By Dr Tedros Adhanom Ghebreyesus, Director-General (WHO)
For more than two years, technology has allowed us to continue meeting, and to continue our work together. But there is no substitute for meeting face-to-face. I look forward to this week; to our conversations, and to moving ahead on the challenges that confront us all.
The COVID-19 pandemic has turned our world upside down. Our world has endured great suffering – and endures it still. I know how difficult the last two years have been for you and the people we serve together. People have lost their lives, loved ones and livelihoods; health systems have been strained to breaking point, and in some cases, beyond; health workers have laboured under extreme circumstances. Some have paid the ultimate price, and we have lost others to stress and depression; communities have faced great disruptions to their lives, with schools and workplaces closed, and the burden of isolation and anxiety; and you, as governments, have been at the centre of the storm, facing multiple challenges:
- To protect both the health and rights of your populations;
- To give reassuring advice in the face of uncertainty;
- To counteract misinformation and disinformation;
- To access vaccines and other tools;
- And you confronted so much more.
I thank all of you for your efforts to protect your communities, and to work with the World Health Organisation (WHO) Secretariat and our partners to protect others around the world. More than two years into the most severe health crisis in a century, where do we stand?
More than six million COVID-19 deaths have been reported to WHO. But as you know, our new estimates of excess mortality are much higher – almost 15 million deaths. Reported cases have declined significantly from the peak of the Omicron wave in January of this year. And reported deaths are at their lowest since March 2020.
In many countries, all restrictions have been lifted, and life looks much like it did before the pandemic. So is it over? No, it’s most certainly not over.
I know that’s not the message you want to hear, and it’s definitely not the message I want to deliver. There’s no question we have made progress, of course we have: 60 percent of the world’s population is vaccinated, helping to reduce hospitalizations and deaths, allowing health systems to cope, and societies to reopen.
But it’s not over anywhere until it’s over everywhere. Reported cases are increasing in almost 70 countries in all regions – and this in a world in which testing rates have plummeted. And reported deaths are rising in my continent – the continent with the lowest vaccination coverage. This virus has surprised us at every turn – a storm that has torn through communities again and again, and we still can’t predict its path, or its intensity. We lower our guard at our peril.
Increasing transmission means more deaths, especially among the unvaccinated, and more risk of a new variant emerging; declining testing and sequencing means we are blinding ourselves to the evolution of the virus; and almost one billion people in lower-income countries remain unvaccinated.
Only 57 countries have vaccinated 70 percent of their population – almost all of them high-income countries.
We must continue to support all countries to reach 70 percent vaccination coverage as soon as possible, including 100 percent of those aged over 60; – 100 percent of health workers; and 100 percent of those with underlying conditions.
Vaccine supply has improved, but absorption has not kept pace. In some countries, we see insufficient political commitment to roll out vaccines. This was impacted by the initial lack of political commitment for equitable access to vaccines, as President Kenyatta said.
In some we see gaps in operational or financial capacity; and in all, we see vaccine hesitancy driven by misinformation and disinformation. WHO’s primary focus now is to support countries to turn vaccines into vaccinations as fast as possible. However, we still see supply-side problems for tests and therapeutics, with insufficient funds, and insufficient access.
The pandemic will not magically disappear. But we can end it. We have the knowledge. We have the tools. Science has given us the upper hand. We call on all countries that have not yet reached 70 percent vaccination coverage to commit to achieving it as soon as possible; and to prioritize the vaccination of all health workers, all over-60s and everyone at increased risk;
- We call on those countries that have reached 70 percent to support those that have not;
- We call on all countries to maintain surveillance and sequencing;
- We call on all countries to be prepared to reintroduce and adjust public health and social measures as necessary;
- We call on all countries to restore essential services as rapidly as possible;
- And we call on all countries to work with your communities to build trust.
But of course, the pandemic is not the only crisis in our world. As we speak, our colleagues around the world are responding to outbreaks of Ebola in DRC, monkeypox and hepatitis of unknown cause, and complex humanitarian crises in Afghanistan, Ethiopia, Somalia, South Sudan, the Syrian Arab Republic, Ukraine and Yemen.
We face a formidable convergence of disease, drought, famine and war, fuelled by climate change, inequity and geopolitical rivalry. As you know, this Health Assembly marks the end of my first term as director-general. I am humbled by the executive board’s decision to nominate me for a second term.
As I have reflected on the past five years, I realised they have been bookended by two visits to warzones. I made my first trip as director-general to Yemen in July 2017, a country which was, and remains, mired in civil war. While I was there, I met a mother and her malnourished child who had travelled for hours to reach the health centre I was visiting in Sana’a. The woman was skin and bone, begging the medical staff for care – not for herself, but for her child.
Then two weeks ago, I was in Ukraine, visiting bombed hospitals and meeting health workers. I visited a reception centre for refugees in Poland, where I met another mother, from the Mariupol area, who told me that when the shelling began, her young daughter was very scared.
“Don’t worry,” her mother told her. “It’s just a thunderstorm. It will pass.”
At our warehouse in Lviv, I held a pediatric crutch that WHO was preparing to deliver – a crutch for children – a tool that children should only need if they are injured playing sport or climbing trees – children being children – not if they are hurt by bombs.
I met people who have lost loved ones; lost their homes; lost their sense of security – and yet somehow, have not lost hope.
In both Yemen and Ukraine, and in other countries I have visited in between during my first term, I saw the profound consequences of conflict for health systems and the people they serve.
More even than pandemics, war shakes and shatters the foundations on which previously stable societies stood. It deprives whole communities of essential health services, leaving children at risk of vaccine-preventable diseases; women at increased risk of sexual violence; expectant mothers at risk of an unsafe birth; and people who live with communicable and noncommunicable diseases without access to the lifesaving services and treatments on which they depend. And it leaves psychological scars that can take years or decades to heal.
For me, this is not hypothetical or abstract; it’s real, and it’s personal. I am a child of war.
The sound of gunfire and shells whistling through the air; the smell of smoke after they struck; tracer bullets in the night sky; the fear; the pain; the loss – these things have stayed with me throughout my life, because I was in the middle of war when I was very young.
Like the mothers I met in Yemen and Ukraine, my mother’s concern was to keep me and my sisters and brothers safe.
When my mother heard gunfire at night, she would make us sleep under the bed, and lay more mattresses on top of that one bed, with all children crammed under the bed, in the hope we might be protected if a shell fell on our house.
I felt that same fear as a parent myself again in 1998, when war returned to Ethiopia, and my children had to hide in a bunker to shelter from the bombardment. That’s when I returned from Nottingham where I was doing my PhD, because I was worried about my family and the rest of the country. Maybe you remember what happened in 1998.
I feel the same pain and loss again now, with war in my homeland once again. Not only a child of war, but following me throughout.
But my story is not unique. It is like so many others – the story of a family who did not start the war, who were not responsible for it, but suffered because of it. War is bad enough. But it is made worse because it creates the conditions for disease to spread.
Indeed, war, hunger and disease are old friends. In the Napoleonic wars and the American Civil War, more soldiers died from disease than in battle.It was no coincidence that the 1918 influenza pandemic – the greatest pandemic – coincided with what was then the greatest war the world had known – the First World War. It’s no coincidence that the final frontier for eradicating polio is in the most insecure regions of Afghanistan and Pakistan.
It’s no coincidence that in 2018, the Ebola outbreak in the relatively stable Equateur province of DRC took two months to control, while the outbreak in the insecure regions of North Kivu and Ituri took two years.
Where war goes, hunger and disease follow shortly behind. The COVID-19 pandemic did not cause the war in Ukraine, and the war did not cause the pandemic. But they are now intertwined. Until this year, Ukraine was among the countries that was making the most rapid progress towards universal health coverage.
We are deeply concerned about the impact of the war on these gains. Already we have seen many clinics and hospitals closed, health workers displaced, and services disrupted.
I visited a hospital in the town of Makariv, west of Kyiv. Its inpatient department had been damaged by a missile strike, and its primary care department was completely destroyed. And it’s not just Ukraine.
So far this year, WHO has verified 373 attacks on health in 14 countries and territories, claiming the lives of 154 health workers and patients, and leaving 131 injured. Even WHO is targeted.
In 2019, our colleagues Dr Richard Mouzoko and Belinda Kasongo were murdered in DRC while working to protect others from Ebola. Attacks on health workers and health facilities are a breach of international humanitarian law. But they are also an assault on the right to health.
In Ethiopia, the Syrian Arab Republic, Ukraine, Yemen and elsewhere, WHO is working in conflict zones to deliver medicines, equipment, training and technical advice to support care for those who need it: to treat the wounded, to give pregnant woman the conditions for a safe and supportive birth, to make sure children receive routine vaccinations, and to support health workers who continue to deliver life-saving services in the most difficult circumstances.
Following the Taliban takeover last year, I travelled to Afghanistan, where I met a group of women nurses who told me they had not been paid in three months, but would continue to serve their patients.
WHO paid their salaries so they could continue to deliver the care on which their communities depend. But ultimately, the one medicine that is most needed is the one that WHO can’t deliver – peace. Peace is a prerequisite for health.
During El Salvador’s Civil War, one-day ceasefires called “days of tranquillity” were declared three times a year, to allow the vaccination of children against polio, measles and more.
In 1990, 159 nations signed a declaration and plan of action endorsing the need for Days of Tranquillity, which have been used in Afghanistan, Côte d’Ivoire, Peru, Uganda and elsewhere.
There can be no health without peace. But equally, there can be no peace without health.The authors of the WHO Constitution knew this, when they wrote that the health of all peoples is fundamental to the attainment of peace and security and is dependent on the fullest co-operation of individuals and States.
Health can contribute to peace by delivering services equitably to all people in a society, especially disadvantaged groups. This can help address the triggers of conflict, such as unequal access to health care, which can often lead to feelings of exclusion and resentment. Equitable health services strengthen community trust, which in turn contributes to strengthening health systems and peacebuilding.
For example, in Tunisia in the aftermath of the Arab Spring, and with WHO support, a Societal Dialogue for Health was established as a platform for Tunisians to express their needs and ideas on health.
In Sri Lanka, WHO has supported a community-based psychosocial intervention called “Manohari”, aimed at violence reduction.
In Colombia, WHO-PAHO supported the reintegration of former combatants with health expertise into the health system, through medical training.
The resolution on Health and Peace that you will consider this week, if adopted, will further support the Secretariat’s efforts to deliver health programmes in conflict-affected areas – programmes that also help to build peace.
Health is one of the few areas in which nations can work together across ideological divides to find common solutions to common problems, and build bridges.
