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IHP news #500 (December 7, 2018)

Highlights of the week

Guardian Op-ed – A Bloomberg 2020 run would help the left – by failing spectacularly

Z Aleem; https://www.theguardian.com/commentisfree/2018/dec/02/michael-bloomberg-2020-progressives

Sometimes it’s interesting to see what doesn’t get tweeted (or retweeted) by the global health community.  This Op-Ed for example.

End-of-the-year press briefing dr. Tedros

IP-Watch – WHO Director Tedros Gives Thoughts On Access To Medicines, Gene Editing, Ebola


(gated) “World Health Organization Director General Tedros Adhanom Ghebreyesus (Dr Tedros) met with United Nations journalists [today], in what he said would become a regular end-of-the-year meeting with the press. He gave an update on the ongoing Ebola outbreak and his views on the recent human gene editing by a Chinese researcher, and on the use of gene drive organisms to fight malaria. He also provided his views on access to affordable and safe medicines.”

See also:

The World Health Organization is creating a panel to study the implications of gene editing after a Chinese scientist controversially claimed to have created the world’s first genetically edited babies. “It cannot just be done without clear guidelines,” Tedros Adhanom Ghebreyesus, the head of the UN health agency, said in Geneva. The organisation was gathering experts to discuss rules and guidelines on “ethical and social safety issues”, added Tedros, a former Ethiopian health minister….”

See also Reuters WHO looks at standards in ‘uncharted water’ of gene editing.

The head of the World Health Organization said Monday it can fight the deadly Ebola outbreak in Congo despite the withdrawal of the U.S. Centers for Disease Control and Prevention, insisting: “We can cover it.”

The comments by WHO Director-General Tedros Adhanom Ghebreyesus came in the wake of commentaries in two medical journals appealing to the CDC to return to the epidemic zone in Congo — saying its expertise is needed. The U.S. experts have been sidelined for weeks, ordered away from the region because of State Department security concerns. Tedros said the U.N. health agency mostly needs the United States to continue the financial and other support it has provided. …”

UCL-Lancet Commission on Migration and Health (& Comments, other research articles & reviews, …)

The Lancet;

“With one billion people on the move or having moved in 2018, migration is a global reality. International migration has increased to 258 million, and the numbers of refugees and people displaced by conflict, natural disasters, and climate change are at their highest levels: 22 and 40 million, respectively. Despite negative political narratives, migration is not overwhelming high-income countries—instead, it takes place mostly between low-income and middle-income countries and most people are migrating for work. By and large, migration is a positive and diverse experience. But migration has also become a political lightning rod.  The UCL–Lancet Commission on Migration and Health steps into this political debate to provide evidence for cooperation and action on what is one of the most pressing issues of the 21st century. The Commission’s foundation is that migration and health are inextricably linked—and key to sustainable development. It provides a framework of migration as a dynamic process, providing evidence of the multiple factors that could be beneficial or detrimental to individuals and systems along the migration journey—at origin, transit, destination, and return. It documents the devastating impacts of forced migration, especially on girls and women, but also the overall benefits to the health of individuals and populations that migration generates. It lays out a research agenda to better ensure the health of migrants. Using the lens of health the Commission shows that migration policies can be both ethical and feasible—calling for governments, international agencies, and professionals to promote health in global mobility.”

Put differently, thisUCL–Lancet Commission provides new data and analyses to dispel some of the pervasive and harmful myths surrounding migration and migrants. The Commission calls for governments, international agencies, and professionals to promote health in global mobility.”


“Report says migrants more likely to contribute than to damage health of host nations”.

  • Or see some key messages from the press release:

“The Lancet: Harmful, unfounded myths about migration and health have become accepted, used to justify policies of exclusion

Stereotypes that migrants are disease carriers who present a risk to public health and are a burden on services are some of the most prevalent and harmful myths about migration. 

Evidence from a comprehensive new report, including new international data analysis, shows these myths to be unfounded, yet they continue to be used to deny migrants entry, restrict access to healthcare, or detain people unlawfully.

Migration benefits national and global economies, and more must be done to counter racism, improve migrants’ access to services, and uphold the rights of migrants.”


See also a tweet from Commissioner Kabir Sheikh: “”Health systems are viewed in terms of geopolitical jurisdiction rather than as the societal response to people’s needs regardless of their official status”.  This needs to change, we argue in the Lancet @MIGHCommission report out today #healthsystemsbeyondborders”

ILO Global Estimates on International Migrant Workers – Results and Methodology


Another migration-linked report, no doubt also with a view on the Marrakesh meeting next week.

This report maps the current state of labour migration and the key characteristics of migrant workers in the world today.”

For coverage of this report, see UN NewsMillions more migrant workers, means countries lose ‘most productive part’ of workforce

A new study launched on Wednesday by the International Labour Organization (ILO) reveals that the number of migrant workers has jumped by millions, leaving some countries without “the most productive part of their workforce.” According to the second edition of ILO’s Global Estimates on International Migrant Workers, approximately 164 million people left home in search of work between 2013 and 2017 – a nine per cent increase since 2013, when that number stood at 150 million….”

“…Nearly 87 per cent of migrant workers are between the ages of 25 and 64, suggesting that some countries of origin are losing the most productive segment of their workforce, which could negatively impact their economic growth….”


COP 24 in Katowice, Poland   (2-14 December)


COP24 stands for ‘The 24th Conference of the Parties to the United Nations Framework Convention on Climate Change’.

From a planetary health perspective, COP 24 in Katowice, Poland is, ahum, “rather important”. It’s in fact considered the most important COP since the one on the Paris agreement.

Below you find some reads and analyses, ahead of the meeting, some coverage on the first few days, and also some info on a WHO report on climate change & health, launched earlier this week.

But first, setting the scene with a few more worrying reports on the deadly spiral the world is involved in, under the current economic system:

Guardian – ‘Brutal news’: global carbon emissions jump to all-time high in 2018


Global carbon emissions will jump to a record high in 2018, according to a report, dashing hopes a plateau of recent years would be maintained. It means emissions are heading in the opposite direction to the deep cuts urgently needed, say scientists, to fight climate change.”

“The rise is due to the growing number of cars on the roads and a renaissance of coal use and means the world remains on the track to catastrophic global warming. However, the report’s authors said the emissions trend can still be turned around by 2020, if cuts are made in transport, industry and farming emissions. … … The research by the Global Carbon Project was launched at the UN climate summit in Katowice… …. The report estimates CO2 emissions will rise by 2.7% in 2018, sharply up on the plateau from 2014-16 and 1.6% rise in 2017.”

Nature – Global warming will happen faster than we think


Three trends will combine to hasten it, warn Yangyang Xu, Veerabhadran Ramanathan and David G. Victor.”

“….the latest IPCC special report underplays another alarming fact: global warming is accelerating. Three trends — rising emissions, declining air pollution and natural climate cycles — will combine over the next 20 years to make climate change faster and more furious than anticipated. In our view, there’s a good chance that we could breach the 1.5 °C level by 2030, not by 2040 as projected in the special report (see ‘Accelerated warming’). The climate-modelling community has not grappled enough with the rapid changes that policymakers care most about, preferring to focus on longer-term trends and equilibria….”

Guardian – Beef-eating ‘must fall drastically’ as world population grows


Current food habits will lead to destruction of all forests and catastrophic climate change by 2050, report finds.”

“People in rich nations will have to make big cuts to the amount of beef and lamb they eat if the world is to be able to feed 10 billion people, according to a new report. These cuts and a series of other measures are also needed to prevent catastrophic climate change, it says. More than 50% more food will be needed by 2050, according to the World Resources Institute (WRI) report, but greenhouse gas emissions from agriculture will have to fall by two-thirds at the same time. The extra food will have to be produced without creating new farmland, it says, otherwise the world’s remaining forests face destruction. Meat and dairy production use 83% of farmland and produce 60% of agriculture’s emissions….”

Some analyses ahead of COP 24


To get an idea of some of the main issues, the global backdrop and conflict lines in Katowice, we recommend:

Devex –  4 things to watch at COP24  ( i.e.: Can climate leaders hold the line? Will coal companies get a foot in, or be shown the door? Is climate financing accounting a hero or a villain? Can the world start to close the ambition gap?)

Guardian‘We are the last generation that can stop climate change’ – UN summit

The UN climate change summit [begins on Monday] with a warning that today’s generation is the last that can prevent catastrophic global warming, as well as the first to be suffering its impacts. Almost 200 nations were set to meet in Poland for two weeks, aiming to hammer out a vital agreement to turn the carbon-cutting vision set in Paris in 2015 into reality. Moves to rapidly ramp up action would be another key goal, with current pledges leaving the world on track for a disastrous 3C of warming.  The negotiations will take place against a background of ominous news: the past four years have been the hottest on record and global emissions were rising again, when they need to fall by half by 2030. Climate action must be increased fivefold to limit warming to the 1.5C scientists advise, according to the UN. The political backdrop contains challenges as well, with climate change denial from the US president, Donald Trump, and attacks on the UN process from Brazil’s incoming Bolsonaro administration….”

FT –  Climate change: populism vs Paris

Also a really neat analysis. Excerpts:

The rise of populist leaders threatens the climate deal struck in the French capital in 2015 and will make UN talks more fraught.”

“… as this year’s UN climate talks kick off on Monday in Poland, Mr Trump and other populist leaders like him have become the single biggest threat to the climate pact. The rise of populism from Europe to Latin America and Asia has made the pact, built on a set of ideals that now appear in short supply, look fragile. And the US proposal to withdraw from the agreement has emboldened others to be more critical. “It takes a globalist response to deal with climate change, and if you are a nationalist, then you believe that was not what you were put on this earth to support,” 

… “The next 20 years is arguably more important than any in history,” Lord Stern explains, because humans will shape the future of the planet in ways that may be irreversible. Michal Kurtyka, the president of the Katowice summit, says delegates are gathering against a much more subdued backdrop. “The appetite for multilateral solutions is not as it was in 2015,” he says. “The general mood is different.” … … The mission of this year’s talks will be “all the more complicated” by the new political situation, says Christiana Figueres, the former head of the UN climate secretariat and a key architect of the Paris deal. The rule book will determine how countries’ greenhouse gas emissions are reported, monitored and verified by the UN body. … …
China, which has assumed more of a leadership role at the climate talks — seizing the opportunity offered by the US stepping back — wants much more flexibility for developing countries, a difficult position for many western nations to accept.

…. Alden Meyer, policy director at the Union of Concerned Scientists, points out that all countries will find the Paris temperature targets difficult to meet.  “This is a political challenge to any form of government, the rate of change, the transformation, the exponential nature of what we need to do to,” says Mr Meyer. “It is not just the authoritarian governments coming in, although they are clearly part of the problem.” Looking beyond Katowice, he says the real challenge isn’t if nations pull out, but rather if they ignore the pact. “What is more corrosive is if . . . leaders don’t seem to have any intention of using domestic policy to meet their Paris commitments.”

And a quote from Michael “global health & planetary health champion” Bloomberg: “…In the end capitalism is working. We do what is in our interest, and stopping climate change and improving the environment today are both things that are in the public and corporate interest.”… ”  Yeah, right.

On the latter, see the GuardianPortrait of a planet on the verge of climate catastrophe  “As the UN sits down for its annual climate conference this week, many experts believe we have passed the point of no return.”

Coverage of first few days in Katowice


UN News – Four things the UN chief wants world leaders to know, at key COP24 climate conference opening


During the UN COP24 Climate Change Conference grand opening on Monday, Secretary-General António Guterres told over 150 world leaders gathered for climate action that “we are in deep trouble” and asked decision-makers to focus on four key things: stepping up climate action, according to a solid plan, with more funding, as a smart investment in the future of the planet.”

Other news snippets from the Grand opening & High-Level segment:

World Bank Group Announces $200 billion over Five Years for Climate Action  (i.e. a doubling of the current 5-year plan).

Sir David Attenborough Launches UN Campaign to Promote Climate Action by the People

The renowned broadcaster Sir David Attenborough has  announced the United Nations’ launch of a new campaign enabling individuals the world over to unite in actions to battle climate change….”  He also emphasized collapse of civilisation is on the horizon (Guardian).   “…The naturalist was chosen to represent the world’s people in addressing delegates of almost 200 nations who are in Katowice ….”

WHO report: COP-24 Special Report: health and climate change


WHO (Press release) – Health benefits far outweigh the costs of meeting climate change goals

Meeting the goals of the Paris Agreement could save about a million lives a year worldwide by 2050 through reductions in air pollution alone. The latest estimates from leading experts also indicate that the value of health gains from climate action would be approximately double the cost of mitigation policies at global level, and the benefit-to-cost ratio is even higher in countries such as China and India. …” “A WHO report launched … …  at the United Nations Climate Change Conference (COP24) in Katowice, Poland highlights why health considerations are critical to the advancement of climate action and outlines key recommendations for policy makers.”

“…Exposure to air pollution causes 7 million deaths worldwide every year and costs an estimated US$ 5.11 trillion in welfare losses globally. In the 15 countries that emit the most greenhouse gas emissions, the health impacts of air pollution are estimated to cost more than 4% of their GDP. Actions to meet the Paris goals would cost around 1% of global GDP….”

You find the report here.

Coverage also in HPW Curbing Climate Change Would Save Over 1 million Lives A Year From Air Pollution Alone


A few other reads & links related to COP24


VoxThe “Trump effect” threatens the future of the Paris climate agreement

Analysis linked to a newly published paper, which tries to assess Trump’s damage (so far) on the Paris process: “The Paris Climate Agreement Vs. The Trump Effect,” by Joseph Curtin.

Guardian –  How to make a carbon tax popular? Give the proceeds to the people

A groundbreaking Canadian scheme that rewards green living holds lessons for world leaders wrangling over carbon emissions at the UN summit in Poland.”

The way forward.

G20 summit in Buenos Aires & global health (on the margins)

Below we’ll first provide some reads related to the G20 summit in Buenos Aires from a global health perspective, and then some of the wider implications of this (underwhelming) summit (of which I personally will mainly remember the already notorious ‘High Five’ between Putin & MSB).

G20 leaders declaration


The global health related paragraph, you find below, in full:

15. We encourage the activities of World Health Organization (WHO), together with all relevant actors, to develop an action plan for implementation of health-related aspects of SDGs by 2030. We commend the progress made by the international community in developing and implementing National and Regional Action Plans on Anti-Microbial Resistance (AMR) based on One-Health approach. We recognize the need for further multi-sectoral action to reduce the spread of AMR, as it is increasingly becoming a global responsibility. We note the work done by the Global AMR R&D Hub and, drawing on this, we look forward to further examine practical market incentives. We will tackle malnutrition, with a special focus on childhood overweight and obesity, through national, community-based and collaborative multi-stakeholder approaches. We reaffirm the need for stronger health systems providing cost effective and evidence-based intervention to achieve better access to health care and to improve its quality and affordability to move towards Universal Health Coverage (UHC), in line with their national contexts and priorities. This may encompass, where appropriate, scientifically proven traditional and complementary medicine, assuring the safety, quality and effectiveness of health services. We will continue to strengthen core capacities required by International Health Regulations (IHR, 2005) for prevention, detection and response to public health emergencies, while recognizing the critical role played by WHO in this regard. We are committed to ending HIV/AIDS, tuberculosis and malaria, and look forward to a successful 6° replenishment of the Global Fund in 2019.”

As somebody put it on Twitter, “in terms of words, better than expected, but no (financial) commitments” (whatsoever).

PS: the G20 also launched an Initiative for Early Childhood Development.

For a very good overall analysis of this declaration, see IISDG20 Declaration Focuses on Fair, Sustainable Development.

HPW – Health On The Margins As G20 Leaders Meet


Analysis published at the start of the G20 Summit (and worth a read).

As world leaders attending this year’s Group of 20 (G20) Summit face off on thorny issues of trade, migration and climate change – health was likely to remain on the margins of the maelstrom, observers said. The two-day Summit of the 20 largest global economies opened today in Buenos Aires, Argentina. … Yesterday, Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, called upon global leaders to recognize health as a Summit priority. “I look forward to taking the #HealthForAll message to world leaders at the #G20Summit”, tweeted Dr. Tedros, upon his arrival in Buenos Aires. … … In a Declaration on 4 October after their meeting in Mar del Plata, Argentina, G20 Health Ministers had called out four key health challenges: childhood malnutrition; health systems strengthening; health systems response to disasters and pandemics; and battling anti-microbial resistance, including through more sustainable agriculture, as top priorities for Summit leaders. It is unclear how the health ministers’ declaration will be reflected in the leaders’ summit this week. …”

That’s clear by now. It’s all in the Communiqué, but with no commitments : )     So mostly political declarations.

HPW – New Global Health Commitments At G20, Nelson Mandela 100th


The ‘Commitments’ (from the title) pertain more to the Global Citizen Festival in South Africa.

Global health reaped a weekend windfall of new international and bilateral commitments over the past two days, beginning with the close of the G20 meeting in Argentina on Saturday, followed by the Mandela 100 Global Citizen festival in Johannesburg yesterday, which saw stars like Beyoncé, Jay-Z and others perform in the name of health and development causes, reaping a historic commitment by the United States of more than US$1.2 billion for the fight against HIV/AIDS and some US$ 139 million for the fight against neglected tropical diseases.”

Our own Minister of Development Cooperation attended the event as well and clearly felt like a rock star on stage.

Lancet (Editorial) – What happened to health in Buenos Aires?


This Lancet Editorial takes a more merciful look at the Buenos Aires summit, from a global health angle. Still, it’s clear that the main hope is put on the next hosts, Japan.

“… one finds signs of hope. The Director-General of WHO, Dr Tedros, is now a permanent attendee. Health is agreed to be an indispensable dimension of our common political and economic futures. Indeed, the G20 Declaration has much to say about health. … … G20 nations have also launched what they call a G20 Initiative for Early Childhood Development—“building human capital to break the cycle of poverty and inequality”. … Next year, the G20 meets in Osaka, Japan. The Government of Japan has already decided to prioritise health. Preparatory meetings have been held in Tokyo. And early ideas are emerging, notably around how to accelerate progress towards Universal Health Coverage….”

Some broader analysis of the G20 summit


Politico – G20 leaders reaffirm ‘rules-based international order’

G20 leaders on Saturday adopted a joint communiqué reaffirming their commitment to “a rules-based international order” — a small, symbolic victory for stability in an era when U.S. President Donald Trump has upended traditional diplomacy by instigating trade wars and employing aggressive protectionist policies and rhetoric….”

Euractiv –   G20 struggles to agree on watered down declaration

The Group of Twenty most powerful nations were nearing an agreement late on Friday (30 November), in which a reference to a rules-based multilateral trade system was expected to be included. But ambition was lowered in the climate field to overcome the US opposition to the Paris Agreement.”   

On the latter, see also Mother Jones –  19 of 20 World Leaders Just Pledged to Fight Climate Change. Trump Was the Lone Holdout.

Project SyndicateThe G20’s Africa Problem

Although the G20 has made a limited effort to broaden its engagement with Africa in recent years, it has yet to include Africans in discussions of global issues that bear directly on their own economic prospects. Yet by consistently treating the region as a ward instead of a coequal partner, the international community is undermining its own future interests.”

And some tweets on the Buenos Aires Summit:

The G-20 in BA was the “avoidance summit”: US, China avoided escalating their trade war; MBS avoided being shunned despite his role in Khashoggi’s murder; Putin avoided any penalty for his latest Ukraine agression. And world leaders avoided doing much of anything for the world.”

#G20Argentina relief that there is a joint communique although very weak – meeting dominated by bilateral meetings – sign of things to come also at #UNGA or @WHO ?”

“Does the weakening of #multilateralism mean less need for #G20 or will #Japan be able to salvage the relevance of the meeting? Will that be possible with view to Saudi presidency in 2020?”

“Achieving a declaration has become the new benchmark of summit success.”

Dr Tedros: “Pleased to work with @ilo Director-General @GuyRyder and @OECD Secretary-General @A_Gurria on a joint programme for health at #G20Argentina Summit. Health is a political choice. Together we can achieve #HealthForAll.”

“Strong leadership at #G20Argentina2018 drives the joint @ILO @oecd @WHO @Working4H programme forward to boost creation of 40million new #healthworker + 80million other jobs by 2030.”

The fact that the G20 policy blogs & briefs from the Sheffield team didn’t contain anything on global health was also telling. See here.

But do check out the blog ‘Don’t cry for meat, Argentina!” 😊

Over to Japanhttp://jcie.or.jp/cross/globalhealth/iag-on-global-health.html

Thanks to @JapanGov, #health remains on the agenda of #G20 2019!”

Kate Raworth – Doing the doughnut at the G20?


Fat chance that anybody listened to her in Buenos Aires, but nevertheless, the blog of the week.

With visualizations in the best Rosling style, though adjusted to the new – planetary health – era.  A must-read!!!

The “nationalism-globalization” debate &  ‘The Left’

The Nation – There Is No Left Case for Nationalism – Endorsing nationalism isn’t compromise. It’s compromised.

By A A Abrahamian; https://www.thenation.com/article/open-borders-nationalism-angela-nagle/

Interesting read.

Guardian – We shouldn’t rush to save the liberal order. We should remake it

Yanis Varoufakis et al ; https://www.theguardian.com/commentisfree/2018/dec/01/liberal-world-order-new-international-yanis-varoufakis-david-adler

The UN security council, the IMF, the World Bank and the ILO were conceived as agencies of change – they can be again.”  Recommended.

World AIDS Day – AIDS at a critical juncture

We covered World AIDS Day (1 December, this year on a Saturday) last week already to some extent.

A few more reads you might want to look into:

UN News – World response to AIDS epidemic at a ‘critical juncture’


Thirty years after the first World AIDS Day, the HIV response stands at a crossroads,  UN Secretary-General António Guterres has said, marking this year’s commemorations. The direction taken now, may determine whether the epidemic can be ended by 2030, or if future generations will have to continue the battle, he said….”

HPW – On World AIDS Day: Big Breakthroughs On HIV Self-Testing


A report launched jointly [today] by Population Services International (PSI), London School of Hygiene and Tropical Medicine and the World Health Organization shows that people’s knowledge of their HIV status in sub-Saharan African countries nearly doubled just four years after self-testing programmes were introduced. Separately, a group of French NGOs called on the French President to lead elimination of HIV/AIDS, tuberculosis and malaria by 2030….”

CGD (blog) – On World AIDS Day, a Moment for Celebration and Self-Reflection

A Glassman & R Silverman; https://www.cgdev.org/blog/world-aids-day-moment-celebration-self-reflection

Mainly for this paragraph:

“… With a new round of global health replenishments in 2019, we are looking critically at recent claims of impact emerging from global health agencies—some of which we do not believe to be sufficiently backed up by rigorous, transparent evidence.  Richard Feachem, the founding director of the Global Fund, put it best: “Raise It, Spend It, Prove It.” Many global health organizations do well on “raise it,” most on “spend it,” but few “prove it.” This is the ultimate accountability; not an OIG report on how monies are spent, but instead, the sound and rigorous measurement, verification, and evaluation of impact for real people at risk for and suffering with preventable disease burden. In the coming weeks, you will see a commentary that is critical of recent Global Fund results reporting. But insufficient impact measurement is almost universal across almost all agencies—and it’s up to all of us to do better…”

Lancet HIV December issue


To mark World AIDS Day (Dec 1), The Lancet HIV’s December issue is dedicated to examining strategies for preventing, diagnosing, and managing paediatric HIV.”

RHM – World AIDS Day: Eliminating Stigma and Discrimination


“In commemoration of the 30th  Anniversary of World AIDS Day, RHM welcomes the news that a Global Partnership for Action to Eliminate All Forms of HIV-related Stigma and Discrimination will be launched on December 10 – Human Rights Day 2018 – and commits to publish and promote research which contributes to the elimination of stigma and discrimination in sexual and reproductive health care.”

Global Health Disruptors  & 10 years Global Health Centre (Graduate Institute)

On Monday 3 December, The Graduate Institute’s Global Health Centre celebrated its 10th anniversary with a nice event, The Overlapping Crises of Democracy, Globalisation and Global Governance – what does it mean for global health?

We’ve been told a video recording of the workshop will be available soon.   For some of the action, check the twitter account of the  Global Health Centre.

Meanwhile, do check out the entire BMJ Opinion ‘Global Health Disruptors’ series (with 2 big parts): https://www.bmj.com/global-health-disruptors

This collection of articles looks at major disruptions that have shaped global health to make it the field it is today, before moving on to look at major disruptions under way at present that are radically changing the face of contemporary global health. Each piece pinpoints the nature, immediate effects, and long term impact of each disruption. Global health is beginning to experience the effect of a world that is more multipolar, less multilateralist, and more ideological. Any one of these issues has the potential to be a disruptive force for global health, let alone all of them together. The challenge ahead lies in accepting these disruptions as being collective problems that require solidarity and a global response, and ensuring for the future that the UN and other multilateral institutions are prepared to deal with interconnected challenges and systematic breakdowns. These disruptions—and not viruses or diseases—are the threats that should keep us awake at night.”

As compared to last week’s IHP issue, some other blogs were also published, for example on the global health care market, NCDs, R&D, and the urban planet.

Polio still a PHEIC

Devex – WHO says international spread of polio still a public health emergency


News from late last week. “The international spread of polio virus continues to be a problem four years after the WHO’s Emergency Committee designated it a public health emergency of international concern. The committee on Friday announced it would extend the emergency by another three months, after data showed an uptick in the number of polio cases worldwide in 2018, including a doubling in Afghanistan….”

See also CIDRAPPolio experts address fears over disease resurgence

“…Michel Zaffran, MEng, director of the WHO’s polio eradication program, said the ongoing PHEIC reflects a dual emergency, both of which pose a threat to other countries: the continued spread of WPV1 in Afghanistan and Pakistan and spread of circulating vaccine-derived poliovirus (cVDPV) in countries that have poor or weak routine immunization programs, such as in Africa and in Papua New Guinea….”

Or see a Lancet World ReportWHO keeps polio on the international health emergency listA spike in new cases of polio heightens concerns of a global resurgence of the disease.”

UN Aid – 2019 Humanitarian Appeal

Reuters – U.N. seeks $21.9 billion in aid next year, largest needs in Yemen


The United Nations appealed for $21.9 billion on Tuesday to address 21 humanitarian crises worldwide next year, including $4 billion for Yemen, its largest aid operation. The appeal to donor countries does not include the funding requirements for Syria, which are expected to bring the total up to $25 billion, it said.”

For more detail, see AP.

Yemen & lessons from the cholera response

Lancet Global Health (Editorial) – Yemen needs a concrete plan—now


in a report released on December 4, the Johns Hopkins Center for Humanitarian Health presents a detailed evaluation, based on an in-depth review and data gathered through 71 key informants, of the epidemic preparedness and response up until the second wave in July 2018. It brings forth unsurprising but sobering facts, among them the likely association between the conflict and increased cholera transmission; the lack of preparedness in terms of surveillance and response capacity; or coordination issues between international and national actors of the response. The 20 global and Yemen-specific recommendations cover the fundamental need of addressing insecurity, of urgently clarifying and harmonising coordination and preparedness, and of making the response more agile by improving surveillance. They include specifics of a targeted WASH and vaccination response and rely on strong integration of planning across sectors, all sensible responses to the issues identified in the analysis. These concrete, action-related reports should be precious input in tackling this and future outbreaks, particularly in war-torn areas. But Yemen needs even more—and the time is now.”

You find the report from the Johns Hopkins Center for Humanitarian Health (with the 20 lessons from Yemen’s cholera response), here: “Cholera in Yemen: A case study of epidemic preparedness and response”.

International Day of Persons with Disabilities  (3 December)

First-ever UN report on disability and development, illustrates inclusion gaps


The United Nations launched its first-ever flagship report on disability and development on Monday; published by, for, and with, persons with disabilities, in the hopes of fostering more accessible, and disability-inclusive societies.”

Other links related to this Day:   DevexDFID launches its first disability inclusion strategy

The United Kingdom’s Department for International Development launched its first disability strategy Monday, which disability champions hailed as “ambitious” but in need of dedicated financing to implement. The plans cover disability inclusion both in DFID’s external programs and within the department, fulfilling a key commitment made by Secretary of State for International Development and former minister for people with disabilities Penny Mordaunt. Disability groups said they were pleased to see a focus on issues such as “mental health conditions, psychosocial or intellectual disabilities,” as well as inclusion in humanitarian contexts included in the strategy. However, implementing it will require dedicated funding from DFID, advocates said….”

WHO celebrates International Day of Persons with Disabilities

Ebola outbreak DRC – Still a blurred (& worrying/unpredictable) picture

As already mentioned earlier in this newsletter, at Tedros’ “meet the press” interview from early this week, the WHO DG sounded rather reassuring. However, not everybody is equally reassured…

Some reads from this week:

CIDRAP – Ebola total rises to 458 in DRC outbreak

With some info on the weekly report from the WHO African regional office (23 Nov-1 Dec). See also, for the latest update, CidrapEbola cases spike as WHO warns of possible reintroduction

MSF – Ebola spreads further into urban communities and isolated areas in North Kivu


The Ebola epidemic continues to spread through the Democratic Republic of Congo (DRC)’s North Kivu province. The newest areas to be affected include the city of Butembo and a number of isolated areas that are hard to reach…. … “We are very concerned by the epidemiological situation in the Butembo area. We now know that this outbreak will last and that we must increase our efforts to get it under control,” says John Johnson, MSF project coordinator in Butembo….”

This short MSF report inspired Helen Branswell to the following tweet: “WHO concerned  [see below], MSF concerned… Don’t like the sound of this.”

Stat News – As Ebola outbreak spreads in Congo, concern grows over supplies of experimental vaccine

H Branswell; Stat News

The Ebola outbreak in the Democratic Republic of the Congo appears to be spreading southward from its current epicenter at Beni, raising concerns it will take root in some larger population centers, including a major regional hub, warned a senior World Health Organization official. Should the outbreak spread more widely in cities like Butembo — where there have already been a number of cases — or Goma, a major center further south, the scale of the outbreak could tax the available supplies of an experimental vaccine being used to help contain spread, said Dr. Peter Salama, who heads the WHO’s emergencies program.

As of Sunday more than 42,000 doses of the vaccine had been used in this outbreak and one earlier in the year in the western part of the DRC. Merck, which is developing the vaccine, has committed itself to maintaining a stockpile of 300,000 doses. “We are extremely concerned about the size of the vaccine stockpile,” Salama told STAT in an interview. “And we’re regularly in touch with Merck to discuss what can be done about that.”…”

Vox – Why the Ebola outbreak in DRC has spun out of control – The WHO’s top emergency responder explains why the outbreak is now the second largest in history.


Analysis from late last week. And recommended. Interview with Peter Salama.

“… In the last two years since I have been here, 80 percent of our major outbreaks have been in conflict-affected areas. This is the issue of the future. The issue of urban outbreaks of high-threat pathogens is really an issue of our generation. I don’t think we’ve fully grappled with that. Now with yellow fever, plague, with Ebola, we are starting to see these patterns. All bets are off [in terms of] thinking we know about the transmission of diseases because of what happened in rural outbreaks in the past. It’s completely different now….”

And a tweet related to what he says on the situation of WHO’s Emergency Contingency Fund: “On the emergency contingency fund .@PeteSalama calls for establishment of formal system as in the G20 guarantee this fund will never fall below $50 million.”    (think the G20 was tone deaf)

Lancet (Letter) – Two data points for gauging outbreak control

Ranu Dhillon et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32755-7/fulltext

“… Outbreak control is typically assessed based on the trajectory of new cases and the overall picture depicted in situation reports issued by WHO, which detail response efforts and provide related data, such as the number of contacts being monitored. This information is helpful but does not always sufficiently clarify how effectively an outbreak is being controlled….”

“For outbreaks like the current [i.e. Ebola DRC ] one, in which transmission is primarily human-mediated and contact-tracing is the main control strategy, there are two metrics, percentage of new cases from known transmission chains and symptom-to-isolation interval, which can provide greater clarity on how controlled an outbreak is….


Finally, some other links:

Guardian (by Sarah Boseley) – Are we on the cusp of a breakthrough in Ebola treatment?

Ebola could be transformed from a terrifying disease into something that can be managed at home if drug trials in the Democratic Republic of the Congo are successful, a leading scientist believes….”

HPW – WHO Emergencies Head Praises Collaboration With Pharma On Ebola, Calls For Expanded “Strategic” Collaboration

The current Ebola outbreak in the Democratic Republic of Congo (DRC) is the second largest ever, occurring in a “perfect storm” of a densely-populated conflict zone. Yet thanks in large part to a strong collaboration between the World Health Organization and the pharmaceutical industry, the outbreak has so far remained confined to two DRC provinces, says Peter Salama, WHO deputy director general for emergency preparedness and response.”

Salama said this at a panel on global health security at the annual assembly of the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA) in Geneva, also marking the 50th anniversary of the federation’s creation.

Global Health security

WHO Emro – WHO Member States sign Khartoum Declaration on Sudan and Bordering Countries: Cross-Border Health Security


Six countries in WHO’s Eastern Mediterranean and African Regions have signed a declaration committing themselves to strengthening preparedness and response to public health threats and events across borders in an effort to further the implementation of the International Health Regulations (IHR 2005) and enhance global health security. The Khartoum Declaration on Sudan and Bordering Countries: Cross-Border Health Security was signed by Chad, Egypt, Ethiopia, Libya, South Sudan and Sudan on 22 November 2018 in Khartoum, Sudan….”

WHO – Simulation exercise puts global pandemic readiness to the test


A simulation for a global pandemic response involving more than 40 countries [will] take place 4-6 December, 2018, coordinated by the World Health Organization’s Global Emergency Operations Centre (EOC) and by the EOC Network, a global network of health emergency operations centres. This is the first global pandemic response training exercise, and the third in a series of simulations this year, following regional exercises in Jordan and Senegal….”

PREVENT Guidance   – Pregnant women and vaccines against emerging epidemic threats: Ethics Guidance for Preparedness, Research and Response


This Guidance provides a roadmap for the ethically responsible, socially just, and respectful inclusion of the interests of pregnant women in the development and deployment of vaccines against emerging pathogens. The Guidance is a product of the Pregnancy Research Ethics for Vaccines, Epidemics, and New Technologies (PREVENT) Working Group—a multidisciplinary, international team of 17 experts specializing in bioethics, maternal immunization, maternal-fetal medicine, obstetrics, pediatrics, philosophy, public health, and vaccine research and policy— in consultation with a variety of external experts and stakeholders. The Guidance begins by setting forth an aspirational vision and makes the case for its moral importance. We then specify 22 concrete recommendations, organized around three key areas: public health preparedness, R&D, and vaccine delivery.

Basically, after the commotion around pregnant women in the (latest) Ebola outbreak, with this guidance, health care and bioethics experts are calling on the scientific community to allow pregnant and lactating women to receive vaccines against emerging infectious diseases.

LSHTM partner in UK’s first-ever dedicated Vaccines Manufacturing Innovation Centre


Led by the Jenner Institute, LSHTM is a partner in the UK’s first-ever dedicated Vaccines Manufacturing Innovation Centre (VMIC), a £66m investment by UK Research and Innovation as part of the UK Government’s Industrial Strategy Challenge Fund (ISCF) Medicines Manufacturing challenge. Based in Oxford and expected to open in 2022, VMIC will be a purpose-built, state-of-the-art facility that will pave the way for the rapid manufacture of vaccines in the event of a pandemic affecting the UK. It will also enable rapid global response to emerging infectious epidemic pathogens such as Ebola and Zika, and innovate new technologies including the manufacture of personalised cancer vaccines. LSHTM is one of three academic institutions to join forces in the new company – VMIC UK – along with the University of Oxford and Imperial College London….”

Lancet World Report – Boosting quality diagnostics could give Africa better health

M Makoni; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)33116-7/fulltext

Africa CDC has launched a new initiative aimed at boosting access to essential diagnostics across the continent. Munyaradzi Makoni reports.”


#MeToo & global health

UNAIDS Executive Director urges transparency on process of release of Independent Expert Panel report


In February 2018, the Executive Director of UNAIDS called for the establishment of an Independent Expert Panel on prevention of, and response to, harassment, including sexual harassment, bullying and abuse of power at the UNAIDS Secretariat. The Panel has completed its report, which was distributed to the members of the UNAIDS Programme Coordinating Board (PCB) on 4 December, together with the UNAIDS Secretariat management response. The Panel’s report and the UNAIDS management response will be presented to the PCB on 11 December at its 43rd meeting. The decision on when the report will be communicated more broadly will be made by the voting members of the PCB. UNAIDS does not decide how the report is communicated to the PCB members and/or the public. The PCB will take a decision on the public release of the report on 6 December. “I fully respect the decision of the Programme Coordinating Board in determining when the report of the Independent Expert Panel will be shared with staff and the public. It is important to have full transparency of the process,” said Michel Sidibé, UNAIDS Executive Director. “Our staff and key partners are keen to see the report and know the findings and recommendations, as well as contribute to discussions on the next steps….”

This plea for full transparency from Sidibé followed this (from earlier this week): UNAIDS suppressing independent report into sex abuse, mismanagement (Code Blue).

But that’s probably just a coincidence.

Sidibé’s plea clearly didn’t suffice. On December 6The NGO Delegation to the UNAIDS PCB Called for the Immediate Release of the Independent Expert Panel’s (IEP) Report .

See also Pam Das’ tweet – “This is odd. The long awaited report by the #PCB on @UNAIDS should have been released Dec 3. Why the delay or doubts on whether there should be a public release?”

And see also this UNAIDS press statementUNAIDS has never offered economic compensation to complainants of sexual harassment in exchange for non-disclosure agreements

Launch of the recommendations of the WHO – Civil Society Task Force


The launch is scheduled for later today (7 Dec).

As a reminder, “in January 2018, a Civil Society Task team was established at the request of dr Tedros to advise WHO on how to strengthen its engagement with civil society to advance the 13th GPW. Led by representatives from 17 countries, and co-facilitated by the UN Foundation and RESULTS, the Task team has developed a set of concrete, actionable recommendations” (etc)

You find the full report with the recommendations here: Together For The Triple Billion: A new era of partnership between the World Health Organization (WHO) and civil society

For a snapshot, see the four focal areas:

Policy dialogue: Build in explicit, accessible opportunities for civil society to provide input into policies and governance at all levels.

At the country level, the Task Team recommends that WHO encourage Member States to consult CSOs in the development of the Country Cooperation Strategy (CCS) and that WHO work with CSOs to create time-bound national roadmaps to complement the CCS, detailing how WHO and CSOs will engage in the following strategy cycle.  At the global and regional levels, the Task Team recommends that WHO take steps to strengthen the roles for civil society in governance and policymaking through increased meaningful CSO engagement.

Health emergencies: Strengthen emergency response by expanding country-level tripartite Health Cluster leadership.

The Task Team recommends that WHO expand the current WHO-Ministry of Health leadership of national Health Clusters to a tripartite arrangement that includes a CSO as co-lead, as recommended by the IASC Reference Module on Cluster Coordination and as contextually appropriate.

Gender equality, health equity, and human rights: Establish an independent “Inclusivity Advisory and Oversight Group.”

The Task Team recommends that WHO establish an Inclusivity Advisory and Oversight Group (IAOG) to support the Director-General, Senior Advisor on Youth and Gender, and the Executive Board to develop and evaluate policies and to provide formal support on gender, youth, equity, and rights mainstreaming. This group should be as diverse as possible, with representation from affected communities, faith-based organizations, and marginalized populations such as women, youth, indigenous groups, and people living with disabilities.

Data, research, and innovation: Develop a platform to crowdsource complementary, disaggregated data from CSOs.

Working with WHO and a third-party technology provider, the Task Team recommends that CSOs set up a data collection platform to collate disaggregated data (e.g. burden, coverage, and uptake data disaggregated by gender, age, race, ethnicity, and socioeconomic status), from across the CSO landscape, including community-based groups in particular, to complement existing sources.”

The Lancet (Offline) – : The invisibility of inequality

R Horton; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)33110-6/fulltext

Horton’s take on the two faces of Singapore, after attending the Raffles Dialogue there last week.

On the one hand he thinks some of Singapore’s “… successes can do much to protect and strengthen the values of globalism so threatened today by renewed tides of nationalism.”  (dream on, Richard)

On the other hand he points to “the contrasting story …  provided by Teo You Yenn’s sharp, moving, and eloquent collection of essays, This Is What Inequality Looks Like (2018).”  Including in Singapore.  Horton then encourages us to (also) not look away from inequality, and instead, help to make it visible.

Lancet (Comment) – A global accountability mechanism for access to essential medicines

M Simao et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32986-6/fulltext

“…Efforts to ensure comprehensive access to essential medicines have been hindered by a dearth of information….” “Most monitoring efforts have focused on measurement of a prespecified list of essential medicines in health facilities….”

“…Without systematic data reporting on national pharmaceutical expenditure, there is a lack of attention to access to essential medicines in major reports such as the World Health Statistics.  The 2015 Millennium Development Goals Task Force report concluded that tracking progress on access to essential medicines was impossible, given the absence of country-level data…”

2018 Global Status on Road Safety

UN News – Road injuries leading cause of death for the young, despite safety gains: UN report


Latest statistics from the World Health Organization (WHO reveal that 1.35 million people die on the roads each year, while road traffic injuries are now the leading cause of death among young people, according to new statistics from the World Health Organization (WHO).”

Some key publications and papers of the week

BMJ Global Health (Commentary) – It is time for academic institutions to align their strategies and priorities with the Sustainable Development Goals

C Cancedda, A Binagwaho, V Kerry; https://gh.bmj.com/content/3/6/e001067.share

There are strategic reasons and value-generating opportunities for academic institutions to fully embrace and actively pursue the health-related Sustainable Development Goal (SDG3) and other SDGs. The SDGs will incentivise academic institutions to think long term and strategically, align fundraising to the pursuit of local priorities, use common health-related metrics to monitor progress, collaborate across sectors and establish effective global health partnerships. The SDGs will also incentivise academic institutions to perfect metrics for institutional capacity strengthening and sustainability, which should be a stated and measurable outcome of any global health partnership.”

Health and Human Rights journal – Special Section on Human Rights and the Social Determinants of Health and a General Papers section


For a good overview of this Special section, read the Editorial  Deepening the Relationship between Human Rights and the Social Determinants of Health: A Focus on Indivisibility and Power(by K H Kenyon, L Forman & C Brolan).

WHO Bulletin December issue


The Editorials were already published online before, but are certainly worth (re-)reading.

Global Public Health – Revisiting the social determinants of health agenda from the global South

Elis Borde et al; https://www.tandfonline.com/doi/full/10.1080/17441692.2018.1551913

In an effort to provide an overview of the conceptual debates shaping the mobilisation around social determinants of health and health inequities and challenge the apparent consensus for equity in health, this essay compares two of the most influential approaches in the field: the WHO Commission on Social Determinants of Health approach (CSDH), strongly influenced by European Social Medicine, and the Latin American Social Medicine and Collective Health (LASM-CH) ‘Social determination of the health-disease process’ approach, hitherto largely invisibilized. It is argued that the debates shaping the equity in health agenda do not merely reflect conceptual differences, but essentially different ethical-political proposals that define the way health inequities are understood and proposed to be transformed. While the health equity agenda probably also gained momentum due to the broad political alliance it managed to consolidate, it is necessary to make differences explicit as this allows for an increase in the breadth and specificity of the debate, facilitating the recognition of contextually relevant proposals towards the reduction of health inequities.”

Critical public health – The integration of evidence from the Commission on Social Determinants of Health in the field of health equity: a scoping review

K M Plamondon et al; https://www.tandfonline.com/doi/full/10.1080/09581596.2018.1551613

« In 2008, the World Health Organization’s Commission on Social Determinants of Health (CSDH) presented an influential compilation of evidence establishing the relationship between health inequities and the unfair distribution of power, wealth, and resources. A decade later, individual and bio-behavioural responses to health inequities persist. The purpose of this scoping review was to explore the extent to which this evidence guided research, practice, and policy in global and public health. To do this, we assessed different ways the CSDH evidence and calls for action were integrated in scholarly publications (citation, portrayal of health inequities, alignment with calls for action, and orientation toward root causes). … …  Among 110 post-CSDH empirical articles, half did not align with CSDH principles for action. This review  illustrates that much scholarly work that purported to contribute to health equity did so in ways that conflicted with the CSDH’s characterization of the remediable nature and distribution of health inequities. These results provide a practical platform for assessing how global and public health efforts can move towards better alignment with the best available evidence about advancing health equity.”

WHO Searo (Book) – Resilient and people-centred health systems: Progress, challenges and future directions in Asia

Editors: Helena Legido-Quigley and Nima Asgari-Jirhandeh  http://apps.who.int/iris/bitstream/handle/10665/276045/9789290226932-eng.PDF?sequence=5&isAllowed=y

400 + pages. Including, interestingly, a chapter 2 on planetary health and resilience in Asia.

Health Systems & Reform – Community Engagement in Support of Moving toward Universal Health Coverage

P Allotey et al; https://www.tandfonline.com/doi/full/10.1080/23288604.2018.1541497

Part of a number of new articles in HS&R focusing on UHC in the Asia-Pacific region.

Community engagement describes a complex political process with dynamic, negotiation and renegotiation of power and authority between providers and recipients of health care in order to achieve a shared goal of universal health care coverage. While examples exist of community engagement projects, there is very little guidance on how to implement and embed community engagement as a concerted, integrated, strategic and sustained component of health systems. Through a series of case studies, this paper explores the factors that enable community engagement particularly with direct impact on health systems.”

Health Systems & Reform – Governance Pathways to Accelerate Progress Towards Universal Health Coverage (UHC) in the Asia-Pacific Region

E-K Yeoh et al; https://www.tandfonline.com/doi/full/10.1080/23288604.2018.1543521

Many countries in the Asia-Pacific region have committed to UHC, which is reflected in both their political commitment and the governance actions they have taken in steering their health systems towards the goals of universal access to care and protection from financial hardship. Countries throughout the region are at different stages of development and have different political and governance contexts which in turn shape how they pursue governance for UHC. This paper reviews the governance functions deployed in the Asia-Pacific and finds that, in many, governance reforms adapting their health systems towards greater regulation, accountability, oversight and stewardship of the health system have been part of their wider move towards UHC. Countries have not followed a set pattern, but shared aspects include: establishing UHC as a goal in national policy-making and priority-setting; the creation of new roles and/or new institutions within the health system; establishing systems of monitoring and evaluation; and putting in place mechanisms to facilitate collaboration and ensure greater accountability. The relationship between governance and UHC in the Asia-Pacific region is found to be complex, negotiated, and shaped by a number of factors in both the internal and external environment including: broader governance arrangements in the public sector (institutional changes and decentralization are particularly prominent factors) and the ability of governments to implement policies and steer the health system.”

Some key blogs and articles of the week

O’Neill Institute – Mapping the evolution of the Right to Health at the Office of the High Commissioner for Human Rights

G MacNaughton et al; http://oneill.law.georgetown.edu/mapping-the-evolution-of-the-right-to-health-at-the-office-of-the-high-commissioner-for-human-rights/

Very insightful blog.

Branko Milanovic (blog) – First reflections on the French ““événements de décembre”


As Emmanuel Macron is the current darling of some (many?) in the global health community, good to try to understand a bit what’s going on in France. Milanovic’s second case here, is more convincing than his first case, at least in my opinion.

Laurie Garrett (CNN) – Macron’s top-down approach to fighting climate change serves as a cautionary tale


Laurie Garrett’s take on the ‘events’ in France. “…Macron’s eager absorption of corporate capitalism into the global governance of climate change now threatens to blow up in his face. It was never about democracy — how could it be? The world’s working poor have no seats in the boardrooms or on the stock markets, and no influence over Amazon’s carbon emissions schemes or the success of Tesla electric trucks….”

As exhausting and daunting as it may be, climate leaders must pay heed to the cries of France’s yellow vests, and the angry masses inside their own nations. A corporate boardroom or gathering of CEOs may be more comfortable. But curing the world’s climate catastrophe, pulling humanity from its existential brink, requires nothing less than solutions found, and supported, across whole societies….”

Jacobin – The Guardian’s Populism Panic

R Burtenshaw et al; https://jacobinmag.com/2018/12/guardian-populism-europe-cas-mudde-hillary-clinton-immigration-tony-blair

Britain’s leading liberal newspaper has set out on a mission to define and defeat “populism.” It has not gone well.”  Recommended analysis, if you want to understand ‘populism’ a bit more.

Will be key, if “global health” doesn’t want to become more marginalized in the years to come (in the North).

CGD (blog) – Three Lessons from the World Bank’s New Worldwide Bureaucracy Indicators Database

P Jakiela; https://www.cgdev.org/blog/three-lessons-world-banks-new-worldwide-bureaucracy-indicators-database

On Tuesday, the World Bank announced the launch of a new database to characterize the quality and composition of the public sector in 115 countries. According to Jim Brumby, the Director of the World Bank’s Governance Global Practice, the Worldwide Bureaucracy Indicators (WWBI) “can help researchers and development practitioners gain a better understanding of the personnel dimensions of state capability, the footprint of the public sector on the overall labor market, and the fiscal implications of the government wage bill.” The new indicators are part of a larger effort by the World Bank’s Bureaucracy Lab, which is seeking to promote the use of evidence and technology in civil service reform….” This blog focuses on 3 patterns that stood out for the author.


Global Health Events

50th Annual Assembly International Federation of Pharmaceutical Manufacturers and Associations

IFPMA convened around the theme of Accelerating Global Health Progress, this year.

For coverage on one session in particular, featuring Rob “PUBLIC financing” Yates & Ilona Kickbusch:

HPW Political Commitment, Public Sector Investment: Key Universal Health Coverage Ingredients

Compulsory public finance remains a key mechanism for achieving universal health coverage (UHC), according to Professor Robert Yates of the Centre on Global Health Security at the London-based Chatham House, Royal Institute of International Affairs. Meanwhile, political will is one of five key ingredients to achieving a broad-based system of accessible health services, noted Prof. Ilona Kickbusch, director of Global Health at the Graduate Institute, Geneva.” “Yates and Kickbusch were among the speakers yesterday at a panel on Universal Health Coverage, hosted by the International Federation of Pharmaceutical Manufacturers & Associations at their 50th Annual Assembly, convened around the theme of Accelerating Global Health Progress.”

As for Kickbusch’s intervention: “… However, universal health coverage is not a narrow matter of identifying finance mechanisms alone, stressed Kickbusch. It is a social contract, with a political dimension. “In global health, we need a comprehensive approach, we need to move out of what I call the disease silos, and create a system across the full spectrum,” Kickbusch said. She defined UHC around five key principles, including: Health is a human right; Health is an investment; “if you are a country on the road development it is also one of the best investments you can have”; Health is a social contract. “No one should fall into poverty or suffer financial hardship because they need to go to a doctor”; Health is a political choice, by governments to invest in health services; Health is an economic force, worth about US$ 10 trillion annually across the world….”

WHO Alliance Webinar – recording: Social protection for health: What are the health policy and systems research priorities?


In case you want to re-watch this webinar (from 21 November)

“… This webinar [will] examine these questions to support a renewed interest in social protection mechanisms as a way of achieving the SDGs, especially the health-related ones. It can be considered an important first step in the embedded research approach. The webinar will cover issues uncovered in a recent paper, Identifying health policy and systems research priorities for the sustainable development goals: social protection for health.”

Coming up next week

  • UHC Day (12 December)
  • The Partners Forum for The Partnership for Maternal, Newborn & Child Health (Delhi, 12-13 December). For more info, including on the three goals of this meeting, see here.

Coming up end of January 2019 – WHO’s 144th Executive Board meeting  (Geneva)


Global governance of health

New Eurodad Report – IMF loan conditions make situation worse for crisis-hit countries, shows new study


The IMF is attaching an increasing number of conditions to its loans to crisis-hit countries – and many of these promote harsh austerity measures which are damaging countries’ ability to provide essential services to their citizens, for example health services. New research , published [today] by the European Network on Debt and Development (Eurodad), examines the conditions for loans approved in 2016-17 and finds that out of 26 countries that received loans, an average of 26.8 conditions are attached, many of which directly or indirectly affect a government’s capacity to provide public services. This is despite IMF claims that it is ‘streamlining’ its conditions and that its programmes do not emphasise fiscal contraction….”

Devex Exclusive: Meet the new OECD-DAC chair


The newly appointed chair of the Development Assistance Committee has said she will strive to “build consensus from the bottom up” as the group of donor countries struggles to modernize and to reach agreement on key issues. Susanna Moorehead is leaving her current role as British ambassador to Ethiopia and Djibouti in order to head up DAC, it is [due to be announced] Wednesday. “

… Moorehead comes to the role at a tricky time for the committee, which is part way through a major reform process started in 2012 and championed by its outgoing chair, Sweden’s Charlotte Petri Gornitzka…. The committee has also been dogged by division between its most powerful members, most recently over proposals around how donor countries should report aid that is invested in the private sector. …”

Moorehead: “DAC needs to be more forward-looking and not be perceived simply as a donor club. “

HPW – New GAVI Strategy To Strengthen Vaccine Delivery, Primary Health Care Systems


See also last week’s IHP news on the latest GAVI Board meeting.

The Board of Gavi, the Vaccine Alliance, has set parameters for a new five-year strategy for the public-private partnership that should not only expand delivery of priority vaccines but also strengthen primary health care systems that are a cornerstone to effective vaccine delivery. ….“Unlike previous vaccine investment strategies, these vaccines will involve building new delivery platforms which will strengthen primary healthcare as a whole,” Ngozi Okonjo-Iweala, Gavi Board Chair, was quoted saying in a press release. “This life-course immunisation approach can help lay the foundation for strengthening primary healthcare as a whole by providing more moments…”

In related news, check out also Save the Children’s new Briefing:  “Measuring Progress on the Pathway to Universal Immunisation Coverage”.  “As Gavi Alliance partners come together on 10th-11th December for the Gavi mid-term review meeting, this is a critical moment to assess progress and prioritise action. Save the Children’s new briefing, Measuring progress on the pathway to universal immunisation coverage, explores progress and required action in a number of areas, including ensuring immunisation is in reach of all children, sustaining and growing immunisation programmes following transition from Gavi support, and vaccine affordability….”

Devex – USAID chief lays out a Trump development doctrine


“…In the absence of a clear development vision from the president — and at a time when other Trump appointees are trying to put their own stamp on American “soft power” through channels such as the foreign assistance review — U.S. Agency for International Development Administrator Mark Green faces a difficult task: to advocate for his own mission, and on his own terms, but in a way that will appeal to a skeptical boss….”

“… Now more than 15 months in office, Green has begun to articulate a vision for USAID that sounds less like a statement of his personal views, and more like a claim to represent the Trump administration’s global development doctrine. … … “It forms the heart of what the Trump administration calls the ‘journey to self-reliance,’” Green said, referring to an internal principle closely associated with Green himself — and which the president has rarely, if ever, invoked.

… In seeking to define development for the Trump era, Green has doubled down on the notion that USAID offers countries an alternative development model to what China is promising — which he called the “authoritarian approach.” He is also betting that pursuing development through a lens of great power competition will allow USAID to still prioritize good development principles and outcomes….”

Devex – High-level support for PEPFAR, with budget cut proposals looming


See also last week’s news: “The United States Congress passed a bill to reauthorize the President’s Emergency Plan for AIDS Relief and its mandate will be extended through 2023 when President Donald Trump signs the legislation into law, which is expected to happen soon.”

(Recommended) Analysis, on the (‘clean extension’) bill & some changes in it.  For next year, there are still major concerns for Trump’s (upcoming) budget request for fiscal year 2020.

In a related link: Trump to sign bill extending HIV/AIDS program, Pence says  (AP).

And see an updated KFF BriefPEPFAR Reauthorization: Side-by-Side of Existing and Proposed Legislation.

Nature (News) – UN treaty agrees to limit gene drives but rejects a moratorium


Treaty’s vague language on how researchers can release engineered organisms has both opponents and supporters of the technology claiming victory.”

“UN countries have rejected a proposal to temporarily ban the release of organisms carrying gene drives — a genetic-engineering technology designed to spread mutations rapidly through a target population. Instead, representatives at the UN Convention on Biological Diversity meeting agreed (in Sharm El-Sheikh, Egypt, 29 Nov)  to changes to the treaty that were vague enough that both proponents and sceptics of the technology are touting victory. Signatories agreed to assess the risks of gene-drive releases on a case-by-case basis, and that local communities and Indigenous groups potentially affected by such a release should be consulted.”

Global Policy Watch (blog) – The Beirut Consensus on Financing for Development


The evaluation of the Financing for Development process from the First International Conference on Financing Sustainable Development indicates that the international financial system is not generating the volume of long-term financing needed to meet the sustainable development goals because of inadequate reforms and cooperation at the international level. Below is the Beirut Consensus on Financing for Development delivered by Mr. Mounir Tabet, Acting Executive Secretary, United Nations Economic and Social Commission for Western Asia (UNESCWA) at the conclusion of the conference organized by UNESCWA in Beirut on 28-29 November 2018.”

And a quick link:  David A. Ricks Elected New President of the IFPMA

David A. Ricks, Chairman and Chief Executive Officer, Eli Lilly and Company, was elected new President of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) for a two-year term. He succeeds Ian C. Read, Chairman of the Board and Chief Executive Officer, Pfizer.”

And a tweet from dr Tedros:

Today I am delighted to announce the creation of the WHO Innovation Hub – a new initiative that will work with partners to help bring new ideas to scale and achieve a measurable difference in people’s health.”



Washington Post – How do resource-constrained countries commit to universal health care?

Joseph Harris; https://www.washingtonpost.com/news/monkey-cage/wp/2018/12/01/how-do-resource-constrained-countries-commit-to-universal-health-care/?utm_term=.a5d71b709ecd

“… on Dec. 12, the world celebrates a newer holiday — Universal Health Coverage Day — which takes place on the anniversary of the U.N. General Assembly’s historic (and unanimous) 2012 endorsement of universal health coverage. The U.N. holiday calls attention to the growing global movement for universal health coverage, a goal the U.N. hopes to see the world achieve by 2030….”

“…In my recent book, “Achieving Access: Professional Movements and the Politics of Health Universalism,” I explore pioneering universal health care and AIDS treatment programs in Thailand and Brazil, as well as the health-care struggles in South Africa….”

“… The book was animated by two simple questions: How and why do resource-constrained countries make costly commitments to universal health care and AIDS treatment? And how are we to make sense of the political dynamics that led to surprising health-care reforms in Thailand and Brazil but delays and disappointment in South Africa?…”

Coming up – UHC Day ‘Results UK’ webinar 12 December


Featuring Rob Yates and Jenny Vaughan. As you know, next year will be an important one for UHC (with the UN HL meeting on UHC in September).

For another upcoming UHC Day webinar: Civil society voices for Universal Health Coverage  (by the Civil society mechanism for UHC2030)

BMJ Global Health – Estimating health opportunity costs in low-income and middle-income countries: a novel approach and evidence from cross-country data

J Ochalek et al; https://gh.bmj.com/content/3/6/e000964

The economic evaluation of healthcare interventions requires an assessment of whether the improvement in health outcomes they offer exceeds the improvement in health that would have been possible if the additional resources required had, instead, been made available for other healthcare activities. Therefore, some assessment of these health opportunity costs is required if the best use is to be made of the resources available for healthcare. This paper provides a framework for generating country-specific estimates of cost per disability-adjusted life year (DALY) averted ‘thresholds’ that reflect health opportunity costs. We apply estimated elasticities on mortality, survival, morbidity and a generic measure of health, DALYs, that take account of measures of a country’s infrastructure and changes in donor funding to country-specific data on health expenditure, epidemiology and demographics to determine the likely DALYs averted from a 1% change in expenditure on health. The resulting range of cost per DALY averted ‘threshold’ estimates for each country that represent likely health opportunity costs tend to fall below the range previously suggested by WHO of 1–3× gross domestic product (GDP) per capita. The 1–3× GDP range and many other previous and existing recommendations about which interventions are cost-effective are not based on an empirical assessment of the likely health opportunity costs, and as a consequence, the health effects of changes in health expenditure have tended to be underestimated, and there is a risk that interventions regarded as cost-effective reduce rather than improve health outcomes overall.”

Work on health and wellness centres makes little headway


In India, that is.  “… The country’s progress in building health and wellness centres (HWCs) is slow and the targets remain distant, going by the latest figures. These centres are envisioned to provide preventive healthcare and replace the health sub-centres which are the first point of contact for a person seeking healthcare in their vicinity. Of 1.5 lakh planned HWCs, close to 3,000 (2 per cent) have been built till date, Union Health Secretary Preeti Sudan told BusinessLine. Of these, 2,800 are in aspirational (economically backward) districts….”

The South African – Motsoaledi defends costly NHI, says it’s not up to the Finance Minister


Health Minister Aaron Motsoaledi has, once again, defended the controversial National Health Insurance (NHI) Bill, despite concerns that it may be wholly unaffordable. Concerns recently raised by the National Treasury are not new but have intensified amid allegations of irregularities in the way in which the bill is being processed. According to a report by Business Day, penned by Tamar Kahn, a leaked Treasury report has revealed vicious infighting regarding procedures which have sought to undermine due process….”

The news inspired Rob Yates to the following tweet:

Worldwide Ministers of Finance don’t like funding #UHC – they need to be told to do so by the Head of State.”

BMJ – Advancing universal health coverage in South Asian cities: a framework

A Adams et al; https://www.bmj.com/content/363/bmj.k4905

Alayne Adams and colleagues propose a framework that emphasizes actions on urban health governance and the social determinants of health to achieve universal health coverage in South Asian cities.”

BMJ – Understanding organisational culture for healthcare quality improvement

R Manion et al; https://www.bmj.com/content/363/bmj.k4907

“Russell Mannion and Huw Davies explore how notions of culture relate to service performance, quality, safety, and improvement.”

Key messages:

« Organisational culture represents the shared ways of thinking, feeling, and behaving in healthcare organisations. Healthcare organisations are best viewed as comprising multiple subcultures, which may be driving forces for change or may undermine quality improvement initiatives. A growing body of evidence links cultures and quality, but we need a more nuanced and sophisticated understandings of cultural dynamics. Although culture is often identified as the primary culprit in healthcare scandals, with cultural reform required to remedy failings, such simplistic diagnoses and prescriptions lack depth and specificity. »

IJHPM – Disease Control Priorities Third Edition: Time to Put a Theory of Change Into Practice; Comment on “Disease Control Priorities Third Edition Is Published: A Theory of Change Is Needed for Translating Evidence to Health Policy

W Isaranutwatchai, A Glassman, K Chalkidou et al; http://www.ijhpm.com/article_3571.html

The Disease Control Priorities program (DCP) has pioneered the use of economic evidence in health. The theory of change (ToC) put forward by Norheim is a further welcome and necessary step towards translating DCP evidence into better priority setting in low- and middle-income countries (LMICs). We also agree that institutionalising evidence for informed priority-setting processes is crucial. Unfortunately, there have been missed opportunities for the DCP program to challenge ill-judged global norms about opportunity costs and too little respect has been shown for the wider set of local circumstances that may enable, or disable, the productive application of the DCP evidence base. We suggest that the best way forward for the global health community is a new platform that integrates the many existing development initiatives and that is driven by countries’ asks.”


Planetary health

Vox – Geoengineering is a last-ditch option to stall global warming — and it’s getting a first test


See also last week’s IHP newsletter on this first pilot.

Guardian – In the face of climate change, ranking states by prosperity invites disaster

H Moore; https://www.theguardian.com/global-development/2018/dec/05/climate-change-ranking-prosperity-invites-disaster-henrietta-moore-ucl

Forget neocolonial indices that put wealthy countries ahead of poor ones on the path to development, we’re all in this together.”

“… Recent years have brought a proliferation of rankings claiming to move away from the obsession with gross domestic product to a more nuanced understanding of prosperity. This trend started with the UN’s human development index, which takes account of life expectancy and education and has grown to include parallel measures such as the world happiness report (another UN publication) and initiatives like the Legatum Institute’s prosperity index and the social progress imperative. Each of these has merit, and there’s much to be commended in assessing the impact of healthcare, education, the rule of law and personal and media freedom. But there’s a serious problem in seeing our world in this way. There’s an uncomfortably close correlation between these supposedly more sophisticated measures and old-fashioned GDP. Perhaps more troubling in the context of a planet threatened by climate change is the reinforcement of a belief that some countries have “made it”, while others need to catch up….” “In truth, many of the world’s most “prosperous” countries are its least sustainable….”

And she concludes: “… we’d be better assessing countries on how they’re helping to meet the shared global challenge of averting climate catastrophe than giving them a complacent, misplaced impression of crossing the prosperity finish line.”

FT- The global growth in meat production


Who eats the most and where is the greatest increase?” With some nice visualizations of the world map. And worrying trends.

This article is part of a FT Special Report Future of Food and Agriculture

From edible alternatives to wasteful plastic packaging and innovative ways of cutting food waste to how blockchain could help poor farmers and what climate change will do to crop yields. Plus the growth of food allergies and why investors are getting interested in ‘veganomics.’”

Finally, a few quick links:

Guardian – Luxembourg to become first country to make all public transport free

Luxembourg is set to become the first country in the world to make all its public transport free.”

Nature Greenland is losing ice at fastest rate in 350 years


infectious diseases & NTDs

Nature (news) – The silent epidemic killing more people than HIV, malaria or TB


“Viral hepatitis is on the rise. Tackling hepatitis B in Africa is key to fighting back.”

WHO – Countries of the Greater Mekong are stepping up to end malaria: Bulletin 7 of the Mekong Malaria Elimination programme


Countries of the Greater Mekong Subregion (GMS) are accelerating toward their shared goal of malaria elimination by 2030. The six GMS countries – Cambodia, China (specifically Yunnan Province), the Lao People’s Democratic Republic, Myanmar, Thailand and Viet Nam – have achieved remarkable progress. Between 2012 and 2017, the reported number of malaria cases fell by 75%. Malaria deaths fell by 93% over the same period. As the lead global technical agency, WHO supports GMS countries as they work to counter multidrug resistance and eliminate malaria. This latest WHO bulletin provides an overview of countries’ achievements to date.”

Mosaic – The unexpected effects of the HIV prevention pill


PrEP is great at blocking HIV, but as its use grows, so do fears that people will be more sexually reckless and spread other STIs. But researchers are coming to think that the opposite could be true.“


CIDRAP – Analysis finds global antibiotic use varies widely in children


A new analysis of global antibiotic use in young children has found that consumption patterns vary widely among countries, with no clear differences between high-income and low-income nations. But the study, which is the first attempt to estimate the amount and type of antibiotics being consumed by children under the age of 5 at the country level, also found some concerning trends. The positive news is that narrow-spectrum antibiotics, which should be used as the first or second options for common childhood bacterial infections, accounted for more than three quarters of antibiotics consumed by young children in 70 countries. But in 17 countries, most notably China and India, broader-spectrum drugs with a higher potential for driving antibiotic resistance accounted for more than 20% of the antibiotics consumed by children. And overall use of a key first-line antibiotic was lower than it should be. The findings appeared [earlier this week] in The Lancet Infectious Diseases  ….”

For the related Lancet Infectious Diseases Comment, see Be AWaRe: new metrics for paediatric antibiotic stewardship

WHO Exec Board 144 (preparatory report ) – Follow-up to the high-level meetings of the United Nations General Assembly on health-related issues: AMR


One of the preparatory documents for the next WHO board meeting, end of January 2019. “This report provides an update on the implementation of resolution WHA68.7 (2015), the global action plan on antimicrobial resistance and United Nations General Assembly resolution 71/3, “Political declaration of the high-level meeting of the General Assembly on antimicrobial resistance,” which was adopted in October 2016, and key ongoing challenges and emerging threats. The political declaration reaffirmed the global action plan and its five overarching objectives, which were developed by WHO in collaboration with, and subsequently adopted by FAO and OIE. The sections below provide a summary of WHO’s actions at all three levels of the Organization, as well as through collaboration with FAO, OIE and other stakeholders to support the implementation of the commitments made in the political declaration and in resolution WHA68.7 ….”

And a quick link, with good news from India:

India set to ban use of ‘last hope’ antibiotic to fatten livestock after bureau story

The Indian government is set to ban the “last hope” antibiotic colistin from being used to make livestock grow faster, in an effort to tackle the rise of superbugs.”



BMJ (Editorial) – Depression in older adults

P Wilkinson; https://www.bmj.com/content/363/bmj.k4922

“Depression in older adults is a neglected chronic disease as important as dementia.”

JCH (Commentary) – Fixed‐dose combination pharmacologic therapy to improve hypertension control worldwide: Clinical perspective and policy implications


Tweeted by Tom Frieden (from Resolve to Save Lives) (and brand new).  “…. Incorporating an earlier and wider use of FDC drug therapy is a practical and effective strategy which has clear policy implications targeted to improve hypertension treatment and control worldwide….”

Plos One – What interventions are required to reduce road traffic injuries in Africa? A scoping review of the literature

E Bonnett et al; https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0208195

« Road traffic accidents are the major cause of mortality among people aged 15–29 years in Africa. World Health Organisation (WHO) and the World Bank launched a Decade of Action for Road Safety in 2011 with the goal of halving the number of injuries and deaths on the roads. No progress has been reported in Low and Middle Income Countries (LMICs) and the number of deaths remains very high. To reach the target set, there is a need for interventions in several areas. This scoping review proposes to produce a synthesis by identifying the kinds of interventions and outcomes which have been carried out on the African continent. … … The study shows that interventions were developed in four fields: road safety policy, health education, safety equipment and data collection. It shows also that there were records of interventions in only twelve countries, mostly in Eastern and Southern Africa. The main conclusion of this study reveals both a lack of road safety interventions and shortcomings in the assessment of those performed and selected for our study. »

Blog – Could raising alcohol taxes save lives?

David Roodman; https://blog.givewell.org/2015/07/30/could-raising-alcohol-taxes-save-lives/

Cfr a tweet: « The case for raising #alcohol taxes is compelling and overwhelming. It needs to be a #globalhealth priority to address #NCDs and improve health. See @davidroodman’s summary of the existing evidence base. »

Gambling with our health: why the stakes don’t get any higher


Jacqui Thornton (LSHTM) dwells on gambling – a commercial determinant of health and another highly-gendered one too.

International Journal for Equity in Health – How do macro-level structural determinants affect inequalities in mental health? – a systematic review of the literature

A McAllister et al; https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-018-0879-9

In Europe and elsewhere there is rising concern about inequality in health and increased prevalence of mental ill-health. Structural determinants such as welfare state arrangements may impact on levels of mental health and social inequalities. This systematic review aims to assess the current evidence on whether structural determinants are associated with inequalities in mental health outcomes….”

“…More comprehensive and gender inclusive welfare states (e.g. Nordic welfare states) had better mental health outcomes, especially for women, and less gender-related inequality. Nordic welfare regimes may also decrease inequalities between lone and couple mothers. A strong welfare state does not buffer against socio-economic inequalities in mental health outcomes. Austerity measures tended to worsen mental health and increase inequalities. Area-based initiatives and educational policy are understudied.”

“Although the literature on structural determinants and inequalities in mental health is limited, our review shows some evidence supporting the causal effects of structural determinants on mental health inequalities. The lack of evidence should not be interpreted as lack of effect. Future studies should apply innovative methods to overcome the inherent methodological challenges in this area, as structural determinants potentially affect both levels of mental health and social inequalities.”


SR/Mat/neonatal & child health

Politico – WHO chief: EU needs to boost HPV vaccine supply


European countries need to help increase supply of a vaccine to prevent cervical cancer, said the World Health Organization chief, especially as they plan to offer the shot to both boys and girls. WHO Director General Tedros Adhanom Ghebreyesus told POLITICO in an interview that gender-neutral vaccination against the human papillomavirus — which causes cervical as well as oral and throat cancers — is “important.”…” But the supply is short,” he continued. “There should be commitment to increase the supply and do it gender neutral.”

Lancet Global Health – A call for the introduction of gender-neutral HPV vaccination to national immunisation programmes in Africa

O D Chido-Amajuoyi; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30405-4/fulltext

With a self-explanatory title.

“…Considering the growing prevalence of HPV-associated cancers in other parts of the world, it is imperative that preventive measures are established by incorporating gender-neutral HPV vaccination into the immunisation programmes of all African nations.”

NEJM (Perspective) – Pregnant Women and the Ebola Crisis

L B Haddad et al; https://www.nejm.org/doi/full/10.1056/NEJMp1814020?query=featured_home

Ebola prevention and control measures in the current outbreak in DRC have benefited from lessons learned from past outbreaks. Yet issues related to pregnant women have been largely ignored in these efforts.”

BMJ Global Health (Commentary) – Still a leap of faith: microfinance initiatives for reduction of violence against women and children in low-income and middle-income countries

A Peterman et al; https://gh.bmj.com/content/3/6/e001143

Economic strengthening interventions, including microfinance initiatives have been proposed as promising strategies to reduce interpersonal violence in low-income and middle-income settings. Despite these recommendations, there is little rigorous empirical evidence that microfinance alone or synergistically with gender norms or equity training can reduce violence against children or intimate partner violence. We call for further investments in evidence generation around economic strengthening before scaling-up potentially ineffective interventions.”

BMJ Global Health – Socioeconomic inequalities in access to skilled birth attendance among urban and rural women in low-income and middle-income countries

G Joseph et al; https://gh.bmj.com/content/3/6/e000898

Rapid urbanisation is one of the greatest challenges for Sustainable Development Goals. We compared socioeconomic inequalities in urban and rural women’s access to skilled birth attendance (SBA) and to assess whether the poorest urban women have an advantage over the poorest rural women….”

CSIS briefing – Women’s economic empowerment and women’s health services: an opportunity for US leadership

J Fleischman; CSIS briefing;

“… In the current polarized political environment, this is a unique area to advance a bipartisan, cross-sectoral approach, building on U.S. leadership in women’s global health to advance the economic potential of women and girls. This policy briefing calls on members of Congress, on a bipartisan basis, to communicate directly with the secretary of state and the administrator of the U.S. Agency for International Development (USAID) to encourage continued U.S. leadership in both women’s global health and economic empowerment to spur economic growth and promote healthy development….”

Well, perhaps if you give this agenda a wacko (Pence-style) evangelical twist : )

Lancet Child & Adolescent Health (Comment) – Protection versus rights: age of marriage versus age of sexual consent

S Petroni et al; https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(18)30336-5/fulltext

Summary: “As many governments worldwide have raised the legal age of marriage to 18 years, some are also considering raising the age of sexual consent. Without close-in-age exemptions, arguments to align the legal age of sexual consent with that of marriage would restrict the ability of adolescents to legally have sex. In contrast to international agreements that affirm 18 years as the minimum age for consent to marriage, international human-rights standards do not recommend specific age limits for sexual consent but urge recognition of adolescents as rights holders, including rights in relation to sexuality. The majority of the world’s young people are having sex before the age of 18 years. Laws that increase the age of sexual consent can be harmful and are often used to curb adolescents’ agency, including denial of adolescents’ rights to make decisions about whether, when, and with whom to have sex. Such laws can also result in stigmatisation or criminalisation (or both) of individuals who have sex before marriage, and increase barriers to accessing sexual and reproductive health. By contrast, providing adolescents with appropriate information and services supports healthy development, agency, and empowerment around their rights, including the right to be informed about their bodies and the right to consent (or not) to sex. Raising the legal age of sexual consent risks restricting adolescents from accessing the health care they need to protect themselves, and there is no evidence that it prevents consensual sex or sexual coercion. Because the consideration to marry and to have sex are very different, the minimum ages need not be aligned.”


Access to medicines

MPP – The Medicines Patent Pool gains new funding from The Wellcome Trust and the Swiss Agency for Development and Cooperation, for implementing expansion plans


The Medicines Patent Pool (MPP) has confirmed funding awards from two major agencies that will support its mandate expansion into patented essential medicines on the World Health Organization’s (WHO) Essential Medicines List (EML) – and those with strong potential for future inclusion. The Wellcome Trust will grant 105,000 CHF and the Swiss Agency for Development and Cooperation (SDC) will award 248,400.00 CHF….”


Human Resources for Health

BMJ Global Health – What is the minimum number of specialist anaesthetists needed in low-income and middle-income countries?

J Davies et al; https://gh.bmj.com/content/3/6/e001005

“…We estimated that, in order to achieve a reasonable standard of healthcare, as indicated by the global median MMR, countries should aim to have at least four PAPs  (physician anaesthesia providers) per 100 000 population. Existing data show that currently 80 countries have fewer than this number…. … Four PAPs per 100 000 population is a modest target, but there is a need to increase training of doctors in many countries in order to train more specialist anaesthetists. It is important that this target is considered during the development of national workforce plans, even if a stepwise approach to workforce planning is chosen.”

IHP – “The roaming doctors” – or what are we waiting for? A plea for interactive cooperation in health

Elies van Belle; http://www.internationalhealthpolicies.org/the-roaming-doctors-or-what-are-we-waiting-for-a-plea-for-interactive-cooperation-in-health/

In this blog, Elies launches a call to develop interactive cooperation in health, to allow all young professionals to get worldwide exposure to health systems, based on exchange and peer learning starting with ‘simple’ clinical experience. The blog explores a circular (health workforce) economy as a potential response to the risks and limitations of a (sterile) North-South rhetoric.

CGD (Brief) – A Tool to Implement the Global Compact for Migration: Ten Key Steps for Building Global Skill Partnerships

M Clemens et al; https://www.cgdev.org/publication/tool-implement-global-compact-migration-ten-key-steps-building-global-skill-partnerships

A somewhat related read. “The world needs better ways to manage international migration for this century. Those better ways finally have a roadmap: the Global Compact for Migration. Now begins the journey. National governments must lead in order to implement that Compact, and they need tools. One promising tool is Global Skill Partnerships. This brief explains what Global Skill Partnerships are and how to build them, based on related experiences around the world….”

Resource: Health Care Provider Performance Review


The Health Care Provider Performance Review (HCPPR) is a systematic review of the effectiveness of strategies to improve health care provider performance in low- and middle-income countries (LMICs).”

“Health workers in LMICs play a central role in preventing and treating illness; however, their performance is often inadequate. Many strategies, such as training, supervision, incentives, and technology-based interventions, exist to improve performance in LMICs. An understanding of the effectiveness of these strategies would be valuable for health programs, donors, researchers, and other development partners. The HCPPR systematically examines published and unpublished studies to characterize the effectiveness of all strategies to improve health care provider performance in LMICs. Studies on any strategy were included for any type of health care provider (including hospital- and clinic-based health workers, community health workers, pharmacists, and staff working in drug shops) for any health condition. … …  The HCPPR includes more than 700 studies. On this website, users can perform rapid on-line analyses of HCPPR data, as well as download more detailed versions of the review’s databases.”



Duncan Green (blog) – Localization in Aid – why isn’t it happening? What to do about it?


Duncan Green spent two days this week discussing ‘Localization in Conflict Settings’. “The subject is littered with aid jargon, but important – how does the humanitarian system ‘transfer power and resources’ to ‘local actors’ rather than outsiders insisting on running the whole thing (badly) themselves? It was organized by Saferworld and Save the Children Sweden to help flesh out a research programme….”

“…The starting point for the discussion is failure: everyone in the aid system agrees that localization is a good idea, but it isn’t happening. According to the background paper: ‘Of the US$16.4 billion of government funding for humanitarian assistance in 2016, 60% (US$12.3 billion) went to multilateral agencies, primarily the UN, and 20% (US$4.0 billion) went to NGOs. The NGO portion was divided between INGOs who received 85% and local and national NGOs who received 1.7% directly. In 2017, the local and national NGO portion increased to 2.7%.’ So first up we need a theory of non-change: why the inertia? A combination of ideas and institutions prevents progress:…”

The health care venture from Amazon, Berkshire and JP Morgan just hired its first female exec, and she comes from a big insurance company


The yet-to-be-named Amazon, Berkshire and J.P. Morgan employer health initiative has hired Dana Gelb Safran from Blue Cross Blue Shield in Massachusetts. Safran specializes in analyzing patient data to improve health.”

Lancet Editorial – The right to a healthy home


Following the request from a number of Member States, WHO released its first ever guidelines linking housing and health on Nov 23….”

“…These guidelines show that the impact of poor housing on health is a matter of international concern. As the world population is growing and ageing and the effects of climate change are felt, designing cross-sectoral interventions addressing poor housing will be crucial if we are to achieve the Sustainable Development Goals on health (SDG 3) and sustainable cities (SDG 11). Going forward, health must remain a central consideration to meet future global housing needs.”

Guardian – Sacking of Italy’s health experts raises political interference concerns


Rather shocking news from Italy.  “Vaccine-sceptic M5S says it plans to replace panel with ‘other deserving personalities’.”

Nature (News) – Researchers sign petition backing plans to end paywalls


“Online letter argues that Plan S — which dictates that research papers be immediately free to read — will not impinge on academic freedom, as some critics claim.”

And interestingly (also in Nature News), China backs bold plan to tear down journal paywalls

“Officials pledge support for European-led ‘Plan S’ to make research papers immediately free to read — but it’s unclear whether China will adopt its policies.”

In a huge boost to the open-access movement, librarians and funders in China have said that they intend to make results of publicly funded research free to read immediately on publication. The move, announced at an open-access meeting this week in Berlin, includes a pledge of support for Plan S, a bold initiative launched in September by a group of European funders to ensure that, by 2020, their scientists make papers immediately open….”

Vox – Is the CRISPR baby controversy the start of a terrifying new chapter in gene editing?

Julia Belluz; https://www.vox.com/science-and-health/2018/11/30/18119589/crispr-technology-he-jiankui

Analysis, one week later. “He Jiankui reminds us scientists can use CRISPR to quietly meddle with the human genome — without oversight.”

Read also a Nature EditorialHow to respond to CRISPR babies

The claims from He Jiankui that he has used gene editing to produce twin girls demand action. A new registry of research is a good start.”

And the Lancet also dedicated an editorial to it this week – CRISPR-Cas9: a world first?



BMC Public Health – Public health emergency preparedness: a framework to promote resilience

Y Khan et al; https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-6250-7

Emergencies and disasters impact population health. Despite the importance of upstream readiness, a persistent challenge for public health practitioners is defining what it means to be prepared. There is a knowledge gap in that existing frameworks lack consideration for complexity relevant to health systems and the emergency context. The objective of this study is to describe the essential elements of a resilient public health system and how the elements interact as a complex adaptive system….”