WMJ_2023_01_final

Official Journal of The World Medical Association, Inc. Nr. 1, April 2023
vol. 69
Contents
Editorial   3
Interview with the WMA Secretary General   4
Interview with the Co-founder of the One Health Initiative   7
Interview with the President of the Pakistan Medical Association   10
WMA International Code of Medical Ethics: 
Highlights from the Revision Process   12
WMA Declaration of Venice: Revision Process and Outcome   16
Update on the Revision of the WMA Declaration of Helsinki   17
Proposed Revision of the WMA Statement on Violence
in the Health Sector by Patients and Those Close to Them   19
Safeguarding Patients’ Rights through WMA Declarations   23
Evidence-Based Medicine: The Role of Education  
to Promote High-Quality Clinical Practice   25
Health in Climate Change at the COP27   27
WMA Members Share Reflections about Earth Day 2023   32
Africa Setting the Stage in Pandemic Prevention, Preparedness,  
Response, and Recovery through the New Public Health Order   40
Report on a Webinar on Research Collaborations in Nigeria   42
Media Training to Shape Kenyan Junior Doctors  
as Health Advocates and Policy Reformers   46
Free Continuing Medical Education on Environmentally Sustainable Practices   49
World Medical Association Officers, Chairpersons and Officials
Dr. Osahon ENABULELE
President
Nigerian Medical Association
8 Benghazi Street,
off Addis Ababa Crescent
Wuse Zone 4, P.O. Box 8829
Wuse, Abuja
Nigeria
Dr. Otmar KLOIBER
Secretary General
World Medical Association
13 chemin du Levant
01212 Ferney-Voltaire
France
Dr. Jung Yul PARK
Chairperson, Finance and
Planning Committee
Korean Medical Association
Samgu B/D 7F 8F 40
Cheongpa-ro,
Yongsan-gu
04373 Seoul
Republic of Korea
Dr. Lujain ALQODMANI
President-Elect
Kuwait Medical Association
123 Fifth Avenue,
1202
Kuwait
Dr. Tohru KAKUTA
Vice-Chairperson of Council
Japan Medical Association
113-8621 Bunkyo-ku, Tokyo
Japan
Dr. Jean-François RAULT
Chairperson,
Socio Medical Affairs Committee
French Medical Council (Conseil
National de l’Ordre des Médecins,
CNOM)
4 rue Léon Jost
75855 Paris Cedex 17
France
Dr. Heidi STENSMYREN
Immediate Past President
Swedish Medical Association
(Villagatan 5) P.O. Box 5610
SE-114 86 Stockholm
Sweden
Dr. Ravindra SITARAM
WANKHEDKAR
Treasurer
Indian Medical Association
Indraprastha Marg 110 002
New Delhi
India
Dr. Jacques de HALLER
Chairperson, Associate Members
Swiss Medical Association
(Fédération des Médecins Suisses)
Elfenstrasse 18, C.P. 300
3000 Berne 15
Switzerland
Prof. Dr. Frank Ulrich
MONTGOMERY
Chairperson of Council
German Medical Association
(Bundesärztekammer)
Herbert-Lewin-Platz 1
(Wegelystrasse)
10623 Berlin
Germany
Dr. Marit HERMANSEN
Chairperson,
Medical Ethics Committee
Norwegian Medical Association
P.O. Box 1152 sentrum 107
Oslo
Norway
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
As we welcomed the new year, our global medical
community remains eager and prepared to develop prompt
and appropriate strategies, policies, and interventions to
combat emerging health risks and enhance health system
resiliency.Multiple health system challenges exist,including
an aging population, antimicrobial resistance, the global
health workforce shortage, increased prevalence of non-
communicable diseases, reported injuries and violent acts,
and various work-related stressors. We are now year closer
to navigating a post-pandemic world and reaching the
deadline of the 2030 Agenda for Sustainable Development.
To date, WMA members have supported those colleagues
working in conflict and emergency settings (e.g. Ukraine
Medical Help Fund, earthquake disaster areas in Turkey
and Syria) and mentored junior doctors throughout their
career path (e.g. Junior Doctors Network).
As the World Health Organization commemorates its
75th anniversary on 7 April 2023, health leaders recognize
the significant achievements – including drug discovery,
pathogen identification, and vaccinations – which were
driven by evidence-based science and collaborations
to address urgent global challenges (https://www.who.
int/campaigns/75-years-of-improving-public-health/
milestones). As this day represents World Health Day,
the “Health for All” theme highlights the call to action
toward strengthening existing and building new initiatives
and partnerships that promote health equity across global
communities. One element, however, is of utmost concern:
the effects of climate change on public health. To address
the climate crisis, WMA members have a unique lens to
leverage their clinical expertise and lead national and global
efforts to advocate for stronger political commitment to
health system preparedness and response for climate action.
We are overjoyed to support the 222nd World Medical
Association (WMA) General Assembly will be held in
Nairobi, Kenya, from 20-22 April 2023. This meeting will
provide opportunities for WMA members to contribute to
scientific discussion on WMA statements and resolutions
as well as expand global health networks with colleagues.
We hope that you can connect with WMA members and
share information about your NMA priorities and activities.
In this issue, Dr. Otmar Kloiber, Dr. Bruce Kaplan, and Dr.
Ashraf Nizami shared personal reflections about WMA
milestones, emerging One Health risks, and challenges
facing the Pakistan medical community, respectively.
Mr. Bjørn Hoftvedt and Dr. Reidun Førde presented an
example where key ethical principles were violated in health
care delivery and research. Dr. César Eduardo Fernandes,
Dr. José Eduardo Dolci, and Dr. Wanderley Bernardo
prepared a commentary on the value of evidence-based
medicine in clinical education and practice. Dr. Lwando
Maki, Dr. Ankush Kumar Bansal, Dr. Muha Hassan, Dr.
Ahmed Taha Aboushady, Dr. Mahesh Prasad Bhatt, Dr.
Lars Rocksén, Dr. Johanna Schauer-Berg, and Dr. Lekha
Rathod offered their perspectives on the 27th Conference
of Parties (COP27). Dr. Marie-Claire Wangari described
therecentreleaseoftheNewPublicHealthOrderforAfrica.
Dr. Ogechuksu Mary-Anne Isokariari, Dr. Vivian Ifeoma
Ogbonna,Dr.Utchay Agiri (Jr),Dr.Chizaram Onyeaghala,
Dr. Taagbara Jolly Abaate, Dr. Celine Ude Osi, Dr. Glory
Ovunda Worgu, Dr. Chinenye Precious Anuonyeh, and Dr.
Dabota Yvonne Buowari provided a report on a webinar
that focused on research collaborations in Nigeria. Dr.
Marie-Claire Wangari, Dr. Brenda Obondo, and Dr. Ruby
Oswere highlighted the use of media training for Kenyan
junior doctors.Dr.Todd Sack shared the WMA’s My Green
Doctor resource as a free continuing medical education on
environmentally sustainable practices.
We are pleased to share this issue of the World Medical
Journal, which presents the highlights from the revision
process of the WMA International Code of Medical Ethics
(by Dr. Ramin Parsa-Parsi, Ms. Siobhan O’Leary, Dr.
Urban Wiesing), the WMA Declaration of Venice (by Dr.
Gerald Harmon), the WMA Declaration of Helsinki (by
the American Medical Association’s Office of International
Relations),and WMA Statement on Violence in the Health
Sector by Patients andThose Close toThem (by Dr.Leonid
Eidelman,Ms.Malke Borow,Dr.Baruch Levi,and Ms.Tali
Rayn-Aloni). Notably, WMA members representing seven
countries described their national perspectives and timely
national initiatives that support Earth Day 2023 and the
adoption of environmentally sustainable practices.We hope
that you can take a moment to review this fifth collaborative
article and be inspired by these exciting NMA activities.
As we look forward to our upcoming annual activities, we
encourageWMAmembersreflectonhowwe–asindividuals
and collectively as WMA members – can strengthen our
contributions to the WMA and the global community. We
look forward to connecting in-person and participating in
valuable conversations and discourse in Nairobi!
Helena Chapman,MD, MPH,PhD
Editor in Chief of the World Medical Journal
editor-in-chief@wma.net
4
For this interview, Dr. Otmar Kloiber,
the World Medical Association (WMA)
Secretary General, shares his perspectives
on WMA activities as well as his
leadership achievements over his tenure
with Dr. Helena Chapman, the WMJ
Editor in Chief.
Over your WMA tenure, what are the
four most significant milestones that
have left a permanent contribution for
the global medical community?
The past two decades have proven to
represent significant achievements for
WMA membership,which represents
116 countries and territories to date.
As the WMA was founded to be the
platform to build universal medical
ethics, national member associations
(NMAs) share expertise and
perspectives on priority ethical issues
at our meetings. We have observed
remarkable unity in respectfully
debating issues and reaching
consensus on many complex topics,
including medical ethics. However,
it is important to note that although
NMAs and WMA members widely
share view and opinions, divergent
views remain, especially concerning
the ethics at the beginning and end-
of-life topics.We utilize this platform
to widely debate priority issues in
order to develop and update WMA
resolutions and statements at our
meetings.
Second, our WMA membership
has maintained our heritage,
by supporting ethical rules and
guidelines that have shaped
medicine in the 20th century:
the Declaration of Geneva, the
Declaration of Helsinki, and the
International Code of Medical
Ethics. As we reference the relevance
of these ethical guidelines in our
daily clinical and public health
practice, we also prepare new
guidelines as well as develop
updates, as deemed necessary for
our medical community. Our efforts,
which ultimately respect the sacred
relationship with patients and society,
recognize that the development of
new technologies, methods, and
procedures influence the need to
prepare up-to-date guidelines for the
global medical community.
Third, we have built strong
relationships with partners, especially
other health professionals, in order
to best serve our patients and
communities. For example, the
World Health Profession Alliance is
a global reflection on medicine and
health care, which depends on strong
cooperation, mutual respect, and joint
advocacy for all health professionals.
Finally, we constantly strive for
professional autonomy and clinical
independence. As physicians, we
contribute to an environment that is
increasinglypronetocommoditisation
andcommandandcontrolapproaches,
whether a private, social insurance
or state-run health care system. We
stand firm in fighting attempts to de-
professionalize medicine and remove
our autonomy, in efforts provide the
best treatment for our patients.
What do you consider to be your most
important leadership achievements
overthepastdecade?Pleaseshareafew
challenges that you have experienced
and how have you addressed them.
Over the past two decades, we have
achieved remarkable milestones
in our WMA initiatives. Our
collective efforts have been the
most significant achievement to
date. First, we have become a strong
community, reinforcing unity in our
policy development as well as our
interactions with international bodies,
governments, and private institutions.
We have demonstrated our leadership
in protecting and maintaining
our policies, which enshrine the
core values and traditions of the
medical profession. Key examples
of the successful development and
renewal of the WMA core policies
include the Declaration of Geneva,
the International Code of Medical
Ethics, and the Declaration of
Helsinki.
Second, we have expanded our
outreach efforts to encourage
other NMAs to contribute to
WMA activities. Our leadership
activities have resulted in stronger
representation from WMA members
across Asian and African countries.
The WMA has increased visibility
on the African continent, with
continued engagement with NMAs,
led by the current WMA president,
Dr. Osahon Enabulele.
Third, the WMA created the first
and only global platform for young
physicians recognized as the Junior
Doctors Network (JDN). This
network has stimulated strong
engagement of the WMA Associate
Members as well as Past Presidents
and Chairs. This youth engagement
has boosted our work on global
health issues, including climate
Otmar Kloiber
Interview with the WMA Secretary General
Interview with the WMA Secretary General
BACK TO CONTENTS
5
and health, antimicrobial resistance,
and pandemic preparedness. The
WMA Associate Membership
represents a valuable resource
for expertise and outreach across
geographic regions.
Finally, as we are practicing in the
21st century, digitisation, social
media, data banks, and artificial
intelligence remain part of our
toolkit. As the WMA has always
relied on science and technology, we
have adopted these new technologies
and provided guidance on how to best
use them in clinical and community
health practice. In 2016, we adopted
the Declaration of Taipei, which
extends the Declaration of Helsinki
into virtual environments, allowing
simultaneous scientific advancement
with participant protection.
How can national medical associations
best support junior doctors in their
professional education?
Many of our WMA members
are involved in developing the
structure and regulation of post-
graduate education and continuing
professional development. Regarding
post-graduate education, as
physicians decide to pursue residency
programs in primary care or speciality
disciplines, several factors should be
improved to support their career path:
1. Working conditions, including
compensation and work hours,
are often intolerable. How can
these working conditions be
improved to support physicians’
health and well-being?
2. Education is often measured in
terms of quantity (not quality) of
time. How can medical education
be evaluated by quality rather
than quantity of time?
3. Medical knowledge is constantly
renewed in very short cycles, due
to scientific advancements in
research and technology. Where
is the logic of adapting education
just by extending the length of it?
4. As junior physicians have
become more flexible to
technological developments,
they are considering other fields
of medicine. For example, the
overlaps between interventional
radiology, cardiology, and surgery
show that our medical disciplines
are dynamic.Why should medical
specialists be passive in their
career path?
5. Post-graduate education is
influenced by the
commercialisation of health
care. Medical education and
training are often seen as a
burden rather than an investment.
How can we strengthen medical
education with less influence
from the commercialisation of
health care?
As our NMAs will experience more
challengesovertime,werecognizethat
extending the length of specialisation
is not the answer anymore.To support
the next generation of health leaders,
we should collectively develop
policies that reflect a more flexible
and dignifying shape of post-graduate
education, complemented with
better opportunities for professional
development.
Aside from the ongoing COVID-19
pandemic, what are the key priorities
that WMA members should address in
the next five years?
Our WMA community continues
to tackle several priorities that affect
global physicians and our patients.
As a global organisation, we have
observed the clash of systems
and ideologies that have raised
conflict across countries as well as
experienced the effects of climate
change, disruptive technology, and
supply chain demands in a globalised
economy. For this reason, our medical
expertise and insight are needed to
address complex global challenges in
the clinical and community setting.
First, we should emphasise the need
for better emergency preparedness,
including our demands for improved
workforce staffing, appropriate
equipment and supplies, and higher
reserves. The COVID-19 pandemic
was a sudden wake-up call for our
global community to improve our
national and global preparedness
measures.
Second, we observe challenges in
human resources in health, noting
the brain drain of talents from low-
to high-income countries. While we
are firmly in favour of the freedom to
work in other countries and, we wish
to foster exchange and the chance
to gain experience abroad, one-
directional movements along a money
gradient are alarming.In high-income
countries, the need for physicians
is aggravated by an increasing
frustration of senior physicians over
an increased bureaucracy, resulting in
a desire for early retirement.
Third, our young generation
demands a better work-life balance.
This movement often means fewer
work hours in societies that have an
increasing medical demand.
Fourth, we support the World Health
Organization’s call for Universal
Health Coverage, which can expand
access to quality health care for all
people. This movement underlines
the indispensable role of health
professionals across health systems.
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Interview with the WMA Secretary General
6
BACK TO CONTENTS
As WMA Secretary General, which
ongoing or new WMA initiatives are
top priorities for this year?
Certainly, we must promptly address
multiple challenges affecting our
global medical community as well
as reinforce our core in medical
deontology and medical ethics. In
October 2022, the WMA adopted
the revised International Code of
Medical Ethics, as a result of one
complete cycle of policy revisions.
We recently have initiated the next
revision cycle with the Declaration
of Helsinki, where we aim to reflect
on values related to new procedures,
technologies, and social movements.
For example, do our principles still
serve the purpose of protecting
humans in research, and do they still
facilitate ethical research?
We recognize that the global speed
of digitisation has influenced the
medical discipline. With the
Declaration of Taipei, we have
established the first set of rules for
the large-scale use of health databases
and biobanks. Our collective work
on artificial – or better “augmented
intelligence” – will continue and
focus on the ethical questions raised
by the use of those technologies.
The underlying question remains:
how can we promote ethical policies
within our value system albeit rapid
technological advancements in
digitisation?
Finally, we continue to support
the Ukraine Medical Help Fund,
as a partnership with WMA, the
Standing Committee of European
Doctors, and the European Forum
of Medical Associations, to provide
medicines and resources to the
medical community. We appreciate
the continued financial support from
the Japan Medical Association, the
French Medical Association, the
Royal Dutch Medical Association,
the Danish Medical Association,
and member societies, partner
organisations, companies, and
individuals.
Otmar Kloiber, MD
Secretary General (2005-2023)
World Medical Association
otmar.kloiber@wma.net
Interview with the WMA Secretary General
7
Interview with the Co-founder of the One Health Initiative
For this interview, Dr. Bruce Kaplan,
[1] the co-founder of the One Health
Initiative (OHI), shares his training
as a veterinarian and epidemiologist,
his leadership on the development of the
OHI (https://onehealthinitiative.com/),
perspectives on emerging One Health
challenges, and how World Medical
Association (WMA) members can
contribute to One Health initiatives,
with Dr. Helena Chapman, the WMJ
Editor in Chief.
Special Note: The OHI Autonomous
pro bono Team includes: Laura H.
Kahn, MD, MPH, MPP; Bruce
Kaplan, DVM; Thomas P. Monath,
MD; *Lisa A. Conti, DVM, MPH;
Thomas M. Yuill, PhD; Helena J.
Chapman, MD, MPH, PhD; Craig
N. Carter, DVM, PhD; Becky
Barrentine, MBA, and Richard
Seifman, JD, MBA
*Deceased 6 November 2020
Please describe three key learning
moments during your training in
veterinarymedicineandepidemiology.
My initial “One Medicine-One
Health” enlightening-learning
experiences came during the first
two years of basic science curriculum
at the Auburn University’s School
of Veterinary Medicine (1959-
1963). Between quarters, I returned
home to Louisville, Kentucky, and
attended some classroom lectures and
laboratory sessions in human anatomy
and pharmacology at the University
of Louisville School of Medicine
with student friends and colleagues.
After having completed veterinary
medical oriented training (e.g.
animal anatomy classroom lectures
and laboratory sessions), it became
apparentthatbasicsciencecoursework
(including pharmacodynamics and
pharmacokinetics) in human and
animal sciences were didactically
similar. For example, I was also able
to easily identify and translate most
analogous anatomical structures (e.g.
limb musculature names with origins
and insertions) on the human cadaver
vis-à-vis that of the canine species.
The only caveat was the occasional
notable technical scientific difference,
such as species variations.
My subsequent epidemiology
training as an Epidemic Intelligence
Service Officer (1963-1965) at the
U.S. Centers for Disease Prevention
and Control (CDC) reinforced and
corroborated the significant academic
comparative features of human and
animal science curricula.This training
offered opportunities to network with
physician and veterinarian colleagues,
including two individuals who had
earned doctorates in veterinary
medicine (DVM) prior to receiving
their doctorate in medicine (MD).
For example, understanding and
appreciating epizootic principles
of herd health and herd immunity
taught in veterinary school proved
applicable and analogous to human
epidemiologic public health
prevention and control procedures
[2].
What were the driving factors that
led to your collaborative efforts to
develop the One Health Initiative in
2006? Since this date, what challenges
has your team faced in leveraging
One Health expertise across global
networks?
As discussed in History of the OHI
team and website, the following
events transpired: “In April 2006,
Dr. Laura H. Kahn [MD, MPH,
MPP] published the CDC article,
‘Confronting Zoonoses, Linking
Human and Veterinary Medicine’
(ht t ps://w w w nc.cdc.gov/eid /
article/12/4/05-0956_article), which
prompted [me] Dr. Bruce Kaplan
[DVM] to contact her. Together
they [we] started the One Health
Initiative team, and Dr. Thomas P.
Monath [MD] joined them [us]
in March of 2007 to establish the
OHI triumvirate. Dr. Kahn, Kaplan
and Monath [One Health Initiative
website owner and his “brainchild”]
initiated the OHI website (www.
archive.onehealthinitiative.com/)
on October 1, 2008. Dr. Kaplan
was designated as the primary OHI
website contents manager/editor” [3].
Since 2006, the primary challenges
to acceptance and implementation
of the One Health concept have
come from a commonly displayed
tribalism, whereby some prominent
global networks set up ‘silo’ oriented
programs and websites that were
reticent to acknowledge other One
Health oriented individuals, groups,
and organisations. More broadly,
One Health leaders throughout
history should be recognized for their
scientific achievements [4]. Although
this gap has been a major hindrance
to elevating meaningful dialogue
and cooperative participation, the
One Health movement has become
internationally recognized with
exponential growth that continues
expanding worldwide.
Bruce Kaplan
Interview with the Co-founder of the One Health Initiative
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8
From the beginning, the OHI team
members (https://onehealthinitiative.
com/contact/) and our first-ever
international OHI website embraced
a strategic policy, asserting a
concerted all-inclusive “ecumenical”
educational effort to help promote
each reputable supportive player in
the nation and global One Health
community. Frankly, international
institutional implementation of the
One Health concept and approach
has been dangerously short-sighted,
incredibly slow, and long overdue.
What are the four most significant
contributions of the One Health
Initiative for the global community?
The One Health movement per
se has demonstrated numerous
monumental documented societal
clinical biomedical research, global
public health, and environmental
impacts. Since the early 21st century,
the three most popular and prominent
News and Publications of the One
Medicine-One Health’s reignition
[5] have included the webpages of
the OHI (https://onehealthinitiative.
com/), CDC One Health Office
(https://www.cdc.gov/onehealth/
index.html), and the One Health
Commission (OHC) (https://www.
onehealthcommission.org/).
The OHI team reported that “The
One Health concept has been
successfully applied to many clinical
health and public health milieus
during the 19th, 20th and early 21st
centuries.” Over the past centuries,
some significant examples of clinical
health advancements were noted
through comparative medical and
surgical endeavors as well as academic
journal issues (e.g. heart disease,
cancer, obesity, anesthesiology, global
Infectious diseases, food safety,
immunizations, antibiotic use and
resistance, emergency and disaster
preparedness [6].
The escalating detrimental climate
changes occur within our global
ecosystem, representing a threat to
safe shelter, clean air, food security,
and safe potable drinking water for
humans and animals.Therefore, these
issuesareinseparableandfundamental
prerequisites for insistently
adopting a One Health approach
for humans, animals, plants, and
the environments in which they
all co-exist.
What are three One Health challenges
that WMA members should better
understand?
First, multidisciplinary-
interdisciplinary professional
collaborations are critical towards
achieving more expeditious and
efficacious results in many clinical
comparative medicine research
issues and epidemiology. Second,
it is important to build upon the
momentum from the 2012 WMA
and World Veterinary Association
(WVA)’s One Health recognition
statement and the 2015 WVA/
WMA Global Conference on One
Health [10,11]. This physician
and veterinarian ‘meeting-of-the-
minds’ represented essential building
block elements to appreciate
and understand the value of
these robust collaborations. Third,
WMA members are challenged
to help promote, encourage, and
educate current human health
providers and their future medical
school student colleagues [12].
As first steps, how can WMA members
contribute their expertise to One
Health collaborations and become
more involved in local and national
initiatives?
First, WMA members can contact
and interact with health care
professionals in other health-
related disciplines. This sentiment
is expressed in the One Health
Initiative’s mission as follows: “forge
co-equal, all-inclusive collaborations
between physicians, osteopathic
physicians, veterinarians, dentists,
nurses and other scientific-health,and
environmentally related disciplines”
(https://onehealthinitiative.com/
mission-statement/).
Second, consider joining university
and national One Health clubs and
organisations (e.g. OHI, OHC)
as well as attending national and
international One Health meetings
to establish liaisons. Third, expand
communication efforts with deans
of various schools of medicine and
public health. Fourth, prepare One
Health op-eds in local and national
newspapers and magazines. Finally,
contact your local and national
political representative and encourage
their participation and support (e.g.
grassroots standpoint).
It cannot be repeatedly emphasised
enough that, without any doubt
or reservations: “One Health is
the collaborative efforts of multiple
disciplines working locally, nationally,
and globally to attain optimal health
for people, animals, plants and our
environment” and “One Health
implementation will help protect and/
or save untold millions of lives in our
generation and for those to come.”
Interview with the Co-founder of the One Health Initiative
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9
References
1. Kaplan B. Biography: Bruce
Kaplan [Internet]. 2021 [cit-
ed 2023 Feb 28]. Available
from: https://onehealthini-
tiative.com/wp-content/up-
loads/2021/11/BIOGRA-
PHY-Dr.-Bruce-Kaplan-No-
vember2021-1.pdf
2. Kaplan B, Atwood SW. Veteri-
narians merged with physician
educations: past and present
combined into one individual
“One Health” examples— a use-
ful conjoined degree program?
[Internet]. 2019 [cited 2023 Feb
28]. Available from: https://one-
healthinitiative.com/wp-content/
uploads/2019/07/JULY-2-2019-
DVM-VMD-MD-DO-Joint-
Degree-Program-1-1.pdf
3. Kahn LH, Kaplan B, Mon-
ath TP; One Health Initiative
Autonomous pro bono team.
History of the One Health Ini-
tiative team and website (April
2006 through September 2015)
and the One Health Initiative
website since October 1, 2008…
revised to June 2020, February
2021 and again to date August
2022 [Internet]. 2022 [cited
2023 Feb 28]. Available from:

Home

history-of-the-one-health-
i n i t i a t i v e – t e a m – a n d –
website-april-2006-through-
s e p t e m b e r – 2 0 1 5 –
a n d – t h e – o n e – h e a l t h –
initiative-website-since-october-
1-2008-revised-to-june-2020-
february-2021-and/
4. Kaplan B. ‘One Medicine-One
Health’: an historic perspec-
tive [Internet]. 2022 [updated
2021 Feb 1; cited 2023 Feb 28].
Available from: https://one-
healthinitiative.com/wp-con-
tent/uploads/2022/08/One-
Medicine-One-Health-An-
H i s t o r i c – P e r s p e c t i v e –
REVISED-SEPT1-2022-from-
FEB1-2021.pdf
5. One Health Initiative. The
21st century U.S. and world-
wide landmark catalyst for “One
Medicine-One Health” [In-
ternet]. 2020 [cited 2023 Feb
28]. Available from: https://
onehealthinitiative.com/the-
21st-century-u-s-and-world-
wide-landmark-catalyst-for-one-
medicine-one-health/
6. One Health Initiative Auton-
omous pro bono Team. “One
Health”, a significant inter-
national public health/com-
parative medicine paradigm
shift! Why? How? [Inter-
net]. 2015 [cited 2023 Feb 28].
Available from: https://www.
archive.onehealthinitiative.com/
p u b l i c a t i o n s / O N E % 2 0
H E A L T H % 2 0
a % 2 0 s i g n i f i c a n t % 2 0
i n t e r n a t i o n a l % 2 0
p u b l i c % 2 0 h e a l t h % 2 0
comparative%20medicine%20
O H I % 2 0 P O S T I N G % 2 0
May%2013%202015.pdf
7. Roubin GS. Renowned phy-
sician interventional cardi-
ologist endorses One Health
concept [Internet]. 2017 [cited
2023 Feb 28]. Available from:
https://onehealthinitiative.
com/renowned-physician-
interventional-cardiologist-
endorses-one-health-concept/
8. One Health Initiative. What
20th century scientific leader
flagged the comparative med-
icine aspect of “One Medi-
cine-One Health”? [Internet].
2020 [cited 2023 Feb 28]. Avail-
able from: https://onehealthini-
tiative.com/what-20th-century-
s c i e n t i f i c – l e a d e r –
flagged-the-comparative-
m e d i c i n e – a s p e c t – o f – on e –
medicine-one-health/
9. One Health Initiative. Declara-
tion of the G20 Health Ministers
in Rome, Italy [Internet]. 2021
[cited 2023 Feb 28]. Available
from: https://onehealthinitiative.
com/declaration-of-the-g20-
health-ministers-rome-italy-5-
6-september-2021-one-health-
approach-highlighted/
10. World Medical Association. One
Health Initiative: WMA and
WVA. 2012 [cited 2023 Feb 28].
Available from: https://www.
wma.net/blog-post/one-health-
initiative-wma-and-wva/
11. One Health Initiative. World
Veterinary Association/World
Medical Association Global
Conference on One Health –
Report and Presentations [In-
ternet]. 2015 [cited 2023 Feb
28]. Available from: https://
www.archive.onehealthinitiative.
com/news.php?query=World+
V e t e r i n a r y + A s s o c i a –
tion %2F Wor l d+Medic al+
A s s o c i a t i o n + G l o b a l +
C o n f e r e n c e + o n +
O n e + H e a l t h + % 9 6 +
Report+and+Presentations
12. Kaplan B. Physicians in the One
HealthVanguard![Internet].2007
[cited 2023 Feb 28]. Available
from: https://onehealthinitiative.
com/physicians-in-the-one-
health-vanguard/
Bruce Kaplan, DVM, Dipl. AVES
(Hon.), CDC/EIS63
Contents Manager and Editor,
One Health Initiative Website
Co-Founder, One Health
Initiative team and website
Sarasota, Florida
bruce@kaplandvm.com
Interview with the Co-founder of the One Health Initiative
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10
For this interview, Dr. Ashraf Nizami,
the President of the Pakistan Medical
Association and Additional Standing
Committee Member of the World
Medical Association (WMA), shares
insight on challenges facing Pakistan
physicians and citizens, with Dr. Helena
Chapman, the WMJ Editor in Chief.
Please share a brief summary of key
facts about Pakistan, including the
economy and health system.
Pakistan is a low-income country
in South Asia that is comprised of
796,095 km2
and 242.92 million
residents. As the fifth-largest country
in the world,the population is divided
into urban (40%) and rural (60%)
communities. Bordering China,
India,Afghanistan,and Iran,Pakistan
has diverse topography of mountains,
fertile plains, plateaus, deserts, lakes,
rivers, and beaches. Pakistan, which
gained its independence in 1947, has
a parliamentary democracy as well
as a 75-year history of four military
governments.
The Pakistan government spends
1.2% of its gross domestic product on
the health system, where there is one
doctor and 0.6 available beds per 1,000
people [1,2]. The urban populace
relies on private health services, while
rural communities seek health services
with traditional healers. Inadequate
nutrition and living conditions are
largely contributing to the spread
of an array of non-communicable
(e.g. diabetes) and communicable
(e.g. malaria, tuberculosis, typhoid)
diseases.
How have the catastrophic floods
impacted Pakistan?
In 2022, the unprecedented rains
and floods in Pakistan have impacted
more than 33 million people, causing
colossal damages to the economy
(US $30 billion), crops (9.4 million
destroyed acres), properties (2 million
houses destroyed), infrastructure
(440 bridges, 13,000 kilometres
of roads, hospitals, and schools
destroyed), animal lives (loss of more
than 1.1 million farm animals), and
human lives (1,700 deaths, 15,000
injuries) [3]. The majority of flood
victims were agriculture labourers,
small farmers, street dwellers, and
daily wagers, living in extreme
poverty in communities of mud
houses. According to the Pakistan
government estimates, 8 million
people have lost their economic
livelihoods, and an additional 8.4 –
9.1 million people will be pushed into
poverty, as a result of these significant
floods [4].
As the phases of rescue and relief are
complete, the Pakistan government
will need US $16 billion for the
rehabilitation and reconstruction of
flood-affected areas over the next
few years [4]. With the current
national economic crisis – and lack of
promised aid from other nations and
international financial institutions
– the government cannot initiate
reconstruction activities of houses,
hospitals, and schools.
How has the Pakistan health system
managed these challenges?
The catastrophic floods primarily
affected populations in Sindh
and Balochistan communities,
and residents are still living in the
temporary shelters [3]. These local
health systems are challenged with
damage to the health infrastructure,
shortages of health personnel, and
limited health supplies, which
ultimately disrupt health service
delivery especially for vulnerable
persons like children, pregnant
women, and breastfeeding mothers.
In addition to the ongoing
coronavirus disease 2019
(COVID-19) pandemic and
endemic infections (e.g. cholera,
human immunodeficiency virus,
leishmaniasis, measles, polio,
typhoid fever), enteric and
respiratory infections, dermatologic
manifestations, and vector-borne
diseases (e.g. malaria, dengue) are
prevalent in these flood-affected
areas.
How does climate justice affect
Pakistan?
Climate justice, which is a concept
that emerged as the result of the
fast-growing global climate crisis,
highlights the anthropogenic
source of the climate crisis, reckless
exploitation of nature, and the labour
force benefiting wealthy individuals,
businesses, and nations. Industrialised
rich nations, who have largely
contributed to this global crisis, are
ill prepared to share the responsibility
and burden of the crisis that severely
affects low-income nations. Future
Muhammad Ashraf Nizami
Interview with the President of the Pakistan Medical Association
Interview with the President of the Pakistan Medical Association
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11
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actions should focus on investments
in climate-friendly modern
infrastructure and technology.
References
1. Finance Division, Government
of Pakistan. Pakistan Economic
Survey, 2021-22. 2021 [cited
2023 Feb 4]. Available from:
https://www.finance.gov.pk/
survey_2022.html
2. World Bank. World Bank Open
data [Internet]. 2023 [cited 2023
Feb 1]. Available from: https://
data.worldbank.org/
3. World Bank. The World Bank in
Pakistan [Internet]. 2022 [cited
2023 Feb 1]. Available from:
https://www.worldbank.org/en/
country/pakistan/overview
4. United Nations. Pakistan
floods: 9 million more risk
being pushed into poverty,
warns UNDP [Internet]. 2023
[cited 2023 Feb 1]. Available
from: https://news.un.org/en/
story/2023/01/1132207
Muhammad Ashraf Nizami,
MD, PhD
Additional Standing Committee
Member, World Medical Association
President & Chairman of International
Relations, Pakistan Medical Association
Lahore, Pakistan
drmanizami@hotmail.com
Interview with the President of the Pakistan Medical Association
12
One notable achievement at
the World Medical Association
(WMA)’s General Assembly in
October 2017 was the adoption of the
revised Declaration of Geneva: The
Physician’s Pledge (DoG) [1]. As the
next logical step, the WMA focused
on another seminal document – the
International Code of Medical Ethics
(ICoME) – which had not been
amended since 2006 [2].
The DoG and ICoME have always
been strongly interrelated, as they
were adopted by the WMA’s second
and third General Assemblies in
1948 and 1949, respectively [3]. By
addressing the ethical failings of
the medical profession during the
Second World War [4], the WMA
solidified its mission as a platform for
establishing professional guidelines
for physician conduct and developing
a global consensus on medical ethics.
As the compatibility of these two
documents has been warranted over
the years, the WMA would need to
align the ICoME with the newly
revised DoG.
A large and inclusive workgroup
was established in 2018, with the
mandate to begin a long-term
review of the ICoME. This ICoME
revision workgroup, representing 19
countries covering all the WMA’s
geographic regions, participated
in regularly scheduled workgroup
meetings, contributing their unique
insights to the revision process.
Workgroup members included
representatives from the German
Medical Association (chair),
American Medical Association,
Japan Medical Association, Brazilian
Medical Association, Australian
Medical Association, South African
Medical Association, British Medical
Association, Kuwait Medical
Association, Nigerian Medical
Association, and Danish Medical
Association. Active observers also
included the Standing Committee of
European Doctors (CPME), Royal
Dutch Medical Association, Chinese
Medical Association, Swedish
Medical Association, Israeli Medical
Association, Federazione Nazionale
degli Ordini dei Medici Chirurghi
e degli Odontoiatri (FNOMCeO),
Conseil National de l’Ordre des
Médecins (CNOM), Norwegian
Medical Association, Consejo
General de Colegios Oficiales
de Médicos (CGCOM), WMA
Associate Members, Junior Doctors
Network, International Committee
of the Red Cross, Confederación
Médica Iberoamericana y del Caribe
(CONFEMEL), and Chairs of the
WMA Medical Ethics Committee.
As a first step, workgroup members
provided feedback on a list of strategic
considerations developed with
Professor Urban Wiesing (WMA
Ethics Advisor).These considerations
served to structure the revision
process by analysing the physician’s
duties toward certain individuals and
groups (starting with the individual
patient, but also including relatives,
other physicians, members of other
professions, and society). Workgroup
members were able to indicate how
these professional relationships were
addressed in their respective national
codes, if at all, and which aspects
should be prioritised for inclusion in
the revised ICoME.
As part of this initial phase of the
revision process, the workgroup also
reviewed the principles in the 2006
version of the ICoME, to ensure
compatibility with the full spectrum
of the WMA policy, focusing
especially on the newly revised DoG
and the Declaration of Helsinki. Dr.
Otmar Kloiber (WMA Secretary
General) participated in the
workgroup meetings and helped
confirm that the content of the revised
ICoME would not contradict existing
WMA policy. Key concepts that had
been added to the DoG – physician
well-being, patient autonomy, duty
to share knowledge, and mutual
respect between medical students
and teachers – were prioritised
Ramin W. Parsa-Parsi
WMA International Code of Medical Ethics:
Highlights from the Revision Process
Siobhan O’Leary
Urban Wiesing
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WMA International Code of Medical Ethics: Highlights from the Revision Process
13
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for inclusion in the ICoME [3].
Initial comments proposed by the
workgroup included physicians’duties
with regards to maintaining medical
records, disclosure of commercial and
other interests, advertising, and the
“fair, just, and prudent stewardship”
of shared health resources.
In addition to addressing the content
of the ICoME, the workgroup also
reviewed the format of the document
and concluded that the language
should be modernised and adapted to
be more gender inclusive. Once a list
of priority topics had been determined
by the workgroup, with input from
WMA constituent members, a
preliminary revised ICoME draft
was prepared and subsequently
approved by the WMA Medical
Ethics Committee (MEC) and
Council for further deliberation at
the Eastern Mediterranean and Latin
American regional conferences held
in early 2020, which were organised
by the Kuwait and Brazilian Medical
Associations in Kuwait City and in
São Paulo, respectively.
The WMA has traditionally held a
series of regional meetings during
such high-profile revision processes
to ensure that not only constituent
members, but also stakeholders
and experts from all of its regions,
had an opportunity to share their
observations and increase global
awareness of key WMA documents.
Topics highlighted during these
initial regional conferences
included informed consent, patient
confidentiality, obligation to report
cases of violence as a member of
the medical profession, ethics of
remote treatment, and physician
conscientious objection.
On the heels of the regional meeting
in Brazil,the coronavirus disease 2019
(COVID-19) pandemic threatened
to impede the progress of the
workgroup. However, the workgroup
adhered to the established workplan
and timeline through regular virtual
meetings. While several regional
meetings were postponed during
the height of the pandemic, the
International Association of Bioethics
virtual meeting was held in June
2020, and provided the workgroup
with an opportunity to gain feedback
from world-renowned medical ethics
experts, including Dr. Ruth Macklin
(Albert Einstein College of Medicine,
United States) and Professor Alex
John London (Carnegie Mellon
University, United States). Notably,
two topics dominated the discussion.
First, although informed consent as it
relates to decisional capacity had been
discussed in the existing ICoME, the
consensus was that further clarity
was needed in the revised Code.
Second, ethical duties of physicians
in the case of a conflict between a
physician’s personal moral beliefs
and professional obligations toward
the patient (including physician
conscientious objection) had not been
addressed in earlier iterations of the
Code.
Around the same time, the WMA
Associate Members hosted a webinar
focused on the ICoME, featuring a
discussion among several members
of the workgroup led by Dr. Joseph
Heyman (Chair, WMA Associate
Members). The COVID-19
pandemic took front and centre
during the webinar, with discussions
highlighting the tension between
the physician’s duty to the individual
patient and to society, as well as the
ethical duty of the physician to help
in emergency situations and how
their duties are directly impacted (e.g.
shortages of protective equipment).
The workgroup continued to finetune
the language of the existing draft in
regular virtual meetings, leading up
to the public consultation held in
May 2021. The public consultation
represented an important opportunity
for the workgroup to gather feedback
from the international medical ethics
community and assess whether the
revision was heading in the right
direction. Notably, there was a
tremendous response from physicians
and ethics experts throughout the
world, particularly with regards to
the paragraph focused on physician
conscientious objection. At the time,
the paragraph called for an objecting
physician to ensure undelayed
continuity of care through effective
referral. This clause was met with
resistance among some physicians and
medical organisations, who called for
stronger protection of the physician’s
right to exercise conscience and
rejected the wording on the grounds
that a physician who morally objects
to a certain intervention might see
such a referral as an act of complicity.
Due to the volume of comments
received on this one paragraph, the
workgroup decided to postpone
further in-depth discussion on this
issue until a dedicated in-person
conference could be held.
After reviewing feedback received
during the public consultation in
three virtual meetings, the workgroup
developed and circulated a revised
draft version to WMA constituent
members for comments. Thereafter,
the workgroup carefully assessed each
comment received from members,
before developing and sharing a
revised draft with the MEC, and
subsequently the Council, requesting
approval to use the draft version
as the basis for further discussion.
While preparations were underway
for the final regional meetings, the
workgroup held a virtual meeting
with CONFEMEL members to offer
a forum to provide further context for
submitted proposed content revisions
of the Code. Following this discussion,
the workgroup incorporated some
proposed revisions into the draft,
including a clause on the physician’s
duty to never participate in or
WMA International Code of Medical Ethics: Highlights from the Revision Process
14
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facilitate acts of torture.
In March 2022, the latest revised
draft was presented at the 14th World
Conference on Bioethics, Medical
Ethics and Health Law, which was
held in Porto, Portugal. In April
2022, at the WMA Council session,
which was held in Paris, France, the
MEC and Council approved the
revised version for use as the basis for
discussion in the remaining regional
meetings. As many travel restrictions
due to the COVID-19 pandemic
were lifted in mid-2022, the WMA
supported regional meetings in Asia,
graciously hosted by the Medical
Association of Thailand in Bangkok,
and Africa, generously hosted by
the Nigerian Medical Association
in Abuja. Major discussion topics
at both meetings included patient
autonomy and informed consent, the
duty to share knowledge, the duty to
help in medical emergencies, the duty
to report unsafe working conditions,
violence against physicians and health
personnel, and other unsustainable
stress factors. Conference attendees
reviewed each paragraph and
provided their assessments, which
were submitted to the workgroup for
careful review.
Between these two regional meetings,
the Indonesian Medical Association
hosted a high-level two-day dedicated
conference on physician conscientious
objection, which brought together
local and international experts in
Jakarta to analyse what had become
the most contentious paragraph in
the revised ICoME draft. Professor
Wiesing provided an overview on
addressing physician conscientious
objection in a pluralistic society.
Dr. Henry Okwuokenye (Medical
Council of Nigeria) called attention
to the unique implications of
physician conscientious objection
in resource poor settings. Professor
Angela Ballantyne (University of
Otago, New Zealand) presented on
mandated referrals or other limits to
physician conscientious objection. Dr.
Alberto Giubilini (Oxford Uehiro
Centre for Practical Ethics, United
Kingdom) defended the argument
against conscientious objection in
the medical profession. Dr. Daniel
Sulmasy (Kennedy Institute of Ethics,
United States) countered with a
presentation in defense of permitting
physicians with a moral objection to
an intervention permitting physicians
not to refer patients.
A more moderate approach to
physician conscientious objection
was presented on the second day
of the meeting, followed by an in-
depth panel discussion. Professor
Robert Card (State University of
New York Oswego, United States)
and Professor Mark Wicclair
(University of Pittsburgh Center for
Bioethics and Health Law, United
States) added to the spectrum of
perspectives on this contentious
issue with their presentations. WMA
members contributed insightful
responses, including Leah Wapner
(Secretary General, Israeli Medical
Association), Dr. Jung Yul Park
(Chair, WMA Finance and Planning
Committee), Dr. René Héman
(President, Royal Dutch Medical
Association,Netherlands),Dr.Patrice
Harris (Past President, American
Medical Association).Also,Dr.Marit
Hermansen (Chair, WMA Medical
Ethics Committee), Dr. Mvuyisi
Mzukwa (Chair, Board of the South
African Medical Association),
and Dr. Kar Chai Koh (President,
Malaysian Medical Association)
helped moderate and chair the
meeting. Workgroup members then
held a hybrid meeting to share their
first impressions of the meeting
outcome.
In July 2022, the latest revised draft
was presented during a session at the
World Congress of Bioethics in Basel,
Switzerland. Later that month, the
workgroup held an extensive virtual
meeting to develop a new compromise
draft of the conscientious objection
paragraph for the final regional
meeting in Washington, D.C., which
offered one final evaluation of the
revised ICoME draft.
In August 2022, this final meeting,
hosted by the American Medical
Association in Washington, D.C.,
featured an impressive lineup of the
world’s top medical experts, including
Professor James Childress (University
of Virginia, United States; co-author
of “Principles of Biomedical Ethics”),
Dr. Susan Bailey (Past-President,
American Medical Association) as
well as Professors London, Sulmasy,
and Wiesing, who had presented
on the ICoME draft in previous
meetings.The meeting was co-chaired
by Dr. Jesse Ehrenfeld (President-
Elect, American Medical Association)
and representatives of the Council on
Ethical & Judicial Affairs (CEJA),
which is responsible for maintaining
and updating the American Medical
Association’s Code of Medical
Ethics. After incorporating feedback
from this workgroup’s meeting, the
final draft was circulated among
WMA constituent members, and
then submitted to the MEC with a
request to forward the document to
the Council and, upon approval, to
the General Assembly for adoption.
The extensive and inclusive global
effort that contributed to the
preparation of the revised ICoME,
led by an engaged workgroup, was
rewarded with the unanimous
adoption of the document at the
WMA’s General Assembly in
October 2022 in Berlin. The final
discussions and approval of the
document were accompanied by a
high-profile scientific session focused
on “Medical Ethics in a Globalized
World”, moderated by Dr. Robert
Golub (Executive Deputy Editor,
JAMA), and featured presentations
WMA International Code of Medical Ethics: Highlights from the Revision Process
15
BACK TO CONTENTS
by Professor Childress and Professor
Tom Beauchamp (co-author of
“Principles of Biomedical Ethics”),
workgroup member Professor
Raanan Gillon (Professor of Medical
Ethics, Imperial College London,
United Kingdom), Professor Ames
Dhai (Chair,UNESCO International
Bioethics Committee), Professor
Wiesing, and Dr. Helen Eboreime
(Director of Medical Services, Edo
State Ministry of Health, Nigeria).
Responses were received from
Kawaldip Sehmi (CEO,International
Alliance of Patient Organizations) as
well as representatives of the Japan
Medical Association, Brazilian
Medical Association, Chinese
Medical Association, and Kuwait
Medical Association.
With the completely revised Code,
the WMA’s advocacy work will
certainly continue with intensified
and concerted efforts to increase
the global visibility of the ICoME,
by translating the Code into other
languages, citing the Code in other
policy and literature documents, and
applying this Code as a blueprint
for national codes of conduct, where
appropriate.
Acknowledgments: The authors
would like to thank to the workgroup
members and observers, as well as the
hosts of the regional meetings, who
have devoted much time, energy, and
expertise into this rewarding four-
year revision process.
References
1. World Medical Association.
WMA Declaration of Geneva
[Internet]. 1948 [updated
2017 Oct; cited 2023 Feb
15]. Available from: https://
www.wma.net/policies-post/
wma-declaration-of-geneva/
2. Parsa-Parsi RW. The
International Code of
Medical Ethics of the World
Medical Association. JAMA.
2022;328(20):2018-21.
3. Parsa-Parsi RW. The Revised
Declaration of Geneva. A
Modern-Day Physician’s Pledge.
JAMA. 2017;318(20):1971-2.
4. Wiesing U, Parsa-Parsi R. The
World Medical Association
launches a revision of the
Declaration of Geneva.Bioethics.
2016;30(3):140.
Ramin W. Parsa-Parsi, MD, MPH
Head, Department for
International Affairs,
German Medical Association
WMA Council Member
WMA Medical Ethics
Committee Member
Chair, WMA ICoME
revision workgroup
Berlin, Germany
rparsa@baek.de
Siobhan O’Leary, MA
International Program Officer,
German Medical Association
WMA Facilitator
Berlin, Germany
Prof. Dr. med. Dr. phil. Urban Wiesing
Director, Institute of Ethics
and History of Medicine
University of Tübingen
Tübingen, Germany
WMA International Code of Medical Ethics: Highlights from the Revision Process
Photo 1. Members of the ICoME revision workgroup, following the adoption of the document during the WMA General
Assembly in October 2022, in Berlin, Germany. Credit: WMA
16
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Few situations in the lives of physicians
are as difficult as dealing with the
death of their patients. Maintaining
the highest standards of medical care
and ethical treatment at the end-of-life
may present clinical, emotional, and
even ethical dilemmas. Through its
policy development process, the World
Medical Association (WMA) seeks to
guide and inform physicians on this
topic as well as other difficult subjects
in order to ensure the highest ethical
and clinical standards for medical care.
As stated in the WMA Code of
Medical Ethics, “the primary duty of
the physician is to promote the health
and well-being of individual patients
by providing competent, timely, and
compassionate care in accordance
with good medical practice and
professionalism.” As such, physicians
have an obligation to relieve pain and
suffering and to promote the dignity
and autonomy of dying patients in
their care. The WMA Declaration
of Venice (https://www.wma.net/
policies-post/wma-declaration-of-
venice/d-1983-01-2006_ove/) and
the WMA Declaration on End-
of-Life Medical Care (https://
w w w.w ma.net /pol icies-post /
wma-declaration-of-venice/) are
two such policies that instruct on
and reinforce these core principles.
Revision History of the WMA
Declaration ofVenice
The WMA Declaration of Venice on
Terminal Illness (https://www.wma.
net/policies-post/wma-declaration-
of-venice-on-terminal-illness/) was
scheduled to undergo the customary
10-year revision process in 2016. At
this time, it was decided to hold the
revision until the related Declaration
on Euthanasia and Physician-
Assisted Suicide (https://www.wma.
net/policies-post/declaration-on-
euthanasia-and-physician-assisted-
suicide/) was revised. In October 2019,
the revised WMA Declaration on
Euthanasia and Physician-Assisted
Suicide was adopted with new wording
that required a revision and adaptation
of the existing the Declaration of
Venice on Terminal Illness. The
WMA Secretariat made minor edits
to the Declaration of Venice to align it
with the WMA’s updated position on
euthanasia.
However,the initial modifications were
deemed incomplete. In February 2021,
the WMA Policy Review Committee
recommended that a third policy, the
WMA Declaration on End-of-Life
Medical Care, undergo revisions and
be combined with the WMA
Declaration of Venice. The Council
asked the American Medical
Association (AMA) to manage this
consolidation.Duetoitscomprehensive
nature, it was determined that the
WMA Declaration of Venice should
remain as the “base” document with
incorporated elements of the end-
of-life care policy. The consolidated
draft was first circulated in late 2021,
with additional language on palliative
care from the WMA’s end-of-life
policy and a paragraph on sedation
to unconsciousness, a topic that
had not previously been addressed.
There was a significant amount of
disagreement about the terminology
used in the draft, and several members
believed that the documents should
not be combined. A well-considered
point was made that pain management
is not exclusive to the end-of-life or
for terminal illness. Indeed, palliative
care should be routinely available not
only to dying patients, or those in
the end-stage of terminal conditions,
but also to patients suffering with
chronic, debilitating diseases that are
not immediately life threatening, but
whose symptoms can and should be
addressed.
The AMA again revised the draft
based on the comments received,
noting the objective of resolving
issues with presumed consent in
organ donation. A revised draft based
on comments was submitted at the
WMA General Assembly held in
Berlin in October 2022.The title of the
Declaration was then updated to reflect
its broader applicability. Retitled as the
“Declaration of Venice on End-of-Life
Medical Care”, the revised draft was
then adopted by the WMA General
Assembly. The previous Declaration
on End-of-Life Medical Care was
then rescinded and archived.
We would like to thank everyone who
submitted comments. We believe
that the most important elements
were included in the new Declaration
and that the WMA’s objectives were
accomplished. It is our hope that the
revised WMA Declaration of Venice
will provide sound guidance to all
physicians for years to come.
Gerald E. Harmon, MD
Immediate Past President, American
Medical Association (AMA)
Chair, AMA Delegation to the
World Medical Association
Georgetown, South Carolina,
United States
Gerald E. Harmon
WMA Declaration of Venice: Revision Process and Outcome
WMA Declaration of Venice: Revision Process and Outcome
17
Update on the Revision of the WMA Declaration of Helsinki
On 5 April 2022, the 220th Council
Session of the World Medical
Association (WMA) approved a
motion by the American Medical
Association (AMA) to form a
Workgroup to revise the Declaration
of Helsinki (DOH).
The Chair appointed the workgroup,
made up of constituent members
from the United States (Chair),
Bangladesh, Belgium, Brazil, China,
Denmark, Finland, Germany,
Israel, Italy, Japan, Malaysia, the
Netherlands, Nigeria, South Africa,
Taiwan, United Kingdom, Uruguay,
the Vatican, and the Associate
Members. The workgroup is
unusually large, but justified by the
importance of the Declaration and its
content. The workgroup is expected
to operate in subgroups, including a
core group responsible for drafting
new language.The first organisational
meeting was held by videoconference
on 3 August 2022, and was led by the
Chair, Dr. Jack Resneck, Jr.
Rationale for Revision
The DOH was last updated in 2013,
and it was due for a routine revision
in 2023. Given the importance of
this policy and the attention it has
received in the context of vaccine
testing during the coronavirus disease
2019 (COVID-19) pandemic, it
was decided that the Declaration
should be reviewed and revised, if
necessary, on a schedule beginning
one year early. The Declaration
requires WMA’s regular attention
to address new topics and schools
of thought and situations, and this
revision demonstrates ownership by
the WMA.
Some of the areas suggested for
revision and new topics to consider
include:
• Patient driven research
• Potential undue patient pressure
• “Open Science” approaches
• Inclusiveness of research
• Prevention trials and the concept of
“vulnerable” groups vs. “concerned”
groups
• Real-world data use for control
groups
• Virtual patient data
• Coherency between the DOH and
the Declaration of Taipei
• Adaptive trial designs
• Branched trial designs
• Dynamic consent
• Challenge trials, especially given
the COVID-19 pandemic
• Compassionate use and
misinterpretation of the current
DOH to justify the use of
questionable medicines
Terms of Reference
The workgroup is encouraged
to invite participation by WMA
partner organisations such as
the Council for International
Organisations of Medical Sciences
(CIOMS), International Federation
of Associations of Pharmaceutical
Physicians and Pharmaceutical
Medicine (IFAPP), and other
international organisations like the
WHO Office of Compliance, Risk
Management and Ethics (CRE), and
the Council of Europe.
Under its guidingTerms of Reference,
the workgroup is invited to:
• Prepare a workplan and schedule
for the revision process, which is
expected to last until October 2024.
• Present findings and suggest areas
for revision and amendments to the
Medical Ethics Committee (MEC)
at its regular meeting in April 2023.
• Prepare an amended draft for
discussion in Council and later
for discussion with the public,
experts, scholars, and interested
organisations.
• Synthesise comments received and
produce a refined draft for the
Council.
• Hold open discussions in multiple
regional conferences with interested
individuals and organisations and
produce a final draft for the MEC
to accept and present to the General
Assembly for adoption.
Regional Meetings
The first regional meeting of the
workgroup was held in conjunction
with a regional expert meeting from
9-11 December 2022, in Tel Aviv,
Israel, and was sponsored by the
Israel Medical Association. Invited
experts contributed information and
participated in open discussions on
the purpose of codes of medical ethics
and the history of the DOH revision
process. Later, experts from Israel
Update on the Revision of the WMA Declaration of Helsinki
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18
and Finland presented talks, and the
meeting shifted to the topics of big
data and augmented intelligence,with
particular focus on consent, use of
patient data, and risks to participants.
In the workgroup meeting, topics
emphasised for discussion were the
relationship between the Declaration
of Taipei and the DOH, and the
aforementioned expert presentations
on consent, patient data, and risks
to participants. The workgroup also
exchanged views on the goals and
process for a public consultation
period later in 2023.
The second regional meeting took
place at the invitation of the Brazilian
Medical Association (Associação
Médica Brasileira, AMB) from 24-25
February 2023, in São Paulo, Brazil.
The regional meeting focused on
the use of placebo in clinical trials
and included speakers from Latin
America, CIOMS, and the United
StatesFoodandDrugAdministration.
Its program primarily focused on the
history of previous DOH revisions
and the use of placebo, the role that
placebo plays in clinical trial design,
and the ethical issues involved. The
final day of the meeting also explored
commonalities and differences across
geographies and national authorities
on the use of placebo, as well as how
to ensure the DOH and CIOMS
guidelines are well aligned on the
topic.
The associated workgroup meeting
discussed where the DOH stood
on the use of placebo in relation to
other partners and ethics documents,
potential edits that might clarify its
use of placebo language, and how
potential edits could be interpreted
and received by the DOH’s global
audience if implemented. The
meeting also agreed upon the
revision’s scope of topics and issues, as
well as next steps to offer suggested
edits following the completion of the
two regional meetings.
The next regional meeting will
be hosted by the Danish Medical
Association on 21-22 September
2023, in Copenhagen, Denmark.
Submitted by the AMA Office of
International Relations
Update on the Revision of the WMA Declaration of Helsinki
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19
According to the World Health
Organization, between 8% and 38%
of health professionals are victims
of physical violence during their
careers and even more are victims of
threats or verbal aggression [1]. The
professions at higher risk are those
involved in direct patient care such
as nurses, paramedics, and emergency
room staff. In the United States,
recent studies have revealed that the
incidence of violence in health care
facilities has increased by more than
60% between 2011 and 2018 – from
6 to 10 intentional injuries by another
person per 10,000 full-time health
professionals [2]. The U.S. health
care and social service industries
have experienced the highest rates of
injuries caused by workplace violence,
and employees are five times as
likely to suffer a workplace violence
injury than those in other workplace
environments [2].
Since the start of the coronavirus
disease 2019 (COVID-19) pandemic,
violence against health personnel
has increased worldwide [3]. One
research study concluded that
although all participants reported
verbal aggression, a total of 58%
of the respondents perceived an
increase in violence against health
professionals, and 9% said that such
violence rates had not occurred before
the COVID-19 pandemic [3]. Also,
an estimated 82% had experienced
threats and physical aggression,
27% reported being threatened by
weapons, and 21% reported the
death or severe injury of a health
professional or patient [3].
In Israel,about 3,500 cases of violence
against health professionals – 20% as
physical violence and 80% as verbal
violence – are reported every year
[4]. One national survey conducted
among physicians and other health
personnel in Israel found that 80%
of respondents reported that they
had experienced some form of
violence in their workplace, and 75%
had experienced verbal violence at
least once a year [4]. Another study
conducted in a general hospital
reported that one-third of hospital
personnel reported experiences of
physical or verbal violence within
the six months preceding the study
[4]. According to the Association
of American Medical Colleges, the
reasons for violence against health
professionals include patients’ anger
and confusion about their medical
conditions and care, patients’
dissatisfaction and frustration amid
staffing shortages, mental health
disorders, political and social issues,
and perceived gender and race
discrimination [5].
WMA Statement on Workplace
Violence in the Health Sector
Violence against health professionals
cannot be tolerated, as there are clear
negative impacts on the physical and
psychological well-being of staff,
including emotional stress, anger,
helplessness, and anxiety. In addition,
it affects their job motivation and
compassion when interacting with
co-workers as well as patients and
their families. Consequently, violence
can impair the quality of care and
cause significant economic damage to
health care systems.
In October 2010, the Israeli Medical
Association (IMA) first proposed
the draft World Medical Association
(WMA) Statement on Workplace
Violence in the Health Sector for
review and discussion by the WMA
Leonid Eidelman
Proposed Revision of the WMA Statement on Violence
in the Health Sector by Patients and Those Close to Them
Malke Borow Tali Rayn-Aloni
Proposed Revision of the WMA Statement on Violence
in the Health Sector by Patients and Those Close to Them
Baruch Levi
BACK TO CONTENTS
20
members. The statement, which was
formally adopted by the 63rd WMA
General Assembly in Bangkok in
October 2012, was the result of
the concerning trend of increasing
violence against health professionals
by patients and their family members
[6]. Since its adoption, however, data
have shown that violence has not
ebbed, and if anything, has worsened.
Furthermore, over the last decade,
the widespread development of social
networks has led to observations of
new threats – harassment and verbal
violence on the Internet.
To address this gap, the IMA
proposed a revision of this original
statement, and the revised statement
was adopted during the 73rd
WMA General Assembly in Berlin
in October 2022. This statement
applied the broad WHO definition of
workplace violence: “The intentional
use of power, threatened or actual,
against another person or against a
group, in work-related circumstances,
that either results in or has a high degree
of likelihood of resulting in injury, death,
psychological harm, mal-development,
or deprivation” [6]. This statement
also calls for taking steps to create
a violence-free cyber-environment,
such as strengthening policies to
protect user data, ensuring the ease
and accessibility of submitting
reports of violence, and engaging law
enforcement for proper legal action
when warranted.
Notably, the WMA Statement on
Workplace Violence in the Health
Sector expresses the WMA’s firm
position against any form of violence
against health personnel and facilities.
Such acts include but are not limited
to, cyber violence, physical violence
or verbal violence by co-workers,
aggressive behaviours exhibited by
patients and companions, and acts
of malicious intent from individuals
in the general public. Therefore,
the WMA calls on its constituent
members, health authorities, and
other relevant stakeholders to
support a collaborative approach
to develop appropriate policies
(e.g. laws and regulations), prepare
relevant protocols for situations of
violence, build education and training
programs to raise public awareness,
enhance security within health care
facilities and support for victims,
and conduct investigations and
data collection through appropriate
reporting systems.
The WMA statement intends to
help support national authorities’ and
national medical associations’ongoing
efforts to combat violence against
health professionals. Some countries,
including Australia, Canada, United
Kingdom, and the United States,
have taken measures aligned with
the WMA statement to enhance
protection for health professionals.
First, in the state of Victoria,
Australia, according to a legislative
amendment from 2018, courts must
impose a custodial sentence on any
offense against injuring doctors
or nurses [7]. Second, Canada
announced a tougher approach
in 2021, where any intimidating
conduct against health professionals
or any obstruction of access to
health care facilities may result in
imprisonment of 10 years [8]. Third,
the United Kingdom launched the
“zero-tolerance” approach in 2018,
following the Assaults on Emergency
Workers Act 2018, which doubled
the maximum prison sentence for
assaulting an emergency health
personnel from six months to one
year [9]. Finally, the United States
has developed and implemented
strategies of risk identification and
assessment as well as mental health
support for health professionals who
have suffered from acts of violence
[10].
Furthermore, the WMA statement
may play a dual role in global efforts
to address the issue of violence
and reduce risk among health
professionals. As it aims to increase
community awareness of this issue
and the need for timely solutions, it
also serves as a general framework
or “blueprint” for guiding policy
makers in the development of local
and national strategies to fight
violence against health professionals.
The adoption, implementation,
and expansion of such policies can
ultimately prioritise health and well-
being of the medical profession.
The Role of the Israeli National
Medical Association
The IMA actively engages in ongoing
national campaigns to raise public
awareness among policy makers and
the general community, in efforts
to lead systematic action against
violence in the health care system.
The WMA Statement on Workplace
Violence in the Health Sector has an
important role in encouraging the
implementationofnecessarymeasures
on global levels to end violence across
health institutions.These local efforts,
when combined with more global
efforts, have increased impact on the
problem of violence worldwide.
The IMA has successfully promoted
two national legislative initiatives
through deliberation and cooperation
with Israeli legislators and ministries.
First, the 2011 legislation for
preventing violence in health care
institutions supported the institution’s
role to prevent aggressors’ entrance to
their premises on certain conditions
[11]. In addition, a 2010 amendment
to the Penal Code expanded the
punishment for attackers of medical
personnel [11].
The IMA has also participated in
an inter-ministerial committee on
violence in health institutions that
published general recommendations
for the government, police system,
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Proposed Revision of the WMA Statement on Violence
in the Health Sector by Patients and Those Close to Them
21
and medical institutions for the
eradication of violence in health
care settings. Among other things,
these recommendations promoted
collaborations with the police
department, in order to formulate
guidelines for handling incidents of
violence across the health care system.
Notably, the IMA operates a call
centre for physicians who experience
violence and encourages physicians
to report and file complaints on
incidents of violence [12].
Throughout 2022, the IMA
promoted the theme, “The time has
come for action”, in a community
campaign that increased awareness
about reducing violence against
medical staff. The association
declared a labour dispute and
supported a physicians’ strike in
protest of escalating violence against
physicians and other health personnel
[12]. These actions aimed to spur the
government to take the necessary
measures stipulated by the inter-
ministerial committee and subsequent
ministerial circular on prevention of
violence in health institutions [13].
To date, however, although national
leadership has discussed and agreed
with an action plan to eradicate
the rampant violence across health
institutions, the financial and
organisational resources have not
yet been directed. Some pending
measures include adding security
guards in health care facilities
and expanding their authority,
establishing police stations in
emergency rooms and psychiatric
hospitals, placing cameras in
hospitals and clinics, further
promoting“zero-tolerance”legislation
(e.g. imposition of significant
fines), and training medical teams
in managing violent behaviours
of patients and their companions.
The IMA continues to formulate
new ideas and support further
legislation that will assist in
reducing violence in the health care
setting.
Conclusion
Violence against health professionals
continues to represent a widespread
global phenomenon, and it has been
on the rise since the start of the
COVID-19 pandemic. Although
some countries are implementing
prompt actions against violence in
health care systems, more robust
national policies are needed to
increase awareness of this issue. The
IMA is convinced that national
medical associations, with the
support of the WMA, possess a key
role in creating a safer and healthier
workplace environment in our health
care systems.We hope and believe that
the adoption of the revised WMA
Statement on Workplace Violence in
the Health Sector will contribute to
strengthening these important global
efforts and fostering safe workplace
environments for health professionals.
References
1. World Health Organization.
Preventing violence against
health workers [Internet]. 2021
[cited 2022 Dec 13]. Available
from: https://www.who.int/
activities/preventing-violence-
against-health-workers
2. U.S. Bureau of Statistics. Fact
sheet – Workplace violence in
healthcare, 2018 [Internet]. 2020
[cited 2022 Dec 14]. Available
from: https://www.bls.gov/iif/
factsheets/workplace-violence-
healthcare-2018.htm
3. Thornton J. Violence
against health workers rises
during COVID-19. Lancet.
2022;400(10349):348.
4. Israeli Ministry of Health. The
reportoftheMinister’scommittee
to eradicate violence in the
health system [Internet]. 2017
[cited 2022 Dec 15]. Hebrew.
Available from: https://www.gov.
il/he/Departments/publicbodies/
committee-violence-prevention
5. Boyle P. Threats against health
care workers are rising. Here’s
how hospitals are protecting their
staffs [Internet].2022 [cited 2022
Dec 15]. Available from: https://
www.aamc.org/news-insights/
threats-against-health-care-
workers-are-rising-heres-how-
hospitals-are-protecting-their-
staffs
6. World Medical Association.
WMA Statement on Workplace
Violence in the Health Sector
[Internet]. 2012 [updated
2022 Oct, cited 2022 Dec 15].
Available from: https://www.
wma.net/policies-post/wma-
statement-on-violence-in-the-
health-sector/
7. Government of Australia.
Preventing violence against
emergency workers [Internet].
2022 [cited 2022 Dec 14].
Available from: https://www.
vic.gov.au/preventing-violence-
against-emergency-workers
8. Government of Canada.
Backgrounder: Amendments to
the Criminal Code to protect
health care workers and people
seeking access to health services
[Internet]. 2021 [cited 2022
Dec 14]. Available from: https://
www.canada.ca/en/employment-
s o c i a l – d e v e l o p m e n t /
news/2021/11/backgrouder-
justice–healthcare-workers-and-
sick-days.html
9. Government of the United
Kingdom. Stronger protection
from violence for NHS staff
[Internet]. 2018 [cited 2022
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Proposed Revision of the WMA Statement on Violence
in the Health Sector by Patients and Those Close to Them
22
Dec 14]. Available from: https://
w w w.gov.u k /gover nment /
news/stronger-protection-from-
violence-for-nhs-staff
10. Congressional Budget Office,
United States. H.R. 1195,
Workplace Violence Prevention
for Health Care and Social
Service Workers Act [Internet].
2021 [cited 2022 Dec 14].
Available from: https://www.cbo.
gov/publication/57135
11. Borow M. Violence in the
health care sector — an updated
look. World Medical Journal.
2012;58:108-9.
12. Israeli Medical Association.
Violence against physicians
[Internet]. n.d. [cited 2022
Dec 14]. Hebrew. Available
from: https://www.ima.
org.il /main / View Content.
aspx?CategoryId=2431
13. Israeli Ministry of Health.
Prevention of and dealing with
violence in the healthcare system.
Circular 6/2020 of the General-
Manager [Internet]. 2022 [cited
2022 Dec 15]. Hebrew. Available
from: https://www.health.gov.il/
hozer/mk06_2020.pdf
Leonid Eidelman, MD
Past president IMA and WMA
Head of Anesthesiology,
Assuta Ashdod Medical Center
Ashdod, Israel
leonid@ima.org.il
Malke Borow, JD
Director, Division of Law and Policy,
Israeli Medical Association
Ramat Gan, Israel
malkeb@ima.org.il
Baruch Levi, PhD
Head of Research Unit,
Israeli Medical Association
Ramat Gan, Israel
baruch@ima.org.il
Tali Rayn-Aloni, MA
Researcher, Israeli Medical Association
Ramat Gan, Israel
Talir@israelma.onmicrosoft.com
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Proposed Revision of the WMA Statement on Violence
in the Health Sector by Patients and Those Close to Them
23
Improving ethical consciousness
among doctors within medical
research and clinical practice has
been one of the most important
contributions of the World Medical
Association (WMA). Previously,
medical training was perceived as a
sufficient ethical safeguard, and that
ethics was unnecessary among doctors
[1]. Here, we present a story which
illustrates how key ethical principles
were violated in Norway, resulting
in devastating negative effects on
the patient and his family. This
example illustrates the importance
of systematic work with ethics and
human rights in medicine.
Case Study of Bronchoscopy and
Consent to Medical Examination
A child (first author) was admitted
to a Norwegian sanatorium for
tuberculosis in the 1950s (Figure
1). He was discharged from Oslo
University Hospital after 11 months
of hospitalisation, where he had
minimal contact with his family
according to hospital rules. His
family lived in their own house in the
countryside outside Oslo, and he had
two brothers.Notably,he was the only
family member who had contracted
the disease.
At that time, bronchoscopy with a
rigid tube was a common method
to diagnose pulmonary diseases.
For children, this procedure was
conducted under full ether narcosis,
but it could still be painful, risky, and
with side effects. When the senior
consultant at the sanatorium decided
to perform the bronchoscopy, he
wrote to the child´s parents to obtain
consent to conduct the procedure.
The parents, who dreaded serious
complications, did not give consent.
Subsequently, the senior consultant
communicated with their family
doctor and asked her to persuade the
parents for consent, stating that if
they did not consent to the procedure,
then the child would be discharged
from the hospital and sent home.
However, for the parents, it was
impossible to take the responsibility
for a seriously ill child, so they
eventually gave their consent for the
procedure. The bronchoscopy was
performed, and due to complications,
the child became seriously ill with
fever (over 39°C), vomiting, weight
loss, and painful herpes zoster. His
parents were very worried about the
child’s health and dissatisfied with the
treatment that he had received at the
sanatorium. Then, nine months after
the admission to the sanatorium and
two months after the bronchoscopy,
they transferred the child to the new
paediatric department at the Oslo
University Hospital.
Research on Bronchoscopy on
Children
In 1960, the senior consultant at
the sanatorium published an article
entitled, “Diagnosis and treatment
of primary tuberculosis in children”
(in Norwegian only), in the Journal of
the Norwegian Medical Association [2].
The study consisted of 934
bronchoscopies conducted on 223
children from 1954 to 1960, where
most of the children were examined
more than once. The author did not
elaborate on ethical dilemmas that
used clinical findings in medical
research. As the patient of our
case study was examined on three
occasions, it is important to note that
the child’s medical record had no trace
of parental consent to include these
clinical data in a research project.
TheNurembergCode–Declaration
of Geneva
The first version of the Declaration
of Helsinki was published in 1964.
However, the Nuremberg Code from
1947 clearly states that in research,
“The voluntary consent of the human
subject is absolutely essential” [3].
We have systematically reviewed
the Journal of the Norwegian Medical
Association index from years 1947
to 1960, and we could not find the
publication of the full version of
the Nuremberg Code. This journal
published reports from the WMA
General Assemblies, but the 1948
version of the Declaration of Geneva
was not published until 1958.
Bjørn Oscar Hoftvedt
Safeguarding Patients’ Rights through WMA Declarations
Reidun Førde
Safeguarding Patients’ Rights through WMA Declarations
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24
Safeguarding Patients’ Rights through WMA Declarations
Discussion
In the 1950s, the main medical
resource for Norwegian physicians
was the Journal of the Norwegian
Medical Association. Although
the Declaration of Geneva was
not published in the Journal of the
Norwegian Medical Association
until 1958, the declaration builds on
the Hippocratic Oath, which was
well recognized among physicians
in the 1950s. One quote from the
Hippocratic Oath includes: “I
will offer those who suffer all my
attention, my science and my love.
Never will I betray them or risk
their well-being to satisfy my vanity”
[4].
Medical treatment and consent.
Threatening to discharge a seriously
ill child from the hospital because the
parents did not provide consent for an
intervention with serious side effects
and few positive consequences was a
violation of basic medical ethics. The
parents felt that they did not have any
choice. New tuberculosis treatment
was introduced in the 1950s, notably
the continuous 24-month treatment
of the “triple therapy” consisting of
streptomycin, para-aminosalicylic
acid, and isoniazid [5]. Mortality
rates were high without this life-
saving treatment. According to the
Norwegian Ministry of Health, 95
children under the age of 15 died of
tuberculosis in the five years period
from 1951 to 1955 [6]. In our case
study,if the child had been discharged
home, then his health situation would
probably have worsened as he would
not have had access to the new
treatment.
Combining clinical work and medical
research. Until the late 1950s, the
difference between clinical practice
and research was often poorly
understood by physicians. Physicians
could “try out” new interventions
in their practice without having
to follow today´s research ethics
requirements such as informed
consent. The Nuremberg Code,
resulting from unethical research
conducted on prisoners during the
World War II concentration camps,
represents a set of rules that require
informed consent from subjects
participating in medical research [7].
Even if Norwegian physicians had
heard of the Nuremberg Code, they
probably associated it only with evil
medical experiments.
Since the late 1940s, robust
frameworks for patient´s rights have
been developed. In 1948, the WMA
prepared the Declaration of Geneva,
which was adopted by the 2nd WMA
General Assembly, which described
general ethical rules in medicine. In
1964, the WMA Assembly adopted
theDeclarationofHelsinki,regulating
medical research on human beings.
The WMA has constantly updated
these two declarations in response to
new clinical and surgical technologies
as well as society’s expectations of
patients´ and research subjects’ rights.
Over time, history has shown the
importance of the WMA´s work
in medical ethics and human rights
through the Declaration of Geneva
(revised in 2017) and the Declaration
of Helsinki (under revision).
Furthermore, national member
associations hold the responsibility
to disseminate these declarations and
statements adopted by the WMA
among their members.
References
1. Rothman DJ. Strangers at the
bedside.A history of how law and
bioethics transformed medical
decision making.New York: Basic
Books; 1991.
2. Frostad S. Diagnostics and
therapy of primary tuberculosis in
children. Tidsskr Nor Legeforen.
1960;80:1091-8. Norwegian.
3. The Nuremberg Code (1947).
BMJ. 1996;313(7070):1448.
4. Boston University. Hippocrates’
Oath [Internet]. 2010 [cited
2023 Jan 20]. Available
from: https://www.bu.edu/
a r i o n / f i l e s / 2 0 1 0 / 0 3 /
Arenas_05Feb2010_Layout-3.
pdf
5. Iseman MD. Tuberculosis
therapy: past, present and future.
Eur Respir J. 2002;20(Suppl
36):87-94s.
6. Tverdal Aa, Nelson E,
Dødeligheten i Norge av
forskjellige årsaker 1951-
98 [Death Rate in Norway
of Various Causes 1951-98].
SHUSrapport nr 3/2002
[National Health Survey Report
No. 3/2022]. 2002. Norwegian.
Available from: https://www.fhi.
no/globalassets/dokumenterfiler/
rapporter/2009-og-eldre/shus-
rapport-dodsarsaker-i-norge-i-
perioden-1951-1998-pdf.pdf
7. Moreno JD, Schmidt U, Joffe S.
The Nuremberg Code 70 years
later. JAMA. 2017;318(9):795-6.
Bjørn Oscar Hoftvedt, MA
Former Special Advisor in
International Issues
Norwegian Medical Association
Oslo, Norway
bhoftved@online.no
Reidun Førde, MD
Professor Emerita, Centre
for Medical Ethics,
Institute of Health and
Society, Medical Faculty
University of Oslo
Oslo, Norway
reidun.forde@medisin.uio.no
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25
Evidence-based medicine (EBM)
has an indispensable role in medical
education and training across global
settings. EBM was formally defined
by Sacket et al. (1996) as “the
conscientious and judicious use of
current best evidence from clinical
care research in the management of
individual patients” [1]. It prepares
and enables health care professionals
to think critically and utilise all
available scientific information
and tools toward shared decision-
making between health professionals
and patients [2]. Some examples
include clinical practice guidelines
and recommendations on patient
safety, risk of surgical procedures,
and clinical outcomes, including the
length of hospitalisation or surgery,
quality of life, pain, weight loss, and
death. These resources can guide
future practice by preparing the
health workforce with robust tools
to conduct comprehensive individual
health assessments, enhance clinical
diagnosis and management, and
ultimately promote high-quality,
patient-centred health care [3,4].
Applying EBM in clinical practice
must be guided by an open, social,
and transparent decision process,
which can capture confidence
levels of risk assessments [5]. The
educational methodology is based
on the general concept of clinical
inquiry and its subparts, such as
the detailed information about
patients and interest populations,
types of intervention or prognostic
indicators, and relevant outcomes
[6,7]. The judicious selection of the
scientific evidence is not limited
to the qualitative assessment of
methodologies in retrieved studies
(internal validation), but rather is
mediated by identifying barriers to
translate research findings to daily
practice (external validation) [8].
This approach demands that health
professionals understand medical
practice, patient care, and the existing
conflicts and dilemmas among
participating stakeholders.
However, the current global
understanding and application of
EBM in clinical and community
practice has been challenged by
two factors: workplace schedules
and stakeholders’ interests. First,
health professionals experience rapid
information sharing and institutional
pressure to complete clinical and
research tasks. They have limited
time to conduct comprehensive
literature reviews and participate
in journal club activities that foster
critical analyses of current practices.
For example, due to the surge in
ambulatory and hospitalisation care
during the coronavirus disease 2019
(COVID-19) pandemic, health
professionals’ shifts were physically
and mentally exhausting, leaving
minimal time to keep up-to-date
with the scientific literature.
Second, sharing evidence-based
information for diverse audiences
and settings may be influenced by
stakeholders’ interests. Audiences
may be resistant or untrusting upon
learning new information or unaware
that scientific findings are constantly
changing and updated with new
research. For example, public health
messaging on COVID-19, disease
transmission, utilization of facial
masks,and vaccinations was confusing
and even debated on public platforms
(e.g. community townhalls, political
debates).
Although clinical practice guidelines
aim to streamline health care service
delivery, health professionals do not
always incorporate these evidence-
based recommendations in practice.
This heterogeneity, which can
significantly impact decision-making
and clinical outcomes, has resulted
from a new global movement that
incorporates marketing principles
with rapid information sharing.
It fosters an environment where
priorities and objectives are poorly
outlined, epidemiologic assessments
on health risks for marginalised
César Eduardo Fernandes
Evidence-Based Medicine: The Role of Education
to Promote High-Quality Clinical Practice
José Eduardo Dolci
Wanderley Bernardo
Evidence-Based Medicine: The Role of Education to Promote High-Quality Clinical Practice
BACK TO CONTENTS
26
populations are limited, and health
initiatives are not patient-centred.
Notably, this movement is starkly
different from the traditional
approach, which focuses on reflection
and critical thinking during the
learning process [9].
The evidence-based learning
experience, which does not limit
expenditure for medicines and other
materials (e.g. prosthetic devices,
technological instruments), compels
us to evaluate the recommended
health procedures and practices and
their impact on clinical outcomes. In
clinical practice, health professionals
regularly analyse whether they should
utilise the best available evidence in
their diverse tasks. If they understand
that the study findings are aligned
with patients’ health status, then they
may promote this evidence for the
clinical management of their patients
[10].
As next steps, global medical
institutions can use asynchronous
and synchronous formats to develop
EBM education initiatives that
increase awareness of EBM concepts
for diverse audiences within the
health system. EBM can support
original work to prevent plagiarism,
timely patient education to combat
misinformation, physician-patient
decision-making to minimise
patriarchal care, and patient-centred
care to improve health outcomes.
References
1. Masic I, Miokovic M,
Muhamedagic B. Evidence based
medicine − new approaches and
challenges. Acta Inform Med.
2008;16(4):219-25.
2. Elessi K, Albarqouni L, Glasziou
P, Chalmers I. Promoting
critical appraisal skills. Lancet.
2019;393(10191):2589-90.
3. Del Mar CB, Glasziou PP. Ways
of using evidence-based medicine
in general practice. Med J Aust.
2001;174(7):347-50.
4. Bala MM, Poklepović Peričić T,
Zajac J, Rohwer A, Klugarova
J, Välimäki M, et al. What
are the effects of teaching
Evidence-Based Health Care
(EBHC) at different levels of
health professions education?
An updated overview of
systematic reviews. PLoS One.
2021;16(7):e0254191.
5. Glasziou P. What is EBM and
how should we teach it? Med
Teach. 2006;28(4):303-4.
6. Del Mar C, Glasziou P,
Mayer D. Teaching evidence-
based medicine. BMJ.
2004;329(7473):989-90.
7. Nunan D, Lindblad A,
Widyahening IS, Bernardo WM,
Chi CC, Cowdell F, et al. Ten
papers for teachers of evidence-
based medicine and health care:
Sicily workshop 2019. BMJ Evid
Based Med. 2021;26(5):224-7.
8. Ioannidis JPA. Why most
published research findings are
false. PLoS Med. 2005;2(8):e124.
9. GreenhalghT,Howick J,Maskrey
N, Evidence Based Medicine
Renaissance Group. Evidence
based medicine: a movement in
crisis? BMJ. 2014;348:g3725.
10. HoffmannTC,Montori VM,Del
Mar C. The connection between
evidence-based medicine and
shared decision making. JAMA.
2014;312(13):1295-6.
César Eduardo Fernandes, MD
Titular Professor of Gynecology,
ABC Medical School (FMABC)
President,
Brazilian Medical Association
São Paulo, Brazil
presidencia.cesar@amb.org.br
José Eduardo Dolci, MD
Titular Professor of
Otorhinolaryngology,
Faculty of Medical Sciences,
Santa Casa de São Paulo
Scientific Director,
Brazilian Medical Association
São Paulo, Brazil
dolci@uol.com.br
Wanderley Bernardo, MD
Professor,
Evidence Based Medicine,
Medical School of São Paulo University
Guidelines Projector Coordinator,
Brazilian Medical Association
São Paulo, Brazil
wmbernardo@usp.br
Evidence-Based Medicine: The Role of Education to Promote High-Quality Clinical Practice
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27
The 27th Conference of Parties
(COP27) to the United Nations
Framework Convention on Climate
Change (UNFCCC) was held in
Sharm El Sheikh, Egypt, from 6-18
November 2022. Eight physicians
from South Africa, Egypt, India,
Finland, Austria, Sweden, and the
United States represented the World
Medical Association (WMA) at
the COP27. Dr. Ankush Kumar
Bansal (United States) and Dr.
Lwando Maki (South Africa) led
the delegation during the first and
second weeks, respectively. The
delegation represented WMA’s views
and position toward climate change,
as expressed through the adoption
of WMA climate change and
environment policies [1-7].
Delegates followed the negotiations
closely throughout the COP27 and
focused on four key areas of health
impacts:
• Nationally Determined
Contributions (NDCs)
• Financing and capacity-building
• Loss and damage including review
of the Warsaw International
Mechanism for Loss and Damage
(WIM)
• Mitigation and adaptation
In addition to the COP27
negotiations, delegates also attended
the daily health community debrief
and strategy meetings as well as
several health-related side events
organised by United Nations
Lwando Maki
Health in Climate Change at the COP27
Ankush Kumar Bansal
Muha Hassan
Health in Climate Change at the COP27
Ahmed Taha Aboushady
Mahesh Prasad Bhatt
Lars Rocksén
Johanna Schauer-Berg
Lekha Rathod
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28
Framework Convention on Climate
Change (UNFCCC), World
Health Organization (WHO), and
health-related non-governmental
organisations. With WMA
communications support, they led
a social media campaign on the
Twitter social media platform, where
delegates shared highlights and key
messages from the COP27 with
WMA members.
Health-Related Side Events
In collaboration with the Global
Climate Health Alliance, WMA
members successfully organised
the “Building Healthy Resilient
Health Systems” panel. On this
panel, Dr. Lwando Maki (South
Africa) described the health impacts
of climate change as witnessed by
health professionals. Dr. Lekha
Rathod (India/Netherlands)
attended the “Hospital-based
Sustainability Practices” side event,
which emphasised the urgency for
health care institutions to implement
mitigation and adaptation plans
to decarbonize and achieve carbon
neutrality. Session panellists shared
the Scope 1 on direct on-site
emissions (e.g. green health systems,
climate-sensitive patient care, climate
ready public health infrastructure,
community climate resilience) and
Scope 2 on emissions from purchased
electricity.
Advocacy and Plenary Statements
Supported by Member States
During the first week, WMA
delegates met with Dr. John Balbus,
an internal medicine and public
health physician who serves as the
Interim Director of the Office of
Climate Change and Health Equity
in the U.S. Department of Health
and Human Services, as well as three
assistants working in global affairs
in the U.S. Department of State. Dr.
Balbus, who works specifically on
the intersection of climate change
and health, with a particular focus
on health and climate equity,
emphasised three specific points.
First, Dr. Balbus promoted the
need for national delegations,
policymakers, and the COP
presidency to apply the health lens on
these climate discussions. He shared
case studies of how climate change
specifically affects human health and
health-seeking behaviours, which can
help government officials convince
policymakers to support urgent
and substantive policy changes to
climate change policies in all fields
(e.g. accessibility and delivery of
care, transportation, food systems,
forestry). Second, he requested that
the medical community brainstorm
on specific solutions to the climate
crisis through research, pilot projects,
and policy proposals and collaborate
with global counterparts to share
this information with policymakers.
Finally, he recommended that the
medical community share their
voices on emerging health issues in
their geographic regions and speak
with a unified voice. After all, if the
climate discussions are not considered
a priority, then policymakers will not
prioritise these environmental health
issues.
During the second week, WMA
delegates followed the opening
ceremony of the high-level COP27
segment, noting that only some
parties focused on health issues.
The delegation had engaged with
several member states from all WHO
regions and advocated for health.
Notably, Dr. Schauer-Berg and Dr.
Rocksén held a meeting with the
WMA delegation from Austria –
Dr. Leonore Gewessler, Minister
of Climate Action, Environment,
Energy, Mobility, Innovation
and Technology, and Dr. Helmut
Hojesky, head of the Austrian
national delegation. They discussed
the health impacts of climate change
on patients with a special focus on
the effects of heat waves, health care
service delivery, and preparedness
of the Austrian health care system
as well as the inclusion of health in
Photo 1. The COP27 delegation during week 1 included WMA members (Dr. Ankush Bansal, Dr. Muha Hassan,
Dr. Ahmed Taha Aboushady) with Dr. John Balbus (U.S. Office of Climate Change and Health Equity) and
three members of the U.S. Department of State. Credit: WMA
Health in Climate Change at the COP27
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29
the Austrian national adaptation
plan. During the COP27 plenary,
delegates stressed that small island
states will suffer dire consequences if
climate change continues its current
trajectory. Member States of Tuvalu,
Antigua, and Barbuda vocalised the
Loss and Damage fund and the need
for a forceful transition to carbon
neutrality.
COP 27 Key Outcomes
As a high-level political meeting with
environment ministers, the COP
included essential discussions and
negotiations for global coordination
to address climate change. As a result,
delegates discussed seven topics at
length, including the loss and damage
fund, Santiago Network, Warsaw
International Mechanism (WIM),
carbon markets, failure to phase out
fossil fuels, involvement of youth and
intergenerational equity, and a right
to a clean, healthy, and sustainable
environment
Loss and Damage Fund
Although certain parties held a
consistent voice for the establishment
of a fund to address loss and damages,
there were intense negotiations
between parties from 18-20
November 2023. The outcome was
the establishment of a new fund for
loss and damages, with a transitional
committee that would make
recommendations for adoption at the
COP28.
Santiago Network
The Santiago Network was formed at
the COP25 in Madrid, with the goal
of helping low-income countries to
identify technical needs and connect
with technical experts and providers
who can address technical needs. At
the COP27, there was a consensus
on the institutional arrangements to
operationalise the Santiago Network.
Warsaw International Mechanism
The WIM was established in 2013,
with the goal of coordinating and
encouraging dialogue on loss and
damage. There was no decision made
on taking the WIM forward by the
parties, as parties were unable to form
a consensus on whether it should be
under the COP or Paris Agreement
governance.
Carbon Markets
Carbon markets, which can be
bought and sold between countries
or entities, are defined as a system
of credits based on carbon emissions
that countries or entities can use to
emit carbon emissions. Although the
use of carbon credits was transparent,
delegates changed the text to allow for
confidentiality around the movement
of carbon credits.
Failure to Phase Out Fossil Fuels
Although a total of 80 countries, led
by India, supported the call to phase
out fossil fuels, parties failed to raise
the mitigation ambitions regarding
fossil fuels including coal. Although
non-profit and non-governmental
organisations, academic, and climate
activist communities have held
Photo 2. The COP27 delegation during week 2 included WMA members, Dr. Lwando Maki, Dr. Lars Rocksén,
Dr. Johanna Schauer-Berg, Dr. Lehka Rathod, and Dr. Mahesh Bhatt (left to right). Credit: WMA
Health in Climate Change at the COP27
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30
consistent voices to phase out fossil
fuels, parties used wording such as
“accelerating efforts towards the
phase-down of unabated coal power
and phase-out of inefficient fossil fuel
subsidies”. Thus, the goal of phasing
out fossil fuels was not accomplished
at the COP27.
Involvement of Youth and
Intergenerational Equity
The COP27 had a youth envoy for
the first time, which recognized the
key role of youth representatives
from country delegations and the
commitment for the appointment
of a youth envoy for future COPs.
Members of the WMA delegation
from the Junior Doctors Network
(JDN) were proud to have represented
young physicians from across the
world at the COP27. JDN members
are planning future activities that
address the climate crisis.
Right to a Clean, Healthy, and
Sustainable Environment
Despite facing pushback from some
parties, the “right to a clean, healthy,
and sustainable environment” phrase,
was included on the cover of the
final document. Notably, this term
was recognised by the UN General
Assembly in July 2022. This phrase,
together with the “right to health”
phrase, are both located in the final
document of the COP27 proceedings,
as a fruitful outcome of the advocacy
work of the health community at the
COP27.
Way Forward to the COP28
Since the COP26, the global health
community, including the WMA,
has successfully encouraged national
delegations to incorporate health
in climate negotiations during
intersessional meetings. The COP27
was the first year that these discussions
extended beyond linking the effects of
climate change to health as a justified
priority for action, by highlighting
the specific harms, causes, and
potential solutions. One positive step
forward at the COP27 was additional
committee meetings and negotiations
related to the Koronivia Joint Work
on Agriculture (KJWA). The KJWA
examines food systems, nutrition,
security, health impacts related to loss
and damage, local and indigenous
communities, resilient health systems,
emissions with respect to carbon
markets and Article 6, and gender
issues and health. Incorporating such
examples as KJWA into these COP27
discussions – and future COP28
proceedings – will emphasise the
urgency and importance of climate
action as well as support ongoing
advocacy efforts by the WMA and
the wider health community.
The COP28 will be held in Dubai,
United Arab Emirates (UAE) from 30
November 30 to 12 December 2023.
Currently,Dr.Sultan Ahmed Al Jaber,
the COP28 president-designate,
and H.E. Mariam Almheiri, the
UAE Minister of Climate Change
and Environment, have pledged to
include health as a top priority item
on the COP28 agenda.To prepare for
the COP28, the WMA delegation
proposes the following actions:
1. To develop and plan lectures
and panel discussions with
collaborating organisations,
which can describe the health
impacts of climate change across
geographic regions and what
physicians are observing due to
climate change (e.g. hurricanes,
typhoons, excessive heat, drought,
nutrient depletion from soil,
vector-borne diseases)
2. To organise and plan the
promotion of previous and
current WMA statements and
declarations on climate change to
national delegations
3. To expand the WMA
Environment Caucus activities
and membership, which can
foster new ideas, encourage
collaborative projects, and
leverage expertise among WMA
members
4. To seek relevant delegations in
order to facilitate advocacy work
during the COP28.
References:
1. World Medical Association.
WMA Declaration of Delhi on
Health and Climate Change
[Internet]. 2009 [updated 2017;
cited 2023 Feb 5].Available from:
https://www.wma.net/policies-
post/wma-declaration-of-delhi-
on-health-and-climate-change/
2. World Medical Association.
WMA Resolution on Climate
Emergency [Internet]. 2019
[cited 2023 Feb 5]. Available
from: https://www.wma.net/
policies-post/wma-resolution-
on-climate-emergency/
3. World Medical Association.
WMA Resolution on Protecting
the Future Generation’s Right to
Live in a Healthy Environment
[Internet]. 2020 [cited 2023 Feb
5]. Available from: https://www.
wma.net/policies-post/wma-
resolution-on-protecting-the-
future-generations-right-to-live-
in-a-healthy-environment/
4. World Medical Association.
WMA Statement on Sustainable
Development [Internet]. 2018
[cited 2023 Feb 5]. Available
from: https://www.wma.net/
policies-post/wma-statement-
on-sustainable-development/
Health in Climate Change at the COP27
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31
5. World Medical Association.
WMA Statement on Divestment
from Fossil Fuels [Internet].2016
[cited 2023 Feb 5]. Available
from: https://www.wma.net/
policies-post/wma-statement-
on-divestment-from-fossil-fuels/
6. World Medical Association.
WMA Statement on Trade
Agreements and Public Health
[Internet]. 2015 [updated 2021;
cited 2023 Feb 5]. Available
from: https://www.wma.net/
policies-post/wma-council-
resolution-on-trade-agreements-
and-public-health/
7. World Medical Association.
WMA Statement on
Occupational and Environmental
Health and Safety [Internet].
2016 [updated 2022; cited
2023 Feb 5]. Available from:
h t t p s : / / w w w . w m a . n e t /
policies-post/wma-resolution-
o n – o c c u p a t i o n a l – a n d –
environmental-health-and-
safety/
Lwando Maki, MBCHB
(UCT), DiPEC (SA), AHM
(YALE/FPD), MRSSAf
South African Medical Association
Cape Town, South Africa
dr.lwando.maki@gmail.com
Ankush Kumar Bansal, MD,
FACP, FACPM, SFHM
Associate Member
World Medical Association
Westlake, Florida, United States
Muha Hassan, MBCHB, BsSc(Hons)
Associate Member
World Medical Association
Coventry, England
Ahmed Taha Aboushady, MD, MPH
Member, Junior Doctors Network
Alexandria, Egypt
Mahesh Prasad Bhatt, MBBS, MS
Associate Member,
World Medical Association
Dehradun, India
Lars Rocksén, MD
Swedish Medical Association
Ornskoldsvik, Sweden
Johanna Schauer-Berg, MD, MPH
Associate Member,
World Medical Association
Salzburg, Austria
Lekha Rathod, MBBS, MScIH
Member, Junior Doctors Network
Utrecht, Netherlands
Health in Climate Change at the COP27
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32
WMA Members Share Reflections about Earth Day 2023
Founded in 1970, Earth Day (https://
www.un.org/en/observances/earth-
day) is celebrated on April 22, as
a reminder of the delicate balance
with nature and the need to conserve
our natural resources [1]. Each year,
the global community organizes in-
person events,press releases,and social
media campaigns to raise awareness
of the need to adopt environmentally
sustainable practices. Over the past
decade, leading health organizations
and institutions have propelled
climate action – incorporating the
One Health concept [2] – to be placed
as a forefront issue on national policy
agendas. However, since the effects
of climate change have unequally
affected global communities, namely
marginalized populations and low-
income countries, it is essential to
develop comprehensive interventions
to ensure inclusivity,equity,and access
to community health services for all
global citizens [3].
The World Health Organization
(WHO) has recognized climate
action and the health effects of climate
change and building public trust as
two of the 13 urgent health needs
[4]. Professional associations like the
World Medical Association (WMA),
the World Veterinary Association
(WVA), and the American Public
Health Association (APHA) have
dedicated plenary sessions and
scientific symposia at conferences
to discuss climate mitigation and
adaptation plans. The Conference
of the Parties to the United Nations
Framework Convention on Climate
Change (COP) – with the COP27
(2022) held in Egypt and the
COP28 (2023) forthcoming in the
United Arab Emirates – experts have
prioritized climate change as part of
national and international priorities
of the 2030 Agenda for Sustainable
Development.
Since the 17 Sustainable Development
Goals (SDGs) are directly linked
to the One Health concept,
incorporating information from the
New England Journal of Medicine
(e.g. Fossil-Fuel Pollution and
Climate Change Series), Lancet (e.g.
Countdown on Health and Climate
Change), and the One Health High-
Level Expert Panel (e.g. One Health
Joint Plan of Action, ‎ 2022‒2026)
can offer a holistic framework to
address emerging health threats
[5-7]. National policies, guidelines,
and actions will be indispensable to
accelerate climate action and ensure
environmentally sustainable action for
a healthy planet Earth. In this article,
physicians from seven countries –
Argentina, Dominican Republic,
Latvia, Nigeria, Spain, Trinidad,
and Turkey – highlighted insightful
reflections about Earth Day activities
and relevant national policies that
promote environmentally sustainable
practices across their countries.
Credit:
Miha
Creative
/
shutterstock.com
WMA Members Share Reflections about Earth Day 2023
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33
WMA Members Share Reflections about Earth Day 2023
Argentina
Argentina, with 44 million residents,
is recognized as the second largest
nation in South America and fourth
largest nation in the Americas region.
This country has borders with Chile
(west), Bolivia and Paraguay (north),
and Brazil and Uruguay (northeast).
The Argentinian landscape is diverse
and ideal for nature enthusiasts,
with five major geographies –
rainforest (northeast),plains (central),
grasslands (central), plateau of
Patagonia (southern), and Andes
Mountains (western).
Over the past decades, Argentina
authorities have reported the effects
of climate change across this national
landscape. As the northern territories
have an estimated increase of 0.5°C
since 1960, with a smaller increase
in central territories, more intense
rainfall and resulting flooding have
occurred [8]. With the biodiversity
crisis, driven by environmental
degradation and habitat loss, bird
and mammal species have become
extinct [9]. Hence, national leaders
have participated in a rewilding
program, supported by the Fundación
Rewilding Argentina in 1998, as well
as prepared official communications
to the UN Frameworks Convention
on Climate Change (UNFCCC) on
national mitigation and adaptation
measures to climate change [8,9].
In 2021, the Law No. 27.621
entitled, the Implementation of
Integral Environmental Education in
Argentina (Ley para la Implementación
de la Educación Ambiental Integral
en la República Argentina) was
adopted, which aims to guarantee the
right to free, federal, non-partisan,
and continued environmental
education for all public and private
academic institutions and promote
environmental sustainability and
conservation to combat the climate
crisis [10].
As health leaders of the Medical
Confederation of the Argentine
Republic (Confederación Médica de
la República Argentina, COMRA)
(https://comra.org.ar/), we celebrate
International Earth Day, in efforts
to raise awareness about the need to
protect our natural environment and
biodiversity,promotethemanagement
of efficient waste management, and
prioritizetherationaluseofdisposable
materials in our medical offices and
health institutions. We have observed
the increased morbidity and mortality
rates due environmental events
(e.g. heat waves, droughts, wildfires,
floods), geographic spread of vector
habitats that increase risk of disease
spread (e.g. dengue, malaria), and
longer pollen seasons. As physicians,
it is our responsibility to lead local
and national efforts to coordinate
conferences that present up-to-date
scientific evidence on the state of our
national and regional environments to
other health professionals. We should
collaborate to develop innovative
messaging on how climate change can
impact health and empower our local
communities and Americas region.
Dominican Republic
Representing the eastern two-thirds
of the island of Hispaniola, the
Ministry of Environment and Natural
Resources of the Dominican Republic
(DR) has a long history of promoting
key legislation and educational
activities that protect natural
resources and encourage the public
to adopt environmentally responsible
and sustainable practices. Over the
past two decades, DR leaders have
supported the implementation of four
significantcommunity-wideactivities.
First, they developed the annual
Environmental Fair as an opportunity
for environmental organizations and
companies to share products and
services related to environmental
sustainability as well as for scientists
to hold scientific seminars about
biodiversity,climate change,and waste
management. Second, they connected
with primary and secondary
school students by organizing
national drawing and photography
competitions on environmental
themes and educational campaigns
about conserving energy and water
resources and recycling. Third,
they endorsed ecological tourism
(e.g. Eagle’s Bay in Pedernales)
and community participation in
cleaning rivers and beaches (e.g.
International Coastal Cleanup).
Finally, they led the development of
the Environmental Training Center
(Centro de Capacitación Ambiental)
of the Industry Association of the
DR (Asociación de Industrias de
la República Dominicana, AIRD),
which offered capacity training
exercises for business and industry
leaders to promote environmentally
sustainable practices.
Furthermore, DR leaders have led
the preparation and adoption of
environmentally conscious and
sustainable national policies in
the country. First, in 2001, the
Law for Environment and Natural
Resources, 64-00 (Ley General sobre
Medio Ambiente y Recursos Naturales,
64-00) established a legal and
regulatory framework for long-term
environmental and conservation
management [11]. Specific actions
focused on biodiversity conservation,
protected areas and restoration of
damaged ecosystems, mitigation and
adaptation of the effects of climate
change, environmental education
awareness, emission regulations,
clean and renewable technology,
and sustainable agriculture and
fishing. Second, in 2010, the National
Strategy for Development, 2010-2030
(Estrategía Nacional de Desarrollo,
2010-2030) incorporated a clear
vision for national directives and
strategies that guide actions for long-
term sustainable and socioeconomic
development by 2030 [12]. After
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34
a comprehensive analysis of
strengths and limitations (including
external risks), focus areas targeted
the economic, education, energy,
environment, and health sectors,
as well as highlighted the need for
active participation across the federal
government, civil and private sectors,
and international partnerships.
Third, in 2014, in collaboration
with the UN Development
Programme (UNDP), DR leaders
supported the National Report of
Human Development, 2014 (Informe
Nacional de Desarrollo Humano,
2014), which noted the importance
of natural resources to protect
human development for current and
future generations [13]. Fourth, in
2015, they adopted the National
Strategy of Environmental Education
(Estrategía Nacional de Educación
Ambiental), which established the
need for environmental education
activities to promote national
awareness for natural resources [14].
Fifth, in 2017, in collaboration with
UNDP, the National Plan for Climate
Change Adaptation (Plan Nacional
de Adaptación al Cambio Climático)
stressed timely strategies and actions
to help mitigate the effects of climate
change in the country [15]. Finally,
they adopted the National Strategy
for Fire Management in the Dominican
Republic, 2016-2025 (Estrategía
Nacional de Manejo de Incendios en
la República Dominicana, 2016-
2025), which highlighted technical
and scientific approaches to prevent
and mitigate the impact of forest
fires on ecological conservation and
biodiversity [16].
TheDRMinistryofEnvironmentand
Natural Resources has contributed
significant leadership to develop
relevant and timely national policies
and activities to protect ecosystem
health. They understand the urgency
to establish a culture of environmental
protection that promotes responsible
and sustainable practices across the
country.They also recognize the need
for continued review and revision of
such policies and activities to support
best guidelines, laws, and practices for
a healthy planet Earth.
Latvia
Earth Day is a symbolic day that
reminds us about the importance of
health for humans, animals, and the
surrounding environment. We can
be exposed to an array of chemical
compounds in our home and
work environments – antibacterial
detergents, paraben-containing
cosmetics, furniture varnish, and
lead-based plumbing or paint – and
this chronic exposure can negatively
impact our physiology over time.
As a global society, we must take
immediate action to conserve our
natural resources and preserve
our environment, as shared in the
common phrase,“leave no trace”[17].
The Big Clean Up Day is the largest
global movement in the world,
uniting 191 countries and millions
of volunteers each year to make
the planet Earth clean, green, and
beautiful.This day has origins tracing
back to three Baltic states during
the 18th and 19th centuries, when
neighbors helped other neighbors in
completing agricultural and livestock
tasks [18]. History has observed the
human spirit rescuing each other, as
heroes helped Heracles clean the
stables of Augeus in Greek mythology.
For Latvians, the word “help” means
more than coming to the neighbor’s
rescue, but rather “helping”our planet
Earth.The Big Clean Up Day, which
has been widely celebrated across
Latvia since 2006 – and supported
by Liela Talka as the largest volunteer
movement in Latvia [19] – resembles
the dedicated efforts of Latvians to
protect the planet Earth. Although
the Big Clean Up Day does regularly
occur on a specific date – sometimes
coinciding with Earth Day – it is
still clear that the common theme of
understanding the delicate balance
of our planet Earth and the need for
environmentally sustainable actions
is incorporated into our minds and
actions.
During the WMA Council Meeting
held in April 2017, the Latvian
Medical Association proposed a
resolution to limit the use of plastic
bags to support environmental
conservation. After WMA
discussion, the WMA Statement
on Environmental Degradation and
Sound Management of Chemicals
was adopted in October 2018 [20].
This historic statement offered great
support for the Latvian Medical
Association for future legislation
in Latvia. For example, plastic bags
(except very light plastic bags) are no
longer freely distributed at stores, and
customers must pay a few cents for
a plastic bag or opt for a paper bag
(as of 1 January 2019), and a national
plan to add 10 cents to the purchase
of plastic bottles and a deposit system
for these plastic bottles including
the 10-cent refund (as of 1 February
2022) [21,22].
As the Latvian Medical Association,
we encourage all NMAs to take
significant strides to preserve our
natural ecosystems. As legislation
alone is not enough to widely
promote sustainable practices, we
must strive to increase national and
international awareness about the
importance of adopting eco-friendly
behaviors. If we seek optimal health
and well-being for all global citizens,
we must start by taking responsibility
for our daily activities, protecting our
natural landscapes (e.g. forests, coral
reefs, soil, oceans), understanding the
physiological processes of the human
body, and adopting nature-based
solutions that honor our planet Earth.
WMA Members Share Reflections about Earth Day 2023
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35
Nigeria
Across Nigeria, several Earth Day
campaigns have followed the “Invest
in our Planet” theme and have used
media sources (e.g. television, radio,
newspapers, and social media) and
public fairs (e.g. open markets and
motor parks) to educate the populace
on the importance of biodiversity
preservation. Jingles are shared
on television and radio programs
to promote wildlife and land
preservation, while some
organizations coordinate tree
planting exercises at local primary
and secondary schools. These
national actions follow a key policy
change in 2020, when the Nigeria
Federal Ministry of Environment
incorporated the Finima Nature Park
(River State, Nigeria) as a wetland
of global importance for biodiversity
[23].This park represents a protected
area for endemic,rare,and endangered
plant and animal species.
For Earth Day 2022, Nigeria leaders
collaborated with other African
leaders from 14 other countries [24].
They encouraged African citizens to
take accountability, recognize the call
to action to change the climate of the
business, political and environmental
sectors, and act boldly to protect
Africa. As they noted that biodiversity
conservation requires collective action
among the federal government,
private sector organizations, and
citizens, they have supported policies
to prevent animal species extinction,
as elephants and hippopotami have
migrated due to industrial activities.
Furthermore, Nigerian leaders have
duly recognized some Nigerian cities
for their ecological contributions to
protecting biodiversity. One example
is Port Harcourt, the capital of Rivers
State, which is recognized as the
“Garden City” because of its green
vegetation and cleanliness.
Spain
At the UN Climate Change
Conference in Glasgow (COP26),
the government of Spain, together
with 44 other countries, voiced
their commitment to modify their
health systems as low-carbon and
sustainable for energy utilization
[25]. These global conference and
events, like the COP26, have helped
doctors become more aware of the
effects of climate change on human
health and the urgent need for climate
action. However, they recognize that
they have received limited clinical
and public health training on these
environmental health topics.
To address this training gap, the
Spanish General Medical Council
(Consejo General de Colegios
Oficiales de Médicos, CGCOM)
has supported two main activities.
First, the CGCOM’s Foundation
for Training (Fundación para la
Formación) team has developed
courses and seminars to train health
professionals on the health effects
of the changing ecosystems and
their collective duty to preserve the
environment and combat climate
change, as stated in the renewed
Code of Medical Ethics [26].Second,
they form part of the One Health
Platform’s Executive Committee,
which offers a platform for scientific
dialogue and debate, supports the
development of relevant policies and
statements, promotes collaborations,
and encourages community health
education activities.
An ambitious step forward has been
the creation of the Medical Alliance
against Climate Change in 2022,
which resulted from a collaboration
between the Scientific Medical
Societies (Sociedades Científicas
Médicas, SCM), the WHO, the
Government of Spain, and the
European Union. This structure,
recognized as pioneer efforts in
Europe, aims to raise awareness
among Spanish doctors to
take a proactive stance on the
decarbonisation of the health sector,
in compliance with the 2030 Agenda
for Sustainable Development.
Therefore, this alliance includes
recommendations for the reduction
of greenhouse gas emissions in health
care (including pharmaceuticals and
anesthesia), transportation, and waste
management. It is urgent that the
wider medical community collaborate
on robust initiatives to combat climate
change and restore the ecological
balance of our planet.
Trinidad and Tobago
In Trinidad and Tobago, Earth Day
is a reminder of the critical role that
environmental sustainability plays in
promoting human health, especially
a country that is home to a diverse
landscape of forests, wetlands, and
coral reefs. These ecosystems support
the country’s economy, service
delivery, and cultural heritage. As
physicians, we recognize that the
health of the environment and the
population are inextricably linked,and
we have a responsibility to promote
sustainable development and protect
the environment for the benefit
of current and future generations.
Notably, the Trinidad and Tobago
Medical Association continues to lead
Earth Day celebrations, including
establishing a subcommittee for
climate change as well as sponsoring
beach clean-ups and plastic recycling
bins at various community locations.
Over the past decade, national
organizations across Trinidad
and Tobago have organized
robust initiatives to celebrate
Earth Day and raise awareness of
environmental sustainability. First,
the Environmental Management
Authority (EMA) has implemented
WMA Members Share Reflections about Earth Day 2023
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36
several policies and programs that
aim to reduce air pollution, manage
waste, and protect biodiversity [27].
Second, the Green Fund, established
in 2018, has provided project findings
for renewable energy, sustainable
agriculture, and waste management.
Third, the Renewable Energy
and Energy Efficiency Technical
Assistance (REETA) project, funded
by the European Union from 2012-
2016, seeks to increase the use of
renewable energy and reduce reliance
on fossil fuels in the country. It
provides technical assistance,training,
and capacity building to government
officials and other stakeholders in
the energy sector. Specifically, the
REETA project aims to support
federal efforts to achieve the goal
of generating 10% of its electricity
from renewable sources by 2021,
and ultimately diversify the economy
and reduce the carbon footprint.
Finally, the government has launched
widespread social media campaigns
that increases awareness of tangible
actions to reduce their carbon
footprint and adopt eco-friendly
behaviors to care for the planet.
The WHO has recognized climate
change as one of the greatest threats
to global health and has called on
health professionals to take action
to mitigate its impact. These actions
include promoting sustainable
development, advocating for policies
that reduce greenhouse gas emissions,
and supporting efforts to adapt to the
impacts of climate change [28]. At
regional and global levels, physicians
can contribute their expertise to
public health messaging that educates
patients, community members, and
colleagues about direct links between
environmental and human health.
They can also participate in research
to better understand the health
impacts of environmental degradation
and climate change and help develop
prompt strategies to mitigate these
impacts.
Turkey
Two major 7.5 magnitude
earthquakes affected southern Turkey
on 6 February 2023, with numerous
aftershocks, resulting in over 46,000
deaths, as of 18 February 2023.
Although this significant natural
event could not have been prevented,
out-of-date neoliberal urbanization
policies and construction practices
caused weak physical infrastructure
and increased risk of Turkish citizens.
More than 6,000 buildings were
destroyed, leaving tens of thousands
of citizens homeless. Public health
infrastructure has collapsed, and
millions of citizens are without
clean drinking water and solid waste
management systems. Notably, 10
urban communities have been exposed
to hazardous waste and carcinogenic
substances (like asbestos) as well as
air pollutants (like particulate matter).
If such debris cannot be properly
managed, widespread soil and water
pollution will impact the surrounding
ecosystem.
Currently, the Turkish Medical
Association (Türk Tabipleri Birliği,
TTB) strives to contribute to
recovery efforts related to the direct
and indirect health consequences of
the earthquake. The Turkish Medical
Association and the Right to Clean
Air Platform have developed fact
sheets and press releases to increase
public awareness of health hazards
related to environmental pollution
and other risks [29-31].Following the
acute post-recovery period, medical
professionals and the civil society
will be mobilized to help construct
ecological cities that are resistant
to the effects of climate crisis and
natural disasters (like earthquakes).
Hence, our Turkish Medical
Association recognizes Earth Day as
an important day to advocate for the
construction of healthy and ecological
cities, fundamental human rights to
safe housing, clean water and air, and
proper infrastructural services, as well
as access to health services.
Conclusion
As we reflect upon the significance
of Earth Day for the WMA and
our National Medical Associations
(NMAs), we learn about the exciting
national policies and community
initiatives that have been successfully
adopted and implemented across
seven countries. These collaborations
showcase strong leadership and
sustainable political commitment
within the African, Americas, and
European regions, which have helped
increase public awareness of the
delicate ecosystem balance and the
observable effects of climate change.
Hence, these countries are leading
global efforts to encourage collective
action and adopt environmentally
sustainable approaches to safeguard
our planet Earth.
This global call to action emphasizes
the urgency for the global workforce
to collaborate across disciplines and
sectors and partner with local and
national stakeholders to implement
robust scientific initiatives. As WMA
members,ourclinicalandpublichealth
expertise offers a unique viewpoint
that can help build trust and rapport
during our direct interactions with
patients and community members
[4]. By using evidence-based
guidelines and statements by leading
health organizations – including
the WMA – we can streamline our
efforts to influence climate action and
appropriate public health messaging
across our countries. In short, our
collective actions can accelerate
progress to achieve the 2030 Agenda
for Sustainable Development,
mitigate risks linked to climate
change, and safeguard population
health.
WMA Members Share Reflections about Earth Day 2023
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37
References
1. History.com. Earth Day 2023
[Internet].2023[cited2023Mar10].
Available from: https://www.history.
com/topics/holidays/earth-day
2. One Health High-Level Expert
Panel (OHHLEP), Adisasmito
WB, Almuhairi S, Behravesh
CB, Bilivogui P, Bukachi SA,
et al. One Health: A new
definition for a sustainable and
healthy future. PLoS Pathog.
2022;18(6):e1010537.
3. Morello-Frosch R,Obasogie OK.
The climate gap and the color
line – racial health inequities and
climate change. N Engl J Med.
2023;388(10):943-9.
4. World Health Organization.
Urgent health challenges for the
next decade. 2020 [cited 2023
Mar 10]. Available from: https://
www.who.int/news-room/photo-
story/photo-story-detail/urgent-
health-challenges-for-the-next-
decade
5. Solomon CG, Salas RN, Malina
D,Sacks CA,Hardin CC,Prewitt
E, et al. Fossil-fuel pollution and
climate change – a new NEJM
Group Series. N Engl J Med.
2022;386(24):2328-9.
6. Romanello M, Di Napoli
C, Drummond P, Green C,
Kennard H, Lampard P, et al.
The 2022 report of the Lancet
Countdown on health and
climate change: health at the
mercy of fossil fuels. Lancet.
2022;400(10363):1619-54.
7. World Health Organization.
One health joint plan of action
(‎2022–2026)‎: working together
for the health of humans, animals,
plants and the environment.
Available from: https://
www.who.int/publications/i/
item/9789240059139
8. United Nations Development
Programme.Countrybackground,
Sustainable Development Goals
and Paris Agreement [Internet].
n.d. [cited 2023 Feb 1]. Available
from: https://www.adaptation-
undp.org/projects/supporting-
argentina-advance-their-nap-
process
9. Donadio E, Di Martino
S, Heinonen S. Rewilding
Argentina: lessons for the 2030
biodiversity targets. Nature.
2022;603(7900):225-7.
10. Government of Argentina. Ley
para la Implementación de la
Educación Ambiental Integral
en la República Argentina. 2021
[cited 2023 Feb 1]. Spanish.
Available from: https://www.
argentina.gob.ar/normativa/
nacional/ley-27621-350594
11. Ministry of Environment and
Natural Resources, Dominican
Republic. [Law for Environment
and Natural Resources, 64-
00]. Santo Domingo: Ministry
of Environment and Natural
Resources; 2000 [cited 2023 Feb
25]. Spanish. Available from:
https://observatorioplanificacion.
c e p a l . o r g / e s / m a r c o s –
reg u l ator ios / le y-genera l-
sobremedio-ambiente-ley-64-
00-de-republica-dominicana
12. Ministry of Environment and
Natural Resources, Dominican
Republic. [National Strategy for
Development, 2010-2030]. 2010
[cited 2023 Feb 23]. Spanish.
Available from: https://mepyd.
gob.do/estrategia-nacional-de-
desarrollo-2030/
13. United Nations Development
Programme. [Report on Human
Development, 2014]. 2014 [cited
2023 Feb 23]. Spanish. Available
from: https://www.cac.int/
sites/default/files/HDR-2014-
Spanish.pdf
14. Ministry of Environment and
Natural Resources, Dominican
Republic. [Law 94-20]. 2020
[cited 2023 Feb 23]. Spanish.
Available from: https://
biblioteca.enj.org/bitstream/
handle/123456789/122223/
LE94-2020.pdf
15. Ministry of Environment and
Natural Resources, Dominican
Republic. [National Adaptation
Plan for Climate Change in the
Dominican Republic, 2015-
2030]. 2016 [cited 2023 Feb 23].
Spanish. Available from: https://
cambioclimatico.gob.do/index.
php/documentos-descargas/
cop25
16. Ministry of Environment and
Natural Resources, Dominican
Republic. [National Strategy
for Fire Management in the
Dominican Republic, 2016-
2025]. 2016 [cited 2023 Mar
8]. Spanish. Available from:
https://ambiente.gob.do/wp-
content /uploads/2016/12/
ESTRATEGIA-NACIONAL-
M A N E J O -DE -F U E G O –
R-D-03222019045916-1-1.pdf
17. U.S. National Park Service.
Leave No Trace Seven Principles
[Internet]. n.d. [cited 2023 Mar
15].Available from: https://www.
nps.gov/articles/leave-no-trace-
seven-principles.htm
18. LVP Portals. No klaušām un
subotņikiem līdz brīvprātīgajām
talkām [Internet]. 2019 [cited
2023 Feb 28]. Latvian. Available
from: https://lvportals.lv/
norises/303798-no-klausam-un-
subotnikiem-lidz-brivpratigam-
WMA Members Share Reflections about Earth Day 2023
BACK TO CONTENTS
38
talkam-20193
19. Let’s Do It World NGO. World
Cleanup Day [Internet]. [cited
2023 Feb 28]. Available from:
https://www.worldcleanupday.org/
20. World Medical Association.
WMA Statement on
Environmental Degradation
and Sound Management of
Chemicals [Internet]. 2020
[cited 2023 Feb 28]. Available
from: https://www.wma.net/
policies-post/wma-statement-
on-environmental-degradation-
and-sound-management-of-
chemicals/
21. Latvian Public Broadcasting
and Public Radio. How Latvian
stores prepare for future ban
on free plastic bags [Internet].
2022 [cited 2023 Feb 28].
Available from: https://eng.lsm.
lv/article/society/environment/
how-latvian-stores-prepare-for-
future-ban-on-free-plastic-bags.
a471497/
22. Vérité C. Latvia introduced
a nationwide deposit system
for bottles to improve waste
management [Internet]. 2022
[cited 2023 Feb 28]. Available
from: https://www.newsendip.
com / lat v ia-int roduced-a-
nationwide-deposit-system-
for-bottles-to-improve-waste-
management/
23. Amusa T. Nigeria’s nature
reserves need more help to protect
biodiversity [Internet]. The
Conservation. 2020 [cited 2023
Mar 10]. Available from: https://
theconversation.com/nigerias-
nature-reserves-need-more-help-
to-protect-biodiversity-134688
24. Earthday.org. Regional Network:
Earthday.org – Africa [Internet].
2023 [cited 2023 Mar 10].
Available from: https://www.
earthday.org/africa/
25. World Health Organization.
Countries commit to develop
climate-smart health care at
COP26 UN climate conference
[Internet]. 2021 [cited 2023 Feb
8]. Available from: https://www.
who.int/news/item/09-11-2021-
countries-commit-to-develop-
climate-smart-health-care-at-
cop26-un-climate-conference
26. Consejo General de Colegios
Oficiales de Médicos. Grupo
de Trabajo Salud y Cambio
Climático [Internet]. 2022
[cited 2023 Feb 8]. Spanish.
Available from: https://www.
cgcom.es/grupo-de-trabajos/
salud-y-cambio-climatico
27. Government of the Republic of
Trinidad and Tobago. About the
Environmental Management
Authority [Internet]. 2021 [cited
2023 Feb 23]. Available from:
https://www.ema.co.tt/about-ema/
28. World Health Organization.
Climate change and health
[Internet]. 2018 [cited 2023
Feb 23]. Available from:
https://www.who.int/news-
r o o m /f a c t- s h e e t s /d e t a i l /
climate-change-and-health
29. Turkish Medical Association.
Factsheet on earthquake, air
pollution, and carbon monoxide
poisoning [Internet]. 2023
[cited 2023 Feb 20]. Turkish.
Available from: https://www.
t t b . o r g. t r / h a b e r _ g o s t e r.
php?Guid=57c4196e-ae91-11ed-
9a7d-94c3131533bf
30. Turkish Medical Association.
Factsheet on asbestos from
debris removal activities will
cause serious health problems
[Internet]. 2023 [cited 2023 Feb
20]. Turkish. Available from:
https://www.ttb.org.tr/haber_
goster.php?Guid=8437eab2-
ac83-11ed-9a7d-94c3131533bf
31. Right to Clean Air Platform.
Precautions should be taken for
secondarydisastersinearthquakes
[Internet]. 2023 [cited 2023 Feb
20]. Turkish. Available from:
https://www.temizhavahakki.
org/depremlerde-ikincil-afetler-
icin-onlem-alinmali/
WMA Members Share Reflections about Earth Day 2023
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39
Ilze Aizsilniece, MD
President, Latvian Medical Association
Riga, Latvia
Dabota Yvonne Buowari, MBBS
Department of Accident
and Emergency,
University of Port Harcourt
Teaching Hospital
Port Harcourt, Nigeria
Helena Chapman, MD, MPH, PhD
Milken Institute School
of Public Health,
George Washington University
Washington DC, United States
Tomás Cobo Castro, MD
Specialist, Anesthesiology
and Reanimation
President, Spanish General
Medical Council (CGCOM)
Madrid, Spain
Jorge Coronel, MD
President, Confederación Médica de
la República Argentina (COMRA)
Buenos Aires, Argentina
Sebnem Korur Fincanci, MD
Turkish Medical Association
Ankara, Turkey
Andrew Lakhan, MBBS
House Officer Internal Medicine,
Eastern Regional Health Authority
Sub-committee Chairperson,
Climate Change and Health
Advocacy, Trinidad and Tobago
Medical Association
Port of Spain, Trinidad
Penelope Paltoo, MBBS
House Officer Internal Medicine,
Eastern Regional Health Authority
Member, Trinidad and Tobago
Medical Association
Port of Spain, Trinidad
Maira Sudraba, Mg. Health. sc.
Latvian Medical Association
Riga, Latvia
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
BACK TO CONTENTS
WMA Members Share Reflections about Earth Day 2023
40
The New Public Health Order for
Africa was released by the Africa
Centres for Disease Control and
Prevention (CDC) in September
2022.The Order,whose design started
in the first year of the pandemic, is a
framework that represents a roadmap
and has five pillars that promotes
sustainable health outcomes and
health security, namely: [1,2]
1. Strong African Public Health
Institutions that represent
African priorities in global health
governance and drive progress on
key health indicators
2. Expanded Manufacturing of
Vaccines, Diagnostics, and
Therapeutics to democratise
access to life-saving medicines
and equipment
3. Investment in Public Health
Workforce and Leadership
Programs to ensure Africa has an
appropriate workforce to address
health threats
4. Increased Domestic Investment
in Health,including the domestic
mobilisation of financial
resources, human capital,
technical resources, and networks
5. Respectful, Action-Oriented
Partnerships to advance vaccine
manufacturing, health workforce
development, and strong public
health institutions
These five pillars were further
reinforced at the 2nd International
Conference on Public Health in
Africa (CPHIA 2022) (https://
cphia2022.com/), which was held
in a hybrid format from 13-15
December 2022. Using the theme,
“Preparedness for Future Pandemics
and Post-Pandemic Recovery: Africa
at a Crossroads”, African researchers,
policymakers, and stakeholders came
together and shared perspectives and
research findings in public health
related to pandemic preparedness and
recovery. This event also encouraged
a new era of strengthened scientific
collaboration and innovation across
the continent.
Importance of the New Public
Health Order
Since 1 January 2023, the African
region has reported more than 12.2
million coronavirus disease 2019
(COVID-19) cases. In addition,
only 125 million tests had been
delivered during that time. These
testing statistics potentially led to
underreported COVID-19 cases,
as the region only reported 256,000
deaths since the start of the pandemic
[3].
Furthermore, the World Health
Organization set a target of 40% of
the population receiving the first dose
of the COVID-19 vaccine by the end
of 2021. To date, only 3% of African
countries (15 out of 48 countries)
have attained this goal, and only four
countries attained the 70% target set
for mid-2022 [4]. Despite these low
vaccination rates,partnerships like the
COVID-19 Vaccines Global Access
(COVAX) helped facilitated current
vaccine coverage levels alongside
other health system strengthening
efforts that were enforced during the
pandemic. Notably, as of 2018, only
two countries have met the Abuja
declaration target of public financing
of 15%, amplifying the pillar on
increased domestic investment in
health [5]. Furthermore, a mRNA
vaccine technology hub was
established in South Africa,with plans
underway to establish hubs in Egypt,
Senegal, Kenya, Tunisia, and Nigeria.
These actions aim to amplify regional
efforts of expanded manufacturing of
vaccines,diagnostics,and therapeutics
as well as clarification of how
technology transfer will happen [6].
As a continent of 1.2 billion people,
the shortage of health personnel is
further compounded by the region
experiencing a high annual incidence
of public health emergencies,
compared to other regions of the
world. This dual challenge can lead
to increased cases of burnout and
moral injury as well as increased
migration of African-trained health
personnel to countries with improved
renumerationandworkingconditions.
Hence, health systems should invest
in leadership programs that will
empower the public health workforce
to handle emerging health issues
across the continent. In addition,
there is a need for regional public
health institutions that are not only
operational nationally, but also have
a governance structure in place to
ensure their long-term sustainability.
Conclusion
The effects of the COVID-19
pandemichaveaffectedhealthsystems
globally.The African region, however,
has remained playing catch up, due
Marie-Claire Wangari
Africa Setting the Stage in Pandemic Prevention, Preparedness,
Response, and Recovery through the New Public Health Order
BACK TO CONTENTS
Africa Setting the Stage in Pandemic Prevention, Preparedness,
Response, and Recovery through the New Public Health Order
41
Africa Setting the Stage in Pandemic Prevention, Preparedness,
Response, and Recovery through the New Public Health Order
the deceleration in economic growth
from 4.1% in 2021 to 3.3% in 2022,
whilst other advanced economies
have gradually reverted to the pre-
pandemic growth trend [5]. Notably,
the New Public Health Order for
Africa has been complimented by
the Africa CDC’s recently approved
autonomy [7].This has commenced a
new frontier in tackling future health
emergencies in a region that has faced
the most health emergencies from not
only COVID-19 but also from Ebola,
drought, food insecurity, and various
humanitarian crises.
With the implementation of the
New Public Health Order for Africa,
we hope that other continents and
regions will merge efforts in their
pandemic prevention, preparedness,
response, and recovery activities.
Recently, World Medical Association
(WMA) members contributed to
the discussion and adoption of three
key WMA resolutions ̶ the WMA
Resolution regarding the Medical
Profession and COVID-19 in
October 2020, the WMA Statement
in Support of Ensuring the
Availability,theQualityandtheSafety
of Medicines Worldwide in October
2021, and the WMA Resolution for
Providing COVID-19 Vaccines for
All (October 2022) [8-10]. As next
steps, the WMA can continue to
expand their current engagements
and establish new collaborations
with other organisations to tackle
emerging health challenges of
the 2030 Agenda for Sustainable
Development.
References
1. Africa Centres for Disease
Control and Prevention. Africa
calls for New Public Health
Order [Internet]. 2022 [cited
2023 Feb 15]. Available from:
https://africacdc.org/news-item/
africa-calls-for-new-public-
health-order/
2. Africa Centres for Disease
Control and Prevention. Call
to action: Africa’s New Public
Health Order [Internet]. 2022
[cited 2023 Feb 15]. Available
from: https://africacdc.org/news-
item/call-to-action-africas-new-
public-health-order/
3. Africa Centres for Disease
Control and Prevention. Latest
updates on the COVID-19 crisis
from Africa CDC [Internet].
2023 [cited 2023 Feb 15].
Available from: https://africacdc.
org/covid-19/
4. WorldBankinAfrica.COVID-19
(Coronavirus) Response in Africa
[Internet]. 2022 [cited 2023 Feb
15]. Available from: https://
www.worldbank.org/en/news/
immersive-story/2022/06/30/
u n l o c k i n g – s u p p l y – a n d –
overcoming-hesitancy-eastern-
and-southern-africa-s-covid-19-
vaccination-journey
5. United Nations. Public financing
for health in Africa: 15% of an
elephant is not 15% of a chicken
[Internet]. 2020 [cited 2023 Feb
15].Available from: https://www.
un.org/africarenewal/magazine/
october-2020/public-financing-
health-africa-when-15-elephant-
not-15-chicken
6. African Development Bank
Group. Six African countries to
receive initial transfer of mRNA
vaccine technology [Internet].
2022. [cited 2023 Feb 15].
Available from: https://www.
afdb.org/en/news-and-events/
six-african-countries-receive-
initial-transfer-mrna-vaccine-
technology-49460
7. Devex. How Africa CDC’s
newly approved autonomy can
actually happen [Internet]. 2022.
[cited 2023 Feb 19]. Available
from: https://www.devex.
com/news/how-africa-cdc-s-
newly-approved-autonomy-can-
actually-happen-103685
8. World Medical Association.
WMA Resolution regarding
the Medical Profession and
COVID-19 [Internet]. 2020
[cited 2023 Feb 19]. Available
from: https://www.wma.net/
policies-post/wma-resolution-
r e g a r d i n g – t h e – m e d i c a l –
profession-and-covid-19/
9. World Medical Association.
WMA Statement in Support
of Ensuring the Availability,
the Quality and the Safety
of Medicines Worldwide
[Internet]. 2021 [cited 2023
Feb 19]. Available from: https://
www.wma.net/policies-post/
wma-statement-in-support-
of-ensuring-the-availability-
the-quality-and-the-safety-of-
medicines-worldwide/
10. World Medical Association.
WMA Resolution for Providing
COVID-19 Vaccines for All
[Internet]. 2022 [cited 2023 Feb
19].Available from: https://www.
wma.net/policies-post/wma-
resolution-for-providing-covid-
19-vaccines-for-all/
Marie-Claire Wangari, MBChB
General Practitioner &
Independent Consultant
Secretary, WMA Junior Doctors
Network (2022-2023)
Nairobi, Kenya
mcwangari.wm@gmail.com
BACK TO CONTENTS
42
Most critical scientific questions or
innovative technologies can often
be solved through collaborations
among research teams with diverse
backgrounds and disciplines [1].
In academia, collaborations occur
when more than one researcher with
common interests form a research
partnership and aim to produce new
scientific knowledge. Collaborative
research offers an open exchange of
ideas, exposure to new skills, access to
funding, higher quality results,
and personal satisfaction. Efficient
communication and ethical conduct
within collaborations ensure
that moral principles including
confidentiality are maintained.
Collaborative research leverages
valuable scientific expertise and
laboratory techniques, expands
networking opportunities, and
promotes the visibility of research
outcomes, including scientific papers
and patent rights [2].It can encourage
mentorship between students
and faculty or early-career and
senior-level researchers as well as
foster academic debate and discussion
with a potential to increase verbal
communication skills [3,4]. Most
importantly, studies have shown
that research collaborations can
enrich personal and professional
lives through contributions to
Report on a Webinar on Research Collaborations in Nigeria
Ogechukwu Mary-Anne
Isokariari
Vivian Ifeoma Ogbonna
Utchay A. Agiri
Chizaram Onyeaghala
Taagbara Jolly Abaate
Celine Ude Osi
Abiye Somiari
Chinenye Precious Anuonyeh
Dabota Yvonne Buowari
Report on a Webinar on Research Collaborations in Nigeria
BACK TO CONTENTS
43
their institutions, professions, and
communities [5].
DemeritsofResearchCollaboration
Challenges exist and may persist
throughout the lifespan of a research
collaboration. First, team members
may not be committed to their tasks,
which may result in friction and
negatively impact group dynamics.
Second, power dynamics may be
observed which may make early-
career professionals and international
collaborators, including students,
become less vocal or confident, when
interacting with more senior-level
researchers [6]. Furthermore, issues
surrounding authorship roles among
team members may be assumed,
rather than openly discussed, leading
to negative feelings among team
members. Third, larger teams may
be heterogeneous with different
motivations, which can create
communication challenges, especially
when developing a consensus. Finally,
language barriers may pose a challenge
to international collaborations.
The Research Collaboration
Webinar
In October 2022, the Association of
Resident Doctors (ARD)’s Research
and Statistics Committee of the
University of Port Harcourt Teaching
Hospital (UPTH) and the African
Science Frontiers Initiative organised
a two-hour Research Collaboration
webinar. The Nigerian Association
of Resident Doctors (NARD) is an
association of all doctors and dentists
in residency training and all medical
and dental officers (below the rank of
principal medical and dental officers)
employed in public tertiary hospitals.
The objective of this webinar was to
stimulate interest in research among
early-career researchers as well as
foster new research collaborations.
Over 180 participants attended this
event, representing Egypt, Germany,
Ghana, India, Italy, Nepal, Nigeria,
Pakistan, Switzerland, Tanzania,
Trinidad and Tobago, and the United
States.
Two keynote lectures stressed the
importance of research training
and collaborations for physicians.
A poll was administered between
lectures, and of the 53 participants
who responded, 22 (41%) had
never published an article, 15 (28%)
reported being involved in a form
of national research collaborations,
11 (21%) had been involved in
international research collaborations,
and 16 (30%) had never been
involved in a research collaboration.
Of the latter group, 15 (94%) wished
that they had been involved in
collaborative research.
During the webinar, short speeches
were given by distinguished
physicians who encouraged the
audience to become actively
involved in research collaborations.
These invited presenters included
Dr. Chinenye Precious Anuonyeh
(President, ARD UPTH from 2021-
2022),Prof.Lucky Onotai (Chairman
Medical Advisory Committee,
UPTH), Dr. Uchechukwu Arum
(Chair, World Medical Association’s
Junior Doctors Network), and
Dr. Olusegun Israel Olaopa (Past
President of the Nigerian Association
of Resident Doctors 2018-2019 and
Initiator of Research Collaboration
Network). The speeches highlighted
their personal experiences in
research collaborations, where they
encouraged members to initiate and
foster collaborative research.
Lecture 1. Research Principles
Made Easy
Dr. Omosivie Maduka, a Nigerian-
based public health physician, shared
insights on research methods and its
underpinning theories in her lecture
entitled, “Research Principles Made
Easy”. The lecture commenced with
the definition, aims, and purpose of
research collaborations. The speaker
commented on the need for scientific
inquiry to identify research gaps and
explore associations between research
variables. Then, she described the
research process, starting with the
conceptualization and articulation
of the research idea through a
comprehensive literature review.
Next, she mentioned that the study
can be by selecting a robust design
and framework to prepare for the data
collection period. Then, as data are
collected and analysed, she said that
researchers can prepare the scientific
publication on study findings. As
technical writing is learned with
practice, attendees were warned
against plagiarism and predatory
journals.
Lecture 2. Physician-Scientist
Collaboration, Making It Work for
Everyone’s Benefit
The second lecture was given by
Dr. Bright Nwaru, a Swedish-based
researcher. He emphasised on the
merits of collaborating with other
health professionals for impactful
health research in his lecture titled,
“Physician-Scientist Collaboration:
Making It Work for Everyone’s
Benefit”. The speaker noted the role
of physician-scientist collaborations
in scientific advancement and
shared best practices for forming
collaborations. He commented that
the social media sites (e.g. Facebook,
LinkedIn), clinical workplaces,
and conference venues can offer
networking opportunities to identify
synergies in scientific interests. The
speaker shared the following eight
fundamental techniques as being
necessary for effective research
collaborations:
• Collaborations should take into
account the individual’s and groups’
mutual expectations.
Report on a Webinar on Research Collaborations in Nigeria
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44
• Roles and responsibilities should
be clearly defined and assigned to
team members.
• A strategy for preserving the group’s
integrity is to discuss and decide on
shared responsibilities.
• Before work, authorship should
be decided, taking into account
each collaborator’s amount of
responsibility.
• Frequent communication may help
in clarifying tasks, ideas, focus, and
timelines.
• There should be an in-depth
discussion of the expectations for
the research data.
• Meetingminutesshouldberecorded
to aid members in remembering
crucial topics covered and serve as
an important record of the group’s
development.
• The group should also decide who
has access to the research data.
Recommendations
Early-career researchers should
seek opportunities for collaborative
research where they can exchange
scientific knowledge and develop
technical writing skills. Given the
increased social connectedness and
globalisation of our world, and
webinars that encourage the
importance of research collaboration
should be organised. Hospital
administrations should foster
international research collaborations
to strengthen research capability,
attract external funding, and
reposition training institutions as
centres for cutting-edge research.
Finally, where collaborations exist,
efforts should be made to promote
unity and sustainability.
Conclusion
Research collaborations allow us to
appreciate the idiomatic expressions
that “two heads are better than one”
and “the more the merrier.” As ARD
members who represent an array of
clinical and surgical specialties, this is
our call to action to actively contribute
and lead research collaborations that
examine national and international
health risks to population health
and well-being. The ARD UPTH
research collaboration webinar was
a wakeup call to early-career health
care researchers in Nigeria and other
African countries, highlighting the
benefits and challenges of research
collaborations for their career
development. We hope that this
webinar has empowered audience
members to form productive
collaborations in their clinical
workplace.
Acknowledgements
The authors appreciate the
authorities of the University of Port
Harcourt Teaching Hospital, Nigeria,
as well as the speakers, attendees,
and executives of the Association of
Resident Doctors of the University of
Port Harcourt Teaching Hospital, in
Rivers State, Nigeria.
References
1. Bansal S, Mahendiratta S,
Kumar S, Sarma P, Prakash A,
Medhi B. Collaborative research
in the modern era: Need and
challenges. Indian J Pharmacol.
2019;51(3):137-9.
2. Mcclunie-Trust P, Jones V,
Winnington R, Shannon K,
Donaldson AE, Macdiarmid R,
et al. Doing case study research
collaboratively: the benefits for
researchers. Int J Qual Methods.
2022;21:1-12.
3. Lizcano-Dallos AR, Vargas-
Daza M, Barbosa-Chacon JW.
Collaborative learning and
technologies in higher education.
Characteristics, advantages
and disadvantages of its
implementation. Proceedings of
the11thInternationalConference
on Education and New Learning
Technologies; 2019 Jul 1-3;
Palma, Spain. Available from:
https://library.iated.org/view/
LIZCANODALLOS2019COL
4. Tang H-H, Hsiao E. The
advantages and disadvantages of
multidisciplinary collaboration
in design education. Arts.
2013;7(1):3-5.
5. Hafernik JJ, Messerschmitt DS,
Vandrick S. Research news and
comment: collaborative research:
why and how? Educ Res.
1997;26(9):31-5.
6. Paphawasit B, Wudhikarn R.
Investigating patterns of research
collaboration and citations in
science and technology. A case of
Chiang Mai University. Adm Sci.
2022;12(2):71.
Report on a Webinar on Research Collaborations in Nigeria
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45
Ogechukwu Mary-Anne
Isokariari, MBBS (UPH), MSc
Epid/Bio (Leeds), MWACP
Department of Community Medicine,
University of Port Harcourt
Teaching Hospital &
Department of Epidemiology,
School of Public Health,
University of Port Harcourt
Port Harcourt, Nigeria
isokariari.ogechukwu@uniport.edu.ng
Vivian Ifeoma Ogbonna,
MBBS (AAU), MNPMCN,
MPH (UPH), FWACP
Department of Community Medicine,
University of Port Harcourt
Teaching Hospital &
Department of Population
and Reproductive Health,
School of Public Health,
University of Port Harcourt
Port Harcourt, Nigeria
viogbonna@gmail.com
Utchay A. Agiri (Jr), MD, FMCFM
Department of Family Medicine,
University of Port Harcourt
Teaching Hospital
Port Harcourt, Nigeria
utchayt@yahoo.com
Chizaram Onyeaghala,
MBBS, MWACP
Department of Internal Medicine,
University of Port Harcourt
Teaching Hospital
Port Harcourt, Nigeria
chizero15@gmail.com
Taagbara Jolly Abaate, MBBS,
MPH, MNPMCN
(Member of National Postgraduate
Medical College of Nigeria)
Department of Community Medicine,
University of Port Harcourt
Teaching Hospital
Port Harcourt, Nigeria
abaatejt83q@gmail.com
Celine Ude Osi, MBBS
Department of Community Medicine,
University of Port Harcourt
Teaching Hospital
Port Harcourt, Nigeria
celineosiude@gmail.com
Abiye Somiari, MBBS,
MWACP, MScPH (Epid)
Department of Community Medicine,
University of Port Harcourt
Teaching Hospital
Port Harcourt, Nigeria
abiyesomiari@gmail.com
Glory Ovunda Worgu,
MBBS, MScPH, FWACP
Department of Community Medicine,
University of Port Harcourt
Teaching Hospital
Port Harcourt, Nigeria
drglory_worgu@yahoo.co.uk
Chinenye Precious Anuonyeh, MBBS,
MMCPsych (Nig), MRCPsych(A)
Specialist Registrar, Department of
Neuropsychiatry and Mental Health,
University Of Port Harcourt
Teaching Hospital
Port Harcourt, Nigeria
anuonyehprecious@gmail.com
Dabota Yvonne Buowari, MBBS
Department of Accident
and Emergency,
University Of Port Harcourt
Teaching Hospital
Port Harcourt, Nigeria
dabotabuowari@yahoo.com
Report on a Webinar on Research Collaborations in Nigeria
BACK TO CONTENTS
46
According to the World Health
Organization (WHO), there are
an estimated 1.57 medical doctors
per 10,000 population, which
does not align with the minimum
recommendation of 21.7 doctors
per 100,000 population [1,2].
This struggling statistic, further
compounded by the current economic
state with inflation and rising costs of
living, results in a volatile job market
and national health system challenges.
Currently, there are close to 4,000
unemployed doctors in Kenya, mainly
junior doctors, as reported by the
Kenya Medical Practitioners
Pharmacists Dentists Union
(KMPDU) (Figure 1). This
has led to many of these junior
doctors actively using social media
platforms to share their frustrations
through Twitter Storms (e.g.,
#SomebodyTellHealthCS in November
2022, #EmployDoctorsNow in
February 2023).
This unemployment challenge is
driven by the lack of a centralised
system for managing human
resources for health. As a result,
there are fewer general practitioners
hired after their mandatory licensure
(internship) year. To address this
issue, there are continued efforts by
the KMPDU and the Kenya Medical
Association (KMA) (http://kma.
co.ke/) on communicating potential
solutions through mainstream
media such as radio and television
interviews. The KMA, which
houses the Young Doctors Network
(YDN) (http://kma.co.ke/contact-
us/committes-and-divisions/kma-
ydn), has an overarching mission of
“Championing for the welfare of Doctors
and Quality Healthcare in Kenya.”
Two of the YDN’s goals are to “provide
a forum for junior doctors to share
experiences, challenges and solutions in
the medical profession” and “provide an
avenue for junior doctors to collaborate
with other-like minded individuals.”
This article aims to describe KMA
YDN’s efforts in media and training
and lessons learnt since their mandate
started in August 2022.
KMA YDN’s Role in Bridging the
Unemployment Gap
On 11 November 2022, the KMA
YDN organised the inaugural KMA
YDN Pre-Internship Conference
in Nairobi, Kenya. Using the theme,
“Positioning the Intern for Impact
and Opportunities in Healthcare,”
the event intended to prepare new
medical school graduates for their
upcoming mandatory licensure
internship. Over 240 in-person and
160 virtual delegates attended the
conference proceedings.
2022 Pre-Internship Conference
This one-day orientation conference
aimed to empower medical doctors
who had recently taken the
Hippocratic oath and were yet to
commence their one-year mandatory
licensure internship (pre-interns)
under the Kenya Ministry of Health
(Figure 2) [3]. The event tackled an
array of topics and gave attendees the
opportunity to network with their
seniors in the medical field ranging
from the KMA and KMPDU
National Leadership, the Medical
Council, and other physicians
working in public and private
sectors. In addition, the inaugural
Marie-Claire Wangari
Media Training to Shape Kenyan Junior Doctors
as Health Advocates and Policy Reformers
Brenda Obondo
Ruby Oswere
Media Training to Shape Kenyan Junior Doctors
as Health Advocates and Policy Reformers
Figure 1. Sunday Nation’s national daily headline from 5
February 2023. Credit: Sunday Nation
BACK TO CONTENTS
47
Media Training to Shape Kenyan Junior Doctors
as Health Advocates and Policy Reformers
KMA YDN Newsletter’s YDN Zine
(https://issuu.com/kmaydnzine/
docs/_october_2022_issue_1_kma_
ydn_newsletter), which highlighted
participants’ insights, was launched at
the event.
Discussions on the Future of
Healthcare Practice for Junior
Kenyan Health Professionals
Leading up to the Pre-Internship
Conference, KMA YDN organised a
Twitter Space, in collaboration with
allied professionals from pharmacy,
dental surgery, and nursing students
(Figure 3). This platform highlighted
the current developments in the
employment of junior healthcare
professionals, shared challenges
per cadre, and presented possible
solutions to these challenges. This
later sparked subsequent discussions
on the “Future of Medicine” at one
of the leading television station’s
breakfast shows, NTV AM Live.
The “Realizing Universal Health
Coverage” show was broadcasted in
December 2022 (https://youtu.be/
A6OnkYQ0Ojg) to commemorate
Universal Health Coverage Day, and
the “What Ails Healthcare Workers”
show aired in January 2023 (https://
youtu.be/H8YDH5DRCIY) (Figure
4).
Conclusion
The partial actualization of the
WHO Global Strategy of Human
Resources for Health; Workforce
2030 recommendation – “countries
investing in education and training,
recruitment, deployment and
retention of health workers to meet
national and subnational needs
through domestically trained health
workers” – has led to the increase in
healthcare training institutions and
subsequently healthcare professionals
trained for the job market, with the
country currently producing close to
800 junior physicians from 11 medical
schools [4]. Despite the positive
strides in physician training, the lack
of a well-structured recruitment,
deployment,andretentionframework,
has led to the junior physicians facing
increased moral injury due to the
volatile job market, as they manage
numerous hiring entities resulting
from the devolved healthcare system.
Figure 2. Promotional flyers for the 2022 KMA YDN
Pre-Internship Conference. Credit: YDN
Figure 3. Promotional flyer for the Tweet Chat, held before
the 2022 KMA-YDN Pre-Internship Conference. Credit:
YDN
Figure 4. Publicity posters for the Future of Medicine
Morning Segments. Credit: NTV AM Live
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48
Media Training to Shape Kenyan Junior Doctors
as Health Advocates and Policy Reformers
For this reason,the use of mainstream
and social media increased public
awareness on this looming issue,
especially when Kenya was
establishing new federal leadership.
By promoting the use of technology,
Kenyan health leaders can shape
conversations within the health space
and create opportunities to empower
junior physicians to be future health
advocates and policy reformers. Our
hope is that these conversations
surrounding the employment of
health professionals and other health-
related discussions spearheaded by
junior health professionals will not
only continue but also align with
leading guidelines such as the World
Medical Association (WMA)’s
International Code of Medical Ethics
[5].
References
1. World Health Organization.
Global Health Observatory:
Medical doctors (per 10 000
population) [Internet]. 2022
[cited 2023 Feb 12]. Availa-
ble from: https://www.who.
int/data/gho/data/indicators/
indicator-details/GHO/medi-
cal-doctors-(per-10-000-popula-
tion)
2. Ministry of Health, Kenya. Pol-
icy Brief: Human Resources for
Health; Gaps and opportunities
for strengthening, Nairobi, Ken-
ya: Ministry of Health, Kenya;
2019. Available from: https://
www.health.go.ke/wp-content/
uploads/2019/01/Human-Re-
source-for-Health-Policy-Brief-
fin.pdf
3. Kenya Medical Association.
2022 KMA YDN Pre-Internship
Conference: External Report
[Internet]. 2022 [cited 2023 Feb
15]. Available from: https://issuu.
com/kmaydnzine/docs/_kma_
ydn_external_2022_pre-intern-
ship_conferenc
4. Zhao Y, Mbuthia D, Munywoki
J, Nzinga J, Gathara D, Nico-
demo C, et al. Systemic crisis in
Kenya’s junior physician work-
force planning training and
development. Paper presented
at: 7th Global Symposium on
Health Systems Research; 2022
Oct 31-Nov 4; Bogota, Co-
lombia. Available from: https://
twitter.com/lizzgitau/sta-
tus/1587842873696948225?s=20
5. World Medical Association.
WMA International Code of
Medical Ethics [Internet]. 2022
[cited 2023 Feb 12]. Available
from: https://www.wma.net/
policies-post/wma-internation-
al-code-of-medical-ethics/
Marie-Claire Wangari, MBChB
Convener, Kenya Medical Association
Young Doctors Network (2022-2024)
Secretary, WMA Junior Doctors
Network (2022-2023)
Nairobi, Kenya
ydn@kma.co.ke
Brenda Obondo, MBChB, MBA-
Health Leadership & Management
Chief Executive Officer,
Kenya Medical Association
Nairobi, Kenya
Ruby Oswere
Level V MBChB Student,
University of Nairobi
Nairobi, Kenya
BACK TO CONTENTS
49
This month, the World Medical
Association (WMA)’s My Green
Doctor program is the focus of a
free 40-minute online Continuing
Medical Education (CME) program
offered by the American Medical
Association to any physician, not just
AMA members. Watch the webinar
yourself at any time, and ask your
office manager to watch and learn
how easy it is to save money with
environmentally sustainable practice
management at the following
link (https://event.on24.
c o m / w c c / r / 4 0 6 2 8 8 3 /
B 0 A 8 A 10 4 4 9A F 6 35 4 58 6 D –
76FEE9D19978). CME credits
can be requested at the following
link (https://edhub.ama-assn.org/
steps-forward/module/2800484).
My Green Doctor is a free money-
saving membership and climate-
saving benefit from the WMA.
Medical offices use My Green
Doctor’s “Meeting-by-Meet-
ing Guide” to learn how to adopt
environmental sustainability, save
resources, and help create healthier
communities. The program adds
just five minutes to each regular
office staff meeting or weekly office
“huddle”, showing that making small
changes at each meeting can add up
over time.
Your team can register as Partner
Society members by visiting the
webpages in English (www.
MyGreenDoctor.org) or Spanish
(www.MyGreenDoctor.es)webpages.
By using the discount code
MGDWMA, your team will save
US $60 and receive full lifetime
access to My Green Doctor. Ask your
clinic or practice manager to register
today and add My Green Doctor to
your next agenda. My Green Doctor
helps your practice to save money and
create healthier communities!
Todd Sack, MD, FACP
Executive Director, My Green
Doctor Foundation
Clinical Associate Professor, Herbert
Wertheim College of Medicine,
Florida International University
Miami, Florida, United States
tsack8@gmail.com
Todd Sack
Free Continuing Medical Education
on Environmentally Sustainable Practices
Free Continuing Medical Education on Environmentally Sustainable Practices
BACK TO CONTENTS