Horton on “the Age of Apprehension” (and what to do about it)
Lancet – Offline: Prescriptions for an Age of Apprehension
Love it how Horton builds up this piece, rhetorically. ‘ …We live at a time of extraordinary political turbulence. Doubt and uncertainty are daily companions. Assumptions that anchored our beliefs are being torn apart and incinerated. Yet we are demonstrably living in an ever healthier world (enter Pinker, Rosling, …)… … But there are shadows. Dark shadows….”
Horton then comes up with 5 prescriptions to try to make continued progress in this Age of Apprehension.
He concludes with an insight from Descartes: “… The “search for truth” was not an end in itself. The end was truth through reason and a “moral code”. Truth matters only to the extent that it is put to moral work. A balm in an Age of Apprehension.”
First International scientific Global Health Security Conference (18-20 June, Sydney)
Inaugural conference on scientific Global Health Security, co-organized by Adam Kamradt-Scott & Rebecca Katz. For a Lancet Profile of Rebecca, see Rebecca Katz: leading light in global health security
From a distance (i.e. Twitter), it looked like a great event.
For some of the action and key quotes, check out tweets on #GHS2019.
Sydney statement on GHS
Do read, and sign (if you wish so), the statement that says that “Addressing global health security threats should be guided by the following set of  principles…”
Coverage & analysis
Science Speaks already covered some of the event, see for example Global Health Security 2019: Committee’s failure to declare Ebola emergency undermines WHO’s legitimacy, experts say
“The decision by a World Health Organization-convened emergency committee Friday not to recognize the current Ebola outbreak in the Democratic Republic of the Congo a Public Health Emergency of International Concern — a PHEIC — may contribute to an erosion of the multilateral agency’s legitimacy and authority over the long term, experts said here today. They argued that emergency committees tasked with advising the WHO Director General on declaring PHEICs have stepped away from criteria set out in international agreements….” (for more on this, see below – the Ebola DRC section).
More to come no doubt in the coming days & weeks, as the conference was wide-ranging. Next time in Africa, as most participants seemed to want in the closing plenary?
Ebola DRC – “If not a PHEIC now, then when ?”
In this Ebola DRC outbreak section, we’ll give an overview of relevant reads since end of last week, when WHO (for the third time) decided not to declare a PHEIC. That clearly sparked quite some commotion in the global health community (and beyond). After that, an update on the current situation.
WHO – Statement on the meeting of the International Health Regulations (2005) Emergency Committee for Ebola virus disease in the Democratic Republic of the Congo
Worth to read in full, if you haven’t done so yet. Gives a fairly detailed overview of the reasoning of this emergency committee (chaired by P. Aavitsland) for not declaring a PHEIC.
Coverage of this decision & (first) reactions among others in:
- Lancet World Report – Ebola outbreak not a PHEIC, says WHO “WHO’s expert panel’s decision came as a surprise to many global health experts, as some worry insufficient funding threatens the response. John Zarocostas reports.”
- The Guardian – WHO calls for more funds to fight DRC Ebola outbreak
- Devex – Merck to make more Ebola vaccine, WHO declines to declare global emergency
(recommended read). Among others, committee chair Preben Aavitsland lays out the reasoning for not declaring a PHEIC , in this article.
Also, a first reaction by Alexandra Phelan (Georgetown). See also: Global Health Law, Policy Expert Says WHO May Need to Establish New Level of Public Health Emergency for Regional Outbreaks
· Lancet (Editorial) – The politics of PHEIC
The Lancet disagrees with the decision from the emergency committee. “…We disagree. The decision appears more political than technical and that is a mistake. The committee seems to have favoured local protectiveness over global galvanising. Yes, Uganda deserves visible credit for its preparedness, collaboration, and transparency. Yes, nearby countries should feel bolstered by the confidence of WHO and its Director-General. And yes, recalcitrant donors should be reassured of the ability of African countries to prepare for and contain infectious disease outbreaks, and thus be deserving of investment. But calling a PHEIC would not distract from any of these local interests, and the decision might backfire in terms of not inciting a sense of urgency from the international community.”
An update then on the current situation:
WHO flags critical funding gap, calls for political parties to join fight against Ebola: WHO Director General briefs Members States on situation in DRC and appeals for funding for the Ebola response
“The Ebola outbreak in the Democratic Republic of the Congo will only end with bipartisan political cooperation and community ownership, according to the World Health Organization’s Director-General, Dr Tedros Adhanom Ghebreyesus. He was speaking to Member States in Geneva after returning from a visit to DRC, where he reviewed the health response and met with leaders from multiple sectors to galvanize their commitment. The organization is also facing a severe funding gap for the response….”
“WHO’s funding needs for the response are US$98 million, of which US$44 million have been received, leaving a gap of US$54 million. The funding shortfall is immediate and critical: if the funds are not received, WHO will be unable to sustain the response at the current scale. Other partners are also facing shortfalls that have led some to reduce or stop operations. The response risks being driven by decisions related to financial capacity rather than operational needs….”
NYT (Editorial Board) | Time Is Running Out to Stop an Ebola Epidemic
“A mass exodus from the DRC could be catastrophic.”
“… experts worry that the worst is yet to come. Hundreds of thousands of people are fleeing the region in response to ethnic violence, potentially carrying the virus far beyond Congo’s borders. The outbreak has already spread into neighboring Uganda; if it reaches South Sudan, a country dotted with refugee camps and teeming with instability, containment could become nearly impossible….” And yes, you guessed it – the op-ed also ends with “…If the current situation doesn’t qualify as a global health emergency, it’s hard to imagine what would.”
See also Reuters – More than 300,000 flee Congo violence, complicating Ebola fight – U.N..
Some other links related to the Ebola outbreak:
- The Conversation – How Africa’s porous borders make it difficult to contain Ebola (by M Fallah)
“ The persistence of Congo’s Ebola outbreak and its deadly spread to Uganda in recent days show how societal issues are as crucial as scientific advances in controlling disease outbreaks, specialists in global public health say….”
- The Conversation – Ebola outbreaks may be more common than we think (by E Glennon et al)
“The best defence against Ebola outbreaks is early detection. If detected early enough, an outbreak can be prevented with targeted, low-tech interventions, such as isolating infected people and their contacts. But our research suggests that most opportunities for early detection and intervention are missed. In fact, we estimate that most times when Ebola jumps from wildlife to people, it is not detected at all. … … To find out how many of these small clusters have occurred, we simulated thousands of Ebola outbreaks based on published data from previous outbreaks. From these simulations, we determined how often we expect a spillover event to fizzle out early versus how often we expect it to progress into a true outbreak. This allowed us to compare the outbreak sizes we expect to see to those that have been reported. We used these comparisons to estimate detection rates of clusters of different sizes. Across different sets of assumptions, we estimated that less than half of all Ebola clusters, and less than 10% of isolated cases, are detected. … … This result suggests that we miss many cases altogether. Because we estimate especially low detection rates for small clusters, it also suggests that we rarely detect outbreaks in their earliest stages….”
See also AFP – Half of Ebola outbreaks go ‘undetected’: study
World Refugee Day (21 June)
UN News – Record displacement shows ‘we’re almost unable to make peace’, warns UN refugee agency chief
“A record 70.8 million people fled war, persecution and conflict in 2018, UN refugee agency chief Filippo Grandi said on Wednesday, appealing for greater international solidarity to counter the fact that “we have become almost unable to make peace”. Unveiling new data indicating that global displacement numbers are at “the highest level” that the UN refugee agency, UNHCR, has seen in its almost 70-year existence, Mr. Grandi noted that these were “conservative” estimates….”
See also the Guardian – More than 70 million people now fleeing conflict and oppression worldwide
“This December, the (first) Global Refugee Forum [ 17-18 December, Geneva ] will be a major test of political will to address the ever-increasing numbers of refugees worldwide….” UNHCR is leading the preparations.
CGD (blog – by C Huang et al) – CGD and RI Launch New Initiative to Expand Formal Labor Market Access for Refugees
“Despite the long list of outstanding challenges related to forced displacement, substantial progress has been made over the past few years. On World Refugee Day this year, we are excited to note recent successes—in particular, the expansion of formal labor market access (FLMA) for refugees.”
2nd International Day of Family Remittances (16 June)
UN News – Remittances matter: 8 facts you don’t know about the money migrants send back home
“This Sunday marks the second International Day of Family Remittances, observed every year on 16 June, in recognition of the fundamental contribution of migrant workers to their families and communities back home. Here are eight things you might not know about the transformative power of these often small – yet major – contributions to sustainable development worldwide:….”
Interesting facts and so well worth a read. Among others, “They are three times more important than international aid, and counting.”
European Development Days 2019 (Brussels 18-19 June)
Devex – Take EDD to Africa, says Senegal President Macky Sall
“Building an equal partnership between the global north and south was a key theme on the opening morning of the European Development Days, the European Union’s flagship development summit — and one high-level speaker challenged the bloc to turn words into action.”
“Opening this year’s conference … European Commission President Jean-Claude Juncker said on Tuesday, “I’ve always believed that European commitment in the world and for the world should not just be charity. The era of charity is over. What we need is partnership, a true partnership between equals, that can provide and create mutual benefits.”
Conversely, European parliament president, Tajani, must have nasty nightmares about migration (especially with the population growth foreseen for SSA on which he also dwelled), from what I heard from him. He also called current inequality in the world ‘unsustainable’ – that much is right, I think.
Macky Sall, the president of Senegal, called for ““… these European Development Days should take place once in Brussels and then perhaps once in another capital, in Africa or the Caribbean or the Pacific, to alternate the host city…”. Totally agree – rotation of the EDD should be obvious, and moreover, the EDD should be organized less often (given ecological concerns).
PS: In general, although I’ve only attended one day, I got away with the impression that global health is ticking less European “development” boxes than before – migration and climate change seem to be the new watchwords in European high-level ‘development’ circles.
Still, there were some global health related sessions (for example a Global Fund/GAVI co-hosted one, unfortunately late in the evening, so with minimal audience, and a plenary on SRHR with among others our Ministers of Development Cooperation, A Decroo, and dr. Tedros).
The EC also made a new deal with WHO on the UHC Partnership. “The EU [signed] a €102 million contribution agreement with the World Health Organisation (WHO) at the European Development Days in Brussels today. The EU will invest in building health care systems to provide quality services in more than 80 African, Caribbean, Pacific, and Asian countries. The “Health Systems Strengthening for Universal Health Coverage Partnership Programme” launched today will benefit in a longer term from an EU overall contribution of €118 million out of a total budget of €123 million. The EU contribution will strengthen the WHO cooperation with governments and country stakeholders to build health care systems that provide quality health services to everyone.”
Finally, Devex’ overall take on the EDD 2019: Interim Year – “… European Development Days, seemed to be in an “interim year,” one of the nearly 9,000 registered participants told Devex. With European Commission President Jean-Claude Juncker’s tenure winding down, and the EU’s 2021-2027 budget still up in the air, the gathering pressed on nonetheless. … … On Wednesday, about 50 EU aid insiders met for an informal breakfast and concluded that one important test of whether the bloc’s engagement with Africa has gone beyond rhetoric will be whether a strong candidate for EU development commissioner emerges from talks over the summer…”
Devex – Q&A: Are the European Development Days value for money? (interview with S Manservi, the (departing) director-general of the European Commission’s development department).
For more on the EDD, see #EDD19 .
Some of the worrying headlines from this week, showing that we’re dangerously close to tipping points (or have already crossed them):
Guardian – Scientists shocked by Arctic permafrost thawing 70 years sooner than predicted
#tippingpoint. “Permafrost at outposts in the Canadian Arctic is thawing 70 years earlier than predicted, an expedition has discovered, in the latest sign that the global climate crisis is accelerating even faster than scientists had feared.”
Other extremely worrying news came from Greenland ( massive & unusually fast melting ) and the Himalaya glaciers – see the Guardian – Himalayan glacier melting doubled since 2000, spy satellites show “Ice losses indicate ‘devastating’ future for region and 1 billion people who depend on it for water.”
Guardian – Chennai in crisis as authorities blamed for dire water shortage
“Authorities in Chennai have been criticised for failing to deal with a crippling water shortage that has brought the Indian city to crisis point, leaving taps dry in homes and forcing schools, offices and restaurants to close as temperatures soar. The four reservoirs supplying the bulk of the city’s drinking water have completely dried up, leading the Chennai Metro Water to cut the water it provides by about 40%. The crisis in India’s sixth largest city comes as the country struggles to deal with a heatwave that has caused hundreds of deaths, with 184 people killed just in the eastern state of Bihar….”
As a reminder: “…In a report released on 14 June, the top government thinktank for the economy, NITI Aayog, said India was facing the worst water crisis in its history. It predicted that 21 cities would run out of groundwater by 2020 and recommended “urgent and improved” management of water resources.”
Vox – The global transition to clean energy, explained in 12 charts
“Renewables have a long way to go and a short time to get there.”
Very good overview of the key messages of the just released Renewables Global Status Report (GSR), released annually by the Renewable Energy Policy Network for the 21st Century (REN21, a think tank).
Guardian – UK set to host critical UN climate crisis summit at end of 2020
“The UK is set to host a critical global summit on the climate crisis at the end of 2020 [COP26], at which the world’s 190 nations must commit to deep cuts in emissions. … … The 2020 summit is seen as the deadline by which leaders must fully adopt the Paris deal and bring forward action plans to keep the global temperature rise to as close to 1.5C as possible. This requires halving global emissions by 2030 and ending emissions within a few decades of that….”
FT – EU to debate adopting 2050 net zero emissions target
“Campaigners warn 30-year climate goals risk being meaningless without short-term actions”.
“A plan to slash EU carbon emissions to “net zero” within 30 years will be debated at a meeting of leaders that begins in Brussels on Thursday, as the bloc considers joining a growing number of nations poised to adopt tough climate goals and radically reduce greenhouse gases within a generation. The UK this month became the first G20 economy to legislate for a net zero 2050 target, with France set to follow suit and Germany and New Zealand considering similar proposals.
Yet a counter trend also casts doubt on whether they will achieve these lofty ambitions: many of those looking to adopt 30-year climate goals are already well off track in meeting existing emissions targets in the near term. … … Campaigners warn that the 2050 target, while broadly positive, risks being meaningless without stronger policies that spell out how carbon emissions will be reduced in the near term — policies that are often much harder to agree on….”
Nature (Editorial Board) – Harness microbes for humanity’s future
“Leading scientists issue a warning: microorganisms will shape our warming world.”
“…In a Consensus Statement published in Nature Reviews Microbiology, 33 leading microbiologists from around the world “put humanity on notice” that the impact of climate change will depend heavily on the response of microorganisms … …. The Consensus Statement provides for the first time a consolidated global view of the reciprocal effects of microorganisms and climate change. … … Microbiologists have been poorly represented in advisory and executive committees that decide on global environmental and public-health policies. Their expertise and advice must be included to help prioritize future actions to mitigate climate change. The statement authors call for microbiology to be integrated into the United Nations Sustainable Development Goals. …”
Lancet Planetary Health (Editorial) – Surging awareness
Good overview of the increasing environmental awareness in recent decades, and certainly the last six months (a ‘storm surge’ of awareness, it’s called). The editorial also points to the importance of “food systems … as key components of this transition…” and concludes, “It is now clear that we need a twin response to the ecological and climate crises and that this requires fundamental changes to how we organise ourselves. We aim to host important research and comment on these intertwined topics in the coming months and years.”
For the new Lancet Planetary health (June) issue, see here
Bonn climate change conference (17-27 June)
HPW – Slash Climate Emissions 45% by 2030; Children’s Health Would Benefit, Says UN Climate Head
“The global community needs to reduce climate emissions by 45% by 2030 to avoid the most dire warming scenarios. But drastic action to confront the “climate emergency” would mean better health and more jobs, declared the UN’s top climate official, Patricia Espinosa, at Monday’s opening of the Bonn Climate Change Conference (SB50), the warm-up to September’s UN Climate Summit….”
“…The Bonn conference, 17-27 June, plays host to a wide range of events, meetings, and negotiating sessions that aim to “raise ambitions” for the September gathering by heads of state at UN Headquarters in New York City, followed by the December Conference of Parties (COP25) in Santiago, Chile….”
On what this would involve (i.e. ‘raising ambition’ to a sufficient level to stay within 1.5 degree scenarios), see for example Climate Action Tracker – Mid-year update: Climate crisis demands more government action as emissions rise
“Amid growing public concern as climate impacts start to bite, governments must take bold action to address the rise in greenhouse gas emissions, but most of them are not, said the Climate Action Tracker at the Bonn climate talks today, as it released its latest update of government action….” With recommendations for various countries and regions.
Meanwhile, diplomatic noises coming from Bonn don’t sound comforting. Do check Andrew Harmer’s tweets.
BMJ Editorial – Tobacco control: new resources, existing treaties, and emerging challenges
L Bauld et al;
“Three research papers in The BMJ examine smoking and efforts to deal with it, and these studies pose important questions about progress made and where to go next….”
“International investment in tobacco control is more important than ever.” The authors of this editorial also point at the value of comparative research on tobacco control. “…Hoffman and colleagues describe a new open access dataset, the International Cigarette Consumption Database….”
Make sure you have a good look at this one, also by S Hoffman et al:
BMJ – Impact of the WHO Framework Convention on Tobacco Control on global cigarette consumption: quasi-experimental evaluations using interrupted time series analysis and in-sample forecast event modelling
S Hoffman et al ; https://www.bmj.com/content/365/bmj.l2287
Interpretation of this study, via the abovementioned editorial:
“… The researchers used interrupted time series analysis and forecast event modelling to assess cigarette consumption levels before and after 2003 for the countries in the ICCD….”
“… They concluded that the FCTC had not accelerated existing declines in consumption overall, but they did find highly variable patterns. High income countries saw large reductions in smoking, but low and middle income countries and Asian countries increased cigarette consumption per capita. At face value, these findings suggest that the FCTC has not yet delivered on its main objective, to reduce smoking and associated harms. But that interpretation is too simplistic, given divergence across countries. As smoking began to fall in high income countries (a trend that began before the treaty), tobacco manufacturers turned their attention to new markets in low and middle income countries where the industry saw the potential for growth. These countries had limited capacity to combat industry attempts to delay or derail FCTC policies. The key lesson from Hoffman and colleagues’ second paper is that ongoing efforts to support FCTC countries to deliver on their obligations are urgently needed. This is not a failure of the treaty but a call for continued investment in international tobacco control to increase capacity, improve governance, and enhance cooperation across countries to combat tobacco industry influence….”
BMJ (Feature) – Smoking cessation: state owned tobacco companies in China and Japan are at odds with their countries’ commitments
“The governments of China and Japan own giant tobacco companies. They’re also in charge of tobacco control. Flynn Murphy and Gabriel Crossley look at how that’s working”
See also the related BMJ Editorial – State versus private ownership of tobacco companies
With the conclusion: “Whether tobacco companies are state or privately owned is thus the wrong question. The real challenge is how best to strictly control the production and consumption of a highly addictive and deadly product. The answer is comprehensive regulation that makes public health and not economic interests the top priority—something that many countries, regardless of ownership, have yet to do.”
High-level lobbying & advocacy is ongoing on UHC, both in Geneva and elsewhere, in the final months before the UN HL meeting on UHC.
See for example Save the Children, in this Blog – From the World Health Assembly to the UN HL meeting – full steam ahead!
Last week, HPW also hinted at some of the current strengths & weaknesses of a (revised, but not yet public) draft of the UHC political declaration – Draft UHC Declaration Strong On R&D Transparency, Weak On R&D Incentives Reform
“In the lead-up to the United Nations High-Level Meeting on Universal Health Coverage (UHC) in September, the latest draft of a planned political declaration calls on member states to increase transparency of the cost of research and development (R&D) – in addition to drug prices – but falls short in the area of R&D incentive reform, with no mention of delinking R&D incentives from medicines prices. … … The latest draft of the political declaration, with revisions said to be suggested by the co-facilitators of the UHC declaration process, is extensively highlighted with additions to the initial text of the zero draft, which also span a range of other issues that include: stronger references to promotion of health lifestyles and diets; improved health services for emergency care and mental health; health workforce strengthening; and increased national public health spending by an additional 1-2 percent of GDP….”
Health: a political choice – Delivering UHC 2030
As already mentioned in the intro, one of the must-reads of the week, in the run-up to the Osaka G20 summit. Co-edited by John Kirton & Ilona Kickbush. Do start with their respective contributions.
John Kirton: “… Universal health coverage is rapidly rising to become an integral part of global governance as a whole. It has become a key political choice at the highest level, and one of the most important ones of all. This publication thus takes the message about the power and promise of universal health coverage beyond the health community to global governance as a whole, and all the actors that shape its work.”
WHO – WHO and EU reinforce cooperation for Universal Health Coverage
A already flagged above (in the EDD section). “WHO and the European Commission (EC) have signed the next phase of the UHC Partnership. The ‘Health System Strengthening for UHC partnership programme worth EUR 123,750 million (US$ 135 million) will support activities between 2019-2022.”
Fifth UHC2030 Steering Committee Meeting 19-20 June 2019 in Geneva
“Key focus: to mobilise countries and the international community in support of a coherent #UHC agenda as set out in the Key Asks from the UHC movement.”
BMJ – China’s Health System Reforms: Review of 10 Years of Progress: What can we learn from China’s health system reform?
“Qingyue Meng and colleagues assess what China’s health system reform has achieved and what needs to be done over the next decade.”
Devex – Opinion: What does UHC look like in the climate change era?
“When the World Health Assembly convened last month, there was one predominant message: Universal health coverage is the central priority in global health. … …. By focusing on UHC, WHA signaled its renewed commitment to a healthier, more equitable world. The WHA is not preparing for that world. It is running down a checklist with the boxes out of order. Health system resilience should be at the top of the list, or at least on par with UHC….”
“Now we’re in the era of climate change. UHC can no longer stand on its own, and if WHO fails to meaningfully prioritize resilience alongside the UHC agenda, these fragile goals of equity will slide back once again. …”
“…The fundamental goals of resilience and UHC are the same: Ensure equity without exception, mitigate health risks, and empower everyone to lead their healthiest lives. The concepts strengthen one another, and at the next annual WHA, they should be better reflected in one another by approving a new, integrated resolution on climate-resilient UHC. An early draft of the political declaration for September’s high-level meeting does include climate resilience, but the U.N. should elevate it to be a priority, which must then carry over to WHA with equal force….”
Not bad, this piece. I would add: WHO should also start attacking this global economic system full-on, and advocate for a post-growth/post-capitalist system. Can’t just be about ‘climate-resilient UHC’.
Global Action Plan (GAP) consultation (17-30 June)
A 2-week consultation is organized on the outline of the ‘Global Action Plan for Healthy Lives and Well-being: Strengthening collaboration among multilateral health organizations to accelerate country progress on the health-related Sustainable Development Goals (SDGs)’ as well as on the 7 GAP GAP accelerator papers.
You might already want to read a few takes on this latest iteration & consultation effort:
- Alex Harris (Head of Global Policy, Wellcome) – We’ve only got 10 years left. And no, I’m not talking about climate change. In which he lists ‘Five actions for a decade on delivery’.
- Thomas Schwarz (MMI) – The making of a “Global Action Plan for healthy lives and well-being for all”: We are still not amused…
SDGs & UN High-level week
Sustainable Development Report 2019
“The Sustainable Development Report 2019 presents the SDG Index and Dashboards for all UN member states and frames the implementation of the Sustainable Development Goals (SDGs) in terms of six broad transformations. It was prepared by teams of independent experts at the Sustainable Development Solutions Network (SDSN) and the Bertelsmann Stiftung….”
For the press release, see New report shows major long term transformations are necessary for achieving the SDGs.
For a related forthcoming (UN) report, see IPS – UN’s Development Goals Remain Largely Elusive
“The United Nations, in a new report to be released next month, has warned “there is no escaping the fact that the global landscape for the implementation of the 17 Sustainable Development Goals (SDGs) has generally deteriorated since 2015, hindering the efforts of governments and other partners” And the commitment to multilateral cooperation, so central to implementing major global agreements, is now under pressure, says the 35-page report, due to be released ahead of the upcoming high-level political forum (HLPF) of the Economic and Social Council (ECOSOC), July 9-18. The reasons for the roadblocks include a spreading economic recession, a decline in development aid, the diversion of funds into humanitarian emergencies, the widespread military conflicts, the growing economic losses from natural disasters, the downsizing of operations by cash-strapped UN agencies, the rise of right-wing governments and the increasing challenge to multilateralism, among others….”
World Economic Forum and UN Sign Strategic Partnership Framework
News from late last week. “The UN-Forum Partnership was signed in a meeting held at United Nations headquarters between UN Secretary-General António Guterres and World Economic Founder and Executive Chairman Klaus Schwab to accelerate the implementation of the 2030 Agenda for Sustainable Development The partnership identifies six areas of focus – financing the 2030 Agenda, climate change, health, digital cooperation, gender equality and empowerment of women, education and skills – to strengthen and broaden their combined impact by building on existing and new collaborations.”
Now the world is truly fucked : )
Global Policy Watch – Political Declaration for the HLPF and the SDG Summit – from Zero to Second Draft
“The Political Declaration for the High Level Political Forum will be adopted by Heads of State and Government (HOSG) at the General Assembly’s Sustainable Development Goals (SDG) Summit in September 2019. With the aim of reaching consensus, Member States have started negotiations and are now deliberating a second draft of the Political Declaration. The Declaration is currently titled, “Gearing up for a Decade of Action and Delivery for Sustainable Development: Political Declaration of the SDG Summit” and is divided into three sections: “I. Our Commitment, II. Our World Today, III. Our Call to Accelerated Action.”…”
IISD – Africa SDG index finds stagnating progress; calls for accelerated action
“The second annual report on the progress of African countries towards the SDGs features data on 52 African countries. The report finds the “most frequently-observed trend is stagnation,” particularly for SDGs 1, 2, 3, 4, 6, 7, 9 and 16. The report identifies a lack of understanding among governments on what it will take to achieve the SDGs, and states that a lack of funding and resources is “the single most significant challenge” in both SDG implementation and monitoring.”
IISD – UN Officials, Co-facilitators Provide Updates on September High-level Events
Good to know perhaps, for the ones among you planning to go to New York in September:
“With 100 days until the UNGA’s 74th session opens, UN Member States were briefed on preparations for five events that will convene during the high-level week in September 2019. The briefing was convened by the UN General Assembly (UNGA) President and included updates from UN officials and co-facilitators for the high-level meetings. The five meetings convening during the UNGA 74 high-level week are: the High-level Meeting on UHC and the UN Secretary-General’s Climate Action Summit (23 September); the SDG Summit, or the UN High-level Political Forum on Sustainable Development (HLPF) under the auspices of the UNGA (24-25 September); the High-level Dialogue on Financing for Development (26 September); and the High-level Midterm Review of the SAMOA Pathway (27 September)….”
Access to Medicines
FT – Poor countries pay up to 30 times more for medicines
“Nations urged to buy more unbranded generics to lower healthcare costs”.
“The world’s poorest countries are paying some of the highest drug prices, with everyday medicines costing up to 30 times more than in rich nations, according to a study. The Washington-based Center for Global Development examined billions of dollars in spending by developing countries, concluding that low- and middle-income countries were paying 20 or 30 times more for medicines such as omeprazole, for heartburn, or paracetamol, a common pain reliever. Pharmaceutical and healthcare markets “don’t work for the poorest countries, especially in South Asia and Africa”, said Kalipso Chalkidou, one of the report’s authors. The study uncovered a stark disparity in the proportion of poorer countries’ use of unbranded generic drugs, usually the least expensive option. … … … Nor was there much competition in the supply of essential medicines in low- and middle-income countries, the report said. These markets tended to be dominated by a single, or small number, of suppliers, directly affecting the prices paid by public bodies or consumers….”
You find the CGD report here: Tackling the Triple Transition in Global Health Procurement.
Key messages also in CGD blogs – The Changing Landscape of Global Health Procurement, Explained in Four Graphs and Four Recommendations to Accelerate Global Access to Quality, Affordable Health Products.
New resource – Knowledge portal on innovation & access to medicines
“A new Knowledge Portal that aims to ease policymakers’ access to reliable information about themes in medicines access, pricing and pharma innovation was launched [today] by the Global Health Centre of Geneva’s Graduate Institute of International and Development Studies. The Portal currently covers some 17 topics grouped under three broad themes – Pricing, Intellectual Property and Innovation. But there are plans to double that number, through a hybrid approach of Wiki-style crowd-sourcing and academic curation of suggested content, says Suerie Moon, research director at the Global Health Centre and project lead. Moon said that the project, supported by the Open Society Foundations, aims to demystify often complex topics and put existing knowledge at the fingertips of policymakers and their advisors – who need vital background on issues that are increasingly hot topics of debate in UN fora, as well as in national health systems….”
(Dis-)trust in Vaccines
Guardian – Survey shows crisis of confidence in vaccines in parts of Europe
This was big news this week in mainstream media, on the results of the first Wellcome Global Monitor survey. “A global survey of attitudes towards science has revealed the scale of the crisis of confidence in vaccines in Europe, showing that only 59% of people in western Europe and 50% in the east think vaccines are safe, compared with 79% worldwide. Around the globe, 84% of people acknowledge that vaccines are effective and 92% say their child has received a vaccine. But in spite of good healthcare and education systems, in parts of Europe there is low trust in vaccines. France has the highest levels of distrust, at 33%….”
See also FT – Poorer countries have more confidence in vaccines
And Cidrap News – Global trust strong in healthcare, scientists, vaccines—with exceptions.
AMR – Launch of the AwaRe campaign
WHO – In the face of slow progress, WHO offers a new tool and sets a target to accelerate action against antimicrobial resistance
“The World Health Organization (WHO) [today] launched a global AWaRe campaign, which aims to support national health systems to make more judicious use of lifesaving drugs so as to combat a worldwide trend of antimicrobial resistance (AMR) – including increased pathogen resistance to common antibiotics, antivirals and anti-fungal medications….”
See also BMJ News – Use some antibiotics more and others less to stem resistance, says WHO
“The AWaRe tool classifies antibiotics into three groups: Access, Watch, and Reserve. It indicates which antibiotics to use for common or serious infections, which ones should be used sparingly or preserved, and which should be used only as a last resort….”
PS: via HPW – … some leading AMR researchers and advocates from the United Kingdom, Thailand, Australia and the US, are saying that a simple global metric is needed to track the quantities of drugs that countries are actually using. Their work, available at Antibioticfootprint.net, and supported by a grant from the Wellcome Trust, compares aggregate use of antibiotics by country, for human and animal sectors, relying upon publicly available, official data….”
And a link:
“In a major boost to combat one of the gravest risks to global health a dedicated funding vehicle allowing partners to devote resources to accelerate global action against Antimicrobial Resistance (AMR) was unveiled here [ i.e. in Holland ] today at a Ministerial Conference. The Tripartite – a joint effort by the Food and Agriculture Organization (FAO), the World Organisation for Animal Health (OIE) and the World Health Organization (WHO), launched the AMR Multi-Partner Trust Fund, which is being supported by an initial contribution of US$5 million from the Government of the Netherlands. … … The AMR Trust Fund has a five-year scope, through 2024, and aims to scale up efforts to support countries to counter the immediate threat of AMR … … The immediate funding appeal is for US$70 million, to be used to support countries and the implementation of the Tripartite’s AMR Workplan 2019-2020, particularly in providing technical support to countries designing National Action Plans on AMR and to scale up local action….”
See also Cidrap News – FAO launches new vehicle to fund antimicrobial resistance.
NEJM Perspective – Sustainable Discovery and Development of Antibiotics — Is a Nonprofit Approach the Future?
T B Nielsen et al ; https://www.nejm.org/doi/full/10.1056/NEJMp1905589?query=featured_home
One of the must-reads of the week. Spot on. “Shifting to a non-profit model for development of antibiotics could encourage discovery and development of truly needed drugs that improve patient outcomes and permit more effective control over the postapproval use of antibiotics to prolong their effectiveness.”
Updates on a few global health stakeholders
Guardian – Nations must protect spending on the vulnerable, says IMF chief
Remarkable news, late last week. “The International Monetary Fund is urging countries to protect spending on health, education and vulnerable groups amid growing concern among its members about excessive levels of inequality, its managing director has said. Announcing the change of approach in an interview with the Guardian, Christine Lagarde said it was now politically incorrect to argue against the impact of social spending on growth and stability. The IMF, she said, had been through a process of introspection after being criticised in the past for imposing anti-poor spending cuts on governments facing financial crises. Lagarde said the new stance was the result of demands from the IMF’s member countries and internal soul-searching on the part of her organisation….”
Quote: ““…There is a consensus in the organisation that social spending can be macro critical. We have surveyed all the mission chiefs and asked them whether social spending was likely to be macro critical and were happily surprised that 80% of them said it was.”…”
Speech by C Lagarde – on IMF’s new strategy on engaging in social spending issue.
New WHO Resource page – Financing Common goods for health
“External funders and governments alike have failed to prioritize investments in core health system functions that are fundamental to protecting and promoting health and well-being. In order to address these under-investments WHO, in close collaboration with external partners, has developed a knowledge programme on financing common goods for health (CGH). This knowledge programme articulates, provides the technical and economic rationale for, and identifies sources and modalities of financing for core CGH. Due to the broad-based benefits of these common goods, related externalities, and often multi-sectoral nature, there is a need for targeted action and investments by both governments, as well as the global community. … … An initial output of this work will be a series of related papers published in a special issue of Health Systems & Reform to coincide with the September 2019 United Nations General Assembly (UNGA). …”
“…Common goods for health are population-based functions or interventions that require collective financing based on their market failures and impact on health and economic progress. “ For overview and definition, see this one pager.
ODI (Working & Discussion paper) – Is the World Bank leaving no one behind?
“…This working paper, which examines the World Bank’s alignment with the commitment to leave no one behind, offers an operational definition for the commitment and devises a set of good-enough indicators of progress for it, which could also be applicable to development cooperation actors….”
UN News – Billions globally lack ‘water, sanitation and hygiene’, new UN report spells out
In spite of significant progress made, “Some 2.2 billion people around the world do not have safely-managed drinking water, while 4.2 billion go without safe sanitation services and three billion lack basic handwashing facilities, according to a new report from the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO). … … The Joint Monitoring Programme report, “Progress on drinking water, sanitation and hygiene: 2000-2017: Special focus on inequalities”, finds that while significant progress has been made toward achieving universal access to WASH, there are huge gaps in the quality of services provided….”
Global gag rule
Reuters – U.S. Democratic lawmakers vote to repeal global gag rule on abortion
“Democratic U.S. lawmakers voted on Wednesday to repeal a rule slashing global access to abortion and to restore worldwide family planning programs, aiming to reverse measures put in place by Republican President Donald Trump. .. … The measures were contained in an extensive $983 billion fiscal year 2020 spending bill for the U.S. government’s State, Labour, Health and Human Services and other departments. Before any money is spent, however, Republicans who control the U.S. Senate are likely to craft a bill that does not embrace the House Democrats’ initiatives. … … Negotiations between the House and Senate are likely to extend for several weeks, if not months, and the White House is also likely to weigh in….”
Female Genital Mutilation – Dakar conference
Via Thomson Reuters:
“Hundreds of delegates from African governments and campaigners gathered in Senegal this week to discuss how to end female genital mutilation (FGM), which world leaders pledged to eradicate under a set of global goals agreed in 2015….” In this piece, you find some quotes from the conference on what should be priorities to end FGM in Africa, still deeply entrenched in quite some countries.
“Religious leaders in Africa must speak up against the practice of female genital mutilation, which affects millions of children across the continent, an international conference in Dakar said on Tuesday… … Participants agreed that religious leaders have a central role in eliminating both genital mutilation and arranged marriages for child brides – traditional practices which affect millions of children in Africa….”
Lancet Viewpoint – Sexual and reproductive health and rights and population policies: from “either/or” to “both/and”
Carmen Barroso et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31280-2/fulltext
“In 2018, The Lancet published Accelerate progress—sexual and reproductive health and rights for all: report of the Guttmacher– Lancet Commission, the most comprehensive and definitive review of this field since the Programme of Action of the International Conference on Population and Development (ICPD) in 1994. The ICPD resolved many longstanding and sometimes bitter disagreements and debates, but, as the Lancet Commission shows, some remain. We identify population growth and sustainable development, people and the planet, and reproductive and sexual rights as the three most important issues facing the field today and propose responses….”
First ever WHO global report on epilepsy
WHO – WHO highlights scarcity of treatment for epilepsy in low-income countries
“Three quarters of people living with epilepsy in low-income countries do not get the treatment they need, increasing their risk of dying prematurely and condemning many to a life of stigma. The findings are published in “Epilepsy, a public health imperative” released today by WHO and leading nongovernmental organizations for epilepsy, the International League Against Epilepsy and the International Bureau for Epilepsy….”
See also HPW or UN News – First-ever WHO global report on epilepsy highlights care gap in poorer countries.
Papers of the week
BMJ Global Health (Editorial)- Action to protect the independence and integrity of global health research
Katerini Storeng (& about 200 signatories); https://gh.bmj.com/content/4/3/e001746
The publication of the week.
“In a recent Viewpoint in the Lancet, some of us shared our experience of censorship in donor-funded evaluation research and warned about a potential trend in which donors and their implementing partners use ethical and methodological arguments to undermine research. Reactions to the Viewpoint—and lively debate at the 2018 Global Symposium on Health Systems Research—suggest that similar experiences are common in implementation and policy research commissioned by international donors to study and evaluate large-scale, donor-funded health interventions and programmes, which are primarily implemented in low resource settings. … … That such experiences are widespread reflects the deeply political nature of the field of ‘global health’ and the interconnections between priority setting, policy making and project implementation, which sit within a broader set of deeply entrenched power structures…”
“…To start a discussion on ways forward, we invited input from an international network of global health, health systems and policy researchers from diverse disciplines. Below, we discuss suggestions, endorsed by more than 200 researchers based in 40 different countries, on how the organisations that commission, undertake and publish research and evaluations can safeguard independence and integrity….”
Globalization & Health – The integration of the global HIV/AIDS response into universal health coverage: desirable, perhaps possible, but far from easy
“The international community’s health focus is shifting from achieving disease-specific targets towards aiming for universal health coverage. Integrating the global HIV/AIDS response into universal health coverage may be inevitable to secure its achievements in the long run, and for expanding these achievements beyond addressing a single disease. However, this integration comes at a time when international financial support for the global HIV/AIDS response is declining, while political support for universal health coverage is not translated into financial support. To assess the risks, challenges and opportunities of the integration of the global HIV/AIDS response into national universal health coverage plans, we carried out assessments in Indonesia, Kenya, Uganda and Ukraine, based on key informant interviews with civil society, policy-makers and development partners, as well as on a review of grey and academic literature.”
Discussion: “While there are many obstacles to successful integration of the global HIV/AIDS response into universal health coverage policies, integration seems inevitable and is happening. Successful integration will require expanding the principle of ‘shared responsibility’ which emerged with the global HIV/AIDS response to universal health coverage, rather than relying solely on domestic efforts for universal health coverage. The preference for national health insurance as the best way to achieve universal health coverage should be reconsidered. An alliance between HIV/AIDS advocates and proponents of universal health coverage requires mutual condemnation of discrimination based on sexual orientation and gender identity, sex work or drug use, as well as addressing of exclusion based on poverty and other factors. The fulfilment of the promise to include civil society in decision-making processes about universal health coverage is long overdue.”
BMJ Analysis – Rethinking health systems in the context of urbanisation: challenges from four rapidly urbanising low-income and middle-income countries
H Elsey, I Agyepong et al; https://gh.bmj.com/content/4/3/e001501
“The world is now predominantly urban; rapid and uncontrolled urbanisation continues across low-income and middle-income countries (LMICs). Health systems are struggling to respond to the challenges that urbanisation brings. … … In this position paper, we analyse the challenges urbanisation presents to health systems by drawing on examples from four LMICs: Nigeria, Ghana, Nepal and Bangladesh. Key challenges include: responding to the rising tide of non-communicable diseases and to the wider determinants of health, strengthening urban health governance to enable multisectoral responses, provision of accessible, quality primary healthcare and prevention from a plurality of providers. We consider how these challenges necessitate a rethink of our conceptualisation of health systems. We propose an urban health systems model that focuses on: multisectoral approaches that look beyond the health sector to act on the determinants of health; accountability to, and engagement with, urban residents through participatory decision making; and responses that recognise the plurality of health service providers. … .”
HP&P – The process of prioritization of non-communicable diseases in the global health policy arena
“… This study examined factors facilitating and hampering the prioritization of NCDs on the United Nations (UN) health agenda. Shiffman and Smith’s political priority framework served as a structure for analysis of a review of NCD policy documents identified through the World Health Organization’s (WHO) NCD Global Action Plan 2013–20, and complemented by 11 semi-structured interviews with key informants from different sectors. The results show that a cohesive policy community exists, and leaders are present, however, actor power does not extend beyond the health sector and the role of guiding institutions and civil society have only recently gained momentum. The framing of NCDs as four risk factors and four diseases does not necessarily resonate with experts from the larger policy community, but the economic argument seems to have enabled some traction to be gained. While many policy windows have occurred, their impact has been limited by the institutional constraints of the WHO. Credible indicators and effective interventions exist, but their applicability globally, especially in low- and middle-income countries, is questionable. To be effective, the NCD movement needs to expand beyond global health experts, foster civil society and develop a broader and more inclusive global governance structure. Applying the Shiffman and Smith framework for NCDs enabled different elements of how NCDs were able to get on the UN policy agenda to be disentangled…..”
BMJ (Analysis) – Grassroots organisations and the sustainable development goals: no one left behind?
“Walter Flores and Jeannie Samuel argue that grassroots organisations are essential to ensure improvements in the health of marginalised populations.”
BMJ Global Health (Commentary) – Achieving affordable critical care in low-income and middle-income countries
H Turner et al; https://gh.bmj.com/content/4/3/e001675
“Improving the quality and availability of critical care is essential for reducing the burden of preventable deaths in low-income and middle-income countries. The conventional high-income country model, based on resource-intensive intensive care units with expensive monitoring and supportive equipment and large numbers of highly trained staff, is unlikely to be suitable for these settings. Currently, costs severely restrict access to critical care in low-income and middle-income countries, and there is an urgent need to develop an alternative affordable critical care model for these settings. Innovative technology and digital health may offer part of the solution and enable the development of an affordable, sustainable and scalable model of critical care in resource-limited settings.”
Blogs & mainstream articles of the week
Washington Post – Trump administration unveils its new Africa strategy — with wins and snags feat
“The effort shifts American focus from aid to industry. “
CGD (blog) – Harmonization is Power: Reflections from Women Deliver 2019
Another take on the latest Women Deliver conference in Vancouver. “… How do we take the energy palpable at last week’s convening and harness it so that many more women and girls worldwide can use their power in the years to come? The name of the game from my perspective now needs to be harmonization—whether in tools and resources, conversations had by different constituencies, or our definitions of success….”
Brookings Institution (blog) – Cities: The labs for Sustainable Development Goal innovation
“When countries adopted the Sustainable Development Goals (SDGs) in 2015, the inclusion of SDG 11 highlighted the importance of urbanization to sustainable development, and committed national governments to support cities in becoming more inclusive and resilient. Four years in, it is clear that cities matter for much more than SDG 11. Mayors and local government officials are demonstrating that cities form the front lines of SDG success, as they translate the agenda’s global aspirations into a blueprint for local progress. Recently, the Brookings Institution held a private gathering of senior government officials whose cities are in the vanguard of localizing the SDGs. The setting provided an unusual opportunity for these city leaders to share their challenges, best practices, and innovations, and—as outlined in our new brief—to define a city-specific perspective on the value of the SDGs and what it will take for local implementation to go to scale….”
For the related (Brookings) report, see Shaping the global agenda to maximize city leadership on the SDGs: the experiences of vanguard cities
“ …During a three-day gathering from April 3-6, 2019 at the Bellagio Rockefeller Center, senior government officials from 14 cities worldwide that are in the vanguard of localizing the SDGs, provided their perspectives in sharing a city-specific agenda for scaling local SDG implementation and refining high-value practices began to emerge. This brief reflects the policy implications of mayoral and city leadership on the SDGs based on their experiences and guidance, with associated recommendations to help accelerate and deepen progress on the SDGs at the local level.”
Stat Op-Ed – What if AI in health care is the next asbestos?
“Artificial intelligence is often hailed as a great catalyst of medical innovation, a way to find cures to diseases that have confounded doctors and make health care more efficient, personalized, and accessible. But what if it turns out to be poison? Jonathan Zittrain, a Harvard Law School professor, posed that question during a conference in Boston Tuesday that examined the use of AI to accelerate the delivery of precision medicine to the masses. He used an alarming metaphor to explain his concerns: “I think of machine learning kind of as asbestos,” he said. “It turns out that it’s all over the place, even though at no point did you explicitly install it, and it has possibly some latent bad effects that you might regret later, after it’s already too hard to get it all out.” …”
Complement perhaps with a new Lancet Comment (by G Leeming et al) – Blockchain in health care: hype, trust, and digital health “The promise of digital health care continues to be enthusiastically promoted but has been difficult to realise. Evidence-based practice, along with patient safety assurances, information governance, and certification, does not fit easily with schemes to accelerate innovation. Trust in the efficacy and safety of new models of care, such as that potentially delivered by artificial intelligence (AI), remains uncertain. Blockchain technology might contribute to overcoming these problems by enabling greater openness, transparency, and trust.”
Inequality (research & commentary)- The Time Has Come for a Global Minimum Wage
“As the International Labour Organization celebrates its 100th anniversary, it should embrace the chance to stop the global race to the bottom.” i.e. “At its centenary conference, the ILO should call for a global minimum wage.”
Exactly. And WHO & the global health community should join in this call. Part of a new Global Deal & Social Contract for this century.
Gates Foundation : launch of Gates Policy Initiative
This initiative will focus on the US. “Bill and Melinda Gates have launched the Gates Policy Initiative to lobby for issues the billionaire couple has been working on through the Bill and Melinda Gates Foundation, The Hill first reported. The initiative will be focused on global health, global development, U.S. education and outcomes for black, Latino and rural students specifically, and efforts to move people from poverty to employment…..”
Tweet of the week
“As @HelenBranswell notes the leader of @WHO is now in the midst of #Ebola, for the 9th time since the epidemic started Aug 1, 2018. In the history of WHO no prior DG went into an active outbreak even 1 time while in office. @DrTedros , not coincidentally, is the 1st African DG.”