H5N1

Butembo: Nurses threaten to go on strike to demand their risk premiums and safety

Via Actualite.cd: Butembo: Nurses threaten to go on strike to demand their risk premiums and safety. Excerpt and then a comment:

Nurses members of the Intersyndicale Nurses of Butembo (North Kivu) threaten to go on strike to claim the payment of their risk premiums.

"We condemn the marginalization of health professionals other than doctors and dentists in Butembo. There we are talking about nurses, laboratory technicians and midwives who are abandoned. Our secretaries-general have just launched (in Kinshasa) the supervisory authorities with a seven-day ultimatum so that the question of our risk premiums can be settled. Otherwise we will start a movement of dry strike, we will observe days "hospitals without nurses,",warned Mr. Kambale Vake Okelo, president of the Intersyndicale of the nurses, of Butembo, revealing to the press the resolutions of the GA. 

The followers of Florence denounce the non-payment of their risk premiums, while they work this last time in "difficult" conditions. 

"The members (of Intersyndicale, editor's note) are sorry to note that despite the recommendations and suggestions made in our memorandum (addressed to the authorities), the question seems not to attract their attention. We will see the urban authority, and in case of unsatisfaction, we will trigger a dry strike," denounces Mr. Kambale Vake Okelo. 

Preventive activities remain suspended In addition to not paying their risk premiums, the nurses have also lashed out at attacks and violence that they continue to suffer as a result of their involvement in the response to the Ebola virus disease that has already hundreds of deaths. Thus, they decided to continue the suspension of prevention activities, including prenatal consultation (CPN), preschool consultation (CPS) and routine vaccinations, as it has been for nearly three months now in the city. of Butembo.  

"The Mayor (of Butembo, Editor's note) has requested that a minimum service of CPN, CPS and routine vaccinations be organized. But we are not going to start them, especially since the inhabitants who claim them are the same ones who continue to keep the malicious people who threaten us. Today, some nursing staff no longer sleep at home, they no longer arrive at their health centers, fearing for their safety. Some refrigerators (which allow the conservation of vaccines, Ed) have been damaged, burned health centers: where will we hold the CPN sessions, CPS or vaccination? Where will we find the inputs we use during the vaccination? We are therefore maintaining the suspension of prevention activities while waiting for the urban authority to convene an exchange framework to establish responsibilities," says Kambale Vake Okelo.  

Note that following this measure of nurses to suspend prevention activities, nearly 2,500 children born since March have not yet been vaccinated against measles, tuberculosis, poliomyelitis and many other diseases in the city. of Butembo. 

Last Monday, June 27, fearing for the health of their children, more than a dozen breastfeeding women went to protest at the town hall of Butembo to claim the vaccine. 

"We demand the vaccine for our children. We come from Matanda Hospital; We have been told that the vaccine is available but we will not have it because our husbands are bandits and they are the ones who are attacking nurses and destroying health facilities. So we ask the mayor to intervene so that our children are vaccinated," said one of them to the press, indicating that there are already "some children who suffer from cough for lack of vaccine."  

More than two weeks ago, the women went to discuss the same issue with the urban authority, but without success. The nurses recommend that the authority organize a social dialogue with the communities to establish the responsibilities, in order to contain the resistance as well as the armed attacks against their colleagues.

It looks like a default response: when an outbreak hits a poor country, the government stops paying the people who are fighting it. If foreign money pours in, it seems rarely to reach the people who are earning it. That may be tough on the patients and their caregivers, but somebody in a suit is always thinking about that retirement villa in the south of France.

DRC Ebola: 6 new cases, 6 deaths, 3 recoveries

The Ministry of Health has published EBOLA DRC - Evolution of the response to the Ebola outbreak in the provinces of North Kivu and Ituri on Tuesday, May 28, 2019. The daily numbers are much lower, but the weekly table shows 88 cases and 57 deaths—25 of them in the community. Excerpt from the Google translation:

EVOLUTION OF THE EBOLA EPIDEMIC  IN THE PROVINCES OF NORTH KIVU AND ITURI 

Tuesday, May 28, 2019 

The epidemiological situation of the Ebola Virus Disease  dated May 27, 2019: 

• Since the beginning of the epidemic, the cumulative number of cases is 1,926, 1,832 confirmed and 94 probable. In total, there were 1,287 deaths (1,193 confirmed and 94 probable) and 503 people healed. 

• 383 suspected cases under investigation; 

• 6 new confirmed cases, including 2 in Katwa, 2 in Butembo and 2 Mabalako; 

• 6 new deaths of confirmed cases, including  

º 1 community death in Katwa; 

º 5 deaths at CTE, including 3 in Butembo and 2 in Mabalako;  

• 3 new healings from the CTE, 2 in Katwa and 1 in Butembo. 

/! \  The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas.

WEEKLY SUMMARY OF EPIDEMIOLOGICAL DATA  

Week 21 (May 20-26, 2019)   

For the week from May 20 to May 26, 2019, we recorded:  

• 2,056 suspected cases investigated and tested in the laboratory 

• 88 new confirmed cases  

º The main outbreaks of the epidemic are Mabalako, Butembo and Katwa.  

• 6 new probable cases validated (the 3 probable cases of Masereka had been erroneously reported to Butembo) 

• 57 deaths of confirmed cases 

º Of the 57 deaths, 25 were community deaths, or 43.9%, and 32 occurred in an ETC. 

• 16 new healed people came out of ETCs

OPERATIONS OF THE RESPONSE

Diplomatic visit to Butembo

• Swedish Ambassador in the DRC Maria Håkansson and British Foreign Minister Harriett Baldwin visited Ebola response teams in Butembo on Monday, May 27, 2019. After the courtesy of the mayor of the city , the two hosts visited different sites of the Ebola response, starting with a vaccination site. They also visited the CTE and the CTE nursery in Butembo. After all these visits, the Swedish Ambassador and the British Foreign Minister visited the Auberge, where Butembo co-ordinates, where they discussed with the teams the situation of the epidemic, the challenges and constraints of the riposte. In addition, they had discussions with women leaders and representatives of religious denominations in Butembo.

Support for providers of the Mabalako sub-coordination

• The Ministry of Health warmly thanks all the local providers who are the main architects of the Ebola response despite the many risks and difficulties they face. All agents involved in the response are entitled to receive their bonus in accordance with the scale in effect since the beginning of this response.

• The Ministry of Health was informed of the decision of some health workers in Mabalako to go on strike on Monday, May 27, 2019. The strike ended on Tuesday, May 28, 2019. These agents are demanding alleged Ebola unpaid premiums between the months of August and December 2018 by the Health System Development Program (HSDP). Based on information collected from the Ministry of Health and the PDSS, there are no Ebola premium arrears for the year 2018.

• However, the situation of these providers needs to be clarified. In fact, after analyzing the lists of strike providers sent to the national coordination by Mangina's sub-coordinator, it appears that they are providers working at the Ebola Treatment Center (ETC) in Mabalako. As a reminder, the management of the CTE Mabalako was entrusted successively to two international NGOs who have ensured the organization of services and payment of Ebola premiums from providers since the beginning of the response. In the future, it will be important to clarify the contract transfer procedure of providers when an agency or agency leaves a health zone to avoid misunderstandings.

• It is important to note that the Ministry of Health has developed, with the support of the World Bank, a manual of simplified human resource management procedures related to the response to the EVD epidemic. The manual states that bonuses are not cumulative and any case of fraud, or attempted fraud, will now be followed by sanctions or even disciplinary measures. The manual also provides several types of control for the payment of premiums. Monitoring missions are carried out every month in the different sub-coordinations to check the lists of providers and the evidence of service rendered (attendance lists). The last mission dates from the beginning of May to validate the payment lists for the month of April 2019. However, during the various checks carried out since January 2019,

• Discussions continue with Mabalako's sub-coordination to determine the merits of these claims. In order to avoid such situations in the future and to ensure greater transparency in the management of human resources, all the agents involved in the response will have to sign standard contracts which will be included in a single database for all organizations involved in the response to Ebola.

FIGURES OF THE RESPONSE

126,084 Vaccinated
persons

• 617 people vaccinated on 27/05/2019.

• Of those vaccinated, 34,726 are high-risk contacts (CHR), 61,763 are contacts of contacts (CC), and 29,595 are front-line providers (PPL).
Persons vaccinated by health zone: 32,639 in Katwa, 25,294 in Beni, 16,391 in Butembo, 10,368 in Mabalako, 6,081 in Mandima, 4,513 in Kalunguta, 3,130 in Goma, 3,048 in Komanda, 2,569 in Oicha, 2,302 in Musienene, 2,155 in Masereka , 1.986 in Lubero, 1.980 in Kayna, 1.935 in Vuhovi, 1.817 in Kyondo, 1.487 in Bunia, 1.040 in Biena, 1.012 in Mutwanga, 690 in Rutshuru, 557 in Rwampara (Ituri), 527 in Nyankunde, 496 in Mangurujipa, 494 in Alimbongo, 420 to Mambasa, 355 to Tchomia, 342 to Kirotshe, 333 to Lolwa, 250 to Mweso, 245 to Kibirizi, 161 to Nyiragongo, 97 to Watsa (Haut-Uélé) and 13 to Kisangani.

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

Healthcare workers infected

106

• One health worker in Katwa, unvaccinated (refusal), is one of the new confirmed cases and one of the new deaths (community deaths).

• The cumulative number of confirmed / probable cases among health workers is 106 (5.5% of all confirmed / probable cases), including 36 deaths.

Purdue Pharma accused of 'corrupting' WHO to boost global opioid sales

Via The Guardian, a disturbing report: Purdue Pharma accused of 'corrupting' WHO to boost global opioid sales. Excerpt:

Purdue Pharma, the drug manufacturer that kickstarted the US opioid epidemic, corruptly influenced the World Health Organization in order to boost painkiller sales across the globe, according to a report by members of Congress. 

An investigation by Katherine Clark and Hal Rogers, who represent districts in Massachusetts and Kentucky hard hit by the US opioid epidemic, accuses Purdue of replicating its false marketing claims about the safety and effectiveness of opioids to change WHO prescribing guidelines in an attempt to expand foreign markets for its drugs.  

“The web of influence we uncovered paints a picture of a public health organization that has been corrupted by the opioid industry,” said Clark. “The WHO appears to be lending the opioid industry its voice and credibility, and as a result, a trusted public health organization is trafficking dangerous misinformation that could lead to a global opioid epidemic.”

The report, called Corrupting Influence. Purdue and the WHO, accuses Purdue of using pharma-funded organisations and specialists to influence the writing of WHO policy to encourage much wider prescribing of addictive high-strength opioids across the globe. It said that, as a result, “WHO guidelines are serving as marketing materials for Purdue”.  

Clark and Rogers plan to deliver their report to the WHO on Wednesday morning after the organization failed to respond to a letter from a dozen members of Congress two years ago warning that Purdue and Mundipharma International, a UK-based network of global companies owned by members of the Sackler family, which owns Purdue Pharma, were pushing to boost opioid sales globally. 

The 2017 letter cautioned the WHO to learn the lessons of the US opioid epidemic, which has claimed more than 400,000 lives over the past two decades. 

“When the WHO failed to respond to the letter, we began to question why they would remain silent about such a significant and devastating public health epidemic. The answers we found are deeply disturbing,” Clark and Rogers said.  

Their report alleges two WHO guidelines for doctors around the world released seven and eight years ago “contain dangerously misleading and, in some instances, outright false claims about the safety and efficacy of prescription opioids”. 

“Alarmingly, these guidelines mirror Purdue’s marketing strategies to increase prescriptions and expand sales,” the report found.

Ebola response in Beni: 30 neighborhood leaders demand six months of arrears from their premiums

Via Radio Moto Butembo-Beni: Ebola response to BENI: 30 neighborhood leaders demand six months of arrears from their premiums. This sounds depressingly like what happened in West Africa: people fighting Ebola on the ground get little or nothing while their income vanishes somewhere higher up the food chain. The Google translation:

To claim their rights, 30 heads of Beni neighborhoods accompanied by their deputies held a sit-in at the office of Beni health zone on Monday, April 8, 2019. They say claim six months of arrears of their premium with the coordination of response activities.  

In a memorandum, they state that they are divorcing from any activity related to the response to the Ebola response. 

"All the chiefs are active. When it comes to money, these people refuse to pay us. Since the month of August, they have paid only one month. Even the units, the leaders do not receive. If all the leaders rise up, it's because of that. We resigned en bloc. While they continue with their IT ... If there are games of pulls and resistances, we raise our hands. We come to claim our right, but they run away from us and do not want to reach a consensus with us," said one of these leaders while the other said: "We live in risks. That is finally the population understood that the disease really exists. So we who have made efforts in this direction, they should not abandon us like that. See, for example, you die in this work ... They do not even come to sympathize ... Not even a reward to the family?" 

Until the evening of this Monday, April 8, 2019, no member of the coordination of the response team has pronounced on this subject.

An epidemic of suspicion — Ebola and violence in the DRC

Via NEJM, an absolute must-read by Dr. Vinh-Kim Nguyen of MSF: An Epidemic of Suspicion — Ebola and Violence in the DRC. Excerpt:

Until the 2014 Ebola epidemic in West Africa, Ebola outbreaks had been sporadic, small, and largely confined to isolated rural villages in Central Africa. But the 2014 epidemic broke all the rules and killed more than 15,000 people; since then, more outbreaks have been reaching larger urban centers, sometimes resulting in uncontrolled spread. 

The current epidemic in the Democratic Republic of Congo (DRC) has triggered a massive international response, which has been met by violence, culminating in attacks at the end of February that partially destroyed Ebola treatment units in the regional hub of Butembo and its township, Katwa. This area is the epicenter of the epidemic, which is likely to be fueled by any breakdown of isolation and treatment efforts.  

Are these urban flares the new norm? What might the ebb and flow of intervention and violence bode for future epidemics? Insights from the front lines may offer some clues. 

As a medical team leader for Médecins sans Frontières (MSF), I work halfway between Butembo and Goma, North Kivu’s capital city and a transport hub. In late January, five Ebola cases were identified in Kayna and Kanyabayonga; MSF opened a center in Kayna to isolate patients with suspected cases and test them for Ebola virus disease (EVD). I soon suspected that most patients would turn out to have diseases other than EVD. 

The standard “isolate and test” model often leads to expectant management for such patients — the tendency is to “cover” patients with antimalarials and broad-spectrum antibiotics, wait for EVD test results, and then discharge patients without Ebola. We instead took a more active approach, treating severe cerebral malaria, typhoid, sepsis, and even cholera. 

I have witnessed how such active clinical management for all patients, along with MSF’s long-term presence in North Kivu, has contributed to the community’s acceptance of our Ebola unit. Having patients emerge from isolation in improved health is powerful evidence that we aim to make everyone better, not just to stop Ebola’s spread.  

Indeed, I’ve come to realize that the most important part of my job is building trust with the communities we serve. Greater trust means more patients presenting early, and early presentation strongly affects the prognosis for many conditions. Building trust starts with relationships with patients and families, which can be nurtured even if patients are in isolation. 

I saw the impact that these relationships had on trust during the 2014–2015 Ebola epidemic in Guinea. Many attempts to engage with affected communities during Ebola epidemics have been tone-deaf: little effort has been made to understand the public’s concerns or to find out what they understand from the messages being conveyed to them. 

Recognizing the need to listen to the community and be prepared to answer hard questions truthfully, we shifted from a health promotion strategy of delivering rote messages — about viral transmission from bats or the importance of hand washing — toward genuine community engagement. We recruited trusted community members and trained them in active listening and communication techniques, discussing how to address questions they would receive from the public. 

The questions the public asked us reflected their sense of anger and betrayal at “Ebola profiteers” and their worries that the focus on Ebola would be short term and would not address more common and equally deadly everyday health issues. We found that acknowledging and addressing issues of poverty and injustice, and using examples drawn from the questioners’ experience, went a long way toward allaying the concerns underlying these questions.  

Yet much of the fundamental work of engaging communities and building trust is still based on outdated health education models and is often led by specialists with little understanding of social science. Such practices continue despite clear epidemiologic evidence that current containment efforts are failing. In the wake of violent attacks on health workers and treatment units, there is growing recognition that more needs to be done to gain community acceptance.

Ebola DRC - Evolution of the Ebola epidemic in North Kivu and Ituri on Thursday February 7 2019

The Ministry of Health has published Ebola DRC - Evolution of the Ebola epidemic in North Kivu and Ituri on Thursday February 7 2019. Excerpt from the Google translation:

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI 

Thursday 7 February 2019   

The epidemiological situation of the Ebola Virus Disease  dated February 6, 2019: 

• Since the beginning of the epidemic, the cumulative number of cases is 791, 737 confirmed and 54 probable. In total, there were 492 deaths (438 confirmed and 54 probable) and 267 people cured. 

• 189 suspected cases under investigation. 

• 2 new confirmed cases, including 1 in Butembo and 1 in Kyondo  

• 4 new confirmed deaths: 

º 2 community deaths, including 1 in Butembo and 1 in Kyondo 

º 2 deaths at Katwa CTE

  

 /! \  The data presented in this table is subject to further changes after thorough investigation and after redistribution of cases and deaths in their health areas. 

News of the response 

Women's safety during the response  

The Ministry of Health is challenged by the circulation of messages on social networks alleging that women have been victims of sexual advances in exchange for work in the response to Ebola.   

Although local women's NGOs have already denounced some of these messages as rumors aimed at tarnishing the image of women working in the response, the Ministry of Health can not ignore these allegations and takes them very seriously.   

Thus, the Ministry of Health asks people who have been victims or witnesses of such incidents to report them confidentially through the free numbers of the civil protection of North Kivu: +243 999 009 405 or +243 820 800 001.  

The Ministry of Health recalls that ALL services related to the response to the Ebola outbreak (vaccination, treatment at the Ebola treatment center, psychological monitoring, dignified and secure burial, etc.) are FULLY FREE . Anyone who offers such services for payment in kind or in cash must be reported.   

In addition, recruitment procedures in the response respond to selection criteria based on professional competence and experience. Only a limited number of Ebola counterparts, identifiable through their official badge, have the capacity to recruit new people to the response.  

Thus, for safety reasons, it is recommended that women ensure:  

• Always ask the person claiming to be a recruiter to have an official badge confirming their position in the response;  

• Do not accept appointments outside the coordination offices of the response; and 

Report any inappropriate behavior.   

Vaccination  

• Since the start of vaccination on 8 August 2018, 75,526 people have been vaccinated , including 20,473 in Beni, 18,784 in Katwa, 8,317 in Butembo, 6,064 in Mabalako, 2,736 in Kalunguta, 2,200 in Komanda, 2,131 in Goma, 1,844 in Oicha. , 1,663 in Mandima, 1,157 in Karisimbi, 1,054 in Bunia, 1,153 in Kayina, 1,082 in Kyondo, 953 in Vuhovi, 920 in Masereka, 744 in Mutwanga, 700 in Lubero, 590 in Rutshuru, 567 in Biena, 527 in Nyankunde, 510 in Musienene, 355 in Tchomia, 306 in Mangurujipa, 254 in Alimbongo, 207 in Kirotshe, 125 in Nyiragongo, 97 in Watsa (Haut-Uélé) and 13 in Kisangani.  

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

China disciplines more than 80 officials linked to major vaccine scandal

Via the South China Morning Post, an AFP report: China disciplines more than 80 officials linked to major vaccine scandal. 

China’s corruption watchdog on Saturday said it had disciplined more than 80 officials linked to a vaccine scandal last year that inflamed public fears over the safety of domestically produced drugs. 

Changchun Changsheng Biotechnology – a major Chinese manufacturer of rabies vaccines – was slapped with a US$1.3 billion fine in October after it was found to have fabricated records. 

Four officials from the China Food and Drug Administration (CFDA), including former deputy director Wu Zhen, have been handed over to prosecutors, the Central Commission for Discipline Inspection said in a statement on Saturday. 

State-run news agency Xinhua detailed the allegations against Wu including nepotism and taking bribes. He has also been expelled from the Communist Party, it said.

“Being ‘ruthless to the people’, Wu allegedly abused his power in drug regulation, severely jeopardising the state’s supervision over drugs,” Xinhua said, citing the corruption watchdog.

The Central Commission for Discipline Inspection also said it would “seriously deal with” more than 80 other provincial or local officials from multiple government organisations, without offering details.

These officials have already been fired or demoted, it said. 

Authorities earlier said the faulty rabies vaccines did not enter the market. But the case provoked outrage from customers fed up with recurring product-safety scandals, particularly in the drug sector. 

The drug company’s chairwoman and 14 employees were arrested after the scandal came to light last July, while more than a dozen national, provincial and local officials were sacked.

Hospitals attacked in Khartoum, Sudan

A letter in The Lancet: Hospitals attacked in Khartoum, Sudan.

The Lancet recently highlighted the humanitarian crisis in Sudan (Jan 19, p 199). In the past weeks, tens of thousands of people across Sudan have been reported to have taken to the streets, calling for an end to President Omar al-Bashir's 30-year rule. According to credible reports received by Amnesty International, security forces had killed 37 protestors by Dec 24, 2018. 

The violent crackdown escalated, with security forces reportedly attacking hospitals in Omdurman on Jan 9, 2019, and Bahri on Jan 13, 2019. Crossing the threshold of hospital grounds is a saddening precedent for a government response that appears to deliberately target health professionals through violence and detention. 

That Sudan had repeated outbreaks of yellow fever, cholera, and Chikungunya, reported as recently as October, 2018, suggests a vulnerability of Sudan's neglected health system. This is in a country whose ruler was alleged in 2010 to have stashed billions of dollars in UK bank accounts. 

As Sudan's health professionals use their voices and bodies to peacefully demand a better health system, the international community should amplify these calls and hold the government to account when they shamefully defy norms by attacking hospitals, patients, and clinicians.

Senior WHO official accused of using Ebola cash to pay for girlfriend's flight

Via The Guardian: Senior WHO official accused of using Ebola cash to pay for girlfriend's flight. Excerpt:

Claims that a senior employee at the World Health Organization misused Ebola funds to fly his girlfriend to west Africa are among a tide of allegations under investigation by the agency.  

An internal inquiry has been launched by the WHO following a series of anonymous whistleblower emails that alleged widespread racism, sexism and misspending.  

The emails, sent to senior management last year, claimed there was systematic discrimination against African staff and that recruitment processes are corrupt.  

Whistleblowers have also alleged that staff misused money intended to fight the Ebola outbreaks in west Africa that began in 2013, as well as an outbreak in the Democratic Republic of the Congo. The author of one email wrote that “corruption stories about logisticians and procurement in WHO [health emergencies department] are legendary”.  

The WHO’s director general, Tedros Adhanom Ghebreyesus, a former health minister of Ethiopia, has instructed the agency’s office of internal oversight to investigate the claims. 

The allegations, some of which were reported by the Associated Press on Thursday, were raised in a series emails, the first of which was sent in April.  

The Guardian has learned that the allegations include claims that funds intended for the Ebola outbreak in west Africa were misused, with staff fabricating a mission so that a senior employee’s girlfriend, a junior professional, could join him during the Ebola response.  

It has also been claimed that, during an Ebola outbreak in DRC last year, a plane was hired to transport three vehicles from a warehouse in Dubai at the cost of $1m (£773,000). Tarik Jašarević, a spokesperson for the WHO, rebutted the claim, and said the agency had shipped 10 vehicles from Dubai in May because “there were no vehicles available for sale in DRC that met minimum UN safety standards at the time”. Jašarević said the cost of transporting the vehicles was $237,801. 

In a statement, the WHO added that the allegations had been “addressed openly by Dr Tedros in global meetings with staff in which he stressed that WHO has zero tolerance for misconduct or discrimination of any kind”.  

The statement added that the WHO’s senior management team is “one of the most diverse and gender-balanced of any United Nations agency”. 

However, whistleblowers reported pervasive racism, and cited a recent example in which a senior staff member had allegedly “humiliated, disgraced and belittled” a colleague from the Middle East.

WHO statement on reports of alleged misconduct

Via email from WHO:

WHO is aware of a news story published today about allegations of misconduct in the organization.

The allegations are being investigated according to WHO’s established procedures, having been referred to WHO’s Office of Internal Oversigh Services by the Director-General, Dr Tedros Adhanom Ghebreyesus.

The anonymous allegations, which had been circulating internally, were also addressed openly by Dr Tedros in global meetings with staff in which he stressed that WHO has zero tolerance for misconduct or discrimination of any kind.

Since Dr Tedros took office as Director-General in July 2017, he has championed openness, transparency and diversity. WHO’s senior management team is now one of the most diverse and gender-balanced of any United Nations agency. All regions of the world are represented and almost two-thirds are women. WHO is working consistently to increase geographical diversity and improve gender balance at all levels as part of its ongoing transformation process.

WHO has established mechanisms by which anyone inside or outside the organization can report concerns about any form of suspected misconduct by WHO personnel. WHO has recently strengthened the capacity of its internal oversight mechanisms and has proven processes for reporting and dealing with allegations of misconduct.

These include an independently-run integrity hotline which anyone can use to report concerns confidentially and anonymously. We regularly report the outcome of substantiated allegations arising from independent investigations to Member States in our reports to Governing Bodies. All these reports are posted on our public website.

WHO listens to all feedback so we can learn and improve and provide the best possible advice and assistance to countries.