#WHO; #ChildAndMaternalMortality


Geneva, Sept 20 (Canadian-Media): More women and their children are surviving today than ever before, according to new child and maternal mortality estimates released yesterday by United Nations groups* led by UNICEF and the World Health Organization (WHO).

​Since 2000, child deaths have reduced by nearly half and maternal deaths by over one-third, mostly due to improved access to affordable, quality health services. But Despite progress, a pregnant woman or newborn dies somewhere in the world every 11 seconds.
 
“In countries that provide everyone with safe, affordable, high-quality health services, women and babies survive and thrive,” said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO. “This is the power of universal health coverage.”  
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Still, the new estimates reveal that 6.2 million children under 15 years died in 2018, and over 290 000 women died due to complications during pregnancy and childbirth in 2017. Of the total child deaths, 5.3 million occurred in the first 5 years, with almost half of these in the first month of life.

Women and newborns are most vulnerable during and immediately after childbirth. An estimated 2.8 million pregnant women and newborns die every year, or 1 every 11 seconds, mostly of preventable causes, the new estimates say.

Children face the highest risk of dying in the first month, especially if they are born too soon or too small, have complications during birth, congenital defects, or contract infections. About a third of these deaths occur within the first day and nearly three quarters in the first week alone.

“Around the world, birth is a joyous occasion. Yet, every 11 seconds, a birth is a family tragedy,” said Henrietta Fore, UNICEF Executive Director. “A skilled pair of hands to help mothers and newborns around the time of birth, along with clean water, adequate nutrition, basic medicines and vaccines, can make the difference between life and death. We must do all it takes to invest in universal health coverage to save these precious lives.”

Vast inequalities worldwide

The estimates also show vast inequalities worldwide, with women and children in sub-Saharan Africa facing a substantially higher risk of death than in all other regions.

Levels of maternal deaths are nearly 50 times higher for women in sub-Saharan Africa and their babies are 10 times more likely to die in their first month of life, compared to high-income countries.

In 2018, 1 in 13 children in sub-Saharan Africa died before their fifth birthday– this is 15 times higher than the risk a child faces in Europe, where just 1 in 196 children aged less than 5 die.

Women in sub-Saharan Africa face a 1 in 37 lifetime risk of dying during pregnancy or childbirth. By comparison, the lifetime risk for a woman in Europe is 1 in 6500. Sub-Saharan Africa and Southern Asia account for around 80% of global maternal and child deaths. Countries in conflict or humanitarian crisis often have weak health systems that prevent women and children from accessing essential lifesaving care.

Progress linked to universal health coverage

The world has made substantial progress in reducing child and maternal mortality. Since 1990, there has been a 56% reduction in deaths of children under 15 years from 14.2 million deaths to 6.2 million in 2018. Countries in Eastern and South-Eastern Asia have made the most progress, with an 80% decline in under-five deaths.

And from 2000 to 2017, the maternal mortality ratio declined by 38%. Southern Asia has made the greatest improvements in maternal survival with a nearly 60% reduction in the maternal mortality ratio since 2000.
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Belarus, Bangladesh, Cambodia, Kazakhstan, Malawi, Morocco, Mongolia, Rwanda, Timor-Leste and Zambia are some of the countries that have shown substantial progress in reducing child or maternal mortality. Success has been due to political will to improve access to quality health care by investing in the health workforce, introducing free care for pregnant women and children and supporting family planning. Many of these countries focus on primary health care and universal health coverage.

#EbolaVaccination; #WHO
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Bujumbura (Hungary), Aug 14 (Canadian-Media): On 13th August, the Ministry of Public Health and AIDS Control kicked off the vaccination campaign for front-line staff against the Ebola virus disease. The campaign started at the Gatumba entry point at the Border with the Democratic Republic of Congo, WHO reports said.

The Ebola vaccination campaign is part of Burundi's preparation for a possible case of Ebola. The campaign will be implemented under leadership of the Ministry of Public Health and AIDS Control, with the support of the World Health Organization (WHO). Financial support is provided by GAVI, the Vaccine Alliance.

Burundi has received doses of the Ebola vaccine (rVSV-ZEBOV) to provide protection against the Zairian strain of the virus, which is currently affecting the Democratic Republic of the Congo (DRC). Although this vaccine is not yet approved and its commercial use is not yet authorized, it has been shown to be effective and safe during Ebola outbreaks in West Africa. Further scientific research is required before the vaccine can be licensed.

The vaccine is used for humanitarian purposes to protect people most at risk of an Ebola outbreak. It will be administered to health and front-line staff working in priority areas where there is a risk of transmission. These are health workers working at points of entry into the country as well as other people potentially exposed to the Ebola virus disease, such as laboratory workers, surveillance teams and people responsible for carrying out dignified and secure burials.

"The vaccination of health and front-line staff is a significant step forward in preparing for the response to this disease," said Dr Kazadi Mulombo, WHO Representative in Burundi. "The vaccine proved highly protective against Ebola in a trial conducted in Guinea in 2015. Pending consideration by the relevant regulatory authorities, the WHO Strategic Advisory Group of Experts on Immunization recommended that the rVSV-ZEBOV vaccine be used as part of a protocol on expanded access and compassionate use during Ebola outbreaks related to the Zaire strain, such as the current one in the DRC. In Burundi, we will use it for prevention purposes.”

Vaccination is one of the many preparedness measures that Burundi has planned to put in place. WHO deployed experts to support these activities and trained 50 national immunization workers on behalf of the Ministry of Public Health and AIDS Control. The training consisted of familiarization with the principles of good clinical practice and standard protocol procedures. This new knowledge is necessary for the administration of the Ebola vaccine and includes the ability to conduct ring vaccination, vaccinating only those people who are most likely to be infected in case of a reported Ebola case in Burundi.

No cases of Ebola have been reported in Burundi, but preparation remains crucial. WHO, which supports Burundi in preparedness activities, has provided logistical support to ensure the cold chain and facilitated the provision of supplies and equipment necessary to carry out the vaccination campaign.

WHO provided special vaccine carriers and upgraded the cold chain of the Expanded Programme on Immunization of the Ministry of Public Health and AIDS Control, through the installation of additional freezers adapted to this type of vaccine. The capacity of local laboratories to analyse samples taken from people suspected of being infected with the Ebola virus has also been strengthened through the upgrading of the laboratory of the National Institute of Public Health.

WHO also supports the Government of Burundi in engaging with communities, community-based active surveillance, capacity building for infection prevention and control and case management and the dissemination of information on Ebola through the mass media.

#highLevelsOfEstrogenInWombLinkedToAutism; #UnivOfCambridgeResearch

United Kingdom, Aug 7 (Canadian-Media): Scientist have identified a link between exposure to high levels of oestrogen sex hormones in the womb and the likelihood of developing autism. The findings are published today in the journal Molecular Psychiatry, Medical X Press news reports said.

Credit: CC0 Public Domain

The discovery adds further evidence to support the prenatal sex steroid theory of autism first proposed 20 years ago.

In 2015, a team of scientists at the University of Cambridge and the State Serum Institute in Denmark measured the levels of four prenatal steroid hormones, including two known as androgens, in the amniotic fluid in the womb and discovered that they were higher in male foetuses who later developed autism. These androgens are produced in higher quantities in male than in female foetuses on average, so might also explain why autism occurs more often in boys. They are also known to masculinise parts of the brain, and to have effects on the number of connections between brain cells.

Today, the same scientists have built on their previous findings by testing the amniotic fluid samples from the same 98 individuals sampled from the Danish Biobank, which has collected amniotic samples from over 100,000 pregnancies, but this time looking at another set of prenatal sex steroid hormones called oestrogens. This is an important next step because some of the hormones previously studied are directly converted into oestrogens.

All four oestrogens were significantly elevated, on average, in the 98 foetuses who later developed autism, compared to the 177 foetuses who did not. High levels of prenatal oestrogens were even more predictive of likelihood of autism than were high levels of prenatal androgens (such as testosterone). Contrary to popular belief that associates oestrogens with feminisation, prenatal oestrogens have effects on brain growth and also masculinise the brain in many mammals.

Professor Simon Baron-Cohen, Director of the Autism Research Centre at the University of Cambridge, who led this study and who first proposed the prenatal sex steroid theory of autism, said: "This new finding supports the idea that increased prenatal sex steroid hormones are one of the potential causes for the condition. Genetics is well established as another, and these hormones likely interact with genetic factors to affect the developing foetal brain."

Alex Tsompanidis, a Ph.D. student in Cambridge who worked on the study, said: "These elevated hormones could be coming from the mother, the baby or the placenta. Our next step should be to study all these possible sources and how they interact during pregnancy."

Dr. Alexa Pohl, part of the Cambridge team, said: "This finding is exciting because the role of oestrogens in autism has hardly been studied, and we hope that we can learn more about how they contribute to foetal brain development in further experiments. We still need to see whether the same result holds true in autistic females."

However, the team cautioned that these findings cannot and should not be used to screen for autism. "We are interested in understanding autism, not preventing it," added Professor Baron- Cohen.
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Dr. Arieh Cohen, the biochemist on the team, based at the State Serum Institute in Copenhagen, said: "This is a terrific example of how a unique biobank set up 40 years ago is still reaping scientific fruit today in unimagined ways, through international collaboration."

#KaiserPoll; #MedicareForAll
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​United States, July 31 (Canadian-Media): During the second presidential elections debate in the United States (U.S.) on "Medicare for All Plan" on Tuesday, the two progressives, Bernie Sanders, longest serving independent in U.S. congressional history and a member of the Democratic caucus,  and Elizabeth Warren,  senior U.S Senator from Massachusetts, found themselves fighting off the moderates on the stage, media reports said.

According to a Kaiser poll -- which provides up-to-date information on the public’s opinions, knowledge, and experiences with the health care system -- with 83% saying it is “very important” for the candidates to discuss about health care system in U.S. in recent elections.

Bernie Sanders (left) and Elizabeth Warren (right)/Twitter

Sanders, who had traveled to Canada this week with about a dozen Type 1 diabetes patients over the border from Michigan to purchase cheaper insulin, took the opportunity to slam the drug industry, saying that insulin makers are price-fixing, and if he’s elected he will hold these companies accountable. ​
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Tim Ryan, Representative for Ohio's 13th congressional district accused Sanders of not knowing what impact the bill would have on union workers.

“I do know. I wrote the damn bill!” Sanders snapped back.

(Reporting by Asha Bajaj)

UNICEFToTripleItsBudget; #CombatingEbolaVirusInDRC

New York, July 30 (Canadian-Media): With an unprecedented number of children affected by the Ebola virus outbreak in the eastern Democratic Republic of Congo (DRC), the United Nations Children’s Fund (UNICEF) on Tuesday said it would need to triple its budget to tackle the complex crisis, which included intensifying the overall public health response and launching measles vaccinations, UN reports said.

On 6 December 2018, at a UNICEF supported crèche in Beni, in the eastern DRC, Kavira Langa Jemima, an Ebola survivor, bathes 6 month old Josue, who's mother is undergoing treatment for Ebola. Credit: UNICEF/Hubbard

“This Ebola response is far more complex because it is in an active conflict zone,” Jerome Pfaffmann, a UNICEF health specialist, told reporters in Geneva, just back from his third visit to the country. 

He underscored that “people in the (eastern Congolese) provinces of North Kivu and Ituri are facing humanitarian and public health crises,” and in addition, half the health facilities in Ituri had been damaged or destroyed over the last two years. 
The UNICEF expert said there were 2,671 confirmed cases of Ebola as of 28 July, including more than 700 children, more than half of whom – some 57 per cent – were under five years of age.  
“When I left, there were 12 new confirmed cases, five were alive and will have the chance to access treatment, but seven had died in the community. This is bad. Having this number of community deaths means we are not ahead of the epidemic,” he said.  
“It is unprecedented to have such a [high] proportion of affected children,” Mr. Pfaffmann continued, adding that both provinces were also facing a measles outbreak. 
So far, UNICEF has vaccinated more than 40,000 children against measles, but a massive scale-up was needed to protect them from various health risks. 
With all this in mind, UNICEF planned to carry out a new strategic response plan to address acute humanitarian and social needs. 
“UNICEF will need to triple its budget to respond to this crisis,” said Mr. Pfaffmann, stressing that “we need desperately the international community to back us up.” 
This budget would include about $70 million for epidemic control activities, $30 million to build community capacities in at-risk areas, and another $70 million to deliver essential services. 
Meanwhile, the UN agency was continuing operations with “colleagues and communities on the ground who are fighting the outbreak tirelessly.” 
Just two days away from the one-year milestone of the Ebola virus disease outbreak in the DRC, the UNICEF expert said it was critical to make the investment to keep the epidemic under control. 
“This is a wake-up call. There must not be a second-year milestone,” Mr. Pfaffmann declared, stressing that community mobilization was critical to curbing the spread of the disease because “they are capable of best doing the things that matter.” 

The report, Start Free, Stay Free, AIDS Free, shows that the pace of progress in reducing new HIV infections among children and expanding access to treatment for children, adolescents and pregnant women living with HIV has slowed significantly and that global targets set for 2018 have been missed, despite important gains being made in some countries.  

Globally, around 160 000 children aged 0–14 years became newly infected with HIV in 2018. This is a major decrease from 240 000 new infections in 2010. However, the bold and important target set for 2018 was fewer than 40 000 new infections.

“The failure to reach the 2018 targets to reduce new HIV infections among children and adolescents and to widen access to life-saving treatment is both disappointing and frustrating,” said Gunilla Carlsson, UNAIDS Executive Director, a.i.  “We need to act quickly to turn this situation around and honour the commitment to end the AIDS epidemic for the next generation.”

Around 82% of pregnant women living with HIV now have access to antiretroviral medicines. There has been considerable progress among countries in eastern and southern Africa, with more than 90% of pregnant women accessing antiretroviral medicines in Ethiopia, Kenya, Uganda, United Republic of Tanzania and Zimbabwe and 95% or higher in Botswana, Malawi, Mozambique, Namibia and Zambia. This has resulted in a 41% reduction in new HIV infections among children, with remarkable reductions achieved in Botswana (85%), Rwanda (83%), Malawi (76%), Namibia (71%), Zimbabwe (69%) and Uganda (65%) since 2010. The progress made by these countries shows what can be achieved through strong political leadership, rapid policy adoption and concerted efforts by all stakeholders.

The report throws light on where gaps need to be filled to prevent new HIV infections occurring among children. For example, in eastern Africa, 10 000 of 26 000 new HIV infections among children in 2018 were the result of women not being retained on treatment throughout pregnancy and breastfeeding. In southern Africa, 17 000 of 53 000 new infections among children were the result of the mother becoming infected with HIV during pregnancy or breastfeeding. A total of 16 000 new infections could have been averted in southern Africa by retaining mothers on treatment throughout pregnancy and breastfeeding. In western and central Africa, almost 27 000 of the 44 000 new infections could have been averted if their mothers had accessed antiretroviral medicines.

“These new data show that many countries have made important progress toward reaching the 2020 targets, and yet others are lagging significantly behind,” said Deborah Birx, United States Global AIDS Coordinator and Special Representative for Global Health Diplomacy. “These stark disparities highlight the critical role of political commitment, rapid policy implementation and data-driven investments in accelerating impact.”

Country-level analysis of how mother-to-child transmission of HIV happens can provide vital information to shape national responses.

“Ending AIDS and achieving universal health coverage means leaving no one behind. Yet, too many children and adolescents with HIV are still missing out on the chance to grow up in full health as they can’t access treatment,” said Ren Minghui, the World Health Organization’s Assistant Director-General for Universal Health Coverage/Communicable and Noncommunicable Diseases. “We need to intensify our efforts to and keep our promise to these children.” 

Children living with HIV are also being left behind in HIV treatment scale-up and are not being diagnosed and treated early enough. An estimated 940 000 children aged 0–14 years were accessing treatment in 2018, double the number that were on treatment in 2010 but far short of the target of 1.6 million set for 2018.
Children living with HIV are still less likely to have access to HIV treatment than adults living with HIV, a disparity that is widening in some countries, especially in western and central Africa. As a result, the AIDS epidemic is still claiming the lives of many children aged 0–14 years. Children in this age group comprised 5% of all people living with HIV in 23 focus countries but accounted for 15% of people who died from AIDS-related illnesses in those countries in 2018. 
"We know how to prevent children from contracting HIV, and we know how to prevent the onset of AIDS in children if they do become infected. They need to be tested and linked to care and treatment as a matter of urgency, but we are missing these opportunities,” said Henrietta Fore, Executive Director of the United Nations Children’s Fund. “Knowing what to do is not enough. We must come together and act with renewed commitment to children and adolescents living with HIV and give them the best chance to survive and thrive.”    

For optimal outcomes, children who become infected with HIV must access treatment as quickly as possible. However, in 2018, only 63% of the 1.1 million infants exposed to HIV in the 23 countries worst affected by the epidemic were tested for HIV by the age of two months.

“In many ways, we as a community have settled for a substandard quality of care for children living with HIV,” said Chip Lyons, President and Chief Executive Officer, Elizabeth Glaser Pediatric AIDS Foundation, “We must not allow children to perpetually receive less than the basic standard of care we demand for adults. Especially when the ultimate consequence of that approach is that children and young people are dying of HIV at disproportionally and unacceptably high rates.”

The report also shows that the target of reducing the annual number of new HIV infections among young women and adolescent girls aged 15–24 years to less than 100 000 by 2020 is unlikely to be reached. Globally, new HIV infections among young women and adolescent girls were reduced by 25% between 2010 and 2018, to 310 000. While new HIV infections among adolescent girls and young women aged 15–24 years have declined by over 40% in Botswana, Burundi, Lesotho and South Africa, missing the global target has meant that 6000 adolescent girls and young women are still becoming infected with HIV every week.

The root factors driving the vulnerability of young women and girls to HIV infection are social, structural and behavioural and must be addressed in order to achieve sustainable prevention outcomes. Gender discrimination, gender-based violence, restricted access to opportunities and a lack of tailored services all compound their vulnerability to HIV. Effective responses prioritize an approach combining access to HIV and sexual and reproductive health services with social, structural and behavioural programmes.

“The disparity in viral load suppression rates among adolescents with HIV compared to adults is unacceptable and behoves the global community to advocate for more robust, potent antiretroviral therapy regimens for adolescents as well as to hasten efforts to prevent new infections in this critically vulnerable population,” said Fatima Tsiouris, Deputy Director of the Clinical and Training Unit and Prevention of Mother-to-Child Transmission Lead at ICAP, Columbia University.

The number of voluntary medical male circumcisions undertaken between 2015 and 2018 stood at over 11 million among all age groups, which means that at least 13 million procedures need to be carried out by 2020 in order to reach the target of voluntarily circumcising 25 million men and boys between 2015 and 2020.

UNAIDS and the United States President’s Emergency Plan for AIDS Relief launched the Start Free, Stay Free, AIDS Free framework in 2016 to build on the achievements of the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive, which ended in 2014.      

UNAIDS
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The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. ​

#UnitedNationshealthagency; #treatmentOfHIV/AIDS

United Nations, July 22 (Canadian-Media): Based on new evidence, the United Nations health agency on Monday announced it was recommending the use of the antiretroviral drug dolutegravir (DTG) – which, with other medication, treats HIV/AIDS – as the preferred first- and second-line treatment for all cases, including pregnant women and those who have the potential to give birth, UN reports said.  

Moisés Maciel da Silva, 19, from São Paulo, Brazil, found out he was living with HIV when he turned 18 years old. © UNICEF/Danielle Pereira

According to the World Health Organization (WHO), initial studies had highlighted a possible link between DTG and birth defects of the brain and spinal cord, that cause conditions like spina bifida in infants born to women who used the drug at the time of conception.
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This safety concern came from a May 2018 study in Botswana, that found four cases of such so-called neural tube defects, out of 426 women who became pregnant while taking DTG.

Based on these preliminary findings, many countries advised pregnant women and those of childbearing potential, to take an alternative antiviral medication called efavirenz (EFV).
However, new expanded evidence-based data from two large clinical trials comparing the efficacy and safety of DTG and EFV in Africa, reveal that the risks of neural tube defects are significantly lower than initial studies had suggested.

The guidelines group also considered mathematical models of the benefits and harms associated with the two drugs; the values and preferences of people living with HIV; factors related to implementing HIV programmes in different countries; and cost.

DTG is more effective, easier to take and has fewer side effects than alternatively prescribed drugs, said WHO. It also has a high genetic barrier to developing drug resistance, which is important given the rising trend of resistance to EFV and other regimens.

In 2019, 12 out of 18 WHO-surveyed countries reported pre-treatment drug resistance levels exceeding the recommended threshold of 10 per cent. These findings combined, informed the decision to update the 2019 guidelines.

Making ‘informed’ choices

In 2019, 82 low- and middle-income countries reported that they would be transitioning to DTG-based HIV treatment regimens. And the new updated recommendations aim to help even more countries improve their HIV policies.

“As for any medications, informed choice is important”, WHO stressed. “Every treatment decision needs to be based on an informed discussion with the health provider weighing the benefits and potential risks”.
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Because WHO underscores the significance of providing information and options to help women make an informed choice, it has convened an advisory group of women living with HIV from diverse backgrounds to advise on policy issues. During these discussions surrounding health - including sexual and reproductive health - WHO highlights the need to continually monitor the risk of neural tube defects that could be associated with DTG.

#Ebola; #DemocraticRepublicoftheCongo

Geneva, July 17 (Canadian-Media/WHO):WHO Director-General Dr. Tedros Adhanom Ghebreyesus today declared the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo (DRC) a Public Health Emergency of International Concern (PHEIC).

“It is time for the world to take notice and redouble our efforts. We need to work together in solidarity with the DRC to end this outbreak and build a better health system,” said Dr. Tedros. “Extraordinary work has been done for almost a year under the most difficult circumstances. We all owe it to these responders -- coming from not just WHO but also government, partners and communities -- to shoulder more of the burden.”

The declaration followed a meeting of the International Health Regulations Emergency Committee for EVD in the DRC. The Committee cited recent developments in the outbreak in making its recommendation, including the first confirmed case in Goma, a city of almost two million people on the border with Rwanda, and the gateway to the rest of DRC and the world.
This was the fourth meeting of the Emergency Committee since the outbreak was declared on 1 August 2018. 

The Committee expressed disappointment about delays in funding which have constrained the response. They also reinforced the need to protect livelihoods of the people most affected by the outbreak by keeping transport routes and borders open. It is essential to avoid the punitive economic consequences of travel and trade restrictions on affected communities.

“It is important that the world follows these recommendations. It is also crucial that states do not use the PHEIC as an excuse to impose trade or travel restrictions, which would have a negative impact on the response and on the lives and livelihoods of people in the region,” said Professor Robert Steffen, chair of the Emergency Committee.

Since it was declared almost a year ago the outbreak has been classified as a level 3 emergency – the most serious – by WHO, triggering the highest level of mobilization from WHO. The UN has also recognized the seriousness of the emergency by activating the Humanitarian System-wide Scale-Up to support the Ebola response.

In recommending a PHEIC the committee made specific recommendations related to this outbreak.
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“This is about mothers, fathers and children - too often entire families are stricken. At the heart of this are communities and individual tragedies,” said Dr. Tedros. “The PHEIC should not be used to stigmatize or penalize the very people who are most in need of our help.”

To date, there have been more than 2,500 cases of infection and nearly 1,670 people have died in the DRC provinces of Ituri and North Kivu, making it the worst outbreak the country has ever faced and the second largest epidemic on record.
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Meanwhile, the World Health Organization (WHO) confirmed that an emergency meeting on the outbreak will take place on Wednesday afternoon in Geneva to decide whether the situation warrants declaring an international emergency.

#FoodSafetyStandards; #WHO
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Geneva, Jul 12 (Canadian-Media/WHO): New International Food Safety Standards protecting consumer health and ensuring fair practices in trade were adopted by 42nd session The Codex Alimentarius Commission (CAC), in Geneva on Jul 8-12, 2019, WHO reports said.

WHO official logo

The Codex strategic plan (2020-2025) provides high level guidance and direction to the work of the CAC. It builds on the current document and continues to emphasise the importance of addressing critical and emerging issues, underpinning standards with risk analysis and scientific evidence and promoting and facilitating participation of all Members in its standard setting work. 

The plan contains a new goal focussing on the use and impact of Codex standards which aims to raise awareness and explore how the use and impact of Codex standards could be measured and how standards could be better tailored to Members’ needs. Implementation plans will be discussed at the FAO/WHO Coordinating Committees which will meet in the six Codex regions between September and November 2019.