Annual Letter Bill & Melinda Gates: We didn’t see this coming
“In this year’s annual letter, we’re highlighting nine more things that have surprised us along this journey. Some worry us. Others inspire us. All of them are prodding us to action. We hope they do the same for you, because that’s how the world gets better.” The letter dwells on a wide range of issues, from Africa as a very young continent, over a nationalist case for globalism (at least in their view), the importance of innovations to help prevent premature birth and for new generation toilets, their view on what needs to be done in the climate change battle, …
Do read the letter, it’s well worth it.
Or check out the coverage in Devex – Q&A: Bill and Melinda Gates expand on 3 surprises from annual letter
Among others, they stress the role of data in driving progress for the poor. This article also zooms in on the collaboration of the Gates Foundation with the World Bank.
Q: “Melinda wrote in the margins of the letter about human capital: “Leave it to economists to come up with such a dry term.” How might the foundation do more to support human capital and how do you envision the potential for partnership with the World Bank and others?”
For more coverage (and the backdrop of this annual letter), see also the Seattle Times – Bill and Melinda Gates warn that ‘go-it-alone’ politics could deal a major setback to global health
“In an interview ahead of the foundation’s release of its annual letter, Bill and Melinda Gates warned that a pullback in support for global health initiatives by some wealthy governments could undercut years of progress in battling polio and other infectious diseases and potentially set the stage for renewed outbreaks.”
Forbes – Bill Gates Gets Why People Are Doubting Billionaires—And He Has A Defense (Even For Mark Zuckerberg)
Interesting read, now that the radical left wing of the Democrats are increasingly questioning (the use of) billionaires. What is Gates’ view on this?
Gates: “I think it’s fascinating that for the first time in my life people are saying, ‘Okay, should you have billionaires?’ ‘Should you have a wealth tax?’ I think it’s a fine discussion.” … .. “It’s a discussion that took place yesterday just a block from Trump Tower, home of America’s first-ever billionaire president. “My opinion is that there should be an estate tax and maybe even higher than we have today. Among The Forbes 400, I don’t think we’d get a majority—Warren [Buffett] and I are sort of against interest on that,” says Gates. “So I think there’s plenty of debate about how capital should be taxed, how estates should be taxed.”
“But as for the kind of disincentivizing economics lamented by the Beatles in “Taxman” and increasingly championed by America’s far left, Gates remains clear: “The idea that there shouldn’t be billionaires—I’m afraid if you really implemented something like that, that the amount you would gain would be much less than the amount you would lose.” Ostensibly, this year’s letter, which lays out their philanthropic observations and priorities, focuses on nine surprises that have inspired the Gateses to take action. In reality, it’s a valentine to the power of philanthropic investment—the idea of giving not to salve problems, but to solve them. All of these initiatives tell a similar story. They’re about “picking novel ideas” or “off-the-wall theories,” as Gates says, and then proving that the concepts work. “Once you find a solution and want to scale that up, it’s usually government money.” … … Ultimately, Gates, whose net worth, even after large donations to the foundation, approaches $100 billion, views philanthropy as a vital force for good. And he thinks that potential critics—even a loony potential British prime minister—will come around to that view.
This paragraph ‘pour la petite histoire’: ) “When I met with Jeremy Corbyn for the first time, does he view me as the billionaire guy who collected more money than he thinks anybody is supposed to collect?” recalls Gates. “Or does he view me as the philanthropist who’s helping improve Africa and hopefully learn about education? Fortunately he was very nice, he viewed me as the second. But I’m sure he had to hesitate: ‘This guy is one of those people that maybe there should be none of.’”
PS: But check out also this related tweet from Owen Barder: “This (from @BillGates) is something that philanthropists tell themselves, and us, but it isn’t really true, is it? His foundation behaves just like a public sector aid agency – with all the same risk aversion, bureaucracy and public sector mindset.”
Africa Leadership meeting: investing in health (9 Feb)
Concept of the meeting & new initiative launched over the weekend:
“African leaders gather[ed] ahead of the 32nd African Union Summit, to launch a new initiative aimed at increasing commitments for health and accelerating path towards Universal Healthcare Coverage. … … According to the 2018 WHO Global Health Expenditure Database, African countries are gradually increasing domestic investments in health with 35 out of 55 AU Member States (over 64%) having increased the percentage of their Gross Domestic Product invested in health over the previous financial year. These increased investments have seen visible results in communities across Africa with shining examples of strengthened sub-national and national health systems. However, while African countries have made huge strides in increasing domestic investments in health, only 2 out of the 55 AU Member States meet Africa’s target of dedicating at least 15% of the government budget to health and do not reach the suggested threshold of US$86.30 per person required to provide a basic package of health services. … … Chaired by HE President Paul Kagame, President, Republic of Rwanda; concurrent Chair, African Union and AIDS Watch Africa, the Africa Leadership Meeting: Investing in Health [will be[ the first platform bringing together governments, private sector and the global development community, to coordinate and accelerate progress toward achieving universal health coverage.”
“Chaired by President Paul Kagame, President, Republic of Rwanda; Chair, African Union, the Africa Leadership Meeting: Investing in Health is a platform launched by the African Union. Partner organisations include: The Global Fund to fight AIDS, Tuberculosis and Malaria, Gavi the Vaccine Alliance, and the Bill & Melinda Gates Foundation. More than a meeting, it is a unique opportunity for African Heads of State and Governments to discuss increased domestic health financing, make pledges to participating organisations, and to engage the private sector – specifically African companies – and to encourage participating organisations to collaborate more to increase impact.”
The Addis Ababa Call to Action was formally adopted during this Summit with a Declaration read by President Kagame.
“Delegates at a high-profile health-themed conference held in Ethiopia’s capital Addis Ababa on Saturday called for more investments to ensure universal health coverage in Africa. The event, titled “The Africa Leadership Meeting: Investing in Health,” was hailed as the first of its kind on the continent during the 32nd African Union (AU) Summit. Speaking at the conference, Rwandan President Paul Kagame, who is also the rotating chair of the AU, said African governments should increase domestic expenditure in health sector to achieve national and international health-related goals, including the AU Agenda 2063 and the 2030 Sustainable Development Goals(SDGs)….”
Kagame called on African governments to encourage the private sector to invest more in health-related services….”
“Kagame added that the progress tracker tool being developed would be used to monitor investments, putting the continent firmly on track for its health targets for Agenda 2063 and the sustainable development goals. The involvement of the private sector would be key, he emphasised….”
“…The meeting saw public and private sectors, as well as donor governments, pledge up to US$200 million to help end epidemics and bring universal health coverage to all. Higherlife Foundation, the Government of Ireland and Government of France all committed to increased financing of health in Africa, with the Government of Japan tabling universal health coverage as an agenda item at the G20 Osaka Summit later this year, carrying forward commitment to and collaboration on health….”
“Bill Gates, Co-Chair, Bill and Melinda Gates Foundation said, “The time to mobilise domestic resources for health is now. The nations of the African Union have set bold, ambitious targets. If governments increase their investments in health, not a decade from now, but immediately, we know it is possible to meet set targets. We can end the epidemics of AIDS, TB, and malaria. We can achieve universal health coverage and grow Africa’s economy in the process.”
“Dr. Tedros Adhanom Ghebreyesus, Director-General, World Health Organization commented, “Universal health coverage is not a luxury only rich countries can afford. All countries can make progress with the resources they have. The Addis Ababa Call to Action is a powerful commitment from African Union leaders to increase domestic financing for health, and to hold themselves accountable for that commitment.”
Cfr a tweet: “In the Addis Ababa Call to Action, countries have not only committed to greater investments in health, but also to smarter investments in health. The smartest investment any country can make is in #PrimaryHealthCare, with an emphasis on promoting health and preventing disease.”
Not everybody was convinced, though, of the Initiative. See Rob Yates, who worried about private health insurance lurking in the background:
“Private health insurance will NOT take Africa to #UHC – it’s inefficient and inequitable and divides populations.”
Africa Business Health Forum (12 Feb)
“The Africa Business: Health Forum 2019 was organized by GBCHealth, Aliko Dangote Foundation and United Nations Economic Commissions for Africa. The goal of the Forum is to build a coalition to crowd in public and private sector resources to deliver transformative health outcomes across the continent.”
You find the concept note here.
Devex – Africa’s $66B health financing gap requires private sector power, experts say
Coverage of this Business Health Forum.
“Heads of state, health experts, development partners, and the private sector met on the sidelines of the 32nd African Union summit for the Africa Business Health Forum on Tuesday to discuss ways to improve health care in Africa through public-private partnerships in an effort to achieve universal health coverage.
Statistics from the new U.N. ECA “Healthcare and Economic Growth in Africa” report provide quantitative evidence that life expectancy has increased, infant mortality has decreased, and Africa is now healthier than 20 years ago. But troubling trends in health finance put these gains at risk. Africa has a health financing gap of at least $66 billion annually, the report states, with all but three African governments meeting the suggested 15 percent allocation of gross domestic product for health, as outlined by the 2001 Abuja Declaration.
The Forum also saw the launch of the African Business Coalition for Health (ABCHealth), “a private sector led coalition of companies and philanthropists who will come together to positively transform health care for Africans growing population. “
“The new collaboration outlines five primary objectives to achieve in its first three years, including working directly with companies to optimize workplace and community health programs, and advocating for policies and initiatives that drive national and regional change.”
“…Business opportunities in the health care and wellness sector in Africa are estimated to be worth $259 billion by 2030, with a potential to create 16 million jobs, the UNECA report estimates….”
Other health news from the African Union summit
The Telegraph – Poorest countries in Africa set to wipe out neglected diseases while richest fall behind
“Some of the poorest countries in Africa are set to wipe out the most common diseases of poverty within the next few years. A review of 49 African countries’ progress in fighting neglected tropical diseases (NTDs) shows that some of the continent’s poorest countries, such as eSwatini (formerly known as Swaziland), Malawi and Mali are outperforming some richer countries such as Botswana and South Africa.
The analysis, by the organisation United to Combat NTDs, looked at the five most common NTDs in Africa: blinding trachoma, the leading cause of infectious blindness; intestinal worms that can stunt the growth of children; mosquito-borne elephantiasis; snail-borne bilharzia and river blindness….”
Devex – What will Egypt focus on as African Union chair?
In addition to a look ahead to Egypt’s upcoming chairmanship of the AU, also with this paragraph:
“…Other key decisions taken at this year’s summit include the launching of the African Medicines Agency to combat disease in Africa, along with the chairman’s announcement of the “Aswan Forum for Peace and Sustainable Development,” a high-level meeting to take place later this year. And in July, heads of state will gather in Niger to officially launch the AU Development Agency — formerly known as the New Partnership for Africa’s Development — following approval of its statute, rules of procedure, and governance structures….”
Gates – ‘Africa hangs in the balance’: Bill Gates on why the continent is so important
“On Sunday, Bill Gates … … addressed the nations of the African Union at their annual summit and urged them to invest more in their health systems. At the summit, African leaders committed to increased spending on health for the 55 countries of the continent. Ahead of his address to the summit, Gates spoke with The Washington Post, about why Africa is so important to the world. Here are excerpts from the interview….”
“The good news about health is that by spending modest amounts on the prioritised areas, you can get phenomenal benefits,” Bill Gates told AFP on the sidelines of the African Union summit in Addis Ababa. “You don’t have to get all the way to middle-income before you can run a great primary healthcare system…. ” Excellent basic healthcare that would prevent easily treatable but deadly conditions is achievable even in Africa’s poorest nations, he stressed.
Finally, you might also want to read Donald Kaberuka’s op-ed in Project Syndicate – Empowering the African Union in which he makes the case for adequate, predictable, and sustainable funding of the AU that comes from within.
Decolonizing Global Health Conference 2019 (Harvard, 8 Feb)
Above you already could read Werner Soors’ short Editorial.
We also recommend Renzo Guinto’s (more general) blog on the need to decolonialize global health. He encourages all of us to write, mobilize and reflect. His blog does not cover the conference in Harvard, though.
“… what do we really mean by #DecolonizeGlobalHealth? In order to prevent this new concept to end up becoming a buzzword that will later fade away, it is vital that the global health community of scholars and practitioners unpack, examine, and reflect upon this idea. From my view, there are at least three areas of inquiry where researchers and policy-makers can ask questions, debate ideas, and find answers….” They are: the analysis of global health, its institutions and processes.
Thomson Reuters Foundation – Women in US Congress move to repeal abortion gag rule
News from late last week.
“ Women in the U.S. Congress took formal steps on Thursday to lift a gag rule imposed by President Donald Trump that has slashed access to abortion globally, introducing legislation that would permanently shut down the controversial policy. … … The proposed law would permanently repeal the rule, which has been used by U.S. presidents for decades to signal their stance on abortion rights, a touchstone issue in U.S. politics….”
See also Guttmacher institute – The Global HER Act Would Repeal the Harmful Global Gag Rule
But it’s early days…
The Lancet Commission on women and cardiovascular disease: time for a shift in women’s health
“… As a catalyst to prompt a new era for women and cardiovascular disease, The Lancet has convened a clinical Commission that will survey the available data on the prevalence and outcomes at the global and regional levels, provide an overview of gaps in the data, and identify the most attainable goals for improving outcomes (panel). In partnership with the Icahn School of Medicine at Mount Sinai in New York, USA, The Lancet Commission on women and cardiovascular disease brings together leading researchers from most regions around the world who have a breadth of clinical expertise in cardiovascular medicine. Importantly, all the Commissioners are women
… The overarching goal of The Lancet Commission on women and cardiovascular disease is to address what has long been understood to be a neglected area in health with fresh new perspectives and ideas. It will challenge the status quo in clinical care and public health policy and messaging, and will establish clear benchmarks and metrics for improving outcomes. This Commission therefore aims to document important aspects of this issue, to aggregate and disseminate the innovative work being done worldwide, and to make recommendations that will prompt a shift in the diagnosis and treatment of women with cardiovascular disease….”
Global Health Security
CEPI partners with IVI to accelerate development of vaccines against emerging global health threats
“The Coalition for Epidemic Preparedness Innovations (CEPI) and the Republic of Korea-based International Vaccine Institute (IVI), an international organisation devoted to vaccines for global health, [today] announced a collaboration to accelerate the development of vaccines against emerging infectious diseases….”
Science insider – EXCLUSIVE: Controversial experiments that could make bird flu more risky poised to resume
“Controversial lab studies that modify bird flu viruses in ways that could make them more risky to humans will soon resume after being on hold for more than 4 years. ScienceInsider has learned that last year, a U.S. government review panel quietly approved experiments proposed by two labs that were previously considered so dangerous that federal officials had imposed an unusual top-down moratorium on such research. One of the projects has already received funding from the National Institutes of Health’s (NIH’s) National Institute of Allergy and Infectious Diseases (NIAID) in Bethesda, Maryland, and will start in a few weeks; the other is awaiting funding. The outcome may not satisfy scientists who believe certain studies that aim to make pathogens more potent or more likely to spread in mammals are so risky they should be limited or even banned. Some are upset because the government’s review will not be made public….”
Interestingly, this year’s Münich security report 2019 has nothing on global health security (at least if GHS is narrowly defined).
Global Fund Replenishment kick-off (Delhi, 8 Feb)
Global Fund – Global Partners Commit to Step Up the Fight Against AIDS, TB and Malaria
This was the press statement after the kick-off meeting in Delhi, last Friday.
“…Hosted by the Government of India, the Preparatory Meeting of the Global Fund’s Sixth Replenishment brought together governments, donors, technical partners and civil society groups in a demonstration of global solidarity to pursue Sustainable Development Goal 3, “health and well-being for all.” The Global Fund is seeking to raise at least US$14 billion for the next three years to help save 16 million lives, cut the mortality rate from HIV, TB and malaria in half, and build stronger health systems by 2023….”
“…France, which this year took over the presidency of the G7, will host the Global Fund’s Sixth Replenishment Conference in Lyon on 10 October 2019. The conference is aimed at raising funds to fight the diseases and build stronger systems for health for the next three years….”
“The Global Fund’s Sixth Replenishment Investment case, presented at the meeting in New Delhi today and available below, describes what can be achieved by a successful Replenishment, the new threats facing global health progress today, and the risks if we don’t step up the fight now.”
See also coverage in HPW – How The Global Fund Plans To Raise US$ 14 Billion To Meet Its Goals
“The Global Fund’s Sixth Replenishment target of at least US$14 billion represents an increase of US$1.8 billion, or 15 percent, over the US$12.2 billion raised during the Fifth Replenishment period from 2016-2018. “To achieve that increase, we actually require all of existing donors, existing small donors, new donors, the private sector. So we are in active dialogue with the full range of existing donors, new donors, potential donors and the private sector. Indeed, at the World Economic Forum meeting in Davos [Switzerland, in January], we issued a challenge to the private sector to mobilize at least a US$ 1 billion out of the US$ 14 billion,” Sands told Health Policy Watch.
… … One promising development flagged by many speakers at the Delhi meet is increasing financial commitments by national governments. “All countries are stepping up domestic financing. Ultimately, sustainable victory against these diseases and sustainable development of health systems is going to be done by governments,” Sands told Health Policy Watch….”
Read also in Xinhua news about how Sands hails the Fund’s health cooperation with China.
GFO – Civil society organizations push for a target of $18 billion for the Global Fund’s Sixth Replenishment
“Organizations representing civil society have renewed their call for a more ambitious target for the Global Fund’s Sixth Replenishment. On the occasion of the preparatory meeting for the replenishment, held on 7–8 February 2019 in New Delhi, India, the Global Fund Advocates Network (GFAN), communities and civil society called for a “bold” replenishment target of $18 billion. This is $4 billion higher than the $14 billion target announced by the Global Fund on 11 January.
“The CSOs said they were also concerned that the $46 billion projected for domestic funding for 2021-2023 represents a 48% increase compared to the $31.1 billion from domestic funding for the current period (2018-2020). The CSOs also noted that the majority of the projected $17 billion increase in total funding – from $66 billion in 2018-2020 to $83 billion in 2021-2023 – is expected to come from domestic funding. … … The CSOs questioned whether these expectations for domestic funding were realistic. “Many low-income countries continue to require international assistance for health to supplement low levels of resources budgeted for health,” the CSOs stated….”
“…In a related development, Ireland has announced that for the Sixth Replenishment it will increase its contribution by 50% (to €45 million from the €30 million it pledged for the Fifth Replenishment). The announcement was made at the African Leadership Meeting in Addis Ababa on February 9. The first country to pledge for the Sixth Replenishment, however, was Luxembourg, which announced a commitment of €9 million, up 11% from its Fifth Replenishment pledge.”
UK hosts GAVI replenishment in 2020
“The UK will host a major international conference in 2020 to raise funds for life-saving vaccinations for some of the world’s poorest children, International Development Secretary Penny Mordaunt announced today.” After Berlin, it’s now again the UK’s turn for the GAVI replenishment.
See also a GAVI press release .
Guardian – Boris Johnson backs call for multibillion cut to UK aid budget
“Calls for a multibillion-pound cut in the UK’s overseas aid budget and closure of the Department for International Development (DfID) as a separate Whitehall entity are set out in a new vision for a post-Brexit “global Britain” backed by the former foreign secretary Boris Johnson. Current definitions of aid spending would be broadened to include peacekeeping, and the BBC’s World Service would be expanded, as part of an effort to restore Britain’s ability to project soft and hard power. The paper argues the UK should be freed to define its aid spending unconstrained by criteria set by external organisations, and its purpose expanded from poverty reduction to include “the nation’s overall strategic goals”. UK aid spending, set by law at 0.7% of gross national income, was £13.4bn in 2016. The proposals are being fed into a Foreign Office review on UK soft power post-Brexit headed by the foreign secretary, Jeremy Hunt….”
Anti-vaccination & Facebook
Guardian – Facebook under pressure to halt rise of anti-vaccination groups
“Facebook is under pressure to stem the rise of anti-vaccination groups spreading false information about the dangers of life-saving vaccines while peddling unfounded alternative treatments such as high doses of vitamin C. So-called “anti-vaxxers” are operating on Facebook in closed groups, where members have to be approved in advance. By barring access to others, they are able to serve undiluted misinformation without challenge. The groups are large and sophisticated. Stop Mandatory Vaccination has more than 150,000 approved members. Vitamin C Against Vaccine Damage claims that large doses of the vitamin can “heal” people from vaccine damage, even though vaccines are safe. Health experts are calling on Facebook to do more to counter these echo chambers….”
Read also (on the Conversation) – Why anti-vaccine beliefs and ideas spread so fast on the internet (by a few Stellenbosch scientists)
Guardian – Measles: WHO warns cases have jumped 50%
“The World Health Organization has warned that efforts to halt the spread of measles are “backsliding”, with case numbers worldwide surging around 50% last year.”
“The UN health agency pointed to preliminary data showing that the disturbing trend of resurgent measles cases was happening at a global level, including in wealthy nations where vaccination coverage has historically been high. …. … the agency said the data it has received so far showed that around 229,000 cases had already been reported, compared to 170,000 for 2017…..
“In Europe and other wealthy areas, meanwhile, experts blame the problem in part on complacency and misinformation about the vaccine. The resurgence of the disease in some countries has been linked to medically baseless claims linking the measles vaccine to autism, which have been spread in part on social media by members of the so-called “anti-vax” movement….”
See also UN News – Measles cases nearly doubled in a year, UN health agency projects
Launch global standards for safe listening devices
WHO – New WHO-ITU standard aims to prevent hearing loss among 1.1 billion young people
“Nearly 50% of people aged 12-35 years – or 1.1 billion young people – are at risk of hearing loss due to prolonged and excessive exposure to loud sounds, including music they listen to through personal audio devices. Ahead of World Hearing Day (3 March), the World Health Organization (WHO) and the International Telecommunication Union (ITU) have issued a new international standard for the manufacture and use of these devices, which include smartphones and audio players, to make them safer for listening.”
See also Health Policy Watch – New WHO-ITU Standard Released On “Safe Listening” To Prevent Hearing Loss
And for some info on the launching event itself, see HPW – WHO Rocks To The “Sound Of Life” At Launch Of WHO-ITU Safe Listening Standard
“ Grammy award-winning musician Ricky Kej performed a “Sound of Life” concert at the World Health Organization to help launch the first-ever global standard for safe listening devices, aimed at raising awareness and inspiring action to prevent sound-induced hearing loss.” Ricky WHO?
Guardian – Plummeting insect numbers ‘threaten collapse of nature’
I bet you got this horror news via the world media this week: “The world’s insects are hurtling down the path to extinction, threatening a “catastrophic collapse of nature’s ecosystems”, according to the first global scientific review.”
“More than 40% of insect species are declining and a third are endangered, the analysis found. The rate of extinction is eight times faster than that of mammals, birds and reptiles. The planet is at the start of a sixth mass extinction in its history, with huge losses already reported in larger animals that are easier to study. But insects are by far the most varied and abundant animals, outweighing humanity by 17 times. “
The analysis, published in the journal Biological Conservation, says intensive agriculture is the main driver of the declines, particularly the heavy use of pesticides. Urbanization and climate change are also significant factors… The world must change the way it produces food, Sánchez-Bayo said, noting that organic farms had more insects and that occasional pesticide use in the past did not cause the level of decline seen in recent decades. “Industrial-scale, intensive agriculture is the one that is killing the ecosystems,” he said. In the tropics, where industrial agriculture is often not yet present, the rising temperatures due to climate change are thought to be a significant factor in the decline. “
Guardian – Climate and economic risks ‘threaten 2008-style systemic collapse’
“The gathering storm of human-caused threats to climate, nature and economy pose a danger of systemic collapse comparable to the 2008 financial crisis, according to a new report that calls for urgent and radical reform to protect political and social systems. The study says the combination of global warming, soil infertility, pollinator loss, chemical leaching and ocean acidification is creating a “new domain of risk”, which is hugely underestimated by policymakers even though it may pose the greatest threat in human history… “This new risk domain affects virtually all areas of policy and politics, and it is doubtful that societies around the world are adequately prepared to manage this risk.””
“The IPPR (Institute for Public Policy Research) report, which launches a wider 18-month project on this topic, urges policymakers to grapple with these risks as a priority, to accelerate the restoration of natural systems, and to push harder on the “green new deal” transition towards renewable energy. In particular, it says, “the younger generations will need help in finding the energy and a sense of control that often eludes them as they begin to realize the enormity of inheriting a rapidly destabilizing world”.”
Guardian – Environmental and social problems could interact in global breakdown, report says
Ann Pettifor; https://www.theguardian.com/commentisfree/2019/feb/11/the-green-new-deal-offers-radical-environmental-and-economic-change
“The revival of the Green New Deal framework (first developed in a report published in 2008) and popularized by Alexandria Ocasio-Cortez and Justice Democrats in the US, is a huge advance for green campaigners and, hopefully, for our threatened species… The Green New Deal demands major structural (governmental and inter-governmental) changes (not just behavioral change) in our approach to the ecosystem… developed on the understanding that finance, the economy and the ecosystem are all tightly bound together.”
In other Green New Deal related news, the Verge reported “The recently announced Green New Deal … … gives public health advocates a chance to confront an overlooked consequence of climate change: worsening mosquito-borne illnesses. “
UN News – UN announces roadmap to Climate Summit in 2019, a ‘critical year’ for climate action
“2019 is a critical year, the “last chance” for the international community to take effective action on climate change, General Assembly President Maria Espinosa said on Thursday, during a briefing to announce the UN’s roadmap to the Climate Summit in September.”
“…The General Assembly President walked the representatives of Member States through some of the key events of 2019, leading up to, and following, the Climate Summit. All of the events, she said, share two goals: a doubling of commitments and ambition at a national level, and ensuring the inclusion of diverse groups in the process of climate action.”
“…The Climate Summit will be followed by the first-ever High Level Political Forum on Climate Action, sponsored by the General Assembly on September 24. The year will be rounded off by the 2019 Climate Conference COP25, which will take place in Chile….”
BMJ Global Health (Commentary) – Neglected tropical diseases and the sustainable development goals: an urgent call for action from the front line
A Addisu et al; https://gh.bmj.com/content/4/1/e001334
“The international community has pledged through the Sustainable Development Goals to eliminate neglected tropical diseases by 2030. Authors from 19 institutions around the world call for urgent reflection and a change in mind-set to garner support and hasten progress towards achieving this fast approaching target. They advocate for an empowering approach that will propel political momentum, milestones and targets for accountability, new science in drug development and increased funding particularly from G20 countries.”
Plos NTDs – China’s shifting neglected parasitic infections in an era of economic reform, urbanization, disease control, and the Belt and Road Initiative
A side effect of the Belt & Road initiative: « …In terms of emerging parasitic diseases, however, a significant downside of increased investments and trade in Africa has been an increase in imported parasitic infections including intestinal schistosomiasis (caused by Schistosoma mansoni), loiasis, African trypanosomiasis, cutaneous leishmaniasis, and falciparummalaria….”
For coverage, see Scidev.net – China opens path to disease via Belt and Road trade route
“China eliminated several parasitic diseases over the last 20 years; There are signs of resurgence along Belt and Road trade route; Chinese workers returning from Africa and Asia import parasitic diseases…”
BMJ Global Health – Is the current surge in political and financial attention to One Health solidifying or splintering the movement?
J Spencer et al; https://gh.bmj.com/content/4/1/e001102
One of the reads of the week.
“The global health field has witnessed the rise, short-term persistence and fall of several movements. One Health, which addresses links between human, animal and environmental health, is currently experiencing a surge in political and financial attention, but there are well-documented barriers to collaboration between stakeholders from different sectors. We examined how stakeholder dynamics and approaches to operationalising One Health have evolved further to recent political and financial support for One Health….”
Findings: “We found that recent attention to One Health at high-level political fora has increased power struggles between dominant human and animal health stakeholders, in a context where investment in collaboration building skills is lacking. The injection of funding to support One Health initiatives has been accompanied by a rise in organisations conducting diverse activities under the One Health umbrella, with stakeholders shifting operationalisation in directions most aligned with their own interests, thereby splintering and weakening the movement. While international attention to antimicrobial resistance was identified as a unique opportunity to strengthen the One Health movement, there is a risk that this will further drive a siloed, disease-specific approach and that structural changes required for wider collaboration will be neglected.”
Lancet Letter on the concept ‘Global Syndemic’
Lancet – The global syndemic of obesity, undernutrition, and climate change
E Mendenhall & M Singer; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30310-1/fulltext
The authors criticize how the recent Lancet ‘Global Syndemic’ Commission used the term ‘syndemic’, but also see some utility in it.
“The Lancet Commission’s interpretation of a global syndemic diverged from the way syndemic was first described by its architect, Singer. This divergence in the proposed concept of global syndemic is somewhat surprising given that The Lancet published a Series on syndemics in 2017;…”
“ Although scientifically divergent from its original conception, thinking about obesity as a global syndemic might have some utility. …” “Obesity exemplifies a pivotal syndemic problem that requires international-level policy interventions to curb the power and influence of multinational corporations, such as Big Sugar and Big Food, which unrelentingly target low-income populations. In this context, arguing for a global syndemic might serve as a political tool to propel positive alliances to take action against multinational corporations. …”
Ebola DRC outbreak
Some reads from this week:
Cidrap News – Ebola treatment trials move to hot spot centers
“Doctors Without Borders (MSF) announced [today] that an ongoing trial of four experimental Ebola treatments will begin enrolling participants at treatment centers in Katwa and Butembo, the current hot spots in the Democratic Republic of the Congo’s (DRC’s) 7-month-long Ebola outbreak.”
“An unparalleled Ebola vaccination programme in the Democratic Republic of the Congo has become engulfed in allegations of impropriety, amid claims that women are being asked for sexual favours in exchange for treatment. Research by several NGOs has revealed that a deep mistrust of health workers is rife in DRC and gender-based violence is believed to have increased since the start of the Ebola outbreak in August. The research, presented at a national taskforce meeting in Beni, follows calls by international health experts urging the World Health Organization to consider issuing a global alert in relation to the outbreak….”
The news report caused a lot of commotion, evidently, but it’s not entirely clear whether it’s true or fake news.
See the following tweet from Isaac Florence : “Huge twist: DRC Ministry of Health issues a statement claiming The Guardian deliberately misinterpreted an internal document and that their headline was false, and calls for retraction. Seems @theIRC are the group to prove who’s right, given they carried out the work.”
WHO expert advisory committee on Developing global standards for governance and oversight of human genome editing – membership announced
“The World Health Organization is pleased to announce the membership of the WHO Expert Advisory Committee on Developing Global Standards for Governance and Oversight of Human Genome Editing. The Committee will examine the scientific, ethical, social and legal challenges associated with human genome editing. The aim will be to advise and make recommendations on appropriate governance mechanisms for human genome editing. The Committee will first meet on 18-19 March in Geneva, to review the current landscape and discuss and agree the workplan for the coming 12-18 months….”
Check out the profiles of the members.
Global health governance & preparations UHC High-level meeting
Global Policy – Gridlock, Innovation and Resilience in Global Health Governance
David Held et al; https://onlinelibrary.wiley.com/doi/10.1111/1758-5899.12654
“Global health governance is in many ways proving more innovative and resilient than other sectors in global governance. In order to understand the mechanisms that have made these developments possible, this article draws on the concept of gridlock, as well as on the additional theoretical strands of metagovernance and adaptive governance, to conceptualize how global health governance has been able to adapt despite increasingly difficult conditions in the multilateral order. The remarkable degree of innovation that characterizes global health governance is the result of two interrelated conditions. First, developments that are normally associated with gridlock in multilateral cooperation, such as institutional fragmentation and growing multipolarity, have transformed, rather than gridlocked, global health governance. Second, global health actors have often been able to harness the opportunities offered by three important pathways of change, namely: (1) a significant degree of organizational learning and active feedback loops between epistemic and practice communities; (2) a highly polycentric system of governance; and (3) the increased role of political leadership as a catalyst for governance innovation. These trends are discussed in the context of three case studies of significant political, social and health relevance, namely HIV/AIDS, the 2014 Ebola outbreak and antimicrobial resistance.”
Devex – 3 questions from the WHO board sessions
“In the lead up to the World Health Assembly in May, member states and civil society will demand answers from WHO on many of these issues, including details surrounding the organization’s internal reforms….”
1.What’s the future of WHO and civil society engagement? … 2. Will WHO overcome its chronic budget woes?…. 3. What does success look like for the U.N. high-level meeting on UHC?
On the last issue: “…It took the whole week of meetings for the draft resolution in preparation for the high-level meeting on universal health coverage taking place in September to be finalized. But some members of civil society have expressed concerns that the meeting may fall short of ambition, and lack clear lines of accountability when it comes to mobilizing the necessary resources for UHC. Some continue to seek clarity on how to bridge current global health investments with UHC objectives…. … Some have also expressed concerns over the United States representative’s comments during the board sessions about dissociating itself from the part of the document pertaining to sexual and reproductive health….”
NCD Alliance – Packed WHO Executive Board meeting sets next steps on NCDs, looks ahead to UHC HLM
The NCD Alliance reflects here on the last WHO EB meeting, focusing on the most relevant discussions for NCDs.
International Food Safety conference (Addis)
WHO – International push to improve food safety: International Food Safety Conference opens with call for greater global cooperation
“Greater international cooperation is needed to prevent unsafe food from causing ill health and hampering progress towards sustainable development, world leaders said at today’s opening session of the First International Food Safety Conference, in Addis Ababa, organized by the African Union (AU), the Food and Agriculture Organization of the United Nations (FAO), the World Health Organization (WHO) and the World Trade Organization (WTO). A follow-up event, the International Forum on Food Safety and Trade, which will focus on interlinkages between food safety and trade, is scheduled to be hosted by WTO in Geneva (23-24 April). The two meetings are expected to galvanize support and lead to actions in the key areas that are strategic for the future of food safety.”
“Each year, food contaminated with bacteria, viruses, parasites, toxins or chemicals cause more than 600 million people to fall ill, and 420,000 to die worldwide, prompting a call from world leaders on Tuesday for greater international cooperation to make the food chain safer.”
IMF & SDGs
IISD – IMF Estimates Spending Needed to Make Progress on SDG Implementation
“The IMF has estimated the additional amount that governments need to spend in order to make “meaningful progress” on the SDGs. Based on a 155-country study of countries at various stages of economic development, the report finds that low-income countries will need to spend a far greater percentage of GDP for this purpose than other countries. The authors recommend increasing tax collection as the first step, while acknowledging that, for low-income countries, this will not be sufficient to fill the financing gap.”
“The study was published in the Fund’s “staff discussion note” series. Titled, ‘Fiscal Policy and Development: Human, Social and Physical Investments for the SDGs,’ the 45-page report argues that countries’ ability to achieve the SDGs will depend on their ability to increase spending on health, education and infrastructure. Based on a 155-country study of countries at various stages of economic development, the authors estimate that low-income countries will need to spend a far greater percentage of GDP for this purpose than other countries. They find that low-income countries will need to increase their annual spending in these areas by 15 percentage points of GDP, whereas emerging market economies will only need to increase their spending by four percentage points. They recommend that developing countries aim to increase their tax-to-GDP ratio by five percentage points of GDP in the next ten years….”
(ps: you find the publication (to be downloaded) at the bottom of this article).
Lancet Editorial – From wonder and fear: make epilepsy a global health priority
“Following International Epilepsy Day on Feb 11, The Lancet publishes a clinical Seminar about epilepsy in adults by Roland Thijs and colleagues. …”
“Epilepsy must become a global health priority, and there lies an immediate imperative to maximise the quality of life for people with epilepsy until it is curable. A united research programme and global campaigns to prevent infections and head trauma that cause seizures, expand access to essential medicines and safe surgery, and defend the civil rights of people with epilepsy, wherever they live, are important steps in this direction.”
Journal articles of the week
Plos One – The impact of supplementary immunization activities on routine vaccination coverage: An instrumental variable analysis in five low-income countries
A Chakrabarti, K Grepin et al ; https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0212049
“Countries deliver vaccines either through routine health services or supplementary immunization activities (SIAs), usually community-based or door-to-door immunization campaigns. While SIAs have been successful at increasing coverage of vaccines in low- and middle-income countries, they may disrupt the delivery of routine health services. We examine the impact of SIAs on routine vaccine coverage in five low-income countries.”
Findings? Cfr a tweet – “Do vertical programs crowd out other health services? We investigated the impact of supplementary immunization activities on coverage of routine immunizations and find evidence that they do.”
Cambridge Core – in the Series ‘Elements in Public Policy’: Making Policy in a complex world
Interestingly, freely online available between 11 and 25 Feb!
“This provocative Element is on the ‘state of the art’ of theories that highlight policymaking complexity. It explains complexity in a way that is simple enough to understand and use. The primary audience is policy scholars seeking a single authoritative guide to studies of ‘multi-centric policymaking’. It synthesises this literature to build a research agenda on the following questions:1. How can we best explain the ways in which many policymaking ‘centres’ interact to produce policy?2. How should we research multi-centric policymaking?3. How can we hold policymakers to account in a multi-centric system?4. How can people engage effectively to influence policy in a multi-centric system?However, by focusing on simple exposition and limiting jargon, Paul Cairney, Tanya Heikkila, Matthew Wood also speak to a far wider audience of practitioners, students, and new researchers seeking a straightforward introduction to policy theory and its practical lessons.”
Lancet – Offline: AMR—the end of modern medicine?
Horton covers the most recent joint LSHTM–Lancet Global Health Lab (on AMR), and says the world should be worried.
A paragraph that caught our attention: “… But perhaps AMR is also telling us something important about our society. Clare Chandler is a medical anthropologist who leads the LSHTM’s Antimicrobial Resistance Centre. She sees antibiotics as a symbol of modernity, and the threat of AMR is therefore a threat to modernity. But what is modernity? A mix, she suggested, of self-improvement, innovation, and technical fixes, all to enable and enhance productivity and profit. Although a “quick-fix” approach to AMR might be achieved through the tools of modernity, perhaps a post-modern approach is needed. In a post-modern era, can society be less defined by antibiotics? Ed Whiting (Director of Policy at the Wellcome Trust) framed AMR as neither a technical challenge nor an interpretive conundrum. As a former adviser to UK ex-Prime Minister David Cameron, he saw AMR as a political provocation. And the political and diplomatic dimensions of AMR have been too often disregarded. It will be a “hard lift”. There is no Global Fund for AMR. Although criticised when first proposed, Ed still believed that a Treaty on AMR held promise. A Treaty could galvanise political commitment and unlock much-needed financing….
WHO – Spending targets for health: no magic number: Health financing working paper No. 1
M Jowett et al ; https://www.who.int/health_financing/documents/no-magic-number/en/
“Absolute levels of public funding are critical to UHC progress; however, health systems vary significantly in what they achieve for a given level of spending. In a new analysis of core health service coverage rates relative to public spending on health, in 83 LMICs, variation is particularly evident at levels below 40 PPP$ per capita (public). While a range of non-health system factors influence a country’s performance, this analysis demonstrates the importance of focusing not only on raising more revenues for health, but also on ensuring available funds are spent efficiently. “
Blogs & mainstream media articles of the week
Andrew Harmer (blog) – Hans Rosling: the Gradgrind of Global Health?
Not entirely convincing, this blog, but well worth a read. “The problem I have with Rosling, as my reference to Dickens’ character Thomas Gradgrind unsubtly indicates, is his obsession with facts….”
The Dickens quote: ““Now, what I want is, Facts. Teach these boys and girls nothing but Facts. Facts alone are wanted in life. Plant nothing else, and root out everything else. You can only form the minds of reasoning animals upon Facts: nothing else will ever be of any service to them. This is the principle on which I bring up my own children, and this is the principle on which I bring up these children. Stick to Facts, sir!” (Dickens, Hard Times. p1.)”
Harmer: “…Facts do exist in the world, of course (while I consider myself to be a constructivist, for me it’s not ‘ideas all the way down’). You can add up the ages of population x , and divide that number by the total population to derive an average age at point y. But, ultimately, all that that gives you is a number. And numbers out of context are a very dangerous thing….”
The need for alternative narratives
Guardian – Fightback against the billionaires: the radicals taking on the global elite
The read from (end of) last week. “When Rutger Bregman and Winnie Byanyima spoke out about taxes at Davos they went viral. They talk with Winners Take All author Anand Giridharadas about why change is coming.”
“…I don’t know whether the left has been sleeping, but there has been a dominant narrative that has remained quite unchallenged in the media. This narrative suggests that there is no connection between the super-rich and abject poverty, that you can keep getting richer and richer, and this has nothing to do with people getting poorer. The idea of the narrative is so important. I think that what you both found yourselves in the middle of at Davos, and what I found myself in on my book tour over the last few months, and what politicians such as Alexandria Ocasio-Cortez have found themselves in the middle of, is the growing challenge to a kind of bullshit narrative around wealth and poverty, access and power; it’s completely wrong and fraudulent, and it’s now crashing down. There is a second narrative about how the world is getting better and better: people in India and China and elsewhere have been coming out of poverty, and the world is the best it’s ever been. Never mind the fact that we’re perhaps 50 years away from catastrophic climate change fuelled by greed. That narrative, too, has had a free ride in the press and culture, including on the left, until now. And then there is a final narrative of companies and billionaires – as long as they are doing good things, we don’t ask what else they do; as long as they are giving back, we don’t ask how they made their money. It’s like a mafia deal: no questions asked.
“… What Winnie pointed out very well in Davos is that most real wealth is actually created at the bottom, by the working and middle classes and at the top there is a huge amount of wealth destruction and exploitation. Entrepreneurs might use the language of entrepreneurialism and hard work, but if you really delve into their business models, you’ll find that they’re not contributing to the common good. They are destroying more than they create.
“… I want to give some examples of the conquest of language – words that everybody uses, not just plutocrats, but that end up doing the plutocrats’ bidding. One is “win-win”. That phrase sounds great. Who could be against win-win? But, in fact, win-win is a darkly powerful way of suggesting that the only kind of progress worth having is the kind that lets the winners win – in tandem, supposedly, with empowering others.
A couple more examples. Take “thought leader”. When you were both in Davos, you were surrounded by thought leaders, who are actually people who don’t say what they truly think: they are the ones who say nice things about the powerful and keep getting invited back.
Another instance is “doing well by doing good”: it sounds positive but it really is about putting the people who are trying to make money in charge of changing a status quo they have no interest in changing. And then there are terms such as “social impact” and “social venture capital” and “impact investing”. They are ways of encouraging us not to use words like “power” and “justice” and “dignity”. They are an attempt to make us not speak about unions and taxes.
“I think most people now understand that this “There is no alternative” talk is bullshit. An understanding seems to be rising that it’s not about left v right or communism v capitalism any more, but about humanism v plutocracy.”
To tax or not to tax the rich more, that is the question
“Thanks to Alexandria Ocasio-Cortez and Elizabeth Warren, the most important battle in American politics is finally on.” (and if it rains in America, you’ll also feel it in global health, sooner or later 😊)
Do check the paragraph on Michael Bloomberg.
Vox – Bill Gates tweeted out a chart and sparked a huge debate about global poverty
Wonderful wrap-up analysis of the heated debate of the past few weeks.
“… over the course of the debate, the two sides’ positions appeared, at least to me, to converge substantially. …” “…The big differences, then, are how to slice and interpret these facts, and which political interests and narratives they serve….”
A few excerpts perhaps:
“…in some ways, Hickel’s response reflects the crux of the dispute between him and Roser. Roser — and most economic historians — do not view poverty as created but as the original state of humankind from its inception until the Industrial Revolution. It is a policy failure insofar as we finally have the tools to end it now and have not done so yet, but what we’re attempting to do is escape humanity’s natural, brutal conditions. Hickel sees things differently….”
“Hickel, and Pinker, too, aren’t interested merely in the granular disputes detailed above. They’re fighting about a narrative. These perceived political stakes are the main reason this fight has gotten so heated. But if we narrow in on the actual numbers that people across the debate can agree upon, there’s less disagreement than one might think. Just about everyone agrees life expectancy is up, education is more common, and poverty rates are down over the last three or four decades regardless of where you set the poverty line. And just about everyone agrees we have a lot further to go. … …I think the basic fact that we’ve made progress in recent decades is important. Politics and the global economy are dismal places, especially if you only see them through the lens of news coverage. It’s easy to become fatalistic. What I take from the progress against extreme deprivation and poverty isn’t a sense that the mission is accomplished, or that Friedrich Hayek Was Never Wrong, but a sense that things can get better, and that trying isn’t hopeless. I hope Hickel, Roser, and Pinker alike can agree on that much.”
BMJ (blog) – Richard Smith: The most devastating critique of medicine since Medical Nemesis by Ivan Illich in 1975
One of the reads of the week. Richard Smith reviews a new book by S O’Mahony.
“Seamus O’Mahony, a gastroenterologist from Cork, has written the most devastating critique of modern medicine since Ivan Illich in Medical Nemesis in 1975. O’Mahony cites Illich and argues that many of his warnings of the medicalisation of life and death; runaway costs; ever declining value; patients reduced to consumers; growing empires of doctors, other health workers, and researchers; and the industrialisation of healthcare have come true. There is a widespread feeling that medicine has lost its way, and Can Medicine Be Cured? The Corruption of Medicine, which has been published this month, describes the loss. “
“Unlike Illich, who believed that modern medicine counterproductively created sickness, O’Mahony does see what he calls a golden age of medicine that began after the Second World War with the appearance of antibiotics, vaccines, a swathe of effective drugs, surgical innovations, better anaesthetics, and universal health coverage for most of those in rich countries. It ended in the late 1970s, meaning that O’Mahony, who graduated in 1983 and is still practising, enjoyed little of the golden age. We are now “in the age of unmet and unrealistic expectations, the age of disappointment…. ”
Project Syndicate – How Foreign Aid Fuels African Media’s Payola Problem
“In many African countries, a dirty secret of journalism is that reporters earn most of their income from payments by their sources. And the dirtiest secret of all is that the international aid community is among the most prolific payers.”
Johns Hopkins magazine – The Perspective Changer: Bloomberg Distinguished Professor Jeremy Shiffman on Shaping the Global Health Agenda
“New Bloomberg Distinguished Professor Jeremy Shiffman views global health through a social science lens.”
Project Syndicate – How Can We Tax Footloose Multinationals?
- Stiglitz – https://www.project-syndicate.org/commentary/corporate-tax-avoidance-end-transfer-pricing-by-joseph-e-stiglitz-2019-02
“ Apple, Google, Starbucks, and companies like them all claim to be socially responsible, but the first element of social responsibility should be paying your fair share of tax. Instead, globalization has enabled multinationals to encourage a race to the bottom, threatening the revenues that governments need to function properly.”
Stiglitz (a member of the Independent Commission for the Reform of International Corporate Taxation ) has some ideas on how to tax them properly, while also paying attention to the “wellbeing of the more than six billion people living in developing countries and emerging markets”.
Duncan Green (blog) – Closing Civic Space: Trends, Drivers and what Donors can do about it
“I finally caught up with a useful May 2018 overview from the always excellent International Center for Not-for-Profit Law. Nothing life-changing, but a clear and concise summary of the origins of the problem and possible responses, based on some 50 contributions to a consultation by the Swedish International Development Cooperation Agency (Sida). Some highlights:…”
What are the new trends in terms of closing civic space, what are the drivers & origins, and what can donors do about it?