key: cord-0863329-tahmvelj authors: Catton, Howard title: International Council of Nurses representing nursing at the World Health Organization: COVID‐19, policy and holding politicians to account date: 2021-09-22 journal: Int Nurs Rev DOI: 10.1111/inr.12702 sha: 96d257ac83b4d0bb4515bb7b501e67ba5a8e73c3 doc_id: 863329 cord_uid: tahmvelj The International Council of Nurses is in a unique position to represent nurses at the World Health Organization, and its task has never been more urgent than this year. Amid the global COVID‐19 pandemic, the death rates of nurses and other health care workers are truly shocking, with around 115 000 deaths. However, many countries do not collect statistics on health and care workers’ deaths and infections from COVID‐19, so the full extent of this awful situation is not known. At this year's World Health Assembly, the body that sets the World Health Organization's agenda for the following year, the International Council of Nurses’ 50‐strong delegation voiced the concerns of nurses and ensured that the views and advice of nurses were heard by the World Health Organization's 194 member states’ delegates. Here, the International Council of Nurses’ Chief Executive Officer Howard Catton describes how the Council is influencing health and care policy worldwide. He urges nurses everywhere to hold their politicians to account. With the death toll of nurses and other healthcare workers officially reaching 115 000 in May 2021, the pandemic passed another terrible milestone alongside all the other awful statistics it has thrown up. It is clear that there has never been a more urgent need for the voices of nurses to be heard on the global stage. The International Council of Nurses (ICN) has been calling for official statistics on infections and deaths among nurses for more than a year, but when the number was finally revealed, it was truly shocking. ICN has voiced the well-founded concerns of the profession where they can potentially have the greatest effect, at the United Nations (UN), the meeting of the G-Seven group of countries and the World Health Organization (WHO). ICN wrote to the UN calling on the world's governments to make a Declaration on Pandemic Preparedness and to create a supra-governmental body to oversee global responses to international health emergencies in the future. This is urgently needed following a damning independent report on global preparedness for the pandemic and the global response to it (see below). ICN also addressed the G-Seven group of countries asking them to draft and agree to a global pandemic treaty that will better prepare and strengthen our health systems and put the protection and safety of nurses and other healthcare workers at its very heart. ICN also represented nursing at the governing body of WHO, the World Health Assembly (WHA), which usually meets in Geneva, Switzerland, each year in May. It consists of representatives from WHO's 194 member states, and its role is to determine WHO's policies, appoint its Director-General and supervise its finances and budgets. This year's WHA meeting was held virtually because of the travel restrictions and other constraints of the ongoing COVID-19 pandemic. Our 50-strong delegation of nurses and nursing students were as fully engaged as they ever have been across the whole agenda. Despite not being able to attend in person, they ensured that the voice of nursing was heard at the world's top health and care policymaking forum. ICN is in a special position to be able to do this work because it has been in 'official relations' with WHO since 1948, the year that WHO was founded. By working within WHO's  CATTON Framework for Engagement with non-State Actors (WHO, 2021a), ICN can contribute to the WHO by representing the global nursing profession to its 194 member states' delegates during the Assembly and work with WHO throughout the rest of the year. The official theme of this year's Assembly was 'Ending this pandemic, preventing the next: building together a healthier, safer and fairer world' . This recognised the devastation that COVID-19 has caused, We know that all of that-ending the pandemic and building for a better future-can only happen if nurses are well-staffed, properly supported, protected, educated and trained. Equally importantly though is the fact that they must be provided with suitable working conditions and paid appropriately for the services they deliver to their communities. It was gratifying to see WHO's new Global Strategic Directions for Nursing and Midwifery (2021-2025) , which ICN contributed to, adopted on the floor of the WHA (WHO, 2021b). The new strategy presents evidence-based practices and policy priorities that can help countries ensure that nurses and midwives contribute optimally to achieving universal health coverage and other population health goals. By publicly adopting it, WHO is pointing the way to solutions to long-lasting issues affecting nurse education, jobs, leadership and practice that will help to achieve WHO's patient safety goals. WHO Director-General Dr Tedros Adhanom Ghebreyesus opened this year's WHA meeting by praising the world's healthcare workforce. But he also announced the devastating news about the 115 000 deaths of health and care workers from COVID-19. Dr Tedros called the pandemic the defining health crisis of our age and warned that until transmission of the virus is controlled in every country, it will not be over; 115 000 deaths in 17 months is equivalent to 200 health and care workers dying every day, a truly sobering thought. Sadly, as nursing is the largest single healthcare worker, we know that many thousands of our colleagues are among those who have died. It was appropriate then, that the WHA adopted its Global Patient Safety Action Plan 2021-2030 at the meeting. ICN had contributed to this and was consulted during its formulation (WHO, 2021c). WHA also adopted its resolution on protecting, safeguarding and investing in the health and care workforce. Governments and employers must do everything they can to protect nurses and their colleagues while they do their vital work during the pandemic and beyond it. ICN's interventions at the WHA contribute to the solutions that WHA devises, and they can have a broad and significant impact on health and care policy globally. This year's interventions focused on items under discussion that have particular resonance for nurses, foremost of which was the global response to the COVID-19 pandemic. In May 2020, WHO set up the Independent Panel for Pandemic Preparedness and Response to examine its response to the pandemic, and at this year's WHA, its report was received and noted by the WHA. ICN had contributed to that report via a webinar in December 2020, in which National Nursing Associations, Nursing Now groups and individual nurses shared experiences of working on the frontlines of the COVID-19 pandemic. The highly critical report, entitled Make it the Last Pandemic says the pandemic was a preventable disaster and identified weak links in the chain of preparedness and response (IPPPR, 2021) . It found that the pandemic alert system was too slow and too meek, the WHO was 'underpowered' , that the response to the pandemic has exacerbated inequalities and that global political leadership was 'absent' . ICN's intervention at WHA in response to the report highlighted the crucial role of nurses during the pandemic, in the emergency care arena and public health and beyond. It alerted the WHA to the damage done to nurses' mental and physical health and well-being and repeated its call for all governments to keep accurate records of the number of infections and deaths from COVID-19 among nurses and other healthcare staff. Other interventions by ICN concerned agenda items on the prevention and control of non-communicable diseases, antimicrobial resistance, WHO's 2030 immunisation agenda, its implementation of the 2030 agenda for sustainable development, the health workforce and WHO's commitment to the UNs' Global Strategy for Women's, Children's and Adolescents' Health (2016 −2030 (UN, 2015) . We now know that the world went into the pandemic shockingly underprepared for it, despite the plans that were in place. We know from the State of the World's Nursing report that there were six million too few nurses, which meant that nearly every country, and especially low and middle-income countries, was in a poor position to cope right from the start (WHO, 2020) . ICN now believes that the true magnitude of the global nursing shortage is far larger than that, with another four million nurses expected to retire by 2030, and an unknown number planning to or having to leave work as a result of the after-effects of the pandemic. The key to a better, healthier future for everyone is the global community's endorsement and investment in nursing leadership, not just at the clinical level. This is of course vital, but nursing leadership is required to take place strategically in health organisations at every level, nationally and internationally. Governments have a duty to listen to the voices of experts, and the experts that are on the ground in these times and in this pandemic are nurses. Right around the world, nurses are on the front lines, often putting their lives at risk because of inadequate personal protective equipment as they struggle to meet the healthcare needs of their sickest patients. By intervening on behalf of our profession at the WHA, ICN is performing the age-old duty of 'speaking truth to power' . Nurses have seen what has gone wrong during the pandemic, and they have witnessed the fault lines in healthcare systems that were so ill-prepared for such an event. Through the ICN, the nurses of the world have spoken, and governments cannot deny that they have heard what has been said. It is now up to governments to take appropriate action to learn the lessons of this pandemic and prepare properly for the next global health emergency, whatever form it takes. The Independent Panel for Pandemic Preparedness & Response. COVID-19: Make it the Last Pandemic World Health Organization Sixty Ninth World Health Assembly. (2021a) Framework of engagement with non-State actors Global strategic directions for nursing and midwifery (--). DRAFT  April  Final draft State of the world's nursing report: Investing in jobs Global strategy for women's, children's and adolescents' health (−) It is up to the nurses, all of us, to determinedly make sure that world leaders take note of what we have to say and hold them to account. Howard Catton is the Chief Executive Officer of the International Council of Nurses (ICN). He is committed to ensuring that ICN effectively represents nursing worldwide, advances the nursing profession, promotes their wellbeing and advocates for health in all policies. He firmly believes that nurses should be at the heart of health policy decision making, and leading healthcare systems and delivery.