This week’s global health priorities include “sequestration” in the US, the upcoming High-level Dialogue on Health in the Post-2015 Development Agenda in Botswana (the revised draft report is just out!), the Global Fund’s launch of a new funding model, a 100 million dollar gift by New York mayor & philantrocapitalist Bloomberg to the global polio eradication initiative, and some new journal issues as today is March 1st.
A new Economist special report focuses (again) on “Emerging (or Aspiring ) Africa”, zooming in on Africans’ own accomplishments this time. Jim Kim and the World Bank will push governments and decision makers to focus more on gender-based violence. Don’t know how Jim interpreted Margaret Chan’s nice words for the (presumably mostly male) Tobacco CEOs, at this week’s Harvard conference on governance of tobacco in the 21st century. Chan yelled: “We need a big gun for Big Tobacco!” We think she should consider a Schwarzenegger-style career shift when her term at WHO ends. All the more so because this year’s Oscar ceremony didn’t focus much on global health, as probably was to be expected. Maybe not enough movie stars are already “factivists”? Enter Chan. For example starring in “Revenge of WHO”, “Down with Tobacco” or “Tobacco’s Halloween”… (come to think of it, maybe her recent Executive Board performance was an audition)
In Europe, (some) Italian election results were very encouraging for Europe, at least for the ones among us who want to stop the mad neoliberal austerity train one way or another, and boost Europe’s social and democratic credentials in the process. Yes, as you might have guessed, not every colleague agrees with this assessment, including some of the editors of this newsletterJ. But as John Kerry said this week while addressing German students, in America you have “the right to be stupid”. We hope Europeans have the same right. It’s a vital one, and should probably be part of the post-MDG framework.
Over to China then. In this week’s guest editorial, Dr. Xiaoyun Liu from Peking University and EV 2012 dwells on a new global health programme between China and the UK, the Global Health Support Program.
Enjoy your reading.
Kristof Decoster, Ildikó Bokros, Peter Delobelle, Basile Keugoung & Wim Van Damme
A new global health programme between China and the UK
By Dr. Xiaoyun Liu, Peking University China Center for Health Development Studies
On the 16th of January 2013, China and the UK government jointly initiated a new programme on global health. As China is an emerging world economy, bilateral and multilateral aid programmes to China (in the health sector) have been decreasing. For example, at a recent conference held in Beijing, AusAID mentioned they may stop their bilateral aid health programme to China after the current ones are completed. They intend to shift then towards other types of collaboration and partnership. At the same time, China, as many other international stakeholders acknowledge, has become an important player on the global stage. Hence, it is keen to contribute to the development of the global health agenda and to apply China’s experiences to support health system strengthening in other developing countries. Yet, in order to take up this new role, China needs to further develop its capacity in global health.
Sequestration in the US & global health impact
1. KFF – GHTC Report Warns Of Cuts To U.S. Global Health Funding, Provides Steps To Strengthen Global Health R&D
According to a report released Tuesday by the Global Health Technologies Coalition (GHTC), sequestration (automatic spending cuts, due to start today) would shrink global health spending at the State Department and USAID, as well as the National Institutes of Health. An Inter Press Service article examines the global health impact of historic, sweeping cuts to the U.S. federal budget. By now, you know sequestration is a (sorry) fact…
Another sorry fact was found in a Pew survey, which noticed limited public support for cutting US spending to specific programs, with one exception: foreign aid. Of 19 options for cutting government spending, only one — reducing foreign aid — was supported by more than 40 percent of Americans, according to the poll. So Eric Goosby, the chief of the State Department’s new Office of Global Health Diplomacy, has his work cut out, including in his own country. For the latest on US global health diplomacy, see Tom Paulson on Humanosphere.
In a final word on the US, you might also want to read the transcript of a CFR event of a while ago, “The Global Burden of Disease and its Implications for U.S. Policy.”, featuring among others Christopher Murray and Thomas Bollykly. Country-specific data emerging from the Global Burden of Disease report will be out on March 5th, next week in other words.
WHO/WB meeting in Geneva on UHC
2. WHO/WB – Background document: Towards Universal Health Coverage: concepts, lessons and public policy challenges
This document was used as background for the joint WHO/WB meeting last week in Geneva. Interesting read.
3. WB – A Sketch of a Ministerial Meeting on Universal Health Coverage
Adam Wagstaff was one of the participants (or rather observers) of the meeting in Geneva. He was very impressed with the performance of the two female chairs. In this blog post, he offers his witty reflections and take home messages. Also the US seems to agree that UHC could be the unifying post-2015 health development goal, by the way.
Another observer last week was Rob Yates, who summarized the Geneva meeting in a tweet as follows: “Amazing consensus on importance of UHC, support for it to be a post 2015 goal and genuine WHO/World Bank collaboration. Also total focus on raising PUBLIC compulsory financing to reach UHC, not a word about private insurance or fees etc.” (Nah, probably more than one tweet J)
Yates also tweeted, referring to Indonesia, that a trade-off is feasible between financing UHC & subsidizing fossil fuels. “Indonesia could finance UHC for all its citizens by reducing its enormous fuel subsidies by one third.” Spot on.
4. MMI network news (editorial) – The political context of Universal Health Coverage
Remco van de Pas;
“UHC is in essence linked to political demands, choices and inherent power relations, both at the national and global level. If we all agree to have UHC included in the post 2015 agenda, then we should be willing to be truly involved in the political and ideological battle that will enfold over the coming period”, argues Remco van de Pas.
More specifically: “The question is whether all the countries that are now supporting the cause of UHC are willing to make progress on further regulation of the financial sector and reform of their fiscal policies. Are these countries able to agree on global redistribution mechanisms and regulatory mechanism to curb the massive amount of untaxed wealth and casino capital, and hence free considerable resources to fund the national social protection floors? Will countries be able to develop true “progressive” taxation schemes, not merely income or VAT based, but rather on wealth and CO2 emission? Or do we want rather global philanthropy to provide the complimentary funds for advances in UHC and social security?”
Post-2015 & Botswana meeting
5. Lancet (Editorial) – Health and the post-2015 development agenda
Next week marks the culmination of a 4-month global consultation on the position of health in the next era of human development. The product of this consultation, a report will provide the focus for discussions in Botswana on March 4—5. About 50 senior officials and experts are due to attend: heads of UN agencies, including Margaret Chan, UNICEF’s Anthony Lake, and ministers of health from a number of countries as well as representatives from the UN Secretary General’s High-level Panel of Eminent Persons on Post-2015 development planning, global health partnerships, the private sector, civil society organizations and academia. This Lancet editorial regrets the paucity of input from LMICs in the consultation process, but by and large applauds the effort. Several factors have emerged during the consultation process as vital for the next stage of human development: building on the conceptual simplicity of the MDGs; taking a people-centred, not disease-centred, approach that captures the determinants of health; and returning to the notion of health as a human right, with equity at its heart. The consultation report proposes a hierarchy of goals, with maximisation of healthy life expectancy at the top. For health to maintain its prominence throughout these processes, it must be positioned as a key contributor to sustainable development, the Lancet editors contend.
By now, you can find a revised report (as of 28 February) on the « World we want » website. Based on the comments received a revised draft report has been prepared, to be considered at the High Level Dialogue in Botswana 5 and 6 of March 2013. A final report will be issued by the end of March.
It’s also worth to have a look at a couple of Lancet letters related to UHC and the post-2015 framework. One Lancet Letter emphasizes that the only route to achieve the health MDGs is through the health worker. « The same is true for UHC and post-2015, only this time with deeper consideration of effective coverage—ie, the difference between the theoretical coverage implied by the availability of the workforce and the actual coverage resulting from the quality of the workforce. » Check out also the letter on the upcoming Third Global Forum on HRH, in Recife, Brazil, in November 2013, (and the vital link with UHC) and another one which makes the case for life expectancy as overarching goal, rather than UHC.
6. IHP – Aid: It Is the End of the World as We Know It… And I Feel Fine
Our colleague Bruno Meessen, a health economist, offers a Schumpeterian view of the ongoing transformations in the aid sector, and draws lessons for the health arena. Tough times are coming for 20th century aid actors in the next decades, he says, but there are also good prospects for the many entrepreneurial actors keen to make a contribution to a better world. A provocative post, so definitely check it out.
As already mentioned in the introduction, Bloomberg pledged 100 million to the Global Polio Eradication Initiative.
Meanwhile, WHO and Islamic leaders are meeting in Egypt to try to stop polio worker attacks. As you probably know, there were more attacks in Northern Pakistan this week.
A Scidev.net piece (by Nick Perkins) says it’s time to take the global out of health campaigns: ”The last stages of polio eradication suggest a new model of health campaigns much more responsive to global changes and local context.”
A NEJM perspective (by Les F. Roberts et al.) argues forcefully for ensuring public health neutrality. The authors comment on the letter sent by 12 deans from prominent US schools of public health to President Obama on January 6, 2013, protesting the conduct of a sham vaccination campaign as part of the hunt for Osama bin Laden.
Global Fund update
7. GFO – issue 211
The GF’s new funding model was officially launched on Thursday, 28 February. The Global Fund forecasts that $1.9 billion will be available in 2013–2014 for the transition period of the new funding model. The transition period will run from March 2013 to September 2014. The announcement was made in a news release issued by the Global Fund. More info on the launch and much more in the new GFO issue.
Another GFO news article zoomed in on the recent PEPFAR evaluation, which identified synergies and challenges working together with the GF.
Health Policy & Financing
8. UNAIDS – UNAIDS and UNDP back proposal to allow least-developed countries to maintain and scale up access to essential medicines
UNAIDS and UNDP launched a new issue brief, titled “TRIPS transition period extensions for least-developed countries.” The issue brief outlines that failure to extend the transition period for LDCs to become fully compliant with TRIPS could seriously impede access to lifesaving antiretroviral treatment and other essential medicines for people most in need. In the issue brief, UNAIDS and UNDP urge WTO members to give urgent consideration to the continued special needs and requirements of LDCs in respect of their social and economic development.
A letter from hundreds of civil society groups to WTO members urged them to support extending the waiver for the TRIPS agreement for Least Developed Countries until they “graduate” from LDC status.
9. Science – The Stability of Malaria Elimination
C. Chiyaka et al.;
In a study published in the journal Science last week, a team of researchers at the University of Southampton, led by Andrew Tatem, suggest the global eradication of malaria could be achieved by individual countries eliminating the disease within their own borders and coordinating efforts regionally. The researchers examined data from 1980 onwards for 30 countries which successfully eliminated malaria and also took part in the 1955 Global Malaria Eradication Programme (GMEP) and found it may be possible for malaria elimination to proceed like a ratchet, tightening the grip on the disease region-by-region, country-by-country, until eradication is ultimately achieved — but without the need for a globally coordinated campaign.
10. Plos (Editorial) – A Reality Checkpoint for Mobile Health: Three Challenges to Overcome
The PLOS Medicine Editors discuss three key challenges — relating to interoperability, open standards, and evaluation — that mobile health advocates will need to overcome to expand and deliver on the initial promise of mobile health pilot projects.
11. CGD – Institute of Medicine Pushes PEPFAR on Data Collection, Disclosure
Mead Over & Rachel Silverman;
Commenting on the PEPFAR evaluation, CGD’s Mead Over and Rachel Silverman propose four commendations where there seems to be agreement and feasible opportunities to improve PEPFAR’s collection, utilization, and dissemination of data and knowledge.
In another blog post on Tomorrow Global, Danielle Parsons summarizes the PEPFAR evaluation. (for the ones who don’t want to read 700 pages).
12. Global Health Council – Letter by Jonathan Quick, chair of Board
In an open letter, Jonathan Quick, chair of the GHC Board of Directors, summarizes the outcomes of a recent board meeting, including an initial set of actions.
13. Humanosphere – Niger arrests doctors associated with Gates-backed vaccine initiative
Allegations of embezzlement of some $1.5 million by health workers in Niger were first identified by GAVI and have been followed up on by law enforcement in Niger. Paulson emphasizes: “It’s not a probe of GAVI or an allegation of impropriety on the part of the vaccine initiative.” (and he draws the comparison with the flawed AP coverage of GF in 2011 and the donor backlash)
14. Lancet (Comment) – The changing face of global child demographics
Danzhen You et al.;
This Lancet Comment zooms in on a recent UNICEF report, “Generation 2025 and beyond: the critical importance of understanding demographic trends for children of the 21st century”. The authors emphasize four points for immediate consideration in global efforts to foster equitable development for children in the 21st century.
15. NEJM (Review) – Tuberculosis
TB disproportionately affects the poorest persons in both high-income and developing countries. However, recent advances in diagnostics, drugs, and vaccines and enhanced implementation of existing interventions have increased the prospects for improved clinical care and global tuberculosis control, Zumla says in this review article.
16. The Atlantic Cities – We’ve Been Looking at the Spread of Global Pandemics All Wrong
The Atlantic Cities profiles the work of Dirk Brockmann, a theoretical physicist and professor of complex systems at Northwestern University, and other researchers who are examining how modern transportation, such as air travel, affect the spread of disease globally. By using hypothetical models based on air travel distance and probability, researchers are beginning to be able to better predict how and when disease might spread, based on other factors such as infection rates, disease dynamics, seasonality, or the age structure of infected populations.
17. Guardian – Africa’s broken promises on improved sanitation exact deadly toll
The number of people in Africa lacking access to safe sanitation is rising, despite repeated promises by the continent’s national leaders to tackle the problem.
Poor sanitation is causing hundreds of thousands of deaths a year in Africa, where 600 million people – about 70% of the population – do not have a safe toilet, according to NGO WaterAid.
18. SAFAIDS – UNAIDS welcomes new paediatric HIV treatment license for the Medicines Patent Pool
UNAIDS welcomes the new collaboration between the Medicines Patent Pool and ViiV Healthcare to increase access to antiretroviral therapy for children. The new agreement is a significant step forwards in HIV treatment for children as very few antiretroviral drugs are formulated for paediatric use. In 2012 UNAIDS estimated that 72% of children living with HIV who were eligible for treatment did not have access.
Under the collaboration, ViiV will allow the paediatric formulation of the antiretroviral medicine abacavir to be supplied to 118 countries under a license agreement. The 118 countries are home to more than 98% of all children living with HIV. See also Reuters on this.
19. Morbidity and Mortality Weekly report – Impact of an Innovative Approach to Prevent Mother-to-Child Transmission of HIV — Malawi, July 2011–September 2012
Frank Chimbwandira et al.;
Authors report on the implementation of Option B+ in Malawi (early results). It already sparked a lot of debate, see for example this blog post.
20. Lancet Early online – Emerging threats to public health from regional trade agreements
Deborah Gleeson et al.;
The ability of governments worldwide to introduce and implement public health policies and laws is increasingly threatened by trade and investment treaties that privilege investors over governments and provide avenues for international corporations to challenge democratically enacted public health policies in different countries. Regional trade agreements are a case in point. The TPP is a prototype of a new style of regional trade agreement that presents profound new threats to global health and health equity, the authors argue.
21. Lancet (Correspondence) – Can WHO survive? An organisational strategy question
The author wonders whether WHO can strategically survive. He thinks the answer is yes, but WHO will regain competitive advantage only when the question of “as what?” is no longer necessary. “This point will come when WHO is managed, and examined, as the species that it is: a strategic organisation with unique values, mission, and vision.”
22. International Health – special issue on global mental health
23. WHO Bulletin – March issue
- Interesting editorial by Ilona Kickbusch et al. on “Global health diplomacy: five years on”. Global health diplomacy is there to stay. Four elements have contributed to the ascent of global health diplomacy.
- The Bulletin has another interesting editorial on congenital syphilis. Authors say it makes sense to build on global efforts to prevent and treat HIV infection during pregnancy to strengthen the fight against maternal syphilis. (in a related article in Plos, Lori Newman & colleagues estimate global rates of active syphilis in pregnant women, adverse effects and antenatal coverage and treatment needed to meet WHO goals).
- A WHO Bulletin article (by Lawrence C. Loh et al) zooms in on private sector contributions and their effect on physician emigration in the developing world. Examining a few countries, it appears that private health-care delivery and financing may decrease physician emigration. More research is needed in other LMICs, they say. In related news, a CGD blog post (by Michael Clemens) focuses on a startup founded by Dr. Adam Kushner, CelRX, which helps migrants buy urgent health care for people back home.
Global Health bits & pieces
KFF – Rwanda To Roll Out Combined Measles-Rubella Vaccination Campaign
“Rwanda has been so successful at fighting measles that next month it will be the first country to get donor support to move to the next stage — fighting rubella too. On March 11, it will hold a nationwide three-day vaccination campaign with a combined measles-rubella vaccine, hoping to reach nearly five million children up to age 14,” the NYT reports. “The dual vaccine costs twice as much — 52 cents a dose at UNICEF prices, compared with 24 cents for measles alone. “The Measles and Rubella Initiative will provide the vaccine and help pay for the campaign.
24. Health Policy – World Health Assembly Agendas and trends of international health issues for the last 43 years
Tomomi Kitamura et al.;
This article presents a chronological analysis of agenda items of the World Health Assembly for the period 1970 to 2012. Among the categories of the WHO reform, communicable diseases and health systems were the most discussed, while health through the life course went relatively unnoticed. The discussed sub-categories were associated with major public health milestones, but the items did not always reflect international health issues in terms of burden of disease and mortality, such as MCH.
25. Journal of Health services Research & Policy – Twelve myths about systematic reviews for health system policymaking
Kaelan A Moat et al.;
In this paper, the authors counter a number of myths related to the use of systematic reviews for health policymaking. Drawing mainly from a famed repository of HSR, they refute twelve constraining beliefs, such as that systematic review topics are not relevant to health system policymaking, that they cannot be found quickly, and that they are not available in formats that are useful for policymakers.
26. AIHA Internet Resources Digest – Spotlight on evidence-based practice and policy in LMICs
The January issue of Internet Resources Digest puts the spotlight on internet resources and evidence-based practice and policy in health care and social work in LMICs, based on the growing acknowledgement and adoption of evidence-based health care in those situations where health problems are severe and resources scarce.
27. Global Public Health – Large-scale road safety programmes in low- and middle-income countries: An opportunity to generate evidence
Adnan A. Hyder et al.;
In this paper, the authors develop a scientific approach for evaluating large-scale road safety programs in LMIC settings, by building on existing evaluation frameworks and introducing a multi-country initiative, the Road Safety in Ten countries project, which provides an interesting opportunity for the evaluation of real-world programs and will contribute to the production of relevant knowledge in the field of road safety.
28. CoreGroup – Review of CHW Effectiveness for MDGs
Henry Perry et al.;
Also at Johns Hopkins Bloomberg School of Public Health, a review of the potential contributions of CHW to achieving the MDGs was recently completed on the request of the MDG Health Alliance.
In an Impatient Optimists blog featuring a Q&A session between the Frontline Health Workers Coalition and the authors of the CHW report, it is stated that “utilizing CHW to deliver health services to women and families can significantly improve the health of children and potentially save 3.6 million children’s lives every year.”
We just want to flag a new EC Communication here: “A decent life for all: Ending poverty and giving the world a sustainable future.” (how about starting in the eurozone, Mr. Barroso ?)