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IHP news 560 : A clash of flawed governance “models”

( 21 Feb 2020)

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

Dear Colleagues,

Some terms seem to be a lot less in vogue these days than just a few years ago (like ‘Grand Convergence’ or ‘Cosmopolitan moment’) whereas others are rapidly gaining momentum - say, 'Age of extinction' or ‘The Great Unraveling’. Against an increasingly dire planetary backdrop, the new WHO-UNICEF-Lancet Commission, A future for the world's children? comes not a day too soon, in other words. Let’s hope the SDG agenda gets a much needed shot in the arm “by placing children, aged 0–18 years, at the centre of the SDGs: at the heart of the concept of sustainability and our shared human endeavour.” The report repositions every aspect of child health through the lens of our rapidly changing climate and other existential threats. Which seems damned right.

Back in the real world, however, quite a few billionaires still think they can promise to ‘Save the World’ while standing at the same time for a very harsh model of neoliberal globalization and economic system (which includes for them, more often than not, top-notch “tax optimization”). Jeff Bezos is no doubt one of the worst examples of this, but there are a few others as well, well versed in “tactical philantropy”, who think they can just buy the world (and elections). The prospect of a US presidential race between 2 oligarchs makes my stomach turn - and I’m being diplomatic here. Fortunately, “Mike” was a disaster at the first big tv debate in which he was involved, and so the scenario seems a bit less likely now. But it’s too early to rule him out. M &M (Money & Men) still rules much of the world.

Meanwhile, COVID-19 has led quite a few mainstream capitalist media to start feeling rather smug again about the western (presumably ‘democratic’) model of governance, after a few rough years – hope they didn’t mean the “Bring in the billionaires” “governance model” described in paragraph two, or also the televangelicals’ one, as in ““This pastor says God is sparing the U.S. from coronavirus because of the Trump administration” “ . In any case, The Economist, the WSJ et al seem to have a field day heavily criticizing the Chinese model of governance. While I agree with much of the criticism of the Chinese governance, which under Xi Jinping deteriorated further in a number of ways, I honestly don’t think we should feel smug these days in the West (either). (PS: Last time I

checked, Japan was also a democracy 😊. You might want to ask the passengers of the Princess

Diamond cruise what they think of their 19th century approach. PS: Let’s not forget also that the current state of the planet (as described in paragraph one and in the abovementioned new Commission) is largely “inspired” by a ruthless and exploitative Western economic system, that went global in recent decades.)

Over to Geneva then. Dr. Tedros and his team stress there’s still a chance to prevent a broader global Covid-19 crisis, and are doing their utmost to do so. Unfortunately, however, funding is materializing slowly. Again. See this (rather diplomatic) quote from earlier this week: “WHO is calling

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for donations to help it help countries prepare. It said that $675m was needed, and that though some contributions had been made, they “have not seen the urgency in funding that we need….”

Fortunately, there might at last be a solution for this (chronic) funding predicament on the horizon. CGD pointed out earlier this week, rightly, that “global development hasn't traditionally overlapped with the entertainment & music industries – until now”. Perhaps WHO should also adjust its fundraising approach? With its Contingency fund for Emergencies (much like the rest of WHO) chronically underfunded, and the WB’s pandemic bonds having turned into some sort of sick joke for investment bankers, I say it’s time for Tedros’ communication & fundraising crews to hire a rapper (or urban hip-hopper) who looks like a mixture of Kanye West and Jim Kim. In a cheeky ‘Naming & Shaming’ clip, the “bro” would be singing ‘Ho- o- o…!! I’m Bond. Pandemic Bond. And I’m making a mothafuckin’ amount of bucks! Ho-o-o- - Wo-o! against a dazzling backdrop of abundant dollar notes and scary Covid-19 & Ebola signs, while enjoying the good life in a swimming pool on the Diamond Princess cruise (the (obligatory) scantily clad “ladies” in such a clip would be (irresistably)

coughing for the occasion 😊). And then WHO’s communications people would spread the word on all social media, together with their new friends from Google and FB - hashtag #OurWorldBankfriends #pandemicinsurance #bigbucks #Wo-o!

Should really help with fundraising, I reckon.

(But in the meantime, I do hope pandemic bond investors will have to pay soon.)

Enjoy your reading.

Kristof Decoster

Featured Article

What role for human rights in global health?

Alicia Ely Yamin is a Senior Fellow at the Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics at Harvard Law School.

My father used to say that “there are two kinds of people in the world: those who divide the world into two kinds of people and those who don’t.” In global health these days it’s difficult not to be part of the former tribe. At the start of this new decade, there are those who peddle “elixirs of optimism” about how the world has never been better off in terms of income, child mortality, etc. On the other hand, there are those of us who believe that life choices and chances have never been so unequal and that something is seriously awry in the political economy of global health. And it has everything to do with the tentacles of neoliberalism spreading across the globe and reaching into every aspect of global health—from research funding/agendas to global/national health governance, and the egregious inequalities in social and political determinants of health. There are of course notable sites of resistance, often from youth--from climate justice action to students clamoring for decolonization of global health.

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But those of us in the so-called “health and human rights” field-- which is in truth a constellation of overlapping fields-- should be more present in these and other subversive movements for social change if human rights is to remain a relevant language of human liberation, and ensure it is not being used to deoderize the degradation that the interlocking systems of power implicated in patriarchy, colonialism and the dominant neoliberal economic paradigm leave in their wake. When “the right to health” is converted into a slogan for UHC or health-related rights consigned to UN agencies and other bureaucracies for “mainstreaming” they are emptied of their mobilizing potential. And that may explain why increasingly movements for social justice in health and beyond are turning to other frameworks.

We have made enormous strides in applying human rights to health, from HIV to sexual and reproductive health and rights, from tobacco regulation to legislation regarding gender-based violence--and those strides have made real and meaningful differences in people’s lives.

But today we need to do more than stand our ground in the face of toxic synergies between growing “illiberalism”, conservative populism, xenophobia, racism, and misogyny. In When Misfortune Becomes Injustice: Evolving Human Rights Struggles for Health and Social Equality, I offer critical (self) reflection on decades of human rights praxis, and argue we need to acknowledge that we have failed to show that health-related and other economic and social rights can be deployed to produce greater social equality. We are not in an “era of implementation.” We are in a heated battle for the soul of the human rights idea—that is, the equal dignity of diverse people across this shared and irreplaceable planet.

We desperately need a global health governance that is fit for purpose in our grossly unequal and yet interconnected world. But operationalizing technocratic models of “human rights- based approaches to health” across agencies that are increasingly beholden to philanthro-capitalist and corporate interests will not curb the dynamics of rapacious deregulation, privatization, labor flexibilization, and the general hollowing out of fiscal space on which health rights and social equality depend. We urgently need to re-energize the original human rights aspirations of a social and international order based upon equal dignity of diverse human beings, which includes economic justice. And that calls for much bolder visions, networked strategies to shift the rigged rules of a multilateral order that has been usurped by global elites-- and for embedding human rights in popular struggles.

Social struggles without concern for human dignity are betrayals; aspirations for transformative change that do not engage with law at national and international levels, are illusions. I am absolutely convinced that human rights can and must be part of broader social movements for health and social equality within and between countries, and in rethinking the deformed political economy of global health more broadly. But in today’s world, in human rights and beyond, we all need to figure out how to be part of the solution, not part of the problem.

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Highlights of the week

Lancet – Offline: Facts are not enough

R Horton; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30405-0/fulltext

I’m not quite sure I fully understood this -it’s Friday morning, so chronic lack of sleep by the end of the week and not enough coffee going through my veins yet, but I’m damned sure you have to read this !

Sweeping analysis of the world and the future by Horton. Even more sweeping than usual I’d say.

And do check for yourself where you find yourself in “the struggle for the soul of global health”. Are you an “intelligent idealist” or an “innocent cynic”? Or, like perhaps many readers of this newsletter, a bit of both?

A future for the world’s children? A WHO-UNICEF-Lancet Commission

https://www.thelancet.com/commissions/future-child

The read of the week. And then some.

“The health and wellbeing of children now and in the future depends on overcoming new challenges that are escalating at such speed as to threaten the progress and successes of the past two decades in child health. The climate emergency is rapidly undermining the future survival of all species, and the likelihood of a world in which all children enjoy their right to health appears increasingly out of reach. A second existential threat that is more insidious has emerged: predatory commercial exploitation that is encouraging harmful and addictive activities that are extremely deleterious to young people’s health. The WHO–UNICEF–Lancet Commission lays the foundations for a new global movement for child health that addresses these two crises and presents high-level recommendations that position children at the centre of the Sustainable Development Goals (SDGs).”

Start perhaps with the Lancet Editorial - No excuses and no time to lose

Coverage in the Guardian: The world is failing to ensure children have a 'liveable planet', report finds

Or HPW: WHO-UNICEF-Lancet Commission Measures Education, Nutrition, Child Health Across 180 Countries

With some info on the Commission's child flourishing index which measures country-level performance and ranks the ability of a child to flourish, survive, and thrive in 180 countries.

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See also UN News - ‘Not a single country’ does enough to help children flourish, say health experts.

Stockholm – 3rd Global Ministerial Conference on road safety (19-20 Feb)

UN News -At Stockholm road safety summit, UN officials join global call to end

‘scourge’ of preventable deaths

https://news.un.org/en/story/2020/02/1057721

“Road traffic accidents take some 1.35 million lives every year and cost most countries three per cent of their gross domestic product, the top UN health official said on Wednesday as the Third Global Ministerial Conference On Road Safety kicked off in Stockholm, Sweden.” Dr. Tedros, that is. Short report of the first day of this meeting.

“… The Chairman’s conclusions, called the Stockholm Declaration, were presented by Swedish Infrastructure Minister Tomas Eneroth, and called for strong political will and international cooperation, along with partnerships across society. It also connects road safety to the implementation of the 2030 Agenda for Sustainable Development, laying out recommendations to accelerate action towards halving global road traffic deaths and injuries by 2030….”

“Meanwhile, Etienne Krug, Director at WHO’s Department of Social Determinants of Health, in a commentary, painted a haunting picture of a new mode of transport that while offering speed and comfort, would kill 1.3 million people per year and injure 50 million more. The UN official explained that half of those killed voluntarily used the system, while the others just happen to be in the vicinity, at “the wrong place at the wrong time”.

For Krug’s Commentary, see It’s time to get serious in addressing the leading killer of our youth

Quotes Krug:

“Countries and cities worldwide are now aspiring to Vision Zero, or no road traffic deaths or severe injuries. In public health, we call that eradication. In doing so, they are adopting the safe system approach and setting ambitious targets in the hope of replicating the spectacular results achieved elsewhere. Unfortunately, fatalities and injuries from road traffic crashes are still on the rise in two-thirds of countries worldwide. In September 2015, all Heads of State committed to the 2030 Agenda for Sustainable Development. This includes the Sustainable Development Goal (SDG) target 3.6 to halve road traffic deaths and injuries by 2030. …”

“…Today, nearly five years later, we are now in a new decade. Despite some progress with countries like Luxembourg that are on track to achieve SDG target 3.6, globally the decrease in road traffic deaths has not even started. Many decades ago, the world was at a crossroad: a transport system centered around private motor vehicles versus one which maintained a share of the road for pedestrians, cyclists and users of public transport. Over time, the decision taken then has resulted in a deadly system that has not only led to injury-related fatalities, but also

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to deaths and ill-health from air pollution and a sedentary lifestyle.   Today, we are at another turning point. …”

WHO - 3rd Global Ministerial Conference on Road Safety

On the aim of the meeting.

Stockholm declaration

https://www.roadsafetysweden.com/contentassets/b37f0951c837443eb9661668d5be439e/stockho

lm-declaration-english.pdf

You find the 4-page Stockholm declaration here.

With at least one gaping hole – see Movendi International

“Civil society groups express deep concern about the complete and inexplicable omission of alcohol control measures from the Stockholm Declaration on Road Safety….”

HPW - Bloomberg Philanthropies Commits US $240 Million To Prevent Road

Traffic Deaths

https://www.healthpolicy-watch.org/bloomberg-philanthropies-commits-us-240-million-to-prevent-

road-traffic-deaths/

“Bloomberg Philanthropies announced a six-year US $240 million commitment to prevent road traffic injuries in low- and middle-income countries on Tuesday, just a day ahead of the Global Ministerial Conference on Road Safety in Stockholm, Sweden. The new commitment aims to fund efforts to prevent 22 million injuries and save 600,000 lives from road traffic accidents. “The price we are paying for our mobility is unacceptable. We need to do much more to save lives on our roads. This new investment is excellent news that comes at a critical time when world leaders convene to decide on achieving a 50% reduction in road traffic deaths by 2030,” said Etienne Krug, director of the Department of Social Determinants of Health at the World Health Organization in a press release….”

Sydney Morning Herald - 'Too many badly designed roads': True costs of trauma

revealed

Herald;

“Every day 102,835 people across the world suffer serious injuries caused by road crashes, costing communities $US6 billion ($9 billion) daily. Crash, repeat, every day of the year. For the first time, these injuries have been broken down by type and size with a new big data tool to jolt policymakers into doing more to make roads safer. Launching the "new vaccine for roads" on the eve of the world's most important road safety conference, the International Road Assessment Program chief executive Rob McInerney said the 3626 people who were killed every day in road

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crashes – a total of around 1.35 million annually – were the tip of the iceberg. Instead of using "amorphous numbers", the new research uses Australian data collected by Victoria's compulsory third party insurer Transport Accident Commission and international databases to breakdown injuries by type, quantity and cost in any country….”

See also New road safety observatory to cut road fatalities in Asia Pacific with better crash data

Covid-19 – A “closing window of opportunity” to contain it?

We feature again an extensive section on Covid-19 this week, but also again in steno-style. As many platforms, (global health security and other) newsletters & media provide extensive and daily coverage on this (Stat, Cidrap News, Telegraph GHS, HPW, …). There are so many angles to this outbreak, from the (almost-) pandemic, the (also viral) fear/rumor/xenophobia pandemics, over the governance & legitimacy crises, geopolitical influence, … to the economic impact, impact on supply chains (including of medicines)… Etc.

PS: WHO still avoided the word ‘pandemic’ this week (and Tedros/Ryan also explained why). Wonder for how long still.

We start again with a section on updates of the last few days (and things you really shouldn’t have missed over the week) (if you have little time, stick to that subsection perhaps), and then sections on respectively science and analysis.

Updates from the last few days & some key Covid-19 news of past week

HPW - Experts Eye Japan For Clues On COVID-19 Trends; In Africa, Egypt, Algeria & South Africa At Highest Risk, Says Lancet Study

https://www.healthpolicy-watch.org/experts-eye-japan-for-clues-on-covid-19-trends-in-africa-

egypt-algeria-south-africa-at-highest-risk-says-lancet-study/

(19 Feb) “Experts were closely watching the development of Japan’s COVID-19 outbreak for signs of whether the virus might escape further out of control, moving closer to the tipping point of a pandemic – the worldwide spread of a new disease. Meanwhile, a new study in The Lancet found that in Africa, Egypt, Algeria and South Africa are at highest risk of new coronavirus cases. However, these countries also have the most prepared health systems and therefore less vulnerable….”

Lancet Study: Preparedness and vulnerability of African countries against importations of COVID-19: a modelling study

See also HPW (20 Feb) - China Sees Sharp Decline In Fresh COVID-19 Cases; But Korean “Superspreader” Event & New Iran Cluster Casts Pall

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“A sharp decline in new COVID-19 cases was reported by China on Thursday, providing a glimmer of hope about the potential to still contain the epidemic – but only if the steady increase being seen in new cases abroad can now be brought under control.”

Stat News (20 Feb) - Experts say confusion over coronavirus case count in China is muddying picture of spread

“Infectious diseases experts are losing confidence in the accuracy of China’s count of cases of the novel coronavirus, pointing toward health officials’ shifting definition of cases over time….”

Quote: “…A serological survey would fill a critical information gap, said Malik Peiris, a virologist at Hong Kong University who is one of the leaders in the response to the 2003 SARS outbreak. (SARS is closely related to the virus that causes Covid-19.) “I think the one single most important thing China can do now … to reassure the population in China, the population in the world about this outbreak, is to do exactly this type of sero-epidemiological study in Wuhan or somewhere in Hubei,” Peiris told STAT. If, as experts expect, that kind of study showed that many mild cases are escaping detection, the world would have a better grasp of how severe this outbreak is and what it would need to expect should the virus sweep the globe….”

Guardian (21 Feb) -… at least 500 cases confirmed in prisons in three Chinese provinces

Cidrap (21 Feb) - US officials clashed over cruise ship passenger flight

In the ongoing debate ‘democratic systems’ are much better to handle outbreaks: “… In other cruise ship developments, the Washington Post, citing unnamed people involved in the discussions, reported today that US government officials on Feb 16 wrestled with whether to allow 14 infected Americans to fly home on a chartered jet with a group of 300 American evacuees. It said officials received word that test results were positive for 14 people shortly before the plane was to leave Japan. Officials from the US Centers for Disease Control and Prevention (CDC) opposed mixing the infected and uninfected people, because of the increased transmission risk, and the State Department had announced earlier that infected people would not be allowed to board the planes. But the State Department and a Trump Administration official ended up overruling the CDC's advice. The infected travelers didn't have symptoms, and the plane had a plastic-lined enclosure to separate the passengers. According to the report, the CDC insisted that the agency not be mentioned in the news release lest people think that the infected people flew with the others based on CDC advice….”

Cidrap - China's COVID-19 death toll tops 2,000; Iran reports first cases

http://www.cidrap.umn.edu/news-perspective/2020/02/chinas-covid-19-death-toll-tops-2000-iran-

reports-first-cases

(19 Feb) “China's death toll in its COVID-19 outbreak passed 2,000 today, as Iran reported its first two cases—both fatal—and the number of local cases grew in Japan, Singapore, and South Korea. … … In other outbreak developments, China changed its COVID-19 case definition again, and instead of counting clinically diagnosed cases as confirmed infections, it will classify them as suspected cases, according to a government statement….”

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See also a BMJ news report - Coronavirus covid-19 has killed more people than SARS and MERS combined, despite lower case fatality rate

HPW - WHO Official Defends Tighter China COVID-19 Surveillance As “Good Public Health Measure”

https://www.healthpolicy-watch.org/who-defends-tough-china-covid-19-surveillance-as-good-

public-health-measure/

(18 Feb) Michael Ryan, that is. Remarkable stance.

Although, admittedly, at an earlier press conference, Ryan had also cautioned (more in general, and also weighing in on the cruise situation) “…that such policies also carry weighty ethical implications….”

“Decisions on mass evacuation and mass quarantines need to be made with the highest public health standards and consideration of human rights,” Ryan said. “In general we need to be very careful in doing those kinds of processes, we have to balance the public health benefit against the issues of quarantine.. how we manage it, from an ethical and human rights perspective.”

Lancet Letter – A distinct name is needed for the new coronavirus

S Jiang et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30419-0/fulltext

“…On the basis of special clinical, virological, and epidemiological characteristics and the uncertainty of the novel coronavirus, to avoid the misleadingness and confusion, and to help scientists and the public with better communication, we, a group of virologists in China, suggest renaming SARS-CoV-2 as human coronavirus 2019 (HCoV-19). Such a name distinguishes the virus from SARS-CoV and keeps it consistent with the WHO name of the disease it causes, COVID-19.”

Stat News - Sanofi announces it will work with HHS to develop coronavirus vaccine

https://www.statnews.com/2020/02/18/sanofi-announces-it-will-work-with-hhs-to-develop-

coronavirus-vaccine/

“Sanofi is the second major vaccine maker to announce it will try to make a vaccine against the new virus, which has infected over 70,000 people, mostly in China. Johnson & Johnson’s vaccine division, Janssen, has also announced it will try to make a vaccine….”

See also Cidrap - HHS partners with drug makers on COVID-19 vaccine, drugs

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Guardian - Health experts question coronavirus quarantine measures on cruise ship

https://www.theguardian.com/world/2020/feb/18/global-health-experts-question-cruise-ship-

coronavirus-quarantine-measures

World media focused very much on the Diamond Princess cruise ship (as well as the other one, that embarked in Cambodia). In this piece the view of global health (law) & governance experts. Recommended.

Quote: “…human rights appeared to have become “a secondary concern during this outbreak”.”

For the (damning) view from a Japanese infectious disease specialist, see Science news - Scientist decries ‘completely chaotic’ conditions on cruise ship Japan quarantined after viral outbreak.

Guardian - Coronavirus causes mild disease in four in five patients, says WHO

https://www.theguardian.com/world/2020/feb/17/coronavirus-causes-mild-disease-in-four-in-five-

patients-says-who

“Covid-19, the new coronavirus that has killed nearly 1,800 people in China, causes only mild disease in four out of five people who get it, the World Health Organization has said. “It appears that Covid-19 is not as deadly as other coronaviruses, including Sars and Mers,” said the WHO director general, Dr Tedros Adhanom Ghebreyesus, adding that officials were “starting to get a clearer picture of the outbreak”. The conclusion comes from analysis of data from Chinese authorities relating to 44,000 cases of Covid-19 in Hubei province, where the coronavirus was first recorded. “More than 80% of patients have mild disease and will recover, 14% have severe disease including pneumonia and shortness of breath, 5% have critical disease including respiratory failure, septic shock and multi-organ failure, and 2% of cases are fatal,” Tedros said in Geneva. “The risk of death increases the older you are.”…”

On the other hand, you hear more and more comparisons (like in Telegraph GHS), with the flu. "More similar to the flu than first thought". See also Reuters - New coronavirus spreads more like flu than SARS: Chinese study (Preliminary findings, in NEJM)

As for the fatality rate, see a tweet from J Konyndyk (20 Feb) – “New fatality rate estimate for COVID-19 is just under 1%. That’s about 10x as deadly as seasonal flu; about half as deadly as 1918 Spanish Flu pandemic.” “Caveat that we don’t know if rate will be lower outside China; could be that smoking rates and air quality there drive it up.”

Science (news) - Scientists ‘strongly condemn’ rumors and conspiracy theories about origin of coronavirus outbreak

https://www.sciencemag.org/news/2020/02/scientists-strongly-condemn-rumors-and-conspiracy-

theories-about-origin-coronavirus

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“A statement in The Lancet assails misinformation about the possibility that COVID-19 came from a lab in Wuhan, China.”

See also the Guardian - Experts fear false rumours could harm Chinese cooperation on coronavirus

“World-leading experts on the novel coronavirus have signed a statement of support for their Chinese colleagues, who are being attacked on social media and even threatened with violence as false rumours circulate about its origins. There is a real risk that the open and transparent relationship between the Chinese scientists and their western counterparts will come to an abrupt end, impeding the sharing of data and the hunt for treatments and vaccines against Covid-19, warned Dr Peter Daszak, president of EcoHealth Alliance in the United States, whose research into emerging diseases led to the identification of the bat origin of Sars, among others. Daszak is one of 27 prominent public health scientists from nine countries who have signed the statement published by the Lancet medical journal. They include Jeremy Farrar, director of the Wellcome Trust in the UK, Jim Hughes, former director of the National Center for Infectious Diseases in the USA, Rita Colwell, former head of the US National Science Foundation and other leaders in infectious disease research and public health….”

US News - China Virus Outbreak Threatens Global Drug Supplies

https://www.usnews.com/news/world/articles/2020-02-17/china-virus-threatens-global-antibiotics-

supply-european-business-group?src=usn_tw

“The world's pharmacies may face a shortage of antibiotics and other drugs if supply problems from China's coronavirus outbreak cannot soon be resolved, the head of a European business group in China warned on Tuesday…”

ABC - World Health Organisation division tackling coronavirus underfunded and facing internal corruption allegations, audits reveal

https://www.abc.net.au/news/2020-02-17/coronavirus-who-underfunded-internal-corruption-

allegations/11970382

Went viral this week. “The World Health Organisation division leading the global response to the coronavirus outbreak is so chronically underfunded it has repeatedly been found to pose a "severe" and "unacceptable" level of hazard to the organisation, recent audits reveal. The WHO Health Emergencies Program, established in 2016, scored the highest risk rating in 2018 and 2019 because a "failure to adequately finance the program and emergency operations [risks] inadequate delivery of results at country level"….”

Covid-19 Contributions tracker

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/donors-and-partners/funding

“The Strategic Preparedness and Response Plan calls for a total resource requirement of US$675m, of which US$61.5m is for WHO’s urgent preparedness and response activities for the period of February to April 2020.”

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Cfr tweet Anthony Costello: “Three weeks ago WHO asked the world to contribute $675 million to tackle the threat of a Coronavirus pandemic. "Commitments" to date: $120 million. Received: $1.2 million. https://who.int/emergencies/diseases/novel-coronavirus-2019/donors-and-partners/funding You couldn't make it up. A pandemic could wipe many trillions off the global economy”.

FT - Official account questions Xi Jinping coronavirus timeline

https://www.ft.com/content/3da73290-5067-11ea-8841-482eed0038b1

(from last weekend). An official magazine reveals Xi was issuing orders on the outbreak much earlier

than thought.

Meanwhile, in China, a ‘wartime campaign’ against the coronavirus is ongoing. See for example the NYT - China expands chaotic dragnet in coronavirus crackdown (from earlier this week) The campaign is not uncontroversial, to say the least.

Cfr a tweet: “…To stop the spread of the coronavirus much of China has effectively shut down. What’s not been fully appreciated is how extensive the closures are. By our calculations 760 million are living under some kind of residential lockdown.” See also NYT.

See also Guardian – Dissent becomes the next victim of coronavirus as China cracks down

“Analysts say epidemic poses gravest threat to authorities since Tiananmen Square – and Beijing’s tight control could backfire.” A few critics (of Xi’s handling of the outbreak) have already ended up in jail or disappeared otherwise.

South China Morning post- Coronavirus: places and airlines restricting China transit

https://multimedia.scmp.com/infographics/news/world/article/3051149/coronavirus-travel-

restrictions-on-china/index.html

Extensive overview (and neat map) of the travel restrictions vs China, an increasingly isolated country now due to the Covid-19 outbreak.

For a similar (and constantly updated) global tracker of travel restrictions (vs China), see also Think Global Health

Stat - The global responders: Who is leading the charge against the coronavirus outbreak

https://www.statnews.com/2020/02/17/who-is-leading-charge-against-the-coronavirus-outbreak/

Some of the names leading the outbreak response. Focus here on WHO, China & US.

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Some additional links:

• HPW – (17 Feb) Number Of New Infections In China Slows, But Fear Of Further International

Spread Remains

Not everybody is totally convinced about this slowing of infections in China, see for example FP - Are

China’s Coronavirus Figures Reliable?

• NBC – (14 Feb) Facebook, Amazon and Google met with WHO to figure out how to stop

coronavirus misinformation

“The meeting was organized by WHO and hosted at Facebook’s Menlo Park campus, a Facebook spokesperson confirmed to CNBC.”

• AP - AP Interview: UN chief says new virus poses ‘enormous’ risks

“The U.N. secretary-general said Tuesday the virus outbreak that began in China poses “a very dangerous situation” for the world, but “is not out of control.” Speaking in an interview with The Associated Press, Antonio Guterres said that “the risks are enormous and we need to be prepared worldwide for that.” Guterres said his greatest worry was a spread of the virus to areas with “less capacity in their health service,” particularly some African countries. The World Health Organization is looking into how to help handle such a development, he added…”

And a few more links related to the situation in Africa in particular:

• You all already know a long time that a first case popped up in Egypt. John Nkengasong’s

statement on this: Africa CDC statement.

• Reliefweb (17 Feb): COVID-19 VIRUS: WAHO, Regional Health Ministers Call for Collective

Response

• Lancet World Report (15 Feb) - Africa prepares for coronavirus

• Dev Discourse: Coronavirus threatening severe economic slowdown in African countries

• IHP (in French, by Sissoko Foussénou - Communauté Economique des Etats de l’Afrique de

l’Ouest et Covid-19 : sommes-nous prêts ? )

Science

We stick here even more to steno-style as other newsletters are far more specialized in this area:

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Resource: WHO database on Covid-19

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-

coronavirus-2019-ncov

New WHO database of publications on #COVID19, which gathers the latest scientific findings and knowledge on the disease.

Reuters - Speed Science: The risks of swiftly spreading coronavirus research

https://graphics.reuters.com/CHINA-HEALTH-

RESEARCH/0100B5ES3MG/index.html?utm_medium=Social&utm_source=twitter

“153 studies have been published on the new coronavirus. 92 were not peer reviewed…”

Nature - More than 80 clinical trials launch to test coronavirus treatments

https://www.nature.com/articles/d41586-020-00444-3

“As HIV drugs, stem cells and traditional Chinese medicines vie for a chance to prove their worth, the WHO attempts to bring order to the search.”

See also Wired - China Launches a Crush of Clinical Trials Aimed at Covid-19.

Nature – Scientists question China’s decision not to report symptom-free coronavirus cases

https://www.nature.com/articles/d41586-020-00434-5

(20 Feb) “Researchers are concerned that China’s official reports on the number of coronavirus infections have not been including people who have tested positive for the virus but who have no symptoms. They fear the practice is masking the epidemic’s true scale. But public health experts say China is right to prioritize tracking sick patients who are spreading the disease….”

Other links:

Cidrap - Studies show COVID-19 likely has multiple infection routes

“As the COVID-19 outbreak grows in China and abroad, new studies attempt to answer questions on how the virus is shed and the range of clinical outcomes, with two studies indicating that shedding—and therefore transmission—likely occurs via multiple routes. Currently, testing for and

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confirmation of infection with COVID-19 is conducted via oral swabs. But in a study published in Emerging Microbes & Infections, Chinese scientists report evidence of an oral-fecal transmission route for COVID-19 viruses and show that, in hospitalized patients, viral RNA was found in anal swabs and in blood samples….”

Nature News (18 Feb) - When will the coronavirus outbreak peak?

“Epidemiologists are working to understand when the COVID-19 coronavirus outbreak will peak and the number of new infections per day will start to decline. Explore the scenarios, from the optimistic — it’ll happen any day now — to the possibility that the peak is months away and that the virus will infect millions more people first.”

Caixin Global – Will Warming Weather Kill Off Covid-19? Scientists Aren’t Sure

Bloomberg - Coronavirus could infect two thirds of globe, researcher says

(modelling estimate from last week). See also Stat - Disease modelers gaze into their computers to

see the future of Covid-19, and it isn’t good (14 Feb).

Guardian - Doctors look to HIV and Ebola drugs for coronavirus cure (20 Feb)

“Early results of trials on Covid-19 patients expected in March.”

Analysis

Lancet Editorial – COVID-19: fighting panic with information

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30379-2/fulltext

The Lancet’s take (21 Feb). Concluding: “…Addressing the Munich Security Conference on Feb 15, 2020, WHO Director-General Dr Tedros Adhanom Ghebreyesus said, “we're not just fighting an epidemic; we're fighting an infodemic.” The ease through which inaccuracies and conspiracies can be repeated and perpetuated via social media and conventional outlets puts public health at a constant disadvantage. It is the rapid dissemination of trustworthy information—transparent identification of cases, data sharing, unhampered communication, and peer-reviewed research—which is needed most during this period of uncertainty. There may be no way to prevent a COVID-19 pandemic in this globalised time, but verified information is the most effective prevention against the disease of panic.”

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Lancet - Authoritarianism, outbreaks, and information politics

https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30030-X/fulltext

By M Kavanagh. You know you have to read this. “Are autocratic states such as China better equipped than their more democratic counterparts to respond to disease outbreaks?...” The answer is no.

He concludes: “Is there an authoritarian advantage in disease response? It seems that authoritarian information politics inhibited a rapid response to the 2019-nCoV outbreak in China, which could have limited the crisis. It is not yet clear if the extraordinary cordons and influx of resources enabled by autocratic rule will prove a successful public health strategy. Yet, in building capacity to prevent, detect, and respond to outbreaks, democratic openness and competitive politics seem more asset than inadequacy.”

Economist – Diseases like Covid-19 are deadlier in non-democracies

https://www.economist.com/graphic-detail/2020/02/18/diseases-like-covid-19-are-deadlier-in-non-

democracies?fsrc=gp_en?fsrc=scn/tw/te/bl/ed/diseaseslikecovid19aredeadlierinnondemocraciesdail

ychart

“Democracies tend to be better than other forms of government at containing and treating outbreaks of disease.”

Think Global Health – What’s next for Covid-19

Tom Frieden; https://www.thinkglobalhealth.org/article/whats-next-covid-19

Analysis as of 18 Feb. Well worth a read. “Containment of the coronavirus would make an enormous difference to health around the world. Is it still possible?”

“…The odds of containment look vanishingly small, but not (quite) yet zero. There are at least half dozen good reasons to be pessimistic about containment, which may be why the U.S. Centers for Disease Control and Prevention (CDC) is foreshadowing that containment may be impossible:… … On the other hand, all is not yet lost, and the benefits from containment would be enormous. There are at least half a dozen reasons not to give up hope:…”

Guardian - China's handling of coronavirus is a diplomatic challenge for WHO

Sarah Bosely ; https://www.theguardian.com/world/2020/feb/18/china-coronavirus-who-

diplomatic-challenge

“The World Health Organization is having to perform a diplomatic balancing act over the new coronavirus outbreak, caught between China – whose draconian measures to contain the disease have delayed transmission to the rest of the world –and China’s critics, who say its behaviour is

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typical of its disregard for human rights. At every press briefing, WHO director general Tedros Adhanom Ghebreyesus has defended China’s handling of the epidemic in the face of critical questions, very often from US journalists….”

“Tension between China and the US is playing a significant part in the handling of the outbreak, causing difficulties for the WHO as it continues to monitor the situation. Both nations have been using the situation to score points….”

See also M Pillinger - Pandemics do have borders (focusing on Hong Kong & Taiwan (commotion) here).

Foreign Policy - How China’s Incompetence Endangered the World

L Garrett; https://foreignpolicy.com/2020/02/15/coronavirus-xi-jinping-chinas-incompetence-

endangered-the-world/

“As the deadly coronavirus began to spread, Beijing wasted the most critical resource to fight it: trust.”

IDS - Social dimensions of the COVID-19 outbreak in China and beyond

https://www.ids.ac.uk/news/ids-researchers-attend-world-health-organization-forum-on-

coronavirus/

“IDS Director Professor Melissa Leach and Research Fellow Dr Hayley MacGregor have been working with colleagues at the Wellcome Trust and the WHO on integrating social sciences into the COVID-19 response, as the virus continues to cause concern globally. A new report has now been published on the Social Science in Humanitarian Action Platform (SSHAP), summarising discussions and research action points from a workshop of social scientists at the Wellcome Trust around; the social contexts and dynamics of transmission and spread; public health responses and communication and messaging. As well as covering the preparedness and response in China the report also covers preparedness, capacities and political dynamics should an outbreak occur in Africa….”

HPW - Laws Governing Global Health Emergencies Need Reform, Experts Say

https://www.healthpolicy-watch.org/laws-governing-global-health-emergencies-need-reform-

experts-say/

Great report by Priti Patnaik of an expert panel meeting in Geneva last week. Must-read.

“A high level panel of experts reviewed key concerns and possible solutions last week at the Geneva launch of the Legal Determinants of Health – The Lancet Commission, Global Health & the Law Report – hosted by UNAIDS on the margins of WHO’s Executive Board meeting….”

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Chatham House - Explainer: Why Investment in Public Health Can Fight Epidemics

https://www.chathamhouse.org/file/explainer-why-investment-public-health-can-fight-epidemics

Rob Yates’s take. “Rob Yates explains why the spread of the coronavirus beyond China continues to highlight disparities between nations that have invested in public health services and those that have not.”

CNN - These bonds were supposed to help fight diseases like coronavirus. They've never paid out

https://amp.cnn.com/cnn/2020/02/15/business/pandemic-bonds-coronavirus/index.html

Including this quote: “… Olga Jonas, a senior fellow at the Harvard Global Health Institute who spent 33 years at the World Bank, described pandemic bonds as a "publicity stunt" that will not help to stop outbreaks or prevent pandemics. The money, she argues, would never arrive quickly enough to make a difference. "Only the reinsurers and investors came out ahead," said Jonas, who spent seven years coordinating the World Bank's response to pandemics…”

RPT-World Bank pandemic bond under pressure as coronavirus spreads

https://uk.reuters.com/article/china-health-worldbank-pandemic/rpt-world-bank-pandemic-bond-under-pressure-as-coronavirus-spreads-idUKL8N2AJ685

(20 Feb) Having said that, there might be some “immanent justice” after all : )

“A World Bank bond designed to deliver funding to help the world’s poorest countries to tackle fast-spreading diseases has lost half its value as the coronavirus outbreak in China has fanned fears that investors could face hefty losses. After the 2013-2016 Ebola outbreak that ravaged Sierra Leone, Guinea and Liberia and killed at least 11,300 people, the World Bank launched bond and insurance instruments under its Pandemic Emergency Financing umbrella in 2017 to establish a mechanism that would speedily deploy funds where needed. …. However, the World Bank’s two so-called pandemic bonds came under scrutiny after the second-worst Ebola outbreak on record. With the coronavirus outbreak having infected more than 74,000 people and claimed more than 2,000 lives, prices for the IBRD pandemic bond with the highest investment risk - the Class B notes - have come under increasing pressure….”

“…For all the good intentions and the prospect that a payout to poor countries might be on the cards, the bonds remain under fire for failing to deliver sufficient or timely aid. One point of contention is the length of time before a payout is triggered. In the case of a coronavirus outbreak for the Class B notes, this is 84 days from when the World Health Organization (WHO) publishes its first “situation report”. In the current outbreak, that would be in mid-April. Think tanks and some policymakers say the focus should be on shoring up healthcare systems and early detection facilities in vulnerable parts of the world that are already overburdened with cases of Ebola, measles, malaria and other deadly diseases.”

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NYT – To prevent the next coronavirus, stop the wildlife trade, conservationists say

https://www.nytimes.com/2020/02/19/health/coronavirus-animals-markets.html?action=click&module=Well&pgtype=Homepage&section=Science

Cfr a tweet Seth Berkley: “…if we want to prevent epidemics that originate in animals, we need to end the global wildlife trade. Trading tens of millions of animals isn’t just a conservation issue, it’s a public health problem.”

Ebola DRC

UN News - Newly licensed vaccine, ‘milestone in the fight’ against Ebola in Africa,

UN health agency

https://news.un.org/en/story/2020/02/1057461

From late last week: “Four countries in Africa have licensed an Ebola vaccine to “cement hard-fought progress” in keeping their people safe from the deadly disease, the UN health agency said on Friday. For the Democratic Republic of the Congo (DRC), Burundi, Ghana and Zambia, the vaccine licensing means that the manufacturer can stockpile and widely distribute it to those nations at risk of Ebola virus outbreaks, according to the World Health Organization (WHO). And once licensed doses are available, use of the vaccine will not require clinical trial or other research protocols….”

See also Devex - Ebola vaccine given the go-ahead in 5 African countries.

AMR

FT Health - AI discovers new antibiotics effective against certain diseases

https://www.ft.com/content/e5bb4e4e-5332-11ea-8841-482eed0038b1

“Artificial intelligence has been used to discover new antibiotics effective against untreatable diseases, marking the advent of a major new tool in the global fight against drug resistance. In a paper published on Thursday in the journal Cell, researchers at the Massachusetts Institute of Technology reported the discovery of a potent new antibiotic, halicin, which was able to able to kill 35 powerful bacteria. Among the pathogens targeted were Clostridium difficile, tuberculosis and Acinetobacter baumannii, an effectively untreatable infection often seen among US veterans, which enters wounds and frequently causes death….”

See also the Guardian - Antibiotic that kills drug-resistant bacteria discovered through AI

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UHC

Forbes - Let’s Worry About Diagnostic Capacity, Not Just During Outbreaks

M Pai; https://www.forbes.com/sites/madhukarpai/2020/02/19/lets-worry-about-diagnostic-

capacity-not-just-during-outbreaks/#7daa28671234

“… Undoubtedly, diagnostics are a fundamental component of a successful outbreak containment strategy, enabling evidence-based control strategies to be implemented without delay in order to contain the outbreak, minimize response costs and save lives. But why is diagnostic capacity discussed only during outbreaks and emergencies? The answer is: neglect. The global health community has neglected diagnostics for decades. Instead of investing in diagnostics and laboratory systems, undue emphasis was placed on empirical or syndromic management for many years. This explains why an Essential Medicines List was developed in the 1970s, but an Essential Diagnostics List was only developed in 2018….” M Pai argues: there’ll be no UHC without diagnostics.

See also BMJ Blog - Laura Hallas: Covid-19 is a timely reminder we need to improve global diagnostic capacity for a similar message.

Lancet Global Health - The global nursing workforce: realising universal palliative

care

W E Rosa, P Farmer et al ; https://www.thelancet.com/journals/langlo/article/PIIS2214-

109X(19)30554-6/fulltext

“… WHO's declaration of the International Year of the Nurse and Midwife makes 2020 the ideal time to promote nursing contributions to palliative care policy, training, and services in low-income and middle-income countries….”

Lancet Global Health (letter) - Medical expenditures: not the only source of

financial hardship – Authors' reply

A Wagstaff et al; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30026-

7/fulltext

Replying to a letter (by K Lönnroth) in the Lancet Global Health, Wagstaff et al conclude:

“UHC should remain focused on the use of health services, rather than on health outcomes, and on the expenditures associated with health service use, rather than on the overall costs of adverse health events. It is not so much a question of being cautious about the use of the term financial protection in UHC monitoring, but rather of being clear that it means financial protection in health services, not financial protection in health.”

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Big Alcohol

Lancet Global Health - Alcohol: global health's blind spot

Robert Marten et al; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30008-

5/fulltext

Marten et al nail it here.

“Non-communicable diseases constitute more than 72% of annual global deaths and are now rightfully receiving increased attention in the global health agenda. However, one of the primary risk factors for non-communicable diseases continues to be neglected: alcohol. Although the alcohol industry uses sophisticated public relations campaigns to maintain this near invisibility within the health agenda, the global health community is also culpable. Global health policy makers do not appreciate the evidence on alcohol, identify and confront interference from the alcohol industry, or prioritise resources, policies, and programmes for alcohol control….”

Excerpt: “Global health charities also persistently ignore alcohol control. Bloomberg Philanthropies, a worldwide leader in tobacco control, convened a high-level task force with former heads of state and finance ministers to consider fiscal policies for health. The philanthropic organisation recognised that alcohol taxes were underused, and, if implemented, could indirectly save up to 22 million lives over the next 50 years. Yet, Bloomberg Philanthropies has not devoted resources to alcohol control programmes. The Wellcome Trust, which announced a major commitment of £200 million to transform research and treatment for mental health, has also invested £171 million in Anheuser-Busch InBev as of 2017. No global health charity has allocated substantial resources or prioritised investment in alcohol control, despite the fact that this neglected issue needs leadership….”

Planetary health

Lancet (Comment) – Climate change and the people's health: the need to exit the

consumptagenic system

Sharon Friel; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30257-9/fulltext

“We … need to disrupt the consumptagenic system that encourages and rewards the exploitation of natural resources, excess production, and hyperconsumerism, and which results in climate change and health inequities. Future policy action and advocacy must focus on the operation of the consumptagenic system. Targets should be the institutions, actors, structures, and ideas that embed, facilitate, and normalise the global dominance of a consumptagenic system addicted to growth irrespective of the environmental, social, and health costs. This focus is particularly important in the industrialised food system and in the processes of urbanisation, two central cogs in this system of excessive production and consumption. … The health community must engage in policy discussions relating to the consumptagenic system and issues such as energy, macroeconomics, food, and infrastructure. Too often, health discourse retreats to the domains of health systems and individual behaviours. Acting on systemic structural factors is crucial if we are to address the common root causes of climate change and health inequities.”

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Open Democracy - Breakdown or breakthrough? Degrowth and the Great

Transition

https://www.opendemocracy.net/en/transformation/breakdown-or-breakthrough-degrowth-and-

great-transition/

Our choice is, basically, between the ‘Great Transition’ or ‘Great Unraveling’ in the decades to come. You find hints of both already now.

Guardian - Firms making billions from ‘highly hazardous’ pesticides, analysis

finds

https://www.theguardian.com/environment/2020/feb/20/firms-making-billions-from-highly-hazardous-pesticides-analysis-finds

“The world’s biggest pesticide companies make billions of dollars a year from chemicals found by independent authorities to pose high hazards to human health or the environment, according to an analysis by campaigners. The research also found a higher proportion of these highly hazardous pesticides (HHPs) in the companies’ sales in poorer nations than in rich ones. In India, 59% of sales were of HHPs in contrast to just 11% in the UK, according to the analysis. The data from Phillips McDougall, the leading agribusiness analysts, are from buyer surveys focused on the most popular products in the 43 nations that buy the most pesticides. It was obtained and analysed by Unearthed, a journalism group funded by Greenpeace UK, and the Swiss NGO Public Eye….”

Guardian - How should Jeff Bezos invest his $10bn Earth Fund?

https://www.theguardian.com/environment/2020/feb/18/how-should-jeff-bezos-invest-his-10bn-

earth-fund-amazon-climate-crisis?CMP=Share_iOSApp_Other

“Scientists propose best use of funds pledged by Amazon founder to fight climate crisis.”

Science News - Humans are a bigger source of climate-altering methane, new

studies suggest

https://www.sciencemag.org/news/2020/02/only-humans-can-create-climate-altering-methane-burns-new-studies-suggest

“Global warming won’t trigger cataclysmic methane releases any time soon.” Somewhat encouraging news.

And a link: Wellcome Trust - Carbon offset policy for travel

New policy.

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SRHR

Devex - Anti-prostitution case threatens localization agenda, experts warn

Devex;

(gated) “The U.S. Supreme Court is set to consider whether global health organizations' local affiliates should adopt policies opposing prostitution. The case could undermine the U.S. government's own effort to put more health services in the hands of local organizations, some experts warn.”

Decoloniality & Global Health

You can re-watch a lecture (from this week) by Madhukar Pai here: “Global Health needs more than a makeover”

https://lecture.ucsf.edu/ets/Play/6078807ec0e6443685293cbce3fc36541d?catalog=e7879ae494bf4fa19fc3c3a8ca6975df21&playFrom=251412&autoStart=true

From the few tweets I’ve seen so far on this lecture, well worth it!

Health in the SDGs: Intersectoral Action for Health

https://www.biomedcentral.com/collections/HealthinSDGs

New Special issue in Globalization & Health, edited by Sameera Hussain, Dena Javadi, Jean Andrey, Ronald Labonté and Abdul Ghaffar.

“This article collection showcases multisectoral approaches to achieving the health and well-being related goals in the United Nations 2030 Agenda for Sustainable Development. The Agenda consists of 17 Sustainable Development Goals (SDGs) that Member States aim to achieve by 2030. Goal 3 focuses explicitly on health, however, almost all other goals are related to or contribute to health and well-being. This article collection is focused on policies and programmes outside the health sector – often in collaboration with the health sector – that have health implications through commercial, cultural, economic, environmental, political, or social determinants of health. Here, we gather critical lessons on effectively engaging other sectors to enhance their health outputs, identifying co-benefits and ‘win-wins’ that enhance human health. With the exception of Brolan et al and Wright et al, all articles in this collection are funded by the Alliance for Health Policy and Systems Research, World Health Organization….”

Do start with the (long awaited) introductory Commentary - Health intersectoralism in the Sustainable Development Goal era: from theory to practice

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(by Sameera Hussain et al). The article gives a neat overview of the contributions to the special issue.

Lancet Global Health March issue

https://www.thelancet.com/journals/langlo/issue/vol8no3/PIIS2214-109X(20)X0003-9

A lot of fabulous stuff in this month’s Lancet Global Health issue.

• Start with the Editorial - Entitled to a healthy, thriving future

After referring to the two big threats identified in the new Commission, this editorial also points out the continuing threats of unfinished agendas for children’s health.

Concluding: “Many of us could not have predicted the substantial and rapid effects of climate change, conflict, economic inequality, and technological advances on health, yet these factors are now immediate priorities. However, we should not lose sight of the unfinished agenda of pneumonia and diarrhoea as the biggest killers of the world's children. “

In addition to the reads mentioned above (in the Highlights section), we certainly also want to flag:

• Burden of disease in francophone Africa 1990–2017: the triple penalty? (Comment by Yap Boum et al related to a new systematic analysis in the Lancet GH) Check out what they mean by this ‘triple penalty’.

• What counts as development assistance for reproductive, maternal, newborn, and child health? (by T Templin & E Bendavid) On the Muskoka-2 method.

• Moving the global disability agenda forward with scarce data (by A Roca)

“The inclusion of people with disabilities into the global development agenda has become more visible in recent years. Disability features prominently in the Sustainable Development Goals3and the United Nations Convention on the Rights of Persons with Disabilities offers a framework for more inclusion in domestic policies and international development. However, it is still a field where evidence is poor, both in quantity and quality. At the Third International Conference on Disability and Development on Nov 5–6, 2019, presenters made this abundantly clear: the evidence on the prevalence of disability and effectiveness of interventions in low-income and middle-income settings is patchy at best, and non-existent in many domains. Great work is being done, but more high-quality data from large well designed studies are needed for evidence-informed decision making….”

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Some papers & reports of the week

UNU-Wider (Working Paper) - A proposal for a new universal development

commitment

J Glennie et al; https://www.wider.unu.edu/publication/proposal-new-universal-development-

commitment

“… what if all countries made a universal development commitment, meaning a scaled contribution? We propose a new universal and scaled financial commitment to development, informed by but not necessarily identical to official development assistance. This paper: (i) sets out how a new era is emerging of fewer very poor countries and higher global ambitions—for example, to end poverty; (ii) proposes a new way to raise and govern international public funds; (iii) discusses the possible size and use of contributions, and the evolution in global governance and democracy that a new deal would entail. We conclude with a set of questions that the proposal raises. »

IJHPM - Beyond Talking: We Need Effective Measures to Tackle Systemic

Corruption and the Power That Allows It to Persist in Health Systems; A Response

to Recent Commentaries

E Hutchinson et al; http://www.ijhpm.com/article_3757.html

14 Commentaries in total, actually. This is their response. “We were delighted to receive 14 responses to our editorial on corruption in health systems and thank the authors for their excellent contributions. It seems that in discussing why health systems researchers are reluctant to discuss corruption, this journal has created a window of opportunity to discuss this neglected topic. Taken together, the responses represent a condensed introduction to the field and key areas of concern….”

Global Health Action – Responding to aid volatility: government spending on

district health care in Zambia 2006–2017

Amy Jackson et al ; https://www.tandfonline.com/doi/full/10.1080/16549716.2020.1724672

“A corruption event in 2009 led to changes in how donors supported the Zambian health system. Donor funding was withdrawn from the district basket mechanism, originally designed to pool donor and government financing for primary care. The withdrawal of these funds from the pooled financing mechanism raised questions from Government and donors regarding the impact on primary care financing during this period of aid volatility. “

“We examined the budgets and actual expenditure allocated from central Government to the district level, for health, in Zambia from 2006 to 2017 and determine trends in funding for primary care….”

Conclusion: “The increase in the budget allocated to primary care could be an example of ‘reverse fungibility’, whereby Government accounted for the gap left by donors. However, the decline in the operational grant demonstrates that this period of aid volatility continued to have an impact on how

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primary care was planned and financed, with less flexible budget lines most affected during this period.”

Eurodad - Impoverished countries spending up to 40% of government revenues

on repaying debt, according to new research

Eurodad;

“ A report published today shows that rapidly rising and more expensive public debt is pitting the rights of creditors against those of the world’s poorest - and in particular women and girls - as countries devote up to 40 per cent of revenue to external debt service. The new research - published by the European Network on Debt and Development (Eurodad) to mark World Day of Social Justice - shows that in at least one of the years between 2014 and 2018, at least 20 governments in the global south spent more than one-fifth of revenue on servicing external debts. This exceeded more than 40 per cent in six countries, including Lebanon, which has been going through a financial and debt crisis and which last week called in the IMF for advice on dealing with debt payments. The other countries are Angola, Djibouti, Jamaica, Sri Lanka and Ukraine. The impact of the growing debt burden is also already playing out in cuts to health and education spending in many affected countries … …. in the 39 developing countries, among those where data is available, health expenditure per capita decreased between 2014 and 2016, while debt repayments rose.”

Tax Justice Network – Financial secrecy index 2020

https://fsi.taxjustice.net/en/

Launched on 18 Feb. “The Financial Secrecy Index ranks jurisdictions according to their secrecy and the scale of their offshore financial activities. A politically neutral ranking, it is a tool for understanding global financial secrecy, tax havens or secrecy jurisdictions, and illicit financial flows or capital flight….” For the ranking, see here.

Press release - Financial Secrecy Index 2020 reports progress on global transparency – but backsliding from US, Cayman and UK prompts call for sanctions

“The US has overtaken Switzerland in a global ranking of countries most complicit in helping individuals to hide their finances from the rule of law – but Cayman has leapfrogged both to rank as the worst offender. The Tax Justice Network’s Financial Secrecy Index 2020, published today, has revealed that financial secrecy around the world is decreasing as a result of recent transparency reforms. On average, countries on the index reduced their contribution to global financial secrecy by 7 per cent. But a handful of jurisdictions accounting for a large share of global financial services have bucked the trend, most notably the US, Cayman and the UK. With Switzerland finally improving enough to move off the top of the index, an Anglo-American axis of secrecy now constitutes by far the greatest global threat of corruption and tax abuse. The Tax Justice Network is calling on policymakers to prioritise sanctions against these backsliders….”

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Some blogs & mainstream news articles of the week

Economist – The World Bank loses another chief economist

https://www.economist.com/finance-and-economics/2020/02/13/the-world-bank-loses-another-

chief-economist

From last week’s issue. Cfr a tweet: “The Economist links Penny Goldberg's departure as World Bank Chief Economist to censorship of Bob Rijkers et al's WB paper apparently showing diversion of WB aid to tax havens. »

See also FT (Alphaville) - The World Bank paper at the centre of a controversy

Conclusion of this great analysis: "Unless public institutions allow for research independence within their set-ups, more bad policies will remain in place, unquestioned by those who fear their career is under threat from reprisal."

You find the (notorious) paper now, at last, here: Elite capture of foreign aid.

Forbes – Global Health Technologies: Time To Re-Think The ‘Trickle Down’ Model

M Pai; https://www.forbes.com/sites/madhukarpai/2020/02/17/global-health-technologies-time-to-

re-think-the-trickle-down-model/#4e8777e144d9

« Technologies (e.g. vaccines, drugs, diagnostics) are critical for addressing global health needs. But the field of global health has a problem - an excessive reliance on the ‘trickle down’ model, where products and innovations are developed in the Global North, and after a decade or two, they slowly trickle down to the Global South, where the biggest needs are, and where technologies often have the greatest impact. This model is not surprising, since every aspect of global health is dominated by high-income countries. Nevertheless, the model needs a re-think. …. …. Should global health still rely on the 'trickle-down science' model? Is there an alternative? The alternative is to develop technologies & solutions in the Global South, and scale them up, to meet the pressing needs of LMICs. … “

Pai goes on, emphasizing that there are many reasons why home-grown innovations have better odds of success than the standard trickle-down model.

Guardian - Mike Bloomberg rocked by re-emergence of sexist remarks

https://www.theguardian.com/us-news/2020/feb/15/michael-bloomberg-booklet-sexist-remarks-

abortion

“ The presidential candidate Michael Bloomberg has insisted he is a “champion for women in the workplace”, after the republication of a 30-year-old booklet purporting to contain his “Wit and Wisdom” cast an uncomfortable spotlight on the billionaire former New York mayor. The Washington

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Post made the 1990 booklet available online as it published an investigation of how Bloomberg has “for years battled women’s allegations of profane, sexist comments”…”

Elizabeth Warren ‘rocked’ Mike “global health champion” Bloomberg a bit more during this week’s

debate 😊.

See also a tweet from Warren: “Mayor Bloomberg has made women—dozens, who knows—sign nondisclosure agreements for sexual harassment and gender discrimination. Mr. Mayor, are you willing to release all of those women from those nondisclosure agreements so we can hear their side of the story? #DemDebate”

ODI – Four expert views on the future of tax for development

ODI;

“In this blog, four of our experts provide insights on the interplay between taxation and development – from informal taxes to civil society, and tax reform to economic transformation….”

Guardian – Citizens' wellbeing should be part of G20's priorities, says report

https://www.theguardian.com/business/2020/feb/20/citizens-wellbeing-should-be-part-of-g20s-priorities-says-report?CMP=share_btn_tw

“The G20 needs to move beyond economic growth and GDP as a measure of progress and factor in human wellbeing and social prosperity, one of its key advisors has said in a new report. In a hard-hitting report due to be submitted to the G20 group of leading developed and developing countries, experts said that issues including the climate emergency and mental health meant judging progress required a different yardstick of success. Against a backdrop of heightened political unrest in several major western nations despite continued growth in economic prosperity, Dennis Snower, president of the Global Solutions Initiative, a thinktank with links to the group of rich nations, said they should adopt a “recoupling dashboard” to assess wellbeing and environment alongside GDP….”

“The report, shared exclusively with the Guardian, Die Zeit and Der Tagesspiegel, said there was an urgent need for all nations to use the dashboard to dramatically increase their focus on social prosperity, as a key tool in the fightback against growing political extremism across advanced economies. … … In a proposal floated ahead of the G20 summit in Saudi Arabia later this year, the dashboard would include four separate measurements of economic and social prosperity: GDP per capita and environmental performance, as well as two new indexes assessing the “solidarity” and “empowerment” of citizens….”

A few tweets of the week

Olga Jones (former WB staff member on pandemic risk):

“”#pandemic bonds were designed by @worldbank to fail from the outset. The cost of $115 million for fat coupons and bankers’ fees was paid from public funds intended for the poorest countries. “

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Devi Sridhar

“Huge problem in #globalhealth is initiavitis- launching initiative after initiative, often focused on same issue. Why? Bc donors want to control easily, but also bc founders want to take credit for 'founding' something new. We need less ego & more humility.”

L Gostin

“I have no desire to criticize China, less so @WHO re #COVID19 This isn't a "war." It should be a ph science-based response that respects human rights, int'l law, #IHR We're trading off lives & rts of indivs in Hubei to wall off virus from int'l spread. It shouldn't work that way”

Rachel Thompson (with appropriate emoji’s )

“Are the side effects of the devastating #COVID2019 outbreak ultimately good news for the planet?

🌍😷🐝 Could this #GlobalHealth emergency be a blessing in disguise for the

#ClimateEmergency ? 🤷‍♀️ #ClimateCrisis #Gaiatheory #Coronavirustruth #Controversial”.

Global health events & announcements

Global Health Watch 6: Call for case studies

https://phmovement.org/ghw6-call-for-case-studies/

Deadline May 31st.

Coming up: webinar series: Handbook on social participation for UHC

https://www.healthsystemsglobal.org/blog/394/Webinar-series-Handbook-on-Social-Participation-for-Universal-Health-Coverage.html

“We are pleased to announce an upcoming webinar series, led by WHO and in collaboration with the Health Systems Governance Collaborative, Health Systems Global, the UHC Partnership, UHC2030 and the Civil Society Engagement Mechanism for UHC2030, which will present chapter findings of a currently developed WHO guidance document, the handbook on social participation for universal health coverage. The handbook will provide best practice guidance to policymakers on how to effectively and meaningfully engage with populations, communities and civil society in national policy, planning and review processes.”

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First webinar: 4 March.

Global governance of health

CGD (blog) - The Greek Tragedy of America and International Finance

C Kenny; https://www.cgdev.org/blog/greek-tragedy-america-and-international-finance

“Increasingly, Washington views international financial organizations as weapons in the global struggle for the neoliberal economic model against China’s state-led approach to development. And often, the international financial institutions are the battlefield itself, in a conflict over voting shares.”

Devex - DFID's entire junior ministerial team is merged with the Foreign Office

https://www.devex.com/news/dfid-s-entire-junior-ministerial-team-is-merged-with-the-foreign-

office-96582

News from late last week: “The junior ministerial team of the U.K.’s Department for International Development was quietly merged with the Foreign & Commonwealth Office on Thursday as part of a government reshuffle. Relief among development professionals at the news that DFID would retain its independence was short-lived; soon after Anne-Marie Trevelyan was announced as DFID’s new secretary of state, it emerged that all of the department’s junior ministers would now be working jointly for FCO, a Whitehall power rival. Prime Minister Boris Johnson has previously threatened to merge the two departments. Although that didn’t happen, the shake-up of the ministerial team was branded “integration by stealth” by one former senior DFID official, who spoke on condition of anonymity. “It is a clear statement of intent on the role development assistance is to play in foreign policy,” he said….”

Devex - Japan leads surge in tied aid

V Chadwick; https://www.devex.com/news/japan-leads-surge-in-tied-aid-96535

“ The world’s major donors reserved almost $21 billion of their bilateral aid for suppliers from their own countries in 2018, official figures show — $4.7 billion more than the year before. But it was one donor — Japan — that was largely responsible for the leap. The figures, released by the Organisation for Economic Co-operation and Development this month, sparked concern from aid advocates who say that tied aid — where procurement is available primarily to companies from the donor country — raises transaction costs and jeopardizes local ownership….”

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Devex - USAID pushes back on counterterror regulation complaints

https://www.devex.com/news/usaid-pushes-back-on-counterterror-regulation-complaints-96583

“The U.S. Agency for International Development has pushed back on reports that a policy intended to prevent U.S. humanitarian funding from supporting terrorism hinders crisis response efforts in Nigeria….”

Guardian - Australia slashes Pacific aid funding for health as region battles medical crises

https://www.theguardian.com/world/2020/feb/18/australia-slashes-pacific-aid-funding-for-health-

as-region-battles-medical-crises

“New figures show the budgets of some programs, including health, slashed in favour of more infrastructure spending.”

Devex – Australia's new international policy directions revealed

https://www.devex.com/news/australia-s-new-international-policy-directions-revealed-96613

“Alex Hawke, the minister for international development and the Pacific, outlined the directions of Australia’s new international development policy in Canberra Wednesday — despite consultation processes for the design of the policy still ongoing. Infrastructure, regional security, and better enabling financing beyond official development assistance were key priorities identified in a new strategy that will seek a whole of government approach to development beyond foreign affairs….”

Development Policy Review - Is development aid securitized? Evidence from a cross‐country examination of aid commitments

M Lazell et al ; https://onlinelibrary.wiley.com/doi/10.1111/dpr.12426

“This article examines whether and how securitization has affected the distribution of UK, US, Danish and Swedish development aid by sector through investigating how conflict in aid‐recipient states—and the extent to which these states are perceived as a security threat—affect aid commitments to priority sectors; democratization and peace, conflict and security….”

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AP - Health concerns meet politics amid Taiwan’s WHO exclusion

AP;

“Taiwan’s exclusion from the World Health Organization is pitting health concerns against geopolitics during the current crisis over the new illness known as COVID-19. Taiwan has called repeatedly for it to be allowed to participate in WHO, from which it has been barred by China. So strong is China’s diplomatic pressure that Taiwan can no longer take part in the organization’s annual World Health Assembly, even as an observer. … … But some observers say Taiwan’s publicity offensive seems at least as much about highlighting its China-imposed diplomatic isolation as it is about public health. Lack of WHO membership puts Taiwan at risk of missing firsthand updates on infectious diseases, but the island’s government has found alternative ways to stay informed, officials and analysts say. “I think the WHO matter is more politics than real needs,” said Alex Chiang, associate professor of international politics at National Chengchi University in Taipei. “Even though we are not in WHO, we can still get this info from many, many other places.”…”

Twitter thread Madhukar Pai (on reciprocity of GH programs & partnerships)

“For an upcoming lecture, I am looking for data on whether global health programs & partnerships are RECIPROCAL. For e.g. for every HIC student/researcher who visits LMICs, how many folks from LMICs are hosted in HIC?”

“From my experience leading a global health program, here are the biggest obstacles to real reciprocity:

1. HIC government visa restrictions are a HUGE issue; even with our invitations, our governments deny visas all the time!

2. HIC universities and donors are keen to support their students, but less keen on the $ being used for LMIC trainees. Most scholarships and fellowships are restricted to HIC citizens or permanent residents.

3. For degree programs in HICs, getting admitted is a challenge for LMIC trainees; GRE/TOEFL, GPA, and such scores are often used to downgrade applications, even among candidates with tons of field/lived experience.

4. Even if admissions are offered, fewer faculty want to supervise international students, since tuition fees are much higher for foreign applicants.

5. With international grants, much of the funds might get allocated to HIC partners (with huge overheads), and the LMIC component of the budget might be too small for them to spend on sending trainees to HICs.

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6. HIC institutions & funders are anxious that they will contribute to the 'brain drain' and that LMIC trainees to come to HICs will never return to their countries.

7. For medical & allied health professionals from LMICs, they are generally not allowed to train in hospitals in HICs, since their training is not deemed valid or equivalent. Even highly qualified LMIC health professionals face huge barriers for licensure.

8. While HIC professors easily get visiting professorship appointments in LMIC institutions, the reverse is rare. HIC institutions rarely reciprocate with honorary/visiting professorship appointments.

9. While HIC students can often fund their own travel to LMICs, LMIC students find this impossible to do so, and their own institutions rarely offer them funding for travel. So, they entirely depend on external funds or HIC partners for travel support.

10. Within LMIC institutions, there is often a rigid 'hierarchy' with senior folks tending to get travel support and invitations. Junior faculty and trainees are not prioritized for exchange visits. So, the same LMIC professor ends up going to all meetings & events!

All evidence points to big challenges with reciprocity in global health. At a minimum, all global health programs in HICs must track some metrics on reciprocity:

1. for each HIC faculty/student who visits an LMIC, how many LMIC faculty/students are received & hosted?

2. What % of donor gifts & scholarships are used for HIC students to travel versus receiving LMIC students?

3. What % of collaborative grant budgets are allocated to HIC vs international partners?

Any other metrics that are straightforward to measure and track?”

UHC

Lancet World Report – Farewell Seguro Popular

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30408-6/fulltext

“Mexico has scrapped its Seguro Popular health-care programme, and its replacement is drawing criticism. David Agren reports from Mexico City.”

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Health Research Policy & Systems - Action research and health system strengthening: the case of the health sector support programme in Mauritania, West Africa

Kirsten Accoe et al ; https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-020-

0531-1

“Access to qualitative and equitable healthcare is a major challenge in Mauritania. In order to support the country’s efforts, a health sector strengthening programme was set up with participatory action research at its core. Reinforcing a health system requires a customised and comprehensive approach to face the complexity inherent to health systems. Yet, limited knowledge is available on how policies could enhance the performance of the system and how multi-stakeholder efforts could give rise to changes in health policy. We aimed to analyse the ongoing participatory action research and, more specifically, see in how far action research as an embedded research approach could contribute to strengthening health systems….”

International Development Policy - Performance-Based Financing (PBF) in Mali: is it legitimate to speak of the emergence of a public health policy?

A Coulibaly et al ; https://journals.openedition.org/poldev/3310

“Performance-based financing (PBF) is just one of a number of recent experiments implemented in Mali to improve maternal and child health indicators. This article presents a qualitative study based on Kingdon’s (1984) multiple streams theory and an approach inspired by development anthropology. The aim was to describe the forms of national ownership of PBF and to determine whether it is possible to speak of the emergence of a PBF public policy in Mali at this stage. The contribution of this study is both theoretical (understanding the emergence of a policy) and empirical (roles of local and international actors). The data came from 33 qualitative interviews conducted with individuals representing various institutions, notably the Ministère de la Santé. The results suggest there has been no emergence of a PBF public policy in Mali due to a myriad of constraints, including an insufficient number of political entrepreneurs, windows of opportunity and funding partners as well as the short duration of the pilot projects.”

Planetary health

Lancet World Report – Locust swarms in east Africa could be “a catastrophe”

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30406-2/fulltext

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“The destruction of crops is threatening food security for millions of people. Sharmila Devi reports. The worst infestation of desert locusts in decades to hit the Horn of Africa should be tackled now to help millions of people, or else the world will face a higher humanitarian cost within months, the UN has warned….”

FT - UK under pressure to re-energise UN climate summit in Glasgow

https://www.ft.com/content/af77e632-50a6-11ea-90ad-25e377c0ee1f

“Stakes are high for post-Brexit Britain to rally world leaders to draw up ambitious carbon reduction plans.”

Washington Times - Jeff Bezos pledges $10B to fight climate change: 'We can save Earth'

https://www.washingtontimes.com/news/2020/feb/17/jeff-bezos-pledges-10-billion-to-fight-

climate-cha/

Guess you know this by now.

Nature - China takes centre stage in global biodiversity push

Nature;

“A major United Nations summit could see China push for ambitious targets and spotlights the country's own conservation efforts.”

“China is expected to take a prominent role when nearly 200 countries gather in ten days’ time to thrash out a major plan to address the biodiversity crisis. The meeting was originally planned to take place in Kunming, China, but has been moved to Rome because of the coronavirus outbreak. China will take over the presidency of the United Nations Convention on Biological Diversity (CBD), which will determine the targets that will form the basis of a legally binding global agreement. The stakes are particularly high this time, because countries have largely failed to meet the 2020 deadline for the current CBD goals.”

See also a related Nature op-ed - Set a global target for ecosystems

“The conservation community must be able to track countries’ progress in protecting wetlands, reefs, forests and more, argue James Watson and colleagues.”

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Coming up – 7th international degrowth/ 16th international society for ecological economics joint conference: Building Alternative Livelihoods in times of ecological and political crisis

http://www.confercare.manchester.ac.uk/events/degrowth2020/

In Manchester (1-5 September).

Guardian - Fates of humans and insects intertwined, warn scientists

https://www.theguardian.com/environment/2020/feb/20/fates-humans-insects-intertwined-scientists-population-collapse

“The “fates of humans and insects are intertwined”, scientists have said, with the huge declines reported in some places only the “tip of the iceberg”. The warning has been issued by 25 experts from around the world, who acknowledge that little is known about most of the estimated 5.5 million insect species. However, enough was understood to warrant immediate action, they said, because waiting for better data would risk irreversible damage….”

Quick links:

• CarbonBrief - Guest post: How close is the West Antarctic ice sheet to a ‘tipping point’?

• The Independent - Climate crisis: One-third of all plant and animal species could be extinct in

50 years, study suggests Based on new US research.

Infectious diseases & NTDs

Reuters - China HIV patients risk running out of AIDS drugs in days: UNAIDS

Reuters;

“HIV patients in China risk running out of life-saving AIDS drugs because quarantines and lockdowns aimed at containing the coronavirus disease outbreak mean they cannot replenish vital medicine stocks, United Nations AIDS agency said on Wednesday. UNAIDS said it had surveyed more

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than 1,000 people with HIV in China and found that the outbreak of the coronavirus, now known as COVID-19, is having a “major impact” on their lives….”

Plos Med (Policy Forum) – Emerging priorities for HIV service delivery

https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003028

“According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), in 2018, an estimated 37.9 million people were living with HIV worldwide. There were also 1.7 million new infections and 770,000 deaths. At the end of June 2019, 24.5 million people were receiving antiretroviral therapy (ART). Nonetheless, increased access to high-quality ART services is needed to further reduce mortality and new infections and to optimize long term outcomes. In this article, we summarize priorities for HIV service delivery research and guidance identified through a World Health Organization (WHO) consultation held at the end of 2018. The priorities identified include linkage from HIV testing to care; rapid initiation of ART (including out-of-facility ART initiation); task sharing and decentralization, including children and patients on second line; ART delivery for stable clients; adherence, retention, and reengagement in care; management of advanced HIV disease; provision of welcoming health services; and strengthening of service integration, particulary for NCDs and family planning. Ongoing evaluation is needed to determine the net effects of introducing differentiated service delivery models, in terms of health service inputs and long-term outcomes for people living with HIV.”

UN News - Polio eradication a UN priority, says Guterres in Pakistan visit

https://news.un.org/en/story/2020/02/1057641

See also WHO Emro - Polio eradication on United Nations Secretary General’s agenda during

Pakistan visit

HPSR - Resource allocation for biomedical research: analysis of investments by major funders

A H Ralaidovy et al; https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-020-0532-0

“Data on grants for biomedical research by 10 major funders of health research were collected from the World RePORT platform to explore what is being funded, by whom and where. This analysis is part of the World Health Organization Global Observatory on Health Research and Development’s work with the overall aim to enable evidence-informed deliberations and decisions on new investments in health research and development. The analysis expands on the interactive data

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visualisations of these data on the Observatory’s website and describes the methods used to enable the categorisation of grants by health categories using automated data-mining techniques….”

Some of the results: “Out of a total of 69,420 grants in 2016, the United States of America’s National Institutes of Health funded the greatest number of grants (52,928; 76%) and had the longest average grant duration (6 years and 10 months). Grants for research constituted 70.4% (48,879) of all types of grants, followed by grants for training (13,008; 18.7%) and meetings (2907; 4.2%). Of grant recipients by income group, low-income countries received only 0.2% (165) of all grants. Almost three-quarters of all grants were for non-communicable diseases (72%; 40,035), followed by communicable, maternal, perinatal and nutritional conditions (20%; 11,123), and injuries (6%; 3056). Only 1.1% of grants were for neglected tropical diseases and 0.4% for priority diseases on the WHO list of highly infectious (R&D blueprint) pathogens…”

Devex – Exclusive: New partnership leverages weather data to tackle mosquito-borne diseases

https://www.devex.com/news/exclusive-new-partnership-leverages-weather-data-to-tackle-mosquito-borne-diseases-96584

“Because mosquitoes thrive in warm and wet environments, even a slight increase in global temperatures will result in more mosquitoes and a greater risk of malaria transmission. Now, a diverse group of partners is coming together to explore how weather data and analytics can help defeat mosquito-borne diseases. With the rise of extreme weather events, there is increased urgency and opportunity for weather data to inform disease program policy and planning, said Martin Edlund, CEO of Malaria No More, who announced the partnership at Devex’s Prescription for Progress event in San Francisco on Thursday. Forecasting Healthy Futures will produce heat maps and dashboards to inform efforts to predict, control, and eliminate mosquito-borne diseases.”

Quick link:

UNAIDS - Crisis in childhood HIV treatment in western and central Africa

AMR

A tweet: “The @UN_PGA will convene a High Level Dialogue on #Antimicrobial Resistance on April 14, 2020 for stocktaking on commitments of the 2016 UNGA Declaration and on the implementation of the recommendations of the #IACG. This will catalyze action in countries”. See here.

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NCDs

Pfizer/Upjohn White paper - Leading the Conversation on Noncommunicable Diseases Worldwide: An Evidence-Based Review of Key Research and Strategies to Develop Sustainable Solutions

White Paper

You gotta like the private sector, I guess, to fully enjoy this paper 😊. “Embracing the role of the private sector, Pfizer launched Upjohn as a division dedicated to the fight against NCDs through a focused, strategic, and collaborative approach across the healthcare value chain…” This white paper provides a review of research and strategies to address noncommunicable diseases (NCDs).

And check out Upjohn’s SNAP framework.

HPW - Ethiopia Passes Landmark Smoking Excise Bill

https://www.healthpolicy-watch.org/ethiopia-passes-landmark-smoking-excise-bill/

“In a strong move for the African state, the Ethiopian Parliament has passed landmark legislation with the express aim of curbing smoking in the country – resulting in some of the strongest taxes on tobacco products on the continent. As a result of the legislation, Ethiopia has now introduced a mixed-excise system on cigarettes in line with the recommendations of the World Health Organization (WHO). This involves a 30% tax rate of the cost of producing cigarettes, in addition to a specific excise rate of eight Ethiopian Birr (ETB) (USD$ 0.25) on each individual packet….”

Sexual & Reproductive / maternal, neonatal & child health

JAMA – Contraceptive Use in Adolescent Girls and Adult Women in Low- and Middle-Income Countries

Jama;

“Do adolescent girls (age 15-19 years) have similar levels of contraceptive use as adult women (age 20-34 years) in low- and middle-income countries? … Findings: In this survey study using data from 261 Demographic and Health Surveys or Multiple Cluster Indicator Surveys for 103 low-and middle-income countries between 2000 and 2017, contraceptive use increased over time among both adolescent girls and adult women, but inequality in use by age persisted and, in some countries,

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increased. Meaning: Targeted strategies are likely to be required for adolescent girls to have equivalent opportunities to use contraceptives as older women.”

Plos Med - Estimating progress towards meeting women’s contraceptive needs in 185 countries: A Bayesian hierarchical modelling study

https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003026

“Expanding access to contraception and ensuring that need for family planning is satisfied are essential for achieving universal access to reproductive healthcare services, as called for in the 2030 Agenda for Sustainable Development. Monitoring progress towards these outcomes is well established for women of reproductive age (15–49 years) who are married or in a union (MWRA). For those who are not, limited data and variability in data sources and indicator definitions make monitoring challenging. To our knowledge, this study is the first to provide data and harmonised estimates that enable monitoring for all women of reproductive age (15–49 years) (WRA), including unmarried women (UWRA). We seek to quantify the gaps that remain in meeting family-planning needs among all WRA….”

Some of the findings: “Among the 1.9 billion WRA worldwide in 2019, 1.1 billion have demand for family planning; of these, 842 million are using modern contraception, and 270 million have an unmet need for modern methods.”

Devex - In Malawi, Trump’s global gag rule creates culture of intimidation

https://www.devex.com/news/in-malawi-trump-s-global-gag-rule-creates-culture-of-intimidation-

96599

« The impacts of the restrictive policy have reached far beyond sexual and reproductive health in the southeast African country, according to advocates. »

F2P blog - Why is the Far-Right so hostile to Gender? How does it understand Masculinity?

N Galasso; https://oxfamblogs.org/fp2p/understanding-the-far-rights-framing-of-masculinities-and-

hostility-to-gender/

“The resurgence of far-right populism, from Brazil to Europe to India and the US, presents a challenge to NGOs unforeseen even a few years ago. The common thread of ethno-nationalism, coupled with calls to revive traditional gender roles and values, is making it harder to protect refugees and ethnic minorities, advance gender justice, and tackle climate change….”

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Journal of Conflict resolution - Polygynous Neighbors, Excess Men, and Intergroup Conflict in Rural Africa

C Koos et al ; https://journals.sagepub.com/doi/pdf/10.1177/0022002719859636

Cfr a tweet: “Polygamy seems associated with neighbouring conflict. Why? Under polygamy, poor young men can’t marry/ gain respect. So are more prone to feel unequal treatment & justify violence. Hence raids on neighbouring groups?”

HP&P - A systematic review of costing studies for implementing and scaling-up breastfeeding interventions: what do we know and what are the gaps?

G Carroll et al; https://academic.oup.com/heapol/advance-article-abstract/doi/10.1093/heapol/czaa005/5740614?redirectedFrom=fulltext

“Despite the well-established evidence that breastfeeding improves maternal and child health outcomes, global rates of exclusive breastfeeding remain low. Cost estimates can inform stakeholders about the financial resources needed to scale up interventions to ultimately improve breastfeeding outcomes in low-, middle- and high-income countries. To inform the development of comprehensive costing frameworks, this systematic review aimed to (1) identify costing studies for implementing or scaling-up breastfeeding interventions, (2) assess the quality of identified costing studies and (3) examine the availability of cost data to identify gaps that need to be addressed through future research….”

Women Lift Health

Women Lift Health ;

The new home of ‘Women Leaders in Global Health’. Check out the website.

As a reminder, “WomenLift Health, sponsored by the Bill & Melinda Gates Foundation (BMGF), aims to accelerate the involvement of women in global health leadership by investing in and elevating talented mid-career women to become global health leaders and to contribute to their fullest potential. Key components of the initiative include the development of a Leadership Journey for mid-career women leaders in global health, the development of a digital platform, a plan to amplify the voices of women global health leaders, a Global Advisory Board, an open and transparent process for continuing Women Leaders in Global Health (WLGH) conferences, integrating women’s leadership discussions in established global health meetings, and establishment of country partner hubs for delivering contextualized solutions to women in health beginning in India and East Africa.”

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Lancet Global Health (Comment) – The burden of viral respiratory infections in young children in low-resource settings

U Okomo et al; https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30037-1/fulltext

Comment linked to a new study in the Lancet Global Health.

“Acute lower respiratory infections (ALRI), encompassing bacterial and viral pneumonias, acute viral bronchiolitis, and bacterial and viral bronchitis, remain the leading cause of global child mortality…. … In The Lancet Global Health, Xin Wang and colleagues estimated the regional and global burden of influenza-virus-associated ALRI in children younger than 5 years in 2018….”

Link:

Cidrap News - Questions remain about mass azithromycin use in African kids

“ Two studies this week in the American Journal of Tropical Medicine and Hygiene are addressing some of the questions raised by a study that has linked mass distribution of an antibiotic to African preschool children to reduced childhood mortality. But the answers remain elusive….”

Access to medicines

Global Public Health - Access to innovative medicines by pharma companies: Sustainable initiatives for global health or useful advertisement?

M de Medeiros Rocha et al ;

https://www.tandfonline.com/doi/full/10.1080/17441692.2020.1729391

“Research & Development on new medicines plays an important role in life and well-being, making pharmaceutical companies important players in global health. Accessibility and financing new medicines, however, poses challenges for governments and patients around the world. Due to pricing and aggressive patent policy issues, pharma companies started to adopt access to medicines as a strategy to not only improve their public image but also to increase their economic performance. More than a useful institutional advertisement to attract new business, initiatives to improve access to medicines must be socially responsible and sustainable. Using content analysis methodology from CSR reports, the present study evaluated how 44 global companies are positioning themselves regarding access, whether these initiatives are aligned to existing access programmes and whether the actions disclosed on behalf of access are sustainable. We have identified 13 major access to medicines approaches that were classified into intrinsic, potentially sustainable and robust

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actions. We concluded that companies overvalue the term access to medicine. This can generate initiatives focused on advertisements rather than long-term actions and highlights the need for clear global criteria for companies and programmes that want to effectively publicise access to medicines as a social responsibility strategy.”

NPR Goats & Soda - The WHO Knows Insulin Is Too Expensive. How It Plans To Drive Down The Price

NPR Goats & Soda;

“… In November, the WHO launched a pilot program to boost the availability of insulin worldwide. The idea is to work with insulin manufacturers to increase the global supply — and in the process, potentially drive down the price of the treatment. Since then, seven pharmaceutical companies have shown interest in participating in the program….”

BMJ Feature - What did we learn from Tamiflu?

https://www.bmj.com/content/368/bmj.m626

“Ten years after questions were first raised over its effectiveness, Owen Dyer charts the fortunes of this blockbuster pill and finds that lack of evidence has not dented its success.”

Human resources for health

Human Resources for Health - Medical training for universal health coverage: a review of Cuba–South Africa collaboration

N Squires, K Chalkidou et al ; https://human-resources-

health.biomedcentral.com/articles/10.1186/s12960-020-0450-9

“Achieving improvements in Universal Health Coverage will require a re-orientation of medical education towards a stronger focus on primary health care. Innovative medical curricula have been implemented in some countries, but in many low- and middle-income countries (LMICs), the emphasis remains focused on hospital and speciality services. Cuba has a long history of supporting LMICs and has made major contributions to African health care and medical training. A scheme for training South African students in Cuba was established 20 years ago and expanded more recently, with around 700 Cuban-trained graduates returning to South Africa each year from 2018 to 2022. The current strategy is to re-orientate and re-train these graduates in South African medical schools for up to 3 years as they are perceived to have inadequate skills. This negative narrative on Cuban-trained doctors in South Africa could be changed dramatically. They have highly appropriate skills in primary care and prevention and could provide much needed services to rural and urban

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under-served populations whilst gaining an orientation to the health problems of South Africa and strengthening their skills. Bilateral arrangements between South Africa and the United Kingdom are providing mechanisms to support such schemes. The Cuban approach to medical education may have lessons for many countries attempting to meet the challenges of Universal Health Coverage.”

BMJ Feature – Brazil strives to replace its More Doctors programme for underserved regions

https://www.bmj.com/content/368/bmj.m537

“An innovative programme called More Doctors, which aimed to bring Cuban doctors to underserved areas in Brazil, attracted a series of compliments, criticism, debate, and controversy in its four years. André Biernath tallies up the results.”

Miscellaneous

IISD - WHO Publishes Global Review of WASH and Health Links

http://sdg.iisd.org/news/who-publishes-global-review-of-wash-and-health-links/

“The World Health Organization (WHO) has released the publication titled, ‘Safer Water, Better Health,’ which estimates the burden of 12 major diseases and adverse health impacts due to inadequate Water Sanitation and Hygiene (WASH). The report also provides evidence for links between WASH and another 14 conditions, such as antimicrobial resistance (AMR), that are not yet quantified….”

Emerging Voices

Health Research Policy & Systems - Supporting the use of research evidence in decision-making in crisis zones in low- and middle-income countries: a critical interpretive synthesis

A Firaz Khalid (EV 2018), J Lavis et al; https://health-policy-

systems.biomedcentral.com/articles/10.1186/s12961-020-0530-2

“Decision-makers in crisis zones are faced with the challenge of having to make health-related decisions under limited time and resource constraints and in light of the many factors that can

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influence their decisions, of which research evidence is just one. To address a key gap in the research literature about how best to support the use of research evidence in such situations, we conducted a critical interpretive synthesis approach to develop a conceptual framework that outlines the strategies that leverage the facilitators and address the barriers to evidence use in crisis zones….”

BMJ Open - Assessment of staffing needs for physicians and nurses at Upazila health complexes in Bangladesh using WHO workload indicators of staffing need (WISN) method

T Joarder (EV 2010) ; https://bmjopen.bmj.com/content/10/2/e035183.full

“This study aimed to assess the current workload and staffing need of physicians and nurses for delivering optimum healthcare services at the Upazila Health Complexes (UpHCs) in Bangladesh….”

HSG blog – Multimedia could play a critical role in re-imagining HPSR

L Brady et al ; https://www.healthsystemsglobal.org/blog/395/Multimedia-could-play-a-critical-role-in-re-imagining-Health-Policy-and-Systems-Research-and-Practice.html

Authored by quite a few EV alumni (on behalf of the Multimedia Working Group for the Sixth Global Symposium on Health Systems Research).

Research

BMJ Global Health (Commentary) - Improving the reporting of health research involving design: a proposed guideline

https://gh.bmj.com/content/5/2/e002248

“Design is being used more frequently in global health practice but is not reported on sufficiently for transparency, evaluability and wider dissemination. Reporting guidelines are useful in improving the quality and quantity of dissemination of work in peer-reviewed literature for global health. Building on available literature and current practice in design for global health, we present a reporting guideline that can be used by scholars and practitioners applying design in their work, and invite input on this work. We present draft guidance which we recommend for reporting on design for global health in order to improve the evidence base for design in global health.”

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Health Research Policy & Systems - Governance of health research funding institutions: an integrated conceptual framework and actionable functions of governance

https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-020-0525-z

“Health research has scientific, social and political impacts. To achieve such impacts, several institutions need to participate; however, health research funding institutions are seldom nominated in the literature as essential players. The attention they have received has so far focused mainly on their role in knowledge translation, informing policy-making and the need to organise health research systems. In this article, we will focus solely on the governance of national health research funding institutions. … … The framework contains 13 functions – 5 dedicated to governance (intelligence acquisition, resourcing and instrumentation, relationships management, accountability and performance, and strategy formulation), 3 dedicated to management (priority-setting, financing and knowledge transfer), and 5 dedicated to transversal logics that apply to both governance and management (ethics, transparency, capacity reinforcement, monitoring and evaluation, and public engagement).