WHO global research priorities for sexually transmitted infections.

Sexually transmitted infections (STIs) are widespread worldwide and negatively affect sexual and reproductive health. Gaps in evidence and in available tools have long hindered STI programmes and policies, particularly in resource-limited settings. In 2022, WHO initiated a research prioritisation process to identify the most important STI research areas to address the global public health need. Using an adapted Child Health and Nutrition Research Initiative methodology including two global stakeholder surveys, the process identified 40 priority STI research needs. The top priorities centred on developing and implementing affordable, feasible, rapid point-of-care STI diagnostic tests and new treatments, especially for gonorrhoea, chlamydia, and syphilis; designing new multipurpose prevention technologies and vaccines for STIs; and collecting improved STI epidemiologic data on both infection and disease outcomes. The priorities also included innovative programmatic approaches, such as new STI communication and partner management strategies. An additional six research areas related to mpox (formerly known as monkeypox) reflect the need for STI-related research during disease outbreaks where sexual transmission can have a key role. These STI research priorities provide a call to action for focus, investment, and innovation to address existing roadblocks in STI prevention, control, and management to advance sexual and reproductive health and wellbeing for all.

The importance of insufficient national data on sexual and reproductive health and rights in international databases.

Looking at SRHR as an isolated set of elements, as is the current practice, does not do justice to the needs and rights of people and communities and may be one of the reasons why challenges remain in the attainment of SRHR for all. SRHR Infographic snapshots were developed for all 194 WHO Member States and included 120 indicators covering a broad range of policy, health systems and service delivery interventions. The snapshots were created using data less than 10 years old publicly available in data repositories maintained by international and global agencies. Data availability was not consistent across countries with low and lower-middle income countries having higher data availability (71%) compared to high income countries (40%). SRHR data that is easily accessible and consistently reported can improve accountability and opportunities for learning to improve people-centred approaches to accelerate the attainment of SRHR for all.

Preparing ethical review systems for emergencies: next steps.

Ethical review systems need to build on their experiences of COVID-19 research to enhance their preparedness for future pandemics. Recommendations from representatives from over twenty countries include: improving relationships across the research ecosystem; demonstrating willingness to reform and adapt systems and processes; and making the case robustly for better resourcing.

Assessing the impact of small-research grants supported by WHO in the Eastern Mediterranean Region 2010-2018.

Background: For decades, WHO has been providing targeted funding for health research on priority areas of public health in the Eastern Mediterranean Region through different grant schemes. Aims: This paper investigated the impact of WHO/EMRO's funding schemes and factors facilitating or hindering such impact. Methods: We assessed the impact of health research funded by WHO/EMRO during 2010-2018 from the health, economic, decision-making, and knowledge translation perspectives, emphasizing accountability and analysis, using the Payback framework, mixed-method approach (quantitative, qualitative), and triangulation. Results: Principal investigators of 45 (45.9%) out of the 98 funded projects responded to the questionnaire. Almost all (88.0%) the 45 projects reported developing at least one decision-making document. Less than half reported producing peer-reviewed documents and conducting target group empowerment, while 24.0% said they secured research funds from other organizations. For 23 projects (51.0%), research results could have had a direct impact on health and on economy, and 25 (56.0%) projects conducted at least one active knowledge translation activity. Using multiple logistic regression, there was no significant association between the country of research and impact on decision-making and implementation of result if health or economic impact was expected. Conclusion: To strengthen the impact of research, WHO/EMRO should embark on a series of interventions to guide and empower countries in the use of research results. Discrepancies between health research systems in the Eastern Mediterranean Region and differences in individual and organizational capacities in the different countries require targeted interventions.

Integrating locally-attuned palliative care into health care systems in the Eastern Mediterranean Region.

At the 2014 World Health Assembly (WHA), the ministers of health of all 194 World Health Organization (WHO) Member States affirmed that palliative care, the prevention and alleviation of pain and suffering of any kind associated with serious illness, "is an ethical responsibility of health systems". The Assembly acknowledged "the urgent need to include palliation across the continuum of care, especially at the primary care level," and emphasized that "inadequate integration of palliative care into health and social care systems is a major contributing factor to the lack of equitable access to such care." This WHA Resolution (WHA 67.19) differs from other resolutions regarding specific diseases, interventions, populations, or other aspects of health care. It differs not only because palliative care is essential to the care of adults and children affected by serious illness or humanitarian crisis of any type, but also because the Resolution draws attention to the essence of medicine and nursing, the prevention and relief of human suffering. It does so by amplifying the too-often unheard call of the suffering, the poorest, sickest, and most vulnerable.

WHO's support for COVID-19 research and knowledge management in the Eastern Mediterranean Region.

Health research, innovation and knowledge management remain major priorities of the WHO's response to the COVID-19 pandemic. WHO's Eastern Mediterranean Regional Office (EMRO) supports priority research initiatives that address gaps in current knowledge regarding the COVID-19 pandemic. Through a specific call for proposals, 122 research proposals were received and reviewed in 2020, of which 17 were recommended for funding from eight countries. Ten countries in the region participated in the global solidarity trial to assess potential therapies for COVID-19. In addition, WHO advocated for early serological and epidemiological investigations ('COVID-19 Unity Studies') on the general population, healthcare workers, pregnant women and neonates, and extending technical, financial and material support for them.Starting in early 2020, scholarly articles on COVID-19 have been published in every issue of the Eastern Mediterranean Health Journal More than 6300 publications on COVID-19 were made available on the WHO knowledge management portal in the last year alone. WHO is also supporting countries in conducting studies to assess the field effectiveness of vaccines deployed nationally. To build and strengthen country capacities, regional webinars and intercountry meetings were conducted on research ethics, national health information systems and evidence-based health policy making. With support from WHO EMRO's new research and knowledge management pillar, countries in the region were well equipped to contribute to a global understanding of the novel virus's characteristics, as well as employ a national response based on informed evidence.

Mapping of health innovations in response to the COVID-19 pandemic in Eastern Mediterranean and selected Arab Countries.

Background: COVID-19 is the first pandemic during which innovative technologies are being used to keep people connected, safe, and productive while being physically and socially apart. Aims: This study aimed to map health innovations in response to the pandemic in the Eastern Mediterranean Region. Methods: Health innovations are defined as novel methods, models, processes, products, services, or a combination that produce notable public health impact in people, families, and communities at large. We used two approaches: an online survey using a specially designed data collection tool and a review of publicly available literature using PubMed, IMEMR, Google Scholar, Google, and INSERM search engines. Data collection was conducted between September 2020 and February 2021. Results: We describe 80 innovations in this region, of which 13 were identified through the online survey and 76 via literature review. For the purposes of this paper, we subclassified two-thirds of these innovations (n = 52; 65%) as "digital health innovations", including telehealth and telemedicine, surveillance, and contact tracing. The rest were classified as "non-digital health innovations", including prevention and clinical management. Conclusion: This mapping exercise provides baseline information on response to the pandemic by the public and private sectors, innovation hubs within and outside the region, as well as by entrepreneurs and innovators. In-depth studies measuring the impact of health innovations will likely only become available when the pandemic is under better control and experts are able to assess the replicability, sustainability and scalability of the health innovations introduced.

Addressing the health-related SDGs in the Eastern Mediterranean Region: Regional Health Alliance strengthens collaboration towards better health.

The United Nations launched the Sustainable Development Agenda 2030 and its 17 Sustainable Development Goals (SDGs) in 2015, as a more detailed and ambitious follow-up to the Millennium Developments Goals (MDGs). Health and wellbeing of all, at all ages, is addressed by the third SDG (SDG3) and health-related targets of other SDGs. However, progress to date on the health-related SDGs in the Eastern Mediterranean Region (EMR) is not on track. Although there was progress in over half of the 50 health-related SDG targets and indicators between 2015 and 2019, there is still a long way to go. Progress is required, among others, in reducing maternal, child and neonatal mortality; increasing vaccination coverage; reducing the number of cases of malaria and HIV; and in tackling the increase in mortality rates due to noncommunicable diseases. Much progress is needed in many health-related SDGs considered as important social, economic and environmental determinants of health.

Enhancing capacity and use of digital health in the Eastern Mediterranean Region: an urgent priority for action.

The Eastern Mediterranean Region (EMR) faces massive challenges that threaten people's livelihood and health due to multiple factors, including socioeconomic disparities, conflicts and emergencies in many countries of the Region. The COVID-19 pandemic has further exacerbated these challenges and significantly disrupted access to essential health services. As highlighted in recent flagship reports, the region is unlikely to achieve health-related Sustainable Development Goals, unless crucial changes are made in the way the goals are pursued. Effective implementation of digital health technologies could provide opportunities to enhance the response to the pandemic, as well as improve the access to health services and develop stronger and more resilient health systems.

A Public Health Research Agenda for Managing Infodemics: Methods and Results of the First WHO Infodemiology Conference.

BACKGROUND: An infodemic is an overflow of information of varying quality that surges across digital and physical environments during an acute public health event. It leads to confusion, risk-taking, and behaviors that can harm health and lead to erosion of trust in health authorities and public health responses. Owing to the global scale and high stakes of the health emergency, responding to the infodemic related to the pandemic is particularly urgent. Building on diverse research disciplines and expanding the discipline of infodemiology, more evidence-based interventions are needed to design infodemic management interventions and tools and implement them by health emergency responders. OBJECTIVE: The World Health Organization organized the first global infodemiology conference, entirely online, during June and July 2020, with a follow-up process from August to October 2020, to review current multidisciplinary evidence, interventions, and practices that can be applied to the COVID-19 infodemic response. This resulted in the creation of a public health research agenda for managing infodemics. METHODS: As part of the conference, a structured expert judgment synthesis method was used to formulate a public health research agenda. A total of 110 participants represented diverse scientific disciplines from over 35 countries and global public health implementing partners. The conference used a laddered discussion sprint methodology by rotating participant teams, and a managed follow-up process was used to assemble a research agenda based on the discussion and structured expert feedback. This resulted in a five-workstream frame of the research agenda for infodemic management and 166 suggested research questions. The participants then ranked the questions for feasibility and expected public health impact. The expert consensus was summarized in a public health research agenda that included a list of priority research questions. RESULTS: The public health research agenda for infodemic management has five workstreams: (1) measuring and continuously monitoring the impact of infodemics during health emergencies; (2) detecting signals and understanding the spread and risk of infodemics; (3) responding and deploying interventions that mitigate and protect against infodemics and their harmful effects; (4) evaluating infodemic interventions and strengthening the resilience of individuals and communities to infodemics; and (5) promoting the development, adaptation, and application of interventions and toolkits for infodemic management. Each workstream identifies research questions and highlights 49 high priority research questions. CONCLUSIONS: Public health authorities need to develop, validate, implement, and adapt tools and interventions for managing infodemics in acute public health events in ways that are appropriate for their countries and contexts. Infodemiology provides a scientific foundation to make this possible. This research agenda proposes a structured framework for targeted investment for the scientific community, policy makers, implementing organizations, and other stakeholders to consider.

Promoting family practice-based model of care: the role of WHO's professional diploma in family medicine in the Eastern Mediterranean Region.

Strengthening Primary Health Care (PHC) through family practice-based model of care is an essential bedrock in achieving Universal Health Coverage (UHC), as called for in Sustainable Development Goal (SDG) 3, target 3.8. However, the shortage of family practitioners worldwide and in most countries of the Eastern Mediterranean Region (EMR) is a daunting challenge. The current production rate of family physicians in the EMR is around 700 annually, against the needed estimate of 21 000 physicians per year based on one family physician/1300 population and the current EMR population growth rate, which reflects the huge shortage of family physicians in the Region.

Research on health priorities: a regional agenda and its implementation in Jordan and Pakistan.

The Eastern Mediterranean Region (EMR) is facing extraordinary social and health challenges, aggravated by epidemiologic variations, high morbidity and mortality burden (communicable, noncommunicable, injuries), consequences of emergencies (including current COVID-19 pandemic), conflicts and massive migrant population movements. Research for health is essential for generating necessary evidence, which contributes to sustainable development, economic growth and sound health policy-making. Moreover, research for health that addresses national public health priorities is essential for developing required evidence for explanations that contribute towards health improvement and can assist in best utilization of available resources towards issues that maximize the research impact on population health.

Air quality and health impacts in the Eastern Mediterranean Region: an eye on COVID-19.

Air quality is intimately linked to human activities, climate, atmosphere and ecosystems. Many of the anthropogenic contributors to air pollution are also sources of greenhouse gases including CO2 and other short-lived climate pollutants, such as Ozone and black carbon, which greatly contribute to the climate change phenomenon and its adverse effects on human health. Unfortunately, fragile and dry ecosystems prevailing in most of our countries in the Eastern Mediterranean Region may be implicated for exacerbation of this air pollution and climate change dilemma even more severely.

From health emergency preparedness to response action: a long journey in Lebanon.

Emergency preparedness is a critical pillar of the International Health Regulations (IHR), a legally binding instrument underlying the global health security regime that came into effect in 2005. Lebanon, a small country of 10 452 km2 bordering the eastern Mediterranean, ratified the IHR in 2007 after the devasting effects of a sudden military conflict in 2006 that severely impacted the recovering health system. Moreover, the Lebanese health system infrastructure was only just recovering from 15 years of civil war that ended in 1990. Since 2005, the country has also faced a complex refugee crisis potentiating the risk of disease outbreaks since 2011, in addition to a severe financial crisis that has degenerated into social unrest since October 2019, and more recently the COVID-19 pandemic since February 2020.

Health research prioritization: global and regional perspectives.

The Eastern Mediterranean Region (EMR) confronts unprecedented health challenges, exacerbated by demographic and epidemiologic changes, triple burden of disease, increasing healthcare costs, as well as the effects of contracted emergencies, social conflicts and massive population movements. Such challenges have repercussions on health care delivery and health research systems. Research for health is essential for developing solutions that contribute to health improvements. Investment in research for health contributes to health, economic growth and equity.

Full implementation of the WHO Framework Convention on Tobacco Control in the Eastern Mediterranean Region is the responsibility of all.

Although the World Health Organization Framework Convention on Tobacco Control (FCTC) came into force in 2005, the tobacco control challenge continues to escalate. Despite the fact that tobacco use is finally projected to decrease in the Eastern Mediterranean Region (EMR), as indicated in the WHO Global Report on Trends in the Prevalence of Tobacco Use, the tobacco epidemic is still far from over.The challenges facing the Region do not have a single source; the tobacco epidemic started as a multi-faceted problem and remains so today. The emergency situation in several EMR countries is pushing tobacco control down the list of priorities for decision-makers, whether directly or indirectly affected by regional conflict. The existence of unregulated and novel tobacco products, such as e-cigarettes, in many EMR countries complicates the situation further. Such products allow affordable access to tobacco products for young people, which consequently increases nicotine dependence and thus worsens the tobacco epidemic.

Biomedical and health research geography in the Eastern Mediterranean Region.

BACKGROUND: Measuring scientific outputs allows for objective evaluation of established health research systems and ranking countries according to scientific achievements. To our knowledge, attempts for systematic mapping health research output in the Eastern Mediterranean Region (EMR) are limited. AIMS: We aimed to conduct a detailed bibliometric analysis of EMR biomedical and health research productivity during the period 2004-2013, considering country of first author. METHODS: We applied an improved PubMed search strategy to obtain precise data on EMR research productivity, limiting articles to reviews, original research and case reports. Data were normalized to global research output, represented by total articles indexed in PubMed per year from 2004-2013, according to population size of each country. Second order polynomial trend lines were calculated and comparing 5-year periods: 2004-2008 with 2009-2013. RESULTS: Inspecting overall raw data, a clear increasing trend is observed. Regional share of global health related research ranged from 0.85-2.36% of total PubMed indexed publications during the study period. Five countries contributed to 80% of all published articles during study period; i.e., Islamic Republic of Iran (39%), Egypt (14%), Saudi Arabia (11%), Tunisia, and Pakistan (8% each). Overall, 2.35 articles are published per 100 000 population per year. While Kuwait maintained the highest per capita publication (followed by Tunisia, Lebanon, Qatar and Islamic Republic of Iran), Qatar, Islamic Republic of Iran and Saudi Arabia demonstrated the highest "per capita" population growth in publications. Three academic institutions accounted for over 10% of all publications that were led by an investigator from the Region. Collectively, most prolific 25 EMR institutions published 44% of all published biomedical and health research in the EMR. CONCLUSIONS: The overall global share of EMR health research publication is smaller than its global share of population or wealth. Biomedical and health research needs greater encouragement and supporting many EMR countries and/or institutions, especially those found to be least prolific in our analysis. The increase in academic publication on health has been more prominent in a few countries only. It is anticipated that the concentration of biomedical and health research in EMR academic institutions would help in translating knowledge into public health outcomes, if more suitable conditions are provided.

Healthy Cities Programme in the Eastern Mediterranean Region: concurrent progress and future prospects.

Urbanization has been rapidly increasing during the past two decades and it is estimated that by 2030, two thirds of the world's population would be living in urban areas, exposing the population to a large number of environmental, social, cultural, economic and behavioural factors that impact population health and wellbeing.In response to such challenges, the Healthy Cities concept was instigated in 1977 that, along with the Alma Ata Declaration and commitment of countries at the Thirtieth World Health Assembly in Geneva, Switzerland, would empower communities to lead socially and economically productive lives. A number of policy documents from the World Health Organization (WHO) and other bodies suggested introducing new approaches to managing cities and addressing health challenges, focusing more on health determinants and prevention than medical interventions.