing, now is not the time to drop our guard as the pandemic is far from over. Now is the time for #SummerSense.

This article was amended on 11-06-2021 to clarify that the #SummerSense campaign is in partnership with UNICEF Europe and Central Asia.

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Jun 10 2021

COVID-19: Learning from experience

Statement by Dr Hans Henri P. Kluge, WHO Regional Director for Europe

10 June, 2021

To date in the European Region, we have 55 million confirmed cases of COVID-19, and 1.2 million deaths. That’s 32% of cases reported globally, and 31% of all deaths.

Overall, for 2 consecutive months we have seen a decline in terms of cases, hospitalizations and deaths. A total of 368 000 new cases were reported last week – a fifth of the weekly cases reported during Europe’s recent peak in April this year. For the first time since last autumn, new deaths dipped below 10 000 last week.

As of this week, some 36 countries out of 53, are easing restrictions due to declining COVID-19 cases. Whilst we should all recognize the progress made across most countries in the Region, we must also acknowledge that we are by no means out of danger.

With increasing social gatherings, greater population mobility, and large festivals and sports tournaments taking place in the coming days and weeks, WHO/Europe calls for caution.

COVID-19 notification rates across the Region show that widespread community transmission continues; the new Delta variant of concern, which shows increased transmissibility and some immune escape, is poised to take hold, while many among vulnerable populations above the age of 60 remain unprotected.

We have been here before.

Over the course of last summer, cases gradually rose in younger age groups, then moved into older age groups, contributing to a devastating resurgence, lockdowns and loss of life in the autumn and winter of 2020.

Let’s not make that mistake again.

Today, WHO/Europe is launching a campaign, together with UNICEF Europe and Central Asia, to encourage everyone to exercise caution, reduce risks and keep safe from COVID-19, while enjoying the summer.

If you choose to travel, do it responsibly. Be conscious of the risks. Apply common sense and don’t jeopardize hard-earned gains. Remember – wash your hands frequently, keep a distance, choose open settings and wear a mask. Avoid the three Cs – settings that are closed, confined or crowded will put you at higher risk.

As vaccination coverage increases, we need to stick firmly to protective measures to suppress the virus. This needs to happen, even as cases decline. A combination of public health measures and vaccination – not one or the other – is the way out of this pandemic.

Just as in 2020, cases have declined as we enter the summer period, but it is no time to cut down on the public health response to COVID-19.

If we are to avoid another resurgence after the summer, we have to take last year’s lessons on board: act fast on signals of increasing cases – expanding testing and sequencing; step up contact tracing; and rapidly attain very high vaccine uptake in the most vulnerable populations.

By doing so, we save lives and livelihoods and bring the pandemic to an end sooner.

In 6 months, more than 400 million doses of COVID-19 vaccines have been administered in the Region. This summer, vaccination needs to happen at a much faster pace. As of today, 30% of people in the Region have received at least one vaccine dose and 17% have completed their series.

Although we’ve come far, we haven’t come far enough.

Vaccination coverage is far from sufficient to protect the Region from a resurgence. The distance to go before reaching at least 80% coverage of the adult population, is still considerable.

We should also remember that being vaccinated does not automatically stop us from becoming ill or spreading the virus. Vaccination does, however, reduce the chance of becoming seriously sick or dying from COVID-19. I therefore urge you to get vaccinated when it is your turn.

Our understanding of the safety and efficacy of vaccines amongst adolescents and children, continues to evolve. For sure, children can be transmitters of COVID-19. However, their risk of severe disease or death is up to 800 times lower than someone who is aged 70 years or more. Our urgent priority should therefore continue to be to protect the elderly, people with comorbidities and our frontline workers. These groups remain unprotected in a number of countries in the Region.

Protecting vulnerable groups to minimize deaths, alleviate the pandemic’s impact and suppress the virus, hinges upon equitable vaccine access. We all have a role to play – keeping everyone safe is everyone’s responsibility.

In closing, once again I call for leadership across the Region to commit, above and beyond words, through action, to pan-European solidarity.

Thank you.

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Jun 10 2021

First Person: Owner of first ‘vegan football club’ scoring sustainable goals

A football club in the west of England has been recognized by the United Nations for its leading role in setting goals to tackle climate change, from planning a low-carbon stadium to selling only 100 percent vegan food. Ahead of the kick-off of the delayed Euro 2020 football competition, owner and chairman, Dale Vince, told UN News that the club aims to be a beacon of sustainability in the sporting world

“Forest Green Rovers began as a rescue mission for me in 2010. This 120-year-old club was facing closure and it happened to be located close to the town, Stroud, where I built Ecotricity, an energy company that aims to replace fossil fuels with sustainable green energy.

I’m a football fan so I thought I’d help out and just a day or so into owning the club, I started to recognize issues that really conflicted with my outlook and the way I lived. The first thing was red meat; we were serving beef lasagne to our players and I was horrified to find myself part of the trade-in meat which is so harmful to the environment. So, we stopped that. We then realized we had to change just about everything to create a green football club, something that had never been done before.

We were communicating with football fans who would stereotypically be considered a very difficult audience and not interested in climate and sustainability issues. We decided to weave sustainability into the DNA of the club, putting it on an equal footing with football.

We identified energy, transport, and food as, biggest sources of carbon emissions in Britain which represent 80 percent of everybody’s personal carbon footprint.

So, we made installed solar panels and now the entire club is powered by 100% green energy. We provided electric car-charging points for fans. The grass of our pitch is organic, it’s free from pesticides and weed killers and we collect rainwater to irrigate the pitch rather than using mains water. Our club strip is even made from a composite material consisting of recycled plastic and coffee grounds.

We have created space for nature around the stadium with eco-trails where people can learn about what we are trying to do in terms of improving biodiversity. Slow worms and orchids thrive in those areas! Our modeling shows a 20 percent increase in biodiversity on the land around the stadium

Then there was the transition to a vegan menu. This was radical 10 years ago and so counterintuitive because football can be macho and seemed an unlikely bedfellow of veganism.

We get described as the world’s only vegan football club and that has been a monster in terms of PR, in terms of making an impact by getting our message around the world.

Our next step is to build the 5,000-capacity Eco Park, made entirely from wood which will be the greenest football stadium with the lowest carbon footprint in the world. It’s not just a football stadium and training ground but a 100-acre sustainable development project which will include a green tech business park, new wetland restoration of a canal, and parkland containing 500 trees and 1.8km of hedgerows.

‘Mistake to talk about making financial sense’

If you go back ten years, it was more expensive to be environmentally friendly than it is today. Solar panels were pricey and electric cars barely existed. Even plant-based food, which should be cheaper than meat, was more expensive.

I would say it’s a mistake to ask whether it makes financial sense to be sustainable. People often question how quickly will a solar panel pay for itself, but they never ask the same about their toaster, mobile phone, or car.

Looking at the big picture, even if it seems like it costs more on day one, it’s absolutely more economic in the long term to be sustainable because of the damage we are doing to the climate, wildlife, and habitats.

Example to others

I think this club has to lead by example; that’s how we bring about change. There are four Premier League clubs and some big clubs in Europe as well that, like Forest Green Rovers, have joined the UN’s Sports for Climate Action initiative, which aims to get the global sports community to take action to counter climate change. I think it’s human nature to see what your peers are doing and to feel that you need to join in.
Businesses are also reacting to what people want in terms of products and outcomes. I think football fans themselves are lobbying their clubs to act and they point to Forest Green Rovers quite frequently as an example to follow.

Our fans don’t just tolerate this sustainability concept, they embrace it in a life-changing way. So many of them have told me their families have gone veggie or vegan, drive electric cars, and have solar panels at home.
In my experience just about everything I’ve focused on in my career can be done better if it is done differently. One of the keys is absolutely to start with a fresh approach.

I also think it’s so important to have fun. If people see you enjoying yourself, they can feel that in your messaging and they are more likely to listen. I don’t talk doom and gloom; I talk about what we can do”.

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Jun 10 2021

The Queen of the United Kingdom and 15 other Commonwealth realms knighted the creators of the Oxford vaccine

Scientists from Oxford University, who developed the vaccine against Covid-19 together with AstraZeneca, were among the British knights on the occasion of the birthday of Queen Elizabeth II, world agencies reported.

Knighthood was awarded to Sarah Gilbert of the Jenner Institute in Oxford, one of the creators of the vaccine, the director of the institute Adrian Hill, the head of the working group that tested the vaccine Andrew Pollard and Peter Horby and Martin Landry of Oxford University. tests have shown that dexamethasone can be used in the treatment of severely ill Kovid-19 patients.

Among those honored is Kate Bingham, who led the British government’s Covid-19 vaccine working group.

A total of 1,129 people received honorary titles from the monarch, 62 percent of whom were honored for their work among various communities during the pandemic.

Among them is 25-year-old Rhys Malous, awarded the British Empire Medal for his involvement in the restructuring of a Wales bottling company that produced more than one million bottles of disinfectants along with a Scottish distillery. Malows estimates that these joint efforts have disinfected nearly 81 million hands during the pandemic.

“We are not scientists, but we felt we could help people defend themselves and that is very important,” he said.

John Brownhill and Amanda Guest also received a medal from the British Empire for their Food4Heroes initiative, which delivered more than 200,000 servings of food to British health workers.

Among the winners is actor Jonathan Price, who will play the role of the late husband of the Queen Prince Philip in the final episodes of the Netflix series “The Crown”. Veteran Englebert Humperdinck also received a medal from the British Empire for his contributions to music.

Traditionally, the list of state honorees is announced twice a year – around Christmas and in June, when Queen Elizabeth II’s birthday is officially celebrated.

The winners are representatives of science, culture, sports, the public and charitable sectors and are selected from nominations made by public organizations and the government. The awards are usually presented in person by Queen Elizabeth II or a high-ranking member of the British royal family at Buckingham Palace, but the pandemic changed the ceremony. Last year, due to the pandemic, the announcement of the list of winners on the occasion of the Queen’s birthday was announced in October.

The Order of the British Empire was founded in 1917 by King George V. The award has five degrees – Knight of the Order of the British Empire, Officer of the Order, followed by Commander, Knights and Ladies Commanders and Knights and Ladies of the Grand Cross of the Order. The last two categories entitle their holders to add the titles “sir” and “lady” to their names.

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Jun 9 2021

WHO tri-regional policy dialogue seeks solutions for international mobility of health professionals

WHO tri regional policy dialogue seeks solutions to challenges facing international mobility of health professionals

WHO / NOOR / Sebastian Liste

In the context of collective efforts to address challenges related to the international mobility of health professionals, especially during the COVID-19 pandemic, the WHO regional directors for the Eastern Mediterranean Region, European Region and South-East Asia Region, Dr Ahmed Al-Mandhari, Dr Hans Henri P. Kluge and Dr Poonam Khetrapal Singh, initiated a virtual tri-regional policy dialogue to review trends and policy responses.

During the 2-day meeting, the regional directors were joined by representatives of ministries, health professional regulatory bodies, United Nations agencies, development partners, technical experts from the 3 WHO regions, and participants from the development, education, finance, migration and trade sectors.

The movement of health workers across WHO regions is particularly prominent. The 3 participating regions include the top countries of origin for migrant doctors working in Organisation for Economic Co-operation and Development (OECD) countries, and 6 of the top countries of origin for migrant nurses.

Promoting health across borders

This unique policy dialogue was a significant part of the activities marking 2021 as the International Year of Health and Care Workers. It aimed to explore opportunities, policy responses and innovations in WHO regions with respect to ethical international recruitment, fair and effective employment and integration of foreign health workers, and harnessing the contribution of diaspora health workers.

The international mobility of health workers has been increasing and, with an estimated global shortage of 18 million health workers by 2030, this trend is expected to continue. Strengthened management of mobility – through improved information, policies and international cooperation, framed by the WHO Global Code of Practice on the International Recruitment of Health Personnel – is necessary to ensure that this contributes to, rather than compromises, the advancement of universal health coverage and health security across WHO Member States.

“The current pandemic has highlighted the centrality of health workers for health security and the health-related Sustainable Development Goals. Countries must invest in a sustainable national health workforce that meets the current and future needs of their populations. That means expanding and transforming the education, training, recruitment, development, distribution, retention and financing of the health workforce, as well as improving working conditions and creating attractive jobs,” said Dr Al-Mandhari, WHO Regional Director for the Eastern Mediterranean.

“Health and care form the largest employment sector in the WHO European Region, employing some 13 million people. This is one of the reasons why addressing health worker mobility is vital for the 53 Member States we serve. It is also the right thing to do, since investing in the sector in a way that benefits both countries of origin and recipient ones is a future investment and good value for money, in terms of positive impact on economies, societies and health overall,” said Dr Kluge, WHO Regional Director for Europe.

“The COVID-19 pandemic has in many ways brought health workforce mobility to the fore. It is time that all stakeholders together chart the path forward, towards increased cooperation between health systems, and towards strengthened health system capacity in both sending and receiving countries. For far too long, the health sector has been sidelined in discussions on health workforce mobility, despite the significant impact this mobility has had, and continues to have, in low- and middle-income countries globally. The health sector must actively promote WHO’s health-in-all-policies approach, coordinating with ministries of labour, education, trade and other relevant ministries to inform policy and achieve health-positive outcomes,” said Dr Khetrapal Singh, WHO Regional Director for South-East Asia.

Investing in the health workforce

At the recent Seventy-fourth World Health Assembly (24–31 May 2021), Member States endorsed 2 resolutions on the health workforce: protecting, safeguarding, and investing in the health workforce, and optimizing the global directions of nursing and midwifery in 2021–2025.

The COVID-19 pandemic has further highlighted the need for strengthened cooperation across countries to address domestic gaps in the health workforce through the recruitment of international health workers.

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Jun 9 2021

WHO study points to interventions for improving cardiovascular health in Tajikistan

A new WHO/Europe study reveals that improved blood-pressure control at the primary health-care level in Tajikistan can be achieved in 12 months using WHO tools. Elevated blood pressure is a condition directly linked to many cardiovascular diseases, which are prevalent in the country.

“This is an important study that shows that even in a relatively low-resource setting, it is possible to achieve and demonstrate change in clinical practice that can be of benefit to patient health,” says Dr Jill Farrington, Regional Medical Officer, Cardiovascular Diseases and Diabetes, WHO/Europe.

The study, published in BMC Health Services Research, examines the implementation and evaluation of essential interventions for the management of hypertension and the prevention of cardiovascular diseases in primary health care.

Disease burden requiring action

The burden of cardiovascular diseases in Tajikistan makes the detection and management of risk factors in primary health-care settings particularly crucial.

The most recent WHO-endorsed STEPwise approach to surveillance (STEPS) report revealed that one third of people in Tajikistan have never had their blood pressure measured, and more than 30% of the population has elevated blood pressure. Findings of the report also showed that over three quarters of the population with elevated blood pressure are not receiving appropriate treatment.

Noncommunicable diseases (NCDs) are the leading cause of death in the WHO European Region. The risk of premature mortality from the 4 major NCDs (cardiovascular diseases, diabetes, cancer and chronic respiratory diseases) is high in Tajikistan, with men being disproportionally affected.

Pilot study to improve cardiovascular health

In 2018, Tajikistan piloted and evaluated the newly developed WHO package of essential NCD interventions (PEN) related to healthy lifestyles, evidence-based treatment protocols, access to essential medicines and technology, risk-based management, team care and task sharing, and systems for monitoring (HEARTS). The WHO PEN/HEARTS technical package aims to provide a strategic approach to improving cardiovascular health using simplified clinical guidelines.

Together with WHO/Europe and the WHO Country Office in Tajikistan, the Ministry of Health and Social Protection convened a national steering group tasked with adapting, piloting and evaluating the technical package with a particular focus on systems monitoring, building sustainable and scalable approaches, and integrating with other health system reforms.

To achieve this, a study that included a complex intervention was developed and piloted in one region of Tajikistan with the participation of 19 primary health-care centres. The study consisted of:

the adaptation of WHO PEN/HEARTS clinical algorithms for hypertension and diabetes;
a 2-day training course for 120 doctors and nurses on the prevention and management of cardiovascular disease risk factors;
supportive supervision visits;
clinical decision support tools; and
quality-improvement support.

After 12 months, blood pressure control significantly improved, as did the assessment of risk factors including blood pressure measurement and smoking status, and prescription of statins and triple therapy.

In the long run, these improvements could translate into significant reductions in premature death from NCDs, including heart disease. This is essential for building an evidence-based health-care system in Tajikistan, and for aligning with the Sustainable Development Goals and the WHO European Programme of Work 2020–2025 to leave no one behind.

The project was financially supported by grants from the United States Centers for Disease Control and Prevention (CDC), and the governments of Denmark, Germany and the Russian Federation.

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Jun 8 2021

FAO, WHO set an example of collaborative action for safe food with a systems approach

The enormous complexity of food production, trade, and consumption poses several challenges that require attention all along the food chain. Yet, when it comes to the consumer, all that matters is that the food we eat is safe and nutritious. To that end, a joint Food and Agriculture Organization–World Health Organization (FAO–WHO) virtual event today brought together relevant actors in Europe and Central Asia for World Food Safety Day, to discuss ways of improving food safety in the context of sustainable food systems.

World Food Safety Day focusses attention and provides an opportunity to raise awareness of the importance of food safety, demonstrate appropriate actions to prevent illness, and foster collaboration across sectors for improved food safety. Every year in Europe and Central Asia alone, over 23 million people fall sick from foodborne illness, burdening most heavily the poor and young. In addition, foodborne illness is responsible for 5 000 preventable deaths every year.

Understanding and reducing food-safety risks requires preventive measures and appropriate response mechanisms from the public and private sectors. The regional event for the 2021 World Food Safety Day also highlighted how the health of people, animals, and plants are inter-connected and may also be linked to food-chain risks.

“Food safety saves lives, enhances livelihoods, and helps to protect the planet; this is why it has always been a priority for our region,” said Vladimir Rakhmanin, FAO Assistant Director-General and Regional Representative for Europe and Central Asia. “It entails a collaborative effort and continuous dialogue between all actors and parties involved to let our food systems remain agile, and FAO is actively supporting this at different levels in the region.”

“The staggering number of individuals falling sick or dying after consuming unsafe food in our region is unacceptable,” said Hans Kluge, WHO Europe Regional Director. “We can do better and we need to do better – and one way of strengthening food safety is by sharpening our focus on the animal, human, and environment interface; COVID-19 being a grave reminder of that, deserving far greater attention.”

The COVID-19 pandemic has required public authorities and value chain operators to consider food-safety controls, in addition to other factors known to impact on the safety of our food supplies, such as the use of new and emerging technologies in food production, the complexity of international food trade, and climate change. Public authorities and food businesses need to take preventive measures and remain vigilant to react rapidly to all food-chain risks.

FAO and WHO jointly advocate for improved food safety through the development of food-safety policies and food-control practices, research, and monitoring and evaluation in a holistic, systemic manner. Examples of a systems approach to ensure food safety include the ‘One Health’ approach for minimising antimicrobial resistance and addressing zoonotic diseases, as well as ‘farm to table’ initiatives that aim to achieve sustainable production and distribution of safe and nutritious food, and minimise food loss and waste.

Policies and decisions need to be based on the best available science, data, and evidence. Efforts need to be stepped up to invest in ensuring the availability and accessibility of better data. With this in mind, the event promoted the sharing of applicable and actionable information and knowledge with various actors from the food systems in Europe and Central Asia. The FAO/WHO Regional Coordinating Committee for Europe is an important platform that allows for the exchange of experience and better communication across the region.

The recording of the event is available on YouTube.

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Jun 7 2021

WHO warns of ‘two-track pandemic’ as cases decline but vaccine inequity persists

Even though COVID-19 cases and deaths have declined in recent weeks, the world is facing a “two-track pandemic”, the UN’s top health official said on Monday in his ongoing campaign to get more vaccines to developing countries.

Tedros Adhanom Ghebreyesus, Director General of the World Health Organization (WHO), said unequal distribution of vaccines has allowed the virus to continue spreading, thus increasing odds of a variant emerging that could render these treatments ineffective.

“Inequitable vaccination is a threat to all nations, not just those with the fewest vaccines”, he warned in his latest media briefing from WHO headquarters in Geneva.

‘A mixed picture’

As of Monday, there were more than 173 million confirmed cases of COVID-19 globally, including 3.7 million deaths.

Tedros reported that new cases have dropped for six weeks, and deaths for five weeks. Despite these “encouraging signs”, he said progress remains “a mixed picture” as last week, deaths rose in Africa, the Americas and the Western Pacific.

“Increasingly, we see a two-track pandemic: many countries still face an extremely dangerous situation, while some of those with the highest vaccination rates are starting to talk about ending restrictions”, he told journalists.

Tedros advised caution in lifting restrictions, given the increased global transmission of variants of concern, as consequences could be disastrous for those not yet inoculated.

Meanwhile, many countries still lack sufficient vaccines. So far, nearly 44 per cent of doses have been administered in richer countries. In poorer nations, the figure is just 0.4 per cent.

The United Nations has been pressing governments to share their excess doses to the global vaccine equity initiative, COVAX. Several countries have pledged donations, which Tedros hoped will soon be fulfilled.

Appeal to G7 leaders

The WHO chief recently called for a global push to vaccinate at least 10 per cent of the world’s population by September, and 30 per cent by December. Reaching the September target will require an additional 250 million doses, with 100 million needed in June and July alone.

With the G7 summit taking place this weekend, Tedros issued an appeal to leaders.

“These seven nations have the power to meet these targets. I am calling on the G7 not just to commit to sharing doses, but to commit to sharing them in June and July”, he said.

“I also call on all manufacturers to give COVAX first right of refusal on new volume of vaccines, or to commit 50% of their volumes to COVAX this year.”

Invest in production

Tedros also highlighted the importance of investing in vaccine production in low income countries, including for routine immunizations.

He noted that several nations are making progress in this area, following the launch of an African Union partnership for vaccine manufacturing.

Relatedly, several companies and countries have expressed interest in participating in a WHO plan to establish a technology transfer hub to facilitate global production of mRNA vaccines. A technical review is underway.

“The biggest barrier to ending the pandemic remains sharing: of doses, of resources, of technology”, Tedros said.

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Jun 7 2021

Global push needed to ensure ‘clean, affordable and sustainable electricity’ for all

During the last decade, more people around the world have gained access to electricity than ever before. However, the number still not connected has grown in Nigeria, the Democratic Republic of Congo and Ethiopia, according to a new UN report on universal access to energy, launched on Monday.

The seventh Sustainable Development Goal (SDG), SDG7, aims to ensure access to affordable, reliable, sustainable and modern energy for all.

However, those nations which remain most off the grid, are set to enter 2030 without meeting this goal unless efforts are significantly scaled up, warns the new study entitled Tracking SDG 7: The Energy Progress Report, published by the International Energy Agency (IAE), International Renewable Energy Agency (IRENA), UN Department of Economic and Social Affairs (UN DESA), World Bank, and World Health Organization (WHO).

“Moving towards scaling up clean and sustainable energy is key to protect human health and to promote healthier populations, particularly in remote and rural areas”, said Maria Neira, WHO Director of the Department of Environment, Climate Change and Health. 

COVID setbacks

The report outlines significant but unequal progress on SDG7, noting that while more than one billion people globally gained access to electricity over the last decade, COVID’s financial impact so far, has made basic electricity services unaffordable for 30 million others, mostly in Africa.

“The Tracking SDG7 report shows that 90 per cent of the global population now has access to electricity, but disparities exacerbated by the pandemic, if left unaddressed, may keep the sustainable energy goal out of reach, jeopardizing other SDGs and the Paris Agreement’s objectives”, said Mari Pangestu, Managing Director of Development Policy and Partnerships at the World Bank.

While the report also finds that the COVID-19 pandemic has reversed some progress, Stefan Schweinfest, DESA’s Director of the Statistics Division, pointed out that this has presented “opportunities to integrate SDG 7-related policies in recovery packages and thus to scale up sustainable development”.

Modernizing renewables

The publication examines ways to bridge gaps to reach SDG7, chief among them the scaling up of renewables, which have proven more resilient than other parts of the energy sector during the COVID-19 crisis.

While sub-Saharan Africa has the largest share of renewable sources in its energy supply, they are far from “clean” – 85 per cent use biomass, such as burning wood, crops and manure.

“On a global path to achieving net-zero emissions by 2050, we can reach key sustainable energy targets by 2030 as we expand renewables in all sectors and increase energy efficiency”, said IAE Executive Director, Fatih Birol.

And although the private sector continues to source clean energy investments, the public sector remains a major financing source, central in leveraging private capital, particularly in developing countries and in a post-COVID context.

Amid the COVID-19 pandemic, which has dramatically increased investors’ risk perception and shifting priorities in developing countries, international financial flows in public investment terms, are more critical than ever to leverage the investment levels needed to reach SDG 7, according to the report.

“Greater efforts to mobilize and scale up investment are essential to ensure that energy access progress continues in developing economies”, he added.

Scaling up clean and sustainable energy is key to protect human health — WHO’s Maria Neira

Other key targets

The report highlighted other crucial actions needed on clean cooking, energy efficiency and international financial flows.

A healthy and green recovery from COVID-19 includes the importance of ensuring a quick transition to clean and sustainable energy”, said Dr. Neira.

Feeding into autumn summit

This seventh edition of the report formerly known as the Global Tracking Framework comes at a crucial time as Governments and others are gearing up for the UN High-level Dialogue on Energy in September 2021 aimed to examine what is needed to achieve SDG7 by 2030 and mobilize voluntary commitments and actions through Energy Compacts.

The report will inform the summit-level meeting on the current progress towards SDG 7, “four decades after the last high-level event dedicated to energy under the auspices of UN General Assembly”, said Mr. Schweinfest.

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Jun 7 2021

Surveillance and One Health in food production key to halting antimicrobial resistance

Antimicrobial agents, such as antibiotics, are essential to treating many human and animal infections and diseases. Their overuse and misuse, however, has led to the development of antimicrobial resistance (AMR), meaning that a drug, such as an antibiotic, might no longer be effective in treating the infection. Without urgent action, the world is at risk of becoming a place where common infections are untreatable or even kill, and where complex surgical procedures become life-threatening.

Due to the overuse of antimicrobials, drug-resistant bacteria can be found in animals and food products intended for human consumption. As a result, food has become a potential vehicle for the transmission of resistant pathogens from animals to humans.

Foodborne diseases are a significant public health concern in the WHO European Region. Every year, about 23 million people fall ill by consuming contaminated food and 5000 people die. A substantial proportion of illnesses and deaths from consuming contaminated food are caused by bacteria, such as campylobacter and salmonella, which show increasing levels of resistance to commonly used antimicrobials.

Surveillance of AMR in the food chain is essential

One of the key ways to highlight the public health threat posed by AMR is through effective surveillance programmes. Information about the levels of AMR in common foodborne pathogens and levels of antimicrobial residues in food of animal origin is extremely important for guiding risk management and policy action.

Unfortunately, few countries in the European Region have sufficient surveillance capacity for AMR in the food chain. That is why it is a key priority for WHO to assist countries in the Region to establish and strengthen systems for surveillance of AMR and antimicrobial residues in the food supply, as well as to integrate AMR testing in existing systems for foodborne disease surveillance and response.

Despite the limited surveillance capacity for AMR in the food chain in the Region, some countries have made good progress.

Strengthening surveillance in Uzbekistan

Dr Gulnora Abdukhalilova is a scientist at the Ministry of Health in Uzbekistan, where she works to reduce AMR and uphold food safety standards. In 2016, she conducted a research project looking at antimicrobial resistant strains of campylobacter and salmonella in chickens bred specifically for food.

The research showed that most of the salmonella strains found in the chicken were multi-drug resistant, meaning that the infections they cause can be difficult to treat. The overuse and misuse of antimicrobials in poultry production was one of the drivers of this resistance.

“Ideally, monitoring resistance should be routine in the health and agricultural sectors,” said Dr Abdukhalilova. “Monitoring of resistance to antimicrobial drugs in common foodborne pathogens simply has to be done.”

As a result of the research, AMR surveillance has been included in Uzbekistan’s National Programme to Combat Microorganism Resistance to Antimicrobial Drugs for 2020–2024.

A One Health approach to fighting AMR

Given that AMR lies at the intersection of human, animal and environmental health, greater coordination across sectors and stakeholders is needed to combat AMR in the food chain. Fostering such coordination is known as the One Health approach.

Because most countries in the European Region lack adequate coordination and data sharing between human and animal sectors, WHO and its partners are committed to working with Members States in the Region to strengthen multisectoral coordination and bolster One Health efforts to combat AMR. This commitment was recently strengthened with the establishment of the Regional One Health Coordination Mechanism by the Food and Agriculture Organization of the United Nations (FAO), the World Organisation for Animal Health (OIE) and WHO.

As a result of her work, Dr Abdukhalilova echoes the need for a One Health approach to fighting AMR in the food chain: “It is important to…coordinate and exchange information between different sectors, such as poultry production and health care”.

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Jun 5 2021

Patients see restraints as torture

The widespread use of a variety of coercive measures has a strong and traumatic impact on patients. Stronger than the psychiatric staff actually believe.

The European Times reported that studies have looked at the patient’s viewpoints of the use of coercion in psychiatric services. In a 2016 study by Paul McLaughlin of the Unit for Social & Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development in England, he and the co-authors reported, that: “qualitative studies consistently show that coercive measures can be experienced by patients as humiliating and distressing.”

Studies make it clear that there may be very serious problems related to the use of force and coercion in psychiatry. The use of seclusion and restrain have been investigated and reported on in hundreds of publications that are available through the medical bibliographical database Medline.

Professor of psychiatry, Riittakerttu Kaltiala-Heino, carried out an analysis of the views of patients who had been subjected to the use of seclusion and restraints. The analysis was based on a review of 300 Medline publications that were available in 2004. In a lecture to the Association of European Psychiatrists’ 12th European Congress of Psychiatry she stated based on this review, that: “in all the studies that have studied patients’ negative experiences the patients have emphasized the experience that it has been a punishment.”

Prof. Kaltiala-Heino specified,

“So, many of the patients think that they have been secluded or restrained because they were punished for some behaviour that was unacceptable or because of a breaking of rules of the board. From more than half of the patients up to almost 90 percent of the patients in various studies have reported that they perceive seclusion as punishment even as torture.”

Coercion causing psychiatric symptoms

Prof. Kaltiala-Heino added, “And patients have also reported increase in a number of psychiatric symptoms including depression, suicidal ideation, hallucinations, loss of contact with reality. So, they feel depersonalized and de-realization experiences have been reported. Patients have also reported persisting nightmares in which they in kind of in their eyes are featured in the seclusion processes, the seclusion situation, the seclusion room of being locking in or tied. It can easily be traced back to the experience of seclusion or restraint.”

The use of such interventions not only may be humiliating and seen as punishment or torture, they also cause strong feeling against the psychiatric staff. In the studies patients talk about, and discuss the anger against the staff who carried out the procedure.

Patients who themselves had been secluded also felt angry and threatened when others were being secluded indicating the lasting traumatic effect the use of seclusion and restraint may have.

Prof. Kaltiala-Heino further noted, that “in most of the studies that have concentrated on patients’ experiences of seclusion and restraint, the negative experiences reported greatly outnumber the positive aspects.”

Psychiatric staff misperceive the actual negative effect

Prof. Kaltiala-Heino said, that from the review of the studies one can conclude that: “staff assumes that patients have a much more positive experiences than what patients actually have.” And she added: “The patients also report much greater variety of negative experiences and much more, much stronger feeling of negative experiences than staff assume they have.”

The misperception goes even further. Prof. Kaltiala-Heino found that: “While staff believes that the seclusion primarily helps the patients, all the patients, the other patients in the ward … when the one who is behaving in the most disturbing and violent way is removed from the interactions. And secondly it benefits the patient her or himself – the target patient. And only in the third rank it is useful for the staff. Then patients who have been secluded actually think that it is the staffs who gains the most benefit of this processes and the least themselves – the persons who was secluded, him or herself.”

Prof. Kaltiala-Heino concluded that despite the research is sporadic and the methodology used is inconsistent that they all nevertheless point in the same direction, that: “the more powerful restriction and the more coercion is used, the more negative the experiences of the patients.”

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Jun 4 2021

UN health agency urges nations to donate 250 million doses of COVID-19 vaccine

Some two billion doses of COVID-19 vaccine have been distributed globally but only 0.5 per cent have reached low-income countries where frontline health workers and the elderly have yet to receive a shot, the World Health Organization (WHO) said on Friday.

“This week, we’ll probably pass the two billion doses – if we have not already passed it…in terms of number of doses of these vaccines, these new COVID vaccines that have actually been developed. And these have been distributed now in over 212 countries,” said Dr Bruce Aylward, Head of the Access to COVID-19 Tools Accelerator (ACT-A) Hub.

Dr. Aylward, who is also Senior Advisor to the WHO Director-General Tedros Adhanom Ghebreyesus, noted that of those two billion doses, “over 75 per cent” had gone to just 10 countries, notably China, the US and India.

This trio “account for about 60 per cent of those doses”, said Dr Aylward, speaking via Zoom, adding that “at the other end of that spectrum” only about “point five per cent of doses” had reached the lowest income countries, which account for about 10 per cent of world population.

‘Two track recovery’

This had led increasingly to “a two-track recovery”, characterised by the successful rollout of vaccines to high-risk populations and even younger populations in higher income and vaccine-producing countries.

By contrast, “in the lower income countries, they’re still struggling to get sufficient product just to be able to vaccinate the health care workers, older populations, who are really the key to getting out of the health, societal and economic crisis that we’re in the midst of”, Dr. Aylward explained, in an urgent appeal for 250 million doses to protect frontline workers and the most vulnerable people.

“The call is for a quarter of a billion doses through the period through end of September, to be donated, at least 100 million of those in June and July – that’s what we need to get the system going.”

80 million doses from the US

He noted that on Thursday the United States had helped to kickstart the appeal and bolster the UN-partnered equitable vaccine distribution scheme COVAX with the announcement that it intended to donate up to 80 million doses, including an initial 25 million shots, this month. “That’s an important start (but) we need many other countries to be joining and important for the US, crucially, is they said these doses are going to come in June.”

It was “absolutely ridiculous” that some countries were still unable to protect their key workers amid “escalating epidemics” even though vaccines had been available for six months, he said.

Briefing reporters in New York on Friday, the UN Spokesperson Stéphane Dujarric welcomed the announcement made by the Biden administration that it will be sharing millions of vaccine doses with both the COVAX facility as well as bilaterally with countries in particular need.

He said Secretary-General António Guterres was extremely grateful to the US Government for the inclusion of UN personnel and Member States delegates serving in the US, in its national vaccination programme, “and for the generous offer to provide vaccines for United Nations frontline personnel serving in the most challenging and dangerous locations around the world.”

“The Secretary-General renews his call to the international community to come together to address the unprecedented challenge of this pandemic, and for countries to share vaccines, particularly with those that are struggling to cope with new surges and variants” he added.

Funding gap

Highlighting the progress made against the coronavirus compared with a year ago, veteran emergency health expert Dr. Aylward, insisted that the development and increasing number of COVID-19 vaccines should not distract from the continued need by all countries to test, trace and treat their populations.

People will continue to die unless a $16 billion funding gap is filled to pay for sufficient personal protective equipment, ventilators, oxygen and steroid medication to help the poorest nations treat their sick, Dr Aylward insisted.

“We still do not understand well enough this pandemic, because we are not enough testing enough”, he said.

“Remember, Tedros talked about ‘test, test, test’ literally months and months and months ago…we’ve made highly accurate, highly affordable rapid diagnostic tests, but with the fixation on vaccines, we’re not getting the money (needed) over there. And we’ve all seen what happens when this disease hits a country that doesn’t have the oxygen and dexamethasone.”

Globally, as of 4 June 2021, there have been 171,708,011 confirmed cases of COVID-19, including 3,697,151 reported deaths, according to WHO.

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Jun 4 2021

Spanish psychiatrist convicted of sexual abuse expelled by medical association

Originally written by Xurxo Melchor, for La Voz de Galicia, in Spanish.

The organisation’s board of directors stresses that Emilio González Fernández’s behaviour is not in line with the ethical and deontological values of the profession.

The board of directors of the Official College of Doctors of A Coruña has unanimously approved the expulsion from the institution of the psychiatrist from Santiago convicted of sexual abuse of a patient. Emilio González Fernández is thus provisionally removed from the profession while the Ethics and Deontology Commission of the institution issues its obligatory opinion, which could lead to the definitive expulsion of the doctor.

The psychiatrist, who is currently 78 years old, was already retired from his post in the Sergas and has also already closed his private practice, which was located at number 84, Calle del Hórreo de Santiago. However, doctors can always practise their profession, as has happened now with the coronavirus pandemic, and the expulsion also deprives him of the social benefits of being a member of a medical association.

Expulsion brings with it an absolute lifetime ban on practising medicine and the loss of the rights inherent in membership. For the board of the Medical Association of A Coruña, the “repeated behaviour” of Emilio González Fernández, who has just admitted in court that he sexually abused a patient and who did the same in 2003 following another complaint, “is not in accordance with the ethical and deontological values of the medical profession”.

The provincial medical institution describes as serious and repeated the facts for which the well-known psychiatrist from Compostela has just been condemned, who has an extensive curriculum such as having been the clinical head of the psychiatric sanatorium of Conxo, in Santiago, or having founded the Psychosocial Centre of Ferrol, as well as being part of the first democratic corporation of Compostela after the municipal elections of 1979. He contested those elections on the lists of Unidade Galega and as a member of the Partido Socialista Galego, as he has always been linked to progressivism and Galicianism.

Emilio González was denounced by a patient and brought to light ten other almost identical cases that also wanted to take him to court, but a long time had passed since the facts took place and the offences were time-barred. Nevertheless, these ten women were to testify as victim-witnesses in the trial that was to be held this month in Santiago Criminal Court 2. Before the date of the hearing arrived, the psychiatrist reached an agreement with the prosecution and the private prosecution whereby he admitted the facts and accepted a sentence of one year and nine months in prison and the payment of a compensation of 6,000 euros to the victim.

Two of the complainants whose cases were time-barred filed complaints at the time with both the Sergas and the Medical Association of A Coruña. The Xunta concluded its investigation with a three-month sanctioning file against Emilio González, against whom the professional institution took no action as it considered that at the time there was no conclusive evidence against him. The psychiatrist categorically denied the facts, so that his lie before the board of directors will now also be taken into account when deciding whether the expulsion becomes definitive.

The young patient whom González Fernández admitted to having sexually abused never filed a complaint with the Medical Association of A Coruña.

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Jun 4 2021

WHO/Europe launches Pan-European Leadership Academy demonstration project to strengthen skills among young public health professionals

From 4 June 2021, young public health professionals from Member States in central Asia, the Western Balkans and the Russian Federation are invited to apply for placements in the Pan-European Leadership Academy (ELA). The ELA is a new initiative to build experience and strengthen skills with WHO in the European Region.

About the Pan-European Leadership Academy

The ELA is a key initiative of the WHO Regional Director for Europe to support the delivery of the European Programme of Work (EPW). Participants will be given opportunities to learn about and participate in the regular work of WHO/Europe, including at the Regional Office, country offices and geographically dispersed offices.

The objective of the project is to give young people working in public health a valuable hands-on learning experience with an emphasis on building participatory leadership capacities and gaining knowledge in international collaboration.

The target date for participants to join the ELA is 1 September 2021, with the placement lasting 12 months.

The ELA Tier 1 curriculum has been designed in consultation with internal and external partners to ensure a comprehensive and well rounded experience. Participants will have access to online learning in key technical areas as well as cross-cutting skill sets and competencies, including leadership, management and emotional intelligence. They may also participate in face-to-face trainings offered by WHO and external partners.

A dedicated induction programme is under development. Throughout their placement period, participants will gain access to career counselling and mentorship support.

Maximizing country impact to deliver WHO goals

The overarching goal of the ELA is to support Member States to achieve the objectives of the 13th General Programme of Work (GPW 13) and the EPW. This includes supporting national health systems to prepare for potential risks and emergencies, and to deliver universal health coverage that leaves no one behind.

When fully operationalized, the ELA will have 2 additional tiers to accommodate mid-level and high-level exchanges.

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Jun 4 2021

Regional Director takes European Programme of Work to countries during visits

The WHO Regional Director for Europe, Dr Hans Henri P. Kluge recently visited a number of countries in the European Region, as COVID-19 vaccines continue to be rolled out, offering hope in the fight against the pandemic.

Visiting Serbia, Hungary, Bosnia and Herzegovina and Montenegro, Dr Kluge had the opportunity to speak with key decision-makers as well as health-care workers and patients.

Serbia

After meeting Dr Zlatibor Lončar, Minister of Health of Serbia, Dr Kluge visited a vaccination centre at Belgrade Fair. He congratulated the country on its success in rolling out vaccines, using digital health – in the form of web pages to register for vaccination. Those signing up receive an SMS or email when it is their turn to be vaccinated, helping smooth the process.

The following day, Dr Kluge attended the opening of cool rooms at the Torlak Institute, alongside Dr Lončar. WHO provided financial support for the cool rooms, which secure the cold chain – a temperature controlled supply chain – for COVID-19 vaccines.

During the country visit, Dr Kluge had the opportunity to speak with President Aleksandar Vučić about COVID-19, most notably vaccination roll-outs and solidarity with other countries, as well as the ongoing European Programme of Work 2020–2025 (EPW), with particular focus on the Roadmap for Health in the Western Balkans 2021–2025.

Hungary

In Hungary, Dr Kluge had the opportunity to speak with high-level representatives, including Prime Minister Viktor Orbán, on a number of issues affecting health in the country. The COVID-19 pandemic has clearly shown the importance of investing in health to strengthen health systems – an issue discussed between the Regional Director and Prime Minister.

In addition, Dr Kluge witnessed first-hand the tireless efforts made by staff at the National Korányi Institute for Tuberculosis and Pulmonology in Budapest. The Institute presented the outcomes of several projects implemented in close collaboration with WHO, which aim to find new modalities for models of care supported by effective payment mechanisms and clinical governance.

The Institute was one of the first in the country to be redesigned as a COVID-19 hospital, completing its conversion in record time, while also maintaining some non-COVID-19 health services. Speaking to staff, Dr Kluge congratulated them on their work tackling the pandemic, while also working to manage patients with noncommunicable diseases and tuberculosis.

Bosnia and Herzegovina

Visiting Bosnia and Herzegovina, Dr Kluge spoke with high-level representatives, seeking to build on support for the EPW, linked to the Roadmap for Health in the Western Balkans 2021–2025. The Roadmap places health at the centre of the country’s economic growth agenda – linking health and the economy, an issue that has been highlighted during the COVID-19 pandemic. Dr Kluge met with the Chairman and the Members of the Presidency of Bosnia and Herzegovina to discuss the EPW – marking the first time a WHO Regional Director for Europe has met with the Presidency in person.

In addition, Dr Kluge signed a biennial collaborative agreement with Minister of Civil Affairs Ankica Gudeljević – focusing on building emergency-resilient, financially stable and robust health systems to leave no one behind in health.

Montenegro

Travelling to Montenegro, Dr Kluge spoke with parliamentarians about pan-European and country-specific health challenges, including tobacco control and universal health coverage. The Regional Director also highlighted the importance of health workers during an address to the Parliamentary Committee on Health, Labour and Social Welfare. In addition, Dr Kluge spoke with the Prime Minister Zdravko Krivokapić, to discuss the EPW and its importance for health in the Region.

Montenegro has also been working on strengthening governance, surveillance, diagnostics and clinical management – part of a digital innovation in health in the country. This forms an important part of the EPW, a point highlighted in discussions with Health Minister Jelena Borovinić Bojović.

The visit also offered an opportunity to discuss digital health and immunization and their role in responding to the pandemic with health workers at a primary health care centre in the capital Podgorica. These centres have helped bring health care and the roll-out of vaccines closer to communities.

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Jun 3 2021

Risk of COVID-19 surge threatens Africa’s health facilities

Critical health facilities across Africa risk being overwhelmed by surging COVID-19 infections, the UN health agency said on Thursday.

The appeal to the continent’s authorities to boost lifesaving facilities comes as the World Health Organization (WHO) warned that vaccine shipments were at “a near halt”.

“The threat of a third wave in Africa is real and rising”, said Dr Matshidiso Moeti, WHO Regional Director for Africa. “Our priority is clear – it’s crucial that we swiftly get vaccines into the arms of Africans at high risk of falling seriously ill and dying of COVID-19.”

20% uptick in cases

As the continent struggles with vaccine shortages, the care of critically ill COVID-19 patients has lagged behind other parts of the world. While Africa has 2.9 per cent of cases globally, it accounts for 3.7 per cent of deaths.

Weak observance of preventive measures likely contributed to the crisis, along with increased population movement and interaction, and the arrival of winter in southern Africa.

In the last two weeks, the continent has recorded a 20 per cent increase in coronavirus infections, compared to the previous fortnight. “The pandemic is trending upwards in 14 countries and in the past week alone (and) eight countries witnessed an abrupt rise of over 30 per cent in cases,” WHO said in a statement.

Intensive care filling up

South Africa has seen “a sustained increase in cases”, while Uganda reported a 131 per cent week-on-week rise last week “with infection clusters in schools, rising cases among health workers and isolation centres and intensive care units filling up”.

Angola and Namibia have also witnessed a resurgence in cases, WHO said, noting that 48.6 million doses have been received in Africa and 31.4 million doses have been administered in 50 countries on the continent.

Poor treatment

Only around two per cent of the population has received at least one dose of COVID-19 vaccine, compared with the 24 per cent global figure.

“While many countries outside Africa have now vaccinated their high-priority groups and are able to even consider vaccinating their children, African countries are unable to even follow up with second doses for high-risk groups,” said Dr. Moeti. “I’m urging countries that have reached a significant vaccination coverage to release doses and keep the most vulnerable Africans out of critical care.”

Globally, as of 3 June 2021, there have been 171,222,477 confirmed cases of COVID-19, including 3,686,142 deaths, reported to WHO. As of 2 June, a total of 1,581,509,628 vaccine doses have been administered.

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Jun 3 2021

Ending this pandemic, preventing the next one: European perspectives at the Seventy-fourth World Health Assembly

The Seventy-fourth World Health Assembly, held on 24–31 May 2021, was once again dominated by discussions on responding to the short- and longer-term consequences of the COVID-19 pandemic, and on ensuring that countries, health systems, organizations and societies are better prepared to meet the challenges of future health threats.

Better prepared, better protected

Central in this Assembly were the questions of how to get out of this health crisis and what lessons to draw from this pandemic. Many expressed the need to ensure equitable access to COVID-19 vaccines.

Responding to the WHO Director-General’s plea to support the “drive to December” to achieve the goal of getting 30% vaccinated in every country around the globe by the end of this year, many Member States from the WHO European Region actively committed to step up their engagement in international cooperation and solidarity. This is to include increased contributions to the COVAX Facility.

Countries also made concrete suggestions to accelerate the production of COVID-19 vaccines and increase both supply and access.

The Assembly decided to convene a special session in November to agree on a global treaty on pandemic preparedness and response. In addition, a Member States working group was established that will take forward the recommendations made by the different assessment panels and review committees.

A new, more solid framework for responding to future health threats will be built, which will strengthen WHO politically, legally and financially. All of these issues will also be discussed at the next session of the WHO Regional Committee for Europe in September.

Building back better

More than 30 resolutions and decisions were adopted at this year’s World Health Assembly. These ranged from issues such as diabetes and malaria to eye care and oral health, disabilities, ending violence against children, social determinants of health, and strategic directions for the health and care workforce. The Assembly deliberately looked beyond the direct response to the pandemic and considered its impact in different areas of public health.

Given the current pandemic’s huge impact on mental health and well-being, the Assembly also endorsed an updated, comprehensive mental health action plan for 2013–2030.

“Before the pandemic struck, WHO/Europe already identified mental health as a flagship of the European Programme of Work 2020–2025,” explained WHO Regional Director for Europe Dr Hans Henri P. Kluge in his intervention. “A silver lining of the crisis is an opportunity to forge a new pathway for mental health promotion and care.”

Dr Kluge noted that 9 out of 10 deaths across the pan-European Region are attributable to noncommunicable diseases. “There are many more battles to be fought. In several countries, the incidence of childhood-onset diabetes is on the rise. We know that diabetes also affects communicable diseases such as tuberculosis and HIV. That is why a World Health Assembly resolution on diabetes is so timely,” he said.

Celebrating outstanding contributions to health

Marking the Year of Health and Care Workers, Member States were effusive in their gratitude towards people working in these professions.

In honour of their dedication, WHO Director-General Dr Tedros Adhanom Ghebreyesus at the opening of the Assembly presented a health award to Dr Catalin Denciu, an intensive care physician from Romania who suffered severe burns when trying to save COVID-19 patients from a fire at the Piatra Neamt County Hospital in November last year.

Receiving the award, Dr Denciu said, “Heroes are those who, each day for more than a year, continue to care for their patients and their families despite all difficulties and barriers.”

Despite this recognition, many health workers are still working with insufficient protection, putting their health and lives at risk on a daily basis. Mr Mircea Timofte, President of the Romanian Order of Nurses and of the European Council of Nurses, called for prioritizing the vaccination of health workers.

The crucial work by scientists was also recognized and praised, including through the 2021 Dr LEE Jong-wook Memorial Prize for Public Health. This year’s Memorial Prize was awarded to the National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine (NRCRM) for its decades of service since the Chernobyl accident 35 years ago.

New members

The Regional Director congratulated Belarus, Denmark, France and Slovenia on their election as new members of the Executive Board, and thanked the outgoing representatives from Germany, Finland, Israel and Romania for their remarkable engagement during their term of 3 years.

Dr Kluge also expressed his appreciation to all the delegates from European Member States who took on various roles as officers to ensure the good conduct of this Assembly. He welcomed the Faroe Islands on its admission as an Associate Member of WHO at the request of Denmark.

About the World Health Assembly

The World Health Assembly is WHO’s main governing body, comprising 194 Member States. Every year, delegates from all Member States come together to agree on the Organization’s priorities and policies. At the Assembly, new health goals and strategies are set, and tasks are assigned in order to reach those goals.

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Jun 3 2021

European psychiatry in bad shape

*Featured photo by Rosa García from Pixabay / This article is part of the series “Mental Health in crisis“

The use of coercion and force continue to be common practice despite efforts to decrease their use.

Recent studies have looked at the patient’s viewpoints of the mental health services. In one study from 2016 retrospective views of patients towards their admission and length of psychiatric hospital stay were analyzed. The study includes an analysis conducted of involuntarily detained inpatients across 10 European countries, of whom 770 were subject to one or more coercive measures while deprived of their liberty.

The findings indicated the damaging effects of the use of coercion in terms of hospital treatment efficacy.

The study’s main investigator Paul McLaughlin of the Unit for Social & Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development in England noted: “The use of coercion in mental health care remains common practice in jurisdictions across the world. As well as involuntary admission to hospital under statutory powers of detention, the most obvious forms of coercive practice are those referred to as ‘coercive measures’–forced administration of psychotropic medication against the patient’s will, involuntary confinement of the patient in isolation or seclusion, and manual or mechanical restraint of the patient’s limbs or body to prevent free movement. Despite the widespread use of coercive measures, however, there is a remarkable lack of empirical evidence as to their association with treatment outcomes.”

The use of coercive measures would only be justified where their use would cause an improvement of a treatment situation for the person subjected to the intervention or alternatively other persons in treatment that would suffer negative effects from the actions of that person. This however seems to not be the case according to several expert studies.

Paul McLaughlin and his co-investigators based on their study’s findings concluded: “Given their widespread use, the association between coercive measures and treatment outcomes is clearly important. Quite apart from the physical risks that go with the use of force, qualitative studies consistently show that coercive measures can be experienced by patients as humiliating and distressing, and consideration has started to be made of the psychological risks of their use.”

Coercion result in longer hospital stay

The study included a total of 2030 involuntary patients from 10 countries. It was found that 770 (37.9%) were subject to one or more coercive measures in the first four weeks of their admission or less, if they were released from the psychiatric hospital earlier. The 770 patients experienced 1462 recorded instances of use of coercive measures.

From this finding Paul McLaughlin concluded that the: “Use of forced medication was associated with patients being significantly less likely to justify their admission when interviewed after three months. All coercive measures were associated with patients staying longer in hospital.”

When considering different variables, it was found that seclusion was a significant predictor of longer hospital stay, adding about 25 days to the average admission.

When reviewing if certain types of coercion were having a stronger impact than others, it was found that forced medication appears to have an extraordinary strong effect. The use of this type of force is strongly contributing to patient disapproval of the psychiatric treatment.

Increasing involuntary commitments

An editorial published in the British Medical Journal in 2017, reviewed the increasing rate of involuntary psychiatric hospital admission in England. It has increased by more than a third in six years. In Scotland, the number of detentions increased by 19% in five years.

Shockingly the scene has deteriorated to a degree that more than half of the admissions to psychiatric hospitals in England now are involuntary. This is the highest rate recorded since the 1983 Mental Health Act.

Germany has also experienced a worsening. A study presented to the World Psychiatric Association’s (WPA) Thematic Conference: Coercive Treatment in Psychiatry held in 2007 reviewed civil commitment rates in Germany. The study found that excluding those commitments which were allowing physical restraint, these more than doubled. The increase is from 24 to 55 per 100,000 inhabitants in the period 1992 to 2005. And when looking at the public commitment rates these increased from 64 to 75. Summarizing the different types, the total of all commitments increased by 38 per cent in Germany.

In addition to the type of deprivations of liberty through civil commitments another form of restraints is also used in Germany. Persons are increasingly being taken before a legal court. The court decision rates with regard to physical restriction, which have been obligatory since 1992, increased more than seven-fold from 12 to 90 per 100,000 inhabitants.

In Denmark the increasing use of the possibility to deprive people of their liberty through involuntary commitment in to psychiatry is even more significant. A nearly linear increase has taken place from 1998 when 1522 persons were committed to 2020 when 5165 persons were involuntary committed.

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