IHP news 544 : Crunch time for global health - International ...

IHP news 544 : Crunch time for global health
( 25 October 2019)

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

Dear Colleagues,

Earlier this week, I came across a review of a Jeff Bezos biography, in “Alternatives Economiques”.
Turns out the richest man on earth is known for ‘having no empathy whatsoever’, and his extremely
“successful” company (Amazon, we reckon you might have heard of it) has ruthless competition
structurally built into all layers of the organization, from the top till the (rather notorious) work floor,
with all that entails (turnover, burnout, …). The fact that somebody like that is ‘the most successful
person on earth’ tells you all you need to know about our current economic system, and who’s
thriving in it. Of course, a quick glance at the current crop of ‘political leaders’, or the ever
expanding list of millionaires, already told you as much.

And hence it cannot come as a big surprise that in many countries around the world where there’s
still some level of (political) ‘democracy’ remaining, people don’t take it anymore. Whether it’s
Lebanon, Hongkong, Iraq or Chile, ordinary citizens have had enough. Laurie Garrett framed the new
wave (with flashes of ‘1968, she thought) as follows on Twitter:” Like their counterparts in
#HongKong young people in #BeirutProtests want genuine democracy, freedom and an end to
corruption.” While true ( see ‘massive anti-government protests sweeping the globe’), it’s also
obvious many of these ordinary citizens’ claims are linked to their disgust with decades of
neoliberalism, and the enormous socio-economic inequality (including lack of good public services)
that goes with it. See a NYT op-ed, ‘Chile learns the price of economic inequality’. Or ask the
Americans, with their world class ‘tax system for plutocrats’ ‘ . Globally, citizens also want
economic justice. And increasingly, the need for a fair transition to a low-carbon economy adds an
additional layer of complexity in quite some countries (as in Chile, Ecuador, France, …). Cfr a telling
tweet: “What we're seeing in Chili needs to serve as a warning to anyone who thinks we can deal
with climate change by simply raising the cost of emitting. If you push the cost of the transition on to
onto the poorest you get a rebellion. And no transition.”

In short, it’s crunch time for many among us, including for global health. Whose side are you on,
what will you fight for, and what exactly is your Theory of Change (and hence the allies you’re
seeking)? Sounds like a nice question for the World Health Summit in Berlin, which starts this
weekend. Against this backdrop of huge global/national inequality and an equally massive ecological
challenge (and their intersection), the term ‘crunch time’ is probably even an understatement. By
way of example, Richard Smith just laid out what it would actually involve to ‘walk the talk’ (as
compared to being a 'carbon boomer'), for health people and the many planetary health fans among
you. So did Richard Horton, in a YouTube video related to Extinction Rebellion.

It’s clear that the ones among us in more or less democratic regimes need to lead on this double
fight against global inequality and climate breakdown, as many of our (often braver) brothers and
sisters in more authoritarian regimes are currently facing a huge crackdown (or worse). Ask the

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Uyghur people in Xinjiang for example. Hope Bill Gates, dr. Tedros and other global health leaders
bring this up next time they meet with Xi Jinping. As “every life has equal value”, wasn’t it?

Enjoy your reading.

Kristof Decoster

Featured Article

Reframe everything you are doing within the lens of
planetary health: the Canadian Conference on Global Health
in a time of Fragmentation
Sameera Hussain (Senior Advisor, Strategic Policy and Development, Canadian Society for
International Health & IHP correspondent for Canada)

Last week marked the annual Canadian Conference on Global Health (CCGH), bringing together
academics, practitioners, and policy makers around the theme of governance – specifically, the
power and politics that have become so characteristic of global health today. From October 17-19 (
with a side event on the 20th), the focus was on all countries, and in particular, Low- and Middle-
Income Countries (LMICs) with existing partnerships and collaborations with Canadian research and
programmatic partners, acknowledging the importance of accountability in governance as well as
the power and privilege occurring in North/South collaborations. For a policy wonk who did her PhD
on tracking the discourse around global governance for health leading up to the SDGs, this was a
particularly exciting conference year, but as luck would have it, I came down with pneumonia,
rendering me incapable of attending. Instead, I experienced first-hand the decentralized Canadian
health system as a service user (!).

Nevertheless, as an avid Twitter follower and member of the conference planning committee, I feel I
can still write this editorial more or less “legitimately”. The plenaries addressed global health
diplomacy, accountability, and the various frameworks that shape policy such as Universal Health
Care and/or Coverage (whatever lingo suits your ideology and convictions) (Day 1); challenges of
good governance in times of conflict (Day 2), and the impacts of climate change and diversity on
health (Day 3). Gender equity was a cross-cutting theme and was highlighted at a networking
breakfast where one could meet some of the leaders listed in the Canadian Women in Global Health
directory, and identify structural barriers to women’s career advancement and begin a discussion on
how to mitigate these.

The closing panel – Intersectoral Action for Governance and Policies - was a stellar one, with a
reminder to link the ecological and social determinants of health and a call to action on climate.
With the CCGH closing just before the federal election (scheduled for October 21), one speaker very
strongly appealed to the audience, “the system isn’t working! We need to adapt! I don’t very much
trust the older generation with this,” urging students and young professionals to go out and vote for
a much-needed transformation from the status quo.

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The sentiments expressed at the conference represent what many, if not most people have on their
minds, not just in Canada but all over the world: a hope for good governance, combating social
injustice, and ensuring that the power is with people instead of entities with competing (or
questionable) interests. In line with the mood of many (and especially young) people around the
globe, a rising anxiety was also palpable about rapidly unfolding climate events and the impact they
already have on our food systems, living conditions, and health. In a sense, this conference, ending
the day before a federal election in Canada was more than timely.

Except the outcome of this election indicated only that Canada is deeply divided (like many other
countries now in the Global North), and there is little scope for the economic justice, social justice,
and bold climate action plan that we urgently need, both in Canada and overseas, partly due to this
polarization. All of these topics were addressed in some aspect of the CCGH program - panels and
posters spoke to the unequal power held by multinational companies and other commercial
determinants of health that promote the consumption of salt, sugar, and fat, contributing to NCDs;
issues of social justice, local governance, women’s active participation in decision-making, culturally
appropriate and gender-sensitive services for health, disability justice; and finally, the SDGs and
wide-ranging intersectoral action needed in the face of looming climate catastrophe. The results
from the popular vote (speaking to Canada’s broken electoral system) indicated that many
Canadians want action on those issues, but certainly the re-election of a government with a
lukewarm approach to making bold social and economic decisions within planetary boundaries
makes it difficult to believe that anything outside the realm of business-as-usual is about to happen.

From my own experience these past two weeks as a user of Canada’s widely lauded Universal Health
Care system (that makes up part of Canadians’ identity), I can happily confirm it is a very good one,
but there is work to be done if we want it to be known as an equitable health system as well. This
relates to important issues like patient-centred care, making diagnostic services easily accessible,
making pharmacare a reality, and linking these with other socially important services such as (clean)
transportation (in my case, 24km to access my family doctor, and a further 8km for X-ray imaging
services) and others that are very much part of the national conversation around determinants of
health (i.e. affordable housing, indigenous communities’ access to safe drinking water, universal
basic income). These serve as a reminder that all countries, be they LMICs or high-income, have
challenges in having responsive, well-functioning and equitable public health systems. Or as Dr.
Tedros and others keep telling us, UHC (and making progress towards the highest attainable
standard of health) is a never-ending journey.

Final note: it’s nice to see CCGH is moving away from a neo-colonial, internationalist framing of
health to one that acknowledges the important work we still have to do in our own communities, in
the lands that we live in, as custodians or as settlers.

Highlights of the week

G20 Okayama Health Ministers’ summit (19-20 October)
Some background: “Health has been an important G20 agenda since 2017. Major pillars include “The
Achievement of UHC,” “Response to Aging Societies,” and “Health Risk Management and Health
Security (Including AMR).”

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HPW - G20 Health Ministers Issue Detailed Declaration On Global Health Goals
https://www.healthpolicy-watch.org/g20-health-ministers-issue-detailed-declaration-on-global-
health-goals/

“A G20 Health Ministers Declaration, issued after a two-day meeting of ministers in Okayama Japan,
has endorsed rapid achievement of universal health coverage, a more effective support of healthy
ageing, increased attention to health emergencies and their underlying causes such as poverty and
weak health systems, and more forceful action on antimicrobial resistance (AMR). The detailed 11-
page statement by health ministers of the world’s 20 largest economies – goes well beyond the
more general commitment by G20 leaders to advance global health goals, which was issued at the
close of their two-day meeting on 27-28 June….”

You find the 11-page declaration here.

Now let’s hope G20 money will be equally ‘detailed’, in the years to come.

Japan Center for International Exchange/UN Foundation - Next Steps on UHC:
Moving Forward from the G20 and the HLM-UHC
http://www.jcie.org/researchpdfs/globalhealth/next_steps_on_UHC_report.pdf

Short report of a meeting from 24 September, but a must-read. And only 4 pages! “On September
24, the morning after the landmark UN High-Level Meeting on UHC (HLMUHC), the Japan Center for
International Exchange (JCIE) and the United Nations Foundation convened senior policymakers and
global health experts for a closed roundtable at the UNAIDS New York office to discuss what the next
steps should be to advance UHC in low- and middle-income countries around the world….” Check
out the 10 points raised by them.

World Polio Day (24 October): Global eradication of wild
poliovirus type 3 declared on World Polio Day

Stat - Two down, one to go: After decades-long campaign, type 3 polioviruses are
set to be eradicated
H Branswell; Stat;

(from earlier this week) Excellent update on where things stand in the fight against polio. “After
months of bad news, the international army of people who have been working for decades to
eradicate polio will likely have something to celebrate this week. A global commission [is expected
to] announce that type 3 polioviruses have been eradicated. The announcement is expected on
Thursday, which is World Polio Day. If it comes, type 3 polio will be the second species of polioviruses
to have been vanquished….”

WHO - Two out of three wild poliovirus strains eradicated.

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See also Devex - The world is now wild poliovirus type 3 free, but experts warn the job is not yet
done

Excerpt: “… international donors also need to stay committed until polio is finally wiped out globally.
At present, GPEI’s plan to 2023 has a funding gap of $3.27 billion, which it hopes will be filled at
the polio pledging summit in Abu Dhabi on Nov. 19. That money does not yet include funding for
inactivated polio vaccine. Funding for that is expected to come from Gavi’s replenishment next
year….”

More coverage in the Telegraph - The war on polio: Two out of three strains eliminated but hotspots
persist.

Quick link:

The Conversation - Valuable lessons from Nigeria’s marathon effort to eradicate polio (by O Tomori)

“Ending the Boko Haram insurgency is the only thing that can see Nigeria through to the end of this
race.”

Planetary Health

BMJ (blog) - Emerging thinking of a new chair of the UK Health Alliance on Climate
Change
Richard Smith; BMJ blog;

Last week, Richard Smith was appointed as the chair of the UK Health Alliance on Climate Change
(UKHACC). “As its name implies, the Alliance comprises health organisations, including the BMA and
many royal colleges, committed to reducing the harm to health from the climate emergency….” In
this piece, he lays out what the role of health professionals might be, in 7 domains (in line with their
7 professional roles).

This paragraph is worth giving in full:

“Might we conduct a similar kind of study by urging health professionals to make changes to reduce
their carbon footprint? We might ask health professionals to make some of the changes listed below
(and others), record their commitments on a website, and follow up on what they actually manage.
The possible actions include not only lifestyle changes, but also forms of advocacy: abandoning
flying (or committing to not more than one return flight a year); reducing the amount they drive;
stopping driving to work; switching to a largely vegetarian diet; reducing the number of clothes they
buy, perhaps committing not to buy any for a year; measuring their own carbon footprint and
developing a plan to reach a personal net-zero by 2025, including off-setting where necessary;
leaflets for their patients; writing to their MPs; joining organisations that are active in combatting
environmental damage.” Oops.

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Laconic tweet from Brendan Kwesiga: “They could do a benchmarking from my village in Uganda. I
think that's the life style of 99.9% of the population.”

Annals of Tourism research - Celebrities, air travel, and social norms
https://www.sciencedirect.com/science/article/pii/S016073831930132X?dgcid=author

This article discusses moral and social norms presented by Fridays for Future. It distinguishes four
celebrity types in relation to their positions on climate change and shows that celebrities live highly
carbon-intense aeromobile lifestyles. The article then discusses the implications of celebrity type
agency in relation to norms regarding air travel.

“…In this paper, four celebrity agency types are identified, i.e. the ‘carbon boomers’, who promote
carbon-intense lifestyles; the ‘carbon’ philistines, who are oblivious to issues of climate change and
lifestyle implications for emissions; the ‘climate change advocates’, who raise carbon awareness but
continue to live highly carbon-intense lifestyles; and the low-carbon performers living lives without
air travel….”

Coverage in the Conversation - These celebrities cause 10,000 times more carbon emissions from
flying than the average person

“The jet-setting habits of Bill Gates and Paris Hilton mean that they produce an astonishing 10,000
times more carbon emissions from flying than the average person. This was the conclusion of my
research mining their social media accounts (tweets, Instagram and Facebook posts) as well as
those of a number of other celebrities for clues as to where they were in the world over the course
of 2017 and how they got there….”

HPW - Mayors Take Charge On Reining In Air Pollution
https://www.healthpolicy-watch.org/mayors-take-charge-on-reining-in-air-pollution/

“Although it was governments that made the big commitments to tackle climate change in the 2015
Paris Agreement, mayors are leading the charge in reducing air pollution on the ground. At a first-
ever World Air Quality Conference, hosted by the City of London, mayors and city leaders from
around the world convened Wednesday, to confer with each other and with experts from the World
Health Organization and civil society about how to ramp up action on air pollution and climate
change….”

And last but not least, *BREAKING* see Youtube “ The editor of @TheLancet, one of the most
prestigious medical journals in the world, has come out officially asking all health professionals to
engage in non-violent social protest to protect people from the climate & ecological breakdown.
Yes you heard that right.”

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CRISPR & other gene-based cures

Stat news - New CRISPR tool has the potential to correct almost all disease-
causing DNA glitches, scientists report
Stat;

“A new form of the genome-editing tool CRISPR-Cas9 appears to significantly expand the range of
diseases that could be treated with the technology, by enabling scientists to precisely change any of
DNA’s four “letters” into any other and insert or delete any stretch of DNA — all more efficiently
and precisely than previous versions of CRISPR. Crucially, scientists reported on Monday, it
accomplishes all that without making genome-scrambling cuts in the double helix, as classic CRISPR
and many of its offshoots do.”

For more on this (very promising) “prime editing”, see the Guardian - New gene editing tool could
fix most harmful DNA mutations

 “…The landmark work opens the door to a new era of genome editing, but scientists caution that
more research is needed before it can be safely used in humans. Beyond proving its safety, another
major hurdle is how to deliver the molecular machinery to cells that need it in sufficient amounts to
treat a disorder.”

Stat - NIH and Gates Foundation launch effort to bring genetic cures for HIV, sickle
cell disease to world’s poor
Stat;

“The National Institutes of Health and the Bill and Melinda Gates Foundation will together invest
at least $200 million over the next four years to develop gene-based cures for sickle cell disease
and HIV with an attribute even rarer in the world of genetic medicine than efficacy, the groups
announced on Wednesday: The cures, they vowed, will be affordable and available in the resource-
poor countries hit hardest by the two diseases, particularly in Africa….”

The initiative aims to test potential cures in the U.S. and SSA countries in the next 7-10 years, and to
then make such therapies available in the hardest-hit areas.

See also Science News - NIH and Gates Foundation lay out ambitious plan to bring gene-based
treatments for HIV and sickle cell disease to Africa

“…sub-Saharan Africa is home to about two-thirds of the 20 million people with sickle cell disease
and the 38 million living with HIV. The NIH-Gates partnership “is an incredible opportunity to find
new therapies and possible cures for two diseases that affect millions of Africans and to make them
available at affordable costs,” said Matshidiso Moeti, who heads the Regional Office for Africa at the
World Health Organization.”

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Update on health SDG indicators (Addis)
On 21-24 October, the IAEG-SDGs meeting convened in Addis Ababa to prepare for the 2020
comprehensive review of the indicator framework. A few reads:

IISD - Statistical Group to Consider 53 Changes to SDG Indicators
IISD

“The UN Inter-Agency and Expert Group on the SDG Indicators is considering 53 suggested changes
to the SDG indicator framework based on input gathered through an open consultation. The IAEG-
SDGs is expected to agree on a final set of proposals during its upcoming tenth meeting in Addis
Ababa, Ethiopia.”

Key messages: The IAEG-SDGs will address 53 proposals for revision, replacement, addition and
deletion within the global SDG indicator framework. New indicators are proposed on breastfeeding,
mental health, AMR, energy use by tourism, migrant deaths, pledges to the GCF, and GHG emissions
and concentrations, among other issues.

IISD - Tracking Antimicrobial Resistance in the Sustainable Development Goals
IISD;

“Without progress on antimicrobial resistance, attainment of the SDGs will fall short; yet the
indicators to track the SDGs have thus far failed to include tracking of AMR. During the 2020
Comprehensive Review of the SDGs indicators, the WHO has proposed an AMR-specific indicator to
track two priority drug-resistant pathogens in the SDGs. It is also critical to tracking access to
needed antimicrobials.”

AMR

GARDP - Uniting Against Antibiotic Resistance: Delivering 5 BY 25
https://www.gardp.org/2019/news-resources/events/uniting-against-antibiotic-resistance-5-by-25/

“On 28th October, Join …the World Health Summit to learn how GARDP’s ‘5 BY 25’ goal will accelerate the
development and delivery of five new and improved treatments to address antibiotic-resistant
infections that pose the greatest threat to health and development.”

See also Gardp - 5 by 25

“5 BY 25’ is designed to contribute to tackle the issue of AMR. As an integral element of WHO’s Global
Action Plan on AMR, GARDP is calling on Member States, philanthropic and other global organizations
to support ‘5 BY 25’ and contribute towards its target of €500 million. This will allow GARDP to bring five
new treatments that address the most urgent public health needs to patients.”

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“The five new treatments will focus on the priority pathogens identified by WHO, and current unmet
needs for diseases and key populations. This includes developing and delivering treatments for children,
newborns with sepsis, and sexually-transmitted infections.”

New Lancet series on drug use - Lancet report calls for new
international approach to drug use

https://www.thelancet.com/series/drug-use

“The drug use landscape is dynamic and changing. Changes in public attitudes and laws towards
drug use have occurred in an increasing number of countries. Global drug production and
consumption are increasing as are the risks and harms to health, while new substances continue to
emerge. This Series focuses on opioids, cannabinoids, stimulants, and new psychoactive
substances. The Series authors review the evidence on the epidemiology of drug use and related
harms and interventions (treatment and policies) to address them. They highlight issues that are
likely to become increasingly important in the next decade.”

Some key messages of this new series via the press release:

“The Lancet: 20th century views and responses to drug use are no longer fit for purpose

Report authors warn that the effects of cannabis legalisation will probably not be seen for another
decade, problems resulting from stimulants are growing globally, and current responses to
emerging substances may no longer be fit for purpose with rapid changes in drug supply and
demand.

To meet the growing challenges that drug use poses to future global health, policies and actions
must be based on science, and not on moral judgements.

Authors call for increased research funding to improve treatments, and for global policymakers to
implement only evidence-based policies and therapies – they estimate that increased provision of
opioid agonist treatment could help avoid around 8-26% of opioid-related deaths, compared to no
treatment.

A report from The Lancet calls for a new international approach to drug use – using evidence-based
policies, which adapt faster, and respond more humanely and effectively to new drugs and their
changing availability and patterns of use. The five-paper Series publishes as the opioid crisis
continues, cannabis legalisation expands, global stimulant problems grow, and the number of new
psychoactive substances (NPS) identified continues to increase. It reviews the global evidence on
these four drug types – analysing patterns of use, related harms, and interventions, and estimating
the benefits of opioid agonist therapy and the growing health impact of stimulant use. The report
will also be presented at the Lisbon Addictions meeting in Lisbon, Portugal on 24 October.”

If you are short of time, we certainly also recommend this Introductory Comment (by Pam Das &
Richard Horton) - The global drug problem: change but not progression which provides a great
overview of the papers (& key messages).

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With also this short paragraph:

“ One region that has not achieved sufficient global attention in drug policy is Africa. By 2050, it is
estimated there will be 14 million more people using drugs in sub-Saharan Africa. An increase in
injecting drug use will be a substantial challenge over the coming decades for African countries with
limited health workforce capacity or health infrastructure….”

World Bank and Global Fund Deepen Partnership with Co-
Financing Agreement

https://www.worldbank.org/en/news/press-release/2019/10/22/world-bank-and-global-fund-
deepen-partnership-with-co-financing-agreement

“The World Bank and the Global Fund have signed a co-financing framework agreement to
accelerate efforts by countries to end HIV, tuberculosis and malaria and build sustainable systems
for health. The framework agreement outlines a new approach for joint financing of investment-
type operations between the two organizations, as well as results-based financing….”

“… The first transaction anticipated to be governed by the framework agreement is a proposed
Global Fund/World Bank investment in Laos to work towards universal health care, with payments to
the country tied to specific results.”

Global Fund

Aidspan - Post-Replenishment: from Pledges to Results
http://www.aidspan.org/node/5088

“Following the Global Fund’s Sixth Replenishment, which raised $14 billion for the Fund’s next
funding cycle, Global Fund Chair Donald Kaberuka and Vice-Chair Lady Roslyn Morauta set out their
priorities for the Global Fund to translate pledges into results. In this Op Ed for Aidspan they
emphasize that there is “room for stronger focus on purpose and efficiency”, as the Board prepares
to make decisions on allocations for 2020 to 2022 at the next Board meeting, in November….”

For the full newsletter, see Aidspan.

Make sure you check out, among others, this Comment by Clare Gibson - Country Coordinating
Mechanisms - key component or white elephant?

“Behind the Global Fund's particularly utilitarian definition of CCMs ("Country Coordinating
Mechanisms") lies a very complex reality. This reality impacts the way that CCMs operate, consultant
Clare Gibson says. CCMs are considered by some to be artificial entities that are expensive and
cumbersome, embodying the blatant hypocrisy of the developed world - hiding behind misleading
concepts such as “national ownership” and “democratic multisectoriality” - and demonstrating little

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or no return on investment. There are, however, some interesting ways that this innovative
partnership model can restore its full value and operational efficiency….”

O’Neill (blog) – More or the same? Reflecting on debates around the Global Fund’s
mandate
M Pillinger; https://oneill.law.georgetown.edu/more-or-the-same-reflecting-on-debates-around-
the-global-funds-mandate/

By Mara Pillinger. “… beneath the relief [on the 14 billion reached], there is a simmering debate over
scope of the Global Fund’s mandate and the balance of resources among global health institutions
more broadly. In the days after the replenishment conference, I took part in two conversations which
highlight the differing views within the global health community…”

Broadly agree with Pillinger’s three takeaways.

And a GF link - Technical Review Panel Observations on the 2017-2019 Allocation Cycle.

Annual meetings IMF/WB : final analysis & way forward?

Bretton Woods Project - Annual Meetings wrap-up: Bretton Woods Institutions
continue sleepwalking, as economic uncertainty and social tensions intensify
https://www.brettonwoodsproject.org/2019/10/annual-meetings-wrap-up-bretton-woods-
institutions-continue-sleepwalking-as-economic-uncertainty-and-social-tensions-intensify/

Must-read wrap-up analysis.

“Bank and Fund struggle to prepare for next financial crisis. A tale of two leaders: Contrasting styles
of Georgieva & Malpass. As BWIs plot climate policies, the way forward remains murky. Bank faces
implementation gap on citizen engagement. Bretton Woods at 75 conference discusses future of
multilateralism.” Seems like WB & IMF are heading in rather different directions, with the new
leadership in place. For example on climate change & on (going beyond) the Washington Consensus
or not.

Devex - Substance over style at Malpass' first World Bank Annual Meetings
https://www.devex.com/news/substance-over-style-at-malpass-first-world-bank-annual-meetings-
95861

“…The 19th replenishment of the International Development Association, implementing reforms
connected to the bank’s recent capital increase, and debate over efforts to strengthen the
institution’s accountability mechanisms topped the agenda….” (for the World Bank)

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“Against a backdrop of global economic turbulence brought on by trade wars and Brexit uncertainty,
climate change protests, and protracted conflicts, World Bank President David Malpass has turned
his attention inward. The new bank president is choosing to focus on the institution’s country
operations during his first six months in office, instead of flashy global initiatives.”

And a link: Eurodad - Annual Meetings round-up: 75 years of the Bretton Woods institutions, little
cause for celebration

WB - Staying focused on better outcomes for the world’s poorest people
https://www.worldbank.org/en/news/feature/2019/10/19/staying-focused-on-better-outcomes-
for-the-worlds-poorest-people?cid=SHR_SitesShareTT_EN_EXT

“….key messages from the Development Committee, a ministerial-level forum of the World Bank
Group and the International Monetary Fund, in a communiqué issued at the close of the institutions’
Annual Meetings in Washington. ….to address global development challenges… to help implement
country platforms that will make better use of development resources and mobilize private sector
solutions… urged continued efforts to protect the most vulnerable, spur job creation, and
strengthen public sector efficiency.”

See also BWP - Development Committee communiqué analysis – Annual Meetings 2019.

Guardian - The Guardian view on the IMF and World Bank: back a global Green
New Deal
Guardian;

“In 1944, and for many years afterwards, the World Bank and the IMF were the international
manifestation of the New Deal. They backed expansionary economic policies and social inclusion, and
were mindful of the rights of individual countries to govern their own affairs. There are now
proposals, backed by the UN, for a global Green New Deal. It would be a good thing all round – for
the world economy, for the planet and for their own long-term prospects – if the IMF and World
Bank chose to back the idea”.

Global Tax justice

Icrict (Independent Commission for the Reform of International Corporate
Taxation) - A time for developing nations to speak up
José Antonio Campo ; https://www.icrict.com/icrict-in-thenews/2019/10/18/a-time-for-developing-
nations-to-speak-up

J A Campo, who chairs the ICRICT tax reform commission, stresses it’s time for developing countries
to get their act together with respect to the ongoing global tax reform (proposals).

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“This is an international tax emergency. In the face of global outrage at the low or no taxes paid by
some of the world’s largest multinational companies, the G20 appointed the Organization for
Economic Co-operation and Development (OECD) a few years ago to design alternatives to end
these abuses. In response, last week, the OECD put forward proposals for a new international tax
system that could be imposed on the world in the coming decades. “

“After decades of inaction, the process could move forward very quickly. After the publication, a
few days ago, of its first proposal in this field, the organization will make a final one in 2020, laying
the base for the new international tax system. After that date, the die will be cast, and it will be
practically impossible to influence the reform process.” “That is why we need to raise the alarm for
developing countries. They can no longer say that they have no voice in the process. The OECD has
offered them a place at the negotiating table by creating a group called the “inclusive framework.”
With 134 members, this is the arena where tomorrow's global tax system will be decided.”

Global Health Security

John Hopkins Center for Health Security launched a Global Health Security index
https://www.ghsindex.org

“The #GHSIndex is the first comprehensive assessment of global health capabilities in 195 countries.”

 • “The Global Health Security (GHS) Index is the first comprehensive assessment and
 benchmarking of health security and related capabilities across the 195 countries that make
 up the States Parties to the International Health Regulations (IHR [2005]). The GHS Index is a
 project of the Nuclear Threat Initiative (NTI) and the Johns Hopkins Center for Health Security
 (JHU) and was developed with The Economist Intelligence Unit (EIU). These organizations
 believe that, over time, the GHS Index will spur measurable changes in national health
 security and improve international capability to address one of the world’s most omnipresent
 risks: infectious disease outbreaks that can lead to international epidemics and
 pandemics….”

It's “a detailed and comprehensive framework of 140 questions, organized across 6 categories, 34
indicators, and 85 subindicators to assess a country’s capability to prevent and mitigate epidemics
and pandemics.” The 6 categories are: Prevention; Detection and reporting; Rapid Response; Health
System; Compliance with International Norms; Risk Environment.

 • For the report, see https://www.ghsindex.org/wp-content/uploads/2019/10/GHS-Index-
 Report_FINAL_Oct2019.pdf

“…This report summarizes the results of the first GHS Index, including overall findings about the state
of national health security capacity across each of the six GHS Index categories, as well as additional
findings specific to functional areas of epidemic and pandemic preparedness. The full report also
offers 33 recommendations to address gaps identified by the GHS Index. All the findings and
recommendations are summarized on pages 12–15 and described in detail throughout the full
report, which begins on page 31.”

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An overall finding: “National health security is fundamentally weak around the world. No country is
fully prepared for epidemics or pandemics, and every country has important gaps to address”. “…The
average overall GHS Index score among all 195 countries assessed is 40.2 of a possible score of
100…”

“Only 13 out of 195 countries assessed by the #GHSIndex score in the highest tier of capacity to
address epidemic threats.”

On the ‘Health System’ category in particular: “ HEALTH SYSTEM: The average score for health
system indicators is 26.4 of 100, making it the lowest-scoring category.”

Coverage for example in Cidrap News - Inaugural Global Health Security Index notes wide
readiness gaps

CEPI launches new call for innovative platform technologies to rapidly respond to
Disease X
https://cepi.net/news_cepi/cepi-launches-new-call-for-innovative-platform-technologies-to-rapidly-
respond-to-disease-x/

(15 October) “The Coalition for Epidemic Preparedness Innovations (CEPI) has [today] launched a call
for proposals to invite funding applications for innovative platform technologies that can be used to
develop vaccines and other immunoprophylactics to rapidly respond to future outbreaks of emerging
infectious diseases and unknown pathogens, known as “Disease X”.”

Health policy watch - We’re Learning More About Gaps In Epidemic Preparedness;
Now We Must Act Rapidly To Close Them
A McClelland et al; https://www.healthpolicy-watch.org/were-learning-more-about-gaps-in-
epidemic-preparedness-now-we-must-act-rapidly-to-close-them/

Great update on the JEEs - (Joint External Evaluation). The second round of JEEs will begin soon.

 “A critical tool to gauge a country’s preparedness ahead of a crisis is the Joint External Evaluation
(JEE), a tool developed by WHO to assess how ready countries are to find, stop, and prevent
epidemics. The recent completion of the 100th JEE is evidence that the tool has received widespread
uptake since it was launched in Tanzania in 2016 – although many gaps identified in the JEE have yet
to be addressed.”

“Nearly half of all countries with completed JEEs are in the WHO African Region, with 91 percent of
African countries having completed an assessment. However, African countries have the lowest
average JEE score (41 on a scale of 100) – the DRC scored only 35% in its recent assessment. Of the
nine countries sharing a border with DRC, none of the WHO priority 1 countries have achieved an
average JEE score above 60% (Uganda, Rwanda, South Sudan, and Burundi). And of the WHO priority
2 countries, none have scored above 50% (Zambia, Tanzania, Central African Republic and Republic
of Congo; Angola has not yet carried out a JEE). These scores indicate that these countries are
underprepared and remain vulnerable to real risks that are playing out within the region….”

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And a few tweets related to a GHS meeting in Goma:

“Investing in disease outbreak preparedness is essential. Ministers from 10 African countries,
convened by @MinSanteRDC”

“@WHOAFRO & partners - are together today in Goma, #DRC, to finalize an #Ebola preparedness
framework & set up cross-border collaboration.”

Ebola DRC – Still a PHEIC, but slowing down at last ?

HPW - Ebola Public Health Emergency Still In Force, Despite Decline in Cases
https://www.healthpolicy-watch.org/ebola-public-health-emergency-still-in-force-despite-decline-
in-cases/

News from late last week. “The World Health Organization is not yet ready to declare that the
Ebola public health emergency in the Democratic Republic of Congo is over – despite significant
recent declines in the pace of new infections. WHO Director General Dr Tedros Adhanom
Ghebreyesus said Friday that he did not find it prudent to end the “Public Health Emergency of
International Concern (PHEIC)” designation for the DRC outbreak, due to continued uncertainties
about the rate of case transmission in rural areas, where new infections are not always reported….”

So still a PHEIC for the next three months at least.

Meanwhile, on the funding front: “….However, WHO is still facing a funding shortfall of at least US
$70.5 million for outbreak response activities in the DRC and US$ 16.7 million for strengthening
regional preparedness. Dr Tedros appealed to donors and regional countries to increase funding,
calling the current lack of funding for regional preparedness “grossly inadequate.”…”

For the full statement, see WHO.

Telegraph - Is Congo's 14 month Ebola outbreak finally nearing an end?
https://www.telegraph.co.uk/global-health/science-and-disease/congos-14-month-ebola-outbreak-
finally-nearing-end/

“Some 14 months after the Ebola outbreak was declared in the Democratic Republic of Congo, there
are signs that the crisis may be winding down….”

See also Nature - The Ebola outbreak is finally slowing down

“The World Health Organization says that the rate of new infections in the Democratic Republic of
the Congo has dropped, as a vaccine moves closer to approval….”

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On the latter, see also:

Stat - With European backing, the world is on the brink of the first approved Ebola
vaccine
https://www.statnews.com/2019/10/18/with-european-backing-the-world-is-on-the-brink-of-the-
first-approved-ebola-vaccine/

From late last week: “The world came a big step closer to having a fully licensed Ebola vaccine on
Friday, with a panel of the European Medicines Agency recommending conditional marketing
authorization for Merck’s experimental Ebola vaccine. Meanwhile, the company announced the
brand name for the vaccine; it will be sold as Ervebo. The vaccine protects against the most common
strain of Ebola viruses to cause outbreaks, the Zaire ebolavirus….”

See also WHO - Major milestone for WHO-supported Ebola vaccine

Lancet Offline – The mistakes we made over Ebola
Richard Horton; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32634-
0/fulltext

Horton on last week’s Global Health Lab at the London school. Overview of the mistakes made over
Ebola (in West-Africa and again in the DRC), but also of what lessons were learnt (in the DRC vs W-
Afr).

Nevertheless, he concludes, wryly: “…I sat in international conferences, convened after the west
Africa outbreaks, where country leaders pleaded for the equivalent of a Marshall Plan, a west
African recovery programme, to counter the de-development that Ebola had wreaked on their
economies. Big promises were made. But the fact is that once Ebola withered away, the
international community lost interest in Africa. The US and Europe were concerned about Ebola only
in so far as it represented a threat to their own borders. Once that threat had dissipated, Africa was
once again left to clear up the debris of a humanitarian catastrophe. Watching this betrayal unfold
was not surprising. It was simply one more deception western nations have perpetrated on African
peoples. Yes, a vast amount of money was invested in controlling Ebola. Yes, important lessons
were learned. Yes, the global health community did sharpen its understanding of public health
emergencies. But Ebola showed how western countries bequeathed one more chapter of duplicity
and treachery on the history of Africa.”

Other reads & links from this week on the Ebola DRC crisis:

 • Devex - WHO: Ebola in DRC still a global public health emergency

“…The PHEIC declaration, first made in July, has become a source of ongoing debate in the global
health community. Some experts expected it would inspire much-needed funding for the response,
but three months later, the disbursement of promised dollars remains slow….”

 • Devex - Tanzania continues to dodge WHO recommendations on Ebola.

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International Lead Poisoning prevention week (20-26
October)

Health policy watch - Campaign To Ban Lead Paint Worldwide Featured For
International Lead Poisoning Prevention Week
https://www.healthpolicy-watch.org/campaign-to-ban-lead-paint-globally-highlight-of-international-
lead-poisoning-prevention-week/

“The World Health Organization and UN Environment kicked off a week-long campaign asking
countries to take more assertive action to ban lead paint, coinciding with International Lead
Poisoning Prevention Week.” The Global Alliance to Ban Lead Paint, a WHO-UN Environment
Partnership involving countries and civil society, has set a goal to ban lead paint in all countries by
2020. To date, only 73 of the 194 WHO member states have legally binding control measures on lead
paint.”

“According to WHO, there is no minimum “safe” level of exposure to lead, which is particularly toxic
to children, and can reduce their IQ along with increasing the risk of developmental and behavioral
problems. Lead paint is a leading source of domestic lead exposure in children.”

Urban health

Thomson Reuters Foundation - African slum map exposes true scale of urban
poverty
http://news.trust.org/item/20191023161812-i4je0/

“Urban scientists on Wednesday launched the first digital map of Africa's sprawl of slums to
expose the true scale of urban poverty and bring services to millions of people. The "Million
Neighbourhoods" project by a team at the University of Chicago aims to map the whole world -
eventually - and become a tool for better city planning as mayors decide which areas most need
sewers, roads and other basics. The interactive, online map was created with an open-source
database that lets any and all volunteers add the location of roads and buildings in unmapped
places….”

“About 53 million people in sub-Saharan Africa live in slums, representing about half the urban
population, according to a study out earlier this year. Africa's urban population is expected to triple
in the next 50 years, according to the United Nations, which has set a goal of ensuring universal
access to affordable housing by 2030. The size of slums is generally under-estimated, even by local
governments, said a programme coordinator at UN-Habitat, the agency for housing and urban
development….”

 17

UHC

UHC 2030 – UNGA: A historic consensus on universal health coverage
https://www.uhc2030.org/news-events/uhc2030-news/unga-a-historic-consensus-on-universal-
health-coverage-555304/

UHC2030 published “a series of articles on the #HLMUHC starting with an overview of the HLM &
then reports from side events organised by ourselves & our partners.”

“UHC2030 report from the UN High-level Meeting on UHC.” If you want to read about the meeting
all over again (from now almost a month ago), and then some more! With lots of quotes from
participants.

Check out also (UHC 2030) Primary Health Care on the Road to UHC: Launch of the 2019 Global
Monitoring Report, New York, 22 September ; Civil society responds to the 2019 UHC Global
Monitoring Report & 1,460 days left: countdown to 2023 - the mid-point of the SDGs.

Stat News - Put communities at the center of universal health coverage
G Carlsson, K Dain et al ; https://www.statnews.com/2019/10/21/communities-center-universal-
health-coverage/

“The Political Declaration on Universal Health Coverage, adopted recently at the United Nations
General Assembly, could set the stage for a fairer world in which health is viewed as a human right
and not as a commodity. On paper, we have a compact that enshrines the idea of universality. At the
local, state, and country levels it will mean healthier populations and greater global health equity.
Moving from declarations to reality won’t be easy. Lessons from the response to the AIDS epidemic
over the past four decades and the evolving response to the global emergency around
noncommunicable diseases (NCDs) clearly demonstrate that community engagement and human
rights must be front and center….”

Bloomberg - China Is Striving for the World’s Best, Cheapest Healthcare
D Lyu et al; Bloomberg;

“Less than five years ago, Chinese healthcare was a closed-off, low-quality system where the richest
left the country for medicines and treatments, and the poorest took a bad diagnosis as a death
sentence. Now, the world’s second largest economy is striving to become a place where patients
can get the best, newest drugs and services faster and cheaper than anywhere else. Pressured by
its growing middle class, the Chinese government has set itself an ambitious target: first-world
health outcomes at a fraction of the cost that other countries, especially the U.S., pays. To get
there, China has doubled the amount it’s pouring into public hospitals in the last five years to $38
billion. It wants to see a healthcare industry valued at $2.3 trillion by 2030, more than twice its size
now. The cost control part will be much harder. Beijing wants the biggest pharmaceutical
companies in the world to bend the knee, lowering their prices drastically in order to get access to

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its vast patient pool. In new drugs, pharmaceuticals from Pfizer to Roche have agreed to cuts of as
much as 70%....”

Lancet World Report – Modi's health reforms: between hope and hype
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32601-7/fulltext

“On Sept 6, Narendra Modi's National Democratic Alliance Government completed the first 100 days
of its second term in office. Patralekha Chatterjee investigates its performance on health.”

Focus here not just on Ayushman Bharat (and its 2 pillars), but also on other health related initiatives
of the Modi government. “On May 23, Prime Minister Narendra Modi and his nationalist Bharatiya
Janata Party (BJP) won a sweeping mandate for a second 5-year term, under the campaign slogan
Sankalpit Bharat, Sashakt Bharat—determined India, empowered India. Modi's campaign promises
included continuation of his flagship schemes, the Swachh Bharat (Clean India) Mission and
Ayushman Bharat (Healthy India), making the National Nutrition Mission a mass movement,
strengthening the capacity of government-run anganwadis (child-care centres), and setting up a
new Ministry of Water Power that would work towards ensuring piped water for every Indian
household by 2024….”

Measles comeback in Africa

LA Times - Measles making a deadly comeback across Africa
LA Times;

Measles outbreaks are returning to many African countries, as low vaccination coverage leaves many
vulnerable.

“… Measles is having a deadly resurgence across Africa, where, as of September, about 44% of this
year’s cases worldwide have been recorded. That’s due in large part to a massive outbreak in the
island nation of Madagascar off the coast of Mozambique, where more than 150,000 cases have
been reported and more than 1,000 people have died due to low vaccination rates and a vaccine
shortage once the outbreak took hold. … … In Uganda, vaccination rates are higher, but thinly
stretched health budgets, mistrust of vaccines and complacency among people who think measles is
a disease of the past have helped lead to the outbreaks. … … Eight other African countries have also
experienced outbreaks, many in places where health workers are in short supply and where keeping
the vaccines cold and effective until they reach children in remote areas is extremely challenging….”

Stroke & World Stroke Day (29 October)

Lancet (Editorial) – Don't be the one: individual responsibility in stroke
prevention
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32460-2/fulltext

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“The latest campaign of the World Stroke Organization (WSO), for World Stroke Day, Oct 29, is
clearly aimed at the individual. With the provocative hashtag and slogan, Don't be the one, it
explains that one in four of us—referencing the 25% lifetime risk of stroke—might not make it home
today. Such a hard-hitting, personalised approach might seem justified given the size of the
problem….”

But the Lancet is no fan: “…The WSO's current campaign, Don't be the one, urges people to avoid
having a stroke by using simple steps including exercising five times per week, eating a healthy
balanced diet, maintaining a healthy weight, stopping smoking, and managing stress and depression.
Placing the responsibility to change solely on the shoulders of the individual is unlikely to be
successful unless supported by sustainable, empowering, and widespread actions from
governmental and international agencies.”

Dementia summit (Japan, 18 Oct)

Guardian - Dementia poses threat to health similar to HIV and Aids, summit told
https://www.theguardian.com/society/2019/oct/18/dementia-similar-threat-global-health-hiv-aids-
world-summit

(Last week) “On Friday ( 18th Oct), In a speech to the World Dementia Council summit in Japan, Hugo
de Jonge, the Dutch health minister, said dementia was underfunded, misunderstood and
overlooked, as HIV and Aids were in their early days.” …“Today, we are on the verge of another
epidemic; not a disease that attacks our immune systems, but our brain, our memory, our
personality, ourselves. Like HIV/Aids in its early days, dementia is a globally underfunded area of
medicine.”

COPASAH conference New Delhi

IHP - Accelerating Social Accountability for Health: short takes from the COPASAH
Global Symposium in New Delhi, 15-18 October 2019
Ravi Ram; https://www.internationalhealthpolicies.org/featured-article/accelerating-social-
accountability-for-health-short-takes-from-the-copasah-global-symposium-in-new-delhi-15-18-
october-2019/

Excellent blog on the recent COPASAH symposium in India. The symposium focused on Citizenship,
Governance and Accountability in health.

Among others, Ravi Ram dwells on the conceptual discussions, the focus on corruption in health
systems, UHC & its (gap in) social accountability, and the need for systems thinking on questions of
accountability and governance in health.

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ITM colloquium

IHP- The 60th ITM Colloquium – Were the dots connected?
Sophie Vusha; https://www.internationalhealthpolicies.org/blogs/the-60th-itm-colloquium-were-
the-dots-connected/

IHP resident Sophie Vusha connects many of the dots at the recent (60th) ITM colloquium, which was
themed ‘Connecting the dots’. Well worth a read, whether you attended the colloquium or not!

RCTs in global health

Lancet Editorial – Where next for randomised controlled trials in global health?
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32458-4/fulltext

Editorial linked to last week’s Nobel prize Economics.

Excerpt: “…While development economics has drawn lessons from medicine, what can medicine
learn from this experimentalist turn in economics? The laureates have shown that RCTs can be done
in some of the most challenging human circumstances. Importantly, the design of interventions
must be based on a detailed understanding of context. Too often, a policy shown to work in one
setting is transplanted to another, with scant regard for whether the situation is at all similar. This
scenario is especially true for health policy, in which a community of highly paid international
consultants travel business class from country to country peddling their favourite idea…. RCTs in
global health must evolve to become more meaningful. Too often, trials are severely restricted, with
little ability to plan for changes across the study (adaptive) and being ready for unforeseen decision
making (simulation modelling) at a huge cost and effort. An upcoming Lancet Global Health Series
on improving efficiency in global health clinical trials aimed both at researchers and funding
bodies will focus on innovative designs and avoiding research waste. The lesson from this year's
Nobel Prizes is that one size does not fit all. In conceiving and doing rigorous experiments to find out
what really works, we need to listen to the voices of the poor and design interventions that respond
to their beliefs, needs, and expectations.” The Editorial says the HOPE-4 trial published last week is
a good example of this.

A few webcasts you might want to re-watch

 • CGD (Event of 18 October) - Do We Still Care About Principles and Measures of ‘Aid
 Effectiveness’?

“For OECD-DAC countries who still provide substantial volumes of aid, do we agree on and still care
about principles, measures and comparisons of what makes development aid “effective”? The
context has changed significantly since donor countries agreed principles in a series of high-level

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