70th World Health Assembly (Geneva) – ongoing (22 May-…)
As mentioned in the intro, the 70th WHA is ongoing and already feels historical. We refer to the WHA section later in this newsletter for a “comprehensive” (well, sort of) (and more or less chronological ) overview of the main action, reports, quotes, …. at the assembly & side-events at the “Palais des Nations” and elsewhere in town. So you find everything on Chan’s last address to Ministers, the DG election of Dr Tedros, WHO’s budget, the many side events on NCDs, global health security, SDGs , … and much more below.
Here we already want to flag where you can find a good overview of the main agenda items, including critical analysis:
WHO Watch & WHA Today
Great resources. Check out, among others:
- Integrated commentary PHM on the entire agenda http://www.ghwatch.org/sites/www.ghwatch.org/files/WHA70_PHMCommentary.pdf (David Legge and others’ usual “magnum opus” with critical analysis of the entire agenda).
- Policy briefs PHM on important issues (about 20 pages –recommended) http://www.ghwatch.org/sites/www.ghwatch.org/files/policy%20brief%20WHA%2070.pdf : Focus on HRH, Access to Medicines (including cancer prevention), Nutrition, Childhood Obesity and NCDs & FENSA (Framework for Engagement with Non State Actors).
Civil society also produced a daily WHA Today. Check out the respective episodes so far.
IP-Watch – Mara Pilinger: World Health Assembly 70: A Spectator’s Guide To Program/Budget, Election, Polio Transition Excellent short report of the introductory briefing for delegates, hosted by the Global Health Centre at the Graduate Institute (on Sunday). Four items, in particular, stand out. The DG election; the program budget for the next two years; polio transition planning; access to medicines & other cross-cutting issues.
Global Health Now – 8 Things To Look For At The 70th World Health Assembly (by our colleagues from Global Health Now, published ahead of the WHA)
In general, IP-Watch has excellent coverage of the WHA. See below for more detail.
Trump budget proposal for 2018 & global health/development
KFF – White House Releases FY18 Budget Request
Must-read breakdown (of the impact of Trump’s budget, if Congress were to pass it (quod non), on respective global health programs): “The White House released its FY 2018 budget request to Congress on May 23, 2017, which includes significant cuts to global health funding. It seeks to shift the U.S. approach to development, stating that, the request “prioritizes and focuses foreign assistance in regions and on programs that advance U.S. national security by helping countries of strategic importance meet near- and long-term political, economic, development, and security needs.”..”
“…Funding provided to the State Department and USAID (through the Global Health Programs account), which represents the bulk of global health assistance, would decline by more than $2.2 billion (-26%), from $8,725 million in FY 2017 to $6,481 million, which would be the lowest level of funding since FY 2008. Funding for global health provided to CDC would decline by $85 million (-20%), from $435 million in FY 2017 to $350 million in FY 2018. Funding for almost all global health programs is reduced or eliminated in the budget request. “
Only GAVI would see an increase. All the rest face significant cuts. But as mentioned, now it’s in the hands of Congress. Meanwhile, Leading Humanitarian, Development, and Global Health Organizations are joining Forces Against the Cuts to Foreign Assistance.
Some more reads related to this Trump 2018 “suggested” budget:
CGD (blog) – President Trump’s First Budget Slashes Foreign Aid (by Erin Colinson)
Devex – Trump budget thrusts US foreign aid into a political fight “President Donald Trump’s budget request released Tuesday marked the end of an era when global development programs could generally fly under the radar, enjoying quiet bipartisan support and — with a few exceptions — steering clear of big political battles, according to development experts who shared their reactions to the proposal….” (PS: Tedros, for one, still hopes global health will remain a bipartisan effort, we learned later this week in Geneva)
CGD (blog by Scott Morris) (& must-read) – There is an Emerging Trump Philosophy for Foreign Assistance “… Emerging from the president’s budget proposal is an approach that sees foreign aid overwhelmingly as an instrument of geostrategic interests. Protecting military aid to Israel and Egypt amidst deep cuts elsewhere is one striking element of this approach. But it’s also reflected in the elimination of the USAID-based “development assistance” account, which has had clearly defined development-related objectives, in favor of a more strategically-oriented “economic support and development fund” based at the State Department. …”
(I admit: an “Emerging Trump Philosophy” sounds a bit odd)
FT – State department funding to take a hit from Trump cuts
“The budget would drastically reduce funding for social and development programmes such as HIV/Aids, malaria, sanitation, education, economic development and protections for the vulnerable. It would refocus spending on combating terrorism and include a “robust” $3.1bn for Israel, the lead US ally in the Middle East. …”
“Including contingency funding, the state department would receive $38bn in 2018, a fraction of the $603bn, a 3 per cent increase, proposed for defence spending.” (PS: WHO also got a 3 % increase this week, but we’re talking slightly different figures here …)
So CDC would also get a huge cut – which inspired Tom Frieden (former head of CDC) to the following remark:
“In essence, the proposed budget would force CDC to fight epidemics and health threats with both hands tied behind their back while wearing a blindfold.”
Devex – US budget chief explains deep foreign aid cuts
Fortunately, budget director Mick Mulvaney offered some insight into why the Trump administration sees fit to slash foreign aid spending, for us dummies who just don’t get it. “Speaking generally about programs slated for cutbacks, Mulvaney told reporters Monday that the White House is particularly skeptical of programs it feels haven’t sufficiently demonstrated a positive impact, as well as programs the U.S. Congress has not authorized with legislation.”
“…Mulvaney said this was “the first time in a long time an administration has written a budget from the perspective of people paying the taxes,” instead of from the perspective of the people implementing the programs they fund. The Trump White House prioritized programs not according to the number of people they purport to benefit, but by whether or not they could be justified to a hypothetical “family in Grand Rapids, Michigan,” the budget director said….”
The billions for weapons to the Saudis and Israel, on the other hand, have clearly demonstrated a “positive impact” in recent years, at least in the pre-Alzheimer brain of Trump et al.
Newsweek – Head of the African Development Bank – Trump’s foreign aid cuts could turn Africa into a “terrorist recruiting field”.
“The United Nations said on Wednesday that the Trump administration’s proposed budget cuts would ‘simply make it impossible’ for the global organization to maintain essential operations.” The statement came from a United Nations spokesman. American financial support for the United Nations would be reduced vastly, including for its peacekeeping operations and international aid programs, according the budget proposal.
Finally, related to the Trump global health news from last week:
WP – How a Trump order on abortion could hurt the fight against AIDS in Africa. “A Trump administration order took effect this week barring U.S. aid for global health organizations that discuss or provide referrals for abortion. But the new policy put another program in the crosshairs: America’s global HIV/AIDS effort….” “…Experts say Trump’s policy could especially affect girls and young women, who are now the most likely people to contract the disease.”
G20 health ministers summit in Berlin (19-20 May)
A couple of tweets perhaps to get the gist of this Declaration, and on the G20 health ministers meeting:
Kent Buse: “1st #G20Health declaration frames #globalhealth in security & public goods terms; less human development or rights”
First time – @WHO at a #G20 meeting – Margaret Chan speaking at opening of #G20Health – welcomes healthsystem focus For Chan’s keynote speech at the G20, see here. A trend that was also noticeable at the WHA, actually : increasing convergence of global health security agenda with UHC. In the words of Tim Evans: it’s not a trade-off.
The biggest risks to our health are not national, yet our cross-border governance structures are often weak #WHODG.
IP-Watch – No Free Lunch, G20 Health Ministers Find At First Meeting
(must-read report of the meeting). “Group of 20 health ministers today finished their first joint table top exercise to simulate the outbreak of a new deadly viral pandemic in “Anycountry” and passed a seven-page final resolution on pandemic preparedness and antimicrobial resistance. Non-governmental experts and health organizations welcomed the first ever meeting of health ministers in the G20 format, but see a risk of framing the debate from a global North security perspective. And despite a call of urgency with regard to antimicrobial resistance, the G20 could not agree to include the de-linking of the cost of investment in R&D from the price of medical products.”
As Kickbusch noted, Angela Merkel looked quite sternly when she told G20 Health ministers that “there is no such thing as a free lunch” when it comes to global health security & funding WHO for it. Still, most seem to think so far that a Big Mac will do just fine for lunch. Or one of these veggie wraps with lots of mayonnaise and few vegetables.
Ahead of the meeting in Berlin, G20 Health Ministers Receive Flurry Of Requests Ahead Of Their First-Ever Meeting (IP-Watch)
And a recommended piece by Marijke Wijroks (interim-CEO Global Fund) – Investment in health is the foundation for sustainable development. Wijroks eloquently made the case for G20 investment in health in this piece. “…This inaugural ministerial meeting signals a growing understanding that strong economies are the product of more than fiscal or trade policy. There are many avenues to achieve growth, and investing to end epidemics creates a rising tide that lift all boats.”
Last but not least, a quote from Angela Merkel – “I believe that health deserves a place on the G20 agenda in our networked world,” Chancellor Angela Merkel said in her opening speech. “It is a question of humanity that every man and every woman should have a fully functional health system to fall back on.
Second Annual Forum on Financing for Development (FfD) (till May 25)
“Innovative sources of financing are necessary to advance stalled progress on eradicating global poverty by 2030, United Nations ambassadors said Tuesday, cautioning that governments alone do not have the required funds to meet the Sustainable Development Goals on poverty, health, environment and justice. Member states gathered early this week at the U.N. for the second annual forum on financing for development, almost two years after the Addis Ababa Action Agenda, which established a framework for implementing the 2030 development goals. Their agreement etches out a range of issues — including gender equality and infrastructure investment — that require further investment in a bid to make good on the SDGs. U.N. member states reached an agreement on SDG financing on Tuesday, reaffirming their commitment to the 2030 Agenda for Sustainable Development but also recognizing “the global trajectory will not deliver the goal of eradicating poverty in all its forms by 2030,” said Marc Pecsteen de Buytswerve, Belgium’s U.N. permanent representative. The agreement specifically calls for government approaches to improve national tax systems, development banks to consider the impact investments could have on women and girls, and work to strengthen data collection on the value of unpaid work, among other measures….”
UN News – UN forum aims to ensure ‘promises made are promises kept’ on financing for development
Short report of the opening day of the meeting, with speeches etc.
“…Meanwhile, a new UN report launched today says that continued slow global economic growth would likely leave about 6.5 per cent of the world population extremely poor in 2030 without national actions supported by international cooperation….”
IISD – Governments Agree on FfD Forum Outcome
“Governments agreed on the conclusions and recommendations of the UN Economic and Social Council’s (ECOSOC) second Forum on Financing for Development Follow-up (FfD Forum), which were subsequently adopted during the Forum. Unlike the conclusions and recommendations of the first FfD Forum, which were short and strictly procedural, this year’s outcome tackles substantive issues. This year’s outcome tackles substantive issues, including the cross-cutting topics of climate change, gender equality, infrastructure and social protection.”
International Day to end Obstetric Fistula (23 May)
Lancet Global Health – Ending fistula within a generation: making the dream a reality
“1 year ago, on May 23, 2016, the International Day to End Obstetric Fistula, the then UN Secretary-General challenged the international community to end obstetric fistula within a generation. This is a goal not only worthy of but mandatory for achieving the Sustainable Development Goals (SDGs) by 2030….” Indeed, “Women and girls living with fistula are among the most “left behind”: the world must ensure that obstetric fistula is eliminated.”
On International Day, UN agency urges ‘hope, healing, dignity’ for fistula sufferers
“Obstetric fistula has largely been eliminated in developed countries, but more than two million women and girls still live with the condition, the head of the United Nations women’s health agency [today] said, calling for investment and support to eliminate the debilitating and stigmatizing condition. “With strong political leadership, investment and action, we can end this scourge in our lifetime,” the Executive Director of the UN Population Fund (UNFPA), Babatunde Osotimehin, said in his message for the Day….”
Some key reads of the week
Remark: the reports and other key reads related to (or released at) the World Health Assembly will be covered below, in the section on the WHA.
BMJ Analysis –Building resilient health systems: a proposal for a resilience index
M Kruk et al; http://www.bmj.com/content/357/bmj.j2323
You know this is a must-read. “Health system resilience begins with measurement of critical capacities ahead of crisis say Margaret E Kruk and colleagues.” They developed a resilience index.
The Lancet – Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015: a novel analysis from the Global Burden of Disease Study 2015
GBD 2015 Health Care Access and Quality Collaborators; http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30818-8/fulltext
Quality is now also on the GBD agenda. This new GBD study ranks health care access and quality for 195 countries, according to 32 diseases. The authors developed a Healthcare Quality and Access (HAQ) Index–on a scale of 0 to 100.
Read also the accompanying Comment in the Lancet – Account for primary health care when indexing access and quality.
Lancet – campaign against Factory Farming
Scott Weathers & Sophie Hermanns; http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31358-2/fulltext?elsca1=tlxpr
This open letter (by 200 + experts from very different sectors) urges WHO to take action on industrial animal farming. “Margaret Chan, the Director-General of WHO, spoke at last year’s World Health Assembly (WHA) to call for action from the international community on three “slow motion disasters” that she expected would soon “reach a tipping point where the harm done is irreversible.” These issues are climate change, antibiotic resistance, and the rise of non-communicable diseases. The election of a new Director-General at WHO this May brings an opportunity to set a new agenda. WHO has already taken leadership on the crises outlined by Chan, especially on antibiotic resistance. We believe that WHO now has the opportunity and mandate to take action on one issue that is essential to mitigating all three disasters: the rise of industrial animal farming….”
See also Devex.
Extremely important issue, and so I hope Tedros will take this up as soon as possible.
In somewhat related news, the Global Campaign to Stop the Machine was also kicked off this week. “We can feed an extra 4 billion people a year if we reject the bloated and wasteful factory farming systems that are endangering our planet’s biodiversity and wildlife, said farming campaigner Philip Lymbery on Monday night, launching a global campaign to Stop the Machine….”
IJHPM – Polycentrism in Global Health Governance Scholarship
“Drawing on an in-depth analysis of eight global health networks, a recent essay in this journal argued that global health networks face four challenges to their effectiveness: problem definition, positioning, coalition-building, and governance. While sharing the argument of the essay concerned, in this commentary, we argue that these analytical concepts can be used to explicate a concept that has implicitly been used in global health governance scholarship for quite a few years. While already prominent in the discussion of climate change governance, for instance, global health governance scholarship could make progress by looking at global health governance as being polycentric. Concisely, polycentric forms of governance mix scales, mechanisms, and actors. Drawing on the essay, we propose a polycentric approach to the study of global health governance that incorporates coalitionbuilding tactics, internal governance and global political priority as explanatory factors.”
Policy Practice (Brief ) – The Evolving Role of Political Economy Analysis in Development Practice
N McCulloch et al; http://thepolicypractice.com/wp-content/uploads/2017/05/PolicyBrief11.pdf
Very neat summary of big trends in international development. “In 2007 The Policy Practice issued two Policy Briefs on “Tackling the Political Barriers to Development: the New Political Economy Perspective” and “Making the New Political Economy Perspective more operationally relevant for development agencies” (Landell-Mills et al 2007; Williams et al, 2007). The present Brief summarises how this approach has evolved in the light of the major shifts in the development context over the last decade and draws out the implications for development practice going forward.”
Plos (blog) – Contemporary issues in global health
One of our heroes and he doesn’t disappoint in this blog. The first point even seems directed at me: “We don’t understand what Planetary Health is, but we know it’s important. ” The blog goes on about Bilateral/supranational bifurcation and ‘glocalism’; the securitization of health, …
Resilience – A House on Shaky Ground: Eight Structural Flaws of the Western Worldview
Not directly related to global health, perhaps, but the read of the week in our opinion. For each structural flaw of the western worldview, Lent also offers an alternative.
Guardian – Wealth redistribution and population management are the only logical way forward
(recommended) “Globalisation and trade have enabled too many countries to overshoot their capacities and run ‘ecological deficits’ with other nations.” Viewpoint based on planned de-growth (for developed countries).
Blog – Five minutes with Robert O Keohane: we shouldn’t fool ourselves by believing that global governance will soon be made democratic
That no doubt also goes for global health governance. But we need to keep trying. It’ll be a generation-long effort, so we hope the generation of the Emerging Voices will pull this off. “Can global governance through organisations such as the United Nations and the World Trade Organization ever be made properly democratic? In an interview with EUROPP’s editor Stuart Brown, Robert O. Keohane discusses the problems with establishing global democratic governance, the distinction between liberal constitutionalist achievements and democracy, and why we should be sceptical of claims that a global democracy is just around the corner.”
Global humanitarian crisis
“The number of unaccompanied child refugees globally has increased five-fold since 2010, according to new figures by UNICEF. In a report released late on [Wednesday], the United Nations Children’s Fund counted 300,000 unaccompanied and separated children worldwide in 2015 and 2016 – up from 66,000 in 2010 and 2011….”
“From Libya to Syria, grinding conflicts in North Africa and the Middle East have damaged health infrastructure and compromised water and sanitation services, threatening the health of 24 million children, the United Nations Children’s Fund (UNICEF) warned today. “Violence is crippling health systems in conflict-affected countries and threatens children’s very survival,” said Geert Cappelaere, UNICEF Regional Director for the Middle East and North Africa. “Beyond the bombs, bullets and explosions, countless children are dying in silence from diseases that could easily be prevented and treated.”…”
Guardian – Business as usual isn’t enough: we need a new approach to humanitarian crises
Assessment one year after the world humanitarian summit in Istanbul. Recommended read.
See also UN News – One year after humanitarian summit, UN stresses reforms to put people ‘at heart’ of decision-making – UN News
Guardian – Outnumbering refugees two to one: how the world ignores war’s greatest scandal
“Conflict, violence and natural disasters forced more than 31 million people to leave home and settle elsewhere within their countries last year, the equivalent of one person every second. But while the number of people uprooted by conflict outnumbers refugees by two to one, they have been largely ignored by the international community, according to a report by the Norwegian Refugee Council’s Internal Displacement Monitoring Centre.”
Coming up this weekend: G7 (Taormina) summit in Italy
Special feature full of analysis – http://www.g8.utoronto.ca/newsdesk/taormina/index.html
See for example John Kirton’s analysis ahead of this meeting. “Three pillars underpin Italy’s G7 presidency, supporting the mission of putting citizens first. … .. Together the leaders will address Italy’s formal agenda of, first, citizen safety; second, economic, environmental and social sustainability, and the reduction of inequalities; and, third, innovation, skills and labour in the age of the next production revolution. The first pillar begins with the management of “human mobility”, framed not as an economic benefit but a security threat, and covers stability in the proximate sub-Saharan African and Middle East and North Africa regions, and the prevention of terrorism. The second pillar consists of inclusive growth, energy and climate change, food security and nutrition, health, women’s and girls’ economic empowerment and education, with the traditional topic of trade, which does not have a place of its own. …” In short, “Taormina will thus be primarily a security summit, with development and especially the economy taking a secondary place.”
I have a hunch global health won’t be very prominent, even if I agree with Ilona Kickbusch that global health needs to pay urgently more attention to migration. But presumably not the way it is framed here, mainly as a security concern…
This Foreign Policy article certainly doesn’t bode well – Trump advisor Stephen Miller blocked G7 migration proposal.
And of course we’ll also be watching out for an American stance on the Paris climate agreement. Will they stay in or pull out? Or just postpone their decision indefinitely?
Ebola outbreak in DRC
Lancet World Report – Ebola outbreak in the DR Congo
“International agencies are implementing response protocols after an Ebola virus disease outbreak was confirmed in the DR Congo. Andrew Green reports.”
Reuters – Tackling Ebola outbreak in remote Congo presents huge challenge: WHO
WHO news from late last week. “…Peter Salama, the WHO’s executive director for health emergencies, said the agency’s risk assessment on the outbreak was that it is high at a national level, medium at African regional level and low at global level. However, he added: “We cannot underestimate the logistic and practical challenges associated with this response in a very remote and insecure part of the country.”
However, this week Stat News reported – Ebola outbreak may be smaller than feared, WHO indicates. “…Given what appears to be the limited scope of the outbreak, the use of an experimental Ebola vaccine may not be required.”
FT – Congo to test experimental vaccine as disease re-emerges
Nevertheless, “Health authorities in the Democratic Republic of Congo are preparing to use an experimental vaccine to help fight an outbreak of Ebola, in what could be an important step towards getting regulatory approval for the world’s first vaccine against the deadly virus…”.
See also Science News – Vaccine could soon be enlisted in the fight against Ebola in the DRC. “The Democratic Republic of the Congo has moved a step closer to using an unlicensed vaccine to battle an Ebola outbreak that began last month in a remote northeastern part of the country. Yesterday, the country’s government submitted a formal vaccine trial protocol, developed with Epicentre, the Paris-based research arm of Doctors Without Borders (MSF), to an ethical review board. If the plan gets the green light, the first doses of the vaccine could go into the arms of people at risk within 2 weeks, according to an official at the World Health Organization (WHO) in Geneva…”
It might not be necessary, though.
Cholera in Yemen
Guardian – Scientists race against time as Yemen’s deadly cholera outbreak spirals
The cholera situation in Yemen is extremely concerning. “As Yemen’s cholera outbreak gathers pace, an investigation is under way to determine whether a new and more deadly strain of the disease is responsible for a second wave of cases that hit the country last month….”
See also Humanosphere – Humanitarians alarmed by rapid spread of cholera in Yemen.
And UN News reports – Senior UN official appeals for aid to stop ‘unprecedented’ spread of cholera in Yemen.
Coming up: Family planning summit in London (July 11)
Devex – Plans for major family planning summit take shape in Europe as US cuts back
“Work is underway for a repeat of a major reproductive health summit, which raised $2.6 billion when it was first held in 2012, as the international community braces itself for the knock-on effects of the United States cuts to family planning services. The 2017 London Summit on Family Planning will be held in London, United Kingdom on July 11, organized by the U.K. Department for International Development, the United Nations Population Fund and the Bill & Melinda Gates Foundation. It is designed to accelerate progress towards the Sustainable Development Goal of universal access to sexual and reproductive health by 2030.”