Guardian Op-ed – A Bloomberg 2020 run would help the left – by failing spectacularly
Sometimes it’s interesting to see what doesn’t get tweeted (or retweeted) by the global health community. This Op-Ed for example.
End-of-the-year press briefing dr. Tedros
IP-Watch – WHO Director Tedros Gives Thoughts On Access To Medicines, Gene Editing, Ebola
(gated) “World Health Organization Director General Tedros Adhanom Ghebreyesus (Dr Tedros) met with United Nations journalists [today], in what he said would become a regular end-of-the-year meeting with the press. He gave an update on the ongoing Ebola outbreak and his views on the recent human gene editing by a Chinese researcher, and on the use of gene drive organisms to fight malaria. He also provided his views on access to affordable and safe medicines.”
“The World Health Organization is creating a panel to study the implications of gene editing after a Chinese scientist controversially claimed to have created the world’s first genetically edited babies. “It cannot just be done without clear guidelines,” Tedros Adhanom Ghebreyesus, the head of the UN health agency, said in Geneva. The organisation was gathering experts to discuss rules and guidelines on “ethical and social safety issues”, added Tedros, a former Ethiopian health minister….”
See also Reuters – WHO looks at standards in ‘uncharted water’ of gene editing.
“The head of the World Health Organization said Monday it can fight the deadly Ebola outbreak in Congo despite the withdrawal of the U.S. Centers for Disease Control and Prevention, insisting: “We can cover it.”
“The comments by WHO Director-General Tedros Adhanom Ghebreyesus came in the wake of commentaries in two medical journals appealing to the CDC to return to the epidemic zone in Congo — saying its expertise is needed. The U.S. experts have been sidelined for weeks, ordered away from the region because of State Department security concerns. Tedros said the U.N. health agency mostly needs the United States to continue the financial and other support it has provided. …”
UCL-Lancet Commission on Migration and Health (& Comments, other research articles & reviews, …)
“With one billion people on the move or having moved in 2018, migration is a global reality. International migration has increased to 258 million, and the numbers of refugees and people displaced by conflict, natural disasters, and climate change are at their highest levels: 22 and 40 million, respectively. Despite negative political narratives, migration is not overwhelming high-income countries—instead, it takes place mostly between low-income and middle-income countries and most people are migrating for work. By and large, migration is a positive and diverse experience. But migration has also become a political lightning rod. The UCL–Lancet Commission on Migration and Health steps into this political debate to provide evidence for cooperation and action on what is one of the most pressing issues of the 21st century. The Commission’s foundation is that migration and health are inextricably linked—and key to sustainable development. It provides a framework of migration as a dynamic process, providing evidence of the multiple factors that could be beneficial or detrimental to individuals and systems along the migration journey—at origin, transit, destination, and return. It documents the devastating impacts of forced migration, especially on girls and women, but also the overall benefits to the health of individuals and populations that migration generates. It lays out a research agenda to better ensure the health of migrants. Using the lens of health the Commission shows that migration policies can be both ethical and feasible—calling for governments, international agencies, and professionals to promote health in global mobility.”
Put differently, this “UCL–Lancet Commission provides new data and analyses to dispel some of the pervasive and harmful myths surrounding migration and migrants. The Commission calls for governments, international agencies, and professionals to promote health in global mobility.”
- Check out the Commission, the related Comments (including Opening up to migration and health (by J Clark et al); Advancing health in migration governance, and migration in health governance (by K Wickramage et al); and a number of research articles & reviews.
- Coverage for example in the Guardian – Myths about migrants spreading disease ‘inform hostile policies’
“Report says migrants more likely to contribute than to damage health of host nations”.
- Or see some key messages from the press release:
“The Lancet: Harmful, unfounded myths about migration and health have become accepted, used to justify policies of exclusion
Stereotypes that migrants are disease carriers who present a risk to public health and are a burden on services are some of the most prevalent and harmful myths about migration.
Evidence from a comprehensive new report, including new international data analysis, shows these myths to be unfounded, yet they continue to be used to deny migrants entry, restrict access to healthcare, or detain people unlawfully.
Migration benefits national and global economies, and more must be done to counter racism, improve migrants’ access to services, and uphold the rights of migrants.”
See also a tweet from Commissioner Kabir Sheikh: “”Health systems are viewed in terms of geopolitical jurisdiction rather than as the societal response to people’s needs regardless of their official status”. This needs to change, we argue in the Lancet @MIGHCommission report out today #healthsystemsbeyondborders”
ILO Global Estimates on International Migrant Workers – Results and Methodology
Another migration-linked report, no doubt also with a view on the Marrakesh meeting next week.
“This report maps the current state of labour migration and the key characteristics of migrant workers in the world today.”
For coverage of this report, see UN News – Millions more migrant workers, means countries lose ‘most productive part’ of workforce
“ A new study launched on Wednesday by the International Labour Organization (ILO) reveals that the number of migrant workers has jumped by millions, leaving some countries without “the most productive part of their workforce.” According to the second edition of ILO’s Global Estimates on International Migrant Workers, approximately 164 million people left home in search of work between 2013 and 2017 – a nine per cent increase since 2013, when that number stood at 150 million….”
“…Nearly 87 per cent of migrant workers are between the ages of 25 and 64, suggesting that some countries of origin are losing the most productive segment of their workforce, which could negatively impact their economic growth….”
COP 24 in Katowice, Poland (2-14 December)
COP24 stands for ‘The 24th Conference of the Parties to the United Nations Framework Convention on Climate Change’.
From a planetary health perspective, COP 24 in Katowice, Poland is, ahum, “rather important”. It’s in fact considered the most important COP since the one on the Paris agreement.
Below you find some reads and analyses, ahead of the meeting, some coverage on the first few days, and also some info on a WHO report on climate change & health, launched earlier this week.
But first, setting the scene with a few more worrying reports on the deadly spiral the world is involved in, under the current economic system:
Guardian – ‘Brutal news’: global carbon emissions jump to all-time high in 2018
“Global carbon emissions will jump to a record high in 2018, according to a report, dashing hopes a plateau of recent years would be maintained. It means emissions are heading in the opposite direction to the deep cuts urgently needed, say scientists, to fight climate change.”
“The rise is due to the growing number of cars on the roads and a renaissance of coal use and means the world remains on the track to catastrophic global warming. However, the report’s authors said the emissions trend can still be turned around by 2020, if cuts are made in transport, industry and farming emissions. … … The research by the Global Carbon Project was launched at the UN climate summit in Katowice… …. The report estimates CO2 emissions will rise by 2.7% in 2018, sharply up on the plateau from 2014-16 and 1.6% rise in 2017.”
Nature – Global warming will happen faster than we think
“Three trends will combine to hasten it, warn Yangyang Xu, Veerabhadran Ramanathan and David G. Victor.”
“….the latest IPCC special report underplays another alarming fact: global warming is accelerating. Three trends — rising emissions, declining air pollution and natural climate cycles — will combine over the next 20 years to make climate change faster and more furious than anticipated. In our view, there’s a good chance that we could breach the 1.5 °C level by 2030, not by 2040 as projected in the special report (see ‘Accelerated warming’). The climate-modelling community has not grappled enough with the rapid changes that policymakers care most about, preferring to focus on longer-term trends and equilibria….”
Guardian – Beef-eating ‘must fall drastically’ as world population grows
“Current food habits will lead to destruction of all forests and catastrophic climate change by 2050, report finds.”
“People in rich nations will have to make big cuts to the amount of beef and lamb they eat if the world is to be able to feed 10 billion people, according to a new report. These cuts and a series of other measures are also needed to prevent catastrophic climate change, it says. More than 50% more food will be needed by 2050, according to the World Resources Institute (WRI) report, but greenhouse gas emissions from agriculture will have to fall by two-thirds at the same time. The extra food will have to be produced without creating new farmland, it says, otherwise the world’s remaining forests face destruction. Meat and dairy production use 83% of farmland and produce 60% of agriculture’s emissions….”
Some analyses ahead of COP 24
To get an idea of some of the main issues, the global backdrop and conflict lines in Katowice, we recommend:
Devex – 4 things to watch at COP24 ( i.e.: Can climate leaders hold the line? Will coal companies get a foot in, or be shown the door? Is climate financing accounting a hero or a villain? Can the world start to close the ambition gap?)
“The UN climate change summit [begins on Monday] with a warning that today’s generation is the last that can prevent catastrophic global warming, as well as the first to be suffering its impacts. Almost 200 nations were set to meet in Poland for two weeks, aiming to hammer out a vital agreement to turn the carbon-cutting vision set in Paris in 2015 into reality. Moves to rapidly ramp up action would be another key goal, with current pledges leaving the world on track for a disastrous 3C of warming. The negotiations will take place against a background of ominous news: the past four years have been the hottest on record and global emissions were rising again, when they need to fall by half by 2030. Climate action must be increased fivefold to limit warming to the 1.5C scientists advise, according to the UN. The political backdrop contains challenges as well, with climate change denial from the US president, Donald Trump, and attacks on the UN process from Brazil’s incoming Bolsonaro administration….”
Also a really neat analysis. Excerpts:
“The rise of populist leaders threatens the climate deal struck in the French capital in 2015 and will make UN talks more fraught.”
“… as this year’s UN climate talks kick off on Monday in Poland, Mr Trump and other populist leaders like him have become the single biggest threat to the climate pact. The rise of populism from Europe to Latin America and Asia has made the pact, built on a set of ideals that now appear in short supply, look fragile. And the US proposal to withdraw from the agreement has emboldened others to be more critical. “It takes a globalist response to deal with climate change, and if you are a nationalist, then you believe that was not what you were put on this earth to support,”
… “The next 20 years is arguably more important than any in history,” Lord Stern explains, because humans will shape the future of the planet in ways that may be irreversible. Michal Kurtyka, the president of the Katowice summit, says delegates are gathering against a much more subdued backdrop. “The appetite for multilateral solutions is not as it was in 2015,” he says. “The general mood is different.” … … The mission of this year’s talks will be “all the more complicated” by the new political situation, says Christiana Figueres, the former head of the UN climate secretariat and a key architect of the Paris deal. The rule book will determine how countries’ greenhouse gas emissions are reported, monitored and verified by the UN body. … …
China, which has assumed more of a leadership role at the climate talks — seizing the opportunity offered by the US stepping back — wants much more flexibility for developing countries, a difficult position for many western nations to accept.
…. Alden Meyer, policy director at the Union of Concerned Scientists, points out that all countries will find the Paris temperature targets difficult to meet. “This is a political challenge to any form of government, the rate of change, the transformation, the exponential nature of what we need to do to,” says Mr Meyer. “It is not just the authoritarian governments coming in, although they are clearly part of the problem.” Looking beyond Katowice, he says the real challenge isn’t if nations pull out, but rather if they ignore the pact. “What is more corrosive is if . . . leaders don’t seem to have any intention of using domestic policy to meet their Paris commitments.”
And a quote from Michael “global health & planetary health champion” Bloomberg: “…In the end capitalism is working. We do what is in our interest, and stopping climate change and improving the environment today are both things that are in the public and corporate interest.”… ” Yeah, right.
On the latter, see the Guardian – Portrait of a planet on the verge of climate catastrophe “As the UN sits down for its annual climate conference this week, many experts believe we have passed the point of no return.”
Coverage of first few days in Katowice
UN News – Four things the UN chief wants world leaders to know, at key COP24 climate conference opening
“During the UN COP24 Climate Change Conference grand opening on Monday, Secretary-General António Guterres told over 150 world leaders gathered for climate action that “we are in deep trouble” and asked decision-makers to focus on four key things: stepping up climate action, according to a solid plan, with more funding, as a smart investment in the future of the planet.”
Other news snippets from the Grand opening & High-Level segment:
World Bank Group Announces $200 billion over Five Years for Climate Action (i.e. a doubling of the current 5-year plan).
“The renowned broadcaster Sir David Attenborough has announced the United Nations’ launch of a new campaign enabling individuals the world over to unite in actions to battle climate change….” He also emphasized collapse of civilisation is on the horizon (Guardian). “…The naturalist was chosen to represent the world’s people in addressing delegates of almost 200 nations who are in Katowice ….”
WHO report: COP-24 Special Report: health and climate change
WHO (Press release) – Health benefits far outweigh the costs of meeting climate change goals
“Meeting the goals of the Paris Agreement could save about a million lives a year worldwide by 2050 through reductions in air pollution alone. The latest estimates from leading experts also indicate that the value of health gains from climate action would be approximately double the cost of mitigation policies at global level, and the benefit-to-cost ratio is even higher in countries such as China and India. …” “A WHO report launched … … at the United Nations Climate Change Conference (COP24) in Katowice, Poland highlights why health considerations are critical to the advancement of climate action and outlines key recommendations for policy makers.”
“…Exposure to air pollution causes 7 million deaths worldwide every year and costs an estimated US$ 5.11 trillion in welfare losses globally. In the 15 countries that emit the most greenhouse gas emissions, the health impacts of air pollution are estimated to cost more than 4% of their GDP. Actions to meet the Paris goals would cost around 1% of global GDP….”
You find the report here.
Coverage also in HPW – Curbing Climate Change Would Save Over 1 million Lives A Year From Air Pollution Alone
A few other reads & links related to COP24
Analysis linked to a newly published paper, which tries to assess Trump’s damage (so far) on the Paris process: “The Paris Climate Agreement Vs. The Trump Effect,” by Joseph Curtin.
“A groundbreaking Canadian scheme that rewards green living holds lessons for world leaders wrangling over carbon emissions at the UN summit in Poland.”
The way forward.
G20 summit in Buenos Aires & global health (on the margins)
Below we’ll first provide some reads related to the G20 summit in Buenos Aires from a global health perspective, and then some of the wider implications of this (underwhelming) summit (of which I personally will mainly remember the already notorious ‘High Five’ between Putin & MSB).
G20 leaders declaration
The global health related paragraph, you find below, in full:
“15. We encourage the activities of World Health Organization (WHO), together with all relevant actors, to develop an action plan for implementation of health-related aspects of SDGs by 2030. We commend the progress made by the international community in developing and implementing National and Regional Action Plans on Anti-Microbial Resistance (AMR) based on One-Health approach. We recognize the need for further multi-sectoral action to reduce the spread of AMR, as it is increasingly becoming a global responsibility. We note the work done by the Global AMR R&D Hub and, drawing on this, we look forward to further examine practical market incentives. We will tackle malnutrition, with a special focus on childhood overweight and obesity, through national, community-based and collaborative multi-stakeholder approaches. We reaffirm the need for stronger health systems providing cost effective and evidence-based intervention to achieve better access to health care and to improve its quality and affordability to move towards Universal Health Coverage (UHC), in line with their national contexts and priorities. This may encompass, where appropriate, scientifically proven traditional and complementary medicine, assuring the safety, quality and effectiveness of health services. We will continue to strengthen core capacities required by International Health Regulations (IHR, 2005) for prevention, detection and response to public health emergencies, while recognizing the critical role played by WHO in this regard. We are committed to ending HIV/AIDS, tuberculosis and malaria, and look forward to a successful 6° replenishment of the Global Fund in 2019.”
As somebody put it on Twitter, “in terms of words, better than expected, but no (financial) commitments” (whatsoever).
PS: the G20 also launched an Initiative for Early Childhood Development.
For a very good overall analysis of this declaration, see IISD – G20 Declaration Focuses on Fair, Sustainable Development.
HPW – Health On The Margins As G20 Leaders Meet
Analysis published at the start of the G20 Summit (and worth a read).
“As world leaders attending this year’s Group of 20 (G20) Summit face off on thorny issues of trade, migration and climate change – health was likely to remain on the margins of the maelstrom, observers said. The two-day Summit of the 20 largest global economies opened today in Buenos Aires, Argentina. … Yesterday, Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, called upon global leaders to recognize health as a Summit priority. “I look forward to taking the #HealthForAll message to world leaders at the #G20Summit”, tweeted Dr. Tedros, upon his arrival in Buenos Aires. … … In a Declaration on 4 October after their meeting in Mar del Plata, Argentina, G20 Health Ministers had called out four key health challenges: childhood malnutrition; health systems strengthening; health systems response to disasters and pandemics; and battling anti-microbial resistance, including through more sustainable agriculture, as top priorities for Summit leaders. It is unclear how the health ministers’ declaration will be reflected in the leaders’ summit this week. …”
That’s clear by now. It’s all in the Communiqué, but with no commitments : ) So mostly political declarations.
HPW – New Global Health Commitments At G20, Nelson Mandela 100th
The ‘Commitments’ (from the title) pertain more to the Global Citizen Festival in South Africa.
“Global health reaped a weekend windfall of new international and bilateral commitments over the past two days, beginning with the close of the G20 meeting in Argentina on Saturday, followed by the Mandela 100 Global Citizen festival in Johannesburg yesterday, which saw stars like Beyoncé, Jay-Z and others perform in the name of health and development causes, reaping a historic commitment by the United States of more than US$1.2 billion for the fight against HIV/AIDS and some US$ 139 million for the fight against neglected tropical diseases.”
Our own Minister of Development Cooperation attended the event as well and clearly felt like a rock star on stage.
Lancet (Editorial) – What happened to health in Buenos Aires?
This Lancet Editorial takes a more merciful look at the Buenos Aires summit, from a global health angle. Still, it’s clear that the main hope is put on the next hosts, Japan.
“… one finds signs of hope. The Director-General of WHO, Dr Tedros, is now a permanent attendee. Health is agreed to be an indispensable dimension of our common political and economic futures. Indeed, the G20 Declaration has much to say about health. … … G20 nations have also launched what they call a G20 Initiative for Early Childhood Development—“building human capital to break the cycle of poverty and inequality”. … Next year, the G20 meets in Osaka, Japan. The Government of Japan has already decided to prioritise health. Preparatory meetings have been held in Tokyo. And early ideas are emerging, notably around how to accelerate progress towards Universal Health Coverage….”
Some broader analysis of the G20 summit
“G20 leaders on Saturday adopted a joint communiqué reaffirming their commitment to “a rules-based international order” — a small, symbolic victory for stability in an era when U.S. President Donald Trump has upended traditional diplomacy by instigating trade wars and employing aggressive protectionist policies and rhetoric….”
“The Group of Twenty most powerful nations were nearing an agreement late on Friday (30 November), in which a reference to a rules-based multilateral trade system was expected to be included. But ambition was lowered in the climate field to overcome the US opposition to the Paris Agreement.”
On the latter, see also Mother Jones – 19 of 20 World Leaders Just Pledged to Fight Climate Change. Trump Was the Lone Holdout.
Project Syndicate – The G20’s Africa Problem
“Although the G20 has made a limited effort to broaden its engagement with Africa in recent years, it has yet to include Africans in discussions of global issues that bear directly on their own economic prospects. Yet by consistently treating the region as a ward instead of a coequal partner, the international community is undermining its own future interests.”
And some tweets on the Buenos Aires Summit:
“The G-20 in BA was the “avoidance summit”: US, China avoided escalating their trade war; MBS avoided being shunned despite his role in Khashoggi’s murder; Putin avoided any penalty for his latest Ukraine agression. And world leaders avoided doing much of anything for the world.”
“Achieving a declaration has become the new benchmark of summit success.”
Dr Tedros: “Pleased to work with @ilo Director-General @GuyRyder and @OECD Secretary-General @A_Gurria on a joint programme for health at #G20Argentina Summit. Health is a political choice. Together we can achieve #HealthForAll.”
The fact that the G20 policy blogs & briefs from the Sheffield team didn’t contain anything on global health was also telling. See here.
But do check out the blog ‘Don’t cry for meat, Argentina!” 😊
Kate Raworth – Doing the doughnut at the G20?
Fat chance that anybody listened to her in Buenos Aires, but nevertheless, the blog of the week.
With visualizations in the best Rosling style, though adjusted to the new – planetary health – era. A must-read!!!
The “nationalism-globalization” debate & ‘The Left’
The Nation – There Is No Left Case for Nationalism – Endorsing nationalism isn’t compromise. It’s compromised.
By A A Abrahamian; https://www.thenation.com/article/open-borders-nationalism-angela-nagle/
Guardian – We shouldn’t rush to save the liberal order. We should remake it
“The UN security council, the IMF, the World Bank and the ILO were conceived as agencies of change – they can be again.” Recommended.
World AIDS Day – AIDS at a critical juncture
We covered World AIDS Day (1 December, this year on a Saturday) last week already to some extent.
A few more reads you might want to look into:
UN News – World response to AIDS epidemic at a ‘critical juncture’
“Thirty years after the first World AIDS Day, the HIV response stands at a crossroads, UN Secretary-General António Guterres has said, marking this year’s commemorations. The direction taken now, may determine whether the epidemic can be ended by 2030, or if future generations will have to continue the battle, he said….”
HPW – On World AIDS Day: Big Breakthroughs On HIV Self-Testing
“A report launched jointly [today] by Population Services International (PSI), London School of Hygiene and Tropical Medicine and the World Health Organization shows that people’s knowledge of their HIV status in sub-Saharan African countries nearly doubled just four years after self-testing programmes were introduced. Separately, a group of French NGOs called on the French President to lead elimination of HIV/AIDS, tuberculosis and malaria by 2030….”
CGD (blog) – On World AIDS Day, a Moment for Celebration and Self-Reflection
A Glassman & R Silverman; https://www.cgdev.org/blog/world-aids-day-moment-celebration-self-reflection
Mainly for this paragraph:
“… With a new round of global health replenishments in 2019, we are looking critically at recent claims of impact emerging from global health agencies—some of which we do not believe to be sufficiently backed up by rigorous, transparent evidence. Richard Feachem, the founding director of the Global Fund, put it best: “Raise It, Spend It, Prove It.” Many global health organizations do well on “raise it,” most on “spend it,” but few “prove it.” This is the ultimate accountability; not an OIG report on how monies are spent, but instead, the sound and rigorous measurement, verification, and evaluation of impact for real people at risk for and suffering with preventable disease burden. In the coming weeks, you will see a commentary that is critical of recent Global Fund results reporting. But insufficient impact measurement is almost universal across almost all agencies—and it’s up to all of us to do better…”
Lancet HIV December issue
“To mark World AIDS Day (Dec 1), The Lancet HIV’s December issue is dedicated to examining strategies for preventing, diagnosing, and managing paediatric HIV.”
RHM – World AIDS Day: Eliminating Stigma and Discrimination
“In commemoration of the 30th Anniversary of World AIDS Day, RHM welcomes the news that a Global Partnership for Action to Eliminate All Forms of HIV-related Stigma and Discrimination will be launched on December 10 – Human Rights Day 2018 – and commits to publish and promote research which contributes to the elimination of stigma and discrimination in sexual and reproductive health care.”
Global Health Disruptors & 10 years Global Health Centre (Graduate Institute)
On Monday 3 December, The Graduate Institute’s Global Health Centre celebrated its 10th anniversary with a nice event, The Overlapping Crises of Democracy, Globalisation and Global Governance – what does it mean for global health?
We’ve been told a video recording of the workshop will be available soon. For some of the action, check the twitter account of the Global Health Centre.
Meanwhile, do check out the entire BMJ Opinion ‘Global Health Disruptors’ series (with 2 big parts): https://www.bmj.com/global-health-disruptors
“This collection of articles looks at major disruptions that have shaped global health to make it the field it is today, before moving on to look at major disruptions under way at present that are radically changing the face of contemporary global health. Each piece pinpoints the nature, immediate effects, and long term impact of each disruption. Global health is beginning to experience the effect of a world that is more multipolar, less multilateralist, and more ideological. Any one of these issues has the potential to be a disruptive force for global health, let alone all of them together. The challenge ahead lies in accepting these disruptions as being collective problems that require solidarity and a global response, and ensuring for the future that the UN and other multilateral institutions are prepared to deal with interconnected challenges and systematic breakdowns. These disruptions—and not viruses or diseases—are the threats that should keep us awake at night.”
As compared to last week’s IHP issue, some other blogs were also published, for example on the global health care market, NCDs, R&D, and the urban planet.
Polio still a PHEIC
Devex – WHO says international spread of polio still a public health emergency
News from late last week. “The international spread of polio virus continues to be a problem four years after the WHO’s Emergency Committee designated it a public health emergency of international concern. The committee on Friday announced it would extend the emergency by another three months, after data showed an uptick in the number of polio cases worldwide in 2018, including a doubling in Afghanistan….”
See also CIDRAP – Polio experts address fears over disease resurgence
“…Michel Zaffran, MEng, director of the WHO’s polio eradication program, said the ongoing PHEIC reflects a dual emergency, both of which pose a threat to other countries: the continued spread of WPV1 in Afghanistan and Pakistan and spread of circulating vaccine-derived poliovirus (cVDPV) in countries that have poor or weak routine immunization programs, such as in Africa and in Papua New Guinea….”
Or see a Lancet World Report – WHO keeps polio on the international health emergency list “A spike in new cases of polio heightens concerns of a global resurgence of the disease.”
UN Aid – 2019 Humanitarian Appeal
Reuters – U.N. seeks $21.9 billion in aid next year, largest needs in Yemen
“The United Nations appealed for $21.9 billion on Tuesday to address 21 humanitarian crises worldwide next year, including $4 billion for Yemen, its largest aid operation. The appeal to donor countries does not include the funding requirements for Syria, which are expected to bring the total up to $25 billion, it said.”
For more detail, see AP.
Yemen & lessons from the cholera response
Lancet Global Health (Editorial) – Yemen needs a concrete plan—now
“in a report released on December 4, the Johns Hopkins Center for Humanitarian Health presents a detailed evaluation, based on an in-depth review and data gathered through 71 key informants, of the epidemic preparedness and response up until the second wave in July 2018. It brings forth unsurprising but sobering facts, among them the likely association between the conflict and increased cholera transmission; the lack of preparedness in terms of surveillance and response capacity; or coordination issues between international and national actors of the response. The 20 global and Yemen-specific recommendations cover the fundamental need of addressing insecurity, of urgently clarifying and harmonising coordination and preparedness, and of making the response more agile by improving surveillance. They include specifics of a targeted WASH and vaccination response and rely on strong integration of planning across sectors, all sensible responses to the issues identified in the analysis. These concrete, action-related reports should be precious input in tackling this and future outbreaks, particularly in war-torn areas. But Yemen needs even more—and the time is now.”
You find the report from the Johns Hopkins Center for Humanitarian Health (with the 20 lessons from Yemen’s cholera response), here: “Cholera in Yemen: A case study of epidemic preparedness and response”.
International Day of Persons with Disabilities (3 December)
First-ever UN report on disability and development, illustrates inclusion gaps
“The United Nations launched its first-ever flagship report on disability and development on Monday; published by, for, and with, persons with disabilities, in the hopes of fostering more accessible, and disability-inclusive societies.”
Other links related to this Day: Devex – DFID launches its first disability inclusion strategy
“The United Kingdom’s Department for International Development launched its first disability strategy Monday, which disability champions hailed as “ambitious” but in need of dedicated financing to implement. The plans cover disability inclusion both in DFID’s external programs and within the department, fulfilling a key commitment made by Secretary of State for International Development and former minister for people with disabilities Penny Mordaunt. Disability groups said they were pleased to see a focus on issues such as “mental health conditions, psychosocial or intellectual disabilities,” as well as inclusion in humanitarian contexts included in the strategy. However, implementing it will require dedicated funding from DFID, advocates said….”
Ebola outbreak DRC – Still a blurred (& worrying/unpredictable) picture
As already mentioned earlier in this newsletter, at Tedros’ “meet the press” interview from early this week, the WHO DG sounded rather reassuring. However, not everybody is equally reassured…
Some reads from this week:
With some info on the weekly report from the WHO African regional office (23 Nov-1 Dec). See also, for the latest update, Cidrap – Ebola cases spike as WHO warns of possible reintroduction
MSF – Ebola spreads further into urban communities and isolated areas in North Kivu
“The Ebola epidemic continues to spread through the Democratic Republic of Congo (DRC)’s North Kivu province. The newest areas to be affected include the city of Butembo and a number of isolated areas that are hard to reach…. … “We are very concerned by the epidemiological situation in the Butembo area. We now know that this outbreak will last and that we must increase our efforts to get it under control,” says John Johnson, MSF project coordinator in Butembo….”
This short MSF report inspired Helen Branswell to the following tweet: “WHO concerned [see below], MSF concerned… Don’t like the sound of this.”
Stat News – As Ebola outbreak spreads in Congo, concern grows over supplies of experimental vaccine
H Branswell; Stat News
“The Ebola outbreak in the Democratic Republic of the Congo appears to be spreading southward from its current epicenter at Beni, raising concerns it will take root in some larger population centers, including a major regional hub, warned a senior World Health Organization official. Should the outbreak spread more widely in cities like Butembo — where there have already been a number of cases — or Goma, a major center further south, the scale of the outbreak could tax the available supplies of an experimental vaccine being used to help contain spread, said Dr. Peter Salama, who heads the WHO’s emergencies program.
As of Sunday more than 42,000 doses of the vaccine had been used in this outbreak and one earlier in the year in the western part of the DRC. Merck, which is developing the vaccine, has committed itself to maintaining a stockpile of 300,000 doses. “We are extremely concerned about the size of the vaccine stockpile,” Salama told STAT in an interview. “And we’re regularly in touch with Merck to discuss what can be done about that.”…”
Vox – Why the Ebola outbreak in DRC has spun out of control – The WHO’s top emergency responder explains why the outbreak is now the second largest in history.
Analysis from late last week. And recommended. Interview with Peter Salama.
“… In the last two years since I have been here, 80 percent of our major outbreaks have been in conflict-affected areas. This is the issue of the future. The issue of urban outbreaks of high-threat pathogens is really an issue of our generation. I don’t think we’ve fully grappled with that. Now with yellow fever, plague, with Ebola, we are starting to see these patterns. All bets are off [in terms of] thinking we know about the transmission of diseases because of what happened in rural outbreaks in the past. It’s completely different now….”
And a tweet related to what he says on the situation of WHO’s Emergency Contingency Fund: “On the emergency contingency fund .@PeteSalama calls for establishment of formal system as in the G20 guarantee this fund will never fall below $50 million.” (think the G20 was tone deaf)
Lancet (Letter) – Two data points for gauging outbreak control
“… Outbreak control is typically assessed based on the trajectory of new cases and the overall picture depicted in situation reports issued by WHO, which detail response efforts and provide related data, such as the number of contacts being monitored. This information is helpful but does not always sufficiently clarify how effectively an outbreak is being controlled….”
“For outbreaks like the current [i.e. Ebola DRC ] one, in which transmission is primarily human-mediated and contact-tracing is the main control strategy, there are two metrics, percentage of new cases from known transmission chains and symptom-to-isolation interval, which can provide greater clarity on how controlled an outbreak is….”
Finally, some other links:
Guardian (by Sarah Boseley) – Are we on the cusp of a breakthrough in Ebola treatment?
“Ebola could be transformed from a terrifying disease into something that can be managed at home if drug trials in the Democratic Republic of the Congo are successful, a leading scientist believes….”
“The current Ebola outbreak in the Democratic Republic of Congo (DRC) is the second largest ever, occurring in a “perfect storm” of a densely-populated conflict zone. Yet thanks in large part to a strong collaboration between the World Health Organization and the pharmaceutical industry, the outbreak has so far remained confined to two DRC provinces, says Peter Salama, WHO deputy director general for emergency preparedness and response.”
Salama said this at a panel on global health security at the annual assembly of the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA) in Geneva, also marking the 50th anniversary of the federation’s creation.
Global Health security
WHO Emro – WHO Member States sign Khartoum Declaration on Sudan and Bordering Countries: Cross-Border Health Security
“Six countries in WHO’s Eastern Mediterranean and African Regions have signed a declaration committing themselves to strengthening preparedness and response to public health threats and events across borders in an effort to further the implementation of the International Health Regulations (IHR 2005) and enhance global health security. The Khartoum Declaration on Sudan and Bordering Countries: Cross-Border Health Security was signed by Chad, Egypt, Ethiopia, Libya, South Sudan and Sudan on 22 November 2018 in Khartoum, Sudan….”
WHO – Simulation exercise puts global pandemic readiness to the test
“A simulation for a global pandemic response involving more than 40 countries [will] take place 4-6 December, 2018, coordinated by the World Health Organization’s Global Emergency Operations Centre (EOC) and by the EOC Network, a global network of health emergency operations centres. This is the first global pandemic response training exercise, and the third in a series of simulations this year, following regional exercises in Jordan and Senegal….”
PREVENT Guidance – Pregnant women and vaccines against emerging epidemic threats: Ethics Guidance for Preparedness, Research and Response
“This Guidance provides a roadmap for the ethically responsible, socially just, and respectful inclusion of the interests of pregnant women in the development and deployment of vaccines against emerging pathogens. The Guidance is a product of the Pregnancy Research Ethics for Vaccines, Epidemics, and New Technologies (PREVENT) Working Group—a multidisciplinary, international team of 17 experts specializing in bioethics, maternal immunization, maternal-fetal medicine, obstetrics, pediatrics, philosophy, public health, and vaccine research and policy— in consultation with a variety of external experts and stakeholders. The Guidance begins by setting forth an aspirational vision and makes the case for its moral importance. We then specify 22 concrete recommendations, organized around three key areas: public health preparedness, R&D, and vaccine delivery. “
Basically, after the commotion around pregnant women in the (latest) Ebola outbreak, with this guidance, health care and bioethics experts are calling on the scientific community to allow pregnant and lactating women to receive vaccines against emerging infectious diseases.
LSHTM partner in UK’s first-ever dedicated Vaccines Manufacturing Innovation Centre
“Led by the Jenner Institute, LSHTM is a partner in the UK’s first-ever dedicated Vaccines Manufacturing Innovation Centre (VMIC), a £66m investment by UK Research and Innovation as part of the UK Government’s Industrial Strategy Challenge Fund (ISCF) Medicines Manufacturing challenge. Based in Oxford and expected to open in 2022, VMIC will be a purpose-built, state-of-the-art facility that will pave the way for the rapid manufacture of vaccines in the event of a pandemic affecting the UK. It will also enable rapid global response to emerging infectious epidemic pathogens such as Ebola and Zika, and innovate new technologies including the manufacture of personalised cancer vaccines. LSHTM is one of three academic institutions to join forces in the new company – VMIC UK – along with the University of Oxford and Imperial College London….”
Lancet World Report – Boosting quality diagnostics could give Africa better health
“Africa CDC has launched a new initiative aimed at boosting access to essential diagnostics across the continent. Munyaradzi Makoni reports.”
#MeToo & global health
UNAIDS Executive Director urges transparency on process of release of Independent Expert Panel report
“In February 2018, the Executive Director of UNAIDS called for the establishment of an Independent Expert Panel on prevention of, and response to, harassment, including sexual harassment, bullying and abuse of power at the UNAIDS Secretariat. The Panel has completed its report, which was distributed to the members of the UNAIDS Programme Coordinating Board (PCB) on 4 December, together with the UNAIDS Secretariat management response. The Panel’s report and the UNAIDS management response will be presented to the PCB on 11 December at its 43rd meeting. The decision on when the report will be communicated more broadly will be made by the voting members of the PCB. UNAIDS does not decide how the report is communicated to the PCB members and/or the public. The PCB will take a decision on the public release of the report on 6 December. “I fully respect the decision of the Programme Coordinating Board in determining when the report of the Independent Expert Panel will be shared with staff and the public. It is important to have full transparency of the process,” said Michel Sidibé, UNAIDS Executive Director. “Our staff and key partners are keen to see the report and know the findings and recommendations, as well as contribute to discussions on the next steps….”
This plea for full transparency from Sidibé followed this (from earlier this week): UNAIDS suppressing independent report into sex abuse, mismanagement (Code Blue).
But that’s probably just a coincidence.
Sidibé’s plea clearly didn’t suffice. On December 6, The NGO Delegation to the UNAIDS PCB Called for the Immediate Release of the Independent Expert Panel’s (IEP) Report .
See also Pam Das’ tweet – “This is odd. The long awaited report by the #PCB on @UNAIDS should have been released Dec 3. Why the delay or doubts on whether there should be a public release?”
And see also this UNAIDS press statement – UNAIDS has never offered economic compensation to complainants of sexual harassment in exchange for non-disclosure agreements
Launch of the recommendations of the WHO – Civil Society Task Force
The launch is scheduled for later today (7 Dec).
As a reminder, “in January 2018, a Civil Society Task team was established at the request of dr Tedros to advise WHO on how to strengthen its engagement with civil society to advance the 13th GPW. Led by representatives from 17 countries, and co-facilitated by the UN Foundation and RESULTS, the Task team has developed a set of concrete, actionable recommendations …” (etc)
You find the full report with the recommendations here: Together For The Triple Billion: A new era of partnership between the World Health Organization (WHO) and civil society
For a snapshot, see the four focal areas:
“Policy dialogue: Build in explicit, accessible opportunities for civil society to provide input into policies and governance at all levels.
At the country level, the Task Team recommends that WHO encourage Member States to consult CSOs in the development of the Country Cooperation Strategy (CCS) and that WHO work with CSOs to create time-bound national roadmaps to complement the CCS, detailing how WHO and CSOs will engage in the following strategy cycle. At the global and regional levels, the Task Team recommends that WHO take steps to strengthen the roles for civil society in governance and policymaking through increased meaningful CSO engagement.
Health emergencies: Strengthen emergency response by expanding country-level tripartite Health Cluster leadership.
The Task Team recommends that WHO expand the current WHO-Ministry of Health leadership of national Health Clusters to a tripartite arrangement that includes a CSO as co-lead, as recommended by the IASC Reference Module on Cluster Coordination and as contextually appropriate.
Gender equality, health equity, and human rights: Establish an independent “Inclusivity Advisory and Oversight Group.”
The Task Team recommends that WHO establish an Inclusivity Advisory and Oversight Group (IAOG) to support the Director-General, Senior Advisor on Youth and Gender, and the Executive Board to develop and evaluate policies and to provide formal support on gender, youth, equity, and rights mainstreaming. This group should be as diverse as possible, with representation from affected communities, faith-based organizations, and marginalized populations such as women, youth, indigenous groups, and people living with disabilities.
Data, research, and innovation: Develop a platform to crowdsource complementary, disaggregated data from CSOs.
Working with WHO and a third-party technology provider, the Task Team recommends that CSOs set up a data collection platform to collate disaggregated data (e.g. burden, coverage, and uptake data disaggregated by gender, age, race, ethnicity, and socioeconomic status), from across the CSO landscape, including community-based groups in particular, to complement existing sources.”
The Lancet (Offline) – : The invisibility of inequality
Horton’s take on the two faces of Singapore, after attending the Raffles Dialogue there last week.
On the one hand he thinks some of Singapore’s “… successes can do much to protect and strengthen the values of globalism so threatened today by renewed tides of nationalism.” (dream on, Richard)
On the other hand he points to “the contrasting story … provided by Teo You Yenn’s sharp, moving, and eloquent collection of essays, This Is What Inequality Looks Like (2018).” Including in Singapore. Horton then encourages us to (also) not look away from inequality, and instead, help to make it visible.
Lancet (Comment) – A global accountability mechanism for access to essential medicines
“…Efforts to ensure comprehensive access to essential medicines have been hindered by a dearth of information….” “Most monitoring efforts have focused on measurement of a prespecified list of essential medicines in health facilities….”
“…Without systematic data reporting on national pharmaceutical expenditure, there is a lack of attention to access to essential medicines in major reports such as the World Health Statistics. The 2015 Millennium Development Goals Task Force report concluded that tracking progress on access to essential medicines was impossible, given the absence of country-level data…”
2018 Global Status on Road Safety
UN News – Road injuries leading cause of death for the young, despite safety gains: UN report
“Latest statistics from the World Health Organization (WHO reveal that 1.35 million people die on the roads each year, while road traffic injuries are now the leading cause of death among young people, according to new statistics from the World Health Organization (WHO).”
Some key publications and papers of the week
BMJ Global Health (Commentary) – It is time for academic institutions to align their strategies and priorities with the Sustainable Development Goals
C Cancedda, A Binagwaho, V Kerry; https://gh.bmj.com/content/3/6/e001067.share
“There are strategic reasons and value-generating opportunities for academic institutions to fully embrace and actively pursue the health-related Sustainable Development Goal (SDG3) and other SDGs. The SDGs will incentivise academic institutions to think long term and strategically, align fundraising to the pursuit of local priorities, use common health-related metrics to monitor progress, collaborate across sectors and establish effective global health partnerships. The SDGs will also incentivise academic institutions to perfect metrics for institutional capacity strengthening and sustainability, which should be a stated and measurable outcome of any global health partnership.”
Health and Human Rights journal – Special Section on Human Rights and the Social Determinants of Health and a General Papers section
For a good overview of this Special section, read the Editorial Deepening the Relationship between Human Rights and the Social Determinants of Health: A Focus on Indivisibility and Power(by K H Kenyon, L Forman & C Brolan).
WHO Bulletin December issue
The Editorials were already published online before, but are certainly worth (re-)reading.
- Shifting global health governance towards the sustainable development goals (by R Marten et al)
- Improving the quality of health care across the health system (by S B Syed et al)
Global Public Health – Revisiting the social determinants of health agenda from the global South
Elis Borde et al; https://www.tandfonline.com/doi/full/10.1080/17441692.2018.1551913
“In an effort to provide an overview of the conceptual debates shaping the mobilisation around social determinants of health and health inequities and challenge the apparent consensus for equity in health, this essay compares two of the most influential approaches in the field: the WHO Commission on Social Determinants of Health approach (CSDH), strongly influenced by European Social Medicine, and the Latin American Social Medicine and Collective Health (LASM-CH) ‘Social determination of the health-disease process’ approach, hitherto largely invisibilized. It is argued that the debates shaping the equity in health agenda do not merely reflect conceptual differences, but essentially different ethical-political proposals that define the way health inequities are understood and proposed to be transformed. While the health equity agenda probably also gained momentum due to the broad political alliance it managed to consolidate, it is necessary to make differences explicit as this allows for an increase in the breadth and specificity of the debate, facilitating the recognition of contextually relevant proposals towards the reduction of health inequities.”
Critical public health – The integration of evidence from the Commission on Social Determinants of Health in the field of health equity: a scoping review
K M Plamondon et al; https://www.tandfonline.com/doi/full/10.1080/09581596.2018.1551613
« In 2008, the World Health Organization’s Commission on Social Determinants of Health (CSDH) presented an influential compilation of evidence establishing the relationship between health inequities and the unfair distribution of power, wealth, and resources. A decade later, individual and bio-behavioural responses to health inequities persist. The purpose of this scoping review was to explore the extent to which this evidence guided research, practice, and policy in global and public health. To do this, we assessed different ways the CSDH evidence and calls for action were integrated in scholarly publications (citation, portrayal of health inequities, alignment with calls for action, and orientation toward root causes). … … Among 110 post-CSDH empirical articles, half did not align with CSDH principles for action. This review illustrates that much scholarly work that purported to contribute to health equity did so in ways that conflicted with the CSDH’s characterization of the remediable nature and distribution of health inequities. These results provide a practical platform for assessing how global and public health efforts can move towards better alignment with the best available evidence about advancing health equity.”
WHO Searo (Book) – Resilient and people-centred health systems: Progress, challenges and future directions in Asia
Editors: Helena Legido-Quigley and Nima Asgari-Jirhandeh http://apps.who.int/iris/bitstream/handle/10665/276045/9789290226932-eng.PDF?sequence=5&isAllowed=y
400 + pages. Including, interestingly, a chapter 2 on planetary health and resilience in Asia.
Health Systems & Reform – Community Engagement in Support of Moving toward Universal Health Coverage
P Allotey et al; https://www.tandfonline.com/doi/full/10.1080/23288604.2018.1541497
Part of a number of new articles in HS&R focusing on UHC in the Asia-Pacific region.
“Community engagement describes a complex political process with dynamic, negotiation and renegotiation of power and authority between providers and recipients of health care in order to achieve a shared goal of universal health care coverage. While examples exist of community engagement projects, there is very little guidance on how to implement and embed community engagement as a concerted, integrated, strategic and sustained component of health systems. Through a series of case studies, this paper explores the factors that enable community engagement particularly with direct impact on health systems.”
Health Systems & Reform – Governance Pathways to Accelerate Progress Towards Universal Health Coverage (UHC) in the Asia-Pacific Region
“Many countries in the Asia-Pacific region have committed to UHC, which is reflected in both their political commitment and the governance actions they have taken in steering their health systems towards the goals of universal access to care and protection from financial hardship. Countries throughout the region are at different stages of development and have different political and governance contexts which in turn shape how they pursue governance for UHC. This paper reviews the governance functions deployed in the Asia-Pacific and finds that, in many, governance reforms adapting their health systems towards greater regulation, accountability, oversight and stewardship of the health system have been part of their wider move towards UHC. Countries have not followed a set pattern, but shared aspects include: establishing UHC as a goal in national policy-making and priority-setting; the creation of new roles and/or new institutions within the health system; establishing systems of monitoring and evaluation; and putting in place mechanisms to facilitate collaboration and ensure greater accountability. The relationship between governance and UHC in the Asia-Pacific region is found to be complex, negotiated, and shaped by a number of factors in both the internal and external environment including: broader governance arrangements in the public sector (institutional changes and decentralization are particularly prominent factors) and the ability of governments to implement policies and steer the health system.”
Some key blogs and articles of the week
O’Neill Institute – Mapping the evolution of the Right to Health at the Office of the High Commissioner for Human Rights
Very insightful blog.
Branko Milanovic (blog) – First reflections on the French ““événements de décembre”
As Emmanuel Macron is the current darling of some (many?) in the global health community, good to try to understand a bit what’s going on in France. Milanovic’s second case here, is more convincing than his first case, at least in my opinion.
Laurie Garrett (CNN) – Macron’s top-down approach to fighting climate change serves as a cautionary tale
Laurie Garrett’s take on the ‘events’ in France. “…Macron’s eager absorption of corporate capitalism into the global governance of climate change now threatens to blow up in his face. It was never about democracy — how could it be? The world’s working poor have no seats in the boardrooms or on the stock markets, and no influence over Amazon’s carbon emissions schemes or the success of Tesla electric trucks….”
“As exhausting and daunting as it may be, climate leaders must pay heed to the cries of France’s yellow vests, and the angry masses inside their own nations. A corporate boardroom or gathering of CEOs may be more comfortable. But curing the world’s climate catastrophe, pulling humanity from its existential brink, requires nothing less than solutions found, and supported, across whole societies….”
Jacobin – The Guardian’s Populism Panic
“Britain’s leading liberal newspaper has set out on a mission to define and defeat “populism.” It has not gone well.” Recommended analysis, if you want to understand ‘populism’ a bit more.
Will be key, if “global health” doesn’t want to become more marginalized in the years to come (in the North).
CGD (blog) – Three Lessons from the World Bank’s New Worldwide Bureaucracy Indicators Database
“On Tuesday, the World Bank announced the launch of a new database to characterize the quality and composition of the public sector in 115 countries. According to Jim Brumby, the Director of the World Bank’s Governance Global Practice, the Worldwide Bureaucracy Indicators (WWBI) “can help researchers and development practitioners gain a better understanding of the personnel dimensions of state capability, the footprint of the public sector on the overall labor market, and the fiscal implications of the government wage bill.” The new indicators are part of a larger effort by the World Bank’s Bureaucracy Lab, which is seeking to promote the use of evidence and technology in civil service reform….” This blog focuses on 3 patterns that stood out for the author.