72nd World Health Assembly (Geneva, 20-28 May)
As mentioned, we’ll try to flag relevant reads & info here, steno-style. Do click on the (many) links if you want to explore more. Devex, Health Policy Watch & GHN all had some great coverage of ongoing discussions at #WHA72. For updates on the Access to Medicines discussion, Knowledge Ecology International is also a great resource.
It’s clear that UHC topped the agenda, given the theme of this year’s WHA, but many other issues (the Ebola DRC outbreak most of all, WHO reform & financing, access to medicines, NCDs, …) are also getting plenty of attention. Pretty much the whole global health agenda gets its slot in the limelight, here, you can say. As usual 😊.
PS: it’s impossible to be exhaustive. So we’ll just flag some highlights.
PS 2: you find all non-state actor statements at the WHA, organized by issue, here.
PHM Analysis of agenda items
But make sure you start by going through PHM’s WHO tracker which features both an integrated Background & Commentary on items coming before WHA72 (pdf: 60 pages: our favourite section: implementation of the SDG 2030 agenda 😊) a number of policy briefs (20 p.: on UHC, access to medicines & vaccines…)
Walk the Talk (Sunday morning – 20 May)
UN News – Promoting ‘a healthy sustainable future’, the UN health agency engages young and young at heart to ‘Walk the Talk’
“Celebrating the importance of fitness, on Sunday morning in the Swiss city of Geneva, the United Nations health agency kicked off its second “Walk the Talk: The Health for All Challenge”.”
“…Cynthia Germanotta, Lady Gaga’s mother, participated to raise the profile of mental health. She shared her first-hand experience of some of the challenges her famous daughter faced and officially launched a new global campaign called “Speak Your Mind” to prioritize and understand mental illness. …”
For more info on Speak your Mind, see The journey of making mental health a development priority.
You can re-watch it here. Please do so, if you didn’t watch it the first time. It’s well worth it !
HPW – Dr Tedros Calls On Member States To Step Up Political Leadership & Investment For Health Impact
Focus on Tedros’ opening speech at the Assembly, in which he gave on overview of WHO results & achievements of the past year. Must-read! You find the full speech here.
“Health is about political leadership, partnership and people, Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, said today in his opening address of the 72nd World Health Assembly in Geneva, adding that these three priorities must guide discussions not only this week, but throughout the next year. The WHO Director-General also emphasised that WHO must balance urgent responses to health crises, such as the Ebola outbreak in the Democratic Republic of Congo (DRC), with greater investments in prevention and primary health care….”
See also GHN coverage – A Surprise Beginning for #WHA72
This article by Brian Simpson focused more on Richard Horton’s fabulous speech, and an equally fabulous rant by a young Zambian activist, Natasha Mwansa. The WHO staff member who was killed in the Ebola outbreak (Richard V Mouzoko) was also commemorated.
Excerpt: “…Something unexpected happened this morning at the opening of the 72nd World Health Assembly. Usually a rote exercise of procedure and aggrandizement, the Assembly surprised many with an unexpected quality: Emotion. The change came early in the morning when Richard Horton, editor-in-chief of The Lancet, gave a passionate guest address in which he shared a personal health crisis [i.e. metastatic cancer]. … he shared responses from his social media followers to his query: “If you had 10 minutes to speak to 194 member states at the World Health Assembly, what would you say?” He selected the top 5 replies and formatted them as demands: Declare a planetary emergency because of climate change; ensure women’s rights; invest in safe surgery and anesthesia; next year, bring ministers of finance because “health is a whole-of-government issue”; and support the Director-General by fully funding WHO….”
And see also WHO – WHO announces four new goodwill ambassadors for promoting global health
“President Ellen Johnson Sirleaf, Cynthia Germanotta (i.e. Lady Gaga’s mother), Alisson Becker (goalkeeper of Liverpool) and Natália Loewe Becker (his wife) to champion global health.”
Devex/HPW/GHN Coverage on specific issues & sessions
UHC (& PHC)
It’s impossible to cover everything related to UHC at this WHA. UHC was all over the place, including all possible links & issues that can be linked to it (as in: ‘No UHC without…’; “… is the prerequisite for UHC…”). Already at the High-Level segment, with all ministers giving their take.
A lot of the discussion was related to the 1st billion of the GPW, and also, obviously, to the UN HL Meeting on UHC in September & aim to create momentum for it (for the zero draft of the political declaration for this HLM, see below). 2019 is a crucial year for UHC. PHC was stressed by pretty much everybody to be key, on the path to UHC (but check out how PHM differs there).
Besides a number of events organized by UHC 2030, there was also a Technical Briefing on UHC. From that latter meeting, we got away with a sense that at least in Africa, there’s some positive trend now in a number of African countries (cfr: statement by dr Moeti (WHO Afro)).
And of course this:
WHO – Delegates at the World Health Assembly agreed three resolutions on universal health coverage (UHC). They focus on: primary healthcare, the role of community health workers, and the September UN General Assembly high-level meeting on UHC.
“The first resolution requires Member States to take measures to implement the Declaration of Astana, adopted at the 2018 Global Conference on Primary Health Care. …”
“The second resolution recognizes the contribution made by community health workers to achieving universal health coverage, responding to health emergencies, and promoting healthier populations. It urges countries and partners to use WHO’s guideline on health policy and system support to optimize community health worker programme, and to allocate adequate resources….”
“The final UHC resolution endorsed by delegates supports preparation for the UN General Assembly high-level meeting on universal health coverage in September 2019. The resolution calls on Member States to accelerate progress towards universal health coverage with a focus on poor, vulnerable and marginalized individuals and groups….”
Some reads & documents we also want to flag:
- Save the Children (blog) – UHC: a Call to action ahead of the High-Level meeting
“…Save the Children launched a Universal Health Coverage and Accountability Index. It highlights the importance of looking at systems for health in a more integrated and comprehensive way – by bridging from traditional health indicators to accountability ones. The hope is that governments, donors and civil society will give equal importance to accountability indicators when they are working towards building stronger health systems. … The Index goes a step further: it shows that countries with less civic space are often those with higher child mortality. And the data in the index reveals that many of those countries have higher perceived levels of public sector corruption and less budget transparency. These factors make it a challenge for civil society and communities to engage in processes and decisions that impact their lives. … … To achieve the goal of UHC, it’s therefore clear we need to build resilient national health systems. And an important component of them is resilient social accountability systems….”
- The Primary Health Care Performance Initiative (PHCPI) also had a well-attended session, on measuring PHC.
- CGD (blog) – As the World Health Assembly Convenes, Let’s Elevate Use of Economic Evidence on the UHC Agenda (blog by Rachel Silverman & Jessie Lu, linked to a new CGD report – “Understanding the Opportunity Cost, Seizing the Opportunity: Report of the Working Group on Incorporating Economics and Modelling in Global Health Goals and Guidelines”.
… the Working Group has established core principles and accompanying recommendations for policymakers seeking to support national governments in setting locally relevant priorities. The report also offers recommendations to international organizations—in particular, the World Health Organization (WHO)—on the appropriate use of economic analysis in the development of international guidelines….” “….Our recommendations have two objectives: first, to empower countries to develop and analyze appropriate evidence to set health priorities for their populations; and, second, to strengthen the WHO guidelines program to increase its value and relevance for national decision makers. The working group understands and acknowledges the challenges that accompany a major shift in how goals and guidelines are developed and recognizes that changes of this magnitude take time to implement.”
Devex coverage – Exclusive: The early stages of the WHO Foundation
Excellent in-depth analysis by J Ravelo. “Even as World Health Organization Director-General Tedros Adhanom Ghebreyesus announced at the 72nd World Health Assembly that the WHO Foundation would be set up this year, Devex has learned the foundation is in very early stages of discussion, and member states have very little information….”
Access to medicines & transparency resolution
KEI – Italy and 11 co-sponsors introduce transparency resolution text to WHA72
James Love; https://www.keionline.org/30793
Update by James Love as of 20 May when the latest iteration of the transparency resolution was published. The resolution will be discussed on Friday.
Tweet Thiru Balasubraniam: “Germany, the UK, and other governments have sought to inflict a death by a thousand cuts to kill the transparency resolution (in the form of 110 brackets).”
For the latest on this resolution, see HPW – Future Of Drug Pricing Resolution Hangs In Balance At World Health Assembly. “ The fate of a potentially game-changing World Health Assembly Resolution that would support greater national and global transparency in drug pricing remained in the balance today as the country co-sponsors tabled a resolution riddled with comments and caveats, and a “drafting group” was urgently formed to huddle on ways to move forward on a compromise text….” “….the latest draft of the resolution is now pockmarked by nearly 100 proposed additions, deletions and amendments, leaving uncertainty over whether WHA delegates could come to a consensus agreement on the resolution in time for a plenary discussion scheduled for tomorrow (Friday). Traditionally, WHA resolutions are only passed by consensus….”
Check out also what civil society has been up to, both at the WHA, and in countries (for example vs the German position).
See also Reuters – WHO drug pricing talks may fail to end secrecy, activists fear
“Governments are working on a drug pricing transparency deal at the World Health Organization’s (WHO) annual assembly, but activists said on Thursday they fear crucial costs may be left out, enabling pharmaceutical firms to keep prices high….”
For some background on the politics around this draft resolution, see also the Economist – The global battle over high drug prices “Western countries, as well as poor ones, are demanding transparency in the cost of drugs.”
And a link:
Ebola DRC outbreak – discussions @WHA & new UN (system-wide) strengthened Ebola response
HPW – Ebola Epidemic Enduring, Conflict Zones Complicate Response, Need Of Breaking Silos Between Actors
Report of the Ebola discussion at the WHA. “The ongoing Ebola outbreak in the Democratic Republic of the Congo (DRC) is not related to the lack of means or experience to fight the epidemic, but the difficulty to reach communities, the World Health Organization Director-General told the World Health Assembly today. The DRC Minister of Health illustrated the complexity of the response, linked to the security environment as well as the density and high mobility of the population in affected zones….”
See also GHN – Bullets and Ebola: The Latest Update from DRC.
“…Kalenga (i.e. MoH DRC) pushed back on the emerging narrative that violence has arisen because the responders are failing at community engagement. “There is the issue of community engagement and then there is the issue of violence. Each requires a different response,” he said. …”
Devex – Questions arise again over need to declare Ebola public health emergency (J Ravelo)
“As the Ebola outbreak rages on in the Democratic Republic of Congo, and the World Health Organization and other organizations face increasing challenges to respond, questions swirl again over whether it’s time to declare a public health emergency of international concern….”
“…Despite the challenges, however, the declaration of a public health emergency of international concern, or PHEIC, seems far from the agenda….”
See also HPW (with assessment by Jeremy Farrar) Collaboration & Science To Fight Epidemics, A Long Road Still Ahead – Speakers Say On the Margins Of WHA
United Nations strengthens Ebola response in Democratic Republic of the Congo
“…the United Nations announced [today] measures to strengthen its response and end the outbreak. … … In view of the increasingly complex environment, the UN in partnership with the Government and all partners is now strengthening its political engagement and operational support to negotiate access to communities; increasing support for humanitarian coordination; and bolstering preparedness and readiness planning for Goma and surrounding countries. WHO is adapting public health strategies to identify and treat people as quickly as possible; expanding vaccination to reach and protect more people; and redoubling work to end transmission in health facilities. The UN Secretary-General has established a strengthened coordination and support mechanism in the epicenter of the outbreak, Butembo. MONUSCO Deputy UN Special Representative of the Secretary-General (DSRSG) David Gressly has been appointed UN Emergency Ebola Response Coordinator (EERC) in the Ebola affected areas of the DRC. Mr. Gressly will work closely with WHO, which will continue to lead all health operations and technical support activities to the Government response to the epidemic. … … WHO’s Dr. Fall said: “This system-wide and international support is exactly what WHO has been calling for. We know that the outbreak response must be owned by the local population, and this new approach reflects what they have asked for: better security for patients and health workers, wider access to vaccination, and a more humane face to the response.”…”
“The United Nations named an Emergency Ebola Response Coordinator on Thursday, creating a new position to boost efforts to contain a 10-month epidemic in the Democratic Republic of Congo that has killed more than 1,200 people….”
“…David Gressly, currently deputy chief of the UN’s MONUSCO peacekeeping mission in Congo, has been appointed to the new post, the statement said. “He will oversee the coordination of international support for the Ebola response and work to ensure that an enabling environment – particularly security and political – is in place to allow the Ebola response to be even more effective,” it said….”
“Democratic Republic of Congo called on Wednesday for Merck’s experimental Ebola vaccine to be fully licensed to facilitate its use in the Ebola-hit country, while saying Johnson & Johnson’s rival drug would complicate matters….”
“Both vaccines are experimental drugs that can be used under strictly controlled research protocols but Merck’s has been used throughout the outbreak and has proven highly effective, the World Health Organization (WHO) says. Congolese Health Minister Oly Ilunga Kalenga told reporters in Geneva that the government would roll out a “geographic ring” vaccination strategy in the coming days….”
Health Emergencies program
“The World Health Organization has demonstrated “impressive progress” in the speed and scale of its emergency response. But it needs to strengthen its human resource capacity and staff trained in emergency response at the country level. It also needs to improve the diversity of its staff, including in its health emergencies program, according to a special report by the Independent Oversight and Advisory Committee of the WHO Health Emergencies Program….”
WHO budget approved
GHN – Booster Shot for Vaccines (Via the explicit stance of A Azar, US Secretary of Health and Human Services)
“… “Vaccines are some of the most thoroughly tested medical products we have. Vaccines are safe, effective, and lifesaving.” No one in Salle XXIII at the World Health Assembly on Tuesday afternoon was expecting anything different, nor would they doubt the statement’s veracity, but relief permeated the room as Alex Azar, US Secretary of Health and Human Services, delivered the full-throated endorsement of vaccines. The US, under President Trump, unequivocally was backing vaccines on the world stage….”
“Faced with a global resurgence of measles, health experts called Tuesday for countries to step up the fight against vaccine resistance, warning the movement was spreading like a contagious disease….” “Resurgence of the once all-but-eradicated disease is linked to the growing anti-vaccine movement in richer nations, which has been identified as a major global health threat. “It’s a contagious disease,” Seth Berkley, who heads the GAVI Vaccine Alliance, told AFP, warning that misinformation about vaccine safety “spreads at the speed of light.”…”
Health & migrants
This was the topic of a side event on Tuesday. Among others, financing was also discussed ( and not for the first time in global health, a new funding mechanism along the lines of the Global Fund was being discussed, to pay for migrant health in LMICs).
See also this Lancet Comment from last week – WHO takes action to promote the health of refugees and migrants (by L Gostin et al).
The yearly controversy on travel expenses
AP Exclusive: UN health agency struggles with travel abuses
Published by AP at the start of the WHA.
“The World Health Organization spent nearly $192 million on travel expenses last year, with staffers sometimes breaking the agency’s own rules by traveling in business class, booking expensive last-minute tickets and traveling without the required approvals, according to internal documents obtained by The Associated Press….”
For some background on this issue, see also Aidnography (2018) Should aid workers fly less? Yes, but it’s a bit more complicated. )
Other (high profile media) criticism of WHO
Guardian – Purdue Pharma accused of ‘corrupting’ WHO to boost global opioid sales
“Purdue Pharma, the drug manufacturer that kickstarted the US opioid epidemic, corruptly influenced the World Health Organization in order to boost painkiller sales across the globe, according to a report by members of [US] Congress. An investigation by Katherine Clark and Hal Rogers, who represent districts in Massachusetts and Kentucky hard hit by the US opioid epidemic, accuses Purdue of replicating its false marketing claims about the safety and effectiveness of opioids to change WHO prescribing guidelines in an attempt to expand foreign markets for its drugs….”
Women & global health equity/GHG (& UHC)
Women in Global Health did its yearly analysis of the gender composition of country delegations:
“The votes are in! And the majority of voters guessed correctly – only 22% of #WHA72 delegations are led by women.”
It’s clear that a lot of sessions also stressed SRHR should be part and parcel of UHC (including in the political declaration for the HLM), and that gender equality in general should be at the heart of UHC.
Global Action Plan for Healthy lives and well-being for all (GAP)
Some of the things we learned on this (still somewhat mysterious) GAP, among others at the Technical Briefing on Monday. As you recall, the GAP was requested by Germany, Ghana & Norway in a Letter, and launched at the WHS in Berlin last year.
12 big development organisations are aligning for it, each trying to play to its strengths (taking the lead, thus, on one or a few of the 7 Accelerators). The aim is indeed to Accelerate the journey towards health SDG 3 (and other health related SDG targets). Each of these Accelerators has a Sherpa. And 80 % of the impact will be in the countries, Peter Singer assured, in spite of the name ‘Global’ Action plan. Not all civil society people are happy with how civil society has been engaged so far in the process. Check out also this Letter from Civil Society to the 12 leads – https://csemonline.net/project/gap-advisory-group-letter-to-who-director-general/
WHO is coordinating, but it’s clear that some of the organizations have far more money than others in this constellation. So let’s see how that works out …
A two-week online consultation on #SDG3+ GAP will take place in June 2019. In September, during Global Health Week in NY, the GAP will be launched. And then it’ll have to be implemented.
New report WHO/UNICEF/… – Adolescent Health: The Missing Population in Universal Health Coverage
“The Sustainable Development Goals and global political momentum behind Universal Health Coverage (UHC) offer significant opportunities to build collective global and national action towards achieving universal health coverage for adolescents. This paper sets out the evidence base on adolescent health and makes the case that to achieve Universal Health Coverage, policy makers need to take urgent action on the leading killers of young people, including road traffic injury.”
“…This paper sets out the evidence base on adolescent health and makes the case that to achieve Universal Health Coverage, policy makers need to take urgent action in the areas of service delivery, financing and governance.”
Air pollution & environment/climate change
HPW – Green Light For First-Ever WHO Strategy On Health, Environment And Climate Change
Coverage of the adoption of this – first ever – WHO strategy on health, environment & climate change. “Faced by an annual death toll of nearly 13 million people due to environmental risks, the World Health Assembly today approved a first-ever global strategy that sets out a transformative plan for action on Health, environment and climate change….”
PS: The new WHO Global strategy on ‘Health, environment and climate change’ doesn’t seem to be Tedros’ top priority though, Andrew Harmer pointed out on Twitter. Unlike polio for example.
It’s more than worth to give the PHM position on this in full (via 5 tweets, in which they urge member states to make 4 bold commitments):
“For @PHM and @MMI, it is becoming clear that our response to address climate change is inadequate. Everywhere we look our environment is collapsing. The IPCC report tells us we have barely 11 years to act, while the @IPBES warns that 1 million species are at risk of extinction. They present us with the same dire warning: act now or it will be too late. Therefore, we urge all member states to make four bold commitments: #1 No longer use the term ‘change’ when describing the environment and climate but instead use the term environmental and climate ‘breakdown’ or ‘crisis’. #2 Bring climate breakdown out of the shadows. It is currently hidden within category three of WHO´s programme ‘Promoting life through the life-course’. #3 Ensure that climate breakdown is adequately funded: 3% of the total WHO budget is clearly not enough. Of the available $108m, just $36m of the total was spent by the end of 2018. Please ensure that all available funds are spent. #4 Finally, demonstrate leadership and mobilise political will by declaring climate breakdown a Public Health emergency of International Concern. You have a stark choice to make: bold, urgent action now, today, or we will run out of time. It is up to you.”
HPW – Air Pollution Does More Damage Than Previously Understood, Leading To Chronic Health Impacts
“Air pollution is doing more damage than previously understood, causing a range of chronic health impacts that go even beyond the annual 7 million deaths estimated by the WHO, said panelists yesterday at a World Health Assembly (WHA) side event, Every Breath Can Do Damage: The Urgency of Air Pollution Action. … …. this week WHO [launched its new Global Health and Energy Platform of Action, co-led with United Nations Development Programme (UNDP), with the aim of accelerating the transition to clean energy to improve health and livelihoods. The new platform will “strengthen the political and technical cooperation between the health and energy sector through a multi-stakeholder platform that will gather government, civil society, UN agencies, and the private sector,” she said. Air pollution is also central to a new WHO global strategy on “Health, environment and climate change,” A72/15, which will be discussed in a formal WHA session [tomorrow]. The strategy, which is up for approval this week by the WHA, notes that “failure to tackle air pollution and to mitigate climate change together result in a lost opportunity to gain the health, economic and environmental multiple benefits.”
WHO – The WHO special initiative for mental health (2019-2023): universal health coverage for mental health
New special WHO initiative on mental health, launched at the WHA.
For more on this new initiative, see this coverage of the (Wednesday) technical briefing on mental health by GHN – A New Plan for Mental Illness, the Silent Killer
“…To address the issues, WHO has launched a special initiative on mental health seeking to raise $60 million to bring quality affordable care to 100 million more people in 12 priority countries by 2023. The effort would enhance mental health care in primary care settings, increase specialty care and services, and bolster community support as well….”
Some other news snippets from the #WHA72
“A side event [yesterday] on the margins of the World Health Assembly launched two new digital health initiatives, while a panel of speakers from government, industry and civil society described how the digital health revolution can help achieve universal health coverage. PATH, a global health non-profit announced the launch of a new Center of Digital and Data Excellence to promote the integration of digital technologies and data best practices across PATH’s programs, which are focused on introducing new technologies for vaccines, drugs, diagnostics, health systems and services in low- and middle-income countries. … … Meanwhile, Novartis Foundation, also announced that it would co-chair with Microsoft a new Broadband Commission Working Group on Digital and Artificial Intelligence (AI) in Health to deliver recommendations for how AI can drive improvements in health systems accuracy, productivity and workflow….”
· Xinhua – Britain announces multi-million dollar boost for global health program
“Britain’s Foreign Secretary Jeremy Hunt announced Monday a 70-million-pound (90 million U.S. dollars) boost for a WHO-backed global health program. The Better Health Program will operate a range of health initiatives to help improve the lives of up to 150 million people across eight emerging economies –Brazil, Mexico, South Africa, Malaysia, Philippines, Thailand, Vietnam and Myanmar. The program, led by British Foreign and Commonwealth Office (FCO), has been developed in consultation with the UK Departments of Health, International Development and Trade, with the assistance of UK government health organisations….”
· WHO – Progress report on HIV, viral hepatitis and sexually transmitted infections 2019: Accountability for the global health sector strategies, 2016–2021
Also released at #WHA72. Cfr a tweet: “The first-ever #HIVHepSTIs2019 progress report reviews success and challenges in implementing #GHSS 2016-2021 adopted at #WHA69. It outlines progress scorecards and 8 joint actions for accelerating progress towards #UHC.”
- Lancet Global Health Comment – WHO’s Snakebite Envenoming Strategy for prevention and control
Ren Minghui (WHO) et al explain the new WHO Snakebite Envenoming strategy, launched on 23 May, and what implementation will involve, timewise, in the coming years.
See also Devex (Vince Chadwick) – The race to tackle snakebite
- UNAIDS (press release) – UNAIDS launches Health Innovation Exchange to connect innovations in health to country needs and investments
“UNAIDS and partners have launched a new initiative to leverage the potential of innovations to improve the health of all. The Health Innovation Exchange will link innovators to investors and innovations to implementers. Launched on the sidelines of the World Health Assembly in Geneva, Switzerland, the initiative aims to support global efforts to reach the Sustainable Development Goals. … … To mark the launch the Health Innovation Exchange, a three-day event held between 21 and 23 May at the Palais des Nations in Geneva, [will] showcase 24 innovations for HIV, tuberculosis and health systems….”
Have to admit I studiously avoided this innovation initiative : )
Short report of the Committee meeting dedicated to polio.
And some tweets:
“The Global Preparedness Monitoring Board calls on #WHA72 to ensure sustained commitment to #healthsecurity and action for global preparedness for infectious disease outbreaks and health emergencies.”
“#WHA72 @WHO announced its Special Initiative for #mentalhealth over 5 years, with aims to raise USD 60 million as catalytic fund, to improve access to mental health care for one million more people in 12 priority countries.
Graduate Institute (Global Health Centre) sessions
I quite enjoyed a number of Graduate institute hosted sessions, starting with the Briefing for Delegates on Sunday, but also the political determinants of health session (Wednesday, with among others Thomas Bollyky (on his recent Lancet study) & Edwin Ng (on how (sufficient) female presence in governments is a political determinant of health)), a Symposium on Innovative financing for NCDs (among others, on a Catalytic Fund for NCDs (or at least the ongoing discussion around it).
The event on the new health economy on Thursday (with among others J Sturchio, A Soucat & I Kickbusch) was equally interesting & entertaining. PS: While there’s some truth to the concept of a ‘health economy’, I’d hope its proponents would find a better (also ecological/planetary health) balance between arguing for health as a big contributor to economic growth, and also to the new wellbeing society we need (and which they also seem to advocate for). That balance is not there, for the moment. And so the concept feels very political/strategic vs “the powers that be” (Ministers of Finance & heads of state, first of all), for the time being.
Zero Draft political declaration for the UN High-Level meeting on UHC released
A must-read of course. First reactions have been a bit mixed, on Twitter.
United Nations Secretary-General appoints Gunilla Carlsson as Executive Director, a.i., of UNAIDS
Meanwhile, the process for the nomination of the next UNAIDS Executive Director is ongoing.
Attacks on health care workers
Devex – Health worker attacks are up, but numbers might not tell the full story
“Reported attacks on health care workers spiked last year, but that may not mean violence against vaccination workers, doctors, nurses, paramedics, and other health workers is actually on the rise. New reporting mechanisms on health care worker attacks are making it easier to document the ongoing issue and potentially giving it more visibility, according to Leonard Rubenstein, chair of the Safeguarding Health in Conflict Coalition and the director of Johns Hopkins Bloomberg School’s program on human rights, health, and conflict….”
Global Palliative care
Lancet Global Health (Comment) – Global palliative care: from need to action
“Katherine Sleeman and colleagues report the first worldwide projection of the future global burden of serious health-related suffering. The calculation followed the methods used by the Lancet Commission on Palliative Care and Pain Relief assessing global palliative care need. Combining these methods with WHO’s revised global and regional projections of mortality up to 2060,3 the authors estimate the global burden of serious health-related suffering requiring palliative care by world regions and age groups for 20 health conditions. The vision of the future delivered by this Article is alarming: “By 2060, an estimated 48 million people (47% of all deaths globally) will die each year with serious health-related suffering, and 83% of these deaths will occur in low-income and middle-income countries”. These numbers indicate that 130 000 people worldwide will die every day with serious health-related suffering by 2060, the equivalent to twice the size of a Super Bowl stadium. The real burden of serious health-related suffering is even greater because the authors’ calculations are based on mortality data and do not include the burden of people living with serious health-related suffering who do not die in a given period….”
“…This Article is timely in the debate about global awareness of palliative care as an essential component of universal health coverage. … … The global health community has the responsibility and the opportunity to improve the quality of life of people living and dying with serious health-related suffering, by recognising it as a public health priority and by supporting initiatives to tackle it. … … The findings of Sleeman and colleagues support the development of a global strategy, implementation, and indicators as a matter of extreme urgency.”
For the new Lancet Global Health Study by Sleeman et al, see The escalating global burden of serious health-related suffering: projections to 2060 by world regions, age groups, and health conditions
#Decolonize global health
Devex – The activists trying to ‘decolonize’ global health
Featuring the likes of Renzo Guinto, Sudipta Saha and Rachel Thompson. Among others.
For some recordings of the Decolonization conference in Harvard, see here.
Oslo Summit on tackling sexual violence in crises
Guardian – The world over, people in crisis suffer sexual violence – this scourge must end
N Kanem (UNFPA) & M Lowcock (UN under SG); https://www.theguardian.com/global-development/2019/may/23/the-world-over-people-in-crisis-suffer-sexual-violence-this-scourge-must-end?CMP=twt_a-global-development_b-gdndevelopment
“Tackling gender violence in crises requires changes of response and focus – as delegates in Oslo for a major summit will be told.”
“…The UN, governments, the International Committee of the Red Cross and civil society organisations are coming together in Norway this week for a first-of-its-kind conference on ending sexual and gender-based violence in humanitarian crises. The aim is to strengthen collective responsibility, promote best practices and increase funding and political commitment to prevention and effective response….” Kanem & Lowcock outline 3 key steps needed to tackle this scourge.
Lancet (Editorial) – We must all support women in the fight for abortion
Starting from the recent Alabama bill, the Lancet argues we should all stand up for protecting safe abortions: “…Abortion is a settled, inviolable right that is central to achieving not only reproductive health goals but women’s freedom over their own bodies. It is of the utmost importance that medical organisations, journals, NGOs, and advocates come together to condemn the rolling back of abortion laws and campaign for rights to be respected.”
Family planning in SSA
Lancet Global Health (Comment) – Modern contraceptives in sub-Saharan African countries
Comment accompanying a new study in the Lancet Global Health – Trends in contraceptive prevalence rates in sub-Saharan Africa since the 2012 London Summit on Family Planning: results from repeated cross-sectional surveys
“In The Lancet Global Health, Saifuddin Ahmed and colleagues present the findings from their study in which they assessed the progress in modern contraceptive prevalence rates since the 2012 London Summit on Family Planning in some sub-Saharan African countries. This programme was launched by the Bill & Melinda Gates Foundation, the UK government, and other partners and laid the foundations for the Family Planning 2020 initiative, which aims to enable 120 million additional women to use modern contraceptive methods by 2020 (“120 by 20”) in the world’s 69 poorest countries. This goal will require increasing the pre-2012 annual growth rate of modern contraceptive prevalence rates from an estimated 0·7 to 1·4 percentage points. …”
Assessment of the study, what it measures, and its constraints.
The authors examined the post-Summit trends in modern contraceptive prevalence rates in nine settings in eight sub-Saharan African countries (Burkina Faso; Kinshasa, DR Congo; Ethiopia; Ghana; Kenya; Niamey, Niger; Kaduna, Nigeria; Lagos, Nigeria; and Uganda).
“Overall, the annual growth rates exceeded the 1·4 percentage points needed to achieve the FP2020 goal of 120 million additional users of modern contraceptives by 2020 in the select study settings. …”But there was quite some variability, both above and under the expected growth rate.
G7 health ministers meeting in Paris: launch of PHC Universal Knowledge Initiative
HPW – G7 Countries Prioritise Primary Health Care At Health Ministers’ Meeting In Paris
Nice report from the G7 Health Ministers’ meeting from last week in France. “Health Ministers from G7 countries wrapped up a two-day meeting today in Paris that focused on strengthening primary health care, health inequalities for developing countries and the elimination of HIV/AIDS, tuberculosis and malaria. Entitled “Ensuring Health Care For All: A G7 Priority,” the meeting of the Group of 7 (G7) most developed countries also announced the launch of a new primary health care initiative – which will seek to improve primary health care through knowledge sharing….”
“…Five international organisations, the OECD, the World Bank, the World Health Organization, the Global Fund and GAVI, a vaccine alliance, have issued a statement to work together to produce a joint report. The report will include among other things an identification of the need for a universal knowledge exchange platform, a mapping of existing expert platforms, and an identification of the current shortcomings regarding knowledge dissemination and the exchange of good practices in the area of people-centred primary health care. The joint report should help to accelerate progress among all our countries, and will be a key step towards achieving and sustaining universal health coverage…”
The WB’s Investing in Health blog also had an article on it (by J Veillard & Tim Evans), worth checking out – Strengthening primary health care is the smartest way to reduce health inequalities
Linking it also to their Human Capital agenda, among others.
“Late last week, Ministers of Health of the G7 and the European Commissioner for Health and Food Safety met with heads of international organizations, representatives from the G5 Sahel countries and with civil society to discuss a joint commitment to strengthen primary health care (PHC).The G7 issued a ministerial statement which establishes several key areas of focus for the G7 on health. It emphasizes: Strengthening the primary health care system as the best way to reduce inequalities and improve health and well-being and socio-economic development, as well as social stability and security. Committing to keep global health as a high-level political priority for the G7, through its engagement among G7 countries but also between G7 and low- and middle-income countries (LMICs). Endorsing an initiative led by France to launch a Primary Health Care Universal Knowledge Initiative, through which interested G7 countries would work with international organizations and LMICs to curate knowledge and accelerate learning to strengthen coverage of PHC to reach the most vulnerable. Supporting a successful Sixth Replenishment Conference of the Global Fund for AIDS, Tuberculosis and Malaria that aims to raise at least USD 14 Billion….”
Medicines Patent Pool – G7 Health Ministers support expansion of the Medicines Patent Pool to essential medicines
“In a joint declaration published [today], the Health Ministers of Canada, France, Germany, Italy, Japan, the United Kingdom, the United States, and the European Commissioner for Health and Food Safety, gathered in Paris on 16-17 May, highlighted the importance of improving access to safe, effective, quality, affordable and essential health products and supported the expansion of the Medicines Patent Pool (MPP) to essential medicines. In 2018, at the request of the international community, the MPP expanded its mandate beyond treatment for HIV, hepatitis C and tuberculosis to other essential medicines. Last week, the MPP published its new framework for prioritising target medicines for in-licensing under its expanded mandate….””
Foreign Policy – U.S. Quietly Waters Down Another Communique on Gender Equality
“This time it’s a G-7 joint statement ahead of a meeting of national leaders in August.”
“The Trump administration pushed the G-7 nations to water down a declaration on gender equality last week as part of its broad effort to stamp out references to sexual and reproductive health in international institutions, according to people involved in the process and drafts reviewed by Foreign Policy. It is only the latest iteration of the administration’s hard-line stance against any language that might suggest approval of abortion in the official documents of international institutions that include the United States. The heavy-handed diplomatic strategy has put Washington at odds with European allies and drawn criticism from women’s advocacy groups for undercutting wider efforts to improve global gender equality….”
“…During the meeting, the ministers also discussed replenishment of the Global Fund, an essential partner in the fight against the three major infectious diseases (AIDS, Tuberculosis, and Malaria) in the world. The U.S. has invested over $13.8 billion in the Global Fund since its establishment in 2002. The U.S. intends to continue its support of the Global Fund and anticipates being able to make a $3.3 billion pledge to the Sixth Replenishment (2020-2022), while offering to match $1 from the United States for every $3 pledged by other donors. … … the ministers participated in a press conference and agreed to the G7 Health Ministers’ Declaration which emphasizes France’s two main deliverables in the G7 health track: replenishment of the Global Fund and establishment of a web-based, information-sharing platform on Primary Healthcare. In the Declaration, the G7 leaders recommit to continue to offer assistance to 76 partner countries and regions to implement the World Health Organization International Health Regulations, building on countries’ expertise and existing partnerships, to strengthen and maintain core capacities required; and therefore, to help reduce the vulnerability of countries to public health emergencies. … … In the afternoon, Secretary Azar hosted ministers for a GHSI Special Meeting on Ebola….”
And a quick link:
Foreign Policy – A French Feminist Foreign Policy
“France is the latest country to pledge allegiance to a gendered international focus. Will it work?”
Global Health Financing
BMJ (Editorial) – Trends in global health financing
WHO – Health Financing policies in FCAS: new guidance & resource page
“WHO offers a systematic approach to health financing policy in FCAS based on its health financing framework and guiding principles.” Check out this new resource webpage.
KFF resource – Breaking Down the U.S. Global Health Budget by Program Area
One pagers. For example on the US Global Health Budget Overview, on HIV/PEPFAR, TB, Malaria/PMI, GF, …
Lancet Planetary Health (Editorial) – Financing a healthy civilisation
Editorial of the new (May) Lancet Planetary Health issue. “…Research into sustainable approaches to end poverty and break the impasse in health funding in low-income countries is essential to the notion of planetary health. In particular, what advances could be made via leapfrogging (eg, skipping expensive development phases) or use of tried and tested approaches to resource allocation (eg, favouring strong primary care and disease prevention)? Is redistribution of DAH from middle-income countries to low-income countries viable or desirable? To what extent is fungibility a threat to government health spending? And at the individual level, how can the challenge of increasing out-of-pocket and other private spending (eg, health insurance or direct service payment by companies) be addressed? Low-income countries have been unable to realise the gains in health spending seen in middle-income countries over the past 20 years. While development assistance for health increased per person from $3 in 1995 to $10 in 2016, overall spending rose by just $10. If seven out of every ten extra dollars spent on health in low-income countries is DAH, it is clear that future developments need to take a different track.”
Cidrap News – Investors push restaurant chains to cut antibiotics in meat supply
“A new report from a global coalition of investors suggests the world’s largest fast food and casual dining companies are getting the message about their role in addressing antibiotic resistance. Three years after it began asking companies to establish a comprehensive antibiotics policy to phase out routine use of antibiotics in livestock, poultry, and seafood supply chains and provide clear targets and timelines, the Farm Animal Investment Risk & Return (FAIRR) coalition says 17 out of 20 companies now have publicly available policies, while 2 have internal policies and 1 is developing a policy. In addition, 13 of the 20 companies are now focused on reducing or prohibiting routine use of either all antibiotics or medically important antibiotics in their supply chains. The FAIRR coalition, which includes 74 institutional investors that manage nearly $5 trillion in combined assets, first began engaging with companies in 2016 …”
Global Fund Observer – latest newsletter issue
Ebola DRC outbreak: almost 2000 cases and counting…
We already covered the Ebola DRC outbreak discussion at the 72nd WHA above, and the UN upgrade in its involvement & system-wide response. Here some more reads & links related to the outbreak:
Cidrap News – Ebola responders on edge as virus sickens 19 more
Latest update: “Against a backdrop of steadily rising Ebola cases, health officials in the Democratic Republic of the Congo (DRC) are bracing for more attacks, as threats continue in the big epicenters of Butembo and Katwa, and are on the rise in smaller hots spots such as Lubero and Kalunguta, the World Health Organization (WHO) said yesterday in a weekly situation report. Meanwhile, the country’s health ministry was poised to report 19 new cases today, according to the latest information from the WHO’s online Ebola dashboard….”
“Echoing a concern raised yesterday in the WHO African regional office update, the WHO said another concern is that health workers are refusing to wear personal protective equipment (PPE) in health facilities and are performing only routine infection prevention and control (IPC) measures, based on violent threats from community members….”
Lancet Editorial – Acknowledging the limits of public health solutions
Acknowledging the limits of public health solutions in a conflicted setting like the DRC, and thus not sure whether a PHEIC would make such a difference, the Lancet argues this is principally a political problem. “…a very real risk remains that the outbreak will cross into Rwanda or Uganda, in which case a declaration of a PHEIC would probably be needed to increase technical capacity and international coordination. For now, the focus remains on DR Congo’s government and opposition groups. Sources at WHO told The Lancet that the organisation is working with the governments of the USA, the UK, and France to influence leadership within the country to address the security situation. There are limits to what the medical community alone can achieve—if the Ebola virus disease outbreak is to be ended, DR Congo’s leaders on all sides of politics must step up and take responsibility for the response.”
Lancet World report – NGOs push for decentralised Ebola treatment in DR Congo
“The initiative, led by MSF and ALIMA, would provide community-based Ebola virus disease care. But pushback from DR Congo Ministry of Health could prove difficult. Miriam Shuchman reports.” “…MSF and the Alliance for International Medical Action (ALIMA) have been pushing for a decentralised approach that moves diagnosis and early care for those suspected of having the disease out of the Ebola treatment centres and into the community, closer to where people live….”
Stat – The Ebola response effort is struggling. Experts say these steps could help
Based on some interviews STAT did with experts like Pierre Rolin (who just retired from CDC); Scott Dowel (BMGF) & Axelle Ronsse (Doctors without Borders).
For other ideas, see the Conversation – Radical ideas are needed to break the DRC’s Ebola outbreak. Here are some (by M Fallah)
Guardian – Congo violence sparks fears over UK Ebola response
“Attacks on health clinics provoke concern that disclosing details of funding might ‘put a target on the head’ of medical workers.”
The Washington Post had a somewhat similar story on doctors going undercover in the DRC Ebola outbreak, given the hostilities against health care workers.
Nature – Ebola survivors are protected from infection years after illness
“Antibody patterns shift as people recover from a deadly virus.” “Scientists have charted how the antibodies of a person infected with Ebola virus evolve over time — and the findings suggest that survivors remain protected from the disease for at least three years after recovery….”
“Vaccine Alliance provides over US$ 9 million to fund Ebola vaccinations in Eastern DRC”.
Health Systems Global
HSR 2020 – Re-imagining health systems for better health and social justice
We reckon must of you know this already by now, but just in case. The choice of the theme for the Dubai 2020 HSR symposium was warmly welcomed, on Twitter and elsewhere.
You might also want to check out this brand new blog (linked to a UHC 2030 event at #WHA72) – Private Sector capacity for public good: how the private sector can contribute to UHC (by M Gautham et al on behalf of the Private Sector in Health TWG). “A global multi stakeholder dialogue on Private Sector Engagement initiated by the UHC2030 will bring together the key highlights of this dialogue later today – 21 May 2019 – at a WHA side event to debate ‘options for aligning business objectives of private sector with public policy objectives of improved equitable access to quality essential health services and financial protection’. In this blog post, the Private Sector in Health TWG outline their contributions to this process and their ‘asks’.”
Lancet Child & Adolescent health (Editorial) – Partnership between health and education in early childhood
“While primary school enrolment rate in developing regions reached 91% at the end of the Millennium Development Goal era, 60% of children and adolescents worldwide (617 million) are not achieving basic proficiency in reading and mathematics expected of their school year. One reason for this disappointing outcome is that many young children are not developmentally on track at the time they enter primary school because of scarce investment in preschool education, according to UNICEF in their latest report, A World Ready to Learn….”
“…Early childhood education needs to be prioritised and recognised as a core strategy for strengthening a country’s education system and population health. To accelerate progress towards multiple SDGs, the synergy between the health and education sectors—alongside nutrition, child protection, and social protection—should be leveraged. Such intersectoral collaboration is crucial to ensure that every child receives the nurturing care that will allow them to reach their full developmental potential….”
Quick link (IISD): SEI Tool Predicts “Ripple Effects” of Each SDG Target
“The Stockholm Environment Institute (SEI) describes its three-step ‘SDG Synergies approach’ in a brief. The approach allows users to uncover indirect “ripple” effects when progress towards Target A amplifies or reduces the effects of Target B. SEI concludes that this approach offers a “smarter, more robust and likely more cost-efficient way” to plan for SDG implementation.”
Guardian – Why the Guardian is changing the language it uses about the environment
“The Guardian has updated its style guide to introduce terms that more accurately describe the environmental crises facing the world. Instead of “climate change” the preferred terms are “climate emergency, crisis or breakdown” and “global heating” is favoured over “global warming”, although the original terms are not banned. “We want to ensure that we are being scientifically precise, while also communicating clearly with readers on this very important issue,” said the editor-in-chief, Katharine Viner. “The phrase ‘climate change’, for example, sounds rather passive and gentle when what scientists are talking about is a catastrophe for humanity.”…”
Guardian – Much shorter working weeks needed to tackle climate crisis – study
“People across Europe will need to work drastically fewer hours to avoid disastrous climate heating unless there is a radical decarbonising of the economy, according to a study. The research, from thinktank Autonomy, shows workers in the UK would need to move to nine-hour weeks to keep the country on track to avoid more than 2C of heating at current carbon intensity levels. Similar reductions were found to be necessary in Sweden and Germany. The findings are based on OECD and UN data on greenhouse gas emissions per industry in the three countries. It found that at current carbon levels, all three would require a drastic reduction in working hours as well as urgent measures to decarbonise the economy to prevent climate breakdown….”
IISD – On International Day, High-level Officials Call for Action on Biodiversity-Food-Health Nexus
“On the International Day for Biological Diversity, the UN Secretary-General warns that the current negative trends in biodiversity and ecosystems are projected to undermine progress towards 80% of the SDG targets. Cristiana Pasca-Palmer, CBD Executive Secretary, calls for concrete measures that need to be urgently implemented in order to preserve and restore the health of the ecosystems and food systems, and thus human health….”
Economist – How climate change can fuel wars
“Droughts are already making conflict more likely. As the world gets hotter, mayhem could spread.” “…climate change is causing environmental upheaval that destabilises regions and raises the risk of bloodshed…”
Guardian – ‘We need everyone’: youth activists call on adults to join climate strikes
“Greta Thunberg and leading youth strikers for climate action from across the world have called for all adults to join a global general strike on 20 September. They are asking citizens to walk out of work just ahead of a crucial UN summit at which nations are being urged to declare much stronger ambition to tackle the climate emergency….”
Some papers and journal articles of the week
BMJ Collection – Solutions for non-communicable disease prevention and control
This Collection, a collaboration between the BMJ & WHO, was launched at the WHA.
“Non-communicable diseases (NCDs) constitute a major global health challenge, hampering nations’ economic growth and sustainable development. The four major groups of NCDs – cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes – account for over 80% of all NCD related deaths and share the same four major risk factors: tobacco use, harmful use of alcohol, unhealthy diets, and physical inactivity. Recently, mental health and environmental determinants were also added to the NCD agenda. This new collection issue brings together a wide and diverse author group, to focus on key issues and suggest scalable solutions to accelerate the implementation of the high level commitments made in the three UN general assembly meetings. As this collection expands over time, it looks to cover the major issues in prevention and control of NCDs, and to provide a holistic perspective on the current challenges and scope of future action to tackle NCDs and improve health worldwide.”
Start with the Editorial – Mobilising society to implement solutions for non-communicable diseases
“…The political landscape for NCDs is entering a critical period globally, but despite implementation challenges we see evidence of renewed political commitments and more buy-in from national governments. This series of articles on NCDs represents a timely collaboration between The BMJ and WHO and builds on the gathering momentum for global action. It provides an outlook on the challenges in the prevention and control of NCDs at national, regional, and global levels and highlights the need for multisectoral and multistakeholder policies and for health-in-all and whole-of-society approaches to curb the epidemic. Authors from diverse settings—including policy experts from academia, WHO, other UN agencies, non-governmental organisations, and business associations—suggest scalable solutions to accelerate the implementation of the commitments made in the three UN General Assembly high level meetings on NCDs. … … The articles in this series cover the main issues in prevention and control of NCDs, including financing and partnership building, integration of NCDs into primary care, implementation research, social determinants of health, multisectoral action, nutrition and environmental influences, a life course approach, and the development cooperation. It provides a holistic perspective on current challenges and possible solutions towards meeting the global NCD targets and improving health worldwide by 2030….”
Lancet Global Health (Comment) – Tackling the health challenges of international migrant workers
Comment accompanying a new (systematic review) study in the Lancet Global Health – Occupational health outcomes among international migrant workers: a systematic review and meta-analysis.
“… In The Lancet Global Health, Sally Hargreaves and colleagues have reported the results of their timely systematic review and meta-analysis to highlight the global prevalence of occupational health outcomes including injuries, mortality, and physical or psychiatric morbidity among international labour migrants….”
Coverage among others in the FT – Health threat to migrant workers revealed in new study. (gated)
BMJ Global Health (Commentary) – Redesigning maternal health services: is centralisation the answer in low-resource settings?
Claudia Hanson et al ; https://gh.bmj.com/content/4/3/e001488
“One key recommendation of the Lancet Commission on High-Quality Health Systems in the Sustainable Development Goal Era published in September 2018 is the redesign of childbirth services. The plea for the childbirth service redesign is underpinned by the assumption that the centralisation of childbirth services to hospitals will result in (1) more efficient delivery care, (2) more skillful maternity providers and (3) more timely emergency care interventions including blood transfusion and caesarean section. We call for research to develop and test context-specific redesign strategies for improved childbirth care based on the two continuums of care: from pregnancy, through to childbirth and postnatal care, and from community to specialised referral care. Strategies need to take into account specific aspects of access, safety and quality of care in the respective setting in order for safe and respectful childbirth care to reach all women.”
Plos Med – Women’s and girls’ experiences of menstruation in low- and middle-income countries: A systematic review and qualitative metasynthesis
“Julie Hennegan and colleagues reveal the experiences and challenges facing women and girls in low- and middle-income countries when menstruating.”
Blogs of the week
CGD (blog) – Are Courts Promoting or Hindering Fair Priority-Setting in Health?
D Wang, K Chalkidou et al; https://www.cgdev.org/blog/are-courts-promoting-or-hindering-fair-priority-setting-health
“When the right to health care is enshrined in law, coupled with mechanisms like judicial accountability for challenging the denial of services, it can be an important tool for achieving Universal Health Coverage. Yet there are concerns that justiciable rights to health care can be an obstacle to fair and efficient priority-setting, which is also critical for achieving sustainable UHC.”
They conclude: “…How litigation for health care affects priority-setting depends on whether courts see their role as protecting the needs of right-holders against priority-setting decisions or, alternatively, as engaging with policymakers and scrutinizing their decisions to demand transparency, fairness, and evidence. This is likely to determine if the judicial protection of health rights promotes or hinders fair and efficient priority-setting and, ultimately, progression towards fair and financially sustainable UHC.”
CGD (blog) – Changing Norms Around Gender and Economic Rewards
“A world where risk-taking and competition weren’t considered quite so admirable or so male, and where more stereotypically “feminine” traits like cooperation were properly recognized and rewarded, would be better for both women and men.”
Global Policy (blog) – How to Measure Inequality
“Jason Hickel argues for the common-sense way of thinking about inequality.” The absolute metric, that is, not the relative one, in his view.
Love that “theory of increasing egregiousness”!