IHP news 478 : Highlights of the week

By on July 13, 2018

Alma Ata 2.0 preparations

New Draft of the Astana Declaration  (3-pager, released late last week)

http://www.who.int/primary-health/conference-phc/DRAFT_Declaration_on_Primary_Health_Care_28_June_2018.pdf

You can comment on this new draft till 22 July.

As for me, I’m missing the bit on ‘A New Economic Order’ (which seems to have disappeared in the mist of time, compared to 40 years ago), and anticipation of catastrophic climate change (and how to (still) try avoid it). Kind of wonder what PHC would amount to in a world of +3 degrees.

Draft programme  (25-26 October, Astana)

http://www.who.int/primary-health/conference-phc/Draft-Programme-Summary.pdf?ua=1

The preliminary programme.

Hope they also give a slot to Alexander Vinokourov (on how to boost your health & wellbeing when cycling). The politically correct version, preferably.

High-Level Political Forum on the SDGs  (9-18 July, New York)

https://sustainabledevelopment.un.org/hlpf/2018

This Forum meets annually under the auspices of ECOSOC.

As already mentioned last week:

The high-level political forum on sustainable development is meeting from Monday, 9 July, to Wednesday, 18 July 2018. The ministerial meeting of the forum is from Monday, 16 July, to Wednesday, 18 July 2018. The theme is: “Transformation towards sustainable and resilient societies”.

The HLPF is also reviewing progress towards the SDGS and focusing in particular on:

Goal 6. Ensure availability and sustainable management of water and sanitation for all; Goal 7. Ensure access to affordable, reliable, sustainable and modern energy for all; Goal 11. Make cities and human settlements inclusive, safe, resilient and sustainable; Goal 12. Ensure sustainable consumption and production patterns; Goal 15. Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, and halt and reverse land degradation and halt biodiversity loss; Goal 17. Strengthen the means of implementation and revitalize the Global Partnership for Sustainable Development, that will be considered each year…”

The first week includes numerous panel and roundtables on the theme and on the SDGs under review.”

Technically, as SDG 3 is not under review this year, perhaps the global health community is a bit less interested than in 2017, but as you know, the whole idea of the SDG agenda is that it’s supposed to be ‘universal’ and ‘holistic’. So what happens in the world on for example SDG 11 (cities), SDG 12 (sustainable consumption & production), … is, as you can imagine, extremely important also for ‘health for all’ in the 21st century.

The expectation is also that “the Declaration – an outcome document to be adopted at the end of the Forum – will encapsulate a strong political message on the international community’s unwavering commitment to realizing the aspirations of the 2030 Agenda.”

Fortunately, The Donald is not around.

Coverage of the HLPF

 

For coverage, we refer mostly to UN News and IISD coverage.

UN News – ‘Laser-sharp focus’ needed to achieve Global Goals by 2030, UN political forum told

https://news.un.org/en/story/2018/07/1014232

Progress has been made on achieving global goals to end poverty and hunger but meeting the targets by the deadline of 2030 will require a laser-sharp focus and a true sense of urgency, a key United Nations forum on sustainable development heard on Monday.”

“… In the opening day’s keynote speech, Professor Jeffrey Sachs, Director of the Center for Sustainable Development at Columbia University, said that there were enough resources in the world for everyone to live free of poverty and it should not require a big effort on the part of large developed countries, to profoundly help those struggling in poverty.  Presenting league tables produced by his team and the Sustainable Development Solutions Network, he said Sweden was the country most on course to achieving the SDGs, and that Europe is “by far” the region doing best so far.  Moreover, the list of the top 10 countries closest to achieving the SDGs mirrors a complementary ranking of the world’s happiest countries. “It is literally the truth”, that sustainable development is the path to happiness, he said.  The happiest countries are the ones that tax themselves the most, he added, noting that Swedes think it is a good thing to pay half their national income to finance quality education and healthcare.  …”

UN News – UN forum spotlights cities, where struggle for sustainability ‘will be won or lost’

https://news.un.org/en/story/2018/07/1014461

Although cities are often characterized by stark socioeconomic inequalities and poor environmental conditions, they also offer growth and development potential – making them central to the 2030 Agenda for Sustainable Development and a main focus of the third day of the United Nations High-Level Political Forum (HLPF) on Wednesday.”

IISD coverage of various days & highlights

http://enb.iisd.org/hlpf/2018/about.html

Coverage for 9 July ; 10 July ; 11 July  etc.

See also IISD for more coverage.

Some Reports

UN Secretariat – 2018 SDG progress report

https://unstats.un.org/sdgs/files/report/2018/TheSustainableDevelopmentGoalsReport2018-EN.pdf

40 p.  The “official” UN SDG progress report.

The Sustainable Development Goals Report 2018 highlights progress being made in many areas of the 2030 Agenda…. … However, the report also shows that, in some areas, progress is insufficient to meet the Agenda’s goals and targets by 2030. This is especially true for the most disadvantaged and marginalized groups. … … With just 12 years left to the 2030 deadline, we must inject a sense of urgency.

SDSN & Bertelsmann Stiftung – SDG Index & Dashboard report

http://www.sdgindex.org/

The SDG Index and Dashboards Report provides a report card for country performance on the historic Agenda 2030 and the SDGs. The annual report shows how leaders can deliver on their promise and it urges countries not to lose the momentum for important reforms. It is produced by the Sustainable Development Solutions Network (SDSN) and the Bertelsmann Stiftung. In order to achieve the ambitious goals, immediate and comprehensive action is needed.”

476 p. This year also with a focus on G20 countries & SDG implementation.

Some of the (additional) findings of this year: Most G20 countries have started SDGs implementation, but important gaps remain; No country is on track towards achieving all SDGs; Conflicts are leading to reversals in SDG progress; Progress towards sustainable consumption and production patterns is too slow; High-income countries generate negative SDG spillover effects; Inequalities in economic and social outcomes require better data.

Global coalition of Civil Society & trade unions – Spotlight on sustainable development 2018

https://www.2030spotlight.org/en

As you can imagine, this stance is rather different from the ‘official’ UN view.

The world is off-track in terms of achieving sustainable development and fundamental policy changes are necessary to unleash the transformative potential of the SDGs.” This is the main message of the Spotlight Report 2018, the most comprehensive independent assessment of the implementation of the 2030 Agenda. The report is launched on the opening day of the High Level Political Forum at the United Nations in New York by a global coalition of civil society organizations and trade unions. When UN Member States adopted the 2030 Agenda, they signaled with the title ‘Transforming our World‘ that it should trigger fundamental changes in politics and society, argues the report. Yet, “three years after its adoption, most governments have failed to turn the vision of the 2030 Agenda into real policies. Even worse, policies in a growing number of countries are moving in the opposite direction, seriously undermining the spirit and the goals of the 2030 Agenda.” The Spotlight 2018 report focuses on policies that are needed and, as the authors underline, “possible”: “There is a need for more coherent fiscal and regulatory policies and a whole-of-government approach towards sustainability.” “Governments should promote policies that are genuinely coherent in the interest of sustainable development, human rights and gender justice.” “The implementation of the 2030 Agenda and the SDGs must not be hidden in the niche of environment and development policies but must be declared a top priority by all heads of government.” “The national strategies for sustainable development should not be regarded as one among many but constitute the overarching framework for all policies.” The 160-page report is supported by a broad range of civil society organizations and trade unions, and informed by the experiences and reports of national and regional groups and coalitions from all parts of the world…. “

ODI (Briefing paper) – ‘Leave no one behind’ index 2018

https://www.odi.org/publications/11159-leave-no-one-behind-index-2018

This index reviews the readiness of 86 countries to ‘leave no one behind’, monitoring the extent to which government systems are set up and ready to meet their leave no one behind commitment. It covers all the countries that are presenting Voluntary National Reviews at the 2018 High-level Political Forum as well as those that presented last year. Building on ODI’s 2017 ‘leave no one behind’ index, this year’s index adds an additional policy indicator on resilience. It also includes a new ‘leave no one behind’ outcome score for each country that captures the extent to which real-world outcomes on leaving no one behind are improving. The index measures governments’ readiness in three areas: Data. Are countries undertaking the necessary surveys to identify those at risk of being left behind? Policy. Do countries have key policies in place that address the needs of those at risk of being left behind – in particular, in relation to: women’s access to land and employment; and universal access to health, which previous ODI research identified as critical areas to support leaving no one behind? Finance. Are governments investing enough in education, health and social protection – the three key sectors that are well recognised to be critical for supporting those at risk of being left behind?”

The World in 2050 – Six transformations needed to achieve the UN Sustainable Development Goals: major report launched

http://www.iiasa.ac.at/web/home/about/news/180710-twi2050-launch.html

The World in 2050 (TWI2050) initiative has launched a new report, setting out six key transformations that will enable the world to meet the SDGs.”

““The transformations presented in the report, Transformations to Achieve the Sustainable Development Goals… … encompass all the major drivers of societal change, including human capacity, consumption and production, decarbonization, and the digital revolution. They provide a way to achieve the SDGs in a manageable way.””

New York City – Local Voluntary Review: NYC is First City in the World to Report to UN on Local Steps Toward Global Goals

https://www1.nyc.gov/site/international/programs/voluntary-local-review.page

As Kent Buse would put it, kudos to NYC!

On Twitter, it was pointed out this shows the usefulness of SDGs at sub-national level, to stimulate progress on SDGs even in countries where governments aren’t very “SDG-minded”.

Further analysis

Global Policy Watch – UN SDG progress reports: how statistics play favorites

https://www.globalpolicywatch.org/blog/2018/07/07/sdg-indicators-how-play-favorites/

Must-read analysis by Roberto Bissio.

As key instruments to assess implementation of the 2030 Agenda, the UN secretariat has published The Sustainable Development Goals Report 2018 and a report on Progress Towards Sustainable Development Goals that should inform the ministers attending the High Level Political Forum of ECOSOC to be held mid-July in New York. Both publications aim to “provide a global overview of the current situation” of the SDGs, “based on the latest available data for indicators in the global indicator framework” and they include the same set of numbers and indicators, only differing in their presentation, the latter being more wordy and text-only and the former a collection of bullet points with ample use of graphs. While reiterating that “the availability of quality, accessible, open, timely and disaggregated data is vital for evidence-based decision-making and the full implementation of the 2030 Agenda” the emphasis on some indicators while ignoring others, an arbitrary management of disaggregation and an inconsistent use or disregard of trends results in a message that fails to convey the “sense of urgency” that UN Secretary-General António Guterres speaks about in his foreword. Even worse, the principle of “common but differentiated responsibilities” of all countries is absent, and the report systematically ignores or downplays evidence of developed countries’ contribution to the present un-sustainability of the planet or unfair appropriation of its resources….”

Global Policy Watch (Briefing) – SDG shadow implementation – hidden in plain sight

https://www.globalpolicywatch.org/blog/2018/07/12/sdg-shadow-implementation/

“…The 2030 Agenda is universal: its vision is inclusive of all countries, all policies, and all sectors of society. But evidence to date shows a pick-and-choose approach among some Member States, UN agencies, civil society and the business sector according to their priorities and interests. Efforts at implementation have not only privileged these diverse priorities and competencies but also have neglected accountability, deliberately or otherwise. … … Some laud the interest and involvement of the major economies / G20 and the corporate sector in the search for the trillions not billions needed to implement the SDGs, but closer attention suggests the trillions may serve the needs of institutional investors and mitigate against the transformation needed to bring justice for people and planet. … … Currently the dynamics around measurement and finance are re-shaping the Agenda. Its bold vision is being undermined not only by what is and is not being measured and financed but also by a failure to focus on strengthening democratically accountable institutions as well as cross-goal, cross-pillar and cross-policy streams….”

“This briefing introduces some of the recent developments in the areas of UN reform, funding and financing, partnership promotion and the measurement of “progress” on SDG indicators.””

The briefing concludes:

The HLPF has become a magnet and a marketplace for all manner of initiatives. It will meet in 2019 at summit level and will be confronted with the growing evidence of being off-course for 2030. This is an essential occasion to address the obstacles to achieving the SDGs. If the Heads of State and Government do not chart a correction course, it is time to consider what really lies behind their championship of the SDGs.

Breastfeeding & Trump

NYT – Opposition to breastfeeding resolution by US stuns WHO officials

https://www.nytimes.com/2018/07/08/health/world-health-breastfeeding-ecuador-trump.html

“If you can’t agree on health multilateralism, what kind of multilateralism can you agree on?”  (I Kickbusch)

In a revelation that stunned the global health community earlier this week, it was reported the US threw a spanner in the works, with the passing of the “breastmilk is best” resolution at last spring’s World Health Assembly. Ecuador, the country which proposed the resolution was threatened with punishing trade measures and the withdrawal of US military aid, and bullied into acquiescence.

In a bid to protect the infant formula industry, the US balked at the language that was used in the resolution which focused on promoting breastfeeding and limiting marketing of baby formula. The threats continued, with other countries being warned not to show support for the resolution. Russia stepped in to save the day, and in an interesting twist to the story, were not threatened by the US. It seems that the only thing that is predictable about the current administration is its lack of predictability.

See also the GuardianTrump administration’s opposition to breastfeeding resolution sparks outrage.

Some more reads related to this contentious issue

 

Associated Press: Trump says U.S. had opposed formula limits, not breastfeeding
“The U.S. opposed a World Health Assembly resolution to encourage breastfeeding because it called for limits on the promotion of infant formula, not because of objections to breastfeeding, President Donald Trump tweeted Monday…” (7/9).

See also Vox The Trump administration isn’t defending women’s choices on breastfeeding. It’s attacking them.

The Atlantic: The Epic Battle Between Breast Milk and Infant-Formula Companies
Some info on the historical background, over the past few decades. “…This latest tussle in Geneva follows a decades-long battle by infant-formula makers to promote themselves as essentially on par with breast milk. And while health experts instead say ‘breast is best,’ as this incident shows, policymakers aren’t always willing to put legislation behind that message…” (Khazan, 7/10).

Vox: The next frontier of Trump’s defence of baby formula
“…[I]t turns out that global health resolution was just one of a few battlefronts in Trump’s fight against policies that support breastfeeding, as the administration increasingly aligns itself with the U.S. infant formula industry. A key policy the industry hopes to influence next is a forthcoming United Nations guideline for ‘follow-up’ formulas or ‘growing‐up milks,’ baby formula marketed for children over six months of age. … But formula companies want to head off regulation through global food guidelines of these follow-up formulas, which are virtually indistinguishable from their infant counterparts when it comes to their packaging and labeling. These products represent the fastest-growing category in the … baby formula market…”

HP&P supplement – Experiences of African health system leadership and its development

https://academic.oup.com/heapol/issue/33/suppl_2

Do start with the Editorial by Lucy Gilson & Irene AgyepongStrengthening health system leadership for better governance: what does it take?

This editorial provides an overview of the six papers included in this special supplement on health leadership in Africa. Together the papers provide evidence of leadership in public hospital settings and of initiatives to strengthen leadership development. On the one hand, they demonstrate both that current leadership practices often impact negatively on staff motivation and patient care, and that contextual factors underpin poor leadership. On the other hand, they provide some evidence of the positive potential of new forms of participatory leadership, together with ideas about what forms of leadership development intervention can nurture new forms of leadership. Finally, the papers prompt reflection on the research needed to support the implementation of such interventions.”

Migration

Guardian – ‘Toxic narrative’ on migration endangers lives, report finds

https://www.theguardian.com/global-development/2018/jul/11/toxic-narrative-migration-endangers-lives-red-cross-report

Coverage of a new IFRC report, brilliantly titled,  “New Walled Order    “The “criminalisation of compassion”, with countries introducing laws that restrict help to those in need, endangers lives and risks pushing humanitarian standards back by a century. A report claims migrants around the world are facing a “new walled order” as barriers to aid and vital services are raised, with children and the elderly most likely to suffer the “dire consequences” as a result. The International Federation of the Red Cross and Red Crescent Societies (IFRC) warns that when organisations are legally prevented from helping people in need, 100 years of progress could be undermined. The federation also criticises the “toxic narrative”, in which aid groups that rescue migrants have been accused of colluding with smugglers and thus endangering lives.”

“… The research, published ahead of the first round of negotiations on the UN’s global compact on migration, cites examples of the “criminalisation” of individual and organisations delivering humanitarian assistance. …”

IISD – Co-facilitators Release Final Draft of Migration Compact

IISD;

Co-facilitators from Switzerland and Mexico have circulated the final draft of the Global Compact for Safe, Orderly and Regular Migration, inviting UN Member States and all relevant stakeholders to conclude the negotiations on 13 July. The compact is based on a set of “cross-cutting and interdependent” guiding principles, namely: people-centered; international cooperation; national sovereignty; rule of law and due process; sustainable development; human rights; gender-responsive; child-sensitive; whole-of-government approach; and whole-of-society approach. The last round of negotiations is taking place from 9-13 July at UN Headquarters in New York, US.”

NYT – Migrants are on the Rise Around the World, and Myths About Them Are Shaping Attitudes

https://www.nytimes.com/interactive/2018/06/20/business/economy/immigration-economic-impact.html?mtrref=t.co&gwh=13926C79DF41E66BE3D31DF8C2AD5B30&gwt=pay

Must-read. With plenty of interesting stats, graphs & figures.

Project Syndicate – The Migration Dilemma

Peter Singer; https://www.project-syndicate.org/commentary/migration-moral-dilemma-europe-america-by-peter-singer-2018-07

Well worth a read, even if I don’t agree entirely with what Singer argues here. “Political leaders who want to act humanely towards asylum-seekers and other migrants now face a moral dilemma. Either they pursue border control that is strict enough to undercut public support for far-right parties, or they risk allowing those parties to gain more power – and challenge the West’s most fundamental values.

Devex – ‘Play the long game:’ US must continue aid in Central America, analysts say

https://www.devex.com/news/play-the-long-game-us-must-continue-aid-in-central-america-analysts-say-93081

“The Trump administration has threatened to cut U.S. aid to the Northern Triangle, but doing so will only exacerbate root causes of migration, analysts say.”

“… In 2014, the unaccompanied minor crisis overwhelmed the southern United States border, prompting a government response to discourage people from the violent and economically underdeveloped “Northern Triangle” from crossing unauthorized into the U.S. Then-President Barack Obama tasked his vice president, Joe Biden, with leading the international response to the crisis. Biden engaged directly that summer with the leaders of El Salvador, Guatemala, and Honduras to craft a plan to reduce migration….”

Find the 7 similarities with the EU migration crisis, including in terms of the political backlash of these crises.

ODI (paper) – Migration and the 2030 Agenda for Sustainable Development

https://www.odi.org/projects/2849-migration-and-2030-agenda-sustainable-development

Migration is one of the defining features of the 21st century and significantly contributes to economic and social development everywhere. As such, migration will be key to achieving the SDGs. In a series of briefings, ODI, with the support of the Swiss Agency for Development and Cooperation (SDC), explains the relationship between migration and critical development issues that are central to the SDGs. The briefings provide a set of recommendations for governments and policymakers tasked with delivering the 2030 Agenda for Sustainable Development.”

For the synthesis paper, see Migration and the 2030 Agenda for Sustainable Development (by M Foresti et al)

“…This synthesis collates, and draws out key findings from, a series of eight ODI policy briefings which analyse the interrelationship between migration and key development areas. Each briefing explores how the links between migration and these different development issues affect the achievement of the SDGs, and offers pragmatic recommendations to incorporate migration into the 2030 Agenda to ensure it contributes to positive development outcomes.”

World Population Day – 11 July

Thomson Reuters – 10 facts about the world’s population

http://news.trust.org/item/20180710155439-tqykh/

“World Population Day, a United Nations’ initiative celebrated every year on July 11 to raise awareness about the exploding world population, focuses on reproductive rights this year to mark 50 years since family planning won recognition as a human right.

In this article, you find 10 key facts.

UN News – World Population Day: ‘A matter of human rights’ says UN

https://news.un.org/en/story/2018/07/1014371

Family planning was affirmed to be a human right 50 years ago, leading to what would become the annual observation of World Population Day, which focuses attention on the impact the number of children born, has on the world. In her message for the Day, UN Population Fund (UNFPA) Executive Director Natalia Kanem took that a step further, saying: “Family planning is not only a matter of human rights; it is also central to women’s empowerment, reducing poverty and achieving sustainable development.” Yet, in developing regions, the UNFPA chief pointed out that some 214 million women still lack safe and effective family planning, for reasons ranging from lack of information or services, to lack of support from their partners or communities….

See also Devex (by C Kalvin (UN Foundation) & N Kanem (UNFPA)) – Family planning gives women a future. It shouldn’t be up for debate.

The road ahead is still arduous, though, see this sad story from Kenya for example:

Guardian –  Teenager at centre of Kenyan court case over botched abortion has died.

A teenager whose botched abortion was at the centre of a high court case in Kenya has died. The girl, who was raped aged 14 and then left with horrific injuries after a backstreet termination, had been the subject of a controversy over whether the Kenyan government was to blame for her death. The girl’s mother and a group of campaigners had filed a case against the government, claiming it had failed to offer the girl – known as JMM – adequate post-abortion care and are calling for the government to reinstate guidelines on safe abortions….”

Lancet – Study on the Mosaic HIV-1 vaccine

Lancet;

A phase 1/2a trial in humans and rhesus monkeys shows that a mosaic adenovirus serotype 26 (Ad26)-based HIV-1 vaccine induces robust immune responses in humans and monkeys.”

Coverage for example in Science DailyNovel HIV vaccine candidate is safe and induces immune response in healthy adults and monkeys

New research published in The Lancet shows that an experimental HIV-1 vaccine regimen is well-tolerated and generated comparable and robust immune responses against HIV in healthy adults and rhesus monkeys. Moreover, the vaccine candidate protected against infection with an HIV-like virus in monkeys. Based on the results from this phase 1/2a clinical trial that involved nearly 400 healthy adults, a phase 2b trial has been initiated in southern Africa to determine the safety and efficacy of the HIV-1 vaccine candidate in 2,600 women at risk for acquiring HIV. This is one of only five experimental HIV-1 vaccine concepts that have progressed to efficacy trials in humans in the 35 years of the global HIV/AIDS epidemic. Previous HIV-1 vaccine candidates have typically been limited to specific regions of the world. The experimental regimens tested in this study are based on ‘mosaic’ vaccines that take pieces of different HIV viruses and combine them to elicit immune responses against a wide variety of HIV strains….”

See also a related Lancet CommentA new step towards an HIV/AIDS vaccine.

Let’s hope that indeed turns out to be the case.

WHO guide to planning healthy and sustainable meetings

WHO Euro;

WHO is releasing a new guide for employers and meeting organizers to promote healthier working environments. “Planning healthy and sustainable meetings”, initially developed for WHO’s own employees, applies established health promotion principles to meetings and events. … … The guide touches upon 4 major elements of a healthy and environmentally friendly lifestyle: a healthy diet, physical activity, a tobacco-free environment and sustainable practices. It gives concrete suggestions on how to apply them when planning a meeting to create a culture of health, well-being and sustainability.”

Rebalance Day/Leave

What this Australian company learnt from giving its staff unlimited paid leave

https://www.theage.com.au/business/workplace/what-this-australian-company-learnt-from-giving-its-staff-unlimited-paid-leave-20180712-p4zqzg.html

Surely an innovative idea for the “SDG / doughnut economics” era.

“…Two years ago, at an all-staff meeting, I announced that we would be introducing unlimited annual leave. To be clear, I wasn’t talking about unlimited unpaid leave. Rather, staff would now be able to take as much leave as their hearts desired and every single day of it would be paid. I had made the decision because I felt that employment law around leave in Australia was fundamentally unfair. It is heavily biased towards employers. …”

“…To rectify this imbalance, and help bring more balance into my team’s lives, unlimited leave was launched. We called it Rebalance Leave, because it wasn’t about more leave for leaves’ sake, it was intended to help staff lead more balanced lives. And two years on, I can confirm that it has made a huge difference….”   It’s intended to compensate for regular overtime.

FT – Wellcome launches £250m Leap Fund to back risky research

https://www.ft.com/content/8f98c154-8066-11e8-bc55-50daf11b720d

The Wellcome Trust, Britain’s wealthiest foundation, is setting up a £250m fund to place “big bets” on risky research that could transform science and health. Wellcome wants to support bold ideas from universities or businesses around the world that would be unlikely to win grants from its own life sciences funding system or from public agencies such as the UK Medical Research Council. Their chances of success would not be high enough to convince the “peer review” panels who normally assess research applications….”

See also Wellcome’s (Jeremy Farrar) announcement – Director’s update: taking risks on bold ideas

Or Stat NewsResearch charity launches $330M initiative to fund high-risk life sciences projects

AMR

Interagency Coordination Group on Antimicrobial Resistance (ICAG) (Discussion paper) – Future global governance for antimicrobial resistance

http://www.who.int/antimicrobial-resistance/interagency-coordination-group/IACG_Future_global_governance_for_AMR_120718.pdf?ua=1

Based on discussions in a small group that took place in April 2018.

Some of the key messages: “… This is a discussion paper and should not be considered a fully comprehensive account of the discussions nor a consensus statement by the IACG but a first step to move the discussions forward; · At this meeting, consensus was reached that the status quo was not delivering and we must build on and strengthen existing governance mechanisms; · Ten requirements for effective AMR governance mechanisms emerged and based on the identified needs, the experts together built a draft model for discussion and debate that provides an outline of the possible future global governance of AMR… “

“…Initial findings suggested that a future global, multi-stakeholder agreement is urgently needed to provide a sufficient mandate to act in accordance with the needs identified, providing the authority to coordinate resource, engage stakeholders, and secure binding commitment for action; · The above goal might best be achieved by the development of a multisector, multi-stakeholder Global Steering Board to be hosted in an existing organisation, led by a time-limited High-Level AMR Commission;…”

Novartis joins the Big Pharma exodus out of antibiotics, dumping research, cutting 140 and out-licensing programs

https://endpts.com/novartis-joins-the-big-pharma-exodus-out-of-antibiotics-dumping-research-cutting-140-and-out-licensing-programs/

Another Big Pharma is retreating from the antibiotics field. Novartis today says its early-stage research group at NIBR is dropping antibacterial and antiviral research programs based in Emeryville, CA. And they’re doing it at a time that drug-resistant strains of bacteria are spreading around the world — an issue that once commanded considerable attention at Novartis….”

Cfr a tweet by Jeremy Farrar:  “Novartis pull out of antibiotics & antiviral research-incredibly bad news & more to come -modern medicine depends on controlling infection -R&D anti-cancer therapies meaningless if cannot prevent/treat infection same with routine surgery, safe child birth.”

You might want to read together with last week’s Letter in the FT (by Thomas Cueni, DG of the International Federation of Pharmaceutical Manufacturers & Associations) “Drugs companies are rising to the challenges of research into superbugs”.

I respectfully disagree with Jim O’Neill’s comments on pharmaceutical companies’ inaction on combating antimicrobial resistance … …”  “…As published in the AMR Industry Alliance’s progress report, in 2016 companies invested at least $2bn in research and development to counter AMR. This figure, despite not representing the total industry investment, is substantial. A 2017 Boston Consulting Group report for the German government estimated that over the same period, governments made available a total of $500m for R&D for new antibiotics. Ten large R&D biopharmaceutical companies have reported to have relevant R&D activities. Pharmaceutical companies are not only active in R&D, but are taking many other tangible steps across the continuum of care — from prevention, monitoring and screening to treatment….”

Etc.   #AMRwashing

Another tweet from Jeremy Farrar to wrap up this item: “Much thought since O’Neill AMR Review – but not enough action – GARDP, CARBX progress but Stewardship, Human & Agriculture, Push & Pull Incentives Political will – lagging. Worth reminding of the Review & ask as a community what have we really changed?

BMJ Opinion – The modern era must end: antibiotic resistance helps us rethink medicine and farming

C de Lima Hutchinson et al ; BMJ opinion;

Brilliant blog. Whether it will be listened to in time is another story.

“… A dramatic reduction in the use of antibiotics goes beyond targeting individual behaviour. It must involve engaging with new approaches to understanding and addressing the connections between humans, animals (including microbes) and environmental health, including careful analysis of how these connections reflect current political and economic values. If we understand the current predicament of antibiotic resistance as emblematic of modern livestock-production, meat consumption, and distribution of economic profits, then we must be prepared to envision futures in which these configurations are as much at stake as individual antimicrobial use behaviour. Calls for the scaling back of excess antibiotics, as well as for the drawing of connections across sectoral and disciplinary lines, provide an opportunity to shift away from, and rethink modern farming and medical practices. The rise in antibiotic resistance can therefore be understood less as a catastrophic end and more as an invitation to conceive alternative configurations of medicine, farming and life beyond the modern era.”

Lancet – Equity in the gender equality movement in global health

C Jones et al (for the Francophone WGH working group); https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31561-7/fulltext

“… an equity challenge remains embedded within the [Women Leaders in Global Health] movement to increase the visibility and recognition of women leaders and experts in global health. Women in Global Health’s analysis of the organisational locations of 300 women leaders collected through an open nominations process on Twitter shows considerable regional disparities…”

“… Building on the increasing momentum and a desire to extend the scope and reach of international visibility for women leaders in global health, WGH wishes to expand the list to include five hundred women (#WGH500). To promote gender equality in global health leadership within this initiative, we must pay careful attention to diversity and recognise women from under-represented countries and language groups. For this reason, we initiated a WGH project to profile French-speaking women working in global health, and we are seeking nominations of francophone women from LMICs in particular….”

Global health governance

 

A few tweets related to global health governance from this week:

Also quite enjoyed Andrew Harmer’s pertinent remark: “The question is rather whether the Global Fund can survive Peter Sands.

  • Anders Nordström (I guess in response to a tweet by dr. Tedros): “We do not only need health systems focusing on keeping people healthy but we need healthy societies providing more healthy choices; food, physical activity, clean energy. Time for a Global Commission on Healthy Societies?”

+ Kent Buse’s reply  – “Agree @NordstrmAnders  – such a Commission could join health-related dots across #SDGs, drive forward @WHO #GPW13 & inform development of Global Health Plan for #SDG3+

Guardian – Robot workers will lead to surge in slavery in south-east Asia, report finds

https://www.theguardian.com/global-development/2018/jul/12/robot-workers-will-lead-to-surge-in-slavery-in-south-east-asia-report-finds

From the global health twitter sphere back to the real world, then:

Robots will slash millions of jobs and create an upswing in trafficking and slavery across south-east Asia, research claims. In a report launched on Thursday, supply-chain analyst firm Verisk Maplecroft predicts that the rise in robot manufacturing will have a knock-on effect that results not only in lost livelihoods but in a spike in slavery and labour abuses in brand supply chains. Earlier this year, the UN International Labour Organisation predicted that  in south Asia’s key manufacturing hubs in Thailand, Cambodia, Indonesia, the Philippines and Vietnam 56 % of workers could lose their jobs over the next two decades due to automation….”

It’s becoming very clear that if we don’t dare to think of a post-capitalist future, the future will be very bleak for billions.

NCDs

BMJ (blog); NCDs—it’s time to embrace the evidence, not industry

J Hanefeld & B Hawkins; BMJ blog;

Embracing actors from any health harming industry is misguided given the scale of the current NCD crisis, argue Johanna Hanefeld and Benjamin Hawkins.”

The recent report of the WHO’s Independent High Level Commission on noncommunicable diseases (NCDs) should be welcomed in so far as it recognises the political importance of this issue, and the need for cross-government approaches and political buy-in at the highest levels. However, the measures it advocates for tackling NCDs are completely inadequate to reverse current trends…. … The report is remarkable in the extent to which it reproduces a pro-business agenda. Indeed, the authors openly admit they were unable to reach consensus on the most controversial issues, namely those involving taxation and curtailing corporate influence….”

And the killer paragraph: “…Increasingly, the exclusion of the tobacco industry is being used not as an example for policy makers and global health actors to follow in relation to other health harming industries, but as a rationale for their continued engagement. The tobacco industry are the bad “other” against which the alcohol and food industries differentiate themselves as legitimate participants in policy forums. For policy makers, the exclusion of “big tobacco” is often held up to counter suggestions of industry influence. Yet we should not be complacent on this point. Embracing actors from any health harming industry is misguided given the scale of the current NCD crisis and their role within this….”

Tobacco control

Lancet (Comment) – Denicotinised cigarettes

John Britton; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31358-8/fulltext

“… In March, 2018, the US Food and Drug Administration (FDA) issued an advanced notice of proposed rule making, as part of its comprehensive plan on tobacco and nicotine regulation, that proposes a radical approach: reducing the nicotine content of combustible cigarettes to minimally or non-addictive levels. Will it work?”  Britton explores the question in this very nice viewpoint.

Among others, he reckons “… It is concerning, therefore, that WHO is considering denicotinisation as a global tobacco control strategy while discouraging the availability of alternative nicotine products.”

Lancet – Offline: The UK’s child health emergency

Richard Horton; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31614-3/fulltext

Another reflection, linked to the 70th NHS anniversary. He wonders why the debate is only about money, and ends like this: “…The UK is facing nothing less than a national emergency regarding the health of its children and young people. This emergency is a scar on the moral body of our country. Who will take responsibility for addressing it? So far, silence from the medical community. Shame on us.”

NEPAD’s transformation into the African Union Development Agency

http://www.nepad.org/content/nepad%E2%80%99s-transformation-african-union-development-agency

See also Devexhttps://www.devex.com/news/un-reform-plans-germany-s-aid-budget-and-harassment-safeguards-this-week-in-development-93111

“…The CEO of the New Partnership for Africa’s Development is “enthusiastic” about the transformation of the NEPAD Agency into the African Union Development Agency, according to a statement released this week. “A core aspect of the current reforms is to streamline and improve effectiveness and efficiency in delivery in the implementation of AU decisions, policies and programmes across all AU organs and institutions,” Ibrahim Mayaki said. During the African Union Summit, which concluded earlier this month, heads of state approved the creation of the African Union Development Agency as the technical body of the African Union. The new agency has until the January 2019 summit to present itself as an organization with its own legal identity and mandate. The creation of the AUDA is part of wider AU reforms led by Rwandan President Paul Kagame.”

Lancet World Report – African Union launches a pan-African anti-malaria campaign

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31606-4/fulltext

African leaders launch a continent-wide Zero Malaria Starts with Me campaign to spur response in the face of a setback in progress in the fight against the disease. John Zarocostas reports. The African Union (AU) Commission and the RBM Partnership to End Malaria launched on July 2 a continent-wide anti-malaria campaign, in a bid to add momentum to the fight against the disease. The “Zero Malaria Starts with Me”, campaign—inspired by Senegal’s nationwide campaign of the same name launched in 2014—… … [was unveiled during the latest AU summit]. It seeks to empower communities to take a greater stake in malaria prevention and care and in generating additional resources. Malaria experts say that what distinguishes this campaign from other campaigns centred around donors is that this is the first Pan-African initiative focused on African countries and what they can do to fight the disease on every level, down to every village….”

Publications of the week

BMJ Global Health – Addressing the tensions and complexities involved in commissioning and undertaking implementation research in low- and middle-income countries

T Doherty et al; https://gh.bmj.com/content/3/4/e000741

Summary: ““Rapid scale-up of new policies and guidelines, in the context of weak health systems in low/middle-income countries (LMIC), has led to greater interest and funding for implementation research. Implementation research in LMICs is often commissioned by institutions from high-income countries but increasingly undertaken by LMIC-based research institutions. Commissioned implementation research to evaluate large-scale, donor-funded health interventions in LMICs may hold tensions with respect to the interests of the researchers, the commissioning agency, implementers and the country government. We propose key questions that could help researchers navigate and minimise the potential conflicts of commissioned implementation research in an LMIC setting.

Gendered health systems: evidence from low- and middle-income countries

Rosemary Morgan et al; https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-018-0338-5

In a multi-study synthesis paper “focusing on four health systems domains, namely human resources, service delivery, governance and financing,” Morgan et al. explore how gendered and/or intersectional gender approaches “can be applied by researchers in a range of low- and middle-income settings (Cambodia, Zimbabwe, Uganda, India, China, Nigeria and Tanzania) to issues across the health system and demonstrates that these types of analysis can uncover new and novel ways of viewing seemingly intractable problems.”

The publication was also co-authored by some EV alumni. Among others Charles Ssemugabo, Sreytouch Vong, ..

Plos Med (Policy Forum) – Climate change and women’s health: Impacts and policy directions

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002603

In a Policy Forum for the special issue on Climate Change and Health, Cecilia Sorensen and colleagues discuss the implications of climate change for women’s health.”

CGD – Projected Health Financing Transitions: Timeline and Magnitude – Working Paper 488

Rachel Silverman; https://www.cgdev.org/publication/projected-health-financing-transitions-timeline-and-magnitude

In recent years, many global health institutions have adopted eligibility and transition frameworks for the countries they support, generating questions about how these frameworks apply in practice—and whether global health progress will be put at risk through premature or poorly planned transition processes. This paper builds on previous work in this space by mapping an indicative timeline of transition through 2040 across five global health financing mechanisms—Gavi, the Vaccine Alliance (Gavi); the Global Fund to Fight AIDS, Tuberculosis, and Malaria (the Global Fund); the World Bank’s International Development Association (IDA); the Global Polio Eradication Initiative (GPEI); and the US President’s Emergency Plan for AIDS Relief (PEPFAR)—with granularity by year and stage of transition. It contextualizes the magnitude of fiscal transition for each country with reference to overall government expenditure on health. Finally, it identifies countries and specific time periods of high transition risk based on cumulative fiscal impact. By 2040, it finds that Gavi and IDA will each see major transformations of their funding portfolios, while few large or aid-dependent countries will transition from Global Fund support. The countries in most fiscal jeopardy from anticipated transition are not those “transitioning” based on GDP per capita or disease burden, but instead those that are likely to be impacted by the near-term winddown of GPEI and reallocations of PEPFAR financing. A handful of countries face many major transitions within a very narrow time window—and the cumulative fiscal effect may be substantial, even if each individual transition should be manageable. Global health donors should build upon these results, working cooperatively at the country level, to ensure countries have a realistic understanding of transition processes to enable appropriate planning, budgeting, and prioritization.”

Or read her accompanying CGD blogWhat You Should Know About Global Health Financing Transitions: Five Key Takeaways  (recommended!!!!)

Some other key articles & blogs of the week

Jason Hickel – The problem with the Human Development Index in an era of ecological breakdown

https://www.jasonhickel.org/blog/2018/7/5/the-problem-with-the-human-development-index-in-an-era-of-ecological-breakdown

The HDI approach is self-defeating, Hickel argues.  “…As long as income counts as 33% of HDI, achieving very high HDI by definition requires growth to the point of outstripping biocapacity.  If all nations in the world were to pursue the highest HDI (which is of course presently the plan), we would “develop” ourselves into ecological collapse….”

Time for a better measure, better suited to the Anthropocene.  (PS: some don’t like the term ‘Anthropocene’ – as it seems to blame all human beings to the same extent -, and prefer instead ‘Capitalocene’; I quite agree)

Guardian – It’s time to burst the biomedical bubble in UK research

https://www.theguardian.com/science/political-science/2018/jul/12/its-time-to-burst-the-biomedical-bubble-in-uk-research

A new study calls for a rebalancing of research and innovation funding to better meet the UK’s economic, social and health needs.”

Make that the entire world.

O’Neill institute – UNICEF: implementing human rights for child health

B M Meier et al ; http://oneill.law.georgetown.edu/unicef-implementing-human-rights-for-child-health/

Part of the excellent O’Neill Institute blog series on Human rights in global health, which explores the implementation of HR law in Global health governance. So far there were posts on WHO, ILO. Now it’s the turn of UNICEF.

Bliss – Exploring masculinities: being a man in the #MeToo era by ISS Counselling Team members

B R Cortez et al ; https://issblog.nl/2018/07/09/exploring-masculinities-being-a-man-in-the-metoo-era/

HT my colleague Willem van de Put.  “A recent workshop on masculinities hosted by the ISS Counselling Team focused on ‘being a man in the #MeToo era’, drawing participants from the ISS and beyond. The workshop provided a space for reflection on lived experiences regarding masculinity, for the exploration of the ways in which masculinities have been constructed and performed, and for the examination of some of the ideals of masculinity across different cultures. This article briefly details some of the workshop’s highlights.”

The best antidote against a mid-life crisis: turns out we men don’t just have one masculinity but several!  Granted, now we still need to learn how to “navigate” them all : )

Plos (blog) – Windows of opportunity for SSB taxation

B Sinclair et al; http://blogs.plos.org/globalhealth/2018/07/windows-of-opportunity-for-ssb-taxation/

SSB taxes are building momentum globally.

“… Part of our research for World Cancer Research Fund International’s new Building Momentum series involves interviewing policymakers, academics and advocates from around the world. In our first report, Building Momentum: lessons from implementing a robust SSB tax, we highlight several common challenges that have attempted to derail the policy process. Our research shows that many key lessons can be learned from countries and jurisdictions who have attempted, and in most cases, succeeded in implementing an SSB tax. These key lessons can be used by countries and applied to their local context. After writing the report, and in light of recent events, we’ve reflected further on the political nature of the nutrition policy process. Many theories of political process help explain how certain policies make it onto the political agenda and are implemented. Here we outline Kingdon’s three stream policy window model (problem stream, politics stream and policy stream) to illustrate our reflections….

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