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International Health Policies newsletter 347: World AIDS Day & COP 21

Dear Colleagues,

More than enough news this week, with of course World AIDS Day and the first week of COP 21 as some of the main events, as well as Zuckerberg’s new philanthropic and tax-efficient “baby”. And much more… So without much further ado, let’s get started.

In this week’s Featured article, Freddy Kitutu (EV 2013) looks at the AMR challenge from an African perspective.

Enjoy your reading.

The editorial team

Featured Article

The evolution of the global response to Antimicrobial Resistance and what Sub Saharan Africa needs to do not to be left behind again!

Freddy Eric Kitutu, MSc.

Pharmacy Department and School of Public Health, Makerere University College of Health Sciences, P O Box 7072, Kampala, Uganda & Uppsala University, Department of Women’s and Children’s Health, International Maternal and Child Health, SE-751 85 Uppsala, Sweden. Freddy was also an EV 2013, Cape Town, South Africa

The year 2015 will leave an indelible mark on global health and many global health stakeholders alike. There was, obviously, the devastating Ebola epidemic, which sent shock waves around the world, but on the bright side, the many lessons learned (at least in panel reports) perhaps also laid the foundation for the unprecedented commitment to tackle Antimicrobial Resistance (AMR) witnessed in 2015. For the battle against AMR, the Ebola outbreak was a blessing in disguise, of sorts. As a wake-up call, it clearly gave a boost to the global health security agenda.

But first, what is AMR and what can be done about it? Microbes have the ability to adapt irrespective of changes in their ecology, reminiscent of the adage “survival of the fittest”. The

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adaptation relies on exposure of the microbe to therapeutic agents, inter-and intra-microbe species exchange of resistance genes and exposure of humans to these microbes. Hence, efforts to contain AMR as a global health threat target either one or all of these three critical events. Neither the inevitability of development of resistance among microbes, nor the interventions to curtail AMR are new but what boggles my mind is why it took decades for the world to agree on and mount an adequate response against AMR development (or at least start with it). In their 2014 paper, Laura J. Shallcross and Sally C. Davies chronicle a total of ten (!) World Health Assembly resolutions on AMR since 1998 that went unheeded. In fact it’s rumored that the WHO Global Strategy for Containment of Antimicrobial Resistance was scheduled to be released on September 11th 2001, when all hell broke loose at the World Trade Center and AMR was overtaken by terrorism as the leading global security threat.

The world hasn’t made much progress in the so called “War on Terror” since then, but on AMR, during the first decade of the 2000s, public health departments in Sweden and some G7 nations continued to analyze data from robust and comprehensive health information systems linking antimicrobial use, laboratory and clinical information. Reports demonstrated the escalation of AMR and potential ramifications for routine hospital and treatment procedures if AMR was left unchecked. For many commentators, we face a real possibility of a world without antibiotics in less than 20 years, and hence a return to the “dark age” of medicine. The O’Neill review report, “Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations” (Dec 2014) was, together with the raging Ebola crisis, perhaps the tipping point. The review had been commissioned by the UK prime minister in July 2014, and the O’Neill review papers managed to take the worrying message on AMR to epidemiologists, capitalists, philantrocapitalists, sociologists and the Davos elite, by providing estimates of the enormous impact of unchecked AMR on the world’s mortality, GDP and economy. O’Neill’s key message: “Drug-resistant infections will cause 10 million deaths a year and cost up to $100 trillion a year by 2050”. Clearly, the kind of message Davos men and women can relate to (especially the second part). So a number of them woke up. O’Neill’s first review paper also showed that AMR would have a different impact in different parts of the world. Over 40% of the expected mortality impact (by 2050) would happen in Africa (with more than 4 million expected AMR related deaths a year in Africa only). Suffice to say, if Africa is not to be left behind again, African countries will need to cover a lot more ground to reverse the trend in the race against the smart superbugs. What is the picture so far on the continent? With the meager data available on Africa’s AMR situation, resistance has already been reported for organisms that cause malaria, AIDS, Tuberculosis, cholera, dysentery, typhoid, gonorrhea and pneumonia. AMR situational analyses by the Global Antibiotic Resistance Partnership (GARP) project in Uganda, Kenya, Tanzania, South Africa and Mozambique have found all five countries ill prepared to intervene to curtail AMR. The analyses have identified weaknesses in all known determinants of emergence of AMR. In addition to a lack of policy and frameworks to address AMR, many countries have weak medicines regulatory capacity, inadequate laboratory infrastructure for AMR testing and reporting and lack of reagents and consumables to reliably support AMR surveillance. In some countries, only AIDS, TB and malaria resistance is considered significant - there might be a link with donor priorities there, although the O’Neill report also indicated that “countries that already have high malaria, HIV or TB rates are likely to particularly suffer as resistance to current treatments increases”.

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The African Union has supported collaboration between and coordination of public health laboratories through the African Public Health Laboratories Network (APHLN) with a view to addressing the Global Health Security Agenda on AMR. On the policy front, a ReAct Africa Node (RAN) was established in 2014, following a meeting of African champions from 10 countries to discuss strategies and innovations to tackle AMR. ReACT fosters debate and collaboration among diverse stakeholders in countries and globally for action against AMR. It uses an innovative holistic approach including empowerment, engaging with and extending networks, translation of evidence into actionable policy for key stakeholders, …. It also has a web-based repository designed to function as a one-stop center for novices and experts on AMR. More recently, ReACT Europe supported the policy process in Ghana culminating in the launch of the country’s AMR Policy. The adoption of the Global Action plan on AMR at the 68th World Health Assembly earlier this year will mark a point in history when the tide turned against AMR. In preparation for this action plan, many African countries are starting near bottom on most if not all of the actionable items. Whereas AMR seems to suggest restriction of antibiotics in many parts of the world, for low and middle income countries the key tension is about guaranteeing access to essential antimicrobial products without fostering excessive use. In addition to a ‘One Health’ approach, a proper AMR response also provides just another imperative to strengthen health systems with mechanisms such as health insurance, de-linking revenue from sale of antibiotics to foster access to quality assured antimicrobials, diagnostics, preventive measures, and evidence-based management protocols for all in need. Approaches will need to be context-specific as some African countries have pluralistic health systems with government run health centres, and non-state players such as mission hospitals, community, private drug outlets, …. Using proven interventions such as WHO/UNICEF’s integrated community case management for childhood illness to address the lack of access to life saving diagnostics and medicines in remote areas is only one suggestion for the African battle against AMR. African countries could use South Africa’s antimicrobial resistance strategy framework as a benchmark. It focuses on three pillars (AMR surveillance, antimicrobial stewardship and infection prevention, control and vaccination) and embeds these in an already existing legal, regulatory and operational framework. It also recognizes that progress will be made against AMR only if these pillars are underpinned by strengthening health systems, educating the workforce and public, strong and functional high level governance as well as a rich and comprehensive legislative regime. It also notes the importance of operationalizing the strategy from setting national core standards to incorporating AMR into job descriptions, performance appraisals and continuing educational activities. Implementation should seek to build on the legal and regulatory framework present in most African countries and thus focus on enforcing the provisions better. The easy part will be identifying key people from animal husbandry, agriculture and human medicines to form National Taskforces on AMR. More energy will need to be spent on translating strategic actions into downstream AMR activities targeting each of the five objectives of the Global AMR Action Plan. If I were in charge, I’d start by strengthening the knowledge and evidence base though research and surveillance. Given that nations will be in the AMR fight for the long haul, creating and sustaining human and animal health databases for clinical information, antimicrobial use, laboratory tests, resistance development and spread, AMR surveillance, diffusion of diagnostics and other innovations against AMR could not be more urgent. Choice of future interventions and evaluation of progress on the other AMR objectives will depend on access to timely, relevant and good quality data. Even the pharma industry in the business of developing newer antibiotics will ask: how soon do you need the new antibiotic, for how many people and where? African governments

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should prove their sovereignty by investing in the clinical and health information databases of our time and contribute to saving the world at least USD 100 trillion by 2050. As well as millions of lives. In short, African countries have their AMR response work cut out !

Highlights of the week

COP 21 in Paris

For a general quick overview of some of the main events and news of the first week in Paris, have a look at UNFCCC newsroom or The Guardian’s section on COP 21. Daily coverage on COP21 you also find on E3G (“E3G provides daily insight into the negotiations and the political momentum that can set the direction for a low carbon economy and a safe climate”)

But before going into some of the detail on COP 21, let me first alert you to a truly terrific paper (from early October), that should inspire us all (in Paris and beyond):

Public Health – Beyond the era of Public Health: charting a path from

sanitarianism to ecological public health

T Lang et al; http://www.ncbi.nlm.nih.gov/pubmed/26427314

“The paper considers the long-term trajectory of public health and whether a 'Golden Era' in Public Health might be coming to an end. While successful elements of the 20th century policy approach need still to be applied in the developing world, two significant flaws are now apparent within its core thinking. It assumes that continuing economic growth will generate sufficient wealth to pay for the public health infrastructure and improvement needed in the 21st century when, in reality, externalised costs are spiralling. Secondly, there is evidence of growing mismatch between ecosystems and human progress. While 20th century development has undeniably improved public health, it has also undermined the capacity to maintain life on a sustainable basis and has generated other more negative health consequences. For these and other reasons a rethink about the role, purpose and direction of public health is needed. While health has to be at the heart of any viable notion of progress the dominant policy path offers new versions of the 'health follows wealth' position. The paper posits ecological public health as a radical project to reshape the conditions of existence. Both of these broad paths require different functions and purposes from their institutions, professions and politicians. The paper suggests that eco-systems pressures, including climate change, are already adding to pressure for a change of course.”

With that being said, over to the COP 21 action then.

Newsroom UNFCCC - Leaders Day at COP21 UN Climate Change Conference

http://newsroom.unfccc.int/unfccc-newsroom/leaders-day/

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A clear and short overview of ‘Leaders Day’ in Paris, with some of the bigwigs’ statements (Obama came up with a new version of ‘yes we can’ for the occasion), and an overview of the series of high-level events during the day to announce strong commitments and launch new initiatives to drive climate action forward further and faster. See also E3G on this Leaders’ Day: Political headlines from Heads at COP21.

Some of the announcements and new initiatives that caught most of the attention on this first day:

*Major powers pledge $20bn for green energy research

* Bill Gates launches multi-billion dollar clean energy fund ; (with also Zuckerberg, Jack Ma, Ratan

Tata, … on board)

* India unveils global solar alliance of 120 countries at Paris climate summit

The “politics” at COP 21

It’s only the first week, so a bit early to tell what’s going on in Paris in front of and behind the scenes.

First the possible political scenarios, as anticipated before the start of the meeting:

E3G (Liz Gallagher) - COP21 Political Scenarios

http://www.e3g.org/library/cop21-political-scenarios

“These scenarios do not attempt to take a crystal ball to the negotiations and predict the future, but they do aim to identify the political drivers and trends which have shaped negotiations ahead of Paris and how this could realistically play out in the agreement, and what this means for the strength of the outcome in Paris. Scenario 1: ‘Le Zombie’ – The least ambitious of the three, this scenario results in a tactical deal rather than an enduring regime. Details are agreed at the negotiator level, with the deal limited to the INDCs. The outcome lacks precision, is highly unstable and is at significant risk of collapse in the future. Scenario 2: ‘Comme ci, Comme ça’ – This scenario is more ambitious, thanks to effective French diplomacy and strategic guidance from key Western leaders. The deal includes guarantees on financial and adaptation support, and although elements remain vague the overall outcome is positively received given a collaborative atmosphere. The outcome needs nurturing to survive and is not enough to drive political momentum on climate action forward beyond Paris. Scenario 3: ‘Va Va Voom’ – Driven by leaders in both developed and developing countries, this scenario sees all major components of the deal outlined, with sufficient clarity to keep the world on track to 2°C. The deal provides clear strategic guidance, empowering future action and setting up 2020 for the next round of negotiations. The outcome cements a new enduring regime, driving climate change into the mainstream.

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Devex – Advice for negotiators at COP21: Get it done and let's get back to work

Simon Maxwell; https://www.devex.com/news/advice-for-negotiators-at-cop21-get-it-done-and-

let-s-get-back-to-work-87352

Maxwell lists four possible scenarios (for outcomes of COP 21), with two very unlikely (worst case & best case). (must-read)

We agree with him also that Paris has to be seen as a departure point, not an endpoint.

We’ll see how this all plays out.

Meanwhile:

(Guardian) vulnerable countries demand 1.5C warming limit.

“Countries most vulnerable to climate change have seized the political initiative at the start of the UN climate talks in Paris by challenging the US, China and Europe to raise their ambitions and set a long-term temperature goal of 1.5C rather than the 2C target. As more than 140 world leaders made short opening statements on Sunday, 44 countries that are members of the Alliance of Small Island States (Aosis), along with other vulnerable countries (i.e. countries from the Climate Vulnerable Forum), declared that the 2C goal being backed by all major blocs would seal the fate of hundreds of millions of people in countries like Bangladesh, the Philippines, Sudan and Vietnam.”

In related news, “Obama met with leaders of small island states at the OECD on Tuesday, pledging that they would be heard. He then took another swipe at those who believe the Paris talks can’t or won’t produce a working deal to stop the destruction of much of the habitable world. “I actually think we’re going to solve this thing,” the president said.” (that was the ‘Yes, we can’ bit)

(Guardian ) India pushes rich countries to boost their climate pledges at Paris.

“India has emerged as a pivotal player in the climate talks, championing developing country demands that the rich take the lead in cutting emissions and providing more money for poor countries.” See also Indian officials accuse OECD of exaggerating climate aid. (I’d assume that the Indian government also uses the term ‘carbon imperialism of the West’ quite a bit these days)

Australia acting as a 'broker' between blocs at Paris climate talks (Guardian)

On Thursday, China joined poor countries in pointing finger at wealthy states over emissions (Guardian): “With the Paris climate talks nearing critical juncture (i.e. on Friday), the Chinese chief negotiator called on rich countries to take responsibility for historical greenhouse gas emissions”. With only one full day of negotiations left before a final text is due to be released by the French presidency for politicians to work on next week, the gaps between rich and poor countries remain wide. But diplomats have been quick to say that all

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sides can be expected to compromise significantly by the end of next week, and it is not unusual for countries to be so far apart at this stage of the talks.”

Clearly, to be continued…

Health at COP 21

Meanwhile, how is ‘health’ doing at the climate negotiations?

WHO’s key messages for COP 21

http://who.int/globalchange/mediacentre/events/cop21-key-messages/en/

5 key messages: (1) Climate change is affecting health now, and will continue to do so; (2) Health protection is possible, and should be a priority for investment of climate adaptation funds; (3) Mitigating climate change can bring large and immediate benefits for health, and for the economy; (4) Healthcare provision is responsible for approximately 10 per cent of global GDP – and its size and contribution to climate change is growing; (5) A strong climate change agreement is a strong health agreement.

BMJ (news) – UN climate chief attacks billions spent on subsidising fossil fuels

http://www.bmj.com/content/351/bmj.h6511

“Health has moved upstage in climate talks in Paris this week as vulnerable countries, UN bodies, and civil society groups press for a more ambitious deal to reduce greenhouse gas emissions. As diplomats from 195 countries work to negotiate a final text ahead of the arrival of decision makers next week, negotiations have underlined the disastrous long term effects on health of a rise in global temperatures. The powerful Like Minded Developing Countries (LMDC) group, which includes China and India, has pressed for health to be included in two key areas of the final text. “We support a right to health,” said Gurdiaz Nijar, a spokesman for the group. The World Health Organization said, “A strong climate change agreement is a strong health agreement. It is essential to safeguard public health.” WHO has estimated that climate change will cause an additional 250 000 deaths each year between 2030 and 2050 from malaria, diarrhoea, heat stress, and undernutrition. Shifting patterns of disease, extreme weather events such as heatwaves and floods, and degradation of air quality, food and water supplies, and sanitation will be mainly responsible, it said. Christiana Figueres, executive secretary of the UN Framework Convention on Climate Change, attacked the billions of dollars spent each year on subsidising fossil fuels, which she said did little to help poor people. “The huge sums involved globally could be much better spent on healthcare,” she said. … Air pollution in urban areas has also risen up the conference agenda because of its much neglected effect on climate”.

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Vox – Why climate change is increasingly seen as an urgent health issue

J Belluz; http://www.vox.com/2015/6/22/8824579/lancet-commission-climate-change

Also worth reading. “The health community is increasingly trying to reframe climate change and other environmental problems as health issues.”

Other COP 21 related essential reads

Guardian - World's richest 10% produce half of global carbon emissions, says Oxfam

http://www.theguardian.com/environment/2015/dec/02/worlds-richest-10-produce-half-of-global-

carbon-emissions-says-oxfam

On Oxfam’s latest report. Piketty came up with similar figures this week in Vox.

Project Syndicate – From Good Intentions to Deep Decarbonization

J Sachs; http://www.project-syndicate.org/commentary/paris-climate-talks-deep-decarbonization-

by-jeffrey-d-sachs-et-al-2015-12

(must-read) “…The most important issue is whether countries will achieve their 2030 targets in a way that helps them to get to zero emissions by 2070 (full decarbonization). If they merely pursue measures aimed at reducing emissions in the short term, they risk locking their economies into high levels of emissions after 2030. The critical issue, in short, is not 2030, but what happens afterward. There are reasons to worry. There are two paths to 2030. We might call the first path “deep decarbonization,” meaning steps to 2030 that prepare the way for much deeper steps after that. The second path could be called the way of “low-hanging fruit” – easy ways to reduce emissions modestly, quickly, and at relatively low cost. The first path might offer little low-hanging fruit; indeed, the low-hanging fruit can become a distraction or worse.”

World AIDS day - December 1st

Plenty of relevant reads – and not just for the HIV/AIDS scholars among you. See also some coverage on the 18th Icasa conference (taking place in Harare, Zimbabwe), in the section ‘global health events of the week’.

The theme of this year’s World AIDS day was ‘The time to act is now’.

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WHO (statement) – Accelerate expansion of antiretroviral therapy to all people

living with HIV

http://www.who.int/mediacentre/news/statements/2015/antiretroviral-therapy-hiv/en/

On World AIDS Day WHO emphasized that expanding antiretroviral therapy to all people living with HIV is key to ending the AIDS epidemic within a generation.

Plos (Speaking of Medicine ) – More people, more time, better data – what we

need to ‘treat-all’ with HIV

Speaking of Medicine;

On World AIDS Day 2015, Helen Bygrave (MSF) discusses the implications of the recently announced WHO ‘treat-all’ policy. She explores whether we can get an idea of some of the key implementation issues by looking at previous experience with a treat-all approach (e.g. PMTCT B+ in Malawi).

UNAIDS (report) - On the Fast-Track to end AIDS by 2030: Focus on location and

population

http://www.unaids.org/en/resources/documents/2015/FocusLocationPopulation

Already released on 24 November (see also last week’s IHP issue for some coverage). “Within the pages of this World AIDS Day report, Focus on location and population, are more than 50 examples of how countries are getting on the Fast-Track. It shows how governments are working with community groups and international partners to scale up health and social services that put people at the centre and located where they can do more people more good.” You might want to read again the press release. Or in fancy visuals, for the occasion of World AIDS day: see http://www.unaids.org/wad2015/

Lancet (Editorial) –The death of AIDS—expected or exaggerated?

http://www.thelancet.com/pb/assets/raw/Lancet/pdfs/S0140673615011617.pdf

Some reflections by the Lancet on this UNAIDS report, “On the Fast-Track to end AIDS by 2030: Focus on location and population”, released on Nov 24: “…In repositioning the HIV/AIDS response within the Sustainable Development Goals framework, UNAIDS recognises the synergy between development and disease programmes. Implicit in the goal of ending the AIDS epidemic by 2030 along with specific targets, however, is the work that remains to control the spread of HIV and diminish AIDS deaths. Substantial challenges exist for key subpopulations such as women and adolescent girls, and transgender people, especially in settings where stigma and other obstacles prevail. This disease-specific approach to health intertwined with development merits both strong support and continued scrutiny.”

Meanwhile, the Global Fund also embraces UNAIDS’ Fast-Track approach.

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Mead Over, in a CGD blog, also reflected on the UNAIDS report, UNAIDS and African AIDS Programs Agree That Effective HIV Prevention Depends on Location, Location, Location. (zooming in UNAIDS’ new strategy, which is in line with the ‘AIDS transition’ strategy, he argues).

NEJM –Ending the HIV–AIDS Pandemic — Follow the Science

A Fauci et al; http://www.nejm.org/doi/full/10.1056/NEJMp1502020?query=featured_home

An update on the (scientific) state of affairs, in the fight against HIV/AIDS, with an overview of recent studies & trials. “…Taken together, these studies have shown definitively that the benefits of prompt initiation of ART — regardless of the CD4+ T-cell count — outweigh the risks, for both the infected person and uninfected sexual partners and that PrEP can be implemented in a way that is both acceptable to patients and safe and effective in blocking HIV transmission. With regard to ART initiation, three critical questions were asked and answered by a “trifecta” of large international randomized, controlled trials over the course of a decade. …” (SMART, HPTN 052, and START)

They conclude: “…Taken together, these studies provide an evidence-based blueprint for effective treatment and prevention of HIV infection and will serve as critical tools in the fight to end the HIV–AIDS pandemic. However, in order to realize that promise, the political will must be mobilized to match the scientific evidence and provide the financial and human resources necessary to dramatically scale up HIV testing and treatment around the world. The science has spoken. There can now be no excuse for inaction.”

WB – World AIDS Day: Four steps to achieve epidemic control

D Wilson et al; http://blogs.worldbank.org/health/world-aids-day-four-steps-achieve-epidemic-

control

Very nice “big picture” blog. “We can dare to envision an end to the coverage gap and control of the HIV epidemic if we can successfully do four things: (i) sustain international HIV financing; (ii) increase domestic HIV financing; (iii) improve efficiency; and (iv) harness innovation in science and technology.“

Lancet Global Health – AIDS and universal health coverage—stronger together

Kent Buse et al; http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(15)00273-

9/fulltext

Must-read. “…The Sustainable Development Goal (SDG) for health reflects a fundamental shift in political priorities, offering a major opportunity for the maturing global AIDS response. The SDGs emphasise more integrated and holistic approaches, recognise the burdens of an increasing number of health concerns—including progressive chronic diseases affecting people living with HIV—and demand more fair and sustainable ways of paying for health through universal health coverage (UHC). If approached strategically, the SDG agenda, including UHC, can significantly benefit people living with and affected by HIV. Both UHC and the AIDS response share common goals around equity, non-discrimination, dignity, and social justice. Therefore, we propose that both movements unite around a five-point agenda designed to deliver health, dignity, and wellbeing for all. …”

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One (report) –£8bn shortfall in tackling Aids threatens 'millions of lives', report

says

http://www.theguardian.com/global-development/2015/dec/01/world-aids-day-8bn-shortfall-

tackle-aids-threatens-millions-lives-report-says

But not all is well on the HIV/AIDS front. “In a report to mark World Aids Day on Tuesday, the group ONE says that “the notion of Aids as an urgent, pressing issue of global concern has faded from the news headlines and the hallways of governments”, risking the hard-won progress made over the past three decades. It says the critical tipping point in the fight against the disease – when the number of people newly added to antiretroviral (ARV) treatment exceeds the number of people newly infected with HIV – has yet to be reached. Last year, 1.9 million people were added to ARV treatment, but 2 million were newly infected. According to the report, global spending on the disease has levelled off. But if the trajectory of the epidemic is to be altered, the £13.2bn ($20bn) spent last year must rise to £21.2bn a year by 2020 at the latest. It stresses that the next five years could offer “a unique window” in which to tackle HIV and Aids. If the £8bn shortfall can be made up and investments and programmes significantly increased, it says, 8 million new infections could be prevented and the “curve of the disease” bent towards the end of the epidemic. But the report adds: “If service levels remain where they are, the epidemic will outpace response measures and, by 2030, threaten to undo the progress we’ve made.”

See also Tom Murphy on this report, on Humanosphere, “HIV/AIDS: Status quo ‘threatens to derail the progress,’ report says”.

Aids Alliance – Is AIDS getting out of control again?

http://www.aidsalliance.org/about/news/660-is-aids-getting-out-of-control-again

This week, Alvaro Bermejo steps down after 12 years in the role of Executive Director of the International HIV/AIDS Alliance. Before going he has issued a stark warning on the back of data released by UNAIDS in its 2015 World AIDS Day report. More in particular, he has raised concerns, in the context of the current UNAIDS-led push to ‘Fast Track’ the AIDS response by 2030, about the apparent flat-lining in the number of people who are becoming newly infected with HIV.

AFP – Adolescent deaths from AIDS tripled since 2000: UNICEF

http://news.yahoo.com/adolescent-deaths-aids-tripled-since-2000-unicef-002123104.html

“The number of adolescents dying from AIDS has tripled over the last 15 years, most of them having acquired the disease when they were infants, according to figures released Friday by UNICEF. AIDS is the number one cause of death among adolescents aged 10 to 19 in Africa and the second leading cause of death among adolescents globally, the United Nations children's agency said in its latest statistical update. "Among HIV-affected populations, adolescents are the only group for which the mortality figures are not decreasing," the report says. "Most adolescents who die of AIDS-related illnesses acquired HIV when they were infants, 10 to 15 years ago, when fewer pregnant women and mothers living with HIV received antiretroviral medicines to prevent HIV transmission from mother to child." …” (see also Associated Press)

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Science Speaks - While “Time to Act is Now,” boundaries, barriers and

delineations that marginalize still stand between HIV service provision and need

A Barton; http://sciencespeaksblog.org/2015/12/02/while-time-to-act-is-now-boundaries-barriers-

and-delineations-that-marginalize-still-stand-between-hiv-services-provision-and-need/

“This year’s theme, ‘the time to act is now’ … refers both to the science that this year validated the value of speeding responses, and the UNAIDS call to put that science to use on a fast track in the next four years.”

… But this week of World AIDS Day also brought news from the field where the barriers still stand in the way of science. From Médecins Sans Frontières a new report, Empty Shelves, Come Back Tomorrow — ARV Stockouts Undermine Efforts to Fight HIV, describes the gaps in supply chains that disrupt lives, treatment and can fuel the spread of drug resistance in four countries that it notes represent many more. The report underscores the critical role of community involvement in program design that could then better reflect the realities of patients’ lives, and the impacts of treatment obstacles. This week also brought (more) bad news from Zimbabwe, where members of populations often referred to as “key” in fighting HIV globally including sex workers, sexual minorities and people who inject drugs, face a particularly hostile policy environment, and where activists attending the International Conference on AIDS and STIs in Africa reported trouble entering the country, harassment, and confiscation of their materials. Adding insult to injury, they reported, their existence — and issues — went unmentioned in UNAIDS leader Michel Sidibe’s conference address, although he has expressed support for those populations in less intimidating settings.”

Guardian – South Africa's Aids programme under threat as international funds

dry up

http://www.theguardian.com/global-development/2015/dec/01/south-africa-aids-programme-

under-threat-international-funds-dry-up

“The Treatment Action Campaign (TAC), which led the fight against Aids denial in South Africa and forced the government to create the world’s largest treatment programme, has been hit hard as donor countries have scaled back on grants to NGOs involved in HIV and Aids programmes. Even after making significant staffing cuts, it has yet to raise the R35m (£1.6m) it says it needs to meet its running costs for the next financial year.” … “… Stephen Lewis, a former UN special envoy for Aids in Africa, said the TAC still has a vital role to play in improving these statistics. On 20 November, his foundation promised to match fund donations to TAC up to a total of $1m.”

“…It is a bitter irony to recognise that on World Aids Day, 1 December, the premier organisation in the fight against HIV/Aids is in desperate financial straits,” said Lewis, who has previously described the TAC as the “spiritual leader” of HIV activism. “Without the TAC’s brilliant, principled, unswerving interventions, millions would have died, and millions would not now be in treatment. They took on a government in denial and forced it to completely reverse policy. If there’s any justice in this world, the international community of funders will fill the TAC’s coffers to overflowing.”

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New Yorker - Mark Zuckerberg and the Rise of Philanthrocapitalism

John Cassidy; http://www.newyorker.com/news/john-cassidy/mark-zuckerberg-and-the-rise-of-

philanthrocapitalism

Analysis of this week’s announcement by Mark Zuckerberg and his wife, Priscilla Chan (on the occasion of the birth or Max), that, during their lifetimes, they will donate to philanthropic causes roughly ninety-nine per cent of their Facebook stock, which is currently valued at close to forty-five billion dollars. The Chan Zuckerberg Initiative will be organized as a limited-liability corporation, rather than as a traditional charity, (and thus be more “flexible”). It will also focus on ‘curing disease’, apparently. Whether Zuckerberg will ‘disrupt’ philanthropy remains to be seen.

Some more interesting reads on the same topic (you should at least read a few of them):

Mark Zuckerberg and Priscilla Chan announce baby girl – and $45bn charity initiative (Guardian)

Using For-Profits to Funnel Big Sums to Charities Raises Transparency Concerns (The Chronicle of Philantropy)

Mark Zuckerberg Wants to Be the Next Bill Gates, but It Will Be Tougher Than He Thinks (Slate)

How Zuckerberg's LLC Could Be More Effective Than Charity (Huffington Post)

WHO –WHO’s first ever global estimates of foodborne diseases find children under 5 account for almost one third of deaths

http://www.who.int/mediacentre/news/releases/2015/foodborne-disease-estimates/en/

Almost one third (30%) of all deaths from foodborne diseases are in children under the age of 5 years, despite the fact that they make up only 9% of the global population. This is among the findings of the report, “WHO estimates of the global burden of foodborne diseases” – the most comprehensive report to date on the impact of contaminated food on health and wellbeing.

Check out also the accompanying Commentary, Why the world needs to do more to prevent global illness, disabilities and deaths from foodborne diseases (by Dr Kazuaki Miyagishima, Director of the WHO's Department of Food Safety and Zoonoses).

Plos – World Health Organization Global Estimates and Regional Comparisons of

the Burden of Foodborne Disease in 2010

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001923

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In this data synthesis, Martyn Kirk and colleagues estimate the global and regional disease burden of 22 foodborne bacterial, protozoal and viral diseases.

Times of India – Hepatitis C cure may cost as low as Rs 67k

http://timesofindia.indiatimes.com/home/science/Hepatitis-C-cure-may-cost-as-low-as-Rs-

67k/articleshow/49966218.cms

“In a move that comes as a huge relief to patients of chronic Hepatitis C, the apex committee of the Central Drugs Standard Control Organisation (CDSCO) has granted a waiver of local trials for crucial new direct-acting antiviral drugs treating the disease. The waiver for sofosbuvir and ledipasvir co-formulation and for daclatasvir is expected to bring the generic version of these drugs, which cost a fraction of the branded versions, into the Indian market within weeks.”

See also Digital Journal, India approves sale of generic Hepatitis C drugs. …” The generic drugs will help in treating millions of hepatitis C patients in developing countries, especially in Africa and South Asia.” … “The move is also expected to increase the flow of patients from the U.S. and Europe to India where insurers and governments have limited the use of these drugs to the sickest patients to control costs.” An interesting development indeed.

Guardian – Humanitarian response treats women's health ‘as an afterthought’, says the UN

http://www.theguardian.com/global-development/2015/dec/03/humanitarian-response-health-

family-planning-women-girls-afterthought-un-population-fund-report

In a new report, the UN population fund (UNFPA) says that in times of crisis, women and girls are left in a precarious situation with a lack of pregnancy, childbirth and family planning services. The UNFPA is calling on governments to scale up funding and action for sexual and reproductive healthcare, and honour international agreements – including the programme for action signed in Cairo in 1994 – that promised to uphold and deliver them at all times. (for some more coverage of the report, see also Thomson Reuters foundation ).

Lancet (Editorial) – Adolescent health: boys matter too

http://www.lancet.com/journals/lancet/article/PIIS0140-6736(15)01160-5/fulltext

“It has been a good year for adolescents. Many global health reports and initiatives now mention adolescents. So also does the latest UN Population Fund's State of the World Population 2015 report, released on Dec 3. Shelter from the Storm: a transformative agenda for women and girls in a crisis-prone world reminds us that there are 26 million women and adolescent girls in their childbearing years in need of humanitarian assistance worldwide. During the past 2 years or so, adolescents have

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been increasingly included in the women's and child health agenda.… In many cases, however, the emphasis is on adolescent girls, especially in discussions about contraception, sexual and reproductive health, child marriage, and education. … But to achieve adolescent health and wellbeing as a basis for sustainable development, economic prosperity, and stable peaceful societies, we need to also focus on adolescent boys for two main reasons. First, adolescent boys have a different risk profile to girls for both immediate health issues and causes of deaths, and for risk factors related to diseases, mortality, and disabilities later in life. Second, adolescent boys should be part of global health discussions about contraception, family planning, and sexual and reproductive health, as well as about the importance of education for both boys and girls. … 2016 will see even more emphasis on adolescent health and wellbeing—and rightly so. A forthcoming Lancet Commission will argue strongly for comprehensive attention to the health and wellbeing of adolescents and will report concrete recommendations. “

International Day of Persons with Disabilities – Dec 3

Some recommended articles & blogs related to this day:

Lancet (Comment) –Opening the GATE to inclusion for people with disabilities

C Khasnabis et al; http://www.lancet.com/journals/lancet/article/PIIS0140-6736(15)01093-4/fulltext

“For more than an estimated billion people with disabilities, assistive technologies are crucial mediators for realising people's rights, and for promoting access and empowerment—the theme of the International Day of Persons with Disability for this year (Dec 3, 2015). … With a longer-living global population, we now need to embrace the concept of assistive services in addition to promotive, preventive, curative, rehabilitative, and palliative services. WHO has responded to this challenge by establishing the Global Cooperation on Assistive Technology (GATE), seeking to remove barriers and to open the metaphorical gate to overcoming activity limitations, and facilitating inclusion and participation in society. … The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) identifies assistive technology as a human rights obligation of both States and international donors. “

Guardian – Poor people living with disabilities are counting on better data for

better lives

http://www.theguardian.com/global-development/2015/dec/03/international-day-persons-

disabilities-poor-people-disabilities-better-data-better-lives

“International Day of Persons with Disabilities should herald a data revolution, to ensure we hear the voices of the 1 billion people living with disabilities.”

World Bank Health (blog) – Shining a light on mental illness: An “invisible

disability”

P Marquez; http://blogs.worldbank.org/health/shining-light-mental-illness-invisible-disability

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(very nice blog) This year’s International Day of Disabled Persons, observed December 3, takes as its theme: “Inclusion matters: Access and Empowerment for People of all Abilities.” Under this umbrella, the U.N. and other international agencies urge inclusion of persons with “invisible disabilities” in society and in development efforts.

Oxfam (blog) – Four Years On, The World Has Changed on Disability

T Wainwright (CEO of ADD international); http://oxfamblogs.org/fp2p/four-years-on-the-world-has-

changed-on-disability/

Nice blog on the rise of disability on the global (development) agenda. “Four years ago I wrote a blog, expressing my concern about how I felt that mainstream development was largely overlooking a large and highly excluded group: persons with disabilities….. Writing today, on the International Day of Persons with Disabilities, I think that the world has moved on. The question now is not if persons with disabilities should be included in development – but how.”

Lancet - Offline: The (higher) responsibilities of science and medicine

Richard Horton; http://www.lancet.com/journals/lancet/article/PIIS0140-6736(15)01122-8/fulltext

“What are the duties of science and medical institutions in times of austerity? Their first responsibility is to protect and advance the interests of those they seek to represent. A fine example was on display last week after the announcement of the UK Government's Comprehensive Spending Review (CSR).” Horton is clearly disappointed about many scientists’ (rather narrow) view that ‘the UK government had listened to the scientific community’. He wasn’t all that surprised, as “medicine and science are full of denominations and sects, each understandably lobbying for themselves—but disappointing nevertheless. … First because the case made for science was done largely on economic grounds. Philip Greenish, Chief Executive of the Royal Academy of Engineering, noted that the UK science budget existed to “drive forward Industrial Strategy”.” … And second, “because of the narrowness of the argument made by some scientists and doctors”. They basically didn’t reflect on the overall shrinking of the state, which will have vast health implications on citizens.

Face it, Richard. Many scientists have sold their soul to the devil…

Global Fund (report) – Resilient and Sustainable Systems for Health

http://www.theglobalfund.org/en/healthsystems/

The Global Fund has identified the following priorities for supporting resilient and sustainable systems for health in the new strategy: (1) Support national health strategies and national strategic plans to control HIV, TB and malaria; (2) Focus on a person, not just a disease: support integrated service delivery; (3) Support specific aspects of a resilient health system central to the Global Fund’s

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mission and core competencies, such as procurement and supply chain management, quality assurance of programs through strong data management and human resources, and financial and risk management; (4) Capture and catalyse innovation from across all sectors to drive greater impact and value for money; (5) Promote and reinforce community responses and involve affected communities in national decision-making; (6) Support countries to leverage domestic and international financing for their systems for health; (7) Tailor investments to the unique stage a country is in along the development continuum, to its specific health system and to the unique constellation of partners in each nation.

Guardian – Enough of aid – let’s talk reparations

Jason Hickel; http://www.theguardian.com/global-development-professionals-

network/2015/nov/27/enough-of-aid-lets-talk-reparations

(yet another must-read from Jason Hickel) “In the mainstream narrative of international development peddled by institutions from the World Bank to the UK’s Department of International Development, the history of colonialism is routinely erased. According to the official story, developing countries are poor because of their own internal problems, while western countries are rich because they worked hard, and upheld the right values and policies. And because the west happens to be further ahead, its countries generously reach out across the chasm to give “aid” to the rest – just a little something to help them along. If colonialism is ever acknowledged, it’s to say that it was not a crime, but rather a benefit to the colonised – a leg up the development ladder. But the historical record tells a very different story, and that opens up difficult questions about another topic that Europeans prefer to avoid: reparations. …. The reparations debate is threatening because it completely upends the usual narrative of development. It suggests that poverty in the global south is not a natural phenomenon, but has been actively created. And it casts western countries in the role not of benefactors, but of plunderers. … This history makes the narrative of international development seem a bit absurd, and even outright false. Frankie Boyle got it right: “Even our charity is essentially patronising. Give a man a fish and he can eat for a day. Give him a fishing rod and he can feed himself. Alternatively, don’t poison the fishing waters, abduct his great-grandparents into slavery, then turn up 400 years later on your gap year talking a lot of shite about fish. …”

Global health events

18th International ICASA Conference on AIDS & STIs in Harare, Zimbabwe

As already mentioned above, this week the 18th ICASA conference takes place in Zimbabwe. It ends today (December 4).

As mentioned on the ICASA site, “The conference theme “AIDS in Post 2015 Era: Linking Leadership, Science & Human Rights” engages the whole continent and all stakeholders in the post MDG framework, where sustainability of the response in reaching 90, 90, 90 of UNAIDS will not be

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possible if Human rights are not a key priority for a new vision of leadership in the context of strengthening the application of science based evidence. The 18th ICASA is an opportunity to renew this global commitment by drawing the world’s attention to the fact that the legacy is now under threat as a result of the global economic downturn. This year’s ICASA is an opportunity for the international community, and all Africans, to join efforts in committing to achieving an AIDS-free Africa.” … Objectives of ICASA 2015 are: (1) Increase African leadership and ownership, as well as investment in financing to support the continental health response. (2) Strengthen the interaction between the public health, science and human right approaches in the control and elimination of the HIV/AIDS and associate diseases. (3) Improve awareness and learning on knowledge, skills, best practices from the response to AIDS and other emergent epidemics (EBOLA, HEPATITIS, SRAS and NCD’s); (4) Promote the development and scale up of evidence-based interventions for HIV/AIDS and associate diseases in the post 2015 era.”

UNAIDS – UNAIDS urges countries across Africa to Fast-Track their response to

HIV

http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2015/novemb

er/20151129_PR_ICASA

“At the opening of the ICASA conference (…), UNAIDS has urged countries to further accelerate their response to HIV. The biennial conference is taking place at a defining moment in the response to the epidemic. “Africa is on the brink of breaking the AIDS epidemic,” said UNAIDS Executive Director Michel Sidibé at the opening ceremony of the conference. “We have no time to lose. We have five years to Fast-Track the AIDS response so that the epidemic can’t rebound.”

MSF report –HIV: Antiretroviral drugs fail to consistently reach patients in

countries most affected by HIV/AIDS

MSF;

In Harare, “MSF warned that life-saving antiretroviral medicines (ARVs) are routinely not making their way to patients in sub-Saharan Africa - most often despite sufficient stocks already being present in countries - and called for urgent improvements in ARV supply chains in the region. A new MSF report, “Empty Shelves, Come Back Tomorrow – ARV Stock Outs Undermine Efforts to Fight HIV” is based on surveys conducted in South Africa, Mozambique, Malawi and the Democratic Republic of Congo (DRC). It shows that most stock outs are due to the inability of ARV supply chains to ensure last mile delivery: the necessary medicines are available in country but do not reach peripheral clinics because of cumbersome procedures, logistical challenges or lack of resources.”

WHO - Global health sector response to HIV, 2000-2015: focus on innovations in

Africa - Progress report

http://www.who.int/hiv/pub/progressreports/2015-progress-report/en/

“This report reviews the bold achievements and challenges of the health sector response to HIV over the past 15 years and the extraordinary gains that have been achieved around the world, especially in the African Region. It highlights how the public health approach has been applied and how innovations have been used to maximize its impact. It shows how mobilizing political commitment,

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involving communities, building partnerships and sustaining solidarity have enabled countries to overcome odds that seemed insurmountable. The next 15 years will be equally daunting – yet countries today can build on the successes, lessons and innovations achieved in each region, to face the immense challenges ahead.” (See WHO Afro for some coverage of this report.)

WHO Global Coordination Mechanism on the Prevention and Control of NCDs - Dialogue on how to strengthen international cooperation on the prevention and control of NCDs within the framework of North–South, South–South and triangular cooperation (meeting in Geneva, 30 Nov-1 Dec)

http://www.who.int/global-coordination-mechanism/dialogues/dialogue-international-

partnership/en/

“The Dialogue on how to strengthen international cooperation on the prevention and control of noncommunicable diseases within the framework of North–South, South–South and triangular cooperation (was) the first global meeting convened by the WHO on NCDs following” (the launch of the SDG agenda in NY). “The Dialogue will provide an opportunity to explore how to countries can fulfil their NCD commitments in the context of the SDGs 2015-2030, which includes a global target to, by 2030, reduce by one third premature mortality from NCDs. In addition, the Dialogue will build on the acknowledgement from world leaders that NCDs constitute one of the major challenges for development in the 21st century, that NCDs worsen poverty, while poverty contributes to rising rates of NCDs, making NCDs a contributing factor to poverty and hunger.”

For the Scope and Purpose of this meeting in Geneva, see Scope and purpose: Dialogue to strengthen international cooperation on NCDs

Check out also the (very interesting) background documents, especially: Rethinking international cooperation for the prevention and control of NCDs (by Andrew Cassels, for the WHO GCM/NCD Secretariat) (must-read!!!)

Last but not least, do read about the general – rather “business-friendly” - atmosphere at the meeting:

Baby milk action –Global Coordinating Mechanism blatantly pushes PPPs

http://www.babymilkaction.org/archives/7795

Must-read! (Pretty scathing, actually.)

PS: “Next week Member States will have another attempt to resolve their differences on the Framework of Engagement with Non State Actors (FENSA) – a confused and contradictory document that is riddled with fundamental problems.” ( “…Up until now, the FENSA discussions have mixed up conflicts of interest with conflicting interests – with the underlying message that that more “engagement” with non-State actors will be beneficial as long as the

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‘engagement rules’ are accepted. IBFAN is calling for a complete reopening of the document to fix its many fundamental problems.”)

Along the same lines, read also Mariska Meurs (Policy Researcher Global Health at Wemos)’ intervention: (below you find the second part of her intervention)

'Secondly, I’m getting very tired of the way in which concerns on private sector influence on policy making and Conflicts of Interest are being responded to in this room. Several CSOs have expressed concerns about the absence of a proper governance mechanism for the GCMNCD and the absence of a WHO policy on Conflicts of Interest and a good Framework for Engagement with non-state actors. In response to that, we are hearing that the private sector has an important role to play; that times have changed; that 60% of people work in the private sector. Nobody is denying that, and being concerned is not the same as being either naïve, afraid or paranoid! I think many here agree that the private sector is important, that is a place where many innovations take place. They are an important source of tax income (that is if they aren’t evading taxes) and they are an important employer. However, all of this does not acquit WHO and member states of the task to formulate a proper policy on conflicts of interest, acknowledging the risks involved, where Conflicts of Interest should be avoided and when and how they should be properly managed.'”

Richard Horton also tweeted quite a lot from the meeting. Among others, he gave 8 lessons from GAVI(‘s successful 7.5 billion replenishment) for NCD (financing). They’re certainly valid lessons. I’d add two: (1) tell the donors that all NCDs only harm little cute babies and children; (2) find a way to frame NCDs as ‘global health security’.

Richard also tweeted this week, “If anyone else uses the word "innovation", I will scream: the most overused and meaningless word in global health.” (I think “innovation” has some stiff competition from “fit for purpose”, actually, especially with all these WHO criticisms being floated). (Tu Quoque, Peter Piot …)

46th Union World Conference on Lung Health – Cape Town (2-6 Dec)

MSF –Report: Out of Step 2015

http://www.msfaccess.org/content/report-out-step-2015

“The 2015 Out of Step report presents the results of a survey of 24 countries conducted by Stop TB Partnership and MSF. Building on the first edition of Out of Step published in 2014, this year’s survey tracked of the latest TB policies, guidelines and tools across five areas: diagnosis and drug resistance testing; drug-sensitive TB (DS-TB) treatment regimens; MDR-TB treatment regimens; models of care; and regulatory frameworks. The results of this survey provide a snapshot of the world’s readiness to defeat the TB epidemic. Although effectively implemented policies and guidelines alone will not be sufficient, they form the foundation for a strong and comprehensive TB response that leaves no one with TB behind.”

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Speaking of Medicine – Step Up to Stop TB

http://blogs.plos.org/speakingofmedicine/2015/12/02/step-up-to-stop-tb/

Grania Brigden discusses the findings of the Out of Step report into national TB policies. The report was launched on December 2 at the 46th Union World Conference on Lung Health, Cape Town, South Africa. “Out of Step shows policy gaps in diagnosis and treatment of all forms of TB, models of care, and the drug regulatory environment. More positively, it also reveals where countries have updated their policies to reflect current best practice.” (see also Science Speaks : “Global and national leaders met this week at the Union World Conference on Lung Health in Cape Town to endorse the Stop TB Partnership’s new plan to end the tuberculosis epidemic by 2035. The plan calls for diagnosing and treating at least 90 percent of all people infected with tuberculosis, including 90 percent of people infected with TB from key populations, and ensuring at least 90 percent of people successfully complete treatment. Health ministers, technical partners and parliamentarians representing, among other countries, the United Kingdom, France, India, Pakistan, and Vietnam, agreed that an immediate and large increase in investments is needed to eliminate tuberculosis as a public health threat. …”

In related news, on Monday, the Treatment Action Group (TAG), an independent think tank, said funding for tuberculosis research fell $1.3 billion short of global targets last year, threatening worldwide goals to eliminate the disease between 2030 and 2035. The $674 million of total funding in 2014 amounted to just a third of the $2 billion experts say is needed per year for research and development to rid the world of TB. (see Reuters )

WHO – World's first child-friendly TB medicines in correct doses

http://www.who.int/tb/features_archive/FDC_formulation_launch/en/

WHO joined the TB Alliance and partners today (i.e. 2 December, in Cape Town) to announce the availability of child-friendly tuberculosis (TB) medicines in the correct doses.

P4P Workshop in Dar Es Salaam, Tanzania

Resyst – 10 things I learned (or learned more) about pay-for-performance

Kara Hanson; http://resyst.lshtm.ac.uk/news-and-blogs/10-things-i-learned-or-learned-more-about-

pay-performance

« Last week RESYST, together with the Ifakara Health Institute, CMI and the Institute of Tropical Medicine in Antwerp, co-hosted a workshop to bring together programme managers, policymakers and researchers to explore the health system effects of pay for performance (P4P) schemes. P4P, in which health workers or facilities are paid incentives for providing specific services, is being introduced in many countries, however, evidence of their impact (both positive and negative) is weak. Over three days, 103 participants discussed and debated a range of country experiences with P4P, for a frank and transparent conversation that (I felt at least), would not have been possible a

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few years ago when the debate about P4P was more polarized and ideological. Here I set out the 10 things I learned (or learned more) about P4P. » Kara goes on to list these 4 (interesting) lessons.

The P4P workshop in Dar Es Salaam was co-organized by the PBF CoP.

1st Technical Consultation of the ‘Healthy Systems – Healthy Lives’ Initiative, 18 November 2015 - Seeking a common ground on health systems

http://health.bmz.de/what_we_do/hss/Publications/Seeking_a_common_ground_on_health_syste

ms/index.html?pk_campaign=23_2015

After its launch at the UN summit in New York, stakeholders of the ‘Healthy Systems – Healthy Lives’ Initiative convened in Geneva. This first technical consultation helped to identify roles and next steps and to gain a common understanding of key concepts.

Kyoto (health ministers) meeting

Global Health diplomacy at work. “Health ministers from South Korea, Japan and China agreed to jointly tackle future Middle East Respiratory Syndrome (MERS) outbreaks and new diseases that pose common problems for the Northeast Asian countries, the government said Sunday.” Includes public health issues ranging from rapidly aging populations to NCDs and UHC.

Global governance of health

IJHPM – The Ghost Is the Machine: How Can We Visibilize the Unseen Norms and Power of Global Health?; Comment on “Navigating Between Stealth Advocacy and Unconscious Dogmatism: The Challenge of Researching the Norms, Politics and Power of Global Health”

Lisa Forman; http://www.ijhpm.com/article_3136_0.html

“In his recent commentary, Gorik Ooms argues that “denying that researchers, like all humans, have personal opinions … drives researchers’ personal opinion underground, turning global health science into unconscious dogmatism or stealth advocacy, avoiding the crucial debate about the politics and underlying normative premises of global health.” These ‘unconscious’ dimensions of global health are as Ooms and others suggest, rooted in its unacknowledged normative, political and power aspects. But why would these aspects be either unconscious or unacknowledged? In this commentary, I argue that the ‘unconscious’ and ‘unacknowledged’ nature of the norms, politics and power that drive global health is a direct byproduct of the processes through which power

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operates, and a primary mechanism by which power sustains and reinforces itself. To identify what is unconscious and unacknowledged requires more than broadening the disciplinary base of global health research to those social sciences with deep traditions of thought in the domains of power, politics and norms, albeit that doing so is a fundamental first step. I argue that it also requires individual and institutional commitments to adopt reflexive, humble and above all else, equitable practices within global health research.”

WHO Bulletin (Editorial) – Learning from Ebola Learning from Ebola: readiness for outbreaks and emergencies

Margaret Chan; http://www.who.int/bulletin/volumes/93/12/en/

From the new Bulletin December issue. Check out also a WHO Bulletin (news) article: “WHO steps up its role in health emergencies”: “The World Health Organization is on the brink of a major transformation into an agency that is fully mandated and equipped to respond to outbreaks and humanitarian emergencies. David Nabarro talks to Fiona Fleck.”

Speaking of David: Ban Ki Moon announced the appointment of David Nabarro (UK) as Special Adviser on the 2030 Agenda for Sustainable Development. The Special Adviser will work with Member States and other relevant stakeholders to galvanise action on implementation of the Agenda. He will also also oversee the Secretary-General’s special initiatives, eg Every Woman Every Child.

Plos (Policy Forum) – The Ebola Vaccine, Iatrogenic Injuries, and Legal Liability

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001911

Amir Attaran and Kumanan Wilson propose a compensation system for vaccine injuries, based on no-fault principles, to ensure that recipients of Ebola vaccines are fairly compensated in cases of iatrogenic harm.

IP-watch - Ebola Vaccine Team Welcomes New UK R&D Financing, Expects Governments To Join In

http://www.ip-watch.org/2015/12/01/ebola-vaccine-team-welcomes-new-uk-rd-financing-expects-

governments-to-join/

(must-read) “Having led the successful collaborative testing of an Ebola-vaccine in record time, John-Arne Røttingen of the Norwegian Institute of Public Health now wants to expand the idea to a

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permanent global financing facility for research and development. And he is optimistic. “Something will happen by the summer of 2016,” Røttingen told Intellectual Property Watch. … Røttingen, who is executive director of Infection Control and Environmental Health, hopes the issue will be discussed by world leaders at Davos (World Economic Forum Annual Meeting) in January 2016. Talks are underway among different actors.”

WHO – Five points WHO would like to see reflected at the World Humanitarian Summit

http://www.who.int/hac/events/worldhumanitariansummit/en/

On a different note, “In May 2016, the global community will converge on Istanbul, Turkey, for the World Humanitarian Summit – the culmination of a worldwide consultation process involving eight regions and more than 23 000 contributing parties. … As part of the consultation process, the World Health Organization has submitted a position paper (July 2015) arguing for the centrality of health in humanitarian action. Here are the five key messages from the document: 1. The health and well-being of affected populations is the ultimate goal of humanitarian action; 2. The risks to health posed by humanitarian emergencies are at all-time highs – and worsening; 3. Protracted conflict situations are among the greatest threats to health and health workers globally; 4. Crises caused by disease outbreaks require the health and humanitarian communities to work together; 5. Managing health risks is essential: preparedness pays at all levels – country regional and global.”

Project Syndicate – Antimicrobial Resistance on the Global Agenda

Jim O’Neill; http://www.project-syndicate.org/commentary/antimicrobial-resistance-countries-

taking-action-by-jim-o-neill-2015-12

“November marked a setback in the fight against drug-resistant infections. … But November also brought some good news – even if it received less notice. When the G-20 met in Antalya, the leaders of the world’s largest economies agreed that antimicrobial resistance was a threat to global

growth. Buried in the last paragraph of the communiqué issued at the conclusion of the summit was an agreement to put the issue on the agenda of the organization’s next meeting. … This is an important development. The G-20 would be an ideal forum in which to take international action against antimicrobial resistance. “ “… The commitment by the G-20 is just one example of the momentum gathering around the issue … ….” … “…In October, the UK and China agreed to establish a global research and development fund, with the aim of attracting £1 billion ($1.5 billion) in investment in research to reduce the spread of antimicrobial resistance.”

In WHO Bulletin (December issue), the (must-read) article by S Hoffman et al is now published, Strategies for achieving global collective action on antimicrobial resistance. (was already online for a while)

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International Health - Innovative financing for late-stage global health research and development: the Global Health Investment Fund

J R Fitchett, R Atun et al;

http://inthealth.oxfordjournals.org/content/early/2015/11/25/inthealth.ihv067.short?rss=1

« Innovative financing strategies for global health are urgently needed to reinvigorate investment and new tools for impact. Bottleneck areas along the research and development (R&D) pipeline require particular attention, such as the transitions from preclinical discovery to clinical study, and product development to implementation and delivery. Successful organizations mobilizing and disbursing resources through innovating financing mechanisms include UNITAID, the Global Fund, and Gavi, the Vaccine Alliance. Although precise numbers are poorly documented, estimated investment in low-income settings falls seriously short of local need. This commentary discusses the newly established Global Health Investment Fund as a case study to support late-stage global health R&D. »

International Health – Perspective and investments in health system strengthening of Gavi, the Vaccine Alliance: a content analysis of health system strengthening-specific funding

F-J Tsai, V Fan et al ;

http://inthealth.oxfordjournals.org/content/early/2015/11/25/inthealth.ihv063.full

This paper aimed to compare the health systems strengthening (HSS) framework of Gavi and WHO and to analyze resource allocation in HSS by Gavi.

BMC Public Health – Charting the evolution of approaches employed by the Global Alliance for Vaccines and Immunizations (GAVI) to address inequities in access to immunization: a systematic qualitative review of GAVI policies, strategies and resource allocation mechanisms through an equity lens (1999–2014)

G Gandhi; http://www.biomedcentral.com/1471-2458/15/1198

GAVI’s focus on reducing inequities in access to vaccines, immunization, and GAVI funds, − both between and within countries - has changed over time. This paper charts that evolution.

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KFF - Donor Funding for Health in Low- & Middle-Income Countries, 2002-2013

http://kff.org/global-health-policy/report/donor-funding-for-health-in-low-middle-income-

countries-2002-2013/

This analysis presents trends in donor funding for health in low- and middle-income countries between 2002 and 2013. Among the findings: funding during the period increased more than five-fold, rising from $4.4 billion to $22.8 billion.

UHC

Health Financing in Africa – Where are we with the ‘How would you draw UHC’ contest?

http://www.healthfinancingafrica.org/home/where-are-we-with-the-how-would-you-draw-uhc-

cartoon-contest

“Three months ago, we launched a contest for cartoon ideas linking UHC and Learning Systems. The contest, part of the second phase of our collaborative research project on UHC, took place from August 24 to October 1, 2015. Yamba Kafando, who oversaw the contest, updates us on the process so far and next steps.” Coming soon: the cartoons!

UHC & Twitter

http://www.symplur.com/healthcare-

hashtags/UHC/analytics/?hashtag=UHC&fdate=10/02/2014&shour=00&smin=00&tdate=11/28/201

5&thour=08&tmin=00

Check out the key UHC influencers on Twitter.

Simon Wright (blog) – Prevention is better than cure

http://blogs.savethechildren.org.uk/2015/11/prevention-is-better-than-cure/

Simon Wright (Save the Children) attended last week’s launch of the Ebola global response report in London. He has some interesting observations.

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“The panel’s report is very comprehensive and its recommendations for better warning systems and a more coordinated global response to future outbreaks of infectious diseases are really important. My concern is that it didn’t say anything about the way that allowing weak, fragmented, underfunded and understaffed health services in countries meant they could not cope with an outbreak. I was hoping that the panel would include a recommendation to build Universal Health Coverage (UHC). Peter Piot, Chair of the panel, did agree with this when I put the question to him, although another audience member said, unhelpfully, that building health systems was like “trying to boil the sea”. … Next year, Japan is the Chair of the G7 and has decided that it will make Universal Health Coverage one of its main topics. This is very exciting but there are lots of questions about what the G7 should actually do. Germany this year started off a “Roadmap” for health systems strengthening. We’re hearing that Japan is particularly interested in how the global community responds to outbreaks. If UHC is only seen as responding to infectious disease outbreaks, then we are missing the chance to help build decent quality everyday health services for their own sake, as well as to be better able to cope with crises….”

In the rest of the blog, Simon pondered the resurrection of the Health Systems Funding Platform.

CGD (report) – Better Hospitals, Better Health Systems, Better Health – A Proposal for a Global Hospital Collaborative for Emerging Economies

Hospitals for Health Working group; http://www.cgdev.org/publication/better-hospitals-better-health-systems-better-health-working-group-report

Read also the accompanying blog (by Maureen Lewis): “Hospitals Are Key to Reaching Universal Health Coverage”.

Planetary health

Obviously, the main planetary health related action is taking place in Paris, this week and the next (but see ‘Highlights of the week’ for info on that).

Oxfam (blog) - Why Degrowth has out-grown its own name

Kate Raworth; https://oxfamblogs.org/fp2p/why-degrowth-has-out-grown-its-own-name-guest-

post-by-kate-raworth/#.Vl1jYvfaucg.twitter

Very interesting post. Kate thinks the degrowth movement is addressing the most profound economic questions of our day and believes that economies geared to pursue unending GDP growth will undermine the planetary life-support systems on which we fundamentally depend. That is why we need to transform the growth-addicted design of government, business and finance at the heart of our economies. From this standpoint, she shares much of the degrowth movement’s analysis, and

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backs its core policy recommendations. But she has a problem with the term ‘de-growth’ and gives 5 reasons why.

Read also the reaction to her post, by Giorgos Kallis, the world’s leading academic on de-growth. You’re wrong Kate. Degrowth is a compelling word. Kallis lists nine reasons why he uses the term.

Annals of Global Health – Climate Change and Health Inequities: A Framework for Action

L Rudolph et al; http://www.annalsofglobalhealth.org/article/S2214-9996%2815%2901206-0/pdf

The authors’ framework is intended as an action framework for public health practitioners. They sought to “develop a conceptual model to achieve the following: 1. Demonstrate the complex relationships between climate change and health inequities; 2. Explicitly build on prevalent public health practice models that address health inequities; 3. Delineate the many opportunities for interventions to promote health and equity, prevent catastrophic climate change, increase climate resilience, and protect people and communities from the inevitable effects of climate change; and 4. Highlight the importance of collaborative action to address the institutions, social relations, and systems that simultaneously drive both climate change and health inequities.”

And in a new blog post, Judith Rodin (Rockefeller foundation) believes the global health framework will shift to include the natural systems on which human health depends (as one of seven potentially game-changing trends she believes will be the next frontier of climate resilience).

Infectious diseases & NTDs

G-Finder (report ) - New funding for Ebola hides an ongoing decline

http://www.eurekalert.org/pub_releases/2015-12/p-gh-nff113015.php

“A new report gives the first ever picture of global investment in Ebola research and development (R&D), reporting that this investment might have come at the expense of efforts to develop drugs, vaccines and diagnostics for other neglected diseases, which collectively cause more than six million deaths every year in developing countries. The eighth annual G-FINDER report, released today, found that $3.4bn was invested in neglected disease R&D in 2014. It also found that new funding for Ebola R&D mobilised in response to the 2014 West African Ebola outbreak was entirely responsible for the $150m increase in neglected disease R&D funding in 2014, with funding for all other neglected diseases essentially unchanged (down $14m, or 0.4%). … The report also noted that when Ebola is excluded, public funding for neglected disease R&D was actually at its lowest level in seven years, with public funding for non-Ebola R&D dropping by $62m in 2014. As the world's biggest funder of neglected disease R&D, much of this decline has been driven by the US Government.

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WHO Bulletin (Policy & Practice) –Rapid diagnostic tests for malaria

T Visser et al; http://www.who.int/bulletin/volumes/93/12/14-151167-ab/en/

« Maintaining quality, competitiveness and innovation in global health technology is a constant challenge for manufacturers, while affordability, access and equity are challenges for governments and international agencies. In this paper we discuss these issues with reference to rapid diagnostic tests for malaria. Strategies to control and eliminate malaria depend on early and accurate diagnosis. Rapid diagnostic tests for malaria require little training and equipment and can be performed by non-specialists in remote settings. Use of these tests has expanded significantly over the last few years, following recommendations to test all suspected malaria cases before treatment and the implementation of an evaluation programme to assess the performance of the malaria rapid diagnostic tests. Despite these gains, challenges exist that, if not addressed, could jeopardize the progress made to date. We discuss recent developments in rapid diagnostic tests for malaria, highlight some of the challenges and provide suggestions to address them. »

Infection control today – With Climate Change, Malaria Risk in Africa Shifts, Grows

http://www.infectioncontroltoday.com/news/2015/12/with-climate-change-malaria-risk-in-africa-shifts-grows.aspx

“A larger portion of Africa is currently at high risk for malaria transmission than previously predicted, according to a new University of Florida mapping study. Under future climate regimes, the area where the disease can be transmitted most easily will shrink, but the total transmission zone will expand and move into new territory, according to the study, which appears in the current issue of the journal Vector-Borne and Zoonotic Diseases. By 2080, the study shows, the year-round, highest-risk transmission zone will move from coastal West Africa, east to the Albertine Rift, between the Democratic Republic of Congo and Uganda. The area suitable for seasonal, lower-risk transmission will shift north into coastal sub-Saharan Africa. Most striking, some parts of Africa will become too hot for malaria.”

UNAIDS – UNAIDS unveils global initiative to scale up HIV testing among young people

http://www.unaids.org/en/resources/presscentre/featurestories/2015/november/20151128_Gabo

n_protestHIV

“ProTest HIV, a global initiative that encourages young people to get tested for HIV, was launched by UNAIDS Executive Director Michel Sidibé in Libreville, Gabon, on 28 November. At the event, Mr Sidibé called on young people worldwide to join the movement and get involved in ending the AIDS epidemic.”

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Some other HIV/AIDS related news bits:

(Guardian) Mobile dating apps spur HIV epidemic among Asia’s teenagers, says UN

(Guardian) Asia's Aids epidemic needs urgent action to prevent even more deaths

(Guardian) Shuga: the taboo-breaking African TV show confronting unsafe sex and HIV

WHO – Statement on the Seventh IHR Emergency Committee meeting regarding the international spread of poliovirus

http://www.who.int/mediacentre/news/statements/2015/ihr-ec-poliovirus/en/

Statement on the teleconference meeting, convened by the Director-General on 10 November 2015.

The Atlantic - Measles Outbreaks Are a Sign of Bigger Problems

Seth Berkley; http://www.theatlantic.com/health/archive/2015/12/measles-elimination-

vaccine/418155/

“This year was supposed to mark the point when measles—one of the most infectious diseases on the planet—was finally under control. As a step in its plan to eliminate measles worldwide by 2020, the World Health Organization set a target to reduce the number of cases by 95 percent between 2000 and 2015. The effect has been significant: Measles deaths have fallen from more than 700,000 in 2000 to around 115,000 last year. But for a disease that's easily preventable, 115,000 deaths—the majority of them children under 5 years old—is still too high. And as the WHO reported in November, progress has flat-lined over the past five years, and outbreaks are still common. What, exactly, went wrong?” …. “However, all of these seemingly disparate cases—and all other measles outbreaks, for that matter—still have a common underlying cause. Whenever measles strikes, it’s more than just an outbreak of a single disease, or an indication that children aren’t receiving their measles shots; it’s also a warning that immunization coverage in general, for all vaccine-preventable diseases, is lower than it should be. To put it another way: When rates of routine vaccination—children receiving all their shots on schedule, as a preventive measure rather than a reaction to an outbreak—start to fall, the first sign is usually a measles outbreak. In global-health security terms, these outbreaks are the proverbial canaries in the coal mine.”

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WHO (Infographic)– Timeline Major infectious threats in the 21st Century & collaboration mechanisms to fight against them

http://www.who.int/csr/disease/anticipating_epidemics/INFOGRAPHIC_WER_timeline_EN.pdf?ua=

1

Very nice visualization.

Lancet (World Report) –Ethiopia could be a model country for tuberculosis control

http://www.lancet.com/journals/lancet/article/PIIS0140-6736(15)01164-2/fulltext

Ethiopia's political commitment, along with an army of thousands of health extension workers, is helping it to successfully tackle tuberculosis. Talha Burki reports from the capital, Addis Ababa.

Lancet (Letter) –Treating snake bites—a call for partnership

L Rago et al ; http://www.lancet.com/journals/lancet/article/PIIS0140-6736(15)01103-4/fulltext

“We welcome the Editorial (Sept 19, p 1110) that highlights the devastating effect of snake bites on health and the fact that Africa could soon be deprived of access to one of the most effective snake bite treatments. Likewise, we appreciate the initiative taken by the Wellcome Trust in organising an event (Sept 22–23, 2015) that brought together key players to identify mechanisms to “reverse the public health neglect of tropical snakebite victims”. But we do not agree with the Editors that snake bites are “largely invisible to WHO”. … “ The authors point to the antivenoms related activities at WHO (and further plans). And they’re ready to partner with interested institutions.

NCDs

BMJ (news) - Tobacco marketing hits poor countries hardest

http://www.bmj.com/content/351/bmj.h6443

“People living in poor countries are exposed to more intense and aggressive tobacco marketing than those in affluent countries, a study has found. The study, published in the Bulletin of the World Health Organization, compared levels of tobacco marketing in 16 countries since 2005, when countries signed up to the WHO Framework Convention on Tobacco Control (WHO FCTC) that required them to adopt strict tobacco control measures, including marketing.”

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See also coverage in the Guardian, “Big tobacco targets the young in poor countries – with deadly consequence”.

And in other tobacco news, British American Tobacco was accused of bribing government officials from three African countries.

BMJ (blog) – Four reasons why we may not be responding in the right way to hypertension in LMICs

Richard Smith; BMJ blog;

Richard Smith reflects on this week’s Novartis Foundation London Dialogue on responding to hypertension in low and middle income countries, which was held this week.

The Lancet Diabetes & Endocrinology (Personal View)- The global diet is getting sweeter, particularly when it comes to beverages

B M Popkin et al; http://www.thelancet.com/journals/landia/article/PIIS2213-8587(15)00419-

2/abstract

“A Personal View, published (today) in The Lancet Diabetes & Endocrinology journal, highlights that the global diet is getting sweeter, particularly when it comes to beverages. After analysing nutritional datasets from around the world, the authors found that trends in sales of sugar-sweetened beverages around the world are increasing in terms of calories sold per person per day and volume sold per person per day. They say: “Consumption is rising fastest in low- and middle-income countries in Latin America, the Caribbean, Africa, the Middle East, Asia and Oceania. The four regions with the current highest consumption are Latin America, North America, Australasia and Western Europe, though intakes are beginning to decline in the latter three.” In the absence of intervention, the rest of the world will move towards a US-style pervasiveness of added sugars in the entire packaged food and beverage supply, with added sugars of all kinds increasing rapidly in the diets of people living in developing countries, while many high-income countries, despite being among the highest sugar consumers, are beginning to see a slight decline in sugar consumption.

While the latest data show that many countries consume high levels of sugar-sweetened beverages, and other countries with lower intakes are seeing steep increases, the authors did find that consumption seems to be decreasing in countries with taxes on such products (e.g., Mexico, Finland, Hungary and France). The authors conclude: “We have shown from trends data that consumption seems to be decreasing in countries with taxes on sugar-sweetened beverages (eg, Mexico, Finland, Hungary, and France). WHO, major scientific bodies, and most countries recognise the importance of reducing consumption of sugar-sweetened beverages to improve public health. The evaluation of not only sugar taxes, but also new marketing controls and front-of-pack labelling, is important and represents one of the next frontiers— namely, can these policies effectively reduce consumption of sugar-sweetened beverages and intake of total added sugars?”

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Sexual & Reproductive / maternal, neonatal & child health

Washington Post – Brazil links dengue-like virus to birth defects in babies

https://www.washingtonpost.com/world/the_americas/brazil-links-dengue-like-virus-to-birth-

defects-in-babies/2015/11/29/80a45ea2-96d4-11e5-aca6-1ae3be6f06d2_story.html

We had heard from Zumba before (although stayed far away from it), now we also know about Zika. Unfortunately, the latter is far less benign. “The dengue-like Zika virus has been linked for the first time to cases of babies being born with small heads, or microcephaly, Brazil’s government said.”

Thomson Reuters Foundation – Number of African child brides to soar by 2050 as population grows: U.N.

yahoo;

“The number of child brides in Africa will more than double by 2050 if current trends persist because of rapid population growth and limited social change, the United Nations children's fund (UNICEF) said last week. Africa will overtake South Asia as the region with the largest number of child brides, their number soaring to 310 million, more than 40 percent of the global total, in 2050, from 125 million, 25 percent of the total, today.”

JAMA – Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality

G Molina et al ; http://jama.jamanetwork.com/article.aspx?articleid=2473490

“Based on older analyses, the WHO recommends that cesarean delivery rates should not exceed 10 to 15 per 100 live births to optimize maternal and neonatal outcomes. Based on updated analyses (in this study) (examining nearly 23 million C-section deliveries worldwide in 2012), national cesarean delivery rates of up to approximately 19 per 100 live births were associated with lower maternal or neonatal mortality among WHO member states. Previously recommended national target rates for cesarean deliveries may be too low.”

For coverage, see the Washington Post: New study challenges decades-old guidelines on how many pregnant women should get C-sections.

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Access to medicines

TWN – WHO: Expert working group on SSFFC definitions established

K M Gopakumar; http://www.twn.my/title2/health.info/2015/hi151107.htm

“The World Health Organization’s work on substandard/spurious/falsely-labelled/falsified/counterfeit (SSFFC) medical products has taken a step forward. The WHO Member State Mechanism (MSM) established a working group on working definitions in a decision taken at its 4th meeting held on 19-20 November at the WHO Headquarters in Geneva.”

Human resources for health

WHO Bulletin –Providing health care in rural and remote areas: lessons from the international space station

A Papali; http://www.who.int/bulletin/online_first/BLT.15.162628.pdf?ua=1

Let’s face it. Who wouldn’t want to read this article?

Miscellaneous

NYT - Senate Confirms Gayle E. Smith as Head of U.S.A.I.D.

New York Times

At last, one may say, USAID has again a boss."The Senate on Monday voted to confirm Gayle E. Smith, a former national security aide to President Obama, to lead the United States Agency for International Development, the federal agency responsible for overseas humanitarian issues like feeding refugees, building clinics, and distributing foreign aid.” You wonder what took them so long.

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Alliance – Advancing the field of health systems research synthesis

http://www.who.int/alliance-hpsr/news/2015/hsrsynth/en/

“Ensuring high-quality information is available to inform policy-making remains a challenge in low- and middle-income countries (LMICs). Addressing this requires different strategies of generating, gathering and synthesizing health systems research (HSR). HSR synthesis – encompassing methods of gathering and synthesizing the results of multiple studies – is one such approach to informing policy-making aimed at improving health systems performance.” An overview of the Alliance’s plans in this respect in the next year.

Social innovation in health initiative

http://healthinnovationproject.org/

“The Social Innovation in Health Initiative is an international collaboration between the Bertha Centre for Social Innovation and Entrepreneurship at the University of Cape Town, the Skoll Centre for Social Entrepreneurship at Oxford University and TDR, the Special Programme for Research and Training in Tropical Diseases, hosted at the World Health Organization in Geneva.”

Simon Maxwell (blog) –The new UK aid strategy: comments and questions

http://www.simonmaxwell.eu/blog/the-new-uk-aid-strategy-comments-and-questions.html

Always worth reading.

Lancet (Editorial) –Nepal: man-made disaster looms

http://www.lancet.com/journals/lancet/article/PIIS0140-6736(15)01162-9/fulltext

The Lancet’s take on the situation at the Nepal border, India’s role in it, and implications for the health system in Nepal & global health security. We have a hunch it won’t be the last “man-made” disaster of Modi’s making…

See also a Lancet Letter (by J Lamichhane), Health consequences of the blockade in Nepal.

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Lancet Global Health (blog) – Human rights at the World Bank: inside out

C Simms; http://globalhealth.thelancet.com/2015/12/01/human-rights-world-bank-inside-

out?utm_source=hootsuite

“Few organisations know more about human rights, inequalities, and diversity than the World Bank; indeed, its website and e-library are replete with information on how each of these relate to the health and wellbeing of individuals and populations. Yet a recent report from the UN Special Rapporteur on Human Rights adds to claims that, internally and externally, the bank does not practise what it preaches and that it often seems incapable of learning from past failures.”

ODI (briefing paper) – A development agenda for China's G20 presidency

R Greenhill et al; http://www.odi.org/publications/10156-g20-presidency-china-development-

agenda

This briefing proposes a potential development agenda for the year ahead in the context of Chinese President Xi’s stated focus on improving global economic and financial governance, and promoting inclusive and interconnected development. That agenda should include: capitalising on China’s specific leadership value; economic transformation and global governance; financing sustainable development; infrastructure; climate change and fossil fuel subsidies.

Washington Post - When China gives aid to African governments, they become more violent

R Kishi et al; https://www.washingtonpost.com/news/monkey-cage/wp/2015/12/02/when-china-gives-aid-to-african-governments-they-become-more-violent/?wpmm=1&wpisrc=nl_cage

Based on a new study. As for the West, we tend to come in violently ourselves (and then we try to redeem ourselves with “aid”).

BD Live - India looks to improve African health

http://www.bdlive.co.za/opinion/2015/12/01/india-looks-to-improve-african-health

“At the recent India-Africa summit in Delhi, Prime Minister Narendra Modi met 54 African heads of state to discuss ways of deepening relationships, including working together to improve public health. For India, the main goal is to increase its lucrative pharmaceutical exports to Africa, which make up about 16% of total exported items including 85% of all antiretroviral drugs used to treat HIV. African ministers, meanwhile, are keen to copy India’s success in developing its drug

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manufacturing industry, both to secure their own medicine supplies and to give their economies a fillip.”

Health Research Policy & Systems - Mobilising the alumni of a Master of Public Health degree to build research and development capacity in low- and middle-income settings: The Peoples-uni

R F Heller et al; http://www.health-policy-systems.com/content/13/1/71

Peoples-uni (People’s Open Access Education Initiative) was established to help build Public Health capacity in low- and middle-income countries (LMICs) through postgraduate level online courses. Graduates are invited to join a virtual alumni group. The authors report the results of efforts to meet the need for health research capacity building by exploring how the course alumni could be mobilised to perform collaborative research into the health problems of their populations.

Emerging Voices

IHP – Pope Francis’ recent visit to Uganda and Kenya: What do the pope’s messages teach us about emerging security threats and global health problems?

Agnes Nanyonjo; http://www.internationalhealthpolicies.org/pope-francis-recent-visit-to-uganda-

and-kenya-what-do-the-popes-messages-teach-us-about-emerging-security-threats-and-global-

health-problems/

Agnes Nanyonjo (EV 2012) reflects on the pope’s recent African visit (focusing on Uganda & Kenya). Pope Francis’ view of real “global health security” and a truly ‘rising Africa’ is quite different from the one of the “powers that be”.

Global Health Announcements

Check out HS Global’s learning centre

And the call for satellite sessions in Vancouver (14-15) November is open now (see here ).