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COVID-19(22)18

05 September 2022TO:

LABOUR AFFAIRS COMMITTEE
ALL MEMBERS & ASSOCIATE MEMBERSBIWEEKLY MEMBERS MEETING PARTICIPANTS
INTERNATIONAL ASSOCIATION GROUP PARTICIPANTS

COVID-19 AND MONKEYPOX UPDATE AS OF 5 SEPTEMBER 2022
Action Required: Globally, as of 2 September 2022, there have been 601,189,435
confirmed cases of COVID-19, including 6,475,346 deaths, reported to WHO. As of 1
September 2022, a total of 12,478,615,692 vaccine doses have been administered.
SITUATION IN NUMBERS BY WHO REGION

GlobalAmericas

Cases
601,189,435
175,912,685

Deaths6,475,346
2,818,706

EuropeSouth-East Asia
Eastern Mediterranean
AfricaWestern Pacific248,289,286
60,028,380
22,987,228
9,294,252
84,676,840

2,077,938
795,826
347,603
174,340
260,920

TOP 12 COUNTRIES
1
2
3
4
5
6
7
8
9

USA
India
BrazilFranceGermany
UK
Korea
Italy
RussiaMOST CASES YESTERDAY
Japan
USA
Korea
RussiaChina
FranceGermany
Italy
BrazilHIGH FATALITIESYESTERDAY
USA
Japan
BrazilRussia
Italy
Korea
Chile
Australia
FranceRegistered Office Walsingham House, 35 Seething Lane, London, EC3N 4AH
Registered in England and Wales No. 2532887

10
11
12

Japan
TurkeySpain

Australia
Reunion
Chile

Philippines
China
Thailand

COVID-19(22)18-Annex-1- ICAO Vaccination Report 30 August 2022
COVID-19(22)18-Annex-2- ICAO Travel Testing Report 30 August 2022
COVID-19(22)18-Annex-3- Weekly Epidemiological Update 31 August 2022
COVID-19(22)18-Annex-4 -WHO covid update 30 August 2022
COVID-19(22)18-Annex-5-post acute phase pandemic scenarios august 2022
COVID-19(22)18-Annex-6- update Monkeypox no78
COVID-19(22)18-Annex-7- update Monkeypox no79
COVID-19(22)18-Annex-8- Monkeypox WHO
COVID-19(22)18-Annex-9-Japan covid updates
Ondrilla Fernandes
Employment Affairs Advisor

Vaccination Report – 30 August 2022
1. Vaccine Implementation
WHO’s Emergency Use Listing(EUL) Vaccines (Last Updated 7 July 2022）
1

Manufacturer

Name of Vaccine

NRA of Record

Vaccine type

Pfizer-BioNTech(US)

BNT162b2/COMIRNATY
Tozinameran (INN)

EMA,USFDAmRNA

AZD1222 Vaxzevria

EMA,
MFDS KOREA,
Japan MHLW/PMDA,
Australia TGA,
COFEPRIS(Mexico),
ANMAT(Argentina)

Non ReplicatingViral
vector

DCGI

Non Replicating Viral
Vector

Ad26.CoV2.S

EMA, DCGINon ReplicatingViral
vectormRNA-1273

EMA, USFDA, MFDSmRNA

SARS-CoV-2
Vaccine(Vero Cells)

NMPA

Inactivated virus(Vero Cells)

COVID-19 Vaccine (VeroCells)NMPA

Inactivated virus(Vero Cell)

SARS-CoV-2 Vaccine,
Inactivated (Vero Cell)/
COVAXIN

DCGI

Whole-Virion Inactivated(Vero Cell)

2

AstraZeneca(UK)

3

Serum Institute of India(India)4

Johnson &Johnson(US)
Moderna(US)

56Sinopharm Beijing(China)Sinovac(China)

7

8
9
10
11

Covishield(ChAdOx1_nCoV-19)

Bharat Biotech (India)
Serum Institute of India(India)NOVAVAX(US)CanSinoBIO (China)

•

DCGI

NVX-CoV2373/Covovax

Protein Subunit

EMA

NVX-CoV2373/Covovax

Protein Subunit

NMPA

Ad5-nCoVNon ReplicatingViral
vector41 Vaccines Approved by at Least One Country

VaccineTypemRNA

Non Replicating
Viral vector

Inactivatedvirus

Protein
SubunitDNA

In Use

5

7

11

16

1

Virus-like
Particles
(VLP)
1

Total

41

Source: https://covid19.trackvaccines.org/vaccines/ （Last Updated 29 August 2022）

•Vaccination against COVID-19 has now started in 218 locations(Source: Our World in Data. Last Updated 29 August 2022)
Location
Worldwide

Doses Given
12.57 billion

Complete Initial Protocol(% of population)
4.99 billion(63.1 %)

Partly Vaccinated(% of population)
5.35 billion(67.6 %)

About this data:
a: This data changes rapidly and might not reflect doses still being reported. It may differ from other sites & sources.
b: Where data for full vaccinations is available, it shows how many people have received at least 1 dose and how
many people have been fully vaccinated (which may require more than 1 dose).Where data for full vaccinations isn't
available, the data shows the total number of vaccine doses given to people. Since some vaccines require more than
1 dose, the number of fully vaccinated people is likely lower. c: It only has full vaccination totals in some locations.

2. Effectiveness of Vaccine and/or Previous Infection against symptomatic
infection for Alpha, Delta and Omicron variantsReferences:
1) Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant2) Comparison of two highly-effective mRNA vaccines for COVID-19 during periods of Alphaand Delta variant prevalence3) Efficacy of inactivated SARS-CoV-2 vaccines against the Delta variant infection in
Guangzhou: A test-negative case-control real-world study4) Effectiveness of COVID-19 vaccines against variants of concern in Ontario, Canada
5) Effectiveness of BNT162b2 Vaccine against Delta Variant in Adolescents
6) A RCT of a third dose CoronaVac or BNT162b2 vaccine in adults with two doses ofCoronaVac
7) Effectiveness of BNT162b2 Vaccine against Delta Variant in Adolescents
8) Effectiveness of BNT162b2 Vaccine against Omicron Variant in South Africa
9) Effectiveness of mRNA-1273 against SARS-CoV-2 omicron and delta variants10) Covid-19 Vaccine Effectiveness against the Omicron (B.1.1.529) Variant11) Effect of mRNA Vaccine Boosters against SARS-CoV-2 Omicron Infection in Qatar
12) Effects of Previous Infection and Vaccination on Symptomatic Omicron Infections
13) Protection of SARS-CoV-2 natural infection against reinfection with the BA.4 or BA.5
Omicron subvariants

3. Latest Relevant Articles•

SARS-CoV-2-specific T cells in the changing landscape of the COVID-19 pandemic.
(Published August 17, 2022)

•Protection against symptomatic disease with the delta and omicron BA.1/BA.2
variants of SARS-CoV-2 after infection and vaccination in adolescents: national
observational test-negative case control study, August 2021 to March 2022,
England(Published August 22, 2022)

 Symptom presentation among SARS-CoV-2 positive cases and the impact of COVID-

19 vaccination; three prospective household cohorts(Published August 22,
2022)

4. Other Information
 Pfizer and BioNTech Submit Application to U.S. FDA for Emergency Use
Authorization of Omicron BA.4/BA.5-Adapted Bivalent COVID-19 Vaccine(Published 22 August 2022)•

CDC: Safety Monitoring of Pfizer-BioNTech COVID-19 Vaccine Booster Doses
Among Children Aged 5–11 Years — United States, May 17–July 31(Published19 August 2022)•

UK: What your NHS COVID Pass letter for travel tells you (Last updated
23 August 2022)

Member States Testing and Quarantine Protocols
Member States

Pre departure test

(Updated on 30 August, 2022)
Test on Arrival

Quarantine

Sourcehttps://af.usembassy.gov/covid-19information/

Afghanistan

No testingNo testing

No quarantine

Albania

No testingNo testing

No quarantine

https://www.gov.uk/foreigntraveladvice/albania/entry-requirements

Algeria

non-vaccinated travelers or
vaccinations older than 9 months
are required PCR test (72 hours
prior to departure)

No testing

No quarantine

https://dz.usembassy.gov/covid-19information/

No testingNo testing

No quarantine

RT-PCR test(72 hours prior to
departure)

No testing

No quarantine

Antigua andBarbudaPartially/Unvaccinated travelers
are required PCR test( 3 days
prior to departure)or Rapid
Antigen Test (24 hours prior to
departure)

Partially/Unvaccinatedpassengers are required
an RT-PCR test on arrival
Quarantine for ten (10)at their own expense.
days in their own homes if
Fully vaccinatedpartially vaccinatedpassengers may berequired to submit to an
RT-PCR test

https://visitantiguabarbuda.com/traveladvisory/

Argentina

No testingNo testing

No quarantine

https://www.argentina.gob.ar/interior/migrac
iones/ddjj-migraciones

Armenia

No testingNo testing

No quarantine

https://www.gov.am/en/covidtravelrestrictions/

Australia

No testingNo testing

No quarantine

https://www.health.gov.au/healthalerts/covid19/international-travel/inboundAustria

No testingNo testing

No quarantine

https://www.austria.info/en/serviceandfacts/coronavirusinformation/entryregulations

Azerbaijan

No testingNo testing

No quarantine

https://az.usembassy.gov/covid19information-for-azerbaijan/

BahamasPartially/unvaccinated travelers
are required - either a RT-PCR ora Rapid Antigen Test( 3 days prior No testing
to departure)

No quarantine

https://travel.gov.bs/

AndorraAngolahttps://visitandorra.com/en/covid-19inandorra/faq-if-you-re-spending-a-fewdaysin-andorra/
https://ao.usembassy.gov/covid19information/

https://healthalert.gov.bh/en/article/entryproceduresthrough-kingdom-of-bahrain

BahrainNo testingNo testing

Bangladesh

Partially/Unvaccinated travelers
are required RT PCR(72 hours
prior to departure)

Travelers showing
symptoms of COVID-19
No quarantine
on arrival must take a
RTPCR/Antigen test.

http://caab.gov.bd/circul/AT-Circular-FSR032022%20(02June22).pdf

Barbados

No testingNo testing

No quarantine

https://www.visitbarbados.org/covid-19travelguidelines-2022

Belarus

No testingNo testing

No quarantine

https://gpk.gov.by/covid-19/

Belgium

No testingNo testing

No quarantine

https://www.info-coronavirus.be/en/travels/

BelizeNo testingNo testing

No quarantine

https://belizetourismboard.org/newsandgallery/belize-covid-19-travel-updates/

Benin

No testingNo testing

No quarantine

https://bj.usembassy.gov/info-covid19/

Travelers are required
to take a COVID-19
RTPCR test on arrival

24 hours or until theyreceive their negative
COVID-19 RT-PCR
result.

https://www.drukair.com.bt/TravelInformation/COVID-19-travel-requirements

Partially/Unvaccinated travelers
are required COVID-19 RT-PCR
Boliviatest (72 hours prior to
No testing(Plurinational State
departure), or COVID-19 nasalof)antigen test (48 hours prior to
departure).

No quarantine

https://www.minsalud.gob.bo/es/

Bosnia andHerzegovina

No quarantine

https://granpol.gov.ba/Content/Read/74?titl
e=COVID-19

No quarantine

https://covid19portal.gov.bw/node/1017

No quarantine

https://www.in.gov.br/en/web/dou//portariainterministerial-n-670-de-1-de-abril-de2022390351794

BhutanBotswana

BrazilNo testingNo testingNo testing

Partially/Unvaccinated travelers
are required COVID-19 RT-PCR
No testing
test (72 hours prior to
departure)
Partially/Unvaccinated travelers
are required COVID-19RT-PCR No testing
test (24 hours prior to departure)

No quarantine

Brunei Darussalam No testing

Unvaccinated travelers

3 days for Unvaccinatedtravelers until receipt ofhttps://www.bruneitourism.com/covid19travellersnegative result for RTadvisory/
PCR test taken on Day 3.

Bulgaria

No testing

No quarantine

No testing

https://coronavirus.bg/bg/azsum/zavrashtam-sebulgaria

Burkina Faso

PCR and RDT tests for
Partially/Unvaccinated travelers travelers without aare required COVID-19 PCR or negative pre-departure
rapid diagnostic test(5 days prior test result or withto departure).
symptoms of COVID-19

BurundiNo testing

Cabo Verde

Partially/Unvaccinated travelers
are required PCR test (72 hours
prior to departure ) or an antigen No testing
test (48 hours prior to departure)

Cambodia

No testing

Cameroon

COVID-19 PCR test (72 hours
prior to departure)

72 hours for positivecases
https://www.sante.gov.bf/covid19
of COVID-19 RDT test on
arrival1.

CanadaCentral African
Republic
Chad
Chile
China

Colombia

PCR test

24 hours while awaiting
the results of the PCR
test

https://www.gov.uk/foreign-traveladvice/burundi/entryrequirements

No quarantine

https://www.gov.uk/foreign-traveladvice/capeverde/entry-requirements

No testing

No quarantine

https://www.embassyofcambodiadc.org/em bassyupdates/pr-no-098-easing-of-entryrequirements-march17-2022

Rapid flow testing

while awaiting the results https://cm.usembassy.gov/covid-19information/of the on arrival test

2 molecular tests( next
https://travel.gc.ca/travel-covid/travelrestrictions/flyingcalendar day and day8
canada-checklist/covid14 days for not qualify as
Not qualified as fully vaccinated after arriving into
19-testing-travellers-coming-intofully vaccinated.10 days
travelers are required molecular Canada)for . Fully
canada?utm_campaign=gac-amc-covidfor travelers with atests (72 hours prior to
2021&utm_source=travelvaccinated travelers
positive COVID-19 test
covid_travelrestrictions_flying_&utm_medium=redirect&
departure)
may be randomly
result on arrival.
utm_content=enselected for on arrival
testing
PCR test(72 hours prior tohttps://cf.usembassy.gov/covid-19information/
No testing
14 daysdeparture)
Unvaccinated and partially
https://www.gov.uk/foreign-traveladvice/chad/entryvaccinated are required PCR
No testing
No quarantine
requirements
test (96 hours prior to departure)
Test between the first 7 days if refusing arrival
PCR(24 hours prior tohttps://www.chile.travel/planviajarachile/and fifth day of arrival. test or positive result
departure)
5 molecular
http://us.china2 nucleic acid test (48 hours
tests(day1,
embassy.gov.cn/chn/lsfw/sjc/202205/t2022
7 days0518_10688101.htm
and 24 hours prior to departure). 2,3,5 and 7 after
arriving)
Unvaccinated and partially
vaccinated are required PCR
test( 72 hours prior to departure) No testing
No quarantine
https://coronaviruscolombia.gov.co/Covid1 9/index.html
or antigen test (48 hours prior to
departure)

Cook Islands

Unvaccinated and partially
vaccinated are required PCR
No testing
test( 72 hours prior to departure)
PCR test( 72 hours prior to
PCR test
departure)
No testingNo testing

while awaiting the resultsof the on arrival test
https://voyage-congo.com/en/
No quarantine
https://cookislands.travel/entry

Costa Rica

No testing

No quarantine

Côte d'Ivoire

PCR test( 2 days prior to departure)

Croatia

No testingNo testing

Cuba

No testing

Randomly RT-PCR test Arrival
Test
at airport
travelers

CyprusNo testingNo testing

Comoros
Congo

Czechia

No testing

No quarantine

https://www.visitcostarica.com/en/costarica/planningyour-trip/entry-requirements
https://deplacement-aerien.gouv.ci/#/home
https://hr.usembassy.gov/covid-19information/

No quarantine

No quarantine

No testingNo testing

No quarantine

NA

NA

NA

Unvaccinated and partially
vaccinated are required (48hours prior to departure)

No testing

No quarantine

Denmark

No testingNo testing

No quarantine

Djibouti

PCR test(72 hours prior to
departure)at airport

ArrivaltravelDominica

Unvaccinated travellers are
required PCR Test result from anasopharyngeal swab (within 72
Travelers with COVIDhours prior to arrival) or Rapid
19 symptoms
Antigen Test result from anasopharyngeal swab (within 48
hours prior to arrival)

Democratic
People's Republic
Democratic
Republic of theCongo

https://www.gov.uk/foreign-traveladvice/comoros/entryrequirements

Testing

No quarantine

positive

https://www.mintur.gob.cu/protocolos/
https://www.pio.gov.cy/coronavirus/uploads/27052022_airportsportsactionplanabolishe
d_EN.pdf
https://www.mvcr.cz/mvcren/article/as-ofdecember27th-2021-the-rules-for-entryinto-the-czech-republicwill-be-tightenedfor-foreign-nationals.aspx

https://www.gov.uk/foreign-traveladvice/democraticrepublic-of-thecongo/entry-requirements
https://en.coronasmitte.dk/travelrules/covidtravelrules
https://www.gov.uk/foreign-travelpositiveeadvice/djibouti/entry-requirements#entryrules-inresponse-to-coronavirus-covid-19

https://discoverdominica.com/en/traveladvisory-fordominica

Dominican
Republic

No testingNo testing

No quarantine

https://www.godominicanrepublic.com/new
sroom/coronavirus/

Egypt

Unvaccinated and partially
Rapid antigen testing
vaccinated are required RT-PCR for who presents signs 7 days if testing positive on https://www.aeropuertoquito.aero/es/protoc r
olo-covid-19.html
test(72 hours prior to departure) or symptoms of COVID- a19
https://www.visa-egypt.com/articles/travelrestrictions
No testingNo testing
No quarantine

El Salvador

No testing

Equatorial Guinea

PCR or antigen test ( 48 hours
prior to departure)

EcuadorNo testingNo testing

No quarantine

https://www.dfa.ie/travel/travel-advice/a-zlist-ofcountries/el-salvador/

3 dayshttps://www.guineaecuatorialpress.com/noti
cias/decreto_por_el_que_se_modifica_el_decreto_129_sobre_las_medidas_de_contro
l_de_la_covid_19

Eritrea

PCR test (72 hours prior to
departure)

Rapid antigen test

Estonia

No testingNo testing

https://er.usembassy.gov/covid19information/#:~:text=passengers%20must
14 days if testing positive %20take%20a%20rapid%20Antigen%20teaonst%20upon%20arrival%20and%20show%20proof%20of%20a%20negative%20PCR%
20testhttps://kriis.ee/en/travelling-crossingNo quarantine
stateborder/travelling-estonia

Eswatini

Unvaccinated are required
RTPCR test(72 hours prior to
departure)

No testing

No quarantine

Ethiopia

Unvaccinated are required
RTPCR test(72 hours prior to
departure) or rapid lateral flow
test
( 24 hours prior to departure)

No testing

No quarantine

Fiji

No testing

Rapid Antigen Test
(within 72 hours
arrival )Finland

No testingNo testingFranceNo testingNo testingof No quarantine
No quarantine

No quarantine

https://www.thekingdomofeswatini.com/trav eladvice/https://www.gov.uk/foreigntraveladvice/ethiopia/entry-requirements

https://www.fiji.travel/articles/frequentlyaskedquestions-travelling-to-fiji
https://www.visitfinland.com/en/practicaltips/covid19/
https://www.diplomatie.gouv.fr/en/comingtofrance/coming-to-france-your-covid-19questionsanswered/article/coming-tofrance-your-covid-19questionsanswered?var_mode=calcul

https://ga.usembassy.gov/u-scitizenservices/coronavirus-update/Gabon

No testingNo testing

GambiaUnvaccinated are required
RTPCR test(72 hours prior to
departure)

Rapid Diagnostic Test
for who presents signs or If testing positive on arrival https://gm.usembassy.gov/covid-19information/
symptoms of COVID-19

Georgia

No testingNo testing

Germany

No testingNo testing

No quarantine

No quarantine

No quarantine

https://georgia.travel/en_US/article/covidtravelalert
https://www.bmi.bund.de/SharedDocs/faqs/
EN/topics/civilprotection/coronavirus/coronavirusfaqs.html

GreeceUnvaccinated are required PCR
Antigen test fortest (48 hours prior tounvaccinateddeparture)
No testingNo testing

GrenadaNo testingNo testing

No quarantine

GuatemalaUnvaccinated are required PCRor
No testing
antigen test (3 days prior to
departure)

No quarantine

https://gt.usembassy.gov/alert-covid-19-2/

GuineaNo testing

No quarantine

https://www.gov.uk/foreigntraveladvice/guinea/entry-requirements#entryrulesin-response-to-coronavirus-covid-19

Guinea-Bissau

Travlers display any
PCR test(within 48 hours prior tosymptoms for COVIDdeparture)
19 on arrival

14 days If someone on
your
https://www.gov.uk/foreign-traveladvice/guineaflight is thought to havebissau/entry-requirements
COVID-19,

GuyanaNot fully vaccinated or
Unvaccinated are required PCR
No testing
test or antigen test (within 72
hours prior to departure)

No quarantine

https://www.health.gov.gy/

No quarantine

https://www.mspp.gouv.ht/

Ghana

Haiti
Honduras

No testing

Unvaccinatedare required
antigen or PCR test(72 hours No testingprior to departure)
Unvaccinatedare required
PCR, Antigen or ELISA test (72 No testing
hours prior to departure)

7 days if testing positive on https://gh.usembassy.gov/ghana-covidarrival
19information/
No quarantine

No quarantine

https://travel.gov.gr/#/
https://bb.usembassy.gov/covidinformation-grenada/

https://hn.usembassy.gov/covid-19information/

No testingNo testing

No quarantine

https://www.police.hu/en/content/for-theattention-oftravelers

No testingNo testing

No quarantine

https://island.is/en/p/entry

India

Not fully vaccinated or
Unvaccinated are required PCR Random testing
test(72 hours prior to departure)

No quarantine

GuidelinesforInternationalarrivalsupdatedo
n10thFebruary2022.pdf (mohfw.gov.in)Indonesia

No testing

No quarantine

https://covid19.go.id/artikel/2022/07/08/sur atedaran-kasatgas-nomor-22-tahun-2022

Iran (Islamic
Republic of)

PCR test(72 hours prior toat airport
departure)
Unvaccinated are required PCR
No testing
test(72 hours prior to departure)

Hungary
Iceland

Iraq

IrelandIsraelNo testing

14 days if testing positive https://www.gov.uk/foreign-traveladvice/iran/entryon arrival
requirements
https://iq.usembassy.gov/covid-19information/
No quarantine

No quarantine

https://www.gov.ie/en/publication/77952governmentadvice-on-internationaltravel/#passengers-arrivinginto-irelandfrom-outside-eueea-eu-icelandlichtensteinand-norway

No testingNo testingNo testing

PCR testing for who
feels sick within 10 days No quarantineof arriving

https://corona.health.gov.il/en/abroad/arrivi ngforeign-nationals/

Italy

No testingNo testing

No quarantine

https://www.esteri.it/en/ministero/normativa
online/focus-cittadini-italiani-in-rientro-dallestero-ecittadini-stranieri-in-italia/

Jamaica

No testingNo testing

No quarantine

https://www.gov.uk/foreigntraveladvice/jamaica/entry-requirements

Japan

RT-PCR, LAMP, TMA, TRC,
Smart Amp, NEAR, Nextgeneration sequence, or CLEIA No testing
test(72 hours prior to departure)

No quarantine

https://www.mhlw.go.jp/stf/covid19/border_test.html

JordanNo testingNo testing

No quarantine

http://international.visitjordan.com/MediaCe
nter/ShowNews/33#news

Kazakhstan

No testingNo testing

No quarantine

Kenya

Unvaccinated are required PCR
No testing
test(72 hours prior to departure)

No quarantine

https://kz.usembassy.gov/covid-19information/
https://www.kcaa.or.ke/sites/default/files/co vid19/documents/COVID19_TRAVEL_REQUIREMENTS_13.3.2022.pdf

Kiribati

No testing for fully vaccinatedTesting within three days
No quarantineof arrival.

KuwaitNo testingNo testing

No quarantine

Kyrgyzstan

No testingNo testing for fully
vaccinatedNo quarantine

Lao People's
Democratic
Republic

No testing for fully vaccinatedNo testing

No quarantine

LatviaNo testingNo testing

No quarantine

LebanonLesotho

Unvaccinatedare required
PCR test(48 hours prior to
No testing
departure) or Rapid Antigen
Test(24 hours
prior todeparture)
Partially vaccinated or
Unvaccinated are required PCR No testing
test(72 hours prior to departure)https://mhms.gov.ki/
https://kw.usembassy.gov/covid-19information/
https://kg.usembassy.gov/covid-19information/
http://www.mofa.gov.la/index.php/statemen
ts/notices/3587-travel-advisory-for-entryand-exit-oflao-pdr-during-thehttps://www.spkc.gov.lv/lv/valstusaslimstibasraditaji-ar-covid-19-0

No quarantine

https://www.moph.gov.lb/en/MoPHPASSNo quarantine

https://www.gov.uk/foreigntraveladvice/lesotho/entry-requirements
https://www.nphil.gov.lr/index.php/liberiahealthministry-introduces-new-covid-19protocols-fortravelers/

Liberia

No testing

Libya

PCR test(48 hours prior to
departure)

Antigen test for who withsymptoms

No quarantine

https://ly.usembassy.gov/u-scitizenservices/covid-19-information/

Lithuania

No testingNo testing

No quarantine

https://nvsc.lrv.lt/en/information-oncovid19/for-arrivals-from-abroad

Luxembourg

No testingNo testing

No quarantine

https://covid19.public.lu/en/travellers/visitin
g-luxembourg.html

Madagascar

Rt-PCR test (72 hoursprior to
departure)

Rapid antigen test

No quarantine

https://madagascartourisme.com/Frfr/border-reopening/

No quarantine

https://www.malawitourism.com/traveladvice/

No quarantine

https://www.malaysia.travel/travel-alert

No quarantine

https://immigration.gov.mv/faq-forvisitingthe-maldives/

14 days if testing positiveon arrival

https://www.gov.uk/foreigntraveladvice/mali/entry-requirements

No testing

Malaysia

Partially vaccinated or
Unvaccinated are required PCR No testing
test(72 hours prior to departure)
No testingNo testing

Maldives

No testing

MalawiMali

No testing

Partially vaccinated or
Travelers who are
Unvaccinated are required PCR suspected of having
test(72 hours prior to departure) COVID-19

No quarantine

MaltaMarshall Islands

No testingNo testing

https://deputyprimeminister.gov.mt/en/healt
h-promotion/covid-19/Pages/travel.aspx

No quarantine

NA (total suspension of international travelers coming into the RMI via air travel until 31
August 2022)
Partially vaccinated or
Unvaccinated are required PCR
No testing
test (three days prior to departure)https://ndmo.gov.mh/rmi-covid19information/

No quarantine

https://mr.usembassy.gov/covid19information-2/

No quarantine

https://mauritiusnow.com/mauritiustraveladvice/

No testing

No quarantine

https://embamex.sre.gob.mx/eua/index.php/en/2016-04-09-20-4051/tourism/1760mexico-s-covid-19monitoring-system

Micronesia
Fully vaccinated with PCR test (72No testing(Federated States of) hours prior to departure)

No quarantine

Partially vaccinated or
Unvaccinated are requiredPCR or
No testing
antigen test (24 hours prior to
departure)

No quarantine

https://covid19.mc/en/travel/i-comefromabroad/

No quarantine

https://www.gov.uk/foreigntraveladvice/mongolia/entryrequirements#entryrules-in-response-tocoronavirus-covid-19

Mauritania

Mauritius
MexicoMonacoNo testingNo testingNo testing

https://gov.fm/index.php/fsmpio

Mongolia

No testingMontenegro

No testingNo testing

No quarantine

MoroccoPartially vaccinated or
Unvaccinated are required PCR No testing
test(72 hours prior to departure)

No quarantine

Mozambique

No testingNo testing

No quarantine

Myanmar

Fully vaccinated with COVID-19
RDT antigen test (48 hours
prior to departure)

5 days if unable to showeither a vaccination
Antigen Rapid Diagnostic certificate or negative
Test
COVID-19 RDT antigen
test result

No testing

https://me.usembassy.gov/covid-19information/
https://www.onda.ma/Je-suisPassager/Guide-duvoyageur/Newsa%C3%A9roportuaires-COVID19
https://mz.usembassy.gov/covid-19information/

https://tourism.gov.mm/covid-19/

Partially vaccinated or
Unvaccinated are required PCR random RT-PCR testing No quarantine
test(72 hours prior to departure) on arrival
PCR test(72 hours prior to
Rapid Antigen Test on
13 days if testing positive
departure)arrival at the airport
on arrival
Partially vaccinated or
Unvaccinated are required
Travelers with COVID-19
RTPCR, True NAAT, Gene Xpert symptoms andNo quarantine
Test(72 hours prior tounvaccinated travelers
departure)

Namibia
Nauru

Nepal

https://op.gov.na/
https://www.nauruair.com/travel-info/covid19update
https://www.immigration.gov.np/post/notice5
https://www.government.nl/topics/coronavir uscovid-19/visiting-the-netherlandsfromabroad/checklist-entry

Netherlands

No testingNo testing

No quarantine

New Zealand

No testing

2 rapid antigen tests(RATs) after arriving

7 days if testing positive on https://covid19.govt.nz/internationaltravel/travelarrival
to-new-zealand-by-air/NicaraguaPartially vaccinated or
Unvaccinated are required PCR No testing
test(72 hours prior to departure)

Niger

Partially vaccinated or
antigen test for
Unvaccinated are required PCR
unvaccinatedtest(72 hours prior to departure)

Nigeria

Unvaccinated and partially
vaccinated are required PCR
test( 48hrs prior to departure)

North Macedonia

No testing

No quarantine

https://www.intur.gob.ni/2020/09/21/nicarag uareanuda-vuelos-comerciales/

7 days (Exemption for
Fully
vaccinatedor
testing negative)

https://www.gouv.ne/index.php/lescommuniquesdu-gouvernement/296-auconseil-des-ministresle-gouvernementreitere-son-engagement-aremplacer-lessalles-de-classe-en-paillote-pardes-sallesde-classe-en-materiaux-definitifs

Days 2 and 7 post-arrival
PCR tests fornvaccinated and partially No quarantine
vaccinatedhttps://covid19.ncdc.gov.ng/advisory/

No testing

https://koronavirus.gov.mk/en/seek-helporreport-irregularities/application-forpeoplereturning-from-travels

NorwayNo testingNo testing

No quarantine

Oman

No testingNo testing

No quarantine

Pakistan

Partially vaccinated or
Unvaccinatedare No testing
required PCR test(72No quarantine

No quarantine

https://www.udi.no/en/corona/about-thecorona-situation/
https://www.omanairports.co.om/news/upd ate-on-travel-restrictions-related-to-covid19/

https://storage.covid.gov.pk/uploads/policie s/Revised%20Inbound%20Policy.pdf

hoursdeparture)

Palau

PanamaPapua New
GuineaParaguay

Peru

Philippines

prior

to

No testing (Mandatory
proof of vaccination for No testing
entry)
Partially vaccinated or Rapid test at
Unvaccinated are
the airport if arequired PCR or
test is not
antigen test(72 hours possible withinprior to departure)that time frame
No testing (Mandatory
proof of vaccination for No testing
entry)
Partially vaccinated or
Unvaccinated are
required RTPCR /No testing
LAMP / NAAT test(72hours
prior to departure)
Partially vaccinatedor Unvaccinated are
required molecular No testing
test test(48 hours
prior to departure)
Vaccinated travelers
without a booster
shot,Partially
vaccinated,orNo testing
UnvaccinatedarerequiredRTPCR
orantigen test(48 hours
prior to departure)

No quarantine

5 days if testing
positive on
arrivalNo quarantine

https://www.palaugov.pw/wpcontent/uploads/2022/07/MHHS-DirectiveNo.-100-22-COVID-19-IsolationQuarantine-Entry-Requirements.pdf

https://www.tourismpanama.com/plan-yourvacation/advisories/
https://www.papuanewguinea.travel/traveladvice-update
https://www.migraciones.gov.py/index.php/t ramites/ingreso-y-salidadelpais/exigencias-sanitarias-vigentes-porcovid-19-para-el-ingreso-al-paraguay

No quarantine

No quarantine

https://busquedas.elperuano.pe/normasleg ales/decreto-supremo-que-modificaeldecreto-supremo-n-184-2020-decretosupremo-no-151-2021-pcm-1988484-1/

exempted forhttps://philippines.travel/safetrip
Fully VaccinatedPolandNo testingNo testing

No quarantine

Portugal

No testingNo testing

No quarantine

Qatar

PCR test (48 hours
prior to departure)

Rapid antigen Exempted fortest for who
Fully
does not have a Vaccinated /pretravel
Recoveredhttps://www.gov.pl/web/koronawirus/inform acje-dla-podrozujacych
https://www.visitportugal.com/en/node/446 781

https://covid19.moph.gov.qa/EN/travel-andreturn-policy/Pages/default.aspx#visitors

PCR(within 24
hours after
arrival )Republic of
Korea

Republic
Moldova

PCR test ( 48 hours
prior to departure)of

PCR test (within
1 day after
No quarantine
arrival)

http://ncov.mohw.go.kr/en/infoBoardList.do ?brdId=14&brdGubun=141&dataGubun=&n
cvContSeq=&contSeq=&board_id=

No testingNo testing

No quarantine

Romania

No testingNo testing

No quarantine

RussianFederation
RwandaPCR test ( 48 hours prior
to departure)
No testingNo testingNo testing

https://www.border.gov.md/index.php/traver sarea-frontierei-perioadapandemica
https://romaniatourism.com/traveladvisory.html

No quarantine

https://washington.mid.ru/en/

No quarantine

https://www.rbc.gov.rw/index.php?id=745

RT-PCR test for until receipt ofhttps://www.stkittstourism.kn/travelrequirements
Unvaccinatednegative RTPCR
Saint Kitts and RT-PCR, NAAT(3 days travelers between test results.
Nevis
prior todeparture) or the ages ofRapid Antigen (1 day prior 1217( within 24
to departure)
hours of arrival)
PCR test ( 5 days prior toSaint Lucia
No testing
No quarantine
departure)https://www.stlucia.org/en/covid-19/
Partially vaccinated or
May be tested for 5 days for Partially http://health.gov.vc/health/index.php/covid19-protocols-documents
Unvaccinatedare Partially
vaccinated orSaint Vincent required Rapid Antigen vaccinated or
Unvaccinatedand thetest(24 hours prior to UnvaccinatedGrenadines
departure) or RT-PCR
(72
hours
prior
to
departure)
Samoa
NAAT(
RT- Rapid antigen
7 days if testing
https://www.health.gov.ws/wpPCR,NEAR,TMA,LAMP
test within thepositive on arrival content/uploads/2022/08/Special-TravelAdvice-for-Travelersor SDA) ( 48-hours prior to first 3 days ofEnteringSamoa_August-2022.pdf
departure) or Rapid antigen arrival
test (24 hours prior todepature)
PCR or antigen test(48https://www.esteri.sm/pub2/EsteriSM/en/Co vid/Covid.html
San Marino
No testing
No quarantine
hours prior to depature)

Partially vaccinated or
Unvaccinatedare
Sao Tome andrequired
AntigenPrincipetest(48 hours prior todepature)

No testing

Saudi Arabia

No testingNo testing

No quarantine

SenegalUnvaccinated PCR or RTPCR test (72 hours prior to No testing
depature)

No quarantine

SerbiaNo testing

No quarantine

Seychelles

Sierra Leone

Singapore
Slovakia
Slovenia

No testing

No quarantine

https://portaldascomunidades.mne.gov.pt/pt/vai-viajar/conselhos-aosviajantes/africa/sao-tome-e-principe
https://www.moi.gov.sa/wps/portal/Home/H ome/dphome/!ut/p/z1/rVK5csIwEO35Cqeg9GiRbCFKDYVtrgwQLjUe4QMriWUOD07PjKkSArwZMgWO7urfXvpIdGyrNZF0NqYx
https://sn.usembassy.gov/covid-19information/
https://www.mfa.gov.rs/en/citizens/travelserbia/covid-19-entry-requirements

Partially vaccinated or
Testing for who
Unvaccinated are required presents
signs or symptoms ofPCR (No quarantine
72 hours prior to departure) COVID-19
or Rapid antigen test (24hours prior to depature)
PCR test ( 72 hours prior to Rapid diagnostic test while waiting for the
departure)
and a PCR test
results of arrival PCR(diagnostic
test and if testingtest) at airport
positive on arrival
PCR test and Antigen
Antigen Rapid Test
Rapid Test( 2 days prior to or PCR Test for who
departure)presents signs
orsymptoms of
7 days for non-fully
COVID-19 on arrival vaccinated.

http://tourism.gov.sc/wpcontent/uploads/2022/03/SeychellesVisitorTravel-Advisory-15-March-20221.pdf

https://travel.gov.sl/faq

https://safetravel.ica.gov.sg/arriving/general -travel/fully-vaccinatedNo testingNo testing

No quarantine

https://www.mzv.sk/web/en/covid-19

No testingNo testing

No quarantine

https://www.gov.si/en/topics/coronavirusdisease-covid-19/bordercrossing/

7 days for who test
PCR or rapid antigen
PCR test ( 72 hours prior topositive on the day-3
Solomon Islands
test on the third day
departure)
COVID-19 PCR or
after arrival
rapid antigen test

https://www.flysolomons.com/library/conten t/Planpage/solomonislands-traveladvisory-24-200722.pdf

Somalia

Partially vaccinated or
Unvaccinated PCR ( 72hours prior to departure)

Antigen Rapid Test
for who are not fully
vaccinated and do
not have predeparture testing
proof on arrival

South Africa

No testingNo testing

14 days if arrival test
positive.

https://www.gov.uk/foreign-traveladvice/somalia/entryrequirements

No quarantine

https://www.gov.za/covid-19/individualsand-households/travelcoronavirus-covid19

Spain

Ag-RDT Test for who
Partially vaccinated or
Unvaccinated are required presents signs or
symptoms of COVID- If arrival test positive.
PCR (72 hours prior to departure) 19 on arrival
https://ss.usembassy.gov/covid-19information/
https://www.sanidad.gob.es/en/profesional
es/saludPublica/ccayes/alertasActual/nCov /spth.htm
No testingNo testing
No quarantine

Sri Lanka

No testingNo testing

No quarantine

Sudan

Partially vaccinated or
Unvaccinated are required
No testing
PCR ( 72 hours prior to
departure)

No quarantine

South Sudan

Suriname

Swedennon-vaccinated are required PCR
test (48 hours prior to departure)or antigen test( 24 hours prior to No testing
departure)

No testingNo testing

https://srilanka.travel/helloagain/

https://sd.usembassy.gov/covid-19information/

No quarantine

No quarantine

Switzerland

No testingNo testing

No quarantine

Syrian Arab
Republic

Partially vaccinated or
Unvaccinated are required PCR( 72 hours prior to departure)

No testing

No quarantine

https://www.flyslm.com/wpcontent/uploads/2022/04/SUR-COVID19Measures-13-April-2022.pdf
https://www.folkhalsomyndigheten.se/thepublichealth-agency-ofsweden/communicablediseasecontrol/covid-19/recommendationsforthose-travelling/https://www.bag.admin.ch/bag/en/home/kra
nkheiten/ausbruecheepidemienpandemien/aktuelleausbruecheepidemien/novelcov/empfehlungen-fuerreisende/quarantaeneeinreisende.html#924144951
https://www.gov.uk/foreigntraveladvice/syria/entry-requirements

Tajikistan

Partially vaccinated or
Unvaccinated are required PCR Random PCR test on
test ( 72 hours prior to departure) arrival.

ThailandPartially vaccinated or
Unvaccinated are required
RTPCR or professional ATK test
( 72
hours prior to departure)

No testing

No quarantine

https://www.tatnews.org/

Timor-Leste

No testingNo testing

10 days for non-fullvaccinatedhttps://www.gov.uk/foreign-traveladvice/timorleste/entry-requirements

Togo

Partially vaccinated or
Unvaccinated are required PCR
test (5 days prior to departure)

No testing

No quarantine

Tonga

Rapid Antigen Test (24 hours
prior to departure)

No testing

5 days from the date of
testing positive.

https://voyage.gouv.tg/?language=en
https://www.gov.to/press-release/openborderpolicy-framework-for-tonga/

No testingNo testing

No quarantine

https://health.gov.tt/preparation-for-entry

TrinidadTobagoand

if arrival test positive.

https://www.gov.uk/foreigntraveladvice/tajikistan/entry-requirements

Tunisia

Partially vaccinated or
Unvaccinated are required PCR
test (48 hours prior to departure) Random rapid lateralor rapid lateral flow test (24 hours flow or PCR test.
prior to departure)

5 days or more from thedate of testing positive.

TürkiyeNo testing

No quarantine

Turkmenistan

TuvaluUgandaUkraineUnited ArabEmirates

No testing

https://www.gov.uk/foreigntraveladvice/tunisia/entry-requirements

https://www.tga.gov.tr/fight-against-covid19-inturkey/

Partially vaccinated are
required PCR test and a
PCR test
7 dayshttps://usa.tmembassy.gov.tm/en
serology antibodies (IgM,
IgG) test(48 hours prior to
departure)
NA(Scheduled commercial flights to and from Tuvalu have been https://fj.usembassy.gov/u-s-citizenservices/covid-19information/suspended since mid-2020)
Partially vaccinated or
https://www.gov.uk/foreign-traveladvice/uganda/entryUnvaccinated are required
requirements#entryrules-in-response-to-coronavirus-covid-19
No testing
No quarantine
PCR test ( 72 hours prior to
departure)
NA
NA
NA
https://visitukraine.today/
unvaccinated are required
PCR test (48 hours prior to
departure)

No testing

No quarantine

https://covid19.ncema.gov.ae/en/News/Det ails/2316

United Kingdom

No testing

United Republicof Tanzania

Rapid test for not
If arrival test positive.
fully vaccinated andUnvaccinated or not fully
are arriving from or
vaccinated are required RT- having traveled
PCR test or Nucleic Acidthrough countries
Amplification Test (72 hours with variants ofprior to departure)
concern or with highnumbers of COVID19 cases

United States

No testingNo testing

No quarantine

https://www.gov.uk/government/news/allcovid-19-travelrestrictions-removed-in-theukhttps://tz.usembassy.gov/covid-19information/

No quarantine

https://www.cdc.gov/coronavirus/2019ncov/travelers/noncitizensUS-airtravel.html

Uruguay

Unvaccinated are required
PCRRT or antigen test (72 No testing
hours prior to departure)

No quarantine

https://www.gub.uy/ministeriosaludpublica/comunicacion/publicaciones/requisi tos-paraingreso-uruguay-personasnacionales-extranjeras

Uzbekistan

No testing

No quarantine

Vanuatu
Venezuela(Bolivarian
Republic of)

No testingNo testing

PCR test (72 hours prior to
No testing
departure)
Unvaccinated are required
PCRRT or antigen test (72 No testing
hours prior to departure)

No quarantine

https://covid19.gov.vu/

No quarantine

https://ve.usembassy.gov/covid-19information/

https://en.baochinhphu.vn/viet-nam-toscrap-covid-19-testrequirements-forvaccinated-entrants-from-midmay11122051320312898.htm

Viet Nam

No testingNo testing

No quarantine

Yemen

NA

NA

NA

ZambiaUnvaccinated are
required PCR (72hours prior to
departure)https://uz.usembassy.gov/covid-19information/

Antigen Rapid
Test for who
presents signs
until test result is https://www.zambiaimmigration.gov.zm/wpcontent/uploads/2022/03/Revised_Travel_
orGuidelines_Zambia.pdf
negative.
symptoms
of
COVID-19onarrivalZimbabwe

Unvaccinated are
required PCR (48hours prior to
departure)

PCR test taken
within 72 hours
is required for
who has no
proof ofvaccination orvalid PCR test
result on arrival

No quarantine

https://zimbabwetourism.net/covid19guidelines-for-travellers/

COVID-19 Weekly Epidemiological Update
Edition 107 published 31 August 2022
In this edition:• Global overview• Special Focus: Update on SARS-CoV-2 variants of interest and variants of concern• WHO regional overviews• Summary of Monthly Operational Update

Global overview
Data as of 28 August 2022
Globally, the number of new weekly cases decreased by 16% during the week of 22 to 28 August 2022, ascompared to the previous week, with over 4.5 million new cases reported (Figure 1, Table 1). The number of
new weekly deaths decreased by 13%, as compared to the previous week, with over 13 500 fatalities reported.
As of 28 August 2022, over 598 million confirmed cases and over 6.4 million deaths have been reported globally.
At the regional level, the number of newly reported weekly cases decreased across all six regions: the Eastern
Mediterranean Region (-37%), the European Region (-20%), the South-East Asia Region (-16%), the Western
Pacific Region (-15%), the African Region (-13%) and the Region of the Americas (-13%). The number of new
weekly deaths decreased across four of the six regions: the African Region (-64%), the Eastern Mediterranean
Region (-35%), the European Region (-30%), and the Region of the Americas (-9%); while it increased in theSouth-East Asian Region (+15%) and remained stable in the Western Pacific Region (+3%).
Figure 1. COVID-19 cases reported weekly by WHO Region, and global deaths, as of 28 August 2022**

20 000 000
15 000 000

Cases

120 000

AmericasSouth-East Asia
EuropeEastern Mediterranean
AfricaWestern Pacific
Deaths100 000

80 00060 000

10 000 000
40 0005 000 000

Reported week commencing**See Annex 1: Data, table, and figure notes
1

22-Aug11-Jul30-May18-Apr

07-Mar

24-Jan13-Dec01-Nov

20-Sep09-Aug28-Jun17-May05-Apr

22-Feb

11-Jan30-Nov

19-Oct07-Sep27-Jul15-Jun04-May23-Mar

10-Feb30-Dec020 0000Deaths

25 000 000

At the country level, the highest numbers of new weekly cases were reported from Japan (1 258 772 new cases;-15%), the Republic of Korea (743 487 new cases; -16%), the United States of America (576 437 new cases;-10%), the Russian Federation (288 580 new cases; +23%) and Germany (206 860 new cases; -22%). The highest
numbers of new weekly deaths were reported from the United States of America (2818 new deaths; -6%), Japan(1990 new deaths; +23%), Brazil (1039 new deaths; -6%), Italy (647 new deaths; -4%) and the Republic of Korea(525 new deaths; +25%).
Current trends in reported COVID-19 cases and deaths should be interpreted with caution as several countries
have been progressively changing COVID-19 testing strategies, resulting in lower overall numbers of tests
performed and consequently lower numbers of cases detected. Additionally, data from countries arecontinuously updated by WHO to incorporate changes in reported COVID-19 cases and deaths made bycountries retrospectively.
Table 1. Newly reported and cumulative COVID-19 confirmed cases and deaths, by WHO Region, as of 28 August 2022**

WHO Region

New cases
in last 7
days (%)

Change in
new cases
in last 7
days *

New
deaths inlast 7days (%)

Change in
new deaths inlast 7 days *Western Pacific

2 390 216
(52%)

-15%

83 039 297
(14%)

3 547
(26%)

3%

258 188(4%)

Europe1 117 601
(24%)

-20%

247 381 780
(41%)

3 425
(25%)

-30%

2 074 258
(32%)

Americas907 084
(20%)

-13%

175 391 153
(29%)

5 336
(39%)

-9%

2 815 191
(44%)

South-East Asia

115 936(3%)-16%

59 962 802
(10%)

792
(6%)

15%

795 389(12%)

Eastern
Mediterranean

47 375(1%)-37%

22 960 506
(4%)

405
(3%)

-35%

347 299(5%)

Africa10 320(<1%)-13%

9 281 437
(2%)

36
(<1%)

-64%

174 281(3%)

Global

4 588 532
(100%)-16%

598 017 739(100%)

13 541(100%)-13%

6 464 619
(100%)

Cumulative
cases (%)

Cumulative
deaths (%)*Percent change in the number of newly confirmed cases/deaths in the past seven days, compared to seven days prior. Data from previous
weeks are updated continuously with adjustments received from countries.
**See Annex 1: Data, table, and figure notes

For the latest data and other updates on COVID-19, please see:• WHO COVID-19 Dashboard• WHO COVID-19 Weekly Operational Update and previous editions of the Weekly Epidemiological Update• WHO COVID-19 detailed surveillance data dashboard

2

Figure 2. COVID-19 cases per 100 000 population reported by countries, territories and areas, 22 - 28 August 2022***See Annex 1: Data, table, and figure notes3Figure 3. COVID-19 deaths per 100 000 population reported by countries, territories and areas, 22 - 28 August 2022****See Annex 1: Data, table, and figure notes
4Special Focus: Update on SARS-CoV-2 variants of interest and variants of concern
Geographic spread and prevalence of VOCs

Globally, from 29 July to 29 August 2022, 138 779 SARS-CoV-2 sequences were shared through GISAID. Amongthese, 138 236 sequences were the Omicron variant of concern (VOC), accounting for 99.6% of sequences
reported globally in the past 30 days.
A comparison of sequences submitted to GISAID in epidemiological week 33 (14 to 20 August 2022) and week
32 (7 to 13 August 2022) shows that BA.5 Omicron descendent lineages continue to be dominant globally, withan increase in weekly prevalence from 72.4% to 78.2%. The prevalence of BA.2 descendent lineages (BA.2.X)
remained stable in week 33 compared to week 32 (2.7% in both weeks). BA.2.75, an Omicron descendent lineage
under monitoring, still shows a relatively low prevalence globally, but a number of countries have observed
recent increasing trends.
WHO continues to monitor all lineages, including descendent lineages of VOCs, to track any increase inprevalence and change in viral characteristics. The current trends describing the circulation of Omicron
descendent lineages should be interpreted with due consideration of the limitations of the SARS-CoV-2
surveillance systems. These include differences in sequencing capacity and sampling strategies between
countries, changes in sampling strategies, reductions in tests conducted and sequences shared by countries
around the world and delays in uploading sequence data to GISAID.
For more information on the assessment of SARS-CoV-2 variants and the WHO classification refer to Annex 2.

Additional resources• Tracking SARS-CoV-2 Variants• COVID-19 new variants: Knowledge gaps and research• Genomic sequencing of SARS-CoV-2: a guide to implementation for maximum impact on public health• Considerations for implementing and adjusting public health and social measures in the context of COVID-19• VIEW-hub: repository for the most relevant and recent vaccine data5

WHO regional overviews:

Region of the Americas

Epidemiological week 22 - 28 August 2022**

African Region

The Region of the Americas reported over 907 000 new cases, a 13% decrease
as compared to the previous week. Five of 56 (9%) countries for which data
are available reported increases in the number of new cases of 20% or
greater, with the greatest proportional increases observed in Honduras (3948
vs 2130 new cases; +85%), Saint Barthélemy (32 vs 23 new cases; +39%) and
Ecuador (6288 vs 4644 new cases; +35%). The highest numbers of new cases
were reported from the United States of America (576 437 new cases; 174.1
new cases per 100 000; -10%), Brazil (104 672 new cases; 49.2 new cases per
100 000; -10%) and Chile (54 867 new cases; 287.0 new cases per 100 000;-13%).

The African Region reported over 10 000 new weekly cases, a 13% decrease
compared to the previous week. Six (12%) countries reported increases in thenumber of new cases of 20% or greater, with some of the greatest
proportional increases seen in Mali (55 vs 15 new cases; +267%), Chad (33 vs
14 new cases; +136%) and Niger (127 vs 55 new cases; +131%). The highest
numbers of new cases were reported from Réunion (5711 new cases; 637.9
new cases per 100 000 population; +12%), South Africa (1480 new cases; 2.5
new cases per 100 000; -5%) and Nigeria (495 new cases; <1 new case per
100 000; +26%).

The number of new weekly deaths reported in the Region decreased by 9%
as compared to the previous week, with over 5300 deaths reported. The
highest numbers of new deaths were reported from the United States ofAmerica (2818 new deaths; <1 new death per 100 000; -6%), Brazil (1039 newdeaths; <1 new death per 100 000; -6%) and Canada (292 new deaths; <1 newdeath per 100 000; similar to the previous week).
9 000 000

African Region

Cases
DeathsRegion of the Americas

6 000 000
4 000

200 000
3 000
150 000

30 0004 000 000

20 000
10 0001 000 0000030-Dec10-Feb23-Mar04-May15-Jun27-Jul
07-Sep19-Oct30-Nov
11-Jan22-Feb05-Apr17-May28-Jun09-Aug20-Sep01-Nov
13-Dec24-Jan07-Mar
18-Apr30-May11-Jul
22-Aug030-Dec10-Feb23-Mar04-May15-Jun27-Jul
07-Sep19-Oct30-Nov
11-Jan22-Feb05-Apr17-May28-Jun09-Aug20-Sep01-Nov
13-Dec24-Jan07-Mar
18-Apr30-May11-Jul
22-Aug05 000 000

2 000 000

1 000

50 00040 0003 000 000

2 000

100 000

Reported week commencing

Reported week commencing

Updates from the Region of the Americas

Updates from the African Region
660 00050 0007 000 000

5 000

250 000

Cases

8 000 000

Cases

300 000

Cases
Deaths

6 000

Deaths350 000

DeathsThe number of new weekly deaths in the Region decreased by 64% ascompared to the previous week, with 36 deaths reported. The highest
numbers of new deaths were reported from South Africa (18 new deaths; <1
new death per 100 000 population; -79%), Réunion (six new deaths; <1 newdeath per 100 000; +200%) and the Democratic Republic of the Congo (fournew deaths; <1 new death per 100 000; +33%).

Eastern Mediterranean Region

European Region

The Eastern Mediterranean Region reported over 47 000 new cases, a 37%
decrease as compared to the previous week. One (5%) country reported anincrease in the number of new cases of 20% or greater: the occupied
Palestinian territory (3355 vs 937 new cases; +258%). The highest numbers of
new cases were reported from the Islamic Republic of Iran (15 605 new cases;
18.6 new cases per 100 000; -55%), Jordan (4832 new cases; 47.4 new cases
per 100 000; -19%) and Lebanon (4469 new cases; 65.5 new cases per
100 000; -41%).

The European Region reported over 1.1 million new cases, a 20% decrease ascompared to the previous week. Two (3%) countries in the Region reported
increases in new cases of 20% or greater, with the highest proportional
increases observed in Ukraine (9113 vs 5439 new cases; +68%) and theRussian Federation (288 580 vs 235 385 new cases; +23%). The highest
numbers of new cases were reported from the Russian Federation (288 580
new cases; 197.7 new cases per 100 000; +23%), Germany (206 860 new
cases; 248.7 new cases per 100 000; -22%) and Italy (157 864 new cases;
264.7 new cases per 100 000; +5%).

The number of new weekly deaths decreased in the Region by 35% comparedto the previous week, with over 400 new deaths reported. The highest
numbers of new deaths were reported from the Islamic Republic of Iran (280
new deaths; <1 new death per 100 000; -41%), Tunisia (24 new deaths; <1
new death per 100 000; -57%) and Pakistan (21 new deaths; <1 new deathper 100 000; -22%).
9 000

14 000 000

8 000

700 000

7 000

600 000

6 000

500 000

5 000

400 000

4 000

300 000

3 000

200 000

2 000

100 000

1 000

12 000 000

European RegionCases

40 000Deaths35 000
10 000 000

30 0008 000 000

25 0006 000 000

20 000
15 0004 000 000

10 0002 000 000

5 000

0

30-Dec10-Feb23-Mar04-May15-Jun27-Jul
07-Sep19-Oct30-Nov
11-Jan22-Feb05-Apr17-May28-Jun09-Aug20-Sep01-Nov
13-Dec24-Jan07-Mar
18-Apr30-May11-Jul
22-Aug045 000030-Dec10-Feb23-Mar04-May15-Jun27-Jul
07-Sep19-Oct30-Nov
11-Jan22-Feb05-Apr17-May28-Jun09-Aug20-Sep01-Nov
13-Dec24-Jan07-Mar
18-Apr30-May11-Jul
22-Aug0

Reported week commencing

Reported week commencing

Updates from the Eastern Mediterranean Region

Updates from the European Region
7

DeathsEastern Mediterranean Region

Cases

Cases

800 000

Cases
DeathsDeaths900 000

Over 3400 new weekly deaths were reported in the Region, a 30% decrease
as compared to the previous week. The highest numbers of new deaths werereported from Italy (647 new deaths; 1.1 new deaths per 100 000; -4%), theRussian Federation (523 new deaths; <1 new death per 100 000; +20%) andSpain (326 new deaths; <1 new death per 100 000; -29%).

South-East Asia Region

Western Pacific Region

The South-East Asia Region reported under 116 000 new cases, a 16%
decrease as compared to the previous week. Three of the 10 countries (30%)
for which data are available showed an increase in the number of new casesof 20% or greater: Bhutan (178 vs 119 new cases; +50%), Timor-Leste (44 vs
33 new cases; +33%) and Bangladesh (1347 vs 1100 new cases; +22%). The
highest numbers of new cases were reported from India (68 703 new cases;
5.0 new cases per 100 000; -20%), Indonesia (30 747 new cases; 11.2 newcases per 100 000; -6%) and Thailand (12 232 new cases; 17.5 new cases per
100 000; -11%).

The Western Pacific Region reported just under 2.4 million new cases, a 15%
decrease compared to the previous week. Two (6%) countries reported
increases in new cases of 20% or greater, with the largest proportional
increases observed in Palau (69 vs 33 new cases; +109%) and Tonga (1100 vs
730 new cases, +51%). The highest numbers of new cases were reported fromJapan (1 258 772 new cases; 995.3 new cases per 100 000; -15%), the Republicof Korea (743 487 new cases; 1450.2 new cases per 100 000; -16%) and China(194 464 new cases; 13.2 new cases per 100 000; +13%).
The Region reported a similar number of deaths as the previous week, withover 3500 new weekly deaths reported. The highest numbers of new deaths
were reported from Japan (1990 new deaths; 1.6 new deaths per 100 000;+23%), the Republic of Korea (525 new deaths; 1.0 new death per 100 000;+25%) and Australia (419 new deaths; 1.6 new deaths per 100 000; -14%).

The Region reported just under 800 deaths, a 15% increase compared to theprevious week. The highest numbers of new deaths were reported from India(422 new deaths; <1 new death per 100 000; +43%), Thailand (195 newdeaths; <1 new death per 100 000; -2%) and Indonesia (123 new deaths; <1
new deaths per 100 000; -19%).
3 500 000

3 000 000

Cases

South-East Asia Region

7 000 000

35 0006 000 000

30 000Deaths2 500 000

Cases

Western Pacific Region

7 000

Deaths

6 000

5 000 000

25 0008 000

1 500 000

15 0001 000 000

10 000500 000

5 000

Cases

4 000

3 000 000
3 000
2 000 000

2 000

1 000 000

1 000

0

0

30-Dec10-Feb23-Mar04-May15-Jun27-Jul
07-Sep19-Oct30-Nov
11-Jan22-Feb05-Apr17-May28-Jun09-Aug20-Sep01-Nov
13-Dec24-Jan07-Mar
18-Apr30-May11-Jul
22-Aug030-Dec10-Feb23-Mar04-May15-Jun27-Jul
07-Sep19-Oct30-Nov
11-Jan22-Feb05-Apr17-May28-Jun09-Aug20-Sep01-Nov
13-Dec24-Jan07-Mar
18-Apr30-May11-Jul
22-Aug0

Deaths

20 000Cases

2 000 000

Reported week commencing

Reported week commencing

Updates from the Western Pacific Region

Updates from the South-East Asia Region
8

Deaths

5 000
4 000 000

Summary of Monthly Operational Update
The Monthly Operational Update is a report provided by the COVID-19 Strategic Preparedness and Response Plan
(SPRP) monitoring and evaluation team which aims to update on the ongoing global progress against the COVID-19
SPRP 2021 framework. In this edition, highlights of country-level actions and WHO support to countries include:

•
•
•
•
•
•
•
•
•
•
•
•
•
•
•

WHO/Europe supports Kazakhstan’s national laboratory working group to develop national laboratory policy
and strategic plans to address COVID-19 lessons learned
Liberia’s Grand Bassa county hits 71% COVID-19 vaccination coverage against its total population
Nepal launches the COVID-19 vaccination campaign for children
Social listening leads to more impactful communication and a stronger COVID-19 response in Fiji
Building emergency care capacities through training: scaling up Afghanistan’s delivery of essential healthservices and health system resilience during the pandemic and beyond
The Bahamas receives the first pediatric COVID-19 vaccines through the COVAX Facility
Palau establishes its national emergency medical team
Increasing COVID-19 vaccination coverage in Togo in 2021 through community dialogue and traditional
leaders
Téchne’s International Multidisciplinary Summer School on “Systemic Design for Health”: responding toneeds identified during the COVID-19 pandemic and beyond
Building a community of learning for women leaders in health emergencies among WHO staff and Member
StatesLeveraging lessons learned and systems from previous epidemics, Uganda builds up its response capacities
to scale up COVID-19 testing and surveillance while maintaining essential health services
WHO develops a method to deliver actionable infodemic insights and recommendations as part of the COVID19 pandemic response
Leaving no one behind: How OpenWHO.org ensures equity in health information delivery for people livingwith disabilities
WHO’s COVID-19 Response Funding in 2022: Delivering science, solutions and solidarity to end the acutephase of the pandemic
Updated WHO guidance and publications

9Annex 1. Data, table, and figure notes
Data presented are based on official laboratory-confirmed COVID-19 cases and deaths reported to WHO by
country/territories/areas, largely based upon WHO case definitions and surveillance guidance. While steps are taken to
ensure accuracy and reliability, all data are subject to continuous verification and change, and caution must be taken wheninterpreting these data as several factors influence the counts presented, with variable underestimation of true case anddeath incidences, and variable delays to reflecting these data at the global level. Case detection, inclusion criteria, testing
strategies, reporting practices, and data cut-off and lag times differ between countries/territories/areas. A small numberof countries/territories/areas report combined probable and laboratory-confirmed cases. Differences are to be expected
between information products published by WHO, national public health authorities, and other sources.
A record of historic data adjustment made is available upon request by emailing epi-data-support@who.int. Please specify
the countries of interest, time period, and purpose of the request/intended usage. Prior situation reports will not beedited; see covid19.who.int for the most up-to-date data. COVID-19 confirmed cases and deaths reported in the last
seven days by countries, territories, and areas, and WHO Region (reported in previous issues) are now available at:https://covid19.who.int/table.
‘Countries’ may refer to countries, territories, areas or other jurisdictions of similar status. The designations employed,
and the presentation of these materials do not imply the expression of any opinion whatsoever on the part of WHO
concerning the legal status of any country, territory, 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. Countries, territories, and areas are arranged under the administering WHO region. The mentionof specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by
WHO in preference to others of a similar nature that are not mentioned. Errors and omissions except, the names ofproprietary products are distinguished by initial capital letters.
[1]

All references to Kosovo should be understood to be in the context of the United Nations Security Council resolution
1244 (1999). In the map, the number of cases of Serbia and Kosovo (UNSCR 1244, 1999) have been aggregated forvisualization purposes.
[2]
A dispute exists between the Governments of Argentina and the United Kingdom of Great Britain and Northern
Ireland concerning sovereignty over the Falkland Islands (Malvinas).
Updates on the COVID-19 outbreak in the Democratic People’s Republic of Korea is not included in this report as thenumber of laboratory-confirmed COVID-19 cases is not reported.

10Annex 2. SARS-CoV-2 variants assessment and classification
WHO, in collaboration with national authorities, institutions and researchers, routinely assesses if variants of SARSCoV-2 alter transmission or disease characteristics, or impact the effectiveness of vaccines, therapeutics, diagnostics
or public health and social measures (PHSM) applied to control disease spread. Potential variants of concern (VOCs),variants of interest (VOIs) or variants under monitoring (VUMs) are regularly assessed based on the risk posed to
global public health.
The classifications of variants will be revised as needed to reflect the continuous evolution of circulating variants andtheir changing epidemiology. Criteria for variant classification, and the lists of currently circulating and previously
circulating VOCs, VOIs and VUMs, are available on the WHO Tracking SARS-CoV-2 variants website. National
authorities may choose to designate other variants and are strongly encouraged to investigate and report newly
emerging variants and their impact.

11

ISSUE 04 | AUGUST 2022

WHO’s Monthly Operational
Update on COVID-19
In this issue
From the field 2Public health response andcoordination highlights

10Partnerships12
Infodemic management

14

OpenWHO and learning 

16

Appeals17
Guidance and publications

18

Key links and useful resources

19

Key figures (as of August 2022)

PCR training carried out in Almaty, Kazakhstan. © WHO Kazakhstan Country Office

WHO/Europe supports Kazakhstan’s national laboratory
working group to develop national laboratory policy andstrategic plans to address COVID-19 lessons learned
At the height of the COVID-19 pandemic, countries faced incredible challenges
including massive demands on laboratory capacity, infrastructure, human resources,
procurement, and difficulties in scaling up diagnostic access. Indeed, most countries
had not anticipated or prepared for a public health crisis of this magnitude. After
more than two years of pandemic, many countries are now reviewing theirlessons learned from their laboratory response to COVID-19 to inform national
laboratory policies and strategic planning with the aim of further strengthening
their laboratory systems. This is an opportunity to share experiences, identify bestpractices, challenges and lessons learned on the laboratory response, and raise
the issue of laboratory sustainability.
Between May and July 2022, WHO/Europe and Kazakhstan’s national laboratory
working group worked on a set of activities to further develop and strengthen
the country’s national public health laboratory system. These included:• analyzing available documentation of current policies and plans in which
the laboratory sector is involved• performing a strengths, weaknesses, opportunities and threats (SWOT)
analysis of the laboratory system during the COVID-19 scale up• performing a situational analysis• developing a vision of Kazakhstan’s laboratory services beyond COVID-19• defining topics and content for policy statements• setting up strategic plans for laboratory services
Continued on next page …

WHO-led UN Crisis Management
Team coordinating 23 UN entities
across nine areas of work
OpenWHO totaled 7 million
enrolments for online courses
available in 65 national and local
languages, including 46 courses
dedicated to the COVID-19
response
951 million tests delivered
via ACT-A
230 GOARN deployments
conducted to support COVID-19
pandemic response
12 409 086 286 vaccine doses
have been administered
as of 17 August 2022
4 867 565 350 persons fully
vaccinated as of 17 August 2022
5 330 599 370 persons
vaccinated with at least one dose
as of 17 August 2022
38.4 million online data
analysed between 15 July 22 –14 August 2022 by WHO as partof social listening and infodemic
management support toMember States* COVAX has shipped over 1.61 billion vaccines to
146 participants as of 16 August 2022
* See Gavi’s COVAX updates for the latest COVAX
vaccine roll-out data
For the latest data and information, including
trends and current incidence, see the WHO COVID-19
Dashboard and Situation Reports.

From the field2

The national laboratory working group met to kick-off theprocess with a SWOT analysis and identification of strategic
priorities and plans for the laboratory system on 3 May.
Priorities to be addressed were identified based on thechallenges that the laboratory system had faced during
the COVID-19 response and included: governance andcoordination, regulatory framework, human resources,quality management systems, procurement and logistics,
biosafety and biosecurity, laboratory information systems,
scientific cooperation.
A second meeting, held on 8 June 2022, gathered a smallergroup consisting of representatives from the national
laboratory working group active in public health, clinicaldiagnostic, private laboratories, laboratory associations,research laboratories and veterinary and ecology laboratories
to finalize the SWOT analysis.
Technical sessions continued throughout July 2022 to address
the priorities identified and approved in May by the national
laboratory working group. By late July, the policy statements
were finalized by the working group.
Moving forward, a follow-up meeting will take place in
September to develop and finalize the laboratory strategicplans and by November 2022, the working groupwill present the compiled national laboratory policy
and strategic plans to relevant stakeholders.
Through this process, WHO is supporting Kazakhstan tomaintain COVID-19 laboratory capacities and ensure thesustainability of investments made into these capacities. Allsuch activities were undertaken with the support of funding
received through WHO’s 2022 Global Health Emergency Appeal.

WHO staff carrying out trainings in Kazakhstan. © WHO Kazakhstan Country OfficeTimeline of WHO/Europe and Kazakhstan’s national laboratory working group activities (2022)

WHO/Europe and Kazakhstan’s national laboratory working group jointly working to develop
and strengthen the country’s national public health laboratory system.

Presentation of thecompiled national
laboratory policy
and strategic plans torelevant stakeholders

May-July 2022

November 2022

3 May 2022

8 June 2022

July 2022

September 2022

First meeting of thenational laboratory
working group to kick-off
the process with:

Second meeting, witha smaller group, tofinalize the SWOT
analysis.

Technical sessions toaddress the priorities
identified and approvedin May.

Follow-up meeting todevelop and finalize
the laboratory
strategic plans.

• a SWOT analysis• identification ofstrategic priorities
and plans for thelaboratory system

By late July:
finalization of thepolicy statements

From the field

3

Liberia’s Grand Bassa county hits 71% COVID-19 vaccination coverage against its total population“It hasn’t been an easy
road, but we have been
supported through andthrough by our national
headquarters and WHO.
This indeed motivated us
as a team to work harderto achieve more andtogether we made it.”
Hon. Minister of Health and WHO Representative to Liberia with the Grand Bassa County Health Team, congratulated
for the milestone achieved. © WHO Liberia / Letitia Nangwale

In July, one of Liberia’s most populated counties – Grand
Bassa – attained 71% COVID-19 vaccination coverage for its
population, making it the third county to have reached thetarget of 70% coverage for persons aged 12 years and above.
This brings Liberia’s vaccination coverage against its total
population to 54%, classifying the country as low-risk
for COVID-19. Liberia now stands as one of eight Africancountries, and the only West African country, to have reachedthe milestone of having vaccinated between 40% and 70%of their total poulations.
Dr Peter Lugala Clement, WHO Representative to Liberia,
paid a visit to Grand Bassa together with the Minister of Health,
Honorable Dr Wilhelmina Jallah, to congratulate the County
Health Team for their great work. As part of this visit, teammembers who had performed exceptional work in supporting
the COVID-19 vaccination received awards. Moving forward,
the County Health Team was advised to develop strategies
on integrating COVID-19 vaccination into routine immunization
and was challenged to reach the global target of 90%
by December 2022.

“I am very proud that our big counties
are setting the trend. First it was
Nimba, then Lofa, and now Grand
Bassa. We congratulate you on a job
well done; this is important for thecountry. Even for vaccination coverageamong health workers, Liberia is way
on top of the charts – thank you.”
Honorable Dr Wilhelmina Jallah
Liberia Minister of Health

Dr Sylvester Wheh
Grand Bassa County Health Officer

As part of the COVID-19 response, the UN in Liberia provided
important technical, material and financial support to the
Ministry of Health, in collaboration with other counterparts.
This would not have been made possible without support
from the COVAX Facility and various partners including
the the European Civil Protection and Humanitarian Aid
Operations (ECHO), the Center for Diseases Control andPrevention (CDC), the Governments of France and Germany
and the US Agency for International Development (USAID).
For more information, click here.

“Vaccines came in 2021 with many
unknowns, coupled with myths andmisconceptions, and we gradually
introduced the vaccines from thecentral level to the counties. (…)
It is evident that giving the power tothe counties, with strong community
engagement and promoting
community ownership of theprocess produces greater results.
Congratulations, we are proud of you.”
Dr Peter Lugala Clement
WHO Representative to Liberia

From the field

4

Nepal launches the COVID-19 vaccination campaign for children
In June, Nepal launched the first phase of the COVID-19
vaccination campaign for children aged 5 to 11 years, in
27 of the country’s 77 districts. This marks another milestone
in Nepal’s COVID-19 vaccination efforts which achieved the
WHO global target of 70% vaccination coverage by mid-2022.
To increase the coverage and ensure all children in the target
age group receive the life-saving vaccine, schools and healthcare posts were selected as vaccination sites. Alongside healthcare workers who travelled across the regions to reach children
yet unreached, school staff played an important role to makethe campaign a success. Many volunteered to man vaccine
registration booths or educate parents and children regarding
the vaccines. Although the responsibilities varied, all wereunanimous in their relief to see children finally able to get
COVID-19 vaccines.
Here are a few stories of school staff and healthcare workers
who are working to turn the campaign into a success.

Ram Hari Khatri, 59, Principal at Shree Sharada Secondary School, Panauti, Kavre© WHO Nepal / S.G.Amatya“As a Nepali citizen, I have supported the nationwide
COVID-19 vaccination campaign from the start and I
have also requested all teachers to do the same (…)
but I was disheartened to see that the children could
not get the life-saving vaccines. (…) Now, with thisnew campaign, my school staff are I are in full swing
to make sure all children receive their dose. We will
make all administration and logistics go smoothly,and I am happy my school is a part of this campaign.”
Ram Hari Khatri
Principal at Shree Sharada Secondary School
Panauti, Kavre

Sukalaksmi Pradhan, an Auxiliary Nurse Midwife (ANM) at Dhungkharka Health Post,
Bethanchok Rural Municipality, Kavre. © WHO Nepal / S.G.Amatya“When the COVID-19 vaccination campaign began lastyear, there were times when no one showed up toreceive the vaccine because people were anxious orscared. So, we went to spread awareness at the local
level, moving from village to village. Our efforts have
proven to be successful. (…) Even though I have to walksome 2–4 hours from the morning to reach a village toprovide this vaccine, I am happy that I am contributing
to ensuring no one is left behind in this campaign.”
Sukalaksmi Pradhan
Auxiliary Nurse Midwife for seven years and contributing
to the ongoing vaccination campaign

Chameli Maya Magar (pictured left), a Community Health Volunteer, at Golanjor
Municipality, Sindhuli. © WHO Nepal / S.G.Amatya“We have been organizing the mothers group meetings
where we speak to the community about the importanceof this [COVID-19] vaccine, the seriousness of the disease,and the efforts from the Government of Nepal to bringthese vaccines to us. We want to make sure that people
have accurate and verified information at their disposal
so that they can make informed choices.”
Chameli Maya Magar
Community Health Volunteer
Moving forward, the second phase of the campaign isscheduled to start in August 2022 in the remaining districts.
For more information, click here.

From the field5

Social listening leads to more impactful communication and a stronger COVID-19 response in Fiji
As COVID-19 cases rose dramatically in Fiji in June 2021
and reports came of people dying at home or arriving at
the hospital too late to be treated, Fiji’s Ministry of Healthand Medical Services, in collaboration with the WHO andother partners turned to the “social listening” system. Set
up in Fiji in May 2021 with support from the European Union,
this system helps understand what the public is thinking
or doing, identify and counter rumours and misinformation
and adjust the response to COVID-19.
To reverse the trend of people seeming to avoid healthcare,risk communication and community engagement specialists
looked at over 600 comments, mostly on social media, which
expressed people’s fear of being trapped alone in hospital
without care or dying there. Insights were then passed on
to other teams responsible for the COVID-19 response.

The online campaign was successful, generating more than
200 000 views for Nurse Bucago’s video alone and hundredsof supportive comments. In real life, this translated into ahigher number of people seeking treatment for COVID-19
and other medical conditions.
Fiji’s social listening system has also helped inform thecountry’s COVID-19 vaccination campaign. Guided by social
listening insights that many people wanted to avoid further
lockdowns, Fiji emphasized messages on the importanceof vaccination as a mean to ease movement restrictions
and provide a safer environment for communities. As a result,
the risk communication and community engagement team
noticed much more positive online conversations about
vaccination and as of 7 July 2022, almost 90% of Fiji’s
eligible population had been vaccinated.
For more information, click here.

A three-part communication campaign was thenlaunched, to demystify and personalize healthcare:
1. To highlight the commitment of nurses, doctors
and paramedics, the Ministry of Health posted theMeet Our Frontliners video on its Facebook page
which shows Nurse Maria Bucago explaining in tears
how she left her husband and five children to servein Fiji’s Emergency Medical Assistance Team (FEMAT)
hospital in the capital, and asking her fellow Fijians
to adhere to the Ministry’s advice.
2. Testimonies of patients treated at the heightof the 2021 surge in cases speaking about
the professionalism, empathy and care theyencountered were posted.
3. Finally, a team from the Ministry of Health wasdedicated to answering questions on social
media and hotlines, directing people to healthcare
resources.

“What happens with the COVID-19
pandemic depends to a large extent
on how we behave as individuals andcommunities. Taking the time to listen
to the public and to understand thedrivers of their behaviour has given
the Government of Fiji, with WHO andpartners, the opportunity to ensurethat their communications and thebroader emergency response are better
tailored to people’s preferences, needs
and expectations. As a result, lives havebeen saved. Given the excellent results
and the capacity that has been built,
we hope social listening will be used toaddress other health challenges in Fijiand elsewhere in the Pacific.”
Dr Mark Jacobs
WHO Representative to the South Pacific and Directorof Pacific Technical Support

Example of risk communication and community engagement during the rollout
of COVID-19 vaccines. © WHO / Arishma Devi

From the field

6

Building emergency care capacities through training: scaling up Afghanistan’s deliveryof essential health services and health system resilience during the pandemic and beyond
Around the world, the COVID-19 pandemic highlighted
significant gaps in emergency and critical care, showing thenecessity of a fully functional Emergency Care System (ECS)
providing 24 hours services for the most vulnerable. This isparticularly the case in Afghanistan where the already fragile
health system is facing multiple acute health crises in addition
to COVID-19 – such as acute watery diarrhoea, dengue andmeasles – as well as various health emergencies and disasters
resulting in large numbers of casualties, such as terrorism,
armed conflicts, road traffic incidents, floods and earthquakes.
Responding to gaps in clinical care training, in December
2021, WHO launched in Afghanistan the WHO-ICRC Basic
Emergency Care course (BEC) – a component of the Emergency
Care Toolkit. Developed by WHO and the International
Committee of the Red Cross, this open-access course trains
frontline health care providers managing acute illness andinjury with limited resources on a systematic approachto the assessment and management of life-threatening
conditions. The course has since been cascaded throughout
the country with courses run monthly. To date, there are
37 BEC trainers and 8 certified master trainers in the
training pool, all from Afghanistan, and 337 frontline healthworkers have been trained on the BEC in Afghanistan,contributing to improving care for everyday and surge
emergencies. As part of the COVID-19 response this BEC
course has proven life‑saving, enabling health workers to
respond to severe cases while enhancing overall patient care.
When an earthquake of 5.9 magnitude struck the southeastern region of Afghanistan on 22 June 2022, affecting
the lives of more than 360 000 people in Paktika and Khost
provinces, causing widespread damage and resulting in over a
thousand deaths and nearly 3000 injuries, WHO’s investment
in emergency care trainings proved invaluable to the response.

BEC Course Master Trainer and Dr Rachel (WHO Emergency Consultant) teaching basic
airway skills together. © Dr Mohammad Ismail AbidIn addition to providing clinical, logistical and technicalresources, the WHO Country Office Team together with
the Afghan BEC Master Trainers urgently came together tohold an emergency care training for 48 participants in
Gardez in July, to enhance the response to the earthquake.
Participants received competency-based training in
Airway, Breathing, Circulation, Disability, Exposure (ABCDE)
assessment, trauma care, shock, altered mental as well asother essential emergency care skills. 41% of participants werefemale, illustrating WHO’s policy to prioritize female healthworkers’ attendance in all BEC courses. As a result, thesefrontline health workers felt better prepared to respond to theaftermath of the earthquake and future potential emergencies.
Moving forward, WHO will continue to hold monthly BEC
trainings across the country, expanding it in targeted
provinces. By doing so, WHO is supporting Afghanistan
to enhance its health systems’ resilience, improve overallpatient care and ensure continuity in essential healthservices delivery beyond the pandemic and during future
health emergencies.

“Thank you for the efforts to make this course
exist, to take action and come to life. When thestudents have practical sessions this makes
it real and interesting. (…) BEC is the mostvital and crucial course for all frontline Afghan
healthcare providers. We would like to havemore courses to improve our learning andtrain more healthcare workers.”
BEC participant practicing ‘bag-mask’ ventilation technique.
© Dr Mohammad Ismail Abid

BEC Course Master Trainer
General Surgeon, Kandahar Teaching HospitalFrom the field

7

The Bahamas receives the first pediatric COVID-19 vaccines through the COVAX Facility

Arrival of the vaccine doses, Lynden Pindling International Airport. © WHO

In July, the Bahamas received 24 000 doses of Pediatric
COVID-19 vaccines through the COVAX Facility – a global effort
between the Coalition for Epidemic Preparedness Innovations(CEPI), Gavi, the Vaccine Alliance, UNICEF, the Pan American
Health Organization (PAHO) and the WHO. These 24 000 Pfizer
vaccine doses arrived at the Lynden Pindling International
Airport, sent by the PAHO Revolving Fund, which is responsible
for the procurement of COVID-19 vaccines for the countriesof the Americas under the COVAX Mechanism.
The arrival marks a historic step toward ensuring the equitable
distribution of pediatric COVID-19 vaccines worldwide.
Various dignitaries came to receive the vaccines, among
which the Prime Minister of the Commonwealth of the
Bahamas, Hon. Phillip Davis; the Minister of Health andWellness, Dr Michael Darville; the PAHO/WHO Country
Representative for the Bahamas and Turks and Caicos Islands,
Dr Eldonna Boisson; and other officials from PAHO/WHO
and the Ministry of Health and Wellness.

Dr Boisson encouraged the public to continue adhering to
the COVID-19 public safety protocols, including wearing
masks which properly cover one’s nose and mouth; respecting
proper coughing and sneezing etiquette; remaining 3–6 feetapart; and frequently washing or sanitizing one’s hands. She
added, “As our children prepare to return to their classrooms,
it is vital to protect our children and loved ones from thevirus. Students, parents, and educators can all have greater
confidence as they participate in school initiatives andextracurricular activities once vaccinated.”
COVID-19 remains a global health emergency and PAHO/WHO
continues to support the Ministry of Health and Wellness
in monitoring the vaccination coverage, implementing theelectronic immunization information systems, and rolling out
communication campaigns to address vaccination hesitancy.
In addition, PAHO/WHO will continue to support the Bahamian
government in its work related to other public health issues,
with the aim of leaving no one’s health behind.

“In the Bahamas, where children will receive the COVID-19 vaccine, we
encourage parents and guardians to follow the national vaccination
recommendations of the Ministry of Health and Wellness. Vaccines
help to minimize disruption to children’s education, routines andother things that are important to their wellbeing.”
Dr Eldonna Boisson
PAHO/WHO Country Representative for the Bahamas and Turks and Caicos Islands

From the field

8

Palau establishes its national emergency medical teamMembers of Palau’s Team Klemat. © WHO

Following a five-day inaugural training in June 2022, Palau
established its national Emergency Medical Team (EMT),
thereby becoming the smallest country in the world bypopulation to have such an EMT. This was done within theframework of a partnership between the Government of the
Republic of Palau, the WHO and the United States Agency forInternational Development (USAID) with the aim to enhance
preparedness for disasters, disease outbreaks and other crises.
Palau’s EMT is named Team Klemat after the rope that holds
the sails of the country’s traditional canoes. It is composedof 18 health professionals, including doctors, nurses, andlogisticians, trained to rapidly respond to sudden-onset
emergencies or outbreaks, which could emerge among thecountry’s population of 18 000 people, spread across 300
islands. In the future, Team Klemat may also look beyond
Palau’s borders to provide support to neighboring countries
and territories, where necessary.

“The current pandemic has reverberated
across the Pacific for months and years,
and has shone a light on the importanceof our local first responders. The supportof the WHO and the work of the Palau
Minister of Health and Human Services
to continue to improve and better
prepare for the next time they are called
upon to serve their community in an
emergency, no matter how dire or austerethe conditions, is commendable. Palau’s
Emergency Medical Team, Team Klemat,
is an inspiration to us all.”
H.E. John Hennessy-Niland
Ambassador of the USA to the Republic of Palau

WHO will provide training and technical support to Team
Klemat and procure equipment and supplies to facilitate its
future deployments. With these materials, known as a “cache,”Team Klemat will be fully self-sufficient and ready to deploy
within hours.
With support from WHO, EMTs have already been establishedin multiple countries, territories and areas within the Western
Pacific region, including the Cook Islands, Fiji, Northern
Mariana Islands, the Solomon Islands, Tonga and Vanuatu.
Additional teams are currently being established includingin Kiribati, the Marshall Islands, the Federated States ofMicronesia, Papua New Guinea and Tuvalu.
WHO’s work to establish and enhance EMT capacity in the
Pacific is supported by the Australian Department of Foreign
Affairs and Trade, the European Union, the Government ofJapan, the New Zealand Ministry of Foreign Affairs and Tradeas well as USAID.
For more information, click here.

“WHO is delighted to work with theGovernment of the Republic of Palau,
USAID and other partners to support theestablishment and training of Klemat. In
Palau, as in other Pacific Island countries
and areas, establishing national EMTs isa critical part of country preparedness
and will enable the rapid and life-saving
response to a wide range of emergencies
in future.”
Dr Mark Jacobs
WHO Representative to the South Pacific and Directorof Pacific Technical Support

From the field

9

Increasing COVID-19 vaccination coverage in Togo in 2021 through community dialogue
and traditional leaders
In this series, WHO showcases summarized country
case studies that demonstrate the Organization’s
progress of the implementation of the 13th Global
Programme of Work.
The full country case studies appeared under the report“For a safer, healthier and fairer world” Results Report,”
which was shared prior to the 75th World Health Assembly.
When Togo’s COVID-19 vaccination campaign started in March
2021, the country promptly took measures to encourage
vaccination, including the obligatory presentation of the
COVID-19 vaccination card to enter any public institution.
The Prime Minister, ministers, members of the national
assembly, heads of United Nations agencies in Togo as wellas health workers also got vaccinated, setting the example.
Yet, by mid-September 2021, only 5.6% of the population
aged 18 and above had received their two doses, meaning
the country was below the WHO-planned 10% thresholdplanned for September 2021 and far away from the 40%
threshold for December 2021.
To reverse this trend and enhance vaccination coverage, the
WHO Country Office in Togo provided technical and financial
support to the Ministry of Health, Public Hygiene and Universal
Access to Health Care, to conduct community dialogues
and awareness-raising activities in the Grand-Lomé region,
where 80% of confirmed COVID-19 cases originated. These
measures aimed to reduce misinformation, break down
potential barriers to vaccine acceptance, and encouragecommunity support for COVID-19 vaccination.

• 13 vehicles were purchased and equipped with soundequipment to disseminate awareness-raising messages
in markets, bus stations, crossroads and areas in frontof bars and restaurants in all neighborhoods of the Grand
Lomé region, under the direct supervision of mayors.
• 32 community dialogues were organized in royal palaces
under the leadership of the 11 canton chiefs of the GrandLomé region. These dialogues mobilized approximately
1600 traditional leaders and included local chiefs, priestsof voodoo temples, women leaders of market vendor
associations, leaders of car and motorcycle driverunions, as well as representatives of local development
committees, youth groups and arts and crafts organizations.
Topics discussed included: poor communication andmisinformation circulating surrounding COVID-19 vaccines;
concerns about the speed with which COVID-19 vaccines
were produced and made available; and the location of
vaccination sites in remote communities.
• Traditional leaders undertook initiatives to encourage
the population to adhere to COVID-19 vaccination
recommendations. Vaccination centres were set up in
the traditional chiefs’ palaces, markets and bus stations
and chiefs personally engaged with the vaccination teams
to dispels rumours. They were also vaccinated in thepresence of their communities, to demonstrate by example.
Practitioners of voodoo cults whose beliefs made themhostile to the use of needles were vaccinated. Finally, audiovisual messages were produced and disseminated throughWhatsApp groups and community radio stations to refutefalse information.
By providing the right information to the public and creatinga channel of exchange between traditional leaders and healthworkers in their respective areas, these social mobilization
measures helped facilitate community acceptance of COVID-19
vaccination. As a result, the national vaccination coverageincreased nearly five-fold, from 5.6% in September 2021 to25.4% by the end of December 2021.
For more information, click here.

Community dialogue session in the royal palace of the township of “adétikopé.”© Joseph Koivogui

Representative of WHO Country Office in Togo, WHO staff and community leaders.
© WHO Country Office in Togo / Ms FiatyPublic health response and coordination highlights

10

Téchne’s International Multidisciplinary Summer School on “Systemic Design for Health:”
responding to needs identified during the COVID-19 pandemic and beyond
Discussions notably pursued theobjective of developing ideas fora multiple diseases treatment center
focusing not just on isolation units
but on creating a safe care environment
centered around patients, families andcommunities. Developing such multiple
diseases treatment center as a newbuilding typology for IPC could offer
the flexibility needed to adapt buildings
to other functions with minimal to noefforts – a big improvement comparedto the major rehabilitation work usuallyrequired to convert disease-specifictreatment units, such a Severe AcuteRespiratory Infection treatment centers,
to other purposes.
Téchne International Multidisciplinary Summer School. © Adrian Lo

In April 2020, in response to Member States’ need for guidance
and assistance in addressing technical aspects and structural
challenges related to their COVID-19 response activities, WHO
created Téchne, the technical science for health network.
Regrouping a range of partners, among which architects,
engineers, designers and public health practitioners fromseveral institutions globally, the network prepares forand responds to acute public health events with urgent
and customized support.
Téchne significantly contributed to the pandemic response on
all levels, providing technical assistance to countries in all
WHO Regions on improving environmental and engineering
controls to make health settings and structures safer
for health workers and patients and reduce the risk of
hospital-acquired infections. As part of this, Téchne notably
helped to create over 6000 new beds for COVID-19 patients bysetting up new health facilities and repurposing existing onesin line with WHO’s safety guidelines.
Responding to a major gap highlighted by the pandemic
surrounding the need to develop more resilient and flexible
health structures, Téchne, in close collaboration with KU
Leuven Faculty of Architecture (Belgium) and the Thammasat
Design School (Thailand), with the Polytechnic di Turin’s
participation, recently organized the first international
multidisciplinary summer school on systemic designfor health. The summer school contributes to Téchne’s longterm objective of national and international capacity building
through multidisciplinary and multicultural working sessions.
Held in Bangkok from 16 to 30 July 2022, the summer school
was attended by 23 Belgian, Burmese, Cambodian, Thai andVietnamese students from different backgrounds. Participants
worked together to develop a systemic design approach to
improve ventilation, temperature, humidity, and daylighting
control strategies for Infection Prevention and Control (IPC)in the context of mainland Southeast Asia.

Leveraging on available WHO guidelines
and standards, students had the opportunity to develop
innovative context-specific spatial and structural solutions
while learning from vernacular architecture and drawing upon
their different backgrounds and expertise.
The summer school was opened by the Rector of Thammasat
University, in the presence of the First Secretary of the Belgian
Embassy in Bangkok and a representative from WHO Country
Office for Thailand.
Overall, this initiative will contribute to Téchné’s aim to create
safer, healthier, equitable and more sustainable healthcare
systems through integrated multidisciplinary, communitybased and informed approaches to problem solving in
the post-COVID-19 environment.
For more information, click here.

“COVID-19 requires us to look critically at every
component of the emergency planning cycle
to identify what we did well and what we
can do better. If a house can be a machine
for living, a hospital must also be a machinefor the delivery of healthcare. Smart design
requires smart thinking so that hospitals are
as fit for purpose as possible – in a world thatis changing rapidly. Making architecture andengineering students aware early in theircareer of healthcare needs might be oneof the best investments we can make.”
Richard Brown
Programme Manager Health Emergencies andAntimicrobial Resistance, Thailand WHO Country OfficePublic health response and coordination highlights

11

Building a community of learning for women leaders in health emergencies among WHO staff
and Member States
Women leaders face specific challenges
working in the response to healthemergencies like the COVID-19
pandemic. Recognizing this, the WHO
Health Emergencies Programme (WHE)
launched a new Women in Leadershipcommunity of learning to help addressthese challenges through peer learning,
networking and continuous learning
opportunities.
This new community of learning is open
to all women who participate in the
Leadership in Emergencies programme,
which has provided flagship training
for WHO staff and member states
representatives since 2019. Initiallyorganized in-person, the Leadership in Emergencies courses
were digitalized when in-person learning was disrupted by
the pandemic. As a result, access to those online trainings wasconsiderably increased and cohorts became more diverse. In
particular, the proportion of women attending the courses has
increased, from 31% in 2019 when courses were run in-person
to 48% in 2022. Currently, 148 women leaders who participatedor will participate in the Leadership in Emergencies
programme and the support team form part of the Womenin Leadership community of learning.
Communities of learning provide space and structure to connect
people, organizations and systems that are eager to sharelearning and work across boundaries. Women make up almost
70% of the global health and social workforce and nearly 90%of the nursing and midwifery workforce, but it is estimatedthey hold only 25% of senior roles. This makes it even more
important for women leaders to be able to share theirexperiences and learn while developing their lives and careers.

“We want to empower and support
women in our training programme who
face gender-related barriers and biases
in pursuing leadership roles. These areimportant learning opportunities anddiscussions that can help shift the fieldof health emergency response toward
becoming a more equal one.”
Heini Utunen
Acting head of the WHE Learning and Capacity
Development Unit, which runs the leadership training

Poster for the first Women in Leadership webinar. Credit: WHO

The Women in Leadership community will help engage
women who are serving in or aspiring to leadership positions
in emergency response and create a sustainable network formutual support. It will also provide an opportunity to advise
senior management and human resources about genderfocused inclusivity in emergencies by creating a channel toidentify concerns, barriers and solutions to the advancementof women working in emergencies.
In July 2022, a community webinar was held to discuss how
gender stereotypes affect the workforce, including women’s
leadership styles, as well as how to build capacities andsystems to address the impact of these stereotypes. In the
coming months, the group will meet to discuss additional
challenges women face in health emergencies, including
COVID-19, and participate in virtual coffees for members
to get to know one another better.
For more information, click here.

“We will not have a sustainable
tomorrow unless we have genderequality. It is not possible to deliver,and we will not be an effective
programme, unless we have equity.”
Dr Michael Ryan
Executive Director, WHO Health Emergencies Programme

Partnerships

12

Leveraging lessons learned and systems from previous epidemics, Uganda builds up its
response capacities to scale up COVID-19 testing and surveillance while maintaining essential
health services
Rawlance Ndejjo,1,2 Chevy Lazenby,1,3 Steven N. Kabwama,2 Alice Namale,2 Suzanne N. Kiwanuka,2 Fred Monje,2 Susan Kizito,2 Rhoda K. Wanyenze,2Jacqueline Maloney,3 Will Wang,3 Chris Troeger,3 Anne Liu,3 Henry Kyobe Bosa.4

Exemplars in Global Health (EGH) identifies positive health outliers,
studies successes, and shares findings so that lessons can be adaptedin comparable settings to improve health across the world and be applied
to future pandemics. The Exemplars in Global Health program is housed
at Gates Ventures – the private office of Bill Gates – and is made possible
by a coalition of global and in-country experts, funders and collaborators.

Using the investments in Ebola
response capacities for COVID-19
rapid response

During the most recent Ebola virus
disease outbreak in 2019, Uganda’s
community surveillance program
trained more than 10 000 healthworkers and village health teams
The following feature was submitted by Gates Ventures, as a WHO partner
on infection prevention and control,organization. It highlights Uganda’s exemplary approaches to testing andepidemic surveillance and othersurveillance, and the maintenance of essential health services (EHS), whichaspects of outbreak response.
was informed by research led by Makerere University School of Public
These trained health workers played
Health between September 2020 and December 2021, with funding froma pivotal role in the country’s ability
the Bill & Melinda Gates Foundation and Gates Ventures. Many of theseto rapidly respond to COVID-19,
approaches were informed by WHO guidance.
through supporting surveillance andcontact tracing. Since the start of
Immediately after WHO declared COVID-19 a public healththe pandemic, Uganda increased its testing capacity fromemergency of international concern at the end of January
one central laboratory at the Uganda Virus Research Institute2020, the Ugandan Ministry of Health activated the Public
to four additional central-level laboratories and GenExpert
Health Emergency Operations Centre and the National Task
testing machines at all regional referral hospitals. The
Force – shifting from preparedness to response when the first
country also scaled up capacity to perform rapid diagnostic
case was recorded on 21 March 2020. Since then, Uganda has
tests, introduced genotypic post-mortem surveillance andperformed over 2.6 million tests and recorded just over 160 000 conducted several serological surveys.
cases (including reinfections) and 3500 deaths (largely driven
Applying a multi-pronged approach to maintain accessby the Delta variant around June 2021).5
to essential health services
Despite challenges in Uganda’s testing and surveillance
To maintain the provision and utilization of essential healthsystems, the country was able to leverage lessons learned
services, Uganda established a committee, which developedand systems developed from previous epidemics.6
and disseminated guidelines to coordinate and enhance thecontinuity of essential health services. Health officials also
implemented a variety of interventions to mitigate supply- anddemand-related obstacles, including task shifting to community
health workers, leveraging technology such as the electronic
logistics management information system for ordering healthcommodities7 and information dissemination via mobile
phones.8 Additionally, virtual communication platforms (such as
Zoom) were used to conduct training and support supervision.
Strong subnational coordination mechanisms were establishedto facilitate the transportation of health care workers andsupplies. Service delivery was adapted to maintain essential
health services through special clinics, outreaches, designatedfacilities for COVID-19 treatment, community drug distribution
and multi-month drug dispensing.
Nurse Guloba Rhode administers a COVID-19 vaccine at Makerere University Hospitalin Kampala, Uganda on 19 January 2022. © Gates Ventures, LLC / Sumy Sadurni

Continued on next page …

1 Corresponding author.
2 School of Public Health, College of Health Science, Makerere University, Kampala, Uganda
3 Gates Ventures
4 Ministry of Health, Kampala, Uganda; Uganda Peoples' Defence Forces, Kampala, Uganda
5 Our World In Data, accessed 31 May 2022
6 Between 2000 and 2016, Uganda experienced eight public health emergencies of international concern: five outbreaks of Ebola virus disease, most recently in 2018 and 2019, and three outbreaks of Marburg virus disease.
7 Annual Health Sector Performance Report 2019/2020; see page 107 here
8 The Pan African Medical Journal, Supplement article – Commentary, 20 May 2020

Partnerships
In May 2021, Uganda’s Ministry of Health worked with WHO
to update national Essential Health Services (EHS) guidelines
and informed these updates, with support from Makerere
University’s School of Public Health and Exemplars in Global
Health. Following their research and recommendations,Uganda’s EHS Continuity Committee published updated
guidelines on maintaining EHS on 24 July 2021, which included
revisions surrounding: the inclusion of additional programmes(e.g. on neglected tropical diseases, noncommunicablediseases, school health, mental health, psychosocial
services), updating terms of reference for regional support
teams to improve coordination and for village task forcesand village health teams, and adding new incentives
for health care workers.

13

The team of researchers at Makerere University subsequently
presented their findings and lessons learned at the launch of
Uganda’s Joint External Evaluation Plan and Global Health
Security Agenda (GHSA) commitments in September 2021.
Building on these, the research team emphasized the needto integrate resilience in preparedness and response planning,
include EHS as a critical pandemic response pillar, and trackand mitigate unintended consequences.
More information can be found in the full case studies
on Uganda’s approach to diagnostic testing and surveillance
and the maintenance of essential health services.
© World Health Organization 2022
All rights reserved. The named authors alone are responsible
for the views expressed in this publication.

Laboratory worker, Kasujja Ronald, at the COVID-19 sample testing laboratory at Entebbe Airport, Entebbe, Uganda on 21 January 2022. © Gates Ventures, LLC / Sumy Sadurni

Infodemic management

14

WHO develops a method to deliver actionable infodemic insights and recommendations as partof the COVID-19 pandemic response
This feature is a summary of the following article: Delivering actionable infodemic insights and recommendations
for the COVID-19 pandemic response, WHO Weekly epidemiological record, No 27, 2022, 97, 313–324. Publishedunder the CC BY‑NC-SA 3.0 IGO licence.
For more information about the WHO Weekly Epidemiological Record, click here.
Since the beginning of the COVID-19 pandemic, infodemic
has been a global issue that may have affected theeffectiveness of public health responses. Infodemics aredefined as too much information, including false or misleading
information, in digital and physical environments during
an acute public health event, which can lead to confusion,
risk-taking and behaviour that can harm health and lead to
mistrust in health authorities and public health response.
To address this challenge, WHO has been using since the onsetof the pandemic a multiprong approach consisting in fourinterlinked strategies, namely: promoting a whole of society
response to the COVID-19 infodemic; supporting the scienceof infodemiology; enhancing workforce’s capacities to respondto infodemics; and building a country toolbox to support
Member States manage infodemics.
Within this framework, in March 2020 WHO’s COVID- 19
incident management support team’s (IMST) developedin collaboration with research partners an integrated
method for public health infodemic analysis and insights
generation. This method is able to generate weekly analysis
of social media, traditional media and other data sources,
to identify, categorize and understand the concerns
and narratives expressed by individuals and communities.

“To keep public health on the agenda,
maintain a whole-of-society approach,maintain your surveillance systems,
or ensure uptake of e-health initiatives
or future vaccination campaigns,
you need to keep managing infodemic
and facilitating clear communication.
Infodemic management is the motherof all public health interventions –without it, their effectivenessis threatened.”
Prof. Neville Calleja
Director of Health Information and Research
Ministry for Health of Malta

Continued on next page …

This three-step method (see below) identifies or anticipatesareas of concern, questions, misinformation and information
voids in narratives circulating, and provides immediately
actionable insights to WHO and Member States for use indecision-making and risk communication. Overall, this helps
to complement rumour-tracking and provide the right healthinformation at the right time in the right format to thepeople who need it.

• Step 1: the WHO team collected data on a weekly
basis from approximately 20 million publicly availablesocial and news media sources in English, Frenchand Spanish, and categorized into conversations
according to a COVID-19-public health taxonomy.
This quantitative identification helped identify
potential topics of concern and information voids.
• Step 2: the dataset was analysed qualitatively
and compared on a weekly basis to identify narratives
and their changes and to characterize changes insentiment in the conversation. WHO then developedand shared a digital infodemic intelligence report(50 pages) with its global and regional infodemic
response networks, including Member States• Step 3: the digital infodemic intelligence was reviewed
by a WHO-led multi-disciplinary team of experts andtriangulated with other data sources to derive insights
on the infodemic. The team then compiled a onepage memo, shared across WHO’s three levels andglobal and regional infodemic response networks,that recommended action to WHO for the week on:(i) messaging and communication optimization; (ii)
research and evidence generation; (iii) improvements
to WHO web pages; (iv) coordination with media
or fact-checking organizations; and (v) risk
communication-related actions.

Infodemic management

15

As this public health taxonomy for analysis of COVID-19
conversations could directly help Member States to deliver
digital infodemic intelligence nationally, the method wasfurther adapted and localized by WHO Country Offices, incollaboration with respective ministries of health and UN
partners. 18 countries across four WHO regions, including
Canada, Indonesia, Mali and the Philippines therefore
adapted the tool. The taxonomy was also tested and used
for automated social listening on the pilot WHO platform“Early AI-supported response with social listening.”

Way forward: disseminating and mainstreaming infodemic
management practice in Member States

Between the start of the pandemic and 23 June 2022, 116
weekly digital infodemic intelligence reports were produced
and disseminated and 4.4 billion user-generated posts
and comments on social media related to COVID-19 wereanalysed. Among other noticeable results based on thisapproach, the WHO Regional Office for South-East Asia also
produced 100 weekly infodemic intelligence reports, and theAfrica Infodemic Response Alliance (AIRA) produced 53 weekly
infodemic trend reports between March 2021 and June 2022.

To leverage on this opportunity, WHO developed a training
programme and is developing country support packages for“pop-up” infodemic insights teams during an outbreak or
emergency. WHO recently co-hosted with UNICEF, the USCDC and Gavi a training where 568 participants from various
Member States learned to promote demand for routine
immunization and COVID-19 vaccines by leveraging on the
integrated analysis methods for infodemic insight generation.
Trainees applied this knowledge to scenarios of outbreak
response to COVID-19, monkeypox and other vaccinepreventable diseases and feedback was overwhelmingly
positive, signaling the relevance of the method. A newround of trainings is currently under consideration.

Overall, these WHO infodemic monitoring insights andrecommendations helped enhance the effectiveness of WHO’s
engagement in relation to COVID-19 and supported Member
States in their response. This tool has also proven to be relevant
for other topics beyond COVID-19, such as for instance the recent
Olympic and Paralympic Games in Beijing, China.

Moving forward, these analytical methods for infodemic
intelligence monitoring and generation could be appliedin epidemic and pandemic preparedness and prevention
for other vaccine-preventable diseases, such as seasonal
influenza and routine immunization. These could also help
in preparing for acute public health events or be adapted
for rapid use in outbreak and emergency response, suchas for instance monkeypox.

“I am currently
participating in
COVID-19 vaccination
outreach and am
already conducting
social listening
and demystifying
misinformation.
(…) Thanks to[the infodemic] training,
I am addressing
infodemics/information
voids regardingmonkeypox, trying tothink ahead of what
people need to know.”

Sample weekly short-text-message report distributedon Signal and WhatsApp messaging platforms for 13–19
April 2022. Credit: WHO

Screenshot showing a participant to the infodemic
training applying the knowledge and tools gainedin the field. Credit: Joel Lamika

Feedback from a participant to
the infodemic training co-hosted
by WHO, UNICEF, the US-CDC andGavi, the Vaccine AllianceOpenWHO and learning

16

Leaving no one behind: How OpenWHO.org ensures equity in health information delivery
for people living with disabilities

Screenshot from the OpenWHO Indian sign language course. Credit: WHO

Across the world, the COVID-19 pandemic has
disproportionally affected people living with disabilities,
highlighting the need for disability-inclusive COVID-19
response. Such response measures require accessible andtimely public health information, among others.
To meet the needs of people living with hearing and/or visual
impairments and ensure equity of health information delivery
during health emergencies, such as the COVID-19 pandemic,
the OpenWHO.org learning online platform has introduced
several approaches.
1. Hearing impairment
It is estimated that more than 1.5 billion people globally livewith hearing loss. OpenWHO courses have transcripts andsubtitles available in different languages, which can help
facilitate access for people living with hearing impairment.
In March 2020, OpenWHO’s “Introduction to COVID-19”
learning materials were made available in Indian sign language
to help meet the needs of learners in one of the world’s mostpopulous countries and beyond. Currently, the course hosts
55 000 learners across 150 countries, with 88.1% of learners
located in India, and other key learning communities situatedin Bangladesh, Pakistan, Saudi Arabia and Iraq. Half of thelearners are students (33.3%), health professionals (9.6%)
or personnel of non-governmental organizations (8.4%).

2. Visual impairment
Globally, at least 2.2 billion people have a near or distancevision impairment. Visual impairment can lead to lower levelsof educational achievement.
OpenWHO has several features to improve accessibility
for learners who are visually impaired, including:• Text alternatives for non-text content;• High-contrast colour schemes to improve readabilityof learning materials; and• Allowing learners to download text items (e.g., slides,
subtitles and supporting materials), which can be exploredin the appropriate resolution or size on a different device
or simply be printed.
In early 2022, OpenWHO began progressively rolling out a
new typeface called Atkinson Hyperlegible across its learningmaterials, which adds several design features that make it easy
for visually impaired people to recognise the letters, increasing
legibility and improving readability.
Overall, OpenWHO courses are free of charge and self-paced
so that anyone interested can complete a course at theirconvenience. This helps ensure that neither cost nor time serveas barriers to access for those who would benefit from thecourses’ accessible features.
The OpenWHO team is devoted to continuing to tailor its learning
approaches to meet the needs of people living with disabilities.
By doing so, OpenWHO can help make health information
accessible and delivered on time across different communities,
promoting equity in learning for health emergencies.

Appeals

17

WHO’s COVID-19 Response Funding in 2022: Delivering science, solutions and solidarity to end
the acute phase of the pandemicWHO’s Global Health Emergency Appeal for 2022 (GHEA)
contributes to our strategic target of 1 billion people being
better protected from health emergencies. This new annual
appeal covers WHO’s requirements to meet urgent emergency
and humanitarian health needs for every region, including the
COVID-19 response.

Contributions to WHO for COVID-19 appeal (Data as of 15 August 2022)

In WHO’s GHEA 2022, published in March 2022, WHO called for
US$ 2.7 billion to serve people around the world in the mostvulnerable settings, including US$ 1.59 billion for ending
the acute phase of the COVID-19 pandemic. Two years of
COVID-19 have stretched health systems, societies and supply
chains, leaving vulnerable communities with less capacity
to cope. The world is witnessing a significant increase in thenumber of people requiring humanitarian assistance – up from
235 million in 2021 to 274 million in 2022.

31.3%

65.1%

Thanks to the generosity of donors, investments in WHO’s
COVID-19 response have helped slow the pandemic’s
destructive path and enabled the introduction of life-saving
tools. But we have not yet addressed the inequities in accessto these tools among many of the communities and countries
that need them most. As of 15 August 2022, WHO has received
US$ 1.038 billion in support of its COVID-19 response andUS$ 57.1 million have been pledged. WHO’s current funding
gap against funds received and pledged is US$ 500 million.

3.6%

Total received: US$ 1.038 billion
Total pledged: US$ 57.1 million
Gap: US$ 500 million

367.0

Regional Office for Africa
Regional Officefor the Americas

165.9

Regional Office for the
Eastern Mediterranean

370.8
153.7

Regional Office for Europe
Regional Office forSouth-East Asia
Regional Office for
the Western Pacific
Headquarters

126.5
66.0
346.2

TOTAL US$ 1.59 billion

WHO COVID-19 budget by major office (US$ million)
WHO’s COVID-19 budget broken down by Access to COVID-19 Tools
Accelerator (ACT-A) pillar (US$ million)
ACT-A Pillars

Total

Diagnostics and therapeutics

214.3

Vaccines

189.8

Health systems and response connector

332.7

Research and development

753.7

Total

1596.1

Guidance and publications

18

This section showcases new or updated guidance and publications related to COVID-19
published by WHO in the past month (as of 15 August 2022).
Public health surveillance for COVID-19
Interim guidance
22 July 2022

Key points
Surveillance for COVID-19 remains critical to ending the COVID-19 emergency worldwide and informing public healthactions to limit the spread of SARS-CoV-2 and reduce morbidity, mortality and impact.
The World Health Organization (WHO) continues to recommend maintaining and strengthening surveillance toachieve the core surveillance objectives for COVID-19. This should include:• early warning for changes in epidemiological patterns• monitoring trends in morbidity and mortality• monitoring burden of disease on health care capacity (health and care workers, hospitalizations and intensive
care unit admissions)• incorporating strategic and geographically representative genomic surveillance to monitor circulation of
known variants of concern (VOCs) and allow for early detection of new variants of concern, circulation of SARSCoV-2 in potential animal reservoirs and changes in virological patterns.
In addition, WHO continues to recommend Member States with the capacity to carry out enhanced surveillance
activities and conduct special studies to:• describe and monitor SARS-CoV-2 infection in high-risk groups who continue to be at the highest risk of
exposure or severe disease• characterize new variants, including aspects of their severity, transmissibility, immune escape and the impact
of countermeasures• better understand post COVID-19 condition (long COVID), including the role of immunity and risk factors.
WHO recommends that the following remain priority groups and settings for SARS-CoV-2 surveillance:• priority groups: Individuals older than 60 years, individuals with immunocompromising diseases or taking
immunosuppressive medications, people with multiple co-morbidities, pregnant women and unvaccinatedindividuals• priority settings: environments where there is a higher chance that people belonging to priority groups
might stay for extended periods of time in close proximity with each other, such as in closed settings, longterm care facilities and nursing homes.
COVID-19 surveillance reporting variables from Member States to WHO include:• daily cases and deaths, as per International Health Regulations (IHR 2005) requirements• required weekly reporting to WHO of detailed surveillance variableso age and sex of probable and confirmed cases and deathso cases and deaths among health and care workers
o number of new cases admitted for hospitalization and to an intensive care unit (ICU)o number of persons tested with a nucleic acid amplification test (NAAT) and other testing methods.
• variants of concern (VOCs) and variants of interest (VOIs): date of detection of first case and weekly relative
prevalence (based on representative sampling)• vaccination: doses administered; number of persons vaccinated with a primary series and booster.
What is new in this version:••••

updated WHO case definitions (see the Annex), contact definitions, priority groups and settings in line withthe latest contact tracing and quarantine guidance
updates of core and enhanced surveillance objectives and methods in various settings, including
environmental and animal surveillance
updated guidance on surveillance of SARS-CoV-2 variants, including the integration of sampling for genomic
surveillance in SARS-CoV-2 testing strategies
updates of COVID-19 surveillance reporting requirements to WHO, which includes the addition of new ICU
admissions for COVID-19 treatment.
-1-

Public health surveillance for COVID-19: interim guidance (22 July 2022)
This document summarizes current WHO guidance for public health surveillance of coronavirus disease2019 (COVID-19) in humans caused by infection with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2). This guidance includes the new elements:• Updated WHO case definitions, contact definitions, priority groups and settings in line with thelatest contact tracing and quarantine guidance• Updates of core and enhanced surveillance objectives and methods in various settings, including
environmental and animal surveillance• Updated guidance on surveillance of SARS-CoV-2 variants, including the integration of samplingfor genomic surveillance in SARS-CoV-2 testing strategies• Updates of COVID-19 surveillance reporting requirements to WHO, which includes the additionof new ICU admissions for COVID-19 treatment.
WHO also updated the COVID-19 case definition, case report form and the process for weekly reporting
aggregated data.
Read guidance

Global Covid-19 Vaccination Strategy in a Changing World

Global COVID-19 Vaccination Strategy in a Changing World: July 2022 update (22 July 2022)
Global Covid-19 Vaccination Strategy in a Changing WorldThis strategy brief outlines updated goals, steps, targets, and operational priorities to guide countries,
policy makers, civil society, manufacturers, and international organizations in their ongoing efforts through2022. The goals are to sustain and enhance momentum to reduce mortality and morbidity, protect healthsystems, and resume socio-economic activities with existing vaccines, and to accelerate the development
and access to improved vaccine products.
Global Covid-19
Vaccination Strategy
in a Changing World
July 2022 update1

Towards the end of 2022, as more scientific uncertainties get resolved and more data becomes available,
WHO will embark on a consultative process to develop a global Covid-19 vaccination strategy for 2023
and beyond.
Read guidance
Therapeutics and COVID-19: living guideline (14 July 2022)
The WHO Therapeutics and COVID-19: living guideline contains the Organization’s most up-to-daterecommendations for the use of therapeutics in the treatment of COVID-19 and is updated regularly as
new evidence emerges. This tenth version of the WHO living guideline now contains 19 recommendations,
including two new recommendations regarding fluvoxamine and colchicine. No further updates to theprevious existing recommendations were made in this latest version.
Read guidance
Based on these WHO Therapeutics and COVID-19: living guideline, WHO produced a series of supportive
tools which are intended to provide supportive information for healthcare workers who are prescribing,administering and monitoring patients for non-severe COVID-19.
• Remdesivir for COVID-19, Administration of Remdesivir for COVID-19 and Safety and monitoringin patients receiving remdesivir for COVID-19• Nirmatrelvir-ritonavir for COVID-19, Administration of Nirmatrelvir-ritonavir for COVID-19
and Safety and monitoring for patients receiving Nirmatrelvir-ritonavir for COVID-19• Molnupiravir for COVID-19, Administration of Molnupiravir for COVID-19 and Safety and monitoringfor patients receiving Molnupiravir for COVID-19

For more information on WHO’s publications, click here.

Key links and useful resources
GOARN
For updated GOARN network activities, click here.
Emergency Medical Teams (EMT)For updated EMT Network activities, click here.
WHO case definition
For the WHO case definitions for publichealth surveillance of COVID-19 in humanscaused by SARS-COV-2 infection, published
December 2020, click here.
WHO clinical case definition
For the WHO clinical case definitionsof the post COVID-19 condition, click here.
EPI-WINFor EPI-WIN: WHO Information Network
for Epidemics, click here.
WHO Publications and Technical Guidance
For updated WHO Publications and Technical
Guidance on COVID-19, click here.

19

Epidemiological Update

For 10 August 2022 Weekly Epidemiological Update,click here. Highlights this week include:• The COVID-19 epidemiological update at the global
and regional levels.
• An update on the circulating SARS-CoV-2 variantsof concern (VOCs), including their geographic spreadand prevalence.

For more information on COVID-19 regional response:• African Regional Office• Regional Office of the Americas• Eastern Mediterranean Regional Office• European Regional Office• South-East Asia Regional Office• Western Pacific Regional OfficeNews

Highlights• Monkeypox: experts give virus variants new names• AFRO/WHO publishes the latest Africa Infodemic Response
Alliance (AIRA) report on Infodemic Trends:• Information Gaps: Do COVID-19 vaccines cause death?
• Key Monkeypox Misinformation Trends: (i) Tecovirimat
is being hoarded in the US; (ii) Monkeypox Vaccine
Components are Dangerous• WHO report shows poorer health outcomes for many
vulnerable refugees and migrants• Kenya and WHO launch bold initiative to transform Africa’s
health emergency response• WHO launches appeal to respond to urgent health needs inthe greater Horn of Africa• UNAIDS, UNICEF, and WHO launch New global alliancelaunched to end AIDS in children by 2030
• Second meeting of the International Health Regulations(2005) Emergency Committee regarding the multi-country
outbreak of monkeypox• WHO publishes the COVID-19 Vaccine Delivery Partnership
Situation Report – July 2022
• Of the 34 countries identified for concerted support by
the CoVDP in January 2022, 23 countries to date havesurpassed 10% coverage, and 7 countries have reached
at least 20% coverage• Interim statement on COVID-19 vaccination for children• WHO makes new recommendations for Ebola treatments,
calls for improved access• Celebrating 70 years of GISRS, decades of collaboration

Science in 5 is WHO’s conversation in science. In this video and audio series WHO experts explain thescience related to COVID-19. Transcripts are available in Arabic, Chinese, English, French, Farsi, Hindi,
Maithili, Nepali, Portuguese, Russian and Spanish.
Monkeypox: Who is at risk? (22 July)
Which communities are most at risk of Monkeypox in the current outbreak and why? WHO’s Andy Seale
explains how we can support the communities at risk in Science in 5.

Long-term qualitative scenarios andconsiderations of their implications for
preparedness and response to the COVID-19
pandemic in the EU/EEA
August 2022
Key messages
•
•

•

•
•

•

There are a wide range of potential trajectories for the progression of the COVID-19 pandemic in the
coming months and years. This document sets out a number of scenarios that are intended to beplausible, internally consistent, and coherent descriptions of possible futures.
The scenarios consider the epidemiological context that can generally anticipated in the EU/EEA from thesummer of 2022 onwards. The timeframe for the scenarios is from 2022 to 2032. In publishing thisdocument, ECDC does not ascribe a probability, nor suggest a higher likelihood of occurrence, for any of the
scenarios described, which are not quantitative forecasts. The scenarios are based on the key variables ofgrowth rate, disease severity and immune protection from severe outcomes.
The qualitative scenarios are not mutually exclusive; over the course of the next decade it is entirely
likely that there could be a transition from one scenario to another, due to changes in the virus, thelevel of immunity in the population or variations in societal response. The coming years will require
extreme vigilance should new, more severe or more transmissible variants of SARS-CoV-2 emerge.
The scenarios and the associated public health response priorities outlined in this document provide a
potential framework for defining overall strategic objectives and actions for managing COVID-19
according to a range of possible trajectories in the future.
Such strategic objectives need to be agreed upon so that operational discussions on the implications
for a wide range of public health activities can take place according to a common understanding.
The public health activities outlined in this document that need to be considered in preparing for potential
future scenarios include, but are but not limited to, surveillance, risk communication, pandemic
preparedness, early warning, vaccination, medical countermeasures, NPI measures and IPC measures.

Background
The European Commission Communication, published in April 2022, put forward an approach for the managementof the pandemic in the months to come, supporting a move from emergency to a more sustainable mode [1]. This
reflected the fact that many EU/EEA countries currently have or are approaching high levels of population immunity
against severe disease (through vaccination and/or natural infection) and, consequently, have observed reduced
severity of outcomes with the currently circulating Omicron variant of concern (VOC).
The Commission Communication also set out an analysis on qualitative long-term scenarios, developed by ECDC,
that demonstrated a wide range of possible outcomes, based on the assumption that SARS-CoV-2 is here to stay
Suggested citation: European Centre for Disease Prevention and Control. Long-term qualitative scenarios and considerations of theirimplications for preparedness and response to the COVID-19 pandemic in the EU/EEA. August 2022. ECDC: Stockholm; 2022.
© European Centre for Disease Prevention and Control. Stockholm, 2022.

TECHNIAL REPORT

Long-term scenarios and their implications for preparedness and response to the COVID-19 pandemic in the EU/EEA

and will probably represent a long-term challenge to public health and healthcare systems. ECDC’s document
elaborates on those longer-term scenarios.
There are a wide range of potential trajectories for the progression of the COVID-19 pandemic in the coming
months and years. The trajectory of the pandemic will ultimately be determined by a large number of parameters
including, but not limited to, characteristics of emerging and circulating variants of SARS-CoV-2, effectiveness andwaning protection from vaccination and/or natural infection, human behaviour, demographics and public health andpolitical responses.
As the COVID-19 pandemic has continually demonstrated, delayed or insufficient action can be costly. Qualitative
scenarios can be used to fill the gap between the need to rapidly implement evidence-informed policy decisions
and the availability of sufficient scientific evidence.
Part 1 of this document presents qualitative scenarios that have been developed to focus on possible trajectoriesof the pandemic for an approximate ten-year period, from the present time onwards. These scenarios areintended to support decision-making until further information becomes available. The scenarios were briefly
described in a European Commission Communication 1 and this document aims to provide further details.
Part 2 outlines public health priorities that are relevant across all of the scenarios, focusing on the shorter-term,
as it is during the next few years that recovery from the COVID-19 pandemic and preparedness for the long-term
management of COVID-19 needs to take place.

1. Qualitative pandemic scenarios
The scenarios presented in Table 1 are intended to be plausible, internally consistent, and coherent descriptionsof possible futures [2]. The scenarios consider the epidemiological context generally anticipated in the EU/EEA from2022 onwards. The timeframe for the scenarios is from 2022 to 2032. These have been developed by a multidisciplinary team at ECDC and previously presented to the ECDC Advisory Forum.
At the time of writing, there are still many uncertainties and knowledge gaps, which ECDC has appraised throughexpert consultation [3]. While many factors may affect the COVID-19 pandemic, the scenarios developed
consider different combinations of the primary variables presented below.
1. Viral properties••••

Viral evolution
Growth rate
Disease severity (intrinsic)
Seasonality.

2. Immunology••

Immune protection from severe outcomes
Duration of protection.

3. Societal factors••••

Societal tolerance for non-pharmaceutical interventions (NPI) and infection prevention and control (IPC) measures
Societal tolerance for the residual risks of COVID-19
Vaccination acceptance
Healthcare system capacities.

4. Medical interventions•••

Vaccines
Antiviral medications
Diagnostics.

1

European Commission Communication: https://health.ec.europa.eu/publications/covid-19-sustaining-eu-preparedness-andresponse_en

2

TECHNIAL REPORT

Long-term scenarios and their implications for preparedness and response to the COVID-19 pandemic in the EU/EEA

Table 1. Description of qualitative long-term scenarios
Scenario

Description

Key scenario assumptions

A diminishedthreatIn this scenario, the vast majority of the global
population has been previously infected with SARSCoV-2 and/or received COVID-19 vaccinations.
Consequently, the observed severity of COVID-19
outcomes has been driven down to very low levels.
While SARS-CoV-2 continues to circulate globally andnew variants are periodically detected, the crossprotective immunity accrued through 2020, 2021 and2022 means that while reinfections are fairly common,
the impact of new variants on hospitalisations andmortality has become and remains very low.

Viral properties
No new variants with significant immune
escape properties emerge.

In this scenario, COVID-19 is deemed across the
EU/EEA to be routinely manageable.
There remains a persistent risk of a SARS-CoV-2
variants of concern emerging that reverses the
dynamics of this scenario and leads to higher levels of
hospitalisation and mortality.

Regularreinfections

In this scenario as in ‘A diminished threat’, a large
proportion of the global population has acquired
natural or vaccine-induced immunity, which provide asignificant reduction of risk for severe outcomes.
However, in this scenario, vaccine-induced and naturalimmunity are less efficient in preventing infection ortransmission, and new immune-evading variants
continue to emerge, driving frequent reinfections.
Although COVID-19 mortality remains relatively low,waning immunity is apparent and there are nonnegligible rates of hospitalisations and mortality
among at-risk populations. However, since most
severe cases are reported in people with known risk
factors, healthcare systems can cope with this burden.
Vaccines targeting the most recent variants are madeavailable on an annual basis and are recommended for
at-risk groups (e.g. immunocompromised, older adults
and others with underlying comorbidities) in order toreduce pressure on healthcare systems, but vaccine
uptake rates continuously decline. EU/EEA countries
have generally abandoned the population-level NPIs
that were implemented in 2020 and 2021. Emphasis isplaced upon voluntary measures when interacting withrisk groups.

Long, barely
manageable
winters

As in the second scenario ‘Regular reinfections’, thevirus continues to circulate at considerable levels andreinfections are common, occurring at a rate of one ormore per year for a healthy person. However, in this
scenario the repeated emergence of moretransmissible and immune evasive variants allows thevirus to outpace vaccines and our immune system's
protection against infection and onward transmission.
In this scenario SARS-CoV-2 transmission intensity
follows a seasonal pattern with the highest
transmission in the EU/EEA between December andFebruary. Thus, the highest SARS-CoV-2 spreadcoincides with that of other seasonal diseases(rhinovirus, RSV, influenza, other humancoronaviruses). While the observed severity of SARSCoV-2 is strongly reduced since the virus first3

Immunology
Natural and vaccine-induced immunity against
severe disease is very high globally;
protection against reinfections is only partial.
Immunity from severe outcomes appears to
be long-lived and rates of severe outcomesare very rare among healthy individuals.
Societal factors
COVID-19 is not considered to be a majorsocietal threat and the majority of the
population has learned to live with theoccasional SARS-CoV-2 reinfection.
Medical interventions
Newer-generation vaccines that work across
SARS-CoV-2 strains appear to be feasible andare expected to limit transmission in the future.
Antiviral medicines are effective at reducing
severe disease.
Viral properties
Transmission levels remain high globally, withseasonal fluctuations.
Immune evasion variants periodically appear.
Immunology
Natural and vaccine-induced immunity is very
high globally but does not protect against
reinfections.
Immunity from severe outcomes appears to belong-lived (e.g. multiple years) and rates ofsevere outcomes are low, but enough waning
immunity exists to threaten the health of at-risk
people.
Societal factors
Declining uptake rates for vaccine boosters
and little political or population acceptance forthe re-introduction of NPIs, due to a collective
sense that reinfections are inevitable but
mostly harmless.
At-risk populations are generally moreamenable to follow-up vaccinations and to
adopting voluntary protective measures during
periods of high transmission.
Medical interventions
The high rate of reinfections and theemergence of new variants has proven to bedifficult to counter with proposed variantadapted SARS-CoV-2 vaccines.
•
Vulnerable populations are often the focus ofannual vaccination campaigns.
Viral properties
Immune evasion variants appear.
A winter seasonal transmission pattern has
become apparent.
Immunology
Combination of variants with immune evasion
and some degree of waning immunity leads tosevere outcomes among some at-risk groups.
Societal factors
The regular reintroduction of a select range oftargeted measures is generally accepted but
there is a very visible opposition to more
stringent population-level NPIs.
There is a minor but steady reduction in public
acceptance of additional vaccine doses.

TECHNIAL REPORT

ScenarioLong-term scenarios and their implications for preparedness and response to the COVID-19 pandemic in the EU/EEA

Description

Key scenario assumptions

emerged, in some years SARS-CoV-2 variants emerge
with higher intrinsic severity and this, combined withwaning immunity and a declining willingness among
the population to accept additional vaccine doses,
leads to significant winter-time strains on healthcare
systems.

-

There remains considerable debate about whether andto what extent population-level NPIs should be reimplemented.

Long,
unmanageable
winters

As in the above scenario, the virus continues tocirculate at considerable levels and reinfections occur
frequently and with a seasonal pattern. The repeatedemergence of more transmissible and immune evasive
variants allows the virus to outpace vaccines as well as
immunological protection against infection and onward
transmission.
In contrast to the above scenario, despite the fact thatthe perceived individual-level risk is low for mostpeople, in winter months, the pool of susceptible
people has built up more quickly. Hospital burdens
increasingly become unmanageable. While much ofthis burden is among at-risk people, there is sufficientwaning of immunity and viral evolution to regularly
lead to hospitalisation rates among the general
population that exceed healthcare system capacities.
Such circumstances would in theory necessitate the reimplementation of stricter NPIs, but they will have tobe targeted, as population-level NPIs have become
highly unpopular and are poorly adhered to. In
addition, attention is paid to promoting voluntary
protective measures, and to annual vaccination
campaigns targeting the general population, even if
there appear to be diminishing returns from suchcampaigns.

A newpandemic

Under this scenario, the persistent threat of novel
pandemic strains emerging is eventually realised. A
new variant of concern (or a different pandemic virus)
begins to circulate and establish itself in exposed
populations, with indications suggesting a significant
impact on public health.
The experience of COVID-19 has demonstrated theimpact that enhanced public health measures can haveif enacted rapidly. Hence in the initial phases,
introducing restrictive and precautionary infection
control and social distancing measures may be
warranted. This will have the dual benefit of reducing
initial spread and minimising immediate burden on
healthcare systems, while also buying time to gain abetter understanding of the scale of the potential
public health threat. It will also help with thecommencement of vaccine roll-out and extend thetime window for effective development anddeployment of strain-specific vaccines and other new
interventions.
If this scenario were to occur in the near future, thegreatest challenge would arguably be to reengage withthe public to aid compliance with restrictions during
the period of uncertainty following initial emergence.
The (re)imposition of stringent restrictions in an
already pandemic-fatigued population would require
careful assessment and different policy approaches
may be needed to obtain public trust and support.

4

Vulnerable populations are generally
amenable to receiving additional vaccinations
and adopting voluntary protective measures.

Medical interventions
Annual vaccination campaigns target the at-risk
population and, periodically, the immunologicalnaïve, including young children.
While antiviral medicines work well whenprovided early in the course of disease, duringseasonal surges the capacity to ensure earlyadministration of antivirals to at-risk
populations is stretched to the limit.
Viral properties
Frequent emergence of more transmissible,
immune-evasive variants
A winter seasonal transmission pattern has
become apparent.
Immunology
The combination of waning immunity andimmune-evasive variants leads to high rates
of severe outcomes among at-risk groups andmoderate rates of severe outcomes among
the general population.
Societal factors
Adherence to unspecific population-level NPIs
is low, but higher for targeted and time-bound
NPI and IPC measures during periods of hightransmission.
Vaccination fatigue across all groups,
accompanied by a widespread sentiment that
if vaccines worked the virus would no longer
be so problematic.
Medical interventions
Annual vaccination campaigns target the full
population but rarely exceed 45% coverage.
While antiviral medicines work well whenprovided early in the course of disease, duringseasonal surges the capacity to ensure earlyadministration of antivirals to at-risk
populations is stretched to the limit.
Viral properties
A new virus has emerged with a high intrinsic
severity and the ability to transmit rapidly
Immunology
The global population is immunologically naïve
to this pandemic virus.
Societal factors
Fatigue from the COVID-19 pandemic and low
levels of resilience as societies are still not
fully recovered from COVID-19.
Medical interventions
Rapid upscaling of vaccine programmes will
be a priority.
The advances in vaccination technologies
exhibited during the COVID-19 pandemic
create hope that within 4−6 months, strainspecific vaccines will become available.
As with the COVID-19 pandemic, it isexpected to take many years to produce
enough vaccine supplies for the entire global
population.

TECHNIAL REPORT

Long-term scenarios and their implications for preparedness and response to the COVID-19 pandemic in the EU/EEA

It is important to note that the scenarios presented in Table 1 represent a range of plausible future possibilities.
The range of scenarios represents a continuum, from least to most severe outcomes (Figure 1). In addition, it isimportant to note that the scenarios presented here are not necessarily mutually exclusive. It is entirely possiblethat for a period of time, one scenario will manifest itself, but this does not preclude a transition into anotherscenario. This underscores the importance of continued vigilance, based on effective surveillance, in order toinform timely and proportionate EU/EEA preparedness and response. However, while preparedness needs to bein place to address the most severe scenarios, there are also specific types of public health responses that should
be in place for each of these scenarios – these are elaborated in Section 2.
Figure 1. Continuum of plausible pandemic scenarios

5

TECHNIAL REPORT

Long-term scenarios and their implications for preparedness and response to the COVID-19 pandemic in the EU/EEA

2. Public health actions required acrosspandemic scenarios
As noted above, the pandemic scenarios presented in this document may at any point transition to a more orless severe scenario. Continued public health vigilance, and preparedness to implement specific types ofmeasures across the scenarios will be paramount to ensure that the scenarios have the least possible health andsocietal impacts in the EU/EEA. A summary of some of the key public health activities that may be relevant foreach scenario is summarised in Table 2 below.
Table 2. Implications and public health actions required, depending on the different scenarios
Scenario nameScenario
number
Viral properties:
public healthconsequences/actionImmunology:
public healthconsequences/actionSocial factors:
public healthconsequences/actionDiminished threatLong, barely
manageable winters

Regular reinfections

Long,
unmanageable
winters

A new pandemic

1

2

3

4

5

• Routine samplingand sequencing
ongoing to support
assurance of strain
stability.
• Integrated
respiratory
surveillance atcommunity andhospital levels.

• Continual variant•
monitoring focusing on
rapidly developing or
atypical clusters andpatients exhibiting•
unusualepidemiological/clinicalpresentation as likely
sources of emergence(symptoms, severity,
duration etc.)•• Requirement for
appropriate levels of
testing implementing
community wide COVID19-specific surveillance(self-testing).

Seasonal scale-upof variant monitoring
and rapid strain
characterisation.
Increased testingand sequencing
requirements may
go beyond‘peacetime’requirements.
Ensure seasonal
rapid antigen testing
capacity is in place
to support routine
self-testing during
peaks.

• Expansive variant
monitoring andrapid strain
characterisation
established as
routine.
• Testing capacity
adjusted to address
seasonal peaks,
with potential
increased relianceon self-testing andquarantine during
peaks due to limits
on community
testing capacity.

• COVID-19 vaccines
introduced into
routine vaccination
programmes,
schedules basedon estimatedduration ofprotection against
severe disease.
Focus onindividuals at risk
and those eligible
but not yet
vaccinated with a
primary course andbooster dose(s).
• Challenge tomaintain vaccine
uptake in theabsence ofsignificant healthburden.
• Basic hygiene
measures promoted,
but specific COVID19
mitigation/interventio
n measures largely
absent in mostsettings (including
towards/within
vulnerable groups).
• Healthcare systems
prioritise non-COVID
care.

• Routine COVID-19•
vaccination programmes
may be supplemented
with targeted booster
campaigns for at-risk
groups where there isevidence of waning
protection against
severe disease.
• Challenge to maintainvaccine uptake.

Consider seasonalstrain-specificvaccination
deployment targeting
at-risk groups, andtheir contacts.
Attendant need for
vaccine teams(human resources,
supplies, etc) andspecial vaccinationsites and delivery
options during timelimited periods.
Supported campaignsfor vaccine uptake in
key groups, including
healthcare workers
and staff in long-termcare facilities (LTCFs),
for both direct andindirect protection.
Seasonal NPI
implementation during
periods of hightransmission/infection
including: selfmonitoring, self-testingand self-isolation for allwith symptoms during‘COVID season’.
Increase adherence
to NPI mitigation andinterventions forvulnerable groups andsettings (social
distancing, use ofmasks in LTCFs,
hospitals).

• Emphasise publichealth value indeploying seasonalstrain-specificvaccination for all.
• Concerted
vaccination
campaign toencourage general
population uptake,emphasising
importance ofvaccination for atrisk groups.
• Utilise communitywide vaccination
centres to support
rapid vaccine
uptake.

• Expansive variant
monitoring andrapid strain
characterisation(genotypic andphenotypicassessment).
• Increased testingand sequencing
requirements,
adjusted toavailable capacity.
• Possible limits intesting availability if
existing tests
display reduced
specificity/sensitivity
to emerging strains.
• Massive global
research effort todevelop strainspecific vaccines.
• Reliance on NPIs
and other ‘social’
measures as theprimary mitigation
approach inabsence of effective
vaccines.

•• Messaging focused on•voluntary isolation if
symptomatic (individual
responsibility).
• Possible targeted ‘light’
mitigations (NPIs, etc.)
for vulnerable groups
and settings withescalating infection rates(e.g. use of masks in•
LTCFs, hospitals).
• Hospitalised/severe
COVID-19 cases
integrated into normal
hospital casemanagement.

6• Seasonal NPI
implementation
during periods ofhightransmission/infection, including:self-monitoring, selftesting and selfisolation for all withsymptoms during‘COVID season’.
• Required adherence
to NPI for vulnerable
groups and settings(shielding, selfisolation, use ofmasks).

Multi-layered response
based on risk-based
approach that optimises
NPIs to maximise publichealth impact, minimises
societal burden, andmaintains adherence.
Options may include:• enhanced contact
tracing, quarantine
and isolation of close
contacts;• increased testing
requirements,
including assisted andself-testing (increased
diagnostic testing
capacity);TECHNIAL REPORT

Scenario nameScenario
numberLong-term scenarios and their implications for preparedness and response to the COVID-19 pandemic in the EU/EEA

Diminished threat

Regular reinfections

Long, barely
manageable wintersLong,unmanageable
winters

A new pandemic

1

2

3

4

5

•

•

Medicalinterventions:public healthconsequences/action• Broadly effective
vaccines, andabsence of immune
escape variants
reduce the need forstrain specificvaccineprogrammes/boosters, but still require
broad-level ofvaccine uptake to be
maintained among
at-risk groups inorder to retain
protection against
severe disease at
population level.
• AV stocks and usage
supported undernormal treatment
guidelines.

• Antiviral usage employedaccording to standard
prescribing practices toreduce severe disease.

The need for
proportionate NPIs inother settings mayneed to be assessed(e.g. use of masks,
social distancing).
Implement specific
COVID-19 hospitalmanagement plans,with possible
reprioritisation of careto address COVID-19
patient needs within
existing capacity
during peak season.

• Increase AV usage
as numbers of cases
increase withpossible need forprioritisedprescription during inpatient surges.

7• Remote working/ on- • NPIs in community
line environments
settings including use
may be considered.
of masks, social
distancing, capacity• The need forlimits etc.
proportionate NPIs in(schools/workplaces
other settings willetc.);
need to be assessed(e.g. use of masks,• viability of nonsocial distancing,essential services.
limits on community(shops, restaurants
gatherings, vaccineetc.);
certification).
• extended use of• Possible
remote working/oninfection/symptomline environments;.
monitoring in• clear communication
community settings
strategies are the key(schools andto emphasising
workplaces, etc.) tocommunity
remain open.
responsibility to• Community
minimise impact;
engagement and• contingencies forcommunication
surge-capacity instrategies key tohealthcare systems
support compliance(including healthcare
in sceptical/fatigued
workers) in place forpopulations.
months.
• Options for
expanded
inpatient/ICU
hospital capacity
during peaks (beds,
healthcare workers,etc.) to manage
COVID cases.
• Increase AV usage as • Reliance on social
numbers of cases
measures in the shortterm until strain-specificincrease with possible
need for prioritised
vaccines becomeprescription during inavailable.
patient surges.
• Vaccine roll-out definedby assessment ofapproaches to minimise
health burden.
• Early assessment ofeffectiveness of existing
medical interventions
and treatments tomitigate (severe)
disease.

TECHNIAL REPORT

Long-term scenarios and their implications for preparedness and response to the COVID-19 pandemic in the EU/EEA

2.1 Public health objectives beyond the acute andtransition phases of the pandemic
There are numerous public health actions that will require priority in the coming years. On 26 April 2022, theEuropean Commission published a Communication on sustaining EU preparedness and response [1]. This iscomplemented by an ECDC-authored perspectives paper, outlining public health considerations for transitioning
beyond the acute phase of the COVID-19 pandemic [4].
To summarise these documents in brief, there is still a strong need to remain vigilant in the longer-term
scenarios described in this paper. The European Commission highlighted the following areas as priorities for
Member State attention:
•
•
•
•
•
•
•
•

Step up vaccination and boosting, taking into account the simultaneous circulation of COVID-19 andother respiratory viruses, such as seasonal influenza.
Set up integrated surveillance systems that are no longer based on the identification and reporting of all
COVID-19 cases, but on obtaining reliable and representative estimates.
Continue targeted testing and sequencing of sufficient samples to accurately estimate variant circulationand detect new variants.
Invest in the recovery of healthcare systems and assess the wider health impacts of the pandemic,
including on mental health and delays in treatments and care.
Apply EU coordinated rules to ensure free and safe travel, both within the EU and beyond.
Support the development of the next generation of vaccines and therapeutics.
Intensify collaboration against mis- and disinformation on COVID-19 vaccines and NPIs.
Continue to deploy global solidarity and improve global governance.

Further details on selected cross-cutting activities that would collectively help to achieve these objectives arepresented below.

2.1.1 Refining surveillanceAppropriate and sustainable surveillance will be essential for tailoring and evaluating responses in all scenarios, anddetecting the early signs of transition from one scenario to another. The current sentinel ILI/ARI and SARI
surveillance systems should be significantly strengthened to increase their geographical coverage, sensitivity, andrepresentativeness [5]. Systems will need to include sufficient coverage of sequencing to detect variant emergenceand trends and will need to be integrated with the overall respiratory virus monitoring strategy. Failure to do so will
hamper the possibility to effectively monitor the levels of virus circulation in the community and protect the mostvulnerable. Furthermore, in the absence of such systems, we will be at constant risk of missing emerging virus
variants or detecting them with significant delay. Such systems will allow for the rapid detection of seasonalincreases at manageable testing levels, while avoiding artefacts that can result from ascertainment bias.

2.1.2 Sequence capacity and sharing
It is in the global interest to ensure that all countries have sequence capacity to monitor virus evolution. It is also
important that countries are incentivised and not disincentivised (e.g. by travel and trade restrictions) to
exchange information as promptly as possible on any new SARS-CoV-2 variants, novel viruses or health threats
generally. Measures are vital to ensure that information sharing from scientific or public health communities on
new variants is widely supported and that the response to the pandemic is globally coordinated.

2.1.3 Enhancing preparedness and response
While much has been learned about the role and effectiveness of response measures during the last two years,
there are still gaps in our understanding about what and when specific measures are optimally applied in theface of changes in the epidemiology of COVID-19.
Priority actions to address these gaps include:•••

Careful assessments of the effectiveness, cost-effectiveness, and social acceptability of the range of NPIs
implemented during the COVID-19 pandemic. This will inform future decision-making if time-limited
introduction of NPIs is required in the future in response to enhanced viral circulation or outbreaks.
It is critical to identify thresholds and develop protocols for outbreak identification and management,
including contact tracing, with an emphasis on congregate and healthcare settings.
Rapid identification and assessment of key epidemiological parameters (including severity, transmissibility,
immune escape) is vital, particularly through the conduct of ‘first few’ studies, for each new variant ofinterest or variant of concern. This includes:−
operational study protocols to quickly assess secondary attack rates and growth rates, and Rt and R0
are needed to provide reliable risk assessments;−
the ability to rapidly assess severity, including follow-up by age group, previous infection, andvaccination status of cases identified, each time a new variant emerges;−
readiness to quickly assess immune escape and waning protection against infection and severe disease,including by age group, previous infection, and vaccination status.

8

TECHNIAL REPORT

Long-term scenarios and their implications for preparedness and response to the COVID-19 pandemic in the EU/EEA

2.1.4 Protection of vulnerable groups
Owing to vaccine protection and immunity from natural infection the majority of the population is currently
expected to be protected from severe COVID-19. However, there will still be parts of the population that remain
vulnerable to unfavourable outcomes (and repeatedly so over time, with each new variant), such as older adults,
people with underlying conditions, the immunocompromised, the unvaccinated/partially vaccinated and those
whose protection from vaccines or natural infection has waned. Efforts should focus on the protection of thesepeople with both pharmaceutical (e.g. vaccine boosters, when necessary, and early access to antiviraltreatments) and non-pharmaceutical interventions.

2.1.5 Prevention of healthcare-associated COVID-19
COVID-19 can be transmitted within healthcare settings, often with devastating outcomes because it affects
people who are already vulnerable to severe disease and death. Optimisation of infection prevention and control
practices in both acute and long-term care settings is the key to mitigating the effects of COVID-19 in terms of
morbidity, mortality and healthcare burden. If variant-adapted vaccines demonstrate a greater effect against
infection and transmission, their administration to healthcare workers and LTCF personnel may be considered toprovide both direct and indirect protection.

2.1.6 Healthcare system management and resilience
COVID-19 has had a heavy toll on healthcare systems and the staff within them. In each of the scenarios
presented it is envisaged that COVID-19 will continue to give rise to hospital admissions, albeit at manageablelevels in the first two scenarios. Healthcare systems need to be capable of dealing with the accumulated backlog
of non-COVID-19 patients requiring management, and to be prepared for scenarios that will place them underfurther pressure. This will require:•••ongoing refinement of preparedness planning in laboratory and healthcare systems to ensure that staff andresources are able to meet increasing demand;increased focus on the resilience and adaptability of these systems in terms of financial and humanresources and allocated goods for healthcare delivery, including the direct negative impact of a decreasing
workforce due to staff infections (irrespective of whether these are acquired outside or within thehealthcare system);an increased understanding of levels of excess mortality and morbidity during the pandemic, which may
also relate to backlogs in non-COVID care.

2.1.7 Behavioural and societal aspects
Two years into the pandemic, there is still insufficient understanding of the behavioural, cultural and societal
drivers that have an impact on population acceptance and adherence to public health interventions (including
NPIs and vaccine uptake), or on how these can change over time. The emergence of a new variant, and theresultant potential need to refine intervention approaches exacerbates this uncertainty. Therefore there is a needto improve the capacity to conduct behavioural insights research on vaccine acceptance and various NPIs.
•

•
•
•

It can be expected that unless there is a major change in the (perceived) risk, severity or susceptibility to
severe outcomes, the willingness to adhere to any reintroduced unspecific population-level NPI measures oreven routine COVID-19 booster doses will decline in the general population over time (possibly less so invulnerable groups and healthcare workers).
It is unclear how the acute phase of the COVID-19 pandemic will lead to sustained lifestyle changes insociety (e.g. from teleworking, seasonal use of NPIs such as masks, as observed in other parts of theworld, adapting buildings to make them COVID-secure, etc.)
The question of protecting the most vulnerable in society through the adoption of targeted massvaccination programmes will need to be investigated, both in terms of effectiveness and cost-effectiveness,following the same processes and methods as are applied for non-pandemic diseases.
Continuing management of mis- and dis-information should be maintained.

2.1.8 Ensuring proportional responses
There is a need for broad political/societal agreement on the appropriate forms, level, and targeting of response
measures within any given scenario. At the milder end of the spectrum of scenarios, there are potentiallysubstantial, negative societal consequences to reintroduced stringent disease control measures and travel bans,
both directly in terms of impact on population health and livelihoods, and socially and politically if large proportionsof the population do not accept them. At the severe end of the spectrum, sufficiently targeted and proportionate
measures will be required to minimise the disruption to society while protecting those most at risk of severe
outcomes. Furthermore, there is a need for continual re-assessment of the risks from new variants balanced against
waning immunity. This will require measures to be proportional to the risk - neither too stringent, nor too relaxed.

2.1.9 Vaccine ‘agility’
As long as SARS-CoV-2 is circulating widely on a global basis, we may expect new variants to arise. New VOCs
may emerge at any time, with unpredictable characteristics, further affecting the duration of protection from9

TECHNIAL REPORT

Long-term scenarios and their implications for preparedness and response to the COVID-19 pandemic in the EU/EEA

current vaccine formulations. However, cell-mediated immunity from current vaccines, which is important forprotection against severe disease, has shown good cross-protection against different VOCs and seems broadly
preserved so far, although the duration of such preserved protection cannot be known until it has been possible
to follow up for a longer period.
It is important to be clear about the objectives of future vaccination and booster campaigns in the general
population and vulnerable groups (e.g. reduce severe disease, hospitalisations and deaths to an acceptable level,
protect vulnerable groups, reduce the overall burden of disease as much as possible, reduce viral circulation),and to balance these against the costs, opportunity costs, benefit and risks associated with repeatedvaccinations. Depending on the objectives and the priorities, and also on the actual added benefit that can beobtained from additional doses, different needs for COVID-19 vaccine development and deployment may arise.
It appears likely that there will be a regular need to develop and manufacture updated vaccines at scale,whether for primary vaccination courses or boosters. At present, the mRNA technology is the platform that candeliver updated versions of approved vaccines most rapidly, although the time required to develop variantadapted formulations at sufficient scale could be too long to have an impact on new waves of VOCs. The
capacity to develop and deploy updated vaccines in a timely manner could be required for decades as the virus
enters an endemic phase, especially given the unpredictability of variant emergence.
Efficiency improvements are required for the full vaccine development cycle, from processes for selecting
updated vaccine targets through to manufacturing. This should be done through a governance mechanism that
also prioritises equity for strain selection and includes consideration of alternative vaccine strategies such as
developing and deploying multivalent vaccines or targeting conserved SARS-CoV-2 virus antigens that may offer
more stable and broader protection against future variants.
Long-term vaccination strategies should align with public health priorities for managing COVID-19 burden as thesituation (and population immunity) evolves, addressing immunity gaps and protecting those most at-risk. Use of
vaccines will also need to be balanced against use of other pharmaceutical and non-pharmaceutical interventions, as theadded benefit derived from vaccines may increase if other measures are not adopted (or do not need to be adopted).
The speed at which vaccines can be produced, distributed and administered to citizens is also vital, given thedevelopment of scenarios that envision the need for a rapid response. This will require substantial global
investment to develop surge capacities, with resources to additionally monitor and respond to acceptance andconcordance challenges for recurrent COVID-19 vaccination in all population groups, but particularly in the mostvulnerable and at-risk population groups [7].

2.1.10 Determine the role of antiviral treatments
Novel antiviral therapeutics that are easily administered for the prevention of severe disease have the potential
to significantly contribute to decreased healthcare burden. It is necessary to define the indications of antiviral
agents and, if approved for use, ensure their availability at least for those who are most vulnerable to severe
COVID-19 and unfavourable outcomes. The potential development of antiviral resistance that can compromise
the effect of antiviral agents needs to be monitored.

2.1.11 Global health
COVID-19 has intensified existing discussions surrounding global health equity and demonstrates very clearly thatno country is safe until all countries are safe. Strategic decisions are required concerning enhanced investments inglobal health infrastructure and bolstering the availability of COVID-19 vaccines, antivirals, personal protection
equipment, medical equipment such as ventilators, and testing reagents on a global scale. Furthermore, there is aneed to support countries globally in conducting epidemiological investigations into new variants of concern.
Our understanding of possible pathways for virus evolution also needs to be improved. During the COVID-19
pandemic there were multiple instances of COVID-19 outbreaks among a range of mammalian species, and there
is a risk that the novel VOCs could emerge through reverse zoonoses, followed by zoonoses. Therefore, theanimal-human interface is a topic deserving of more attention at global level.

2.1.12 Lessons learned and after-action reviews
The COVID-19 pandemic has had a myriad of long-ranging impacts on public health and the world at-large. It isimperative that innovations and good practices that emerged during the pandemic are safeguarded. Lessons learned
must be acted upon so as to improve public health preparedness and response to future large-scale outbreaks andpandemics. An evidence-based approach should inform decision-making during the transition phase. Structured afteraction reviews and lessons learned exercises should be an important activity area during the pandemic transition phaseand there should be sufficient high-level buy-in to ensure that the results of these exercises are acted upon [8].

10TECHNIAL REPORT

Long-term scenarios and their implications for preparedness and response to the COVID-19 pandemic in the EU/EEA

3. Long-term strategic considerations
In the longer-term, through sufficient planning, preparedness, and foresight, the EU/EEA can be better equipped
to sustainably handle the additional long-term challenge that COVID-19 has created, in addition to other preexisting and continuing infectious disease threats. In this respect, pandemic preparedness in the EU/EEA needs
to be enhanced and coordination of responses between Member States optimised.
To achieve this, firstly, the overall strategic objectives and actions for future management of COVID-19 must be
agreed upon so that there is a common playing field. Secondly, operational discussions are required on theimplications for a wide range of public health activities, including surveillance, risk communication, pandemic
preparedness, early warning, vaccination, medical countermeasures, NPI measures and IPC measures.
Finally, moving forward, it is imperative that public health agencies have the best possible information, to ensurethat recommended mitigation measures are commensurate with assessed levels of risk.

Conclusion
Given the number of uncertainties surrounding possible trajectories for the COVID-19 pandemic, particularly inlight of the continued high levels of viral transmission globally, and the possibility that new variants of concern
may arise, it seems clear that SARS-CoV-2 is here to stay. As such, public health systems, clinical services andsociety in general will need to adapt to the fluctuating levels of threat that this virus is likely to present in the
coming years.
The scenarios presented here are based on a range of plausible trajectories, and have been developed tosupport and inform decision-making concerning the type of long-term investments and arrangements required to
manage the next phases of the COVID-19 pandemic. Common to all scenarios is the perpetual risk posed by new
SARS-CoV-2 variants. A key message is that even when or where current scenarios appear to be less severe,
adequate surveillance and monitoring systems need to be in place to detect changes in the level of threat posedby SARS-CoV-2, and preparedness must be strengthened in order to mount an effective and proportionate
response to rapidly deteriorating situations. The wide range of possible outcomes presented in this document
serves as a reminder that there is much work yet to be done to strengthen global and EU health security against
COVID-19 and future pandemics.

11

TECHNIAL REPORT

Long-term scenarios and their implications for preparedness and response to the COVID-19 pandemic in the EU/EEA

References
1.

2.
3.

4.

5.

6.

7.
8.

9.

10.

European Commission (EC). Communication from the European Commission to the European Parliament,
the Council, the European Economic and Social Committee and the Committee of the Regions COVID-19 Sustaining EU Preparedness and Response: Looking ahead. 26 April 2022. Brussels: EC; 2022. Available
at: https://health.ec.europa.eu/publications/covid-19-sustaining-eu-preparedness-and-response-lookingahead-0_en
Amer M, Daim TU, Jetter A. A review of scenario planning. Futures. 2013;46. Available at:https://www.sciencedirect.com/science/article/pii/S0016328712001978
European Centre for Disease Prevention and Control (ECDC). ECDC expert consultation on knowledge andresearch gaps related to the COVID-19 public health response. Stockholm: ECDC, 2022. Available at:https://www.ecdc.europa.eu/en/publications-data/ecdc-expert-consultation-knowledge-and-researchgaps-related-covid-19-public
Suk JE, Pharris A, Beauté J, Colzani E, Needham H, Kinsman J, et al. Public health considerations fortransitioning beyond the acute phase of the COVID-19 pandemic in the EU/EEA. Eurosurveillance.
2022;27(17):2200155. Available at: https://www.eurosurveillance.org/content/10.2807/15607917.ES.2022.27.17.2200155
European Centre for Disease Prevention and Control (ECDC)/World Health Organization Regional Officefor Europe (WHO). Operational considerations for respiratory virus surveillance in Europe. Copenhagen
and Stockholm: WHO/ECDC, 2022. Available at: https://www.ecdc.europa.eu/en/publicationsdata/operational-considerations-respiratory-virus-surveillance-europe
European Centre for Prevention and Disease Control (ECDC). COVID-19 surveillance guidance. Transition
from COVID-19 emergency surveillance to routine surveillance of respiratory pathogens. Stockholm;
ECDC: 2021. Available at: https://www.ecdc.europa.eu/en/publications-data/covid-19-surveillanceguidanceEuropean Centre for Disease Prevention and Control (ECDC). Facilitating COVID-19 vaccination
acceptance and uptake in the EU/EEA. Stockholm: ECDC; 2021. Available at:https://www.ecdc.europa.eu/en/publications-data/facilitating-covid-19-vaccination-acceptance-and-uptake
European Centre for Disease Prevention and Control (ECDC). Conducting in-action and after-action
reviews of the public health response to COVID-19. Stockholm: ECDC; 2020. Available at:https://www.ecdc.europa.eu/en/publications-data/conducting-action-and-after-action-reviews-publichealth-response-covid-19
Verelst F, Hermans L, Vercruysse S, Gimma A, Coletti P, Backer JA, et al. SOCRATES-CoMix: a platform fortimely and open-source contact mixing data during and in between COVID-19 surges and interventions inover 20 European countries. BMC Med. 2021 Sep 29;19(1):254. Available at:https://www.ncbi.nlm.nih.gov/pubmed/34583683
Pastor-Satorras R, Castellano C, Van Mieghem P, Vespignani A. Epidemic processes in complex networks.
Reviews of Modern Physics. 2015;87.3 (2015): 925. Available at:https://journals.aps.org/rmp/abstract/10.1103/RevModPhys.87.925

12LAST UPDATED: 23 AUGUST 2022

Monkeypox& mass gatherings
RECOMMENDATIONS FOR MASS GATHERINGSDURING A MONKEYPOX OUTBREAKUPDATE NO.

78

Confirmed cases of monkeypoxfrom 1 Jan 2022 to 17 Aug 2022

2

MONKEYPOX UPDATE

Photo: www.choosechicago.com

Why mass gatherings matter
Mass gatherings include activities and events of any size and typeAll have in common:•

the attendance of small or large number of people•

in close proximity and•prolonged and frequent interaction between people.

3

MONKEYPOX TRANSMISSION

Monkeypox transmission
Monkeypox is caused by the monkeypox virus•

Monkeypox virus is transmitted by close contact with someone who has signs
and symptoms (face-face, mouth-mouth, skin-skin, mouth-skin) or throughcontaminated particles of the virus if infected person has lesions in the mouth.

Photo: CDC

4

Monkeypoxtransmission
and mass
gatherings
Gatherings do not amplify transmission bythemselves – it is the risky behaviour during
events that matters•

Common exposure settings for monkeypox are
gatherings like parties, prides, parades, festivals,
concerts, and other congregation of people andthese may be a conducive environment for thetransmission.

•

Gatherings are the opportunities for information
outreach and risk communication and community
engagement (RCCE) activities.

5

A risk-based approach forholding safe gatherings••

WHO recommends that the decision-making process
related to holding, modifying, postponing or cancelling
gatherings should rely on a risk-based approach,tailored to the characteristics of the event.
In the context of the current outbreak monkeypoxassociated risks should be considered and factored inwhen planning a gathering event.

Communication& Consultation

Risk assessment:

Monitoring& review

1 Risk evaluation
2 Risk mitigation
3 Risk communication

Postponing or cancelling gatherings in areas
where monkeypox cases have been detected iscurrently not required as a default measure.
Recording& reporting
Fig. 3-step WHO Risk Assessment approach

6

PUBLIC HEALTH ADVICE

Public health advice
for event organizers
during the current
monkeypox outbreakConsider if the event you are planning is most
likely to be associated with risks of monkeypoxtransmission•

Link with health authorities and be aware of monkeypox
situation in the host area•

Instruct event staff on how to manage a possible case ofmonkeypox during the event•

Facilitate the adoption of appropriate PHSM to prevent riskof transmission of monkeypox
https://www.who.int/publications/i/item/WHO-MPX-Gatherings-2022.1

7

PUBLIC HEALTH ADVICE

What youneed to know
The event organizers should:•

Share information about monkeypox with prospective
attendees and all those involved in the event.

•Advise that anyone showing signs and symptoms
consistent with monkeypox symptoms should stay at
home.

8

PUBLIC HEALTH ADVICE

Individual
protective measures
to stay safe during
gatherings•

Get local health advice on monkeypox if attending
any specific event that might be related withincreased risk for monkeypox transmission•

Refrain from close contact with any otherindividuals and avoid attending gatherings if you
present signs and symptoms consistent withmonkeypox.

•

As skin-to-skin, mouth-to-month transmission during
sexual activity has been frequently reported as a likely
source of infection, sexual contact should be
avoided if you feel you may be infected withmonkeypox– even if you have not yet had aconfirmatory test.

9

PUBLIC HEALTH ADVICE

General advice
for the public•

Provide emotional and practical support to any friends
or family members who may be asked to self-isolate.

•

Contribute with combating misinformation by sharing
only reliable, evidence-based and non-stigmatizing
information from trustworthy sources.

•

Stigmatizing people because of the disease isnever okay.

10

IN SUMMARY

We all have a common goal:stop the outbreak and suppress
onward transmission
WHO encourages event organizers to:•

Raise awareness and avoid stigma•

Apply necessary PHSM according to the risk
assessment results•

Protect people at risk and prevent
transmission in all settings

Photo: cbsnews.com

11Additional resources
EPI-WIN Webinar on Monkeypox outbreak and mass gatherings(recording and presentations)
https://www.who.int/news-room/events/detail/2022/06/24/default-calendar/WHO-EPI-WIN-webinar-monkeypox-and-mass-gathering

WHO EURO: Monkeypox outbreak: Resource toolkit for event organisers
https://www.ecdc.europa.eu/en/publications-data/monkeypox-outbreak-resource-toolkit-event-organisers

WHO Monkeypox outbreak toolbox
https://www.who.int/emergencies/outbreak-toolkit/disease-outbreak-toolboxes/monkeypox-outbreak-toolbox

WHO EURO, ECDC: Interim advice for public health authorities on summer
events during the monkeypox outbreak in Europe, 2022
https://cdn.who.int/media/docs/librariesprovider2/country-sites/interim-advice-for-public-health-authorities-on-summer-events-during-the-monkeypoxoutbreak-in-europe-2022.pdf?sfvrsn=230439fc_1&download=true

Monkeypox Q&A
https://www.who.int/philippines/news/q-a-detail/monkeypox

12

LAST UPDATED: 27 AUGUST 2022

Monkeypox outbreak
updateSITUATION – TRANSMISSION – COUNTERMEASURESUPDATE NO.

79

MONKEYPOX

Monkeypox
declared a Public
Health Emergency
of International
Concern (PHEIC)
Cases reported across all 6 WHO regions
and 92 countries•

Reported since 1970s, but since May 2022, theoutbreak has rapidly spread to many new countries
and shown atypical symptoms•

New modes of transmission are being reported•

Clear risk of further international spread

Photo: WHO / EURO

2

CONFIRMED CASES & DEATHS

Global epidemiological situation
Number of cases

Data as of 27 August 2022, 17:00 CEST

Date of notification

Since 1 Jan 2022, cases reported to WHO from 101 (5 new) Member States / territories
across all 6 WHO regions•

As of 27 August 2022 (17h CEST), a total of 47,751 laboratory confirmed cases including 15 deaths(3 new), have been reported to WHO•

Number of cases has increased by 9.3% compared to the previous week3Confirmed cases of monkeypoxfrom 1 Jan 2022 to 29 Aug 2022

The designations employed and the presentation of the material in this publication do not imply the expression of any
opinion whatsoever on the part of WHO 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.

Data source: World Health Organization
Map production: WHO Health Emergencies Programme©WHO 2022. All rights reserved.

4

RENAMED STRAINSCurrent outbreakis due to variant
named Clade IIb
Monkeypox clades have been renamed on
13 August 2022•

Monkeypox virus is part of the Orthopoxvirus
genus which includes variola virus (smallpox) andcowpox virus•

There are two variants of monkeypox:
Clades I and II•

Clade I was formerly known as the Congo Basin Clade(Central African)•

Clade II was formerly known as the West African Clade•

Clade II has two sub-clades, Clade IIa and Clade IIb•

Clade IIb is attributed to most cases in the current
outbreakPhoto: WHO / EURO

5

Symptoms incurrent outbreak
People may experience all, only a few orno symptoms•

Symptoms can include:Ø fever,
Ø swollen lymph nodes,
Ø typical or atypical rash•

New clinical features include severe inflammation of therectum - proctitis (which is characterised by rectal bleeding,pain, diarrhoea), inflammation of the urethra (urethritis) andurinary retention•

Many cases are without any symptoms•

Complications include severe pain, secondary infections,abscesses, blindness, inflammation of the heart muscle andthe brain (myocarditis and encephalitis)

Photo: WHO / EURO

6

Some atypicalpresentations
This outbreak has seen atypical clinicalpresentation, such as:•

only a few or a single lesion•

absence of skin lesions in some cases, with anal pain andbleeding•

lesions in the genital or perineal/perianal area which do not
spread further•

lesions appearing at different (asynchronous) stages ofdevelopment•

the appearance of lesions before the onset of fever
Photo: WHO / EURO

7

VULNERABLE POPULATIONS

Vulnerable
populations
The overwhelming majority of cases (99%)
are male*•

Males between 18-44 years of age continue to bedisproportionately affected (77%)•

The majority of cases (98.1%) have been detected in
Men having sex with men (MSM)•

Those who identify as gay, bisexual or MSM and thosewith recent multiple partners have been primarily
affected•

Among cases with known HIV status, 39% are HIV
positive•

Many health workers have also been infected, mostly
in the community. At least three cases of infection due
to occupational exposure has been reported•

Pregnant women, children and thoseimmunocompromised continue to be vulnerable andshould take precautions

A sexual health worker who got infected. Photo credit: WHO / EURO

8

TRANSMISSION

Modes oftransmission
Monkeypox virus is transmitted from one
person to another by close contact•

Knowledge of monkeypox transmission is evolving•

Most commonly reported mode of transmission
was sexual encounters•

Person to person contact
Ø Close contact with skin lesions, body fluidsØ Ulcers, lesions or sores in the mouth andother mucocutaneous lesions
Ø Inhaling contaminated particles or virus,
usually in close proximity•

Contaminated materials
Ø Needles, tattoos, bedding, linens, clothing,eating utensils, sex toys•

Common exposure settings include parties,
bars, and large gatherings
Photo: Urban Connections

9

TRANSMISSIONManaging the
spreadPersons remain infectious while they havesymptoms, normally for between 2- 4 weeks•

Household members and sexual partners are at
greater risk of infection•

Those at risk should avoid close contact withpeople who have suspected or confirmedmonkeypox•

Any person with suspected or confirmedmonkeypox should be isolated until their lesions
have crusted and the scabs have fallen off

Photo: WHO / EURO

10

TRANSMISSIONManaging the contacts of monkeypox
infected persons
Contacts should be monitored daily for the onset of symptoms for a period of 21 days•

Asymptomatic contacts:
Ø should not donate blood, cells, tissue, organs, breast milk, or semen while they are under symptom
surveillanceØ can continue daily activities such as work and school (i.e., no quarantine is necessary)•

Health workers exposed while not wearing appropriate PPE do not need to be excluded from work if
asymptomatic, but should undergo active monitoring•

Proper information and training is needed for health workers and services providers

11Vaccines againstmonkeypox
In the past, vaccination against smallpox wasdemonstrated to be about 85% effective inpreventing monkeypox•

Research has yielded several safer vaccines for smallpox•

Second generation smallpox vaccines (ACAM 200)•

Third generation MVA – BN & LC16 smallpox vaccines
approved for monkeypox•

Supplies and access remain limited•

Primary (pre-exposure) preventive vaccination (PPV) is
recommended for persons at high risk of exposure•

men who have sex with men, others with multiple sex
partners•

health workers, clinical laboratory personnel working onmonkeypox,•

Others who may be at high risk

Photo: WHO / EURO

Post-exposure vaccination (PEPV) is
recommended for close contacts of cases,
ideally within 4 days (within 14 days if
asymptomatic), especially for those at high riskof severe disease12

THERAPEUTICS & ANTIVIRALS

Therapeutics& antivirals•

Tecovirimat
Ø is approved for treatment of smallpox in the US and CanadaØ has received full market approval for monkeypox by the European Medical Agency(EMA) under ‘exceptional circumstances’Ø WHO recommendation is for use under randomized control trial or Monitored
Emergency Use of Unregistered and Experimental Interventions (MEURI)
Ø not approved by WHO for Emergency Use Listing (EUL)Ø on grounds of compassionate use, limited supplies may be made available togovernments for treatment of severe disease

Photo: siga.com

13WHO PUBLIC HEALTH ACTIONS

WHO public health actions to
support member states
WHO and partners are working with Member States to understand the source andcharacteristics of the current outbreaks and raise awareness of monkeypox symptoms
and protective measures•

WHO has developed surveillance case definitions and new guidance for laboratory testing for the current
monkeypox outbreak in non-endemic countries•

Public health investigations are ongoing, including extensive case finding and contact tracing, laboratory
investigation, clinical management and isolation provided with supportive care•

WHO is working on ensuring rapid access to testing for monkeypox•

Genomic sequencing has been undertaken to determine the monkeypox virus clade(s) in this outbreak•

Vaccination for monkeypox is being deployed in some countries to manage close contacts, such as
health workers. WHO is convening experts to discuss recommendations on vaccination•

Participation in coordinated clinical trials for vaccines and therapeutics with standardized collection ofclinical and outcome data has been encouraged

14

Additional resources
Multi-country monkeypox outbreak:External situation reports
https://www.who.int/emergencies/situation-reports

OpenWHO: Monkeypox introduction
English:https://openwho.org/courses/monkeypoxintroduction

Français:

https://openwho.org/courses/variole-dusinge-introduction

OpenWHO: Monkeypox epidemiology,
preparedness and response
English:https://openwho.org/courses/monkeypoxintermediate

Français :https://openwho.org/courses/variole-du-singeintermediaire/Monkeypox outbreak toolbox
https://www.who.int/emergencies/outbreak-toolkit/diseaseoutbreak-toolboxes/monkeypox-outbreak-toolbox

Key facts about Monkeypox
https://www.who.int/news-room/fact-sheets/detail/monkeypox

WHO website: Monkeypox
https://www.who.int/health-topics/monkeypox/#tab=tab_1

Monkeypox Q&A
https://www.who.int/philippines/news/q-a-detail/monkeypox

Monkeypox: public health advice forgay, bisexual and other men who havesex with men
https://www.who.int/publications/m/item/monkeypox-publichealth-advice-for-men-who-have-sex-with-men

15

Multi-country outbreak of monkeypox
External Situation Report 4, published 24 August 2022
Data as received by WHO national authorities by 17:00 CEST, 22 August 2022
Risk assessment
Global risk – Moderate
WHO Regional risk
 European Region – High
 African Region, Region of the Americas, Eastern Mediterranean Region,
Southeast Asia Region – Moderate Western Pacific Region – Low-Moderate

Laboratory
confirmedcases
41 664

Deaths

12

Countries/
areas/
territories
96

HighlightsDuring the week of 15 to 21 August, the number of cases reported in the Region of the Americas shows acontinuing steep rise, confirming trends seen over the last several weeks. Globally, after four consecutive
weeks of increase, the number of monkeypox cases reported declined by 21% overall during the same
week (n=5907 cases) as compared to the previous week (n=7477 cases). This decrease may reflect earlysigns of a declining case count in the European region, which would need to be subsequently confirmed.
On 8 August, WHO convened a meeting of two WHO Collaborating Centres for orthopoxviruses and otherexperts in poxvirology and viral evolution to consider the naming of monkeypox virus (MPXV) variants.
Henceforth, the Congo Basin or Central African clade will be referred to as Clade I; the West African clade
will be referred to as Clade II, with subclades IIa and IIb, the latter referring to the variant that is
predominant in the multi-country outbreak.
WHO has updated the interim guidance on vaccines and immunization for monkeypox. Updates include
a clearer emphasis on the groups at risk of monkeypox for consideration for preventive vaccination, andupdated terminology for pre- and post-exposure vaccination. To reduce confusion with the terms used in
the management of HIV, the changes include using primary preventive (pre-exposure) vaccination (PPV)
rather than pre-exposure prophylaxis (PrEP), and post-exposure vaccination (PEPV) rather than postexposure prophylaxis (PEP).

Page 1

Epidemiological Update
From 1 January through 22 August 2022, 41 664 laboratory-confirmed cases of monkeypox and 12 deaths havebeen reported to WHO from 96 countries/territories/areas[i] in all six WHO Regions (Table 1). Since the last editionof this report published on 10 August 2022, 13 859 new cases (50% increase) and 1 new death were reported;and 7 new countries reported cases. In the past seven days, 23 countries reported an increase in the weekly
number of cases, with the highest increase reported in the United States of America. There are 16 countries thathave not reported new cases for over 21 days, the maximum incubation period of the disease.
The number of weekly new cases reported globally decreased by 21% in week 33 (15-21 August) (n=5907 cases)
compared to week 32 (8-14 August) (n=7477 cases). The majority of cases reported in the past 4 weeks were
notified from the Region of the Americas (60.3%) and the European Region (38.7%).
As of 22 August, the ten countries that have reported the highest cumulative number of cases globally are UnitedStates of America (n = 14 049), Spain (n = 6119), Brazil (n = 3450), Germany (n = 3295), The United Kingdom (n =3225), France (n = 2889), Canada (n = 1168), Netherlands (n = 1090), Peru (n = 937), and Portugal (n = 810).
Together, these countries account for 88.9% of the cases reported globally.
In the past seven days, two countries reported their first case. These include Iran (Islamic Republic of) andIndonesia.
Figure 1. Epidemiological curve of weekly aggregated confirmed cases of monkeypox by region, from 1 January
to 22 August 2022 17:00 CEST**This figure shows aggregated weekly data, for epidemiological weeks ending on Sundays. Data on the current
week, with incomplete data, will be presented in the next situation report.

Page 2

Table 1. Number of cumulative confirmed monkeypox cases and deaths reported to WHO, by WHO Region,
from 1 January 2022 to 22 August 17:00 CEST
WHO Region
African Region
Region of the Americas
Eastern Mediterranean Region
European Region
South-East Asia Region
Western Pacific Region
Cumulative

Confirmed
cases
404
20 43835
20 652
14
121
41 664

Deaths
7
2
0
2
1
0
12

Other key epidemiological findings:
 The outbreak continues to affect young people of male gender, with 98.2% (20 138/20 500) of cases withavailable data on the gender being males with a median age of 36 years (Interquartile range: 30-43 years).
Fewer than 1% (140/23 626) of cases with age data available are aged 0-17 years. This proportion differs
between countries, with those in West and Central Africa reporting a greater proportion of cases among
young age groups: 38.7% (65/168) of cases for whom age was available were among the age group 0-17,
out of which 12.5% (21/168) were aged 0-4.
 Among cases with sexual orientation reported, 95.8% (9484/9899) identified as men who have sex withmen. Of all reported types of transmission, a sexual encounter was reported most commonly, with 5954
of 7250 (82.1%) of all reported transmission events.
 The majority of cases were likely exposed in a party setting with sexual contacts, with 2204 of 3639
(60.6%) of all likely exposure categories.
 Among cases with known HIV status, 45% (4501/10 036) are HIV positive.
Infection among Health Care Workers
As of 22 August 2022, a small proportion of cases have been reported among health workers (HW) (n=256; 5.2%of cases with information available on the route of transmission), however, most were infected in the communityand further investigation is ongoing to determine whether the remaining infection was due to occupational
exposure. Healthcare-associated infection (HAI) has been confirmed in three cases to date.
For further information, please see the WHO Multi-country Monkeypox Outbreak – Global Trends.

Page 3

Figure 3. Geographic distribution of confirmed cases of monkeypox reported to or identified by WHO from official public sources from 1 January 2022 to 22 August
17:00 CEST

Page 4

Updates and WHO Advice
WHO continues to closely monitor and respond to the outbreak and support international coordination andinformation sharing with the Member States and partners. Clinical and public health incident response have been
activated by Member States to coordinate comprehensive case finding, contact tracing, laboratory investigation,
supported isolation, clinical management, implementation of infection prevention and control measures, risk
communication and community engagement, and vaccination activities, as well as support ongoing
epidemiological and countermeasures research.

Surveillance and Laboratory

WHO has updated the Monkeypox Case investigation form (CIF), as well as a minimum dataset Case reporting
form (CRF), to include the latest information on symptomatology and epidemiological parameters, and to alignwith the Temporary Recommendations issued by the Director General, after the declaration of the Public Health
Emergency of International concern (PHEIC).
Currently, WHO has received the CRF for around 90% of the total confirmed cases reported at the global level.
The consistency and completeness of these data vary widely between countries, but overall the analysis of thecollected information in the global report provides a good view of the ongoing outbreak.
WHO is piloting a systematic collection of information about the outbreak response implemented by countries
for monkeypox through a Policy and Response Tracker, which includes information about surveillance, testing,isolation, quarantine and vaccination.
On 8 August, WHO convened a meeting of two WHO Collaborating Centres for orthopoxviruses and other experts
in poxvirology and viral evolution to consider the nomenclature of monkeypox virus (MPXV) variants. Goingforward the Congo Basin or Central African clade will be referred to as Clade I; the West African clade will bereferred to as Clade II, with subclades IIa and IIb, the latter referring to the variant that is predominant in the
global outbreak.

Clinical management, vaccines and therapeutics
Vaccines
WHO has updated the interim guidance on vaccines and immunization for monkeypox. Updates include a clearer
emphasis on the groups at risk of monkeypox for consideration for preventive vaccination, and updated
terminology for pre- and post-exposure vaccination. To reduce confusion with the terms used in the preventionof HIV infection, the changes include using primary preventive (pre-exposure) vaccination (PPV) rather than preexposure prophylaxis (PrEP), and post-exposure vaccination (PEPV) rather than post-exposure prophylaxis (PEP). The
guidance emphasizes that the effectiveness of vaccination in the context of the current monkeypox outbreakremains uncertain. As before, WHO strongly encourages Member States to convene their national immunization
technical advisory groups (NITAGs) to review the emerging evidence and develop policy recommendations forPage 5the use of vaccines as relevant to the national context, both to ensure readiness in countries where there are few
or no cases reported, as well as to support a timely response when required. It is recommended to implement
vaccine efficacy studies during vaccine roll-out to document vaccine effectiveness and evaluate immunization
strategies.
Post-exposure vaccination (PEPV) is recommended for close contacts of cases, ideally within four days of first
exposure (and up to 14 days in the absence of symptoms), to prevent onset or mitigate severity of the disease.
Primary preventive vaccination before exposure (PPV) is recommended for individuals at high risk of exposure(importantly but not exclusively gay, bisexual and other men who have sex with men and/or have multiple sexual
partners) and for health workers at high risk of exposure, laboratory personnel working with orthopoxviruses,
clinical laboratory personnel performing diagnostic testing for monkeypox, and outbreak response teammembers (as designated by national public health authorities).
Persons at risk of exposure and at higher risk of severe disease (e.g. immunocompromised persons, pregnant
women, or children who are potential contacts or members of the same household as persons with monkeypox)
should be offered vaccination with appropriate vaccine on a case-by-case basis. All decisions around
immunization of individuals with monkeypox or smallpox vaccines (before or following potential exposure)should be by shared clinical decision-making between the health care provider and prospective vaccinee, basedon a joint assessment of risks and benefits, on a case-by-case basis.
Member States using vaccines against monkeypox are strongly encouraged to do so within a framework ofcollaborative clinical studies using standardized design methods and data collection tools for clinical and outcome
data, in order to rapidly increase evidence generation, especially on vaccine efficacy/effectiveness and safety.
Where participation in placebo-controlled clinical efficacy trials for monkeypox vaccines and schedules is notconsidered feasible, the use of a range of other robust study designs to assess vaccine effectiveness should be
rapidly put in place employing standard data collection methods, where resources allow.

Therapeutics
Caring for patients with suspected or confirmed monkeypox requires early recognition through screening
protocols adapted to local settings, and rapid implementation of appropriate IPC measures (including
implementation of transmission-based precautions and prompt isolation), testing to confirm diagnosis,
symptomatic management of patients with mild or uncomplicated monkeypox and monitoring for and treatmentof complications and life-threatening conditions such as progression of skin lesions, severe pain, proctitis, urinary
retention, secondary bacterial infection of skin lesions, ocular lesions, and rarely, encephalitis, myocarditis and/or
death. Patients with mild or uncomplicated monkeypox who isolate at home require careful assessment of theability to safely isolate and maintain required IPC precautions in their home to prevent transmission to otherhousehold and community members and have access to care if they progress or worsen. Precautions (isolation
and IPC measures) should remain in place until lesions have crusted, scabs have fallen off and a fresh layer of skinhas formed underneath.
To enable reliable evaluation of therapeutic interventions, randomized trials using CORE protocols are thepreferred approach. Unless there are compelling reasons not to do so, every effort should be made to implement
randomized trial design. It is feasible to conduct placebo-controlled studies, especially in individuals at low risk
for serious disease. Harmonised data collection for safety and clinical outcomes using the WHO Global ClinicalPlatform for monkeypox, would represent a desirable minimum dataset in the context of an outbreak, including
the current event.

Page 6

WHO is seeking feedback on the Target Product Profile (TPP) therapeutics for monkeypox cases from experts in
the industry, product developers, the scientific community, national infection control programme personnel andclinicians currently involved in the management and control of monkeypox. The TPP is intended to guide andprioritize the evaluation of repurposed therapeutic agents for monkeypox or the development of new therapeutic
agents.

Risk Communication and Community Engagement
Balanced risk communication and community engagement approaches need to reach the most affected
populations. It is most effective to use existing trusted networks to reach those who identify as gay, bisexual ormen who have sex with men (MSM) and those with recent multiple sex partners. In most countries these
networks can be accessed by partnering with HIV/AIDS networks. Engagement efforts should include open
questions with detailed advice and answers, that present alternatives to high-risk activities which are codeveloped with affected population groups.
Affected persons should be aware of emerging information and knowledge about symptoms and updated
behavioural advice to avoid further spread of monkeypox. As vaccines, testing and therapeutics become moreavailable, communication with individuals on; 1) who should access these measures, 2) how they can be accessed,3) how they work, 4) the known limitations of specific measures, should be consistently communicated. This
information should be shared through trusted channels, key influencers and community based and civil society
organizations representing affected populations. Unknowns and nuances of vaccines, testing and therapeutics
should be consistently and transparently shared with people receiving these.

Page 7

Technical guidance and other resources
WHO Guidance and Public Health Recommendations











WHO
Vaccinesandimmunizationformonkeypox:
Interimguidance,
24
August2022. https://apps.who.int/iris/bitstream/handle/10665/361894/WHO-MPX-Immunization-2022.2-eng.pdf
WHO Second meeting of the International Health Regulations (2005) (IHR) Emergency Committee regarding the multicountry outbreak of monkeypox, 23 July 2022. https://www.who.int/news/item/23-07-2022-second-meeting-of-theinternational-health-regulations-(2005)-(ihr)-emergency-committee-regarding-the-multi-country-outbreak-ofmonkeypox
WHO Director-General's statement at the press conference following IHR Emergency Committee regarding the multicountry outbreak of monkeypox, 23 July 2022. https://www.who.int/director-general/speeches/detail/who-directorgeneral-s-statement-on-the-press-conference-following-IHR-emergency-committee-regarding-the-multi--countryoutbreak-of-monkeypox--23-july-2022
WHO Global clinical data platform for monkeypox case report form (CRF), 15 July 2022.
https://www.who.int/publications/i/item/WHO-MPX-Clinical_CRF-2022.2
Public health advice for gatherings during the current monkeypox outbreak, 28 June 2022:
https://www.who.int/publications/i/item/WHO-MPX-Gatherings-2022.1
WHO Surveillance, case investigation and contact tracing for Monkeypox: Interim guidance, 24 June
2022. https://www.who.int/publications/i/item/WHO-MONKEYPOX-surveillance-2022.2
Clinical management and infection prevention and control for monkeypox: Interim rapid response guidance, 10 June
2022. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1
WHO Technical brief (interim) and priority actions: enhancing readiness for monkeypox in WHO South-East Asia Region,
7 July 2022. https://cdn.who.int/media/docs/default-source/searo/whe/monkeypox/searo-mpx-tbrief22.pdf

Data management






The WHO Global Clinical Platform for monkeypox, 14 June 2022. https://www.who.int/tools/global-clinicalplatform/monkeypox
Globalclinicaldata
platformformonkeypox
casereportform(CRF),
14June
2022. https://www.who.int/publications/i/item/WHO-MPX-Clinical-CRF-2022.1
Case and contact investigation form (CIF), 16 June 2022. https://www.who.int/publications/m/item/monkeypoxminimum-dataset-case-reporting-form-(crf)
WHO Go.Data: Managing complex data in outbreaks. https://www.who.int/tools/godata
Monkeypox Case investigation form (CIF) and minimum dataset Case reporting form (CRF).
https://www.who.int/publications/m/item/monkeypox-minimum-dataset-case-reporting-form-(crf)

Risk communication and community engagement









Monkeypox Q&A, 23 August 2022. https://www.who.int/philippines/news/feature-stories/detail/frequently-askedquestions-about-monkeypox
Risk communication and community engagement (RCCE) for monkeypox outbreaks: Interim guidance, 24 June 2022.
https://www.who.int/publications/i/item/WHO-MPX-RCCE-2022.1
Interim advice for public health authorities on summer events during the monkeypox outbreak in Europe, 2022. 14 June
2022. https://www.who.int/europe/publications/m/item/interim-advice-for-public-health-authorities--on-summerevents-during-the-monkeypox--outbreak-in-europe--2022
Interim advice on Risk Communication and Community Engagement during the monkeypox outbreak in Europe, 2022.
Joint
reportbyWHO
Regional
officeforEurope/ECDC,
2
June
2022.
https://www.euro.who.int/__data/assets/pdf_file/0009/539046/ECDC-WHO-interim-advice-RCCE-Monkeypox-2-062022-eng.pdf
WHO Monkeypox outbreak: update and advice for health workers, 26 May 2022. https://www.who.int/docs/defaultsource/coronaviruse/risk-comms-updates/update_monkeypox-.pdf?sfvrsn=99baeb03_1
Monkeypox: public health advice for gay, bisexual and other men who have sex with men, 18 July 2022.
https://www.who.int/publications/m/item/monkeypox-public-health-advice-for-men-who-have-sex-with-men

Page 8

Risk communication and community engagement. Public health advice on the recent outbreak of monkeypox in the WHO
European Region, 24 May 2022. https://www.euro.who.int/__data/assets/pdf_file/0004/538537/public-health-advicemonkeypox-eng.pdf

Laboratory and diagnostics





WHO
Laboratory
testingforthemonkeypox
virus:
Interimguidance,23May
2022. https://apps.who.int/iris/handle/10665/354488
WHO Guidance on regulations for the transport of infectious substances 2021-2023, 25 February
2021. https://www.who.int/publications/i/item/9789240019720
Genomic epidemiology of monkeypox virus. https://nextstrain.org/monkeypox?c=country
Monkeypox: experts give virus variants new names, 12 August 2022. https://www.who.int/news/item/12-08-2022monkeypox--experts-give-virus-variants-new-names

Disease Outbreak News and situation reports










Monkeypox outbreak 2022: https://www.who.int/emergencies/situations/monkeypox-oubreak-2022
Multi-country
outbreakofmonkeypox,
External
situation
report#3
10August2022:
https://www.who.int/publications/m/item/multi-country-outbreak-of-monkeypox--external-situation-report--3---10august-2022
WHO Multi-country outbreak of monkeypox, External situation report #2 – 25 July 2022:
https://www.who.int/publications/m/item/multi-country-outbreak-of-monkeypox--external-situation-report--2---25july-2022
WHO Multi-country outbreak of monkeypox, External situation report #1 - 6 July 2022:
https://www.who.int/publications/m/item/multi-country-outbreak-of-monkeypox--external-situation-report--1---6july-2022
WHO
diseaseoutbreaknews:
Monkeypox,
all
items
relatedtomulti-country
outbreak: https://www.who.int/emergencies/emergency-events/item/2022-e000121
WHO disease outbreak news: Monkeypox, all previous items including endemic countries and traveler-associatedoutbreaks: https://www.who.int/emergencies/emergency-events/item/monkeypox

Training and Education







WHO monkeypox outbreak toolbox, June 2022. https://www.who.int/emergencies/outbreak-toolkit/disease-outbreaktoolboxes/monkeypox-outbreak-toolbox
WHO factsheet on monkeypox, 19 May 2022. http://www.who.int/news-room/fact-sheets/detail/monkeypox
Health topics – Monkeypox: https://www.who.int/health-topics/monkeypox
Open WHO. Online training module. Monkeypox: Introduction. 2020
English: https://openwho.org/courses/monkeypox-introduction
Français: https://openwho.org/courses/variole-du-singe-introduction
Open WHO. Extended training. Monkeypox epidemiology, preparedness and response. 2021.
English: https://openwho.org/courses/monkeypox-intermediate;
Français: https://openwho.org/courses/variole-du-singe-intermediaire

Other Resources






WHO AFRO Weekly Bulletin on Outbreaks and Other Emergencies, all previous items: https://www.afro.who.int/healthtopics/disease-outbreaks/outbreaks-and-other-emergencies-updates
WHO 5 moments for hand hygiene. https://www.who.int/campaigns/world-hand-hygiene-day
WHO One Health. https://www.who.int/health-topics/one-healthWorld Organisation for Animal Health, founded as OIE: Monkeypox. https://www.woah.org/en/disease/monkeypox/
Joint WHO Regional Office for Europe - European Centre for Disease Prevention and Control, Monkeypox surveillancebulletin Situation reports (who.int)

Page 9

Joint WHO Regional Office for Europe - European Centre for Disease Prevention and Control, Monkeypox Resource toolkit
to support national authorities and event organizers in their planning and coordination of mass and large gathering
events. https://www.who.int/europe/tools-and-toolkits/monkeypox-resource-toolkit-for-planning-and-coordination-ofmass-and-large-gathering-events/
WHO European Region Interim advice for public health authorities on summer events during the monkeypox outbreak inEurope, 2022 https://www.who.int/europe/publications/m/item/interim-advice-for-public-health-authorities--onsummer-events-during-the-monkeypox--outbreak-in-europe--2022
Weekly epidemiological record (WER) no.11, 16 March 2018, Emergence of monkeypox in West Africa and Central Africa
19702017. http://apps.who.int/iris/bitstream/handle/10665/260497/WER9311.pdf;jsessionid=7AB72F28D04CFE6CE249961
92FC478FF?sequence=1 Jezek Z., Fenner F.: Human Monkeypox. Monogr Virol. Basel, Karger, 1988, vol 17, pp 1-5. doi:
10.1159/isbn.978-3-318-04039-5

Annex 1: Data, table and figure notes
Caution must be taken when interpreting all data presented. Differences are to be expected between information
products published by WHO, national public health authorities, and other sources using different inclusion criteria
and different data cut-off times. While steps are taken to ensure accuracy and reliability, all data are subject tocontinuous verification and change. Case detection, definitions, testing strategies, reporting practice, and lagtimes differ between countries/territories/areas. These factors, amongst others, influence the counts presented,
with variable underestimation of true case and death counts, and variable delays to reflecting these data at the
global level.
[i]‘Countries’ may refer to countries, territories, areas or other jurisdictions of similar status. The designations
employed, and the presentation of these materials do not imply the expression of any opinion whatsoever on
the part of WHO concerning the legal status of any country, territory, or area or of its authorities, or concerning
the delimitation of its frontiers or boundaries.

Annex 2: Confirmed cases of monkeypox by WHO region and country from 1 January 2022 to
22 August 2022, 17:00 CEST*
WHO Region

African Region

Eastern
Mediterranean
RegionCountry
Benin
Cameroon
Central African Republic
Congo
Democratic Republic of the Congo
Ghana
Liberia
NigeriaSouth Africa
Iran (Islamic Republic of)LebanonMorocco
Qatar
Saudi Arabia
Sudan
United Arab Emirates

Page 10

Confirmed
Cases
3
7
3
3
163
47
2
172
4
1
6
1
3
6
2
16

Confirmed
Deaths
0
0
2
0
0
1
0
4
0
0
0
0
0
0
0
0

European
RegionRegion of theAmericas

AndorraAustria
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
CyprusCzechia
Denmark
Estonia
FinlandFranceGeorgia
Germany
Gibraltar
GreeceGreenland
Hungary
Iceland
IrelandIsraelItaly
LatviaLithuania
Luxembourg
Malta
MonacoMontenegro
Netherlands
NorwayPolandPortugal
Republic of Türkiye
Republic of Moldova
Romania
Russian Federation
SerbiaSlovakia
Slovenia
Spain
SwedenSwitzerland
The United Kingdom
Argentina
BahamasPage 11

4
218
624
3
4
22
4
39
169
9
22
2889
2
3295
6
50
2
63
12
113
208
689
4
5
45
31
3
2
1090
76
114
810
1
2
34
1
31
12
43
6119
141
416
3225
72
2

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0

South-East
Asia Region

Western
Pacific Region

Cumulative

Barbados
BermudaBolivia (Plurinational State of)BrazilCanadaChile
Colombia
Costa Rica
CuraçaoDominican Republic
EcuadorGuadeloupe
GuatemalaHonduras
Jamaica
Martinique
MexicoPanamaPeru
Puerto Rico
Saint Martin
United States of America
Uruguay
Venezuela (Bolivarian Republic of)
India
Indonesia
ThailandAustralia
China
Japan
New Caledonia
New ZealandPhilippines
Republic of Korea
Singapore
96 countries/territories/areas

1
1
37
3450
1168
189
164
3
1
6
19
1
4
3
4
1
252
4
937
66
1
14 049
2
1
9
1
4
89
3
4
1
4
4
1
15
41 664

0
0
0
1
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
12

Corrigendum: This report was revised on 25 August to correct the number of cases reported in week 32 (8-14
August) from 5213 cases to 7477 cases.

Page 12JAPAN COVID UPDATESNew requirement for inbounds from September 7, 2022
The government announced that they would change the criteria for inbound people who
may enter Japan by air effective from September 7, 2022.
Before departure from their home countries
Regardless of the countries’ categories by the Japanese quarantine authority, all seafarers
coming from all countries and areas shall follow the following criteria.
[Seafarers who had a vaccination certificate (Boosted: 3 doses or more) *] A Covid-19 certificate (negative certificate) is not required.
They must have a vaccination certificate (boosted) by allowable vaccines in Japan.
(https://www.mhlw.go.jp/content/mesure_en.pdf).
 A three-day of isolation is recommended.
[For other seafarers]
 Persons visiting Japan shall get a negative certificate of COVID-19 test (PCR test orother method authority allows) seventy-two (72) hours before flight departure.
(Twenty-four (24) hours test instead 72 hours is highly recommended) A three-day of isolation is required.
On-arrival Testing at the airport
Red-category:Yellow-category(Not boosted):(Boosted):Blue-category:

Yes
Yes
No
No

Note: Persons who may be positive by the airport testing cannot pass animmigration check until released (7 days at least).
Required Isolation after arrival
Red-category(Not boosted): Three days in designated accommodation. The third-day testing is required.
They cannot use public transportation after the third-day testing (negative results). Afterthen they can move to their domestic destination using public transportation.
Red-category(Boosted): Three (3) days in accommodation.

Provided by the Japanese Shipowners’ Association

Yellow-category(Not boosted): Three (3) days in accommodation.
Transfer to the hotel (or to the vessel) using public transportation within 24 hours after
testing (specimen collection) at the airport. After the isolation period (3 days), move to thedestination using public transportation (using non-public transportation is recommended).
Yellow-category(Boosted): Not required
Blue-category: Not required
They may move to the destination any time after arrival. They may use public
transportation. For details, kindly refer to the following URL:
https://www.mofa.go.jp/ca/cp/page22e_000925.html
Categories as of July 27
Red-category Countries-None
Yellow-category Countries•[Asia & Oceania]-India, North Korea, Kiribati, Cook Islands, Samoa, Sri Lanka,
Solomon Islands, Tuvalu, Tonga, Nauru, Niue, Pakistan, Vanuatu, Fiji, Bhutan,
Brunei, Vietnam, Marshall Islands, Macau, Micronesia, and Maldives.

••[North America]-None[Middle & South America]-Antigua and Barbuda, Uruguay, Guyana, Cuba, Grenada,
Suriname, Saint Kitts and Nevis, Saint Vincent and the Grenadines, Saint Lucia,
Dominica, Sierra Leone, Trinidad and Tobago, Nicaragua, Haiti, Bahamas,
Barbados, Venezuela, Belize, and Honduras•[Europe]-Albania, Andorra, Ukraine, Uzbekistan, Kazakhstan, North Macedonia,
Cyprus, Kosovo, San Marino, Georgia, Tajikistan, Turkmenistan, Vatican City,
Belarus, Portugal, Malta, and Liechtenstein.

•[Middle East & Africa]-Angola, Yemen, Egypt, Eswatini, Eritrea, Oman, Cape Verde,
Gabon, Gambia, Guinea, Guinea-Bissau, Kuwait, Comoros, Republic of the Congo,
Democratic Republic of the Congo, Saudi Arabia, São Tomé and Príncipe, Syria,
Zimbabwe, Sudan, Seychelles, Equatorial Guinea, Senegal, Somalia, Chad, Central
African Republic, Tunisia, Togo, Turkey, Namibia, Niger, Palestine, Burkina Faso,
Burundi, Botswana, Mali, Mauritius, Mauritania, Libya, Liberia, Lesotho, andLebanon (in no particular order)

Blue-category Countries- Other than the above-listed countries

Provided by the Japanese Shipowners’ Association