World Malaria Day and World Immunization Week (with the global vaccine summit in Abu Dhabi as the obvious global health event of the week) get some attention in this newsletter. It’s great to see new donors contributing and taking ownership (and it’s so much better than buying a Premier League club!). Hopefully polio will indeed be history in a few years from now.
Abu Dhabi also happens to host the permanent headquarters of the Abu Dhabi dialogue, a “collaborative approach to short-term labour mobility in Asia in order to maximize benefits for all”. The Abu Dhabi declaration (2008) launched this dialogue. It focuses on developing action-oriented partnerships between countries of origin and destination for development around the subject of temporary contractual labour. Sounds like a great (and much needed) initiative in a region known for exploitation of migrant workers and lavish 7 star hotels. I’d rather be Sheikh Mohammed bin Zayed than a Pakistani construction worker in Abu Dhabi or Dubai, let’s put it this way. Hopefully Gates and the other conference participants (especially business executives) had time to explore possible synergies with the Abu Dhabi dialogue this week. Once kids are fully vaccinated, they’ll need a good education and then jobs. Hopefully, these will be fair jobs, unlike the ones in a Bangladesh garment factory that made the headlines this week for all the wrong reasons.
So when are we going to see a Gates sponsored global health event on decent and healthy work? If MNCs are serious about ‘responsible capitalism’ (see this recent interview with Unilever’s CEO for a good example ), and given Bill’s excellent relations with the business community, this would seem to be the logical next step for the philantrocapitalist – and now that Bill Clinton is on Twitter, he’ll surely want to get into the game too. We agree with Justine Greening and others that no sustainable development will be possible without the private sector, but as Tom Paulson documented this week in a piece related to the horror in Bangladesh, it’s about time an industry-wide movement establishes standards that ensure worker safety and fair labor practices. Obviously, the American Chamber of Commerce and other Davos men and women will be quick to point out that we shouldn’t “interfere in domestic politics”, that the poor in countries like Bangladesh need their jobs more than workplace safety or that this is not exactly a global health ‘best buy’. Yet, if for (a lofty goal like) polio eradication national and local leaders can be involved, as they should, why would something similar not be possible for scrutinizing the global value chain of multinational companies (including the subcontractors) and ensuring accountability? Many of them claim they’re already doing that – most of the big retailers have ethics policies. Yet, we have a feeling they don’t get ‘value for money’. By the way, the contrast with the impact of corruption and bad press on donor behaviour is striking. Now there’s no talk of multinationals pulling out of Bangladesh, they instead remind me of Pontius Pilate.
So let’s organize a High-Level Event in London on fair labour standards and let Cameron, Merkel, Xi and all these other decision makers draft a Global Plan to Eradicate Lousy Working Conditions (the local clown can give the opening speech, or his little brother), including a detailed roadmap. After all, in the polio fight, Gates and co also don’t just focus on the desired outcome, they also pay attention to the political and social process necessary to get results. It goes without saying that a Public-Private Partnership will be needed to implement the GPELWC roadmap – without innovative mechanisms, you can’t achieve targets in the 21st century.
Before the High-Level event, participants should read this recent blog post from Duncan Green (Oxfam). Green wonders what would change if we tried to make inequality history rather than poverty. A lot, it turns out, even if he admits there are plenty of challenges. He suggests a tree tier approach: make poverty history, make inequality history and make externalities history. It’s obvious all need to happen. Soon.
In this week’s guest editorial, Werner Soors dwells on a few turbulent days in Boston. Unlike some of my colleagues who love running (Wim Van Damme and Luc Van Leemput (aka ‘Ironman’) ran the Antwerp marathon last weekend) Werner had no intention of taking part in the Boston marathon. That turned out to be a good idea. He attended the UHC & ethical dilemmas conference in Harvard instead. An even better idea. Read why.
Enjoy your reading.
Kristof Decoster, Ildikó Bokros, Peter Delobelle, Basile Keugoung & Wim Van Damme
Boston, Boylston and a bit of Berklee
Werner Soors (ITM)
When some day in the future people will be asked what happened in Boston in April 2013, I reckon few will come up with Harvard’s conference on universal health coverage. Yet, while the city’s public life froze between the marathon bombing on Boylston street and the capture of ‘suspect 2’ a few days later, part of the global public health community gathered in central Boston to discuss ethical dilemmas on the path to UHC in developing country health systems. As media coverage was possibly not fairly distributed between the two events – and as the International Health Policies newsletter is what you’re subscribed to – let me tell you about the conference, in this very particular Bostonian context.
Day 1 started as you would expect at any high-end conference dedicated to ‘developing countries’ yet with participants from the Global South – as usual – underrepresented: opening with Julio Frenk’s refurbished rendering of Mexico’s Seguro Popular (unifying the selective technocrat approach and the social rights-based approach), meandering through Adam Wagstaff’s metaphor of UHC as ‘old wine in a new bottle’ (but we like the wine) and spiced up with a dose of gratuitous criticism (the WHO box is not convincing enough – Gita Sen).
How could I have been so naïve as to having expected something more thrilling? (Should I stay or should I go? – The Clash, 1982)
But then there was William Hsiao (known for his work on health systems in many developing countries, including Vermont – introduction by Norman Daniels), and things suddenly changed. Good old Bill gently woke up the audience (I think the US can teach the world how not to go for universal coverage), convincingly showed how the overly simplistic cube can be layered to reveal inequities within a society (see slide 8 of one of Hsiao’s earlier presentations) and argued that political paths to universal coverage in the end are defined by setting ethical priorities. In the afternoon, Peter Berman expanded on similar thoughts, explained how different pathways lead to different outcomes, and claimed that ends should drive the means: let us discuss the ethical basis of these choices. This led in the evening of day 1 to some animated discussions.
So far so good: 300+ conference attendees went for a rest, expecting more in-depth food for thought on ethics and UHC on day 2. Who could foresee that a couple of hours later a shootout at the MIT campus would lead to a 24-hour manhunt that paralysed the city? (You know something is happening, but you don’t know what it is – Bob Dylan, Ballad of a thin man, 1965) The conference resumed with four hours of delay the next day, with less than 50 participants.
On day 2, the conference started as unsettling as the empty Boston streets: Nir Eyal – associated Harvard professor of medical ethics – made a plea not to use coverage as WHO does, to stay away from universal population coverage and instead go for what he calledselective facilitation. The latter basically means giving the rich no coverage (you might also call it ‘selective universal coverage’; history sometimes repeats itself). In Eyal’s view, this is a matter of fairness and would leave more money for the poor. Your man in Boston was flabbergasted, but not speechless. Mr. Eyal, isn’t that reasoning a bit at odds with long-standing evidence for broad collection and pooling? Would you really expect the rich to keep on paying if they get no benefits? – Indeed, Mr. Soors, I can see a political will for that in my country. Which did leave me speechless: I never before had regarded the US of A as the exemplary ‘developing country’.
(You can fool some people sometimes, but you can’t fool all the people all the time – Bob Marley, Get up, stand up, 1973)
The following session however not only lifted my spirits, it – more importantly – provided a landmark in ethical reasoning, thanks to the quartet of Marc Fleurbaey (Princeton), Matt Adler (Duke), Larry Temkin (Rutgers) and Alex Voorhoeve (LSE & Princeton). They engaged in an in-depth discussion on the social welfare function, Pigou-Dalton transfers as the equitable cousin of the efficiency-oriented Pareto principle, and solidarity, all within the framework of universal coverage. If you ever have the chance to hear any of these four gentlemen in your neighbourhood, do not hesitate. For a teaser, please have a look at one of Fleurbaey’s key publications: Health, equity and social welfare.
After having concluded the conference, the organisers announced that ‘suspect 2’ had been captured. They didn’t say that Dzhokhar Tsarnaev had arrived more dead than alive at the Beth Israel Deaconess hospital, just in front of the conference building. Most of the conference attendees applauded, and left satisfied. Thousands of Bostonians started dancing in the streets till the early hours.
Following up on this conference, WHO hopes to produce a guideline later this year. Working title: A fair path to universal coverage. We’ll keep you informed.
World Immunization week
1. FT – Gulf backing sought for polio eradication
2. News medical – GPEI presents comprehensive six-year polio eradication plan at Global Vaccine Summit
At the Global Vaccine Summit, the Global Polio Eradication Initiative (GPEI) presented a comprehensive six-year plan. Global leaders and individual philanthropists signaled their confidence in the plan by pledging close to three-quarters of the plan’s projected US$5.5 billion cost over six years. They also called upon additional donors to commit up front the additional US$1.5 billion needed to ensure eradication. This article gives an overview of some of the speeches and statements. For more coverage, see the KFF global health digest.
Increased funding from Muslim nations and philantropists, in addition to traditional Western donors, was one of the main goals of the summit. For polio, that definitely seems to be happening (see KFF for an overview).
In advance of the Global Vaccine Summit, global leaders all emphasized how important this event was going to be. Just in case you were wondering how high polio eradication (and immunization in general) are now on the international agenda: Ban Ki Moon & Bill Gates, Kofi Annan, Desmond Tutu, Seth Berkley, Justine Greening and many more all had their say. And in case you still wonder: Psy (Gangnam Style, Gentleman) is also on board.
3. Lancet (Comment) – Poliomyelitis in Pakistan: time for the Muslim world to step in
Quanta A Ahmed, Sania Nishtar & Ziad A Memish;
Saudi Arabia and its health authorities are uniquely placed to bring about change in Pakistan for a number of reasons, Ahmed et al argue. “Pakistan’s demoralised public health workers must be supported by a robust international approach that combines both traditional diplomatic and imaginative political responses to draw on the powerful authority of the international Muslim community, including the Organization of the Islamic Conference, the International Fatwa Body in Mecca, and Al Azhar in Egypt. Only then can we relegitimise infection control authorities and engender confidence in both public health officials and the vulnerable Pakistani population. The Muslim world is responding emphatically. Sheikh Mohammed bin Zayed Bin Sultan Al Nahyan of Abu Dhabi is partnering with the Bill & Melinda Gates Foundation in a US$100 million commitment to the Global Polio Eradication Initiatives and Endgame Strategic Plan 2013—18 to be announced at the Global Vaccine Summit, Abu Dhabi, during World Vaccination Week (April 24—30). Such endorsement emphasises the recognition of poliomyelitis eradication as both a prime challenge and an extraordinary opportunity for the Muslim world.”
4. CSIS – The US role in global polio eradication
This paper provides an overview of the global polio eradication effort, emphasizing the US role.
5. CGD – World Immunization Week: Leaders and laggards
Amanda Glassman & Denizhan Duran;
In the journal Vaccine’s Decade of Vaccines supplement, CGD authors propose a way to rank and compare countries in terms of their commitment to vaccination. In addition to looking at recipient countries, they look at how much donors contribute to global vaccination efforts.
6. BMJ (blog) – Vaccines and developing countries: why the high prices?
Kate Elder & Jennifer Cohn;
MSF staff expand in this BMJ blog post on their statement of last week, in which they argued that the Decade of Vaccines plan “lacks ambition when it comes to bringing vaccine prices down and making vaccines better adapted for use in developing countries.” (see also this Sci Dev net article ).
World Malaria Day
7. FT special report on malaria
The Financial Times just published a special report on malaria featuring articles examining issues including prevention, treatment, and research and development. Check out for example Andrew Jack’s lead article on the current state of affairs in the battle against malaria (on malaria policy, research & financing).
For some more background, see also this Huffington Post op-ed by a Roll Back Malaria representative.
You might also want to check out this article on the Guardian Global Development Professionals Network, with some advice for the Global Fund (according to Richard Feachem, former director of the GF) in the battle against malaria.
8. Malaria (Commentary) – It is time to rethink tactics in the fight against malaria
Laurence Slutsker et al.;
Laurence Slutsker and Patrick Kachur of the CDC’s Division of Parasitic Diseases and Malaria, write in a Malaria Journal opinion piece: “After a decade of steady success, this year’s commemoration of the date is also an opportunity to reconsider current approaches and assess the state of the science needed to keep pace in the global effort to combat malaria.” … “The challenge now is to know where people are being infected and tailor the tools that programs are using so that they are most effective.” They give a couple of examples.
9. WHO – WHO launches emergency response to antimalarial drug resistance
On World Malaria Day, WHO recognizes significant accomplishments in preventing and controlling malaria, including in high-burden countries in sub-Saharan Africa, but highlights the threat of antimalarial drug resistance in south-east Asia’s Greater Mekong subregion, where an emergency response to Artemisinin Resistance is now being launched. There is support from the Gates Foundation and the Global Fund for these containment efforts. As for the global funding needed for malaria control: “In total, an estimated US$ 5.1 billion is needed every year between 2011 and 2020 to achieve universal access to malaria prevention, diagnostic testing, and treatment around the world. Although many countries have increased domestic financing for malaria control, the total available global funding remained at US$ 2.3 billion in 2011 – less than half what is required.”
10. Guardian – Cambodia tests mass use of repellents in fight against malaria
Check out how ITM researchers are involved in a new two-year project to test the effectiveness of the mass use of repellents in Cambodia (so their use may be incorporated in the government’s strategic anti-malaria plan).
We also want to draw your attention to some other malaria related news stories:
* In a Humanosphere article, Tom Paulson reports on a recent speech by WHO’s malaria chief in Seattle. Excerpts: “In one year, if we don’t keep up, we could easily undo this past decade of progress. I’m concerned that we may not be keeping up.” … “One of the issues few in the global health community like to talk about in public, is that the international community’s approach to fighting malaria — though successful in the short term — isn’t addressing the long-term risk of reducing natural immunity.”
* Also thanks to a Humanosphere reporter : “The US Food and Drug Administration has developed a device – a fake drug detector – that the agency hopes can help combat the growing problem of fake drugs. The FDA will first zoom in on malaria to test the effectiveness of the device, as in sub-Saharan Africa, 20% of the drugs used to fight malaria are outright counterfeits, and 35% are “substandard” ….
* Todd Summers reports on the success of the President’s Malaria Initiative (PMI) (in a CSIS blog post). He also discusses some remaining and new challenges.
11. Chatham House – Development Assistance for Health: Critiques and Proposals for Change
Suerie Moon et al.;
Concerns about the current DAH system include volume, volatility, additionality, priority-setting, coordination, accountability and the rationale and justification for development assistance, Moon et al argue. in this Working group paper. Proposals for reform are considered including raising resources through new taxes, e.g. on financial transactions or innovative financial mechanisms; ways of reforming the institutions through which assistance is channelled; and new proposals that go beyond the current system, including the use of international law to codify mutual obligations and new institutions such as a Global Social Protection Fund.
12. IHP – Development Cooperation post-2015: from switching the poles to ditching the poles?
Our colleague Pierre Massat recently attended a Belgian Directorate General for Development Cooperation (DGD) event entitled “Development Cooperation in the Health Sector: Still the same approach ? In this blog post, he summarizes some of the key messages (including some blunt ones by our own director who was one of the speakers).
Check out also a Devex interview with Dennis Brown, executive director of UNITAID. Broun discusses innovations in global health financing, lessons from UNITAID for the global health community, and solutions to overcoming obstacles to entering markets, ensuring supply chains, and improving access.
13. UNAIDS – Africa Health Forum 2013: Finance and Capacity for Results
This Feature article reports on the recent Africa Health Forum 2013 meeting in Washington.
Other ‘financing health in Africa’ related material: read the second part of the interview with Mr Agostino Paganini on the Health Financing in Africa blog, “The Bamako initiative died a long time ago’.
14. Global Post – US budget negotiations threaten global health spending
Journalist Sam Loewenberg launched a GlobalPost global health series, The Seven Million, in which he focuses on the efforts to reduce child mortality worldwide. In this first story, Loewenberg provides a nice overview of the American political landscape as it pertains to foreign aid and global health spending. “A review of … correspondence to Congress obtained by GlobalPost provides insight into the behind-the-scenes battles that will determine how the United States will continue to support global health”.
The World Health Assembly is coming up, so WHO is popping up more and more in the global health news again:
- WHO Emergency response framework:
The purpose of this Emergency Response Framework (ERF) is to clarify WHO’s roles and responsibilities in this regard and to provide a common approach for its work in emergencies.
- WHO Watch:
The coming World Health Assembly, taking place may 2013 in Geneva, is bringing PHM health activists together within the broad initiative ‘Democratising Global Health Governance – WHO watch’. WHO Watch is a resource for advocacy and mobilisation and an intervention in global health governance. From 15 – 31st of May PHM health activists will ‘watch’ WHO. The activities start with an orientation workshop where ‘watchers’ are prepared for the day to day watching. PHM statements and positions will be developed on various topics and presented on the ghwatch website.
- WHO reform implementation plan:
The WHO reform implementation plan browser reflects the current status of the different reform proposals. The system is updated on a regular basis. It provides details of outcomes and outcome indicators, outputs, key deliverables, and budgets at the output level.
15. Foreign Policy –
There’s no business like pandemic business… Nobody writes better about viruses and potential pandemics than Laurie Garrett – who needs Hollywood blockbusters if you can make people shiver just by writing prose? Laurie offers a detailed account of how the H7N9 virus emerged and describes the two possible paths it may now follow, by pulling from her own experiences in the SARS epidemic ten years ago and reflecting on parallels between the two. She also ponders the question inevitable in a journal targeting the American audience: is this – again – a Chinese cover-up?
This Guardian story also points out that – according to a WHO official – H7N9 is one of the most lethal flu viruses. For more updates on H7N9, see for example KFF, Nature (here and here). The first case in Taiwan just popped up.
For the system thinkers among you, Ben Ramalingam explores the importance of managing such pandemic risks through collaboration, innovation and systemic thinking.
16. UHC forward – The role of the private sector in moving towards universal coverage – Using the example of Heartfile Pakistan
At a panel discussion hosted by the International Partnership for Innovation (IPIHD) and Partners for a New Beginning Secretariat, discussants explored Heartfile (from Pakistan) as a potential model for achieving UHC efforts through innovations in financing. What is the private sector’s role in achieving UHC? What are the challenges and best practices we can draw from the Heartfile experience? And how can we scale up and replicate successful models in the push towards universal coverage? Christina Synowiec discusses all these issues in a nice blog post.
17. Health Policy & Planning – Lessons learned from stakeholder-driven sustainability analysis of six national HIV programmes
Itamar Katz et al.;
In light of the decline in donor HIV funding, HIV programmes increasingly need to assess their available and potential resources and maximize their utilization. This article presents lessons learned related to how countries have addressed the sustainability of HIV programmes in a stakeholder-driven sustainability analysis. Countries recognize the need to prepare for an alternative to ‘universal access by 2015’, acknowledging that their capacity might be insufficient to reach such high-coverage levels by then.
18. GFO – new issue
This new issue includes an article by Kate Macintyr & David Garmaise on the recent Global Fund pre-replenishment meeting in Brussels. And much more.
19. Lancet – Offline: I find such people intolerable
Horton dwells on the “most neglected issue in global health”, civil registration and vital statistics, in some reflections on the recent Bangkok summit (including some thoughts on the “funeral” of the Health Metrics Network). For the Bangkok Global Call to Action, see here.
20. Reuters – South Africa seeks to close drug patent loophole
South Africa plans to overhaul its intellectual property laws to improve access to cheaper medicines by making it harder for pharmaceutical firms to register and roll-over patents for drugs, a senior official said on Monday. Yet another country taking action on “ever-greening”.
21. Speaking of Medicine – Eliminating neglect and neglected tropical diseases
PLOS NTDs Editor-in-Chief, Peter Hotez, highlights progress in the elimination of neglected tropical diseases through mass drug administration and other measures.
He reports on measures undertaken to help Togo become the first sub-Saharan African country to eliminate lymphatic filariasis, and says three things must happen to continue to help countries eliminate NTDs.
22. KFF – HHS Global Health Official Discusses Tobacco-, Drug Patent-Related Trade Negotiations
Inside U.S. Trade features an interview with HHS Assistant Secretary for Global Affairs Nils Daulaire, who discusses how “the department is playing a larger role than ever before in the development of U.S. trade policy, including on sensitive issues in the Trans-Pacific Partnership (TPP) negotiations like a draft proposal for a tobacco-specific ‘safe harbor’ and the U.S. stance on issues related to intellectual property protections for pharmaceuticals.
For more on regional trade agreements and public health, see also this Lancet Viewpoint by Gleeson et al (in today’s issue, but already online for a while – see a previous newsletter).
23. Science Speaks – Guns, apartheid, recycling . . . all part of oral arguments as Supreme Court takes on “anti-prostitution pledge”
Barton reports on the oral arguments made on Monday before the US Supreme Court in the case of USAID vs Alliance for Open Society International, (AOSI) et al – also known as the case of the “anti-prostitution pledge”. The case challenges a 2003 federal statute that requires non-profit organizations to adopt an “anti-prostitution policy” in order to receive federal funding for HIV/AIDS programs abroad, on the grounds that it violates the First Amendment. The Obama administration is getting quite a bit of flak for its stance.
“Supreme Court justices appeared divided on Monday… ” Reuters reported. The case is expected to be decided by late June.
24. Science Speaks – Bill would acknowledge, sustain USAID role in global health research and development
Barton reports on a “deficit neutral” bill, The 21rst Century Global Health and Technology Act, which, if enacted, “would codify the existing role of USAID in global health research, recognize its unique role in identifying needs for new global health technologies as well as facilitating their use, and make the most of the agency’s position, to coordinate global health research and development by other U.S. agencies.”
25. Working paper – Transforming global governance for the 21st century
Alexander Betts, Jochen Prantl, Devi Sridhar, and Ngaire Woods
This paper explores the transformation of governance in four sectors (finance, health, migration, and security) and highlights the implications for developing countries.
Global health announcements
- MSF scientific day 2013 – 10 May
MSF Scientific Day 2013 will be streamed live online from the Royal Society of Medicine, London, UK, from 09.00am – 06.00pm (GMT+1) on 10th May 2013
“MSF Scientific Day is a unique opportunity to showcase medical and scientific research carried out in MSF programmes around the world. Presenting and debating the findings from our research is vital to improve the quality of our humanitarian programmes. By streaming the event online, we hope to engage the wider humanitarian and global health community in this discussion. “
The agenda for this year’s MSF Scientific Day has now been finalised.
- The keynote speech by international health expert, co-founder of the Gapminder Foundation and TED talks alumnus Hans Rosling on the synergy and conflict between research and advocacy. This will be followed by a panel discussion on the impact of MSF’s research.
- Treatment in conflict and emergency settings including TB in Somalia and hepatitis E in South Sudan
- New approaches to preventing malaria in Mali and Chad, cholera vaccination in an outbreak in Guinea, and preventing malnutrition in Niger by cash transfer and food supplementation
- Challenges for MSF including the introduction of a medical error reporting system and parenteral artesunate for severe malaria
- The role of social media and health looking at the effect of MDR-TB patients blogging about their experiences
Online viewers can expect:
- A live stream of Scientific Day presentations and talks
- A low-bandwidth stream for those with temperamental internet connection
- A real-time online discussion with the chance to submit questions to presenters
- An on-line gallery of posters presented at the event
- Live Twitter Q&A sessions with selected presenters
26. CGD – Impact of Conditional Cash Transfers on Maternal and Newborn Health
Amanda Glassman et al.;
Conditional cash transfers (CCTs) have been shown to increase health service utilization among the poorest, but little is written on the effects of such programs on maternal and newborn health. The authors carry out a systematic review of studies on CCTs that report maternal and newborn health outcomes, including studies from eight countries. They find that CCTs have increased antenatal visits, skilled attendance at birth, delivery at a health facility, and tetanus toxoid vaccination for mothers, and reduced the incidence of low birth weight. The programs have not had a significant impact on fertility or Caesarean sections while impact on maternal and newborn mortality has not been well documented thus far. They also offer some recommendations.
* Duncan Green reports on the new ‘Government Spending Initiative’. See CGD Europe’s Development Digest: “In a joint initiative, Oxfam and Development Finance International have pulled together and analysed the budgets of 52 low- and middle-income countries (with another 34 to follow), resulting in a new database – Government Spending Watch – and accompanying report (summarized here ). The data covers seven sectors (agriculture/food, education, environment and climate change, gender, health, social protection and water/sanitation), from 2008 to 2015, and compares planned versus actual spending, disaggregated by types and source. It also identifies gaps, and calls on governments to collect and publish more and better data.”
* Jonathan Glennie looks at financing post-2015 in a Guardian analysis. “We should treat developing countries as money-makers, not aid recipients, and remember that finance is always political.”
* Just for the sake of the title, you should probably already read this blog post on the Broker – “Who wants to follow? British leadership claims hamper international cooperation.”
* Another article on Guardian Global Development Professionals Network, “Capacity building is key to delivering development in Africa”: Development agencies should help governments to define and implement their own priorities, but not dictate what those should be. With some info on the new WB approach.