Reducing Maternal Mortality in Low- and Middle-Income Countries Through Skilled Birth Attendants

Maternal mortality remains one of the most urgent and preventable global health challenges. Despite decades of international commitments, women in low- and middle-income countries (LMICs) continue to face an unacceptably high risk of death during pregnancy and childbirth. Increasing access to skilled birth attendants (SBAs) is one of the most effective and evidence-based strategies to reduce maternal mortality and advance global health equity.

Maternal Mortality as a Global Health Priority

The World Health Organization (WHO) has long identified maternal mortality as a global priority for improving global health outcomes. Maternal mortality is defined as the “death of a woman while pregnant or within 42 days of the end of pregnancy…from any cause related to or aggravated by the pregnancy.”

The United Nations Millennium Development Goal 5 (MDG5), which aimed to reduce the global maternal mortality ratio (MMR) by three-quarters, was not met by its 2015 deadline. As a result, the burden of avoidable maternal deaths persists in many low-resource countries, rural areas, and disadvantaged communities.

Current trends show a global maternal mortality ratio of 211 maternal deaths per 100,000 live births. In low- and middle-income countries, as defined by the World Bank, this ratio exceeds 800 maternal deaths per 100,000 live births. This unacceptable death toll highlights the urgent need for further action in resource-poor countries to address the major causes of maternal death and end avoidable maternal mortality by increasing investment, access, and equity in skilled birth attendants for all.

Background: Causes of Maternal Mortality in LMICs

According to the World Health Organization, the leading global causes of maternal death include hemorrhage, hypertension, and sepsis. A WHO systematic analysis identifies post-partum hemorrhage as the leading cause of maternal death in LMICs and worldwide, accounting for 21.7% of all maternal deaths.

Post-partum hemorrhage is preventable mainly with access to appropriate resources and timely care. However, when it occurs, hemorrhaging can lead to death in less than two hours. This makes it both one of the most preventable and most emergent maternal health complications. Focusing on this specific cause allows policy efforts to narrow their scope and target areas where intervention can have the most significant impact.

Global Commitments and Sustainable Development Goal 3.1

This policy statement is informed by the call to action outlined in Sustainable Development Goal (SDG) 3.1. Developed by the United Nations to extend and deepen the Millennium Development Goals, SDG 3.1 commits member states to reducing global maternal mortality and achieving a more sustainable and healthier future by 2030.

While global improvements have been achieved, maternal mortality declined by 38% over 17 years, with an average annual reduction of 3%. Progress remains uneven. These improvements are likely due to increased awareness, technological advancements, and improved access to healthcare resources in certain regions. However, maternal mortality continues to be a significant cause of death in LMICs, underscoring the continued relevance and urgency of SDG 3.1.

The Role of Primary Prevention and Health Systems Strengthening

Primary interventions addressing family planning, including contraception use, education, and access to legal and safe abortion services, have contributed significantly to reductions in maternal mortality. Research published in the Maternal and Child Health Journal indicates that the indirect effects of contraception use have saved one million lives in high-risk areas.

The Indonesian Family Planning Program demonstrates the impact of primary prevention. If similar programs were implemented in low-income areas, unmet family planning needs could be reduced from 10% to 7%, preventing more than 37,000 maternal deaths.

Despite these gains, achieving SDG 3.1 requires addressing unmet needs within health systems to reduce risks during pregnancy and childbirth. Improvements in skilled delivery and healthcare environments alone could reduce maternal mortality ratios by an additional 19–20%.

Skilled Birth Attendants and Maternal Mortality Reduction

While global progress has been made, LMICs (particularly in Sub-Saharan Africa) continue to experience disproportionately high maternal mortality rates. Sub-Saharan Africa accounts for nearly two-thirds of all maternal deaths worldwide. These regions face persistent challenges related to inadequate, inaccessible, and inequitable healthcare resources.

Skilled delivery is a critical intervention for reducing preventable maternal complications. The World Health Organization defines skilled birth attendants as accredited health professionals, such as midwives, doctors, or nurses, who have been educated and trained to a high level of proficiency. Evidence shows that where 100% of births are attended by skilled health staff, maternal mortality ratios fall to fewer than five deaths per 100,000 live births. This strong correlation underscores the life-saving impact of skilled birth attendance.

Purpose and Scope of the Policy Statement

The purpose of this policy statement is to bridge the gap in maternal mortality outcomes between high-income and low- and middle-income countries, in alignment with Sustainable Development Goal 3.1. The goal aims to reduce the global maternal mortality ratio to fewer than 70 deaths per 100,000 live births by 2030, using indicators such as MMR and the proportion of births attended by skilled health personnel.

Women in high-income countries face a 1 in 5,400 chance of dying from a maternal complication, compared to a 1 in 45 chance in low-income settings. These disparities must be addressed by expanding access to quality care, reducing avoidable maternal deaths, improving MMR outcomes in LMICs, addressing urban-rural inequities, and strengthening future healthcare resources. According to the United Nations, investing in health systems could save up to 5 million mothers’ lives.

Target Areas for Intervention

Low- and middle-income countries account for 94% of all maternal deaths globally. Sub-Saharan Africa contributes two-thirds of these deaths, while South Asia accounts for one-fifth, together representing 86% of global maternal mortality.

High-priority countries include South Sudan, Somalia, the Central African Republic, Yemen, Syria, Sudan, the Democratic Republic of Congo, Chad, Afghanistan, Haiti, Guinea, Nigeria, and Ethiopia. Maternal mortality ratios in these countries range from 31 to 1,150 per 100,000 live births.

Within these regions, rural and Indigenous populations face an 80-percentage-point gap in skilled birth attendance and a 25-percentage-point gap in antenatal care and education. Similar disparities exist in high-income countries, including the United States, where socioeconomic and racial inequities drive higher maternal mortality rates in low-income and Black communities.

Policy Context and Precedents

This policy builds on prior international efforts, including the American Public Health Association’s 2011 Call to Action to Reduce Global Maternal, Neonatal, and Child Morbidity and Mortality. That policy emphasized political commitment, targeted funding, professional competency, and program evaluation to address stalled progress toward MDG5.

It also aligns with the World Federation of Public Health Associations’ policy statement Reducing Maternal Mortality as a Human Right, which calls for stronger government accountability, improved health systems, enhanced policy research, and the promotion of gender equity. This statement advances those recommendations explicitly by focusing on skilled birth attendants, training, and access to essential equipment in low-resource settings.

Recommendations to Reduce Maternal Mortality Through Skilled Birth Attendance

To address the ongoing maternal mortality crisis in low-resource areas and close gaps in achieving the Millennium and Sustainable Development Goals, it is recommended that governments and advocacy organizations:

• Increase skilled birth attendance to more than 90% in areas where coverage is currently below 50%.
• Expand healthcare utilization in the poorest LMIC regions with the highest maternal mortality ratios.
• Improve access to essential supplies, medications, and hygienic clinical practices.
• Promote and support maternal healthcare training programs in low-resource districts.
• Strengthen primary prevention contraception programs.
• Require national antenatal care and skilled birth attendance guidelines, including licensing and regulation.
• Develop comprehensive strategies for skilled attendant provision, including clinic locations, staffing, monitoring, and training.
• Enhance capacity building and cultural competency in maternal healthcare settings.
• Leverage UN agencies, the WHO, the World Bank, and other multilateral organizations to inform stakeholders.
• Ensure access to life-saving medications such as Misoprostol and simple blood-loss management tools to prevent deaths from post-partum hemorrhage.

Advancing Equity in Maternal Health

Reducing maternal mortality in low- and middle-income countries is both a public health imperative and a matter of human rights. Expanding access to skilled birth attendants, strengthening health systems, and addressing inequities across populations are essential steps toward ending preventable maternal deaths and achieving Sustainable Development Goal 3.1.

Life Course Immunization: Why Lifelong Vaccination is Essential for Public Health

Immunization is a lifelong shield that goes beyond childhood. While pediatric vaccination programs have seen tremendous success, adult and adolescent immunization remains a dangerously overlooked pillar of global health. This critical gap leaves populations vulnerable to preventable diseases, pandemics, and needless suffering at every stage of life.

For decades, vaccination has been rightly celebrated for its role in conquering infectious diseases. A powerful new consensus from the world’s top health organization is expanding its mission: vaccination is a cornerstone of preventing non-communicable diseases (NCDS) like heart attacks, strokes, and diabetic complications.

The urgency to close this gap has never been greater. This paradigm shift is the driving force behind a new global initiative.

The 2024 Geneva Accord: A New Strategy for a New Health Reality

In November 2024, a pivotal meeting in Geneva, convened by the world’s most influential health and community NGOs, aimed to address a silent crisis: the alarming decline in adult vaccination rates and its cascading impact on global health.

The result was a Call to Action: International Health and Community NGOs Advocate for Life-Course Vaccination. This document represents a consensus among organizations representing millions of health professionals and citizens worldwide. It moves the conversation from why life-course immunization is essential to how we must achieve it. Now, with a vital new concept, life-course vaccination is necessary for NCD prevention and healthy aging.

Supported by a Coalition of Global Health Leaders:

This call to action is endorsed by the following organizations, representing millions of doctors, nurses, pharmacists, public health experts, medical students, and aging advocates worldwide:

• All.Can

• Cittadinanzattiva-Active Citizenship Network

• Coalition for Life Course Immunisation (CLCI)

• EMR NCD Alliance

• European Interdisciplinary Council on Aging (EICA)

• European Specialist Nurses Organisation

• Global Ageing Network 

• International Council of Nurses (ICN)

• International Federation of Medical Students’ Associations (IFMSA)

• International Federation of Social Workers (IFSW)

• International Federation on Ageing (IFA)

• International Pharmaceutical Federation (FIP)

• International Pharmaceutical Student’s Federation (IPSF) 

• Junior Doctors Network, World Medical Association (JDN, WMA)

• World Federation of Public Health Associations (WFPHA)

• World Medical Association (WMA)

• World Obesity Federation

• World Organization of Family Doctors (WONCA)

• World Patients Alliance

The Growing Immunization Gap: How Vaccines Prevent Chronic Disease

The traditional benefits of vaccination, such as preventing outbreaks, reducing healthcare costs, and protecting the vulnerable, remain critically important. Yet, recent data reveal a concerning decline in vaccination rates, posing a threat to global health security.

Reports from the WHO, UNICEF, and other bodies show:

• Adult vaccination rates have stagnated or dropped since the pandemic, particularly among aging and at-risk populations.
• Measles outbreaks are resurging in countries where the disease was previously controlled.
• Low uptake of flu, COVID-19, and RSV vaccines in high-risk groups leads to preventable hospitalizations and deaths, straining healthcare systems.

This evidence underscores the urgent need for the coordinated strategy outlined in the new Call to Action.

What does this mean in practice?

• Influenza & COVID-19 increase heart attacks and strokes: These viral infections cause severe inflammation, which can destabilize arterial plaque, leading to cardiovascular events, risks that vaccinations can reduce.
• RSV & pneumonia can lead to respiratory decline: In older adults or those with COPD, a severe respiratory infection can result in permanent lung damage and a significant decline in functional health.
• HPV & cancer: The human papillomavirus (HPV) is a leading cause of cervical, oropharyngeal, and other cancers. HPV vaccination is, quite literally, a form of cancer prevention.
• Shingles & chronic pain: Reactivation of the varicella-zoster virus, the cause of chickenpox, can lead to debilitating, long-term nerve pain, drastically reducing quality of life.

By preventing the initial infection, vaccines directly prevent the chronic conditions that follow.

The 10-Point Plan: A Roadmap to Integrate Vaccination and NCD Prevention

The coalition’s document provides a clear roadmap. Here are the 10 critical actions it urges advocates and policymakers to implement:

1. Protect Health and Social Care Workers: Ensure they are prioritized to prevent the spread of disease to vulnerable patients.
2. Guarantee Equitable Access: Tailor vaccine access to every stage of life, removing financial and logistical barriers.
3. Mobilize the Health Workforce: Provide tools and resources for vaccine delivery across all care settings.
4. Establish Adult Vaccine Schedules: Develop clear, comprehensive, and equitable vaccination schedules for adults that complement existing pediatric programs.
5. Develop Robust Immunization Registries: Implement interoperable systems to track vaccine uptake in real-time.
6. Integrate Vaccination with NCD Prevention: Recognize the strategic role of vaccination in preventing complications from non-communicable diseases, such as heart disease and diabetes.
7. Expand and Simplify Vaccination Pathways: Make getting vaccinated easier through community-based and mobile clinics.
8. Raise Awareness and Build Confidence: Run public campaigns highlighting the value of vaccination throughout one’s life.
9. Embed Community Engagement: Involve communities in vaccine program design and development to ensure they meet real needs.
10. Leverage the Health Workforce: Empower health professionals, from students to retirees, to be champions for vaccination.

The Tangible Benefits of a Life-Course Immunization Approach

Adopting this framework offers profound advantages that strengthen societies:

• Prevents Deadly Outbreaks: High vaccination coverage across all ages creates a stronger herd immunity, protecting those who can’t be vaccinated.
• Dramatically Reduces Healthcare Costs: Preventing diseases such as shingles, pneumonia, and HPV-related cancers reduces hospitalizations, long-term care needs, and lost productivity.
• Protects Vulnerable Populations: A vaccinated community is a safer environment for older people, newborns, and individuals with weakened immune systems.
• Builds Resilient Health Systems: By preventing illness, health systems are less burdened and better able to handle other crises.
• Promotes Healthy Communities: Lifelong immunization supports well-being at every age and helps entire communities live healthier, more active lives.

From Call to Action to Reality: How We Can All Participate

Implementing this vision requires a commitment from all sectors. The Call to Action provides the blueprint, but we all have a role to play in its implementation.

• Policymakers: Must prioritize funding, establish national adult schedules, and remove regulatory barriers.
• Healthcare Providers: Can integrate vaccine discussions into every routine care visit, for every age group.
• Individuals & Communities: Should stay informed, advocate for access, and get recommended vaccines.
• Organizations: Can sign on to support the call to action and promote their messages internally and externally.

A Healthier Future for All Generations

Life-course immunization is a fundamental right and a shared societal responsibility. We can no longer silo infectious disease and chronic disease efforts. We must unite these two pillars of health.

Life-course immunization is the powerful and practical link that ties it all together. The 2024 Geneva Call to Action provides the definitive framework for achieving this goal. By embracing this strategy, we aren’t just preventing the flu or shingles; we are preventing heart failure, debilitating pain, and cancer. We aim to promote health throughout a person’s lifetime, rather than just treating a specific illness or condition.

By uniting behind this powerful consensus from the world’s leading health authorities, we can build healthier, more equitable, and more resilient communities for generations to come.

If your organization would like to endorse our Call to Action and join us in this effort, please get in touch with us at secretariat@wfpha.org

Click here to read the full, official Call to Action document supported by international NGOs

Climate Change and Public Health: Why the Climate Emergency Is a Health Emergency

Climate change is no longer a distant threat. It is a present and accelerating crisis undermining health, safety, and well-being worldwide. As extreme weather intensifies, global temperatures rise, and environmental systems destabilize, the consequences for human health grow more severe. The World Federation of Public Health Associations (WFPHA) issues this call to action to highlight the urgent need for governments, institutions, and health leaders to confront the accelerating climate emergency with decisive, health-centered policies.

The Climate Crisis: A Global Failure With Human Consequences

Since the adoption of the Sustainable Development Goals (SDGs) in 2015, progress has been significantly hindered by accelerating climate change. Although solutions exist, global action has been too slow, fragmented, and insufficient to safeguard population health. Scientific evidence shows that:

• Global warming is accelerating, driving extreme heat, catastrophic fires, severe storms, droughts, and flooding.

• Disruptions across land, water, and ecosystems are worsening faster than anticipated.

• Opportunities for meaningful intervention are narrowing, as climate extremes become more frequent and intense.

The health risks are profound. Climate change affects food security, water quality, air quality, housing stability, and economic livelihoods, all of which are critical determinants of health.

Children: The Most Vulnerable Victims of Climate Change

UNICEF calls climate change the defining challenge for children’s rights. Nearly 1 billion children live in areas at extremely high risk from climate impacts. Many face overlapping threats such as:

• Flooding

• Heatwaves

• Water scarcity

• Disease outbreaks

• Poor air quality

Because children will experience climate impacts for longer and more intensively than adults, climate inaction constitutes severe intergenerational injustice.

Scientific Consensus: Human Influence Is Unmistakable

Despite decades of warnings, global emissions continue to rise. The IPCC confirms:

• Each of the last four decades has been warmer than the one before.

• Global temperatures have already increased by about 1.1°C above pre-industrial levels.

• Warming over land is even higher, posing heightened threats to health and safety.

Recent climate disasters, including heatwaves, fires, and severe storms, would be nearly impossible without human-induced warming.

The Mounting Toll: Water Scarcity, Disasters, and Economic Loss

Freshwater scarcity, already affecting billions, is expected to worsen dramatically. Extreme weather events have increased fivefold in the past 50 years, causing:

• 2.06 million deaths

• $3.6 trillion USD in economic losses

• Disproportionate impacts on developing nations

These inequities represent a profound moral and public health failure.

A Clear Path Forward: Mitigation and Adaptation

Even if emissions stopped today, warming would continue due to high atmospheric CO₂ levels. Therefore, climate resilience requires:

• Mitigation – drastically reducing greenhouse gas emissions.

• Adaptation – preparing health systems, communities, and infrastructure for unavoidable impacts.

Renewable energy, sustainable food systems, water preservation, and reduced consumption are essential pathways to a healthier, more resilient world.

The Economic Case for Climate Action

Climate mitigation not only protects lives but also yields immense economic benefits. Research shows that limiting warming to 2°C could prevent trillions in GDP losses annually and save millions of lives through:

• Cleaner air

• Healthier diets

• Increased physical activity

• Reduced climate-related disasters

The cost of inaction vastly outweighs the cost of solutions already available.

Global Inequity: Those Most Affected Contribute the Least

Low-income and climate-vulnerable countries face the most significant climate risks despite having contributed least to global emissions. Wealthier nations must:

• Provide financial support

• Honor climate finance commitments

• Invest in research and adaptation

• Address climate-related loss and damage

Mechanisms like the Green Climate Fund were designed for this purpose, yet contributions fall drastically short.

Strengthening the Public Health Response

Evidence gaps persist, especially in mental health, maternal health, child health, and impacts in low-income countries. Increased funding and research are urgently needed to guide effective interventions and support the world’s most vulnerable populations.

Why Immediate Action Is Essential

Climate change is harming health today and threatens to undermine the prosperity, safety, and stability of future generations. Governments, public health leaders, and community organizations must prioritize:

• Strong emissions reduction targets

• Rapid decarbonization

• Climate-resilient health systems

• Protection for vulnerable populations

• Public health leadership at every level

The science is unequivocal: human activity is driving climate change, and political inaction threatens catastrophic outcomes.

A Call for Health-Centered Climate Leadership

Health must be at the center of climate policy. Governments hold a responsibility not only to their citizens but to the global community and to future generations. Climate change is a health emergency—and addressing it is both a moral and practical imperative.

The WFPHA reaffirms its commitment to advocate for a healthier future and urges all partners, organizations, and health professionals to join in the effort.

Who Must Act Now

This call to action is directed toward:

• National and multilateral policymakers

• Local and regional government officials

• Public health associations and agencies

• Health care leaders and emergency planners

• Community organizations and NGOs

• Urban planners, infrastructure specialists, and social service providers

• Educational leaders and private-sector partners

These groups play essential roles in designing and implementing climate-healthy policies, reducing emissions, strengthening resilience, and protecting vulnerable populations.

Key Recommendations for Immediate Progress

• Set and enforce ambitious emission-reduction targets.

• Increase commitments to the Green Climate Fund and ensure contributions are fulfilled.

• Hold governments accountable for policies affecting health.

• Support decarbonization across energy, transportation, food systems, and investment markets.

• Advocate for equitable compensation for climate-driven loss and damage.

• Engage communities in developing localized resilience strategies.

• Restore ecosystems critical to water, food, and mental well-being.

• Integrate health considerations into all public policies.

Moving Forward Together

Climate change and public health are inseparable.

Recognizing this connection is essential to protecting lives and shaping a healthier, more equitable future. The WFPHA stands with global partners to demand immediate, effective, and equitable climate action, because the climate emergency is unequivocally a health emergency.

Advancing Adult HPV Vaccination: From Evidence to Action

Human papillomavirus (HPV) is one of the most prevalent infections in the world, affecting up to 80% of individuals at some point in their lives. While the immune system clears most infections naturally, persistent high-risk HPV oncogenic genotypes can lead to serious health outcomes, including cervical, anal, vaginal, vulvar, penile, and oropharyngeal cancers. 

Even with highly effective vaccines authorized for adults and available in sufficient supply, vaccination rates among adults remain far too low. Expanding adult HPV vaccination offers a vital opportunity to reduce disease burden, strengthen long-term health outcomes, and accelerate progress toward broader cancer prevention goals.

Why Universal Vaccination Matters for Long-Term Cancer Prevention

Although early HPV prevention initiatives largely prioritized younger age groups, there is now broad recognition that universal HPV vaccination across adulthood is a crucial component of comprehensive disease prevention. Adults continue to face new exposure risks throughout their lives, and vaccination can protect them against HPV types they have not yet encountered. 

Importantly, natural immunity from previous infections does not offer complete protection against other high-risk genotypes, meaning adults with prior HPV exposure still gain meaningful benefit from vaccination. Emerging evidence also highlights positive outcomes when vaccination is delivered before or after cervical conization, reinforcing its value across different stages of adult care.

Barriers Limiting Adult Vaccine Uptake and Why They Must Be Overcome

Although clinical and economic advantages are well-established, adult vaccine uptake remains low due to:

• Lack of awareness and misconceptions about vaccine efficacy
• Limited access and insufficient provider recommendations
• Policy and funding gaps within national immunization programs

Many adults were not vaccinated during adolescence due to eligibility criteria, vaccine availability, or limitations in the healthcare system. Expanding eligibility can close this gap. 

Policymakers are key to establishing sustainable vaccination programs by embedding HPV vaccination for medically or socially vulnerable adults into routine healthcare and ensuring adequate funding and equitable access. Adult programs should not compromise coverage in younger populations. Cultural and linguistic sensitivity must also be part of these strategies to support trust and acceptance.

Accelerating Progress Toward WHO Elimination Goals

WHO has set ambitious goals for cervical cancer elimination, prioritizing adolescent girls as the primary target group, but extending vaccination to boys and adults whenever feasible. National programs should move forward using emerging evidence and practical implementation models. 

Strengthened vaccination systems can help reduce HPV-related cancers, improve health equity, and support progress toward global elimination.

Strengthening Policy and Practice for Adult HPV Vaccination

This call to action emphasizes the value of adult HPV vaccination from public health and economic perspectives. It highlights the global burden of HPV-related diseases and successful policy models from multiple countries. 

Key recommendations include integrating adult vaccination into routine care, expanding national immunization guidelines, strengthening awareness efforts, and adopting universal and inclusive approaches that span ages, genders, and geographies.

Risk Stratification Isn’t Enough, Adults Still Need Protection

Risk-based approaches are limited due to the widespread nature of HPV and varied exposure patterns. Several key considerations support universal adult vaccination:

Adults Remain at Ongoing Risk

Individuals continue to face new exposure risk throughout adulthood.

Men Are Disproportionately Underserved

Without access to established screening programs and often acquiring infections later, adult males represent a highly vulnerable group.

Ending Transmission Requires Addressing the Viral Reservoir

To eliminate HPV-related cancers, transmission must be stopped at its source, requiring immunization of both women and men.

Vaccination Works Even After Exposure

Adults previously exposed to certain HPV types still benefit from protection against other genotypes.

Public Health Outcomes Are Significant

Adult vaccination provides direct protection while reducing transmission and decreasing overall disease burden.

Current Age-Restricted Funding Leaves People Behind

Many national funding systems exclude adults who are still at risk.

Vaccination Must Be Easy to Access

Success depends on convenience, such as pharmacies, workplaces, and community hubs serving as vaccination sites.

A Consensus on Adult Vaccination Is Needed

Clear and unified policy guidance is essential to strengthen recommendations and drive adoption.

Low- and Middle-Income Countries Must Help Shape Global Policy

These regions carry the highest disease burden and must be active contributors to ensure global equity.

Faster Elimination Is Achievable

Countries like Sweden demonstrate that vaccinating adults can accelerate the elimination of HPV-related cancers.

Clear, Inclusive Communication Matters

Language such as “universal vaccination” promotes gender equity and reduces stigma.

A Global Call to Action for Policymakers and Health Leaders

Governments, global health organizations, and national public health associations are urged to expand HPV vaccination programs, particularly for adults and males, mobilize resources, and embed evidence-based strategies into national immunization plans. 

By committing to these priorities today, countries can accelerate cancer prevention and move closer to eliminating HPV-related disease.

Moving Forward Toward Global Health Equity

Expanding HPV vaccination to adults is a critical, evidence-based strategy to reduce HPV-related disease and advance global cancer prevention. Universal adult vaccination delivers individual and population-level benefits, especially in regions with limited access to screening and care. Progress requires collaboration among policymakers and health leaders to address gaps in access, awareness, and coverage. 

Integration into routine healthcare, stigma-free and inclusive communication, and a focus on vulnerable populations, such as individuals living with conditions like HIV, are essential. Taking timely action will drive progress toward eliminating HPV-related cancers and building a more equitable global health future.

Read our original call to action here.

Watch our video on this HPV call to action here.

Policy Statement on Polio Eradication: The Last Battle?

Understanding Poliomyelitis and Its Global Impact

Poliomyelitis (polio) is an infectious viral disease that predominantly affects children under 5 years old. The virus spreads through person-to-person contact, primarily via the fecal-oral route or, less frequently, through contaminated food and water. It multiplies in the intestines and can invade the nervous system, causing permanent paralysis.

Approximately 1 in 200 infections results in irreversible paralysis, and 5–10% of paralyzed individuals die due to respiratory muscle immobilization. Despite this, 90% of infected individuals remain asymptomatic carriers.

There is no cure for polio; it is preventable only through routine childhood immunization.

Global Progress Toward Polio Eradication

In 1988, the World Health Assembly adopted a resolution calling for the worldwide eradication of polio, leading to the creation of the Global Polio Eradication Initiative (GPEI). National governments, the WHO, Rotary International, the CDC, UNICEF, the Bill & Melinda Gates Foundation, and Gavi, the Vaccine Alliance support this effort.

Since then, global cases of wild poliovirus have decreased by over 99%, from an estimated 350,000 cases in 2019 to 175 in 2020, and just 2 cases reported by mid-September 2021.

Countries Where Polio Remains Endemic

Polio remains endemic in Afghanistan and Pakistan (wild polio type 1, WPV1).

• In Pakistan, 72 of 468 (15%) environmental samples tested positive in 2017. In 2020, 84 cases of WPV1 were reported, and by mid-September 2021, one case had been recorded.

• In Afghanistan, WPV1 cases increased from 21 (2018) to 29 (2019) and 56 (2020). By mid-September 2021, one wild polio case had been reported.

WHO estimates that successful polio eradication will save USD $40–50 billion, while failure could result in 200,000 new cases annually within the next decade.

Recommendations to Address Current Challenges in Polio Eradication

Strengthen International Relations with Pakistan and Afghanistan

Pakistan and Afghanistan function as a single epidemiological zone due to significant cross-border population movements. Both countries have collaborated through joint Technical Advisory Group (TAG) meetings and have agreed to vaccinate children under ten at border points on the same day.

Further strategic efforts should include:

• High-quality, large-scale vaccination campaigns targeting core reservoir areas.

• Policies are shaped through collaboration between government and public-private partners, such as the National Highway Authority and media networks.

• Support for ongoing WHO and partner engagement with the new Afghan government and authorities in Pakistan.

Reach Under-Immunized Children Using Innovative Approaches

Reaching under-immunized children remains a significant challenge due to vaccine refusals, operational gaps, difficulties in tracking mobile populations, and challenges in following up when children are not at home.

To strengthen reach and immunization quality:

• Use digital tools such as GIS mapping and mobile-based monitoring to track outbreaks.

• Redesign door-to-door campaigns to prioritize border entry and exit points.

• Expand vaccination efforts to include non-health workers and migrant populations.

Maintain Continuity of Operations Across the Pakistan–Afghanistan Region

Although GPEI operations in Pakistan are well funded, efficiency is hindered by gaps in documentation within the public health delivery system. A lack of electronic immunization records complicates accurate tracking.

Key steps include:

• Conduct all external reviews within the immunization indicator’s 28-day average lifespan.

• Supplement finger-marking with immunization cards and digital records.

• Integrate polio surveillance with broader health services across both countries.

• Provide community services (such as hygiene kits and maternal/child care supplies) during polio campaigns.

Address the Dual Challenge of Polio and COVID-19

In 2020, GPEI paused polio activities to redirect resources to the COVID-19 response, during which polio cases resurged (84 in Pakistan, 56 in Afghanistan).

To address this dual burden, revised operational procedures should include:

• Water, Sanitation, and Hygiene (WASH) promotion

• Non-pharmaceutical infection control (masks, sanitizers, thermometers)

• Enhanced staff training for safe campaign implementation

Summary

Eradicating poliovirus in Afghanistan and Pakistan requires unified action across military, religious, governmental, and social institutions. It demands trans-disciplinary leadership that ensures transparent processes and upholds both security and primary health objectives. Strong national capacity is essential to meet global commitments and to ensure every child receives lifesaving vaccinations.

Key Messages

• Polio is a highly infectious viral disease that attacks the nervous system and can cause irreversible paralysis and death.

• There is no cure for polio; it can only be prevented through immunization.

• Polio remains endemic in two countries: Afghanistan and Pakistan.

• Failure to stop polio could result in as many as 200,000 new cases every year, for up to 10 years, across the world.

• Eradicating polio will save lives and could save USD $50 billion in low-to middle-income countries.

• Continued coordination among international organizations, NGOs, philanthropists, religious institutions, and governments is essential to eradicate polio finally.

References

1. World Health Organization. (2019, July 22). Poliomyelitis.

2. Global Polio Eradication Initiative. (2021, May 25). Polio + Prevention.

3. Elhamidi, Y., Mahamud, A., Safdar, M., Al Tamimi, W., Jorba, J., Mbaeyi, C., Hsu, C. H., Wadood, Z., Sharif, S., & Ehrhardt, D. (2017). Progress Toward Poliomyelitis Eradication – Pakistan, January 2016-September 2017. MMWR. Morbidity and mortality weekly report, 66(46), 1276–1280.

4. Polio Eradication Initiative. (2021). National Emergency Action Plan 2021.

5. Shah, S., Saad, M., Rizwan, M., Haidari, A., & Idrees, F. (2016). Why We Could Not Eradicate Polio from Pakistan and How Can We? Journal of Ayub Medical College Abbottabad – Pakistan, 28(2), 423-425.

6. Hussain, S.F., Boyle, P., Patel, P. et al. Eradicating Polio in Pakistan: an Analysis of the Challenges and Solutions to this Security and Health Issue. (2016). Global Health 12(63).

7. Pakistan, Pakistan Polio Eradication Programme, National Emergency Operations Centre. (n.d.). National Emergency Action Plan for Polio Eradication 2020.

Public Health Professionals’ Education and Training (PET) Policy: Ensuring a Trained Public Health Workforce

Globally, public health training primarily occurs through Master of Public Health (MPH) programs, although undergraduate and doctoral programs also exist. Although difficult to measure, globally public health teaching programs appear to be increasing in number. Accreditation of public health programs, however, remains inconsistent.

There are several locally developed public health competency sets, designed to guide the content of public health education programs and practice guidelines. A recent analysis has demonstrated that these competency sets align with the content and meaning of the Global Charter, with some including additional competencies driven by local (but globally relevant) need (including human rights, cultural responsiveness, and systems thinking) (Coombe et al, 2020). It is also worth noting that efforts are underway to include competencies related to climate change and holistic approaches, such as One Health (for example, WHO ASPHER, 2021).

Developing such competencies, as well as tackling hyper-specialized, fragmented, and “silo” learning models to influence complex webs of policy and governance, can be achieved through building interprofessionalism and interdisciplinarity.

Global Emergencies and the Demand for Public Health Workforce Training

In 2019–21, the world experienced massive transcontinental bushfires in both North and South America, the Arctic, and Australia; at least 20 major floods and cyclones, including Cyclone Amphan in Asia; severe droughts affected all continents (more than 10% of North America); earthquakes and landslides; volcanic eruptions; and infectious diseases, including the SARS CoV-2 pandemic. All these emergencies mobilized public health responses, highlighting the need for public health leaders and professionals to be involved at every level of emergency management and recovery planning and execution.

In the short or long term, the consequences of public health emergencies result in populations that are, in some ways, restricted or displaced, with associated threats to wellbeing, including the security of shelter, food and water provision, health care, income, gender equality, and education. Many aspects of universal progress towards the Sustainable Development Goals are disrupted when such emergencies arise. For example, analyses point to a regression in women’s progress as a result of epidemics (Power 2020, Özkazanç-Pan 2020).

During environmental and health emergencies, public health competence, including familiarity with its key principles, is essential to the management and subsequent recovery of people, their environments, and coexisting plants and animals. Most of these events have resulted in the mobilization of public health responses.

In addition, there is now evidence that public health graduate employers are seeking specific competencies in climate change and global warming, including climate change justice, climate mitigation, GIS mapping, and climate modelling (Krasna et al., 2020).

The Critical Role of Trained Public Health Departments

It is therefore critical that public health efforts are included in the mitigation and recovery plans developed for real-world use, but this is not possible if trained public health professionals do not staff public health departments, and if public health professionals are not part of routine governance and government processes. Results of the recent PHWINS survey in the USA showed that only 14% of public health staff had public health qualifications (Sellers et al, 2019). We note that in Australia, very few advertised public health jobs require public health qualifications (Watts et al, 2019).

In addition, public health graduates are employed in many sectors, not necessarily in the broad field of public health and health care or the government sector. There is a need to assess the labour market demand and develop public health job taxonomies which will clearly define governmental jobs and job profiles to enhance hiring of public health graduates (Krasna H et al, 2021), bearing in mind that the supply of graduates may outstrip current employment demand (Watts et al, 2021).

Challenges in Maintaining Public Health Programs

Public health is both reactive and proactive. However, public health initiatives can cause public health programs to become victims of their own success, because when public health initiatives work, the obvious and immediate need for them dissipates. Examples of successful programs include routine contact tracing in non-pandemic times, clean air and water initiatives, and accident-reduction programmes. Often, these initiatives are handed over to specialized departments, for example, women’s health and cancer screening programs.

Maintaining resources for routine public health program maintenance can be difficult when resources are limited and public interest and political imperatives wane. When interventions work well to prevent disease, it can seem as if nothing has happened, making the importance of sustained public health provision invisible to the general public.

Public health initiatives are also multifaceted; they often begin with straightforward epidemiology, but successful controls also draw on social epidemiology, health promotion, policy, cultural responsiveness, Indigenous knowledges, systems thinking, advocacy, and capacity building. The WFPHA Global Charter can be applied to any public health problem and used to identify gaps and shortfalls in short- and long-term responses.

Arguably, management of the ongoing SARS-CoV-2 pandemic has been hampered in many places by inappropriate, fragmented, partial, and incomplete application of public health initiatives.

Example of an Outbreak Response Lacking Public Health Coordination: Housing Tower Lockdowns in Melbourne

During the COVID pandemic, on the afternoon of July 4th in Melbourne, and early in Melbourne’s “second wave,” with no warning, a group of nine public housing tower blocks housing around 3,000 people were completely locked down. The towers had been identified as central to the transmission of SARS-CoV-2 and also connected to other transmission sites. This was the first time emergency powers in relation to the pandemic had been enacted in Victoria.

Residents were immediately confined to their homes, not allowed to leave even for necessities such as medicines and infant formula. Following testing, although rules were relaxed somewhat in eight blocks, residents of one tower remained confined for two weeks. The tower blocks house a multicultural group of residents, many of whom arrived as asylum seekers and refugees, for whom English is not a first language, and for whom having members of the security services patrolling their homes, with whom they were not able to effectively communicate, was frightening.

The decision to lock down the towers was made by the Victorian Government, which, although acting on broad public health advice, was made at speed and without apparent consultation with public health staff. Whilst the appropriate health officer signed the orders, it was with insufficient time to discuss the implications of this action.

An ombudsman investigation into the way this was conducted showed that whilst the need to lockdown might have been necessary, the way it was carried out, without due consideration of the impact on residents, breached their human rights.

Despite Australia’s SARS-CoV-2 response being an example of a reasonably well-controlled outbreak response, it has nevertheless encountered challenges with far-reaching implications when public health-trained staff were not involved in incident management. This example shows that, even in a country with a trained core public health workforce, poor communication between departments when public health responses are not implemented and coordinated by public health professionals can have far-reaching implications.

Importance of Public Health Workforce Training Across All Units

Public health is a discrete part of health service provision, with its own specialist training. Some critical aspects of public health have developed as sub-specialities (for example, epidemiology and biostatistics, vaccination and immunization, and health promotion) in the same way that other health specialities have. However, the successful implementation of public health programs requires an understanding of all aspects of public health.

It has been noted that public health units in various countries are led by people with little or no public health training, a factor that has been considered by public health organizations in the past, including the WHO and the WFPHA (Sadana 2007, WHO 2006). As there is a potential oversupply of public health graduates, public health units need to prioritize employing public health-educated graduates to prevent them from being lost to other employers and missing meaningful change-agent opportunities (Watts et al., 2021; Krasna et al., 2021).

We propose that the importance and visibility of public health can be improved if appropriately trained people are included in all plans, directly or indirectly, that involve the health of whole populations.

We note that not all public health education programs are based on public health competencies and are not all accredited courses, potentially leading to inconsistencies in course content and delivery (Watts et al., 2021). We therefore also propose that public health education draws on practical experiences from service provision, where possible through teaching staff having government public health service provision, including through joint appointments, and that all public health teaching programmes should be based on a locally appropriate set of competencies, and that public health courses should be accredited. This will provide graduates with a set of knowledge and skills on which employers can rely.

Recommendations

• The WFPHA endorses the need for all jurisdictions working with populations affected by emergencies to employ staff who have been appropriately trained in public health.

• That WFPHA endorses the inclusion of staff trained in public health (both during the development of public health plans and programmes designed to manage responses to public health emergencies, and during regular activities), whether the need arises from environmental or pathogenic causes.

Actions Sought

• The WFPHA petitions its members, including their managers, to demonstrate the importance of undertaking training in accordance with a set of public health competencies that align with the WFPHA Global Charter.

• The WFPHA petitions its members to ensure that those teaching in core areas of public health are appropriately trained in the discipline of public health, in accordance with a set of public health competencies that align with the WFPHA Global Charter.

• The WFPHA, through the PET working group, identifies and distinguishes between foundational and specialized competencies for the purpose of accrediting varying programme levels (undergraduate, postgraduate, and doctoral levels), similar to the CEPH mechanism in the USA, to both harmonize public health training globally and distinguish between public health training and the more hyper-specialized and fragmented learning models.

• The WFPHA develops a mechanism to endorse public health competency sets for accreditation of public health education and training programs.

• That WFPHA lobbies the WHO to recommend that appropriately qualified people staff public health departments and teaching programs.

References

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