Global Alliance against Chronic Respiratory Diseases (GARD)

Preamble

Chronic respiratory diseases within the global NCD agenda.

Noncommunicable diseases (NCDs) cause 41 million deaths every year, equivalent to 71% of all global deaths. 85% of premature deaths (among those aged 30–69 years) occur in low- and middle-income countries (LMIC).[1]

The WHO Global Action Plan for the Prevention and Control of Noncommunicable Diseases (2013–2030) was adopted by the sixty-sixth World Health Assembly in 2013 and included the target of a 25% relative reduction in premature mortality from NCDs by 2025.[2] These NCDs include cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes. Subsequently, in the 2030 Agenda for Sustainable Development, Heads of State and Government made a commitment in Sustainable Development Goal (SDG) target 3.4: “By 2030, reduce by one third premature mortality from NCDs, through prevention and treatment and the promote mental health and well-being.”[3]

Asthma and COPD (chronic obstructive pulmonary disease) are the 2 main chronic respiratory diseases (CRDs): effective prevention, diagnosis, treatment and monitoring of asthma and COPD are essential to reduce the global burden of deaths and suffering, particularly in LMIC.[4]

COPD is the third leading cause of death globally. In 2019, 3.2 million people died from COPD, while 0.5 million people died from asthma.[5] The Global Burden of Disease Survey 2019 estimates that 262 million (224–309) people are affected by asthma, and 212 million (200–225) by COPD.[6]

Asthma frequently affects young people: it is the commonest chronic disease in childhood and is responsible for considerable morbidity: uncontrolled symptoms lead to absence from school and work and associated costs for people living with asthma, their families, and the wider community.

The prevention, diagnosis, and management of chronic respiratory diseases, is central to the NCD agenda at WHO and aligns with the Thirteenth General Programme of Work (GPW13) outcomes.[7]

• 1.1: Improved access to quality essential health services
• 1.3: Improved access to essential medicines, vaccines, diagnostics, and devices for primary health care.
• 3.2: Risk factors reduced through multisectoral action

The Global Alliance against Chronic Respiratory Diseases (GARD)

GARD is a voluntary alliance of national and international organizations, institutions and agencies committed towards the common goal to reduce the global burden of respiratory diseases. The GARD initiative was set up to respond to a resolution of the World Health Assembly (WHA) in May 2000 (resolution WHA53.17) that emphasized the need to increase awareness of the growing epidemic of chronic diseases worldwide.[8] GARD was officially launched in 2006 in Beijing, with 4 strategic objectives: 1. Advocacy, 2. Partnership, 3. National plans on prevention and control, and 4. Surveillance.[9] The GARD governance structure comprises an executive committee (5 members plus 3 advisers) and a planning group (17 members representing the 11 working groups and 6 regional groups) – current serving members were elected in 2019 by the general meeting.

The evolution of GARD

The policies and procedures which govern the way in which WHO can work together with external partners have evolved in recent years. The Framework of Engagement with Non-State Actors (FENSA) was endorsed by the World Health Assembly in 2016. The transformation agenda was launched in July 2017 and included a new approach to partnerships. In order to work more efficiently, to create synergies, to focus on priority areas aligned with WHO priorities, and to catalyse political will and investment of resources, there is a need to update the GARD governance structure and the methods of working.

Under the revised terms of reference, GARD will continue to be an informal network for stakeholders to engage in the promotion of lung health: through prevention, diagnosis, and management of chronic respiratory diseases.

The primary focus will be to ensure equitable access to diagnosis and safe, effective, quality, and affordable treatment for people living with asthma and COPD, supported by Secretariat from the NCD Management unit within the NCD Department.

1. Vision and goal

The Global Alliance against Chronic Respiratory Diseases (GARD) is a voluntary alliance of national and international organizations, institutions and agencies committed to the vision of a world where all people breathe freely.

The overarching goal of GARD is to reduce the global burden of chronic respiratory diseases, focusing on low- and middle-income countries.

2. Objectives and proposed actions of GARD

Objective 1: Undertake advocacy efforts to raise awareness and build support for prevention, diagnosis and management of chronic respiratory diseases

In this respect GARD would:

a. Drive political commitment and mobilize resources from Member States, UN agencies and non-State actors.

b. Raise global awareness through coordinated annual efforts on; World Asthma Day (led by the Global Initiative for Asthma), World Lung Day (led by the Forum of International Respiratory Societies), World COPD Day (led by the Global Initiative for Chronic Obstructive Lung Disease).

c. Promote and disseminate WHO tools relevant to lung health and chronic respiratory diseases

d. Support WHO in advocacy efforts at global and regional level.

e. Support country level efforts to raise awareness and advocate for chronic respiratory diseases, linking with WHO country offices and ministries of health.

Objective 2: Promote networking for knowledge sharing

In this respect GARD would:

a. Assist and disseminate knowledge regarding efforts to expand access to inhaled medicines and diagnostic tools.

b. Share best practices relating to chronic respiratory disease prevention, diagnosis, and management, including health promotion and health literacy.

c. Disseminate research and innovation being done by their organization or stakeholders they represent.

d. Encourage multidisciplinary and cross-sectoral dialogue on issues relevant to lung health promotion.

e. Share knowledge, experience and resources with other GARD members.

3. Nature of GARD, its Secretariat and structure

GARD aims to facilitate cooperation to promote lung health. It acts as an informal mechanism for advocacy activities and information exchange undertaken by its members. GARD strives to achieve its vision through advocacy and collaborative efforts of its members and is not a separate legal entity.

Subject to the availability of sufficient human and financial resources for this purpose, the secretariat (the “Secretariat”) for GARD will be provided by WHO.

GARD includes a plenary body called the Membership Assembly comprised of members as further described below in these terms of reference.

As a WHO network, all GARD activities shall at all times be aligned with the normative/technical policies of WHO.

4. Members

GARD membership will be open to the following collaborating parties:

• public health agencies working in the area of chronic respiratory diseases
• intergovernmental organizations
• nongovernmental organizations
  • representing people living with chronic respiratory diseases
  • representing health care providers active in chronic respiratory care, to include among others
    • respiratory specialist doctors
    • primary care doctors
    • nurses and nurse practitioners
    • allied health professionals; physiotherapists, occupational therapists
    • community health workers
    • pharmacists
• private sector entities organized through constituencies or international business associations
• philanthropic foundations
• academic institutions and research groups.

All stakeholders seeking to apply for GARD membership must meet the following criteria:

• must be an entity and not an individual
• work actively in the field of chronic respiratory diseases/lung health promotion and align to the vision, goal, and objectives of GARD
• have an organized structure
• commit to actively engage in the work of GARD
• provide information on their organization and sign the WHO tobacco-arms disclosure statement.

Responsibilities of members:

• promote the work, vision, goal, and objectives of GARD
• actively participate in GARD activities, discussions, and collaborations
• participate in the GARD Membership Assembly
• participate, as appropriate, in GARD project groups
• share knowledge and information (case studies, programme results, research findings etc.) with other members
• support and enhance, without compromising, the scientific and evidence-based approach that underpins WHO’s work.

Member organizations will be listed on the WHO GARD webpage.

Observers

Industry associations/umbrella organizations representing manufacturers of diagnostics tools, medicines and other products or services relevant to the prevention and control of chronic respiratory diseases.

5. Meetings

Membership Assembly

GARD will hold 1 Membership Assembly every year. The Membership Assembly comprises 1 delegate nominated by each member. Under specific circumstances, a member may request an additional delegate to attend, subject to prior approval by the Steering Committee.

The functions of the Membership Assembly are to:

• review the work plan and the report of the Steering Committee
• serve as a platform for exchange of views and consultation among members
• deliberate on issues proposed by the Steering Committee that promote the objectives of GARD.

GARD may also hold additional ad hoc meetings, as necessary and appropriate.

To the extent possible and appropriate, meetings of GARD may be combined with meetings of other relevant bodies or events.

6. Steering Committee

The Steering Committee consists of 10–12 members nominated by WHO, including representatives from global respiratory organizations and an organization representing people living with asthma/COPD. The Steering Committee will include representation from all 6 WHO regions (Africa, Americas, Eastern Mediterranean, Europe, South-East Asia, Western Pacific).

WHO will chair the Steering Committee. With the exception of WHO, the term of office of Steering Committee members will be 2 years, renewable once.

Responsibilities:

• provide the overall strategic direction in consultation with WHO for the operative work of GARD
• review membership applications
• organize the Membership Assembly and its agenda
• establish project groups, develop and approve their work plans (see Appendix 1)
• endorse the GARD work plan.

7. Project groups

Project groups provide a mechanism whereby a group of members with similar interests can exchange information and collaborate on agreed specific tasks/projects in line with the GARD’s vision, goal, and objectives.

Project groups will function according to the standard operating procedures for GARD project groups (Appendix 1).

Creation of project groups may be proposed by any member and their establishment shall be subject to approval by the Steering Committee and the WHO Secretariat.

Project groups shall have a workplan that is approved by the Steering Committee and that describes the objectives, activities, deliverables and timeline for the proposed project group.

Project groups will report on progress at the Membership Assembly and will also provide a written report on their activities to the Steering Committee on an annual basis.

The initial term of a project group shall not normally exceed 2 years based on the agreed work plan with an automatic sun-setting clause. The term may, however, be extended based on need and efficacy as determined by the Steering Committee.

8. Secretariat support

The main responsibilities of the Secretariat are to provide administrative and operational support to GARD as necessary and appropriate subject to the availability of funds and in accordance with WHO rules, procedures and policies. This includes:

• operate day to day administrative business of GARD in consultation with the Steering Committee and coordinate implementation of its work plan;
• coordinate the organization of the membership assembly;
• conduct assessment and due diligence on membership applications, correspond with Members, and confirm admission of new members;
• maintain the GARD website;
• facilitate engagement of all members and the development of the GARD strategy to ensure the effective functioning of collaborative work;
• conduct periodic reviews of the role, functioning, and impact of GARD and initiate amendments to these terms of references, as appropriate, with a view to improving the functioning of GARD;
• chair the GARD Steering Committee;
• prepare and distribute documentation for the Membership Assembly (such as agendas, meeting reports, list of participants);
• establish a central repository of information and documents relevant to GARD;
• Prepare the GARD work plan and resource requirements for submission to the Membership Assembly for consideration and advice.

9. Modus operandi

GARD is not a decision-making body and will aim to reach consensus on issues being discussed.

The Secretariat reserves the right not to implement any GARD recommendation or activities which it determines gives rise to undue financial, legal, or reputational liability or is contrary to WHO policies, regulations and procedure.

Members shall not make public statements about GARD activities on behalf of the Secretariat without the prior consent of the Secretariat acting in consultation with the Steering Committee.

10. Visual identity

GARD will have a visual identity provided by WHO. Use of the visual identity by members will be subject to case-by-case approval by WHO taking into account its policies, regulations, and procedures.

Members shall not use WHO’s name, acronym, and emblem without explicit written authorization. This includes the display of WHO emblem and name on any premises, equipment, as well as on any communication and/or training materials, training certificate, social media tools or publications.

11. Publications

As a general rule and subject to its discretion, WHO shall be responsible for issuing publications about GARD activities. All decisions about the preparation and dissemination of publications made by GARD members (other than WHO) concerning GARD activities shall be made by consensus by the Steering Committee.

Copyright in any publication made by WHO shall be vested in WHO. This also applies if the work is issued by WHO and is a compilation of works by GARD members or is otherwise a work prepared with input from 1 or more GARD members. Copyright in a specific separable work prepared by a GARD member shall remain vested in that GARD member (or remain in the public domain, if applicable), even if it forms part of another work that is published by WHO and of which WHO owns the copyright as a whole.

Any publication by a member, other than WHO, referring to GARD activities shall contain appropriate disclaimers as decided by WHO, including that the content does not necessarily reflect the views or stated policy of the members (including WHO, acting as the GARD Secretariat).

12. GARD website

GARD will have a website that is housed within WHO’s domain. Weblinks to members may be included in the GARD website upon request by the concerned member(s) and subject to applicable Secretariat policies, rules, and regulations.

13. Financing of, and fundraising for, the activities of GARD and its participants (including the secretariat support)

Each member will, in principle, be responsible for meeting its own expenses in relation to GARD unless agreed otherwise on a case-by-case basis by the Secretariat. Members shall disclose to the Secretariat any third-party funding support that they have received to participate in GARD activities.

In order to minimize financial costs and environmental impact, the general assembly and Steering Committee meetings will generally be held virtually. In-person meetings will be considered on a case-by-case basis by the Secretariat, depending on available funding and ensuring equitable access for all participants.

The Secretariat and day to day operations will be supported by in-kind donations by members. The Secretariat may also raise funds from other sources to support the work of the GARD, in accordance with WHO rules and procedures, as appropriate.

All Secretariat funds shall be administered in accordance with WHO’s policies including its financial regulations, rules, and practices. Contributions will be acknowledged by the Secretariat in accordance with its applicable rules, policies, and practices. Contributors will be listed on the GARD website.

14. Termination of participation in GARD

Any member may terminate its involvement in GARD by providing 1 month written notice to the Secretariat.

A Member will be deemed to have withdrawn from GARD if such member is not present at 2 successive membership assemblies without providing explanation to the Steering Committee.

The involvement of any member shall terminate, if the member is engaged in activities that are incompatible with the policies of the Secretariat or contrary to the vision, goals, and objectives of GARD.

The decision to terminate involvement of a member shall be made by the Secretariat, in consultation with the Steering Committee, as appropriate.

The Secretariat shall be responsible for informing members of any termination notices it has received or termination notices it has issued.

WHO may with the provision of 3 months prior written notice to the members, terminate its role as the Secretariat of GARD or withdraw from GARD.

[1] Global Health Observatory

[2] Global action plan for the prevention and control of noncommunicable diseases 2013–2020. Geneva: World Health Organization; 2013.  

[3] United Nations. Transforming our world: the 2030 Agenda for Sustainable Development.

[4] NCD Countdown 2030: pathways to achieving Sustainable Development Goal target 3.4. Lancet. 2020;396(10255):918-34. 

[5] World Health Organization. Global Health Estimates 2019.

[6] GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204-22.

[7] The Thirteenth General Programme of Work, 2019–2023. Geneva, World Health Organization; 2019.

[8] Prevention and control of noncommunicable diseases.

[9] Bousquet J, Dahl R, Khaltaev N. Global Alliance against Chronic Respiratory Diseases. Allergy 2007: 62: 216-223.

Appendices

Appendix 1: Standard operating procedure (SOP) for GARD project groups

Purpose

The purpose of this SOP is to ensure that GARD project groups are effective and impactful, and that their activities are well aligned with the priority areas for GARD and WHO.

Furthermore, the assessment process and ongoing monitoring of GARD projects should be transparent and fair, with clear understanding of roles and responsibilities of WHO Secretariat, the GARD Steering Committee and GARD members.

Scope

This SOP will detail the procedures involved in GARD project group

1. Proposal submission: the proposal of a new project group by GARD members
2. Proposal assessment: the assessment of a project proposal by WHO Secretariat and GARD Steering Committee
3. Monitoring and evaluation: the ongoing monitoring and evaluation of a project group by the project group members, the GARD Steering Committee and WHO Secretariat.

Responsibilities

GARD members involved in project groups are responsible for providing all requested information during the submission and monitoring and evaluation procedures. Project group members are responsible for the overall success of the project and must keep the steering group updated on progress. Project group members should also ensure that project outcomes are disseminated widely, for maximum impact.

The organization leading the project group is responsible for securing and administering funding for the project activities. Project group funds will not be administered by WHO.

The Steering Committee will assess project group proposals against pre-defined criteria. The Steering Committee will monitor the progress of active project groups through review of an annual report, and make recommendations on the extension of project timelines if relevant.

The WHO Secretariat will support the Steering Committee and receive their recommendations. Final decisions regarding project group proposals and extensions will be made by the WHO Secretariat. The Secretariat will ensure that project group activities are updated on the WHO webpage and communicated to relevant colleagues within WHO.

Procedures

1. Proposal of new project groups

The lead organization for the proposed project will complete the project proposal template – only projects providing the full information required will be assessed.

Project proposal template (to be converted into a DataForm)

2. Assessment of project proposals

The following criteria will be used by the Steering Committee to assess project proposals:

• the project should benefit from the networking opportunities of GARD: i.e. there should be more than 1 GARD member organization involved
• the project must address 1 of the GARD priority focus areas, and align with WHO General Programme of Work
• the project must be directly relevant to low- or middle-income countries
• the project proposal must state specific deliverables and timelines
• the project lead must have identified funding to support the project activities
• the project should have a plan for monitoring and evaluation, and a plan to share project outcomes
• the project should engage with WHO country office and ministry of health where relevant.

The project will be assessed by 3 members of the Steering Committee, who are not involved in the project proposal.

The approved proposal will form the basis of the project workplan.

Details of approved GARD project groups will be posted on the GARD webpage. The project lead is responsible for providing up-to-date information to post on the webpage.

3. Monitoring and evaluation

All project groups should include monitoring and evaluation within their project workplan.

Project groups will report on progress at the Membership Assembly and will also provide a written report on their activities to the Steering Committee on an annual basis.

The initial term of a project group shall not normally exceed 2 years based on the agreed work plan with an automatic sun-setting clause. The term may, however, be extended based on need and efficacy as determined by the Steering Committee.