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Dear Colleagues,
In this week’s issue we’ll first come back on the final days of #UNGA78’s high-level week, including the TB High-Level summit, some NCD related action and overall analysis ( eg. we certainly enjoyed Devex’ assessment of Guterres sounding more and more like a “class warrior”, and Erdogan mistakenly taking the abundant SDG colours for LGBTQ+ community colours ). More importantly, it remains to be seen whether the three HL meetings on health will indeed produce some effect beyond New York in the months and years to come. In the end, that will depend on all of us, I guess. Anyway, the bulk of this newsletter is again focused on PPPR (among others, on the pandemic accord negotiations in Geneva (& related analysis), and a HL meeting in Berlin, convened by the German government – ‘Pandemics, no time for neglect’ ‘ (28 Sept)); Global Health Governance, planetary health and access issues.
But the week also featured World Contraception Day (26 September) and International Safe Abortion Day (28 September), very big priorities as well, still (sadly). The Lancet also came up with a(n overdue?) Lancet Commission on Women, power, and cancer. Meanwhile, in Gastein, the annual European health forum meeting (26-29 Sept) was this year properly themed, Health systems in crisis: countering shockwaves and fatigue . Yes, in case you’re wondering, that’s no different in Europe these days.
2023 isn’t over yet, but it’s already clear it’ll be an historic year – and no, not because the SDG agenda happens to be halfway, nor because Wellcome & the Gates Foundation seem to get along just fine these days. Two examples of why we’ll all remember this year:
Planetary awareness on the urgency and danger of the climate (& planetary) crisis is at last near global now. That doesn’t mean we’ll do the needed collectively, far from it (“Sapiens oblige”), but at least in terms of awareness humanity made a quantum leap forward. Very late, yes. By the way, this week, we noticed – again – how differently “very important people” (all men unfortunately) assess the current situation on this front. In media quotes, the International Energy Agency chief (Fatih Birol) and Bill Gates both saw the glass half full. Others much less so, see for example Johan Rockström’s assessment during #UNGA78: ““We are not making progress. Face existential challenges. And need a transformative action plan. Following another – politically flat – SDG summit & NY Climate Week….”. And Stephen Barlow even considered, in a well-argued Twitter/X thread, Birol’s relative optimism as “Complete and delusional nonsense” . Personally, I tend to side with Rockström & Barlow (and also Horton, it seems, in today’s Offline), also due to the very tricky geopolitical situation, political economy and vested interests involved. Though both Birol & Gates said a few sensible things too.
2023 is also, as noted in Le Monde, very much a year in which the recalibration of power on the world stage – with the Global South claiming more and more its place at the table, and in some cases even setting up their own tables altogether – is happening. True, in Global Health, 2021-2022 already sparked a ‘rupture’, as the sorry Covid vaccine saga pushed most global health stakeholders (well, except Thomas Cueni & friends perhaps) to the realization that charity-based “solidarity” should be a thing of the past. In sync with the blatant Covid vaccine inequity, the Decolonize Global Health movement gained further momentum, thus also increasing the pressure on ‘mainstream global health power’. This already led to Africa CDC’s New Public Health Order, for example. Nevertheless, the recalibration is a work in progress, both in general ànd in global health.
Like others, we reckon the ‘Global South’ is a very broad and thus ambiguous entity, and it appears at least three countries want to “lead” it (China, India and Brazil, with South-Africa probably not far behind). With Gordon Brown, we agree, however, that with increasing power, also increased responsibility comes. So we’re all for “Going after the Petrostates”, as he did (though way too coyly) in a Guardian op-ed earlier this week. I’d suggest WHO & Wellcome put this ‘Let the petro states at last pay!’ issue sky-high on their ‘health day’ agenda at COP28 : )
We leave you with a merry #UNGA78 quote from Mark Suzman (Gates Foundation) on Linkedin: “Soccer players have the world cup, film makers have Cannes, global health and development change makers have #Goalkeepers!”
Let me translate that for our times: “Soccer players now fancy Saudi Arabia, actors worry about AI, and “change makers” probably have better things to do than hanging around at a Gates Foundation event in the year 2023.”
Enjoy your reading.
Kristof Decoster
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02181-5/fulltext
Sorry, Horton. Have to put you right on top again : )
He compares the sorry #UNGA “outcomes” with the real challenge – for which, unfortunately we probably have less than a decade left, according to the friend he mentions, J Rockström and others. In fact, it appears Horton’s friend even says it’s too late already, and we’re heading for global civilizational collapse, ‘as tipping points have been well and truly tipped’.
David McCoy et al; https://gh.bmj.com/content/8/9/e013067
“….This paper discusses the emerging and growing health-security nexus in the wake of COVID-19 and the international focus on global health security. In recognising the contested and fluid concept of health security, this paper presents two contrasting approaches to health security: neocolonial health security and universal health security. Building from this analysis, we present a novel heuristic that delineates the multiple intersections and entanglements between health and security actors and agendas to broaden our conceptualisation of global health security configurations and practices and to highlight the potential for harmful unintended consequences, the erosion of global health norms and values, and the risk of health actors being co-opted by the security sector.”
· See also the Press release: Redefining Global Health Security: A Novel Framework Sheds Light on Equity and Decolonial Approaches
“A new policy paper spotlights the need to address the potential pitfalls of the growing health-security nexus.”
K Bertram & M Pai; https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0002368
“… There are many reasons why single-issue advocacy is popular. It is often easier to rally people around a clear, simple call to action. Donors often push for it, and everyone needs to see quick wins and success stories to keep motivated. But single-issue advocacy comes with some dangers”. The authors then list a number of these dangers.
And then argue for the following way forward: “… How do we deal these perils of single-issue advocacy? There are no easy solutions, but we can advocate for universal health coverage (UHC), stronger health systems, and greater investments in issues that affect health outcomes overall, in addition to advocating for whatever we are most passionate about. UHC is the one thing that grows the pie and unites us all, regardless of which area or population group we care about. There is no area in global health that will not benefit from UHC and a stronger, more equitable health system. The primary principle of UHC is universality—that all people are covered. Advocacy for UHC is people-centered, not focused on specific population groups or health interventions. While every disease or interest group is quick to emphasize that their area is critical for UHC, they also need to shift their single-issue advocacy to cover UHC and stronger health systems. In short, everyone in health must become an advocate for health as a human right and UHC. …. “
Nevertheless, “ … Even UHC, at some level, is constrained within the health space, when some of biggest challenges for health lie in the social, economic and political realm. Widening economic inequities, Global North’s domination of geopolitics, racial capitalism, racism, and heteropatriarchy are massive issues that UHC cannot directly address…”
Indeed.
A Darnal; https://www.worldpoliticsreview.com/global-south-countries-term-brics/?share-code=U83Zn87XcdIQ
Informative read. “…. It is important to clarify what the Global South is and is not, and to demonstrate the shortcomings of the most widely used arguments against the concept by applying them to Western-centered labels and other geopolitical and economic groups. To that end, there is a vast body of literature exploring and conceptualizing the meaning of the Global South, created by academics from around the world, including in the West. In a nutshell, the concept helps subvert paradigms and pejorative labels created by historically dominant powers by shedding light on “the different levels of in- or exclusion in international decision-making processes,” as Sinah Theres Kloss argues….”
“The “Global South” is the most multifaceted and neutral label available to refer to states that have historically been relegated to the margins of the world order….”
As we hadn’t discussed this HL meeting yet in last week’s IHP issue (the TB HL meeting took place on Friday).
PS (via HPW ) on the process now: The three political declarations on health adopted this week – on pandemics, universal health coverage and tuberculosis – will be referred to the UN General Assembly for formal ratification, said UNGA president Dennis Francis. It is possible that the 11 member states including Russia, Syria and Venezuela that disputed consensus had been reached on these declarations in a letter sent to the UN Secretary General earlier this week will object then. “Our delegations oppose any attempt to pretend to formally adopt any of the draft outcome documents in question, during the meetings scheduled for 18, 20, 21 and 22 September 2023, respectively,” the 11 warned. “In addition, we reserve the right to take appropriate action upon the formal consideration of these four draft outcome documents in the coming weeks, after the conclusion of the High-Level Segment of the 78th Session of the General Assembly, when they must all be considered by the General Assembly in accordance with its rules of procedures. However, none of the 11 contested the adoption of the declarations in the HLMs despite some of them speaking during the proceedings.”
https://www.who.int/news/item/22-09-2023-world-leaders-commit-to-new-targets-to-end-tb
WHO press statement after the TB HL meeting.
“World leaders at the United Nations General Assembly’s High-Level Meeting on Tuberculosis have approved a Political Declaration with ambitious new targets for the next five years to advance the global efforts towards ending the TB epidemic. The targets include reaching 90% of people with TB prevention and care services, using a WHO-recommended rapid test as the first method of diagnosing TB; providing social benefit packages to all people with TB; licensing at least one new TB vaccine; and closing funding gaps for TB implementation and research by 2027. ….”
PS: “….In the lead-up to this historic meeting, WHO Director-General, Dr Tedros Adhanom Ghebreyesus, officially launched the TB vaccine accelerator council to facilitate the development, licensing and use of new TB vaccines…..”
Coverage of the HL meeting. Some chunks:
“…. This declaration contains clear targets for the fight against TB. The TB community should be proud of their amazing work done to secure these targets. However, we know commitments alone aren’t enough and declarations will gather dust without further action,” said Lucica Ditiu, executive director of the Stop TB Partnership….” “In 2018 member states promised to provide $13 billion a year in annual TB funding by 2022, yet they’re providing less than half that amount – who is accountable for the failure to follow through on this promise?”…”
“The declaration offers a number of new wins for patients, notably “specific, measurable and time-bound targets to find, diagnose, and treat people with TB with the latest WHO recommended tools, as well as time-bound and specific targets for funding the TB response and R&D,” according to a civil society analysis of the TB declaration …. Another big win for the TB community is stronger language around a commitment “to strengthen financial and social protections for people affected by TB and alleviate the health and non-health related financial burden of TB experienced by affected people and their families” and to ensure that by 2027 100% of people with TB “have access to a health and social benefits package so they do not have to endure financial hardship because of their illness”….”
“But some key targets have also been watered down, such as the erosion of language around gender and human rights with none of the key asks related to ensuring that all national TB responses are “equitable, inclusive, gender-sensitive, rights-based and people-centred” being secured…..”
https://www.devex.com/news/tuberculosis-gets-some-ambitious-commitments-but-will-they-be-met-106267
More coverage & analysis via Devex.
“The meeting was the last of the three high-level meetings focused on health held during UNGA last week. Similar to the others, it ended with mixed reactions as advocates warned that the political declaration lacked or did not fully reflect some key asks from the TB community such as monitoring national strategic plans. In addition, Zimbabwe’s President Emmerson Dambudzo Mnangagwa and Saint Kitts and Nevis Prime Minister Terrance Drew were the only heads of state that attended the meeting. But Lucica Ditiu, executive director of the Stop TB Partnership, told Devex there’s still reason to celebrate. The declaration was adopted, despite earlier objections to some language in the draft. It also contains some concrete deliverables on funding…..”
On the financing: “….In the declaration, governments committed to mobilizing at least $22 billion a year by 2027, and $35 billion annually by 2030 for TB. They also committed to mobilize $5 billion a year by 2027 for TB research and innovation. These targets are ambitious, especially given that the funding commitments governments made at the last high-level meeting on TB in 2018 were not met. Less than half of the $13 billion they committed to raise by 2022 was made available. In addition, only half of the $2 billion they committed for annual TB research and development materialized….”
“ …. Prior to the meeting, there were already concerns that it may have a low turnout among heads of state. …. Ditiu said that while there were “amazing people” in the room, she expected more high-level personalities, adding that ministers of health struggle with their health budgets, and TB could benefit from support from finance ministers and heads of state. ….This is the U.N. General Assembly after all, not the World Health Assembly, she said. “You don't need to torture people for a year with declarations and to bring them to New York if it's a conversation with ministers of health. We have other platforms [for that], obviously, WHA … [but also] our own board,” she said.
“It's also disheartening because it gives a signal that TB remains medical and at the level of ministers of health,” she said, adding that TB remains the biggest infectious disease killer…..”
· And finally, a tweet from Nina Schwalbe:
“Reflections from yesterday’s high-level TB meeting at #UNGA78 Activist enthusiasm (@StopTB brought in civil society) ; Lack of high-level presence (only 1 head of state and 1 deputy prime minister spoke) ; Focus on future vaccines (vs. effective treatment available now).”
Obviously, just a flavour, as there was a lot more on NCDs – see the NCD Alliance overview.
https://healthpolicy-watch.news/ncd-gathering-unga/
“With lifestyle and diet risk factors for noncommunicable diseases (NCDs) exacerbated by climate change and air pollution, a group of national and global health leaders called for more intensive action on NCD prevention and control on the sidelines of the 78th UN General Assembly. “NCDs continue to be a public health threat that requires concerted efforts, great investments and prioritization to put countries back on course towards achieving global targets as we inch towards 2030,” said Kwaku Agyemang-Manu, Minister of Health of Ghana, who co-chaired the second annual gathering of the Global Group of Heads of State and Government for the prevention and control of NCDs. ….”
“The gathering on September 21, coinciding with the UN High-Level Meeting on Universal Health Coverage, builds on the first such meeting in Accra, Ghana in 2022, which coincided with the launch of the Global NCD Compact 2020–2030. The Compact aims to align countries around scaled-up commitments and action on the prevention and control of NCDs essential to achieving both UHC and other health-related Sustainable Development Goals (SDGs). …. The meeting was convened and led by the Global Group of Heads of State and Government for the Prevention and Control of NCDs – an informal, voluntary collaboration of countries that signed onto the Global NCD Compact, and committed to developing specific national responses on NCDs, with the aim of reducing related mortality one-third by 2030 in line with SDG target 3.4. ….”
Habib Benzian et al; https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(23)00205-0/fulltext
“The WHO Global Oral Health Status Report, published in 2022, highlighted the alarming state of oral health worldwide and called for urgent action by integrating oral health into non-communicable diseases (NCDs) and universal health coverage initiatives. 3·5 billion people have oral diseases, surpassing all other NCDs combined. The detrimental role of sugars as a risk factor for oral diseases and other NCDs has also been well documented. Despite the evidence, oral diseases and sugars are not part of the current NCD framing, which focuses on five diseases and five risk factors (ie, 5 × 5). Oral diseases and sugars remain sidelined, disproportionately affecting poor and disadvantaged populations. In this Viewpoint, we advocate for the integration of oral diseases and sugars into the current approach towards the prevention and control of NCDs. An expanded 6 × 6 framework would recognise growing evidence and would reiterate the need to strengthen action, resource allocation, and policy development for NCDs. We present the evidence and rationale for, and benefits of, an expanded NCD framework and detail recommendations to guide efforts towards improved priority, investment, and equitable health outcomes for NCDs, including oral health.”
· PS: At a side-event on oral health and UHC, co-sponsored by the Lancet and Egypt, Israel, Malaysia and Tonga, Richard Horton gave the intro statement (virtually). The side event focused on on kick-starting the WHO Global Oral Health Action Plan, a commitment to strengthening and scaling up efforts to include oral health as part of universal health coverage.
Horton: “…It’s very strange to reflect how and why the wider public health and global health communities have for so long failed to recognize the importance of oral health – and I include the Lancet in that criticism. When I look back at my own medical training in the 1980ies, oral health was entirely omitted from the curriculum. It has been for far too long an extraordinary oversight given the substantial burden of morbidity, the reduced quality of life, the reduced work productivity, family disruptions, and lost school days – all from oral diseases. Indeed, oral diseases are highly prevalent conditions, much more so than most people understand, affecting over 3.5 billion people worldwide, and especially those who live in resource-poor or marginalised settings. So there is a lot for us to catch up on…..”
“World faces ‘malaria emergency’ from resistance to insecticides, waning efficacy of drugs, funding shortfalls and climate change.”
“African leaders have warned that the world is facing the “biggest malaria emergency” of the past two decades. Heads of state and experts came together in a show of unity to call for urgent action on malaria at the UN general assembly on Friday, saying progress on eradicating the disease faced serious setbacks from mosquitoes’ growing resistance to insecticides, and the decreased effectiveness of antimalarial drugs and diagnostic tests. …. ….The group of leaders at the UN called for the establishment of national malaria councils to keep the disease on countries’ development priorities, and for extra funding from the World Bank to tackle malaria…..”
C Lynch; https://www.devex.com/news/unga-special-edition-gloom-shrouds-a-divided-world-106265
Overall analysis of #UNGA78. A few chunks of interest to us:
“The $500B elephant in the room. Devex got a peek at the Biden administration’s confidential negotiating strategy in closed-door talks on the declaration world leaders informally adopted at the summit on the SDGs. The U.S. and a small group of allies — Australia, Canada, Japan, New Zealand, and the United Kingdom — put forward a series of amendments generally aimed at limiting the role of the U.N., where all 193 members have a say, in negotiations on the reform of the international financial system. It also sought to water down a provision committing countries to “advance” Guterres’ proposal to establish a $500 billion SDG stimulus plan in a “timely manner.” The U.S. and its partners tried to call for more discussions. In the end, they failed to gain support and relented, apparently calculating it was not worth the cost of blowing up the summit.”
“… Not so high level. The three health-related high-level meetings concluded last week, but some argued it could have used a different title. Very few heads of state attended the meetings, adding to advocates' disappointment on the declarations. For tuberculosis, only Zimbabwe’s President Emmerson Dambudzo Mnangagwa and Saint Kitts and Nevis’ Prime Minister Terrance Drew showed up among world leaders. There were also only 13 heads of state who spoke at the high-level meeting on pandemic prevention, preparedness, and response. Helen Clark, former prime minister of New Zealand, who spoke at a Devex event on the sidelines of UNGA, said the little interest from heads of state just after the COVID-19 crisis is “reprehensible.”….”
Ian Scoones (IDS) ; https://zimbabweland.wordpress.com/2023/09/18/the-sustainable-development-goals-a-missed-opportunity/
Dire assessment by Ian Scoones of the future of the SDG agenda (published ahead of the SDG summit). “The SDGs (Sustainable Development Goals) are at their mid-point of implementation to 2030. Some are claiming there are reasons to be ‘hopeful’, but I am not. I was back in 2015 when they were launched, as they seemed a real opportunity to address transformations to sustainability across sectors, breaking down siloes. As many warned at the time, this hasn’t happened. The SDGs sadly have become a vehicle for mobilising funds for particular pet projects and the transformative, political potential has all but been lost…..”
PS: He also argues, correctly, that the SDGs are no longer “the only game in town”.
Another excerpt: “….Just as the MDGs before, the SDGs have become focused on ‘development’ issues in the global south. The universal ambitions have not been reached and northern countries, including the UK, have been lacklustre in their response, showing no leadership. With the world’s political axes reconfiguring, looking to China, India, Brazil (and the expanded BRICS bloc) must be a priority, but they don’t see the SDGs as ‘theirs’, more a liberal intervention from the West, with ‘high impact initiatives’ being the new flagship . And what has been offered has been a menu of technological solutionism that does nothing to address the underlying political dynamics that cause the problems in the first place. …. …. Western development priorities are not the only game in town. New configurations are emerging and the SDGs, and the focus of the SDGs may soon be seen as last year’s (or decade’s) thing, outdated before even completed…..”
· For another SDG related analysis, see HPW - Governments and Philanthropy Can’t Address Stalled SDGs Alone (by J L Castro (Vital Strategies)) “…it is a time for reckoning and for action. A time to acknowledge that achieving the SDGs is not the responsibility of governments and philanthropists alone. We need everyone at the table, from grassroots civil society to academia, the private sector and multilateral finance and banking institutions, if we are going to accelerate progress on the SDGs….”
· And a Link: Vox - Governments once imagined a future without extreme poverty. What happened?
Among others, with the rather disappointed reaction of (German) civil society on the outcome of the three HLMs. “The universal aim of these meetings was to establish the right direction to address these acute health challenges by 2030. Declarations had been painstakingly put together during several months of long and sometimes tedious processes which international civil society hoped would “be as concrete as possible: previous decisions should be reaffirmed, new strategic approaches should be defined, concrete implementation steps should be named, responsibilities should be determined and their financing should be guaranteed.””
Quote: “….Many civil society stakeholders feel that the results of the summits were far from meeting expectations. Action Against AIDS Germany issued a press release which said: “Weak declarations were adopted that represent nothing more than a minimum consensus of the involved community of states. Declarations that hurt no one and do not do justice to the multiple problems. Until the beginning of the meetings, it was anything but certain that the declarations would be adopted at all: on the eve of the summit meetings, Russia, in solidarity with a few states within its sphere of influence, had threatened to boycott the adoption of the declarations. Their voices had been ignored in the negotiations, the letter claimed.” “Unfortunately, the opposite is true,” said Sylvia Urban, spokesperson for Action against AIDS, “too many concessions were made to the forces that propagate conservative values. Of course there are differences in ideas about family, women’s rights, the perception of sexual identities and the status and importance of civil society involvement. But to stop naming vulnerable groups is going too far!...”
Rob Yates; Chatham House;
“The dwindling role of aid financing could provide the impetus for developing countries to expand domestic public health spending.” Optimistic as always, Rob. Though perhaps correct for some countries.
https://www.bmj.com/content/382/bmj.p2205
“An urgent repurposing of the UHC agenda is needed to identify and remedy the gaps in access to healthcare for those who need it most, argue Vinayak Bhardwaj and Mit Philips.”
The MSF authors conclude: “…. An urgent repurposing of the UHC agenda is needed to both identify and remedy the gaps in access to healthcare for those who need it most. To progress towards universal healthcare for all we recommend urgent mobilisation of resources targeted to free healthcare to mitigate financial barriers leading to people foregoing care, proactive provision and systematic monitoring of migrant-sensitive healthcare, and specific, funded plans to provide for the health needs of people during emergencies. Introducing these would be a basic requirement for any plan that genuinely intends to “leave no one behind.””
“the robust pipeline of tuberculosis vaccines can provide hope for people affected by it and those who have been working to end the disease….”
“One of the most talked about vaccine candidates, the M72 vaccine showed a 50% efficacy in preventing pulmonary TB disease in a phase 2b trial. The Bill & Melinda Gates Foundation and Wellcome this year announced $550 million in funding to support phase 3 clinical trials of the vaccine in more than 50 trial sites in Africa and Southeast Asia… It will take years for the results of the trial, and the vaccine won’t likely be 100% effective, but it can provide a huge amount of information about TB, and inform the development of the next generation of vaccines, said Jeremy Farrar, the chief scientist at the World Health Organization…. “I have never been more optimistic in TB that in this decade we’ll have tools that will transform it,” he told Devex.”
“But it’s not just about developing new tools. Farrar shared how the development of a new TB vaccine also provides an opportunity for change in the equity debate. …. … For tuberculosis, in particular, I think that there is an opportunity. The vaccine M72 is being developed with philanthropic money from the Gates Foundation and from Wellcome Trust in South Africa, in Indonesia, in Malawi, in Kenya, in Vietnam, [and] many countries, with other similar studies being done in India, and I hope in the future in central South America. So this is a global enterprise. And the ownership of that won't rest in Washington or Paris or London. This is something which, in my view, could actually transform the equity debate, because this can help sustain the technology transfer that the vaccines are not researched, developed, and manufactured in the global north, but their research developments, the clinical trials, and the manufacturing will be in the so-called global south…..”
“Multilateral efforts to combat climate change may have seemed shaky, at best, during this week’s United Nations General Assembly. However, the philanthropy sector sent a clear message — in the form of multiple multimillion-dollar pledges — climate action has become a top priority…..” (that’s gonna work, multi-million dollar pledges to deal with trillion dollar challenges)
https://www.thenewhumanitarian.org/news/2023/09/27/unga-takeaways-climate-change-ai-big-aid
Excerpt on AI:
“The elephant in the room: Artificial intelligence had only minor billing on the official agenda but was a looming presence on the sidelines. Blame it on months of hype, hope, and fear triggered by the rise of ChatGPT. Discussions focused on AI risks and opportunities in everything from climate action to geopolitics, big data to development, and international justice to biosecurity.
Public health must be a central part of the AI governance discussion, Tom Inglesby, director of the Johns Hopkins Center for Health Security, told one such panel at the Clinton bash. “The benefits we’re talking about will not be evenly distributed and the burdens will fall on the already marginalised.”While AI can be used to predict or respond to outbreaks – quick dengue detection, low-barrier diagnostic tools, or sped-up vaccine manufacturing, for example – it can also be misused and weaponised. “To realise the benefit of that, my worry is that we also have to take the concerns of AI head on,” Inglesby said…..”
· And a link: MPP - Voluntary licensing and technology transfer deemed critical to support manufacturing capacity at UN General Assembly
With New York’s HL event on PPPR over, the action moves again to Geneva. And this Thursday, there was also an event in Berlin.
“In their statements during the New York discussions on PPR, a number of developing countries emphasized the need for addressing equity considerations in on-going negotiations in Geneva. ….
…Developed countries, including the EU emphasized their support to the Pandemic Fund and to the ACT Accelerator. Norway in its statement pushed for an interim countermeasures platform…..”
https://www.devex.com/news/pandemic-treaty-draft-lacks-accountability-106258
“Negotiators in Geneva are contentiously drafting a global accord on pandemic prevention, preparedness, and response — but experts are concerned about whether accountability measures will ensure it has teeth. “In the current draft, there are no accountability mechanisms,” said Lawrence Gostin, director of WHO’s Collaborating Center on Global Health, during a Devex event held on the sidelines of the United Nations General Assembly in New York City this week…..”
…. “There is a lack of trust in Geneva now among the negotiators — [global] north and south — and this is at the heart of it,” he said.”
Also with the view of Nina Schwalbe.
· See also NPR – The world hopes to enact a pandemic treaty by May 2024. Will it succeed or flail?
Also with an assessment by L Gostin of how the negotiations are going.
A Soliman et al (Authors are all members or former members of the Bureau of the INB) https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02018-4/fulltext
“Although the process of drafting a pandemic accord has been transparently informed to global communities in 2022 and 2023, there has been a substantial amount of misinformation related to the contents of the WHO Convention, Agreement, or Other International Instrument on Pandemic Prevention, Preparedness, and Response (WHO CA+) circulated on platforms such as YouTube and X (formerly Twitter). This misinformation includes assertions that this pandemic treaty threatens national sovereignty, that WHO would deploy troops to enforce the treaty, and that national armed forces would be deployed to implement the treaty under UN orders….”
The authors thoroughly debunk this fake news. “Sovereignty stands as one of the key guiding principles in the proposed bureau text. Sovereignty entails that WHO member states, in accordance with the UN Charter and general principles of international law, possess the sovereign right to enact and implement legislation in alignment with their health policies by upholding the purposes and objectives of the WHO CA+ and carrying out the obligations under the WHO CA+ in a manner consistent with the principles of the sovereign equality and the territorial integrity of member states and that of non-intervention in the domestic affairs of other member states. The bureau text includes provisions safeguarding national sovereignty, which has been consistently emphasised by the Intergovernmental Negotiating Body (INB) during negotiations. …. ….The WHO CA+ was drafted by countries through the INB's processes and is expected to be agreed upon by the World Health Assembly in 2024. This step will not give the WHO CA+ international legal effect until an as yet undetermined number of countries ratify, at which point it will become part of international law, binding those countries that have agreed to it. The right of a sovereign state to ratify the accord, or not to ratify it, is not subject to WHO overruling, but rather is part of the autonomy of each nation. WHO's powers are delineated in a legally binding international constitution that confines its authority to undertaking international health work. WHO does not hold jurisdiction over national health work. The WHO Director-General and staff cannot enforce decisions, such as imposing a lockdown, mandating vaccination, or dictating the opening or closing of borders. Such decisions remain within the sovereign domain of each country….”
Ellen ‘t Hoen ; https://www.ft.com/content/c76d6f5a-0d82-493c-8d8a-5cdf8cf4a1d4
“Addressing this IP issue is crucial to ensuring pharmaceutical products are available in future emergencies.”
“Discussions now taking place at the World Health Organization seek to reach consensus on a new pandemic agreement. The intention is to learn from mistakes made during Covid-19 to better prepare for the future. Unfortunately, a key intellectual property problem remains unaddressed, threatening to limit the scope of what the agreement can achieve in assuring timely and equitable access to pandemic countermeasures. Pharmaceutical products such as medicines, vaccines and diagnostics can be protected by several types of intellectual property, including patents and trade secrets. Although a basic description of how to manufacture a product may exist in published patent documents, its manufacture at scale often requires access to associated trade secrets developed by the patent owner. This is especially true of complex products such as monoclonal antibodies or mRNA vaccines. The current draft does not address this and is thus essentially limited to enabling the manufacture of comparatively simple pharmaceutical products, which generally do not require access to information that is not publicly available. To extend its scope, countries must consider an additional measure that can compel the sharing of trade secrets in a pandemic emergency. Such a measure would be in the interest of high-income countries (HICs) just as much as low- and middle- income ones (LMICs)…..”
“…. We therefore propose a new measure requiring countries to compel intellectual property owners to share trade secrets when determined necessary in a pandemic emergency. It is based on powers already used in HICs in the context of antitrust law and national emergencies. Such powers are compatible with the World Trade Organization agreement, which only requires that trade secrets be protected against unfair competition…..”
Guest essay by M Sirleaf & A Phelan; GHF
“In today’s edition, global health legal scholars Matiangai Sirleaf & Alexandra Phelan, argue that enshrining the principle of CBDR in a pandemic accord could go towards “decolonizing global health law”. They illustrate how CBDR and related principles can be applied to the issue of access and benefits sharing, and for financing matters. But they also caution against using Loss and Damage (L&D) approaches as seen in the policy response to the climate crisis. They say that applying L&D to pandemics could result in “assigning blame for the emergence of infectious diseases in resource constrained settings, rather than allocating responsibility derived from colonialism.” However tailoring this approach to pandemics would involve “reparatory justice for the losses and damage experienced in already resource-constrained settings arising out of the Global North’s actions, such as engaging in acts of vaccine apartheid,” they suggest.”
Cfr their abstract: “Global health law for pandemics currently lacks legal obligations to ensure distributional and reparative justice in critical areas, such as equitable access to vaccines, diagnostics, and therapeutics, and compensatory financing to strengthen health systems. This reflects the colonial history and present of international law for infectious diseases. In contrast, Global South efforts in the realm of international environmental law have propelled the development of novel international legal mechanisms to address global injustices arising from the disproportionate contributions to — and impacts of — climate change and biodiversity loss. These mechanisms seek to address international inequity, colonialism, and injustice, and include operational provisions to realize common but differentiated responsibilities (CBDR), access and benefit-sharing (ABS), and loss and damage (L&D). Early efforts to draft an international treaty for pandemic preparedness and response to build a more robust global health architecture provide new possibilities for decolonizing global health law. This is especially true when it comes to recognition of CBDR and ABS in global health law-making; however, caution is warranted when applying L&D to pandemic preparedness and response, as this framework could undermine global solidarity when it is needed most. This column explores the appropriateness of these international environmental law mechanisms, encouraging countries to consider integrating them in global health law reform processes.”
https://www.bmz.de/en/news/pandemics-conference?utm_source=msf.de&utm_medium=shortener
“The German Federal Ministry for Economic Cooperation and Development (BMZ) and the German Federal Ministry of Health (BMG) [plan to] convene a dedicated high-level forum entitled “Pandemics – no time for neglect” on 28 September 2023. The forum will be held in Berlin. Together, we will discuss necessary actions and political priorities regarding pandemic prevention, preparedness, and response as well as financing resilient health systems.”
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02184-0/fulltext
“Waning demand has left COVAX, the scheme to provide COVID-19 vaccines to lower-income countries, with billions of unspent dollars. What to do with the money? Ann Danaiya Usher reports.”
“Gavi, which raised resources for COVAX, might end up with more than US$3 billion in unspent donor grants. This could have far-reaching implications for the power balance in global health, whereby Gavi, with its tremendous fundraising capabilities, could further strengthen its position at the expense of other agencies. How did COVAX end up with so much extra money? And what should be done with this enormous sum if lower-income countries no longer want COVID-19 vaccines?”
“…. It is not obvious how these unspent billions of dollars in COVAX should best be used, and donors have already postponed their decision twice. In early 2022, Gavi had envisioned that some of the money could be used to respond to a future pandemic. But repurposing funds earmarked for COVID-19 would require that some donors seek approval, which would risk treasuries taking the money back and it being lost to both Gavi and global health. Faced with this prospect, Gavi is holding on to about half the money for the next few years for COVID-19 vaccines and is looking to repurpose the rest for other vaccine-related initiatives run by Gavi.”
“So far, donors have approved the Gavi Secretariat's proposals to keep $1·65 billion of the remaining unspent COVAX money for COVID-19 vaccines…. Global health experts have expressed surprise and dismay at the donors’ willingness to reserve resources on this scale for COVID-19 vaccines. …”
“…. Although the donors have approved the earmarking of $1·65 billion up to 2025 for COVID-19, they are aware that all this money will probably not be spent. John-Arne Røttingen, Norway's Global Health Ambassador and Gavi board member, representing Norway, Sweden, Finland, the Netherlands, and Switzerland, acknowledges that country demand will likely remain low. As such, he does not expect the funds allocated for 2023 or for 2024–25 to be fully used up, noting that some of the demand can be covered by vaccine donations…..”
https://aidspan.org/whose-national-strategy/?utm_medium=email&utm_source=es
This week’s issue has two articles focusing on country ownership. This is the first one. “Donors encourage country ownership but what does this mean in practice?” Focus is here on national strategic disease plans or NSPs.
Second one: Heavy-handedness will not deliver the best results
“ CSOs in Zambia complain to the Global Fund about the Country Team’s approach in grant making.”
S Peck et al; https://www.cgdev.org/blog/team-europe-initiatives-three-years
“In 2020, the European Union (EU), together with its Member States and financial institutions, formed “Team Europe” to provide a collective global response to the COVID-19 pandemic. Although born out of a crisis, the Team Europe approach has now become the norm for how investments in developing countries are managed by the EU. 168 Team Europe Initiatives (TEIs) are currently being rolled out across the globe. In this blog, we look at the geographical and sectoral distribution of these TEIs, as well as the Member States and the institutions who are involved in them. And we look at the outstanding questions around the transparency of the projects, the coherence across the initiatives and the ownership of the investments by partner countries. ….”
Among others, they note: a focus on sub-Saharan Africa; and prioritizing the EU Green deal and human development. On the latter: “ …while the focus on the external dimension of the European Green Deal remains, a significant share (58 percent) of the initiatives is directed at human development. No fewer than 10 EU Member States joined forces on a TEI on sexual and reproductive health and rights in Sub-Saharan Africa. ….”
And the TEIs are dominated by large players (France, Germany, and the European Investment Bank).
P Baker et al; https://www.cgdev.org/blog/five-proposals-new-era-uk-global-health-policy
“The UK is, hopefully, coming out of its nadir in international development. This is marked by planned rises in development spend, an ambitious new international development white paper, a supportive Minister, and a new parliament in 2024. But before considering any proposal, future governments with ambitious plans for global health must first be clear on the current challenges…..” Which they then list before moving to the aim of the blog:
“In this blog, we lay out an initial set of five proposals that future governments may wish to consider when responding to these challenges….”
The blog concludes: “The UK’s white paper, a supportive Minister, rising development spend in 2023-2024, and a new parliament in 2024 offers a chance to step up UK global health policy and practice. Against this backdrop, CGD is conducting a review of global health challenges and opportunities facing a future UK government in 2024 (look out for this in October). Based on our initial findings, we encourage the UK to seek a new health financing compact between donors and country governments, leverage the UK’s comparative advantage in health systems as much as in science, set clear global health priorities and monitor them, reform research systems to support global health, and proactively strengthen and reform the global health architecture while minimising trade-offs with national system development. The UK has lost its historic leadership in global health, now is the opportunity to regain it.”
https://www.hrw.org/news/2023/09/25/imf-austerity-loan-conditions-risk-undermining-rights
“Compound Problems of Rising Inequality, Flawed Mitigation Efforts.”
“The International Monetary Fund, with a global debt crisis looming, is setting conditions for its loans that risk undermining people’s economic, social, and cultural rights, Human Rights Watch said in a report released today. The conditions are compounding problems related to rising inequality. The 131-page report, “Bandage on a Bullet Wound: IMF Social Spending Floors and the Covid-19 Pandemic,” analyzes loans approved from March 2020, at the start of the Covid-19 pandemic, until March 2023 to 38 countries, with a total population of 1.1 billion, and finds that the vast majority are conditioned on austerity policies, which reduce government spending or increase regressive taxes in ways likely to harm rights. It also finds that recent IMF initiatives, announced at the beginning of the pandemic, to mitigate these impacts such as social spending floors are flawed and ineffective in addressing the harms caused by the policies. …”
With some recommendations.
· The HRW report: Bandage on a Bullet Wound: IMF Social Spending Floors and the Covid-19 Pandemic
T Frieden & M Buissonnière; https://www.devex.com/news/opinion-revitalize-world-bank-health-spending-with-3-pragmatic-changes-106184
“…. Based on our long-standing support for and close partnership with the bank, we believe the following three fundamental changes are needed to strengthen its health programming and make it work for countries in greatest need: reshape what it funds, rework how it funds, and focus its role.”
On the first issue: “The bank should fund not only investment costs, e.g., buildings, but also operating costs, e.g., salaries, maintenance, and supplies. In particular, projects must have sufficient staff to work within government programs….. “
On the second: “The bank must overhaul its operating procedures. These procedures are complex, rigid, and slow. Even after funding is approved it can take months or years before funds flow to designated health projects. Intricate disbursement and procurement processes involving multiple layers of documentation, approval, and compliance checks create challenges in accessing funds. The authors offer some suggestions to change this….”
On the third: “The bank needs to sharpen its focus on serving the current needs of lower-income countries…. By having a clear focus on a grants-and-debt-relief model, the bank can clarify its role as a financial institution supporting countries and delivering sustainable impact.”
“Basic childhood immunisation rebounded in 2022, as lower-income co untries committed historic levels of domestic funding to immunisation programmes. Data on outbreaks, population growth, geographic equity highlights challenges ahead, as countries seek to recover immunisation to pre-pandemic levels and expand progress while dealing with multiple threats.”
“…In 2022, lower-income countries collectively contributed US$ 162 million to co-finance Gavi-supported vaccines, the highest amount in Gavi’s history. This brings the total amount contributed by lower-income countries since 2008 – when country co-financing began – to US$ 1.5 billion. The report shows that, despite a period of economic turmoil, and with the exception of three waivers due to humanitarian crises, all countries met their vaccine co-financing targets in 2022. This data highlights that immunisation remains a top priority on the political agenda as well as a challenge, with country co-financing projected to substantially increase again, by more than 30%, in 2023….”
Check out the other findings.
https://www.who.int/news/item/22-09-2023-new-analysis-confirms-world-seeing-an-upsurge-of-cholera
From late last week (and also mentioned by Tedros in his media briefing this Wednesday as a major worry). “Comprehensive cholera statistics for 2022, published by WHO today, shed light on the scale and extent of the ongoing cholera upsurge. While data for cholera remain inadequate, cases reported to WHO in 2022 were more than double those in 2021. Forty-four countries reported cases, a 25% increase from the 35 countries that reported cases in 2021. Not only were there more outbreaks, but the outbreaks were larger. Seven countries –Afghanistan, Cameroon, Democratic Republic of the Congo, Malawi, Nigeria, Somalia, Syrian Arab Republic–have each reported over 10 000 suspected and confirmed cases. The larger the outbreak, the harder it typically is to control….”
“….Current data for 2023 suggest that this global upsurge is continuing. Twenty-four countries are currently reporting active outbreaks, with some countries in the midst of acute crises…..”
“….WHO has appealed for US$ 160.4 million to respond to cholera through the global strategic preparedness, readiness and response plan. US$ 16.6 million has been released from the WHO Contingency Fund for Emergencies for cholera response in 2022 and 2023……”
· Coverage among others via Cidrap News - WHO: Cholera cases more than doubled in 2022
Related: Science - A time of cholera (also focusing on the link with climate change)
https://www.thelancet.com/commissions/women-power-and-cancer
“Women interact with cancer in complex ways, as healthy individuals participating in cancer prevention, as patients, as health professionals, researchers, policymakers, and as unpaid caregivers. In all these domains, women often are subject to overlapping forms of discrimination, such as due to age, race, ethnicity and socio-economic status, that render them structurally marginalized. These myriad factors can restrict a woman’s rights and opportunities to avoid cancer risks, are a barrier to diagnosis and quality cancer care, maintain an unpaid caregiver workforce that is predominantly female, and hinder women’s professional advancement. The Lancet Commission on women, power and cancer was created to address urgent questions at the intersection of social inequality, cancer risk, and outcomes, and the status of women in society.”
· Check out the Commission.
With 10 key findings & 10 priority actions.
· Related Lancet Comment – Women, power, and cancer: a need for change and a force for progress (by M Bertagnoli)
https://www.theguardian.com/society/2023/sep/26/feminist-approach-cancer-save-lives-800000-women
Coverage. “Gender inequality and discrimination impede timely diagnoses and quality care for women around the world, says report.”
“Health experts are calling for a “feminist approach” to cancer to eliminate inequalities, as research reveals 800,000 women worldwide are dying needlessly every year because they are denied optimal care….. gender inequality and discrimination are reducing women’s opportunities to avoid cancer risks and impeding their ability to get a timely diagnosis and quality care, according to a report published in the Lancet. The largest report of its kind, which studied women and cancer in 185 countries, found unequal power dynamics across society globally were having “resounding negative impacts” on how women experience cancer prevention and treatment. …. There was particular focus on “women’s cancers” – including breast and cervical – despite lung and colorectal cancer being among the top three causes of deaths from the disease, researchers said…..”
“Gender inequalities are also hindering women’s professional advancement as leaders in cancer research, practice and policymaking, which in turn perpetuates the lack of women-centred cancer prevention and care, the report adds….”
PS: “ A second study published in the Lancet Global Health suggests 1.5m premature cancer deaths in women under 70 in 2020 could have been prevented with the elimination of exposures to key risk factors or via early detection and diagnosis…..”
· More coverage via Stat: Women face host of disadvantages in cancer prevention and care, report finds
“Former British PM calls for 3% levy on oil and gas export revenues of biggest producers to generate $25bn a year for global south.”
“Countries with large oil and gas deposits have enjoyed a record bonanza in the last two years, amounting to about $4tn (£3.3tn) last year for the industry globally. Levying a 3% windfall tax on the oil and gas export revenues of the biggest-producing countries would yield about $25bn a year.
Previous calls for windfall taxes on oil revenues have focused on large private-sector companies such as Shell, BP, Total and ExxonMobil. However, private-sector companies account for only about 15% of oil and gas production worldwide. Most production comes from nationally owned oil companies, known as NOCs, in countries such as Saudi Arabia, the United Arab Emirates and Norway. Brown said the money could be used to help countries in the global south raise people out of poverty, cut greenhouse gas emissions and cope with the effects of the climate crisis…..”
For Brown’s oped in the Guardian, see
“Petrostates like Saudi Arabia and Norway have made staggering oil and gas profits. A simple levy could funnel money to the countries that need it…
D Rodrik & I Diwan; https://www.project-syndicate.org/commentary/low-middle-income-countries-debt-development-climate-crisis-by-dani-rodrik-and-ishac-diwan-2023-09
Excerpt: “…. Our own proposal for a “bridging compact” operationalizes this idea. Led jointly by the United Nations, the World Bank, and the IMF, it would support not just insolvent countries in need of debt haircuts, but also illiquid countries in need of rescheduling. Countries that have experienced negative net transfers with important creditors could choose to enter an adjustment program that postpones their debt obligations in exchange for a commitment to reforms. The goal is to create value through coordination, with the presumption that a country can grow out of debt if it is provided with liquidity, and if it pursues policies to achieve sustainable growth. To be effective, this bridging compact must be anchored in a national renewal program that includes measures to constrain budgets and reforms to move onto a new growth path. That will require more funding from both the IMF and the World Bank, with conditionalities extending beyond the typical three-year IMF program. Countries that avail themselves of this option should be the first to benefit from a scaling-up of IMF and MDB funding, which in turn would help to prevent a systemic debt crisis that would hurt everyone…..”
“Even before the United Nations Climate Ambition Summit last week in New York, September was a busy month on the climate diplomacy front — especially in lower-income countries that bear the brunt of climate change but have done little to cause it themselves. Kenya's Nairobi played host to the high-profile inaugural Africa Climate Week. There was the World Summit of Development Banks in Cartagena, Colombia, where climate finance was a big topic. The focus then shifted to New Delhi as it hosted the summit for the Group of 20 major economies, where some of the most powerful global south countries promised to triple their renewable energy capacity. As lower-income countries grow ever distrustful of the global north’s climate leadership, they are looking to themselves, playing host and taking on larger roles in high-profile international convenings….”
“…Increasingly, lower-income countries are not just demanding a greater voice, but setting the agenda and driving solutions such as expanding the transition to green energy. It’s indicative of a broader movement in which they feel empowered to decide their own futures, not just on climate but on international trade and finance. …. Meanwhile, the demand for climate finance — especially from their wealthier counterparts — is growing louder. Experts say the meetings will help build consensus by the time the annual U.N. Climate Change Conference, this year dubbed COP 28, comes around later this year. There, high-income nations tend to hold outsize influence. …Broadly speaking, lower-income nations are seeking more climate finance to pay for the so-called loss and damage already caused by climate change in order to adapt to ongoing changes and to mitigate further ones. And high-income nations are unwilling to provide all the financing that is needed, said T. S. Tirumurti, who is India’s former permanent representative to the U.N. and has been a part of several COP negotiations. That is evident in their failure to provide a promised $100 billion per year in climate finance to lower-income countries….”
“…. Another theme common in the meetings is the ask for equity for countries grappling with major development needs. Most future climate projections require all countries to make drastic emission cuts while lower-income countries say they will need time to grow and improve the living conditions for their populations. …“I think this is an issue that came up quite strongly — that it's climate action, but not at the cost of development,” Mathai of WRI said…..”
https://www.nature.com/articles/d41586-023-02995-7
“But to breach the Paris agreement’s limit, the heating must be sustained for many years.”
“In its August 2023 monthly update, Berkeley Earth — a non-profit climate-monitoring organization — has put the chance of 2023 being on average 1.5 °C warmer at 55%. This is up from a chance of less than 1% predicted by the team before the start of the year, and the 20% chance estimated using July’s figures. ….”
K Kupferschmidt; https://www.science.org/content/article/malaria-cases-could-ebb-even-hotter-world-other-diseases-will-get-worse
“Researchers struggle to convey the complex impacts of climate warming on infectious disease.”
Malaria cases could ebb in an even hotter world. But other diseases will get even worse. Dengue first of all. This excellent article tackles what we know about how climate change is going to impact infectious diseases around the world. It's also about communication, complexity and nuance.
Part of a special issue in Science – An unhealthy climate More articles will be published in the coming days (see also the extra section on ‘Infectious Diseases’ below).
“Vector-borne diseases are a special worry. A warmer climate favors the mosquito that spreads dengue and may already be fueling a worldwide surge…..”
https://news.un.org/en/story/2023/09/1141312
“The consequences of poor chemicals and waste management worldwide are fuelling an “unprecedented global toxic emergency”, independent UN human rights experts have warned, ahead of a major summit ….”
“The fifth session of the International Conference on Chemicals Management (ICCM-5), organized by UN environment programme UNEP and hosted by Germany, kicks off in Bonn on Monday. “ICCM-5 is expected to be a watershed moment for international cooperation on chemicals and wastes”, said a statement released by the group of more than 30 experts. ….”
https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(23)00214-0/fulltext
“A UN's special rapporteur on human rights and the environment is exploring whether international dispute mechanisms compromise action on climate change and development—and how that can change.”
“….Concerned about the influence of these international agreements, the UN's special rapporteur on human rights and the environment David R Boyd is exploring how ISDS mechanisms relate to the right to a clean, healthy and sustainable environment. Boyd tells the Lancet that ISDS lawsuits, and even the threat of such claims, are blocking urgently needed actions to prevent planetary catastrophe and protect human rights. “An explosion of ISDS claims in recent years is led by fossil fuel, mining and other extractive industry corporations, resulting in exorbitant damages awards against states, permits granted for environmentally destructive activities, and the weakening of vital rules intended to address the climate crisis,” says Boyd. … A press release from the Office of the United Nations High Commissioner for Human Rights hints that states have already been ordered to pay more than US$100 billion to corporations in the coal, oil, gas, electricity and mining industries by international arbitration panels—a figure that will be explained when Boyd's final report is published in October….. Boyd believes states must take immediate action to end their exposure to ISDS claims by withdrawing their consent to arbitration under existing investment agreements, negotiating a removal of ISDS or terminating existing agreements that include these mechanisms.”
“He believes a wholly new regime is needed for governing international investment that “advances, and does not undermine, the achievement of climate and other sustainable development goals and the realisation of human rights”.”
“IEA’s Fatih Birol says uptake of solar power and EVs is in line with net zero goal but rich countries must hasten their broader plans.”
“The prospects of the world staying within the 1.5C limit on global heating have brightened owing to the “staggering” growth of renewable energy and green investment in the past two years, the chief of the world’s energy watchdog has said. Fatih Birol, executive director of the International Energy Agency, and the world’s foremost energy economist, said much more needed to be done but that the rapid uptake of solar power and electric vehicles were encouraging……”
· See also Climate Home News - The International Energy Agency calls on countries to bring forward net zero targets and rely less on fossil fuel technofixes.
https://fortune.com/2023/09/20/bill-gates-climate-exaggeration-bloomberg-prince-william-earthshot/
“The world will not be able to meet its agreed-upon goal to limit future warming to 1.5 degrees Celsius (2.7 degrees Fahrenheit) above pre-industrial temperatures, but it won’t hit the 3-degree Celsius mark either, said Gates, who is not a climate scientist. Gates cited a reason for thinking it won’t be as bad as it once looked: Since 2015, until last year, the world went on a “gigantic” innovation binge in efforts that could help curb climate change….”
““I’m the person who’s doing the most on climate in terms of the innovation and in how we can square multiple goals,” Gates said during an onstage interview at the New York Times’ Climate Forward Summit. The threats, while severe and acute, have solutions and therefore won’t lead to the end of the world, he says. “There’s a lot of climate exaggeration,” he said earlier this week at a separate event, the Earthshot Prize Innovation Summit, which he attended with billionaire Michael Bloomberg and Prince William of the UK. “Climate is not the end of the planet. So the planet is going to be fine.”…”
“He reiterated that sentiment at the Times event a few days later. “There are effects on humanity, the planet less so,” Gates said. “It’s a fairly resilient thing. But the reason I'm engaged is because it affects human welfare.” He went on to say that he views the climate crisis primarily through the lens of malnutrition, which will only become exacerbated as it becomes increasingly difficult to grow crops in equatorial regions due to global warming. His optimism stems from his belief that humanity will find a way to solve the problems climate change will undoubtedly present…..”
“Air pollution causes seven million premature deaths every year – yet a minuscule 1% of international development funding ($17.3 billion) and 2% of international public climate finance ($11.6 billion) was allocated to reducing it between 2015 and 2021. This is according to the Clean Air Fund’s (CAF) report on global air pollution mitigation funding released on Thursday. The funders included are multilateral development banks such as the World Bank, bilateral development agencies and governments that fund low- and middle-income countries via loans and grants. …”
“During the same period, development funders committed almost three times as much money ($47.4 billion) to fossil fuel-prolonging projects, primarily oil and gas extraction and production, according to the report. More positively, funding for fossil fuel-prolonging projects declined over time and by 2021, outdoor air quality funding ($2.3 billion) exceeded investments in fossil fuel-prolonging projects ($1.5 billion) for the first time…..”
PS: “…. The money doesn’t always go where it is needed most. A staggering 86% of funds for outdoor air quality improvement went to five countries: China (37%), Philippines (20%), Bangladesh (17%), Mongolia (6%) and Pakistan (6%). India and Nepal have the highest population-weighted exposure to air pollution (PM2.5), yet they each received less than 1% of the total. Meanwhile, Africa received 5% although five of the top 10 countries with the highest average PM2.5 exposure are on the continent….”
See also Morocco world news :
“The pharmaceutical giant’s plans in Africa are in question after a lack of communication. …. German biotech giant BioNTech is revising its plans for a vaccine factory network in Africa, according to business news outlet Bloomberg. According to a report published on Saturday, the company is reconsidering its plans for factories in Rwanda, South Africa, and Senegal, over a year after they broke ground on their Rwanda facility. Although the company recently shipped six containers to Kigali for construction purposes, they are reportedly considering scrapping the South Africa facility and downgrading the Senegal site to a smaller-scale factory or possibly an R&D center. The revised plans bring Africa’s vaccine self-sufficiency hopes into question, especially after countries in the continent struggled to perform effective vaccination campaigns during the COVID-19 pandemic. The planned factory network in Africa was part of the German company’s efforts to ensure equal global access to mRNA vaccines, which were infamously hoarded by richer countries during the recovery from the pandemic……”
· Related tweet by Fatima Hassan: “This IS why we previously called it a CON-tainer model! Words. Voluntary measures and pledges are not enforceable. We need a new system. #CONtainer #Biontech.”
PS: do read (by B Baker & F Hassan): Covid-19’s silver lining? The WHO mRNA Technology Transfer Programme for the Global South - Overcoming IP Barriers is central to the South-South Innovation and Access Goals of the WHO mRNA Technology Transfer Programme.
“The impact generic and biosimilar medicine manufacturers can have on reducing global health inequities has not yet been fully realised. To assess what is currently being done by the generics industry to expand access to medicine in low- and middle-income countries (LMICs), a new report from the Access to Medicine Foundation profiles five market-leading companies: Cipla, Hikma, Sun Pharma, Teva, and Viatris.”
Key messages: “Along with detailed company profiles, the report identifies key findings and opportunities to strengthen manufacturing and improve availability of generic and biosimilar medicines. Although examples of access strategies could be identified, within these there was almost no evidence of strategies designed to boost affordability by taking ability-to-pay into account, especially for patients paying out of pocket. In 90 of the 108 countries in scope, at least one of the companies has registered a product – but for the essential medicines analysed in more detail, companies vary significantly in their registration practices in LMICs. “
See also last week’s IHP news.
“A new deal between Danish company Novo Nordisk and South African generic manufacturer Aspen will massively expand the supply of insulin in sub-Saharan Africa and also transfer the production rights and technology to the African company. The deal will more than double Novo Nordisk’s production in a year, from its current level of meeting the insulin needs of 500,000 people with diabetes in sub-Saharan Africa to being able to supply insulin for 1,1 million people by next year. By 2026, the two companies will be able to meet the insulin needs of 4,1 million people living with type 1 and type 2 diabetes across the African continent. According to the agreement, Novo Nordisk has a minimum purchase obligation from Aspen of €195.5 million for the period 2024-2028. …”
““The human insulin will be distributed at low cost to health authorities and non-governmental organisations through government tenders as part of Novo Nordisk’s sustainable business integrated model, iCARE. With iCARE, Novo Nordisk will guarantee a ceiling price of human insulin at $3 per vial,” according to a media release from the company. …”
“The expanded commitment supports the African Union’s Pharmaceutical Manufacturing Plan for Africa. The collaboration between the partnership allows for local production, storage, and distribution of human insulin in vials in the African continent and means more equitable access to lifesaving care to people with diabetes,” the company added.”
“Revital Healthcare EPZ Ltd., a leader in African medical device manufacturing, announces a historic milestone in African manufacturing excellence. The company is the first to be granted Pre-Qualification (PQ) status by the World Health Organization (WHO) on July 11, 2023 for their early activation auto-disable (AD) syringe in Africa. This marks Revital’s more than ten-year commitment to injection safety in immunization programming across Africa….”
“…. There are currently eight manufacturers who have WHO PQ status for this product, however Revital’s is the first and only to be produced in Africa. This is expected to decrease average syringe transport times by up to 80-90% for Africa, critical for rapid outbreak response and timely immunization campaigns…. … This work was made possible through a grant from the Bill & Melinda Gates Foundation. ….”
W Liang et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01856-1/fulltext
“….. Previous evaluations of health-related poverty alleviation efforts in China have been narrow in scope, fragmented, and largely subjective. Recognising the complexity of this issue and the need for comprehensive evaluation of China's poverty alleviation policies and interventions, a Commission has been formed as a collaboration between Tsinghua University's Vanke School of Public Health and The Lancet. The Commission's 30 independent Commissioners are experts in fields such as health policy, development economics, epidemiology, sociology, governance, and implementation science; are from high-income, middle-income, and low-income countries; and have good gender representation. We aim to assess systematically, critically, and independently, China's experiences, setbacks, and challenges regarding its poverty alleviation campaign, especially around health-related domains. To achieve this goal, the Commission plans to conduct a series of independent investigations into the different dimensions and the effects of China's Health and Poverty Alleviation Campaign. …”
“… The main findings of the Commission's work are expected to be available by 2024. Through the collection and analysis of empirical evidence, the Commission endeavours to track the progress of and provide valuable insights into China's ongoing and future trajectory for sustainable health and poverty alleviation. It will also provide new evidence to other countries who are developing health-related policies to alleviate poverty.”
https://www.imperial.ac.uk/news/247943/experts-warn-that-global-health-challenges/
“Countries will need innovative, fair and inclusive leadership to navigate new and increasingly complex global health challenges.”
“This was the main takeaway from a roundtable discussion hosted by the Centre for Health Economics and Policy Innovation at the (Imperial College) Business School, which brought together experts from academia, public health organisations and politics to debate the issues. The roundtable was co-organised with the George Institute UK and the Saw Swee Hock School of Public Health (NUS), as a special event in the context of a meeting of a new Lancet Commission - the Pandemic Readiness, Implementation, Monitoring and Evaluation (PRIME) Commission. The Commission, co-led by Imperial’s Professor Helena Legido-Quigley, Chair in Health Systems Science, set out goals for their report, which is expected to publish in The Lancet in 2025….”
https://www.who.int/news/item/26-09-2023-ban-smoking-and-vaping-in-school-to-protect-young-people
“Today, the World Health Organization released two new publications, “Freedom from tobacco and nicotine: guide for schools,” and “Nicotine- and tobacco-free school toolkit” to help protect children’s health just in time for back-to-school season in many countries. … ….The new guide and toolkit are step by step manuals for schools to create nicotine- and tobacco-free campuses, but it takes a “whole of school” approach – which includes teachers, staff, students, parents, etc. The guide and toolkit include topics on how to support students to quit, education campaigns, implementing policies and how to enforce them…..”
“The guide highlights four ways to foster a nicotine- and tobacco-free environment for young people: banning nicotine and tobacco products on school campuses; prohibiting the sale of nicotine and tobacco products near schools; banning direct and indirect ads and promotion of nicotine and tobacco products near schools; and refusing sponsorship or engagement with tobacco and nicotine industries.”
Halina Suwalowska et al;https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(23)00420-5/fulltext
“Every year, millions of dead people across the globe remain unidentified and are never returned to their families or communities. The circumstances surrounding their death are often unknown, and their bodies go unclaimed. Identification represents one of the most basic of all human rights and yet with continuing humanitarian disasters, infectious disease outbreaks, mass migrations on precarious and often deadly land and sea routes, as well as human trafficking, the numbers of unidentified dead bodies grow. The presence of unidentified bodies raises pressing ethical and practical concerns that demand immediate attention to successfully attain global health objectives including serving the vulnerable, reducing health inequalities, and responding to humanitarian crises….”
“New research concludes that disparities in treatment show the need to improve access to care, particularly in developing countries.”
“About 40% of people living with diabetes globally go undiagnosed, according to new research. Most people who are not diagnosed live in Africa (60%), followed by south-east Asia (57%) and the western Pacific region (56%), says the 2023 diabetes global industry overview, the largest survey of its type to date. Half of those who are diagnosed do not receive treatment, said the report….”
D C Lim et al ; https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(23)00182-2/fulltext
“Healthy sleep is essential for physical and mental health, and social wellbeing; however, across the globe, and particularly in developing countries, national public health agendas rarely consider sleep health. Sleep should be promoted as an essential pillar of health, equivalent to nutrition and physical activity….”
Key messages from WHO’s media briefing on Wednesday.
“ A dearth of data and low public awareness of the presence of pollutants in the indoor air we breathe are the greatest impediments towards making spaces more healthy, experts said at the first World Health Organization/Europe Indoor Air Conference. The conference on Wednesday 20 September, was the first-ever WHO event focusing on the wide range of indoor air pollutants that can affect the health of people in modern homes and buildings. It was co-hosted by WHO’s European Region, the Swiss government and the Geneva Health Forum. ….”
“The conference went beyond long-discussed issues of indoor air pollution from coal and biomass heating and cooking systems, which are a major issue in many low and middle-income countries, including parts of WHO’s 53-country European Region. ….”
https://healthpolicy-watch.news/europe-struggles-to-keep-health-systems-afloat/
Coverage of the Gastein Forum.
“European health systems, among the best-funded and most equitable in the world, face a barrage of threats to their long-term stability, highlighting the difficulty of achieving and maintaining universal health coverage even in the world’s wealthiest regions.”
“Experts and political leaders from across the World Health Organization’s (WHO) European region are gathered at the annual European Health Forum meeting in the idyllic resort town of Bad Hofgastein, Austria, this week to debate how to navigate Europe through the labyrinth of threats to the universal health care enjoyed by most of its citizens. A rapidly ageing population, growing healthcare worker shortages, underinvestment in health systems and external shocks such as climate change and inflation driven by the Russian invasion of Ukraine are putting Europe’s healthcare systems through a battery of stress tests as the bloc looks to move on from the COVID-19 pandemic…..”
“Summary of the 2023 UN High-level Meeting on Universal Health Coverage.” Also with some quotes from the two panels.
“World Bank Group President Ajay Banga on Tuesday said proposed new contributions from wealthy countries combined with balance sheet changes could boost the bank's lending capacity by $100 billion to $125 billion over a decade. Banga told a Council on Foreign Relations event that the contributions would come outside the bank's normal shareholding structure and regular country contributions to the International Development Association fund for the poorest countries….”
Z Lassi et al; https://blogs.bmj.com/bmjgh/2023/09/26/elevating-australias-global-health-leadership-a-path-to-equity-and-security/
« Australia’s global health efforts, particularly in research support, lag behind those of similar countries. This limited funding could hinder Australia’s impact on cross-border health challenges, missing collaboration and expertise exchange opportunities. By broadening project scopes, fostering alliances in the Asia-Pacific region, and strengthening international partnerships, Australia can better position itself as a global health leader, effectively responding to emerging health threats…..”
“This article considers the dynamics at play in the Western Pacific Regional Office (WPRO), where member states will meet in Manila on 16-20 October to elect the region’s new director.”
“ WPRO comprises 1.9 billion people in 37 countries and areas straddling a vast geography from the steppes of North Asia to remote islands in the depths of the Pacific and icy Antarctic fringes. For the past year, it has been under the interim leadership of former WHO Deputy Director General and European Regional Director, Dr Zsuzsanna Jakab. …. Normally, the election of a regional director at a distant WHO outpost would not set the blood racing. WPRO is different. Its Pacific rim is a region of intense geopolitical competition as a repository of oil, gas, fish, and precious sea-bed resources coveted by regional and global powers. There is almost daily confrontation as China contests the rights of others such as the Philippines, Canada, Japan and US to navigate the South and East China seas which are major international trade routes. …”
“Why should such power games affect the small matter of an election in the branch office of a technical body? It is because health is securitised in geopolitics. Human health and access to essential supplies to sustain it contributes to the strength of nations and is an area of intense competition. ..”
https://onlinelibrary.wiley.com/doi/10.1111/1758-5899.13270
By B Reinsberg et al.
· And via ONE’s Aftershocks newsletter:
“Kenyan President William Ruto and Congolese President Felix Tshisekedi are demanding a permanent African seat on the UN Security Council.”
https://www.devex.com/news/as-government-shutdown-looms-us-aid-funds-remain-in-limbo-106292
It’s that time of the year again in the banana republic of the United States… (with 30 Sept as a deadline).
“The U.S. government’s fiscal year ends in a matter of days, and while much of the attention is focused on whether the government will shut down, there’s another problem, too. There are potentially billions of dollars in foreign affairs funding being held up and due to expire…..”
Related: Devex - House conservatives unleash broadside attack on U.S. aid funding
At the African Union summit in Nairobi on 12 July 2023, African parliamentarians launched the first working group on mobilizing domestic resources for Health in Africa. This already led to a Nairobi Declaration.
Brad W. Setser; https://onlinelibrary.wiley.com/doi/full/10.1111/dech.12787
“The Common Framework is the internationally agreed process for coordinating the restructuring of the debt of low-income countries. To date, this process, which was established by the G20 in late 2020 during the COVID-19 pandemic, has failed to provide an efficient path toward agreement with new bilateral creditors (such as China), market creditors and the traditional bilateral creditors. An analysis of the key country cases demonstrates how tensions between different creditors have complicated the application of the Common Framework and delayed agreement on new financial terms. The Common Framework was built on a case-by-case judgement of the scale of debt relief needed. It has become a case-by-case negotiation on the format for carrying out a restructuring, as well as the terms of the restructuring. China's participation in official creditor committees, the clear innovation in the Common Framework, has proved to be a source of delay rather than a mechanism for creating consensus. Almost three years after the initial agreement on the Common Framework, there still is no model for an internationally coordinated restructuring that both delivers significant debt relief and includes the Chinese policy banks.”
https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0001859
by V Ridde et al.
“The U.S. Chamber of Commerce wants to spearhead a global private-public effort to ensure universal health coverage throughout the world by 2030. …. In a white paper, the chamber outlines the daunting challenges that such an undertaking would face but also makes recommendations about how those challenges could be met. … The main hurdle will be raising the $176 billion needed to achieve the goal, especially for low- and middle-income countries (LMICs) that will need to raise $108 billion of those funds…..”
See also the press release. “This critical white paper delves deep into the nature of innovative finance and how to overcome the challenges hindering its potential to close the UHC funding gap.” “
“Unlocking Barriers to Scale Innovative Financing for Universal Health Coverage: The number of innovative financing mechanisms have grown since their initial rise to prominence in the early 2000s. Despite their growth over the last two decades, innovative finance has not lived up to expectations of filling the UHC funding gap. This paper has identified barriers to scale that fall into two categories— general barriers and barriers faced by the private sector specifically…..”
(#hahahahahaha)
Focus on Asia Pacific.
“….Recently, through its Domestic Resource Mobilization Collaborative (DRM Collaborative), the Joint Learning Network has been looking at how countries in the Asia Pacific region can work smarter to finance their health systems using their own domestic resources. The topic raises tricky questions for those who have, in the past, been supported by funding from external sources. What’s the best way to navigate a health financing transition that does not lead to increased out-of-pocket (OOP) spending by patients? How can domestic resources be mobilized through general taxation, and augmented by health taxes and social health insurance contributions?...”
Via IFPMA’s newsletter:
· The political declaration on PPPR which Member States approved is an important signal that countries are learning the lessons of the pandemic.
· The WHO launched several initiatives to strengthen the systems and tools for global health security, including:
· The WHO Hub for Epidemic and Pandemic Intelligence in Berlin;
· The mRNA Technology Transfer Hub in Cape Town to boost local production capacity;
· The Universal Health and Preparedness Review to enhance accountability for preparedness;
· The WHO BioHub system to improve sharing of biological samples;
· The Global Health Emergency Corps;
· The WHO is working with Member States on an interim mechanism for equitable access to medical countermeasures (MCMs).
· Overarching all of these initiatives are the two Member State-led processes in Geneva, to negotiate amendments to the International Health Regulations (IHR), and a legally-binding pandemic accord or agreement…..”
“Climate change may release dangerous pathogens frozen for centuries in Arctic permafrost.”
Also part of the special issue in Science.
“Temperatures in the Arctic are rising twice as fast as in the rest of the world. And viable pathogens are clearly lurking in the soil, says Marion Koopmans, a virologist at the Erasmus Medical Center who runs a European consortium dubbed the Versatile Emerging infectious disease Observatory (VEO) that’s studying how northern-latitude warming might influence infectious diseases. “What you see now is studies that find infectious viruses from permafrost.” The odds are low that smallpox or anything comparably dangerous will spring from the soil after centuries in the deep freeze, says veterinary microbiologist Frank Aarestrup, who heads the VEO project with Koopmans and whose lab at the Technical University of Denmark has been screening the midden samples for DNA. “But it’s better that we should investigate it now rather than after something has been released.” Yet some scientists do worry that the effort itself could unleash a human pathogen….”
· And another article in the same Science Series: Flight risks
“Migratory birds efficiently ferry pathogens around the world. As a warming climate reshapes their journeys, infectious disease experts are on guard for new threats to humans.”
M A Stoto et al ; https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-023-00973-2
« A number of scientific publications and commentaries have suggested that standard preparedness indices such as the Global Health Security Index (GHSI) and Joint External Evaluation (JEE) scores did not predict COVID-19 outcomes. To some, the failure of these metrics to be predictive demonstrates the need for a fundamental reassessment which better aligns preparedness measurement with operational capacities in real-world stress situations, including the points at which coordination structures and decision-making may fail. There are, however, several reasons why these instruments should not be so easily rejected as preparedness measures…..”
« ….From a methodological point of view, these studies use relatively simple outcome measures, mostly based on cumulative numbers of cases and deaths at a fixed point of time. A country’s “success” in dealing with the pandemic is highly multidimensional – both in the health outcomes and type and timing of interventions and policies – is too complex to represent with a single number. In addition, the comparability of mortality data over time and among jurisdictions is questionable due to highly variable completeness and representativeness. Furthermore, the analyses use a cross-sectional design, which is poorly suited for evaluating the impact of interventions, especially for COVID-19. Conceptually, a major reason that current preparedness measures fail to predict pandemic outcomes is that they do not adequately capture variations in the presence of effective political leadership needed to activate and implement existing system, instill confidence in the government’s response; or background levels of interpersonal trust and trust in government institutions and country ability needed to mount fast and adaptable responses. These factors are crucial; capacity alone is insufficient if that capacity is not effectively leveraged. However, preparedness metrics are intended to identify gaps that countries must fill. As important as effective political leadership and trust in institutions, countries cannot be held accountable to one another for having good political leadership or trust in institutions. Therefore, JEE scores, the GHSI, and similar metrics can be useful tools for identifying critical gaps in capacities and capabilities that are necessary but not sufficient for an effective pandemic response. »
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(23)00582-0/fulltext
“In July, both the EU and Russia made mobile laboratory donations to African countries for use in routine disease surveillance and outbreak control activities. Esther Nakkazi reports.”
“…. In an exclusive analysis that ranks top companies on their efforts to combat global warming, STAT found that, with increasing pressures from investors and other stakeholders, many biotech and pharma companies are now starting to take action. But most companies still do not publicly report their greenhouse gas emissions. Even when companies do share such data, there is no standard protocol for measuring emissions. And a majority of companies have yet to set concrete targets for emissions reduction….”
“Of the 100 largest companies in the pharma and biotech sector, only 33 were taking actions that qualified them to be included in STAT’s analysis, which evaluates companies based on 20 metrics chosen for their value in demonstrating transparency, credibility, scope, and implementation of climate policies. And only one in four of the 100 top companies report their emissions to the Carbon Disclosure Project (CDP), a global nonprofit that is considered the gold standard for climate transparency….”
https://www.uaf.edu/news/near-surface-permafrost-will-be-nearly-gone-international-team-finds.php
“Most of Earth’s near-surface permafrost could be gone by 2100, an international team of scientists has concluded after comparing current climate trends to the planet’s climate 3 million years ago. The team found that the amount of near-surface permafrost could drop by 93% compared to the preindustrial period of 1850 to 1900. That’s under the most extreme warming scenario in the latest report of the Intergovernmental Panel on Climate Change. By 2100, Earth’s near-surface permafrost, within the upper 10 to 13 feet of the soil layer, may exist only in the eastern Siberian uplands, Canadian High Arctic Archipelago and northernmost Greenland — just like it did in the mid-Pliocene Warm Period. The research, published Aug. 28 in Proceedings of the National Academy of Sciences, was led by Donglin Guo of the Chinese Academy of Sciences and Nanjing University of Information Science & Technology. Scientists from the United States, Russia, United Kingdom, Germany, Japan, Canada, The Netherlands, France and Sweden collaborated in the research…..”
From last week. “From Beijing, climate envoy Xie Zhenhua stood firm against stronger rhetoric against coal, oil and gas deployed at UN headquarters.”
“China’s climate envoy Xie Zhenhua said today that a global fossil fuel phase-out is unrealistic, dampening hopes that such an aim could be agreed at the Cop28 climate talks. In a speech in Beijing today, the veteran negotiator said that “completely eliminating fossil energy is not realistic”, according to a translation provided by the Center for China and Globalization….”
PS: “…..In his speech today, Xie took aim at wealthy countries for failing to deliver the $100 billion a year of climate finance they promised by 2020 which “pertains to the trust between the North and the South”. Rich nations say they are “confident” of delivering that money this year, although the figures won’t be out until 2025…..”
https://www.devex.com/news/how-india-and-the-g20-ducked-the-coal-question-again-106245
“Under an Indian presidency at the Group of 20 major economies’ summit earlier this month, world leaders pledged to triple renewable energy capacity by 2030, but failed to set goals on the phasing out of fossil fuels — a reflection of New Delhi’s own conflicted stance on clean energy transition, said climate activists.”
“…. India has presented itself on the global stage as a champion of the green agenda, but it has also expressed reluctance to commit to phase out coal. Despite significant progress on increasing its renewable energy capacity in recent years, coal still generates around 70% of India’s electricity supply and powers the country’s rapid economic development, being both essential for industry and a huge source of employment. At the 26th United Nations climate summit, or COP 26, in Glasgow in 2021, India, alongside China, blocked a call to include the phasing out of the use of coal in the final declaration — a move which drew heavy criticism from other nations. New Delhi has argued that calls from the West for low- and middle-income countries to reduce their dependence on coal are hypocritical, given the continued reliance of Europe and the United States on other fossil fuels. “The Indian position is absolutely right on that in the sense that you cannot talk about phasing out coal and ignore gas,” Ashish Fernandes, CEO of Indian think tank Climate Risk Horizons, told Devex in an interview. But he added that India has used the failure of higher-income nations to follow through on climate pledges to counter pressure to take action at home. “The West’s hypocrisy becomes a very convenient screen for India to hide behind,” he said, creating a reluctance at forums such as the G20 from all parties to “talk about the elephant in the room.”
https://www.cgdev.org/blog/imf-support-climate-resilience-africa-helpful-more-can-be-done
“The IMF has now approved ten new loans to countries under its new Resilience and Sustainability Trust (RST), established in 2022 to provide financial support on concessional terms to countries facing long-term structural challenges arising from two key threats: climate change and pandemic preparedness. Five of these loans have been extended to countries in Africa, where the effects of these challenges are particularly damaging…..”
“But overall demand for IMF support under the RST from other countries in the region is extensive. What can be said about the experience of African countries with IMF climate finance to date? How have IMF-supported programs been designed and implemented under the RST? What can be said about the access of African countries to RST financing?....”
“Our overall assessment of the five RST programs in Africa approved so far—for Kenya, Niger, Rwanda, Senegal and Seychelles—is that the IMF is providing useful support for climate action. But serious issues remain on the financing side……”
https://www.who.int/publications/m/item/covid-19-vaccination-insights-report-23-september-2023
“A standard analytic report produced of key COVID-19 vaccine implementation data, including uptake, supply received, and delivery financing across WHO Member States, the COVAX AMC portfolio and the 34 Countries for Concerted Support.”
https://www.ft.com/content/9aaec956-acfe-4abe-afb2-6b94c623515c
“Big-selling molnupiravir treatment produces permanent mutations that can be passed from patient to patient.”
“A blockbuster drug developed by US pharmaceutical group Merck to treat Covid-19 has been linked to mutations transmitted when the coronavirus spreads between patients, a finding that will increase scrutiny about its usefulness and the billions spent by governments on its procurement. Researchers analysed a family tree of 15mn sequences of coronavirus to see which mutations had occurred and when, with the results showing they increased in 2022 after molnupiravir, which is also known by the trade name Lagevrio, was introduced in many countries. The mutations were also more likely to be seen in older age groups and people more at risk of severe disease who were taking molnupiravir, and in countries where the antiviral treatment was more widely used. The findings will raise concerns about the effectiveness of antiviral drugs to treat Covid-19 as health authorities prepare for a busy autumn after a rise in cases driven by Omicron subvariants with a large number of mutations. The researchers, from the UK’s Francis Crick Institute, the universities of Cambridge, Liverpool and Cape Town, Imperial College London and the UK Health Security Agency, matched the signature in these mutations to those seen in trials of the drug…..”
“…. The study, which is peer reviewed and was published in Nature, also suggests there were small clusters of mutations that were able to transmit between patients, though the genetic signature is not linked to any current variants of concern. There is no evidence the uptick of cases driven by Omicron variants such as BA. 2.86 is linked to the use of molnupiravir……”
· See also the Guardian – Use of antiviral may be fuelling evolution of Covid, scientists say
“There is no evidence molnupiravir has produced more dangerous variants of Covid, but scientists said the mutations increased the genetic diversity of the virus in the wild and provided more options for future evolution……”
https://www.nature.com/articles/d41591-023-00084-w
“We asked leading researchers to share new discoveries about SARS-CoV-2 and COVID-19, from how the virus spreads and the risk of long COVID to the impact of vaccines and masks.”
They are: “the nose has a role in viral transmission… ; nearly half of COVID-19 survivors have post-acute sequalae…. ; face masks work but mandates need nuance…. ; correlates of protection are unreliable for some vaccines…. T cell immune responses offer protection from severe disease.”
“How a schoolteacher and a dog educator became crucial to the global fight against coronavirus.”
“At the onset of the Covid-19 pandemic, the fight against the disease was described by heads of government and public health bosses on primetime television. Countries would receive daily updates collated from data that had been analysed by the world-leading virologists and academics. But three years later, the pandemic’s trajectory is becoming more difficult to predict – and decision-makers are increasingly reliant on the warnings of a diverse bunch of independent researchers…..”
https://www.nature.com/articles/d41586-023-02996-6
“A large cohort study measured how frequently women reported bleeding after receiving COVID-19 jabs.”
by Michael M. Touchton, F M Knaul et al; https://www.mdpi.com/2673-8112/3/9/102
“We provide policy lessons for governments across Latin America by drawing on an original dataset of daily national and subnational non-pharmaceutical interventions (NPIs) during the COVID-19 pandemic for eight Latin American countries: Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Mexico, and Peru. Our analysis offers lessons for health system decision-making at various levels of government and highlights the impact of subnational policy implementation for responding to health crises. However, subnational responses cannot replace coordinated national policy; governments should emphasize the vertical integration of evidence-based policy from national to local levels while tailoring local policies to local conditions as they evolve. ….”
https://www.nature.com/articles/s41586-023-06651-y
Related tweet Eric Topol:
“Just out @Nature. The most comprehensive lab assessment of #LongCovid including the immune system, cortisol, other viral pathogens (such as EBV), & proteins differentiates those affected (aligned w/ self-reported symptoms) with very high (96%) accuracy….”
“Scientists can now show key differences in the blood of those who recover from Covid — and those who don't.”
“More than three years into the pandemic, the millions of people who have suffered from long Covid finally have scientific proof that their condition is real. Scientists have found clear differences in the blood of people with long Covid — a key first step in the development of a test to diagnose the illness. The findings, published Monday in the journal Nature, also offer clues into what could be causing the elusive condition that has perplexed doctors worldwide and left millions with ongoing fatigue, trouble with memory and other debilitating symptoms…..”
https://www.theguardian.com/world/2023/sep/22/china-global-surge-mpox-world-health-organization
From last week. “WHO says China facing ‘sustained community transmission’ of virus first detected as imported case last year.”
“China is fuelling a global surge in mpox cases, accounting for the majority of new cases reported in September, according to the World Health Organization. The number of weekly cases reported globally increased by 328% in the week to 10 September, data shows. Most of that rise came from China, where more than 500 new cases were reported in August. The WHO said China was experiencing “sustained community transmission” of the virus, which was first detected as an imported case in September last year…..”
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(23)00578-9/fulltext
Among others discussing vaccines & modified mosquitoes.
However, the Editorial concludes: “The availability of these tools to control dengue is important, but the spread of the disease is intertwined with the dramatic alterations brought by climate change. Any effort to control dengue will need to go in parallel with developing measures to counteract climate change: the time to act is now, we cannot delay.”
https://www.bmj.com/content/382/bmj.p2181
“A multi-sector combined framework for the elimination of communicable diseases, co-designed with affected communities, is urgently needed to end communicable disease and meet the 2030 sustainable development goals for health, argue Jose Ramos-Horta and Poonam Khetrapal Singh.”
https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0002373
by N Cockburn et al.
D Nadal et al; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(23)00431-X/fulltext
Sept 28 is World Rabies Day.
“The Zero by 30 strategy—the global plan to eliminate dog-mediated human rabies deaths by 2030 —has increased awareness of rabies throughout the world and instilled a sense of urgency in implementing control strategies. Targeted calls for action appear to be motivating policy makers and the public in rabies-endemic countries to achieve this goal. Given the impact of the disease on particularly vulnerable and marginalised communities where rabies currently causes an estimated 59 000 human deaths per year, this trend is welcome; however, with only 7 years until 2030, many people now question whether it is still possible to reach the target of having no further human deaths due to dog-mediated rabies….”
“… Post-exposure prophylaxis can bring down the rabies death toll swiftly if bite victims can quickly access affordable rabies biologicals (vaccines and immunoglobulins). Now that the Gavi Board of the Vaccine Alliance has approved resuming their 2018 decision to start the roll-out of human rabies vaccines for post-exposure prophylaxis using a 1-week, three-dose regimen, there is hope to reach or at least come close to the goal of Zero by 30…. Despite this positive development, societal and public health costs due to rabies will continue to grow if the complementary strategy of mass dog vaccination is not implemented. …”
“… To support countries' efforts, the United Against Rabies initiative (a One Health collaboration launched in 2020 by the Food and Agriculture Organization of the United Nations, the World Organisation for Animal Health, and WHO to accelerate progress towards Zero by 30) has gathered a broad range of stakeholders to advocate, cooperate with, and support the implementation of national rabies control programmes that rely on awareness and education, human post-exposure prophylaxis, and mass dog vaccination…..”
https://www.nejm.org/doi/full/10.1056/NEJMoa2210956?query=featured_home
And related NEJM perspective: Artemisinin-Resistant and HRP-Negative Malaria Parasites in Africa
“… An additional threat now comes from the emergence of P. falciparum parasites with a deletion in the hrp2 gene, the hrp3 gene, or both. The presence of these deletions means that the parasite does not produce histidine-rich protein (HRP), the target of the most widely used rapid diagnostic tests (RDTs) for malaria. Patients infected with parasites that do not produce HRP, and who consequently have a negative RDT, may not receive effective malaria treatment, which increases their risk of severe disease and facilitates the spread of the parasite…..”
“…. Now published in The Lancet Global Health and using 5 existing mathematical HIV models, the researchers aimed to assess whether providing VMMC for the next 5 years would continue to be a cost-effective use of HIV programme resources in sub-Saharan Africa. The models applied assumptions based on HIV epidemiology in VMMC priority countries focusing on Malawi, South Africa, and Zimbabwe. The impact and cost-effectiveness were projected over 50 years to capture clients’ lifetime HIV exposure and infection. Findings reveal that a continuation of VMMC was cost-effective even in regions with low HIV incidence…”
· And a link: BBC news - Bangladesh: Nearly 1,000 people die of dengue in severe outbreak
“ Nearly 1,000 people have died of dengue in Bangladesh this year, in what authorities say is the country's most severe outbreak of the disease yet”
Based on a new ICMR (Indian Council of Medical Research) study.
“A new study by an international team of researchers suggests that in countries where people and livestock live in proximity and use many of the same antibiotics, inadequate sanitation and environmental controls could be aiding the spread of antibiotic-resistant pathogens.”
“The case study, published last week in Frontiers in Ecology and the Environment, found that strains of antibiotic-resistant Escherichia coli collected from people and meat products sold at markets in Cambodia contained resistance genes and mobile resistance elements that were strikingly similar, which suggests they had been exchanged at some point between humans and animals—a process that is likely occurring on a frequent basis. The authors say the findings highlight the fact that in low-resource countries where livestock are allowed to roam freely, and access to clean water and sanitation is limited, there is ample opportunity for bacterial pathogens from humans and animals to swap genes and other mechanisms that promote the spread of antimicrobial resistance. And they argue that in similar settings, fixing those issues may be as important in the fight against AMR as efforts to limit antibiotic use in humans and animals….”
C Kirchhelle; https://www.nature.com/articles/s41599-023-02127-6
“Over eight decades of mass antimicrobial exposures have changed microbial populations and genes at a global level. This thought piece argues that adequately responding to the anthropogenic transformation of the microbial commons requires reframing antimicrobial resistance (AMR) as the pheno- and genotypic signal of a new geological era – an Antibiocene….”
· Finally, via Politico on the US:
“The Advanced Research Projects Agency for Health, the new agency charged with funding high-risk, high-reward research, plans to spend $104 million to combat antibiotic resistance, which HHS Secretary Xavier Becerra called an "urgent and growing threat." Harvard Medical School will lead the multi-institution research team. The program, called DART, for Defeating Antibiotic Resistance through Transformative Solutions, will seek to better understand how antibiotic resistance starts and develop new antibiotics…..
https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0002402
By N F Nyangasi et al.
Francesca R. Dillman Carpentier et al ; https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004291
« The World Health Organization (WHO) have released a new guideline, “Policies to protect children from the harmful impact of food marketing” which recommends the development of comprehensive laws to reduce children’s exposure to unhealthy food marketing. This new guideline extends previous recommendations to limit the adverse effects of unhealthy food marketing on the health of the world’s children. We consider here whether these new recommendations go far enough…..”
https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0002292
By S N Onteri et al.
https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0002342
By G E Guindon et al.
AP;
“Suicide and suicidal ideation are "everywhere" for Afghan women as they become increasingly isolated and restricted, often by male relatives tasked with upholding the Taliban's decrees, the UN's women chief told the Security Council Tuesday…..”
“Jobs in health care are known to be challenging for workers’ mental health. But the mental health toll can be especially burdensome for registered nurses, health technicians, and health care support workers, who are at a higher risk of suicide compared to the general population, according to a study published on Tuesday in the Journal of the American Medical Association that looked at a nationally representative cohort of about 1.84 million employed people (both within the health care field and outside) observed from 2008 to 2019…..”
https://www.science.org/content/article/how-much-heat-dangerous-during-pregnancy
“Intense heat is a particular hazard in pregnancy. New studies are probing why.”
re the AMoCO study. “Severe complications following unsafe abortions up to seven times more likely in two hospitals in fragile and conflict-affected settings: these are the findings of one of the very first studies on the subject, carried out in two referral hospitals in Bangui in the Central African Republic and Jigawa State in northern Nigeria. Behind the statistics, real stories of real women – and a universal vulnerability….”
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(23)00452-7/fulltext
Comment related to a new study in Bangladesh.
“The U.S. FDA is cracking down on lax testing practices by dozens of makers of healthcare products following hundreds of deaths overseas from contaminated cough syrups, a Reuters review of regulatory alerts found.”
“The Food and Drug Administration has reprimanded at least 28 companies this year, saying they failed to prove sufficient testing of ingredients used in over-the-counter drugs and consumer products for the toxins ethylene glycol (EG) and diethylene glycol (DEG), according to a Reuters analysis of agency import alerts and warning letters to manufacturers. The manufacturers include U.S.-based companies and exporters from India, South Korea, Switzerland, Canada and Egypt. The FDA has flagged more manufacturers for failing to test raw materials susceptible to EG and DEG contamination in 2023 than in the previous five years combined, the Reuters analysis found….”
https://www.ijhpm.com/article_4510.html
by A Koduah, T Mirzoev et al;
C Barrett; Nature ;
“Research into vaccines, crop seeds and other innovations for low- or middle-income nations could be rewarded by offering longer patent coverage for profitable, non-essential inventions.”
“There is a global gap in investment into research and development: 74% of the total is spent in high-income countries, and most of the benefits tend to stay there. States, aid agencies and philanthropic organizations are trying to bridge the gulf, but the greatest untapped potential lies in motivating private-sector investment, argues economist Christopher Barrett. He proposes ‘benevolent’ patent extensions: the inventor who applies to patent a discovery that targets the needs of people in low- and middle-income countries can offset the costs by extending another patent, for a profitable, non-essential product.”
From India: “Currently, the Patents Act explicitly permits anyone to file a pre-grant opposition. But as per the draft patent amendment rules, the maintainability of persons or civil society organisations filing pre-grant oppositions will be decided by the controller.”
“The draft patent amendment rules made public on August 23 this year could hugely benefit big pharma but turn out to be disastrous for patients in India and in countries in the global South, which rely on generic drugs manufactured in India, in accessing affordable drugs and vaccines…..”
· Related tweet by Shaily Gupta:
“This can be so so problematic. For years, HIV positive networks, TB community have filed oppositions to block patent evergreening by companies in India. This amendment can basically put an end to their right to oppose and ensure access to lifesaving generics for India and beyond.”
Ming Ong; https://gh.bmj.com/content/8/9/e013076
“… This paper presents a framework identifying the barriers that impede global health innovation and hinder equitable access to health technologies. The framework presents clear typologies of barriers across global health R&D thematic areas. These include the market failures that require R&D incentives to stimulate innovation, how the complexity of product registration hinders access within specific regulatory domains and how health system implementation issues prevent affected populations from accessing the tools they require. Current and historical examples are provided for each end-point, and three case studies explore key barriers and how solutions have or may be applied….”
And a link:
· Devex - Opinion: WHO oxygen resolution is an opportunity for medical gas sector (by E Cahuzac et al)
V Sriram et al ; https://gh.bmj.com/content/8/9/e012661
“Associations, unions and other organised groups representing health workers play a significant role in the development, adoption and implementation of health policy. These representative health worker organisations (RHWOs) are a key interface between employers, governments and their members (both actual and claimed), with varying degrees of influence and authority within and across countries. Existing research in global health often assumes—rather than investigates—the roles played by RHWOs in policy processes and lacks analytical specificity regarding the definitional characteristics of RHWOs. In this article, we seek to expand and complicate conceptualisations of RHWOs as key actors in global health by unpacking the heterogeneity of RHWOs and their roles in policy processes and by situating RHWOs in context….”
“Nina Bergman from the Swedish Association of Health Professionals talks about the working conditions of health workers in Sweden and the trade union’s support for the struggles for workers’ rights in the Global South.”
“Germany’s bid to address its nursing shortage through international recruitment spans Latin America, eastern Europe, and Asia. India, especially the State of Kerala, finds itself among the top cadre providers.”
· And via ONE’s Aftershocks newsletter (referring to the NYT article from last week on CHWs):
“86% of community health workers in Africa are completely unpaid. You read that correctly: 86%. Completely. Unpaid. And the mere 14% who are paid are often woefully under-compensated. Community health workers provide primary care to over 1 billion people globally. Recent protests in Kenya unlocked small stipends for 100,000 female healthcare workers, but grave employment (and care) gaps persist across the country…..”
C Biruk; https://www.berghahnjournals.com/view/journals/cja/41/2/cja410205.xml
“Trust, transparency, and racialised suspicion in global health infrastructures.”
Focus lies here on an analysis of technologies for distributing per diems.
P Hotez; https://www.latimes.com/opinion/story/2023-09-22/antiscience-climate-change-covid-vaccines-antivax
Reflecting on science in the Covid pandemic. Focus on US.
He concludes: “….We must find ways to preserve our achievements in biomedicine and support scientists, even if that means both the scientists and those in positions of power engage political leaders and challenge ideologues to reject their anti-science rhetoric and agenda. Otherwise, almost a century of America’s preeminence in science will soon decline, our democratic values will erode, and our global stature will fall.”
J E Bickenbach et al; https://www.weforum.org/agenda/2023/09/why-re-defining-health-will-boost-the-economy/
“Human functioning is a new health assessment framework that encompasses biological health and the lived experience of health, which together contribute to well-being. This pioneering approach can promote the 'economy of well-being' by creating a society made of healthy, thriving individuals. The next steps for integrating human functioning into public structures include recognizing functioning as a major health indicator and setting up a new research field called 'human functioning science'.”
“…. We believe ‘human functioning’, a health assessment framework developed by the World Health Organization (WHO), can promote this progressive vision. We recently published an article in Frontiers in Science where we presented this concept’s revolutionary potential and outlined a strategy for integrating it into health and social systems. This approach may not only unlock progress toward the economy of well-being but also advance the United Nations (UN) Sustainable Development Agenda….”
J-An Ochipinti et al ; https://gh.bmj.com/content/8/9/e012942
“…. The aim of this paper is to provide a systemic perspective on the interdependencies between brain capital (particularly mental health), economic and social well-being, and resilience. Through a Mental Wealth lens, the paper offers fresh insights into enhancing national prosperity and resilience to better face looming global threats….”
“"Advanced economy" is a bit of a euphemism for what is actually something like "advanced-levels-of-appropriation-from-the-global-South-and-future-generations economy".”
“Health Policy & Systems #Research is a key lever to fast-tracking #GlobalHealth goals.”
“We are not making progress. Face existential challenges. And need a transformative action plan. Following another - politically flat - SDG summit & NY Climate Week, here is a @TIME 100 Voices OpEd on implications of the Latest Health Check of the Planet.”
“Learning from experts in UN procedures: Seems both Political Declarations on Pandemics and UHC have been "accepted" by Member States during this UNGA informal session. Formal "adoption" (hopefully by consensus) and potentially with text reservations expected in October UNGA”
“….But the longer I work in this sector, the more I realize that for many people, the point is to engage in process, not real action for progress.”
Was a reaction on a tweet by Ayoade Alakija
“@WHO Ministerial Breakfast on Medical Countermeasures- Let’s stop mucking around and let’s just do it! Too much focus on processes/talk and not enough on actually fixing the challenges. The next pandemic isn’t going to wait for the outcome of these endless discussions. #UNGA78.”
“Statements of intention by global pharmaceutical companies to manufacture in Global South may not be worth the paper they are written on, & are no substitute for the needed public investment in R&D which is linked to regional manufacturing & roll out.”
“Good to get these honest questions out in the open. I‘d add: When is the #globalhealth community ready to start self-reflecting (own agency / responsibility), instead of always pointing fingers elsewhere? (Perhaps a 2024 @WorldHealthSmt topic, as I had suggested for this year…).
Was a reaction to a tweet from Ilona Kickbusch:
„And we must ask why the hopes and efforts of global health advocates to put health on the agenda of heads of state – be it to fight pandemics or to establish UHC – have been so brutally shattered.“ #UNHLM twitter.com/ilonakickbusch…
“It is 2023 and still no decision on global access to Covid19 treatments and diagnostics @wto. . Some countries were clearly missing out on these essential tools in past years. It shows @wto is not up to task and adressing IP barriers should part of the pandemic treaty @WHO.”
“Great to hear that civil society have developed a guideline/principles for their meaningful involvement in global health. If you work in global health & keep making missteps with civil society and can't put a finger on why, this webinar is for you: https://us02web.zoom.us/meeting/register/tZMtduyvqzgqHdca7XXJaR5GW1aBmTxR7bUY#/registration (on 12 October) “@STOPAIDS is driving in collaboration with a consortium of CSOs.”