WMJ_2024_02

Official Journal of The World Medical Association, Inc. Nr. 2, June 2024
vol. 70
Contents
Editorial   3
WMA Council Report Seoul, Republic of Korea, 18-20 April 2024   4
WMA Code of Conduct    9
WMA Council Resolution on Proposed Legislation in UK on the Treatment
of Migrants Disregarding the Injunction Interim Measures Rule 39 of ECHR   10
WMA Council Resolution Calling for the Immediate Withdrawal
of the Bill Lifting the Ban on Female Genital Mutilation in Gambia   11
WMA Council Resolution on Anti-LGBTQ Legislation in Uganda   12
WMA Council Resolution on Organ Donation in Prisoners   13
WMA Council Resolution on the Protection of Healthcare in Israel and Gaza  14
European Union’s Actions to Fight AMR using a One Health Approach   15
Pioneering Change: The Junior Doctors Network’s Role at the CND67 and Beyond   17
UN Commission on Narcotic Drugs Statement
by the UNODC Young Doctors Network on Access to Controlled Drugs   19
Pandemic Negotiations at the World Health Organization:
Perspectives from the World Health Assembly in May 2024   20
Interview with National Medical Associations’ Leaders
of the Latin America and the Caribbean Region    23
Interview with the President of the Association of Medical Schools in Africa   31
Interview with the President of the Pan-American Federation
of Associations of Medical Schools    35
Interview with the President of the Association for Medical Education
in the Eastern Mediterranean Region   38
Interview with the President of the Association of Medical Schools in Europe   41
A Forum for Significant Ethical Questions   43
Healthcare Resource Allocation: Smoking, Lung Cancer, and the National Health Service   46
Sports Medicine in China after the 2022 Beijing Winter Olympics   49
WMA Members Discuss National Initiatives to Enhance Food Security and Safety 52
WORLD MEDICAL ASSOCIATION OFFICERS,
CHAIRPERSONS AND OFFICIALS
Dr. Lujain ALQODMANI
President
Kuwait Medical Association
123 Fifth Avenue,
1202
Kuwait
Dr. Otmar KLOIBER
Secretary General
World Medical Association
13 chemin du Levant
01212 Ferney-Voltaire
France
Dr. Jack RESNECK
Chairperson,
Finance and Planning Committee
American Medical Association
AMA Plaza, 330 N. Wabash,
Suite 39300
60611-5885 Chicago, Illinois
United States
Dr. Ashok PHILIP
President-Elect
Malaysia Medical Association
4th Floor, MMA House,
124 Jalan Pahang
53000 Kuala Lumpur
Malaysia
Dr. Tohru KAKUTA
Vice-Chairperson of Council
Japan Medical Association
113-8621 Bunkyo-ku, Tokyo
Japan
Dr. Zion HAGAY
Chairperson,
Socio Medical Affairs Committee
Israeli Medical Association
2 Twin Towers, 35 Jabotinsky St.,
P.O. Box 3566
52136 Ramat-Gan
Israel
Dr. Osahon ENABULELE
Immediate Past President
Nigerian Medical Association
8 Benghazi Street,
off Addis Ababa Crescent
Wuse Zone 4, P.O. Box 8829
Wuse, Abuja
Nigeria
Mr. Rudolf HENKE
Treasurer
German Medical Association
(Bundesärztekammer)
Herbert-Lewin-Platz 1
(Wegelystrasse)
10623 Berlin
Germany
Dr. Jacques de HALLER
Chairperson,
Associate Members
Swiss Medical Association
(Fédération des Médecins Suisses)
Elfenstrasse 18, C.P. 300
3000 Berne 15
Switzerland
Dr. Jung Yul PARK
Chairperson of Council
Korean Medical Association
Samgu B/D 7F 8F 40
Cheongpa-ro,
Yongsan-gu
04373 Seoul
Republic of Korea
Dr. Steinunn
THÓRDARDÓTTIR
Chairperson,
Medical Ethics Committee
Icelandic Medical Association
Hlidasmari 8
201 Kópavogur
Iceland
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 policies or positions
3
Editorial
Editorial
BACK TO CONTENTS
Over the past two years, international meetings have highlighted
the need to continue initiatives to address the three C’s (climate
change, conflict, coronavirus disease 2019 pandemic), including
driving factors that affect other sectors such as antibiotic resistance,
changing demographics, disaster preparedness, food insecurity,
and health system resiliency. These public health challenges
require One Health solutions and can only be managed through
one collective voice of global leaders – a voice that demands
urgent joint action and participation across borders, disciplines,
and sectors. An example of one important voice is our World
Medical Association (WMA) community.
As WMA members represent more than 114 national medical
associations (NMAs), their medical and public health expertise
can help national leaders develop relevant evidence-based policies
and guidelines that can strengthen health system preparedness.
During the 226th WMA Council Meeting in April 2024,WMA
members contributed to the review and acceptance of five timely
resolutions. Specifically, WMA leaders reinforced the call for
a bilateral, negotiated, and sustainable ceasefire to protect the
health workforce and public safety as well as strongly condemn
any violations of international humanitarian law, in response to
the ongoing conflict in Gaza and Israel.Notably,WMA members
will participate in the upcoming regional expert meeting in
Washington, DC in August 2024, and after compiling collective
input from previous expert meetings,they will prepare a final draft
that will be reviewed and considered for adoption by the Council
and General Assembly at the 75th WMA General Assembly in
Helsinki, Finland in October 2024.
The 77th World Health Assembly (WHA), held in May
2024, concluded with amendments to the International Health
Regulations and a concrete plan to finalise negotiations related
to the Pandemic Accord at least by the next WHA. During the
proceedings, Member States approved resolutions on diverse
global health issues, including antimicrobial resistance, climate
change and health,infection prevention and control,and maternal
and child health. These high-quality resources – together with
the scientific reports from leading agencies like the World
Meteorological Organization (WMO)’s Global Annual Decadal
Climate Update (2024-2028) and State of the Climate – can offer
valuable insight for scientific debates at international meetings
during the latter half of this year.
After the 226th WMA Council Meeting in April 2024, we are
enthusiastic to support the 75th WMA General Assembly that
will be held in Helsinki, Finland, from 16-19 October 2024.This
event will present numerous opportunities to network with other
NMAs,contribute to scholarly debates on pressing medical ethics
and global health topics, and recognise the important role of
NMAs within the WMA community.
In this issue, Ms. Janice Blondeau prepared a detailed summary
of the WMA proceedings and included the WMA Code of
Conduct and five adopted resolutions. Dr. Roser Domènech
Amadó highlighted the European Union’s actions to fight
antimicrobial resistance using the One Health approach. Dr.
Pablo Estrella Porter described the junior doctors’ role at the UN
Office on Drugs and Crime (UNODC)’s 67th Commission on
Narcotic Drugs and shared the Statement by the UNODC Young
Doctors Network. Dr.Yassen Tcholakov provided updates related
to the Pandemic Accord discussions during the 77th WHA.
Since WMA members are global health leaders who understand
the existing knowledge and practice gaps in medical education
and training within their countries and geographic regions, we
encourage NMAs to openly share these national and regional
analyses and research findings at upcoming scientific events and
the World Medical Journal. First, Dr. Jorge Coronel, Dr. Marcelo
Mingo, Dr. César Eduardo Fernandes, Dr. Carlos Serrano, Jr., Dr.
Simone Mc Fee, Dr. Damion Basdeo, and Dr. José Minarrieta
shared their perspectives on their leadership experiences, ongoing
NMA activities, and strengths and existing challenges in medical
education in Argentina,Brazil,Trinidad andTobago,and Uruguay,
respectively. Second, Dr. E. Oluwabunmi Olapade-Olaopa, Dr.
Marcos Núñez Cuervo, Dr. Ahmed Al Rumayyan and Dr. Harm
Peters shared their perspectives on medical education within
the African, Americas, Eastern Mediterranean and European
regions,respectively.Dr.Nora Schultz presented the history of the
German Ethics Council,as an independent body that contributes
expertise to bioethical and biomedical questions. Dr. Gayatri
Vijapurkar discussed healthcare resource allocation related to
smoking and lung cancer within the UK National Health Service.
Dr. Shiyi Chen and colleagues described increased public interest
in participating in winter sports in China after the 2022 Beijing
Winter Olympics. Finally, WMA members representing six
countries shared insight on national policies and community
activities that support food security and safety measures related to
World Food Safety Day 2024.
We are excited to expand our discussions and networking
opportunities at the 75th WMA General Assembly in Helsinki!
Helena Chapman, MD, MPH, PhD
Editor in Chief of the World Medical Journal
editor-in-chief@wma.net
4
The 226th Council session of the
World Medical Association (WMA)
convened in the city of Seoul,
Republic of Korea, from 18-20 April
2024 (Photo 1).
Wednesday, 17 April
WMA Caucus Environment and
Health
In a pre-Council briefing, the WMA
Caucus Environment and Health met
on 17 April, 2024, with guest speaker
Dr. Samantha Pegoraro, of the Air
Quality, Energy, and Health Unit
at the World Health Organization
(WHO), who joined virtually. Dr.
Pegoraro gave a presentation entitled,
“Air Pollution and Climate Change:
An Overview of WHO Activities
Targeting Health Professionals,”
where she outlined ongoing work
by the WHO, to empower health
professionals and build capacity
within the health sector and health
workforce.
Thursday, 18 April
Council
The 226th Council session, held
in Seoul, Republic of Korea, was
attended by 100 delegates from
34 national medical associations
(NMAs). The meeting was called to
order by the Chair of Council, Dr.
Jung Yul Park. He welcomed newly
attending Council members – Dr.
Carlos Henrique Mascarenhas Silva
(Brazilian Medical Association),
Dr. Amit Kochhar (British
Medical Association), Dr. José
Minarrieta (Uruguayan Medical
Association), and ASCM (Additional
Standing Committee Member) Dr.
Thirunavukarasu Rajoo (Malaysian
Medical Association) – and read out
apologies for absent members.
Chair of Council’s Report
Dr.Park welcomed Council members,
delegates, and other colleagues to his
hometown of Seoul. He highlighted
that numerous current global
challenges have impacted physicians
and how they work, ranging from
wars and armed conflicts to climate
change and violations of physicians’
rights, even in the Republic of
Korea. Dr. Park urged broader
collaboration, cooperation, and
stronger solidarity among WMA
members. He expressed his wish
for Council members to listen and
learn from each other as well as share
perspectives on presented issues. He
stated that he sees that the WMA has
a pivotal role in representing nearly
10 million physicians around the
world, while aiming to ensure
the highest possible international
standards of healthcare.
Dr. Park reported that, both
internationally and domestically, he
had delivered speeches and lectures,
namely the health impacts of
climate change. He called for urgent
action for the implementation of
Climate Medicine in medical school
curricula. In closing, he expressed his
appreciation to all members of the
WMA Secretariat for their support
and hard work throughout the year.
President’s Interim Report
The WMA President, Dr. Lujain
Alqodmani, thanked the Korean
Medical Association for hosting this
Council Session, and she provided an
overview of activities for her first six
months in office. She noted that each
activity aligned with the advocacy
priorities for her term as President,
particularly climate change, gender
equality, universal health coverage,
and intergenerational equity. Dr.
Alqodmani declared that she has
focused on providing direct support
to WMA members, highlighting
the importance of safeguarding
physicians’ rights worldwide and
ensuring that they have safe work
environments to effectively and
ethically provide healthcare services.
She reported on the alarming increase
in conflicts and attacks on healthcare
facilities and personnel across the
world, urging WMA members to
work together to ensure the safety of
all health personnel.
In response to Chinese Medical
Association expressing its opposition
to the Taiwan’s participation in the
WHO’s activities, the President
responded that it is her responsibility
to advocate for Taiwan’s participation
in WHO’s health programs. She
reminded WMA members that
WMA adopted the WMA
Resolution in Support of Taiwan’s
Participation in all WHO Health
Programs and Inclusion in the
International Health Regulations
(IHR) Mechanism at the 72nd
WMA General Assembly in October
2021 [1].
In response to Dr. Omar Khorshid
(Australian Medical Association),
who proposed that the WMA do
Janice Blondeau
WMA Council Report
Seoul, Republic of Korea, 18-20 April 2024
WMA Council Report
BACK TO CONTENTS
5
more to address the unprecedented
attacks on healthcare facilities
and personnel, particularly in the
conflict between Hamas and Israel,
the President stated that the WMA
has released several statements
including a letter to the president of
the International Committee of the
Red Cross (ICRC) to show support
and express the need to protect the
right to health for all people. Dr.
Alqodmani referred to her written
report, in which she expressed the
need for the WMA to take a stronger
stance to ensure that these violations
do not continue, drawing attention to
the recent attacks in Sudan, Congo,
and Haiti. She reminded WMA
members of the open letter of the
World Health Professions Alliance
calling for humanitarian law to be
upheld in all regions of the world.She
also noted that the previous media
statement titled, WMA Takes Stand
Against Humanitarian Violations,
Calls for Urgent Action in Gaza, had
urged a humanitarian pause in the
conflict [2]. Dr. Alqodmani added
that the Council would be reviewing
a new proposed emergency resolution
from the British Medical Association.
In closing, Dr. Alqodmani thanked
the Secretary General, WMA
Secretariat,and Executive Committee
for their support.
Secretary General’s Report
The WMA Secretary General,
Dr. Otmar Kloiber, reported on
the Revision of the Declaration of
Helsinki, with the phase 1 public
comments period conducted in
February 2024, to address issues
arising from the regional meetings.
He advised that the phase 2 public
comments period is planned for June
2024,once additional topics have been
addressed. Dr. Kloiber stated that the
workgroup intends to deliver a final
updated draft of the Declaration
of Helsinki to the Medical Ethics
Committee. This document will be
proposed, reviewed, and considered
by the Council and the General
Assembly in Helsinki, Finland, in
October 2024.
He referred to the Consensus
Framework for Ethical Collaboration,
a consensus-based framework
agreement to publicly align on shared
ethical values, which was drafted in
2014, as a partnership between the
WMA, International Alliance of
Patients Organizations, International
Council of Nurses, International
Pharmaceutical Federation
(pharmacists), and International
Federation of Pharmaceutical
Manufacturers and Associations
(IFPMA). Now, 10 years later, he
stated that partners will discuss
whether the agreement needs to
be extended, if new topics should
be included, and how to foster its
implementation, especially in Africa.
Under the topic of human
rights, Dr. Kloiber reported on
initiatives to protect patients and
doctors, specifically in Israel and
Gaza, Iran, Pakistan, Republic of
Korea, Russia and Ukraine, Sudan,
and Turkey.
On other topics, he mentioned the
Health Care in Danger (HCiD)
initiative, through which the WMA
Secretariat has a close working
relationship with the ICRC
headquarters. Dr. Kloiber said that
the WMA was represented by Past
President Dr. José Luiz Gomes do
Amaral at the 6th Global Ministerial
Summit on Patient Safety in
Santiago, Chile, which was occurring
at the same time as the Council
session. He commented that recent
work activities in preparation for the
World Health Assembly would be
reported in an extra agenda item.
Dr. Kloiber thanked the Taiwan
Medical Association for donating
to the Junior Doctors Network’s
travel fund and the Korean Medical
Association for providing travel
grants for junior doctors to attend
this Council meeting in Seoul.
In closing, he reported on
developments from the World
Federation for Medical Education
(WFME), which is now revising its
standards for continuing medical
education (CME) and continuing
professional development (CPD).
Council Resolutions Approved by
the 226th Council Session
The following five Council
resolutions were approved by the
226th Council session in Seoul,
Republic of Korea, in April 2024, as
follows:
Treatment of Migrants in the UK
The proposed revision of the WMA
Council Resolution on Proposed
Legislation in UK on theTreatment of
Migrants disregarding the Injunction
Interim Measures Rule 39 of ECHR
was adopted by the Council.
Bill Lifting the Ban on Female Genital
Mutilation in Gambia
The proposed WMA Council
Resolution calling for the immediate
withdrawal of the bill lifting the
ban on female genital mutilation in
Gambia was adopted by the Council.
Anti-LGBTQ Legislation in Uganda
The proposed revision of the WMA
Council Resolution on Anti-LGBTQ
Legislation in Uganda was adopted
by the Council.
Organ procurement from prisoners
The proposed revision of the WMA
Council Resolution on Organ
Donation in China, renamed the
WMA Council Resolution on Organ
Donation in Prisoners, was adopted
by the Council.
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WMA Council Report
6
Protection of Healthcare in Gaza
The proposed WMA Council
Resolution calling for a ceasefire
and the protection of healthcare in
Gaza was deferred to the Council
session on Saturday, 20 April 2024.
In the meantime, the British Medical
Association and the Israeli Medical
Association agreed to review the
current draft and endeavour to reach
a compromise.
Standing Committees
The Council adjourned for the
meetings of the Standing Committees
and agreed to reconvene on 20
April to consider the reports of the
Standing Committees and one urgent
item deferred by the Council session.
The Secretary General informed
the Council that Dr. Tai-Yuan Chiu
(Taiwan Medical Association) had
to return to Taiwan, as he had been
appointed Minister of Health and
Welfare of Taiwan. The Council
congratulated him.
As the Medical Ethics Committee
and the Socio-Medical Affairs
Committee held meetings on 18
April, details of the Council decisions
resulting from these two Committees
were finalised on Saturday, 20 April.
Friday, 19 April
Finance and Planning Committee
The Finance and Planning Committee
received reports from the Chair of
the WMA Associate Members, the
Junior Doctors Network (JDN), and
the World Medical Journal.
Chair of WMA Associate Members
Dr.Jacques de Haller,the Chair of the
WMA Associate Members,presented
his activity report for November 2023
to March 2024. He stated that the
WMA Associate Members have a
partly renewed Steering Committee,
following elections at their Plenary
Meeting in Kigali, in October 2023.
New members of the Steering
Committee are Dr. Julie Bacqué
(French Medical Association) in
her position of Associate Member
Representative to the WMA General
Assembly; Dr. Helen Gofwan
(Nigerian Medical Association) for
the Student Associate members, and
Dr. Marie-Claire Wangari (Kenya
Medical Association) as the new
Chairperson of the JDN.
Dr. de Haller continued that
the group has mainly managed
the organisation of a webinar
entitled, “Misinformation and
Disinformation”, with the activities
of the numerous Associate Members’
Workgroups and Taskforces. He said
that the webinar, which was held in
January 2024, was successful with
substantial contributions from several
continents, and an audience of almost
60 participants.
He noted that WMA Associate
Members are currently involved in
the following Workgroups: Associate
Members’ Workgroup on Aging
Physicians, Associate Members’
Workgroup on Medical Neutrality,
Associate Members’ Informal
Group to Assist Response on the
Declaration of Helsinki revision,
WMA Workgroup on Medical
Technology, WMA Workgroup on
the Declaration of Helsinki, WMA
Workgroup on Environment, and
WMA Workgroup on Epidemics and
Pandemics.
Junior Doctors Network
Dr.Wangari,Chairperson of the JDN,
presented her report for October
2023 to March 2024. She introduced
the 2023-2024 Management Team:
• Deputy Chairperson: Dr. Balkiss
Abdelmoula (Tunisia / Germany)
• Secretary: Dr. Deena Mariyam
(India /United Arab Emirates)
• Membership Director: Dr. Pablo
Estrella (Ecuador / Spain)
• Medical Education Director: Dr.
Merlinda Shazellenne (Malaysia)
• Medical Ethics Officer: Dr. Shiv
Joshi (India)
• Socio-Medical Affairs Officer: Dr.
Francisco Pego (Portugal)
• Communications Director: Dr.
Sazi Nzama (South Africa)
• Publications Director: Dr. Jeazul
Ponce Hernandez (Mexico / Spain)
• Immediate Past Chair: Dr.
Uchechukwu Arum (Nigeria /
United Kingdom)
• Immediate Past Deputy Chair: Dr.
Lwando Maki (South Africa)
Dr. Wangari reported that the JDN
2023/24 Management Team strategy
focuses on three areas: improving
and creating meaningful engagement
among members, improving the
sustainability of the JDN, and
increasing visibility of the JDN in
the WMA and wider community.
She thanked the Taiwan Medical
Association for their continued
financial support that enabled JDN
members to share their work and key
insights in the global health space.
In addition, Dr. Wangari thanked
the Korean Medical Association for
their generous contribution via the
travel stipend grant for the 226th
WMA Council Session in Seoul.
Through this inaugural grant,27 JDN
members from various regions of the
world applied for the travel grant,
and a total of 13 scholarships were
awarded.
In efforts to increase JDN
membership, Dr. Wangari said that
the JDN has engaged junior doctors
interested in joining national JDNs or
establishing new networks in Brazil,
Cote d’Ivoire, Dominican Republic,
France, Indonesia, Republic of Korea,
and Uganda. She mentioned that the
JDN hosted an ad hoc newcomer’s
membership session, as a hybrid
event, at the Americas region session
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WMA Council Report
7
of the 2024 International Federation
of Medical Students’ Associations
(IFMSA) March Meeting, in Quito,
Ecuador. She noted that membership
has grown 15.47% since August 2023,
with 881 registered members.
World Medical Journal
Dr. Helena Chapman, Editor of the
World Medical Journal, presented
her activity report for October 2023
to March 2024, highlighting that
2024 marks the 70th anniversary
of the journal. She advised that
over the last six months, the World
Medical Journal editorial team has
worked with authors to prepare the
December 2023 and March 2024
issues. These two journal issues have
incorporated collective articles by 22
countries to highlight the emerging
threat of antimicrobial resistance
(AMR) for World AMR Awareness
Week in December 2023, and to
promote vaccine adherence across all
populations for World Immunization
Week in April 2024. She thanked
JDN and National Medical
Association (NMA) leadership
and commitment to promote the
One Health concept, coordinate
widespread community health
activities that increase public
awareness, and support the
development of relevant policies that
strengthen health system resiliency.
Saturday, 20 April
The Council,using a consent calendar
for efficiency,considered the Standing
Committee reports.
Medical Ethics Committee
The Council considered the report of
the Medical Ethics Committee and
reached the following decisions:
Declaration of Helsinki
The Council approved that the
workgroup for the Declaration of
Helsinki revision continue its work
and proceed with organising the
remaining meetings as well as the
second public consultation in June
2024.
Assisted Reproductive Technologies
The Council approved that the
proposed revision of recommendation
14 of the WMA Statement on
Assisted Reproductive Technologies
be circulated to constituent members
for comments.
Declaration of Kigali
The proposal to revise the name of the
WMA Declaration on the Ethical
Use of Medical Technology to the
Declaration of Kigali, was approved
by the Council and will be forwarded
to the General Assembly for adoption.
Finance and Planning Committee
The Council considered and approved
the Report of the Finance and
Planning Committee and made the
following decisions via the consent
calendar:
Financial Statement
The pre-audited WMA Financial
Statement for 2023 was approved
by the Council and will undergo an
audit.
Statutory Meetings
• The Council approved that the
238th Council Session be held
from 27-29 April 2028.
• The Council approved that the
78th General Assembly be held
from 18-21 October 2028, which
will be forwarded to the General
Assembly
• The Council approved that the
proposed theme, “The Impact
of Artificial Intelligence on
Medical Practice, especially in
the Doctor-Patient Relationship”,
of the Scientific Session of the
WMA General Assembly in
Porto, Portugal, in October 2025,
be forwarded to the General
Assembly.
• The Council declined the
invitation from the Pakistan
Medical Association to host the
235th Council Session in Karachi,
Pakistan, in 2026.
Code of Conduct
The Code of Conduct was extracted
for individual consideration. The
proposed amendments to the WMA
Procedures and Operating Policies on
Code of Conduct were approved by
the Council without further changes.
Socio-Medical Affairs Committee
The Council considered the Report
of the Socio-Medical Affairs
Committee, with no items extracted
for individual consideration. Council
decisions reach via the consent
calendar are as follows:
Epidemics and Pandemics
The Council approved that the
proposed revision of the WMA
Statement on Epidemics and
Pandemics be circulated within the
membership for comments.
Human Papillomavirus Vaccination
The proposed revision of the WMA
Statement on Human Papillomavirus
Vaccination was approved by the
Council and will be forwarded to the
General Assembly for adoption.
Mental Health of Physicians
The Council approved that the
proposed WMA Statement on
Specific Care for the Mental Health
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WMA Council Report
8
of Physicians be circulated again
within the membership for further
comments.
Air Pollution
The Council approved that the
proposed WMA Declaration on
Prevention and Reduction of Air
Pollution to Improve Air Quality
be circulated again within the
membership for further comments.
Aging Physicians
The Council approved that the
proposed WMA Resolution on
Aging Physicians be circulated within
the membership for comments.
Urgent Item – Healthcare in Gaza
The proposed Council Resolution
calling for a ceasefire and the
protection of healthcare in Gaza as
amended,was adopted by the Council,
as the WMA Council Resolution on
the Protection of Healthcare in Israel
and Gaza.
WMA’s Work with the World
Health Organization
During this Council session, other
presentations made during the Seoul
meeting covered WMA’s ongoing
work with the WHO as well as on the
international stage.
International Health Regulations
and the Proposed Pandemic
Agreement
The Council received a presentation
by Dr. Yassen Tcholakov, Past Chair
of the JDN, on the amendment of
the IHR and International Pandemic
Negotiations, in relation to the
proposed Pandemic Agreement.
He highlighted the WMA’s
activities, including participation
in extensive meetings and ongoing
efforts to provide input on the
Intergovernmental Negotiating
Body (INB) Article 7 on Health and
Care Workforce. He outlined the
objectives of the WMA, namely to
pursue mechanisms of equity in the
global response, ensure the protection
of health personnel, and advocate for
physical and mental health as well
as safe working environments and
labour conditions. Dr. Tcholakov
highlighted that the WMA holds
a timely position as a relevant
international organisation to continue
engaging on these topics.
Health Workforce Advocacy
The Council received a presentation
by the WMA Advisor Dr. Caline
Mattar on health workforce advocacy.
Sheprovidedbackgroundinformation
on the WHO Global Strategy on
Human Resources for Health, a
framework to guide policy and
investment decisions in health labour
markets, with the aim of ensuring a
healthy workforce that is capable and
equipped to deliver quality health
services, and contributing to universal
health coverage, health security,
and overall health and well-being.
The WMA has the opportunity to
bring forward national physician
perspectives, offer a strong national
and international voice on physician-
led care, ​
and serve as a champion
of decent work, fair wages, and
workplace safety through the
implementation of the Global Care
Compact. Dr. Mattar presented
opportunities for WMA members
to advocate and amplify physicians’
voices, by responding to requests for
national input, sending letters, and
engaging in national advocacy with
ministries in their countries.
Antimicrobial Resistance
The Council received a presentation
on AMR by the WMA Advisor
Dr. Caline Mattar. She shared that
the UN High-level Meeting will be
held in September 2024, and that a
Zero draft of the UN resolution has
been released. Dr. Mattar outlined
main advocacy points, such as the
timely involvement of NMAs in the
National Action Plan development,
implementation, and monitoring and
evaluation, urging expanded access
of new AMR products to areas with
the greatest unmet need. WMA
members can become engaged at a
national level with advocacy around
the health workforce message for
the High-level Meeting as well
as participate in National Action
Plan implementation. In addition,
WMA members were invited to
share information with their national
experts who are invited to contribute
to these WMA AMR initiatives.
Other Business
Dr. Park introduced the video
invitation from the Uruguayan
Medical Association, which will host
the 229th WMA Council Session in
Montevideo, Uruguay, from 24-26
April 2025.
Dr. Kloiber thanked the Korean
Medical Association, other staff and
volunteers, past and present officers,
Council members,observers,advisors,
Associate Members and their Chair,
World Medical Journal editorial
team, legal advisor and facilitator,
interpreters, WMA Secretariat, and
especially the Chair of Council,
Professor Park, and Dr. Alqodmani.
Dr. Park called upon Dr. Alqodmani
to speak briefly about the inaugural
Women in Medicine lunch. She
thanked those who made the event
possible and announced that the
second Women in Medicine lunch
will be planned for October 2024.
References
1. World Medical Association.
WMA Resolution in Support
of Taiwan’s Participation in all
WHO Health Programs and
Inclusion in the Internation-
BACK TO CONTENTS
WMA Council Report
9
al Health Regulations (IHR)
Mechanisms [Internet]. 2021
[cited 2024 Jun 7]. Available
from: https://www.wma.net/pol-
icies-post/wma-council-resolu-
tion-on-observer-status-for-tai-
wan-to-the-world-health-or-
ganization-who-and-inclu-
sion-as-participating-par-
t y – t o – t h e – i n t e r n a t i o n –
al-health-regulations-ihr/
2. World Medical Association.
WMA Takes Stand Against
Humanitarian Violations, Calls
for Urgent Action in Gaza
[Internet]. 2024 [cited 2024
Jun 7]. https://www.wma.net/
news-post/wma-takes-stand-
against-humanitarian-violations-
calls-for-urgent-action-in-gaza/
Janice Blondeau, BBus(Comn)
Communications and Media Consultant
World Medical Association
E-mail: janice.blondeau@wma.net
At the 226th Council session, held
in Seoul, Republic of Korea, in
April 2024, the Council approved
the proposal entitled, “Proposed
Amendments on the WMA
Procedures and Operating Policies on
Code of Conduct,” as amended (FPL
226/POPs Code of Conduct REV/
Apr2024), and forwarded it to the
General Assembly for information.
Individual Agreement
Following the decision made by the
Council during the 226th Council
session, the WMA is enforcing the
Code of Conduct (Chapter 8, Clause
8.2 of the WMA Procedures and
Operating Policies), which reads: “All
attendees of WMA hosted meetings,
events, and other activities, including
social gatherings are expected to
exhibit respectful, professional, and
collegial behaviour. To this end, every
participant is asked to sign a code
of conduct when registering for the
event.”
Each participant must complete their
own registration and will be asked
to agree to the Code of Conduct
individually. Please note that no one
else may register on behalf of the
participant.
Anti-Harassment Policy (Chapter 8,
Clause 8.3 of the WMA Procedures
and Operating Policies)
WMA has zero tolerance towards
any type of harassment, including
sexual misconduct, of any attendee
of a WMA-hosted meeting, event,
and other activity, including social
gatherings. Any form of retaliation
against those who report or participate
in an investigation of allegations of
harassment is not tolerated.
Any persons who believe they have
experienced or witnessed an act
of harassment, including sexual
misconduct, are encouraged to report
it to any member of the WMA
Secretariat.
Photo 1. Group photo at the Geunjeongjeon Hall of the Gyeongbokgung Palace during the 226th Council Session in Seoul. Credit: WMA
WMA Code of Conduct
BACK TO CONTENTS
WMA Council Report
10
WMA COUNCIL RESOLUTION ON PROPOSED
LEGISLATION IN UK ON THE TREATMENT OF
MIGRANTS DISREGARDING THE INJUNCTION
INTERIM MEASURES RULE 39 OF ECHR
Adopted by the 223rd WMA Council
session, Nairobi, Kenya, April 2023 and
revised by the 226th WMA Council session,
Seoul, Korea, April 2024
The WMA expresses its grave concern about
the United Kingdom (UK) government
intention to pursue the Safety of Rwanda Bill
that legislates the reversal of the Supreme
Court’s recent unanimous judgement of the
risk of harm in Rwanda.The Bill risks leaving
people who are vulnerable, fleeing dangerous
situations and who have often experienced
trauma, subject to an environment where they
are potentially re-traumatised and unable to
access the medical attention they may urgently
need. This will have a detrimental impact on
the mental health of those removed.
The WMA is troubled by the proposed
provisions in the Bill that would allow
ministers to disregard 
the measures 
issued
by the European Court of Human Rights
(ECHR) under Rule 39 of the rules of the
court in relation to the treatment of migrants
and prohibits courts from having regard to
any such measure. The WMA is committed
to the principle of respect for international
law. If enacted, this legislation would remove
an important protection for people seeking
asylum, other migrants and those health
workers caring for them.
Rule 39 interim measures have prevented the
forced removal of asylum seekers from the UK
to Rwanda, under a controversial offshoring
scheme that the UK medical community
has condemned on medical, ethical and
humanitarian grounds.
Human Rights are only meaningful and
effective if they are applied equally to everyone.
Given the key role of the United Kingdom in
drafting the European Convention on Human
Rights, 
this 
creates a dangerous precedent
that other nations might seek to follow.
WMA COUNCIL RESOLUTIONS
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11
WMA COUNCIL RESOLUTION CALLING
FOR THE IMMEDIATE WITHDRAWAL OF
THE BILL LIFTING THE BAN ON FEMALE
GENITAL MUTILATION IN GAMBIA
Adopted by the 226th WMA Council
session, Seoul, Korea, April 2024
1. The WMA Council meeting in Seoul
notes with dismay the bill currently before
the Gambian Parliament to lift the ban on
female genital mutilation (FGM) in force
since 2015. On 18 March 2024, Gambian
MPs voted overwhelmingly in favour
of the bill which has then been sent to a
parliamentary committee for a final review
before a final vote in around three months’
time.
2. According to UNICEF, 76 per cent of
women (15–49 years) and 51 per cent of
girls (0–14 years) have experienced FGM
[1]. Since FGM was banned in 2015, only
two cases have been prosecuted and the
first conviction for performing mutilation
was not handed down until August 2023
[2].
3. Although Gambia ratified the Maputo
Protocol on Women’s Rights in Africa,
drawn up by the African Union, which
condemns and prohibits all forms of
female genital mutilation as a violation
of the fundamental rights of girls and
women, it remains widely practiced across
the Country.
4. The Council recalls the WMA
Statement on Female Genital Mutilation
condemning the practice of genital
mutilation or cutting of women and girls,
regardless of the level of mutilation, and
opposing the participation of physicians in
these practices.
5. Reiterating that all forms of FGM
constitute a violation of the human
rights of girls and women and that its
practice can lead to permanent damage to
health, including chronic pain, infections,
difficulties during childbirth and even
death during or after the mutilation,
the WMA Council urges the Gambian
authorities to:
• Respect their international human rights
obligations, in particular the Maputo
Protocol on Women’s Rights in Africa,
and therefore immediately withdraw
the bill lifting the ban on female genital
mutilation;
• Instead, reinforce its legislation for the
elimination of FGM with adequate
funding and a comprehensive set of
policies to empower women and girls to
exercise their human rights.
6. The WMA Council calls on WMA
constituent members and individual
physicians to mobilize and advocate against
the bill and for women’s rights in Gambia.
[1] https://www.unicef.org/gambia/media/1581/
f ile/UNICEF%20Gambia%20Annual%20
Report%202022.pdf
[2]https://www.amnesty.org/en/latest/news/2024
/03/gambia-parliament-must-not-lift-the-ban-
against-female-genital-mutilation/
WMA COUNCIL RESOLUTIONS
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12
WMA COUNCIL RESOLUTION ON
ANTI-LGBTQ LEGISLATION IN UGANDA
Adopted by the 223rd WMA Council
Session, Nairobi, Kenya, April 2023
Revised and adopted by the 74th WMA
General Assembly,Kigali,Rwanda,October
2023
Revised as Council Resolution by the 226th
WMA Council Session, Seoul, Korea, April
2024
PREAMBLE
The WMA is gravely concerned about the
“Anti-Homosexuality law” that was passed in
the Ugandan parliament on March 21, 2023
and signed into law by Ugandan President
Yoweri Museveni in May. The WMA
originally condemned the bill in a press release
issued on March 24, 2023.
While the Uganda Constitutional Court
did strike down sections of the law that
restricted healthcare access for LGBT people,
criminalized renting premises to LGBT
people,and an obligation to report alleged acts
of homosexuality, on April 3, 2024, the court
upheld the abusive and radical provisions
of the Anti-Homosexuality Act, including
sections which criminalize certain consensual
same-sex acts and makes them punishable by
death or life imprisonment.A provision on the
“promotion” of homosexuality is also of grave
concern, exposing anyone who “knowingly
promotes homosexuality” to as much as
twenty years in prison.
This kind of law challenges the role of
physicians to objectively provide information
to patients and, where appropriate, those close
to them. Physicians could face disciplinary
action or retribution for pointing out in the
context of treatment that homosexuality is
a natural variation of human sexuality. This
can impact the professional practice of a
physician, as can be seen in other countries
that have implemented similar legislation. It
can also impact the health of individuals and
the population as a whole if patients of the
LGBTQ+ community are fearful of accessing
healthcare or of being forthcoming with
information when they require medical care.
As stated in its Statement on Natural
Variations of Human Sexuality and supported
in its Statement on Transgender People, the
WMA condemns all forms of stigmatisation,
criminalization of and discrimination against
people based on their sexual orientation.
The WMA reasserts that being lesbian,
gay, or bisexual are natural variations within
the range of human sexuality and that
discrimination, both interpersonally and at
the institutional level, anti-homosexual or
anti-bisexual legislation and human rights
violations, stigmatisation, criminalization of
same-sex partnerships, peer rejection and
bullying continue to have a serious impact
upon the psychological and physical health of
lesbian, gay or bisexual people.
Further, the WMA emphasises that everyone
has the right to determine one’s own gender
and recognises the diversity of possibilities
in this respect and calls for appropriate legal
measures to protect the equal civil rights of
transgender people.
RECOMMENDATIONS
Therefore, the WMA, reaffirming its
statements on Natural Variations of Human
Sexuality and on Transgender People, calls on:
• Ugandan authorities to immediately repeal
the Anti-Homosexuality law in its entirety;
• WMA Constituent members to condemn
the Ugandan law and advocate against
any similar legislation that is proposed or
enacted.
WMA COUNCIL RESOLUTIONS
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13
WMA COUNCIL RESOLUTION ON
ORGAN DONATION IN PRISONERS
Adopted by the 173rd WMA Council
Session, Divonne-les-Bains, France, May
2006 and reaffirmed by the 203rd WMA
Council Session, Buenos Aires, Argentina,
April 2016 and revised by the 226th WMA
Council Session, Seoul, Korea, April 2024
Whereas the WMA Statement on Human
Organ and Tissue Donation and
Transplantation stresses the importance of
free and informed choice in organ donation
and
Whereas the statement explicitly states that
prisoners and other individuals in custody are
not in a position to give consent freely, and
therefore, their organs must not be used for
transplantation and
Whereas, prior to 2014, there were reports of
Chinese prisoners being executed and their
organs procured for donation; and
Whereas the WMA reiterates its position
that organ donation be achieved through the
free and informed consent of the potential
donor; and
Whereas the WMA General Assembly in
Copenhagen in 2007 was informed that
the Chinese Medical Association (ChMA)
stated in a letter by Dr. Wu Mingjang, (then)
Vice President and Secretary General of the
ChMA that
1. the Chinese Medical Association agrees
to the WMA Statement on Human
Organ Donation and Transplantation, in
which it states that organs of prisoners
and other individuals in custody must
not be used for transplantation, except
for members of their immediate family.
The Chinese Medical Association will,
through its influence, further promote
the strengthening of management
of human organ transplantation and
prevent possible violations made by the
Chinese Government.” [1]
Whereas the Chinese Medical Association
(ChMA) gave a statement regarding the
proposed WMA Declaration on Organ
Donation for Transplantation from Executed
Prisoners at the 223rd Council meeting in
Nairobi 2023, stating:
1. “The Chinese Medical Association
(ChMA) fully supports China’s
complete prohibition on the use of
organs from death penalty prisoners
for transplantation, implemented on
January 1st, 2015. This policy has
significantly contributed to the successful
development of voluntary deceased
organ donation in China, propelling the
nation to rank second globally in annual
deceased organ donation and benefiting
numerous Chinese patients.
2. ChMA firmly supports and adheres
China’s comprehensive legal and
regulatory system,as well as the technical
capacity developed to facilitate the legal
enforcement, ensuring the continued
prohibition of using organs from executed
prisoners and the ongoing success of the
national organ donation program.
3. ChMA encourages all her members
(to) actively participates (in) China’s
efforts to establish a self-sufficient organ
donation system in line with WHO
guiding principle, condemns the practice
of using organs from executed prisoners
for transplantation.ChMA will continue,
and also call upon all national medical
associations, particularly those with
legislation permitting the practice of the
use of organs from executed prisoners,
to educate physicians on ethical values
and conduct in order to prevent such a
practice.”
Whereas the WMA reiterates paragraphs
17,18 and 19 of the undisputed WMA
Statement on Organ and Tissue Donation,
last revised at the WMA 68th. General
Assembly in Chicago, United States, October
2017, which read:
1. Prisoners and other people who are
effectively detained in institutions should
be eligible to donate after death where
checks have been made to ensure that
donation is in line with the individual’s
prior, un-coerced wishes and, where the
individual is incapable of giving consent,
authorisation has been provided by a
family member or other authorized
decision-maker. Such authorisation may
not override advance withholding or
refusal of consent.
2. Their death is from natural causes and
this is verifiable.
3. In jurisdictions where the death penalty is
practised, executed prisoners must not be
considered as organ and/or tissue donors.
While there may be individual cases
where prisoners are acting voluntarily
and free from pressure, it is impossible
to put in place adequate safeguards to
protect against coercion in all cases.
Whereas there have been reports of
purported inappropriate organ procurement
from prisoners within several nations and
the WMA should remain firmly on record to
condemn inappropriate organ procurement
from prisoners and other people who are
effectively detained in institutions in all
nations.
The WMA will amend the title of the WMA
WMA COUNCIL RESOLUTIONS
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14
Council Resolution on Organ Donation
in China (2006) to the WMA Council
Resolution on Organ Donation in Prisoners.
Therefore, the Workgroup on Organ
Procurement (November 2023) proposes to
amend the WMA Council Resolution on
Organ Donation in China (2006), to read as
follows:
The WMA reiterates its position that organ
donation be achieved through the free and
informed consent of the potential donor.
The WMA calls on its Constituent member
associations to condemn any practice of using
prisoners and other people who are effectively
detained in institutions as organ donors in
any manner that is not consistent with the
WMA Statement on Organ and Tissue
Donation and ensure that physicians are not
involved in the removal or transplantation
of organs from executed prisoners, and the
WMA demands all national governments
to immediately cease the practice of using
prisoners and other people who are effectively
detained in institutions as organ donors in any
manner that is not consistent with the WMA
Statement on Organ and Tissue Donation.
[1] https://www.wma.net/news-post/chinese-
medical-association-reaches-agreement-
with-world-medical-association-against-
transplantation-of-prisoners-organs/
WMA COUNCIL RESOLUTIONS
BACK TO CONTENTS
WMA COUNCIL RESOLUTION ON THE PROTECTION
OF HEALTHCARE IN ISRAEL AND GAZA
Adopted by the 226th WMA Council
session, Seoul, Korea, April 2024
PREAMBLE
In response to the ongoing conflict in Israel
and Gaza, the WMA is gravely concerned by
the deepening healthcare and humanitarian
crisis in Gaza, the growing starvation and the
lack of medical care and deeply concerned
about the continued imprisonment and abuse
of hostages.
RECOMMENDATIONS
The WMA Council and its constituent
members call for:
1. A bilateral, negotiated and sustainable
ceasefire in order to protect all civilian
life, secure the release and safe passage
of all hostages and to allow the transfer
of humanitarian aid for all those in need.
2. The immediate and safe release of all
hostages.
3. Pending their release, humanitarian aid
and healthcare attention to be provided
to the hostages.
4. All parties to abide by international
humanitarian law and the principle of
medical neutrality to safeguard the rights
and protection of healthcare facilities,
healthcare personnel and patients from
further threat, interference and attack.
5. Unimpededandacceleratedhumanitarian
access throughout all of Gaza, including
the entry of humanitarian aid and safe
passage of medical personnel. This
also includes the evacuation of urgent
medical cases to reduce secondary
morbidity and mortality, public health
risks, and alleviate pressure on hospitals
inside Gaza.
6. The re-establishment of access to
healthcare and the creation of a safe
working environment for healthcare
personnel to work in through the
restoration of medical capacity and
essential services.
7. Verified investigations into alleged gross
violations and abuses of human rights
and international humanitarian law
including attacks on healthcare staff and
facilities and the misuse of those facilities
for military purposes.
8. The upholding by physicians of the
principles in the WMA Declaration of
Geneva and other documents that serve
as guidance for medical personnel during
times of conflict.
15
Combatting antimicrobial resistance
(AMR) has been a priority for the
European Commission for the past
two decades. AMR is considered
one of the main health threats in
the European Union (EU), which
will continue to spread if decisive
action is not taken. According to
the World Health Organization
(WHO), 700,000 people worldwide
lose their lives each year to drug-
resistant bacteria, with more than
35,000 of these deaths occurring in
the EU alone [1,2].This burden could
increase to over 10 million annual
deaths by 2050 [1]. In addition,
AMR significantly impacts the
economy and healthcare systems,
accounting for an estimated EUR 1.5
billion every year in healthcare costs
and productivity losses [3]. These
numbers cannot – and importantly
are not – being ignored by the EU.
In terms of public awareness, the level
of general attention paid to AMR is
very low – comparable to the level of
interestinclimatechangeinthe1980s.
AMR is a silent killer,and the general
public are still not fully aware of the
impending risks. AMR is a disastrous
and out-of-control situation with
increasing annual mortality rates,
and the whole of society needs to
understand the urgent need to address
it. For this reason, the European
Commission is placing a substantial
emphasis on raising public awareness
around AMR, by providing guidance
on specific actions to Member States,
healthcare professionals, and citizens
in order to mitigate the risk of AMR
spreading across their communities.
The EU’s fight against AMR is
founded on a One Health approach.
This is an approach that recognises
human, animal, and environmental
health as one collective unit within
a shared ecosystem [4]. Taking this
approach means that our initiatives
on AMR – both in terms of science,
but also, importantly in terms of our
proposals, considers all ecosystems
within our shared environment.
In June 2023, the EU proposed
the Council Recommendation on
accelerating the EU’s actions to
combat AMR through the application
of the One Health approach [5]. As
one of the most ambitious EU actions
against AMR to date, this
recommendation establishes targets
to be achieved by 2030, including
a 20% reduction in antibiotic
consumption in humans. These
targets are an important way to
drive action against AMR, while
respecting national circumstances and
maintaining patient health and safety.
The Recommendation also includes
increased monitoring and surveillance
and enhanced infection prevention
and control measures, which gives a
boost to research and development
efforts and incentives to ensure access
to antimicrobials. One example of an
incentive would be revenue guarantees
for pharmaceutical companies that
invest in research and development
of novel antibiotics. Further flagship
targets include a 50% reduction of
the sales of antimicrobials for farmed
animals and aquaculture,and statistics
have shown that sales decreased by
more than 28% between 2018 and
2022[6,7].Thistargetiscoupledwitha
ban of routine use to groups of animals
for prophylactic purposes, as well as
growth promoters in farmed animals.
In parallel, in April 2023, the EU
proposed the most comprehensive
revision of the EU’s pharmaceutical
legislation in two decades. The
objective is to ensure the supply
of safe, effective and innovative
medicines to all Europeans, while
maintaining a strong and competitive
pharmaceutical sector in Europe.
The proposed new legislation includes
measurestostimulatethedevelopment
of novel antibiotics, including
‘transferable data exclusivity vouchers’
to developers of novel antimicrobials.
The voucher, which will be subject to
strict conditions, will offer developers
an additional year of data protection
from competing companies for their
novel antimicrobials. This system
will consequently generate revenues
for businesses that successfully
develop innovative medicines against
AMR. This legislation also includes
measures to improve the use of
all antimicrobials and establish an
environmental risk assessment for
antimicrobials for human use [8].
Like other global health priorities,
health financing plays an essential
role in mitigating AMR risk. In
addition to raising AMR awareness
and communication, the European
Commission has been supporting
Member States as well as Norway,
Iceland, and Ukraine, with EUR
50 million of available funding
towards reducing the risk of
exposure of citizens to antibiotic-
resistant bacteria. To support global
cooperation on AMR, the EU Global
Health Strategy helps support the
WHO and their initiatives to identify
Roser Domènech Amadó
European Union’s Actions to Fight AMR
using a One Health Approach
European Union’s Actions to Fight AMR using a One Health Approach
BACK TO CONTENTS
16
the types of antibacterials needed and
initiativestoexpediteclinicaltrials[9].
The EU also actively works with the
Quadripartite Organisations (WHO,
Food and Agriculture Organization
of the United Nations, World
Organization of Animal Health, and
UN Environmental Programme),
with G7 and G20, and in the
ongoing negotiations for a Pandemics
Agreement. Under the Transatlantic
Task Force on AMR (TATFAR),
which was established in 2009,
the EU frequently exchanges best
practices with experts from Canada,
Norway, the United Kingdom, and
the United States on AMR [10]. On
the future global stage, the EU holds
great hope for an ambitious outcome
from the UN General Assembly
High-level Meeting on AMR in
September 2024, especially as all
international partners will commit
to timely, concrete, and evidence-
based actions against AMR spread.
In conclusion, when tackling AMR,
scientific evidence shows that our
global society cannot delay any further
in this call to action. Our generation
has had the privilege of living in the
safe antibiotics era, and we should
not be the last generation to do so.
From individuals to international
partners, we can collectively continue
to take urgent and ambitious actions
in order to make an impactful
difference in reducing AMR risks.
References
1. World Health Organization.
No time to wait: securing the
future from drug-resistant
infections [Internet]. 2019
[cited 2024 Apr 20]. Available
from: https://www.who.int/
publications-detail-redirect/
no-time-to-wait-securing-the-
future-from-drug-resistant-in-
fections
2. European Centre for Disease
Prevention and Control. Key
messages: health burden of
antibiotic resistance [Internet].
2022 [cited 2024 Apr 20].
Available from: https://
health.ec.europa.eu/system/
files/2020-01/amr_2017_fact-
sheet_0.pdf
3. The Organisation for Economic
Co-operation and development:
antimicrobial resistance tackling
the burden in the European
Union [Internet]. 2019 [cited
2024 Apr 30]. Available from:
AMR-Tackling-the-Burden-in-
the-EU-OECD-ECDC-Brief-
ing-Note-2019.pdf
4. World Health Organization.
Tripartite and UNEP support
OHHLEP’s definition of “One
Health” [Internet]. 2021 [cited
2024 Apr 20]. Available from:
https://www.who.int/news/
item/01-12-2021-tripartite-and-
unep-support-ohhlep-s-defini-
tion-of-one-health
5. Evroux C, Antunes L, European
Parliamentary Research Service.
Stepping up EU action to combat
antimicrobial resistance: the ‘One
Health’ approach. PE 751.397.
Brussels: European Union; 2023.
Available from: https://www.
europarl.europa.eu/RegData/
etudes/BRIE/2023/751397/
EPRS_BRI(2023)751397_
EN.pdf
6. European Medicines Agency.
European Surveillance of
Veterinary Antimicrobial
Consumption (ESVAC): 2009–
2023. 2009 [cited 2024 Apr
20]. Available from: https://
www.ema.europa.eu/en/vet-
erinary-regulatory-overview/
antimicrobial-resistance-vet-
erinar y-medicine/europe-
an-surveillance-veterinary-an-
timicrobial-consumption-es-
vac-2009-2023
7. European Food Safety Authority.
Multi-agency report highlights
importance of reducing
antibiotic use [Internet]. 2024
[cited 2024 Apr 20]. Available
from: https://www.efsa.europa.
eu/en/news/multi-agency-re-
port-highlights-importance-re-
ducing-antibiotic-use
8. EuropeanCommission.European
Health Union: EU steps up
the fight against antimicrobial
resistance [Internet]. 2023 [cited
2024 Apr 20]. Available from:
https://ec.europa.eu/commis-
sion/presscorner/detail/en/
ip_23_3187
9. European Commission. EU
Global Health Strategy: Better
Health for All in a Changing
World. Brussels: European
Commission; 2022. Available
from: https://health.ec.europa.
eu/publications/eu-global-
health-strategy-better-health-
all-changing-world_en
10. Centers for Disease Control
and Prevention: Transatlantic
Taskforce on Antimicrobial
Resistance (TATFAR) [Internet]
2024. [cited 2024 Apr 30].
Available from: https://www.cdc.
gov/drugresistance/tatfar/index.
html
Roser Domènech Amadó
Director for One Health,
Directorate-General for Health
and Food Safety (DG SANTE),
European Commission
Brussels, Belgium
Roser.Domenech-Amado@ec.europa.eu
European Union’s Actions to Fight AMR using a One Health Approach
BACK TO CONTENTS
17
BACK TO CONTENTS
The United Nations Office on Drugs
and Crime (UNODC) supported the
organisation of the 67th Commission
on Narcotic Drugs (CND67), which
was held in Vienna, Austria, from 14-
22 March 2024. This global meeting
brings together Member States
with their government officials,
policymakers, health enforcement,
and experts from ministries of
health, justice, and interior, as well as
international organisations such as
the International Narcotics Control
Board (INCB), World Health
Organization, and Civil Society
associations. The UNODC aims
to enhance global peace, security,
sustainable development, and
human rights, by addressing issues
related to drugs, crime, corruption,
and terrorism. Health professionals
can play a fundamental role in
supporting the UNODC mission and
commitment to the 2030 Agenda for
Sustainable Development, through
striving to enhance access to and
availability of controlled medicines
for medical and scientific purposes,
and hence combat the global drug
problem.
During the CND67, the Resolution
63/3 was adopted, which underlines
the global commitment to the
equitable and effective use of
controlled medicines, emphasising
the need for comprehensive education
and training programs for healthcare
professionals and adequate provision
of evidence-based guidelines and
tools​
. Specifically, the Resolution
63/3 states: “Promoting awareness-
raising, education and training as
part of a comprehensive approach to
ensuring access to and the availability
of internationally controlled substances
for medical and scientific purposes
and improving their rational use”
[1]. This commitment recognises
that drug use disorders negatively
impact health, safety, and well-being,
and are exacerbated by stigma and
discrimination that hinder access to
necessary help.
According to the World Drug Report
2023, the number of users of illicit
drugs worldwide has increased by
23% over the past decade, from an
estimated 240 million people in
2011 to 296 million people in 2021
[2]​
. Findings demonstrated that
the burden of drug use disorders
is significantly related to opioid
and cannabis use, and that existing
disparities in geography (e.g.
opioid use in Europe, opioid and
methamphetamine use in Asia,
cocaineinLatinAmerica),gender(e.g.
women may face barriers in accessing
treatment due to social stigma or fear
of legal sanctions),and socioeconomic
status (e.g. individuals living in Africa
and Asia have inconsistent access
to essential controlled medications
for pain relief and palliative care)
can hinder the prompt delivery of
supporting and life-saving treatment
to combat drug use disorders.
Implementing regulations that focus
on public health can ensure that
controlled medicines are accessible
and available where necessary, while
managing commercial influences and
minimising the risks of diversion and
non-medical use [2].
For the first time, the Junior Doctors
Network (JDN) of the World
Medical Association (WMA)
contributed significantly to the event
proceedings on 18-19 March 2024
(Photo 1). During the CND67 event
plenary, the JDN representative (Dr.
Pablo Estrella Porter) delivered a
compelling statement prepared by
the UNODC’s newly established
Young Doctors Network, framing
the challenges in the access to
controlled medicines. He emphasised
the urgent need to integrate medical
education in prescribing controlled
medications and pain management
strategies, seek sufficient financial
resources for training and the
implementation of regulatory
frameworks, work collaboratively to
find a balance between over restrictive
and excessively tolerant regulations,
and address stigma around the
prescription and use of controlled
medicines (Photo 2).
This advocacy was key in highlighting
the junior doctors’ perspective in
Pablo Estrella Porter
Pioneering Change: The Junior Doctors Network’s Role
at the CND67 and Beyond
The Junior Doctors Network’s Role at the CND67 and Beyond
Photo 1. Junior Doctors Network representative, Dr. Pablo
Estrella, at CND67. Credit: JDN
18
the global discourse on drug control
and patient care as well as their
leadership to create a youth network
to collaborate on these pressing issues.
Ms. Ghada Waly, Director-General
and Executive Director of the United
Nations Office at Vienna / UNODC,
shared this sentiment at the CND67
on 14 March 2024: “And to put our
words into action, new UNODC
programming is building connections
in the medical field, recently launching
a network of young doctors from around
the world to discuss sustainable solutions
for stubborn barriers to access” [3].
During the CND67 side event
entitled, “Taking the Pledge4Action
to ensure adequate availability of
internationally controlled essential
medicines,” the JDN representative
sharedrealexamplesofthebarriersthat
junior doctors face when prescribing
and accessing key medications in
the clinical practice. He specifically
highlighted the lack of continuous
education for prescribing medications
(including controlled medicines),
importance of identifying patients
who misuse controlled medicines,and
limited availability of medications in
low- and middle-income countries.
This event showcased the global
commitment to improving access to
essential medicines, with discussions
featuring representatives from
various countries and organisations,
such as Belgium, Brazil, Ghana,
INCB, CAPSA Canada, and the
International Association for Hospice
and Palliative Care (IAHPC). The
engagement of junior doctors in
this forum has the potential to drive
conversations toward practical and
innovative solutions for increasing
accessibility of prescribed medication
as well as strengthening healthcare
resiliency.
The CND67 and its side events
underscored the political will among
Member States to enhance access to
controlled medicines, balancing the
need for medical use and preventing
non-medical use. Although the CND
is not primarily centred on health
matters, the participation of junior
doctor representatives at the plenary
and inside events, along with the
engagement of diverse stakeholders,
demonstrated an increasing
willingness to address health-related
issues within the context of drug
control policies. This indicates a
growingrecognitionoftheimportance
of integrating health perspectives into
the broader framework of narcotic
drug regulations.
At the CND67 plenary, the Young
Doctors Network shared a statement
(“Statement by the UNODC Young
Doctors Network on Access to
Controlled Drugs”) that was prepared
by the members in collaboration
with UNODC and proposed five
recommendations:
• To strengthen education and
training in rational prescribing of
controlled substances
• To foster global partnerships to
share best practices and innovations
• To advocate for policy reforms
to balance access to controlled
medicines and prevent misuse
• To support research and data
sharing to inform evidence-based
policymaking
• To address stigma around
controlled medicines and
ensure equitable access to them,
particularly in low- and middle-
income countries
Additional information about this
statement can be reviewed at the end
of this article.
Junior doctors hold a key role in
advocating for policy reforms,
participating in international
dialogues, and implementing best
practices in clinical settings related
to emerging global health challenges,
like controlled medicines. The JDN
representative demonstrated that
their dedicated efforts can advocate
for timely policy decision-making
on the availability and rational use
of controlled medicines, which may
help influence clinical and public
health practice. Their involvement
in UNODC’s initiatives, particularly
in the accessibility of controlled
medicines, sets a precedent for future
engagement and policy development.
This landmark event specifically
highlighted existing challenges and
paved the way for actionable solutions,
aligning with the UN 2030 Agenda
for Sustainable Development and
ensuring that no one is left behind in
accessing essential healthcare services.
References
1. United Nations Economic and
Social Council. Commission
on Narcotic Drugs, Resolution
63/3 [Internet]. 2024 [cited 2024
The Junior Doctors Network’s Role at the CND67 and Beyond
Photo 2.Formal presentation by the Junior Doctors Net-
work representative, Dr. Pablo Estrella, on the Statement
of the Young Doctors Network at the CND67 plenary.
Credit: JDN
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19
Apr 29]. Available from: https://
www.unodc.org/documents/
commissions/CND/Drug_Reso-
lutions/2020-2029/2020/Resolu-
tion_63_3.pdf
2. United Nations Office on Drugs
and Crime. World Drug Report
2023. Vienna; UNODC; 2024.
Available from: https://www.
unodc.org/res/WDR-2023/
WDR23_Exsum_fin_SP.pdf
3. United Nations Office on Drugs
and Crime. CND Event: On the
road to 2029: how to accelerate
our efforts to ensure safe access
to essential medicines for all
patients in need while ensuring
a rational use and preventing
diversion [Internet]. 2024 [cited
2024 May 3]. Available from:
https://www.unodc.org/unodc/
en/speeches/2024/cnd67-on-
the-road-to-2029.html
Pablo Estrella Porter, MD, MPH
PhD student, Universidad de Valencia
Public Health resident, Hospital
Clínico Universitario de Valencia
Valencia, Spain
pestrellaporter@gmail.com
The Junior Doctors Network’s Role at the CND67 and Beyond
BACK TO CONTENTS
UN COMMISSION ON NARCOTIC DRUGS
STATEMENT BY THE UNODC YOUNG DOCTORS
NETWORK ON ACCESS TO CONTROLLED DRUGS
PREAMBLE
Despite the undeniable necessity of
some substances controlled under the
international drug conventions, especially
in pain management and palliative care,
numerous barriers prevent equitable access
worldwide. These barriers include strict
regulatory frameworks, education for
health professionals, limited funding, and
the stigmatisation of their use, leading to
preventable suffering for millions of patients
worldwide. As junior doctors, we play a
crucial role in improving access to controlled
medicines at a local,national,and international
level through rational prescribing practices,
raising awareness among peers and patients,
as well as shaping strategies to tackle this
issue. Health professionals must navigate the
delicate balance between achieving the desired
therapeutic objectives while addressing the
risks of dependence, and overcoming overly
restrictive or excessively tolerant regulations,
diversion, and non-medical use.
CALL FOR ACTION
Given the key role that doctors play in rational
prescribing, recognising signs of dependency,
contributing to patient monitoring,improving
communication, and promoting awareness we
call upon action to:
1. Engage in medical education, integrating
comprehensive knowledge on drugs under
international control and pain management
strategies. Junior doctors are in the prime
moment to be fully and professionally
educated with a long-lasting effect on our
medical practice.
2. Provide sufficient resources and establish
proper regulations for pain management.
A national pain treatment plan should
encompass pain prevention, treatment,
education, and the management of
medicines containing controlled
substances.
3. Foster collaboration between drug control
regulators and health professionals from
their early stages of medical education.
Listening to health professionals and
ensuring their participation in the
development and implementation of
national guidelines is crucial for promoting
rational prescription practices.
4. Address the stigma associated with
controlled medicines and stress the critical
need for targeted postgraduate education
for healthcare professionals.This education
must carefully address the complexities
associated with the use of controlled
medicines, while preventing diversion and
non-medical use.
5. Acknowledge the unique position of junior
doctors in navigating the complexities of
narcotic drugs, and highlight the need for
creating and maintaining platforms,spaces,
and funding for exchanging best practices
and collaborating in new initiatives inside
healthcare networks already existing with
support from Member States and other
stakeholders.
20
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The World Medical Association
(WMA) has been closely monitoring
international negotiations on
the management of pandemics.
The coronavirus disease 2019
(COVID-19) pandemic exposed
significant shortcomings in our
current international systems,
resulting in overworked doctors,
unsafe working conditions, and
unequal access to preventive and
protective resources such as vaccines.
In response, various temporary
measures were implemented to
address these challenges, but they
ultimately proved to be insufficient.
Recognising the need to tackle
the root causes, the World Health
Organization (WHO) initiated a
process in late 2021, to negotiate a
new international legal instrument
for pandemic management, with a
focus on addressing international
inequities, commonly referred to as
the Pandemic Accord [1].
Definitions
Pandemic Accord: The international
legal instrument currently being
negotiated at the WHO aims “to
prevent, protect against, control and
provide a public health response to
the international spread of disease in
ways that are commensurate with and
restricted to public health risks, and
which avoid unnecessary interference
with international traffic and trade”
[2].
International Health Regulations
(IHR): The IHR are an instrument
of international law that is legally-
binding on 196 countries and which
create rights and obligations for
countries, including the requirement
to report public health events. The
Regulations also outline the criteria to
determine whether or not a particular
event constitutes a “public health
emergency of international concern” [3].
Process and Progress
This negotiation process began in
early 2022, and ran concurrently with
efforts to amend the IHR, with the
goal of finalising these World Health
Assembly (WHA) negotiations in
2024 (Photo 1). Despite significant
efforts, the Pandemic Accord
negotiations did not result in a
consensus on some critical issues [4].
However, the WHA agreed to extend
the negotiation timeline by one year,
resuming these discussions in July
2024. This extended mandate will
build on the successes of numerous
accomplishments during the first two
years of negotiations, including many
parts of the draft text with a predicted
consensus, namely the Health and
Care Workforce section that was a
priority topic of WMA advocacy [5].
Meanwhile, the amendments to
the IHR were successfully adopted,
marking a significant step forward
in global health governance [6]. Key
improvements include:
• Equity Focus: The amendments
ensure more equitable access to
medical products during health
emergencies.
• Strengthened Financing:
Mechanisms for financing
pandemic preparedness and
response have been enhanced to
ensure that all countries, regardless
of income level, can respond
effectively to health crises.
• Clearer Criteria for Pandemic
Emergencies: A new definition of
a “pandemic emergency” provides
clearer criteria for triggering
international responses.
• States Parties Committee: This
committee will facilitate better
implementation of the IHR,
assess and improve core capacities,
finance initiatives, and ensure
equitable access to relevant health
products [7].
Despite these advancements, some
have criticised the lack of compliance
mechanisms within the revised IHR
and the difficulty in holding countries
accountable for their commitments.
Next Steps
The primary objective of improving
equity in pandemic responses remains
central as negotiations continue
in 2024 and 2025. The agreement
aims to do so by ensuring that all
countries stand to benefit from
global surveillance by warranting
redistributive equity in resources used
to respond to pandemics, technology
transfer to continue improving
regional and national manufacturing
capacity and self-reliance, and
financial support from countries
with more resources or experience.
Reaching an agreement at the next
WHA would guarantee better
protection for health personnel during
future pandemics, optimal allocation
of resources to interrupt transmission,
and faster, more effective responses
Yassen Tcholakov
Pandemic Negotiations at the World Health Organization:
Perspectives from the World Health Assembly in May 2024
Perspectives from the World Health Assembly in May 2024
21
to future health crises. Furthermore,
it can offer a framework for local
and national leaders to reinforce
prevention measures and surveillance
that can help prevent future
pandemicsbypromotingmultisectoral
collaboration, recognising and
addressing environmental, climatic,
social, anthropogenic, and economic
factors driving pandemic risk,through
a One Health approach, and creating
systems for pathogen specimen and
genetic information sharing between
countries.
Given the significant amount of
disinformation about the WHO and
theWHA negotiations [8],it is crucial
for trustworthy actors, including
national medical associations and the
WMA, to continue advocating for
effective international collaboration
and investments in health that benefit
all people. This ongoing support and
advocacy are essential as we strive to
improve global health governance
and ensure equitable responses to
future pandemics. Together, we
can make meaningful progress in
protecting public health worldwide.
By reviewing WMA communications
and keeping informed on these
WHA negotiations, we can use
this information when discussing
pressing health topics with ministries
of health or national negotiators.
Additionally, all WMA members
are invited to provide input to the
ongoing review and evaluation of
the WMA Statement on Epidemics
and Pandemics, published in October
2017 [9], which is expected to be
discussed at the WMA General
Assembly in Helsinki, Finland, in
October 2024.
References
1. World Health Organization.
World Health Assembly agrees
to launch process to develop
historic global accord on
pandemic prevention,
preparedness and response
[Internet]. 2021 [cited 2024 Jun
5]. Available from: https://www.
who.int/news/item/01-12-2021-
world-health-assembly-agrees-
to-launch-process-to-develop-
historic-global-accord-on-pan-
demic-prevention-preparedness-
and-response
2. World Health Organization.
Pandemic prevention,
preparedness and response
accord [Internet]. 2023
[cited 2024 Jun 5].Available from:
https://www.who.int/news-
room/questions-and-answers/
item/pandemic-prevention–pre-
paredness-and-response-accord
3. World Health Organization.
International Health Regulations
[Internet]. n.d. [cited 2024 Jun
5]. Available from: https://www.
who.int/health-topics/interna-
tional-health-regulations
4. Fletcher ER. Breaking – WHO
member states fail to reach
agreement on Pandemic Accord;
way forward in hands of World
Health Assembly [Internet].
Health Policy Watch. 2024
[cited 2024 Jun 5]. Available
from: https://healthpolicy-watch.
news/breaking-pandemic-ac-
cord-negotiations-stall-again-
with-way-forward-in-hands-of-
world-health-assembly/
5. World Health Organization.
Intergovernmental Negotiating
Body to draft and negotiate a
WHO convention, agreement or
other international instrument
on pandemic prevention,
preparedness and response:
Report by the Director-General
[Internet]. A77/10. 2024 [cited
2024 Jun 5]. Available from:
https://apps.who.int/gb/ebwha/
pdf_files/WHA77/A77_10-en.
pdf
6. World Health Organization.
World Health Assembly
agreement reached on
wide-ranging, decisive package
of amendments to improve the
International Health Regulations
[Internet]. 2024 [cited 2024 Jun
Perspectives from the World Health Assembly in May 2024
Photo 1. Dr. Tedros Adhanom Ghebreyesus, WHO Director-General, shared concluding remarks and words of encourage-
ment for the work ahead on the Pandemic Accord negotiations during the closing plenary of the 77th World Health Assembly
in Geneva from 22 May-1 June 2024. Credit: Yassen Tcholakov
BACK TO CONTENTS
22
5]. Available from: https://www.
who.int/news/item/01-06-2024-
world-health-assembly-agree-
ment-reached-on-wide-ranging-
-decisive-package-of-amend-
ments-to-improve-the-interna-
tional-health-regulations–and-
sets-date-for-finalizing-negotia-
tions-on-a-proposed-pandemic-
agreement
7. World Health Organization.
International Health Regulations
(2005) [Internet]. A77/A/
CONF./14. 2024 [cited 2024 Jun
5]. Available from: https://apps.
who.int/gb/ebwha/pdf_files/
WHA77/A77_ACONF14-en.
pdf
8. Finch A, Klock KA, Gostin
LO, Halabi SF, Wetter S.
Safeguarding the Pandemic
Agreement from disinformation
[Internet]. Council on Foreign
Relations. 2024 [cited 2024 Jun
5]. Available from: https://www.
thinkglobalhealth.org/article/
safeguarding-pandemic-agree-
ment-disinformation
9. World Medical Association.
WMA Statement on Epidemics
and Pandemics [Internet]. 2017
[cited 2024 Jun 5]. Available
from: https://www.wma.net/poli-
cies-post/wma-statement-on-ep-
idemics-and-pandemics/
Yassen Tcholakov, MD, MSc, MIH
Assistant Professor, Department of
Global and Public Health, McGill
University, Montreal, Canada
Public Health Physician,
Nunavik Department of Public
Health, Kuujjuaq, Canada
yassen.tcholakov@mcgill.ca
Perspectives from the World Health Assembly in May 2024
BACK TO CONTENTS
23
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Dr.Jorge Coronel,Dr.César Eduardo
Fernandes, Dr. Simone Mc Fee, and
Dr. José Minarrieta, the Presidents
of the national medical associations
(NMAs) of Argentina, Brazil,
Trinidad and Tobago, and Uruguay,
as well as Dr. Marcelo Mingo as
the Secretary General, Dr. Carlos
Serrano, Jr. as the International
Relations Director, and Dr. Damion
Basdeo as the Immediate Past
President of the NMAs of Argentina,
Brazil, and Trinidad and Tobago,
join this interview with Dr. Helena
Chapman, the WMJ Editor in Chief.
They share their perspectives on
their leadership experiences, ongoing
NMAactivities,strengthsandexisting
challenges in medical education, and
how the World Medical Association
(WMA) can support NMA initiatives
in the Americas region.
As you reflect upon your journey
as NMA president, please describe
one memorable experience, one
challenge and how you resolved the
challenge, and one hope for the
future of medicine.
Argentina: During the coronavirus
disease 2019 (COVID-19)
pandemic, the Confederación
Médica de la República Argentina
(COMRA) was a leading entity in
the dissemination of health policies
and proposals that aimed to advocate
for improved workplace safety
and working conditions for health
professionals. They also contributed
to the widespread promotion of
immunisation adherence and self-
care for patients. Currently, members
continue to collaborate with national
health authorities in the development
of protocols and regulations to
prioritise high-quality patient care
and workplace safety for health
Interview with National Medical Associations’ Leaders
of the Latin America and the Caribbean Region
Interview with National Medical Associations’ Leaders of the Latin America and the Caribbean Region
Jorge Coronel
Damion Basdeo
Simone Mc Fee
José Minarrieta
Marcelo Mingo
Carlos Vicente Serrano, Jr.
César Eduardo Fernandes
24
BACK TO CONTENTS
professionals in Argentina.
As the COMRA represents the
national body of physicians across
Argentina, we seek recognition by
national authorities of our collective
healthcare duties to the population,
and advocate for a safe workplace and
working conditions and remuneration
aligned with our professional
training and responsibilities. Hence,
we believe that we can collectively
strengthen primary care across all
sectors and help to prevent disease
transmission and sequelae. We hope
for a more equitable health system,
where patients have easy access to
treatments and medications for
the entire population, and health
professionals feel safe, recognised,
and valued in their workplace, which
will reduce emigration in search of
additional opportunities.
Brazil: Since the start of the first term
of the Brazilian Medical Association
(Associação Médica Brasileira,AMB)
leadership (2020-2023), we have had
a number of remarkable experiences.
As president, I have contributed to
intense and constructive debates with
our board of directors, focused on
tackling the most pressing challenges
facingtheBrazilianmedicalandhealth
scene. Although our team celebrates
each achievement, one key initiative
was the creation of the Extraordinary
COVID-19 Monitoring Committee
(CEM COVID) (https://amb.org.
br/category/cem-covid/), which
offered an expert panel to review
and discuss research findings with
specialists and serve as a reliable
source of COVID-19 information
for the Brazilian population, health
professionals, and mainstream media.
As the AMB aims to improve
medical education in Brazil, we
have been busy denouncing the
indiscriminate opening of medical
schools and systematically opposing
all proposals to increase the
flexibility of the Revalida (exam
that legitimises medical diplomas
issued by international universities).
Although this problem is complex
and remains far from a satisfactory
resolution, the AMB is not standing
still. Last year, after we discussed
the issue with Dr. Camilo Santana
(Brazil Minister of Education) to
identify timely solutions,the Ministry
of Education set up a working group
with the AMB, the Federal Council
of Medicine (CFM), and the
National Academy of Medicine
(ANM). In this context, the work
of the Parliamentary Action Center,
created to represent the political-
institutional channel for Brazil’s
doctors in 2021, helps articulate
consistent responses in defence of
medicine and health.
As I look ahead to tomorrow,
we just started our second term
administration (2024-2026), I firmly
believe that technology across the
planet will continue to contribute
to the evolution of medical practice,
enabling more accurate diagnoses.
Recognising advances in public
policies to promote health, more
effective treatments coupled with
greater accessibility and access to care
hasthepotentialtoreduceinequalities.
The future of our profession in the
Americas region will depend on
strengthening associations and unity
among health professionals. After all,
as technologies evolve, we contribute
our unique talents to society. The
success of medicine depends on
what makes us human, including our
capacity to be sociable, empathetic,
and caring with our communities.
Trinidad and Tobago: Although my
journey as the Trinidad and Tobago
Medical Association (T&TMA)
president has been short, I fondly
remember the celebratory dinner that
the association held for the medical
and dental sciences graduating
classes of 2023. Since mentorship
is important to our association, we
use the graduation ceremony as an
opportunity to meet the new interns
and remind them of our continued
support throughout their professional
journey. As I spoke to the newly
minted doctors and repeated the
WMA physician’s pledge, I was
reminded of the nobility of our
profession and the fact that it is
one of the few esoteric professions.
Thus, mentorship and honesty are
invaluable to preserving the honour
of our profession.
The T&TMA recently had the
opportunity to work with the
Trinidad and Tobago Ministry of
Health in hosting a symposium on
non-communicable diseases for the
primary care physicians across the
nation. The task was monumental,
and albeit limited time due to
work schedules, teamwork was the
key ingredient in overcoming this
challenge and organising a successful
national event. As we requested
assistance from the wider association,
members volunteered their time
and shared new ideas, and hence we
had sufficient staffing to ensure that
our team accomplished our goals.
Looking toward the future, I hope
that T&TMA will continue to be
influential in developing timely
health policies that strengthen access
and availability to healthcare services
in the country, the Caribbean, and
the Americas region.
Uruguay: In October 2023, I was
elected as president of the Sindicato
Médico del Uruguay (SMU) (https://
www.smu.org.uy/), after having
served as Secretary (2022-2023) and
working closely with the Immediate
Past President, Dr. Zaida Arteta.
Over these last few months, we have
been evaluating key policy documents
that can help Uruguayan physicians
improve the quality of health
service delivery, especially for those
working in the public sector (like
Interview with National Medical Associations’ Leaders of the Latin America and the Caribbean Region
25
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paediatricians) in Montevideo. We
believe that this example represents
an opportunity for collective and
bipartisan negotiation, where
physicians can actively advocate
to improve workplace and service
delivery conditions through a
democratic process.
How would you describe the current
opportunities for NMA members
to help influence healthcare policy-
making activities in your country?
Argentina: As COMRA members, we
are currently developing collaborative
alliances and agreements with
national leaders who contribute to
public health policies and health
system management. Important
political changes have occurred across
Argentina, and we hope that health
authorities will communicate with the
COMRA to collaborate on the design
of health policies that can be debated,
revised, and consequently adopted
into legislation.As we have conducted
relevant debates on pressing topics,
leaders have prepared policy proposals
that support comprehensive health
plans for the entire population. For
example, as the national constitution
proposes that health management
be divided by province, we have
requested that the Ministry of
Health propose basic guidelines
and integrative proposals across the
nation.
For decades, the COMRA has
maintained a Drug Commission that
promotes their Rational Use through
a National Therapeutic Formulary, as
a list of drugs endorsed by the World
Health Organization and inspired
by other therapeutic formularies (e.g.
United Kingdom). In addition, the
COMRA aims to develop continuing
education courses in management and
auditing as well as a training institute
that can transition into a medical
school over time. Currently, a mutual
agreement has been established
with the University of Buenos Aires
Faculty of Medicine to offer
continuing education courses for
physicians in Argentina.
Brazil: As the AMB management
has encouraged active participation
for all members on general or specific
debates on health-related issues, we
have significantly influenced public
policy-making activities (including
recent decisions) in Brazil. Today, our
association has a significant presence
and voice in important official forums,
with inclusion in the Commission
for Updating the Roll of Procedures
and Events in Supplementary
Health (Cosaude), contributions to
some important health government
agencies, and participation in the
National Commission for the
Incorporation of Technologies in the
Unified Health System (Conitec).
Overall, we seek to establish active
and relevant contributions to dialogue
across all levels of government, from
the municipalities to the Ministry
of Health. The AMB maintains a
status separate from any political
or ideological involvement in order
to contribute to national health
discourse that focuses exclusively on
best medical practices. Through this
inclusive and non-partisan approach,
the AMB can ensure that health
policies consider evidence-based
science and in the interests of the
Brazilian population.
Trinidad and Tobago: The T&TMA
is recognised as a key stakeholder
in the national health system, and
members are often invited to actively
contribute to policy-making activities.
It is important for the association
to remain steadfast in its resolve to
highlight existing gaps in healthcare
service delivery and support relevant
policies to fill these gaps.
Uruguay: Since the SMU was founded
in August 1920, members have been
actively engaged in the discussion and
development of robust proposals that
complement our political agendas,
as well as the vision that Uruguayan
physicians have regarding public
health policies. We believe that these
policies should offer a comprehensive
overview for local and national health
stakeholders, as well as for other
medical associations and global health
systems. Although the Uruguayan
health system (Sistema Nacional
Integrado de Salud: https://www.
gub.uy/ministerio-salud-publica/
sistema-nacional-integrado-salud)
has limitations, the framework was
established and has continued to be
strengthened by physicians who are
indispensable leaders who contribute
to pressing health issues in national
debates and discussions at national
conventions, congresses, journal clubs,
and assemblies.
How do perceive the physician-
patient relationship and rapport in
the clinical setting in your country?
Argentina: In Argentina, the image of
the physician is prestigious, and the
physician-patient relationship must be
developed in a cordial manner, based
on the hegemonic medical model.
Physicians feel a moral obligation to
alleviate suffering and respect patients’
beliefs and autonomy, although
recognising that the physician-patient
relationship can deteriorate due
to diverse stressors (e.g. economic
and legal aspects) of the medical
profession. For example, physicians
may need to obtain more than two
employment opportunities to achieve
a stable income, as observed during
the current economic crisis, and their
limited attention and time spent with
patients may erode the physician-
patient relationship.
Brazil: The doctor-patient
relationship, which requires mutual
respect and open communication, is
the basis of good medical practice.
Professionals who are attentive to
Interview with National Medical Associations’ Leaders of the Latin America and the Caribbean Region
26
BACK TO CONTENTS
people can better understand their
needs, concerns, and expectations.
In Brazil, it is common for patients
to complain about the coldness and
indifference of some doctors. This
may be due to doctors’ excessive
work schedules (risk of burnout) or
inadequate professional training,
noting the proliferation of medical
schools of unsatisfactory quality that
places poorly trained professionals in
clinical practice.
On the other hand,many doctors have
developed a more empathetic view
during the COVID-19 pandemic,
observing how the virus weakened
the sick and their families in an
unprecedented way. As they were
learning about virus transmission
each day, without effective treatments
available, they were more welcoming
and potentially learned from societal
pain. As such, we began to rethink
the speed of medical consultations,
valuing patient interactions without
the overhead clocks, returning to
the ancestral bonds between doctors
(those who care) and patients (those
who are cared for). In reality, we live
in a country with limited resources,
and we use our resources sparingly
and responsibly, in order to ensure
that everyone – without exception –
has the right to receive high-quality
healthcare.
Trinidad and Tobago: As physicians
are widely respected in Trinidad and
Tobago, it can lead to patients being
timid to question the opinion of their
physicians, especially among senior
citizens. Hence, it is important for
physicians to encourage patients to ask
questions and share in the decision-
making process for an appropriate
clinical management related to their
health and well-being. These actions
will inevitably strengthen physician-
patient rapport, trust, and treatment
adherence.
Uruguay: Our clinical responsibilities
have been supported by key
relationships within the health
system, primarily focusing on
interactions between physicians and
patients. We believe that patients
should be directly involved in their
healthcare services, which can be
challenging at times due to limited
time for evaluating, diagnosing, and
managing patients’ health concerns
in the outpatient setting. As a global
medical community, we should
consider opportunities to advocate
for our patients and identify ways
to improve this process within
healthcare systems. For instance,
the Consejo General de Colegios
Oficiales de Médicos (CGCOM)
of Spain submitted a proposal to
the United Nations Educational,
Scientific and Cultural Organization
(UNESCO) to declare the doctor-
patient relationship as an intangible
heritage of humanity, and the SMU
supports this initiative.
How would you describe the
anticipated challenges in medical
education over the next decade in
your country?
Argentina: Although traditional
academic institutions are recognised
with prestige, medical education
in Argentina is currently in crisis.
Although certain educational policies
havebeenimplementedacrossmedical
schools in different jurisdictions, we
have observed that medical graduates’
quality of knowledge is poor. Also,
some general trends are apparent
in medical residencies, including
medical graduates selecting specialties
with higher incomes (versus primary
care specialties), and more than 50%
of most residency placements are
obtained by female medical graduates.
Hence, we believe that there are
three key challenges to achieving
high-quality medical education in
Argentina.First,most medical schools
(albeit some private institutions) have
limited financial resources, as they
depend on economic support from the
government.Second,medical training
programs should remain updated with
the evidence-based science,supported
through agreements that can link
institutions with professors to develop
high-quality training curricula.Third,
physicians should be compensated
adequately for their responsibilities,
since they work in one or all of the
three sub-sectors (namely, medicine
or public health) that are financed
by unions or private activities (e.g.
medical pharmaceutical companies).
The COMRA strongly defends the
physician union and salary across all
subsystems.
Brazil: In Brazil, the main challenge
is the unbridled opening of medical
schools. In 2023, the AMB and the
University of São Paulo School of
Medicine (FMUSP) conducted
a study, published in the Medical
Demography in Brazil [1], which
noted that the largest expansion of
medical education in Brazil’s history
was recorded between 2013 and
2022. In 2022, Brazilian authorities
reported that a total of 389 schools
offered 41,805 medical education
placements. Of this total, 23,287 new
placements were opened after 2013,
which was linked to an increase of
almost four times greater than data
recorded between 2003 and 2012 (e.g.
5,990 authorised placements). At this
rate, there will be over one million
doctors in the country by 2035.
The rationale of this expansion
is based on the reality of doctor
shortages across rural communities,
and that increased medical education
placements can resolve this burden.
However, countless doctors return
to practise medicine in urban areas
due to increased pay and working
conditions. Moving forward, we can
strengthen medical education and
training and incentivise doctors to
fulfil primary care leadership roles
in rural and low-income populations
Interview with National Medical Associations’ Leaders of the Latin America and the Caribbean Region
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acrossBrazil.Structuralpublicpolicies
should be adopted to recognise
doctors and other health professionals
and guarantee that high-quality and
safe health services – from northern
to southern Brazil – are provided by
well-trained health professionals.
Trinidad and Tobago: Presently,
Trinidad and Tobago has been
experiencing a deficit of post-
graduate training options, which is
not anticipated to improve over the
next decade. Ongoing efforts aim
to engage all stakeholders to help
find innovative solutions to provide
affordable post-graduate medical
educationandencouragedoctors(who
have attained their post-graduate
qualifications) to work locally. As
continued medical education has been
at the forefront of local discussions,
health leaders support ongoing
initiatives to increase access to these
educational opportunities over the
next decade.
Uruguay: As physicians and
representatives of the SMU, it is our
obligation to prioritise health literacy,
where we can empower, create, and
strengthen continuing medical
education. Medical recertification can
reinforce the inseparable link between
clinical practice and education,
helping physicians to stay updated
on their clinical knowledge and skills,
including new technologies, policies,
and guidelines that may affect their
daily practice. For example, we have
started to engage in discussions about
the use of artificial intelligence in
both academic and clinical settings,
particularly its potential applications
to enhance medical practice and
ethical considerations.
From the medical education
perspective, how has your NMA
responded to the existing and
emerging health challenges within
your country?
Argentina: We believe that
postgraduate medical education
programs can represent the first step
to addressing existing and emerging
challenges in Argentina. Hence, the
COMRA has developed medical
education courses in a hybrid format
(virtual coupled with in-person
attendance), in collaboration with the
University of Buenos Aires Faculty
of Medicine, and official degrees are
awarded by the university.
Brazil: The AMB leads and
contributes to various initiatives in
medical education and advocacy to
address Brazil’s health challenges.
First,the General Medicine Congress
2023 allowed medical professionals
from different specialties to exchange
experiences, clarify daily challenges
facedbyspecialistsandnon-specialists,
and promote relevant debates and
learning. These discussions helped
encourage professionals to search
for continuing education courses to
acquire new knowledge and improve
practice aligned with innovative
technology. Second, the AMB has led
advocacy efforts to caution authorities
about the increased placements across
medical schools. In 2023, they met
with Dr. Nísia Trindade (Minister
of Health in Brazil) to discuss
health professionals’ training and
preparedness to work in underserved
areas, evaluations of medical schools,
and strengthening the Unified Health
System, and they plan to continue
this important dialogue.
Trinidad and Tobago: The T&TMA
has been at the forefront of
promoting continuing medical
education for over a decade. Our
association has submitted proposals
to the Medical Board of Trinidad
and Tobago (MBTT), as well as
has held discussions with other
stakeholders, reflecting our desire
that continuous medical education
should be mandatory for all practising
physicians. In fact, we host at least
four continuing medical education
activities each month, and we also
provide support and co-sponsor
activities with other specialist
organisations. For example, when
Mpox emerged as a challenge within
the Americas region, we hosted a
webinar on this topic, and physicians
from many Caribbean islands
participated and contributed to the
discussion period. As the T&TMA is
well known locally for our educative
thrusts, we aim to enhance our
ability to provide continuing medical
education opportunities throughout
the country.
Uruguay: The SMU represents
a national voice on a variety of
emerging health issues, contributing
to public debate, the development
of public policies, and the media.
For example, during the COVID-19
pandemic, our members provided
clinical expertise to the Government
of Uruguay for the development
of timely health guidelines and
public messaging. They have also
supported collaborative efforts for
mass vaccination campaigns to
protect population health. More
recently, with the increase in dengue
cases across the Americas region,
our association is working with
national health authorities within
the healthcare system to improve
and expand the delivery of healthcare
services throughout the country.
From your perspective and
national experiences, how has the
coronavirus disease 2019
(COVID-19) affected medical
education in your country?
Argentina: During the COVID-19
pandemic, social restrictions across
Argentina impacted medical
trainees who were unable to
develop fruitful relationships with
colleagues, mentors, and patients,
Interview with National Medical Associations’ Leaders of the Latin America and the Caribbean Region
28
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and simultaneously we observed
that they refrained from pursuing
certain critical medical specialties like
emergencies and intensive care. Also,
as academic programs were primarily
suspended or delayed, technological
advancements allowed professors
to modify in-person courses to
virtual learning for undergraduate
and postgraduate students as well as
support telemedicine consults with
patients.
Brazil: The COVID-19 pandemic
greatly affected medical education
and training in Brazil. First,
academic institutions were forced
to quickly adjust their curricula and
methodologies as well as transition
from the face-to-face to the virtual
model – and now the hybrid model.
Without these efforts during this
period of social isolation, medical
education would have significantly
disrupted learning. However, the
transition to the virtual world has left
gaps.Since medical education requires
a holistic and practical approach,
the limitations imposed during
the pandemic may have affected
the quality and depth of training.
Hence, continued monitoring and
evaluation of medical education
programs by authorities will be
essential to maintain high-quality
education. Second, the pursuit of
professional excellence was noted as
indispensable, as health professionals
were faced with challenges that
required additional skills in intensive
care medicine, crisis management,
and public health. More than ever,
organisations must offer professional
development opportunities through
training programs, continued
education courses, and access to
relevant educational resources.
Trinidad and Tobago: Overall, the
COVID-19 pandemic has made
medical education more accessible,
as the use of technology has allowed
medical students and physicians
alike to access tutorials and educative
sessions “on the go”.We are no longer
confined to meeting in a classroom or
amphitheatre for academic learning
and networking. This improvement
has allowed busy physicians to
incorporate educational activities into
their schedule.
However, in the immediate post-
COVID-19 era, we observed a
decline in practical skills, since
medical students had fewer physical
interactions with patients, which
resulted in a decline in physical
examination skills. Hence, it is
important for established physicians
to engage these young doctors and
help them improve these clinical
skills. We recognise that the
internship period has become even
more important after the COVID-19
pandemic.
Uruguay: Since broadband internet
became widely available throughout
Uruguay in 2019, distance education
has been successfully implemented
during the pandemic. While distance
education has its advantages, it is
important to find a balance between
in-person and virtual learning
environments. This balance is
incredibly important in medical
training,whichrequireshumancontact
to acquire optimal communication
skills and foster positive physician-
patient relationships.
How does your NMA leadership
implement the WMA policies in the
organisation?
Argentina: The communications
officer of the COMRA regularly
shares the World Medical Journal issues
and WMA declarations, resolutions,
and statements, with special emphasis
on medical ethics, with COMRA
members. We have received valuable
positive feedback from COMRA
members and colleagues on these
high-quality documents.
Brazil:The implementation of WMA
policies in the AMB follows an
organised and collaborative process.
Decisions are made at the WMA
General Assembly, after deliberation
by the relevant bodies, which take
into account the global context and
the needs of NMAs around the
world. When we receive the WMA
guidelines, AMB leaders carefully
analyse the proposed policies, assess
their applicability in the Brazilian
context, and consider the impact that
they will have on national medical
practice. This process guarantees
an approach that is aligned and
consistent with international
standards and specific needs of our
medical community.
Trinidad and Tobago: The T&TMA
is actively involved in ensuring access
to healthcare to all Trinidad and
Tobago citizens. Our leadership has
established a committee dedicated
to organising healthcare activities
in rural areas and supporting
efforts to increase accessibility to
healthcare services. The association
has partnered with the Trinidad
and Tobago Ministry of Health to
develop timely public health activities
and policies, including educating
the public on non-communicable
disease risks. Recognising that the
social determinants of health are
fundamental to healthcare, T&TMA
members have recently focused on
intimate partner violence and child
sexual abuse in 2024, by educating
physicians and partnering with non-
governmental organisations.
The T&TMA has a legacy of
leaders who advocate for education
and training opportunities, timely
changes in healthcare practice, and
practical ways of implementing
WMA policies. In 2023, Dr. Damion
Basdeo (T&TMA President, 2023),
who led the charge on climate change
and medicine, collaborated with
members of other regional medical
Interview with National Medical Associations’ Leaders of the Latin America and the Caribbean Region
29
Interview with National Medical Associations’ Leaders of the Latin America and the Caribbean Region
BACK TO CONTENTS
associations to educate doctors
throughout the region via the recently
formed CARibbean Health Alliance
for Climate Action (CARHACA)
[2]. Our T&TMA leaders have
also helped promote vaccination
adherence during the COVID-19
pandemic, in keeping with the WMA
Resolution for Providing COVID-19
Vaccines for All, which was adopted
by the 73rd WMA General Assembly
in Germany in October 2022 [3].
Uruguay: Within the SMU, the
International Affairs Commission is
comprised of experts representing a
broad ideological spectrum. As the
commission discusses and debates
key issues prioritised by the WMA,
they develop an institutional position
for formal presentation to the
association’s Executive Committee.
After further discussion within this
committee, the association shares the
final institutional position with the
WMA, as well as any revised policies
and documents (e.g. Declaration of
Helsinki, Declaration of Geneva,
International Code of Medical
Ethics) with the wider membership.
The association also supports
the Medical Journal of Uruguay
(https://revista.rmu.org.uy/index.
php/rmu), as the official journal for
membership. Next year, we have the
honour of hosting the WMA Council
Meeting in the capital of our country,
Montevideo.
How can the WMA support the
ongoing NMA activities in your
country?
Argentina: As COMRA leaders, we
would like to collaborate with national
health authorities in the design
and development of relevant health
policies to improve workplace
conditions for physicians and the
entire healthcare team as well
as maintain continuing medical
education as a valuable tool to
improve the quality of care. We
believe that these activities can help
physicians remain updated on rapidly
advancing evidence-based medicine
and simultaneously feel recognised
for their selfless medical service to
improving patient care. Hence, the
WMA can help support the economic
costs for national medical associations
to develop and offer innovative
physicians’ training opportunities on
the topics related to health system
management and clinical updates,
which can offset costs to low- and
middle-income nations.
Brazil: The WMA can support the
AMB through several key strategies.
First, the WMA can use its global
platform to advocate for issues
important to the AMB, such as the
impact on the quality of medical
education due to the proliferation
of medical schools in Brazil,
accreditation of medical education
in Brazil, healthcare funding, public
health initiatives, and professional
autonomy, in order to ensure high
standards of education and patient
care. Second, the WMA and the
AMB can collaborate on offering
continuing medical education
programs, which can help Brazilian
doctors have expanded access to
the latest medical knowledge and
practices. Third, the WMA can
facilitate connections between
Brazilian and global researchers,
which can help present funding
opportunities and foster professional
networking toward the development
of research collaborations on
important medical topics. Fourth,
the WMA can establish professional
exchange programs that promote
knowledge sharing and professional
development, where doctors can
participate in short-term cross-
cultural clinical and surgical training
opportunities and directly learn about
different healthcare systems. Finally,
the WMA can help support the AMB
in advancing telemedicine and digital
health initiatives, which are crucial
for reaching underserved populations
in Brazil.
Trinidad and Tobago: The WMA can
support the T&TMA by helping to
promote local and regional medical
research. In developing countries,
like Trinidad and Tobago, few
regional medical journals exist,
and editorial teams may not have
the capacity to meet the demands
for publication and dissemination
of local research. For example, the
Caribbean Medical Journal (https://
www.caribbeanmedicaljournal.org/),
albeit limitations in finances, staffing,
and specialised skill sets, represents
an important scientific resource from
the Caribbean region with findings
that are applicable to other countries
across the Americas, Africa, and Asia.
Like other Caribbean territories,
Trinidad and Tobago is affected by
several public health issues, including
climate change and health, which
disproportionally affect developing
nations in the Americas region.
The implementation of large-scale
policies can have a global influence
that trickles down to small island
developing states (SIDs). The WMA
can help T&TMA serve as a voice for
other developing countries and help
highlight issues that affect SIDs on
an international stage.
Uruguay: Physicians worldwide face
similarchallengesintheirdailyclinical
responsibilities, including improving
the quality of healthcare services for
citizens and ensuring the occupational
safety of healthcare professionals.
Therefore, global exchanges between
medical professional organisations
are essential, and the WMA provides
the platform for this respectful shared
dialogue of opinions and declarative
positions, especially regarding topics
related to medical ethics. We believe
that the WMA should continue to
support open discussion and debate
on pressing issues, such as forced
30
Interview with National Medical Associations’ Leaders of the Latin America and the Caribbean Region
BACK TO CONTENTS
population displacement caused
by conflicts and wars, famine, and
climate change, and seek collective
contributions from national medical
associations for the development of
key policy statements. We sincerely
appreciate the opportunity to express
our professional perspectives from
our small country of 3.5 million
residents, as we are enthusiastic about
representing our SMU in the best
interest of the profession and citizens.
References
1. Faculdade de Medicina da
Universidade de São Paulo &
Associação Médica Brasileira.
Demografia Médica no Brasil
2023. São Paulo: FMUSP
& AMB; 2023. Portuguese.
Available from: https://amb.org.
br/wp-content/uploads/2023/02/
DemografiaMedica2023_8fev-1.
pdf
2. James B, Jackson C, Basdeo
D, Lakhan A, Williams L,
Hospedales J, et al.; Trinidad
and Tobago Medical Association
Working Group. Caribbean
Health Alliance for Climate
Action (CARHACA) Statement.
2023 [cited 2024 Apr 21].
Available from: https://
t n t m e d i c a l . c o m / c a r i b b e –
an-health-alliance-for-cli-
mate-action-carhaca-statement/
3. World Medical Association.
WMA Resolution for Providing
COVID-19 Vaccines for All
[Internet]. 2022 [cited 2024 Apr
21]. Available from: https://www.
wma.net/policies-post/wma-res-
olution-for-providing-covid-19-
vaccines-for-all/
Authors
Jorge Coronel, MD
President, Confederación Médica de
la República Argentina (COMRA)
Buenos Aires, Argentina
comra@confederacionmedica.com.ar
Damion Basdeo, MD
Immediate Past President (2023),
Trinidad and Tobago Medical
Association (T&TMA)
Port of Spain, Trinidad and Tobago
medassoc@tntmedical.com
César Eduardo Fernandes, MD
President, Brazilian Medical
Association (AMB)
São Paulo, Brazil
presidencia.cesar@amb.org.br
Simone Mc Fee, MD
President (2024), Trinidad and Tobago
Medical Association (T&TMA)
Port of Spain, Trinidad and Tobago
president@tntmedical.com
José Minarrieta, MD
President, Sindicato Médico
del Uruguay (SMU)
Montevideo, Uruguay
secretaria@smu.org.uy
Marcelo Mingo, MD
Secretary General, Confederación
Médica de la República
Argentina (COMRA)
Buenos Aires, Argentina
elrefugio.mm@gmail.com
Carlos Vicente Serrano, Jr., MD
International Relations Director,
Brazilian Medical Association
São Paulo, Brazil
carlos.serrano@fm.usp.br
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For this interview, Professor E.
Oluwabunmi Olapade-Olaopa,
president of the Association of
Medical Schools in Africa (AMSA),
shares his perspectives on leadership
experiences, strengths, and existing
challenges in medical education, and
how the World Federation of Medical
Education (WFME) (https://
wfme.org/) and the World Medical
Association (WMA) members can
foster collaborations, with Dr. Helena
Chapman, the WMJ Editor in Chief.
What are the organisational goals,
priorities, and current activities of
AMSA?
AMSA plays a critical role in
advancing medical education and
healthcare in Africa. The need
to establish this association was
proposed during a medical education
conference on 15 December 1961 at
Ibadan, Nigeria [1]. Five universities
attended this event, including the
University of Leopoldville (Kinshasa,
Democratic Republic of Congo),
Diop University (Dakar, Senegal),
Makerere University (Kampala,
Uganda), University of Khartoum
(Khartoum, Sudan), and University
of Ibadan (Ibadan, Nigeria).
AMSA was formally inaugurated
in December 1963, at the Medical
Education conference in Kampala,
by the unanimous resolution of the
five schools who were joined by the
University of Lagos Medical School.
Representatives from two new
medical schools (University of
Tanzania, Dar es Salaam and
University of Ethiopia, Addis Ababa)
were also present as observers. The
association went into hibernation in
the mid-1980s and was revitalised
in 2014, through the efforts of
the World Health Organization
Regional Office for Africa (WHO-
AFRO), supported by the WMA
and WFME, taking advantage of the
opportunities provided by the sub-
Saharan African Medical Schools
Survey (SAMSS), and the Medical
Education Partnership Initiative
(MEPI) projects [2,3].
As the leading medical (and dental)
education force in Africa, AMSA’s
primary goal is to ensure that medical
schools in Africa deliver high-quality,
socially responsive medical education
and conduct impactful community-
directed research. It also serves as a
forum for medical schools to share
ideas and address challenges facing
medical education and healthcare
delivery in Africa, by enabling the
acquisition of globally standardised
skills required for clinical practice
and research on the continent by
graduates of its component schools
[1]. AMSA’s vision is to drive
excellence in medical (and dental)
education and propel the continent
towards a healthier future, and the
mission is to empower medical
schools across the continent to equip
their graduates with the attitude,
knowledge, skills, and cultural
sensitivity needed to address critical
health challenges facing African
communities. This will be achieved
by setting and upholding the highest
standards for medical schools,thereby
ensuring the quality of generations of
physicians and dentists who will serve
the healthcare needs of Africa.
AMSA’s priorities include embracing
innovation to foster sustainable
development in medical education,
thus elevating the quality of
medical practice throughout Africa,
establishing a strong network of
schools and educators across the
continent and with the international
medical education community, and
providing a platform for sharing
best practices and innovations in
medical education. It also aims to
empower African medical schools
to continuously improve through
capacity building initiatives,
stimulating research in medical
education and related fields, and
advocating for equitable access
to medical education across the
continent by recognising and
addressing demographic and cultural
peculiarities.
AMSA’s current activities include
publishing educational resources [3],
leveraging technology to hold hybrid
workshops and webcast symposia
with international faculty, and
promoting collaborative research
(e.g. South-South and North-
South medical education networks).
More recently, AMSA has been
collaborating with member
institutions and international
partners to build on the foundation
laid by multinational collaborative
medical education strengthening
projects (e.g. Sub-Saharan African
Medical School Study, SAMSS;
Medical Education Partnership
Initiative, MEPI; Consortium of
New Sub-Saharan African Medical
Schools, CONSAMS), during which
a community of practice of medical
education was established in the
sub-region [4-6]. AMSA employs a
multifaceted approach to maintain
high-quality accreditation standards,
ensuring graduates meet the highest
benchmarks for patient care.
E. Oluwabunmi Olapade-Olaopa
Interview with the President of the Association
of Medical Schools in Africa
Interview with the President of the Association of Medical Schools in Africa
32
Over the past year, what do you
consider to be your most important
leadership achievements as
president (2023-2024)?
AMSA is proud to announce
several key achievements that will
significantlyimpactmedicaleducation
across the continent.First,the AMSA
Executive Committee has approved
a new Constitution and established
the AMSA Secretariat at Ibadan to
strengthen governance and provide
administrative and financial stability
for the association. Second, AMSA
is actively planning its upcoming
conference, scheduled for the third
quarter of 2025 in Ibadan, Nigeria,
which will promote scientific and
professional exchanges, networking,
and social interactions between all
stakeholders in medical education in
Africa. Third, AMSA has increased
contact with medical schools across
the continent, thus increasing our
membership pool and expanding our
network in Africa. Finally, renewed
partnerships with the WHO-AFRO
will allow the association to leverage
expertise and resources to address
critical challenges facing Africa’s
health systems.
How has the coronavirus disease
2019 (COVID-19) affected medical
education across your geographic
region?
Like other parts of the world,
the COVID-19 pandemic had
a significant effect on medical
education in Africa, limiting
the infrastructure and teaching
methodologies in the traditional
classroom. As these changes were
aligned with safety guidelines, there
was an urgent acquisition of new
equipment to enable the adoption
of virtual classrooms (e.g. Zoom
meetings, email groups, social media
platforms) and the introduction
of capacity building programs for
faculty to equip them with the skills
for virtual instruction. The virtual
platforms, however, challenged how
educators were able to maintain
community-based module training
standards. Indeed, the year-long
closure created a significant backlog
of admissions to medical schools
which has been cleared gradually
enabling the continued production of
much-needed physicians and dentists.
Finally, the global post-pandemic
economic crisis exacerbated the
financial constraints of African
medical schools with relatively
reduced income (e.g. government
funding,lower enrollment,donations)
and increased expenditure (e.g.
information communications
technology systems, staff training),
making efficient resource
management mandatory.
What are the current strengths
and existing challenges in medical
education across your geographic
region,andhowcanthesechallenges
be addressed?
AMSA is proud of the current
strengths in medical education across
theregion.First,despitethecontinuing
migration of medical professionals
to high-income countries, there
remains an appreciable pool of highly
qualified and experienced academic
and non-academic staff in Africa’s
medical schools who are committed
to medical training and research.
This dedicated pool of human
capital forms the basis for the
continued delivery of high-quality
medical education aligned with
global standards in these institutions.
Second, Africa’s strong medical
education culture fosters a reputation
for excellence, making its medical
graduates a much sought after brand
globally. Third, most medical schools
in Africa are developing a robust
network of accomplished alumni
who offer valuable connections
and potential support for their
alma mater, which ultimately helps
promote AMSA’s vision and mission.
Finally, since an increasing number of
medical schools in Africa are involved
in cutting-edge global research
projects, the resultant generation of
new knowledge and innovations,
coupled with active international
collaboration, enables award-winning
advancements in medical education
and biomedical research.
On the other hand, AMSA
understands that there are existing
challenges in medical education
which require solutions. Regarding
financial issues, AMSA can improve
organisational and research funding
mechanisms by increasing the
financial membership, developing
sustainable fundraising initiatives,
and facilitating a culture of research
collaboration between medical
schools, national and international
funding agencies, and industry
partners. Regarding academic issues,
AMSA can ensure contemporary
curricula by encouraging the regular
review of curricula to reflect the
local cultures, healthcare needs,
and industry demands, whilst
maintaining global standards,
incorporating new technologies,
and developing innovative teaching
methods [7]. AMSA can strengthen
faculty development by encouraging
knowledge exchange and faculty
development programs as global
partnerships between medical schools
as well as identifying opportunities for
individual professional development.
It can also facilitate further
development of graduate tracking
mechanisms and networks by medical
schools, building on the foundations
laid during the SAMMS and MEPI
Projects.
Regarding the observed explosion
of medical schools, collaborations
with postgraduate medical colleges,
universities, and medical councils
to increase the production of
medical specialists and postgraduate
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Interview with the President of the Association of Medical Schools in Africa
33
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biomedical science teachers, as well as
ensure effective national and regional
medical education accreditation and
monitoring systems, can collectively
help to increase the demand for
staff and quality assurance. Also,
sharing best practices for student
funding including scholarships and
low-interest loans can minimise the
economic burden associated with
medical training.
Aside from the COVID-19
pandemic, how would you describe
the anticipated challenges in
medical education over the next
decade in your geographic region?
First, the increasing migration of
skilled (“brain drain”) from Africa to
high-income countries may reduce
the human capital index of the
continent and exacerbate the uneven
distribution of physicians and other
health professionals, which will
adversely affect medical education
and healthcare delivery on the
continent [8]. Second, the population
explosion in Africa will result in
larger medical school class sizes
and less individualised attention for
students due to strained resources and
worsening of the existing shortage of
faculty. Third, socioeconomic barriers
(due to widening socioeconomic
gaps) may limit access to medical
education for talented students
from disadvantaged backgrounds,
whilst geographic disparity (uneven
distribution of medical schools and
resources) could further disadvantage
certain regions, leaving them with
fewer qualified physicians and
dentists. Finally, the difficulty in
standardisation of medical education
due to the explosion of medical
schools (especially for-profit
institutions) and the increasing costs
of training may reverse the gains
of previous efforts to increase the
retention of graduates across the
continent.
What are the key priorities that
WFME andWMA members should
address in the next five years?
Over the next five years, there are
four specific priorities where AMSA,
WFME, and WMA members
can foster robust collaborations.
First, the rapid increase in medical
schools, particularly in countries
with inadequate accreditation and
monitoring systems, may lead to
a decline in the overall standard
of medical education and will
therefore need to be addressed by all
stakeholders. Second, the pressure to
standardise medical education across
diversely located institutions may
stifle innovation and hinder efforts
to develop curricula that are adapted
to local healthcare needs. Third, with
the increasing globalisation of
medical and other health professionals
training, extra effort is required to
ensure medical schools in Africa
preserve the cultural sensitivity
that is necessary to maintain social
responsiveness. This is particularly
important as most schools have
community-based training
programs that focus on increasing
retention by producing culturally
adapted graduates. Finally, with the
importance of standardisation
throughout the continuum of
medical education being increasingly
recognised, AMSA must work with
the WMA, WFME, and African
Medical Councils and Postgraduate
Medical Colleges on global initiatives
that standardising postgraduate
medical education.
References
1. Monekosso GL. A brief history
of medical education in sub-
Saharan Africa. Acad Med.
2014;89(8 Suppl):S11-5.
2. African Region, World Health
Organization. Experts discuss
improvement of medical
education and training
[Internet]. 2014 [cited 2024 May
10]. Available from: https://
www.afro.who.int/news/experts-
discuss-improvement-medical-
education-and-training-africa
3. Olapade-Olaopa EO,
Sewankambo N, Iputo JE,
Rugarabamu P, Amlak AH,
Mipando M, et al. Essential
professional duties for the sub-
Saharan medical/dental graduate:
an Association of Medical
Schools of Africa initiative. Afr J
Med Med Sci. 2016;45(3):221-7.
4. Mullan F, Frehywot S, Omaswa
F, Buch E, Chen C, Greysen
SR, et al. Medical schools in
sub-Saharan Africa. Lancet.
2011;377(9711):1113-21.
5. Frehywot S, Mullan F, Vovides
Y, Korhumel K, Chale SB,
Infanzon A, et al. Building
communities of practice: MEPI
creates a commons. Acad Med.
2014;89(8 Suppl):S45-9.
6. Eichbaum Q , Hedimbi M,
Bowa K, Belo C, Vainio O,
Kumwenda J, et al. New medical
schools in Africa: challenges
and opportunities. CONSAMS
and value of working in
consortia. Ann Glob Health.
2015;81(2):265-9.
7. Hammad N, Ndlovu N, Carson
LM, Ramogola-Masire D,
Mallick I, Berry S, Olapade-
Olaopa EO. Competency-based
workforce development and
education in global oncology.
Curr Oncol. 2023;30(2):1760-75.
Interview with the President of the Association of Medical Schools in Africa
34
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8. Olapade-Olaopa EO,
Sewankambo NK, Iputo JE.
Defining sub-Saharan Africa’s
health workforce needs: going
forwards quickly into the past
comment on “non-physician
clinicians in sub-Saharan
Africa and the evolving role of
physicians”. Int J Health Policy
Manag. 2016;6(2):111-3.
E. Oluwabunmi Olapade-Olaopa
Esq., MD, FRCS, FWACS,
FAS, FNAMed, FAMedS
President, Association of Medical
Schools in Africa (AMSA)
Ibadan, Nigeria
okeoffa@gmail.com
Acknowledgement:The author would
like to thank Mr. Jesusogo Akinyemi
for his assistance with the preparation
of this article.
Interview with the President of the Association of Medical Schools in Africa
35
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For this interview, Professor Marcos
Núñez Cuervo, President of the Pan-
American Federation of Associations
of Medical Schools (PAFAMS)
(Federación Panamericana de
Facultades de Medicina, FEPAFEM)
(https://www.fepafempafams.org/
index.php/en/fepafem-pafams-en/
definition), shares his perspectives
on leadership experiences, strengths
and existing challenges in medical
education, and how the World
Federation of Medical Education
(WFME) (https://wfme.org/) and
the World Medical Association
(WMA) members can foster
collaborations, with Dr. Helena
Chapman, the WMJ Editor in Chief.
What are the organisational goals,
priorities, and current activities of
PAFAMS?
Founded in 1962, PAFAMS is
the leading non-governmental
organisation consisting of more
than 650 affiliated medical schools
in 13 countries (Argentina, Bolivia,
Canada,Chile,Colombia,Dominican
Republic, Ecuador, Guatemala,
Mexico, Panama, Peru, United
States, Venezuela), that aims to link
medical education programs with
healthcare institutions across the
Americas region. The organisational
mission is to “promote quality in
medical education in the manner that
it impacts health, through academic,
research and extension activities”.
For the upcoming year, PAFAMS
leaders recognize three main
priorities across the Americas region,
including supporting professional
networks, offering capacity building
opportunities, and incorporating
primary healthcare and One Health
topics in training. First, the Pan-
American Mobility (Exchange)
program plans to support scientific
and cultural exchanges that help
expand networks between students
and faculty members across the
region. Second, the development of
a diploma course that incorporates
leadership training for medical school
deans, directors, and administrators
will help build capacity on
strengthening academic programs
in the region. Third, guided by the
Pan American Health Organization
(PAHO)’s published guidelines,
innovative measures to introduce
primary healthcare and One Health
topics into medical education and
training will be crucial to foster a
holistic view of the determinants
of health that influence physical
and mental health and well-being.
Together, these priorities can help
bridge existing gaps with innovative
solutions that reinforce high-
quality medical education programs
that serve local communities.
Over the past year, what do you
consider to be your most important
leadership achievements as
president (2023-2024)?
Over the past year, I have been
honoured to serve as the PAFAMS
president and lead our collective
activities that aim to strengthen
medical education and training. First,
we have successfully strengthened
regional networks, by encouraging
inactive members to participate
in ongoing activities as well as
incorporating new partnerships with
associations like the Latin American
Association of Medical Schools
(Asociación Latinoamericana y del
Caribe de Facultades y Escuelas
de Medicina, ALAFEM) with
our federation. Second, we have
established a sustainable community
system that helps streamline
PAFAMS communications
through the website (https://www.
webfepafem-pafams.org/), monthly
newsletter,andthreesocialmediatools
(Instagram, LinkedIn, Twitter/X).
Third, together with WFME, we
have supported the development
of the first known Pan-American
Diploma on Senior Management
and Leadership, directed to regional
leaders and academic professors.
Finally, I have served as an invited
panellist and speaker at more than
10 scientific events across North
and South America, the Caribbean,
and Europe, highlighting topics of
medical education, international
accreditation, and challenges
in global medical education.
How has the coronavirus disease
2019 (COVID-19) affected medical
education across your geographic
region?
The COVID-19 pandemic had an
unprecedented impact on medical
education, especially among low-
and middle-income countries
(LMICs) which were less prepared
to initiate virtual learning in their
academic programs. The influence
of the social determinants of health
has demonstrated the significant
inequities and disparities between
Marcos Núñez Cuervo
Interview with the President of the Pan-American
Federation of Associations of Medical Schools
Interview with the President of the Pan-American Federation of Associations of Medical Schools
36
BACK TO CONTENTS
countries in the Americas, including
large gaps in information technology,
educational resources, and internet
availability for distance learning.
Furthermore, health professionals
have observed the unequal access
to recommended immunizations
(including COVID-19 vaccines
and boosters) between high-income
countries and LMICs, noting that
vaccine hesitancy has led to increased
risk of infectious disease outbreaks
like measles to date. Finally, mental
health concerns like depression and
suicidal thoughts were exacerbated,
due to the short- or long-term
effects of the severe acute respiratory
syndrome coronavirus 2 (SARS-
CoV-2), solitary conditions due to
recommended social restrictions,
and overwhelmed academic
responsibilities in the virtual,
university or clinical workplace.
What are the current strengths
and existing challenges in medical
education across your geographic
region,andhowcanthesechallenges
be addressed?
Health leaders have witnessed
strengths that can help continue
to support medical education and
training in the Americas region.
First, as local, regional, and national
differences exist between medical
schools in the Americas region,
robust collaborations that identify
synergies, leverage expertise, and
promote best practices within
medical associations, government
and non-government organisations,
and society will be crucial to prepare
physicians to address challenges of
the 21st century. With health
surveillance systems, physicians
should have a comprehensive
understanding of the common
communicable and non-
communicable diseases affecting
communities. Also, PAFAMS
leaders have been able to incorporate
diverse communication strategies
(e.g. WhatsApp, email, newsletters,
social media, websites) to share
news, analyse scenarios, and explore
novel solutions with associations
and members. Finally, PAFAMS
colleagues, representing countries
from Canada to Chile, have shared
insightandvaluablerecommendations
based on their expertise and best
practices in clinical medicine,
medical education, and research.
Health leaders have also noted
challenges related to promoting high-
quality medical education with a set
of competencies (e.g. knowledge,
skills, abilities) for their clinical
responsibilities. First, with limited
trainingindigitaltechnologies,leaders
should consider including academic
training on telemedicine, software
programs, and other technological
applications that can alleviate the fast-
paced clinical environment. Second,
with limited health financing for
primary care, leaders can lead didactic
theory and practice (e.g. case studies)
that incorporate the framework for
person- and community-centred care
to manage acute and chronic illnesses.
Third, with a visible digital gap
between countries and regions,shared
knowledge exchanges on clinical
and surgical medicine, medical
ethics, and research topics can help
bridge connections and expand
professional networks. Although
complicated challenges, we can
collectively aim to identify synergies,
collaborate on pressing global health
needs, and identify opportunities
to replicate best practices in
clinical and community settings.
Aside from the COVID-19
pandemic, how would you describe
the anticipated challenges in
medical education over the next
decade in your geographic region?
WFME and PAFAMS leaders as
well as the wider medical community
have openly discussed anticipated
challenges in medical education across
the Americas region. First, weak
healthcare infrastructure coupled with
unstable political and community
leadership across countries can hinder
the rapid identification of community
needs and the development of
relevant policies to protect population
health. Second, as the health impacts
of climate change, ranging from
natural disasters to potential zoonotic
spillover, will be unveiled over time,
satellite data can be particularly
useful toward monitoring these
landscape changes for subsequent
action (e.g. air quality management,
disease early warning systems, heat
risk maps). Special considerations
should be applied to ensuring that
vulnerable populations, such as
rural, indigenous, and LGBTQIA+
communities, have equitable access to
primary healthcare services. Third, in
addition to the reported global health
workforce shortage, the migration of
health professionals from LMICs to
high-income countries (“brain drain”)
widens the gaps between the Global
North and South. Finally, since
medical education programs across
the geographic region remain diverse
in coursework, training opportunities,
and timeline, regional conferences
that permit academic debates and
information sharing can offer
valuable resources for health leaders.
What are the three key priorities
that WFME and WMA members
should address in the next five years?
Over the next five years, I believe
that WFME and WMA members
can focus their efforts on three key
priorities that ultimately strengthen
global medical education and
training. First, WMA members
can establish a memorandum of
understanding with the International
Federation of Medical Students’
Associations (IFMSA) and Junior
Doctors Network (JDN) to
ensure high-quality curriculum
Interview with the President of the Pan-American Federation of Associations of Medical Schools
37
BACK TO CONTENTS
development for medical education,
by promoting shared governance and
incorporating medical students’ and
junior physicians’ feedback. Second,
they can incorporate the established
IFMSA networks with the Pan-
American Mobility (Exchange)
program and support shared learning
of clinical and research knowledge
and skills among professors and
students across continents. Third,
WFME and WMA leaders can
invite IFMSA and JDN members to
participate in the event proceedings
of the XXIII Pan American Medical
Education Conference (Conferencia
Panamericana de Educación
Médica, COPAEM), which will
be held in Quito, Ecuador, in 2025.
Marcos Núñez Cuervo,
MD, FICS, M.Ed
President, PAFAMS (2022-2025)
Pan American Federation of
Associations of Medical Schools
presidencia@webfepafem-pafams.org
Interview with the President of the Pan-American Federation of Associations of Medical Schools
38
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For this interview, Professor Ahmed
Al Rumayyan, president of the
Association for Medical Education
in the Eastern Mediterranean Region
(AMEEMR), shares his perspectives
on leadership experiences, strengths
and existing challenges in medical
education, and how the World
Federation of Medical Education
(WFME)(https://wfme.org/)andthe
World Medical Association (WMA)
members can foster collaborations,
with Dr. Helena Chapman, the WMJ
Editor in Chief.
What are the organisational goals,
priorities, and current activities of
AMEEMR?
AMEEMR is dedicated to advancing
medical education across the Eastern
Mediterranean region. Central to our
mission is promoting excellence in
medical education, fostering a culture
of quality and accreditation, and
nurturing faculty members in health
professions education. Our primary
goal is to promote a comprehensive
spectrum of medical education,
from undergraduate to postgraduate
studies and continuous professional
development, through a diverse range
of activities. These efforts include
facilitating the exchange of teaching,
research, and evaluation materials
among educators and institutions,
organising exchange visits for medical
educators and students between
member countries, and actively
supporting and promoting faculty
development programs and scholarly
activities.
Furthermore, AMEEMR advocates
for WFME accreditation standards,
policies, and procedures in medical
education and collaborates closely
with relevant accreditation bodies
and member states, in order to
uphold high-quality educational
practices and ensure recognition. We
prioritise collaborations with partner
associations within WFME and
affiliated international organisations
(like WMA) to further our collective
goals in advancing medical education.
Overall, AMEEMR’s organisational
goals, priorities, and current activities
reflect our commitment to enhancing
medical education standards and
fostering excellence in the Eastern
Mediterranean region.
Over the past year, what do you
consider to be your most important
leadership achievements as
president (2023-2024)?
As president, I am enthusiastic
to highlight a few leadership
achievements from the past year.
First,since AMEEMR is a non-profit
organisation, securing support from
King Saud bin Abdulaziz University
for Health Sciences (KSAU-HS)
and allocating resources for the
execution of AMEEMR initiatives
have enabled the association to
advance medical education in the
Eastern Mediterranean region.
Notably, KSAU-HS’s support led
to the creation of the AMEEMR
website (http://rupipspsrv01:700/
Pages/Home.aspx) in 2022. Second,
establishing strategic collaborations
with like-minded entities, such as
the World Health Organization
and the Education and Training
Evaluation Commission (ETEC)
(as the National Commission for
Assessment and Accreditation), has
expanded discourse between health
professionals in medical and health
sciences education and healthcare
systems.
Third, on a practical level, the
successful adoption of WFME
standards by accrediting agencies
in the region has enhanced medical
training and improved the quality of
medical education.The incorporation
of infectious disease and pandemic
topics as well as interprofessional
education and collaborative practices
into medical curricula provided
additional knowledge and skills in
teamwork, communication, and
patient care. Fourth, as a regional
faculty enhancement initiative
initiated in 2022, AMEEMR has
invited leading health professions
education speakers to present
AMEEMR monthly webinars. Due
to these successful webinars, the
AMEEMR Virtual Symposium
entitled, Medical Education in the
Context of the Eastern Mediterranean
Region, was held on 21-22 May 2022.
For this academic year, six monthly
webinars have been scheduled
for December 2023 to June 2024.
AMEEMR also plans to work
towards creating annual Health
Professions Education Conferences.
Finally, I am most proud of the
establishment of the Health Professions
Education journal (ISSN:2452-3011)
(https://hpe.researchcommons.org/
journal/) in 2015, an international,
peer-reviewed, open-access journal
that publishes empirical and
theoretical contributions from
all health professions disciplines.
In recent years, the journal has
Ahmed Al Rumayyan
Interview with the President of the Association for Medical
Education in the Eastern Mediterranean Region
Interview with the President of the Association for Medical Education in the Eastern Mediterranean Region
39
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increased popularity among the
medical education community, based
on citations (15 out of 45), notable
impact for a new journal with five
years,and formal indexation in Scopus
and Google Scholar (CiteScore of
4.1) (while exploring indexation in
MEDLINE).
How has the coronavirus disease
2019 (COVID-19) pandemic
affected medical education across
your geographic region?
The impact of the COVID-19
pandemic on educational strategies
and healthcare management varied
across regions and countries,
prompting tailored responses
based on population demographics
and available resources. First, the
COVID-19 pandemic necessitated
the adoption of e-learning and
blended learning methodologies
across the delivery of theoretical
and practical educational content
and assessment measures in health
professions education. There was
also a significant shift towards
utilising technology for governance,
administration, and faculty
development initiatives. Second,
the need to implement proactive
measures, such as the integration
of infectious disease and pandemic
topics into existing medical curricula,
helped prepare health professionals
with the necessary knowledge and
skills to manage future pandemics.
What are the current strengths
and existing challenges in medical
education across your geographic
region,andhowcanthesechallenges
be addressed?
The Eastern Mediterranean region
offers diverse clinical environments
and patient populations, providing
medical students with rich learning
experiences in clinical and health
professions education research. The
region’s cultural diversity enriches
medical education by exposing
students to various healthcare beliefs,
practices, and perspectives. Recently,
there has been an increased number
of recognised accreditation agencies
by the WFME, with notable support
from health professions education
leaders within the region towards
AMEEMR initiatives. Many medical
institutions are investing in faculty
trainings for health professional
educators within the region.
Albeit these strengths, diverse
challenges inevitably exist when
dealing with two dynamic fields
of health and education. First,
institutions are facing resource
constraints in terms of funding,
infrastructure, and technology access,
which can hinder the delivery of high-
quality medical education. Second,
political situations in some countries
within the AMEEMR region can
lead to disparities in healthcare access,
which can affect the educational
experiences of medical students as
well as population health outcomes.
Third, graduates may be unable to
meet the minimum competency
requirements if WFME standards or
guidelines are incohesive, including
limited uniformity in curricula,
assessment methods, and educational
outcomes. Fourth, the fragmentation
of health professions education
activities in the region is leading to
resource duplication and limited
collaborations, which can hinder the
ability to address systemic issues and
advocate for necessary reforms or
improvements in health professions
education.
To address these challenges and
adhere to the WFME standards,
health professional educators
should invest in medical education
infrastructure, prioritise investment
in facilities,technology,and resources,
and establish roadmaps to ensure
consistency and quality in medical
education across the region. Regional
collaborations among medical
institutions can facilitate the sharing
of resources, expertise, and best
practices. Engaging with local
communities and healthcare
stakeholders can help medical
schools address disparities and
tailor educational programs to meet
the needs of diverse populations.
Finally, relevant institution and
universities can emphasise the
need for sustainable funding,
multidisciplinary collaborations, and
robust infrastructure development
to advance knowledge, improve
healthcare outcomes, and support
medical research initiatives in the
region.
Aside from the COVID-19
pandemic, how would you describe
the anticipated challenges in
medical education over the next
decade in your geographic region?
Over the next decade, AMEEMR
anticipates six specific challenges
affecting medical education in the
Eastern Mediterranean region.
First, with rapid advancements
in medical technology, including
artificial intelligence, integrating these
applications effectively into medical
curricula while ensuring equitable
access and training for all students will
offer novel insight into combatting
complex challenges like climate
change. Second, incorporating timely
health topics (e.g. aging population,
increase in non-communicable
diseases) into medical education
can help ensure that curricula are
relevant to evolving healthcare needs.
Third, interdisciplinary education
and training will be fundamental to
prepare future healthcare professionals
to respond to emerging infectious
diseases, antimicrobial resistance,
health impacts of climate change, and
other global health threats.
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Fourth, the mental health and well-
being of medical students and faculty
should be monitored, in order to
provide adequate support systems
that can help reduce stigma and
promote self-care. Fifth, fostering
interprofessional education and
collaborations among healthcare
professionals can improve patient
outcomes, enhance teamwork, and
address multifaceted healthcare
challenges. Finally, by navigating
ethical dilemmas, such as emerging
technologies, end-of-life care, and
patient autonomy, medical leaders
can ensure that medical students
are equipped with appropriate
knowledge and skills to uphold
ethical standards in clinical practice.
What are the three key priorities
that WFME and WMA members
should address in the next five years?
Over the next five years, the WFME
and the WMA can focus on three
key priorities to ensure high-quality
medical education and training in
the Eastern Mediterranean region
and world. First, the continuum
of WFME standards to include
postgraduate training program as
well as continuous professional
development initiatives will be
fundamental to demand high-quality
curricula that prepare physicians to
address emerging global threats. By
establishing informative roadmaps,
medical education leaders can feel
confident in leading academic efforts
that ensure consistency and quality
in medical education that follows
WFME standards and WMA ethical
values.
Second, reinforcing standards
and guidelines will be necessary
to address the use of artificial
intelligence and diverse medical
technology in available curricula.
Medical educators and physicians
can lead efforts to formulate the code
of ethics that can help their teams
navigate anticipated ethical dilemma
relevant to technology-based medical
education and patient care. Finally,
yet importantly, I believe that the
WFME and the WMA should
prioritise addressing the mental
health of medical students, faculty,
and physicians in their policies and
initiatives. With rapid changes of
clinical roles and responsibilities in
their professional development as
well as rapport with patients and
communities, maintaining optimal
physical and mental health and well-
being cannot be overlooked to avoid
burnout and other complications.
Prof. Ahmed Al Rumayyan,
MD, FAAP, FRCPC
President, Association for Medical
Education in the Eastern
Mediterranean Region (AMEEMR)
Dean, College of Medicine,
King Saud bin Abdulaziz
University for Health Sciences
Riyadh, Kingdom of Saudi Arabia
rumayyana@ksau-hs.edu.sa
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For this interview, Professor Harm
Peters, president of the Association of
Medical Schools in Europe (AMSE),
shares his perspectives on leadership
experiences, strengths and existing
challenges in medical education, and
how the World Federation of Medical
Education (WFME) (https://
wfme.org/) and the World Medical
Association (WMA) members can
foster collaborations, with Dr. Helena
Chapman, the WMJ Editor in Chief.
What are the organisational goals,
priorities, and current activities of
AMSE?
The primary goals of AMSE are
to promote the highest quality,
standards, value, and relevance of
management, medical education,
research, and patient care in medical
schools throughout Europe. AMSE´s
current activities focus on quality
assurance and accreditation processes
to ensure that the quality of medical
education programs is aligned with
the WFME scheme for recognising
accrediting agencies. This process
includes collaborating with national
and international stakeholders and
organising conferences to increase
access to best practices and resources,
as well as advocating for policies that
support medical education.
Like other stakeholders in medical
education research, AMSE is
concerned about the so-called
“reproducibility crisis”, a term
referring to the widespread
concern that scientific studies (e.g.
biomedicine) cannot be replicated or
reproduced by other researchers. The
reliability and credibility of scientific
findings are compromised, not only
by a lack of replication studies, but
also by a lack of transparency, small
sample sizes, selective reporting, and
publication bias. AMSE, therefore,
supports efforts to address the
“reproducibility crisis” in medical
research, which is reinforced by the
European University Association
(EUA)’s agreement to reform research
assessments and the Coalition for
Advancing Research Assessment
(CoARA) initiative (https://coara.
eu/).
Over the past year, what do you
consider to be your most important
leadership achievements as
president (2023-2024)?
Over the past year, there have been
several noteworthy achievements
within AMSE. First, AMSE was
selected as the new regional member
representing Europe on the WFME
Executive Council, with formal
recognition at the WFME Executive
Council meeting in Quebec, Canada,
on 11-12 April 2023 (https://amse-
med.eu/amse-newsletter-2023-
no-6/). This acknowledgment has
substantially increased the reach and
importance of AMSE within Europe.
Second, the AMSE Annual
Conference was held at the Grigore
T. Popa University of Medicine and
Pharmacy of Iasi in Iasi, Romania,
from 5-7 October 2023. Using
the conference theme, “Digital
Transformation for Healthcare
Professions: Patient Care, Education,
and Research”, attracted more than
531 participants (426 in-person,
103 online) from over 19 countries
(Bosnia and Herzegovina, Czech
Republic, Georgia, Germany,
Greece, Hungary, Italy, Lithuania,
Malta, Oman Poland, Republic of
Moldova, Romania, Serbia, Slovenia,
Spain, United Arab Emirates,
United Kingdom, United States). In
addition to insightful keynote talks,
workshops, presentations, and posters,
the inaugural Peter Dieter Leadership
Award was formally presented to
Professor Ronald Harden, Editor
of Medical Teacher and former long-
standing Secretary General of the
Association for Medical Education in
Europe.
How has the coronavirus disease
2019 (COVID-19) pandemic
affected medical education across
your geographic region?
The COVID-19 pandemic had
a significant impact on medical
education in the World Health
Organization (WHO) European
Region. This period was marked by
an abrupt shift to online learning and
social distancing measures to reduce
the risk of virus transmission. To
meet these challenges, the
adaptation of medical curricula
included integrating more virtual
patient encounters, simulations,
and telemedicine experiences into
curricula to ensure that students
continued to receive comprehensive
training despite restrictions on
in-person clinical activities. The
stress and anxiety associated with
the pandemic, combined with the
challenges of adapting to new learning
formats and uncertainties about the
future, took a toll on the mental well-
being of medical students, faculty,
and healthcare professionals. Beyond
Harm Peters
Interview with the President of the Association
of Medical Schools in Europe
Interview with the President of the Association of Medical Schools in Europe
42
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medical education, the pandemic
significantly affected medical schools
and universities in Europe in the areas
of patient care and research.
What are the current strengths
and existing challenges in medical
education across your geographic
region,andhowcanthesechallenges
be addressed?
There are several strengths in medical
education across the WHO European
Region. First, many medical
schools offer high-quality training
with well-established curricula,
experienced faculty, and state-of-
the-art facilities. Second, clinical
training in the European region is
extensive, and students learn from
hands-on experiences in a variety
of clinical settings. Third, medical
students generally can participate in
cutting-edge research that reinforces
health guidelines and protocols.
Fourth, many medical schools have
established international partnerships
that facilitate knowledge exchange,
research collaborations, and cultural
understanding.
One main challenge in medical
education in the European Region
is the shortage of qualified faculty,
which can directly affect the quality of
patient care and academic education
available to medical students.
Second, medical education leaders
should respond to the accelerating
speed at which new approaches and
technologies are being incorporated
into almost all areas of medical
practice. These developments have
implications for what needs to be
taught, how it is taught, and how
faculty are trained to teach in these
new areas.Third,with the demanding
nature of medical education and
training, combined with the stressors
of the healthcare environment, there
is a need to promote coping
mechanisms to manage mental health
and well-being of medical students
and faculty. Addressing these
significant challenges will require
investment in faculty development,
efforts to ensure equitable access to
resources among medical schools,
provision of training and support
for faculty to effectively integrate
technology into curricula and
teaching methods, and efforts to
promote the well-being of students
and faculty. By building on existing
strengths, medical education in
the WHO European Region can
continue to prepare future generations
of healthcare professionals to meet
the evolving needs of patients and
communities.
Aside from the COVID-19
pandemic, how would you describe
the anticipated challenges in
medical education over the next
decade in your geographic region?
Several challenges in medical
education are likely to shape the
landscape in the WHO European
Region over the next decade.
First, the changing landscape of
healthcare in Europe is characterised
by changing demographics of the
population, increasing prevalence
of non-communicable diseases,
and emerging global health threats.
Second, noting the global shortage
of the health workforce, a substantial
increase of the number of healthcare
professionals is required to maintain
diversity and inclusion, address
healthcare disparities, and provide
culturally competent care. Third,
rapid advances in technology, such as
artificial intelligence, virtual reality,
and telemedicine, will continue to
impact medical education with the
need to effectively integrate these
technologies into curricula effectively
while ensuring equitable access and
addressing digital literacy among
faculty and students. Meeting these
anticipated challenges will require
collaboration among medical
educators, healthcare institutions,
policy-makers,and other stakeholders
to innovate and adapt medical
education programs to meet the needs
of patients and society in the WHO
European Region.
What are the three key priorities
that WFME and WMA members
should address in the next five years?
Both the WFME and the WMA
play a vital role in setting standards
and guidelines for medical education
and practice throughout the world.
Together with AMSE, WFME and
WMA members should address
the following three priorities over
the next five years. First, they
can enhance quality assurance in
medical education, which can help
further develop and strengthen the
mechanisms for quality assurance
in medical education, accreditation
processes,and continuing professional
development. Second, they can
adapt medical education curricula
to rapid advances in technology,
such as telemedicine, digital health
solutions, artificial intelligence,
and the emerging field of genomic
and personalised medicine, which
can ensure that future healthcare
professionals are equipped with
the necessary skills and knowledge.
Finally, they can promote diversity
and inclusivity in medical education
and advocate for policies that address
global health disparities in access
to and outcomes of healthcare for
underserved populations in different
regions of the world.
Prof. Dr. med. Harm Peters, MHPE
Charité – Universitätsmedizin
Berlin, Germany
Dieter Scheffner for Medical Education
and Educational Research
President, Association of Medical
Schools in Europe (AMSE)
Berlin, Germany
president@amse-med.eu
Interview with the President of the Association of Medical Schools in Europe
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Since 2008, the German Ethics
Council has been serving as an
advisory body to German politics and
society on bioethical, biomedical, and
wider-ranging ethical questions. The
real beginning of its story, however,
goes back to 2001. At this time,
Germany was torn over the question
of whether to permit the import of
human embryonic stem cell lines
from abroad, which hold potential for
medical innovation. To generate such
cell lines, human embryos must be
destroyed, which is strictly forbidden
by the German Embryo Protection Act
(Embryonenschutzgesetz). German
scientists wished to import and use
existing human embryonic stem
cell lines and argued that as the
embryos used to generate the stem
cell lines had been destroyed long
ago, using the regenerating cell lines
without creating new ones should
be permissible. Faced with complex
ethical questions around this issue,
German politicians wished to obtain
interdisciplinary expert advice and
created two advisory groups.
The first group, the parliamentary
Commission of Inquiry (Enquête-
Kommission) on Law and Ethics in
Modern Medicine, composed of 13
parliamentarians and 13 external
experts, was set up by the federal
parliament in the year 2000 [1]. The
second group, the National Ethics
Council (Nationaler Ethikrat), was
installed by the federal government
in May 2001, and explicitly ruled out
participation by active politicians [2].
For five years, these two remarkably
similar advisory bodies worked in
sometimes fierce rivalry. They often
covered the same topics, starting
with their recommendations on
the aforementioned issue of human
embryonic stem cell imports,
published in late 2001. Both groups
were divided in their opinions, with
a majority of the Commission of
Inquiry being opposed to imports,
whereas a majority of the National
Ethics Council voted in favour [3,4].
Establishment of the German
Ethics Council Act of 2007
Soon, there was growing recognition
that a unified advisory body that
would serve both the parliament’s
and the government’s needs might be
preferable to having two committees
ploughing the same field. As a
result, the German Ethics Council Act
(Gesetz zur Einrichtung des Deutschen
Ethikrats) was adopted in July 2007,
as a federal law that establishes
the terms for the Council’s work.
According to the Act, the “German
Ethics Council shall pursue the questions
of ethics, society, science, medicine
and law that arise and the probable
consequences for the individual and
society that result in connection with
research and development, in particular
in the field of the life sciences and their
application to humanity” [5].
The German Ethics Council and
the National Ethics Council have
similar frameworks. The 26 members
of the German Ethics Council
should represent “scientific, medical,
theological, philosophical, ethical, social,
economic and legal concerns, […]
contain representatives of a variety
of ethical approaches and a pluralist
spectrum of opinion” and may not
hold an active political mandate [6].
Like its predecessor, the German
Ethics Council is also supported
in conducting its duties by an
administrative office located in Berlin.
An important difference, however,
is that half of the German Ethics
Council’s members are nominated
by the government and half by the
federal parliament, thus ensuring
that both political bodies have a
recognised voice within the Council’s
composition, including opposition
parties. Members are asked to serve
for four years and can return for a
second term, after which they cannot
be renominated. The German Ethics
Council began its work in April 2008,
with many of its inaugural members
previously having served on either
the parliamentary Commission of
Inquiry or on the National Ethics
Council, thus providing continuity to
both committees’ previous work.
Duties of the German Ethics
Council
The three core duties stipulated
by the German Ethics Council
Act include “informing the public
and encouraging discussion in
society”, “preparing Opinions and
recommendations for political and
legislative action”, and international
“cooperation with national ethics
councils and comparable institutions”.
Fostering Public Discourse. The
German Ethics Council is requested
to inform the public and encourage
open discussion within society. It
holds several free-to-attend public
events each year, ranging from all-day
conferences to evening symposiums,
external expert hearings, and short
online-only events. Here, Council
members usually discuss the topic
Nora Schultz
A Forum for Significant Ethical Questions
A Forum for Significant Ethical Questions
44
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of the day with external experts and
members of the public who can submit
their own questions and comments.
The Council provides extensive
documentation of these events,
with video recordings, transcripts
and speakers’ presentations usually
made available for downloading. In
recent years, the Council has also
developed an active social media
presence to explore further channels
for interaction with the public. Many
Council publications, as well as
press releases and information about
events are translated from German to
English and available on the website
(www.ethikrat.org).
Preparing Opinions and
Recommendations. Although this task
is second on the Act’s list, this is what
many Council members spend most
of their time on. Preparing scholarly
documents that offer academic
perspectives on diverse (bio)ethical
and biomedical topics requires in-
depth research, deliberation, drafting
and revising.This work is usually split
between a smaller working group and
plenary discussions with all Council
members. Consensus is not required.
In fact, the Act explicitly states that
members may express dissenting
views in the Council’s publications –
and they often do. Whilst unanimous
recommendations may have greater
impact and convey more clarity, the
controversies of complex ethical issues
cannot always be resolved. Many
Council publications thus include split
votes or alternative recommendations
and aim to support decision makers
in forming their own opinions by
elucidating the arguments behind
each position.
From the beginning, the scope of the
Act’s focus on questions “in connection
with research and development, in
particular in the field of the life sciences
and their application to humanity”
has been debated. The Council’s
first Opinion was published in
2009, discussing the anonymous
relinquishment of infants in baby
drops or anonymous birthing
facilities. Many subsequent projects
have focused more closely on ethical
questions in life science research
and development, including reports
on human biobanks, human-animal
mixtures, pre-implantation and other
types of genetic diagnostics, brain
death, biosecurity, embryo donation,
and human germline editing. Other
projects have tackled broader societal
or predominantly legal issues, such as
the costs and benefits in healthcare
systems, patient welfare in hospitals,
intersexuality, prohibition of incest,
dementia, benevolent coercion, and
animal welfare. In recognition of
the increasing interconnectedness of
many developments and areas within
society, the Council has recently
expanded its scope, or example with
projects on artificial intelligence and
climate justice.
Networking with National and
International Councils and Institutions.
The German Ethics Council meets
regularly with select partner councils,
including those from France and the
United Kingdom,for a yearly trilateral
meeting, and those from Austria and
Switzerland. The second trilateral
meeting is held in German. Council
representatives also attend biannual
European National Ethics Councils’
fora, which are based on the rotating
presidencies of the European Union’s
Council and the Global Summit of
National Ethics Committees, held
every two years.
Achievements
Over the past 16 years since its
foundation, 76 members have served
on the German Ethics Council, and
collectively, they have published
a total of 24 Opinions and 14 Ad
Hoc Recommendations, as well as
organised more than 55 public events.
The arrival of coronavirus disease
2019 (COVID-19) forced some
drastic changes upon the way
the Council worked. As the virus
appeared in Germany in early 2020,
the German Ethics Council was
approaching a changeover, with
around half of its members (including
the Chair) finalising their second
term and thus leaving the Council.
With Germany entering its first
lockdown in March 2020, Council
members connected online in a series
of late-night sessions to draft the
first pandemic-related publication.
Published on 27 March 2020, the
Ad Hoc Recommendation titled,
Solidarity and Responsibility during
the Coronavirus Crisis, was the first
of nine publications and four public
events dedicated exclusively to the
pandemic, covering, for example,
immunity certificates, access to
vaccines and social contacts, triage,
mandatory vaccinations, and mental
health of young people [6].
Like many organisations, the
German Ethics Council aimed to
find ways to effectively communicate
and collaborate throughout the
pandemic, despite social restrictions.
Although virtual meetings were
successful, Council members soon
noticed limitations compared to in-
person meetings as there were fewer
opportunities to build trust and
rapport. Nowadays, the Council aims
to combine the best of both worlds
by offering a hybrid platform with
a mix of in-person attendance and
video-conference participation.Public
events are livestreamed for those who
cannot participate at the venue and
offer virtual audience interaction.
The external perception of the
German Ethics Council also changed
during the pandemic.With substantial
political and public interest in ethics
advice on pandemic-related topics,
Council members frequently appeared
on camera (e.g. news and talk shows),
observing new opportunities to
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engage with the public in multi-
faceted ways. However, as restrictions
of public freedoms continued
and controversies surrounded
vaccinations, some Council members
found themselves the target of abusive
remarks, misinformation campaigns,
and even threats. Undoubtedly, there
are still lessons to be learned from
the pandemic on how to address and
communicate complex ethical issues
under pressure, and the German
Ethics Council continues to reflect
on these questions internally, publicly
and in exchange with its international
partner committees.
As the German Ethics Council
begins its fifth term in mid-2024,
about half of its members will leave
their positions, and new members
will join and contribute to the scope
of the new work programme for the
rest of the year and beyond. As recent
work has highlighted that diverse
challenges are propelling the need to
find ethically acceptable solutions for
a culturally diverse and increasingly
interconnected world, the Council
will continue to contribute to these
important endeavours in preparing
recommendations, fostering public
discourse, and networking with
relevant councils and institutions
around the world.
Note: The author has been a research
officer in the German Ethics Council’s
administrative office since November
2008.
References
1. German Bundestag. [Enquete
Commission on Law and Ethics
of Modern Medicine] [Internet].
n.d. [cited 2024 May 10].
German. Available from:
htt ps://webarc hiv.bunde-
stag.de/cgi/show.php?file-
ToLoad=113&id=1040
2. National Ethics Council.
Establishment of a National
Ethics Council: Cabinet proposal
of 25 April 2001 [Internet]. 2001
[cited 2024 May 10]. German.
Available from: https://web.ar-
chive.org/web/20110410210252/
http://www.ethikrat.org/archiv/
nationaler-ethikrat/einrichtung-
serlass
3. German Bundestag. Summary
report: supplement to the interim
report on stem cell research
focussing on importation
problems [Internet]. 2007 [cited
2024 May 10]. Available from:
https://webarchiv.bundestag.de/
archive/2007/0206/parlament/
gremien/kommissionen/ar-
chiv14/medi/2zwisch_engl.pdf
4. German National Ethics
Council. The import of human
embryonic stem cells: opinion.
Berlin: German National Ethics
Council; 2002. Available from:
https://uni-bonn.sciebo.de/s/
B30W3vdjlp9QXj5/download
5. German Ethics Council. Act on
the Establishment of the German
Ethics Council (Ethics Council
Act – EthRG) [Internet]. 2007
[cited 2024 May 10]. Available
from: https://www.ethikrat.org/
en/the-german-ethics-coun-
cil/#m-tab-0-ethicscouncilact
6. German Ethics Council.
Solidarity and responsibility
during the coronavirus crisis: ad
hoc recommendations [Internet].
2020 [cited 2024 May 10].
Available from: https://www.
ethikrat.org/en/topics/medi-
cine-and-health/public-health/
Nora Schultz, PhD
Scientific Officer (Wissenschaftliche
Referentin)
German Ethics Council
(Deutscher Ethikrat)
Berlin, Germany
schultz@ethikrat.org
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The National Health Service (NHS)
is the United Kingdom’s health
service, which uses a tax-funded
model that allows healthcare to be
accessed free at the point of service.
Healthcare wait lists are currently
sorted by the urgency of procedures,
averaging around 18 weeks for
elective procedures and two weeks for
cancer referrals, and the proportion of
patients exceeding those wait times
has drastically increased. The
coronavirus disease 2019
(COVID-19) pandemic has resulted
in a tremendous backlog of persons
seeking non-COVID-19-related
care, with wait list numbers at 7.54
million cases as of March 2024 [1].
This means that there are longer
wait lists for treatments and clinical
procedures for diseases unrelated
to COVID-19, which should be
managed in an efficient,cost-effective,
and fair manner.
The scarcity of healthcare resources
brings forth dilemmas of fairness
and distributive justice. Within these
dilemmas, one must ask if it is fair
for personal responsibility for health
to be a factor when making decisions
about resource allocation, which
adds additional layers of complexity
to the debates of distributive justice.
In the ideal world, healthcare is a
right, and known harmful substances
such as cigarettes would be banned.
However, this is easier said than done.
In today’s world, some challenges
to consider include the rights and
liberties of individuals to make
their own healthcare decisions, the
powerful tobacco company lobbies,
the struggles of enforcing laws and
prohibiting back door trade, and
the effectiveness of bans. In the
meantime, is there another way to
navigate healthcare shortages by de-
prioritising patients using personal
responsibility?
This article aims to describe some
of these complexities and stimulate
discussion that can explore the
ethics of personal responsibility and
distributive justice, specifically in
relation to smoking, lung cancer,
and treatment wait lists. It will be
structured into three segments –
defining personal responsibility for
health, presenting luck egalitarianism
(LE) as an ethical theory that may
be applied to resource allocation, and
exploring two critiques of LE.
Defining Personal Responsibility
for Health
I would like to define personal
responsibility for health (PR) as
being a notion that holds individuals
to account for choices they make
regarding their health. The NHS
acknowledges the importance of
PR – a section within the NHS
Constitution is dedicated to outlining
these responsibilities. The first point
stated is: “please recognise that you
can make a significant contribution
to your own, and your family’s, good
health and wellbeing, and take personal
responsibility for it” [2]. This is
clearly noted in the Constitution,
but it is unclear how the NHS
will hold patients accountable to
their responsibilities. The United
Kingdom’s Department of Health
and Social Care does not detail the
extent to which individuals take
responsibility for their health. One
way to hold patients accountable is
to de-prioritize them on treatment
wait lists – it is safe to say PR is
controversial for a plethora of reasons.
Let’s explore this specifically in
relation to smoking and lung cancer.
I would dissect the key aspects of
patient choice to engage in behaviours
linked with health or illness to involve
two main concepts – firstly, whether
patients are able to make informed
decisions (e.g. whether they were
provided with enough information
of risks and benefits of behaviours),
and secondly, whether they are able
to have free will (free from coercion
or compulsion). To address the first
aspect: tobacco smoking has been
a part of human history for many
centuries, and the link between
smoking and lung cancer has been
long established since the mid-
1900s, with cigarette smoking being
identified as the cause of a global lung
cancer epidemic in the 1940-1950
[3]. In the United Kingdom, cigarette
packets are printed with grotesque
images of health risks associated
with smoking, with the clear message
that Smoking Kills. It can be said the
harms of smoking are well circulated
to increase patient awareness. This
means the second aspect of choice,
making decisions with free will, free
of coercion and compulsion, is the
main point of contention.
Addiction is the reason for the
continuation of smoking and
is supposedly a state in which
behavioural control has been
extinguished, rendering the smoker
unable to do otherwise. When the
smoker is under such compulsion to
continue smoking, it seems unfair to
Gayatri Vijapurkar
Healthcare Resource Allocation: Smoking,
Lung Cancer, and the National Health Service
Healthcare Resource Allocation: Smoking, Lung Cancer, and the National Health Service
47
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use the term patient choice when no
such choice exists. However, Hanna
Pickard, professor of Philosophy and
BioethicsatJohnsHopkinsUniversity,
reasons that although smoking and
subsequent addiction may impair the
ability to exert behavioural control
upon oneself, the impairment does
not mean the ability to do otherwise
has been extinguished [4]. In other
words, Pickard endorses the view that
addiction does not mean compulsion.
The NHS Smoking Cessation
Services (SCS) rely on a mixture
of Cognitive Behavioural Therapy
(CBT) and pharmacological therapy
to help counsel smokers wishing to
stop, as well as support them through
the nicotine withdrawal effects. CBT
especially would not be successful if
the ability to do otherwise had been
extinguished, as it relies on educating
patients to question their thoughts
and behaviours, which then supports
them to make decisions that may be
better for them.
However, there are more nuanced
complexities that must be considered.
Studies have shown that individuals
who smoke usually start smoking in
adolescence. In the United Kingdom,
eight out of ten adult smokers start
smoking before they turn 19 years
of age [5]. Furthermore, smoking
habits are intertwined with lower
socioeconomic groups, and already
marginalised communities such
as travelling communities. When
such pivotal factors play a role in
an individual developing smoking
habits, is it truly fair to say that these
individuals are making a choice to
smoke? Do they actually have free
will when under the influence of
families and social groups? These
questions must be asked to ensure
ethical theories can be applied in the
real world.To counter these questions,
holding patients accountable for
their choices is only fair when there
is a level playing field. However, can
this ever be reality, and does anyone
ever truly have free will? Such
debates are controversial, but in my
opinion, a topic being controversial
should be changed to the topic being
conversational. By this, I mean to
say that generating respectful and
productive conversations around
such controversial topics can lead to
policies being developed that are fair
and avoid exacerbating inequalities
already present in healthcare.
LE as an Ethical Theory for
Resource Allocation
I will illustrate LE and how it
incorporates the concept of choice.
Generally, LE is intended as an
account of justice/fairness and
emphasises the role of responsibility
directly in matters of distributive
equity. It holds that moral equality
between people is dependent on
the idea that individuals take
responsibility for their choices and
face any later consequences (p.665)
[6]. When applied to healthcare, LE
holds that patients should be held
accountable for their choices, which
may lead to disease development. It
incorporates the role of responsibility
by distinguishing between option luck
versus brute luck.
I will illustrate the difference between
these two types of luck by using a
scenario with two patients, X and Y,
who have been diagnosed with lung
cancer (scenario adapted from p.129)
[7]. Patient X follows an unhealthy
lifestyle and smokes heavily, whereas
Patient Y follows a healthy lifestyle,
keeping active and fit. Both patients
are unlucky – not all heavy smokers
develop lung cancer, thus Patient
X has “bad luck” in that aspect. It is
even more unfortunate for individuals
with healthy lifestyles to develop lung
cancer, and it is evident that Patient
Y has “bad luck”. LE holds that the
“bad luck” of the two patients is
morally very different (p.129) [7].
Patient X could have reduced their
chances of developing lung cancer by
choosing not to smoke and choosing
to maintain a healthy lifestyle,
whereas Patient Y did not have any
control over developing lung cancer.
By differentiating this, LE attributes
Patient X’s bad luck to bad option
luck, whereas Patient Y’s bad luck is
attributed to bad brute luck.
LE holds inequalities caused by bad
brute luck must be compensated as a
matter of justice. These individuals
must not be held responsible for
their bad health – they should receive
priority when distributing scarce
and expensive treatment (e.g. for
lung cancer). Patients who have ill-
health because of bad option luck are
deemed to be responsible for their
poor health, thus should not be given
priority over patients with poor brute
luck, like Patient Y. LE’s concept of
luck suggests health and disease are
essentially lotteries. LE does not
argue treatment should be withheld
from patients with bad option luck,
nor wishes bad health upon patients
who have made poor health choices.
It simply provides a way to determine
how to distribute resources when they
are scarce, thus providing a way to
organise waiting lists.
Exploring Two Critiques of LE
Perhaps the strongest critique of
LE is against the concept of option
luck because whether smokers have
an option is heavily debated. The
word option suggests smokers have
the freedom to make the choice of
picking up a cigarette and lighting
it, and then repeatedly doing so. This
paints a very black and white picture
of a topic that has many grey areas.
As health professionals, we must
strive to empower individuals who
already face inequalities. If patients
are to be held accountable for their
choices, they must also be provided
with the appropriate support should
they wish to alter their choices. This
Healthcare Resource Allocation: Smoking, Lung Cancer, and the National Health Service
48
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means if individuals who smoke
are to be held accountable for their
choice if they develop lung cancer,
they must also have been given plenty
of opportunities to engage with
SCS. Such SCS are available on the
NHS, established to primarily target
disadvantaged smokers, and have
been successful in reducing smoking
rates among these target groups [8].
Another argument against LE is
that diseases such as cancer are often
multifactorial and defining the extent
towhichsmokingisacauseofdiseaseis
difficult,which is why personal choice
should not factor into healthcare
decisions. The multifactorial model
of disease provides a holistic outlook
on disease causation, but it may be
used as a scapegoat to avoid taking
responsibility for one’s actions.
Alex Broadbent, a philosopher of
epidemiology, acknowledges that
diseases can have multiple causes,
but also presents that diseases can
also share some common aetiology in
his contrastive model of disease (p.145)
[9]. Despite lung cancer having
a combination of environmental
and genetic causes, smoking causes
significant increases in disease risk.
Tables produced by the International
Agency for Research on Cancer and
the World Cancer Research Fund
classify lung cancer risk factors as
either increasing risk or decreasing
risk with either sufficient or
convincing evidence or limited
or probable evidence [10]. This
categorisation indicates it is possible
to isolate causal factors despite
diseases being multifactorial.
Smoking is categorised as increasing
risk, with sufficient or convincing
evidence. This shows that in many
cases when smokers develop lung
cancer, smoking cessation would have
avoided the development of lung
cancer [10].
Conclusion
This article illustrates some nuances
and complexities associated with
incorporating personal responsibility
in matters of distributive justice.
Although it aims to stimulate
conversations around such
controversial topics, many arguments
and counterarguments remain for
debates when it comes to discussing
personal responsibility in healthcare.
My utmost hope is that harmful
substances will be completely banned,
and that healthcare services will
strive to avoid further exacerbating
pre-existing healthcare inequalities,
especially if personal responsibility is
incorporated into resource allocation
(such as through de-prioritisation).
References
1. British Medical Association.
NHS Backlog Data Analysis
[Internet]. 2023 [cited 2024
May 10]. Available from:
https://www.bma.org.uk/advice-
and-support/nhs-deliver y-
a nd-work force /pressu res/
nhs-backlog-data-analysis
2. Department of Health and
Social Care, Government of
United Kingdom. The NHS
Constitution for England
[Internet]. 2016 [cited 2024 May
10]. Available from: https://www.
gov.uk/government/publications/
t he-nhs-const it ut ion-for-
england/the-nhs-constitution-
for-england#contents
3. Proctor RN. The history of
the discovery of the cigarette–
lung cancer link: evidentiary
traditions, corporate denial,
global toll: Table 1. Tobacco
Control. 2012;21(2):87-91.
4. Pickard H. Psychopathology
and the ability to do
otherwise. Philosophy and
Phenomenological Research.
2013;90(1):135-63.
5. Cancer Research UK. More
than 200,000 UK children
start smoking every year
[Internet]. 2013 [cited 2024
May 10]. Available from:
https://news.cancerresearchuk.
org/2013/03/22/more-than-
200000-uk-children-start-
smoking-every-year/
6. Tan KC. A defense of
luck egalitarianism. The
Journal of Philosophy.
2008;105(11):665-90.
7. Bognar G, Hirose I. The
ethics of health care rationing:
an introduction. London:
Routledge; 2014.
8. Hiscock R, Bauld L, Amos
A, Platt S. Smoking and
socioeconomic status in England:
the rise of the never smoker
and the disadvantaged smoker.
Journal of Public Health.
2012;34(3):390-6.
9. Broadbent A. Philosophy of
Epidemiology. London: Palgrave
Macmillan London; 2013.
10. Cancer Research UK. Lung
cancer risk [Internet]. 2015 [cited
2024 May 10]. Available from:
https://www.cancerresearchuk.
or g / he a lt h-pr ofe s s ion a l /
cancer-statistics/statistics-
by-cancer-type/lung-cancer/
risk-factors
Gayatri Vijapurkar
BA Hons, MB BChir
University of Cambridge
Cambridge, United Kingdom
gayatrivijapurkar@hotmail.com‌
Healthcare Resource Allocation: Smoking, Lung Cancer, and the National Health Service
49
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In February 2022, the Olympic flame
from the Temple of Hera in Greece
was lit again in Beijing, China. As the
International Olympic Committee
(IOC) had officially elected Beijing
to host both the Summer 2008
and Winter 2022 Olympic Games,
Beijing became the only double-
Olympic city in the world. Over the
past seven years, tremendous changes
have occurred in China and around
the world, and the development and
pattern of China’s winter sports have
undergone a complete transformation.
The success of the 2022 Beijing
Winter Olympics attracted
global attention, with over
two billion people watching
the 6,000-hour broadcast. The
Winter Olympics sportsmanship
showcased athletes’ tenacity and
perseverance, and audiences were
inspired people to strive forward.
Notably, the IOC President Thomas
Bach praised Beijing for its frugality
of the 2022 Beijing Winter Olympics.
Total revenue from advertising
sponsorship, event broadcasting fees,
and brand authorisation reached US
$2.8 billion, setting a new “miracle”
for the Winter Olympics. In this
article, the authors aim to explore the
underlying reasons for the success of
the 2022 Beijing Winter Olympics,
which can provide profound insights
into China’s future in sports, culture,
economy, and public health.
Winter Sports to Help Build a
Healthy China
Achieving a healthy life for all is the
next step after the successful hosting
of the 2022 Beijing Winter Olympics.
The Healthy China 2030 Plan
outlines that the number of people
who regularly participate in physical
exercise will reach 530 million by
2030.The national call – “To encourage
300 million people to practise winter
sports” – has encouraged all Chinese
citizens to participate in winter
sports, such as skiing, skating, ice
hockey,and curling.Over the past few
years, various ice and snow clubs and
cultural events have become popular,
expanding across the Shanghai Pass
and China. In southern regions,
where residents are less familiar
with winter sports due to different
climatic and topographic regimes,
12 provinces (30%) are currently
participating in winter sports. Hence,
these trends demonstrate that the
presence the Winter Olympics in
Beijing has led to an increased number
of citizens participating in winter
sports across the city and country.
Continuously expanding the social
effects of winter sports as well as
the general sports industry will be
a major driving force for the future
construction of a Chinese population.
It can help ensure the broad and
sustainable development of the
national fitness campaign as well as
support efforts to achieve the national
health system goals. It can also move
the focus of medical care from disease
treatment to health promotion and
disease prevention, which can greatly
reduce medical expenses and improve
the overall physical fitness and quality
of life of citizens.
Strengthening the National Health
System
According to the Healthy China
2030 Plan, the total scale of China’s
health service industry will exceed 8
trillion yuan by 2020 and will reach
16 trillion yuan by 2030. The sports
health industry is expanding in scale,
coverage, and industry chains, and
has incorporated winter sports and
cultural tourism, which is crucial for
the Healthy China 2030 Plan and
nationaleconomicgrowth.Duringthe
preparation and hosting of the 2022
Beijing Winter Olympics,the medical
and safety service stations, including
sports venues, fitness centres, and
sports health management platforms,
were significantly improved to meet
the safety and health protection of
sports participants. Hebei Province,
the main host of the Beijing Winter
Olympics, led the construction of a
coordinated health security pattern
acrossmultiplefieldsanddepartments.
Based on this successful experience,
future large-scale sports events, sports
activities, fitness, and recreation are
recognised as inseparable from the
solid medical security software and
hardware infrastructure and system
construction. Achieving a sports-
driven, health-promoting system
that leads in sports fitness, injury
prevention, and recovery, which fits
the concept of healthy cities and
sports cities,can enhance the practical
application of the Healthy China 2030
Plan across the nation.
PromotingChina’sSportsMedicine
Industry
During the 2022 Beijing Winter
Olympics, one joke alluding to skiing
injuries was circulated on social
media: “As 300 million people play
on the ice and snow, the end of the ski
slope is the orthopaedic department.”
Shiyi Chen
Sports Medicine in China after the 2022 Beijing Winter Olympics
Sports Medicine in China after the 2022 Beijing Winter Olympics
50
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However, Li Guoping, who serves as
a core member of the IOC’s Medical
and Scientific Committee, head of
the medical core expert group of
the 2022 Beijing Winter Olympics,
and the founding chairman of the
Chinese Society of Sports Medicine,
disagreed. He said: “Along the ski
slopes and ice rinks, the core is the precise
protection, prevention, treatment,
and rehabilitation provided by sports
medicine from start to finish, including
the construction of rescue teams with ski
doctors and the application of minimally
invasive reconstruction and sports
rehabilitation technologies.” Therefore,
he believes that “the end of the ski slope
should be happiness and health, and the
higher goal is to return to sports after
injury.”
Sports medicine was once defined
as “Special Medicine”, and now it
is rapidly developing as a national
secondary discipline of clinical
medicine. Since the establishment
of the Chinese Society of Sports
Medicine in 2007, the connotation
of sports medicine in China has been
continuously expanded and enriched.
Although sports medicine was
previously exclusively dedicated to
serving elite athletes,it now combines
theories, methods, and technologies
from internal medicine, surgery,
traditional medicine, rehabilitation
medicine, and diagnostic imaging to
achieve sports injuries prevention,
treatment, and rehabilitation for the
general public.
Furthermore, the continued large-
scale development of winter sports
will provide important insights
and opportunities for the Chinese
sports medicine community in seven
areas. These topics include health
promotion by exercise, medical
services and protection for winter
sports events, precise treatment and
management of winter sports injuries,
international exchanges in winter
sports medicine, and innovation and
translation in sports medicine.
Health Promotion by Exercise
Exercise is beneficial for fitness and
disease prevention and can enhance
physical fitness and immune function.
However, chronic diseases such as
hypertension are more prevalent
during winter months, due to the
increased blood viscosity, reduced
blood circulation, and winter haze
events (e.g. increased PM2.5
), which
can negatively influence respiratory
health. Examining the impact of
winter sports on health outcomes
can open new directions for sports
medicine. In order to implement
the Healthy China 2030 Plan, health
leaders should be committed to
ensuring the widespread promotion
of fitness to prevent chronic diseases
and strengthen health service
management.
Medical Services and Protection for
Sports Events
Providing medical care and support
for major domestic and international
athletic events has always been a core
mission and key research area. Higher
demands may be placed on the rescue
system, medical treatment level, and
facility conditions for sports team
services and event support. Sports
medicine experts should lead next
steps to establish a fully equipped
medical centre to monitor and treat
sports injuries and strengthen the
treatment model observed during the
2022 Beijing Winter Olympics.
Comparedwithsummersports,winter
sports have higher requirements
in terms of technology, venues,
safety protection, and emergency
equipment. For example, winter
sports require high-speed skating
and sharp turns, which place high
demands on physical qualities such as
strength, core stability, explosiveness,
endurance, coordination, balance, and
joint mobility. To minimise potential
sports injuries, it will be crucial to
promote the value of winter sports
across China and the world,especially
better understanding the injury
risks, taking precautions to protect
health, and familiarising oneself with
emergency treatments.
Precision Treatment and
Management of Winter Sports
Injuries
At the 2022 Beijing Winter
Olympics, many athletes returned
to the field after receiving medical
treatment for injuries (e.g. knee
ligament injuries), continuing to
bring honour to their countries.
Arthroscopic minimally invasive
surgery, as the preferred surgical
treatment for tendon and ligament
injuries and ruptures, can be
performed quickly with subsequent
sports rehabilitation, for prompt
recovery and return to competitive
sports. As diverse winter sports
are promoted across China, health
leaders should explore other surgical
and non-surgical treatment options,
as part of precision (or personalised)
medicine.
As sports injuries like knee ligament
injuries may require surgical
interventions, soft tissue sprains can
imply conservative management
without surgery. However, sports
medicine requires careful evaluation
and treatment, to reduce risk of
chronic impairment with sequelae.
In 2005, the new concept of sports
rehabilitation was first proposed
in China, shifting from traditional
rehabilitation to the integration of
sports and medicine and emphasising
personalised patient guidance. As
the authors have estimated that
the total scale of China’s sports
medicine market will reach 200
billion yuan in the future, where half
of revenue accounts for non-surgical
management, health leaders should
explore ways to promote the value of
the sports rehabilitation industry.
Sports Medicine in China after the 2022 Beijing Winter Olympics
51
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International Exchanges in Winter
Sports Medicine
The 13th Five-Year Plan for Sports
Development proposes to strengthen
and expand international cooperation
and exchange in sports and engage
in mutually beneficial collaborations.
By learning from international
winter sports training programs,
Chinese health leaders can identify
knowledge and practice gaps and
develop strategies to improve
training programs for the Chinese
athletes’ safety as they prepare for
competitions.
Innovation and Translation in
Sports Medicine
The history of the Summer and
Winter Olympics has been closely
linked to research and innovation
in sports medicine. The 2022
Beijing Winter Olympics were held
during the coronavirus disease 2019
(COVID-19) pandemic. Notably,
behind the Bird’s Nest Stadium,
where the opening and closing
ceremonies were held, scientists
contributed to technological
innovations and applications in
various fields, including closed-loop
health monitoring for competition,
5G technology, cloud computing, big
data and artificial intelligence, winter
sports rescue, air transportation, and
remote medical consultations.
Summary
The Healthy China 2030 Plan has
established a set of priorities for the
populace, including “To encourage 300
million people to practise winter sports”,
that physical exercise can reduce
risks of chronic diseases. Significant
movement to participate in winter
sports was observed after the 2022
Beijing Winter Olympics. As an
emerging discipline, sports medicine
represents a multidisciplinary
system that focuses on the sports
injury treatment, rehabilitation, and
prevention. Specifically, two main
goals of sports medicine in China
include “promotion by exercise” and
“function priority, early rehabilitation,
and return to sports”. Moving
forward, sports medicine can identify
lessons learned during the 2022
Beijing Winter Olympics and
continue to promote integrated
scientific research that explores
how technology can help advance
treatment, rehabilitation, and
prevention approaches for the global
population.
Shiyi Chen, MD
President, Chinese Society of Sports
Medicine, Chinese Medical Association
Department of Sports Medicine,
Huashan Hospital, Fudan University
Shanghai, China
cshiyi@163.com
Sports Medicine in China after the 2022 Beijing Winter Olympics
52
As food. security and safety are
directly related to nutritional health
outcomes, limited access to adequate
food intake can lead to underweight
(e.g. wasting, stunting) or overweight
conditions and negative health
impacts. As a result of the 1996
World Food Summit, food security
is defined “when all people, at all times,
have physical, [social] and economic
access to sufficient, safe and nutritious
food which meets their dietary needs and
food preferences for an active and healthy
life” [1]. This definition describes the
four elements of food security as food
availability (sufficient production
and supply of high-quality food),
food access (adequate food supply
at the household level), utilisation
(biological process of food ingestion
that influences nutritional health
outcomes), and stability (consistent
state of food availability, access, and
utilisation) [1].
According to the United Nations
(UN), an estimated 735 million
people (9.2% of the global population)
conveyedfacingchronichunger(when
compared to 613 million in 2019),
and 2.4 billion people expressed
living with moderate to severe food
insecurity (when compared to 391
million in 2019) in 2022 [2]. Also,
the World Health Organization
(WHO) reported that approximately
420,000 deaths and 600 million
cases (1 in 10 persons) of food-
borne illnesses each year result from
ingesting contaminated foods [3].
This global burden is especially
challenging for low- and middle-
income countries (LMICs), with
more than US $110 billion annual
estimated losses from economic and
health expenditure due to unsafe food
[3]. Noting the multidimensional
nature of food security, it is essential
to understand the emerging risks to
food systems, such as limited political
commitment, climate or weather
variability, urbanisation (e.g. loss of
lands), health status (e.g. immune
function to combat infectious
diseases), consumer choices of
convenient and pre-packaged foods
(including fast foods), and economic
access to food supplies [1].
The UN Sustainable Development
Goals (SDGs) present the close
connections of food security and
safety to at least 12 of the 17 goals,
namely reducing poverty (SDG 1),
reducing hunger (SDG 2), optimal
health and well-being (SDG 3), work
productivity and economic prosperity
(SDG 8), responsible production and
consumption(SDG12),andcollective
action and partnerships (SDG 17)
[4,5]. To achieve these ambitious
goals, food systems should
apply the One Health concept
(interconnectedness of humans,
animals, and surrounding
WMA Members Discuss National Initiatives
to Enhance Food Security and Safety
WMA Members Discuss National Initiatives to Enhance Food Security and Safety
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Credit:
Riccardo
Mayer
/
shutterstock.com
53
environments) and enhance multi
sectoral coordination across scientific
disciplines and sectors, which can
ultimatelyincorporateevidence-based
scientific findings into management
and policy decisions, strengthen
stakeholder communication and
engagement, support safe domestic
and international trade, and promote
proactive systems to identify and
respond to emerging risks [5].
Over the past decade, the road to
ensure high-level commitments for
endorsing global food safety led to
the UN General Assembly’s adoption
of Resolution 73/250 in 2018 and the
World Health Assembly (WHA)’s
approval of the Resolution WHA73.5
in 2020, declaring World Food
Safety Day on 7 June (https://www.
who.int/campaigns/world-food-
safety-day/2024) [6,7]. This annual
celebration, led by the WHO and the
Food and Agriculture Organization
(FAO) of the UN, offer a renewed
focus on supporting high-quality
food sources for health and well-
being, sustainable development,
agriculture productivity, and
economic prosperity. The 2024
theme, “Food Safety: Prepare for the
Unexpected”, presents an opportunity
for community citizens (from
consumers to producers) to reflect
upon the collective responsibility of
strengthening food systems as well
as recognize existing challenges (e.g.
extreme weather events like droughts
and floods, reduced crop yield) that
impact food access and availability
across global communities.
To advocate for equitable and
sustainable nutrition actions, global
health leaders should first examine
food and nutrition security across
nations, such as the Global Nutrition
Report (https://globalnutritionreport.
org/) and Global Alliance for Food
Security (https://www.gafs.info/
home/), and analyse epidemiological
trends and existing challenges of food
systems facing communities. This
valuable information can help leaders
design relevant local and national
initiatives that foster multi sectoral
collaborations with community
stakeholders and meet community
needs. In this article, physicians from
six countries – Argentina, Myanmar,
Philippines, South Africa, Trinidad
and Tobago, and Uruguay – provided
a holistic view of local, national, and
regional efforts to promote food safety
through timely policy development,
community outreach, and capacity
building across their national health
systems.
Argentina
Foodborne illnesses pose a significant
public health challenge to health and
well-being in Argentina, and the
World Food Safety Day offers a call
to act as guardians of life, committed
to unravelling and eradicating the
invisible threats that lurk in our food.
Argentina, a country of 44 million
residents, has a diverse geography
and climatology regimes, serving as
a major food producer and exporter
for soybean and beef, but also other
staple products (e.g. barley, cotton,
maize, mate, rice, sorghum, sugar,
tobacco wheat) [8].The Government
of Argentina has made strides in
improvingfoodsafety,albeiteconomic
crises over the past two decades, but
existing challenges highlight the need
for continued vigilance and action.
Over the past few years, the
Government of Argentina has
implemented various policies and
programs to enhance food safety. In
2019, the Government of Argentina
adopted the Food Emergency
Law (Ley 27519 de Emergencia
Alimentaria), valid until December
2022, which will permit a 50%
increase (8,000 million Argentine
pesos or US $135 million) in food
assistance to the nation [9]. Also,
in 2019, the National Food Security
Plan (Plan Nacional de Seguridad
Alimentaria, PNAS) was launched,
with the aim of enabling access to
complementary food resources for
populations experiencing social and
nutritional vulnerabilities, including
children (less than 14 years of age),
elderly, pregnant women, and persons
with disabilities [10]. In 2021, the
Promotion of Healthy Eating Law (Ley
27642 de Promoción de la Alimentación
Saludable) was approved, which
established the addition of health
advisory labels (e.g. calories, saturated
and total fats, sodium, sugars) on the
front of food packages as well as the
implementation of food and nutrition
education in primary and secondary
schools [11,12]. Also, in 2021, the
“Argentina against Hunger” National
Plan (Plan Nacional “Argentina contra
el Hambre”) was adopted, which
promoted wider access to the basic
food basket distributions [13].Finally,
social leaders and municipalities
have regularly supported community
initiatives, such as the “Safe Foods”
(“Alimentos Seguros”) campaigns,
which help increase public awareness
about proper food handling and
preparation practices.
Furthermore, notable efforts have
been made across the Americas
region to support food and nutritional
security. The Food Code (Codex
Alimentarius) is a collection of food
standards, guidelines, and codes,
which is an essential element of the
FAO and WHO Food Standards
Program to safeguard consumer
health and fair practices in food trade
[14]. The Pan American Alliance
for Nutrition and Development has
fostered regional cooperations to
address food safety and nutrition
challenges [15]. Although these
robust efforts are widely recognised,
more work is needed to strengthen
food safety regulations, improve
health surveillance systems, and
promote collaboration among
stakeholders across the food supply
chain.
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WMA Members Discuss National Initiatives to Enhance Food Security and Safety
54
On this international health day,
physicians can continue to lead this
global movement that advocates for
elevated food safety standards across
the Americas region and globe.
Only when we conquer the dangers
that exist on our plates can we fully
celebrate the culinary arts as a true
expression of health, well-being,
and the joy of living. Together, we
can promote a world where resilient
systems ensure the integrity of every
ingredient that reaches our tables,and
every bite represents a celebration of
nutrition, not a risk to our well-being.
Myanmar
In Myanmar, a country of 53 million
residents and 135 ethnic groups, the
agricultural sector represents the core
of the national economy, including
32% of the gross domestic product,
56% of the labour force, and 21%
of exports [16]. However, according
to the World Food Programme, an
estimated 2.8 million Myanmar
citizens are recognised as food
insecure in 2021 [17]. Since the
start of the Myanmar coup on 1
February 2021, food insecurity and
hunger have become even more
widespread, further exacerbating
conditions resulting from climate
change and the coronavirus disease
2019 (COVID-19) pandemic, with
potential risks for food insecurity to
up to 3.4 million additional residents
[17]. By obstructing assistance
delivery and arresting humanitarian
personnel, the military has denied
food, water, and essential medications
to the displaced population [18].
The combined rise in food products
(e.g. rice, cooking oil) and fall in
agricultural output has posed a
danger to food availability for one-
fifth of the 54 million residents [19].
Furthermore, Myanmar military and
security use massive quantities of
fossil fuels in their bombard aircraft
and tanks, resulting in environmental
disturbances like forest destruction,
emissions of greenhouse and other
poisonous gases, and damage to water
infrastructure, as well as population
exposures to harmful air, water, and
soil quality.
The National League for Democracy
(NLD), an influential pro-democracy
party established in 1988, had
supported a food sector reform in
2016. The strategic plan aimed to
provide food and nourishment to
food-insecure regions, with the vision
that Myanmar’s under-five children
would have improved their nutritional
status aligned with government goals
by 2022 [20]. However, as part of
this political crisis, the NLD’s food
sector reform plan was halted, and
hence there was a drastic reduction
in agricultural production. Food
security across the country is now
jeopardised, and farmers are unable to
return home to work their land due to
the military-installed land mines on
the premises [21]. Through military
operations (e.g. using fighter planes
to attack agricultural fields, setting
entire communities on fire), farmers’
homes, possessions, and crops (e.g.
rice, paddy, bean, pulse seeds) have
been set ablaze and destroyed by the
junta’s soldiers.
To date, Myanmar’s people continue
to be targeted by Myanmar’s military
and security forces, and humanitarian
aid is needed through financial
transfers, food distribution and
nutrition programs, and livestock
and fisheries restocking in regions
damaged by Myanmar’s military and
security forces [22]. As next steps, we
put forward a plea to international
organisations (including the WMA
and Junior Doctors Network) and
the wider community, to advocate for
urgent localised action to strengthen
food security and support for the
Myanmar population.
Philippines
The Philippines, an island nation
with a complex geography of the
archipelago with more than 7,000
islands, alongside socio-economic
disparities, has observed unique
obstacles to food availability, access,
utilisation, and stability for citizens.
However, since 2020, the nation is
taking strides through a variety of
measures to ensure that every Filipino
has access to adequate, nutritious,
and sustainable food sources. To
support this commitment, an inter-
agency task force was established
under Executive Order No. 101,
dubbed the Zero Hunger Task Force
(National Food Policy) on 10 January
2020, which focuses on ensuring
the availability and accessibility of
food for all Filipinos, as to eradicate
hunger and achieve food security by
2030 [23].
Over the past decade, the
Department of Agriculture (DA) has
implemented several programs and
projects to support food productivity
and accessibility for the nation. First,
the Comprehensive National Fisheries
Industry Development Plan 2021-2035
was developed in 2016, to ensure the
sustainability of marine resources
and improve the livelihood of coastal
communities [24]. Second, the
Kadiwa ni Ani at Kita was launched
in September 2019, as a market
linkage between food producers and
consumers that provided high-quality
produce to consumers and ensured
fair prices for farmers and fisherfolk
[25]. Third, the “Plant, Plant, Plant
Program” (“Ahon Lahat, Pagkaing
Sapat, ALPAS, Laban sa COVID-19”)
program was established in 2020, to
promote the national agri-fishery
industry through innovative
technologies and farming and fishery
practices, to support farmers, fishers,
and consumers [26]. Fourth, the
Philippine Integrated Rice Program
was developed in 2020, to improve
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WMA Members Discuss National Initiatives to Enhance Food Security and Safety
55
rice productivity and achieve rice self-
sufficiency through the use of hybrid
seeds, modern farming techniques,
and adequate irrigation [27]. Finally,
the Urban Agriculture Program was
developed in 2020, to encourage
city dwellers to start gardening in
their backyards, empty lots, and even
containers [28].
As the Government of the Philippines
recognised early on that food safety,
nutrition, and food security are
inextricably linked, leaders enacted
the inaugural Code on Sanitation of
the Philippines (PD. 856) in 1975,
to serve as a reference and guide
for enforcing sanitation standards
(including food establishments).
More recently, the Food Safety Act
of 2013 (RA 10611) established
the foundation for implementing a
farm-to-fork food safety regulatory
system, which aimed to safeguard
consumer health, promote fair trade
practices, and enhance the global
competitiveness of Philippine food
products. It has achieved these goals
by managing hazards in the food
chain, implementing precautionary
measures informed by scientific
risk analysis, and aligning with
international standards [29]. To
support these food safety standards, a
NationalCodexTechnicalCommittee
was established in 2005, and
Presidential Proclamation No. 160 was
adopted in 1999, to commemorate
Food Safety Awareness Week each
October [30]. Future directions
include reassessing policy frameworks,
establishing and strengthening
partnerships to incorporate food
safety into mainstream practices,
ensuring protection against cross-
contamination and foodborne
illnesses, improving public education
through comprehensive information
dissemination, and acknowledging
the pivotal role of food safety in
achieving food security [31].
Indeed,the journey towards achieving
food security in the Philippines is
multifaceted, requiring concerted
efforts from the government, private
sector, civil society, and communities.
By addressing the challenges in
agricultural productivity, empowering
local producers, adopting
nutrition-sensitive approaches, and
strengthening food supply chains,
the Philippines is making significant
progress toward the realisation of
the SDG of Zero Hunger. As these
efforts continue to evolve and expand,
the nation moves closer to ensuring
that every Filipino has access to safe,
nutritious, and sustainable food, not
just today, but for generations to
come.
South Africa
Although South Africa, a country
of 57 million residents, is recognised
as Africa’s economic powerhouse,
the Global Hunger Index was
estimated at 13.0 (moderate) in 2023,
on a scale of 0 (no hunger) to 100
(alarming hunger) (https://www.
globalhungerindex.org/south-africa.
html) [32]. Based on the General
Household Survey in 2021, the
Statistics South Africa reported that
an estimated 2.1 million households
experienced hunger, 2.6 million had
inadequatefoodaccess,and1.1million
reported severe inadequate food
access in South Africa [33]. As food
insecurity is driven by socioeconomic
inequalities, cheaper counterfeit
foods (foods produced without safety
standards) lack nutritional value and
may contain harmful substances, as
observed with documented reports of
hospital admissions and child deaths
[34,35].
The Government of South Africa
has adopted two key policies and
community actions to address the
challenge of food security. First, the
Foodstuffs, Cosmetics and Disinfectant
Act 54 of 1972 established guidelines
for manufacture,sale,and importation
of food items, cosmetics, and
disinfectants in South Africa. The
government employs environmental
health officers across each district,
with primary responsibilities to
inspect food products that are sold in
formal and informal establishments.
Second, the National Policy on Food
and Nutrition Security for South Africa
(2018-2023) was launched in 2017,
to present a situation analysis,identify
quantitative metrics to measure trends
over time, and promote best practices
to establish clearly [36]. Finally, the
Government of South Africa has
clamped down on syndicates that
manufacture counterfeit food by
investigating and prosecuting cases
of unregulated food production
and sales. As clandestine factories
continue to exist, coupled with the
increased number of migrants who
ship foods to their home countries,
further actions are urgent to hault
the production and sale of counterfeit
foods from continuing to spread
throughout the region.
Stronger food security in South
Africa and the African continent is
essential to ensure economic growth
and promote food safety to all
Africans.Without strong policies and
law enforcement efforts to stomp out
counterfeit foods, the African region
can anticipate growing healthcare
expenditure, especially related to
non-communicable diseases (like
cancers) management. Economic
transformation policies have the
potential to reduce inequalities and
eradicate poverty.
Notably, doctors working in the
public sector and non-governmental
organisations have a fundamental
role in identifying community
members who experience hunger or
malnutrition and referring them to
relevant social programs.For example,
doctors can partner with charitable
organisations with missions relevant
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WMA Members Discuss National Initiatives to Enhance Food Security and Safety
56
for distributions of food resources to
community members experiencing
food insecurity and help alleviate need
for themselves and their families.
Trinidad and Tobago
The Caribbean Public Health
Agency (CARPHA) estimates that
1 in 49 persons in the Caribbean (or
142,000 persons) would be exposed
and ill with foodborne pathogens
each year. Notably, infants of ages
1-4 years account for 40% of these
cases [37]. Globalisation increases the
risk and spread of foodborne illnesses
in Trinidad and Tobago, as it entails
the spatial and temporal distribution
ofmassmovementofpersonsandfood
products, ingredients, equipment,
and supplies. Since the consumption
of contaminated food products
distributed throughout a region can
have detrimental economic impacts
on food corporations, such as massive
recall programs, the economic and
reputational impacts of foodborne
illnesses are of significant national
concern to Caribbean nations that
depend on tourism.
As climate change is inextricably
linked to food safety, Caribbean
nations will need to implement
adaptations that will strengthen
food production and distribution
systems and reduce risk of exposure
to emerging foodborne pathogens, in
order to mitigate microbial adaptation
and antimicrobial resistance. This is
further compounded by inadequate
public health resources, including
infrastructure and limited support
for policy, legislation, and funding of
public health initiatives to improve
food safety. To prioritise food safety,
the Republic of Trinidad and Tobago
in collaboration with CARPHA
and the Pan American Health
Organization (PAHO) hosted two
workshops in Trinidad and Tobago
and Barbados in January 2024, in
order to strengthen the Climate
Resilient Food and Water Safety
Plans for Trinidad and Tobago [38].
Also, Trinidad and Tobago leaders
support the ongoing evaluation of the
National Food Safety Policy of Trinidad
and Tobago (2018-2023), as a policy
that provides a harmonised approach
amongst governmental agencies and
key stakeholders, to achieve food
safety and consumer health protection
[39].
Across the Caribbean, physicians
play an important role in reducing
the spread of foodborne illnesses as
individuals afflicted with the illness
would first seek medical attention.
Early warning signs can prompt
physicians to alert other members of
the health team to initiate an outbreak
response and identify sporadic cases
and clusters for prevention and
control efforts.However,as laboratory
capacity across LMICs may be limited
to identify all microbiological (e.g.
viruses, mycotoxins) and chemical
agents (e.g. pesticide residues),
physicians may be unable to properly
treat the foodborne illness without
understanding the microbiological
and chemical aetiology. Furthermore,
physicians also serve a secondary role
as food safety educator, and their
direct interactions educating patients
on these potential risks is crucial.
As future steps, national authorities
can advocate to strengthen regulatory
compliance, food safety systems
along the food continuum from
farm to table, and educational food
safety campaigns for consumers.
They can also promote collaborative
teamwork amongst all stakeholders
including regulatory agencies,
public health institutions, producers,
processors, distributors, wholesalers,
retailers, and consumers. Finally,
medical training programs should
consider incorporating food safety
in the curricula or adding continuing
education programs to emphasise
food safety, to prepare physicians
to manage outbreak scenarios and
patient education in the clinical and
community setting.
Uruguay
In Uruguay, a population with
3.5 million residents, food and
nutritional insecurity represents a
significant challenge. Findings from
the National Household Income
and Expenditure Survey reported
that 14.6% of Uruguayan households
(and 16.3% of the population) face
a moderate or severe degree of food
and nutritional insecurity [40].
There are higher documented rates
of food security (15.6% moderate
and 3% severe levels) in the capital
city of Montevideo (departments of
Artigas, Tacuarembó, Rivera, Cerro
Largo, Treinta y Tres), and lower
documented rates in the central and
eastern regions (departments of
Flores, Florida, Durazno, Lavalleja,
Maldonado, Rocha) [40]. As data
clearly reveal stark differences in
food insecurity across Uruguay,
further exploration of driving factors
affecting this variation can lead to
timely policies that can be developed
and implemented to address these
regional discrepancies.
Overthepastdecade,theGovernment
of Uruguay has supported several
national policies and plans to support
access and availability of food
resources for the population. In 2006,
the Uruguay Social Card (Tarjeta
Uruguay Social) (formerly, the Food
Card) was approved, where home
visits to populations experiencing
socioeconomic vulnerability offered
monetary benefits to help improve
accessibility to food and other
basic necessities [41]. In April
2023, the Uruguay’s Ministry of
Social Development (Ministerio
de Desarrollo Social) adopted
the Territorial Food Plan (Plan de
Alimentación Territorial, PAT),
which aims to expand the number
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WMA Members Discuss National Initiatives to Enhance Food Security and Safety
57
of dining facilities of the National
Dining System (Sistema Nacional
de Comedores) and deliver meals
to low-income and marginalised
communities. To support these
initiatives, the Ministry of Social
Development also educates residents
on food safety and storage, to help
extend the quality of food sources. As
the program is operational six days
a week (closed on Sundays), double
portions are provided on Saturdays
[42].
To reflect the Government of
Uruguay’s commitment to reducing
nutritional and food insecurity among
its population, additional efforts
have promoted the search for self-
sustaining and sustainable solutions
to ensure that all citizens enjoy the
full right to adequate nutrition.
Within state policies, national leaders
recognize the role of family farming
to achieve Food Sovereignty in rural
communities. This policy promotes
the access to organic foods,
nutritionally adequate to the
requirements of the population,
which can help reverse food and
nutritional insecurity across the
country. Leaders have met with
farmers (including those with small
and family farms) and collaborated
on the implementation of specific
trainings in economic financing and
other forms of professional assistance,
which not only increase food
production, but also improve their
quality of life.These resources benefit
farmers and their families, as well
as contributes to the strengthening
of local economies and reducing
dependence on food imports [43].
As physicians contribute to leading
clinical care across health institutions,
it is important to highlight the crucial
role that nutrition professionals play
inmultidisciplinaryteamsdedicatedto
tacklingfoodinsecurity.Consequently,
they collaborate with health teams to
ensure that patients have access to
safe and secure nutritional sources,
balanced by sufficient quantity and
high-quality nutritional value. Their
expertise is an essential component
of the healthcare team, where they
help strengthen each individual’s
ability to maintain a healthy lifestyle
through optimal nutritional intake
and support the related targets of the
2030 UN Agenda for Sustainable
Development.
Conclusion
The World Food Safety Day offers a
timely opportunity for global leaders
to identify existing barriers that
hinder the access and availability of
high-quality and safe food sources
across communities. Food systems
are complex and involve diverse
stakeholders,ranging from consumers
to producers, requiring a holistic
view to better understand the food
chain (e.g. distribution, processing,
retail, service), farming practices and
post-harvest activities, and consumer
behaviours (including food waste) [5].
Since food security and safety topics
overlap with at least 12 of the 17
SDGs, leaders can collectively discuss
emerging risks to food systems (e.g.
impact of climate change on crop
yield or pathogen transmission),
brainstorm on sustainable solutions to
promote equitable food systems (e.g.
farm-to-table initiatives enhanced
foodsystemsmonitoring),anddevelop
relevant policies, partnerships, and
community activities that prioritise
nutritional health outcomes.
WMA members regularly contribute
their clinical expertise to scientific
discourse on diverse health topics
that directly impact population
health outcomes across their nations
and geographic regions. In their
clinical role, physicians can help
identify patients experiencing food
or nutritional insecurity, collaborate
with the healthcare team,and connect
patients with available community
and state resources. For example,
three specific clinical questions –
Within the past 12 months, have you felt
anxious about running out of food before
you were able to buy more food? Have
you run out of food and were unable
to buy more food? Have you obtained
resources from a food bank? – can help
physicians maintain an open dialogue
with patients, examine nutrition risks
associated with social determinants of
health, and create a safe environment
by reducing shame or stigma [44].
Furthermore, in their academic role,
they can encourage medical school
administrators to incorporate food
systems courses in existing curricula
or continuing education courses and
hence prepare future physicians to
address emerging global health topics.
This collective article provides
a comprehensive review of local
and national policies, stakeholder
engagement and risk communication,
and public activities that increase
awareness of foodborne risks
(including antimicrobial resistance
and zoonotic diseases) and drive
community action to ensure proactive
food systems for all ages. These
collaborations exemplify the robust
leadership across African, Americas,
South-East Asian, and Western
Pacific regions, highlighting novel
policies and events that underscore
the fundamental role of sustainable
agriculture to ensure food security
and safety and safeguard population
health.
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WMA Members Discuss National Initiatives to Enhance Food Security and Safety
Authors
Maria Minerva P. Calimag,
MD, MSc, PhD
Departments of Pharmacology
and Clinical Epidemiology,
University of Santo Tomas, Faculty
of Medicine and Surgery
Manila, Philippines
Helena Chapman, MD, MPH, PhD
Milken Institute School
of Public Health,
George Washington University
Washington DC, United States
Maymona J. Choudry,
RN, MD, MPH
Department of General Surgery,
Vicente Sotto Memorial Medical Center
Cebu City, Philippines
Mark Dookeran, PhD
(Food Science and Technology),
Chief Public Health
Inspector, Trinidad and Tobago
Ministry of Health
Part-Time Senior Lecturer,
Department of Chemical
Engineering, St. Augustine Campus,
University of the West Indies
Port of Spain, Trinidad and Tobago
José Lodovico Palma, MD
Secretary, Institutional Relations,
Confederación Médica de la
República Argentina (COMRA)
Buenos Aires, Argentina
Mhlengi Vella Ncube, PhD
Head, Unit for Health
Policy and Research
South African Medical Association
Pretoria, South Africa
Guillermo Silva Marins
Nutritionist
Representative, Asociación Uruguaya
de Dietistas y Nutricionistas
Montevideo, Uruguay
Débora Sotelo, MS
(Clinical Nutrition)
Nutritionist
Representative, Asociación Uruguaya
de Dietistas y Nutricionistas
Salto, Uruguay
Wunna Tun, MBBS, MD
Fellow, Medical Education
JDN Secretary
Yangon, Myanmar
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