Global access to quality-assured medical products: the Oxford Statement and call to action

Lancet Global Health – Global access to quality-assured medical products: the Oxford Statement and call to action

P Newton et al (on behalf of the Oxford Statement Signatories) https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30426-7/fulltext From the new Lancet Global Health December issue (see also below). Check out this global call signed by nearly 160 leading researchers, advocates and policymakers that is urging immediate action to combat poor-quality medical products. This call to action, known as the Oxford Statement, is the first-ever global call on this issue.   Linked to the Medicines we can Trust campaign. It’s an issue that comes at a steep price, as most of you know: poor-quality medicines cost the global economy US $10-200 billion every year.   To address this challenge, Oxford Statement signatories call for four key interventions: adoption of the WHO’s “Prevent, Detect and Respond” strategy; better cross-sector collaboration; increased investment in supply chains and regulatory systems; and scaling up multidisciplinary research. “… In September, 2018, the first international Medicine Quality and Public Health Conference was held at Oxford University, UK, to discuss opportunities and solutions to ensure that all people have access to affordable and quality-assured medical products. Delegates developed the short Oxford Statement, calling for investment, policy change, and action to eliminate substandard and falsified medical products. The statement was born out of discussion between governments, national and international agencies, non-governmental organisations, professional associations, and academic institutions who together examined the latest evidence on the epidemiology and public health implications of substandard and falsified medical products. Here, we expand this statement with a call to action (panel) and research agenda (appendix 1)….”

Bill Gates isn’t very happy with Elizabeth Warren’s wealth tax

Bill Gates goes after Warren on wealth tax, won’t commit to backing her over Trump: voting for whoever is more professional

https://www.mediaite.com/election-2020/bill-gates-goes-after-warren-on-wealth-tax-wont-commit-to-backing-her-over-trump-voting-for-whoevers-more-professional/ Unlike the gist of this article (and also Anand Ghiridharadas, who wrote a poignant Twitter threat on this news), I’m reading this more as Gates hoping that Biden ( who’s presumably ‘more professional’ in Gates’ line of thinking than Warren (or Sanders)) will run against Trump. Regardless, it says a lot about his willingness to really pay heavy wealth taxes… Thankfully, Elizabeth Warren already offered to explain her wealth tax to Bill Gates  (Guardian)

Vox - How a wealth tax could totally remake charity in the United States

https://www.vox.com/future-perfect/2019/9/20/20856818/wealth-tax-emmanuel-saez-gabriel-zucman-bill-gates-charity “Emmanuel Saez and Gabriel Zucman have a plan that could force foundations to pay out right away.” Their new paper has potentially huge implications for global health as well. "Saez & Zucman propose making foundations and donor-advised funds subject to the wealth tax if they are still controlled by their wealthy benefactor. The Bill and Melinda Gates Foundation would be treated the same as Bill and Melinda Gates, individually."  PS: good to know perhaps - these economists advised Elizabeth Warren on her wealth tax. Excerpt on the current mood in the US: “…In the past year, a massive, predominantly left-wing backlash to mega-philanthropy has broken out. Writers like Anand Giridharadas, Rob Reich, and Rutger Bregman have turned the idea that philanthropy is taking on tasks that are properly the role of government — and allowing the rich to expand their influence and avoid taxation in the process — into a mainstream critique, one that major philanthropists have been forced to answer….” And on the plan: “…The new paper considers even bolder options: A “radical” wealth tax of 10 percent of wealth over $1 billion that’s meant to gradually draw down the wealth of billionaires, and a “confiscatory” tax of 90 percent on wealth over $1 billion meant to raise huge sums of revenue all at once and then (by setting a de facto maximum wealth level) never again. Most strikingly, from a philanthropic perspective, Saez and Zucman propose making foundations and donor-advised funds subject to the wealth tax if they are still controlled by their wealthy benefactor. The Bill and Melinda Gates Foundation would be treated the same as Bill and Melinda Gates, individually. To avoid the tax, the foundation would have to either (a) put people other than the Gates in effective control or (b) spend its philanthropic funds quickly….” Meanwhile, the FT reported that this other global health billionaire, Michael Bloomberg takes steps towards a democratic run.  “…He has not decided whether to run for president but is back to actively considering it and is taking this step to keep his options open….” Tweet from A Giradharadas: “…The great plute freak-out continues. @MikeBloomberg  cannot tolerate a Democratic candidate who would end the Second Gilded Age. So who better to protect the plutes than himself?” Warren already welcomed Bloomberg to the race and pointed him, Gates & others to her  calculator for the billionaires 😊 PS: in this week Lancet issue, Laurie Garrett wrote a perspective of Michael Bloomberg - Michael Bloomberg: the optimistic engineer. Like Gates, Bloomberg is a remarkable person with a great track record on public health, planetary health, etc (even if I don’t share his fondness of capitalist recipes, certainly not to deal with climate breakdown). As for the US election, he should just get out of the way, though. This is no time for billionaires running for president.   But Bloomberg probably senses weakness from that other ‘centrist’ Democrat candidat, Joe Biden. He’s probably right – in that respect at least.

Planetary health

Guardian - Climate crisis: 11,000 scientists warn of ‘untold suffering

https://www.theguardian.com/environment/2019/nov/05/climate-crisis-11000-scientists-warn-of-untold-suffering?CMP=share_btn_tw “The world’s people face “untold suffering due to the climate crisis” unless there are major transformations to global society, according to a stark warning from more than 11,000 scientists. “We declare clearly and unequivocally that planet Earth is facing a climate emergency,” it states. “To secure a sustainable future, we must change how we live. [This] entails major transformations in the ways our global society functions and interacts with natural ecosystems.” There is no time to lose, the scientists say: “The climate crisis has arrived and is accelerating faster than most scientists expected. It is more severe than anticipated, threatening natural ecosystems and the fate of humanity.” The statement is published in the journal BioScience on the 40th anniversary of the first world climate conference, which was held in Geneva in 1979. The statement was a collaboration of dozens of scientists and endorsed by further 11,000 from 153 nations. The scientists say the urgent changes needed include ending population growth, leaving fossil fuels in the ground, halting forest destruction and slashing meat eating….”

Guardian - Most countries' climate plans 'totally inadequate' – experts

https://www.theguardian.com/environment/2019/nov/05/most-countries-climate-plans-totally-inadequate-experts?CMP=share_btn_tw “Only the 28 countries of the European Union and a few others including Norway, Switzerland and Ukraine are on track. Of the 184 national Paris pledges made, 136 are judged insufficient in the report, published by the Universal Ecological Fund.” This news was linked to Trump’s move to formally exit the Paris climate agreement. For more on this, see below.

Guardian - Trump begins year-long process to formally exit Paris climate agreement

https://www.theguardian.com/us-news/2019/nov/04/donald-trump-climate-crisis-exit-paris-agreement “Donald Trump is moving to formally exit the Paris climate agreement, making the United States the only country in the world that will not participate in the pact, as global temperatures are set to rise 3C and worsening extreme weather will drive millions into poverty.” See also  Climate change news  - US will keep seat at climate talks after it leaves Paris deal Anyhow, I put my hopes on a resounding Democrat victory in 2020.

Vox - The Paris climate agreement is at risk of falling apart in the 2020s

https://www.vox.com/energy-and-environment/2019/11/5/20947289/paris-climate-agreement-2020s-breakdown-trump However, even that might not be enough to ‘save’ the Paris climate agreement in the ‘20s. Based on a new paper - The Paris Agreement in the 2020s: Breakdown or Breakup?  (by N Sachs). Great read on the problems looming for this 21^st century  wicked ‘collective action’ problem from hell. “….on 4^th Nov, the US filed paperwork that will begin the process of leaving the Paris climate agreement. Withdrawal will take final effect on November 4, 2020, one day after the next US presidential election.”  “If Trump is reelected, the treaty is likely doomed. The rest of the world simply won’t continue ratcheting up its ambitions and taking on costs while the US pursues a course of climate unilateralism. But even if he isn’t, the absence of US climate leadership, which is now effectively a permanent condition, will deprive the agreements of one of its central engines.”  Indeed, even if a Democrat is voted in and rejoins Paris, the rest of the world can’t be sure that in 2024, things might change again…

Health policy watch - Delhi Air Pollution Emergency Triggers Protests, Political Squabbles – But No Real Action

https://www.healthpolicy-watch.org/delhi-air-pollution-emergency-triggers-protests-political-squabbles-but-no-real-action/ It’s Blade Runner time again in Delhi.  And as usual, fingers are pointing in all political directions. “… India’s Prime Minister (PM) Narendra Modi maintained his silence over the crisis, while on a trip abroad…The Prime Minister’s Office had announced it would be hosting an emergency meeting on the issue soon. Still, citizens were critical of prime minister Modi’s decision to remain away from Delhi during the “public health emergency.” See also HPW - Delhi Declares “Public Health Emergency” As City Residents Choke On Air Pollution

Reuters - Aviation industry to counter flight shaming movement: IATA chief

https://mobile.reuters.com/article/amp/idUSKBN1XF1HE?feedType=RSS&feedName=environmentNews&__twitter_impression=true “The aviation industry is to launch a campaign it hopes will counter a 'flight shaming' movement that has weakened demand for air travel in Europe where some travelers are increasingly concerned about their environmental impact.”  “The industry's image has been damaged this year by a growing Swedish-born movement led by activists such as teenager Greta Thunberg calling for greater action against climate change, including ditching air travel.”

Health Policy Watch - Spain To Host Climate Conference On Behalf Of Chile From December 2-13 In Madrid

https://www.healthpolicy-watch.org/spain-offers-to-host-climate-conference-on-behalf-of-chile/ “Spain offered to host the upcoming UN Climate Conference (COP 25) on behalf of Chile on Thursday, which said on Wednesday that it could not stage this year’s meeting in Santiago due to security concerns related to the civil unrest that has been raging for the past two weeks in the capital city.”

Lancet Global Health – Affordability of the EAT–Lancet reference diet: a global analysis

K Hirvonen et al; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30447-4/fulltext “The EAT–Lancet Commission drew on all available nutritional and environmental evidence to construct the first global benchmark diet capable of sustaining health and protecting the planet, but it did not assess dietary affordability. We used food price and household income data to estimate affordability of EAT–Lancet benchmark diets, as a first step to guiding interventions to improve diets around the world.” “…The diet costs a small fraction of average incomes in high-income countries but is not affordable for the world's poor. We estimated that the cost of an EAT–Lancet diet exceeded household per capita income for at least 1·58 billion people. … … Current diets differ greatly from EAT–Lancet targets. Improving diets is affordable in many countries but for many people would require some combination of higher income, nutritional assistance, and lower prices.”

Ebola DRC – Transmission rate slows

Cidrap News - DRC Ebola cases hit 3,285 as transmission rate slows

http://www.cidrap.umn.edu/news-perspective/2019/11/drc-ebola-cases-hit-3285-transmission-rate-slows Recent update. “From Oct 28 to Nov 3, only 10 new Ebola cases from five health zones were confirmed in the Democratic Republic of the Congo (DRC), but the World Health Organization (WHO) warns that security issues and poor access continue to hinder the response in rural hot spots. In research findings, a study today highlighted serious long-term symptoms among Ebola survivors….” “… a new study in Clinical Infectious Diseases, reports that 75.5% of Ebola survivors experience at least one new cardinal symptom up to 4 years after infection. Of those who experienced new symptoms, 85.8% said the complications interfered with daily life. The study was based on surveys of 326 Ebola survivors from Liberia. Survivors reported high rates of joint pain, headache, vision problems, and fatigue….”

BBC- Ebola: Attackers kill DR Congo journalist shining light on virus

https://www.bbc.com/news/world-africa-50283286 “A Congolese journalist who had been raising awareness about the Ebola virus in the Democratic Republic of Congo has been killed at his home.”

UN News - Ebola emergency chief decries new attacks on frontline staff, after DR Congo worker death

https://news.un.org/en/story/2019/11/1050551 “Security measures for staff helping to fight health emergencies need to be stepped up urgently, a UN health agency top official said on Monday, after a frontline Ebola epidemic community worker was reportedly stabbed to death at his home in northeast Democratic Republic of the Congo (DRC). Speaking at a public event in Geneva, Dr Mike Ryan from the World Health Organization (WHO), said that in his 25-year humanitarian career, violence carried out deliberately against health workers and hospitals had never been so bad. The “overwhelming impact” had been on local health workers, not international staff, Dr Ryan told a Geneva Peace Week event, in his capacity as Director of WHO’s Health Emergencies Programme….” “Despite the risks of working in insecure locations, “one doesn’t really have a choice but to go, as the epidemic will continue to spread and intensify like a fire if it’s not put out”, he said. “It does put our workers at the extreme edge of risk.” “Echoing Dr Ryan’s message of sympathy, WHO Regional Director for Africa, Dr Matshidiso Moeti tweeted her condolences to the family and friends of the worker killed in DRC.”

AFP-300 attacks on Ebola health workers in DR Congo this year: report

AFP "Health workers battling an Ebola outbreak in the DR Congo have been attacked 300 times, leaving six dead and 70 wounded since the start of the year in three provinces, authorities said on Monday. The latest attack occurred in the early hours of Sunday after a Congolese radio host, who helped spread information in the fight against Ebola, was stabbed to death at his home in the Ituri region …. ... A report from the Congolese health ministry said since January 1, 2019 there had been 'more than 300 attacks on health workers' which had killed six people and injured 70 others, among them health care workers and patients.”

FP - On the Front Lines of the Trump Administration’s Ebola Response - The United States has mounted a wide-ranging response to the latest deadly outbreak, as only it can.

A Azar, R Redfield & A Fauci; https://foreignpolicy.com/2019/11/04/trump-administration-ebola-response-azar-redfield-fauci-congo/ The view of some senior Trump administration public health officials on the US engagement in the DRC Ebola outbreak so far. “To support Congo, WHO, neighboring nations, and the U.S. Centers for Disease Control and Prevention (CDC) have been providing technical assistance to respond to the outbreak for more than a year…A total of 317 CDC staff have completed 492 deployments, and the United States is the single largest national donor of financial assistance to combat the crisis, with nearly $158 million in contributions via USAID.”

Reuters – Johnson & Johnson files for European approval of Ebola vaccine

https://www.reuters.com/article/us-johnson-johnson-ebola/johnson-johnson-files-for-european-approval-of-ebola-vaccine-idUSKBN1XH1J2 “Johnson & Johnson (JNJ.N) said on Thursday it had filed for an approval from European regulators for its two-dose experimental vaccine to protect against Ebola, less than a month after the agency recommended approval of Merck & Co Inc’s (MRK.N) vaccine….”

NPR Goats & Soda - This Congolese Doctor Discovered Ebola But Never Got Credit For It — Until Now

https://www.npr.org/sections/goatsandsoda/2019/11/04/774863495/this-congolese-doctor-discovered-ebola-but-never-got-credit-for-it-until-now Dr. Jean-Jacques Muyembe, that is. His story is well known at ITM, perhaps less well known so far elsewhere. Excerpt: “…Today, Peter Piot is the director of the prestigious London School of Hygiene and Tropical Medicine. He's friends with Muyembe and expresses nothing but admiration for not only his scientific prowess, but the way he has managed public health emergencies. But in his book, he mentions Muyembe only in passing, as a bright scientist constantly pressuring Piot for more resources. When asked if he feels responsible for writing Muyembe out of history, Piot pauses. "I think that's a fair comment," he says. "But my book was not an attempt to write the history of Ebola, but more my personal experience." Piot says at the time of that first Ebola outbreak, African scientists were simply excluded. White scientists — with a colonial mentality — parachuted in, took samples, wrote papers that were published in the West and took all of the credit. But things are changing, he says. Muyembe, for example, is finally starting to get his due. He was recently given a patent for pioneering the first treatment for Ebola and he has received several international awards, including the Royal Society Africa Prize and, just this year, the Hideyo Noguchi Africa Prize. "That reflects, I think, the [change in] power relations in global health and science in general," he said….”

Democratic Republic of Congo launches major push against measles, cholera, and rotavirus

https://www.gavi.org/library/news/press-releases/2019/democratic-republic-of-congo-launches-major-push-against-measles-cholera-and-rotavirus/ “The Democratic Republic of Congo (DRC), with support from Gavi and partners, will protect millions against deadly diseases thanks to three immunisation drives launched last week: a largescale measles follow-up campaign, an emergency campaign to provide a 2nd dose of oral cholera vaccine (OCV) to affected populations in North Kivu, and introduction of rotavirus vaccine into the national routine immunisation programme….”

Women & Girls’ rights & upcoming Nairobi summit

Guardian - British government takes global lead on violence against women and girls

https://www.theguardian.com/global-development/2019/nov/02/british-government-takes-global-lead-on-violence-against-women-and-girls?CMP=twt_a-global-development_b-gdndevelopment “Britain has become the biggest government funder of programmes to prevent violence against women and girls globally after launching a seven-year project targeting countries with some of the highest levels of abuse.” “The £67.5m programme will scale up projects that have already shown success in reducing violence across Africa and Asia, and will pilot and research new ideas to tackle the global crisis….”

Lancet Editorial – ICPD at 25 years: time to expand the agenda

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32717-5/fulltext 25 years after the Cairo International Conference on Population and Development (ICPD), “the community will reconvene in Nairobi, Kenya, on Nov 12–14, to review progress and accelerate the implementation of the ICPD Programme of Action.” “… the Nairobi Summit represents an important rallying opportunity, particularly in light of the upcoming 2020 US presidential election. The summit also presents a chance for individual governments and other organisations to make a range of economic, political, and practical commitments for implementing the ICPD Programme of Action, for which elaboration of accountability structures will be vital…” “…But to counter growing opposition, what is also needed from Nairobi is a bold and comprehensive vision for meeting the sexual and reproductive health needs of all people across the lifecourse, positioned as a vital component of universal health coverage. In 2018, the Guttmacher–Lancet Commission on sexual and reproductive health and rights articulated such a vision. Crucially, the Commission argued that sexual rights, access to safe abortion, comprehensive sexuality education, and support for adolescents to make informed, independent choices about their reproductive and sexual lives—all issues that have long proved controversial—are fundamental to the right to health and to sustainable development. As this issue of The Lancet goes to press, however, there seems little indication that the summit will produce a high-level declaration, probably a reflection of the troubling political climate. Nonetheless, when participants meet in Nairobi later this month they will be faced with an important choice: seek to limit controversy and confine ambitions to the agenda set out in Cairo 25 years ago, or press forward with a renewed and expanded plan fit for purpose for the next quarter of a century?”

Guardian Op-Ed- No woman should be slapped for screaming as she gives birth

Ann Yates ; https://www.theguardian.com/global-development/2019/nov/06/respectful-maternity-care-ann-yates?CMP=twt_a-global-development_b-gdndevelopment “Respect in childbirth is a human right. As a midwife of many years’ experience, I am calling for a global effort towards more compassion in maternity care.” “The International Confederation of Midwives (ICM) is taking a stand against disrespect in childbirth and will be reconfirming its commitment to quality care by midwives for women at a summit in Nairobi next week, which marks the 25th anniversary of the international conference on population and development. The programme of action agreed at the conference pledged appropriate healthcare services for women through pregnancy and childbirth.” “We are calling on national health ministers to create policies that prioritise respectful maternity care and highlight that the responsibility of care lies with the healthcare provider and individual professionals.” … Global professional organisations, NGOs and international organisations are vital in recognising and upholding respectful maternity care as a human right. ICM calls on the World Health Organization, UN Women and other global stakeholders to set up a respectful maternity care council and framework whereby countries are investigated and rated according to their treatment of expectant mothers during childbirth.”

AP - UN official says fight for women’s equality is far from over

https://apnews.com/aa55e5bf6df649b5abc873aedf11a280 “The top U.N. gender equality official said Tuesday that more must be done to combat discrimination and violence against women and girls that she says persists in every part of the world. At the same time, U.N. Women’s Executive Director Phumzile Mlambo-Ngcuka expressed cautious optimism ahead of next year’s 25th anniversary of the conference that adopted the only international platform to achieve women’s rights and empowerment. The 150-page platform was adopted by 189 governments at the 1995 Beijing women’s conference….”

Thomson Reuters (Op-Ed) - Universal health coverage will remain elusive for women and adolescents unless it includes sexual and reproductive health and rights

Helen Clark, Michelle Bachelet & Graça Machel; http://news.trust.org/item/20191106170941-6sgrk It’s not only good public health; it makes economic sense as well, they say. “This week, Nairobi plays host to global leaders, policymakers and influencers to mark the 25th anniversary of the ground breaking International Conference on Population and Development (ICPD) in 1994 which established an ambitious programme of action to achieve comprehensive sexual and reproductive health and reproductive rights for all. The Nairobi Summit takes place at a time of critical importance for sexual and reproductive health and rights. Ideologically driven forces are seeking to roll back hard-won gains, to slash funding for essential services, and to remove references to these services and rights from international agreements….” « … It is fitting that ICPD+25 is being held in the region of the world most vulnerable to the negative effects of cuts to sexual and reproductive health and rights. …” “… Providing a comprehensive package of sexual and reproductive health interventions is affordable and attainable. In low- and middle-income countries, the Guttmacher-Lancet Commission (2018) estimated that the cost of meeting all women’s needs for contraceptive, maternal and newborn care (not including HIV treatment and care) amounted to US$13.0 per capita annually. This is surely something that the world can – and must – afford….”

Global Health Security

BMJ Global Health - Joint external evaluation of the International Health Regulation (2005) capacities: current status and lessons learnt in the WHO African region

https://gh.bmj.com/content/4/6/e001312 “The International Health Regulations (IHR, 2005) are an essential vehicle for addressing global health security. Here, we report the IHR capacities in the WHO African from independent joint external evaluation (JEE). The JEE is a voluntary component of the IHR monitoring and evaluation framework. It evaluates IHR capacities in 19 technical areas in four broad themes: ‘Prevent’ (7 technical areas, 15 indicators); ‘Detect’ (4 technical areas, 13 indicators); ‘Respond’ (5 technical areas, 14 indicators), points of entry (PoE) and other IHR hazards (chemical and radiation) (3 technical areas, 6 indicators). The IHR capacity scores are graded from level 1 (no capacity) to level 5 (sustainable capacity). From February 2016 to March 2019, 40 of 47 WHO African region countries (81% coverage) evaluated their IHR capacities using the JEE tool. No country had the required IHR capacities. Under the theme ‘Prevent’, no country scored level 5 for 12 of 15 indicators. Over 80% of them scored level 1 or 2 for most indicators. For ‘Detect’, none scored level 5 for 12 of 13 indicators. However, many scored level 3 or 4 for several indicators. For ‘Respond’, none scored level 5 for 13 of 14 indicators, and less than 10% had a national multihazard public health emergency preparedness and response plan. For PoE and other IHR hazards, most countries scored level 1 or 2 and none scored level 5. Countries in the WHO African region are commended for embracing the JEE to assess their IHR capacities. However, major gaps have been identified. Urgent collective action is needed now to protect the WHO African region from health security threats.”

Global Health Governance – The Jigsaw Puzzle of Global Health Security

R Fadaak; http://blogs.shu.edu/ghg/2019/11/02/the-jigsaw-puzzle-of-global-health-security/ One of the reads of the week. “This paper traces the uneven and recent history of ‘global health security’ (GHS) as a conceptual space that emerged in the 1990s, and questions how it is undergoing transformation today. It argues that GHS has shifted – from at one time exclusively referring to revisions occurring to international public health norms (the International Health Regulations), to now marking a complex arena where multiple actors debate and re-consider what counts as both ‘preparedness’ and measurable health systems strengthening ‘action’. This shift is explored here in three ways: (1) by focusing on early landmarks of conceptual change occurring in the idea of ‘global health security’ across the 2000s; (2) by evincing these changes through a case-study on the Global Health Security Agenda (GHSA); and (3) by highlighting some of the effects that this change introduces in thinking about—and acting on behalf of—GHS. These changes that have taken place over the last decade have far-reaching effects on both global health policy and project development.” Part of the new GHG 2019 Fall and Spring issue.

Nature (Review article) – A new twenty-first century science for effective epidemic response

J Bedford, J Farrar, J Nkengasong et al; https://www.nature.com/articles/s41586-019-1717-y “With rapidly changing ecology, urbanization, climate change, increased travel and fragile public health systems, epidemics will become more frequent, more complex and harder to prevent and contain. Here we argue that our concept of epidemics must evolve from crisis response during discrete outbreaks to an integrated cycle of preparation, response and recovery. This is an opportunity to combine knowledge and skills from all over the world—especially at-risk and affected communities. Many disciplines need to be integrated, including not only epidemiology but also social sciences, research and development, diplomacy, logistics and crisis management. This requires a new approach to training tomorrow’s leaders in epidemic prevention and response.”

Global Policy - Climate Change, Pandemics, Biodiversity Loss: No Country is Sufficiently Prepared

G Recchia et al (on behalf of the Centre for the Study of Existential Risk, University of Cambridge);  https://www.globalpolicyjournal.com/blog/04/11/2019/climate-change-pandemics-biodiversity-loss-no-country-sufficiently-prepared “… more often than not, and on more issues than not, governments fail to imagine how worst-case scenarios can come about – much less plan for them. … … A recent report published by Cambridge University’s Centre for the Study of Existential Risk argues that this needs to change. If even only one catastrophic risk manifests – whether through nature, accident or intention – it would harm human security, prosperity and potential on a scale never before seen in human history. There are concrete steps governments can take to address this, but they are currently being neglected.  The risks that we face today are many and varied. They include: Tipping points in the environmental system due to climate change or mass biodiversity loss. Malicious, or accidentally harmful, use of artificial intelligence. Malicious use of, or unintended consequences from, advanced biotechnologies. A natural or engineered global pandemic. Intentional, miscalculated, or accidental use of nuclear weapons. …” For some of the recommendations, see also the report .

Vaccines

Stat - A Takeda vaccine for dengue appears effective, but the story is nuanced

https://www.statnews.com/pharmalot/2019/11/06/takeda-dengue-vaccine-sanofi/ “In the wake of controversy over a Sanofi (SNY) dengue vaccine, Takeda (TAK) Pharmaceuticals is betting its own effort will meet a largely unmet medical need and, in the process, become a best-selling product. But preliminary results released on Wednesday suggest the company has more work to do to ensure its vaccine does not encounter the same problems that have hobbled its rival. A key hurdle Takeda must clear is to demonstrate that its own vaccine is not hindered by an issue that has clouded Sanofi’s Dengvaxia vaccine, which can actually make future cases of the mosquito-borne virus more severe in people who were not previously infected. After this finding was disclosed two years ago, a widespread vaccination campaign run by the Philippine government was abruptly halted amid scandal. Sanofi has struggled ever since to make a success of the product. For the moment, Takeda reported preliminary results that are decidedly mixed. When taking into account all four serotypes, or strains, of the dengue virus, the Takeda vaccine demonstrated an overall 80.2% effectiveness rate. The late-stage study, published in the New England Journal of Medicine, tested two doses in more than 19,000 children and adolescents in eight countries….” See also Science News - New dengue vaccine performs well in large trial, but safety remains key concern. And NPR Goats & Soda - There's A Promising New Vaccine For One Of The World's Top Health Threats

Lancet Infectious Diseases - The public health crisis of underimmunisation: a global plan of action

L Gostin et al; https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(19)30558-4/fulltext “Vaccination is one of public health's greatest achievements, responsible for saving billions of lives. Yet, 20% of children worldwide are not fully protected, leading to 1·5 million child deaths annually from vaccine-preventable diseases. Millions more people have severe disabling illnesses, cancers, and disabilities stemming from underimmunisation. Reasons for falling vaccination rates globally include low public trust in vaccines, constraints on affordability or access, and insufficient governmental vaccine investments. Consequently, an emerging crisis in vaccine hesitancy ranges from hyperlocal to national and worldwide. Outbreaks often originate in small, insular communities with low immunisation rates. Local outbreaks can spread rapidly, however, transcending borders. Following an assessment of underlying determinants of low vaccination rates, we offer an action based on scientific evidence, ethics, and human rights that spans multiple governments, organisations, disciplines, and sectors.”

JAMA - The Search for a Universal Flu Vaccine Heats Up

J Abasi; https://jamanetwork.com/journals/jama/fullarticle/2755344 “This Medical News article discusses the urgent need for a more broadly protective, durable influenza vaccine—and advancements toward it.” “… Collaboration has long been a missing piece of the universal flu vaccine puzzle. But spurred by scientific advances and factors like the 2009 pandemic, the WHO and other groups are coming together to accelerate progress. Chief among the new initiatives is the Global Funders Consortium for Universal Influenza Vaccine Development, an information-sharing collaboration between 20 major international groups including the WHO, the Sabin Vaccine Institute, the Bill and Melinda Gates Foundation, the United Kingdom–based Wellcome Trust, and several US Department of Health and Human Services entities….”

WHO Afro – Nine African countries agree to begin journey towards pooled procurement to increase their access to affordable life-saving vaccines

https://www.afro.who.int/news/nine-african-countries-agree-begin-journey-towards-pooled-procurement-increase-their-access “Nine middle-income countries in Africa have agreed to work towards pooled procurement mechanisms by first sharing vital information on their vaccine purchasing practices, including the prices they pay and their suppliers. Sharing information and ultimately pooling their orders will better leverage their individual purchasing power and thus strengthen their vaccine security and increase their access to affordable life-saving vaccines.  Their commitment on 1 November to improve in-country and cross-border processes was made following a three-day workshop organized by the World Health Organization (WHO) Regional Office for Africa in Mbabane, Kingdom of Eswatini to address access to safe and affordable vaccines in middle-income countries, where immunization coverage is decreasing….” “The workshop brought together the countries that, due to their middle-income status, are not eligible for immunization financing support from Gavi, the Vaccine Alliance (Algeria, Botswana, Cabo Verde, Kingdom of Eswatini, Gabon, Mauritius, Namibia, São Tomé and Príncipe and Seychelles)….”

Polio

Guardian - Pakistan accused of cover-up over fresh polio outbreak

https://www.theguardian.com/global-development/2019/nov/07/pakistan-accused-of-cover-up-over-fresh-polio-outbreak?CMP=twt_a-global-development_b-gdndevelopment “Officials in Pakistan have been accused of covering up an outbreak of the most dangerous strain of polio and planning a covert vaccination programme to contain the disease. According to a source in Pakistan’s polio eradication programme and documentation seen by the Guardian, a dozen children have been infected with the P2 strain of polio, which causes paralysis and primarily effects those under five. The P2 strain had previously been eliminated from the country. However, the new cases were allegedly kept hidden from the government and from international donors, including the UK’s Department for International Development, under direct instruction from Babar Bin Atta, the prime minister’s focal representative on polio eradication, who was last month forced to resign after he was accused of corruption. DfID has donated millions to Pakistan’s polio eradication programme….”

Mental health

Increase in child and adolescent mental disorders spurs new push for action by UNICEF and WHO

https://www.unicef.org/press-releases/increase-child-and-adolescent-mental-disorders-spurs-new-push-action-unicef-and-who “ With the alarmingly high rates of self-harm, suicide and anxiety among children and young people around the world, UNICEF and the World Health Organization are teaming up with some of the world’s leading minds to tackle this growing threat.  “Too many children and young people, rich and poor alike, in all four corners of the world, are experiencing mental health conditions,” said Henrietta Fore, UNICEF Executive Director. “This looming crisis has no borders or boundaries. With half of mental disorders starting before age 14, we need urgent and innovative strategies to prevent, detect and, if needed, treat them at an early age.”  In a joint push to put child and adolescent mental disorders higher up on the global health agenda, UNICEF and WHO [will] co-host their first ever conference on the topic in Florence, Italy, 7-9 November. The conference is part of Leading Minds, UNICEF’s new annual global conference series to highlight major issues affecting children and young people in the 21st century….”

Lancet – Offline: A perilous birthday party for mental health

Richard Horton; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32716-3/fulltext Absolute must-read on the state of affairs for the global mental health community. Horton wrote this reflection “after attending a celebration of a decade in the life of the university's Centre for Global Mental Health” (King’s College London).  “Festivities quickly turned into an analysis of the state of global mental health. The conclusions were disturbing.” After giving a nice overview of the rise of global mental health on the policy agenda over the last decade, Horton then lists five factors why the position of global mental health is still precarious.

Nutrition - SUN gathering in Kathmandu (4-7 November)

https://scalingupnutrition.org/sungg2019/ “The SUN (Scaling up Nutrition) Global Gathering brings together all SUN Government Focal Points and representatives of their partners from civil society, donor, United Nations agencies, private sector partners, academia, media, parliamentarians and others. It is the flagship event of the SUN Movement and an important moment where members take stock of progress and challenges, share their innovations and learn what is helping to reduce malnutrition across all SUN Countries….” This was the fifth SUN global gathering. “…Over 1,000 delegates from 61 countries are attending the conference to discuss the progress, challenges and priorities ahead to ending malnutrition by 2030, a target set by the United Nations’ World Health Assembly….”

Devex – 'Must do more, better and faster,' SUN progress report on malnutrition says

https://www.devex.com/news/must-do-more-better-and-faster-sun-progress-report-on-malnutrition-says-95984 “Only 11 of 61 Scaling Up Nutrition Movement countries are on track to meet World Health Assembly stunting-reduction targets by 2025, according to a new report released as members meet to take stock and formulate the movement’s next phase. “This fact calls all of us to increase our support to country-level action: we must do more, better and faster,” SUN Movement lead group chair Henrietta Fore wrote in the progress report, which was released at the SUN Global Gathering 2019 on Wednesday in Kathmandu….” “The 11 countries that have already successfully reduced the number of stunted children under age 5 by 40% — a key WHA target — are Bangladesh, Burkina Faso, Côte d’Ivoire, El Salvador, Eswatini, Ghana, Kenya, Kyrgyzstan, Liberia, Peru, and Tajikistan. Since SUN was launched in 2010, the number of children under 5 affected by stunting has decreased from 171 million to 149 million globally. But in the 61 SUN countries, approximately 95 million children in this age group are stunted and nearly 24 million suffered from wasting in 2018….

Humanitarian aid & counter-terrorism

New Humanitarian - Aid workers question USAID counter-terror clause in Nigeria

https://www.thenewhumanitarian.org/news-feature/2019/11/05/USAID-counter-terror-Nigeria-Boko-Haram?utm_source=twitter&utm_medium=social&utm_campaign=social Key messages: “USAID adds ambiguous counter-terror clause to all grants; UNICEF rejects US funding as undermining humanitarian principles; Nigerian military cuts off aid to 800,000 people in extremist-controlled areas; Humanitarians call for dialogue with donors on counter-terror regulations.” “USAID, the biggest funder by far in Nigeria, introduced a clause late last year into all its grant contracts with tough new conditions aimed at preventing Boko Haram and the breakaway Islamic State of West Africa Province, or ISWAP, from benefiting from US assistance….”

UHC

CGD (blog) - The Dynamics of Health Technology Assessment: Is it Just About the Evidence?

D Ollendorf et al; https://www.cgdev.org/blog/dynamics-health-technology-assessment-it-just-about-evidence “… As more countries move to introduce HTA as a key component of their UHC strategy, and countries with existing HTA bodies revisit their processes, it is critically important to better understand how the structure of the HTA body—the membership, and the processes of appraisal and deliberation–can impact the quality and consistency of HTA recommendations. Below we outline a set of features that may modify the way evidence feeds through the HTA process to inform health coverage decisions, highlighting where more research is needed…”

New resources WHO & partners  on PFM and Fiscal Space for Health

https://www.who.int/health-topics/health-budget#tab=tab_1 Will be presented and discussed at the upcoming Montreux Symposium. (12-14 Nov) “…As part of the Montreux Collaborative Agenda on Fiscal Space, PFM and Health Financing, WHO is supporting countries and partners in fostering dialogue between health and finance authorities, with the aim to strengthen domestic PFM systems and make budget practices more effective toward UHC.” Check out for example Leveraging public financial management for better health in Africa

Access to Medicines

Devex - Q&A: James Love on the biggest challenges in the fight for affordable drugs

https://www.devex.com/news/q-a-james-love-on-the-biggest-challenges-in-the-fight-for-affordable-drugs-95972 Recommended (big picture) read.

UNAIDS -Winnie Byanyima joins UNAIDS as Executive Director

https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2019/november/20191101_winnie-byanyima Official start of Winnie at the helm of UNAIDS. Great news, not just for UNAIDS but also for the global health community in general. “Ms Byanyima brings a wealth of experience and commitment in harnessing the power of governments, multilateral agencies, the private sector and civil society to advance a people-centred development agenda. Ms Byanyima most recently held the post of Executive Director of Oxfam International. She also served for seven years as the Director of Gender and Development at the United Nations Development Programme.”

PHM - Welcoming New PHM Global Coordinator

https://phmovement.org/announcement-welcoming-new-phm-global-coordinator/ “PHM Global Secretariat moves to India: Dr. T. Sundararaman appointed Global Coordinator.” “From November 2019 the PHM Global Secretariat is being hosted in India.  Dr. T. Sundararaman (known to many of us as Sundar) has been appointed Global Coordinator. This transfer is in line with the movement’s practice of rotating the secretariat across member countries. While it has been established in Savar, Bangladesh, it has been transferred to Bangalore, India, before transferring to Cairo, Egypt, and Cape Town in South Africa. Sundar will be the fifth global coordinator after Dr. Qasem Chowdhury, Dr. Ravi Narayan, Dr. Hani Serag and Bridget Lloyd. For the last 10 years, from June 2009 – October 2019, PHM’s Global Secretariat has been hosted by the People’s Health Movement South Africa, and led by Bridget Lloyd. …”

Global Fund

GFO – new issue

http://www.aidspan.org/node/5097?pk_campaign=email-attrib-Word-PDF-download&pk_kwd=gfo-issue-367 We draw in particular your attention to the following articles:

• The Global Fund Board should emphasize transition planning and outcomes

“The Global Fund Board will discuss the Sustainability, Transition and Co-Financing policy next week at its 42nd Board meeting. Planning transition from Global Fund support, as well as transition implementation, and outcomes, deserves the attention of the Board. The fact that countries that had transitioned away from Global Fund grants witness a spike in HIV infections and that some of those countries apply anew for support is a worrisome trend.”

• Are Country Coordinating Mechanisms a modus operandum, a governance ideal or a tool for countries to progress towards universal health coverage? (Analysis & Commentary)

PS: You might also want to read 2 new letters in the Lancet, related to a more methodological issue (on measuring ‘impact’) The Global Fund impact – Authors' reply

HIV

UNAIDS – Worldwide, more than half of new HIV infections now among key populations and their sexual partners

UNAIDS; “In 2018, the global distribution of new HIV infections in 2018 crossed a threshold: the majority of global new infections were among key populations and their sexual partners…”

Update SDG indicators

IISD – New Indicators on AMR, Dispute Resolution, GHG Emissions Agreed for SDG Framework

IISD “The UN’s group of experts on the SDGs indicators has agreed on 32 changes to the global indicator set.  The changes include eight new indicators being added to the framework, and replacements for indicators under Goal 13 (climate action). The changes will proposed to the UN Statistical Commission for consideration when it meets in March 2020.” “The UN Inter-Agency and Expert Group on the SDG Indicators (IAEG-SDGs) held its tenth meeting from 21-24 October 2019, in Addis Ababa, Ethiopia. The members considered a range of suggested changes gathered through a consultation process that began in May 2019. It has accepted proposals to add the following new indicators to the framework:…” Among others, on AMR: “Reduce the percentage of bloodstream infections due to selected antimicrobial resistant organisms, for SDG target 3.d (Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks)” PS: also important:  Another new indicator: “Redistributive impact of fiscal policy (with Gini coefficient reported)for SDG target 10.4 (Adopt policies, especially fiscal, wage and social protection policies, and progressively achieve greater equality)”

Human resources for Health

Guardian - As German health minister, I’m championing both migration and patriotism

Jens Spahn; https://www.theguardian.com/commentisfree/2019/nov/07/german-health-minister-migration-patriotism By the German health minister: “In Germany we’re welcoming international migrants into our health professions by focusing on shared values, not differences.” “… To find a common identity bridging cosmopolitan and regional identities, I propose a weltoffener patriotismus. Weltoffen is tricky to translate into English. It roughly means being open-minded towards the world, open to new ideas and cultures. Weltoffener patriotismus does not make divisions based on ethnicity, but defines clear premises based on which everybody can join. If a nation is the home we build together, weltoffener patriotismus offers the foundation that everybody agreeing on a set of rules can stand on.  … How does that translate into policy? As minister of health I am the only minister in my party, the CDU, dealing with welfare state issues. And health and nursing are key symbols of national unity because how we treat the sick and the elderly typifies how we define national solidarity. … Germany is ageing rapidly. We need skilled migration to fill the gaps in our health and nursing sector and seek professionals from abroad. We are signing international agreements with Mexico, the Philippines and Kosovo. These countries boast many well-educated youngsters struggling to find a job who we want to invite to work in Germany. We are setting up a German agency for international healthcare professionals (GAP) to facilitate their transition.”

Webinars

CSEM - Post-HLM Civil Society Webinar: Taking the UN HLM on UHC Forward

https://csemonline.net/project/post-hlm-civil-society-webinar-taking-the-un-hlm-on-uhc-forward/ In case you want to re-watch the webinar.

Upcoming webinar HS Governance Collaborative/London school (14 November) – Research priorities: what are we missing on anti-corruption?

WHO; “Corruption costs lives (e.g. one study estimates that 140 000 children’s deaths a year are caused by corruption) and resources (e.g. another study estimates the global average loss rate for health care fraud and abuse to be 6.19% of total health expenditure), it also weakens health systems (e.g. favor the introduction of substandard medical products) and exacerbates inequalities (e.g. one study shows that informal payments are regressive and concentrated among the poorest). Corruption impacts on the achievement of the SDGs, in particular SDG3 (good health and well-being), SDG5 (gender equality), SDG10 (reduced inequalities) and SDG16 (peace, justice and strong institutions). This webinar will present recent researches on anti-corruption undertaken by LSHTM and SOAS, before starting discussion on a new research agenda on anti-corruption….”  Among others with Dina Balabanova, M McKee, E Hutchinson, …

Lancet Global Health – December issue

https://www.thelancet.com/journals/langlo/issue/vol7no12/PIIS2214-109X(19)X0013-3 Do start with the Editorial - Stop industry interference, save lives “Japan, Jordan, Bangladesh, and Lebanon are lagging in implementing measures to protect their public health policy making efforts from tobacco industry interference, according to the first ever Global Tobacco Industry Interference Index. The report, published last month by global industry watchdog, Stopping Tobacco Organizations and Products (STOP), used publicly available information to rank 33 countries from all regions in their overall efforts to guard against industry meddling….” Interesting Comments (linked to new studies) for example also on Chronic kidney disease in sub-Saharan Africa;   Integrated vaccine economics for countries transitioning from Gavi support …

Some papers of the week

Lancet Editorial - Physician burnout: the need to rehumanise health systems

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32669-8/fulltext From last week’s Lancet issue. “In response to concerning rates of burnout among US clinicians and trainees, the National Academy of Medicine published a report, Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-being, on Oct 23. The report aims to find solutions to burnout by shifting focus away from the individual and by proposing systemic changes in health-care organisations, academic institutions, and at all levels of government.”

WHO Bulletin – November issue

https://www.who.int/bulletin/volumes/97/11/en/ Most articles already appeared online before. If you haven’t done so yet, make sure you check out this research article by B M O’Hare:

• International corporate tax avoidance and domestic government health expenditure

In the article she compares estimated losses from international corporate tax avoidance in individual countries and domestic government health expenditure, with reference to the annual threshold of 86 United States dollars (US$) per capita required to achieve universal health coverage. Findings: “Data were available for 100 countries: 24 low-, 28 lower-middle-, 21 upper-middle- and 27 high-income countries. Domestic government health expenditure was under US$ 86 per capita in all 24 low-income countries and in 24 of 28 lower-middle-income countries. International corporate tax lost per capita was higher than domestic government health expenditure in 19 low-income and 10 lower-middle-income countries. If the revenue lost to tax avoidance were recouped and allocated to the health sector, average annual government health expenditure could increase from US$ 8 to US$ 24 per capita in the low-income countries studied and from US$ 54 to US$ 91 per capita in the lower-middle-income countries.”

BMJ Global Health – Realist evaluations in low- and middle-income countries: reflections and recommendations from the experiences of a foreign researcher

B Gilmore; https://gh.bmj.com/content/4/5/e001638 “Realist evaluation, a methodology for exploring generative causation within complex health interventions to understand ‘how, why and for whom’ programmes work, is experiencing a surge of interest. Trends indicate that the proliferation in the use of this methodology also applies to research in low- and middle-income countries (LMICs). The value of using realist evaluation for project evaluation is also being noticed by non-governmental organisations (NGOs) and other programme implementers within such contexts. Yet, there is limited exploration of the use of realist evaluations in LMICs, especially their use by foreign researchers. This paper draws on the author’s experience of conducting two realist evaluations across three different sub-Saharan African settings: Mundemu, Tanzania; Kabale, Uganda and Marsabit, Kenya. The realist evaluations were used as an operations research methodology to study two NGO community health programmes. This paper highlights four main challenges experienced by the author throughout the methodological process: (1) power imbalances prevalent during realist interviews, (2) working through translation and what this means for identfying Context-Mechanism-Outcome Configurations, (3) limited contextual familiarity and being an ‘engaged researcher’ and (4) the use or dependence on ‘WEIRD’ theories (i.e. theories based on the study of Western, Educated, Industrialized, Rich, Democratic people) within testing and refinement….”

WHO Bulletin - Development assistance for community health workers in 114 low- and middle-income countries, 2007–2017

C Lu et al; https://www.who.int/bulletin/online_first/BLT.19.235499.pdf?ua=1 This article estimates the level and trend of development assistance for community health worker-related projects in low- and middle-income countries between 2007 and 2017. “Between 2007 and 2017, total development assistance targeting CHW projects was around United States dollars (US$) 5 298.02 million, accounting for 2.5% of the US$ 209 277.99 million total development assistance for health. The top three donors (Global Fund to Fight AIDS, Tuberculosis and Malaria, the government of Canada and the government of the United States of America) provided a total of US$ 4 350.08 million (82.1%) of development assistance for these projects. Sub-Saharan Africa received a total US$ 3 717.93 million, the largest per capita assistance over 11 years (US$ 0.39; total population: 9 426.25 million). Development assistance to projects that focused on infectious diseases and child and maternal health received most funds during the study period. “Conclusion: “The share of development assistance invested in the CHW projects was small, unstable and decreasing in recent years….”

IJHPM – Towards Critical Analysis of the Political Determinants of Health; Comment on “How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention”

J Smith; http://www.ijhpm.com/article_3684.html Nice short comment on the recent perspective article “How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention,” by Lencucha and Throw.

International Journal of Health services - New Ways or Old Tricks? The World Bank’s Gender Strategy and Its Implications for Health

Luke Power; https://journals.sagepub.com/doi/full/10.1177/0020731419885090#articleShareContainer “This paper provides a critical examination of the World Bank’s document, “World Bank Group Gender Strategy: Gender Equality, Poverty Reduction, and Inclusive Growth.” While the World Bank suggests that this paper is a distinction from past practices, others maintain that it is a continuation of previous neoliberal strategies. Thus, the aim of this analysis is to elucidate the implications of the proposed strategies on both gender equality and health equity. The analytical framework derives from both feminist political economy and the political economy of health literature. Within the document there is a direct emphasis on privatization and deregulation. Moreover, there is a clear re-articulation of both the state and female-citizenship: the former is presented as an “enabling agent,” and the latter depoliticized. Accordingly, it is argued that the promotion of macroeconomic strategies leads to the exaggeration of gender inequalities due to the perpetuation and crystallization of social inequalities. This consequently leads to the entrenchment of health inequities. These health inequities are compounded by the promotion of a “reduced state” that focuses on constructing a “workfare” state and a citizen who is resigned to community politics. Thus, instead of promoting gender equality, this report reflects a tendency toward its perpetuation.”

Some key blogs & mainstream articles of the week

Guardian - Doctors call for tighter control of traditional Chinese medicine

https://www.theguardian.com/education/2019/nov/06/doctors-europe-call-for-tighter-control-of-traditional-chinese-medicine “Europe’s leading doctors are to call for tighter regulation of traditional Chinese medicine, anxious that recent recognition by the World Health Organization will encourage the use of unproven therapies that can sometimes be harmful. The Federation of European Academies of Medicine (FEAM) and the European Academies’ Science Advisory Council [will] issue a joint statement on Thursday urging the WHO to clarify how traditional Chinese medicine and other complementary therapies should be used. Earlier this year, the WHO decided to add a chapter on traditional Chinese medicine to the International Classification of Diseases, which lists treatments available globally for medical conditions. The ICD is influential with governments, which look at its recommendations when deciding how to spend health budgets….”

CGD (blog) - The Sustainable Development Agenda: Race to the Top or Race to the Bottom?

M Cardenas; https://www.cgdev.org/blog/sustainable-development-agenda-race-top-or-race-bottom Spot on article. Remarks by M Cardenas, which were prepared for the Global Development Network (GDN) 2019 Conference, held in Bonn, Germany on October 23-24, 2019. “…the [SDG] race to the top can be severely undermined by another race that is also taking place: The race to the bottom when it comes to corporate income taxation….” “…This is a contradiction in terms: there cannot be progress in terms of the SDGs–where collective action is crucial, and provision of public goods indispensable–without a strong engagement on the part of the government. Without state capacity the ladder of development breaks down. I firmly believe that achieving the SDGs is very unlikely if governments do not have the fiscal capacity that is required. Moreover, without direct taxation–both of corporations and individuals—it is extremely difficult for countries to raise more revenues as a share of GDP while at the same time reducing income inequality. While countries remain engaged in a race to the bottom in terms of tax policies, the race to the top in terms of development is an aspiration with very limited possibilities of success.”

Open Democracy - From development to dignity: a profound challenge for international cooperation

J Glennie; https://www.opendemocracy.net/en/transformation/development-dignity-profound-challenge-international-cooperation/ « People don’t want pity, they want respect. Why not put that challenge at the heart of decision-making?” With some suggestions from Jonathan Glennie to help boost this paradigm shift in international cooperation.

Oxfam (blog) - Doing better on defending civic space

S Brechenmacher et al; https://oxfamblogs.org/fp2p/doing-better-on-defending-civic-space/ “In a new Carnegie Endowment paper, “Defending Civic Space: Is The International Community Stuck?”, Saskia Brechenmacher and Thomas Carothers take stock of and argue for bolstering transnational efforts to push back against the global trend of closing space for civil society.” Some other nice blogs from this week:

• F2P - The ‘NGO-ization’ of research: what are the risks?

(focusing on the DRC)

• ODI - Tackling aid populism: reflections on Canada and beyond

On the rise of aid populism “…We are now witnessing the political repurposing of aid in many countries to serve the cause of nationalism, even as it directly challenges evidence of good development practice….”

Some tweets of the week

• Robert Marten:

“#India’s Air Quality should be considered a public health emergency of international concern #PHEIC, but will it be @DrTedros ?”

• Richard Horton:

“Today I sat in the office of a professor at the London School of Hygiene and Tropical Medicine and learned about one of the biggest scandals afflicting modern medicine and medical research. For Offline next week. If the lawyers allow.”

HPW - Challenges & Opportunities Of Cutting-Edge Health Technologies Discussed At WTO-WHO-WIPO Symposium

https://www.healthpolicy-watch.org/challenges-opportunities-of-cutting-edge-health-technologies-discussed-at-wto-who-wipo-symposium/ Short report on a symposium from last week. “Cutting-edge health technologies – such as gene editing therapies for cancer – have the potential to save lives, and the international intellectual property system should be leveraged to drive innovation and bring those therapies to people who need them, said the leaders of global health, trade and intellectual property agencies at a Trilateral Symposium on Thursday. The symposium, convened under the theme “Cutting-edge Health Technologies: Opportunities and Challenges,” is the eighth such open forum co-hosted by the World Health Organization (WHO), the World Trade Organization (WTO), and the World Intellectual Property Organization (WIPO) to foster collaboration around public health and intellectual property….”

Coming up – 2019 Women Leaders in Global Health conference (Kigali, 9-10 Nov)

https://www.wlghconferences.org/ First time the conference will take place in an LMIC.

Coming up: Health taxes joint planning session (Montreux, 11 Nov)

https://www.who.int/news-room/events/detail/2019/11/11/default-calendar/health-taxes-joint-planning-session

Coming up: WHO 2019 symposium on Health Financing for UHC: Fiscal Space, Public Financial Management and Health Financing  (12-14 Nov, Montreux)

https://www.who.int/news-room/events/detail/2019/11/12/default-calendar/collaborative-agenda-on-fiscal-space-pfm-and-health-financing-2019 On invitation only.

Coming up: Health for All Film festival

https://www.who.int/news-room/events/detail/2019/10/24/default-calendar/the-health-for-all-film-festival WHO invites filmmakers to participate in their inaugural film festival.  Deadline: 30 January 2020. “in May 2020, on the occasion of the 73rd World Health Assembly, WHO will host the first-ever Health for All Film Festival in Geneva….” First you take Geneva, then Cannes 😊.

Coming up – BRICS summit in Brazil (13-14 Nov)

See a tweet from earlier this week: “10 days from now Brazil will host the 11th BRICS Summit. Xi Jinping, Narendra Modi, Vladimir Putin and Cyril Ramaphosa will be in Brasília. Yet there is no public debate about the event whatsoever. Will be the most low-key summit since the group's first summit in 2009.” For more info on this upcoming BRICS summit, see IISD 11th BRICS Summit  (13-14 Nov, Brasilia) “… The new areas of BRICS cooperation spearheaded by Brazil, are: strengthening of cooperation on science, technology and innovation; enhancement of cooperation on digital economy; invigoration of cooperation on the fight against transnational crime, especially against organized crime, money laundering and drug trafficking; and encouragement to the rapprochement between the New Development Bank (NDB) and the BRICS Business Council….”

Stat - What money? The CDC is urged to acknowledge industry funding

https://www.statnews.com/pharmalot/2019/11/05/cdc-foundation-disclaimers-corporate-funding/?utm_content=bufferbc73a&utm_medium=social&utm_source=twitter&utm_campaign=twitter_organic (gated) “ Several advocacy groups petitioned the Centers for Disease Control and  Prevention to stop making claims that it does not accept commercial support or have financial relationships with drug makers and other companies that may benefit from agency research. In arguing their case, the groups contend that disclaimers appear in various CDC publications, even though the agency has actually accepted tens of millions of dollars of commercial support through the National Foundation for the Centers for Disease Control and Prevention. The nonprofit, which was created by Congress to generate private sector support for the agency’s work, was launched in 1995….”

Social Europe - UN treaty on business and human rights vital for economic and social justice

S Burrow; https://www.socialeurope.eu/un-treaty-on-business-and-human-rights-vital-for-economic-and-social-justice Via Ronald Labonté (Twitter). Good update on where things stand on this front.  Not too bad, actually.

Devex – World Bank staff chastise the board over lack of diversity

https://www.devex.com/news/world-bank-staff-chastise-the-board-over-lack-of-diversity-95876 “The World Bank’s board of executive directors is failing to live up to its own standards on gender equality, which is preventing the multilateral development bank from hitting international diversity and inclusion targets, staff say. Despite setting tough gender equality targets for the World Bank’s staff, only 5 of the board’s 25 executive directors are women — representing the governments of Thailand, Uganda, Nigeria, the United States, and India….”

Devex - Opinion: The new US development agency could be a game-changer for health innovation

Steve Davis (president & CEO of PATH); https://www.devex.com/news/opinion-the-new-us-development-agency-could-be-a-game-changer-for-health-innovation-95930 True, some of the invited Devex writers are quick to see ‘game-changers’ 😊. “A signature effort of the Trump administration to bring more private sector capital and ingenuity into its global development efforts has unfortunately fallen victim to congressional gridlock. With another stopgap funding measure, the widely anticipated launch of the U.S. International Development Finance Corporation, or DFC, was stalled from its Oct. 1 deadline. Experts from across sectors herald this new agency, which was created last year with bipartisan support in Congress and in close coordination with the Trump administration. Many agree it has real promise, thanks to its mandate to engage the private sector in U.S. global development efforts and the pipeline of promising investment opportunities on the horizon….”

South Centre – Quarterly report

https://www.southcentre.int/wp-content/uploads/2019/10/South-Centre-Quarterly-Report-July-September-2019.pdf “This Quarterly Report summarizes the activities undertaken by the South Centre during the period 1st July to 30 September 2019. It is intended to provide information, organized by themes, about recent developments in the areas covered by the Centre’s Work Program…”  Among others, on AMR, global inequality, reform of the tax system.

Guardian - World's largest trade deal RCEP faces delay as India pushes back against China

https://www.theguardian.com/business/2019/nov/04/worlds-largest-trade-deal-rcep-faces-delay-as-india-pushes-back-against-china?CMP=share_btn_tw The Modi administration doesn’t want to join RCEP. The stance of authoritarian populists on big trade agreements like this one (see also Trump), for reasons of PR or otherwise, tends to be more astute than liberal politicians’. No agreement was reached, and so RCEP is postponed.

IIS - SDSN Publication Identifies Four Steps to Fight SDG Data Gaps

IISD; “The report ‘Counting on the World to Act – A Roadmap for Governments to Achieve Modern Data Systems for Sustainable Development’ details an action plan for governments and development partners for building and leading national data ecosystems. The recommendations have been designed for national statisticians, chief data scientists, chief data officers, ministers of planning and others concerned with evidence-based decision-making in support of sustainable development.”

ProPublica: Pence's office pressured USAID to award grants to Christian groups in Iraq

https://edition.cnn.com/2019/11/06/politics/mike-pence-usaid-iraq-foreign-aid/index.html Sounds vaguely familiar if you’re from Belgium : )

Devex - AfDB's capital boost

https://www.devex.com/news/trump-s-paris-withdrawal-afdb-s-capital-boost-and-south-sudan-s-fragile-peace-this-week-in-development-95999 “The African Development Bank’s shareholders approved the largest-ever capital increase for the development financing institution — a 125% boost that brings the AfDB’s capital resources to $208 billion. …”

• Quick link:

FT op-ed - Progress toward sustainable development is seriously off track (by A Guterres, SG of the UN). Gated. Key message: the private sector needs to lead on financing SDGs.    

• Tweet from Larry Gostin:

“Today begins 3-day  @WHO @WHOSEARO #UHC meeting for Parliamentarians. In Seoul, I will test pilot  @oneillinstitute @GUGlobalHealth @WHO @UNDP #LegalSolutionsForUHC Network. The key idea is to train MPs & MoH to reform & implement nat'l laws for universal, affordable, equitable UHC.”

Lancet World Report – Violent protests in Chile linked to health-care inequities

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32720-5/fulltext “Many grievances are driving civil unrest in Chile, but inequities in the health-care system are a key one. Barbara Fraser reports.”

IJHPM - Defining the Benefit Package of Thailand Universal Coverage Scheme: From Pragmatism to Sophistication

Viroj T************ et al ; http://www.ijhpm.com/article_3685.html “Benefit package is crucial for implementing universal health coverage (UHC). This editorial analyses how the benefit package of the Thai Universal Coverage Scheme (UC Scheme) evolved from an implicit comprehensive package which covered all conditions and interventions (with a few exceptions), to additional explicit positive lists. … ” You might also want to read Institutionalising participatory health governance: lessons from nine years of the National Health Assembly model in Thailand  (BMJ Global Health).

Hindustan Times - India’s public spending on healthcare continues to remain lowest globally

https://www.hindustantimes.com/india-news/india-s-public-health-spending-lagging-behind/story-6YPZFSfWMVlHGipDXyUEFO.html « India’s neighbours, such as Sri Lanka (1.68%), Indonesia (1.40%), Nepal (1.17%) and Myanmar (1.02%) are spending far more than India on healthcare, which could have an impact on its efforts to achieve Universal Health Coverage (UHC). …” « India released National Health Profile-2019 (NHP-2019) on Wednesday, and, at 1.28% of the GDP (2017-18 Budget Estimate), the country’s public expenditure on health continues to remain the lowest globally, making it seem like an uphill task to meet the target of 2.5% of the GDP by 2025 that the government is aiming at….”

Guardian - Warren unveils $20.5tn plan for universal healthcare without middle-class tax hike

https://www.theguardian.com/us-news/2019/nov/01/elizabeth-warren-healthcare-plan-taxes “Moderate Democrats attack plan, with Joe Biden calling it ‘mathematical gymnastics’”

BMJ Global Health - Measuring progress towards universal health coverage: national and subnational analysis in Ethiopia

https://gh.bmj.com/content/4/6/e001843 “Aiming for universal health coverage (UHC) as a country-level goal requires that progress is measured and tracked over time. However, few national and subnational studies monitor UHC in low-income countries and there is none for Ethiopia. This study aimed to estimate the 2015 national and subnational UHC service coverage status for Ethiopia….”

Guardian – Africa poised to lead way in global green revolution, says report

https://www.theguardian.com/environment/2019/nov/08/africa-poised-lead-way-global-green-revolution-says-report “Africa is poised to lead the world’s cleanest economic revolution by using renewable energy sources to power a massive spread of urbanisation, says an IEA report. The IEA, or International Energy Agency, predicts that solar energy will play a big role in supporting the continent’s growing population and industrialisation over the next 20 years….”

Project Syndicate - Death by Dirty Cooking

Project Syndicate; “ It would cost an estimated $4.4 billion annually to meet the world’s residential clean-cooking needs – far more than what is currently available. While that figure is not small, it is dwarfed by the costs of inaction….”  By K Yumkella, former UN SG and chair of UN Energy. Excerpt: “… A new initiative aims to change this. The World Bank’s Clean Cooking Fund, launched at September’s United Nations climate action summit in New York, will mobilize $500 million to help ensure universal access to clean cooking by 2030. This includes scaling up the production of clean-cooking fuels, developing well-functioning supply chains to deliver them to billions of people, and encouraging innovation and diffusion of relevant technologies. To this end, the CCF will leverage World Bank and other development-bank resources to attract private investment, including by creating new revenue streams and incentives across value chains. It will also develop an impact bond market for the clean-cooking sector. Moreover, the CCF will support a global platform for knowledge and innovation, including the Health and Energy Platform of Action, convened by the World Health Organization, the UN Development Programme, and the World Bank in collaboration with the civil-society organizations Hivos and ENERGIA….

Demand a People’s Climate Summit

https://act.350.org/sign/peoples-climate-summit/ Hard to argue with, this petition. Long overdue too, such a People’s Climate Summit. “… The Chilean government has suspended the COP25 climate talks. So we demand a People’s Climate Summit instead – and at this Summit, we want the United Nations to prioritize the voices of people, not polluters. It’s time to kick polluters out of the climate talks and give them back to the people. We are specifically calling for: The United Nations must center the voices of the people in all global efforts to address the climate emergency. More space must be given to civil society, social movements, Indigenous peoples, frontline communities, and the public at large to shape a global response to the climate crisis.  The UN Framework Convention on Climate Change (UNFCCC) Secretariat must guarantee the safe and full participation of civil society in all future climate talks. This includes working with host countries to prioritize public participation. The UNFCCC must kick polluters out of the climate talks. The fossil fuel industry and their corporate front groups attend the climate talks for the sole purpose of silencing the voices of the people. They have no right to sit at a table that they are setting on fire. The protection of human rights must become a central pillar of any global climate agreement and included in all national pledges to address the crisis. This means a renewed focus on addressing the human rights violations caused by fossil fuel companies. …” Quick link: (Guardian)   Blue spaces: why time spent near water is the secret of happiness “Coastal environments have been shown to improve our health, body and mind. So should doctors start issuing nature-based prescriptions?”   Not sure, now that the sea is rising everywhere : )  

Telegraph - Europe's first ever native Zika cases should be a 'wake-up call' for the continent

https://www.telegraph.co.uk/global-health/science-and-disease/europes-first-ever-native-zika-cases-should-wake-up-call-continent/ “The Zika virus has been picked up for the first time in Europe, in what an expert has branded a “wake-up call” for the continent.  The European Centre for Disease Prevention and Control has confirmed that three cases found in August in the French Riviera town of Hyères were transmitted locally, rather than being brought home by travellers.  Although around 2,400 cases of Zika have been detected in Europe since 2015 - when the outbreak in South America took off - all these infections were picked up and brought back by tourists visiting other continents.  But the three new cases were acquired locally - people in France were bitten by Asian tiger mosquitoes infected with the virus….”

Scidev.net - New blood test to detect Zika approved in Brazil

https://www.scidev.net/global/health/news/new-blood-test-to-detect-zika-approved-in-brazil.html “Brazilian scientists have developed a blood test than can detect Zika in less than four hours. It works even in patients with dengue, yellow fever and chikungunya. National health authorities approved it for production.”

UK Govt- UK aid to help vaccinate more than 400 million children a year against polio

https://www.gov.uk/government/news/uk-aid-to-help-vaccinate-more-than-400-million-children-a-year-against-polio “International Development Secretary Alok Sharma has pledged new UK aid support to help vaccinate more than 400 million children a year against polio.” “The UK’s new package of up to £400 million will go towards the Global Polio Eradication Initiative. This means the UK, along with other donors, will help support more than 20 million health workers and volunteers to reach children with vaccines and other healthcare. This funding which runs from 2020 to 2023 will help buy tens of millions doses of polio vaccine every year – enough to vaccinate more than 750 children a minute….”

AP - Zanzibar tests drones spraying rice fields to fight malaria

Associated Press; “ For the first time drones are being tested to help fight malaria on the island of Zanzibar, off the coast of Tanzania. The drones will spray a silicone-based liquid on rice paddies, where there are large expanses of stagnant water where malaria-carrying mosquitoes lay their eggs. The substance will spread across the water and prevent the eggs from hatching. It is hoped this will significantly reduce the numbers of the malaria-carrying anopheles mosquitoes in the area. The spraying by drones is a test to see if it will help the government of Zanzibar reach its goal of eliminating malaria on the archipelago by 2023, according to the strategic plan adopted by Zanzibar Malaria Elimination Program….” See also Reuters -  Researchers use drones to pilot a new tool to fight malaria “Scientists seeking a breakthrough in the fight against malaria have used drones to spray rice fields in Zanzibar - not with traditional pesticides but with a thin, non-toxic film….”

CGD (blog) - Managing “Deep” Uncertainty in Global Health: The Case of TB Testing

R Cassidy et al; https://www.cgdev.org/blog/managing-deep-uncertainty-global-health-case-tb-testing “Policymakers and clinicians in global health often face considerable uncertainty when making decisions. Statistical uncertainty—arising from the fact that analysis and modelling typically use samples rather than whole populations—can be accounted for by placing confidence intervals on the estimated impacts of different policies and treatment regimes. However, “deep” uncertainty—which may arise from issues including missing data or limited external validity from existing trials—poses a more fundamental challenge to decision-making. In a newly published article in The Proceedings of the National Academy of Sciences, we examine such “deep” uncertainty in the context of a new diagnostic test for Tuberculosis (TB), including discussions of diversification, and ask what a reasonable policy response might be for public health agencies combatting TB….”

Guardian - Measles wipes out immune system's memory, study finds

https://www.theguardian.com/science/2019/oct/31/measles-wipes-out-immune-systems-memory-study-finds This study went viral last week.   “Measles causes long-term damage to the immune system, leaving children who have had it vulnerable to other infections long after the initial illness has passed, research has revealed. Two studies of unvaccinated children in an Orthodox Protestant community in the Netherlands found that measles wipes out the immune system’s memory of previous illnesses, returning it to a more baby-like state, and also leaves the body less equipped to fight off new infections….” The research underscores the case for vaccination as the anti-vaxx movement is growing.

HRW - UAE: Prisoners Denied Lifesaving HIV Treatment

Human Rights Watch; “United Arab Emirates (UAE) prison authorities are denying non-national HIV-positive detainees in at least one UAE prison regular and uninterrupted access to lifesaving antiretroviral treatment, Human Rights Watch said today. Detainees living with HIV are also segregated from the rest of the prison population in an isolated area and report facing stigma and systemic discrimination….”

Lancet  Editorial - Chagas disease: still a neglected emergency

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32671-6/fulltext “A report from the Pan American Health Organization (PAHO), released on Oct 19, describes progress in the spread and control of Chagas disease. The report—Control, interruption of transmission and elimination of Chagas disease as a public health problem—describes the troubling issues confronting regions dealing with this neglected infectious disease. The statistics are worrying. 70 million people in South and central America are at risk of infection, of whom 6 million are infected, with the majority unaware. The report estimates 14 000 deaths per year are a direct result of Chagas disease, a burden affecting mainly low-income populations who do not have access to diagnosis and treatment. …” “In 2009, we published an Editorial entitled “Chagas disease: a neglected emergency”. Unfortunately, there has been little progress over the past decade because of the complex nature of the disease.  … … In an increasingly interconnected world, it is dangerous to view a disease historically restricted to one specific region as someone else's problem. This report should be proof enough that international collaboration with a focus on improving control and treatment of Chagas disease is long overdue and that this infection requires a truly international response. As the report says, Chagas disease is now present in North America, Europe, Asia, and Oceania….”

HPW - World Health Organization And Sudan Ministry of Health Scale Up Response To Cholera Outbreak

https://www.healthpolicy-watch.org/world-health-organization-and-sudan-ministry-of-health-scale-up-response-to-cholera-outbreak/ “As a cholera outbreak inches closer to Sudan’s capital city of Khartoum, the Sudanese Ministry of Health and the World Health Organization are scaling up the response. Two cholera cases were confirmed in the district of Khartoum State on October 19. As of Monday, November 3, the Ministry of Health had reported 332  suspected cases of cholera since 28 August when the first case was detected….” Quick links: First New HIV Strain in 19 Years Identified  (Scientific American)

Cidrap News - Report gives fast food chains low grades on antibiotics in beef

http://www.cidrap.umn.edu/news-perspective/2019/11/report-gives-fast-food-chains-low-grades-antibiotics-beef From the US: “A new report card on the nation's major restaurant chains shows that most continue to get a failing grade when it comes to serving beef raised without the routine use of medically important antibiotics.”

The Wire - 'Wai-Wai' Group Wants Junk Food in Name of Nutrition, Gates Foundation Says No

https://thewire.in/south-asia/is-the-gates-foundation-funding-junk-food-in-the-name-of-nutrition-in-nepal “The Chaudhary Group makes Wai-Wai noodles and says a fortified version of its product will be supplied to the Baliyo Nepal nutrition initiative that the Bill and Melinda Gates Foundation is paying for.” However, “In a statement, the Bill and Melinda Gates Foundation has clarified that “noodles are not one of the foods being promoted by Baliyo Nepal”. “Noodles are not one of the foods being promoted by Baliyo Nepal, and we do not expect them, including Wai Wai noodles, to be eligible to become a Baliyo Nepal product. To be eligible, partners must ensure foods meet a high nutritional standard, either by being naturally rich in nutrients or by being fortified. Baliyo Nepal verifies nutritional standards by using the Australian Government’s Health Star Rating system and requires all products to have a 3-star rating or higher,” the foundation said.”

Framework Convention Alliance - The ILO Ends Contracts with Tobacco Companies

https://www.fctc.org/the-ilo-ends-contracts-with-tobacco-companies/ News from end last week. “ “At its ongoing 337th Session, the Governing Body of the International Labour Organization (ILO) reaffirmed its commitment to no longer rely on funding from tobacco companies and affiliated organisations. The Governing Body of the ILO endorsed an integrated strategy to address decent work deficits in the tobacco sector, which will be implemented free from tobacco industry money. The Framework Convention Alliance (FCA) congratulates the ILO for its efforts to end child labour in Tanzania, Malawi, Uganda and Zambia; financed by voluntary contributions from multi- and bilateral aid for development cooperation, and /or ILO resources….”

Reuters - China gives conditional OK to its first self-developed Alzheimer's drug

Reuters; I might have to reconsider retiring in the Middle Kingdom 😊. See also Science News - Alzheimer’s experts greet China’s surprise approval of a drug for brain disease with hope and caution.

The Conversation - How business misrepresented evidence: the South African sugar tax story

G Fooks et al; https://theconversation.com/how-business-misrepresented-evidence-the-south-african-sugar-tax-story-125421 “In a recently published study on the political activities of the soft drinks industry in the lead up to South Africa introducing a sugar tax, we outlined the complex and systematic way in which big corporations and business associations misrepresented evidence to the country’s National Treasury….”

Science (Policy Forum) - To help aging populations, classify organismal senescence

Science; “Globally, citizens exist for sustained periods in states of aging-related disease and multimorbidity. Given the urgent and unmet clinical, health care, workforce, and economic needs of aging populations, we need interventions and programs that regenerate tissues and organs and prevent and reverse aging-related damage, disease, and frailty. In response to these challenges, the World Health Organization (WHO) has called for a comprehensive public-health response within an international legal framework based on human rights law. Yet for a clinical trial to be conducted, a disease to be diagnosed, intervention prescribed, and treatment administered; a corresponding disease classification code is needed, adopted nationally from the WHO International Classification of Diseases (ICD). Such classifications and staging are fundamental for health care governance among governments and intergovernmental bodies. We describe a systematic and comprehensive approach to the classification and staging of organismal senescence and aging-related diseases at the organ and tissue levels in order to guide policy and practice and enable appropriate interventions and clinical guidance, systems, resources, and infrastructure.”

Lancet- Offline: The broken promise of cancer medicine

R Horton; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32675-3/fulltext Horton came up with a poignant story last week, based on his own experience. “…for many, perhaps even most, of those living with cancer, the reality of survivorship falls far short of the imagined ideal. In truth, the lives of those living with cancer are becoming enslaved to brief, bureaucratic, and impersonal contacts with specialists who have little time for intimate exchange beyond writing repeat prescriptions, ordering follow-up scans, and checking computer screens for lab results. Cancer care—I emphasise care, not treatment—is failing (and failing badly) to serve the majority of cancer survivors….” …If survivorship isn't to be a meaningless, self-regarding oncological affectation—and it just might be exactly that—the cancer medicine community has got to face up to the horrifying depth of its broken promise.” And a quick link: Bloomberg - Impossible Foods Is Creating Plant-Based Pork as It Eyes China “Impossible Foods Inc. is working to launch plant-based pork as it looks to enter China, the crown jewel of the $2.7 trillion global meat market….”

TMIH - Sexual and reproductive health knowledge among adolescents in eight sites across sub‐Saharan Africa

https://onlinelibrary.wiley.com/doi/abs/10.1111/tmi.13332 Objective of this paper was to examine knowledge of menstruation, HIV and STIs other than HIV across eight sites in SSA to develop effective programmatic interventions enabling adolescents to achieve positive SRH as they transition to adulthood.

Vaccine – Effect of donor funding for immunization from Gavi and other development assistance channels on vaccine coverage: Evidence from 120 low and middle income recipient countries

https://www.sciencedirect.com/science/article/pii/S0264410X19314379 “Donor assistance for immunization has remained resilient with increased resource mobilization efforts in recent years to achieve current global coverage targets. As a result, more countries continue to introduce new vaccines while optimizing coverage for traditional vaccines. Gavi the Vaccine Alliance has been at the forefront of immunization support specifically among low and middle income countries, alongside other channels of development assistance which continue to play a vital role in immunization. Using available recipient country level data from 1996 to 2016, we estimate the impact of Gavi support for vaccines and health systems strengthening on vaccine coverage for 3 dose DPT, 3 dose pneumococcal conjugate vaccine, 3 dose pentavalent, 2 dose measles and 2 dose rotavirus vaccines. We investigate the same effects of total aid for immunization from other channels of development assistance…” “We found significant positive effects of aid particularly among the newer vaccines. Using 2016 country specific disbursements and coverage levels as baseline, we estimated that among recipient countries below the universal target, additional DAH per capita required to reach 90%, ranged from 0.01USD to 4.33USD for PCV, 0.03USD to 9.06USD for pentavalent vaccine and 0.01USD to 2.57USD for rotavirus vaccine. The estimated number of children vaccinated through 2016, attributable to Gavi support totaled 46.6million, 75.2million and 12.3million for PCV, pentavalent and rotavirus vaccines respectively….”

HPW – Italian Health Minister Moves To Replace Key Architect of WHA Resolution On Drug Price Transparency

https://www.healthpolicy-watch.org/italian-health-minister-moves-to-replace-key-architect-of-wha-resolution-on-drug-price-transparency/ “In a move fraught with international political overtones, Italy’s new Minister of Health is moving to replace the Director General of the Italian Drug Agency (AIFA), Dr Luca Li Bassi, who was the key architect of the May World Health Assembly (WHA) resolution supporting greater price transparency in medicines markets, Health Policy Watch has learned….”

HPW - Civil Society Pressures French Leaders To Adopt Transparency Amendments

https://journals.sagepub.com/doi/full/10.1177/0020731419885090#articleShareContainer “A coalition of over 40 personalities – from doctors and economists to actors and health access activists – released an open letter Tuesday calling on the French Prime Minister Edouard Philippe and the Minister of Health Agnès Buzyn to support a series of amendments to the French Social Security Budget Bill for 2020 providing for greater transparency around the selection and pricing of drugs purchased for the national health system. The bill, which provides the framework for public health system funding, will be going before the French Senate next week, and drug pricing amendments were previously blocked by the Minister of Health in a presentation of the bill to the National Assembly on October 24th. … … The strongly-worded statement goes on to call the rejection of the price transparency measures a “denial of the French commitment made to the World Health Organization,” referring to France’s vote in favor of the landmark price transparency resolution passed at the 72nd World Health Assembly in May. While political leaders in other European countries such as Malta and Italy have been pushing the transparency agenda, civil society actors such as l’Observatoire Transparence Médicaments (OTM) have been driving the conversation around pricing transparency in France….”

Globalization & Health - Pension and state funds dominating biomedical R&D investment: fiduciary duty and public health

S Roller; https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-019-0490-x “Who benefits from the commercial biomedical research and development (R&D)? Patients-consumers and investors-shareholders have traditionally been viewed as two distinct groups with conflicting interests: shareholders seek maximum profits, patients - maximum clinical benefit. However, what happens when patients are the shareholders? With billions of dollars of public risk capital channeled into the drug development industry, analysing the complex financial architecture and the market for corporate control is essential for understanding industry’s characteristics, such as pricing strategies or R&D priorities. Adding investments by governmentally-mandated retirement schemes, central and promotional banks, and sovereign wealth funds to tax-derived governmental financing shows that the majority of biomedical R&D funding is public in origin. Despite this, even in the high-income countries patients can be denied access to effective treatments due to their high cost. Since these costs are set by the drug development firms that are owned in substantial part by the retirement accounts of said patients, the complex financial architecture of biomedical R&D may be inconsistent with the objectives of the ultimate beneficiaries. The divergence in economic and public health performance of the drug development industry is resultant from its financial underwriting by enormously expanded pension schemes, governmentally mandated to represent the interests of “captive” beneficiaries, as well as similar policymaker-designed funding flows, whose standards of transparency, accountability and representation are substantially lower than that of governments themselves. Strengthening those elements of institutional design and thus ensuring active responsible shareholding in the interest of the patients-savers is an under-utilised, but potentially high-impact opportunity for advancing public health.”

Financial Express - Affordable healthcare: Indian diagnostic R&D is poised to be the next success story

https://www.financialexpress.com/lifestyle/health/affordable-healthcare-indian-diagnostic-rd-is-poised-to-be-the-next-success-story/1753943/ “Is India on the brink of becoming a #diagnostics powerhouse?” Read this article from #FINDdx leadership. FIND refers to ‘Foundation for Innovative New Diagnostics’. “…Diagnostics innovation is key to affordable healthcare and central to the UHC agenda that India is trying to achieve through its Ayushman Bharat programme. With the right framework conditions and support through initiatives such as “Make in India” alongside the introduction of the Indian EDL, Indian diagnostic R&D is poised to be the next success story, one that builds on past achievements and strengthens the country’s position as a leading provider of healthcare solutions, to the benefit of our fellow citizens and the global community….”

Stat News – China has become the pharmacy to the world — and a national security risk for the U.S.

https://www.statnews.com/pharmalot/2019/11/05/china-security-risk-gibson/ (gated) “As concern mounts over the global pharmaceutical supply chain, more fingers are being pointed at India and China due to increasing quality-control infractions at manufacturing facilities. Such problems have led to shortages of key medicines — notably, the lower-cost generics that account for 89% of all prescriptions filled in the U.S. But Rosemary Gibson, a health care and patient safety expert at The Hastings Center, a bioethics nonprofit, argues that developments in China pose an even greater risk. As the key supplier of active pharmaceutical ingredients, China ultimately threatens the national security of the U.S., which was the theme in her April 2018 book, “China Rx: Exposing the Risks of America’s Dependence on China for Medicine,” written with Janardan Prasad Singh. Last week, she testified before a House committee on supply chain issues and we subsequently chatted about the problem. This is an edited version of the conversation.” Quick link: NYT - Trump Administration sues Gilead, maker of HIV prevention drugs. ““The Trump administration on Wednesday sued Gilead Sciences, a pharmaceutical company that sells HIV-prevention drugs that can cost patients up to $20,000 a year [in the U.S.], accusing the company of earning billions from research funded by taxpayers without paying taxpayers back …”

IHP - Engaging community health workers in the management of NCDs: country experiences from Asia

https://www.internationalhealthpolicies.org/featured-article/engaging-community-health-workers-in-the-management-of-ncds-country-experiences-from-asia/ Insightful blog by Asia Pacific Observatory on Health Systems and Policies, based on a recent policy brief.

Humanitarian Health Digest  (new issue)

http://hopkinshumanitarianhealth.org/assets/documents/HHD_3Q_2019_FINAL!.pdf The Humanitarian Health Digest is published quarterly by @TheLancet  and @JohnsHopkinsSPH. This issue features commentaries on "Health worker safety in the context of large-scale outbreaks" and "Prioritising mental health in conflict".

Plos Med (Editorial) - Health and medical research for all: The challenge remains open

https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002970 “On our 15th anniversary, the PLOS Medicine editors discuss progress in open access, medical publishing and the journal's mission over the years.”

Lancet (Comment) - North–South inequities in research collaboration in humanitarian and conflict contexts

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32482-1/fulltext In last week’s Lancet issue. “The Syrian conflict, now in its eighth year, has galvanised the attention of humanitarian agencies, international organisations, and academic institutions. The global response necessitated new forms of North–South research collaboration, often involving international investigators unfamiliar with the social make-up, political economy, or the nature of the conflict in the Middle East. Research has led to new knowledge on the health and social implications of the crisis and highlighted challenges of the humanitarian response. But some of this research has revealed ethically dubious fieldwork practices, inequities, and power dynamics in the funding, conduct, and dissemination of academic research across global North–South divides….” … We propose three guiding principles for developing more equitable and long-term research partnerships….”

Angus Deaton - Randomization in the tropics revisited: a theme and eleven variations

https://scholar.princeton.edu/sites/default/files/deaton/files/deaton_randomization_revisited_v2_2019_01.pdf New paper from Angus.  Might be worth reading, also given the recent Nobel prize Economics.

Stat - Google to acquire Fitbit for $2.1 billion in major health tech deal

https://www.statnews.com/2019/11/01/google-to-acquire-fitbit-for-2-1-billion-in-major-health-tech-deal/ News from late last week. “Google parent company Alphabet announced on Friday it will buy Fitbit for $2.1 billion — a massive deal that will pit Google squarely against Apple (AAPL) in the market for health and fitness tracking.  The deal immediately transforms the market for fitness trackers and smartwatches, which are increasingly being seen as clinical tools for monitoring health and gathering reams of health data….”

Devex - Global agriculture fund GAFSP embarks on new replenishment model

https://www.devex.com/news/global-agriculture-fund-gafsp-embarks-on-new-replenishment-model-95986 “Ten years after G-20 leaders created the Global Agriculture and Food Security Program to tackle hunger and malnutrition, the fund will hold its first replenishment event next June in Berlin, seeking $1.5 billion.  Channeled through actors including the Food and Agriculture Organization and World Bank, GAFSP says the money would support sustainable food systems in at least 30 countries, provide a 20% increase in income to 10 million farmers, and create 1.1 million jobs in the 2020-2025 period….” “In early 2018, the steering committee decided to extend GAFSP until 2030 to align with the Sustainable Development Goals. According to the minutes, the Bill & Melinda Gates Foundation, for instance, “indicated a willingness to go back to their leadership for funds in 2019 if there was a significant replenishment moment with contributions by several donors and clearer articulation of GAFSP’s leverage proposition.” The fund released its investment case, last month, pointing out that “progress on Sustainable Development Goal 2 (SDG2) — to end hunger, achieve food security and improved nutrition and promote sustainable agriculture — is actually going in reverse.”…”

HP&P - Yes, no, maybe so: the importance of cognitive interviewing to enhance structured surveys on respectful maternity care in northern Indi

Kerry Scott (EV 2014) et al; https://academic.oup.com/heapol/advance-article/doi/10.1093/heapol/czz141/5610565?searchresult=1 “Quantitative survey findings are important in measuring health-related phenomena, including on sensitive topics such as respectful maternity care (RMC). But how well do survey results truly capture respondent experiences and opinions? Quantitative tool development and piloting often involve translating questions from other settings and assessing the mechanics of implementation, which fails to deeply explore how respondents understand survey questions and response options. To address this gap, we conducted cognitive interviews on survey questions (n = 88) adapted from validated RMC instruments used in Ethiopia, Kenya and elsewhere in India. …  We analysed the interviews to revise the tool and identify question failures, which we grouped into six areas: issues with sequencing, length and sensitivity; problematic response options; inappropriate vocabulary; temporal and spatial confusion; accessing different cognitive domains; and failure to resonate with the respondent’s worldview and reality. Although women tended to provide initial answers to the survey questions, cognitive interviews revealed widespread mismatch between respondent interpretation and question intent. Likert scale response options were generally incomprehensible and questions involving hypothetical scenarios could be interpreted in unexpected ways. Many key terms and concepts from the international RMC literature did not translate well and showed low resonance with respondents, including consent and being involved in decisions about one’s care. This study highlights the threat to data quality and the validity of findings when translating quantitative surveys between languages and cultures and showcases the value of cognitive interviews in identifying question failures. While survey tool revision can address many of these issues, further critical discussion is needed on the use of standardized questions to assess the same domains across contexts.”

• Check out also the latest micro-blog (by Renzo Guinto, EV 2014) in the series related to the 10^th EV anniversary. See Decolonizing global health and the ‘EV vibe’   Well worth a read!

Global Health Action - New impulses from international development for more comprehensive and balanced public engagement evaluation

M Haensggen;  https://www.tandfonline.com/doi/full/10.1080/16549716.2019.1680067 “Public engagement in health research has gained popularity because of its potential to co-create knowledge, generate dialogue, and ground research in the priorities and realities of the target groups. However, public engagement that achieves these objectives could still entail unforeseen negative consequences or a wasteful use of resources. Although the evaluation of public engagement has evolved in recent years, we lack consistent evaluation criteria for systematic and transparent assessments of success and failure. This article introduces standard evaluation criteria from the field of development aid evaluation (effectiveness, efficiency, impact, relevance, sustainability) to promote more systematic and comprehensive evaluation practice. I apply these criteria to the public engagement component of a recent research project into antimicrobial resistance, antibiotic use, and health behaviour in Thailand and Laos….”

HP&P – Examining the use of economic evaluations in health-related humanitarian programmes in low- and middle-income countries: a systematic review

L Makhani et al;  https://academic.oup.com/heapol/advance-article/doi/10.1093/heapol/czz144/5614357?searchresult=1 “The costly nature of health sector responses to humanitarian crises and resource constraints means that there is a need to identify methods for priority setting and long-term planning. One method is economic evaluation. The aim of this systematic review is to examine the use of economic evaluations in health-related humanitarian programmes in low- and middle-income countries….”  

Book – Healthy and Sustainable Food Systems

Edited by M Lawrence et al; https://www.routledge.com/Healthy-and-Sustainable-Food-Systems-1st-Edition/Lawrence-Friel/p/book/9780815393276 “This comprehensive text provides the latest research on key concepts, principles and practices for promoting healthy and sustainable food systems….”