Seventieth Regional Committee for Europe: virtual session, 14–15 September 2020: matters arising from resolutions and decisions of the World Health Assembly and the Executive Board

W OR LD HEALTH OR GAN IZA T I ON R EGIO N AL OFF I C E FOR E U R OPE UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Telephone: +45 45 33 70 00 Fax: +45 45 33 70 01 Email: eugovernance@who.int Web: http://www.euro.who.int/en/who-we-are/governance Regional Committee for Europe EUR/RC70/6 70th session Virtual session, 14–15 September 2020 27 August 2020 200644 Provisional agenda item 5 ORIGINAL: ENGLISH Matters arising from resolutions and decisions of the World Health Assembly and the Executive Board In May 2020, at its virtual de minimis session, the Seventy-third World Health Assembly adopted resolution WHA73.1 on COVID-19 response. The WHO Regional Director for Europe will also reflect on the regional implications of this resolution, as well as the lessons learned, in his annual report, to be presented to the WHO Regional Committee for Europe at its 70th session. In addition, following informal consultations with Member States on 3 and 26 June 2020, and based on the feedback received from Member States, four resolutions and four decisions of technical substance were considered suitable for adoption by the Health Assembly without further discussion under the written silence procedure. The remaining resolutions and decisions proposed by the 146th Executive Board will be considered at the resumed session of the Seventy-third World Health Assembly, scheduled to take place later in 2020. This document reviews the resolutions and decisions under the technical agenda items referred to above, considered to be of particular interest to the WHO European Region. EUR/RC70/6 page 2 Contents Resolution WHA73.1 ................................................................................................................. 3 COVID-19 response ......................................................................................................... 3 Resolution WHA73.2 ................................................................................................................. 4 Global strategy to accelerate the elimination of cervical cancer as a public health problem and its associated goals and targets for the period 2020–2030 .......................... 4 Resolution WHA73.3 ................................................................................................................. 5 Global strategy for tuberculosis research and innovation ................................................. 5 Resolution WHA73.4 ................................................................................................................. 5 Integrated people-centred eye care, including preventable vision impairment and blindness ........................................................................................................................... 5 Resolution WHA73.5 ................................................................................................................. 6 Strengthening efforts on food safety ................................................................................. 6 Decision WHA73(9) .................................................................................................................. 7 Immunization Agenda 2030 .............................................................................................. 7 Decision WHA73(11) ................................................................................................................ 8 Global strategy and plan of action on public health, innovation and intellectual property ............................................................................................................................. 8 Decision WHA73(12) ................................................................................................................ 9 Decade of Healthy Ageing 2020–2030 ............................................................................. 9 Decision WHA73(14) .............................................................................................................. 10 Influenza preparedness ................................................................................................... 10 EUR/RC70/6 page 3 Resolution WHA73.1 COVID-19 response Regional implications 1. Resolution WHA73.1 requests the Director-General to allocate the necessary financial and human resources at all levels of the Organization for activities to support Member States in improving health emergency preparedness. To further enhance emergency preparedness in the European Region, the Regional Office is establishing a geographically dispersed office (GDO) in Istanbul, Turkey, for emergency preparedness and response. The GDO’s main focus will be capacity-building and skills development in emergency risk management. It will work closely with the preparedness, readiness and capacity-building team in the Regional Office to provide normative programmes and regionally-adapted guidance to Member States. 2. Strengthening preparedness is a critical component of Priority 2 of GPW 13, in particular Outcome 2.1, “countries prepared for health emergencies”, and of EPW’s core priority 2, “protecting against health emergencies”. 3. Guided by GPW 13, the IHRMEF and the Action Plan to Improve Public Health Preparedness and Response in the WHO European Region 2018–2023, the health emergencies programme in the European Region is supporting countries in assessing the status of their national preparedness, readiness and response capacities, and promoting knowledge sharing by documenting good practices. • As at 1 July 2020, 51 States Parties in the European Region had submitted their self-assessment reports for 2019 using the IHR (2005) State Party self-assessment annual reporting tool, scoring on average 75% across all 13 technical areas under the IHR (2005). The three weakest technical areas on average in the European Region are: points of entry (60%); risk communication (65%); and chemical events (67%). • As at 1 July 2020, 18 countries in the European Region had requested WHO support and completed a joint external evaluation. Although these evaluations have been delayed due to COVID-19, the Regional Office will continue to support the self-assessment process in the six countries that have requested WHO support to conduct a joint external evaluation over the coming two years. • The importance of reviewing lessons learned to improve ongoing and future emergency responses should be reiterated to Member States. Member States are encouraged to review lessons learned from the COVID-19 pandemic and conduct intra-action and after-action reviews of their response at appropriate times. To support Member States in reviewing ongoing COVID-19 response efforts at the country level, WHO has developed COVID-19 intra-action review guidance and an accompanying toolkit. • Due to COVID-19, the annual regional simulation exercise for national IHR (2005) focal points, the Joint Assessment and Detection of Events (JADE), is expected to be postponed to 2021. In November 2019, IHR (2005) national focal points from all 55 IHR (2005) States Parties in the WHO European Region were invited to join the JADE 2019 exercise. Of those 55, 46 States Parties participated in the exercise to assess and further improve their capacities for communication EUR/RC70/6 page 4 and coordination in response to public health events, as per the IHR (2005) obligations. The feedback from participants, including those from western European countries, on the quality and conduct of the exercise, as well as on the overall exercise itself, was overwhelmingly positive. The JADE 2019 exercise, which took place in November 2019, turned out to be very timely, given the COVID-19 pandemic, which hit the European Region only a few months later. Resolution WHA73.2 Global strategy to accelerate the elimination of cervical cancer as a public health problem and its associated goals and targets for the period 2020–2030 Regional implications 4. The Executive Board recommended to the 73rd World Health Assembly the adoption of the Global strategy to accelerate the elimination of cervical cancer as a public health problem. Numerous Member States (including in the WHO European Region, through an online consultation in June 2019) had already agreed to its adoption. The resolution underlines that vaccination against human papillomavirus (HPV), screening for and treatment of pre-cervical cancer diseases, early detection and prompt treatment of early invasive cancers and palliative care will bring countries towards elimination of cervical cancer as a public health threat. The strategy sets ambitious goals to be achieved by 2030: 90% of girls to be fully vaccinated against HPV by the age of 15 years; 70% of women to be screened for cervical cancer at 35 and 45 years of age; and 90% of patients diagnosed to receive treatment for cervical cancer. 5. In the European Region, there are an estimated 69 100 new cases of cervical cancer and 30 200 cervical cancer-related deaths annually. By 2019, 38 of the 53 Member States in the Region had introduced HPV vaccines; many achieved high coverage rates and demonstrated a reduction in HPV infection prevalence and incidence of pre-cervical cancer diseases. In 2016, Uzbekistan was chosen as a “demonstration country” for a coalition of United Nations agencies – WHO, the International Agency for Research on Cancer (IARC), United Nations Children’s Fund, United Nations Population Fund (UNFPA), the International Atomic Energy Agency, UNAIDS, UNWOMEN – to show results. In 2019, the HPV vaccine was successfully introduced in Uzbekistan with WHO and UNICEF support. The WHO Regional Office for Europe, together with the IARC and UNFPA, is supporting both the development of a new screening programme based on HPV testing, and the development of palliative care. Lack of funding remains a challenge for continuing support to low- and middle-income countries for reaching 2030 elimination goals. Despite the efforts of WHO and other United Nations agencies, no major funding has been raised so far. EUR/RC70/6 page 5 Resolution WHA73.3 Global strategy for tuberculosis research and innovation Regional implications 6. The acceleration of research and innovation is in line with the draft European Programme of Work (2020–2025) (EPW) and the Tuberculosis Action Plan for the WHO European Region 2016–2020. To boost progress towards ending tuberculosis (TB) in the Region, the European Tuberculosis Research Initiative (ERI-TB) was established, including key academics, public health and national programme representatives, key partners and community representatives. Through the Initiative, the European TB Research Agenda was developed, which sets priorities and documents good practices on how country research can contribute to better outcomes. 7. To accelerate implementation of innovative treatments for drug-resistant TB (DR-TB), ERI-TB launched regional operational research on the introduction of fully oral more effective and shorter treatment regimens. The new initiative supports 11 Member States with a high burden of DR-TB in scaling up access to new TB medicines, fostering good clinical care, building research capacity and contributing to the generation of evidence to back up new WHO recommendations. 8. To ensure universal access to people-centred TB care, the Regional Office supports the application of digital health solutions for data collection and patient management, and prioritizes Video-Supported Treatment (VST), an alternative to hospitalization and mandatory daily clinic visits. Given the great need to rapidly transition to fully oral and people-centred treatment for DR-TB, the use of VOT brings opportunities to reduce the programmatic costs associated with treatment, minimize transmission of infections, including COVID-19, reduce stigma, and contribute to better treatment outcomes. 9. The Regional Office supports research for country capacity-building through the Structured Operational Research Training TB (SORT-TB) initiative. Resolution WHA73.4 Integrated people-centred eye care, including preventable vision impairment and blindness Regional implications 10. Over 30 million people in the European Region experience visual impairment, including 2.7 million who are blind. In eight out of 10 cases, blindness can be avoided with appropriate treatment or early prevention. Leading causes of visual impairment and blindness in the European Region include noncommunicable chronic eye conditions, such as diabetic retinopathy, glaucoma, age-related macular degeneration, complications of high myopia and retinopathy of prematurity. For example, the 2019 World report on vision highlights that Europe has the highest prevalence of age-related macular degeneration. EUR/RC70/6 page 6 11. Eye care contributes to achieving Sustainable Development Goal 3 (Ensure healthy lives and promote well-being for all at all ages) and its target 3.8 (Achieve universal health coverage, including financial risk protection, access to quality essential health-care services, and access to safe, effective, quality and affordable essential medicines and vaccines for all). To this end, two indicators for eye care – effective coverage of refractive error (tracer indicator 19) and effective coverage of cataract surgery (tracer indicator 31)1 – are being considered for inclusion in the universal health coverage index under the WHO Impact Framework for the Thirteenth General Programme of Work, 2019–2023 (GPW 13), to monitor progress towards universal health coverage. 12. Eye care is also relevant to other Sustainable Development Goals, including Goal 4 (Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all), Goal 5 (Achieve gender equality and empower all women and girls) and Goal 8 (Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all). 13. Consequently, several Regional Office programmes contribute to the prevention of blindness. The WHO noncommunicable diseases best buys2 include diabetic retinopathy screening for all diabetes patients and treatment (and if available, laser photocoagulation) for the prevention of blindness. 14. The WHO European Conference on Screening took place on 11–12 February 2020, with the participation of representatives of 45 countries. It included a special session on diabetic eye screening which provided an opportunity for the sharing of evidence-based approaches, best practice and country experiences. A situation analysis of diabetes eye screening programmes in the European Region is underway, and an operational guide for implementation of diabetes eye screening programmes is being prepared. 15. In June 2019, the Regional Office also initiated a disability and rehabilitation programme, which includes eye care. Efforts are being made to integrate comprehensive eye- care services and secure access to low-vision and rehabilitation services for those in need. An assessment of the met and unmet needs for assistive technology is taking place in several Member States, which includes assistive products for vision impairment and blindness, such as spectacles, optical and digital magnifiers, braille equipment, and talking and touch watches. 16. WHA73.4 provides a mandate for the Regional Office to accelerate actions and develop specific tools for continuing its support to Member States. Resolution WHA73.5 Strengthening efforts on food safety Regional implications 17. Health and food safety are intrinsically linked and must be recognized as preconditions for and outcomes of sustainable development. Food safety and efforts to address zoonotic 1 See document EB144/7, Annex 1, Table 2, available at http://apps.who.int/gb/ebwha/pdf_files/EB144/B144_7-en.pdf. 2 Tackling NCDs: “best buys” and other recommended interventions for the prevention and control of noncommunicable diseases. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/259232). EUR/RC70/6 page 7 diseases are core capacity requirements under the International Health Regulations (IHR) (2005) for preventing the spread of disease. 18. Foodborne diseases are a significant public health concern in the European Region. In 2010, an estimated 23 million people fell ill and approximately 4700 people died from consuming unsafe food. The overall burden of foodborne disease in the Region was estimated to be 413 020 disability-adjusted life years. Unsafe food is not only a threat to human health, but also has a significant impact on socioeconomic development. 19. The Action Plan to Improve Public Health Preparedness and Response in the WHO European Region 2018–2023 was adopted by the Regional Committee through its resolution EUR/RC68/R7. The Action Plan aims to strengthen and maintain adequate capacities in the European Region to effectively prevent, prepare for, detect and respond to public health threats, and to provide assistance to affected countries, when necessary. The Action Plan outlines a series of actions to be taken by Member States and WHO, which includes measures to strengthen the One Health approach to prevent and control emerging and re-emerging infectious diseases, including those caused by unsafe food. 20. Food safety contributes to the EPW’s core priority 2, “protecting against health emergencies” and core priority 3, “promoting health and well-being”. The WHO European food safety and zoonotic diseases programme is closely linked to the health emergencies programme. It aims to strengthen national food safety systems with a particular focus on improving the core capacities for zoonotic diseases and food safety as defined under the IHR (2005). This includes the capacity to monitor and manage antimicrobial resistance in the human–animal–environment interface, detect and respond to food safety incidents and emergencies, address zoonotic diseases through a multisectoral One Health approach, communicate about food safety risks and engage in setting and implementing international food standards. 21. Resolution EB146.R9 requests WHO to update the global strategy for food safety. Member States in the European Region and the European Union have played a key role in bringing the issue of food safety forward to the World Health Assembly. Considering the evolving context of food safety in the European Region, the global strategy is expected to provide strategic direction and a basis for strengthening food safety in the WHO European Region and supporting Member States in managing food safety risks effectively. Decision WHA73(9) Immunization Agenda 2030 Regional implications 22. Given the value in preventing morbidity and mortality from vaccine-preventable diseases, immunization is recognized as a priority public health intervention by the Member States in the European Region. The political commitment to this priority is evident from the broad reach of immunization services in Member States in the Region. WHO/UNICEF 2019 immunization estimates indicate that the European Region has maintained its third dose of diphtheria-tetanus-pertussis (DTP3) vaccination coverage at 95% for the second consecutive year, with 32 countries in the Region reaching more than 95% coverage. EUR/RC70/6 page 8 23. With the European Vaccine Action Plan 2015–2020 coming to an end in 2020, and in the context of the EPW, a multistakeholder consultative process (which includes Member States) will lead to the development of a regional immunization agenda 2030. The agenda will be aligned to the vision and goals of the global Immunization Agenda 2030. Aligning itself to that Agenda, the regional immunization agenda will envision a European Region in which everyone enjoys the full benefits of vaccines throughout the life-course, through measures that are equity based, people focused, country owned, data enabled, partnership based, innovation and research driven, and primary health care based. 24. The Regional Office’s guidance and support to Member States will be needs based, ranging from operational support to policy dialogue on immunization system issues, and disease-specific control activities. Measles incidence and mortality in the European Region have underscored deficiencies in local health systems, immunity gaps in local populations and the need to understand the root causes of underperformance while creating local solutions. Region-specific strategic focus areas, which are developed using a bottom-up process based on national priorities, will serve as the foundation of a regional framework for action. Decision WHA73(11) Global strategy and plan of action on public health, innovation and intellectual property Regional implications 25. The implementation plan for the global strategy and plan of action on public health, innovation and intellectual property, requested by Member States at the Seventy-first World Health Assembly, is currently being developed by WHO headquarters. This, together with the requested informal consultations, is expected to also provide guidance for action at the regional level. 26. Several work streams in the Regional Office already contribute to the implementation of the strategy and plan of action on public health, innovation and intellectual property, as well as the recommendations made by the expert panel that reviewed it in 2018. 27. The Action Plan to Strengthen the Use of Evidence, Information and Research for Policy-making in the WHO European Region (EUR/RC66/12) sets out principles and directions to promote the prioritization, generation and use of health research. Regional cooperation in science, technology and innovation, to enhance knowledge sharing and translation, is fostered by the European Health Research Network. The Evidence-informed Policy Network Europe aims to increase Member States’ capacity to systematically and transparently translate research evidence into both policy and practice. The Health Evidence Network synthesis report series supports public health decision-makers in applying the best available evidence in their decision-making. 28. The Regional Office is fully committed to working with Member States and non-State actors, including from industry, to identify how to enable access to medicines. WHO and the Government of Norway will be hosting a high-level meeting in March 2021 for Member States and stakeholders, including from industry, to review roles and responsibilities under the existing “social contract”. EUR/RC70/6 page 9 29. WHO encourages and supports the application and management of intellectual property in a manner that maximizes health-related innovation and promotes access to health products. Activities need to be consistent with the provisions in the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), including the Doha Declaration on TRIPS and Public Health, and other World Trade Organization instruments related to that Agreement. The Regional Office is able to provide technical support to Member States in the Region, on request, in collaboration with other competent international organizations including, where appropriate, with regard to policy processes and to countries that intend to make use of the provisions contained in the TRIPS Agreement. Decision WHA73(12) Decade of Healthy Ageing 2020–2030 Regional implications 30. The proposed launch of the WHO-led United Nations Decade of Healthy Ageing 2020–2030, on 1 October 2020 (the International Day of Older Persons), coincides with the end of the Strategy and Action Plan for Healthy Ageing in Europe, 2012–2020. The plan for the Decade comprises the second global action plan under the Global strategy and action plan on ageing and health, which will frame continued work on healthy ageing in the European Region. Of the 89 Member States that actively contributed to the consultation process for planning the Decade, 44 were from the European Region, illustrating the Region’s high interest in and political commitment to action on healthy ageing. Based on the Decade and drawing on experience from work with countries in the European Region in 2012–2020, a regional implementation plan could tailor the global framework to the needs of countries in the Region. 31. Three of the four action areas of the Decade are already included under corresponding themes in the European Strategy and Action Plan: creation of age-friendly environments; alignment of health systems to the needs of older persons; and development of systems for long-term care. Under these headings, the Regional Office, in cooperation with Member States, has contributed to the global toolbox for healthy ageing that will continue to provide the basis for work in the European Region during the Decade. The toolbox includes a handbook and set of guidance materials for age-friendly environments, and a country assessment tool including country reports and cross-country assessments on integrated, person-centred long-term care systems. Moreover, the European Region has shown leadership in providing guidance on long-term care in the context of COVID-19, which has served as a blueprint for a corresponding global guide. 32. The fourth action area of the Decade, “change how we think, feel and act towards age and ageing”, has been an underlying principle of work in the European Region. Its inclusion in the plan for the Decade will provide a welcome opportunity to strengthen this aspect of work on ageing and bring together corresponding interventions. The need for countering ageism has also been illustrated during the COVID-19 response in many instances. EUR/RC70/6 page 10 Decision WHA73(14) Influenza preparedness Regional implications Strengthening influenza preparedness in the WHO European Region 33. Implementation of the Pandemic Influenza Preparedness (PIP) Framework partnership contribution (PC) in the European Region since 2014 has resulted in the establishment or strengthening of fundamental surveillance and response capacities in the five PIP PC recipient countries (Armenia, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan). As of 2020, Ukraine is also a PIP PC recipient country. The achievements contribute to the implementation and strengthening of the majority of core capacities under the IHR (2005) and thus preparedness and response to outbreaks of other high-threat pathogens, including the COVID-19 pandemic. 34. Although PIP PC implementation has been delayed due to the COVID-19 pandemic, the focus of the Regional Office’s work with the six PIP PC recipient countries over the coming years will be on further institutionalizing newly established systems and mechanisms, as well as ensuring country ownership and the long-term sustainability of what has been achieved. Issues pertaining to the Nagoya Protocol on Access and Benefit-sharing 35. There are a few known examples in which the Nagoya Protocol has resulted in complications or delays in the sharing of influenza viruses with WHO collaborating centres in time for meetings on the composition of influenza vaccines. The report by the Director-General, contained in document EB146/18, concludes that a systematic approach is needed to gather comprehensive information about these and other issues that are arising. Such a review will involve Global Influenza Surveillance and Response System laboratories and partners. 36. This has the following implications for Member States in the European Region: • Member States are encouraged to speed up implementation of the Nagoya Protocol and follow the example of countries that have adopted legislation in that regard that does not regulate access to genetic resources, such as has been done in the Netherlands.3 Such legislation means that no prior informed consent is needed to access genetic resources in that country, thus reducing bureaucracy and delays when speed is of the essence, such as during a public health emergency. • The importance of timely influenza virus sharing should be reiterated among Member States, especially as influenza surveillance and virus sharing has been compromised as a result of COVID-19. • National influenza prevention and control strategies, including the use of seasonal vaccination, should be promoted. 3 See https://subsites.wur.nl/en/absfocalpoint/policy/Legislation.htm. EUR/RC70/6 page 11 Influenza and COVID-19 37. The timing of the emergence and geographic spread of COVID-19 coincided with the influenza season in the European Region. Public health measures taken in response to the COVID-19 pandemic influenced routine influenza surveillance systems, which include epidemiological and virological surveillance, and impacted influenza transmission. This has important implications for the forthcoming influenza season, in particular for ensuring that all countries restore routine functioning of the Global Influenza Surveillance and Response System and leverage it to monitor COVID-19 as well as influenza. Member States need to remain vigilant to detect seasonal influenza virus variants or viruses with pandemic potential. They will need to continue to share samples and data by WHO to issue influenza vaccine recommendations. They will also need to maintain influenza vaccine programmes this season to ensure that key target groups – in particular health care workers and at-risk groups – are protected to ensure resilience for the health care system. Finally, health systems need to strengthen their preparedness to deal with the potential for COVID-19 and Influenza to occur simultaneously. Member States will need to be able to surge their capacity to deal with these infectious diseases whilst maintaining essential health services. This requires a focused approach that seeks to integrate functions and services for influenza and COVID-19 wherever possible to optimize use of scarce resources whilst recognizing that in some instances differentiated approaches will be necessary. = = =