US Funding Suspension To WHO May Affect Other Essential Health Services
Polio eradication is on WHO program that will likely take a big hit in light of US funding suspension.

Essential health programmes such as polio eradication and trauma management, and programmes in the World Health Organizations’ Emergencies program, will be hit hardest by the suspension of US funding to the WHO. 

“The reality is for my programme, a lot of that US funding is aimed at direct life saving services to people in the most destitute circumstances in the world,”  said Mike Ryan, WHO’s Executive Director of Health Emergencies. “We have a huge operational, technical, and financial relationship with the USA, and we’re very grateful for that relationship… I very much hope that it will only be a 60-day stay [on funding].”

Ryan made the statement in response to a line of questioning regarding whether WHO would be hard hit by a loss of US funding. A WHO spokesperson had previously told reporters that approximately 81% of WHO’s 2020-2021 budget had already been funded, and the Health Emergencies program had been allocated an additional US $1billion for the global COVID-19 response.

Approximately a quarter US funds would have been directed towards ‘core’ health programs outside of the COVID-19 response, and over US $650 million had been pledged to support other specific health areas such as polio eradication, immunization, and nutrition programmes. In Iraq and Syria for example, WHO programs there were concerned about the impact of loss of funding on health services, not as much on the COVID-19 response, according to Ryan.

“I hope that the US believes funding WHO is an important investment not just to help others, but for the US to remain safe itself,” added WHO Director General Dr Tedros Adhanom Ghebreyesus. “As former Minister of Health for Ethiopia, I am a living witness to appreciate the US support at the country level, and now as Director-General I am a living witness to appreciate the support the US gives the WHO. I hope the freezing of the funding will be reconsidered, and the US will once again support WHO’s work and continue to save lives.”

However, it’s unclear whether the US president has broad authority to put a moratorium on all funding WHO receives. However, the President could instruct US agencies to scale back funding for the organization. 

Ryan added that the WHO team is focusing on the health work on the ground, instead of “where the next paycheck will come from.”

“We’re concerned about supporting our friends and colleagues in the frontline who risk their lives every day, every single day to deliver life saving interventions to people around the world,” said Ryan. 

Just two days ago, one staff member, Pyae Sone Win Maung, was killed and another critically injured while transporting COVID-19 samples in Myanmar. “I don’t think their families are that concerned about the overall funding situation,” Ryan said. WHO Southeast Asia Regional Director Poonam Khetrapal Singh also condemned the attack on Twitter, saying, “As they deliver essential lifesaving services, our health workforce deserves gratitude, respect, appreciation and support for their selfless services.”

“But one thing we would like to assure to the world is that we will work day and night. And we will not be deterred by any attacks,” Dr Tedros said. “And as our colleagues say, attacks like this only strengthens our resolve.”

Africa at the Beginning of the Infection Curve

The WHO Health Emergencies Executive Director additionally warned today that many countries in the WHO Africa region were at the beginning of the COVID-19 infection curve. But leveraging innovation and agile public health systems could help countries “avoid the worst of the pandemic.”

“We’ve seen an almost 250% fold increase in cases in Sudan. In the last week, in Tanzania,Mali, Congo, Gabon, Guinea, Cabo Verde and Eritrea we saw increases of more than 100% in the last week. In many other countries in Africa, cases increased somewhere between 30 and 90%. So, we are at the beginning in Africa,” Ryan said on Wednesday. There are currently 15,394 confirmed cases and 716 deaths in the WHO Africa region

But some African nations have rapidly rose to meet the COVID-19 challenge – South Africa has so far tested 120,000 people with a 2.7% positivity rate. The country focused on a prevention and surveillance based strategy, rapidly training 28,000 community health workers in case detection and rolling out 67 mobile lab units across the country. 

“That much testing for that return, it’s incredible,” said Ryan. “We need to leverage the capacities that exist in Africa. The innovation, the science. We need to connect scientists and laboratories across Africa.”

For a number of African countries the case load remains under 100, and most of them are imported cases according to WHO COVID-19 Technical Lead Maria Van Kerkhove.

As such, Ryan said, countries across the continent must keep focused “on preparation, on surveillance, on community mobilization.”

WHO DG Urges Eastern Mediterranean Countries to Step Up Response

Dr Tedros urged Health Ministers from WHO Eastern Mediterranean countries to strengthen their COVID-19 response as infections accelerated in countries across the region. The WHO Director-General met online with Minister of Healths from the Eastern Mediterranean Region on Wednesday, just a day before the holy month of Ramadan.

“The epidemic in the Islamic Republic of Iran now appears to be waning, but most other countries in the region are seeing increasing numbers of new infections every day,” said Dr Tedros in prepared remarks.

“We have been impressed by the progress being made across many EMRO countries. The active outreach to almost 70 million people in Iran through the national campaign; the rapid scaling up of testing in United Arab Emirates; the commitment to establishing temporary isolation units in Pakistan; the use of polio assets in Afghanistan and in Somalia.

“In spite of this clear progress, I am of course asking you to do more. First, the response to COVID demands a whole-of-government approach. As Ministers of health, you play a vital,  central role, but you cannot do it alone so continuing with the whole of government approach will be very important to beating this virus.

“Second, we call on countries to implement proven public health measures aggressively: detect, test, isolate and care for every case, and trace and quarantine every contact.

“And third, we urge you to pay careful attention to ensuring that essential public health services continue safely and effectively.”

Dr Tedros further affirmed WHO’s support and highlighted resources available at countries’ disposal, including a United Nations Supply Chain System, launched last week to ramp up the distribution of essential supplies to countries in need. The Organization is also coordinating global Solidarity Trial to explore therapeutic options for COVID-19, monitoring healthcare worker infections and prevention, and updating technical guidance.

Total cases of COVID-19 as of 10:00PM CET 22 April 2020, with active case distribution globally. Numbers change rapidly.

Regional Trends in Europe, the Americas, and Southeast Asia

Following a downward trend in new COVID-19 cases, the federal council has released a three-step re-opening plan, starting from April 27. In Switzerland, the Federal Office of Public Health (FOPH) has confirmed 28,268 positive coronavirus cases with 1217 deaths.

In conjunction with this plan, the FOPH has also widened the criteria for coronavirus testing, now allowing for asymptomatic people at risk of spreading infection to be tested. This measure comes as a study shows that the current testing regime in Geneva has confirmed only one of every six cases and calls for increased testing to avoid a second wave of infections. 

The European Council is drafting a recovery plan to bolster corona-hit economies. A roadmap released on Tuesday emphasizes strengthening Europe’s “strategic autonomy” to reduce reliance on foreign suppliers, as the EU leaders prepare to endorse a 540 billion euros ($587 billion) package that would help pay lost wages, keep companies afloat and fund health care systems. The European Centre for Disease Prevention and Control currently records 1,101,681 cases of coronavirus in Europe, with 107,453 deaths.

United States President Donald Trump will be signing an executive order today implementing a 60-day ban on issuing permanent residency cards to immigrants. A bipartisan $484 billion coronavirus relief package was passed by the Senate on Tuesday, which would replenish a depleted loan program for distressed small businesses and provide funds for hospitals, states and coronavirus testing. 

Public health officials in the US have been retracing the path of the virus across the country and have found that the earliest deaths occurred in early February in California, almost three weeks before the first officially confirmed coronavirus death in Seattle – indicating the virus may have begun circulating in the community much earlier than expected.  A second wave of COVID-19 may occur in the fall, coinciding with seasonal flu to cripple the weakened healthcare system, warned Robert Redfield, director of the Center for Disease Control and Prevention in an interview with the Washington Post. The United States of America has the world’s highest number of positive coronavirus cases and confirmed deaths, with 825,306 cases and 45,075 deaths.

In Latin America, WHO PAHO is dispatching an additional 1.5 million PCR tests this week, followed by another 3 million next week to strengthen laboratory surveillance networks across member states, PAHO Director Carissa F. Etienne said in a press briefing Tuesday. As cases started to ramp up across the region, countries have faced increasing difficulty keeping up with the demand for testing.

“We need a clearer view of where the virus is circulating and how many people have been infected in order to guide our actions,” Etienne said in a press release.

In Southeast Asia, India’s central government has approved an amendment to the Epidemic Diseases Act, 1897 that aims to end violence against health care workers. Anyone found guilty of attacking a healthcare worker could be imprisoned for 6 months to 7 years, according to Union Minister Prakash Javadekar. The move comes after several complaints from the medical fraternity on the acts of violence against doctors and other medical staff during the COVID-19 crisis in India, which has now bloomed to more than 20,000 confirmed coronavirus cases and over 600 deaths.

Gauri Saxena contributed to this story

Image Credits: WHO Africa Regional Office, Johns Hopkins CSSE.