ICN AT THE AND THE 73RD WORLD HEALTH ASSEMBLY, 2020 148TH WHO EXECUTIVE BOARD, 2021
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INTERNATIONAL COUNCIL OF NURSES
ICN AT THE
73RD WORLD HEALTH ASSEMBLY, 2020
AND THE
148TH WHO EXECUTIVE BOARD, 2021
Prepared by Erica Burton - ICN Senior Advisor, Nursing & Health Policy
TABLE OF CONTENTS
INTRODUCTION..............................................................................................................3
OPENING OF THE RESUMED WHA73 .........................................................................3
Address by WHO Director-General Dr Tedros Adhanom Ghebreyesus WHA73.3
Keynote address by Her Royal Highness Princess Muna Al-Hussein of Jordan
(HRH), WHO Patron for Nursing & Midwifery..........................................................4
OPENING OF THE EB148...............................................................................................5
Address by WHO Director-General Dr Tedros Adhanom Ghebreyesus ..............5
COVID-19 response...................................................................................................5
WHO’s work in health emergencies ........................................................................6
Strengthening WHO’s global emergency preparedness and response ........6
......Strengthening preparedness for health emergencies: implementation of the
International Health Regulations (2005)..................................................................7
Interim progress report of the Review Committee on the functioning of the
International Health Regulations (2005) during the COVID-19 response.............7
Mental health preparedness and response for the COVID-19 pandemic.............8
WHO Global Code of Practice on the International Recruitment of Health
Personnel...................................................................................................................9
Global action on patient safety................................................................................9
Global vaccine action plan & Immunization Agenda 2030...................................10
Antimicrobial resistance.........................................................................................11
Decade of Healthy Ageing.......................................................................................12
Political declaration of the third high-level meeting of the General Assembly
on the prevention and control of non-communicable diseases.........................12
Ending tuberculosis................................................................................................13
Data and innovation: draft global strategy on digital health...............................13
Substandard and falsified medical products........................................................13
Social determinants of health.................................................................................14
Accelerating the elimination of cervical cancer as a global public health
problem.....................................................................................................................15
The highest attainable standard of health for persons with disabilities............16
2
INTERNATIONAL COUNCIL OF NURSES
INTRODUCTION
The World Health Organization (WHO) 73rd World Health Assembly (WHA73)
Executive Board (EB) reports on matters which was held virtually 9-14 November
which require further action, study and 2020 and the 148th session of the WHO
investigation or report. These are then Executive Board (EB148) which was held
considered by the World Health Assembly virtually 18-26 January 2021. It also cov-
(WHA), the supreme decision-making ers the agenda item “COVID-19 response”
body of the WHO. The WHA typically takes during the de minimis session held in May
placed in May of each year but, in 2020, 2020 and certain written procedure items
due to the COVID-19 pandemic, items that were summarized at the 73rd WHA. It
were discussed over a written silence pro- provides a brief overview of agenda items
cedure and in a de minimis and a resumed that are of particular importance to nurs-
session. This report is organised by topic ing and to ICN and its member National
and covers the resumed session of the Nurses Associations.
OPENING OF THE RESUMED WHA73
Address by WHO Director-General Dr Tedros Adhanom
Ghebreyesus WHA73
The Director-General (DG) opened with more than ever, the world needs nurses
an acknowledgment that 2020 was the and midwives. Please join me, wherever
International Year of the Nurse and the you are, in standing to show your appreci-
Midwife. ation for these true health heroes.”
“This Assembly was intended to be a Focusing on the COVID-19 pandemic, Dr
moment of recognition for the incredible Tedros spoke of the need for solidarity, the
contribution that nurses and midwives social and economic impact, the world’s
make every day, in every country. The existing inequalities and injustices, the fail-
pandemic has robbed us of that opportu- ings and the successes thus far, and the
nity. But it has only served to illustrate why need for strengthening, implementing and
nurses, midwives and all health workers financing WHO. He noted the findings of
are so important. Nurses and midwives the WHO Results Report which showed
have been on the frontlines of the fight progress and important work in promoting
against COVID-19, putting themselves healthy populations, universal health cov-
in harm’s way. Many have made the ulti- erage, outbreak response, and prevention,
mate sacrifice in service of humanity. Last testing and treatment for HIV, tuberculosis,
month, WHO published the first State of malaria, hepatitis C, hypertension, diabe-
the World’s Nursing report. It shows that tes and cancer. Dr Tedros underscored
the world is facing a shortfall of six million that health is a prerequisite for and must
nurses to achieve and sustain universal be at the centre of development, a neces-
health coverage. But it also provides a road sity and an investment.
map for governments to invest in nursing,
to fill that gap and progress towards uni-
versal health coverage. Health for All. Now
3
ICN AT THE 73RD WORLD HEALTH ASSEMBLY, 2020 AND THE 148TH WHO EXECUTIVE BOARD, 2021
Keynote address by Her Royal Highness Princess Muna
Al-Hussein of Jordan (HRH), WHO Patron for Nursing &
Midwifery
Her Royal Highness (HRH) Princess Muna The Princess reminded delegates that
recognised the contribution of healthcare health workers are continuing their
workers for their courage and relentless fight against other health challenges:
fight against COVID-19 and said that “Preventable diseases do not stop killing
“applause without action is no longer young children; mothers do not stop hav-
acceptable.” The Princess called health ing babies; cancer continues to require
workers “heroes” and recalled the WHA’s treatment; our elders still require health
commitment to action during the Ebola and care services.” She also stressed that
crisis, saying, “Now the COVID-19 pan- once a vaccine is available, “we will be
demic is here and, once more dear friends, faced with a staggering task of vaccinating
health workers are dying, but this time in billions of people. No country will succeed
their thousands, the majority of which are without properly preparing their health
nurses. We must invest in health workers. system.”
We must invest in educating and employ-
ing more health workers to ensure every Given that 70% of the world’s health work-
mother, child, student, parent, and grand- ers are women, HRH also raised the need
parent has access to safe health services. for “investment in transformative, gender
We must invest in fair pay and protection of equity and rights policies”.
health and care workers. We must invest in
health workforce that would help the world
recover.”
Dr Tedros Adhanom Ghebreyesus
4
INTERNATIONAL COUNCIL OF NURSES
OPENING OF THE EB148
Address by WHO Director-General Dr Tedros Adhanom
Ghebreyesus
In his opening, Dr. Tedros described drastic health workers and older people is under-
inequalities between countries in access to way in all countries. He called for countries
the COVID-19 vaccine saying “…the world with bilateral contracts to be transparent
is on the brink of a catastrophic moral fail- with COVAX and give priority to COVAX’s
ure – and the price of this failure will be place in the vaccine queue. Dr Tedros
paid with lives and livelihoods in the world’s described lessons learnt which included
poorest countries.” the need to increase preparedness and
response, that the health of humans, ani-
Not only does this me-first approach leave mals and the planet are intimately inter-
the world’s poorest and most vulnerable twined; and that the world needs a stronger
people at risk, it is also self-defeating. WHO.
Ultimately, these actions will only prolong
the pandemic, the restrictions needed He announced that 2021 had been desig-
to contain it, and human and economic nated as the International Year of Health
suffering.” and Care Workers to “…focus on making
WHO an organization that attracts the best
Dr Tedros called on countries to work people, gives them the best environment
together in solidarity to ensure that within – inclusive and diverse – and enables and
the first 100 days of 2021, vaccination of empowers them to do and be their best.”
COVID-19 response
Document: A73/CONF./1 Rev.1, EB148/16, obstacles, including the provisions of the
EB148/17, WHA73.1, EB148(2) TRIPS Agreement and the flexibilities
Read the ICN WHA statement here and within the Doha Declaration on the TRIPS
the EB statement here Agreement and Public Health; 5) reiterates
the importance of urgently meeting the
In May 2020, the WHA73 de minimis ses- needs of low- and middle-income coun-
sion was held and resolution WHA73.1 tries in order to fill the gaps in efforts to
COVID-19 response was adopted which: overcome the pandemic, through timely
1) calls for intensification of cooperation and adequate development and humani-
and collaboration at all levels in order to tarian assistance; 6) recognises the role of
contain and control the COVID-19 pan- extensive immunization against COVID-19
demic and mitigate its impact; 2) acknowl- as a global public good for health in pre-
edges the key leadership role of WHO and venting, containing and stopping transmis-
the fundamental role of the UN system in sion in order to bring the pandemic to an
catalysing and coordinating the compre- end, once safe, quality, efficacious, effec-
hensive global response to the pandemic, tive, accessible and affordable vaccines
and the central efforts of Member States; are available.
3) expresses its highest appreciation of,
and support for, the dedication, efforts and The resolution calls on Member States,
sacrifices, above and beyond the call of international organisations and other
duty, of health professionals, health work- stakeholders, and the DG to take action on
ers and other relevant frontline workers, as a number of points. The reader is encour-
well as the WHO Secretariat, in respond- aged to refer to the resolution for these
ing to the pandemic; 4) calls for the univer- details.
sal, timely and equitable access to, and fair
distribution of, all quality, safe, efficacious In October 2020, the WHO held an
and affordable essential health technolo- EB Special Session on the COVID-19
gies and products needed as a global pri- response during which ICN made a state-
ority, and the urgent removal of unjustified ment on the agenda item “Update on
5
ICN AT THE 73RD WORLD HEALTH ASSEMBLY, 2020 AND THE 148TH WHO EXECUTIVE BOARD, 2021
implementation of resolution WHA73.1 on information available. ICN reiterated the
the COVID-19 response”. importance of data in keeping track of the
impact on the health workforce and moni-
At its January 2021 session, the EB report toring the response to the pandemic. The
EB148/16 describes WHO’s continuing COVID Effect could increase the current
work while the report EB148/17 gives more nursing shortages to a number nearly half
background information. the size of the current nursing workforce.
ICN called on Member States to establish
In its statement to the EB148, ICN high- health, education and retraining opportu-
lighted findings from its latest report nity, or “HERO”, funds to support people
showing that nurses are experiencing who have lost their jobs in some sectors
psychological distress, abuse and mass to retrain to join the healthcare workforce.
traumatisation as a result of the pandemic.
More than 1.6 million healthcare workers EB decision EB148(2) was made after
have been infected with over 2262 nurse consideration of this agenda item along
deaths. This data is unreliable as many with the agenda items below. Please see
countries do not have adequate reporting below for more information.
mechanisms or are failing to make the
WHO’s work in health emergencies
Documents, A73/11, A73/INF./4, EB148/18, the Rt Hon Helen Clark, who is a former
EB148/19, EB148/INF./4, EB148/CONF./4, Prime Minister of New Zealand.
EB148/CONF./4 Add.1,WHA73.1,
WHA73.8, EB148(2) Ms Clark said: “The world needs to do two
Read the ICN WHA statement here things: Act more decisively now to stem the
pandemic, and fundamentally reset pre-
The Co-Chairs of the Panel submitted the paredness and response systems to help
second progress report of the Independent ensure that this can’t happen again.”
Panel for Pandemic Preparedness and
Response. The report highlights that the Addressing the EB, Panel Co-chair, former
world was not prepared and must do bet- President of Liberia Ellen Johnson Sirleaf
ter. Key messages of the report: said: “We need to listen more to healthcare
• The public health measures which workers and heed their advice. Draw on
would curb the pandemic need to be the knowledge of those who manage local
applied comprehensively responses.”
• The pandemic response has deepened
inequalities Strengthening WHO’s global
• The global pandemic alert system is not emergency preparedness and
fit for purpose response
• There has been a failure to take The COVID-19 crisis and other recent
seriously the already known existential health emergencies have shown that the
risks posed by pandemic threat world is still not effectively able to pre-
pare for, predict, prevent, respond to and
• WHO has been underpowered to do the
recover from a multi-country outbreak or
job expected of it.
pandemic. Several Member States shared
proposals to strengthen WHO in its capac-
The report acknowledges the dire shortage ities to plan for and respond to health
of nurses world-wide, and highlights wor- emergencies. Common to all proposals
ries about so many nurses being burnt out for strengthening pandemic preparedness
and planning to retire from the profession and response is the recognition that mul-
earlier than planned, as a direct result of tinational leadership is required to ensure
the impact of the COVID-19. that actions are taken in solidarity and for
the common good: health emergency pre-
It includes information from ICN’s paredness is a paradigmatic global public
December 2020 webinar, in which nurses good. The report (EB148/18) contains key
from around the world shared their expe- areas for action for consideration.
riences with one of the panel’s Co-chairs,
6INTERNATIONAL COUNCIL OF NURSES
the Rt Hon Helen Clark
Strengthening preparedness coordination of health emergency prepar-
for health emergencies: edness; 3) improve national coordination
implementation of the International and collaboration regionally, internationally
Health Regulations (2005) and with all stakeholders; 4) prioritise com-
& munity involvement and capacity-building
in all preparedness efforts; 5) engage
Interim progress report of women in all stages of preparedness pro-
the Review Committee on the cess to mainstream gender perspective
functioning of the International in planning and response; 6) strengthen
Health Regulations (2005) during
the COVID-19 response health system capacity to continue to pro-
vide essential health services and PHC
during health emergencies; 7) invest
The Review Committee on the Functioning in health emergency preparedness; 8)
of the International Health Regulations improve governance and decision-making
(2005) during the COVID-19 Response processes and enhance institutional and
was convened by the Director-General on 8 operational capacity and infrastructure for
September 2020 at the request of Member public health.
States in resolution WHA73.1. The EB
report (EB148/19) summarises the work of The decision requested the DG to partici-
the Review Committee including priorities pate in UN operational reviews after major
and preliminary findings. The Committee health emergencies and to conduct a study
will continue its deliberations with the aim on the need for potential benefits of com-
to present a final report to the DG for the plementary mechanisms to be used by the
74th WHA in May 2021. However, not- DG to alert the global community about
ing that the review of the event is taking the severity of a public health emergency
place while the event is still unfolding, the in order to mobilise necessary support and
Committee may not have all the elements facilitate coordination.
necessary to conclude its deliberations by
then. The WHA called on the Member States
and the DG to work with UN entities to: 1)
The WHA adopted decision WHA73.8 in strengthen UN system-wide coordination
which it made several requests and calls in different country, health and humani-
including calling on Member States to: 1) tarian emergency contexts; 2) systemati-
fully comply with the IHR to continue to cally review and revise UN preparedness
build core capacities to detect, assess, and response strategies for outbreaks; 3)
report on and respond to public health enhance UN system leadership for pre-
events; 2) prioritise the improvement and paredness and response coordination; 4)
7ICN AT THE 73RD WORLD HEALTH ASSEMBLY, 2020 AND THE 148TH WHO EXECUTIVE BOARD, 2021
increase collaboration between relevant programmes, institutions employing nurses
actors to accelerate preparedness for pan- and organisations participating in disaster
demics and disease outbreaks, in particu- and emergency response to adopt these
lar in fragile situations and conflict-affected competencies.
areas.
As outlined in decision 148(2), the EB
In its statement to the WHA, ICN high- called for the development of a reso-
lighted that nurses make a vital contri- lution on strengthening WHO’s health
bution to preventing and responding to emergency preparedness and response
epidemics, pandemics and health emer- capacities, including to address the recom-
gencies and efforts to build capacities of mendations of the Independent Panel for
nurses must be accelerated. It is crucial to Pandemic Preparedness and Response,
include the health and safety of the health- the Review Committee on the Functioning
care workforce in all health emergency of the International Health Regulations
preparedness and response plans. ICN (2005) during the COVID-19 Response,
encouraged Member States to consult the and the Independent Oversight and
updated Core Competencies in Disaster Advisory Committee for the WHO Health
Nursing to support workforce develop- Emergencies Programme.
ment and encouraged nursing educational
Mental health preparedness and response for the COVID-19
pandemic
Documents: EB148/20, EB148(3) funding for mental health; to take action to
Read the ICN WHA statement here mainstream knowledge of mental health
among other health professionals; and to
Before the coronavirus disease (COVID- study the impact of COVID-19 on mental,
19) pandemic, almost one billion people neurological and substance use conditions
globally had a mental disorder. Mental and their consequences. The EB requested
health is one of the most neglected areas the DG to support Member States to mon-
of health. Human rights violations against itor changes and disruptions in services,
people with mental health conditions are and to promote and expand access to
numerous and widespread around the inclusive, integrated, evidence-based
world. The pandemic is profoundly affect- primary and community mental health
ing mental health and well-being. Mental services and psychosocial supports; to
and neurological manifestations, such as strengthen WHO’s capacity in respect of
depression, anxiety and delirium/encepha- work on mental health at global, regional
lopathy, are reported in COVID-19 patients. and country levels; and to systematically
Many people with pre-existing mental, integrate mental health into all aspects of
neurological and substance use disorders the work of the Secretariat on UHC.
are facing exacerbation of symptoms due
to stressors, while the limited available In its statement to the EB, ICN noted
services are disrupted. Of the 130 coun- that the impact on the mental health of
tries participating in a recent WHO survey, health workers who are disproportion-
93% reported disruptions in one or more ately affected by the pandemic and at risk
services for mental, neurological and sub- of full-blown stress response syndromes,
stance use disorders. anxiety and burnout must not be over-
looked. Service disruptions, underfunding
The EB adopted decision EB148(3) in and continued neglect of mental health will
which it recommended that the 74th WHA increase the number of nurses leaving the
endorse the updated comprehensive men- profession, worsening future nursing work-
tal health action plan 2013-2030; and urged force shortages. Nurses are invaluable for
Member States to develop and strengthen, mental health promotion, prevention and
as part of a broader whole-of-society care. We need nurses now more than ever
approach, the timely and quality provision to support the COVID-19 response and to
of the whole range of comprehensive and ensure the delivery of mental health ser-
integrated mental health services and psy- vices. ICN urged governments to place
chosocial supports; to allocate adequate mental health at the centre of national
8INTERNATIONAL COUNCIL OF NURSES
COVID-19 response and recovery plans.
WHO Global Code of Practice on the International Recruitment
of Health Personnel
Documents: A73/9, WHA73(30) health and care workers in response to
Read the ICN WHA73 statement here COVID-19, the WHA designated 2021 as
the International Year of Health and Care
WHO Global Code of Practice on the Workers. The WHA requested the DG to
International Recruitment of Health engage WHO and Member States to make
Personnel establishes and promotes vol- the best use of the International Year of
untary principles and practices and facili- Health and Care Workers to advance pro-
tates health system strengthening. It was gress on SDG 3 and to engage with WHO
designed by Member States to serve as regions to update the Global Strategic
a continuous and dynamic framework for Directions for Nursing and Midwifery 2016–
global dialogue and cooperation. The WHO 2020 to be considered by the 74th WHA.
Expert Advisory Group (EAG) reviews the
relevance and effectiveness Code and the The COVID-19 pandemic has exposed the
report of its second review is included in vulnerabilities of nurse supply flows, high-
the WHA report. The EAG confirms that lighted existing nurse supply gaps and the
the relevance of the Code is high and effect of staffing shortages at country level
growing and that both Code effectiveness and has disrupted international nurse sup-
and underlying availability of information ply. Country-level nursing workforce policy
to assess its effectiveness, have strength- change, guided by the Code and supported
ened considerably since 2015. However, by international organisations, is now
there are critical gaps in the Code’s imple- more important than ever. In its statement
mentation with current levels insufficient to to the EB, ICN recommended Member
realise the Code’s full potential as required States implement a self-sufficiency indica-
to progress towards UHC and the SDGs. tor of level of percentage reliance on for-
eign trained nurses to give policy makers
The WHA acknowledged synergies with the insight into the extent of dependence on
global agenda on nursing and midwifery international nurse supply and would also
in the International Year of the Nurse and enable tracking and monitoring of the mile-
the Midwife and the role of health and care stone commitment of the Global Strategy
workers at the forefront of the fight against on Human Resources for Health, that by
the pandemic and adopted decision 2030 all countries will have made pro-
WHA73(30) Human resources for health. It gress towards having their dependency on
commended the successful conclusion of foreign-trained health professionals and
the work of the EAG, encouraged Member implementing the Code.
States to implement recommendations of
the EAG, and requested the EAG to fur- ICN also extended its support to the
ther assess the Code’s relevance and update of the Global Strategic Directions
effectiveness after the period 2023-2024. for Nursing and Midwifery.
To acknowledge the tireless efforts of the
Global action on patient safety
Documents: EB148/6 and EB148/6 Add.1, care. The COVID-19 pandemic has shone
EB148(5) light on the importance of patient safety
Read the ICN EB statement here issues such as personal protective equip-
ment (PPE), health worker safety, medica-
Evidence suggests that hospitalisations in tion safety and patient engagement.
low- and middle-income countries lead to
134 million adverse events annually, con- In order to create a world in which no
tributing to 2.6 million deaths and that, in one is harmed in healthcare, and every
high-income countries, about one in ten patient receives safe and respectful care,
patients is harmed while receiving hospital every time, everywhere, the Global patient
9ICN AT THE 73RD WORLD HEALTH ASSEMBLY, 2020 AND THE 148TH WHO EXECUTIVE BOARD, 2021
safety action plan 2021-2030: Towards been important in gaining global attention
eliminating avoidable harm in health care on the importance of patient safety and
was drafted. The action plan will provide crucial for ICN to highlight the impact of
strategic direction for all stakeholders in nurses in ensuring patient safety. World
improving patient safety in their practice Patient Safety Day 2020 highlighted the
domain through policy actions as well as launch of the Health Worker Safety Charter
implementation of recommendations at which calls on governments and local
the point of care. The guiding principles health service leaders to take five actions
of the action plan are: 1) engage patients to better protect health workers. ICN noted
and families as partner in safe care; 2) its strong support for the Charter and
achieve result through collaborative work- called on governments to sign and act on
ing; 3) analyse data to generate learning; it. ICN’s September 2020 report revealed
4) translate evidence into measurable the true extent of the dangers nurses face
improvement; 5) base policies and action at work including violence and abuse,
on the nature of the care setting; 6) use unsafe staffing levels, work-related stress,
both scientific expertise and patient expe- and severe PPE shortages. ICN believes
rience to improve safety; 7) instil safety that health worker safety and patient safety
culture in the design and delivery of health are two sides of the same coin and that
care. if nurses and healthcare workers are not
protected, the safety of patients cannot be
ICN welcomes the global patient safety guaranteed.
action plan and is pleased to have contrib-
uted to its development, including provid- In decision EB148(5), the EB recom-
ing consultation on the third draft. Having mended to the 74th WHA to adopt the action
nurses involved in the design and oper- plan and that the DG report back progress
ation of patient safety plans and policy on its implementation to the 76th WHA and
interventions will greatly contribute to their annually thereafter.
success. In its statement to the EB, ICN
noted that World Patient Safety Day has
Global vaccine action plan & Immunization Agenda 2030
Documents: A73/7, EB148/14, WHA73(9) major milestone. There is a need to coor-
Read the ICN WHA73 statement here dinate an integrated immunization agenda
Read the ICN EB148 statement here with PHC and this should be in line with
the PHC strategy that WHO is currently
Immunization is important now more than rolling out. Countries are facing immense
ever for wellbeing and the economy. The challenges in sustaining routine immuni-
global vaccine action plan (2011-2020) zation services with the pandemic result-
expired at the end of 2020. Despite sig- ing in huge setbacks. WHO expressed its
nificant progress made in the last decade, reliance on Member States to continue to
most of the global and regional immuni- empower communities and health workers
zation goals were not achieved and one to improve the reach and efficacy of immu-
in five children will still lack access to all nization services.
life-saving vaccines. Through a broad con-
sultative process, the successor global The WHA adopted decision WHA73(9) in
vision and overarching strategy for vac- which it endorsed IA2030. The report pre-
cines and immunization: Immunization sented to the EB contains progress made
Agenda 2030 (IA2030) was developed. It on the operational elements. Member
provides the strategic framework to tackle States, development partners and civil
key issues related to immunization within society organisations will contribute to
primary health care (PHC) and universal operationalising IA2030. They will build on
health coverage during 2021–2030 and the ownership and accountability and mon-
is a living document. The immediate task itoring and evaluation frameworks, and
and focus should be the COVID-19 vaccine strengthened implementation planning, as
rollout in an equitable manner. However, it well as communications and advocacy.
is crucial to have a broader immunization
agenda and its adoption by WHA73 was a ICN welcomes IA2030 and strongly
10INTERNATIONAL COUNCIL OF NURSES
believes in the power of immunization as forward PHC with integrated immunization
a tool for global health and sustainable structures. The rate of nursing and mid-
development. The strong involvement wifery personnel is included as a Global
of nurses at all stages: planning, design, Strategic Priority Objective Indicator in the
implementation and delivery, is essential Agenda and shortages are one cause of
for the success of this agenda. Nurses success or failure in achieving IA2030. As
offer valuable expertise in behavioural and such, ICN asked governments to ensure
social strategies to address under-vacci- the availability and appropriate distribution
nation, support effective communication, of a skilled and motivated nursing work-
increase health literacy, build public con- force to achieve IA2030.
fidence in immunization and are driving
Antimicrobial resistance
Documents: EB148/11 COVID-19 response. Key national and
global challenges to implement the AMR
Antimicrobial resistance (AMR) threatens action plan include prioritisation of key
the achievement of many of the SDGs activities and integration of mode of ser-
and the objectives of the WHO General vice delivery aligned with the COVID-19
Programme of Work. WHO is spearhead- response; operationalisation of the One
ing the response to AMR and coordinating Health approach into multisectoral work;
the global One Health response, through lack of access to quality diagnostics and
the newly established Antimicrobial antimicrobials; sustaining political commit-
Resistance Division. A risk assessment by ment; and lack of financial and technical
the Secretariat shows that the COVID-19 resources.
pandemic has disrupted the planned and
ongoing national AMR activities. Strategies The EB noted the report which provides a
for addressing antimicrobial resistance, summary of WHO action at all levels since
including surveillance, infection prevention May 2019.
and control, WASH, antimicrobial steward-
ship, awareness and multisectoral coor-
dination, have been incorporated into the
Erica Burton, Senior Advisor, Nursing & Health
Policy – Delivering an ICN intervention virtually 11ICN AT THE 73RD WORLD HEALTH ASSEMBLY, 2020 AND THE 148TH WHO EXECUTIVE BOARD, 2021
Decade of Healthy Ageing
Documents: A73/5, A73/INF./2, WHA73(12) United Nations Decade of Healthy Ageing
(Resolution 75/131). WHO will lead this
Healthy Ageing is the process of devel- work in close collaboration with the UN
oping and maintaining the functional abil- Department of Social and Economic
ity that enables well-being in older age. Affairs and its regional commissions, the
Functional ability is about having the capa- UN Population Fund, the Office of the
bilities that enable all people to be and High Commissioner for Human Rights, UN
do what they have reason to value. As of Development Programme, UN Habitat, UN
2019, there are more than one billion peo- Women, World Bank, and other relevant
ple over the age of 60, most of whom live international and regional organisations.
in low- and middle-income countries and
many of whom do not have access to basic The Decade of Health Ageing is based
resources and are faced with multiple bar- on the Global strategy and action plan on
riers that prevent their full participation in ageing and health (2016-2030) and builds
society. By the end of 2030, that number on the Madrid International Plan of Action
will be 34% higher, increasing to 1.4 billion. on Ageing. Older people will be at the cen-
tres of the Decade which will address four
The WHA adopted decision WHA73(12) areas for action: change how we think, feel
in which it endorsed the proposal for a and act towards age and ageing; ensure
Decade of Health Ageing 2020-2030 and that communities foster the abilities of
requested the DG to transmit the decision older people; deliver person-centred inte-
to the United Nations Secretary-General grated care and primary health services
for consideration by the UN General responsive to older people; and provide
Assembly (UNGA). In December 2020, access to long-term care for older people
the UNGA welcomed the Decade proposal who need it.
and decided to proclaim 2021-2030 the
Political declaration of the third high-level meeting of the
General Assembly on the prevention and control of non-
communicable diseases
Documents: A73/5, EB148/7, EB148/7 urgently require strengthening. Currently,
Add.1, EB148/7 Add.2, EB148(7) many countries have few usable mortality
data and weak information on risk factor
Only 17 and 15 countries are on track to exposure and morbidity. Data on NCDs
meet SDG target 3.4 to reduce premature are often not well integrated into national
mortality from NCDs by a third by 2030 in health information systems. Improving
women and men respectively. The COVID- country-level surveillance and monitoring
19 pandemic is having a deadly interplay remains a top priority in the fight against
with the NCD epidemic. Early analysis of NCDs.
data from the May rapid survey indicates
people with hypertension and/or diabe- The reports included a mid-point evaluation
tes are two to four times more vulnera- of the implementation of the WHO global
ble to becoming severely ill with or die action plan for the prevention and con-
from COVID-19. There are widespread trol of noncommunicable diseases 2013–
disruptions in NCD services and they 2020 (NCD-GAP), which has now been
are having very negative consequences: extended to 2030 to align with the SDG
under-diagnosis of cancers, an increase agenda. They also included a final evalua-
in out-of-hospital death and long-term tion of the global coordination mechanism
complications. Tackling NCDs must be an on the prevention and control of noncom-
integral part of the immediate response to municable diseases (GCM/NCD).
COVID-19 and of the recovery at global,
regional and national levels, as well as part The EB adopted decision EB148(7) and
of the strategies to build back better. The requested the DG, in consultation with
current capacities for NCD surveillance Member States, to develop an option paper
remain inadequate in many countries and on the GCM/NCD for further guidance by
12INTERNATIONAL COUNCIL OF NURSES
the 74th WHA and to present a 2023-2030
roadmap for the NCD-GAP 2013-2030 for
consideration by the 75th WHA.
Ending tuberculosis
Documents: A73/4, WHA73.3 critical to ending TB and advancing related
research and innovation. The 2030 mile-
Tuberculosis (TB) is the leading cause of stone of ending the TB epidemic will not
death from a single infectious agent glob- be met without strengthening linkages
ally with approximately 1.5 million deaths between elimination of TB and relevant
in 2018 and drug-resistant TB poses a SDG targets, including through universal
serious threat to health security and anti- health coverage and intensified research
microbial resistance. There is an over- and innovation.
whelming urgency to make available new
TB medicines, diagnostics, and vaccines The global strategy for tuberculosis
but the pace of local innovation is impeded research and innovation will support the
by weak links between national TB pro- efforts of governments and other stake-
grammes and public research institutes, holders to accelerate TB research and
and by a lack of adequate research infra- innovation and improve equitable access
structure in many countries with a high to the benefits of research.
burden of TB. Furthermore, commitments
made through United Nations high-level The WHA adopted resolution WHA73.3 in
meetings on AIDS, universal health cov- which it adopted the global strategy.
erage, and antimicrobial resistance are
Data and innovation: draft global strategy on digital health
Documents: A73/4, WHA73(28) vision of health for all.
The SDG agenda notes that the spread The Strategy has four strategic objec-
of information and communication tech- tives: 1) promote global collaboration and
nology and global interconnectedness advance the transfer of knowledge on
has great potential to accelerate human digital health; 2) advance the implemen-
progress, bridge the digital divide and tation of national digital health strategies;
develop knowledge societies. Strategic 3) strengthen governance for digital health
and innovative use of digital technologies at global, regional and national levels; 4)
will be and essential element of achieving advocate people-centered health system
the WHO triple billion goals. The Global that are enabled by digital health.
Strategy on Digital Health 2020-2025 aims
to strengthen health systems through The WHA adopted decision WHA73(28) in
the application of digital health technolo- which it endorsed the global strategy on
gies for consumers, health professional digital health.
health care providers and industry towards
empowering patients and achieving the
Substandard and falsified medical products
Documents: EB148/12 from this issue, with reports of substandard
or falsified medical medicines, vaccines
Substandard and falsified medical products and in vitro diagnostics from all regions of
continue to pose an unacceptable global the world.
public threat. WHO has identified this issue
as one of the urgent health challenges for The EB noted the report which contains
the next decade given that more than one the reports of the 8th and 9th meetings
in ten medicines in low- and middle-income of the Member State mechanism on sub-
countries are estimated to be substandard standard and falsified medical products
or falsified. No country remains untouched which took place in October 2019 and
13ICN AT THE 73RD WORLD HEALTH ASSEMBLY, 2020 AND THE 148TH WHO EXECUTIVE BOARD, 2021
2020 respectively. The list of prioritised • Develop and leverage existing
activities for 2020-2021: activity for effective risk
• Develop and promote training communication and make
material and guidance documents to recommendations for awareness
strengthen the capacity of national/ campaigns on substandard and
regional regulatory authorities for falsified medical product
the prevention and detection of, • Enhance Member States’ capacity
and response to, substandard and to expand awareness, effectiveness,
falsified medical products impact and outreach in their work on
• Expand and maintain the Global substandard and falsified medical
Focal Point Network among national products’
medicines regulatory authorities • Promote shared understanding
to facilitate cooperation and among Member States from a public
collaboration health perspective regarding medical
• Improve Member States’ products in transit;
understanding of detection • Identify and develop appropriate
technologies, methodologies and strategies to understand and
“track and trace” model address the distribution or supply of
• Increase Member States’ knowledge substandard and falsified medical
of the links between substandard products via the internet.
and falsified medical products and
access to quality, safe, efficacious
and affordable medical products
Hoi Shan Fokeladeh, Advisor, Nursing & Health
Policy – Delivering an ICN intervention virtually
Social determinants of health
Documents: EB148/24, EB148.R2 development. The COVID-19 pandemic
has disproportionately affected already
The first principle of the WHO Constitution vulnerable communities, highlighting the
includes the need to tackle the root causes scale of health inequalities at all levels.
of disease which involves systematically There is growing evidence of the role
addressing social, environmental and played by SDoH on the differentials in
economic determinants of health (SDoH). expose, vulnerability, health outcomes and
SDoH negatively affect health outcomes consequences of the COVID-19 pandemic.
and lead to health inequities (avoida-
ble and unfair difference in health status The EB report outlines the rationale for
between groups) which undermine human integrating a focus on SDoH into global
14INTERNATIONAL COUNCIL OF NURSES
and national health responses, the impor- public health emergencies. The resolution
tance of which has been brought into sharp requests the DG to: 1) support Member
relief by the pandemic of coronavirus dis- States in monitoring and capacity-build-
ease (COVID-19). ing to address SDoH and to facilitate
knowledge exchange on best practice for
The EB recommended to the 74th WHA intersectoral action on SDoH; 2) prepare
the adoption of resolution EB148.R2 which an updated report on progress made in
calls on Member States to: 1) strengthen addressing SDoH and recommendations
efforts on addressing SDoH with the aim for future action for consideration by the
of reducing health inequities an address 76th WHA in 2023; 3) prepare an opera-
unequal distribution of health resources; tional framework for measuring, assessing
2) monitor and analyse inequities in health and addressing SDoH and health inequi-
using cross-sectoral data to inform national ties ad their impact on health outcomes
policies that address SDoH; 3) integrate for consideration by the 76th WHA; 4)
considerations related to SDoH in public strengthen collaboration with UN agencies,
policies and programmes using a health- civil society and the private sector; 5) work
in-all-polices approach; 4) along with all collaboratively with academia and scien-
stakeholders, mobilise financial human tific research to generate evidence and
and technological resources to enable the best practices.
monitoring and addressing of SDoH; 5)
SDoH in COVID-19 recovery and for future
Accelerating the elimination of cervical cancer as a global
public health problem
Documents: A73/4, WHA73.2
The WHA adopted resolution WHA73.2 in
Cervical cancer is the fourth most com- which it adopted the global strategy and
mon cancer among women worldwide but its associated goals and targets for the
is preventable and curable through vacci- period 2020-2030; urged Member States
nation, screening and treatment. There is to implement the interventions in the global
a disproportionate burden in remote and strategy; called upon stakeholders to sup-
hard-to-reach areas, on marginalised com- port implementation of the strategy, coor-
munities or those in vulnerable situations, dinate efforts, and work collaboratively to
and on women and girls living with HIV, in avoid shortages and strengthen the sup-
which this is the most common cancer. The ply of vaccines, tests and diagnostic tools,
human papillomavirus (HPV) is the primary medicines, radiotherapy and surgery in
cause of cervical cancer and prioritisation respect of human papillomavirus in order
of vaccination of girls against HPV is the to meet the growing demand, including
most effective long-term intervention for by reducing prices and increasing global
reducing the risk of cervical cancer. The and local production, and to develop fur-
disease burden is the highest in low- and ther cost-effective and innovative interven-
middle-income countries where many do tions for vaccination, screening, diagnosis,
not have national vaccine implementation treatment and care; and requested the DG
and have limited screening and treatment. to provide support to Member States on
a number of issues in implementing the
The global strategy to eliminate cervical strategy including build health workforce
cancer as a public health problem sets capacity and to prioritize support for inter-
90-70-90 targets to reach by 2030: 90% of ventions for high-burden countries being
girls fully vaccinated with the HPV vaccine mindful of the burden on vulnerable and
by the age of 15; 70% of women screened marginalised communities and on women
using a high-performance test by the age and girls living with HIV.
of 35, and again by the age of 45; and 90%
of women identified with cervical disease
receive treatment (90% of women with
pre-cancer treated and 90% of women with
invasive cancer managed).
15ICN AT THE 73RD WORLD HEALTH ASSEMBLY, 2020 AND THE 148TH WHO EXECUTIVE BOARD, 2021
The highest attainable standard of health for persons with
disabilities
Documents: EB148/36, EB148/CONF./8, attainable standard of health; 2) address
EB148.R6 all obstacles that prevent persons with
disabilities from accessing health care
The rights of people with disability are not services, information, skills and goods by
being met when it comes to equal access making facilities accessible, training health
to health services, protection during health professionals on the human rights, dig-
emergencies and achieving the high- nity, autonomy and needs of person with
est attainable standard of health through disabilities and by providing appropriate
access to cross-sectoral public health measures for exercising legal capacity; 3)
interventions, such as water, sanitation develop, implement and strengthen poli-
and hygiene services. This failing inevita- cies and programmes that improve access
bly reflects the lack of inclusion of people to rehabilitation; 4) collect health-related
with disability in society more widely and data, disaggregated by disability, age
perpetuates discrimination against them. and sex, education level and household
income; 5) provide health services and
The WHO global disabilities action plan care of the same quality as others without
2014-2021: better health for all people with discrimination on the basis of disability; 6)
disability, developed to scale up the health take measures to ensure comprehensive,
sector response for people with disability, accessible and affordable access to health
will expire in 2021 and the EB report laid systems and care for all persons with dis-
out the progress made thus far. Much pro- abilities, while recognising the unique vul-
gress has been made, but it is clear that nerabilities of those who may be living in
major gaps still exist; people with disa- care and congregated living settings in
bility continue to face significant barriers times of public health emergencies such
and inequalities in accessing everyday as COVID-19. The resolution invites other
health services. WHO noted that failure stakeholders to collaborate with Member
to include people with disability in health States, forge partnerships to share knowl-
responses to COVID-19 has left them par- edge, amplify the voices of persons with
ticularly exposed to the risks of contracting disabilities, and include these persons in
COVID-19, developing severe symptoms health research. The resolution further
or dying from COVID-19, as well as having requests the DG to: 1) develop a global
poorer health in general during and after report on the highest standard of health
the pandemic. for persons with disabilities that addresses
effective access and quality health ser-
The EB recommended that the 74th WHA vices, including universal health coverage
adopt resolution EB148.R6 in which it (with rehabilitation as part of it), health
urges Member States to: 1) incorporate a emergencies and health and wellbeing,
disability- and gender-sensitive and inclu- by the end of 2022; 2) fully implement the
sive approach in decision making and UN Disability Inclusion Strategy across all
designing programmes in order that they levels of WHO; 3) support the creation of
receive effective health services as a part a global research agenda; and 4) provide
of UHC, equal protection during complex Member States with technical knowledge
humanitarian emergencies and disasters, and capacity-building support necessary to
and equal access to cross-sectoral public incorporate a disability-sensitive and inclu-
health interventions to achieve the highest sive approach.
16INTERNATIONAL COUNCIL OF NURSES
Howard Catton, ICN CEO
International Council of Nurses
3, Place Jean Marteau
1201 Geneva, Switzerland
+41229080100
icn@icn.ch
www.icn.ch
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