WMJ_2022_02.jan23

ISSN 0049-8122
Official Journal of The World Medical Association, Inc. Nr. 2, August 2022 vol. 68
Contents
Editorial 3
The Ukraine Medical Help Fund   4
Opinion: There is No Place for Racism in Medicine…   6
A Prescription for Survival: Nuclear Abolition is Core Business for Doctors 8
The Voice of Global Veterinary Medicine   11
How COVID-19 Vaccine Access is Still Limited in 2022: A Call to Action 13
The Current Development of Health Management and its Role in the Future Medical Model in China    17
Hands-on Deck Approach toward Planning and Implementing Advocacy in Global Health
from Junior Doctors’ Lens   21
2022 Kenya Medical Association’s Young Doctors Network Conference:
The Unspoken Mental Health Pandemic   24
Highlights from the 75th World Health Assembly   28
World Tuberculosis Day 2022: A Closer Look at the Dominican Republic   35
WMA Members Reflect on World Oceans Day 2022   39
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
Republic of Korea
Dr. Osahon ENABULELE
WMA President-Elect
Nigerian Medical Association
8 Benghazi Street,
off Addis Ababa Crescent,
Wuse Zone 4, 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
ISSN 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
The coronavirus disease 2019 (COVID-19) pandemic
continues to challenge global response efforts, with
an estimated 595 million cases and 6.4 million deaths
worldwide reported by the World Health Organization
(WHO) (as of 24 August 2022). Health professionals
have experienced fatigue and exhaustion in the
workplace, as a result of the surge in health care service
utilization during the circulating Omicron variants.
These occupational stressors and risk of burnout may
impact the future of the health care industry and
attribute to the projected global health workforce
shortage of 15 million by 2030.
With the global emergence of monkeypox cases, the
WHO declared monkeypox as a “public health emergency
of international concern” on 23 July 2022. According to
the US Centers for Disease Control and Prevention, an
estimated 44,503 monkeypox cases were reported in 96
countries(asof23August2022).Ofthistotal,44,116cases
werethefirstreportedmonkeypoxcasesin89countries.Of
this total, 40,971 cases were the first reported monkeypox
cases in 87 countries. This zoonotic disease of concern –
coupled with the COVID-19 pandemic – will urge
global health leaders to discuss next steps in national
preparedness and response plans to ensure global security.
Apart from these emerging pathogens, the ongoing
Russian invasion of Ukraine has directly impacted oil
and gas exports, and hence led to cascading effects on
food and energy costs. Communities have been afflicted
by the effects of climate change and natural hazards –
including heat waves,wildfires,and flooding – that affect
the delicate balance within the aquatic,atmospheric,and
terrestrial ecosystems. Close attention to the impacts
of natural and anthropogenic activity on our planet
will require the One Health concept (human-animal-
environment nexus) to be a central element of local and
national initiatives that aim to strengthen health system
preparedness and resilience.
On 4 August 2022, the United Nations (UN) Secretary-
General António Guterres provided an update to the
General Assembly,where he referenced the Our Common
Agenda report as a “booster shot” to galvanize collective
action to achieve the ambitious targets of the 2030
Agenda for Sustainable Development. In this report, he
stressed four primary categories – redistributing global
power and resources, enhancing youth engagement
in policy decisions, delivering public goods during
crises, and strengthening the UN infrastructure and
preparedness – that will incorporate “five agendas for
change” with expanded capabilities in the behavioral
sciences, data, digital technologies, innovation, and
strategic management. This call to action aims to
encourage global leaders to make substantial forward
strides toward addressing health priorities and fostering
sustainable action.
The 221st World Medical Association (WMA)
General Assembly will be held in Berlin, Germany,
from 5-8 October 2022. At this event, WMA members
will discuss policy statements, share comments and
revisions to WMA resolutions, and connect with global
colleagues.
In this issue, Dr. Otmar Kloiber provided an update
about ongoing efforts by the WMA, the Standing
Committee of European Doctors, and the European
Forum of Medical Associations, to support the Ukraine
Medical Help Fund. Dr. Frank Ulrich Montgomery
defined racism and offered recommendations to end
racism in the health care and community setting. Ms.
Mitchell, Ms. McGinty, Dr. Ruff, Dr. Helfand, Dr.
Umaña, and Mr. Christ discussed the development of
the Treaty on the Prohibition of Nuclear Weapons.
Dr. Rafael Laguens described the World Veterinary
Association (WVA), potential collaborations between
physicians and veterinarians, and his current priorities
and activities as WVA president. Finally, WMA
members highlighted national activities, perspectives
on pressing health issues, and reflections about World
Oceans Day and ocean sustainability.
We are honored to present this second issue of the World
Medical Journal with several high-quality articles for the
global community.WMA members can use this valuable
platform to expand networking opportunities within
the WMA community of diverse clinical and surgical
specialties. By sharing germane information across
countries – such as the World Oceans Day activities and
reflections – we can identify existing knowledge and
practice gaps, develop novel solutions to complex global
challenges, and ultimately advance scientific knowledge
and safeguard population health.
Helena Chapman, MD, MPH, PhD
Editor in Chief of the World Medical Journal
E-mail: editor-in-chief@wma.net
4
Since the end of the Soviet Union,
Ukraine has searched for its place in
Europe.Torne, between an old Soviet-
educated and Russia-friendly political
elite and a new western European-
affiliate young leadership, Ukraine
took a rocky road to independence.
At the end of 2013, protests against
the Moscow-friendly government,led
by President Wictor Janukowitsch,
escalated when the president refused
to sign the association agreement with
the European Union. In February
2014, he was driven out of office
and fled to Moscow. The change in
government was followed by a bloody
separation of eastern provinces with
the help of Russian forces, which
not only helped the rebels in the east
but also occupied and annexed the
Crimean Peninsula.
Russian troops were concentrated
along the Russian border to Ukraine
and in Belorussia, north of Ukraine.
The Russian president Vladimir
Putin started an invasion of Ukraine
on 24 February 2022, allegedly for
the “demilitarization” of Ukraine [1].
Soon after the invasion had begun, it
became clear that it would face fierce
Ukrainian resistance. On the other
hand, we learned that Russian forces
would likewise attack military and
civil targets without discrimination.
The high number of observed attacks
on health facilities suggested targeted
attacks on hospitals and clinics.
The sudden occurrence of a high
number of wounded people, the rapid
displacement of persons, and the war-
derived depletion of medical stocks
led to a sharp increase in medical
demand for human resources and
materials. Our colleagues from the
Ukraine Medical Association called
for help from three international
organisations, the World Medical
Association (WMA), the Standing
Committee of European Doctors
(CPME), and the European Forum
of Medical Associations (EFMA).
During the first days of the war against
Ukraine, a rapid survey showed that
the neighbouring western countries
were already experiencing a stream
of refugees from Ukraine, mainly
women and children. Also, there was
a strong demand for medical goods
and medicines to be exported to
Ukraine. Together with the medical
associations from Poland, Slovakia,
Romania, Hungary, France, Japan,
and later the Saxony State Chamber
of Physicians, the three international
groups formed the Ukraine Task
Force during the first days of March
2022. The Polish Chamber of
Physicians and Dentists immediately
coordinated logistical operations,
and many more remote medical
associations spontaneously donated
money to support Ukraine.
The Japan Medical Association
(JMA) took the initiative by asking
the WMA how to bring resources
directly to the physicians in Ukraine.
The WMA Executive Committee
agreed to install a special fund to
collect donations for Ukraine together
with the CPME and EFMA [2].The
WMA Past President, Prof. Leonid
Eidelman, was asked to lead the
activities. By joining the Taskforce,
the JMA provides a seed funding
of over 100 million Yen, which is
The Ukraine Medical Help Fund
The Ukraine Medical Help Fund
Otmar Kloiber
BACK TO CONTENTS
Photo 1. The Mayor of Lviv, Andrii Sadovy (left), together with the WMA Past President Leonid
Eidelman (right), expressing gratitude for the delivery of medical goods. Credit: WMA
5
equivalent to more than 700.000
Euros. Significant grants from the
medical associations of France, the
Netherlands, Denmark, Iceland,
Taiwan, Croatia, and Switzerland,
the regional medical associations of
France and Norway and the South-
eastern EFMAs,and the JMA strongly
supported the fund (Photo 1).
Colleagues and other individuals,
companies, and regional medical
associations donated numerous
smaller but still impressive grants.
By the middle of June 2022, the fund
had collected more than 2.7 million
Euros.
The acquisition of products was more
difficult than anticipated, at least at
the beginning of the war. Seemingly a
run-on medical goods and medicines
had begun with the onset of the war,
and supplies fell short in Ukraine and
their close western neighbours. With
the support of the Israel Medical
Association, Prof. Leonid Eidelman
helped acquire medicines and medical
products for the first shipment from
Israel via Poland to Ukraine (Photo 2).
In Poland,the CPME Past-President,
Dr. Konstanty Radziwill, who serves
as the current governor of the Greater
Masovian Region in Warsaw, lent his
support to the project.Prof.Eidelman
accompanied the first transport of
goods to Lviv himself. Prof. Andrii
Basilewitsch, Board member of the
Ukraine Medical Association and
Liaison to EFMA, welcomed Prof.
Eidelman delivering the transport
to Lviv in Ukraine. During his visit,
Prof. Eidelman contacted “Freedom
to Ukraine”, a non-governmental
organization volunteer group that
delivered medical and humanitarian
supplies into the war zone. Through
these communications, he learned
about the drastic increases in surgical
and neurosurgical cases, often treated
with insufficient materials and
equipment.
Following this visit, the steering
committee decided to cooperate with
the“Freedom to Ukraine”organization
and provide surgical equipment for
one department of Neurosurgery in
Kyiv. When a second large transport
of medical goods and medicines had
reached Ukraine, the “Freedom to
Ukraine” organization helped deliver
these resources to the war zone. The
Ukraine Medical Help Fund also
ordered craniotomy equipment for
Kyiv, which is necessary to treat many
types of head injuries.
In May 2022, the Saxon Chamber
of Physicians joined the task force
to offer help in acquiring urgently
needed medical products for Ukraine.
Together with a non-governmental
organisation from Dresden, “Hope
for Ukraine”, they supported two
deliveries of medicines to Ukraine.
Currently, the Ukraine Medical
Help Fund is ordering materials for a
maternity clinic in Mykolaiv, general
intensive care clinic in Cherkasy, and
the Ukraine Medical Association.
As long as funds are available,
these global efforts will continue to
support Ukraine. Notably, the three
organisations administering the fund
– WMA, CPME, and EFMA – have
decidedtoassumetheadministrational
costs, and no fund money is received
by these organisations. We are
sincerely grateful for the support that
we have received in our efforts to help
our Ukrainian colleagues and their
patients.
References
1. Donahue P, Krasnolutska D.
Understanding the roots of
Russia’s war in Ukraine [Internet].
2022[cited 2022Jun 30]. Available
from: https://www.bloomberg.
com/news/articles/2022-03-02/
understanding-the-roots-
of-russia-s-war-in-ukraine-
quicktake
2. World Medical Association.
Ukraine Medical Help Fund by
WMA,CPME and EFMA.2022
[cited 2022 Jun 30]. Available
from: https://www.wma.net/
news-post/ukraine-medical-
help-fund-by-wma-cpme-and-
efma/
Otmar Kloiber, MD
WMA Secretary General
E-mail: otmar.kloiber@wma.net
The Ukraine Medical Help Fund
BACK TO CONTENTS
Photo 2. Materials ready for delivery to Ukraine. Credit: Israel Medical Association
6
Opinion: There is No Place for Racism in Medicine…
BACK TO CONTENTS
There are many challenges in the
delivery of medical services worldwide.
One specific problem that has been
underestimated in its importance in
the health setting has been recently
discussed: racism in medicine. With
increased mobility and transparency
of the global medical workforce and
general societies,it becomes more and
more apparent about how unjust and
improper all forms of racism are. A
medicalprofessionthatisrepresentative
of the general population has a crucial
role in addressing health disparities as
a result of racism.
At the next General Assembly (GA)
of the Word Medical Association
(WMA) in Berlin (Germany), a
resolution prepared and submitted
by the German Medical Association
“Bundesärztekammer” (BÄK) aims
to condemn racism in all medical
services and behaviours of medical
professionals. In this editorial, the
author will use quotations from this
draft resolution, Proposed WMA
Declaration on Racism in Medicine,
which will be presented and discussed
during the GA in October 2022.
The WMA was founded in Paris in
1947, in reaction to World War II and
the atrocities that German physicians
had committed under a construct of
social and racial hygiene that was based
on the theory of racial differences
and supremacy. In the late 1940s, the
Nuremberg Trials clearly showed
the devastating results of a medical
profession acting in close collaboration
with an autocratic government using
social constructs instead of biological
and genetic evidence. The BÄK is
deeply committed to prevent these acts
of unethical behaviour from happening
again.
Racismcanappearinmanyformswithin
the healthcare and community setting.
• Racism can occur during the
interactions of patients and their
physicians. Healthcare professionals
may be reluctant to see patients of
another racial origins, recognizing
that different treatments are advised
for racial groups. Alternatively,
patients may also refuse treatment
by physicians on the basis of their
colour,race or origin.
• Racism can hinder or undermine
the foundation of trust that is
essential for successful patient-
physician relationships.
• Systemic racism creates barriers of
entry to the medical profession for
certain historically excluded groups.
These barriers are caused by various
factors, including implicit and
explicit bias in admission to medical
school, curricula of medical schools
and residency programs, faculty
development,and hiring practices.
• Structural racism can also influence
participation, and therefore
inclusivity, in medical research.
Historical examples of unethical
experimentation or research in the
absence of informed consent on
marginalized communities have
led to a high level of mistrust of the
medical establishment.
We must face it: Although many
declarations and resolutions exist
worldwide from a wide range of
organisations – including multilateral
political institutions like the WMA to
local medical communities – racism
still exists.The presence of racism has a
direct impact on patients’ physical and
mental health and quality of life.
As leaders of the global medical
community, it is therefore adamant that
we:
• Condemn racism in all its forms,
wherever and whenever it occurs;
• Declare racism as a public threat;
• Acknowledge that racism is
structural and deeply engrained in
health care;
• Assert that racism is based on a
social construct with no basis in
biological reality,and that any effort
to claim superiority by exploiting
racist assumptions is unethical,
unjust,and harmful;
• Recognize that the experience of
racism is a social determinant of
health and responsible for present
health inequities;
• Commit to actively promoting
equity and diversity in medicine and
strive for an inclusive and equitable
health environment.
The WMA has a longstanding history
of fighting racism in all its forms. For
severaldecades,weassertedthatracesdo
not exist in a genetic sense,but represent
a social and often historical construct.
Racism stems from a false ideology
that human beings can be grouped
into a hierarchy of racial categories
primarily based on inherited physical
traits.This harmful social construct has
no basis in biological reality; however,
racist policies and ideas are still used to
perpetuate, justify, and sustain unequal
treatment.It is our ethical obligation to
conquer racism wherever it exists.
FrankUlrichMontgomery, MD
WMA Chair of Council
Berlin, Germany
E-mail: monti@montgomery.de
Opinion: There is No Place for Racism in Medicine…
Frank Ulrich Montgomery
7
WMA General Assembly 2022
BACK TO CONTENTS
8
A Prescription for Survival: Nuclear Abolition is Core Business for Doctors
BACK TO CONTENTS
The International Physicians for
the Prevention of Nuclear War
(IPPNW) has been hard at work as
we look forward to the first Meeting
of States Parties to the Treaty on
the Prohibition of Nuclear Weapons
(TPNW). This treaty, often referred
to as the nuclear ban treaty, is the
result of decades of hard work and
careful advocacy by community
groups, activists, health advocates,
and the survivors of nuclear weapons
use, both in Hiroshima and Nagasaki
and in numerous nuclear tests.
In 2005, born out of deep frustration
with the global inaction on nuclear
abolition, Dr. Ron McCoy, a
Malaysian IPPNW obstetrician,
conceived a new campaign that
unitedmanypeopleandorganisations
around the world yearning for
an end to nuclear weapons. The
International Campaign to Abolish
Nuclear Weapons (ICAN) was
founded in Melbourne, Australia, by
the Australian affiliate of IPPNW:
the Medical Association for the
Prevention of War (MAPW),
which served as the incubator of
this new global initiative. Since its
foundation, the work has gained
momentum, building on decades of
persistent medical advocacy by the
IPPNW. The campaign adopted
a humanitarian lens and a robust
toolkit, focusing on divestment
and awareness raising. Notably, in
January 2021, the TPNW entered
into force, making nuclear weapons
illegal.
In the words of Setsuko Thurlow,
a hibakusha from Hiroshima and
now Canadian campaigner, “I’ve
been waiting for this moment for
seven decades, and now it has finally
arrived”. Now, we find ourselves in a
unique moment in history where our
vulnerability and interconnectedness
have been laid bare by a global
pandemic. Health inequities have
never been more apparent, and it is
increasingly clear that the possession
of nuclear weapons does not deter
war, but instead provides cover for
potentially harmful and immoral
incursions on sovereign nations. In
short, the need for nuclear abolition
could not be clearer. Either we
eliminate nuclear weapons, or they
will eliminate us.
Ruth Mitchell
Molly McGinty
Tilman Ruff
A Prescription for Survival:
Nuclear Abolition is Core Business for Doctors
Ira Helfand
Carlos Umaña
Michael Christ
9
A Prescription for Survival: Nuclear Abolition is Core Business for Doctors
BACK TO CONTENTS
The global federation of the IPPNW,
which has affiliates in 55 countries
with thousands of participating
health professionals, is grateful for
our partnership with the World
Medical Association (WMA). We
know that we can only achieve a world
free of nuclear weapons by working
together, drawing on the strengths
and insights that each partner brings
to the discussion. Along with the
International Council of Nurses
(ICN), International Federation
of Medical Students Associations
(IFMSA), and the World Federation
of Public Health Associations
(WFPHA), the IPPNW and the
WMA have recently released the
below Joint International Health
Statement for the first Meeting of
States Parties of the TPNW.
The Joint Statement
Representing physicians, nurses,
public health professionals, and
medical students worldwide, we
speak with a united voice on the
urgent need to eliminate nuclear
weapons as a matter of global health
and survival. Updated evidence on
the catastrophic consequences of any
use of nuclear weapons, the acute
and growing danger of their use,
and the impossibility of any effective
humanitarian and health response
following nuclear explosions on
populations, should underpin the
work of the upcoming 1st Meeting
of States Parties (1MSP) of the
Treaty on the Prohibition of Nuclear
Weapons (TPNW).
The TPNW is based upon a
body of indisputable evidence,
documented by scientists, health
professionals, and experts in crisis
management and response, that the
consequences of nuclear weapons use
are catastrophic, global, and without
remedy. The Treaty concludes – and
we concur – that the prohibition and
elimination of nuclear weapons is
the only responsible course of action
in the face of such consequences.
The detonation of nuclear weapons
produces incinerating heat, powerful
shock waves and overpressures,
ionizing radiation, an intense
electromagnetic pulse, and massive
amounts of smoke and soot that
can alter the Earth’s climate. Unlike
conventional weapons or other
weapons of mass destruction, nuclear
weapons instantaneously wipe out
entire populations, level cities, and
devastate the environment. They
produce radioactive contamination
that remains active for millennia,
causing cancers and other illnesses
that can persist across generations.
Moreover, the environmental
consequences of nuclear war,
including severe climate disruption,
can lead to global famine and, in the
most extreme case,human extinction.
No meaningful medical or disaster
relief response to the detonation of
nuclear weapons is possible.
Since the adoption of the Treaty,
new data about climate effects
has been published documenting
the impacts from both limited
and large-scale nuclear conflicts.
IPPNW has submitted a briefing
paper to the 1MSP that summarizes
the blast, heat, and radiation effects
of nuclear weapons, as well as the
global impacts of nuclear war on
climate, nutrition, and food security.
This evidence should continue to
drive the process of implementing
the Treaty, its prohibitions, and its
positive obligations.
The world has not been this close to
nuclear war since the Cuban Missile
Crisis of 1962. If the conflict in
Ukraine were to escalate to the use of
nuclear weapons, the consequences
would almost certainly be global
and catastrophic. Diplomacy is
urgently needed to remove the
danger of nuclear escalation in
the current crisis, and needs to
progress to negotiations among all
nuclear-armed states to eliminate
their nuclear arsenals under strict
verification and timelines.
As the World Health Organisation
has stated, nuclear weapons pose the
greatest immediate threat to human
health and welfare. The elimination
of nuclear weapons is the only way
to put an end to this preventable and
intolerable threat.
As member and observer states
prepare to meet in Vienna for the 1st
Meeting of States Parties, we call for
prompt and universal ratification and
implementation of the Treaty on the
Prohibition of Nuclear Weapons.
Our Organizations
• The ICN is the international
federation of nursing organi­
zations representing national
nurses’ associations in 130
countries.
• The IFMSA envisions a world
in which medical students
unite for global health and are
equipped with the knowledge,
skills, and values to take on
health leadership roles locally
and globally. Founded in
1951, it is one of the world’s
oldest and largest student-run
organizations. It represents,
connects, and engages a network
of 1.3 million medical students
from 145 national member
organizations in 134 countries.
• The IPPNW is a federation of
health professional organizations
in 55 countries dedicated to the
eradication of nuclear weapons.
The IPPNW received the Nobel
Peace Prize in 1985,and founded
the International Campaign
10
BACK TO CONTENTS
to Abolish Nuclear Weapons
(ICAN), which received the
Nobel Peace Prize in 2017.
• The WFPHA is an international
federation of 130 national
and regional public health
associations, representing
five million public health
professionals worldwide. The
WFPHA is the only worldwide
professional society representing
and serving the broad field of
public health internationally.
• The WMA is an international
organization representing physi­
cians, with 115 national member
organizations and thousands of
associate members worldwide.
Through the process of developing
and negotiating the TPNW, we
have presented compelling evidence
with one united voice of health
professionals through working papers
and submissions, oral testimonies,
commentaries, and articles. These
efforts have been influential, and this
evidence on the real consequences
and risks of nuclear weapons is
reflected in the TPNW. On 20 June
2022, the day before the Meeting
of States Parties, the 2022 Vienna
Conference on the Humanitarian
Impacts of Nuclear Weapons will be
held and aims to review and update
this evidence. We look forward to
increasing collaborations over the
years to come,as we work to overcome
the greatest threats to our health,and
indeed, our very existence.
Ruth Mitchell, BA, BSc, BMBS,
FRACS, FFSTEd, MAICD,
Chair of the Board, IPPNW
Vancouver, BC, Canada
E-mail:
ruth.mitchell.ippnw@gmail.com
Molly McGinty, BSc
Nuclear Program Associate, IPPNW
Malden, Massachusetts, United States
Tilman Ruff, MBBS, FRACP, AO
Co-President, IPPNW
Melbourne, VIC, Australia
Ira Helfand, AB, MD
At-Large Board Member, IPPNW
Leeds, Massachusetts, United States
Carlos Umaña, MD
Co-President, IPPNW
Madrid, Spain
Michael Christ, BSc
Executive Director, IPPNW
Malden, Massachusetts, United States
A Prescription for Survival: Nuclear Abolition is Core Business for Doctors
11
The Voice of Global Veterinary Medicine
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The World Veterinary Association
(https://worldvet.org/) is an
international organisation that
integrates veterinary associations
on all continents and represents the
global veterinary profession. The
WVA’s vision is to be recognised,
respected, and trusted to influence
the mission to improve animal health,
animal welfare, public health, and the
environmentforthegoodofhumanity,
animals, and the planet worldwide.
Founded in 1959, as an evolution of
the Permanent Committee for the
International Veterinary Congresses,
the early history of the WVA started
with the announcement of its first
congress,which was held in Hamburg,
Germany, in 1863.
As respect for diversity, mutual
collaboration, and solidarity are
part of the WVA’s identity, science,
education, and advocacy are the
instruments to achieve these goals.
The WVA activities are carried
out in an independent, ethical, and
professionally responsible manner
by the three governing bodies: the
General Assembly, the highest
governing body of the Association;
the Council, as the executive body;
and the Executive Committee, which
acts on behalf of the Council between
meetings.
The main objectives of the WVA are
to unite the veterinary profession;
protect, promote, and maintain the
status and interest of veterinarians;
to maximise the contributions of
the veterinary profession to animal
health and welfare, public health,
environmental protection, animal
production, and food safety; to
establish, promote, and maintain
high standards for veterinary medical
education and professional ethics;
to encourage and promote the
exchange of veterinary knowledge
and professional dialogue; and to
establish and enhance strategic
partnerships and relationships with
other international organisations and
bodies.
After identifying emerging health
issues, recognizing limited resources,
and considering input from
WVA members, key partners, and
governing bodies, the WVA’s current
strategy was developed. The four
priority areas include One Health,
veterinary education, pharmaceutical
stewardship, and animal welfare.
Another ancillary point for the
Association is improving operations
and promoting visibility and essential
partnerships. The WVA continues
its work in these described priority
areas through the efforts of different
committees and working groups,
which include a vast network of
external experts who support the
WVA endeavours. Moreover, the
WVA ensures effective cooperation to
achieve its goals through collaborative
partnerships with intergovernmental
agencies, non-government
organizations, industry leaders, and
other relevant stakeholders.
Some specific goals are to provide
education on One Health topics at
the annual WVA Global Summit;
develop a position statement on the
global climate emergency; develop
a common self-assessment tool for
veterinary colleges; conduct regional
surveys regarding accreditation
veterinary education standards in
use; advocate for the availability and
access to quality pharmaceuticals
and biologics for veterinarians
worldwide; develop a list of essential
veterinary pharmaceuticals that
should be available for use by food
animal practitioners; and contribute
to discussions on global antimicrobial
resistance as they pertain to
veterinarians and their access to and
use of antimicrobials.
The WVA’s vision aims to build
the voice of the global veterinary
profession, which can be recognised,
respected and trusted by the different
stakeholders and international
organisations, such as the World
Medical Association (WMA),
the World Health Organisation
(WHO), the Food and Agriculture
Organization of the United Nations
(FAO), and the World Organisation
for Animal Health (founded as
OIE). The WVA would like to use
its voice to expand dialogue and
seek understanding, agreement, and
alliances with different partners.
Notably, the WVA considers the
WMA a sister organisation because
bothorganizationssharesimilarvalues
and interests of their membership.
There is an essential memorandum of
understanding between WMA and
WVA, which recognises the mutually
beneficial relationship and the need
to establish working arrangements.
Specifically, it states that “The Parties
will collaborate in the One-Health
concept, which is a unified approach
to veterinary and human medicine
(veterinarians and physicians) in
order to improve Global Health.”The
scope of this cooperation includes:
The Voice of Global Veterinary Medicine
Rafael Laguens
12
BACK TO CONTENTS
supporting the concept of joint
educational efforts between human
medical and veterinary medical
schools; strengthening cross-species
disease surveillance and control
efforts to prevent zoonotic diseases;
collaborating in the responsible use
of antimicrobials concerning critical
antimicrobial lists for humans and
animals; and enhancing collaboration
between human and veterinary
medical professions in medical
education, clinical care, public health,
and biomedical research.
As the newly elected WVA president
for the 2022-2023 term (https://
worldvet.org/news/welcome-dr-
rafael-laguens/), I am interested in
leading our WMA initiatives that
align with the four priority areas and
objectives of the WVA strategy. We
will contribute to reinforce the One
Health approach as a framework to
shape the WVA’s concrete actions,
strategies, and collaborative work
with different sectors. Indeed, we
aim to strengthen the Association
by reinforcing the unity of members,
increasing the number of member
associations, improving internal
and external communication, and
optimizing its governance.
This article offers an excellent
opportunity to improve mutual
understanding and strengthen ties
between the WMA and the WVA
as well as between physicians and
veterinarians across the globe.
As both professions exemplify
specialized training and expertise,
both organizations have a unique
role and share the responsibility
for contributing to global efforts
that highlight the value of the
One Health approach in essential
decision-making. Notably, each
profession can guide the development
of concrete actions and strategies that
promote a more integrated approach
of interdisciplinarity collaborations
within a wide range of disciplines
and sectors, even beyond human and
animal medicine.
Moving forward, humanity must be
better prepared to prevent, predict,
detect,and respond to global threats –
such as emerging infectious diseases,
antimicrobial resistance, and climate
change – as well as promote actions
to achieve sustainable development.
If humans intend to continue living
on Earth, they must begin to reverse
their environmentally unfriendly
behaviours and implement actions to
achieve a healthy and habitable planet
for the next generation.
Rafael Laguens, DVM
President, World Veterinary Association
Soria, Spain
E-mail: rlaguens@gmail.com
The Voice of Global Veterinary Medicine
13
How COVID-19 Vaccine Access is Still Limited in 2022: A Call to Action
BACK TO CONTENTS
Globalisation allowed diversification
of trade and urbanisation and
increased global mobility, leading to
easier transmission of human and
animal diseases [1]. The coronavirus
disease 2019 (COVID-19) pandemic
is the perfect illustration of the
emergence and spread of a new
infectious pathogen across the globe.
As of 22 July 2022,the World Health
Organization (WHO) reported an
estimated 565 million cases and six
million deaths due to COVID-19
[2]. This commentary will discuss
how the mechanisms to distribute
medical countermeasures to tackle
this pandemic are inadequate and
exacerbate areas of pre-existing
inequalities [1].
According to the Global COVID-19
Access Tracker, more than 74% of
high- and upper-middle-income
countries are fully vaccinated [3].
Lifted from sanitary measures,
higher-income countries (HIC)
are experiencing a new economic
bloom, while the disparities with
lower-middle-income countries
(LMIC) dug deeper. According to
the World Bank, the pandemic has
reversed the progress made in the
Sustainable Development Goals
(SDG), especially in targets aiming to
end poverty. It is estimated that 100
million more people have fallen into
extreme poverty, and 80% of them are
from middle-income countries [4].
According to Our World in Data,only
15.2% of low-income countries (LIC)
have received one dose of vaccine [5].
At the end of 2021, 75% of high-risk
health care professionals in LICs are
not yet been covered by vaccines [6],
while countries in Europe and North
America have started to roll out the
fourth booster. This effect can be
described as a “vaccine apartheid” [7].
According to the Independent Panel
for Pandemic Preparedness and
Response, deaths increase faster in
vaccine-uncovered regions. Many
lives in LMICs could be lost from
vaccine-preventable deaths from
future severe variants [8]. Currently,
LMICs account for 63% of the
reported deaths worldwide, with
excess mortality estimates as high as
87% [9]. Many parallel the current
vaccine apartheid with the HIV/
AIDS epidemic, where deaths in
HICs decreased after the apparition
of anti-retroviral medications, but
12 million Africans died waiting
for azidothymidine to reach the
continent [10].
Having life-saving vaccines on the
market one year into the pandemic
is undeniably the most impressive
achievement of modern medicine.
The COVID-19 vaccines resulted
from an unprecedented global
collaboration in data sharing, open
research, and worldwide vaccine
trials. It is important to note that
vaccines are funded mainly by public
funds from governments and grants
[11]. However, the privatisation of
technologies makes them challenging
to access. The vaccine access disparity
is nothing new.During the last H1N1
epidemic in 2009, HICs bought
almost all the supply of vaccines,
leaving the most affected countries
in LMICs without any supplies [11].
To counter this scenario, in April
2020, the WHO created the COVAX
facility to procure vaccines for both
high- and low-income countries.
The COVAX pledged to equitably
distribute vaccines so that 20% of
the most vulnerable population in
every country could have access to
vaccination. It also offered subsidised
lower prices for 92 LMICs [9].
Although the idea seemed equitable,
the reality was different. Ultimately,
COVAX failed to deliver its promises.
In 2021, 4.2 billion vaccines were
administered, and 70% were in
HICs, representing 16% of the world
population. First, there was an issue
with the governance of COVAX,
which served foremost the interests
of stakeholders and powerful HIC
countries. COVAX was structured
under the Access to COVID-19
Tools Accelerator (ACT-A), a super-
Public-Private-Partnership (PPP)
announced in April 2020 at G20 by
European Commission and the Gates
Foundation. The entire structure was
fragmentedwithalackoftransparency
and public accountability. Instead
of having its own governing board,
COVAX was financed via GAVI and
CEPI, two previously established
PPPs for vaccine procurement and
research and development, and
dependent on their boards with
heavy pharmaceutical representation
and philanthro-capitalists. Notably,
there was minimal representation
from LMICs and civil societies [12].
If there were better representations
of LMICs, perhaps COVAX would
have performed better in achieving its
mission.
Second, by aiming to facilitate
vaccine access to LMICs to tackle
a health security problem, which
impacts every corner of the planet,
How COVID-19 Vaccine Access is Still Limited in 2022:
A Call to Action
Wenzhen ( Jen) Zuo
14
COVAX is unavoidably competing
against the interests of powerful
HICs. In 2020, HICs bypassed
COVAX and stuck in bilateral deals
with pharmaceutical companies with
advance purchase agreements. This
“vaccine nationalism” was meant to
secure early access to vaccines for their
domestic population and hoarding
5-10 times their national population’s
need [11]. When all global vaccine
supplies were bought up by bilateral
agreements, few were left for
COVAX. When the Serum Institute
of India banned the exportation of
the generic AstraZeneca vaccines to
COVAX, the delivery of promised
doses in 2021 to LMICs was
halted. With all the HICs by-
passing COVAX, it was transformed
into a new aid-dependent vaccine
distribution facility, relying solely on
donations from countries and funding
from private partners. Furthermore,
wealthy countries preferred
employing “vaccine diplomacy” in
bilateral donations to LMICs to
“reap geopolitical and diplomatic
benefits” [12]. Pfizer and Moderna,
both pharmaceutical companies, are
promising vaccines to COVAX, but
they had always prioritised orders
from wealthy countries before
delivering to COVAX [11].
On UNICEF’s Global Vaccine
Tracker, most HICs, despite having
reached 70% of vaccination, are still
securing more doses to be delivered
for up to 300% of vaccination
coverage. In comparison, countries
like Tanzania can only secure 35% of
their needs to cover 44% of their total
population [3]. Currently, COVAX is
trying to fundraise US$6 billion to
deliver 600 million doses of vaccine
to cover 70% of 92 LMIC/LICs [13].
However, according to UNICEF, at
least 1.4 billion doses are still needed
to be administered to reach that
70% vaccination target [3]. Hence,
the dosages that COVAX pledged
to donate only represent 43% of the
doses necessary to achieve the global
target. The rest will need to be self-
funded by countries already strained
from other urgent health priorities
and debts.This financial year,COVAX
has only 7% of its planned budget
secured [3], and it does not seem to
have enough financial resources to
guarantee the projected delivery of
600 million doses. Even if it could
ensure this quantity, there will not
be enough doses to reach the 70%
vaccination target set by the WHO
by mid-2022.
The reliance on the donor-run
COVAX, has no power to stop future
divergence of vaccines. As a potential
solution, the WHO created the
mRNA Vaccine Technology Transfer
Hub in South Africa and sub-hubs in
a few other countries in Africa, Latin
America, and Asia to de-centralise
vaccine production and promote self-
reliance.South Africa’s Afrigen is now
reverse engineering mRNA vaccines
without assistance from Moderna
and hopes to initiate phase 1 trials by
autumn 2022 [14]. It will likely need
at least 3-5 years, if not more, to reach
the market. This Hub will build the
capacity for LMICs to produce their
future pandemic vaccines. It can also
use the same technology for future
local production of malaria and HIV
vaccines. However, the mRNA hubs
will likely not hasten the end of the
current pandemic.
Despite the WHO’s COVID-19
Technology Access Pool (C-TAP)
for knowledge transfer, no
pharmaceutical companies have been
incentivised to participate, especially
since the pandemic created the perfect
thriving, profitable environment.
Once a vaccine is developed, they
had guaranteed purchases from all
countries for the entire duration of
the pandemic. The mRNA vaccine
is a new technology and not easily
replicable, heavily relying on supply
chains for its components. As such,
why would these pharmaceutical
companies release their patents?
Currently,thereare11agreementswith
primary pharmaceutical companies
related to vaccine development in
the African continent. However,
except for one, most are “filled and
finish” types that do not require a
complete knowledge transfer to truly
decolonise from A-Z the production
of the mRNA technologies [15]. In
March 2022, Moderna announced
a partnership with Kenya to start a
local manufacturing site, in which
Moderna plans to ship “mRNA
vaccine factory kit” [9] and can
expand in the future for the “fill and
finish” type [16]. This, however, is not
proper knowledge transfer.
An actual knowledge transfer needs
more substantial incentives, such
as a patent waiver. The latter was
proposed by India and South Africa
at the World Trade Organisation
(WTO) in October 2020, to waive
all patents on vaccines, diagnostics,
therapeutics, and medical equipment.
In March 2022, a leaked text from
the WTO showed that this Trade
Related Aspects of Intellectual
Property Rights (TRIPS) waiver
has been watered-down, making the
proposed text a much weaker waiver,
with additional conditions limiting
its usage for patent lifting [18]. The
Médecins Sans Frontières (MSF)
stated that this new text only involves
vaccines and does not address other
barriers to intellectual property,
such as critical information about
manufacturing. It fails to cover all
countries: only developing countries
that export less than 10% of the world
vaccine exports in 2021 are eligible,
excluding countries like Brazil or
China with the largest capacity to
produce immediately generic mRNA
vaccines [19]. Despite allowing
developing countries to produce
their vaccine, this will be labour and
funding intensive.It could take longer
to market a competitive generic
BACK TO CONTENTS
How COVID-19 Vaccine Access is Still Limited in 2022: A Call to Action
15
mRNA vaccine, by excluding major
generic-exporting countries. This
watered-down TRIPS waiver protects
the interests of pharmaceutical
companies concentrated in HICs by
maintaining their price and profits.
In conclusion, the COVID-19
pandemic showed an inequitable
colonial distribution of life-saving
vaccines.It perpetuates the reliance on
few HICs for their well-kept vaccine
secrets, which are global public
goods resulting from public funding
and global scientific collaboration.
Unfortunately, despite all the global
advocacy efforts to lift patents for
all medical countermeasures, a
watered-down WTO TRIPS-waiver
was signed at the WTO ministerial
meeting on 17 June 2022 in Geneva,
far away from the initial text proposed
by India and South Africa. The next
question to consider was: How
can we encourage pharmaceutical
companies to share their knowledge
and help mRNA vaccine hubs build
their capacity to produce vaccines for
a future pandemic?
To date, we must not forget that
the global pandemic has not ended.
In preparation for a future variant
that may require another wave of
worldwide boosters, current generic
manufacturers must be encouraged
to maintain their capacity to scale
up quickly the production of a
large quantity of vaccines for future
worldwide increased demands.
The recognition of newer vaccine
candidates from the LMICs (such
as the Cuban candidates) should
be better promoted and accepted
worldwide.COVAXneedstofacilitate
access to newer vaccine candidates at
a truly affordable cost and advocate
for knowledge transfers. Also, HIC
leaders should be kept accountable
to no longer hoard and pre-order
excessive boosters.
Finally,thereisaneedtourgeACT-A/
COVAX to be transparent and
accountable: the executive decisions
should exclude any commercial
interests from pharmaceutical
representatives. To avoid commercial
and powerful philantro-capitalists
influencing global health agenda and
priorities, our governments need to
increase countries’ direct financing
of the WHO. This commentary has
not touched upon vaccine delivery
and hesitancy, which are other equally
important building blocks of vaccine
access [11]. The latter will require
local governments to be empowered
to perfect their own vaccination
program according to the local
needs and tackle the challenges of
vaccine hesitancy [9]. Finally, the new
pandemic instrument, with an early
draft being formed now in Geneva,
will need to be legally binding and
have a robust system to reinforce
future equitable access to vaccines,
diagnostics and therapeutics, and
mandatory patent waiver and
knowledge sharing. Pandemic
preparedness and investment into
health systems strengthening and
strengthening local capacity to tackle
the pandemic in all its steps will be
crucial. As a global community, it
is time for us to join our voices and
advocate for improved pandemic
preparedness and response via the new
pandemic instrument negotiations.
Special thanks to Prof. Kenneth
Shadlen (London School of
Economics), Prof. David Heymann
(London School of Hygiene &
Tropical Medicine), and Prof.
Carolyn Stephens (London School of
Hygiene & Tropical Medicine), who
served as mentors of the described
content and guided my reflections to
prepare this article.
References
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6. World Health Organization.
Only 1 in 4 African health
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only-1-4-african-health-work-
ers-fully-vaccinated-against-cov-
id-19
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How COVID-19 Vaccine Access is Still Limited in 2022: A Call to Action
16
BACK TO CONTENTS
7. Lanziotti VS,Bulut Y,Buonsenso
D, Gonzalez-Dambrauskas S.
Vaccine apartheid: this is not
the way to end the pandemic.
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8. Sirleaf EJ, Clark H. Report
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the last pandemic. Lancet.
2021;398(10295):101-3.
9. Yamey G, Garcia P, Hassan F,
Mao W, McDade KK, Pai M,
et al. It is not too late to achieve
global COVID-19 vaccine equity.
BMJ. 2022;376:e070650.
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N, Tshangela A, Raji T.
COVID-19 vaccines: how to
ensure Africa has access. Nature.
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11. Wouters OJ, Shadlen KC,
Salcher-Konrad M, Pollard AJ,
Larson HJ, Teerawattananon
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GlobPublicHealth.2021;0(0):1-17.
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Summary: consolidated financing
framework for ACT-accelerator
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Mar 22]. Available from: https://
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item/summary-consolidated-fi-
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celerator-agency-and-in-coun-
try-needs
14. Maxmen A. South African
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15. UNICEF. UNICEF COVID-19
Vaccine Market Dashboard
[Internet]. 2022 [cited 2022
Apr 24]. Available from:
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chive.com/?u=40658b1a132cd-
c263e35b5b97&id=59cc9c8a5e
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cess.org/msf-responds-poten-
tial-compromise-trips-waiver
Wenzhen (Jen) Zuo, MD, CCFP
Co-lead of JDN
Pandemic Working Group
Hospitalist, Vancouver General Hospital
MPH candidate, London School
of Hygiene and Tropical Medicine
London, United Kingdom
E-mail: wenzhen.zuo@mail.mcgill.ca
How COVID-19 Vaccine Access is Still Limited in 2022: A Call to Action
17
The Current Development of Health Management and its Role in the Future Medical Model in China
The emergence and development of
health management is the inevitable
result of the transformation of the
medical model. In the history of
human development, the medical
model has transitioned through
the spiritualist medical model, the
natural philosophy medical model,
the biomedical model, and the bio-
psycho-social medical model, which
finally promoted the emergence of
the discipline of health management.
In traditional Chinese medicine,
the idea of health management
(“Zhiweibing”) reflects the notion
that the disease cure has not yet been
developed. The idea of Zhiweibing
originates from The Yellow Emperor’s
Classic of Internal Medicine, a classic
Chinese medicine book written more
than 2,000 years ago. It states, “A
sage does not treat the disease that
one already has, but rather treats
the disease that has not yet been
developed. A sage does not treat the
turmoil that already existed in the
nation, but rather treats the turmoil
that has not yet been developed.”This
statement stresses the importance of
disease prevention.
After the People’s Republic of China
was founded in 1949, and being
aware that China lacked doctors
and medicines, the country has
continuously given priority to disease
prevention in its national policies.
It has established a tertiary medical
and preventive health care network
covering urban and rural areas,
established a cooperative medical
system suitable for China’s national
conditions, and trained nearly 1.3
million rural doctors at multiple
levels and through various channels.
Additionally, it has extensively
conducted patriotic health campaigns
and implemented the health policy of
“focusing on the medical and health
professionals in the countryside”.
By 1977, after more than 20 years
of efforts, infectious and parasitic
diseases were effectively controlled
[1]. Consequently, the overall health
condition of the Chinese population
has improved.
However, after the Reform and
Opening-up in 1978, and especially
starting with the 21st century, the
health care needs of the Chinese
population grew significantly, as
their living standards improved with
rapid economic growth. Meanwhile,
population ageing accelerated (Table
1). Due to poor diet, about one-third
of the population is overweight or
obese. Also, a total of 40% of the
adult male population smoke, and
fewer than 20% of the population are
engaged in physical activity. Hence,
the incidence of chronic diseases
continuously increases within the
population [2].
With the accelerated pace of life,
staying up late, and mental stress,
about three-quarters of adults are at
risk of developing chronic diseases
due to risk factors such as unhealthy
lifestyles. In one recent study, authors
analysed Ministry of Health data
from 2000 to 2017, and reported
that the leading causes of mortality
in Chinese adults were malignant
tumours, cerebrovascular disease,
cardiovascular disease, respiratory
disease, and injury and toxication
[3]. As these causes were attributed
to more than 85% of the total deaths
in 2017, it propels health leaders to
Qing Guo
Zhenyun Guo
The Current Development of Health Management
and its Role in the Future Medical Model in China
BACK TO CONTENTS
Year
Number of people over 60 years
(in 0.1 billion)
Percentage of population (%)
1999 1.24 10.3
2010 1.78 13.26
2015 2.21 16.0
2020 2.60 18.7
2030 3.71 25.6
2045 4.47 33.5
Table 1. The reported and projected numbers and percentages of people over age 60 in China,
1999-2045 [2].
18
tailor primary prevention and control
efforts to reduce risk factors of non-
communicable diseases, including
cardiovascular disease [3].
Chinese leaders realised that
the country was unable to meet
population needs by solely expanding
hospitals and increasing the number
of hospital beds. Moreover, the health
system recognized that there were
significant challenges associated with
its ageing population and increased
incidence of chronic diseases. In
order to solve these issues, China
adopted the concept of Western
health management, and since then,
theoretical research and practical
exploration of health management in
China have made major progress over
the past 20 years.
In recent years, the health
management industry in China has
developed rapidly, supported by
government policies. In 2013, leaders
proposed in the document, “Several
Opinions of the State Council on
Promoting the Development of the
Health Service Industry”, which
emphasised the need to start by
improving the quality of health care
and health literacy of the population,
by strengthening the health service
industry [4]. As the total output value
of the health industry was 4 trillion
yuan in 2013, the development goal
for the total output value of the health
industry aimed to reach 8 trillion
yuan in 2020 and 16 trillion yuan in
2030. According to reports, China
has achieved the established goals
for 2020 [5]. Moreover, since 2013,
the “China Health Service Industry
Development Report 2013-2021”,
published every two years, provides
a regular analysis, trend prediction,
and international comparison of the
development of China’s health service
industry [5].
As the health management industry
continues to grow, its concepts have
been widely adopted in Chinese
academia. In July 2007, the Chinese
Medical Association Health
Management Branch was established,
and in October of the same year, the
Chinese Journal of Health Management
was launched. In January 2011, the
“IntroductiontoHealthManagement”
was published and distributed by the
People’s Medical Publishing House,
as the first monograph on Chinese
health management [6]. It provided
academic support for universities to
develop health management courses
and promote the cultivation of health
management talents.
In September 2011, China’s first
health management college was
established. In December 2013, the
Zhiweibing and Health Management
doctoral degree was approved by
the Academic Degrees Committee
of the State Council, marking the
establishment of the full bachelor-
master-doctoral training structure
in health management. The Mobile
Health Management System
Engineering Research Centre of
the Ministry of Education was also
founded as a research centre dedicated
to the application of information
technology, big data, and artificial
intelligence in health management.
In November 2015, “Health
Management” was published by the
People’s Medical Publishing House,
as a textbook for China’s Twelfth
Five-Year Plan [7]. Over the past 10
years, many colleges and universities
have launched undergraduate majors
in health service and management,
and as of March 2022, 136 colleges
and universities had established
this major [8,9]. After 20 years of
theoretical and practical research, a
health management discipline with
Chinese characteristics has formed.
Basic Concepts of Health
Management
Health management aims to identify,
monitor, and control for health risk
factors continuously [9]. In 2009, the
Chinese Medical Association Health
Management Branch organised an
event where experts from the national
health management academic
community could jointly compile
and promulgate the “Preliminary
Consensus of Chinese Experts on
the Concept and Discipline System
of Health Management”. This
consensus describes the concept of
health management as follows: “It is
the medical practice and process that,
based on modern health concepts,
physiological-psychological-social
medical models, and Chinese
medicine Zhiweibing concepts,
by adopting theories, techniques,
methods, and means of modern
medicine and modern management,
comprehensively detects, evaluates,
effectively treats and continuously
tracks individuals’ or groups’ overall
health status and risk factors affecting
health. Its purpose is to obtain
maximum health benefits with
minimum investment” [10].
Health management may be centred
on people’s health, with an emphasis
on early screening, assessment, and
intervention coupled with a long-
term continuous, cycle-to-start,
spiral-rising whole-person, whole-
course, and all-round health services
[11]. There are three steps to health:
1) understanding one’s health with
health data collection and health
screening; 2) caring for and evaluating
one’s health with health risk
assessment and health evaluation; and
3) improving and promoting one’s
health with health risk intervention
and health promotion. Health
management seeks to achieve the
maximum health benefits through
the most optimal resource investment.
With this practical process, health
BACK TO CONTENTS
The Current Development of Health Management and its Role in the Future Medical Model in China
19
screening and data collection is the
premise, health assessment and risk
analysis represent the means, health
risk factor intervention is the key, and
health promotion is the goal.
Medical professionals with
corresponding qualifications or
training in systematic medicine can
offer health management services
to individuals who are healthy
(asymptomatic) or managing non-
communicable diseases. To support
these services,information technology
can provide technological support
and empowerment, and financial
insurance can reduce economic
hardships.
Implementation of the “533 Health
Management” Project and Further
Promotion of the “Healthy China”
Strategy
In order to address the increased
incidence of chronic diseases and
pressure of population ageing, it is
necessary to alter the strategy from
“treatment-centred” to “health-
centred”. To this end, the State
Council promulgated the “Healthy
China 2030” Planning Outline in
2019 and formulated the “Opinions
on Implementing the Healthy
China Action” [12,13]. After five
years of hard work, China’s health
service industry has maintained an
overall well developing trend, but
contradictions and difficulties remain.
On the health industry side, patient
data records were often incomplete
and discontinuous, and medical
institutions failed to share data and
break data barriers. No chronic
disease multidimensional health risk
assessment model had been formed.
On the population’s side, low health
literacy led to people not adapting to
healthy lifestyles. Hence, the country
ineffectively met health needs of the
population, including an unbalanced
development of the health service
industry, poor accessibility to health
services, and relatively low-quality
services [14].
In order to find a solution,China must
rely on scientific and technological
progress. Therefore, the “Healthy
China” strategy aims to develop
healthcare with 5G+ technology. The
three characteristics of connection,
interaction, and aggregation of
Internet health services can promote
the interconnection of information
within health service institutions,
the intercommunication of health
services for service providers, and the
union between service institutions. It
breaks down the information barriers
of health resources and makes health
data open and connected.
This “533 Health Management”
system seeks to build personal health
profiles for Chinese residents using
early (early screening, assessment,
intervention) and comprehensiveness
(comprehensive population, areas,
life-cycle) active health management
service systems. It combines
5G networks and medical and
health wearable devices as well
as relies on big data technology
and artificial intelligence [15].
Furthermore, it integrates health
information resources, including
hospitals, physical examination
centres, health management
institutions, insurance institutions,
and third-party institutions, that
build wearable devices. Through
this platform, the decentralised
health data of individuals, families,
communities, medical institutions,
health management institutions, and
commercial insurance institutions can
be integrated into personal dynamic
health electronic profiles, which can
be viewed in real-time by medical
staff,health managers,and individuals.
These links provides protection for
individuals and families to achieve
active health consultation through
the remote consultation system.
As the system aims to build
standardised and generalizable
chronic disease risk stratification
assessment and early warning models,
it integrates a new health service
modelof“healthmanagement+health
insurance”. After the early screening
stage and early assessment stage,
individuals’ risks are identified, and
the system formulates individualised
and precise intervention plans, such
as improving lifestyle factors (e.g.
diet, exercise), mental health, and
continuous follow-up and assessment.
In 2022, the pilot programs of
the “533 Health Management”’
project will be launched nationwide,
focusing on health management
services for chronic diseases such as
cerebrovascular disease, diabetes, and
obesity. First, the “5G+ Zhiweibing
andThree-Early Health Management
System” collects individual health
data using traditional Chinese
medicine questionnaires and infrared
thermal imaging technology. Using a
system combining Chinese medicine
concepts and artificial intelligence,
it automatically analyses data and
provides individualised conditioning
and intervention (e.g. traditional
Chinese medicine acupuncture, Tui
Na, massage, dietary regime). Second,
wearable “533 Health Management’’
devices, like the minimally invasive
continuousglucosemonitoring device,
can assess real-time glucose levels and
provide timely recommendations on
nutrition and physical activity. Over
the next three years, the “533 Health
Management” project aims to build a
new health service model to achieve
health promotion, disease prevention,
and chronic disease management.
References
1. Guo Q. The road to harmony: a
study on community health security
of laid-off workers in China.
Hangzhou, Zhejiang: Zhejiang
University Press; 2006.
The Current Development of Health Management and its Role in the Future Medical Model in China
BACK TO CONTENTS
20
2. National Bureau of Statistics
of China. National Data, 2021
[Internet]. National Bureau
of Statistics of China; 2021
[cited 2022 Apr 8]. Available
from: https://data.stats.gov.cn/
easyquery.htm?cn=C01&z-
b=A0201&sj=2020
3. Zou H, Li Z,Tian X, Ren Y.The
top 5 causes of death in China
from 2000 to 2017. Sci Rep.
2022;12(1):8119.
4. The State Council of the People’s
Republic of China. Several
opinions of the State Council on
promotingthedevelopmentofthe
health service industry [Internet].
The State Council of the People’s
Republic of China; 2013 [cited
2022 Apr 7]. Available from:
http://www.gov.cn/zwgk/2013-
10/14/content_2506399.htm
5. Guo Q. China Health Service
Industry Development Report
2021. Beijing: People’s Health
Publishing House; 2021.
6. Guo Q. Introduction to health
management. Beijing: People’s
Health University Press; 2011.
7. Guo Q. Health management.
Beijing: People’s Health University
Press; 2015.
8. Guo Q. Adapt to the change of
medical model and vigorously
cultivate health management
talents.Chinese Journal of Health
Management. 2015;9(3):161-3.
9. Pang B. The person in charge
of the Department of High-
er Education of the Ministry
of Education answered report-
ers’ questions on the ‘Notice on
the announcement of the 2021
Annual Recording and Trial
results of undergraduate majors in
ordinary colleges and universities’
[Internet]. The State Council of
the People’s Republic of China;
2022 [cited 2022 Apr 7].
Available from: http://www.gov.
cn/zhengce/2022-02/25/con-
tent_5675577.htm
10. Wang L. Basic knowledge
of health managers. Beijing:
People’s Health Publishing
House; 2019.
11. Chinese Medical Association
HealthManagementAssociation;
Editorial Board of Chinese
Journal of Health Management.
Preliminary consensus of
Chinese experts on health
management concept and
discipline system. Chinese Journal
of Health Management.
2009;3(3):141-7.
12. Liu Y. “Healthy China 2030”
planning outline issued by the
Central Committee of the
Communist Party of China and
the State Council [Internet].
The State Council of the People’s
Republic of China; 2016
[cited 2022 Apr 7].
Available from: http://www.gov.
cn/zhengce/2016-10/25/con-
tent_5124174.htm
13. The State Council of the People’s
Republic of China.Opinions of the
State Council on implementing
the Healthy China Action
[Internet]. The State Council of
the People’s Republic of China;
2019 [cited 2022 Apr 7].
Available from: http://
www.gov.cn/zhengce/con-
t e n t / 2 0 1 9 – 0 7 / 1 5 / c o n –
tent_5409492.htm
14. Guo Q. A practical path for
implementing the “Healthy
China 2030” scheme. Health
Research. 2016;36(6):601-4.
15. Guo Q. Analysis on the
construction and application
prospects of 5G + “Three
Early” Health Management
system. Health Research.
2021;41(4):361-4.
Qing Guo, MD, PhD
Institute of Health
Management Research,
Zhejiang Chinese Medical University
President, of Chinese Society of
Health Management of the
Chinese Medical Association
Hangzhou, China
E-mail: qguo@zcmu.edu.cn
Zhenyun Guo, MS
Institute of Health
Management Research,
Zhejiang Chinese Medical University
President, of Chinese Society
of Health Management of
Chinese Medical Association
Hangzhou, China
The Current Development of Health Management and its Role in the Future Medical Model in China
BACK TO CONTENTS
21
Hands-on Deck Approach toward Planning and Implementing Advocacy in Global Health
BACK TO CONTENTS
On 9 April 2022, the Junior Doctors
Network (JDN) of the World Medical
Association (WMA) organised the
webinar, Sharing Best Practices –
How to Plan and Implement Global
Health Advocacy. As part of the 75th
World Health Assembly (WHA75),
the event offered an opportunity for
student and early career professional
groups to share experiences between
different organisations and inspire
audience members to actively
participate in global health advocacy
(Figure 1). Other participating
organisations included Universities
Allied for Essential Medicines
(UAEM),the International Federation
of Medical Students’ Associations
(IFMSA), the Spice Route, and
the Young Doctors’ Movement of
the World Organisation of Family
Doctors (WONCA) South Asia
region. During this webinar, speakers
explained how their organisations
meaningfullyengageyouthinadvocacy
activities, taking into account the
policy cycle of identifying a problem,
determining goals and a target
audience, and then implementing
this plan while continuously receiving
feedback to improve activities [1].
Being a health advocate is recognized
among the core competencies of
physicians and other health care
providers [2]. However, this is often
not reflected in educational strategies
to prepare students,postgraduates,and
early career professionals. In order to
teach advocacy skills, such strategies
that move away from classical lectures
and seminars and include more
interactive formats (e.g. simulations)
and hands-on experiences (e.g. project
placements) should be promoted [3].
Key Messages from the Panellists
Junior Doctors Network
The JDN alumnus showcased actions
taken by junior doctors to shape
the global climate change agenda,
underlining the background of
increased vulnerability and the health
outcomes of climate change. First
actions involved the drafting process
of internal policy documents (as well
as the revision of existing policies) to
set the WMA position as the base for
Marie-Claire Wangari
Flora Wendel
Laura Kalkman
Hands-on Deck Approach toward Planning and Implementing
Advocacy in Global Health from Junior Doctors’ Lens
Yassen Tcholakov
Mercy Wanjala
Figure 1. Promotional poster for the Sharing Best
Practices webinar, held on 9 April 2022.
Credit: JDN
22
further advocacy efforts. Additional
steps included conducting research
and data collection in collaboration
with global academia and international
organisations, in efforts to
communicate the health professionals’
perspectives to policymakers.
Parallel to these efforts, the JDN
followed global policymaking venues,
such as meetings of the United
Nations Framework Convention
on Climate Change (UNFCCC)
including negotiations of the Paris
Agreement, and reported findings to
JDN members, the WMA leadership,
and the health community at large.
These efforts involved working
closely with decision-makers and
stakeholders such as member states,
Non-State Actors (NSA), and the
World Health Organisation (WHO).
In addition, the JDN was involved
in a joint initiative with the WHO
and the Global Climate Change and
Health Alliance (GCHA). In closing,
the speaker recommended that young
advocates do not underestimate the
impact of their voices, be patient
and maintain their enthusiasm, and
collaborate with others while avoiding
duplicated efforts.
International Federation of Medical
Students’ Associations
Iris Blom, IFMSA Liaison Officer to
the WHO, shared the organization’s
vision to ensure that youth voices are
engaged in global health decision-
making at the highest level, noting
the importance of youth participation
at the WHO. Given their official
relations with the WHO, she
highlighted that the WHA serves as a
platform to engage with stakeholders
and decision-makers from member
states and WHO officials in Geneva.
Since the WHA75 offered a valuable
virtual space to connect, to create a
platform for interaction in the virtual
space, IFMSA leadership invited
numerous youth stakeholders as well
as WHO Officials (including the
WHO Director-General) to interact
on a virtual space (Twitter) [3,4].
They presented results of tracking
youth engagement during the meeting
and shared reflections from medical
students and general takeaways for
youth engagement.IFMSA leadership
plans to enhance structured modalities
of engagement, such as the national
youth delegate programs to the WHO.
Young Doctors’ Movement of the World
Organisation of Family Doctors
Dr. Sankha Randenikumara,
the WONCA Young Doctors’
representative, presented an example
of best practices on local advocacy in
Sri Lanka.With the vision to integrate
family medicine concepts into primary
care practice in a resource-poor rural
setting, they built the infrastructural
and human resource capacity of a
primary care clinic, progressively
increasing primary care services and
decreasing congestion at already
overloaded secondary and tertiary
hospitals. He actively advocated for
the extension and reorganisation of
the service delivery model at the clinic,
to provide first-contact, personalised,
comprehensive, continuous, and
coordinated services to families and
communities with a focus on health
promotion, disease prevention, and
health education. They combined
both facility- and community-based
approaches to increasing access to
health promotion and preventive
services,sufficient water and sanitation,
herbal gardens, and better waiting
areas at clinics.
As a junior doctor, he worked with a
committeeofotherexperienceddoctors
and community representatives, where
they could achieve one common goal:
creating a model primary health
care centre that could be emulated
throughout Sri Lanka. The initiative
received a provincial award, and the
organisers were invited by the World
Bank to join an expert committee for a
national project. Although a successful
project, he noted that differing
priorities of external supporters
had posed a few challenges. Hence,
he reiterated that it is important
to manage team priorities while
balancing sponsors’ needs (albeit more
financial power). He highlighted that
as personal experiences are valuable
for one’s advocacy efforts, starting at
the micro-level and embarking on
an unexplored path can present an
enormous opportunity for personal
and professional growth and success.
Universities Allied for Essential
Medicines
Dr. Maurice Remy, the European
Coordinator of UAEM, introduced
national advocacy efforts for
coronavirusdisease2019(COVID-19)
prevention and control in Germany.
Several actions emphasized the
need for the public return of
governmental investments to research
and development of severe acute
respiratory syndrome coronavirus
2 (SARS-CoV-2) diagnostics,
therapeutics, and vaccines, including
socially responsible licensing.
Through press releases in local and
national journals and newspapers,
radio stations, podcasts, and webinars,
they raised public awareness and
engaged the wider community in a
petition addressed to the German
government. Additional advocacy
efforts provided UAEM advocates
with a campaign roadmap, including
templates and guides for social
media, complementary materials,
and links to educational webinars.
Reaching out and collaborating with
other youth organisations helped to
increase visibility by resharing and
reposting tweets and statements or
collaborating on joint educational
events. As lessons learned, he noted
that setting clear goals of advocacy
actions and tailoring efforts to the
intended target group are essential,
BACK TO CONTENTS
Hands-on Deck Approach toward Planning and Implementing Advocacy in Global Health
23
and that changing public discourse
will require a quick reaction and a
shift of the campaign focus.
Conclusion
In summary, this JDN webinar
highlighted how different youth-led
organisations advocated on global
health topics. Speakers described
how they worked on policy activities,
collaborated with internal and external
stakeholders, and addressed decision-
makers’ concerns. They also stressed
that advocacy efforts through on-the-
ground actions or virtual spaces can
increase awareness on pressing topics
and improve population health.
The WMA JDN plans to continue
advocacy work through its working
groups, with the Working Group on
WHO Activities specifically focusing
on capacity building and engagement
around this UN agency’s field of
work. These upcoming events will
offer junior doctors and other youth
members an opportunity to acquire
essential skills to participate in health
advocacy, harnessing their energy,
skills, and practical experiences to
tackle health challenges. Also, the
WHA75 incorporated sessions where
junior doctors could directly engage
with the WMA leadership on drafting
interventions,learn techniques on how
to approach stakeholders and decision-
makers, and raise awareness with the
broader public.
Lastly, incorporating social media in
individual advocacy efforts can lead
to a greater reach to organizational
members and the wider community.
During the Pre-WHA workshop and
the WHA75, the JDN delegation
promoted the first JDN Twitter
space [4]. The JDN leadership and
delegates posted several tweets
during the Pre-WHA and WHA75
using two hashtags (#JDNWHA
and #JDNWHA75). These online
interactions led to increased traffic
on the JDN’s Twitter handle with the
Twitter space announcement. Notably,
the JDN’s most interacted Tweet to
date included 4,275 impressions (as of
19 June 2022), and the JDN’s Twitter
account increased the engagement rate
by 3.7% between 25April and 31 May
2022 (as of 19 June 2022) [5].
References
1. Oxford Medicine. The advocacy
planning cycle [Internet].
The Partnership for Maternal,
Newborn & Child Health. 2013
[cited 2022 Jul 20]. Available
from: https://oxfordmedicine.
com/oxford/fullsizeimage?im-
ageUri=%2F10.1093%2Fmed
%2F9780199565276.001.000
1%2Fmed-9780199565276-g
raphic-010-full.gif&uriChap-
ter=%2F10.1093%2Fmed%2F97
80199565276.001.0001%2Fmed-
9780199565276-chapter-3
2. Royal College of Physicians
and Surgeons of Canada.
CanMEDS: better standards,
better physicians, better care
[Internet]. 2022 [cited 2022 Jun
28]. Available from: https://www.
royalcollege.ca/rcsite/canmeds/
canmeds-framework-e
3. Earnest MA, Wong SL, Federico
SG. Perspective: physician
advocacy:what is it and how do we
do it? Acad Med.2010;85(1):63-7.
4. Junior Doctors Network of the
World Medical Association.
WMA JDN Twitter space
recording [Internet]. May
27, 2022 [cited 2022 Jun 28].
Avai­lable from: https://twitter.
com/i/spaces/1ZkJzbrqWBRJv
5. Junior Doctors Network of the
World Medical Association.
Twitter space: WMA Junior
Doctors Network reflection
of WHA75 [Internet]. 2022
May 27 [cited 2022 Jun 28].
Avai­lable from: https://twitter.
com/WMAJDN/status/152944
7991756656641?s=20&t=5k3e
Qc7TNgtQDBwPihc_Xg.%20
Marie-Claire Wangari, MBChB
JDN Member
Project Manager, Africa Health Business
Nairobi, Kenya
E-mail: mcwangari.wm@gmail.com
Flora Wendel, MD
JDN Working Group on
Primary Health Care
Research Assistant,
Chair of Public Health, and Health
Services Research, LMU Munich
Munich, Germany
Laura Kalkman,MD
JDN Working Group on
WHO Activities
PhD candidate, Infectious
Diseases and Tropical Medicine
University Medical Centre,
Amsterdam, Netherlands
YassenTcholakov, MD, MSc, MIH
JDN Chairperson
Assistant Professor,
Department of Epidemiology,
Biostatistics, and Occupational Health,
McGill University
Montreal, Canada
Mercy Wanjala, MBCHB,
MMED Fam. Med
JDN Member
Family Physician,
MBA Healthcare
Management Candidate,
Strathmore Business School
Nairobi, Kenya
BACK TO CONTENTS
Hands-on Deck Approach toward Planning and Implementing Advocacy in Global Health
24
2022 Kenya Medical Association’s Young Doctors Network Conference: The Unspoken Mental Health Pandemic
BACK TO CONTENTS
The Kenya Medical Association
(KMA) (http://kma.co.ke/) houses
the Young Doctors Network
(YDN) (http://kma.co.ke/contact-
us/committes-and-divisions/
kma-ydn) committee, which
aims to increase the participation
of younger physicians in the
association. The KMA-YDN aims to
connect, develop, and support young
doctors by providing opportunities
to explore and develop their personal
and professional growth.
One of these avenues is the annual
one-day KMA-YDN conference,
which is held as a prelude to the
KMA Annual Scientific Conference
(ASC). Using the theme, “The
Unspoken Mental Health Pandemic”,
this year’s conference was held on 1
May 2022, in Eldoret Town. This
event incorporated various social
media campaigns and conversations
on mental health in the months
leading up to the event. These side
events intended to amplify the voices
and efforts towards creating safe
spaces for mental health advocacy in
the country.
Background
In 2019, Uhuru Kenyatta, the
president of the Republic of Kenya,
highlighted that the country
was facing a mental health crisis,
which led to the formation of
a Mental Health Taskforce to
address the mental health concerns
of Kenyans. After reviewing the
mental health landscape, the Mental
Health Taskforce recommended a
presidential declaration of mental
ill-health as a national public health
emergency. Further, the Taskforce
urged the government and employers
to provide healthy working spaces and
access to mental health amenities [1].
The national burden of mental health
illness is concerning. In Kenyan
health facilities, an estimated 25%
of outpatients and 40% of inpatients
suffer from mental conditions, such
as depression, substance abuse, stress,
and anxiety disorders [2]. Notably,
the COVID-19 pandemic placed a
serious strain on healthcare workers’
mental health and well-being, due
to the strenuous nature of serving
on the frontlines [3]. The “Protecting
the Wellbeing and Strengthening
the Resilience of Frontline Health
Workers” study, which interviewed
nurses and community health
volunteers between January 2021
and June 2022, concluded that two in
every five healthcare workers reported
symptoms of post-traumatic stress
disorder [4].
Furthermore, in 2021, mental
health conditions cost the Kenyan
economy US $572 million, which is
equivalent to 0.6% of the country’s
Gross Domestic Product (GDP) [5].
Considering this burden, the KMA-
YDN aimed to increase mental
health awareness, particularly among
health professionals, and utilised the
Marie-Claire Wangari
Lyndah Kemunto
Raymond Mugume
2022 Kenya Medical Association’s Young Doctors Network Conference:
The Unspoken Mental Health Pandemic
Nicholas Mutuku
Kevin Kipkoech
25
2022 Kenya Medical Association’s Young Doctors Network Conference: The Unspoken Mental Health Pandemic
BACK TO CONTENTS
pre-conference to offer a platform to
discuss ideas on improving mental
health and well-being.
Mental Health in the COVID-19
Era
The opening address was presented
by Dr. Priscilla Makau, the technical
assistant for the Presidential Advisor
on mental health.She highlighted the
key efforts of the Kenyan government
towards improving the state of
mental health services through the
Mental Health Taskforce as well as
the planned construction of the 600-
bed capacity, international-standard
neuropsychiatric hospital in Kajiado
County.
In addition, Dr. Kariuki, Dr. Mutisya,
and Dr. Kayiza (in absentia) from
the University of Nairobi provided
an informative presentation on the
increased cancer risk of using oral
and nasal toxicant products such as
khat and tobacco products. Presenters
recommended that further in-depth
investigations be conducted on these
products in the Kenyan market and
their potential effects. They also
suggested to advocacy efforts can
inform policy decision-makers and
lobby the government of Kenya to
regulate all smokeless tobacco, areca
nut, and khat products.
Mr. Kevin Kipkoech and Ms.
Precious Esther from Maseno
University gave a presentation on a
study from the Maseno University/
KEMRI – Stanford Research Group
on COVID-19 and the health
of Adolescent Girls and Young
Women (AGYW) in Kisumu. They
highlighted the Friendship Bench
intervention as one of the mental
health strategies to tackle the negative
impacts of gender based violence
(GBV) amongst the AGYW.
In the first plenary session, panellists
acknowledged how the COVID-19
pandemic affected the mental
health and well-being of the general
population, noting the continued
moral injury affecting frontline health
professionals. Furthermore, it was
stressedthatisolationduetolockdown
and social movement restrictions
fuelled loneliness that either triggered
or worsened depression amongst
health professionals and the general
public. To address this challenge,
panellists emphasised how mental
health needs a multidisciplinary
approach for collaborative efforts with
psychologists in case management.
Debriefing sessions and safe space
provisions at workstations can
promote mental health support for
health professionals. 
It’s Ok not to be Ok: Stories from
the Frontline Plenary and Thriving
at Work Workshop
These two sessions were preluded by
a fireside presentation by Dr. Yingzi
Zhao, who described key preliminary
findings from an ongoing study on
the licencing internship experience
for General Practitioners in Kenya.
He said that the study showed that
61% of respondents felt that they were
unable to have a work-life-balance
during their licensing internship,with
53% of respondents feeling worn out
due to the workload. These negative
outcomes ultimately had a ripple
effect on their choice of specialties,
with the majority wanting to opt-out
from the clinical specialties.
This presentation paved the way for
the following two sessions, which
were held as open-space discussions
on the concept of “thriving at work”.
This concept is based on the Thriving
at Work report (https://www.gov.uk/
government/publications/thriving-
at-work-a-review-of-mental-health-
and-employers), which summarised
the findings of an independent review
on mental health and employers in
January 2017, that was conducted at
the request of the United Kingdom
Prime Minister, Mrs.Theresa May.
These two conference sessions
shared the report findings and the
applicability to junior doctors in
Kenya and Uganda. Whilst there
was a growing appreciation of the
acute need for solutions that improve
doctors’ well-being, particularly in
their early careers, burnout, substance
use problems, and suicide were
mentioned as some notable concerns.
The KMA National Leadership and
senior physicians in attendance voiced
their willingness to support efforts
that improve mental health within the
health workforce and fortify mental
well-being in the medical profession.
In spite of the lively discussions,
the topic of “thriving at work” was
far from exhausted, and there was a
general consensus on having more
KMA sessions that offer up-to-date
solutions to enhance mental health
and well-being of KMA members
and health professionals.
Speed Mentorship Workshop
As one of the solutions towards
strengthening mental health and well-
being amongst health professionals,
a speed mentorship session gave
participants the opportunity to
mentor and reverse-mentor each
other for 10-15 minutes (Photo 1).
Topics included career development
and branding, the art of networking,
global health leadership, work-life
balance, and doctorpreneurship
(combined entrepreneurship,
investments, and savings).The session
also had fireside presentations on
financial options available to KMA
Sacco young doctors as well as a
lecture by Dr. Michael Mwachiro
on the importance of mentorship
with personal insights from his book,
Reflections on Mentorship.
26
Social Media Initiatives
Preparing for the conference, the
KMA-YDN had collected stories
from members during World
Mental Health Day 2021 (“Mental
Health in an Unequal World”),
to guide them when curating this
national conference. Also, the KMA-
YDN hosted Twitter Spaces for
both workshops, which promoted
mental health and well-being in the
workplaces of KMA members and
the general public. Furthermore,
the launch of the initiative,
#TufungukeMadaktari (Let’s open up
doctors” in Kiswahili), resulted from
a tripartite agreement between KMA,
the Kenya Psychiatrists Association
(KPA), and the Chiromo Lane
hospital, the leading private mental
health hospital in Kenya.
Other Initiatives
To promote physical activity after the
conference, the KMA-YDN hosted
a soccer match between the KMA
football team (Daktari FC) and the
local medical school football team
(Moi University) (Photo 2). The
match ended in a thrilling 2-2 draw
and paved the way for plans to host
more activities through the KMA
divisions and the Medical Students’
Associations of Kenya (MSAKE)
chapters (https://twitter.com/
MSAKE_Kenya).
Conclusion
The 2022 KMA-YDN Conference
discussed the burden of mental health
challenges and presented innovative
solutions to mitigate risk amongst
the general Kenyan population
and its health professionals (Photo
3). These efforts included social
media campaigns, such as the
Twitter spaces and the launch of
the #TufungukeMadaktari initiative,
which both provided a valuable
platform for doctors to find outreach
resources, attend skill-building
workshops, and participate in sports
activities.
The KMA-YDN calls on junior
doctors and national medical
associations worldwide to enhance
advocacy efforts that increase
investments and promote initiatives
for universal access to mental health
services. However, this can only be
achieved when we put the health of
our health professionals first, namely
their mental health and well-being.
Hence, we call upon junior doctors’
networks and national medical
associations to have multiple avenues
for this such as mentorship sessions,
open space discussions and sports and
games that complement the clinical
options offered, so as to enable their
members thrive at work.As the saying
goes, “there is no health without
mental health.”
Photo 1. In-person attendees for the Speed Mentorship session at the KMA Young Doctors Network Con-
ference 2022. Credit: Dr. Simon Kigondu, KMA President
Photo 2. Daktari FC team with the KMA National Executive Council and the KMA Conference Keynote
Speaker, Dr. Letlape Tebogo Kgosietsile, President of the Association of the Medical Councils of Africa
(AMCOA). Credit: Dr. Simon Kigondu, KMA President
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2022 Kenya Medical Association’s Young Doctors Network Conference: The Unspoken Mental Health Pandemic
27
References
1. Task Force on Mental Health,
Ministry of Health (Kenya).
Mental health and wellbeing:
towards happiness and national
prosperity. Nairobi: The Task
Force on Mental Health; 2020.
Available from: https://mental.
health.go.ke/download/mental-
health-and-wellbeing-towards-
happiness-national-prosperity-
a-report-by-the-taskforce-on-
mental-health-in-kenya/
2. Ndetei DM, Khasakhala
LI, Kuria MW, Mutiso VN,
Ongecha-Owuor FA, Kokonya
DA. The prevalence of mental
disorders in adults in different
level general medical facilities
in Kenya: a cross-sectional
study. Ann Gen Psychiatry.
2009;8(1):1-8.
3. De Kock JH, Latham HA, Leslie
SJ, Grindle M, Munoz SA,
Ellis L, et al. A rapid review of the
impact of COVID-19 on the
mental health of healthcare
workers: implications for
supporting psychological well-be-
ing. BMC Public Health.
2021;21(1):1-8.
4. The Aga Khan University.
Promoting the mental health
of frontline health workers.
Nairobi [Internet]. Nairobi: Aga
Khan University Press; 2022.
Available from: https://www.aku.
edu/news/Pages/News_Details.
aspx?nid=NEWS-002800
5. Ministry of Health (Kenya).
Kenya Mental Health
Investment Case 2021: providing
evidence for the long-term health,
social and economic benefits of
investment in mental health
in Kenya. Nairobi: Ministry
of Health; 2022. Available
from: https://mental.health.
g o . k e / d o w n l o a d / k e n –
ya-mental-health-invest-
ment-case-2021/
6. Zhao Y, Gathara D, Nicodemo
C, Were F, English M. Medical
officer-interns in Kenya:
internship experience, wellbeing,
educational and work environment
[Internet]. 2022 [cited 2022 Jul
15]. Available from: https://bit.
ly/2022KMAYDNConfPPT2
Marie-Claire Wangari, MBChB
KMA YDN Mental Health &
Wellness Coordinator (2020-2022)
Project Manager, Africa
Health Business
Nairobi, Kenya
Lyndah Kemunto, MBChB,
MBA-HCM
WMA-JDN Communication Director
KMA YDN Convener (2020-2022)
Nairobi, Kenya
Raymond Mugume, MBChB
EPI Surveillance Officer,
WALIMU-UGANDA
Project lead, Thriving at Work-Uganda
Kampala, Uganda
Nicholas Mutuku, BSC MBChB
Tutorial Fellow,
School of Health Sciences,
Kisii University
Kisii, Kenya
Kevin Kipkoech, MBChB with IT
Co-Investigator,
Kemri-Stanford Research Group
Kisumu, Kenya
Photo 3. Event speakers, organizers, and attendees at the 2022 KMA YDN Conference.
Credit: Dr. Simon Kigondu, KMA President
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2022 Kenya Medical Association’s Young Doctors Network Conference: The Unspoken Mental Health Pandemic
28
Highlights from the 75th World Health Assembly
BACK TO CONTENTS
Highlights from the 75th World Health Assembly
The The
The World Health Organization
(WHO),founded in 1948, is a United
Nations agency that works to achieve
its vision of all peoples attaining the
highest possible level of health. The
WHO strives to promote health,keep
the world safe, and serve vulnerable
populations. The WHO is composed
of three important bodies [1]:
• Secretariat, which consists of the
staff working for the organization;
• Executive Board (EB), which
is composed of 34 individuals
elected by the Health from
different member states
Assembly, considering equitable
geographical distribution
• (with a minimum of three
members for each WHO
Region);
• World Health Assembly (WHA),
which serves as the WHO’s
highest decision-making body
where each member state holds
one vote and where the direction
of the organization is set.
The WHA usually meets once a year
in May, although special sessions can
be called for on an ad hoc basis. It
convenes all 194 WHO member states,
a number of official Observers,as well
as Non-State Actors (NSA) such as
non-governmental organizations.The
World Medical Association (WMA)
is an organization in official relations
with the WHO, which allows it to
participate in the meetings of the
WHO Governing Bodies (WHA)
Yassen Tcholakov
Wenzhen ( Jen) Zuo
Marie-Claire Wangari
Caitlin Pley
Lwando Maki
Wunna Tun
Jihoo Lee
Flora Wendel
29
and the Executive Board meetings
amongst others as NSA. Thus, the
WMA forms an official delegation
and attends the WHA to represent
physicians from its member
associations in discussions on global
health-related issues. Furthermore,
the WMA also sometimes partners
with other organizations to amplify
its reach. One such example is the
World Health Professions Alliance
(WHPA), which brings together
41 million health care professionals
worldwide, including dentists,
pharmacists, nurses, physiotherapists,
and physicians.
The WMA leadership coordinates the
organization’s activities related to its
representation at the Assembly, and
the Junior Doctors Network (JDN)
actively contributes to that work. The
JDN has been organizing capacity
building workshops and sending
delegations to the WHO governing
body meetings since its foundation.
Individual JDN members also present
their inputs on the WHA agenda
items through diverse channels,
consultations, and social media.
Key Issues at this WHA
Although numerous critical global
health issues were discussed at this
WHA, this article will not present a
comprehensive overview of all such
items. It will describe selected topics
of importance, which were suggested
for follow-up and reporting by the
WMA leadership or attracted interest
of the JDN delegates.
OpeningAddressandRe-electionof
Dr.Tedros Adhanom Ghebreyesus
At the 75th World Health Assembly
(WHA75), the opening ceremony
highlighted the theme, “Health for
peace, peace for health”. Various
heads of state gave addresses with
the overarching message of gratitude
for the WHO’s efforts during the
COVID-19 pandemic and the
continued calls for peace due to the
various impact of wars upon socio-
economic and health systems (Photo
1).
Dr. Tedros Adhanom Ghebreyesus,
the WHO Director-General, also
gave a moving welcome address
[2], where he shared his personal
story of being a child of war and
how these experiences affected
him. He highlighted that disease is
compounded by war, climate change,
and geopolitical issues, and shared
information from his visits to conflict
regions both in Ukraine and Yemen.
Finally, he called on all Member
States to ensure peace for health and
to use health as a way of bringing and
maintaining peace.
Dr. Tedros Adhanom Ghebreyesus
also addressed the global impact
of COVID-19 and thanked the
global health community for the
efforts over the last two years and
their collaborations with the WHO.
He highlighted that although the
epidemiological situation is currently
improving, the COVID-19 pandemic
is not over until it is over everywhere.
He then reaffirmed the call for
WHO Member States to commit to
achieving a vaccine coverage over 70%
for the general population and a 100%
coverage for health care professionals,
persons over 60 years of age,and other
communities at greatest risk.
At the WHA75,the WHO Director-
General, Dr. Tedros Adhanom
Ghebreyesus was re-elected to the
position for another five-year term.
He took the opportunity to reiterate
the five priority areas for his ongoing
work as Director General [3]:
• enacting a radical shift towards
promoting healthy lives and well-
being, and preventing disease by
addressing its root causes;
• reorienting health systems
towards primary health care as
the foundation of universal health
coverage;
• strengthening systems and tools
for epidemic and pandemic
preparedness and response at all
levels;
Highlights from the 75th World Health Assembly
BACK TO CONTENTS
Photo 1. The Human Rights and Alliance of Civilizations Room where many WHA discussions and
negotiations occurred. Credit: JDN
30
• accelerate progress towards the
Sustainable Development Goals
through science and innovation,
data and delivery, and digital
tools;
• strengthening the WHO’s
leading role at the centre of the
global health architecture.
Increase in WHO Financing
One of the most critical issues for
the WHO is its financing. Indeed,
currently only approximately 20% of
the WHO’s budget comes from the
so-called “assessed contributions”,
which are non-earmarked funds that
the organization can choose to deploy
as it sees best in order to accomplish
its mandate [4]. The remainder of
the WHO financing comes from
voluntary contributions by Member
States, private funders such as
philanthropic organizations, and the
newly created WHO Foundation.
Those voluntary contributions differ
from assessed contributions, as they
are usually given for a specific area of
work or a specific project. Thus, they
provide the organization with less
flexibility in determining how to best
use these resources to address general
public health needs or respond to
unpredictable events.
WHO financing has been
ambitiously discussed many times in
the past, but overall dialogue leads
to a very modest change. This year,
however, those discussions were
critically different: Member States
agreed to work towards increasing
their assessed contribution to cover
50% of the budget by the 2030-
2031 budget cycle. Although these
negotiations have not been easy,
the WHO Working Group on
Sustainable Financing – unable to
reach consensus during WHA74
and requiring an extension until
WHA75 – noted that these valuable
discussions will likely result in
WHO’s increased sustainability and
capacity to deploy its programs.
Non-communicable Diseases
During this WHA75, a renewed
roadmap 2023-2030 for non-
communicable disease (NCD)
treatment and prevention offering
technical guidance to the Member
States was discussed. This roadmap
highlighted ways of improving
knowledge on NCD epidemiology
and means of addressing barriers
to implementing cost-effective
interventions for prevention
and control efforts. It also offers
recommendations for the integration
of NCD services into primary
healthcare and continued work to
streamline these comprehensive
services. During these discussions
on the roadmap, Member States
expressed their concern that there
had been insufficient attention paid
to NCDs, especially with regard to
financing, despite NCDs recognized
as the leading cause of death
worldwide. Also, while there was
some progress on the reduction of
tobacco use, no significant progress
in reducing other NCD risk factors
across WHO regions was described.
Additionally, the importance of
mental health and access to mental
health services was underlined.This is
a key issue that needs to be addressed
at the community and primary
healthcare level due to the underlying
stigma and discrimination, despite
the important impact on entire health
systems. It was also noted that the
mental health of frontline healthcare
professionals had been particularly
affected during the COVID-19
pandemic. Lastly, Member States
were also urged to explicitly describe
how they plan to tackle environmental
risk factors relating to NCDs, such as
air pollution.
Health Emergency Architecture
As the WHA75 promoted the theme
of peace, technical and political
issues were widely discussed among
Member States. Conversation around
health emergencies mostly revolved
around debating two competing
resolutions on the situation in
Ukraine: one proposed by Ukraine
and 45 Member States, and the
other proposed by Russia and one
other Member State. The outcome
of these discussions was the adoption
of the Ukrainian resolution with a
strong majority, and the rejection
with a strong majority of the Russian
resolution, which was characterized
as “a tool for disinformation” by the
Ukrainian delegates. Indeed, the
Russian proposal failed to mention
that the current state of the Ukrainian
health crisis was secondary to an
ongoing war. The adoption of this
resolution means there will be a
report prior to the next WHA76 on
how much the Russian Federation
has respected the call to action.
Continuous impacts on the health of
Ukrainians from the attacks “would
necessitate that the Assembly should
consider the application of relevant
articles of WHO Constitution”
(meaning that it may suspend voting
rights of the Russian Federation at a
later assembly).
The COVID-19 pandemic has
shown us the challenges of rapid,
efficient, and coherent response in
emergency situations. The need for
new mechanisms and structures
was rapidly apparent and attempts
to create sometimes temporary,
sometimes long-term new solutions
to the challenges were seen over the
past two years. Although some of
those new initiatives have worked
well and must be conserved, others
have faced significant challenges. As
such, they must attempt different
ways to meet their objectives,which is
recognized as the global architecture
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Highlights from the 75th World Health Assembly
31
for health emergencies. Conceptually,
this architecture includes:
• governance that ensures a coherent,
equitable, and coordinated global
health emergency response
preparedness;
• systems and tools to prepare
for, prevent, detect, and rapidly
respond to health emergencies;
• financing to support the above
governance and systems and
tools.
A white paper by the WHO Director-
General proposed a way forward for
how to bring everything together.This
paper places the WHO at the centre
of pandemic governance through the
establishment of the Global Health
Emergency Council and the WHA
Committee for Emergencies. It also
aims to scale up the independent
review process by moving the
Universal Health and Preparedness
Review (UHPR) process from
its pilot phase to implementation
phase. Finally, it delves in how we
can strengthen systems already
in place such as the global health
emergency workforce and existent
various partnerships. Finance is also
identified as a key issue with some
recommended temporary solutions.
Nevertheless, the white paper is still
many steps away from a concrete plan
for implementation. Those next steps
will have to be discussed in future
meetings and through structures that
are to be set up. Importantly, despite
naming them, the document poorly
defines how equity and solidarity will
be addressed, which should be one of
the guiding principles in the future
governance of health emergencies.
Furthermore, it does not truly discuss
root causes of health emergencies:
poverty, environmental degradation,
and conflicts.
Monkeypox
The WHO Health Emergencies
Programme provided technical
briefings to WHA delegates on the
evolving multi-country outbreak of
the monkeypox virus. The disease
is endemic in Western and Central
Africa, where it causes thousands
of cases each year, although the true
burden is unknown [5]. The WHO
declared a “public health emergency
of international concern” on 23 July
2022. Now, the ongoing outbreak
across more than 90 countries has
surpassed 40,000 cases, at the time
of writing on 23 August 2022 [6].
This epidemiological situation is
unusual, and genomic surveillance
and investigations are ongoing.
However, it currently appears that
the heightened incidence in non-
endemic countries, as well as the
evidence for sustained human-to-
human transmission, is likely the
result of both increased global travel
and waning population immunity to
orthopoxviruses since the cessation
of routine smallpox vaccination.
Medical countermeasures against
monkeypox virus exist, in the form
of modified smallpox vaccines and an
antiviral drug called tecovirimat, but
they are in limited quantities and few
health professionals are licensed to
treat monkeypox.
WHA delegates commented that
the goal of outbreak response in
non-endemic countries should be
containment, through a compendium
of measures,including contact tracing,
intensified clinical and laboratory
surveillance,sensitizationofclinicians,
wider health education, targeted
interventions for key populations,and
the use of medical countermeasures.
However, although the goal should be
containment, experts acknowledged
that significant uncertainty in the
data, including clear evidence of
undetected community transmission
and thus no robust estimate of the
extent of disease spread, meant that
the ability to stop transmission could
not be guaranteed.
Crucially, Member State delegates
from the African and South East
Regions pointed out that the global
community was now paying the
price for an endemic disease that had
remained unmanaged for decades.The
tools available to prevent and control
monkeypox infections are scarcely
available in endemic countries, and
very little research is being conducted
to advance our understanding of its
dynamics and to develop better, more
accessible tools. More investment
is urgently needed to improve our
capability to fight infectious diseases
that are endemic in poorer regions of
the world. However, regardless of the
national security interests of high-
income countries, all individuals,
wherever they live, have a right to
health and protection from disease.
Interventions
The WMA delivered a number of
statements at this WHA on the
following topics:
• Immunization Agenda 2030 [7];
• WHO’s Work in Health
Emergencies [8];
• Strengthening WHO
Preparedness for and Response to
Health Emergencies [9];
• Global Health for Peace Initiative
[10];
• Draft Implementation Road
Map 2023–2030 for the WHO
Global Action Plan for the
Prevention and Control of Non-
communicable Diseases 2013–
2030 (Constituency statement)
[11];
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Highlights from the 75th World Health Assembly
32
• Human Resources for Health
(Constituency statement) [12];
• Joint WMA and GAPA
Recommendations on WHO
Draft Action Plan (2022-2030)
to Effectively Implement the
Global Strategy to Reduce the
Harmful Use of Alcohol as a
Public Health Priority [13].
Participation in the WHA
Civil Society Participation
This WHA was the first WHO
Governing Body meeting that took
place in person since the 146th
Executive Board Meeting in February
2020. The resumption of in-person
global health activities in Geneva are
likely a good sign for the world,which
will hopefully lead to continued
meaningful engagement.This meeting
was nevertheless impacted by many
factors which limited engagement.
Indeed, event invitations were sent
very late to civil society organizations.
Details regarding participation were
provided only two weeks prior to the
event, and organizations were given
only two working days to process
the registration of delegates. These
WHO actions are contrary to the
participation and representation
principles held by the JDN and
debatably also highlights a failure of
the WHO to meet its legal obligations
of engagement with civil society. We
truly hope that the challenges faced
this year are unique and that full
engagement will be possible in future
meetings.
The impacts of these actions were
felt in the JDN delegation. Some
delegates were unable to submit
applications for visas to travel to
Switzerland in a timely manner, and
hence were unable to attend.Also,the
delegation logistics were challenging
as only a small number of people
were allowed in the negotiation space.
Despite these challenges, the JDN
tried its best to play its dual role of
empowering young and early career
physicians as well as contributing
to the WMA. While the JDN had
coordinated virtual delegations to
external meetings over the past two
years, this was the first time that
such an endeavour was attempted in
a hybrid mode. Due to the successful
hybrid meeting, JDN members
agreed that the meeting format was
beneficial for the organization and
could enhance member participation
and engagement in the future.
On a positive note, it is important
to highlight that the WHO is also
exploringwaysofensuringmeaningful
engagement of the civil society. This
year, informal preparatory meetings
were held for the second time, which
were well attended and served as an
interesting convening opportunity.
Additionally, modalities of virtual
participation can facilitate easier
participation from a greater diversity
of voices and should be maintained
even after the pandemic.
JDN Pre-WHA Workshop
The JDN held a two-day training
workshop ahead of the WHA
Council Session (Photos 2-3). This
hybrid event focused on giving
the JDN delegation skills for their
week-long engagements at the
WHA75, such as Negotiating
Global Health and Global Health
Governance and Diplomacy and
the WHO. Participants discussed
crucial agenda items that affect
junior doctors, namely, pandemic
preparedness, NCDs, and human
resources for health. In addition, the
agenda included a workshop on Social
Media and its Role in Global Health
Advocacy as well as Careers in Global
Health pertaining to transitions from
clinical work to other fields such as
public health and global health.
The event was attended by over 20
participants as well as approximately
20 online participants. In fact, there
were minimal disparities among
online delegates, who represented
most of the WHO regions in
Africa, Asia, and Europe. Important
efforts were deployed to ensure that
online delegates benefitted from the
experience as much as those who were
present in the room.
Social Media Presence
From 25 April to 31 May 2022, the
Pre-WHA Organizing Committee
posted key social media messages on
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Highlights from the 75th World Health Assembly
Photo 2. JDN Delegation in front of the Palais des Nations. Credit: JDN
33
matters pertaining to the WHA75
via the JDN social media channels
(primarily Twitter and Instagram).
The delegates’ personal handles were
tagged in key posts, and there were
WHA75 specific hashtags for JDN’s
participation (#JDNWHA and
#JDNWHA75).
Twitter analytics revealed that the
interactions with the JDN handle
increased considerably compared
to other posts made in the year
(engagement rate of 3.7%, as of
19 June 2022). Furthermore, the
JDN hosted their first Twitter space
where the delegation shared their
experiences during the week of the
Pre-WHA and the WHA75,with the
Twitter Space Announcement being
the JDN’s most interacted Tweet to
date (wih 4,275 impressions, as of 19
June 2022).
Conclusion
Numerous highlights occurred during
this WHA75. The WHO Director-
General was re-elected for another
five-year term, and Member States
agreed to work towards significantly
increasing their assessed contributions
and thus empowering the WHO to
truly play its global health leadership
role. Some progress was made in
re-working the global architecture for
emergency responses with the small
steps of preliminary amendments to
the International Health Regulations
to enable further substantive changes
in the coming two years. Notably, the
changing global geopolitical situation
was addressed through the theme of
peace for health.
The WMA was present in all
important discussions that occurred
during the WHA. JDN members from
around the world have consistency
demonstrated incredible capacity to
take on leadership in global health.
We hope that this is recognized by the
National Medical Associations, and
that JDN members can contribute
to national efforts related to global
health, recognizing their wealth of
experience and knowledge. 
References
1. World Health Organization.
Governance [Internet]. 2022
[cited 2022 Jun 29]. Available
from: https://www.who.int/
about/governance
2. World Health Organization.
Director-General’s address at
the high-level welcome at the
75th World Health Assembly
– 22 May 2022 [Internet]. 2022
[cited 2022 Jun 29]. Available
from: https://www.who.int/
director-general/speeches/detail/
who-director-general-s-opening-
address-at-the-75th-world-
health-assembly—22-may-2022
3. World Health Organization.
Presentation by Dr Tedros
Adhanom Ghebreyesus as a
can­
di­
date for the post of
Director-General at the
150th session of the Executive
Board [Internet]. 2022 [cited
2022 Jun 29]. Available from:
https://www.who.int/director-
g e n e r a l / s p e e c h e s / d e t a i l /
presentation-by-dr-tedros-
adhanom-ghebreyesus-as-a-
candidate-for-the-post-of-
director-general-at-the-150th-
session-of-the-executive-board
4. World Health Organization.
How WHO is funded [Internet].
2022. [cited 2022 Jun 29].
Available from: https://www.
who.int/about/funding
5. World Health Organization.
WHO is supporting African
countries to strengthen
monkeypox surveillance and
response actions [Internet]. 2022
[cited 2022 Jun 29]. Available
from: https://www.afro.who.
int/news/who-supporting-
african-countries-strengthen-
monkeypox-surveillance-and-
response-actions
6. US Centers for Disease
Control and Prevention. 2022
Monkeypox outbreak global map
[Internet]. 2022 [cited 2022 Aug
23]. Available from: https://www.
cdc.gov/poxvirus/monkeypox/
response/2022/world-map.html
7. World Medical Association. Item
14.5 Immunization Agenda 2030
[Internet].2022[cited2022Jun29].
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Highlights from the 75th World Health Assembly
Photo 3. JDN Delegation to the World Health Assembly. Credit: JDN
34
Available from: https://www.wma.
net/wp-content/uploads/2022/05/
WHA75-WMA-Statement-
Immunization-Agenda-2030-
May2022.pdf
8. World Medical Association. Item
16.3 WHO’s Work in Health
Emergencies [Internet]. 2022
[cited 2022 Jun 29]. Available
from: https://www.wma.net/
wp-content/uploads/2022/05/
WHA75-WMA-Statement-
W H O s – w o r k – i n – h e a l t h –
emergencies-May2022.pdf
9. World Medical Association.
Item 16.2 Strengthening WHO
Preparedness for and Response to
Health Emergencies [Internet].
2022 [cited 2022 Jun 29]. Available
from: https://www.wma.net/
wp-content/uploads/2022/05/
WHA75-WMA-Statement-
WHO-preparedness-for-and-
response-to-health-emergencies-
May2022.pdf
10. World Medical Association.
Item 17.2 Global Health for
Peace Initiative [Internet]. 2022
[cited 2022 Jun 29]. Available
from: https://www.wma.net/
wp-content/uploads/2022/05/
WHA75-WMA-Statement-
G l o b a l – Pe a c e – i n i t i a t i v e –
May2022.pdf
11. World Medical Association.
Constituency Statement on
Agenda Item 14.1: Follow-up
to the Political Declaration of
the Third High-level Meeting
of the General Assembly on
the Prevention and Control of
Non-communicable Diseases
[Internet]. 2022 [cited 2022 Jun
29]. Available from: https://
www.wma.net/wp-content/
uploads/2022/05/WHA75-
HPs-constituency-statement-
on-NCDs.pdf
12. World Medical Association.
Constituency Statement on
Agenda Item 15. Human
Resources for Health [Internet].
2022 [cited 2022 Jun 29]. Available
from: https://www.wma.net/
wp-content/uploads/2022/05/
WHA75-HPs-constituency-
statement-on-HRH-1.pdf
13. World Medical Association. Joint
WMA and GAPA Statement on
the Draft Action Plan (2022-
2030) to Effectively Implement
the Global Strategy to Reduce
the Harmful Use of Alcohol
as a Public Health Priority
[Internet]. 2022 [cited 2022 Jun
29]. Available from: https://
www.wma.net/wp-content/
uploads/2022/05/WHA75-
WMA-GAPA-statement-
WHO-draft-action-plan-on-
alcohol-May2022.pdf
Yassen Tcholakov, MD, MSc, MIH
JDN Chairperson
Assistant Professor,
Department of Epidemiology,
Biostatistics, and Occupational Health,
McGill University
Montreal, Canada
E-mail: yassen.tcholakov@mcgill.ca
Wenzhen (Jen) Zuo, MD, CCFP
Co-lead of JDN
Pandemic Working Group
Hospitalist, Vancouver General Hospital
MPH candidate, London School
of Hygiene and Tropical Medicine
London, United Kingdom
E-mail: wenzhen.zuo@mail.mcgill.ca
Marie-Claire Wangari, MBChB
JDN Member
Project Manager, Africa
Health Business
Nairobi, Kenya
Caitlin Pley, MB, Ma, BChir BA
JDN Member
Academic Foundation Doctor, Guy’s and
St Thomas’ NHS Foundation Trust
London, UK
Lwando Maki, MBCHB, FCPHM,
MMED, PHM, MRSSAf
JDN Deputy Chair
Internal Medicine Resident,
University of Cape Town
Public Health Medicine Specialist,
University of Pretoria, South Africa
E-mail: dr.lwando.maki@gmail.com
Wunna Tun, MBBS, MD
Fellow in Medical Education
JDN Secretary
Yangon, Myanmar
Jihoo Lee, MD
JDN Member
Medical Resident, Department
of Internal Medicine,
Seoul National University Hospital
Seoul, Republic of Korea
Flora Wendel, MD
JDN Working Group on
Primary Health Care
Research Assistant, Chair of
Public Health and Health Services
Research, LMU Munich
Munich, Germany
BACK TO CONTENTS
Highlights from the 75th World Health Assembly
35
World Tuberculosis Day 2022: A Closer Look at the Dominican Republic
BACK TO CONTENTS
World Tuberculosis (TB) Day 2022
was commemorated on March 24, to
increase awareness of the economic
and social drivers associated with
TB burden. TB is now the second
leading cause of global mortality due
to a single infectious agent – second
to the coronavirus disease 2019
(COVID-19) – and has caused an
estimated 10 million cases and 1.5
million deaths in 2020 [1]. Despite
significant achievements to reduce
TB case notifications and mortality
over the past decade, disruptions in
clinical, public health, and laboratory
services due to the COVID-19
pandemic have resulted in the
increased reporting of TB cases and
deaths [1].
Using the theme, “Invest to end TB.
Save lives”, World TB Day 2022
campaigns highlighted the urgency
of national investments to prioritize
ongoing efforts and accelerate
momentum to achieve the established
targets of the End TB Strategy and
the Sustainable Development Goals.
The End TB Strategy includes
milestones on reducing TB cases
(90% by 2030, 95% by 2035) and
deaths (80% by 2030, 90% by 2035)
and eliminating catastrophic costs
affecting families [2]. This strategy
incorporates three pillars as a robust
framework to ensure equitable access
to high-quality TB health services:
1) integrated, patient-centred TB
care and prevention (Pillar 1); 2)
bold policies and supportive systems
(Pillar 2); and intensified research and
innovation (Pillar 3) [2].
Notably, the first UN General
Assembly High-level meeting on
TB, which was held in September
2018, offered renewed hope and
joint commitment by Member States
to strengthen investment for TB
diagnosis, treatment, and prevention
that reduces stigma and curbs TB
transmission [3]. Using the theme,
“United to end TB: An urgent global
response to a global epidemic”, this
meeting resulted in the development
of a political declaration to support
continued progress to achieve End
TB targets, which was later adopted
by the United Nations General
Assembly in October 2018 [3].
With these ambitious global targets,
Member States strive to accelerate
national plans and take immediate
steps to curb TB transmission.
Impact of the COVID-19 Pandemic
In low- and middle-income countries,
however, challenges were observed
in the readiness of health system
preparedness to manage the “dual
epidemics”of COVID-19 andTB [4].
Unprepared health system leadership
and infrastructure coupled with
coexisting health priorities slowed
efforts to implement solutions that
increased access and availability of
essential TB services. Also, insufficient
health workforce support, recognized
through continued training and
appropriate workplace environments,
and weak connections to primary
health centres have hindered health
teams to feel empowered in their
daily tasks and build rapport with
community members in their health
promotion activities [4].
Potential recommendations can
combat these challenges by ensuring
that robust governance supports
sustainable national health budgets
and builds networks of community
stakeholders [4]. Also, supporting
health professional training and
safe workplace environments can
reinforce the health and well-being
of essential personnel and reduce the
risk of burnout or other mental health
stressors. With increased internet
coverage, albeit access issues that have
been proposed as a social determinant
of health, digital health interventions
ranging from telemedicine to
social media technology during
the COVID-19 pandemic can be
modified and adapted for TB care
[5,6].
Americas Region
In the Americas region, reported
TB deaths were more than 10%
higher in 2022 than 2015 – where
3,000 deaths alone were attributed
to the COVID-19 pandemic – with
an estimated 291,000 new cases and
27,000 deaths [1,7]. Current Pan
American Health Organization
(PAHO) reports show that there
are 13 high TB burden countries in
the Americas region, defined with
more than 10,000 annual TB cases
Helena Chapman
Bienvenido Veras-Estévez
World Tuberculosis Day 2022:
A Closer Look at the Dominican Republic
36
BACK TO CONTENTS
or an incidence rate of more than
44 (per 100,000 people). These 13
high TB burden countries represent
88.7% of the regional burden, where
Brazil, Colombia, Haiti, Mexico, and
Peru represent 69.8% of the total
number of TB cases [7]. Notably,
three countries have documented
an incidence rate of over 100 (per
100,000 people): Haiti (166.6 per
100,000 people), Peru (115.2 per
100,000 people), and Bolivia (102.8
per 100,000 people). These statistics
demonstrate the ongoing TB burden
within the Americas region and the
critical need to take prompt action to
end TB transmission.
A Closer Look at the Dominican
Republic
The Dominican Republic (DR) is a
middle-income country of 11 million
residents and occupies the eastern
two-thirds of the island of Hispaniola
in the Caribbean. According to
the World Health Organization
(WHO), 4,500 new TB cases with
an incidence rate of 41 (per 100,000
people) were reported in 2020,
marked by a continued decline from
60 (per 100,000 people) in 2016
[8]. The DR Ministry of Health
aims to follow the End TB Strategy,
including stopping the TB chain of
transmission, detecting 90% of TB
cases, and curing 90% of diagnosed
TB patients by 2035.
According to the Strategic Plan for
the National TB Response from 2019-
2021, 11 provinces represent 87% of
the total TB cases in the DR,and four
provinces have the largest number
of co-infected TB/HIV cases [9].
This document highlights the need
to focus on the social determinants
of health, emerging drug resistant
strains, co-infected TB/HIV persons,
and at-risk populations living in
marginalised communities [9]. This
guidance document replaced the
Strategic Plan for the National TB
Response from 2015-2020. Notably, in
March 2022, national health leaders
met and declared that they will review
the Strategic Plan for the National TB
Response from 2019-2021, in efforts
to update the content and launch
the Strategic Plan for the National TB
Response from 2022-2025 [10].
Like other countries, as the
COVID-19 pandemic influenced
the delivery of essential TB services,
existing gaps were observed in clinical
care (e.g. missed opportunities
for early diagnosis within at-risk
communities such as prisoners and
immigrants), community health (e.g.
risk perception related to health-
seeking behaviours, co-infected
TB/diabetes cases), and laboratory
services (e.g. expiration of laboratory
reagents). However, the exact impact
on the COVID-19 pandemic on TB
incidence and mortality rates in the
DR is unknown. We will describe a
few specific clinical, epidemiology,
and research gaps and proposed
actions, aligned with the three pillars
of the End TB Strategy, which were
identified in the Strategic Plan for the
NationalTB Response from 2019-2021
[9].
Pillar 1. Integrated, patient-centred TB
care and prevention
Patient-centred care that supports
patients’ holistic health care needs
and decisions represents an essential
component of TB prevention
and control. In the DR, patient
attrition to TB management has
been attributed to multiple factors,
including challenges navigating the
health system (e.g. scheduling and
quality of health services), social
determinants of health, existing
stigma and discrimination, history
of mental illness or substance abuse,
and poor health literacy [9]. Real-
time surveillance monitoring at the
DR National TB Program has been
challenged due to weak connections
between the provincial epidemiology
centre and community primary care
units (unidades de atención primaria,
UNAP, in Spanish), especially for
contact tracing activities.
By expanding the national TB
surveillance system, DR health
leaders can identify and monitor
risk factors associated with patients’
low adherence to the treatment
duration related to directly observed
treatment short-course (DOTS)
[9]. Contact tracing can identify
contacts of TB cases, monitor their
symptoms, and refer individuals with
respiratory symptoms to local health
centres. Community-based education
programs can help increase awareness
of TB risk and disease, promote the
importance of treatment adherence,
and stress that TB is a curable disease,
which can ultimately help reduce TB-
related stigma and discrimination. By
strengthening the networks between
the National TB Program and
hospital and community health staff
– such as primary care physicians,
medical residents, nursing personnel,
and community health promoters
– these health teams can contribute
their technical expertise to promote
integral, patient-centred care for TB
prevention and control.
Pillar 2. Bold policies and supportive
systems
The commitment of governments
and national health systems is
indispensable to support and maintain
robust National TB Programs. In the
DR, health leaders have reported
that 15% of TB patients do not have
a form of legal documentation (e.g.
identification card) as part of the legal
national registry [9]. As a result, they
can face economic hardships as they
may be unable to receive economic
benefits of available social programs
financed by the government.
World Tuberculosis Day 2022: A Closer Look at the Dominican Republic
37
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To address this gap,DR health leaders
can collaborate with the Central
Electoral Board to expand the
national registry to eligible persons
who merit status as well as community
organisations to identify individuals
who lack legal documentation [9].
The DR health system can also
reinforce links between TB patients
and two social programs, the
Single System Beneficiary (Sistema
Único de Beneficiarios, SIUBEN,
in Spanish) and the Progression
in Solidarity (Progresando con
Solidaridad, PROSOLI, in Spanish).
SIUBEN was founded in 2004,by the
Executive Order 1073-04, to identify
vulnerable persons and ensure
their access to social programs and
monetary subsidies,according to their
socioeconomic status. PROSOLI was
founded in 2012, by the Executive
Order 488-12, to strengthen the
social protection of families living
in extreme poverty. Likewise,
establishing links between TB
patients and the Dominican Social
Security System can offer additional
economic resources including food
supplementation. These efforts
ensure that TB patients can have
the appropriate legal documentation
to access health services for prompt
TB diagnosis and treatment and
social programs for economic and
nutritional support throughout the
disease management.
Pillar 3. Intensified research and
innovation
Operational TB research, which
aims to analyse operational health
services of local programs and
develop solutions that can improve
overall quality and effectiveness, can
help advance scientific understanding
of disease burden and streamline
essential TB services [11,12]. In the
DR, inadequate research funding
to examine the effectiveness of
established TB interventions and
limited technical capacity linked with
international standards to support
operational research are recognized
limitations [9].
As such, DR health leaders can
identify potential national and
international funding opportunities
to support operational research that
can closely examine current practices
within the National TB Program and
identify innovative recommendations
to strengthen national TB response
efforts [9]. The formation of a
national TB research network can
help share offer scientific events to
disseminate findings that can energise
the health community and reinforce a
robust framework with best clinical
and public health practices to
combat emerging challenges in TB
prevention and control. This network
can also provide valuable learning
opportunities for graduate students
and early career professionals to gain
key skills in designing and conducting
community-based research studies.
Conclusion
During the COVID-19 pandemic,
successful global achievements in TB
prevention and control have reverted
and may hinder efforts to accelerate
progress toward the End TB Strategy
and the Sustainable Development
Goals. National health systems,
together with guidance from leading
health organisations, must invest in
National TB Programs’ efforts to end
TB transmission. Notably, the World
Medical Association (WMA), which
supported the UN General Assembly
High-level meeting on TB in 2018,
prepared the WMA Resolution on
TB in 2017 [13]. An updated WMA
resolution will be fundamental to
propel the WMA membership to
take national action and promote the
TB prevention and control guidelines
of leading international organisations.
As forward steps, WHO and PAHO
leaders have recommended timely
actions to strengthen ongoing
initiatives that can achieve the
targets of the End TB Strategy and
the Sustainable Development Goals
[1,7]. First, early diagnosis initiatives
can focus on expanding the universal
application of rapid molecular tests
(e.g. Xpert MTB Rif), identifying
drug-resistant strains, and increasing
the active surveillance of contact cases.
These efforts can minimise laboratory
errors and missed opportunities for
early diagnosis. Second, guaranteed
DOTS administration by trained
health personnel at health centres or
home visits can build rapport, avoid
interrupted doses, and strengthen
patients’ adherence to long-term
clinical management. Recent WHO
guidance on six- and nine-month
oral regimens for drug-resistant TB
strains will offer short, cost-effective
therapeutic regimens for TB patients
[14]. Third, increased national
funding for TB care, including
food supplements, can provide TB
patients with additional economic
and nutritional support during their
treatment. Surveys that capture the
financial hardships for patients and
families during their TB management
will inform authorities of program
gaps that can drive additional
solutions to mitigate this family
burden. Finally, increased efforts
to identify vulnerable communities
for TB transmission, including
indigenous populations, can support
the development of prompt and
ethical health policies and continued
education programs that can promote
direct interactions among community
residents, health practitioners, and
leaders.
As we recognize World TB Day 2022
– and the “Invest to end TB. Save
lives” theme – global health leaders
continue to analyse the impacts of
the COVID-19 pandemic on TB
prevention and control efforts.To take
World Tuberculosis Day 2022: A Closer Look at the Dominican Republic
38
BACK TO CONTENTS
collective action toward achieving the
targets of the End TB Strategy and
the Sustainable Development Goals,
national health systems must commit
sustainable funding for National
TB Programs, renew links between
the National TB Program and local
communities, and develop proactive
and innovative approaches to educate
and reach at-risk populations for early
diagnosis and treatment.
References
1. World Health Organization.
World Tuberculosis Report
2021 [Internet]. Geneva: WHO;
2021 [cited 2022 May 27].
Available from: https://www.
who.int/publications/digital/
global-tuberculosis-report-2021/
covid-19
2. World Health Organization.
The End TB Strategy. Geneva:
WHO; 2015 [cited 2022 May
27]. Available from: https://
www.who.int/teams/global-
tuberculosis-progr amme/
the-end-tb-strategy
3. World Health Organization. UN
General Assembly High-Level
Meeting on the fight against
tuberculosis [Internet]. 2018
[cited 2022 May 27]. Available
from: https://www.who.int/
news-room/events/un-general-
assembly-high-level-meeting-
on-ending-tb
4. Chapman HJ, Veras-Estévez
BA. Lessons learned during
the COVID-19 pandemic to
strengthen TB infection control:
a rapid review. Glob Health Sci
Pract. 2021;9(4):964-77.
5. Benda NC, Veinot TC, Sieck CJ,
Ancker JS. Broadband internet
access is a social determinant
of health! Am J Public Health.
2020;110(8):1123-5.
6. Pai M, Kasaeva T, Swaminathan
S. Covid-19’s devastating effect
on tuberculosis care – a path
to recovery. N Engl J Med.
2022;386(16):1490-3.
7. Pan American Health
Organization. Factsheet 2022:
the End of TB Strategy: main
indicators in the Americas
[Internet]. 2022 [cited 2022
May 27]. Available from: https://
www.paho.org/en/documents/
factsheet-2022-end-tb-strategy-
main-indicators-americas
8. World Health Organization.
Tuberculosis profile: Dominican
Republic [Internet]. 2022
[cited 2022 May 27]. Available
from: https://worldhealthorg.
shinyapps.io/tb_profiles/?_
inputs_&lan=%22EN%22
9. Dominican Republic Ministry
of Health. Plan Estratégico
de la Respuesta Nacional a
la Tuberculosis 2019-2021
[Internet]. 2019 [cited 2022 May
27]. Spanish. Available from:
https://repositorio.msp.gob.do/
handle/123456789/2128
10. Dominican Republic Ministry of
Health. MSP inicia revisión plan
Nacional (PEN) 2022-2025)
con miras a fortalecer respuesta
a la enfermedad [Internet]. 2022
[cited 2022 May 27]. Spanish.
Available from: https://www.
msp.gob.do/web/?p=14778
11. Remme JH, Adam T, Becerra-
Posada F, D’Arcangues C, Devlin
M, et al. Defining research to
improve health systems. PLoS
Med. 2010;7(11):e1001000.
12. Harries AD,Thekkur P, Mbithi I,
Chakaya JM,Tweya H,Takarinda
KC, et al. Real-time operational
research: case studies from the
field of tuberculosis and lessons
learnt. Trop Med Infect Dis.
2021;6(2):97.
13. World Medical Association.
2017. WMA Resolution
on Tuberculosis [Internet].
2017 [cited 2022 May 27].
Available from: https://
www.wma.net/policies-post/
wma-resolution-on-tuberculosis/
14. World Health Organization.
WHO issues rapid
communication on updated
guidance for the treatment
of drug-resistant tuberculosis
[Internet]. 2022 [cited 2022
Jun 10]. Available from: https://
www.who.int/news/item/02-
05-2022-who-issues-rapid-
communication-on-updated-
guidance-for-the-treatment-of-
drug-resistant-tuberculosis
Helena Chapman, MD, MPH, PhD
Milken Institute
School of Public Health,
George Washington University,
United States
Bienvenido Veras-Estévez,
MD, MPH
Department of Epidemiology,
Hospital Regional Universitario
José María Cabral y Báez &
Faculty of Health Sciences,
Universidad Católica del Cibao
Santiago de los Caballeros & La Vega,
Dominican Republic
E-mail:
bienvenido.veras@ucateci.edu.do
World Tuberculosis Day 2022: A Closer Look at the Dominican Republic
39
Each year, World Oceans Day is
commemorated on 8 June, and
countries collectively raise awareness
of the annual theme through
activities, press releases, and social
media campaigns. The 2022 theme,
“Revitalization: Collective Action for
the Ocean”, provides an opportunity
for global citizens to reflect on the
marine ecosystem, recognize and
understand the man-made impacts
on ocean health, and encourage
communities to develop initiatives
that enhance ocean sustainability [1].
Oceans, which represent one-third
of Earth’s surface, offer numerous
benefits to the world, including
supportforadiversemarineecosystem,
contributions to atmospheric gas
exchange, and climate regulation [2].
However,oceans can also provide food
and medicinal products, economic
resources, marine transportation, and
recreational activities [2].
All nations will need to prioritize
ocean management and conservation
in order to achieve the milestones
of the Sustainable Development
Goal (SDG) 14 (Conserve and
sustainably use the oceans, seas, and
marine resources). By applying the
comprehensive definition of One
Health, which was recently published
by the One Health High Level Expert
Panel, global leaders can strengthen
efforts to promote healthy ocean
ecosystems through multidisciplinary
collaborations and community
engagement [3]. In this article,
physicians from 16 countries − the
Dominican Republic, Iceland, India,
Italy, Kenya, Malaysia, Myanmar,
Nigeria, Philippines, Poland, South
Africa, Spain, Sweden, Thailand,
Trinidad and Tobago, and Uganda −
shared insight and reflections about
World Oceans Day 2022.
Dominican Republic
The Dominican Republic,a Caribbean
island nation with approximately 11
million residents, is connected to the
Atlantic Ocean to the north and the
Caribbean Sea to the south. Ocean
sustainability is crucial for our global
ecosystems that are directly linked to
humanandanimalhealth,promotedby
the One Health concept [3]. The safe
and proper management of coastlines
is a significant priority for the political
leadership of Caribbean island nations
that depend on the multi-million-
dollar tourism industry. As oceans
offer an important income source for
fishermen and consumers, economic
profits can be invested in continued
development of the tourism sector,
including improved infrastructure
and services. These actions directly
impact the economic sustainability of
coastline communities in nearby zones
and regions.
WMA Members Reflect on World Oceans Day 2022
BACK TO CONTENTS
WMA Members Reflect on World Oceans Day 2022
Credit:
Romolo
Tavani
/
shutterstock.com
40
The Dominican Republic’s Ministry
of Environment and Natural
Resources has represented a strong
voice to protect natural ecosystems
across the country. Notably, in
July 2022, the All-Atlantic Ocean
Research Forum 2022, hosted by
Brazil, the United States, and the
European Commission, launched
the All-Atlantic Ocean Research
and Innovation Alliance Declaration
[4]. At this meeting, the minister of
the Ministry of Higher Education,
Science, and Technology (MESCyT,
in Spanish) voiced his support for
the collective regional and global
commitment to ocean sustainability.
For example, he mentioned that the
arrival of sargassum has impacted
the country’s coastlines, and national
leaders aim to identify alternative
measures to use sargassum, such as
food supplements for livestock and
fertilizer and biofuel manufacturing.
He also announced that MESCyT
would continue to support funding
for research projects that examine
ocean health and biodiversity (e.g.
sargassum, mangroves, marine life) –
of the Atlantic Ocean and Caribbean
Sea – and identify potential solutions
to protect these natural ecosystems.
Furthermore, like other countries,
another national challenge is plastic
pollution.Recently,the“PlasticIsland”
term was used to depict the challenges
of plastic bottle manufacturing and
use, community-based activities that
promote plastic recycling, and the
collection and disposal of plastic
bottles in landfills in the Dominican
Republic and global oceans [5]. As
this documentary offered a closer
look at the impact of plastic pollution
in the Dominican Republic, this
example can be observed across
other countries, stressing that plastic
pollution remains a global priority.
Caring for our global oceans requires
sustainable collaborations that can
generate a cultural change within
our society to actively preserve
our natural resources. During this
“decade of action”, nations should
form robust collaborations across
disciplines and sectors to support
specific actions that promote ocean
sustainability. These efforts can
include increasing overall awareness
of our cultural interactions with
oceans,promoting the appropriate use
(reduce, reuse, recycle) of disposable
materials, understanding the harmful
effects of ocean acidification and
overfishing, and developing policies
and regulations with individual or
industry sanctions for plastic and
chemical pollution. As global health
leaders, we have an indispensable role
in propelling collective actions for
this essential paradigm shift.
Iceland
As a Nordic island in the north
Atlantic ocean, our country
recognizes that healthy oceans
are essential to protect all natural
ecosystems. The recent report from
the UN’s Intergovernmental Panel
on Climate Change (IPCC) noted
the detrimental effects of climate
change on our planet – including
ocean acidification and changes to
ocean currents affecting Iceland –
and urged immediate action to
combat the climate crisis [6]. Each
June, we support World Oceans
Day and Iceland’s Fishermen’s
Day (Sjómannadagurinn), to raise
awareness of the need to lead the
sustainable use of natural resources
and honor the dedicated fishermen
and fishing industry since our nation’s
foundation, respectively. Since 1938,
Iceland’s Fisherman’s Day has been
celebrated on the first Sunday in
June, which closely aligns with World
Oceans Day on 8 June.
For decades, the Icelandic
Environment Agency, under the
Ministry for the Environment and
Natural Resources, has coordinated
national projects to protect the sea
and its ecosystems.The agency focuses
on disseminating timely information
to the public about the state of
marine pollution, including plastic
pollution. This year, in connection
with World Oceans Day and Iceland’s
Fishermen’s Day, the agency hosted
an exhibition in the capital city of
Reykjavík, to educate the public on
oil pollution in the sea and urge the
call for global actions that minimize
adverse effects on the surrounding
marine ecosystems. Notably, the
exhibition included a documentary
that highlighted the swift actions of
responders when the Wilson Muuga
cargo ship ran aground at Hvalsnes
in Reykjanes, the southwestern
region of Iceland, in December 2006.
Visitors observed the mechanical
equipment on display, which was
used to clean up the oil pollution
after the spill. This historic example
illustrates the delicate balance of our
global ecosystems and our collective
responsibility to respect and protect
these natural resources.
India
India is a culturally rich and
diversified country with a coastline
that stretches over half of its
perimeter. Coastline and landlocked
communities are directly impacted by
fluctuations in available employment
opportunities and resources, such as
seafood and fish oil, that depend on
ocean sustainability [7]. Furthermore,
as our coastlines include the most
enchanting beaches in the world, the
tourism industry is important for the
national economy.
Ocean health is inextricably linked
to human health. Infectious diseases
transmitted through water, harmful
algal blooms, poisoned seafood,
and chemical pollution are all
indicators that our oceans are in
jeopardy. Whales, dolphins, and
other marine animals swim in the
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WMA Members Reflect on World Oceans Day 2022
41
microplastic-contaminated ocean
waters and consume the same seafood
that people ingest [8]. Maintaining
the condition of our oceans involves
more than merely safeguarding human
health; it also entails inventing novel
means of saving lives. The diversity
of marine organisms in our oceans
holds great promise for a multitude of
medications and natural commodities
to counter diseases and improve
the quality of our lives. Novel drugs
derived from marine sources have
been created to treat cancer,antibiotic-
resistant staphylococcus infections,
inflammation, asthma, and pain [9].
As a global community, it is critical to
recognize that ocean health affects us
all in different ways and that we must
take prompt actions to conserve this
delicate ecosystem.
The government of India has taken
numerous steps to improve ocean
sustainability and production and
reverse their decline.First,in 2020,the
Ministry of Earth Sciences (MoES)
released India’s Draft Blue Economy
Policy for public consultation, which
aims to increase the blue economy’s
contribution to India’s gross domestic
product, improve coastal populations’
lives, preserve marine biodiversity,
and protect marine areas and
resources [10]. Second, in 2019, India
and Norway established the India-
Norway Ocean Dialogue, where
Integrated Ocean Management was
emphasized as a strategy to manage
renewable and non-renewable
natural resources [11]. This marine
framework, including the use of
marine spatial planning, which can
minimize economic sector conflicts
and maintain the ocean’s overall
environmental condition. Third, over
the next five years, India plans to
establish a Deep Ocean Mission,with
a budget of more than Rs 4,000 crore,
to explore the marine ecosystem
through deep ocean exploration
and biodiversity conservation [12].
Finally, the MoES, supported by the
National Centre for Coastal Research,
is collaborating with selected United
Kingdom and Japanese institutions,
to examine the current distribution
of marine litter and microplastics in
Indian coastal sediment, water, and
biota [13]. Considering these efforts,
upcoming ocean initiatives can
strengthen India’s position as a vital
fulcrum for sustainable development
of ocean resources globally.
Italy
Italy, a country of almost 59 million
residents, is surrounded by the
Mediterranean Sea and includes
several islands,including Sardinia.The
Mediterranean Sea is a basin of the
Atlantic Ocean, wedged between the
lands of Europe, Africa, and Asia.The
crystalline sea and the fine white sand
characterize these Italian coastlines,
including the Sardinian coastline
of more than 1,849 kilometers
long. As the ocean is a significant
source of food and employment
for surrounding communities and
countries,environmental protection is
a prerequisite for good health. Man-
made activities on the land and sea
can impact ocean health, as humans
and nature are closely linked and
inter-dependent [3].
Over the past year, several initiatives
have been organized across Italy to
promote the need to protect ocean
resources and biodiversity. First,
the Italian Ministry of Ecological
Transition announced the proposal to
designate the Mediterranean Sea as an
emission control area for sulfur oxides.
Second, among other photographic
exhibitions, the Museum of Natural
History “Giancarlo Ligabue” in Venice
hosted “The Living Sea” exhibit, in
order to raise awareness about the sea
and its essential functions for human
life [14]. Finally, the UNESCO
Intergovernmental Oceanographic
Commission launched 10 projects
in Sardinia, to educate governments,
private sector, and civil society about
our oceans as valuable resources for
our planet, health, and future [15].
As an Italian medical community, we
should continue to discuss current
challenges and develop a consensus
for best practices to protect our
oceans and surrounding ecosystems.
As described in Andean civilizations,
nature was recognized to have rights
– the rights to exist and be restored in
case of damage – but the inability to
claim such rights. This notion alludes
to the fact that human beings can
claim these rights on behalf of nature
[16,17].For this reason,health leaders
and citizens alike must integrate the
One Health concept into our national
and international action plans that
protect our oceans. These efforts can
include implementing community
education programs on ocean
ecosystems and developing policies
and regulations with sanctions for
plastic or chemical pollution by
individuals or industries.
Kenya
Kenya, a country of approximately 51
million people, has a southwestern
border with the Indian Ocean. Over
the past few years, the Government
of Kenya has reported variable
rainfall patterns (e.g. shorter long
rain seasons), increased droughts
and floods, and sea level rise due
to melting glaciers [18]. With the
ongoing climate crises, climate risks
include ocean acidification as well as
projected sea level rise from 25cm to
82cm by 2080 [18]. These effects will
directly endanger marine life, which
provides oxygen for our planet, and
hinder economic survival for ocean-
based industries and trade located in
surrounding landlocked countries.
The Government of Kenya was
among the first African nations to
sign the Clean Seas initiative (https://
www.cleanseas.org/) in 2017, which
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WMA Members Reflect on World Oceans Day 2022
42
aims to reduce plastic in water bodies
[19]. These actions were a result of
more than 3.7 kilos of plastic per
capita that are found annually in the
city of Mombasa, which lies along the
Kenyan coast. Subsequently, single-
use plastic bags were banned in 2017,
and plastic disposable bottles, plates,
and silverware were later prohibited in
national parks in 2022. This political
commitment, observed through
environmental policies and legal
enforcement, sets the stage for other
African nations to establish robust
guidelines and regulations to not only
protect the marine ecosystem,but also
to expand efforts toward the broader
issue of climate change.
As we commemorate World Oceans
Day, we must remember that we are
responsible to protect our oceans
as valuable natural resources. Our
global efforts should advocate for
the attainment of SDG 14 targets
through strict environmental
regulations, beach clean-ups, and the
promotion of circular economies in
the workplace.
Malaysia
Healthy oceans are – hopefully
– what we can pass onto future
generations. Land only occupies an
estimated 25% of the Earth’s surface,
and yet we have managed to pollute
the remaining 75% (oceans) with
our activities. Malaysia, a country
of 32 million residents in Southeast
Asia, consists of the Peninsular
Malaysia (between Thailand and
Singapore) and Borneo (provinces
Sabah and Sarawak). Most of the
country is surrounded by bodies of
water, including the South China
Sea, Sulu Sea, and Celebes Sea. To
commemorate World Oceans Day
2022, the Malaysian Department
of Fisheries partnered with the
oceanarium Aquaria KLCC and
launched the “Danger to the Beauty”
underwater mermaid show to
demonstrate the harmful effects of
microplastics in oceans [20].
For almost five decades, the
Malaysian government has promoted
environmental sustainability through
the Malaysia’s Environmental Quality
Act of 1974. Over the past few years,
many 3R (reduce, reuse, recycle)
shops have emerged. With variation
per state protocols, some shopping
centres have installed a nominal fee
for plastic bags, while others have
completely abolished the usage of
polystyrene foams and plastic bags.
Notably, government leaders actively
advocate for local beach, river, and
sea clean-up activities for the public.
They also regularly plant more
mangrove trees to reduce soil erosion,
support coastal regions, and create a
safe habitat for the flora and fauna of
mangrove swamps.
Malaysian citizens and tourists enjoy
close connections with the oceans
and participate in recreation activities
like water sports, fishing, and beach
activities. As a nation, we must take
responsibility in preserving the
marine ecosystem, participating in
beach clean-ups, and being proactive
in complying with the three Rs.
General awareness and acceptance to
reduce plastic usage in our medical
practice and the general community
will pave the way toward healthier
oceans.
Myanmar
The ocean has long been the site of
Member State warfare and diplomacy,
where geopolitical conflicts have
resulted from historical territorial
claims or the need to occupy
important strategic islands. Increased
strategic and economic value of the
ocean, imbalanced power, and limited
diplomaticrelationscanleadtoserious
tensions and even naval warfare.These
power inequalities over the ocean
disputes have led to costly litigation
and political maneuvering. As a
global community, we are entering a
new era regarding oceans and climate
change, where international laws will
be tested.
OceanhealthispertinenttotheUnited
Nations 2030 Agenda for Sustainable
Development and the SDGs,
namely through SDG 14 (life below
water). However, SDG 14 is linked
with SDG 1 (eliminating poverty),
SDG 2 (ending hunger), SDG 3
(excellent health and well-being),
SDG 10 (decreased inequalities), and
SDG 16 (peace, justice, and strong
institutions). When wild fish supplies
in the world’s oceans collapse, food
insecurity grows, which negatively
impacts impoverished persons
depending on seafood. Chemical
emissions from warfare into the seas
endanger the aquatic ecosystem,
which can lead to contaminated water
supplies and toxic bioaccumulation in
marine organisms. Ultimately, these
impacts are detrimental to human
and planetary health.
Clinicians, medical associations,
and countries should work together
to create warning systems that give
timely and reliable information about
howhealthcaresystemsandphysicians
can identify and address marine-
related health threats. Governments
and transnational leaders will need to
prioritize ocean governance in order
to achieve the targets of the six SDGs
that relate to ocean sustainability.
Nigeria
Although World Oceans Day is not
widely celebrated across Nigeria, a
country with 216 million residents,
the Nigerian populace depends
on the oceans for food, recreation,
and transportation. The theme
offers a call to action for Nigerian
leaders to strengthen regulations
for environmental monitoring and
encourage residents to be proactive in
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WMA Members Reflect on World Oceans Day 2022
43
BACK TO CONTENTS
protecting the ocean and other water
bodies.
One important salt water source is
the Bonny River, located in Rivers
State of southern Nigeria, which
empties into the Atlantic Ocean
(“Okolomatoru” in the local Ibani
language). The Bonny River provides
economic opportunities for seafood
harvests of crabs,scallops,and oysters;
transportation from the island to
Port Harcourt and neighboring
communities; recreational swimming
and boating; sanitation practices
for locally constructed toilets at
river banks; spirituality linked with
supernatural powers upon drinking
river water; and religious acts as items
(e.g. coins, chicken, cloth) are thrown
into the sea to appease the goddess of
the sea.
Over the past two years, media
sources have reported mass croaker
fish (Genyonemus lineatus) deaths,
including a deceased whale, on the
shores of the Bonny River and other
coastal cities in Rivers, Bayelsa, and
Delta states in southern Nigeria.
These observations led to national
guidelines to strongly discourage
the consumption of deceased fish.
Initial research studies conducted
on fish populations in the Bonny
River revealed the presence of the
bioaccumulation of heavy metals
in tissues [21]. Further exposure
assessments concluded that these
toxic concentrations of copper, zinc,
and iron in fish were far above the
maximum recommended safe levels
by the joint Food and Agriculture
Organization (FAO) and World
Health Organization (WHO)
Committee [22]. After further review
and analysis, these levels were linked
to the crude oil spillage and other
industry activities in the marine
ecosystem.
Since physicians do not receive
specialized training in toxicology,they
may be unaware of the risks of heavy
metal exposures on health outcomes.
As a low-resource country, clinical
diagnosis and management may be
compounded by the lack of modern
diagnostic facilities across health
institutions. For example, patients
may have to travel to other cities
(like Port Harcourt) by sea or by air
to access tertiary healthcare services.
Moving forward, strengthening
epidemiological surveys and
screening programs can help identify
any emerging illnesses within the
community. Also, educational
campaigns on water pollution, due
to plastics or improper disposal of
industrial waste and chemicals, can
increase community awareness of
potential hazards of consuming
seafood.
Philippines
World Oceans Day 2022 highlighted
the theme, “Revitalization: Collective
Action for the Ocean”, which
emphasized the need to work together
to create a new balance with the
ocean that restores its vibrancy and
brings new life. For the protection
of biodiverse maritime species and
resources, World Oceans Day offers
a reminder to citizens that humanity
depends on oceans for life and
livelihood [1]. Global activities aim
to inform the public of the impact of
human actions on the ocean, develop
a worldwide movement of citizens for
the ocean, and mobilize and unite the
world’s population on a project for
the sustainable management of all
oceans [23].
The Philippines, a country of
approximately 110 million residents,
is located in the coral triangle region,
bordered by the South China Sea
(west), Philippine Sea (east), and
Celebes Sea (southwest). Known
as the “Amazon of the Sea”, this
maritime and archipelagic country
has more than 50% of the population
living and making a livelihood in
the coastal zones [24]. According
to the Philippine Government’s
Department of Environment and
Natural Resources (DENR), the
marine biodiversity of the Philippine
seas includes various species, such
as five marine turtles, 28 marine
mammals, 168 cartilaginous fishes,
648 mollusks, 829 algae, 1,062
seaweed, and 1,755 reef-associated
fishes [24].
As a Filipino nation, we recognize
that ocean resources are limited
and vulnerable to many emerging
challenges, such as overexploitation,
effects of climate change, and marine
plastic pollution. To commemorate
the Month of Ocean 2022 in May
2022, DENR personnel collaborated
with selected local and national
government agencies and community
stakeholders in General Santos
City, leading activities including
coastal clean-ups, clean-up dives,
and educational seminars on the
proper disposal and recycling of
plastics and recommendations to
avoid single-use plastics [25]. Using
the theme, “Protect, and Restore
Ecosystems and Biodiversity”, these
activities aimed to encourage Filipino
citizens to promote the protection,
preservation, and conservation of
marine biodiversity, leading up to
World Oceans Day [25]. Notably, the
DENR’S Biodiversity Management
Bureau and the Philippine Coast
Guard signed a formal agreement to
address emerging issues, needs, and
gaps that hinder the conservation of
the coastal and marine ecosystems
[26].
Poland
The Polish Chamber of Physicians
and Dentists greatly appreciates and
supports the celebration of World
Oceans Day. We believe that this day
presents an excellent opportunity to
raise public awareness of our oceans,
WMA Members Reflect on World Oceans Day 2022
44
including reported warming waters
and increased chemical and plastic
pollution. Global ocean warming
and pollution negatively impact the
delicate marine ecosystem and human
health. Caring for ocean waters and
promoting healthy ecosystems, which
represent inestimable treasures of
the planet Earth, must be constantly
supported and promoted by all
countries across the world.
Physicians, who are acutely aware
of the risks associated with ocean
warming and pollution, should
actively participate in community
educational activities that promote
pro-environmental behaviors. They
should also contribute to protecting
the natural environment each day
by reducing plastic consumption,
preventing food waste, and saving
water resources. The medical
community has the responsibility to
take care of the natural environment −
including our global oceans −
which will be handed over to future
generations.
South Africa
South Africa is endowed with a long
coastline, spanning approximately
3,000 kilometres along the south
Atlantic and Indian oceans. The
country’s rich oceans sustain a
complex web of socio-economic
activities, including commercial
oil and gas, aquaculture, tourism,
conservation, port harbours, fisheries,
and telecommunication. The ocean is
also linked to South Africa’s cultural
heritage, and is therefore significant
for the well-being of South Africans
and the safeguarding of traditions.
The unsustainable use of oceans, seas,
and marine resources has a myriad
of impacts on health and livelihoods.
With more than three billion people
worldwide depending on marine and
coastal resources for their livelihoods,
ocean deterioration has resulted from
ocean acidification and overfishing as
well as plastic, chemical, solid waste,
and other forms of marine pollution.
A marine litter crisis exists in South
Africa, with South African beaches
and coastlines getting flooded by solid
waste, including plastic [27]. This
raises the risk of microplastic toxicity
via the food chain, with negative
health consequences [28].
The Department of Forestry,Fisheries
and the Environment has led several
marine national initiatives, including
the Marine Spatial Planning (MSP)
initiative, the National MSP Data
and Information Report (NDIR),
and the Marine Protected Area
(MPA) network [29]. However, we
have observed that the health sector
has had limited participation in these
community and policy activities. This
year, as the South African community
coordinated World Oceans Day 2022
activities, we again noted that health
stakeholder participation was sadly
lacking in marking this important
commemoration, presumably due
in part to insufficient recognition of
direct links between health and the
oceans.
In conclusion, the South African
Medical Association (SAMA) is
encouraged by this year’s World
Oceans Day theme, namely
“Revitalization: Collective Action
for the Ocean”. The imperative to
collectively strengthen the resilience
of marine and coastal ecosystems,
and take action for their restoration
in order to achieve healthy and
productive oceans, is a universal
human responsibility spelled out in
SDG 14. We call on physicians and
other health professionals in South
Africa, the African continent, and
globally, to rally behind the cause of
sustainable ocean health.
Spain
The Spanish medical profession
is an active member of the
Organising Committee of the One
Health platform, recognized as a
comprehensive approach to health
through the interrelationship between
human, animal, and environmental
health. Through the Foundation
for Training, the Spanish General
Medical Council (CGCOM) focuses
its efforts on training professionals
and citizens with seminars that raise
awareness of One Health issues. In
addition, the institution is working to
adapt its Code of Ethics and Medical
Ethics to make the preservation of
the environment and the fight against
climate change an ethical duty.
In January 2022, the CGCOM
collaborated with several institutions
to launch the Medical Alliance on
Climate Change (https://www.
cgcom.es/observatorios and https://
www.cgcom.es/grupo-de-trabajos/
salud-y-cambio-climatico). These
institutions include the Scientific
Societies of Anaesthesiology, Family
Medicine, Preventive Medicine,
Public Health Medicine, Health
Managers,and Cardiology;theWHO
Department of Public Health and
Environment; the Spanish Office for
Climate Change; the Representation
of the European Commission in
Spain; the European Parliament
Office in Madrid; and the Ministry of
Health in Spain. This Alliance aims
to raise awareness among Spanish
doctors and to take a proactive stance
on the decarbonisation of health, in
compliance with the 2030 Agenda for
Sustainable Development. The initial
document of this Alliance, which was
prepared by expert authors, focuses
on the long-term environmental and
health effects of ocean warming as
well as potential responses to combat
the climate crisis.
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WMA Members Reflect on World Oceans Day 2022
45
Sweden
Since Sweden’s shoreline is one of
the longest in Europe, many Swedes
have a special fondness for the sea and
the coastal regions. Due to climate
change, rising sea levels threaten to
affect the supply of both water and
arable land in low-lying coastal areas.
Increased rainfall from autumn to
spring seasons can lead to flooding
events and affect arable land. Such
overflow can contaminate water
reservoirs and increase the risk of
transmission of waterborne diseases
such as Salmonella. Also, antibiotic
residues in the sea and the transfer
of plastic contaminants between
marine species and humans have
been identified as significant health
hazards.
Physicians have an important role to
playinsharinginformationwithglobal
communities about the health effects
of climate change and the importance
of clean oceans.The Swedish Medical
Association promotes innovative
strategies to engage with citizens
and raise awareness on appropriate
medication use and disposal as well
as the importance of adhering to
recommended antibiotic prescriptions
to reduce the risk of antimicrobial
resistance. We also share information
with healthcare providers and other
decision-makers about disposable
plastic, including how the healthcare
industry recycles and disposes of
its waste products. These collective
efforts will ultimately accelerate the
path toward achieving the targets of
SDG 14.
Thailand
The Medical Association of Thailand
isdeeplyconcernedaboutmaintaining
clean and healthy oceans for our
country and world. In Thailand, the
ocean is the primary source of our
protein intake as well as our salt
and freshwater supply, and hence we
cannot survive without this natural
resource. Man-made pollution of the
ocean, such as waste, cigarette butts,
chemicals, and plastics, is extremely
harmful to humans and marine
ecosystems of fish,crabs,and shellfish.
In support of World Oceans Day
2022, we highlight an innovative
initiative supported by the Ministry
of Public Health entitled, “Smoke
Free Beaches”. After the Department
of Marine and Coastal Resources
reported that cigarettes were a
significant source of pollution in the
sand and water, a national law was
introduced to ban smoking across 24
beaches in 2018. Disregard for this
ban could result in jail time or fines.
This unique Department of Marine
and Coastal Resources of Bangkok
program,which aligns tobacco control
with healthy oceans and beaches, was
publicly recognized with the World
No Tobacco Day 2022 Award in
May 2022 (https://www.who.int/
news/item/27-05-2022-world-no-
tobacco-day-2022-awards—the-
winners).
Trinidad and Tobago
As a boy and Sea Scout in Trinidad
and Tobago, I loved the ocean. I
remember helping fishermen pull
their nets and snorkelling over sea
grass beds in clear seawater. Over
time, however, seagrass became
barren mudflats, the fiddler crabs
disappeared, there were fewer fish,
and the water grew turbid. Much of
the coastline became polluted from
the national oil and gas industry,
with increasing plastic waste choking
drains and rivers, contributing to
worsening floods, littering coasts, and
harming wildlife.
We live on a watery planet, with some
70% of the Earth’s surface covered
by oceans. The oceans help regulate
climate, provide food and medicines,
and transport most of our goods.
Ninety percent of the excess heat
of the global warming from the use
of fossil fuels is stored in the ocean,
powering more deadly hurricanes
and bleaching coral reefs, which
undermine food security and coastal
defences. The oceans also absorb a
significant amount of carbon dioxide
produced by humans, slowing global
warming, but acidifying the ocean
with many negative impacts on
marine life,such as plankton,shellfish,
and corals.
My personal observations and
understanding that our ecosystems are
valuable natural resources motivated
me to establish EarthMedic and
EarthNurse (https://earthmedic.
com/) in 2021. Using the theme,
“Promoting the Health of People
and Planet Together”, this non-profit
organization aims to mobilise health
professionals globally as ‘white coat
diplomats’ to advocate for “Patient
Earth”.These efforts are indispensable
as our lives and livelihoods ultimately
depend on the health of the Earth
and especially the oceans.
Doctors and other health professionals
in Trinidad and Tobago need to
awaken to the planetary health crisis,
especially the importance of ocean
health, and address the twin threats
of climate change and pollution. An
excellent step in the right direction is
the designation of Tobago’s North-
East region as the largest UNESCO
designated ‘man and biosphere’
(MAB) site in the English-speaking
Caribbean. This 840 square kilometre
area is a mostly untouched ridge-to-
reef ecosystem, including coral reefs,
mangroves,andtheworld’sfirsttropical
rainforest reserve (Tobago Main Ridge
Forest Reserve) established in 1776.
By joining the World Network of
Biosphere Reserves, the objective is to
restore people’s love and appreciation
for nature and the ocean and help
preserve this remarkable human and
natural landscape.
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WMA Members Reflect on World Oceans Day 2022
46
Uganda
Although Uganda is a landlocked
country without access to open
seas or oceans, our 47 million
citizens are equally affected by the
consequences of inaction towards
ocean preservation. This East African
country shares borders with Kenya
(west), Democratic Republic of the
Congo (east), South Sudan (south),
and Tanzania and Rwanda (north)
as well as Lakes Victoria, Edward,
and Albert. With the current climate
crisis, protecting marine and human
health must be emphasized across our
country and region, including caring
for lakes and rivers.
As a call to action for our medical
community, physicians can serve as
leaders in local initiatives that support
proper waste management, including
proper placement and recycling of
plastic bottles. Although we have
observed that proper disposal of
disposable masks occurred during the
pandemic, we need to take prompt
action on plastics. As physicians, it
is important to become involved in
leadership and advocacy activities
to protect our ecosystems, such
as education campaigns that can
raise community awareness of the
importance of healthy oceans and
empower residents to take local
action.
Conclusion
Each year, our global community
recognizes international days and
themes – like World Oceans Day
(“Revitalization: Collective Action
for the Ocean”) – to highlight an array
of key topics and promote collective
action through education, policy, and
advocacy activities [30]. By reflecting
upon the valuable perspectives of
physician leaders, we can appreciate
these testimonies and learn about
successful initiatives that have
implemented across their nations to
promote ocean sustainability. Using
the One Health concept,we can better
understand our direct connections to
animal and environmental health,
identify knowledge and practice gaps
and limitations in current programs,
and develop innovative practices to
protect and conserve these marine
ecosystems. By sharing our clinical
and public health expertise with
local and national authorities, we can
help advance scientific knowledge
and research capacity on ocean
health, encourage citizens to become
involved in community activities, and
contribute to national plans that are
aligned with the targets and indicators
of SDG14 and other related SDGs
of the 2030 Agenda for Sustainable
Development.
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WMA Members Reflect on World Oceans Day 2022 (“Revitalization: Collective Action for the Ocean”)
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Authors
Dabota Yvonne Buowari, MBBS
Department of Accident
and Emergency,
University of Port Harcourt
Teaching Hospital
Port Harcourt, Rivers State, Nigeria
Maymona Choudry, RN, MD, MPH
Department of General Surgery
Vicente Sotto Memorial Medical Center
Cebu City, Philippines
Tomás Cobo Castro, MD
President, Spanish General Medical
Council (CGCOM)
Madrid, Spain
C . James Hospedales,
MBBS, MSc, FFPH
Trinidad and Tobago
Medical Association
Chaguanas, Trinidad, West Indies
Shiv Joshi, MBBS, MD,
PGDGM, ICPBHR, CHR
JDN Medical Ethics Officer
Senior Resident, Department of
Community Medicine, Jawaharlal
Nehru Medical College, Datta
Meghe Institute of Medical Sciences
(Deemed to be University)
Wardha, India
Klaudiusz Komor, MD
Vice-President, Supreme Medical
Council, Polish Chamber of
Physicians and Dentists
Warsaw, Poland
Raymond Mugume,
MBChB, Dip.SLT
WALIMU-Uganda
Kampala, Uganda
Mvuyisi Mzukwa, MBCHB
Chairperson, South African
Medical Association (SAMA)
Pretoria, South Africa
With acknowledgement to the SAMA
Health Policy & Research Unit
Teresa Perra, MD
Resident in General Surgery,
Azienda Ospedaliero,
Universitaria di Sassari
Sassari, Italy
Steinunn Þórðardóttir, MD, PhD
President, Icelandic Medical Association
Reykjavík, Iceland
Merlinda Shazellenne,
MBBS, AIMST
Chairperson, JDN-Malaysian Chapter
Honorary Secretary, Malaysian
Medical Association, Negeri Sembilan
Seremban, Malaysia
Sofia Rydgren Stale, MD
President, Swedish Medical Association
Stockholm, Sweden
Wonchat Subhachaturas, MD
Advisor and Past President,
Medical Association of Thailand
WMA Past President (2010-2011)
Bangkok, Thailand
Wunna Tun, MBBS, MD
Fellow in Medical Education
JDN Secretary
Yangon, Myanmar
Bienvenido Veras-Estévez,
MD, MPH
Department of Epidemiology,
Hospital Regional Universitario
José María Cabral y Báez &
Faculty of Health Sciences,
Universidad Católica del Cibao
Santiago de los Caballeros & La Vega,
Dominican Republic
Marie-Claire Wangari, MBChB
General Practitioner
Nairobi, Kenya
BACK TO CONTENTS
WMA Members Reflect on World Oceans Day 2022 (“Revitalization: Collective Action for the Ocean”)