Thirtieth Standing Committee of the Regional Committee for Europe: Copenhagen, Denmark, 7–8 June 2023: report of the fourth session

Thirtieth Standing Committee of the Regional Committee for Europe Fourth session Copenhagen, Denmark, 7–8 June 2023 EUR/SC30(4)/REP 17 July 2023 | 230479 ORIGINAL: ENGLISH Report of the fourth session EUR/SC30(4)/REP page 2 Contents Opening of the session ............................................................................................................................ 3 Introduction........................................................................................................................................ 3 Opening remarks ................................................................................................................................ 3 Adoption of the provisional agenda and provisional annotated programme......................................... 3 Activity report by the WHO Regional Director for Europe ...................................................................... 3 Update on the health emergency response in the WHO European Region............................................ 5 Discussion ........................................................................................................................................... 6 Implementation of decision EUR/RCSS3(2) ............................................................................................. 7 Updates from the subgroups of the Thirtieth Standing Committee of the Regional Committee for Europe ................................................................................................................................................ 7 SCRC subgroup on WHO/Europe’s work at the country level............................................................ 7 SCRC subgroup on WHO/Europe’s governance ................................................................................. 8 73rd session of the WHO Regional Committee for Europe ..................................................................... 8 Provisional agenda and provisional annotated programme .............................................................. 8 Technical items on the RC73 agenda ................................................................................................. 9 Governance items on the RC73 agenda ........................................................................................... 11 Address by a representative of the Staff Association of the European Region of the World Health Organization ............................................................................................................................... 12 Regional implications of recent global governing bodies meetings ...................................................... 13 Private session ....................................................................................................................................... 14 Membership of WHO governing bodies and committees: assessment by the SCRC of nominations received ....................................................................................................................... 14 Election of officers for RC73 ............................................................................................................. 14 Elective posts on global governing bodies ....................................................................................... 15 Closure of the session ............................................................................................................................ 15 Annex 1. Agenda .................................................................................................................................... 16 Annex 2. List of participants .................................................................................................................. 17 EUR/SC30(4)/REP page 3 OPENING OF THE SESSION Introduction 1. The fourth regular session of the Thirtieth Standing Committee of the Regional Committee for Europe (SCRC) took place on 7–8 June 2023 in hybrid format hosted from the WHO Regional Office for Europe (WHO/Europe) main office in Copenhagen, Denmark. The SCRC met in closed session on 7 June to discuss implementation of decision EUR/RCSS3(2) (item 5 of the agenda) and updates from its subgroups (item 6 of the agenda), with a further private session to discuss elections and nominations (item 10 of the agenda). Remaining agenda items were discussed in a public meeting on 8 June, open to all Member States in the WHO European Region, pursuant to Rule 3 of the Rules of Procedure of the Standing Committee of the Regional Committee for Europe. Opening remarks 2. The Chairperson welcomed all participants and declared the meeting open. The report of the third session of the Thirtieth SCRC, held on 14–15 March 2023 in Almaty, Kazakhstan, had been circulated to SCRC members, comments had been incorporated, and the report had been duly approved electronically and published on the WHO/Europe website. ADOPTION OF THE PROVISIONAL AGENDA AND PROVISIONAL ANNOTATED PROGRAMME 3. The provisional agenda (document EUR/SC30(4)/1) and provisional annotated programme (document EUR/SC30(4)/2)) were adopted. 4. One SCRC member suggested that consideration should be given to producing a “living”, interactive combined agenda and programme, with live links to documents. ACTIVITY REPORT BY THE WHO REGIONAL DIRECTOR FOR EUROPE 5. The WHO Regional Director for Europe said that WHO/Europe’s activities continued to take a dual- track approach: ensuring preparedness for future health emergencies while strengthening essential basic health services. Despite COVID-19 and mpox having been declassified as public health emergencies of international concern, and the state of emergency following the earthquakes in Türkiye having been lifted, the devastating war in Ukraine remained an ongoing and unfolding health emergency. In the days following the collapse of the Nova Kakhovka dam, WHO had provided support for the prevention of waterborne diseases and was working with the Ministry of Health of Ukraine to conduct continual health needs assessments. Lack of access to the occupied parts of Kherson remained a critical issue. There had been more than 1000 attacks against health care during the 15 months of full-scale war in Ukraine. Health should never be a target. 6. With regard to protecting against health emergencies, WHO/Europe was moving towards a new phase in the COVID-19 response and recovery through a regional transition plan, to be launched imminently, which would include 13 strategic shifts to support countries and communities. The transition would frame the development of the next five-year regional strategy and action plan for health emergency preparedness, response and resilience, Preparedness 2.0. Support for Ukrainian refugee-receiving countries had been separated from health emergency operations in Ukraine. In April, a high-level consultation with six key refugee-hosting countries had been held in Bratislava, Slovakia, to share best practices and lessons learned, build capacity to deliver health services, and develop contingency plans for unforeseen future EUR/SC30(4)/REP page 4 events. The first meeting of the Technical Advisory Group on Risk Communication, Community Engagement and Infodemic Management had been held. Lastly, greater attention was being paid to long COVID, which was affecting one in 10 COVID-19 survivors in the Region, through a three-tiered approach: recognition; research and reporting; rehabilitation. 7. On moving towards universal health coverage, a regional meeting on the health and care workforce had been held in Bucharest, Romania, highlighting that the health workforce was already in crisis. The meeting had culminated in the adoption of the Bucharest Declaration on the health and care workforce, urging political action and commitment to protect, support and invest in health and care workers across the Region. The framework for action on the health and care workforce in the WHO European Region 2023–2030 would be presented at the 73rd session of the WHO Regional Committee for Europe (RC73). Policy dialogues had been held across central Asia on various topics. The Ninth High-level Meeting of the Small Countries Initiative had culminated in a statement on mental health, digital tools in health, access to medicines, the health and care workforce, and the prevention and control of noncommunicable diseases (NCDs). 8. With regard to promoting health and well-being, the HIV situation in eastern Europe and central Asia was particularly concerning. Key populations – people who inject drugs and men who have sex with men – faced legal barriers, discrimination and stigma that hindered their access to life-saving medicines and health care. Late diagnosis was a significant problem. HIV detection and treatment programmes must therefore be a political and investment priority. Evidence-informed policy would be key. With regard to tuberculosis, progress had been made: a six-month injection-free treatment programme had been developed for multidrug-resistant tuberculosis, which needed to be rolled out. A ministerial conference on environment and health would be held in Budapest, Hungary, in July. Lastly, the WHO European Healthy Cities Network had done much to show solidarity and support to Türkiye in the wake of the devastating earthquakes. 9. A Special Initiative on NCDs and Innovation had been established by the Regional Director, to consider urgent action required to meet the Sustainable Development Goals by the target date of 2030, in particular to reduce death by stroke in the eastern part of the Region and death from cancer in the western part of the Region. The Special Initiative would also take a more forward-looking approach, beyond 2030, to consider the generational shift required to build a Region resistant to NCDs as a vision for 2050. 10. Refugee and migrant health remained at the forefront of WHO/Europe’s work, in the spirit of the European Programme of Work, 2020–2025 (EPW), and leaving no one behind. The second high-level interregional meeting on the health of refugees and migrants had been held. The joint initiative by the three WHO regional directors for Africa, Europe and the Eastern Mediterranean was intended to develop a new narrative on migrant health, underpinned by the principles of solidarity, humanity, human rights and sustainable development. A new WHO report had recently been launched, Addressing human trafficking through health systems: a scoping review, proposing a series of policy considerations, including the need to train health professionals in survivor-centred trauma-informed care. The report underlined the unique position of health systems and health workers to identify, treat and protect trafficked persons and those at risk. 11. The four flagship initiatives of the EPW were well under way. On immunization, the Roadmap to Accelerate the Elimination of Cervical Cancer as a Public Health Problem in the WHO European Region 2022–2030 was being implemented. WHO provided direct support to Member States, such as through a recent mission to Kazakhstan to meet parliamentarians and give guidance on a human papillomavirus (HPV) vaccination strategy, vaccine procurement and a plan for vaccine introduction. With regard to behavioural and cultural insights, several activities had been undertaken, including working with individual Member States to incorporate behavioural and cultural insights into public health work. Tailored country support was being provided for mental health initiatives in several Member States. Lastly, the call for applications to join the Strategic Partners’ Initiative for Data and Digital Health had been launched. EUR/SC30(4)/REP page 5 12. On empowering leadership in health care, direct country contact was crucial. Four country missions had been conducted from March to May 2023, including the first ever mission to Greenland, to visit island communities and meet a local health worker to discuss health care administration and mental health challenges in remote locations with extreme weather conditions. Three high-level ministerial visits and six diplomatic missions had been received at the WHO/Europe main office in Copenhagen. Several activities had been undertaken with regard to country partnership. WHO/Europe continued to work closely with the European Commission and the Eurasian Economic Commission on health care cooperation. 13. With regard to the Pan-European Leadership Academy, the Tier 2 demonstration project had been completed in May 2023. Tier 3 of the Academy, which would support high-level decision-makers, was currently under development. 14. To ensure that WHO/Europe was fit for purpose, the first Topline Accountability Report would be presented to RC73, looking into the health of WHO as an organization. The WHO/Europe Enabling Hub in Istanbul, Türkiye, would be opened in July 2023, beginning with a partial relocation of a restructured and strengthened Division of Business Operations, which would greatly enhance WHO/Europe’s capacity to implement the EPW. Progress was being made with the building of infrastructure and facilities, and it was anticipated that the staff transition would be completed by June 2024. Change was being made in close consultation with the Staff Association of the European Region of the World Health Organization (EURSA), with every effort to protect the most vulnerable staff members, in particular those who were locally recruited. 15. Lastly, several significant meetings and events were scheduled for the coming months, in particular the ministerial conference to commemorate 15 years of The Tallinn Charter: Health Systems for Health and Wealth. The conference would focus on building an integrated health systems vision, based on trust and transformation. Patients, nurses and doctors would be front and centre of the discussions. The health system performance assessment framework was being revised, in collaboration with the Organisation for Economic Co-operation and Development. 16. A film on mental health, which had won the very short film category in the recent Health for All Film Festival, was shown. UPDATE ON THE HEALTH EMERGENCY RESPONSE IN THE WHO EUROPEAN REGION 17. The Regional Emergency Director outlined the continuing emergency in Ukraine, and in particular the health-related impacts of the collapse of the Nova Kakhovka dam. WHO/Europe was working closely with the Ministry of Health of Ukraine to tackle the consequences of the ensuing displacement and the longer- term impacts on drinking-water supply, the mental health and social consequences, and the environmental implications. Regular “three-level” missions with incident management team colleagues from the WHO Country Office in Ukraine, WHO/Europe and WHO headquarters were being conducted. WHO/Europe was also providing continuous support to refugee-receiving and -hosting countries and would convene neighbouring countries to discuss common challenges. 18. Ongoing risks to health in Ukraine included the further escalation of conflict and the destruction of critical infrastructure, as well as disruption to and destruction of health services, further displacement and population movement, lack of humanitarian access to certain areas, continued risk of communicable diseases, mental health and psychosocial trauma both in Ukraine and in refugee-receiving countries, and barriers to access to essential health care. The potential for crisis fatigue given the protracted nature of the conflict was worrying. WHO’s priority health actions in Ukraine included supporting emergency and routine health services; providing mental health and psychosocial support; expanding rehabilitation services; distributing medical supplies and equipment, generators and fuel to support continuity of services in hospitals and primary care facilities; and preventing and addressing sexual misconduct, both in Ukraine and in refugee-hosting countries. EUR/SC30(4)/REP page 6 19. In Türkiye, following the earthquakes of unprecedented scale, WHO was progressing towards support for recovery and reconstruction. More than 55 000 people had died, 107 000 had been injured, and 3 million had been made homeless. The state of emergency had been lifted on 9 May. The response had included an unprecedented deployment of international emergency medical teams. The post-emergency response was being coordinated by the Turkish national medical rescue team and the Ministry of Health. WHO and the United Nations Children’s Fund (UNICEF) were continuing to lead coordination of the health and nutrition sector in several provinces. WHO was working closely with the Ministry of Health, providing training for mental health and psychosocial support, and conducting rapid assessments in the most affected provinces. WHO had provided medical supplies worth US$ 1.6 million to the Ministry of Health and health authorities on the ground. The following priority concerns remained: problems with access to essential health services, partly due to health facility destruction; trauma, disability and rehabilitation service provision; environmental hazards, particularly debris removal and asbestos; and an active cholera outbreak in the north-west Syrian Arab Republic. WHO/Europe was working with the WHO Regional Office for the Eastern Mediterranean to send regular missions into the north-west Syrian Arab Republic. 20. On COVID-19, despite the status of public health emergency of international concern having been lifted, the pandemic continued. A transition plan was being developed for the European Region to preserve the gains made during the pandemic and to build resilient health systems that could prepare for and respond to a range of hazards. The new architecture for health emergency preparedness, response and resilience had five subsystems: building collaborative surveillance systems, in cooperation with the WHO Hub for Pandemic and Epidemic Intelligence; enhancing community protection and establishing risk communication, community engagement and infodemic management; enhancing equitable access to countermeasures by sustaining and expanding the platforms for sharing COVID-19 knowledge; ensuring safe and scalable care; and building on strong and effective emergency coordination. The transition phase, from July 2023 to June 2024, would lead to Preparedness 2.0, the new regional strategy and action plan to strengthen health emergency preparedness, response and resilience in the Region, scheduled for adoption at RC74. 21. Lastly, on mpox, although the status of public health emergency of international concern had been lifted, vigilance was key; resurgences had been noted in parts of France and the United Kingdom of Great Britain and Northern Ireland. WHO/Europe had spearheaded the elimination strategy, based on strong surveillance, availability of diagnostics and vaccines for high-risk groups, and close work with affected communities. A strong One Health approach was needed to ensure that there was no animal reservoir of the virus. Discussion 22. In the discussion that followed, members of the SCRC thanked the Regional Director and Regional Emergency Director for their presentations, which had provided an excellent overview of WHO/Europe’s work. Particular concern was expressed with regard to the situation in Ukraine. Work to strengthen health systems preparedness was commended, in particular efforts to maintain focus on resilience and longer- term issues in the context of acute emergencies. One SCRC member asked, with regard to surveillance and data sharing and the work of the WHO Hub for Pandemic and Epidemic Intelligence, whether national laboratory networks were being asked to contribute data. With regard to the organizational reforms, the move towards greater transparency, good governance and budget management, in consultation with Member States, was appreciated; it was emphasized that every effort must be made to ensure that the practicalities of reform and the uncertainties for staff were also addressed in a consultative manner. 23. The SCRC member from Ukraine thanked the Regional Director, the whole WHO team and all governments and people in the Region that were supporting Ukraine in the current crisis. The collapse of the Nova Kakhovka dam had resulted in a wide range of health risks, to which WHO provided rapid response to support Ukrainian health authorities and health workers in containing the health consequences of flooding. This included delivery of essential medicines to hospitals serving the affected population, disease surveillance, and rapid assessment of mental health and other emerging needs. EUR/SC30(4)/REP page 7 24. An observer from the Russian Federation welcomed the work of WHO/Europe, in particular on HIV in the Region and on emergency preparedness and response, and urged all participants to refrain from politicizing the SCRC’s agenda. 25. The Regional Emergency Director said that there was a general agreement on the benefits of a more integrated approach, in respect of both surveillance and laboratory capacity-building. The Regional Emergency Director stressed that every effort must be made to leverage the priority gains made during the pandemic: significant laboratory capacities had been built in some Member States, such as Tajikistan, which should be maintained. 26. The Regional Director said that WHO/Europe was committed to strengthening cooperation with the WHO Academy in Lyon, France. One Health remained a strong priority. With regard to communication and changing perceptions, WHO/Europe’s work on assessing the quality of care of hospitals would be a good starting point. The Regional Director and all staff would remain committed to helping the people of Ukraine. IMPLEMENTATION OF DECISION EUR/RCSS3(2) 27. The Executive Director, Executive Director’s Division, recalled that on 20 April 2023, 30 Member States in the Region had requested a special session of the Regional Committee, which had been convened in virtual format on 15 May 2023, in line with Rule 5 of the Rules of Procedure of the Regional Committee for Europe. The meeting had been chaired by Ms Kronig Romero (Switzerland), who had served as Executive President of RC72. 28. The Regional Committee had been requested by 30 Member States to consider a draft decision on the closure of the WHO European Office for the Prevention and Control of Noncommunicable Diseases (NCD Office), located in Moscow, Russian Federation, and the relocation of its functions and management of activities to the WHO/Europe main office in Copenhagen. Two proposed amendments to the draft decision had been received: the first from Tajikistan, proposing to relocate the NCD Office from Moscow to Dushanbe, Tajikistan, and the second from the Russian Federation, proposing to establish a subcommittee to discuss the matter further. Over three rounds of voting, the two amendments had been rejected, and the decision to close the NCD Office in Moscow and relocate its functions and management of activities to the WHO/Europe main office in Copenhagen had been adopted without amendment. 29. To implement decision EUR/RCSS3(2), a letter had been sent by the WHO/Europe Secretariat to the Government of the Russian Federation to trigger the clause of the host agreement on closure, within six months, of the NCD Office. The Secretariat had also held discussions with Member States on the financial repercussions of the closure of the Office. A group of 12 Member States had agreed to cover the US$ 5.6 million cost of continuing the Office’s work, uninterrupted, during the transition period. The Office’s international staff had already been relocated to Copenhagen to safeguard the Office’s work. 30. The Chairperson announced that the report on the proceedings of the special session would be circulated to all Member States in the Region for electronic adoption imminently. UPDATES FROM THE SUBGROUPS OF THE THIRTIETH STANDING COMMITTEE OF THE REGIONAL COMMITTEE FOR EUROPE SCRC subgroup on WHO/Europe’s work at the country level 31. The Chair of the SCRC subgroup on WHO/Europe’s work at the country level said that the subgroup had met five times since RC72. The subgroup had considered the work of WHO collaborating centres and subregional cooperation and strategies. At its previous meeting, the subgroup had focused on country EUR/SC30(4)/REP page 8 support teams. Every effort was being made to engage with Member States and hear from them directly about their experiences. The Secretariat had provided information on 10 ongoing projects. 32. The Director, Division of Country Support, said that although the vision of the Strategy for Collaboration Between the WHO Regional Office for Europe and Member States in the WHO European Region was long term, initial measurable progress was already visible in each of the building blocks. The network of WHO collaborating centres had been broadened, and almost half were directly involved in country support. Dialogue with Member States had been stepped up, in particular through the adoption of medium-term country cooperation strategies in nine countries, with a further 20 in preparation. 33. Implementation of the Strategy was being monitored closely; improvements had already been seen in seven of the 10 indicators. The Secretariat would report back to the Regional Committee at RC73, in line with the midterm report on implementation of the EPW. SCRC subgroup on WHO/Europe’s governance 34. The Chair of the SCRC subgroup on WHO/Europe’s governance said that the subgroup had also met five times since RC72. The current year, 2023, was a significant year for the subgroup, as it was required to conduct a periodic governance review as a vehicle for considering several issues in the run-up to RC73 to check that governance systems were functioning well and to propose any changes that the subgroup felt would be worth considering. One of the matters discussed had been the amount of work required to convene a special session of the Regional Committee. The subgroup had also considered draft procedures for creating, renewing or closing geographically dispersed offices (GDOs). Lastly, the subgroup had discussed the format of RC73, which it considered would be best held in person, following the model of the most recent World Health Assembly and Executive Board meetings. RC73 would be livestreamed, to enable anyone unable to attend to follow the proceedings remotely. 73RD SESSION OF THE WHO REGIONAL COMMITTEE FOR EUROPE Provisional agenda and provisional annotated programme 35. The Regional Director said that important lessons had been learned from RC72, in response to which several significant changes had been made to the RC73 agenda and programme. First, budgetary matters would be discussed on the second day to guarantee sufficient time. The number of technical items on the agenda had been reduced to four. Briefings and side events would be held virtually prior to the session. A new procedure was being implemented for the preparation of draft decisions and resolutions, in a process more in line with that of the global governing bodies. Having recently concluded the host agreement with the Ministry of Health of Kazakhstan, the practical and logistic arrangements could proceed. All Member States were encouraged to include a youth representative in their national delegations. 36. With regard to the programme, the first day would be the political day, focusing on the EPW midterm review. A ministerial lunch would be held on the prevention and control of NCDs. The second day would focus on governance, looking at implementation of the recommendations made by the Agile Member States Task Group on Strengthening WHO’s Budgetary, Programmatic and Financing Governance. The third day would be the technical day, with four items on the agenda: health emergencies, including Preparedness 2.0; refugee and migrant health; the health and care workforce; and antimicrobial resistance (AMR). 37. The Head of the WHO European Centre for Primary Health Care gave an overview of the preparations for the International Conference on Primary Health Care Policy and Practice: Implementing for Better Results, which would precede RC73. The Conference would have three main objectives: to take stock of progress and results since the adoption of the Astana Declaration in 2018; to shift the focus from discussing approaches and frameworks to successfully implementing transformation; and to look forward and EUR/SC30(4)/REP page 9 consider how to future-proof primary health care transformation. The Conference would be streamed online, with an online platform being launched in advance, for inclusive participation. The platform would provide live engagement during the Conference, through optional, topical and Region-specific sessions; regional chats and meet-ups; and an online post for exhibits focusing on country transformation and online versions of the innovation booths. 38. One member of the SCRC and one observer welcomed the proposed agenda and programme for RC73, the changes to which constituted a significant step forward and were very positive. Primary health care was considered a crucial issue for the Region, and the International Conference would be an important event. 39. At the recommendation of the SCRC subgroup on WHO/Europe’s governance, the SCRC agreed to hold RC73 in person, with livestreaming to allow external participants to follow the proceedings. 40. The Team Leader, Regional Governance and Languages Unit, presented a timeline for document production for RC73, aiming for the statutory dispatch date of 12 September 2023. The agenda for RC73 would be interactive, with live links to the documents for the session. Conference documents would be prepared as draft decisions. Member States could decide whether to take ownership of those decisions and elevate them to Member State-driven resolutions. 41. A short video was shown, detailing natural, geographical and cultural points of interest in Kazakhstan. Technical items on the RC73 agenda Roadmap on antimicrobial resistance for the WHO European Region 2023–2030 42. The Director, Division of Country Health Programmes, presented the draft roadmap on antimicrobial resistance for the WHO European Region 2023–2030. While many Member States in the Region had a national action plan on AMR, implementation was lacking. The United Nations High-level Meeting on Antimicrobial Resistance, due to be held in May 2024, would be an important opportunity to garner dedicated investment and for WHO to call for joint commitment to implement best practices on AMR. The roadmap had three main outcomes: prevention, control and treatment. It was underpinned by a One Health approach and positioned AMR at the centre of universal health coverage, primary health care and patient safety. The roadmap had been the subject of thorough consultation with Member States, civil society organizations and WHO collaborating centres. A suite of technical guidance documents would be produced and disseminated to support Member States in implementation. A knowledge exchange and implementation platform would be set up, along with a network of national AMR focal points. Inclusive stakeholder forums would be convened to exchange best practices and identify investment areas to optimize implementation of the roadmap. 43. In the ensuing discussion, members of the SCRC welcomed the roadmap and commended the consultative approach in its preparation. One delegation would send its comments on the roadmap in writing. Questions were raised with regard to how measures on AMR fitted into the broader context of surveillance, and what the Secretariat considered to be the potential benefits and risks of having a separate funding stream for AMR, rather than including it in surveillance or clinical outcomes, since countering AMR was not an end in itself. Members also asked whether indicators would be used to measure implementation of national action plans, and how WHO/Europe would provide coordination to ensure a truly pan-European approach, since AMR was a cross-border issue. More information on how the One Health approach would be applied, involving environmental and animal health partners, would be welcome. 44. The Director, Division of Country Health Programmes, said that from the human health perspective, an integrated, coordinated approach was needed. Many Member States had good networks for exchanging ideas and best practices in that regard. Universal health coverage and primary health care provided a good EUR/SC30(4)/REP page 10 foundation for tackling AMR. Laboratory strengthening and surveillance would contribute to improvements in laboratory capacity for work on AMR. Any effort to improve diagnostics would also contribute to tackling AMR. To ensure a pan-European approach, a network of national focal points was being established. Communities of practice in each of the action areas of the roadmap would bring knowledge from across the Region together in one place. 45. The Programme Manager for the Control of Antimicrobial Resistance described ongoing efforts across WHO, through the Working Group on Antimicrobial Resistance, encompassing work on emergencies, infection prevention and control, laboratory quality management, and food safety, among other areas. Laboratory strengthening was integral to core capacities under the International Health Regulations 2005 and a key element in efforts to tackle AMR. A surveillance network for central Asia and eastern Europe was working alongside the European Centre for Disease Prevention and Control’s AMR network and was being expanded. While patients were advised not to obtain antibiotics without a doctor’s prescription, there was indeed a lack of coherence in prescribing. The WHO AWaRe (Access, Watch, Reserve) antibiotic book had recently been published, which was an important reference work. Reference materials on non-antibiotic prescription had also been issued, inspired by the experience of Member States. Behavioural insights were particularly useful with regard to changing attitudes to over-the-counter sales. 46. The Regional Director drew attention to the link with the Access to Novel Medicines Platform, which had been launched through the Oslo Medicines Initiative. Consideration was being given to adding a working group on AMR under the aegis of the Platform, in dialogue with the pharmaceutical industry. Framework for action on the health and care workforce in the WHO European Region 2023–2030 47. The Director, Division of Country Health Policies and Systems, said that the draft framework for action on the health and care workforce in the WHO European Region 2023–2030 was based on five pillars, with health workers at the centre, and a focus on the actions needed to recruit and retain them. Two more pillars constituted the ecosystem in which health and care workers performed, including considerations of how to optimize their performance and how to work with the education sector to build the workforce. The ecosystem was supported by two further pillars: investment and planning, which required a whole-of- government and whole-of-society approach. Each pillar included actions for Member States with support from the Secretariat, and actions to be taken by WHO. An annex provided a monitoring and evaluation framework, including indicators for each pillar. A draft decision was being proposed for adoption of the framework for action, acknowledging the Bucharest Declaration on the health and care workforce, urging Member States to implement the framework and requesting the Regional Director to implement the actions required of the Secretariat. 48. Representatives of several Member States underscored the importance of strengthening the health and care workforce, expressed their support for the draft framework for action and said that they wished to cosponsor a Member State-led resolution on the topic, for adoption at RC73. Health emergency preparedness, response and resilience in the WHO European Region: preparing for an updated regional strategy and action plan (Preparedness 2.0) 49. The Regional Emergency Director described the phased approach that would be taken to designing Preparedness 2.0 in consultation with the SCRC and a technical advisory group that was being established. Key priorities would be presented at RC73 for consultation, leading to the finalization of a fully fledged strategy and action plan for adoption at RC74. Such an approach was intended to allow flexibility to adapt to and take account of the outcomes of several ongoing global processes. Preparedness 2.0 would be based on five strategic priority areas: governance and leadership for health emergencies; collaborative surveillance; community protection; safe and scalable care; and access to countermeasures. Regarding the establishment of the technical advisory group, 17 experts from across the Region had been selected. EUR/SC30(4)/REP page 11 The group would help shape and refine Preparedness 2.0 and would assist in the preparation of the interim report for presentation at RC73. 50. Lastly, the Emergency Medical Teams Initiative would be included in the discussions on Preparedness 2.0. The recent emergency in Türkiye had shown the teams to be a flexible and agile health workforce. Consultations would be held with Member States in the European Region to discuss the recommendation to regionalize the global Emergency Medical Teams 2030 Strategy. 51. One member of the SCRC and one invited guest commented on the dense emergency preparedness agenda. It was important to ensure clarity with regard to the added value of WHO as it worked alongside other organizations and entities with country presence in the emergency response context. A balance must be struck between ensuring the timely development of Preparedness 2.0 and allowing space to adapt to the future outcomes of ongoing global processes. 52. The Regional Emergency Director said that WHO/Europe was fully committed to aligning its emergency response work with that of other agencies and with WHO’s approach at global level. The three- level approach taken in response to the crisis in Ukraine had been highlighted as good practice by Member States. Documentation for RC73 would be submitted in good time. The Technical Advisory Group on the development of the strategy and action plan on health emergency preparedness, response, and resilience (Preparedness 2.0) in the WHO European Region would, however, require time to consult before its interim report could be prepared. Action plan for refugee and migrant health in the WHO European Region 2023–2030 53. The Director, Division of Country Support, said that since the Strategy and Action Plan for Refugee and Migrant Health in the WHO European Region had expired in 2022, a new plan was being prepared, in a thorough consultation process, for the period 2023–2030. The most recent version of the draft action plan included a clarification of the target group based on internationally agreed definitions of refugees and migrants; clearer references to links between migrant health and other programme areas; and a revised indicator framework. Europe’s migrants made a significant contribution to European society and health systems. Without taking measures to address migrant and refugee health, universal health coverage would never be achieved. 54. An observer to the SCRC asked whether the action plan would include concrete examples of emergency situations in the Region that had resulted in population displacement and influenced migrant health. 55. The Director, Division of Country Support, said that a progress report submitted to RC72 (document EUR/RC72/17(I)) had contained a detailed analysis of migration flows and of the diversity of migrant and refugee populations in the Region. Governance items on the RC73 agenda 56. The Executive Director, Executive Director’s Division, said that the second day of RC73 on governance and budget matters would begin with a closed session on elections and nominations for membership of the SCRC, the Executive Board and the Regional Evaluation Group. The plenary would subsequently consider the Topline Accountability Report delivered by the Regional Director, covering four elements to be discussed in sub-sessions throughout the day: budget matters; business operations, human resources and asset management; partnerships; and governance structures and practices. Progress reports and matters arising from the World Health Assembly and the Executive Board would be considered through written statements submitted ahead of the session. 57. The Topline Accountability Report would provide Member States with a review of how WHO/Europe was led, governed and managed and would respond to the recommendations of the Working Group on Sustainable Financing and the Agile Member States Task Group. Consultation with Member States on all EUR/SC30(4)/REP page 12 new initiatives, as recommended by the Agile Member States Task Group, would be a priority for WHO/Europe. A shortlist of 25 key performance indicators had been drawn up, which would be the subject of the consultation. The SCRC subgroup on WHO/Europe’s governance had provided excellent guidance. 58. With regard to documentation, an update on Programme budget 2022–2023 implementation would be presented, along with the regional plan of implementation for Programme budget 2024–2025, which would be based on the priority areas identified by Member States. Other documents would include the standard report and guidance note on membership of WHO bodies and committees, an audit and compliance report, documents relating to accreditation of non-State actors, the report of the five-yearly independent governance review, a report on WHO collaborating centres, a report on hosted partnerships with a focus on the European Observatory on Health Systems and Policies, and the progress reports due at this session. 59. One member of the SCRC suggested, with regard to elections and nominations, that a procedure whereby candidate countries presented themselves and their priorities could be implemented. More information on the links and coordination between country offices, the WHO/Europe main office in Copenhagen and WHO headquarters would be welcome. Another member commended the Secretariat on the concept of the Topline Accountability Report and looked forward to seeing the key performance indicators. The comprehensive overview of how WHO/Europe was using its resources was considered timely and welcome. 60. The Executive Director, Executive Director’s Division, welcomed the suggestion regarding the presentation of candidates for elective posts, which would be given further consideration. 61. The Special Adviser on Transformation and Organizational Development said that efforts were continuing to facilitate enhanced engagement between capitals, the WHO/Europe main office in Copenhagen and the permanent missions in Geneva, to keep colleagues in all locations abreast of the developments in the preparation for governing body meetings, ensure that regional perspectives were reflected in global processes, and vice versa, and maximize information sharing across the Organization in a complex hybrid working environment. ADDRESS BY A REPRESENTATIVE OF THE STAFF ASSOCIATION OF THE EUROPEAN REGION OF THE WORLD HEALTH ORGANIZATION 62. A video statement by the President of EURSA was broadcast, in which she expressed appreciation for the initiatives by the Regional Director and members of the management team to maintain a healthy relationship with staff and foster a spirit of fruitful collaboration with EURSA. 63. The management’s commitment to the survey “Towards a healthy, respectful work environment” was commended. Staff continued to report high workload levels, leading to an unhealthy work–life balance, with 30% of 2022 survey respondents across WHO/Europe having experienced symptoms of burnout. Furthermore, almost half had reported having experienced harassment and other types of offensive behaviour. EURSA urged management to encourage discussion at the team, division and organization levels about working conditions and their potential improvement; encourage staff to participate in the survey and take measures to protect participants’ privacy and data confidentiality; and explore ways to systematically integrate staff health and well-being as a measure of organizational performance. The appointment of the new Coordinator for Preventing and Responding to Sexual Exploitation, Abuse and Harassment (PRSEAH) for WHO/Europe was welcome. 64. EURSA was concerned about the ongoing restructuring of the Division of Business Operations and its impact on the Human Resources and Talent Management Unit and other enabling functions and called on management to ensure transparency in the restructuring process. Previous restructuring processes had shown that early engagement of staff and their representatives was key. EUR/SC30(4)/REP page 13 65. EURSA looked forward to discussing with management its recommendations for updating the flexible working arrangements policy. Regarding the forthcoming comprehensive review of the compensation package, EURSA was committed to working with the human resources team in the Region and the International Civil Service Commission to ensure that the compensation package would be fit for purpose and would allow WHO to attract and retain staff with the highest standards of efficiency, competence and integrity. EURSA called on Member States to ensure that the United Nations common system continued to be based on trust, fairness, reliability, stability, transparency and predictability. 66. To support more connection with staff in country offices and GDOs, the President advised that 50% of members of the EURSA Committee were now stationed in offices outside Copenhagen. WHO/Europe staff reiterated their commitment to continue working to accomplish the Organization’s mandate. 67. One member of the SCRC expressed concern with regard to the reports of staff burnout, high levels of bureaucracy, poor management, and lack of clarity on enabling functions and asked how the Regional Director was seeking to address those issues. 68. The Vice-President, EURSA, said that the Staff Association was working closely with the Regional Director and divisional directors, relaying staff concerns and providing a safe space for staff feedback. EURSA was also working closely with the PRSEAH Coordinator for WHO/Europe. Every effort was being made to cooperate with management and the Regional Director to ensure a physically and emotionally healthy working environment. 69. The Regional Director said that the health and well-being of staff were his priority. The information collected through the survey, which had shown concerning levels of burnout among respondents, would be reported under the key performance indicators of the Topline Accountability Report. The staff well-being indicator would be tracked and shared with Member States. Several initiatives were being taken to protect staff against burnout. Senior managers from country offices, divisions and units had used the survey results at team meetings to identify and manage sources of stress. Managers and teams were supported by the staff physician and the staff counsellor. Monthly well-being webinars were held on topics such as workload and burnout, stress management for managers, grief and loss, and preventing post-traumatic stress. Additional counsellors had been hired to support staff in Ukraine and to address the psychological aftermath of the earthquake in the Gaziantep office in Türkiye. 70. The leadership and management capacities of senior managers were being strengthened, including through the WHO Pathways to Leadership for Health Transformation training workshop, which was run jointly with the WHO Regional Office for Africa. Workshops on psychological safety had been held for 150 staff members. The newly appointed PRSEAH Coordinator for WHO/Europe would lead education, awareness raising, training and action for staff protection, in coordination with global initiatives led by WHO headquarters. 71. Acknowledging the impact of the transition to the Enabling Hub in Istanbul, the Regional Director pledged to ensure that every member of staff affected would have all the necessary information to make decisions about how to proceed. Every effort would be made to ensure that the Hub was fully operational within the target time frame. The interim guidelines on flexible working arrangements had been in place since early 2021, and discussions on enhancing the regional policy would continue, taking account of lessons learned since 2020. REGIONAL IMPLICATIONS OF RECENT GLOBAL GOVERNING BODIES MEETINGS 72. The outgoing Chair of the Executive Board, acting as the link between the Executive Board and the SCRC, described developments at global level with implications for the European Region. In April, the Standing Committee on Health Emergency Prevention, Preparedness and Response had held its second EUR/SC30(4)/REP page 14 meeting. Many issues had been identified that required more discussion at future meetings. A clear role for the Standing Committee on Health Emergency Prevention, Preparedness and Response and its relation to other ongoing processes still needed to be defined. Duplication of work must be avoided. 73. The Seventy-sixth World Health Assembly had been marked by the adoption of Programme budget 2024–2025, with an increase in assessed contributions and the introduction of the replenishment model. It was hoped that those measures would enable WHO to be more independent, efficient and effective, particularly at country level. The Agile Member States Task Group had produced comprehensive recommendations, including a new template and timeline for proposing resolutions. The Task Group had worked closely with the Executive Board, taking the suggestions made during Executive Board retreats and translating them into concrete recommendations. On topics related to the RC73 agenda, the new Global Strategy for Infection Prevention and Control had been adopted and the WHO Global Action Plan on Promoting the Health of Refugees and Migrants had been extended to 2030. Important discussions had been held on health emergency preparedness and response, which should be taken into account during discussions on Preparedness 2.0 at RC73. 74. While repetitive voting on political issues such as the health situations in the occupied Palestinian territory, including east Jerusalem, and the occupied Syrian Golan was a long-standing issue for the World Health Assembly, recent further politicization of the Health Assembly agenda is a matter of concern. PRIVATE SESSION Membership of WHO governing bodies and committees: assessment by the SCRC of nominations received 75. The Thirtieth SCRC met in private session to review the nominations received for membership of the Executive Board, the SCRC and the Regional Evaluation Group. Members of the SCRC assessed which candidates would best meet the selection criteria enumerated in the Rules of Procedure of the Regional Committee for Europe and relevant resolutions. To avoid conflict of interest issues, SCRC members who had submitted nominations for membership of one of the bodies or committees were requested to temporarily leave the meeting when candidates for that particular body were being evaluated. 76. The Secretariat was asked to draft assessment reports, informed by the discussion, listing the candidates for each governing body and committee that the SCRC deemed to have best met the criteria enumerated in the Rules of Procedure of the Regional Committee for Europe and relevant resolutions. The assessment reports would be communicated to all Member States that submitted their nomination for a particular governing body or committee in support of efforts to achieve consensus among them, as prescribed by Rule 14.2.2 (b) of the Rules of Procedure of the Regional Committee for Europe. Election of officers for RC73 77. The term of office of the current Vice-Chairperson of the SCRC, who would ordinarily be elected Deputy Executive President of the Regional Committee, was due to expire, therefore precluding her from subsequently serving as Chairperson of the SCRC, as is customary for the Deputy Executive President of the Regional Committee. 78. The SCRC agreed to nominate Dr Adriana Pistol (Romania) to serve as Deputy Executive President of RC73. EUR/SC30(4)/REP page 15 Elective posts on global governing bodies World Health Assembly 79. The SCRC was informed that, for the Seventy-seventh World Health Assembly, the European Region would be required to submit candidates for the following posts: • Vice-President of the Assembly • Vice-Chairperson of Committee A • General Committee: 5 members • Committee on Credentials: 3 members. Executive Board 80. The SCRC was informed that, for the 155th session of the Executive Board, the European Region would be required to submit candidates for the following posts: • Vice-Chair • Standing Committee on Health Emergency Prevention, Preparedness and Response: 2 members. Programme, Budget and Administration Committee of the Executive Board 81. The SCRC was informed that it would be required to submit candidates for one post as member of the Programme, Budget and Administration Committee of the Executive Board. CLOSURE OF THE SESSION 82. Following the customary exchange of courtesies, the Chairperson declared the fourth meeting of the Thirtieth Standing Committee of the Regional Committee for Europe closed. EUR/SC30(4)/REP page 16 Annex 1. Agenda 1. Opening of the session and welcome by the Chairperson 2. Adoption of the provisional agenda and provisional programme 3. Activity report by the WHO Regional Director for Europe 4. Update on the health emergency response in the WHO European Region 5. Implementation of decision EUR/RCSS3(2) 6. Updates from the subgroups of the Thirtieth Standing Committee of the Regional Committee for Europe (SCRC) 7. 73rd session of the WHO Regional Committee for Europe (RC73) (a) Provisional agenda and provisional annotated programme (b) Technical items on the RC73 agenda (c) Governance items on the RC73 agenda 8. Address by a representative of the Staff Association of the European Region of the World Health Organization 9. Regional implications of recent global governing bodies meetings 10. Membership of WHO governing bodies and committees 11. Other matters and closure of the session EUR/SC30(4)/REP page 17 Annex 2. List of participants I. Member States Czechia Representative(s) Dr Alena Šteflová First Medical Faculty of Charles University, Expert to the Ministry of Health Alternate(s) Ms Marcela Kubicova Head of Unit of Bilateral Cooperation and International Organizations, Department of International Affairs and the European Union, Ministry of Health France Representative(s) Professor Christian Rabaud (online) Director General for Health, Directorate General for Health, Ministry for Solidarity and Health Adviser(s) Ms Christine Berling (online) Chief, Department of European and International Affairs, Ministry for Solidarity and Health Dr Roxane Berjaoui Advisor, Department of European and International Affairs, Directorate General for Health, Ministry for Solidarity and Health Greece Representative(s) Dr Asimina (Mina) Gaga Alternate Minister of Health, Ministry of Health Kazakhstan Representative(s) Dr Marat Edigeevich Shoranov1 Rector, Asfendiyarov Kazakh National Medical University Alternate(s) Ms Gulnara Zhanetovna Mukhanova (online) Director, Department of International Cooperation and Integration, Ministry of Healthcare Adviser(s) Ms Yuliya Suchshenko (online) Head of the Department of Global Health and PHC Promotion, The Salidat Kairbekova National Research Center for Health Development, Ministry of Healthcare 1 Chairperson of the Thirtieth Standing Committee of the Regional Committee for Europe. EUR/SC30(4)/REP page 18 Luxembourg Representative(s) Dr Thomas Dentzer Chief Operating Officer, National Health Laboratory, Ministry of Health Montenegro Representative(s) Ms Mirjana Đjuranović Head, Department for international cooperation, Ministry of Health Norway Representative(s) Dr Cathrine Marie Lofthus Secretary General, Ministry of Health and Care Services Adviser(s) Mr Arne-Petter Sanne Senior Advisor, Section for International Cooperation, Ministry of Health and Care Services Romania Representative(s) Dr Adriana Pistol Secretary of State, Ministry of Health Turkmenistan Representative(s) Dr Sachly Nuryyeva Head, Department of Epidemiological Surveillance, State Sanitary-Epidemiologic Service, Ministry of Health and Medical Industry Ukraine Representative(s) Dr Sergii Dubrov First Deputy Minister of Health, Ministry of Health United Kingdom of Great Britain and Northern Ireland Representative(s) Ms Anna Wechsberg International Director, Department of Health and Social Care Adviser(s) Ms Nicky Shipton-Yates WHO Policy Manager, International Directorate, Department of Health and Social Care EUR/SC30(4)/REP page 19 II. Observers and invited guests Dr Marc Danzon (online) WHO Regional Director for Europe emeritus Professor Michel Kazatchkine (online) Special Advisor to Regional Director Dr Hans Troedsson (online) Special Advisor to Regional Director Dr Anne Marie Worning (online) Special Advisor to Regional Director Ambassador Ms Nora Kronig Romero2 (online) Ambassador for Global Health, Head, International Affairs Division, Vice-Director General, Federal Office of Public Health, Switzerland Dr Kerstin Vesna Petrič3 (online) Director-General, Public Health Directorate, Slovenia Ms Michaela Told Consultant on Governing Reform III. WHO Dr Hans Henri P. Kluge Regional Director for Europe Mr David Allen Director, Division of Business Operations Dr Natasha Azzopardi Muscat Director, Division of Country Health Policies and Systems Dr Piroska Ostlin Acting Director, Division of Country Health Policies and Systems Dr Nino Berdzuli Director, Division of Country Health Programmes Mr Robb Butler Executive Director, Executive Director’s Division Ms Oxana Domenti (online) WHO Representative to the European Union Ms Mirona Eriksen Technical Officer, Regional Governance and Languages Unit Dr Gauden Galea Strategic Advisor to the Regional Director Dr Egle Granziera Senior Legal Officer, International, Constitutional, and Global Health Law, WHO Headquarters, Geneva Ms Gabrielle Jacob Special Adviser, Transformation and Organizational Development, Regional Director’s Office 2 Executive President of the 72nd session of the WHO Regional Committee for Europe. 3 Chairperson of the Executive Board, and link between Executive Board and the Thirtieth Standing Committee of the Regional Committee for Europe EUR/SC30(4)/REP page 20 Mr Willy Palm Team Leader, Regional Governance and Languages Unit Dr Gerald Rockenschaub Regional Emergency Director Ms Vladlena Sotskov Technical Assistant, Regional Governance and Languages Unit Dr Gundo Aurel Weiler Director, Division of Country Support Dr Kremlin Wickramasinghe Regional Adviser (Nutrition, Physical Activity and Obesity), Division of Country Health Programmes, Moscow = = =