Shifting Paradigm
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SHIFTING PARADIGM How the BRICS Are Reshaping Global Health and Development ACKNOWLEDGEMENTS This report was developed by Global Health Strategies initiatives (GHSi), an international nonprofit organization advocating for improved access to health technologies and services in developing countries. Our efforts engaged the expertise of our affiliate, Global Health Strategies, an international consultancy with offices in New York, Delhi and Rio de Janeiro. This report comprises part of a larger project focused on the intersections between major growth economies and global health efforts, supported by a grant from the Bill & Melinda Gates Foundation. GHSi senior leadership, who advised the team throughout development of this report, includes David Gold and Victor Zonana (New York), Anjali Nayyar (Delhi) and Alex Menezes (Rio de Janeiro). Brad Tytel, who directs GHSi’s work on growth economies and global health, led the development of the report. Katie Callahan managed the project and led editorial efforts. Chandni Saxena supervised content development with an editorial team, including: Nidhi Dubey, Chelsea Harris, Benjamin Humphrey, Chapal Mehra, Daniel Pawson, Jennifer Payne, Brian Wahl. The research team included the following individuals, however contents do not necessarily reflect the opinions of their respective institutions: Brazil Carlos Passarelli, Senior Advisor, Treatment Advocacy, UNAIDS Cristina Pimenta, Associate Professor, School of Biological Sciences, Veiga de Almeida University Russia Kirill Danishevskiy, Assistant Professor, Postgraduate School of Health Management, Department of Public Health, Moscow Sechenov Medical Academy India Sagri Singh, Independent Consultant, GHAR Consulting Inc. China Guo Yan, Professor, School of Public Health, Peking University Health Science Center Joan Kaufman, Distinguished Scientist and Senior Lecturer, Heller School for Social Policy and Management, Brandeis University and Lecturer in Global Health and Social Medicine, Harvard Medical School South Africa Regina Osih, Independent Consultant, Public Health and Infectious Disease Matshidiso Masire, BridgingDialogue Sridhar Venkatapuram, Wellcome Trust Fellow, London School of Hygiene & Tropical Medicine, provided overall guidance. We are extremely grateful to Amy Adelberger, Sanjaya Baru, Nicole Bates, Katherine Bliss, Xiaoqing Lu Boynton, Deborah Brautigam, Martyn Davies, Steve Davis, Samu Dube, Jean Duffy, Ksenia Eroshina, Gabrielle Fitzgerald, Meenakshi Datta Ghosh, Dan Gwinnell, Yanzhong Huang, Suresh Jadhav, Salim Karim, Stephanie Lazar, Donna Lomangino, Ashok Malik, Dai Min, Steve Morrison, Rani D. Mullen, Adrianne Nickerson, Blessed Okole, Linda Patterson, Bin Pei, Pronob Sen, Nina Schwalbe, Markus Steiner, Ian Temple, Vasiliy Vlassov and Tom Wheeler for their support and input. © 2012 Global Health Strategies initiatives (GHSi) [email protected] TABLE OF CONTENTS Executive Summary 5 1. Introduction 13 2. Brazil 19 Brazil Overview 19 Brazil’s International Cooperation 21 Brazil’s Health Cooperation 24 Brazilian Innovation and Implications for Global Health 29 3. Russia 33 Russia Overview 33 Russia’s Foreign Assistance 35 Russia’s Health Assistance 37 Russian Innovation and Implications for Global Health 41 4. India 43 India Overview 43 India’s Foreign Assistance 45 India’s Health Assistance 49 Indian Innovation and Implications for Global Health 51 5. China 57 China Overview 57 China’s Foreign Assistance 59 China’s Health Assistance 62 Chinese Innovation and Implications for Global Health 66 6. South Africa 71 South Africa Overview 71 South Africa’s Foreign Assistance 73 South Africa’s Health Assistance and Impact 75 on Global Health Innovation 7. Beyond BRICS 79 8. Key Findings and Conclusions 85 Citations 93 1 2 KEY MILESTONES OF BRICS’ ENgagEMENT IN GLOBAL HEALTH 2001: Under pressure from Brazil, India and other developing countries, WTO member Brazil pledges US$20 million states announce Doha Declaration to over 20 years to the encourage full use of TRIPS flexibilities to 1993: Serum Institute GAVI Alliance ensure access to essential medicines of India receives Brazil spearheads efforts WHO prequalification 2001: Indian manufacturer Cipla begins for its measles offering high quality ARVs at fraction of cost to establish UNITAID, an vaccine; India is first of other manufacturers, increasing access innovative financing mechanism developing country for millions of HIV/AIDS patients globally to increase access to essential 1950: China to receive WHO medicines and health launches international prequalification 2002: First Russian contribution technologies assistance program to Global Fund 1996: Brazil becomes Russia commits to reimburse 1955: Soviet Union first developing 2002: India’s Shantha Biotech develops low- Global Fund for grants launches economic country to guarantee cost, high quality hepatitis B vaccine and received through 2010; total and technical free ARV access to all receives WHO prequalification; price falls commitments to reach US$317 development program HIV/AIDS patients from US$23 to less than US$1 per dose million by 2013 1950–1965 1990s 2001–2005 2006 1960: Brazil establishes 1997: Russia joins 2003: Using lessons learned from 2003 SARS China commits national system G7, resulting in epidemic, China begins prioritizing disease US$37 million to combat for international creation of G8 surveillance in Southeast Asia malaria in Africa at Forum cooperation on China-Africa Cooperation 2003: India, Brazil and South Africa establish 1964: India launches the IBSA trilateral to coordinate initiatives, Russia sets agenda for International Technical including those for health St. Petersburg G8 meeting to and Economic ensure discussion on combatting Cooperation Programme, 2003: Brazil takes leadership role in elevating infectious diseases globally its cornerstone foreign tobacco control as a global health priority; assistance program subsequently 168 countries sign onto BRICS foreign ministers Framework Convention on Tobacco Control meet for first time as geopolitical bloc 2003: First Chinese contribution to Global Fund; total commitments reach First Indian contribution US$30 million by 2012 to Global Fund; total commitments reach 2003: India announces, going forward, it will US$10 million by 2012 only accept bilateral assistance from US, UK, Germany, Japan, Russia and EU 2003: First South African contribution to Global Fund; total commitments reach US$10 million by 2012 2004: South Africa launches African Renaissance and Cooperation Fund, mechanism to channel its development assistance 2005: India launches National Rural Health Mission, aiming to improve health of its rural population Global Health Strategies initiatives ghsinitiatives.org China passes Japan to become 2nd largest global economy Brazilian and South WHO announces China’s African Ministers of China commits SFDA complies with Foreign Affairs sign additional US$73 international vaccine onto Oslo Ministerial million for malaria South Africa invited to regulation standards, India launches Declaration, which treatment centers join BRICs paving way for Development WHO prequalification establishes health and other facilities Administration CAPRISA, partially of Chinese-manufactured Partnership to oversee as key component of in Africa at Forum vaccines foreign policy on China-Africa funded by South international assistance Cooperation African government, South Africa is first program First South African announces study country to announce contribution to China commits proving efficacy of ARV- plans for national roll-out South Africa plans to the GAVI Alliance; US$124 billion for based microbicide gels of GeneXpert, a state of launch its first-ever pledges US$20 million domestic health to prevent HIV infection the art molecular development agency, over 20 years sector reform among women TB diagnostic SADPA 2007 2009 2010 2011 2012 Russia releases concept Russia and US sign Serum Institute of India, Brazil hosts WHO World India removed from note on international MOU to cooperate in partnership with PATH Conference on Social WHO list of polio- assistance priorities on global eradication and WHO, launches Determinants of Health endemic countries and pledges to of polio meningitis A vaccine, contribute US$400- MenAfriVac – China releases US$500 million each China hosts first vaccine designed white paper on foreign year; commits to ministerial meeting specifically for Africa assistance program – first eventually provide on drug-resistant public document on its UN recommended TB; World Health Brazil begins providing policies and approach 0.7% of GDP to Assembly later passes infrastructure and international assistance MDR-TB resolution capacity building Russia hosts First support to ARV factory Global Ministerial in Mozambique – Conference on Healthy Africa’s first public Lifestyles and NCDs pharmaceutical facility resulting from South- At first-ever BRICS Health South collaboration Ministers’ Meeting, countries issue declaration First Russian highlighting global public contribution to the GAVI health as joint priority Alliance; pledges US$80 million over 10 years China’s MOST announces US$300 million partnership with Gates Foundation to fund R&D for global health and agriculture products Russia commits US$36 million to support global response to NCDs at UN Summit on Non- Communicable Diseases 3 Global Health Strategies initiatives ghsinitiatives.org 4 LIST OF ACRONYMS ABC Brazilian Agency for Cooperation AMC Advanced Market Commitment ARF African Renaissance