1 IHP news 403 : And it’s only week one (27 Jan 2017) The weekly International Health Policies (IHP) newsletter is an initiative of the Health Policy unit at the Institute of Tropical Medicine in Antwerp, Belgium. Dear Colleagues, Glass half full people and “sober optimists” must have a pretty rough time these days, I feel sorry for them. As I heard earlier this week from a friend, “it took just one tweet, "As long as you live you'll never see a photograph of 7 women signing legislation about what men can do with their reproductive organs" by Guardian Editor Martin Belam to bring home the fact that Trump is here to stay, and the impact of that on the lives of people, particularly minorities and the vulnerable in the United States and across the world.” So here we are. With a rogue superpower, and a megalomaniac “moron-in-chief” now, with all the power he’s ever dreamed of. The Chinese year of the rooster has never felt as appropriate. What that will imply for global health, let alone planetary health, is becoming clearer with every executive order Trump is signing. Suffice to say that the WHO DG election (or at least the first round) felt a bit like a sideshow this week. On the bright side, the new world disorder might actually shake up a bit our (admittedly, rusty) world view – with some of the bad guys of before fast becoming the (almost) good guys – and inspire some global health stakeholders to team up (rather than compete), faced with a potentially disastrous global health & sustainable development adversary like Trump. Some of the EU leaders have similar hopes (but they still need to survive 2017 first…). Anyway, it’s clear we all need to put up a fight in the coming years. Last week’s Women’s marches around the globe were a great start. Scientists are following suit. And if all that doesn’t work, there’s always a wicked Plan B ! . In this week’s Featured article, Deepika Saluja (EV 2016) reflects on the homelessness people she encountered when staying in the US and Canada for some conferences, end of last year. Enjoy your reading. The editorial team
Transcript
1
IHP news 403 : And it’s only week one
(27 Jan 2017)
The weekly International Health Policies (IHP) newsletter is an initiative of the Health Policy unit at the Institute of Tropical Medicine in Antwerp, Belgium.
Dear Colleagues,
Glass half full people and “sober optimists” must have a pretty rough time these days, I feel sorry for them. As I heard earlier this week from a friend, “it took just one tweet, "As long as you live you'll never see a photograph of 7 women signing legislation about what men can do with their reproductive organs" by Guardian Editor Martin Belam to bring home the fact that Trump is here to stay, and the impact of that on the lives of people, particularly minorities and the vulnerable in the United States and across the world.”
So here we are. With a rogue superpower, and a megalomaniac “moron-in-chief” now, with all the power he’s ever dreamed of. The Chinese year of the rooster has never felt as appropriate. What that will imply for global health, let alone planetary health, is becoming clearer with every executive order Trump is signing. Suffice to say that the WHO DG election (or at least the first round) felt a bit like a sideshow this week.
On the bright side, the new world disorder might actually shake up a bit our (admittedly, rusty) world view – with some of the bad guys of before fast becoming the (almost) good guys – and inspire some global health stakeholders to team up (rather than compete), faced with a potentially disastrous global health & sustainable development adversary like Trump. Some of the EU leaders have similar hopes (but they still need to survive 2017 first…).
Anyway, it’s clear we all need to put up a fight in the coming years. Last week’s Women’s marches around the globe were a great start. Scientists are following suit. And if all that doesn’t work, there’s always a wicked Plan B ! .
In this week’s Featured article, Deepika Saluja (EV 2016) reflects on the homelessness people she encountered when staying in the US and Canada for some conferences, end of last year.
Post-travel reflections on the issue of homelessness
Deepika Saluja (EV 2016 & PhD student (Public Health) at Indian Institute of Management, Ahmedabad, India)
I was on a conference marathon, attending 3 prominent international conferences in the area of Public Health (QHR2016, APHA2016 & HSR2016) and an intense training program (EV4GH) across several cities of the U.S. & Canada. It was during my visit to these places that I found numerous homeless people sitting along the street side with notes saying ‘hungry’, ‘need money for food’, ‘any money for food will help’. I saw several people sleeping on the roadside under the shed of a restaurant or in a corner against the pillar or at the store entrances, squeezing themselves into as little pieces as possible to fight against the chilling winter. They had created their own little covers from cardboard boxes or their tiny tents from scrapped materials, hoping that it would protect them from the outside world. I was deeply pained to see these homeless people struggling with the cold weather and an empty stomach every few hours.
Following which, I went on a trail of thoughts imagining how it would feel to be in a situation like this, taking me back to the state of homeless people in my own country, India. Something seemed different. I was wondering what was driving them into such a situation. U.S., Canada being developed countries with per capita GDP and per capita welfare spending among the top 20 across the world and better social security mechanisms, I could not rationalize the extent of homelessness there (even if, in Vancouver for example, I got some explanations from public health experts on why the city struggles with a serious homelessness problem).
My own country is still a developing nation grappling with extreme poverty issues, hence, it is common to find homeless people even in the urban areas. The primary reason for homelessness in India is extreme poverty, while in the west, several other individual and relational factors like family break-up, domestic violence, mental illness, addiction challenges etc. are found to contribute to homelessness - coupled with migration recently.
However, I noticed a difference in the way these homeless people approach others for help. In India, a poor homeless person is likely to be an illiterate and cannot read or write even in his/her own local language. Generally dressed in unkempt clothes, these people find it difficult to convey their message and have to largely rely on nonverbal gestures. Unlike them, at least some homeless people in the west appear better dressed, and are able to communicate their circumstances well through written messages. The latter manner of seeking help is less intrusive, provides clarity on their situation and reason for seeking help. One can even find people explicitly asking money for drugs or alcohol. Recently, a prankster carried out a social experiment in New York to find out who would receive more help: a homeless drug addict or a homeless father, and to everyone’s surprise, the former was able to get a good sum of money in an hour with messages like ‘stay high man’ & ‘get a big bottle for yourself’.
This cultural aspect reflected by their behavior and mode of communication is just one bit of the entire story. If we try to understand this at a macro level, then there are several structural and systemic factors reacting with their individual circumstances making them land in situations like
these. Failure in the state’s social security system to address the needs of this section of population – too many holes in it, certainly in the US? - coupled with several structural factors like poverty, increasing unemployment, lack of affordable housing and access to other welfare services makes the situation even worse. As reasons are rooted across several political and social welfare dimensions, tackling homelessness actually needs a multi-pronged approach.
My observations from the streets in Northern America made me think of how such conferences are successful in bringing out the voices of the neglected homeless people living on the streets endlessly. APHA has a specific caucus dedicated to homelessness (for every annual meeting) with sub-themes such as: housing as a human right, impact evaluation of interventions targeted to homeless people, severity of multiple health conditions experienced by them etc. Also, these conferences (especially HSR2016) emphasize the role of civil society organizations and community engagement as an important mechanism to promote active citizenship among the community members. A key question for HPSR researchers is perhaps this one: how are communities to be engaged if many citizens are (too often) desensitized to issues of power and privilege in their own local settings? Somehow, our social justice antennas seem to be triggered more in faraway lands…
The United Nations Commission on Human rights estimated a 100 million homeless people worldwide in 2005; and over one billion for people living in any sort of insecure, temporary or illegal housing. A recent global poll conducted by GlobeScan in 24 countries found a significant increase in perceived seriousness of poverty and homelessness as national concerns. Hence it becomes essential to see how the learnings and ideas generated through such conference discussions get translated into reality. At least if we’re serious about ‘leaving no one behind’…
Highlights of the week
As last week’s IHP deadline came a bit earlier than usual, and news is rather “abundant” these days, this week’s newsletter will be a bit longer than usual. So get your cigar(s) & glass of wine ready!
WHO – 140th Executive Board meeting (Geneva, 23 Jan- 1Feb)
The 140th WHO EB meeting is in full swing. All eyes were on the first round of the DG election (see below). Here first some general information, and info/coverage of other agenda items. We’ll try to keep it short.
Resources: Provisional agenda, background documents, Statements by non-State actors in official relations with WHO at the WHO governing body meetings (organized per agenda item), recorded (webcast) public sessions ; list of EB participants (as published by WHO), ‘What and who is the EB’ (Imaxi), … (draft) resolutions & decisions, ... (= at bottom of the page).
First, some important info, briefings & letters from civil society actors:
Briefings MSF & PHM on important EB agenda items. (which includes “…The Executive Board have decided to admit into official relations with WHO the following NSAs: Bill & Melinda Gates Foundation, … ”). Also on the same tricky issue, a hard-hitting Open Letter to WHO’s Executive Board (by civil society groups): Conflict of interest safeguards far too weak to protect WHO from influence of regulated industries (the case of the Bill and Melinda Gates Foundation) . “With all the World Health Organization’s posturing about conflict of interest safeguards and due diligence in its new approach to collaborating with non-state actors in its recently revised constitutional “Basic Documents,” the WHO ended speculation about its ambiguous plan when it proposed to admit the Bill and Melinda Gates Foundation into “Official Relations” with the WHO and as a non-voting member of its governing body, the World Health Assembly….” “…Making up WHO budget shortfalls with funding from major investors in food, drug, and alcohol companies (which are often headquartered in wealthy countries) further compromises the independence of the WHO. Granting the Gates Foundation Official Relations status signifies a sharp departure from the post-WWII tradition of the World Health Assembly and makes a mockery of the conflict of interest safeguards purported to underpin the new “Framework of engagement with non-State actors (FENSA).” We urge the Executive Board to defer the decision to accept the Gates Foundation and any other new and legacy applicants for Official Relations status for which there has been no conflict of interest safeguard review on the record for consideration by Member States of the Executive Board….”
In another letter, CSOs, NGOs & academic orgs camee together to pledge the #EB140 MS and @who secretariat to implement #UNSGAccessMeds here.
Do read also (on TWN) - WHO: Member States raise information deficit for decisions on official relations.
Executive Board meeting: agenda items & coverage
(must-read) Margaret Chan’s Address to the Executive Board at its 140th session (relatively upbeat, this time). This item got most attention in global media: World must not miss early signals of any flu pandemic: WHO (Reuters). “The World Health Organization called on all countries on Monday to monitor closely outbreaks of deadly avian influenza in birds and poultry and to report promptly any human cases that could signal the start of a flu pandemic. Different strains of bird flu have been spreading across Europe and Asia since late last year, leading to large-scale slaughtering of poultry in certain countries and some human deaths in China. Experts fear the virus could mutate to spread more easily among people….”
See also Reuters (26 Jan) - Proliferation of bird flu outbreaks raises risk of human pandemic.
Coverage of the EB by IP-Watch, Devex & others (remark: most emphasis was on the first
round of the DG election, see below).
IP-Watch: (ahead of EB) – overview of main agenda items (must-read & open access now) WHO Board Meeting Playbook: Election Of New DG, Antimicrobial Resistance, Genetic Sequence Data
IP Watch - WHO Board: UN Report On Medicines Too Hot; DG Candidates To Be Narrowed.
More coverage of the EB meeting (and respective agenda items) will follow on IP-Watch (in the coming days). Same for Devex.
(must-reads) Daily reports by the Global Health Watchers:
January 23 (2-pager): overview of all agenda items of the day
January 24 (3-pager)
More to follow in the coming days – see GH Watch.
PS: for the ones short in time, we already want to flag that Germany & UK supported an increase in assessed contributions (10%) for WHO. US, Russia, China & even the African region didn’t.
Still, IP Watch also reported - US Could Agree To Slight Funding Increase At WHO Despite Trump Threats. “While US President Trump is preparing executive orders to reduce the US role in the United Nations and other international organisations, as reported by news outlets such as the New York Times, at the EB this week the US delegates did not give any indication that the US intends to withdraw its financial support to the WHO. The US said they could not support the 10 percent proposed increase but could envisage a smaller increase. The US representative said that in addition to their assessed contribution, the US provided the WHO with over US$270 million in voluntary contributions in 2016. “This has been testament to our trust in WHO as the leading institution to advance the global health agenda,” he said.”
WHO DG election: round 1
Geneva felt a bit like ‘The Voice’ this week, with the 6 candidates first narrowed down to 5 (on Tuesday morning) and then to 3 (on Wednesday evening). The 3 selected ones (Tedros, Nishtar & Nabarro) will now really start the campaign and take on each other in ‘the battles’. Some coverage of what happened this week:
“The WHO Executive Board selected by vote the following 3 candidates to be presented to World Health Assembly as nominees for the post of Director-General of WHO. Five candidates were interviewed by Member States today prior to the vote. The names of the 3 nominees were announced at a public meeting on Wednesday evening, 25 January 2017.” Unoffical tally of the 3 selected candidates: Tedros (30), Nishtar (28), Nabarro (18). Somewhat surprising was the low score of Flavia Bustreo (as compared to round 1 where she scored much better).
PS: Tom Frieden casted the vote for the US.
Analysis & background of the three selected ones:
(must-read) IP-Watch – WHO Director Candidates Down To Three, Europe Drops In Ranking
Includes this quote by Mathias Bonk : « “Today's election reflected the real choices of the EB Members. European votes were divided between the three European candidates,” said Mathias Bonk, a global health consultant who shared his predictions ahead of Wednesday’s results. “Nabarro will be much stronger in May.””
PS: Douste-Blazy had been considered a strong contender, earlier in the reace.
Politico - Three candidates from three continents vie to be next global health chief With the
remaining European from a country that will leave the EU…
Ilona Kickbush’s tweet summed it up well: “WHO elections have always been political but This time around @WHO #DGelection will be influenced by world politics as never before #EB140.”
From earlier this week, a podcast (25 min) with three influential global health governance voices: Chatham House “As the World Health Organization begins to produce a shortlist of candidates vying to lead it, David Heymann talks to Jeremy Farrar, Devi Sridhar and Ilona Kickbusch about the election of the next director-general of the UN health agency. “
On Thursday morning (10 am), the 3 selected candidates gave press conferences.
A tweet: “.@davidnabarro meets press @WHO. "Being #NextDG is a job I've spent most of my life training for" http://www.davidnabarro.info/index.asp?PageID=20 … #Nabarro4DG #EB140”
Now that Nabarro remains one of the key contenders, no doubt good to have a good look at the Reflections he prepared. (almost as many as EB agenda items – so he’s surely the one to beat!)
As for the next step in the campaign, see a tweet by Kickbusch: “Next phase of campaign activities:I t would be good to have transparency about campaign managers, funding and expenditures #DGelections @WHO”
IP-Watch – WHO Director General Candidates Hold Colorful Meeting With The
(must-read) Coverage of the press conferences - “The three remaining candidates to be director general of the World Health Organization today met at length with UN journalists in the WHO and highlighted their plans for reform including finding new sources of funding for the continually cash-strapped UN agency that now could face threats from the US president to cut US funding.”
Lancet – Reimagining WHO: leadership and action for a new Director-General
L Gostin & E Friedman; http://www.thelancet.com/pb/assets/raw/Lancet/pdfs/S0140673617302039.pdf
(must-read) They were razor-quick with their analysis (I assume they had it ready before the three names had been decided): “Three candidates to be the next WHO Director-General remain: Tedros Adhanom Ghebreyesus, David Nabarro, and Sania Nishtar. The World Health Assembly’s ultimate choice will lead an organisation facing daunting internal and external challenges, from its own funding shortfalls to antimicrobial resistance and immense health inequities. The new Director-General must transform WHO into a 21st century institution guided by the right to health. Topping the incoming Director-General’s agenda will be a host of growing threats—risks to global health security, antimicrobial resistance, non-communicable diseases, and climate change—but also the transformative potential of the Sustainable Development Goals, including their universal health coverage target. Throughout, the next Director-General should emphasise equality, including through national health equity strategies and, more boldly still, advancing the Framework
Convention on Global Health. Success in these areas will require a reinvigorated WHO, with sustainable financing, greater multisector engagement, enhanced accountability and transparency, and strengthened normative leadership. (i.e. five building blocks, in other words) WHO must also evolve its governance to become far more welcoming of civil society and communities. To create the foundation for these transformative changes, the Director-General will need to focus first on gaining political support. This entails improving accountability and transparency to gain member state trust, and enabling meaningful civil society participation in WHO’s governance and standing up for the right to health to gain civil society support. Ultimately, in the face of a global environment marked by heightened nationalism and xenophobia, member states must empower the next Director-General to enable WHO to be a bulwark for health and human rights, serving as an inspiring contra-example to today’s destructive politics, demonstrating that the community of nations are indeed stronger together.”
Check out also the appendix.
Some reads from earlier this week, on the stakes in this WHO DG election:
Stat News - A guide to the selection of the new head of the World Health Organization. (by Helen
Branswell)
Project Syndicate - Breaking the WHO’s Glass Ceiling (by Peter Singer & Jill Sheffield) Strong call for Tedros. “It is time to break the WHO’s African-leadership glass ceiling.”
Jill Sheffield also published a reply to Buse et al’s Comment in the Lancet - WHOse agenda for WHOm? Analysing the manifestos of the candidates for Director-General of WHO. “…A quick glance at the chart would suggest that only David Nabarro stands for gender equality, which is patently absurd. For example, Dr. Tedros has focused on the health of girls and women in Ethiopia, a seriously low resource setting, bringing down the incidence of female genital cutting, dramatically increasing contraceptive prevalence and legalising abortion. This is a clear signal of his commitment to gender equality. I encourage everyone to look at the experience and accomplishments of each candidate.”
Lancet – Act now: a call to action for gender equality in global health
Roopa Dhatt et al (on behalf of the Women’s Leadership in Global Health Strategy Roundtables, hosted by Women in Global Health and the Global Health Centre at the Graduate Institute of International and Development Studies); http://www.thelancet.com/pb/assets/raw/Lancet/pdfs/S0140673617301435.pdf
Must-read. “To the Members of the WHO Executive Board and Governing Bodies, as members of the global health community, we are writing to highlight the current leadership gap in global health and to call upon the WHO and its Member States to take decisive steps to achieve gender parity. Women are under-represented across the WHO political space. …”
You might also want to check out the survey results of the DG election poll - by Women in Global Health.
78% of respondents of the survey felt that “Gender factors into the perceived leadership qualities of the candidates and will impact how the next WHO Director-General is selected.” 74% of respondents based on their previous answer would advocate to the WHO governing bodies for a gender equal short-listing of the candidates during the first round of voting at the January WHO Executive Board meeting.
WHO reform, global health governance & global health security must-reads from this week
BMJ Global Health – Introduction to comments on 'Outsourcing: how to reform
The BMJ Global health editor-in-chief introduces three comments on Negin & Dillon’s (rather controversial) article of a few months ago, and the authors’ reply.
“…We present three important comments on Negin and Dhillon's article; all disagreeing with their argument, but nonetheless recognising an urgent need for change at the WHO. Their perspectives will be important for the incoming Director General, as much as Negin and Dhillon's response to these comments. …”
All are must-reads. And relatively short!
WHO's weakness is not technical, but due to lack of accountability (by David Legge & other PHM
scholars & activists)
WHO outsourcing dilemma: for whose benefit, at whose expense? (JR Sharma et al)
WHO is badly in need of reform, but it cannot replace NGOs like our own (by MSF’s Joanne Liu)
And the response from the authors to these three comments - WHO must prioritise its roles and
then be positioned and supported to execute effectively.
BMJ Global Health – Synergies and tensions between universal health coverage
and global health security: why we need a second ‘Maximizing Positive Synergies’
initiative
Gorik Ooms et al; http://gh.bmj.com/content/2/1/e000217
(must-read) “A kind of courtship is going on between proponents of universal health coverage (UHC) and proponents of global health security (GHS). In our opinion, efforts to make progress on the path to UHC and efforts to improve GHS can be synergistic, but are not self-evidently so. Making this
partnership work will require careful thinking and planning….” They suggest something like a re-run of the Maximizing Positive Synergies initiative, this time focusing on UHC & GHS.
They conclude: “Based on the considerations above, we would conclude that the courtship between UHC and GHS could at best result in a marriage of convenience. And such a marriage of convenience should be properly planned. …”
Suerie Moon et al; http://www.bmj.com/content/356/bmj.j280
(must-read) “Reports on the response to Ebola broadly agree on what needs to be done to deal with disease outbreaks. But Suerie Moon and colleagues find that the world is not yet prepared for future outbreaks.” The authors grouped recommendations from these reports under key themes and identified the greatest areas of progress and stasis
Guardian – The global goals need optimism. So how can we meet them in Trump's
“It’s foolish to expect the sustainable development goals to succeed in the current context. We need to adapt quickly “ Exactly. Hard-hitting analysis.
Lancet (Editorial) – Law: an underused tool to improve health and wellbeing for
The Lancet reflects on “Advancing the right to health: The vital role of law”, a recently released report. “…three areas in the chapter about the process of public health law reform deserve special attention and further thought: …” The editorial concludes: “…Nevertheless, this is an important report, and law, especially through an intersectoral lens, could provide big successes in achieving healthier populations in the future. All involved in policy making need to take heed.”
Must-read.
Trump(ism) early days & ramifications for global (ill)health, planetary (ill) health & further global rise of authoritarianism
I have a hunch we’ll need a separate section in this newsletter in the future for all the havoc Trump & crew are wreaking on global/planetary health & the world in general, but as this was just the first
week of his “administration”, so for now, I put all entries under the section ‘highlights of the week’ (what’s in a name). It’s been quite a week so far…
Let’s hope, with Politico, that a ‘government by edict’ is not sustainable - Trump’s flashy executive actions could run aground.
Women’s Marches around the globe
The week(end) started rather well, as you know.
Read for example (in Foreign Policy) - The Women's March heard around the world.
And Dena Javadi (EV 2014, and probably one of many EVs joining these marches around the world), taking part in the Geneva one “On Marche” She mentions, among others, “Women’s March is launching Women’s March Global, an NGO rooted in the idea of citizenship and the mantra “think global, act local.” Moving forward, Women’s March Global will be working closely with the 161 coalitions in 61 countries that helped organize marches and asking them to identify 3 local policy priorities in their communities. It started with mobilizing and now it’s all about organizing, making sure that the power of citizenship is used effectively and efficiently to bring about real action. What we can expect from Women’s March Global over the next year is support for each local coalition as they choose their 3 policy goals and organize days of action for locally-relevant causes….”
But then we basically had had it for the good news, for the rest of the week, with the possible exception of the end of TPP (which also Bernie Sanders agreed was a good thing).
We assume you kept abreast of the shocking series of executive orders on migration & visas, the wall, etc… Here we’ll focus on the ones more directly linked to global & planetary health, as well as the on the quick rise in authoritarianism in the US – the Economist now labels the US a ‘flawed democracy’.
Trump & UN & international liberal order
Guardian – UN funding: alarm at reports Trump will order sweeping cuts
“US allies have reacted with a mix of alarm and scepticism to reports that the Trump administration is preparing to order sweeping cuts in funding to the UN and other international organisations, while potentially walking away from some treaties. According to one draft executive order leaked to US media outlets, there is to be a 40% cut to US voluntary contributions to international bodies. Funds are to be cut off to any international organisation that gives full membership to the Palestinian Liberation Organisation or Palestinian Authority, or supports programs that fund abortion, or skirts sanctions on Iran or North Korea. A second order calls for a review and possible withdrawal from certain forms of multilateral treaties that do not involve “national security, extradition or international trade”. As examples, according to the New York Times which first reported the orders,
potential targets include the Convention on the Elimination of All Forms of Discrimination Against Women and the Convention on the Rights of the Child….”
See also the NYT - Trump prepares orders aiming at Global Funding and Treaties.
“President Trump’s proposed audits of U.S. international funding will reportedly call for a review of development aid to countries that “oppose important United States policies” – a plan that could prove uncomfortable for some of the biggest recipients of U.S. taxpayer dollars….” (see CNS )
CGD’s Charles Kenny gave the right answer to this: Cutting UN Funding Will Cost the US. (recommended blog) “But focusing in on the United Nations and related agencies, the proposed cuts would do almost nothing to reduce the deficit while weakening US national security and international leadership. Cuts to peacekeeping in particular would increase the risk the administration had to put US troops in harm’s way. US funding for the United Nations and its agencies amounts to a little over $4.5 billion a year—…”
Or read Patrick “The Internationalist” Stewart ‘s analysis(CFR) - Trump’s UN Executive Order Would Cut Off America’s Nose to Spite Its Face.
And some quick links:
Guardian - Human rights now face their gravest threat – Trumpism.
Humanosphere - Senate bill would halt U.N. funding; House bill would force U.S. to quit U.N. Just to
mention that noises from Congress don’t sound exactly more reassuring.
“In one of a number of sharp reversals from the Obama era, Donald Trump on Monday signed an executive order banning international NGOs from providing abortion services or offering information about abortions if they receive US funding….”
That was bad enough, even if not entirely unexpected (sadly), but then worries increased even more:
“Donald Trump’s executive order prompts fears for groups fighting Aids and Zika and working against child and maternal deaths.”
“… The policy has been repealed and reinstated several times in the past, but women’s reproductive rights groups said Trump had signed the “most extreme” and sweeping order of its kind. The policy has been expanded to affect “all global health assistance furnished by all departments or agencies”, according to a White House statement published on Monday. Suzanne Ehlers, president and CEO of PAI, described the expanded version of the law as “irrational and backward”. “Our preliminary analysis,” Ehlers said, “based on the presidential memorandum yesterday, is that [the global gag rule] is not only more severe and sweeping, but it’s more expansive than that introduced by previous presidents. “Family planning assistance funding by USAid is a budget of around $610m. But if our reading of this memorandum is accurate, it will cover all global health assistance. That is in the ball park of $9.4bn.” …”
Guardian – Dutch respond to Trump's 'gag rule' with international safe abortion fund
But when the going gets tough, you can count on the Dutch (well, sometimes ). “Up to 20 countries have indicated support for the Netherlands’ plan to set up an international safe abortion fund to plug a $600m funding gap caused by Donald Trump’s reinstatement of the “global gag rule”, the Dutch international development minister, Lilianne Ploumen, said on Wednesday. Ploumen took soundings from a number of her colleagues around the world on Tuesday evening after the Netherlands said it would act to mitigate the impact on hundreds of charities around the world. The “global gag rule”, also known as the Mexico City policy, was reimposed by Trump on Monday, and bans US federal funding for NGOs in foreign countries that provide abortion services or abortion advocacy. ‘We’re in talks with 15 to 20 countries and we’ve also spoken to foundations,” Ploumen told the Guardian…”
“The Dutch government says it wants an international fund to finance access to birth control, abortion and education for women in developing countries. Minister for Foreign Trade and Development Cooperation Lilianne Ploumen announced the plan Tuesday in reaction to an executive memorandum U.S. President Donald Trump signed a day earlier. It reinstituted a ban on U.S. funding to international groups that perform abortions or provide information about abortions. Ploumen wants to launch a new fund that could be supported by governments, businesses and social organizations to “compensate this financial setback as much as possible.”
(even the Belgian development minister seems to be on board already – Washington Post)
Some other reads & analyses related to the reinstatement of the global gag rule
Devex – NGOs scramble to safeguard programs in wake of Trump's expanded 'global gag rule
Amanda Glassman (CGD blog) - Zombie Policy on International Family Planning Rises Again.
“…Like many, I will point out that reinstating the global gag rule does not reduce abortion. On the contrary, there is evidence from sub-Saharan Africa that the rule reduced women’s access to contraception between 1994 and 2008, causing more unwanted pregnancies and more abortion. One affected organization, Marie Stopes International, estimates that the loss of US Government funding through reinstatement of the rule will result in 6.5 million unintended pregnancies and 2.2 million abortions, and 21,700 maternal deaths, all related to the scale down of their services in response to the anticipated cuts in US government support….”
See also Vox - Trump reinstated the global gag rule. It won't stop abortion, but it will make it less safe.
Or in a tweet from I Kickbusch: “Estimate - 2.2 million more abortions - the political determinants of health rule #pdoh”
Laurie Garrett on the reinstatement - Gag me: Trump's anti-abortion executive order.
Many organisations have already condemned the reinstatement of the global gag rule – but one particular one so far not (as Tim France noted on Twitter) https://www.plannedparenthood.org/files/9814/8486/3032/Coalition_Statement_Opposing_the_Global_Gag_Rule.pdf
MSF - 'Global gag rule': stop playing politics with women's lives, MSF tells Trump.
Guardian - Global gag rule' jeopardises future of Asia health initiatives, campaigners say.
Guardian - 'Global gag rule' could have dire impact in Latin America, activists warn.
And a few more resources related to the global gag rule (history & impact):
Guttmacher study (2015) on impact Global Gag rule:
BMJ (news) – Trump signs order targeting key elements of Affordable Care Act
http://www.bmj.com/content/356/bmj.j406
“In the first hours of his presidency, US president Donald Trump issued an executive order that directed federal agencies in his new administration to take immediate action to slow, impede, or halt the implementation any provision of the Affordable Care Act that imposed a “burden” on individuals, healthcare providers, insurers, and states….”
See also the Washington Post - Trump signs executive order that could effectively gut Affordable Care Act’s individual mandate.
US Uncut - Harvard doctors just revealed how many people will die from repealing Obamacare. “Two physicians with decades of experience studying death rates relating to changes in health coverage have concluded that repealing Obamacare is fatal. Drs. David Himmelstein and Steffie Woolhandler, both professors of public health at the City University of New York’s Hunter College and lecturers in medicine at Harvard Medical School, both agree that even under the most conservative estimates, getting rid of President Obama’s signature healthcare reform law will result in 43,956 deaths every year.”
But there is quite some debate on these and other estimates.
Guardian - Republicans look poised for three-part plan to repeal and replace Obamacare
“House Republicans seem poised to use a three-part process to repeal and replace Obamacare, as laid out to members in the party’s annual retreat. The first involves repealing the Affordable Care Act through the reconciliation process, a mechanism that allows only budget bills to be passed in the Senate without being subject to the filibuster. This would effectively change the threshold for passage in the upper chamber from the 60-vote super majority to a simple majority of 51. The second involves executive actions through the Department of Health and Human Services following the confirmation of Georgia congressman Tom Price, who has been nominated by President Trump to lead the department. The third would be a separate standalone bill. This three-pronged approach stands in contrast to that outlined by Trump who has urged a replacement “very quickly” after repeal….”
“If the Affordable Care Act is repealed, the Centers for Disease Control and Prevention could lose 12 percent of its budget.”
Trump & HIV global health programs
Washington Post – Trump team’s compassionate act will keep up the momentum on AIDS prevention
M Gerson; Washington Post;
“This Inauguration Day brings an act of compassion, outreach and bipartisanship by the Trump leadership team. The Trump administration will retain Ambassador Deborah Birx as the coordinator of PEPFAR (the President’s Emergency Plan for AIDS Relief) until a successor is named and confirmed. This action was taken, I am told by administration sources, at the urging of Ivanka Trump and Vice President-elect Mike Pence….” Encouraging signal by Trump towards PEPFAR, Gerson thinks.
Compensates slightly for the worrying stuff in the previous newsletter on PEPFAR – see also Jeremy Youde (blog) & in the section on the global gag rule reinstatement (and possible implications for US HIV funding). The Economist is equally worried - The global gag rule is likely to hit the fight against HIV/AIDS.
Rise of authoritarianism in US / Purge / crackdown on public health & science/
Trump & planetary (ill-)health
Just some early warning signs of the new ‘flawed democracy’:
Washington Post - CDC abruptly cancels long-planned conference on climate change and health
(self-censorship?) (see also Stat News - CDC canceled climate conference as a ‘strategic retreat’ )
EWG - Leaked memo: Leaked Memo Details Trump's Plans for War on Public Health, Environment and Science “An internal memo by President Donald Trump’s top environmental policy adviser reveals the new administration's plans to dismantle key air and water protection programs, and slash the budget of the Environmental Protection Agency.”
Vox - Sudden changes at the EPA, USDA, and CDC under Trump, explained “Government scientists are being ordered not to talk about their research — and it’s only week one.” See also The Washington Post.
(very nice paper – important one for the (multi-sectoral) SDG era ) “The multi-factorial causes of obesity demand integrated prevention policies with the collaboration of diverse sectors, although to date, there is little evidence of engagement by non-health sectors in developing obesity prevention policies. In this commentary, we develop a three-step argument for improving intersectoral collaboration. We first note that to encourage non-health sectors in developing and implementing integrated preventive policies, obesity should be reframed as a systemic problem rather than its dominant framing as a matter of individual behavioural change. We then propose a co-framing of obesity, such that it aligns with the policy goals of diverse non-health sectors. Finally, drawing on the network governance literature, we argue that a network-based governance approach with an independent network administrative organization will best facilitate multisectoral collaboration through a successful co-framing strategy.”
You know us - we can’t “resist” this kind of blog. “This blog explores how power and privilege manifest within the institutions and processes of health systems research.”
Nature (news) – World’s foremost institute on death and disease metrics gets massive cash boost
Speaking of power in global health, “The world’s premier centre for health metrics — the science of measuring and analysing global health problems, and how they relate to healthcare and biomedical research funding — will receive a US$279-million cash injection from the Bill & Melinda Gates Foundation. The University of Washington’s Institute for Health Metrics and Evaluation (IHME) in Seattle, also home town to the Gates Foundation, announced the funding boost on 25 January….”
See also the University of Washington’s press release, or Sue Desmond-Hellman (CEO of Gates Foundation) - How do you spend $5 billion a year? (It’s a question I don’t need to worry about, I humbly admit)
ASTMH (Editorial) - Noma: Time to Address a Collective Moral Failure
R Ravinetto; http://www.ajtmh.org/content/early/2017/01/19/ajtmh.16-0997
« In this issue of the journal, Srour and others give a comprehensive overview of the history, epidemiology, etiology, pathogenesis, microbiology, prevention, diagnosis, and treatment of noma, a
devastating orofacial gangrene that affects malnourished children in tropical regions. Even if exclusively present in tropical regions, noma is better described as a “poverty disease” rather than as a “tropical disease, ” because it has accompanied extreme poverty and poor nutrition for centuries. With the exception of cases occurred in concentration camps during World War II, noma disappeared from Europe and North America by the end of the nineteenth century, thanks to the economic development and improved access to nutrition and health care. Today, it is particularly present in the sub‐Saharan Africa “noma belt, “ stretching from Senegal to Ethiopia….”
… Today’s strong call of Srour and others to put an end to the unacceptable neglect where noma patients, noma survivors, and their families are left, and in particular their advocacy for inclusion of noma in the World Health Organization (WHO) list of Neglected Tropical Diseases (NTDs), is neither exaggerated nor unrealistic….”
“The Obama Foundation will focus on developing the next generation of citizens — and what it means to be a good citizen in the 21st century. It will draw strength from the rich diversity and vitality of Chicago, where the President and First Lady met and raised their daughters, and it will have nonprofit programs across the city, the United States, and the world.”
A tweet: “So the Obama Foundation launches. With a board of private equity execs, lobbyists, and an Uber advisor. #Resist”
WHO published a revised list of diseases likely to cause public health emergencies
Lancet – The Berlin Declaration on Knowledge in the Sciences and Humanities for Sustainable Development
R Horton ; http://www.thelancet.com/BerlinDeclaration2017
“A draft Berlin Declaration on Knowledge in the Sciences and Humanities for Sustainable Development was circulated at the Academic Publishing in Europe Conference, held in Berlin on January 17, 2017. It is not yet a milestone in the global movement for Sustainable Development. But, with a little commitment, we can perhaps do more than hope that it might be. …”
“Do sign up to support the new Berlin declaration for knowledge in the sciences & humanities for sustainable development: to agree to internationally agreed goals such as fact-based decision making in society, enhanced cooperation, and to improving the life of citizens and protecting the ecosystem. “
Horton et al taking on Trump, Farage and all the rest of them.
For more on this declaration, see also this week’s Offline. “…Academic publishing has lost touch with the concerns of the very society it is supposed to serve. It has become so wrapped up in its own technical preoccupations and internecine struggles that the global predicaments that publishers should be addressing have been forgotten or ignored….” Hence the new declaration. “In 2003, the Berlin Declaration on Open Access to Knowledge in the Sciences and Humanities was published. It was a self-declared milestone in the open access movement. 2017 demands another Berlin Declaration, one directed to the crises we face today….”
Global health events
Davos 2017
We covered Davos last week already quite in detail (at least until Thursday morning). A very quick
recap (& rest of the global health related highlights):
Nature (News) on the Launch of CEPI - Vaccine initiative marks bold resolution Was the main global health news in Davos – see last week’s IHP issue. (we already reported on the Access Accelerated Initiative last week also (for NCDs))
2017/ ( a bit more “Davos brainwashed”, perhaps, but worth reading)
“… For health specifically, there were three major conclusions. Firstly, pandemic preparedness continues to dominate global discussions, with the announcement of new partnerships. Bill Gates announced the Coalition for Epidemic Preparedness Innovations (CEPI), which was founded by the Bill & Melinda Gates Foundation, the governments of India and Norway, the Wellcome Trust, and the World Economic Forum. CEPI will work to rapidly build vaccines to outpace pandemics. This should move the world from a reactive mode as the next epidemic hits to a more proactive one. Secondly, there is an increased focus on addressing chronic diseases within the realm of the United Nations Sustainable Development Goals. There are now more than 50 companies that are in the World Economic Forum’s Global Health and Healthcare Partnership Community that are advocating for actions to target chronic diseases. … .. Finally, shared value and responsible leadership approaches continue to gain traction in health. I moderated a roundtable on Shared Value Insurance hosted by FSG in partnership with AIG and Discovery/Vitality to define and outline best practices on Shared Value Insurance. There was broad recognition of the need for insurers to move from waiting for and paying for catastrophes – be they related to weather or health – to dynamically supporting predictive
and preventive interventions to lessen their occurrence and impact. Vitality’s Life, Health, and Motor Vehicle products are pioneering this approach.”
Devex - 3 major global development trends from Davos (by Raj Kumar) (recommended!!)
The 3 trends: With scarce aid dollars, it’s all about leverage; Treating private companies like peers (see below); Financing engineering can be a good thing (with some info on the GFF).
An interesting paragraph: “One of the biggest announcements in Davos this year was a new vaccine initiative designed to get ahead of the next big pandemics. One reason this has failed in the past is certainly money, and this initiative, called CEPI, made headlines in large part because of the huge commitments made, now totaling over $700 million. But what’s been missed in the excitement is the way in which private pharmaceutical companies are engaged in the project. GSK’s chief executive Andrew Witty was on stage at Davos with Bill Gates and Wellcome Trust Director Jeremy Farrar (among others) when he made a fascinating comment. He explained that GSK doesn’t intend to make either profit or loss from its involvement with CEPI. GSK will bring its prodigious research capabilities to bear on developing the vaccines that CEPI identifies as priorities and will cover its costs using CEPI’s funds. But, Witty explained, other companies may choose to make a profit from CEPI if they wish. It’s up to them. What’s novel is the idea that the corporate partners of CEPI are being treated as peers. Even though many governments are providing funding to CEPI, no one is asking these pharma companies to change their business model in order to be part of developing these vaccines. It’s their research capabilities that are being utilized to solve this global challenge, not their ability to provide the cheapest bid or to write a check. “
Devex – Jim Kim thinks more donors should leverage their funds
Devex ;
“World Bank President Jim Kim is bullish on the opportunity for grant-making institutions such as the Global Fund to use a little financial engineering to make health and development dollars go farther. Speaking at a breakfast event Thursday at the World Economic Forum in Davos, Switzerland, Kim made a pitch to global health donors, asking them to consider channeling their funds through the Global Financing Facility for maternal and child health, which promises a four to five time multiplication effect for the money it receives. By de-risking investments for the private sector and allowing countries to access low-interest financing, the GFF makes it attractive for countries to take World Bank loans for health projects — and to spend more of their own money on those projects. Kim thinks more donors should use it….” Talks are going on with the GF.
There was also a first contribution from the private sector to the GFF Trust fund (10 million).
Devex - Gates doubles down on malaria eradication with influential new group. “[Today] marks the launch of the End Malaria Council, a group of influential public and private sector leaders committed to eradicating malaria, convened by Bill Gates and Ray Chambers.” For more on this new group, concerned that malaria might fall off the radar, see Humanosphere – “Malaria: World leaders unite in ‘unique’ effort to eradicate the disease”.
Indeed, Reuters also reported Malaria champions see Trump uncertainty at crucial time.
Read for the Randomistas (& their opponents.) “…This sense of mixed progress was evident at a recent conference organized by the Washington, D.C.-think tank Center for Global Development, where some of the most prominent randomistas gathered to take stock.”
An excerpt: “…Even at the World Bank and USAID, only a small portion of projects are subject to impact evaluations, agreed Amanda Glassman, chief operating officer and senior fellow at the Center for Global Development. And it gets worse, Glassman said. Every year, her group does an exhaustive review to identify large-scale health programs that made a big impact. Of about 250 that they looked through this year, "only 50 used rigorous method to establish the attributable impact. And none of the very largest programs in global health had done any impact evaluation at all," including two major international non-profit organizations: Global Fund to Fight AIDS, Tuberculosis as well as GAVI, the Global Alliance for Vaccines and Immunization….”
UNAIDS – Review panel meets to strengthen UNAIDS model
“A special panel has begun deliberations on how to strengthen UNAIDS’ unique model and further align it to international efforts to achieve the 2030 Agenda for Sustainable Development. The Global Review Panel on the Future of the UNAIDS Joint Programme Model includes representatives of United Nations Member States, key populations affected by HIV, United Nations agencies and other multilateral organizations and private foundations. … …. At the first meeting of the panel, held on 20 January in Geneva, Switzerland, Ms Clark called on the panel to ensure that UNAIDS remains at the forefront of United Nations reform, while Mr Sidibé challenged panel members to develop bold ideas for the future of the Joint Programme.”
World Development Report 2017 – Launch on Monday 30 January http://live.worldbank.org/world-development-report-2017
“What makes some policies work while others fail? The World Development Report 2017: Governance and the Law aims to answer this fundamental question. Frequently, policies that fail to generate development outcomes endure across countries and over time. Putting governance front and center of the development debate is essential for promoting sustained economic growth and encouraging more equitable and peaceful societies. “
Global governance of health
Lancet (Letter) – The Sustainable Development Goals: ambiguities of accountability
E Engebretsen et al ; http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30152-
6/fulltext
Must-read for the ones among you who care about SDG accountability. “…In addition to adequate measurements and indicators, we believe that there is a need for a robust formative evaluation system that scrutinises accountability mechanisms and possible double-duty paradoxes embedded in the operationalisation and implementation of the SDGs.”
International institute for Environment and development - Turning the tide: creating incentives for sustainable oceans
David Steinbach; http://www.iied.org/turning-tide-creating-incentives-for-sustainable-oceans
As mentioned by Kent Buse in a tweet: “Framework proposed by @Dave_Steinbach for #SDG14 may help with systems thinking to implement #SDG3 #Agenda2030”
WHO - Global Health Observatory
http://www.who.int/research-observatory/en/
As a reminder (also with a view on discussions this week at the EB) – “The Global Observatory on Health R&D (hereafter called ‘the Observatory’) is a global-level initiative that aims to help identify health R&D priorities based on public health needs, by: consolidating, monitoring and analysing relevant information on the health R&D needs of developing countries; building on existing data collection mechanisms; and supporting coordinated actions on health R&D.”
“…today’s investments in health R&D are poorly aligned with global public health needs. As little as 1% of all funding for health R&D is allocated to diseases such as malaria and tuberculosis, although they account for more than 12% of the global disease burden. The WHO Global Observatory on Health R&D builds on existing data to enable decisions on R&D priorities. “ Another shocking stat:
“There are 352 times more health researchers in high-income countries than in low-income countries”.
“The 2016 meeting of the High-Level Political Forum (HLPF) took place from 11 to 20 July 2016 at the United Nations Headquarters in New York. Twenty-two countries presented voluntary national reviews (VNRs) of the implementation of the 2030 Agenda, and particularly the sustainable development goals (SDGs), over a day and a half during the Ministerial Segment of the HLPF under the auspices of the Economic and Social Council (ECOSOC). This report synthesizes some of the findings of the VNRs, drawing primarily from the written reports and executive summaries of the majority of countries. It uses a theme based analysis drawn largely from the voluntary common guidelines contained in the Annex to the Secretary-General’s report on critical milestones towards coherent, efficient and inclusive follow-up and review at the global level. The report examines reporting countries’ efforts to implement the 2030 Agenda, including challenges, gaps, achievements and lessons learned.”
For some more analysis & overview of current processes leading up to the HLPF in July 2017, see also Sarah Dayringer (blog on Global Policy Watch) - In the 2017 High-Level Political Forum on Sustainable Development: Civil Society plays key role in voluntary national reviews and coherence
Lancet – Access to Medicine Index—what about sustainability?
From last week’s Lancet issue. By David Heymann. “…The Access to Medicine Index 2016, which will be presented at a public meeting later this month at the time of the WHO Executive Board meeting in Geneva, ranks the top 20 research-based pharmaceutical companies on their efforts to improve access to medicine in low-income and middle-income countries (LMICs).” Heymann has some more suggestions.
Lancet (Perspective) – Governance for the future of global health
P Piot. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30138-1/fulltext
“The Roll Back Malaria (RBM) Partnership Board is delighted to announce the appointment of Dr. Kesetebirhan Admasu to the role of Chief Executive Officer (CEO).” Former Ethopian health minister, among others.
Xinhua - Interview: WHO chief looks forward to China's "particular vision" for global health cooperation
Xinhua;
Some more detail on Chan & Xi Jinping’s cosy global health relationship last week at the Geneva headquarters. “WHO chief Margaret Chan on Tuesday praised Chinese President Xi Jinping as a "visionary and strategic leader", saying that she looks forward to talking with him about how China will bring its particular vision for health as a centerpiece for international cooperation. World Health Organization (WHO) Director-General Chan made the remarks in a written interview ahead of her meeting with Xi scheduled for Wednesday at WHO's headquarters in Geneva.”
You might also want to read China plays bigger role in global health landscape (Xinhua). “Seth Berkley, CEO of the Global Alliance for Vaccines and Immunization (GAVI), told Xinhua in a recent interview that Chinese vaccines are "significantly cheaper" than those made by many other countries. GAVI-procured Chinese-made Japanese encephalitis (JE) vaccines are up to 95 percent less expensive than those produced in the West…. … With an average price of 42 U.S. cents per dose, the live attenuated vaccine made by the Chengdu Institute of Biological Products, is providing life-saving protection to millions of children in low-income countries, including Laos, Nepal and Cambodia, under GAVI's program, according to Berkley. …
… … Chinese JE vaccines became available on the global market after the World Health Organization (WHO) endorsed China's vaccine regulatory body in 2011. JE vaccines subsequently became the first prequalified Chinese vaccine to ever be licensed for use on children in 2013. "We are seeing huge potential for China to supply the global public vaccine market via WHO prequalification, including for emergency outbreaks such as yellow fever and Ebola," WHO Director-General Margaret Chan told Xinhua prior to Chinese President Xi Jinping's visit to Switzerland earlier this month.” “
Lancet Global Health - Global health and Mr Trump's "new world order"
Chris Simms; http://globalhealth.thelancet.com/2017/01/20/global-health-and-mr-trumps-new-
world-order
“A recent study of 268 political parties in 31 European countries shows that a key factor explaining the rise in populism is the emergence of neoliberalism that began in the 1970s.(1) The Brexit vote, the election of Donald Trump, and trends in European elections are described in multiple quarters as part of a new world order. Yet what passes for a “new world order” may in fact be no more than a continuation of the neoliberal juggernaut transiting from one era to another, to emerge stronger and more daunting than ever. Past experience suggests that this does not augur well for global health.” Nice one.
Politico - World looks for a better doctor: Margaret Chan’s controversial legacy shapes search for new head of World Health Organization.
Piece published ahead of this week’s WHO DG election round. A bit harsh on Margaret Chan (’s legacy), I feel. (If we were to use the same benchmarks for the Donald, don’t know where we would arrive on the continuum. )
JAMA (viewpoint) – A Global Vaccine Injury Compensation System
S F Halabi et al; http://jamanetwork.com/journals/jama/fullarticle/2599241
An excerpt: “…A global vaccine injury compensation system to bring economic certainty would represent a substantial advance to this critical component of the global public health system and build trust necessary for vaccines—especially in emergency contexts. Such a system would address barriers to vaccine manufacturers’ participation as well as perceptions that contribute to vaccine hesitancy in low-resource countries. A prominent perception shared by persons in low-resource settings is that diseases with pandemic potential that affect the global poor are neglected by the world’s major medical research institutions. When one of those diseases threatens Europe or North America, those institutions and their sponsoring governments invest in relevant medical research but do so using the global poor as relatively unprotected human research subjects.6 A global vaccine injury compensation system may reduce the hesitancy among those making the decision to receive a candidate vaccine with a limited safety profile.”
*Finally, a tweet by Kent Buse on the transparency at the Global Fund (selection of a new boss) – as compared with WHO:
“Agree both counts-Understand @GlobalFund selection com't to publish shortlist of EXD candidates mid-Feb in advance of Board #transparency”
*And the Official Launch of the African CDC is scheduled for 31 January. Last week we already covered some reads (mostly in the Lancet) on the African CDC’s priorities.
UHC
Is the Alma Ata vision of comprehensive primary health care viable? Findings from an international project
Ronald Labonté et al ; http://www.tandfonline.com/doi/full/10.3402/gha.v7.24997
« The 4-year (2007–2011) Revitalizing Health for All international research program (http://www.globalhealthequity.ca/projects/proj_revitalizing/index.shtml ) supported 20 research teams located in 15 low- and middle-income countries to explore the strengths and weaknesses of comprehensive primary health care (CPHC) initiatives at their local or national levels. … … Evidence of comprehensiveness (defined in this research program as efforts to improve equity in access, community empowerment and participation, social and environmental health determinants, and intersectoral action) was found in many of the cases. … … Despite the important contextual differences amongst the different country studies, the similarity of many of their findings, often generated using mixed methods, attests to certain transferable health systems characteristics to create and sustain CPHC practices. These include: Well-trained and supported community health workers (CHWs) able to work effectively with marginalized communities; Effective mechanisms for community participation, both informal (through participation in projects and programs, and meaningful consultation) and formal (though program management structures); Co-partnership models in program and policy development (in which financial and knowledge supports from governments or institutions are provided to communities, which retain decision-making powers in program design and implementation) ; Support for community advocacy and engagement in health and social systems decision making. These characteristics, in turn, require a political context that supports state responsibilities for redistributive health and social protection measures. »
Planetary health
A rather worrying link for us Europeans (based on new research, reported in the Guardian) - Europe faces droughts, floods and storms as climate change accelerates “…Hans Bruyninckx, the director of the EEA, which produced the report said that there was now “not a snowball’s chance in hell” of limiting global warming to 2C without the full involvement of the US, which has just elected a climate-sceptic president.”
Devex - World Bank accused of incentivizing investments in fossil fuels through $5 billion policy loans portfolio.
Very worrying news from last week, based on new research in NEJM. “One of the big questions about extensively drug-resistant tuberculosis is whether this severe form of the disease is on the rise due to a failure of medications or if it's spreading through the air. A new study of more than 400 patients in South Africa finds, unfortunately, that the answer appears to be the latter. Airborne transmission is the driving force behind a spike in extensively drug-resistant tuberculosis (XDR-TB) in South Africa, according to a report just published in the New England Journal of Medicine. "The majority of the new cases, two-thirds of the cases in fact, were due to person-to-person transmission," says Dr. Sarita Shah, lead author of the study. "What was surprising is that previously the assumption had been that drug- resistant TB is primarily caused by failure to treat TB effectively. This [study] really overturns our thinking and provides the evidence that the vast majority of XDR-TB cases are caused by direct transmission."”
See also Reuters - Person-to-person contact may cause most drug-resistant TB cases.
NYT - Are new drugs for Hepatitis safe? A new report raises concerns
NYT;
“Drugs approved in recent years that can cure Hepatitis C may have severe side effects, including liver failure, a new report suggests. “
GF – New Global Fund Results Show Further Progress Against HIV, TB and Malaria
“…The new results, highlighting cumulative progress by programs supported by the Global Fund since 2002, show that the number of people currently on antiretroviral therapy increased 8.5 percent to 10 million. New smear-positive TB cases detected and treated rose by 9.4 percent to more than 16.6 million. Over 713 million insecticide treated nets were distributed to help families protect themselves from malaria, an increase of 8.1 percent. The results are based on data from the first half of 2016….”
“The U.S. Food and Drug Administration is backing a fast-track approval process for a drug used to treat Chagas disease, but some say this approval process has a history of making drugs too expensive to help those who need it most.”
NPR - New Medical Worry: Deadly Fungal Infection That Resists Treatment
“You've probably heard of antibiotic resistance — germs that can resist the drugs designed to wipe them out. Now there's a new kind of resistance to worry about — fungal infections that are resistant to treatment. The fungal infection in question is Candida auris, which can cause infections in the mouth, genitals, ears, wounds or, worst of all, the bloodstream. While other species of Candida can lead to the same kinds of infections, Candida auris is getting worldwide attention because, according to a study in the February 2017 journal Emerging Infectious Diseases, some cases have proved to be resistant to all three classes of drugs available to treat fungal infections. The first reported case was in Japan in 2009 but it has now been found on five continents….”
Foreign Policy – Deadly yellow fever outbreak in Brazil sparks fear of Zika like epidemic
“There’s an outbreak of a deadly mosquito-borne illness in Brazil that has health officials worried — and this time it’s not Zika, but yellow fever. On Monday, Brazilian authorities announced new tallies of a deadly outbreak of yellow fever in the eastern state of Minas Gerais. With fresh memories of the Zika epidemic, international health officials worry Brazil’s new outbreak could trigger a large-scale epidemic if it isn’t curtailed in time….”
See also BBC news - Brazil orders 11.5 million yellow fever vaccine doses.
Royal Society of Tropical Medicine and Hygiene - The London Declaration on Neglected Tropical Diseases: 5 years on
David H Molyneux; https://academic.oup.com/trstmh/article/2937752/The-London-Declaration-on-Neglected-Tropical?searchresult=1
“In January 2012, key actors in global health met in London to commit to increasing support for the control and elimination of neglected tropical diseases (NTDs). As a result, the ‘The London Declaration’ made specific commitments to: increase the number of drug donations available to countries, increase bilateral funding, support non-governmental development organisations (NGDOs) and philanthropic financial commitment to NTD intervention and research. This meeting coincided with the publication of the WHO Roadmap defining the targets for countries if World Health Assembly (WHA) Resolutions were to be achieved towards the dates of 2020 and 2025. It is appropriate to summarise what progress has been made and what challenges have emerged….”
CGD (paper) - A Global Treaty to Reduce Antimicrobial Use in Livestock
For the related blog (by Charles Kenny et al), see An Ambitious Goal for International Cooperation in 2017: A Global Treaty to Tackle Antimicrobial Resistance. “In a new CGD policy paper, we argue that a global treaty to reduce antibiotic use in animals could help make inroads into that problem. Such a treaty could be modeled on lessons learned from the 1987 Montreal Protocol on Substances that Deplete the Ozone Layer—a milestone in international cooperation often considered one of the most successful global treaties of all time. … … Here, we outline three core components of a global treaty to curb antimicrobial use in animals…”
NCDs
Lancet (Editorial) Tobacco elimination: an economic and public health imperative
This Lancet editorial from last week came back on the recent report by the National Cancer Institute (NCI) of the US National Institutes of Health, in collaboration with WHO, “The Economics of Tobacco and Tobacco Control”.
A BMJ Editorial did the same this week - Using economics to combat the tobacco disease epidemic.
In related news, see also a CGD blog - Tripling tobacco taxes: Key for achieving the UN Sustainable Development Goals by 2030.
And a quick link related to new (US) research on vaping: E-cigarettes are expanding tobacco product use among youth: First national analysis shows e-cigarettes attract low-risk adolescents who were unlikely to start smoking. “E-cigarettes are actually attracting a new population of adolescents who might not otherwise have smoked tobacco products, according to a new American study.”
Sexual & Reproductive / maternal, neonatal & child health
United Nations Committee Affirms Abortion as a Human Right
“In a landmark case, Peru has compensated a woman for denying her a medically indicated abortion. In 2001, K.L. was a 17-year-old who was diagnosed as having a fetus with anencephaly at 14 weeks’ gestation. As described below, this fetal anomaly is routinely lethal. Although abortion was legal in Peru in this circumstance, a hospital director refused her request for an abortion. She was forced to continue her pregnancy and deliver the doomed fetus, which survived only four days. Working with human rights lawyers, K.L. filed a complaint with the United Nations Human Rights Committee, based in Geneva. In 2005, the Committee concluded that Peru had violated several articles of the International Covenant on Civil and Political Rights, and it ordered financial compensation to K.L. Fifteen years after the incident, reparations were finally made for Peru’s “cruel, inhuman, and degrading treatment.” This marked the first time a United Nations Committee had held a country accountable for failing to ensure access to safe, legal abortion….”
Access to medicines
Remark: the Lancet Commission on Essential Medicines for UHC was published in today’s issue – it already appeared online in November last year.
Big news to start this section. “More than a decade after World Trade Organization member states approved the first-ever legal amendment to a WTO agreement, the change to the international intellectual property agreement has entered into effect. Five more members ratified the amendment in recent days, bringing supporters over the minimum needed to put into effect for the amendment aimed at boosting exports of medical products made under compulsory licence….”
See also Reuters - Poor countries allowed to import generic drugs - WTO or Third World Network - TRIPS amendment on access to cheaper drugs comes into force
“A protocol amending the WTO TRIPS Agreement that would enable developing countries with insufficient or no manufacturing capacities in the pharmaceutical sector to import cheaper generic medicines produced under compulsory licencing finally came into force on Monday, 23 January. In a press release, the WTO Secretariat reported that Burkina Faso, Nigeria, Liechtenstein, the United Arab Emirates and Viet Nam have notified in recent days that they have ratified the protocol amending the TRIPS Agreement, thus reaching the two-thirds threshold needed to formally amend the TRIPS Agreement….”
IP-Watch – Medicines Patent Pool TB Deal Praised But Raises Concerns Of Affordability
“The Medicines Patent Pool announced today that it has signed a license agreement with Johns Hopkins University for a candidate tuberculosis treatment. Although seen as a major step forward by public health groups, they said the agreement does not include guarantees that the treatment that could be brought to the market would be affordable for all….”
See also Medicines patent pool.
Coming up: 21st Expert Committee on the Selection and Use of Essential Medicines (27-31 March)
“The meeting of the 21st WHO Expert Committee on the Selection and Use of Essential Medicines will be held at WHO Headquarters, Geneva, from 27 to 31 March 2017 to revise and update the
WHO Model List of Essential Medicines (EML) including Essential Medicines for Children (EMLc). Applications to be considered by the Expert Committee for inclusion of new medicines, and changes to or deletion of currently listed medicines in the EML and EMLc are now available via the link below for public review and comment. Comments may be made until 24 February 2017 and will be published on this webpage, along with all other documents relating to the meeting of the Expert Committee….”
RAPS – Doctors without Borders objects to Sanofi receiving an exclusive license for Zika
raps;
“Doctors Without Borders (MSF) on Monday objected to the US government’s granting of an exclusive patent license to Sanofi Pasteur for a developing Zika vaccine, though Sanofi fired back on Tuesday explaining the risks of developing such a vaccine. …” Read why.
FT – Egypt combats hepatitis C epidemic with state-run scheme
“…Since the programme began two years ago, nearly 1m hepatitis C patients have been treated, most at the government’s expense, and experts say it could be a model for the rest of the world. Globally, some 700,000 people die every year from liver disease related to hepatitis C, according to the World Health Organisation. “We are thrilled because what was really needed was a champion country to say ‘Yes we can do this’,” says Charles Gore, president of the Geneva-based World Hepatitis Alliance, a patient-led organisation. “We have such large numbers of the infection globally, so we really need to know how to do this. Egypt is providing such a wonderful field test.”…”
Quick links:
Euractiv - Counterfeit Chinese and Indian drugs invade Africa. “Over the course of just two weeks, the World Customs Organisation (WCO) seized 113 million antimalarial, anti-inflammatory and antibiotic tablets bound for Africa. The true extent of the problem remains unknown.”
Scroll.in – Bedaquiline debate: Domicile requirement for TB patients to get live-saving drug may no longer apply. See also NPR – A Teen's Family Fought To Get Her A Restricted TB Drug — And Won.
“A teenager who sued the Indian government to gain access to a new drug against multidrug-resistant tuberculosis was granted her petition in a ruling handed down by the New Delhi High Court on January 18, according to the family lawyer. … … That drug, bedaquiline, has been approved for use only in a handful of Indian cities and only for the small subset of patients who can demonstrate laboratory evidence of extensively drug resistant TB, or XDR-TB. … … The ruling has hastened the Indian government's rollout of bedaquiline. In a court hearing on January 20, representatives for the
government said that the Revised National Tuberculosis Control Program (RNTCP) in India would make bedaquiline available in 70 more centers nationally by mid-2017, according to the legal team representing the family….”
Human resources for health
Coming up: Symposium on the contribution of Community Health Workers to the attainment of the SDGs, 21 – 23 February, Kampala, Uganda
C Ssemugabo; http://www.internationalhealthpolicies.org/symposium-on-the-contribution-of-
“Next month, Makerere University School of Public Health (MakSPH), Kampala, Uganda and Nottingham Trent University (NTU), UK in collaboration with the Ministry of Health (MOH), Uganda are organising a symposium on the contribution of Community Health Workers (CHWs) to the attainment of the Sustainable Development Goals (SDGs). The symposium will take place in Hotel Africana, Kampala, Uganda, from 21st till 23rd February. The aim is to share knowledge on the contribution of CHWs to national health systems, and identify and discuss how they might contribute towards the achievement of the health (and broader development) SDG agenda. In addition, the symposium will facilitate interdisciplinary research collaboration and learning, and propose a way forward on how to improve the work of CHWs within the health sector….”
Check out what the symposium will involve. And do register!
Miscellaneous
Austerity economics has just been smashed. By the IMF.
Ben Philipps; http://www.globaldashboard.org/2017/01/26/austerity-economics-just-smashed-imf/
“…[Today] the IMF will launch a new report, “Macro-Structural Policies and Income Inequality in Low-Income Developing Countries”, the latest in series that mark the intellectual journey the IMF research department has been travelling in recent years.”
“This paper is not the first by the IMF to take a stand on inequality, but it is notable because it claims in no uncertain terms that public spending – i.e. the opposite of the budget cuts that it once advocated for – decreases income inequality. They even have a formula – a 1% increase in public spending, they report, leads to a 2.3 decrease in inequality after 5 years. … … The paper also takes a strong stand against prioritizing indirect taxes, such as VAT, showing that they increase inequality.”
“The first woman to lead the UN's largest agency (i.e. UNDP) has announced she will step down after eight years in office. She told her staff to continue fighting for the agency's goals despite "times of change across the UN system."”
Guardian - Global public sector corruption fuels rise of populist politicians, report says
“Increasing levels of public sector corruption worldwide are providing fertile ground to rising populist politicians, according to the annual index of perceived corruption. Transparency International’s corruption perceptions index 2016 – which ranks 176 countries on a scale of 0 (highly corrupt) to 100 (very clean) – shows that more countries have declined than improved compared with figures for last year….”.
From poverty to power (blog ) - What makes Networks tick? Learning from (a lot of) experience
Recommended. “When are networks the right response to a development challenge (as opposed to a monumental talking shop - more hot air than action?) Oxfamers Andrew Wells-Dang, Stéphanie de Chassy, Benoit Trudel, Jan Bouwman and Jacky Repila discuss. “ Learning points from a recent workshop.
And a follow-up blog post - Handy NGO Guide to Social Network Analysis (by Duncan Green).
Humanosphere - 7 global health issues to watch in 2017
Ranging from superbugs, over dangerous complacency around HIV, and reproductive health care on the precipice, to the uncertain future of global health and international aid. Good overview.
Project Syndicate - Hope for Global Health in 2017
M Sanicas; Project Syndicate.
“…As we begin 2017, it is important to recognize the public-health victories that we have achieved.” Sanicas lists some of these (from 2016).
Guardian – When it comes to salaries, charity CEOs still want to have their cake and eat it
Recommended. “Charity bosses have not learned from criticism around remuneration and risk distancing themselves further from their supporters.” (as mentioned before, we consider some big wig health leaders (i.e. the ones that love to go to Davos to announce new initiatives with the private sector) vulnerable as well)
Devex – Was there an Obama development doctrine?
Devex;
Well worth a read. “For the last eight years, U.S. development professionals have looked to President Barack Obama to steer the country’s aid efforts. As he now leaves office, the development community is left to examine the legacy of the 44th president’s decisions — and the logic that underpinned them. Was Obama’s approach to development guided by a doctrine of its own? If so, what was it?”
And now that, sadly, Obama is fast becoming history, a few quick links related to the new US administration:
IPS - Trump’s UN Pick: “UN Could Benefit from a Fresh Set of Eyes” (Nikki Haley at a confirmation
hearing ) It’s fast becoming clear what this ‘fresh set of eyes’ will entail.
CGD (blog) (by E Collinson) – What Tillerson’s Leadership Could Mean for US Development Policy
(analysis & some (reluctant) hopes, based on Tillerson’s hearing). Emphasis on “reluctant”.
“With early optimism surrounding the 2015 Paris agreement on climate change now fading into anxiety over potential changes to U.S. environmental policy under a Trump administration, many are looking for new leaders in the fight against global warming. Hospitals should step into the breach. Doing so could both slow climate change and improve healthcare systems globally.”
“… The health sector’s role in addressing climate change goes beyond advocacy and research. It can spearhead real change by transforming global healthcare delivery by rethinking how hospitals and other health facilities are run. By taking action now, hospitals can demonstrate to others how to “kick the coal habit….” “…To heal more patients, the health sector must start healing the planet. Making hospitals low-carbon and climate-resilient in the face of extreme weather by using renewable energy is the sort of leadership that would keep progress moving in an effort to improve health and reduce climate change. Hospitals could start on this today.”
BMJ Global Health – Decentralising and integrating HIV services in community-based health systems: a qualitative study of perceptions at macro, meso and micro levels of the health system
Co-authored by R McCollum & R Karuga; http://gh.bmj.com/content/2/1/e000107
“HIV services at the community level in Kenya are currently delivered largely through vertical programmes. The funding for these programmes is declining at the same time as the tasks of delivering HIV services are being shifted to the community. While integrating HIV into existing community health services creates a platform for increasing coverage, normalising HIV and making services more sustainable in high-prevalence settings, little is known about the feasibility of moving to a more integrated approach or about how acceptable such a move would be to the affected parties. … … We used qualitative methods to explore perceptions of integrating HIV services in two counties in Kenya, interviewing national and county policymakers, county-level implementers and community-level actors. …”
Journal of Pharmaceutical Policy and Practice – Engagement of the private pharmaceutical sector for TB control: rhetoric or reality?
N Konduri et al; http://joppp.biomedcentral.com/articles/10.1186/s40545-016-0093-3
“Private-sector retail drug outlets are often the first point of contact for common health ailments, including tuberculosis (TB). Systematic reviews on public-private mix (PPM) interventions for TB did not perform in-depth reviews specifically on engaging retail drug outlets and related stakeholders in the pharmaceutical sector. Our objective was to better understand the extent to which the World Health Organization’s (WHO) recommendation on engaging retail drug outlets has been translated into programmatic policy, strategy, and intervention in low- and middle-income countries….”
The paper focuses on TB, but takeaway messages also have implications for malaria, reproductive health, family planning, public health and for those debating the issue of scale (coverage) with that of effective regulation and incentives.
BMJ global health – Introducing rapid tests for malaria into the retail sector: what are the unintended consequences?
E Hutchinson et al; http://gh.bmj.com/content/2/1/e000067
“The observation that many people in Africa seek care for febrile illness in the retail sector has led to a number of public health initiatives to try to improve the quality of care provided in these settings. The potential to support the introduction of rapid diagnostic tests for malaria (mRDTs) into drug shops is coming under increased scrutiny. Those in favour argue that it enables the harmonisation of policy around testing and treatment for malaria and maintains a focus on market-based solutions to healthcare. Despite the enthusiasm among many global health actors for this policy option, there is a limited understanding of the consequences of the introduction of mRDTs in the retail sector. We undertook an interpretive, mixed methods study with drug shop vendors (DSVs), their clients and local health workers to explore the uses and interpretations of mRDTs as they became part of daily practice in drug shops during a trial in Mukono District, Uganda. This paper reports the unintended consequences of their introduction. It describes how the test engendered trust in the professional competence of DSVs; was misconstrued by clients and providers as enabling a more definitive diagnosis of disease in general rather than malaria alone; that blood testing made drug shops more attractive places to seek care than they had previously been; was described as shifting treatment-seeking behaviour away from formal health centres and into drug shops; and influenced an increase in sales of medications, particularly antibiotics.”
Globalization & Health – Criteria to assess potential reverse innovations: opportunities for shared learning between high- and low-income countries
O Bhattacharrya et al; http://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-016-0225-1
“Low- and middle-income countries (LMICs) are developing novel approaches to healthcare that may be relevant to high-income countries (HICs). These include products, services, organizational processes, or policies that improve access, cost, or efficiency of healthcare. However, given the challenge of replication, it is difficult to identify innovations that could be successfully adapted to high-income settings. We present a set of criteria for evaluating the potential impact of LMIC innovations in HIC settings….”
HP&P – Infectious disease risk and international tourism demand
J Rossello et al ; https://academic.oup.com/heapol/article-abstract/doi/10.1093/heapol/czw177/2926036/Infectious-disease-risk-and-international-tourism?redirectedFrom=fulltext
“For some countries, favourable climatic conditions for tourism are often associated with favourable conditions for infectious diseases, with the ensuing development constraints on the tourist sectors of impoverished countries where tourism’s economic contribution has a high potential. This paper evaluates the economic implications of eradication of Malaria, Dengue, Yellow Fever and Ebola on the affected destination countries focusing on the tourist expenditures….”
Plos – The World Health Organization Fetal Growth Charts: A Multinational Longitudinal Study of Ultrasound Biometric Measurements and Estimated Fetal Weight
“Using data from a multinational longitudinal study of ultrasound biometric measurements and estimated fetal weight, Mariana Widmer and colleagues report on the WHO fetal growth charts. Read the Author Summary.”
TMIH – Beyond counting stillbirths to understanding their determinants in low- and middle-income countries: a systematic assessment of stillbirth data availability in household surveys
A Christou et al; http://onlinelibrary.wiley.com/doi/10.1111/tmi.12828/full
Objective: “To systematically map data availability for stillbirths from all countries with Demographic and Health Surveys (DHS) surveys to outline the limitations and challenges with using the data for understanding the determinants and causes of stillbirths, and for cross-country comparisons.”
HP&P – Evaluating the effect of integrated microfinance and health interventions: an updated review of the evidence
L Lorenzetti et al; https://academic.oup.com/heapol/article-abstract/doi/10.1093/heapol/czw170/2957092/Evaluating-the-effect-of-integrated-microfinance?redirectedFrom=fulltext
“Evaluating the effect of integrated microfinance and health interventions: an updated review of the evidence.”
Finally, if you came this far in the newsletter, you might as well want to read an ‘alternative fact’ blog - Guns, Germs and Steel in the Trump era (on IHP).
