WMJ_2022_01_final.jan23

ISSN 2256-0580
Official Journal of The World Medical Association, Inc. Nr. 1, May 2022 vol. 68
Contents
Editorial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
WMA 2022 Council Report Paris, April 7-9, 2022  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
A Council Resolution in Support of Ukraine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  14
Comments on Standing up for Doctors and Civilians in Ukraine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Interview with the WMA President  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  16
Report on a Symposium on Violence against Women and Girls in Port Harcourt, Nigeria . . . . . . . . . . . . . . . .  19
The Effects of COVID-19 on Global Marketing Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  22
Interview on the Burden of Rare Diseases with Swedish Neurologist and Psychiatrist . . . . . . . . . . . . . . . . . . . .  26
Fifteen Months after the Military Coup: Myanmar Doctors are in the Secret Health Service  . . . . . . . . . . . . . .  28
Mental Health Issues within the Healthcare System during the COVID-19 Pandemic –
Global and Malaysian Viewpoint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Report of WMA JDN Thematic Session on Warfare Ethics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  34
WMA Members Share Perspectives related to World Health Day 2022 (“Our Planet, Our Health”) . . . . . . . . 37
Obituary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Obituary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  42
World Medical Association Officers, Chairpersons and Officials
Dr. Heidi STENSMYREN
WMA President
Swedish Medical Association
(Villagatan 5) P.O. Box 5610
SE-114 86 Stockholm
Sweden
Dr. Otmar KLOIBER
Secretary General
World Medical Association
13 chemin du Levant
01212 Ferney-Voltaire
France
Dr. Jung Yul PARK
WMA Chairperson of the Finance
and Planning Committee
Korean Medical Association
Samgu B/D 7F 8F 40
Cheongpa-ro,
Yongsan-gu
04373 Seoul
Korea, Rep.
Dr. Osahon ENABULELE
WMA President-Elect
Nigerian Medical Association
8 Benghazi Street, Off Addis
Ababa
Crescent Wuse Zone 4, FCT,
P.O. Box 8829 Wuse Abuja,
Nigeria
Dr. Kenji MATSUBARA
WMA Vice-Chairperson
of Council
Japan Medical Association
113-8621 Bunkyo-ku, Tokyo
Japan
Dr. Jean-François RAULT
Chair of the Socio Medical Affairs
Committee
Conseil National de l’Ordre des
Médecins (CNOM) France
4 rue Léon Jost
75855 Paris Cedex 17
France
Dr. David BARBE
WMA Immediate
Past-President
American Medical Association
AMA Plaza, 330 N. Wabash, Suite
39300 60611-5885 Chicago,
Illinois
United States
Dr. Ravindra Sitaram
WANKHEDKAR
WMA Treasurer
Indian Medical Association
Indraprastha Marg 110 002
New Delhi
India
Dr. Joseph HEYMAN
WMA Chairperson of the
Associate Members
(deceased February 12, 2022)
Prof. Dr. Frank Ulrich
MONTGOMERY
Chairperson of Council
Bundesärztekammer
Herbert-Lewin-Platz 1
(Wegelystrasse)
10623 Berlin
Germany
Dr. Marit HERMANSEN
WMA Chair of the Medical Ethics
Committee
Norwegian Medical Association
P.O. Box 1152 sentrum
107 Oslo
Norway
Dr. Anthea MOWAT
WMA Interim Chairperson of the
Associate Members
British Medical Association
BMA House, Tavistock Square
WC1H 9JP London
United Kingdom
www.wma.net
Official Journal of The World Medical Association
Editor in Chief
Dr. Helena Chapman
Milken Institute School of Public Health, George Washington University, United States
editor-in-chief@wma.net
Assistant Editor
Mg. Health. sc. Maira Sudraba
Latvian Medical Association
lma@arstubiedriba.lv, editor-in-chief@wma.net
Journal design by
Erika Lekavica
dizains.el@gmail.com
Publisher
Latvian Medical Association
Skolas Street 3, Riga, Latvia
ISSNL 0049-8122
Opinions expressed in this journal – especially those in authored contributions –
do not necessarily reflect WMA policy or positions
3
Editorial
Editorial
BACK TO CONTENTS
As our global community welcomed the start to 2022,
and another year of the coronavirus disease 2019
(COVID-19) pandemic, the World Health Organiza­
tion reported an estimated 289 million cases and 5.4
million deaths across the globe (as of January 2, 2022).
Now, four months later, an estimated 518 million cases
and 6 million deaths have been documented (as of May
15, 2022). As a result, COVID-19 is now recognized as
the leading cause of mortality due to a single infectious
agent, ahead of tuberculosis, HIV/AIDS, and malaria.
Over the past two years, as clinical and laboratory
resources have been prioritized for global COVID-19
response efforts, health systems have experienced
an increased surge of health care service utilization.
Health professionals have faced physical and mental
exhaustion, leading to increased risk of burnout and
other mental health concerns, amidst the ongoing global
health workforce shortage. Also, other global events
have impacted community health and safety, including
Myanmar health professionals who have been arrested
or attacked, and three million Ukrainians who have left
their country following the Russian invasion. As the
direct and indirect effects of the COVID-19 pandemic
continue to unfold before our eyes, it is clear that global
solidarity remains essential to streamline health system
preparedness and response efforts during the pandemic.
The United Nations has voiced the need to accelerate
sustainable actions during the “decade of action”, in
efforts to achieve the goals, targets, and indicators of
the 17 Sustainable Development Goals by 2030. These
global and local efforts are fundamental to address
emerging health challenges of this decade, including
air pollution, antimicrobial resistance, effects of climate
change, mental health, prevention and control of
communicable and non-communicable diseases, and
zoonotic spillover.
Over the first quarter of 2022, the 220th WMA Council
Session offered a hybrid format for WMA members to
share policy updates, discuss comments and revisions
to WMA resolutions, and directly connect with
colleagues. This meeting raised awareness on an array of
global issues that will be discussed at upcoming events,
including the 221st WMA Council Session which will
be held in Germany.
In this issue, Dr. Heidi Stensmyren has shared her
perspectives on priorities and upcoming activities during
her tenure as WMA president. Dr. Thomas Lindén has
offered insight on the global burden of rare diseases and
proposed actions that can strengthen global initiatives.
Mr. Nigel Duncan has prepared a comprehensive
summary of the WMA statements and resolutions that
were presented at the 220th WMA Council Session.
Finally, WMA members have contributed their
articles that highlight national activities, perspectives
on pressing health issues, and reflections about World
Health Day.
It is with great honor that I have prepared this inaugural
editorial for the World Medical Journal. Our editorial
team hopes that the World Medical Journal, as a high-
quality resource for the global medical community, can
provide a platform for WMA members to disseminate
ongoing activities with our colleagues. Together, as
WMA members, we must leverage our expertise and
build our professional networks that can facilitate
prompt knowledge sharing across our countries.
Helena Chapman, MD, MPH, PhD
Editor in Chief of the World Medical Journal
E-mail: editor-in-chief@wma.net
4
In the year of the 75th anniversary
of the first General Assembly of the
World Medical Association (WMA)
in Paris, the WMA returned to the
French capital for its 220th Council
meeting. It was a hybrid meeting
and the first time that members had
met face-to-face since the General
Assembly in Tbilisi in 2019. Around
150 participants attended in person,
with a further 70 participants joining
online. Some 40 National Medical
Associations (NMA) and constituent
members were represented.
Thursday, April 7
Council
The Chair of Council, Dr. Frank
Ulrich Montgomery (Germany),
opened the meeting and welcomed
those Council members who were
attending in person and those who
were logging in online.New members
were welcomed, and apologies were
also received.All guests from affiliated
organisations and observers were also
welcomed.
The meeting then stood in memory of
two leading members who had died –
Dr. Jim Appleyard, President from
2003-04, and Dr. Joe Heyman, Chair
of the Associate Members – as well
as all those physicians who had died
in the conflict between Ukraine and
Russia.
Interim Report of the President
Dr. Heidi Stensmyren (Sweden)
spoke about the challenge of
COVID-19 and the way in which
the WMA had had to adapt. She said
that they had seen multiple technical
developments relating to vaccines
and medical research, which had led
to more students and young doctors
going into the medical technology
sector. By using new technology,
regional meetings had been held, and
she highlighted the Confederation
of Medical Associations in Asia
and Oceania weekly meetings with
updates on COVID-19, where the
NMAs shared their knowledge. She
referred to the war in Ukraine and
the violations of several international
treaties. Health care had become
more of a target, and she encouraged
members to take action and prevent
these occurrences. Finally, she spoke
about the increased awareness of the
importance of public health and the
need to be more active in the public
debate.
Report of the Secretary General
Dr. Otmar Kloiber tabled a 24-
page report detailing the activity of
the Secretariat during the past six
months. He spoke about the need to
revise the Declaration of Helsinki.
There were new issues coming up on
medical experimentation and clinical
trials, on patient driven research
and research protocols. Since the
Declaration was last discussed a
decade ago, he reminded members
that the WMA formal revision
process will need to be completed
by 2023. The American Medical
Association volunteered to take a
lead role in this revision process. He
said they should repeat the process of
being very inclusive, involving patient
groups, other non-governmental
organizations, and industry. He
suggested that a workgroup be set up
to start the revision process this year,
which was supported by the Council
and numerous NMAs.
Ukraine
Dr. Kloiber reported on the help
which the WMA was giving to
its colleagues in Ukraine. A group
of organisations, including the
CPME, EFMA and the past WMA
President, Dr. Leonid Eidelman, had
joined forces to work together and
a task force had been formed. With
the announcement from Japan of a
considerable donation, the Ukraine
Medical Help Fund was opened and
very rapid help had come from many
other NMAs, as well as a number
of individual donations. Dr. Kloiber
expressed his gratitude to all those
who had donated to this fund.
Report of the Chair of Council
The Council received a written report
from the Chair of Council looking
back over the last five months. This
referred to the situation in Ukraine
which had shown the fragility of our
geopolitical systems. This had led to
a humanitarian crisis with millions
of people on the move. It was the
WMA’s challenge to provide medical
services and public health care to
these people. In his oral report, Dr.
Montgomery added they should not
forget the COVID-19 pandemic, and
that they had to work continuously
in both affluent and less affluent
countries. In some affluent countries,
they had to fight fake news against
vaccination, whereas in the largest
WMA 2022 Council Report
WMA 2022 Council Report Paris, April 7-9, 2022
Nigel Duncan
BACK TO CONTENTS
5
parts of the world they had to combat
the inequity of vaccines. This was an
oxymoron and had been the core of
his work.
Matters of Urgency
Russian Invasion in Ukraine
An emergency Resolution in support
of medical personnel and citizens of
Ukraine in the face of the Russian
invasion was submitted by the
Norwegian Medical Authority,
merged with two other Resolutions
from the French and Spanish
Medical Associations. Speakers
supported the Resolution, which
expressed shock at the Russian army’s
bombing of Ukrainian civilians
and hospitals. It also expressed
support for Ukrainian colleagues.
Several friendly amendments were
proposed and accepted. However,
five amendments proposed by the
Russian Medical Association failed
after a seconder could not be found.
Other amendments also failed when
no seconders could be found.
The emergency Resolution, as
amended, was unanimously accep­
ted and approved by Council.
(see. p. 14)
Socio-Medical Affairs Committee
Election
An election took place for the Chair
of the Committee, following the
election of the previous chair, Dr.
Osahon Enabulele,as President-elect.
Two candidates were nominated, Dr.
Lujain Alqodmani (Kuwait Medical
Association) and Dr. Jean-François
Rault (Conseil National de l’Ordre
des Médecins). In a vote, Dr. Rault
was declared the winner by 15 votes
to 10.
Health and Environment
The committee received an oral
report from the Environment
Caucus, chaired by the Kuwait
Medical Association, which had
met the previous day. Among the
items discussed was the UN Climate
Change Conference in Glasgow, the
need to revise the WMA Statement
on the Prevention of Air Pollution
due to Vehicle Emissions, and a
discussion on green initiatives from
WMA members.
Medical Technology
The Chair of the workgroup on
Medical Technology gave an oral
report on the activity of the group.
The group had met several times as a
whole and in sub-groups. Members
had worked to map theWMA policies
related to medical technology. This
included defining the term ‘medical
technology’ as a point of reference for
the revision of the WMA Declaration
on Medical Ethics and Advanced
Medical Technology. The workgroup
was planning to submit a proposed
first draft of the revision in advance of
the next Council meeting in October
2022.
Prison Conditions and the Spread of
Communicable Diseases
AproposedrevisionoftheDeclaration
of Edinburgh on Prison Conditions
and the Spread of Tuberculosis and
Other Communicable Diseases was
presented to the committee by the
Uruguay Medical Association. The
revised document said that prisoners
should receive the same standard of
healthcare as people outside prisons
and that it was the responsibility of
the state to guarantee the right to
life and health of people deprived of
liberty.
The committee agreed to recommend
circulating the document among
NMAs for comment.
Use of Telehealth for the Provision of
Health Care
The committee received an oral
report from the Chinese Medical
Association (CMA) on a revised
Statement on Guiding Principles
for the Use of Telehealth for the
Provision of Health Care. This dealt
with the ethical,legal,and professional
issues relating to telehealth. During
a debate, friendly amendments were
discussed and accepted.
The committee agreed to recommend
that the proposed revision, as
amended, be approved by the Council
and forwarded to the General
Assembly for adoption.
Health Hazards of Tobacco Products
and Tobacco-Derived Pro­ducts
A proposed revision of the WMA
Statement on Health Hazards of
Tobacco Products and Tobacco-
Derived Products was introduced by
the American Medical Association. It
had been decided that the Statement
should undergo a major revision
under the 10-year review rule and the
revised document had updated the
policy. It recommends that national
governments increase taxation
of tobacco and tobacco-derived
products, stating that taxation is a
highly cost-effective and inexpensive
tool.
The committee recommended that
the revised Statement should be sent
to the Council for forwarding to the
General Assembly for adoption.
Protection and Integrity of Health
Per­
so­
nnel in Armed Conflicts and
Other Situations of Violence
The committee considered a proposed
revisionoftheWMAStatementonthe
Protection and Integrity of Medical
WMA 2022 Council Report
BACK TO CONTENTS
6
Personnel in Armed Conflicts and
Other Situations of Violence. The
revision had been undertaken by
the Associate Members and it was
explained that if the committee
agreed to the revision, under the
10-year review rule, the Declaration
on the Protection of Health Care
Workers in Situation of Violence
would be rescinded and archived.The
revised Statement expresses great
concern about the persistent attacks
and misuse of hospitals and other
medical facilities, as well as threats,
killings, and other violence against
patients and healthcare personnel
in emergency contexts. And it
condemns in the strongest terms this
scourge of violence against healthcare
personnel and facilities, which it
says has disastrous humanitarian
implications, with critical impact
on the capacity of health systems to
provide the care needed.
The committee recommended that
the revised Statement should be sent
to the Council for forwarding to the
General Assembly for adoption.
Global Burden of Chronic Disease
The committee considered the
proposed revision of the Statement
on the Global Burden of Chronic
Disease. The Council in 2021
had decided that the Statement
should undergo a major revision
and the Brazil Medical Association
was appointed rapporteur. The
committee was told that chronic
non-communicable diseases were
the leading cause of mortality and
disability in both the developed and
developing world, the four main
NCDs (NCD4) being cancers,
cardiovascular diseases, chronic
respiratory diseases, and diabetes.
Ongoing and anticipated global
trends that would lead to more
chronic disease problems in the
future included an aging population,
urbanizationandinadequatecommu­-
nity planning, increasingly sedentary
lifestyles, climate change, and the
rapidly increasing cost of medical
technology to treat NCDs. The
NCD4 merited global attention. The
primary solution for these diseases
was prevention, tobacco use, poor
diet, physical inactivity, and alcohol
abuse being the four most common
modifiable risk factors for NCDs.
During the debate that followed, it
was argued that the document failed
to prioritise action points.There were
more than 50 recommendations, and
it was suggested that only the most
important recommendations should
be put forward. In the light of this,
the committee recommended that
the revised Statement be recirculated
for further comments.
Occupational and Environmental
Health and Safety
The Kuwait Medical Association
presented a proposed revision of the
WMA Resolution on Occupational
and Environmental Health and
Safety, which had undergone a
major 10-year review. In proposing
a number of recommendations
for ensuring that all workers had
access to risk based occupational
and environmental health and safety
services, the revised document refers
to the COVID-19 pandemic. This
had led to an increased number
of employees working outside the
employer’s premises, using digital
information and communication
technologies either full-time or
part-time. This had presented risks
associated with isolating employees,
particularly individuals living alone,
and could result in increased levels
of stress and anxiety. During a brief
debate, the committee agreed to
two amendments. The first added
the words: ‘Extended working
hours and employee availability in
addition to diminished boundaries
between personal and professional
life may impact work-life balance’. A
second amendment included a new
sentence:‘Employers should consider
promoting and offering essential
vaccines to employees’. It was also
decided to classify the document as a
Statement rather than a Resolution.
The committee recommended that
the revised Statement, as amended,
be approved by the Council and
forwarded to the General Assembly
for adoption.
Patient Safety and Professional
Regula­tion
A proposed WMA Statement was
presented by the British Medical
Association (BMA) on improving
patient safety involving a whole
system cultural change and by
redefining the role of professional
regulation. It was proposed that the
Statement be merged with the WMA
Declaration on Patient Safety, which
was described as ‘quite light’. It was
argued that this whole issue was a
vital and fundamental one for doctors,
who were petrified about issues of
safety. There was now an even more
overwhelming understanding about
why systemic change was the key to
enable doctors to deliver patient safety.
Previous WMA Declarations had put
the onus on doctors. The committee
was told that new recommendations
in the proposed Statement referred
to doctors having to work in a
resource environment, introducing
the idea of a culture of learning
and support, and most importantly
the call for a paradigm change in
individual professional regulation,
where effectively the system went
into the dock not the individual. This
amounted to a major revision.
During the debate, it was suggested
that the document should be
recirculated to include the issues of
better technology and medical health
records.
WMA 2022 Council Report
BACK TO CONTENTS
7
The committee recommended that
the revised Statement be recirculated
for further comments.
Racism in Medicine
The German Medical Association
submitted a proposed Declaration
on Racism in Medicine. This declares
that physicians from marginalized
communities faced racism from
patients, other physicians, and health
professionals, and that racism was
structural and deeply engrained
in health care. During the debate
that followed, a large number of
amendments were proposed. It was
argued that the preamble should be
adjusted to delete the text that race
as a concept was not biologically,
genetically or scientifically justified.
It was also suggested that a number
of empirical statements in the text
should be limited to a minimum.
The amendments, however, were
opposed on the grounds that they
would undermine the document,
and the amendments were eventually
withdrawn.
The committee agreed to recommend
to Council that the proposed
Declaration be approved for
forwarding to the Assembly for
adoption.
Discrimination against Elderly
Indi­viduals
The committee considered a proposed
Declaration on Discrimination
against Elderly Individuals within
Healthcare Settings, submitted by the
Spanish Medical Association. This
calls on the medical profession to
eliminate all forms of discrimination
due to health and age.The committee
was told that doctors should not
allow age to interfere in their duties.
The Declaration attempted to clarify
this ethical obligation, where doctors
must not discriminate on any basis. In
the brief debate that followed, it was
proposed that the document should
be recirculated for further comment
because it needed more work.
However, this was opposed, and on
a vote the proposal to recirculate was
defeated by 12 votes to nine.
The committee recommended
that the proposed Declaration
be approved by the Council and
forwarded to the General Assembly
for adoption.
COVID-19 Vaccines for All
The Committee considered the
proposed Resolution for Providing
COVID-19 Vaccines for All.
During the debate,it was emphasized
that this was a time sensitive,
crucial issue for their patients. The
American Medical Association
spoke about trying to recommend
as much distribution of vaccines
across the global population to
under developed areas. This should
take precedence over issues such as
intellectual property. They had to see
that these vaccines got into the hands
and arms of those who needed them.
Several friendly amendments tidying
up the language of the document
were proposed and accepted.
The committee recommended
that the proposed Resolution, as
amended, be sent to the Council for
adoption by the General Assembly.
The Uyghurs and Other Minorities in
China
The committee considered the pro­
–
posedWMAResolutiononAcknow­
ledgement and Condemnation of
the Genocide against the Uyghurs
and Other Minorities in China. The
BMA opened the debate with a brief
history of the issue. It pointed out
that the Uighur Tribunal in 2021 had
concluded that the People’s Republic
of China had committed genocide
and that medical professionals were
actively involved. It argued that
if the CMA failed to speak out
about such conduct that it would
be detrimental to the WMA and
would bring the profession into
disrepute. The CMA responded that
the BMA proposal was not in line
with the facts, and it firmly opposed
the proposed Resolution. Instead, it
suggested that a workgroup be set up
to discuss rescinding the Resolution
and that the WMA should visit the
Xinjiang province in China to find
out what was really happening. The
BMA replied by saying that it was
not convinced the WMA would be
granted free and independent access
that would be required if the team
visited the area. Other speakers
said that the WMA was not an
investigative body and should await
the forthcoming visit to Xinjiang
by Dr. Michelle Bachelet, United
Nations High Commissioner for
Human Rights.
On a vote, it was decided by 13 votes
to nine to postpone further discussion
on this issue until Dr. Bachelet’s visit
to the area. The committee decided
to recommend such a postponement
to the Council.
Policy Review 2022: Classification of
Policies
The committee considered the
classification of 2012 policies
on Socio-Medical Affairs and
recom­mended that:
the Resolution on Economic
Embar­goes and Health be reaffirmed;
that the following policies undergo a
minor revision:
– Statement on Self-Medication
– Statement on the Ethical
Implica­
tions of Collective Action by
Phy­sicians
WMA 2022 Council Report
BACK TO CONTENTS
8
– Statement on Forced and Coerced
Sterilisation
– Resolution on Medical Assistance
in Air Travel
– Resolution on Tuberculosis
that there should be major revisions
of:
– Resolution in Support of the Me­
dical Associations in Latin Ame­
rica
and the Caribbean
– Statement on Electronic Cigarettes
and Other Electronic Nicotine Deli­
very Systems
-Statement on Violence in the Health
Sector by Patients and Those Close to
Them and that the following should
be rescinded and archived:
– Resolution on Health and Human
Rights Abuses in Zimbabwe be
rescinded and archived
– Resolution on Poland be rescinded
and archived.
The Socio-Medical Affairs Commi­
ttee was adjourned.
Friday, April 8
Finance and Planning Committee
Dr. Jung Yul Park (Korea) took the
chair.
Membership Dues Payments
The committee received the report
on membership dues payments for
2022 and considered the report
on membership dues arrears. The
Treasurer, Dr. Ravi Wankhedkar,
reported that 64 percent of dues
payments had been received and,
taking into account those members
that were scheduled to pay in
instalments, the WMA expected
to reach 99 percent of the baseline
amount. Concerning dues arrears,
it was reported that the Secretariat
would continue to be in contact with
those members in arrears with the
aim of bringing them back into good
standing in the near future.
The committee recommended that
the Council approve the Report on
Membership Dues Arrears.
Financial Statement
The committee considered the inte­
–
rim Financial Statement for 2021
which was due to be audited in June
2022. Dr. Wankhedkar provided an
in-depth analysis of the contents of
the document and an update on the
current year’s financial status. He said
this represented a solid financial basis,
with no financial losses to be reported
and a more than satisfactory income.
The committee recommended that
the Council approve the interim
Financial Statement for 2021.
Strategic Plan
The Secretary General gave an oral
report on the WMA Strategic Plan.
Hesaidthattheoriginalplanfor2020-
2025 had deviated to some extent due
to the COVID-19 pandemic and the
war in Ukraine. In terms of advocacy
work for Universal Health Coverage
(UHC) and emergency preparedness,
he said there was a need for UHC to
be realised in order to improve the
Association’s capacity on emergency
preparedness, which was more
important now than ever before.
During the pandemic, those health
care systems that were stronger were
better able to cope than those that
were weaker. He also reported that a
lot of time and manpower had been
invested in the Ukraine Medical Help
Fund project in coalition with EFMA
and the CPME. He said that the
WMA needed a long-term plan for
the Secretariat to be better equipped
and staffed. As they slowly recovered
from the pandemic, the WMA would
have to adapt to the new normal.
Statutory Meetings
Planning and arrangements for future
WMA meetings were considered by
the committee.
Several dates were considered for
meetings in 2026 and one invitation
was received for hosting the Council
Session in 2024.These were:
– the 229th Council Session to be
held from 23-25 April 2026
– the 76th General Assembly to be
held from 7-10 October 2026
– an invitation from the Korean
Medical Association for Seoul to host
the 226th Council Session in 2024
The committee recommended that
these dates be approved by the
Council.
Dr. Ramin Parsa-Parsi (Germany)
extended an invitation to all members
toparticipateintheGeneralAssembly
in Berlin on 5-8 October 2022, with
the theme of the Scientific Session
‘Medical Ethics in a Globalized
World’ and a celebration of the 75th
anniversary of the German Medical
Association on 6 October 2022.
Special Meetings
Dr. Kloiber highlighted several
forthcoming meetings:
– Hearings and conferences on the
International Code of Medical
Ethics in the Pacific, Asian, African
and North American regions were
planned during the year so that the
revised ICoME could ideally be
WMA 2022 Council Report
BACK TO CONTENTS
9
presented to the Council and the
General Assembly for adoption in
October 2022;
– They were planning to continue the
One Health conference, which had
been held twice, first in Spain and
then in Japan;
– Following the International
Roundtable on Vaccination
co-orga­
nized by the WMA, German
Medical Association, and the
Pontifical Academy for Life, as well
as Dr. David Barbe’s participation at
a Vatican conference on public health
during his term as theWMA President,
the WMA looked forward to working
with the Vatican on seminars and
conferences on various subjects.
Associate Membership
The committee received a report from
the Associate Members presented by
theInterimChair,Dr. AntheaMowat.
She again remembered the work of
two leading Associate members who
had died, Dr. Jim Appleyard and Dr.
Joe Heyman. She said they had been
shining examples in their membership
of the Associate Members. In its
written report, the group reported on
several webinars that were held, as
well as its membership on numerous
workgroups.
Junior Doctors Network
An oral report was given by the JDN
Chair, Dr. Yassen Tcholakov. He said
that the membership of the Network
continued to grow,as did its workload.
The JDN has six active working
groups. The Network had held fully
virtual bi-annual meetings since
October 2020, which had allowed a
greater number of JDN members to
participate than usual. In its written
report, the JDN said it continued to
maintainstronglinkswithotherhealth
professionals’ associations, including
the International Federation of
Medical Students’ Associations, the
Student Network of the International
Physicians for the Prevention of
Nuclear War, the European Junior
Doctors Association, and the WHO
Global Health Workforce Network
Youth hub.
Past Presidents and Chairs of Council
Network
The committee also received the
report of the Past Presidents and
Chairs of Council Network.
Legal Seat of the WMA
An oral report was given by the
Secretary General on the dissolution
of “The World Medical Association,
Inc.”intheUnitedStatesandretaining
association status only in France. Dr.
Kloiber explained the complications
of the process of deregistration of a
US incorporation and informed the
committee that he had commissioned
a US law firm to work on this issue.
The committee recommended that
the Council approve the Secretary
General’s progress report.
Rules Applicable to WMA Associate
Membership
A progress report was given to
the committee by the workgroup
on Associate Membership Rules
Changes. It was again made clear that
the revisions were editorial in nature
and clarified internal procedures and
electoral processes. The changes did
not alter the existing relationship
between the Constituent Members
and the Associate Members, nor to
their relationship with the Council
and the General Assembly.
The committee recommended that
the Council approve the proposed
revision of the rules and forward it to
the General Assembly for adoption.
Procedures of Conducting Virtual
Meetings
The committee heard an oral report
on proposed amendments to the
WMA Bylaws and Procedures of
Operating Policies in relation to
conducting virtual meetings. A
number of recommendations were
proposed, many of which had already
been implemented in the virtual
meetings that had been carried out
during the pandemic.
The committee approved the
amendments and recommended
that they be sent to the Council for
forwarding to the General Assembly
for adoption.
LGBTQ Equity in Venues Hosting
WMA Meetings and Functions
New internal guidelines relating to
LGBTQ equity in venues hosting
WMA meetings and functions
were presented to the committee.
The guidelines reaffirm the WMA’s
commitment to non-discrimination.
After a lengthy debate,the committee
recommended that the Council
approve the guidelines, as amended.
Green Guidelines for WMA Meetings
Proposed green guidelines for WMA
meetings to create more sustainable
events were considered by the
committee. The document deals with
the need for appropriate locations
for WMA meetings, transport
options and eco-friendly practices, in
particular regarding food/beverage,
waste management, and events
materials. It also refers to the need
to reduce significantly health and
carbon emission damage as well as
cost for participants, food waste,
packaging recycling, and reusable
and recycled materials. The CMA
proposed monitoring and evaluating
the implementation of the proposed
WMA 2022 Council Report
BACK TO CONTENTS
10
guidelines. The committee decided
that this suggestion should be passed
to the WMA Secretariat to determine
where and how it could be integrated
into the proposed guidelines, to
address potential budget or staffing
questions, as well as the proposal
to delegate the responsibilities to
the Environment Caucus. These
proposals would be considered at the
next meeting.
World Medical Journal
The committee received a written
report from Dr. Pēteris Apinis, who
was retiring after 14 years as editor in
chief. During that time, he said, the
World Medical Journal had preserved
its traditions, while growing,
changing its format, and switching
to an electronic magazine format.
They had changed the contents of the
magazine, but it remained the World
Medical Journal as it had come out
since 1954. He said the WMJ was a
valuable brand that they could not
afford to lose or squander. It was a
powerful weapon they could use to
disseminate information to NMAs
and doctors throughout the world.
It was not only a journal, but also a
vehicle for helping the WMA achieve
its mission of improving medical
education, science, ethics and health
care for all the peoples of the world.
In her oral report,Ms.Maira Sudraba,
Assistant to the Editor, said that Dr.
Helena Chapman had taken over as
the new editor and planned to attend
the General Assembly in Berlin.
Public Relations
The committee received an oral and
written report on public relations.
Despite the slight decrease in the
number of press releases over the past
six months, the WMA had continued
its high profile in the media.
Committee members were reminded
of the importance of sharing WMA
press releases with their local media.
The number of twitter followers
had increased to 14,700, while the
WMA Facebook page had more
than 13,600 followers. On YouTube,
the WMA had increased its online
presence during the COVID-19
pandemic with a series of interviews
with health leaders from around the
world
Medical Ethics Committee
The committee was called to order
by the chair, Dr. Marit Hermansen
(Norway).
International Code of Medical Ethics
The committee received an oral
report on the process of revising
the International Code of Medical
Ethics (ICoME). It was reported
that a number of conferences had
been held, and several more were
planned over the next few months.
These will be a regional meeting
in Asia organized by the Medical
Association of Thailand in Bangkok
on 7-8 June 2022, a conference on
conscientious objection organized by
the Indonesian Medical Association
on 4-5 July 2022, a regional meeting
in Abuja, Africa, organized by the
Nigerian Medical Association
in early August 2022, and a final
expert meeting organized by the
American Medical Association
in Washington on 11-12 August
2022. The committee also received
a proposed draft of the revised
ICoME. Members were informed
that the revisions were approaching
the finishing line, although some
important issues needed to be
addressed before sending the draft
to Council.
The committee recommended that
the draft document be approved
by the Council for ongoing work
and for use during the forthcoming
conferences.
Reproductive Technologies
An oral report was received from the
South African Medical Association
on the proposed revision of the WMA
Statement on Assisted Reproductive
Technologies. The committee was
told that this was a major revision
and was proving to be very complex
and challenging in getting universal
consensus.There were vast differences
in national legislation. In view of this,
the workgroup proposed that further
discussion be postponed until the
next meeting in Berlin.
The committee agreed to recommend
to the Council that the issue be
postponed to the next committee
meeting at the General Assembly in
October.
Physicians Treating Relatives
The South African Medical Asso­
ciation also presented a further
revised draft of the proposed WMA
Statement on Physicians Treating
Relatives, which declared that
physicians should avoid routinely
acting as a relative’s primary care
physician. This was a proposal, which
was first put forward in 2019,and had
led to several debates. The committee
was told that the document had been
circulated several times and that many
of the comments received had been
incorporated into the Statement.
During the debate that followed,
several more amendments were
agreed. One suggested amendment
wastochangethewording:‘Physicians
should avoid routinely acting as a
relative’s primary care physician’ to
‘physicians are not encouraged to act
as a relative’s primary care physician’.
However, this was not supported, and
there was also a move to recirculate the
document for further discussion. On
a vote, it was decided by 17 votes to
four not to recirculate.The committee
eventually agreed to recommend that
the proposed Statement, as amended,
WMA 2022 Council Report
BACK TO CONTENTS
11
should be sent to the Council for
forwarding to the General Assembly
for adoption.
Organ Procurement from Executed
Prisoners
An oral report was received from the
workgroup on organ procurement
from executed prisoners. The
workgroup, which was installed
in 2021, had drafted a first version
of a new policy, focusing on the
commitment of the WMA and all
constituent members to combat the
practice of organ transplantation on
executed prisoners. The committee
was told that three aspects
underpinned the workgroup’s
approach.Firstly,thefullcommitment
on the part of the Chinese Medical
Association (CMA) in fighting
the transplantation of organs from
executed prisoners. Secondly,
given that strong commitment by
the CMA to respect the universal
principles the WMA wanted to
uphold, and bearing in mind changes
made to the organ procurement law
in China applying these principles,
the workgroup unanimously voted
to propose the withdrawal of
the WMA Resolution on organ
procurement in China adopted in
South Africa in 2006. Thirdly, there
was the full unanimous commitment
of all the members of the workgroup
to propose a ongoing resolution that
reflected the commitment of China
and all NMAs to fight the organ
procurement from prisoners and
executed prisoners.
The committee received the report
and the chair noted the workgroup’s
intention to propose rescinding
the Council Resolution on Organ
Donation in China at a later stage.
Declaration of Venice and End of Life
Care
The committee considered the
proposed major revision of the
WMA Declaration of Venice on
terminal illness submitted by the
American Medical Association. The
Declaration was planned to undergo
the 10-year revision process in 2016,
but this was delayed until the related
WMA Declaration on Euthanasia
and Physician-Assisted Suicide was
revised. In October 2019, the revised
Declaration on Euthanasia was
adopted with new wording, requiring
a revision of the Declaration of
Venice. In 2021, it was also decided
that the Declaration on End-of-
Life Medical Care should undergo a
major revision and it was proposed
to merge the Declaration of Venice
and the Declaration on End of
Life Medical Care. The AMA-led
workgroup was now proposing to
combine the Declaration of Venice
with the Declaration on End of Life
Care, mentioning the Declaration on
Euthanasia and Physician Assisted
Suicide. It had tried to acknowledge
that care at end of life did not always
involve terminal illness. Palliative
care should be routinely available
to people suffering from chronic
debilitating disease. The workgroup
was now seeking recirculation of the
Declaration of Venice, taking into
account recent comments.
The committee agreed to recommend
to the Council that the proposed
revision of the Declaration of Venice
be recirculated for comment.
Medical Ethics in the Event of Disasters
An oral report was received on a
proposed policy on medical ethics in
the event of disasters.The workgroup
considering the policy had concluded
that ethical aspects of different
public health emergencies, such
as pandemics, epidemics, climate
change emergencies, and disasters,
were similar and could be combined
into a single policy. Technical and
socio-medical aspects of emergencies
and disasters would be covered in
a separate policy. The workgroup
decided to form a smaller sub-group
to draft a statement.
The committee received the report.
Professional and Ethical Use of Social
Media
The Junior Doctors Network
presented a proposed major
revision of the WMA Statement
on Professional and Ethical Use
of Social Media, which calls for
NMAs to establish social media
guidelines for their members. The
committee was told that the revision
had three main objectives − to
include reference to other WMA
policies, to put greater emphasis on
evidence-based information and to
call attention to fake information.
The workgroup proposed forwarding
the document to the Council for
adoption by the General Assembly.
The committee agreed to amend the
guidelines by deleting the sentence
that physicians should ‘request
permission from the patient before
publishing his/her data and images
on social networks and explain the
reason for this disclosure to them and
how it will be used’. The committee
was also told that doctors should be
involved in social media and should
be prepared to involve themselves in
discussions on misinformation and
disinformation.
The committee recommended
that the proposed revision of the
Statement, as amended, should
be approved by the Council and
forwarded to the General Assembly
for adoption.
Classification of Policies
The committee recommended that
two documents should undergo a
major revision:
WMA 2022 Council Report
BACK TO CONTENTS
12
– Declaration of Washington on
Biological Weapons
– Regulation inTimes Armed Conf­lict
and Other Situations of Violence
And that two documents should be
reaffirmed with minor revisions:
– Statement on Safe Injections in
Health Care
– Resolution on Prohibition of Forced
Anal Examinations to Substantiate
Same-Sex Sexual Activity
Saturday, April 9
Plenary Council
The Council resumed to consider
reports from the three committees.
Medical Ethics Committee Report
The Council agreed to forward two
documents to the General Assembly
for adoption:
– proposed Statement on Physicians
Treating Relatives
– proposed revision of the Statement
on Professional and Ethical Use of
Social Media
It approved the updated draft of
the revised International Code of
Medical Ethics for further discussion.
It approved postponing debate on
the proposed Statement on Assisted
Reproductive Technologies until the
next meeting.
It approved the recirculation of the
proposed Declaration of Venice and
End of Life Care and the classification
of documents as recommended by the
committee.
Finance and Planning Committee
The Council approved the Report
on Membership Dues Arrears, the
interim Financial Statement for
2021, the proposed dates for future
meetings, and plans to continue
with the dissolution of “The World
Medical Association, Inc.” in the
United States. It also agreed that
the proposed revision of the Rules
Applicable to WMA Associate
Membership should be forwarded to
the General Assembly for adoption,
as well as the amendments to the
WMA Procedures of Operating
Policies relating to virtual or hybrid
meetings.
The remainder of the Finance and
Planning Committee report was
accepted.
Socio-Medical Affairs Committee
COVID-19 Vaccines for All
In a further debate on the proposed
Resolution for Providing COVID-19
Vaccines for All, the Council agreed a
new paragraph stating that the WMA
urged all parties to ‘confront vaccine
hesitancy by providing evidence-
based guidance on the safety and
necessity of vaccines’.
The Council agreed to forward the
proposed Resolution, as amended, to
the General Assembly for adoption.
Acknowledgement and Condem­
nation
of the Genocide against the Uyghurs and
Other Minorities in China
The Council considered the proposed
Resolution on Acknowledgement
and Condemnation of the Genocide
against the Uyghurs and Other
Minorities in China. The BMA
repeated its strong belief that the
WMA should ask the Chinese
Medical Association to recognise
and condemn the genocide. BMA
speakers clarified their reasons for
this, including the extensive evidence
of the independent tribunal’s findings
on the matter. And they asked what
more could be expected by waiting
for another report. The time for
waiting was over. The BMA again
proposed a motion that that the
WMA should ask the CMA to
recognise and condemn the genocide.
But the motion fell after it failed to
find a seconder.
A second recommendation from the
Socio-Medical Affairs Committee
was then put to the Council that the
proposed Resolution, as amended,
be postponed temporarily, pending
further documentation from inde­
pendent sources on the claims
included in the proposed Resolution.
On a vote, the motion was supported
by 19 votes to six.
The remainder of the SMAC report
wasapproved,includingthefollowing
documents to be forwarded to the
General Assembly for adoption:
– proposed revision of the Statement
on Guiding Principles for the Use
of Telehealth for the Provision of
Health Care
– proposed revision of the Statement
on Health Hazards of Tobacco
Pro­ducts and Tobacco-Derived
Pro­ducts
– proposed revision of the Resolution
on Occupational and Environmental
Health and Safety
– proposed Declaration on Racism in
Medicine
– proposed Declaration on
Discri­
mination against Elderly
Individuals within Healthcare Settings
– proposed revision of the Statement
on the Protection and Integrity
of Medical Personnel in Armed
WMA 2022 Council Report
BACK TO CONTENTS
13
Conflicts and Other Situations of
Violence
– proposed Resolution for Providing
COVID-19 Vaccines for All
The Council approved the
classi­
fication of documents as
recommen­
ded by the committee.
Advocacy and Communication
The Council received an oral re­
port
about the Advocacy and
Commu­nications workgroup.
Mem­
bers were told that the
workgroup had been restructured and
had not met.
Disciplinary Matters
The Council received a complaint
by the Supreme Medical Council of
Poland about the Belarusian Medical
Association and the National Medical
Chamber of Russia, and responses
from the National Medical Chamber
of Russia. The Chair of Council read
out the articles and bylaws relating
to the complaints, which required
four months’ notice. As a result,
there would be no discussion at this
meeting, but the matter would be
discussed at the next meeting in
Berlin in October 2022.
Similarly, there had been a complaint
from the BMA about the CMA and
this matter would also be discussed in
Berlin.
75th World Health Assembly
The Council received an oral report
on the agenda of the upcoming
75th World Health Assembly in
May 2022. It was not clear what
format the meeting would take. But
among the issues to be discussed
were strengthening the response
to health emergencies, universal
health coverage, human resources
for health and a treaty on pandemic
preparedness.
After final thanks from the Secretary
General to the meeting’s organisers,
the Council meeting was brought to
a close.
Mr. Nigel Duncan
Public Relation Consultant, WMA
E-mail:
nduncan@ndcommunications.co.uk
WMA 2022 Council Report
BACK TO CONTENTS
14
COUNCIL RESOLUTION
IN SUPPORT OF MEDICAL
PERSONNEL AND CITIZENS
OF UKRAINE IN THE FACE
OF THE RUSSIAN INVASION
Preamble
Reminding that the World Medical
Association was founded on the
backdrop of the atrocities of war
and how the medical profession
was abused for violation of human
rights and dignity;
Reaffirming the WMA Decla­
ration of Geneva as a beacon
of fundamental principles to
which the world’s phy­
sicians are
committed;
Deeply shocked by the Russian
army’s bombing of Ukrainian
civilians and hospitals, including
maternity wards, thus infringing
on medical neutrality in conflict
zones. The WMA and its members
express their solidarity with the
Ukrainian people and provide
their support for Ukrainian and
international healthcare workers
mobilized under extremely difficult
conditions;
Recalling the WMA’s Statements
on the Cooperation of National
Medical Associations during or
in the Aftermath of Conflicts, on
Armed Conflicts, the Regulations
in Times of Armed Conflict and
Other Situations of Violence, the
Statement on the Protection and
Integrity of Medical Personnel
in Armed Conflicts and Other
Situations of Violence, the
Declaration on the protection of
healthcare workers in emergency
situations and the Statement on
Medical Care for Migrants;
Emphasizing the need to respect
the Geneva Conventions and
their protocols as the core of
international humanitarian law, as
well as the United Nations Security
Council Resolution 2286;
Considering the suffering and
human tragedy caused by the
Russian invasion of Ukraine,
including a refugee crisis on a
massive scale;
Recommendations
1.The Constituent Members of the
WMA stand in solidarity with the
Ukrainian Medical Association
and all healthcare professionals;
2. The WMA condemns Russia’s
in­
vasion of Ukraine and calls for
an end to hostilities; The WMA
considers that Russia’s political
leadership and armed forces bear
responsibility for the human
suffering caused by the conflict;
3. The WMA calls on Russian and
Ukrainian doctors to hold high the
principles in the WMA Declaration
of Geneva and other documents
that serve as guidance for medical
personnel during times of conflict;
4.The WMA demands that the par-
ties to the conflict respect relevant
Humanitarian Law and do not use
health facilities as military quarters,
nor target health institutions,
workers and vehicles, or restrict
the access of wounded persons and
patients to healthcare, as set out
in the WMA Declaration on the
Protection of Health Workers in
Situations of Violence;
5.The WMA stresses that the par­ties
to the conflict must strive to protect
the most vulnerable populations;
6. The WMA underlines that it is
essential that access to medical care
be guaranteed to all victims, civil
or military, of this conflict, without
distinction.
7. Physicians and all other medical
personnel, both Ukrainian and
international, involved in NGOs,
must not under any circumstances
be hindered in the exercise of their
unwavering duty,in accordance with
the international recommendations
provided in the WMA declaration
on the protection of healthcare
workers in emergency situations,
the WMA’s position on the
protection and integrity of medical
personnel in armed conflicts and
other violent situations and in the
declaration of the United Nations
General Assembly on the rights
and responsibility of individuals,
groups and organs of society
to promote and protect human
rights and universally recognized
fundamental freedoms.
8. The WMA calls on the parties
to ensure that essential services are
provided to those within areas
dama­
ged and disrupted by conflict;
9. The WMA calls on the inter­
–
national community and govern-
ments to come to the aid of all
persons displaced by this conflict –
more than 10 million to date –
who may choose their country as a
destination following their depar­
ture from Ukraine.
10. The WMA urges all nations
recei­
ving persons fleeing the
conflict to ensure access to safe
and adequate living conditions and
essential services to all migrants,
including appropriate medical care,
as needed.
A Council Resolution in Support of Ukraine
A Council Resolution in Support of Ukraine
BACK TO CONTENTS
15
In April 2020, part of the
background of the WMA Council
Meeting in Paris was the ongoing
Russian invasion in Ukraine.
Reports of civilian casualties, tar­
geting of hospitals, housing, and
other civilian infrastructure as well
as a refugee crisis unprecedented in
Europe since World War II brought
the Council together in adopting
an urgent resolution in support of
Medical Personnel and Citizens of
Ukraine in the face of the Russian
invasion. The resolution recalled the
historical formation of the WMA,
the declaration of Geneva, other
WMA statements, and the Geneva
conventions and protocols. The
delegates expressed their solidarity
with Ukrainian doctors and other
health professionals.
Through the Resolution,the Council
underlined the responsibility of
Russian authorities and armed
forces for the human suffering as
a result of the conflict. Council
members emphasized that access to
medical aid may not be restricted,
and health care institutions, health
care professionals and patient
transports may not be attacked.
The WMA Council appealed to the
international community to come
to the aid of the millions of people
displaced by the war. After the
end of hostilities, priority must be
given to the rebuilding of essential
infrastructure, including shelter,
sewerage, fresh water supplies,
and food provisions, followed by
the restoration of educational and
occupational opportunities.
Marit Hermansen, MD
WMA Chair of the Medical
Ethics Committee
Norwegian Medical Association
E-mail: axel.rod@legeforeningen.no
Comments on Standing up for Doctors and Civilians in Ukraine
Comments on Standing up for Doctors and Civilians in Ukraine
Marit Hermansen
11. The WMA calls on the par­
ties to the conflict as well as the
international community to ensure
that when the conflict ends, priority
must be given to rebuilding the
essential infrastructure necessary
for a healthy life, including shelter,
sewerage, fresh water supplies,
and food provision, followed by
the restoration of educational and
occupational opportunities.
BACK TO CONTENTS
16
For this interview, Dr. Heidi
Stensmyren, the WMA President,
shares her perspectives on current
and upcoming WMA
activities with
Dr. Helena Chapman,
the WMJ Editor in Chief
As we enter the third year of the
COVID-19 pandemic, physicians
have experienced an array of
physical, mental, and emotional
exhaustion. Whathasmotivatedyou
in your daily activities throughout
these hardships, and how can this
motivate other physicians across the
globe?
The physicians’ work situation with
high demands and comprehensive
personal responsibility for patient
safety, but limited resources and
diminishing mandate, is not new.
Long before this pandemic,it has been
one of our biggest challenges. The
pandemic has pushed the situation
further than ever before, resulting in
unacceptable and exhausting working
conditions, visibly demonstrated in
sick leave statistics, burnout, and
physicians leaving or planning to
leave clinical care. Also, there is a
notable rise in the number of medical
students worldwide who plan to work
in other industries other than clinical
care, including medical technology.
This observation may be a healthy
sign, which shows students capable
of making rational choices. Still,
it is a clear sign that health care
is not an attractive workplace and
the proverbial “canary in the coal
mine” reflects the population’s future
healthcare.
With this perspective, from the start,
I was concerned about the effect of
the pandemic on our health care. As
we knew that the pandemic would
continue for an extended period,it was
clear that the biggest challenge would
be to endure and maintain resiliency
in our work situations. This has not
been the case in a vast majority of
the healthcare systems; industrialized
and wealthier economies were not
exempted.
Despite the daily exhausting and
frustrating situation, I am motivated
to find a way forward to improve and
modernize health care systems. As
a physician and manager, I diagnose
the organization; I seek dysfunctions
in the system, identify how we can
better organize and utilize resources,
and try to make changes by removing
obstacles or implementing better
solutions. One of the challenges of
traditional health care providers is
to phase out old systems that we
often cling to. Too often, we provide
advanced and high-tech medical
care in an old-fashioned way with
significant repetitive manual work.
With increasing demands on care,
this is not sustainable, and we must
not only aim to refine medical therapy
but rather be capable to provide care
at a sufficient scale. We often state
that we will not be able to provide
care in ‘this’ way in the future. With
the pandemic – the future is here, and
the crisis is deep. Never waste a crisis!
This is our opportunity to change. In
a situation with an extreme workload,
the solution is not to run faster, but
change the playing field and move to
another position while there is time.
I urge physicians around the globe
not to abandon the field, but take on
additional duties or new positions
like managerial roles and change the
way we provide health care services.
Be the physicians of the health care
system because it is ailing and needs
treatment. Just as we promote care of
the highest standard for our patients,
we need to aim for the best and most
efficient technical tools for providing
care.
Another critical motivator for me
is that health care is a fundamental
pillar of society. Our legacy as
physicians goes beyond the treatment
of individual patients. My work is
essential for my patient as well as
the society. Good public health is
essential for a developed and well-
functioning society, and it is highly
connected with the economy. There
are no social services without a
well-working economy, just as we
need well-working supply-chains to
provide high-quality and efficient
health care. Our knowledge is of
greater value if shared and utilized
as a resource to make a better society.
With this, we have the mandate and
responsibility to engage in public
discussions and manage our health
care systems.
As WMA president, what do you
consider to be your most important
leadership achievements over the
past months? Please share a few
challengesthatyouhaveexperienced
and how have you addressed them.
My presidency is an example of
adaptation to a changing world. The
plan was originally to start the work
to strengthen collaborations with
other global institutions. They alone
Interview With The WMA President
Heidi Stensmyren
Interview with the WMA President
BACK TO CONTENTS
17
have the mandate to form governing
structures for a more equitable
provision of health care, and the
pandemic has demonstrated the need
to collaborate. With the pandemic
still holding a firm grip on the world,
putting meetings and collaborations
on hold, I have spent much time at
the Karolinska University Hospital,
participating in countless online
conferences. My free time is spent
promoting vaccinations and the need
for the implementation of ethical,
governing touchstones in research.
Without trust in research, as well as
health care, the mandate amongst
people will be non-existent, thereby
preventing important public health
initiatives.
Another contribution is promoting
women’s initiatives around the globe.
I am very proud of all the work of
women,stepping up,taking on leading
positions. Women are significant
contributors to health care, but are
underrepresented in leading roles. As
the organization for physicians around
the world, WMA representation
needs to reflect the physicians of
today in order to stay relevant. WMA
needs leaders from all walks of life –
we need early-career trainees as well
as the mid-career physicians who
have families to support and loans
to pay off. It is challenging to take
on top positions in addition to full-
time clinical obligations. That said,
one of my most fervent wishes and
contributions is to be a role model
and an example of what is possible. If
I can do it – you can do it!
In addition to COVID-19 clinical
care and response efforts, what are
the three greatest challenges that
physicians currently face, and how
does the WMA plan to support their
activities?
There is no lack of challenges,
and physicians face different trials
depending on where they live and
work. But, there are some common
threads. The working conditions
and the need to transform them is a
real-time obstacle. Here, the WMA
promotes physicians’ autonomy as
well as physician-led institutions and
health care facilities. It is difficult to
transform health care without taking
on a leading role.
We need to see the physician’s role as
broader than the one-to-one care. In
many ways, the world at large does
not see physicians’ roles as limited as
much as we do ourselves. Our role
must be more encompassing; we
must embrace and promote health
technologies,medical technology,and
health care management. The WMA
expresses this sentiment in its basic
documents outlining the aim of the
medical profession.
The last challenge is making space
and opportunity for early-career
physicians. Physicians tend to work
hard and long,and the career pathway
is often seen as a continuing and
constant upward to stay in the lead
position. It is an obligation both
to prepare the next leader and to
leave space, to hand over the baton
to the next. We encourage early-
career physicians to become and
be the leaders we need; it is our
responsibility to see to that they can.
The Swedish Society of Surgeons
have a program called, “Pass the
knife,” ensuring early-career surgeons
receive the needed experience to
ensure the future and the best patient
outcomes. Breakthrough changes can
be made if we show confidence and
share influence and power. We need
to prevent “pulling up the ladder” and
instead prepare our successors for
managerial positions.
Which ongoing or new WMA
initiatives are top priorities for this
year?
The pandemic is not over and
therefore important issues such as
access to vaccines and the need for
more sustainable work conditions for
physicians are important topics for our
medical community. Violence against
health professionals is a growing
concern and must be combated.
We collaborate with other global
healthcare organizations to shine a
light on these critical issues. Much of
this work needs to be done at national
Interview With The WMA President
BACK TO CONTENTS
18
levels urging governing bodies to
protect their health professionals.
Health care professionals used to be
seen as neutral in conflicts, but are
increasingly becoming targets and
victims of war crimes. The war in
Ukraine is, of course, on top of the
WMA agenda. The WMA has set
up a fund and collected contributions,
and provided medical equipment to
Ukraine. We will continue to point
out the unacceptable situation of war
crimes and attacks on health facilities.
The WMA agenda is “agile,”
depending on the current world
situation. The Earth has become
more conflicted, and this reflects
our agenda. In every conflict, when
markets are dysfunctional and
unemployment rises – the vulnerable
suffer most. This is why there is a
need for stronger collaboration across
borders and between organizations,
for building more robust global
governing structures.
Which successful regio­
nal or
national initiatives have provided
clinical and public health support
and offered lessons for other
countries?
Since there are several initiatives in
many fields, it would be impossible
to list them all – so I will mention a
few. Countries with well-functioning
infrastructure and clear mandates,
suchastheNetherlandsandDenmark,
have been highly efficient in their
COVID-19 decision-making and
establishing easy access to vaccines
and mass vaccination efforts. Taiwan
has been able to scale production lines
and provide the country, as well as the
market,with essential equipment. The
United States, with its vast market,
highly capable medical companies,
and well-established research
departments (in combination with
massive financing), has pushed
through regulations and critical
components to bring vaccines to the
market at speed never before seen in
the history of the world. Although
the list is long, but what is crucial
to note is that none of us – country
or person – could have achieved
these successes alone! Isolation is
not a solution; the value of sharing
knowledge is the most important
lesson the world should take away
from this pandemic. The essence and
spirit of the ‘knowledge sharing’ is
stipulated in the WMA’s Declaration
of Geneva of the physician pledge:
“I will share my medical knowledge
for the benefit of the patient and the
advancement of healthcare.”
As WMA president, what do you
hope to accomplish over the next
few months, and how can WMA
membership help support these
efforts?
I hope to contribute to collaboration
and dialogue. The world has, in many
ways, connected more during the
pandemic years. Although we have
“fast-forwarded” the use of digital
meeting tools, many countries have
become even more isolated. In the
last few years, we have lost the benefit
of meeting in person and forging
friendships, bonds, and collaborations
that not only help solve the world’s
problems but also the essence of
what makes us human. These losses
are impossible to measure, but I like
to hope they would have prevented
some of the conflicts the world now
faces. I hope to help reignite this
togetherness,and invite the physicians
of the world to join us!
Heidi Stensmyren, MD, MBA
President
World Medical Association
Interview With The WMA President
BACK TO CONTENTS
19
Gender-based violence is a serious
violation of human rights and is a life-
threatening, health and protection
issue [1], which is rooted in gender
inequality, the abuse of power and
harmful traditional practices [2].The
United Nations describes gender-
based violence as a shadow pande­
mic, with underreported statistics,
acknow­
ledging that physical or
sexual violence is experienced by 1 in
3 women worldwide by an intimate
partner [2, 3]. As perpetrators are
usually individuals trusted by the
victims or the parents or guardians of
victims, it can complicate scenarios
where the extended family system is
practiced, such as in Nigeria.Women
can serve as accomplices, as they may
encourage their partners, brothers
or male relatives to abuse females
around them.
In Nigeria, the prevalence of gender-
based violence is unknown,including
the prevalence of gender-based
violence perpetrated on primary
school students [4]. The National
Population Commission of Nigeria
conducted the- Demographic and
Health Survey in 2018.In this survey,
a total of 41,821 women between
the ages of 15 to 49 years from 41.8
million households were interviewed.
The survey results revealed that
31% of women after they turned
15 years of age had experienced
physical violence [5]. Sexual violence
had been experienced by 15% of
women regardless of marital status.
The findings showed that 58% of
married women had been physically
abused by their husbands, 59% of
unmarried women by their mothers
or stepmothers, or lone women
where 28% of perpetrators were
strangers and 27% were current or
former boyfriends [5].
During the COVID-19 pandemic,
the number of cases of gender-based
violence increased worldwide due
to the implementation of curfews,
lockdowns and social distancing
restrictions to control disease trans­
mission [3,6]. As the victims of
gender-based violence were locked
in their homes with their abusers,
public campaigns were launched
against this “shadow pandemic” to
raise awareness of the rise in domestic
violence worldwide during the
pandemic [3]. Between the current
scenarios in Nigeria with the rise
of gender-based violence observed
during the COVID-19 pandemic,
a symposium on violence against
women and girls was organized to
bring advocates and human rights
activists together to combat this
challenge in Nigerian society.
Symposium on Gender-Based
Violence
A symposium on gender-based vio­
lence was held in Port Harcourt,
the capital of Rivers State, located
in Southern Nigeria, on Friday, 22
October 2021. Under the theme
“Prevention and Response to
Gender-based Violence in Rivers
State, Nigeria”, it was organized
by the Rivers State branch of the
Medical Women’s Association of
Nigeria, an association of female
dental and medical practitioners in
Nigeria. The symposium included
the keynote address “Gender-based
Violence Response in Nigeria,
Where We Are and Where We Need
to Go”, by the Nigerian Resident
representative of the United Nations
Population Fund (UNFPA). The
agenda also included a presentation
by the Chair of the Medical Women’s
International Association Special
Interest Group in Violence against
Women and Girls as well as two
panel sessions.
The panelists were representatives
of different professional associations
(Rivers State branch of the Medical
Women’s Association of Nigeria,
MWAN; National Association of
Nigerian Nurses and Midwives;
International Federation of Women
Lawyers, FIDA), non-governmental
Report on a Symposium on Violence against Women and Girls in Port Harcourt, Nigeria
Dabota Yvonne Buowari
Obelebra Adebiyi
Vetty Agala
BACK TO CONTENTS
Report on a Symposium on Violence against Women and Girls
in Port Harcourt, Nigeria
20
Report on a Symposium on Violence against Women and Girls in Port Harcourt, Nigeria
organizations (Mother of Good
Counsel; Rivers State Indigenous
Non-governmental Organizations
and Civil Societies), faith-based
organizations (Catholic Women
Organization; Catholic Police
Chaplaincy, Rivers State), and other
groups (Centre for Gender and
Development Studies University of
Port Harcourt, Nigeria; Medecins
Sans Frontieres) involved in
advocacy on violence against women
and girls. The first panel, “Gender-
based Violence – Problem Analysis
and Perspective”, and the second
panel, “Gender-based Violence,
Interventions, Innovations and
Next Steps”, raised important issues
from panelists who work to identify
challenges and possible solutions
to reduce gender-based violence in
local communities.
The panel moderators posed several
discussion topics. First, with the
increased prevalence of gender-
based violence during the pandemic,
panelists described risk factors
attributed to gender-based violence
against women and girls in Nigeria.
In addition to gender inequality and
abuse of power, they highlighted
the preference for the boy child,
social discrimination against women
and girls including women’s rights,
harmful cultural practices and
social norms, and acceptance of
gender-based violence as a social
norm. They said that often survivors
did not receive encouragement to
report domestic violence in efforts
to maintain family honor and that
women lack economic power and the
right of inheritance. For example,
they shared that in the typical
Nigerian society, boys are trained
to believe that they are stronger and
preferred, which results in feelings
of aggression and superiority over
the female gender. They noted that
women experience discrimination
regardless of their marital or social
status, and girls are made to believe
that they do not play an important
role in society except for domestic
chores.
Second, panelists highlighted the
impacts of gender-based violence
in the community and local efforts
to prevent its occurrence. Since
encounters can include early marriage
and harmful widowhood practices,
female genital mutilation, physical
and intimate partner violence, and
economic and psychological abuse,
measures require the collaborative
efforts of various stakeholders. They
recommended the development
of public education and awareness
campaigns about gender-based
violence and reproductive rights,
especially targeting rural areas.
Other described strategies included
leadership and peace building
efforts with civil rights and non-
governmental organizations, colla­
boration with traditional and
religious leaders, counselling
sessions for couples and survivors
including anger management, and
enhanced surveillance reporting
for legal documentation. Also,
electronic empowerment and skills
acquisition, education of the girl
child, legal protection of survivors
and persecution of perpetrators,
and the establishment of gender-
based violence clinics and shelters
were discussed as complementary
strategies. Finally, they encouraged
the training of first responders and
healthcare professionals, including
the formation of gender-based
violence response team of doctors,
legal practitioners, social workers,
psychologists, psychiatrists, and law
enforcement.
Third, panelists commented on the
role of the Nigerian law concerning
gender-based violence and efforts to
prevent it. They mentioned that the
Nigerian constitution protects the
rights of every human being living in
Nigeria,includingtherighttodignity,
right as a person,right to life,right to
the freedom of movement, and right
to inheritance. In 2015, Violence
against Persons (Prohibition) Act
was passed in Nigeria, which aims to
eliminate different types of violence
in the country [3]. It encompasses
compensation for gender-based
violence survivors and opening
the sex offender registry for public
viewing as well as provides penalties
for various offences related to
violence against persons. Although
this legislation exists, harmful
traditional practices still occur in
Rivers State, Nigeria.
Future Steps
Gender-based violence negatively
affects women’s physical, mental and
emotional health, ranging from risk
of contracting HIV/AIDS, feelings
of self-blame and depression, and
ultimately impairing dignity and
self-esteem [2]. Therefore, future
steps should include a four-pronged
approach: developing organizational
collaborations, enforcing appropriate
legislation, strengthening clinical
support, and supporting community
participation. Collaborations among
civil rights societies and community
organizations are necessary to
increase awareness and identify
synergies toward the elimination
of gender-based violence. Orga­
nizational members work directly
with communities, where they
can build rapport, conduct needs
assessments, and collectively develop
appropriate solutions.
Legislation related to gender-based
violence should be enforced and
offer protection for all citizens.
Also, coordinated efforts of health
professionals can bring heightened
awareness of continuing education
courses as well as support surveillance
systems for reporting including toll-
free hotlines for victims. Finally,
community engagement activities
BACK TO CONTENTS
21
can increase awareness among
citizens and reduce the stigma for
survivors. Future research on gender-
based violence in Nigeria should
explore the actual statistics about
it as well as examine achievable
preventable measures and strategies
against gender-based violence in the
country.
Conclusion
Gender-based violence is a global
problem, and it is predominant in
Nigerian communities. Abusive
and violent relationships can
negatively affect physical, mental,
and emotional health and well-being
of affected individuals. Hence, the
legal consequences and punishment
of perpetrators should be enforced
with all communities, protecting
vulnerable individuals from this
harmful behavior. Community
participation and enlightenment
on gender-based violence can
accompany legal enforcement and
highlight community intolerance.
Above all, educating the girl child
will empower her economically and
serve as a preventive measure against
gender-based violence in the future.
References
1. United Nations Refugee Agency,
Africa. Gender-based violence
[Internet]. UNHCR; 2021 [cited
2022 Apr 29]. Available from:
https://www.unhcr.org/en-us/
gender-based-violence.html
2. World Health Organization.
Violence against women [Internet].
WHO; 2021 [cited 2022 Apr 29].
Available from: https://www.who.
int/news-room/fact-sheets/detail/
violence-against-women/
3. United Nations Women.
The shadow pandemic: violence
against women during COVID-19
[Internet]. UN; n.d. [cited 2022
Apr 29]. Available from: https://eca.
unwomen.org/en/news/in-focus/in-
focus-gender-equality-in-covid-19-
response/violence-against-women-
during-covid-19
4. Ekine A. Gender-based violence in
primary schools, Nigeria [Internet].
Brookings; 2020 [cited 2022 Apr
29]. Available from: https://www.
brookings.edu/research/gender-
based-violence-in-primary-schools-
nigeria/
5. National Population Commission.
Nigeria demographic and health
survey 2018: key indicators report.
Abuja and Rockville: NPC
and ICF; 2019. Available from:
https://nationalpopulation.gov.ng/
ndhs-2018-key-finding/
6. Sri AS, Das P, Ganapragasam S,
Persuade A. COVID-19 and the
violence against women and girls:
‘the shadow pandemic’. Int J Soc
Psychiatry. 2021;67(8):971-3.
Dabota Yvonne Buowari, MBBS
Department of Accident
and Emergency,
University of Port Harcourt
Teaching Hospital,
Port Harcourt, Rivers State, Nigeria
Medical Women’s
Association of Nigeria
E-mail: dabotabuowari@yahoo.com
Obelebra Adebiyi, BDS, MPH
Rivers State Hospitals
Management Board,
Port Harcourt, Rivers State, Nigeria
Medical Women’s
Association of Nigeria
Vetty Agala, MBBS, MPH,
MWACP Public Health
Rivers State Ministry of Health,
Port Harcourt, Rivers State, Nigeria
Medical Women’s
Association of Nigeria
Report on a Symposium on Violence against Women and Girls in Port Harcourt, Nigeria
BACK TO CONTENTS
22
COVID-19, Behavioral, and
Social Norms
COVID-19 had a detrimental effect
on the livelihoods of many beyond
the clinical aspects,such as infection,
mortality, and hospitalisation rates.
The pandemic altered consumers’
product needs, shopping and
purchasing behaviours, and post-
purchase satisfaction levels [1,2].
One of the primary outcomes
of lockdown intervention due to
COVID-19 was the panic buying
phenomenon, which was evident
across the globe [3,4]. Studies found
that attitudes, subjective norms,
scarcity,time pressure,and perceived
competition positively influenced
customers’ panic buying intention
[5]. Opinions and beliefs drove
behaviour and attitude towards the
pandemic; negative and positive
opinions influenced behavioural
intention [6].
Consumer behaviour comes from
intentions that are influenced by
subjective attitudes and norms.
According to Ajzen [7], the
consumer’s behaviour is a function of
intention to perform the behaviour;
the intention is based on attitude,
subjective norm, and perceived
behavioural control concerning
the behaviour. Social norms and
behavioural intentions are difficult
to follow in a dynamic environment
shaped by shocks such as the
COVID-19 pandemic [6]. These
modified social behaviours affected
global economies, greatly benefiting
some sectors while adversely
impacting others (Table 1).
COVID-19 and Marketing Acti­
–
vities
The effect of marketing in
the health sector is not a new
pheno­
menon; previous studies have
illustrated healthcare marketing as
a discipline used in public health,
focusing mainly on educating and
recommending effective products
and interventions to customers
using a scientific approach [15,16].
The Centre for Disease Control
and Prevention (CDC) [17]
defines healthcare marketing as a
discipline in public healthcare that
involves developing, educating,
and conveying health news and
practices using client-based and
evidence-centered plans to protect
and improve well-being of various
societies.The pandemic has certainly
affected budget trends in marketing
activities, and the crisis showed
changes in consumer behaviour and
marketing spending by companies
during economic downturns caused
by lockdowns [18].
The CMO Spend Survey depicts
a decrease in marketing budgets,
nearly by half to 6.4% in 2021
The Effects of COVID-19 on Global Marketing Trends
The Effects of COVID-19 on Global Marketing Trends
Michael Mncedisi Willie
Sectors with notable beneficial impacts Sectors with adverse impacts
Telehealth and telemedicine Tourism
Online entertainment and streaming
(Netflix, HBO, Spotify)
Offline entertainment
(cinemas, social activities)
Tech companies (video-conferencing,
virtual project management)
Construction
Online delivery services
Hospitality and event coordination (con-
ferences)
Education (video games for children)
Transportation logistics (roads, railway, air
transportation)
Food retail (grocery stores) Food services (pubs, cafes, restaurants)
Fitness (smartphone apps for fitness) Media and recreation
Industries (automobile)
Table 1. Industries that experienced notable benef icial or adverse impacts as a result of the pandemic.
Source: [9-14]
BACK TO CONTENTS
Sipho Kabane
23
compared to the 11% budgeted for
marketing in 2020, thus indicating
that companies have become even
less aggressive in their marketing
strategies [19]. Companies opted
for new cost-effective marketing
techniques amid pressures on
marketing budgets [20]. Consumer
brands, financial services companies,
and healthcare seem to have been
less impacted compared to sectors
such as the media sector, travel,
hospitality, and tech products.
However, the CMO Survey report
indicates a positive posture on digital
experience during the pandemic;
more than 85% of companies
surveyed said that they observed
increased value placed on digital
experiences by their customers [19].
COVID-19 and Digital Marketing
The COVID-19 pandemic further
accelerated innovations in digital
media, with exponential increases
in investments of digital platforms
such as websites, Facebook, Twitter,
Instagram, LinkedIn, and YouTube
[21]. Enablers such as mobile
phone access observed a massive
rise in entities investing in mobile
applications to offer services to
clients and reach customers quicker
[22].Since the start of the pandemic,
research has demonstrated the
growing importance of social
media marketing, such as one
study conducted in North America
that found that social media
consumption (72%) and posting
(43%) increased [2,23]. Global
health systems adopted marketing
to reach their constituents, as many
governments employed digital
channels to report, communicate,
update, and educate citizens about
misinformation and myths about the
pandemic. Figure 2 depicts results
from the Binary Fountain [24],
which administered a survey with
304 healthcare mar­
keters in April
2020, where crisis communication
was the main category that changed
significantly during the COVID-19
pandemic. It also showed a notable
marginal increase in updating
online directories and search
engine optimisation as well as a
decline in website optimisation
from 21.6% to 15.8%, although this
latter finding contrasts with global
trends of increased website usage.
Abbas, Wang, Su and Ziapour [25]
found that social media had an
indispensable role as a medium of
providing the correct information
during the COVID-19 pandemic.
Conclusion
During the COVID-19 pandemic,
consumers modified their
beha­
viours as a result of national
inter­
ventions to reduce disease
trans-mission, such as lockdown
and social distancing measures.
Business sectors expanded their
operating model by opting for
Figure 1. Marketing budget as a percentage of total revenue (Health), 2020 vs. 2021.
Source: Adapted from Gartner (2021) [19]
Figure 2. The impact of the COVID-19 pandemic on healthcare marketing initiatives.
Source: Adapted from Binary Foundation [25]
The Effects of Covid-19 on Global Marketing Trends
BACK TO CONTENTS
24
The Effects of Covid-19 on Global Marketing Trends
innovative marketing platforms
to quickly deliver services and
products to consumers. Digital
information portals such as
Face­
book, Twitter, LinkedIn, and
YouTube experienced exponential
growth. Healthcare and tele­
medicine
sectors benefited from increased
virtual communications, whereas
recreation, travel, and hospitality
sectors were adversely affected.
Technology connected patients
to medical service providers,
ensuring access to telemedicine,
video conferencing, and medication
delivery. Although content
marketing and branding were
less prioritised, online product
purchases, crisis management,
communication, and information
sharing were widely accessed on
virtual portals.
Healthcare systems can further
optimise the infrastructure
established during the pandemic to
educate, communicate, and inform
the public about available medical
advancements. Countries learned
how collaboration, transparency,
and information sharing increased
health system preparedness. Key
lessons from the pandemic should
go beyond communicating reports
and crisis management to foster
collaboration and connect experts
and medical service providers across
the globe.
References
1. Ali Taha V, Pencarelli T,
Škerháková V, Fedorko R, Košíková
M. The use of social media and
its impact on shopping behavior
of Slovak and Italian consumers
during COVID-19 pandemic.
Sustainability. 2021;13:1710.
2. Mason AN, Narcum J, Mason
K. Social media marketing gains
importance after Covid-19. Cogent
Business & Management. 2021;8:1.
3. Ahmad AR, Murad HR. The
impact of social media on panic
during the COVID-19 pandemic
in Iraqi Kurdistan: Online
Questionnaire Study. J Med
Internet Res. 2020;22(5):e19556.
4. Chua G, Yuen KF, Wang X,
Wong YD. The determinants of
panic buying during COVID-19.
Int J Environ Res Public Health.
2021;18(6): 3247.
5. Alexa L, Apetrei A, Sapena J.
The COVID-19 lockdown effect
on the intention to purchase
sustainable brands. Sustainability.
2021;13(6):3241.
6. Singh G, Aiyub AS, Greig T,
Naidu S, Sewak A, Sharma S.
Exploring panic buying behaviour
during the COVID-19 pandemic:
a developing country perspective.
International Journal of Emerging
Markets. 2021.
7. Ajzen I. The theory of planned
behaviour: a bibliography [Internet].
2020 [cited 2022 Apr 29]. Available
at: https://people.umass.edu/aizen/
tpbrefs.html
8. Ziółkowska J. Finding oppor­
tunities in uncertain times. The
case study of a tourist guides
venture in the EU. Sustainability.
2021;13(23):12959.
9. De’ R, Pandey N, Pal A. Impact
of digital surge during Covid-19
pandemic: a viewpoint on research
and practice. Int J Inf Manage.
2020;55:102171.
10. Monaghesh E, Hajizadeh A. The
role of telehealth during COVID-19
outbreak: a systematic review based
on current evidence. BMC Public
Health. 2020;20(1):1193.
11. Sharma A, Nicolau JL. An
open market valuation of the effects
of COVID-19 on the travel and
tourism industry. Ann Tour Res.
2020;83:102990.
12. International Labour Organi­
sation. Sectoral impact, responses
and recommendations [Internet].
ILO; 2021 [cited 2022 Apr 29].
Available at: https://www.ilo.org/
global/topics/coronavirus/sectoral/
lang–en/index.htm
13. Aigbavboa CO, Aghimien DO,
Thwala WD, Ngozwana MN.
Unprepared industry meet pande­
mic: COVID-19 and the South
Africa construction industry.
Journal of Engineering, Design and
Technology. 2022;20(1):183-200.
14. Lee C-C, Chen M-P. The im­
pact of COVID-19 on the travel
and leisure industry returns. Some
international evidence. Tourism
Economics. 2022;28(2):2:451-72.
15. Habes M, Alghizzawi M, Ali
S, SalihAlnaser A, Salloum SA.
The relation among marketing
ads, via digital media and mitigate
(COVID-19) pandemic in Jordan.
International Journal of Advanced
Science and Technology. 2020;
29(7):12326-48.
16. Shreoshe S. Healthcare mar­
–
keting strategies in the time
of COVID-19. Referral MD;
2020 [cited 2022 Apr 29]. Available
from: https://getreferralmd.com/
2020/04/healthcare-marketing-
strategies-in-the-time-of-covid-19/
17. Centers for Disease Control
and Prevention. Gateway to health
communication. CDC; 2021
[cited 2022 Apr 29]. Available
from: https://www.cdc.gov/
healthcommunication/index.html/
BACK TO CONTENTS
25
18. Hoekstra JC, Leeflang PSH.
Marketing in the era of COVID-19.
Ital J Mark. 2020:249-60.
19. CMO Spend Survey. The state
of marketing budgets 2021: insights
from Gartner’s annual CMO spend
survey [Internet]. Gartner; 2021
[cited 2022 Apr 29]. Available
from: https://www.gartner.com/
en/marketing/insights/articles/all-
industries-saw-marketing-budgets-
cut-in-2021
20. Chaffey D. 2022 digital mar­
–
keting trends: 25 practical
recommendations to implement
[Internet]. Smart Insights; 2021
[cited 2022 Apr 29]. Available at:

Home

digital-marketing-strategy/digital-
marketing-trends-innovation/
21. Appel G. Grewal L, Hadi R,
Stephen AT. The future of social
media in marketing. J Acad Mark
Sci. 2020;48(1):79-95.
22. Dwivedi YK, Ismagilova E,
Hughes DL, Carlson J, Filieri R,
Jacobson J, et al. Setting the future of
digital and social media marketing
research: perspectives and research
propositions. International Journal
of Information Management.
2021:59:102168.
23. Wold S. COVID-19 is chan­
ging how, why and how much
we’re using social media [Internet].
Digital Commerce 360; 2020 [cited
2022 Apr 29]. Available from:
https://www.digitalcommerce360.
com/2020/09/16/covid-19-is-
changing-how-why-and-how-
much-were-using-social-media/
24. Binary Fountain. COVID-19
impact on healthcare marketing
initiatives [Internet]. 2020 [cited
2022 Apr 29]. Available from:
https://www.marketingcharts.com/
wp-content/uploads/2020/05/
Binar yFountain-COVID-19-
Impact-Healthcare-Marketing-
Initiatives-Jun2020.png
25. Abbas J, Wang D, Su Z, Ziapour
A. The role of social media in the
advent of COVID-19 pandemic:
crisis management, mental health
challenges and implications. Risk
Manag Healthc Policy. 2021;
14:1917-32.
Michael Mncedisi Willie,
MBA, MSc
General Manager,
Policy Research and Monitoring,
Council for Medical Schemes,
South Africa
Email:
m.willie@medicalschemes.co.za
Sipho Kabane MBCHB, MBA,
M. Phil (Economic Policy), PhD
Council for Medical Schemes,
South Africa
BACK TO CONTENTS
The Effects Of COVID-19 On Global Marketing Trends
26
For this interview, Dr. Thomas
Lindén, the Government Chief
Medical Off icer of Sweden, shares
his perspectives on the global burden
of rare diseases with
Dr. Helena Chapman,
the WMJ Editor in Chief
Please describe your training, cur­
rent position, and relationship to
the WMA.
My name is Thomas Lindén, and I
am the Government Chief Medical
Officer of Sweden. I am a neurologist
and psychiatrist and have worked
for many years with the Swedish
Medical Association and served
as an official advisor to the World
Medical Association in Medical
Ethics and Socio-Economic Affairs.
Now, I direct the department of
Knowledge-based Policy of Health
Care at our National Board of Health
and Welfare that issues guidelines
for medical practise, supports patient
safety and improvement of health
care, and regulates highly specialised
services at the national level.
What happened at the Ministerial
Conference on “Rare Diseases” in
February 2022?
In February 2022, the Ministerial
Conference: Care and Innovation
Pathways for an EU Policy on Rare
Diseases was held in Paris, France.
At this meeting, the Presidency Trio
of the Council of European Union
(France,Czech Republic and Sweden)
presented a call for the commitment
to an updated goals-based European
Strategy for rare diseases within the
Presidency Trio for 2023.
Diseases can be found on the
French Presidency of the Council
of the European Union webpage
(https://presidence-francaise.
consilium.europa.eu/en/news/press-
release-ministerial-conference-on-
innovation-and-care-pathways-for-
a-european-policy-on-rare-diseases/).
What are “rare diseases”?
A disease is defined as “rare” if it
affects less than 1 in 2,000 people,
although many rare diseases affect
only a handful of individuals. With
over 6,000 rare diseases,these illnesses
may be the result of genetic or nervous
disorders, and may be chronic or
even life-threatening. So even if
every single disease is rare, together
they affect a large population. In the
European Union alone, rare diseases
affect an estimated 30 million people.
What is the global burden of
adults and children living with rare
diseases, and why are rare diseases
considered a global priority?
Individuals diagnosed with a rare
disease can feel overwhelmed and
experience changes in various aspects
of their lives. This diagnosis can
affect your health care and insurance
coverage as well as your social
behaviours related to social care,
educational plans, and workplace
issues. The only variation across
countries may be variations in cultural
perceptions and financial resources.
What are the current challenges
that health systems face in medical
management and financing for
persons living with rare diseases?
How has the COVID-19 pandemic
impacted the health system
management of rare diseases?
If we take a more strategic view on
specific differences between countries
and regions, we will see that there is
a more “medical-oriented” approach
in the Western world. This is due
to the fact that historically the rare
disease movement united and became
empowered to push the adoption
of the US Orphan Drug Act and
the European Union’s regulation on
orphan medicinal products.
Which successful national ini­
tiatives have provided clinical and
public health support for persons
living with rare diseases? What
lessons can other countries learn
from these initiatives?
Notably, Sweden supported the
development of Agrenska, a national
knowledge centre, led by chairman
Anders Olauson. His team designed
this centre to provide knowledge
support for health care, social
interactions for patients and families
living with similar diseases and their
families, and provisions for research.
In the Scandinavian countries,leaders
have pushed for a long-standing
strategy that incorporates medical and
social aspects as well as the workplace
perspective of persons living with rare
diseases.This trend has now expanded
to other geographic regions, as
demonstrated by the adoption of a
UNGA Resolution for people living
with a rare disease and their families.
[The resolution says, “Recognizing
also that persons living with a rare
disease and their families constitute a
Interview on the Burden of Rare Diseases with Swedish Neurologist and Psychiatrist
Thomas Lindén
Interview on the Burden of Rare Diseases with Swedish
Neurologist and Psychiatrist
BACK TO CONTENTS
27
psychologically,socially,culturally and
economically vulnerable population
throughout their life course, facing
specific challenges in several areas,
including but not limited to health,
education, employment and leisure”.]
Where does the research and/or
practice gap lie in streamlining
medical care and financing for
global populations living with rare
diseases?
In December 2021, the African
Summit on Rare Diseases 2021 was
held in Accra, Ghana. At that event,
all geographic regions of Africa were
represented by patients’organisations,
governments, and scientific experts.
Event highlights showed that medical
diagnostics and care, health system
preparedness and culture, and policies
did not prioritize rare diseases.
Many junior doctors, however, were
enthusiastic to enter the field of rare
diseases. On the other hand, Latin
America depicted a great dynamic of
patients’organisations and a positively
evolving landscape in terms of access
to care. However, there was a trend
towards health “judicialization” –
and noting challenges with equity –
where persons may have to go to trial
to receive approval of reimbursed
prescribed drugs by local insurance
companies.
It is particularly difficult to analyze
Asia as a continent, especially since it
is extremely diverse in terms of size,
ability to pay for health care services,
and general healthcare systems
landscape. For example, Japan has a
good health care system, with robust
data and registries that represent a
necessary starting point for addressing
rare diseases.
Also, Scandinavia showed best
practice in terms of holistic care,
and Europe has a well-developed
approach with national plans and a
European Reference Network. In
summary,there is no ideal situation in
any country, and we must collectively
contribute to this call to action to
improve care for persons living with
rare diseases.
How has the COVID-19 pande­
mic impacted health system
management of rare diseases?
The Rare Disease International (RDI)
has conducted studies that show
that the rare diseases community
has shared experiences across the
world: Centres for rare diseases
have been commissioned for the
COVID-19 response. Appointments
for rehabilitation therapies, such
as speech and physical therapies,
have been postponed or cancelled.
Caregivers had to stop working or
significantly reduce their working
hours since the pandemic started.
Globally, the rare diseases community
and patient organisations have
responded in different ways. These
efforts include developing surveys
to identify the impacts of the
COVID-19 pandemic and releasing
public statements to raise awareness
on rarer diseases. Notably, they have
assisted patients to continue to
access treatment and care, such as the
creation of Special Emergency Funds,
and help local, national, and regional
authorities develop a response to the
crisis that considers the specific needs
of persons and families living with
rare diseases.
What are specific calls to action
where WMA membership can raise
awareness of rare diseases over the
next five years?
Together, as physicians of the world,
we have a strong voice. Patients with
rare diseases represent a group that
is easily forgotten and put aside by
more vocal and acutely ill groups.
The number of different diagnoses
makes pharmaceutical development
especially challenging, which should
be tackled collectively by many
nations. We also need to add social
services and an inclusive society as
we raise attention to the treatment
of rare diseases. For WMA members,
it is important to emphasize that
regular communications to health
professionals and decision-makers
would offer additional support for
these patients.
Thomas Lindén, MD, PhD, MSc
Government Chief Medical
Officer, Sweden
E-mail:
thomas.linden@socialstyrelsen.se
BACK TO CONTENTS
Interview on the Burden of Rare Diseases with Swedish Neurologist and Psychiatrist
28
It has been fifteen months since
Myanmar’s military coup. On the
eve of February 1, 2021, Myanmar
military ousted the democratically
elected Myanmar government,
its ministers and member of the
parliament after the National League
for Democracy (NLD) gained
reelection by a landslide. Before the
coup, Myanmar had been in the early
phase of democratic development,
led by State Counsellor Aung
San Suu Kyi, following decades
of harsh military rule. Since then,
tens of thousands of physicians and
medical professionals have walked
away from military-run hospitals
and institutions to join countrywide
Civil Disobedience Movement
(CDM) against the military junta
[1]. It is considered that 80-100%
of healthcare professionals in each
region in Myanmar have opted to
engage with CDM, which led to
the biggest doctors’ protest in world
history [2].
Prior to the initiation of CDM,
doctors and healthcare professionals
continued to serve hospitals and
the general public, informing
patients about their engagement
with CDM. With the aid of local
and international donors, CDM
physicians established mobile clinics,
free charitable clinics, and hospitals
to ensure patient care and give free
treatment in private hospitals [3].
They continued to deliver patient
care in compliance with the Geneva
Declaration and the physician’s
pledge [4]. Some drugs, oxygen
concentrators, and medical devices
were transported to Myanmar ethnic
areas by Myanmar diasporas to
assist Myanmar doctors in providing
patients with the highest possible
medical standards [3].
However, the peaceful campaign
did not last long since the army
declared physicians to be enemies
of the military and began assaulting,
detaining, and murdering medical
personnel. It is because doctors were
the first to initiate CDM and if they
arrested doctors, there would be no
one to take care of protestors and
they would control the country easily.
Furthermore, Myanmar physicians
had their passports confiscated, they
were deprived of citizenship, and
their doctor licenses were revoked [5].
Private clinics, medical personnel,
and ambulances were targeted by
the military for no apparent reason.
The World Medical Association
(WMA), in the statement issued
in the third week of February 2022
[6], criticized the detention and
harassment of physicians by the
Myanmar army and security forces
while treating patients in Myanmar.
Since doctors continue to practice
in secret, providing lifelines to
communities that are rejected by
the military run healthcare facilities
and have no access to medical
treatment, their freedom and their
lives are jeopardized [7]. Myanmar
has been affected by the pandemic
third wave, where even the severely
ill COVID-19 patients were denied
admission in army hospital. Even
an ambulance transporting a
COVID-19 patient was shot at and
barred from hospital [2].Doctors and
other health professionals were jailed
and tortured, but they continued
to care for COVID-19 patients
in secret [1]. The military invaded
oxygen cylinder management
faci­
lities, hospitals, demolished the
COVID-19 treatment facility, and
detained physicians and other health
care professionals [8].
The WMA and its members are
very disturbed by the terrorization,
arrest, kidnapping, and murder of
health care personnel for treating
patients in Myanmar. During the
WMA Council Meeting in April
2021, the WMA released a strong
expression of solidarity for the
people and health professionals in
Myanmar [9]. Myanmar’s military
ignored these declarations, believing
that they could not be interfered
with taking action and shooting
and murdering Myanmar citizens
and medical personnel. Myanmar
medics, however, continue to care for
citizens, including those who have
been hurt by the military. Although
the injured need blood transfusion,
junta troops arrest and imprison
young people attempting to donate
blood, resulting in fewer blood
donations [10].
Since some international
orga­
nizations, like the United
Nations, do not have power to
intervene, incidents of violence
against physicians continue. If the
Myanmar military cannot find the
doctor, they abduct the doctor’s
family members and force them to
surrender. Some physicians have
given up the comfort of city life and
the country’s oppressive junta to
arm themselves and care for patients
in the country’s dense jungle [11].
Representatives of National Medical
Fifteen Months After the Military Coup: Myanmar Doctors Are in Secret Health Service
Wunna Tun
Fifteen Months after the Military Coup: Myanmar Doctors are
in the Secret Health Service
BACK TO CONTENTS
29
Associations (NMA) from across the
world attended the WMA Virtual
Annual Meeting in October 2021
and endorsed the WMA Policy
Statement to support physicians in
Myanmar [12].
More concerning issues include arrest
warrants of medical professionals
delivering medical care, ambulances
being wrecked, and medical facilities
seized [13].The military is scrambling
to apprehend COVID-19 patients as
well as doctors and nurses caring for
COVID-19 patients [14]. Myanmar
citizens were slain and burnt, as was
health personnel who assisted in safe
transfer of children and women [15].
In October 2021, the Myanmar army
conducted air attacks on Myanmar
villagesandtowns,includinghospitals
and clinics, irrespective of the WMA
statement. According to reports, the
military regime increasingly utilized
chemical weapons in airstrikes,
targeting innocent civilians, using
Myanmar military planes to drop
bombs on hospitals and people on
a consistent schedule [16,17]. The
army has interrupted humanitarian
and drug deliveries and it has
detained people who are found to
possess medical drugs [18]. Tens
of thousands of Myanmar doctors
and medical personnel have been
injured, imprisoned, humiliated, and
massacred during the 15-month
military takeover, and their
families have been kidnapped and
slaughtered.
The world community is powerless
to safeguard Myanmar and has
taken no action to address these
hallmarks of military war crimes
against Myanmar’s physicians and
humanity.Armed troops and security
forces responsible for the deaths and
torture of Myanmar physicians have
not been brought to justice. During
Myanmar military air attacks,
physicians secretly treat patients
evacuating them from hospitals.
To date, the WMA and international
statements have not halted the
military war crimes. I am writing
to urge the WMA, NMAs,
international organizations, and the
United Nations agencies to directly
support local doctors by providing
medical equipment and drugs for
Myanmar, imposing a flight ban in
Myanmar, and bringing Myanmar’s
military and security forces to the
International Criminal Court for
their crime against humanity.
References
1. Radio Free Asia. 2022. Junta-
Run public hospitals rejecting
even Myanmar’s sickest CO­
VID-19 patients [Internet].
RFA; 2022 [cited 2022 Apr 27].
Available from: https://www.
rfa.org/english/news/myanmar/
hospitals-07292021170330.html
2. Tatum M. Threats, torture, and
telemedicine: Myanmar’s health
workers need help [Internet].
Devex; 2022 [cited 2022 Apr 27].
Available from: https://www.devex.
com/news/threats-torture-and-
telemedicinemyanmar-s-health-
workers-needhelp-102803/
3. Camp K. Conditions worsen
in Myanmar one year after coup
[Internet]. Baptist Standard; 2022
[cited 2022 April 27]. Available from:

Home

news/world/conditions-worsen-in-
myanmar-one-year-after-coup/
4. Parsa-Parsi RW. The revised
Declaration of Geneva: a modern-
day physician’s pledge. JAMA.
2017;318(20):1971-2.
5. Nachemson A. ‘Using citi­
zenship
as a weapon’ Myanmar military
targets critics [Internet]. Aljazeera;
2022 [cited 2022 Apr 27]. Available
from: https://www.aljazeera.com/
news/2022/4/20/citizenship-as-a-
weapon-myanmar-military-targets-
critics
6. World Medical Association. Ha­
rassment and arrest of doctors in
Myanmar condemned by physician
leaders [Internet]. WMA; 2022
[cited 2022 Apr 27]. Available from:
https://www.wma.net/news-post/
harassment-and-arrest-of-doctors-
in-myanmar-condemned-by-
physician-leaders/
7. Poulter D, Crisp L. The dete­
riorating humanitarian crisis
in Myanmar calls for urgent
international action [Internet].
Politics Home; 2022 [cited 2022 Apr
27]. Available from: https://www.
politicshome.com/thehouse/article/
the-deteriorating-humanitarian-
crisis-in-myanmar-calls-for-urgent-
action
8. Covid-19 super-spreader risk for­
ces world to work with Myanmar’s
regime [Internet]. The Straits Times;
2022 [cited 2022 Apr 27]. Available
from: https://www.straitstimes.
com/asia/se-asia/covid-19-super-
spreader-risk-forces-world-to-
work-with-myanmars-regime/
9. World Medical Association.
Health personnel in Myanmar must
be protected says WMA [Internet].
WMA; 2022 [cited 2022 Apr 27].
Available from: https://www.wma.
net/news-post/health-personnel-in-
myanmar-must-be-protected-says-
wma/
10. The junta’s war on humanitarian
groups is bleeding Myanmar dry
[Internet]. Frontier Myanmar;
2022 [cited 2022 Apr 27]. Available
from: https://www.frontiermyanmar.
n e t / e n / t h e – j u n t a s – w a r – o n –
humanitarian-groups-is-bleeding-
myanmar-dry/
BACK TO CONTENTS
Fifteen Months After the Military Coup: Myanmar Doctors Are in Secret Health Service
30
11. Wallen B, Zoramsanga I.
From trainee doctor to guerrilla
warrior: How Myanmar’s youth are
preparing for civil war [Internet].
The Telegraph; 2022 [cited 2022
Apr 27]. Available from: https://
www.telegraph.co.uk/wor ld-
news/2021/08/13/trainee-doctor-
guerrilla-warrior-myanmars-youth-
preparing-civil/
12. World Medical Association.
WMA General Assembly
[Internet]. WMA; 2022 [cited
2022 Apr 27]. Available from:
https://www.wma.net/news-post/
wma-general-assembly-7/
13. Violence against or obstruction
of health care in Myanmar (23
February- 08 March 2022)
[Internet]. OCHA Reliefweb;
2022 [cited 2022 Apr 27]. Available
from: https://reliefweb.int/report/
myanmar/violence-against-or-
obstruction-health-care-myanmar-
23-february-08-march-2022/
14. Reuters. Myanmar troops arrest
18 medics for treating members
of anti-junta groups [Internet].
CNN; 2022 [cited 2022 Apr 27].
Available from: https://www.cnn.
com/2021/11/24/asia/myanmar-
arrest-medics-intl-hnk/index.html
15. Robbins S. Myanmar: The
Christmas eve massacre with ‘all the
hallmarks of a war crime’ [Internet].
Sky News; 2022 [cited 2022 Apr
27]. Available from: https://news.
sky.com/stor y/myanmar-the-
christmas-eve-massacre-which-
has-all-the-hallmarks-of-a-war-
crime-12542890/
16. Mon NA, Quadrini M.
There’s a crisis unfolding in south­
eastern Myanmar [Internet].The
Diplomat; 2022 [cited 2022 Apr
27]. Available from: https://
thediplomat.com/2022/04/theres-
a-crisis-unfolding-in-southeastern-
myanmar/
17. Elmore B. Myanmar deserves
our support too [Internet].
The Geopolitics; 2022 [cited
2022 Apr 27]. Available from:
h t t p s : / / t h e g e o p o l i t i c s . c o m /
myanmar-deserves-our-support-too/
18. Treating Covid patients in
secret Myanmar clinics [Internet].
France 24; 2022 [cited 2022 Apr
27]. Available from: https://
w w w. f r a n c e 2 4 . c o m / e n / l i v e –
news/20211227-treating-covid-
patients-in-secret-myanmar-clinics/
Wunna Tun, MBBS, MD
Fellow in Medical Education
JDN Secretary
E-mail: onlinewunna@gmail.com,
secretary.jdn@wma.net
BACK TO CONTENTS
Fifteen Months After the Military Coup: Myanmar Doctors Are in Secret Health Service
31
The coronavirus disease 2019
(COVID-19) pandemic has brought
about sudden and unexpected
hardships with ensuing emotional
difficulties for many individuals.
Besides economic challenges,
psychological sequelae are expected
as a result of recovery from infection
coupled with concomitants of
enforced lockdowns and quarantine
measures. Increasing reports of
‘long COVID’ have been emerging,
wherein ‘brain fog’ affecting
concentration and memory stands
out as a predominant symptom.
Studies have found that COVID-19
patients have suffered more
mobility problems, pain, anxiety
and depression, and one particular
study from China showed that many
patients will not fully recover within
a year of COVID-19 infection in
addition to mental health symptoms
being a significant burden. Another
review found that despite the
longterm effects from direct
COVID-19 infection, associated
with no or mild symptoms, increased
the prevalence of anxiety, depression,
post-traumatic stress disorder
(PTSD), and sleep disturbances were
evident when compared to levels
within the general population [1].
This could well appear to be another
‘pandemic’ of mental health issues
running parallel to COVID-19,
poised to outlive COVID-19’s
physical medical issues, and will be
felt for years to come.
The resilience of healthcare
pro­
fessionals in Malaysia had
been tested to the limit during
this pandemic. The world has been
privy to observed photos, videos
and audio recordings of doctors and
other healthcare professionals on the
frontlines feeling stressed, burnt-out,
and anxious.Healthcare professionals
and doctors in general are already at
higher risk of mental health issues,
which is often under-recognised.
Personal mental health issues are not
prioritised, especially in developing
countries like Malaysia, where it is
still wrought with taboo and stigma.
Hence, the question is what degree
of mental health support should be
offered while we strive to continue
practicing in one of the most stressful
jobs in the world?
Doctors are often ‘masters of
disguise’, and they may adopt a
façade of happiness on the outside,
but suffer silently on the inside.They
can develop work-related trauma,
especially in emergency medicine
and surgical specialties. Even when
there is no medical error, doctors
may never forgive themselves for
losing a patient. In fact, suicide
can sometimes be the ultimate
self-punishment for the perfectionist
medical practitioner. These personal
hardships include long hours at
work, immersion in patients’ pains
and issues, relationship setbacks
including divorce and custody
battles, and family challenges like
disabled children and deaths.Patients
expressing their frustrations as a way
of ventilating can be mirrored in our
own lives. Nonetheless, doctors still
see a need to portray a strong front
for our patients, a deception that we
sometimes erroneously perceive as
reality itself.
In a review of 21 studies, the rate of
depression among doctors varied,
with the prevalence ranging from
14% to 60%, which was comparable
to rates of the general population
[2]. Males, however, seem to be at
higher risk, when compared to the
general population, despite women
outnumbering men in the profession.
Anxiety among doctors appears to be
higher than in the general population,
with prevalence estimates of between
18% and 55% [3]. Self-medication
and the rate of drug use were similar
among doctors, and the general
population. Prescription drugs such
as benzodiazepines were used more
frequently by doctors as compared
to illicit street drugs. A review of 14
publications also showed that levels
of alcohol consumption in doctors
were similar to consumption levels
in the general population [3].
Global healthcare providers working
to fight the COVID-19 outbreak
may be more susceptible to develop
mental health symptoms. From our
experience, contributing factors
here include fear of contracting the
disease, unavailability of personal
protective equipment and medical
supplies, long working hours,
increased patient load, lack of
Mental Health Issues within the Healthcare System during the COVID-19 Pandemic
Mental Health Issues within the Healthcare System during the
COVID-19 Pandemic – Global and Malaysian Viewpoints
Philip Parikial George
Prem Kumar Chandrasekaran
BACK TO CONTENTS
32
effective COVID-19 medication,
death of their colleagues after
exposure to COVID-19, enforced
social distancing, and isolation
from their family and friends.
Furthermore, the hopeless situation
of some patients may take a toll on
their mental resilience. The working
efficiency of healthcare professionals
gradually decreased as the pandemic
prevailed. One Chinese study
found that among 1,257 healthcare
professionals working with
COVID-19 patients, 50.4% reported
symptoms of depression, 44.6% had
symptoms of anxiety, 34% suffered
from insomnia, and 71.5% reported
feeling generally distressed [4].
A survey using Zung’s Self-rating
Anxiety questionnaire, which was
conducted among 983 Malaysian
university students during the
COVID-19 pandemic and
lockdown, highlighted that 20.4%,
6.6%, and 2.8% of respondents
experienced minimal to moderate,
marked to severe, and most extreme
levels of anxiety, respectively [5]. A
recent unpublished survey conducted
among healthcare students in a
private Malaysian university during
the pandemic revealed that 33.9%
experienced moderate to extremely
severe depression symptoms, 30.5%
were with anxiety symptoms, and
19.5% with those of stress; a total
of 31.3% of students reported poor
satisfaction with life, and 29.7%
expressed poor resilience [6]. Aside
from the COVID-19 risk, students
experienced other challenges from
online learning, such as internet
connectivity, network signal and
internet speed, absence of real-time
sharing of ideas and information,and
limited in-person social interactions
with peers.
Another survey employing the
Psychological General Well-being
Index (PGWBI) questionnaire
with 217 healthcare professionals
during the pandemic in late 2020
found 54.8% reporting moderate to
severe distress [7]. In our opinion,
the most common mental disorder
due to COVID-19 was likely an
adjustment disorder, a self-limiting
syndrome that typically occurs in
response to a stressful event, but
which may still cause distress and
dysfunction in daily life. Generalised
Anxiety Disorder predictably
may be the next most common
psychiatric disorder [8], followed by
depression, insomnia and PTSD, as
healthcare professionals recovered
from serious COVID-19 infections.
Common psychiatric disorders
(mood and anxiety disorders)
showed a weaker relationship with
the markers of COVID-19 severity
in terms of incidence as compared
to neurological disorders, suggesting
that they were more related to being
diagnosed COVID-19 than the
direct manifestations of the illness
[9]. This should prompt us to look
into stigma as another entity that
needs to be addressed, as a result of
long-term physical or mental health
concerns from COVID-19 infection,
vaccine hesitancy, and economic
hardship.
There are many challenges when
providing a much-needed mental
healthcare service structured towards
healthcare professionals, including
doctors. The limited resources,
both human- and service-related,
and coupled with the stigma and
discrimination towards mental
health disorders, prohibit access to
proper mental health care. It may be
wise to begin educating, locally and
internationally, on this topic with
emphasis on early career training.
Medical students’ curriculum
should contain a mandatory ‘must-
pass’ module on maintaining
good mental health and building
resilience. Practicing doctors should
be offered continuing medical
education programmes that focus on
strengthening mental health skills
and resilience. We could further
consider convincing the relevant
medical associations to provide
free and confidential counselling,
or enticing voluntary organisations
to provide better accessibility to
confidential medical assistance for
doctors. This is available in Australia
throughtheDoctors’HealthAdvisory
Service that consists of a confidential
phone help-line offering personal
advice to medical practitioners and
students facing difficulties. Finally,
considering this pandemic has
caused a change in travel behaviour,
and with borders now re-opening to
international travel, the adoption of
risk assessment strategies should be
undertaken to calculate the risk score
for individual countries that rely on
the medical tourism industry so as to
minimise virus transmissibility [10].
In summary, healthcare providers
are more susceptible to developing
mental health issues and, in light of
the move into our current endemic
phase, we conclude by calling for a
more structured approach towards
detecting and addressing stress
and other mental health-related
problems across the globe, including
low- and middle-income nations like
Malaysia. These endeavours should
targetstrategiesinresilience-building
early on in professional healthcare
careers, whilst taking into cognisance
stigma being a major deterrent
towards help-seeking behaviour,
given the cultural obstacles within
our region. Prioritising these issues
will equip healthcare professionals
to be better protected to deal with
challenges in the mental health
landscape between the public and
private medical sectors in Malaysia
and globally. Lastly, ensuring safe
global travel will instill confidence
for those medical personnel involved
in medical tourism to adapt to
changes in the ‘new norm’.
Mental Health Issues within the Healthcare System during the COVID-19 Pandemic
BACK TO CONTENTS
33
References
1. Bourmistrova NW, Solomon T,
Braude P, Strawbridge R, Carter B.
Long-term effects of COVID-19 on
mental health: a systematic review. J
Affect Disord. 2022;299:118-25.
2. Bailey E, Robinson J, McGorry
P. Depression and suicide among
medical practitioners in Australia.
Intern Med J. 2018;48(3):254-8.
3. Johns G, Samuel V, Freemantle
L, Lewis J, Waddington L. The
global prevalence of depression and
anxiety among doctors during the
COVID-19 pandemic: systematic
review and meta-analysis. J Affect
Disord. 2022;298(Pt A):431-41.
4. Huang Y, Zhao N. Generalised
anxiety disorder, depressive
symptoms and sleep quality during
COVID-19 outbreak in China: a
web-based cross-sectional survey.
Psychiatry Res. 2020;288:112954.
5. Sundarasen S, Chinna K,
Kamaludin K, Nurunnabi M,
Baloch GM, Khoshaim HB, et al.
Psychological impact of COVID-19
and lockdown among university
students in Malaysia: implications
and policy recommendations. Int
J Environ Res Public Health;
2020;27;17(17):6206.
6. Ching XW, Lee WJ, Tan ZT,
Nasir H, Nadzri MSM, George PP.
Mental health evaluation of students
in a private university in Malaysia
during the pandemic. Unpublished.
7. Islam M, George P, Sankaran
S, Su Hui J, Kit T. Impact of
COVID-19 on the mental health
of healthcare workers in different
regions of the world. BJPsych Open.
2021;7(S1):S258-9.
8. Taquet M, Geddes JR, Husain M,
Luciano S, Harrison PJ. 6-month
neurological and psychiatric
outcomes in 236,379 survivors of
COVID-19: a retrospective cohort
study using electronic health records.
Lancet Psychiatry. 2021;8(5):416-
27.10. Omar K, Raja DB, Taib
NAA, Rajaram N, Ahmed J, et al.
Risk stratification and assessment
framework for international travel
and border measures amidst the
COVID-19 pandemic – a Malaysian
perspective. Travel Med Infect Dis
2022 Mar; 47:102318.
9. Lai J, Ma S, Wang Y, Cai Z, Hu
J, Wei N, et al. Factors associated
with mental health outcomes among
health care workers exposed to
coronavirus disease 2019. JAMA
Netw Open. 2020;3(3):e203976.
10. Omar K, Baha Raja D, Abdul
Taib NA, Rajaram N, Ahmed J,
Arvinder-Singh HS, et al. Risk
stratification and assessment
framework for international travel
and border measures amidst the
COVID-19 pandemic – a Malaysian
perspective. Travel Med Infect Dis.
2022;47:102318.
Philip Parikial George,
MBBS, MMed (Psych)
Professor and Head of Department
of Psychiatry, International
Medical University,
Seremban, Malaysia
E-mail: philip_george@imu.edu.my
Prem Kumar Chandrasekaran,
MBBS, M. Psych.Med
Assocciate Professor and Head
of Neurobehavioural Services,
Penang Adventist Hospital,
George Town, Malaysia
Mental Health Issues within the Healthcare System during the COVID-19 Pandemic
BACK TO CONTENTS
34
The War in Ukraine, Syria,
Afghanistan, the military coup in
Myanmar, and other internal conflicts
stressed the ethical dilemmas faced
by physicians around the world [1-
4]. These conflict environments
require difficult decisions and pose
severe work safety, mental health,
and everyday practice challenges for
both junior and senior physicians.
The World Medical Association
(WMA) has helped and guided
physicians to maintain the highest
possible standards of ethical behavior
and work towards the achievement of
the highest international standards in
medical ethics, and health care for all
people in the world [5].
The Junior Doctors Network (JDN)
actively works to amplify the work
of the WMA, whilst continuing
to be a WMA platform for junior
doctors [6]. The JDN acknowledges
that junior doctors are also affected
by conflict environments and that
there is a need to highlight medical
ethics so that they are better equipped
to face the complex scenarios
requiring difficult decisions in such
environments. In this light, the JDN
Medical Ethics working group hosted
a panel discussion on Medical Ethics
in War at the JDN Spring Hybrid
Meeting during the WMA Council
Session in Paris on April 6, 2022.The
panel discussion was chaired by Dr.
Lwando Maki (JDN Deputy Chair
and Medical Ethics Working Group
Co-chair) and moderated by Dr.
Wunna Tun (JDN Secretary) and
Dr. Shiv Joshi (JDN Medical
Ethics Officer and Medical Ethics
Working Group Co-chair).The panel
discussion was held at the offices of
the French Medical Council. The
session was well attended by junior
doctors from all WMA regions and
representative partner organizations
of the JDN.
The first keynote presentation was
delivered by Dr. Cecil Wilson, past
president of the WMA and American
Medical Association (AMA). On
behalf of the WMA, Dr . Wilson
has worked with the Defense
Health Board on the subject of war,
military, and medical ethics. Under
the leadership of Dr. Wilson, the US
Department of Defense developed
a range of options in their response
efforts. In his address entitled, “Dual
Loyalty. Military Medicine”, he said
that the core ethics of the medical
profession were under threat in
countries in situations of war, armed
conflict, and civil unrest. There
is a clinical role conflict between
professional duties to patients and
obligations, expressed or implied
and real or perceived, to the interest
of a third party such as an employer,
an insurer or the military, which can
violate patients’ rights. He described
various ethical guidelines set by
the WMA such as the Declaration
of Geneva or Physician’s Pledge,
International Code of Medical
Ethics, Statement on the Protection
and Integrity of Medical Personnel
in Armed Conflicts and Other
Situations of Violence, Regulations
in Times of Armed Conflict and
Other Situations of Violence and
Other Situations of Violence, and
Declaration ofTokyo – Guidelines for
Physicians Concerning Torture and
other Cruel, Inhuman or Degrading
Treatment or Punishment in Relation
to Detention and Imprisonment [7-
11]. He spoke about how military
professionals most appropriately
balance their obligations to their
patients with their military duties.
Some recommendations during the
time of war and conflict included
promoting knowledge of medical
ethics and an ethical culture among
military health care professionals and
ensuring that military health care
professionals’ first ethical obligation
is to patients. He suggested providing
military treatment facilities with
access to high-quality ethical services
and concluded that creating an
environment that supports ethical
conduct and minimizes conflicts of
dual loyalty is important in military
Report of WMA JDN Thematic Session on Warfare Ethics
Report of WMA JDN Thematic Session on Warfare Ethics
Lwando Maki
Wunna Tun
Shiv Joshi
BACK TO CONTENTS
35
medicine.
Next, Dr. Jacques de Haller, WMA
Associate Member and Immediate
Past President of Standing
Committee of European Doctors,
presented the WMA revised policy
draft on the proposed revision
of the WMA Statement on the
Protection and Integrity of Medical
Personnel in Armed Conflicts and
Other Situations of Violence and
comments (SMAC 220/Protection
of Healthcare Personnel COM
REV/Apr2022) [9]. Dr. de Haller
highlighted that the policy replaced
the two previous WMA policies – the
one that deals with the protection of
healthcare workers and that of the
ethical principles of their protection
that are the same in both conflict
and non-conflict environments. He
emphasizedthesignificanceof WMA
policies such as the one that described
the protection of physicians and
other members of the physician-led
multidisciplinary team. He proceeded
with underlining the importance of
thepolicyincorporationintheexisting
international agreements, as globally
relevant to all healthcare personnel,
and offered key recommendations for
governments, non-state governments,
non-state actors, and NMAs. He
shared two policy recommendations:
1) governments, non-state govern­
ments, and non-state actors must
support and strictly respect the ethical
rules of the medical profession;
and 2) physicians should educate
governments about the consequences
of war.
The third speaker was Dr. Jean-
Francois Cerfon, President Conseil
départemental du Haut-Rhin de
l’Ordre des Médecins, who spoke on
war and disaster medicine.Dr.Cerfon
stated that war and disaster medicine
is a speciality that is not practiced daily
at the global level,although specialists
use their expertise in difficult and
unfortunate circumstances [12]. He
highlighted the unique challenges
war and disaster medicine faced,
including the unpredictability of war
and conflict, patient numbers, broad
pathology spectrum, difficult working
environment,and insufficient resource
for efficient clinical practice. He
described the important principles
of medical ethics when practicing
war and disaster medicine, such as
impartiality and medical neutrality.
He emphasized that physicians’safety
must always come first, as physicians
must be safe before they can proceed
with patient care.
The final speaker was Dr. Russell
D’Souza, who is the International
Chair of UNESCO Bioethics in the
Asia Pacific Division. His topic was
“Ethics of War – Can It be Morally
Justified?”. He pointed out that
the waging of war is the last act in
conflict and that war must adhere
to formal codes of war, such as The
Hague and Geneva Conventions.
He introduced the “Just War Theory”
and cautioned that the theory is not
intended to justify wars, but rather
to prevent them. He drew attention
to the principles of Jus ad Bellum,
which describes the reasons for going
to war, and Jus in Bello, which refers
to the conduct of war.He commented
on the importance of this distinction,
as at times a war might be ethical or
unethical (e.g.use of torture,chemical
warfare, drones for surveillance).
Noting the interest of the audience,
Dr. D’Souza mentioned that all wars
are unethical and enumerated the six
conditions for a just war: 1) just cause;
2) right intentions; 3) reasonable
chances to succeed; 4) benefits
proportional to losses; 5) war must be
the last resort; and 6) war can only be
declared by a legitimate authority.
In summary, all panel presentations
were received well, and a robust
discussion ensued among attendees.
Key discussion points included
the following: the role of medical
students in times of conflict; should
they practice medicine because of
the limited number of available
physicians or enlist in the military;
definitions of personal protective
equipment in conflict settings; and
protective measures for physicians.
This event accentuated that physicians
must always remember that their
safety comes first, in order to
provide appropriate care to patients.
Moreover, all health professionals
must adhere to the principles of
medical ethics in both conflict and
non-conflict environments, as they
are a constant and guiding light in
both times of peace and war.
References
1. World Medical Association. Medi­
–
cal neutrality must be observed in
Ukraine [Internet]. WMA; 2022
[cited 2022 Apr 29]. Available
from: https://www.wma.net/news-
post/medical-neutrality-must-be-
observed-in-ukraine/
2. World Medical Association.
World’s health professionals call for
an end to Syria hospital air strikes
[Internet]. WMA; 2019 [cited 2022
Apr 29]. Available from: https://
www.wma.net/news-post/worlds-
health-professionals-call-for-an-
end-to-syria-hospital-air-strikes/
3. World Medical Association. World
Medical Association appeals for
medical neutrality [Internet]. WMA;
2010 [cited 2022 Apr 29]. Available
from: https://www.wma.net/news-
post/world-medical-association-
appeals-for-medical-neutrality/
4.WorldMedicalAssociation.WMA
Resolution in Support of Medical
Personnel and Citizens of Myanmar
[Internet]. WMA; 2021 [cited 2022
Apr 29]. Available from: https://www.
wma.net/policies-post/wma-council-
resolution-in-support-of-medical-
personnel-and-citizens-of-myanmar/
BACK TO CONTENTS
Report of WMA JDN Thematic Session on Warfare Ethics
36
5. World Medical Association. Medical
ethics [Internet]. WMA; 2022
[cited 2022 Apr 29]. Available from:
https://www.wma.net/what-we-
do/medical-ethics/
6. World Medical Association.
About us [Internet]. WMA; 2020
[cited 2022 Apr 29]. Available
from: https://www.wma.net/
junior-doctors/about-us/
7. Parsa-Parsi RW. The revised
declaration of Geneva: a modern-
day physician’s pledge. JAMA; 2017.
318(20):1971-2.
8. World Medical Association.
WMA International Code of
Medical Ethics [Internet]. WMA;
2018 [cited 2022 Apr 29]. Available
from: https://www.wma.net/policies-
post/wma-international-code-of-
medical-ethics/
9. World Medical Association.
WMA Statement on the Protection
and Integrity of Medical Personnel in
Armed Conflicts and Other Situations
of Violence [Internet]. WMA; 2017
[cited 2022 Apr 29]. Available from:
https://www.wma.net/policies-post/
wma-statement-on-the-protection-
and-integrity-of-medical-personnel-
in-armed-conflicts-and-other-
situations-of-violence/
10. World Medical Association.
WMA Regulations in Times of
Armed Conflict and Other Situations
of Violence [Internet]. WMA; 2017
[cited 2022 Apr 29]. Available from:
https://www.wma.net/policies-
post/wma-regulations-in-times-of-
armed-conflict-and-other-situations-
of-violence/
11. World Medical Association.
WMA Declaration of Tokyo –
Guidelines for Physicians Concer­
ning Torture and other Cruel,
Inhuman or Degrading Treatment or
Punishment in Relation to Detention
and Imprisonment [Internet].
WMA; 2020 [cited 2022 Apr 29].
Available from: https://www.wma.
net/policies-post/wma-declaration-
of-tokyo-guidelines-for-physicians-
concerning-torture-and-other-cruel-
inhuman-or-degrading-treatment-
or-punishment-in-relation-to-
-detention-and-imprisonment/
12. Ciottone GR, Biddinger PD,
Darling RG, Fares S, Keim
ME, Molloy MS, et al (editors).
Ciottone’s disaster medicine, 2nd ed.
Philadelphia: Elsevier; 2016.
Lwando Maki, MBCHB, FCPHM,
MMED, PHM, MRSSAf
JDN Deputy Chair
E-mail: dr.lwando.maki@gmail.com
Wunna Tun, MBBS, MD
Fellow in Medical Education
JDN Secretary
E-mail: onlinewunna@gmail.com,
secretary.jdn@wma.net
Shiv Joshi, MBBS, PGDGM,
MD, ICPBHR(UNESCO), CHR
JDN Medical Ethics Officer,
Faculty, Department of Community
Medicine, JNMC, DMIMS (DU),
Sawangi (Meghe), India
BACK TO CONTENTS
Report of WMA JDN Thematic Session on Warfare Ethics
37
Each year, World Health Day is
recognized on April 7, and nations
promote activities that raise
community awareness of the annual
theme. The 2022 theme, “Our Planet,
Our Health”, offers a timely look at
our changing ecosystems and direct
and indirect impacts on human
and animal health. Since the World
Health Organization reported that
12.6 million annual deaths are linked
to living and working in unhealthy
environments, the One Health
concept offers a holistic view of the
delicate balance of humans, animals,
and the environment [1,2].
Understanding these risks will be key
to achieving optimal health indicators
by the Ministries of Health as well as
the indicators and targets of the 2030
Agenda for Sustainable Development.
As leaders openly discuss global
health challenges − ranging from the
effects of climate change, pandemic
preparedness, economic and food
security, air and water pollution,
and health system preparedness −
transdisciplinary collaborations can
leverage expertise and expand
networks for the development of
innovative actions plans for the next
decade.In this article,physicians from
the Dominican Republic, Germany,
Nigeria, Spain, Sweden, Switzerland,
and the United States offered insight
and shared their ongoing activities
about the World Health Day 2022
celebrations.
Dominican Republic
As global citizens, we should actively
support the “Our Planet,Our Health”
theme for World Health Day 2022,
recognizing that innovative strategies
that incorporate the One Health
concept(human-animal-environment
nexus) are fundamental to achieve
the Sustainable Development Goals
(SDG), including SDG 3 (Good
Health and Well-being) and 13
(Climate Action). Over the past
decades, scientists have reported
significant ecosystem challenges –
such as the degradation of natural
resources, development of megacities,
impact of air and water pollution,
and expanded mosquito and tick
habitats – which can impact human
and animal health. Moving forward,
health leaders should develop robust
approaches to address this global
burden and ultimately support the
delicate balance within our ecosystem.
Over the past year, the Pan American
Health Organization has supported
two key initiatives of the Dominican
Republic (DR) Ministry of Health.In
September 2021, the National Action
Plan for the Control of Antimicrobial
Resistance was updated, based on
shared dialogue among community
stakeholders representing disciplines
andsectorslinkedwithhuman,animal,
and environmental health. With
antimicrobial resistance recognized
as one of the leading public health
challenges, resulting in an estimated
700,000 reported annual deaths,
proactive steps to reduce antimicrobial
resistance should incorporate the
One Health concept. Notably, this
plan will adhere to the International
Health Regulations with five actions
related to antimicrobial resistance: a)
raise awareness and understanding;
b) reinforce the scientific knowledge
base; c) support infection control
measures; d) promote optimal
antimicrobial practices; and e) ensure
financial sustainability [3].
In April 2022, the DR Ministry of
Health organized a series of national
activities, including a “Health Path”
three-kilometer hike, children’s
acti­
vities focusing on healthy habits,
educational seminars with different
audiences, and workshops on healthy
cooking. These efforts aimed to
encourage DR citizens to make
conscious efforts to care for the planet,
including buying local agricultural
products, reducing consumption
of highly processed foods, and
recycling products [4]. Also, within
the National Health Plan, the DR
Ministry of Health highlighted the
importance of addressing the effects
of climate change that can support
a resilient environment and prevent
premature illness and death due to
natural disasters [4].
Germany
Since 2017, the German Alliance on
Climate Change and Health (KLUG)
brings together health professionals
and organisations advocating for
a transformative change towards a
healthier tomorrow. The ongoing
activities on green hospitals,planetary
health education, and climate
resilient (public) health systems led
the German Medical Association to
make climate change a top priority
for its 2021 General Assembly.
World Health Day 2022 was used
once again as an opportunity to
communicate the consequences of
the climate crisis and other global
environmental changes to policy-
makers and the public. Focusing on
the increased heat stress experienced
in Germany over the past decades,
a new analysis showed a surge of
heat-related morbidity and mortality
in hospital statistics between 2000
and 2020. The German Medical
Association and KLUG had long
been calling for a national heat action
plan as well as more ambitious climate
goals. Inaction on climate mitigation
WMA Members Share Perspectives related to World Health
Day 2022 (“Our Planet, Our Health”)
World Health Day 2022: Contributions from WMA Members
BACK TO CONTENTS
38
and adaptation in the health sector
and broader society will threaten
our well-being and widen health
inequalities. This World Health Day
must therefore pave the way for a
healthier tomorrow for people and
the planet.
Nigeria
Over the past few years, Nigerian
health leaders have noted several
national priorities geared towards
achieving a healthy nation: reversing
climate change, achievement of
universal health coverage, and the
reduction of air and water pollution.
Many local and national initiatives
have been developed to combat these
challenges and improve the physical
and mental health well-being of the
populace.
Various Nigerian medical associations
and organizations supported the
“Our Planet, Our Health” theme
to recognize the importance of
World Health Day 2022. First, the
Enugu State branch of the Nigerian
Medical Association shared a
position statement that included a
five-step action plan on the topics of
transportation (e.g. walk or bike at
least once per week), energy (e.g. turn
offthelightwhennotinuse),nutrition
(e.g. avoid highly processed foods and
beverages), healthy lifestyles (e.g.
quit smoking), and consumption and
shopping (e.g. use recyclable grocery
bags) (1). These action plans offer
simple steps and tips that can be used
to reduce morbidity and mortality
and also improve the lifespan of the
populace [5]. Second, the national
executives of the Medical Women’s
Association of Nigeria (MWAN)
released a position statement about
promoting health and well-being
during the COVID-19 pandemic.
For instance, the Lagos State branch
(located in southwest Nigeria) of the
MWAN and the Nigerian Medical
Association collaborated on a webinar
to commemorate World Health Day
2022.These webinars offered valuable
insight to audience members on
the topics, “Health Promotion for
Wellbeing in the Midst of a Changing
Climate”and “Investing in our Planet
– the Role of the Healthcare Sector”.
Third, various medical organizations
enlightened the populace of Nigeria
on lifestyle modifications to promote
healthy lifestyle behaviors through
using audio (radio) and video media
(television). Health promotion
exercises were organized by the Edo
State branch of the MWAN, where
female doctors and spouses of male
doctors were screened for cervical
cancer, hypertension, hepatitis B and
C, and anaemia.
Spain
World Health Day can offer an
opportunity to mark a before and
after in the care and maintenance
of our health in an indivisible way.
Today, our global population is
aware that climate change represents
one of the greatest threats to global
health. Since Spanish physicians are
aware of the role that climate change
plays in society, the Spanish General
Medical Council has supported two
initiatives. First, in January 2022,
they launched the Medical Alliance
Against Climate Change, which
will allow the 250,000 Spanish
physicians to collaborate on national
climate action policies, as part of their
commitment to the 2030 Agenda and
the Sustainable Development Goals.
Over the next four years, they will
support collaborations among federal,
non-governmental organizations, and
communities, initiate a series of
regular health promotion activities
including courses, and encourage
citizenstoreducethecarbonfootprint.
Second, they support the Gender and
Profession Observatory, where they
can work to contribute and achieve
equality between women and men.
Implementing a cross-cutting gender
perspective in the medical profession
and in all areas of health will mean
taking better care of the health of the
planet and of all people.
Also, more than 130 foundations,
including the Foundations of the
Spanish General Medical Council for
Social Protection and International
Cooperation, have joined the Spanish
Foundations Climate Pact, an
initiative of the Spanish Association
of Foundations (AEF) and the Daniel
and Nina Carasso Foundation. The
aim of this initiative is to encourage
the philanthropic sector in Spain
to take decisive steps towards
collaborations in climate action. The
pact, structured in seven pillars, offers
a foundation to promote a movement
of action and awareness for Spanish
foundations to activate and promote
an active fight to confront the climate
crisis and resulting inequalities.
Sweden
ForWorld Health Day 2022,Sweden’s
governmental health agencies
focussed on the importance of clean
air and water and enough food for all
as a means for better and more equal
health. Notably, the Swedish Medical
Association lifted the “Healthy
Climate Prescription”, which was
supported together with the WHO,
WMA and other organizations. In
a broader perspective, we recognize
that the conditions of our housing
and neigbourhoods greatly affect
the development of healthy lives.
To align with the international
theme, we promoted green areas
across our towns and cities, as
they not only provide shelter and
shadow, but also opportunities for
relaxation, recovery, and physical
exercise. Governmental agencies,
non-govern­
mental organizations, and
organizations continue to work
together to address mental health
and well-being. We recognize the
significant challenge to provide
World Health Day 2022: Contributions from WMA Members
BACK TO CONTENTS
39
equitable health for all, especially
noting the aftermath of disrupted
school attendances and delays with
entering the labour market during the
COVID-19 pandemic.
Switzerland
In October 2021, the Swiss Medical
Association adopted a comprehensive
strategy for the Swiss medical
profession on climate change, entitled
Planetary Health: Strategy of the
Swiss Medical Profession on the
Possibilities of Action Concerning
Climate Change (https://www.fmh.
ch/files/pdf26/20210819-sante-
planetaire-strategie-du-corps-
medical-suisse-sur-les-possibilites-d-
action-concernant-le-changement-
climatique.pdf). In order to prepare,
adopt, and implement the measures
adopted, it set up a working group
that represents the various disciplines
and functions within the medical
profession in Switzerland. As an
intergenerational and sustainable
project, representatives of medical
students (swimsa) and the member
organization of Doctors for the
Environment (AefU) will also be
involved in these activities.
The vision of this stimulating work
was formulated as follows: “The
Swiss medical profession supports
a strengthening of measures to
promote Planetary Health. In doing
so, it has the vision of a sustainable
health-promoting and climate-
resilient Swiss health system and
helps to achieve this objective with
proportionate, financially viable
measures.”The working group, which
was scientifically accompanied by
the Institute of Public Health at
the University of Basel, formulated
the need for action in the following
four areas: a) information of the
medical profession and patients;
b) reduction of greenhouse gas
emissions (mitigation); c) adaptation
to foreseeable climatic developments
(adaptation); and d) strengthening
the role of physicians as role models.
The delegates of the Swiss Medical
Association take this concern very
seriously and approved an annual
budget of around CHF 300,000
for the implementation of practice-
relevant concepts. In a first step,
the environmental footprint of the
General Office/Administration of the
SwissMedicalAssociationwithits120
employees will be precisely calculated,
on the basis of which concrete goals
will then be implemented. For the
practicing medical doctors, the
working group will develop initial
projects during 2022.
United States
The American Medical Association
(AMA) recognizes the serious threat
the climate crisis poses to human
health. We know that physicians
across the country are already
seeing the health impacts of the
climate crisis in their patients, and
we recognize that the harms will
disproportionately fall on historically
marginalized communities who are
least able to prepare for, and recover
from, heat waves, poor air quality,
and other impacts. That’s why we are
a member of The Medical Society
Consortium on Climate and Health,
a group of leading health care
organizations that represent some
600,000 clinicians across the U.S.
The AMA has signed on to the U.S.
Call to Action on Climate, Health,
and Equity: A Policy Action Agenda
which recognizes climate change is
the greatest public health challenge
of the 21st century, action to reduce
climate change can dramatically
improve health, and equity must be
central to climate action.
The AMA is also a member of the
Steering Committee for the National
Academy of Medicine Action
Collaborative on Decarbonizing the
U.S. Health Sector, a public-private
partnership of leaders from across
the health system committed to
addressing the sector’s environmental
impact while strengthening its
sustainability and resilience. The U.S.
health sector is responsible for an
estimated 8.5% of national carbon
emissions. Dramatically reducing
the carbon footprint of the health
care ecosystem would have immense
health, social justice, and economic
benefits. The public health threat of
climate change is real, it is here, and
it requires us to work collaboratively –
and with great purpose and urgency –
to solve the short- and long-term
challenges we face.
Conclusion
As we reflect on World Health Day
2022, taking into consideration the
described initiatives and reflections
from seven countries, we recognize
that urgent action is crucial to develop
sustainable solutions to achieve the
Sustainable Development Goals by
2030.This“decadeofaction”prioritizes
three types of action – global, local,
and people – that empower all sectors
to contribute to reducing the global
burden of infectious and chronic
diseases, advancing equity, and
supporting sustainable health system
budgets [6]. The “Our Planet, Our
Health”theme is a timely reminder of
the valuable role of multidisciplinary
collaborations across sectors and
disciplines to achieve the ambitious
targets and indicators of the SDGs.
Together, as National Medical
Associations and individual World
Medical Association (WMA)
members, we must support the
One Health concept and organize
initiatives – like World Health Day –
that leverage expertise and promote
shared knowledge about emerging
health risks across our global
communities.
World Health Day 2022: Contributions from WMA Members
BACK TO CONTENTS
40
References
1. World Health Organization.
Preventing disease through healthy
environments: a global assessment
of the burden of disease from
environmental risks [Internet].
WHO; 2018 [cited 2022 Apr 24].
Available from: https://www.who.int/
publications/i/item/9789241565196/
2. World Health Organization.
Tripartite and UNEP support
OHHLEP’s definition of “One
Health” [Internet]. WHO; 2021
[cited 2022 Apr 24]. Available from:
https://www.who.int/news/item/01-
12-2021-tripartite-and-unep-
support-ohhlep-s-definition-of-one-
health/
3. Pan American Health Orga­
ni­
zation. Con el enfoque de Una Salud,
República Dominicana actualiza su
Plan Nacional de Acción de Control
delaResistenciaalosAntimicrobianos
(RAM) [Internet]. PAHO; 2021
[cited 2022 Apr 24]. Available from:
https://www.paho.org/es/noticias/9-
9 – 2 0 2 1 – c o n – e n f o q u e – s a l u d –
republica-dominicana-actualiza-su-
plan-nacional-accion-control/
4. Pan American Health Orga­
ni­
zation. En el día mundial de la salud
la OPS en República Dominicana
llama a la población a cuidarse y
cuidar el planeta [Internet]. PAHO;
2022 [cited 2022 Apr 24]. Available
from: https://www.paho.org/es/
noticias/7-4-2022-dia-mundial-
salud-ops-rd-llama-poblacion-
cuidarse-cuidar-planeta/
5. Ango, J; Media Publicity and
Awareness Committee, Enugu
State Branch of Nigerian Medical
Association. Position statement
on World Health Day 7th April
2022. Enugu State Branch, Nigeria:
Nigerian Medical Association; 2022.
6. United Nations. Decade of action
[Internet]. UN; 2022 [cited 2022 Apr
30]. Available from: https://www.
un.org/sustainabledevelopment/
decade-of-action/
Dabota Yvonne Buowari, MBBS
Department of Accident and
Emergency, University of Port
Harcourt Teaching Hospital, Port
Harcourt, Rivers State, Nigeria
Helena Chapman, MD, MPH, PhD
Milken Institute School of Public
Health, George Washington
University, United States
Yvonne Gilli, MD
Switzerland Medical Association,
Switzerland
Laura Jung, MD, MSc
Leipzig University Hospital
Department of Infectious Diseases
and Tropical Medicine & German
Alliance on Climate Change and
Health (KLUG), Germany
Elizabeth LaRocca, JD
Assistant General Counsel & Director
International Relations, American
Medical Association, United States
Thomas Lindén, MD, PhD, MSc
Government Chief Medical Officer,
Sweden
Jaime Medrano, MBA
Spanish General Medical Council,
Spain
Bienvenido Veras-Estévez,
MD, MPH
Department of Epidemiology,
Hospital Regional Universitario
José María Cabral y Báez &
Faculty of Health Sciences,
Universidad Católica del Cibao,
Dominican Republic
World Health Day 2022: Contributions from WMA Members
BACK TO CONTENTS
41
Dr.William James Appleyard (Jim Appleyard) died on 29 January
2022 at the age of 86 after a long battle with cancer.
Dr. Appleyard was rooted in the traditional English education
system. Graduating from Exeter College, Oxford, which was
founded in 1314, he conducted his medical education at Guy’s
Hospital in London.He specialized in paediatric medicine,which
was not only his field of work throughout life,but also his passion,
as evidenced by most of his other appointments.
Following completion of his training at Guy’s Hospital, the
Children’s Hospital in Louisville, Kentucky and Great Ormond
Street Hospital in London, Dr. Appleyard was appointed
consultant paediatrician at Kent and Canterbury Hospital in
1971. He continued to work as a consultant for 27 years until
1998. He founded the Mary Sheridan Centre for children
with disabilities in 1972, the first child development centre
outside London. He was the initiator of the Special Care Baby
Unit at the Centre, which opened in 1973 and was recognised
as a multidistrict neonatal intensive care unit in 1983. He was
professor in paediatric medicine at St. Georges University for ten
years from 1986-1996, and became an Honorary Fellow of the
Royal College of Paediatrics and Child Health in 2011.
Dr. Appleyard developed an interest in medical education and
served on the Board of Medical Education of the British Medical
Association (BMA). He was Dean of Clinical Sciences at Kigezi
International School of Medicine based in Kabale, Uganda
from 2000-2004. Later, he became active in the International
Association of Medical Colleges and for six years served as its
president.
In 1995, Dr. Appleyard became a representative of the British
Medical Association (BMA) in the Council of the World Medical
Association (WMA). For the next ten years, he participated in
various activities on behalf of the BMA and WMA.He was Chair
of the WMA Standing Committee on Medical Ethics from
1995-1999. During that time, he oversaw the amendment to the
Declaration of Helsinki, which was accepted at the 48th WMA
General Assembly in South Africa in 1996. He was the convener
of the group that presented the WMA Declaration of Ottawa
on Child Health, and later became chair of the workgroup that
prepared the WMA Statement on the Ethical Considerations
regarding Health Databases, which later developed into the
WMA Declaration of Taipei. In 2002, he was elected President
of the WMA and, following his year as President-Elect, he
became its President from 2003-2004. His main focus during his
presidency was the rights of children and he was unwaivering in
speaking on their behalf at every occasion.
After retirement,Dr.Appleyard became active in the International
College of Person Centered Medicine, serving on its Board and
becoming its president from 2013-2017.He continued to be active
in the College, participating regularly in remote Board meetings
until late 2021 and serving as an advisor to the Board until his
death in January 2022. During this time, he published several
articles on person centred medicine and chaired its educational
program.
Dr. Appleyard had a very gentle presence, bringing the concept
of a gentleman to mind. Even when he did not agree with his
counterpart, he was always ready to hear out their argumentation
and his critique was generally quite positive.He stressed the rights
of children and the importance of listening to their views relative
to their age. When he was diagnosed with incurable cancer, he
informed his colleagues of his condition but continued to work
with them on various tasks until the end.
He will be sorely missed by his wife Elizabeth, his son, Richard,
his daughters Suzanne and Lisa, as well as his many friends and
colleagues around the world.
Jón Snædal, MD
(Obituary written by WMA Past-President)
Obituary
William James Appleyard
Obituary
BACK TO CONTENTS
42
42
Dr. Joseph M. Heyman (1942-2022) died at home in West
Newbury, Massachusetts on February 12, 2022, shortly after
being diagnosed with pancreatic cancer.He was noted as someone
with leadership,intellect,friendliness,warmth,and understanding.
Dr. Heyman graduated with a BS from The City College of New
York, New York City and an MD from the State University of
New York, Downstate Medical Center, Brooklyn, New York. He
served for three years in the United States Public Health Service,
Northern Navajo Indian Hospital, Shiprock, New Mexico, where
he was General Medical Officer,Venereal Disease Control Officer
and Chief of Ambulatory Services. He subsequently served as a
resident in the Sinai Hospital of Baltimore, where he received
Certification and Fellowship of the Board of Obstetrics and
Gynecology.
In 1973 he began his 41 years of OB/GYN practice in
Newburyport, MA. There he formed the Women’s Health Care
group, and later was in solo gynecology practice, and Chief
Medical Information Officer of Whittier IPA, Inc. He served
as President of the Medical Staff of Anna Jacques Hospital, a
member of the Executive Committee of the hospital Board of
Directors, and a board member of the Tufts Associated Health
Maintenance Organization. He was also founder and president
of the Whittier IPA, a non-profit organization of Physicians in
Merrimack Valley.
Recognizing the importance of organized medicine in dealing
with the structures of health care and how health is delivered, Dr.
Heyman began a journey serving as president of the Essex North
District Medical Society followed by speaker and president of the
Massachusetts Medical Society.
Dr.Heyman was a member of the American Medical Association
(AMA) House of Delegates, chair of the Council on Medical
Service and for eight years a member of the AMA’s Board of
Trustees. As a member of the Board he served as secretary, chair
of the Finance Committee and Chair of the AMA Board.
Knowing the significance of the work of hospital staffs, Dr.
Heyman served on the Board of Commissioners of the Joint
Commission and internationally on the Joint Commission
International. And he was a member of the Board of Directors
of the Lower Merrimac Valley Physician Hospital Association.
Dr. Heyman served on three subcommittees for the United
States Office of the national Coordinator for Health Information
Technology,and from the US Department of Health and Human
Services was a member of the Practice Physicians Advisory
Council.
Joseph Heyman was a leader internationally where he
participated in the World Medical Association.He was a member
of the Council and Ethics Committee and beginning in 2014,
the chair of the World Medical Association Associate Member.
As Chair he brought an enthusiasm and energy from around the
world as he guided the members in the development of principles
in medical ethics that would be considered by the WMA Council.
Dr. Heyman understood the importance of discussions on issues.
The give and take of differences of opinion that he greeted with
thoughtfulness and consideration,as well as a stalwart support for
the importance of medical ethics.
Joe was still involved even in retirement, where he became active
in the West Newbury Democratic Town committee where he
served on the Town Financial Committee, even as he served with
the local, national and international medical societies.
Survivors in his immediately family include his wife, Laurie
Heyman of West Newbury, MA; his daughter, Eve Heyman
Tuminaro with her husband, Dave, and their children, Sierra and
MacKenzie, in Oak Bluffs, MA; his son, Todd Heyman with his
wife,Sizuy,and their children Autumn and Meadow,in Hartland,
VT; his two nieces, Zeka Glucs, and her husband, Dave, and
Caroline Kuspa all in Santa Cruz, CA
The AMA Foundation is honored to administer the Joe Heyman,
MD Fund. Dr. Heyman’s desire is to support medical students
of color with financial need through our Underrepresented in
Medicine Scholarship Program. https://amafoundation.org/heyman/
As members of the family, friends and colleagues what we will
all remember is the wonderful work Dr. Joseph Heyman has
provided over his lifetime in health care.
And what we will all treasure is remembering that Joe was a
thoughtful, kind, caring and a happy man.
Cecil B. Wilson, MD, MACP
(Obituary written by WMA Past-President)
Joseph M. Heyman, MD, FACOG
Obituary
Obituary
BACK TO CONTENTS