22 January 2021

Looking back at a year that changed the world

WHO’S RESPONSE TO COVID-19
 22 January 2021

Looking back at a year that changed the world

WHO’S RESPONSE TO COVID-19

iii
Looking back at a year that changed the world: WHO’s response to COVID-19
WHO/WHE/2021.01
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iv
CONTENTS

FOREWORD FROM THE DIRECTOR-GENERAL vi

2020: RESPONSE IN NUMBERS viii

Global overview of deployed resources viii
Overview of COVID-19 SPRP monitoring and evaluation ix
Essential supplies by region x

INTRODUCTION1
About this document 1
Epidemiological overview: January to December 2020 2
WHO’s Strategic preparedness and response plan 5
Financing the plan for 2020 8

PUTTING HEALTH AT THE HEART OF THE GLOBAL COVID-19 RESPONSE 11

Coordination and planning 11
Steering a global whole-of-UN response 11
Keeping track and adjusting course 16
Translating evidence into knowledge and action 16
Activating a WHO core strength 16
Putting knowledge into practice 18
Real-time, rapid response capacity strengthening and support 19
Surveillance, contact tracing, isolation and quarantine: the backbone of outbreak response 22
Laboratories and diagnostics 26
Managing the infodemic, risk communication, community engagement 28
Clinical management 32
Infection prevention and control 34
Points of entry, travel and trade 35
Protecting essential health services 36
Delivering for countries: global logistics and supply chains,and operational support 40

DRIVING RESEARCH AND INNOVATION 42

From R&D blueprint to a global roadmap for COVID-19 research and innovation 42
Progress against Global research roadmap 43
Therapeutics45
Diagnostics46
Vaccine development 46
Defining the desired characteristics of safe and effective vaccines to combat the pandemic 47
WHO Solidarity Vaccine Trial 47

LOOKING AHEAD TO NEW CHALLENGES IN 2021 49

ANNEX A: OVERVIEW OF COVID-19 SPRP MONITORING

AND EVALUATION 51

ANNEX B: COVID-19 CONTRIBUTIONS 53

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 v
FOREWORD FROM
THE DIRECTOR-GENERAL
The COVID-19 pandemic is the greatest crisis of our time, claiming more
than 2 million lives and causing the biggest shock to the global economy
since World War II. The social and economic restrictions that have been
implemented in many countries to control the virus have exposed and
exacerbated inequalities. Progress towards the Sustainable Development
Goals has stalled, and in some cases may have reversed. Up to 100 million
people have slipped into extreme poverty, the first rise in global poverty in
more than two decades. Despite all these challenges, there are reasons for
hope. We must guard against complacency; but we should also look ahead
with a renewed sense of optimism.
The first reason for hope is simple: we know what works to control the
virus. In February 2020, WHO’s Strategic preparedness and response plan
set out the essential pillars of the response that were required to reduce
transmission of the virus, save lives, and protect the vulnerable. Since then,
WHO has scaled up and adapted its emergency platforms, and supported
countries to implement national COVID-19 plans. Through WHO’s 157 global,
regional, and national offices, we have supported countries to adapt to
every context, and through our planning and operational support platforms
we have ensured that our guidance can be translated into action.
In under 12 months we have shipped more than 250 million items of personal
protective equipment around the world; strengthened hundreds of national
and subnational laboratories with technical support and the supply of more
than 250 million COVID-19 tests; coordinated the deployment of more than
180 teams and missions to strengthen critical response functions at national
and subnational level; delivered vital medical supplies including oxygen,
and supported more than 12 000 intensive care beds in health systems that
might otherwise have been overwhelmed. Countries have shown that when
they have a robust system for testing, isolating, and treating cases, and
tracing and quarantining contacts, we can get ahead of the virus and control
transmission. We have seen that when health systems are prepared, when
health workers are protected and trained, and when they have access to the
knowledge and treatments they need, we can save lives. And we have shown
that even in the most difficult situations we can protect the vulnerable, and
deliver essential care.
The second reason for hope is the arrival of new medical countermeasures.
WHO’s R&D Blueprint for research during emergencies provided the platform
to launch what, in under a year, has become a global biomedical research
effort with no parallel in history. Those efforts are now bearing fruit. The
emergency use listing of a safe and effective vaccine against COVID-19 is a
moment of huge significance, and one we should all take encouragement
from. New rapid diagnostic tests have been approved, and progress has been
made in the search for effective therapies. But the hard work is far from over.
The urgency and commitment with which the scientific community rose
to the challenge of developing vaccines, diagnostics and therapeutics
must now be matched by the common purpose with which we in the global
community ensure that these new technologies are distributed fairly. To that
end, WHO and partners* established the Access to COVID-19 Tools Accelerator
(ACT‑Accelerator) in April 2020. Together with Gavi and the Coalition for
Epidemic Preparedness Innovations, WHO co-leads COVAX, the vaccines pillar
of the ACT-Accelerator, which aims to ensure that no countries are left behind
in the rush to roll out vaccines.

* ACT-Accelerator partners include: The Bill & Melinda Gates Foundation; the Coalition for Epidemic Preparedness
Innovations; FIND; Gavi, the Vaccine Alliance; the Global Fund to Fight AIDS, Tuberculosis and Malaria; Unicef;
Unitaid; the Wellcome Trust; the World Bank Group; the International Federation of Pharmaceutical Manufacturers
and Associations; and the Developing Countries Vaccine Manufacturers Network.

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 vi
 Unless COVAX is fully funded and utilized we risk repeating the moral
and market failures that plagued the early stages of the global response to
COVID-19, with the hoarding and misallocation of a vital public health resource.
An uncoordinated, me-first approach to vaccination not only condemns the
world’s poorest and most vulnerable to unnecessary risk, it is strategically and
economically self-defeating. Solidarity and equity are our routes out of the
pandemic and to global prosperity.
There is now a once in a generation chance to The pursuit of short term and narrow
self‑interest is the road to prolonging
harness the political will to forge a new global the pandemic, the restrictions
needed to contain it, and human
compact on health security, and to translate the and economic suffering.
efforts to control COVID-19 around the world into The work we must undertake
together to ensure that every
a legacy of lasting change. country is prepared to receive
and distribute vaccines equitably
and effectively will be one of the greatest challenges of the pandemic.
WHO is already working closely with countries and partners to support
the development and implementation of national deployment and
vaccination plans for COVID-19 vaccines, to ensure countries are able
and ready to access vaccines through the COVAX facility.
The third reason for hope is that there is now a once-in-a-generation chance
to harness political will to forge a new global compact on health security,
and to translate efforts to control COVID-19 into a legacy of lasting change
in the way we prepare for, prevent and respond to pandemics, as part of
WHO’s wider mission to promote health, keep the world safe and serve
the vulnerable. We can’t predict with certainty what and where the next
potential pandemic might be, but we can say with absolute certainty that
it is never further away than just around the corner. We must not only be
willing, but hungry to learn and apply the lessons of COVID-19. The work of
the Independent Panel for Pandemic Preparedness and Response, the Review
Committee of the International Health Regulations and the Independent
Oversight and Advisory Committee of the WHO Health Emergencies
Programme will all have recommendations for Member States, and for
WHO and its partners. But some lessons are already plain to see. Our health
security depends on recognizing the intrinsic links between emergency
preparedness and response, universal health coverage, and the intimate
connections between the health of humans, animals and the planet. A strong
WHO will turn these lessons into action, make building back better more
than a slogan, and ensure that they guide our work over the next 12 months
as we continue to fight COVID-19 with every tool at our disposal.

Dr Tedros Adhanom Ghebreyesus

WHO Director-General

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 vii
2020: RESPONSE IN NUMBERS

88.2%

US$ 1.5 billion raised US$ 1.7 billion requested

Global overview of deployed resources

23 12 000
United Nations (UN) entities
Intensive care unit beds provided
participating in UN Crisis
by WHO through surge mechanisms
Management Team

509 19 million
COVID-19 related publications
(technical documents) Tests shipped

191 140
Internationally deployed Emergency
Countries, territories and areas
Medical Teams (EMTs) and GOARN
on Partners Platform
deployments

150
243 million COVID-19 online trainings available
PPE shipped, including masks, face on OpenWHO
shields, gloves, gowns and goggles
4.7 million
Course enrolments

156
WHO offices have implemented 58
an Incident Support Team Countries, territories and areas
implementing sero‑epidemiological
investigations or studies

35
Countries, territories and areas
on WHO clinical platform
19.7 million
Respirator masks shipped

*Data as of 31 December 2020

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 viii
Overview of COVID-19 SPRP monitoring and evaluation

Proportion of countries with a COVID-19 preparedness and response plan (target: 100%)

46% 83% 91%

A plan explains the strategy to prepare and respond across all sectors of government and society. Evidence of a plan can include
a framework of response for national and subnational authorities. WHO provides operational planning guidelines to support
country preparedness and response.

Proportion of countries with a functional COVID-19 coordination mechanism (target: 100%)

45% 92% 97%

Functional in this context means that the mechanism has the key components outlined in the Framework for a Public Health
Emergency Operations Centre, including plans/procedures, physical infrastructure, information systems and standards,
and human resources.

Proportion of countries that have a COVID-19 community engagement plan (target: 100%)

19% 85% 97%

A community engagement plan should include at least four of the six recommended actions outlined in the SPRP.

Proportion of countries that have access to laboratory testing capacity (target: 100%)

85% 100%
Laboratory testing capacity is defined as either in-country laboratory testing capacity, or access to international laboratories
that can provide results within 72 hours.

Proportion of countries that have a COVID-19 clinical referral system (target: 100%)

37% 75% 89%

A clinical referral system should outline how patients need to be managed and streamlined by the health care system (e.g. first
points of contact for individuals, fever clinics, designated referral facilities, hotlines etc. as relevant in the national context).

At 1 March At 30 June At 31 December

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 ix
Essential supplies by region

0 850 1,700 3,400 Kilometers

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever
on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities,
or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines
for which there may not yet be full agreement.
© WHO 2021. All rights reserved.

African region Region of the Americas Eastern Mediterranean region

Sample collection kits: 2 833 835 Sample collection kits: 1 019 862 Sample collection kits: 663 160
Tests (manual PCR): 1 431 634 Tests (manual PCR): 10 504 038 Tests (manual PCR): 1 133 720
Face shields: 1 417 810 Face shields: 3 333 200 Face shields: 864 985
Gloves: 8 216 521 Gloves: 4 696 000 Gloves: 5 613 000
Goggles: 165 810 Goggles: 322 940 Goggles: 173 520
Gowns: 1 535 679 Gowns: 1 613 020 Gowns: 759 322
Medical masks: 53 077 950 Medical masks: 55 136 330 Medical masks: 26 267 550
Respirators: 2 595 630 Respirators: 7 669 760 Respirators: 1 350 095

European region South-East Asia region Western Pacific region

Sample collection kits: 210 650 Sample collection kits: 2 271 550 Sample collection kits: 114 300
Tests (manual PCR): 451 270 Tests (manual PCR): 1 936 700 Tests (manual PCR): 252 064
Face shields: 1 715 300 Face shields: 371 836 Face shields: 761 700
Gloves: 8 463 100 Gloves: 2 125 500 Gloves: 1 770 000
Goggles: 386 380 Goggles: 86 510 Goggles:310 807
Gowns: 1 349 048 Gowns: 556 000 Gowns: 427 210
Medical masks: 39 215 500 Medical masks: 6 940 500 Medical masks: 13 798 150
Respirators: 5 299 150 Respirators: 604 495 Respirators: 2 061 035

*8 January 2021

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 x
INTRODUCTION

About this document

2020 has been an extremely challenging year for the This first part of the report sets out a brief history of
world, and for the World Health Organization (WHO). the COVID-19 pandemic so far, including some of the key
In this report we look back at how the whole Organization milestones in WHO’s early response, and describes the
has risen to that challenge. Since 2016, when WHO Strategic preparedness and response plan (SPRP) that WHO
established the Organization’s Health Emergencies and partners developed and updated to guide the world’s
Programme, WHO has worked with partners and donors response to COVID-19 at the global, regional, national,
to establish and strengthen the key platforms needed and community level. In part two, we explore how WHO
to support countries to prepare for and respond to has worked at the global, regional, and national level to
health emergencies. In 2020 these platforms provided support countries to first adapt the SPRP to their own
WHO with the foundation from which to launch and contexts, and then to deliver their own national COVID-19
coordinate the largest global public health response and action plans. Part three details the depth and breadth
the most rapid, most complex biomedical research and of WHO’s efforts to coordinate and accelerate research
development effort in history. As the pandemic has grown and innovation efforts for high-priority medical and
and evolved to touch almost every aspect of global health non-medical countermeasures that are accessible to all.
and wellbeing, so WHO’s response has evolved to bring The final, fourth part of the report looks at some of the
every facet of the Organization’s strength and expertise lessons that WHO has taken from the past 12 months, and
to bear on COVID-19. looks ahead to the challenges of 2021, as every pillar of
the response adapts to the urgent need to prepare and
It is important to emphasize that this report reflects
strengthen health systems in advance of the new vaccines,
on WHO’s role at the centre of a global response that has
diagnostics, and other technologies that will add to our
unfolded on a scale that dwarfs any single organization –
growing list of countermeasures against COVID-19.
even one with a footprint of 150 dedicated country
offices around the world. WHO is proud of the role we
have played in supporting national authorities to control
COVID-19 transmission, protect the vulnerable, and
save lives, but wherever and whenever there have been
accomplishments they belong to us all. First and foremost
they belong to all of the communities around the world
that have been affected by COVID-19, and that have
taken collective and individual action to stop the spread
of the virus. They belong to the health workers who have
sacrificed so much to be our first line of defense against
the virus, and to keep essential health services running.
They belong to the politicians and leaders who have
shown the will to tackle COVID-19, and who have given
their populations the tools and knowledge they need
to protect themselves, with WHO’s support whenever
and wherever it has been requested. They belong to
the many partner organizations that have worked with
WHO to support every aspect of the response. And they
belong to every individual and every organization that
has contributed financially, materially, and through
their actions to support WHO’s work over the past 12
months. All contributions are absolutely vital, but the
flexible donations WHO has received from many generous
donors are especially valuable, as they have enabled the
Organization to rapidly adapt its support as the pandemic
has placed dynamic stresses on different health systems
and supply chains over the past 12 months.

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 1
Epidemiological overview: January to December 2020
The first signal hinting at the emergence of COVID-19
was detected on the final day of 2019 (figure 1). On Rapid action to scale-up WHO capacity
31 December, WHO’s Country Office in the People’s • 76% of all WHO country offices initiated support for the
Republic of China picked up a media statement by the development of a national COVID-19 response strategy,
Wuhan Municipal Health Commission that referred to a rising to 87% of all country offices in fragile, conflict-affected,
cluster of cases of viral pneumonia. The WHO Country and vulnerable countries.
Office immediately notified the International Health • 62% of WHO country offices provided expert advice to ministries
of health and partners on priority interventions
Regulations focal point in the WHO Western Pacific
Regional Office, and within 24 hours WHO had activated • 62% of WHO country offices launched the Early Warning Alert
and Response System for COVID-19, rising to 77% of offices
its Incident Management Support Team (IMST) across in fragile, conflict-affected, and vulnerable countries.
the three levels of the Organization. On 5 January 2020
WHO alerted all Member States to the cluster through
the International Health Regulations Event Information January February
System, and several days later reported that the cluster
had been caused by the novel coronavirus that we now
know as COVID-19. • 83% of WHO country offices initiated support for logistics, supply
chain and procurement for the COVID-19 response, rising to 90% of
all country offices in fragile, conflict-affected, and vulnerable countries.
Figure 1 The first 30 days: timeline of WHO’s early response • 81% of WHO country offices initiated support to issue sitreps,
rising to 93% of all country offices in fragile, conflict-affected,
31 Dec | WHO’s Country and vulnerable countries.
Office in the People’s • 79% of WHO country offices initiated capacity-building or training
Republic of China picked relevant national and partner staff in technical areas, rising to 87% of
up a media statement all country offices in fragile, conflict-affected, and vulnerable countries.
by the Wuhan Municipal
Health Commission from 2 Jan | After receiving
their website on cases further information from 22-23 Jan | The WHO
of ‘viral pneumonia’ in Chinese officials about the 9 Jan | WHO received Director-General convened
Wuhan, People’s Republic cluster of cases of ‘viral confirmation that an IHR Emergency
of China. At the same pneumonia of unknown the cluster of cases Committee to advise on
time, WHO’s Epidemic cause’, WHO informed was caused by a new whether the outbreak of a
Intelligence from Open Global Outbreak Alert coronavirus. Over the new coronavirus constituted
Sources (EIOS) platform and Response Network next few days WHO a public health emergency
also picked up a media (GOARN) partners in convened expert networks of international concern
report on ProMED readiness for response. in all key response areas, (PHEIC). Based on the limited
(a programme of the GOARN partners include and activated the R&D data available the committee
International Society major public health Blueprint and Global 13 Jan | WHO publishes was unable to declare a
for Infectious Diseases) agencies, laboratories, Coordination Mechanism first protocol for a RT-PCR PHEIC but recommended
about the same cluster sister UN agencies, for Research and assay by a WHO partner it be reconvened within
of cases of “pneumonia international organizations Development to prevent laboratory to diagnose 10 days when more
of unknown cause”. and NGOs. and respond to epidemics. the novel coronavirus. information was available.

1 Jan | WHO requested 5 Jan | WHO shared 10 Jan | Over a period of 20-21 Jan | WHO 30 Jan | The WHO
information on the reported detailed information three days WHO publishes conducted the first mission Director-General declared
cluster of atypical pneumonia about the cluster of cases a comprehensive package to Wuhan and met with the novel coronavirus
cases, and activated its through the IHR (2005) of guidance documents for public health officials to outbreak a public health
Incident Management Event Information System, countries, covering topics learn about the response emergency of international
Support Team (IMST), as part accessible to all Member related to the management to the cluster of cases concern (PHEIC), WHO’s
of its emergency response States, and published a of an outbreak of a new of novel coronavirus. highest level of alarm,
framework, which ensures Disease Outbreak News respiratory new disease. after reconvening
coordination of activities and article on the cluster, 24 Jan | WHO held an the IHR Emergency
response across the three accessible by the public. informal consultation Committee. At that time
levels of WHO (Headquarters, on the prioritization of there were 98 reported
Regional, Country) for public candidate therapeutic cases and no reported
health emergencies. agents for use in novel deaths in 18 countries
coronavirus infection. outside China.

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 2
 Those countries that have been able to reduce
As the virus spread rapidly, lives and livelihoods around
transmission and bring outbreaks under control have
the world began to change. In just 3 months almost
1 million cases had been reported from every one of
been able to minimize mortality from COVID-19, and
by maintaining the ability to deliver quality clinical care
WHO’s regions (figure 2). By the end of 2020 only a very
small handful of countries had yet to report a case of
and the continued delivery of essential health services
have therefore also minimized mortality from all causes.
COVID-19. But although the disease has affected every
By contrast, in countries that have been unable to
region and almost every country over the past 12 months,
there have been significant variations in the extent and
control community transmission, outbreaks have grown
exponentially. In most countries that have experienced
intensity of transmission not only between regions,
but also between countries within regions, and between
uncontrolled transmission, the rapid increase in patients
subnational areas within countries (figure 3).
seeking hospital care has forced authorities to introduce
widespread population-level
physical distancing measures and
Those countries that have been able to reduce movement restrictions in order to
transmission and bring outbreaks under slow spread and buy time to set in
place other control measures. These
control have been able to minimize mortality distancing measures and movement
restrictions, can break chains of
from COVID-19. COVID‑19 transmission by limiting
contact between people. However, these measures can
also have a negative impact on individuals, communities,
and societies by placing severe restrictions on social and
economic life. Such measures disproportionately affect
disadvantaged groups, including people in poverty,
migrants, internally displaced people and refugees,
who most often live in overcrowded and under resourced
settings, and depend on daily labour for subsistence.
At the regional level, Europe and the Americas together
account for approximately 70% of all reported cases
and deaths during 2020. South-East Asia and the Eastern
Mediterranean account for the 18% and 7% of cases,
respectively, although the Eastern Mediterranean
accounts for a greater proportion of deaths. Africa and
the Western Pacific account for 2% and 1%, respectively,
of global cases and deaths.

Figure 2 Weekly cases of COVID-19 by WHO Region as at 21 January 2021

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 3
Figure 3 Cumulative geographical distribution of COVID-19 cases as at 21 January 2021

Source: World Health Organization

Despite some improvements in treatment COVID-19

remains a severe disease, with most estimates putting
the case fatality ratio greater than 10% in people over
65 years of age. Countries with older populations –
primarily high-income countries – have fared worst,
as the risk of death from COVID-19 rises steeply with
age and the burden of non-
Men appear to be more biologically susceptible communicable diseases. There
is also evidence that the virus has
to severe infection and death. By contrast, in differential impacts on women
and men. Men appear to be more
many countries women are at an increased risk biologically susceptible to severe
of exposure to COVID-19 through the provision infection and death. By contrast,
in many countries women are
of care (women account for approximately 70% at an increased risk of infection
through the provision of care
of the global health workforce), and are often (women account for approximately
disproportionately affected by the social and 70% of the global health workforce),
and are often disproportionately
economic implications of response measures. affected by the social and economic
implications of response measures.
These impacts include but are not limited to a loss of
sexual and reproductive health services, and a steep
Deeply disturbed that when COVID-19 rise in the incidence of gender-based violence, with
lockdowns began, there was a 60% UN Women estimating national increases of more
increase of gender-based violence than 60% in reports of gender-based violence coinciding
cases according to the WHO's response with lockdowns. These periods of peak demand for
to COVID-19 report (2021) social protection and refuge services coincide with
periods that these services have been significantly
curtailed due to COVID-19.

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 4
WHO’s Strategic preparedness and response plan
WHO’s Strategic preparedness and response plan (SPRP) was published on 4 February, four days after
the declaration of a global public health emergency on 30 January. As the pandemic evolved, the SPRP
was updated in April to underline the importance of critical aspects of the public health response, and
in particular to respond to the difficulties faced by many countries at that time by setting out clear
criteria that countries could use to ensure that they exited lockdowns safely and sustainably.
The response strategy is organized around nine technical and operational response pillars (figure
4), plus a tenth overarching global research and innovation pillar. The strategy is designed to
achieve three simple goals: to control transmission of the virus, to save lives, and to protect the
vulnerable. The structure of the pillars is mirrored by WHO’s Incident Management Support Team
(IMST) across all three levels of the organization: WHO’s global headquarters, its regional offices,
and over 150 country offices. The IMST provides the technical, operational, planning, coordination,
logistical, and safety management infrastructure to support the response at the appropriate
organizational scale (subnational, national, regional and global).

Figure 4 The pillars of WHO’s response to COVID-19

Surveillance, contact tracing, and case investigation
Infodemic management, risk communication,

Maintaining essential health systems

Travel, trade, and points of entry

Infection prevention and control

Laboratories and diagnostics
and community engagement

Coordination
and planning
Clinical management

Operational support
and logistics

Accelerated research
and innovation

There are 10 main pillars of WHO’s COVID-19 response, and these pillars can be divided into three broad groups. Seven
discrete technical and operational pillars are underpinned by the two broad, cross-cutting pillars of coordination and
planning, and operational support and logistics. Within each of the technical pillars is a component that intersects with
a tenth pillar that coordinates and facilitates accelerated research and development in every area of the response. This
structure forms the basis of the WHO Incident Management Support Team across all three levels of the Organization.

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 5
The SPRP was developed, and should be considered, in the Although the IMST structure is the same, the practical
context of WHO’s Thirteenth General Programme of Work emphasis is different at each level of WHO. At the global
(GPW13), which puts impact and delivering for countries level, the primary focus is on the rapid scaling, adaptation,
at the heart of the Organization’s mission. GPW13 makes and sustainability of key planning, coordination, and
WHO accountable for three ambitious, overlapping operational support platforms to facilitate the work of the
targets: 1 billion more people better protected from technical pillars at all levels of the response. Within the
health emergencies; 1 billion more people benefitting technical pillars at the global level, there is a dual focus
from universal health coverage; and 1 billion more people on: 1) the rapid development and periodic reappraisal of
enjoying better health and well-being. Each of these three key norms, standards, and guidance to set the parameters
interlinked goals are directly challenged by COVID-19, and key requirements of an effective response at national
and the pandemic is a challenge that has been met level; and 2), working through the crosscutting operational
by the mobilization of the entire Organization (figure 5). platforms to ensure that countries are supported to
meet those requirements. At the
regional level, the primary focus is
Figure 5 COVID-19 intersects with WHO’s triple billion targets on working closely with countries
to understand their detailed needs
and contexts, and to adapt and
tailor technical and operational
support accordingly. Established
partnerships with regional economic,
political, and public health institutions
provide key platforms through which
more people WHO can multiply and coordinate
benefiting from support to countries. The national
universal health level and, increasingly, subnational
coverage level, is where these international
and regional efforts translate into
direct support for governments
and affected populations.
The SPRP and its update provided
a template that countries could
adapt, with support from regional
and country offices, to create their
more people more people own national COVID-19 action plans.
better protected enjoying better WHO’s direct support to countries
from health health and has been targeted to support the
emergencies well-being delivery of those plans, but not all
countries require or request the same
degree of support from WHO, and
the support requirements of many
countries have changed over the
course of the pandemic. For example,
in countries with well developed
health emergency preparedness and
readiness capacities, WHO’s support is limited more to
the provision and adaptation of the technical guidance,
norms, and standards that are needed to guide the
response. At the other end of the spectrum, particularly
in countries or subnational areas that are fragile, conflict-
affected, and/or vulnerable (FCV countries), WHO’s
support is more operational, in some cases working with
partners as a provider of last resort for essential services
and commodities.

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 6
 To prioritize countries for support during COVID-19,
WHO has used several of the tools and platforms that have
been developed and strengthened since 2016 to assess
national health emergency preparedness and response
capacities in line with the International Health Regulations.
Assessments of national operational readiness to respond
to COVID-19, and their vulnerability and risk, were
based on a combination of the results reported through
the self‑assessment International Health Regulations
State Parties Annual Reporting tool, information from
voluntary joint external evaluations, and other contextual
information from country-specific COVID-19 situation
analysis. Other crucial factors included whether or not a
country had been included in the UN Global Humanitarian
Response Plan (GHRP) for COVID-19, and the current and
projected position of a country on a continuum of intensity
of COVID-19 transmission (figure 6).
Meeting the needs of countries has meant WHO has
had to scale up its footprint at national level on a global
scale. At a national level, the Organization has redirected
more than half of its pre-COVID-19 human resources to
the response, and temporarily added more than 1200
new people to the workforce to deliver the technical and
operational support that governments have requested,
with more than 60% of this surge in capacity concentrated
© WHO / Ploy Phutpheng in GHRP countries. This scale up was achieved rapidly,
with the result that 80% of WHO country offices were
A health volunteer in Thailand takes the temperature of a patient during providing technical support and support for procurement,
a home visit. Activities such as this contribute to ensuring 1 billion more logistics, information management, training and capacity
people are better protected from health emergencies. strengthening by the end of February 2020 (figure 7).

Figure 6 Country risk and vulnerability mapping

Increasing COVID-19 transmission intensity

ort
u pp
als
i on
rat
ope
nd
la
ca
hni
tec
g
in
e as
cr
In
WHO increases the degree of technical and operational support
available to countries on the basis of their position on a spectrum
of COVID-19 transmission risk and their preparedness and readiness
capacities. Countries with uncontrolled community transmission and
low preparedness and readiness capacities are given the highest
priority for the greatest degree of support, which may include WHO
and implementing partners acting as provider of last resort for
essential health services and commodities. Decreasing national preparedness and readiness capacity

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 7
Financing the plan for 2020
BOX 1
The results of the initial prioritization analysis have The COVID-19 Solidarity Response Fund
been regularly updated as the pandemic has evolved,
and these results have guided WHO’s allocation of funds The COVID-19 Solidarity Response Fund for
and resources throughout 2020. Of the US$ 1.5 billion the World Health Organization (WHO) enables
that WHO has raised from more than 70 donors corporations, individuals, foundations, and other
(see Annex B) throughout 2020 (table 1), including organizations around the world to directly support
more than US$ 240 million from the COVID-19 Solidarity global efforts, led by WHO, to help countries prevent,
Response Fund (box 1), the vast majority of funds have detect, and respond to the COVID-19 pandemic.
been allocated to fund activities and the purchase and
The Solidarity Response Fund was created at the
distribution of essential supplies and equipment at the
request of WHO by the United Nations Foundation
regional and national level (figures 7, 8, and 9). Initial
(UNF) and the Swiss Philanthropy Foundation (SPF).
response activities during January, immediately following
The intended use of the Solidarity Response Fund is
the emergence of COVID-19, were financed through the
to contribute towards funding the COVID-19 SPRP.
WHO Contingency Fund for Emergencies mechanism,
The Solidarity Response Fund is a first-of-its-kind
which released US$ 10 million for the COVID-19
platform for the private sector and the general public
response during the first month of the response. A total
to actively accelerate and support global efforts
of US$ 583.5 million was utilized to support national
to contain and mitigate the ongoing pandemic
response in countries included in the GHRP (table 2).
by pooling flexible financial resources.
The majority (approximately 80%) of funding received
by WHO for the response was earmarked to an extent, The Solidarity Response Fund has also given
either geographically or otherwise designated for a rise to a unique opportunity for inter-agency
circumscribed range of activities or materials (figure 10). collaboration, as it funds a broad range of activities
needed to combat the pandemic, including those
undertaken by key partners such as UNICEF,
which has joined Solidarity Fund efforts to support
vulnerable groups, and the World Food Programme
(WFP), which has joined the Solidarity Fund efforts
to deliver vital supplies to front-line responders
during the pandemic.

Table 1 Availability and utilization of funds for 2020

Funds available and utilization US$ million

Funds requested 1 740.0

Funds received 1 520.0

Funds for 2020 SPRP implementation 1 402.2

Utilization* 1 267.8

Balance 134.3

*Based on interim 2020 year-end figures and estimated 2021 Q1

transition period implementation. Balance carried forward for SPRP 2021
implementation.

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 8
Figure 7 Utilization* by major office (US$ million) Figure 8 Utilization* of funds by level of organization
(US$ million)

al 1 267.8 (100% al 1 267.8 (100%

Tot ) Tot )
148.0 148.0
(11%) 258.8 (11%)
(20%)
111.0 111.0
(9%) (9%)

80.8 112.0
(6%) 134.9
(9%)
(11%)

95.9
(8%) 896.9
(71%)

123.3
(10%)
315.2
(25%)

Regional Office for Africa Total of countries

Regional Office for the Americas and PAHO Regional offices
Regional Office for the Eastern Mediterranean Headquarters
Regional Office for Europe Global services (includes global research and innovation)
Regional Office for South-East Asia
Regional Office for the Western Pacific
Headquarters
Global services (includes global research and innovation)

Figure 9 Utilization* of funds by pillar group (US$ million) Figure 10 Utilization* by type of funding by level
of ear‑marking (US$ million)

al 1 267.8 (100% al 1 267.8 (100%

Tot ) Tot )
117.3
(9%)
252.2
329.3
(20%)
(26%)

555.7
(44%)

898.4 382. 8
(71%) (30%)

Global and regional coordination and support Flexible

Support to COVID-19 national plans Designated
Research and innovation Specified

Fully flexible funding can be used to fund urgent activities and purchase
essential supplies and equipment to support any country on the basis of
need. Use of designated funding is subject to a limited level of earmarking
by donor, typically by geographical area or set of countries. Specified
contributions are typically for use only in specific countries and/or pillar
*Based on interim 2020 year-end figures and estimated 2021 Q1 transition or set of activities.
period implementation

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 9
Table 2 Utilization* of funds in Global Humanitarian
Response Plan countries by WHO region

Region US$ million

Regional Office for Africa 156.3

Regional Office for the Americas and PAHO 67.3

Regional Office for the Eastern Mediterranean 294.8

Regional Office for Europe 36.8

Regional Office for the South-East Asia 17.7

Regional Office for the Western Pacific 10.7

Total 583.5

*Based on interim 2020 year-end figures and estimated 2021 Q1 transition

period implementation

Table 3 Top 10 highest contributors to the SPRP

Contributor US$ million

Germany 434.00

European Commission 135.76

United Kingdom of Great Britain 127.68

and Northern Ireland

COVID-19 Solidarity Response Fund 84.07

World Bank 65.56

Kuwait 60.00

Iran (Islamic Republic of; World Bank) 51.97

Japan 50.47

United States of America 36.57

United Nations Development Programme 33.35

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 10
PUTTING HEALTH AT THE HEART
OF THE GLOBAL COVID-19 RESPONSE
Part 2 of this report describes how WHO has adapted Coordination and planning
and scaled up key platforms at the global, regional, and
national level to support countries respond to COVID-19.
The existence of these platforms, the Contingency Fund Steering a global whole-of-UN response
for Emergencies to kick start the response, and the COVID-19 is a crisis that touches every aspect of every
Organization’s ability to respond to COVID-19 at a global society, and our collective response has had to encompass
scale owes a great deal to the foresight and the generosity that broad range of needs and requirements on a
of our donors. global scale. Meeting that challenge has meant bringing
the whole of the United Nations system together to
coordinate a response that reflects the full spectrum
of its capabilities. WHO has been at the forefront
of that coordination process.
At the global level, overall UN coordination is achieved
through the UN Crisis Management Team (UNCMT), which
was triggered on 4 February 2020 and is led by WHO.
This is the highest possible level of crisis alert in the UN
COVID-19 is a crisis that touches system, and this is the first time this mechanism has been
every aspect of every society, activated for a public health crisis. The UNCMT brings the
collective strengths of 23 UN entities under one response
and our collective response has umbrella, and met more than 25 times during 2020. These
high-level meetings are essential in order to set and
had to encompass that broad adjust strategic goals and resolve urgent issues as they
range of needs and requirements arise in response to constant feedback from over 130 UN
Country Teams and Resident Coordinators embedded in
on a global scale. the response at national level. The COVID-19 supply chain
platform, for example, was an initiative launched as a result
of this process, and is described in more detail later as
part of WHO’s work in operational support and logistics.

Figure 11 GHRP priority countries, territories, and areas identified for targeted technical and operational support

Countries included in GHRP in March

Countries added to GHRP in May 0 850 1,700 3,400 Kilometers

Disclaimer: The designations employed and the presentation of material in this publication do not imply the expression World Health Organization
of any opinion whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any country,
territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.
© WHO 2020. All rights reserved.

Priority countries, territories or areas

Afghanistan, Angola, Argentina, Aruba,* Bangladesh, Benin, Bolivia, Brazil, Burundi, Burkina Faso, Cameroon, Central African Republic, Chad, Chile,
Colombia, Costa Rica, Curaçao,* Djibouti, Dominican Republic, Democratic People’s Republic of Korea, Democratic Republic of the Congo, Ecuador,
Egypt, Ethiopia, Guyana, Haiti, Iran, Iraq, Jordan, Kenya, Lebanon, Liberia, Libya, Mali, Mexico, Mozambique, Myanmar, Niger, Nigeria, oPt, Pakistan,
Panama, Paraguay, Peru, Philippines, Republic of Congo, Rwanda, Sierra Leone, Somalia, South Sudan, Sudan, Syria, Tanzania, Togo, Trinidad and
Tobago, Turkey, Uganda, Ukraine, Uruguay, Venezuela, Yemen, Zambia, Zimbabwe.
* Aruba (Netherlands), Curaçao (Netherlands)

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 11
The formation of the UNCMT facilitated the development © WHO / P. Phutpheng
of two further strategic frameworks to complement
the SPRP, with its focus on the public health response
to COVID-19 (figure 11). The Global Humanitarian
Response Plan (GHRP) for COVID-19 was published on
25 March, updated on 7 May, and sets out the strategy
for a whole-of-UN response to the effects of COVID-19
in the 63 countries around the world with the most
pressing humanitarian needs (figure 12). Under the
umbrella of the GHRP, the members of the Inter-Agency
Standing Committee (IASC), effectively encompassing
the entire humanitarian system and including WHO,
have been able to coordinate their actions to address
the most urgent humanitarian health, protection and
socioeconomic needs caused by the pandemic. At WHO’s
request, the heads of the IASC agencies initiated a UN
system-wide scale‑up – the highest level of emergency
response for the humanitarian system.
At the same time as the development of the GHRP,
the UN Development Coordination Office (UNDCO) led
the development of a UN framework for the immediate
socio-economic response to COVID 19, which outlines
an integrated support package offered by the UN
Development System to protect the needs and rights
© WHO / P. Phutpheng
of people living under the duress of the pandemic, with
a focus on the most vulnerable countries. With WHO’s WHO is working to ensure that 1 billion more people are better protected
input, both the GHRP and the Socio-economic framework from health emergencies. Pictured here, is the team at the Thai National
have substantial public health components, ensuring that Influenza Centre at the National Institute of Health, that validated the virus
health is at the heart of the whole-of-UN response, with DNA to confirm the first COVID-19 case in Thailand. The Institute is part
WHO at the forefront of delivery. of the Ministry of Public Health.

Figure 12 Complementary strategies make up the whole-of-UN approach

Coordination, planning, and monitoring

Accelerated research and development
Strategic preparedness

Global humanitarian

Risk communication and community engagement

and response plan

response plan

Surveillance
Laboratories
Points of entry, and international travel
Case management
Infection prevention and control
Technical support and guidance
Operational support and logistics
Essential health services and systems
Socio-economic
response plan

Protecting people
Economic recovery
Macroeconomic response
Social cohesion

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 12
As Health Cluster Lead Agency, WHO leads the efforts At the regional level, WHO Regional Directors coordinate
to integrate and deliver the public health response to with UN Development Coordination Office Regional
COVID-19 through the GHRP, providing coordination and Directors on strategy, planning and information sharing.
operational support in 30 countries in partnership with A number of technical and operational bodies have been
900 national and international partners, to implement established at regional level to facilitate coordination
the GHRP and maintain essential health services. between UN and other partners for multi-sectorial
This task is streamlined by the Global Health Cluster action, including regional public health institutes
COVID-19 Task Team, based at WHO headquarters, which and development banks.
identifies critical challenges and supports the adaptation
and implementation of WHO COVID-19 guidance in
low‑capacity, humanitarian settings, and captures and
disseminates good practice. The Global Health Cluster
also co-leads the Global Information Management,
Assessment and Analysis Cell, which manages and
analyzes COVID‑19‑related information to support global
decision-making, and provides technical support and
services to prioritized countries (figure 11).

Figure 13 Global Health Cluster Public Health Information System dashboard as at September 2020

The Global Health Cluster Public Health Information System dashboard provides a quarterly update on the status of key response indicators in all countries
where there is an activated Health Cluster.

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 13
Supporting and enabling national planning and coordination
Within the overall response at the national level, With national plans in place, the next step is to match
the UNCMT coordinates with UN Country Teams in available international support and resources to address
136 countries to facilitate joint action by UN entities any gaps, and to continually monitor implementation
and international agencies in support of national and adjust course as appropriate. The COVID-19 Partners
authorities. WHO country offices play vital strategic, Platform (box 2, figure 14) is designed to enable national
technical and operational roles within the UNCTs. and international partners to come together with national
All six WHO regional offices and all 150 country offices authorities to plan, track, and resource the COVID-19
have activated a COVID-19 IMST to provide operational response.
and technical support to national governments in all
Initially the Platform offered three main features:
aspects of readiness and response, including planning
and coordination. • an action checklist to review and monitor the status
of implementation across the nine main pillars of the
WHO’s direct support for planning and coordination
public health response;
role at the national level has been multifaceted. First,
WHO’s country and regional offices have worked closely • a resource tracker to highlight country resource needs
to support national authorities to tailor the WHO SPRP (financial, supplies, and personnel) to deliver the
to their own national contexts in the form of national necessary public health response;
COVID-19 preparedness and response plans. This support • a resource tracking database to provide a transparent
has been provided either in situ by country offices overview of donor contributions to the COVID-19
and/or technical missions deployed from regional offices, response.
or remotely where travel restrictions have prevented Further functionality has been added in response
direct deployments. More than half of all staff in WHO to feedback from users, including a direct link to the
country offices have dedicated time to the COVID-19 COVID-19 Supply Chain System via a supply portal
response, and all programmes have had to adjust ways integrated into the platform. With more than 120
of working to account for and support the COVID-19 countries and 80 donors actively using the platform,
response. The process of formulating national actions further feedback will enable the platform to continue
plans was aided by the publication of operational planning to evolve to meet changing requirements.
guidelines guidance, which was developed by WHO to
provide a practical guide to develop and update COVID-19
national plans across the major pillars of COVID-19
preparedness and response. The proportion of countries,
territories and areas in all regions with a preparedness
and response plan increased from 47% in March 2020 to
91% by 31 December 2020, with an increase from 45% to
97% in the proportion of countries, territories and areas
with a functional COVID-19 coordination mechanism.
The target for both indicators is 100%.

“The Partners Platform, created at the end of January, has

become a critical tool to help countries highlight financial,
supply and personnel needs and deliver the necessary
public health response.”
Dr Tedros Adhanom Ghebreyesus
Director-General, World Health Organization

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 14
 BOX 2

Partners Platform: uniting behind a shared plan

When COVID-19 began spreading, countries needed
to plan, coordinate, and resource their response.
Pakistan, for example, recognized the urgent need
to adopt a strategic approach to identifying needs,
developing a country-level response plan, and
coordinating at both the national and provincial
level. Pakistan health officials began to work closely
with WHO and the UN Resident Coordinator to plan
the COVID-19 response, launching the Pakistan
Figure 14 The COVID-19 Partners Platform*
Preparedness and Response Plan in April. And key
to creating and implementing the plan was the
online Partners Platform.
5 798 users spanning
Countries can build and tailor their own response across 992 organizations
plans using the platform, choosing from a checklist and 207 countries,
of 143 key actions based on constantly updated territories and areas
expert guidance from WHO and other key response
partners. All actions are fully costed, which enables
countries to note where they need financial
assistance and donors to track what actions are 119 countries,
taking place, where the biggest resource needs and territories and areas
gaps lie, and how to prioritize which allocations go sharing national
where. Crucially, the Partners Platform is the only response plans
place where the major donor partners can see what
each other is doing in the emergency response,
make informed decisions, and coordinate. By using 106 countries,
the Platform, partners can visualize which regions territories and areas
in the country need more help and direct their tracking actions under
donations accordingly. pillars of public health
“For the first time we have a tool that allows us to for entire national
monitor fund flow, this is both operationally useful system
and a great service to all our partners,” says Mr
Julien Harneis, UN Resident Coordinator of Pakistan. To date, 90 countries
During 2020 a total of 18 major donors provided shared resource needs
information on their contributions to support the totaling US$ 9.28
countries COVID-19 Preparedness and Response Plan billion across nine
totalling more than US$ 1.2 billion. response pillars
Pakistan’s successful use of the Platform has been
replicated globally. By the end of 2020, 90 countries
had shared their public health response resource
needs totalling US $9.3 billion, with 77 donors 77 donors responded
detailing more than US$ 15 billion I contributions totaling approximately
to finance the public health and other aspects US$ 15.4 billion
of the response.
*Data as of 31 December 2020

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 15
Keeping track and adjusting course Translating evidence into knowledge
Real-time strategic planning and adjustment, and action
coordination, and evidence-based decision-making
depends on access to quality and timely operational and Activating a WHO core strength
situational tracking data. In addition to WHO’s core role in
the management and communication of epidemiological Since January 2020, when COVID-19 was first identified,
data (described in more detail later), WHO’s COVID-19 WHO has been able to leverage its unique core strength
monitoring and evaluation framework gathers and as a technical and normative agency to rapidly gather and
publishes key performance and situational data for a synthesize evidence into authoritative technical guidance
set of global and national indicators (Annex A). These across a broad range of thematic areas covering the
indicators are publicly available and regularly updated to spectrum of the public health response.
ensure that the response is able to evolve as the pandemic
Drawing extensively on WHO’s convening power, expert
changes course. In addition, WHO’s Guidance for
networks, advisory groups, collaborating centres,
Conducting a Country COVID-19 Intra-Action Review (IAR)
and strong ties with national knowledge and expertise
was developed to guide countries to conduct periodic
has enabled the Organization to continually ask
reviews of their national and subnational COVID-19
questions with profound implications for our collective
response. IAR’s are a country-led facilitated process that
understanding of what constitutes an effective response
bring together a small group of COVID-19 responders
and how we achieve it: what do we know about the virus,
with knowledge of the public health response to identify
and what works most effectively to control it in different
practical areas for immediate remediation and sustained
contexts? Asking these questions systematically, pillar by
improvement of the ongoing response.
pillar, about every aspect of the public health response
has enabled WHO to publish and periodically reappraise,
and support the implementation of more than 500
guidance documents and scientific briefings, ranging from
how best to safely transition out of a lockdown to advice
on the appropriate use of masks in different situations
Figure 15 WHO technical guidelines are updated regularly (figure 15; figure 16). The Strategic and Technical Advisory
to reflect new evidence Group on Infectious Hazards (STAG-IH) held its first of
many meetings on COVID-19 in January, and has been
a vital mechanism through which many critical questions
have been addressed to inform the global response.
WHO published the first tranche of core COVID-19-specific
guidance for countries over three days from 10 January,
covering topics related to the management of an
outbreak of a new disease, including:
• infection prevention and control;
• laboratory testing;
• national capacities review tool;
• risk communication and community engagement;
• disease commodity package;
• travel advice;
• clinical management;
• surveillance case definitions.
Some of the key documents and guidance notes
are explained in more detail below, under the
appropriate headings.

What do we know about the virus,

and what works most effectively
to control it in different contexts?

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 16
Figure 16 Knowledge to action – a dynamic adaptive system

Leverage evidence and expertise Authoritative, accessible guidance

• Expert networks • Rapid, constantly re-evaluated
• Collaborating centres • Multi-disciplinary
• Strategic advisory groups • Multi-lingual
• Massive online consultations/meetings • Multi-agency
• R&D Blueprint for Epidemics • Adapted to different contexts
• Multi-country studies/trials (Solidarity, Unity) • Content shared through multiple channels

Monitoring and Learning Implementation

• KPI driven monitoring and evaluation • Digital transformation of knowledge into learning
• Country case studies and reports using innovative training platform: OpenWHO

• Targeted operational research • 150+ country offices and six regional platforms
provide tailored operational and technical support
• Infodemic monitoring and engagement
• Multi-agency operational platforms surge people
• Inter-action reviews and SimEx support and material resources (UN supply chain; EMTs;
• Regional Consultations and engagement GOARN, TECHNE)
with country offices and Member States

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 17
Putting knowledge into practice
WHO regional offices play a vital role in the development
of guidance, but also make a unique contribution through
their work to adapt and translate relevant guidance
to national and subnational contexts. This is essential to
ensure that the guidance process is not a dry academic
exercise, but is brought to life in practice. Another
key platform for ensuring that guidance is translated By the end of 2020 more
into knowledge and action is training. The OpenWHO
training platform was created in 2017 to provide targeted than 4.7 million people had
and disease-specific training for health workers and enrolled on OpenWHO.
responders before and during emergencies – a need that
was clearly identified during the 2014 outbreak of Ebola
virus disease in west Africa.
The training programmes and modules on the
OpenWHO platform are based on the latest state-of-the
art knowledge from WHO guidelines (figure 17), and are Figure 17 The OpenWHO interface
updated to reflect any changes in light of new evidence.
Uptake on the platform had been steady since its launch
in January 2017, but has exploded during 2020 as a result
of the huge global appetite for knowledge and training
about COVID-19. By the end of 2020 more than 4.7 million
people had enrolled on the platform (figure 18), and
more than 2.5 million certificates of completion has been
issued for 148 COVID 19-specific courses ranging from
clinical care and the use of personal protective equipment
to training for filed data tools available in more than
42 languages. More modules are planned for 2021.
In November 2020, [Link] was named Gold
Winner for the ‘Best international digital transformation
of a training programme in response to COVID-19’
by the Learning Technologies Awards.

Figure 18 OpenWHO uptake since 2017

OpenWHO was launched in 2017 for pandemic preparedness

4 500 000
Accumulated enrolments

4.7 million
total enrolments

500 000
Jun Aug Oct Dec Feb Apr Jun Aug Oct Dec Feb Apr Jun Aug Oct Dec Feb Apr Jun
2017 2018 2019 2020
Jan

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 18
Real-time, rapid response capacity strengthening and support
Online training is an extremely powerful tool through Access to a well-trained, rapidly deployable, certified and
which WHO can reach a large global audience to largely self-sufficient surge emergency health workforce
strengthen national capacities. However, there are specific has been vital for many countries that found health
specialized areas that require more immediate, direct, services overstretched, and in some cases overwhelmed,
and short-term solutions during emergencies, either by the explosive nature of COVID-19 transmission. WHO
in the form of in-person training programmes and/or facilitates that access through more than 100 EMT focal
through surge deployments to boost critical capacity. points worldwide, who have worked closely with the EMT
secretariat at WHO throughout 2020 to implement and
WHO regional offices, often working in concert with key
monitor COVID 19 emergency response operations. More
regional partners, have been one of the primary vehicles
than 30 EMTs certified for international deployment were
through which WHO has been able to support countries
able to respond to 60 requests for support from another
through the deployment of technical support missions.
country during 2020. Most often these deployments
These missions enable experts from WHO and partners
were made within WHO regions, with teams from
to deliver targeted and tailored technical guidance and
regional neighbours best placed and more than willing
training in critical tools and systems. Despite the ongoing
to work in solidarity with host countries. In addition to
travel restrictions and disruption, WHO regional offices
these international deployments, a further 46 national
have continued to deploy experts to support countries
teams across all WHO regions were deployed within
in situ wherever safe, with missions to over 130 countries
their own national borders to respond to acute needs
to during 2020, implementing innovative digital solutions
at the subnational level.
such as webinars and remote working where restrictions
make direct deployment unfeasible. Regional platforms Given the unprecedented volume of deployments
have also been an essential support-delivery tool as the throughout 2020, the WHO EMT Secretariat has surveyed
pandemic has progressed. the EMT network to identify challenges and opportunities to
inform future EMT deployments, refine the EMT deployment
Surge support and training is also where two established
mechanism, and the EMT Global Classification process. The
WHO emergency platforms – the Emergency Medical
results of the survey are being analysed and will provide
Teams (EMT; box 3) initiative and the Global Outbreak
a more comprehensive understanding of EMT fieldwork
Alert and Response Network (GOARN) – have excelled
and lessons learned as the initiative prepares for 2021.
during COVID-19.

WHO regional offices, often working in concert

with key regional partners, have been one of
the primary vehicles through which WHO has
been able to support countries.

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 19
 BOX 3

Emergency Medical Teams: manifest solidarity

Emergency Medical Teams (EMTs) are WHO-classified Team leader Dr Wojtek Wilk describes how mentors
teams of health-care professionals who can be from Spain helped his EMT from Poland develop their
deployed to provide immediate assistance to countries skills related to issues of water supply, water treatment
and territories during natural disasters, outbreaks and and sewerage. Teams must demonstrate competence
emergencies. During the COVID-19 pandemic, demand outside their specialist areas and, he says, “mentorship
for EMTs surged across different regions, and WHO is therefore a major part of the global classification
facilitated the transfer of knowledge and practices process. A mentor provides advice and hope and is
in the spirit of solidarity. of immense help in overcoming obstacles.”
In the WHO European Region, eight EMTs have During the COVID-19 pandemic, EMTs have adapted
responded to requests for assistance from six different to provide on-the-job COVID-19 training and support
countries to help with the COVID-19 response in 2020. to ministries of health. They aim to strengthen triage
The Region has 50% of global EMT capacity, with and hospital referral procedures and improve infection
15 WHO-classified teams and more than 30 others under prevention and control measures, including proper
mentorship, ready to be deployed in the coming years. patient flow and treatment protocols for COVID-19
patients.
In 2020, a new twinning programme encouraged
experienced EMTs to partner with interested Member Dr Wilk explains that this reflects a shift in the way EMTs
States and nongovernmental organizations to help them operate. For example, professionals with expertise in
strengthen national emergency response capacities treating patients directly in field hospitals and intensive
that have played a key role in COVID-19 response. care units and dealing with trauma and surgical
interventions have found themselves needing to
Georgia and Germany were the first to collaborate
employ a different range of skills during the pandemic.
in this way. Georgia benefitted from German EMT
The training and capacity-building component of their
expertise to train its own national team, which then
work has come to the fore during this time.
became heavily involved in the country’s COVID-19
response. Azerbaijan and Turkey are now adopting The programme is a tangible manifestation of solidarity
the same formula. Demand for homegrown EMTs during the duress of the COVID-19 pandemic, notes
has increased during the pandemic, with support Dr Wilk. “I was asked recently if there is fear associated
from national governments or nongovernmental with working in a COVID-19 hospital,” he recalls.
organizations. “The only answer I could think of was, ‘there is fear,
of course, but somebody has to do it’. The world needs
Dr Harald Veen, a mentor for the WHO EMT initiative,
teams that can deploy to wherever there is a need,
says the focus is on building national teams that can
if the situation in their home country permits. This
respond rapidly in a crisis. “The health professionals in
is assistance, but also solidarity.”
these teams used to be focused on packing up to leave
for another country, but with COVID-19 everything
changed, and there was an immediate need for their
expertise at a national level.”
Alongside the twinning programme, a mentorship
scheme enables a greater number of teams to quickly
reach the required standards for WHO classification and
subsequent deployment. The WHO scheme encourages
established EMTs to offer advice and support to newer,
yet-to-be-classified teams. There are currently 65 teams
under mentorship globally, and a further 28 teams have
declared an interest in starting the process.

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 20
 GOARN partners are drawn from a global network
of expert institutions and health and humanitarian
emergency response Organizations. Throughout 2020
GOARN partners made in excess of 400 offers of technical
support, with experts deployed from around 30 partner
institutions and technical networks to provide direct
and remote support to countries at their request. Many
deployments are made within region, leveraging the
regional expertise of partner institutes. GOARN colleagues
from UNICEF, IFRC, US CDC, and OCHA are embedded
in the global COVID 19 incident management team,
supporting WHO’s work across all pillars of response.
WHO and GOARN partners are also
© WHO / Blink Media – Gilliane Soupe supporting over 60 projects worldwide
to implement [Link] – an app for
contact tracing and outbreak response
developed by WHO in collaboration
with partners in GOARN. [Link]
is a simple to use but powerful app
that integrates a database and user
interface to help gather and analyse
case and contact data, including
laboratory data, clinical outcomes and
other details from case investigations.
The app is particularly useful for the
management of contact follow-up
and the visualization of chains of
transmission for epidemiological
investigation.
Training, briefings, and direct user
and technical support have been
provided by WHO and GOARN
partners both remotely and in country
throughout 2020. More recently, in
the fourth quarter of 2020 the [Link]
community of practice was launched,
Real-time capacity strengthening and support provided by WHO through partners, including GOARN, and now serves as the main point of
is a primary vehicle used to support countries. Pictured here, Mauritius responds to the COVID-19 communication for users worldwide
pandemic working with samples at the Candos Virology Lab. seeking the latest information
and documentation, tips, training
materials, and troubleshooting. An
OpenWHO course is also available,
with more than 100 000 unique users
during 2020.

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 21
Surveillance, contact tracing, isolation and quarantine: the backbone
of outbreak response
Disease surveillance and the public health capacities to WHO’s technical guidance, translated and adapted at
identify, isolate and treat cases, and trace and quarantine regional and at country level to specific contexts, covers
contacts, are the backbones of the COVID-19 response every aspect of COVID-19 surveillance, case investigation
and the keys to controlling transmission in the absence and epidemiology, from the case definition through to
of a widely available vaccine. Stopping the spread of the use of digital tools for contact tracing and the use
SARS‑CoV-2 means ensuring that all cases are promptly of rapid diagnostic tests. This guidance is constantly
and effectively isolated and receive appropriate care, and updated to take into account advances in our collective
that the close contacts of all cases are rapidly identified understanding of the virus and new developments in
so that they can be quarantined and medically monitored technology. Direct technical support to countries to train
for the 14 day maximum incubation period of the virus. and support national epidemiologists is deployed from
At the global, regional, and national level, WHO has scaled WHO headquarters, regional offices, and country offices,
up and adapted existing platforms, and implemented new and through partnerships such as GOARN.
platforms for surveillance and public health measures
Putting guidelines and training into practice requires
to support countries.
a large, adaptable and trained workforce. In many cases
WHO took rapid action with partners in January to WHO has been able to support national authorities
establish a global surveillance system that gathers to train newly recruited and volunteer contact tracers
standardized data at global, regional, and country and surveillance officers to rapidly scale up their public
levels. Each day throughout 2020 WHO has undertaken health workforce (box 4). However, in some cases a
the considerable task of collating, validating, analysing different approach has been required to meet capacity
and disseminating official daily case and death counts requirements. The redeployment of WHO’s highly skilled
reported by 212 countries, territories and areas. These Poliovirus response teams and TB programme resources
data are routinely published through a wealth of country at subnational levels in response to COVID-19 (box 5,
and region-specific situation reports and dashboards, box 6) has shown that, even in the most challenging
as well as globally via the WHO COVID-19 Dashboard circumstances, an agile, multidisciplinary rapid-response
(figure 19) – which has continued to receive between emergency workforce can ensure that populations in some
1-2 million visitors per week during 2020. of the most vulnerable and fragile contexts can benefit
from a comprehensive public health approach to COVID-19.

At the global, regional,

BOX 4
and national level,
Boosting contact tracing in Chad
WHO has scaled Almost 190 medical students in Chad, trained by the ministry with the
up and adapted support of WHO, are helping to take the pressure off Chad’s health
workforce during the country’s response to COVID-19. Chad has just
existing platforms, 4.3 doctors and 23.2 nurses per 100 000 inhabitants, the majority of whom
are in the capital N’Djamena.
and implemented
The medical students in Chad have been trained to follow up with people
new platforms for asked to quarantine due to COVID-19, and to carry out screening at points
surveillance and public of entry. Support from the students has improved case investigation,
and increased capacity for the control and surveillance of travellers at
health measures to N’Djamena entry points and in the provinces. WHO provided training,
and equipped the new recruits with gloves, masks, non-contact infrared
support countries. forehead thermometers, contact-tracking sheets.
After a peak in the number of confirmed cases in early May, Chad
succeeded in significantly reducing transmission.

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 22
© UNICEF / Pakistan
BOX 5

Pivoting polio assets to combat COVID-19

WHO Polio Eradication Officers have played a
crucial role in the COVID-19 response, applying
their wide range of skills to support communities
in some of the world’s most fragile, vulnerable, and
conflict-affected settings. Controlling the COVID-19
pandemic is essential to prevent an increase in
vaccine-preventable diseases – including polio –
by helping to limit the impact of the pandemic on
routine immunization programmes in vulnerable
contexts. Here we shine the spotlight on four WHO
Polio Eradication officers who have stepped up to
take on COVID-19.
Pakistan resumed polio vaccination activities on 20 July with a campaign in
select districts after a 4-month suspension of all polio vaccination activities Nasrin Ahmadi, District Polio Officer
due to the COVID-19 pandemic. in Afghanistan
“I chose to continue to do public health awareness
© WHO / Afghanistan – Roya Haidari
during the COVID-19 pandemic. I wanted to help
save people’s lives and continue to serve my
people,” says Nasrin Ahmadi, a polio worker and
volunteer for the COVID-19 response in Balkh
province in Afghanistan.
Eight months since the first COVID-19 case was
reported in Afghanistan, polio programme frontline
workers continue to support outbreak response.
During the pandemic, Nasrin has taken on extra
duties to identify suspected COVID-19 cases, share
accurate information with communities, and trace
individuals returning from abroad to encourage
them to isolate. Throughout, she has continued
to educate families on the importance of polio
vaccination.
Nasrin Ahmadi, a polio worker and volunteer in Afghanistan, continued
serving her community wit public health awareness-raising activities during Mohamed Sharif Mohamed, Regional Polio
the COVID-19 pandemic. Eradication Officer in Somalia
In addition to his polio duties, Mohamed provides
© WHO / Somalia – Ismail Taxta – Ildoog
COVID-19 support to 17 districts in Banadir, Somalia,
through coordinating and training COVID-19 teams,
carrying out active surveillance visits to health
facilities and reviewing reports submitted by district
polio officers on the pandemic response.
In September, he took part in the first immunization
campaign to resume in Somalia since COVID-19
arrived in the country. All children who took part in
the campaign were offered deworming tablets and
vitamin A in addition to measles and polio vaccines.
Delivering multiple services is crucial in the context
of ongoing polio and measles outbreaks in Somalia,
and low overall population immunity.

A young girl waits to be vaccinated during national polio and measles

vaccination campaign in Mogadishu, Somalia.

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 23
© WHO / Saiyna Bashir
BOX 5 (continued)

Samreen Khalil, Polio Eradication Officer

in Pakistan
Polio teams in Pakistan have been working to
support the COVID-19 response since the beginning
of the pandemic, as well as continuing with their
work to eradicate polio.
In Peshawar, the team has adapted existing acute
flaccid paralysis (AFP) surveillance networks
embedded in hospitals and health facilities to detect
COVID-19 as well as polio. Polio staff like Dr Samreen
Khalil have been helping with testing and have
trained health workers on infection prevention and
Dr Samreen Khalil, WHO Polio Eradication Officer, collects a sample from control. Polio data management systems across the
Muhammad Shabir at his residence to test for COVID-19 on 10 July 2020 country and a call centre in the capital, Islamabad,
in Peshawar, Pakistan. assist in addressing misinformation and helping
to detect suspected COVID-19 cases.
© WHO / Angola
Sylvester Maleghemi, Polio Team Lead
in South Sudan
In the African region, the polio eradication
programme has a long history of responding to
other disease outbreaks and health emergencies.
With its unmatched technical expertise, disease
surveillance and logistics capacities, as well as
wide community networks, the polio team in South
Sudan was perfectly placed to mobilise a large-scale
emergency response to COVID-19, while maintaining
polio eradication efforts.
Sylvester Maleghemi, WHO Polio Team Lead in South
In the African region, the polio eradication programme has a long history
Sudan, explains, “Across Africa, polio infrastructure
of responding to other disease outbreaks and health emergencies.
With its unmatched technical expertise, disease surveillance and and staff are found at district, province, all the way
logistics capacities as well as wide community networks, the polio team to the national level, so whenever there’s an outbreak,
was perfectly placed to mobilise a large-scale emergency response polio teams are always the first to respond.”
to COVID-19, while maintaining polio eradication efforts.

BOX 6

Using TB resources to fight COVID-19

During the COVID-19 pandemic in Nigeria, WHO has designated as super-trainers. During contact tracing,
been supporting the government in an initiative to WHO has also been sensitizing surveillance teams
improve contact tracing, active case searching and on symptoms and detecting TB and COVID-19.
testing using the existing Tuberculosis (TB) infrastructure
From April to June 2020, 30 rural communities were
in the country.
visited, 3 072 households were screened with 2 235
The outbreak of COVID-19 in February 2020 and the suspected TB patients identified out of which 277 TB
public health response measures put in place to curtail patients were notified through the Niger state TB &
the spread of the pandemic led to fear the virus might Leprosy control program, all being tested for COVID-19.
impact active TB case finding activities. Instead, WHO
WHO continues to support Nigeria at all levels to ensure
and health officials have been using the structure to
that the COVID-19 response takes advantage of extensive
effectively combine case detection for TB and COVID-19.
structures and human resources available in the TB
In States like Niger, 18 WHO TB supervisors and disease control programme to increase detection, diagnosis
surveillance and notification officers (DSNO) have been and management of cases at the community level.

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 24
In addition to active surveillance for COVID-19, WHO Serological surveillance determines how widespread a virus
also recommends that countries use existing syndromic has been in a population by looking for antibodies to the
respiratory disease surveillance systems such as those virus in blood samples from the general population. This
for influenza-like illness (ILI) or severe acute respiratory type of surveillance is crucial to help us answer questions
infection (SARI) for COVID-19 surveillance. Using existing about what proportion of the population remains at
systems and platforms is an efficient and cost-effective the highest risk, transmission patterns, the presence
approach to enhancing COVID-19 surveillance. Using and duration of any immunity in the population, clinical
the established WHO Global Influenza Surveillance severity, and risk factors for infection. WHO has launched
and Response System (GISRS), countries are testing the Unity Studies to enable any country, in any resource
for COVID-19 disease in clinical specimens coming in setting, to rapidly gather data on these key epidemiological
from influenza sentinel surveillance sites every week. parameters to understand and respond to the COVID-19
pandemic. A total of 63 countries have already initiated
Unity Studies. The WHO African and European regions
are currently leading the way, with 19 countries in each
region having implemented a study. A total of 111 countries
intend to launch at least one Unity Study. Results from
these studies could play an important part in decisions
WHO took rapid action with about the design and timing of national and regional
partners in January to establish immunization strategies as vaccines start to become
available. Importantly, the Unity Study protocols are
a global surveillance system that designed to make it easy to share, aggregate, and analyse
data at the global level to support global decision‑making.
gathers standardized data at global,
The appetite of the global public for authoritative,
regional, and country levels. verified, and timely epidemiological data has been
unprecedented. Regional and global WHO COVID-19
Situation Reports have continued to serve as a digest
of global epidemiological trends, whilst highlighting
important recent events, guidance and actions taken
Figure 19 COVID-19 dashboard by WHO and partners. Over 300
situation and operation reports
have been published, and are viewed
by over 3 million readers each week.
In addition, and in collaboration with
international organizations, academic
institutions and public health
agencies, a global open content
dataset of public health and social
measures (PHSM) implemented by
countries is maintained and updated
regularly. Data from all sources are
quality checked, harmonized and
maintained in a central database.
Guidance has also been provided to
countries on monitoring transmission
intensity, health system capacity, and
the use of other key performance
and situational indicators to guide
the evidence-based recalibration
of PHSM.
The WHO COVID-19 Dashboard publishes daily verified data on cases and deaths in each country
and WHO region. The dashboard was viewed by between 1 million and 2 million visitors per week
throughout 2020.

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 25
 Laboratories
and diagnostics
Diagnostic laboratory testing is
a cornerstone of the management
of the COVID-19 pandemic. It allows
for the detection of cases to inform
care and for the isolation of infected
individuals to interrupt disease
transmission. Confirmatory testing
also enables the disease to be tracked
in the community, and for clusters of
cases to be identified. From the outset
in January WHO worked across multiple
platforms to ensure that all countries
have access to the technical expertise,
equipment, supplies, and logistics
capacity to ensure timely and accurate
testing capacity for COVID-19.
Working with a partner laboratory
in Germany, Charité University, WHO
published the first instructions on
how to set up a validated polymerase
chain reaction (PCR) test for COVID-19
within just 2 weeks of the publication
of the COVID-19 genome sequence
in early January 2020. By the third
week of January 2020, WHO had
contracted manufacturers to produce
the necessary reagents and supplies
© WHO / Blink Media – Fabeha Monir
for SARS-CoV-2 PCR tests. WHO
WHO is supporting COVID-19 preparedness and response for vulnerable Rohingya refugees and
began shipping PCR tests to over
host communities in Cox’s Bazar, Bangladesh. WHO assisted the IEDCR (Institute of Epidemiology 150 labs around the world before
Disease Control And Research) Field Laboratory in Cox’s Bazar to increase COVID-19 testing February 2020, and has continued
capacity from around 100 tests per day to over 1500 per day. Pictured here, a laboratory strengthening its support for national
technologist completes a PCR test at the IEDCR Field Laboratory in Cox’s Bazar Medical College. efforts since.

BOX 7

Expanding COVID-19 testing in the Philippines

Since first cases of COVID-19 were detected in the Philippines, the WHO country office,
with support from a grant from the European Commission, has worked closely with both
the Department of Health and local governments to establish and accredit COVID-19 testing
laboratories across the regions.
In May 2020 there were 23 real-time reverse transcription polymerase chain reaction (rRT-PCR)
laboratories in major regions. By October 2020 capacity had increased to 112 laboratories
operating in all regions and able to test samples. Thirty-five licensed cartridge-based PCR
or GeneXpert laboratories are now operating in almost all regions.
With the increase in laboratory capacity, WHO and the Government turned their attention
to strengthening competency and proficiency through training. The WHO team rapidly
responded to the need for capacity strengthening for COVID-19 diagnostics in Zamboanga City
in Mindanao during a large cluster of infections were recorded between June and July. WHO
has also provided the National Reference Laboratory and five other subnational laboratories
with reagents, test kits, extraction kits, and other consumables.

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 26
Working from a blueprint that WHO has used for PCR tests remain the gold standard of SARS-CoV-2 testing for
numerous other high-threat pathogens, the Organization accuracy, but other types of tests have also been developed,
rapidly established a reference laboratory network including rapid antigen detection tests. These are faster,
across the six WHO regions. The network now includes easier to administer and considerably cheaper. Although
24 laboratories with expertise in virology, diagnostics, they are not a replacement for PCR tests, they can provide
sequencing, and viral culture. Initially, one of the primary an important boost to testing capacity under the right
functions of these laboratories was to support countries circumstances (box 8).
that did not have testing capacity, or that needed to
In October, WHO worked with partners including the
have results confirmed. By the fourth quarter of 2020
Africa Centres for Disease Control and Prevention, the
all countries and territories surveyed by WHO could
Bill & Melinda Gates Foundation, the Clinton Health Access
test for the SARS-CoV-2 virus (box 7). Progress has been
Initiative, the Foundation for Innovative New Diagnostics
especially rapid in the WHO African region. In February
(FIND), the Global Fund, and Unitaid, to reach a milestone
2020 only two laboratories in the WHO African Region
agreement with manufacturers to make 120 million rapid
could diagnose a COVID-19 case. By October 2020 there
antigen tests available to low-income and middle-income
were 750 laboratories across the region able to test
countries through the ACT-Accelerator (see below for
for the SARS-CoV-2 virus and, crucially, testing has been
more on the ACT-Accelerator). FIND and WHO are working
decentralized in many countries to significantly reduce
together to accelerate appropriate use by supporting
the turn around time for results.
implementation research to optimize the use of rapid
The reference laboratory network is now increasingly tests in line with WHO guidance. Rapid tests may be
involved in quality assurance, capacity strengthening especially useful in areas where community transmission
and strategic planning, but there are still considerable is widespread and where PCR testing is either unavailable
challenges to overcome in ensuring that countries or, more likely, where test results are significantly delayed.
maintain and increase their testing capacity. As demand As well as supporting test, trace, and isolate strategies,
for tests has exceeded supply and led to international the tests can help to rapidly identify or confirm new
shortages, WHO’s operational support and logistics outbreaks; support outbreak investigations through
team and partners across WHO regional offices have screening; and monitor disease trends.
worked with WHO’s technical experts to ensure that
national laboratories continue to be resupplied with
quality-assured reagents and other consumables. By BOX 8
31 December 2020, WHO had procured and shipped
more than 19 million tests. It will be vital to maintain Antigen testing in the Americas
sustain this mechanism throughout 2021. The WHO Regional Office of the Americas
(WHO/PAHO) has deployed 190 000 new COVID-19
antigen diagnostic tests to Ecuador, El Salvador,
Honduras and Suriname, and is conducting training
to implement pilot testing of their operation.
In addition, consultations and training on
implementation of the COVID-19 antigen-based rapid
diagnostic test are being undertaken in Jamaica, the
Bolivarian Republic of Venezuela, Honduras, Costa
Rica, and Trinidad and [Link] tests, recently
approved by WHO, could transform the COVID-
19response by allowing healthworkers to undertake
accurate, rapid testing of symptomatic patients,
even in remote communities.
“By providing results quickly, the new test will
empower frontline health workers to better manage
cases by isolating patients to prevent further
spread and to begin treatment immediately”,
By the fourth quarter of the WHO Regional Director for the Americas,
Carissa Etienne commented.
2020 all countries and
WHO/PAHO’s Strategic Fund, a regional mechanism for
territories surveyed by pooled procurement of essential medicines and health
WHO could test for the supplies, is facilitating access to these diagnostic tests,
which fall within the remit of the ACT-Accelerator.
SARS-CoV-2 virus.

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 27
Managing the infodemic, risk communication, community engagement
The widespread use of mobile technology and social WHO’s approach to infodemic management is
media has fundamentally changed many aspects of our multifaceted. The WHO Information Network for
daily lives, and the production and consumption of risk Epidemics (EPI-WIN) covers four strategic areas of work
communication during health emergencies is no different. to respond to infodemics: (i) identifying, gathering and
During outbreaks, the potential for misinformation and assessing real-time evidence to help form public health
disinformation has multiplied exponentially over the past recommendations and policies; (ii) simplifying this
decade as these technologies have grown in popularity. knowledge into actionable behavioral change messages;
The problems of misinformation, disinformation, a lack (iii) amplifying impact by engaging communities and
of information, and information presented in a way that reaching out to key stakeholders in communities with
is not accessible to some communities have increasingly tailored advice and messages; and (iv), quantifying,
been identified as a significant exacerbating factor during monitoring, and tracking the infodemic through social
other recent health emergencies, but COVID-19 has given media technology platforms to guide the effectiveness
the issue a global dimension. The infodemic has the of public health measures.
potential to cause real harm wherever and whenever it
is allowed to go unchecked. WHO’s work on infodemic
management ensures that WHO’s is not only the
authoritative voice on COVID-19, but a relatable one that
resonates with individuals and communities everywhere.
The aim of infodemic management is to make information
available at the right time, and present that information
in the right way, in order to bring about positive behavior
changes during and in advance of health emergencies.

EPI-WIN transforms WHO guidelines into easily digestible animations,

mythbusters and infographics tailored to different communities of users,
and translated into many different languages.

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 28
WHO EPI-WIN translates new science into evidence- The next goal for EPI-WIN is quantification of the extent
based messaging and information products. The and influence of information disseminated and consumed
platform works with faith-based organizations, through the web, mass and social media, chat apps and
employers and workers, the health sector, cities and other information channels. WHO is currently working
local governments, the travel and tourism sector, event with partners to develop a framework for an evidence-
organizers and many other groups; producing a wealth based, quantifiable understanding of the global COVID-19
of mythbusters, running fact checks, and hosting and conversation through an analysis of online platforms.
convening webinars and conferences specifically aimed This, in turn, will inform the development of analytical
at countering the flow of misinformation. capabilities for the real-time monitoring of audience
conversations about COVID-19. WHO already uses a
To better address audience and community needs,
digital listening approach, which quantifies, tracks and
EPI-WIN convenes regular engagement webinars with
analyses trends in keywords and topics associated with
key stakeholders to understand their concerns and
COVID-19 in order to better understand infodemic trends.
information needs. This enables WHO to tailor advice
The evidence-based approach to infodemic management
and messages to help these stakeholders communicate
is still in its infancy, and there are many important
the right messages to the audiences they interact with.
questions that remain to be answered, such as how
Through this process, stakeholders amplify the right
online behaviour affects offline action, how overwhelming
public health messages though established, trusted and
amounts of information affect health-seeking behaviour,
recognized channels. Throughout 2020 WHO convened
and how should we judge the relative success of policy
60 technical webinars through EPI-WIN since January 2020,
interventions aimed at counteracting misinformation?
providing a channel for rapid information dissemination
Ultimately, infodemics will be most effectively managed
and a forum for participants to pose their own questions
by empowering communities and institutions at a
and shape the content of future webinars. Cumulatively,
local and national level, and WHO is committed to
EPI-WIN COVID-19 live webinars have reached over 13 000
rapidly strengthening this capacity. In October 2020
participants from 121 countries and territories.
WHO partnered with Ryerson University’s Social
Media Lab and the International Federation of Medical
Students Associations (IFMSA) to
Ultimately, infodemics will be most effectively develop open‑source COVID-19
misinformation fact-checking tools.
managed by empowering communities and These tools are designed to help
policy makers understand and
institutions at a national level. counteract misinformation that poses
a threat to health systems at a local
level and include a COVID-19 fact-checkers data set is an
international repository of more than 200 active COVID-19
fact-checking groups. The COVID Global Misinformation
Dashboard enables users to access and search a catalogue
3000 debunked COVID-19 claims based on the date a
claim was made, what language the claim was made in,
where the claim originated, and other data fields that offer
insights into the nature of infodemics.

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 29
In November 2020 WHO held the first virtual infodemic Risk Communication and Community Engagement (RCCE)
management training programme, with over 270 participants is both a technical pillar of the public health response to
coming together for eight training sessions over four COVID-19 and a foundational way of working to enable
weeks. The training gave participants a thorough other technical pillars such as surveillance to achieve
grounding in infodemic management, including practical their goals. The aim of RCCE is to:
training on tools for monitoring rumours, fact-checking
and verification, as well as learning how to respond • provide timely, relevant and actionable life‑saving
information through the most appropriate communication
effectively and testing interventions to slow down the
approaches to encourage people to adopt safe health
spread of misinformation. The first session included an
practices and reduce fear, stigma and misinformation;
information crisis simulation, in which participants played
the role of a public health communications officer in a • listen to community feedback to understand the
major city during a fictional public health incident. The beliefs, fears, rumours, questions and suggestions
training was co-sponsored by the US Centers for Disease communities have about COVID-19 and use this
Control and Prevention, Africa Centres for Disease Control to guide the response – helping to ensure the
and Prevention and the Global Risk Communication accountability of the COVID-19 response;
and Community Engagement Collective Service. • use innovative approaches to encourage behaviour
change and take actions to prevent and reduce
the spread of the disease;
• identify and support community-led solutions
for bringing the outbreak under control.

Singapore’s COVID-19 response is a collective effort of stakeholders from

businesses, the community, and government, including working with more
than 5000 migrant ambassadors who engage with the migrant worker
communities in their own languages. Pictured here, migrant workers attend
a workshop to learn how to effectively wash their hands and wear masks
as part of COVID-19 prevention measures.

© WHO / Blink Media – Juliana Tan

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 30
 The RCCE Collective Service was launched in June 2020 by
WHO, UNICEF and the IFRC with support from the GOARN
and the Bill and Melinda Gates Foundation. The service
provides a dedicated coordination structure, supporting
the coordinated delivery of the Risk Communication and
Community Engagement strategy produced by WHO,
Teams at the country level are able UNICEF, and IFRC aligned with the WHO COVID-19 SPRP
and the COVID-19 Global Humanitarian Response Plan.
to adapt tools and guidelines to the
The aim of the RCCE Collective Service is to ensure more
contexts in which they work, and consistent, systematic and predictable support to regional
and national partners involved in the public health,
decide which tools, support and humanitarian and development responses to the COVID-19
guidance is best suited to of the pandemic. By enhancing national, regional and global
coordination, and ensuring that community feedback and
specific needs in country. insights collected across the response inform decision-
making, both the quality and the
consistency of RCCE approaches will
BOX 9 be improved – building community
trust and enhancing the effectiveness
An intercultural health model in Colombia of the response. The Collective
Under current COVID-19 guidance, all communities across Colombia are Service is the primary coordination
obliged to cremate people when they die, but an exception has been made forum for RCCE activities within the
for the indigenous people of Alta Guajira. The Wayúu people’s beliefs and COVID-19 global response, providing
cultural practices around death are such that the Government will allow priority guidance to help the regions
them to bury their dead underground or in a vault. The decision was made and the countries in their response
before COVID-19 reached the rural communities of Alta Guajira, who live to the pandemic. There are RCCE
in a vast desert of 8200 square kilometres in 22 000 scattered hamlets. working groups in each region that
support national-level coordination
Following Government instructions to protect themselves against mechanisms, which are typically led
COVID-19 is difficult for people living in Alta Guajira. With temperatures by the ministry of health and co-led
at over 40° C, wearing masks, which are already scarce, is uncomfortable. by WHO, UNICEF, IFRC or another
There is not enough fresh water for people to wash their hands regularly, technical organization. Teams at the
and it takes one hour on foot to reach water sources. country level are able to adapt tools
and guidelines to the contexts in
It was clear that the best way to reach the Wayúu people was through
which they work, and decide which
primary health care services, located close to home, that connect
tools, support and guidance is best
and appeal to their own culture. The department and the local health
suited to of the specific needs in
authorities agreed to promote primary health care adapted to the
country (box 9). By the end of 2020,
characteristics of the territory and the current situation, and with
97% of 195 countries, territories
the effective participation of the community.
and areas surveyed had a national
PAHO/WHO has supported local authorities to implement an COVID-19 risk communication plan:
“intercultural” health model with the Wayúu people. This initiative close to the target of 100% and a
is supported by the UHC Partnership, which assists 115 countries significant improvement on 19%
in accelerating progress to achieve Universal Health Coverage (UHC) reported in March 2020. However,
through funding provided by the European Union (EU), the Grand Duchy that proportion falls to 89% when only
of Luxembourg, Irish Aid, the Government of Japan, the French Ministry the 64 priority countries, territories
for Europe and Foreign Affairs, the UK Department for International or areas are considered, with 81% of
Development and Belgium. this subset reporting that they have
mechanisms to capture and act on
community feedback.

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 31
 Clinical management
Approximately 15% of patients with COVID-19 develop Despite the global prevalence of COVID-19, our
severe disease that requires oxygen support, and 5% have understanding of the severity, clinical features and
critical disease with complications such as respiratory prognostic factors of COVID-19 in different settings
failure, acute respiratory distress syndrome, sepsis and and populations remains incomplete. WHO has therefore
septic shock, thromboembolism, and/or multi-organ encouraged countries, health facilities and institutions to
failure. WHO convened the first of many teleconferences participate in a global effort to collect anonymized clinical
with its clinical expert network on 9 January, and published data related to hospitalized suspected or confirmed cases
its first guidance on the clinical management of patients of COVID-19, and contribute these data to the Global
with COVID-19 on 10 January. Since then, WHO has worked COVID-19 Clinical Data Platform: a secure, limited-access,
with expert networks (including EDCARN) and partners to password-protected platform hosted on OpenClinica.
develop the most up-to-date technical guidance for the
clinical care of COVID-19 patients, and the design of critical
case management infrastructure including intensive care At the national level, a key aspect of
units, based on an ongoing assessment of new evidence
generated by the international community and first WHO’s support has been to expand
responders, and supported by the guideline development
group. These guidelines are then rapidly translated into and ensure access to essential
training courses and materials to be made available respiratory equipment and supplies,
through OpenWHO and through the direct deployment
of expert trainers at national and subnational levels. including mechanical ventilators.

© WHO / Blink Media – Ehtiram Jabi

As part of WHO’s support of Azerbaijan’s response to COVID-19, the REACT-C19 project brought 19 Azerbaijani doctors working abroad in Turkey back to their
home country to assist in training Azerbaijani medical personnel in proper procedures relating to triage, treatment, and protective gear. Pictured, medical
staff work in the ‘red zone’ of a temporary medical facility established for COVID-19 patients in Baku, Azerbaijan.

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 32
To harmonize data collection across diverse global
settings, WHO has developed standard case report forms BOX 10
(CRFs) which contain a minimum set of key variables, and
Breathing life into the clinical management
forms the basis of three types of CRF: a core rapid CRF for
of COVID-19
adults and children; a separate CRF for pregnant women;
and a CRF for multisystem inflammatory syndrome While the need for personal protective equipment
in children and adolescents. in health facilities is well known, a less-publicized but
equally vital resource is medical oxygen, which helps
At the national level, a key aspect of WHO’s support
severely ill patients breathe and potentially avoid
has been to expand and ensure access to essential
the need to be intubated.
respiratory equipment and supplies, including mechanical
ventilators, especially in low-income and middle-income The production and delivery of medical oxygen was
countries (box 10). The WHO COVID-19 Essential Supplies a challenge worldwide even before the pandemic,
Forecasting Tool is designed to help governments, as it is often left out of hospital budgets because
partners, and other stakeholders to estimate potential demand for it can be difficult to predict.
requirements for essential supplies to respond to the
In responding to COVID-19, WHO’s has procured
current pandemic of COVID-19. WHO’s work to secure
and distributed oxygen supplies for vulnerable
and deliver essential clinical supplies through the
countries. By December 2020, WHO had sent more
COVID-19 Supply Chain System is described in more detail
than 16 500 oxygen concentrators and 40 000 pulse
below, but the procurement and logistical aspects of
oximeters and oxygen monitors to 121 countries.
supply must also be backed up with rapid, on call technical
These devices will bring broader health benefits,
expertise. To meet this need, WHO formed a panel to
such as to children with severe pneumonia, people
technical experts to provide rapid advice on all aspects
undergoing surgery, and pregnant women.
of respiratory support for hospitalized patients.
WHO is also working with countries, such as Papua
The Respiratory Therapists Independent Experts Advisory
New Guinea, Ukraine, Somalia and South Sudan,
Group has advised the WHO emergency and outbreak
on a more sustainable solution to rising demand:
response team throughout 2020 in key areas including:
oxygen generation plants.
• innovative respiratory support
technologies;
• appropriate clinical research
methodologies relevant to
respiratory therapy in COVID-19
clinical management;
• appropriate management of
respiratory support techniques in
patients with respiratory distress;
• mechanisms for improving access
to medical oxygen and equipment
in resource-constrained countries;
• specifications of mechanical
ventilators and suitability for
deployment in countries of need;
• training materials and modules
aimed at improving the capacity
of frontline healthcare workers
in resource‑constrained countries.

© WHO / Blink Media – Fabeha Monir

WHO verifies the oxygen cylinder supply at a health facility in Kutupalang refugee camp in Cox’s Bazar,
Bangladesh.

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 33
 Infection prevention and control protective equipment (PPE).
WHO advises the use of masks as part of efforts to
In the absence of medical countermeasures, infection limit the spread of COVID-19, and published guidance
prevention and control (IPC) measures are one of the in June 2020, updated in December 2020, that sets out
most effective weapons we have to combat the spread the scientific evidence relevant to the use of masks for
of COVID-19. WHO developed rapid guidelines in January reducing the spread of SARS-CoV-2, the virus that causes
covering infection prevention with two main goals in COVID-19, and practical considerations including:
mind:
• mask management;
• to prevent or stop the spread of COVID-19 infections • masking in health facilities in areas with community,
during healthcare delivery in order to prevent cluster and sporadic transmission;
health facilities from amplifying the disease,
protect health workers and patients, and protect
• mask use by the public in areas with community and
cluster transmission;
essential health services;
• alternatives to non-medical masks for the public;
• to prevent or stop the spread of COVID-19 in public and
• exhalation valves on respirators and non-medical
private and community settings through a comprehensive
masks;
package of individual and organizational/institutional
prevention and control measures. • mask use during vigorous intensity physical activity;
• essential parameters to be considered when
For healthcare settings, WHO has produced and regularly manufacturing non-medical masks.
updated extensive guidance on what facilities should be
doing to be prepared to respond to a case of an emerging Much of the guidance related to the use of masks stems
respiratory virus such as the novel coronavirus, how from new research commissioned by WHO. WHO has also
to identify a case once it occurs, and how to properly worked extensively with partners to produce guidance
implement IPC measures to ensure there is no further on IPC in public settings such as schools and workplaces.
transmission to health workers or to other patients and Acute shortages of vital PPE in the early stages of
others in the healthcare facility. Guidance also covers the pandemic led to widespread shortages, difficulties
IPC considerations during home care for patients with in procurement, and a rush to scale up alternative
suspected or confirmed COVID-19, the cleaning and manufacturing capacity. In addition to playing a key role
disinfection of surfaces, and the rational use of personal in the procurement and distribution of PPE to countries,
WHO also produced and continues to update the
© WHO / Lindsay Mackenzie key technical reference specifications on the quality,
performance characteristics and related standards of PPE
to be used in the context of COVID-19 including surgical
masks, non-surgical masks, gloves, goggles, face shields,
gowns and N95 masks.

WHO collaborates with hospitals around the

world to prevent the spread of COVID-19 during
healthcare delivery. The main goals are to prevent
health facilities from amplifying the disease, protect
health workers and patients, and protect essential
health services.

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 34
Points of entry, travel and trade
All parts of the global economy have been severely
affected by COVID-19, but no sector has been hit as hard BOX 11
as international travel and trade, and few sectors are
as vital to the response. Moving large volumes of vital Strengthening points of entry in Bangladesh
supplies from consolidation hubs to final destinations In the 6 months since the first case of COVID-19 was
in countries has been made extremely difficult by the detected in Bangladesh, WHO, with financing from
collapse in commercial transport worldwide. Most European Union Humanitarian Aid, has supported the
recently, WHO, as custodian of the International Health government to screen nearly 1 million people entering
Regulations (2005), has worked urgently with all partners the country by air, land, and sea.
in order to ensure that transport corridors can be
operated safely in support of the global response. In April Since the beginning of the pandemic, WHO has
2020, the Directors-General of WHO, and the International worked with the Government of Bangladesh, the
Labour Organization and the Secretary-General of the International Organization for Migration (IOM), and
International Maritime Organization issued a joint issued other partners to implement passenger screening,
a joint statement on medical certificates of seafarers, ship early detection and isolation of suspected cases.
sanitation certificates (SSCs), and medical care of seafarers WHO has supported the government to create a
in the context of the COVID-19 pandemic. series of procedures and guidelines on detecting and
Throughout 2020 WHO has worked closely with screening ill passengers, isolating and quarantining
organizations representing aviation, maritime, trade, contacts, and managing cases. In addition, WHO has
and tourism sectors to develop joint guidance, joint supported enhanced data management and IPC.
statements of support, monitor the measures taken by To protect frontline workers at points of entry, WHO
governments and private entities that impact international has distributed 80 000 items of PPE such as masks,
travel and trade, and to assess and mitigate the health hand sanitizers, face shields, and gloves.
and economic impact of such measures, in line with the
provisions of the International Health Regulations (2005).
WHO has worked closely with countries to strengthen
capacities at points of entry (box 11).

© WHO / Ain Media

WHO helps facilitate entry of medical supplies into countries. Pictured here, WHO helped coordinated the entry of two PCR machines, donated
by the Government of Turkey to the Palestinian Authority, through Erez crossing into the Gaza Strip. The machines will double the testing capacity
of local health authorities in Gaza, enabling COVID-19 testing of 2000 samples per day.

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 35
 Protecting essential health services
COVID-19 has presented all countries and health systems WHO continues to closely monitor the impact of the
with the challenge of an increase in the demand for care pandemic on essential health services at the national
caused by COVID-19. Added to this increased demand, level. In August 2020, WHO reported the results of a global
the response to the virus has often entailed limitations on pulse survey that described disruptions across all services
movement, reduced staffing, and lowered capacity at health and mitigation strategies to maintain essential health
care facilities. At the same time, misinformation has often services through the life course. WHO is assisting Member
contributed to an increase in fear or a loss of trust in health States in fast-tracking actions to ensure continued delivery
systems, which can result in a significant change in health- of essential health services in the context of COVID-19.
seeking behavior amongst the general population. All of
Even a temporary interruption to basic health-care
the above factors have the potential to severely disrupt
services such as routine immunization services can lead
the delivery of health care for all non-COVID-19 conditions.
to secondary health crises such as outbreaks of vaccine-
WHO’s guidance Maintaining essential health services: preventable diseases, amplifying the long-term damage
operational guidance for the COVID-19 context was first caused by COVID-19 and exacerbating morbidity and
published in March 2020 and was updated in June 2020. mortality. The latest data on vaccine coverage estimates
The guidance recommends practical actions that countries from WHO and UNICEF for 2019 shows that improvements
can take at national and local levels to maintain access such as the expansion of the HPV vaccine to 106 countries
to safe, high-quality, essential health services in the and greater protection for children against more diseases
pandemic context. It also outlines sample indicators for are in danger. Preliminary data for the first four months
monitoring the performance of essential health services of 2020, during which services are most likely to have
during differing COVID-19 transmission scenarios. At been affected by COVID-19, points to a substantial drop
the regional level, WHO has undertaken a major review in the number of children completing three doses of the
of COVID-19 national response plans from all WHO vaccine against diphtheria, tetanus and pertussis (DTP3).
regions to evaluate their alignment with the operational This is the first time in 28 years that the world could see a
guidance outlined above, and has recommended actions reduction in DTP3 coverage – the marker for immunization
for improvement that will be supported by regional coverage within and across countries.
and country offices.

© WHO / Blink Media – Nana Kofi Acquah Even a temporary

interruption to basic
health-care services
such as routine
immunization services
can lead to secondary
health crises such as
outbreaks of vaccine-
preventable diseases.

During the COVID-19 pandemic, WHO is supporting the Ghana Health Service in their efforts to
continue providing essential medical services to the population. At the Greater Accra Regional Hospital,
vaccinations continue to be offered along with other critical services for children.

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 36
Vaccines can be delivered safely during the pandemic, FCV contexts.
and WHO is supporting countries to adapt immunization
As Health Cluster Lead Agency, WHO leads the efforts
delivery strategies so that programmes can be conducted
to integrate and deliver the public health response to
under safe conditions, without undue risk to health
COVID-19 through the GHRP, providing coordination and
workers, caregivers, and the community (box 12). WHO
operational support in 30 countries in partnership with
guidance produced at the global level has been adapted
900 national and international partners, to implement the
and translated at the regional and national levels to tailor
GHRP and maintain essential health services addressing
it to specific contexts, including fragile, vulnerable, and
the needs of 63 million people. This task is streamlined
conflict-affected settings. WHO is also working at the
by the Global Health Cluster COVID-19 Task Team, based
national level to ensure the supply of essential medical
at WHO headquarters, which identifies critical challenges
supplies and personal protective equipment. In Syria, for
and supports the adaptation and implementation of WHO
example, WHO and UNICEF supported a 5-day national
COVID-19 guidance in low-capacity, humanitarian settings,
immunization campaign in June to close vaccination gaps
and captures and disseminates good practice. The Global
among children. During the campaign, with infection,
Health Cluster also co-leads the Global Information
prevention and control measures in place, health workers
Management, Assessment and Analysis Cell, which
vaccinated more than 210 100 children and reviewed the
manages and analyzes COVID-19-related information
vaccination status of 900 000 children to determine the
vaccines they still needed.
In fragile, conflict-affected, and
vulnerable (FCV) settings such as
Syria, emerging health emergencies
such as COVID-19 can easily
disrupt or overstretch already
weak capacities for health service
delivery. There is an absolute moral
imperative to provide care and
to meet the needs of populations
in these settings. There is also a
need, whilst acknowledging that
protracted crises will continue for
the foreseeable future, to reduce the
risks to affected populations from
health emergencies, and to increase
the resilience of health services within

WHO supports countries around the world to

protect essential health services during the
COVID-19 pandemic. Pictured here, a midwife
checks the blood pressure of a patient during a © WHO / Blink Media – Nana Kofi Acquah
postnatal visit.

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 37
© WHO / Blink Media – Fabeha Monir

WHO is supporting COVID-19 preparedness and response for vulnerable Rohingya refugees and host communities in Cox’s Bazar, Bangladesh.

BOX 12

Ensuring essential health services in the world’s largest refugee camp

The burden of a health emergency within As part of WHO’s efforts to limit the impact of COVID-19
a humanitarian crisis in the camp it has been essential to continue to treat
people living with non-communicable diseases (NCDs),
Three years into the Rohingya Emergency Response in
and prevent and control risk factors. WHO supports
Cox’s Bazar, Bangladesh, under the coordination of WHO
the Bangladesh Civil Surgeon Office to lead on NCD
the health sector in is providing health care to 860 000
care coordination based on the WHO Package of
Rohingya Refugees and 417 295 Bangladeshis living in
Essential NCD Interventions, which includes capacity
the surrounding areas of the refugee camps. The size
building of primary health care staff and community
and density of the camp, coupled with the vulnerability
outreach workers, health promotion activities on NCD
of its population, mean a serious COVID-19 outbreak
risk factors, supply of essential NCD commodities, and
would have severe knock-on consequences for the entire
the strengthening of NCD surveillance and monitoring
health system. The health facilities run by health sector
in the Cox’s Bazar district. As a result, 94% of primary
partners to provide services to the population include
health care facilities in Cox’s Bazar can manage diabetes,
38 primary health care centres, 97 Health Posts, and
cardiovascular diseases, and chronic respiratory
23 special facilities and three field hospitals, all staffed
diseases: all of which can confer an increased risk
by approximately 3500 health care workers.
of severe COVID-19.
Monitoring the provision of essential health services
Ensuring women’s rights to sexual and reproductive health
in the world’s largest refugee camps has been key to
minimizing the impact of COVID-19 on the lives and Balancing COVID-19 precautions with the need to
well-being of the camp’s populations. A quarterly health maintain essential health service delivery is a challenge,
facility monitoring system is undertaken to provide but in area of women’s right to sexual and reproductive
supportive supervision and issue guidance to all health health care there is a clear imperative to ensure the
facilities, and to monitor compliance with the Essential continuity of the service. A total of 96 461 women
Minimum Service Package, including weekly inter-agency of reproductive age in the camp are currently using
supportive supervision visits to camps. methods of contraception, including long-acting
reversible contraceptives, and family planning methods
Supportive supervisions to date have strengthened
such as subcutaneous injectable contraception.
laboratories in the camps by improving biosafety and
ensuring quality. An IPC assessment was carried out in To meet the immediate sexual and reproductive health
45 health facilities in the camps and government facilities, needs of vulnerable women, adolescents and girls
followed by training and supportive supervisions to in Cox’s Bazar, WHO is ensuring the availability of
address identified gaps. To date, IPC training has been emergency reproductive health kits and other medical
provided to 1831 humanitarian health care workers and supplies at partner health facilities.
814 government staff from implementing partners and
government facilities, respectively. While reducing the
risks of transmission among health care workers and
patients, this culture of patient safety is also helping
build trust in the health care system.

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 38
 BOX 12 (continued)

Adapting routine immunization in response to COVID-19

Immunization is an essential health service that has In April 2020, immunization services in the refugee camps
been significantly affected by the COVID-19 pandemic. were halted due to the lockdown following the first
Disruption of immunization services, even for brief COVID-19 positive cases among the host community.
periods, will result in increased numbers of susceptible In response, the Government, WHO, and health sector
individuals, and raise the likelihood of outbreak-prone partners developed a health-facility-based transitional
vaccine preventable diseases, such as measles. strategy to resume routine immunization services at fixed
and outreach immunization sites throughout the camps,
Vaccines are especially important in the Rohingya
with extra IPC precautions to limit the risk of transmission.
refugee camps due to the densely populated
WHO Health Field Monitors have monitored immunization
camp. With no previous history of vaccination, the
sessions, and found that during the observed sessions,
Rohingya people arrived in Cox’s Bazar with very
97% of vaccinators were wearing facemasks, whilst 89%
low protection against vaccine-preventable diseases.
of caregivers were maintaining physical distancing to
The Government of Bangladesh, supported by WHO,
reduce the risk of COVID-19 infection. The immunization
UNICEF, and other health partners, launched the
strategy for the camps is revised periodically to ensure
Routine Expanded Program of Immunization in
vaccinations can continue despite fresh challenges to
Cox’s Bazar in July 2018, providing six vaccines against
prevent outbreaks of other communicable diseases.
ten life-threatening diseases (diphtheria, whooping
cough, influenza, tetanus, polio, tuberculosis, measles,
rubella, hepatitis B and pneumonia), targeting children
under 2 years of years of age and pregnant women.

WHO is supporting COVID-19 preparedness and response for vulnerable Rohingya refugees and host communities in Cox’s Bazar, Bangladesh.

© WHO / Blink Media – Fabeha Monir

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 39
to support global decision-making, and provides technical support and services to prioritized countries.

Delivering for countries: global logistics and supply chains,

and operational support and increased the risk of poor quality equipment entering
the marketplace that did not meet the correct technical
specifications for its intended purpose.
The COVID-19 pandemic delivered the biggest shock
to global trade since World War II, and led to the The breakdown of normal market functioning for essential
total collapse of market mechanisms for many of the response commodities posed a huge challenge for the
commodities vital to the response effort. A simultaneous effective implementation of response pillars at national
surge in demand for personal protective equipment, level in the first few months of the response. Clinical care,
medical supplies such as oxygen concentrators and infection prevention and control, laboratory testing, and
respirators, and laboratory reagents and test kits the safeguarding of essential health services all depend to
coincided with significant disruption to international trade a large extent on access to personal protective equipment,
routes and manufacturing capacity. This perfect storm laboratory equipment and supplies, and essential
led to a scramble for commodities, wild price fluctuations, medicines and equipment. The lack of a coordinated
and equitable mechanism for purchasing and distributing
essential response commodities on the basis of need,
rather than the ability to pay, spurred the creation of
the Supply Chain Task Force. The Task Force is co-chaired
by WHO and WFP, and was convened to establish an
integrated COVID-19 Supply Chain System (CSCS).
The Supply Chain Task Force includes representation
from a broad range of participating organizations (WHO,
WFP, UNICEF, OCHA, World Bank,
The Global Fund, UNOPS, UNDP,
UNFPA, UNHCR, NGOs, Red Cross
and Federation and other cluster
partners). The complementary core
strengths of the Task Force members
gives the CSCS enormous power as
a complete end-to-end service that
incorporates demand forecasting,
technical specification and quality
assurance, purchasing consortia
to combine collective purchasing
and areas of market expertise, and
logistical knowhow and scale. The
power of this system is put at the
service of any approved stakeholder
who has an active role in a national
level COVID-19 preparedness and
response action plan. These approved

WHO’s Health Emergencies Programme

maintains a Logistics hub located within the
International Humanitarian City in Dubai. The
WHO/Dubai operation maintains over 17 000
square meters of temperature-controlled
warehousing and manages an inventory of
medicines, medical supplies, and equipment
valued at US$ 40 million. Since the start of
the COVID-19 pandemic, the WHO/Dubai
operation has expanded to over four times
its original size and has completed over 324
© WHO / Blink Media – Natalie Naccache shipments to 108 destinations across all six
WHO geographic regions.

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 40
 stakeholders can request supplies
through the CSCS via the purpose
built COVID-19 Supply Portal, which
is available within the COVID-19
Partners Portal.
Since the launch of the COVID-19
Supply Portal, 228 requests for
essential supplies have been
submitted and validated at country-
level by supply coordinators working
on behalf of Resident Coordinators.
More than 143 supply coordinators
have been appointed from WHO and
partner agencies, including UNICEF,
WFP, the Office of the Resident
Coordinator, UNDP and UNOPS.
Together, supply coordinators have
validated requests valued at over
US$ 92 million (table 1), with more
© WHO / Blink Media – Natalie Naccache requests being submitted every day.

The COVID-19 Supply Portal has received 228 requests for essential Maintaining the supply chain is
supplies since its launch in 2020. a continual and dynamic process, which will take an extra
dimension of complexity during 2021 as a new generation
of rapid diagnostics become available, followed by the first
generation of COVID-19 vaccines. Many of the vaccines
are likely to present substantial additional challenges
due to their requirements for a seamless cold chain from
production facility to point of administration. Supporting
the establishment a robust, resilient, and equitable
distribution chain for these new technologies will require
further evolution of the CSCS.

Maintaining the supply chain

is a continual and dynamic process,
which will take an extra dimension
of complexity during 2021 as a
new generation of rapid diagnostics
become available, followed by the
first generation of COVID-19 vaccines.

Table 4 Shipped items as of 31 December 2020

Laboratory supplies Personal protective equipment

Antigen RDTs Sample PCR tests Face shields Gloves Goggles Gowns Medical Respirators
collection Masks
kitst

3 433 300 7 113 357 15 709 426 8 464 831 30 884 121 1 445 967 6 240 279 194 435 980 19 580 165

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 41
DRIVING RESEARCH
AND INNOVATION
From R&D blueprint to a global roadmap for COVID-19 research and

innovation
BOX 13
WHO’s R&D blueprint has been developed since 2016 in Spurring innovation in Africa
response to lessons learned from the west Africa outbreak
of Ebola virus disease and other recent outbreaks, with A WHO study has found that of 1000 new or
the aim of strengthening coordination between scientists modifications of existing technologies that have
and global health professionals, accelerating the research been developed worldwide to target different
and development process during emergencies, and areas of the COVID-19 response, Africa accounts
catalysing research and innovation in preparation for for 13% of these innovations. The response areas
future emergencies. Throughout 2020 those foundational include surveillance, contact tracing, community
efforts have provided the platform for the unprecedented engagement, treatment, laboratory systems
scale of COVID-19 research and innovation efforts. and infection prevention and control.

The unprecedented speed and unity of purpose that has In Africa, 57.8% of the technologies were ICT-driven,
characterized COVID-19 research has built on detailed 25% were based on 3D printing and 10.9% were
preparatory work with national and regional regulators robotics. The ICT-based innovations include WhatsApp
that has meant countries are primed to launch trials Chatbots in South Africa, self-diagnostic tools in
through streamlined emergency regulatory processes, Angola, contact tracing apps in Ghana and mobile
with “disease X” trial protocols and target product profiles health information tools in Nigeria. The countries with
for therapeutics, vaccines, and diagnostics that were ready the most innovations were South Africa (13%), Kenya
and waiting to be adapted to COVID-19. (10%), Nigeria (8%) and Rwanda (6%).

The first point of departure for COVID-19 research and Earlier this year, all 47 African Member-States in
development efforts came on 10 January 2020, when the WHO African Region adopted a WHO strategy
the Global Coordination Mechanism for Research and for scaling up health innovations in Africa. By 2023,
Development to Prevent and Respond to Epidemics held 80% of all Member States agreed to perform needs
its first teleconference, as did the Scientific Advisory Group assessments to identify critical gaps in their health
for the R&D Blueprint. Those early discussions led to the systems and establish coordination mechanisms
first global forum of international scientists on COVID-19, to scale up innovations.
at WHO’s Geneva headquarters on 11–12 February 2020. The WHO Regional Office for Africa has created a
After assessing what was known at the time about the global database of innovations to share knowledge,
new virus, the more than 400 international experts ideas and successes, and has set up a COVID-19
in attendance agreed on the critical thematic areas technology access pool to share intellectual property
of research to prioritize, the mechanisms required to and data. The inaugural WHO health innovation
coordinate research to ensure no stone was left unturned, challenge, which aimed to tackle some of the most
and the need for a framework to ensure that the most pressing health needs of the world’s most vulnerable
important research was funded efficiently. These populations, included 2400 entries, including from
discussions were synthesized in the COVID-19 Global 44 African countries.
research roadmap that set out nine key areas (see also “COVID-19 is one of the most serious health
box 13) to prioritize for accelerated research: challenges in a generation, but it is also an
1 viral natural history, transmission and diagnostics; opportunity to drive forward innovation, ingenuity
and entrepreneurship in life-saving health
2 virus origin, and management measures technologies,” said Dr Matshidiso Moeti, WHO
at the human‑animal interface; Regional Director for Africa. “It’s great to see the
3 epidemiological studies; youthful energy of the continent fired up to fight
COVID-19. Solar-powered automatic handwashing
4 clinical characterization and management; tools, mobile applications that build on Africa’s rapidly
5 infection prevention and control, including protection growing connectivity. These home-grown innovations
of health care workers; are uniquely adapted to the African context.”

6 candidate therapeutics;
7 candidate vaccines;
8 ethical considerations for research;

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 42
 Progress against Global research roadmap

Transmission Therapeutics
• WHO laboratory and biosafety guidance, • Landscape analysis of therapeutics
and diagnostic strategy for testing in resource- • Treatment master protocol developed
constrained settings • Solidarity trial launched and expanded.
• Landscape analysis of diagnostic assays • Agreements finalized with five manufacturers
in development/available of medicines included in the Solidarity trial
• Studies of viral shedding during acute infection
Vaccines
Human-animal interface • Landscape analysis of vaccine candidates
• Investigation of replication and excretion of • Master protocol developed for phase 2b/3 trials
COVID-19 in fur farms in China: negative result.
• Target product profile produced for COVID-19
• Investigation of replication and excretion vaccines
of COVID-19 from pets in contact with human
cases: ongoing Ethics
• Investigation of susceptibility of pets and • Key ethical concepts paper published
livestock: ongoing
• Policy briefs produced on ethics of research
for COVID-19; ethics of resource allocation and
Epidemiology equitable access; ethics of restrictive measures
• Core protocols developed for four early sero-epi
investigations and one environmental investigation, Social sciences
under the Unity study umbrella
• Review of psychosocial impacts of COVID-19
• Epidemiological studies using one or several • Review and key lessons of health protection policies
of the core Unity protocols have been started
in 31 countries • Research into impacts of quarantine on
contraception, HIV treatment access, delivery modes
and quality of SRH care
Clinical management
• Clinical management protocol developed. • Research protocol development and research
implementation on health care worker perceptions
• Protocols developed to assess transmission of infection prevention and control procedures
through aerosol/high-flow oxygen
• Toolbox on Good Participatory Practice for COVID-19
• Global anonymized clinical data platform developed clinical trials and Working with Community Advisory
for rapid collection of relevant clinical data Boards for COVID-19 related clinical trials
Health workers and infection prevention and control
• Development of rapid reviews on the social, cultural,
behavioural considerations on the use of face
• Systematic reviews of evidence informing IPC coverings; immunity passports; and home care
guidance for the COVID-19 response, such as the
effectiveness of medical masks versus respirators Coordination
for health worker protection; physical distancing;
utility of universal mask use in public and in health • Global research roadmap published
care facilities. • Framework for coordinated investment in research
developed
• Research on optimal features and characteristics
of non-medical masks, including choice of fabric,
number and combination of layers, shape, and
coating – this research informed WHO updated
guidance on masks.
• Researched efficacy and safety of decontamination
and re-use methods for masks and respirators.
• Developed protocol for case-control study to assess
risk factors for COVID-19 in health workers.

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 43
9 integrating social sciences in the outbreak response.
The forum also discussed a framework for coordinated investment that
fed into the formation of the ACT-Accelerator, which was established in April
and is described in more detail below.
A second Global Forum on COVID-19 Research and Innovation was convened
by WHO in July 2020, during which over 1000 participants took stock of the
progress that had been made towards meeting the goals of the Global research
roadmap, and reviewed priorities for further research.
This third part of the report explores the progress that has been made in
key areas of research, including vaccines, diagnostics, and therapeutics, looks Disease severity
at how the ACT-Accelerator is helping the world to prepare for the equitable
roll out of new technologies, and highlights the key WHO initiatives that are
supporting the world’s scientific community to build the evidence base needed
to guide effective public health policy.
In relation to this final point, which is intrinsically linked to WHO’s role in the
formulation of normative guidance during the response, WHO continually
gathers and catalogues newly published international scientific findings and
knowledge on COVID-19 in multiple languages as a resource for researchers.
The global literature indexed in the WHO COVID-19 database is updated daily
via searches of bibliographical databases, hand searching, and through expert
referrals. The WHO evidence retrieval sub-group has begun collaboration with
key partners to build a more comprehensive database. The database is built
by BIREME, the Specialized Center of WHO/PAHO, and part of the Regional
Office’s Department of Evidence and Intelligence for Action in Health. WHO
also supports the COVID-19 living Network Meta-Analysis initiative, which
enables users to easily visualize what research is underway across the world
(figure 20).

Figure 20 The COVID-19 living Network Meta-Analysis

Type of pharmacological treatment

The COVID-19 living Network Meta-Analysis initiative has so far gathered and analysed data from 2202
studies of treatments from WHO’s International Clinical Trials Registry Platform. 1231 of these trials
are currently recruiting patients. The initiative produces a living map of ongoing research in order
to identify gaps in real time.

Source at: [Link]

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 44
Therapeutics
While the search for an effective treatment for COVID-19 By October 2020, over 12 000 patients were recruited
continues, WHO has cautioned against giving unproven in 500 participating hospitals in 30 countries, with
treatments to patients with COVID-19 until there is 43 countries approved to begin recruiting. Overall,
sufficient evidence of benefit. On 18 March, in order 116 countries in all six WHO regions have joined
to increase the chances of finding a safe and effective or expressed an interest in joining the trial.
treatment in the shortest possible time, WHO launched
Each participating country is a sponsor to the trial in
the Solidarity Trial – a large international clinical trial
its country and supports its implementation, including
to help find an effective treatment for COVID-19 and,
financially. WHO is actively supported the:
equally importantly, rule out candidate therapeutics that
do not confer clinical benefit. Enrolling patients into one • identification of hospitals participating in the trial;
large randomized multi-centre trial overcomes the risk of • training of hospital clinicians on the web-based
multiple small trials being unable to generate the strong randomization and data system;
evidence needed to determine the relative effectiveness • shipping the trial drugs as requested by each
of potential treatments to international standards. The participating country.
enrolment of more patients, across international sites with
COVID-19 transmission, gives the world the best chance of On 15 October 2020 the Solidarity Trial published interim
obtaining a statistically significant result in as short a time results. It found that all four of the treatments evaluated
as possible across as broad a group of trial candidates as (remdesivir, hydroxychloroquine, lopinavir/ritonavir and
possible. interferon) had little or no effect on overall mortality,
initiation of ventilation, nor duration of hospital stay in
The trial protocol is designed so that more treatments can hospitalized patients. The only treatments so far found
be added as promising candidates graduate from earlier to have a significant clinical benefit in terms of reduced
stages of clinical development. On its launch, the Solidarity mortality are corticosteroids, after results were reported
trial compared four treatment options with standard care, from a number of well-designed studies in the summer
aiming to discover whether any of the treatments were of 2020 following the recommendations of the Global
able to slow disease progression or improve survival. The research roadmap. Based on the findings from seven trials,
treatments were Remdesivir; Lopinavir/ Ritonavir; Lopinavir/ WHO issued interim guidance in September 2020 stating
Ritonavir with Interferon beta-1a; and Chloroquine or that WHO strongly recommends that corticosteroids
Hydroxychloroquine. (i.e. dexamethasone, hydrocortisone or prednisone)
be given orally or intravenously for the treatment
of patients with severe and critical COVID-19.
The Solidarity Trial is now evaluating other treatments for
inclusion, to continue the search for effective COVID-19
therapeutics. Newer antiviral drugs, immunomodulators,
and anti-SARS CoV-2 monoclonal antibodies are under
consideration as candidates for trial. The results to date
are proof that large international trials are possible in
the midst of a pandemic, and offer the statistical power
to quickly and reliably answer critical public health
questions during a health emergency. In 2021, the
evidence produced by the Solidarity Trial will be essential
to guide the therapeutics that are made available through
the therapeutics pillar of the ACT-Accelerator.

The results to date are proof that

large international trials are possible
in the midst of a pandemic, and
offer the statistical power to quickly
© WHO / Blink Media – Fabeha Monir
and reliably answer critical public
health questions during a health
In March 2020, WHO launched the Solidarity Trial to increase the chance of
finding a safe and effective treatment in the shortest possible time. emergency.
22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 45
Diagnostics Vaccine development
The COVID-19 pandemic has created an urgent need Safe and effective vaccines for COVID-19 will be powerful
to rapidly increase testing services to support efforts tools in the global effort to control the COVID-19
to control the spread of COVID-19 and effectively treat pandemic. Since January WHO has worked with
patients. Since January 2020 many hundreds of new tests international partners to coordinate and accelerate the
have been marketed to detect COVID-19, with limited or research and development, manufacture, and regulatory
no independent data on their performance. Countries evaluation of vaccines at a scale that has never been
have faced challenges in the appropriate selection attempted before. In the final quarter of 2020 the world
and effective deployment of molecular and serological saw the first evidence that these efforts had born fruit
diagnostics, and most recently antigen-detecting rapid with the approval of a number of vaccines by national
diagnostic tests (Ag-RDTs). regulatory authorities.
Several Ag-RDTs for SARS-CoV-2, usually in a lateral flow The pace of this progress, advancing in less than
immunoassay (LFI) cassette format, have recently been 12 months from the discovery of a new pathogen to a
developed and commercialized. These simple-to-use tests vaccine with emergency authorization for use in humans,
offer the possibility of rapid case detection, especially of forces us to rethink what it is possible in global health
the most infectious patients in the first week of illness, when we find the urgency, political will, resources,
at or near the point of care. However, performance can expertise, and spirit of collaboration to act with such
be highly variable based on the test characteristics and focus in pursuit of a global good. With that same degree
the population tested, with sensitivity dropping markedly of commitment we must now approach the formidable
in patients without a high viral load. challenge of having every safe and effective vaccine
approved, manufactured, distributed, and made available
WHO has worked with other key stakeholders to defined
to everyone across the world on the basis of risk and
minimum performance specifications for point of care
need. This process will require meticulous planning and
Ag-RDTs in a Target Product Profile. Using these criteria
negotiation, and a marshaling of our collective resources.
WHO has approved several Ag-RDTs for emergency use
It will also require patience: it is unlikely that enough
listing, and reached an agreement with partners and
vaccines will be available in 2021 to have a significant
manufacturers to make 120 million tests available for
impact on global transmission. At the same time, we must
use in low-income and middle-income countries.
maintain our commitment to ensuring that as many of the
WHO has produced interim guidance on the use of Ag- most promising of the more than 200 candidates still in
RDTs for SARS-CoV-2, featuring important considerations development have the best chance of success. WHO will
for implementation. In December 2020 WHO also launched continue its work across a number of key areas to ensure
the SARS-CoV-2 Ag-RDT training package: a structured that each of these goals are realised throughout 2021.
comprehensive collection of training resources and tools for
relevant institutions to organize, run and evaluate training
of trainers and/or training of health workers who will be
performing SARS-CoV-2 testing using
Ag-RDTs. Materials can be adapted
and customized based on national
guidelines, delivery modality and
target group of participants. However,
as yet there is limited experience with
Ag-RDTs tests in routine settings.
WHO is therefore sponsoring a multi-
country, multi-site program to monitor
the implementation of Ag-RDTs for
COVID-19 to assess field performance,
acceptability, feasibility and/or impact
and inform and optimize settings for
most effective utilization. In November
2020 WHO issued a call for proposals
to participate in the monitoring of
Ag-RDTs in low-income and middle-
income countries to better understand
field performance, acceptability, © WHO / Blink Media – Nana Kofi Acquah
feasibility, cost-effectiveness
and impact of these tests. WHO has shipped more than 5 million test kits during 2020 to support national laboratories.

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 46
 Defining the desired characteristics Mapping candidate vaccines and
of safe and effective vaccines to combat their progress across the world
the pandemic As of December 2020 there are over 210 candidate
To guide the efforts of vaccine developers, WHO has vaccines in development, with at least 48 candidate
drawn up a Global Target Product Profiles for COVID-19. vaccines in human trials. Of the vaccines in human trials,
This document outlines the minimum and desired about 10 are in phase III trials, and three have so far
attributes of safe and effective vaccines. The TPPs announced the successful completion of phase 3 trials.
cover two types of vaccines: vaccines for the long-term WHO continues to undertake regular landscape analyses
protection of people at higher risk of COVID-19 such as of all candidates in development. WHO is also fostering
healthcare workers; and vaccines for use in response to regular open dialogue between researchers and vaccine
outbreaks with rapid onset of immunity. These profiles developers to expedite the exchange of scientific results,
are essential as we evaluate which of the more than 210 debate concerns, and propose rapid and robust methods
candidates in development to prioritise for clinical testing. for vaccine evaluation.

WHO has also coordinated expert consultations to

identify the potential role of different animal models
WHO Solidarity Vaccine Trial
and laboratory assays to evaluate and screen candidate The Solidarity Trial for COVID-19 therapeutics was able
vaccines before their evaluation in humans. to deliver conclusive results in record time because of its
global scope. WHO has proposed and designed a similar
approach for the comparison of vaccines. WHO’s expert
group on immunization has designed a large international
randomized controlled clinical trial, the WHO Solidarity
The pace of this progress … forces Vaccines Trial, which aims to evaluate efficiently and
rapidly (within 3–6 months of each vaccine’s introduction
us to rethink what it is possible into the study) the efficacy of multiple vaccines, helping
to ensure that weakly effective vaccines are not deployed.
in global health. High enrolment rates facilitated by flexible trial design
and hundreds of study sites in high-incidence locations
© WHO / Blink Media – Gilliane Soupe will yield results on short-term efficacy for each vaccine
within just a few months of including that vaccine.
Preparations are complete to initiate the trial in two
countries in at least 15 trial sites in January 2021, with an
anticipated enrolment rate of 2oo patients per site per
week.
WHO expert groups are also considering:
• criteria to prioritize which vaccines should go into
Phase 2 and 3 clinical trials;
• a Phase 2b/3 protocol that can be used by all vaccine
developers to shape their trial, which will enable
real-time evaluation of the benefits and risks of each
promising candidate vaccine.

WHO has worked with international

partners to coordinate and
accelerate the research and
development, manufacture, and
regulatory evaluation of vaccines
at a scale that has never been
As of December 2020, there are over 210 COVID-19 candidate vaccines
in development, with at least 48 candidate vaccines in human trials. attempted before.

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 47
Ensuring access and preparing health systems – the ACT-Accelerator
As safe and effective vaccines, therapies, and diagnostics an actively managed portfolio. The Facility continually
become available, it is vital that they are accessible to monitors the COVID-19 vaccine landscape to identify the
everyone who needs them. WHO will continue to work most suitable vaccine candidates, based on scientific
throughout 2021 to align research and development, merit and scalability, and works with manufacturers
fast‑track regulatory approvals, harness manufacturing, to incentivize them to expand their production capacity
and work with funders so that all populations in all in advance of vaccines receiving regulatory approval.
countries can access the tests, treatments and vaccines
Funding is a crucial part of ensuring the roll out of
the world needs. One of the main vehicles for achieving
vaccines to all countries as they become available,
this goal is the ACT-Accelerator.
but there is also a huge amount of work to be done
Launched at the end of April 2020, at an event co-hosted to prepare health systems and distribution chains for
by the Director-General of the World Health Organization, the safe and coordinated administration of any vaccine.
the President of France, the President of the European Throughout 2020 WHO has rapidly developed guidelines
Commission, and the Bill & Melinda Gates Foundation, and is working intensively with countries to strengthen
the ACT-Accelerator brings together governments, readiness for COVID-19 vaccines.
scientists, businesses, civil society, philanthropists, and
In December 2020 the WHO Vaccine Country Readiness
global health organizations (the Bill & Melinda Gates
and Delivery workstream released guidance on developing
Foundation, CEPI, FIND, Gavi, The Global Fund, Unitaid,
a national deployment and vaccination plan (NDVP)
Wellcome, WHO, and the World Bank) to accelerate
for COVID-19 vaccines. This guidance is intended to
development, production, and equitable access to
help countries develop their plan for COVID-19 vaccine
COVID-19 tests, treatments, and vaccines.
introduction. A Vaccine Readiness Assessment Tool
The ACT-Accelerator is organized into three pillars of (VIRAT) has also been developed for use by Ministries
work: diagnostics, treatment, vaccines, plus health system of Health, with support from WHO and UNICEF country
strengthening through the cross-cutting health systems offices. The VIRAT provides a roadmap for countries to
connector. Each pillar is vital to the overall effort and plan for COVID-19 vaccine introduction and a structured
involves innovation and collaboration. Underpinning all framework for countries to self-monitor their readiness
of these pillars is the Access and Allocation workstream progress against key milestones.
led by WHO, which is is developing the principles,
Other resources in development include guidance and tools
framework and mechanisms needed to ensure the fair
on: planning for COVID-19 vaccine acceptance and demand;
and equitable allocation of new COVID-19 technologies.
managing the supply, logistics, and distribution; monitoring
Of all the technologies under development, vaccines have vaccination; and conducting an evaluation of the vaccine
arguably the most important role to play in ending the introduction. COVID-19 vaccination training packages will
acute phase of the pandemic. The COVAX Facility forms a include a blend of online learning modules, materials for in
key part of the vaccine pillar of the ACT-Accelerator, and person trainings, and job aides. Initial training packages will
is co-led by Gavi, the Coalition for Epidemic Preparedness focus on health workers and the national/sub-national focal
Innovations (CEPI), and WHO, working in partnership with points for COVID-19 vaccine introduction.
developed and developing country vaccine manufacturers.
COVAX aims to accelerate the development and
manufacture of COVID-19 vaccines, and to guarantee fair
and equitable access for every country in the world by
sharing the risks associated with vaccine development,
by investing in manufacturing upfront so vaccines can be
deployed at scale as soon as they are proven successful,
and by pooling procurement and purchasing power
to ensure the delivery of sufficient volumes of vaccine
to end the acute phase of the pandemic during 2021.
The principal role of the COVAX Facility is to maximize
the chances of people in participating countries getting
access to COVID-19 vaccines as quickly, fairly and safely as
possible. By joining the Facility, participating countries and
economies will not only get access to the world’s largest
and most diverse portfolio of COVID-19 vaccines, but also

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 48
LOOKING AHEAD TO
NEW CHALLENGES IN 2021
We started 2020 never having heard of COVID-19. We The first challenge is to strengthen and sustain the
end 2020 with more than 1.5 million lives lost to the evidence-based public health and social measures that
disease, a pandemic that is still accelerating in some parts have been shown to control the virus, but that have not
of the world, and a global population that in some places yet been applied consistently on a global, regional, and
is growing frustrated and fatigued by the public health national scale. In the near and medium term, all countries
response to the virus. The challenges ahead of us in 2021 will continue to be faced by the same core public health
will pose as stern a test as anything we have faced so far challenges: how to control transmission of the SARS-CoV-2
in this pandemic. But if we can meet those challenges virus; how to provide care to COVID-19-infected individuals
the potential rewards are enormous. at different levels of existing health systems; and how
to protect essential health services. For all countries in
Although the epidemiological situation that confronts us
2021, the answers to these questions will continue to be
in the first quarter of 2021 is grave, we are now forearmed
through the use of context-appropriate public health and
with the knowledge and, increasingly, the tools that will
social measures. A robust system for testing, isolating
enable us to plot a course out of the pandemic. WHO
and treating cases, and tracing and quarantining contacts
has massively and rapidly scaled its emergency response
will remain the key to controlling transmission and the
platforms to support countries around the world to put
backbone of the COVID-19 public health response for at
their own response plans into action, and we have seen
least the next 12 months. Prepared health systems, staffed
that when countries have based those plans on WHO’s
by protected and trained health workers with access to the
guidance they have been able to reduce the transmission
knowledge and treatments they need, will reduce mortality
of SARS-CoV-2, save lives, and protect the vulnerable.
from all causes. We know what works. A key challenge for
In 2021 we must carry forward our hard-won knowledge, WHO will be to support countries to more accurately gauge
integrate new tools such as vaccines into the response, and report their own capacities for implementation, and
and marry them to the political will to act in a spirit of provide targeted support for rapid ameliorative action
multilateralism and solidarity to ensure that WHO is able where gaps are identified. Addressing this challenge will be
and empowered to support every country to adapt and particularly important in FCV contexts, in which COVID-19
deliver their national COVID-19 action plans on the basis health strategies must be adapted to context-specific
of a new global Strategic Response Plan. and evolving needs, with an increasing focus on reducing
all‑cause excess morbidity and mortality.
WHO’s COVID-19 response plan for 2021 adapts the
original pillars of WHO’s COVID-19 strategy to incorporate FCV contexts are also particularly important when we
the lessons that we have learned during 2020 in order come to consider the third core public health challenge
to address the key emerging challenges that will define faced by all countries: the protection of essential health
our collective progress against COVID-19 over the next services. The relevant pillars of the 2021 strategy will
12 months. address the evolving challenge at national level and
subnational level to balance measures that prevent the
direct morbidity and mortality attributable to COVID-19,
the indirect morbidity and mortality caused by the
overwhelming of health systems and the interruption of
other essential health and social services, and the acute
and long-term detrimental effects on health, including
mental health, and wellbeing of the socioeconomic
consequences of some response measures. As the
pandemic has progressed so has our appreciation
of the importance of that balance, and the complexity
inherent in attaining it amidst a highly dynamic situation.

The challenges ahead of us in 2021 will pose

as stern a test as anything we have faced so
far in this pandemic.

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 49
The second major challenge facing countries, WHO, and The degree to which health systems are ready and
the global response during 2021 is how best to integrate prepared to integrate new technologies such as vaccines
new technologies into the response in the most efficient and rapid diagnostics will ultimately determine the
and effective way, and to do so in such a way that rate at which the world is able to control the pandemic.
strengthens health systems for the future. COVID-19 has exposed systemic weaknesses in global
and national health systems and health security
The authorization in December 2020 by some national
mechanisms. The need to invest in health system
regulators of several vaccines against COVID-19 for
capacities to both control COVID-19 through existing
emergency use was a watershed moment, and on
measures and to implement a COVID-19 vaccination
31 December 2020 WHO listed the Comirnaty COVID-19
presents us with a generational opportunity, and a
mRNA vaccine for emergency use, making the
moral obligation, to ensure that these investments have
Pfizer/BioNTech vaccine the first to receive emergency
a lasting benefit in terms of our collective global health
validation from WHO.
security, and result in an enduring improvement in the
Safe and effective vaccines will be powerful tools in health and prosperity of societies. Ending the COVID-19
the global effort to control the COVID-19 pandemic, pandemic means controlling transmission in every
but the scale of work required to realize, and in many country and in every context, no matter how challenging.
ways understand, the potential of this first generation Ultimately we will bring about that control through an
of COVID-19 vaccines to change the course of the evolving combination of vaccination, other new tools,
pandemic cannot be overstated. The first critical hurdle and public health and social measures, all of which will
to overcome is that of access, and it is a challenge that require investment in health system capacities that are
can be overcome through the COVAX pillar of the ACT- foundational for both health security, for universal health
Accelerator. COVAX is the only mechanism that can ensure coverage, and for primary care.
vaccines will be available worldwide, and that is the only
A coherent approach to strengthening health systems
way to ensure that the pandemic is brought to an end.
must be woven into the COVID-19 response that
COVAX will be fully funded and enabled to meet its target develops inter-dependent and integrated capacities
of securing and delivering 2 billion vaccine doses by the for comprehensive surveillance, data and information
end of 2021. For this ambitious plan to be successful, we systems, regulation, communication and planning/
must continue to accelerate the work that was started in oversight capacities, and risk management within
2020 to prepare health systems in all countries to address essential health services. Throughout 2020, WHO and
the logistical and public health challenges of what will partners have supported countries to strengthen and
be the most complex vaccination effort in history. adapt health systems during the COVID-19 pandemic.
One of the overarching challenges of 2021 will be to
ensure that these investments
It will be important to ensure that the response are consolidated and built upon
to ensure that we not only end
protects health and wellbeing in the broadest the pandemic in every country,
sense, including the incorporation of mental but that we build a healthier,
more sustainable, and more secure
health and psychosocial support as an integral future. WHO’s GPW13 provides the
principles and the framework to build
component in many aspects of the COVID-19 a healthier and safer world; if we can
response, from case management and risk stay true to those principles in our
response to the global emergency
communication and community engagement to of COVID-19, we can ensure that
it is a tragedy that leaves a legacy
the strengthening of essential health services. of positive change.

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 50
ANNEX A:
Overview of COVID-19 SPRP monitoring and evaluation
Country/area-level coordination, planning Surveillance, rapid response teams and case
and monitoring investigations

Countries/areas with CVOID-19 National Plan Countries/areas implementing seroepidemiological investigations

or studies

91%
30% 70%
47% 100%
0% 20%
Countries/areas with a functional multi-sectoral, multi-partner
coordination mechanism for COVID-19 preparedness and response Countries/areas testing for COVID-19 and reporting routinely
through established sentinel or non-sentinel ILI, SARI, ARI
surveillance system
97%

45% 100% 100%

Countries/areas that put in place at least one social and physical 18% 50%
distancing measure related to schools or offices in the context
of COVID-19 Priority countries/areas where the IMST has a focal point for contact
tracing implementation and training
99%
72% 5% 23%
0% 100%
0% 100%
Countries/areas reporting having at least one mass gathering event
affected by COVID-19, following a risk assessment exercise

47% 17% 36% Points of Entry (PoE)

5% 100% Countries/areas which produce and distribute messages and PoEs

for both travelers and staff working at the PoE facilities and
conveyances

Risk communication and community engagement

72% 27%
Countries/areas which have a national COVID-19 risk communication
and community engagement plan 5.6% 100%

Countries/areas in which all designated PoE have public health

97% emergency contingency plans

19% 100%
35% 63%

Priority countries/areas where a RCCE coordination mechanism 29% 100%

is active and formally implemented

89%

47% 100%

Priority countries/areas that have mechanisms in place to capture

community feedback

81% Yes No No information Not applicable

6% 100% Indicator applies

Baseline value (global) Target value to priority countries (b)

Data as of 8 January 2021

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 51
 National laboratories Operational support and logistics

Countries/areas with COVID-19 laboratory test capacity Number of medical masks (3 plies) shipped to priority countries
by WHO

100%
113 119 480
85% 100%
Number of laboratory testing kits shipped to priority countries
Countries/areas participating in WHO External Quality Assessment by WHO
Project (EQAP)

2 457 222
85% 15%

85% 100% Priority countries/areas where at least one IMST team member
has been trained in the use of Essential Supply Forecast Tool

Countries/areas scoring 100% on EQAP

52% 48%
95% 5% 47% 100%
75% 100%

Maintaining essential health services and systems

Infection prevention and control (IPC)
Countries/areas that have defined essential health services to be
Countries/areas that have a national IPC programme and WASH maintained during COVID-19 pandemic
standards within all healthcare facilities

46% 20% 34%

39% 15% 45%
22% 100%
27% 100%
Priority countries/areas where at least one VPD immunization
Countries/areas with Long-Term Care Facilities (LTCF) that have a campaign was affected (suspended or postponed, fully or partially)
national policy and/or guidelines on IPC for COVID-19 in LTCFs by COVID-19

44% 7% 31% 19% 45% 55%

22% 100% 0% 27%

Priority countries/areas where the IMST has as focal point

for IPC training
Cross-cutting issues
83% 16%
Priority countries/areas with multi-sectoral mental health
50% 100% and psychosocial support technical working group

80% 6% 14%
Case management 47% 100%

Countries/areas that have clinical referral system in place to care Countries/areas that have national occupational safety and health
for COVID-19 cases plans or programmes for health workers

89% 28% 6% 67%

37% 100% 17% 100%

Yes No No information Not applicable

Indicator applies
Baseline value (global) Target value to priority countries (b)

Data as of 8 January 2021

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 52
ANNEX B:
COVID-19 contributions
Table 5 Contributors to the SPRP

Contributor US$ million Contributor US$ million

Afghanistan (Asian Development Bank) 5.20 COVID-19 Solidarity Response Fund 84.07

Afghanistan (GAVI) 0.29 Croatia 0.71

Afghanistan (World Bank) 4.77 Cyprus 0.11

Africa Re Foundation 0.25 Czech Republic 0.26

African Development Bank Group 11.43 Denmark 17.13

Alwaleed Philanthropies 5.00 East African Community 8.52

Ancash 3.14 Estonia 0.11

Australia 9.58 EU 1.18

Austria 3.09 EU NEAR 5.57

Azerbaijan 10.00 European Commission 135.76

Banco Centroamericano de Integracion 0.75 Finland 1.10

Economica (BCIE)
Fond d’Assistance Economique et Sociale (FAES) 0.47
Bangladesh 0.05
Fondo Mixto 0.34
Bangladesh (World Bank) 2.92
France 5.88
Belize 0.01
Fundación Yamuni Tabush 0.03
Bill & Melinda Gates Foundation 14.41
Gabon (World Bank) 6.83
Bulgaria 0.11
GAVI Alliance 11.77
CAF-Development Bank of Latin America 0.70
Germany 434.00
Cameroon (African Development Bank) 0.70
Guinea (World Bank) 1.79
Canada 20.92
Guinea-Bissau 11.83
Caribbean Development Bank (CDB) 0.06
Holy See, Rome 0.11
Centers for Disease Control and 12.40
Prevention(CDC), United States of America Iceland 0.20

Central African Republic (World Bank) 2.45 Iran (Islamic Republic of; World Bank) 51.97

CERF 0.80 Ireland 9.23

Chad (Islamic Development Bank) 0.11 Italy 8.77

Chad (World Bank) 2.04 Japan 50.47

China 25.10 King Baudouin Foundation United States (KBFUS) 3.25

Clinton Health Access Initiative 0.24 King Salman Humanitarian Aid & Relief Center, 23.00
KSrelief
Confederation of Caribbean Credit Unions 0.08
(CCCU) Kuwait 60.00

Côte d’Ivoire 0.44 Latvia 0.11

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Looking back at a year that changed the world: WHO’s response to COVID-19 53
Table 5 Contributors to the SPRP (continued)

Contributor US$ million Contributor US$ million

Lebanon (World Bank) 5.56 Southern African Development Community 8.50

Liberia (Global Fund) 1.07 Spain 3.56

Libya (Asian Development Bank) 0.48 Standard Chartered Bank Ltd, Gambia 0.15

Liechtenstein 0.31 Susan Thompson Buffett Foundation 15.11

Lithuania 0.01 Sweden 3.89

Luxembourg 1.23 Switzerland 5.37

Madagascar (World Bank) 3.70 Tetra Pak Export FZE, United Arab Emirates 0.24

Mauritania (World Bank) 0.40 Thailand 0.05

Miscellaneous 0.03 Ukraine (World Bank) 9.41

Mozambique (Islamic Development Bank) 0.94 UN Agencies (UNICEF, UNFPA, IOM) 0.29

Netherlands 9.62 UNDP Mutli-Partner Trust Fund (MPTF) 1.63

New Zealand 3.27 UNFCU Foundation 0.07

Norway 6.99 United Kingdom of Great Britain 127.68

and Northern Ireland
Novartis 0.50
United Nations Central Emergency 20.91
OPEC Fund for International Development (OFID) 1.50 Response Fund (CERF)

PandemicTech, Texas 0.02 United Nations Children’s Fund (UNICEF) 3.90

Pilipinas Shell Foundation, Inc. (as PR of GFATM) 0.15 United Nations Development Programme (UNDP) 33.35

Portugal 0.57 United Nations Office for 0.91

South‑South Cooperation
Republic of Korea 6.53
United Nations Office for the Coordination 21.78
Romania 0.061 of Humanitarian Affairs (UNOCHA)

Russian Federation 1.00 United Nations Population Fund (UNFPA) 6.17

Sandoz AG 0.10 United States of America 36.57

Sao Tome and Principe 0.71 Viet Nam (Supply Chain Fund) 0.05
(Asian Development Bank)
Vital Strategies 2.61
Sao Tome and Principe (World Bank) 1.31
World Bank 65.56
Saudi Arabia 32.00
World Food Programme (WFP) 0.19
Serbia 1.10
Yemen (Islamic Development Bank) 20.00
Singapore 0.50
Total received in 2020 1 539.53
Slovakia 0.22

Slovenia 0.07

Sony 0.07

22 January 2021
Looking back at a year that changed the world: WHO’s response to COVID-19 54
Table 6 Contributors to the Member States COVID Pool

Contributor US$ million

Bangladesh 0.1

Bulgaria 0.1

Cyprus 0.1

Denmark 7.4

Estonia 0.1

Iceland 0.2

Italy 7.8

Latvia 0.1

Liechtenstein 0.3

Lithuania 0

Netherlands 8.4

Portugal 0.6

Republic of Korea 0.3

Serbia 1.1

Singapore 0.5

Viet Nam 0.1

Total 27.2

The COVID-19 Member-State Pooled Fund is a subset of all COVID-19

Strategic preparedness and response plan (SPRP) funding and enables WHO
to deliver on its mandate to implement the priority actions outlined in the
SPRP. The pooled Fund enables Member States to pool their contributions
into a single, flexible fund that can be used immediately to support
countries. It fascilitates rapid action by WHO through increased flexibility
administrative processes, and delivers efficiency and value for money.

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Looking back at a year that changed the world: WHO’s response to COVID-19 55
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