The world needs an effective WHO
During the high-level segment the previous day, UN Secretary-General António Guterres, the WHO director general, and heads of state, including French President Emmanuel Macron, addressed the session.

“The pandemic demonstrated why the world needs the WHO, but also why the world needs a more effective WHO, with more authority and sustainable funding. I welcome the recommendation of the Sustainable Financing Working Group to increase mandatory contributions to 50 percent of the base budget over the next decade,” said WHO Director General Dr. Tedros Gebreyesus at the opening of the Assembly.

“We still face many challenges, and we must decide exactly where we are now. The pandemic is far from over. And as we continue to fight it, we face the challenge of rebuilding public health, as 90 percent of member states report disruption of one or more essential health services,” he added.

Address by the First Lady of Ukraine
Ukraine’s first lady, Olena Zelenskaya, addressed the Assembly plenary on Monday. She called on the WHO to help address the country’s mental health crisis, warning that the effects of the war with Russia could be felt for decades.

“The war unleashed by Russia has shown us horrors we could not even imagine,” the first lady of Ukraine said. – The WHO has committed itself to protecting the most important human rights – the rights to health and life. Both of these rights are now being violated in Ukraine. Not a single Ukrainian – neither a child nor an adult – is sure that tomorrow he or she will just wake up, that a missile will not hit the house where that person lives. Doctors are not sure that ambulances will not be bombed on their way to patients.”

Zelenska called on the WHO and the international community to help Ukraine with mental health recovery for survivors of the war. “After what Ukrainians experienced during the occupation, at the front, in bomb shelters, under bombing, abroad … they need rehabilitation just as much as those who were physically injured,” Zelenska said.

Responding to emergencies
The Health Assembly will discuss global strategies for food safety, oral health and tuberculosis research and innovation. The session will also discuss the report of the WHO Sustainable Finance Working Group.

Strengthening WHO’s preparedness and response to health emergencies, prevention of sexual exploitation, violence and harassment, polio control and the global Health for Peace initiative are also on the agenda.

The Health Assembly is WHO’s highest decision-making body, setting policy for the organization and approving its budget. Delegations from all of WHO’s 194 member states participate in WHA.

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Monkeypox is a rare viral disease that usually occurs in the forested areas of Central and West Africa, which are home to animals that carry the virus.

The WHO said in a statement that so far about 80 cases of infection have been confirmed in 11 countries worldwide, with another 50 cases being studied.

“As we enter the summer season in the European region with mass gatherings, festivals and parties, I am concerned that there will be more cases of infection…,” said WHO European Regional Director Hans Kluge.

Monkeypox is transmitted by direct human-to-human contact, including sexual contact, or by contact with contaminated materials.

Monkeypox is a usually self-healing disease with symptoms lasting 14 to 21 days. The infection usually causes mild symptoms, with itching or pain in the affected areas on the skin; in some cases, the infection may be more severe.

The number of cases in the region is relatively low at this point, but the fact that some of the cases do not appear to involve travel to countries where monkeypox is endemic is a cause for concern.

Many cases are detected in clinics specializing in sexually transmitted infections. At this point, it is unclear how widely the virus is circulating in the population, but an increase in cases should be expected in the coming days.

The WHO said people with suspected illness should be tested and isolated.

WHO is working closely with countries in the region, sharing information and supporting the detection and investigation of cases.

WHO says it is monitoring the rapidly evolving situation and will publish updates on it.

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The Global Report on Assistive Technology presents, for the first time, data on global need and the reality of access. The document outlines recommendations for improving the lives of millions of people with disabilities through modern devices.

“Assistive technologies change lives: they enable children with disabilities to get an education, and adults to be employed and have social contacts, and the elderly to have an independent life with dignity,” said WHO Director-General Tedros Gebreyesus.

He stressed that denying people wheelchairs and other devices is not only a violation of human rights, but also shortsighted in terms of economics. The head of the WHO called on all countries to fund programs for access to assistive technologies and “give everyone a chance to realize their potential.

240 million children with disabilities

Today, nearly 240 million children have disabilities. Denying these children the technology they need to develop is harming society as a whole. UNICEF Executive Director Catherine Russell emphasized that without wheelchairs and other assistive technology, children with disabilities would be denied an education and would be at greater risk of child labor, stigma, and discrimination.

The authors of the report believe that by 2050, the number of people needing one or more assistive devices is likely to rise to 3.5 billion. Part of this trend is due to a rapidly aging population and an increase in non-communicable diseases.

Disparities in access to assistive devices
Experts note a huge gap in access to wheelchairs between people with disabilities who live in rich and poor countries. In industrialized countries, 90 percent of all people with disabilities have access to the devices they need, while in poor countries, only three percent do.

The main reason for this situation is that many devices are unaffordable for people with disabilities and their families. About two-thirds of the people who use assistive devices reported that they paid for them out of their own pockets. Others had help from family members and friends.

Assistive devices are a means for people with disabilities to participate in community life and in society at large on an equal basis with others. Without wheelchairs and other aids, people with disabilities are often isolated and live in poverty.

Access to assistive technology for children with disabilities is often the first step toward development, access to education, participation in sports and community life, and preparation for employment.

The authors of the report made a number of specific recommendations to improve access to needed accommodations for people with disabilities.
Among other things, they suggested investing in innovations that improve the lives of people with disabilities, as well as including the supply of assistive technology in humanitarian operations.

The Convention on the Rights of Persons with Disabilities

Let’s remind that the Convention on the Rights of Persons with Disabilities, adopted in December 2006, entered into force in May 2008. About 160 countries of the world ratified it. It became the first legally binding international agreement on protection of this vulnerable category of the population. The document contains 50 articles, which set forth measures aimed at the protection and promotion of the rights of persons with disabilities, the elimination of discrimination against them, ensuring their right to work, health care, education, full participation in society, access to justice, security of person, freedom from exploitation and abuse, freedom of movement, individual mobility, etc. The Convention points the way to the implementation of already existing universally recognized human rights as they pertain to persons with disabilities.

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• Recently in the USA the results of the research have been published. The research has revealed increased levels of bacteria resistant to antibiotics in people hospitalized during the pandemic of coronavirus infection, both those who underwent COVID-19 and those whose tests were negative. The researchers concluded that the pandemic had affected the bacteria’s development of resistance to antibiotics. Is there a similar trend in Russia and other countries?
• Indeed, the intensive use of antibiotics to treat COVID-19 complications provoked a burst of antibiotic resistance in bacteria and fungi. For example, there is now a rapid increase in the incidence of deep mycoses, which are extremely severe and cause high mortality. Note that if we talk about pathogen resistance, we are not only talking about bacteria – fungi have recently begun to come out on top in terms of resistance to drugs.

Although the pandemic has played a negative role, in general the problem has a long history and is related to the massive use of antibiotics, which is only increasing every year. For example, use of these drugs increased by 65% from 2000 to 2015. Much of the increase is due to increased access to drugs in developing countries.

Antibiotics are indispensable in the treatment of infectious diseases, as well as for prevention of immune impairment, but the irrational and excessive use of such drugs has created a global problem of drug resistance of pathogens, which have adapted to survive in the presence of antibiotics.

Treating infections caused by resistant strains is much more difficult and expensive, and for panresistant microorganisms (those resistant to all known drugs. – RT) may have no effect at all.

Every day doctors are faced with infections that do not respond to available antimicrobials.

• The World Health Organization (WHO) has named the problem of antimicrobial resistance as one of the ten global threats to human health. How common are such infections and how often do doctors encounter them in their practice? What diseases are most often caused by them?
• There is a whole group of such pathogens. These bacteria cause nosocomial infections, which are difficult to treat and especially dangerous for weakened patients. It is in hospitals that the most suitable conditions for the emergence of such resistant microorganisms arise. Dangerous fungal diseases are also on the rise.

For example, some fungi previously known as typical saprotrophs (microorganisms that feed on dead remains – RT) are becoming pathogenic to humans. Especially with the COVID-19 pandemic, the number of fungi resistant to all antifungal drugs in use is growing.

At the same time, the development of new drugs requires very large resources: the development of a new effective antibiotic requires 10-12 years and requires $800 million to $2 billion.

Large foreign pharmaceutical companies and leading universities are engaged in such developments. However, on the whole, the pharmaceutical industry has not paid enough attention to this area in the last decade.

• How big is the “contribution” of medical organizations to the problem? For example, antibiotics are often prescribed to patients without microbiological studies, by blind selection. Can this also be a negative factor?
• Yes, the erroneous prescription of antibiotics without prior testing for pathogen sensitivity can contribute to the development of antibiotic resistance.
• Researchers at Australia’s Monash University recently found that a significant percentage of beef and salmon sold in supermarkets are populated by bacteria that are resistant to a variety of commonly used antibiotics. Another study has emerged that suggests antibiotic-resistant bacteria can be transmitted to humans from pigs – the animals’ microflora is gaining resistance due to the use of antibiotics on farms. Is the use of antibiotics in livestock farming one of the causes of resistant strains?
• Yes, this factor also contributes to the emergence of resistant strains. But this is due to human consumption of products containing antibiotic residues, not to the possible transmission of animal pathogens to humans.
• According to the WHO, none of the antibiotics currently in clinical development will be able to solve the problem of bacterial resistance, since almost all of the drugs belong to the old class of active ingredients. Does this mean that traditional antibiotics will soon cease to perform their functions?
• Antibiotics will continue to be used in medicine, but we just need to create drugs with a different principle of action. I would like to point out that the technology for developing traditional antimicrobials is also evolving. So now it is very important to modify classic antibiotics with semi-synthetic or synthetic antibiotics of the next generations.

Antibiotics are produced with the help of natural producers – special microorganisms – as well as by biosynthesis. Natural antibiotics have a number of advantages. They are structurally diverse, highly active against pathogens, and have a broad spectrum of action. However, their production is difficult to scale up.

In the last decade, biosynthesis has been increasingly used to produce antibiotics. In addition, work is underway to modify already known natural antibiotics using chemical or genetic methods.

The new substance must meet a number of requirements. For example, its molecules must be bioavailable – to penetrate the bacterial membrane and bind to specific targets in the pathogen. Also, such drugs should have no side effects, not be toxic, and be inexpensive to produce. Selecting a substance that meets all the necessary requirements is very difficult, so new antibiotics appear relatively rarely.

Of course, since the discovery of antibiotics in the first half of the 20th century, the search for new drugs has evolved considerably. In recent years, scientists have had access to microbial genome sequencing technology, which has opened up entirely new strategies for finding drugs.

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