Icn at the 73Rd World Health Assembly, 2020 and the 148Th Who Executive Board, 2021

INTERNATIONAL COUNCIL OF NURSES

ICN AT THE 73RD WORLD HEALTH ASSEMBLY, 2020 AND THE 148TH WHO EXECUTIVE BOARD, 2021

Prepared by Erica Burton - ICN Senior Advisor, Nursing & Health Policy TABLE OF CONTENTS

INTRODUCTION...... 3

OPENING OF THE RESUMED WHA73 ...... 3

Address by WHO Director-General Dr Tedros Adhanom Ghebreyesus WHA73.3

Keynote address by Her Royal Highness Princess Muna Al-Hussein of Jordan (HRH), WHO Patron for Nursing & Midwifery...... 4

OPENING OF THE EB148...... 5

Address by WHO Director-General Dr Tedros Adhanom Ghebreyesus ...... 5

COVID-19 response...... 5

WHO’s work in health emergencies ...... 6

Strengthening WHO’s global emergency preparedness and response ...... 6

...... Strengthening preparedness for health emergencies: implementation of the International Health Regulations (2005)...... 7

Interim progress report of the Review Committee on the functioning of the International Health Regulations (2005) during the COVID-19 response...... 7

Mental health preparedness and response for the COVID-19 pandemic...... 8

WHO Global Code of Practice on the International Recruitment of Health Personnel...... 9

Global action on patient safety...... 9

Global vaccine action plan & Immunization Agenda 2030...... 10

Antimicrobial resistance...... 11

Decade of Healthy Ageing...... 12

Political declaration of the third high-level meeting of the General Assembly on the prevention and control of non-communicable diseases...... 12

Ending tuberculosis...... 13

Data and innovation: draft global strategy on digital health...... 13

Substandard and falsified medical products...... 13

Social determinants of health...... 14

Accelerating the elimination of cervical cancer as a global public health problem...... 15

The highest attainable standard of health for persons with disabilities...... 16

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INTRODUCTION The World Health Organization (WHO) 73rd World Health Assembly (WHA73) Executive Board (EB) reports on matters which was held virtually 9-14 November which require further action, study and 2020 and the 148th session of the WHO investigation or report. These are then Executive Board (EB148) which was held considered by the World Health Assembly virtually 18-26 January 2021. It also cov- (WHA), the supreme decision-making ers the agenda item “COVID-19 response” body of the WHO. The WHA typically takes during the de minimis session held in May placed in May of each year but, in 2020, 2020 and certain written procedure items due to the COVID-19 pandemic, items that were summarized at the 73rd WHA. It were discussed over a written silence pro- provides a brief overview of agenda items cedure and in a de minimis and a resumed that are of particular importance to nurs- session. This report is organised by topic ing and to ICN and its member National and covers the resumed session of the Nurses Associations.

OPENING OF THE RESUMED WHA73

Address by WHO Director-General Dr Tedros Adhanom Ghebreyesus WHA73 The Director-General (DG) opened with more than ever, the world needs nurses an acknowledgment that 2020 was the and midwives. Please join me, wherever International Year of the Nurse and the you are, in standing to show your appreci- Midwife. ation for these true health heroes.”

“This Assembly was intended to be a Focusing on the COVID-19 pandemic, Dr moment of recognition for the incredible Tedros spoke of the need for solidarity, the contribution that nurses and midwives social and economic impact, the world’s make every day, in every country. The existing inequalities and injustices, the fail- pandemic has robbed us of that opportu- ings and the successes thus far, and the nity. But it has only served to illustrate why need for strengthening, implementing and nurses, midwives and all health workers financing WHO. He noted the findings of are so important. Nurses and midwives the WHO Results Report which showed have been on the frontlines of the fight progress and important work in promoting against COVID-19, putting themselves healthy populations, universal health cov- in harm’s way. Many have made the ulti- erage, outbreak response, and prevention, mate sacrifice in service of humanity. Last testing and treatment for HIV, tuberculosis, month, WHO published the first State of malaria, hepatitis C, hypertension, diabe- the World’s Nursing report. It shows that tes and cancer. Dr Tedros underscored the world is facing a shortfall of six million that health is a prerequisite for and must nurses to achieve and sustain universal be at the centre of development, a neces- health coverage. But it also provides a road sity and an investment. map for governments to invest in nursing, to fill that gap and progress towards universal health coverage. Health for All. Now

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Keynote address by Her Royal Highness Princess Muna Al-Hussein of Jordan (HRH), WHO Patron for Nursing & Midwifery Her Royal Highness (HRH) Princess Muna The Princess reminded delegates that recognised the contribution of healthcare health workers are continuing their workers for their courage and relentless fight against other health challenges: fight against COVID-19 and said that “Preventable diseases do not stop killing “applause without action is no longer young children; mothers do not stop hav- acceptable.” The Princess called health ing babies; cancer continues to require workers “heroes” and recalled the WHA’s treatment; our elders still require health commitment to action during the Ebola and care services.” She also stressed that crisis, saying, “Now the COVID-19 pan- once a vaccine is available, “we will be demic is here and, once more dear friends, faced with a staggering task of vaccinating health workers are dying, but this time in billions of people. No country will succeed their thousands, the majority of which are without properly preparing their health nurses. We must invest in health workers. system.” We must invest in educating and employing more health workers to ensure every Given that 70% of the world’s health work- mother, child, student, parent, and grand- ers are women, HRH also raised the need parent has access to safe health services. for “investment in transformative, gender We must invest in fair pay and protection of equity and rights policies”. health and care workers. We must invest in health workforce that would help the world recover.”

Dr Tedros Adhanom Ghebreyesus 4 INTERNATIONAL COUNCIL OF NURSES

OPENING OF THE EB148

Address by WHO Director-General Dr Tedros Adhanom Ghebreyesus In his opening, Dr. Tedros described drastic health workers and older people is under- inequalities between countries in access to way in all countries. He called for countries the COVID-19 vaccine saying “…the world with bilateral contracts to be transparent is on the brink of a catastrophic moral fail- with COVAX and give priority to COVAX’s ure – and the price of this failure will be place in the vaccine queue. Dr Tedros paid with lives and livelihoods in the world’s described lessons learnt which included poorest countries.” the need to increase preparedness and response, that the health of humans, ani- Not only does this me-first approach leave mals and the planet are intimately inter- the world’s poorest and most vulnerable twined; and that the world needs a stronger people at risk, it is also self-defeating. WHO. Ultimately, these actions will only prolong the pandemic, the restrictions needed He announced that 2021 had been desig- to contain it, and human and economic nated as the International Year of Health suffering.” and Care Workers to “…focus on making WHO an organization that attracts the best Dr Tedros called on countries to work people, gives them the best environment together in solidarity to ensure that within – inclusive and diverse – and enables and the first 100 days of 2021, vaccination of empowers them to do and be their best.”

COVID-19 response Document: A73/CONF./1 Rev.1, EB148/16, obstacles, including the provisions of the EB148/17, WHA73.1, EB148(2) TRIPS Agreement and the flexibilities Read the ICN WHA statement here and within the Doha Declaration on the TRIPS the EB statement here Agreement and Public Health; 5) reiterates the importance of urgently meeting the In May 2020, the WHA73 de minimis ses- needs of low- and middle-income coun- sion was held and resolution WHA73.1 tries in order to fill the gaps in efforts to COVID-19 response was adopted which: overcome the pandemic, through timely 1) calls for intensification of cooperation and adequate development and humani- and collaboration at all levels in order to tarian assistance; 6) recognises the role of contain and control the COVID-19 pan- extensive immunization against COVID-19 demic and mitigate its impact; 2) acknowl- as a global public good for health in pre- edges the key leadership role of WHO and venting, containing and stopping transmis- the fundamental role of the UN system in sion in order to bring the pandemic to an catalysing and coordinating the compre- end, once safe, quality, efficacious, effec- hensive global response to the pandemic, tive, accessible and affordable vaccines and the central efforts of Member States; are available. 3) expresses its highest appreciation of, and support for, the dedication, efforts and The resolution calls on Member States, sacrifices, above and beyond the call of international organisations and other duty, of health professionals, health work- stakeholders, and the DG to take action on ers and other relevant frontline workers, as a number of points. The reader is encour- well as the WHO Secretariat, in respond- aged to refer to the resolution for these ing to the pandemic; 4) calls for the univer- details. sal, timely and equitable access to, and fair distribution of, all quality, safe, efficacious In October 2020, the WHO held an and affordable essential health technolo- EB Special Session on the COVID-19 gies and products needed as a global pri- response during which ICN made a state- ority, and the urgent removal of unjustified ment on the agenda item “Update on

4 5 ICN AT THE 73RD WORLD HEALTH ASSEMBLY, 2020 AND THE 148TH WHO EXECUTIVE BOARD, 2021

implementation of resolution WHA73.1 on information available. ICN reiterated the the COVID-19 response”. importance of data in keeping track of the impact on the health workforce and moni- At its January 2021 session, the EB report toring the response to the pandemic. The EB148/16 describes WHO’s continuing COVID Effect could increase the current work while the report EB148/17 gives more nursing shortages to a number nearly half background information. the size of the current nursing workforce. ICN called on Member States to establish In its statement to the EB148, ICN high- health, education and retraining opportu- lighted findings from its latest report nity, or “HERO”, funds to support people showing that nurses are experiencing who have lost their jobs in some sectors psychological distress, abuse and mass to retrain to join the healthcare workforce. traumatisation as a result of the pandemic. More than 1.6 million healthcare workers EB decision EB148(2) was made after have been infected with over 2262 nurse consideration of this agenda item along deaths. This data is unreliable as many with the agenda items below. Please see countries do not have adequate reporting below for more information. mechanisms or are failing to make the

WHO’s work in health emergencies Documents, A73/11, A73/INF./4, EB148/18, the Rt Hon Helen Clark, who is a former EB148/19, EB148/INF./4, EB148/CONF./4, Prime Minister of New Zealand. EB148/CONF./4 Add.1,WHA73.1, WHA73.8, EB148(2) Ms Clark said: “The world needs to do two Read the ICN WHA statement here things: Act more decisively now to stem the pandemic, and fundamentally reset pre- The Co-Chairs of the Panel submitted the paredness and response systems to help second progress report of the Independent ensure that this can’t happen again.” Panel for Pandemic Preparedness and Response. The report highlights that the Addressing the EB, Panel Co-chair, former world was not prepared and must do bet- President of Liberia Ellen Johnson Sirleaf ter. Key messages of the report: said: “We need to listen more to healthcare • The public health measures which workers and heed their advice. Draw on would curb the pandemic need to be the knowledge of those who manage local applied comprehensively responses.” • The pandemic response has deepened inequalities Strengthening WHO’s global • The global pandemic alert system is not emergency preparedness and fit for purpose response • There has been a failure to take The COVID-19 crisis and other recent seriously the already known existential health emergencies have shown that the risks posed by pandemic threat world is still not effectively able to prepare for, predict, prevent, respond to and • WHO has been underpowered to do the recover from a multi-country outbreak or job expected of it. pandemic. Several Member States shared proposals to strengthen WHO in its capac- The report acknowledges the dire shortage ities to plan for and respond to health of nurses world-wide, and highlights wor- emergencies. Common to all proposals ries about so many nurses being burnt out for strengthening pandemic preparedness and planning to retire from the profession and response is the recognition that mul- earlier than planned, as a direct result of tinational leadership is required to ensure the impact of the COVID-19. that actions are taken in solidarity and for the common good: health emergency pre- It includes information from ICN’s paredness is a paradigmatic global public December 2020 webinar, in which nurses good. The report (EB148/18) contains key from around the world shared their expe- areas for action for consideration. riences with one of the panel’s Co-chairs,

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the Rt Hon Helen Clark

Strengthening preparedness coordination of health emergency prepar- for health emergencies: edness; 3) improve national coordination implementation of the International and collaboration regionally, internationally Health Regulations (2005) and with all stakeholders; 4) prioritise com- & munity involvement and capacity-building in all preparedness efforts; 5) engage Interim progress report of women in all stages of preparedness pro- the Review Committee on the cess to mainstream gender perspective functioning of the International Health Regulations (2005) during in planning and response; 6) strengthen the COVID-19 response health system capacity to continue to provide essential health services and PHC during health emergencies; 7) invest The Review Committee on the Functioning in health emergency preparedness; 8) of the International Health Regulations improve governance and decision-making (2005) during the COVID-19 Response processes and enhance institutional and was convened by the Director-General on 8 operational capacity and infrastructure for September 2020 at the request of Member public health. States in resolution WHA73.1. The EB report (EB148/19) summarises the work of The decision requested the DG to partici- the Review Committee including priorities pate in UN operational reviews after major and preliminary findings. The Committee health emergencies and to conduct a study will continue its deliberations with the aim on the need for potential benefits of com- to present a final report to the DG for the plementary mechanisms to be used by the 74th WHA in May 2021. However, not- DG to alert the global community about ing that the review of the event is taking the severity of a public health emergency place while the event is still unfolding, the in order to mobilise necessary support and Committee may not have all the elements facilitate coordination. necessary to conclude its deliberations by then. The WHA called on the Member States and the DG to work with UN entities to: 1) The WHA adopted decision WHA73.8 in strengthen UN system-wide coordination which it made several requests and calls in different country, health and humani- including calling on Member States to: 1) tarian emergency contexts; 2) systemati- fully comply with the IHR to continue to cally review and revise UN preparedness build core capacities to detect, assess, and response strategies for outbreaks; 3) report on and respond to public health enhance UN system leadership for pre- events; 2) prioritise the improvement and paredness and response coordination; 4)

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increase collaboration between relevant programmes, institutions employing nurses actors to accelerate preparedness for pan- and organisations participating in disaster demics and disease outbreaks, in particu- and emergency response to adopt these lar in fragile situations and conflict-affected competencies. areas. As outlined in decision 148(2), the EB In its statement to the WHA, ICN high- called for the development of a reso- lighted that nurses make a vital contri- lution on strengthening WHO’s health bution to preventing and responding to emergency preparedness and response epidemics, pandemics and health emer- capacities, including to address the recom- gencies and efforts to build capacities of mendations of the Independent Panel for nurses must be accelerated. It is crucial to Pandemic Preparedness and Response, include the health and safety of the health- the Review Committee on the Functioning care workforce in all health emergency of the International Health Regulations preparedness and response plans. ICN (2005) during the COVID-19 Response, encouraged Member States to consult the and the Independent Oversight and updated Core Competencies in Disaster Advisory Committee for the WHO Health Nursing to support workforce develop- Emergencies Programme. ment and encouraged nursing educational

Mental health preparedness and response for the COVID-19 pandemic Documents: EB148/20, EB148(3) funding for mental health; to take action to Read the ICN WHA statement here mainstream knowledge of mental health among other health professionals; and to Before the coronavirus disease (COVID- study the impact of COVID-19 on mental, 19) pandemic, almost one billion people neurological and substance use conditions globally had a mental disorder. Mental and their consequences. The EB requested health is one of the most neglected areas the DG to support Member States to mon- of health. Human rights violations against itor changes and disruptions in services, people with mental health conditions are and to promote and expand access to numerous and widespread around the inclusive, integrated, evidence-based world. The pandemic is profoundly affect- primary and community mental health ing mental health and well-being. Mental services and psychosocial supports; to and neurological manifestations, such as strengthen WHO’s capacity in respect of depression, anxiety and delirium/encepha- work on mental health at global, regional lopathy, are reported in COVID-19 patients. and country levels; and to systematically Many people with pre-existing mental, integrate mental health into all aspects of neurological and substance use disorders the work of the Secretariat on UHC. are facing exacerbation of symptoms due to stressors, while the limited available In its statement to the EB, ICN noted services are disrupted. Of the 130 coun- that the impact on the mental health of tries participating in a recent WHO survey, health workers who are disproportion- 93% reported disruptions in one or more ately affected by the pandemic and at risk services for mental, neurological and sub- of full-blown stress response syndromes, stance use disorders. anxiety and burnout must not be over- looked. Service disruptions, underfunding The EB adopted decision EB148(3) in and continued neglect of mental health will which it recommended that the 74th WHA increase the number of nurses leaving the endorse the updated comprehensive men- profession, worsening future nursing work- tal health action plan 2013-2030; and urged force shortages. Nurses are invaluable for Member States to develop and strengthen, mental health promotion, prevention and as part of a broader whole-of-society care. We need nurses now more than ever approach, the timely and quality provision to support the COVID-19 response and to of the whole range of comprehensive and ensure the delivery of mental health ser- integrated mental health services and psy- vices. ICN urged governments to place chosocial supports; to allocate adequate mental health at the centre of national

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COVID-19 response and recovery plans.

WHO Global Code of Practice on the International Recruitment of Health Personnel Documents: A73/9, WHA73(30) health and care workers in response to Read the ICN WHA73 statement here COVID-19, the WHA designated 2021 as the International Year of Health and Care WHO Global Code of Practice on the Workers. The WHA requested the DG to International Recruitment of Health engage WHO and Member States to make Personnel establishes and promotes vol- the best use of the International Year of untary principles and practices and facili- Health and Care Workers to advance pro- tates health system strengthening. It was gress on SDG 3 and to engage with WHO designed by Member States to serve as regions to update the Global Strategic a continuous and dynamic framework for Directions for Nursing and Midwifery 2016– global dialogue and cooperation. The WHO 2020 to be considered by the 74th WHA. Expert Advisory Group (EAG) reviews the relevance and effectiveness Code and the The COVID-19 pandemic has exposed the report of its second review is included in vulnerabilities of nurse supply flows, high- the WHA report. The EAG confirms that lighted existing nurse supply gaps and the the relevance of the Code is high and effect of staffing shortages at country level growing and that both Code effectiveness and has disrupted international nurse sup- and underlying availability of information ply. Country-level nursing workforce policy to assess its effectiveness, have strength- change, guided by the Code and supported ened considerably since 2015. However, by international organisations, is now there are critical gaps in the Code’s imple- more important than ever. In its statement mentation with current levels insufficient to to the EB, ICN recommended Member realise the Code’s full potential as required States implement a self-sufficiency indica- to progress towards UHC and the SDGs. tor of level of percentage reliance on foreign trained nurses to give policy makers The WHA acknowledged synergies with the insight into the extent of dependence on global agenda on nursing and midwifery international nurse supply and would also in the International Year of the Nurse and enable tracking and monitoring of the mile- the Midwife and the role of health and care stone commitment of the Global Strategy workers at the forefront of the fight against on Human Resources for Health, that by the pandemic and adopted decision 2030 all countries will have made pro- WHA73(30) Human resources for health. It gress towards having their dependency on commended the successful conclusion of foreign-trained health professionals and the work of the EAG, encouraged Member implementing the Code. States to implement recommendations of the EAG, and requested the EAG to fur- ICN also extended its support to the ther assess the Code’s relevance and update of the Global Strategic Directions effectiveness after the period 2023-2024. for Nursing and Midwifery. To acknowledge the tireless efforts of the

Global action on patient safety Documents: EB148/6 and EB148/6 Add.1, care. The COVID-19 pandemic has shone EB148(5) light on the importance of patient safety Read the ICN EB statement here issues such as personal protective equip- ment (PPE), health worker safety, medica- Evidence suggests that hospitalisations in tion safety and patient engagement. low- and middle-income countries lead to 134 million adverse events annually, con- In order to create a world in which no tributing to 2.6 million deaths and that, in one is harmed in healthcare, and every high-income countries, about one in ten patient receives safe and respectful care, patients is harmed while receiving hospital every time, everywhere, the Global patient

8 9 ICN AT THE 73RD WORLD HEALTH ASSEMBLY, 2020 AND THE 148TH WHO EXECUTIVE BOARD, 2021

safety action plan 2021-2030: Towards been important in gaining global attention eliminating avoidable harm in health care on the importance of patient safety and was drafted. The action plan will provide crucial for ICN to highlight the impact of strategic direction for all stakeholders in nurses in ensuring patient safety. World improving patient safety in their practice Patient Safety Day 2020 highlighted the domain through policy actions as well as launch of the Health Worker Safety Charter implementation of recommendations at which calls on governments and local the point of care. The guiding principles health service leaders to take five actions of the action plan are: 1) engage patients to better protect health workers. ICN noted and families as partner in safe care; 2) its strong support for the Charter and achieve result through collaborative work- called on governments to sign and act on ing; 3) analyse data to generate learning; it. ICN’s September 2020 report revealed 4) translate evidence into measurable the true extent of the dangers nurses face improvement; 5) base policies and action at work including violence and abuse, on the nature of the care setting; 6) use unsafe staffing levels, work-related stress, both scientific expertise and patient expe- and severe PPE shortages. ICN believes rience to improve safety; 7) instil safety that health worker safety and patient safety culture in the design and delivery of health are two sides of the same coin and that care. if nurses and healthcare workers are not protected, the safety of patients cannot be ICN welcomes the global patient safety guaranteed. action plan and is pleased to have contrib- uted to its development, including provid- In decision EB148(5), the EB recom- ing consultation on the third draft. Having mended to the 74th WHA to adopt the action nurses involved in the design and oper- plan and that the DG report back progress ation of patient safety plans and policy on its implementation to the 76th WHA and interventions will greatly contribute to their annually thereafter. success. In its statement to the EB, ICN noted that World Patient Safety Day has

Global vaccine action plan & Immunization Agenda 2030 Documents: A73/7, EB148/14, WHA73(9) major milestone. There is a need to coor- Read the ICN WHA73 statement here dinate an integrated immunization agenda Read the ICN EB148 statement here with PHC and this should be in line with the PHC strategy that WHO is currently Immunization is important now more than rolling out. Countries are facing immense ever for wellbeing and the economy. The challenges in sustaining routine immuni- global vaccine action plan (2011-2020) zation services with the pandemic result- expired at the end of 2020. Despite sig- ing in huge setbacks. WHO expressed its nificant progress made in the last decade, reliance on Member States to continue to most of the global and regional immuni- empower communities and health workers zation goals were not achieved and one to improve the reach and efficacy of immu- in five children will still lack access to all nization services. life-saving vaccines. Through a broad con- sultative process, the successor global The WHA adopted decision WHA73(9) in vision and overarching strategy for vac- which it endorsed IA2030. The report pre- cines and immunization: Immunization sented to the EB contains progress made Agenda 2030 (IA2030) was developed. It on the operational elements. Member provides the strategic framework to tackle States, development partners and civil key issues related to immunization within society organisations will contribute to primary health care (PHC) and universal operationalising IA2030. They will build on health coverage during 2021–2030 and the ownership and accountability and mon- is a living document. The immediate task itoring and evaluation frameworks, and and focus should be the COVID-19 vaccine strengthened implementation planning, as rollout in an equitable manner. However, it well as communications and advocacy. is crucial to have a broader immunization agenda and its adoption by WHA73 was a ICN welcomes IA2030 and strongly

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believes in the power of immunization as forward PHC with integrated immunization a tool for global health and sustainable structures. The rate of nursing and mid- development. The strong involvement wifery personnel is included as a Global of nurses at all stages: planning, design, Strategic Priority Objective Indicator in the implementation and delivery, is essential Agenda and shortages are one cause of for the success of this agenda. Nurses success or failure in achieving IA2030. As offer valuable expertise in behavioural and such, ICN asked governments to ensure social strategies to address under-vacci- the availability and appropriate distribution nation, support effective communication, of a skilled and motivated nursing work- increase health literacy, build public con- force to achieve IA2030. fidence in immunization and are driving

Antimicrobial resistance Documents: EB148/11 COVID-19 response. Key national and global challenges to implement the AMR Antimicrobial resistance (AMR) threatens action plan include prioritisation of key the achievement of many of the SDGs activities and integration of mode of ser- and the objectives of the WHO General vice delivery aligned with the COVID-19 Programme of Work. WHO is spearhead- response; operationalisation of the One ing the response to AMR and coordinating Health approach into multisectoral work; the global One Health response, through lack of access to quality diagnostics and the newly established Antimicrobial antimicrobials; sustaining political commit- Resistance Division. A risk assessment by ment; and lack of financial and technical the Secretariat shows that the COVID-19 resources. pandemic has disrupted the planned and ongoing national AMR activities. Strategies The EB noted the report which provides a for addressing antimicrobial resistance, summary of WHO action at all levels since including surveillance, infection prevention May 2019. and control, WASH, antimicrobial steward- ship, awareness and multisectoral coordination, have been incorporated into the

Erica Burton, Senior Advisor, Nursing & Health 10 Policy – Delivering an ICN intervention virtually 11 ICN AT THE 73RD WORLD HEALTH ASSEMBLY, 2020 AND THE 148TH WHO EXECUTIVE BOARD, 2021

Decade of Healthy Ageing Documents: A73/5, A73/INF./2, WHA73(12) United Nations Decade of Healthy Ageing (Resolution 75/131). WHO will lead this Healthy Ageing is the process of devel- work in close collaboration with the UN oping and maintaining the functional abil- Department of Social and Economic ity that enables well-being in older age. Affairs and its regional commissions, the Functional ability is about having the capa- UN Population Fund, the Office of the bilities that enable all people to be and High Commissioner for Human Rights, UN do what they have reason to value. As of Development Programme, UN Habitat, UN 2019, there are more than one billion peo- Women, World Bank, and other relevant ple over the age of 60, most of whom live international and regional organisations. in low- and middle-income countries and many of whom do not have access to basic The Decade of Health Ageing is based resources and are faced with multiple bar- on the Global strategy and action plan on riers that prevent their full participation in ageing and health (2016-2030) and builds society. By the end of 2030, that number on the Madrid International Plan of Action will be 34% higher, increasing to 1.4 billion. on Ageing. Older people will be at the cen- tres of the Decade which will address four The WHA adopted decision WHA73(12) areas for action: change how we think, feel in which it endorsed the proposal for a and act towards age and ageing; ensure Decade of Health Ageing 2020-2030 and that communities foster the abilities of requested the DG to transmit the decision older people; deliver person-centred inte- to the United Nations Secretary-General grated care and primary health services for consideration by the UN General responsive to older people; and provide Assembly (UNGA). In December 2020, access to long-term care for older people the UNGA welcomed the Decade proposal who need it. and decided to proclaim 2021-2030 the

Political declaration of the third high-level meeting of the General Assembly on the prevention and control of noncommunicable diseases Documents: A73/5, EB148/7, EB148/7 urgently require strengthening. Currently, Add.1, EB148/7 Add.2, EB148(7) many countries have few usable mortality data and weak information on risk factor Only 17 and 15 countries are on track to exposure and morbidity. Data on NCDs meet SDG target 3.4 to reduce premature are often not well integrated into national mortality from NCDs by a third by 2030 in health information systems. Improving women and men respectively. The COVID- country-level surveillance and monitoring 19 pandemic is having a deadly interplay remains a top priority in the fight against with the NCD epidemic. Early analysis of NCDs. data from the May rapid survey indicates people with hypertension and/or diabe- The reports included a mid-point evaluation tes are two to four times more vulnera- of the implementation of the WHO global ble to becoming severely ill with or die action plan for the prevention and con- from COVID-19. There are widespread trol of noncommunicable diseases 2013– disruptions in NCD services and they 2020 (NCD-GAP), which has now been are having very negative consequences: extended to 2030 to align with the SDG under-diagnosis of cancers, an increase agenda. They also included a final evalua- in out-of-hospital death and long-term tion of the global coordination mechanism complications. Tackling NCDs must be an on the prevention and control of noncom- integral part of the immediate response to municable diseases (GCM/NCD). COVID-19 and of the recovery at global, regional and national levels, as well as part The EB adopted decision EB148(7) and of the strategies to build back better. The requested the DG, in consultation with current capacities for NCD surveillance Member States, to develop an option paper remain inadequate in many countries and on the GCM/NCD for further guidance by

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the 74th WHA and to present a 2023-2030 roadmap for the NCD-GAP 2013-2030 for consideration by the 75th WHA.

Ending tuberculosis Documents: A73/4, WHA73.3 critical to ending TB and advancing related research and innovation. The 2030 mile- Tuberculosis (TB) is the leading cause of stone of ending the TB epidemic will not death from a single infectious agent glob- be met without strengthening linkages ally with approximately 1.5 million deaths between elimination of TB and relevant in 2018 and drug-resistant TB poses a SDG targets, including through universal serious threat to health security and anti- health coverage and intensified research microbial resistance. There is an over- and innovation. whelming urgency to make available new TB medicines, diagnostics, and vaccines The global strategy for tuberculosis but the pace of local innovation is impeded research and innovation will support the by weak links between national TB pro- efforts of governments and other stake- grammes and public research institutes, holders to accelerate TB research and and by a lack of adequate research infra- innovation and improve equitable access structure in many countries with a high to the benefits of research. burden of TB. Furthermore, commitments made through United Nations high-level The WHA adopted resolution WHA73.3 in meetings on AIDS, universal health cov- which it adopted the global strategy. erage, and antimicrobial resistance are

Data and innovation: draft global strategy on digital health Documents: A73/4, WHA73(28) vision of health for all.

The SDG agenda notes that the spread The Strategy has four strategic objec- of information and communication tech- tives: 1) promote global collaboration and nology and global interconnectedness advance the transfer of knowledge on has great potential to accelerate human digital health; 2) advance the implemen- progress, bridge the digital divide and tation of national digital health strategies; develop knowledge societies. Strategic 3) strengthen governance for digital health and innovative use of digital technologies at global, regional and national levels; 4) will be and essential element of achieving advocate people-centered health system the WHO triple billion goals. The Global that are enabled by digital health. Strategy on Digital Health 2020-2025 aims to strengthen health systems through The WHA adopted decision WHA73(28) in the application of digital health technolo- which it endorsed the global strategy on gies for consumers, health professional digital health. health care providers and industry towards empowering patients and achieving the

Substandard and falsified medical products Documents: EB148/12 from this issue, with reports of substandard or falsified medical medicines, vaccines Substandard and falsified medical products and in vitro diagnostics from all regions of continue to pose an unacceptable global the world. public threat. WHO has identified this issue as one of the urgent health challenges for The EB noted the report which contains the next decade given that more than one the reports of the 8th and 9th meetings in ten medicines in low- and middle-income of the Member State mechanism on sub- countries are estimated to be substandard standard and falsified medical products or falsified. No country remains untouched which took place in October 2019 and

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2020 respectively. The list of prioritised • Develop and leverage existing activities for 2020-2021: activity for effective risk • Develop and promote training communication and make material and guidance documents to recommendations for awareness strengthen the capacity of national/ campaigns on substandard and regional regulatory authorities for falsified medical product the prevention and detection of, • Enhance Member States’ capacity and response to, substandard and to expand awareness, effectiveness, falsified medical products impact and outreach in their work on • Expand and maintain the Global substandard and falsified medical Focal Point Network among national products’ medicines regulatory authorities • Promote shared understanding to facilitate cooperation and among Member States from a public collaboration health perspective regarding medical • Improve Member States’ products in transit; understanding of detection • Identify and develop appropriate technologies, methodologies and strategies to understand and “track and trace” model address the distribution or supply of • Increase Member States’ knowledge substandard and falsified medical of the links between substandard products via the internet. and falsified medical products and access to quality, safe, efficacious and affordable medical products

Hoi Shan Fokeladeh, Advisor, Nursing & Health Policy – Delivering an ICN intervention virtually

Social determinants of health Documents: EB148/24, EB148.R2 development. The COVID-19 pandemic has disproportionately affected already The first principle of the WHO Constitution vulnerable communities, highlighting the includes the need to tackle the root causes scale of health inequalities at all levels. of disease which involves systematically There is growing evidence of the role addressing social, environmental and played by SDoH on the differentials in economic determinants of health (SDoH). expose, vulnerability, health outcomes and SDoH negatively affect health outcomes consequences of the COVID-19 pandemic. and lead to health inequities (avoidable and unfair difference in health status The EB report outlines the rationale for between groups) which undermine human integrating a focus on SDoH into global

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and national health responses, the impor- public health emergencies. The resolution tance of which has been brought into sharp requests the DG to: 1) support Member relief by the pandemic of coronavirus dis- States in monitoring and capacity-build- ease (COVID-19). ing to address SDoH and to facilitate knowledge exchange on best practice for The EB recommended to the 74th WHA intersectoral action on SDoH; 2) prepare the adoption of resolution EB148.R2 which an updated report on progress made in calls on Member States to: 1) strengthen addressing SDoH and recommendations efforts on addressing SDoH with the aim for future action for consideration by the of reducing health inequities an address 76th WHA in 2023; 3) prepare an opera- unequal distribution of health resources; tional framework for measuring, assessing 2) monitor and analyse inequities in health and addressing SDoH and health inequi- using cross-sectoral data to inform national ties ad their impact on health outcomes policies that address SDoH; 3) integrate for consideration by the 76th WHA; 4) considerations related to SDoH in public strengthen collaboration with UN agencies, policies and programmes using a health- civil society and the private sector; 5) work in-all-polices approach; 4) along with all collaboratively with academia and scien- stakeholders, mobilise financial human tific research to generate evidence and and technological resources to enable the best practices. monitoring and addressing of SDoH; 5) SDoH in COVID-19 recovery and for future

Accelerating the elimination of cervical cancer as a global public health problem Documents: A73/4, WHA73.2 The WHA adopted resolution WHA73.2 in Cervical cancer is the fourth most com- which it adopted the global strategy and mon cancer among women worldwide but its associated goals and targets for the is preventable and curable through vacci- period 2020-2030; urged Member States nation, screening and treatment. There is to implement the interventions in the global a disproportionate burden in remote and strategy; called upon stakeholders to sup- hard-to-reach areas, on marginalised com- port implementation of the strategy, coor- munities or those in vulnerable situations, dinate efforts, and work collaboratively to and on women and girls living with HIV, in avoid shortages and strengthen the sup- which this is the most common cancer. The ply of vaccines, tests and diagnostic tools, human papillomavirus (HPV) is the primary medicines, radiotherapy and surgery in cause of cervical cancer and prioritisation respect of human papillomavirus in order of vaccination of girls against HPV is the to meet the growing demand, including most effective long-term intervention for by reducing prices and increasing global reducing the risk of cervical cancer. The and local production, and to develop fur- disease burden is the highest in low- and ther cost-effective and innovative interven- middle-income countries where many do tions for vaccination, screening, diagnosis, not have national vaccine implementation treatment and care; and requested the DG and have limited screening and treatment. to provide support to Member States on a number of issues in implementing the The global strategy to eliminate cervical strategy including build health workforce cancer as a public health problem sets capacity and to prioritize support for inter- 90-70-90 targets to reach by 2030: 90% of ventions for high-burden countries being girls fully vaccinated with the HPV vaccine mindful of the burden on vulnerable and by the age of 15; 70% of women screened marginalised communities and on women using a high-performance test by the age and girls living with HIV. of 35, and again by the age of 45; and 90% of women identified with cervical disease receive treatment (90% of women with pre-cancer treated and 90% of women with invasive cancer managed).

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The highest attainable standard of health for persons with disabilities Documents: EB148/36, EB148/CONF./8, attainable standard of health; 2) address EB148.R6 all obstacles that prevent persons with disabilities from accessing health care The rights of people with disability are not services, information, skills and goods by being met when it comes to equal access making facilities accessible, training health to health services, protection during health professionals on the human rights, dig- emergencies and achieving the high- nity, autonomy and needs of person with est attainable standard of health through disabilities and by providing appropriate access to cross-sectoral public health measures for exercising legal capacity; 3) interventions, such as water, sanitation develop, implement and strengthen poli- and hygiene services. This failing inevita- cies and programmes that improve access bly reflects the lack of inclusion of people to rehabilitation; 4) collect health-related with disability in society more widely and data, disaggregated by disability, age perpetuates discrimination against them. and sex, education level and household income; 5) provide health services and The WHO global disabilities action plan care of the same quality as others without 2014-2021: better health for all people with discrimination on the basis of disability; 6) disability, developed to scale up the health take measures to ensure comprehensive, sector response for people with disability, accessible and affordable access to health will expire in 2021 and the EB report laid systems and care for all persons with dis- out the progress made thus far. Much pro- abilities, while recognising the unique vul- gress has been made, but it is clear that nerabilities of those who may be living in major gaps still exist; people with disa- care and congregated living settings in bility continue to face significant barriers times of public health emergencies such and inequalities in accessing everyday as COVID-19. The resolution invites other health services. WHO noted that failure stakeholders to collaborate with Member to include people with disability in health States, forge partnerships to share knowl- responses to COVID-19 has left them par- edge, amplify the voices of persons with ticularly exposed to the risks of contracting disabilities, and include these persons in COVID-19, developing severe symptoms health research. The resolution further or dying from COVID-19, as well as having requests the DG to: 1) develop a global poorer health in general during and after report on the highest standard of health the pandemic. for persons with disabilities that addresses effective access and quality health ser- The EB recommended that the 74th WHA vices, including universal health coverage adopt resolution EB148.R6 in which it (with rehabilitation as part of it), health urges Member States to: 1) incorporate a emergencies and health and wellbeing, disability- and gender-sensitive and inclu- by the end of 2022; 2) fully implement the sive approach in decision making and UN Disability Inclusion Strategy across all designing programmes in order that they levels of WHO; 3) support the creation of receive effective health services as a part a global research agenda; and 4) provide of UHC, equal protection during complex Member States with technical knowledge humanitarian emergencies and disasters, and capacity-building support necessary to and equal access to cross-sectoral public incorporate a disability-sensitive and inclu- health interventions to achieve the highest sive approach.

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Howard Catton, ICN CEO

International Council of Nurses 3, Place Jean Marteau 1201 Geneva, Switzerland +41229080100 [email protected] www.icn.ch

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