World Health Organization Consultation Research Articles

Influencing the global governance of alcohol: Alcohol industry views in submissions to the WHO consultation for the Alcohol Action Plan 2022-2030.

In 2020, the Secretariat of the World Health Organization (WHO) conducted an open consultation, with public submissions, for the purpose of developing an Alcohol Action Plan to "strengthen implementation" of the WHO's 2010 Global Strategy to Reduce the Harmful Use of Alcohol. The consultation process and public submissions provided an opportunity to critically examine alcohol industry perspectives and arguments in relation to the global governance of alcohol. 48 alcohol industry submissions to the WHO's 2020 consultation were included for analysis. Directed content analysis was used to examine the policy positions and arguments made by industry actors. Thematic analysis was employed to further explore the framing of industry arguments. In framing their arguments, alcohol industry actors positioned themselves as important stakeholders in policy debates; differentiated "normal" drinking from consumption that merits intervention; argued that alcohol policy should be made at the national, rather than global, level; and supported industry self-regulation or co-regulation rather than cost-effective public health measures to prevent harms from alcohol. The alcohol industry's submissions to the WHO's 2020 consultation could be seen as efforts to stymie improvements in the global governance of alcohol, and repeats several framing strategies that the industry has used in other forums, both national and global. However, their arguments appear to have had little traction in the creation of the Alcohol Action Plan. Changes from the Working Document to the adopted Action Plan show little acceptance by WHO of industry arguments.

From the Wright Brothers to the A380: Developing Transplantation Takes Teams of Teams.

From the Wright Brothers to the A380: Developing Transplantation Takes Teams of Teams.

Management of Conflicts of Interest in WHO's Consultative Processes on Global Alcohol Policy.

The World Health Organization (WHO) has engaged in consultations with the alcohol industry in global alcohol policy development, including currently a draft action plan to strengthen implementation of the Global strategy to reduce the harmful use of alcohol. WHO's Framework for Engagement with Non-State Actors (FENSA) is an organization-wide policy that aims to manage potential conflicts of interest in WHO's interactions with private sector entities, non-governmental institutions, philanthropic foundations and academic institutions. We analysed the alignment of WHO's consultative processes with non-state actors on "the way forward" for alcohol policy and a global alcohol action plan with FENSA. We referred to publicly accessible WHO documents, including the Alcohol, Drugs and Addictive Behaviours Unit website, records of relevant meetings, and other documents relevant to FENSA. We documented submissions to two web-based consultations held in 2019 and 2020 by type of organization and links to the alcohol industry. WHO's processes to conduct due diligence, risk assessment and risk management as required by FENSA appeared to be inadequate. Limited information was published on non-state actors, primarily the alcohol industry, that participated in the consultations, including their potential conflicts of interest. No minutes were published for WHO's virtual meeting with the alcohol industry, suggesting a lack of transparency. Organizations with known links to the tobacco industry participated in both web-based consultations, despite FENSA's principle of non-engagement with tobacco industry actors. WHO's consultative processes have not been adequate to address conflicts of interest in relation to the alcohol industry, violating the principles of FENSA. Member states must ensure that WHO has the resources to implement and is held accountable for appropriate and consistent safeguards against industry interference in the development of global alcohol policy.

A framework for scabies control.

Scabies is a neglected tropical disease (NTD) that causes a significant health burden, particularly in disadvantaged communities and where there is overcrowding. There is emerging evidence that ivermectin-based mass drug administration (MDA) can reduce the prevalence of scabies in some settings, but evidence remains limited, and there are no formal guidelines to inform control efforts. An informal World Health Organization (WHO) consultation was organized to find agreement on strategies for global control. The consultation resulted in a framework for scabies control and recommendations for mapping of disease burden, delivery of interventions, and establishing monitoring and evaluation. Key operational research priorities were identified. This framework will allow countries to set control targets for scabies as part of national NTD strategic plans and develop control strategies using MDA for high-prevalence regions and outbreak situations. As further evidence and experience are collected and strategies are refined over time, formal guidelines can be developed. The control of scabies and the reduction of the health burden of scabies and associated conditions will be vital to achieving the targets set in WHO Roadmap for NTDs for 2021 to 2030 and the Sustainable Development Goals.

A Framing Analysis of Consultation Submissions on the WHO Global Strategy to Reduce the Harmful Use of Alcohol: Values and Interests.

In response to the magnitude of harms caused by alcohol, the World Health Organization (WHO) Global Strategy to Reduce the Harmful Use of Alcohol (GAS) was endorsed in 2010. We analysed submissions to the 2019 WHO consultation on the implementation of the GAS to identify how different stakeholders frame alcohol use and control; and to assess how stakeholders engage with the consultation process, with possibly harmful consequences for public health policy. All submissions from WHO Member States, international organisations, non-governmental organisations (NGOs), academic institutions and private sector entities were identified and used as data for an inductive framing analysis. This involved close reading and data familiarisation, thematic coding and identifying emergent framings. Through the analysis of texts, framing analysis can give insights into the values and interests of stakeholders. Because framing influences how issues are conceptualised and addressed, framing analysis is a useful tool to study policy-making processes. We identified 161 unique submissions and seven attachments. Emerging frames were grouped according to their function: defining the problem, assigning causation, proposing solutions, or justifying and persuading. Submissions varied in terms of the framing they deployed and how this was presented, eg, how the problem was defined. Proposed policy solutions also varied. Targeted solutions emphasising individual responsibility tended to be supported by industry and some Member States. Calls for universal regulation and global mobilisation often came from NGOs and academia. Stakeholders drew on evidence and specific value systems to support the adoption of certain problem and solution ideas and to oppose competing framing. Alcohol control is a contested policy field in which different stakeholders use framing to set the agenda and influence what policy solutions are considered legitimate. WHO should consider which interests are served by these different framings and how to weigh different stakeholders in the consultation process.

Strengthening public health education of undergraduate medical students through early primary healthcare services’ association

Background: The World Health Organization consultation paper on the teaching of community medicine 2010 highlighted the need to change the focus from didactic lectures to more interactive teaching learning methods. The objective of this study was detection of difference between didactic and early training at primary healthcare centers at different levels of knowledge, acquired skills, and attitudes of undergraduate medical students.Methods: This interventional study included students of academic year 2017-18 had summer training course in public health department as a part of the Faculty aim of early clinical exposure of preclinical students (i.e., first three grades) (n=25). The public health training course focuses mainly on raising students' skills of basic primary health care services. Comparable group of 75 students from the regular system were randomly selected. This intervention aimed to design new educational process and determine its outcomes evaluating Learner’s knowledge, their attitudes, and gained skilled.Results: The interventional group had positive attitudes ranging from 59-93% for different topics given. The conventional methods group had statistically insignificant higher scores in the summative assessment 20.5±2.2 versus 19.6±3.1 of the interventional group (p value 0.11). The acquired skills of the interventional group ranged from 9.3±2.1 to14.9±1.5.Conclusions: Early field contact gained higher positive attitude among medical students and it showed high skill acquisition. It is recommended to be used more frequently in public health practical teaching for undergraduate students.

Modelling for Taenia solium control strategies beyond 2020

The cestode Taenia solium is responsible for a considerable cross-sectoral health and economic burden due to human neurocysticercosis and porcine cysticercosis. The 2012 World Health Organization (WHO) roadmap for neglected tropical diseases called for the development of a validated strategy for control of T. solium; however, such a strategy is not yet available. In 2019, WHO launched a global consultation aimed at refining the post-2020 targets for control of T. solium for a new roadmap for neglected tropical diseases. In response, two groups working on taeniasis and cysticercosis mathematical models (cystiSim and EPICYST models), together with a range of other stakeholders organized a workshop to provide technical input to the WHO consultation and develop a research plan to support efforts to achieve the post-2020 targets. The workshop led to the formation of a collaboration, CystiTeam, which aims to tackle the population biology, transmission dynamics, epidemiology and control of T. solium through mathematical modelling approaches. In this paper, we outline developments in T. solium control and in particular the use of modelling to help achieve post-2020 targets for control of T. solium. We discuss the steps involved in improving confidence in the predictive capacities of existing mathematical and computational models on T. solium transmission, including model comparison, refinement, calibration and validation. Expanding the CystiTeam partnership to other research groups and stakeholders, particularly those operating in different geographical and endemic areas, will enhance the prospects of improving the applicability of T. solium transmission models to inform taeniasis and cysticercosis control strategies.

Use of tetanus-diphtheria (Td) vaccine in children 4–7 years of age: World Health Organization consultation of experts

For lifetime protection against diphtheria and tetanus, the World Health Organization (WHO) recommends six doses of diphtheria and tetanus containing vaccines. Td (reduced diphtheria toxoid, ≥2–5 IU) vaccines are currently licensed for ages 7 years and older, but use of Td vaccine for ages 4 years and older would have advantages for immunization programs in many low- and middle-income countries. For this reason, WHO convened an expert consultation to review the currently available evidence for the use of Td vaccine from 4 to 7 years of age which concluded: (1) no relevant biological difference in immune response in the relevant age group compared with children over 7 years of age; (2) adequate seroprotection in several studies with Td vaccine in the 4–7 age group and many studies using combination vaccines; (3) durable and protective response of at least 9–11 years duration in several longitudinal and modelling studies, (4) less reactogenicity compared with use of full-dose diphtheria vaccine, potentially improving the vaccination experience; and (5) adequate control of diphtheria in several countries using Td-containing combination vaccines in 4–7 year old children. On this basis, the experts concluded that from a programmatic perspective, Td vaccine given in ages 4–7 years, as a second booster dose in a six-dose series, would provide adequate protection against diphtheria and tetanus and recommended steps to include this change in age extension listed in the package insert.

Considerations for Rice (Oryzasativa) Fortification with Essential Micronutrients in Public Health Intervention

Background and Rationale: Fortification of staple foods and commonly used condiments with vitamins and minerals has been considered one of the most cost-effective interventions to prevent and control micronutrient deficiencies. Because of its wide local consumption, acceptability, reach, and quantum of consumption, rice (Oryzasativa) far exceeds the requirements of a staple food vehicle that can be considered for fortification purposes at a population-level intervention. The World Health Organization (WHO) has the mandate to develop evidenceinformed guidelines for the fortification of staple foods as a public health intervention, including rice fortification with micronutrients. The WHO, in collaboration with the Global Alliance for Improved Nutrition (GAIN), convened a consultation on “Technical Considerations for Rice Fortification in Public Health” in Geneva, Switzerland in 2012 to provide technical inputs to the guideline development process, particularly with reference to feasibility and implementability.
 Conclusion: The industrial and regulatory technical considerations in rice fortification, as well as the considerations for implementing it as a public health strategy and assuring equitable access and universal coverage and priority research areas for the forthcoming years were reviewed in this article based on WHO consultation
 Bangladesh Journal of Medical Science Vol.19(2) 2020 p.189-193

Enhancing global health communication during a crisis: lessons from the COVID-19 pandemic.

The understanding and practice of public health crisis communication are improved through the study of responses to past crises, but require retooling for present challenges. The 'Addressing Ebola and other outbreaks' checklist contains guiding principles built upon maxims developed from a World Health Organization consultation in response to the mad cow (bovine spongiform encephalopathy) crisis that were later adopted for Ebola. The purpose of this article is to adapt the checklist for the health communication challenges and public health practices that have emerged during the coronavirus disease 2019 (COVID-19) pandemic. The communication challenges of promoting vaccine acceptance are used to illustrate a key area that requires strengthened communication. Type of program or service: Effective communication principles for application during the COVID-19 pandemic. The COVID-19 pandemic has introduced unique challenges for public health practitioners and health communicators that warrant an expansion of existing health communication principles to take into consideration: the new infodemic (or mis/disinfodemic) challenge - particularly as treatments and vaccines are being developed; communication of risk and uncertainty; health-information behaviours and the instantaneous nature of social media, and the relationship between media literacy and health literacy; the effects of the pandemic on other health issues; and the need for a flexible communication strategy that adapts to the different stages of the pandemic. Principles discussed in this article will help build preparedness capacity and offer communication strategies for moving from the acute phase to the 'next normal' with likely prevention (e.g. herd immunity achieved through vaccination) and societal COVID-19 resilience.

Sexual health services in the Arab region: Availability, access, and utilisation

ABSTRACTSexual health is shaped by cultural, economic, and social norms in society. In the Arab region, cultural sensitivities and taboos surrounding sexuality are prominent and may prevent individuals from accessing and utilising sexual health services. It is important to map out available sexual health services to identify the challenges in availability, access, and treatment, and determine opportunities for improvement. We collected data on sexual health services through (1) relevant published and unpublished literature, (2) Arab media which included forums, websites, blogs and posts, and online surveys conducted in the Arab region, (3) a questionnaire emailed to sexual and reproductive health experts, organisations, clinics, and non-governmental organisations (NGOs), (4) phone and in-person formal and informal interviews with sexual health experts in the field, and (5) advice and recommendations from sexual health experts attending a World Health Organization (WHO) consultation meeting in Dubai related to sexual health in the Arab region. Although there is significant progress when it comes to the availability and provision of sexual health services in Arab countries, there is still a lot to be done to ensure that appropriate needs are met. This study discusses the implication of findings to inform programme and policy implementation in the region.

Making Fair Choices on the Path to Universal Health Coverage: Applying Principles to Difficult Cases

—Progress toward universal health coverage (UHC) requires making difficult trade-offs. In this journal, Dr. Margaret Chan, the World Health Organization (WHO) Director-General, has endorsed the principles for making such decisions put forward by the WHO Consultative Group on Equity and UHC. These principles include maximizing population health, priority for the worse off, and shielding people from health-related financial risks. But how should one apply these principles in particular cases, and how should one adjudicate between them when their demands conflict? This article by some members of the Consultative Group and a diverse group of health policy professionals addresses these questions. It considers three stylized versions of actual policy dilemmas. Each of these cases pertains to one of the three key dimensions of progress toward UHC: which services to cover first, which populations to prioritize for coverage, and how to move from out-of-pocket expenditures to prepayment with pooling of funds. Our cases are simplified to highlight common trade-offs. Though we make specific recommendations, our primary aim is to demonstrate both the form and substance of the reasoning involved in striking a fair balance between competing interests on the road to UHC.

Modelling efforts needed to advance herpes simplex virus (HSV) vaccine development: Key findings from the World Health Organization Consultation on HSV Vaccine Impact Modelling

Development of a vaccine against herpes simplex virus (HSV) is an important goal for global sexual and reproductive health. In order to more precisely define the health and economic burden of HSV infection and the theoretical impact and cost-effectiveness of an HSV vaccine, in 2015 the World Health Organization convened an expert consultation meeting on HSV vaccine impact modelling. The experts reviewed existing model-based estimates and dynamic models of HSV infection to outline critical future modelling needs to inform development of a comprehensive business case and preferred product characteristics for an HSV vaccine. This article summarizes key findings and discussions from the meeting on modelling needs related to HSV burden, costs, and vaccine impact, essential data needs to carry out those models, and important model components and parameters.

Using probabilistically linked data to investigate the burden of Respiratory Syncytial Virus (RSV) in children <5 years of age on secondary care in England

ABSTRACTObjectivesThis study aims to describe the burden of respiratory syncytial virus (RSV) in children <5 years of age on secondary care in England using linked laboratory surveillance and hospital admissions databases. We will compare our results with previous estimates of the burden of RSV in secondary care based on statistical modelling techniques.
 ApproachNational laboratory surveillance data was probabilistically linked to the Hospital Episode Statistics (HES) database for children aged <5 years in England from 01/08/2010 to 31/07/2012. Linkage was based on NHS and hospital number, date of birth, sex and post code. Only records where the laboratory test was within one week of hospital admission were included. Using the linked data, we estimated the probability of a respiratory hospital admission being related to RSV based on patient characteristics, calendar week and diagnostic coding. We used these probabilities to estimate the national incidence of RSV-associated hospital admissions. Admission rates were calculated by age group (<1 year, 1-4 years) using Office for National Statistics (ONS) mid-year population estimates.
 ResultsThere was an average of 11,289 RSV-positive laboratory records per year during the study period. Preliminary results indicate that 75% of RSV-positive laboratory records linked to a hospital admission. 92% of linked hospital admissions occurred between November and March each year. 76% of the linked hospital admissions were in children aged <1 year. There were significant differences in coding of RSV-associated hospital admissions by age, and over two-thirds of RSV-associated hospital admissions did not have a primary diagnosis indicating RSV as the cause of disease. We will present results on the number of linked hospital admissions, unlinked hospital admissions potentially caused by RSV and the total estimated number of RSV-associated hospital admissions, stratified by age, calendar week and primary diagnosis.
 ConclusionThis study is the first to link laboratory and hospital data for RSV in England, and therefore the first to describe laboratory-confirmed RSV-associated hospital admissions on a national scale. Our approach to estimate the national incidence of admissions based on developing probability weights from a smaller, linked sample has applications not just for RSV but for other seasonal infections. In addition, with a World Health Organization (WHO) consultation last year estimating that an RSV vaccine will be available commercially within 5-10 years, the results of this study can be used in mathematical models of potential vaccine strategy, contributing to the identification of optimal target groups for a potential licensed vaccine.

Straightforwardness, Universality, and Effectiveness of the Balance Method of I Ching Acupuncture

Introduction: Acupuncture has been a branch of Traditional Chinese Medicine for almost 5000 years. Since being established, acupuncture has had a long course of development and changes. Following a recommendation from the World Health Organization Consultation on Acupuncture, in 1996, “Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials” was published in 2002. The Balance Method of I Ching Acupuncture is fully based on the I Ching (Yi Jing, or Book of Changes) and is subordinate to meridian theory. This ancient method relies on interrelations among the acupuncture meridians and enables effective acupuncture treatment. Discussion: The effect of the Balance Method of I Ching Acupuncture on a limited number of disorders is reviewed. The same effectiveness of this method is expected for a vast majority of disorders. To ascertain the effectiveness of acupuncture in general, and of the Balance Method of I Ching Acupuncture in particular, large studies should be performed. Conclusions: According to a large volume of clinical data obtained by practitioners of the Balance Method of I Ching Acupuncture, it appears to be a very straightforward, universal, and effective method. Additional meticulous research is required to investigate and reaffirm the consistency and therapeutic value of this method.

Justification of CT for Individual Health Assessment of Asymptomatic Persons: A World Health Organization Consultation

An international expert consultation was convened by the World Health Organization (WHO). The purpose of the meeting was to review the use of CT in examining asymptomatic people. This is often referred to as individual health assessment (IHA). IHA was identified as a global phenomenon unenthusiastically tolerated, and not actively promoted, structured, or regulated in most countries. This paper identifies the state of the art for IHA and some considerations in relation to its justification, in different regions of the world. The outcomes reached include the following: questions around terminology and culture of IHA practice; review of IHA in some countries, regions, and international bodies; dilemmas for participants in IHA; risk communication, education, and training for professions and public; the desirability of guidelines and clinical audit; social, ethical, public health, and resource considerations; and a framework for IHA and regulatory considerations.Three subcategories of examination for asymptomatic individuals were identified: formal screening programs; examinations for which the evidence base or risk profile is incomplete; and opportunistic examinations with little or no evidence or risk profile to suggest they have any merit. The latter challenges the justification principle of radiation protection. In addition, the issue of the costs, direct and indirect, associated with false positives and/or equivocal/incidental findings were highlighted. These and other considerations make it difficult to view some IHA as a bona fide medical activity. To allow it to be viewed as such requires that it be conducted within a robust clinical governance framework that includes regulatory dimensions.

A roadmap for MERS-CoV research and product development: report from a World Health Organization consultation.

As part of the World Health Organization (WHO) R&D Blueprint initiative, leading stakeholders on Middle East respiratory syndrome coronavirus (MERS-CoV) convened to agree on strategic public-health goals and global priority research activities that are needed to combat MERS-CoV.

Data Sharing as Part of the Normal Scientific Process: A View from the Pharmaceutical Industry

In this week’s PLOS Medicine, Modjarrad and colleagues report the outcome of a World Health Organisation (WHO) consultation on developing global norms for sharing data and results during public health emergencies, with a focus on clinical, epidemiologic, and genetic features of emerging infectious diseases as well as experimental diagnostics, therapeutics, and vaccines [1]. There can be little doubt that the need to find effective health care solutions as quickly as possible to prevent or stop the spread of infectious disease in an emergency makes rapid data sharing the right thing to do for patients and society. Many of the barriers to data sharing in public health emergencies identified in the paper by Modjarrad et al. have been highlighted as areas for change to enable data sharing more generally [2,3]. We are perpetually in the midst of several health care crises, including those of neglected tropical diseases and other chronic diseases, for which data sharing has the potential to lead to faster and better solutions. As a matter of principle, we should be willing to share data without regards to which disease is being studied. So, which data and when?

Percent Body Fat Standards in Korean Adolescents

Obesity is defined as the excessive fat accumulation which leads to health problem. The World Health Organization (WHO) consultation reported Asian populations have different associations among body mass index (BMI), %BF and health risk from Caucasians. Some Asians showed increased health risks at lower BMI than Caucasians. The percent body fat (%BF) standards for health risks were identified in adults for various populations including sex and races. The %BF for metabolic disease risks were reported for American youth. However, the %BF is limited in Asian adolescents. PURPOSE: to identify %BF cut-off points related to metabolic syndrome in a large sample of Korean adolescents. METHODS: The participants (n=2,123; boy=1,107, girl=1,016) were middle and high school students, aged 12 to 17 years from the Korean National Fitness Award Project in 2013. The %BF was estimated via the eight-polars bioelectrical impedance analysis. Metabolic syndrome was classified using an established standard based on the National Cholesterol Education Program (Adult Treatment Panel III) definition modified for age (modified NCEP). Age- and sex-specific %BF z-scores were calculated for every adolescent using the LMS (L=skewness, M=median, and S=coefficient of variation) curves to take growth and development into account. Receiver operating characteristic (ROC) curve analysis was used to identify the %BF cut-off points using %BF z-scores from LMS as the test and metabolic syndrome as the criterion. RESULTS: Based on the modified NCEP criteria for metabolic syndrome, the area under the ROC curves (AUC) for %BF was 0.836 and 0.801 for boys and girls, respectively. The ROC analysis based on the modified NCEP criteria indicated that the 77.8th and 86.6th %BF percentiles for boys and girls, respectively. According to LMS curves, the %BF cut-off points based on the modified NCEP criteria were from 22.2% to 23.8% for boys (aged 12-17) and from 32.0 to 37.3% for girls (aged 12-17). CONCLUSION: Age- and sex-specific %BF cut-off points were identified in relation to metabolic syndrome status in Korean adolescents. These %BF might be used as a useful tool to discriminate metabolic abnormality due to obesity for Korean adolescents.

WHO consultation on clinical evaluation of vaccines, 17–18 July 2014, WHO Headquarters, Geneva, Switzerland

A World Health Organization (WHO) consultation on guidelines for National Regulatory Authorities (NRAs) and vaccine manufacturers on clinical evaluation of vaccines was held from 17 to 18 July 2014, to review key scientific challenges that regulators have been facing since the establishment of the WHO Guidelines on Clinical Evaluation of Vaccines. The guidelines, adopted by the WHO Expert Committee on Biological Standardization (ECBS) in 2001, have served as the basis for setting or updating national requirements for the evaluation and licensing of a broad range of vaccines as well as for WHO vaccine prequalification. Regulators from Australia, Brazil, China, Canada, Germany, India, Republic of Korea, South Africa, United States of America and the United Kingdom were represented. The International Federation for Pharmaceutical Manufacturers’ Association (IFPMA) and the Developing Country Vaccine Manufacturers’ Network (DCVMN) provided industry representation.The consultation concluded that the guidelines should be revised to address issues that were raised in the context of vaccines that were the subject of clinical development in the past decade. Although the current guidelines have served well over time, it was recognized that an update would further increase their utility and would help regulators, manufacturers, vaccine developers and academia to respond to the challenging questions regarding the safety, immunogenicity, efficacy and effectiveness of vaccines intended for global use. A summary of the main outcomes of the consultation and proposals for the next steps regarding the guidelines and beyond are provided in this report.