IHP news 504: Highlights of the week

By on January 11, 2019

A neat proposal for the Global Fund Replenishment

Project Syndicate – Fully Filling the Global Fund

J Sachs et al; https://www.project-syndicate.org/commentary/global-fund-aids-tb-malaria-replenishment-round-by-jeffrey-d-sachs-et-al-2019-01

Sachs et al look ahead to the GF replenishment in Lyon, France, later this year. At last, they come up with a half-decent proposal for our populist times.

“…In the previous replenishment round, the Global Fund identified a total three-year financing need of around $98 billion, of which all but around $30 billion could be met by domestic budgets and other sources. Yet, instead of filling the $30 billion gap (roughly $10 billion per year), the donors gave the Global Fund just $13 billion. The lack of adequate funding meant that all three diseases continued to kill and to spread unnecessarily. This time, the entire shortfall must be covered. The Global Fund will soon issue its own assessment of financing needs, but the numbers are unlikely to change much: around $30 billion over three years, or $10 billion per year….”

“… Here, then, is a basic proposal: The Global Fund should pledge its efforts to raise $30 billion for the next three years. Half of the $30 billion could come from donor governments. The US should continue its tradition of bipartisan support. China, a past Global Fund beneficiary, should now become a donor. The other half of the funding should come from the world’s richest people, whose wealth has soared in recent years. Gates has set the standard, and, under the Giving Pledge that he and Warren Buffett have launched, hundreds of the super-rich could easily pledge $5 billion per year for the period 2020-2022.”

We hope especially the latter part will inspire financing for other global public goods as well (at least as long as we don’t manage to properly tax billionaires around the globe).  If Macron is smart, he should listen to Sachs et al on this one. And if he isn’t, I’m sure Rosa Luxemburg (see below) could be a source of inspiration, 100 years after her death 😊.

Lancet Offline- Rosa Luxemburg and the struggle for health

R Horton; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30050-9/fulltext

The centenary of Rosa Luxemburg’s death is an opportunity to reconsider her legacy for health. Her arguments remain relevant for health today, Horton argues. Excerpt:

“…The Rosa Luxemburg Stiftung, established in 1990, is a Berlin-based foundation dedicated to using her ideas and values to illuminate contemporary social challenges. In 2018, the foundation published an analysis, written by Amit Sengupta, Chiara Bodini, and Sebastian Franco, which stands as a Luxemburgian manifesto for health. Entitled The Struggle for Health, the paper argues that the organisation of modern society “stands in contradiction to the rights of populations to health and healthcare.” At the heart of this contradiction lie the adverse effects of globalisation—the modern reincarnation of imperialism—including conflict, inequality, and the rise of authoritarian government. The result is a “global health crisis”. Good health depends on the political, economic, and social forces that shape conditions of living—unemployment, insecurity, and precarity. This global crisis has weakened the solidarity that helped to deliver strong systems of social protection after 1945. The rising influence of the World Bank, World Trade Organization, and private foundations has undermined WHO and enfeebled multilateralism. One consequence is a deepening democratic deficit in global health. …”

“Zero polio transmission and health for all”, WHO Director-General gives new year’s wish to the people of Afghanistan and Pakistan

WHO

WHO Director-General Dr Tedros Adhanom Ghebreyesus highlighted WHO’s commitment to the final push to eradicate polio on a 4-day visit to Afghanistan and Pakistan – the only two countries where wild poliovirus cases were reported last year. He also commended the governments of both countries for their efforts to provide universal access to health services….”

“…The visit took place shortly after WHO Director-General Dr Tedros Adhanom Ghebreyesus took over the Chair of the Polio Oversight Board, which guides and oversees the Global Polio Eradication Initiative – spearheaded by national governments, WHO, Rotary International, UNICEF, CDC and the Bill & Melinda Gates Foundation – as a clear sign that the eradication of this disease is a priority for WHO.  …”

See also Xinhua News – Polio likely to be eliminated from Pakistan by end 2019: WHO official

Jim Yong Kim resigns

The shock news of the week.

Devex – Jim Kim’s resignation sparks questions about the next World Bank president

https://www.devex.com/news/jim-kim-s-resignation-sparks-questions-about-the-next-world-bank-president-94101

World Bank President Jim Kim took the institution’s staff and board members by surprise when he announced his resignation, giving just three weeks’ notice of his plan to leave three years early, in order to join an infrastructure investment firm. The shock move, which was announced Monday, raised concerns among some members of the international development community about who will take over when Kim leaves on Feb. 1. Advocacy groups called for the selection process to be more “open, transparent, and merit-based” than in previous years.”

Later on in the week, more detail became known on the move from Jim Kim, and the debate on his successor also took off:

Reuters – World Bank’s Kim to join Global Infrastructure Partners

https://www.reuters.com/article/us-worldbank-kim/world-banks-kim-to-join-global-infrastructure-partners-idUSKCN1P302H

World Bank Group President Jim Yong Kim will join Global Infrastructure Partners (GIP), a private equity fund that invests in projects in wealthy and developing countries, the firm said on Tuesday, a day after Kim’s shock resignation from the bank. Kim, who joins New York-based GIP on Feb. 1 as a partner and vice chairman, has accepted a one-year ban from dealings with any World Bank units, including its private sector lending arm, the International Finance Corp, a person familiar with his departure arrangements said…..”

FT World Bank’s Jim Yong Kim to join private equity firm

https://www.ft.com/content/f1bf145a-1364-11e9-a581-4ff78404524e

Excerpts:

A primary concern for the World Bank in managing Mr Kim’s departure has been to insulate him from possible conflicts of interest: at GIP he will be working on infrastructure investments in developing economies, which is the World Bank’s core business. …”

“… His departure has triggered what is expected to be a hard-fought succession race, but supporters of the World Bank worry that the circumstances of Mr Kim’s exit risked demeaning the institution and its work. “There must be some big pull out there that explains it, but I’m disappointed in the sense that it doesn’t somehow befit the nature of the institution, that you could just dump it in this particular way,” said Johannes Linn, a former World Bank official and non-resident senior fellow at the Brookings Institution, a Washington-based think-tank.

“…GIP — which did not return a request for comment — is among a breed of private investment funds that have emerged as leading financiers of renewable power generation assets that are replacing legacy coal and gas plants. ….”

Devex – Nominations for new World Bank president to open Feb. 7

https://www.devex.com/news/nominations-for-new-world-bank-president-to-open-feb-7-94127

“The hunt for the next president of the World Bank will kick off next month and will be “open, merit-based and transparent,” according to the institution’s board of executive directors. Nominations for the bank’s next leader will officially open on Feb. 7 and close on March 14, according to a statement published Thursday. The plan is to have a new president in time for the World Bank spring meetings in Washington, D.C., in April….”

“… Scott Morris, a senior fellow and director of the U.S. Development Policy Initiative at the Center for Global Development, said the quick progress in setting out a timeline for Kim’s replacement indicates that the White House intends to keep control of the nomination. “I think it means that the U.S. is serious about putting forward a candidate, with an expectation that they will prevail. They would not have allowed the clock to start otherwise,” Morris said. But the move does not necessarily mean they have a specific candidate in mind, he added….”

Oxfam (blog) – World Bank President Jim Kim resigns: what’s his legacy and what happens next?

https://oxfamblogs.org/fp2p/world-bank-president-jim-kim-resigns-whats-his-legacy-and-what-happens-next/

Speculation is swirling about the reasons for World Bank President Jim Yong Kim’s abrupt departure this week. But what’s his legacy, and what happens next? Nadia Daar, head of Oxfam’s Washington DC office, gives a steer.”  A mixed bag, in her opinion. Well worth a read, this balanced blog.

On how the WB’s selection process (typically) goes, criteria, … see this Devex primer.

Earlier this week, Nature reported “Some analysts worry that Jim Yong Kim’s successor will be unlikely to support causes antithetical to the US administration, such as climate change.”

FT – World Bank chief ’s resignation to test US sway over successor Kim departure will spark tussle regarding American stranglehold on presidency

https://www.ft.com/content/f1bf145a-1364-11e9-a581-4ff78404524e

Recommended (though gated).

“… The sudden departure more than three years ahead of schedule tees up a battle between the Trump administration, which will have the central role in choosing his replacement, and critics seeking to break America’s stranglehold on the WB presidency. It will be an immediate test of the White House ‘s highly skeptical approach to multilateral institutions – especially one such as the WB that works closely with China and enthusiastically finances climate change projects.”

Other recommended analysis of the (succession) battle ahead:

Charles Kenny (in Slate) – “Bank of America:   “ “The U.S. shouldn’t get to pick the head of the World Bank. And not just because Trump is president.”

Kevin Gallagher (in the FT) –  “Choice of next president will test institution’s legitimacy and relevance”; Kim’s resignation from World Bank leaves multilateralism at stake

Excerpts:

“… To regain the legitimacy and relevance of the World Bank, its members should nominate a set of candidates, debate those candidates and quickly choose one person as their collective nominee to stand against US president Donald Trump’s nominee. Not only are the prospects of meeting the world’s stated development goals at stake, but so is the future of the multilateral system….

… … The Trump administration couldn’t have less legitimacy for nominating a World Bank president than it does now — as it is in the midst of a human resources crisis where the most merited members of the administration have left or been fired….”

“…Kim presided over much turmoil and leaves an institution at an important crossroads where its legitimacy and relevance are at stake. The World Bank’s crises of legitimacy and relevance come from the inside and out….

There is also real concern over the World Bank’s cosy relationship with the private sector. According to the bank’s own assessments, its emphasis on “public-private partnerships” has attracted very little private investment and, when it did, the risks of development projects were seen to be borne by the bank and host country governments while the rewards went to the private sector. As noted in recent FT Alphaville columns, even cosier have been efforts — in the name of expanding the World Bank’s lending — to securitise development loans in the same manner that Wall Street securitised mortgage loans that led to the global financial crisis….”

 

PS: For the ones among you who want to get a flavor of the Twitter discussion on Monday, after the news broke on Jim Kim’s resignation, we refer to the ‘Global Health Governance’ section below.

Predictions 2019

As mentioned in this week’s intro, a bunch of outlets, organizations, observers, … came with their (global health and other) predictions for 2019.

Below we just flag some you might want to read:

FT Health – Predictions for 2019

Andrew Jack; https://www.ft.com/content/4838cff6-101d-11e9-acdc-4d9976f1533b

The big themes for the year ahead: pharmaceutical takeovers; pricing pressure; and the potential for new diseases.” According to Andrew Jack, in the intro of last week’s FT Health newsletter.   He also thought it’d be another tough year for prevention.

WEF10 reasons to be optimistic in 2019  Among others, ‘drones to the rescue’, and also: “5) Protection from pandemics: The outbreak of the Ebola virus in West Africa in 2014-16 demonstrated just how unprepared the world was for a major epidemic outbreak. Launched at our 2017 Annual Meeting, the Coalition for Epidemic Preparedness (CEPI) aimed to address this by funding development of vaccines before diseases erupt. Less than two years old, CEPI is already developing 15-20 vaccines including three – for Lassa Fever, MERS, and Nipah – that have been designated an urgent threat by the World Health Organization. In 2019 we should see more partners join the coalition and vaccines pursued for new diseases that pose a threat to human health, for example Chikungunya – a mosquito-borne virus whose name derives from a term meaning “to become contorted” – and Rift Valley Fever .

Not sure everybody is that optimistic about our protection from pandemics …

NPRWhat’s Coming In 2019? Global Thinkers Make Big, Bold Predictions

“Pundits in global health and development came up with nine bold predictions.” Recommended.

Among others: “Positive social change will be contagious in Africa…. Urban slums will grow…. More countries will follow the U.S. example of pulling out of U.N. funding… There will be more significant infectious disease outbreaks — maybe even a pandemic … but the odds are good we can beat back a bad outbreak.There will be fewer food crises.Wealthy countries will turn away more people seeking asylum. … “

As you can see, not every prediction qualifies for being ‘bold’ 😊.

AxiosGlobal disease risk worsening as anti-vaccination campaigns spread

By Peter Hotez. “…The response to the anti-vaccine lobby by U.S. and European government agencies has been modest, leaving much of the defense of vaccines to academics. This situation will have to change if outbreaks of vaccine-preventable diseases continue or increase. What to watch: The anti-vaccine movement could also move beyond its stronghold areas into Africa, Asia and Latin America. 2018 already saw anti-vaccine activities adversely affect child health vaccination programs in India, Indonesia and Thailand….”

IRIN Ten humanitarian crises and trends to watch in 2019

Recommended. Make sure you check out trend 6 in particular (not a new trend, though).

WBYear in Review: 2018 in 14 Charts

Nice one!  (even if not really predictions for the new year)

MSF Access Our wishlist 2019.

G7 plans for the new year

Euractiv – France to advocate multilateralism to address inequality at G7

https://www.euractiv.com/section/politics/news/france-to-advocate-multilateralism-to-address-inequality-at-g7/

Fighting inequality and global warming will be key objectives of the French G7 Presidency in 2019. The aim of developing closer relations with Africa, in the interests of multilateralism, is also highlighted by France.”

And see also this tweet: “Gender equality will be a central theme of the work of the French #G7 Presidency. An equality label will be created for the G7 Summit and ministerial meetings. #G7equality .”

GHAP & Pure Earth (report) – Pollution knows no borders: how the pollution crisis in low-and middle-income countries affects everyone’s health, and what we can do to address it

https://www.pureearth.org/wp-content/uploads/2019/01/PE_PollutionKnowsNoBordersFinal.pdf

Important and hard hitting new report on the transboundary impacts of toxic pollution.

Results for Development – Health Systems Strengthening Accelerator Concept Note

https://www.r4d.org/resources/hss-accelerator-concept/

Worth checking out. 8 pages. “This is an abridged version of the Health Systems Strengthening Accelerator concept, co-created by USAID, Results for Development, the Nigeria-based Health Strategy and Delivery Foundation (HSDF), ICF and several other partners as part of USAID’s Broad Agency Announcement process. The Accelerator is a global initiative to improve how health systems strengthening is done locally and globally. The Accelerator will connect locally-driven health system innovation with global knowledge, improve the institutional architecture for evidence-based and sustainable health system strengthening (HSS), and accelerate countries’ journeys to self-reliant health systems.”

“…The Accelerator will also explore a potential paradigm-changing approach to health system strengthening—one that questions not just what the levers are for better health system performance today, but what is the institutional “architecture” that countries need to sustain their own ongoing, evidence-based health system strengthening into the future. …”

PS: not quite sure USAID is fully ‘operational’ given the current shutdown in the US…

OECD/DAC  worries

Brookings  (blog) – Don’t undermine the basic architecture of OECD/DAC statistics: A Letter of warning

https://www.brookings.edu/blog/future-development/2018/12/21/dont-undermine-the-basic-architecture-of-oecd-dac-statistics-a-letter-of-warning/

In response to ongoing efforts to rethink ODA measurement and broader development finance, following is a letter from three former OECD/DAC chairs who worry that the basic role of the OECD/DAC in measurement is eroding.”

Ebola DRC outbreak – Ebola response resumes

We’ll have to see what the rather weird and controversial outcome of the elections in DRC will spark, in terms of impact on the Ebola response as well, but for now, this was some of the main news from this week on the Ebola outbreak:

UN News – DR Congo: Ebola response resumes despite ‘risky environment’

https://news.un.org/en/story/2019/01/1030052

“Despite a precarious security environment and continuing pockets of mistrust on the part of affected populations, the World Health Organization (WHO) reported on Tuesday that all Ebola-affected areas in the Democratic Republic of the Congo’s (DRC) North Kivu Province are now accessible to health workers.”

The Ebola outbreak is in reality, several distinct outbreaks in the different affected areas. While the major outbreak in Beni, which was responsible for a large proportion of cases in recent months, is coming under control, the positive trend there is not mirrored elsewhere.”

As for the possible impact of the elections on Ebola, our colleagues from Global Health Now referred on Thursday to a commentator  wondering what will happen if Oly Ilunga is ousted as minister of health.  “ “By the time a new government gets its act together on Ebola, the disease could be all over the DRC and all over East Africa,” Kilian wrote. “

Let’s hope it won’t get to that.

Some other reads from this week:

Huffington Post – Election Chaos Is Making History’s Second-Largest Ebola Outbreak Worse

https://www.huffingtonpost.com/entry/ebola-outbreak-congo-election_us_5c3036a7e4b0bcb4c25bd57d

Interesting read from end of last week, featuring the views of many global health outbreak staff & observers. Among others WHO’s Ryan  ( WHO assistant director-general for emergency preparedness and response), Ron Klain (former Ebola czar Obama administration), J Stephen Morrison, …

The elections were ‘the third wave of destabilization’ in this outbreak response.

Excerpt: “…The global health community may need a new security solution, Klain said. While Ryan argues that the United Nations security force, known as MONUSCO, has been protecting WHO workers and other responders on top of its peacekeeping mission in the area, Klain is pushing for a separate force dedicated solely to protecting public health responders.  “For four years, I have been advocating the creation of a ‘white helmet’ battalion of security forces that could operate globally to protect infectious disease responders. What is going on now in the DRC shows the need for such a force,” Klain said.”

Stat – WHO’s Tedros: Experimental Ebola vaccine in the DRC has saved countless lives

Stat News

Must-read interview with dr Tedros himself.

Lancet Editorial – Was DR Congo’s Ebola virus outbreak used as a political tool?

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30002-9/fulltext

From its very start, the people of DR Congo have perceived the Ebola response as politicised….”

It is therefore a pity that their fears, at least in part, were proven to be justified. On Dec 26, 2018, DR Congo’s Independent National Electoral Commission (CENI) invoked concerns about the Ebola outbreak and terrorism to postpone the elections in three areas in North Kivu (Beni, Beni ville, and Butembo) until March….   That the Ebola outbreak was used to control the electoral power of those likely to oppose Emmanuel Ramazani Shadary (the candidate who incumbent president Joseph Kabila chose as a successor) shows just how important these elections are. The consequences of CENI’s announcement on the Ebola response are immeasurable, not only for its effect on epidemic control but also in terms of trust lost. These elections were celebrated as an important step towards a more democratic process and populous sovereignty. That this was jeopardised by leveraging the very health concerns that the Congolese people need the Government to alleviate is deeply regrettable.”

Lancet World Report – Logistical challenges in the DR Congo Ebola virus response

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30076-5/fulltext

“The ongoing outbreak in the DR Congo has recently surpassed 600 cases. To fight this outbreak, the Ebola response team faces many logistical challenges. Miriam Shuchman reports.”

The Economic Times – New single-dose Ebola drug treatment developed

The Economic Times;

Encouraging research news for future outbreaks: “Scientists have developed an experimental drug that in one dose successfully protected nonhuman primates against a lethal infection of all strains of the deadly Ebola virus. “

For the study, see Cell Host & Microbe.

Other links:

Devex – Orphan numbers rise as Ebola persists in DRC

Cidrap NewsDRC Ebola outbreak total rises to 613 infections

This article also had some info on nosocomial illnesses:

“… The report also had more detailed information about healthcare-acquired infections and illness patterns. It said that, as of Jan 2, 86 nosocomial infections have been reported, mainly in Beni, Butembo, Katwa, and Mabalako. No new illnesses in healthcare workers have been reported, keeping that total at 55, including 18 deaths. Of all cases reported in the outbreak, 22% had a history of exposure to a hospital within 3 weeks of getting sick, the WHO said….”

On Twitter, the debate on whether a PHEIC is warranted still goes on. Check out the twitter accounts of Larry Gostin, Helen Branswell & Laurie Garret, for example.   Not everybody is convinced that declaring a PHEIC would mobilize the international community more than is the case now…

And other interesting tweet (by Ben Philipps) : “Private investors in the @WorldBank‘s pandemic insurance facility haven’t lost a penny to tackle the two Ebola outbreaks in #DRC. They only start to pay if it spreads into a second country.”

Stat – New Ebola-like virus is discovered in China

https://www.statnews.com/2019/01/08/new-ebola-like-virus-is-discovered-in-china/

The notorious filovirus family — which includes such dangerous actors as the Ebola and Marburg viruses — seems to just keep getting bigger. In a new study, scientists from Singapore and China have announced they found a new branch of the family, in bats in China. While there is no evidence the new virus — called Měnglà after the place where it was discovered — has caused outbreaks in people, the virus has traits similar to those that have helped its cousin viruses break into human cells. The study was published in the journal Nature Microbiology on Monday….”

UHC reads

WB – Intertemporal Dynamics of Public Financing for Universal Health Coverage : Accounting for Fiscal Space Across Countries

A Tandon et al; http://documents.worldbank.org/curated/en/639541545281356938/Intertemporal-Dynamics-of-Public-Financing-for-Universal-Health-Coverage-Accounting-for-Fiscal-Space-Across-Countries

Cfr a tweet by Thomas Paalu “Messages for #UHC: public expenditures on #health grew at 5% annual pace in poor countries compared to 3% in rich – some convergence happening. But with great variations! Increased aggregate fiscal space was enabler in poor, re-prioritization in rich countries.”

“…  Although how money is expended is just as critical as the overall resource envelope, we analyze changes in per capita public financing for health in real terms, a proxy for realized fiscal space, within and across 151 countries over time. This allows for an assessment not just of trends in public financing for health but also of contributions from three macro-fiscal drivers — economic growth, changes in aggregate public spending, and reprioritization for health — exploiting a macroeconomic identity that captures the relationship between these factors. Analysis of data from 2000 to 2015 shows per capita public financing for health in low- and middle-income countries increased by 5.0 percent per year on average: up from US$60 (2.2 percent of GDP) in 2000 to US$117 (2.8 percent of gross domestic product [GDP]) in 2015. … …  At 3.1 percent per year, annual growth in public financing for health was lower among high-income countries, albeit from a much higher baseline in 2000. Increases in on-budget external financing comprised most of the changes among low-income countries, whereas domestic government revenues dominated changes in composition of public financing among lower- and upper-middle-income countries. Public financing increased at a faster rate than OOP sources for health in most regions except for South Asia. Although there are important country-specific differences, it is notable that more than half of the increase in public financing for health was due to economic growth alone. For the remainder of the increase, aggregate public spending contributed more than reprioritization across low and lower-middle-income countries, whereas the reverse was true in high-income countries. … … Although country context matters, the importance of economic growth for public financing for health underscores the critical need to situate, integrate, leverage, and proactively manage health financing reforms within a country’s overall macro-fiscal context and to assess different pillars of fiscal space holistically.”

Health Affairs – It’s Still The Prices, Stupid: Why The US Spends So Much On Health Care, And A Tribute To Uwe Reinhardt

G Morrison et al; Health Affairs;

A 2003 article titled “It’s the Prices, Stupid,” and coauthored by the three of us and the recently deceased Uwe Reinhardt found that the sizable differences in health spending between the US and other countries were explained mainly by health care prices. As a tribute to him, we used Organization for Economic Cooperation and Development (OECD) Health Statistics to update these analyses and review critiques of the original article. The conclusion that prices are the primary reason why the US spends more on health care than any other country remains valid, despite health policy reforms and health systems restructuring that have occurred in the US and other industrialized countries since the 2003 article’s publication. On key measures of health care resources per capita (hospital beds, physicians, and nurses), the US still provides significantly fewer resources compared to the OECD median country. Since the US is not consuming greater resources than other countries, the most logical factor is the higher prices paid in the US. Because the differential between what the public and private sectors pay for medical services has grown significantly in the past fifteen years, US policy makers should focus on prices in the private sector.”

For coverage, see for example Global Health News Wire

Lancet Public Health (Editorial) – Universal Health Coverage: realistic and achievable?

https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30268-8/fulltext

This editorial puts in perspective a study (and some related Comments) that appeared online already in December 2018.

Excerpts:

In this issue of The Lancet Public Health, Mark Moses and colleagues estimate the cost of achieving UHC in all countries. … … Such national data and country comparisons are important for informing political leaders and policy makers on progress and gaps, but they do not capture the full picture. For Simon Wieser and Klaus Eichler, writing in an accompanying Comment, the quality of health-care services is likely to differ between countries, and inefficiencies in current health-care systems need to be considered when calculating UHC costs. Financing is an essential, and often forgotten, component of UHC. But progress toward UHC also requires coordinated actions across the different pillars of a health system— the health workforce in particular, but also health service delivery platforms and governance … … It is becoming clear that countries need a customised path towards UHC. There is no off-the-shelf model to implement. …”

The Editorial concludes: “ … Dr Tedros, WHO’s Director-General, is reforming WHO to make it a more effective political instrument to deliver UHC. As a regular attendee at G20 meetings and a former foreign minister in Ethiopia, his political influence could well exceed that of any current global health leader. As 2019 beckons, we should be optimistic that UHC is not merely an idealistic hope. It is, instead, a perfectly realistic and achievable objective.”

Lancet Editorial – 2019 in the USA: shutdowns and showdowns

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30001-7/fulltext

“If the events of the end of 2018 and early days of 2019 in Washington, DC, portend anything, it will be yet another contentious year ahead in the USA at the intersection of politics, governance, and health. The engine of much of the conflict is the acrimony resulting from years of partisan political entrenchment….  … The shutdown affects approximately 800 000 federal employees from nine Cabinet departments whose funding has lapsed, including the Environmental Protection Agency, Department of Agriculture, and the Food and Drug Administration (FDA). The shutdown speaks to the complexity and distributed nature of the American political system that impinges on health. …

…The conditions under which that reopening is achieved will have tremendous implications for the coming year. With Pelosi at the helm leading an assertive congressional cohort who are comfortable disagreeing with the president, there could be more action specifically around lowering drug prices, which continued to rise in 2018, and increasing health coverage…. … with the past few years of a Republican stronghold on congress and the plausible legislative threats to the ACA removed, a distinct opportunity now exists to revisit all the possibilities for expanding and achieving universal health coverage in the USA, from Medicare for All to a public option. It will take a showdown, but the show must—and will—go on.”

Migration & trafficking

UN News – Rising human trafficking takes on ‘horrific dimensions’: almost a third of victims are children

https://news.un.org/en/story/2019/01/1029912

A new UN report published on Monday shows that human trafficking is on the rise and taking on “horrific dimensions”, with sexual exploitation of victims the main driver. Children now account for 30 per cent of those being trafficked, and far more girls are detected than boys. The study from the United Nations Office on Drugs and Crime (UNODC, draws on information from 142 countries, examining trafficking trends and patterns….”

See also Thomson Reuters –   Human trafficking worsens in conflict zones as militants deploy slaves – UN

In other (migration) news, I’m sure you saw (parts of) Trump’s address to the US (see BBC News – Trump wall: President addresses nation on border ‘crisis’ ); the man is now clearly in ‘bunker-modus’ (on his wall). In the EU, the news wasn’t much better, cfr a new Oxfam report on Lesbos. See the Guardian – Oxfam condemns EU over ‘inhumane’ Lesbos refugee camp  “The EU has been strongly criticised over conditions in Greece’s largest refugee camp, where Oxfam reported women are wearing nappies at night for fear of leaving their tents to go to the toilet.”

Leaders of “developed” countries are letting down migrants, in the US, as much as in the EU, or Australia…

Lancet Gastroenterology & Hepatology – Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission

https://www.thelancet.com/journals/langas/article/PIIS2468-1253(18)30270-X/fulltext

“Viral hepatitis is a major public health threat and a leading cause of death worldwide. Annual mortality from viral hepatitis is similar to that of other major infectious diseases such as HIV and tuberculosis. Highly effective prevention measures and treatments have made the global elimination of viral hepatitis a realistic goal, endorsed by all WHO member states. Ambitious targets call for a global reduction in hepatitis-related mortality of 65% and a 90% reduction in new infections by 2030. This Commission draws together a wide range of expertise to appraise the current global situation and to identify priorities globally, regionally, and nationally needed to accelerate progress. We identify 20 heavily burdened countries that account for over 75% of the global burden of viral hepatitis. Key recommendations include a greater focus on national progress towards elimination with support given, if necessary, through innovative financing measures to ensure elimination programmes are fully funded by 2020. In addition to further measures to improve access to vaccination and treatment, greater attention needs to be paid to access to affordable, high-quality diagnostics if testing is to reach the levels needed to achieve elimination goals. Simplified, decentralised models of care removing requirements for specialised prescribing will be required to reach those in need, together with sustained efforts to tackle stigma and discrimination. We identify key examples of the progress that has already been made in many countries throughout the world, demonstrating that sustained and coordinated efforts can be successful in achieving the WHO elimination goals.”

For the related Comment, see   Elimination of viral hepatitis by 2030: ambitious, but achievable

The Commission shares experiences  – both positive and negative – from which lessons can be learned as we accelerate efforts to eliminate viral hepatitis by 2030. Although ambitious, this target is achievable, but only with coordinated efforts from all stakeholders. “

NCDs

NYT – Research Details How Junk Food Companies Influence China’s Nutrition Policy

https://www.nytimes.com/2019/01/09/health/obesity-china-coke.html

“… China’s fitness-is-best message, as it happens, has largely been the handiwork of Coca-Cola and other Western food and beverage giants, according to a pair of new studies that document how those companies have helped shape decades of Chinese science and public policy on obesity and diet-related illnesses like Type 2 diabetes and hypertension.

The findings, published Wednesday in The BMJ and The Journal of Public Health Policy, show how Coca-Cola and other multinational food companies, operating through a group called the International Life Sciences Institute, cultivated key Chinese officials in an effort to stave off the growing movement for food regulation and soda taxes that has been sweeping the west. The group, known as ILSI, is a worldwide organization with a Washington headquarters, funded by many of the biggest names in snack foods, including Nestlé, McDonald’s, Pepsi Co. and Yum! Brands as well as Coca-Cola. It has 17 branches, most of them in emerging economies like Mexico, India, South Africa and Brazil, and promotes itself as a bridge between scientists, government officials and multinational food companies. But in China, ILSI is so well-placed that it runs its operations from inside the government’s Centre for Disease Control and Prevention in Beijing….”

Read the BMJ FeatureMaking China safe for Coke: how Coca-Cola shaped obesity science and policy in China

Susan Greenhalgh investigates how, faced with shrinking Western markets, the soft drink giant sought to secure sales and build its image in China.”

Do check out also the related BMJ Editorial (by M McKee et al)  The hidden power of corporations

Excerpts from the latter:

“…The growing literature on what are termed “the commercial determinants of health” pays particular attention to the hidden and invisible forms of power, whereby large corporations use various methods to shape thinking about what are appropriate responses to the health consequences of their products. In the accompanying article, Susan Greenhalgh describes how the Coca-Cola Company came to dominate obesity policy in China even though its influence was obscured behind the public face of intermediaries …”

“…In the late 1970s, Coca-Cola took advantage of the opening of Chinese society to the international community, exploiting the then extremely limited opportunities for Chinese researchers to access funds to undertake studies or to develop links with Western counterparts. It was not, however, Coca-Cola that made the approaches to Chinese researchers. Instead it was an organisation called the International Life Sciences Institute—a name that combined ideas of health, academia, and international links while also forming a memorable acronym, ILSI. Yet ILSI was established by a Coca-Cola executive with substantial funding from the company….

“…. We now know that corporations make extensive use of third parties such as ILSI to create a dominant narrative that frames how issues are viewed and sets the boundaries within which responses are seen as “reasonable,” while excluding the most effective measures—especially those that harm the interests of the corporations—from the agenda…”

High intake of dietary fiber and whole grains associated with reduced risk of non-communicable diseases

 

Lancet – Carbohydrate quality and human health: a series of systematic reviews and meta-analyses

A Reynolds et al. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31809-9/fulltext

Coverage in  Science News – “Observational studies and clinical trials conducted over nearly 40 years reveal the health benefits of eating at least 25g to 29g or more of dietary fiber a day, according to a series of systematic reviews and meta-analyses.”

And some info from the Lancet Press Release:

« People who eat higher levels of dietary fibre and whole grains have lower rates of non-communicable diseases compared with people who eat lesser amounts, while links for low glycaemic load and low glycaemic index diets are less clear.

The study was commissioned by the World Health Organization to inform the development of new recommendations for optimal daily fibre intake and to determine which types of carbohydrate provide the best protection against non-communicable diseases (NCDs) and weight gain….”

Some key papers of the week

American Journal of Tropical Medicine and Hygiene – Strengthening Mentoring in Low- and Middle-Income Countries to Advance Global Health Research: An Overview

A Lescano et al; http://www.ajtmh.org/content/journals/10.4269/ajtmh.18-0556?TRACK=RSS

Mentoring is a proven path to scientific progress, but it is not a common practice in low- and middle-income countries (LMICs). Existing mentoring approaches and guidelines are geared toward high-income country settings, without considering in detail the differences in resources, culture, and structure of research systems of LMICs. To address this gap, we conducted five Mentoring-the-Mentor workshops in Africa, South America, and Asia, which aimed at strengthening the capacity for evidence-based, LMIC-specific institutional mentoring programs globally. The outcomes of the workshops and two follow-up working meetings are presented in this special edition of the American Journal of Tropical Medicine and Hygiene. Seven articles offer recommendations on how to tailor mentoring to the context and culture of LMICs, and provide guidance on how to implement mentoring programs. This introductory article provides both a prelude and executive summary to the seven articles, describing the motivation, cultural context and relevant background, and presenting key findings, conclusions, and recommendations.”

Climate change, migration and health systems resilience: Need for interdisciplinary research [version 1; referees: awaiting peer review]

V Ridde et al; https://f1000research.com/articles/8-22/v1

Climate change is one of today’s major challenges, among the causes of population movements and international migration. Climate migrants impact health systems and how they respond and adapt to their needs and patterns. But to date, the resilience of health systems in the context of climate change has been little explored. The purpose of this article is to show the importance of studying, from an interdisciplinary perspective, the relationships between climate change, migration, and the resilience of health systems….” “…While universal health coverage is a major international goal, little research has to date focused on the existing links between climate, migration, health systems and resilience. We propose an interdisciplinary approach relying on the concept of health system resilience to study adaptive and transformative strategies to articulate climate change, migration and health systems.”

Antibiotics; Something Borrowed, Something New: A Governance and Social Construction Framework to Investigate Power Relations and Responses of Diverse Stakeholders to Policies Addressing Antimicrobial Resistance

H Legido-Quigley, J Hanefeld et al; https://www.mdpi.com/2079-6382/8/1/3

We quite enjoyed this short article.

While antimicrobial resistance (AMR) has rapidly ascended the political agenda in numerous high-income countries, developing effective and sustainable policy responses in low- and middle-income countries (LMIC) is far from straightforward, as AMR could be described as a classic ‘wicked problem’. Effective policy responses to combat AMR in LMIC will require a deeper knowledge of the policy process and its actors at all levels—global, regional and national—and their motivations for supporting or opposing policies to combat AMR. The influence of personal interests and connections between for-profit organisations—such as pharmaceutical companies and food producers—and policy actors in these settings is complex and very rarely addressed. In this paper, the authors describe the role of policy analysis focusing on social constructions, governance and power relations in soliciting a better understanding of support and opposition by key stakeholders for alternative AMR mitigation policies. Owing to the lack of conceptual frameworks on the policy process addressing AMR, we propose an approach to researching policy processes relating to AMR currently tested through our empirical programme of research in Cambodia, Pakistan, Indonesia and Tanzania. This new conceptualisation is based on theories of governance and a social construction framework and describes how the framework is being operationalised in several settings.”

Human Resources for Health – How are gender inequalities facing India’s one million ASHAs being addressed? Policy origins and adaptations for the world’s largest all-female community health worker programme

R Ved, K Scott, A George et al; https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-018-0338-0

India’s accredited social health activist (ASHA) programme consists of almost one million female community health workers (CHWs). Launched in 2005, there is now an ASHA in almost every village and across many urban centres who support health system linkages and provide basic health education and care. This paper examines how the programme is seeking to address gender inequalities facing ASHAs, from the programme’s policy origins to recent adaptations….”

Helion – Mapping stakeholders and policies in response to deliberate biological events

R Katz et al; https://www.sciencedirect.com/science/article/pii/S240584401832351X

Recent infectious disease outbreaks have brought increased attention to the need to strengthen global capacity to prevent, detect, and respond to natural biological threats. However, deliberate biological events also represent a significant global threat, but have received relatively little attention. While the Biological Weapons Convention provides a foundation for the response to deliberate biological events, the political mechanisms to respond to and recover from such an event are poorly defined. We performed an analysis of the epidemiological timeline, the international policies triggered as a notional deliberate biological event unfolds, and the corresponding stakeholders and mandates assigned by each policy. The results of this analysis identify a significant gap in both policy and stakeholder mandates: there is no single policy nor stakeholder mandate for leading and coordinating response activities associated with a deliberate biological event….”

HP&P – Review of international efforts to strengthen the global outbreak response system since the 2014–16 West Africa Ebola Epidemic

S J Ravi et al; https://academic.oup.com/heapol/advance-article-abstract/doi/10.1093/heapol/czy102/5280810?redirectedFrom=fulltext

Must-read review article.

The 2014–16 West Africa Ebola epidemic was a watershed moment for global health. The outbreak galvanized global action around strengthening infectious disease prevention, detection and response capabilities. We examined the nascent landscape of international programmes, initiatives and institutions established in the aftermath of the 2014–16 Ebola outbreak with the aim of assessing their progress to date to illustrate the current state of the world’s global health security architecture. We also compare these efforts with shortcomings in epidemic management documented during the epidemic, and underscore remaining gaps in regional and global epidemic response capabilities that might benefit from additional programmatic and financial support. Notably, most of the post-Ebola initiatives considered in this analysis have yet to meet their financial goals. Operational progress has also been limited, revealing a need for continued investments to improve outbreak surveillance and detection capabilities specifically. Furthermore, our review highlighted the dominance of the USA and Europe in leading and financing efforts to coordinate long-term recovery efforts in West Africa, strengthen health systems across the continent, and enhance global preparedness for future epidemics, raising important questions about ownership of global health security efforts in non-Western regions of the world. Finally, the lack of transparency and available data on these initiatives’ activities and budgets also complicate efforts to project their impacts on the global health security landscape.”

WHO Bulletin – The palm oil industry and noncommunicable diseases

S Kadandale et al; https://www.who.int/bulletin/online_first/18-220434.pdf?ua=1

Large-scale industries do not operate in isolation, but have tangible impacts on human and planetary health. An often overlooked actor in the fight against noncommunicable diseases is the palm oil industry. The dominance of palm oil in the food processing industry makes it the world’s most widely produced vegetable oil. We applied the commercial determinants of health framework to analyse the palm oil industry. We highlight the industry’s mutually profitable relationship with the processed food industry and its impact on human and planetary health, including detrimental cultivation practices that are linked to respiratory illnesses, deforestation, loss of biodiversity and pollution. This analysis illustrates many parallels to the contested nature of practices adopted by the alcohol and tobacco industries. The article concludes with suggested actions for researchers, policy-makers and the global health community to address and mitigate the negative impacts of the palm oil industry on human and planetary health.”

For coverage, see Reuters – WHO study likens palm oil lobbying to tobacco and alcohol industries

The study was co-authored by researchers at the U.N. children’s fund UNICEF, the London School of Hygiene and Tropical Medicine and Britain’s University of Exeter.

Policy Brief – Bottom-up Accountability of Health Care Providers in Uganda

https://www.poverty-action.org/sites/default/files/publications/Bottom-Up-Accountability-Health-Care.pdf

From October 2018. “In Uganda, researchers conducted a large-scale randomized evaluation of a program called Accountability Can Transform (ACT) Health. The program provided community members and health care workers information about the quality of their local health services and brought them together to create action plans for how to improve local health service accountability, delivery, and quality. The study built on previous research of a similar program called Power to the People, which was found to greatly improve child health.

As for the findings, cfr a tweet by M Kruk: “1/2 RIP Björkman and Svensson’s Power to the People? Large, carefully done experiment on community accountability to improve clinic/provider performance in Uganda finds no effects on child mortality.”

HP&P – Policy change and micro-politics in global health aid: HIV in South Africa

M Kavanagh et al; https://academic.oup.com/heapol/advance-article-abstract/doi/10.1093/heapol/czy103/5281233?redirectedFrom=fulltext

Efforts to improve the effectiveness of global health aid rarely take full account of the micro-politics of policy change and implementation. South Africa’s HIV/AIDS epidemic is a case in point, where the US President’s Emergency Plan for AIDS Relief (PEPFAR) has provided essential support to the national AIDS response. With changing political context, PEPFAR has shifted focus several times—most recently reversing the policy of ‘transition’ out of direct aid to a policy of re-investing in front-line services in priority districts to improve aid effectiveness. However, this policy shift has not led to the expected impact on health services. This paper reports the findings of a study on the implementation of the recent policy through interviews at randomly selected sites in high HIV-burden districts of South Africa that capture the experiences of public-sector health leaders….”

Some key blogs of the week

Jason Hickel – Degrowth: A Call for Radical Abundance

https://www.filmsforaction.org/articles/degrowth-a-call-for-radical-abundance/#.XDXl2gYtYyQ.twitter

Puzzling title, you might say. Excerpts:

“… the birth of capitalism required the creation of scarcity.  The constant creation of scarcity is the engine of the juggernaut. … … Scarcity is the engine of capitalist expansion. And, crucially, the scarcity was artificially created.  Created by elite accumulation, backed up by state violence. …”

“… Today, we feel the force of scarcity in the constant threat of unemployment.  We must be ever-more productive at work or else lose our jobs to someone who will be more productive than we are.  But there is a paradox: as productivity rises, less labor is needed.  … Scarcity creates recruits to the ideology of growth. …

… It’s strange, isn’t it?  The ideology of capitalism is that it is a system that generates immense abundance (so much stuff!)  But in reality it is a system that relies on the constant production of scarcity. This conundrum was first noticed back in 1804, and became known as the Lauderdale Paradox.  Lauderdale pointed out that the only way to increase “private riches” (basically, GDP) was to reduce what he called “public wealth”, or the commons. …”

“… It doesn’t have to be this way.  We can call a halt to the madness – throw a wrench in the juggernaut.  By de-enclosing social goods and restoring the commons, we can ensure that people are able to access the things that they need to live a good life without having to generate piles of income in order to do so, and without feeding the never-ending growth machine.  “Private riches” may shrink, as Lauderdale pointed out, but public wealth will increase. … In this sense, degrowth is the very opposite of austerity.  While austerity calls for scarcity in order to generate growth, degrowth calls for abundance in order to render growth unnecessary. … Degrowth, at its core, is a demand for radical abundance.”

From Povery to Power blog – Why we finally need to face up to information fatigue in 2019 (and 3 ways to do it)

https://oxfamblogs.org/fp2p/why-we-finally-need-to-face-up-to-information-fatigue-in-2019-and-3-ways-to-do-it/

Guest post by Caroline Cassidy, a freelance communications specialist and associate for ODI and On Think Tanks.” Recommended.  Her analysis of the information fatigue we all feel is spot on. As for how to face up to it, in her opinion, I’m less convinced.

From Poverty to Power (blog) Who Are the World’s Poor? New overview from CGD

https://oxfamblogs.org/fp2p/who-are-the-worlds-poor-new-overview-from-cgd/

“Guest post from Gisela Robles and Andy Sumner.”

“…In a new  CGD working paper, Gisela Robles and I take a closer look at the data on global poverty to answer this question in finer detail. We find that when poverty is measured over multiple dimensions—including education, health, and standards of living—identifying the global poor reveals some important findings….”. They list three key findings: The world’s poor are young, often children but not necessarily farmers; Rural poverty is more about infrastructure. Urban poverty is more about child mortality and food; Just how multidimensional poverty is depends on where you live.

And this: “…What is surprising is that deprivations in health indicators overlap least frequently with other dimensions of poverty. This points towards the importance of giving health poverty direct attention in policy….”

WEF (blog) Globalization 4.0 must provide for the poorest, or it risks causing chaos for everyone

G Pantuliano (ODI); https://www.weforum.org/agenda/2019/01/globalization-4-0-must-provide-poorest-risk-chaos-everyone

Smarter than Klaus Schwab’s “Davos manifesto”.  Much smarter.

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