WB/IMF Spring meetings: some more news & analysis
Bretton Woods Project – Spring Meetings wrap-up 2019: what crisis of multilateralism?
Key messages: “Bank and Fund governance issues deepen crisis of multilateralism; Double standards on tax and failure to address rising debt remain; Bank’s investment in fossil fuels back in the spotlight; Billions to Trillions push producing limited results.”
World Bank/IMF Spring Meetings 2019: Development Committee Communiqué
The Communiqué reiterated support for climate change & for the Human Capital project, among others.
On the latter, in particular, the Communiqué said this: “ Investments in human capital that produce better learning and health outcomes are critical to productivity and economic well-being. We welcome the strong start on the Human Capital Project and the fact that close to 60 countries have joined thus far. We request further development of disaggregated data and refinement of indicators under the Human Capital Index and an emphasis on policy reforms that achieve tangible results. We look forward to an update on the Human Capital Project in October 2019.”
There will also be a more explicit link between IDA & the Human Capital project. See WB – World Bank Launches Human Capital Plan to Propel Investment in Africa’s People
“The World Bank unveiled a new plan [today] to help African countries strengthen their human capital….” “… In an effort to help countries turn these indicators around, the World Bank’s Africa Human Capital Plan is setting ambitious targets to be achieved in the region by 2023. These include a drastic reduction in child mortality to save 4 million lives, averting stunting among 11 million children, and increasing learning outcomes for girls and boys in school by 20%. These achievements can raise Africa’s Human Capital Index score upwards to increase the productivity of future workers by 13%. … … The World Bank will increase its investments in human capital in Africa by 50% in the next funding cycle. This includes new World Bank grants and concessional finance for human capital projects in Africa totaling $15 billion in fiscal years 2021-2023. …”
Devex – World Bank pandemic facility ‘an embarrassing mistake,’ says former chief economist
As already flagged in last week’s IHP issue, “Lawrence Summers, the World Bank’s former chief economist, slammed an initiative launched in 2016 that aimed to create an insurance market for pandemics, calling the facility “an embarrassing mistake” and a symptom of “financial goofiness” within the institution….” The PEF, that is.
As somebody put it on Twitter, “why does the boss (Jim Kim) first have to leave before criticism of the PEF was possible, especially with all these eminent economists working at the WB? “
In case you wonder what the WB’s Pandemic Emergency Facility is (and is not), see this great blog by Lorcan Clark – Four features of the World Bank’s Pandemic Emergency Financing Facility — Structuring, Pricing and Trading Pandemic Risk
“This month (April 2019) has seen the first public announcement for the updated version of the Pandemic Emergency Financing Facility — PEF 2.0. This post describes four features of the PEF and seeks to inform debate as the discussions begin on the future of international finance for pandemic risks.”
Devex – From critic to cheerleader — David Malpass’ first week at the World Bank
“The World Bank Spring Meetings, which concluded on Sunday, might have lacked the policy significance that accompanied last year’s negotiations over the terms of the institution’s capital increase, but they did offer something else: a first glimpse of David Malpass as the bank’s president.”
With among others, Malpass on climate change, multilateralism & China, future priorities for the WB under his leadership, low likelihood of more internal WB reform, a shift back to country-led programming,…
Devex – World Bank looking for new options in fragile and conflict states
“The World Bank is currently in the consultation phase of a new strategy for fragility, conflict, and violence, which officials hope will help the institution enter conflict-affected areas earlier and with a better understanding of how security and development intersect….”
Fourth Annual Health Financing Forum (9-10 April)
“The World Bank Group and USAID, in collaboration with the GFF, hosted the 4th Annual Health Financing Forum on April 9-10. The Health Financing Forum explored the frontiers of resource mobilization for health including innovations that have the potential to catalyze significant progress in health financing.”
Not much info available on this Forum, apart from the concept note…
Meanwhile, the economic situation in quite a few African countries is deteriorating. See Bloomberg – World Bank Warns Africa Bond Bonanza Risks Hurting Nations
“The World Bank warned that high demand for African Eurobonds will place countries at a higher risk of debt distress once an increase in U.S. rates prompts investors to turn their backs on emerging-market assets. “We are very concerned,” World Bank Chief Executive Officer Kristalina Georgieva said … … The situation can become “very difficult,” she said. There are 17 African countries that are in high debt, or high distress, said Georgieva. Those in the worst situations include Chad, Republic of Congo, Gambia, Mozambique, South Sudan and Zimbabwe, she said.”
1st Digital Health Guidelines WHO
WHO – WHO releases first guideline on digital health interventions
“WHO [today] released new recommendations on 10 ways that countries can use digital health technology, accessible via mobile phones, tablets and computers, to improve people’s health and essential services….” See WHO Guideline: recommendations on digital interventions for health system strengthening.
As a reminder on the term ‘digital health’, “…Digital health, or the use of digital technologies for health, has become a salient field of practice for employing routine and innovative forms of information and communications technology (ICT) to address health needs. The term digital health is rooted in eHealth, which is defined as “the use of information and communications technology in support of health and health-related fields”. Mobile health (mHealth) is a subset of eHealth and is defined as “the use of mobile wireless technologies for health”. More recently, the term digital health was introduced as “a broad umbrella term encompassing eHealth (which includes mHealth), as well as emerging areas, such as the use of advanced computing sciences in ‘big data’, genomics and artificial intelligence”…”
HPW – New WHO Digital Health Guidelines Assess “Appropriateness” Of Technology Options
Excellent coverage & analysis. Must-read.
Importantly, “…The guidelines emphasise that “digital health interventions are not a substitute for functioning health systems, and that there are significant limitations to what digital health is able to address. Digital health interventions should complement and enhance health system functions through mechanisms such as accelerated exchange of information, but will not replace the fundamental components needed by health systems such as the health workforce, financing, leadership and governance, and access to essential medicines.” The guidelines also clearly prioritise the needs of vulnerable communities, stating that implementation of the recommendations “should not exclude or jeopardize the provision of quality non-digital services in places where there is no access to the digital technologies or [where] they are not acceptable or affordable for target communities.” “Digital health is not a silver bullet,” Bernardo Mariano, WHO’s chief information officer, said in the release….”
2nd WHO Fair Pricing Forum (Jo’burg): more coverage & analysis
WHO – At WHO Forum on Medicines, countries and civil society push for greater transparency and fairer prices
“At a global forum on fair pricing and access to medicines, delegates from governments and civil society organizations called for greater transparency around the cost of research and development as well as production of medicines, to allow buyers to negotiate more affordable prices….”
“…WHO will launch a public online consultation in the coming weeks to collect views and suggestions for a definition of what actually constitutes a ‘fair price’ from relevant stakeholders….”
HPW – “Dialogue” Highlighted As Way Forward At Closure Of WHO Fair Pricing Forum
Excellent coverage of the meeting. And thus recommended.
You might also want to read UN News – Greater transparency, fairer prices for medicines ‘a global human rights issue’, says UN health agency
“While developing countries have long struggled with the price of medicines, today’s costs have rendered it a world-wide challenge, and the key topic of concern at a global medicines forum in South Africa, co-sponsored by the World Health Organization (WHO). “This is a global human rights issue”, said WHO Assistant Director-General for Medicines and Health Products Mariângela Simão on Saturday at the WHO Forum on Medicines in Johannesburg. “Everyone has a right to access quality healthcare”….”
See also K Perehudoff et al (Health & Human Rights blog), on access to medicines & the human rights obligations of Big Pharma – WHO Fair Pricing Forum: Watching for Drug Industry Accountability
Global Measles crisis
Guardian – Measles cases up 300% worldwide in 2019, says WHO
“Measles cases worldwide rose by 300% during the first three months of 2019 compared with the same period last year, the World Health Organization(WHO) has said, amid growing concerns over the impact of anti-vaccination campaigns, particularly spread through social media…”
“…there is also concern over Africa, which has less vaccine coverage than other regions. WHO says its Africa region had the biggest rise in cases in the last three months compared with the same time last year – a 700% increase.”
For the new WHO measles surveillance data, see here.
See also UN News – ‘A global measles crisis’ is well underway, UN agency chiefs warn.
“… two UN agency heads declared on Monday that we now stand “in the middle of a global measles crisis”. “Cases have soared across the world, including in places where measles had previously been eliminated, like the United States”, asserted Henrietta Fore, Executive Director of the UN Children’s Fund (UNICEF) and Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO)….”
Ebola DRC – still not a PHEIC (& criticisms); change of strategy needed; vaccine works well
Stat News – WHO stops short of declaring Ebola crisis a global health emergency
News from late last week (Friday), which you probably already know by now. For the official WHO statement, see here.
“The Ebola outbreak in the Democratic Republic of the Congo still does not warrant the declaration of a global health emergency, the World Health Organization said Friday — a decision that is sure to trigger substantial debate as the virus continues to spread unabated….”
Not everybody agreed with this assessment, as you can imagine. This piece contains views of David Fidler, Tom Frieden, …
For more reactions, see also The Guardian (includes an MSF reaction – in short: “regardless of the official status of the outbreak, the outbreak is Not under control, urgent change of strategy needed”), Georgetown global health experts (including Rebecca Katz, who was disappointed by the decision); or Vox – The WHO just decided the latest Ebola outbreak is not a global emergency with criticisms and/or surprise expressed by Larry Gostin, Tom Inglesby, …
Reuters – Ebola is real, Congo president tells skeptical population
“Congolese President Felix Tshisekedi on Tuesday implored people in areas hit by the nation’s worst-ever Ebola outbreak to accept the disease is real and trust health workers….”
“…“If we follow the instructions, in two or three months Ebola will be finished,” he optimistically told a crowd after having his temperature taken and washing his hands, as required of all incoming passengers to Beni airport….”
A tweet on the (not very nice) financial situation of the outbreak response:
Dr Tedros: “Funding shortages are hampering the #Ebola response in #DRC. We need a total of US$148m for all partners to fund the response until July. To date, we have only received US$74 millions. I urge donors to step forward. Stopping this outbreak is our collective responsibility.”
Stat News – The data are clear: Ebola vaccine shows ‘very impressive’ performance in outbreak
“The experimental Ebola vaccine being used to try to contain the outbreak in the Democratic Republic of the Congo is protective 97.5% of the time, according to new data released by the World Health Organization on Friday. The data — the first to be released on how the vaccine is working in the outbreak — suggest a “very impressive” performance by the vaccine, said Michael Osterholm, director of the University of Minnesota’s Center for Infectious Diseases Research and Policy, who reviewed the report for STAT….”
And a milestone has been reached: DRC reaches 100,000 people vaccinated against Ebola in North Kivu and Ituri.
Foreign Policy – Your Cell Phone Is Spreading Ebola
Laurie Garrett ; Foreign Policy;
“A deadly outbreak in Congo has become a global emergency because of a raging conflict over valuable minerals.” Laurie Garrett has some ideas for an additional strategy to tackle the Ebola outbreak.
“The international community must double down to halt the sale of minerals that drive the conflict and by proxy….” Coltan in particular. … The Trump administration, G-20, and OECD should immediately scrutinize the conflict minerals trade and the many government attempts to limit their use in cell phones and other electronics. Japan, as the host of the upcoming G-20 Summit, should place trade in coltan and its impact on the Ebola epidemic on the June gathering’s Osaka agenda….”
NEJM (Perspective) -Shifting the Paradigm — Applying Universal Standards of Care to Ebola Virus Disease
W Fisher et al; https://www.nejm.org/doi/full/10.1056/NEJMp1817070
“…It should no longer be acceptable to have two standards of care — one for patients in resource-constrained settings and another for those in countries where resources are more readily available. The ongoing response to EVD is teaching us that higher standards are no longer aspirational but are possible, and that during inevitable future outbreaks of EVD, no matter how remote the setting, we can provide people who are sick and suffering with the type of care that we would want to receive.”
Global Financing Facility (GFF) expansion
Save the Children (blog) – Quantity and quality: Expansion of the GFF offers the chance to maximise its potential
Earlier this week, the GFF Investors Group convened for its 8th meeting, where the Secretariat planned to launch a new wave of countries.
“A few months on from the Global Financing Facility’s (GFF) Oslo replenishment, where more than US$1 billion was raised to improve the health and nutrition of mothers, adolescents, children and newborns, the GFF has confirmed its planned expansion to a total of 50 countries….” Save the Children’s view on how this should be done. Key reforms are needed, they say.
GFF – A message from GFF Director Mariam Claeson
“As we move into the expansion phase, incorporating learning from countries in the lead, I want to thank you all for our great partnership for women, children and adolescent health and nutrition and for what we have accomplished together in the last two years. After more than 2 ½ years as Director of the GFF — longer than the two years I had originally planned and agreed on — I’m leaving the GFF by the end of June, to time my departure with the transition into the next fiscal year and a new phase of the GFF coinciding with, and being part of, the organizational change across the Human Development family of the World Bank – our host agency.”
Guess Mariam is going back to the Gates Foundation.
More UNAIDS commotion
AP Exclusive: UN whistleblower targeted in misconduct probe
“… Confidential documents obtained by The Associated Press show UNAIDS is grappling with previously unreported allegations of financial and sexual misconduct involving Martina Brostrom, who went public last March with claims that one of the organization’s top officials assaulted her in 2015….” “…As part of a preliminary internal inquiry, investigators for the World Health Organization, which oversees UNAIDS, wrote that they had found “evidence” that Brostrom and her former supervisor may have taken part in “fraudulent practices and misuse of travel funds,” the documents show….”
AP coverage can be a bit sensational, as you might recall from the past (related to other global health actors), still, this sort of uproar can have (big) implications on donors. See for example another AP report from later this week – US ‘concerned’ over misused funds allegations at UNAIDS
Lancet Global Health May issue
In this new Lancet Global Health issue, there’s so much to delve into, so do check it out in detail during this long Easter weekend. You can indulge in one chocolate egg per article 😊.
But of the articles not published online before, we especially want to draw your attention to:
- The Editorial – The true meaning of Leaving no one behind
“… When on a collective journey towards a common objective such as the Sustainable Development Goals, with a rallying cry of “leaving no one behind” and a central aim of “reaching the furthest behind first”, this system of communication is fundamental to move beyond just the rhetorical: to be truly reached, the furthest one behind will need to understand what she is being told, and most likely, that exchange will have to be done in her own language. That principle should apply to all aspects of development, including global health….”
- As a rather neat example of putting rhetoric into practice, the Lancet Global Health published (in French) this Comment – Plaidoyer contre l’exclusion des francophones dans la recherche en santé mondiale.
- Are expensive vaccines the best investment in low-income and middle-income countries? (Comment by L Simonsen et al)
Nature (News) – Promising malaria vaccine to be tested in first large field trial
“The vaccine can confer up to 100% protection and will be given to 2,100 people on the west African island of Bioko.” “A malaria vaccine that can provide up to 100% protection against the disease will be tested in a large clinical trial for the first time, to study its efficacy under real-world conditions….”
“In laboratory studies, the vaccine, called PfSPZ, has proven the most effective malaria vaccine developed so far, giving healthy volunteers complete protection….”
In other malaria vaccine news, see Bloomberg – Malaria Vaccine Took 30 Years. It’s Still a Work in Progress (on the [RTS,S] vaccine )
HPW – Europe-Africa partnership spearheads development of next-generation antimalarial drug
“The European & Developing Countries Clinical Trials Partnership (EDCTP) has granted new funding of €10m over five years to support late-stage clinical trials of a next-generation antimalarial combination including KAF156 (ganaplacide). The trials will be conducted in four countries in West and Central Africa: Burkina Faso, Gabon, Mali and Niger. Led by the WANECAM consortium (West African Network for Clinical Trials of Antimalarial Drugs), ten academic organisations based in Africa and Europe will collaborate with the not-for-profit organization Medicines for Malaria Venture (MMV) and the pharmaceutical company Novartis to develop its compound KAF156 in combination with a new formulation of lumefantrine. The aim is to advance the development of a much-needed new antimalarial therapy while strengthening clinical trial development capabilities in Africa….”
Financing for Development Forum (15-18 April): UN chief appeals for more money for the SDGs
Eurodad – State of emergency: UN convenes Financing Forum while a new wave of debt crises threatens to derail sustainable development
“This week, governments [will] meet at the United Nations in New York for the Financing for Development Forum, and the challenge is very clear. Too little progress has been made towards achieving the UN’s SDGs, which to a large extent is the consequence of lacking finance. The 2015 Addis Ababa Action Agenda, a UN framework adopted at the same time as the SDGs, which is supposed to ensure money flows toward development and the achievement of the SDGs, is not fulfilling its objective. … …. A task force of international agencies, including the UN, World Bank and IMF have just released a new Financing for Sustainable Development Report, which highlights that a new wave of debt crises has begun to strike. 40% of low income countries have severe debt problems, and also in richer countries, private and public debt levels are soaring. Consequently, global debt levels have reached new record highs. …”
UN News – Critical moment for sustainable development
““Uneven growth, rising debt levels, possible upticks in financial volatility, and heightened global trade tensions” are hampering progress on reaching the Sustainable Development Goals (SDGs), UN chief António Guterres told the Forum on Financing for Development on Monday, during what he called “a critical moment” to “accelerate action for sustainable development”.”
“…“Simply put,” he spelled out “we need more money to implement the Sustainable Development Goals”….”
See also Devex – “The Financing for Development forum at the U.N. headquarters this week was characterized by a sense of urgency and discussions of the need to act faster to mobilize the capital needed to finance the Sustainable Development Goals. From discussions about the need for integrated national financing frameworks, domestic resource mobilization, and cracking down on illicit financial flows, to how to engage institutional investors and measure impact, the meetings were a stocktaking exercise that found significant shortfalls. The meeting is seen as a key stepping stone to a summit on financing the SDGs that will be held during U.N. General Assembly meetings in September.”
Health Taxes to Save Lives: Report from the Bloomberg Philanthropies’ Task Force on Fiscal Policy for Health
HPW – “Tax The Things That Are Killing Us” To Help Curb NCDs, New Report Recommends
See also last week’s IHP newsletter. Great coverage of this new report in Health Policy Watch. “Raising taxes on tobacco, alcohol and sugary beverage products by more than 50 percent could prevent more than 50 million premature deaths due to noncommunicable diseases (NCDs) over the next 50 years, while yielding over US$ 20 trillion in revenue. That is the conclusion of a report by a global task force headed by philanthropist Michael Bloomberg and economist Lawrence Summers.”
You might also want to read (CGD blog by Bill Savedoff) – New High-Level Report Calls for Higher Taxes on Tobacco, Alcohol, and Sugary Beverages to Prevent Millions of Deaths
He explains why this report is so important and lists the report’s five key messages.
BMJ Global Health (blog) – ‘Sin tax’: making clear who commits the sin
Concerns have been expressed especially in social media about the use of the term ‘sin’ in sin tax. However, the authors of this piece suggest not to get rid of the term. Instead, ‘sin tax’ should perhaps be more accurately called ‘corporate sin tax’, argue Renzo Guinto (EV 2014) and G G Amul. “it must be clear that it is not the consumer but the commercial drivers, particularly the harmful industries, that commit the grave sin. “
Window on Climate Change May Be Even Smaller Than Feared
“The window to act on climate change may be even smaller than we realized, according to a University of Virginia School of Law professor’s new paper in the Harvard Environmental Law Review. Professor Michael Livermore and co-author Peter Howard of the New York University Institute of Policy Integrity argue in “Sociopolitical Feedbacks and Climate Change” “that developing international cooperation to reduce the greenhouse gas emissions that contribute to the problem must come during a time of economic and political stability. Otherwise, they say, the ability to forge meaningful international agreements may be lost. “We explore the possibility that humankind is wasting a short window of opportunity to address climate change, one that may soon shut as climate damages incapacitate effective political action,” they write in their paper….”
Open Democracy – What will you say to your grandchildren?
“Facing oncoming climate disaster, some argue for ‘Deep Adaptation.’ What we really need is ‘Deep Transformation.’” One of the reads of the week, this essay from Jeremy Lent.
UNCTAD – Top economists outline plan for a global green new deal
“UNCTAD officials and experts detail a five-point plan to rebalance development and guide a new form of multilateralism.”
“Two leading economists have put forward a solution to the challenges they see facing the multilateral system of trade, investment and finance ahead of the annual spring meetings of the International Monetary Fund (IMF) and the World Bank Group (WBG) in the United States capital of Washington DC, running from 12 to 14 April. The ‘Geneva Principles for a Global Green New Deal’ are outlined in a new report by UNCTAD’s Richard Kozul-Wright and the University of Boston’s Kevin Gallagher. In ‘A New Multilateralism for Shared Prosperity: Geneva Principles for a Green New Deal’, they spell out five key steps that need to be taken to solve the system of “predatory rent-seeking” or “crocodile capitalism” they believe has broken the social contract established in the wake of World War II, allowing global corporations to benefit while the general public loses….”
Science Daily – Warming Arctic permafrost releasing large amounts of potent greenhouse gas
“A recent study shows that nitrous oxide emissions from thawing Alaskan permafrost are about twelve times higher than previously assumed. About one fourth of the Northern Hemisphere is covered in permafrost, which is thawing at an increasing rate. As temperatures increase, the peat releases more and more greenhouse gases. And, even though researchers are monitoring carbon dioxide and methane, no one seems to be watching the most potent greenhouse gas: nitrous oxide….”
New Food Economy – World Health Organization drops its high-profile endorsement of the EAT-Lancet diet
“The UN health authority cites concerns about the economic impact on poor, livestock-producing countries. British Medical Journal reports that the World Health Organization (WHO), the arm of the United Nations charged with monitoring global health, has dropped its endorsement of the EAT-Lancet Commission’s planetary health diet—a much-ballyhooed, well-publicized attempt at saving the planet through the food we eat. The organization pulled out of sponsoring a launch event in Geneva, Switzerland, on March 28, after Gian Lorenzo Cornado, Italy’s ambassador to the United Nations, questioned the diet’s impact on public health. The ambassador stated that radical, drastic limitations on animal livestock production—the commission’s primary recommendation—would cause economic hardship in developing countries….”
- In other planetary health news, check out also Linda Mans’ reaction on Andrew Harmer’s blog on whether the WHO should declare climate change a Public Health Emergency of International concern. See here. Under Harmer’s blog, you also find an insightful view from Colin Butler on this issue. He has his doubts.
As for my own view, via a tweet: “I think WHO should declare a new sort of emergency for the medium-term risk of civilizational collapse: “a Public Health Super-Emergency of International Concern (PHSEIC)” (in line with Global Health’s fondness of ‘super’-bugs):) Or perhaps a Planetary Health Emergency of International Concern.” 😊.
- PS: for the ones among you who still wonder what an “eco-phany” is, see this excerpt (about the metamorphosis of a (former) university staff member/ Climate Extinction participant ) from the FT:
“… Green began to read about climate change. “For a month, I went around in shock. I just saw the world completely differently,” she says. “I suddenly felt so incredibly vulnerable — I realised just how fragile life on the planet really is.” Concerned that her colleagues were unaware of the gravity of the situation, Green started handing out climate science papers at work. Nobody denied there was a problem, but people tended to grow uncomfortable if the discussion went on too long and meetings would quickly move to the next agenda item: budgets, staffing, curricula. “I had this really rude awakening where I realised that my career was completely pointless — it was irrelevant, it was meaningless,” Green says. “Either I’m going to continue doing what I do and not sleeping well at night because of the crisis that we’re in, or I’m going to jump ship. How can we knowingly educate students for a future that doesn’t exist?” A friend of hers coined a phrase — “ecophany” — to describe Green’s metamorphosis. She has since resigned from her job to support Extinction Rebellion, persuading hundreds of academics and scientists to endorse its principles. Green has also started volunteering as UK director of Scientists Warning, a public engagement group. Her biggest frustration is with those who tell her privately that they support Extinction Rebellion’s aims but do not want to say so publicly for fear of harming their careers. “There’s still this view — and it does prevail in academia — that you work within the system,” Green says. “What they don’t yet get is that the system is the cause of the problem. Either we dismantle this edifice that we’ve built, or it’s going to crumble.” …”
New ILO report – Stress, overtime, disease, contribute to 2.8 million workers’ deaths per year, reports UN labour agency
“Stress, excessively-long working hours and disease, contribute to the deaths of nearly 2.8 million workers every year, while an additional 374 million people get injured or fall ill because of their jobs, the UN labour agency, ILO, said on Thursday. In a new report underlining ILO’s message that no paid work should threaten your wellbeing, your safety or your life, the agency identifies several new or existing occupational risks of growing concern, that affect women more than men. These include modern working practices overall, world population growth, increased digital connectivity and climate change, which are believed to account for losses of almost four per cent of the global economy….”
Stat News – As calls mount to ban embryo editing with CRISPR, families hit by inherited diseases say, not so fast
Not everybody is convinced of “scientists’ emphatic calls to prohibit “embryo editing” of disease-causing genes”.
“…Changing a single DNA “letter” in the genome of a very early embryo has the potential to correct a genetic defect not only in any resulting baby but also in all of that baby’s descendants. That, warn opponents of such “germline editing,”would change the human gene pool, a step they worry could have unforeseen and irreversible consequences. They also argue that known carriers of genetic diseases could have embryos screened for harmful mutations before being used in IVF. The opponents have largely dominated public discussion of this use of CRISPR, especially after a Chinese scientist announced last November that he had changed the genome of two IVF embryos and produced the world’s first “CRISPR babies.” Worldwide condemnation was instantaneous, and since then a group of prominent CRISPR experts called for a global moratorium on using CRISPR for reproduction … … Watching all this have been people with a special interest in embryo editing: those who carry genetic mutations that can cause severe disease. They wonder whether experts who denounce embryo editing have any understanding of what millions of people with such inherited diseases — especially ones that have plagued their families for generations — suffer….”
PS: He Jiankui, perhaps the most notorious scientist on earth now, made it to Time’s List of 100 most influential people in 2019. As did Greta Thunberg. In both cases, well deserved…
Some key papers, reports and journal articles of the week
Lancet Editorial – Universal health care in 21st century Americas
“Despite considerable progress, the Pan American Health Organization (PAHO) estimates that 30% of the population of the Americas still do not have access to the health care they need because of multifaceted barriers. On April 9, leaders… gathered with academics, activists, and representatives of social movements in Mexico City to hear the report of the Commission on Universal Health in the 21st Century. … … The Commission is unflinching in its acknowledgment of social inequality as a barrier to health. … … However, it notes that the social determinants approach to health, although useful, can compartmentalise these factors without critically examining why these determinants have arisen and whom they are serving. The Commission criticises the consolidation of a worldwide economic model based on globalisation and increasing commercialisation and urbanisation, which it sees has led to climate change, migration, an increase in non-communicable diseases, mental health disorders, road traffic injuries, and violence. … … By examining health beyond its social determinants, the PAHO Commission not only delivers actionable recommendations with regional impact but also presents the global order of the 21st century as a barrier to health for all.”
BMJ Global Health – Addressing upstream determinants of health in Germany’s new global health strategy: recommendations from the German Platform for Global Health
Jens Holst; https://gh.bmj.com/content/4/2/e001404
“To strengthen its expanding role in global health, the German government is currently preparing a new global health strategy, to be published in 2019. As social, political and economic determinants are highly relevant for population health, the German government will need to increase coherence in order to promote its emphasis on creating equal opportunities and reducing inequalities in and between countries. For further strengthening its commitment to universal health coverage, for promoting decent work and healthy labour conditions, and for enforcing the right to health, the German government will have to stress the mandatory role of the public sector for global health.” (recommend – and not just for Germany : ))
Global Health Action – Does the political will exist to bring quality-assured and affordable drugs to low- and middle-income countries?
E Beck, Ellen ‘t Hoen et al; https://www.tandfonline.com/doi/full/10.1080/16549716.2019.1586317
“Increased coverage with antiretroviral therapy for people living with HIV in low- and middle-income countries has increased their life expectancy associated with non-HIV comorbidities and the need for quality-assured and affordable non-communicable diseases drugs . Funders are leaving many middle-income countries that will have to pay and provide quality-assured and affordable HIV and non-HIV drugs, including for non-communicable diseases.” This study estimates “costs for originator and generic antiretroviral therapy as the number of people living with HIV are projected to increase between 2016 and 2026, and discuss country, regional and global factors associated with increased access to generic drugs.”
“The global HIV response increased access to affordable generic drugs in low- and middle-income countries. Cheaper active pharmaceutical ingredients and market competition were responsible for reduced drug costs. The development and implementation of regulatory changes at country, regional and global levels, covering intellectual property rights and public health, and flexibilities in patent laws enabled prices to be reduced. These changes have not yet been applied in many low- and middle-income countries for HIV, nor for other infectious and non-communicable diseases, that lack the profile and political attention of HIV. Licensing backed up with Trade-Related Aspects of Intellectual Property Rights safeguards should become the norm to provide quality-assured and affordable drugs within competitive generic markets….”
BMJ Global Health – Managing health research capacity strengthening consortia: a systematised review of the published literature
N Tagoe, S Mollyneux et al ; https://gh.bmj.com/content/4/2/e001318
“Locally relevant research is considered critical for advancing health and development in low- and middle-income countries (LMICs). Accordingly, health research capacity strengthening (HRCS) efforts have intensified, increasingly through consortia. Yet, the knowledge base for managing such consortia is not well defined. This review aimed to ascertain the scope and quality of published literature on HRCS consortium management processes, management-related factors influencing consortium operations and outcomes, and the knowledge gaps….”
Health Promotion International (Editorial) – Trends, fads and taboos in health promotion
S Van den Broucke; https://academic.oup.com/heapro/article/33/5/735/5145152
Nice short read. On the difference between trends, fads & taboos in health promotion.
“…Health promotion research and practice do not operate in a void. They are part of society and therefore subject to societal forces. As for any other discipline or professional field, it is almost inevitable that trends show up in the preferences for certain themes, paradigms, strategies or methods in health promotion. As long as these trends are acknowledged and critically reflected upon they are of little harm. Although they may reduce the potential for innovation, they also concentrate efforts and facilitate collaboration. Fads and taboos, on the other hand, are more dangerous and threaten to hold back the development of health promotion as a professional field: fads because they are more about capturing attention than about real innovation, and taboos because they draw the lines of normality and acceptability too strictly.”
Turns out Kingdon’s Multiple Streams Theory is also a bit of a ‘fad’ : )
BMJ Global Health – How to use relevant data for maximal benefit with minimal risk: digital health data governance to protect vulnerable populations in low-income and middle-income countries
N Tiffin, A George et al; https://gh.bmj.com/content/4/2/e001395
“Globally, the volume of private and personal digital data has massively increased, accompanied by rapid expansion in the generation and use of digital health data. These technological advances promise increased opportunity for data-driven and evidence-based health programme design, management and assessment; but also increased risk to individuals of data misuse or data breach of their sensitive personal data, especially given how easily digital data can be accessed, copied and transferred on electronic platforms if the appropriate controls are not implemented. This is particularly pertinent in low-income and middle-income countries (LMICs), where vulnerable populations are more likely to be at a disadvantage in negotiating digital privacy and confidentiality given the intersectional nature of the digital divide. The potential benefits of strengthening health systems and improving health outcomes through the digital health environment thus come with a concomitant need to implement strong data governance structures and ensure the ethical use and reuse of individuals’ data collected through digital health programmes. We present a framework for data governance to reduce the risks of health data breach or misuse in digital health programmes in LMICS. We define and describe four key domains for data governance and appropriate data stewardship, covering ethical oversight and informed consent processes, data protection through data access controls, sustainability of ethical data use and application of relevant legislation. We discuss key components of each domain with a focus on their relevance to vulnerable populations in LMICs and examples of data governance issues arising within the LMIC context.”
BMJ Global Health (Analysis) – Because space matters: conceptual framework to help distinguish slum from non-slum urban areas
R Lilford et al; https://gh.bmj.com/content/4/2/e001267
“Despite an estimated one billion people around the world living in slums, most surveys of health and well-being do not distinguish between slum and non-slum urban residents. Identifying people who live in slums is important for research purposes and also to enable policymakers, programme managers, donors and non-governmental organisations to better target investments and services to areas of greatest deprivation. However, there is no consensus on what a slum is let alone how slums can be distinguished from non-slum urban precincts. Nor has attention been given to a more fine-grained classification of urban spaces that might go beyond a simple slum/non-slum dichotomy. The purpose of this paper is to provide a conceptual framework to help tackle the related issues of slum definition and classification of the urban landscape…”
Health Promotion International – Beyond positive a priori bias: reframing community engagement in LMICs
“Showing the causal link between community engagement and improved health outcomes is a ‘holy grail’ of health policy. This article argues that this ‘holy grail’ has remained elusive because community engagement in primary health care is under-theorized, having been based on positive a priori assumptions, e.g. that people necessarily want to be engaged in governing their health system. By adopting a theory-driven approach and an agnostic premise, we show that understanding why, how and when community engagement may emerge or function spontaneously is important for informing efforts to support community engagement in primary health care primary health care governance….”
WB report – Out-of-Pocket Expenditures on Health : A Global Stocktake
Released at last week’s Spring Meetings. In case you hadn’t noticed it yet.
“…This paper provides an overview of research on out-of-pocket health expenditures, reviewing the various summary measures and the results of multi-country studies using these measures. The paper presents estimates for 146 countries from all World Bank income groups for all summary measures, along with correlations between the summary measures and macroeconomic and health system indicators….” “Large differences emerge across countries in per capita out-of-pocket expenditures in 2011 international dollars, driven in large part by differences in per capita income and the share of gross domestic product spent on health. The two measures of dispersion or risk — the coefficient of variation and Q90/Q50 — are only weakly correlated across countries and not explained by the macroeconomic and health system indicators. Considerable variation emerges in the out-of-pocket health expenditure budget share, which is highly correlated with the incidence of “catastrophic” expenditures. Out-of-pocket expenditures tend to be regressive and catastrophic expenditures tend to be concentrated among the poor when expenditures are assessed relative to income, while expenditures tend to be progressive and catastrophic expenditures tend to be concentrated among the rich when expenditures are assessed relative to consumption. At the extreme poverty line of $1.90-a-day, most impoverishment due to out-of-pocket expenditures occurs among low-income countries.”
HP&P – ‘LMICs as reservoirs of AMR’: a comparative analysis of policy discourse on antimicrobial resistance with reference to Pakistan
“… However, there is a dearth of research on differences in issue framing by external agencies and LMIC’s national policymakers on the problem of AMR; such analyses are imperative to identify areas of conflict and/or potential convergence. We compared representations of AMR across nine policy documents produced by multilateral agencies, donor countries and an LMIC at the forefront of the global response to AMR—Pakistan. We analysed the texts in relation to five narratives that have been commonly used to frame health issues as requiring action: economic impact, stunting of human development, consequences for health equity, health security threats and relationship with food production. We found that AMR was most frequently framed as a threat to human health security and economic progress, with several US, UK and international documents depicting LMICs as ‘hotspots’ for AMR. Human development and equity dimensions of the problem were less frequently discussed as reasons to address the growing burden of AMR. It is clear that no single coherent narrative on AMR has emerged, with notable differences in framing in Pakistani and external agency led documents, as well as across stakeholders primarily working on human vs animal health. While framing AMR as a threat to economic growth and human security has achieved high-level political attention and catalysed action from governments in high-income countries, our analysis suggests that conflicting narratives relevant to policymakers in Pakistan may affect policy-making and impede the development and implementation of integrated initiatives needed to tackle AMR.”
SRHM – Sexual health, sexual rights and sexual pleasure: meaningfully engaging the perfect triangle
S Gruskin et al ; https://www.tandfonline.com/doi/full/10.1080/26410397.2019.1593787
Looks like we finally have found a new ‘triangle’ in global health circles. Hurray! Tell the Thai (and dr. Suwit in particular 😊). Whether this one “moves the mountain”, that will be context-specific, I’m afraid.
“To improve sexual health, even in this charged political moment, necessitates going beyond biomedical approaches, and requires meaningfully addressing sexual rights and sexual pleasure. A world where positive intersections between sexual health, sexual rights and sexual pleasure are reinforced in law, in programming and in advocacy, can strengthen health, wellbeing and the lived experience of people everywhere. This requires a clear understanding of what interconnection of these concepts means in practice, as well as conceptual, personal and systemic approaches that fully recognise and address the harms inflicted on people’s lives when these interactions are not fully taken into account. Bridging the conceptual and the pragmatic, this paper reviews current definitions, the influences and intersections of these concepts, and suggests where comprehensive attention can lead to stronger policy and programming through informed training and advocacy.”
Journal of Global Health – China: leapfrogging to become a leader in global health?
Titiporn Tuangratananon, Kun Tang, Rapeepong Suphanchaimat, Viroj Tangcharoensathien, and Suwit Wibulpolprasert; http://www.jogh.org/documents/issue201901/jogh-09-010312.htm
Even if written by Thai authors, not Chinese, this is an interesting & wide-ranging read. Based on discussions at an expert meeting in Beijing, it appears.
They conclude: “Undoubtedly, China is one of the largest global economic leaders and has the potential to becoming a global health leader, going beyond simply financial contributions. A more comprehensive collaborative strategy to rapidly build China’s global health capacity is the missing piece of a more powerful China engagement….”
Some key blogs and other mainstream press articles of the week
Guardian – There’s a dark side to women’s health apps: ‘Menstrual surveillance’
Guardian – Wellcome Trust drops plans to trial four-day working week
A pity, but great they put the issue on the agenda (in the broader “global health world”, at least). “The Wellcome Trust has scrapped plans to trial a four-day week for its 800 head office staff , saying it would be “too operationally complex to implement”….”
Still way better than the dumbhead advice from Jack Ma (who was also a member, at least originally, of some high-level WHO NCD commission, I believe) to work at least 72 hours, if you’re really ‘passionate’ about your work. For him (Alibaba), that is, obviously.
CGD (blog) – It’s Technology, Stupid: How Important is Innovation for Better Development Outcomes?
“Income growth is the holy grail of development. At least that’s been the implicit view of much of the development community in recent history. The ultimate aim of development is to improve people’s lives, and GDP growth and income distribution are the yardsticks of this hallowed ground. This is because income (whether spent by individuals or the state via taxation and redistribution) is used to obtain all of the things fundamental to better lives, such as healthcare, education, and nutrition. While the development community has spent decades searching, with limited success, for reliable models of economic growth, however, advances in technology have been quietly increasing these other quality of life measures. Technology is defined here in the economic sense as improved knowledge—of how to make products, for example, or how to organise people, deliver services, or cure diseases. Technology can be embodied in physical products—and these may be cutting-edge and thus fit the conventional notion of technology—but it does not have to be. We have not yet arrived at a dependable model of raising incomes, but the “development” that any level of money can buy is growing, and technology has been the force increasing the bang per buck; it has allowed us to shortcut the route to development. To explore this dynamic, we consider child mortality rates….”
IHP – Keynote Speech by Jean-Paul Adam, Minister of Health of the Republic of Seychelles at the Second WHO Africa Health Forum : ‘Domestic Financing for Sustainable Health Security in Africa’
J-P Adam; IHP;
The Minister of the Seychelles made quite an impression with this keynote speech at the recent (2nd) WHO Africa Health Forum.
Science – African research projects are failing because funding agencies can’t match donor money
“Although African countries appreciate research grants from donor countries, they often chafe at the condition that they bring in their own money in order to be eligible. Some research projects fall by the wayside because African granting agencies simply have no way to provide their share of the money, sometimes called counterfunding, the heads of 15 national science councils in Africa said at a meeting held here on 4 and 5 April. The funding agencies usually ask for contributions between 20% and 50% of the project cost, says Peter Ndemere, executive secretary of the Uganda National Council for Science and Technology (UNCST) in Kampala. For donor agencies, it’s a way to raise interest and make sure African partners are committed to the project….”
NPR – The End Of Empathy
Empathy is out, ‘selective empathy’ is in, it seems, in many countries around the world. Gloomy read.
From a somewhat different angle (i.e. starting from the sorry Brexit saga), you might also want to read Richard Horton’s Offline this week – The case for compromise.
Blog – Public health has a language problem
Nice blog on the jargon haunting public health, for example “SDH”.
Excerpt: “….Everything we do in public health is supposed to be for the public good, but we talk like we’re not really of the public we serve. A bit like – dare I say it – politicians. We all bang on about the need to engage with our populations and the importance of co-production, then we try to do it by using phrases like ‘engage with our populations’ and ‘co-production’. Real-life humans don’t use these words. I don’t say to my wife “Becci, I think we should engage with one another to co-produce tonight’s tea”. No wonder we’re struggling to sell the importance of public health.”
Devex – Opinion: Corporations must be held liable for abuses
Alice Evans explores why we don’t (yet) have corporate accountability (she sees two main reasons), but sees hopeful signs in many places in continental Europe, with more and more organisations & stakeholders pushing for corporate accountability (legislation), with respect to supply chains, and other human rights issues far away.