2.2 Epidemics and pandemics prevented
2.2.2 Proven prevention strategies for priority pandemic-/epidemic-prone diseases implemented at scale
Scorecard
The strong global scoring for WHO’s leadership in the context of output 2.2.2 can be attributed to shared achievements in implementing prevention strategies for yellow fever, cholera, meningitis and viral hemorrhagic fevers, including Ebola virus disease. Despite the challenges posed by COVID-19 in 2020, WHO provided apt technical support to Member States and partners such as issuing guidance on decision-making principles and standard operating procedures to inform global vaccine allocation, an important pillar of the disease-specific prevention strategies. The global scores for the Secretariat’s delivery of global public health goods and value-for-money reflect its consequential work in this area, as well as its having seized the opportunity to further leverage and jointly implement new solutions and approaches to overcome the challenges of COVID-19. WHO will continue to bridge and scale partnerships to build an overarching platform for the management of pandemic- and epidemic-prone diseases which employ similar mechanisms and target many of the same vulnerable populations and at-risk geographic areas. Underpinning these strategies will be WHO’s increasing integration of gender, equity and human rights into all aspects of health emergency prevention by collating and using more disaggregated data, prioritizing actions according to health needs and risks, and equitably distributing resources such as vaccines.
Achievements and challenges
Throughout 2020 WHO has continued to work with partners to develop and deliver global strategies to prevent and control high-threat infectious hazards. Despite COVID-19 WHO was able to continue to address priority high-threat pathogens and epidemic-prone diseases including viral haemorrhagic fevers, yellow fever, meningitis and cholera.
The Eliminate Yellow Fever Epidemics (EYE strategy) completed its fourth year of a 10-year plan and despite the global challenges of COVID-19 was able to adapt in effective and innovative ways. The EYE partnership successfully procured critical supplies of personal protective equipment to enable vaccination campaigns to continue against the background of COVID-19, and the annual EYE partners’ meeting was held virtually with over 215 participants from 44 countries.
Yellow fever vaccine supply has improved significantly, and it is estimated that approximately 48 million people were protected against yellow fever in Africa and the Americas by mass vaccination campaigns during 2020. Notable progress was made in Nigeria, which implemented a phased campaign targeting over 40.7 million people, while Brazil maintained vaccination in states and municipalities with yellow fever circulation and Bolivia and Colombia resumed postponed vaccination campaigns.
There were also important technical developments such as the publication of decision-making principles and standard operating procedures to inform global vaccine allocation for preventive mass vaccination; updated surveillance standards, with renewed emphasis on a detailed clinical, epidemiological and vaccination history; and the endorsement of a national risk assessment tool for yellow fever in Africa and a third regional reference laboratory for faster confirmation.
Since the launch of the report of the Global Task Force on Cholera Control and its road map to 2030, Bangladesh, Zanzibar (an autonomous region of the United Republic of Tanzania) and Zambia have formally launched comprehensive plans for cholera elimination. Somalia has finalized its plan; and Ethiopia, Kenya, the United Republic of Tanzania and Zimbabwe are currently developing their national cholera control plans along the lines set out in the Global Roadmap. By the end of 2020, a total of 74 million doses of oral cholera vaccines had been shipped to 22 countries under the strategy.
Although the COVID-19 pandemic led to a global disruption of immunization activities including oral cholera vaccine campaigns, both outbreak response and preventive campaigns were able to safely and successfully resume in 2020. A total of 13 million oral cholera vaccine doses were shipped to eight countries during 2020, including almost eight million doses for preventive vaccination. Responses to cholera outbreaks were implemented in Cameroon, the Democratic Republic of the Congo, Ethiopia, Mozambique and Uganda. Preventive campaigns were implemented or are being implemented in the Democratic Republic of the Congo, Uganda, Zambia as well as Zanzibar in the Republic of Tanzania.
The first-ever resolution for meningitis prevention and control was endorsed by the Seventy-third World Health Assembly in November 2020, paving the way for implementation of a global road map for defeating meningitis by 2030, as approved by Member States. Collaborative networks combining emergencies and response to epidemics, prevention and management of neurological complications and sequelae, and prevention of cases and deaths by vaccination are now in place to ensure its implementation. Despite the impact of the COVID-19 pandemic on immunization activities, the Secretariat has supported the immunization of more than 28 million individuals through preventive or reactive vaccination in three African countries. The result of these steady efforts up to 2020 has been the elimination of meningococcal serogroup A epidemics in Africa and control of major outbreaks due to other serogroups. A platform for integrated surveillance is now being implemented in Member States of the African Region, with the promotion and identification of a new generation of rapid diagnostic tests for meningitis.
WHO continues to implement global and regional prevention and control activities for viral haemorrhagic fevers including Ebola virus disease. These served as the basis for revised guidance documents, training, country-based strategies and R&D products (vaccines, therapeutics and diagnostics) during the recent 2018–20 Ebola outbreaks in the Democratic Republic of Congo and Uganda. In 2020 the International Coordinating Group on Vaccine Provision – which brings together IFRC, MSF, UNICEF and WHO – announced the establishment of a global Ebola vaccine stockpile to contain future Ebola epidemics by ensuring timely access to vaccines for the 23 at-risk countries in Africa. The Ervebo® licensed vaccine is now prequalified by WHO and licensed by the US Food and Drug Administration as well as in eight African countries. Two anti-Ebola monoclonal therapeutics, Inmazeb® and Ebanga®, were both approved by US Food and Drug Administration for treatment of Ebola virus disease; discussions are ongoing to establish a global therapeutics stockpile.
Looking forward, WHO will work with partners to ensure that the response to COVID-19, and in particular the drive to strengthen national capacities for rolling out COVID-19 vaccines, translates into accelerated progress for the prevention of epidemics and pandemics. Although the approach to controlling each vaccine-preventable disease is different, the various control strategies have a number of key common requirements such as mechanisms to allocate scarce resources and platforms to plan, coordinate and resource national control strategies and subsequently integrate them into national health systems. Crucially, most control strategies target the same countries and regions, which very often tend to be low-capacity, fragile, conflict-affected and vulnerable settings. Tools developed to plan, coordinate and resource national COVID-19 action plans point towards a new, integrated approach in epidemic and pandemic prevention that rallies disease-control programmes, national authorities, partners and donors around common plans and shared platforms for coordinating and operationally supporting disease-control strategies likely to benefit the most vulnerable populations.