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WHO Resolution Aims to Bridge Global Gap in Skin Care
A medical resident in the South Pacific will soon make history. After he graduates in 2026, he's slated to become the first dermatologist to serve the Solomon Islands, a nation of 800,000 people. His training is both a breakthrough and the product of an international effort to improve access to skin care.
As they gathered in Fiji in late May to support the resident's regional training program, visiting dermatologists got thrilling news: In Geneva, the World Health Organization (WHO) unanimously passed a landmark resolution to support global skin health.
Dermatology trainee Joseph Sangatu, slated to become the first dermatologist in the Solomon Islands, and American dermatologist Esther Freeman, MD, PhD, in the patient ward at the Pacific Dermatology Trainin Cengter in Suva, Fiji.
'We're here 2 days after the resolution passed, already implementing it,' said Claire Fuller, a London-based consultant dermatologist and chair of the International League of Dermatological Societies (ILDS) in an interview. 'The timing is fantastic.'
Addressing a Global Care Crisis
The resolution aims to tackle stark disparities in global dermatological care.
Africa and the Pacific islands have only zero to three dermatologists per million people, Esther Freeman, MD, PhD, associate professor of dermatology at Harvard Medical School and director of Global Health Dermatology at Massachusetts General Hospital, Boston, said in an interview from Fiji. 'Many countries have zero dermatologists. There are two dermatologists in Papua New Guinea for 10 million people,' she said.
In May, at the annual meeting of the Society for Investigative Dermatology in San Diego, Freeman told colleagues about other gaps in care: In parts of Africa, people with albinism can't find sunscreen, and moisturizer for atopic dermatitis costs double the typical monthly salary. In Australia, only six dermatologists serve rural areas.
At least a billion patients with skin disease have no access to dermatologic care, she said, and many more can't afford it.
The WHO's 'Skin Diseases as a Global Public Health Priority' resolution, proposed by the Ivory Coast and backed by Nigeria, Togo, Micronesia, and China, aims to implement a coordinated global strategy through initiatives like Fiji's regional training program.
The resolution, which passed without the support of the absent US delegation, doesn't come with funding. But José Ruiz Postigo, MD, PhD, a Neglected Tropical Diseases medical officer with WHO, told Medscape Medical News from Fiji that the vote is still transformative.
A resolution comes with a high level of mandate, he said. 'When you approach someone at a ministry of health and they ask why you are doing this, to what extent is this a priority, you show them the resolution.'
What Will the Resolution Do?
One goal of the resolution is to boost the training of dermatologists around the world through programs such as the Fiji's Pacific Dermatology Training Center . It's the first dermatology training program ever established in the Pacific islands, and three Fijians are graduating as the region's inaugural dermatologists.
The center, supported by a 5-year ILDS agreement, is similar to programs that have been implemented in other parts of the world. A regional center in Tanzania, for example, serves 16 countries across Africa.
Fuller emphasized that training isn't just a matter of producing dermatologists: '80% of dermatology burden is caused by about 10 diseases. We've got an achievable curriculum, and we can train community frontline workers on these 10 diseases.'
Freeman agreed, noting that a focus on 10 diseases is 'much more manageable . '
'We definitely need dermatologists to train the trainers, but they're not the only key players. We'll never have enough dermatologists,' she said. 'Using Papua New Guinea as an example, we need to acknowledge who's on the ground. It could be nurses, medical officers, pharmacists. There's a lot of different cadres of health workers, and this gives us an opportunity to think about the big picture of how we treat people on the front line.'
Funding Isn't Allocated — But It's Encouraged
Even though it doesn't allocate funding, the resolution specifically recommends that member states increase investment and financing for skin health.
'We in the dermatology community can go to WHO members and say, 'You signed up for this resolution, how can we help you deliver it?'' Fuller said. 'We're not waiting for governments to just act on this; we're going to help them do it.'
In addition, the resolution 'opens the door' toward nongovernmental funding, she said. 'Everyone can go to a donor, a university, and say 'Look, in view of this resolution, we want to do this, but we need money.' It's something concrete to point to.' The resolution also mandates WHO to develop internal dermatological resources. 'There's no dermatology department,' Fuller added. 'An obvious solution is to develop a dermatological resource within WHO.'
As for the ultimate goal, she said, 'we'd like to be able to say that access to dermatological care is a standard: Any person with a common skin disease would be able to go to their frontline healthcare provider and get it addressed, and there would be specialist services available to refer to when needed.'
