Despite notable scientific and medical advances, broader political, socioeconomic and behavioural factors continue to undercut the response to the COVID-19 pandemic1,2. Here we convened, as part of this Delphi study, a diverse, multidisciplinary panel of 386 academic, health, non-governmental organization, government and other experts in COVID-19 response from 112 countries and territories to recommend specific actions to end this persistent global threat to public health. The panel developed a set of 41 consensus statements and 57 recommendations to governments, health systems, industry and other key stakeholders across six domains: communication; health systems; vaccination; prevention; treatment and care; and inequities. In the wake of nearly three years of fragmented global and national responses, it is instructive to note that three of the highest-ranked recommendations call for the adoption of whole-of-society and whole-of-government approaches1, while maintaining proven prevention measures using a vaccines-plus approach2 that employs a range of public health and financial support measures to complement vaccination. Other recommendations with at least 99% combined agreement advise governments and other stakeholders to improve communication, rebuild public trust and engage communities3 in the management of pandemic responses. The findings of the study, which have been further endorsed by 184 organizations globally, include points of unanimous agreement, as well as six recommendations with >5% disagreement, that provide health and social policy actions to address inadequacies in the pandemic response and help to bring this public health threat to an end.

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Background: Human immunodeficiency virus (HIV), hepatitis B (HBV) and C (HCV) viruses infect millions of people around the world. People who use drugs (PWUD) are at high risk of such viral diseases and could be the source of these infections to other people. Shared needle, unsafe extra-marital sexual contact, skin popping and other risky behaviors are well-known risk factors for the prevalence of these infections among PWUD worldwide. There is no valid information regarding the danger and rate of the above-mentioned viral infections and associated risk factors among PWUD referred to healthcare facilities in Kabul, Afghanistan for the treatment and support. Objectives: The main objective of this study was to determine the prevalence and risk factors of HBV, HCV, and HIV among PWUD in Kabul, healthcare facilities. Methods: This study was conducted in 7 public and private healthcare facilities at the primary care level in Kabul, which provides social support and medical care to PWUD. All patients who referred to the healthcare facilities from May 2016 to October 2016 and signed the consent were included in this study. Results: Out of 410 PWUD, 15 (3.7%) were positive for the HBV surface antigen (HBsAg), 45 (11%) were positive for HCV antibody, and one (0.2%) was positive for HIV antibody. Among the risk factor variables studied, the administration of drugs by injection was considered the most important for HCV (OR = 3.80, P < 0.01) and viral infections among PWUD (OR = 5.40, P < 0.01). Conclusions:This study draws attention to the high prevalence and spread of viral hepatitis among PWUD in Kabul, Afghanistan. The prevalence of HCV and HBV was higher among PWUD compared to general populations, and drug use via injection was an important risk factor for transmitting viral infections. Based on our results, active preventive programs focusing on educational campaigns targeted at the youth populations should be undertaken in Afghanistan. Further studies, especially among PWUD living without shelter in Kabul and other major cities of Afghanistan, are recommended in order to better analyze the dangers among drug addicts in Afghanistan.

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To the Editor-The new coronavirus (SARS-CoV-2) and the disease it causes (coronavirus disease 2019 (COVID-19) is now a concerning issue that has impacted public health and the global economy. As of May 4, 2020, this infection has involved >210 countries with >3.5 million cases and 240,000 deaths. 1,2 On February 24, 2020, the first SARS-CoV-2-positive case was reported in Afghanistan in Herat province. The disease has spread rapidly to the major cities and finally to all 34 states in a limited period. As of May 4, 2020, there have been 2,894 SARS-CoV-2positive cases and 90 COVID-19-related deaths in Afghanistan. 2 Afghanistan has taken many measures to combat COVID-19, but it also faces a lot of many challenges, many of which fall into 3 areas: prevention, diagnosis, and treatment. 3