Laurie Garrett – Global Health in a Populist and Nationalist Age
From late last week, but an absolute must-read (if you haven’t done so yet). Laurie Garrett explores the new ( and rather difficult) ‘environment’ for global health.
She ends like this: “…. Global health should not be a matter of endless charity, political whim, profiteering, or philanthropic trendiness. Health is a right, which must be demanded from the bottom up, and achieved through the largesse, skills, and commitment of all, sharing and hoping for the future of humanity. Period.”
Do read also Anne Slaughter’s – in the words of Kent Buse – “Perceptive if pessimistic analysis of prospects for rules-based multilateralism & UN” – The return of anarchy? (recommended) “…The next four to eight years may well see the end of the United Nations as a serious forum for global decisionmaking about peace and security….”
We also think the near future will be one of regional blocks (or worse) rather than multilateralism – especially if Trump & the GOP get a second term.
Meanwhile, make sure you also read (Oxfam’s) Duncan Green’s On Populism, Nationalism, Babies and Bathwater – Duncan reports on a recent conversation with Oxfamers who were over from the US. “How should ‘we’ – the aid community broadly defined – respond to the rising tide of nationalism, populism, and attacks on aid?” Must-read.
Duncan concludes: “…Concerned that the development community could jump into current northern battles on populism, Brexit etc not primarily because doing so is vital to helping the world end poverty in the long term, or because the issues that matter have suddenly become universal, but because the values of northern activists push them to get involved for personal reasons. If that happens, we risk forfeiting our legitimacy, which in the eyes of northern publics and policy makers is rooted in our links with and understanding of events in the South. And what do we gain if ‘Going Northern’ doesn’t add much to the existing progressive forces in the North? And although many issues like equal rights, inequality etc are universal, some things (like famine) are not….”
At least a question worth pondering indeed, also for the global health community.
Humanosphere – Gates Foundation’s rose-colored world view not supported by evidence
Martin Kirk & Jason Hickel; http://www.humanosphere.org/opinion/2017/03/gates-foundations-rose-colored-world-view-not-supported-by-evidence/
(must-read) “The annual public letter from Bill and Melinda Gates has become a much-celebrated event in the global development calendar. But lost in the excitement around this year’s letter is the fact that it uses 6,000 words to paint a picture that is so selective in its use of facts that it amounts to little more than propaganda for a failing aid and development industry, and indeed a failing ideology. And the 2017 letter is especially striking for just how out-of-sync it feels with the zeitgeist.” Kirk & Hickel rip the annual letter from the Gates Foundation apart, while acknowledging the good the Foundation has done and is still be doing.
But read also Charles Kenny’s reply (CGD) – Really, Global Poverty *Is* Falling. Honest. You won’t regret it.
Bill Gates meets with Donald Trump (part two) – 20 March
After Trump’s election victory, Gates already met with him ( in Trump Tower). On Monday, Bill went to the White House.
We recommend the following two pieces (published ahead of the meeting):
“Two American billionaires with extremely divergent worldviews are engaging in a quiet war of rhetoric about global health and development. One is Bill Gates; the other is Donald Trump. [On Monday], Gates is scheduled to meet with the president. And ahead of that meeting, Gates has been putting out articles and letters that seem like thinly veiled arguments against Trump’s “America First” approach to foreign aid.” (for example in Time magazine)
Quartz – We’re wondering what exactly Bill Gates and Donald Trump will have to talk about tomorrow The tone has changed (as compared to December, when Gates was sort of dreaming that Trump would turn out a new JF Kennedy), but “Gates is, however, among the few tech industry leaders still trying to talk to the president. “
As for the meeting itself, rather little information was released afterwards (by both parties). See Bloomberg :
“President Donald Trump met with Microsoft Corp. co-founder Bill Gates at the White House on Monday, just days after releasing a budget proposal that would impose deep cuts on funding for many of the causes championed by the billionaire philanthropist. White House spokesman Sean Spicer said the two spoke about their “shared commitment to finding and stopping disease outbreaks around the world.” Gates, who wrote an article saying cuts to foreign aid Trump proposed would make America “less safe,” didn’t speak to reporters afterward. … … Sarah Logan, a spokeswoman for the foundation, said in a statement after the meeting that the organization “has a long history of working with officials on both sides of the aisle to pursue shared priorities like global health and development and domestic education.””
As so little information is available on what the two (gentle)men (?) discussed, I jotted down an imaginary conversation between the two (on IHP) – Bill Gates teaches Donald Trump on the many merits of foreign aid for America – Lesson 1. If anybody feels like writing down other lessons (or even a whole tutorial for The Donald), be our guest!
World TB Day – Friday 24 March
“2017 is the second year of a two-year “Unite to End TB” campaign for World TB Day. This year, WHO will place a special focus on uniting efforts to “Leave No One Behind”, including actions to address stigma, discrimination, marginalization and overcome barriers to access care.” “…Last year, WHO reported that 10.4 million people fell ill with TB and there were 1.8 million TB deaths in 2015, making it the top infectious killer worldwide.”
WHO – WHO issues ethics guidance to protect rights of TB patients
“New tuberculosis (TB) ethics guidance, launched today by the World Health Organization (WHO), aims to help ensure that countries implementing the End TB Strategy adhere to sound ethical standards to protect the rights of all those affected….”
Guardian – Decades of TB progress threatened by drug-resistant bacteria, warn experts
“The rise of multi-drug resistant bacteria threatens to overturn decades of progress on tuberculosis (TB), experts are warning. Multi-drug resistant (MDR) and extensively drug-resistant (XDR) strains of TB are causing increasing concern, says a new report in the Lancet Respiratory Medicine journal. Migration and travel mean that drug-resistant cases of tuberculosis that are difficult to treat have appeared in almost every part of the world.”
“In a comment piece in the journal Dr David W Dowdy, from the Johns Hopkins Bloomberg School of Public Health in the US, said the report described an epidemic that is at a crossroads….” “…Over the next decade, it is quite possible that we will see a drug-resistant tuberculosis epidemic of unprecedented global scale. But it is also possible that the next decade could witness an unprecedented reversal of the global drug-resistant tuberculosis burden. The difference between these two outcomes lies less with the pathogen and more with us as a global tuberculosis control community and whether we have the political will to prioritise a specific response to the disease. Drug-resistant tuberculosis is not standing still; neither can we.”
For the new Lancet Respiratory Medicine report – see here. The Lancet Respiratory Medicine Commission “focuses on multidrug-resistant, extensively drug-resistant, and incurable tuberculosis, and highlights the growing burden of disease, the implications for patient management, as well as social and legal aspects”.
Read also a Lancet (Comment) – Reducing global tuberculosis deaths—time for India to step up “As another World Tuberculosis Day passes by the outlook for tuberculosis control is far from optimistic, especially for India, the ground zero for the global epidemic.”
And finally, a Lancet World Report – New plan to end tuberculosis in south and southeast Asia “Health ministers from south and southeast Asia agreed to fast-track strategies to eliminate tuberculosis by 2030 at a WHO regional meeting in Delhi last week. Dinesh C Sharma reports.”
Trump & US health care
It’s clearly not a walk in the park – repealing Obamacare. It turns out a very difficult balancing act for the GOP leadership & Trump to keep enough GOP conservatives ànd moderates on board in order to get the required number of votes.
Ahead of an important vote in the House (on Thursday), (NYT) House Republicans rolled out amendments to their plan to replace the ACA. (see also Reuters or FT – Party makes last-ditch effort to bridge divisions and keep Trump’s promise on track : “Republicans seeking to keep Donald Trump’s healthcare overhaul on track have made a series of last-ditch changes to their plans as they struggle to unite the party behind them. Party leaders on Monday night announced revisions to their healthcare bill in an effort to bridge the divide between conservatives and moderates ahead of a planned vote in the House of Representatives on Thursday. Divisions within the party are threatening Mr Trump’s progress not just on healthcare but also in other areas, including tax reform….”
On Wednesday, Trump himself also made a last-ditch pitch to Republicans to back the healthcare bill (Guardian). See also NYT or FT – Trump warns Republicans to support health law (or lose their seats in 2018).
Guardian – House plans Friday healthcare vote as Trump gives ultimatum to Republicans
(must-read) And this is the latest state of affairs. Friday looks set to be D-Day now (for the House). “Emissaries for Donald Trump have told Republicans that the president was done negotiating over healthcare legislation and that the House of Representatives must vote on the current bill Friday or he would leave the Affordable Care Act in place. White House budget director Mick Mulvaney reportedly told a conference of House Republicans: either vote or lose your chance to replace Obamacare. For their part, the Republican leadership announced a series of votes for Friday, including one on an amendment to repeal essential health benefits in Barack Obama’s signature law. A vote on the full bill was planned for later on Friday, , after a vote initially planned for Thursday was delayed. “ Still not clear whether the bill has the votes to pass. And then it still has to go to the Senate (where the GOP’s majority is smaller).
See also Vox – The Republican health care plan is totally nuts (also with an eye on the Senate already)
Trump & global health
To start this section, by now a sorry fixture in this newsletter, we remind you of Trump’s “brand new image”: during a joint press conference with German Chancellor Angela Merkel last week on Friday, Trump denied he was “an isolationist”, rather he’s “a free trader, but also a fair trader“. Ahum.
Foreign Policy – Trump’s America First budget puts Africa last “Slash-and-burn cuts to the State Department and USAID would deepen the worst humanitarian crisis since World War II.”
Perhaps providing a little bit of comfort, Senate Majority Leader (GOP) Mitch McConnell rejected in an AP interview Trump’s foreign aid cuts. For what it’s worth. As for the rising resistance to Trump’s budget blueprint, see also Humanosphere – Congressional resistance leaves Trump’s foreign aid cuts ‘dead on arrival’. (good overview from late last week)
Also the US military emerge as a key voice in the budget debate (Devex). (info on two defense-related congressional hearings this week) See also Military Leaders on Capitol Hill Today Push to Protect State Department, USAID Budget.
Laurie Garrett (CFR) – Trump 2018 Budget Proposal: What We Know (And Don’t Know) Breakdown based on the info available. (Must-read) See also KFF for this tentative (global health & development, soft power, …. ) breakdown. We already covered the (likely) key global health (programme) implications of Trump’s budget blueprint in last week’ IHP newsletter.
Foreign Policy – Trump administration eyes $1 billion in cuts to UN peacekeeping; The White House also targets hundreds of millions in funding for U.N. programs for children and the poor.
“…The White House budget office informed State Department officials this week that the administration plans to eliminate all U.S. funding to the $326 million International Organizations and Programs account, which provides more than $130 million to the U.N. Children’s Fund, a sizeable chunk of the more than $500 million the U.S. contributed to UNICEF in 2016, and around $70 million to the U.N. Development Program. They were also told to brace for a 40 percent cut to the State Department’s U.N. peacekeeping budget. The U.S. contributed over $2 billion to the U.N.’s $8 billion-plus peacekeeping budget last year. The proposed cuts, which were drafted by the White House Office of Budget and Management, show that the Trump Administration is seeking far deeper cuts to the U.N. in the international affairs budget than to the State Department or USAID.”
Some of the news perhaps less covered last week:
“Buried in the cuts to science and public health in President Trump’s newly released budget blueprint is a longtime conservative proposal to award lump sums of money to states – block grants – to let them decide how to respond to public health issues such as the Zika virus. That proposal is “a really bad idea,” according to Dr. Tom Frieden, who until this past January was director of the U.S. Centers for Disease Control and Prevention….”
- NYT – Article on (the devastating) impact of Trump’s budget on the Fogarty International center. This center is dedicated to supporting global health research. See also Stat – Trump proposes shuttering NIH program that promotes medical research overseas. Extraordinarily foolish, many scholars reckon.
- Devex – Digging deep: How Trump’s budget affects everything from local jobs to foreign stability Helicopter view analysis – and well worth a read.
- Washington Post – When the US funds global health, other countries do too Not that sure about this argument from Amy Patterson. See her forthcoming book Dependent Agency in the Global Health Regime: Local African Responses to Donor AIDS Efforts.
- US lawmakers united in condemnation of plan to discontinue ‘life-changing’ aid programme that has provided food for 40 million children in poor countries (Guardian – on the McGovern-Dole Food for Education program)
You might also want to listen to a CGD podcast (with Amanda Glassman & Scott Morris) – What Do the Trump Administration’s Budget Cuts Mean—and What Do They Mask? – Podcast with Scott Morris and Amanda Glassman “…Major global health programs, such as PEPFAR (on HIV/AIDS) and US contributions to the vaccination alliance GAVI, appear to be safe. Yet CGD senior fellow Amanda Glassman worries about other areas, including family planning, which she wrote about after the administration issued an executive order cutting funding for foreign family planning services, and the US role in ensuring global health security. “The budget did have a callout for an emergency response fund in case of outbreaks, but I understand that to be just for domestic use,” she tells me. “Really we have to think about fighting disease over there so it doesn’t come here. This is a global undertaking.”
JAMA – Presidential Immigration Policies- Endangering Health and Well-being?
L Gostin et al ; http://jamanetwork.com/journals/jama/fullarticle/2613724
“This Viewpoint discusses President Trump’s executive orders on US immigration policy and how they could affect health care, health systems, and public and global health.”
As for Trump’s “slash & burn” impact on planetary health, see the ‘planetary health’ section.
Lancet Public Health – Implementation of key demand-reduction measures of the WHO Framework Convention on Tobacco Control and change in smoking prevalence in 126 countries: an association study
“A new study assesses the association between the implementation of key tobacco control measures and change in smoking prevalence in 126 countries.” It turns out the global tobacco control treaty (WHO FCTC) has indeed reduced smoking rates in its first decade, but (a lot) more work is needed.
“…The global tobacco control treaty has increased the adoption of tobacco reduction measures around the world, which has led to a 2.5% reduction in global smoking rates” (a significant change).
Read also the accompanying Lancet Public Health Comment – Understanding the association between the WHO Framework Convention on Tobacco Control, adoption of tobacco control policies, and reduction in smoking prevalence
Plus the Lancet Public Health Editorial – The power of a treaty :
“… in their study published in The Lancet Public Health, [the authors] looked at the association between the change in countries’ implementation of five key measures (increased taxes on tobacco products; protection of people from tobacco smoke; health warnings; enforcement of bans on tobacco advertising, promotion, and sponsorship; and cessation aid) and the change in smoking prevalence in those countries from 2005 to 2015. Their results are clear: countries’ implementation of these key measures is associated with a decrease in smoking. Importantly, the more interventions, the larger the effect: overall, each additional measure implemented at the highest level was associated with a reduction in smoking prevalence of 1·57%. On average, smoking rates across all 126 countries went down from 24·7% in 2005 to 22·2% in 2015. These results are important because they show the potential of tobacco control measures to reduce tobacco use, they do validate the importance of such treaty and the public health impact it can have in countries.”
“…From April, the FCTC 2030 project will support WHO FCTC Parties that are eligible to receive official development assistance to achieve the SDGs by advancing implementation of the FCTC. The project will provide extra technical support to aid governments in developing countries to advance tobacco control. It aims to address the drastic disparities between countries with many low-income and middle-income countries struggling under the weight of the tobacco epidemic. Control of the tobacco epidemic is essential for countries worldwide. Not only can it have devastating health consequences but also the tobacco epidemic costs countries’ economies enormously through increased health-care costs and decreased productivity. “Tobacco—a threat to development” will be the theme of this year’s World No Tobacco Day on May 31. The campaign aims to “demonstrate the threats that the tobacco industry poses to the sustainable development of all countries, including the health and economic well-being of their citizens””
Sustainable Development Solutions Network (SDSN)- World Happiness Report 2017
Launched on the International Day of Happiness, 20 March. You find the exec summary here. (2 pages only) Some key messages: Norway tops the ranking, happiness is both personal and social; much of Africa is struggling, China’s people are no happier than 25 years ago, and happiness has fallen in the US.
See also UAE takes happiness global with new council “The Ruler of Dubai has announced the formation of the World Happiness Council, headed by a Columbia professor. Headed by Columbia University Professor Jeffrey Sachs, the 12-member council will focus on six key areas: health, education, environment, personal happiness, happy cities and community standards for happiness, each with its own sub-council chaired by a different member of the team. “The council aims to support international goals to standardise happiness as a measure of development, as we are doing in the UAE,” Sheikh Mohammed noted on his Twitter account. The council will be tasked with compiling an annual Global Happiness Report, highlighting international practices and achievements with regards to happiness and happiness research. … ”
As “the Smurfs” are now officially also enrolled for the SDGs – see “Ahead of International Day, UN and Smurfs team up to promote happiness and sustainable development” (UN News), it’s fair to say that Jeffrey Sachs is from now on ‘Big Smurf’. Jeffrey has to lead the world towards ‘Smurfdom’. Gargamel can be found in the White House (among others).
PS: The Economist reported (in a nice blog on this new World Happiness Report) – Mental illness is a better predictor of misery than poverty is (in the rich countries at least. And they thus conclude: “In rich countries at least, investing in care for mental illness provided the best return (as measured by happiness gains) on public expenditure.”) Not much attention for the link between mental illness & poverty though…
UNDP- Human Development report 2016: Human Development for everybody
“A quarter-century of impressive human development progress continues to leave many people behind, with systemic, often unmeasured, barriers to catching up. A stronger focus on those excluded and on actions to dismantle these barriers is urgently needed to ensure sustainable human development for all. …. … The report finds that although average human development improved significantly across all regions from 1990 to 2015, one in three people worldwide continue to live in low levels of human development, as measured by the Human Development Index.”
See UN News for a quick overview of key messages- Despite progress, world’s most marginalized still left behind – UN development report.
Coverage and analysis in the Guardian – Identity politics and intolerance a barrier to development, says UN report.
“… The annual human development index said that at a time when global action and collaboration were imperative in achieving the sustainable development goals by 2030, exclusion and intolerance could prevent progress reaching everyone. “Brexit is one of the most recent examples of a retreat to nationalism … ” the report said. “Intolerance of others in all its forms – legal, social or coercive – is antithetical to human development.” Overall, the report said, millions of women, indigenous peoples and ethnic minorities continue to be excluded from a quarter-century of impressive global progress on human development. There have been significant achievements worldwide between 1990 and 2015, including the halving of the under-five mortality rate and ending extreme poverty for a billion people. But systemic discrimination – in both developed and developing countries – has left the world’s most marginalised groups behind, with the gap set to widen unless “deep-rooted barriers” to development are removed, the United Nations Development Programme (UNDP) 2016 human development report found.”
See also Humanosphere – Global progress hides crippling inequality and suffering, U.N. report says. and IP – Watch – UN Development Programme Calls For Reform Of IP And Investor Protection Regimes.
IISD – UN Establishes Inter-Agency Coordination Group on AMR
All you need to know about the (end of last week established) UN Inter-agency coordination group on AMR. “UN Secretary-General António Guterres announced the establishment and membership of an ad hoc inter-agency coordination group on antimicrobial resistance. The group, chaired by Amina Mohammed, UN Deputy Secretary-General, and Margaret Chan, WHO Director-General, will convene its first meeting shortly and report to the UN Secretary-General during the UNGA’s 73rd session.“
“…Amina Mohammed, UN Deputy Secretary-General and co-chair of the group, said AMR poses a “formidable threat” in the attainment of the SDGs, particularly in developing countries, noting that if “superbugs” are not stopped, SDG targets will likely not be met by 2030.
Health Systems & Reform –Taking Results Based Financing from Scheme to System
Z C Shroff, Nhan Tran, B Meessen, M Bigdeli & A Ghaffar; http://www.tandfonline.com/doi/full/10.1080/23288604.2017.1302903
Introduction to a special issue.
“Over the last 15 years, a growing number of low- and middle-income countries (LMICs) have adopted Results-Based Financing (RBF) approaches for their health sectors. This special issue presents key findings from the research program “Taking Results-Based Financing from Scheme to System.” The issue includes four case studies on RBF in LMICs, and three cross-cutting articles—one on reframing RBF and two on scaling RBF up from projects and schemes to its integration into national health systems….”.
Make sure you also read the rest, starting with part two From Scheme to System (Part 2): Findings from Ten Countries on the Policy Evolution of Results-Based Financing in Health Systems.
WHO Bulletin – Understanding and measuring quality of care: dealing with complexity
J Hanefeld et al; http://www.who.int/bulletin/online_first/BLT.16.179309.pdf?ua=1
“Existing definitions and measurement approaches of quality of health care often fail to address the complexities involved in understanding the quality of care. It is perceptions of quality, rather than clinical indicators of quality, that drive service utilization and are essential to increasing demand. Here we reflect on the nature of quality, how perceptions of quality influence health systems and what such perceptions indicate about measurement of quality within health systems. We discuss six specific challenges related to the conceptualization and measurement of the quality of care: perceived quality as a driver of service utilization; quality as a concept shaped over time through experience; responsiveness as a key attribute of quality; the role of management and other so-called upstream factors; quality as a social construct coproduced by families, individuals, networks and providers; and the implications of our observations for measurement….”
World Water Day – March 22
Guardian – World Water Day: one in four children will live with water scarcity by 2040
“One in four of the world’s children will be living in areas with extremely limited water resources by 2040 as a result of climate change, the UN has warned. Within two decades, 600 million children will be in regions enduring extreme water stress, with a great deal of competition for the available supply. The poorest and most disadvantaged will suffer most, according to research published by the children’s agency, Unicef, to mark World Water Day on Wednesday….”. For the UNICEF report, see here.
Some other links & tweets related to World Water Day:
Reuters – Governments must recognise wastewater as resource – U.N. “Wastewater from households, industries and agriculture should not be seen as a problem but a valuable resource which could help meet the demands for water, energy and nutrients from a growing global population, a U.N. water expert said. Globally, more than 80 percent of wastewater is released into rivers and lakes without treatment with a negative impact on health and the environment, according to the 2017 U.N. World Water Development Report published on Wednesday.… … But wastewater contains nutrients such as phosphorus and nitrates which can be turned into fertiliser, said Richard Connor, editor-in-chief of the report.”
WHO DG election campaign
All three candidates are campaigning hard. Still, it was a bit Sania Nishtar’s week, we felt.
- First she got to answer some questions in the weekly FT health newsletter (the other two candidates will follow soon) (among others, she stressed being a change maker throughout her career & that she wants to scale up the health emergencies programme).
“I will definitely scale up the health emergencies programme. Exercising stewardship to protect the world against infectious threats is WHO’s exclusive mandate. … …My New Vision for WHO hinges on leveraging its comparative advantages and normative role, which will involve stepping back from noncore roles, in any case.”
- And then she got a big forum on Global Health Now in a series of Q&A (must-reads!!)
Check out also her new vision for WHO.
Global Health Now – The Changemaker: WHO DG Candidate Sania Nishtar’s Q&A, Part I “The next WHO Director-General needs be a changemaker, a campaigner who can meet with heads of state on critical health issues and persuade them to “get it done,” says Sania Nishtar, one of 3 finalists in the running to lead the organization.”
Global Health Now – Culture Change: WHO DG Candidate Sania Nishtar’s Q&A, Part II “A focus on core priorities, a culture based on accountability and cost effectiveness, and a revamped funding process for WHO are some of the key changes Sania Nishtar says she would undertake if elected as Director-General of the WHO.”
Global Health Now – The Politics of Global Health: WHO DG Candidate Sania Nishtar’s Q&A, Part III
““WHO is entering a new era of responsibilities, where a political role assumes great importance—and it must realign and reconfigure,” says Sania Nishtar, one of three finalists in the race for DG. The future, Nishtar says, demands that WHO deal more directly with heads of government whose decisions in finance, trade, IP [intellectual property], investment treaties, food, migration, etc. have major impacts on global health.”
As for the other two (who will surely also get their spot in the limelight in the coming weeks), David Nabarro seems to be on a world tour (he met with Theresa May, among others, and was happy with Boris Johnson’s backing as well ), and do read Tedros’ view in Devex – Putting people first at the WHO — from ill health to public health emergencies.
New WHO Leader Will Need Human Rights to Counter Nationalistic Populism
Eric Friedman & Larry Gostin; https://www.hhrjournal.org/2017/03/new-who-leader-will-need-human-rights-to-counter-populism/?platform=hootsuite
Must-read. “The need for WHO leadership on human rights—and for global leadership on health and human rights beyond WHO—has always been present, yet has become ever more pressing. A reactionary, nationalist populism has been gaining momentum, particularly in the United States and parts of Europe, and some of its most disturbing features, such as xenophobia and disregard for international law and institutions, are surfacing elsewhere. Persisting health challenges—such as immense national and global health inequities, with universal health coverage and the Sustainable Development Goals offering some hope of lessening them—and growing threats such as outbreaks of infectious disease, worsening antimicrobial resistance, and climate change demand the type of leadership that the right to health entails. In this immensely challenging environment, WHO needs to become a 21st century institution that has the gravitas and credibility to carve a path through these obstacles towards global health justice. The next WHO Director-General, to be elected in May, must lead the organization there.” Enter the Framework Convention on Global Health which should get the firm support from the next WHO DG, they say.
WHO – 3rd Global Disease Resource Tracking meeting (20-24 March)
“WHO is hosting the 3rd Global Disease Resource Tracking meeting in Geneva between 20–24 March 2017. This year, we are combining data work sessions with country teams (March 20-23), with the establishment of a Consortium on Tracking Disease-Specific Expenditures (March 24-25).”
Stat News – Facing significant yellow fever outbreak, Brazil appeals for more vaccine
“Brazil, in the grips of an unusually large yellow fever outbreak, has asked for millions of doses of vaccine from an international emergency stockpile. The body that maintains and manages the stockpile, the International Coordinating Group on Vaccine Provision, has approved the release of more than 3.5 million doses of the vaccine, according to the Brazilian office of the Pan American Health Organization. The office said the vaccine should arrive in Brazil over the next few days. The request signals public health officials’ increasing concern over the scale of Brazil’s outbreak. The country is already home to one of four yellow fever vaccine manufacturers in the world, and it normally produces enough to meet its own needs. But since last December, Brazil has recorded a larger-than-normal number of cases of yellow fever. And as cases have crept ever closer to two of the country’s largest cities — Rio de Janeiro and São Paulo — there have been fears that the disease could start to spread in these cities and, from them, to other parts of the Americas….”
Another excerpt perhaps: “…The virus normally spreads in what is known as a jungle or sylvatic cycle, with transmission between Haemagogus mosquitoes and monkeys. Occasionally a person becomes infected, but human cases are generally rare in the jungle cycle. But if the virus finds its way into cities, it can infect Aedes mosquitoes, which live in close proximity to people, and that can trigger a cycle of hard-to-contain urban yellow fever. Given the severity of the disease, the specter of urban yellow fever alarms public health officials. Still, the World Health Organization said last week that to date there is no evidence that Aedes mosquitoes are spreading the virus.”
Meanwhile, in other yellow fever vaccination news, CDC is evaluating the use of fractional dose vaccinations (in the DRC).
Science March – Science march on Washington, billed as historic, plagued by organizational turmoil
“…At the heart of the disagreements are conflicting philosophies over the march’s purpose. In one corner are those who assert that the event should solely promote science itself: funding, evidence-based policies, and international partnerships. In another are those who argue that the march should also bring attention to broader challenges scientists face, including issues of racial diversity in science, women’s equality, and immigration policy.”
Social Science & Medicine – Health inequities in the age of austerity: The need for social protection policies
Arne Ruckert & Ronald Labonté; http://www.sciencedirect.com/science/article/pii/S0277953617301752
“This commentary assesses the impacts of the global austerity drive on health inequities in the aftermath of the global financial crisis of 2008. In doing so, it first locates the origins of austerity within the 40 year history of neoliberal economic orthodoxy. It then describes the global diffusion of austerity since 2008, and some of its key policy tenets. It next describes the already visible impacts of austerity-driven welfare reform on trends in health equity, and documents how austerity has exacerbated health inequities in countries with weak social protection policies. We finally identify the components of an alternative policy response to the financial crisis than that of austerity, with specific reference to the need for shifts in national and global taxation policies and public social protection policies and spending. We conclude with a call for a reorientation of public policy towards making human health an overarching global policy goal, and how this aligns with the multilaterally agreed upon Sustainable Development Goals.”
Guardian – Rotavirus vaccine could save lives of almost 500,000 children a year
“A vaccine capable of enduring scorching temperatures for months at a time could strike a decisive blow in the fight against rotavirus, preventing nearly half a million children around the world from dying of diarrhoea each year. Médecins Sans Frontières (MSF) has hailed successful trials of the BRV-PV vaccine in Niger as a “game changer” in tackling rotavirus infection, which is the leading cause of severe diarrhoea globally and claims the lives of an estimated 1,300 children daily, most of them in sub-Saharan Africa.” “It must be approved by the World Health Organization before it can be widely distributed, a process that is underway…” (see also NYT ).
See the study in NEJM – Efficacy of a Low-Cost, Heat-Stable Oral Rotavirus Vaccine in Niger.
For the broader picture (including on GAVI’s role, prequalification, … ), we also recommend reading the NEJM Editorial –A new hope .
WHO/UNICEF – From coast to coast: Africa unites to tackle threat of polio
“More than 190 000 polio vaccinators in 13 countries across west and central Africa will immunize more than 116 million children over the next week, to tackle the last remaining stronghold of polio on the continent. The synchronized vaccination campaign, one of the largest of its kind ever implemented in Africa, is part of urgent measures to permanently stop polio on the continent. All children under five years of age in the 13 countries – Benin, Cameroon, Central African Republic, Chad, Côte d’Ivoire, Democratic Republic of Congo, Guinea, Liberia, Mali, Mauritania, Niger, Nigeria and Sierra Leone – will be simultaneously immunized in a coordinated effort to raise childhood immunity to polio across the continent.”
Europe’s treatment of child refugees ‘risks increasing radicalisation threat’
It’s sad that increasingly, we have to frame it like this to get the attention of right wing top politicians in Europe. “Europe’s “abysmal” treatment of refugee children, who have made up about a third of those seeking asylum on the continent over the last two years, will increase the danger of their later radicalisation and drift into criminality, a damning report from the Council of Europe has said. A system that allows the sexual and physical abuse of children in overcrowded detention centres, where they are often separated from their families, will only condemn Europe to trouble in the future the report warns.”
G20 & health
Science 20 Dialogue – Improving global health strategies and tools to combat communicable & noncommunicable diseases
Some concise recommendations on global health for Angela Merkel, from Science 20 Academies. Both short-term & long-term evidence based strategies are needed, they say.
See also Science academies of the G20 states have joined forces to highlight the global challenge of diseases that endanger global health and threaten the global economy. “In a joint statement – delivered today to Chancellor Angela Merkel – the academies offer strategies and tools to tackle communicable and non-communicable diseases and to strengthen public health systems. The joint document provides a basis for the G20 Summit consultations.”
Global Policy (Working paper) – Corporate influence on the G20: The case of the B20 and transnational business networks
“Over the past eight years, the G20 has emerged as one of the most prominent political fora for international cooperation. For transnational corporations and their national and international associations and lobby groups, the G20 process provides important opportunities to engage with the world’s most powerful governments, shape their discourse, and influence their decisions. For this purpose, business actors have created a broad network of alliances and fora around the G20, with the Business20 (B20) as the most visible symbol of corporate engagement. A new working paper published by GPF and Heinrich-Böll-Stiftung maps out the key business players and associations from the different sectors and branches involved in the work of the G20, and analyzes their core messages and policy recommendations.”
Save the Children position paper for G 20 leaders
Includes a global health section.
BMJ (Editorial )- Health workers are vital to sustainable development goals and universal health coverage
L Fairall et al; http://www.bmj.com/content/356/bmj.j1357
« … The interagency and expert group on sustainable development goal indicators recognised the pivotal role of health workers in the quest for universal coverage, calling for their “recruitment, development and training in developing countries.” In many of these countries, where doctors are in short supply, this means depending on non-physicians, whether nurses, clinical officers, or healthcare extension workers. We question whether this vital aspect of healthcare delivery is receiving the attention it deserves. »
The authors have their doubts about the game changing potential of mHealth, CHWs – “Task shifting to community health workers, without adequate support from trained professionals, can easily become task dumping” – and data driven quality improvement of health systems.
They conclude: “It is time to refocus attention on the recruitment, empowerment,and retention of healthcare providers, who in many countries are non-physician clinicians…”.
Lancet Editorial – What has Europe ever done for health?
The Lancet’s take on what Europe has done for health so far (and future prospects). As you might know, “March 25, 2017, marks the 60th anniversary of the signing of the Treaties of Rome—two treaties that gave birth to the European Economic Community (EEC) and to the European Atomic Energy Community (EURATOM).”
Lancet Editorial – Preparing for future global health emergencies
(must-read) “On March 13–14, Chatham House and the Graduate Institute Geneva-Global Health Centre hosted a roundtable meeting on preparedness for global health crises. Representatives from WHO and the UN, including member states, global health and development agencies, foundations, academia, and non-profit initiatives shared their work and experiences on monitoring preparedness for outbreaks and other public health emergencies. Several themes emerged…” “ … Chatham House and the Graduate Institute will contribute to this ecosystem through a new Monitoring and Accountability for Preparedness initiative (MAP-Global Health Crises). Harvard University and the US National Academy of Sciences have convened a meeting to advance these discussions on April 18, and meetings are planned by others. The Geneva meeting is a good first step towards identifying the stakeholder ecosystem required to ensure that countries and the global community continue to strengthen their collective preparedness for the health crises that will inevitably arise.”
Lancet (Correspondence) – Getting pandemic prevention right
“The voices of the countries most affected by Ebola have not been at the forefront of the numerous global commissions convened to review the crisis. The history of the HIV pandemic suggests that nuances of managing such a response need to come from those who managed the response and were most affected by it. One review suggests that the global response to Ebola remains inadequate. This Correspondence is a regional perspective from west Africa, the community most affected by the Ebola epidemic and by infectious-disease outbreaks in general. Systematic inclusion of the perspective of the most affected people in these epidemics will contribute to the overall success of health-related security efforts worldwide….” An analysis of all these HL reports from their perspective. They point out quite some gaps.
WHO – Aligning public financial management and health financing: Health financing working paper No. 4
C Cashin, J Kutzin et al ; http://www.who.int/health_financing/documents/aligning-pfm-health-financing/en/
“In recent years, many countries have committed to UHC as a national policy priority. Since public funds are the cornerstone of sustainable financing for UHC in most countries, the public financial management (PFM) system – the institutions, policies and processes that govern the use of public funds – plays a key role. …” … “Aligning public financial management and health financing: sustaining progress toward universal health coverage” outlines areas where the PFM system and PFM rules are crucial for the effective implementation of health financing policy in support of UHC and offers guidance for improving alignment. Many of the steps toward improving alignment between the PFM system and health financing policy are considered good PFM practices in general. But specific measures may be called for to address the particular needs of health budgeting. The main objective is to support productive dialogue between health and finance authorities of finance to better harmonize the PFM system with health financing policy and thereby achieve UHC goals according to principles of good public-sector management. The paper was commissioned by World Health Organization (WHO) and jointly prepared by Results for Development Institute (R4D) and WHO under the auspices of WHO’s Department of Health Systems Governance and Financing, Health Financing Unit. It is part of the Collaborative Agenda on Fiscal Space, Public Financial Management and Health Financing Policy.”
Vox – Scientists made a detailed “roadmap” for meeting the Paris climate goals. It’s eye-opening.
“…In a new paper for Science, a group of European researchers lay out a vivid way to frame the climate challenge — with details on what would have to happen in each of the next three decades if we want to stay well below 2°C.” At least if you don’t consider geo-engineering. It’s jaw-dropping.