Interview with Jean Drèze – We need to go beyond self-interest or we’re doomed
From last weekend, but the read of the week. Interview with development economist and activist Jean Drèze. “…In a freewheeling chat, Drèze spoke about, among other things, the problems with economists, his idea of success, nationalism, and activism.”
Excerpts from the start of the interview:
“ Q: In general, economists are a part of the problem and not the solution. Would you agree?
A: Well, economics can be a very useful discipline if studied critically. But if you are not critical, then it can become toxic. If you take economic models at face value, you could end up being in a world of your own.
Q: But even as a discipline, economics seems biased against the poor.
A: It’s not just economics. In many disciplines, if you look at the history of ideas, it is essentially ideas that are convenient for the privileged and the powerful that tend to flourish; they are the ones that get sponsored, the ones around which conferences are organised, and so on. In contrast, ideas that are deemed threatening to the established order tend to be sidelined….”
BMJ collection on global health disruptors
Ilona Kickbusch and Andrew Cassels introduced this series of articles on global health disruptors. So do start with their (excellent) contribution: Ilona Kickbusch and Andrew Cassels: Disruptions that shape global health
“With global governance and global health at a turning point, it seems apt to use the occasion of the 10th anniversary of the Global Health Centre at the Graduate Institute to look back at global health disruptors of the past two decades and to look forward at what will shape global health in the future….”
But we recommend all contributions as they’re all very insightful and focused. Without any doubt, the series of the week. Probably more to come in the days ahead, leading up to the 10th anniversary of the Graduate Global Health Institute.
Robert Marten: Millennium Development Goals
“The millennium development goal framework is a blueprint for current and future policy, says Robert Marten.”
Francis Omaswa – The end of the cold war
“A new paradigm is unfolding in resourcing development assistance, says Francis Omaswa.”
Kent Buse et al – AIDS
“The AIDS movement changed everything—or did it, ask Kent Buse, Sheila Tlou, and Nana Poku.” (also a good read with a view on World AIDS Day (1 Dec)). See below for more on that.
Andrew Cassels – Global Health Partnerships
“They’ve shaped global health governance, now should global health partnerships broaden their influence, asks Andrew Cassels.”
Cfr a tweet by Kent Buse: “On Global Health Partnerships, @CasselsDr asks & hints at answer: ‘Whether innovative governance can facilitate long term strategic decision making or whether the availability of donor financing will once again be the deciding factor.’”
Sharon Friel: Doha Declaration
“Power imbalances threaten access to medicines for all countries, says Sharon Friel.”
Ronald Labonté: 2008 financial crisis
“We don’t have the money to deliver the sustainable development goals, says Ronald Labonté.”
“…Unless, and until, private global finance is effectively reigned in, the health outcomes promised in the SDGs will remain illusory rhetoric as the financing won’t be available….”
G L Burci: WHO Framework Convention on Tobacco Control
“Gian Luca Burci discusses this breakthrough treaty that continues to stand alone.”
M Tichenor & D Sridhar; The Bill and Melinda Gates Foundation
Perhaps the best contribution I’ve read so far. “The Gates Foundation has expanded the power of private philanthropic organisations, say Marlee Tichenor and Devi Sridhar.”
“…The agreement [between IHME & WHO ] is also an indication of how the Gates Foundation has expanded its ownership of the measurement of global health problems into the heart of the foremost global health institution and ensured that only these data will be accepted globally. …”
PS: also something to look forward to (cfr a tweet Devi Sridhar) : “Marlee and I have a longer research paper coming out on the history & politics of Global Burden of Disease Data & the partnerships among the World Bank, WHO, IHME and Gates- so more to come…”
“Civil society organisations have had profound influence on global governance, say Nanoot Mathurapote and Weerasak Putthasri.”
Suerie Moon; SARS & Ebola
“SARS and Ebola redefined the World Health Organization, but didn’t resolve its funding problems, says Suerie Moon.”
“Haik Nikogosian asks whether China’s infrastructure strategy will reshape global health.”
And last but not least:
Stephen Morrison – Decay of the postwar multilateral Western order
“Global health is a product of the Western postwar liberal international order—an order that is today besieged, says Stephen Morrison.” Nice analysis, even if I don’t fully share his view (see below).
Blog – Global health needs to change its game in the era of populism, perhaps the main global health disruptor of our times
My own (slightly disruptive) contribution in this Global Health disruptors debate. In it, I argue that global health should aim for a more nuanced approach versus populism, even if that’s difficult.
“Genome edited baby” commotion
We figured most of you have followed this story closely throughout the week. The commotion might also have repercussions on other CRISPR (global health) applications. Some reads, more or less chronologically:
Insightful read from earlier this week, providing some of the broader background: “A Chinese scientist has reported he’s created the world’s first gene-edited babies, an announcement that’s shocked the scientific community because it defies an unofficial international moratorium on editing human embryos intended for a pregnancy….” (recommended)
Quote: “…Harvard biologist and genetics pioneer George Church said the claims were “probably accurate. “I’ve been in contact with the Shenzhen team and have seen the data,” he said by email from Indianapolis. “The sequencing assays used are generally unambiguous especially when done in multiple cell types at different developmental stages and in two children.” Church added: “Is the genie really out of the bottle? Yes.”…”
However, CRISPR-baby scientist fail[ed] to satisfy critics (Nature News)
“He Jiankui gives talk about controversial genome-edited baby claim, but ethical questions remain.”
“Some scientists worry the startling claim will lead to knee-jerk regulations and damage the public’s trust in gene editing.”
Closing statement Human Genome Editing Summit : that said, basically, that ‘…proceeding with any clinical use of germline editing remains irresponsible at this time.” They don’t rule it out for the future, though, if all risks can be addressed, and other vital conditions are fulfilled.
“The Chinese government said Thursday it had halted research that allegedly led to the births of the world’s first gene-edited babies, as the organizers of an international summit on human genome editing made clear that such research should not have been done and that, for now, similar attempts should not be made. “We continue to believe that proceeding with any clinical use of germline editing remains irresponsible at this time,” the 14-member organizing committee said in a statement, referring to the editing of sperm, eggs, or early embryos in ways that create changes that would be inherited by future generations. Still, much as they did after the original human genome editing summit, held in 2015 in Washington, D.C., the organizers left the door open to one day sanctioning germline editing to prevent or cure certain inherited diseases if the technical, ethical, and regulatory challenges can be met….”
And Science – Organizers of gene-editing meeting blast Chinese study but call for ‘pathway’ to human trials So not a moratorium.
IP-Watch – Gene Editing: Fears Lead To Call For Moratorium At CBD, Discussions Ongoing
Not related to the news from Hong Kong, but from last week already, on the Convention on Biological Diversity Meeting: “Gene editing techniques have opened the way to a new world of innovations. One of them is the potential eradication of malaria-carrying mosquitoes. What appears as a very attractive way to help with malaria eradication is denounced by civil society groups arguing that the technology is in its infancy. Wiping out entire species could have unforeseen environmental, health, and social consequences, they say. They are calling for a moratorium preventing the release of gene drive organisms in the wild. They also describe the gene drive mosquitoes as a Trojan horse, hiding broader interests of agricultural multinational corporations.” (gated)
IP-Watch – UN Biodiversity Convention Agrees On Precautionary Approach To Synthetic Biology
And this update from the CBD meeting: (gated) While the world has been taken by surprise after a Chinese researcher declared he had genetically modified twin babies, and critics are rising from all parts, the Convention on Biological Diversity adopted a decision on synthetic biology today at the close of its biennial meeting. The decision which calls for a precautionary approach was hailed by civil society groups which were calling for a moratorium preventing gene drive organisms to be released in the wild.
Finally, see also the Guardian on this CGD – China urged to lead way in efforts to save life on Earth
“China must play a leading role if the world is to draw up a new and more effective strategy to halt the collapse of life on Earth, according to senior delegates at the close of this week’s UN biodiversity conference….”
“With the US absent, Europe distracted and Brazil tilting away from global cooperation, the onus has shifted towards Beijing, the diplomats said after two weeks of slow-moving talks on how to maintain the natural infrastructure on which humanity depends. China will host the next high-level negotiations, in 2020, which will be the most important in more than 10 years. This is the deadline for nations to agree on fresh global targets for the protection and management of forests, rivers, oceans, pollinators and other wildlife. Conservationists hope this “new deal for nature and people” becomes as much of a priority as the Paris climate accord and helps to reverse the current wave of extinction, which is at the highest rate the world has seen since the age of the dinosaurs….”
G20 summit in Buenos Aires, Argentina (30 Nov-1 Dec)
“On 30 November and 1 December, world leaders will meet in Buenos Aires to wrap up the G20’s work in 2018 and issue a leaders’ declaration with a focus on fair and sustainable development.”
Most of the action is still to happen, so here we just flag the prospective agenda .
And a read related to the draft communique, which is apparently rather weak on climate change:
Draft G20 statement waters down Paris climate commitment “Argentinian official says ambiguity over the Paris Agreement is needed to avoid a split with the US, days before critical UN climate talks begin.” Resolve to stand up for the Paris agreement (as weak as it is) against critical voices, such as the US (and now also Brazil), may be weakening.
John Kirton also asked whether the Buenos Aires Summit will be the first failed G20 summit since its start 10 years ago. It’s certainly going to be another big test for ‘multilateralism’ (of what is still left of it…).
2018 Report Lancet Countdown on Health and Climate Change
“The 2018 report shows an increasing proportion of the global population are vulnerable to heat-related death due to climate change. An Editorial discusses how using health might be key to humanising climate change conversations.”
- The Lancet Report: The 2018 report of the Lancet Countdown on health and climate change: shaping the health of nations for centuries to come
- The Editorial: Humanising health and climate change
Excerpt: “…The 2018 report of the Lancet Countdown on health and climate change by Nick Watts and colleagues published on Nov 28 provides a snapshot and direction of travel for 41 global indicators at the intersection between health and climate change. Indicator 5.1: media coverage of health and climate change shows that health still represents only a small proportion of climate change media coverage, but has increased by an average of 4% per year over the past decade compared with a decline in overall climate change coverage by an average of 1·25% per year. Health potentially holds the key to humanising climate change conversations, contributing to more rapid and effective behaviour change—and it therefore matters how it is positioned. Describing the effects of climate change through a humanising lens would mean that instead of framing climate change with arbitrary deadlines of 2030, or 2050, we approach it intergenerationally:…”
- From the Press release:
“The Lancet: Proportion of population vulnerable to heat exposure is rising globally
More people globally are vulnerable to heat exposure, potentially causing them heat stress, cardiovascular disease and kidney disease. Europe and the eastern Mediterranean are more vulnerable than Africa and southeast Asia due to many older people living in cities. In 2017, 157 million vulnerable people were exposed to heatwaves globally, and 153 billion hours of labour were lost due to heat exposure. While promising trends have begun, funding for adaptation to climate change still falls short of the commitments made in the Paris Agreement. The proportion of the global population vulnerable to heat-related death and disease is growing as a result of climate change’s effects on growing populations of older people, people living in cities, and people with non-communicable diseases (NCDs), according to the 2018 report of The Lancet Countdown on Health and Climate Change….”
- Finally, coverage in the Guardian – Climate change already a health emergency, say experts
Including this quote from Dr Tedros: “The findings are clear and the stakes could not be higher,” said Tedros Adhanom Ghebreyesus, the WHO director-general. “We cannot delay action on climate change. We cannot sleepwalk through this health emergency any longer.”
Run-up to COP24 in Katowice (next 2 weeks)
Below some info on what the agenda is for Katowice, as well as a series of worrying reports from a number of organisations, ahead of COP 24.
UN News – The crunch ‘COP 24’ UN climate change conference: what’s at stake and what you need to know
“As global temperatures continue to rise, climate action is lagging and the window of opportunity is closing. On Sunday, the United Nations will kick off critical negotiations on how to address the problem collectively and urgently, during a two-week climate change conference in Katowice, Poland, known as “COP 24”. … … UN News put together this guide to COP 24 to answer some of the biggest questions you may have and make sure you’re all caught up, with a ringside seat on the action. …”
“…This year’s COP in Katowice, Poland, is particularly crucial because 2018 is the deadline that the signatories of the Paris Agreement agreed upon in order to adopt a work programme for the implementation of the Paris commitments. This requires the singular most important ingredient: trust between all countries. Among the many elements that need to be ironed out is the financing of climate action worldwide. Because the clock is ticking on climate change, the world cannot afford to waste more time: we must collectively agree on a bold, decisive, ambitious and accountable way forward….”
And as a reminder, for next year: “…To build on the outcomes of COP 24, and to strengthen climate action and ambition at the highest possible levels, UN Secretary-General António Guterresis convening a Climate Change Summit next September. In advance of the 2020 deadline for countries to finalize their national climate plans, the Summit is designed to focus on practical initiatives to limit emissions and build resilience. ..”
See also IISD Policy Brief – Paris Agreement Implementation Guidelines: How Do We Get There?
For the WB’s view on what to expect in Katowice (and WB highlights), see here. “…This policy brief outlines expectations for the Katowice Climate Change Conference, and is structured around the three questions of the 2018 Talanoa Dialogue: Where are we? Where do we want to go? and How do we get there?”
“The priority outcome from negotiations at COP24 will be the finalization of the “Paris rulebook”, namely, the framework of rules that will guide the implementation of the Paris Agreement. The World Bank Group will announce new climate targets for 2025, including a major boost on adaptation, as well as analytical work on new mobility, transport, the energy sector, and the just transition, focusing on delivering low carbon pathways to development.”
See also Devex (on the climate financing): “The OECD reported Thursday that overall public climate finance to developing countries rose from $48.5 billion in 2016 to $56.7 billion in 2017. The increase was mostly attributable to more multilateral finance, with bilateral spending falling slightly. Developed countries have committed to providing $100 billion in climate finance by 2020. The terms of that agreement — and the basic definition of “climate finance” — are poised to be a major topic of discussion at the climate talks in Poland. …”
UN News – CO2 emissions on the rise for first time in four years, UN agency warns
“A new report released on Tuesday by the United Nations Environment Programme (UNEP) shows that global carbon dioxide (CO2) emissions rose again during 2017 after a three year hiatus, highlighting the imperative for countries to deliver on the historic Paris Agreement to keep global warming to below 2°C above pre-industrial levels. The report comes just days before the key UN climate change conference known as COP 24, taking place in Katowice, Poland, with the agency urging nations to triple their efforts to curb harmful emissions. The UNEP report comes hot on the heels of the watershed Intergovernmental Panel on Climate Change (IPCC) report on global warming, released in October, which cautioned that emissions had to stop rising now, in order to keep temperature increases below 1.5°C, and reduce the risks for the well-being of the planet and its people….”
“If the IPCC report represented a global fire alarm, this report is the arson investigation,” …
See also Nature News on this new UNEP report: Nations must triple efforts to curb greenhouse-gas emissions
“ Governments of the world need to triple their current efforts to reduce greenhouse-gas emissions in order to prevent global warming of more than 2 °C by 2030, the United Nations Environment Programme (UNEP) said in its annual “emissions gap” report. Released on 27 November ― just a week before the latest UN climate summit in Katowice, Poland ― the UNEP report projects that current national policies would allow global greenhouse-gas emissions to rise by around 10% by 2030, compared with 2017 levels (see ‘Top emitters’). But emissions would need to decrease by 25% over the same period to maintain a likely chance of limiting warming to 2 °C. Countries would need to reduce their emissions by 55% to restrict warming to below 1.5 °C.”
Guardian – Past four years hottest on record, data shows
“Global temperatures have continued to rise in the past 10 months, with 2018 expected to be the fourth warmest year on record.”
“Average temperatures around the world so far this year were nearly 1C (33.8F) above pre-industrial levels. Extreme weather has affected all continents, while the melting of sea ice and glaciers and rises in sea levels continue. The past four years have been the hottest on record, and the 20 warmest have occurred in the past 22 years. The warming trend is unmistakeable and shows we are running out of time to tackle climate change, according to the World Meteorological Organization, which on Thursday published its provisional statement on the State of the Climate in 2018. The WMO warned that, on current trends, warming could reach 3C to 5C by the end of this century.”
The Guardian – Global food system is broken, say world’s science academies
The Guardian – Global food system is broken, say world’s science academies
“Global food systems are failing humanity and speeding up climate change: New report from 130 national academies issues wake-up call to leaders on eve of COP24.”
“The current approach to food, nutrition, agriculture, and the environment is unsustainable and must change. There is no time to waste, say the 130 national academies of science and medicine across Africa, Asia, the Americas and Europe that compose the InterAcademy Partnership….”
And some other links related to COP 24 (and COP 25):
Social Europe – COP 24 Must Be The Turning Point Towards ‘Just Transition’
“The next round of global climate negotiations, COP 24, takes place in December. It will need to make rapid progress on implementing the Paris Agreement so as to close the gap between what science requires and what countries are doing. European trade unions believe it must also be a milestone on the journey towards a ‘just transition’, guaranteeing that workers will not be sacrificed in the effort to cut emissions and arrest climate change. COP 24 must be the Just Transition COP.”
“Reversal comes two months after country agreed to host COP25 conference in 2019 – and one month after far-right climate sceptic won election.”
BMJ Editorial – Air pollution moves up the global health agenda
N Linou et al; https://www.bmj.com/content/363/bmj.k4933
“UN recognises air pollution as a key risk factor for NCDs.“ “The international community working on the prevention and control of non-communicable diseases (NCDs) has historically focused on four disease groups (diabetes, cancer, cardiovascular diseases, and chronic respiratory diseases) and four risk factors (tobacco use, harmful use of alcohol, unhealthy diets, and physical inactivity). The United Nations high level meeting on NCDs, held in September 2018, signalled a shift from this four-by-four approach to a five-by-five response, adding mental health conditions and key environmental risk factors to the list…”
The Implant files
You probably also got this via your newspaper this week. “The Implant Files investigation reveals damage caused by poor regulation and lax testing rules.”
See also BMJ News – Medical device industry: international investigation exposes lax regulation
“A global investigation from International Consortium of Investigative Journalists reveals the rising human toll of lax controls and testing standards pushed by a booming industry…”
World AIDS Day (1 Dec)
“This year marks the 30th anniversary of the first World AIDS Day. Thirty years of activism and solidarity under the banner of World AIDS Day. Thirty years of campaigning for universal access to life-saving services to treat and prevent HIV. But after 30 years, AIDS is still not over. We have miles to go….”
Last week, we already flagged the latest UNAIDS report, see also:
UNAIDS Press release – New UNAIDS report shows that 75% of all people living with HIV know their HIV status
“Report also calls for increased efforts to reach the 9.4 million people living with HIV who are not aware that they are living with the virus and the estimated 19.4 million people living with HIV who do not have a suppressed viral load…”
“Developing countries are struggling to provide HIV-positive children with World Health Organization (WHO)-recommended treatments because pediatric versions of HIV medicines don’t exist, are priced out of reach, or haven’t been registered in all countries that need them, said MSF ahead of a Vatican City meeting of HIV stakeholders on scaling up diagnosis and treatment for children. Worldwide, only about half of HIV-positive children receive treatment, and half of those continue to receive suboptimal regimens, putting them at risk of increased side effects, resistance, and treatment failure. Pharmaceutical companies must stop dragging their feet and address their delays and failure to develop appropriate formulations of HIV medicines for children….”
UNICEF (via UN News) – 80 adolescents a day will still die of AIDS by 2030, despite slowdown in epidemic
“By 2030, around 80 adolescents will be dying of AIDS every day if “we don’t accelerate progress in preventing transmission,” the head of UNICEF said on Thursday. In a report released on Thursday, Children, HIV and AIDS: The World in 2030, current trends indicate AIDS-related deaths and new infections are slowing, but the downward trajectory is not happening fast enough….”
“More than 130,000 people were newly diagnosed with HIV last year in Eastern Europe, the highest rate ever for the region, while the number of new cases in Western Europe declined, global public health experts said on Wednesday….”
Letter TAC & Section 27 to South-African Leader (A Yawa & M Heywood)– Letter to President Cyril Ramaphosa: Send a message to world leaders to commit financially to fighting Aids
“That is why we are asking you personally to make a statement on World AIDS day that includes a strong call on the leaders at the 2018 G20 meeting to ensure the funding increases and the international solidarity needed to deliver quality treatment and prevention services around the world”.
Lancet Comment – Engaging men in HIV treatment and prevention
By A Adeyeye et al.
Lancet Comment – Stemming HIV in adolescents: gender and modes of transmission
“The HIV/AIDS community is paying increasing attention to the estimated 1·8 million (uncertainty bounds 1·3 million to 2·4 million) people younger than 15 years living with HIV globally, as was evident by the focus on adolescents at the XXII International AIDS Conference in July, 2018. This attention is welcome, and it is crucial to curtailing the HIV epidemic. But while age disaggregation can help elucidate the spread and impacts of the HIV epidemic, it is not enough. A gender lens is also needed….”
Latest PEPFAR results & (US) Senate passage
US Department of State – Secretary Pompeo Announces Latest Lifesaving PEPFAR Results
With some “Pomp”, I assume : )
“…PEPFAR has now saved more than 17 million lives. As of September 30, 2018, PEPFAR is supporting over 14.6 million people on lifesaving antiretroviral treatment, including over 700,000 children. This is compared with the 50,000 people who were on HIV treatment in Africa when PEPFAR began in 2003. PEPFAR has also enabled over 2.4 million babies to be born HIV-free to mothers living with HIV and supported over 6.8 million orphans, vulnerable children, and their caregivers….”
PS: The House of Representatives approved the PEPFAR reauthorization on Nov. 13. And just last night, PEPFAR also passed the Senate (5-year re-authorization), with bipartisan support. Great news ahead of World AIDS day! Now it’ll go to the White House.
See also Devex – “…The PEPFAR Extension Act of 2018, passed by the Senate late Wednesday night, awaits President Donald Trump’s signature to become law. …” “…On Thursday, Vice President Mike Pence announced a new $100 million effort within PEPFAR to expand engagement with faith-based organizations in HIV prevention and treatment efforts.”
Global Public Goods for Health
Devex Op-Ed- 3 ways to strengthen multilateral cooperation on global public goods
J Kraus, N Schwalbe, G Yamey, S Fewer; https://www.devex.com/news/opinion-3-ways-to-strengthen-multilateral-cooperation-on-global-public-goods-93846
“…GPGs are shorthand for a set of collective action activities that address transnational health challenges, such as research and development for neglected diseases, pandemic preparedness, and global health leadership and stewardship…”
“… In a new policy paper, we’ve examined the potential support for GPGs from four organizations that provide the most development assistance for health: Gavi, the Global Fund, World Bank, and World Health Organization. In light of the critical funding gap, and bilateral funding increasingly tied to foreign policy agendas, we found that these organizations are well-placed to deliver support for GPGs. Further, all four multilaterals want to step up their investments in GPGs, and could immediately intensify their cooperation in three areas….”
“…As these organizations and others work to operationalize the Global Action Plan, they can build upon their shared interest in three essential GPGs: health data, development and access to health technologies, and health security….”
You find the (Duke) policy paper here: Intensified multilateral cooperation on global public goods for health: three opportunities for collective action (recommended)
Gavi Board starts framing Alliance’s approach to 2021-2025 period
“The Board approves in principle a set of new and expanded vaccine programmes.”
“The Gavi Board has made a series of decisions that will help shape the Alliance’s approach for the period 2021-2025 during a two-day meeting in Geneva’s Global Health Campus. The Board will adopt the 2021-2025 strategic goals at its next meeting in June 2019.”
“As part of its Vaccine Investment Strategy (VIS), the Gavi Board approved a future investment in six new and expanded vaccine programmes, contingent on the final parameters of Gavi’s 2021-2025 strategy (Gavi 5.0) and sufficient funding being made available after Gavi’s next replenishment….”
And “…“Unlike previous vaccine investment strategies, these vaccines will involve building new delivery platforms which will strengthen primary healthcare as a whole,” said Dr Berkley….”
CDC – Health Security Supplement: Building the Evidence Base for Global Health Security
“The Building the Evidence Base for Global Health Security Supplement shares lessons learned from efforts to build vital systems in multiple countries. Articles offer examples of effective interventions and strategies to improve the efficiency of ongoing programs. In addition, the supplement highlights a new scientific global health security framework as well as CDC’s work with partners in disease prevention, detection, and response. “
Cfr a tweet: “Approximately ~70% of countries are not prepared to manage and control a public health emergency. Find out what countries and their partners can do to improve #globalhealthsecurity implementation activities.”
For a bit more detail on this supplement, see for example: Global Health Security Implementation: Expanding the Evidence Base
“… To address this evidence gap, the US Centers for Disease Control and Prevention (CDC), as a WHO Collaborating Center for the Implementation of IHR Core Capacities, works with its partners to develop the evidence base for effective global health security interventions. At CDC, the efforts to improve global health security implementation are primarily focused on strengthening public health systems to increase the capacity to prevent, detect, and respond to public health threats. These capacities include surveillance, public health laboratory systems, workforce development, outbreak investigation, and emergency response. Through CDC’s direct engagement and collaboration with partners, CDC provides technical, scientific, and fiscal support to a number of countries to implement activities that build toward sustainable global health security systems in countries and regions. This supplement shares the lessons learned from efforts to build global health security capacity in multiple countries spanning Africa, Asia, and Latin America. We grouped the articles in the supplement into 4 sections: Overview, Prevent, Detect, and Response, in alignment with the Global Health Security Agenda action packages…”
Stat (Op-Ed) – Nurses will help turn the promise of universal health care into a reality
I Kickbusch Stat News;
I sure hope so. “…Health is a political choice — and nurses need to be where these choices are made. More nurses are ascending to higher political office than ever before, and they are also rising up the ranks of global health policy workers. As a political issue, quality health care is increasingly a vote winner; nurses have credibility in speaking to it. Achieving universal health coverage — meaning everyone, everywhere has access to the health services they need, when they need them, without suffering financially — is a top priority in global health. According to a new report published by the World Innovation Summit for Health and the UHC Forum 2018, universal health care won’t be attainable without nurses and midwives. Yet policy approaches to universal health care have traditionally neglected the health workforce and the role of nurses. This omission misses two important points: … “
“…nurses increasingly step up and demand their place at decision-making tables. Nursing Now, a global campaign to raise the profile of nurses launched earlier this year, has inspired nurses in more than 61 countries to take charge and establish their own groups to advocate for more influence for the profession. Electing and appointing more nurses as leaders in health and beyond will be essential for driving forward the universal health coverage agenda….”
2018 Global Nutrition Report
For some coverage, check:
“More than four in 10 children drink sugary drinks every day and one in three never eat fruit every day, according to a global report that warns most countries are unlikely to meet nutrition targets. Researchers warn the standard of diets around the world is “diabolical”, and that problems such as obesity, anaemia and micronutrient deficiency are being neglected. While progress has been made in tackling child stunting, the report provides the most comprehensive picture of diets globally to date, analysing statistics on exclusive breastfeeding, dietary diversity and the consumption of sugary drinks….” ““What we highlight in this report is just how important and just how diabolical the state of diets are – whether it’s for infants, young children, adolescents and adults,”…”
“Every country in the world experiences the burden of malnutrition and many nations now see a compounding of different forms including stunting, wasting, anemia, and obesity, according to the “2018 Global Nutrition Report.” Child stunting, anemia in women of reproductive age, and overweight in women were examined in 141 countries that had consistent data on those malnutrition indicators. Findings show 88 percent (124 countries) have high levels of at least two different types of malnutrition, while 29 percent have high levels of all three….”
HPW – Better housing means better health and well-being, stress new WHO guidelines
“The World Health Organization has issued a first-ever set of global “Housing and Health Guidelines” intended to guide national governments as well as development actors in shaping healthier housing policies, standards and codes.”
For the WHO Guidelines, see here.
Civicus Monitor report on civil rights
Guardian – Civil rights ‘under serious attack’ across the globe
“Nearly six in 10 countries are seriously restricting people’s freedoms, according to a new report that warns of a growing repression around the world. According to the study, there is little or no space for activism in countries such as Eritrea and Syria, and also worrying signs in countries where democracy is considered well established, such as France, the US, Hungary and India. The report by Civicus Monitor, an alliance of civil society groups, found that fundamental rights – such as freedom of expression and peaceful assembly – were under attack in 111 of 196 countries….”
Ebola outbreak DRC – Now the 2nd largest ever & calls for US involvement (in analyses)
Some reads, news and analysis/advocacy from this week:
NYT – Battle Against Ebola in Congo pits Medical Hope Against Local Chaos
Report by Donald McNeil. “ A vaccine and new treatments are on hand, but the outbreak is in an area rife with unpredictable gunfire, bandits and suspicion of outsiders”.
CIDRAP (news) – DRC’s 426-case Ebola outbreak now 2nd largest ever
“After nearly 5 months and now 426 cases, the Ebola outbreak in North Kivu and Ituri provinces of the Democratic Republic of the Congo (DRC) has become the world’s second largest—and second deadliest—outbreak of the hemorrhagic fever disease ever recorded….”
WHO Afro – Malaria control campaign launched in Democratic Republic of the Congo to save lives and aid Ebola response
“A surge in malaria in North Kivu is complicating the #Ebola response there, so response partners have launched a campaign to distribute anti-malarials & mosquito nets to nearly half a million people.”
“Controlling malaria is critical in areas like North Kivu, as it causes widespread disease and death, especially among the region’s children,” says Dr Yokouide Allarangar, WHO’s Representative to the DRC. “This anti-malaria campaign will also help reduce the pressure on the overall health system, which is currently striving to protect people from the ongoing Ebola threat in the region.”
See also Cidrap News – Malaria spike in Ebola zone prompts mass treatment efforts.
Cidrap – Ebola cases surge to 419 as treatment trial launches
“… In another new outbreak development, the health ministry said in a Nov 24 announcement that an ethics committee at the University of Kinshasa has approved a protocol for testing four experimental Ebola treatments, which are currently being used on an emergency basis in Ebola treatment centers. They are mAb114, Zmapp, remdesivir, and Regeneron’s REGN-EB3 antibody….”
And a Lancet World Report – Randomised controlled trial begins for Ebola therapeutics
“A trial to assess the efficacy of investigational therapeutics against Ebola virus disease has been launched in DR Congo with some questioning the trial design. Esther Nakkazi reports.”
A link from late last week:
“The World Health Organization says a worrying number of the newest Ebola cases amid Congo’s ongoing outbreak are in patients not usually known to catch the disease: babies. In an update published this week, the U.N. health agency reported 36 new confirmed cases of Ebola, including seven in newborn babies and infants younger than 2 years old….”
And some (must-read) analysis, recommendations & pleas:
JAMA (Viewpoint) – Ebola and War in the Democratic Republic of Congo Avoiding Failure and Thinking Ahead
L Gostin et al; https://jamanetwork.com/journals/jama/fullarticle/2717586
“In this Viewpoint, Gostin and colleagues review recommendations developed by experts convened by Georgetown University on how the international community can respond to the 2018 Ebola outbreak in the Democratic Republic of Congo (DRC) in the midst of active conflict and insecurity from armed rebels.” With 8 recommendations.
They conclude: “The Ebola epidemic in the DRC has reached a dangerous moment, requiring new political and security strategies. Supporting DRC and WHO leadership, the US has capabilities that should be carefully and responsibly deployed. From a humanitarian perspective, the CDC and USAID have experienced personnel and key capacities that could help prevent the epidemic from spreading regionally, which would cost thousands of lives and devastate local economies. The US and partners should also support the UN to adapt and expand its capacity to safeguard health workers and the public. This is the first Ebola outbreak during which armed attacks impede the response, but it will not be the last major health crisis amidst insecurity. The global health playbook must expand to meet that reality.”
NEJM Perspective – Ramping Up the Response to Ebola
“Additional seasoned responders are needed to help control the DRC Ebola outbreak, but CDC staff have been pulled from the field due to security concerns. These concerns need to be addressed to that CDC can return.”
Also: “…Given the rapidly growing case numbers, limited ability in the field to conduct contact investigations, and high potential for cross-border spread, we believe that declaration of a PHEIC seems warranted now. It would increase both political attention and the financial resources flowing to the control effort. But leaders need not wait for such a declaration before they deepen their commitments: in recognizing the urgency of the concern expressed by the emergency committee, they can act now….”
International Day for the Elimination of Violence against Women (25 November)
UN News – Violence against women a ‘mark of shame’ on our societies, says UN chief on World Day
“Violence against women and girls is not only a fundamental human rights issue but also a “moral affront” against them and a “mark of shame” on all societies, United Nations Secretary-General António Guterres has said, calling greater action by everyone around the world to root out the scourge.”
“… This year, the global United Nations UNiTE campaign to end violence against women and girls is highlighting our support for survivors and advocates under the theme ‘Orange the World: #HearMeToo’. Phumzile Mlambo-Ngcuka, the Executive Director of UN Women, the Organization’s entity for gender equality and the empowerment of women, also highlighted that the theme is a call “to listen to and believe survivors”, to end the culture of silencing, and to put the survivors at the centre of the response. “The focus must change from questioning the credibility of the victim, to pursuing the accountability of the perpetrator,” she said, underscoring that #HearMeToo is “therefore also a strong call to law enforcement.”…”
“ In a stark finding, a new UN report has revealed that globally some 50,000 women were killed last year at the hands of intimate partners or family members, urging greater coordination between police, justice and social systems to better protect women and girls. Globally, about 87,000 women lost their lives in homicides (intentional killings) in 2017, according to the Global study on homicide: Gender-related killing of women and girls, issued by the UN Office on Drugs and Crime (UNODC).
For the UNODC study on homicide, see here.
WHO-Violence against women – Strengthening the health response in times of crisis
WHO Feature story.
Female Genital Mutilation
Guardian – UK pledges £50m to help end FGM across Africa by 2030
“The UK has said it will provide £50m of aid funding to tackle female genital mutilation across Africa. The package will help reinforce the movement to end FGM and support vulnerable girls in some of the world’s least wealthy countries. Officials said the funding was the biggest single investment by any international donor and would bolster a drive to end the practice by 2030….”
Devex – Opinion: UK’s commitment to end FGM is vital — but we must look beyond Africa
With some more detail on this new DFID initiative.
But more is needed: “… While this is fantastic news for the Africa-led movement to end female genital cutting, we are still missing large-scale recognition that the practice takes place outside Africa, in the Middle East, and Asia — with at least 15 million girls at risk by 2030 in Indonesia alone. There is little data and research on female genital cutting in the Middle East and Asia, but initial research suggests that within the Dawoodi Bohra community in India and Pakistan, for example, 80 percent of women may have been cut. The practice is known to occur in Malaysia, where the deputy prime minister, who is also the women’s minister, Dr. Wan Azizah, recently stated that female genital cutting is “cultural” and not mutilation. These are just two examples of at least 15 countries outside Africa where the practice is known to occur, but where national data on female genital cutting is not collected….”
Politico – WHO Chief: Frieden should keep advisory roles until sexual misconduct charges resolved
(gated) See also the New York Post – Ex-CDC’s sex abuse case could go to trial
“…The sex abuse case against former city health commissioner and Centers for Disease Control chief Dr. Thomas Frieden could be headed to trial next year. Frieden, who is accused of groping a woman’s backside in his Brooklyn Heights apartment last year, made a brief appearance in Brooklyn Supreme Court Tuesday, where the judge set a possible trial date of Jan. 17….”
A few pertinent tweets from a global health observer (‘Health in Myanmar’)
“Tom Frieden continues leadership/advisory role in non-communicable diseases @WHO despite the arrest/charges.”
Sounds fair to me, even if on the MeToo scale Frieden seems far from the worst offender.
Farewell to Amit Sengupta (PHM)
PHM – People’s Health Movement (PHM) tribute: Dr Amit Sengupta
Very sad news, which you might have already picked up on social media. I remember Amit as whipsmart, very kind, generous and with a great sense of humour. And I’m probably not the only one wondering whether there’ll ever be a person again on this planet who can summarize the WHO’s WHA/EB 200+ agenda items in 15 minutes…
See also a Scroll.In Obituary – “One of the strongest pillars”: Dr Amit Sengupta, a leader of the public health movement, dies at 60.
Check out also his (just (re-)published) article in BMJ Tackling the primary care access challenge in South Asia.
More analysis on PHA4 in Dhaka
Must-read. “Governments’ protection of transnational corporations is the greatest threat to health, says Fran Baum in her wrap up of the Fourth People’s Health Assembly.”
Lancet – Offline: The future of scientific knowledge
Horton’s take on “Plan S” (and related issues).
“…The radical shift to a world where individual articles and not journals are the currency of science has taken power away from publishers and put it in the hands of funders. Some publishers may not recognise just how “fundamental” that “transformation” really is….”
“… two decades editing this journal have taught me two principles. First, a journal only deserves to survive if it stands for something more than simply being a repository for research papers. What is the journal’s view of the world and the subject it serves? What is its philosophy, perspective, and personality? What is its attitude? What is its argument? Second, to justify sustainability a journal must add some kind of value back to science—value beyond peer review, versatile online publication, and volume, all of which could be delivered by one massive platform managed by a consortium of research funders. Quality, for example. These principles are a foundation for trust between publishers and the science community. I don’t know whether they are strong enough to withstand the tailwinds behind Plan S or visions that seek to eliminate primary research from journals entirely….”
But he admits the fate of the Lancet is not in his hands…
Canada’s Global Health Role
There are a number of Letters in this week’s Lancet issue related to this, commenting on an earlier Lancet Series in this regard.
For example, the hard-hitting Canada’s global health role (by B Mukhopadhyay, A-E Birn et al)
“In the Lancet Series on Canada’s global health role, Stephanie A Nixon and colleagues perpetuate liberal myths about Canadian nation-building and foreign policy, proffering an uncritical historical assessment of the country’s global health involvement….” “… Global health equity demands more than aspirational narratives and meek apologies. A bona fide contribution would entail exposing the full range of Canadian policies’ deleterious effects on health in order to reverse them.” Ahum.
For the reply by the authors (to this and another letter), see here. Their nuanced reply is also very much recommended.
Measles cases spike globally due to gaps in vaccination coverage
“Reported measles cases spiked in 2017, as multiple countries experienced severe and protracted outbreaks of the disease. This is according to a new report published today by leading health organizations. Because of gaps in vaccination coverage, measles outbreaks occurred in all regions, while there were an estimated 110 000 deaths related to the disease….”
Some key papers of the week
Globalization & Health – The financial sustainability of the World Health Organization and the political economy of global health governance: a review of funding proposals
“The World Health Organization (WHO) continues to experience immense financial stress. The precarious financial situation of the WHO has given rise to extensive dialogue and debate. This dialogue has generated diverse technical proposals to remedy the financial woes of the WHO and is intimately tied to existential questions about the future of the WHO in global health governance. In this paper, we review, categorize, and synthesize the proposals for financial reform of the WHO. It appears that less contentious issues, such as convening financing dialogue and establishing a health emergency programme, received consensus from member states. However, member states are reluctant to increase the assessed annual contributions to the WHO, which weakens the prospect for greater autonomy for the organisation. The WHO remains largely supported by earmarked voluntary contributions from states and non-state actors. We argue that while financial reform requires institutional changes to enhance transparency, accountability and efficiency, it is also deeply tied to the political economy of state sovereignty and ideas about the leadership role of the WHO in a crowded global health governance context.”
PHM – Global Health Watch 5: chapter on management consulting firms in global health
All you ever wanted to know about the influence of McKinsey, the Boston Consulting Group, … in global health.
Key blogs & other articles of the week
Andrew Harmer (blog) – Taking a bit (out) of the doughnut
Recommended. Harmer reviews Kate Raworth’s book on doughnut economics, also coming up (towards the end) with some constructive criticism, as well as singling out the ‘elephant in the room’.
IHP (blog) – Health Financing and Gender: Insights from our Discussions at the HSR2018 Symposium in Liverpool
During a session in Liverpool, the authors looked at how gender inequity is addressed in health financing. Check out some of the design principles, pragmatic solutions, and the road ahead.
Ed Whiting (Wellcome Trust) – A manifesto for better conferences?
Worth a read. “It’s been quite the autumn so far for mega-gatherings in global health- from all the activity at UN General Assembly on TB and Non-Communicable diseases, to Astana, the Global Mental Health Summit in October, and many many others besides….” Exactly. What can be about this inflation of global health events? Some suggestions here from Ed Whiting.
O’Neill Institute (blog) – What’s special about the system of United Nations Special Procedures?
The latest in the Georgetown series.
“The United Nations Special Procedures are far more interesting than their title suggests, and we argue it is time for more of us to recognize this. We portray the Procedures as a missing population, neglected both by proponents of global health and global health law, and by many human rights advocates too. We call for them to be seen as an essential supplement to the cast of characters—courts, UN treaty bodies, non-governmental organizations, victims, and states—that dominate accounts of human rights law. We describe this as ‘peopling’ human rights law, or to be more accurate, peopling it differently. So what or who are the United Nations Special Procedures? They are a system of independent experts appointed to monitor and report on human rights violations, and more generally to advise and assist in promoting and protecting rights. They work alone (either as special rapporteurs or independent experts), in formal groups (working groups), and in ad hoc collaborations. Their remit extends to the full range of rights: civil, economic, political, cultural, and social …”