Executive overview

First health day at the UN Climate Conference

For the first time, a day was dedicated to health at the 2023 United Nations Climate Change Conference (COP 28). More than 40 million health professionals joined the call to action by WHO and civil society organizations to prioritize health in governmental negotiations, aiming to expedite the phase-out of fossil fuels, and 149 countries signed the COP28 UAE Declaration on Climate and Health. These groundbreaking initiatives, coordinated by the WHO Secretariat in partnership with key stakeholders, have elevated the political discourse and effectively integrated health considerations into the global climate change agenda. However, more ambitious action is needed to curb the countless deaths resulting from climate change and environmental pollution each year. The WHO Secretariat will provide support by guiding countries in reducing air pollution and implementing the COP26 commitments to build a climate-resilient, low-carbon and sustainable health system.

45 countries reduced their road traffic death by 30% or more in 10 years

WHO reported that 45 countries reduced their road traffic deaths by 30% or more, despite a proliferation of motor vehicles, during the Decade of Action 2011–2020. The WHO Secretariat has established what works: political will to match the scale and urgency of the crisis combined with WHO best practice measures, such as laws on speed, drink-driving, seat belts, helmets and child car seats. For example, through a network of parliamentarians, the WHO Secretariat facilitated the adoption of the African Union’s Road Safety Charter in all but two countries. However, the decline in road traffic deaths falls far short of what is needed to halve road traffic fatalities by 2030. For its part, the WHO Secretariat is working with 30 high-mortality countries to stabilize and then reduce road traffic death rates by 2025.

53 countries have policies to eliminate trans fats

Another 13 countries implemented best practice policies to eliminate industrially produced trans-fatty acids in the food supply during the biennium, bringing the total to 53 countries, 42 of which have done so since the WHO call for action was issued in 2018. The WHO Secretariat has provided standards and guidance through workshops to increase regulatory and laboratory capacities for developing and implementing trans-fatty acids regulations based on the REPLACE trans fat action package. For example, in 2023, regulatory training was provided in the Region of the Americas and the African Region, while China and Ukraine were supported through WHO laboratory protocols to conduct assessments of trans-fats with limited resources. Despite the progress made to date, more than half of the world’s population are still not covered by trans-fatty acids best practices in countries that together account for at least 90% of the total global trans-fatty acids burden. To drive progress further, the WHO Secretariat has started to to validate whether countries have a framework with a best practice policy as well as robust monitoring and enforcement mechanisms.

56 countries on track to reduce tobacco use

Tobacco use is declining in 150 countries, 56 of which are on track to achieve the global target for reducing tobacco use by 2025. There are 19 million fewer current tobacco users globally than there were two years ago, while 151 countries are protected by at least one measure of the MPOWER technical package and 101 are protected by at least two measures. Member States are increasingly equipped to use fiscal measures to improve health, reduce health care costs and generate a revenue stream for development – thanks in part to increased technical support and updated guidance from the Secretariat; for example, more than 90 countries increased their tobacco excise tax between 2020 and 2022. However, only a 25% relative reduction in global tobacco use is projected for 2025, falling short of the 30% voluntary target agreed in the global action plan for the prevention and control of noncommunicable diseases 2013–2020. While the prevalence of tobacco use among women is tracking towards a 40% relative reduction by 2025, the comparable reduction among men is currently too slow at 21%.  For its part, the WHO Secretariat is working with more than 40 countries to strengthen tobacco control policies at the highest level in order to reduce tobacco use.

178 countries have action plans on antimicrobial resistance

An additional 29 countries developed multisectoral national action plans on antimicrobial resistance during the biennium 2022–2023, bringing the total to 178 countries, while the number of countries reporting data on resistant infections has more than tripled in the last seven years. These data and plans provide the basis for countries to address the resistance to life-saving antimicrobial medicines. The WHO Secretariat supports countries in reporting data to the Global Antimicrobial Resistance and Use Surveillance System and to Tracking Antimicrobial Resistance Country Self-Assessment Surveys; it also provides technical assistance and guidance products such as a core package of people-centred interventions and the WHO AWaRe (Access, Watch, Reserve) antibiotic book. Support is also provided to countries to promote increased community engagement, such as the Communities Empowered to Tackle Antimicrobial Resistance initiative in the Americas. However, only 11% of countries have dedicated national budgets for implementing their national action plans, highlighting the need for enhanced commitments at the United Nations General Assembly high-level meeting on antimicrobial resistance to be held in September 2024.

Reduction in mortality after implementation of WHO toolkit

A study has shown a 34% to 50% reduction in mortality from acute conditions in hospitals in Nepal, Uganda and Zambia following the implementation of WHO emergency care tools and the Basic Emergency Care course that was developed by the World Health Organization, the International Committee of the Red Cross and the International Federation for Emergency Medicine. This toolkit has been implemented by the WHO, nongovernmental organization partners, governments and universities in more than 60 countries. Some countries have incorporated Basic Emergency Care training into local curricula, such as in Costa Rica where it is now a requirement for nursing and medical undergraduates. The study period ranged from 10 to 24 months and the results suggest a reduction in mortality due to pneumonia, diarrhoea, asthma, postpartum haemorrhage, road traffic injury and diabetic crisis (ketoacidosis), suggesting that the toolkit will impact multiple Sustainable Development Goals targets, including those related to under 5 and maternal mortality rates, deaths from noncommunicable diseases and road traffic injuries, and deaths attributable to air pollution and unsafe water and sanitation. The Basic Emergency Care 25x25 initiative for nurses and midwives will bring this intervention to scale in 25 countries by 2025, with additional expansion through the WHO Acute Care Action Network.

Record numbers receive tuberculosis treatment

In 2022, the first-ever all-oral treatment regimens for multidrug-resistant tuberculosis were made available, greatly reducing treatment times and improving the quality of life for people with multidrug- and rifampicin-resistant tuberculosis. WHO introduced guidelines recommending the use of the new all-oral treatment regimens, contributing to uptake in 109 countries. More than 7.5 million people with tuberculosis received access to diagnosis and treatment – the highest since monitoring begun almost 30 years ago. However, incidence remains high and off-target. The WHO Secretariat supported 16 of the countries most disrupted by the COVID-19 pandemic to get back on track towards the End TB Strategy targets. During 2023, a Member States high-level meeting at the United Nations General Assembly political declaration gave a commitment to ensure that at least 90% of those who develop tuberculosis will be treated and at least 90% of those at risk of the disease will be provided with preventive treatment.

Supply constraints resolved with 2 malaria vaccines

During the biennium, the world’s first malaria vaccine, RTS,S/AS01, has been administered to 2 million children in Ghana, Kenya and Malawi, resulting in a vaccine-attributable 13% drop in all-cause mortality among children who are age-eligible for vaccination. During the biennium 2022–2023, WHO also issued prequalification approval for a second vaccine, R21/Matrix-M, and recommended its use in children. The availability of the two vaccines resolves supply constraints and 20 countries have been approved for the support of Gavi, the Vaccine Alliance in introducing the vaccine as a part of their comprehensive malaria control plans. During the biennium 2022–2023, an additional three countries were certified malaria-free by WHO: Azerbaijan, Belize and Tajikistan. When implemented broadly, malaria vaccines are expected to save tens of thousands of lives a year. For its part, the WHO Secretariat is working to support 26 high-burden malaria countries to be on track for achieving the health-related Sustainable Development Goals targets by 2025.

An AIDS-free generation is possible

More than 75% of people living with HIV globally are receiving antiretroviral therapy and almost all of those who are receiving treatment are achieving viral suppression, which means that they cannot infect others. The uptake of WHO guidance has been strong: 150 countries use WHO recommendations on pre-exposure prophylaxis in their national guidelines; 63 countries have routinely implemented national policies supporting HIV self-testing; 116 countries have adopted WHO-preferred first-line antiretroviral therapy for adults and adolescents; and 98 countries have implemented routine data viral load monitoring for adults and adolescents. We are now beginning to see a path towards meeting the Sustainable Development Goals  target of ending the HIV epidemic: six countries have achieved the “95-95-95” goals for the control of HIV and an additional 16 countries are close to doing so, while Botswana became the first high-burden country to be certified by WHO for, among other things, achieving an HIV case rate of fewer than 500 per 100 000 live births. This demonstrates that an AIDS-free generation is possible.

14 countries eliminated at least one neglected tropical disease

A total of 14 countries eliminated at least one neglected tropical disease during the biennium 2022–2023:
- the Democratic Republic of the Congo eliminated dracunculiasis (Guinea worm disease);
- Benin, Iraq, Malawi, Mali, Saudi Arabia, Togo and Vanuatu eliminated trachoma;
- Equatorial Guinea, Ghana, Rwanda and Uganda eliminated African trypanosomiasis;
- Bangladesh and the Lao People’s Democratic Republic eliminated lymphatic filariasis.
In addition, Bangladesh became the first country in the world to eliminate visceral leishmaniasis, thanks to a collaboration including the Special Programme for Research and Training in Tropical DiseasesThis brings to 50 the number of countries acknowledged by WHO as having eliminated a neglected tropical disease, marking the halfway point to the 100-country target set for 2030. Sustained political commitment remains critical to achieving the target.

Projected workforce shortage in 2030 reduced

The 2022 rounded estimates indicate a reduction in the projected global health workforce shortage from the earlier estimate of 18 million to 10 million by 2030, based on current trends (mostly depicting a pre-COVID-19 pandemic situation).  However, there are a number of regional variations; for example, the African and the Eastern Mediterranean regions will have an increasing share of the total health workforce shortage in 2030. The implementation of the National Health Workforce Accounts  system has increased progressively since its inception in 2016; it offers a standardized measurement approach to workforce indicators and human resources for health information systems strengthening and was used by 176 countries in 2023. Looking ahead, the WHO Secretariat is working to support countries, particularly those that will bear an increasing share of the total health workforce shortage in 2030, to stimulate investments in workforce education and employment.

Managing hypertension with WHO HEARTS

An additional seven million people are under treatment for hypertension through application of the WHO HEARTS’ simple, algorithmic approach. The WHO Secretariat reported that improving global blood pressure control from the current level of 23% to 50% or more would avert 76 million cardiovascular deaths, 120 million strokes, 79 million myocardial infarctions, and 17 million cases of heart failure between 2023 and 2050. In addition, WHO developed and promoted the WHO HEARTS’ simple, algorithmic approach to cardiovascular disease management in primary health care. However, more efforts are needed to reach the 1 in 3 adults worldwide affected by hypertension.

Kits provide essential NCD medicines during emergencies

Since 2017, more than 142 000 WHO noncommunicable disease kits have been distributed to 28 countries, territories and areas affected by conflicts and/or natural disasters and placed in humanitarian hubs – including South Sudan, Ukraine and Gaza Strip and West Bank – and making it one of the most purchased emergency kits. Direct technical and financial support to preserve or restore essential NCDs essential services during acute emergencies is part of this response, including through the deployment of WHO NCD emergency kit, an essential set of medicines and supplies for the management diabetes, hypertension, asthma, and other NCDs. Each kit provides affordable, safe and dependable access to lifesaving NCD medicines and supplies for 10 000 people for over three months. However, people affected by humanitarian emergencies are at increased risk of noncommunicable diseases, with 1 in 23 of the world’s population in need of humanitarian assistance in 2023.

International instruments progress

The Intergovernmental Negotiating Body (INB) advanced in drafting a WHO Pandemic Agreement, while the Working Group on Amendments to the International Health Regulations (2005) focused on key amendments to enhance the existing regulations. The aim is for the outcomes of these negotiations to be submitted for consideration by the Seventy-seventh World Health Assembly.

Pandemic Fund disbursed US$ 338 million to 37 countries in 2023

The Pandemic Fund made its first round of disbursements – amounting to US$ 338 million – to 37 countries in 2023. The creation of the Fund in 2022 marked an important change in the world’s commitment to providing dedicated, long-term financing to strengthen prevention, preparedness and response capacities at the country and community levels.  As an accredited implementing entity, WHO distributed US$ 159 million – almost half of the approved projects for the first round of disbursements. In addition, WHO continues to host the secretariat of the G20 Joint Finance and Health Task Force and to lead efforts to identify gaps in preparedness and financing and to work with partners to strengthen mechanism to close these gaps. The WHO Secretariat is working to increase preparedness for emergencies in all countries, as measured through International Health Regulations (2005) States Parties self-assessment annual reporting, and to support countries through the grant management process for the Pandemic Fund.

Increased genomic sequencing capability for SARS-CoV-2

There has been a 62% increase (from 103 to 167) in the proportion of Member States with genomic sequencing capability for SARS-CoV-2 between February 2021 and December 2023. Angola, Bahamas, Central African Republic, Dominican Republic, Honduras, Maldives and Sudan are among the countries that have gained a sequencing capacity. The WHO Secretariat has supported countries in all six regions to develop national genomic surveillance strategies, policies, programmes and, in 2023, five countries (Ghana, Georgia, Kyrgyzstan, Namibia and Oman) costed their sequencing programmes using the global genomics costing tool co-developed by WHO and four partner agencies. Launched in May 2023, the International Pathogen Surveillance Network aims to collaboratively solve common challenges in pathogen genomics, accelerate progress on the deployment of pathogen genomic surveillance and improve public health decision-making. This initiative is in line with the WHO global genomic surveillance strategy for pathogens with pandemic and epidemic potential 2022–2032, which aims for all WHO Member States to have timely access to a genomic sequencing capability. Further collaborative investments in foundational laboratory and surveillance systems are needed by WHO Member States and partner organizations.

Equitable access to licensed vaccines during outbreaks

In 2023,

-  62 million persons were protected for life from yellow fever via campaigns and an additional 17.4 million children protected via routine immunization in Africa;

-  1.4 million people were vaccinated against meningitis in response to outbreaks of Meningococcus C in Niger and Nigeria, and 1.5 million were vaccinated preventively against Meningococcus A in Cameroon;

- 127 000 doses of Ebola vaccines with a short shelf-life were repurposed to preventatively vaccinate health care and frontline workers in three at-risk countries as no Ebola virus disease outbreaks were reported; and

-  36 million of the 74 million doses of the oral cholera vaccine requested by 14 countries were provided.

WHO hosts the Secretariat of the International Coordinating Group on vaccine provision for cholera, meningitis, yellow fever and Ebola virus disease, working with partners to make available and ensure equitable access to licensed vaccines during outbreaks. During the biennium, 5 million doses of the newly prequalified pentavalent conjugate meningococcal vaccine were secured for the stockpile for use in future. The WHO Secretariat anticipates that the production of the oral cholera vaccine could rise from 37 million doses to 52 million doses in 2024 if a simplified formulation is prequalified, which would contribute to completing the restoration of vaccine coverage of at-risk groups for epidemic- and pandemic-prone diseases to pre-COVID-19 pandemic levels.

Reaching remaining unvaccinated children

Intensified polio eradication efforts are reaching the remaining unvaccinated children in a handful of districts in Pakistan and Afghanistan – the only areas with endemic wild polio in the world. The WHO Secretariat coordinated the administration of more than 800 million vaccinations in more than 30 countries in 2023, while a concerted subregional emergency response across five neighbouring countries in south-east Africa arrested the transmission of the wild poliovirus after an outbreak in early 2022.Gender analysis is a fundamental practice of the WHO Secretariat in formulating tailored, gender-responsive plans. Female health workers play a crucial role in facilitating access to households and raising awareness among female caregivers. Despite setbacks due to ongoing poliovirus outbreaks, the African Region pursues a phased approach for seamless transition of the Region’s polio assets, tools and knowledge to sustain the critical functions related to immunization, disease surveillance and emergency response. The Eastern Mediterranean Region has developed an investment case that shows a high return on investment in sustaining the polio infrastructure. In the South-East Asia Region, the focus is on utilizing the integrated networks to reach zero-dose children. The WHO commitment of US$ 33.2 million funding from the core voluntary contributions account has been catalytic to sustaining the essential polio functions through integration and ensuring their long-term sustainability in more than 50 countries that transitioned their crucial infrastructure from a reliance on resources through the Global Polio Eradication Initiative.

Steep increase in humanitarian health needs on a global scale

The Contingency Fund for Emergencies released funding, in as little as 24 hours, to 22 graded emergencies in 2023, in line with WHO’s Emergency Response Framework. In 2023, the amount of US$ 79 million was released to fund the initial response to acute events and scale up life-saving health operations in protracted crises in response to escalating needs. As part of WHO’s core functions related to preparing for and responding to health emergencies, especially in crisis-affected settings, the Organization worked closely with partners to support the efforts of national governments to increase the quality and coverage of health services; strengthen primary, secondary and hospital health care by deploying mobile teams and reinforcing health facilities; improve public health surveillance and early warning systems, as well as other systems for actionable health information; conduct vaccination campaigns; distribute medicines and supplies; and train health workers; and scale up mental health and psychosocial support services. For example WHO provided scaled-up mental health and psychosocial support services to 2 million people in the Syrian Arab Republic and Türkiye following earthquakes, as well as the deployment of mental health and psychosocial support experts to 12 complex emergency countries, including Ukraine. There has been a steep increase in humanitarian health needs on a global scale, driven by overlapping and interacting aggravating factors, including the accelerating effects of climate change, increased conflict and insecurity, increasing food insecurity, weakened health systems in the wake of the COVID-19 pandemic, economic downturns and new infectious disease outbreaks.