Day: June 25, 2022

The thirty-second meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) on the international spread of poliovirus was convened by the WHO Director-General on 15 June 2022 with committee members and advisers attending via video conference, supported by the WHO Secretariat. The Emergency Committee reviewed the data on wild poliovirus (WPV1) and circulating vaccine derived polioviruses (cVDPV) in the context of global eradication of WPV and cessation of outbreaks of cVDPV2 by end of 2023. Technical updates were received about the situation in the following countries and territories: Afghanistan, Democratic Republic of the Congo, Israel, Malawi, the occupied Palestinian territory and Pakistan, and written updates were provided by Eritrea and Yemen.

Wild poliovirus

The committee was very concerned that a second WPV1 had been detected in south-eastern Africa, in Mozambique, close to the border with Malawi where the first case was detected. Furthermore, genetic sequencing analysis of the two wild polioviruses indicates a single importation event from Pakistan / Afghanistan into southeastern Africa; the importation event is estimated to have occurred between July 2019 (date of the common node between Pakistan viruses and Malawi/Mozambique viruses) and December 2020 (date of the common node between Malawi and Mozambique viruses). COVID19-related severe movement restrictions implemented in March 2020 in Pakistan and Afghanistan means it is less likely exportation could have occurred between March and December 2020. The Malawi and Mozambique viruses independently evolved for about 0.9 and 1.2 years respectively until first detected and are both considered orphan viruses, and the absence of detection of circulating WPV1 viruses in Malawi and Mozambique between 2019 and 2021 suggests surveillance gaps in southeastern Africa. The original WPV1 cluster in south Asia has not been detected there since December 2020.

The committee noted that the certification of polio eradication African Region was not affected by the outbreak, as it is due to importation rather then endemic transmission. The committee also noted the importance of cross border activities in the outbreak response.

A multi-country response to the WPV1 outbreak is continuing, with four immunization rounds being conducted in Malawi, Mozambique, Tanzania, Zambia; Zimbabwe will join the response for rounds 3 and 4. Additionally, retrospective case searching, surveillance strengthening and improving essential immunization are all ongoing. The committee noted that while administrative coverage was high, problems with population data made these coverage estimates unreliable. Monitoring coverage by Lot Quality Assurance Sampling (LQAS) showed far lower coverage, and the committee noted that countries that have long been polio free needed assistance from GPEI partners in the implementation of supplementary immunization activities (SIAs).

The committee was concerned about the recent outbreak of WPV1 in the North Waziristan district of southern Khyber Pakhtunkhwa (KP) province in Pakistan. Since the last Emergency Committee (EC) meeting in February 2022, Pakistan has reported ten WPV1 cases from North Waziristan and two WPV1 positive environmental samples from the neighboring district of Bannu. With the ongoing WPV1 circulation in South KP, the risks to the rest of Pakistan has escalated.

The key challenges which hampered progress in southern KP include the complex security situation, specifically in North and South Waziristan, which resulted in inadequate access, missed children and reduced quality of SIAs. Community resistance with refusals to vaccination (including vaccination boycotts and fake finger-marking without vaccination), lack of female frontline workers and high turnover of frontline workers, and weak health infrastructure and service delivery all pose challenges. The ten WPV1 cases reported in 2022 are zero dose for routine immunization, zero dose or under-immunized in SIAs, and are from refusal families.

Another challenge in South KP is the sub-optimal Routine Immunization (RI) and progress on strengthening RI in South KP is slow.

The committee commended the dedication of frontline health workers who continue to seek every child who needed vaccination and extended its sympathy to the families of the 17 health workers who were killed in February 2022 in Takhar and Kunduz in Afghanistan. It is encouraging that 2.6 million previously unreached children have been vaccinated, and the number of children not yet accessed by immunization teams was down to an estimated 700,000. Data provided to the committee clearly showed that where house to house polio campaigns are possible the vaccine coverage is far higher.

There has been continuous / steady progress in the rest of Pakistan with no WPV1 detection in last 11 months. Last WPV1 case and positive environmental sample outside of South KP were detected in January 2021 and July 2021 respectively.

Circulating vaccine derived poliovirus (cVDPV)

Eritrea has reported detection of cVDPV2 for the first time, and the virus is most closely linked to a virus found in Sudan in 2020, indicating that both new international spread and missed transmission has occurred. Furthermore, the detection of cVDPV2 in Ghana, Togo and Côte d’Ivoire appears to have resulted from new spread from Nigeria. A new outbreak of cVDPV3 has been detected in Israel in a population sub-group who refuse vaccination. Environmental detection has also occurred in sites in the occupied Palestinian territory. High levels of transmission of cVDPV2 are occurring in northern Yemen, northern Nigeria, and eastern DR Congo, which have reported 115 out of 127 cases to date in 2022. Because of the conflict, no immunization rounds have been conducted in northern Yemen.

Despite the ongoing decline in the number of cases and lineages circulating, the risk of international spread of cVDPV2 remains high as evidenced by recent spread from Nigeria to West Africa. The large amount of transmission occurring in Nigeria along with chronically low immunization coverage is now resulting in spread to multiple countries, while the detection of cVDPV2 in Eritrea of an orphan virus means that missed transmission has occurred in the Horn of Africa also. The persistence of cVDPV2 in Somalia is another concern. The successful introduction of novel OPV2 and re-introduction of tOPV are expected to mitigate the risk of international spread of cVDPV2, particularly as supply issues are resolved in the second half of 2022.

The committee noted that the roll out of wider use of novel OPV2 continues under EUL. The committee also noted the delays concerning the importance of timely, quality outbreak response with countries avoiding timely response with monovalent OPV2 or trivalent OPV, preferring to wait for novel OPV2 to become available. The committee noted that SAGE recommends that speed in the rollout of any of these three vaccines is of paramount importance and countries should avoid delays associated with waiting for novel OPV2.

The committee noted that the outbreak in Israel again shows that even countries with high immunization coverage can have pockets of high risk children which can sustain an outbreak.

Conclusion

Although heartened by the apparent progress, the Committee unanimously agreed that the risk of international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC) and recommended the extension of Temporary Recommendations for a further three months. The Committee recognizes the concerns regarding the lengthy duration of the polio PHEIC and the importance of exploring alternative IHR measures in the future but concluded that there are still significant risks as exemplified by the importation of virus into Malawi and Mozambique. The Committee considered the following factors in reaching this conclusion:

Ongoing risk of WPV1 international spread:

Based on the following factors, the risk of international spread of WPV1 remains:

the current outbreak of WPV1 in Pakistan where there have been 10 cases in just the last three month which must be contained;

high-risk mobile populations in Pakistan such as migrants, nomads, displaced populations, particularly Afghan refugees represent a specific risk of international spread.

the unpredictable situation in Afghanistan, with ongoing and deteriorating humanitarian crises including food insecurity and risk of financial collapse disrupting eradication activities;

the detection of WPV1 in Malawi and Mozambique, particularly as the route from Pakistan to Africa remains unknown;

the sub-optimal immunization coverage obtained through recent rounds in southeastern Africa, meaning ongoing transmission could be occurring;

complacency leading to inadequate surveillance means that such transmission could be missed;

the large pool of unvaccinated ‘zero dose’ children in Afghanistan in formerly inaccessible areas in many provinces, while decreasing, still represent a major risk of re-introduction of WPV1 in those communities;

although COVID-19 cases are currently at low levels in Afghanistan and Pakistan, further waves of cases are possible, which may have unpredictable adverse impacts on polio surveillance and on immunization activities.

Ongoing risk of cVDPV2 international spread:

Based on the following factors, the risk of international spread of cVDPV2 appears to remain high:

the actual ongoing cross border spread including into newly infected countries;

the explosive outbreak of cVDPV2 in northern Yemen, and ongoing high transmission in eastern Democratic Republic of the Congo and northern Nigeria, which have caused international spread to neighbouring countries;

the lack of timely high quality responses in many countries;

the ever-widening gap in population intestinal mucosal immunity in young children since the withdrawal of OPV2 in 2016 and consequently high concentration of zero dose children in certain areas, especially the four areas mentioned above (second dot point)

the same factors regarding the COVID-19 pandemic as mentioned above;

Other factors include

Weak routine immunization: Many countries have weak immunization systems that can be further impacted by various humanitarian emergencies including COVID-19, and the number of countries in which immunization systems have been weakened or disrupted by conflict and complex emergencies poses a growing risk, leaving populations in these fragile states vulnerable to outbreaks of polio.

Lack of access: Inaccessibility continues to be a major risk, particularly in several countries currently infected with cVDPV, i.e. Nigeria, Niger and Somalia, which all have sizable populations that have been unreached with polio vaccine for prolonged periods.

Risk categories

The Committee provided the Director-General with the following advice aimed at reducing the risk of international spread of WPV1 and cVDPVs, based on the risk stratification as follows:

States infected with WPV1, cVDPV1 or cVDPV3.

States infected with cVDPV2, with or without evidence of local transmission:

States no longer infected by WPV1 or cVDPV, but which remain vulnerable to re-infection by WPV or cVDPV.

Criteria to assess States as no longer infected by WPV1 or cVDPV:

Poliovirus Case: 12 months after the onset date of the most recent case PLUS one month to account for case detection, investigation, laboratory testing and reporting period OR when all reported AFP cases with onset within 12 months of last case have been tested for polio and excluded for WPV1 or cVDPV, and environmental or other samples collected within 12 months of the last case have also tested negative, whichever is the longer.

Environmental or other isolation of WPV1 or cVDPV (no poliovirus case): 12 months after collection of the most recent positive environmental or other sample (such as from a healthy child) PLUS one month to account for the laboratory testing and reporting period - These criteria may be varied for the endemic countries, where more rigorous assessment is needed in reference to surveillance gaps.

Once a country meets these criteria as no longer infected, the country will be considered vulnerable for a further 12 months. After this period, the country will no longer be subject to Temporary Recommendations, unless the Committee has concerns based on the final report.

TEMPORARY RECOMMENDATIONS

States infected with WPV1, cVDPV1 or cVDPV3 with potential risk of international spread

WPV1

Afghanistan: most recent detection 4 May 2022

Malawi: most recent detection 19 November 2021

Mozambique: most recent detection 25 March 2022

Pakistan: most recent detection 15 May 2022

cVDPV1

Madagascar: most recent detection 9 May 2022

cVDPV3

Israel: most recent detection 24 March 2022

These countries should:

Officially declare, if not already done, at the level of head of state or government, that the interruption of poliovirus transmission is a national public health emergency and implement all required measures to support polio eradication; where such declaration has already been made, this emergency status should be maintained as long as the response is required.

Ensure that all residents and long­term visitors (i.e. > four weeks) of all ages, receive a dose of bivalent oral poliovirus vaccine (bOPV) or inactivated poliovirus vaccine (IPV) between four weeks and 12 months prior to international travel.

Ensure that those undertaking urgent travel (i.e. within four weeks), who have not received a dose of bOPV or IPV in the previous four weeks to 12 months, receive a dose of polio vaccine at least by the time of departure as this will still provide benefit, particularly for frequent travelers.

Ensure that such travelers are provided with an International Certificate of Vaccination or Prophylaxis in the form specified in Annex 6 of the IHR to record their polio vaccination and serve as proof of vaccination.

Restrict at the point of departure the international travel of any resident lacking documentation of appropriate polio vaccination. These recommendations apply to international travelers from all points of departure, irrespective of the means of conveyance (e.g. road, air, sea).

Further intensify cross­border efforts by significantly improving coordination at the national, regional and local levels to substantially increase vaccination coverage of travelers crossing the border and of high risk cross­border populations. Improved coordination of cross­border efforts should include closer supervision and monitoring of the quality of vaccination at border transit points, as well as tracking of the proportion of travelers that are identified as unvaccinated after they have crossed the border.

Further intensify efforts to increase routine immunization coverage, including sharing coverage data, as high routine immunization coverage is an essential element of the polio eradication strategy, particularly as the world moves closer to eradication.

Maintain these measures until the following criteria have been met: (i) at least six months have passed without new infections and (ii) there is documentation of full application of high quality eradication activities in all infected and high risk areas; in the absence of such documentation these measures should be maintained until the state meets the above assessment criteria for being no longer infected.

Provide to the Director-General a regular report on the implementation of the Temporary Recommendations on international travel.

States infected with cVDPV2, with or without evidence of local transmission:

1. Afghanistan: most recent detection 9 Jul 2021

2. Benin: most recent detection 9 September 2021

3. Burkina Faso: most recent detection 9 June 2021

4. Cameroon: most recent detection 29 October 2021

5. CAR: most recent detection 4 May 2022

6. Chad: most recent detection 25 March 2022

7. Côte d’Ivoire: most recent detection 9 February 2022

8. DR Congo: most recent detection 7 April 2022

9. Djibouti: most recent detection 27 March 2022

10. Egypt: most recent detection 28 April 2021

11. Eritrea: most recent detection 3 September 2021

12. Ethiopia: most recent detection 16 September 2021

13. Gambia: most recent detection 9 September 2021

14. Ghana: most recent detection 17 May 2022

15. Guinea: most recent detection 3 August 2021

16. Guinea Bissau: most recent detection 26 July 2021

17. Liberia: most recent detection 28 May 2021

18. Mauritania: most recent detection 3 November 2021

19. Mozambique: most recent detection 26 March 2022

20. Niger: most recent detection 18 April 2022

21. Nigeria: most recent detection 16 April 2022

22. Pakistan: most recent detection 11 August 2021

23. Senegal: most recent detection 18 November 2021

24. Sierra: Leone most recent detection 1 June 2021

25. Somalia: most recent detection 10 March 2022

26. South Sudan: most recent detection 8 April 2021

27. Togo: most recent detection 22 March 2022

28. Uganda: most recent detection 2 November 2021

29. Ukraine: most recent detection 24 December 2021

30. Yemen: most recent detection 3 March 2022

States that have had an importation of cVDPV2 but without evidence of local transmission should:

Officially declare, if not already done, at the level of head of state or government, that the prevention or interruption of poliovirus transmission is a national public health emergency

Undertake urgent and intensive investigations to determine if there has been local transmission of the imported cVDPV2

Noting the existence of a separate mechanism for responding to type 2 poliovirus infections, consider requesting vaccines from the global mOPV2 stockpile based on the recommendations of the Advisory Group on mOPV2.

Further intensify efforts to increase IPV immunization coverage, including sharing coverage data.

Intensify national and international surveillance regional cooperation and cross-border coordination to enhance surveillance for prompt detection of poliovirus.

States with local transmission of cVDPV2, with risk of international spread should in addition to the above measures:

Encourage residents and long­-term visitors to receive a dose of IPV four weeks to 12 months prior to international travel.

Ensure that travelers who receive such vaccination have access to an appropriate document to record their polio vaccination status.

Intensify regional cooperation and cross-­border coordination to enhance surveillance for prompt detection of poliovirus, and vaccinate refugees, travelers and cross-­border populations, according to the advice of the Advisory Group.

For both sub-categories:

Maintain these measures until the following criteria have been met: (i) at least six months have passed without the detection of circulation of VDPV2 in the country from any source, and (ii) there is documentation of full application of high quality eradication activities in all infected and high risk areas; in the absence of such documentation these measures should be maintained until the state meets the criteria of a ‘state no longer infected’.

At the end of 12 months without evidence of transmission, provide a report to the Director-General on measures taken to implement the Temporary Recommendations.

States no longer infected by WPV1 or cVDPV, but which remain vulnerable to re-infection by WPV or cVDPV

WPV1

cVDPV

China: most recent detection 25 January 2021

Congo: most recent detection 1 June 2021

Iran (Islamic Republic of): most recent detection 20 February 2021

Kenya: most recent detection 13 January 2021

Mali: most recent detection 23 December 2020

Sudan: most recent detection 18 December 2020

South Sudan: most recent detection 18 April 2021

Tajikistan: most recent detection 13 August 2021

These countries should:

Urgently strengthen routine immunization to boost population immunity.

Enhance surveillance quality, including considering introducing supplementary methods such as environmental surveillance, to reduce the risk of undetected WPV1 and cVDPV transmission, particularly among high risk mobile and vulnerable populations.

Intensify efforts to ensure vaccination of mobile and cross-­border populations, Internally Displaced Persons, refugees and other vulnerable groups.

Enhance regional cooperation and cross border coordination to ensure prompt detection of WPV1 and cVDPV, and vaccination of high risk population groups.

Maintain these measures with documentation of full application of high-quality surveillance and vaccination activities.

At the end of 12 months without evidence of reintroduction of WPV1 or new emergence and circulation of cVDPV, provide a report to the Director-General on measures taken to implement the Temporary Recommendations.

Additional considerations

The Committee was very concerned by the importation of WPV1 into Africa and the low quality campaigns so far and urged GPEI to provide urgent support to the countries involved in the response, Malawi, Mozambique, Tanzania, Zambia and Zimbabwe. These countries need to collaborate and coordinate in a timely fashion to achieve the following:

the investigation of all AFP cases and contacts with appropriate stool samples, and undertake a search for missed cases and polio compatible cases;

high quality polio campaigns with high coverage and careful post campaign monitoring;

where appropriate, share the results of epidemiological investigations especially where these involve cross border populations;

in Malawi and Mozambique, ensure the Temporary Recommendations around vaccination of departing travelers are fully implemented and provide a report at the next committee meeting concerning implementation; and

surveillance should be enhanced in other countries in the region, particularly if there is significant movement of Malawian citizens into that country.

The committee remains very concerned about the situation in Afghanistan and expressed its condolences to the family, friends and colleagues of the killed polio workers. Security arrangements must be reviewed and improved to prevent any further attacks. Noting the humanitarian crisis still unfolding in the country, the committee urged that polio campaigns be integrated with other public health measures wherever possible, including screening children for malnutrition, vitamin A administration and measles vaccination.

The committee also strongly suggests house to house campaigns be implemented wherever feasible as these campaigns have been shown to enhance identification of zero dose and under-immunized children. , noting that this modality may require further human and financial resourcing. In Pakistan, there is concern about persistent low grade WPV1 transmission in the central epidemiological corridor (including South KP and South East Afghanistan) and there is a need to strongly address gaps in surveillance and SIA quality.

The Committee welcomed the further progress achieved with the introduction and delivery of nOPV2 but was concerned to hear of significant delays in outbreak response timelines as countries opted to delay response in order to use nOPV2. Polio outbreaks should continue to be met with an aggressive and timely response with the immediately available type-2 vaccine as recommended by SAGE.

The high case numbers of cVDPV2 in Nigeria present a risk not only to Nigeria but also surrounding countries. The committee noted with concern the high number of zero dose children in Nigeria and the low routine immunization rates. The committee urged Nigeria to continue to strengthen essential immunization and improve the quality of polio campaigns.

The WPV1 outbreak in southeastern Africa serves as a reminder to all countries of the risk of missed importation and subsequent spread. All countries need to review their surveillance systems to identify high risk populations with accumulation of zero dose children, particularly where recovery of surveillance following the COVID-19 pandemic has been only partial. Countries also need to take greater ownership of polio prevention and surveillance, especially as donor funding is diverted to COVID-19 needs and other emerging public health issues such as monkeypox, and other global issues such as the war in Ukraine. Countries and international partners need to make clear messaging about the importance of vaccination in the face of ‘vaccine fatigue’ and skepticism in many communities.

The committee noted with concern that in Yemen, children are not being accessed for immunization in the Houthi held areas. The committee encouraged ongoing dialogue with all stakeholders to allow access to immunization for all children throughout the country. Stopping transmission in Somalia and Yemen is one of the main challenges in meeting the global goal of stopping outbreaks of cVDPV2 by end of 2023.

The Committee warned of the ongoing effects of COVID-19 particularly on essential immunization and surveillance with possible future disruptions of polio programme activities.

The committee noted the ongoing work around the duration of the polio PHEIC, and possible amendments to the IHR, and suggested that the committee be kept informed of the process.

Based on the current situation regarding WPV1 and cVDPV, and the reports provided by affected countries, the Director-General accepted the Committee’s assessment and on 20 June 2022 determined that the situation relating to poliovirus continues to constitute a PHEIC, with respect to WPV1 and cVDPV. The Director-General endorsed the Committee’s recommendations for countries meeting the definition for ‘States infected with WPV1, cVDPV1 or cVDPV3 with potential risk for international spread’, ‘States infected with cVDPV2 with potential risk for international spread’ and for ‘States no longer infected by WPV1 or cVDPV, but which remain vulnerable to re-infection by WPV or cVDPV’ and extended the Temporary Recommendations under the IHR to reduce the risk of the international spread of poliovirus, effective 20 June 2022.

Source: World Health Organization

Less than half (49 per cent) of the 2.1 billion COVID vaccine donations promised to poorer countries by G7 countries have been delivered, according to new figures published today by Oxfam and the People’s Vaccine Alliance.

On the eve of this year’s G7 Summit, taking place in the German Alps, a new analysis shows that had the missing donated doses been shared in 2021,it could have been enough to save almost 600,000 lives in low and middle income countries, the equivalent of one every minute.

The worst offenders are the UK and Canada, who have failed to deliver anywhere near the number of vaccines they promised. Just 39 per cent of the100 million doses the UK pledged to deliver by the end of this month have actually been delivered. While the deadline to meet their respective commitments isn’t until the end of the year, only 30 per cent of Canada’s 50.7 million doses and 46 per cent of the 1.2 billion pledged by the US have been delivered. So-called ‘Team Europe’ have collectively delivered just 56 per cent of the 700 million doses promised by the middle of 2022 and Japan has delivered 64 per cent of the 60 million doses it said it would send.

Latest data from Airfinity suggests that rich nations may have already secured over half (55 per cent) of the new generation of Omicron-specific mRNA COVID-19 vaccines being developed by Moderna and Pfizer/ BioNTech. This is even before they have been approved for use, making it likely that many developing countries will yet again be left at the back of the queue.

Max Lawson, Head of Inequality Policy at Oxfam and Co-Chair of the People’s Vaccine Alliance, said: “On every level, rich nations have massively betrayed poor countries when it comes to COVID vaccines. First, they stockpiled all the supply for themselves, then they promised to donate their leftovers, but hundreds of millions of these doses never materialised.

“Rich nations are already hoarding the new generation of Omicron specific vaccines, whilst people in poorer countries will be forced to continue to face new variants with vaccines that are increasingly ineffective. The only way to fix this is to give nations the rights to make their own, not rely on rich countries to pass on doses they no longer need and deliver too late for the millions who have died.”

New data published yesterday by Imperial College London found that 599,300 deaths could have been averted in 2021 had 40 per cent of people in all countries been fully vaccinated. The billion missing doses that G7 countries failed to deliver would have been enough to reach this target. Nearly all these preventable deaths were in low- and middle-income countries.

To date only 14 per cent of people in low-income countries and 18 per cent of people on the African continent are fully vaccinated – far from the target to have 70 per cent coverage in all nations by the middle of the year. Despite such low vaccine coverage, the Imperial College research found COVID vaccines have saved 446,400 lives in Africa and 180,300 in low-income countries

At the same time, rich nations led by the EU and UK have forced through a text at the WTO which has failed to waive intellectual property on vaccines, treatments and technology that would have enabled developing countries to produce their own generic vaccines. Instead, the text adds even more bureaucratic hurdles and further protects the hugely profitable monopolies of firms such as Pfizer/BioNTech and Moderna. The People’s Vaccine Alliance is calling on all countries facing shortages of vaccines, tests and treatments to save lives and end the pandemic by using all trade rule flexibilities available and circumventing WTO rules if necessary. They say the G7 and other rich countries must not stand in their way.

The campaign groups also says that the model of leaving developing countries to rely on donations in order to vaccinate people is completely flawed and actually leads to frustration and mistrust.

Julia Kosgei, Policy Advisor at The People’s Vaccine Alliance said: “Hundreds of thousands of lives have been saved in Africa by the vaccines, but so many more deaths could have been prevented. Vaccination programs have worked best when doses have arrived on time, allowing governments to plan and scale up distribution. But many countries waited a year to get their first doses. When doses finally arrived, they came all at once, often close to their expiry date, which is totally unmanageable and unfair for countries that have already struggling health systems.

“Developing countries do not want to have to wait for leftovers, they want the reliability and dignity of being able to produce their own doses. It is a disgrace that rich countries stalled negotiations on an IP waiver to scale up vaccine production across the world so that pharmaceutical corporations could maximise profits while people died without access. To add insult to injury they couldn't even be bothered to ensure timely access to the doses they didn't even need.

“Rich countries have demonstrated that they cannot be trusted to act in the interests of public health for everyone, everywhere - it's time for leaders from the global south to take matters into their own hands. We hope that governments will do whatever is needed to protect their populations – whether that is using flexibilities in global intellectual property rules or circumventing them to save lives. Rich countries must not get in their way.”

Previous research by the People’s Vaccine Alliance found that vaccine monopolies are making it 5 times more expensive to vaccinate the world, while Moderna and Pfizer / BioNTech are making over $1,000 profit every second from COVID vaccines.

Source: Oxfam

The WHO Director-General has the pleasure of transmitting the Report of the Meeting of the International Health Regulations (2005) (IHR) Emergency Committee regarding the multi-country monkeypox outbreak, held on 23 June 2022, from 12:00 to 17:00 Geneva time (CEST). The WHO Director-General concurs with the advice offered by the IHR Emergency Committee regarding the multi-country monkeypox outbreak and, at present, does not determine that the event constitutes a Public Health Emergency of International Concern (PHEIC).

Since 11 May 2022, the WHO Secretariat alerted the States Parties to the IHR in relation to this event, through postings on the Event Information Site (a secured platform established by the WHO Secretariat for information sharing with States Parties to the IHR). These postings aimed to raise awareness about the extent of the outbreak, inform readiness efforts, and provide access to technical guidance for immediate public health actions recommended by the WHO Secretariat.

Convening an IHR Emergency Committee signals an escalation of the level of alert for States Parties to the IHR and the international public health community, and it represents a call for intensified public health actions in response to this event.

The WHO Director-General is taking the opportunity to express his most sincere gratitude to the Chair, Vice-Chair, and Members of the IHR Emergency Committee, as well as to its Advisers.

Proceedings of the meeting

Members of and Advisers to the Emergency Committee were convened in person (Chair and Vice-Chair) and by teleconference, via Zoom.

The WHO Secretariat welcomed the participants. The Representative of the Office of Legal Counsel briefed the Members and Advisers on their roles and responsibilities and identified the mandate of the Emergency Committee under the relevant articles of the IHR. The Ethics Officer from the Department of Compliance, Risk Management, and Ethics provided the Members and Advisers with an overview of the WHO Declaration of Interests process. The Members and Advisers were made aware of their individual responsibility to disclose to WHO, in a timely manner, any interests of a personal, professional, financial, intellectual or commercial nature that may give rise to a perceived or actual conflict of interest. They were additionally reminded of their duty to maintain the confidentiality of the meeting discussions and the work of the Committee. Each Member and Adviser was surveyed. No conflicts of interest were identified.

The Principal Legal Officer then facilitated the election of officers of the Committee, in accordance with the rules of procedures and working methods of the Emergency Committee. Dr Jean-Marie Okwo-Bele was elected as Chair of the Committee, Professor Nicola Low as Vice-Chair, and Dr Inger Damon as Rapporteur, all by acclamation. The meeting was handed over to the Chair who introduced the objectives of the meeting: to provide views to the WHO Director-General on whether the event constitutes a public health emergency of international concern, and if so, to provide views on potential temporary recommendations.

Presentations

The WHO Director-General joined by video and welcomed the participants, welcoming the Committee’s advice on the event.

The WHO Secretariat presented the global epidemiological situation, highlighting that since the beginning of May 2022, 3040 cases have been reported to WHO from 47 countries. Transmission is occurring in many countries that have not previously reported cases of monkeypox, and the highest numbers of cases are currently reported from countries in the WHO European Region. Initial cases of monkeypox, detected in several countries in different WHO Regions, had no epidemiological links to areas that have historically reported monkeypox, suggesting that undetected transmission might have been ongoing for some time in those countries. The majority of confirmed cases of monkeypox are male and most of these cases occur among gay, bisexual and other men who have sex with men in urban areas and are clustered social and sexual networks.

The clinical presentation is often atypical, with few lesions localized to the genital, perineal/perianal or peri-oral area that do not spread further, and an asynchronous rash that appears prior to the development of a prodromal phase (i.e. lymphadenopathy, fever, malaise). There have been few hospitalizations to date, and one death in an immunocompromised individual was reported. Some preliminary research has estimated that the reproduction number (R0) to be 0.8 and, among cases who identify as men who have sex with men, to be greater than 1. The mean incubation period among cases reported is estimated at 8.5 days, ranging from 4.2 to 17.3 days (based on 18 cases in Netherlands). The mean serial interval is estimated at 9.8 days (95% CI 5.9-21.4 day, based on 17 case-contact pairs in the United Kingdom). To date, 10 cases of infection have been reported among health care workers, of which at least nine were non-occupational.

Representatives of Canada, the Democratic Republic of the Congo, Nigeria, Portugal, Spain, and the United Kingdom updated the Committee on the epidemiological situation in their countries and the current response efforts.

The WHO Secretariat then presented the draft “WHO Strategic Plan for the Containment of the Multi-Country Monkeypox Outbreak.” The plan emphasized that a strengthened, agile, and collaborative approach must be adopted, with a particular focus on raising awareness and empowering affected population groups to adopt safe behaviors and protective measures based on the risks they face, and on stopping further spread of monkeypox within those population groups.

The WHO Secretariat also presented their technical guidance, offered to countries in support of their efforts in responding to this event, and revolving around: enhanced surveillance; isolation of cases; contact identification and monitoring; strengthened laboratory and diagnostic capacities; clinical management and infection prevention and control measures within health care and community settings, including care pathways; engagement with affected population groups and effective communication to avoid stigmatization; robust care pathways, including the use of medical countermeasures under collaborative research frameworks, using standardized data collection tools to rapidly increase evidence generation on efficacy and safety of these products.

Deliberative session

Following the presentations session, the Committee reconvened in a closed meeting to examine the questions in relation to whether the event constitutes a PHEIC or not, and if so, to consider the Temporary Recommendations, drafted by the WHO Secretariat in accordance with IHR provisions. At the request of the Chair, the WHO Secretariat reminded the Committee Members of their mandate and recalled the definition of a PHEIC under the IHR: an extraordinary event, which constitutes a public health risk to other States through international transmission, and which potentially requires a coordinated international response.

The Committee discussed key issues related to the outbreak, including: current observations of plateauing or potential downward trends in case numbers in some of the countries experiencing outbreak early on; the need for further understanding of transmission dynamics; the challenges related to contact tracing, particularly because of anonymous contacts, and potential links to international gatherings and LGBTQI+ Pride events conducive for increased opportunities for exposure through intimate sexual encounters; the need for continuous evaluation of interventions that appear to have had an impact on transmission; the identification of key activities for risk communications and community engagement, working in close partnership with affected communities to raise awareness about personal protective measures and behaviours during upcoming events and gatherings; the need to evaluate the impact of different interventions, including the evaluation of vaccination strategies implemented by certain countries in response to the outbreak, and the availability and equity in access and licensing of medical countermeasures.

The Committee was concerned about the potential for exacerbation of the stigmatization and infringement of human rights, including the rights to privacy, non-discrimination, physical and mental health, of affected population groups, which would further impede response efforts. Additionally, for the protection of public health, some Members of the Committee expressed the views that laws, policies and practices that criminalize or stigmatize consensual same-sex behaviour by state or non-state actors create barriers to accessing health services and may also hamper response interventions.

Additional knowledge gaps and areas of uncertainty, for which more information is needed rapidly to support a more comprehensive assessment of the public health risk of this event, include: transmission modes; full spectrum of clinical presentation; infectious period; reservoir species and potential for reverse zoonoses; the possibility of virus; and access to vaccines and antivirals and their efficacy in humans.

The Committee recognized that monkeypox is endemic in parts of Africa, where it has been noted to cause disease, including fatalities, for decades, and that the response to this outbreak must serve as a catalyst to increase efforts to address monkeypox in the longer term and access to essential supplies worldwide.

Conclusions and advice

The Committee noted that many aspects of the current multi-country outbreak are unusual, such as the occurrence of cases in countries where monkeypox virus circulation had not been previously documented, and the fact that the vast majority of cases is observed among men who have sex with men, of young age, not previously immunized against smallpox (knowing that vaccination against smallpox is effective in protecting against monkeypox as well). Some Members suggested that, given the low level of population immunity against pox virus infection, there is a risk of further, sustained transmission into the wider population that should not be overlooked. The Committee also stressed that monkeypox virus activity has been neglected and not well controlled for years in countries in the WHO African Region.

The Committee also noted that the response to the outbreak requires collaborative international efforts, and that such response activities have already started in a number of high-income countries experiencing outbreaks, although there has been insufficient time to have evaluated the effectiveness of these activities.

While a few Members expressed differing views, the committee resolved by consensus to advise the WHO Director-General that at this stage the outbreak should be determined to not constitute a PHEIC.

However, the Committee unanimously acknowledged the emergency nature of the event and that controlling the further spread of outbreak requires intense response efforts. The Committee advised that the event should be closely monitored and reviewed after a few weeks, once more information about the current unknowns becomes available, to determine if significant changes have occurred that may warrant a reconsideration of their advice.

The Committee considered that the occurrence of one or more of the following should prompt a re-assessment of the event: evidence of an increase in the rate of growth of cases reported in the next 21 days, both among and beyond the population groups currently affected; occurrence of cases among sex workers; evidence of significant spread to and within additional countries, or significant increases in number of cases and spread in endemic countries; increase in number of cases in vulnerable groups, such as immunosuppressed individuals, including with poorly controlled HIV infection, pregnant women, and children; evidence of increased severity in reported cases (i.e. increased morbidity or mortality and rates of hospitalization; evidence of reverse spillover to the animal population; evidence of significant change in viral genome associated with phenotypic changes, leading to enhanced transmissibility, virulence or properties of immune escape, or resistance to antivirals, and reduced impact of countermeasures; evidence of cluster of cases associated with clades of greater virulence detected in new countries outside West and Central African countries.

Source: World Health Organization

Germany accused Russia of taking the world hostage with its “grain war” on Friday as Berlin hosted a conference to address concerns the Ukraine conflict could cause hunger in some countries.

Held under the banner “Uniting for Global Food Security”, the meeting brought together foreign, agriculture and development ministers from 40 countries ahead of a G7 leaders summit in Bavaria starting on Sunday.

With stalled grain deliveries from Ukraine leaving many countries fearing food shortages, the conference was attended by G7 ministers as well as hard-hit nations like Nigeria, Tunisia and Indonesia.

Moscow is “deliberately causing food prices to explode … in order to destabilise entire countries”, Foreign Minister Annalena Baerbock told the meeting, accusing Russia of waging a “cynical grain war”.

At a news briefing ahead of the conference, Baerbock had accused Russia of using hunger “quite deliberately as a weapon of war” and “taking the whole world hostage”.

As a result of Russia’s invasion of top agricultural exporter Ukraine, grain deliveries across the Black Sea have been stalled by minefields and a Russian military blockade of Ukrainian ports.

The crisis has seen food prices soar and contributed to the global spike in inflation.

The United Nations has warned that it is currently affecting poorer African countries the most because of their heavy dependence on Russian and Ukrainian wheat.

United Nations Secretary General Antonio Guterres told the conference the world was facing “an unprecedented global hunger crisis”.

“There can be no effective solution to the global food crisis without reintegrating Ukraine’s food production as well as the food and fertiliser produced by Russia into world markets,” he said.

Moscow denies blocking the passage of cargo vessels and blames Western sanctions against Russia for contributing to the food crisis.

But US Secretary of State Antony Blinken on Friday said “Russia is the only one responsible for the crisis”.

“I would like to highlight that in contrast to what Russia says, it is not the sanctions (that) are responsible” for the crisis, he said.

“Food security is a global good that must not be utilised as a tool for political means,” he added.

Turkiye has been spearheading efforts to resume grain deliveries across the Black Sea and this week agreed to pursue talks on how to solve the crisis after a meeting with Russian officials in Moscow.

The Turkish defence ministry said four-way grain talks between Russia, Ukraine, Turkiye and the UN could be held in Turkiye “in the coming weeks”.

In a video message recorded for the summit, Chancellor Olaf Scholz said Germany was “in intensive talks… to get exports of Ukrainian agricultural products by sea back on track as quickly as possible” as well as “working on alternative export routes via rail and road”.

But South African Agriculture Minister Angela Thokozile Didiza said the main priority should be to end the conflict through diplomacy.

“It has always been clear that cessation of hostilities and persuading those in conflict to come to the table and negotiate” is the best route to peace, she said.

Though the meeting was not billed as a donor conference, Britain on Thursday evening pledged an additional 372 million pounds ($456 million) in aid for the countries worst affected by rising global food prices.

The package includes 130 million pounds for the World Food Programme this financial year, the government said in a statement.

Source: Nam News Network

Russian President Vladimir Putin said Moscow’s military action in Ukraine was not responsible for the global food crisis, instead blaming the West for preventing the export of Russian grain.

“The food market is unbalanced in the most serious way,” Putin said, addressing a “BRICS Plus” virtual summit that brought together the leaders of 17 countries, including China, India, Brazil and South Africa.

Putin accused Western countries, in particular the United States, of “destabilising global agricultural production” with restrictions on the delivery of fertiliser from Russia and Belarus, and by “making it difficult” for Moscow to export grain.

“Rising prices on agricultural staples, such as grain, have hit the hardest developing countries, developing markets where bread and flour are a necessary means of survival for the majority of the population,” Putin said.

He also slammed the “hysteria” surrounding grain that has been trapped in Ukrainian ports since the start of Russia’s military actions, saying that it “does not solve any problems on the global grain market”.

Putin said Russia is a “responsible actor on the global food market” and is ready to “honestly fulfil all its contractual obligations”.

Washington and Brussels have hit Moscow with unprecedented sanctions after Putin sent troops into pro-Western Ukraine on Feb 24.

Source: Nam News Network

GENEVA —

The World Health Organization's chief said Saturday that the monkeypox outbreak was a deeply concerning evolving threat but did not currently constitute a global health emergency.

WHO Director-General Tedros Adhanom Ghebreyesus convened a committee of experts Thursday to advise him whether to sound the U.N. health agency's strongest alarm over the outbreak.

A surge of monkeypox cases has been detected since early May outside of the West and Central African countries where the disease has long been endemic. Most of the new cases have been in Western Europe.

More than 3,200 confirmed cases and one death have now been reported to the WHO from more than 50 countries this year.

"The emergency committee shared serious concerns about the scale and speed of the current outbreak," noting many unknowns about the spread and gaps in the data, Tedros said.

"They advised me that at this moment the event does not constitute a Public Health Emergency of International Concern (PHEIC), which is the highest level of alert WHO can issue but recognized that the convening of the committee itself reflects the increasing concern about the international spread of monkeypox."

Tedros said the outbreak was "clearly an evolving health threat" that needed immediate action to stop further spread, using surveillance, contact-tracing, isolation and care of patients, and ensuring vaccines and treatments are available to at-risk populations.

'Intense response' needed

"The vast majority of cases is observed among men who have sex with men, of young age," chiefly appearing in urban areas, in "clustered social and sexual networks," according to the WHO report of the meeting.

While a few members expressed differing views, the committee resolved by consensus to advise Tedros that at this stage, the outbreak was not a PHEIC.

"However, the committee unanimously acknowledged the emergency nature of the event and that controlling the further spread of outbreak requires intense response efforts."

They are on standby to reconvene in the coming days and weeks depending on how the outbreak evolves.

The committee recommended that countries improve diagnostics and risk communication.

It noted that many aspects of the outbreak were unusual, while some members suggested there was a risk of sustained transmission due to the low level of population immunity against the pox virus infection.

Knowledge gaps

The committee that considered the matter is made up of 16 scientists and public health experts and is chaired by Jean-Marie Okwo-Bele, a former director of the WHO's Vaccines and Immunization Department.

Thursday's five-hour private meeting was held in person at the WHO's Geneva headquarters and via video conference.

The committee discussed current observations of plateauing or potential downward trends in case numbers in some countries; difficulties in contact tracing due to anonymous contacts, and "potential links to international gatherings and LGBTQ+ Pride events conducive for increased opportunities for exposure through intimate sexual encounters."

They were also concerned that the potential stigmatization of affected groups could impede response efforts.

There are knowledge gaps on transmission modes, the infectious period, as well as over access to vaccines and antivirals and their efficacy, they said.

Blistery rash

The normal initial symptoms of monkeypox include a high fever, swollen lymph nodes and a blistery chickenpox-like rash.

Initial outbreak cases had no epidemiological links to areas that have historically reported monkeypox, suggesting that undetected transmission might have been going on for some time.

Few people have been hospitalized to date, while 10 cases have been reported among health care workers.

The WHO's current plan to contain the spread focuses on raising awareness among affected population groups and encouraging safe behaviors and protective measures.

There have been six PHEIC declarations since 2009, the last being for COVID-19 in 2020 — though the sluggish global response to the alarm bell still rankles at the WHO HQ.

A PHEIC was declared after a third emergency committee meeting Jan. 30. But it was only after March 11, when Tedros described the rapidly worsening situation as a pandemic, that many countries seemed to wake up to the danger.

Source: Voice of America

While highlighting various ways to build inclusive societies and prevent atrocities, speakers stressed that the international community has failed to translate the responsibility to protect into reality, as the General Assembly concluded its first annual debate on the principle. (For background information, see Press Release GA/12429.)

Myanmar’s representative said that, since the 2021 military coup, his country has faced unprecedented levels of violence, with widespread and systematic serious atrocities against the civilian population, including children. The people of Myanmar are crying out for the application of the responsibility to protect, he stressed, asking: “How many more innocent lives have to be sacrificed to have such decisive collective action from the Security Council?”

Iraq’s representative said that, despite the adoption of the Convention on the Prevention and Punishment of the Crime of Genocide, atrocities continue. The international community has failed to translate the goals of prevention into reality. Therefore, legislative and legal methods must be adopted to implement that document. Commending the United Nations Investigative Team to Promote Accountability for Crimes Committed by Da'esh/ISIL (UNITAD) — which is collecting evidence for future prosecutions in national courts — he emphasized, however, that the responsibility to protect falls upon States, including countering all efforts to incite such crimes.

To that point, the representative of Ghana underscored the important role of media, noting that, ahead of his country’s 2020 presidential and parliamentary elections, over 600 youth journalists were trained in conflict sensitivities, including hate speech and inflammatory language — a measure that enabled the peaceful transition of power there.

The representative of the United States, in a similar vein, affirmed the need for education as a preventive measure. Unlawful attacks on schools rob children of their education and hope for a better future, he said, adding that 100,000 children were killed or maimed in armed conflict since 2005. He urged Member States to leverage education for the prevention of atrocities, highlighting the critical role of teachers in building societies that are inclusive and respectful of diversity

Uruguay’s representative said her country’s National Peace Operations Training Institute will include the issue of protection of children, positioning the country as a regional centre for training and capacity-building for States engaging in peacekeeping missions. Echoing other delegations, she voiced support for the declaration by France and Mexico that Member States should voluntarily refrain from using the veto in cases of atrocities.

Nonetheless, the Permanent Observer of the Sovereign Order of Malta stressed that the current geopolitical landscape is proof that insufficient steps have been made to mitigate crimes against girls, boys and adults. Mechanisms at the United Nations are faulty, as well. “Surely we can begin to try and make amends by acting swiftly in protecting and supporting the next generation in the fight against indiscriminate acts of genocide, ethnic cleansing and war crimes such as sexual violence,” he said.

Also speaking today were representatives of the Philippines, Israel, Egypt, Morocco, South Africa, Haiti, Ireland, Russian Federation and Ukraine.

Speaking in exercise of the right of reply were representatives of Iran and Israel.

Statements

HAROLD ADLAI AGYEMAN (Ghana) said children constitute close to 40 per cent of persons displaced by conflict and violence globally. If not killed, they are maimed, sexually abused and exploited or even trafficked. In some cases, children as young as six years old have been forcibly recruited, radicalized and trained for combat. Unless structural issues, such as corruption, poverty, economic exclusion, high rates of unemployment and dwindling opportunities are effectively addressed, the conditions for atrocities will remain, he warned. His country is continuing its efforts to implement the responsibility to protect through regulations, policies and institutional arrangements. Ahead of Ghana’s 2020 presidential and parliamentary elections, over 600 youth journalists were trained in conflict sensitivities, including hate speech and inflammatory language in the media. Also, the National Youth Authority convened leaders of some 50 youth groups from across the country to sign onto the National Youth Peace Charter. Those measures proved useful in contributing to stability immediately after the election and enabled the peaceful transition of power, he said.

JULIAN SIMCOCK (United States) noted that, since 2005, more than 100,000 children have been killed or maimed in armed conflict and 93,000 have been unlawfully recruited or used as child soldiers. Countless more remain vulnerable to rape and sexual violence. Unlawful attacks on schools rob children of their education and hope for a better future. When displaced, they remain vulnerable to exploitation. Noting his delegation is pushing the Security Council to better integrate the children and armed conflict agenda into its work, he urged Member States to implement the seven priorities listed by the Secretary-General’s report — with particular focus on leveraging education for the prevention of atrocities. Teachers can play a critical role in building societies that are inclusive and respectful of diversity, foregrounding the importance of accountability as a critical deterrent for future perpetrators of atrocities. He stressed that in most countries affected by conflict, children comprise the majority of the populations. Condemning the mass atrocities committed by the Russian Federation against civilians in Ukraine, he called for the international community to take collective action against that State to put a halt to those crimes. The United States is resolutely committed to pursuing accountability, and the international community must ensure that such crimes do not go unpunished.

ANGELITO AYONG NAYAN (Philippines), noting that his country supported the inclusion of the responsibility to protect as a regular Assembly agenda item, warned that the concept should never be used as a license to intervene in domestic and internal affairs and undermine the sovereignty of States. Children embody the most compelling justification for the existence of States — namely, to protect its most vulnerable charges in order to preserve itself. Affirming that prevention is key to guaranteeing the safety of children and young people from atrocity crimes, he called for a whole-of-Government approach and stressed that the Philippines values the dignity of every person and protects the most vulnerable — especially children. The Philippines understands “sovereignty as responsibility” and ensures that systems are in place to monitor and respond to early warnings of atrocity crimes, he said. It has also enacted a law on the Special Protection of Children in Armed Conflict, which reaffirms that children are “zones of peace” who cannot be recruited into Government forces or be allowed to participate in armed conflict; they must be treated as victims, not enemies.

SARAH GOLDIE WEISS (Israel) said that her country faces terrorist groups — including Iran’s proxy Hizbullah to the north and Hamas to the south — that willingly and knowingly place civilians at harm daily to drive up civilian casualty counts and garner international sympathy and support. Moreover, those terrorist groups purposely use Lebanese and Palestinian civilians, including children, as their human shields, while targeting and directly attacking Israeli civilians, including children. They recruit minors on an ongoing basis to act as fighters and terrorists and incite their own populations, particularly children, to violent extremism and anti-Israel and anti-Jewish hatred. The responsibility to protect principle must critically address the role and responsibility of non-State actors and terrorist groups that commit atrocities while blatantly disregarding international law. She pointed out that the principle is an emerging doctrine, rather than constituting or creating novel legal rules or obligations. The responsibility to protect doctrine should be applied within the framework of existing legal norms and only in the direst of situations, involving mass atrocity crimes, ethnic cleansing or genocide, she said.

AHMED FAHMY ABDELGAYED SHAHIN (Egypt) said a consensus on the conceptual framework on the right to protect must be reached before it is mainstreamed into the United Nations system — requiring a necessary precondition to be included as an item on the General Assembly’s agenda, and before any practical steps are taken to enforce that concept. He stressed that the main responsibility to protect and prevent genocide, war crimes, ethnic cleansing and crimes against humanity falls upon Member States, and the international community should be focused on its role to enable countries to bear their responsibility. The focus on reaching a global approach should not only be confined to security and military aspects, but dealing with root causes, including foreign occupation, as well as poverty and food security, and promoting tolerance. He noted that deviation in the title of the item from the language of the summit document was one reason Egypt voted against it in the Assembly’s seventy-fifth session. Voicing other issues with language in the Secretary-General’s report, he affirmed that fragmenting the discussions would not strengthen international consensus and would not permit effective implementation of the principle — also deviating from Assembly efforts to reach a clear definition. Citing his delegation’s commitment to international criteria regarding protection from the crimes, he urged Member States to continue consideration of the issues towards a consensus on the responsibility to protect.

OMAR HILALE (Morocco), emphasizing that a prevention programme related to the responsibility to protect is necessary, underscored that no Member State or region can consider itself sheltered from the risk of atrocity crimes. Thus, an institutional architecture, which is robust on the national level and defends the rule of law, promotes respect for human rights, ensures peace and security and guarantees development must be implemented. Moreover, a commitment to gender equality is indispensable to properly design a national agenda for the responsibility to protect. In that regard, his country drew up a national action plan on women, peace and security in cooperation with the United Nations Entity for Gender Equality and the Empowerment of Women (UN-Women). In addition, Morocco is also committed to fully implementing the Fez Action Plan, which highlights the voice, authority and exemplary role of religious leaders in the fight against hate speech and the prevention of violent extremism.

GABRIELA LILIÁN GONZÁLEZ HERNÁNDEZ (Uruguay), associating herself with the Group of Friends of the Responsibility to Protect, said it is increasingly important to put children at the centre of efforts to prevent atrocities and urged Member States to endorse the Paris Principles and Safe Schools Declaration. Uruguay’s National Peace Operations Training Institute will include the issue of protection of children, positioning the country as a regional centre for training and capacity-building for States engaging in peacekeeping missions. With more than 100 million people displaced by conflict and atrocities worldwide, the international community must come together to help vulnerable populations. She called for the Security Council to hold periodic briefings on the issue, voicing support for the declaration by France and Mexico that Member States should voluntarily refrain from using the veto in cases of atrocities. Stressing that use of force can only take place as a last resort, she noted that prevention is the most important pillar of the responsibility to protect, while impunity must not shield those committing atrocities.

JONATHAN DAVID PASSMOOR (South Africa) praised the complementary roles played by the United Nations Office on Genocide Prevention and the Responsibility to Protect and the mandate of the two Special Advisers on the Prevention of Genocide and on the Responsibility to Protect. One of the most effective ways to protect people from the crimes being discussed is to close the impunity gap for perpetrators, he said, outlining several national laws in that regard. However, the continued exposure of children and young people to atrocity crimes across the world remains a grave concern, as does the continued inability of the international community to end conflicts and provide critical support to children and young people in conflict zones. The latter raises questions about the global community’s commitment to assisting States in bolstering protection, as well as responding collectively with a State that is manifestly failing to provide protection. The international community must strengthen the tools provided by the Charter of the United Nations for the pacific settlement of disputes, he said, highlighting the role played by regional bodies and welcoming the inclusion in the Secretary-General’s report of references to the African Charter on the Rights and Welfare of the Child.

CELINE PIERRE FABRE (Haiti) noted the Secretary-General’s report emphasizes that children are often targeted in conflict situations. Further, when they are forced to drop out of school, there is a long-lasting negative societal impact. While major progress has been made since the 2005 World Summit outcome document on the principle of the responsibility to protect, she nonetheless noted that, in 2020, 42 per cent of forcibly displaced people were children, with over 1,200 cases of rape and other forms of sexual violence against them — one of highest rates since 2005. She noted Haiti is facing multiple challenges, including gang violence, deterioration of security, abductions and confinement, with women and girls especially vulnerable to sexual violence during captivity. Citing instances of sexual violence against girls as young as five, as well as against men and boys, she stressed that the situation remains critical, with Haiti’s Minister for Foreign Affairs emphasizing the urgent need for its national police to receive solid support from the international community in the coming days — not weeks or months. The international community must ensure equitable access to education to reduce the vulnerability of children, including by promoting their socioeconomic prosects.

KYAW MOE TUN (Myanmar) said that, when national authorities manifestly fail to protect their populations, the international community must take timely, decisive and collective action to protect the populations in danger. Since the 2021 military coup, Myanmar has faced unprecedented levels of violence, mass atrocities and displacement, with the illegal junta committing widespread and systematic serious atrocities against the civilian population, including children. Over 1.2 million people have been displaced by deliberate attacks against the residential towns and villages, he said, noting that the barbaric nature of the junta troops can be seen in recent footage from Radio Free Asia and has been documented by the Human Rights Council’s Independent Investigative Mechanism for Myanmar. “The deteriorating crisis in Myanmar is not a situation where the national authority is failing to protect its people,” he said. Instead, it is one in which the military is deliberately attacking its people to gain control over them by instilling terror and fear. The people of Myanmar are crying out for the application of the responsibility to protect, which has sadly not been heeded yet, he said, asking: “How many more innocent lives have to be sacrificed to have such decisive collective action from the Security Council?”

SHARON LENNON (Ireland), aligning herself with the European Union and the Group of Friends of the Responsibility to Protect, highlighted opportunities to pursue long-term avenues of preventing the risk of atrocity crimes against children and youth, including investing in inclusive and unprejudiced education, engaging them in peacebuilding and creating inclusive early warning systems. Further, there are underexplored opportunities to deepen the understanding of the gendered dynamics and drivers of atrocity crimes, including by examining the intersecting and mutually reinforcing efforts of the responsibility to protect and women, peace and security agendas. This could contribute to more holistic, inclusive, age-, and gender-transformative approaches to early warning and response efforts, she said. Stressing the crucial role of accountability mechanisms, including the International Criminal Court, she reiterated the responsibility across the United Nations system to people facing the devastating reality of atrocity crimes, including accounting for any use of the veto to the full membership of the United Nations through the Veto Initiative.

GENNADY V. KUZMIN (Russian Federation) said that, when the concept of the responsibility to protect was being developed in 2005, delegations were told that it would not be used as a tool for interfering in States’ domestic affairs. Its supporters emphasized that the 2005 World Summit outcome document placed the responsibility to protect populations from genocide, war crimes, ethnic cleansing and crimes against humanity on States themselves, whereas the international community was granted a secondary role. All those and other reassurances he cited have been negated by subsequent events in Libya in 2011 where a reference to the responsibility to protect was used as an excuse by Western countries to launch an unprovoked aggression against a sovereign State, he said, referring to the United States-led North Atlantic Treaty Organization (NATO) coalition’s “carpet bombing” of Libya that plunged its population into a chaotic civil war. The responsibility to protect is not an international legal instrument. It is a simply a political framework relevant in 2005, but discredited by subsequent events, he said, adding that it is a repackaging of the infamous concept of humanitarian intervention which Western countries actively used from the 1960s to the 1990s in blatant violation of the Charter of the United Nations.

AHMED KAMIL RHAIF ALBU-MOHAMMED (Iraq) said genocide is a planned and organized strategy with deliberate effects, extending beyond the borders of the country affected. Despite the adoption of the Convention on the Prevention and Punishment of the Crime of Genocide, atrocities continue - meaning the international community has failed to translate the goals of prevention into reality and must adopt legislative and legal methods to implement the document. He thanked the United Nations Special Adviser for a recent visit to Iraq, as the country looks for compensation for victims there and seeks to ensure accountability. In recent years, terrorists, especially Islamic State in Iraq and the Levant (ISIL), also known as Da’esh, have pursued atrocities in a deliberate manner, including crimes defined as genocide, ethnic cleansing and crimes against humanity; these were perpetrated against anybody with an ideology that differs from that of the terrorist group. Reports by UNITAD show that genocide has been perpetrated against Iraqi people. He cited the creation of that agency as an exceptional step. The agency is now collecting, preserving and storing evidence for future prosecutions in national courts. However, he emphasized that the main and first onus of the responsibility to protect falls upon States, including countering all efforts to incite such crimes.

SERHII DVORNYK (Ukraine), associating himself with the European Union, stated that, on 24 February, the Russian Federation launched a full-scale invasion of his country under the fake pretext of protection from genocide. However, thousands of Ukrainian civilians, including children, have been killed everywhere in the country. A predator presenting itself as a victim, Moscow has fabricated a claim of genocide in the Donbass region of Ukraine to justify its invasion, with war crimes and crimes against humanity committed by Russian Federation soldiers camouflaged under the term “de-Nazification”. Ukraine immediately initiated a case in the International Court of Justice concerning allegations of genocide against the Russian Federation on 26 February, with the Court ordering it to immediately suspend its so-called “military operations” — but that State has disregarded the ruling. Ukraine remains further committed to cooperating with the International Criminal Court Prosecutor in his efforts. He noted the Russian Federation used its “veto” to prevent the Council from exercising its main responsibility at the beginning of the invasion, and the Assembly has assumed responsibility, adopting three resolutions. Russian Federation forces continue to raze to the ground Ukrainian cities and villages, with at least 324 children killed and 593 wounded — crimes that are not subject to any statute of limitation, while their protection in time of conflict should be prioritized in the Assembly. Voicing regret that the Secretary-General’s 2022 report does not directly cover the consequences of the Russian Federation war against Ukraine, he echoed the European Union’s statement that the collection of accurate, timely and reliable information on grave human rights abuses perpetrated against children is a key indicator for the responsibility to protect mandate.

PAUL BERESFORD-HILL, Permanent Observer for the Sovereign Order of Malta, said that when conflict erupts, sexual violence is present. Sexual violence against children and young people is not only a crime but can cause long-term impacts, including, among others, unwanted or unplanned pregnancies, chronic health conditions, post-traumatic stress disorder, and sadly, suicide. Despite the disproportionate targeting of sexual violence towards young females, he highlighted that males are targeted by sexual violence too, pointing to the use of rape, sexual violence and exploitation as a weapon of war against boys and young men in many countries, including Bosnia and Herzegovina, Democratic Republic of the Congo, Central African Republic, Myanmar and Ukraine. Those victims will face ostracism as a consequence of cultural norms and the prevalence of the “macho” cult, particularly evident during war and civil conflict. They also face the risk of prosecution, as rape by another man can be regarded as an illegal act and is criminalized in dozens of countries. The current geopolitical landscape is proof that insufficient steps have been made to mitigate these crimes against girls, boys and adults. Further, mechanisms at the United Nations are faulty, as well. “Surely, we can begin to try and make amends by acting swiftly in protecting and supporting the next generation in the fight against indiscriminate acts of genocide, ethnic cleansing, and war crimes such as sexual violence,” he said.

Source: United Nations