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IHP news 552 : Have a great end of the year!

( 20 Dec 2019)

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

Dear Colleagues,

As many of you are no doubt in festive mood already, we won’t keep you long in this week’s intro. Let me just wish you a merry Christmas (for some of you) and a great end of the year (for everybody).

As for the global health big shots among you, I hope one of your New Year’s resolutions will be inspired by, of all people, Boris Johnson – the current champ of the “Bullshit-Industrial complex”. In

line with what Boris told his ministers, do stay away from Davos next year 😊. There’s really nothing you can do there for ‘global health’ as it should be (with exception perhaps of AMR & a bit of global health security stuff/pandemic preparedness exercises to impress the Donald – a self-proclaimed germaphobe). By attending Klaus Schwab’s party, you instead lend legitimacy to a so called “multi-stakeholder” forum where global business & finance rules, nobody else. The right to health will always be a side show there. Even Johnson gets that “Davos” is a relic of the MDG era (as well as late-stage capitalism). I certainly hope it doesn’t survive the ‘20s.

This week’s Featured article is from Clara Affun-Adegbulu. She reflects on the painful Brexit election from last week.

Enjoy your reading. And see you all in 2020!

Kristof Decoster

Featured Article

Health, politics by other means

Clara Affun-Adegbulu (ITM)

One week on from the British elections, it is still a powerful talking point for people in the UK, from all parts of the political spectrum and both on social media and in real-life. The campaign was uncharacteristically divisive and acrimonious, so I suppose it was inevitable that whatever way the

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election went, some people would end up being very bitterly disappointed. I was one of them, having hoped against hope that a different party would win.

My reason for this is the widening inequality in general and in health in particular, which are linked to the decade-long austerity programme that the current Tory government put in place. Deep cuts to public spending have resulted in amongst others, a surge in food insecurity, homelessness and poverty, some of the most important determinants of health. Yet when I went back to read the winning party’s manifesto and examined their plans on health, I realised the focus was squarely on health systems strengthening activities such as increasing funding for the NHS, building and upgrading hospitals, recruiting and training more healthcare workers, increasing GP appointments, and improving service delivery. Although with politicians, one can never be sure that campaign promises will become policy, this is nevertheless laudable. However, it is not enough, because while the NHS is a system that the British people can be truly proud of, for many reasons, the truth is that the NHS by itself, cannot improve the health of the British population or substantially reduce health inequalities and inequities. As we know, health is not made in hospitals or in this case, health systems.

My disappointment has been worsened by the realisation that the Brexit drama is not over, by a long shot. The defining issue of the last three years, Brexit once again, took centre stage during the election campaign. In the immediate aftermath of the elections, the focus was on the campaigns run by the major parties, the winners and losers, the “shock results”, and how the conservatives, led by Boris Johnson, managed to win by such a wide margin. This then turned to conversations about the future of Labour and the Liberal Democrats, and the future of the United Kingdom itself. These are both very typical in the post-election period, and I was hoping the attention would soon turn to policymaking and implementation especially in health and social welfare. Unfortunately, this has not been the case, and Brexit is still dominating the agenda, to the exclusion of other important subjects like health.

While this all sounds very grim, the last few months in particular, have reminded me that health is political, and I have a stronger realisation that if I am to contribute to reduce inequalities, I must look beyond my research and engage more actively with political processes. I must never let apathy take over.

As someone who is naturally optimistic and always tries to see the glass as half full, I would like to end with some good news. It appears that there are signs and rumours of an impending end to the austerity years! I want this to be true and of course hope that it will very quickly begin remedying the effects of the last decade.

In the meantime however, A luta continua!

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Highlights of the week

IHP - Work-life balance and work-life joy in global health: Four regional perspectives and a Call to Action

Pragati Hebbar, Katri Bertram, Shehnaz Munshi & Guillermo Hegel;

https://www.internationalhealthpolicies.org/featured-article/work-life-balance-and-work-life-joy-in-

global-health-four-regional-perspectives-and-a-call-to-action/

As the end of the year is approaching fast now, these 4 authors (from different regions), all working in global health, launch a call to action on work-life balance and work-life joy. We hope all organisations an institutions will read it carefully.

Do share your own experiences, good practices, challenges, … either under the article or on Twitter – using the hashtags #worklifejoy #worklifebalance #globalhealth.

Global Health Governance

Vox - How McKinsey infiltrated the world of global public health

Julia Belluz & M Buissonniere; https://www.vox.com/science-and-

health/2019/12/13/21004456/bill-gates-mckinsey-global-public-health-bcg

“The Gates Foundation brought billions of dollars to the sector — and a business-friendly ethos consultants could exploit.” In case you didn’t read this brilliant piece of investigative journalism yet, do so asap. The read of the week.

Tweet: “How the Gates Foundation took on the "reform" of the World Health Organization (WHO) - hiring Boston Consulting Group & McKinsey.”

The piece sparked quite some Twitter traffic (see below – Tweets of the week).

Think Global Health - In Global Health, What’s Past Is Prologue

Ruth E. Levine; https://www.thinkglobalhealth.org/article/global-health-whats-past-prologue

“The global health community cannot jury-rig its way to the future and requires fresh thinking to address new challenges.”

Excerpt: “… the global health community is recognizing that the battle for better health in poor countries will not be won disease-by-disease, vaccine-by-vaccine. And it won’t be won by well-intentioned outsiders. … … Programs established to deal with particular diseases in particular ways are now being asked to align with host government priorities and improve systems. The delivery

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channels, procurement systems, and monitoring data that were created for a single purpose, once imagined to be time-limited, are now being asked to serve broader health systems long into the future…

… We need to take a hard look at the current architecture—the roles, responsibilities, and funding levels of different parts of the global health ecosystem—and figure out which parts have a permanent role and which ones should be gracefully phased out. We have to create governance structures that suit a moment of geopolitical flux. We have to think through how the funds now available can be best used to achieve the greatest health gains—not only in particular disease areas, but across all health conditions. And, most importantly, we have to find ways to work with low-income countries that have been dependent on development assistance for health so that they strengthen their own health systems and mobilize resources through effective taxation.”

The Telegraph - Wellcome Trust warns on returns as it pumps £1.1bn into good

causes – including treating snakebites

https://www.telegraph.co.uk/business/2019/12/17/wellcome-trust-warns-returns-pumps-11bn-

good-causes-including/?WT.mc_id=tmg_share_tw

(gated) “A populist backlash across the West has been driven by flatlining wages in the wake of the financial crisis, according to the £27bn Wellcome Trust. The trust - which uses income from its investments to pump hundreds of millions of pounds into medical research and other good work - said that returns could suffer in the 2020s as investors lose faith in capitalism. After taking into account inflation, wages in many countries are barely moved from their peak in 2008 before disaster struck. Wellcome's funds rose in value by 6.9pc to £26.8bn in the year to October. This allowed it to invest £1.1bn into projects including medical science and human health research, up from £723m last year. …”

(WHO) Alliance – Local evidence is essential for stronger health systems

https://www.who.int/alliance-hpsr/news/2019/local-evidence-stronger-health-systems/en/

“On 8 November 2019, the leadership team from the Alliance for Health Policy and Systems Research (HPSR) met with the Director-General and senior management of the World Health Organization to discuss the critical role that the Alliance plays in strengthening health systems around the globe. At the meeting, the Director-General, Dr Tedros Adhanom Ghebreyesus, underscored that strong health systems are the foundation for achieving universal health coverage (UHC). Prof David Peters, Chair of the Alliance Board, noted that HPSR is transdisciplinary research by its nature, which makes it well positioned to provide the needed evidence for achievement of UHC and the Sustainable Development Goals (SDGs)….”

“… In addition to its work across the organization, the Director-General encouraged the Alliance to be ambitious, emphasizing its country-level, demand-driven work. Ensuring that Member States are identifying and working toward their own priorities is of utmost importance to the Organization, and projects like the Country-led Implementation Research for Universal Health Coverage, which the Alliance has been coordinating in Nepal, Ethiopia and India, are good examples of this.”

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Devex – Uganda chosen to host Africa's biggest HIV conference amid LGBT

crackdown

https://www.devex.com/news/uganda-chosen-to-host-africa-s-biggest-hiv-conference-amid-lgbt-crackdown-96267

“In her plenary address at the International Conference on AIDS and STIs in Africa this month, Cindy Kelemi, executive director of the Botswana Network on Ethics, Law, and HIV/AIDS, called attention to missing political leadership in the HIV response. "In our beloved Africa, there are many countries with anti-LGBTI policies and laws," she told the audience in Kigali, Rwanda. "We need political leadership to remove political and structural barriers." The very next day, ICASA officials announced that Uganda — a country that has recently renewed a crackdown on its LGBT community — would host its 2021 conference, the largest gathering related to HIV/AIDS on Africa’s calendar.”

“…In that context, ICASA's selection of Uganda generated a mixed response from local and international activists, including Winnie Byanyima, UNAIDS’ new executive director, who called for the country to repeal its law criminalizing same-sex relations so that LGBT people can attend the conference….”

• PS: and for the fans: Mark Suzman (incoming CEO Gates Foundation, on Linkedin ) - A New Era of Collaboration in Philanthropy

On the new era of “philanthropic partnerships”. …“increasingly, philanthropic partnerships are figuring more prominently in our work. While this model isn’t entirely new, it’s an attractive way for philanthropists and philanthropic organizations to join forces, to align diverse perspectives, and to share knowledge and best practices to maximize impact….”

World Bank – IDA replenishment

Devex - World Bank hits IDA replenishment target despite smaller US pledge

https://www.devex.com/news/world-bank-hits-ida-replenishment-target-despite-smaller-us-pledge-

96226

(gated) “The World Bank has surpassed its funding target by ensuring commitments of $82 billion for the International Development Association, despite a lower pledge from the United States. The new commitments to the bank’s fund for low-income countries, announced in Stockholm on Friday, come from 52 countries, including six first-time donor governments. The countries collectively committed to raise $82 billion for IDA 19 — a record for the development finance institution and $7 billion more than it raised during the last IDA replenishment in 2016….”

See also a WB press release: Global Community Renews Commitment to the World’s Poorest

Countries with $82 Billion

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“A global coalition of development partners announced today their commitment to maintain momentum in the fight against extreme poverty, with $82 billion for the International Development Association (IDA), the World Bank’s fund for the poorest. The financing, which includes more than $53 billion for Africa, will help countries invest in the needs of their people, boost economic growth, and bolster resilience to climate shocks and natural disasters…”

See also a tweet Scott Morris:

“ @Morris_Scott : US now gives 50% more to @GlobalFund for three diseases than for all development needs in low-incomes via @WBG_IDA (and falling over time; meanwhile #China doubles IDA pledge & near zero to GF)”

And a related CGD blog - The US and China Have Very Different Takes on IDA and the Global Fund: Why that Matters for the Future of Multilateral Aid (by A Glassman & Scott Morris)

For the US as a donor: “…In an era when the overall envelope of donor contributions is not growing (at least from traditional donors—more on that later), the allocation of existing contributions has direct bearing on the multilateral institutions themselves. To put it bluntly, when it comes to fundraising from donors at a time of fixed resources, there will necessarily be winners and losers, with a decision to allocate more to one replenishment (Global Fund) most likely entailing a decision to reallocate away from another (IDA)….” Do read the whole blog.

Guardian - Debt in developing economies rises to record $55tn

https://www.theguardian.com/business/2019/dec/19/debt-in-developing-economies-rises-to-record-55tn

“Emerging market and developing economies (EMDEs) pushed their borrowing to a record $55tn (£42tn) last year, according to the World Bank, marking an eight-year surge that is the “largest, fastest and most broad-based in nearly five decades”. While much of the growth in debt levels was driven by China, the Washington-based development agency said most of the 100 countries covered by its analysis were affected, following an increased dependency on borrowing by both private and public sector organisations. The analysis in Global Waves of Debt, a study of the four significant episodes of debt accumulation since 1970, found the debt-to-GDP ratio of developing countries had climbed 54 percentage points to 168% since the debt buildup began in 2010….”

Global Fund

HPW - Global Fund Announces Record-High Funding Allocations To Countries To

Fight AIDS, TB and Malaria

https://www.healthpolicy-watch.org/global-fund-announces-record-high-funding-allocations-to-

countries-to-fight-aids-tb-and-malaria/

“After collecting a windfall of nearly US$14 billion in donor commitments in October, the Global Fund to Fight AIDS, TB and Malaria, on Wednesday published its blueprint to distribute most of the

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money to over 100 low- and middle-income countries worldwide, saying that allocations will increase by 23% over the next three years. Nigeria, Mozambique and the Democratic Republic of Congo are set to receive the largest awards with over $US 890 million, $US 751 million and $US 644 million respectively. according to the allocation plan published on the Global Fund website. Tanzania, Uganda, South Africa, Malawi, India and Zimbabwe would receive allocations of $US 500-US $600 million each, followed by grants ranging from tens of million to several hundred million dollars each to other qualifying African, Asian and Latin American countries, as well as Russia and former Soviet Union states. The allocation amounts represent thresholds against which countries then apply for final funding in one or all of the disease categories. The country allocations total some US$12.71 billion… … In addition, countries can also apply to a separate fund of US$890 million for so-called “catalytic investments” that aim to scale up specific aspects of HIV and TB prevention or treatment, as well as strengthening health services overall….”

“Most eligible countries will receive funding increases, the Global Fund said. Countries in Africa are receiving around US$2 billion more than in the previous period, and countries in West & Central Africa have the biggest increase – US$780 million. Worldwide, there are 32 countries with an increase of 40% or higher….”

See also the GF press release: Highest-Ever Funding Allocations Announced to Fight AIDS, TB and Malaria

And the new GFO issue - Global Fund announces $12.71 billion for 2020-2022 country allocations.

Coming up - WHO EB meeting

KEI - EB146: WHO proposes changes to the modalities of non-State actors’

engagement in WHO’s governing bodies

Balasubramaniam @ThiruGeneva ; https://www.keionline.org/32065

Already flagging one very tricky debate for the next WHO EB meeting. Warrants some “investigative

journalism” as well 😊

UNAIDS

UNAIDS Executive Director outlines her vision to the UNAIDS Board

https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2019/decemb

er/pcb45

“Winnie Byanyima, speaking at the first meeting of the UNAIDS Programme Coordinating Board (PCB) since her appointment as the UNAIDS Executive Director, has outlined her priorities for 2020. … … The Executive Director of UNAIDS said that UNAIDS would step up its work in four areas: women and girls in Africa; defending the human rights of everyone; putting science, innovation and

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technology in the hands of people; and financing the global AIDS response….” You find her full opening address here.

• See also a blog by M Pillinger - Byanyima's strategy: focus on injustice & innovation in the fight against HIV

“Last week, UNAIDS new Executive Director, Dr. Winnie Byanyima, announced the creation of a strategic advisory group to be co-chaired by Georgetown’s own Matt Kavanagh (along with Quarraisha Abdool Karim, Associate Scientific Director at CAPRISA, and Rico Gustav, Executive Director GNP+). ……. But the Global Health Policy & Politics Initiative is particularly excited by the opportunity to support the bold vision that Byanyima is laying out—one which merges a rights-based approach and a focus on innovation in service delivery to address inequality. …”

“She also called the global community out on two “collective failures”. One is the “failure to put equality at the center of our struggle;” the other, the “failure to put in place what we know works.””

Pillinger: “In June, we’ll be launching the HIV Policy Lab, a database that tracks key policies related to HIV prevention, testing, and treatment; human rights; and health systems strengthening across 194 countries. By measuring countries’ policies against global norms and standards, the Policy Lab will help advocates and policymakers visualize (literally and metaphorically) where reform is needed….”

• In less encouraging news, the Guardian reported UN #MeToo whistleblower sacked for alleged sexual and financial misconduct “Martina Brostrom, who accused senior UNAids official of sexual harassment, claims her dismissal is an act of ‘retaliation’”.

Lancet series on double burden of malnutrition

https://www.thelancet.com/series/double-burden-malnutrition

“The double burden of malnutrition is the coexistence of overnutrition (overweight and obesity) alongside undernutrition (stunting and wasting), at all levels of the population—country, city, community, household, and individual. This four paper Series explores how this coexistence is affecting low-income and middle-income countries. Malnutrition in its many forms has previously been understood and approached as a separate public health issue, but the new emergent reality is that undernutrition and overnutrition are interconnected and, therefore, double-duty actions that simultaneously address more than one dimension must be implemented for policy solutions to be effective. In addition to policy recommendations, the Series includes a focus on both historical and biological contexts, and new economic analysis.”

Do start with the Editorial - A future direction for tackling malnutrition

“…Malnutrition in its many forms has previously been understood and approached as a separate public health issue, but the new emergent reality is that undernutrition and overnutrition are interconnected and, therefore, double-duty actions that simultaneously address more than one dimension must be implemented for policy solutions to be effective….”

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Coverage for example in:

UN News - One third of poorer countries face both undernutrition and obesity: WHO report.

The Telegraph - WHO hits out at junk food companies as ‘twin-pronged’ nutrition crisis hits global growth and development goals

“The World Health Organization has hit out at the world's largest processed food manufacturers, accusing them of fuelling a new global health crisis. Modern diets are causing major obesity and under-nutrition challenges worldwide, according to a new four-paper series published today in The Lancet, in cooperation with the WHO. The series – entitled The Double Burden of Malnutrition – argues that dysfunctional food markets are endangering global growth and development as they do not efficiently deliver the nutrition that people need to grow and prosper. One the one hand, millions of children are growing up stunted for a lack of nutritious foods, while others are falling victim to a wide range of conditions and cancers linked to obesity because of an oversupply of junk food. The twin problems can co-exist in the same countries, communities and even households across both the developed and developing world. In a press conference organised to launch the Lancet paper, the WHO said multinational food giants were refusing to voluntarily reduce sugar and salt levels in food….”

UHC

Economist Intelligence Unit (Study) - Moving Universal Health Coverage from

Ambition to Practice

Economist Intelligence unit

“This Economist Intelligence Unit study analyses how 10 countries meet the goals of Universal Health Coverage in five key domains, including policy, health system resources, access and outcomes. Countries are allocated Traffic Lights, which we hope will serve as a starting point for further discussion on progress and gaps around UHC. The study was undertaken after an extensive literature review and consultation with an advisory board of experts in this field.”

ODI (blog) - Busting four myths about Universal Health Coverage

Emma Samman; https://www.odi.org/blogs/busting-four-myths-about-universal-health-coverage-0

Nice summary of the ODI report on the political economy of UHC in 49 countries.

Independent GFF observer – new 2019 scorecard on health financing in 27 GFF

implementing countries

https://africahbn.info/sites/default/files/resources/ahbn_2019_health_expenditure_domestic_spen

ding_scorecard.pdf

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Cfr. a Tweet: “ Only one country has reached the $86 minimum for #UHC and only two the Abuja target of governments spending 15% of total expenditure in health.”

Journal of Equity in Health - How is equity approached in universal health

coverage? An analysis of global and country policy documents in Benin and

Senegal

E Paul et al ; https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-019-1089-9

“Equity seems inherent to the pursuance of universal health coverage (UHC), but it is not a natural consequence of it. We explore how the multidimensional concept of equity has been approached in key global UHC policy documents, as well as in country-level UHC policies….”

Conclusion: “While equity is widely referred to in global and country-specific UHC policy documents, its multiple dimensions results in a rather rhetorical utilisation of the concept. Whereas equity covers various levels and types, many global UHC documents fail to define it properly and to comprehend the breadth of the concept. Consequently, perhaps, country-specific policy documents also use equity as a rhetoric principle, without sufficient consideration for concrete ways for implementation.”

Palliative Care

The London Economic - Study reveals just how unequal access to dignified

healthcare is at the end of people’s lives

https://www.thelondoneconomic.com/lifestyle/health/study-reveals-just-how-unequal-access-to-dignified-healthcare-is-at-the-end-of-peoples-lives/17/12/

“Just 14% of people around the world have access to top level palliative care services that allow them to die with dignity, a new study has found.”

“Researchers found more than half of the world’s population, mainly in low and middle-income countries, have very poor or non-existent access to palliative care. The study, led by the University of Glasgow, highlights that palliative care services are lagging behind the rapidly growing need for specialised care that can relieve suffering at the end of life. With an 87% increase in serious health-related suffering that can be relieved by palliative care services predicted by 2060, the research calls for a major review of global policies to promote palliative care….”

See also the section ‘Miscellaneous’ for more reads on dignified dying.

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Reflecting on 2019 & looking ahead to 2020

Or perhaps you can just look back on the entire decade. For example in this marvelous Longread from the Guardian - The age of perpetual crisis: how the 2010s disrupted everything but resolved nothing

Ending ominously: “…If you think the 2010s, our age of crises, have seen too much upheaval – or if you think things haven’t been shaken up enough – just wait.”

WHO on Medium – Global health bright spots 2019

https://medium.com/@who/global-health-bright-spots-2019-888bf800f108

Overview of bright spots structured along the ‘triple billion targets’ pillars of WHO’s Programme of Work. Plus a fit-for-purpose WHO.

I would be interested, personally, in a list of tricky issues & trends for global health to ponder as 2019 comes to a close. For example: (1) the Gates Foundation award for Modi; (2) increasing (and long overdue) backlash against philanthropy (see Anand Giridharadas et al); (3) the entire – euhm, reasonable - world is screaming for a climate emergency, quid WHO? (4) What about global health leaders’ stance versus authoritarian regimes with ever less “constraints” (India, China, …) and flawed democracies going rogue? (It’s sad football players (like Özil) and clubs (see FC Cologne ) show more moral courage than many global health leaders) I’m sure there are many more of these issues to ponder.

Lancet Editorial - Health and medicine in 2019: what have we learned?

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)33138-1/fulltext

This (great) Editorial goes in this direction, asking also some of the more difficult questions.

“2019 has been a tumultuous year in health and medicine. This week's World Report reviews some of the major global events. …. … Major research efforts supported by The Lancet in 2019 focused on the intersection between climate change, nutrition, and health…. … Events this year have shown how closely politics and health are interconnected and how tension can run high….”

The Editorial also draws some important lessons from this year, among others on the rise of a well-informed civil society, and the need to continuously recalibrate our definitions of health.

Do check out the Lancet World Report - 2019: a year in review

On: vaping & lung injury, Ebola – a PHEIC; climate emergency; US migrant crisis; healthy China; measles worldwide; Sidibé & UNAIDS; US opioid payouts; UN HL meeting on UHC; dengue resurgence, Nairobi summit on ICPD25.

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Links:

One - The most important health wins of 2019.

Gates Foundation - 2019 in review.

Global Refugee Forum (17-18 December, Geneva)

The aim was: “The first Global Refugee Forum comes at the end of a tumultuous decade in which the number of refugees has risen to over 25 million people worldwide. Guided by the Global Compact on Refugees, the Global Refugee Forum is an opportunity to translate the principle of international responsibility-sharing into concrete action. The Forum [will] showcase impactful pledges and contributions and the exchange of good practices.”

The Forum is supposed to take place every four years.

Some reads related to this Forum in Geneva:

• The New Humanitarian - Three tests for the Global Refugee Forum

This analysis tells it like it is. “Speaking ‘frankly about challenges’ may be easier said than done.”

“… Scheduled to take place every four years, the gathering, which runs Monday through Wednesday, has two specific objectives. The first is to provide a platform to announce pledges and contributions of financial, material, or technical support, as well as refugee resettlement places and other safe and legal routes to asylum. The second is to facilitate the exchange of good practices and lessons learned, focusing particularly on education, jobs and livelihoods, energy and infrastructure, protection capacity, and solutions. The GRF follows the adoption of the Global Compact on Refugees by UN member states a year ago, the culmination of a process initiated in 2016 by the UN secretary-general to address the increasingly thorny issues related to large-scale movements of refugees and migrants.”

Excerpt: “… While the GRF has generated an enormous amount of interest within and beyond the humanitarian community, a number of important questions remain. First, while UNHCR has an understandable determination to accentuate the positive by focusing on achievements and contributions, it remains to be seen if the meeting will also, in Grandi’s words, “speak frankly about challenges”. Will the GRF, for example, reflect upon the EU’s role in returning refugees to detention and death in Libya, on the systematic efforts by President Donald Trump’s administration to exclude refugees and asylum seekers from the United States, or on the cruelty of Australia’s offshore processing? And will there really be an open discussion on the pressures being employed to induce the premature repatriation of Burundian refugees in Tanzania, Rohingya refugees in Bangladesh, and Syrian refugees in Lebanon?...”

• Coverage of the event via Devex - Why education stole the show at the Global Refugee

Forum

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“How to finance and deliver education for refugees has taken center stage at this week’s Global Refugee Forum in Geneva as many organizations pledge to do more.”

• A tweet: “Just looked through the 28-page programme of the Global Refugee Forum. First impression: lots of emphasis on education, self-reliance, jobs, inclusion & energy, but not a lot on the right to seek asylum, reception conditions, refoulement, detention or externalization.”

• Euractiv - UN hails ‘decisive shift’ in refugee assistance at global meet

“The UN hailed Wednesday (18 December) a “decisive shift” in the approach to helping surging numbers of displaced people, after a summit ended with billions in donations and concrete promises to simplify refugee integration….” Among others: “UNHCR said it had received a number of major financial pledges, including more than $4.7 billion by the World Bank Group, and $1.0 billion from the Inter-American Development Bank. In addition, a broad range of states and other entities had jointly pledged more than $2.0 billion to support refugees and host communities….”

See also Devex - World Bank pledges $2.2B for refugees and host communities.

“…The bank recognizes that there is an increasing overlap between development and humanitarian issues, said Axel van Trotsenburg, the World Bank’s managing director of operations, during the Global Refugee Forum in Geneva, where the funding was announced….”

• Devex - Can the Global Refugee Forum deliver what the UN compact is missing?

“ As the first Global Refugee Forum gets underway in Geneva, refugee advocates are holding out for concrete commitments and accountability mechanisms to put the Global Compact on Refugees into action….”

And a link from earlier this week. Devex - Opinion: 5 tests for success at the Global Refugee Forum

PS: a Lancet Editorial pays attention to the plight of the Rohingya people this week - The Rohingya

people: past, present, and future whose situation is utterly neglected.

Ebola DRC

Some links from this week:

The Telegraph - Experts breathe sigh of relief as WHO say Ebola patient was not reinfected with the

deadly disease

“There is relief in Democratic Republic of Congo as authorities have said that a man thought to be reinfected with the Ebola virus was in fact suffering from a “resurgence” of the disease - that is, the

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virus was still lurking in his immune system. There was alarm last week among experts when the first reports came through that a patient had died after catching the deadly virus a second time - a case of reinfection with Ebola has never been documented and survivors are thought to be immune. A post mortem confirmed that the man died because of a resurgence of the disease rather than a reinfection….”

Cidrap News - (Dec 16) More violence in Beni as DRC tracks new Ebola cases

HPW (Dec 13) - Ebola Surges After Attacks On Healthcare Workers

“ The number of new Ebola virus cases in the ongoing outbreak in the Democratic Republic of the Congo shot up to 27 confirmed cases in the last week, triple the number of 9 confirmed cases reported between 27 November to 3 December. The recent surge in cases comes in the wake of insecurity and a series of violent attacks on Ebola workers that froze the response….”

BMJ Global Health Commentary – Ebola and the narrative of mistrust

E Richardson et al ; https://gh.bmj.com/content/4/6/e001932

Fabulous read. “Transmission of Ebola virus in West Africa and the Democratic Republic of the Congo has been traced to local people’s belief in misinformation and low trust in institutions. But such analyses—and others—of Ebola transmission employ bourgeois empiricist methodologies and draw from a mental map whose contours are shaped by coloniality. By tracing human rights failings to the impoverished discursive infrastructure of objectivist epidemiology, we can transform global health by transforming its representations.”

A quote: “It is unlikely one will find an article from the WHO describing multinational corporations (eg, mining companies) as superspreaders, since conventional epidemiologists would likely deem such an analysis ‘political’ or ‘unscientific’. Those mining companies continue their predatory accumulation unchecked,6 contributing to the underdevelopment of health and other public service systems, bolstered by research paradigms that fixedly construe them as outside the domain of ‘evidence-based’ global health research or action….”

They conclude: “Epistemic reconstitution may be challenging to accomplish, and it may fail in the face of funders who would rather not face the implications of looking beyond the individual as a vector of disease, since this could question the very accumulation of wealth they depend on. Nonetheless, those of us who take on the task of explaining to the world why they are sick are in danger of becoming something more than ‘prisoners of the proximate’ (ie, methodologists who understand the determinants of human health in terms of downstream, individual-level risk). Without change, we risk becoming the apparatchiki—the agents of the apparatus—of global health apartheid by decoupling analyses of power from disease dynamics.”

Lancet Letter – Ebola response and community engagement: how to build a

bridge?

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32532-2/fulltext

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Co-authored by J-J Muyembe. “… several teams have succeeded in managing the response and have defended that they have made every effort to involve the community, but without much success. This raises the question of whether the community engagement is understood in the same way by all stakeholders, and how will the management of the epidemic in an active conflict zone be perceived by international, national, and local actors? International and national actors have never confronted such a complex crisis, and local actors have never confronted a disease with a transmission potential as high as Ebola. What does the community think about this notion of community involvement? Deciphering the discrepancies in perceptions of community involvement between different actors and the community will lead to short-term operational consequences on the dynamics of the current EVD outbreak….”

Stat News – FDA approves an Ebola vaccine, long in development, for the first time

https://www.statnews.com/2019/12/19/fda-approves-an-ebola-vaccine-long-in-development-for-the-first-time/

“The Food and Drug Administration announced Thursday it has approved an Ebola vaccine developed by Merck, making it the first for the deadly disease approved in the United States. The vaccine, Ervebo, protects against Zaire ebolaviruses, the species of the virus that has been the most common cause of Ebola outbreaks. Ebola Zaire is the virus responsible for the current long-running outbreak in the Democratic Republic of the Congo. The FDA’s decision follows similar action taken earlier by the European Commission, which licensed the vaccine on Nov. 11….”

New resource: WHO Health Emergency Dashboard

https://extranet.who.int/publicemergency

Dazzling new resource that gives the overview of WHO’s Health Emergency activities all over the world. “The World Health Organization (WHO) Health Emergency Dashboard is a platform which aims to share information about public health events and emergencies. The data on the dashboard is refreshed every fifteen (15) minutes and data is accurate as at time of refreshing….”

COP 25 (Madrid)

UN SG Guterres was disappointed himself of the underwhelming outcomes of COP25, and the expression ‘COP-out’ went viral, that tells you all you need to know. Let’s hope Glasgow next year will provide the breakthrough (and raised ambition) needed.

Some overall analyses:

Climate home news - Cop25 Bulletin: The future of climate talks

https://www.climatechangenews.com/2019/12/15/cop25-bulletin-future-climate-talks/

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Excerpts: “… At Cop25, a few nations – Brazil, the US, Saudi Arabia and Australia in particular – were emboldened as never before to stand against the world and nakedly try to weaken efforts to tackle climate change to benefit their short term interests. Call this, if you like, the Trump effect. The US president has blown apart the assumption that opprobrium from fellows will foment a race to the top on climate. On the flip side, a far larger number of governments held firm; preferring to see no deal, than what they viewed as a bad deal. Call that the Greta effect. Certainly more leaders than ever feel their electoral futures are tied directly to their efforts on climate change….”

“Regardless of what happens to individual governments in the coming months and years, polarisation is the future of climate politics. Even as the impacts of climate change rain down harder, making citizens’ demands grow more potent, resistance from those who see action, not warming, as their existential threat will grow more desperate….”

Climate Home News – Cop25: What was achieved and where to next?

https://www.climatechangenews.com/2019/12/16/cop25-achieved-next/

Must-read. “After two weeks of talks, many issues remain unresolved. Here we break down the major fights and minor breakthroughs of the UN conference in Madrid.” On ambition, global carbon market, double counting, loss and damage, and much more.

Planetary Health

Guardian - India suffers most pollution-linked deaths in world, study finds

https://www.theguardian.com/world/2019/dec/19/india-suffers-most-pollution-linked-deaths-in-

world-study-finds

“India leads the world in pollution-linked deaths– followed by China and Nigeria – according to a report published on Wednesday that estimated the global impact of contaminants in the air, water and workplace. The report by the Global Alliance on Health and Pollution (GAHP) found pollution to be the largest environmental cause of premature death on the planet, causing 15% of all deaths – some 8.3 million people. Among the 10 countries with the most pollution deaths in 2017, the latest year for which data was available, were some of the world’s largest and wealthiest nations, as well as some poorer ones. India and China led in the number of pollution deaths, with about 2.3 million and 1.8 million respectively, followed by Nigeria, Indonesia and Pakistan….”

“Chad, Central African Republic and North Korea saw the highest number of deaths per 100,000 people (287, 251 and 202 respectively)…”

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TB

HPW - WHO Recommends Worldwide Adoption Of All Oral-Regimen For MDR/RR-

TB

https://www.healthpolicy-watch.org/who-recommends-worldwide-adoption-of-all-oral-regimen-

for-mdr-rr-tb/

News from last week. “The World Health Organization issued new guidelines for the treatment of multi drug-resistant (MDR) tuberculosis on Wednesday, prioritizing for the first time an all-oral treatment regimen. The new treatment recommends replacing the painful injectable drugs that patients had to endure under previous treatment guidelines with a shorter course of oral bedaquiline – one of only three new drugs approved for treatment of TB within the last half century. The update was announced in a rapid communication released by WHO after an independent panel reviewed new evidence on treating multi-drug resistant (MDR) and rifampicin-resistant (RR) TB in November….”

Cholera

WHO - Drop in cholera cases worldwide, as key endemic countries report gains in

cholera control

WHO;

“The number of cholera cases decreased globally by 60% in 2018, the World Health Organization (WHO) announced in a report that points to an encouraging trend in cholera prevention and control in the world’s major cholera hotspots, including Haiti, Somalia and the Democratic Republic of the Congo….”

““The global decrease in case numbers we are observing appears to be linked to large-scale vaccination campaigns and countries beginning to adopt the Global Roadmap to 2030 strategy in their national cholera action plans,” said Dr Dominique Legros, who heads WHO’s cholera programme in Geneva. “…”

NCD Policy cube

Healthy Societies - The NCD Policy Cube: representing the strength of policy

environments to combat NCDs

https://www.healthysocieties2030.org/ncds/ncd-policy-cube

“The NCD "Policy Cube", developed as part of the PA4NCDs project, brings together three axes to assess the strength of a policy framework to combat diet-related NCDs: comprehensiveness,

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effectiveness and equity. The fuller the cube, the more robust the policy framework for the prevention and control of NCDs….”

“As part of the PA4NCDs project researchers across six countries have reviewed these elements of national-NCD policy and created a policy cube to reflect the strength of the national policy response, which you can find below….”

Cfr a tweet:

“The #NCDCube shows variation in comprehensiveness & effectiveness of policies - but in all 6 study countries, there is serious & concerning neglect of #equity, #gender and #HumanRights rights in #NCD policy.”

Global Tobacco – Turning point?

WHO - WHO launches new report on global tobacco use trends

https://www.who.int/news-room/detail/19-12-2019-who-launches-new-report-on-global-tobacco-

use-trends

“For the first time, the World Health Organization projects that the number of males using tobacco is on the decline, indicating a powerful shift in the global tobacco epidemic. The findings, published today in a new WHO report, demonstrate how government-led action can protect communities from tobacco, save lives and prevent people suffering tobacco-related harm. “Declines in tobacco use amongst males mark a turning point in the fight against tobacco,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. …”

Coverage for example in UN News: UN health agency signals tobacco might be reaching burn-out among men

“In 2018, there were slightly more than a billion males using tobacco around the world, “over 40 million more than in the year 2000,” he said. “But now for the first time, we are seeing declines in use, with WHO projecting that there will be at least two million fewer men using tobacco in 2020, and five million less by 2025.” Describing the development as a “powerful shift in the global tobacco epidemic” in view of the fact that more than four in five smokers are male, Dr Krech explained that it mirrors “consistent reductions” by 100 million women since the turn of the century….”

HPW - Tobacco Use Projected To Decline Among Men Worldwide In 2020; But Shift To E-Cigarettes Unknown Factor

“ For the first time in two decades, tobacco use is projected to decline among men in 2020, according to a new World Health Organization report on trends in global tobacco use. However, the new report does not consider trends in e-cigarette use, where use may in fact be increasing….”

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Gambling

Lancet – Offline: Gambling—“We are everywhere, we see everything”

R Horton; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)33152-6/fulltext

Horton comes back on last week's Global Health Lab, held at the London School of Hygiene & Tropical Medicine. Topic: gambling.

“… If we truly want to tackle gambling, we will have to rethink fundamental assumptions about the way our societies and their economies are structured….”

“All three speakers at last week's Global Health Lab conveyed the utter evil of an industry that does indeed prey on those facing social peril and financial precarity. Gambling is not taken seriously enough by the global health community. It is a world we don't see and still less understand. But as the gambling industry itself says: “We are everywhere, we see everything.” It's time we shed our ignorance.”

The right to health

HHR - Challenges in Promoting the Interdependence of all Human Rights

Dainius Puras; https://www.hhrjournal.org/2019/12/challenges-in-promoting-the-interdependence-

of-all-human-rights/

“I am taking the opportunity presented by this series of reflections on the right to health to comment on my experiences as the UN Special Rapporteur on the right to health, especially as I am now entering the final year of this mandate….”

“…In the current political economy, human rights are often used selectively. It is crucial to counteract this by stressing the indivisibility and interconnectedness of all human rights. We are witnessing rising populism and nationalism in many countries. This can result in a combination of some improvement in social and economic rights (addressing poverty, providing better healthcare), and at the same time shrinking space for civil society, and restricting civil and political rights and freedoms. In my missions to countries and in reports, I have warned that such a selective approach to human rights will not be helpful in achieving the Sustainable Development Goals (SDGs), including Goal 3 (ensure healthy lives and promote wellbeing for all at all stages). To fully achieve this goal, people need to be empowered to take control and ownership of their lives and their health, which also requires democracy and space for civil society. Realization of the right to physical and mental health is absolutely dependent on realization of all human rights. I can illustrate this interdependence of rights with two important issues: the right to health in childhood, and the right to mental health….”

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UK election & global health/DFID/…

Some reads on the (likely) impact of the UK election on a number of health/development related issues (health worker migration, DFID, NHS, …), in the UK and abroad :

IHP - Will the 2019 UK Election impact on the health workforce in Africa? Feels

like a rhetorical question…

J A Asamani et al ; https://www.internationalhealthpolicies.org/blogs/will-the-2019-uk-election-

impact-on-the-health-workforce-in-africa-feels-like-a-rhetorical-question/

Interesting blog by WHO Afro staff.

Devex - Future of DFID hangs in the balance after Conservative landslide

https://www.devex.com/news/future-of-dfid-hangs-in-the-balance-after-conservative-landslide-

96225

“The fate of the U.K. Department for International Development appears more uncertain than ever after aid-skeptic Boris Johnson’s Conservative party secured a decisive majority in Thursday’s election. The landslide victory, which saw the Conservatives win 365 seats in parliament — the party’s biggest majority since the 1980s — reignited fears that the prime minister could merge DFID with the Foreign & Commonwealth Office. Johnson has previously said he wants Britain’s $14.5 billion aid budget to come under the foreign secretary and be spent more in line with the country’s “national interest.”…”

There’s clearly a lot of animosity (and opposition) about/against this possible merger. See the Independent - More than 100 charities join senior Tories in urging Boris Johnson to abandon plans to axe foreign aid department.

Or the Guardian - Aid groups warn Boris Johnson against combining DfID with Foreign Office Among others, making the claim that 2020 would be a particularly dumb year to do this, the same year the UK is hosting the UN climate summit. But it sounds like a “near done” deal…

Do check out also an interesting (comparative) read in Devex - What happens when an aid department is folded?

“If the merger goes ahead, it would not be the first country to undergo such a shift. Devex spoke to experts in Canada, Australia, and Norway, where aid agencies have already been merged with their foreign affairs ministries, to find out what impact it had.” In Norway (sort of a hybrid model), it seems to have worked out best. Australia was the most disastrous.

• Martin McKee in a BMJ Editorial : What does Boris Johnson’s victory mean for the NHS?

His message: ‘Don’t look to the manifesto for answers’.

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Access to Medicines

WHO - WHO prequalifies first biosimilar medicine to increase worldwide access

to life-saving breast cancer treatment

https://www.who.int/news-room/detail/18-12-2019-who-prequalifies-first-biosimilar-medicine-to-

increase-worldwide-access-to-life-saving-breast-cancer-treatment

“Today the World Health Organization (WHO) prequalified its first biosimilar medicine – trastuzumab – in a move that could make this expensive, life-saving treatment more affordable and available to women globally. Breast cancer is the most common form of cancer in women. … … Trastuzumab – a monoclonal antibody – was included in the WHO Essential Medicines List in 2015 as an essential treatment for about 20% of breast cancers. It has shown high efficacy in curing early stage breast cancer and in some cases more advanced forms of the disease….”

Coverage in the Guardian - Low-cost breast cancer drug 'could save lives in low income countries'

“World Health Organization approved cheap version of ‘essential medicine’ Herceptin.”

Vaccines

Devex - Is the world ready for an HIV vaccine?

https://www.devex.com/news/is-the-world-ready-for-an-hiv-vaccine-96186

“Nearly 40 years after HIV was discovered, scientists are cautiously optimistic they are on the brink of a vaccine effective enough to roll out on a wide scale. Results from advanced vaccine trials are expected in the coming years. But even if an effective vaccine is found — is the world ready to roll it out? That’s the question some researchers and advocates are asking, warning that the global health community needs to lay the groundwork in expectation of good results, in order to avoid delays of a vaccine rollout and consequently increased infections that could have been prevented with a vaccine….”

“… Now, there are three advanced vaccine trials. Results from two of the vaccine trials are expected in 2022. If a vaccine is found at least 50% efficacious — the percent reduction in the contraction of the disease in vaccinated individuals compared to people not vaccinated — it could trigger efforts to license a vaccine and then roll it out. If any of these vaccines show above 50% efficacy in the coming years, it could be on the market in less than a decade, Corey said….”

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AMR

Lancet - Antibiotic exposure among children younger than 5 years in low-income

and middle-income countries: a cross-sectional study of nationally representative

facility-based and household-based surveys

G Fink et al; Lancet;

Perhaps not very surprising, but shocking nonetheless. Children under 5 in LMICs get prescribed huge amounts of antibiotics, many of them unnecessary.

HIV

Scientists call for government action to control and treat unprecedented outbreak

of childhood HIV in Pakistan

Based on this new study in the Lancet Infectious Diseases - HIV infection predominantly affecting children in Sindh, Pakistan, 2019: a cross-sectional study of an outbreak

Via the press release:

“The HIV outbreak in Pakistan is unprecedented in terms of the proportion of young children affected, mostly under 5-years-old. It represents a 54% increase in paediatric diagnoses over the past 13 years, according to an observational study of more than 30,000 people in the town of Ratodero, published in The Lancet Infectious Diseases journal. The results, which are the first scientific report on the outbreak, appear to confirm observations by a government taskforce that HIV was mostly transmitted to children as a result of health care providers using contaminated needles and blood products. …”

Coverage in the Guardian - Pakistani children infected with HIV 'exposed to unsafe jabs'

“More than 700 children in Pakistan were infected with HIV, the virus that can cause Aids, through unsafe injections to treat them for conditions such as diarrhoea and through contaminated blood donations, according to an investigation. Until single-use, safe needles are introduced worldwide, which the World Health Organization says must happen by the end of 2020, experts say oral medicines should be the first choice wherever possible. They call for urgent action to improve infection control, the running of blood banks and the regulation of clinics in Pakistan. Most of the affected children were given injections with contaminated, re-used needles….”

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Some papers of the week

BMJ Global Health - Never let a crisis go to waste’: post-Ebola agenda-setting for

health system strengthening in Guinea

D Kolie et al; https://gh.bmj.com/content/4/6/e001925

“Guinea is a country with a critical deficit and maldistribution of healthcare workers along with a high risk of epidemics' occurrence. However, actors in the health sector have missed opportunities for more than a decade to attract political attention. This article aims to explain why this situation exists and what were the roles of actors in the agenda-setting process of the post-Ebola health system strengthening programme. It also assesses threats and opportunities for this programme's sustainability….” Using Kingdon’s framework.

IJHPM - Monitoring Sustainable Development Goals 3: Assessing the Readiness of

Low- and Middle-Income Countries

Joy B Nabukalu et al ; « http://www.ijhpm.com/article_3725.html

“The Millennium Development Goals (MDGs) availed opportunities for scaling up service coverage but called for stringent monitoring and evaluation (M&E) focusing mainly on MDG related programs. The Sustainable Development Goals 3 (SDGs) and the universal health coverage (UHC) agenda present a broader scope and require more sophisticated M&E systems. We assessed the readiness of low- and middle-income countries to monitor SDG 3….”

Their conclusion: “ There are common challenges confronting M&E at county-level. Countries have omitted key indicators for monitoring components of the SDG 3 targets especially those on NCDs and injuries. The role of other sectors in monitoring SDG 3 targets is not adequately reflected. These could be bottlenecks to tracking progress towards SDG 3 if not addressed. Beyond providing compendium of indicators to guide countries, we advocate for a more binding minimum set of indicators for all countries to which they may add depending on their context. Ministries of Health (MoHs) should prioritise M&E as an important pillar for health service planning and implementation and not as an add-on activity.”

Globalization & Health - Circular economy and environmental health in low- and

middle-income countries

C Y Wright et al ; https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-019-0501-y

« The circular economy framework for human production and consumption is an alternative to the traditional, linear concept of ‘take, make, and dispose’. Circular economy (CE) principles comprise of ‘design out waste and pollution’, ‘retain products and materials in use’, and ‘regenerate natural systems’. This commentary considers the risks and opportunities of the CE for low- and middle-income countries (LMICs) in the context of the Sustainable Development Goals (SDGs), acknowledging that LMICs must identify their own opportunities, while recognising the potential positive and negative environmental health impacts….”

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Globalization & Health - Health for all by all-pursuing multi-sectoral action on

health for SDGs in the WHO Eastern Mediterranean Region

A Al-Mandhari, A Ghaffar et al ; https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-019-0504-8

More preparation for Dubai.

“…The WHO Regional Office for the Eastern Mediterranean Region, through Vision 2023, aims at addressing these determinants by adopting an equity-driven, leaving no one behind approach. Advocating for Health in All Policies, multi-sectoral action, community engagement, and strategic partnerships are the cornerstone for this approach….”

Globalization & Health - Financing intersectoral action for health: a systematic

review of co-financing models

F McGuire et al ; https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-019-0513-7

« …This study aimed to identify and characterise cross-sectoral co-financing models, their operational modalities, effectiveness, and institutional enablers and barriers. »

Conclusion: “Co-financing remains in an exploratory phase, with diverse models having been implemented across sectors and settings. By incentivising intersectoral action on structural inequities and barriers to health interventions, such a novel financing mechanism could contribute to more effective engagement of non-health sectors; to efficiency gains in the financing of universal health coverage; and to simultaneously achieving health and other well-being related sustainable development goals. »

IJHPM - Where Do We Start? Building Consensus on Drivers of Health Sector

Corruption in Nigeria and Ways to Address It

O Onwujekwe, D Balabanova et al ; http://www.ijhpm.com/article_3723.html

“Corruption is widespread in Nigeria’s health sector but the reasons why it exists and persists are poorly understood and it is often seen as intractable. We describe a consensus building exercise in which we asked health workers and policy-makers to identify and prioritise feasible responses to corruption in the Nigerian health sector….” “… Participants identified 49 corrupt practices from the literature review and their own experience as most important in the Nigerian health system. The NGT prioritised: absenteeism, procurement-related corruption, underthe-counter payments, health financing-related corruption, and employment-related corruption. This largely reflected findings from the literature review, except for the greater emphasis on employment-related corruption from the NGT. Absenteeism, Informal payments and employment-related corruption were seen as most feasible to tackle. …. .”

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BMC Public Health - The coin model of privilege and critical allyship: implications

for health

S A Nixon; https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7884-9

“The goal of this article is to advance understanding and action on health inequities and the social determinants of health by introducing a framework for transformative change: the Coin Model of Privilege and Critical Allyship….” “First, I introduce the model, which explains how social structures produce both unearned advantage and disadvantage. The model embraces an intersectional approach to understand how systems of inequality, such as sexism, racism and ableism, interact with each other to produce complex patterns of privilege and oppression. Second, I describe principles for practicing critical allyship to guide the actions of people in positions of privilege for resisting the unjust structures that produce health inequities. The article is a call to action for all working in health to (1) recognize their positions of privilege, and (2) use this understanding to reorient their approach from saving unfortunate people to working in solidarity and collective action on systems of inequality.”

WHO Alliance - New database of Alliance-supported publications

https://www.who.int/alliance-hpsr/news/2019/new-publications-database/en/

This database was launched last week. “The database currently contains around 600 outputs from Alliance grantees or from work commissioned or undertaken by the Alliance. The outputs include journal articles, project documents, manuals and guides, news and commentary, annual reports, flagship reports, research issues and briefing notes. The database will serve as an open repository of knowledge products aimed at strengthening health systems, underpinned by the Alliance’s principles of equity, collaboration, systems thinking and leadership.”

BMC Public Health - Going upstream – an umbrella review of the macroeconomic

determinants of health and health inequalities

Y Naik et al ; https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7895-6

« The social determinants of health have been widely recognised yet there remains a lack of clarity regarding what constitute the macro-economic determinants of health and what can be done to address them. An umbrella review of systematic reviews was conducted to identify the evidence for the health and health inequalities impact of population level macroeconomic factors, strategies, policies and interventions….”

HHR (Viewpoint) – The Maturing Right to Health: Deeper, Broader and More

Complex but Still Unequal

G MacNaughton; https://www.hhrjournal.org/2019/12/the-maturing-right-to-health-deeper-broader-and-more-complex-but-still-unequal/

“Looking back over the past 25 years, the right to health has matured in healthy ways. It is deeper, broader and considerably more complex. From a narrow focus on freedoms, such as nondiscrimination and privacy, the right to health has grown to encompass a broad range of

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entitlements, including universal health care and the underlying or social determinants of health. From a siloed right of interest to a few lawyers, the right to health has come to be understood as requiring an interdisciplinary approach, involving experts in many disciplines—most notably health professionals—to fully realize the right for all. This broad and complex understanding of the right to health is also reflected in the United Nations Sustainable Development Agenda 2030 as Goal 3: “Ensure healthy lives and promote well-being for all at all ages.” All of these advancements are worthy of celebration….”

You might also want to read (in the same journal) - A Letter to Young and Future Leaders in Struggles

for Health Rights and Social Justice (by A E Yamin)

Some blogs & mainstream articles of the week

IDS Bulletin - The Belt and Road Initiative and the SDGs – how China can help

achieve equitable, sustainable development by 2030

https://www.ids.ac.uk/news/the-belt-and-road-initiative-and-the-sdgs-how-china-can-help-achieve-

equitable-sustainable-development-by-2030/

“The actions of China’s ‘project of the century’, said to span 67 countries and be worth between eight and nine trillion dollars, will be critical to whether climate change goals and the SDG 2030 deadline – now just ten years away – are to be met. A new IDS Bulletin ‘The Belt and Road Initiative and the SDGs: Towards Equitable, Sustainable Development’, examines the impact of BRI on environmental and social standards and how it can act as a critical link to delivering the 2030 Agenda.”

Devex - Scale of urban sanitation crisis is underestimated globally, new report

shows

https://www.devex.com/news/scale-of-urban-sanitation-crisis-is-underestimated-globally-new-

report-shows-96251

“The scale of the urban sanitation crisis is underestimated globally, according to a new report released Wednesday by the World Resources Institute. … … In the report, researchers analyzed 15 cities in sub-Saharan Africa, South Asia, and Latin America, which account for a population of about 101 million people. They found that on average, 62% of sewage and fecal waste is unsafely managed, which can include ineffective septic tanks, open defecation, shoddily constructed and flooded pit latrines, as well as open sewers….”

F2P blog - What is behind the Global Crackdown on Civil Society? In Conversation

with Dom Perera and Tonu Basu

https://oxfamblogs.org/fp2p/30502-2/

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“Last week I went along to the launch of People Power Under Attack 2019, the latest output of the Civicus Monitor project on the state of civil society organizations around the world. Afterwards, I picked the brains of two of the speakers, Dom Perera of Civicus, and Tonu Basu of Open Government Partnership. Here are a few of their insights…”

Main findings: “The big finding this year is that just 3% of the world’s population live in countries that have open civic space, which is our top rating, down from 4% last year. We’ve seen some big downgrades – Australia and Malta losing their gold rating. We’ve also seen a massive bloating in the ‘repressed’ category, the second lowest, after the downgrade of India and Nigeria. So across the world, the picture is of civil society under attack. It’s quite bleak….”

Think Global Health - The Lost Cities and Towns of Asia and Africa

T Bollyky ; https://www.thinkglobalhealth.org/article/lost-cities-and-towns-asia-and-africa

“A global definition of cities means better understanding of local urban health.”

“…New research from the European Commission (EC) suggest, however, that the United Nations (UN) World Urbanization Prospects, long considered the authoritative measure of global urbanicity, have grossly underestimated the share of people in Africa and Asia who live in towns and cities. Using a combination of high-resolution satellite imagery, remote sensing, and census data, these European Commission researchers, led by Lewis Dijkstra, estimate that East Africa and Southern Asia are roughly twice as urban as the UN data indicate….”

F2P blog - What if families & friends are the main source of Social Protection?

F2P;

Cfr tweet: “Family is the first responder. Important blog on informal social protection in #Africa where - despite aid stereotypes - most families look after themselves.”

“Most discussion about ‘social protection’ focusses on programmes run by aid donors or governments, but that misses out on an awful lot. Some of my LSE students are doing a project for Oxfam on ‘informal forms of social protection’ – what families and communities are doing to build their resilience against shocks (accidents, unemployment, crop failure etc) in countries like DRC and Somalia. I suggested going back to Portfolios of the Poor, and talking to ODI, but what else would people recommend? Has anyone used diaries or ethnography to unpack what is going on?

In that vein, I was struck by a really lovely piece in this week’s Economist arguing that ‘in much of Africa the family is bank, business and welfare state’. …”

Katri Bertram (blog) - Compassion in Global Health

https://katribertram.wordpress.com/2019/12/17/compassion-in-global-health/

Poignant blog with a message to keep in mind the whole year, not just at this time of the year.

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Among others, she wonders whether compassion in global health needed to deliver results? The answer is yes. And concludes: “…In the global health work place, this same culture of compassion should apply. Otherwise, we will be like organizations advocating for gender equality that allow gender pay gaps and gender harassment to flourish internally. We’ll hollow out, and forget what we stand for. Global health that only serves ourselves is not global health. That’s just ego. Time to bring compassion and humility back in.”

Some tweets of the week

All are related to the McKinsey/Boston consulting & global health Vox article:

R Horton – “WHO has reached out to say this article isn’t fully fair. WHO argues that the amount spent on consultants ($12m over 3y) is reasonable given its $6bn size; consultants are fully accountable to WHO’s leadership; that WHO operates results-based not input-based reporting. Views?”

“Indeed. My additional point to WHO is that surely WHO does not need to outsource to management consultants when it has the whole global health community to draw on and partner with. Look to those who inherently support you rather than those who want to make money out of you.”

Laurie Garrett: “There's been a lot of justifiable buzz abt this powerful piece on McKinsey & other consulting cos taking over global health. I'd add, based on my yrs @CFR, that @gatesfoundation& @WHO also stopped listening to & supporting think tanks & academics.”

Ilona Kickbusch: “This is why I state repeatedly that we need more investigative journalism in #globalhealth”

Global health events

Devex – Preventing deaths from advanced HIV disease: Highlights from ICASA 2019

https://www.devex.com/news/preventing-deaths-from-advanced-hiv-disease-highlights-from-icasa-

2019-96131

“Countries are still ill-equipped to detect and treat people suffering through advanced stages of the disease,” Médecins Sans Frontières said in a press release for a report on AHD in 15 countries, released on Dec. 1 for World AIDS Day. The report noted that “funding and access to commodities for AHD remain extremely limited” and that significant gaps in the implementation of the minimum package of care for AHD means “many opportunities to reduce avoidable mortality are being missed.” It also called for “a focus on and a drastic acceleration of measures to decrease mortality,” through the planning, funding, and implementation of the World Health Organization’s

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package of screening, prophylaxis, and treatment for major opportunistic infections, or OIs, such as tuberculosis and cryptococcal meningitis. …”

“The need to ramp up efforts to tackle AHD was the focus of several sessions at this year’s ICASA…”

Call for Participation in the 4th Symposium on Global Health Policy Research in Dubai (8 November)

https://docs.google.com/forms/d/e/1FAIpQLSdbSAc_xSAPhJawdKFkNCCw0Z78pKFzEscgVfei7NYnhf

GqxQ/viewform

One-day symposium on global health policy research. The symposium will be held in Dubai, UAE on Sunday, November 8th, 2020 in advance of the HSR symposium. This is a call for papers, among others. The event is being supported by the Alliance for a Healthier World at Johns Hopkins University (https://www.ahea lthierworld.jhu.edu/) and by SHAPES.

Coming up – Decolonizing Global Health Conference (Duke) (31 January)

https://sites.duke.edu/dukedgh/

Cfr a tweet by Gavin Yamey: “The 2020 Decolonizing Global Health Conference is on Jan 31 @DukeU. Delighted that @DukeCPIGH is a cosponsor. Wonderful array of speakers including @paimadhu @seyeabimbola & Allysha Maragh-Bass. … ... We will be live streaming.”

Registration: here.

Global governance of health

Devex - DFID official criticizes EU for 'condescending' rules on tied aid

https://www.devex.com/news/dfid-official-criticizes-eu-for-condescending-rules-on-tied-aid-96066

“A senior aid official from the United Kingdom has criticized the European Union for its “condescending” policy of channeling humanitarian assistance through EU entities. The comments come as U.K.-based NGOs are set to lose their eligibility for EU aid funding, some of which is reserved for organizations headquartered within the EU, after the country leaves the bloc in January. By contrast, EU NGOs will retain eligibility for U.K. funding as it no longer formally ties aid, although most of its aid contracts still go to U.K. organizations….”

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CFR - Violence Against Women: Beyond Multilateral Virtue Signaling

C Thorpe; https://www.cfr.org/blog/violence-against-women-beyond-multilateral-virtue-signaling

“Multilateral institutions often focus on rhetoric over action in countering violence against women. States inclined to do better should take matters into their own hands and adopt feminist foreign policies.”

Washington Blade – Congress agrees to boost in funds for Trump’s HIV plan — and then some

https://www.washingtonblade.com/2019/12/17/congress-agrees-to-300-million-in-funds-for-

trumps-hiv-plan-and-then-some/

“In a positive move in the fight against HIV/AIDS, the spending package Congress unveiled this week more-or-less meets President Trump’s request for an additional $300 million for his plan on the domestic front, but also rejects his proposed draconian cuts for research and global programs. House and Senate appropriators announced a bipartisan agreement on Monday to keep the government in operation for fiscal year 2020. The deal was reached days before a government shutdown would occur without additional funds and with limited time before Congress is set to adjourn for the holidays….”

“…In terms of funds for global programs, the agreement also rejects the major cuts proposed by the Trump administration. PEPFAR funding at the State Department matches FY-19 levels, at $4.37 billion, rejecting a $1 billion cut Trump proposed in his budget. Additionally, the deal includes $1.56 billion for the Global Fund, which is the first installment of a new three year pledge, and reaffirms the U.S. share of 33 percent of Global Fund contributions….”

For more detail, see a KFF brief - Global Health Funding in the FY 2020 Conference Agreement

KFF brief - The U.S. Government and Global Health Security

J Mishaud et al; https://www.kff.org/global-health-policy/issue-brief/the-u-s-government-and-global-health-security/

Neat brief. Start with the ‘key facts’.

IISD - OECD issues recommendation on coherent SDG implementation

IISD;

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“The Recommendation was developed in response to demand for guidance on the “how” of coherent SDG implementation.” “The Recommendation shares eight principles for promoting PCSD (Policy Coherence for Sustainable Development), which are organized around three pillars: vision and leadership, policy interactions and impact.”

UHC

Guardian - More than 600 French doctors threaten to quit amid funding row

https://www.theguardian.com/world/2019/dec/16/600-french-doctors-threaten-to-quit-health-

funding-row

“More than 600 French hospital doctors have threatened to resign if the government does not increase health funding, as striking medics prepare to take to the streets this week across the country. The doctors warn that budget cuts, bed closures and staff shortages are bringing France’s health system to the brink of collapse and putting patients’ lives at risk. “Public hospitals in France are dying,” wrote 660 medics from hospitals all over France in an unprecedented open letter, saying funding cuts were threatening patient safety in what was once seen as one of the best healthcare systems in the world….”

Sociological Forum - The Politics of Expanding Healthcare Access to the Poor and Informal Sectors

J Harris; https://onlinelibrary.wiley.com/doi/abs/10.1111/socf.12551?campaign=woletoc

“How do the politics of agenda setting and policy adoption operate in the arena of healthcare reform in the industrializing world? Literature on the twenty‐first‐century developmental state emphasizes the role of democratic competition and civil society in causing political parties to take up new agendas, while power resources theory stresses the role of left‐wing political parties and labor unions in policy adoption. Yet, core tenets of these theories have not been considered extensively in light of dynamics in the industrializing world. This article examines the politics of policy adoption in countries that have recently aimed to provide healthcare access and financial protection to the poor and people in the informal sector in Mexico and Turkey. In line with literature on the twenty‐first‐century developmental state, we find democratic competition to play an important role in causing political parties to take up new agendas. However, examination of the cases illuminates surprising dynamics that challenge important elements of sociological theory: right‐leaning political parties played important roles in adoption, while labor unions and left‐wing parties oppose reform in the cases. Public health‐minded physicians leading change teams played important roles in agenda setting and leading the process of implementation.”

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Globalization & Health - Health equity monitoring is essential in public health: lessons from Mozambique

A Llop-Girones et al ; https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-019-0508-4

“…the Sustainable Development Goals (SDGs) have re-emphasized the need to invest in comprehensive health information systems to monitor progress towards health equity; however, knowledge on the capacity of health information systems to be able do this, particularly in low-income countries, remains very limited. As a case study, we aimed to evaluate the current capacity of the national health information systems in Mozambique, and the available indicators to monitor health inequalities, in line with SDG 3 (Good Health and Well Being for All at All Ages)….”

Planetary health

Guardian - Depression and suicide linked to air pollution in new global study

https://www.theguardian.com/environment/2019/dec/18/depression-and-suicide-linked-to-air-

pollution-in-new-global-study

“People living with air pollution have higher rates of depression and suicide, a systematic review of global data has found. Cutting air pollution around the world to the EU’s legal limit could prevent millions of people becoming depressed, the research suggests. This assumes that exposure to toxic air is causing these cases of depression. Scientists believe this is likely but is difficult to prove beyond doubt. The particle pollution analysed in the study is produced by burning fossil fuels in vehicles, homes and industry. The researchers said the new evidence further strengthened calls to tackle what the World Health Organization calls the “silent public health emergency” of dirty air. “We’ve shown that air pollution could be causing substantial harm to our mental health, making the case for cleaning up the air we breathe even more urgent,” said Isobel Braithwaite, at University College London (UCL), who led the research….”

The research was published in the journal Environmental Health Perspectives.

IISD – 73 Countries commit to net zero CO2 emissions by 2050

http://sdg.iisd.org/news/73-countries-commit-to -net-zero-co2-emissions-by-2050/

At least a bit of progress at COP 25. “The COP25 Presidency announced additional commitments within the Climate Ambition Alliance. Chile's Minister of Environment Carolina Schmidt said 73 parties to the UNFCCC, 14 regions, 398 cities, 768 businesses and 16 investors are working to achieve net-zero CO2 emissions by 2050. …”

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Guardian - How the race for cobalt risks turning it from miracle metal to deadly chemical

Guardian;

“As a case in the US alleges links between tech companies and child miners in Congo, the Guardian’s global environment editor assesses the dangers of element in high demand for batteries.”

Millennium: Journal of International Studies - Governing the End Times? Planet Politics and the Secular Eschatology of the Anthropocene

D Rothe; https://journals.sagepub.com/doi/full/10.1177/0305829819889138

“This article furthers the debate on the political implications of the Anthropocene – the most recent geological epoch marked by catastrophic environmental change – by engaging it through the lens of political theology. The article starts from the observation that discourses on the Anthropocene and related political projects are deeply influenced by a linear temporality and a common orientation towards the threat of the end of time. It distinguishes three competing discourses of the Anthropocene, eco-catastrophism, eco-modernism and planetary realism. The article analyses how these discourses invoke and update key symbols, images, and storylines of Christian political theology. Furthermore, it studies how each discourse mobilises these secularised Christian motifs to promote competing planet political projects. Each of these projects develops a different position towards the unfolding planetary crisis and the related threat of the end of time. Eco-catastrophism calls for a planetary emergency management, eco-modernism promotes ongoing experimentation with the planet, whereas planetary realism translates into what could be called a ‘realpolitik of resilience’. Revealing the Western theological roots of the Anthropocene and planet politics is essential if the emerging literature on the Anthropocene wants to live up to its promise of pluralising and decolonising IR.”

Reuters - Global coal demand to remain stable up to 2024: IEA

https://uk.reuters.com/article/us-iea-coal/global-coal-demand-to-remain-stable-up-to-2024-iea-

idUSKBN1YL005

“Global coal demand is expected to remain stable until 2024 as growth in Asia offsets weaker demand from Europe and the United States, the International Energy Agency (IEA) said on Tuesday. The IEA report is being published just after negotiators from more than 190 countries met in Madrid over the last two weeks to try to thrash out rules to meet the 2015 Paris Climate Agreement, which demands a virtual end to coal power by 2050….”

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Nature Sustainability – Human impacts on planetary boundaries amplified by Earth system interactions

https://www.nature.com/articles/s41893-019-0454-4

“The planetary boundary framework presents a ‘planetary dashboard’ of humanity’s globally aggregated performance on a set of environmental issues that endanger the Earth system’s capacity to support humanity. While this framework has been highly influential, a critical shortcoming for its application in sustainability governance is that it currently fails to represent how impacts related to one of the planetary boundaries affect the status of other planetary boundaries. Here, we surveyed and provisionally quantified interactions between the Earth system processes represented by the planetary boundaries and investigated their consequences for sustainability governance. We identified a dense network of interactions between the planetary boundaries. The resulting cascades and feedbacks predominantly amplify human impacts on the Earth system and thereby shrink the safe operating space for future human impacts on the Earth system. Our results show that an integrated understanding of Earth system dynamics is critical to navigating towards a sustainable future.”

Infectious diseases & NTDs

Scidev.net - Study uncovers cause of aggressive leishmaniasis strain

https://www.scidev.net/global/health/news/study-uncovers-cause-of-aggressive-leishmaniasis-

strain.html

“After six years of research, Brazilian scientists have discovered that the presence of the Leishmania RNA virus in disease-carrying parasites leads to more aggressive forms of leishmaniasis, a discovery they say opens the way to new treatments….”

Washington Post – They built a Chinese boomtown. It left them dying of lung disease with nowhere to turn.

Washington Post;

Cfr a tweet by Rachel Silverman: “Global health should brace itself for the coming lung disease epidemic, a lagged response to thick air pollution, mining, and construction debris. 23 million at risk of developing pneumoconiosis, a lung disease caused by inhaling dust, in China alone.”

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And a link to a new study : DNA vaccination before conception protects Zika virus–exposed pregnant macaques against prolonged viremia and improves fetal outcomes.

AMR

The Telegraph - The perfect predator? Inside the Tbilisi clinic pioneering a radical superbug treatment

https://www.telegraph.co.uk/global-health/science-and-disease/perfect-predator-inside-tbilisi-

clinic-pioneering-radical-superbug/

“… the Eliava Institute – housed in a Stalin-era building overlooking the Mtkvari river in Tbilisi, Georgia – has come to global attention as antibiotic resistance increases and once treatable diseases are left without a ready cure. The centre has been producing an alternative to antibiotics since the early Soviet period – tiny viruses called bacteriophages, or simply “phages,” that invade bacteria and multiply until they burst out and destroy their host. Phages are the most abundant organisms on the planet and are used to treat bacterial diseases in humans on the principle that “my enemy’s enemy is my friend”. The therapy has been common in Georgia for almost a century but now hundreds of foreign patients are coming to Tbilisi every year for treatment. The majority are from mainland Europe but the centre also sees patients from the UK, US and Asia. Is it just another false hope, an unregulated money making exercise? Or might phages really have a role to play in modern medicine, especially as antibiotics start to fail?...”

Interesting read.

NCDs

Lancet Global Health - Global burden of cancer attributable to infections in 2018: a worldwide incidence analysis

C de Martel et al ; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30488-

7/fulltext

“Infectious pathogens are strong and modifiable causes of cancer. The aim of this study was to improve estimates of the global and regional burden of infection-attributable cancers to inform research priorities and facilitate prevention efforts….”

Findings: “We found that, for 2018, an estimated 2·2 million infection-attributable cancer cases were diagnosed worldwide, corresponding to an infection-attributable ASIR of 25·0 cases per 100 000 person-years. Primary causes were Helicobacter pylori (810 000 cases, ASIR 8·7 cases per 100 000 person-years), human papillomavirus (690 000, 8·0), hepatitis B virus (360 000, 4·1) and hepatitis C virus (160 000, 1·7). Infection-attributable ASIR was highest in eastern Asia (37·9 cases per

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100 000 person-years) and sub-Saharan Africa (33·1), and lowest in northern Europe (13·6) and western Asia (13·8). China accounted for a third of worldwide cancer cases attributable to infection, driven by high ASIR of H pylori (15·6) and hepatitis B virus (11·7) infection. The cancer burden attributed to human papillomavirus showed the clearest relationship with country income level (from ASIR of 6·9 cases per 100 000 person-years in high-income countries to 16·1 in low-income countries)….”

Health Systems & Reform - The Politics of Taxes for Health: An Analysis of the Passage of the Sugar-Sweetened Beverage Tax in Mexico

E James, M Reich et al ; https://www.tandfonline.com/doi/full/10.1080/23288604.2019.1669122

“This article explores the politics of passage of the SSB tax in Mexico, using published documents, media articles, and interviews with key stakeholders. The article examines first the period of agenda setting when the tax was included in the President’s fiscal reform package; and second, the period of legislative passage, when the bill was introduced in Congress and was passed. The analysis uses Kingdon’s three streams theory of agenda setting, to explain how the tax emerged on the agenda and how agenda setting shaped and enabled legislative passage. The article offers five lessons related to the politics of passing the SSB tax in Mexico. First, passing an SSB tax was difficult and required high-level organization, cooperation, planning, and effort. Second, supporters needed an understanding of how to manage the political and economic context, facilitated by a grant from Bloomberg Philanthropies. Third, framing the tax as generating revenue helped get the proposal onto the policy agenda and enabled buy-in from the powerful Hacienda. Fourth, forming networks within the legislature early on allowed tax proponents to have a network of allies within Congress ready when the SSB tax was introduced as a bill. Finally, early public relations campaigns helped shape public perception that Mexico’s obesity epidemic was driven in part by SSB consumption. This is the first paper that uses political science theory and primary data collection and interviews with a broad range of stakeholders, to explain how Mexico passed an SSB tax despite opposition from a strong national SSB industry.”

William Davidson Institute - Revenue Estimates from Taxing “Bads” in 16 Low- and Middle-Income Countries

Ben Davis, W Savedoff et al ; https://wdi.umich.edu/wp-content/uploads/Excise-Tax_White-Paper_10.24.19_web.pdf

Paper from September 2019. “…The primary conclusion drawn from the modeling exercise is that for most of the target countries, the amount of additional revenue possible through increased taxation of “bads” is important relative to select economic indicators. Even in the most restrictive scenario (Table 9), additional excise tax revenue as a percentage of domestic general health expenditure is greater than 50% for 14 of the 16 target countries and greater than 100% for 7 of the 16 target countries. Moreover, additional excise tax revenue as a percentage of current health expenditure is greater than 10% for 14 of the 16 target countries…”

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BMJ - E-cigarettes are independent risk factor for respiratory disease, study finds

https://www.bmj.com/content/367/bmj.l7019

“Use of electronic cigarettes appears to be an independent risk factor for respiratory disease in addition to tobacco smoking, according to the first population based long term analysis to investigate the association. “We found that for e-cigarette users the odds of developing lung disease increased by about a third, even after controlling for their tobacco use and their clinical and demographic information,” said the lead author Stanton Glantz, professor of medicine at the University of California, San Francisco. “We concluded that e-cigarettes are harmful on their own, and the effects are independent of smoking conventional tobacco,” he added….”

The study was published in the American Journal of Preventive Medicine.

Globalization & Health - Contradictions within the SDGs: are sin taxes for health improvement at odds with employment and economic growth in Zambia

https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-019-0510-x

“A recurring discussion in the literature relates to the possible contradictions among the Sustainable Development Goals (SDGs). The focus has been on economic goals, such as economic growth and goals related to climate change. We explore the possible contradictions that may arise between economic goals and health goals, specifically, the goal on Non-Communicable Diseases (NCDs) — SDG3.4. As a way to achieve SDG3.4, countries have been urged to introduce sin taxes, such as those on sugar. Yet others have argued that such taxes may affect employment (SDG 8.5), economic growth (SDG 8.1), and increase poverty (SDG1). However, there is limited or no reliable evidence, using actual experience, on the effect of sugar tax on health and economic outcomes. This makes it hard to assess the possible contradictions in SDGs that sugar taxes may generate….”

BMJ Global Health (Commentary) - Improving the implementation of tobacco control policies in low-and middle-income countries: a proposed framework

C Hoe et al ; https://gh.bmj.com/content/4/6/e002078

“Although tobacco control policies have been adopted across the globe, effective implementation continues to be a major challenge, particularly in low-income and middle-income countries, where almost 80% of the world’s smokers reside. This conceptual framework illustrates the constellation of factors that have been shown to influence implementation fidelity: political commitment, institutional capacity and operational effectiveness, social climate and tobacco industry interference. Researchers and practitioners can use this framework to identify the points of leverage

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in the implementation process and contribute to actionable knowledge as well as theory development.”

Lancet Comment - Long overdue: a fresh start for EU policy on alcohol and health

P De Coninck et al ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)33103-

4/fulltext

“We encourage the European Commission to address four key concerns….” Not just relevant for the European Union.

Sexual & Reproductive / maternal, neonatal & child health

Plos Med - Estimating the global impact of poor quality of care on maternal and neonatal outcomes in 81 low- and middle-income countries: A modeling study

V Chou et al ; https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002990

“In low-resource settings where disease burdens remain high and many health facilities lack essentials such as drugs or commodities, functional equipment, and trained personnel, poor quality of care often results and the impact can be profound. In this paper, we systematically quantify the potential gain of addressing quality of care globally using country-level data about antenatal, childbirth, and postnatal care interventions….”

BMJ Global Health - Are inequities decreasing? Birth registration for children under five in low-income and middle-income countries, 1999–2016

A Bhatia et al ; « https://gh.bmj.com/content/4/6/e001926

“Although global birth registration coverage has improved from 58% to 71% among children under five globally, inequities in birth registration coverage by wealth, urban/rural location, maternal education and access to a health facility persist. Few studies examine whether inequities in birth registration in low-income and middle-income countries have changed over time. We combined information on caregiver reported birth registration of 1.6 million children in 173 publicly available, nationally representative Demographic Health Surveys and Multiple Indicator Cluster Surveys across 67 low-income and middle-income countries between 1999 and 2016. …. ….” Findings: “14 out of 67

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countries had achieved complete birth registration. Among the remaining 53 countries, 39 countries successfully decreased the percentage of children without birth registration. … Although birth registration improved on average, progress in reducing wealth inequities has been limited. …”

Quick link:

Guardian - Sierra Leone ordered to revoke ban on pregnant schoolgirls

“Regional court ruling hailed as ‘landmark moment for thousands of girls’ who will no longer be forced to miss lessons and exams.”

Access to medicines

BMJ Global Health Editorial - WHO essential medicines for reproductive health

Roopan Gill et al; https://gh.bmj.com/content/4/6/e002150

“Since 1977, the WHO’s Model List of Essential Medicines has been a rigorous evidence-based document providing a list of essential and life-saving medicines. Specifically, over the course of the last few decades, a large body of scientific evidence and programmatic use has accumulated for existing medicines for reproductive health and the development of new life-saving therapies. The 21st edition of the WHO Model List of Essential Medicines issued in June 2019, added heat stable carbetocin and tranexamic acid (TXA) to the core list of medicines for reproductive health and moved mifepristone and misoprostol from the complementary to the core list. All of these medicines are important for preventing the leading causes of maternal morbidity and mortality….”

HPW - Novartis Relinquishes European Patent For Kymriah Cancer Cell Therapy

https://www.healthpolicy-watch.org/novartis-revokes-patent-for-gene-therapy-for-blood-cancer/

“Novartis has relinquished a patent granted by the European Patent Office for Kymriah, a promising new gene therapy for certain forms of leukemia, claiming the patent was no longer essential to the development and marketing of the treatment. The decision followed the moves by the Swiss-based NGO, Public Eye and the French-based Doctors of the World/Médecins du Monde to contest the patent in the European Patent Office. Their opposition, filed in in July, claimed that the price of the innovative therapy was “exorbitant” – with one infusion of the therapy costing CHF 370,000 in Switzerland….”

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Stat (Op-ed) – Artificial intelligence and machine learning can be the backbones of a drug launch playbook

https://www.statnews.com/2019/12/17/ai-machine-learning-drug-launch-

playbook/?utm_content=buffer8219f&utm_medium=social&utm_source=twitter&utm_campaign=t

witter_organic

“New tools can help drug makers better target patient populations and prescribers to lift the launch of a new drug.”

See also Nature - How Artificial Intelligence Will Change Medicine “Right now the biggest bets are being placed in the realm of drug discovery….”

South Centre (Research paper) - Medicines and Intellectual Property: 10 Years of the WHO Global Strategy

G Velasquez; https://www.southcentre.int/research-paper-100-december-2019/

“ The negotiations of the Intergovernmental Working Group on Public Health, Innovation and Intellectual Property (IGWG) (2006-2008), undertaken by the Member States of the World Health Organization (WHO), were the result of a deadlock in the 2006 World Health Assembly where the Member States were unable to reach an agreement on what to do with the 60 recommendations in the report on Public Health, Innovation and Intellectual Property submitted to the Assembly in the same year by a group of experts designated by the Director-General of the WHO. The result of these negotiations was the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property (GSPOA) that was approved by the World Health Assembly in 2008. One of the objectives of the IGWG’s Global Strategy and Plan of Action was to substantially reform the pharmaceutical innovation system in view of its failure to produce affordable medicines for diseases that affect the greater part of the world’s population living in developing countries. The intellectual property (IP) rights imposed by the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) and the trade agreements could become some of the main obstacles to accessing medicines. The GSPOA made a critical analysis of this reality and opened the door to the search for new solutions to this problem. Ten years after the approval of the GSPOA, the results are uncertain and poor.”

And a quick link:

Stat - In a first step, Trump administration unveils two proposals to permit drug importation

“The Trump administration released two highly anticipated policy documents Wednesday that, if finalized, would facilitate the importation of cheaper drugs from abroad — though both represent early first steps toward that goal. The drafts create two pathways for importation. One would let states, drug wholesalers, or pharmacies apply to import certain drugs from Canada, pending a sign-

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off from the Department of Health and Human Services. A second would let drug makers import their own products sold in other countries….”

See also the Guardian - US unveils plan to import lower-priced drugs from Canada.

Miscellaneous

Stat News - Female researchers are less likely than men to frame their work with positive words, study finds

https://www.statnews.com/2019/12/16/spin-doctors-skew-male-female-researchers-are-less-likely-

than-men-to-frame-their-work-with-positive-words/

“Are men more impressed with their own scientific research than women? Or are women warned off “overstating” their work? A new analysis suggests it might be a little of both. Women were 12.3% less likely than men to frame their work with positive words like “novel” or “excellent” in abstracts, according to a new study of 15 years of clinical research publications. In the case of only top-tier journals — there are numbered rankings for this in the arcane world of scientific publishing — the gap widened to 20.4%. These differences may be more than semantic, according to the authors of the study, which was published Monday in BMJ. Publication in one high-impact journal leads to citations in articles appearing in other journals, eventually snowballing into a measure of a researcher’s influence. And not just in theory: Cumulative citations count explicitly in recruitment, promotion, pay, and funding….”

O’Neill Institute (blog) – An international human right to die with dignity ?

R Reingold; https://oneill.law.georgetown.edu/an-international-human-right-to-die-with-dignity/

“Every year, some terminally ill individuals seek the assistance of physicians in order to end their lives – either through physician assisted suicide (PAS) or euthanasia. PAS is defined as a physician’s facilitation of a patient’s death by providing the necessary means and/or information to enable the patient to perform the life-ending act. Euthanasia is defined as a person’s – physician or otherwise – administration of a lethal agent to a patient for the purpose of relieving the patient’s intolerable and incurable suffering. While most countries ban both PAS and euthanasia, some are revisiting such prohibitions. Are these prohibitions in line with current international human rights standards? Or is there room to argue that such standards protect a “right to die with dignity”?...”

While we’re at it, you might also want to check out Lancet commission on the value of death – priorities for research (by K Sleeman)

As a reminder, “The Lancet Commission on the Value of Death believes that modern health care has an unhappy relationship with death and is searching for ways to improve the relationship.”

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And Dying in Intensive Care in low-income countries (Tim Baker et al)

“ An increasing number of people in low-income countries (LICs) are dying in Intensive Care Units (ICUs). There is little written about the quality of these deaths. This article aims to highlight this neglected issue and provide a roadmap for the way forward….”

Conclusion: “High death rates in ICUs in LICs are common. Most of us would prefer not to die in an ICU, but this is happening to an increasing number of people in low-income countries. Enhanced community engagement, improved patient selection for ICU care and an increased focus on dignified dying could lead to substantial gains including improving deaths for many.

NEJM Catalyst Innovations in Care Delivery — A New Journal Leading the Transformation of Health Care Delivery

T Lee et al ; https://www.nejm.org/doi/full/10.1056/NEJMe1914982?query=featured_home

“Four years ago, the NEJM Group launched NEJM Catalyst as a forum for emerging ideas and practical innovations in health care delivery, creating robust dialogue among health care leaders, clinicians, researchers, and other experts. NEJM Catalyst is now entering a new phase with the creation of a peer-reviewed digital journal, NEJM Catalyst Innovations in Care Delivery…”

Science - Elsevier deal with France disappoints open-access advocates

https://www.sciencemag.org/news/2019/12/elsevier-deal-france-disappoints-open-access-

advocates

“Publishing giant Elsevier has signed a national license deal with Couperin, France’s consortium of universities and research organizations, but critics say it doesn’t do enough to advance open access (OA) to scientific journal articles. Its terms are at odds with Plan S, a mandate to make publications immediately free to read starting in 2021, which France’s National Research Agency has backed….”

NYT – China responds slowly, and a Pig Disease becomes a lethal pandemic

https://www.nytimes.com/2019/12/17/business/china-pigs-african-swine-fever.html

Cfr. a tweet: “Is authoritarianism in and of itself inherently bad for public health? African #swinefever may only affect pigs and not humans. But important lessons around citizen trust in institutions where the state does not trust it’s citizens. #onehealth #outbreak”

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Emerging Voices

Check out the latest contribution in the EV 10th anniversary microblog-series, by Freddy Kitutu (EV 2013) - I am because EV4GH is, and EV4GH is because we are.

Meanwhile, stay tuned for an EV Twitter chat on 15 January (4 pm CET) related to the Dubai EV call (with tips & tricks), and a FB live chat (probably on the 18th of January.