Berlin Declaration on Sepsis
Urgent Call for the Enforcement of the World Health Assembly Resolution (WHA70.7) and Reinvigorated Global Action on Sepsis
Delegates and supporter organizations (1) of the 2023 Central World Sepsis Day Event convened in Berlin on September 12 under the Patronage of Dr. Karl Lauterbach, Federal Minister of Health of Germany and Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), and co-organized by the Global Sepsis Alliance, European Sepsis Alliance, Sepsis Foundation, and Deutschland Erkennt Sepsis (Germany Recognizes Sepsis),
Acknowledging the Progress Made in the Fight Against Sepsis, including:
a. Adoption of the historic World Health Assembly Resolution (WHA70.7) (2) in 2017 to improve the prevention, diagnosis, and clinical management of sepsis, based on the initiative of Germany;
b. Prioritization of sepsis in national health policies, strategies, and/or initiatives by at least 16 countries (3);
c. Underwriting the 2030 World Sepsis Declaration (4) by over 14,000 stakeholders globally;
d. Generation of paramount evidence on the significant global burden of sepsis across 195 countries and territories, as published in Lancet in 2020 (5);
e. Publication of the first Global Sepsis Report in 2020 by the WHO (6);
f. Establishment of 5 Regional Sepsis Alliances worldwide, that brings together 120 member organizations of the Global Sepsis Alliance, including medical and public health associations, sepsis survivors, patient organizations, and foundations, and
g. Annual commemoration of World Sepsis Day on September 13 with the engagement of a multitude of stakeholders through global awareness-raising campaigns since 2012;
Concerned that Despite the Progress and Paramount Scientific Evidence,
a. Sepsis remains a major global health threat, and a leading cause of death, disability, and healthcare spending around the world (7), accounting for about 20% or 1 in every 5 deaths (5);
b. Sepsis affected 48.9 million people and claimed 11 million lives of children and adults only in 2017 (5);
c. Sepsis-related deaths might be even higher, up to 13.7 million, based on the Global Burden of Disease Study, estimating that 7.7 million deaths associated with 33 bacterial pathogens would rank as the second leading cause of deaths globally in 2019 (8);
d. 15.8 million sepsis cases and 5.11 million or nearly half of all sepsis-related deaths occurred in individuals with underlying injuries or non-communicable diseases (5);
e. Most of the estimated 14.9 million excess deaths during the COVID-19 pandemic (9) are to be attributed to viral sepsis as the final common pathway to death from most infectious diseases (2, 7, 10);
f. Sepsis disproportionally affects low- and middle-income countries (LMICs) with 85% of cases occurring in LMICs (5) and remains a lead cause of hospital deaths in high-income countries (HICs);
g. Sepsis continues to have a high economic burden, accounting for an estimated mean of 2.65% of the healthcare budget or 0.33% of GNP expenditures (11);
h. Sepsis awareness remains low among policymakers, healthcare professionals, the general public, and other public- and private stakeholders;
i. Sepsis burden is especially challenging in the context of the aging population in HICs, as well as prevailing poverty, poor sanitation, hunger, and weak health systems in LMICs, and armed conflicts;
j. Sepsis burden will be further aggravated by the climate change impact with concerning trends in the incidence of dengue, chikungunya, and other vector-borne infections (12), and
k. The enforcement of the WHA70.7 Sepsis Resolution remains low, as less than 10% of the 194 WHO Member States have prioritized sepsis in their national health policies, strategies, and/or initiatives as of 2023;
Realizing that,
a. Health-related Sustainable Development Goals and aspirations for Universal Health Coverage (UHC), Antimicrobial Resistance (AMR), and the Pandemic Prevention, Preparedness, and Response (PPPR) cannot be achieved without reinvigorated actions against sepsis at national, regional, and global levels;
b. Policymakers rightly prioritizing AMR, including in the outcome documents of the G7 and G20 Health Ministers’ Meetings in 2023, must address and equally prioritize sepsis as the ultimate final pathway to death from infections rendered untreatable due to AMR, and
c. Improved prevention, early diagnosis, and timely treatment of sepsis, through enhanced vaccination, nutrition, and hygiene practices, education of health professionals and the general public, and effective AMR stewardship, can contribute to strengthening holistic and patient-centered national health systems;
1. Call on the UN Member States to ensure urgent and full-scale enforcement of the commitments declared in the 2017 WHA70.7 Sepsis Resolution, namely to:
a. Include prevention, diagnosis, and treatment of sepsis in national health systems strengthening in the community and in healthcare settings;
b. Develop and implement standard and optimal care and strengthen medical countermeasures for diagnosing and managing sepsis in health emergencies;
c. Increase public awareness of the risk of progression to sepsis from infectious diseases;
d. Develop training for all health professionals on infection prevention and control (IPC) and patient safety, and the importance of recognizing sepsis as a preventable and time-critical condition with urgent therapeutic need, and of communicating with patients, relatives, and other parties using the term “sepsis” in order to enhance public awareness;
e. Promote research aimed at innovative means of diagnosing and treating sepsis across the lifespan, including research for new antimicrobial and alternative medicines, rapid diagnostic tests, vaccines, and other important technologies, interventions, and therapies;
2. Request the Director-General of WHO to ensure oversight for full-scale implementation of the following articles of WHA70.7 Resolution:
a. To develop WHO guidance including guidelines, as appropriate, on sepsis prevention and management;
b. To support Member States, as appropriate, to define standards and establish the necessary guidelines, infrastructures, laboratory capacity, strategies, and tools for reducing the incidence of, mortality from and long-term complications of sepsis, and
c. To collaborate with other organizations in the United Nations system, partners, international organizations, and other relevant stakeholders in enhancing access to quality, safe, efficacious, and affordable types of treatments for sepsis, and infection prevention and control, including immunization, particularly in developing countries, while taking into account relevant existing initiatives;
3. Call on Key Stakeholders in Global Health,
including the UN Member States, UN agencies (UNDP, UNFPA, UNICEF, UN Women, WHO, and the World Bank), bi- and multi-lateral development agencies, the leading public-private partnerships (PPPs), and philanthropic foundations in global health (e.g., BMGF, CHAI, GAVI, The Global Fund, Rockefeller Foundation), Innovative Financing platforms (e.g., GlobalGiving, One Campaign, UNITAID), as well as the business sector, academia, professional associations, and civil society to:
a. Urgently prioritize appropriate positioning of sepsis in the Global Health Architecture, including in high-level forums (World Health Assembly, UN General Assembly, World Health Summit, Davos Economic Forum, G7, G20), as despite the paramount evidence on the significant burden of sepsis and its contribution to the deaths toll from HIV, Malaria, TB, and other priority infectious diseases, political and financial investments in the global sepsis response remain disproportionally low (8);
b. Urgently prioritize the development of Global and National Sepsis Strategies and Action Plans within the holistic policies for IPC, UHC, AMR, and PPPR, and ensure synergy of policy advocacy and action;
c. Establish regular (annual or bi-annual) monitoring and reporting mechanisms on the enforcement of WHA70.7 Sepsis Resolution, and strengthen data collection and surveillance systems for sepsis;
d. Initiate the 2nd WHA Resolution on Sepsis for submission to the 78th Session of WHA, with more specific and measurable targets, call for WHO to prioritize sepsis leadership in its organizational structure at all levels, call for synergies in policies and action for sepsis, UHC, AMR, and PPPR, and to recognize the World Sepsis Day as the fourteenth official WHO global health day (13);
e. Ensure increased and sustainable funding for sepsis at all levels, through domestic budgetary allocations, international development assistance, integration of sepsis in health system strengthening portfolios of global PPPs, private sector, and Innovative Financing platforms;
f. Prioritize the establishment of country-led coordination mechanisms for the design and implementation of national sepsis strategies, action plans, and patient-centered clinical pathways (14) (stand-alone or as part of broader sectoral policies) under the leadership of national health authorities and with the engagement of all relevant stakeholders on the ground, and
g. Ensure the establishment of a global academic network on sepsis for generation, consolidation, and dissemination of the proven and emerging evidence, knowledge, and innovations;
4. Finally, Call on G7 and G20 Leaders,
building on the example of the 2022 Berlin Communiqué of the G7 Health Ministers (15), to intensify efforts for strengthening the detection, diagnostics, and therapy of sepsis, synergize sepsis responses with antimicrobial stewardship and IPC, and ensure increased and sustainable funding for reinvigorated global action on sepsis.
