lebioblog

En partenariat avec le projet MUN du lycée de Ferney, avec la participation de Georges KONIECZNY.

COMMITTEE : World Health Organisation

ISSUE : Which measures can be taken to prevent and manage the chronic diseases of obesity and diabetes?

CHAIRS : Emma ROBINSON & Emna TOUNSI

KEY WORDS

Diabetes: a chronic disease related to hormonal dysfunction of the pancreas affecting about 6% of the world's population. There are two main types: type I diabetes of genetic origin which most often affects children, teenagers and young adults; type II diabetes which accounts for 90% of diabetes cases, most often concerns people over 45 years of age who suffer from an unbalanced diet, might be overweight or even obese. There is also a type III diabetes related to pregnancy and a type IV related to Alzheimer's disease, but these cases of diabetes are marginal.

Diabetes mellitus: corresponds to a dysfunction in the regulation mechanism of glycemia, the level of glucose in the blood. The dysfunction concerns exclusively insulin, which is the main hormone regulating the glucose level in the blood. It is often associated with type II diabetes

Obesity: a chronic disease resulting from an imbalance between energy intake and expenditure. This imbalance leads to an accumulation of reserves stored in adipose tissue (body fat), resulting in numerous complications. The clinical diagnosis of obesity is based on the calculation of the BMI.

BMI, Body Mass Index: Calculation used to estimate an individual's body fat. The BMI corresponds to a person’s weight (in kg) divided by the square of their height (in square metres). According to the WHO classification, a person is defined as being overweight when their BMI is more than 25 and obese when their BMI is superior to 30.

OVERVIEW

Obesity has become a major global public health problem, causing 4 million deaths per year, particularly in developed countries. Diseases linked to unhealthy lifestyles and ageing populations are a new health challenge for countries in the Asia-Pacific region. The latter have indeed managed to rid themselves of more traditional diseases, but are now faced with these non-communicable diseases, warns the World Health Organisation. In the USA, the number of adults with diabetes has increased since 1995 by at least 50% in 42 states and by 100% or more in eight others, according to federal statistics. These diseases are characterized by an epidemic-like growth. While the origins of diabetes may be partly genetic, the main causes are our current consumer society, unhealthy lifestyles and psychological factors. Obesity also plays a major role in inducing diabetes.

Today, 425 million people worldwide have diabetes according to the International Diabetes Federation. Regardless of the type, diabetes can lead to complications that affect many parts of the body and increase the overall risk of premature death. In Côte d'Ivoire, as in many African countries, diabetes killed more than 300,000 Africans in 2017, and it is projected that 41 million people on the continent will have diabetes by 2045. Africa will then be the region of the world with the most important increase. Examples of possible complications are heart attacks, strokes, kidney failures, leg amputations, vision loss and nerve damage. During pregnancy, poorly controlled diabetes increases the risk of intrauterine death and other complications for both the mother and the infant.

A person with diabetes or obesity represents an expense. Direct charges refer to the provision of health services to treat health problems related to obesity or diabetes, i.e. expenditure on hospital admissions, consultations and medication consumption.

1. Indirect costs refer to the loss of productivity when people have to leave work for health reasons, either temporarily or permanently. These costs are calculated on the contribution that these people could have made to the economy if they were not ill. It is also possible to see a reduction in the productivity of workers as they suffer from illnesses that affect them physically and psychologically.

Obesity also affects the quality of life: it can lead to discrimination, which in turn can lead to stigmatisation and social marginalisation. These situations can be caused by teachers, employers, health professionals, the media, and even friends or family. This can lead to significant long-term risks, such as depression and reduced self-esteem. These dangers are susceptible to creating a vicious cycle of loss of self-confidence, which turns into a fear of being judged, which may then discourage people suffering from the disease from engaging in outdoor physical activity or seeking expert medical treatment. Children in particular suffer from obesity-related stigma: an obese child is 63% more likely to be bullied than a healthy child, and bullying, if aggravated or sustained, can even lead to suicide.

The Global Cost of Diabetes Global health expenditure (in billions of USD) due to diabetes in 2015, and predictions for 2040, by region

Source: Statista

RELEVANT UN TREATIES AND EVENTS

13/05/1989

Establishment of diabetes prevention and control, with a special focus on diabetes mellitus, whilst making the prevention of diabetes a priority for the World Health Organization.

22/05/2004

Recognition of the interdependence of nations, communities and individuals regarding public health issues, alongside the central role governments play in creating an environment which encourages individuals, families and communities to make positive, life-enhancing decisions about a healthy diet and physical activity.

26/05/2012

Supporting Member States in the Global Strategy for Infant and Young Child Feeding, with the latest evidence on nutrition, progress in implementing the global plan, and the report on the implementation of the International Code of Marketing of Breast-milk Substitutes. This links to diabetes as women who suffer from the disease find complications in being able to breastfeed their newborns.

World Diabetes Day annually takes place on 14 November and World Obesity Day on 4 March, aimed to raise greater awareness regarding these major issues.

POSSIBLE SOLUTIONS

1. Education

• Create educational programmes in schools to make children aware from an early age of what a healthy lifestyle entails, what a balanced diet looks like and the importance of practising physical activity at least 3 times a week;

• Organise daily group gymnastics sessions for all classes;

• Provide grants and technical assistance to help schools ensure healthy eating in school restaurants, e.g. through salad bars, more fruit and vegetables, limiting sugary drinks and foods etc.

• Setting up vegetable gardens in schools to promote access to balanced nutrition and to raise awareness and direct involvement of children in their diet and consumption habits;

2. Professional sphere

• Make a gym/workout room accessible to all in the workplace; offer reduced or free access to nearby clubs and gyms;

• Allow sufficiently long breaks for employees to engage in physical activity;

• Provide healthy food and drink in canteens, vending machines and other workplaces, while limiting access to sugary drinks and promoting access to clean water;

3. Economy

• Introduce taxes on certain foods that contain too much fat, salt or sugar in order to reduce the intake of products that worsen obesity and diabetes (e.g. soda tax in France);

• Use the revenue from these taxes to reduce the price of healthier foods and drinks;

• Ban or reduce certain advertising (fast food, excessively fatty or sugary foods etc.);

• With the help of nutrition experts, establish and introduce a visual system of products in supermarkets that allows consumers to better visualise the content and quality of their purchases; (on energy or nutritional quality (e.g. carbohydrates))

4. Medical domain

• Manage stress with relaxation techniques (cardiac coherence, sophrology, techniques that help to de-stress and limit obsessions) to try and limit eating disorders;

• Prescribe physical activity sessions supervised by health specialists for overweight or obese people;

• Consult a nutritionist or dietician at the first signs of overweight;

• Psychological support for patients during therapy, to encourage them to remain motivated and to learn more about the causes of eating disorders;

5. Infrastructure

• Improve access to active public transport such as free or affordable bicycles provided by the public authorities;

• Improving urban facilities, e.g. adding stairs when possible, providing safe cycle paths, etc.

• Make lifts or other means of transport and static movement more difficult to access - except for those with reduced mobility issues - to encourage people to use healthier means of transport (bicycles, walking, etc.) and at the same time reduce the negative effects of greenhouse gases;

• Provide subsidies and incentives for the purchase of bicycles, walking equipment and other sustainable transport means, to encourage the population to use these means of transportation which allow for a minimum and regular level of physical activity.

BIBLIOGRAPHY

• https://apps.who.int/iris/bitstream/handle/10665/254648/9789242565256-fre.pdf;jsessionid=6B69541EA0EB3D752D6D0DCFB9492471?sequence=1 (WHO World Diabetes Report(eng))

• https://www.who.int/health-topics/diabetes#tab=tab_1 (Diabetes (eng))

• https://www.who.int/health-topics/obesity#tab=tab_1 (Obesity(eng))

• https://www.youtube.com/watch?v=PkHwH-kBn5I (What is Diabetes ?)

• https://www.youtube.com/watch?v=ERR2qfSw11k (What are the causes of Obesity )

• https://www.nouvelobs.com/topnews/20130528.AFP4269/l-oms-s-attaque-a-l-obesite.html

• https://www.cdc.gov/obesity/strategies/index.html

• https://www.oecd.org/health/health-systems/Heavy-burden-of-obesity-Policy-Brief-2019.pdf

• https://www.cdc.gov/obesity/strategies/index.html

• https://www.nouvelobs.com/topnews/20130528.AFP4269/l-oms-s-attaque-a-l-obesite.html

• https://www.euro.who.int/en/health-topics/noncommunicable-diseases/obesity/publications/2017/weight-bias-and-obesity-stigma-considerations-for-the-who-european-region-2017

• https://apps.who.int/iris/bitstream/handle/10665/80480/A65_R6-en.pdf World Health Assembly Resolution (Global Strategy on Diet, Physical Activity and Health)

• https://apps.who.int/iris/bitstream/handle/10665/172224/WHA42_R36_eng.pdf?sequence=1&isAllowed=y World Health Assembly Resolution (prevention and control of blood sugar)

• https://apps.who.int/iris/bitstream/handle/10665/20142/A57_R17bis-en.pdf World Health Assembly Resolution (Global Strategy on Diet, Physical Activity and Health)

• https://www.allodocteurs.fr/archives-de-plus-en-plus-de-diabetiques-en-asie-pacifique-11533.html evolution of diabetes in Asia

• https://www.lemonde.fr/ameriques/article/2012/11/16/les-chiffres-du-diabete-explosent-aux-etats-unis_1791637_3222.html evolution of diabetes in the United States

• https://www.federationdesdiabetiques.org/information/diabete/chiffres-monde

• https://www.lemonde.fr/sciences/article/2019/03/04/le-diabete-bombe-a-retardement-pour-l-afrique_5431307_1650684.html

Research Report, Ferney-Voltaire Model United Nations 2022

COMMITTEE : World health Organisation
ISSUE : How to ensure global and equitable access to COVID-19 vaccines?
CHAIRS : Emma Robinson & Emna TOUNSI

KEY WORDS

Coronavirus SARS-CoV-2 : virus from the coronaviridae family, responsible for the
infectious respiratory disease called Covid-19, first identified in China in January 2020.

Vaccine : substance administered into the body - usually by injection - which aims to protect
against viruses by introducing killed or attenuated forms of infectious agents to stimulate the
body’s immune response and create the necessary antibodies to fight the real disease.
There are 3 main types of vaccines:
1) Live attenuated vaccines, which contain disease causing pathogens but deprived of
their infectious capacity, allowing a fairly effective protection against the targeted virus.
However, this type of vaccine is not recommended for pregnant women or people with a
weakened immune system;
2) Inactivated vaccines, which do not contain a live virus or bacterium but rather
fractions of the deactivated infectious agent. This is the most commonly used method for
vaccines;
3) Messenger RNA vaccines: this technique replicates the genetic code of the virus’
antibody protein so that, once inserted in the body, the latter can promote the
production of proteins and antigens allowing the immune system to quickly recognize
and destroy the virus.

Vaccination : strategy aiming to protect the population by using vaccines to fight serious
diseases. Even before the COVID-19 pandemic, vaccination as a preventive measure was a highly
controversial issue.

GAVI, Global Alliance for Vaccines and Immunisation : international organization created by
the WHO in January 2000 to address the issue of vaccination. It created the COVAX program in
April 2020 to promote the equitable distribution of COVID vaccines on a global scale.
Global and equitable access : Granting the right to benefit from something - in this case,
vaccines - at all levels, regional, national, or international, and regardless of the economic
situation, political context, or social status of individuals.

OVERVIEW

In November 2019, the first coronavirus cases appeared in the Chinese city of Wuhan.
Today, there are more than 240 million people who have contracted the disease, and the death
toll exceeds 4 million deaths, numbers that will continue to rise if the global community doesn't
intervene quickly to implement both short term and long-term solutions. While some countries
are already preparing to offer a third vaccination dose to their citizens, other countries have not
even started their vaccination strategies yet.
Covid-19 is a viral infection that affects all age groups, but manifests itself in various ways. A
patient can be asymptomatic, which means they’ve contracted the disease but without
manifesting any outward signs. The virus can also be perceived as only a mild sickness, such as a
simple cold or a temporary flu; and in the most serious cases, for patients presenting immunal
or respiratory deficiencies, the virus tends to exacerbate pre-existing medical conditions,
causing more severe respiratory disorders that can often prove to be fatal.

1) Vaccination policies, the only real solution?
The ease with which the virus spreads from one individual to another has led to
long-lasting and devastating social, economic and political impacts, prompting many countries
to adopt more or less radical preventive measures, such as quarantine, confinement, border
closures, curfews, etc. Although these measures help to slow down the spread of the disease,
serious economic and social consequences will continue to arise as long as the virus isn’t fully
eradicated. In order to do so, it is therefore important to implement long term solutions, and the
international community has turned to medical experts and pharmaceutical industries for help
and advice.
To date, no conventional chemical drug is able to fully cure or prevent the virus. Medication
such as paracetamol can help limit its unpleasant effects, but the only effective preventive
treatment against COVID-19 is vaccination: it allows individuals to protect themselves whilst
simultaneously reducing the virus’ chances of spreading to others. For this reason, governments
alongside private investors have encouraged and financed the development, purchase and
distribution of vaccines.

2) Main challenges and inequalities
As vaccine production increases, inequalities accumulate as well. As of May 2021, 75% of
all vaccine doses had been administered in only 10 countries. Higher income countries are not only able to produce the vaccines, but also purchase them quickly and distribute them to their
own populations without much difficulty. Pursuing national self-interests, some countries such
as India have even tried to block vaccine exports abroad. So even if lower income countries such
as some in Africa or Asia had sufficient funding to buy the necessary doses, they would still have
to deal with governmental measures restricting vaccine exportations abroad. Another major
problem is the transportation and storage of vaccines, which both require specialized and costly
infrastructures, such as adequate roads, adapted vehicles and freezers. Many countries are
currently unable to properly distribute vaccine doses to all their citizens, especially those living
in rural areas, and then provide the necessary preservation means for them. Finally, a shortage
of health care personnel to properly administer vaccines and a lack supporting medical and
technical equipment such as syringes or computers, is a serious hindrance as well.
In addition to these material and technical problems, the attitudes of certain governments and
individuals can be a major obstacle to immunisation. Certain political or other influential figures
contribute to the spread of misinformation regarding vaccines and discourage their fellow
citizens from getting vaccinated. In Tanzania, for example, the country’s Health Minister held a
press conference denying the vaccine’s positive results and instead promoted a vegetable
smoothie that was supposed to fight the virus. This refusal to recognize the importance of
vaccines and the tendency to condemn the entire vaccination process is slowing down the fight
against the pandemic.

3) A major global issue
Our highly globalized and interconnected world requires vaccination on a global scale for
vaccination measures to be truly successful. If only a few citizens of certain countries are
vaccinated, it will be difficult to keep borders open for travel or trade, both of which are essential
to the economic well-being of many countries.

"No one is safe from COVID-19 until the entire world is safe."
- Volkan Bozkır, President of the United Nations General Assembly

In partnership with the WHO, the NGO GAVI established the COVAX program, which to
date remains the only global initiative working with States and manufacturers alike to ensure
the availability of Covid vaccines worldwide. According to the latest data, COVAX has already
shipped more than 236 million doses to 139 program participants, and continues to build on
support from States and donor foundations to ensure equitable vaccine procurement and
distribution. But the platform still faces many challenges, such as vaccine export controls in
some countries, inaccessible locations, insufficient funding, and competition from States that
favor direct agreements with pharmaceutical companies instead of a more cooperative
approach.

RELEVANT UN TREATIES AND EVENTS

25/01/2008
Global Immunisation Strategy - World Health Assembly

This strategy aims to expand access to new vaccines whilst monitoring the population for
potential side effects. The Assembly stresses the importance of working with international
partners and donors to ensure the proper distribution of vaccines as well as setting an affordable
price for all countries, especially low-income countries. It also calls on the international
community to further research, development and regulatory measures in the field of vaccines,
particularly for developing countries.

21/02/2013
Global vaccine action plan 2011-2020 - WHO
In May 2012, the World Health Assembly and 194 countries came together to implement a
global vaccine action plan to reduce the number of deaths linked to curable or preventable
diseases. The plan is based on six principles, namely: Country ownership, Shared responsibility
and partnerships, Equity, Integration, Sustainability and Innovation. In practical terms,
immunisation is an important component of the right to health, so it is important that people
are informed about immunisation and that governments provide effective immunisation
services. For its implementation, it is necessary to ensure good organisation and financial
management.

26/02/2021
Resolution on equitable distribution of COVID-19 vaccines - UN Security Council
In February 2021, the Security Council gathered to address the issue of global immunisation.
Aware of the humanitarian conflicts and the varying degrees of inequality between countries, a
resolution was drafted and ratified to find solutions to obstacles that slow down the fight against
Covid-19. Specifically, it was proposed that no country should stockpile vaccines, but that all
vaccines produced should be available for immediate use; that all health systems should be
optimised; and that parties engaged in armed conflict should sign a ceasefire to facilitate the safe
transport and distribution of vaccines.

POSSIBLE SOLUTIONS
In order to ensure global, rapid and efficient vaccine production and distribution,
cooperation between States and international organisations must be promoted, on financial,
technical and material levels.

Favoring an adapted and efficient distribution
- Establish a collective management of vaccination policies to allow for a proportional
distribution of vaccines in relation to the number of a country’s inhabitants.
- Prioritize immunisation for essential medical personnel, as well as for people in poor
health or advanced in age.
- Take advantage of existing multilateral architecture, particularly COVAX, to strengthen
supply chains and expand global vaccine delivery capacity.
- Encourage partnerships with companies such as DHL, FedEx and UPS, which are well
equipped to meet cold chain transport requirements in a safe and timely manner.

Building trust and cooperation
- In order to counteract fake news and promote public confidence in vaccines, a possible
solution is to conduct awareness campaigns in schools, public places, on social media etc.
so that the population is fully aware of the health situation, the exact functioning of
vaccines, as well as the urgent need to get vaccinated.

Promote research, production and distribution
- Harmonise the fight against COVID-19 by pooling together the efforts of all laboratories
internationally to increase knowledge related to the virus and better anticipate future
pandemics.
- Ensure that outdated policies, such as those related to trade, taxation and customs, do
not slow down or prevent global distribution.
- Another possibility would be to adapt laws protecting the intellectual property of
vaccines: models of intellectual property exploitation based on sharing, rather than
control, can be encouraged, for example. Another possibility would be to amend patent
laws to protect the technology required for developing or producing the mRNA vaccine,
rather than the product itself (the vaccine).