Ebola DRC – Tipping point ?
For the latest WHO outbreak news (9 May), see WHO.
Stat News – ‘On a knife edge’: Ebola outbreak threatens to escalate as violence rises
Helen Branswell; Stat;
Must-read. Ominous one.
“The Ebola outbreak in the Democratic Republic of the Congo is threatening to spiral out of control, with ongoing violence aimed at the Ebola response workers undermining efforts to stop spread of the deadly virus. STAT spoke to a number of experts involved with or closely monitoring the situation to try to get a sense of where the outbreak in northeastern DCR is heading. Each one agreed: A disaster is unfolding….” Includes the views of Jeremy Farrar, Mike Ryan, Michael Osterholm, Bob Kitchen, …
Stat – WHO broadens the pool of people who can get the Ebola vaccine
“The World Health Organization announced Tuesday it is going to substantially ramp up the number of people eligible to be vaccinated against Ebola in a bid to try contain a dangerous outbreak in the Democratic Republic of the Congo that seems on the cusp of spinning out of control. Now, people even further removed from individuals who have contracted the virus — an additional ring of contacts — will be offered Merck’s experimental Ebola vaccine. And others in the region who are deemed to be at some but not immediate risk of being exposed to Ebola will be eligible for another experimental vaccine, made by Janssen, the vaccine division of Johnson & Johnson. Responders, including the WHO and other organizations, will also set up more pop-up vaccination clinics to allow people who want to be vaccinated to go outside their neighborhoods to get the shots….”
DR Congo: Ebola claims over 1,000 lives, Guterres commits ‘whole’ UN system, to help ‘end the outbreak’
“Now in its tenth month, the Ebola epidemic in the Democratic Republic of the Congo (DRC) has claimed more than a thousand lives, prompting Secretary-General António Guterres to throw the support of “the whole United Nations system” into stemming the spread of the deadly virus.”
“…“With important shifts in the response now being implemented, the Secretary-General has emphasized his commitment to a collective UN-wide approach, both in Kinshasa, where the UN is led by his special representative, and in the areas affected by the virus, where the response is led by WHO [World Health Organization], all in close liaison with Congolese leaders both in Kinshasa and eastern DRC”, said his Deputy Spokesperson, Farhan Haq, in a statement on behalf of the UN chief.
See also CIDRAP News – Ebola outbreak hits 1,600 cases amid armed clashes
Reuters Exclusive: Mineral traders in Rwanda helping fund Congo rebels – U.N. panel
“Traders in Rwanda profiting from tin, tungsten and tantalum smuggled across the border from mines in eastern Democratic Republic of Congo are helping fund a rebellion in their resource-rich neighbor, according to a U.N. expert panel report. The confidential report, seen by Reuters on Tuesday, said while Congolese government requirements that exporters ensure minerals are conflict-free had halted nearly all trade from the country’s east, smuggling into Rwanda and Burundi had increased. … … … M23 rebels commanded by warlord Bosco Ntaganda, who is wanted by the International Criminal Court for war crimes, have been fighting government soldiers in eastern Congo’s North Kivu province since April. The U.N. report said Rwanda and Uganda were providing arms, troops and advice to M23….”
Related tweet from Anthony Costello: “The real cause of the Ebola epidemic in the Congo: violence around mineral smuggling through Rwanda.”
- You might also want to read a Stat op-ed by Tom Inglesby et al – Urgent steps are needed to prevent Ebola from spinning out of control in the DRC
Inglesby (director of JH’s Center of Health Security) et al list three steps, related to the financing gap, new security steps & vaccination.
“The Trump administration’s desire to crack down on global human trafficking may restrict U.S. efforts to fight Ebola in the Democratic Republic of the Congo. The White House’s decision to enforce tighter aid restrictions on countries that do not meet anti-trafficking criteria — and a lack of transparency from the administration about how those decisions are being made — has led to confusion and uncertainty about which programs will be allowed to continue, and which will be suspended, Devex has learned. At a Senate hearing on Wednesday, that concern spilled over into a discussion about the U.S. Agency for International Development’s evolving strategy to combat the escalating Ebola outbreak in eastern DRC. Senator Robert Menendez questioned USAID Administrator Mark Green about the agency’s plan to broaden its activities in Ebola-affected communities, and whether that plan would be permitted under the Trump administration’s unusually strict interpretation of a law designed to fight human trafficking….” The picture is rather blurred.
The positive side: like WHO and other donors, USAID is adapting its strategy, to try to avoid this outbreak from spiraling out of control.
Twitter discussion continues on (need for) PHEIC
Some tweets from this week:
“Those who’ve said “community engagement ” can stop the violence, allowing #Ebola fighters to defeat the virus must now see the limits of “talk” in a war zone. Every HCWer fighting the epidemic is risking bombs, bullets, arson & physical assaults. We have never been here before.”
“Agree-When #PHEIC was constructed this kind of scenario was not imagined. Countries who once told @WHO it should not be operational now leave it to cope in a war zone and beg for money as long as #Ebola stays in Africa. #DRC government prefers to pay $$$ to Washington lobbyists.”
“The world needs a reliable financing system for #healthsecurity as a global public good – the #G20 must address this – present donor based approaches do not work – ALL countries must step up as must business”
“Key #Ebola facts pointing to an emergency in #DRC: > 1K cases; $54 mil funding gap; distrust-1/4 think Ebola untrue; 1st outbreak in virtual warzone; community deaths not on contact lists… Explain how this isn’t a PHEIC? OK maybe PHEIC won’t help, but status quo unacceptable”
5th UN Global Road Safety Week highlights need for strong leadership (6-12 May)
“The Fifth UN Global Road Safety Week acknowledges that strong leadership is needed to advance road safety in countries and communities and achieve related Sustainable Development Goal and other global targets. … …”
We recommend your read:
Lancet Global Health (Editorial) – Speaking up for global road safety
“This week marks the fifth UN Global Road Safety Week. This year’s biennial events and activities aim to galvanise public demand for stronger leadership for road safety worldwide. Every day some 3700 people die on the world’s roads, equating to 1·35 million lives lost every year, according to WHO. Furthermore, up to 50 million people are left injured or disabled after a crash. Poorer countries bear the brunt of the burden, with 93% of deaths taking place in low-income or middle-income countries. Regionally, Africa and southeast Asia experience the highest number of fatalities. What is most shocking, however, is the fact that road traffic crashes are the number one cause of death for children and young people between the ages of 5 and 29 years globally. Despite the size of the problem and the continuing increase in traffic density around the world, high-level actors have been slow to convene on this issue….”
“As the decade of road safety ends, many countries are unlikely to meet the ambitious SDG target of halving all deaths due to road traffic crashes by 2020. Significantly reducing the number of injuries and fatalities on the world’s roads will require concerted multisectoral action from government agencies, politicians, the police, the automotive industry, schools, health services, non-governmental organisations, civil society, and road users in all countries. Having responsible and accountable leadership in place is crucial to mobilise action….”
You might also want to read Michael Bloomberg, on the current state of affairs for (and work/progress so far of) the “Bloomberg Philanthropies Initiative for Global Road Safety”
Big Alcohol & trends alcohol (ab)use
Lancet – Global alcohol exposure between 1990 and 2017 and forecasts until 2030: a modelling study
Cfr the press release:
“The Lancet: Targets to reduce harmful alcohol use are likely to be missed as global alcohol intake increases
Globally, alcohol intake increased from 5.9 litres pure alcohol a year per adult in 1990, to 6.5 litres in 2017, and is predicted to increase further to 7.6 litres by 2030. This is likely to be caused by increased alcohol use in low- and middle-income countries as they become wealthier. Between 2010-2017, the most notable increases in alcohol drinking occurred in India and Vietnam, compared with significant decreases in Azerbaijan, Russia, the UK, and Peru. The world is not on track to achieve global targets to reduce harmful alcohol use, and the authors call for effective policy measures, such as the WHO best-buys including increasing taxation, restricting availability, and banning alcohol marketing and advertising, to be introduced globally.
Increasing rates of alcohol use suggest that the world is not on track to achieve targets against harmful alcohol use, according to a study of 189 countries’ alcohol intake between 1990-2017 and estimated intake up to 2030, published in The Lancet….”
Check out also the related Lancet Comment – Increases in alcohol consumption in middle-income countries will lead to increased harms
“The WHO Global Monitoring Framework for Non-Communicable Diseases includes an ambitious global target of a 10% reduction in the harmful use of alcohol by 2025. A modelling study by Jakob Manthey and colleagues in The Lancet indicates that this goal will not be met, with a plateau in consumption in high-income countries offset by marked projected increases in middle-income countries….”
And some great coverage in the Guardian – World alcohol consumption on the rise as China’s thirst grows.
Planetary Health: IPBES report, 2 new IMF papers, …
IPBES (press release) – Nature’s Dangerous Decline ‘Unprecedented’; Species Extinction Rates ‘Accelerating’
We trust you heard about this landmark report via the media earlier this week. “Nature is declining globally at rates unprecedented in human history — and the rate of species extinctions is accelerating, with grave impacts on people around the world now likely, warns a landmark new report from the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES), the summary of which was approved at the 7th session of the IPBES Plenary, meeting last week (29 April – 4 May) in Paris. “The overwhelming evidence of the IPBES Global Assessment, from a wide range of different fields of knowledge, presents an ominous picture,” said IPBES Chair, Sir Robert Watson. “The health of ecosystems on which we and all other species depend is deteriorating more rapidly than ever. We are eroding the very foundations of our economies, livelihoods, food security, health and quality of life worldwide.” “The Report also tells us that it is not too late to make a difference, but only if we start now at every level from local to global,” he said. “Through ‘transformative change’, nature can still be conserved, restored and used sustainably – this is also key to meeting most other global goals. By transformative change, we mean a fundamental, system-wide reorganization across technological, economic and social factors, including paradigms, goals and values.”…”
For the key messages of the report, see this press release.
The report goes a step further than previous studies by linking the loss of species to humans and analyzing its effect on food and water security, farming, and economies.
Alternatively, you might also want to read coverage in:
“Landmark UN-backed report finds that agriculture is one of the biggest threats to Earth’s ecosystems.”
“…The next 18 months will be crucial. For the first time, the issue of biodiversity loss is on the G8 agenda. The UK has commissioned Partha Dasgupta, a professor at Cambridge University, to write a study on the economic case for nature, which is expected to serve a similar function as the Stern review on the economics of climate change. Next year, China will host a landmark UN conference to draw up new global goals for biodiversity….”
“…The next year and a half is likely to be crucial because world leaders will agree rescue plans for nature and the climate at two big conferences at the end of 2020. That is when China will host the UN framework convention on biodiversity gathering in Kunming, which will establish new 20-year targets to replace those agreed in Aichi, Japan, in 2010. Soon after, the UN framework convention on climate change will revise Paris agreement commitments at a meeting in either the UK, Italy, Belgium or Turkey.””
- Or the Guardian op-ed by Robert Watson, chair of IPBES: Loss of biodiversity is just as catastrophic as climate change
“…The IPBES assessment has shown the strong interrelationship between climate change, the loss of biodiversity and human wellbeing. Climate change has been identified as a primary driver of biodiversity loss, already altering every part of nature. Likewise, the loss of biodiversity contributes to climate change, for example when we destroy forests we emit carbon dioxide, the major “human-produced” greenhouse gas. We cannot solve the threats of human-induced climate change and loss of biodiversity in isolation. We either solve both or we solve neither. The IPBES report shows that governments and businesses are nowhere close to doing enough. The world is on track to miss the targets of the Paris agreement, the Aichi biodiversity targets and 80% of the UN sustainable development goals (food, water and energy security), because of our poor stewardship of the natural world….” (including SDG 3).
Some tweets to frame the issues properly:
Tweet Greta Thunberg on the term ‘climate change’:
“It’s 2019. Can we all now please stop saying “climate change” and instead call it what it is: climate breakdown, climate crisis, climate emergency, ecological breakdown, ecological crisis and ecological emergency? #ClimateBreakdown #EcologicalBreakdown”
Tweet Laurie Garrett on the term ‘planetary health’:
“If we were candid we would replace the term #PlanetaryHealth with Collective Suicide or Environmental Self-Destruction. The PH term holds no clarity outside of a small medical/publ hlth coterie.”
Global Policy (blog) – Global Inequality is 25% Higher than it would have been in a Climate-Stable World
“Nicholas Beuret on how global warming has radically changed the economies and fortunes of the world’s nations.”
Based on a new paper in the Proceedings of the National Academy of Sciences – Global warming has increased global economic inequality
“… the economic injustice of climate change has already been operating for 60 years. The study, published in the Proceedings of the National Academy of Sciences, compared different countries’ GDP per capita – a measure of the average person’s economic standard of living – between 1961 and 2010. It then used climate models to estimate what each country’s GDP would have been without the effects of climate change. The findings are stark. Many poorer countries’ economies have rapidly grown in the last 50 years, albeit often at great social and environmental cost and to the benefit of the globalised economy. But even that growth has been held back substantially by climate change – the gap in GDP per capita between richer and poorer countries is 25% higher than it would have been in a climate-stable world….”
IMF (blog) – Getting Real on Meeting Paris Climate Change Commitments
Includes links to 2 new IMF papers –
Cfr a tweet: “The IMF estimates that fossil fuels were artificially propped up by more than $5.2 trillion in subsidies in 2017 — or 6.5% of total global GDP….”
Guardian – Aid funding must recognise climate change emergency, say MPs
“The British government’s aid spending is failing to recognise the “scale and urgency” of the climate change challenge facing the world, MPs warn. Climate change must be placed at the centre of aid strategy and funding, if it is to address the seriousness of threats facing developing countries, the committee said. It urged a minimum spend of £1.76bn annually and a halt to funding fossil fuel projects in developing countries, unless they can demonstrate they support transition to zero emissions by 2050….”
UN News – Climate change: ‘A moral, ethical and economic imperative’ to slow global warming say UN leaders, calling for more action
“It is nothing less than a “moral, ethical and economic imperative” to take more action to mitigate the existential threat posed by climate change, said top executives from across the United Nations system on Thursday.” “Calling on Member States to take “urgent action to limit global temperature rise to 1.5°C above pre-industrial levels”, the leaders of more than 30 UN agencies and entities, issued a formal, joint appeal for governments everywhere to “step up ambition and take concrete action” ahead of the landmark Climate Action Summit, which has been convened by UN chief António Guterres this September….”
Global Health Security
NEJM Perspective – Stopping the Gaps in Epidemic Preparedness
One of the reads of the week, given the Ebola threat risking to spiral out of control. Once more.
“New patterns of viral emergence and spread are being driven by ecologic and sociologic changes, such as climate change, migration of vector species to new areas, changing interactions between people and animals, increasing connectivity between communities, more and faster travel, urbanization, and political instability and conflict. Our preparations for epidemics must keep pace with such changes. … … The WHO remains the global resource for preparing for and responding to epidemics, and its Health Emergencies Program has made much progress since its launch in 2016. In addition, the Centers for Disease Control and Prevention, nongovernmental organizations such as Doctors Without Borders, and many other groups have long played invaluable global roles. What is lacking are clear definitions of the relationships among countries, the WHO, and organizations engaged in epidemic preparedness and response….”
“… The German government prioritized international epidemic preparedness throughout its presidencies of the Group of 7 (G7) and Group of 20 (G20) industrialized countries. As the host of the annual Munich Security Conference and a member of the United Nations Security Council, Germany is in a strong position to lead efforts to secure global health in insecure situations…”
Farrar also suggests to deploy peace negotiators with experience in conflict resolution for public health. Among others.
White House – US Government Global Health Security strategy
Was released this week. More info in this White House on aims & priorities Briefing
See also this media statement by CDC: “The Global Health Security Strategy (GHSS), released [today], reaffirms a continued and coordinated U.S. Government (USG) approach to strengthening the world’s capacity to prevent, detect, and respond to infectious disease threats, whether natural, accidental, or deliberate….” and announcement by USAID’s Mark Green USAID: “ The strategy will pursue three interrelated goals: 1) strengthened capacity in developing nations to implement obligations under the International Health Regulations (2005); 2) increased international support for The Global Health Security Agenda (GHSA); and 3) a Homeland prepared and resilient against global health threats.”
On Twitter, Jeremy Youde already gave some of his preliminary thoughts on the strategy.
The Economist Intelligence Unit (report) – The Cost of Complacency: Report Underscores Major Gaps in World’s Response to Drug-Resistant Tuberculosis
“A new report published today by The Economist Intelligence Unit (EIU), and made possible with support from Johnson & Johnson, emphasizes the urgent need for focused global action to address the growing threat of drug-resistant tuberculosis (DR-TB). DR-TB is the leading contributor to deaths from antimicrobial resistance (AMR).”
“Report estimates DR-TB deaths in a single year cost the global economy at least US$17.8 billion and calls for commitment and action to end the epidemic. Urgent action needed for hundreds of thousands who go undiagnosed and untreated for DR-TB – the leading contributor to deaths from antimicrobial resistance”
In other AMR (governance) news, a tweet from Kelley Lee:
“Grappling with complex challenge of potential treaty for antimicrobial resistance @UniofOxford this week with impressive multidisciplinary group including @shoffmania, @GorikOoms, @clarewenham, Thomas Hale, Anthony So, John-Arne Rottingen and Gian Luca Burci. #amrtreaty”
Global Action Plan (GAP)
Global Action Plan (GAP) For Healthy Lives and Well-Being for All – Consultation with Non-State Actors on GAP and its ‘Accelerators’ on Community & Civil Society Engagement, Determinants of Health and Primary Health Care
Discussion paper & draft report of the meeting of 30 April in New York.
“The attached draft report from the non-state actor consultation held in New York on 30 April 2019 is open for feedback until 16 May 2019. We invite participants at the meeting, and those unable to attend, to read the report and send any responses in writing. We would appreciate if feedback is limited to 300 words or less and sent to [email protected] The draft report presents proposals for the consideration of the 12 Global Action Plan agencies on how they might strengthen their work to accelerate progress on health, particularly in the areas of community and civil society engagement, determinants of health and primary health care. We would particularly encourage feedback on the actions and draft standards/principles proposed to enhance community and civil society engagement.”
Blog by Mareike Haase: Global Action or Dissatisfaction?
With some civil society concerns on the GAP process so far.
Such as: a fairly intransparent process; the lack of human resources for health doesn’t get enough attention, and so NGOs suggest to add HRH as an ‘accelerator’. They also think it would also be wise to integrate non-profit civil society organisations into the development of the GAP from an early stage on. And see a conflict of interest for WHO.
During the upcoming World Health Assembly, the GAP and its process will be at the core of debate.
UN HLM on UHC preparations, panel discussions & meetings
HPW – Universal Health Coverage Requires Finance For Healthcare Systems & Prevention
You can re-watch this event from early this week on Key Asks from the UHC movement for the UN HLM on UHC, in Geneva, here.
Great coverage in this article of a panel discussion from earlier this week in Geneva, ‘Moving Forward together, Key Asks from the UHC Movement for the UN HLM’. “Stimulating national government investments in health systems and reducing the large global burden of environmental and work-related health risks are two complementary approaches to universal health coverage (UHC) that are key to its success, said WHO’s lead on the issue. WHO Assistant Director-General Ranieri Guerra was speaking today at a Geneva panel discussion on “Key Asks from the UHC Movement” that should be considered at the United Nations High Level Meeting on Universal Health Coverage, planned for 23 September in New York. The panel debate was sponsored by the Geneva-based Graduate Institute’s Global Health Centre.”
“…At last week’s UN multi-stakeholder meeting, it was suggested that a 7th Ask on gender equality and women’s rights be considered, including a reference to the right to sexual and reproductive health. This seventh Ask may prove to be a politically contentious one, noted Kickbusch, in the wake of a political dispute over a reference to health services for victims of sexual violence, which was removed from a UN Security Council Resolution on Ending Sexual Violence in Conflict, approved on 23 April….”
MMI input in the panel discussion (Thomas Schwarz)
Recommended. Thomas spoke about: UHC as an umbrella? UHC 2030 as a movement? Multi-stakeholderism; and health as a social contract.
Quote (on UHC 2030 as a movement): “A social movement for health must be a people’s health movement. A movement for health cannot be organized top-down, with a secretariat hosted by WHO and the World Bank, and with interactive multi-stakeholder consultations and a civil society engagement mechanism. So call UHC2030 as you like, but not a movement. …”
Recordings multi-stakeholder hearing NY (29 April)
if you want to re-watch some of the sessions.
Access to Medicines
HPW – Group Of Developed Countries Seek To Delay Italian Proposal On Drug Price Transparency
“A number of developed countries are working to delay a landmark proposal at the World Health Organization by Italy to increase transparency of drug prices and R&D costs in an effort to make medicines more affordable, according to sources. The Italian proposal has garnered a number of supporters, including within Europe; but at an informal WHO consultation today and last week at the European Union, countries such as Germany, France, and the United Kingdom have begun pushing for postponement of discussions, sources said….”
“A new draft text from an informal consultation at the World Health Organization yesterday shows a North-South divide emerging as member states made changes to the proposed resolution on the transparency of drug prices and the costs of research and development (R&D), brought forward by Italy earlier this year, that is slated for discussion at the World Health Assembly later this month.
The changes, led by high-income European states, with support from the United States and Australia, were described by civil society advocates for transparency of drug prices and R&D costs as an attempt to strip the resolution of any meaning and purpose, by deleting key provisions that make it useful in promoting transparency….”
In related news, “…more than 100 civil society organizations and health experts sent an open letter to World Health Organization (WHO) Member State delegates urging them to oppose harmful proposed changes to the draft World Health Assembly (WHA) resolution on transparency to be discussed at the 72nd WHA on May 20-28, 2019 in Geneva, Switzerland. …”
GAVI (press release) – Inactivated polio vaccine now introduced worldwide
“After the introduction of inactivated polio vaccine (IPV) into Zimbabwe and Mongolia’s routine immunisation programmes with Gavi’s support, every country worldwide, including all 73 Gavi-supported countries, have now introduced the vaccine which protects children against the disease…”
The Telegraph – How a Wikipedia for drug discovery is disrupting big pharma
Interesting article on the open source pharma movement. With the views of Els Torreele (MSF Access Campaign), Matthew Todd and others. Also listing a few examples, like Open Source Malaria and the Pandemic Response box.
Lancet – Offline: Time to radically rethink non-communicable diseases
“The strategies that underpin global health orthodoxy today, expressed as an almost exclusive concern with Sustainable Development Goal (SDG) 3, will fail to deliver healthy lives for all…. … Unless global health leaders reinterpret, resituate, and reactivate their advocacy and practice in the context of an urgent planetary emergency, their well intentioned words will be wasted. Perhaps the best example of this misplaced thinking is to be found in the strategies to prevent and control non-communicable diseases (NCDs)—a global movement that is dangerously off course….”
“…In her University College London–Lancet Annual Lecture last week, economist Rachel Nugent, who led The Lancet’s 2018 Taskforce on NCDs and Economics, challenged the NCD and global health communities to think differently. She explicitly framed NCDs as a “global emergency”….. “ She recommended to invoke the idea of a syndemic, even if that’s no panacea.
Health Systems & Reform – Political Economy of Non-Communicable Diseases: From Unconventional to Essential
Michael L Reich; https://www.tandfonline.com/doi/full/10.1080/23288604.2019.1609872
One of the reads of the week, based on a keynote speech at the latest PMAC conference in Bangkok.
“In January 2019, the Prince Mahidol Award Conference organized an international meeting on “the political economy of non-communicable diseases”—the first major global health symposium to include political economy in its title and as its frame for discussion. This commentary is based on a plenary presentation made at the start of the conference. The overall goal of PMAC 2019 was “to foster and enhance global momentum for NCD prevention and control,” using a political economy perspective. The organizers called this “an unconventional outlook.” This commentary argues that political economy should become viewed as a conventional, indeed, an essential outlook for NCDs, and more broadly for global health. Political economy factors are integral to the problems of NCDs and therefore must also be integral to the policy responses….”
Health ministries leverage Coca-Cola’s distribution and marketing expertise
“Project Last Mile shares Coca-Cola business models to help governments make sure medicines are available where they are needed most. Project Last Mile is an innovative partnership that is improving the availability of life-saving medicines and demand for health services in hard-to-reach communities across Africa by sharing the expertise and network of Coca-Cola….”
“Project Last Mile is a unique partnership between The Coca-Cola Company, The Coca-Cola Foundation, United States Agency for International Development (USAID), the Bill & Melinda Gates Foundation and the Global Fund to fight AIDS, Tuberculosis and Malaria. It aims to extract and apply key private sector lessons for the benefit of reaching millions of patients accessing public health services in eight African countries.”
As for example Robert Marten argued on Twitter, this sort of partnership is just insane in the SDG era.
Anthony Costello replied: “We should not be surprised. The neoliberal ideologues in charge of major global funds want to sanitise companies that hugely contribute to the problem.”
International Day of the Midwife (5 May)
WHO – International Day of the Midwife 2019
“International Day of the Midwife is celebrated each year on 5 May. The theme for this year’s celebration is Midwives: Defenders of Women’s Rights.”
Do read also (UN News) – International Day of the Midwife: 5 things you should know
Lancet (Editorial) – Research futures—from 2019 to 2029
“What will the world of research look like in 2029? How will research be funded? What are the pathways to open science? How will researchers work, and what will be the role of technology? How will the research information system change, and what will education look like? On May 2, at a conference organised by the European Health Forum Gastein, and hosted by Wellcome in London (UK), possible drivers shaping the future of research were outlined. Three main scenarios provided pegs for broader discussion, based on the outcomes of the Research Futures report by Elsevier (publisher of The Lancet) and Ipsos MORI. The report outlined plausible futures for research: “brave open world”, “tech titans”, and “Eastern ascendance”….”
Disability & conflict
Geneva Academy – Disability and Armed Conflict
“Our new publication Disability and Armed Conflict brings attention to the devastating impact conflict has on persons with disabilities and, crucially, highlights that many of the key international humanitarian law (IHL) provisions that serve to minimize the impact of armed conflict – such as the proportionality assessment and advanced effective warnings – are not being applied in a disability inclusive manner, resulting in persons with disabilities being killed, seriously injured or left behind as families flee armed attacks. … … ‘This publication brings attention to this extremely important, yet much overlooked topic that has been predominately ignored by states, humanitarian organizations, the United Nations (UN), civil society, the media as well as academics. It is the outcome of more than three years of research funded by SNIS and Pro Victimis, including field research in the Democratic Republic of the Congo, Colombia, Palestine, Ukraine and Vietnam…”
Gearing up for the 72nd WHA (20-28 May, Geneva)
HPW – WHA 2019 Top Issues: Budget, UHC, Access To Medicines, Emergencies, Environment
You know you have to read this analysis ahead of #WHA72 in full.
“This year’s World Health Assembly will provide perhaps the best measure to date of the World Health Organization director-general’s policies since taking office nearly two years ago. But it will also reflect changing times for country relationships and for the state of global health. … … The WHA will take on a wide range of topics in a short time, including universal health coverage, the next two-year budget, organizational reform and a host of staffing and internal issues, access to medicines, emergencies and pandemics, environment and health, antimicrobial resistance, and actions on a variety of diseases such as polio, tuberculosis, and non-communicable diseases. Below is a look at some of the issues ahead….”
Focus in this analysis on UHC, budget (with 8 % increase of ceiling for 2020-2021 asked for by Tedros), health emergencies (high profile now, with Ebola outbreak ongoing); access to medicines & vaccines; and the WHO draft global strategy on health, environment, and climate change, and a draft action plan, for small island developing states particularly vulnerable to climate change.
HPW – World Health Assembly Agenda, Technical Briefings, Side Events – Online Links To The Big Moments Ahead
“The first “World Health Assembly Journal” for the upcoming World Health Assembly, 20-28 May, has been published online, together with the provisional agenda for the 72nd WHA and links to some 50 progress reports, strategy plans and updates that will shape the face of the meeting between WHO’s 194 member states. The already wide breadth of topics on the agenda – ranging from anti-microbial resistance and health emergencies to WHO’s internal reorganization and its 2019-23 budget plan – will be complimented by a series of 8 technical briefings…….”
WHO results report 2018 – Programme Budget 2018-2019 Mid-Term Review
The WHO results report 2018 is out, among others with info on what WHO achieved on UHC, health emergencies & healthier populations. This Mid-term Review 2018–2019 is a summary of key achievements and results in the first year of the biennium. This report presents areas where WHO had impact and the financial resources that were required to achieve them. Key results are organized using the triple billion targets.
Devex – Exclusive: Questions arise over Tedros’ new deputy director-general
“An internal complaint at the World Health Organization’s ethics office has questioned the appointment of Dr. Zsuzsanna Jakab as WHO’s new deputy director-general as part of the agency’s organizational restructuring in March. The complaint, filed after the appointment and seen by Devex, came from a “group of concerned staff members at WHO” who “feel confused and outraged” by Jakab’s elevation. The complaint alleges that Jakab, while serving as regional director of WHO’s European office from 2010 to early 2019, was a recipient of “many allegations of harassment.” In addition, the complaint also alleges that by appointing 67-year-old Jakab to the position, WHO has violated the retirement age limit of 65. While WHO’s ethics office has since closed the case, the emerging details raise questions on the legitimacy of Jakab’s appointment and the credibility of WHO’s oversight processes….”
“…The issue comes a few weeks before the 72nd World Health Assembly, where WHO’s restructuring will likely be a major topic of discussion….”
Scientific American – The World Health Organization Needs to Put Human Behavior at the Center of Its Initiatives
WHO needs a ‘nudge unit’, the authors of this piece argue, in order to incorporate insights from behavioral research into large-scale policy initiatives. They also explain what such a nudge unit should do.
Global Fund update
Aidspan – Global Fund Board’s new Chair and Vice-Chair appointed using new selection process
“The Global Fund Board has appointed Donald Kaberuka as Chair of the Board and Roslyn Morauta as Vice-Chair. Each will serve for a two-year term starting from the adjournment of the 41st Board Meeting on 16 May 2019. In choosing its new chair and vice-chair, the Board followed a selection process that it adopted in May 2018. Under the new process, a Board Leadership Nominations Committee (BLNC) was created to coordinate the selection and an executive search firm was engaged to provide support. The new selection process maintains the current practice of rotation between the implementer and donor voting groups for the final candidates for Board chair and vice-chair….”
“The new chair, Donald Kaberuka, who is from Rwanda, was nominated by the donor bloc; and the new vice-chair, Roslyn Morauta, who lives in Papua New Guinea, was nominated by the implementer bloc. This is the first time in the history of the Global Fund that the person nominated by the donor bloc hails from an implementing country….”
Global Fund- 4-pager on its “new” focus on UHC
“…The Global Fund’s strategy for 2017-2022 commits us to supporting resilient and sustainable systems for health, and promoting and protecting human rights and gender equality – two critical foundations of universal health coverage….”
…The Global Fund is the largest multilateral investor in sustainable systems for health, investing US$1 billion a year on health system strengthening, including: improving procurement and supply chains; strengthening data systems and data use; training qualified health care workers; building stronger community responses and systems; and promoting the delivery of more integrated, people-centered health services so people can receive comprehensive care throughout their lives.
… A new catalytic funding mechanism will support innovative activities that amplify ongoing programs: service delivery integration, data quality and data usage, human resources for health, procurement and supply chain management and improving health sector governance
… The Global Fund is working with other health agencies including Gavi, WHO, and the Global Financing Facility as part of the Global Action Plan’s “Sustainable Financing Accelerator;” and with the African Union and the World Bank to accelerate the capacity of countries to raise more domestic resources, give greater priority to health spending, and improve the efficiency and equity of investments in health. …”
- PS: For an example of this new Global Fund approach/emphasis, see Uhuru: Kenya, Global Fund to implement Universal Health Coverage.
“President Uhuru Kenyatta has lauded the partnership between the Government of Kenya and The Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund) in the delivery of health services to Kenyans, especially in the war against malaria, TB and HIV/AIDS.”
- And a quick link:
“The Global Fund [today] announced a partnership agreement with PharmAccess Foundation to support African countries accelerate progress toward universal health coverage by harnessing digital technology. PharmAccess is a Dutch non-governmental organization with presence in Africa, dedicated to championing the development of mobile and digital technology platforms to expand access to affordable healthcare in sub-Saharan Africa. … … Kenya, Rwanda, Nigeria and Ethiopia have been identified by the Global Fund as potential key pilot countries given their commitment to achieving universal health coverage and focus on digital technology.”
Guardian – Mali gives top job to UN executive accused of ‘tolerating harassment’
Sidibé has been appointed health minister in Mali. He leaves UNAIDS immediately.
As for an overview Sidibé’s legacy at UNAIDS, and more specifically his contribution to the HIV response, you might want to read the UNAIDS press release, UNAIDS congratulates Michel Sidibé on his appointment as Minister of Health and Social Affairs of Mali
Global Financing Facility
GFF – Final report 8th Investors group meeting (15 April)
Well worth scanning.
Among others: “…The Director of the GFF Secretariat gave an update on GFF progress from the last year, particularly with the strengthening of the partnership and its critical role in reaching the replenishment milestone of US$1 billion in November 2018 in Oslo. Dr. Mariam Claeson also announced her departure from the GFF Secretariat on June 30. ▪ The Minister of Health from Nigeria provided a detailed account of Nigeria’s experience and results with the GFF (GFF-IG8-2 PPT) as well as next steps for successfully meeting Nigeria’s health priorities. ▪ The GFF Portfolio Update was presented as a synthesis of the progress in the 27 GFF-supported countries, and all country representatives presented updates on their country’s individual successes and challenges (GFF-IG8-3). ▪ Global Affairs Canada facilitated a panel discussion on the role of Gavi, GFF, and Global Fund in the Global Health Architecture. ….”
World Bank update
Tim Evans will join McGill Faculty of Medicine in September
The link does no longer work, but I’m guessing Tim is still moving to McGill. Back to academia, in other words.
“…Dr. Evans is currently the Senior Director of the Health, Nutrition and Population (HNP) Global Practice at the World Bank Group. Over the last six years, he has re-oriented its multi-billion dollar investments in low- and middle-income countries around the pursuit of Universal Health Coverage. Flagship initiatives during his tenure have included establishing a Global Financing Facility (GFF) to eliminate preventable maternal and child mortality, inaugurating the first-ever insurance for pandemics in the wake of the Ebola outbreak in West Africa (PEF) and catalyzing efforts to measure primary care performance (PHCPI)….”
What this bodes for the WB & global health, with Jim Kim also gone already for a while, is anybody’s guess…
In other WB related news, you might also want to read this article from Charles Kenny (CGD) – Fighting crony capitalism at the World Bank (the Hill)
Cfr. a tweet from Justin Sandefur – “World Bank aid to the poorest countries is increasingly diverted to its private sector arm, which provides “undisclosed levels of subsidy to firms selected on opaque, non-competitive grounds, involving no input from beneficiary countries.”
Tax expert fired for stance on transwomen
Times – Tax expert Maya Forstater fired for saying trans women aren’t women
“An internationally renowned researcher on tax avoidance is believed to be the first person in Britain to lose her job for saying that transgender women are not women. Maya Forstater, 45, was told by her managers that she had used “offensive and exclusionary” language. She was accused of “fear-mongering” for tweeting her concerns about government proposals to allow people to legally self-identify as the opposite sex. Forstater has begun employment tribunal proceedings against her former employer, the London office of the Centre for Global Development (CGD) think tank. …”
For the full story in Forstater’s own words, see Medium – I lost my job for speaking up about women’s rights.
Sure her name rings a bell for readers of this newsletter, including on tax evasion in LMICs. See for example a former CGD blog – Exaggerating Multinational Tax Avoidance Does Not Help Africa
New newsletter on Anti-corruption, Transparency, & Accountability (ACTA) in Health Systems
As for the first issue, see here.
“WHO [ i.e. The Department of Health Systems Governance and Financing and the Department of Gender, Equity and Human Rights at the World Health Organization], UNDP, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund) joined forces to convene a multi-stakeholder consultation to inform the creation of the first global network focused on ACTA in health systems. This newsletter is one of the channels through which we hope to continue the conversation….”
JAMA (Perspective) – Health Concerns in Urban Slums – A Glimpse of Things to Come?
“In this Viewpoint, authors from the International Center for Diarrheal Disease Research in Bangladesh discuss rapid urbanization in low- and middle-income countries and the associated challenges of meeting the basic health care needs of growing urban slum populations.”
Some papers & reports of the week
Globalization & Health – Inclusive engagement for health and development or ‘political theatre’: results from case studies examining mechanisms for country ownership in Global Fund processes in Malawi, Tanzania and Zimbabwe
“For many countries, including Malawi, Tanzania and Zimbabwe, 2017 was a transition year for support from the Global Fund to Fight AIDS, Tuberculosis and Malaria as one funding cycle closed and another would begin in 2018. Since its inception in 2001, the Global Fund has required that countries demonstrate ownership and transparency in the development of their funding requests through specific processes for inclusive, deliberative engagement led by Country Coordinating Mechanisms (CCMs). In reporting results from case study research, the article explores whether, in the context of the three countries, such requirements continue to be fit-for-purpose given difficult choices to be made for financing and sustaining their HIV programmes…. … The findings show how complex, competing priorities for limited resources increasingly strain processes for inclusive deliberation, a core feature of the Global Fund model. Each country has chosen expansion of HIV treatment programmes as its main strategy for epidemic control relying almost exclusively on external funding sources for support. This step has, in effect, pre-committed HIV funding, whether available or not, well into the future. It has also largely pre-empted the results of inclusive dialogue on how to allocate Global Fund resources. As a result, such processes may be entering the realm of ‘political theatre,’ or processes for processes’ sake alone, rather than being important opportunities where critical decisions regarding priorities for national HIV programmes and how they are funded could or should be made. … … To address this, the Global Fund has begun an initiative to shore-up the capabilities of CCMs, with specialised technical and financial support, so that they can both grasp and influence the overall financing and sustainability of HIV programmes, rather than focussing on Global Fund programmes alone…”
Canadian Journal of Public Health – Building the political case for investing in public health and public health research
Steven Hoffman et al; Canadian Journal of Public Health;
Well worth a read, this 4-page Comment, even you’re not from Canada.
“Governments around the world vastly underinvest in public health, despite ever growing evidence demonstrating its economic and social benefits. Challenges in securing greater public health investment largely stem from the necessity for governments to demonstrate visible impacts within an election cycle, whereas public health initiatives operate over the long term and generally involve prevention, statistical lives and underlying conditions. It is time for the public health community to rethink its strategies and craft political wins by building a political case for investing in public health—which extends far beyond mere economic and social arguments. These strategies need to make public health visible, account for the complexities of policymaking networks and adapt knowledge translation efforts to the appropriate policy instrument.”
Plos Med – The healthcare response to human trafficking: A need for globally harmonized ICD codes
“In a Perspective, Jordan Greenbaum and Hanni Stoklosa make the case for inclusion of codes for human trafficking in international diagnosis classification systems. Part of the ongoing Collection on Trafficking, Exploitation and Health.”
“…We are calling on WHO to include HT among the ICD-11 codes, which will take effect in 2022. Inclusion of diagnostic codes at WHO level is critical to harmonizing international public health efforts to end trafficking….”
Global Health Action – Research collaboration on community health worker programmes in low-income countries: an analysis of authorship teams and networks
E N Maleka, H Schneider et al; https://www.tandfonline.com/doi/full/10.1080/16549716.2019.1606570
“Global health research partnerships, which promote the exchange of ideas, knowledge and expertise across countries, are considered key to addressing complex challenges facing health systems. Yet, many studies report inequalities in these partnerships, particularly in those between high and low-and-middle-income countries (LMICs). This paper examines global research collaborations on community health worker (CHW) programmes, specifically analysing the structures of authorship teams and networks in publications reporting research on CHW programmes in low-income countries (LICs)….”
The authors conclude: “Knowledge production on CHW programmes in LICs flows predominantly through a pool of connected HIC authors and North–South collaborations. There is a need for strategies harnessing more diverse, including South–South, forms of partnership.”
Nature – Rising rural body-mass index is the main driver of the global obesity epidemic in adults
NCD Risk Factor collaboration; Nature
A remarkable new study: “Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities. This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity. Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017—and more than 80% in some low- and middle-income regions—was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing—and in some countries reversal—of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women….”
Oxfam Briefing paper – It’s not all about the money: Domestic revenue mobilization, reducing inequality and building trust with citizens
“This Oxfam briefing paper examines the challenges to the ‘success’ of domestic revenue mobilization (DRM) efforts, raises some questions about how to measure progress, and urges both governments and donors to shift to a more equity-centered approach to DRM. This paper emphasizes that DRM is about more than just increasing revenue; it is about how revenues are collected (i.e. who pays). Oxfam advocates that DRM efforts should reduce inequalities, not reinforce them.”
Some blogs of the week
IHP (blog) – From “Health for All” to “Universal Health”: The Americas Region Seems to Get it. Again.
Insightful blog from Renzo, focusing on a recent PAHO report.
O’Neill Institute (blog) – Health and safety at workplaces: an opportunity for a joint effort
“Last April 29 was the first official world day for safety and health at work….” Blog on what WHO & ILO could do, jointly, in this respect.
Keynote by Christine Lagarde at Paris Forum – How to Ensure the Effective and Sustainable Financing of International Development
Helicopter view by the IMF boss at a recent Forum in Paris. Well worth a read.
Excerpt: “…Our work at the IMF has shown that many countries need to significantly scale up spending to meet the SDGs by 2030. The additional spending needs in vital areas such as health, education, and priority infrastructure represent as much as 15 percentage points of GDP on average in low-income developing countries—which is equivalent to about half a trillion US dollars in 2030. This is clearly a considerable challenge. How can this be financed in a way that is sustainable? This is the key question. The first step begins at home—raising more domestic revenue, making spending more efficient, reducing corruption, and improving the business environment. We believe that countries can raise as much as 5 percentage points of GDP in additional tax revenue—ambitious, but doable. But this alone will not be enough. Developing countries will also need support from the international community—from bilateral donors, international institutions, and the private sector….”
F2P (blog) – On tackling ‘Development Effectiveness’ and the long journey ahead
“Making aid and development more effective has been a central aim of the development sector in the last two decades. Successive meetings have brought together donors and recipients to devise a way forward in addressing the poor development results of aid and development co-operation overall. Indeed, four High Level Fora (HLF 2003, 2005, 2008, 2011) and two High-Level Meetings (HLM 2014, 2016) discussed, shaped and reviewed the effectiveness agenda. This agenda is encapsulated in evolving frameworks ensuing from each meeting: Rome 2003, Paris 2005 & Accra 2008, Busan 2011, Mexico 2014, Nairobi 2016. These frameworks put forward a set of commonly agreed effectiveness principles and commitments. The agenda moved from an initial focus on aid to one on development effectiveness….”
Excerpt: “…One of the achievements of Busan was to bring on board South-South Co-operation (SSC) providers like China and India. The Busan Partnership and the subsequent GPEDC [ Global Partnership for Effective Development Co-operation ] had hoped to constitute a common global framework and rallying platform. But by now, China, India and Brazil have exited the GPEDC process, blaming an agenda still dominated by the OECD-DAC and Western norms. The three countries, plus South Africa, did not attend the Nairobi High Level Meeting (HLM2) in 2016. This begs the question: is a global framework possible (or desirable) when there is not even an agreed forum to discuss it? If yes, what platform could rally all actors? The UN Development Co-operation Forum is seen by major SSC providers as more representative. But whether it could play that role and what would be the division of labor with the GPEDC remain an open question.”
Duncan Green (blog) – INGOs and Aid’s Middle Income Country Trap – What are the Options?
“Duncan Green on what INGOs can do in fast developing semi-authoritarian countries.” Like in the Philippines now, under Duterte. Green sees three options, neither of them very enticing.
BMJ (blog) – Let’s talk about sex
If you got this far in the newsletter, we don’t want to withhold this insightful blog from you 😊.
“What may be of concern is not how often an individual has sex, but whether it matters to them”, argues Kaye Wellings, commenting on her latest (UK focused) study. She’s a Professor of Sexual and Reproductive Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine.
And no worries, findings & comments probably don’t just pertain to the UK.
BMJ Global Health (blog) – Let’s talk about sex – what has sexuality got to do with violence during global health fieldwork?
“Valéry Ridde and colleagues recently published an Editorial entitled “It’s time to address sexual violence in academic global health”. While I support the call to fight the violence endured by women, I disagree with the authors in a number of respects.”