WHO EMBARKS ON A PROJECT TO IMPROVE ACCESS HEARING AID ACCESS IN LOW- AND MIDDLE-INCOME COUNTRIES 

By 2050, nearly 2.5 billion people are projected to have some degree of hearing loss and at least 700 million will require hearing rehabilitation. 

Unaddressed hearing loss has far-reaching consequences on the lives and livelihoods of those affected. People who are hard of hearing usually communicate through spoken language and can benefit from hearing aids, cochlear implants, and other assistive devices as well as captioning.

Globally, over 400 million people could benefit from use of hearing aids. Of these, a mere 17% currently use these devices, with levels as low as 10% in the African Region. The development of innovative low-cost technologies with effective service delivery models, policy and regulatory changes to improve access, and combatting the stigma and lack of awareness are some of the potential solutions to improve access to hearing aids.

To address this global gap, WHO is collaborating with the United Nations Office for Project Services (UNOPS) and ATscale, the Global Partnership for Assistive Technology, to develop service delivery models for fitting and maintenance of high-quality hearing aids among those in need especially in LMICs. 

A technical working group has been set up to guide the process. An introductory meeting of the working group was held late last month, with the participation of experts from across the world.

Work will now be undertaken to study available models of service provision in resource limited settings, to propose models informed by expert insights, and to field test models in multiple countries. Over the longer-term, it is hoped the project will see these service delivery models implemented in countries, and scaled up. 

In an article prepared by staff from WHO’s NCD Department, The Ear Institute, University College London and the Institute of Health Metrics and Evaluation, University of Washington, the current gaps in the use of hearing aids in WHO regions is as high as 90%.

Our new collaboration with UNOPS and ATscale will work to develop service delivery models for fitting and maintenance of high-quality hearing aids among those in need especially in LMICs. 

LARGE DECLINES IN THE GLOBAL COVERAGE OF HPV VACCINATIONS

Official data published by WHO and UNICEF has recorded the largest sustained decline in childhood vaccinations in approximately 30 years.

It was hoped that 2021 would be a year of recovery during which strained immunization programmes would rebuild and the cohort of children missed in 2020 would be caught-up. Instead, declines in coverage for other basic vaccines has pushed the world off-track to meet global goals, including the immunization indicator for the Sustainable Development Goals.

Of note for NCDs, over a quarter of the global coverage of human papillomavirus (HPV) vaccines that was achieved in 2019 has been lost. This has grave consequences for the health of women and girls. Globally, coverage of the first dose of human HPV vaccine is only 15%, despite the first vaccines being licensed over 15 years ago. HPV vaccination is central to WHO’s ambitions to eliminate cervical cancer, and we have set the target of 90% of girls being fully vaccinated with HPV vaccine by age 15 years by 2030.

In response, WHO and UNICEF are working with Gavi, the Vaccine Alliance and other partners to deliver the global Immunization Agenda 2030, a strategy for all countries and relevant global partners to achieve set goals on preventing diseases through immunization and delivering vaccines to everyone, everywhere, at every age. Together, the Immunisation Agenda is calling on governments and relevant actors to:

• Intensify efforts for catch-up vaccination to address backsliding on routine immunization, and expand outreach services in underserved areas to reach missed children and implement campaigns to prevent outbreaks;
• Implement evidence-based, people-centred, and tailored strategies to build trust in vaccines and immunization, counter misinformation and increase vaccine uptake particularly among vulnerable communities;
• Ensure current pandemic preparedness and response and the global health architecture strengthening efforts lead to investment in primary health care (PHC) services, with explicit support to strengthen and sustain essential immunization; 
• Ensure political commitment from national governments and increase domestic resource allocation to strengthen and sustain immunization within PHC;
• Prioritize health information and disease surveillance systems strengthening to provide the data and monitoring needed for programmes to have maximum impact; and
• Leverage and increase investment in research to develop and improve new and existing vaccines and immunization services that can achieve community needs and deliver on IA2030 goals.

In 2022 the world is experiencing one of the largest backslides of global immunization rates in history, including historic declines in HPV vaccination coverage.

In our video, we explain why now is the only chance we have to work together, to pull resources and invest in vaccinating humanity against all diseases and illnesses.

NCD STORY FROM THE FIELD: ADDRESSING INEQUITIES IN BREAST CANCER TREATMENT IN SUB-SAHARAN AFRICA

In sub-Saharan Africa, preventing and treating breast cancer is a pressing public health issue. Breast cancer survival rates five years after diagnosis stand at a dismal 40% in sub-Saharan Africa – as compared to over 90% in most high-income countries.

In countries showing successful reductions in breast cancer mortality rates, most breast cancer patients are diagnosed at an early stage, when the disease is more likely curable. In sub-Saharan Africa, late-stage diagnosis and inadequate access to quality breast cancer care lead to high death rates. Most women are diagnosed at advanced stages when treatment is difficult, costly and less likely to achieve a cure.

In our latest NCD Story from the Field, WHO has interviewed Dr Miriam Mutebi, a breast surgical oncologist and Assistant Professor in the Department of Surgery at the Aga Khan University in Nairobi, Kenyain, who illustrates the many barriers to accessing quality breast cancer treatment. She also talks about the importance of closing the gap between diagnosis and treatment, and employing a multidisciplinary approach to cancer care.


Through our Global Breast Cancer Initiative WHO supports governments to provide centralized services for breast cancer with the aim of ensuring that 80% of breast cancer patients undergo full-course multimodality treatment. With the three pillars of the initiative – health promotion and early detection, timely diagnosis, and comprehensive breast cancer management – WHO aims to reduce global breast cancer mortality by 2.5% per year by 2040.

The world is currently progressing at about a quarter of the rate needed to achieve the health-related targets by 2030. This message from Dr Tedros was shared at the High-Level Political Forum on Sustainable Development.

To improve on that rate, the Director-General's three asks to countries are to prioritize health for sustainable development, to have a strategic focus toward a stronger global health architecture and to strengthen incentives for collaboration and hold multilateral agencies accountable through the SDG3 Global Action Plan

CONSULTING WITH MEMBER STATES ON A FRAMEWORK TO TRACK GLOBAL ORAL HEALTH PROGRESS 

Oral diseases are among the most common NCDs worldwide. While largely preventable, there were estimated to be more than 3.5 billion oral diseases and other oral conditions globally in 2019. 

At this year’s World Health Assembly, a landmark strategy on oral health was adopted by Member States, which will inform the development of a new global action plan and framework to track progress. 

The global strategy is the first concrete step towards the full implementation of last year’s  WHA74.5 resolution on oral health. With actions for WHO Member States, international partners, civil society and the private sector, the strategy sets four overarching goals to guide Member States, to:

• develop ambitious national responses to promote oral health;
• reduce oral diseases, other oral conditions and oral health inequalities;
• strengthen efforts to address oral diseases and conditions as part of UHC;
• consider the development of targets and indicators, based on national and subnational contexts, building on WHO guidance, to prioritize efforts and assess the progress made by 2030

Between May and July, WHO had an opportunity to consult with Member States representatives, mainly Chief Dental Officers, about the draft monitoring framework of the global oral health action plan in all WHO regions.

The objectives of this consultation were to understand the current efforts on oral health agenda in the Member States, foster collaboration and network among Chief Dental Officers, and discuss the development of the draft monitoring framework and the feasibility of related indicators.

Including WHO colleagues, more than 250 people participated in the discussion. Strong momentum was observed with the active engagement from Member States to accelerate the promotion of oral health promotion, in line with the resolution and global strategy. We also received important feedback from Member States to improve the draft monitoring framework, which is being developed and will be considered at WHA76 in 2023.

Also this week, Dr Bente Mikkelsen, Director, Noncommunicable Diseases was invited to speak at the 7th Symposium on Population Medicine and Public Health, themed on 'Population Medicine: From Theory to Practice and Responding to the Population Health Challenge in Multimorbidity', hosted by the School of Population Medicine and Public Health, Chinese Academy for Medical Sciences, Peking Union Medical College.

Dr Mikkelsen's intervention focused on the importance of tackling multi-morbidity, with particularly worrying trends in the rise in premature NCD mortality across South-East Asia, and the necessary milestones for WHO Member States and partners to achieve on our road to the Fourth UN High-level meeting on the prevention and control of NCDs in 2025. 

Other sessions focused on the themes of Child and Adolescent Health, the influence of multimorbidity on healthcare and health policies, and establishing a research agenda. 

NEW IARC PROJECT ON CLASSIFYING TUMOURS

A new project titled Mapping the Evidence for the WHO Classification of Tumours: a Living Evidence Gap Map by Tumour Type, led by researchers of the WHO Classification of Tumours programme at the International Agency for Research on Cancer (IARC), has received a grant of €3.5 million from the European Commission. This four-year project, undertaken in collaboration with six other international institutions, was launched on 1 July 2022.

The principal aim of the project is to optimize cancer diagnosis research by mapping the needs identified by the WHO Classification of Tumours using an evidence-based approach. This will be of enormous value to those involved in cancer diagnosis and cancer research, and to those funding research.

It will produce an overview of the existing evidence for the WHO Classification of Tumours series (also known as the WHO Blue Books), with an emphasis on mapping existing evidence gaps and identifying pockets of low-level evidence, as well as relevant evidence synthesis and continuous updating.

NEW TECHNICAL BRIEF PUBLISHED ON PARKINSON DISEASE

Parkinson disease is a degenerative condition of the brain associated with motor symptoms, such as slow movement, tremor, rigidity, and walking imbalance, and a wide variety of non-motor complications, such as cognitive impairment, mental health disorders, pain and other sensory disturbances.

Globally, the prevalence of Parkinson disease has doubled in the past 25 years with global estimates in 2019 showing over 8.5 million individuals living with the condition. Disability and death due to Parkinson disease are increasing faster than for any other neurological disorder. Current estimates suggest that, in 2019, Parkinson disease resulted in 5.8 million disability-adjusted life years, an increase of 81% since 2000, with deaths more than doubling since 2000 to 329,000 deaths.

In line with the Intersectoral global action plan on epilepsy and other neurological disorders (A75/10 Add.4) agreed by Member States at World Health Assembly 75 in May, a technical brief titled “Parkinson disease: a public health approach” has been published. The brief outlines the global burden, treatment gaps, crucial areas for intervention in Parkinson disease and several areas for action, including:

• global health policies to implement strategies focused on Parkinson disease;
• prevention and reduction of risks for PD including education and awareness;
• assured access to treatment and care, including access to, and education of, an interdisciplinary workforce trained in neurological disorders; and
• delivery of services and the management of PD at various levels of health systems.

HOUSEKEEPING AND COUNTRY IMPACT

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We are also piloting a new On The Pulse feature series, working with WHO Regional and Country Offices to explore our country impact on NCDs! If you would like to be kept in the loop about this, please also let me know by writing.

THE TWEETS WE RETWEET

• Ghana Health Service @_GHSofficial co-hosts the Ghana NCD Forum towards a coordinated NCD response aligned with national strategy and WHO's Global NCD Compact (July 2022)
• Issue four of the Newsletter of the WHO Special Programme on Primary Health Care (July 2022)