IHP News 533 : Myths for Our Times, the UHC Political Declaration & 1

IHP news 533 : Myths for our times, the UHC political declaration & 1-year mark Ebola

(2 August 2019)

The weekly International Health Policies (IHP) newsletter is an initiative of the Health Policy unit at the Institute of Tropical Medicine in Antwerp, Belgium.

Dear Colleagues,

This week (29 July), Earth Overshoot Day was “celebrated” (at least for the planet, in Belgium we already had an early “celebration” in April …). Against the dire backdrop of climate breakdown, Alex Evans explored, in a very insightful thread on Twitter, what could be core myths for progressives, or ‘big unifying stories’ to face and address the many wicked challenges of our times. The Guardian’s George Monbiot argues we need a Restoration Myth (historically, a very effective myth), Evans reckons we also need a – complementary - Emergence myth: “…About how we grow into our adulthood as a species: recognising our responsibilities, realising our potential... .and above all, becoming co-creators….” “…Emergence … allows us to recognise that we're in our adolescent years as a species. Testing the limits, rebelling, working through deep themes of initiation. We're *supposed* to make mistakes - and to learn from them….”

But as I tell my own teenager from time to time, at some point one also has to grow up :)

As far as I am concerned, we should certainly also see the limits of the (also in some global health circles quite popular) DWEIB myth (HT Roge Karma) - “…the “Don’t Worry, Everything is Better now” or DWEIB … narrative is perhaps the most compelling defense of global capitalism out there. Sure, the wealthiest individuals might own a grossly disproportionate amount of global wealth, the rules may be rigged in favor of the rich, and hundreds of millions may continue to live without their basic needs met, but the DWEIBs (shorthand for those who promote the DWEIB narrative) are quick to point out that the system that produced these conditions has done more for the poor than any other. Global capitalism may not be perfect but the benefits it brings—namely, eradicating poverty as we know it—far outweighs its costs. … … Once you accept the DWEIB narrative—that global capitalism has indeed been responsible for lifting billions out of poverty and radically improving the lives of even the most marginalized—then calls for systemic or structural change seem misguided at best and sinister at worst. …” As you might have guessed, like the author of this paragraph, I’m not a fan.

Anyway, not all is lost. At this very moment, the dauntless Laurie Garrett is on a ‘fact finding mission’ to Greenland and the Arctic (let’s hope after that, she also goes to Siberia where a state of emergency has been declared). In the same encouraging news category, Ethiopia planted more than 350 million trees in 12 hours (sort of a world record). As for Greta Thunberg, who will sail to New York for the Climate Summit, I count on a stop-over at the UN High-Level meeting on UHC, as the final draft of the political declaration (or at least I’m guessing this is the final draft ) doesn’t exactly radiate a sense of climate urgency. Guess that’ll be something for the “stocktaking” in 2030 (huh).

In other news, the 1st anniversary of the Ebola Outbreak declaration in the DRC was commemorated on August 1. Quote: “This is a wake-up call. There must not be a second-year milestone” (Jerome Pfaffman, UNICEF). Exactly. The new (worrying) cases in Goma don’t help, though.

Enjoy your reading.

Kristof Decoster

Featured Article

Listening to each other in polarized times: do we need exercise?

Bart Criel (ITM)

In many countries around the globe, the debate in the public arena has become harsh. Yes, the Internet and social media platforms have dramatically multiplied opportunities for people to share opinions, comment on social, cultural and political events, interact with like-minded and other people,… which is great. At the same time, however, this plethora of communication channels - that can be (and often are) used anonymously - boosted intensity, and in many cases brutality in tone and content when “discussing”. With, unfortunately, increasingly very polarized and sterile debates as a result. The very nature of communication on social media – going for short, crisp and often provocative messages – makes it poorly fit to address complex issues and provide proper space for nuancing. True, Global Health remains a bit of an ‘outlier’ in this respect: social media traffic on issues pertaining to Global Health has generally remained ‘civilized’. Let us cross fingers. Still, Global Health doesn’t operate in a vacuum, and faces an ever more polarizing world.

This overall trend is very much in line with, and probably played a key role in, changes in the political landscape in this country (Belgium), and in many other Western (liberal) democracies. Other parts of the world (India, Brazil, …) have also not stayed immune for this hardening of the political debate. Focusing on my country, Belgium, two trends seem to stand out: on the one hand, an increasing fragmentation in the political arena with the more ‘traditional’ political parties (i.e. social and Christian democrats, liberal parties) on the verge of an existential crisis; and on the other hand, the emergence and growth of political groups at both extremes of the spectrum. The picture at the European level isn’t that different, although perhaps less pronounced than in Belgium.

The two above mentioned trends (increasing polarization of the debate, and political fragmentation plus evaporation of the center) can of course not be isolated from the greater worldwide (and rather worrisome) picture of increasing uncertainty and instability, a crisis in multilateralism, growing social inequalities, unevenly distributed gains from globalization, the rise of populist (and often authoritarian) politics, shortsighted management of migration flows, navel- gazing identity debates, the backlash against neoliberalism and austerity which seems to lead to an increasingly neo-illiberal world … Shifts in the global distribution of power, with loss of power by a formerly hegemonic West, may also have contributed to the rise in populism according to some analysts. Meanwhile, a credible

and broadly shared progressive alternative for neoliberalism is still lacking, in spite of the many interesting ideas currently raised on fairer & sustainable ways forward, by public intellectuals, scientists, grassroots movements and (some) politicians.

It is a bit in the light of all these trends that a small consortium of Flemish information media (Knack, De Standaard, Bruzz and StampMedia) launched a very interesting project earlier this year, a couple of weeks before the European, federal and regional elections (which took place in Belgium on May 26th ). The initiative was about promoting dialogue between people with different, sometimes fiercely opposed ideas and opinions on a wide range of themes, cross-cutting society. This project was part of My Country Talks , an international platform for political dialogue. It was labelled by the organizers as “Het Grote Gelijk” – which is Dutch for (forgive me the entirely free translation!) “I, myself, am of course right!”.

Citizens aged 18 or more were offered the possibility to debate with somebody (unknown to them) who had also accepted the invitation to participate, but with different ideas and opinions on a range of issues. Each interested participant was asked to respond to a small survey probing for her/his positioning on a selection of currently ‘hot’ themes in the public debate in Belgium. Side remark: The themes were not – purposely - confined to the Belgian (regional or federal) level; in many cases, they were also, at least partly, European and global issues. Put differently, if they are to be addressed, they cannot do without international collaboration and regulation.

The project staff managing “Het Grote Gelijk”, with due respect of privacy, then matched two people (who live relatively close to each other) with a different ‘profile’ in terms of social and political opinions and convictions. They then independently informed each one of the potential pair and asked whether they would agree to be put in touch with one another. If that was the case for both, the project staff shared the names and email addresses, together with a short narrative summary of the main results of the survey in which both had participated. This summary addressed the following questions: what is your profession? What do you like to do in your free time? Can you present/describe yourself in three words? What makes you happy? What are you worried about? The project organizers then listed about a half dozen of issues on which disagreement appeared rather big. These were formulated as questions and could then be taken as a basis for the forthcoming discussion. For instance: should the use of cars be discouraged?

Eventually, two people, who had never met before, thus got connected. All duos were invited to come to Brussels on Sunday 5 May to interact with each other, in a big hall, with each duo sitting face-to-face at a small table. More than 2000 people had accepted the invitation!

And so had I.

Yes, I admit, there was some suspense in the air. My “match” was a man of 54 year, with a university bachelor degree, an independent entrepreneur in the construction business, heading a small firm. To respect his privacy, I won’t share more personal details here. We could not make it to Brussels on that particular day, due to a private commitment from my side, but we agreed, after one or two email exchanges, to meet in the evening in a tranquil pub in my municipality. Over a beer (we’re both Belgians!), and later in the evening a coffee, we started our discussion on questions listed by the project staff. Is the Islam compatible with Western values? How to address the population explosion in sub-Saharan Africa and the migration to Europe? Does politics still “work” in the complex country that Belgium is? Are the (many) taxes Belgians pay properly used? Are there not

too many people in our country abusing our social security system? All in all, we spent some 2 hours together but we still did not fully exhaust the discussions on the initial list of issues.

With hindsight, a few months later now, how do I look back at this experience? Not in anger, that’s for sure! All in all, I found it pleasant and interesting. I am glad I participated. My match and I had a mutually respectful interaction without major stumbling blocks. Some selection bias in the ‘population’ of people choosing to participate in this project might have something to do with this, but so be it. We exchanged ideas and views rather than opposing/confronting them (and each other). I appreciated the fact that my match’s background provided him with insights and experiences that I – as an academic with a focus on health systems in LMICs – do not have. And vice- versa. I think we learned a fair bit from each other. Or, at least, the discussion made us think things over. And see – and look for - nuances. What I definitely also experienced in this face to face exchange is that it is not sufficient to have a clear opinion, one also needs a coherent set of arguments to back it up. Not always easy. In real life, we tend all too often not to go beyond contrasting our opinions. That night, my match and I were also open enough to express our voting intentions for the (then forthcoming) elections: yes, we were going for different political parties, but they weren’t terribly different. He was more surprised than I was. We also agreed to stay in touch via mail. And my match did actually do so, he mailed me a while ago – I still have to answer. Writing this piece for the IHP Newsletter is a good reminder to do so. Perhaps I can share this editorial with him?

The political editor-in-chief of Knack magazine, one of the principal organizers of the event, nicely summarized the initiative: ‘When one looks at political debates, on tv or on social media, one would think that we live in a totally fractured society. When you look at this experience, though, you get a different picture. That is a clear win’. And the rector of the (Flemish) University of Brussels (VUB), Professor Caroline Pauwels, one of the supporters of this initiative, said that ‘If we are no longer convinced of the usefulness of a conversation with each other, then there only remains ‘an eye for an eye, and a tooth for a tooth’. Eventually, we will then end up without eyes and without teeth’.

Are there any lessons to be learned from this experience for the public (and global) health community? Being someone with a special interest for (the) front-line (providers) within the larger realm of health systems, at the intersection where health workers interact on a daily basis with people, I almost instantly think of the need to continuously search for a balance between professionally defined needs and people’s demands. The two overlap, of course, but only partially. All too often, the former tend to dominate and accordingly shape the supply of health care. Truly listening to each other, acknowledging that rationales and expectations may differ, focusing in the first place on commonalities rather than differences, would already be a major step forward. Not per se an easy endeavor because such an exercise needs to be dynamic, is naturally time-intensive, and requires self-awareness and an openness to introspection from the ‘supply-side’. But eventually it will contribute to building trust. And trust is essential in health care, as Jeremy Farrar (Wellcome Trust) argued just last week. The current Ebola outbreak in the DRC is just one of the latest examples in this respect. Lack of trust between people on the one hand and the complex web of health professionals, public authorities, institutions, donors, the international community at large may very well (at least partially) explain why the outbreak, sadly, has become a regional health crisis, one year later. We hope of course that this Ebola outbreak can be controlled, but also that when this is finally behind us, we do not simply return to ‘business as usual’, but instead, start investing in listening to each other, and from thereon, act accordingly in (re)building health systems. Put differently, as GAVI’s Seth Berkley argued a few weeks ago, “this Ebola outbreak should not be viewed in isolation, but must be seen as a symptom of a deeper public health crisis”. To address it, the conceptual framework and value basis of Primary Health Care provide an excellent way forward.

Coincidentally, when writing these words, I am on my way to Lubumbashi, DRC, for a working visit to the School of Public Health. This time, some festivities are also scheduled during my stay to celebrate our longstanding collaboration. My visit will again be an opportunity to interact with Congolese colleagues and further finetune my understanding of the complexity of managing health systems in such a very different environment. We will again try our best to listen to each other. As our Congolese academic partners largely share the same values, collectively constructed over time, this will not be too difficult, certainly when compared to the polarized debates mentioned in the opening paragraph of this editorial.

A final remark perhaps. The question remains, of course, as Richard Horton hinted in a remarkable Offline contribution from a few weeks ago, ‘The Ethical darkness of global health’, when should global health stop talking and shaking hands, at least with powerful actors? Where is the threshold, for risk of helping to legitimize unsavory regimes, when some (public/global health) ‘common ground’ no longer suffices, due to huge human rights violations in other areas, or a large-scale crack- down on opposition and civil society?

But that’s something for another contribution. And in any case, that’s more a question for ‘power’ in global health than for an academic…

Highlights of the week

High-Level Meeting on UHC – final draft political declaration https://www.un.org/pga/73/2019/07/24/draft-political-declaration-of-the-high-level-meeting-on- universal-health-coverage-silence-procedure/

Early this week, it appeared that the final draft of the political declaration had been published. But then it turned out that the silence procedure had been broken. For more info on the latter, see UN. “In particular it highlights that silence was broken on paras 29, 68, and 69 on SRHR and paras 70 and 71 on migration…”

Anyway, by now the final draft is released, it appears – see here. (11 pages) In the coming days and weeks, no doubt, you’ll see some analyses of strengths & weaknesses. Civil society is underwhelmed, according to initial reactions. But do judge for yourself first.

And the die-hards among you might want to explore the MMI synopsis of selected drafts to find out how the draft has evolved over time. (from the Zero draft to the ‘Final Draft’).

Planetary Health

Lancet Comment - Heat and health: a forthcoming Lancet Series

Anthony Capon et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31759- 3/fulltext

For every existential threat humanity faces, a Lancet Series or Commission comes to the rescue .

“Planet Earth is heating up, with heatwaves increasing in frequency, intensity, and duration…. “

“…There is a pressing need to find improved ways to live, work, and play in the heat, and enable civilisations to continue to thrive. Integrating knowledge from disciplines including epidemiology, physiology, medicine, built environment, and cultural studies will be essential for optimal health preparedness. The Lancet will publish in 2020 a new multidisciplinary Series of papers on heat and health. Led jointly from the University of Sydney, Sydney, NSW, Australia, and the University of Washington, Seattle, WA, USA, the Series will synthesise evidence and make recommendations to improve public health responses during heatwaves and support sustainable human adaptation to extreme heat….”

UNDP - Climate and health: finding common cause https://www.undp.org/content/undp/en/home/blog/2019/climate-and-health--finding-common- cause.html

By Mandeep Dhaliwal. “The UN Climate Summit 2019 and UN High-Level Meeting on Universal Health Coverage, which will take place on 23 September, are a critical opportunity to better connect science, policy and action for people and planet….”

See also last week’s IHP Featured article by Rachel Thompson.

Guardian – Just 10% of fossil fuel subsidy cash 'could pay for green transition' https://www.theguardian.com/environment/2019/aug/01/fossil-fuel-subsidy-cash-pay-green- energy-transition

“Switching just some of the huge subsidies supporting fossil fuels to renewables would unleash a runaway clean energy revolution, according to a new report, significantly cutting the carbon emissions that are driving the climate crisis. Coal, oil and gas get more than $370bn (£305bn) a year in support, compared with just $100bn for renewables, the International Institute for Sustainable Development (IISD) report found. Just 10-30% of the fossil fuel subsidies would pay for a global transition to clean energy, the IISD said.”

Lancet Editorial – Saving the Pacific islands from extinction https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31722-2/fulltext

“… The biannual Pacific Health Ministers Meeting (Aug 5–8) in French Polynesia is an important opportunity to assess progress of the Healthy Islands journey and decide on recommendations going forward. Agenda items include universal health coverage, health and climate change, health security, NCDs, water and sanitation, and immunisation. … .. . With next month's UN climate action summit and the High-Level Mid-Term Review of SAMOA—the overarching framework for guiding global, regional, and national development efforts to achieve the SDG aspirations of small island developing states—the world must turn its attention to protect the livelihood, security, and wellbeing of the peoples of this special archipelago.”

PS: you find a lot more planetary health news in the separate Planetary Health section (see below).

Ebola DRC – One year and counting…

Reads this week focused on the sad milestone (1 year declaration of Ebola outbreak), the new (worrying) case in Goma, countries like Rwanda (at least for a while) and Saudi Arabia not complying with the IHR (Rwanda in response to the Goma situation, it appears), and further commotion on the WB’s Pandemic Bonds.

An overview:

One year Ebola joint statement & analyses

Joint statement by heads of agencies on the Ebola outbreak in the DRC - At 1-year mark, we mourn the lives lost, and call for solidarity https://www.who.int/news-room/detail/31-07-2019-at-1-year-mark-we-mourn-the-lives-lost-and- call-for-solidarity

Includes also a quick overview of all efforts (& achievements so far).

Cidrap News - On eve of 1-year mark, WHO calls Ebola in DRC 'relentless' http://www.cidrap.umn.edu/news-perspective/2019/07/eve-1-year-mark-who-calls-ebola-drc- relentless

“Employing an effective vaccine, conducting extensive surveillance, and building community trust have all gone a long way in limiting the spread of Ebola in the Democratic Republic of the Congo (DRC). But 1 year after the first cases were identified in North Kivu and Ituri provinces, experts from the World Health Organization (WHO) said today at a press conference that the fight against the virus must continue. WHO officials called the disease "relentless and devastating."

"This is not a milestone we ever wanted to mark," Matshidiso Moeti, MBBS, the WHO Regional Director for Africa said. "But this outbreak is one with unprecedented challenges."…”

BMJ News –Ebola: one year anniversary of epidemic in DRC is “unwanted milestone” https://www.bmj.com/content/366/bmj.l5004

Includes a chronology of events of the past year.

Also: “ Moeti told reporters that DRC’s head of state had appointed a high level task force chaired by one of the country’s senior Ebola experts and that an acting health minister has been designated, to continue collaboration with WHO.”

Devex - Ebola in DRC: One year into the outbreak J Ravelo; https://www.devex.com/news/ebola-in-drc-one-year-into-the-outbreak-95364

“Today marks one year since WHO declared an Ebola outbreak in the North Kivu province. Devex speaks to humanitarian actors about the response and how it has impacted realities on the ground. “

Includes a very elaborated chronology of all Ebola related events of the past year, since the start of the outbreak (declaration).

FT – Why Ebola cannot be tamed in Congo https://www.ft.com/content/4237a412-b1e2-11e9-bec9-fdcab53d6959

“International criticism of the response grows.”

Excerpts:

“… The accepted explanation for the failure of the international response has been to blame the low-level conflict that has destabilised eastern Congo for two decades. The presence of armed groups in North Kivu province made it difficult to reach victims and administer vaccinations, the country’s health ministry and the World Health Organization have said. … … Some members of the response effort have been attacked and medical centres burnt down. But dozens of interviews with health professionals, aid workers, victims and their families paint a more complex picture of a response that has succeeded in some areas and failed in others. … … … Health workers with the government and WHO have treated communities poorly, he added, issuing ultimatums rather than advice. … There is also a perception some people have profited from the response. Hundreds of expensive off- road vehicles ply the region’s bumpy roads and “Ebola-business” has become a refrain among locals puzzled by the big inflow of money into their region. …”

“ … Anne Marie Pegg, a Médecins Sans Frontières doctor who co-ordinates the aid group’s efforts in eastern Congo, said the issue was not the implementation of the response, but with the strategy itself. Following the experience in west Africa from 2014-16 when the health services of Sierra Leone,

Guinea and Liberia collapsed under the outbreak, the response in Congo has focused on creating a parallel health system where suspected cases are diverted into specialist facilities. In hindsight, given that the Congolese epidemic has so far totalled far fewer cases — 2,593 in Congo versus 28,616 in west Africa — it was the wrong approach, she said. Instead, money should have been invested in building up existing health centres to test patients before sending confirmed cases on for treatment, Ms Pegg said.

“But a change may be under way….” The article then goes on about the plans of the new “Muyembe committee”.

Guardian - Rwanda closes border with DRC over deadly Ebola outbreak

Guardian

“Rwanda has closed its border with the Democratic Republic of the Congo, where a deadly Ebola outbreak that started a year ago has killed more than 1,803 people. The closure came after a second death linked to the Ebola virus was confirmed on Wednesday in the densely populated Congolese city of Goma, which is on the porous border with Rwanda. The World Health Organization, which declared the DRC outbreak a global health emergency last month, has recommended against travel or trade restrictions. It has also said the risk of regional spread was “very high”. The DRC presidency’s office said it regretted what it described as a unilateral decision by the Rwandan authorities to restrict movement at the border, “which runs counter to the advice of the World Health Organization”….”

Still on Goma, “…Earlier on Thursday, a DRC official said the one-year-old daughter of the man who died on Wednesday was at a treatment centre after showing signs of the disease. He had spent several days at home with his family while showing symptoms. If this suspected case is confirmed, it could be the first transmission of Ebola in this outbreak inside Goma…” By now, this third case in Goma is confirmed (see AFP ).

Last week, Saudi Arabia already suspended visas to people from DRC a week after WHO had declared the year-long #Ebola outbreak there a public health emergency & 2 weeks before the start of the Haj, the world's largest annual mass gathering.

Guardian - Panic and confusion as Rwanda closes border with DRC over Ebola outbreak https://www.theguardian.com/global-development/2019/aug/01/rwanda-closes-border-with-dr- congo-over-deadly-ebola-outbreak-goma

Update: but then the border went open again. “Rwanda’s government briefly closed and then reopened part of a busy land border with the Democratic Republic of the Congo on Thursday, prompting panic and confusion in both countries….”

“The Rwandan government faced intense pressure from international agencies to keep the border open, the Guardian learned….”

Financing update (+ vaccines) AP - WHO hails new DRC aid in fight against Ebola

(from late last week).

“The head of the WHO on Saturday said a shortage in funding to halt the spread of the deadly Ebola virus in the Democratic Republic of Congo was finally being filled. Tedrus Ghebreyesus, the director general of the World Health Organization, said that several countries had renewed pledges of financial aid after the Ebola outbreak was declared an international emergency earlier this month. "Especially in the last couple of weeks there is renewed commitment to finance the shortages we were facing," Ghebreyesus told AFP at a summit in Nigeria's capital Abuja. The support raised hopes the epidemic could be restrained, he said. The comments came after the World Bank announced Wednesday it would deploy a further $300 million (269 million euros) in addition to $100 million already provided after Ebola erupted in August 2018. But officials said another $200 million could be needed in the coming six months….”

HPW still signals a big funding gap, though, see Ebola Outbreak Marks 1 Year With Huge Funding Gap, Questions On Vaccine Strategy (1 August)

“ Today, 1 August, marks the one-year anniversary of the Ebola outbreak in the Democratic Republic of the Congo (DRC), with the World Health Organization calling on international donors to provide the US$ 324 million required to fund the next 6 months of the response. Amid continued transmission and growing concerns over the further spread of the disease across borders and within DRC, questions remain regarding the vaccine strategy, and the possibility for DRC to deploy a second vaccine to help contain transmission….”

“…The WHO is now calling on international donors to increase funding to implement its 4th Strategic Response Plan (SRP) for the period of July through December, which is currently being developed and reported to be released soon. WHO estimates the plan to cost $324 million, significantly more than the estimated US$ 200 million contributed to the response efforts since the outbreak began in August 2018.”

On the issue of the second vaccine, “WHO partners, including Médecins Sans Frontières (MSF/Doctors Without Borders) and Wellcome Trust, are calling on the DRC government to introduce the second experimental vaccine developed by Johnson & Johnson (J&J) as part of a more comprehensive vaccination programme, with a focus on prevention around the periphery of the high- transmission areas. “WHO supports the introduction of a second vaccine, in line with the SAGE [Strategic Advisory Group of Experts on Immunization] recommendations, but subject to the appropriate national approvals,” the WHO official told Health Policy Watch.”

FT – Ebola outbreak fails to trigger World Bank pandemic bonds https://www.ft.com/content/385ed732-aee3-11e9-8030-530adfa879c2?sharetype=blocked

Excerpts:

“Bonds issued by the World Bank with the aim of helping developing countries deal with pandemics are facing fresh scrutiny as investors continue to enjoy high returns while the Ebola outbreak worsens in central Africa.”

“…But funding connected to the World Bank’s pandemic bonds, issued in 2017, has been less forthcoming. One relatively small slice — the so-called “cash” element — has delivered $31.4m to help with the crisis. But the larger “insurance” element of the Ebola bonds is yet to pay out a penny, instead continuing to deliver a coupon of 11.1 per cent over the Libor rate to investors. … … The total possible insurance payout for Ebola is $150m and comes in three tranches: when 250, 750 and 2,500 people have died across at least two countries, $45m, $45m and $60m, respectively, will be disbursed. … … “Linking the payout of a financial instrument to the deaths of people is perverse,” said Bodo Ellmers, head of policy at the European Network on Debt and Development. “The whole design is a scandal,” he said, adding: “If the purpose was to ensure that pandemics are . . . addressed quickly and efficiently then this facility has clearly failed . . . The World Bank are under pressure to show that they’re acting because it’s obvious that they have money in the pot.” Annette Dixon, vice-president for human development at the World Bank, defended the payout criteria, saying the non-payment “is a positive thing” because it shows that the outbreak “has not yet reached the level of a pandemic across countries.” …”

Do see the section “Tweets of the week” (below) to find out what Anthony Costello thinks of all this.

Quick link Reuters (July 25): IMF says ready to aid Congo in Ebola crisis if needed

“The International Monetary Fund said on Wednesday it had ample scope to provide financial support to Congo if it needs help dealing with an Ebola outbreak that has been declared an international health emergency.”

Some other Ebola related reads

UN News - UNICEF must triple budget to combat Ebola outbreak in DR Congo; complex crisis impacting unprecedented number of children https://news.un.org/en/story/2019/07/1043491

“With an unprecedented number of children affected by the Ebola virus outbreak in the eastern Democratic Republic of Congo (DRC), the United Nations Children’s Fund (UNICEF) on Tuesday said it would need to triple its budget to tackle the complex crisis, which included intensifying the overall public health response and launching measles vaccinations. “This Ebola response is far more complex because it is in an active conflict zone,” Jerome Pfaffmann, a UNICEF health specialist, told reporters in Geneva, just back from his third visit to the country. …”

UNICEF also announced it is stepping up efforts in South Sudan, as it considers the country vulnerable to cross-border infections.

NYT - In Congo, a New Plan to Fight Ebola Follows a Government Power Struggle https://www.nytimes.com/2019/07/26/health/ebola-africa.html?smid=tw-nythealth&smtyp=cur

“Documents obtained by The Times reveal a power struggle within Congo that may have encouraged Ebola's spread.”

Stat - WHO, preparing for the worst, makes plans for reduced doses of Ebola vaccine Stat News;

“The World Health Organization is drawing up plans to use reduced doses of Ebola vaccine in the Democratic Republic of the Congo in the event that supplies in the long-running outbreak run short, according to the head of the WHO’s health emergencies programs. There is currently no shortage of the vaccine — half a million doses are available, Dr. Mike Ryan said in an interview with STAT. If the outbreak continues at the current pace, he said, that will be enough to see the effort through to early next year, when the manufacturer, Merck, will have new stock available. But if the outbreak were to deteriorate substantially, it’s conceivable supplies of the experimental vaccine would be tapped out later this year, Ryan said, stressing the WHO has to plan for that possibility: “We have to be responsible.”…”

Thomson Reuters - Opinion: There is no quick-fix solution to the Ebola crisis in Congo http://news.trust.org/item/20190729131746-gdvlj

By E Capobianco (IFRC’s global director of health and care).

“If we aim to end this outbreak within the next twelve months, we need three strategic shifts.”

“First, we need to move beyond an exclusively Ebola-focused response. the humanitarian needs in North Kivu and Ituri are enormous. It is time for a comprehensive approach that addresses the Ebola outbreak, but also tackles broader health and humanitarian needs. … Second, we need to use this response as an opportunity to strengthen the fragile health system in Eastern Congo…. .. Third and most importantly, we need to put communities at the centre of this response and strengthen their own resilience….”

Migrants/refugees & health

Plos Med (Editorial) - Migrants and refugees: Improving health and well-being in a world on the move https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002876

“The PLOS Medicine Editors discuss migrant and refugee health, and announce a forthcoming special issue devoted to the topic.”

BMJ Editorial – WHO’s global action plan to promote the health of refugees and migrants S Pant et al ; https://www.bmj.com/content/366/bmj.l4806

“Responses to migration must remain firmly rooted in social justice.”

Tobacco control & vaping

HPW - 136 Countries Now Have Tobacco Control Policies; Progress Slow On Smoking Cessation Services https://www.healthpolicy-watch.org/136-countries-now-have-tobacco-control-policies-progress- slow-on-smoking-cessation-services/

“The last decade has seen dramatic progress in the fight against tobacco, with some 136 countries having implemented policies such as smoking bans in public places, higher taxes or graphic packaging on tobacco products. But there is a huge unmet demand for services to help smokers quit, a critical intervention that lags behind other tobacco control measures, according to the latest World Health Organization report on the tobacco epidemic, launched [last week on ] Friday.”

“Today, 5 billion people live in countries that have implemented at least one of WHO’s six recommended tobacco control measures – four times more people than a decade ago. This, however, still leaves 2.6 billion people unprotected by tobacco control policies, and “at risk from the health and economic harms caused by tobacco use,” the report warns. The report also found that only 2.4 billon people, or 32 percent of the world’s population, live in countries providing comprehensive smoking cessation services….”

See also the WHO news release - WHO launches new report on the global tobacco epidemic & WHO report - WHO Report on the Global Tobacco Epidemic, 2019

More coverage in the Guardian - Battle against tobacco epidemic is far from won, WHO report finds.

You find Dr Tedros’s take (on the report) in a Lancet Comment - Progress in beating the tobacco epidemic.

Interesting paragraph: “…Much has been written and said about the potential of electronic nicotine delivery systems (ENDS) such as e-cigarettes to help tobacco users quit. Although tobacco and related industries promote these products as tools for quitting, the evidence does not support their use as part of population-based cessation strategies. The aerosols of ENDS contain toxic chemicals that are harmful to both users and non-users and are, therefore, products that come with health risks

of their own. And in combination with smoking, which is the practice with the majority of ENDS users, the health effects of two or more products are combined. ENDS on their own are associated with increased risk of cardiovascular diseases and lung disorders and adverse effects on the development of the fetus during pregnancy. For adolescents, the addictive nature of nicotine can lead to dependence and may harm adolescent brain development, including reduced activity in the prefrontal cortex. Use of ENDS could also lead to a new generation of nicotine and tobacco users, as seen in some countries, especially given how these products are marketed to young people. Although the specific level of risk associated with ENDS has not yet been conclusively estimated, ENDS are undoubtedly harmful, should be strictly regulated, and, most importantly, must be kept away from children. It is also incorrect to think that heated-tobacco products are the answer, as they simply move tobacco users from one harmful tobacco product to another.”

Lancet - JUUL Labs' sponsorship and the scientific integrity of vaping research Andy S L Tan et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31718- 0/fulltext

“… JUUL Labs Inc (hereafter JUUL Labs) is the current market leader in the USA for e-cigarettes and accounts for almost 80% of retail sales of e-cigarettes in the USA. …” “…JUUL Labs has been the focus of concern for this troubling trend. Initially branded as a Silicon Valley start-up, JUUL Labs received a US$12·8 billion investment in late 2018 from Altria, manufacturer of cigarette brands such as Marlboro, for a 35% share in the company… … Shortly after the investment from Altria, JUUL Labs appeared to employ similar strategies used by Philip Morris and other tobacco companies to influence research on vaping. JUUL Labs established JLI Science, in early 2019, with the stated goal to “better understand the effects and impact vaping products have in the long term, while also discouraging new users, and to share those results with the scientific community”….”

The authors used Cohen and colleagues' eight criteria for evaluating tobacco industry-supported scientific research and found potential weaknesses in JUUL Labs-sponsored research programme in seven of the eight criteria.

“ … The above weaknesses undermine the scientific credibility of JUUL Labs-sponsored research, increase the risk of JUUL Labs influencing the research agenda of the tobacco control research field as a whole, and undermine public health. In light of these weaknesses and potential adverse impacts, we recommend continued scrutiny of JUUL Labs research funding activities, evidence arising from funded studies, and how these findings are disseminated and used for public relations gains and lobbying actions.”

World Hepatitis Day

(see also last week’s IHP news)

UN News - Eliminating hepatitis calls for ‘bold political leadership, with investments to match,’ UN health chief says https://news.un.org/en/story/2019/07/1043261

“Calling for “bold political leadership” ahead of World Hepatitis Day, the UN World Health Organization (WHO) on Friday urged countries to take advantage of recent reductions in the costs of diagnosing and treating viral hepatitis and scale up investments in disease elimination. “

“A new study by WHO, published on Friday in Lancet Global Health, found that investing $6 billion per year in eliminating hepatitis in 67 low- and middle-income countries would avert 4.5 million premature deaths by 2030, and more than 26 million deaths beyond that target date. A total of $58.7 billion is needed to eliminate viral hepatitis as a public health threat in these 67 countries by 2030. This means reducing new hepatitis infections by 90 per cent and deaths by 65 per cent. “Today 80 per cent of people living with hepatitis can’t get the services they need to prevent, test for and treat the disease,” said WHO Director-General Dr. Tedros Adhanom Ghebreyesus. …”

See also HPW - WHO Calls On Countries To Scale Up Hepatitis Services, Invest In Elimination

And the WHO press release - WHO urges countries to invest in eliminating hepatitis.

Global health governance

CGD - Five Things the Health Minister Should Do to Enhance the UK’s Global Health Footprint

Kalipso Chalkidou; https://www.cgdev.org/publication/five-things-health-minister-should-do- enhance-uks-global-health-footprint#.XT8L4GfkRMk.twitter

“As Health Secretary Matt Hancock returns to his role as part of Boris Johnson’s premiership, he has an opportunity to make good on the UK’s renewed confidence and ambition by drawing on what the new prime minister calls the “best healthcare [system]” to drive improvements in health globally. The UK’s Department of Health and Social Care controls its biggest-ever official development assistance (ODA) budget, doubling between 2017 and 2018 to just under £200m, or 1.3 percent of the country’s aid allocation. This places the UK’s secretary of state for health in a unique position to truly make a difference in countries’ journeys towards universal healthcare coverage (UHC), whilst also defending (and making a case for more of) the ODA money his department has been allocated, even to development aid’s harshest critics. Here are five things he can do to make this happen, both using his own department’s ODA budget and influencing how DFID’s majority share is spent….”

Among others, (1.) Adopt the Global Skills Partnership for training, attracting, and retaining healthcare professionals—an approach that benefit both the NHS and the originator countries. (2.) Boost support for NHS International as an agent of soft power, with particular emphasis on sharing NHS knowledge products and strengthening local institutions and governance, at countries’ request. (3. ) Work with DFID to set up a What Works Centre for Best Buys in Health, starting with healthcare commodity procurement and health taxes.

BMJ Editorial - A new global health strategy for Germany I Kickbusch et al; https://www.bmj.com/content/366/bmj.l4662

Meanwhile, Ilona Kickbush, J Farrar et al lay out what an international advisory board established in 2017 would like Germany to focus on in global health, in the years to come. “The strategy must be founded on Germany’s unwavering support for multilateralism.”

BMJ (blog) - Ilona Kickbusch and Gabriel Leung: China steps up to convene a new global health meeting BMJ;

Fortunately, the global health meeting they refer to, the inaugural Global Health Forum of the Boao Forum for Asia (BFA), took place in the eastern city of Qingdao in Shandong province (and not in Hong Kong). Their take on what the meeting focused on and what it could mean for China in global health in the future.

“On the one hand, the forum reflected the priorities of the international global health debate— UHC, antimicrobial resistance, ageing, non-communicable disease control, disaster preparedness and emergencies as well as Chinese priorities such as traditional medicine in the context of UHC. … … At the end of the forum it was announced that it would now become an ongoing event. The opportunities for this to become an exciting forum to exchange experiences between China and the world is enormous, especially if the cross linkages to other Chinese initiatives, like its strong programmes in Africa or its Belt and Road Initiative are included. The exchanges on technological innovations hold great potential. As international participation increases its health diplomacy impact could become significant. “

CFR (blog) - Apathy Continues to Plague Global Health T Mullan; https://www.cfr.org/blog/apathy-continues-plague-global- health?utm_medium=social_owned&utm_content=072519&utm_source=tw

“In a world awash in troubles, nothing less than catastrophe will spur policymakers to forceful action on global health. Unfortunately, concerted action could come too late to prevent local crises from becoming global emergencies.” Blog focusing on the COC report card on Global Health.

“…The abysmal international response to the [Ebola DRC ] crisis is symptomatic of a broader apathy toward global health governance. For three straight years, leading think tank heads have relegated health promotion to the absolute bottom of the global agenda, ranking it as the lowest priority among ten issue areas of global concern in the Council of Councils (CoC) Report Card on International Cooperation….”

World Breastfeeding Week (1-7 August)

The theme of this year’s World Breastfeeding Week is “Empower Parents, Enable Breastfeeding.” See also a WHO World Breastfeeding Week message (by WHO’s Tedros & UNICEF’s Fore)

“This week, as countries around the world celebrate World Breastfeeding Week, UNICEF and WHO are calling on governments and all employers to adopt family-friendly policies that support breastfeeding. … … As the world marks World Breastfeeding Week, WHO and UNICEF call on governments and all employers to adopt family-friendly policies – including paid maternity leave for a minimum of 18 weeks, and preferably, for a period of six months – as well as paid paternity leave….”

UN News - Greater investment in family-friendly policies critical to support breastfeeding – UNICEF https://news.un.org/en/story/2019/07/1043521

“While the benefits of breastfeeding for both children and mothers are extensive, policies that support nursing, particularly in workplaces, are not yet available to most mothers worldwide, the Head of the United Nations Children’s Fund (UNICEF) said on Wednesday. “The health, social and economic benefits of breastfeeding – for mother and child – are well-established and accepted throughout the world”, according to UNICEF Executive Director Henrietta Fore. “Yet, nearly 60 per cent of the world’s infants are missing out on the recommended six months of exclusive breastfeeding”.

“This year, the commemoration is accompanied by a fact sheet with new data from the 2019 Global Breastfeeding Scorecard, which revealed, among other things, that only four out of 10 babies in 2018 were exclusively breastfed. …”

Do check out also IHME visualizations on exclusive breastfeeding prevalence.

WHO Statement on governance and oversight of human genome editing https://www.who.int/news-room/detail/26-07-2019-statement-on-governance-and-oversight-of- human-genome-editing

Fairly obvious why WHO came up with this statement now.

“The WHO expert advisory committee on governance and oversight of human genome editing convened on 18-19 March 2019. At this meeting the Committee in an interim recommendation to the WHO Director-general stated that “it would be irresponsible at this time for anyone to proceed with clinical applications of human germline genome editing.” WHO supports this interim recommendation and advises regulatory or ethics authorities to refrain from issuing approvals concerning requests for clinical applications for work that involves human germline genome

editing. “Human germline genome editing poses unique and unprecedented ethical and technical challenges,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “I have accepted the interim recommendations of WHO’s Expert Advisory Committee that regulatory authorities in all countries should not allow any further work in this area until its implications have been properly considered.” WHO’s Expert Advisory Committee continues its consideration of this matter, and will, at its forthcoming meeting in Geneva on 26-28 August 2019. evaluate, inter alia, effective governance instruments to deter and prevent irresponsible and unacceptable uses of genome edited embryos to initiate human pregnancies.”

Spatial database sub-Saharan public health facilities

Late last week, KEMRI Wellcome Trust launched a dataset of comprehensive public health facilities from 50 countries and islands in sub-Saharan Africa. The set contains information on 98,745 public health facilities. It’s a first of its kind dataset. With some nice visualizations as well.

Nature - A spatial database of health facilities managed by the public health sector in sub Saharan Africa https://www.nature.com/articles/s41597-019-0142-2

“Health facilities form a central component of health systems, providing curative and preventative services and structured to allow referral through a pyramid of increasingly complex service provision. Access to health care is a complex and multidimensional concept, however, in its most narrow sense, it refers to geographic availability. Linking health facilities to populations has been a traditional per capita index of heath care coverage, however, with locations of health facilities and higher resolution population data, Geographic Information Systems allow for a more refined metric of health access, define geographic inequalities in service provision and inform planning. Maximizing the value of spatial heath access requires a complete census of providers and their locations. To-date there has not been a single, geo-referenced and comprehensive public health facility database for sub- Saharan Africa. We have assembled national master health facility lists from a variety of government and non-government sources from 50 countries and islands in sub Saharan Africa and used multiple geocoding methods to provide a comprehensive spatial inventory of 98,745 public health facilities.”

Childhood cancer: GBD study

Lancet Oncology - The global burden of childhood and adolescent cancer in 2017: an analysis of the Global Burden of Disease Study 2017 https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(19)30339- 0/fulltext?utm_campaign=PHPfeature&utm_source=Childhoodcancer

Cfr the press release:

“The Lancet Oncology: Globally, more than 11 million years of healthy life lost due to childhood cancer in 2017.

Study is first analysis to quantify the impact of childhood cancer in terms of years of healthy life lost to ill-health and premature death. Collectively, childhood cancers are the 6th biggest contributor to total cancer burden worldwide after adult cancers of the lung, liver, stomach, colon, and breast; and the 9th leading cause of childhood disease burden globally. India, China, Nigeria, Pakistan, Indonesia, and the USA face the largest burden of childhood cancer among countries with the highest population of children. Lack of diagnosis and access to healthcare and a younger population are responsible for disproportionately large childhood cancer burden in many of the poorest countries.

While the number of new cancer cases in children and adolescents (aged 0-19 years) is relatively low at around 416,500 globally in 2017, treatment-related ill-health and disability and fatal cancer are estimated to cause around 11.5 million years of healthy life lost globally every year, according to the first Global Burden of Disease Study (GBD) to assess childhood and adolescent cancer burden in 195 countries in 2017, published in The Lancet Oncology journal. Children in the poorest countries face a disproportionately high cancer burden—contributing over 82% of the global childhood cancer burden—equivalent to almost 9.5 million years of healthy life lost in 2017. Most (97%) of this global burden is related to premature death, with around 3% due to impaired quality of life. …”

For a related Lancet Child & Adolescent Health Editorial, see Fighting childhood cancer with data.

Access to Medicines

ITM – Access to quality medicines gains momentum https://www.itg.be/E/Article/access-to-quality-medicines-gains-momentum

“High-level event at the 72nd World Health Assembly with several donors in attendance put the quality of medicines firmly on the health agenda. The WHA was held on on 21 May 2019.” My colleague Raffaella Ravinetto is leading this effort.

Do check out the (now final) report (8-pager) - Assuring Medicines Quality in Medicines procurement

Lancet Global Health (Comment) - Antiviral treatment for hepatitis C: rebalancing cost, affordability, and availability G Dusheiko et al; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30313- 4/fulltext

“In The Lancet Global Health, Bryony Simmons and colleagues examine to what extent voluntary licensing might have improved treatment uptake for HCV [Hepititis C Virus] infection in LMICs since 2014. ….”

“…Over the study period, two companies introduced active licences for DAAs [i.e. Direct-acting antiviral (DAA) regimens for hepatitis C virus ] for HCV: Gilead introduced licences first for sofosbuvir and later for the newer compounds ledipasvir, velpatasvir, and voxilaprevir, including 91 countries (predominantly LMICs) in these agreements; and Bristol-Myers Squibb introduced a licence for daclatasvir via the Medicines Patent Pool to cover 112 LMICs. … … Nevertheless, the data support the inference that voluntary licensing has been beneficial for treatment access. Robust generic competition and the Medicines Patent Pool provide a platform for more affordable spending on DAA, which should incentivise and encourage case finding. … … Licensing agreements and the procurement of generic drugs have facilitated the roll-out of treatment for HIV and AIDS, and could also lead to progress for HCV.”

Global Fund

GF - Leading Artists and Athletes Pledge to Help End AIDS, TB and Malaria for Future Generations https://www.theglobalfund.org/en/news/2019-07-30-leading-artists-and-athletes-pledge-to-help- end-aids-tb-and-malaria-for-future-generations/

“Global artists including Sir Elton John, Charlize Theron, Zara Larsson, Penélope Cruz, Annie Lennox, Ed Sheeran, David Oyelowo, Freida Pinto, Trevor Noah, Jennifer Garner, Thandie Newton, Diane Kruger, Simon Pegg, Neil Patrick Harris and Youssou N’Dour, among others, have signed an open letter to 7-year-olds promising to end AIDS, tuberculosis and malaria as epidemics by 2030 – the year the children will become adults. The letter is a call to action for the world to step up the fight to end the three deadliest infectious diseases. The letter reads: “Let’s be honest, we’re leaving you with a long to-do list – fighting injustice, promoting equality, protecting the planet. But, we promise you this: over the next 11 years, we are going to do everything we can to remove one thing from that list. Actually, we’ll remove three things: AIDS. Tuberculosis. Malaria. We will step up the fight, so you don’t have to.”…”

Even if you’re not a ‘global artist’, you can add your name to the Letter. “…The letter to 7-year-olds is supported by leading advocacy organization Global Citizen. From today, the public can take action by signing the letter for the chance to earn tickets to the Global Citizen Festival in New York in September 2019….”

Devex - How is North Korea coping with TB one year after Global Fund grant cuts? https://www.devex.com/news/how-is-north-korea-coping-with-tb-one-year-after-global-fund-grant- cuts-95312

Analysis by Jenny Ravelo. “Advocates working to address the tuberculosis burden in North Korea are calling on the Global Fund to Fight AIDS, Tuberculosis and Malaria to resume its grants in the country in the next two months to ensure thousands of patients don’t fall out of treatment. The call comes just a few months before the fund's sixth replenishment conference in October. In less than a year, about 100,000 TB patients in North Korea dependent on Global Fund-financed drugs will be left with no medicines after the remaining buffer stocks run out by June 2020….”

GFO -latest issue http://www.aidspan.org/gfo_article/global-fund-board-approves-initiatives-worth-18-million- unfunded-quality-demand-register

Check out in particular:

• Global Fund Head of Resilient and Sustainable Systems for Health describes evolution in the approach to health systems strengthening

“Viviana Mangiaterra became the Global Fund’s Head of Resilient and Sustainable Systems for Health in 2014, hired to design the Fund’s approach to health system strengthening. Soon to leave the Global Fund for an academic position, Ms. Mangiaterra spoke to the Observateur du Fonds Mondial about her five years at the Fund in this critical role.”

• Domestic financial contributions to HIV, TB and malaria programs remain low in Global Fund ‘high-impact’ Asian countries

“…A new analysis by Aidspan assesses the domestic contributions to the health sector and to the three disease programs globally, focused on nine Asian countries, classified as ‘high impact’ by the Global Fund: Bangladesh, Cambodia, India, Indonesia, Myanmar, Pakistan, the Philippines, Thailand and Viet Nam. The Global Fund Observer published a similar analysis for high-impact African countries in 2018. The analysis found that domestic contributions to the HIV, TB and malaria responses remain low in high-impact Asian countries, particularly for malaria. Domestic resources accounted for 64% of the total available funding for HIV, 55% for TB and 46% for malaria, in the 2015-2017 implementation period. The share of domestic resources rose, in the 2018-2020 period, to 81% for HIV, 63% for TB and 65% for malaria. Despite this increase, the countries still face huge funding gaps in the current 2018-2020 period….”

And a quick link on the US Congress:

Homeland Preparedness News: Legislation to provide financial support to the Global Fund to fight AIDS, tuberculosis, and malaria was introduced in the U.S. House of Representatives last week.

“… The bill affirms the historical U.S. commitment to providing 33 percent of funding to the Global Fund. It also supports ongoing efforts by other donors to increase their financial commitments. The Trump Administration had proposed cutting the U.S.’s traditional contribution to the Global Fund….”

UNAIDS

UNAIDS - Mapping HIV laws and policies UNAIDS;

“A new website that enables people to identify national laws and policies related to the AIDS response has been launched by UNAIDS. Covering areas as diverse as a country’s ability to diagnose

HIV among young babies, the existence of laws that discriminate against transgender people and whether people are prosecuted for carrying condoms, the Laws and Policies Analytics website aims to give a full overview of a country’s laws and policies related to the HIV response. It also allows to view policy data jointly with other data on the HIV epidemic and response….”

PMNCH

PMNCH Board welcomes new chair and outlines a way forward for the 2021-2025 Strategic Plan https://www.who.int/pmnch/media/news/2019/new_chair_and_strategic_plan/en/

Short report on the PMNCH Board meeting of 9-11 July in The Hague.

“The PMNCH Board confirmed the appointment of The Right Honourable Helen Clark as Chair at its 23rd Board meeting. Board members reviewed progress made in implementing the PMNCH 2019 Workplan; and considered the partnership’s role in continuing to ensure that women’s, children’s and adolescents’ health and well-being remains a priority in the political agenda and that this is reflected in the development of the 2021-2025 Strategic Plan…. During the two-day meeting, directives came from the Board on PMNCH’s 2021-2025 Strategic plan, along with a request for the Partnership to maintain its niche in areas where it could provide added value in the broad scope of women’s, children’s and adolescents’ health. The Board reflected on the importance of PMNCH to ensuring that women’s, children’s and adolescents’ health is embedded within the UHC framework while continuing to focus on the SRMNCAH continuum of care.”

For the presentations, see PMNCH.

GAVI

Vaccine-X - Shaping markets to benefit global health – a 15-year history and lessons learned from the pentavalent vaccine market M Malhame et al; https://www.sciencedirect.com/science/article/pii/S2590136219300348

“Market shaping for health products used in lower-income countries strives to benefit public health. As a funder of vaccines, Gavi, The Vaccine Alliance (Gavi) has goals for its market shaping efforts, achieved through a strategy developed and implemented by the Gavi Secretariat, UNICEF, the World Health Organization (WHO) and the Bill & Melinda Gates Foundation (BMGF). A case-study of Gavi’s fifteen-year engagement with a vaccine against diphtheria, tetanus, pertussis, hepatitis B and haemophilus influenzae type b (pentavalent) provides evidence of the benefits and potential risks of trying to influence markets. During 2001–18, Gavi disbursed US$3.5 billion to support use of 50 million pentavalent doses annually before 2005, increasing to ∼300 million doses annually by 2016. During this time, eight manufacturers invested in vaccine development and manufacturing and the first two manufacturers have subsequently ceased production. Following its strategy, Gavi implemented coordinated market interventions including technical assistance to manufacturers,

improving market information transparency, risk-sharing agreements and innovative procurement aiming to stimulate and capitalize on a competitive market. In 2018 supply allows ∼80 million children per year to be immunised, a sixteen-fold increase from 2005, with vaccine-related costs per child for donors and countries of one-quarter the 2005 level. Lessons learned include the importance of frameworks and strategies; the need to adjust interventions with changing conditions; the important role of manufacturers; and the potentially powerful effects of interconnected markets. This case study is limited by its focus on a single health product in a specific market, however the lessons can inform other market shaping efforts when taken in context. ….”

WHO Bulletin – August issue https://www.who.int/bulletin/volumes/97/8/en/

Editorials Do start with the editorial by Michael Reich - Political economy analysis for health

“… WHO is increasingly engaged in political economy analysis that is incorporated into technical guidance… … These activities, as well as others, reflect efforts throughout the development community to incorporate political economy analysis… … One core challenge for political economy proponents is to provide a robust method of analysis that is easily learned and applied by practitioners to generate usable knowledge and assist in policy…”

He ends with three specific recommendations for WHO to engage more effectively with political economy as part of the organization’s overall technical support, to advance health goals at both the global and the national levels.

But do check out also the other Editorials, resp. Advancing the science and practice of primary health care as a foundation for universal health coverage: a call for papers (by E Langlois et al, already online before) and Biomedical research; what gets funded where? (by T Adam et al)

News - James Chau https://www.who.int/bulletin/volumes/97/8/19-030819/en/

“James Chau: connecting people”. “James Chau talks to Ana Lesher Treviño about the challenges faced in communicating about public health.”

The days are gone when I used to watch him on CCTV (when he was a news anchor in China), and like me, James has put on some weight (global health is a fairly unhealthy business : )), I noticed last time I saw him in Geneva at the WHA, but this is a great & interesting interview nevertheless. Not just for health communications people.

Wellcome Trust & Research culture

Nature Letter - Researchers pay the cost of research https://www.nature.com/articles/s41563-019-0443-z

The Wellcome Trust wants to adjust the definition of scientific ‘excellence’.

Excerpt: “The factors driving poor research culture are complex and connected. Existing initiatives such as Wellcome’s new bullying and harassment policy have attempted to isolate and address single symptoms, while broader schemes such as the Royal Society’s Changing Expectations programme are struggling to secure the scale of change needed. To generate real progress, Wellcome is committing to making research culture a priority for every part of our organization, and adopting the consistent approach needed to tackle the root causes of a poor research culture. Our first target will be to improve management and leadership — a driver that was highlighted in our PhD survey data, and which is linked to many poor research practices. The current system predominantly rewards ‘excellence’ based on what a researcher produces, while under-emphasising how the research was produced. Factors such as good management of a team should be supported, rewarded and required….”

HIV/ malaria & resistance

Lancet Infectious Diseases - Antimalarial drug resistance in Africa: the calm before the storm?

M Conrad et al; https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(19)30261- 0/fulltext

“Antimalarial drug resistance, in particular resistance to Plasmodium falciparum, challenges the treatment and control of malaria. In this Review, we summarise evolving patterns of antimalarial drug resistance in Africa. Resistance to aminoquinolines and antifolates is long-standing, yet with greatly decreased use of chloroquine to treat malaria, the prevalence of resistance to chloroquine has decreased. Resistance to antifolates, which are used to prevent malaria in some settings, remains widespread. Resistance to artemisinin-based combination therapies, the standard treatments for malaria in Africa, has emerged in southeast Asia. At present, resistance to artemisinins or key partner drugs included in combination therapies does not appear to be a substantial problem in Africa. However, emergence of resistance to artemisinin-based combination therapies in Africa would probably have devastating consequences, and continued surveillance for the emergence of resistance on this continent is a high priority.”

Nature – Alarming surge in drug-resistant HIV uncovered https://www.nature.com/articles/d41586-019-02316-x

“Health authorities have uncovered an alarming surge in resistance to crucial HIV drugs. Surveys by the World Health Organization (WHO) reveal that, in the past 4 years, 12 countries in Africa, Asia

and the Americas have surpassed acceptable levels of drug resistance against two drugs that constitute the backbone of HIV treatment: efavirenz and nevirapine….”

“More than 10% of adults with the virus have developed resistance to these drugs in 12 nations. Above this threshold, it’s not considered safe to prescribe the same HIV medicines to the rest of the population, because resistance could increase. Researchers published the findings this month in WHO report. “I think we have kind of crossed the line,” says Massimo Ghidinelli, an infectious-disease specialist at the Pan American Health Organization in Washington DC. Overall, 12% of women surveyed had a drug-resistant form of HIV, compared with 8% of men….”

SDGs

Open Democracy - 9 reasons the International Development Sector needs to get political, address power relations, and adopt a transformative agenda S McCloskey; https://www.opendemocracy.net/en/opendemocracyuk/9-reasons-international- development-sector-needs-get-political-address-power-relations-and-adopt-transformative-agenda/

“The Sustainable Development Goals are sending out distress signals. They won’t eradicate global poverty whilst they’re hitched to a broken neoliberal paradigm of development, new evidence suggests.”

Brookings Institute - How much does the world spend on the Sustainable Development Goals? Homi Kharas et al; https://www.brookings.edu/blog/future-development/2019/07/29/how-much- does-the-world-spend-on-the-sustainable-development-goals/

One of the blogs of the week. « … In a forthcoming paper, we zoom out on the global SDG financing landscape in order to zoom back in on country-specific contexts and gaps. In particular, we consider how much the world’s governments are already spending on SDG-related issues every year, how spending varies across income levels, and how the spending patterns link to country-by-country estimates of needs. We focus on the public sector due to its lead responsibility for tackling both the public goods and the “no one left behind” issues embedded in the SDGs and the 2015 Addis Ababa Action Agenda on financing for development, the latter including a “social compact” commitment to provide universal access to basic services. This research can be considered as complementary to assessments of where the private sector can best contribute to SDG financing. Below we summarize some preliminary findings, noting that all results are subject to refinement as we complete the analysis….” (1) Global public sector SDG spending is already more than $ 20 trillion per year; (2) SDG spending rises proportionally with GDP per capita; (3) minimum SDG spending needs are approximately $ 300 per capita; (4) financing gaps vary by income level and country. Kharas et al then also list three options to fill the financing gap.

Global Policy Watch - Technocratic Fiddling While the Planet Burns: Towards a Higher Level of Ambition for the HLPF

Kate Donald; https://www.globalpolicywatch.org/blog/2019/07/29/technocratic-fiddling-while-the- planet-burns-towards-a-higher-level-of-ambition-for-the-hlpf/

“The 2019 High-Level Political Forum on Sustainable Development… … took place last week at the UN in New York, and in general terms, it was more of the same. Admirable rhetoric, but not much evidence of serious efforts at comprehensive implementation, and a host of major flaws and limitations to contend with. As CESR has observed at previous HLPFs (see 2017 and 2018), the space given to civil society is far too limited, most of the Voluntary National Reviews feel very disconnected from reality, and one leaves with the feeling that most governments are at best timidly tinkering around the edges, making minor adjustments to business-as-usual while the planet burns. There were, however, three elements that made this year’s HLPF somewhat distinct….”

SDGs & Health – scientific literature summary of 50 papers

If you don’t have time to read the peer-review literature on health in the SDG agenda, check out this summary by Kent Buse & Sarah Hawkes (gated, but you can get a good sense from the first pages):

Oxford Bibliographies - Sustainable Development Goals

“…In our review of the English language literature, we identified over fifty papers addressing some aspect of the SDGs and health. We are reluctant to conceptualize these as a single literature on the broad, diverse, and complex nature of sustainable development as it relates to human health, particularly since a significant proportion are commentaries rather than primary studies or new theoretical/conceptual ideas. We have grouped the papers into six areas: the genesis and significance of Agenda 2030 and its relationship to health; goals, targets, and indicators; projections of progress and financing implications; goal interdependence and intersectoral collaboration; human rights, participation, and the principle of leaving no one behind; critiques and criticisms. If any topic dominates, it is on universal health coverage, one of the thirteen targets in SDG3; conversely the literature tends to lack a detailed prescriptive guidance on how to move from analysis to action. …”

Some papers of the week

BMJ Analysis - Time to align: development cooperation for the prevention and control of non-communicable diseases https://www.bmj.com/content/366/bmj.l4499

“Téa Collins and colleagues (with among others, Rachel Nugent & Tim Evans) call for coordinated global action to catalyse effective national responses to non-communicable diseases.”

PS: Collins is adviser for the Global Coordination Mechanism on the Prevention and Control of Noncommunicable Diseases at the WHO. Recommended analysis.

Some of the key messages: “Investments in NCD prevention and control offer great potential to countries at all income levels to advance their economic growth. Adequate catalytic development funds for NCD prevention and control are particularly important in low income and fragile countries, where resources are limited but the needs are great. Traditional North-South development assistance is increasingly being replaced by South-South and triangular cooperation. Scope and funding of national multisectoral plans for NCD prevention and control are insufficient, perpetuating a misalignment between development cooperation and the needs and priorities of recipient countries.”

Global Health Action - Reframing NCDs? An analysis of current debates

K Adjaye-Gbewonyo et al ; https://www.tandfonline.com/doi/full/10.1080/16549716.2019.1641043

Also recommended. “There have been many debates in recent years as to whether the communicable disease versus non-communicable disease (NCD) division is a meaningful one in disease classification. Several critiques have been raised about the framing of NCDs, regarding not only the prominent role that infections play in the aetiology of NCDs, but also the communicability of many social determinants of NCDs and the individualistic, ‘lifestyle’ framing of NCDs that tends to focus on health behaviours to the neglect of socio-political, environmental, and structural determinants of health. In this paper, we give a historical overview of the usage of the NCD terminology and analyse some of the recent debates regarding the naming and framing of NCDs. We argue that a lack of reflection on the assumptions underlying the naming and framing of NCDs may lead to the collection of insufficient epidemiological data, the development of inappropriate interventions and the provision of inadequate care. Work in social epidemiology, health promotion, medical anthropology, demography, and other fields may provide insights into the ways in which efforts targeting NCDs may be reframed to improve impact and efficacy. In addition, concepts such as multimorbidity and syndemics, frameworks such as ecosocial theory and approaches based in the social sciences may provide a way forward in the conceptualization of disease.”

HP&P - A systems perspective on the importance of global health strategy developments for accomplishing today’s Sustainable Development Goals

J Byskov et al; https://academic.oup.com/heapol/advance- article/doi/10.1093/heapol/czz042/5541031?searchresult=1

“Priority setting within health systems has not led to accountable, fair and sustainable solutions to improving population health. Providers, users and other stakeholders each have their own health and service priorities based on selected evidence, own values, expertise and preferences. Based on a historical account, this article analyses if contemporary health systems are appropriate to optimize population health within the framework of cross cutting targets of the SDGs. We applied a scoping review approach to identify and review literature of scientific databases and other programmatic web and library-based documents on historical and contemporary health systems policies and strategies at the global level. Early literature supported the 1977 launching of the global target of Health for All by the year 2000. Reviewed literature was used to provide a historical overview of systems components of global health strategies through describing the conceptualizations of health determinants, user involvement and mechanisms of priority setting over time, and analysing the

importance of historical developments on barriers and opportunities to accomplish the SDGs. Definitions, scope and application of health systems-associated priority setting fluctuated and main health determinants and user influence on global health systems and priority setting remained limited. In exploring reasons for the identified lack of SDG-associated health systems and priority setting processes, we discuss issues of accountability, vested interests, ethics and democratic legitimacy as conditional for future sustainability of population health. To accomplish the SDGs health systems must engage beyond their own sector boundary. New approaches to Health in All Policies and One Health may be conducive for scaling up more democratic and inclusive priority setting processes based on proper process guidelines from successful pilots. Sustainable development depends on population preferences supported by technical and managerial expertise.”

PS: Political Economy Analysis for Health Financing Reform (by Susan Sparkes et al) is now also online. “…As countries pursue health financing policies that support progress towards Universal Health Coverage, the analysis and management of these political concerns must be incorporated in reform processes. This article proposes an approach to political economy analysis to help policy makers develop more effective strategies for managing political challenges that arise in reform….” With applications on Mexico and Turkey.

Health Systems & Reform – Introduction to Special Issue on Political Economy of Health Financing Reform Susan Sparkes, Joe Kutzin, A Soucat, J Bumps & M Reich; https://www.tandfonline.com/doi/full/10.1080/23288604.2019.1649915

“This special issue of Health Systems & Reform, sponsored by the World Health Organization (WHO), places political economy at the center of health financing reform. The motivation for the World Health Organization’s program of work in this area is to make political economy analysis an integral part of reform design, adoption and implementation processes to improve the performance and equity of health systems. The articles show the importance of political economy factors in influencing the outcomes of health financing reform. They also highlight how political economy analysis can be a powerful lever to improve the chances that technically sound policy proposals are adopted and implemented….”

The Introduction gives a good overview of the articles in this special issue.

And, “The World Health Organization’s support for the development and publication of this special issue is aligned with Director-General Tedros Adhanom’s widely cited statement that “Universal health coverage is ultimately a political choice.” As emphasized throughout this special issue, policies needed to advance towards UHC, including those related to health financing, are political in nature. The articles in this special issue provide a concrete approach and examples that show how political economy analysis can be used in the health sector, and the importance of doing more in this field …”

BMJ Global Health Supplement – Advancing Emergency Care Research in Low- and Middle-income Countries https://gh.bmj.com/content/4/Suppl_6

Do start with the Analysis - Emergency care research as a global health priority: key scientific opportunities and challenges.

BMJ Global Health - The global pool of simulation exercise materials in health emergency preparedness and response: a scoping review with a health system perspective

G McDarby et al; https://gh.bmj.com/content/4/4/e001687

“Simulation Exercises (SimEx) are an established tool in defence and allied security sectors, applied extensively in health security initiatives under national or international legislative requirements, particularly the International Health Regulations (2005). There is, however, a paucity of information on SimEx application to test the functionality of health systems alongside emergency preparedness, response and recovery. Given the important implications health services resilience has for the protection and improvement of human life, this scoping review was undertaken to determine how the publicly available body of existing global SimEx materials considers health systems, together with health security functions in the event of disruptive emergencies….”

…SimEx are an effective approach used extensively within health security and emergency response sectors but is not yet adequately used to test health system resilience. Currently available SimEx materials lack an integrated health system perspective and have a limited focus on the quality of services delivered within the context of response to a public health emergency. The materials do not focus on the ability of systems to effectively maintain core services during response. Without adjustment of the scope and focus, currently available SimEx materials do not have the capacity to test health systems to support the development of resilient health systems. Dedicated SimEx materials are urgently needed to fill this gap and harness their potential as an operational tool to contribute to improvements in health systems. They can act as effective global goods to allow testing of different functional aspects of health systems and service delivery alongside emergency preparedness and response.”

Globalization & Health - Strengthening national health research systems in the WHO African Region – progress towards universal health coverage S Rusakaniko, J Nabyonga-Orem et al; https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-019-0492-8

“Health challenges and health systems set-ups differ, warranting contextualised healthcare interventions to move towards universal health coverage. As such, there is emphasis on generation of contextualized evidence to solve local challenges. However, weak research capacity and inadequate resources remain an impendiment to quality research in the African region. WHO African Region (WHO AFR) facilitated the adoption of a regional strategy for strengthening national health research systems (NHRS) in 2015. We assessed the progress in strengthening NHRS among the 47 member states of the WHO AFR….”

Canadian Foreign Policy Journal - Health in Canadian foreign policy: the role of norms and security interests

Arne Ruckert et al ; https://www.tandfonline.com/doi/abs/10.1080/11926422.2019.1642216?journalCode=rcfp20

« Despite health’s prominent place in Canadian foreign policy, as evidenced in the on-going support for maternal newborn and child health (MNCH) initiatives, little is known about the driving forces behind the integration of health into foreign policy. Based on document analysis and expert interviews, we provide an empirically grounded but theoretically informed perspective on health’s role in Canadian foreign policy. We argue that the integration of health into Canadian foreign policy cannot be understood by drawing on a single theoretical perspective. Instead we suggest that the integration of health into foreign policy follows competing logics, depending on whether or not health concerns intersect with high politics (such as national security and economic interests). In cases where health is directly or indirectly related to major security threats, realist theory (and the securitization logic) can best explain health’s positioning in foreign policy by highlighting the role that state interests play in maximizing security. In instances where health is not related to high politics concerns, liberal internationalism with its focus on the cultural and normative driving forces provides a more useful theoretical understanding of how or why health enters foreign policy prominence. »

Environmental Research - Malignant mesothelioma in Sub-Saharan Africa: A case report from Lubumbashi, DR Congo.

J P Kitenge et al ; https://www.sciencedirect.com/science/article/pii/S0013935119303536

Case report on the use (and long term-impact of) asbestos in the DRC. “Although asbestos has been used throughout Africa in the past decades, no reports of asbestos-related malignant mesothelioma are available from sub-Saharan Africa, except from South Africa and Zimbabwe. We present a case of a 39-year-old man who died from a histologically proven malignant mesothelioma of the peritoneum in Lubumbashi, DR Congo. No occupational exposure to asbestos could be found in his history. In view of his young age, we speculated that he had been exposed to asbestos as a child, which was highly plausible because he had grown up in one of the numerous mining estates of the region. The houses of these estates were often built with asbestos-containing materials, notably roofs made of corrugated asbestos-cement. The possibility of past domestic or environmental exposure to asbestos was substantiated by the identification of chrysotile and crocidolite fibres in samples of asbestos-cement collected from the home where the patient had lived as a child. To our knowledge, this is the first report of malignant mesothelioma from a country in the Central African region. We expect that heightened awareness and improved diagnosis will lead to the detection of more asbestos-related diseases in Africa.”

International Journal of Health Services - Medical Tourism in Guatemala: Qualitatively Exploring How Existing Health System Inequities Facilitate Sector Development

A Céron, W Flores, R Labonté et al ; https://journals.sagepub.com/doi/full/10.1177/0020731419866085

« This article explores how existing health inequities in the Guatemalan health system facilitate the emergence of its medical tourism industry….”

Applied Health Economics & Health Policy - Health Insurance in Sub-Saharan Africa: A Scoping Review of the Methods Used to Evaluate its Impact S Degroote, V Ridde & M de Allegri; https://link.springer.com/article/10.1007%2Fs40258-019- 00499-y

“We conducted a scoping review with the objective of synthesizing available literature and mapping what designs and methods have been used to evaluate health insurance reforms in sub-Saharan Africa…. The findings of our scoping review are in line with the observation emerging from prior reviews focused on content in pointing at the fact that evidence on the impact of health insurance is still relatively weak as it is derived primarily from studies relying on observational designs. Our review did identify an increase in the use of quasi-experimental designs in more recent studies, suggesting that we could observe a broadening and deepening of the evidence base on health insurance in Africa over the next few years.”

BMJ (Analysis) - Burnout in healthcare: the case for organisational change https://www.bmj.com/content/366/bmj.l4774

“Burnout is an occupational phenomenon and we need to look beyond the individual to find effective solutions, argue A Montgomery and colleagues.” Nice one, with also some concrete suggestions in this respect.

Journal of African cultural studies - The capacity-building-workshop-in-Africa hokum’ M N Jayawardana; https://www.tandfonline.com/doi/full/10.1080/13696815.2019.1630265

One of the reads of the week. Should be freely available, in my opinion, this poignant read.

Globalization & Health - What is the meaning of urban liveability for a city in a low-to-middle-income country? Contextualising liveability for Bangkok, Thailand

A Alderton et al; https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-019- 0484-8

“…This study conceptualised urban liveability for Bangkok, a city in a LMIC context, with potential for adjustment to other cities. …”

Lancet Comment – Non-communicable diseases and climate change: linked global emergencies Rachel Nugent et al ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31762- 3/fulltext

“In the annual University College London–Lancet Global Health Lecture in April, 2019, we called for non-communicable diseases (NCDs) to be regarded as a global emergency and we compared the spread of NCDs to climate change, a global emergency of unprecedented proportion. This is not hyperbole—there is ample reason for that claim….”

Some blogs & mainstream articles of the week

Nature Microbiology - Archive of Failures in Global Health

M Pai; https://naturemicrobiologycommunity.nature.com/users/20892-madhukar-pai/posts/51659- archive-of-failures-in-global-health

“Global health seeks to solve big problems. We're bound to fail. Although failures can help us learn, we rarely seem to publish or discuss failed products and strategies in global health. This blog post aims to crowd source and compile a list of failures in global health.”

Hope you all weigh in! The first one he listed: “1. Failure to deliver on the Alma-Ata declaration: Despite the 1978 Alma Ata declaration on "Health For All by 2000", nearly half the world's population lacks access to essential health services.”

HSG blog – Equity, challenge studies and community engagement in bioethics https://www.healthsystemsglobal.org/blog/352/Equity-challenge-studies-and-community- engagement-in-bioethics-.html

Insightful blog by Bridget Pratt and Dorcas Kamuya, Vice Chair and Co-Chair (respectively) for the HSG Ethics of Health Systems Research TWG

“At the beginning of July we attended the Oxford Global Health and Bioethics Conference which had participants from 40 countries … … The conference explored the current and future role and agenda of bioethics, so with our health systems and health systems research hats on, we wanted to share some of the stand out moments….”

IHP - Can a mysterious disease in Bihar open a window of opportunity for health care reform?

Vikash R Keshri; https://www.internationalhealthpolicies.org/blogs/can-a-mysterious-disease-in- bihar-open-a-window-of-opportunity-for-health-care-reform/

Vikash applies Kingdon’s multiple streams framework on the recent (annual, but this year bigger) ‘outbreak’ of ‘Acute Encephalitis or Encephalopathy Syndrome’ (AES) in Bihar.

BMJ Blog – Ulrick Sidney: Visas for global health events—too many are losing their seat at the table BMJ blog

“Visa barriers for researchers from low and middle income countries make global health events less equitable and effective, says Ulrick Sidney.” Story related to the latest WHA.

Some tweets of the week

Amy Maxmen (Nature):

“Since when did virologist Peter Piot become the leading expert on #DRC political affairs? STAT, Science NYT...I am very confused by your reporting.”

Philip Matthew:

“#RANConference2019 takeaway: #AntimicrobialResistance is closely linked to broken #healthsystems; and can escalate the costs for implementation of #UHC. #LMICs need to promote innovations and linkages at country level: and international community needs to help with #financing.”

Anthony Costello:

“The VP for human development at the World Bank says non-payment on their pandemic bonds for the Ebola outbreak, which pay 11.1% over Libor to investors, “is a positive thing”. You couldn’t make it up. Ethics gone mad.” & follow-up tweet: “This is the “innovative finance” that is corrupting the Global Fund and other donor instruments.”

Jason Hickel :

“Scotland is joining New Zealand and Iceland to prioritize well-being - rather than growth - as the main objective of government policy. May many other nations follow suit. (link: https://www.ted.com/talks/nicola_sturgeon_why_governments_should_prioritize_well_being) ted.com/talks/nicola_s…”

+ follow-up: “All three of these countries are currently led by women. As Sturgeon puts it, "I'll leave you to decide whether that's relevant."

Global health events & announcements

Coming up - International flagship conference – From Politics to Power? Rethinking the Politics of Development (Manchester, 9-11 September) http://www.effective-states.org/conference-2019/

“…The programme is now available for this major international conference convened by the Effective States and Inclusive Development Research Centre (ESID), at the Global Development Institute, The University of Manchester….” ESID is DFID-funded.

Looks like a rather interesting conference. To be combined with the start of the Premier League season, a ‘power (and money)’ exercise in its own right.

Global governance of health

CGD - Chinese Leadership and the Future of BRI: What Key Decisions Lie Ahead?

Brad Parks; https://www.cgdev.org/publication/chinese-leadership-and-future-bri-what-key- decisions-lie-ahead?utm_source=190730&utm_medium=cgd_email&utm_campaign=cgd_weekly

“… China is now substantially weaker at home than it was during the early days of BRI…. “

“…. In the coming years, China will confront a series of decisions about how to engage with three different groups: (1) citizens in the countries where it is implementing BRI projects; (2) leaders of the same countries; and (3) donors and lenders outside of China. These decisions will shape the ultimate outcomes that are achieved via BRI—and whether China finds itself in a position that is more similar to the first or second scenario that I have just described. In the remainder of this essay, I will introduce the big decisions that lie ahead and the considerations that ought to be weighed by those who set strategy and make policy in Beijing….”

“…Decision 1: Demand Accountability or Wait for Voters in BRI Countries to Do So? … … Decision 2: Charm the Leader or the People Who Hire and Fire Him?... … Decision 3: Make Development Finance Institutions Outside of China Collaborators or Competitors?... “

Devex - UNICEF chief asks for 'courage' in addressing findings on harassment, abuse https://www.devex.com/news/unicef-chief-asks-for-courage-in-addressing-findings-on-harassment- abuse-95346

“UNICEF is undertaking structural changes to reform the “toxic” workplace culture an independent task force recently revealed. But there are still more questions than answers on how UNICEF can become more equitable and supportive, UNICEF management said during a recent global town hall meeting. “We cannot condone nor ignore bad behavior. It cannot creep into our culture. This is the time we need to build on this report, roll up our sleeves, and do something about it,” UNICEF Executive Director Henrietta Fore said during the internal one-and-a-half hour town hall….”

The Telegraph – New development secretary Alok Sharma signals he will protect UK aid budget

Telegraph;

“New international development secretary Alok Sharma has signalled that he is committed to sticking with the UK’s contribution to foreign aid. In a statement published on the day of his appointment to the Cabinet, Mr Sharma said he would work to deliver Brexit and “make sure UK aid is tackling global challenges” including climate change, disease and humanitarian disasters. “Investing 0.7 per cent of [gross national income] on international development shows we are an enterprising, outward-looking and truly global Britain that is fully engaged with the world,” he said….”

But do check out also Devex - DFID and UK aid still under threat, experts warn

Good analysis. Among others, arguing that for the moment Johnson has his hands full with preparing Brexit, and that he might gamble on going for an early election (to secure more Conservatives in parliament), after which a ‘reorganization’ of aid/DFID/… might still happen.

Guardian - Bob Geldof's firm's use of tax haven is legal, but the system hurts African nations

M Hearson; https://www.theguardian.com/global-development/2019/jul/31/bob-geldof-firms-use- of-a-tax-haven-is-legal-but-damaging-to-african-nations

Martin Hearson, a research fellow at the Institute of Development Studies, researching international tax treaties, comes back on Mauritius Leaks (see last week’s newsletter).

“…Tax treaties with Mauritius reduce African countries’ tax revenues considerably. When I analysed the impact of treaties, I found that African countries’ treaties impose more limits on their

ability to tax investment than they need to, and recent research published by the Tax Justice Network points to Mauritius as one of the most aggressive negotiators.

“…There are signs that the tide is turning: Rwanda and South Africa have negotiated new, stronger treaties with Mauritius; Senegal, unsatisfied with Mauritius’ attitude to renegotiations, has decided to terminate its treaty altogether. Kenya’s treaty with Mauritius was recently struck down in the Nairobi High Court. Other countries are considering renegotiations….”

AJPH - Revisiting the Corporate and Commercial Determinants of Health

Martin McKee & David Stuckler; https://ajph.aphapublications.org/doi/10.2105/AJPH.2018.304510

“Oldie” (2018) but a goldie.

“We trace the development of the concept of the corporate determinants of health. We argue that these determinants are predicated on the unchecked power of corporations and that the means by which corporations exert power is increasingly unseen. We identify four of the ways corporations influence health: defining the dominant narrative; setting the rules by which society, especially trade, operates; commodifying knowledge; and undermining political, social, and economic rights. We identify how public health professionals can respond to these manifestations of power.”

Devex –2 months until launch, how is the new US DFI shaping up? https://www.devex.com/news/2-months-until-launch-how-is-the-new-us-dfi-shaping-up-95369

“With two months before the new U.S. International Development Finance Corporation is set to open its doors, the agency’s architects continue to resolve political issues and iron out operational details….”

Geoforum (Critical Review) – Neo-illiberalism

R. Hendrikse; https://www.researchgate.net/publication/326238539_Neo-illiberalism

“This review brings together a set of trends to rethink neoliberalism. Decades of neoliberalization have transformed Western political economies, and although the financial crisis debunked the ideology for a fraud, the practices have simply refused to die since. Instead, neoliberalism assumed an authoritarian character, feeding popular resistance. Although leftist challenges failed to break its spell, Brexit and Trump bulldozed right-wing populism into the mainstream of the neoliberal heartlands. Where these events have conventionally been presented as ruptures to the status quo, this review suggests that they herald the next neoliberal wave shaping global capitalism. This

phase is described as neo-illiberalism, signifying the illiberal mutation and restoration of transatlantic neoliberalism, marked by brazen attacks on constitutional checks, balances and rights across vast neoliberalized landscapes. These are executed by neoliberal elites working with and/or adopting nativist narratives and policies of the radical right, unevenly adapting Western neoliberalism to a nascent neo-illiberal world order.”

BMJ (Blog) - Angela Merkel: Implementing sustainable development goal 3

BMJ Blog; “Speaking in Berlin earlier this year, Angela Merkel reminded world leaders that health is a shared task and that to live dignified lives, we must all collaborate on common goals.”

Was first published in Health: a political choice

As we’ve read now Macron, Merkel and Abe in BMJ blogs, recently, we think it’s time for BMJ to also ask the likes of Johnson, Trump and Putin for their view on global health.

Devex - UNRWA in the spotlight https://www.devex.com/news/ebola-hits-goma-dfid-faces-uncertainty-and-unrwa-in-the-spotlight- this-week-in-development-95390

“The United Nations oversight body is looking into allegations that leadership at the U.N. Palestinian refugee agency abused their authority for personal gain. The allegations are detailed in an internal, confidential report, which was obtained by Al Jazeera. Commissioner-General Pierre Krahenbuhl, who is one of the people facing allegations, told Al Jazeera he rejects the characterization of the agency’s leadership team, and said, “We should be judged on the findings of the independent investigation not on allegations, rumors or fabrications.” The probe comes at the same time UNRWA is battling a funding crisis brought on by the Trump administration’s decision to drastically reduce — and then entirely eliminate — U.S. contributions to the U.N. agency. The 10-page report contains "credible and corroborated reports" from current and former UNRWA employees, who allege that an "inner circle" of UNRWA leaders "have engaged in misconduct, nepotism, retaliation ... and other abuses of authority.” The report alleges that this inner circle used the funding crisis in 2018 as an excuse to concentrate power, while disregarding the agency’s rules and procedures, leading to an “exodus of senior and other staff.”…”

And a quick link:

NYT - Kelly Craft Is Confirmed as U.S. Ambassador to United Nations

UHC

Vox - On health care, there are 3 types of Democrats running for president https://www.vox.com/2019/7/30/20747974/democratic-debate-health-care-medicare-for-all

“What we learned about the candidates’ 2020 health care plans from the first night of the second Democratic debate.”

“The 2020 presidential candidates at the opening night of the second Democratic primary debate fell into three buckets on health care, the top issue for Democratic voters so far. In an intricate and often confusing section of the debate, with candidates jockeying to define what “Medicare-for-all” even means, the first 30 minutes of the debate brought some clarity. There are essentially three perspectives from Democrats: 1) the ones who want to blow up the whole system for universal single-payer, 2) the ones who worry about the disruption of a single-payer system and its ensuing political fallout, and 3) those who try to split the difference, speaking instead to values like universal coverage….”

You know us. Generally, we prefer to blow up things : )

Vox also covered the second debate - The messy health care discussion at the second Democratic debate, explained.

See also the New York Times.

Foreign Policy - Crowdfunding Can’t Cure China’s Health Care https://foreignpolicy.com/2019/07/30/crowdfunding-cant-cure-chinas-health-care/

“Rural Chinese are turning to mutual aid apps—but the pool only goes so far.”

Excerpts:

“… As a result, hundreds of thousands of people a day must travel to places like Beijing or Shanghai from smaller cities to receive dependable treatment. One massively popular online insurance service, backed by the Chinese tech giant Alipay, promises to cut through those lines—and the sometimes crippling costs of care. … … For those left languishing in waiting rooms, the sight of a sky- blue Ant Financial logo, a QR code that links to its proprietary Alipay app, and the words “No need to get in line: Make appointments, take numbers, and pay fees here” are a sight for sore eyes. Ant Financial is the highest-valued tech start-up in the world, a $150 billion juggernaut spun out of the massive Alibaba conglomerate. … … In October 2018, Alipay launched an insurance product aimed at lower-income patients. Its “mutual aid” service allows for crowdfunding and pooled insurance

products to offset costs for larger illnesses not covered by traditional insurance programs. More than 50 million users have enrolled in Ant Financial’s Xiang Hu Bao (“mutual protection”) program since it was launched. … … For the migrant workers who make up 47 percent of Xiang Hu Bao users (as of April 2019), mutual aid provides the predictability to offset the hidden costs of financing hospital visits and treatment costs. Alongside new insurance products, Ant Financial also integrated features to allow patients to take numbers and make payments via the Alipay app. That makes hospital access easier for those who lack the personal connections needed to skip the lines—or the money to pay somebody to take a number and wait in place of them. … … Xiang Hu Bao clearly comes as a blessing for patients needing a stopgap for medical expenses. However, it may lead to the long-term worsening of existing divisions—with a new technological patina. Patchy insurance coverage, complex hospital bureaucratic processes, and insufficient provider services have cultivated an environment where technology companies see gaps they can fill in—and profit from. This is only going to get worse in the future.”

WB (blog) - Nutrition: The key to achieve Universal Health Coverage and unleash Human Capital

Gerda Verburg; http://blogs.worldbank.org/health/nutrition-key-achieve-universal-health-coverage- and-unleash-human-capital

“2019 is a crucial year to ensure that good nutrition is at the heart of the Universal Health Coverage Agenda. The G20 Leader’s Summit in Japan and the High-Level Meeting on Universal Health Coverage (UHC) at the UN General Assembly are opportunities to galvanise global commitment to ensure health and nutrition for all, recognizing the strong links to climate action and the fact that health and nutrition are human rights, preconditions, outcomes and drivers for sustainable development. It may sound like common sense, but we must not be complacent.”

“… The political declaration for the High-Level Meeting on Universal Health Coverage on 23 September 2019, needs to include nutrition to lead the way. I trust the World Bank will be a strong advocate for this, next to so many governments and stakeholders who want to see nutrition as a strong foundation for UHC. The Scaling Up Nutrition Global Gathering in Kathmandu, Nepal, 5-7 November 2019, and the 2020 Nutrition Summit in Tokyo, Japan, are opportunities to ensure all countries make strong commitments toward integrating nutrition into national UHC plans.”

The Conversation - Migrants must be part of South Africa’s universal health plan. Here’s why

S Frade et al; https://theconversation.com/migrants-must-be-part-of-south-africas-universal-health- plan-heres-why-120925

“A glaring weakness in South Africa’s proposed NHI is care for migrants. Rather than addressing its aims of ensuring equitable access to quality healthcare for all, the NHI – in its current form – legitimises the persistent exclusion of international migrants from South Africa’s public health system….”

International Journal for Equity in Health - Catastrophic health care expenditure in Myanmar: policy implications in leading progress towards universal health coverage

Chaw-Yin Myint et al ; https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-019-1018- y

“Around the world, millions of people are impoverished due to health care spending. The highest catastrophic health expenditures are found in countries in transition. Our study analyzes the extent of financial protection by estimating the incidence of catastrophic health care expenditure in Myanmar and its association with sociodemographic factors….”

BMJ Global Health – Bi-directional drones to strengthen healthcare provision: experiences and lessons from Madagascar, Malawi and Senegal

A Knoblauch et al; https://gh.bmj.com/content/4/4/e001541

“Drones are increasingly being used globally for the support of healthcare programmes. Madagascar, Malawi and Senegal are among a group of early adopters piloting the use of bi- directional transport drones for health systems in sub-Saharan Africa. This article presents the experiences as well as the strengths, weaknesses, opportunities and threats (SWOT analysis) of these country projects. Methods for addressing regulatory, feasibility, acceptability, and monitoring and evaluation issues are presented to guide future implementations. Main recommendations for governments, implementers, drone providers and funders include (1) developing more reliable technologies, (2) thorough vetting of drone providers’ capabilities during the selection process, (3) using and strengthening local capacity, (4) building in-country markets and businesses to maintain drone operations locally, (5) coordinating efforts among all stakeholders under government leadership, (6) implementing and identifying funding for long-term projects beyond pilots, and (7) evaluating impacts via standardised indicators. Sharing experiences and evidence from ongoing projects is needed to advance the use of drones for healthcare.”

Lancet Review - New Zealand health system: universalism struggles with persisting inequities

F Goodyear-Smith et al; https://www.thelancet.com/journals/lancet/article/PIIS0140- 6736(19)31238-3/fulltext

“New Zealand was one of the first countries to establish a universal, tax-funded national health service. Unique features include innovative Māori services, the no-fault accident compensation scheme, and the Pharmaceutical Management Agency, which negotiates with pharmaceutical companies to get the best value for medicines purchased by public money. The so-called universal orientation of the health system, along with a strong commitment to social service provision, have contributed to New Zealand's favourable health statistics. However, despite a long-standing

commitment to reducing health inequities, problems with access to care persist and the system is not delivering the promise of equitable health outcomes for all population groups. Primary health services and hospital-based services have developed largely independently, and major restructuring during the 1990s did not produce the expected efficiency gains. A focus on individual-level secondary services and performance targets has been prioritised over tackling issues such as suicide, obesity, and poverty-related diseases through community-based health promotion, preventive activities, and primary care. Future changes need to focus on strengthening the culture and capacity of the system to improve equity of outcomes, including expanding Māori health service provision, integrating existing services and structures with new ones, aligning resources with need to achieve pro-equity outcomes, and strengthening population-based approaches to tackling contemporary drivers of health status.”

And a quick link:

CapX (by J Sturchio et al) - We cannot achieve universal health coverage without the private sector

One of the arguments used: “Countries with mixed public-private systems have done a better job of providing universal access.”

Planetary health

We start this section with a worrying tweet from David Wallace – Wells on a leak from the IPCC report due early August:

“If this leak is accurate, it means that the UN will announce in August that the world's land has already more or less reached the level of warming the UN summit in September is designed to merely strategize a way to possibly prevent.”

“This is important - leaked IPCC report due out in August claims that we've already seen 1.41° C of warming *on landmasses*: (link: https://twitter.com/MelanieBergma18/status/1156249784166100993 ) )

Rolling Stone - Greenland Is Melting Away Before Our Eyes https://www.rollingstone.com/politics/politics-news/greenland-ice-sheet-melt-865803/

Quote: “…This melt event is a good alarm signal that we urgently need change our way of living,” said Fettweis. “It is more and more likely that the IPCC projections are too optimistic in the Arctic.” Altogether, the Greenland ice sheet contains enough ice to raise global sea levels by about 24 feet.”

Meanwhile, in Siberia, Siberian Wildfires Prompt[ed] Russia to Declare a State of Emergency.

Guardian – The Guardian view on climate breakdown: an emergency for all, but especially the poor https://www.theguardian.com/commentisfree/2019/jul/31/the-guardian-view-on-climate- breakdown-an-emergency-for-all-but-especially-the-poor?CMP=share_btn_tw

Quote: “…A 4C rise this century, which is now considered a realistic prospect, would produce at least 300 million refugees and drown cities in the US and China. It is the duty of richer nations to do all they can to hold back the soaring temperatures which they did most to produce, and to take what action they can to mitigate their impact – abroad as well as at home. It is also in their self-interest.”

Guardian - Amazon deforestation: Bolsonaro government accused of seeking to sow doubt over data https://www.theguardian.com/world/2019/aug/01/amazon-deforestation-bolsonaro-government- accused-doubt-data

“Ministers look at setting up alternative monitoring scheme as existing system shows alarming rise in clearance rates.” Gosh.

Climate change news - UN warned corporate courts could thwart climate efforts https://www.climatechangenews.com/2019/07/24/un-warned-corporate-courts-thwart-climate- efforts/

“Campaigners are urging reform of an obscure system that allows coal, oil and gas companies to sue governments if climate policies hit their profits”. The ISDS system, off course. “The EU is locking horns with a bloc of countries led by the US and Japan over a mechanism included in more than 3,000 trade deals, ahead of UN talks in Vienna in October….”

Nature (News) - Harvard creates advisory panel to oversee solar geoengineering project https://www.nature.com/articles/d41586-019-02331-y

“Scientists will inject particles of calcium carbonate into the atmosphere and study their effects on incoming sunlight.”

“Plans to test a technique that would cool the planet by blocking sunlight are one step closer to reality. Harvard University in Cambridge, Massachusetts, has created an external advisory panel to

examine the potential ethical, environmental and geopolitical impacts of this geoengineering project, which has been developed by the university’s researchers. Known as the Stratospheric Controlled Perturbation Experiment (SCoPEx), the project would involve the release of calcium carbonate particles from a steerable balloon some 20 kilometres above the southwestern United States….”

SS&M - The (in)visible health risks of climate change

L Parry et al; https://www.sciencedirect.com/science/article/abs/pii/S0277953619304423

“This paper scrutinizes the assertion that knowledge gaps concerning the health risks from climate change are unjust, and must be addressed, because they hinder evidence-led interventions to protect vulnerable populations. First, we propose a taxonomy of six inter-related forms of invisibility (social marginalization, forced invisibility by migrants, spatial marginalization, neglected diseases, mental health, uneven climatic monitoring and forecasting) which underlie systematic biases in current understanding of these risks in Latin America, and therefore advocate an approach to climate-health research that draws on intersectionality theory to address these inter-relations. Then, we contend these invisibilities should be understood as outcomes of structural imbalances in power and resources, rather than haphazard blind-spots in scientific and state knowledge. Our thesis, emerging from theorizing of governmentality, is that a context-dependent and socially-constructed tension shapes whether the benefits of making vulnerable populations and their risks legible to the state outweigh the costs. To be seen is to be politically counted and receive rights, yet political theory and empirical evidence demonstrate the perils of visibility to people at the margins. … Finally, drawing on recent work on citizenship in post-colonial settings, we conceptualize climate change as an ‘open moment’ of political rupture, and propose strategies of social accountability, empowerment and trans-disciplinary research which should enable the marginalized to reach out for greater power….”

Bretton Woods Project (Briefing) - Low-carbon infrastructure, sustainable finance, and people-focused development: The role of multilateral development banks https://www.brettonwoodsproject.org/2019/07/low-carbon-infrastructure-sustainable-finance-and- people-focused-development/

“This briefing emphasises the interdependence between the SDGs and the Paris Climate Agreement, in terms of ensuring that all new infrastructure is climate resilient and aligned with the low- or zero-carbon pathways required to avert catastrophic climate change – which would render achieving the SDGs impossible. It argues that multilateral development banks (MDBs) must adopt a more robust joint definition of ‘sustainable infrastructure’, and mainstream it in their approach to infrastructure lending, in order to help catalyse a shift away from ‘business as usual’ approaches to carbon-intensive infrastructure that are not aligned with effective climate action or the SDGs.”

And some quick links:

• Independent - Human body ‘close to thermal limits’ due to extreme heatwaves caused by climate change, scientist says

“Swathes of land could soon become uninhabitable amid catastrophic weather changes.”

• Guardian - Climate crisis already causing deaths and childhood stunting, report reveals

“‘Insidious’ health-related impacts in Australia and Pacific include lowered cognitive capacity and spread of diseases.”

Infectious diseases & NTDs

Nature - ‘Mosaic’ HIV vaccine to be tested in thousands of people across the world https://www.nature.com/articles/d41586-019-02319- 8?utm_source=twt_nnc&utm_medium=social&utm_campaign=naturenews&sf216730216=1

“The experimental vaccine targets more strains of the virus than any other ― and seems to have longer lasting effects.”

BMJ - HIV in 2019: it’s all about dolutegravir https://www.bmj.com/content/366/bmj.l4931

“Every other year the International AIDS Society (IAS) meets to hear the latest basic and clinical research. Keith Alcorn says that this year the scientific presentations, as well as the hallway chatter, were dominated by a new drug for HIV.”

United Nations Economic and Social Council calls for urgent action to scale up the AIDS response https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2019/july/20 190726_ecosoc

“ECOSOC resolution calls for the United Nations General Assembly to convene a high-level meeting to review progress made against the 2016 Political Declaration on Ending AIDS.”

“The United Nations Economic and Social Council (ECOSOC) has adopted a resolution that calls on countries to urgently scale up evidence-informed programmes to end the AIDS epidemic as a public

health threat by 2030. It says the AIDS epidemic is not yet over and calls for reinvigorated efforts by all stakeholders. Adopted on 24 July 2019 during ECOSOC’s coordination and management meeting in New York, United States of America, the resolution calls on the United Nations General Assembly to decide by no later than September next year the date of a high-level meeting to review progress made on the United Nations commitment to end AIDS as a public health threat by 2030….”

Sabin-Aspen Vaccine Science & Policy Report - Accelerating the Development of a Universal Influenza Vaccine https://www.influenzer.org/app/uploads/2019/07/sabin-aspen-report-digital.pdf

“…the first annual report of the Sabin-Aspen Vaccine Science & Policy Group, which explores challenges and opportunities to develop a universal influenza vaccine. Here you will find a package of Big Ideas and supporting work, designed to overcome the scientific, financial, and organizational barriers to developing a vaccine that confers lifelong immunity against even the most catastrophic strains of influenza….”

USAID – USAID announces $300 million commitment in the fight against TB

USAID;

“The U.S. Agency for International Development (USAID) is pleased to announce a five-year, $300 million award, the TB Implementation Framework Agreement (TIFA), to improve the prevention, detection, and treatment of tuberculosis (TB). The lead partner in the cooperative agreement for the TIFA effort is John Snow, Inc., Research and Training Institute. A key component of the TB Accelerator initiative USAID Administrator Mark Green announced at the United Nations General Assembly (UNGA) High-Level Meeting (HLM) on TB in September of 2018, the TIFA will work to increase local ownership, financing, and accountability by creating partnerships with host- government entities in 24 USAID TB priority countries to empower them to implement locally generated, context-specific solutions….”

BMJ (blog) - Depo-Provera: WHO set to review guidance on use by women at high HIV risk

BMJ;

“A World Health Organization guideline development group [will] convene next week (29-31 July) to review recommendations for the use of contraceptive methods by women at high risk of contracting HIV. The group will review the status of the three monthly injectable contraceptive Depo-Provera, using new evidence from a randomised clinical trial published in the Lancet last month….”

The New Yorker – How mosquitoes changed everything

Brooke Jarvis; New Yorker;

“They slaughtered our ancestors and derailed our history. And they’re not finished yet.

See also a brand new book, The Mosquito: A Human History of Our Deadliest Predator

And a quick link:

The Telegraph - Bangladesh struggles to control the worst dengue outbreak in its history

AMR

BMC Health Services - Assessing the impact of law enforcement to reduce over-the-counter (OTC) sales of antibiotics in low- and middle-income countries; a systematic literature review

Tom Jacobs et al; https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-4359- 8

“Many low- and middle-income countries (LMIC) are moving towards enforcing prescription-only access to antibiotics. This systematic literature review aims to assess the interventions used to enforce existing legislation prohibiting over-the-counter (OTC) sales of antibiotics in LMICs, their impact and examine the methods chosen for impact measurement including their strengths and weaknesses….”

NCDs

Foreign Affairs –Let Them Eat Junk

E J Gomez; https://www.foreignaffairs.com/articles/2019-07-31/let-them-eat-junk

“Snack and Soda Companies Seek Political Cover in the Developing World.” “The junk food industry is expanding its business in Brazil, India, Mexico, and other emerging markets. Eduardo J. Gómez outlines the steps these companies have taken to head off the type of government regulation and public scrutiny they faced in the U.S. and Europe.”

Article on the rising power and influence of junk food industries, based on Gomez’ new book.

Open Democracy - Welcome to Boris Johnson’s government of all the lobbyists https://www.opendemocracy.net/en/opendemocracyuk/welcome-to-boris-johnsons-government- of-all-the-lobbyists/

“The prime minister’s new team has strong links to leading corporate lobbyists – they are representing the ultra-rich who want to shape Brexit.”

SS&M - Sugar-based beverage taxes and beverage prices: Evidence from South Africa's Health Promotion Levy

N Stacey et al; https://www.sciencedirect.com/science/article/abs/pii/S0277953619304599

“A growing number of jurisdictions are introducing taxes on sugar-sweetened beverages (SSBs) in efforts to reduce sugar intake, obesity, and associated metabolic conditions. A key dimension of the impact of such taxes is how they induce changes in the prices of the taxed beverages and their un- taxed substitutes. At present these taxes have typically been based solely on volume. More recently, however, due to the potential to target the source of SSBs' health harms and to incentivize product reformulation, SSB taxes are being levied based on sugar content. In April of 2018 South Africa implemented such a tax, the Health Promotion Levy (HPL), at a rate of 0.021 ZAR (approximately 0.15 US cents) for each gram of sugar over an initial threshold of 4 g/100 ml. … .. we study changes in beverage prices following the introduction of the HPL. We find null price increases among un-taxed beverages and find significant price increases for carbonates, the largest taxed product category. However, within carbonates we find similar price increases in price for low- and high-sugar brands, despite the underlying difference in tax liability. In addition, while we find evidence of product reformulation, we find significant price increases among the brands that reduced their sugar content. While the findings are broadly consistent with the price changes of volume- based SSB taxes, future considerations of price effects of sugar-based SSB taxes need to account for the opportunity for intra-firm heterogeneity in price response among large multi-product firms.”

Quick link:

UK's first supermarket designed by public health experts launches in Central London (Evening Standard)

“The store gives greater visibility to healthy foods, such as fruit, vegetables and pulses.”

Sexual & Reproductive / maternal, neonatal & child health

Stat News - This company wants to make a once-a-month option for birth control pills https://www.statnews.com/2019/07/30/lyndra-once-a-month-birth-control/

“What if you could take your birth control pill just once a month? That’s the vision behind the newest effort from Lyndra Therapeutics, which is hoping its slow-release drug delivery technology can help improve adherence rates for pill-based birth control. Oral contraceptives fail more often than some other birth control options, in part because many people struggle to remember to pop a birth control pill at the same time every single day. On Tuesday, the company announced it has scored a $13 million grant from the Bill and Melinda Gates Foundation to develop a once-monthly oral contraceptive. It’s the latest target for the Boston-based biotech company, which is developing a drug delivery platform that slowly releases medication in the stomach over a set period of time — “making daily pills a thing of the past.”…”

NEJM (Perspective) - Population and the Environment — Time for Another Contraception Revolution

D Anderson; https://www.nejm.org/doi/full/10.1056/NEJMp1906733?query=featured_secondary

“As the world population continues to grow, pressures on the environment will become more critical. The time seems ripe for another contraception revolution to provide options for the diverse populations that are not currently being served by modern contraception….”

See also an interview with the author in Stat News – “To mitigate the effects of climate change, one researcher calls for a ‘contraception revolution’” on what she has in mind.

Among others: “…We need more user-friendly, non-prescription methods for women. And the other big — huge — gap is male contraception….”

Access to medicines

AP - Iranians say US sanctions blocking access to needed medicine

“With Iran’s economy in free fall after the U.S. pullout from the nuclear deal and escalated sanctions on Tehran, prices of imported medicines have soared as the national currency tumbled about 70% against the dollar. Even medicines manufactured in Iran are tougher to come by for ordinary Iranians, their cost out of reach for many in a country where the average monthly salary is equivalent to about $450….”

Hindustan Times - ‘Biotech R&D makes India hub of quality drugs, vaccines’: Trevor Mundel of Gates foundation https://www.hindustantimes.com/india-news/biotech-r-d-makes-india-hub-of-quality-drugs- vaccines-trevor-mundel-of-gates-foundation/story-yHPTub2aJbqYbnVtMEd7rL.html

“Trevor Mundel (Gates Foundation) says India is not just making vaccines but making them within a quality system, has not been accomplished, broadly [i.e. by other countries like China, Indonesia… ], and that is the unique aspect India has brought to the game.”

Plos Med - Competition and price among brand-name drugs in the same class: A systematic review of the evidence https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002872

“Ameet Sarpatwari and colleagues assess market competition among brand-name drugs with similar therapeutic effects.” This article focuses on the US market.

HP&P - “The biggest reform to China's health system”: did the zero-markup drug policy achieve its goal at traditional Chinese medicines county hospitals?

X Shi et al; https://academic.oup.com/heapol/advance-article- abstract/doi/10.1093/heapol/czz053/5541025?redirectedFrom=fulltext

“The zero-markup drug policy (ZMDP) was heralded as the biggest reform to China’s modern health system. However, there have been a very limited number of investigations of the ZMDP at county hospital level, and those limited county hospital studies have several limitations in terms of sample representativeness and study design. We investigated the overall and dynamic effects of ZMDP at traditional Chinese medicine (TCM) county hospitals….”

“…On average, the ZMDP reform was associated with the reduction in the share of revenue from drug sales (3.1%), revenue from western medicines sales (12.7%), revenue from medical care services (3.6%) and gross hospital revenue (3.4%), as well as increased government subsidies (24.4%). The ZMDP reform was not significantly associated with the number of annual outpatient and inpatient visits. In terms of dynamic effects, the share of revenue from drug sales decreased by 2.5% in the

implementation year and by about 5% in the subsequent years. Revenue from western medicine sales fell substantially in the short term and continued to drop in the long term. Government subsidies went up strikingly in the short term and long term, and revenue from medical care services and gross revenue decreased only in the implementation year. The ZMDP achieved its stated goal through reducing the share of revenue from drug sales without disrupting the availability of healthcare services at TCM county hospitals. The success of ZMDP was mainly due to the huge growth in the government’s financial investment in TCM hospitals.”

Human resources for health

BMJ Global Health - Using mobile technologies to support the training of community health workers in low-income and middle-income countries: mapping the evidence

N Winters et al; https://gh.bmj.com/content/4/4/e001421

“This paper maps the evidence published between 2000 and 2018 on the use of mobile technologies to train community health workers (CHWs) in low- and middle-income countries (LMICs) across nine areas of global healthcare, including the neglected areas of disability and mental health….”

Conclusion: “…The evidence map shows significant gaps in the use of mobile technologies for training, particularly in the currently neglected areas of global health. Significant work will be needed to improve the evidence-base, including assessing the quality of mobile-based training programmes.”

And a quick link:

BMJ Global Health (blog) - Our experience with rapid evidence synthesis: mid-level health providers (MLHPs) for Primary Health Care

“What does conducting rapid evidence synthesis for decision making look like? Sandeep Moola shares his experience for developing one on MLHPs for LMICs.”

Miscellaneous

Lancet Editorial - d Building capacity in Africa's national science academies https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31725-8/fulltext

“On July 23, the InterAcademy Partnership released Harnessing Science, Engineering and Medicine to Address Africa's Challenges, a call for greater collaboration and investment in Africa's national science academies from policymakers and international organisations such as the UN….”

“…The report has several recommendations to help bolster African science, engineering, and medical capacity. At the international level, it calls on the UN and the African Union to work with African researchers to develop skills in policy advocacy—helping local governments formulate research activities and identify solutions for local problems. It calls for the Network of African Science Academies to increase capacity and build stronger collaborative networks among each other and the diaspora of African researchers in the global north….”

Current Affairs – 5 Myths about global poverty

Roge Karma; https://www.currentaffairs.org/2019/07/5-myths-about-global-poverty

“Don’t be fooled by the simplistic talking points of capitalism’s defenders…” Well worth a read.

MIT Technology review - Facebook is funding brain experiments to create a device that reads your mind

MIT Technology review;

Huh. “Big tech firms are trying to read people’s thoughts, and no one’s ready for the consequences.”

Guardian Long Read - How the media framed the way we see the migrant crisis

D Trilling; https://www.theguardian.com/news/2019/aug/01/media-framed-migrant-crisis-disaster- reporting

“Disaster reporting plays to set ideas about people from ‘over there’.”

Economist - A new study tracks the surge in Chinese loans to poor countries

Economist;

“Nearly half of China’s credit is hidden, and much of it goes to vulnerable borrowers.”

“…China's outstanding loans to other countries have risen from almost nothing in 2000 to more than $700bn today…”

Research

BMJ Global Health - Priority setting for new systematic reviews: processes and lessons learned in three regions in Africa

E E Effa et al ; https://gh.bmj.com/content/4/4/e001615

« Priority setting to identify topical and context relevant questions for systematic reviews involves an explicit, iterative and inclusive process. In resource-constrained settings of low-income and middle- income countries, priority setting for health related research activities ensures efficient use of resources. In this paper, we critically reflect on the approaches and specific processes adopted across three regions of Africa, present some of the outcomes and share the lessons learnt while carrying out these activities….”

HP&P - Assessing scalability of an intervention: why, how and who?

K Zamboni et al; https://academic.oup.com/heapol/advance- article/doi/10.1093/heapol/czz068/5542084?searchresult=1

“Public health interventions should be designed with scale in mind, and researchers and implementers must plan for scale-up at an early stage. Yet, there is limited awareness among researchers of the critical value of considering scalability and relatively limited empirical evidence on assessing scalability, despite emerging methodological guidance. We aimed to integrate scalability considerations in the design of a study to evaluate a multi-component intervention to reduce unnecessary caesarean sections in low- and middle-income countries….”

“…Here, we document our experience and the methodological challenges we encountered in integrating a scalability assessment in our study protocol. These include: achieving consensus on the purpose of a scalability assessment; and identifying the optimal timing of such an assessment, moving away from the concept of a one-off assessment at the start of a project. We also encountered tensions between the need to establish the proof of principle, and the need to design an innovation that would be fit-for-scale. Particularly for complex interventions, scaling up may warrant rigorous research to determine an efficient and effective scaling-up strategy….”