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IHP news 532 : Scary movie: Heat for All

(26 July 2019)

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

Dear Colleagues,

If even cool Scandinavians like Stefan Peterson (UNICEF) see “scary stuff” in the world – Stefan was referring to the superbug candida auris, a rather “unusually” behaving fungus, perhaps due to climate change - you will forgive this half- neurotic editor for considering our world more and more as a “Scary Movie” with endless sequels. Apart from the oil tanker games in the Strait of Hormuz, this week’s cliffhangers featured among others also drug-resistant malaria parasites spreading across South-East Asia, unprecedented wildfires in the Arctic, acceleration of Amazon deforestation … And oh yes, before I forget, some also consider Boris Johnson, the new PM in the UK, as a rather scary thing. And not just for DFID.

On BoJo, a Guardian journalist saw it right earlier this week, trying to understand Johnson’s rise to power over the years, pointing out: “… the ultramodern colonisation of politics by show business and its tropes. What Johnson understood was that in the digital age, voters were behaving more like an audience consuming entertainment than a civically engaged electorate. His shtick was no longer an aspect of his politics. It was his politics.” I would add that the increasing number of cynical voters, having been disappointed by elites of both sides for too long (as they all just seem(ed) to govern ‘in line with the markets’) is a partial explanation for the rise of the likes of Boris et al (see Berlusconi, ages ago). “One might as well have some fun, if the world goes down anyway”, that sort of thinking. It won’t last (see Trump), but it might just work for one big election.

It’s also worth giving a paragraph in full by Nick Dearden, in his assessment of what can be expected under the Dude – with a whiff of Rodrik’s trilemma. “… this model of capitalism has become incompatible with the preservation of liberal democracy. The radical action needed to tackle climate change requires a fundamentally different economic model. The immense difference which new technology will make to our society (think mass automation of jobs) will likewise have a huge effect on our society and economy. We either need to move away from market mechanisms and the profit motive and share the burdens and benefits of these developments much more equally. Or we need to dispense with the idea of democracy altogether, and maintain this deeply unequal system by whipping up social division and nationalism. …” For the time being, it seems the second camp is winning. However, 2020 might already present a different picture. Unfortunately, as Paul Mason rightly argues in his ‘manifesto for a post-carbon world’, time is running out…

With that, in the remainder of this intro, I’d like to spend some attention on the increasing eco-anxiety in our world. Indeed, “The climate emergency isn’t just damaging the planet, it’s also harming our mental health.” Now, according to an article in one of my favourite magazines, De Groene Amsterdammer, the German philosopher Odo Marquard (1928-2015) argued that human beings are ‘homo compensators’, all the time going from optimism to pessimism (and back), not

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committing to any of the two, as we – deep down at least - know they constantly have to compensate each other. Not sure it’s a valid theory, but I quite like the idea, certainly in ecologically (geopolitically, and otherwise) frightening times like now.

And so, one afternoon, you might feel ‘a shred of cosmic gratitude’, like Steven Pinker, because you realize that at least in some places, there’s airco nowadays. Praise the Lord! But towards the end of the evening, when you see the satellite pictures of the wildfires in the Arctic on your twitter feed, you rather sympathize with your evangelical friends who begin to see increasing signs of a ‘Second Coming’ (I have to add though that this time round, in addition to massive (i.e. biblical-style) flooding, we might also be in for some “Great Cooking”). The next day, you might again navigate between optimism and pessimism, and so this goes on till the end of your days (or the planet). Admittedly, there are no guarantees to maintain your mental ecological stability in this way, but hey, there are other tips & tricks too, which don’t require you to make Big Pharma even richer.

In countries like Belgium, the UK and Holland, for example, increasingly the royal families have taken up an additional function (to justify their royal (tax-paid) existence), serving the purpose of calming & soothing public opinion's frayed nerves. They used to be just there for some harmless entertainment, but now they also play a tranquillizer role for the masses – “Did you see these stilettos? And that fancy dress? What a cute royal baby! The King drinks a Heineken (or two)...”. Etc. Too bad for the French (who enthusiastically beheaded royals in the past, and now are stuck with Emmanuel Macron) or the Americans. But for the latter, discerning Kim Kardashian’s (arguably royal) butt on Instagram probably has a similar soothing impact – “everything is still normal in America, ouf!”

Let me already wish you all the best with this difficult ecological ‘homo compensator’ balancing act in the years to come. More importantly perhaps, do also – as was the theme at the MSF scientific days - embrace your fear, because it’s necessary “to run towards your fear to create real change”.

In other news from this week, Mauritius (and Bob Geldof) got some bad press; Jason Hickel announced he’ll join the Lancet Commission on Reparations and Redistributive Justice, which will publish its report in 2020, if all goes well. We will also pay attention to the 10th IAS conference on HIV science in Mexico, and the 2019 ReAct Africa Conference on Antimicrobial Resistance in Nairobi, which focuses on ways to advance UHC while combating AMR on the continent. As for the Ebola DRC outbreak, there was some funding progress (at least partly due to the PHEIC declaration from last week, it appears, even if a trademark ‘take no hostages’ Laurie Garrett analysis in FP

certainly also hit home, I reckon, in WB corridors 😊).

Enjoy your reading.

Kristof Decoster

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Featured Article

Connecting the dots between health and climate: a call to action for UNGA 2019

Rachel Thompson ( Policy Fellow @World Obesity Federation)

The interconnections between climate and human health are now widely recognised: by scientists, by policymakers and by communities experiencing the effects of the #ClimateEmergency first-hand. From the global health perspective, the evidence base for the links between health and climate change is growing. Dots are being connected between dengue and warming, lung disease and air pollution, malnutrition and unsustainable agriculture. The message is simple: our activity impacts the climate, which in turn impacts human health. Although the logic of this message is embedded in Agenda 2030 and its ‘indivisible’ SDGs, policy silos separating global health and climate remain - and are limiting progress.

These limitations will be evident at the upcoming 74th United Nations General Assembly (UNGA), when high level events on health and climate will run in parallel. Practically, this means that Heads of State cannot attend the High Level Meeting (HLM) on Universal Healthcare Coverage (UHC) and the UN Climate Action Summit, which are both on 23rd September. Symbolically, this demonstrates how, despite the SDG rhetoric of synergy and multi-sector action, the global responses to health and climate challenges are split at the highest levels. The first meeting of Health and Climate Ministers took place in Abu Dhabi this month but the ‘health-climate nexus’ described remains vague.

UHC focuses on access to healthcare, yet the concept itself is not accessible or well understood by those working outside the health sector. In adopting UHC the health community has made it easier to talk to finance ministers (undoubtedly important) but has potentially made it harder to work with other sectors that are involved in the determinants of health, such as climate. Is anyone in the climate community excited about the UHC High Level Meeting? Unlikely. Meanwhile, human health barely features on the agenda of the Climate Summit and activists are only beginning to leverage human health arguments, which mainly focus on air pollution.

To fulfil the multi-stakeholder, whole-of-government development programme described by the SDGs, there is an urgent need for more joined up working. But how? Connecting the policy dots between healthcare financing reforms (the subject of the UHC HLM) and climate change may feel tenuous at best. The challenge for both health and climate advocates is thus to translate what we all know, that human and climate health are connected, into tangible policy actions that can address both agendas. To do this, we need to look at the systemic determinants of human and climate health.

Food and nutrition are at the centre of health and climate systems, offering many clear ways to connect the dots towards multi-sector action. Two recent Lancet commissions – The EAT-Lancet Commission on Food, Planet, Health and the World Obesity Federation’s Lancet Commission on The Global Syndemic of Obesity, Undernutrition, and Climate Change – provide a robust evidence base and a wide range of recommendations for policy makers to consider. The implementation of food and diet related actions can help join the dots and foster integration at UNGA74 and beyond.

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Linking obesity, undernutrition and climate change is a powerful way for policymakers to implement the SDG logic of integration and synergy, as well as to understand the trade-offs between for example, economic growth and public health policies such as ‘sin taxes’. Taking a systems-based approach to human and planetary health problems encourages solutions that can address multiple issues. For example, shifting the systems that provide food in schools, manage food waste, and control food advertising can have positive health and sustainability outcomes, but it requires government led action.

As the EAT Lancet commission made clear, healthy and sustainable diets will be key to mitigating climate change but they are also key to preventing diseases like obesity, diabetes and cancer. The Global Syndemic shows how the drivers behind undernutrition are the same as those that underlie the obesity epidemic and climate change: a system that privileges [corporate] wealth over health, and which both health and climate advocates must fight to change. ‘Business as usual’ is responsible for the climate and nutrition crises we face and is contributing to the growing epidemic of obesity that is linked to the Non Communicable Disease (NCD) emergency. Shifting the global food system to promote human and planet health is possible but will require a more explicit focus on the commercial determinants of health and post-growth/post-capitalism approaches if it is to be successful.

Food system transformation offers a common ground for convergence between health and climate communities to tackle these issues, but one that has not yet been sufficiently exploited by civil society or policymakers. Global health advocates in New York for the UHC HLM should not miss the opportunity to listen and talk to climate allies, to forge new alliances. The climate summit will likely overshadow the UHC HLM, certainly in terms of Head of State attendance and ambition, but the proximity of the two concurrent events is a chance to start working together on food and food systems. Nutrition is key to good health outcomes and food systems are key to good climate outcomes. Health and climate advocates at this year’s UNGA have a unique opportunity to help global leaders connect these dots.

Highlights of the week

Ebola DRC – Funding progress

A lot happened this week, certainly on the financing front. Some of the updates & key reads:

Cidrap News - Ebola region rocked by more violence as new funds announced

http://www.cidrap.umn.edu/news-perspective/2019/07/ebola-region-rocked-more-violence-new-

funds-announced

“Yesterday the Allied Democratic Forces (ADF), a rebel group, attacked two villages near Beni, killing 12 people who live in the heart of the Democratic Republic of the Congo's (DRC's) ongoing Ebola outbreak. The terrorists killed nine in Eringeti and three in Oicha, according to Reuters. ADF has not publically pledged allegiance to the Islamic state (ISIL), but that hasn’t stopped ISIL from claiming responsibility for the attacks. The violence comes as two major donors announced added funding of response efforts….”

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Meanwhile, at the Security Council (on Wednesday), “…Today the United Nations' Stabilization Mission (MONUSCO) said groups like the ADF and the Mai-Mai, have created a "deadly environment" for responders, who have been both threatened and killed, UN News reported….”

And both the World Bank & USAID increased funding.

“Today the World Bank Group announced an additional $300 million to help scale up response efforts in the DRC. … … According to the World Bank, the money will cover the Ebola-affected health zones in DRC and enable the government, World Health Organization (WHO), UNICEF, World Food Programme, International Organization for Migration, and other responders to step up the frontline health response. Also today, the US Agency for International Development (USAID) announced an additional $38 million for the outbreak, which includes $15 million directed toward the WHO. USAID has given $136 million to the outbreak since August of 2018….”

WB - World Bank Mobilizes US$300 Million to Finance the Ebola Response in

Democratic Republic of Congo

https://www.worldbank.org/en/news/press-release/2019/07/24/world-bank-mobilizes-us300-

million-to-finance-the-ebola-response-in-democratic-republic-of-congo

“The World Bank Group today announced that it is mobilizing up to US$300 million to scale up support for the global response to the Ebola epidemic in the Democratic Republic of Congo (DRC). The announcement follows the declaration by the World Health Organization (WHO) that the current outbreak constitutes a Public Health Emergency of International Concern….”

“… The US$300 million in grants and credits will be largely financed through the World Bank’s International Development Association (IDA) and its Crisis Response Window, which is designed to help countries respond to severe crises and return to their long-term development paths. … … The US $300 million in World Bank financing announced today comes in addition to the US$100 million disbursed by the World Bank and the Pandemic Emergency Financing Facility (PEF) in response to the current Ebola Outbreak in DRC since August 2018. Details on the Bank’s total financing for the DRC Ebola response to date are available here. “

Given the rather peculiar timing of this WB funding news, we have a hunch that Laurie Garrett’s hardhitting piece in Foreign Policy (published on Monday) also played a key role. Laurie more in particular attacked the Pandemic Financing Facility.

See Laurie Garrett - The World Bank Has the Money to Fight Ebola but Won’t Use It (must-read!!!)

“In Congo, thousands have died due to a misguided finance-driven approach to fighting pandemics that puts investors before victims. “

Excerpts:

“According to the French foreign-aid agency GHA France, those managing the PEF insisted this week that “activation criterion of the insurance window are not linked to decision about IHR procedures concerning PHEIC,” meaning that WHO may declare a global emergency, but it will not have any

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impact on the World Bank’s decision to release money. According to PEF documents, up to $200 million to combat Ebola should be released when, “upon an activation of pre-agreed parametric trigger (based on public and observable data), the private sector will make agreed-upon payouts to the IBRD.” The key objective of the PEF is “providing financial support to PEF Eligible Countries and Responding Agencies to help prevent a high-severity infectious disease outbreak from becoming a pandemic.” … … In April the World Bank’s former chief economist, Lawrence Summers, denounced the PEF, labeling it “an embarrassing mistake” and a symptom of “financial goofiness” within the World Bank. … … Back in 2017 when Kim announced creation of the PEF, I repeatedly asked World Bank officials about those “pre-agreed parametric triggers”—what would constitute a trigger for release of funds, and who would decide? I never received answers. As Summers argues, the market—those investors and bond holders—will always be averse to such a trigger declaration because it removes their profits. In other words, thousands of people might die in the Ebola epidemic, but never formally trigger release of $200 million before the PEF five-year payout period for investors.”

PS: The UN Security Council convenes on July 31 to review the Ebola crisis.

Laurie again: “…When the United Nations Security Council convenes on July 31 to review the Ebola crisis, it should specifically name and blame those armies and governments. Until then, international recriminations should focus on the World Bank. It is appalling that the bank has failed the people of Ituri and North Kivu, and placed the people of neighboring South Sudan, Uganda, Rwanda, and Burundi in harm’s way. It must be held accountable for its unconscionable refusal to release the PEF funds that are, by design, specifically meant to address precisely the sort of situation now unfolding in the Democratic Republic of the Congo.”

See also Devex - The European Union is set to allocate a further €30 million to the Ebola DRC response (as was already announced last week). “…Pariat (DG of humanitarian department) said the EU was preparing to step up its response to the crisis through its Emergency Aid Reserve, designed to facilitate quick responses to unforeseen events….”

“…USAID’s new funding commitment brings the agency’s total assistance to over $136 million. The funding will cover infection prevention and control and community engagement efforts, surveillance, health care worker training, promotion of safe and dignified burials, and food assistance. The United States is also funding preparedness efforts in neighboring Burundi, Rwanda, South Sudan, and Uganda, according to a news release….”

PS: on the funding issue, Bloomberg reported earlier in the week Ebola Funding Need to Triple as International Risk Escalates

“The Ebola emergency in the Democratic Republic of Congo will require about three times more money than currently provided, the United Nations agency leading the public-health response said. The World Health Organization estimates $324 million is needed to fund its response and preparedness in the Africa region over the next six months. Additional funds will be required to support other functions outside the WHO’s remit to help stop transmission of the deadly hemorrhagic virus, the Geneva-based agency said in an email Tuesday.”

Cidrap News - DRC health minister resigns after government takes Ebola reins

http://www.cidrap.umn.edu/news-perspective/2019/07/drc-health-minister-resigns-after-

government-takes-ebola-reins

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See also last week’s IHP newsletter: “…the country's health minister resigned today following the president's decision over the weekend to put outbreak leadership in the hands of a government expert committee….” Read about his rationale, explained eloquently in a letter. Also the contention on the declaration of a PHEIC and on the use of a second vaccine played a role. Amongst others.

See also HPW - DR Congo Health Minister Resigns After President Takes Control Of Ebola Emergency

Stat News - What if we’re no longer afraid of Ebola?

H Branswell; Stat;

Poignant hypothesis by Helen Branswell, who links the lack of international attention to “lessons learned” at the West-African Ebola outbreak from 2014. The wrong lessons, for people in DRC now.

“…Now I wonder if the West African outbreak taught citizens of the U.S. and other countries that typically help out in an Ebola outbreak a different lesson. Maybe the idea that eventually took root was that Ebola wasn’t the threat to us that we thought it was. What if, ironically, the worst Ebola outbreak ever de-fanged Ebola? That definitely shouldn’t be the lesson anyone took from that horrible outbreak. What West Africa and northeastern DRC should teach us is that struggling states with weak health systems are fertile ground for hard-to-contain disease outbreaks that will be massively expensive to stop if they aren’t addressed quickly and aggressively….”

“…in the meantime I am left wondering if we have learned to fear this virus less. And in the process, if we have let Ebola drift toward the column of bad diseases — things like cholera and yellow fever, Guinea worm and malaria — that we’re not so concerned about. Sure, they sicken and kill lots of people. But they don’t do it here.”

HPW - Gavi Says 1.3 Million Doses Of Merck’s Ebola Vaccine Will Be Made

Available; MSF Says Field Supply “Extremely Low” & “Sporadic”

https://www.healthpolicy-watch.org/gavi-says-1-3-million-doses-of-merck-ebola-vaccine-available-

over-6-18-months-msf-says-field-supply-extremely-low-sporadic/

“There is no shortage of Merck’s life-saving Ebola vaccine on the ground in the Democratic Republic of Congo, and more doses will be produced, sufficient to immunise 1.3 million people over the next 6-18 months, a spokesman for Gavi, the Vaccine Alliance, told Health Policy Watch on Tuesday. Meanwhile, Merck, producer of the V920 investigational vaccine, confirmed that it is ramping up production in both US and German production sites to make more vaccines available as soon as possible. But those upbeat statements, contrast sharply with reports by Médecins Sans Frontières (MSF) from ground zero of the outbreak in the Democratic Republic of Congo, where vaccine stocks are reported to be “extremely low”, supply is “sporadic”, and a ring vaccine strategy focused on immunising contacts of Ebola victims is no longer sufficient to contain the disease outbreak, extending across some 500 square kilometres, and to the borders of Rwanda and Uganda….”

Stat Op-ed- The real public health emergency of international concern: the DRC

Seth Berkley; https://www.statnews.com/2019/07/25/ebola-real-public-health-emergency-drc/

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“The decision to declare the yearlong Ebola outbreak in the Democratic Republic of the Congo as a public health emergency of international concern (PHEIC) will almost certainly help focus the world’s attention on this deepening crisis. But while it is already bringing much-needed donor funds and international assistance, the danger is that this decision could have unintended repercussions that further hinder the emergency response on the ground. If this gamble is to be successful, then the response will need to go beyond the immediate Ebola crisis and address much deeper long-term issues that have plagued the region — issues that ultimately created this situation in the first place. Because in truth it is not just Ebola, but more broadly the situation in the DRC itself, that represents a public health emergency, and one that really should be of international concern….”

“…public health in the DRC is in a state of emergency.”

Lancet World Report – Ebola outbreak declared a PHEIC, world waits for next

steps

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31712-X/fulltext

Well worth a read, as you can imagine. Coverage of the PHEIC declaration (rationale/background, …) & ‘what now?’

A few quotes: “…David Heymann, professor of Infectious Disease Epidemiology at the London School of Hygiene & Tropical Medicine, told The Lancet: “Based on what I understand from the chair of the Emergency Committee, it appears to have interpreted the need for funding as one of the reasons a PHEIC was called as well as to better respond to the humanitarian needs while adding resources in the outbreak response”. “This has not been done in the past, but the Emergency Committees continue to evolve in their interpretation of the [International Health Regulations (2005)], and I guess this will now set a precedent to be considered at Emergency Committee meetings in the future”, he added. Heymann, a former senior WHO official who was instrumental in the crafting of the revised International Health Regulations in 2005 in the aftermath of the SARS and H5N1 outbreaks, also pointed out that “it is clear some countries require a PHEIC or its equivalent in order to access greater resources for humanitarian crises such as this”.

“…Some health diplomats and emergency experts were surprised by all the caveats that accompanied the declaration that blunted its effect, which one described as “PHEIC light”….”

Some other Ebola DRC related links

• The Conversation (Yap Boum) - Why declaring Ebola a public health emergency isn’t a silver bullet

“…the issue of unrest in North Kivu needs to be solved as it remains one of the major catalysts of this outbreak. Solving the outbreak requires a peaceful environment, wherein the community trusts the Ebola response team, and therefore, increase its engagement. Without a higher community awareness and engagement, it is difficult to see the end of Ebola outbreak in the DRC.”

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• AU Press release - African Union to Deploy More Experts in Response to Ebola Crisis in the DRC

That decision at least seemed linked to the PHEIC declaration, last week: “The African Union (AU) is to deploy more members of the African Voluntary Health Corps (AVoHC) to support the response to the Ebola virus disease outbreak in the Democratic Republic of Congo (DRC), the second largest outbreak in the history of Ebola since it was discovered in 1976. In a briefing to the media (watch), Dr John Nkengasong, the Director of the African Union’s Africa Centres for Disease Control and Prevention (Africa CDC) confirmed that the AU will re-activate the African Voluntary Health Corps and deploy them not just in the DRC but also in other countries within the region. The decision to increase the number of volunteers is in response to the declaration by the WHO, categorising the outbreak as a public health emergency of international concern (PHEIC)….”

• Guardian - Are motorcycle taxis making the Ebola crisis worse?

“The Congolese trading city of Butembo relies on its ‘taxi-motos’ to keep business running, but the taxi unions are resistant to helping government Ebola efforts – and their bikes could be spreading the disease.”

• Nature - Science under fire: Ebola researchers fight to test drugs and vaccines in a war zone

“Violence in the Democratic Republic of the Congo has interrupted clinical trials and forced scientists to change how they immunize people.”

• Devex - US Senators search for ways to aid Ebola response in latest hearing

• AU - Chairperson of the AU Commission to convene a forum of African Private Sector and Donors to mobilize resources for Ebola Response in DRC

“…the Chairperson of the African Union Commission (AUC) will be convening a Forum of the Africa against Ebola Solidarity Trust Fund (AAESTF), African private sector and International partners, during the first week of September 2019. The aim of this Forum is to mobilise adequate resources to respond to the on-going Ebola Virus Disease (EVD) outbreak in the Democratic Republic of Congo (DRC ….”

• Cidrap (update as of 25 July) - No further cases in Uganda or Goma. So far.

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UHC High-Level Meeting preparations, advocacy, Twitter chat…

HPW - Drug R&D, Sexual & Reproductive Health Scrutinised In Draft UHC

Declaration

https://www.healthpolicy-watch.org/drug-rd-sexual-reproductive-health-scrutinised-in-draft-uhc-

declaration/

Must-read, from late last week. “Disclosure of costs for drug research and development (R&D) and “alternative financing mechanisms” for new health products remain outstanding points to be resolved by countries in finalising a draft United Nations General Assembly political declaration on universal health coverage (UHC). A final draft of the declaration had been expected this week, but as of Friday afternoon, language on sexual and reproductive health and rights (SRHR) and drug development issues appeared to be unresolved in the draft text, obtained by Health Policy Watch. Observers close to the negotiations told Health Policy Watch that they feared that disputes over the SRHR language in particular could extend finalising the declaration beyond this month. If negotiations around SRHR become divisive, sources warned that the timeline for finalising the declaration could even extend into September, just ahead of the UN General Assembly High-Level meeting on UHC….”

For the 12 July draft, see here.

HSG – We won’t advocate without you, so what did you tell us?

https://www.healthsystemsglobal.org/blog/350/We-won-t-advocate-without-you-so-what-did-you-

tell-us-.html

HSG advocacy focuses on two points, on 'making commitments to evidence' & 'investing in people'. Inspired by a survey among HSG members.

UHC 2030 – overview of HL event & series of side-events NY (September)

https://www.uhc2030.org/news-events/uhc2030-events/un-high-level-meeting-on-universal-health-

coverage-555293/

For the ones going to New York in September, do check them out.

This week, a ‘Healthy Access’ Twitter chat organized by Devex also took place, related to the HLM. You might want to check out the #HealthyAccess hashtag.

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Planetary Health

New Statesman (essay) - My manifesto for a post-carbon future

Paul Mason ; https://www.newstatesman.com/politics/environment/2019/07/my-manifesto-post-

carbon-future

“It was once widely believed that time was on the side of progress. But now it is clear that time is something we do not have. “ One of the reads of the week.

“…We are faced with the prospect of two transitions – beyond work and beyond carbon. That the climate crisis must take precedence is unarguable: the task is to formulate a new left politics in which the post-work and post-carbon projects are fused….”

“…From the Green New Deal to the just transition, my fear is that the left has armed itself with platitudinous phrases to avoid hard choices. It is likely that, given the scale of the endeavour, we will need decisive, centralised state action and ownership. The place for creativity, localism, entrepreneurship and consultation will be in the implementation, not the decision….”

United Nations Announces 2019 Climate Action Summit “Clean Air Initiative”,

Calls for Governments at All Levels to Join

https://in.one.un.org/un-press-release/united-nations-announces-2019-climate-action-summit-

clean-air-initiative-calls-for-governments-at-all-levels-to-join/

“Ahead of the upcoming 2019 Climate Action Summit, the United Nations, the World Health Organization (WHO), the United Nations Environment Programme (UN Environment) and Climate and Clean Air Coalition announced today the “Clean Air Initiative”, calling on governments at all levels to join the Initiative. The “Clean Air Initiative” calls on national and subnational governments to commit to achieving air quality that is safe for citizens, and to align climate change and air pollution policies by 2030….”

BBC News - Climate change: 12 years to save the planet? Make that 18 months

https://www.bbc.com/news/science-environment-48964736

“… There's a growing consensus that the next 18 months will be critical in dealing with the global heating crisis, among other environmental challenges. Last year, the Intergovernmental Panel on Climate Change (IPCC) reported that to keep the rise in global temperatures below 1.5C this century, emissions of carbon dioxide would have to be cut by 45% by 2030. But today, observers recognise that the decisive, political steps to enable the cuts in carbon to take place will have to happen before the end of next year. The idea that 2020 is a firm deadline was eloquently addressed by one of the world's top climate scientists, speaking back in 2017….” Focus in this piece on the upcoming political milestones & conferences in 2019 & 2020, like the Special Climate Summit (Sept 2019), and COP25 (Chile) & COP26 (UK).

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In spite of all the doom and gloom, there are also reasons to be cheerful: “…Whether it's the evidence of heatwaves, or the influence of Swedish school striker Greta Thunberg, or the rise of Extinction Rebellion, there has been a marked change in public interest in stories about climate change and a hunger for solutions that people can put in place in their own lives. People are demanding significant action, and politicians in many countries have woken up to these changes….” Accurate assessment, in my opinion.

Climate Change news - Guterres asks all countries to plan for carbon neutrality by

2050

https://www.climatechangenews.com/2019/07/22/guterres-asks-countries-plan-carbon-neutrality-

2050/

“In a letter to heads of state, the UN chief set net zero emissions as the benchmark for ambition, ahead of a landmark summit in September.” Looks like some good practice (to be copied also for the UN HL Meeting on UHC? )

“In excerpts of the letter seen by Climate Home News, Guterres invited governments to send “a brief summary or an indication of the plans” they are expecting to bring to the summit by 7 August. Countries are expected to compete for the spotlight during the high-level meeting, with only the most ambitious and meaningful strategies being showcased on stage….”

Medium - What Will the Economy Be When It Grows Up?

https://medium.com/post-growth-institute/what-will-the-economy-be-when-it-grows-up-

16982fd2c2f7

“In conventional economics, growth is recorded as a good thing in itself, even if it comes at the cost of social and environmental breakdown. If we considered growth to be a means to an end, what would that end be? What would we call it, and what comes after it? These are the questions Katherine Trebeck and Jeremy Williams answer in their new book, The Economics of Arrival — Ideas for a Grown-up Economy. …”

And some quick links:

• Independent - Huge swathes of the Arctic on fire, ‘unprecedented’ satellite images show

“Vast swathes of the Arctic are suffering from "unprecedented" wildfires, new satellite images have revealed. North of the Arctic circle, the high temperatures are facilitating enormous wildfires which are wreaking ecological destruction on a colossal scale….” “…The World Meteorological Organisation (WMO) has described the fires in the northern hemisphere as “unprecedented” and warned of the enormous impact they are having on CO2 levels contributing to the climate crisis….”

“Mark Parrington, a senior scientist at the European Centre for Medium-Range Weather Forecast, said the amount of CO2 emitted by Arctic wildfires between 1 June and 21 July 2019 is around 100 megatonnes and is approaching the entire 2017 fossil fuel CO2 emissions of Belgium….”

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• Guardian - Make environmental damage a war crime, say scientists

“International lawmakers should adopt a fifth Geneva convention that recognises damage to nature alongside other war crimes, according to an open letter by 24 prominent scientists. The legal instrument should incorporate wildlife safeguards in conflict regions, including protections for nature reserves, controls on the spread of guns used for hunting and measures to hold military forces to account for damage to the environment, say the signatories to the letter, published in the journal Nature….”

• Guardian - Amazon deforestation accelerating towards unrecoverable 'tipping point'

Deforestation of the Brazilian Amazon has surged above three football fields a minute, according to the latest government data, pushing the world’s biggest rainforest closer to a tipping point beyond which it cannot recover. The sharp rise – following year-on-year increases in May and June – confirms fears that president Jair Bolsonaro has given a green light to illegal land invasion, logging and burning….” “…The steady erosion of tree cover weakens the role of the rainforest in stabilising the global climate. Scientists warn that the forest is in growing danger of degrading into a savannah, after which its capacity to absorb carbon will be severely diminished, with consequences for the rest of the planet.”

Boris in charge (at least for now) while DFID survives another day ( also for now)

Devex - DFID survives another day as Alok Sharma named new secretary of state

https://www.devex.com/news/dfid-survives-another-day-as-alok-sharma-named-new-secretary-of-

state-95349

“Alok Sharma was named as the U.K.’s latest secretary of state for international development on Wednesday, joining the cabinet of new Prime Minister Boris Johnson. He becomes the Department for International Development’s fifth leader in four years, with insiders saying that frequent changeovers have become a source of disruption and frustration internally. Nonetheless, it was a moment of quiet relief for the development community amid speculation that DFID might lose its secretary of state under aid skeptic Johnson and be asked to report to the Foreign & Commonwealth Office….”

Some other reads, on DFID’s possible future (under Johnson) and Rory Stewart’s rather good track record (in only 3 months):

Guardian - Trade and foreign aid: will Boris Johnson bring an end to DfID?

“Johnson’s wish that aid should serve the UK’s political and commercial interests could mean a merger for the Department of International Development.”

But “…Privately, some NGOs believe Johnson has too much else on his plate at the moment, not least from Brexit and Iran, to worry about changes to Whitehall….”

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Devex - Boris in, Rory out amid fears for future of UK aid

CGD (blog) - In (Partial) Defense of “Best Practice”: What Works in Development

Charles Kenny is one of the many who appreciated Rory Stewart’s (short) stint. Well worth a read, this blog.

ODI - Dear Prime Minister, five priorities for the UK government By 5 ODI experts (and largely wishful thinking, I’m afraid)

Germany, UK and global health

International Report of the Konrad-Adenauer Stiftung – Germany has to invest

even more in global health

I Kickbusch; https://www.kas.de/en/web/auslandsinformationen/artikel/detail/-/content/germany-

has-to-invest-even-more-in-global-health

“For some time, Germany has been extremely active in the field of global health and has contributed greatly to shaping central elements of global health structures. Nevertheless, Germany should continue to invest in expanding global health infrastructure and coordinate its own activities even more closely than it has in the past.”

With the following conclusion: “…Coordination and coherence continue to pose a major challenge, and the advisory body report contains several proposals on that score. A new strategic coordinating body for Global Health could contribute to ensuring transparency and responsibility. Appointing a Global Health ambassador for Africa might secure the coordination of various Africa strategies relating to Global Health on the part of the German federal government. The body recommends that Germany should continue to consolidate its leadership role in the area of Global Health. A special opportunity to do so is afforded by the upcoming Presidency of the European Union in 2020.”

Lancet -Global partnerships and the Chief Medical Officer's 2019 annual report

C Falconer, Sally Davies et al; https://www.thelancet.com/journals/lancet/article/PIIS0140-

6736(19)31666-6/fulltext

“The Chief Medical Officer for England's 2019 annual report focuses on UK engagement with global health.”

“…In the Annual Report of the Chief Medical Officer, 2019; Health, our global asset—partnering for progress, leaders from around the world reflect on UK engagement in global health and advise on some of the challenges to health and potential improvements to UK strategies. Their “letters” highlight the changing landscape of health….”

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Tweet Horton: “England’s Chief Medical Officer defends the importance of global partnerships as the UK awaits a Prime Minister who is committed to walking our nation off a cliff edge. We truly live in a post-rational world.”

Coverage for example in BBC News - Medical chief calls for global health effort or the Telegraph - Killer global health threats should be treated like terrorism, says Chief Medical Officer

“Britain must tackle killer health threats from abroad in the same way it handles terrorism, because deadly infections know no borders, the government’s chief medical officer has said. In her final report before stepping down to become the first female Master of Trinity College Cambridge, Dame Sally Davies said the UK must adopt a similar approach to global health as does with its counter-terrorism (CONTEST) strategy. The strategy brings together intelligence organisations from across the world to ‘prevent, pursue, protect and prepare’ for a terrorist attack and ensures countries act swiftly together in the event of an atrocity. Dame Sally said Britain must adopt a similar approach to stop pandemics.”

10th IAS Conference on HIV Science in Mexico City, Mexico (21-24 July) & other HIV news

http://www.ias2019.org/

The 10th IAS Conference on HIV Science was held in Mexico City, Mexico, July 21-24. This biennial conference addresses advances in basic, clinical, and operational HIV research, as well as the applications of the science for policy and practice.

Press releases

For some of the press releases from the conference, see press releases. Science Speaks Blog also has lots of expert coverage from IAS 2019.

You might want to start with this press release: Is the global HIV response in crisis?

“More than 5,000 people from 140 counties have gathered in Mexico City for the opening of the 10th IAS Conference on HIV Science (IAS 2019), where global experts called for urgent action to address the health needs of millions of people affected by humanitarian crises. Experts grappled with the question, “Is the global HIV response in crisis?” They focused on challenges that threaten the roll out of universal healthcare, including HIV services, to all people. They range from migration to conflict to the difficulties of reaching specific populations, including women and girls and people who inject drugs. More than 135 million people around the world are in need of humanitarian assistance mostly due to conflict, with natural disasters driving the nee d for emergency assistance….”

See also - As AIDS conference opens in Mexico, migrants are a focus

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UNAIDS - UNAIDS calls on countries to accelerate efforts and close service gaps to

end the AIDS epidemic among children and adolescents

https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2019/july/20

19722_PR_SFSFAF_report

“A new report released today at the 10th IAS Conference on HIV Science in Mexico City, Mexico, shows that the world is lagging behind in its commitment to end the AIDS epidemic among children and adolescents. The report, Start Free, Stay Free, AIDS Free, shows that the pace of progress in reducing new HIV infections among children and expanding access to treatment for children, adolescents and pregnant women living with HIV has slowed significantly and that global targets set for 2018 have been missed, despite important gains being made in some countries. …”

AmfAR, AVAC & Friends of the Global Fight Against AIDS, TB & Malaria (report)

http://endaids.org/

This report showed pathways to success (HIV incidence & mortality), focusing on 6 different settings “from Malawi and Thailand to London and San Francisco”.

Guardian - Trial of HIV prevention implant hailed as boost in fight against disease

Guardian;

“An implant containing an HIV-prevention drug has been trialled in humans, in a step experts have hailed as an exciting development in curtailing infections….”

See also Stat News - Merck unveils early data on HIV drug it says could be ‘a game changer’ or the NYT - Someday, an Arm Implant may prevent HIV infection for a year

WHO - WHO recommends dolutegravir as preferred HIV treatment option in all

populations

https://www.who.int/news-room/detail/22-07-2019-who-recommends-dolutegravir-as-preferred-

hiv-treatment-option-in-all-populations

“Based on new evidence assessing benefits and risks, the WHO recommends the use of the HIV drug dolutegravir (DTG) as the preferred first-line and second-line treatment for all populations, including pregnant women and those of childbearing potential. …”

And some links:

Science Speaks Blog - Recency testing opens doors to faster, focused HIV responses, raises questions of community involvement

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“On Sunday here in a preconference session, U.S. PEPFAR leader Ambassador Dr. Deborah Birx extolled the value of HIV recency tests – a diagnostic advance that can tell if a person newly diagnosed with HIV was infected in the last year, or before. That information can help identify new clusters of transmissions, inform and maximize the efficiency of testing contacts, reach communities and networks eluding notice now, and provide useful information to clients that can help them to be better involved in their care. The testing was a tool that could maximize the use of funding, she said, and “have even a greater impact on the epidemic.”…”

FT – GSK looks for boost from two-drug trial

https://www.ft.com/content/59a17dd6-ad59-11e9-8030-530adfa879c2

(gated) “A new HIV treatment with only two drugs has proved as effective as the traditional three-drug combination, setting up a new chapter in the fight against the deadly virus. The medication has been approved by both US and European regulators.”

Devex – Candidate HIV vaccine to be tested for efficacy in MSM, transgender

individuals

https://www.devex.com/news/candidate-hiv-vaccine-to-be-tested-for-efficacy-in-msm-transgender-individuals-95339

“Janssen Pharmaceutica has revealed new data about its investigational HIV vaccine candidate at the 10th International AIDS Society Conference on HIV Science taking place in Mexico City….” “…The results were from Janssen’s ASCENT trial, which evaluated 152 healthy adults in Kenya, Rwanda, and the United States. The trial made use of the organization’s “mosaic” HIV vaccine, named so as it combines immunogens created using genes from different subtypes of HIV-1, the most common HIV type….”

Journal of the IAS Society (Editorial) – Maximizing the impact of HIV prevention

technologies in sub‐Saharan Africa

Journal of the International AIDS society;

Editorial from a special issue, on maximizing the impact of HIV prevention technologies in SSA (based on discussions at a Banburry meeting in 2017).

Global Fund update

MSF Access (Technical Brief) - Beware the Global Fund Procurement Cliff

https://msfaccess.org/beware-global-fund-procurement-cliff

“Safeguarding supply of affordable quality medicines and diagnostics in context of risky transitions and co-financing. “ Four-pager.

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“For the last two decades, the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) has helped to scale up access to affordable, quality-assured medicines and diagnostics that have saved millions of lives. However, this progress is under threat. Following stagnating donor funding globally, the Global Fund has in recent years revised its policies that determine funding for countries, including its funding allocation methodology and its Sustainability, Transition and Co-financing (STC) policy. As a result, countries are shifting from Global Fund-supported mechanisms to national processes for the purchase of medicines and diagnostics for the three diseases. Médecins Sans Frontières (MSF) believes this shift is often premature and poses significant risks to people’s access to quality medicines and diagnostics, with dire implications for people with HIV, tuberculosis (TB), or malaria. This policy brief analyses risks to the affordability, quality and supply of medicines and diagnostics, and provides recommendations for the Global Fund, affected countries, donor countries and the World Health Organization to collectively address these challenges.”

PATH – Global Fund Prospective Country Evaluation

https://www.path.org/programs/health-systems-innovation-and-delivery/global-fund-prospective-country-evaluation/

Independent evaluation of GF investment in 8 countries. “Commissioned by the Global Fund's Technical Evaluation Reference Group (TERG) in 2017, the PCE is an embedded mixed-methods evaluation platform designed to examine the Global Fund business model, investments, and contribution to disease program outcomes and impact in eight countries. The Institute of Health Metrics and Evaluation (IHME) and PATH work hand in hand with evaluation partners in the Democratic Republic of the Congo, Guatemala, Senegal, and Uganda; and the Euro Health Group (EHG), University of California San Francisco (UCSF), and Itad work with teams in Cambodia, Mozambique, Myanmar, and Sudan.”

You might want to start with the cross-country synthesis findings. (3 pages)

Access to Medicines

FT – Time to make essential cancer drugs more affordable

Ellen ‘t Hoen & Jamie Love; https://www.ft.com/content/06a76e44-a965-11e9-90e9-fc4b9d9528b4

“Governments can do more to pressure makers to bring down prices.”

"…We urge the WHO to develop a second list of medicines — those that would be labelled “essential” if they were available at affordable prices.”

Excerpts:

“…In the past, the WHO’s Essential Medicines List has focused almost entirely on cheap off- patent medicines. In recent years, first with drugs for HIV, and more recently for hepatitis, cancer and autoimmune diseases, there are pressures to include new drugs, some of them extremely expensive. This presents challenges for government healthcare budgets because their use can

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potentially divert resources from more cost-effective therapies. … … Our plea for making these new essential cancer medicines affordable in the developing world is bound to spark concern that the low prices will deter research and development spending for new drugs. But most of today’s drug sales are in high income countries, and returns from developing countries for many cancer drugs are inconsequential. These concerns over innovation incentives do not require us to tolerate high prices and unequal access. They could be addressed through other measures that delink R&D spending from drug prices, including research grant programmes or “market entry rewards” that provide payouts for the development of drugs that meet specific needs….”

In response, check out also this CGD blog (by Kalypso Chalkidou et al) - Improving Cancer Outcomes for the World’s Poorest Is About More than Getting Rid of Patents

“The Financial Times recently published an opinion calling for more affordable cancer drugs for the world’s poor. Given the growing burden of cancer in developing countries, including across sub-Saharan Africa, it is right to pay more attention to the affordability of cancer treatments in lower- and middle-income countries (LMICs). However, we are not convinced that removing the patents of the latest metastatic cancer treatments as the authors propose—and hence lowering the price of these drugs in poor countries—will improve outcomes for cancer patients in these countries. Here’s why: …”

They list five (rather good) reasons.

Global vaccination

Vox - Who should get the HPV vaccine? The recommendations keep changing.

Julia Belluz; https://www.vox.com/policy-and-politics/2019/7/22/20687590/hpv-vaccine-age-45-

older-adults-boys-men

Interesting read. “The HPV vaccine is now recommended for some people as old as 45.”

GAVI (press) - IFFIm issues NOK600 million Vaccine Bonds

https://www.gavi.org/library/news/press-releases/2019/iffim-issues-nok600-million-vaccine-bonds/

“The International Finance Facility for Immunisation (IFFIm) today issued NOK600,000,000 Zero Coupon Notes to help finance research and development of new vaccines by the Coalition for Epidemic Preparedness Innovation (CEPI). CEPI is a public private initiative that accelerates development of vaccines against emerging infectious diseases and enables equitable access to these vaccines for affected populations during outbreaks. The vaccine bonds will frontload a NOK600 million pledge from the Government of Norway to Gavi in support of CEPI ….”

Bloomberg – Climate Change May Draw $200 Billion Vaccine Boom, Analyst Says

https://www.bloomberg.com/news/articles/2019-07-24/climate-change-may-draw-200-billion-vaccine-boom-analyst-says

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“Higher temperatures across the globe could expose almost a billion more people to risks for diseases like Zika and Ebola by 2080 and that may be a boon for some drugmakers, Morgan Stanley tells investors. Climate change could spell the rapid spread of infectious diseases and Europe in particular is at risk, analysts led by health-care specialist Matthew Harrison wrote in a note to clients….”

Nature (Comment) - Mandate vaccination with care

https://www.nature.com/articles/d41586-019-02232-0

“Governments that are considering compulsory immunizations must avoid stoking anti-vaccine sentiment, argue Saad B. Omer, Cornelia Betsch and Julie Leask.”

World Hepatis Day (28 July)

Lancet Global Health (Comment) – Pricing viral hepatitis as part of universal

health coverage

https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30321-3/fulltext

“In the past decade, the profile of viral hepatitis has increased on the global health agenda with a greater recognition of the burden of disease, availability of highly effective vaccines (for hepatitis A and B), highly effective treatments (for hepatitis B and C), and greater political efforts to support hepatitis work globally. WHO has set targets to eliminate viral hepatitis as a public health threat by 2030. Therefore, it is surprising that the WHO's 2017 estimates of the cost for providing universal healthcare coverage (UHC) through essential health programmes did not include testing or treatment for viral hepatitis. In The Lancet Global Health, David Tordup and colleagues from WHO set out to rectify this omission, expanding the previous analysis. They provide the additional cost for the scale-up of testing and treatment for hepatitis in 67 countries and find that, despite being a large sum, it is small relative to the total cost of UHC….”

PS: “…Access to affordable medicines in all countries will be key to reach hepatitis elimination. This study suggests that elimination is feasible in the context of universal health coverage. It points to commodities as key determinants for the overall price tag and to options for cost reduction strategies.”

Multi-drug resistant malaria parasites spread in South-East Asia

Some of the really scary news of the week.

Two New Studies in the Lancet Infectious Diseases

Evolution and expansion of multidrug-resistant malaria in southeast Asia: a genomic epidemiology

study and Determinants of dihydroartemisinin-piperaquine treatment failure in Plasmodium

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falciparum malaria in Cambodia, Thailand, and Vietnam: a prospective clinical, pharmacological, and

genetic study

Cfr the Lancet Infectious Diseases press release:

“The Lancet Infectious Diseases: Rapidly spreading multidrug-resistant parasites render frontline malaria drug ineffective in southeast Asia

Preliminary data from multi-country randomised trial find that half of patients in Cambodia, Thailand, and Vietnam not cured by first-line malaria treatment. Authors call for widely used drug combination to be abandoned in the affected countries in southeast Asia and for accelerated malaria elimination to prevent further development of multidrug resistant malaria, which would jeopardise malaria control and could spread, causing a global health emergency.

Multidrug-resistant forms of Plasmodium falciparum parasites, the most lethal species causing human malaria, have evolved even higher levels of resistance to antimalarial drugs and spread rapidly since 2015, becoming firmly established in multiple regions of Cambodia, Laos, Thailand, and Vietnam, where they are causing alarmingly high treatment failure rates to a widely used frontline malaria drug combination. The findings of two studies, published in The Lancet Infectious Diseases journal, reveal that by 2016–2018 malaria parasites resistant to both artemisinin and its widely used partner drug piperaquine represented more than 80% of the parasites circulating in northeast Thailand and Vietnam, despite having only emerged in western Cambodia in 2008….”

See also the Comment in the Lancet Infectious diseases - Accelerated evolution and spread of multidrug-resistant Plasmodium falciparum takes down the latest first-line antimalarial drug in southeast Asia

And great and alarming coverage in the Guardian - Drug-resistant malaria parasites 'spreading aggressively' across south-east Asia or NPR - Study: Malaria Drugs Are Failing At An 'Alarming' Rate In Southeast Asia.

ReAct Africa Conference On Antimicrobial Resistance in Nairobi (23-25 July)

HPW - ReAct Africa Conference On Antimicrobial Resistance Opens in Nairobi

https://www.healthpolicy-watch.org/react-africa-conference-on-antimicrobial-resistance-opens-in-

nairobi/

“The 2019 ReAct Africa Conference on Antimicrobial Resistance (AMR), which opened Tuesday in Nairobi, Kenya, will focus on ways to advance universal health coverage while combating antimicrobial resistance (AMR) on the continent. Some 24 African countries are taking place in the three day event co-sponsored by the United Kingdom-based Fleming Fund dedicated to supporting

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low and middle income countries tackle AMR, along with the South Centre, Wellcome Trust, Swedish International Development Agency Sida, and others. The conference is tackling a wide range of policy issues that affect AMR response: from preventing and managing infections with effective water and sanitation strategies, to medicines quality and regulation; and AMR in the animal and environmental sectors. The conference will also showcase models of country success as well as gaps in National Action Plans when it comes to AMR responses needed to meet the threat of bacteria, viruses and other pathogens that are increasingly resistant to medications….”

See also ReAct. “23-25 July, ReAct Africa and South Centre [will] host a conference with the theme, “Achieving Universal Health Coverage while addressing Antimicrobial Resistance” in Nairobi, Kenya. This year’s conference will focus on the connection between achieving UHC & AMR. Specifically, the conference will focus on how addressing AMR is a path to attaining UHC and what country programs can be leveraged on.”

PS: ReAct is an independent network dedicated to the problem of antibiotic resistance.

HPW – React Africa 2019: Universal Health Coverage Can Help Combat

Antimicrobial Resistance

https://www.healthpolicy-watch.org/react-africa-2019-universal-health-coverage-can-help-combat-antimicrobial-resistance/

“Neonatal sepsis is one of the leading causes of newborn deaths globally, and increasing pathogen resistance to available first-line treatments is a prime example of rising antimicrobial resistance. That is why the Global Antibiotic Research and Development Partnership (GARDP) – a not-for-profit research organization that develops new or improved antibiotic treatment – is seeking alternatives. GARDP’s first clinical trial of one such candidate, Fosfomycin, is taking place right now in the coastal region of Kenya to determine safety and appropriate dosing for infants. The GARDP research was one feature of a three-day conference that took place here this week (23-25 July) on tackling antimicrobial resistance in Africa….”

“…availability of AMR data, especially in developing countries has been, and continues to be a challenge. So generating better data is one key area in which players in the antimicrobial debate are increasingly focused. This is particularly true of the Wellcome Trust, a research charity organization based in the UK, which has made surveillance and monitoring of AMR one of the pillars guiding it’s 5-year AMR programme….”

“ … UHC can therefore lead to better AMR control – by assuring people’s access to a reputable supply of medicines – and to advice from medical practitioners about how they should be used. Ghana is one example of this principle in action. It has provided health insurance coverage for the majority of its population – 18 million people out of a population of 28 million. As a result, pregnant women and infants are now able to access healthcare at zero cost, courtesy of the universal health insurance programme, initiated in 2006. Since the programme also provides for key drug products free of charge, through hospital suppliers, patients do not have to buy products themselves from the pharmacy. “… … According to Kikimoto, provision of health insurance will go a long way towards addressing the issue of self-medication, which can in turn lead to over-use or misuse of drugs, resulting in antimicrobial resistance.”

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Super-Scary Fungi

Stat - The superbug Candida auris is giving rise to warnings — and big questions

H Branswell; Stat News;

“What’s known about the fungus Candida auris confounds the scientists who study it, the doctors who struggle to treat the persistent infections it causes, and the infection control teams that endeavor to clear it from hospital rooms after infected patients leave. But the list of what’s not known about this highly unusual fungus is longer still — and fascinating. Experts say there’s an urgent need for answers and for funding with which to generate them. Candida auris was first spotted a decade ago in Japan, and more recently has been popping up in far-flung parts of the globe. The fungus doesn’t behave like a fungus. It causes outbreaks like a bacterium and is generally highly resistant to available antifungal drugs. It’s a growing problem, and a deeply concerning one….” This article has the view of a number of scientists.

Excerpt:

“The nearly simultaneous emergence on different continents of a highly drug resistant fungus that acts like a bacteria seems … well, kind of unsettling. What happened to allow this species of Candida to act in ways Candida fungi don’t normally act? A related concern: If this fungal species learned this trick, can others? Is that what the future holds? A just-published study in the journal mBio theorizes that climate change may have contributed in part to the emergence of C. auris. The authors say that historically the human body temperature has acted as protection against invasive fungal infections — in effect, we’re too hot for them to be able to grow well in us. But as the globe has warmed, they’ve adapted. If the theory is correct, other fungi may follow C. auris’ path, posit Arturo Casadevall, of the Johns Hopkins Bloomberg School of Public Health, and his co-authors. “Whether C. auris is the first example of new pathogenic fungi emerging from climate change … its emanation stokes worries that humanity may face new diseases from fungal adaptation to hotter climates,” they write….”

Global health security

IPS - Here’s How the World Can Be Better Prepared to Handle Epidemics

I Nsofor; http://www.ipsnews.net/2019/07/heres-world-can-better-prepared-handle-epidemics/

Focus here on what G20 countries can and should do.

“The 2019 G20 Summit was held recently in Osaka, Japan. The Summit ended with the “G20 Osaka Leaders’ Declaration”, which identifies health as a prerequisite for sustainable and inclusive economic growth, and the leaders committed to various efforts to improve epidemic preparedness. These efforts are commendable, but the G20, comprised of 19 countries and the European Union with economies that represent more than 80 percent of global Gross Domestic Product (GDP), also must do more to lead by example in epidemic preparedness by ensuring they all have a ReadyScore. This is managed by preventepidemics.org, the world’s first website to provide clear

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and concise country-level data on epidemic preparedness. It measures a country’s ability to find, stop and prevent health threats. Then, they need to demonstrate they are ready to take steps to improve their score, as needed….” See ReadyScore.

GHN - Global Health Security Starts with Countries

https://www.globalhealthnow.org/2019-07/global-health-security-starts-countries

By C Ihekweazu (Director-General of the Nigeria Centre for Disease Control).

Blended finance for global health

KFF (Brief) - Blended Finance for Global Health: Summary of a Policy Roundtable

J Michaud & J Kates; https://www.kff.org/global-health-policy/issue-brief/blended-finance-for-

global-health-summary-of-a-policy-roundtable/

« Blended finance – the strategic use of public and philanthropic financing to catalyze private sector investments1 – has been the subject of increasing attention in development and global health, including by the U.S. government. Last year, Congress and the White House agreed to create a new government agency (the Development Finance Corporation, DFC) focused on blended finance and private sector investment, USAID has instituted policy changes to support of more private sector engagement, and the agency recently released a blended finance roadmap for global health. However, growing excitement in this area has not always translated into consistent action, and many remain unfamiliar with how blended finance works and what its potential is. Though we have seen new blended finance projects in health launched over the last few years, the health sector still comprises a small proportion of the blended finance portfolio globally. In the past only a small percentage of U.S. blended finance support focused on the health sector and overall funding amounts for blended finance are small compared to traditional assistance, raising questions of how global health will fit within U.S. blended finance efforts going forward. To examine this issue further the Kaiser Family Foundation held a policy roundtable in February 2019 with a group of stakeholders and experts. The discussion focused on the role of the U.S., the potential and the challenges of blended finance for global health, and recommended next steps. This brief provides some background on blended finance and global health, and summarizes key points from the discussion. »

Mauritius Leaks (& Bob Geldof)

https://www.icij.org/investigations/mauritius-leaks/treasure-island-leak-reveals-how-mauritius-

siphons-tax-from-poor-nations-to-benefit-elites/

“Treasure Island: Leak Reveals How Mauritius Siphons Tax From Poor Nations To Benefit Elites. Based on 200,000 files, Mauritius Leaks exposes a sophisticated system that diverts tax revenue from poor nations back to the coffers of Western corporations and African oligarchs….”

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As mentioned in the intro. Not that clear to what extent the leaks still represent the current situation in Mauritius (probably to some extent).

“Mauritius Leaks, a new investigation by the International Consortium of Investigative Journalists and 54 journalists from 18 countries, provides an inside look at how the former French colony has transformed itself into a thriving financial center, at least partly at the expense of its African neighbors and other less-developed countries. The island, which sells itself as a “gateway” for corporations to the developing world, has two main selling points: bargain-basement tax rates and, crucially, a battery of “tax treaties” with 46 mostly poorer countries. Pushed by Western financial institutions in the 1990s, the treaties have proved a boon for Western corporations, their legal and financial advisers, and Mauritius itself — and a disaster for most of the countries that are its treaty partners. “What Mauritius is providing is not a gateway but a getaway car for unscrupulous corporations dodging their tax obligations”…”

And not a good week for Bob Geldof either. We can only hope his offspring (like Bono’s son, in the band ‘Inhaler’) starts making music : )

But see also an poignant but apt tweet from Anand Giridharadas: “Now, this isn't Goldman Sachs. Geldof's shift into this kind of work reflects his times. All around the world, ultra-elites are pushing the theory that the best way to help people is no longer aid or government, but "win-win" business. It's a fund to make the world better.”

7th WHO No Tobacco report & other tobacco control news

Cfr. a tweet on the launch, later today:

“ We're getting ready for the launch of the 7th @WHO #NoTobacco Report from Rio de Janeiro on Friday, 26 July 2019. Tobacco control is a perfect example of what can be achieved in global health through health diplomacy and global commitment.”

FT – Tobacco campaign group looks to name and shame

https://www.ft.com/content/cf60deb6-ae28-11e9-8030-530adfa879c2

“Michael Bloomberg-backed initiative launches online database of companies promoting tobacco.”

“An online platform naming companies that help to promote the tobacco industry is the latest effort from a $20m initiative funded by the US billionaire Michael Bloomberg to counter tobacco industry tactics. The online database, launched on Thursday, was compiled by Stopping Tobacco Organisations and Products, the first globally co-ordinated tobacco industry campaign group. It lists companies, think tanks and other organisations that Stop believes promote the tobacco industry without necessarily acknowledging their links to the sector, according to the researchers.”

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Hypertension

HPW - Two-Thirds Of People In Low & Middle-Income Countries With

Hypertension Don’t Get Treatment

https://www.healthpolicy-watch.org/two-thirds-of-people-in-low-middle-income-countries-with-

hypertension-dont-get-treatment/

From late last week. “… a new study in The Lancet has found that two-thirds of people in low- and middle-income countries, where the prevalence of hypertension is rising most rapidly, don’t receive any treatment at all. People in sub-Saharan Africa, which has the highest incidence of hypertension, or high blood pressure, had the least access to treatment, according to the study, The state of hypertension care in 44 low-income and middle-income countries: a cross-sectional study of nationally representative individual-level data from 1·1 million adults, published Thursday….”

SRHR

Guardian - Cost of global push to prevent women dying in childbirth to increase

sixfold

https://www.theguardian.com/global-development/2019/jul/19/cost-of-global-push-to-prevent-

women-dying-in-childbirth-to-increase-sixfold?CMP=share_btn_tw

News from late last week. “The cost of preventing women from dying in childbirth is projected to increase sixfold by 2030, requiring billions of dollars to achieve global targets, according to the UN. The estimate was released by the UN population fund (UNFPA) on Thursday, offering a snapshot of the scale of the challenge the agency has set itself to end preventable maternal deaths by 2030. Similarly ambitious is a target established by the UN sustainable development goals to reduce maternal mortality to less than 70 deaths for every 100,000 live births. Researchers at UNFPA and Johns Hopkins University calculated that the annual cost of direct services, such as paying for medical staff, drugs and supplies when a woman is giving birth, will reach $7.8bn (£6.2bn) by 2030, up from an estimated $1.4bn last year. Donor aid for maternal healthcare fell between 2013 and 2017, from $4.4bn $3.9bn….”

“…UNFPA also projected that the annual cost of meeting the growing need for modern forms of contraception would almost double, from $2.3bn in 2018 to $4.5bn by 2030. The UNFPA, working with Johns Hopkins, Victoria University, the University of Washington and global health organisation Avenir Health, will present more detailed cost projections on maternal health, family planning, ending female genital mutilation and child marriage at a November summit in Kenya to mark the 25th anniversary of the landmark international conference on population and development held in Cairo. Projections for individual countries will also be produced to encourage governments to increase their health budgets….”

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HPW - US Pick For UN Ambassador Disputes Sexual & Reproductive Rights, Draws

Opposition

https://www.healthpolicy-watch.org/us-pick-for-un-ambassador-disputes-sexual-reproductive-

rights-draws-opposition/

From Wednesday: “A United States congressional committee met [today] to vote on whether or not to recommend Andrew Bremberg for confirmation as Ambassador to the United Nations in Geneva. Bremberg is a controversial pick due to his extreme stance against abortion and his pledge to vote against any UN resolution that includes the right to abortion where legal, even in cases of sexual violence….”

“If recommended by the Committee in [today’s] vote, Bremberg’s confirmation will still be subject to a vote by the full Senate….”

Oxfam (blog) - Supporting Feminist and Queer Activists Under Growing Threat

Worldwide

https://oxfamblogs.org/fp2p/supporting-feminist-and-queer-activists-under-growing-threat-

worldwide/

“… the Urgent Action Sister Funds, recently published our report, Feminist Resistance and Resilience––A Reflection on Closing Civic Space. The report brings together the experiences of several dozen women human rights defenders (WHRDs), as well as LGBTI activists from across North America, Europe, Central Asia, Middle East, Africa, and Latin America. Our report found WHRDs and LGBTI activists are facing increased censorship, surveillance, harassment, and threats from their governments, and are often the first to bear the brunt of violence. The report finds there to be a growing consensus within the broader human rights community that our current approaches to protection and safety are inadequate. But while it is clear that the mechanisms available to WHRDs now are failing, the report also finds clear lessons for funders who want to support activists in this difficult climate. Five key recommendations are explained in greater detail below….”

And a link:

Lancet Viewpoint - Sexual and reproductive health and rights and population policies: from “either/or” to “both/and” (by Carmen Barroso et al)

Breastfeeding in Africa

Nature - Mapping exclusive breastfeeding in Africa between 2000 and 2017

https://www.nature.com/articles/s41591-019-0525-0

“Exclusive breastfeeding (EBF)—giving infants only breast-milk (and medications, oral rehydration salts and vitamins as needed) with no additional food or drink for their first six months of life—is one of the most effective strategies for preventing child mortality. Despite these advantages, only 37% of

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infants under 6 months of age in Africa were exclusively breastfed in 20175, and the practice of EBF varies by population. Here, we present a fine-scale geospatial analysis of EBF prevalence and trends in 49 African countries from 2000–2017, providing policy-relevant administrative- and national-level estimates….”

“Previous national-level analyses found that most countries will not meet the World Health Organization’s Global Nutrition Target of 50% EBF prevalence by 20256. Our analyses show that even fewer will achieve this ambition in all subnational areas….” Only 3 African countries seem on track.

Physical activity gender gap

Lancet Public Health (Editorial) - Time to tackle the physical activity gender gap

https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(19)30135-5/fulltext

“2019 might well be the year of women's sport. While coverage has long been overshadowed by the male leagues, viewing opportunities and public engagement has been growing. Public excitement perhaps peaked during the Women's Football World Cup, with television audiences across the world increased by millions on previous years. As female athletes challenge inequalities over pay and investment and shift social expectations, could their example be used to tackle the gender gap in physical activity in the wider population?...”

SDGs – Was it all mere ‘lip service’ in 2015 ?

BertelsmannSt/UNSDSN 2019 report – Long in words but short on action: UN

sustainability goals are threatened to fail

https://www.bertelsmann-stiftung.de/en/topics/latest-news/2019/june/long-in-words-but-short-

on-action-un-sustainability-goals-are-threatened-to-fail/

From 19 June, already, but worth re-emphasizing, heading towards the SDG Leaders’ summit in September - see a tweet from Helen Clark: “#SDGs progress is way off track: on many goals & targets it's slow; on some, trends are negative. BertelsmannSt/ UNSDSN 2019 report tells unvarnished truth: was signing up to #2030Agenda mere lip service? Will Leaders' Summit in Sept resolve to do better?”

“In 2015, the international community pledged to jointly contribute to better economic, ecological and social development by 2030. In September, the heads of state and government will meet again for the first time to review the situation. The current SDG report shows that while the global community talks a lot about sustainability goals, it does not invest enough in implementing them. What began as a historic summit could end up as mere lip service. In 2015, 193 states agreed to implement the 17 UN Sustainable Development Goals by 2030. The fight against poverty and hunger is just as important as the commitment to more climate protection or better educational opportunities. This year, the heads of state and government want to meet for the first time for an interim review in New York. The results should be sobering: The latest edition of the SDG Report*

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shows that no country is currently on track to meet all targets by 2030. The industrialized countries play an ambivalent role in their implementation. On the one hand, they come closest to fulfilling the goals. On the other hand, they hinder global implementation by incurring environmental and economic costs for third countries due to high living standards and consumer preferences. These are the findings of the current Sustainable Development Report, based upon which we and the Sustainable Development Solutions Network (SDSN) have been analyzing the implementation of the UN goals since 2015.”

Devex - Domestic resources for development a 'highly neglected' action area,

experts say

https://www.devex.com/news/domestic-resources-for-development-a-highly-neglected-action-

area-experts-say-95313

“Development leaders crafted the Addis Ababa Action Agenda with an eye on mobilizing domestic public resources. But the focus on helping countries raise more funds and effectively manage them, borne from the Financing for Development Forum in 2015, has since been eclipsed by a focus on private capital and private business, according to some development experts. “It’s highly neglected. It’s not a matter of chance, as neglected as it is, it is systematically happening,” said Neeti Biyani, who leads the Centre for Budget and Governance Accountability’s advocacy efforts around transparency and accountability in the global financial system….”

Global Policy Watch - VNRs, National “Spotlight” Reports and the Future of the

HLPF

E Marmo; https://www.globalpolicywatch.org/blog/2019/07/23/vnrs-national-spotlight-reports/

Recommended analysis & quotes from a side-event at the HLPF, on Voluntary National Reviews & civil society shadow ‘Spotlight’ reports. “An event titled “National Reports on 2030 Agenda: What do They (Not) Tell Us?,” jointly hosted by the United Nations Development Program (UNDP), the Committee for Development Policy (CDP), Global Policy Forum (GPF) and Social Watch, explored these tensions and sought to identify opportunities to improve reporting, monitoring, follow-up and accountability in these national review processes….

Quote: “Roberto Bissio of Social Watch discussed findings from national and regional “spotlight reports” from civil society, quoting examples from Finland, Guatemala, the Philippines, Jordan, France and the regional report on the EU and its “externalities” among others. Highlighting the importance of independent reports in holding governments accountable to areas often omitted in VNRs (like inequalities, extra-territorial impacts and spillovers, tax havens, arms flows etc.), Bissio presented clear tensions in achieving the SDGs at a national level. These tensions are not receiving the level of discussion needed in the VNRs, but countries cannot meet the 2030 deadline without addressing them….”

IISD - HLPF Ministerial Segment Calls for Commitment to “Very Obvious” Solutions

http://sdg.iisd.org/news/hlpf-ministerial-segment-calls-for-commitment-to-very-obvious-solutions/

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“In the first of three keynote speeches, Mary Robinson, Chair of The Elders, said that in October 2018, the IPCC report “altered our understanding of the situation that we’re in,” making it clear that a 1.5-degree Celsius rise is the upper limit of safety for the world. Along with the IPBES report in May 2019 on species extinctions, these findings made clear that the 2030 Agenda and the Paris Agreement on climate change can no longer be considered voluntary, Robinson said. “

Excerpt:

“Hoesung Lee, Chair of the Intergovernmental Panel on Climate Change (IPCC), gave the final keynote speech. He explained that global warming is already impeding progress towards some SDGs, for example driving outmigration in agriculturally dependent countries. He said that the 1.5 degree warming limit would help achieve most SDGs, but it also creates some trade-offs that must be balanced. For example, all pathways to a 1.5 degree limit require removing carbon dioxide (CO2) from the atmosphere, and this entails planting trees and various forms of carbon capture and storage, all of which will have a large land and water footprint. CO2 removal, therefore, will compete with other uses for land and water, and have impacts on agricultural systems and biodiversity. He said reaping the potential benefits is contingent on international cooperation, with social justice and equity as core elements. Lee said the solution is “very obvious,” which is to pursue a world of high-efficiency energy and materials consumption, along with low GHG-intensive food consumption. He concluded that the 1.5 limit has been found unfeasible in a world characterized by inequality, poverty and lack of international cooperation.”

IPS - Will a Global Fund Help Deliver UN’s Development Agenda?

http://www.ipsnews.net/2019/07/will-global-fund-help-deliver-uns-development-agenda/

“… A new joint declaration, “Stand Together Now for a Just, Peaceful and Sustainable World”, adopted by dozens of CSOs July 17, said: “We are standing alongside many others around the world in calling out a state of emergency. Humanity cannot afford to wait, people are demanding transformative change, and we are not willing to accept the current lack of action and ambition from many governments …”

Nature (World View) - Sustainable development will falter without data

https://www.nature.com/articles/d41586-019-02139-

w?utm_source=twt_nnc&utm_medium=social&utm_campaign=naturenews&sf215993615=1

“Unless governments establish competent monitoring systems, the world will not reach the UN Sustainable Development Goals, says Jessica Espey.”

“… The creation of fit-for-purpose systems will require a massive, coordinated commitment from governments and the international community. The research group I lead in the UN Sustainable Development Solutions Network outlines the needs in a forthcoming report (see www.sdsntrends.org). Four building blocks are crucial: strong governance; appropriate policies and standards; a culture of innovation; and a case that can convince global donors and national governments to make sufficient investments. … … …Sustainable development will falter without data. We must put national data systems in place, or the SDGs will be little more than feel-good aspirations.”

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Medium - The tyranny of national averages

M Burke; https://medium.com/atlasai/the-tyranny-of-national-statistics-d3a79af526a9

This article went viral. For good reason, check out the pictures of Africa, at the bottom. Burke shows the growing ability — and clear importance — of measuring outcomes below the national level.

Lancet Offline – Global health's indifference to poverty must end

R Horton; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31710-6/fulltext

“Global health thrives on fashion. During the era of the MDGs, that fashion was poverty. The manifesto for the MDGs was the Commission on Macroeconomics and Health, chaired by Jeff Sachs and published in 2001…. … Fashions have changed. Now we are mobilised by universal health coverage, global health security, and a climate emergency. These issues are rightly important. Perhaps the fact that since 1990 over 1 billion people have been taken out of extreme poverty means that global health activists see poverty as old news. Yet beating poverty remains a prerequisite for flourishing and sustainable lives. Disappointingly, global health and its leaders have judged poverty to be yesterday's idea….”

Horton concludes: “Ending poverty must return as a political objective for global health. Health professionals are uniquely placed to draw attention to the acute personal consequences of poverty. We can be powerful advocates for action. Poverty is not an economic state. It is an insidious disease of the human soul. Poverty consumes lives, eroding mental resources, diminishing cognitive capacities, and destroying life possibilities. Universal health will never be achieved unless and until poverty is eradicated. How tragic that our global health leaders have forgotten this lesson.”

HSG/Alliance call for mentees & other HSG/EV news & blogs

HSG/Alliance call for mentees: publication mentorship for first-time women

authors in the field of HPSR

https://www.healthsystemsglobal.org/blog/349/Call-for-Mentees-Publication-Mentorship-for-first-

time-women-authors-in-the-field-of-HPSR.html

We reckon you’ve seen this call already by now but just in case. Deadline is September 6.

Check out also the latest HSG newsletter for updates on Health Systems Global & all TWGs.

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IHP - Democratizing research and bridging gaps – insights from the DHAKA Global

Conference on Implementation Science and Scale-up

Pragati Hebbar, Olivia Biermann, Joarder Taufique, Robinson Karuga & A.S.M.

Shahabuddin;https://www.internationalhealthpolicies.org/featured-article/democratizing-research-

and-bridging-gaps-insights-from-the-dhaka-global-conference-on-implementation-science-and-

scale-up/

Emerging voices, EV alumni & facilitators give their take on the Dhaka Global conference on Implementation Science and Scale-up. Warmly recommended!

HSG (blog) – Hearing the Emerging Voices: Views on good locations for global and

regional health systems research symposia

Charles Ssemugabo (EV 2016 & current EV resident at ITM);

https://www.healthsystemsglobal.org/blog/351/Hearing-the-Emerging-Voices-views-on-good-

locations-for-global-and-regional-health-systems-research-symposia.html

Charles starts from a Twitter discussion from a while ago on good locations for future HSR symposia in LMICs (where Stefan Peterson, among others, argued ‘let the demand side speak’). And then goes on giving some results from a quick survey/crowdsourcing among EV4GH, who gave their preferred options in their own continent, even if they don’t all comply with the 8 criteria put forward by HSG in another blog post. One thing is sure: we all agree the next global HSR symposium should be in a LMIC.

Papers of the week

BMJ Global Health (Commentary) – The problem of ‘trickle-down science’ from

the Global North to the Global South

D Reidpath et al; https://gh.bmj.com/content/4/4/e001719

“Countries in the Global South continue to struggle to train and retain good researchers and practitioners to address local, regional and global health challenges. As a result, there is an ongoing reliance on the Global North for solutions to local problems and an inability to develop alternative approaches to problem solving that take local (non-northern) contexts into account. Current paradigms of scientific advancement provide no long-term models to challenge the status quo or privilege knowledge that is generated primarily in the Global South. This has major impacts on access to funding which perpetuates the problem. There needs to be a concerted and demonstrable shift to value and promote the development of research and scientific traditions that are borne out of the reality of local contexts that complement knowledge and evidence generated in the Global North.”

“Trickle-down economics holds that the way to lift the poor out of poverty is to support wealth creation in those who are already rich. The underlying assumption is that as the wealth of the rich grows, they will purchase more goods and services, creating opportunities for the less well-off to benefit. The theory is in direct contrast to one that actively redistributes wealth. The analogy in

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science is that the way to improve science in the less developed parts of the world (the Global South) is to concentrate the intellectual gravitas, the resources and the opportunities into the Global North. The concentration will produce the best science which will trickle methods, theories, and insights down to the Global South….” Like with trickle down economics, that’s not exactly working out.

Poignant must-read.

Human Resources for Health - Salaried and voluntary community health workers:

exploring how incentives and expectation gaps influence motivation

H Ormel et al; https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-019-

0387-z

“The recent publication of the WHO guideline on support to optimise community health worker (CHW) programmes illustrates the renewed attention for the need to strengthen the performance of CHWs. Performance partly depends on motivation, which in turn is influenced by incentives. This paper aims to critically analyse the use of incentives and their link with improving CHW motivation.”

Conclusions: “Whether CHWs are employed or engaged as volunteers has implications for the way incentives influence motivation. Intrinsic motivational factors are important to and experienced by both types of CHWs, yet for many salaried CHWs, they do not compensate for the demotivation derived from the perceived low level of financial reward. Overall, introducing and/or sustaining a form of financial incentive seems key towards strengthening CHW motivation. Adequate expectation management regarding financial and material incentives is essential to prevent frustration about expectation gaps or “broken promises”, which negatively affect motivation. Consistently receiving the type and amount of incentives promised appears as important to sustain motivation as raising the absolute level of incentives.”

Globalization & Health - Zika, abortion and health emergencies: a review of

contemporary debates

Clare Wenham et al; https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-

019-0489-3

“The Zika outbreak provides pertinent case study for considering the impact of health emergencies on abortion decision-making and/or for positioning abortion in global health security debates. This paper provides a baseline of contemporary debates taking place in the intersection of two key health policy areas, and seeks to understand how health emergency preparedness frameworks and the broader global health security infrastructure is prepared to respond to future crises which implicate sexual and reproductive rights. Our paper suggests there are three key themes that emerge from the literature; 1) the lack of consideration of sexual and reproductive health (SRH) services in outbreak response 2) structural inequalities permeate the landscape of health emergencies, epitomised by Zika, and 3) the need for rights based approaches to health. Global health security planning and response should specifically include programmatic activity for SRH provision during health emergencies.”

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International Health - International funding for mental health: a review of the last

decade

B H Liese et al ; https://academic.oup.com/inthealth/advance-article-

abstract/doi/10.1093/inthealth/ihz040/5537164?redirectedFrom=fulltext

“Mental health represents one of the most significant and increasing burdens to global public health. Over the past decade, the once invisible field has gained recognition on the global health agenda and this increased recognition is expected to increase international funding for mental health. Our review found that few studies have been conducted as to the level of international funding for mental health and there is a need for a differentiated assessment. We conducted such an assessment of global development-related assistance for mental health between 2006 and 2016 and established categories to serve as a baseline for future measurement. We found that development assistance specifically dedicated to mental health accounted for just 0.3% of all development assistance for health. … .”

Globalization & Health - How environmental treaties contribute to global health

governance

J-F Morin et al ; https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-019-

0493-7

“Recent work in international relations theory argues that international regimes do not develop in isolation, as previously assumed, but evolve as open systems that interact with other regimes. The implications of this insight’s for sustainable development remains underexplored. Even though environmental protection and health promotion are clearly interconnected at the impact level, it remains unclear how global environmental governance interacts with global health governance at the institutional level. In order to fill this gap, this article aims to assess how environmental treaties contribute to global health governance….”

Health Systems & Reform (Commentary) - Political Context and Health Financing

Reform

J Shiffman; https://www.tandfonline.com/doi/full/10.1080/23288604.2019.1633894

Shiffman comments on the special issue (see also previous IHP newsletters).

“The articles in this special issue make two particularly valuable contributions to understanding health financing reform. First, through historical case studies, they provide rich empirical evidence showing that reform is more than a technical matter: it is also a heavily political undertaking. Second, they provide guidance to reformers on political management, illustrating the utility of a framework that identifies groups of actors who facilitate and obstruct change, including interest groups and political leaders….”

“The articles in this special issue attend to political context, but highlight individual agency. In this commentary I do the reverse. I do so with a view to calling attention to some of the larger and more enduring factors—pertaining to nature of the political system and party rule, features of civil

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society and the global political environment—that alongside human agency may explain why major health financing reforms advance in some national settings but not others….”

BMJ Global Health Commentary – It is not enough that we require data to be

shared; we have to make sharing easy, feasible and accessible too!

G K Hajduk et al ; https://gh.bmj.com/content/4/4/e001550

“The sharing of health data, including clinical trial data, is required more and more often by research publishers, regulatory agencies, ethics committees and funding bodies. Despite these requirements, there are currently no clear standards and guidelines of how, where and when researchers should share their data. The confusion among researchers regarding issues related to data sharing has led funders such as The European and Developing Countries Clinical Trials Partnership (EDCTP) to devise initiatives that will provide their grantees, and the wider scientific community within the field of global health research, with clear guidance and a range of tools to facilitate the data sharing process. In an effort to support and facilitate data sharing, the EDCTP is working in collaboration with The Global Health Network to assess whether a cross-cutting knowledge hub around data sharing would help researchers find the optimum repository and to gather their data in a form that is ready for sharing.”

Globalization & Health - Book review: Human Rights in Global Health: Rights-

Based Governance for a Globalizing World

https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-019-0491-9

Unni Gopanathan reviews the book “Human Rights in Global Health: Rights-Based Governance for a Globalizing World” edited by Benjamin Mason Meier and Lawrence O. Gostin. And does so elegantly.

SS&M - How do actors with asymmetrical power assert authority in policy agenda-

setting? A study of authority claims by health actors in trade policy

B Townsend et al; https://www.sciencedirect.com/science/article/abs/pii/S0277953619304241

Highlights: “How non-state actors attempt to exert authority in health governance is underexplored. Using the trade domain as a case example of the commercial determinants of health. We combine framing analysis with authority claims in policy actor submissions. We identify four claims to authority; institutional; networked; legal; and expert. We show differences in how market and public interest actors use authority claims.”

IJHPM – It Will Take a Global Movement to Curb Corruption in Health Systems;

Comment on “We Need to Talk About Corruption in Health Systems”

M Witvliet; http://www.ijhpm.com/article_3649.html

We are always in favour of global movements : ) “Corruption in health systems is a problem around the world. Prior research consistently shows that corruption is detrimental to population health. Yet public health professionals are slow to address this complicated issue on a global scale. In the

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editorial entitled “We Need to Talk About Corruption in Health Systems” concern with the general lack of discourse on this topic amongst health professionals is highlighted. In this invited commentary three contributing factors that hamper public dialogue on corruption are discussed. These include (i) corrupt acts are often not illegal, (ii) government and medical professionals continued acceptance of corruption in the health systems, and (iii) lack of awareness within the general public on the extent of the problem. It is advocated that a global movement that is fully inclusive needs to occur to eradicate corruption.”

For another IJHPM Comment on the Editorial, see Demystify False Dilemmas to Speak About Corruption in Health Systems: Different Actors, Different Perspectives, Different Strategies; Comment on “We Need to Talk About Corruption in Health Systems

Blogs & mainstream articles of the week

Felix Dodds – Is Civil Society arguing itself out of political space?

https://blog.felixdodds.net/2019/07/is-civil-society-arguing-itself-out-of.html

Must-read blog, based on Dodss’ new book, Stakeholder Democracy

“In the context of sustainable development, this book describes how we are moving from representative to participatory democracy, and how we are now in a "stakeholder democracy," which is working to strengthen represented democracy in a time of fear. Since the 1992 Rio Earth Summit the idea of stakeholder democracy has grown, with stakeholders engaged in helping governments and intergovernmental bodies make better decisions, and in helping them to deliver those decisions in partnerships amongst various stakeholders, with and without government. Seen through a multi-stakeholder, sector and level lens, this book describes the history of the development of stakeholder democracy, particularly in the area of sustainable development. … The book illustrates successful practical examples of multi-stakeholder partnerships (MSPs) to implement agreements and outline elements of an MSP Charter. This will provide a benchmark for partnerships, enabling those being developed to understand what the necessary quality standards are and to understand what is expected in terms of transparency, accountability, financial reporting, impact and governance.”

In this blog, Dodds zooms in more specifically on the two different political discourses in play since 1992, that of stakeholders and that of civil society.

And argues, “the conceptual framework for civil society by its nature increases the space of industry from one of nine [i.e. as there are 9 “stakeholders”] to one to two. So let's be clear the advocates for this by their own actions are giving up massive space for industry and reducing space for other stakeholders. It also allows governments and intergovernmental organizations to just group anyone who isn’t industry into a catch-all group….”

Gulf News - UAE’s foreign aid always exceeds UN target

https://gulfnews.com/opinion/op-eds/uaes-foreign-aid-always-exceeds-un-target-1.65235685

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Overview of the UAE’s foreign aid, by Kristian Alexander.

Project Syndicate - The Most Important Health-Care Tool Is Trust

J Farrar; https://www.project-syndicate.org/commentary/health-trust-science-wellcome-global-

monitor-by-jeremy-farrar-2019-07

Farrar comes back on the results of the Wellcome Global Monitor from a while ago, pointing out how vital trust is for public health outcomes. “A new survey offers unprecedented data on public attitudes toward science and health. As the world faces profound science-related challenges – from climate change to antimicrobial resistance – policymakers, practitioners, and civic leaders would do well to learn as much as possible from it.”

“…Public-health outcomes like that cannot be achieved without trust. No matter how exciting the treatment, how clever the delivery method, or how robust the science, there will be no impact unless the local community is open to it. A single survey cannot explain why people feel the way they do, let alone offer a foolproof strategy for governments, international institutions, and health-care professionals seeking to win people’s trust. But, as the world faces profound science-related challenges – from climate change to antimicrobial resistance – policymakers, practitioners, and civic leaders would do well to learn as much as possible from the Wellcome Global Monitor’s unprecedented, unique, and invaluable data.”

Tweet of the week

Freddy Kitutu (EV 2013), from the ReACT Africa conference on AMR in Nairobi:

"What doesn't kill microbes, makes them stronger", Philip Nguyen, Director, QI, USP. Substandard Antimicrobial medicines breed AMR. #RANconference2019 #SCMeetingAMR “

Global health events & announcements

BMC blog - MSF’s Scientific Days: embracing fear in a changing climate

BMC blog;

A reecap of the MSF scientific days. “Médecins Sans Frontières (MSF) held their sixteenth annual Scientific Days program May 9-10, 2019 at the Royal Society in London, which BMC was proud to attend and be an official sponsor of. Each year during Scientific Days, MSF brings together delegates – and through its live-stream, a virtual audience from around the world – to share the latest research and innovation in humanitarian medical programming. Here, Anna Brow shares an overview of this year’s event.”

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“At this year’s annual Scientific Days conference held by Médecins Sans Frontières (MSF) in London, delegates were dared to embrace fear. From the fear of unknown challenges to the known threats that we see on the frontline of humanitarian aid, presenters encouraged us to run towards that fear to create real change….”

Global governance of health

Lancet Perspective – The public health and industry partnership conundrum

Sandro Galea; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31615-

0/fulltext

Sandro Galea reviews the new book by Jonathan Marks, Director of the Bioethics Program at Penn State University, The Perils of Partnership: Industry Influence, Institutional Integrity, and Public Health. “He shows us how industry engagement imperils the work of public health and argues that, by consequence, the goals of public health are far better served by dissociation from the private sector altogether….” Galea admires the book but doesn’t agree with Marks. “Simply put, I do not think it is possible, nor desirable, for public health to disengage from corporate sector partners; the public–private relationship is here to stay and we should be using Marks's work to thoughtfully inform such engagements, not as a guide to disengagement. Three lines of reasoning lead to this conclusion….”

CGD (blog) - Foreign Private Investment in Low-Income Countries: More Important Than You Think

Nancy Lee et al; https://www.cgdev.org/blog/foreign-private-investment-low-income-countries-

more-important-you-think

“In a world of stagnating public aid, limited fiscal space, and rising public debt in low-income countries (LICs), can they realistically expect to rely more on private finance from foreigners? What does the evidence suggest? Our new paper looks at recent cross-border private capital inflows to LICs. You might be surprised at what has happened since the global financial crisis….”

The conclusion:

“Much of the news for LICs is encouraging, and some of it flies in the face of conventional wisdom. For LICs, private inflows are an important and growing source of finance. The inflows are not all captured by resource-rich LICs. Increasingly, policies, not just resource endowments, shape LIC destinations for foreign capital. The relation between median capital inflows/GDP and median regulatory quality is significantly positive for non-resource-rich LICs. While many have focused on China’s role as a LIC creditor, China is also playing a key role in diversifying sources of FDI in Africa.

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But there is also not-so-good news. More private foreign investment does not necessarily mean more private domestic investment in LICs. And private inflow ratios do not predictably rise with country per capita income. That means that donors reducing concessional finance as countries move out of LIC status should not assume private inflows will take up the slack.”

New Book - New book explores innovations in global health

https://eurekalert.org/pub_releases/2019-07/uotr-nbe_1072219.php

“Poor access to care in low- and middle-income countries due to high costs, geographic barriers, and a shortage of trained medical staff has motivated many organizations to rethink their model of health service delivery. Many of these new models are being developed by private sector actors, including non-profits, such as non-governmental organizations, and for-profits, such as social enterprises. By partnering extensively with public sector organizations, these non-state actors have enormous potential to scale innovation in global health. A new book from Rotman-UTP Publishing, Private Sector Entrepreneurship in Global Health, provides insights into how these leading organizations operate and target hard-to-reach groups may yield key insights to sustainably improve health care for all….”

Access Observatory 2019 Report

https://docs.wixstatic.com/ugd/37a51e_0a74a93f03d54c9e9ece916f774930df.pdf

Cfr an apt tweet from Kalypso Chalkidou: “Given limited donor investment, Big Pharma takes lead in health system strengthening and communication/education when it comes to cancer/NCDs in LMICs. Emphasis on cancer drugs (breast, cervical, lung, paed) in Kenya/Eastern Africa, South Africa, Asia.”

Opinion: It's time to address the root causes of human suffering in the Sahel

Mark Lowcock (UN Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, & head of OCHA). ; Thomson Reuters;

“Military and humanitarian efforts in the Sahel will fail unless there is sustained development, better leadership and action on climate risks.” Coming from Lowcock’s mouth, probably good to heed.

Three areas of action are needed: “… First, the Sahel needs sustained development investment to build basic services, improve infrastructure, manage population growth and find more diversified income sources for people. … … Second, strong national leadership, together with more effective international support, is needed to strengthen the rule of law, judicial systems, and human rights frameworks, which can help bring sustainable peace and development to the region…. … Third, we need to continue to save and protect lives. This year, humanitarian agencies aim to help 15 million

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people in Burkina Faso, Cameroon, Chad, Mali, Niger and Nigeria with shelter, food, water and sanitation, livestock support, nutrition and health services. Donors, and especially the European States, have been very generous. However, six months into 2019, we’ve only reached 22.3 per cent funding….”

KFF - New Online Resource Tracks Legislation Affecting Global Health

https://www.kff.org/global-health-policy/press-release/new-online-resource-tracks-legislation-

affecting-global-health/

“A new KFF online resource tracks more than 30 bills introduced in the current (US) Congress that would affect global health policy….”

“The U.S. Global Health Legislation Tracker covers current legislation on an array of topics, from implementing a strategy to help end preventable maternal and child deaths to creating an action plan on climate change. There is also legislation regarding reproductive health, global health security, and LGBTI issues….”

CGD (blog) - China’s New Debt Sustainability Framework Is Largely Borrowed from the World Bank and IMF. Here’s Why That Could Be a Problem.

Scott Morris et al; https://www.cgdev.org/blog/chinas-new-debt-sustainability-framework-largely-

borrowed-world-bank-and-imf-heres-why-could

“At the second Belt and Road Forum for International Cooperation last April, China’s Ministry of Finance released a debt sustainability framework for the Belt and Road initiative. The announced DSF seems to be China’s answer to concerns about debt risks. But is it up to the task?...”

Health Finance Institute – issue 1 of their newsletter

https://mailchi.mp/22fae38a2c94/health-finance-institute-issue-1-july-2019?e=b6d11fd97d

“The Health Finance Institute (HFI) was formed in 2019 and it aims to expand the fiscal space for non-communicable diseases (NCDs) globally. By catalyzing financing and building partnerships, we work to increase access to prevention, management, treatment, and control of NCDs, helping achieve Sustainable Development Goal (SDG) 3: good health and well-being….”

“On May the 21st, 2019 alongside the 72nd World Health Assembly, we organized its Inaugural Symposium on Financing for NCDs in Geneva, Switzerland at the Geneva Graduate Institute. Check

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out our Symposium report. We are thrilled to have begun our second phase of work with WHO High Level Commission on NCDs, to support the Commission’s work to understand the need and scope for a global catalytic multidonor trust fund for NCDs and mental health….”

Lancet Editorial – Hopes for health from new European Commission leader

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31679-4/fulltext

The Lancet has some high hopes when it comes to the new EC leader, Ursula von der Leyen, after hearing her commitments and policy goals in the EP: “…Possessing a medical doctorate and a Masters in Public Health, von der Leyen is in a strong position to become a Commission President with a focus on health. Indeed, she opens her guidelines for the 2019–24 session of the European Parliament with the statement “Europe is a unique aspiration. It is an aspiration of living in a natural and healthy continent.” … … “…We hope that her medical background and her commitment to sustainable development will create a strong European Commission with a focus on public health and environmental sustainability.”

Lancet Editorial – The slowdown in eradicating hunger

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31680-0/fulltext

“In 2015, the UN set the goal to eradicate hunger and malnutrition and to ensure nutritious food for all (Sustainable Development Goal 2) by 2030. On July 18, the Food and Agriculture Organization (FAO) and UN partners published their annual report The State of Food Security and Nutrition in the World. Following the trend from the two previous reports, the results point to the unlikelihood of achieving this goal. … … Although we welcome the monitoring of the food insecurity and nutrition problem, which is key to assess progress, monitoring on its own is not enough to address the situation. If the policies implemented are not effective, then we must call for stronger political commitment and international cooperation to solve the roots of the problem: poverty and inequality. On Aug 1, Qu Dongyu begins a 4-year term as the new Director-General of FAO—we look forward to his proposals to get us on track to end hunger by 2030.”

And a quick link:

EC - European Commission appoints new Director-General to its department for international cooperation and development, reinforces top management across other departments

“The European Commission has today decided to appoint Mr Koen Doens to the position of Director-General in its department for international cooperation and development (DG DEVCO), in view of Mr Stefano Manservisi's retirement on 1 October 2019….”

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UHC

FT Health – Duterte’s health care-for-all drive faces tough execution test

https://www.ft.com/content/f9b54e00-ad46-11e9-8030-530adfa879c2

(gated) “Philippine politics and finance will struggle to deliver costly programme.”

Lancet Editorial – Prioritising primary care in the USA

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31678-2/fulltext

“Although the USA spends more on health care despite having worse outcomes than other high-income nations, one area where it underinvests is primary care. Research has shown that higher levels of spending on primary care lead to improved patient outcomes and lower overall health-care costs. On July 17, 2019, the Patient-Centered Primary Care Collaborative (PCPCC) issued the first report to look at primary care spending by state, including spending from across different types of payers: commercial insurance companies, government-provided insurance (Medicare and Medicaid), as well as the uninsured….”

Planetary health

Guardian - 'No doubt left' about scientific consensus on global warming, say experts

https://www.theguardian.com/science/2019/jul/24/scientific-consensus-on-humans-causing-global-

warming-passes-99

“The scientific consensus that humans are causing global warming is likely to have passed 99%, according to the lead author of the most authoritative study on the subject, and could rise further after separate research that clears up some of the remaining doubts. Three studies published in Nature and Nature Geoscience use extensive historical data to show there has never been a period in the last 2,000 years when temperature changes have been as fast and extensive as in recent decades…. It had previously been thought that similarly dramatic peaks and troughs might have occurred in the past, including in periods dubbed the Little Ice Age and the Medieval Climate Anomaly. But the three studies use reconstructions based on 700 proxy records of temperature change, such as trees, ice and sediment, from all continents that indicate none of these shifts took place in more than half the globe at any one time…”

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Guardian - EU moves to tackle deforestation caused by chocolate and other products

https://www.theguardian.com/global-development/2019/jul/25/eu-moves-to-tackle-deforestation-

caused-by-chocolate-and-other-products?CMP=twt_a-global-development_b-gdndevelopment

“Campaigners hail scheme to protect and restore forests around the world as ‘pivotal step’ towards ensuring goods remain untainted.”

Working paper - Zero Carbon Sooner: The case for an early zero carbon target for the UK

Tim Jackson; https://www.cusp.ac.uk/themes/aetw/zero-carbon-sooner/

By the one and only Tim Jackson, on the UK. No doubt also relevant for other ‘developed’ countries.

“This briefing paper addresses the question of when the UK should aim for zero (or net zero) carbon emissions. Starting from the global carbon budget which would allow the world an estimated 66% chance of limiting climate warming to 1.5o C, the paper derives a fair carbon budget for the UK of 2.5 GtCO2. The briefing then analyses a variety of emission pathways and target dates in terms of their adequacy for remaining within this budget. A key finding is that a target date for zero carbon is not sufficient to determine whether the UK remains within its carbon budget. Policy must specify both a target date and an emissions pathway. For a linear reduction pathway not to exceed the carbon budget the target year would have to be 2025. Nonlinear pathways, such as those with constant percentage reduction rates, have a higher chance of remaining within the available budget provided that the reduction starts early enough and the reduction rate is high enough. It is notable that reduction rates high enough both to lead to zero carbon (on a consumption basis) by 2050 and to remain within the carbon budget require absolute reductions of more than 95% of carbon emissions as early as 2030. On this basis, the paper argues in favour of setting a UK target for net zero carbon emissions by 2030 or earlier, with a maximum of 5% emissions addressed through negative emission technologies.”

Foreign Policy – Why central banks need to step up on global warming

Adam Tooze; https://foreignpolicy.com/2019/07/20/why-central-banks-need-to-step-up-on-global-warming/

Interesting analysis. “A decade after the world bailed out finance, it’s time for finance to bail out the world.”

Excerpts:

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“What central bankers—the world’s preeminent economic decision-makers since the 1980s—are beginning to worry about is the potential for climate change to trigger financial crisis. … … Two years later in Paris, leading central bankers and regulators founded the Network for Greening the Financial System (NGFS), which aims to throw the weight of key financial institutions behind the goals of the Paris climate agreement. The membership of the NGFS now includes most of the central banks of the G-20, such as the European Central Bank and the People’s Bank of China. Private financial actors have also joined the green finance bandwagon. At the One Planet Summit in New York City in 2018, 23 leading global banks, eight of the top 10 global asset managers, the world’s leading pension funds and insurers, the two preeminent shareholder advisory service companies, and other major financial firms—which are together responsible for managing almost $100 trillion in assets—committed themselves to the transparency principles of the blue-ribbon Task Force on Climate-related Financial Disclosures, which was launched by Carney in his capacity as head of the Financial Stability Board and is chaired by Michael Bloomberg….”

“…the most critical question would remain whether the green agenda of the world’s central banks is adequate to the challenge of mitigating the effects of the climate crisis—and perhaps holding it within manageable bounds. The central banks have the powers to be a major part of the climate response. As of yet, their response is defensive, focusing on managing financial risks. The rest of us have no choice but to hope that they move into a more proactive mode in time.”

Science (Policy Forum) – The case for a supply-side climate treaty

https://science.sciencemag.org/content/365/6451/325

“The Paris Agreement can be strengthened by a treaty limiting global fossil fuel supply”.

“During decades of international climate policy negotiations, aiming to limit demand for fossil fuels, the stock of carbon dioxide in the atmosphere has increased considerably, and even the flow of emissions to the atmosphere continues to grow. To reach the Paris Agreement's goal of keeping global warming well below 2°C, substantial parts of the world's fossil fuels simply cannot be combusted and must be left in the ground. Recent work thus suggests redirecting climate policies toward fossil fuel producers directly by capping the flows of extraction and restricting the stocks of resources available for exploration. We synthesize key economic mechanisms that support this approach, arguing that an international treaty among fossil fuel–producing countries could (i) enhance the impact of the Paris Agreement in the presence of free riders; (ii) stimulate investment in low-carbon technology research and development (R&D); (iii) provide insurance against a failed Paris Agreement; and (iv) make carbon policies more acceptable to fossil fuel producers, thus increasing their support….”

Global Environmental Change - Human health as a motivator for climate change mitigation: results from four European high-income countries

https://www.sciencedirect.com/science/article/abs/pii/S095937801830551X

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“Invoking health benefits to promote climate-friendly household behavior has three unique advantages: (i) health co-benefits accrue directly to the acting individual, they are "private goods" rather than public ones; (ii) the evidence base for, and magnitude of health co-benefits is well-established; and (iii) the idea of a healthy life-style is well-engrained in public discourse, much more so than that of a climate-friendly life-style. In previous research, assessing the influence of information on health effects on people’s motivation to adopt mitigation actions, health co-benefits for the individual were typically confounded with collective health co-benefits, for example from pollution reduction. The present research aims to overcome this limitation by providing information on individual health co-benefits that are unconditional on the actions of others (direct health co-benefits). We report effects of this kind of health information on stated willingness to adopt mitigation actions as well as on simulation-based carbon emission reductions in a pre-registered experimental setting among 308 households in 4 mid-size case-study cities in 4 European high-income countries: France, Germany, Norway and Sweden. ……. For households receiving information on direct health co-benefits, we find a higher mean willingness to adopt food and housing actions, and a greater proportion very willing to adopt one or more mitigation actions (OR 1.86, 95% CI 1.1, 3.12); and a greater simulated reduction in overall carbon footprint: difference in percent reduction -2.70%, (95% CI -5.34, -0.04) overall and -4.45%, (95% CI -8.26, -0.64) for food. Our study is the first to show that providing information on strictly unconditional, individual health co-benefits can motivate households in high-income countries to adopt mitigation actions.”

Global Dashboard (blog) – 10 thoughts from an Extinction Rebellion newbie

Alex Evans; https://www.globaldashboard.org/2019/07/23/10-thoughts-from-an-extinction-

rebellion-newbie/

Well worth a read. And yes, do join Extinction Rebellion, wherever you live.

“… XR feels very different – in its focus on solutions rather than just protest; in its refusal to play them-and-us politics when they’re on the ascendant all around; in how it aims to combine community level organising with international mobilisation. Climate change has for a long time felt like everyone’s watching everyone else, waiting for someone to do something. XR doesn’t feel like that. And so far, it looks like it’s having a powerful effect.”

Quick links:

Yale - How Airplane Contrails Are Helping Make the Planet Warmer

“New research shows that condensation trails from aircraft exhaust are playing a significant role in global warming. Experts are concerned that efforts to change aviation engine design to reduce CO2 emissions could actually create more contrails and raise daily temperatures even more….”

NYT (Op-Ed)- How to Save the Amazon Rain Forest

“Countries in the Amazon Basin are falling behind on their targets to cut deforestation. Environmental enforcement combined with economic incentives could be a way forward.”

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"Scientists warn that we may be close to a 'tipping point' — a degree of deforestation at which the Amazon basin will no longer be able to generate its own rainfall by recycling moisture and thus cease to support rain forest ecosystems…"

Infectious diseases & NTDs

The Conversation - Africa needs specialist capacity to tackle the spread of infectious diseases

J Pulliam et al; https://theconversation.com/africa-needs-specialist-capacity-to-tackle-the-spread-of-

infectious-diseases-120117

“Over the past ten years, a community of practice has begun to develop in Africa around research that uses models to understand and evaluate population-level health problems and their potential solutions. This type of research – known as Applied Epidemiological Modelling – involves developing and applying analytical tools for problems that can’t be addressed by traditional statistical methods. These tools are particularly useful for combating infectious diseases. This kind of modelling is a complex, multidisciplinary field that has flourished over the past 15 to 20 years. But most work has been done by researchers based in Europe and North America – far away from the places where infectious diseases pose the biggest threat. This mismatch can lead to imbalances in the focus of research. ….”

“The traditional approach to capacity development for mathematical modelling, including epidemiological modelling, involves bringing small groups of specialists from developed countries to teach short courses to groups of African students. These typically last for no more than a week and are usually one-off events, or are repeated with new groups of students. That approach can be useful for imparting technical skills. But it’s not enough to build local capacity. … … Alternative ways of working have been developed. For the past 10 years workshops run under the International Clinics in Infectious Disease Dynamics programme have helped develop capacity in Applied Epidemiological Modelling on the continent….”

NYT articles on Rabies

A small series of NYT articles, see for example Rabies Kills Tens of Thousands Yearly. Vaccinating

Dogs Could Stop It. Where rabies is entrenched and 5 things to know about rabies

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HPW - Patients treated for visceral leishmaniasis can still transmit the disease even after completing treatment, study shows

https://www.healthpolicy-watch.org/patients-treated-for-visceral-leishmaniasis-can-still-transmit-

the-disease-even-after-completing-treatment-study-shows/

“The results of an innovative “infectivity” study conducted by the Drugs for Neglected Diseases initiative (DNDi) and the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) confirm that people successfully treated for visceral leishmaniasis in South Asia can still infect others if they develop a skin condition known as post-kala-azar dermal leishmaniasis (PKDL). The results were published in Clinical Infectious Diseases this week….”

Quick link:

The Conversation - Gender matters in responding to major disease outbreaks like Ebola

AMR

Global Health Action - The ‘Drug Bag’ method: lessons from anthropological studies of antibiotic use in Africa and South-East Asia

https://www.tandfonline.com/doi/full/10.1080/16549716.2019.1639388

“Understanding the prevalence and types of antibiotics used in a given human and/or animal population is important for informing stewardship strategies. Methods used to capture such data often rely on verbal elicitation of reported use that tend to assume shared medical terminology. Studies have shown the category ‘antibiotic’ does not translate well linguistically or conceptually, which limits the accuracy of these reports. This article presents a ‘Drug Bag’ method to study antibiotic use (ABU) in households and on farms, which involves using physical samples of all the antibiotics available within a given study site. We present the conceptual underpinnings of the method, and our experiences of using this method to produce data about antibiotic recognition, use and accessibility in the context of anthropological research in Africa and South-East Asia. … The Drug Bag method produce accurate antibiotic use data as well as provide a talking point for participants to discuss antibiotic experiences. We propose it can help improve our understanding of antibiotic use in peoples’ everyday lives across different contexts, and our reflections add to a growing conversation around methods to study ABU beyond prescriber settings, where data gaps are currently substantial.”

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NCDs

CNN - Facebook and Instagram to restrict content related to alcohol, tobacco and e-cigarettes

https://edition.cnn.com/2019/07/24/health/facebook-instagram-alcohol-tobacco-bn/index.html

“Facebook [will] unveil a new policy on Wednesday to restrict sales and limit content related to alcohol and tobacco products, including e-cigarettes, a company spokeswoman tells CNN. The new policy will prohibit all private sales, trades, transfers and gifting of alcohol and tobacco products on Facebook and Instagram, the spokeswoman said. Any brands that post content related to the sale or transfer of these products will have to restrict that content to adults 18 or older. The new policy will go into effect Wednesday and will also apply to any Facebook groups created to sell alcohol or tobacco products…”

WHO Bulletin - Correlation between noncommunicable disease mortality in people aged 30–69 years and those aged 70–89 years

Peter Byass; https://www.who.int/bulletin/online_first/BLT.18.227132.pdf?ua=1

The article aims “to investigate whether the key metric for monitoring progress towards sustainable development goal target 3.4, that is measuring premature noncommunicable disease mortality (deaths among people aged 30–69 years) is ageist.” The answer is more or less no.

Byass concludes: “As the established WHO metric for premature noncommunicable disease mortality was predictive of noncommunicable disease mortality in older people, the metric should not be construed as ageist. Focusing resources on measuring premature noncommunicable disease mortality will be appropriate, particularly in settings without universal civil death registration. This approach should not prejudice the provision of health services throughout the life-course.”

NIH - NIH publishes the largest genomic study on type 2 diabetes in sub-Saharan African populations

https://www.nih.gov/news-events/news-releases/nih-publishes-largest-genomic-study-type-2-

diabetes-sub-saharan-african-populations

“National Institute of Health researchers have reported the largest genomic study of type 2 diabetes (T2D) in sub-Saharan Africans, with data from more than 5,000 individuals from Nigeria, Ghana and Kenya. Researchers confirmed known genomic variants and identified a novel gene ZRANB3, which may influence susceptibility to the disease in sub-Saharan African populations. The gene could also influence the development of T2D in other populations and inform further research. In a study

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published in the journal Nature Communications, researchers analyzed genomic data available on participants through the Africa America Diabetes Mellitus study, the single largest diabetes genomic association study conducted on the continent. Using the information available from 5,231 people, they found many genomic variants to be significantly associated with T2D….”

BMJ Global Health - Towards better diagnostic tools for liver injury in low-income and middle-income countries

S Moed et al; https://gh.bmj.com/content/4/4/e001704

“Liver disease is a significant public health burden in both high-income and low-income countries, accounting for over 2 million annual, global deaths. Despite the significant mortality burden, liver diseases are historically a neglected problem due to a lack of accurate incidence and prevalence statistics, as well as national and international programmes targeting these diseases. A large portion of deaths due to liver diseases can be treated (eg, chronic hepatitis B), cured (eg, chronic hepatitis C) or prevented (eg, acute liver failure due to medications) if prompt diagnosis is made, but currently diagnostic methods fall short. Therefore, there is a critical need to fund the development of prompt, effective diagnostics for liver function, specifically in low-income and middle-income countries where the landscape for this testing is sparse. Here, we review and compare available and currently emerging diagnostic methods for liver injury in low-income and middle-income settings, while highlighting the opportunities and challenges that exist in the field.”

Lancet Psychiatry – Compensatory strategies below the behavioural surface in autism: a qualitative study

L A Livingston et al; https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30224-X/fulltext

Via the press release :

“The Lancet Psychiatry: Compensatory strategies to disguise autism spectrum disorder may delay diagnosis

First scientific study of compensatory strategies — techniques to camouflage autism — finds that they have positive and negative outcomes, increasing social integration, but possibly also resulting in poor mental health for autistic people, and could be a barrier to diagnosis.

For the first time, compensatory strategies used by people with autism have been investigated and collated in a qualitative study using an online survey of 136 adults, published in The Lancet Psychiatry journal….”

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SS&M - Research on media framing of public policies to prevent chronic disease: A narrative synthesis

https://www.sciencedirect.com/science/article/abs/pii/S0277953619304228

“Media studies of policy framing tend to focus on tobacco, alcohol and nutrition. Arguments in support of policy often use health or societal frames. Arguments opposing policies use economic, practical or ideological frames. The effectiveness and impact of frames within different contexts is underexplored. Understanding the influence of framing on attitudes will aid public health advocates.”

Reuters – Swiss minister under fire for tobacco sponsorship of Expo pavilion (in Dubai)

https://www.reuters.com/article/us-swiss-philip-morris-expo/swiss-minister-under-fire-for-tobacco-sponsorship-of-expo-pavilion-idUSKCN1UJ1T9

“Swiss Foreign Minister Ignazio Cassis is under fire over a 1.8 million Swiss francs ($1.8 million) sponsoring deal his department struck with tobacco giant Philip Morris International to help fund Switzerland’s Expo 2020 pavilion in Dubai….”

Sexual & Reproductive / maternal, neonatal & child health

Devex - High cost of healthy food linked to stunting, new study finds

https://www.devex.com/news/high-cost-of-healthy-food-linked-to-stunting-new-study-finds-95336

“High prices of nutritious foods in low- and middle-income countries partly explain high rates of undernutrition, according to new research from the International Food Policy Research Institute….” “While prior research has been conducted on the link between nutritious food prices and obesity, a study conducted by IFPRI and published in the Journal of Nutrition on Tuesday is the first to examine a link between food prices and undernutrition….”

The Telegraph - Protecting women’s rights is linked to a healthier population, research find

https://www.telegraph.co.uk/global-health/women-and-girls/protecting-womens-rights-linked-

healthier-population-research/

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“Countries that strongly support women’s economic and social rights are more likely to have healthy populations than nations which do not, researchers have found. A study in the BMJ Open journal found that protecting women’s rights leads to faster development and better health outcomes for men and women in both developing and developed countries. The study, based on data from 162 countries between 2004 and 2010, found that vaccination rates, reproductive health, death rates, life expectancy and disease prevention rates were consistently better than average in countries where women’s rights were highly respected. …”

HPW - Wellcome-funded initiative to unlock secrets of human development

https://www.healthpolicy-watch.org/wellcome-funded-initiative-to-unlock-secrets-of-human-development/

“A world-first research project will unravel how human embryos develop in the first weeks and months after fertilisation, improving our understanding of fertility, birth defects and regenerative medicine. The £10 million Wellcome-funded Human Developmental Biology Initiative (HDBI) will build a ‘family tree’ of how cells divide and specialise following fertilisation*, to understand how tissues and organs develop and reveal new insights into how this process can go wrong….”

Access to medicines

HPW - Global Innovation Index 2019 Released, Focus On The Future of Medical Innovation

https://www.healthpolicy-watch.org/global-innovation-index-2019-released-focus-on-the-future-of-

medical-innovation/

“The Global Innovation Index 2019 was released today with an overarching theme of “Creating Healthy Lives – The Future of Medical Innovation.” In addition to ranking countries according to their innovation performance on 80 indicators, this year’s Index also analyses the medical innovation landscape, and how emerging innovations, such as artificial intelligence (AI), genomics, and mobile health applications, will impact delivery of healthcare in developed and developing countries. The Global Innovation Index 2019 found that overall, “Switzerland is the world’s most-innovative country followed by Sweden, the United States of America (U.S.), the Netherlands and the United Kingdom (U.K.),” according to a World Intellectual Property Organization (WIPO) press release….”

See also UN News - Switzerland ranked as most innovative country in new UN report.

“The World Intellectual Property Organization, WIPO, named Switzerland as the world’s most innovative country on Wednesday, during the launch of its latest Global Innovation Index, (GII) in the Indian capital New Delhi. Following Switzerland in the rankings are Sweden, the United States, the Netherlands and the United Kingdom. India has risen most in the rankings since 2018, jumping five places to fifty-second most innovative country. The annual Index, which has been published for the

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last 12 years by WIPO, and a number of partners, is designed to help policy makers better understand innovation activity, which WIPO describes as a “main driver of economic and social development”. Overall, this year’s Index finds that, despite the global economic slowdown, innovation is “blossoming”, particularly in Asia, but trade disruptions and protectionism are putting this at risk. It also notes that planning for innovation is critical for success…”

Stat News - The Indian pharmaceutical industry is in denial over drug-quality charges

https://www.statnews.com/2019/07/22/indian-pharmaceutical-industry-drug-quality-

charges/?utm_content=bufferfa647&utm_medium=social&utm_source=twitter&utm_campaign=twi

tter_organic

“Katherine Eban’s new book, “Bottle of Lies,” has focused a very intense spotlight on the mostly ignored transgressions of the Indian generic pharmaceutical industry in the processes they follow — or all too often don’t follow — to make quality products. This industry, which has rarely been subjected to such rigorous journalistic scrutiny, has lashed back at Eban, attacking her integrity and her work….”

BMJ - Spending on World Health Organization essential medicines in Medicare Part D, 2011-15: retrospective cost analysis

https://www.bmj.com/content/366/bmj.l4257

Interesting analysis of medicines utilization in the US using the ‘essential medicines’ concept.

BMJ Global Health (Editorial) -The need for comprehensive and multidisciplinary training in substandard and falsified medicines for pharmacists

E Ferrario, V Wirtz et al ; https://gh.bmj.com/content/4/4/e001681

“…Worldwide, pharmacists are the professionals charged with the final custody of medicines, before they are dispensed to patients, as well as ensuring the proper use and administration of medicines. They may also take up different roles in the supply chain from manufacturing to procurement of medicines. Being experts, they are properly positioned to stem the tide of SF (substandard & falsified) medicines….”

“…There are various steps which can be undertaken to strengthen the training of pharmacists in Quality of Medicines and Public Health. First, governments, in collaboration with professional

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associations, institution of higher education and other relevant stakeholders should identify their own educational needs and gaps in the curriculum. Second, a discussion at the international level could galvanise support and help identifying common requirements in pharmacy education. Third, countries should develop goals and implementation plans for curriculum reforms including accountability mechanisms to demonstrate progress. Universal health coverage aims to achieve access to essential quality health services and medicines without incurring excessive financial hardship. There is no access to medicines without quality and more emphasis on training of pharmacists in SF medicines is urgently needed.”

Human resources for health

Human Resources for Health - The contribution of non-physician clinicians to the provision of surgery in rural Zambia—a randomised controlled trial

J Gajewski et al; https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-019-

0398-9

“The global shortage of surgeons disproportionately impacts low- and middle-income countries. To mitigate this, Zambia introduced a ‘task-shifting’ solution and started to train non-physician clinicians (NPCs) called medical licentiates (ML) to perform surgery. The aim of this randomised controlled trial was to assess their contribution to the delivery of surgical care in rural hospitals in Zambia….”

Miscellaneous

WB – How important are Global Value Chains for development? Read the new WDR2020 draft report and comment

World Bank

“…a draft of the World Development Report (WDR) 2020 – Trading for Developing in the Age of Global Value Chains is now available online for public comment. …”

“… the 2020 WDR marks a milestone in the following respects: The report approaches the topic from a development perspective, whereas much of the literature to date focuses on advanced countries and a few large developing countries. The report showcases and advocates the need for new types of data and analysis on the determinants of GVC participation and the consequences for economic growth, inequality, poverty, employment, and the environment. The report also looks ahead at how new technologies and changing trade policies may affect the prospects for development through GVCs….”

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BMJ (Analysis) - Distinguishing opinion from evidence in guidelines

https://www.bmj.com/content/366/bmj.l4606

“The experience of experts can be useful when developing guidelines, but structures need to be in place to avoid opinion being confused with evidence, say Holger J Schünemann and colleagues.”

Quick links:

Brookings Inst (blog) - The silo problem: Connecting the UN’s efforts to promote sustainable

development and prevent violent extremism

“This week, diplomats and civil society activists will travel to New York to attend the annual U.N. High-Level Political Forum (HLPF) on Sustainable Development. This year’s theme is Sustainable Development Goal (SDG) 16, on working towards “peaceful, just and inclusive societies.” Meanwhile, the U.N. Secretary-General convened some 1,000 diplomats and civil society actors last week in Nairobi to discuss progress on preventing violent extremism (PVE) in Africa. The agenda was founded on the 2015 U.N. Plan of Action to Prevent Violent Extremism….”

Stat Plus - Fight for coveted CRISPR patents gets knottier, as MilliporeSigma makes new claims

Research

Global Health Promotion - A systematic scoping review of asset-based approaches to promote health in communities: development of a framework

V Cassetti et al; https://journals.sagepub.com/doi/full/10.1177/1757975919848925

« Asset-based approaches to health promotion have become increasingly popular as a way to tackle health inequalities by empowering people in more disadvantaged communities to use local resources and increase control over health and its determinants. However, questions remain about how they work in practice. This article presents the findings from a systematic scoping review of the empirical literature on asset-based approaches in communities. The aim was to identify the key elements of asset-based approaches, and how they are operationalised in interventions aimed at promoting health and reducing inequalities in local communities….”

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International Health - Face and content validity of a prospective multidimensional performance instrument for service delivery in district health systems in low-income countries: a Delphi study

E A Yisuf et al ; https://academic.oup.com/inthealth/advance-article-

abstract/doi/10.1093/inthealth/ihz064/5537694?redirectedFrom=fulltext

“Valid performance indicators help to track and improve health services. The aim of this study was to test the face and content validity of a set of performance indicators for service delivery in district health systems of low-income countries….”