IHP News 559 : “Public Enemy Number One”

IHP news 559 : “Public enemy number one”

( 14 February 2020)

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,

I know, I know, it’s Valentine today, so I probably shouldn’t talk about the eerily sounding “Covid- 19” in this short intro, let alone about the even more dreaded “P word” but WHO and dr. Tedros were clearly in no mood for Valentine earlier this week, when describing the virus as “a global threat, potentially worse than terrorism”. “The world must wake up and consider this enemy virus as public enemy number one,” Tedros said. With world media and public opinion going berserk all around the world for a few weeks now, I think that shouldn’t be too much of a problem. The other part of his message, however, that it’s about "solidarity, solidarity and solidarity", might prove much harder in the weeks and months to come, given how Sapiens is wired.

When thinking of pandemics, in this visual culture of ours, we probably all have (subconsciously or not) a particular movie in mind when considering some of the most dire scenarios. For some of you, that might be “Contagion”, for me, it’s no doubt “Twelve Monkeys” (1995), with among others, Bruce Willis, a stunning Madeleine Stowe and a young Brad Pitt. Back in the innocent ‘90s, it all felt a bit surreal, even the obligatory rogue scientist popping up towards the end. But what a great movie! Now in the year 2020, with the scary ongoing public health experiment (aka ‘the coronavirus cruise ship quarantines’), occasionally I get the feeling that “Twelve Monkeys” is being mixed up with “the Poseidon Adventure” . Anyway, as you can imagine, lots of focus again in this week’s newsletter on the coronavirus, now labelled SARS-CoV-2. (PS: on a different note, I had to look up the word “pangolins” this week, this sort of vocabulary comes a bit less naturally to me than, say, neoliberalism or capitalism . )

In other news this week, the Munich security report 2020 coined the term Westlessnness, I let you find out for yourself what the term implies. It’s both good and bad, I’d say, but with huge implications for the world, not just for global health.

In the featured article below, Priti Patnaik gives her in-depth take on the latest (146th) WHO Executive Board meeting.

Enjoy your reading. (And Valentine, if you can !)

Kristof Decoster

Featured Article

WHO 146th Executive Board Meeting – the technical meets the political

Priti Patnaik (Independent Journalist & Researcher)

The 146th Executive Board meeting of the WHO was like an investment case in action for donors.

Here was WHO leadership noting the passing of key resolutions, lending support to new initiatives, urging countries to work together to arrive at a consensus on vexatious issues, while briefing technical experts and the media every day on the emerging outbreak of novel Coronavirus (Covid- 19). In the midst of this, it was also responding to calls to reform the International Health Regulations in order to give WHO more nimble-footedness in addressing emergencies. The gigantic global health machine was in motion for all to see. This past month has also seen WHO take on disinformation and fake news. So there was much for donors to see, especially and not the least, the dwindling reserves of the Contingency Fund for Emergencies – now at less than $20 million.

The technical is the political

The dynamics of political health diplomacy were playing out in the main arena where a few member states gathered to variously speak for Taiwan’s inclusion in WHO processes and China dissuading them for “hyping up” the issue. WHO technocrats and member states expressed solidarity with China and cautioned against stigmatizing affected people.

On a number of occasions, member states were reminded to stick to “technical discussions”, and not veer into political matters including on Taiwan and Palestine. But apart from these traditionally complicated political questions, the current dynamic unfolding between China and USA in the context of the coronavirus (Covid-19), has been a story to watch, particularly the travel and trade related decisions. It has inevitably drawn WHO into this bilateral dynamic. At another event in the same week, questions were raised on whether WHO had praised China too soon in its efforts to fight the outbreak, even as there were reports on forced restrictions on movements of people within the country. A member from the senior WHO leadership who was present, said “Damned if you do, damned if you don’t”. And added that it is only in hindsight that one can make these judgments, but for the time being the limited number of cases outside to China, showed that “something was working”. There is no doubt Director-General Tedros has had to walk a tightrope in delivering technical expertise, liaising with a multitude of actors to address the outbreak, while being rooted in political realities and operating in varied cultural contexts. (Earlier this week, in a budget proposal the US government suggested a 50% cut in its funding to WHO.)

Like wheels within wheels, smaller, hugely pertinent informal negotiations rolled on throughout the week, many of which had commenced earlier to the meeting. Countries huddled together were engaged in long drawn discussions trying to reach a consensus or hammering out a compromise including on matters pushing for deeper engagement on price and availability of drugs, or asking for stricter norms to address alcohol related deaths, among others.

Access to medicines

Meetings at WHO are a great indicator of national priorities in many countries. It was sobering to hear the United States of America, several times during the week, somewhat restrained in its voice compared to previous years. Observers were of the view that high prices of drugs have become a

flash point domestically in many countries including USA. High income countries have been coalescing around efforts for greater transparency around prices of medicines. Unlike before, it seems countries may not have to struggle any more to have these issues on the WHO agenda. It might not be totally coincidental that it has finally become “an issue”, ever since high income countries started experiencing strains on their budgets in trying to procure expensive medicines.

After five rounds of consultations, a proposal initiated and facilitated by Brazil eventually gathered enough support for it to be co-sponsored by a broad spectrum of more than 40 countries including the European Union, to arrive at a consensus.

Essentially, the decision adopted by the Board, seeks to give a “political push” to prior commitments made to implement the recommendations of the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property (GSPoA) review in 2018 [WHA71(9)]. Further the DG has been asked to convene informal consultations amongst countries in 2020 to “further discuss the recommendations of the review panel not emanating from the global strategy and plan of action on public health, innovation and intellectual property”. Some countries believe that these issues were beyond the original scope of the GSPoA including discussions on improving transparency in R&D costs, discussions on shortages of medicines and asking countries to commit to spending at least 0.01% of their gross domestic product to basic and applied research relevant to the health needs of developing countries.

In addition, the DG has also been tasked with convening informal consultations in 2020 on promoting and monitoring transparency of medicines and actions to prevent shortages.

It is understood that Switzerland and the USA were opposing efforts for greater transparency of costs around research and development. Also, that there was resistance on language around shortage of drugs. One source alluded to the hesitation on the part of some member states to commit resources to prevent shortage of drugs.

Finally, the decision mandates the DG to allocate resources to implement prioritized actions addressed to the WHO secretariat as mentioned in the GSPoA review. The DG has also been asked to report on the progress on the implementation to the Assembly in 2021 following a discussion at the Executive Board.

Discussions and negotiations around access to medicines have matured and have acquired a dynamic of their own. After all, the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property (GSPoA) is a dozen years old.

And in a sign of things to come, other issues have come to the fore.

The buzz around alcohol negotiations at the EB

Of the number of competing objectives, negotiations around tougher policies to address alcohol- related deaths, to an extent, had observers guessing till the penultimate day of the closure of the meeting on how the discussions would conclude.

Somewhat similar to the access to medicines ecosystem, a few big “producer” countries and others opposed stronger policies although the burden of deaths on account of harmful consumption of alcohol is distributed across the board causing 3 million deaths annually. There has been a worldwide increase in harmful alcohol consumption, particularly in low- and middle-income countries, in the last ten years. This effectively means that WHO and member states efforts on this have failed.

USA, UK, Japan, and Brazil mounted the strongest opposition apart from Haiti, Australia, New Zealand and Canada. However, France, Germany, Italy, also big producers, did not oppose, a source said. (The biggest overall alcohol burden is in Europe - which is the heaviest alcohol consuming region and has the biggest burden of harm.)

The decision was eventually sponsored by Bangladesh, Bhutan, India, Indonesia, Islamic Republic of Iran, Philippines, the Russian Federation, Sierra Leone, Sri Lanka, Thailand and Viet Nam, Norway and the European Union.

It appeared trade officials had trumped health officials on this matter and this could be attributed to the silence from certain countries in the African Union on this issue, according to people close to the discussions. But this could not be confirmed.

While sponsors of the decision had pushed for legally binding norms to address alcohol-related deaths, the final decision compromised on “an action plan” (2022–2030) to effectively implement the older Global Strategy to Reduce the Harmful Use of Alcohol that was adopted in 2010. They also managed to push for greater allocation of resources to address this effectively. The countries also managed to retain language on linkages to cancer - “sufficient evidence for carcinogenicity of alcohol and a causal contribution of the use of alcohol to the development of several types of cancers in humans”.

The DG has also been asked to develop a technical report on the harmful use of alcohol related to cross-border alcohol marketing, advertising and promotional activities, including those targeting youth and adolescents, that will also inform the development of the action plan.

Although less ambitious than what they hoped for, supporters of the decision called the adoption of the decision as historic. It is expected that addressing alcohol-related deaths will continue to remain on the agenda and might even break out of the larger umbrella on non-communicable diseases and demand its own policy space.

According to a few experts associated with the discussions, member states were “not in a mood to negotiate a binding treaty”, but others believe that it is a matter of time before lessons from the tobacco treaty can be transposed on to a framework to monitor alcohol-related deaths.

WHO is also a curious place. Countries that took progressive positions on access to medicines found themselves fighting stronger policies on fighting alcohol-related deaths, in effect contributing to risks of cancer-related deaths linked to harmful use of alcohol.

All of this emphasises the need for continued checks and balances – which is what civil society groups are most worried about – the shrinking of the space that could affect their ability to engage with WHO and its member states on key issues such as this.

The homogenising of civil society and non-state actors

Concerns were raised about WHO’s efforts to limit the participation of public interest civil society groups in governing body meetings in terms of the number of representatives and the number of statements they can make. More importantly, by lumping non-state actors including civil society and commercial actors into clusters or constituencies without taking into account their diversity, WHO could impinge on meaningful engagement and reduce the efficiency and effectiveness of its interactions with such groups, members from civil society reckon. After all, these groups represent a wide variety of expertise and positions in a range of thematic areas that directly inform the work of WHO.

The organization surely needs to do both – enable deeper engagement with public interest civil society actors and also prevent conflicts of interest and undue influence on WHO by commercial actors – both of whom are in official relations with WHO. At the Board meeting, WHO said it will work on a detailed engagement strategy in the coming year and will implement “the constituency model” in a limited manner.

Questions over WHO transformation remain

While member states were deeply appreciative of WHO’s efforts particularly on emergencies, and other areas of work, they also drew attention to and expressed concern over WHO’s slow pace on its transformation agenda, its hiring of consultants, and in particular, the lack of clarity on the WHO Foundation.

Overall, it seemed multilateralism was doing alright – something donors must recognise. Countries spoke of solidarity and global health security in the same breath.

Highlights of the week

Annual letter Gates foundation: Why we swing for the fences

Do read the annual later in full here: Gates notes

“Twenty years after starting our foundation, we’re just as optimistic about the power of innovation to drive progress.” Bill & Melinda reflect on the first 20 years of their foundation.

Excerpt: “…As always, Warren Buffett—a dear friend and longtime source of great advice—put it a little more colorfully. When he donated the bulk of his fortune to our foundation and joined us as a partner in its work, he urged us to “swing for the fences.” That’s a phrase many Americans will recognize from baseball. When you swing for the fences, you’re putting every ounce of strength into hitting the ball as far as possible. You know that your bat might miss the ball entirely—but that if you succeed in making contact, the rewards can be huge. That’s how we think about our philanthropy, too. The goal isn’t just incremental progress. It’s to put the full force of our efforts and resources behind the big bets that, if successful, will save and improve lives….”

“In this year’s letter, we write about the work we’ve done on health and education and why we think the risks we’ve taken have set us up for future progress. We also write about two issues that have emerged as priorities for us—the climate crisis and gender equality—and how they will factor into our next 20 years….

Vox - The surprising strategy behind the Gates Foundation’s success https://www.vox.com/future-perfect/2020/2/11/21133298/bill-gates-melinda-gates-money- foundation

Must-read analysis of the Gates annual letter. “Bill and Melinda Gates’ philanthropy, explained.”

“… the 2020 annual letter doesn’t just rattle off statistics. It delves into the strategy behind their giving, which is important for understanding everything the Gateses have done to this point. … [swing for the fences] … What the Gateses took that to mean was that they should look for opportunities of high leverage, where a smaller investment can lead to a much bigger payoff. “The goal isn’t just incremental progress,” they write. “It’s to put the full force of our efforts and resources behind the big bets that, if successful, will save and improve lives.”

It’s an approach that has had a consequential impact — and that should serve as a model for other foundations and donors who want to give effectively.”

… But there’s more to dig into here. The Gateses’ 20th anniversary letter is unusually clear in making the point that the couples’ and their foundation’s success is not built on direct provision of services, or using their money to directly fund, say, vaccine distribution. Their success is, instead, built on leverage: specifically, the ability of the Gateses with their smaller but more flexibly deployable pot of money to forge coalitions with large international organizations and governments that can in turn mobilize many more billions of dollars than the Gates Foundation can alone. …” Some cases in point: GAVI & Global Fund.

Third Global NCD Alliance Forum & other NCD news

As a reminder, the third Global NCD Alliance Forum took place this week (9-11 February 2020), in Sharjah, UAE. The aim was to provide a prime opportunity to unite and mobilise NCD civil society to monitor governments’ progress and advocate for action to implement global pledges five years ahead of the next UN HLM and the 2025 date for globally agreed NCD targets.

HPW - Countries Falling Behind In Meeting Noncommunicable Disease Control Targets https://www.healthpolicy-watch.org/countries-falling-behind-in-meeting-noncommunicable- disease-control-targets/

“Governments are falling behind in the battle against a “global epidemic” of noncommunicable diseases (NCDs), say two new reports by the World Health Organization and the NCD Alliance, launched on the first day of a Global NCD Alliance Forum in Sharjah, United Arab Emirates. Many countries are stalled in implementing basic prevention policies, such as reducing tobacco and harmful alcohol consumption; promoting health eating and physical activity; and strengthening early NCD detection and treatment in primary health care systems, according to the WHO NCD Progress Monitor 2020 report, released Monday. Such policies are among the so-called WHO “Best Buys” for NCD prevention. Only 19% of 194 countries surveyed have fully implemented tobacco taxes; just 20% are meeting targets for salt-reduction, and one-third of countries are providing basic NCD health services such as drug therapy and counseling. And less than half of the 194 countries surveyed met at least two of the ten targets that would reflect progress against NCDs – a “grim sign” as the report calls it….”

“Data from the second report, the NCD Alliance’s Bridging the Gap backs up this stark reality. The report, based on surveys of national and regional NCD alliances, found that only 20 percent of members believed that their country is on track to meet global NCD targets. Some 82% of members did not believe their country had sufficient accountability mechanisms to ensure NCD targets were being met. … … The Bridging the Gap report points to gaps in five major areas that are impeding progress – political leadership, investment, care, community engagement, and accountability….”

See also the joint press release WHO/NCD Alliance - A tsunami of noncommunicable diseases can be avoided if action taken now, reports say

Plos Med - An evaluation of Chile’s Law of Food Labeling and Advertising on sugar- sweetened beverage purchases from 2015 to 2017: A before-and-after study https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003015

“Lindsey Smith Taillie et al. describe the changes in purchases of sugary beverages after implementation of Chile's law on food labeling and advertising, implemented to combat childhood obesity.”

Great coverage (by Sarah Boseley) in the Guardian - Chile's drastic anti-obesity measures cut sugary drink sales by 23%

“The world’s toughest controls over the promotion of sugary drinks, brought in by a nation beset by obesity, have cut purchases by nearly a quarter in two years, research has shown. Instead of a sugar tax, which the UK and other countries have chosen to impose, Chile has banned sales in schools and adopted stark black and white labels aimed at warning and educating families about the health dangers of junk food and drinks for their children….”

146th WHO Executive Board meeting (continued)

As we covered most of the agenda last week already, one more link perhaps (see also Priti Patnaik’s Editorial):

HPW - WHO Needs To Accelerate New Polio Vaccine Rollout & Action On Harmful Alcohol Consumption, Says Executive Board https://www.healthpolicy-watch.org/eb-says-who-should-accelerate-action-to-reduce-harmful- alcohol-consumption-deadlocked-on-breast-milk-substitutes-report/

“After a total of 12.5 hours of consultations in five informal meetings, a bloc of countries led by Thailand won WHO Executive Board approval for a landmark decision to develop a new ten year- action plan to reduce the harmful use of alcohol. Representatives of Norway and the European Union joined as co-sponsors in a compromise decision, which nonetheless saw an earlier reference to the possible development of an international legal instrument removed. Civil society actors who had lobbied hard for the new action plan, described it as a “historic moment” but lamented that the

“overarching need” for more binding international measures to limit alcohol marketing and advertising, particularly to youths, had not been answered. However, the compromise text asked WHO to prepare a technical report on the harmful use of alcohol related to cross-border advertising, including marketing targeted towards youth. The compromise also greatly softened a reference to WHO’s own internal policies, which generally tolerate alcohol consumption in office cafeterias and official events, including at the Geneva Headquarters….”

Coronavirus / “SARS-CoV-2”

Again plenty of news, analysis and great reads – from an abundance of angles – this week, on the now relabelled virus, SARS-CoV-2.

We will start with a section with some of the latest updates, and then – for the ones who want to go deeper – other sections (Some of the broader implications; Science, Analysis, other news snippets…).

PS: Dr. Tedros & team give daily press briefings and are in general doing a great job, certainly also in terms of transparency & sharing of info. One of his key messages : Coronavirus should be seen as 'public enemy number one', says WHO Other key messages from Tedros were on the need for global solidary, and he also warned against 'trolls and conspiracy theories'.

The sections below will be “in steno” – as you can imagine.

Latest updates With a focus on the last two days, via Cidrap News, HPW, Stat, Nature, …

• HPW - Sharp Overnight Increase In Chinese COVID-19 Cases; Heightened Concerns About Pandemic

“After two days of more hopeful signs that new cases of the novel coronavirus in China might be stabilizing, a sharp increase of 14,840 new COVID-19 infections was reported early Thursday morning by the Province of Hubei, more than 10 times the previous day. The upsurge in cases was in part due to an expansion of diagnostic criteria, said Hubei officials in a statement….” (PS: on Friday, the death count was revised downwards – due to ‘double counting’)

PS: earlier this week, FT had reported China accused of under-reporting coronavirus outbreak “Health experts say official testing system captures only a fraction of cases.”

Some see the hand of Bruce Aylward already in these updated numbers (see below).

In this piece also some info on the worrying situation in Singapore, a new (large scale) study with higher case fatality rate and some detail on the just concluded WHO Research and Innovation Forum. (see also below for the latter )

Earlier this week, a UN crisis team was formed (headed by Mike Ryan). “ Ryan said the team will help the WHO focus on its health mission, while other UN groups add their expertise on the wider social and economic implications of the outbreak….”

Meanwhile, hundreds of health workers seem to be infected in Wuhan; an international WHO team (led by Bruce Aylward) is now on the ground in China (Beijing) – but featuring no CDC people … (see also HPW on the foreseen role of this team).

For an update on this team, see Reuters - Experts fear China reluctant to accept WHO ground mission (13 Feb) “China is dragging its heels in accepting help on the ground from international health specialists, diplomats and experts said on Thursday, noting four days after a World Health Organization (WHO) advance team arrived in Beijing no details have been released on how and when the full mission will deploy….”

Meanwhile, in China, the political fallout continues – (Guardian) China purges regional leaders hours after spike in deaths and new cases

See also the Economist - Send for the hard men: China makes big changes in Hubei, both political and virus-related. Looks like Xi is sending in the Public Security guys now…

• UN News – Outside China, Coronavirus transmission ‘iceberg’ may not be as big as feared (13 Feb) “As infections from COVID-19 coronavirus continue to rise, a senior UN health expert on Thursday said that there were some indications that disease transmission outside China might not be the tip of the “iceberg” that had been feared. “We’re not seeing a dramatic increase in transmission outside China,” Dr. Michael Ryan, the World Health Organization’s (WHO) Health Emergencies Programme chief, said, while urging against making hasty assessments….”

• Nature - Scientists fear coronavirus spread in countries least able to contain it

Must read. “Concerns are rising about the virus’s potential to circulate undetected in Africa and Asia.”

For related reads (on (urgent) ramping up the situation in LMICs, and the role of WHO and others in this), see Reuters - Countries rush to build diagnostic capacity as coronavirus spreads

“A week ago, only two laboratories in Africa could diagnose the novel coronavirus that originated in China and is rapidly spreading around the world. As of Sunday, the World Health Organization (WHO) expected every nation in Africa to be able to diagnose the disease. The rush reflects a global push for diagnostic capabilities, particularly in developing countries, in hopes of averting a global

pandemic. But it is being slowed by a desperate need for virus samples necessary to validate the tests….”

See also the Guardian - African countries braced for 'inevitable' arrival of coronavirus

“Health centres step up preparations as World Health Organization raises fears about ability to cope with major outbreak.”

See also a Lancet World Report - Africa prepares for coronavirus

“With cases of novel coronavirus spreading worldwide, governments and institutions are getting ready for the first cases in Africa. Munyaradzi Makoni reports from Cape Town.”

Among others: “The Africa Centres for Disease Control and Prevention (Africa CDC) established the Africa Task Force for Novel Coronavirus on Feb 3. It is working with WHO on surveillance, including screening at points of entry, infection prevention and control in health-care facilities, clinical management of people with severe 2019-nCoV infection, laboratory diagnosis, and risk communication and community engagement…. … As of Feb 10, WHO said that 11 countries were capable of testing for 2019-nCoV, and reagents should be delivered to other countries this week. … … Africa's preparedness efforts have been boosted with $25 million from the Bill & Melinda Gates Foundation, with some of it going towards training. 15 experts from the African Union received training on laboratory diagnosis for 2019-nCoV in Dakar, Senegal, on Feb 6–8. …”

PS: For a related paper from end of last week, see Preparedness and vulnerability of African countries against introductions of 2019-nCoV.

Others look more optimistically at the threat – (Quartz) The lessons of West Africa’s Ebola’s crisis will save the continent from the worst of coronavirus

“…The aftermath of Ebola now means West African countries including Senegal, Liberia, Sierra Leone, Cote d’Ivoire and Nigeria currently rank as better prepared for COVID-19 than richer countries with more sophisticated health systems, says Gyude Moore, fellow at Center for Global Development in Washington D.C and former minister for public works in Liberia….”

• WHO - World experts and funders set priorities for COVID-19 research

WHO press release after the two-day R&D meeting in Geneva: “Leading health experts from around the world have been meeting at the World Health Organization’s Geneva headquarters to assess the current level of knowledge about the new COVID-19 disease, identify gaps and work together to accelerate and fund priority research needed to help stop this outbreak and prepare for any future outbreaks. The 2-day forum was convened in line with the WHO R&D Blueprint – a strategy for developing drugs and vaccines before epidemics, and accelerating research and development while they are occurring. … … The meeting, hosted in collaboration with GloPID-R (the Global Research Collaboration for Infectious Disease Preparedness) brought together major research funders and over 300 scientists and researchers from a large variety of disciplines. They discussed all aspects of the outbreak and ways to control it including: the natural history of the virus, its transmission and diagnosis; animal and environmental research on the origin of the virus, including management measures at the human-animal interface; epidemiological studies; clinical

characterization and management of disease caused by the virus; infection prevention and control, including best ways to protect health care workers; research and development for candidate therapeutics and vaccines; ethical considerations for research; and integration of social sciences into the outbreak response….”

See also UN News - UN health agency developing COVID-19 virus treatment master plan

“The World Health Organization (WHO) is developing a master plan for coordinating clinical trials that could lead to potential therapies for patients infected with the COVID-19 virus, the agency’s chief, Tedros Adhanom Ghebreyesus, announced on Wednesday.”

And Cidrap News - Easy COVID-19 test tops research priorities as cases climb

Also a great summary of the 2-day meeting in Geneva. “A global research meeting wrapped up today to set priorities to answer key questions about COVID-19 and tackle the outbreak, with a simpler diagnostic test and treatment protocols at the top of the list….”

• Stat - Disease caused by the novel coronavirus officially has a name: Covid-19 With everything you want to know about the new name of the virus ( SARS-CoV-2) and disease (Covid-19)

For an update (including on the sensitivity in China around the name SARS-CoV-2), see Science News - A bit chaotic.’ Christening of new coronavirus and its disease name create confusion.

• Lancet Comment – COVID-19: what is next for public health? (Feb 13) (by David Heymann et al, on behalf of the WHO Scientific and Technical Advisory Group for Infectious Hazards)

“The WHO Scientific and Technical Advisory Group for Infectious Hazards (STAG-IH), working with the WHO secretariat, reviewed available information about the outbreaks of 2019 novel coronavirus disease (COVID-19) on Feb 7, 2020, in Geneva, Switzerland, and concluded that the continuing strategy of containment for elimination should continue, and that the coming 2–3 weeks through to the end of February, 2020, will be crucial to monitor the situation of community transmission to update WHO public health recommendations if required….”

• Science (News) - Labs scramble to spot hidden coronavirus infections

“The seeming precision of the global tallies of cases and deaths caused by the novel coronavirus now spreading from Wuhan, China belies an alarming fact. The world is in the dark about the epidemic’s real scale and speed, because existing tests have limited powers—and testing is far too spotty. “We are underestimating how common this infection is,” cautions Jeremy Farrar, head of the Wellcome Trust….”

Some of the broader implications

• HPW - WHO Protests Price Shocks & Hoarding Of Vital Protective Gear Needed To Fight Coronavirus

From late last week. “The world is facing a “severe disruption” in stocks of personal protective equipment vital for health workers to fight the novel coronavirus raging through China’s Hubei Province and threatening other countries worldwide, said WHO Director-General Dr Tedros Adhanom Ghebreyesus at a Friday press briefing.”

See also Stat (Feb 7) - Coronavirus concerns trigger global run on supplies for health workers, causing shortages

• FT Health - Drugmakers braced for coronavirus disruption to China supplies

“CEO of India’s Cipla warns of Chinese lockdown cutting off access to essential ingredients.”

• Guardian Briefing - Will the coronavirus outbreak derail the global economy?

Yes. The question, is how long, and how drastic. Hard to say, at this stage.

Science (vaccines, (modelling) projections, …)

This is not really IHP’s niche, but a few links anyhow on developments in this respect.

The Conversation - Coronavirus outbreak: a new mapping tool that lets you scroll through timeline

This new outbreak mapping tool is developed by the London school of Hygiene and Tropical Health.

Guardian - Tedros Adhanom Ghebreyesus says vaccine for COVID-19 virus could be 18 months away

Tom Frieden on the JAMA study - New study an eye-opener on how coronavirus is spreading and how little we know (CNN) Game changer, in his opinion. Health workers are at high risk.

Guardian - Coronavirus 'could infect 60% of global population if unchecked'

Let’s just say this is a ‘modeller’ : )

Telegraph - Death rate for patients hospitalised with coronavirus in Wuhan nearly 20 per cent, study shows

“But the true mortality rate could be as low as one per cent if all mild and asymptomatic cases are taken into account, researchers say.”

FT Health - Data experts battle to map path of coronavirus outbreak (14 Feb) “Researchers have to rely on statistics from China that have been called into doubt”.

Nature - Did pangolins spread the China coronavirus to people?

Stat News - Hospitals, governments need more data to prepare for the new coronavirus outbreak (by Caitlin Rivers et al)

“…we see three other urgent priorities: understanding health care worker infections, understanding the circumstances around deaths from these coronavirus infections, and the surveillance strategy for 2019-nCoV across China.”

NYT - The urgent questions scientists are asking about Coronavirus

Was an interesting read, published just ahead of the 2-day R&D meeting in Geneva.

HPW - Over 30 Antiviral Drugs Being Tested Against Novel Coronavirus – As WHO Convenes Global Innovation Forum

Interview with Thomas Cueni.

Guardian - China trials anti-HIV drug on coronavirus patients

Cidrap - Unmasked: Experts explain necessary respiratory protection for COVID-19 (13 Feb) Looks more and more like surgical masks don’t really do the job…

Analyses

Stat - Understanding pandemics: What they mean, don’t mean, and what comes next with the coronavirus https://www.statnews.com/2020/02/12/understanding-pandemics-what-they-mean-coronavirus/

Absolutely brilliant briefing by Helen Branswell on ‘pandemics’.

Science - Mission impossible? WHO director fights to prevent a pandemic without offending China https://www.sciencemag.org/news/2020/02/mission-impossible-who-director-fights-prevent- pandemic-without-offending-china

One of the “big picture” reads of the week. On the difficult path Tedros has to tread in this outbreak.

For a related read, see also Vox - China hid the severity of its coronavirus outbreak and muzzled whistleblowers — because it can On the tricky business of disease diplomacy.

Ellen ‘t Hoen - Coronavirus: The Latest Problem Big Pharma Won’t Solve https://www.barrons.com/articles/coronavirus-the-latest-problem-big-pharma-wont-solve- 51581078600

Hardhitting & thus a must-read.

See also Stat - Major drug makers haven’t stepped up to manufacture NIH coronavirus vaccine, top U.S. health official says.

“No major pharmaceutical company has come forward to say it would manufacture a vaccine for the novel coronavirus currently being developed by the National Institutes of Health, a top U.S. official acknowledged Tuesday, a reality that he called “very difficult and very frustrating.” The comments by Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, highlight how challenging it could be to translate the NIH’s work, being undertaken in partnership with the biotech company Moderna Therapeutics, into a vaccine that could be marketed….”

Vox - The coronavirus cruise ship quarantine is a scary public health experiment https://www.vox.com/2020/2/11/21132732/coronavirus-cruise-ship-quarantine-japan

That’s the least you can say. By Julia Belluz.

Lancet (Comment) - Do not violate the International Health Regulations during the COVID-19 outbreak https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30373-1/fulltext

New Comment by 16 global health law scholars.

“… In imposing travel restrictions against China during the current outbreak of 2019 novel coronavirus disease (COVID-19), many countries are violating the IHR. We—16 global health law scholars—came to this conclusion after applying the interpretive framework of the Vienna

Convention on the Law of Treaties3 and reaching a jurisprudential consensus on the legal meaning of IHR Article 43 (panel)….”

Time – Peter Piot quoted on the need to reform the IHR https://time.com/5778998/ebola-coronavirus- lessons/?utm_source=twitter.com&utm_medium=social&utm_campaign=social-share-article

Piot: “…The International Health Regulations’ all-or-nothing approach must reform. In most emergencies, there is a spectrum of alerts–think of hurricanes with levels of severity from Category 1 to Category 5–and it should not be a binary decision for health….”

Amanda Glassman (in the Hill) - Stop coronavirus and the next epidemic by establishing a health security fund now Stop coronavirus and the next epidemic by establishing a health security fund now

She links such a fund with the G7. “Before or during the 2020 G-7 meeting, leaders should launch a Global Health Security Challenge Fund that will incentivize countries to make capital investments to close their preparedness gaps.”

But see this tweet: ”In already fragmented donor flows context, why another “vertical“ fund? A Health Security Challenge Fund? This on top of a "vertical" fund for NCDs recommended in report by WHO launched yesterday? Fragmentation leads to distorted country health budgets!”

FT - Coronavirus crisis challenges basis of China’s social contract https://www.ft.com/content/ba1c1538-49a6-11ea-aeb3-955839e06441

(gated) One of the many analyses on how the coronavirus presents a huge challenge for Xi Jinping and the Chinese governance model in general.

FT - US warns over Chinese ‘spying’ on African disease control centre FT

From late last week – it’s clear that the US-China relation in this outbreak faces many potential hurdles. “The Trump administration has cited concerns over Beijing's scientific spying program as the reason it wants to block a Chinese plan to build an $80m headquarters for the Africa Centers for Disease Control and Prevention in Ethiopia, amid growing competition for influence in the continent….”

See also Xinhua - China refutes U.S. official's claims of China "stealing Africa's genomic data"

Devex - What NGOs need to do if the coronavirus reaches Africa https://www.devex.com/news/what-ngos-need-to-do-if-the-coronavirus-reaches-africa-96562

“The new coronavirus could wreak havoc on weak health systems in Africa. If the virus reaches Africa, NGOs have a key role to play, experts from WHO and Catholic Relief Services tell Devex.”

Some other analysis:

• Nature Editorial - As coronavirus spreads, the time to think about the next epidemic is now

“World leaders and international donors must strengthen the most vulnerable nations’ health-care systems.”

• Tom Bollyky in the Atlantic - Coronavirus Is Spreading Because Humans Are Healthier

“Medical advances have dramatically extended life spans worldwide, but investment in basic health care has not kept up.”

Not everybody is convinced about the link Bollyky sees, but an interesting read.

• New Scientist - Could the new coronavirus really kill 50 million people worldwide?

Not for the (rather unlikely) figure, but for this quote:

““The worry is not just those infected by the coronavirus itself, but all the services that will no longer run,” says Devi Sridhar at the University of Edinburgh, UK. “You will see all kinds of knock-on effects.”… These will be most serious in poor countries whose health systems are already struggling. For instance, children began dying from measles when vaccination stopped during recent Ebola outbreaks in Africa. “UNICEF calls these the uncounted dead,” says Sridhar….”

• Telegraph - Coronavirus: super spreaders could disrupt efforts to contain outbreak, say experts

Of course, PH people aren’t happy with the term ‘super spreaders’.

• NYT - In Coronavirus, China weighs benefits of buffalo horn and other remedies

“China is advising doctors to consider mixing Western antiviral drugs with traditional Chinese medicine for the treatment of the coronavirus. But experts question the efficacy of Chinese remedies.”

• CGD brief (by J Konyndyk) - Expert Recommendations for US and Global Preparedness for COVID-19

“The novel coronavirus outbreak that emerged in late 2019 has infected tens of thousands in China, community transmission is feared in other countries, and containment looks increasingly unlikely.”

“…There is an urgent but closing window to prepare for large-scale spread of the disease in the US and elsewhere. This paper recommends actions to address pressing gaps in US and global preparedness in the event that COVID-19 cannot be contained and sustained human-to-human transmission occurs beyond China….”

Other news snippets & links

• Stat News - Fluctuating funding and flagging interest hurt coronavirus research, leaving crucial knowledge gaps

Only recently, coronavirus research has gotten again a bit in vogue.

• WHO online training - Online training as a weapon to fight the new coronavirus

“The learning team of the WHO Health Emergencies Programme worked with technical experts to quickly develop and publish the online course on 26 January – 4 days before the 2019-nCoV outbreak was declared a public health emergency of international concern….”

• Telegraph - Chinese app reveals if citizens have been in contact with the coronavirus

“The app will notify users if they have been near someone carrying the deadly virus”. More than a bit ‘Big Brother’ scary, if you ask me.

• IHP - Assurances, People and Plans: Nigeria Braces for Novel Corona Virus Impact (take on situation in Nigeria, by Nsisong Asanga)

• Economist - Curbing the Asian contagion Focus here on China’s Asian neigbours. Singapore is seen as a ‘role model’.

Ebola DRC

HPW - Ebola Outbreak Remains An International Public Health Emergency, Says WHO Committee https://www.healthpolicy-watch.org/ebola-outbreak-still-an-international-public-health-emergency- says-who-committee/

“The Director General of the World Health Organization today decided that the smoldering Ebola outbreak in the Democratic Republic of the Congo should remain a “public health emergency of international concern,” following recommendations from a committee of experts convened under the International Health Regulations. The last embers of the 1.5 year long outbreak appeared to be dying out, with only 3 cases reported in the past week, and no cases in the past 3 days. The outbreak has been contained to only two health districts. “As long as there is a single case of Ebola in an area as insecure and unstable as eastern DRC, the potential remains for a much larger epidemic,” said Dr Tedros Adhanom Ghebreyesus, director general of the WHO at a press briefing Wednesday. With the WHO and worldwide media attention occupied by the coronavirus outbreak, “we must not forget Ebola,” added the Director General.

…WHO has determined that the risk of national and regional spread is still “high.”…”

“…Nonetheless, the Director general said, the “signs are extremely positive” in the Ebola outbreak. It seems likely that all districts affected by the outbreak will reach the 42-day Ebola-free threshold needed to declare the outbreak over by the next time the Emergency Committee reconvenes…”

See also AP - WHO chief ‘very encouraged’ by dip in Congo Ebola cases

Or a tweet from Helen Branswell (Stat): “In the 3 weeks from Jan 20 to Feb 9 there were only 13 #Ebola cases diagnosed in DRC.”

Lancet Correspondence - Ebola virus disease and breastfeeding https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32967-8/fulltext

“We commend Mija Ververs and Akanksha Arya for highlighting an urgent need for evidence-based breastfeeding guidance in the context of Ebola virus disease. In response to the ongoing Ebola outbreak, WHO assembled an expert panel to create recommendations and implementation guidance on breastfeeding, as informed by a systematic review of evidence. On Feb 10, 2020, WHO published recommendations for the management of pregnant and breastfeeding women in the context of Ebola virus disease….”

See also a Lancet Editorial - Appropriate care for pregnant women in Ebola outbreaks

“On Feb 10, new WHO guidelines were released for the management of pregnant and breastfeeding women in the context of Ebola virus disease, outlining appropriate steps for clinicians to take in DR Congo. The country has had 3428 confirmed cases of Ebola over the past 18

months, the second worst outbreak after the 2014–16 west Africa outbreak of around 28 000 cases. Pregnant women require special guidelines in Ebola-stricken areas for several reasons….”

AMR

O’Neill Institute (blog) – Behind the headlines: 10 million deaths from antimicrobial resistance by 2050 (or not?)

E Friedman; https://oneill.law.georgetown.edu/behind-the-headlines-10-million-antimicrobial- deaths-by-2050-or-not/

Interesting short blog from Eric Friedman. He goes to the origin of the often mentioned figure of 10 million deaths per year by 2050, and draws some conclusions (+ recommendations). Among others, several lessons on how health (and other) information is/should be presented.

Lancet Infectious Diseases (Review) - The Lancet Infectious Diseases Commission on antimicrobial resistance: 6 years later R Laxminarayan et al ; https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30003- 7/fulltext

“In 2013, a Lancet Infectious Diseases Commission described the state of antimicrobial resistance worldwide. Since then, greater awareness of the public health ramifications of antimicrobial resistance has led to national actions and global initiatives, including a resolution at the high-level meeting of the UN General Assembly in 2016. Progress in addressing this issue has ranged from a ban on irrational drug combinations in India to commitments to ban colistin as a growth promoter in animals, improve hospital infection control, and implement better antimicrobial stewardship. Funds have been mobilised, and regulatory barriers to new antibiotic development have been relaxed. These efforts have been episodic and uneven across countries, however. Sustained funding for antimicrobial resistance and globally harmonised targets to monitor progress are still urgently needed. Except for in a few leading countries, antimicrobial resistance has not captured the sustained focus of national leaders and country-level actors, including care providers.”

Road Safety

WHO - Ministers to agree new global road safety agenda to 2030 https://www.who.int/news-room/detail/07-02-2020-ministers-to-agree-new-global-road-safety- agenda-to-2030

Looking ahead to the meeting in Stockholm next week. “Government ministers and senior officials from over 100 countries will meet in Stockholm, Sweden from 19-20 February to discuss new steps to halve road traffic deaths and injuries by 2030, in line with global targets agreed in the United Nations Sustainable Development Goals (SDGs)….”

“…Hosted by the Government of Sweden in collaboration with WHO, the 3rd Global Ministerial Conference on Road Safety offers delegates an opportunity to share successes and lessons learned, chart future strategic directions for global road safety, and define ways to fast-track progress around proven strategies to save lives. The Stockholm Declaration will be presented as the final outcome document of the Ministerial Conference calling for strong political will and international cooperation as well as partnerships across many sectors of society. The Declaration will lay out key recommendations for accelerated action to drive progress towards halving global road traffic deaths and injuries by 2030….”

Lancet Comment – Another summit on global road safety? Key questions to ask ministers A Hyder; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30159-8/fulltext

“The 3rd Global Ministerial Conference on Road Safety will be held in Stockholm, Sweden, on Feb 19–20, 2020, as the Decade of Action 2011–20 for global road safety comes to an end. Such summits are important for global road safety in many ways. First, they can bring political attention to road traffic injuries. Second, they can provide a stimulus for countries to assess their own situations and take action. Finally, they present an opportunity for the global community to track progress of road safety efforts over time. Yet is this what global road safety needs at this juncture? Is global road safety succumbing to big declarations without action? It is time for some healthy introspection….”

“…as the world meets for another global summit and prepares another declaration, there are seven questions to ask ministers of health and transport to assess their previous actions and judge future plans….”

“…The 3rd Global Ministerial Conference on Road Safety could serve as an important milestone for monitoring progress related to global road safety across member states of WHO, and could provide a global forum for charting the direction of future partnerships and programmes. However, this will only happen if ministers are asked tough questions and there are frank and difficult conversations. Global road safety is a key component of the Sustainable Development Goals. Yet it will remain a declaration unless there is real support for implementing effective interventions in all countries. A forthcoming Series on road traffic injuries in The Lancet later this year will further assess the state of global road safety. It is time to express disappointment, demonstrate activism, hold decision makers accountable, refuse inequity of outcomes, and insist on science-based politics of road safety.”

Air pollution

Plos Med - Improving air quality needs to be a policy priority for governments globally https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003041

“In this Perspective, Aziz Sheikh discusses the importance of research to understand the impact of air pollution on human health, commenting on a study by Yaohua Tian and colleagues that examined

associations between ambient air quality and risk of hospitalization for pneumonia in adults in China.”

Guardian - Fossil fuel pollution behind 4m premature deaths a year – study https://www.theguardian.com/environment/2020/feb/12/fossil-fuel-pollution-behind-4m- premature-deaths-a-year-study

“Air pollution from burning fossil fuels is responsible for more than 4m premature deaths around the world each year and costs the global economy about $8bn a day, according to a study. The report, from Greenpeace Southeast Asia and the Centre for Research on Energy and Clean Air, found that burning gas, coal and oil causes three times the number of deaths as road traffic accidents globally. Children, especially those living in low-income countries, are particularly affected with an estimated 40,000 dying each year before they reach their fifth birthday because of exposure to particulate pollution from fossil fuels….”

Planetary Health

FT - Flat carbon output in 2019 raises hope that emissions have peaked https://www.ft.com/content/b42bba4c-4c13-11ea-95a0-43d18ec715f5

A glimmer of hope. But no more than that. See also CNBC - Energy-related CO2 emissions ‘flatlined’ last year, IEA says, raising hopes about climate “Energy-related carbon dioxide emissions “flatlined” last year, the International Energy Agency said Tuesday in a report that raised hopes about the Earth’s climate. Global emissions remained at approximately 33 gigatonnes in 2019 despite the world economy growing by 2.9%, the IEA said. The agency cited several factors, including a drop in emissions from electricity production in advanced economies due to the “expanding role” of renewables like wind and solar….”

Climate Change News - World misses symbolic February deadline to ratchet up climate action before Cop26 Climate change news;

“The 2015 Paris Agreement seeks to raise global ambition every five years. But only three nations have issued upgraded climate plans nine months before Cop26 in Glasgow.”

Guardian - UK to lead global fight against illegal logging and deforestation https://www.theguardian.com/environment/2020/feb/13/uk-lead-global-fight-illegal-logging- deforestation-cop-26

“The UK is to spearhead a major global crackdown on illegal timber and deforestation, with plans to form a coalition of developing countries against the trade as part of its hosting of crunch UN climate talks this year….” “Deforestation is a leading factor in rising global greenhouse gas

emissions, but many developing nations lack the means and institutions to combat illegal logging and regulate forest industries. The Department for International Development (DfID) will shortly lay out plans to help countries strengthen the rule of law, support the trade in responsible forestry and provide on-the-ground assistance to stamp out illegal logging….”

HHR - How Can We Overcome the Great Procrastination to Respond to the Climate Emergency? R Hammonds; https://www.hhrjournal.org/2020/02/how-can-we-overcome-the-great- procrastination-to-respond-to-the-climate-emergency/

Recommended read – by Rachel Hammonds. Among others, she discusses the seven Climate Justice Principles developed by the Mary Robinson Foundation which offer a rights-based path to engaging with climate change debate and decision making.

Congenital heart disease awareness week (Feb 7-14) https://nationaldaycalendar.com/congenital-heart-defect-awareness-week-february-7-14/

Congenital heart disease is an underrecognized NCD of childhood – this week tries to raise more awareness globally.

Lancet Child & Adolescent Health- Global, regional, and national burden of congenital heart disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017 GBD 2017 Congenital Heart Disease Collaborators; https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(19)30402-X/fulltext#section- 3d6acba1-acea-4be2-8dc9-b7e14e5b6583

“Previous congenital heart disease estimates came from few data sources, were geographically narrow, and did not evaluate congenital heart disease throughout the life course. Completed as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017, this study aimed to provide comprehensive estimates of congenital heart disease mortality, prevalence, and disability by age for 195 countries and territories from 1990 to 2017.”

Some of the key findings: CHD has climbed to be number 2 and 4 cause of infant mortality in high- middle and middle SDI (socio-demographic index) countries and to number 8 and 7 cause of infant mortality in low and low-middle SDI countries.

And a few figures: • CHD caused globally 261,247 deaths in 2017 (34.5% decline from 1990) ; • 180,624 were infants; over 85% of deaths were in low-income countries; • 11,998,283 people lived with CHD globally in 2017 (18.7% increase from 1990), causing 589,479 years lived with disability

Do check out also the related Comment - Congenital heart disease: a global public health concern

SRHR

UN News - $683 million appeal to deliver reproductive health services, where they’re most needed https://news.un.org/en/story/2020/02/1057191

“With more than half of all maternal deaths occurring in countries affected by humanitarian crises and fragility, the UN Population Fund (UNFPA) is calling for greater international support to provide life-saving reproductive health and protection services in these locations. The sexual and reproductive health agency has launched a $683 million appeal this year to assist nearly 48 million women, girls and young people in 57 countries affected by conflict or natural disasters….”

Xinhua – UN pledges support for reproductive health agenda in Africa Xinhua;

“The United Nations will support African governments to expand access to quality and affordable reproductive health services for disadvantaged groups like women and girls living in urban slums, officials said on Wednesday. Dereje Wordofa, deputy executive director of the United Nations Population Fund (UNFPA), said in a speech read on his behalf by Hala Youssef, a UNFPA policy expert, that promoting access to reproductive health services like contraceptives is key to tackling poverty and inequality in Africa…

… Kenya is hosting a week-long pan-African conference on advancing the sexual and reproductive health and rights of women and girls in urban informal settlements. More than 500 delegates, including lawmakers, policymakers, researchers and campaigners, attending the Feb. 10-14 conference will share knowledge and best practices aimed at revitalizing the reproductive health agenda in the continent. Topics slated for discussion at the conference include the unmet need for modern family planning methods, unsafe abortions, sexual violence and unintended pregnancies that are rampant in Africa's urban slums.”

Child mortality

Study: In some African countries, more than half of women have lost a child University of Chicago;

“Sociologists introduce new way to measure cumulative impact of child loss on mothers.”

“University of Chicago and University of Southern California sociologists have proposed a way to estimate how the death of a child impacts mothers in sub-Saharan Africa. Their new study found that, in some countries, more than half of women have lost a child. In contrast to traditional measures of infant and child mortality, the study captures the cumulative impact of child loss through a mother’s lifetime. … … Published in the Proceedings of the National Academy of Sciences, the first-of-its-kind study uses two decades of data from 20 countries in sub-Saharan Africa. The researchers found that more than half of 45- to 49-year-old mothers have experienced the death of a child under age five. Nearly two-thirds have experienced the death of any child, irrespective of age. “In the shadows of very high child mortality rates that the global health community typically focuses on, are all these grieving parents that never receive any attention,” said lead author Emily Smith-Greenaway, assistant professor of sociology at the USC Dornsife College of Letters, Arts and Sciences. “These results increase our recognition of bereavement as itself a public health threat—one that’s unfairly concentrated in low-income regions of the world.”

African Union summit (Addis, 9-10 Feb)

AU Summit: Guterres calls for ‘collective, comprehensive, coordinated’ response to challenges facing Africa https://news.un.org/en/story/2020/02/1057011

“The challenges facing African nations are “complex, multi-faceted and far-reaching" but a “collective, comprehensive and coordinated” response by the global community will build on the momentum that already exists to help the continent thrive, the UN chief told the African Union Summit on Sunday.”

AU - First Continental Report on the Implementation of Agenda 2063

As a reminder: “The January 2013 African Union Summit adopted Agenda 2063 – “The Africa We Want” – as Africa’s blueprint and master plan for sustainable development and economic growth of the continent. … …. against this background the African Union Commission (AUC) and the African Union Development Agency-NEPAD (AUDA-NEPAD) were tasked with coordinating continental- level progress reports towards achieving Agenda 2063’s First Ten-Year Implementation Plan. This report is a consolidation and evidence-based assessment of country and regional-level progress reports on Agenda 2063, complemented with interventions and results achieved at the regional and continental level.”

New Times - Africa to create health financing hubs

“In a bid to increase spending on healthcare in Africa, the African Union (AU) is expected to establish health financing hubs across the continent. This was revealed on Monday, February 10 on the sidelines of the 33rd African Union Summit in Addis Ababa, Ethiopia. In a speech that was read by Rwanda’s Foreign Affairs Minister, Vincent Biruta, on behalf of President Paul Kagame, the Minister said it was critical to support member countries to achieve universal health coverage. “Therefore, it is very important that regional health financing hubs are in the process of being established to

support Member States,” the speech read in part. According to the speech, a ‘Partnership Forum with Regional Economic Communities’ was convened in November 2019 to discuss the hosting of the regional hubs….”

New Times - Reproductive health: First Lady pushes for policy shift in Africa

“ First Lady (i.e. from Rwanda) Jeannette Kagame has said that policy reforms, youth engagement and partnerships are key to enhancing adolescents’ sexual and reproductive health in Africa….”

Trump budget request 2021 & global health

Devex - New year, similar budget request aims to slash aid budget https://www.devex.com/news/new-year-similar-budget-request-aims-to-slash-aid-budget-96547

Here we go again… “The Trump administration released its fiscal year 2021 budget request Monday, which once again called for significant cuts to foreign aid, cuts that development experts said are likely to be dismissed by Congress as they have been in the past several years. The proposal calls for $44.1 billion in foreign aid spending in FY2021, a reduction of more than 20% from the $55.7 billion approved for FY2020. Included in the budget request are several proposals to consolidate different spending accounts and significant cuts to both global health and humanitarian assistance….”

See also Foreign Policy - Trump Seeks to Halve U.S. Funding for World Health Organization as Coronavirus Rages “The president’s new budget would cut more than $3 billion in global health programs.”

The dickhead.

For more detailed analysis (and breakdown of funding requests for various US global health programs), see KFF - White House Releases FY21 Budget Request

PS: one of the few positive exceptions: GAVI - United States endorses Gavi with recommendation of US$ 1.16 billion, four-year commitment Exceeding the previous pledge in 2015.

Some papers and reports of the week

Lancet Comment – Learning health systems: an empowering agenda for low- income and middle-income countries

Kabir Sheikh et al ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)33134- 4/fulltext

“Institutions in high-income countries (HICs) are the main funders and generators of academic knowledge on health systems in low-income and middle-income countries (LMICs), and much too often this knowledge reflects their priorities rather than the needs of health systems in LMICs. This power imbalance between HICs and LMICs has been the focus of calls for reforms to global and HIC institutions. However, change must also come from within LMICs. To address this power imbalance, learning must be prioritised as a core part of strengthening health systems in LMICs….”

Read what this entails.

BMJ Global Health (Editorial) – Making sense of estimates of health aid from China K K McDade et al ; https://gh.bmj.com/content/5/2/e002261

Their conclusion: “China has become a major player in the global development financing landscape. But due to limited data transparency, there are significant differences in the methodological approaches used to generate existing estimates of health aid from China. And so, it is important to exercise caution when comparing and reporting these estimates. Coherent approaches to estimating Chinese aid for health could improve alignment between China and other donors and allow for more efficient resource allocation by both fellow donors and recipient countries. Further, enhanced data transparency could also help mitigate some of the reputational risks that China has incurred recently. However, despite differences and room for growth, the existing estimates paint a consistent picture: China’s role in global health is no longer ‘emerging’. It has arrived. »

WHO Strategic Meeting on Social Determinants of Health (final summary) https://www.who.int/social_determinants/strategic-meeting/Meeting_summaryv3.pdf?ua=1

“This report summarises discussions from the WHO Strategic Meeting on Social Determinants of Health (SDH) that took place in Geneva on 12-13 September 2019.”

“The overall objectives of this meeting were: to review developments in the field of SDH since the Commission on the Social Determinants of Health (CSDH) (see: Closing the gap in a generation: health equity through action on the social determinants of health (2008); and to identify key areas of work and activities for the new WHO Department of SDH.”

JAMA Forum - Legal Solutions for Universal Health Coverage

L Gostin; https://jamanetwork.com/journals/jama/fullarticle/2760725

Must-read. Among others, with a concise overview of the 3 core legal determinants of health: “…health laws must fulfill each element of universal health coverage, health systems must be well governed, and public officials must abide by the rule of law.”

BMJ Global Health (Analysis) - Strengthening medical specialisation policy in low- income and middle-income countries

V Sriram & S Bennett; https://gh.bmj.com/content/5/2/e002053

“The availability of medical specialists has accelerated in low-income and middle-income countries (LMICs), driven by factors including epidemiological and demographic shifts, doctors’ preferences for postgraduate training, income growth and medical tourism. Yet, despite some policy efforts to increase access to specialists in rural health facilities and improve referral systems, many policy questions are still underaddressed or unaddressed in LMIC health sectors, including in the context of universal health coverage. … …. In this article, we describe three critical policy questions on medical specialties and health systems with the aim of provoking further analysis, discussion and policy formulation: (1) What types, and how many specialists to train? (2) How to link specialists’ production and deployment to health systems strengthening and population health? (3) How to develop and strengthen institutions to steer specialisation policy? We posit that further analysis, discussion and policy formulation addressing these questions presents an important opportunity to explicitly determine and strengthen the linkages between specialists, health systems and health equity.”

Final ODA data for 2018 https://devinit.org/publications/final-oda-data-2018/

“This factsheet presents analysis of the OECD DAC’s release of final official development assistance (ODA) data for 2018. It shows how much was given and in what form, as well as a breakdown of recipient countries and sectors, and whether donor countries disbursed funds to projects focused on climate or gender….”

“…ODA spending to sectors key for strengthening human capital – health, education and social protection – is decreasing as a share of total ODA….”

HP&P - Community engagement for health system resilience: evidence from Liberia’s Ebola epidemic K Barker, M Kruk et al; https://academic.oup.com/heapol/advance- article/doi/10.1093/heapol/czz174/5732805?searchresult=1

“The importance of community engagement (CE) for health system resilience is established in theoretical and empirical literature. The practical dimensions of how to operationalize theory and implement its principles have been less explored, especially within low-resource crisis settings. It is therefore unclear how CE is drawn upon and how, if at all, it facilitates health system resilience in times of health system crises. To address this critical gap, we adapt and apply existing theoretical CE frameworks to analyse qualitative data from 92 in-depth interviews and 16 focus group discussions collected with health system stakeholders in Liberia in the aftermath of the 2014–15 Ebola outbreak. Health system stakeholders indicated that CE was a crucial contributing factor in addressing the Ebola epidemic in Liberia. Multiple forms of CE were used during the outbreak; however, only some forms were perceived as meaningful, such as the formation of community- based surveillance teams….”

Lancet Infectious Diseases (Editorial) - Staying on target https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30008-6/fulltext

Editorial of the new February issue of Lancet Infectious Diseases. “In the Editorial in last month's issue we discussed the possibility of targeting malaria eradication, and in the November, 2019, issue we looked at progress towards the target of eradicating dracunculiasis. The start of a new decade is an appropriate time to take stock of past targets for infectious diseases' control and reflect on the value and appropriateness of future goals….”

A few blogs and mainstream articles of the week

Lancet Offline: How to defeat political populism R Horton; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30363-9/fulltext

Horton gives the background here of Lancet Migration. “At last week's Global Health Lab, held at the London School of Hygiene & Tropical Medicine, we asked, “What is the impact of populism on global health?” Tim Haughton, Jonathan Kennedy, Chiara Rinaldi, and Martin McKee sought to answer that question with an audience of the School's students and faculty….”

“The political weaponisation of migration is a threat to ideas of universality, equity, and justice, ideas that are central to our concepts of health and health care. According to the International Organization for Migration (IOM), there are 272 million international migrants today—people living in a country other than their own. The IOM emphasises how small this number is: just 3·5% of the world's population. But that figure still represents over half the population of the European Union. It is a vast signal of human vulnerability. … … Last week, The Lancet announced the launch of Lancet Migration, a new global collaboration to advance migration health. This initiative follows the 2018 publication of our UCL–Lancet Commission on Migration and Health, chaired by Ibrahim Abubakar. Miriam Orcutt is Lancet Migration's Executive Director and she will lead a programme of work on migration's intersection with universal health coverage, the climate emergency, and gender. The academic community can't retreat in the face of extreme political populism, which is fuelling racism, xenophobia, and hate. We have to do something. Lancet Migration is our effort to resist. Please join us.

PS: While I certainly agree migration is a key element in the rise of political populism, it’s not the only one. I miss this (i.e. the importance of also making the world socio-economically fairer) a bit in Horton’s piece.

You might want to read together with a new Guardian Longread - The trouble with anti-populism: why the champions of civility keep losing.

HSG blog – It’s time to get the right balance for women in science and research https://www.healthsystemsglobal.org/blog/391/It-s-time-to-get-TheRightBalance-for-women-in- science-and-research.html

“…To promote the roles and contributions of women in HPSR and to demand more actions to tackle the structural barriers facing women in the field and beyond, Health Systems Global (HSG) has been planning the campaign: ‘Getting the balance right: Addressing gender power relations in and beyond health systems research.’…”

CGD (blog) - “Reasonable” Health Technology Assessment: What Does It Require?

J Lakin & K Chalkidou; https://www.cgdev.org/blog/reasonable-health-technology-assessment-what- does-it-require

“Governments are under continuous pressure to make difficult trade-offs about the use of scarce public resources. This applies to the budget as a whole, but also within sectors like health. “

Health Financing in Africa (blog) – Call it bananas, I don’t care G van Heteren; http://www.healthfinancingafrica.org/home/call-it-bananas-i-dont-care

10 years of PBF is being celebrated. The whole year, blogs will be published – with this one (by G van Heteren) kicking off the series.

“After a few decades of practical experience, we can safely say that Performance-Based Financing (PBF) can be a powerful approach, but only if we keep agile on updating it. Call it bananas, I don’t care…but in moving PBF/RBF let’s be clear and constantly critical about the basics, brace ourselves for the serious battles, be honest about money and power, and act collectively…”

PS: Health Financing in Africa also started another series of blogs – #10ans du Rapport Mondial sur la Couverture Sanitaire Universelle. 1st contribution by Léonard Ntakarutimana (in French) - Le rapport OMS 2010 sur le financement des systèmes de santé et la couverture sanitaire universelle: quelles résultats pour les populations africaines?

Open Democracy - If work dominated your every moment, would life be worth living? https://www.opendemocracy.net/en/transformation/if-work-dominated-your-every-moment- would-life-be-worth-living/

Important read, certainly for all the (/us) workaholics in global health …” An obsession with work causes needless human suffering and immiserates our imagination.”

Excerpt: “…‘Total work’, a term coined by the German philosopher Josef Pieper just after the Second World War in his book Leisure: The Basis of Culture (1948), is the process by which human beings are transformed into workers and nothing else. By this means, work will ultimately become total, I argue, when it is the centre around which all of human life turns; when everything else is put in its service; when leisure, festivity and play come to resemble and then become work; when there remains no further dimension to life beyond work; when humans fully believe that we were born only to work; and when other ways of life, existing before total work won out, disappear completely from cultural memory. We are on the verge of total work’s realisation. Each day I speak with people for whom

work has come to control their lives, making their world into a task, their thoughts an unspoken burden….”

Katri Bertram - Engaging in women's networks does not exclude engaging with men https://katribertram.wordpress.com/2020/02/11/engaging-in-womens-networks-does-not-exclude- engaging-with-men/

Among others on the importance of being mentored by women. “….What I do hope, though, is that younger men also look for (female) role models and mentors….”

PS: Katri also wrote another blog - Founder's Syndrome in Global Health (or as others call it, ‘Initiavitis’).

Social Watch – UN 2020: Between ‘Likes’ and love R Bissio; http://www.socialwatch.org/node/18408

"Last year over 200 defenders of Human Rights and the environment were killed in Latin America. They gave their lives for their communities and for the principles that the United Nations stands for. And yet, the statistical framework for the SDGs tells us that the “partnerships” that should contribute to achieve sustainable development will be measured by the dollars they mobilized. The blood spilled by our friends and colleagues doesn't count." During a debate over the 75th anniversary of the UN, at the Pyeong Chang Peace Forum, Social Watch coordinator Roberto Bissio expressed the frustrations of civil society over the lack of meaningful interaction with the UN.”

IHP – The ‘Down’ side to the 2020 Oscars S Nagesh; https://www.internationalhealthpolicies.org/featured-article/the-down-side-to-the-2020- oscars/

Shubha Nagesh describes what stood out for her at this year’s Oscar ceremony: “…when The Peanut Butter Falcon actor Zack Gottsagen took the stage with his co-star Shia La-Beouf, to become the first presenter with Down syndrome in the ceremony’s history.” And links this to the situation in India, where she works: “In India, and specifically where I work, Uttarakhand, the Himalayan state of India, we don’t see enough inclusion in society for persons with disabilities (particularly for young adults)….”

Why Is Bloomberg's Long History of Egregious Sexism Getting a Pass? https://www.gq.com/story/bloomberg-sexism

If I’m correct, Bloomberg is some sort of ‘global health champion’.

“The surging Democratic presidential candidate has fielded some 40 sexual harassment and discrimination lawsuits brought against him and his organizations over decades.”

Tweets of the week

Richard Horton “I’m in a place where I’m not allowed to say who is present. And someone has just said: “I’m tired of the SDGs.” Five years in, a decade to go, and still with no serious understanding of the meaning of sustainability, isn’t this rather shocking? “

Jason Hickel “Words that are not mentioned in the Paris Agreement text: -coal -oil -gas -fossil fuels This has to change. We need legally binding commitments to scale down fossil fuels with concrete, annual targets. And we need them this year.”

David Wallace-Wells “Four of the six countries most skeptical of capitalism are the BRICs—for about a generation the poster children of globalization-driven growth.” (Tweet related to WEF - These countries think capitalism does more harm than good )

Global health events

UN News - World Urban Forum: cities must be ‘at the heart’ of sustainable development (Abu Dhabi)

https://news.un.org/en/story/2020/02/1057021

“The official opening of the 10th Session of the World Urban Forum (WUF) took place in Abu Dhabi on Sunday, with UN chief António Guterres telling delegates that cities and towns were crucial to deliver sustainable development across the globe during the next decade….”

See also Devex - New Global Resilient Cities Network will embrace strategic partnerships

“The Global Resilient Cities Network was announced Tuesday at the 10th session of the World Urban Forum in Abu Dhabi, United Arab Emirates, after months of negotiations. The network is an evolution of 100 Resilient Cities after The Rockefeller Foundation made the decision to stop funding for the program. Chief resilience officers — high-level advisors appointed by a city’s mayor, and partially paid by the 100 Resilient Cities program — have been involved in the design of the network, which will take a fundamentally different approach to partnerships….”

Healthy societies, healthy populations (Wilton Park Dialogue, West Sussex, 10-12 Feb)

https://www.wiltonpark.org.uk/event/wp1734/

Aim of this 3-day expert meeting/event: “… The World Health Organization has committed to the ‘triple billion’ goals, with the aim of providing a further billion people with better health and wellbeing (in addition to ensuring that a billion more people have universal health coverage and protecting a billion more people from health emergencies). What would better health and wellbeing look like? What are the societal determinants and surrounding factors that enables healthy society and population levels? What will this mean in practice, for example in systems and societal change? How can this be achieved? What are the potential co-benefits between actions for our climate and people’s health? This Wilton Park dialogue, in partnership with the Swedish Ministry of Foreign Affairs, will bring together senior leaders and experts from a wide range of organisations and interests – including those focused primarily on health, climate, food, urban planning, consumers and the private sector for a global conversation to identify ways to build healthy societies and therefore healthy populations. Agenda 2030 sets an ambitious agenda for health (SDG3), and through the interdependent 17 SDGs demands a radically different and holistic approach. The goal is healthier lives and wellbeing for all not merely survival. Innovative approaches will be needed to boost healthier populations and societies if the goal of ensuring a further billion people are healthier as defined by WHO is to be met. To address the main risk factors behind the rapid escalation of NCDs, mental health and other causes of ill-health and early deaths such as the threats caused by Anti-microbial resistance, systemic change will be needed through collaboration between leaders and experts well beyond the traditional health sector.

… … Questions to address include some of the factors to be focused on including, addressing social, economic and environmental determinants of healthy societies, promoting multisectoral approaches for better health and prioritising health in policies and healthy settings. Equally, understanding better the dynamics between people’s growing demand for health, commercial factors and political decisions. How to transform societal health, and leverage institutions and incentives the different actors who shape citizens’ health, and empower the citizens themselves to make healthier choices.

The outcome of the conference could potentially both advise the continued work by WHO and potentially lead to an agreement on the need for more analytical and policy work on this theme e.g. by the establishment of a Commission of Healthy Societies for Healthy People.”

You find the full program (and “line-up”) here.

LSHTM-Charité Global Health Lecture Series in Berlin https://www.lshtm.ac.uk/newsevents/events/series/lshtm-charite-global-health-lecture-series- berlin

“The LSHTM-Charité Global Health Lecture Series brings together leading scientists from the UK, Germany and further afield to present cutting-edge research on pressing global health issues and to

discuss the implications of their work for policy and practice. The series will cover a variety of topics including pandemic preparedness, anti-microbial resistance, health systems and digital health.”

Peter Piot, Dr Moeti & others kicked off the series, this week – on pandemic preparedness.

Coming up – 19 Feb: launch of a major new report on child health and well-being by an independent WHO-UNICEF- Lancet Commission.

WHO;

“Entitled A future for the world’s children?, this is the first comprehensive, independent report to reposition every aspect of child health through the lens of our rapidly changing climate and other existential threats….”

Global governance of health

Devex - Anne-Marie Trevelyan named secretary of state for international development https://www.devex.com/news/breaking-anne-marie-trevelyan-named-secretary-of-state-for- international-development-96572

“The short-term future of the U.K. Department for International Development appeared secure Thursday after Prime Minister Boris Johnson named its new boss. Anne-Marie Trevelyan, member of parliament for Berwick-upon-Tweed, will replace Alok Sharma as secretary of state for DFID. … … Former DFID chief Sharma, who held the role for just six months, will now head the U.K.’s preparations for the COP26 United Nations climate talks — a role he must juggle with his other new position, leading the Department for Business, Energy & Industrial Strategy.”

SS&M - A disconnected policy network: The UK's response to the Sierra Leone Ebola epidemic

J Georgalakis; https://www.sciencedirect.com/science/article/abs/pii/S0277953620300708

“This paper investigates whether the inclusion of social scientists in the UK policy network that responded to the Ebola crisis in Sierra Leone (2013–16) was a transformational moment in the use of interdisciplinary research. … … Far from being one cohesive community of experts and government officials, the network of 134 people was weakly held together by a handful of super- connectors. Social scientists’ poor connections to the government embedded biomedical community may explain why they were most successful when they framed their expertise in terms of widely

accepted concepts. The whole network was geographically and racially almost entirely isolated from those affected by or directly responding to the crisis in West Africa. Nonetheless, the case was made for interdisciplinarity and the value of social science in emergency preparedness and response. The challenge now is moving from the rhetoric to action on complex infectious disease outbreaks in ways that value all perspectives equally.”

Devex - UK jeopardizing development gains in Ghana with rapid reduction of aid, watchdog warns https://www.devex.com/news/uk-jeopardizing-development-gains-in-ghana-with-rapid-reduction- of-aid-watchdog-warns-96554

“Progress made with U.K. aid support to Ghana is at risk of being lost amid a rapid transition by the donor to a post-aid approach, the U.K. aid watchdog has warned. The Independent Commission for Aid Impact found the U.K. had been “mostly effective” in supporting Ghana’s poorest citizens, with particularly strong results in health and education. But the watchdog warned that the sustainability of those programs was jeopardized by the U.K. government’s fast and poorly-planned transition away from bilateral support toward a “mutual prosperity” approach, emphasizing an economic partnership with Ghana. Bilateral aid to Ghana fell from £86.5 million ($138.7 million) in 2011 to £56.4 million in 2017….”

Stat - Priscilla Chan charts an ambitious, unglamorous course to fight disease. (Her husband is involved, too.) https://www.statnews.com/2020/02/11/priscilla-chan-charts-an-ambitious-unglamorous-course-to- fight-disease-her-husband-is-involved-too/

It’s not “Priscilla, queen of the desert”, but Zuckerberg’s spouse . Insightful analysis of Priscilla Chan’s key role in the Chan Zuckerberg initiative. Well worth a read.

Guardian - Trump puts Cuban doctors in firing line as heat turned up on island economy https://www.theguardian.com/global-development/2020/feb/11/trump-puts-cuban-doctors-in- firing-line-as-heat-turned-up-on-island-economy

“A Cuban medical programme that has helped some of the world’s poorest communities has become the latest target of the Trump administration’s escalating attempts to pressure Havana’s faltering economy. Dubbed “Cuban doctors”, the celebrated – if controversial – humanitarian medical mission was founded more than half a century ago in the aftermath of Fidel Castro’s revolution, in part to enhance the country’s international influence. Currently active in over 60 countries, the scheme has provided healthcare across the globe, from indigenous Amazon peoples

to slum residents in Africa to the victims of Haiti’s 2010 earthquake. Now its work has come under renewed fire via a combination of allegations, led by Washington, which has accused Havana of using the doctors to undermine democracy, not least in Venezuela – which hosts one of the biggest missions. Havana has also been accused – in claims taken up by Washington – of “exploiting” the medical staff sent on the missions. … … In response, Cuban officials, and analysts who have closely studied the work of the medical missions, accuse the US of using the claims as cover for its policy of strangling the Cuban economy in the hope of damaging the left-wing regime, while warning that poor patients will be the biggest victims. … While some two dozen missions are provided free of cost by Havana, other countries where the doctors are deployed pay Cuba for the medical services, bringing in $6.3bn (£4.8bn) annually, Havana’s largest source of foreign currency. The US campaign against the Cuban doctors has intensified amid recent political changes in Latin America, which have led to the expulsion of the missions from several countries, including Bolivia and Brazil, where left-wing governments have been replaced by right-wing regimes closely aligned with Trump and Washington….”

EconoTimes - China: rise of a new philanthropic power https://www.econotimes.com/China-rise-of-a-new-philanthropic-power-1574262

“In response to the ongoing coronavirus emergency, on January 31, Chinese billionaire Jack Ma pledged the equivalent of US$144 million for medical supplies for Wuhan and Hubei as well as $14 million to help develop a vaccine. … … In China, public figures have long since practised philanthropy – understood as “voluntary action for the public good” – often quietly. But given the magnitude of Jack Ma’s fortune, 21st in the world at approximately $43 billion, this decision indicates that Chinese philanthropy is at a historic turning point….”

Analysis of the current Chinese philanthropy landscape and projected trends. “…China’s philanthropic sector will become a force to be reckoned with far beyond its borders in the 21st century.”

Planetary health

Guardian - UK unprepared for COP 26 conference, warn climate leaders https://www.theguardian.com/environment/2020/feb/07/mary-robinson-attacks-unhelpful-uk- over-cop-26-climate-talks

“The UK is showing a “lack of coherence” in its leadership of vital UN climate crisis talks this year and giving the damaging impression that the talks are not a high priority, one of the world’s leading voices on the climate crisis has said. Mary Robinson, a former UN climate envoy and Ireland’s first female president, also said the perception that major British politicians, including the ex-prime minister David Cameron and former foreign secretary William Hague, were unwilling to take on the role of leading the COP 26 summit was damaging….”

Guardian - Antarctic temperature rises above 20C for first time on record https://www.theguardian.com/world/2020/feb/13/antarctic-temperature-rises-above-20c-first- time-record

“The Antarctic has registered a temperature of more than 20C (68F) for the first time in history, prompting fears of climate instability in the world’s greatest repository of ice….”

Infectious diseases & NTDs

BMJ Global Health - The quality of malaria care in 25 low- income and middle-income countries https://gh.bmj.com/content/5/2/e002023

By Erlyn Macarayan (EV 2014), A Jha et al.

Conclusions: “Quality of malaria care remains poor and varies widely in endemic LMICs. Treatments are often prescribed regardless of malaria test results, suggesting that presumptive diagnosis is still commonly practiced among cases of suspected malaria, rather than the WHO recommendation of ‘test and treat’. To reach the 2030 global malaria goal of reducing mortality rates by at least 90%, focussing on improving the quality of malaria care is needed.”

Think Global Health - Diabetes and TB—A Complicating Combo

K Wiens (IHME); https://www.thinkglobalhealth.org/article/diabetes-and-tb-complicating-combo

“Though they are entirely different types of diseases TB and diabetes exacerbate each other in surprising—and costly—ways.”

GFO - Global Fund finances majority of insecticide-treated nets for malaria globally https://www.aidspan.org/node/5195

From the new Global Fund Observer issue. “The Global Fund supports more than half of all long- lasting insecticide-treated nets distributed globally, to countries fighting malaria. The Global Fund therefore has considerable market influence, not only in terms of price but also in making the nets

more accessible. Global deliveries of long-lasting insecticide-treated nets follow malaria epidemic trends; countries with a higher malaria burden receive more nets. Sub-Saharan Africa, the region with the highest malaria burden globally, received 86% of these nets delivered globally, between 2004 and the second quarter of 2019….”

Link: new UNAIDS investment book

“The Investment Book, an online tool for UNAIDS donors that capitalizes on the unique value of UNAIDS, has been launched. Highlighting the opportunities that are available for partnership and donor investment, the Investment Book shows the impact of investment opportunities at the global, regional and country levels…..”

AMR

The Bureau of Investigative Journalism – India to ban antibiotic pollution from pharma factories

The bureau of investigative journalism;

“The Indian government is to limit the amount of antibiotic residue permitted in wastewater released by drug factories, after a series of stories by the Bureau of Investigative Journalism. A draft bill published on 23 January introduces limits on the concentrations of antibiotics found in the waste discharged by pharmaceutical factories into rivers and the surrounding environment. Experts believe anything above these limits fuels the creation of drug-resistant bacteria, or superbugs….”

Critical Public Health - Antimicrobial resistance as a problem of values? Views from three continents

A Broom et al ; https://www.tandfonline.com/doi/full/10.1080/09581596.2020.1725444

“Much has been written about the problem of antimicrobial resistance (AMR) and the action required to rein in this emerging global health threat. Addressing AMR is often operationalised as requiring ‘behavior change’ of clinicians and of patients, in combination with improving the drug development pipeline. Few have approached AMR as a challenge fundamentally embedded within the cultural fabric of modern societies and the (varied) ways they are organised economically, socially and politically. Here, drawing on a decade of work across a range of health contexts, we approach the problem of AMR as one of values and culture rather than of individual behavior. We reframe AMR as a social and political concern resulting from a confluence of factors and practices including: temporal myopia, individualisation, marketisation, and human exceptionalism. To effectively tackle AMR, we advocate solidaristic models that espouse collective responsibility and recognise relative opportunity to act rather than a continuation of the individualistic behavioural models that have, so far, proven largely ineffective.”

NCDs

BMJ Global Health -The household economic burden of noncommunicable diseases in 18 countries https://gh.bmj.com/content/5/2/e002040

Another PURE output.

Some of the findings and implications: “Households with NCDs in lower middle income countries (LMICs) spend more on healthcare and are at greater risk of catastrophic expenditure and impoverishment than households without after adjustment for potential confounders. An alarmingly large number of individuals with NCDs report not taking prescribed medicines for NCDs due to cost, particularly among women in low-income countries (LICs). What do the new findings imply? Insufficient progress has been made towards international goals, and we are far from achieving financial risk protection for people with NCDs, particularly in LMICs and LICs. While the burden of NCD care may appear greatest in LMICs, the burden in LICs may be disguised by foregone care due to costs, with women likely most dramatically affected….”

BMC Health Services - Integration of mental health care in private not-for-profit health centres in Guinea, West Africa: a systemic entry point towards the delivery of more patient- centred care?

A Sow et al ; https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-4914-3

“Patient-centred care is an essential component of quality of health care. We hypothesize that integration of a mental health care package into versatile first-line health care services can strengthen patient participation, an important dimension of patient-centred care. The objective of this study is to analyse whether consultations conducted by providers in facilities that integrated mental health care score higher in terms of patient participation….”

Conclusion of the study: “Integrating a mental health care package into versatile first-line health services can promote more patient-centred care.;..”

HP&P - The EVITA framework for evidence-based mental health policy agenda setting in low- and middle-income countries

N Votruba et al ; https://academic.oup.com/heapol/advance- article/doi/10.1093/heapol/czz179/5732810?searchresult=1

“The burden of mental illness is excessive, but many countries lack evidence-based policies to improve practice. Mental health research evidence translation into policymaking is a ‘wicked problem’, often failing despite a robust evidence base. In a recent systematic review, we identified a gap in frameworks on agenda setting and actionability, and pragmatic, effective tools to guide action to link research and policy are needed. Responding to this gap, we developed the new EVITA 1.1 (EVIdence To Agenda setting) conceptual framework for mental health research–policy interrelationships in low- and middle-income countries (LMICs)….” “…EVITA 1.1 is novel and unique because it very specifically addresses the mental health research–policy process in LMICs and includes policy agenda setting as a novel, effective mechanism….”

Lancet Comment – The global burden of chronic kidney disease https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32977-0/fulltext

New Comment linked to a new GBD study in the Lancet - Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017.

One of the findings: “Globally, in 2017, 1·2 million (95% uncertainty interval [UI] 1·2 to 1·3) people died from CKD.”

Link: BMJ Global Health - Call for Papers: NCD Prevention in Humanitarian Settings

“BMJ Global Health, in collaboration with the International Rescue Committee, the Conflict & Health Research Group at King’s College London and the College of Health at Lehigh University, are pleased to announce a call for papers on Non-Communicable Disease (NCD) Prevention in Humanitarian Settings. Edited by BMJ Global Health associate editor Dr. Eduardo J. Gómez of Lehigh University, Dr. Lilian Kiapi of the International Rescue Committee, and Dr. Preeti Patel of King’s College London, this special issue will examine the response to NCDs in humanitarian conflict settings….”

Sexual & Reproductive / maternal, neonatal & child health

Open Democracy (Investigation)- Trump-linked religious ‘extremists’ target women with disinformation worldwide https://www.opendemocracy.net/en/5050/trump-linked-religious-extremists-global-disinformation- pregnant-women/

“Lawmakers demand action as openDemocracy reveals global spread of false and “manipulative” activities, posing “grave risks” to women and democracy.”

“A global network of ‘crisis pregnancy centres’, backed by US anti-abortion groups linked to the Trump White House, has been condemned by lawmakers, doctors and rights advocates for targeting vulnerable women with “disinformation, emotional manipulation and outright deceit”….”

See also Revealed: US-linked anti-abortion centres ‘lie’ and ‘scare women’ across Latin America (Open Democracy)

The New Humanitarian - Aid organisations fail to protect LGBTQI+ aid workers in the field https://www.thenewhumanitarian.org/opinion/2020/01/16/LGBTQI-aid-workers-diversity- discrimination

“‘We are not getting it right for diverse employees in the field, nor are we are meeting our duty of care obligations for those working at HQ.’”

BMJ Global Health Supplement - Using geospatial data and analytics to guide reproductive, maternal, newborn, child, and adolescent health programs

Editors: K Nilsen et al https://gh.bmj.com/content/4/Suppl_5

With some new articles added this week, to this supplement.

UNAIDS - UNAIDS and IAEA forge a powerful partnership against the interlinked diseases of cervical cancer and HIV https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2020/februar y/20200207_PR_IAEA_MOU

“UNAIDS and the International Atomic Energy Agency (IAEA) have joined forces to increase action against cervical cancer and HIV. In a memorandum of understanding signed following an event to mark World Cancer Day at the headquarters of IAEA in Vienna, Austria, the two organizations pledged to scale up and expand services for adolescent girls and women affected by the two diseases. “

See also a Lancet World Report - UNAIDS and IAEA join forces on HIV and cervical cancer.

International Health - Inter-relationships among key reproductive health indicators in sub-Saharan Africa focusing on the central role of maternal literacy

M A Woldegiorgis et al; https://academic.oup.com/inthealth/advance- article/doi/10.1093/inthealth/ihz117/5733227?searchresult=1

“Indicators of reproductive health (RH) are expected to be both inter-related and associated with key social determinants. As the provision of RH services is usually integrated, the effort to improve one RH component should influence the other components. However, there is a lack of evidence-based models demonstrating the inter-relationships. The purpose of this study was to examine the interrelationships among key RH indicators and their relationship with women’s literacy in sub-Saharan Africa (SSA)….”

Quick links:

Lancet Editorial - Preventing teenage pregnancies in Brazil “ Last week, a campaign was jointly launched by the Brazilian Ministry of Health and the Ministry of Women, Family and Human Rights to reduce the country's high teenage pregnancy rate. Under the slogan “adolescence first, pregnancy later”, the campaign aims to make adolescents and their parents aware, via television, billboards, and social media, of the risks and consequences of teenage pregnancies….”

Guardian - Tampons wars: the battle to overthrow the Tampax empire

Access to medicines

WHO and FIND formalize strategic collaboration to drive universal access to essential diagnostics https://www.who.int/news-room/detail/10-02-2020-who-and-find-formalize-strategic- collaboration-to-drive-universal-access-to-essential-diagnostics

“The World Health Organization (WHO) and the Foundation for Innovative New Diagnostics (FIND) announced [today] that a memorandum of understanding has been signed by the two organizations to formalize a strategic collaboration that will strengthen diagnosis in resource-poor countries by closing major diagnostic gaps at country level and bolstering disease surveillance that will inform public health initiatives and enhance outbreak preparedness and response….”

FT Health - Africa’s silent killer: fake drugs https://www.ft.com/content/feae3ea1-cbc4-4188-96bf-8de8d01257d3

“Nigeria and others must sign up to a new initiative to fight counterfeiters.” The Lomé initiative, that is.

Human resources for health

Human Resources for Health - Is enhancing the professionalism of healthcare providers critical to tackling antimicrobial resistance in low- and middle-income countries?

M Khan et al; https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-020- 0452-7

“… We investigate whether weaknesses in HCP (health care providers) professionalism result in boundaries between qualified HCPs and unqualified providers being blurred, and how these weaknesses impact inappropriate provision of antibiotics by HCPs in two LMIC with increasing AMR— Pakistan and Cambodia….”

Miscellaneous

Economist - Special report on the Belt and Road Initiative https://www.economist.com/special-report/2020/02/06/chinas-flagship-foreign-policy-aims-to-put- itself-at-the-centre-of-the-world-once-again

From last week’s Economist issue. “The Belt and Road Initiative revives memories of China’s imperial tributary system, says Dominic Ziegler.”

ODI - The new development diplomacy in middle-income countries: the changing role of traditional donors in India

N Gulrajani et al ; https://www.odi.org/publications/16604-new-development-diplomacy-middle- income-countries-changing-role-traditional-donors-india

“Development diplomacy refers to the repurposing of development assistance to service public diplomacy ambitions and aspirations, and simultaneously achieve development goals. While a dual approach like this is not new, the rising power and influence of emerging markets provides the backdrop for Development Assistance Committee donors to reframe their bilateral development cooperation in distinct ways. This report explores the conceptual and empirical practice of development diplomacy in a single middle-income country. As a large and powerful emerging economy that still faces significant development challenges, India is an important site of contemporary development diplomacy. After presenting our conceptual framework, the report examines factors that enable its application to three bilateral donors (France, UK and Japan) operating in India, and concludes by outlining some of the emerging opportunities and risks deriving from their exercise of development diplomacy.”

Devex - These 4 trends will define the future of development, Achim Steiner says https://www.devex.com/news/these-4-trends-will-define-the-future-of-development-achim-steiner- says-96539

“The head of the United Nations Development Programme has outlined four key factors he says will define the future of development.” Inequality, decarbonization, the fourth industrial revolution and governance.

Guardian - A humanitarian crisis looms in Africa unless we act fast to stop the desert locust

Q Dongyu & M Lowcock ; https://www.theguardian.com/global-development/2020/feb/12/a- humanitarian-crisis-looms-in-africa-unless-we-act-fast-to-stop-the-desert-locust

“…The worst outbreak of desert locusts in decades is currently underway in the Horn of Africa. It is the biggest of its kind in 25 years for Ethiopia and Somalia – and the worst Kenya has seen for 70 years. The impacts of the outbreak in these countries are particularly acute as pastures and crops are being wiped out in communities that were already facing food shortages….”

“… but the window to contain this crisis is closing fast. We only have until the beginning of March to bring this infestation under control as that is when the rain and planting season begins. The swarms are highly mobile; the terrain often difficult; the logistical challenges immense. But left unchecked – and with expected additional rains – locust numbers in East Africa could increase 500 times by June….”

See also the New Humanitarian - Locusts 2.0: Experts fear new swarms in eastern Africa, 20 times as large

Save the Children (press release) – Children in Conflict at Highest Risk of Violence since Records Began

Save the Children;

“New analysis also reveals how conflict affects girls and boys differently: The number of children in high intensity conflict areas is 149 million, double the number of all children in the United States; Nine in 10 child victims of sexual violence are girls; Boys more likely to be killed in direct warfare, if girls are killed or badly injured it is more likely to be a result of indiscriminate explosive weapons.”

Thomson Reuters – Slavery not a crime for almost half the countries in the world - study

Reuters;

“Slavery is not a crime in almost half the countries in the world, a study of global laws said on Wednesday, urging nations to close legal loopholes that allow abusers to escape punishment.;..”

Emerging Voices

Last week (6 February) was the deadline for the EV call for Dubai. Review of the applications received will start shortly!

BMC Health Services Research - Dissonances and disconnects: the life and times of community based accountability in the national rural health mission in Tamilnadu, India https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-4917-0

By Rakhal Gaitonde (EV 2012) et al.

Research

Health Research Policy & Systems - Review of published evidence on knowledge translation capacity, practice and support among researchers and research institutions in low- and middle-income countries

V I Murunga et al ; https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-019- 0524-0

“Knowledge translation (KT) is a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of knowledge to yield beneficial outcomes for society. Effective KT requires researchers to play an active role in promoting evidence uptake. This paper presents a systematised review of evidence on low- and middle-income country (LMIC) researchers’ KT capacity, practice and interventions for enhancing their KT practice (support) with the aim of identifying gaps and informing future research and interventions….”

Health Research Policy & Systems - Exploring the evolution of engagement between academic public health researchers and decision-makers: from initiation to dissolution

N Jessani et al ; https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-019- 0516-0

“Relationships between researchers and decision-makers have demonstrated positive potential to influence research, policy and practice. Over time, interest in better understanding the relationships between the two parties has grown as demonstrated by a plethora of studies globally. However, what remains elusive is the evolution of these vital relationships and what can be learned from them with respect to advancing evidence-informed decision-making. We therefore explored the nuances around the initiation, maintenance and dissolution of academic–government relationships….”

SS&M - Health for all? A qualitative study of NGO support to migrants affected by structural violence in northern France

B Pursch et al ; https://www.sciencedirect.com/science/article/pii/S0277953620300575

“NGOs in northern France support migrants within a complex and contested space. Restrictions and power dynamics threaten migrant wellbeing and life chances. Structural violence is a convincing lens through which to examine these issues.”