Hans Kluge, Regional Director, WHO Europe

“Europe is uniquely positioned to spearhead efforts against sepsis. Leveraging cutting-edge research, fostering international collaboration, and advocating for comprehensive health policies, we can catalyze significant progress in sepsis prevention, diagnosis, and treatment”. With this strong message, WHO Regional Director for Europe, Hans Kluge opened the 7th Annual Meeting of the European Sepsis Alliance, reiterating the continued support of WHO and calling on European leaders to join the fight against sepsis.

Prof. Evangelos Giamarellos-Bourboulis, ESA Chair

ESA Annual Meetings are unique opportunities to take stock of the progress of sepsis policy, research, and advocacy. We are proud and honoured to have assembled such a distinct panel of speakers, each bringing their unique perspective, contributing to describing the current situation of sepsis care in Europe.
Philippe Roux confirmed the indirect contribution of EU policies through the ongoing focus on reducing the burden of antimicrobial resistance (AMR). The recently approved European Council recommendations on AMR, besides encouraging education on sepsis, will entail European guidelines on infection prevention and control and on antimicrobial stewardship for the treatment of major infections, to the development of which ESA has indicated its interest and availability. Furthermore, the Horizon Europe program has already provided a total of €35 million support to sepsis-focused grants.

Mariam Jashi, CEO, Global Sepsis Alliance

However, despite the encouraging progress, and the staggering data shared by the speakers, concern was raised that sepsis is still not a priority in European health policy. Both the Global Sepsis Alliance (GSA) CEO, Dr Mariam Jashi, and the GSA founder, Prof. Konrad Reinhart, highlighted the disproportion between the policy focus and financing for AMR, compared to sepsis. Less than 10% of UN member states have prioritized sepsis in their health systems, highlighted Dr Jashi, who also stressed that the 4.95 million deaths attributable or associated with AMR are only part of the 13.66 million sepsis deaths. “Sepsis should be positioned in the global health agenda and in the mainstream of the global health architecture”, she exhorted.

Hon. Nathalie Muylle, Chamber of Representatives, Belgium

The meeting was also an opportunity to learn from countries that have prioritized sepsis. Belgium, currently holding the Presidency of the European Council, was deliberately well represented, also considering the significant progress and concrete steps initiated by sepsis survivor Ilse Malfait and the survivor group SEPSIBEL, who succeded to convince Health Minister Frank Vandenbroucke to commission a sepsis national plan. Ilse is supported in Belgium by far-sighted politicians such as Nathalie Muylle, who explained why in her view it is so crucial to prioritize sepsis: “It is more than just ticking another box in the long list of health priorities. It is about tackling a widespread threat that […] does not choose its victims and does not discriminate”. Muylle also enunciated the key elements of the upcoming Belgian plan, such as data collection, education, awareness campaigns, guidelines for early diagnosis and treatment, and specialized support for sepsis survivors.

Simone Mancini, Nora Lüthi, Edoardo De Robertis, Ron Daniels, Ilse Malfait

Similar elements were also shared in the first panel, where Dr Nora Lühti from Switzerland and Dr Ron Daniels from the UK helped participants understand what it takes to set up a national plan prioritizing sepsis nationally. The interventions confirmed that survivors and families can be a powerful trigger for action in a country, as was the case of the UK or Belgium. The leadership of dedicated professional was instead the main vector of change in other countries like Switzerland. Prof. De Robertis highlighted that tools and knowledge about sepsis are available, however, probably only few scientific societies (i.e. intensivists, anaesthesiologists), focus on sepsis while this condition has a horizontal nature, and can happen especially outside healthcare facilities. Furthermore, the correlation with AMR and pandemic preparedness must be further explored by healthcare professionals. Prof. De Robertis also stressed on the need to provide support to survivors, which is one of the priorities brought up by Ilse Malfait. Ilse shared once more her poignant story and said she was lucky, as she had “only” the limbs amputated, and also because she has access to a good rehabilitation therapy, but this is not the case for all patients in Belgium, who too often suffer from neurological problems too, without an adequate post-sepsis care. Information and support to sepsis survivors must be improved and widely disseminated, as it is the case for other diseases such as cancer. The issues of improving data collection, personalized treatment, equity in access to healthcare were also discussed by panelists and the audience.

Ulrika Knutsson, Ron Daniels, Ann Gills, Aurica Pripa

Aurica Pripa, ESA Patient and Family support Working Group, shared her dream of a society where sepsis is the most prevented (and no more preventable) cause of deaths, where awareness, treatment, and support to patients and their families contribute to improve patient outcome. The key message of the panel “Understanding sepsis: from silos to a common fight” was that the whole society must be involved in improving sepsis awareness, sepsis cannot be an issue of only patients and healthcare professionals, but media, industry, charities, and lay persons must all be involved. Ron Daniels once more stressed on the need to change the narrative about AMR, that is something concrete happening today, and hitting certain populations more than others. However, AMR does not kill people, but untreatable infections and sepsis do. Ann Gils, from the Belgian cancer organisation Kom Op Tegen Kanker, stressed on the need to break silos between sepsis and other diseases like cancer, that have much more visibility and support.

Shahrzad Kiavash

Finally, Shahrzad Kiavash’s witness, similarly to the one of Ilse, confirmed the need to improve sepsis awareness as her life could have been different right now if the doctors attending her in the first hours of her sepsis experience would have acted adequately.

Marco Cavaleri, European Medicines Agency

The last session discussed the challenges of setting up and running research networks on sepsis, ARDS, and related areas, and their critical value contributing to the preparedness of Europe for the next pandemic. Prof. Giamarellos raised the importance for research networks of involving physicians beside qualified research centers to make sure that results are broadly embraced and adopted in sepsis treatment, as for the case of biomarkers. Prof. Artigas went even further by suggesting including non-physician investigators in research networks for pre-clinical studies, benefiting from their knowledge and scientific approach. The importance of networks was also stressed by Prof. Artigas if Europe wants to compete with the US. The point was echoed by Marco Cavaleri, who stressed on the importance of European clinical trial networks which should be well funded through European money (via HERA for example) or national funds, to operate effectively and continuously. Those networks should also involve patients, ARDS, and sepsis experts, identify products, biomarkers, and phenotypes that could help us be prepared for the next pandemic. Regarding the issue of comparability of data, Prof. Linder also suggested using the ongoing national plans to collect harmonized clinical data.

Konrad Reinhart, Antonio Artigas, Evangelos Giamarellos-Bourboulis, Adam Linder

Despite realizing that sepsis still needs to gain visibility, that awareness must be continuously improved, and that the scientific knowledge is still investigated, the event concluded with a shared feeling of empowerment, as participants realized the progress since the inception of ESA in 2018. We are today in the right direction of a strong European sepsis agenda, jointly led by advocates, patients, physicians, industry, and policymakers.

The recording of the entire event is available below and on YouTube.

Mariam Jashi, CEO of the Global Sepsis Alliance, discussed current and future collaborations with Mandeep Dhaliwal, Director of the HIV, Health and Development Group of the United Nations Development Programme (UNDP), and Roy Small, UNDP Policy Specialist.

On behalf of the Global Sepsis Alliance and its Founding President Prof. Konrad Reinhart, Dr. Jashi expressed special gratitude to Mr. Achim Steiner - UNDP Administrator and Vice Chair of the UN Sustainable Development Group. Over the years, Mr. Steiner has supported GSA in its advocacy efforts, highlighting the critical role of a stronger global sepsis response in achieving the health-related SDGs and the 2030 Agenda for Sustainable Development.

Mariam Jashi presented to Mandeep Dhalawal the latest estimates of the global burden of sepsis, with 48.9 million cases and 13.7 million deaths each year. She also summarized the progress, achievements, remaining challenges, and the way forward to make the fight against sepsis the next global health success story.

The UNDP Director and the GSA CEO agreed to continue dialogue and closer collaboration to position sepsis higher on the global health and development agenda, including through the 2030 Multi-Year Strategic Plan (to be launched in May 2024) and high-level side events on the margins of the 79th UN General Assembly and the 2024 High-Level Meeting on AMR.

With UNDP's strengthened health portfolio at the global, regional, and national levels, the Global Sepsis Alliance looks forward to this new phase of partnership and accelerating progress towards the health-related SDGs through reinvigorated global action on sepsis.

Update March 18, 2024: The event has concluded, thank you for joining. You can rewatch it above.

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The 7th Annual Meeting of the European Sepsis Alliance will go down today, Monday, March 18, 2024 – and it’s not too late to join the free livestream on YouTube or embedded above.

We start at 11:00h Brussels Time (click here to see your time zone) and we have an amazing line-up of speakers for you, including sepsis survivors, policymakers, advocates, sepsis experts, and more. In addition to hearing thought-provoking presentations, we are super excited to host 3 distinct panel discussions featuring inspiring panelists and intriguing discussions.

So, what are you waiting for? Join the livesteam now and interact with us and other viewers, directly in the chat on YouTube.

In case you can’t make it live, the event will be available for recap as soon as it has concluded, at the same link and embedded above.

The Global Sepsis Alliance is deeply saddened by the untimely death of Prof. Dr. Tobias Welte, our esteemed colleague, President of the world's first sepsis society, Board Member of the Global Sepsis Alliance, and the Chairman of the Board of Trustees of the Sepsis Stiftung.

“In Tobias Welte, Germany has not only lost one of its most distinguished physicians and scientists and an internationally highly respected infection and lung researcher but also a lovable person, reliable friend, and advisor to many people from all areas of society. Tobias Welte’s uniqueness lay not only in his intellectual brilliance and scientific curiosity but also in his deeply human medical attitude, unclouded by any professional arrogance. It was also evident in his willingness to swim against the tide if necessary to overcome outdated structures and build new, forward-looking ones.”

— Prof. Konrad Reinhart, Chairman of the Sepsis Foundation and Founding President of the Global Sepsis Alliance

The Global Sepsis Alliance extends its immense gratitude to Prof. Welte's work and contribution to advancing the sepsis cause.

His major research work and practice in internal medicine, pulmonology, and infectious diseases will be remembered by his colleagues and generations of young researchers and medical professionals he has mentored and guided throughout his career.

Our thoughts are with the family and friends of Tobias during this difficult time.

On March 8, celebrating International Women’s Day, the Global Sepsis Alliance (GSA) and the Medical Women’s International Association (MWIA) signed a Memorandum of Understanding. 

In line with the MWIA President's triennial theme – One Humanity: Health Solutions Through our Partnerships, the GSA and MWIA agree to collaborate for the advancement of the global agenda for sepsis as an essential milestone towards improving Women’s Health. 

• Every year, sepsis affects 48.9 million people worldwide and claims the lives of 13.7 million children, women, and men

• 26.2 million cases of sepsis are estimated to occur in women compared to 22.7 million cases in men

• Globally, maternal sepsis cases are estimated at 5.7 million, and

• Every year, we lose 261,000 mothers as they give birth

This immense human suffering is preventable and global health partners have a critical role to play in raising awareness, advocating for policy changes, and training healthcare providers on the latest knowledge in sepsis, especially on the impact of sepsis among women and girls. 

Given the above, the Medical Women’s International Association and the Global Sepsis Alliance agree on the following:

1. MWIA as the WHO Non-State Actor and ECOSOC-accredited NGO to support GSA in high-level advocacy on sepsis at the World Health Assemblies (WHA), ECOSOC Commission on the Status of Women (CSW) Sessions, and WHO Executive Board Meetings.

2. GSA to convene high-level sepsis side events on the margins of UN General Assembly Sessions, the World Health Assembly, World Health Summit, and UNITE Summits with MWIA as a policy partner.

3. MWIA to ensure the organization of webinars for members of 42 officially affiliated National Associations of MWIA on sepsis, including how it affects women and girls.

4. GSA to provide public awareness raising and training tools for healthcare providers on prevention, early identification, and treatment of sepsis.

5. Sepsis Survivors and family members of the GSA network to support MWIA webinars for raising awareness on sepsis among medical women.

6. GSA and MWIA to ensure consistent advocacy on sepsis among national governments, global health authorities, UN agencies, academia, and civil society.

7. GSA, through its Regional Sepsis Alliances, Member Organizations, and networks, supports MWIA Women’s research and development efforts.

8. MWIA to support GSA and its Regional Sepsis Alliances in Africa, Asia-Pacific, Europe, and Eastern Mediterranean in implementation, data collection, and analysis of sepsis-related research.

Niranjan ‘Tex’ Kissoon, President of the Global Sepsis Alliance, and Louise Thwaites and Michael Wong, Program Chairs, are honored and excited to officially open the registrations for the 2024 WSC Spotlight on April 23, 2024.

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“We are thrilled to extend a warm welcome to thousands of colleagues joining us from across the globe for yet another exceptional opportunity to delve into and exchange insights on the newest trends, advancements, and innovations in the field of sepsis practice and research.”

— Niranjan ‘Tex’ Kissoon, President

Dr. Niranjan ‘Tex’ Kissoon

As always, the 2024 WSC Spotlight will be free of charge and completely virtual, enabling broad participation from all parts of the world. For years, the WSCs have engaged between 8,000 and 20,000 scholars and practitioners from more than 180 countries.

Over one day and 9 highly relevant sessions, over 40 internationally renowned speakers, panelists, and moderators will address the role of AI, predictive modeling in sepsis, the need for early diagnosis and treatment of sepsis in surgical patients, the role of biomarkers, personalized approaches to sepsis management, how hypervolemia increases the mortality risk in sepsis, community programs to prevent and diagnose sepsis, and much more.

Whatever topic and speaker is most relevant to you, the Program Chairs Louise Thwaites, Board Member of the GSA and APSA, and Michael Wong, Founder and Executive Director of PPAHS, are excited to welcome you on April 23.

Dr. Louise Thwaites

Michael Wong

Just as with our previous World Sepsis Congresses in 2016, 2018, 2021, and 2023, and WSC Spotlights in 2017, 2020, and 2022, this free online congress brings together highly ranked representatives of international and national healthcare authorities, non-governmental organizations, policymakers, patients, patient advocacy groups, clinical scientists, researchers, and pioneers in healthcare improvement.

The Global Sepsis Alliance welcomes the recent release of the World Health Organization webpage on the clinical management of sepsis and the ongoing work on the WHO Guidelines on Sepsis. Said website was released by the WHO Department of Integrated Health Services (IHS) in January 2024.

GSA commends the leadership and the team of the WHO IHS Department for the work on the new WHO Guidelines on Clinical Management of Sepsis, which are planned to be launched by the end of 2024.

The guidelines will respond to the call by the 2017 World Health Assembly Resolution (WHA 70.7) to develop WHO guidance on the prevention and management of sepsis. The new recommendations will support UN Member States in the development and implementation of national programs for the clinical management of sepsis in adults and children. The Guidelines will be intended for healthcare professionals, policymakers, expert advisers, and technical/program staff at organizations involved in the early identification and clinical management of pediatric and adult patients with sepsis.

Sepsis continues to affect at least 48.9 million children, women, and men every year and remains associated with 1 in every 5  deaths worldwide. Most of these deaths are preventable through effective prevention, early identification, and clinical management of this medical emergency, including effective AMR stewardship.

Therefore, the Global Sepsis Alliances and its Regional Sepsis Alliances look forward to closer collaboration with WHO Geneva Headquarters and respective Regional Offices in assisting with the dissemination of the new WHO Guidelines on the clinical management of sepsis and for the advancement of national and global policies and program capacities in prevention, timely detection, and treatment of sepsis.

The most difficult sentence we have ever had to read has to have been “The death of Kuan Brown was avoidable”, as it appeared in the Medical Examiner’s report.

Kuan was our healthy and incredibly fit 18-year-old son, who was training passionately to fulfill his dream of playing college football in America. That dream, and our beautiful boy, were taken from us on Tuesday, 23rd August 2022, when he passed away very unexpectedly due to undiagnosed sepsis.

It was all so sudden. Kuan played football on the weekend. On Monday, he started feeling unwell, and by Wednesday he had a temperature, had started vomiting, and had diarrhea. We arrived at the Emergency Department in the early morning of Thursday but after spending seven and a half hours there, we were sent home with a diagnosis that he “just had a virus” and that we should give him Panadol and Nurofen and keep him hydrated. The reality is, that Kuan had bacterial pneumonia and was in the early stages of sepsis.  Five days later, he was dead.

The defining day was the Thursday when we took him to the hospital. It was a day marred by an unimaginable series of hospital failures and poor judgments by medical professionals. The triage nurse told us Kuan was fighting an infection and was being categorised as “urgent”, but it was more than three and a half hours until he was even seen by a doctor. She examined him briefly and ordered a reactive protein test, a blood test, and a Covid test. We waited another three hours for the results. We were told the blood results simply showed a viral infection with no further treatment required. We left the hospital mid-afternoon, seven and half hours later, with the clear impression that this was not anything serious.

What emerged after Kuan’s death, was the extent of information that we were not told at the time. Information that was disclosed in the clinical governance investigation report months later, that we believe would almost certainly have saved Kuan’s life, had we been aware of it. The report told us that Kuan was triaged ‘Category 2’, which as per the Australasian Triage Scale, is given to people who need to have treatment within 10 minutes and have an imminently life-threatening condition. Had we been told this and understood what it meant; we would not have waited patiently for three and a half hours to be seen by a doctor. We have never received a satisfactory explanation for why this happened, other than there were an overwhelming number of patients present in the emergency department at the time.

The most concerning finding in the report was that when triaged, Kuan had clearly met the criteria for sepsis as per the New South Wales Health Adult Sepsis Pathway, with an onset of fever, cough, and breathlessness, including two ‘Yellow Zone’ criteria of an elevated heart rate of 137 bpm and a raised temperature of 39.2° C. This should have triggered an immediate response for the medical team to follow the sepsis pathway. It did not. The sepsis pathway stipulates that when a patient presents with two ‘Yellow Zone’ criteria including a new onset of signs and symptoms of infection, a blood gas is obtained to measure lactate, due to a lactate result of equal or above 2 (≥2) being a significant indicator with sepsis. A lactate level was not measured, and blood cultures were not collected. This would have saved his life. It was reported that workload pressures in the emergency department and false reassurance by the junior medical officer’s assessment of Kuan, led to him not having a senior medical review.

The report also confirmed that the doctor that eventually saw Kuan was an International Medical Graduate, who was on ‘Status 1 Supervision’. This meant she should have been under the full supervision of a senior doctor for every patient she examined. She saw Kuan alone, and the Senior Medical Officer on duty at the time, did not see Kuan at any stage. This International Medical Graduate decided to discharge Kuan, without understanding the results of the tests that were done on him. This explanation given in the report was that this junior doctor was placed in a position by the hospital where she was required to make decisions outside of her scope of practice, knowledge, and experience, as a result of not receiving the education, training, and supervision required for junior medical officers.

The c-reactive protein test she administered is a nonspecific blood test for a type of protein associated with inflammation in the body. Essentially it assessed the level of infection and inflammation within Kuan’s body. We now know that 8 to 10 mg/liter or lower is the normal range. Kuan’s result came back at 173ml/liter – 20 times the normal level. Yet, he was discharged with Panadol and Nurofen, just 44 mins after this result was confirmed. His discharge diagnosis was gastroenteritis presumed infectious.

What became evident from the investigation that was conducted on the hospital a few months later, was that 11 years after the New South Wales Health Adult Sepsis Pathway was introduced, it had still not been embedded in the routine practices of this hospital’s emergency department. In fact, the identification and management of sepsis was not mandatory in the junior doctor and international medical graduate orientation program for this hospital, and was the responsibility of individual medical staff to book in and attend. More disturbing was learning that this junior doctor did not even attend hospital orientation. This explains the report’s note that, “the level of appreciation and understanding of the signs of sepsis, in the context of a young person who looked well and reported feeling better following analgesia, led to best practice sepsis management not being commenced.”

We can blame the hospital and the medical professionals entirely. We believe we have good reasons to do that. The reality is though, we didn’t know anything about sepsis at the time. Of course, we are now very aware of the blatantly obvious symptoms, and it makes it harder to comprehend how medical professionals in an emergency department failed to act upon Kuan’s symptoms. What we have come to realise is that relinquishing our responsibility as parents and relying entirely on health professionals was not necessarily the right thing to do. Had we been aware of the symptoms of sepsis at that time, there is no doubt our beautiful Kuan would still be with us. We believe that we all collectively failed Kuan. This is why we want to share Kuan’s story – none of the results were shared with us or explained to us at any point. Had they been, our lives today would have been very different.

Most of us come from cultures in which we go to hospitals expecting answers and to receive the level of care we need. The reality is, that most healthcare systems are failing to meet the needs of those they serve. They don’t have all the answers. We are not suggesting we all need to become knowledgeable in everything that has the potential to harm us. Instead, we believe it’s about creating a culture of mutual accountability. Our role in that is to be curious. Ask questions and continue to ask questions, until you are satisfied with the responses, and you receive the level of care you need. The other side of mutual accountability is medical services and health professionals adopting a duty of candour. An obligation to share every piece of information with patients and families and demonstrate complete transparency and vulnerability.

Kuan had an enormous impact on so many people during his short life. He invested time in other people and lived his life in such a way that he was a blessing to everyone who knew him. One of his school friends captured the essence of Kuan in her tribute when she said, "Kuan cared for the people around him more than most knew. There is something truly special about a person who can share their passion and their love in ways that push others to try and achieve the same". He was loved and is now deeply missed, by so many. We will continue to fight for more protection for others in a similar situation – because that is what he would have wanted. This is Kuan’s story. The power of our collective stories is what will get us to the next stage!

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The article above was written by Duncan and Jolene Brown, Kuan’s parents, and is shared with their explicit consent. The views in the article do not necessarily represent those of the Global Sepsis Alliance. They are not intended or implied to be a substitute for professional medical advice. The whole team here at the Global Sepsis Alliance and World Sepsis Day wishes to thank them for sharing their son’s story and for fighting to raise awareness for sepsis.

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