Two international days were “celebrated” this week – World Cancer Day and the International Day of Zero Tolerance to Female genital mutilation. Encouragingly, UN data show a decline in female genital mutilation in Africa and the Middle East. Yet, according to WHO, some three million girls remain at risk every year and 140 million have been affected by the practice. I don’t know whether the African Cup pays attention to the issue, but if it doesn’t, next time football stars should tackle it. By the way, the final is between football powerhouse Nigeria and, somewhat surprisingly, Burkina Faso.
The first draft of the report of the consultation on health in the post-2015 development agenda is now open for public comment; feedback is welcome till 19 February. It appears a fairly balanced document, although we live of course in far from balanced times. To convince yourself of this, check out for example the new documentary“Inequality for all”, starring the economist Robert Reich. The documentary was an unexpected hit at the recent Sundance film festival and is already labelled ‘Another Inconvenient Truth, this time about the economy’. Hopefully the new and much hyped “virtual middle class” can put pressure on leaders around the world to do something about the widening inequality.
Other relevant news for the global health community this week includes the release of the 2012 IHME report on global health funding, the EU budget negotiations and possible implications for the aid budget, and the second meeting of the High-Level Panel on the post-2015 development agenda in Monrovia, Liberia. Cameron argued for a more responsible capitalism but still seemed to prefer growth over addressing inequality at the final press conference, unlike most of the others present in Monrovia.
Next week, a Gates/WHO 2-day meeting on global health estimates will take place – (Richard Horton is warming up already, and tweeted the following about something he just read in a preparatory paper circulated by WHO: “Then the bombshell: “There is a need for an overarching WHO global health estimates advisory process.” Read: we want to control the numbers.”).
A LSHTM symposium is also scheduled on preventing global NCDs through low carbon development. Horton again: “Time to bring two big global health agendas together?” Recently, at an event in Delhi, NYT columnist Thomas Friedman said the defining challenge of this generation is sustainable development (the babyboomer generation’s challenge was freedom, he argued). He continued: “There is a happy ending, but we just don’t know yet whether it will be fiction or non-fiction.” Well, I know what Las Vegas thinks. Also next week, on February 11, a new Lancet series will be launched on next steps for NCDs.
In this week’s guest editorial, NS Prashanth and Radhika Arora, Emerging Voices from India, reflect on their country, a month and a half after the horrific gang-rape and the start of the societal backlash. It’s a very powerful piece with a strong message, so definitely check it out. In the Guardian, Sarah Boseley reportson unnecessary hysterectomies in the Indian private sector. Women in India, much work remains to be done…
Enjoy your reading.
Kristof Decoster, Ildikó Bokros, Peter Delobelle, Basile Keugoung & Wim Van Damme
Women in India: It’s not only the law that needs reform
by NS Prashanth and Radhika Arora (Emerging Voices from India)
Six weeks ago a young girl was gang raped in Delhi. She was on her way home from watching a late evening screening of the Life of Pi. Brutally injured, she surpassed all expectations of any survival; her fighting spirit helped her withstand multiple surgeries, until she died 13 days later on December 29, 2012. She expressed a desire to see the men who raped her (and injured her friend) caught and convicted for their crimes. The incident shook the nation and resonated with communities across the world. Young people took to the streets in several cities across the country amid allegations of over-reaction from the Indian government on the protestors, rather than more necessary structural changes to the Indian judiciary. Fareed Zakaria called it India’s Arab Spring. The paternalistic biases of the Indian society lay exposed, typified by domineering responses from male Indian cinema stars, who in a display of shameless chivalry, talked of protecting a woman because she is fragile and weak, to a national level woman politician proclaiming rape as an end of a woman’s life due to dishonour. Even as they were trying to put their reactions out to the media, their statements belied the nature of our society, a male dominated one.
World Cancer Day
1. Lancet (Editorial) – The failure of cancer medicine?
Feb 4 was World Cancer Day, an opportunity to critically consider progress against cancer. This editorial inquires whether it’s fair to say that the cancer medical community has failed patients living with cancer. The editorial also gives an overview of the Lancet Comments dedicated to World Cancer day and the cancer challenge in LMICs. An appeal to world leaders: stop cancer now (by Franco Cavalli, representing oncologists) sketches the dire situation and suggests the actions that need to be taken. Another Comment (by Kulendran et al.) emphasizes that managing non-communicable diseases, particularly cancer, forms a central part of the SDGS.
Ahead of World Cancer Day, WHO launched a survey showing that more than half of all countries are struggling to prevent cancer and to provide appropriate long-term treatment and care to avoid human suffering and protect countries’ social and economic development. Nearly 13 million cancer cases are newly diagnosed each year, and 7.6 million people died from cancer worldwide in 2008. Already more than two-thirds of these new cancer cases and deaths occur in developing countries where cancer incidence continues to increase at alarming rates.
2. Lancet (Comment) – Seizing the opportunity to close the cancer divide
Felicia M. Knaul et al.;
Knaul and colleagues debunk four myths which have undermined global efforts to address the cancer divide: that in LMICs interventions for cancer prevention, treatment, and care are unnecessary, unaffordable, unattainable, and inappropriate because they divert resources from other more acute and burdensome health priorities.
You might also want to read a Project Syndicate op-ed (by Seth Berkeley) on fighting cancer in developing countries with vaccines.
And don’t forget to sign the declaration dedicated to the cause of closing the global cancer equity divide.
Meanwhile, we noticed this rather gloomy WHO tweet on Twitter: “Dr Chan: Given the costs of cancer care, prevention is likely to be the only viable policy option for many low-income countries.” Let’s hope that will change in the future.
The world we want – First draft report
The first draft of the report of the consultation on health in the post-2015 development agenda was made public last weekend and is now open for public comment. It’s a technical report that summarizes the main themes and messages that have emerged thus far. Chapter 8 offers the (very preliminary) recommendations in terms of post-MDG health goals: healthy life expectancy, UHC, a combination of both, a set of MDG-style health goals, …
You can send your feedback by email to firstname.lastname@example.org with the subject line “Comments on draft health report”, or immediately on this webpage. For the ones who fancy Twitter, you can also join in there using #health2015 as hashtag.
A revised version of this report will be considered at the High Level Dialogue on health in the post-2015 agenda, and a final report will be presented to the High Level Panel of Eminent Persons on the Post-2015 Development Agenda in March 2013. Beyond this, the report will also serve as an input into the discussions on post-2015 development agenda and the sustainable development goals that will take place during 2013 and 2014.
Below we’ll cover some of the post-MDG action on TB, here we also want to refer to a Gates Foundation blog post (on ‘Impatient Optimists’) in which the author hopes for universal family planning by 2030.
Bangkok PMAC Conference
3. BMJ (news) – The health sector cannot mount an effective response on its own to global health threats
Human and animal health and environmental sectors need to collaborate systematically and internationally to reduce the health, social, and economic burden of existing and emerging infectious diseases, the “One Health” PMAC meeting in Bangkok agreed last week. They must also acknowledge and tackle the drivers of disease, including overconsumption of global resources, change in land use, international trade practices, and climate change. You can check the programme – most presentations and keynote speeches will probably be uploaded later – here. Do check the synthesis power point by the lead rapporteur.
4. Lancet (Comment) – A major event for new tuberculosis vaccines
Christopher Dye et al.;
Bad news on the TB vaccine front: hopes that a new tuberculosis vaccine was finally on the way, the first for 90 years, have been dashed by trial results showing it did not protect babies against the disease. Optimism had surrounded the vaccine candidate, known as MVA85A, because trials in adults had gone well. But the study published in the Lancet, shows the vaccine did not have a comparable effect when given to babies in South Africa. See also Sarah Boseley on this disappointment in the Guardian.
5. Nature – Ahead of WHO meeting, experts clash over tuberculosis targets
TB experts gathered in Geneva on Wednesday for a WHO-sponsored two-day meeting to discuss a consensus on the appropriate post-2015 tuberculosis goals. In the 2015 Millennium Development Goals, TB is named under Goal 6, with the objective of reducing global TB incidence, but “the tuberculosis community is itching to get its goals included with more definition in the post-2015 development agenda,” the journal notes. There’s a lot of disagreement on the next 10-year objective. One possible goal would be to cut the projected 2015 annual deaths in half by 2025, but some other people say that the 50 percent target will not inspire sufficient action and enthusiasm. (yes, Charles Kenny might have another opinion on this)
6. NYT – Feeding a Disease With Fake Drugs
“Thanks to billions of dollars spent on diagnosis and treatment of TB over the past decade, deaths and infections are slowly declining, but fake and poorly made antibiotics are being widely used to treat tuberculosis”, according to a new study
published in the International Journal of Tuberculosis and Lung Disease. Roger Bate, a resident scholar at the American Enterprise Institute and an author of the study, summarizes the key messages in this New York Times opinion piece. “These substandard drugs are almost certainly making the disease more resistant to drugs, posing a grave health threat to communities around the world”. He suggests some urgent actions to be taken.
In related news, Al Jazeera emphasizes that most substandard TB drugs in developing countries tend to come from legitimate manufacturers.
Global Fund & HIV news
7. Aidspan – Advocates Meet in Amsterdam to Strategise on Global Fund Resource Mobilisation
Seventy members of the GF Advocate’s Network (GFAN) gathered in Amsterdam on 28–30 January to strategise on ways to advocate for more resources for the Fund. The meeting was organised and hosted by International Civil Society Support (ICSS). What distinguished this meeting was that it brought together advocates from the North and the South to jointly strategise about resource mobilisation in both settings. Advocates identified a number of events already scheduled for 2013 that provide opportunities to advocate for a fully-funded Fund. These include the G8 and G20 meetings, World AIDS Day (and TB Day and Malaria Day) – but also events such as the BRICS Summit on 26–27 March; the African Union meetings in March and May; and the Tokyo International Conference on African Development on 1–3 June. (let’s see whether the others open their purses now; personally I think GF advocates should occupy the City and Wall Street in 2013, as well as a couple of tax havens – synergies with Cameron’s G8 agenda can no doubt be found)
In a GFO Commentary, Kate McIntyre & David Garmaise also urge the Global Fund to become more active in communicating information about the new funding model to its broad audience of people working on and interested in Global Fund matters.
8. Lancet (Editorial) – Counselling and testing children for HIV in South Africa
A Lancet editorial applauds the first national guidelines on counselling and testing children for HIV, issued by the South African Human Sciences Research Council. They strike a good balance and provide legal clarity.
Chances are Horton & co are much less fond of what’s happening in Uganda right now – with the kick-off of mandatory HIV testing (or ‘provider-initiated testing’ as the new programme is called). “All people who seek treatment in public health centres across the country will undergo mandatory HIV testing under a new plan to increase access to HIV prevention and treatment, the health ministry has announced.”
9. Lancet – Serodiscordancy and HIV prevention in sub-Saharan Africa
Connie Celum et al.;
Celum et al. comment on a new Lancet study (by Bellan et al.), which emphasises that substantial HIV risk in coupled relationships occurs before relationship establishment and from sexual encounters outside an established partnership. Most important is the conclusion that HIV risk within established partnerships and from outside partners should be addressed with prevention strategies. In their Comment, Celum et al. argue that serodiscordant couples could be an identifiable, targetable, vanguard population for implementation of evidence-based, combination HIV prevention. A package of prevention strategies provided to couples can substantially reduce HIV incidence.
10. HLSP institute (Comment) – Five ways to begin the end of AIDS
Peter Godwin & Clare Dickinson;
Beginning ‘the end of AIDS’ requires re-thinking critical elements of global, regional and country AIDS programming. This paper proposes five ways forward that challenge decades of institutional thinking.
EU Budget & Aid
11. Guardian – EU aid for family planning sparks debate as budget cuts loom
The EU Budget negotiations are still ongoing, with again a “starring” role for David “I don’t know what I’m doing, but it feels great” Cameron. In the run-up to the budget meeting, predictions for the implications on EU aid were dire (see here or here for example). Let’s see what will transpire. Anyhow, chances are that the European Parliament will not just accept the agreement, if it materializes later this afternoon, at least if we may believe Belgian firebrand Guy Verhofstadt. But in the end, aid will suffer, one can fear. Within EU aid, EU aid for family planning is an even more contagious issue, this Guardian article explains. The axe looms.
By the way, always good to check Euractiv for some of the latest news on the EU budget negotiations and other EU & development news. (Negotiations in Brussels have been described as a ‘bazaar’, but that’s obviously not the first time. One wonders what takes us Europeans so long to invite the Turkish to the ball )
12. Guardian – Aid for vaccines is subsidising Big Pharma, doctors claim
Large sums of public money intended to ensure children in the developing world are immunised against disease are effectively being used to subsidise Big Pharma, MSF claims. MSF is concerned that immunisation schemes in poor countries are unsustainable, and often unsuitable for hot climates. However, they deny they are anti-GAVI. Seth Berkeley (obviously) rejects the criticism. To be continued.
In more cheerful vaccine news, GAVI will fund HPV immunization projects in 8 countries. “GAVI-funded pilot projects are due to start in eight countries — Ghana, Kenya, Laos, Madagascar, Malawi, Niger, Sierra Leone and Tanzania, and a full rollout of funding will be available to those countries that can demonstrate their ability to deliver the vaccine.”
13. NEJM (Global Health review article) – Designing Tomorrow’s Vaccines
Gary J. Nabel;
In this Global Health Review article, Nabel says vaccines have yet to realize their full potential for several reasons. But there are reasons to be optimistic that the challenges for the vaccines of tomorrow can be addressed. Scientific, medical, and biotechnologic advances promise to improve the utilization of existing vaccines and expand the horizons for tomorrow’s vaccines.
Health Policy & Financing
14. IPWatch – WHO, WTO, WIPO Provide Policymakers Policy Options For Public Health
“For the first time, the three global intergovernmental bodies dealing with health, intellectual property and trade (WHO, WIPO, WTO) have pooled their expertise on a study of policies needed to advance medical and health technologies and to ensure they reach the people who need them,” a WHO press release states. The book covers a broad range of complex, yet linked issues relating to public health and innovation in medical technologies, with the ultimate goal of accessibility — making medical advances available globally to all who are sick. This IPWatch article summarizes the key messages from the 3 leaders of the respective bodies, Pascal Lamy, Margaret Chan & Francis Gurry at the launch of the book.
15. Lancet – Offline: The Rockefeller Foundation is back!
Horton seems relieved that the Rockefeller Foundation is fully back on the global health scene, after years of relative sidelining by the Gates Foundation. Much credit for the revival goes to Judith Rodin, he claims. The Foundation has become one of the leading voices for UHC. At the recent centenary celebrations in Beijing, the foundation even looked a century ahead. (not sure the foundation will still exist then, though)
We also want to draw your attention to the new WHO health policy & systems research approach, as advocated in a (just published) Lancet Comment (but which already appeared online just before the Beijing HSR symposium), ‘Changing mindsets in health policy and systems research’ (by Abdul Ghaffar et al.). HPSR will be vital in the momentum towards UHC.
16. BMJ (news) – GSK backs campaign for disclosure of trial data
GlaxoSmithKline has become the first drug company to sign up to a campaign for all clinical trials to be registered and their full results disclosed. Oops for the others!
17. KFF – US Government Engagement in Global Health: A Primer
U.S. support for global health involves many different U.S. government departments and agencies, Congressional committees, initiatives, and funding streams. As a multi-pronged, multi-billion dollar investment that targets a myriad of global health challenges, countries, and stakeholders, the U.S. global health response is complex.
This KFF primer provides basic information about global health and U.S. government programs that address global health. (For some mysterious reason, John Brennan isn’t mentioned)
18. Humanosphere – Global health spending is stable, non-communicable diseases neglected
Paulson reflects on the main findings of the new (2012) IHME report on global health funding. “The good news here is that the spending on global health remains relatively stable despite the economic slowdown and a tendency for governments (and donors) to tighten their budgetary belts by cutting spending overseas. But the bad news is that this period of stability may not last, and there may already be a “serious mismatch” between where the money goes and where the need is greatest.” NCDs get very little funding, still.
19. Humanosphere – The Sudden Death and Rebirth of the Global Health Council
As somebody tweeted this week, Murphy shows quite in detail how ‘Gates dependency’ led to the demise (and rebirth) of the Global Health Council. (“performance” data were lacking, or something like that)
20. New Book: Global Health Diplomacy
Eds: Ilona Kickbusch et al.;
A new book on Global Health Diplomacy, edited by Ilona Kickbusch, Graham Lister, Michaela Told and Nick Drager, sets out defining principles for global health diplomacy and examines the current agenda of the field as well as relationships between the different diplomatic areas.
21. International journal of health services – new issue
Among other articles in this new issue, we want to draw your attention to an article
on the Arab Spring and health – two years on; and an article on the Politics of Medicine and the Global Governance of Pandemic influenza.
- CGD’s Charles Kenny is not a fan of ‘zero’ targets in the post-MDG framework, to say the least.
- Some people think the post-MDG negotiations are going nowhere, and that we need nothing less than “a new Global Deal”. (in the Guardian)
- Check out Claire Melamed’s take home messages from Monrovia (2nd High Level panel meeting). For example: the private sector is lagging behind, for the moment. Guess they focus more on SDGs as this affects their business more?
- 160 ideas so far for post-MDG targets, and counting… So perhaps you want to check out this new tracker. ODI just set up the “Future Development Goals Tracker”. It’s a new online database that allows you to browse and search (almost) everything the world has proposed so far on future goals, targets and indicators. (check it out and drown)
- Finally, the Africa Report has a critical article about philantrocapitalists: “doing good at a price”; and Yanzhong Huang is somewhat critical of the Chinese government in a piece for Global Health Governance in which he reflects on SARS, ten years later. He debunks five myths. Spread the word on Weibo.