MPs to WHO: If You Want Pandemic Treaty Implemented, Engage with Us 06/12/2022 Maayan Hoffman Parliamentarians from around the world have called on the World Health Organization to engage civil society in the establishment of a “pandemic treaty,” if the organization hopes to have such a document not only ratified but also implemented. “The current process remains exclusionary,” said Giada Girelli, a senior analyst on human rights and justice at Harm Reduction International, who opened a session on the subject of the treaty at the UNITE Global Summit in Lisbon on Monday. “Members of parliament are not systematically engaged. The conceptual zero-draft continues to have limited details regarding civil society.” The UNITE session took place as members of the intergovernmental negotiating body (INB) kicked-off their own meeting in Geneva. Last year, at a special meeting of the World Health Assembly, participants resolved to create an outline for how to manage the prevention, preparedness and response to any future pandemics. The INB was appointed in February to write the first draft. This draft was presented to member states last month and is being further developed during the current meeting. The expectation is that it will be completed by WHO’s 77th World Health Assembly in May 2024. But the parliamentarians at the UNITE event said they felt left out of the process, when ultimately it is up to them to pass the legislation to actually implement WHO initiatives and policies, even if governments approve them. Parliamentarians are also generally responsible for budget allocations. In October, a collaboration agreement was signed between WHO and the UNITE Parliamentarians Network for Global Health to expand outreach to the world’s elected politicians on burning global health priorities. But exactly how this MOU will ultimately play out is still to be determined. Uruguay MP Luis Enrique Gallo on December 5, 2022 “There is no consensus without the participation of civil society,” stressed Uruguay MP Luis Enrique Gallo. “If you want legislation that brings together all the lessons learned from the pandemic, we have to work with the opinions of states, the opinions of national parliaments, of community leaders, academics, scientists etc.” Gallo bemoaned that he was only made aware of the pandemic treaty through UNITE and not directly by WHO. “How is it that I am an MP linked to the health sector for 20 years and I did not know that this was being discussed by the most major health organization in the world?” Gallo asked. MP Ruth Labode of Zimbabwe on December 5, 2022 Another MP, Ruth Labode of Zimbabwe, expressed similar sentiments. “When I heard about it, I started Googling about the pandemic treaty,” Labode said. “It’s not a bad thing. “But if you ask MPs in this room if they really know about it, the details about it, no one knows. “The treaty is stuck in Geneva,” she continued. “We have WHO offices in our area. How come no one is talking about it there?” Gallo said that it is parliamentarians’ jobs to hold their governments accountable and that after some of the mistakes of COVID, the pandemic treaty could be a tough sell. “There was the COVAX fund and we paid into that fund, but we never got the vaccines,” Gallo said. “They were late. There were not enough. Whatever it was, the end result was not good. We do not want to repeat that.” Case study: Uruguay “The COVID-19 pandemic revealed not only the fragility of the national health systems around the world, but the fragility of democratic institutions across the world,” said Georgian MP Mariam Jashi. “Even countries with stronger health systems and older, more established democracies struggled.” She cited a report by Freedom House, which found that since the start of the pandemic in December 2019, the status of human rights and democracy had deteriorated in more than 80 countries. Georgian MP Mariam Jashi Uruguay is a country of only 3.5 million people. According to Gallo, in the first waves, the government managed to implement a strong and successful COVID response. “There are integrated private and public health sectors so we have equitable access to healthcare,” Gallo explained. In addition, he added that the health system and civil society leaders were at first brought around the decision-making table and played a key role in COVID-19 crisis management. A team of 50 scientists were recruited to draft recommendations for the executive power and mandates were made based on these. But overtime, he said, the situation shifted. In 2020, Uruguay had only 181 people die of COVID-19 or related illnesses. In January, February and March of the next year, 793 people died. The scientists suggested another lockdown of 200 days because infection was rapidly spreading, but their advice was this time ignored. In April there were 1,600 deaths. In May there were 1,800. “We were once the country that best managed the pandemic and then we were the country with the worst figures in terms of COVID deaths per capita on earth,” Gallo said. The reason: “There was no longer any social dialogue,” Gallo claimed. He said, “We need to learn to listen. Decision makers need to learn how to listen and to take into account several opinions. And they need to leave room for the people and organizations that are on the front lines.” “We have to ensure that MPs are more empowered,” Jashi stressed. The UNITE Global Summit runs from Dec. 5-7, 2022. Click here for full coverage. Reporting for this series was supported by UNITE Parliamentarians for Global Health. Image Credits: Maayan Hoffman. Keep Momentum on Pandemic ‘Treaty’, Urges Tedros 05/12/2022 Kerry Cullinan INB co-chair Precious Matsoso and Dr Tedros Keep the momentum to negotiate a pandemic instrument, urged Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO) at the start of the third meeting of the intergovernmental negotiating body (INB) on Monday. “The conceptual zero-draft that your bureau has developed is a true reflection of the aspirations for a different paradigm for strengthening pandemic prevention, preparedness, response and recovery,” said Tedros. “As we move to a new phase of this process, I urge you to maintain momentum.” Almost exactly a year ago, a special meeting of the World Health Assembly resolved to negotiate a treaty to outline the future global pandemic prevention, preparedness and response. Members of the INB were appointed in February and developed the draft in record time, presenting it to member states in late November. Support for draft – but with more detail At Monday’s meeting, most member states expressed support for the draft as the basis for a ‘zero draft’ to launch official negotiations on the first of the three-day meeting, but many thought the draft was too general. “I’m very happy with the common voice in this room that the document we provided you with is a good basis for the next steps,” said INB co-chair Roland Driece. “Nobody said it was not and most of you think that, with improvements or alterations, it could serve in an improved way as a zero draft for negotiations next year.” But, Driece added, most member states “wanted to have more elaborated text” that also had more legal terminology and definitions. “Furthermore, many of you said this conceptual zero draft has a lot of good starting points, but we need to focus on the real priorities, focus on the issues that have the most impact and most of you said that is because May 2024 is coming rather soon,” added Driece. INB co-chair Roland Driece The body has until the WHO’s 77th World Health Assembly in May 2024, a mere 17 months, in which to develop and present an agreement. In that regard, Tedros announced that he has asked Dr Jaouard Mahjour to continue to co-ordinate the INB’s secretariat. Mahjour’s contract as WHO’s Assistant Director-General for emergency preparedness and international health regulations ended on the last day of November. “I have asked Dr Mahjour to continue as head of the secretarial team for the INB and the [International Health Regulations] amendment process. The team established to support your work has made me proud, with their delivery and efficiency. Time is short, and there is much work to do,” added Tedros. The Group of Friends of the Pandemic Treaty, a group of 43 countries from different regions of the world, called for the treaty to be “an ambitious legally binding agreement which has a real-world impact in terms of pandemic prevention, preparedness, response and recovery”. The US, UK and the European Union stressed that the treaty could not address everything, but needed to prioritise key concerns. Meanwhile, the African region said that some of their concerns had been left out, such as the need to reflect that government investment in medical R&D was part of the “global good” – and presumably, this knowledge should be freely available. It also wanted the agreed principle of equity to be “operationalised” and included throughout the document. Dovetailing with IHR reform Most states wanted the process of reforming the IHR and the development of the treaty to dovetail, with China articulating that the IHR reform and development of the treaty needed to be “fully coordinated, consistent and complementary in terms of content”. Stressing that the treaty needed to be formulated with respect for the sovereignty of member states, China also called for “the stigmatization of countries that report cases which helped to motivate countries to share information and pathogen timely way” to be included in the principal part of the document. This was echoed by South Africa, which pointed out how it had been stigmatised and punished with travel bans after it had identified and shared the omicron variant of COVID-19 with the international community. Steven Solomon, WHO principal legal officer Treaty, agreement or convention? In response to member states’ queries about the different legal forms of a pandemic instrument, WHO principal legal officer Steven Solomon said that both an agreement and a convention “are both treaties within the meaning of international law”. In addition, said Solomon, a convention and a “framework convention” were “not mutually exclusive” and it is “possible to have a hybrid approach as well as one or the other”. COVID-19 Translated into Three Years of ‘Human Rights Violations’ 05/12/2022 Maayan Hoffman Prof Lawrence Gostin, a member of the independent Panel for a Global Health Convention “Every aspect of the COVID-19 response, beginning with the origins of the pandemic in Wuhan to China’s current Zero-COVID strategy, has had severe restrictions on human rights,” according to Prof Lawrence Gostin, a member of the independent Panel for a Global Health Convention. Speaking Monday afternoon at the UNITE Global Summit in Lisbon, he called on parliamentarians to take a “moment of reflection” on the untold human suffering that resulted from the pandemic. “It is not just the millions of lives lost or the trillions of dollars lost,” said Gostin, “but the vast deprivation of freedom, noxious discrimination and erosion of democratic ideals.” Although Monday’s sessions focused specifically on pandemic response and preparedness – human rights will be tackled more thoroughly on Wednesday – Gostin used the summit to speak to participants via Zoom and recount the many human rights violations that ensued over the past three years. He also issued a battle cry for parliamentarians to put practices in place to halt these violations before the next pandemic. He recalled how, in the early days of the pandemic in Wuhan, there was “less than full transparency” in terms of reporting the outbreak to the word. Even the transfer of the genomic sequence of the virus came “somewhat late.” “There was a crackdown on protesters and particularly a brave, whistle-blower doctor who later died in Wuhan,” he Gostin said. He then fast-forwarded to China’s current zero-COVID strategy, which he said is enforced via extreme surveillance and restriction methods. But the violations did and do not end in the Red Dragon state, said Gostin. Countries cramped down on political protests, delayed elections, enacted abusive restrictions and arrested members of marginalised populations all in the name of COVID, according to Gostin. These violations could be bucketed into two categories, he said – one: violations of political and democratic rights, and two: unequal and discriminatory practices. ‘Vaccine apartheid’ “There was vaccine apartheid, as populations in the United States, Europe and other high-income countries were protected and so many others were left behind, in Africa and other low-income countries,” Gostin noted. Countries from Egypt and Russia, to Venezuela, Madagascar and Bangladesh threatened the civil or political rights of their citizens, violating the right to freedom of expression and access to accurate information from journalists and healthcare workers. Hungary’s prime minister even used emergency powers to direct funding away from cities that were opposition strongholds. Those who were disfavoured in marginalized populations fell victim to arbitrary arrests. For example, Venezuela targeted returning refugees for quarantine in inhumane and degrading facilities, he said. “We all remember the initial scramble for diagnostics tests, personal protective equipment and ventilators,” Gostin said. “But global outrage should have peaked when the most vulnerable in the world were unable to get vaccines.” In June 2021, according to Gostin, one-third of people in rich countries were fully vaccinated while only 0.2% of people in low-income countries had two shots. The COVAX facility never got the funding it needed to ensure full vaccinations nor could it get the vaccine doses it required. “Today, these inequalities are manifested in antiviral therapeutics like Paxlovid,” Gostin continued. “The COVID-19 pandemic has reverberated into other spheres, with lower standards of living, people being pushed into absolute poverty, inadequate education and nutrition – all exacerbated now because of the Ukraine crisis.” He said the crises caused by COVID-19 and Ukraine merged with climate change, and have left more than 200 million people in acute hunger. “At its core, human rights are about human dignity,” Gostin concluded. “It is now for us to honour … the lives of everyone harmed by these violations by undertaking transformational reforms in global health, human rights security and inequity so that when the next crisis hits, we will at least reassert the fundamental principle of human dignity that emerged after World War II.” The UNITE Global Summit runs from Dec. 5-7, 2022. Click here for full coverage. Reporting for this series was supported by UNITE Parliamentarians for Global Health. Image Credits: Maayan Hoffman, Screenshot. After COVID-19, Five Policy Recommendations from Malaysia 05/12/2022 Maayan Hoffman Malaysian MP Kelvin Yil Lee Wuen at the UNITE Global Summit on December 5, 2022. COVID-19 was a “global stress test” for parliamentarians, whose job is to propose policies, said Kelvin Yil Lee Wuen, a parliamentarian from Malaysia. Speaking Monday at the UNITE Global Summit in Lisbon, the MP proposed five global policy recommendations, which he said his own country had adopted. 1 – Create conducive policies and infrastructure to enable innovation According to Wuen, countries must enhance platforms and processes so that the public and private sector can innovate in real time. 2 – Establish robust and comprehensive inner-country and global data and knowledge sharing Wuen said that countries should work together to determine and implement best practices. In addition, the world should look toward a global medical network. By agreeing on standards between the U.S. Food and Drug Administration, the European Medicines Agency and other regulatory bodies “it doesn’t have to take so much time to approve new drugs, interventions and vaccines. We have to figure out how to be more efficient.” 3 – Invest in global capabilities for the early characterization of pathogens and assessment 4 – Improve and increase education “We need to empower the people by breaking misinformation early,” said Wuen. He recalled that there was a rise in fake news in Malaysia during the pandemic, including around basic principles, like what it means for a vaccine to receive emergency use approval. “We need to educate people so that in the future when vaccines are approved the public has assurance that they are safe to use and that their benefits outweigh their risks,” Wuen stressed. He noted that improving communications should happen immediately if the world wants to be ready for the next crisis. “In a public health crisis, communication is as important – if not more important – than medical intervention,” Wuen said. “To get people to comply, they need to have confidence in the system and to have that trust they need communication.” 5 – A fair, equitable, inclusive and accountable distribution network Wuen said that on the domestic and international levels, systems must be developed to distribute drugs, treatments and vaccines. He said “this includes the controversial topic of an intellectual property (IP) waiver for life-saving vaccines. “It is vaccines in bodies that save lives,” Wuen added. The pandemic reignited a long-standing debate about the right balance between private profits and public health. While some argued that the World Trade Organization rules on IP harmed access to COVID vaccines in poor countries, others said lifting it would remove the incentive for drugmakers to keep developing the life-saving shots. A partial IP waiver on COVID vaccines was agreed on in June and the WTO’s TRIPS’s Council has until 17 December to decide whether to extend it. “The COVID response had its ups and downs, but vaccine inequality is one of our biggest moral failings,” Wuen said. Vaccines in 100 days? CEPI Director of Policy Neren Rau speaking at the UNITE Global Summit on December 5, 2022. Wuen spoke as part of a UNITE Global Summit session titled “Preparing for the pandemic by developing vaccines in 100 days.” The session featured two speakers from the Coalition for Epidemic Preparedness Innovations (CEPI), including Director of Policy Neren Rau. He offered his organization’s plan to ensure there are vaccines for everyone during the next pandemic, which centers on more diversified vaccine manufacturing. CEPI has developed more than 70 partnerships in 50 countries around the world to develop vaccines, enable vaccines and get them into the right people’s hands at a reasonable cost. “Access lies at the heart of our plan,” Rau said. “Achieving the 100-day plan aspiration would give the world a fighting chance of tackling and containing outbreaks before they spread and become pandemics.” CEPI’s 100-day plan is to develop a working vaccine within 100 days of the start of the next pandemic. The first vaccines – for typhoid fever and meningitis – took more than 100 years to develop. The vaccine for Ebola took 20 years. It took 364 days to get the first approved COVID-19 vaccine, Rau said, and with the proper efficiencies, the number of days it would take to develop the next vaccine would be only 250. So, why is CEPI so focused on 100 days? “The lives that will be saved,” Rau stressed. “The difference is almost 70 million lives between 364 days and 100 days.” But he added that the plan only works if the vaccine is distributed to the country or region of the outbreak “regardless of where that might be.” He said, “this requires a fundamental shift in international collaboration and cooperation toward a system founded on the principles of equitable access.” The COVID-19 pandemic will not be the world’s last, Wuen added. The next one is “closer than we think.” The UNITE Global Summit runs from Dec. 5-7, 2022. Click here for full coverage. Reporting for this series was supported by UNITE Parliamentarians for Global Health. Image Credits: Maayan Hoffman. MPs Are Urged to Redirect Funding Towards Prevention and Primary Care 05/12/2022 Maayan Hoffman The head of the Health Division at the Organisation for Economic Co-operation and Development called on parliamentarians to redirect health funding towards prevention and primary care to help improve health outcomes. Speaking Monday at the opening session of the UNITE Global Summit in Lisbon, Francesca Colombo said that a basic health analysis proves the need to be focused in this direction. “Only 3% of total health spending is devoted to tackling poor risk factors and public health measures,” she told a room of more than 30 parliamentarians and other health leaders in the Senate Chamber of the Portuguese Parliament. “Return on investment in tackling unhealthy lifestyles is very high.” She noted for example that every dollar invested in tackling obesity has a $6 return on investment in economic benefits. Moreover, she said that her organization’s work has shown that three out of four deaths from antimicrobial resistance (AMR) could be averted by spending just a few dollars more – $2 per person. “While COVID-19 demonstrated that countries with strong health systems and universal health coverage are better prepared to manage health threats, investments in primary care account for less than $1 in every $6 present in health systems,” Colombo stressed. Finally, she added, too much health spending is at best ineffective and at worst harmful. A 2017 OECD report showed 20% of health expenditures make no or minimal contribution to good health outcomes. How to address these failings “The global shortage of healthcare workers must be urgently addressed, including finding equitable solutions to address international health workforce migration,” said Colombo. “The pandemic accelerated the use of digital tools like telehealth and remote diagnostics. Yet more needs to be done to accelerate the equitable development and use of these tools. “Finding new ways to pay for global public goods, such as vaccines and antimicrobials will be essential to be ready for future crises,” she added. The OECD has calculated that even in high-income countries an annual investment totalling 1.4% of GDP is needed to make health systems strong enough to meet the challenges of another pandemic on the scale of COVID-19, Colombo said. She expressed concern that finance ministers’ enthusiasm for investing in health is fading away. Raising parliamentarians’ voices Ricardo Baptista Leite, president and founder of UNITE Parliamentarians The UNITE Global Summit is meant to once again raise up parliamentarians’ voices around issues of health and health security. The event began around 9 a.m. in the Senate Chamber. Although the room is no longer in use, it continues to be harnessed for conferences and its rows of parliamentary chairs lent to the import of the conference on Monday morning. The theme of the UNITE summit is “from pandemic to prosperity,” a topic that Ricardo Baptista Leite, president and founder of UNITE, said should be “self-explanatory.” But, like Colombo, he said that the discussion is coming at a difficult time – a time when governments want to move beyond the pandemic and are focused on other challenging issues like the Russia-Ukraine war and rising inflation and cost-of-living in their countries. Leite said that nonetheless, parliamentarians must make their voices heard. “We are still in a pandemic, still suffering from the results of severe lockdown and the consequences of our lack of preparedness,” he said. “That is why our first day is focused on infection control and pandemic preparedness and response.” Ilona Kickbusch, founder of the Global Health Centre at the Graduate Institute in Geneva Over the next two days, the conference will also look at the future of health systems and health as a human right. Participants will be charged with answering three questions: What progress have we made so far during the UN’s Sustainable Development Goals period? What have we learned to help us make even more progress by 2030? What is the role of parliamentarians in helping drive that progress? “Parliamentarians should be at the forefront of the fight,” stressed Professor Ilona Kickbusch, founder of the Global Health Centre at the Graduate Institute in Geneva, who also spoke as part of the introductory session. “Parliamentarians should be the link between their constituents and their governments.” The UNITE Global Summit runs from Dec. 5-7, 2022. Click here for full coverage. Reporting for this series was supported by UNITE Parliamentarians for Global Health. Image Credits: Maayan Hoffman. Wendy Reaser: Struggling with Obesity in Canada 03/12/2022 Editorial team A special project celebrating the fifth anniversary of “Our Views, Our Voices” | Learn more Wendy Reaser One time, as Wendy Reaser was visiting the emergency room, she heard a specialist describing her as “fat and lazy,” adding that she did not want to put the work into being healthy. This experience, as well as many other unpleasant interactions with health professionals, left Wendy discouraged and traumatized. “For many years, this statement had me convinced that because I’m living with obesity, I didn’t have the right to care from medical professionals,” she shares in the NCD Diaries project, an initiative launched by the NCD Alliance. “I was convinced that nothing could be done and I wasn’t worth saving.” NCDs (noncommunicable diseases) are diseases that are not transmissible from person to person and they represent the first cause of death and disability worldwide. The NCD Diaries project is meant to support individuals like Wendy, so that they can share their lived experiences of NCDs, drawing on their unique local contexts, challenges faced and their aspirations and recommendations to drive change on NCDs. Canada, where Wendy lives, provides its citizens with universal healthcare coverage. “While this is fantastic because everyone has access to treatment, it doesn’t always mean that you get treated well,” Wendy writes. “Living with obesity is a daily struggle physically and mentally,” she explains. “Not only do we have to live with our shame and self-loathing, but we also must live with the judgement of those around us. Often, we are made to feel that we aren’t deserving of medical help, with many health care providers having been trained to tell us to simply ‘eat less and move more’.” Luckily for Wendy, she eventually found doctors with a different approach. “One day I visited my family doctor, who had been with us for about a year, to express concern about symptoms I was experiencing that were noticeable in my dad prior to his death from a heart attack,” she recalls. “I expected her to say that it was my weight, that I had to eat less and exercise more. I didn’t expect her to sit up and pay attention, and to immediately put in an urgent referral to a cardiologist. But that’s exactly what she did.” The cardiologist explained to Wendy that her heart was enlarged because she had sleep apnea, so her lungs were lacking oxygen. “I’d just started sleep apnea treatment 6 months before seeing him,” she writes. “He was confident that if I continued this treatment, ‘tweaked my eating and maybe moved around just a little more,’ my heart would be fine in under a year.” Wendy emphasizes that the doctor’s words saved her life. “It’s interactions like these that began to restore my confidence in navigating my care journey, and my faith in the medical profession,” she explains. Health professionals, she argues, need better training to provide care empathetically and effectively for people living with obesity. “Healthcare providers must accept that people living with obesity are not fat and lazy,” Wendy says. “There are several factors including genetics, medication, and even monetary constraints that can and do contribute to someone becoming obese. There’s a way to discuss obesity-related issues respectfully and helpfully, that doesn’t leave a deflated feeling of failure.” Read Wendy Reaser’s full NCD Diary. Read previous post. Image Credits: Courtesy of NCD Alliance. US Eager to Move Ahead with Pandemic Accord that Promotes Equity but not ‘Transactional’ Linkage between Data and Benefit-Sharing 02/12/2022 Elaine Ruth Fletcher Pamela Hamamoto, lead US negotiator on the WHO pandemic accord, in Geneva this week. The United States, once a reluctant partner in the initiative for a new global pandemic accord, is now keen to move ahead in negotiations over an agreement. The accord would expedite more rapid global data sharing and response to looming threats as well as ensuring greater equity in access to medicines and treatments, said the lead US negotiator of the instrument, Pamela Hamamoto on Friday. But Washington would like to avoid what she described as “transactional” language directly linking the two issues, as some developing nations have suggested. Nations like South Africa, for instance, cite bitter experiences with rapid, transparent sharing of genetic data on new SARS2 variants, which did nothing to improve the country’s access to badly-needed COVID medicines or vaccines. “Overall, the concept of equity, as I said, is very important. And it is certainly something that the United States is committed to to helping work on that and improve… the availability of medical countermeasures broadly speaking, going forward,” Hamamoto said. But in terms of a direct “linkage between the access and benefit sharing… I actually don’t necessarily think that that linkage is that helpful,” she said. “We’re also very interested in you know, as are others, in the rapid transparent sharing of data,” she said, adding, “what I hope is that… the sort of transactional nature of that concept doesn’t hamper us in being aspirational in our thinking, how we approach this and move forward.” Hamamoto was speaking in Geneva Friday along with Loyce Pace, US Assistant Secretary for Global Affairs, after a week of closed-door meetings with WHO officials and other WHO member states ahead of a third round of member state negotiations on a ‘conceptual’ zero draft text for the treaty due to start next week. First ‘zero draft’ circulated in late November Loyce Pace, Assistant Secretary for Global Affairs, US Department of Health and Human Services, in Geneva this week. This initial ‘zero draft’ text of a proposed pandemic accord was circulated among member states in late November. The draft calls for for “early, safe, transparent and rapid sharing of samples and genetic sequence data of pathogens” – a measure supported by the pharmaceutical industry – but simultaneously calls for “the fair and equitable sharing of benefits” – which the private sector and many developed countries along with the US have resisted, saying that too tight a linkage between any country’s agreement to share pathogen data and benefits reaped could slow down pandemic response. The draft also makes a strong case for more emphasis on regional production of vaccines and other pandemic-related products as well as ‘strategic stockpiles’ of pandemic response supplies. Speaking on that point, Pace and Hamamoto both underlined that the US is supportive of efforts to regionalize production of pandemic countermeasures. “We’re very committed to leaning into overall concepts of equity and transparency,” Hamamoto said. “making sure that we’re better prepared for the surveillance, detection and rapid response to future outbreaks. More comprehensive data and sample sharing on a fast timeframe as well rapid, rapid response .. and more equitable access to medical countermeasures, possibly through regional and local manufacturing.” Current text is hanging too much on the Christmas tree However both women warned that the current text, including many member state proposals for amendments and additions, will need considerable refinement to get the approval of the US and other member states. “There are so many ornanments we’re trying to put on the Christmas tree,” said Pace. “And that is understandable, and yet there are various work streams that will emerge, where there can be a higher and better use for some areas than others.” Added Hamamoto, “I think it’s just there’s just too much in there that is, is maybe not at the right level, like a more tactical playbook… as opposed to, you know, international agreements. “What we’re focused on next week is to really move it towards something that’s appropriately scoped to begin,” she said. “What it represents now is a collection of all the inputs that the Bureau has received so far for member states and external stakeholders as well,” she noted, referring to the small member state group guiding the process. “And everything has just been collected, sorted to a certain extent into some specific chapters…. But there’s a lot of work that still needs to be done around scope around structure around governance. And so in a nutshell, there’s a lot that needs to change before we were going to be able to sign on to it, as is the same for a lot of Member States, probably most.” Negotiations over revisions to International Health Regulations happening in parallel Negotiations over revisions to the WHO’s International Health Regulations are also proceeding in parallel. It was the US which tabled a series of proposed amendments to the IHR at the May World Health Assembly as matter for negotiations, finally winning the agreement of the member state body to engage in a parallel process to revise the 2005 WHO agreement on procedures for responding to outbreak and emergency threats. Assembly Approves Process to Update International Health Regulations on Pandemic Response Revising the IHR is deemed to be a quicker fix to some of the shortcomings in global pandemic response as once any revisions are approved, they would take effect immediately. A new international convention or accord would have to be ratified state by state. However agreement on those revisions, and alignment with the new pandemic accord, will also be a complex process, she admitted. “Obviously, there’s a lot cooking in that space, with so many member states and frankly, amendments being brought to the table,” Pace said. “That’s a good thing because I think we weren’t sure, frankly, earlier this year, to what degree the member states would be interested in engaging in that [IHR] process. And so I know a lot of being done to look through those various proposals and align them with the work that Ambassador Hamamoto is leading on the front end.” Hints at adjustments in negotiating schedule – but not endpoint Standing ovation at 2021 special World Health Assembly session that decides to negotiate a new pandemic accord. Hamamoto also suggested that some of the mid-term milestones that have been set in the negotiating schedule for the pandemic accord over the coming two years, might have to be adjusted in order to accommodate the complexity of the process. According to the current timeline, a firm ‘zero draft’ text is supposed to be ready to put before WHA member states for the full-fledged start of negotiations by February 2023. However, Hamamoto said that she was in no way suggesting that member states should prolong deliberations over the text beyond the May 2024 date that was agreed to by WHO member states exactly a year ago, as the date by which a final draft text should be brought before the World Health Assembly. “You know, the pretty broadly held view is that we need to make sure that the process is set up right so that we feel that we can that we have the space to do our work, and make sure we get this right and so we don’t blow this opportunity to put together an accord that is going to be meaningful and implementable,” Hamamoto said. “But May 2024 is the planned and hoped-for end-date and I’m not suggesting going beyond that. However, the time line along the way is ambitious. And we do also have these parallel processes, so we just want to make sure in theese early stages, what is being called the zero draft, that we get that right.” Image Credits: E Fletcher/Health Policy Watch , E Fletcher/Health Policy Watch. UN Environment: Investments in ‘Nature-Based’ Climate Solutions Must Double by 2025 02/12/2022 Stefan Anderson Climate, biodiversity, and land degradation goals will be out of reach unless investments into nature-based solutions quickly ramp up to $384 billion/year by 2025, more than double of the current $154 billion/year, according to UN Environment Programme. A new report by the United Nations Environment Programme warns that investment in nature-based solutions must double by 2025 if the world is to limit global warming to 1.5°C, as well as halting biodiversity loss and progressively increasing land degradation. The report comes a week before world leaders will gather at the UN Biodiversity Conference (COP15) in Montreal, Canada, where they are set to negotiate an agreement that aims to halt and reverse biodiveristy loss by 2030. UNEP is calling on governments to agree on a clear framework for countries to require the financial sector to align its activities with ‘nature positive’ goals. “The science is undeniable. As we transition to net-zero emissions by 2050, we must also reorient all human activity to ease the pressure on the natural world on which we all depend,” said Inger Andersen, Executive Director of UNEP. “This requires governments, business and finance to massively step up investments in nature-based solutions because investments in nature are investments in securing the future for generations to follow.” Nature-based solutions are actions to protect, manage, or restore natural ecosystems, and are already well-documented to be critical to any response to climate change. The World Bank estimates that nature-based solutions can reduce by 37% the carbon emissions reductions that are needed by 2030 to meet the Paris Agreement goals. The Intergovernmental Panel on Climate Change (IPCC) has also pointed to nature-based solutions, such as biodiversity preservation, as key to realistic emissions reductions. “Phasing out coal and decarbonizing the energy systems will not be enough without adjacent massive investments into nature-based solutions,” the report found. “Politicians, business and finance leaders and citizens globally must transform their relationship with nature to work with it rather than against it.” Nature-negative expenditures are 3 to 7 times higher than nature-based solution investment Governments need to scale-down environmentally harmful subsidies and investments, and increased nature based solutions (Nbs) if 1.5C is to remain within reach. While the world faces the overlapping planetary crises of climate change, biodiversity loss and pollution, nature-negative expenditures are 3 to 7 times larger than current investments in nature-based solutions, the report found. With the impacts of these crises already being felt by millions of people around the world, particularly the most vulnerable, UNEP said immediate action is required to begin mitigating and reversing the most harmful impacts. Government expenditures on harmful subsidies to fisheries, agriculture and fossil fuels is estimated at $500 billion to $1 trillion annually. Harmful subsidies are highest in the energy and agricultural sectors, estimated at $340 to $530 billion and around $500 billion per year respectively. By contrast, investment in nature based solutions (Nbs) currently are estimated at just $154 billion annually. “These flows severely undermine efforts to achieve critical environmental targets,” the report warns. “Delayed action is no longer an option in the face of the devastating effects of climate change, the extinction crisis and severe land degradation globally.” This warning is the latest in a series of dire calls to action by UNEP. Its adaptation and emissions gap reports equally stressed the need for immediate action if any hopes of averting climate disaster are to be kept alive. “We had our chance to make incremental changes, but that time is over,” Andersen said at a press conference launching the UNEP emissions gap report in late October, which benchmarked the gap between countries’ actual emissions and needed reductions to keep 1.5C alive. “Only a root-and-branch transformation of our economies and societies can save us from accelerating the climate disaster.” Private sector must step up as governments faces overlapping crises Private capital must start investing in harnessing the power of nature to reduce and remove emissions, restore degraded land and seascapes and turn the tide on biodiversity loss, the report found. The UNEP report reveals that private capital represents just 17% of total investments into nature-based solutions. Governments currently provide the other 83%, but the report stresses they will be unlikely to be able to significantly scale up funding due to current global financial challenges linked to war, debt, and poverty. As a result, private funding for nature-based solutions will have make-up the shortfall, requiring an increase by “several orders of magnitude” in the coming years. Total investments in nature-based solutions will need to hit $384 billion by 2050, more than double the present level of $154 billion annually, the report concludes. The roadmap provided by the report calls for ramping up private capital investments in sustainable supply chains, offsetting unavoidable impacts, reducing activities with negative climate and biodiversity impacts, and investing in “net zero” and “nature positive” activities. This will require a U-turn from the current state of private financial flows. “While robust evidence is lacking, it is widely recognized that private finance flows are predominantly negative for nature and almost certainly exacerbate the situation,” the report states. “These flows severely undermine efforts to achieve critical environmental targets,” the report states. “As the IMF warns of the ‘darkest hour’ in 2023 for global growth, this report is a reminder that many short-term efforts to boost GDP by governments, without attention to the fact that nature underpins many economies, will impose greater costs for both present and future generations in years to come,” the UNEP document concludes. Investment in protecting planet’s oceans disproportionately low The trajectory of annual nature-based solution investment needs to limit climate change to below 1.5°C, haltbiodiversity loss and achieve land degradation neutrality, $ billion (2022 US$). The UNEP analysis also found just 9% of investment in nature-based solutions are directed towards marine ecosystems, a disproportionately low amount given the critical role of oceans in climate mitigation, adaptation, food security, and biodiversity conservation. The Earth’s oceans cover over 70% of the planet’s surface, absorb around 25% of all CO2 emissions, and provide 17% of the world’s protein. Since the start of the Industrial Revolution, oceans have absorbed a third of human carbon dioxide emissions, making them one of the largest carbon sinks, topped only by global rainforests. The lack of investment in marine protection comes at a time of crisis for the world’s oceans. Projections show that by 2050, our oceans may contain more plastics than fish. These will not only suffocate marine life, but also phytoplankton, the microorganisms at the heart of oceans’ abilities to absorb carbon dioxide, as forests and plants do on dry land. As millions of tons of plastic break down in oceans across the world, uncounted quantities of microplastics are infiltrating phytoplankton, blocking sunlight-absorbing mechanisms, which in turn prevents the process of photosynthesis, and damages their ability to capture carbon in the seas. Yet current annual investment in marine protected areas sits at just $980 million, as compared to protection efforts in terrestrial systems, which receive almost US$23 billion annually. US$8–11 billion is needed to increase marine protected areas to 30% by 2030, the report concludes. “While the world is enduring multiple crises, this report provides clarity,” Jochen Flasbarth, State Secretary in the German Federal Ministry for Economic Cooperation and Development (BMZ), said. “It shows that by significantly increasing public and private investments in nature-based solutions, it is possible to tackle climate change, biodiversity loss and land degradation – and at the same time harness many societal and economic benefits. We need to act now.” Image Credits: UNEP. How Does Corruption Affect Health Systems Around the World? 02/12/2022 Editorial team When Patty García was a medical student in Peru some 30 years ago, she was already aware of the detrimental effect of corruption on health systems. “Back then, the corruption related to the distribution of drugs,” Garcia, who would go on to become her country’s Health Minister in 2016, shares during the latest episode of the “Global Health Matters” podcast with host Garry Aslanyan. “Because at that point resources were scarce, probably it was not seen as a big issue because there was not much to steal. But when I became Minister of Health, I realised the magnitude of the problem.” García, who currently is a professor at the School of Public Health at Cayetano Heredia University in Lima, joins Aslanyan, together with Monica Kirya, a lawyer and the Senior Program Adviser at the U4 Anti-Corruption Resource Centre in Norway, as well as Jonathan Cushing, Head of the Transparency International Health Program. “According to Transparency International, $500 billion in public health spending is estimated to be lost globally every year due to corruption,” Aslanyan remarked. “It has been labelled the disease of the health system, hindering and preventing progress towards universal health coverage.” Fighting corruption, all the guests agreed, is essential to achieve universal health coverage. Corruption as a matter of life and death According to Kirya, it is important to consider the phenomenon as a matter of life and death. “You can look at it from the perspective of an expectant mother in labour, or an accident victim bleeding profusely who can’t access urgently needed health care simply because there are no doctors,” she said, sharing the experience of her native Uganda. “One of the reasons why there are no or very few doctors in public health facilities in Uganda increasingly has to do with corruption. It became clear from the research I’ve done that medical graduates are having to pay huge bribes to district service commissions to be recruited.” While health workers are often considered amongst those responsible for corruption, they are also one of its victims, Kirya argues. In order to fight corruption effectively, it is crucial to understand how widespread and complex the phenomenon is. “We’ve absolutely got to get away from this idea that corruption just happens in low-resource settings and low-resource systems,” said Cushing, adding that while “petty bribery” might be more visible, corruption happens everywhere. “It’s much more perhaps more complex, more hidden in higher income countries, but it happens,” he added. “Until we address that, we’re not going to get anywhere.” García revealed that as health minister, she experienced how difficult dismantling the networks behind widespread corruption can be. “I was really concerned about the lack of medications at the health centres, while I knew that we have had a very important process in which we bought medications for all the country,” she recalled. “We started an investigation and we found an illegal operation that was removing the drugs from storage and public hospital pharmacies and placing them in private pharmacies,” she added. “I was working with the Ministry of Internal Affairs and with the police; it was like in the movies.” However, as soon as she left office about 14 months after she was appointed, the investigation was called off. “The problems are still ongoing,” she concluded. The need for leaders with integrity Garcia, Kirya, and Cushing agreed on how hard and complex fighting corruption effectively is, but also stated that this reality should not deter anyone from pursuing the mission. “We can’t afford to be pessimistic,” said Kirya. “We can’t just give up.” “I think that my key call is transparency and leadership,” added Cushing. “We need to have integral leaders. Leaders who are leaders with integrity.” Listen to previous episodes on the Health Policy Website >> Learn more about “Global Health Matters” podcast>> Image Credits: Global Health Matters Podcast, Courtesy of TDR. Twenty Years On, HIV Activist is Still Fighting for Access to Cheaper Medicine 01/12/2022 Kerry Cullinan HIV activist Hazel Tau Twenty years ago, Hazel Tau, a young South African living with HIV, and her peers had little chance of getting antiretroviral (ARV) treatment because it was completely unaffordable. The South African price for just one of the three ARV drugs she needed, AZT, was 665% higher than the best-priced generic available elsewhere in the world. Only around 20,000 South Africans with private healthcare were on ARVs at the time because of the price. So Tau, an activist with the Treatment Action Campaign, agreed to be one of the public faces of a challenge to the price of ARVs – cleverly brought as a complaint to the Competition Commission alleging that two pharmaceutical companies were charging excessive prices for first-line ARVs. At the time, then-president Thabo Mbeki disputed that HIV caused AIDS and claimed that ARVs were poison, so pressuring the government to act on drug prices was a non-starter. The targets were GlaxoSmithKline South Africa and Boehringer Ingelheim, with Tau and others complaining that they had contravened the country’s Competition Act by abusing their dominant market positions on ARV prices. The SA Competition Commission’s Mapato Ramakgopa explained that the commission agreed with Tau and others, and had sought an order from the competition tribunal to compel the firms to grant voluntary licences to allow generic manufacturers to make genetic ARVs in return for a reasonable royalty. “The firms were found to have abused market dominance and fortunately, before the case could be heard by the tribunal, the manufacturers settled the matter and agreed to allow licences for generic and local manufacturers,” said Ramakgopa. Bittersweet victory “It was a bittersweet experience because of everyone who could not be saved,” said Tau, speaking at a commemorative event on Thursday. “I lost friends, family, colleagues. We lost millions of people who were breadwinners. But I will say I was happy with the outcome.” Finally, she and others could look forward to a life with access to affordable treatment. But Tau’s struggle for treatment access continues today as she is fighting for cheaper cancer drugs. “We know that, in developed countries, they’ve got cheaper drugs that can help people who have got cancer of different types, but we still have to pay it so I’m not feeling good about that,” said Tau. She is also still fighting the stigma faced by people living with HIV – and says that it is time for stand-alone HIV clinics – largely the result of special HIV funding – to be integrated as part of chronic care to spare those who need HIV care from being conspicuous when they go for treatment. “I blame us for having that HIV clinic. I wish HIV was just dealt with like other chronic diseases, normally without saying ‘this is an HIV thing’ because the stigma started there,” says Tau. Speaking on World AIDS Day, Tau said that she honoured those who had passed on and those newly infected and wished that AIDS awareness campaigns were active every day. Access to affordable medicine Access to affordable medicine continues to haunt people from poorer countries, as the COVID-19 pandemic showed when millions of people in low and middle-income countries could not get vaccines as these had all been bought by wealthy countries. The question of intellectual property (IP) rights on essential medicine is as burning an issue today as it was during the AIDS era. Fatima Hassan, director of the Health Justice Initiative (HJI), was one of the lawyers representing Tau and others – and more recently, has been campaigning for wider access to COVID-19 vaccines and therapeutics. Fatima Hassan ‘The reason we brought the case was because we saw the ‘Lazarus’ drugs. We saw them working for people in the USA. We saw them working for people in Europe.,” said Hassan. “We saw what Brazilian and Thai activists were doing to try to get compulsory measures in place for their governments to introduce generic therapies into their country. But our government was having none of that. It was in denial of the science and it refused to implement a public sector programme, which is the reason why we had to focus on the price of abuse in the private sector.” Hassan says that today’s struggles include fighting for access to expensive cancer treatments, exorbitant cystic fibrosis drugs and cabotegravir, an HIV prevention injection that received regulatory approval for use in South Africa on Thursday but remains too expensive for most. “Pharmaceutical companies have these IP monopolies which then means that we’ve got to continuously fight them on pricing because, in the absence of our government, taking the necessary executive action or issuing compulsory licences, we’re always going to have to rely on civil society or the Competition Commission to deal with the abuse of dominance, capture of the market and excessive pricing,” said Hassan. 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Keep Momentum on Pandemic ‘Treaty’, Urges Tedros 05/12/2022 Kerry Cullinan INB co-chair Precious Matsoso and Dr Tedros Keep the momentum to negotiate a pandemic instrument, urged Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO) at the start of the third meeting of the intergovernmental negotiating body (INB) on Monday. “The conceptual zero-draft that your bureau has developed is a true reflection of the aspirations for a different paradigm for strengthening pandemic prevention, preparedness, response and recovery,” said Tedros. “As we move to a new phase of this process, I urge you to maintain momentum.” Almost exactly a year ago, a special meeting of the World Health Assembly resolved to negotiate a treaty to outline the future global pandemic prevention, preparedness and response. Members of the INB were appointed in February and developed the draft in record time, presenting it to member states in late November. Support for draft – but with more detail At Monday’s meeting, most member states expressed support for the draft as the basis for a ‘zero draft’ to launch official negotiations on the first of the three-day meeting, but many thought the draft was too general. “I’m very happy with the common voice in this room that the document we provided you with is a good basis for the next steps,” said INB co-chair Roland Driece. “Nobody said it was not and most of you think that, with improvements or alterations, it could serve in an improved way as a zero draft for negotiations next year.” But, Driece added, most member states “wanted to have more elaborated text” that also had more legal terminology and definitions. “Furthermore, many of you said this conceptual zero draft has a lot of good starting points, but we need to focus on the real priorities, focus on the issues that have the most impact and most of you said that is because May 2024 is coming rather soon,” added Driece. INB co-chair Roland Driece The body has until the WHO’s 77th World Health Assembly in May 2024, a mere 17 months, in which to develop and present an agreement. In that regard, Tedros announced that he has asked Dr Jaouard Mahjour to continue to co-ordinate the INB’s secretariat. Mahjour’s contract as WHO’s Assistant Director-General for emergency preparedness and international health regulations ended on the last day of November. “I have asked Dr Mahjour to continue as head of the secretarial team for the INB and the [International Health Regulations] amendment process. The team established to support your work has made me proud, with their delivery and efficiency. Time is short, and there is much work to do,” added Tedros. The Group of Friends of the Pandemic Treaty, a group of 43 countries from different regions of the world, called for the treaty to be “an ambitious legally binding agreement which has a real-world impact in terms of pandemic prevention, preparedness, response and recovery”. The US, UK and the European Union stressed that the treaty could not address everything, but needed to prioritise key concerns. Meanwhile, the African region said that some of their concerns had been left out, such as the need to reflect that government investment in medical R&D was part of the “global good” – and presumably, this knowledge should be freely available. It also wanted the agreed principle of equity to be “operationalised” and included throughout the document. Dovetailing with IHR reform Most states wanted the process of reforming the IHR and the development of the treaty to dovetail, with China articulating that the IHR reform and development of the treaty needed to be “fully coordinated, consistent and complementary in terms of content”. Stressing that the treaty needed to be formulated with respect for the sovereignty of member states, China also called for “the stigmatization of countries that report cases which helped to motivate countries to share information and pathogen timely way” to be included in the principal part of the document. This was echoed by South Africa, which pointed out how it had been stigmatised and punished with travel bans after it had identified and shared the omicron variant of COVID-19 with the international community. Steven Solomon, WHO principal legal officer Treaty, agreement or convention? In response to member states’ queries about the different legal forms of a pandemic instrument, WHO principal legal officer Steven Solomon said that both an agreement and a convention “are both treaties within the meaning of international law”. In addition, said Solomon, a convention and a “framework convention” were “not mutually exclusive” and it is “possible to have a hybrid approach as well as one or the other”. COVID-19 Translated into Three Years of ‘Human Rights Violations’ 05/12/2022 Maayan Hoffman Prof Lawrence Gostin, a member of the independent Panel for a Global Health Convention “Every aspect of the COVID-19 response, beginning with the origins of the pandemic in Wuhan to China’s current Zero-COVID strategy, has had severe restrictions on human rights,” according to Prof Lawrence Gostin, a member of the independent Panel for a Global Health Convention. Speaking Monday afternoon at the UNITE Global Summit in Lisbon, he called on parliamentarians to take a “moment of reflection” on the untold human suffering that resulted from the pandemic. “It is not just the millions of lives lost or the trillions of dollars lost,” said Gostin, “but the vast deprivation of freedom, noxious discrimination and erosion of democratic ideals.” Although Monday’s sessions focused specifically on pandemic response and preparedness – human rights will be tackled more thoroughly on Wednesday – Gostin used the summit to speak to participants via Zoom and recount the many human rights violations that ensued over the past three years. He also issued a battle cry for parliamentarians to put practices in place to halt these violations before the next pandemic. He recalled how, in the early days of the pandemic in Wuhan, there was “less than full transparency” in terms of reporting the outbreak to the word. Even the transfer of the genomic sequence of the virus came “somewhat late.” “There was a crackdown on protesters and particularly a brave, whistle-blower doctor who later died in Wuhan,” he Gostin said. He then fast-forwarded to China’s current zero-COVID strategy, which he said is enforced via extreme surveillance and restriction methods. But the violations did and do not end in the Red Dragon state, said Gostin. Countries cramped down on political protests, delayed elections, enacted abusive restrictions and arrested members of marginalised populations all in the name of COVID, according to Gostin. These violations could be bucketed into two categories, he said – one: violations of political and democratic rights, and two: unequal and discriminatory practices. ‘Vaccine apartheid’ “There was vaccine apartheid, as populations in the United States, Europe and other high-income countries were protected and so many others were left behind, in Africa and other low-income countries,” Gostin noted. Countries from Egypt and Russia, to Venezuela, Madagascar and Bangladesh threatened the civil or political rights of their citizens, violating the right to freedom of expression and access to accurate information from journalists and healthcare workers. Hungary’s prime minister even used emergency powers to direct funding away from cities that were opposition strongholds. Those who were disfavoured in marginalized populations fell victim to arbitrary arrests. For example, Venezuela targeted returning refugees for quarantine in inhumane and degrading facilities, he said. “We all remember the initial scramble for diagnostics tests, personal protective equipment and ventilators,” Gostin said. “But global outrage should have peaked when the most vulnerable in the world were unable to get vaccines.” In June 2021, according to Gostin, one-third of people in rich countries were fully vaccinated while only 0.2% of people in low-income countries had two shots. The COVAX facility never got the funding it needed to ensure full vaccinations nor could it get the vaccine doses it required. “Today, these inequalities are manifested in antiviral therapeutics like Paxlovid,” Gostin continued. “The COVID-19 pandemic has reverberated into other spheres, with lower standards of living, people being pushed into absolute poverty, inadequate education and nutrition – all exacerbated now because of the Ukraine crisis.” He said the crises caused by COVID-19 and Ukraine merged with climate change, and have left more than 200 million people in acute hunger. “At its core, human rights are about human dignity,” Gostin concluded. “It is now for us to honour … the lives of everyone harmed by these violations by undertaking transformational reforms in global health, human rights security and inequity so that when the next crisis hits, we will at least reassert the fundamental principle of human dignity that emerged after World War II.” The UNITE Global Summit runs from Dec. 5-7, 2022. Click here for full coverage. Reporting for this series was supported by UNITE Parliamentarians for Global Health. Image Credits: Maayan Hoffman, Screenshot. After COVID-19, Five Policy Recommendations from Malaysia 05/12/2022 Maayan Hoffman Malaysian MP Kelvin Yil Lee Wuen at the UNITE Global Summit on December 5, 2022. COVID-19 was a “global stress test” for parliamentarians, whose job is to propose policies, said Kelvin Yil Lee Wuen, a parliamentarian from Malaysia. Speaking Monday at the UNITE Global Summit in Lisbon, the MP proposed five global policy recommendations, which he said his own country had adopted. 1 – Create conducive policies and infrastructure to enable innovation According to Wuen, countries must enhance platforms and processes so that the public and private sector can innovate in real time. 2 – Establish robust and comprehensive inner-country and global data and knowledge sharing Wuen said that countries should work together to determine and implement best practices. In addition, the world should look toward a global medical network. By agreeing on standards between the U.S. Food and Drug Administration, the European Medicines Agency and other regulatory bodies “it doesn’t have to take so much time to approve new drugs, interventions and vaccines. We have to figure out how to be more efficient.” 3 – Invest in global capabilities for the early characterization of pathogens and assessment 4 – Improve and increase education “We need to empower the people by breaking misinformation early,” said Wuen. He recalled that there was a rise in fake news in Malaysia during the pandemic, including around basic principles, like what it means for a vaccine to receive emergency use approval. “We need to educate people so that in the future when vaccines are approved the public has assurance that they are safe to use and that their benefits outweigh their risks,” Wuen stressed. He noted that improving communications should happen immediately if the world wants to be ready for the next crisis. “In a public health crisis, communication is as important – if not more important – than medical intervention,” Wuen said. “To get people to comply, they need to have confidence in the system and to have that trust they need communication.” 5 – A fair, equitable, inclusive and accountable distribution network Wuen said that on the domestic and international levels, systems must be developed to distribute drugs, treatments and vaccines. He said “this includes the controversial topic of an intellectual property (IP) waiver for life-saving vaccines. “It is vaccines in bodies that save lives,” Wuen added. The pandemic reignited a long-standing debate about the right balance between private profits and public health. While some argued that the World Trade Organization rules on IP harmed access to COVID vaccines in poor countries, others said lifting it would remove the incentive for drugmakers to keep developing the life-saving shots. A partial IP waiver on COVID vaccines was agreed on in June and the WTO’s TRIPS’s Council has until 17 December to decide whether to extend it. “The COVID response had its ups and downs, but vaccine inequality is one of our biggest moral failings,” Wuen said. Vaccines in 100 days? CEPI Director of Policy Neren Rau speaking at the UNITE Global Summit on December 5, 2022. Wuen spoke as part of a UNITE Global Summit session titled “Preparing for the pandemic by developing vaccines in 100 days.” The session featured two speakers from the Coalition for Epidemic Preparedness Innovations (CEPI), including Director of Policy Neren Rau. He offered his organization’s plan to ensure there are vaccines for everyone during the next pandemic, which centers on more diversified vaccine manufacturing. CEPI has developed more than 70 partnerships in 50 countries around the world to develop vaccines, enable vaccines and get them into the right people’s hands at a reasonable cost. “Access lies at the heart of our plan,” Rau said. “Achieving the 100-day plan aspiration would give the world a fighting chance of tackling and containing outbreaks before they spread and become pandemics.” CEPI’s 100-day plan is to develop a working vaccine within 100 days of the start of the next pandemic. The first vaccines – for typhoid fever and meningitis – took more than 100 years to develop. The vaccine for Ebola took 20 years. It took 364 days to get the first approved COVID-19 vaccine, Rau said, and with the proper efficiencies, the number of days it would take to develop the next vaccine would be only 250. So, why is CEPI so focused on 100 days? “The lives that will be saved,” Rau stressed. “The difference is almost 70 million lives between 364 days and 100 days.” But he added that the plan only works if the vaccine is distributed to the country or region of the outbreak “regardless of where that might be.” He said, “this requires a fundamental shift in international collaboration and cooperation toward a system founded on the principles of equitable access.” The COVID-19 pandemic will not be the world’s last, Wuen added. The next one is “closer than we think.” The UNITE Global Summit runs from Dec. 5-7, 2022. Click here for full coverage. Reporting for this series was supported by UNITE Parliamentarians for Global Health. Image Credits: Maayan Hoffman. MPs Are Urged to Redirect Funding Towards Prevention and Primary Care 05/12/2022 Maayan Hoffman The head of the Health Division at the Organisation for Economic Co-operation and Development called on parliamentarians to redirect health funding towards prevention and primary care to help improve health outcomes. Speaking Monday at the opening session of the UNITE Global Summit in Lisbon, Francesca Colombo said that a basic health analysis proves the need to be focused in this direction. “Only 3% of total health spending is devoted to tackling poor risk factors and public health measures,” she told a room of more than 30 parliamentarians and other health leaders in the Senate Chamber of the Portuguese Parliament. “Return on investment in tackling unhealthy lifestyles is very high.” She noted for example that every dollar invested in tackling obesity has a $6 return on investment in economic benefits. Moreover, she said that her organization’s work has shown that three out of four deaths from antimicrobial resistance (AMR) could be averted by spending just a few dollars more – $2 per person. “While COVID-19 demonstrated that countries with strong health systems and universal health coverage are better prepared to manage health threats, investments in primary care account for less than $1 in every $6 present in health systems,” Colombo stressed. Finally, she added, too much health spending is at best ineffective and at worst harmful. A 2017 OECD report showed 20% of health expenditures make no or minimal contribution to good health outcomes. How to address these failings “The global shortage of healthcare workers must be urgently addressed, including finding equitable solutions to address international health workforce migration,” said Colombo. “The pandemic accelerated the use of digital tools like telehealth and remote diagnostics. Yet more needs to be done to accelerate the equitable development and use of these tools. “Finding new ways to pay for global public goods, such as vaccines and antimicrobials will be essential to be ready for future crises,” she added. The OECD has calculated that even in high-income countries an annual investment totalling 1.4% of GDP is needed to make health systems strong enough to meet the challenges of another pandemic on the scale of COVID-19, Colombo said. She expressed concern that finance ministers’ enthusiasm for investing in health is fading away. Raising parliamentarians’ voices Ricardo Baptista Leite, president and founder of UNITE Parliamentarians The UNITE Global Summit is meant to once again raise up parliamentarians’ voices around issues of health and health security. The event began around 9 a.m. in the Senate Chamber. Although the room is no longer in use, it continues to be harnessed for conferences and its rows of parliamentary chairs lent to the import of the conference on Monday morning. The theme of the UNITE summit is “from pandemic to prosperity,” a topic that Ricardo Baptista Leite, president and founder of UNITE, said should be “self-explanatory.” But, like Colombo, he said that the discussion is coming at a difficult time – a time when governments want to move beyond the pandemic and are focused on other challenging issues like the Russia-Ukraine war and rising inflation and cost-of-living in their countries. Leite said that nonetheless, parliamentarians must make their voices heard. “We are still in a pandemic, still suffering from the results of severe lockdown and the consequences of our lack of preparedness,” he said. “That is why our first day is focused on infection control and pandemic preparedness and response.” Ilona Kickbusch, founder of the Global Health Centre at the Graduate Institute in Geneva Over the next two days, the conference will also look at the future of health systems and health as a human right. Participants will be charged with answering three questions: What progress have we made so far during the UN’s Sustainable Development Goals period? What have we learned to help us make even more progress by 2030? What is the role of parliamentarians in helping drive that progress? “Parliamentarians should be at the forefront of the fight,” stressed Professor Ilona Kickbusch, founder of the Global Health Centre at the Graduate Institute in Geneva, who also spoke as part of the introductory session. “Parliamentarians should be the link between their constituents and their governments.” The UNITE Global Summit runs from Dec. 5-7, 2022. Click here for full coverage. Reporting for this series was supported by UNITE Parliamentarians for Global Health. Image Credits: Maayan Hoffman. Wendy Reaser: Struggling with Obesity in Canada 03/12/2022 Editorial team A special project celebrating the fifth anniversary of “Our Views, Our Voices” | Learn more Wendy Reaser One time, as Wendy Reaser was visiting the emergency room, she heard a specialist describing her as “fat and lazy,” adding that she did not want to put the work into being healthy. This experience, as well as many other unpleasant interactions with health professionals, left Wendy discouraged and traumatized. “For many years, this statement had me convinced that because I’m living with obesity, I didn’t have the right to care from medical professionals,” she shares in the NCD Diaries project, an initiative launched by the NCD Alliance. “I was convinced that nothing could be done and I wasn’t worth saving.” NCDs (noncommunicable diseases) are diseases that are not transmissible from person to person and they represent the first cause of death and disability worldwide. The NCD Diaries project is meant to support individuals like Wendy, so that they can share their lived experiences of NCDs, drawing on their unique local contexts, challenges faced and their aspirations and recommendations to drive change on NCDs. Canada, where Wendy lives, provides its citizens with universal healthcare coverage. “While this is fantastic because everyone has access to treatment, it doesn’t always mean that you get treated well,” Wendy writes. “Living with obesity is a daily struggle physically and mentally,” she explains. “Not only do we have to live with our shame and self-loathing, but we also must live with the judgement of those around us. Often, we are made to feel that we aren’t deserving of medical help, with many health care providers having been trained to tell us to simply ‘eat less and move more’.” Luckily for Wendy, she eventually found doctors with a different approach. “One day I visited my family doctor, who had been with us for about a year, to express concern about symptoms I was experiencing that were noticeable in my dad prior to his death from a heart attack,” she recalls. “I expected her to say that it was my weight, that I had to eat less and exercise more. I didn’t expect her to sit up and pay attention, and to immediately put in an urgent referral to a cardiologist. But that’s exactly what she did.” The cardiologist explained to Wendy that her heart was enlarged because she had sleep apnea, so her lungs were lacking oxygen. “I’d just started sleep apnea treatment 6 months before seeing him,” she writes. “He was confident that if I continued this treatment, ‘tweaked my eating and maybe moved around just a little more,’ my heart would be fine in under a year.” Wendy emphasizes that the doctor’s words saved her life. “It’s interactions like these that began to restore my confidence in navigating my care journey, and my faith in the medical profession,” she explains. Health professionals, she argues, need better training to provide care empathetically and effectively for people living with obesity. “Healthcare providers must accept that people living with obesity are not fat and lazy,” Wendy says. “There are several factors including genetics, medication, and even monetary constraints that can and do contribute to someone becoming obese. There’s a way to discuss obesity-related issues respectfully and helpfully, that doesn’t leave a deflated feeling of failure.” Read Wendy Reaser’s full NCD Diary. Read previous post. Image Credits: Courtesy of NCD Alliance. US Eager to Move Ahead with Pandemic Accord that Promotes Equity but not ‘Transactional’ Linkage between Data and Benefit-Sharing 02/12/2022 Elaine Ruth Fletcher Pamela Hamamoto, lead US negotiator on the WHO pandemic accord, in Geneva this week. The United States, once a reluctant partner in the initiative for a new global pandemic accord, is now keen to move ahead in negotiations over an agreement. The accord would expedite more rapid global data sharing and response to looming threats as well as ensuring greater equity in access to medicines and treatments, said the lead US negotiator of the instrument, Pamela Hamamoto on Friday. But Washington would like to avoid what she described as “transactional” language directly linking the two issues, as some developing nations have suggested. Nations like South Africa, for instance, cite bitter experiences with rapid, transparent sharing of genetic data on new SARS2 variants, which did nothing to improve the country’s access to badly-needed COVID medicines or vaccines. “Overall, the concept of equity, as I said, is very important. And it is certainly something that the United States is committed to to helping work on that and improve… the availability of medical countermeasures broadly speaking, going forward,” Hamamoto said. But in terms of a direct “linkage between the access and benefit sharing… I actually don’t necessarily think that that linkage is that helpful,” she said. “We’re also very interested in you know, as are others, in the rapid transparent sharing of data,” she said, adding, “what I hope is that… the sort of transactional nature of that concept doesn’t hamper us in being aspirational in our thinking, how we approach this and move forward.” Hamamoto was speaking in Geneva Friday along with Loyce Pace, US Assistant Secretary for Global Affairs, after a week of closed-door meetings with WHO officials and other WHO member states ahead of a third round of member state negotiations on a ‘conceptual’ zero draft text for the treaty due to start next week. First ‘zero draft’ circulated in late November Loyce Pace, Assistant Secretary for Global Affairs, US Department of Health and Human Services, in Geneva this week. This initial ‘zero draft’ text of a proposed pandemic accord was circulated among member states in late November. The draft calls for for “early, safe, transparent and rapid sharing of samples and genetic sequence data of pathogens” – a measure supported by the pharmaceutical industry – but simultaneously calls for “the fair and equitable sharing of benefits” – which the private sector and many developed countries along with the US have resisted, saying that too tight a linkage between any country’s agreement to share pathogen data and benefits reaped could slow down pandemic response. The draft also makes a strong case for more emphasis on regional production of vaccines and other pandemic-related products as well as ‘strategic stockpiles’ of pandemic response supplies. Speaking on that point, Pace and Hamamoto both underlined that the US is supportive of efforts to regionalize production of pandemic countermeasures. “We’re very committed to leaning into overall concepts of equity and transparency,” Hamamoto said. “making sure that we’re better prepared for the surveillance, detection and rapid response to future outbreaks. More comprehensive data and sample sharing on a fast timeframe as well rapid, rapid response .. and more equitable access to medical countermeasures, possibly through regional and local manufacturing.” Current text is hanging too much on the Christmas tree However both women warned that the current text, including many member state proposals for amendments and additions, will need considerable refinement to get the approval of the US and other member states. “There are so many ornanments we’re trying to put on the Christmas tree,” said Pace. “And that is understandable, and yet there are various work streams that will emerge, where there can be a higher and better use for some areas than others.” Added Hamamoto, “I think it’s just there’s just too much in there that is, is maybe not at the right level, like a more tactical playbook… as opposed to, you know, international agreements. “What we’re focused on next week is to really move it towards something that’s appropriately scoped to begin,” she said. “What it represents now is a collection of all the inputs that the Bureau has received so far for member states and external stakeholders as well,” she noted, referring to the small member state group guiding the process. “And everything has just been collected, sorted to a certain extent into some specific chapters…. But there’s a lot of work that still needs to be done around scope around structure around governance. And so in a nutshell, there’s a lot that needs to change before we were going to be able to sign on to it, as is the same for a lot of Member States, probably most.” Negotiations over revisions to International Health Regulations happening in parallel Negotiations over revisions to the WHO’s International Health Regulations are also proceeding in parallel. It was the US which tabled a series of proposed amendments to the IHR at the May World Health Assembly as matter for negotiations, finally winning the agreement of the member state body to engage in a parallel process to revise the 2005 WHO agreement on procedures for responding to outbreak and emergency threats. Assembly Approves Process to Update International Health Regulations on Pandemic Response Revising the IHR is deemed to be a quicker fix to some of the shortcomings in global pandemic response as once any revisions are approved, they would take effect immediately. A new international convention or accord would have to be ratified state by state. However agreement on those revisions, and alignment with the new pandemic accord, will also be a complex process, she admitted. “Obviously, there’s a lot cooking in that space, with so many member states and frankly, amendments being brought to the table,” Pace said. “That’s a good thing because I think we weren’t sure, frankly, earlier this year, to what degree the member states would be interested in engaging in that [IHR] process. And so I know a lot of being done to look through those various proposals and align them with the work that Ambassador Hamamoto is leading on the front end.” Hints at adjustments in negotiating schedule – but not endpoint Standing ovation at 2021 special World Health Assembly session that decides to negotiate a new pandemic accord. Hamamoto also suggested that some of the mid-term milestones that have been set in the negotiating schedule for the pandemic accord over the coming two years, might have to be adjusted in order to accommodate the complexity of the process. According to the current timeline, a firm ‘zero draft’ text is supposed to be ready to put before WHA member states for the full-fledged start of negotiations by February 2023. However, Hamamoto said that she was in no way suggesting that member states should prolong deliberations over the text beyond the May 2024 date that was agreed to by WHO member states exactly a year ago, as the date by which a final draft text should be brought before the World Health Assembly. “You know, the pretty broadly held view is that we need to make sure that the process is set up right so that we feel that we can that we have the space to do our work, and make sure we get this right and so we don’t blow this opportunity to put together an accord that is going to be meaningful and implementable,” Hamamoto said. “But May 2024 is the planned and hoped-for end-date and I’m not suggesting going beyond that. However, the time line along the way is ambitious. And we do also have these parallel processes, so we just want to make sure in theese early stages, what is being called the zero draft, that we get that right.” Image Credits: E Fletcher/Health Policy Watch , E Fletcher/Health Policy Watch. UN Environment: Investments in ‘Nature-Based’ Climate Solutions Must Double by 2025 02/12/2022 Stefan Anderson Climate, biodiversity, and land degradation goals will be out of reach unless investments into nature-based solutions quickly ramp up to $384 billion/year by 2025, more than double of the current $154 billion/year, according to UN Environment Programme. A new report by the United Nations Environment Programme warns that investment in nature-based solutions must double by 2025 if the world is to limit global warming to 1.5°C, as well as halting biodiversity loss and progressively increasing land degradation. The report comes a week before world leaders will gather at the UN Biodiversity Conference (COP15) in Montreal, Canada, where they are set to negotiate an agreement that aims to halt and reverse biodiveristy loss by 2030. UNEP is calling on governments to agree on a clear framework for countries to require the financial sector to align its activities with ‘nature positive’ goals. “The science is undeniable. As we transition to net-zero emissions by 2050, we must also reorient all human activity to ease the pressure on the natural world on which we all depend,” said Inger Andersen, Executive Director of UNEP. “This requires governments, business and finance to massively step up investments in nature-based solutions because investments in nature are investments in securing the future for generations to follow.” Nature-based solutions are actions to protect, manage, or restore natural ecosystems, and are already well-documented to be critical to any response to climate change. The World Bank estimates that nature-based solutions can reduce by 37% the carbon emissions reductions that are needed by 2030 to meet the Paris Agreement goals. The Intergovernmental Panel on Climate Change (IPCC) has also pointed to nature-based solutions, such as biodiversity preservation, as key to realistic emissions reductions. “Phasing out coal and decarbonizing the energy systems will not be enough without adjacent massive investments into nature-based solutions,” the report found. “Politicians, business and finance leaders and citizens globally must transform their relationship with nature to work with it rather than against it.” Nature-negative expenditures are 3 to 7 times higher than nature-based solution investment Governments need to scale-down environmentally harmful subsidies and investments, and increased nature based solutions (Nbs) if 1.5C is to remain within reach. While the world faces the overlapping planetary crises of climate change, biodiversity loss and pollution, nature-negative expenditures are 3 to 7 times larger than current investments in nature-based solutions, the report found. With the impacts of these crises already being felt by millions of people around the world, particularly the most vulnerable, UNEP said immediate action is required to begin mitigating and reversing the most harmful impacts. Government expenditures on harmful subsidies to fisheries, agriculture and fossil fuels is estimated at $500 billion to $1 trillion annually. Harmful subsidies are highest in the energy and agricultural sectors, estimated at $340 to $530 billion and around $500 billion per year respectively. By contrast, investment in nature based solutions (Nbs) currently are estimated at just $154 billion annually. “These flows severely undermine efforts to achieve critical environmental targets,” the report warns. “Delayed action is no longer an option in the face of the devastating effects of climate change, the extinction crisis and severe land degradation globally.” This warning is the latest in a series of dire calls to action by UNEP. Its adaptation and emissions gap reports equally stressed the need for immediate action if any hopes of averting climate disaster are to be kept alive. “We had our chance to make incremental changes, but that time is over,” Andersen said at a press conference launching the UNEP emissions gap report in late October, which benchmarked the gap between countries’ actual emissions and needed reductions to keep 1.5C alive. “Only a root-and-branch transformation of our economies and societies can save us from accelerating the climate disaster.” Private sector must step up as governments faces overlapping crises Private capital must start investing in harnessing the power of nature to reduce and remove emissions, restore degraded land and seascapes and turn the tide on biodiversity loss, the report found. The UNEP report reveals that private capital represents just 17% of total investments into nature-based solutions. Governments currently provide the other 83%, but the report stresses they will be unlikely to be able to significantly scale up funding due to current global financial challenges linked to war, debt, and poverty. As a result, private funding for nature-based solutions will have make-up the shortfall, requiring an increase by “several orders of magnitude” in the coming years. Total investments in nature-based solutions will need to hit $384 billion by 2050, more than double the present level of $154 billion annually, the report concludes. The roadmap provided by the report calls for ramping up private capital investments in sustainable supply chains, offsetting unavoidable impacts, reducing activities with negative climate and biodiversity impacts, and investing in “net zero” and “nature positive” activities. This will require a U-turn from the current state of private financial flows. “While robust evidence is lacking, it is widely recognized that private finance flows are predominantly negative for nature and almost certainly exacerbate the situation,” the report states. “These flows severely undermine efforts to achieve critical environmental targets,” the report states. “As the IMF warns of the ‘darkest hour’ in 2023 for global growth, this report is a reminder that many short-term efforts to boost GDP by governments, without attention to the fact that nature underpins many economies, will impose greater costs for both present and future generations in years to come,” the UNEP document concludes. Investment in protecting planet’s oceans disproportionately low The trajectory of annual nature-based solution investment needs to limit climate change to below 1.5°C, haltbiodiversity loss and achieve land degradation neutrality, $ billion (2022 US$). The UNEP analysis also found just 9% of investment in nature-based solutions are directed towards marine ecosystems, a disproportionately low amount given the critical role of oceans in climate mitigation, adaptation, food security, and biodiversity conservation. The Earth’s oceans cover over 70% of the planet’s surface, absorb around 25% of all CO2 emissions, and provide 17% of the world’s protein. Since the start of the Industrial Revolution, oceans have absorbed a third of human carbon dioxide emissions, making them one of the largest carbon sinks, topped only by global rainforests. The lack of investment in marine protection comes at a time of crisis for the world’s oceans. Projections show that by 2050, our oceans may contain more plastics than fish. These will not only suffocate marine life, but also phytoplankton, the microorganisms at the heart of oceans’ abilities to absorb carbon dioxide, as forests and plants do on dry land. As millions of tons of plastic break down in oceans across the world, uncounted quantities of microplastics are infiltrating phytoplankton, blocking sunlight-absorbing mechanisms, which in turn prevents the process of photosynthesis, and damages their ability to capture carbon in the seas. Yet current annual investment in marine protected areas sits at just $980 million, as compared to protection efforts in terrestrial systems, which receive almost US$23 billion annually. US$8–11 billion is needed to increase marine protected areas to 30% by 2030, the report concludes. “While the world is enduring multiple crises, this report provides clarity,” Jochen Flasbarth, State Secretary in the German Federal Ministry for Economic Cooperation and Development (BMZ), said. “It shows that by significantly increasing public and private investments in nature-based solutions, it is possible to tackle climate change, biodiversity loss and land degradation – and at the same time harness many societal and economic benefits. We need to act now.” Image Credits: UNEP. How Does Corruption Affect Health Systems Around the World? 02/12/2022 Editorial team When Patty García was a medical student in Peru some 30 years ago, she was already aware of the detrimental effect of corruption on health systems. “Back then, the corruption related to the distribution of drugs,” Garcia, who would go on to become her country’s Health Minister in 2016, shares during the latest episode of the “Global Health Matters” podcast with host Garry Aslanyan. “Because at that point resources were scarce, probably it was not seen as a big issue because there was not much to steal. But when I became Minister of Health, I realised the magnitude of the problem.” García, who currently is a professor at the School of Public Health at Cayetano Heredia University in Lima, joins Aslanyan, together with Monica Kirya, a lawyer and the Senior Program Adviser at the U4 Anti-Corruption Resource Centre in Norway, as well as Jonathan Cushing, Head of the Transparency International Health Program. “According to Transparency International, $500 billion in public health spending is estimated to be lost globally every year due to corruption,” Aslanyan remarked. “It has been labelled the disease of the health system, hindering and preventing progress towards universal health coverage.” Fighting corruption, all the guests agreed, is essential to achieve universal health coverage. Corruption as a matter of life and death According to Kirya, it is important to consider the phenomenon as a matter of life and death. “You can look at it from the perspective of an expectant mother in labour, or an accident victim bleeding profusely who can’t access urgently needed health care simply because there are no doctors,” she said, sharing the experience of her native Uganda. “One of the reasons why there are no or very few doctors in public health facilities in Uganda increasingly has to do with corruption. It became clear from the research I’ve done that medical graduates are having to pay huge bribes to district service commissions to be recruited.” While health workers are often considered amongst those responsible for corruption, they are also one of its victims, Kirya argues. In order to fight corruption effectively, it is crucial to understand how widespread and complex the phenomenon is. “We’ve absolutely got to get away from this idea that corruption just happens in low-resource settings and low-resource systems,” said Cushing, adding that while “petty bribery” might be more visible, corruption happens everywhere. “It’s much more perhaps more complex, more hidden in higher income countries, but it happens,” he added. “Until we address that, we’re not going to get anywhere.” García revealed that as health minister, she experienced how difficult dismantling the networks behind widespread corruption can be. “I was really concerned about the lack of medications at the health centres, while I knew that we have had a very important process in which we bought medications for all the country,” she recalled. “We started an investigation and we found an illegal operation that was removing the drugs from storage and public hospital pharmacies and placing them in private pharmacies,” she added. “I was working with the Ministry of Internal Affairs and with the police; it was like in the movies.” However, as soon as she left office about 14 months after she was appointed, the investigation was called off. “The problems are still ongoing,” she concluded. The need for leaders with integrity Garcia, Kirya, and Cushing agreed on how hard and complex fighting corruption effectively is, but also stated that this reality should not deter anyone from pursuing the mission. “We can’t afford to be pessimistic,” said Kirya. “We can’t just give up.” “I think that my key call is transparency and leadership,” added Cushing. “We need to have integral leaders. Leaders who are leaders with integrity.” Listen to previous episodes on the Health Policy Website >> Learn more about “Global Health Matters” podcast>> Image Credits: Global Health Matters Podcast, Courtesy of TDR. Twenty Years On, HIV Activist is Still Fighting for Access to Cheaper Medicine 01/12/2022 Kerry Cullinan HIV activist Hazel Tau Twenty years ago, Hazel Tau, a young South African living with HIV, and her peers had little chance of getting antiretroviral (ARV) treatment because it was completely unaffordable. The South African price for just one of the three ARV drugs she needed, AZT, was 665% higher than the best-priced generic available elsewhere in the world. Only around 20,000 South Africans with private healthcare were on ARVs at the time because of the price. So Tau, an activist with the Treatment Action Campaign, agreed to be one of the public faces of a challenge to the price of ARVs – cleverly brought as a complaint to the Competition Commission alleging that two pharmaceutical companies were charging excessive prices for first-line ARVs. At the time, then-president Thabo Mbeki disputed that HIV caused AIDS and claimed that ARVs were poison, so pressuring the government to act on drug prices was a non-starter. The targets were GlaxoSmithKline South Africa and Boehringer Ingelheim, with Tau and others complaining that they had contravened the country’s Competition Act by abusing their dominant market positions on ARV prices. The SA Competition Commission’s Mapato Ramakgopa explained that the commission agreed with Tau and others, and had sought an order from the competition tribunal to compel the firms to grant voluntary licences to allow generic manufacturers to make genetic ARVs in return for a reasonable royalty. “The firms were found to have abused market dominance and fortunately, before the case could be heard by the tribunal, the manufacturers settled the matter and agreed to allow licences for generic and local manufacturers,” said Ramakgopa. Bittersweet victory “It was a bittersweet experience because of everyone who could not be saved,” said Tau, speaking at a commemorative event on Thursday. “I lost friends, family, colleagues. We lost millions of people who were breadwinners. But I will say I was happy with the outcome.” Finally, she and others could look forward to a life with access to affordable treatment. But Tau’s struggle for treatment access continues today as she is fighting for cheaper cancer drugs. “We know that, in developed countries, they’ve got cheaper drugs that can help people who have got cancer of different types, but we still have to pay it so I’m not feeling good about that,” said Tau. She is also still fighting the stigma faced by people living with HIV – and says that it is time for stand-alone HIV clinics – largely the result of special HIV funding – to be integrated as part of chronic care to spare those who need HIV care from being conspicuous when they go for treatment. “I blame us for having that HIV clinic. I wish HIV was just dealt with like other chronic diseases, normally without saying ‘this is an HIV thing’ because the stigma started there,” says Tau. Speaking on World AIDS Day, Tau said that she honoured those who had passed on and those newly infected and wished that AIDS awareness campaigns were active every day. Access to affordable medicine Access to affordable medicine continues to haunt people from poorer countries, as the COVID-19 pandemic showed when millions of people in low and middle-income countries could not get vaccines as these had all been bought by wealthy countries. The question of intellectual property (IP) rights on essential medicine is as burning an issue today as it was during the AIDS era. Fatima Hassan, director of the Health Justice Initiative (HJI), was one of the lawyers representing Tau and others – and more recently, has been campaigning for wider access to COVID-19 vaccines and therapeutics. Fatima Hassan ‘The reason we brought the case was because we saw the ‘Lazarus’ drugs. We saw them working for people in the USA. We saw them working for people in Europe.,” said Hassan. “We saw what Brazilian and Thai activists were doing to try to get compulsory measures in place for their governments to introduce generic therapies into their country. But our government was having none of that. It was in denial of the science and it refused to implement a public sector programme, which is the reason why we had to focus on the price of abuse in the private sector.” Hassan says that today’s struggles include fighting for access to expensive cancer treatments, exorbitant cystic fibrosis drugs and cabotegravir, an HIV prevention injection that received regulatory approval for use in South Africa on Thursday but remains too expensive for most. “Pharmaceutical companies have these IP monopolies which then means that we’ve got to continuously fight them on pricing because, in the absence of our government, taking the necessary executive action or issuing compulsory licences, we’re always going to have to rely on civil society or the Competition Commission to deal with the abuse of dominance, capture of the market and excessive pricing,” said Hassan. 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COVID-19 Translated into Three Years of ‘Human Rights Violations’ 05/12/2022 Maayan Hoffman Prof Lawrence Gostin, a member of the independent Panel for a Global Health Convention “Every aspect of the COVID-19 response, beginning with the origins of the pandemic in Wuhan to China’s current Zero-COVID strategy, has had severe restrictions on human rights,” according to Prof Lawrence Gostin, a member of the independent Panel for a Global Health Convention. Speaking Monday afternoon at the UNITE Global Summit in Lisbon, he called on parliamentarians to take a “moment of reflection” on the untold human suffering that resulted from the pandemic. “It is not just the millions of lives lost or the trillions of dollars lost,” said Gostin, “but the vast deprivation of freedom, noxious discrimination and erosion of democratic ideals.” Although Monday’s sessions focused specifically on pandemic response and preparedness – human rights will be tackled more thoroughly on Wednesday – Gostin used the summit to speak to participants via Zoom and recount the many human rights violations that ensued over the past three years. He also issued a battle cry for parliamentarians to put practices in place to halt these violations before the next pandemic. He recalled how, in the early days of the pandemic in Wuhan, there was “less than full transparency” in terms of reporting the outbreak to the word. Even the transfer of the genomic sequence of the virus came “somewhat late.” “There was a crackdown on protesters and particularly a brave, whistle-blower doctor who later died in Wuhan,” he Gostin said. He then fast-forwarded to China’s current zero-COVID strategy, which he said is enforced via extreme surveillance and restriction methods. But the violations did and do not end in the Red Dragon state, said Gostin. Countries cramped down on political protests, delayed elections, enacted abusive restrictions and arrested members of marginalised populations all in the name of COVID, according to Gostin. These violations could be bucketed into two categories, he said – one: violations of political and democratic rights, and two: unequal and discriminatory practices. ‘Vaccine apartheid’ “There was vaccine apartheid, as populations in the United States, Europe and other high-income countries were protected and so many others were left behind, in Africa and other low-income countries,” Gostin noted. Countries from Egypt and Russia, to Venezuela, Madagascar and Bangladesh threatened the civil or political rights of their citizens, violating the right to freedom of expression and access to accurate information from journalists and healthcare workers. Hungary’s prime minister even used emergency powers to direct funding away from cities that were opposition strongholds. Those who were disfavoured in marginalized populations fell victim to arbitrary arrests. For example, Venezuela targeted returning refugees for quarantine in inhumane and degrading facilities, he said. “We all remember the initial scramble for diagnostics tests, personal protective equipment and ventilators,” Gostin said. “But global outrage should have peaked when the most vulnerable in the world were unable to get vaccines.” In June 2021, according to Gostin, one-third of people in rich countries were fully vaccinated while only 0.2% of people in low-income countries had two shots. The COVAX facility never got the funding it needed to ensure full vaccinations nor could it get the vaccine doses it required. “Today, these inequalities are manifested in antiviral therapeutics like Paxlovid,” Gostin continued. “The COVID-19 pandemic has reverberated into other spheres, with lower standards of living, people being pushed into absolute poverty, inadequate education and nutrition – all exacerbated now because of the Ukraine crisis.” He said the crises caused by COVID-19 and Ukraine merged with climate change, and have left more than 200 million people in acute hunger. “At its core, human rights are about human dignity,” Gostin concluded. “It is now for us to honour … the lives of everyone harmed by these violations by undertaking transformational reforms in global health, human rights security and inequity so that when the next crisis hits, we will at least reassert the fundamental principle of human dignity that emerged after World War II.” The UNITE Global Summit runs from Dec. 5-7, 2022. Click here for full coverage. Reporting for this series was supported by UNITE Parliamentarians for Global Health. Image Credits: Maayan Hoffman, Screenshot. After COVID-19, Five Policy Recommendations from Malaysia 05/12/2022 Maayan Hoffman Malaysian MP Kelvin Yil Lee Wuen at the UNITE Global Summit on December 5, 2022. COVID-19 was a “global stress test” for parliamentarians, whose job is to propose policies, said Kelvin Yil Lee Wuen, a parliamentarian from Malaysia. Speaking Monday at the UNITE Global Summit in Lisbon, the MP proposed five global policy recommendations, which he said his own country had adopted. 1 – Create conducive policies and infrastructure to enable innovation According to Wuen, countries must enhance platforms and processes so that the public and private sector can innovate in real time. 2 – Establish robust and comprehensive inner-country and global data and knowledge sharing Wuen said that countries should work together to determine and implement best practices. In addition, the world should look toward a global medical network. By agreeing on standards between the U.S. Food and Drug Administration, the European Medicines Agency and other regulatory bodies “it doesn’t have to take so much time to approve new drugs, interventions and vaccines. We have to figure out how to be more efficient.” 3 – Invest in global capabilities for the early characterization of pathogens and assessment 4 – Improve and increase education “We need to empower the people by breaking misinformation early,” said Wuen. He recalled that there was a rise in fake news in Malaysia during the pandemic, including around basic principles, like what it means for a vaccine to receive emergency use approval. “We need to educate people so that in the future when vaccines are approved the public has assurance that they are safe to use and that their benefits outweigh their risks,” Wuen stressed. He noted that improving communications should happen immediately if the world wants to be ready for the next crisis. “In a public health crisis, communication is as important – if not more important – than medical intervention,” Wuen said. “To get people to comply, they need to have confidence in the system and to have that trust they need communication.” 5 – A fair, equitable, inclusive and accountable distribution network Wuen said that on the domestic and international levels, systems must be developed to distribute drugs, treatments and vaccines. He said “this includes the controversial topic of an intellectual property (IP) waiver for life-saving vaccines. “It is vaccines in bodies that save lives,” Wuen added. The pandemic reignited a long-standing debate about the right balance between private profits and public health. While some argued that the World Trade Organization rules on IP harmed access to COVID vaccines in poor countries, others said lifting it would remove the incentive for drugmakers to keep developing the life-saving shots. A partial IP waiver on COVID vaccines was agreed on in June and the WTO’s TRIPS’s Council has until 17 December to decide whether to extend it. “The COVID response had its ups and downs, but vaccine inequality is one of our biggest moral failings,” Wuen said. Vaccines in 100 days? CEPI Director of Policy Neren Rau speaking at the UNITE Global Summit on December 5, 2022. Wuen spoke as part of a UNITE Global Summit session titled “Preparing for the pandemic by developing vaccines in 100 days.” The session featured two speakers from the Coalition for Epidemic Preparedness Innovations (CEPI), including Director of Policy Neren Rau. He offered his organization’s plan to ensure there are vaccines for everyone during the next pandemic, which centers on more diversified vaccine manufacturing. CEPI has developed more than 70 partnerships in 50 countries around the world to develop vaccines, enable vaccines and get them into the right people’s hands at a reasonable cost. “Access lies at the heart of our plan,” Rau said. “Achieving the 100-day plan aspiration would give the world a fighting chance of tackling and containing outbreaks before they spread and become pandemics.” CEPI’s 100-day plan is to develop a working vaccine within 100 days of the start of the next pandemic. The first vaccines – for typhoid fever and meningitis – took more than 100 years to develop. The vaccine for Ebola took 20 years. It took 364 days to get the first approved COVID-19 vaccine, Rau said, and with the proper efficiencies, the number of days it would take to develop the next vaccine would be only 250. So, why is CEPI so focused on 100 days? “The lives that will be saved,” Rau stressed. “The difference is almost 70 million lives between 364 days and 100 days.” But he added that the plan only works if the vaccine is distributed to the country or region of the outbreak “regardless of where that might be.” He said, “this requires a fundamental shift in international collaboration and cooperation toward a system founded on the principles of equitable access.” The COVID-19 pandemic will not be the world’s last, Wuen added. The next one is “closer than we think.” The UNITE Global Summit runs from Dec. 5-7, 2022. Click here for full coverage. Reporting for this series was supported by UNITE Parliamentarians for Global Health. Image Credits: Maayan Hoffman. MPs Are Urged to Redirect Funding Towards Prevention and Primary Care 05/12/2022 Maayan Hoffman The head of the Health Division at the Organisation for Economic Co-operation and Development called on parliamentarians to redirect health funding towards prevention and primary care to help improve health outcomes. Speaking Monday at the opening session of the UNITE Global Summit in Lisbon, Francesca Colombo said that a basic health analysis proves the need to be focused in this direction. “Only 3% of total health spending is devoted to tackling poor risk factors and public health measures,” she told a room of more than 30 parliamentarians and other health leaders in the Senate Chamber of the Portuguese Parliament. “Return on investment in tackling unhealthy lifestyles is very high.” She noted for example that every dollar invested in tackling obesity has a $6 return on investment in economic benefits. Moreover, she said that her organization’s work has shown that three out of four deaths from antimicrobial resistance (AMR) could be averted by spending just a few dollars more – $2 per person. “While COVID-19 demonstrated that countries with strong health systems and universal health coverage are better prepared to manage health threats, investments in primary care account for less than $1 in every $6 present in health systems,” Colombo stressed. Finally, she added, too much health spending is at best ineffective and at worst harmful. A 2017 OECD report showed 20% of health expenditures make no or minimal contribution to good health outcomes. How to address these failings “The global shortage of healthcare workers must be urgently addressed, including finding equitable solutions to address international health workforce migration,” said Colombo. “The pandemic accelerated the use of digital tools like telehealth and remote diagnostics. Yet more needs to be done to accelerate the equitable development and use of these tools. “Finding new ways to pay for global public goods, such as vaccines and antimicrobials will be essential to be ready for future crises,” she added. The OECD has calculated that even in high-income countries an annual investment totalling 1.4% of GDP is needed to make health systems strong enough to meet the challenges of another pandemic on the scale of COVID-19, Colombo said. She expressed concern that finance ministers’ enthusiasm for investing in health is fading away. Raising parliamentarians’ voices Ricardo Baptista Leite, president and founder of UNITE Parliamentarians The UNITE Global Summit is meant to once again raise up parliamentarians’ voices around issues of health and health security. The event began around 9 a.m. in the Senate Chamber. Although the room is no longer in use, it continues to be harnessed for conferences and its rows of parliamentary chairs lent to the import of the conference on Monday morning. The theme of the UNITE summit is “from pandemic to prosperity,” a topic that Ricardo Baptista Leite, president and founder of UNITE, said should be “self-explanatory.” But, like Colombo, he said that the discussion is coming at a difficult time – a time when governments want to move beyond the pandemic and are focused on other challenging issues like the Russia-Ukraine war and rising inflation and cost-of-living in their countries. Leite said that nonetheless, parliamentarians must make their voices heard. “We are still in a pandemic, still suffering from the results of severe lockdown and the consequences of our lack of preparedness,” he said. “That is why our first day is focused on infection control and pandemic preparedness and response.” Ilona Kickbusch, founder of the Global Health Centre at the Graduate Institute in Geneva Over the next two days, the conference will also look at the future of health systems and health as a human right. Participants will be charged with answering three questions: What progress have we made so far during the UN’s Sustainable Development Goals period? What have we learned to help us make even more progress by 2030? What is the role of parliamentarians in helping drive that progress? “Parliamentarians should be at the forefront of the fight,” stressed Professor Ilona Kickbusch, founder of the Global Health Centre at the Graduate Institute in Geneva, who also spoke as part of the introductory session. “Parliamentarians should be the link between their constituents and their governments.” The UNITE Global Summit runs from Dec. 5-7, 2022. Click here for full coverage. Reporting for this series was supported by UNITE Parliamentarians for Global Health. Image Credits: Maayan Hoffman. Wendy Reaser: Struggling with Obesity in Canada 03/12/2022 Editorial team A special project celebrating the fifth anniversary of “Our Views, Our Voices” | Learn more Wendy Reaser One time, as Wendy Reaser was visiting the emergency room, she heard a specialist describing her as “fat and lazy,” adding that she did not want to put the work into being healthy. This experience, as well as many other unpleasant interactions with health professionals, left Wendy discouraged and traumatized. “For many years, this statement had me convinced that because I’m living with obesity, I didn’t have the right to care from medical professionals,” she shares in the NCD Diaries project, an initiative launched by the NCD Alliance. “I was convinced that nothing could be done and I wasn’t worth saving.” NCDs (noncommunicable diseases) are diseases that are not transmissible from person to person and they represent the first cause of death and disability worldwide. The NCD Diaries project is meant to support individuals like Wendy, so that they can share their lived experiences of NCDs, drawing on their unique local contexts, challenges faced and their aspirations and recommendations to drive change on NCDs. Canada, where Wendy lives, provides its citizens with universal healthcare coverage. “While this is fantastic because everyone has access to treatment, it doesn’t always mean that you get treated well,” Wendy writes. “Living with obesity is a daily struggle physically and mentally,” she explains. “Not only do we have to live with our shame and self-loathing, but we also must live with the judgement of those around us. Often, we are made to feel that we aren’t deserving of medical help, with many health care providers having been trained to tell us to simply ‘eat less and move more’.” Luckily for Wendy, she eventually found doctors with a different approach. “One day I visited my family doctor, who had been with us for about a year, to express concern about symptoms I was experiencing that were noticeable in my dad prior to his death from a heart attack,” she recalls. “I expected her to say that it was my weight, that I had to eat less and exercise more. I didn’t expect her to sit up and pay attention, and to immediately put in an urgent referral to a cardiologist. But that’s exactly what she did.” The cardiologist explained to Wendy that her heart was enlarged because she had sleep apnea, so her lungs were lacking oxygen. “I’d just started sleep apnea treatment 6 months before seeing him,” she writes. “He was confident that if I continued this treatment, ‘tweaked my eating and maybe moved around just a little more,’ my heart would be fine in under a year.” Wendy emphasizes that the doctor’s words saved her life. “It’s interactions like these that began to restore my confidence in navigating my care journey, and my faith in the medical profession,” she explains. Health professionals, she argues, need better training to provide care empathetically and effectively for people living with obesity. “Healthcare providers must accept that people living with obesity are not fat and lazy,” Wendy says. “There are several factors including genetics, medication, and even monetary constraints that can and do contribute to someone becoming obese. There’s a way to discuss obesity-related issues respectfully and helpfully, that doesn’t leave a deflated feeling of failure.” Read Wendy Reaser’s full NCD Diary. Read previous post. Image Credits: Courtesy of NCD Alliance. US Eager to Move Ahead with Pandemic Accord that Promotes Equity but not ‘Transactional’ Linkage between Data and Benefit-Sharing 02/12/2022 Elaine Ruth Fletcher Pamela Hamamoto, lead US negotiator on the WHO pandemic accord, in Geneva this week. The United States, once a reluctant partner in the initiative for a new global pandemic accord, is now keen to move ahead in negotiations over an agreement. The accord would expedite more rapid global data sharing and response to looming threats as well as ensuring greater equity in access to medicines and treatments, said the lead US negotiator of the instrument, Pamela Hamamoto on Friday. But Washington would like to avoid what she described as “transactional” language directly linking the two issues, as some developing nations have suggested. Nations like South Africa, for instance, cite bitter experiences with rapid, transparent sharing of genetic data on new SARS2 variants, which did nothing to improve the country’s access to badly-needed COVID medicines or vaccines. “Overall, the concept of equity, as I said, is very important. And it is certainly something that the United States is committed to to helping work on that and improve… the availability of medical countermeasures broadly speaking, going forward,” Hamamoto said. But in terms of a direct “linkage between the access and benefit sharing… I actually don’t necessarily think that that linkage is that helpful,” she said. “We’re also very interested in you know, as are others, in the rapid transparent sharing of data,” she said, adding, “what I hope is that… the sort of transactional nature of that concept doesn’t hamper us in being aspirational in our thinking, how we approach this and move forward.” Hamamoto was speaking in Geneva Friday along with Loyce Pace, US Assistant Secretary for Global Affairs, after a week of closed-door meetings with WHO officials and other WHO member states ahead of a third round of member state negotiations on a ‘conceptual’ zero draft text for the treaty due to start next week. First ‘zero draft’ circulated in late November Loyce Pace, Assistant Secretary for Global Affairs, US Department of Health and Human Services, in Geneva this week. This initial ‘zero draft’ text of a proposed pandemic accord was circulated among member states in late November. The draft calls for for “early, safe, transparent and rapid sharing of samples and genetic sequence data of pathogens” – a measure supported by the pharmaceutical industry – but simultaneously calls for “the fair and equitable sharing of benefits” – which the private sector and many developed countries along with the US have resisted, saying that too tight a linkage between any country’s agreement to share pathogen data and benefits reaped could slow down pandemic response. The draft also makes a strong case for more emphasis on regional production of vaccines and other pandemic-related products as well as ‘strategic stockpiles’ of pandemic response supplies. Speaking on that point, Pace and Hamamoto both underlined that the US is supportive of efforts to regionalize production of pandemic countermeasures. “We’re very committed to leaning into overall concepts of equity and transparency,” Hamamoto said. “making sure that we’re better prepared for the surveillance, detection and rapid response to future outbreaks. More comprehensive data and sample sharing on a fast timeframe as well rapid, rapid response .. and more equitable access to medical countermeasures, possibly through regional and local manufacturing.” Current text is hanging too much on the Christmas tree However both women warned that the current text, including many member state proposals for amendments and additions, will need considerable refinement to get the approval of the US and other member states. “There are so many ornanments we’re trying to put on the Christmas tree,” said Pace. “And that is understandable, and yet there are various work streams that will emerge, where there can be a higher and better use for some areas than others.” Added Hamamoto, “I think it’s just there’s just too much in there that is, is maybe not at the right level, like a more tactical playbook… as opposed to, you know, international agreements. “What we’re focused on next week is to really move it towards something that’s appropriately scoped to begin,” she said. “What it represents now is a collection of all the inputs that the Bureau has received so far for member states and external stakeholders as well,” she noted, referring to the small member state group guiding the process. “And everything has just been collected, sorted to a certain extent into some specific chapters…. But there’s a lot of work that still needs to be done around scope around structure around governance. And so in a nutshell, there’s a lot that needs to change before we were going to be able to sign on to it, as is the same for a lot of Member States, probably most.” Negotiations over revisions to International Health Regulations happening in parallel Negotiations over revisions to the WHO’s International Health Regulations are also proceeding in parallel. It was the US which tabled a series of proposed amendments to the IHR at the May World Health Assembly as matter for negotiations, finally winning the agreement of the member state body to engage in a parallel process to revise the 2005 WHO agreement on procedures for responding to outbreak and emergency threats. Assembly Approves Process to Update International Health Regulations on Pandemic Response Revising the IHR is deemed to be a quicker fix to some of the shortcomings in global pandemic response as once any revisions are approved, they would take effect immediately. A new international convention or accord would have to be ratified state by state. However agreement on those revisions, and alignment with the new pandemic accord, will also be a complex process, she admitted. “Obviously, there’s a lot cooking in that space, with so many member states and frankly, amendments being brought to the table,” Pace said. “That’s a good thing because I think we weren’t sure, frankly, earlier this year, to what degree the member states would be interested in engaging in that [IHR] process. And so I know a lot of being done to look through those various proposals and align them with the work that Ambassador Hamamoto is leading on the front end.” Hints at adjustments in negotiating schedule – but not endpoint Standing ovation at 2021 special World Health Assembly session that decides to negotiate a new pandemic accord. Hamamoto also suggested that some of the mid-term milestones that have been set in the negotiating schedule for the pandemic accord over the coming two years, might have to be adjusted in order to accommodate the complexity of the process. According to the current timeline, a firm ‘zero draft’ text is supposed to be ready to put before WHA member states for the full-fledged start of negotiations by February 2023. However, Hamamoto said that she was in no way suggesting that member states should prolong deliberations over the text beyond the May 2024 date that was agreed to by WHO member states exactly a year ago, as the date by which a final draft text should be brought before the World Health Assembly. “You know, the pretty broadly held view is that we need to make sure that the process is set up right so that we feel that we can that we have the space to do our work, and make sure we get this right and so we don’t blow this opportunity to put together an accord that is going to be meaningful and implementable,” Hamamoto said. “But May 2024 is the planned and hoped-for end-date and I’m not suggesting going beyond that. However, the time line along the way is ambitious. And we do also have these parallel processes, so we just want to make sure in theese early stages, what is being called the zero draft, that we get that right.” Image Credits: E Fletcher/Health Policy Watch , E Fletcher/Health Policy Watch. UN Environment: Investments in ‘Nature-Based’ Climate Solutions Must Double by 2025 02/12/2022 Stefan Anderson Climate, biodiversity, and land degradation goals will be out of reach unless investments into nature-based solutions quickly ramp up to $384 billion/year by 2025, more than double of the current $154 billion/year, according to UN Environment Programme. A new report by the United Nations Environment Programme warns that investment in nature-based solutions must double by 2025 if the world is to limit global warming to 1.5°C, as well as halting biodiversity loss and progressively increasing land degradation. The report comes a week before world leaders will gather at the UN Biodiversity Conference (COP15) in Montreal, Canada, where they are set to negotiate an agreement that aims to halt and reverse biodiveristy loss by 2030. UNEP is calling on governments to agree on a clear framework for countries to require the financial sector to align its activities with ‘nature positive’ goals. “The science is undeniable. As we transition to net-zero emissions by 2050, we must also reorient all human activity to ease the pressure on the natural world on which we all depend,” said Inger Andersen, Executive Director of UNEP. “This requires governments, business and finance to massively step up investments in nature-based solutions because investments in nature are investments in securing the future for generations to follow.” Nature-based solutions are actions to protect, manage, or restore natural ecosystems, and are already well-documented to be critical to any response to climate change. The World Bank estimates that nature-based solutions can reduce by 37% the carbon emissions reductions that are needed by 2030 to meet the Paris Agreement goals. The Intergovernmental Panel on Climate Change (IPCC) has also pointed to nature-based solutions, such as biodiversity preservation, as key to realistic emissions reductions. “Phasing out coal and decarbonizing the energy systems will not be enough without adjacent massive investments into nature-based solutions,” the report found. “Politicians, business and finance leaders and citizens globally must transform their relationship with nature to work with it rather than against it.” Nature-negative expenditures are 3 to 7 times higher than nature-based solution investment Governments need to scale-down environmentally harmful subsidies and investments, and increased nature based solutions (Nbs) if 1.5C is to remain within reach. While the world faces the overlapping planetary crises of climate change, biodiversity loss and pollution, nature-negative expenditures are 3 to 7 times larger than current investments in nature-based solutions, the report found. With the impacts of these crises already being felt by millions of people around the world, particularly the most vulnerable, UNEP said immediate action is required to begin mitigating and reversing the most harmful impacts. Government expenditures on harmful subsidies to fisheries, agriculture and fossil fuels is estimated at $500 billion to $1 trillion annually. Harmful subsidies are highest in the energy and agricultural sectors, estimated at $340 to $530 billion and around $500 billion per year respectively. By contrast, investment in nature based solutions (Nbs) currently are estimated at just $154 billion annually. “These flows severely undermine efforts to achieve critical environmental targets,” the report warns. “Delayed action is no longer an option in the face of the devastating effects of climate change, the extinction crisis and severe land degradation globally.” This warning is the latest in a series of dire calls to action by UNEP. Its adaptation and emissions gap reports equally stressed the need for immediate action if any hopes of averting climate disaster are to be kept alive. “We had our chance to make incremental changes, but that time is over,” Andersen said at a press conference launching the UNEP emissions gap report in late October, which benchmarked the gap between countries’ actual emissions and needed reductions to keep 1.5C alive. “Only a root-and-branch transformation of our economies and societies can save us from accelerating the climate disaster.” Private sector must step up as governments faces overlapping crises Private capital must start investing in harnessing the power of nature to reduce and remove emissions, restore degraded land and seascapes and turn the tide on biodiversity loss, the report found. The UNEP report reveals that private capital represents just 17% of total investments into nature-based solutions. Governments currently provide the other 83%, but the report stresses they will be unlikely to be able to significantly scale up funding due to current global financial challenges linked to war, debt, and poverty. As a result, private funding for nature-based solutions will have make-up the shortfall, requiring an increase by “several orders of magnitude” in the coming years. Total investments in nature-based solutions will need to hit $384 billion by 2050, more than double the present level of $154 billion annually, the report concludes. The roadmap provided by the report calls for ramping up private capital investments in sustainable supply chains, offsetting unavoidable impacts, reducing activities with negative climate and biodiversity impacts, and investing in “net zero” and “nature positive” activities. This will require a U-turn from the current state of private financial flows. “While robust evidence is lacking, it is widely recognized that private finance flows are predominantly negative for nature and almost certainly exacerbate the situation,” the report states. “These flows severely undermine efforts to achieve critical environmental targets,” the report states. “As the IMF warns of the ‘darkest hour’ in 2023 for global growth, this report is a reminder that many short-term efforts to boost GDP by governments, without attention to the fact that nature underpins many economies, will impose greater costs for both present and future generations in years to come,” the UNEP document concludes. Investment in protecting planet’s oceans disproportionately low The trajectory of annual nature-based solution investment needs to limit climate change to below 1.5°C, haltbiodiversity loss and achieve land degradation neutrality, $ billion (2022 US$). The UNEP analysis also found just 9% of investment in nature-based solutions are directed towards marine ecosystems, a disproportionately low amount given the critical role of oceans in climate mitigation, adaptation, food security, and biodiversity conservation. The Earth’s oceans cover over 70% of the planet’s surface, absorb around 25% of all CO2 emissions, and provide 17% of the world’s protein. Since the start of the Industrial Revolution, oceans have absorbed a third of human carbon dioxide emissions, making them one of the largest carbon sinks, topped only by global rainforests. The lack of investment in marine protection comes at a time of crisis for the world’s oceans. Projections show that by 2050, our oceans may contain more plastics than fish. These will not only suffocate marine life, but also phytoplankton, the microorganisms at the heart of oceans’ abilities to absorb carbon dioxide, as forests and plants do on dry land. As millions of tons of plastic break down in oceans across the world, uncounted quantities of microplastics are infiltrating phytoplankton, blocking sunlight-absorbing mechanisms, which in turn prevents the process of photosynthesis, and damages their ability to capture carbon in the seas. Yet current annual investment in marine protected areas sits at just $980 million, as compared to protection efforts in terrestrial systems, which receive almost US$23 billion annually. US$8–11 billion is needed to increase marine protected areas to 30% by 2030, the report concludes. “While the world is enduring multiple crises, this report provides clarity,” Jochen Flasbarth, State Secretary in the German Federal Ministry for Economic Cooperation and Development (BMZ), said. “It shows that by significantly increasing public and private investments in nature-based solutions, it is possible to tackle climate change, biodiversity loss and land degradation – and at the same time harness many societal and economic benefits. We need to act now.” Image Credits: UNEP. How Does Corruption Affect Health Systems Around the World? 02/12/2022 Editorial team When Patty García was a medical student in Peru some 30 years ago, she was already aware of the detrimental effect of corruption on health systems. “Back then, the corruption related to the distribution of drugs,” Garcia, who would go on to become her country’s Health Minister in 2016, shares during the latest episode of the “Global Health Matters” podcast with host Garry Aslanyan. “Because at that point resources were scarce, probably it was not seen as a big issue because there was not much to steal. But when I became Minister of Health, I realised the magnitude of the problem.” García, who currently is a professor at the School of Public Health at Cayetano Heredia University in Lima, joins Aslanyan, together with Monica Kirya, a lawyer and the Senior Program Adviser at the U4 Anti-Corruption Resource Centre in Norway, as well as Jonathan Cushing, Head of the Transparency International Health Program. “According to Transparency International, $500 billion in public health spending is estimated to be lost globally every year due to corruption,” Aslanyan remarked. “It has been labelled the disease of the health system, hindering and preventing progress towards universal health coverage.” Fighting corruption, all the guests agreed, is essential to achieve universal health coverage. Corruption as a matter of life and death According to Kirya, it is important to consider the phenomenon as a matter of life and death. “You can look at it from the perspective of an expectant mother in labour, or an accident victim bleeding profusely who can’t access urgently needed health care simply because there are no doctors,” she said, sharing the experience of her native Uganda. “One of the reasons why there are no or very few doctors in public health facilities in Uganda increasingly has to do with corruption. It became clear from the research I’ve done that medical graduates are having to pay huge bribes to district service commissions to be recruited.” While health workers are often considered amongst those responsible for corruption, they are also one of its victims, Kirya argues. In order to fight corruption effectively, it is crucial to understand how widespread and complex the phenomenon is. “We’ve absolutely got to get away from this idea that corruption just happens in low-resource settings and low-resource systems,” said Cushing, adding that while “petty bribery” might be more visible, corruption happens everywhere. “It’s much more perhaps more complex, more hidden in higher income countries, but it happens,” he added. “Until we address that, we’re not going to get anywhere.” García revealed that as health minister, she experienced how difficult dismantling the networks behind widespread corruption can be. “I was really concerned about the lack of medications at the health centres, while I knew that we have had a very important process in which we bought medications for all the country,” she recalled. “We started an investigation and we found an illegal operation that was removing the drugs from storage and public hospital pharmacies and placing them in private pharmacies,” she added. “I was working with the Ministry of Internal Affairs and with the police; it was like in the movies.” However, as soon as she left office about 14 months after she was appointed, the investigation was called off. “The problems are still ongoing,” she concluded. The need for leaders with integrity Garcia, Kirya, and Cushing agreed on how hard and complex fighting corruption effectively is, but also stated that this reality should not deter anyone from pursuing the mission. “We can’t afford to be pessimistic,” said Kirya. “We can’t just give up.” “I think that my key call is transparency and leadership,” added Cushing. “We need to have integral leaders. Leaders who are leaders with integrity.” Listen to previous episodes on the Health Policy Website >> Learn more about “Global Health Matters” podcast>> Image Credits: Global Health Matters Podcast, Courtesy of TDR. Twenty Years On, HIV Activist is Still Fighting for Access to Cheaper Medicine 01/12/2022 Kerry Cullinan HIV activist Hazel Tau Twenty years ago, Hazel Tau, a young South African living with HIV, and her peers had little chance of getting antiretroviral (ARV) treatment because it was completely unaffordable. The South African price for just one of the three ARV drugs she needed, AZT, was 665% higher than the best-priced generic available elsewhere in the world. Only around 20,000 South Africans with private healthcare were on ARVs at the time because of the price. So Tau, an activist with the Treatment Action Campaign, agreed to be one of the public faces of a challenge to the price of ARVs – cleverly brought as a complaint to the Competition Commission alleging that two pharmaceutical companies were charging excessive prices for first-line ARVs. At the time, then-president Thabo Mbeki disputed that HIV caused AIDS and claimed that ARVs were poison, so pressuring the government to act on drug prices was a non-starter. The targets were GlaxoSmithKline South Africa and Boehringer Ingelheim, with Tau and others complaining that they had contravened the country’s Competition Act by abusing their dominant market positions on ARV prices. The SA Competition Commission’s Mapato Ramakgopa explained that the commission agreed with Tau and others, and had sought an order from the competition tribunal to compel the firms to grant voluntary licences to allow generic manufacturers to make genetic ARVs in return for a reasonable royalty. “The firms were found to have abused market dominance and fortunately, before the case could be heard by the tribunal, the manufacturers settled the matter and agreed to allow licences for generic and local manufacturers,” said Ramakgopa. Bittersweet victory “It was a bittersweet experience because of everyone who could not be saved,” said Tau, speaking at a commemorative event on Thursday. “I lost friends, family, colleagues. We lost millions of people who were breadwinners. But I will say I was happy with the outcome.” Finally, she and others could look forward to a life with access to affordable treatment. But Tau’s struggle for treatment access continues today as she is fighting for cheaper cancer drugs. “We know that, in developed countries, they’ve got cheaper drugs that can help people who have got cancer of different types, but we still have to pay it so I’m not feeling good about that,” said Tau. She is also still fighting the stigma faced by people living with HIV – and says that it is time for stand-alone HIV clinics – largely the result of special HIV funding – to be integrated as part of chronic care to spare those who need HIV care from being conspicuous when they go for treatment. “I blame us for having that HIV clinic. I wish HIV was just dealt with like other chronic diseases, normally without saying ‘this is an HIV thing’ because the stigma started there,” says Tau. Speaking on World AIDS Day, Tau said that she honoured those who had passed on and those newly infected and wished that AIDS awareness campaigns were active every day. Access to affordable medicine Access to affordable medicine continues to haunt people from poorer countries, as the COVID-19 pandemic showed when millions of people in low and middle-income countries could not get vaccines as these had all been bought by wealthy countries. The question of intellectual property (IP) rights on essential medicine is as burning an issue today as it was during the AIDS era. Fatima Hassan, director of the Health Justice Initiative (HJI), was one of the lawyers representing Tau and others – and more recently, has been campaigning for wider access to COVID-19 vaccines and therapeutics. Fatima Hassan ‘The reason we brought the case was because we saw the ‘Lazarus’ drugs. We saw them working for people in the USA. We saw them working for people in Europe.,” said Hassan. “We saw what Brazilian and Thai activists were doing to try to get compulsory measures in place for their governments to introduce generic therapies into their country. But our government was having none of that. It was in denial of the science and it refused to implement a public sector programme, which is the reason why we had to focus on the price of abuse in the private sector.” Hassan says that today’s struggles include fighting for access to expensive cancer treatments, exorbitant cystic fibrosis drugs and cabotegravir, an HIV prevention injection that received regulatory approval for use in South Africa on Thursday but remains too expensive for most. “Pharmaceutical companies have these IP monopolies which then means that we’ve got to continuously fight them on pricing because, in the absence of our government, taking the necessary executive action or issuing compulsory licences, we’re always going to have to rely on civil society or the Competition Commission to deal with the abuse of dominance, capture of the market and excessive pricing,” said Hassan. 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After COVID-19, Five Policy Recommendations from Malaysia 05/12/2022 Maayan Hoffman Malaysian MP Kelvin Yil Lee Wuen at the UNITE Global Summit on December 5, 2022. COVID-19 was a “global stress test” for parliamentarians, whose job is to propose policies, said Kelvin Yil Lee Wuen, a parliamentarian from Malaysia. Speaking Monday at the UNITE Global Summit in Lisbon, the MP proposed five global policy recommendations, which he said his own country had adopted. 1 – Create conducive policies and infrastructure to enable innovation According to Wuen, countries must enhance platforms and processes so that the public and private sector can innovate in real time. 2 – Establish robust and comprehensive inner-country and global data and knowledge sharing Wuen said that countries should work together to determine and implement best practices. In addition, the world should look toward a global medical network. By agreeing on standards between the U.S. Food and Drug Administration, the European Medicines Agency and other regulatory bodies “it doesn’t have to take so much time to approve new drugs, interventions and vaccines. We have to figure out how to be more efficient.” 3 – Invest in global capabilities for the early characterization of pathogens and assessment 4 – Improve and increase education “We need to empower the people by breaking misinformation early,” said Wuen. He recalled that there was a rise in fake news in Malaysia during the pandemic, including around basic principles, like what it means for a vaccine to receive emergency use approval. “We need to educate people so that in the future when vaccines are approved the public has assurance that they are safe to use and that their benefits outweigh their risks,” Wuen stressed. He noted that improving communications should happen immediately if the world wants to be ready for the next crisis. “In a public health crisis, communication is as important – if not more important – than medical intervention,” Wuen said. “To get people to comply, they need to have confidence in the system and to have that trust they need communication.” 5 – A fair, equitable, inclusive and accountable distribution network Wuen said that on the domestic and international levels, systems must be developed to distribute drugs, treatments and vaccines. He said “this includes the controversial topic of an intellectual property (IP) waiver for life-saving vaccines. “It is vaccines in bodies that save lives,” Wuen added. The pandemic reignited a long-standing debate about the right balance between private profits and public health. While some argued that the World Trade Organization rules on IP harmed access to COVID vaccines in poor countries, others said lifting it would remove the incentive for drugmakers to keep developing the life-saving shots. A partial IP waiver on COVID vaccines was agreed on in June and the WTO’s TRIPS’s Council has until 17 December to decide whether to extend it. “The COVID response had its ups and downs, but vaccine inequality is one of our biggest moral failings,” Wuen said. Vaccines in 100 days? CEPI Director of Policy Neren Rau speaking at the UNITE Global Summit on December 5, 2022. Wuen spoke as part of a UNITE Global Summit session titled “Preparing for the pandemic by developing vaccines in 100 days.” The session featured two speakers from the Coalition for Epidemic Preparedness Innovations (CEPI), including Director of Policy Neren Rau. He offered his organization’s plan to ensure there are vaccines for everyone during the next pandemic, which centers on more diversified vaccine manufacturing. CEPI has developed more than 70 partnerships in 50 countries around the world to develop vaccines, enable vaccines and get them into the right people’s hands at a reasonable cost. “Access lies at the heart of our plan,” Rau said. “Achieving the 100-day plan aspiration would give the world a fighting chance of tackling and containing outbreaks before they spread and become pandemics.” CEPI’s 100-day plan is to develop a working vaccine within 100 days of the start of the next pandemic. The first vaccines – for typhoid fever and meningitis – took more than 100 years to develop. The vaccine for Ebola took 20 years. It took 364 days to get the first approved COVID-19 vaccine, Rau said, and with the proper efficiencies, the number of days it would take to develop the next vaccine would be only 250. So, why is CEPI so focused on 100 days? “The lives that will be saved,” Rau stressed. “The difference is almost 70 million lives between 364 days and 100 days.” But he added that the plan only works if the vaccine is distributed to the country or region of the outbreak “regardless of where that might be.” He said, “this requires a fundamental shift in international collaboration and cooperation toward a system founded on the principles of equitable access.” The COVID-19 pandemic will not be the world’s last, Wuen added. The next one is “closer than we think.” The UNITE Global Summit runs from Dec. 5-7, 2022. Click here for full coverage. Reporting for this series was supported by UNITE Parliamentarians for Global Health. Image Credits: Maayan Hoffman. MPs Are Urged to Redirect Funding Towards Prevention and Primary Care 05/12/2022 Maayan Hoffman The head of the Health Division at the Organisation for Economic Co-operation and Development called on parliamentarians to redirect health funding towards prevention and primary care to help improve health outcomes. Speaking Monday at the opening session of the UNITE Global Summit in Lisbon, Francesca Colombo said that a basic health analysis proves the need to be focused in this direction. “Only 3% of total health spending is devoted to tackling poor risk factors and public health measures,” she told a room of more than 30 parliamentarians and other health leaders in the Senate Chamber of the Portuguese Parliament. “Return on investment in tackling unhealthy lifestyles is very high.” She noted for example that every dollar invested in tackling obesity has a $6 return on investment in economic benefits. Moreover, she said that her organization’s work has shown that three out of four deaths from antimicrobial resistance (AMR) could be averted by spending just a few dollars more – $2 per person. “While COVID-19 demonstrated that countries with strong health systems and universal health coverage are better prepared to manage health threats, investments in primary care account for less than $1 in every $6 present in health systems,” Colombo stressed. Finally, she added, too much health spending is at best ineffective and at worst harmful. A 2017 OECD report showed 20% of health expenditures make no or minimal contribution to good health outcomes. How to address these failings “The global shortage of healthcare workers must be urgently addressed, including finding equitable solutions to address international health workforce migration,” said Colombo. “The pandemic accelerated the use of digital tools like telehealth and remote diagnostics. Yet more needs to be done to accelerate the equitable development and use of these tools. “Finding new ways to pay for global public goods, such as vaccines and antimicrobials will be essential to be ready for future crises,” she added. The OECD has calculated that even in high-income countries an annual investment totalling 1.4% of GDP is needed to make health systems strong enough to meet the challenges of another pandemic on the scale of COVID-19, Colombo said. She expressed concern that finance ministers’ enthusiasm for investing in health is fading away. Raising parliamentarians’ voices Ricardo Baptista Leite, president and founder of UNITE Parliamentarians The UNITE Global Summit is meant to once again raise up parliamentarians’ voices around issues of health and health security. The event began around 9 a.m. in the Senate Chamber. Although the room is no longer in use, it continues to be harnessed for conferences and its rows of parliamentary chairs lent to the import of the conference on Monday morning. The theme of the UNITE summit is “from pandemic to prosperity,” a topic that Ricardo Baptista Leite, president and founder of UNITE, said should be “self-explanatory.” But, like Colombo, he said that the discussion is coming at a difficult time – a time when governments want to move beyond the pandemic and are focused on other challenging issues like the Russia-Ukraine war and rising inflation and cost-of-living in their countries. Leite said that nonetheless, parliamentarians must make their voices heard. “We are still in a pandemic, still suffering from the results of severe lockdown and the consequences of our lack of preparedness,” he said. “That is why our first day is focused on infection control and pandemic preparedness and response.” Ilona Kickbusch, founder of the Global Health Centre at the Graduate Institute in Geneva Over the next two days, the conference will also look at the future of health systems and health as a human right. Participants will be charged with answering three questions: What progress have we made so far during the UN’s Sustainable Development Goals period? What have we learned to help us make even more progress by 2030? What is the role of parliamentarians in helping drive that progress? “Parliamentarians should be at the forefront of the fight,” stressed Professor Ilona Kickbusch, founder of the Global Health Centre at the Graduate Institute in Geneva, who also spoke as part of the introductory session. “Parliamentarians should be the link between their constituents and their governments.” The UNITE Global Summit runs from Dec. 5-7, 2022. Click here for full coverage. Reporting for this series was supported by UNITE Parliamentarians for Global Health. Image Credits: Maayan Hoffman. Wendy Reaser: Struggling with Obesity in Canada 03/12/2022 Editorial team A special project celebrating the fifth anniversary of “Our Views, Our Voices” | Learn more Wendy Reaser One time, as Wendy Reaser was visiting the emergency room, she heard a specialist describing her as “fat and lazy,” adding that she did not want to put the work into being healthy. This experience, as well as many other unpleasant interactions with health professionals, left Wendy discouraged and traumatized. “For many years, this statement had me convinced that because I’m living with obesity, I didn’t have the right to care from medical professionals,” she shares in the NCD Diaries project, an initiative launched by the NCD Alliance. “I was convinced that nothing could be done and I wasn’t worth saving.” NCDs (noncommunicable diseases) are diseases that are not transmissible from person to person and they represent the first cause of death and disability worldwide. The NCD Diaries project is meant to support individuals like Wendy, so that they can share their lived experiences of NCDs, drawing on their unique local contexts, challenges faced and their aspirations and recommendations to drive change on NCDs. Canada, where Wendy lives, provides its citizens with universal healthcare coverage. “While this is fantastic because everyone has access to treatment, it doesn’t always mean that you get treated well,” Wendy writes. “Living with obesity is a daily struggle physically and mentally,” she explains. “Not only do we have to live with our shame and self-loathing, but we also must live with the judgement of those around us. Often, we are made to feel that we aren’t deserving of medical help, with many health care providers having been trained to tell us to simply ‘eat less and move more’.” Luckily for Wendy, she eventually found doctors with a different approach. “One day I visited my family doctor, who had been with us for about a year, to express concern about symptoms I was experiencing that were noticeable in my dad prior to his death from a heart attack,” she recalls. “I expected her to say that it was my weight, that I had to eat less and exercise more. I didn’t expect her to sit up and pay attention, and to immediately put in an urgent referral to a cardiologist. But that’s exactly what she did.” The cardiologist explained to Wendy that her heart was enlarged because she had sleep apnea, so her lungs were lacking oxygen. “I’d just started sleep apnea treatment 6 months before seeing him,” she writes. “He was confident that if I continued this treatment, ‘tweaked my eating and maybe moved around just a little more,’ my heart would be fine in under a year.” Wendy emphasizes that the doctor’s words saved her life. “It’s interactions like these that began to restore my confidence in navigating my care journey, and my faith in the medical profession,” she explains. Health professionals, she argues, need better training to provide care empathetically and effectively for people living with obesity. “Healthcare providers must accept that people living with obesity are not fat and lazy,” Wendy says. “There are several factors including genetics, medication, and even monetary constraints that can and do contribute to someone becoming obese. There’s a way to discuss obesity-related issues respectfully and helpfully, that doesn’t leave a deflated feeling of failure.” Read Wendy Reaser’s full NCD Diary. Read previous post. Image Credits: Courtesy of NCD Alliance. US Eager to Move Ahead with Pandemic Accord that Promotes Equity but not ‘Transactional’ Linkage between Data and Benefit-Sharing 02/12/2022 Elaine Ruth Fletcher Pamela Hamamoto, lead US negotiator on the WHO pandemic accord, in Geneva this week. The United States, once a reluctant partner in the initiative for a new global pandemic accord, is now keen to move ahead in negotiations over an agreement. The accord would expedite more rapid global data sharing and response to looming threats as well as ensuring greater equity in access to medicines and treatments, said the lead US negotiator of the instrument, Pamela Hamamoto on Friday. But Washington would like to avoid what she described as “transactional” language directly linking the two issues, as some developing nations have suggested. Nations like South Africa, for instance, cite bitter experiences with rapid, transparent sharing of genetic data on new SARS2 variants, which did nothing to improve the country’s access to badly-needed COVID medicines or vaccines. “Overall, the concept of equity, as I said, is very important. And it is certainly something that the United States is committed to to helping work on that and improve… the availability of medical countermeasures broadly speaking, going forward,” Hamamoto said. But in terms of a direct “linkage between the access and benefit sharing… I actually don’t necessarily think that that linkage is that helpful,” she said. “We’re also very interested in you know, as are others, in the rapid transparent sharing of data,” she said, adding, “what I hope is that… the sort of transactional nature of that concept doesn’t hamper us in being aspirational in our thinking, how we approach this and move forward.” Hamamoto was speaking in Geneva Friday along with Loyce Pace, US Assistant Secretary for Global Affairs, after a week of closed-door meetings with WHO officials and other WHO member states ahead of a third round of member state negotiations on a ‘conceptual’ zero draft text for the treaty due to start next week. First ‘zero draft’ circulated in late November Loyce Pace, Assistant Secretary for Global Affairs, US Department of Health and Human Services, in Geneva this week. This initial ‘zero draft’ text of a proposed pandemic accord was circulated among member states in late November. The draft calls for for “early, safe, transparent and rapid sharing of samples and genetic sequence data of pathogens” – a measure supported by the pharmaceutical industry – but simultaneously calls for “the fair and equitable sharing of benefits” – which the private sector and many developed countries along with the US have resisted, saying that too tight a linkage between any country’s agreement to share pathogen data and benefits reaped could slow down pandemic response. The draft also makes a strong case for more emphasis on regional production of vaccines and other pandemic-related products as well as ‘strategic stockpiles’ of pandemic response supplies. Speaking on that point, Pace and Hamamoto both underlined that the US is supportive of efforts to regionalize production of pandemic countermeasures. “We’re very committed to leaning into overall concepts of equity and transparency,” Hamamoto said. “making sure that we’re better prepared for the surveillance, detection and rapid response to future outbreaks. More comprehensive data and sample sharing on a fast timeframe as well rapid, rapid response .. and more equitable access to medical countermeasures, possibly through regional and local manufacturing.” Current text is hanging too much on the Christmas tree However both women warned that the current text, including many member state proposals for amendments and additions, will need considerable refinement to get the approval of the US and other member states. “There are so many ornanments we’re trying to put on the Christmas tree,” said Pace. “And that is understandable, and yet there are various work streams that will emerge, where there can be a higher and better use for some areas than others.” Added Hamamoto, “I think it’s just there’s just too much in there that is, is maybe not at the right level, like a more tactical playbook… as opposed to, you know, international agreements. “What we’re focused on next week is to really move it towards something that’s appropriately scoped to begin,” she said. “What it represents now is a collection of all the inputs that the Bureau has received so far for member states and external stakeholders as well,” she noted, referring to the small member state group guiding the process. “And everything has just been collected, sorted to a certain extent into some specific chapters…. But there’s a lot of work that still needs to be done around scope around structure around governance. And so in a nutshell, there’s a lot that needs to change before we were going to be able to sign on to it, as is the same for a lot of Member States, probably most.” Negotiations over revisions to International Health Regulations happening in parallel Negotiations over revisions to the WHO’s International Health Regulations are also proceeding in parallel. It was the US which tabled a series of proposed amendments to the IHR at the May World Health Assembly as matter for negotiations, finally winning the agreement of the member state body to engage in a parallel process to revise the 2005 WHO agreement on procedures for responding to outbreak and emergency threats. Assembly Approves Process to Update International Health Regulations on Pandemic Response Revising the IHR is deemed to be a quicker fix to some of the shortcomings in global pandemic response as once any revisions are approved, they would take effect immediately. A new international convention or accord would have to be ratified state by state. However agreement on those revisions, and alignment with the new pandemic accord, will also be a complex process, she admitted. “Obviously, there’s a lot cooking in that space, with so many member states and frankly, amendments being brought to the table,” Pace said. “That’s a good thing because I think we weren’t sure, frankly, earlier this year, to what degree the member states would be interested in engaging in that [IHR] process. And so I know a lot of being done to look through those various proposals and align them with the work that Ambassador Hamamoto is leading on the front end.” Hints at adjustments in negotiating schedule – but not endpoint Standing ovation at 2021 special World Health Assembly session that decides to negotiate a new pandemic accord. Hamamoto also suggested that some of the mid-term milestones that have been set in the negotiating schedule for the pandemic accord over the coming two years, might have to be adjusted in order to accommodate the complexity of the process. According to the current timeline, a firm ‘zero draft’ text is supposed to be ready to put before WHA member states for the full-fledged start of negotiations by February 2023. However, Hamamoto said that she was in no way suggesting that member states should prolong deliberations over the text beyond the May 2024 date that was agreed to by WHO member states exactly a year ago, as the date by which a final draft text should be brought before the World Health Assembly. “You know, the pretty broadly held view is that we need to make sure that the process is set up right so that we feel that we can that we have the space to do our work, and make sure we get this right and so we don’t blow this opportunity to put together an accord that is going to be meaningful and implementable,” Hamamoto said. “But May 2024 is the planned and hoped-for end-date and I’m not suggesting going beyond that. However, the time line along the way is ambitious. And we do also have these parallel processes, so we just want to make sure in theese early stages, what is being called the zero draft, that we get that right.” Image Credits: E Fletcher/Health Policy Watch , E Fletcher/Health Policy Watch. UN Environment: Investments in ‘Nature-Based’ Climate Solutions Must Double by 2025 02/12/2022 Stefan Anderson Climate, biodiversity, and land degradation goals will be out of reach unless investments into nature-based solutions quickly ramp up to $384 billion/year by 2025, more than double of the current $154 billion/year, according to UN Environment Programme. A new report by the United Nations Environment Programme warns that investment in nature-based solutions must double by 2025 if the world is to limit global warming to 1.5°C, as well as halting biodiversity loss and progressively increasing land degradation. The report comes a week before world leaders will gather at the UN Biodiversity Conference (COP15) in Montreal, Canada, where they are set to negotiate an agreement that aims to halt and reverse biodiveristy loss by 2030. UNEP is calling on governments to agree on a clear framework for countries to require the financial sector to align its activities with ‘nature positive’ goals. “The science is undeniable. As we transition to net-zero emissions by 2050, we must also reorient all human activity to ease the pressure on the natural world on which we all depend,” said Inger Andersen, Executive Director of UNEP. “This requires governments, business and finance to massively step up investments in nature-based solutions because investments in nature are investments in securing the future for generations to follow.” Nature-based solutions are actions to protect, manage, or restore natural ecosystems, and are already well-documented to be critical to any response to climate change. The World Bank estimates that nature-based solutions can reduce by 37% the carbon emissions reductions that are needed by 2030 to meet the Paris Agreement goals. The Intergovernmental Panel on Climate Change (IPCC) has also pointed to nature-based solutions, such as biodiversity preservation, as key to realistic emissions reductions. “Phasing out coal and decarbonizing the energy systems will not be enough without adjacent massive investments into nature-based solutions,” the report found. “Politicians, business and finance leaders and citizens globally must transform their relationship with nature to work with it rather than against it.” Nature-negative expenditures are 3 to 7 times higher than nature-based solution investment Governments need to scale-down environmentally harmful subsidies and investments, and increased nature based solutions (Nbs) if 1.5C is to remain within reach. While the world faces the overlapping planetary crises of climate change, biodiversity loss and pollution, nature-negative expenditures are 3 to 7 times larger than current investments in nature-based solutions, the report found. With the impacts of these crises already being felt by millions of people around the world, particularly the most vulnerable, UNEP said immediate action is required to begin mitigating and reversing the most harmful impacts. Government expenditures on harmful subsidies to fisheries, agriculture and fossil fuels is estimated at $500 billion to $1 trillion annually. Harmful subsidies are highest in the energy and agricultural sectors, estimated at $340 to $530 billion and around $500 billion per year respectively. By contrast, investment in nature based solutions (Nbs) currently are estimated at just $154 billion annually. “These flows severely undermine efforts to achieve critical environmental targets,” the report warns. “Delayed action is no longer an option in the face of the devastating effects of climate change, the extinction crisis and severe land degradation globally.” This warning is the latest in a series of dire calls to action by UNEP. Its adaptation and emissions gap reports equally stressed the need for immediate action if any hopes of averting climate disaster are to be kept alive. “We had our chance to make incremental changes, but that time is over,” Andersen said at a press conference launching the UNEP emissions gap report in late October, which benchmarked the gap between countries’ actual emissions and needed reductions to keep 1.5C alive. “Only a root-and-branch transformation of our economies and societies can save us from accelerating the climate disaster.” Private sector must step up as governments faces overlapping crises Private capital must start investing in harnessing the power of nature to reduce and remove emissions, restore degraded land and seascapes and turn the tide on biodiversity loss, the report found. The UNEP report reveals that private capital represents just 17% of total investments into nature-based solutions. Governments currently provide the other 83%, but the report stresses they will be unlikely to be able to significantly scale up funding due to current global financial challenges linked to war, debt, and poverty. As a result, private funding for nature-based solutions will have make-up the shortfall, requiring an increase by “several orders of magnitude” in the coming years. Total investments in nature-based solutions will need to hit $384 billion by 2050, more than double the present level of $154 billion annually, the report concludes. The roadmap provided by the report calls for ramping up private capital investments in sustainable supply chains, offsetting unavoidable impacts, reducing activities with negative climate and biodiversity impacts, and investing in “net zero” and “nature positive” activities. This will require a U-turn from the current state of private financial flows. “While robust evidence is lacking, it is widely recognized that private finance flows are predominantly negative for nature and almost certainly exacerbate the situation,” the report states. “These flows severely undermine efforts to achieve critical environmental targets,” the report states. “As the IMF warns of the ‘darkest hour’ in 2023 for global growth, this report is a reminder that many short-term efforts to boost GDP by governments, without attention to the fact that nature underpins many economies, will impose greater costs for both present and future generations in years to come,” the UNEP document concludes. Investment in protecting planet’s oceans disproportionately low The trajectory of annual nature-based solution investment needs to limit climate change to below 1.5°C, haltbiodiversity loss and achieve land degradation neutrality, $ billion (2022 US$). The UNEP analysis also found just 9% of investment in nature-based solutions are directed towards marine ecosystems, a disproportionately low amount given the critical role of oceans in climate mitigation, adaptation, food security, and biodiversity conservation. The Earth’s oceans cover over 70% of the planet’s surface, absorb around 25% of all CO2 emissions, and provide 17% of the world’s protein. Since the start of the Industrial Revolution, oceans have absorbed a third of human carbon dioxide emissions, making them one of the largest carbon sinks, topped only by global rainforests. The lack of investment in marine protection comes at a time of crisis for the world’s oceans. Projections show that by 2050, our oceans may contain more plastics than fish. These will not only suffocate marine life, but also phytoplankton, the microorganisms at the heart of oceans’ abilities to absorb carbon dioxide, as forests and plants do on dry land. As millions of tons of plastic break down in oceans across the world, uncounted quantities of microplastics are infiltrating phytoplankton, blocking sunlight-absorbing mechanisms, which in turn prevents the process of photosynthesis, and damages their ability to capture carbon in the seas. Yet current annual investment in marine protected areas sits at just $980 million, as compared to protection efforts in terrestrial systems, which receive almost US$23 billion annually. US$8–11 billion is needed to increase marine protected areas to 30% by 2030, the report concludes. “While the world is enduring multiple crises, this report provides clarity,” Jochen Flasbarth, State Secretary in the German Federal Ministry for Economic Cooperation and Development (BMZ), said. “It shows that by significantly increasing public and private investments in nature-based solutions, it is possible to tackle climate change, biodiversity loss and land degradation – and at the same time harness many societal and economic benefits. We need to act now.” Image Credits: UNEP. How Does Corruption Affect Health Systems Around the World? 02/12/2022 Editorial team When Patty García was a medical student in Peru some 30 years ago, she was already aware of the detrimental effect of corruption on health systems. “Back then, the corruption related to the distribution of drugs,” Garcia, who would go on to become her country’s Health Minister in 2016, shares during the latest episode of the “Global Health Matters” podcast with host Garry Aslanyan. “Because at that point resources were scarce, probably it was not seen as a big issue because there was not much to steal. But when I became Minister of Health, I realised the magnitude of the problem.” García, who currently is a professor at the School of Public Health at Cayetano Heredia University in Lima, joins Aslanyan, together with Monica Kirya, a lawyer and the Senior Program Adviser at the U4 Anti-Corruption Resource Centre in Norway, as well as Jonathan Cushing, Head of the Transparency International Health Program. “According to Transparency International, $500 billion in public health spending is estimated to be lost globally every year due to corruption,” Aslanyan remarked. “It has been labelled the disease of the health system, hindering and preventing progress towards universal health coverage.” Fighting corruption, all the guests agreed, is essential to achieve universal health coverage. Corruption as a matter of life and death According to Kirya, it is important to consider the phenomenon as a matter of life and death. “You can look at it from the perspective of an expectant mother in labour, or an accident victim bleeding profusely who can’t access urgently needed health care simply because there are no doctors,” she said, sharing the experience of her native Uganda. “One of the reasons why there are no or very few doctors in public health facilities in Uganda increasingly has to do with corruption. It became clear from the research I’ve done that medical graduates are having to pay huge bribes to district service commissions to be recruited.” While health workers are often considered amongst those responsible for corruption, they are also one of its victims, Kirya argues. In order to fight corruption effectively, it is crucial to understand how widespread and complex the phenomenon is. “We’ve absolutely got to get away from this idea that corruption just happens in low-resource settings and low-resource systems,” said Cushing, adding that while “petty bribery” might be more visible, corruption happens everywhere. “It’s much more perhaps more complex, more hidden in higher income countries, but it happens,” he added. “Until we address that, we’re not going to get anywhere.” García revealed that as health minister, she experienced how difficult dismantling the networks behind widespread corruption can be. “I was really concerned about the lack of medications at the health centres, while I knew that we have had a very important process in which we bought medications for all the country,” she recalled. “We started an investigation and we found an illegal operation that was removing the drugs from storage and public hospital pharmacies and placing them in private pharmacies,” she added. “I was working with the Ministry of Internal Affairs and with the police; it was like in the movies.” However, as soon as she left office about 14 months after she was appointed, the investigation was called off. “The problems are still ongoing,” she concluded. The need for leaders with integrity Garcia, Kirya, and Cushing agreed on how hard and complex fighting corruption effectively is, but also stated that this reality should not deter anyone from pursuing the mission. “We can’t afford to be pessimistic,” said Kirya. “We can’t just give up.” “I think that my key call is transparency and leadership,” added Cushing. “We need to have integral leaders. Leaders who are leaders with integrity.” Listen to previous episodes on the Health Policy Website >> Learn more about “Global Health Matters” podcast>> Image Credits: Global Health Matters Podcast, Courtesy of TDR. Twenty Years On, HIV Activist is Still Fighting for Access to Cheaper Medicine 01/12/2022 Kerry Cullinan HIV activist Hazel Tau Twenty years ago, Hazel Tau, a young South African living with HIV, and her peers had little chance of getting antiretroviral (ARV) treatment because it was completely unaffordable. The South African price for just one of the three ARV drugs she needed, AZT, was 665% higher than the best-priced generic available elsewhere in the world. Only around 20,000 South Africans with private healthcare were on ARVs at the time because of the price. So Tau, an activist with the Treatment Action Campaign, agreed to be one of the public faces of a challenge to the price of ARVs – cleverly brought as a complaint to the Competition Commission alleging that two pharmaceutical companies were charging excessive prices for first-line ARVs. At the time, then-president Thabo Mbeki disputed that HIV caused AIDS and claimed that ARVs were poison, so pressuring the government to act on drug prices was a non-starter. The targets were GlaxoSmithKline South Africa and Boehringer Ingelheim, with Tau and others complaining that they had contravened the country’s Competition Act by abusing their dominant market positions on ARV prices. The SA Competition Commission’s Mapato Ramakgopa explained that the commission agreed with Tau and others, and had sought an order from the competition tribunal to compel the firms to grant voluntary licences to allow generic manufacturers to make genetic ARVs in return for a reasonable royalty. “The firms were found to have abused market dominance and fortunately, before the case could be heard by the tribunal, the manufacturers settled the matter and agreed to allow licences for generic and local manufacturers,” said Ramakgopa. Bittersweet victory “It was a bittersweet experience because of everyone who could not be saved,” said Tau, speaking at a commemorative event on Thursday. “I lost friends, family, colleagues. We lost millions of people who were breadwinners. But I will say I was happy with the outcome.” Finally, she and others could look forward to a life with access to affordable treatment. But Tau’s struggle for treatment access continues today as she is fighting for cheaper cancer drugs. “We know that, in developed countries, they’ve got cheaper drugs that can help people who have got cancer of different types, but we still have to pay it so I’m not feeling good about that,” said Tau. She is also still fighting the stigma faced by people living with HIV – and says that it is time for stand-alone HIV clinics – largely the result of special HIV funding – to be integrated as part of chronic care to spare those who need HIV care from being conspicuous when they go for treatment. “I blame us for having that HIV clinic. I wish HIV was just dealt with like other chronic diseases, normally without saying ‘this is an HIV thing’ because the stigma started there,” says Tau. Speaking on World AIDS Day, Tau said that she honoured those who had passed on and those newly infected and wished that AIDS awareness campaigns were active every day. Access to affordable medicine Access to affordable medicine continues to haunt people from poorer countries, as the COVID-19 pandemic showed when millions of people in low and middle-income countries could not get vaccines as these had all been bought by wealthy countries. The question of intellectual property (IP) rights on essential medicine is as burning an issue today as it was during the AIDS era. Fatima Hassan, director of the Health Justice Initiative (HJI), was one of the lawyers representing Tau and others – and more recently, has been campaigning for wider access to COVID-19 vaccines and therapeutics. Fatima Hassan ‘The reason we brought the case was because we saw the ‘Lazarus’ drugs. We saw them working for people in the USA. We saw them working for people in Europe.,” said Hassan. “We saw what Brazilian and Thai activists were doing to try to get compulsory measures in place for their governments to introduce generic therapies into their country. But our government was having none of that. It was in denial of the science and it refused to implement a public sector programme, which is the reason why we had to focus on the price of abuse in the private sector.” Hassan says that today’s struggles include fighting for access to expensive cancer treatments, exorbitant cystic fibrosis drugs and cabotegravir, an HIV prevention injection that received regulatory approval for use in South Africa on Thursday but remains too expensive for most. “Pharmaceutical companies have these IP monopolies which then means that we’ve got to continuously fight them on pricing because, in the absence of our government, taking the necessary executive action or issuing compulsory licences, we’re always going to have to rely on civil society or the Competition Commission to deal with the abuse of dominance, capture of the market and excessive pricing,” said Hassan. 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MPs Are Urged to Redirect Funding Towards Prevention and Primary Care 05/12/2022 Maayan Hoffman The head of the Health Division at the Organisation for Economic Co-operation and Development called on parliamentarians to redirect health funding towards prevention and primary care to help improve health outcomes. Speaking Monday at the opening session of the UNITE Global Summit in Lisbon, Francesca Colombo said that a basic health analysis proves the need to be focused in this direction. “Only 3% of total health spending is devoted to tackling poor risk factors and public health measures,” she told a room of more than 30 parliamentarians and other health leaders in the Senate Chamber of the Portuguese Parliament. “Return on investment in tackling unhealthy lifestyles is very high.” She noted for example that every dollar invested in tackling obesity has a $6 return on investment in economic benefits. Moreover, she said that her organization’s work has shown that three out of four deaths from antimicrobial resistance (AMR) could be averted by spending just a few dollars more – $2 per person. “While COVID-19 demonstrated that countries with strong health systems and universal health coverage are better prepared to manage health threats, investments in primary care account for less than $1 in every $6 present in health systems,” Colombo stressed. Finally, she added, too much health spending is at best ineffective and at worst harmful. A 2017 OECD report showed 20% of health expenditures make no or minimal contribution to good health outcomes. How to address these failings “The global shortage of healthcare workers must be urgently addressed, including finding equitable solutions to address international health workforce migration,” said Colombo. “The pandemic accelerated the use of digital tools like telehealth and remote diagnostics. Yet more needs to be done to accelerate the equitable development and use of these tools. “Finding new ways to pay for global public goods, such as vaccines and antimicrobials will be essential to be ready for future crises,” she added. The OECD has calculated that even in high-income countries an annual investment totalling 1.4% of GDP is needed to make health systems strong enough to meet the challenges of another pandemic on the scale of COVID-19, Colombo said. She expressed concern that finance ministers’ enthusiasm for investing in health is fading away. Raising parliamentarians’ voices Ricardo Baptista Leite, president and founder of UNITE Parliamentarians The UNITE Global Summit is meant to once again raise up parliamentarians’ voices around issues of health and health security. The event began around 9 a.m. in the Senate Chamber. Although the room is no longer in use, it continues to be harnessed for conferences and its rows of parliamentary chairs lent to the import of the conference on Monday morning. The theme of the UNITE summit is “from pandemic to prosperity,” a topic that Ricardo Baptista Leite, president and founder of UNITE, said should be “self-explanatory.” But, like Colombo, he said that the discussion is coming at a difficult time – a time when governments want to move beyond the pandemic and are focused on other challenging issues like the Russia-Ukraine war and rising inflation and cost-of-living in their countries. Leite said that nonetheless, parliamentarians must make their voices heard. “We are still in a pandemic, still suffering from the results of severe lockdown and the consequences of our lack of preparedness,” he said. “That is why our first day is focused on infection control and pandemic preparedness and response.” Ilona Kickbusch, founder of the Global Health Centre at the Graduate Institute in Geneva Over the next two days, the conference will also look at the future of health systems and health as a human right. Participants will be charged with answering three questions: What progress have we made so far during the UN’s Sustainable Development Goals period? What have we learned to help us make even more progress by 2030? What is the role of parliamentarians in helping drive that progress? “Parliamentarians should be at the forefront of the fight,” stressed Professor Ilona Kickbusch, founder of the Global Health Centre at the Graduate Institute in Geneva, who also spoke as part of the introductory session. “Parliamentarians should be the link between their constituents and their governments.” The UNITE Global Summit runs from Dec. 5-7, 2022. Click here for full coverage. Reporting for this series was supported by UNITE Parliamentarians for Global Health. Image Credits: Maayan Hoffman. Wendy Reaser: Struggling with Obesity in Canada 03/12/2022 Editorial team A special project celebrating the fifth anniversary of “Our Views, Our Voices” | Learn more Wendy Reaser One time, as Wendy Reaser was visiting the emergency room, she heard a specialist describing her as “fat and lazy,” adding that she did not want to put the work into being healthy. This experience, as well as many other unpleasant interactions with health professionals, left Wendy discouraged and traumatized. “For many years, this statement had me convinced that because I’m living with obesity, I didn’t have the right to care from medical professionals,” she shares in the NCD Diaries project, an initiative launched by the NCD Alliance. “I was convinced that nothing could be done and I wasn’t worth saving.” NCDs (noncommunicable diseases) are diseases that are not transmissible from person to person and they represent the first cause of death and disability worldwide. The NCD Diaries project is meant to support individuals like Wendy, so that they can share their lived experiences of NCDs, drawing on their unique local contexts, challenges faced and their aspirations and recommendations to drive change on NCDs. Canada, where Wendy lives, provides its citizens with universal healthcare coverage. “While this is fantastic because everyone has access to treatment, it doesn’t always mean that you get treated well,” Wendy writes. “Living with obesity is a daily struggle physically and mentally,” she explains. “Not only do we have to live with our shame and self-loathing, but we also must live with the judgement of those around us. Often, we are made to feel that we aren’t deserving of medical help, with many health care providers having been trained to tell us to simply ‘eat less and move more’.” Luckily for Wendy, she eventually found doctors with a different approach. “One day I visited my family doctor, who had been with us for about a year, to express concern about symptoms I was experiencing that were noticeable in my dad prior to his death from a heart attack,” she recalls. “I expected her to say that it was my weight, that I had to eat less and exercise more. I didn’t expect her to sit up and pay attention, and to immediately put in an urgent referral to a cardiologist. But that’s exactly what she did.” The cardiologist explained to Wendy that her heart was enlarged because she had sleep apnea, so her lungs were lacking oxygen. “I’d just started sleep apnea treatment 6 months before seeing him,” she writes. “He was confident that if I continued this treatment, ‘tweaked my eating and maybe moved around just a little more,’ my heart would be fine in under a year.” Wendy emphasizes that the doctor’s words saved her life. “It’s interactions like these that began to restore my confidence in navigating my care journey, and my faith in the medical profession,” she explains. Health professionals, she argues, need better training to provide care empathetically and effectively for people living with obesity. “Healthcare providers must accept that people living with obesity are not fat and lazy,” Wendy says. “There are several factors including genetics, medication, and even monetary constraints that can and do contribute to someone becoming obese. There’s a way to discuss obesity-related issues respectfully and helpfully, that doesn’t leave a deflated feeling of failure.” Read Wendy Reaser’s full NCD Diary. Read previous post. Image Credits: Courtesy of NCD Alliance. US Eager to Move Ahead with Pandemic Accord that Promotes Equity but not ‘Transactional’ Linkage between Data and Benefit-Sharing 02/12/2022 Elaine Ruth Fletcher Pamela Hamamoto, lead US negotiator on the WHO pandemic accord, in Geneva this week. The United States, once a reluctant partner in the initiative for a new global pandemic accord, is now keen to move ahead in negotiations over an agreement. The accord would expedite more rapid global data sharing and response to looming threats as well as ensuring greater equity in access to medicines and treatments, said the lead US negotiator of the instrument, Pamela Hamamoto on Friday. But Washington would like to avoid what she described as “transactional” language directly linking the two issues, as some developing nations have suggested. Nations like South Africa, for instance, cite bitter experiences with rapid, transparent sharing of genetic data on new SARS2 variants, which did nothing to improve the country’s access to badly-needed COVID medicines or vaccines. “Overall, the concept of equity, as I said, is very important. And it is certainly something that the United States is committed to to helping work on that and improve… the availability of medical countermeasures broadly speaking, going forward,” Hamamoto said. But in terms of a direct “linkage between the access and benefit sharing… I actually don’t necessarily think that that linkage is that helpful,” she said. “We’re also very interested in you know, as are others, in the rapid transparent sharing of data,” she said, adding, “what I hope is that… the sort of transactional nature of that concept doesn’t hamper us in being aspirational in our thinking, how we approach this and move forward.” Hamamoto was speaking in Geneva Friday along with Loyce Pace, US Assistant Secretary for Global Affairs, after a week of closed-door meetings with WHO officials and other WHO member states ahead of a third round of member state negotiations on a ‘conceptual’ zero draft text for the treaty due to start next week. First ‘zero draft’ circulated in late November Loyce Pace, Assistant Secretary for Global Affairs, US Department of Health and Human Services, in Geneva this week. This initial ‘zero draft’ text of a proposed pandemic accord was circulated among member states in late November. The draft calls for for “early, safe, transparent and rapid sharing of samples and genetic sequence data of pathogens” – a measure supported by the pharmaceutical industry – but simultaneously calls for “the fair and equitable sharing of benefits” – which the private sector and many developed countries along with the US have resisted, saying that too tight a linkage between any country’s agreement to share pathogen data and benefits reaped could slow down pandemic response. The draft also makes a strong case for more emphasis on regional production of vaccines and other pandemic-related products as well as ‘strategic stockpiles’ of pandemic response supplies. Speaking on that point, Pace and Hamamoto both underlined that the US is supportive of efforts to regionalize production of pandemic countermeasures. “We’re very committed to leaning into overall concepts of equity and transparency,” Hamamoto said. “making sure that we’re better prepared for the surveillance, detection and rapid response to future outbreaks. More comprehensive data and sample sharing on a fast timeframe as well rapid, rapid response .. and more equitable access to medical countermeasures, possibly through regional and local manufacturing.” Current text is hanging too much on the Christmas tree However both women warned that the current text, including many member state proposals for amendments and additions, will need considerable refinement to get the approval of the US and other member states. “There are so many ornanments we’re trying to put on the Christmas tree,” said Pace. “And that is understandable, and yet there are various work streams that will emerge, where there can be a higher and better use for some areas than others.” Added Hamamoto, “I think it’s just there’s just too much in there that is, is maybe not at the right level, like a more tactical playbook… as opposed to, you know, international agreements. “What we’re focused on next week is to really move it towards something that’s appropriately scoped to begin,” she said. “What it represents now is a collection of all the inputs that the Bureau has received so far for member states and external stakeholders as well,” she noted, referring to the small member state group guiding the process. “And everything has just been collected, sorted to a certain extent into some specific chapters…. But there’s a lot of work that still needs to be done around scope around structure around governance. And so in a nutshell, there’s a lot that needs to change before we were going to be able to sign on to it, as is the same for a lot of Member States, probably most.” Negotiations over revisions to International Health Regulations happening in parallel Negotiations over revisions to the WHO’s International Health Regulations are also proceeding in parallel. It was the US which tabled a series of proposed amendments to the IHR at the May World Health Assembly as matter for negotiations, finally winning the agreement of the member state body to engage in a parallel process to revise the 2005 WHO agreement on procedures for responding to outbreak and emergency threats. Assembly Approves Process to Update International Health Regulations on Pandemic Response Revising the IHR is deemed to be a quicker fix to some of the shortcomings in global pandemic response as once any revisions are approved, they would take effect immediately. A new international convention or accord would have to be ratified state by state. However agreement on those revisions, and alignment with the new pandemic accord, will also be a complex process, she admitted. “Obviously, there’s a lot cooking in that space, with so many member states and frankly, amendments being brought to the table,” Pace said. “That’s a good thing because I think we weren’t sure, frankly, earlier this year, to what degree the member states would be interested in engaging in that [IHR] process. And so I know a lot of being done to look through those various proposals and align them with the work that Ambassador Hamamoto is leading on the front end.” Hints at adjustments in negotiating schedule – but not endpoint Standing ovation at 2021 special World Health Assembly session that decides to negotiate a new pandemic accord. Hamamoto also suggested that some of the mid-term milestones that have been set in the negotiating schedule for the pandemic accord over the coming two years, might have to be adjusted in order to accommodate the complexity of the process. According to the current timeline, a firm ‘zero draft’ text is supposed to be ready to put before WHA member states for the full-fledged start of negotiations by February 2023. However, Hamamoto said that she was in no way suggesting that member states should prolong deliberations over the text beyond the May 2024 date that was agreed to by WHO member states exactly a year ago, as the date by which a final draft text should be brought before the World Health Assembly. “You know, the pretty broadly held view is that we need to make sure that the process is set up right so that we feel that we can that we have the space to do our work, and make sure we get this right and so we don’t blow this opportunity to put together an accord that is going to be meaningful and implementable,” Hamamoto said. “But May 2024 is the planned and hoped-for end-date and I’m not suggesting going beyond that. However, the time line along the way is ambitious. And we do also have these parallel processes, so we just want to make sure in theese early stages, what is being called the zero draft, that we get that right.” Image Credits: E Fletcher/Health Policy Watch , E Fletcher/Health Policy Watch. UN Environment: Investments in ‘Nature-Based’ Climate Solutions Must Double by 2025 02/12/2022 Stefan Anderson Climate, biodiversity, and land degradation goals will be out of reach unless investments into nature-based solutions quickly ramp up to $384 billion/year by 2025, more than double of the current $154 billion/year, according to UN Environment Programme. A new report by the United Nations Environment Programme warns that investment in nature-based solutions must double by 2025 if the world is to limit global warming to 1.5°C, as well as halting biodiversity loss and progressively increasing land degradation. The report comes a week before world leaders will gather at the UN Biodiversity Conference (COP15) in Montreal, Canada, where they are set to negotiate an agreement that aims to halt and reverse biodiveristy loss by 2030. UNEP is calling on governments to agree on a clear framework for countries to require the financial sector to align its activities with ‘nature positive’ goals. “The science is undeniable. As we transition to net-zero emissions by 2050, we must also reorient all human activity to ease the pressure on the natural world on which we all depend,” said Inger Andersen, Executive Director of UNEP. “This requires governments, business and finance to massively step up investments in nature-based solutions because investments in nature are investments in securing the future for generations to follow.” Nature-based solutions are actions to protect, manage, or restore natural ecosystems, and are already well-documented to be critical to any response to climate change. The World Bank estimates that nature-based solutions can reduce by 37% the carbon emissions reductions that are needed by 2030 to meet the Paris Agreement goals. The Intergovernmental Panel on Climate Change (IPCC) has also pointed to nature-based solutions, such as biodiversity preservation, as key to realistic emissions reductions. “Phasing out coal and decarbonizing the energy systems will not be enough without adjacent massive investments into nature-based solutions,” the report found. “Politicians, business and finance leaders and citizens globally must transform their relationship with nature to work with it rather than against it.” Nature-negative expenditures are 3 to 7 times higher than nature-based solution investment Governments need to scale-down environmentally harmful subsidies and investments, and increased nature based solutions (Nbs) if 1.5C is to remain within reach. While the world faces the overlapping planetary crises of climate change, biodiversity loss and pollution, nature-negative expenditures are 3 to 7 times larger than current investments in nature-based solutions, the report found. With the impacts of these crises already being felt by millions of people around the world, particularly the most vulnerable, UNEP said immediate action is required to begin mitigating and reversing the most harmful impacts. Government expenditures on harmful subsidies to fisheries, agriculture and fossil fuels is estimated at $500 billion to $1 trillion annually. Harmful subsidies are highest in the energy and agricultural sectors, estimated at $340 to $530 billion and around $500 billion per year respectively. By contrast, investment in nature based solutions (Nbs) currently are estimated at just $154 billion annually. “These flows severely undermine efforts to achieve critical environmental targets,” the report warns. “Delayed action is no longer an option in the face of the devastating effects of climate change, the extinction crisis and severe land degradation globally.” This warning is the latest in a series of dire calls to action by UNEP. Its adaptation and emissions gap reports equally stressed the need for immediate action if any hopes of averting climate disaster are to be kept alive. “We had our chance to make incremental changes, but that time is over,” Andersen said at a press conference launching the UNEP emissions gap report in late October, which benchmarked the gap between countries’ actual emissions and needed reductions to keep 1.5C alive. “Only a root-and-branch transformation of our economies and societies can save us from accelerating the climate disaster.” Private sector must step up as governments faces overlapping crises Private capital must start investing in harnessing the power of nature to reduce and remove emissions, restore degraded land and seascapes and turn the tide on biodiversity loss, the report found. The UNEP report reveals that private capital represents just 17% of total investments into nature-based solutions. Governments currently provide the other 83%, but the report stresses they will be unlikely to be able to significantly scale up funding due to current global financial challenges linked to war, debt, and poverty. As a result, private funding for nature-based solutions will have make-up the shortfall, requiring an increase by “several orders of magnitude” in the coming years. Total investments in nature-based solutions will need to hit $384 billion by 2050, more than double the present level of $154 billion annually, the report concludes. The roadmap provided by the report calls for ramping up private capital investments in sustainable supply chains, offsetting unavoidable impacts, reducing activities with negative climate and biodiversity impacts, and investing in “net zero” and “nature positive” activities. This will require a U-turn from the current state of private financial flows. “While robust evidence is lacking, it is widely recognized that private finance flows are predominantly negative for nature and almost certainly exacerbate the situation,” the report states. “These flows severely undermine efforts to achieve critical environmental targets,” the report states. “As the IMF warns of the ‘darkest hour’ in 2023 for global growth, this report is a reminder that many short-term efforts to boost GDP by governments, without attention to the fact that nature underpins many economies, will impose greater costs for both present and future generations in years to come,” the UNEP document concludes. Investment in protecting planet’s oceans disproportionately low The trajectory of annual nature-based solution investment needs to limit climate change to below 1.5°C, haltbiodiversity loss and achieve land degradation neutrality, $ billion (2022 US$). The UNEP analysis also found just 9% of investment in nature-based solutions are directed towards marine ecosystems, a disproportionately low amount given the critical role of oceans in climate mitigation, adaptation, food security, and biodiversity conservation. The Earth’s oceans cover over 70% of the planet’s surface, absorb around 25% of all CO2 emissions, and provide 17% of the world’s protein. Since the start of the Industrial Revolution, oceans have absorbed a third of human carbon dioxide emissions, making them one of the largest carbon sinks, topped only by global rainforests. The lack of investment in marine protection comes at a time of crisis for the world’s oceans. Projections show that by 2050, our oceans may contain more plastics than fish. These will not only suffocate marine life, but also phytoplankton, the microorganisms at the heart of oceans’ abilities to absorb carbon dioxide, as forests and plants do on dry land. As millions of tons of plastic break down in oceans across the world, uncounted quantities of microplastics are infiltrating phytoplankton, blocking sunlight-absorbing mechanisms, which in turn prevents the process of photosynthesis, and damages their ability to capture carbon in the seas. Yet current annual investment in marine protected areas sits at just $980 million, as compared to protection efforts in terrestrial systems, which receive almost US$23 billion annually. US$8–11 billion is needed to increase marine protected areas to 30% by 2030, the report concludes. “While the world is enduring multiple crises, this report provides clarity,” Jochen Flasbarth, State Secretary in the German Federal Ministry for Economic Cooperation and Development (BMZ), said. “It shows that by significantly increasing public and private investments in nature-based solutions, it is possible to tackle climate change, biodiversity loss and land degradation – and at the same time harness many societal and economic benefits. We need to act now.” Image Credits: UNEP. How Does Corruption Affect Health Systems Around the World? 02/12/2022 Editorial team When Patty García was a medical student in Peru some 30 years ago, she was already aware of the detrimental effect of corruption on health systems. “Back then, the corruption related to the distribution of drugs,” Garcia, who would go on to become her country’s Health Minister in 2016, shares during the latest episode of the “Global Health Matters” podcast with host Garry Aslanyan. “Because at that point resources were scarce, probably it was not seen as a big issue because there was not much to steal. But when I became Minister of Health, I realised the magnitude of the problem.” García, who currently is a professor at the School of Public Health at Cayetano Heredia University in Lima, joins Aslanyan, together with Monica Kirya, a lawyer and the Senior Program Adviser at the U4 Anti-Corruption Resource Centre in Norway, as well as Jonathan Cushing, Head of the Transparency International Health Program. “According to Transparency International, $500 billion in public health spending is estimated to be lost globally every year due to corruption,” Aslanyan remarked. “It has been labelled the disease of the health system, hindering and preventing progress towards universal health coverage.” Fighting corruption, all the guests agreed, is essential to achieve universal health coverage. Corruption as a matter of life and death According to Kirya, it is important to consider the phenomenon as a matter of life and death. “You can look at it from the perspective of an expectant mother in labour, or an accident victim bleeding profusely who can’t access urgently needed health care simply because there are no doctors,” she said, sharing the experience of her native Uganda. “One of the reasons why there are no or very few doctors in public health facilities in Uganda increasingly has to do with corruption. It became clear from the research I’ve done that medical graduates are having to pay huge bribes to district service commissions to be recruited.” While health workers are often considered amongst those responsible for corruption, they are also one of its victims, Kirya argues. In order to fight corruption effectively, it is crucial to understand how widespread and complex the phenomenon is. “We’ve absolutely got to get away from this idea that corruption just happens in low-resource settings and low-resource systems,” said Cushing, adding that while “petty bribery” might be more visible, corruption happens everywhere. “It’s much more perhaps more complex, more hidden in higher income countries, but it happens,” he added. “Until we address that, we’re not going to get anywhere.” García revealed that as health minister, she experienced how difficult dismantling the networks behind widespread corruption can be. “I was really concerned about the lack of medications at the health centres, while I knew that we have had a very important process in which we bought medications for all the country,” she recalled. “We started an investigation and we found an illegal operation that was removing the drugs from storage and public hospital pharmacies and placing them in private pharmacies,” she added. “I was working with the Ministry of Internal Affairs and with the police; it was like in the movies.” However, as soon as she left office about 14 months after she was appointed, the investigation was called off. “The problems are still ongoing,” she concluded. The need for leaders with integrity Garcia, Kirya, and Cushing agreed on how hard and complex fighting corruption effectively is, but also stated that this reality should not deter anyone from pursuing the mission. “We can’t afford to be pessimistic,” said Kirya. “We can’t just give up.” “I think that my key call is transparency and leadership,” added Cushing. “We need to have integral leaders. Leaders who are leaders with integrity.” Listen to previous episodes on the Health Policy Website >> Learn more about “Global Health Matters” podcast>> Image Credits: Global Health Matters Podcast, Courtesy of TDR. Twenty Years On, HIV Activist is Still Fighting for Access to Cheaper Medicine 01/12/2022 Kerry Cullinan HIV activist Hazel Tau Twenty years ago, Hazel Tau, a young South African living with HIV, and her peers had little chance of getting antiretroviral (ARV) treatment because it was completely unaffordable. The South African price for just one of the three ARV drugs she needed, AZT, was 665% higher than the best-priced generic available elsewhere in the world. Only around 20,000 South Africans with private healthcare were on ARVs at the time because of the price. So Tau, an activist with the Treatment Action Campaign, agreed to be one of the public faces of a challenge to the price of ARVs – cleverly brought as a complaint to the Competition Commission alleging that two pharmaceutical companies were charging excessive prices for first-line ARVs. At the time, then-president Thabo Mbeki disputed that HIV caused AIDS and claimed that ARVs were poison, so pressuring the government to act on drug prices was a non-starter. The targets were GlaxoSmithKline South Africa and Boehringer Ingelheim, with Tau and others complaining that they had contravened the country’s Competition Act by abusing their dominant market positions on ARV prices. The SA Competition Commission’s Mapato Ramakgopa explained that the commission agreed with Tau and others, and had sought an order from the competition tribunal to compel the firms to grant voluntary licences to allow generic manufacturers to make genetic ARVs in return for a reasonable royalty. “The firms were found to have abused market dominance and fortunately, before the case could be heard by the tribunal, the manufacturers settled the matter and agreed to allow licences for generic and local manufacturers,” said Ramakgopa. Bittersweet victory “It was a bittersweet experience because of everyone who could not be saved,” said Tau, speaking at a commemorative event on Thursday. “I lost friends, family, colleagues. We lost millions of people who were breadwinners. But I will say I was happy with the outcome.” Finally, she and others could look forward to a life with access to affordable treatment. But Tau’s struggle for treatment access continues today as she is fighting for cheaper cancer drugs. “We know that, in developed countries, they’ve got cheaper drugs that can help people who have got cancer of different types, but we still have to pay it so I’m not feeling good about that,” said Tau. She is also still fighting the stigma faced by people living with HIV – and says that it is time for stand-alone HIV clinics – largely the result of special HIV funding – to be integrated as part of chronic care to spare those who need HIV care from being conspicuous when they go for treatment. “I blame us for having that HIV clinic. I wish HIV was just dealt with like other chronic diseases, normally without saying ‘this is an HIV thing’ because the stigma started there,” says Tau. Speaking on World AIDS Day, Tau said that she honoured those who had passed on and those newly infected and wished that AIDS awareness campaigns were active every day. Access to affordable medicine Access to affordable medicine continues to haunt people from poorer countries, as the COVID-19 pandemic showed when millions of people in low and middle-income countries could not get vaccines as these had all been bought by wealthy countries. The question of intellectual property (IP) rights on essential medicine is as burning an issue today as it was during the AIDS era. Fatima Hassan, director of the Health Justice Initiative (HJI), was one of the lawyers representing Tau and others – and more recently, has been campaigning for wider access to COVID-19 vaccines and therapeutics. Fatima Hassan ‘The reason we brought the case was because we saw the ‘Lazarus’ drugs. We saw them working for people in the USA. We saw them working for people in Europe.,” said Hassan. “We saw what Brazilian and Thai activists were doing to try to get compulsory measures in place for their governments to introduce generic therapies into their country. But our government was having none of that. It was in denial of the science and it refused to implement a public sector programme, which is the reason why we had to focus on the price of abuse in the private sector.” Hassan says that today’s struggles include fighting for access to expensive cancer treatments, exorbitant cystic fibrosis drugs and cabotegravir, an HIV prevention injection that received regulatory approval for use in South Africa on Thursday but remains too expensive for most. “Pharmaceutical companies have these IP monopolies which then means that we’ve got to continuously fight them on pricing because, in the absence of our government, taking the necessary executive action or issuing compulsory licences, we’re always going to have to rely on civil society or the Competition Commission to deal with the abuse of dominance, capture of the market and excessive pricing,” said Hassan. 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Wendy Reaser: Struggling with Obesity in Canada 03/12/2022 Editorial team A special project celebrating the fifth anniversary of “Our Views, Our Voices” | Learn more Wendy Reaser One time, as Wendy Reaser was visiting the emergency room, she heard a specialist describing her as “fat and lazy,” adding that she did not want to put the work into being healthy. This experience, as well as many other unpleasant interactions with health professionals, left Wendy discouraged and traumatized. “For many years, this statement had me convinced that because I’m living with obesity, I didn’t have the right to care from medical professionals,” she shares in the NCD Diaries project, an initiative launched by the NCD Alliance. “I was convinced that nothing could be done and I wasn’t worth saving.” NCDs (noncommunicable diseases) are diseases that are not transmissible from person to person and they represent the first cause of death and disability worldwide. The NCD Diaries project is meant to support individuals like Wendy, so that they can share their lived experiences of NCDs, drawing on their unique local contexts, challenges faced and their aspirations and recommendations to drive change on NCDs. Canada, where Wendy lives, provides its citizens with universal healthcare coverage. “While this is fantastic because everyone has access to treatment, it doesn’t always mean that you get treated well,” Wendy writes. “Living with obesity is a daily struggle physically and mentally,” she explains. “Not only do we have to live with our shame and self-loathing, but we also must live with the judgement of those around us. Often, we are made to feel that we aren’t deserving of medical help, with many health care providers having been trained to tell us to simply ‘eat less and move more’.” Luckily for Wendy, she eventually found doctors with a different approach. “One day I visited my family doctor, who had been with us for about a year, to express concern about symptoms I was experiencing that were noticeable in my dad prior to his death from a heart attack,” she recalls. “I expected her to say that it was my weight, that I had to eat less and exercise more. I didn’t expect her to sit up and pay attention, and to immediately put in an urgent referral to a cardiologist. But that’s exactly what she did.” The cardiologist explained to Wendy that her heart was enlarged because she had sleep apnea, so her lungs were lacking oxygen. “I’d just started sleep apnea treatment 6 months before seeing him,” she writes. “He was confident that if I continued this treatment, ‘tweaked my eating and maybe moved around just a little more,’ my heart would be fine in under a year.” Wendy emphasizes that the doctor’s words saved her life. “It’s interactions like these that began to restore my confidence in navigating my care journey, and my faith in the medical profession,” she explains. Health professionals, she argues, need better training to provide care empathetically and effectively for people living with obesity. “Healthcare providers must accept that people living with obesity are not fat and lazy,” Wendy says. “There are several factors including genetics, medication, and even monetary constraints that can and do contribute to someone becoming obese. There’s a way to discuss obesity-related issues respectfully and helpfully, that doesn’t leave a deflated feeling of failure.” Read Wendy Reaser’s full NCD Diary. Read previous post. Image Credits: Courtesy of NCD Alliance. US Eager to Move Ahead with Pandemic Accord that Promotes Equity but not ‘Transactional’ Linkage between Data and Benefit-Sharing 02/12/2022 Elaine Ruth Fletcher Pamela Hamamoto, lead US negotiator on the WHO pandemic accord, in Geneva this week. The United States, once a reluctant partner in the initiative for a new global pandemic accord, is now keen to move ahead in negotiations over an agreement. The accord would expedite more rapid global data sharing and response to looming threats as well as ensuring greater equity in access to medicines and treatments, said the lead US negotiator of the instrument, Pamela Hamamoto on Friday. But Washington would like to avoid what she described as “transactional” language directly linking the two issues, as some developing nations have suggested. Nations like South Africa, for instance, cite bitter experiences with rapid, transparent sharing of genetic data on new SARS2 variants, which did nothing to improve the country’s access to badly-needed COVID medicines or vaccines. “Overall, the concept of equity, as I said, is very important. And it is certainly something that the United States is committed to to helping work on that and improve… the availability of medical countermeasures broadly speaking, going forward,” Hamamoto said. But in terms of a direct “linkage between the access and benefit sharing… I actually don’t necessarily think that that linkage is that helpful,” she said. “We’re also very interested in you know, as are others, in the rapid transparent sharing of data,” she said, adding, “what I hope is that… the sort of transactional nature of that concept doesn’t hamper us in being aspirational in our thinking, how we approach this and move forward.” Hamamoto was speaking in Geneva Friday along with Loyce Pace, US Assistant Secretary for Global Affairs, after a week of closed-door meetings with WHO officials and other WHO member states ahead of a third round of member state negotiations on a ‘conceptual’ zero draft text for the treaty due to start next week. First ‘zero draft’ circulated in late November Loyce Pace, Assistant Secretary for Global Affairs, US Department of Health and Human Services, in Geneva this week. This initial ‘zero draft’ text of a proposed pandemic accord was circulated among member states in late November. The draft calls for for “early, safe, transparent and rapid sharing of samples and genetic sequence data of pathogens” – a measure supported by the pharmaceutical industry – but simultaneously calls for “the fair and equitable sharing of benefits” – which the private sector and many developed countries along with the US have resisted, saying that too tight a linkage between any country’s agreement to share pathogen data and benefits reaped could slow down pandemic response. The draft also makes a strong case for more emphasis on regional production of vaccines and other pandemic-related products as well as ‘strategic stockpiles’ of pandemic response supplies. Speaking on that point, Pace and Hamamoto both underlined that the US is supportive of efforts to regionalize production of pandemic countermeasures. “We’re very committed to leaning into overall concepts of equity and transparency,” Hamamoto said. “making sure that we’re better prepared for the surveillance, detection and rapid response to future outbreaks. More comprehensive data and sample sharing on a fast timeframe as well rapid, rapid response .. and more equitable access to medical countermeasures, possibly through regional and local manufacturing.” Current text is hanging too much on the Christmas tree However both women warned that the current text, including many member state proposals for amendments and additions, will need considerable refinement to get the approval of the US and other member states. “There are so many ornanments we’re trying to put on the Christmas tree,” said Pace. “And that is understandable, and yet there are various work streams that will emerge, where there can be a higher and better use for some areas than others.” Added Hamamoto, “I think it’s just there’s just too much in there that is, is maybe not at the right level, like a more tactical playbook… as opposed to, you know, international agreements. “What we’re focused on next week is to really move it towards something that’s appropriately scoped to begin,” she said. “What it represents now is a collection of all the inputs that the Bureau has received so far for member states and external stakeholders as well,” she noted, referring to the small member state group guiding the process. “And everything has just been collected, sorted to a certain extent into some specific chapters…. But there’s a lot of work that still needs to be done around scope around structure around governance. And so in a nutshell, there’s a lot that needs to change before we were going to be able to sign on to it, as is the same for a lot of Member States, probably most.” Negotiations over revisions to International Health Regulations happening in parallel Negotiations over revisions to the WHO’s International Health Regulations are also proceeding in parallel. It was the US which tabled a series of proposed amendments to the IHR at the May World Health Assembly as matter for negotiations, finally winning the agreement of the member state body to engage in a parallel process to revise the 2005 WHO agreement on procedures for responding to outbreak and emergency threats. Assembly Approves Process to Update International Health Regulations on Pandemic Response Revising the IHR is deemed to be a quicker fix to some of the shortcomings in global pandemic response as once any revisions are approved, they would take effect immediately. A new international convention or accord would have to be ratified state by state. However agreement on those revisions, and alignment with the new pandemic accord, will also be a complex process, she admitted. “Obviously, there’s a lot cooking in that space, with so many member states and frankly, amendments being brought to the table,” Pace said. “That’s a good thing because I think we weren’t sure, frankly, earlier this year, to what degree the member states would be interested in engaging in that [IHR] process. And so I know a lot of being done to look through those various proposals and align them with the work that Ambassador Hamamoto is leading on the front end.” Hints at adjustments in negotiating schedule – but not endpoint Standing ovation at 2021 special World Health Assembly session that decides to negotiate a new pandemic accord. Hamamoto also suggested that some of the mid-term milestones that have been set in the negotiating schedule for the pandemic accord over the coming two years, might have to be adjusted in order to accommodate the complexity of the process. According to the current timeline, a firm ‘zero draft’ text is supposed to be ready to put before WHA member states for the full-fledged start of negotiations by February 2023. However, Hamamoto said that she was in no way suggesting that member states should prolong deliberations over the text beyond the May 2024 date that was agreed to by WHO member states exactly a year ago, as the date by which a final draft text should be brought before the World Health Assembly. “You know, the pretty broadly held view is that we need to make sure that the process is set up right so that we feel that we can that we have the space to do our work, and make sure we get this right and so we don’t blow this opportunity to put together an accord that is going to be meaningful and implementable,” Hamamoto said. “But May 2024 is the planned and hoped-for end-date and I’m not suggesting going beyond that. However, the time line along the way is ambitious. And we do also have these parallel processes, so we just want to make sure in theese early stages, what is being called the zero draft, that we get that right.” Image Credits: E Fletcher/Health Policy Watch , E Fletcher/Health Policy Watch. UN Environment: Investments in ‘Nature-Based’ Climate Solutions Must Double by 2025 02/12/2022 Stefan Anderson Climate, biodiversity, and land degradation goals will be out of reach unless investments into nature-based solutions quickly ramp up to $384 billion/year by 2025, more than double of the current $154 billion/year, according to UN Environment Programme. A new report by the United Nations Environment Programme warns that investment in nature-based solutions must double by 2025 if the world is to limit global warming to 1.5°C, as well as halting biodiversity loss and progressively increasing land degradation. The report comes a week before world leaders will gather at the UN Biodiversity Conference (COP15) in Montreal, Canada, where they are set to negotiate an agreement that aims to halt and reverse biodiveristy loss by 2030. UNEP is calling on governments to agree on a clear framework for countries to require the financial sector to align its activities with ‘nature positive’ goals. “The science is undeniable. As we transition to net-zero emissions by 2050, we must also reorient all human activity to ease the pressure on the natural world on which we all depend,” said Inger Andersen, Executive Director of UNEP. “This requires governments, business and finance to massively step up investments in nature-based solutions because investments in nature are investments in securing the future for generations to follow.” Nature-based solutions are actions to protect, manage, or restore natural ecosystems, and are already well-documented to be critical to any response to climate change. The World Bank estimates that nature-based solutions can reduce by 37% the carbon emissions reductions that are needed by 2030 to meet the Paris Agreement goals. The Intergovernmental Panel on Climate Change (IPCC) has also pointed to nature-based solutions, such as biodiversity preservation, as key to realistic emissions reductions. “Phasing out coal and decarbonizing the energy systems will not be enough without adjacent massive investments into nature-based solutions,” the report found. “Politicians, business and finance leaders and citizens globally must transform their relationship with nature to work with it rather than against it.” Nature-negative expenditures are 3 to 7 times higher than nature-based solution investment Governments need to scale-down environmentally harmful subsidies and investments, and increased nature based solutions (Nbs) if 1.5C is to remain within reach. While the world faces the overlapping planetary crises of climate change, biodiversity loss and pollution, nature-negative expenditures are 3 to 7 times larger than current investments in nature-based solutions, the report found. With the impacts of these crises already being felt by millions of people around the world, particularly the most vulnerable, UNEP said immediate action is required to begin mitigating and reversing the most harmful impacts. Government expenditures on harmful subsidies to fisheries, agriculture and fossil fuels is estimated at $500 billion to $1 trillion annually. Harmful subsidies are highest in the energy and agricultural sectors, estimated at $340 to $530 billion and around $500 billion per year respectively. By contrast, investment in nature based solutions (Nbs) currently are estimated at just $154 billion annually. “These flows severely undermine efforts to achieve critical environmental targets,” the report warns. “Delayed action is no longer an option in the face of the devastating effects of climate change, the extinction crisis and severe land degradation globally.” This warning is the latest in a series of dire calls to action by UNEP. Its adaptation and emissions gap reports equally stressed the need for immediate action if any hopes of averting climate disaster are to be kept alive. “We had our chance to make incremental changes, but that time is over,” Andersen said at a press conference launching the UNEP emissions gap report in late October, which benchmarked the gap between countries’ actual emissions and needed reductions to keep 1.5C alive. “Only a root-and-branch transformation of our economies and societies can save us from accelerating the climate disaster.” Private sector must step up as governments faces overlapping crises Private capital must start investing in harnessing the power of nature to reduce and remove emissions, restore degraded land and seascapes and turn the tide on biodiversity loss, the report found. The UNEP report reveals that private capital represents just 17% of total investments into nature-based solutions. Governments currently provide the other 83%, but the report stresses they will be unlikely to be able to significantly scale up funding due to current global financial challenges linked to war, debt, and poverty. As a result, private funding for nature-based solutions will have make-up the shortfall, requiring an increase by “several orders of magnitude” in the coming years. Total investments in nature-based solutions will need to hit $384 billion by 2050, more than double the present level of $154 billion annually, the report concludes. The roadmap provided by the report calls for ramping up private capital investments in sustainable supply chains, offsetting unavoidable impacts, reducing activities with negative climate and biodiversity impacts, and investing in “net zero” and “nature positive” activities. This will require a U-turn from the current state of private financial flows. “While robust evidence is lacking, it is widely recognized that private finance flows are predominantly negative for nature and almost certainly exacerbate the situation,” the report states. “These flows severely undermine efforts to achieve critical environmental targets,” the report states. “As the IMF warns of the ‘darkest hour’ in 2023 for global growth, this report is a reminder that many short-term efforts to boost GDP by governments, without attention to the fact that nature underpins many economies, will impose greater costs for both present and future generations in years to come,” the UNEP document concludes. Investment in protecting planet’s oceans disproportionately low The trajectory of annual nature-based solution investment needs to limit climate change to below 1.5°C, haltbiodiversity loss and achieve land degradation neutrality, $ billion (2022 US$). The UNEP analysis also found just 9% of investment in nature-based solutions are directed towards marine ecosystems, a disproportionately low amount given the critical role of oceans in climate mitigation, adaptation, food security, and biodiversity conservation. The Earth’s oceans cover over 70% of the planet’s surface, absorb around 25% of all CO2 emissions, and provide 17% of the world’s protein. Since the start of the Industrial Revolution, oceans have absorbed a third of human carbon dioxide emissions, making them one of the largest carbon sinks, topped only by global rainforests. The lack of investment in marine protection comes at a time of crisis for the world’s oceans. Projections show that by 2050, our oceans may contain more plastics than fish. These will not only suffocate marine life, but also phytoplankton, the microorganisms at the heart of oceans’ abilities to absorb carbon dioxide, as forests and plants do on dry land. As millions of tons of plastic break down in oceans across the world, uncounted quantities of microplastics are infiltrating phytoplankton, blocking sunlight-absorbing mechanisms, which in turn prevents the process of photosynthesis, and damages their ability to capture carbon in the seas. Yet current annual investment in marine protected areas sits at just $980 million, as compared to protection efforts in terrestrial systems, which receive almost US$23 billion annually. US$8–11 billion is needed to increase marine protected areas to 30% by 2030, the report concludes. “While the world is enduring multiple crises, this report provides clarity,” Jochen Flasbarth, State Secretary in the German Federal Ministry for Economic Cooperation and Development (BMZ), said. “It shows that by significantly increasing public and private investments in nature-based solutions, it is possible to tackle climate change, biodiversity loss and land degradation – and at the same time harness many societal and economic benefits. We need to act now.” Image Credits: UNEP. How Does Corruption Affect Health Systems Around the World? 02/12/2022 Editorial team When Patty García was a medical student in Peru some 30 years ago, she was already aware of the detrimental effect of corruption on health systems. “Back then, the corruption related to the distribution of drugs,” Garcia, who would go on to become her country’s Health Minister in 2016, shares during the latest episode of the “Global Health Matters” podcast with host Garry Aslanyan. “Because at that point resources were scarce, probably it was not seen as a big issue because there was not much to steal. But when I became Minister of Health, I realised the magnitude of the problem.” García, who currently is a professor at the School of Public Health at Cayetano Heredia University in Lima, joins Aslanyan, together with Monica Kirya, a lawyer and the Senior Program Adviser at the U4 Anti-Corruption Resource Centre in Norway, as well as Jonathan Cushing, Head of the Transparency International Health Program. “According to Transparency International, $500 billion in public health spending is estimated to be lost globally every year due to corruption,” Aslanyan remarked. “It has been labelled the disease of the health system, hindering and preventing progress towards universal health coverage.” Fighting corruption, all the guests agreed, is essential to achieve universal health coverage. Corruption as a matter of life and death According to Kirya, it is important to consider the phenomenon as a matter of life and death. “You can look at it from the perspective of an expectant mother in labour, or an accident victim bleeding profusely who can’t access urgently needed health care simply because there are no doctors,” she said, sharing the experience of her native Uganda. “One of the reasons why there are no or very few doctors in public health facilities in Uganda increasingly has to do with corruption. It became clear from the research I’ve done that medical graduates are having to pay huge bribes to district service commissions to be recruited.” While health workers are often considered amongst those responsible for corruption, they are also one of its victims, Kirya argues. In order to fight corruption effectively, it is crucial to understand how widespread and complex the phenomenon is. “We’ve absolutely got to get away from this idea that corruption just happens in low-resource settings and low-resource systems,” said Cushing, adding that while “petty bribery” might be more visible, corruption happens everywhere. “It’s much more perhaps more complex, more hidden in higher income countries, but it happens,” he added. “Until we address that, we’re not going to get anywhere.” García revealed that as health minister, she experienced how difficult dismantling the networks behind widespread corruption can be. “I was really concerned about the lack of medications at the health centres, while I knew that we have had a very important process in which we bought medications for all the country,” she recalled. “We started an investigation and we found an illegal operation that was removing the drugs from storage and public hospital pharmacies and placing them in private pharmacies,” she added. “I was working with the Ministry of Internal Affairs and with the police; it was like in the movies.” However, as soon as she left office about 14 months after she was appointed, the investigation was called off. “The problems are still ongoing,” she concluded. The need for leaders with integrity Garcia, Kirya, and Cushing agreed on how hard and complex fighting corruption effectively is, but also stated that this reality should not deter anyone from pursuing the mission. “We can’t afford to be pessimistic,” said Kirya. “We can’t just give up.” “I think that my key call is transparency and leadership,” added Cushing. “We need to have integral leaders. Leaders who are leaders with integrity.” Listen to previous episodes on the Health Policy Website >> Learn more about “Global Health Matters” podcast>> Image Credits: Global Health Matters Podcast, Courtesy of TDR. Twenty Years On, HIV Activist is Still Fighting for Access to Cheaper Medicine 01/12/2022 Kerry Cullinan HIV activist Hazel Tau Twenty years ago, Hazel Tau, a young South African living with HIV, and her peers had little chance of getting antiretroviral (ARV) treatment because it was completely unaffordable. The South African price for just one of the three ARV drugs she needed, AZT, was 665% higher than the best-priced generic available elsewhere in the world. Only around 20,000 South Africans with private healthcare were on ARVs at the time because of the price. So Tau, an activist with the Treatment Action Campaign, agreed to be one of the public faces of a challenge to the price of ARVs – cleverly brought as a complaint to the Competition Commission alleging that two pharmaceutical companies were charging excessive prices for first-line ARVs. At the time, then-president Thabo Mbeki disputed that HIV caused AIDS and claimed that ARVs were poison, so pressuring the government to act on drug prices was a non-starter. The targets were GlaxoSmithKline South Africa and Boehringer Ingelheim, with Tau and others complaining that they had contravened the country’s Competition Act by abusing their dominant market positions on ARV prices. The SA Competition Commission’s Mapato Ramakgopa explained that the commission agreed with Tau and others, and had sought an order from the competition tribunal to compel the firms to grant voluntary licences to allow generic manufacturers to make genetic ARVs in return for a reasonable royalty. “The firms were found to have abused market dominance and fortunately, before the case could be heard by the tribunal, the manufacturers settled the matter and agreed to allow licences for generic and local manufacturers,” said Ramakgopa. Bittersweet victory “It was a bittersweet experience because of everyone who could not be saved,” said Tau, speaking at a commemorative event on Thursday. “I lost friends, family, colleagues. We lost millions of people who were breadwinners. But I will say I was happy with the outcome.” Finally, she and others could look forward to a life with access to affordable treatment. But Tau’s struggle for treatment access continues today as she is fighting for cheaper cancer drugs. “We know that, in developed countries, they’ve got cheaper drugs that can help people who have got cancer of different types, but we still have to pay it so I’m not feeling good about that,” said Tau. She is also still fighting the stigma faced by people living with HIV – and says that it is time for stand-alone HIV clinics – largely the result of special HIV funding – to be integrated as part of chronic care to spare those who need HIV care from being conspicuous when they go for treatment. “I blame us for having that HIV clinic. I wish HIV was just dealt with like other chronic diseases, normally without saying ‘this is an HIV thing’ because the stigma started there,” says Tau. Speaking on World AIDS Day, Tau said that she honoured those who had passed on and those newly infected and wished that AIDS awareness campaigns were active every day. Access to affordable medicine Access to affordable medicine continues to haunt people from poorer countries, as the COVID-19 pandemic showed when millions of people in low and middle-income countries could not get vaccines as these had all been bought by wealthy countries. The question of intellectual property (IP) rights on essential medicine is as burning an issue today as it was during the AIDS era. Fatima Hassan, director of the Health Justice Initiative (HJI), was one of the lawyers representing Tau and others – and more recently, has been campaigning for wider access to COVID-19 vaccines and therapeutics. Fatima Hassan ‘The reason we brought the case was because we saw the ‘Lazarus’ drugs. We saw them working for people in the USA. We saw them working for people in Europe.,” said Hassan. “We saw what Brazilian and Thai activists were doing to try to get compulsory measures in place for their governments to introduce generic therapies into their country. But our government was having none of that. It was in denial of the science and it refused to implement a public sector programme, which is the reason why we had to focus on the price of abuse in the private sector.” Hassan says that today’s struggles include fighting for access to expensive cancer treatments, exorbitant cystic fibrosis drugs and cabotegravir, an HIV prevention injection that received regulatory approval for use in South Africa on Thursday but remains too expensive for most. “Pharmaceutical companies have these IP monopolies which then means that we’ve got to continuously fight them on pricing because, in the absence of our government, taking the necessary executive action or issuing compulsory licences, we’re always going to have to rely on civil society or the Competition Commission to deal with the abuse of dominance, capture of the market and excessive pricing,” said Hassan. 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US Eager to Move Ahead with Pandemic Accord that Promotes Equity but not ‘Transactional’ Linkage between Data and Benefit-Sharing 02/12/2022 Elaine Ruth Fletcher Pamela Hamamoto, lead US negotiator on the WHO pandemic accord, in Geneva this week. The United States, once a reluctant partner in the initiative for a new global pandemic accord, is now keen to move ahead in negotiations over an agreement. The accord would expedite more rapid global data sharing and response to looming threats as well as ensuring greater equity in access to medicines and treatments, said the lead US negotiator of the instrument, Pamela Hamamoto on Friday. But Washington would like to avoid what she described as “transactional” language directly linking the two issues, as some developing nations have suggested. Nations like South Africa, for instance, cite bitter experiences with rapid, transparent sharing of genetic data on new SARS2 variants, which did nothing to improve the country’s access to badly-needed COVID medicines or vaccines. “Overall, the concept of equity, as I said, is very important. And it is certainly something that the United States is committed to to helping work on that and improve… the availability of medical countermeasures broadly speaking, going forward,” Hamamoto said. But in terms of a direct “linkage between the access and benefit sharing… I actually don’t necessarily think that that linkage is that helpful,” she said. “We’re also very interested in you know, as are others, in the rapid transparent sharing of data,” she said, adding, “what I hope is that… the sort of transactional nature of that concept doesn’t hamper us in being aspirational in our thinking, how we approach this and move forward.” Hamamoto was speaking in Geneva Friday along with Loyce Pace, US Assistant Secretary for Global Affairs, after a week of closed-door meetings with WHO officials and other WHO member states ahead of a third round of member state negotiations on a ‘conceptual’ zero draft text for the treaty due to start next week. First ‘zero draft’ circulated in late November Loyce Pace, Assistant Secretary for Global Affairs, US Department of Health and Human Services, in Geneva this week. This initial ‘zero draft’ text of a proposed pandemic accord was circulated among member states in late November. The draft calls for for “early, safe, transparent and rapid sharing of samples and genetic sequence data of pathogens” – a measure supported by the pharmaceutical industry – but simultaneously calls for “the fair and equitable sharing of benefits” – which the private sector and many developed countries along with the US have resisted, saying that too tight a linkage between any country’s agreement to share pathogen data and benefits reaped could slow down pandemic response. The draft also makes a strong case for more emphasis on regional production of vaccines and other pandemic-related products as well as ‘strategic stockpiles’ of pandemic response supplies. Speaking on that point, Pace and Hamamoto both underlined that the US is supportive of efforts to regionalize production of pandemic countermeasures. “We’re very committed to leaning into overall concepts of equity and transparency,” Hamamoto said. “making sure that we’re better prepared for the surveillance, detection and rapid response to future outbreaks. More comprehensive data and sample sharing on a fast timeframe as well rapid, rapid response .. and more equitable access to medical countermeasures, possibly through regional and local manufacturing.” Current text is hanging too much on the Christmas tree However both women warned that the current text, including many member state proposals for amendments and additions, will need considerable refinement to get the approval of the US and other member states. “There are so many ornanments we’re trying to put on the Christmas tree,” said Pace. “And that is understandable, and yet there are various work streams that will emerge, where there can be a higher and better use for some areas than others.” Added Hamamoto, “I think it’s just there’s just too much in there that is, is maybe not at the right level, like a more tactical playbook… as opposed to, you know, international agreements. “What we’re focused on next week is to really move it towards something that’s appropriately scoped to begin,” she said. “What it represents now is a collection of all the inputs that the Bureau has received so far for member states and external stakeholders as well,” she noted, referring to the small member state group guiding the process. “And everything has just been collected, sorted to a certain extent into some specific chapters…. But there’s a lot of work that still needs to be done around scope around structure around governance. And so in a nutshell, there’s a lot that needs to change before we were going to be able to sign on to it, as is the same for a lot of Member States, probably most.” Negotiations over revisions to International Health Regulations happening in parallel Negotiations over revisions to the WHO’s International Health Regulations are also proceeding in parallel. It was the US which tabled a series of proposed amendments to the IHR at the May World Health Assembly as matter for negotiations, finally winning the agreement of the member state body to engage in a parallel process to revise the 2005 WHO agreement on procedures for responding to outbreak and emergency threats. Assembly Approves Process to Update International Health Regulations on Pandemic Response Revising the IHR is deemed to be a quicker fix to some of the shortcomings in global pandemic response as once any revisions are approved, they would take effect immediately. A new international convention or accord would have to be ratified state by state. However agreement on those revisions, and alignment with the new pandemic accord, will also be a complex process, she admitted. “Obviously, there’s a lot cooking in that space, with so many member states and frankly, amendments being brought to the table,” Pace said. “That’s a good thing because I think we weren’t sure, frankly, earlier this year, to what degree the member states would be interested in engaging in that [IHR] process. And so I know a lot of being done to look through those various proposals and align them with the work that Ambassador Hamamoto is leading on the front end.” Hints at adjustments in negotiating schedule – but not endpoint Standing ovation at 2021 special World Health Assembly session that decides to negotiate a new pandemic accord. Hamamoto also suggested that some of the mid-term milestones that have been set in the negotiating schedule for the pandemic accord over the coming two years, might have to be adjusted in order to accommodate the complexity of the process. According to the current timeline, a firm ‘zero draft’ text is supposed to be ready to put before WHA member states for the full-fledged start of negotiations by February 2023. However, Hamamoto said that she was in no way suggesting that member states should prolong deliberations over the text beyond the May 2024 date that was agreed to by WHO member states exactly a year ago, as the date by which a final draft text should be brought before the World Health Assembly. “You know, the pretty broadly held view is that we need to make sure that the process is set up right so that we feel that we can that we have the space to do our work, and make sure we get this right and so we don’t blow this opportunity to put together an accord that is going to be meaningful and implementable,” Hamamoto said. “But May 2024 is the planned and hoped-for end-date and I’m not suggesting going beyond that. However, the time line along the way is ambitious. And we do also have these parallel processes, so we just want to make sure in theese early stages, what is being called the zero draft, that we get that right.” Image Credits: E Fletcher/Health Policy Watch , E Fletcher/Health Policy Watch. UN Environment: Investments in ‘Nature-Based’ Climate Solutions Must Double by 2025 02/12/2022 Stefan Anderson Climate, biodiversity, and land degradation goals will be out of reach unless investments into nature-based solutions quickly ramp up to $384 billion/year by 2025, more than double of the current $154 billion/year, according to UN Environment Programme. A new report by the United Nations Environment Programme warns that investment in nature-based solutions must double by 2025 if the world is to limit global warming to 1.5°C, as well as halting biodiversity loss and progressively increasing land degradation. The report comes a week before world leaders will gather at the UN Biodiversity Conference (COP15) in Montreal, Canada, where they are set to negotiate an agreement that aims to halt and reverse biodiveristy loss by 2030. UNEP is calling on governments to agree on a clear framework for countries to require the financial sector to align its activities with ‘nature positive’ goals. “The science is undeniable. As we transition to net-zero emissions by 2050, we must also reorient all human activity to ease the pressure on the natural world on which we all depend,” said Inger Andersen, Executive Director of UNEP. “This requires governments, business and finance to massively step up investments in nature-based solutions because investments in nature are investments in securing the future for generations to follow.” Nature-based solutions are actions to protect, manage, or restore natural ecosystems, and are already well-documented to be critical to any response to climate change. The World Bank estimates that nature-based solutions can reduce by 37% the carbon emissions reductions that are needed by 2030 to meet the Paris Agreement goals. The Intergovernmental Panel on Climate Change (IPCC) has also pointed to nature-based solutions, such as biodiversity preservation, as key to realistic emissions reductions. “Phasing out coal and decarbonizing the energy systems will not be enough without adjacent massive investments into nature-based solutions,” the report found. “Politicians, business and finance leaders and citizens globally must transform their relationship with nature to work with it rather than against it.” Nature-negative expenditures are 3 to 7 times higher than nature-based solution investment Governments need to scale-down environmentally harmful subsidies and investments, and increased nature based solutions (Nbs) if 1.5C is to remain within reach. While the world faces the overlapping planetary crises of climate change, biodiversity loss and pollution, nature-negative expenditures are 3 to 7 times larger than current investments in nature-based solutions, the report found. With the impacts of these crises already being felt by millions of people around the world, particularly the most vulnerable, UNEP said immediate action is required to begin mitigating and reversing the most harmful impacts. Government expenditures on harmful subsidies to fisheries, agriculture and fossil fuels is estimated at $500 billion to $1 trillion annually. Harmful subsidies are highest in the energy and agricultural sectors, estimated at $340 to $530 billion and around $500 billion per year respectively. By contrast, investment in nature based solutions (Nbs) currently are estimated at just $154 billion annually. “These flows severely undermine efforts to achieve critical environmental targets,” the report warns. “Delayed action is no longer an option in the face of the devastating effects of climate change, the extinction crisis and severe land degradation globally.” This warning is the latest in a series of dire calls to action by UNEP. Its adaptation and emissions gap reports equally stressed the need for immediate action if any hopes of averting climate disaster are to be kept alive. “We had our chance to make incremental changes, but that time is over,” Andersen said at a press conference launching the UNEP emissions gap report in late October, which benchmarked the gap between countries’ actual emissions and needed reductions to keep 1.5C alive. “Only a root-and-branch transformation of our economies and societies can save us from accelerating the climate disaster.” Private sector must step up as governments faces overlapping crises Private capital must start investing in harnessing the power of nature to reduce and remove emissions, restore degraded land and seascapes and turn the tide on biodiversity loss, the report found. The UNEP report reveals that private capital represents just 17% of total investments into nature-based solutions. Governments currently provide the other 83%, but the report stresses they will be unlikely to be able to significantly scale up funding due to current global financial challenges linked to war, debt, and poverty. As a result, private funding for nature-based solutions will have make-up the shortfall, requiring an increase by “several orders of magnitude” in the coming years. Total investments in nature-based solutions will need to hit $384 billion by 2050, more than double the present level of $154 billion annually, the report concludes. The roadmap provided by the report calls for ramping up private capital investments in sustainable supply chains, offsetting unavoidable impacts, reducing activities with negative climate and biodiversity impacts, and investing in “net zero” and “nature positive” activities. This will require a U-turn from the current state of private financial flows. “While robust evidence is lacking, it is widely recognized that private finance flows are predominantly negative for nature and almost certainly exacerbate the situation,” the report states. “These flows severely undermine efforts to achieve critical environmental targets,” the report states. “As the IMF warns of the ‘darkest hour’ in 2023 for global growth, this report is a reminder that many short-term efforts to boost GDP by governments, without attention to the fact that nature underpins many economies, will impose greater costs for both present and future generations in years to come,” the UNEP document concludes. Investment in protecting planet’s oceans disproportionately low The trajectory of annual nature-based solution investment needs to limit climate change to below 1.5°C, haltbiodiversity loss and achieve land degradation neutrality, $ billion (2022 US$). The UNEP analysis also found just 9% of investment in nature-based solutions are directed towards marine ecosystems, a disproportionately low amount given the critical role of oceans in climate mitigation, adaptation, food security, and biodiversity conservation. The Earth’s oceans cover over 70% of the planet’s surface, absorb around 25% of all CO2 emissions, and provide 17% of the world’s protein. Since the start of the Industrial Revolution, oceans have absorbed a third of human carbon dioxide emissions, making them one of the largest carbon sinks, topped only by global rainforests. The lack of investment in marine protection comes at a time of crisis for the world’s oceans. Projections show that by 2050, our oceans may contain more plastics than fish. These will not only suffocate marine life, but also phytoplankton, the microorganisms at the heart of oceans’ abilities to absorb carbon dioxide, as forests and plants do on dry land. As millions of tons of plastic break down in oceans across the world, uncounted quantities of microplastics are infiltrating phytoplankton, blocking sunlight-absorbing mechanisms, which in turn prevents the process of photosynthesis, and damages their ability to capture carbon in the seas. Yet current annual investment in marine protected areas sits at just $980 million, as compared to protection efforts in terrestrial systems, which receive almost US$23 billion annually. US$8–11 billion is needed to increase marine protected areas to 30% by 2030, the report concludes. “While the world is enduring multiple crises, this report provides clarity,” Jochen Flasbarth, State Secretary in the German Federal Ministry for Economic Cooperation and Development (BMZ), said. “It shows that by significantly increasing public and private investments in nature-based solutions, it is possible to tackle climate change, biodiversity loss and land degradation – and at the same time harness many societal and economic benefits. We need to act now.” Image Credits: UNEP. How Does Corruption Affect Health Systems Around the World? 02/12/2022 Editorial team When Patty García was a medical student in Peru some 30 years ago, she was already aware of the detrimental effect of corruption on health systems. “Back then, the corruption related to the distribution of drugs,” Garcia, who would go on to become her country’s Health Minister in 2016, shares during the latest episode of the “Global Health Matters” podcast with host Garry Aslanyan. “Because at that point resources were scarce, probably it was not seen as a big issue because there was not much to steal. But when I became Minister of Health, I realised the magnitude of the problem.” García, who currently is a professor at the School of Public Health at Cayetano Heredia University in Lima, joins Aslanyan, together with Monica Kirya, a lawyer and the Senior Program Adviser at the U4 Anti-Corruption Resource Centre in Norway, as well as Jonathan Cushing, Head of the Transparency International Health Program. “According to Transparency International, $500 billion in public health spending is estimated to be lost globally every year due to corruption,” Aslanyan remarked. “It has been labelled the disease of the health system, hindering and preventing progress towards universal health coverage.” Fighting corruption, all the guests agreed, is essential to achieve universal health coverage. Corruption as a matter of life and death According to Kirya, it is important to consider the phenomenon as a matter of life and death. “You can look at it from the perspective of an expectant mother in labour, or an accident victim bleeding profusely who can’t access urgently needed health care simply because there are no doctors,” she said, sharing the experience of her native Uganda. “One of the reasons why there are no or very few doctors in public health facilities in Uganda increasingly has to do with corruption. It became clear from the research I’ve done that medical graduates are having to pay huge bribes to district service commissions to be recruited.” While health workers are often considered amongst those responsible for corruption, they are also one of its victims, Kirya argues. In order to fight corruption effectively, it is crucial to understand how widespread and complex the phenomenon is. “We’ve absolutely got to get away from this idea that corruption just happens in low-resource settings and low-resource systems,” said Cushing, adding that while “petty bribery” might be more visible, corruption happens everywhere. “It’s much more perhaps more complex, more hidden in higher income countries, but it happens,” he added. “Until we address that, we’re not going to get anywhere.” García revealed that as health minister, she experienced how difficult dismantling the networks behind widespread corruption can be. “I was really concerned about the lack of medications at the health centres, while I knew that we have had a very important process in which we bought medications for all the country,” she recalled. “We started an investigation and we found an illegal operation that was removing the drugs from storage and public hospital pharmacies and placing them in private pharmacies,” she added. “I was working with the Ministry of Internal Affairs and with the police; it was like in the movies.” However, as soon as she left office about 14 months after she was appointed, the investigation was called off. “The problems are still ongoing,” she concluded. The need for leaders with integrity Garcia, Kirya, and Cushing agreed on how hard and complex fighting corruption effectively is, but also stated that this reality should not deter anyone from pursuing the mission. “We can’t afford to be pessimistic,” said Kirya. “We can’t just give up.” “I think that my key call is transparency and leadership,” added Cushing. “We need to have integral leaders. Leaders who are leaders with integrity.” Listen to previous episodes on the Health Policy Website >> Learn more about “Global Health Matters” podcast>> Image Credits: Global Health Matters Podcast, Courtesy of TDR. Twenty Years On, HIV Activist is Still Fighting for Access to Cheaper Medicine 01/12/2022 Kerry Cullinan HIV activist Hazel Tau Twenty years ago, Hazel Tau, a young South African living with HIV, and her peers had little chance of getting antiretroviral (ARV) treatment because it was completely unaffordable. The South African price for just one of the three ARV drugs she needed, AZT, was 665% higher than the best-priced generic available elsewhere in the world. Only around 20,000 South Africans with private healthcare were on ARVs at the time because of the price. So Tau, an activist with the Treatment Action Campaign, agreed to be one of the public faces of a challenge to the price of ARVs – cleverly brought as a complaint to the Competition Commission alleging that two pharmaceutical companies were charging excessive prices for first-line ARVs. At the time, then-president Thabo Mbeki disputed that HIV caused AIDS and claimed that ARVs were poison, so pressuring the government to act on drug prices was a non-starter. The targets were GlaxoSmithKline South Africa and Boehringer Ingelheim, with Tau and others complaining that they had contravened the country’s Competition Act by abusing their dominant market positions on ARV prices. The SA Competition Commission’s Mapato Ramakgopa explained that the commission agreed with Tau and others, and had sought an order from the competition tribunal to compel the firms to grant voluntary licences to allow generic manufacturers to make genetic ARVs in return for a reasonable royalty. “The firms were found to have abused market dominance and fortunately, before the case could be heard by the tribunal, the manufacturers settled the matter and agreed to allow licences for generic and local manufacturers,” said Ramakgopa. Bittersweet victory “It was a bittersweet experience because of everyone who could not be saved,” said Tau, speaking at a commemorative event on Thursday. “I lost friends, family, colleagues. We lost millions of people who were breadwinners. But I will say I was happy with the outcome.” Finally, she and others could look forward to a life with access to affordable treatment. But Tau’s struggle for treatment access continues today as she is fighting for cheaper cancer drugs. “We know that, in developed countries, they’ve got cheaper drugs that can help people who have got cancer of different types, but we still have to pay it so I’m not feeling good about that,” said Tau. She is also still fighting the stigma faced by people living with HIV – and says that it is time for stand-alone HIV clinics – largely the result of special HIV funding – to be integrated as part of chronic care to spare those who need HIV care from being conspicuous when they go for treatment. “I blame us for having that HIV clinic. I wish HIV was just dealt with like other chronic diseases, normally without saying ‘this is an HIV thing’ because the stigma started there,” says Tau. Speaking on World AIDS Day, Tau said that she honoured those who had passed on and those newly infected and wished that AIDS awareness campaigns were active every day. Access to affordable medicine Access to affordable medicine continues to haunt people from poorer countries, as the COVID-19 pandemic showed when millions of people in low and middle-income countries could not get vaccines as these had all been bought by wealthy countries. The question of intellectual property (IP) rights on essential medicine is as burning an issue today as it was during the AIDS era. Fatima Hassan, director of the Health Justice Initiative (HJI), was one of the lawyers representing Tau and others – and more recently, has been campaigning for wider access to COVID-19 vaccines and therapeutics. Fatima Hassan ‘The reason we brought the case was because we saw the ‘Lazarus’ drugs. We saw them working for people in the USA. We saw them working for people in Europe.,” said Hassan. “We saw what Brazilian and Thai activists were doing to try to get compulsory measures in place for their governments to introduce generic therapies into their country. But our government was having none of that. It was in denial of the science and it refused to implement a public sector programme, which is the reason why we had to focus on the price of abuse in the private sector.” Hassan says that today’s struggles include fighting for access to expensive cancer treatments, exorbitant cystic fibrosis drugs and cabotegravir, an HIV prevention injection that received regulatory approval for use in South Africa on Thursday but remains too expensive for most. “Pharmaceutical companies have these IP monopolies which then means that we’ve got to continuously fight them on pricing because, in the absence of our government, taking the necessary executive action or issuing compulsory licences, we’re always going to have to rely on civil society or the Competition Commission to deal with the abuse of dominance, capture of the market and excessive pricing,” said Hassan. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
UN Environment: Investments in ‘Nature-Based’ Climate Solutions Must Double by 2025 02/12/2022 Stefan Anderson Climate, biodiversity, and land degradation goals will be out of reach unless investments into nature-based solutions quickly ramp up to $384 billion/year by 2025, more than double of the current $154 billion/year, according to UN Environment Programme. A new report by the United Nations Environment Programme warns that investment in nature-based solutions must double by 2025 if the world is to limit global warming to 1.5°C, as well as halting biodiversity loss and progressively increasing land degradation. The report comes a week before world leaders will gather at the UN Biodiversity Conference (COP15) in Montreal, Canada, where they are set to negotiate an agreement that aims to halt and reverse biodiveristy loss by 2030. UNEP is calling on governments to agree on a clear framework for countries to require the financial sector to align its activities with ‘nature positive’ goals. “The science is undeniable. As we transition to net-zero emissions by 2050, we must also reorient all human activity to ease the pressure on the natural world on which we all depend,” said Inger Andersen, Executive Director of UNEP. “This requires governments, business and finance to massively step up investments in nature-based solutions because investments in nature are investments in securing the future for generations to follow.” Nature-based solutions are actions to protect, manage, or restore natural ecosystems, and are already well-documented to be critical to any response to climate change. The World Bank estimates that nature-based solutions can reduce by 37% the carbon emissions reductions that are needed by 2030 to meet the Paris Agreement goals. The Intergovernmental Panel on Climate Change (IPCC) has also pointed to nature-based solutions, such as biodiversity preservation, as key to realistic emissions reductions. “Phasing out coal and decarbonizing the energy systems will not be enough without adjacent massive investments into nature-based solutions,” the report found. “Politicians, business and finance leaders and citizens globally must transform their relationship with nature to work with it rather than against it.” Nature-negative expenditures are 3 to 7 times higher than nature-based solution investment Governments need to scale-down environmentally harmful subsidies and investments, and increased nature based solutions (Nbs) if 1.5C is to remain within reach. While the world faces the overlapping planetary crises of climate change, biodiversity loss and pollution, nature-negative expenditures are 3 to 7 times larger than current investments in nature-based solutions, the report found. With the impacts of these crises already being felt by millions of people around the world, particularly the most vulnerable, UNEP said immediate action is required to begin mitigating and reversing the most harmful impacts. Government expenditures on harmful subsidies to fisheries, agriculture and fossil fuels is estimated at $500 billion to $1 trillion annually. Harmful subsidies are highest in the energy and agricultural sectors, estimated at $340 to $530 billion and around $500 billion per year respectively. By contrast, investment in nature based solutions (Nbs) currently are estimated at just $154 billion annually. “These flows severely undermine efforts to achieve critical environmental targets,” the report warns. “Delayed action is no longer an option in the face of the devastating effects of climate change, the extinction crisis and severe land degradation globally.” This warning is the latest in a series of dire calls to action by UNEP. Its adaptation and emissions gap reports equally stressed the need for immediate action if any hopes of averting climate disaster are to be kept alive. “We had our chance to make incremental changes, but that time is over,” Andersen said at a press conference launching the UNEP emissions gap report in late October, which benchmarked the gap between countries’ actual emissions and needed reductions to keep 1.5C alive. “Only a root-and-branch transformation of our economies and societies can save us from accelerating the climate disaster.” Private sector must step up as governments faces overlapping crises Private capital must start investing in harnessing the power of nature to reduce and remove emissions, restore degraded land and seascapes and turn the tide on biodiversity loss, the report found. The UNEP report reveals that private capital represents just 17% of total investments into nature-based solutions. Governments currently provide the other 83%, but the report stresses they will be unlikely to be able to significantly scale up funding due to current global financial challenges linked to war, debt, and poverty. As a result, private funding for nature-based solutions will have make-up the shortfall, requiring an increase by “several orders of magnitude” in the coming years. Total investments in nature-based solutions will need to hit $384 billion by 2050, more than double the present level of $154 billion annually, the report concludes. The roadmap provided by the report calls for ramping up private capital investments in sustainable supply chains, offsetting unavoidable impacts, reducing activities with negative climate and biodiversity impacts, and investing in “net zero” and “nature positive” activities. This will require a U-turn from the current state of private financial flows. “While robust evidence is lacking, it is widely recognized that private finance flows are predominantly negative for nature and almost certainly exacerbate the situation,” the report states. “These flows severely undermine efforts to achieve critical environmental targets,” the report states. “As the IMF warns of the ‘darkest hour’ in 2023 for global growth, this report is a reminder that many short-term efforts to boost GDP by governments, without attention to the fact that nature underpins many economies, will impose greater costs for both present and future generations in years to come,” the UNEP document concludes. Investment in protecting planet’s oceans disproportionately low The trajectory of annual nature-based solution investment needs to limit climate change to below 1.5°C, haltbiodiversity loss and achieve land degradation neutrality, $ billion (2022 US$). The UNEP analysis also found just 9% of investment in nature-based solutions are directed towards marine ecosystems, a disproportionately low amount given the critical role of oceans in climate mitigation, adaptation, food security, and biodiversity conservation. The Earth’s oceans cover over 70% of the planet’s surface, absorb around 25% of all CO2 emissions, and provide 17% of the world’s protein. Since the start of the Industrial Revolution, oceans have absorbed a third of human carbon dioxide emissions, making them one of the largest carbon sinks, topped only by global rainforests. The lack of investment in marine protection comes at a time of crisis for the world’s oceans. Projections show that by 2050, our oceans may contain more plastics than fish. These will not only suffocate marine life, but also phytoplankton, the microorganisms at the heart of oceans’ abilities to absorb carbon dioxide, as forests and plants do on dry land. As millions of tons of plastic break down in oceans across the world, uncounted quantities of microplastics are infiltrating phytoplankton, blocking sunlight-absorbing mechanisms, which in turn prevents the process of photosynthesis, and damages their ability to capture carbon in the seas. Yet current annual investment in marine protected areas sits at just $980 million, as compared to protection efforts in terrestrial systems, which receive almost US$23 billion annually. US$8–11 billion is needed to increase marine protected areas to 30% by 2030, the report concludes. “While the world is enduring multiple crises, this report provides clarity,” Jochen Flasbarth, State Secretary in the German Federal Ministry for Economic Cooperation and Development (BMZ), said. “It shows that by significantly increasing public and private investments in nature-based solutions, it is possible to tackle climate change, biodiversity loss and land degradation – and at the same time harness many societal and economic benefits. We need to act now.” Image Credits: UNEP. How Does Corruption Affect Health Systems Around the World? 02/12/2022 Editorial team When Patty García was a medical student in Peru some 30 years ago, she was already aware of the detrimental effect of corruption on health systems. “Back then, the corruption related to the distribution of drugs,” Garcia, who would go on to become her country’s Health Minister in 2016, shares during the latest episode of the “Global Health Matters” podcast with host Garry Aslanyan. “Because at that point resources were scarce, probably it was not seen as a big issue because there was not much to steal. But when I became Minister of Health, I realised the magnitude of the problem.” García, who currently is a professor at the School of Public Health at Cayetano Heredia University in Lima, joins Aslanyan, together with Monica Kirya, a lawyer and the Senior Program Adviser at the U4 Anti-Corruption Resource Centre in Norway, as well as Jonathan Cushing, Head of the Transparency International Health Program. “According to Transparency International, $500 billion in public health spending is estimated to be lost globally every year due to corruption,” Aslanyan remarked. “It has been labelled the disease of the health system, hindering and preventing progress towards universal health coverage.” Fighting corruption, all the guests agreed, is essential to achieve universal health coverage. Corruption as a matter of life and death According to Kirya, it is important to consider the phenomenon as a matter of life and death. “You can look at it from the perspective of an expectant mother in labour, or an accident victim bleeding profusely who can’t access urgently needed health care simply because there are no doctors,” she said, sharing the experience of her native Uganda. “One of the reasons why there are no or very few doctors in public health facilities in Uganda increasingly has to do with corruption. It became clear from the research I’ve done that medical graduates are having to pay huge bribes to district service commissions to be recruited.” While health workers are often considered amongst those responsible for corruption, they are also one of its victims, Kirya argues. In order to fight corruption effectively, it is crucial to understand how widespread and complex the phenomenon is. “We’ve absolutely got to get away from this idea that corruption just happens in low-resource settings and low-resource systems,” said Cushing, adding that while “petty bribery” might be more visible, corruption happens everywhere. “It’s much more perhaps more complex, more hidden in higher income countries, but it happens,” he added. “Until we address that, we’re not going to get anywhere.” García revealed that as health minister, she experienced how difficult dismantling the networks behind widespread corruption can be. “I was really concerned about the lack of medications at the health centres, while I knew that we have had a very important process in which we bought medications for all the country,” she recalled. “We started an investigation and we found an illegal operation that was removing the drugs from storage and public hospital pharmacies and placing them in private pharmacies,” she added. “I was working with the Ministry of Internal Affairs and with the police; it was like in the movies.” However, as soon as she left office about 14 months after she was appointed, the investigation was called off. “The problems are still ongoing,” she concluded. The need for leaders with integrity Garcia, Kirya, and Cushing agreed on how hard and complex fighting corruption effectively is, but also stated that this reality should not deter anyone from pursuing the mission. “We can’t afford to be pessimistic,” said Kirya. “We can’t just give up.” “I think that my key call is transparency and leadership,” added Cushing. “We need to have integral leaders. Leaders who are leaders with integrity.” Listen to previous episodes on the Health Policy Website >> Learn more about “Global Health Matters” podcast>> Image Credits: Global Health Matters Podcast, Courtesy of TDR. Twenty Years On, HIV Activist is Still Fighting for Access to Cheaper Medicine 01/12/2022 Kerry Cullinan HIV activist Hazel Tau Twenty years ago, Hazel Tau, a young South African living with HIV, and her peers had little chance of getting antiretroviral (ARV) treatment because it was completely unaffordable. The South African price for just one of the three ARV drugs she needed, AZT, was 665% higher than the best-priced generic available elsewhere in the world. Only around 20,000 South Africans with private healthcare were on ARVs at the time because of the price. So Tau, an activist with the Treatment Action Campaign, agreed to be one of the public faces of a challenge to the price of ARVs – cleverly brought as a complaint to the Competition Commission alleging that two pharmaceutical companies were charging excessive prices for first-line ARVs. At the time, then-president Thabo Mbeki disputed that HIV caused AIDS and claimed that ARVs were poison, so pressuring the government to act on drug prices was a non-starter. The targets were GlaxoSmithKline South Africa and Boehringer Ingelheim, with Tau and others complaining that they had contravened the country’s Competition Act by abusing their dominant market positions on ARV prices. The SA Competition Commission’s Mapato Ramakgopa explained that the commission agreed with Tau and others, and had sought an order from the competition tribunal to compel the firms to grant voluntary licences to allow generic manufacturers to make genetic ARVs in return for a reasonable royalty. “The firms were found to have abused market dominance and fortunately, before the case could be heard by the tribunal, the manufacturers settled the matter and agreed to allow licences for generic and local manufacturers,” said Ramakgopa. Bittersweet victory “It was a bittersweet experience because of everyone who could not be saved,” said Tau, speaking at a commemorative event on Thursday. “I lost friends, family, colleagues. We lost millions of people who were breadwinners. But I will say I was happy with the outcome.” Finally, she and others could look forward to a life with access to affordable treatment. But Tau’s struggle for treatment access continues today as she is fighting for cheaper cancer drugs. “We know that, in developed countries, they’ve got cheaper drugs that can help people who have got cancer of different types, but we still have to pay it so I’m not feeling good about that,” said Tau. She is also still fighting the stigma faced by people living with HIV – and says that it is time for stand-alone HIV clinics – largely the result of special HIV funding – to be integrated as part of chronic care to spare those who need HIV care from being conspicuous when they go for treatment. “I blame us for having that HIV clinic. I wish HIV was just dealt with like other chronic diseases, normally without saying ‘this is an HIV thing’ because the stigma started there,” says Tau. Speaking on World AIDS Day, Tau said that she honoured those who had passed on and those newly infected and wished that AIDS awareness campaigns were active every day. Access to affordable medicine Access to affordable medicine continues to haunt people from poorer countries, as the COVID-19 pandemic showed when millions of people in low and middle-income countries could not get vaccines as these had all been bought by wealthy countries. The question of intellectual property (IP) rights on essential medicine is as burning an issue today as it was during the AIDS era. Fatima Hassan, director of the Health Justice Initiative (HJI), was one of the lawyers representing Tau and others – and more recently, has been campaigning for wider access to COVID-19 vaccines and therapeutics. Fatima Hassan ‘The reason we brought the case was because we saw the ‘Lazarus’ drugs. We saw them working for people in the USA. We saw them working for people in Europe.,” said Hassan. “We saw what Brazilian and Thai activists were doing to try to get compulsory measures in place for their governments to introduce generic therapies into their country. But our government was having none of that. It was in denial of the science and it refused to implement a public sector programme, which is the reason why we had to focus on the price of abuse in the private sector.” Hassan says that today’s struggles include fighting for access to expensive cancer treatments, exorbitant cystic fibrosis drugs and cabotegravir, an HIV prevention injection that received regulatory approval for use in South Africa on Thursday but remains too expensive for most. “Pharmaceutical companies have these IP monopolies which then means that we’ve got to continuously fight them on pricing because, in the absence of our government, taking the necessary executive action or issuing compulsory licences, we’re always going to have to rely on civil society or the Competition Commission to deal with the abuse of dominance, capture of the market and excessive pricing,” said Hassan. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
How Does Corruption Affect Health Systems Around the World? 02/12/2022 Editorial team When Patty García was a medical student in Peru some 30 years ago, she was already aware of the detrimental effect of corruption on health systems. “Back then, the corruption related to the distribution of drugs,” Garcia, who would go on to become her country’s Health Minister in 2016, shares during the latest episode of the “Global Health Matters” podcast with host Garry Aslanyan. “Because at that point resources were scarce, probably it was not seen as a big issue because there was not much to steal. But when I became Minister of Health, I realised the magnitude of the problem.” García, who currently is a professor at the School of Public Health at Cayetano Heredia University in Lima, joins Aslanyan, together with Monica Kirya, a lawyer and the Senior Program Adviser at the U4 Anti-Corruption Resource Centre in Norway, as well as Jonathan Cushing, Head of the Transparency International Health Program. “According to Transparency International, $500 billion in public health spending is estimated to be lost globally every year due to corruption,” Aslanyan remarked. “It has been labelled the disease of the health system, hindering and preventing progress towards universal health coverage.” Fighting corruption, all the guests agreed, is essential to achieve universal health coverage. Corruption as a matter of life and death According to Kirya, it is important to consider the phenomenon as a matter of life and death. “You can look at it from the perspective of an expectant mother in labour, or an accident victim bleeding profusely who can’t access urgently needed health care simply because there are no doctors,” she said, sharing the experience of her native Uganda. “One of the reasons why there are no or very few doctors in public health facilities in Uganda increasingly has to do with corruption. It became clear from the research I’ve done that medical graduates are having to pay huge bribes to district service commissions to be recruited.” While health workers are often considered amongst those responsible for corruption, they are also one of its victims, Kirya argues. In order to fight corruption effectively, it is crucial to understand how widespread and complex the phenomenon is. “We’ve absolutely got to get away from this idea that corruption just happens in low-resource settings and low-resource systems,” said Cushing, adding that while “petty bribery” might be more visible, corruption happens everywhere. “It’s much more perhaps more complex, more hidden in higher income countries, but it happens,” he added. “Until we address that, we’re not going to get anywhere.” García revealed that as health minister, she experienced how difficult dismantling the networks behind widespread corruption can be. “I was really concerned about the lack of medications at the health centres, while I knew that we have had a very important process in which we bought medications for all the country,” she recalled. “We started an investigation and we found an illegal operation that was removing the drugs from storage and public hospital pharmacies and placing them in private pharmacies,” she added. “I was working with the Ministry of Internal Affairs and with the police; it was like in the movies.” However, as soon as she left office about 14 months after she was appointed, the investigation was called off. “The problems are still ongoing,” she concluded. The need for leaders with integrity Garcia, Kirya, and Cushing agreed on how hard and complex fighting corruption effectively is, but also stated that this reality should not deter anyone from pursuing the mission. “We can’t afford to be pessimistic,” said Kirya. “We can’t just give up.” “I think that my key call is transparency and leadership,” added Cushing. “We need to have integral leaders. Leaders who are leaders with integrity.” Listen to previous episodes on the Health Policy Website >> Learn more about “Global Health Matters” podcast>> Image Credits: Global Health Matters Podcast, Courtesy of TDR. Twenty Years On, HIV Activist is Still Fighting for Access to Cheaper Medicine 01/12/2022 Kerry Cullinan HIV activist Hazel Tau Twenty years ago, Hazel Tau, a young South African living with HIV, and her peers had little chance of getting antiretroviral (ARV) treatment because it was completely unaffordable. The South African price for just one of the three ARV drugs she needed, AZT, was 665% higher than the best-priced generic available elsewhere in the world. Only around 20,000 South Africans with private healthcare were on ARVs at the time because of the price. So Tau, an activist with the Treatment Action Campaign, agreed to be one of the public faces of a challenge to the price of ARVs – cleverly brought as a complaint to the Competition Commission alleging that two pharmaceutical companies were charging excessive prices for first-line ARVs. At the time, then-president Thabo Mbeki disputed that HIV caused AIDS and claimed that ARVs were poison, so pressuring the government to act on drug prices was a non-starter. The targets were GlaxoSmithKline South Africa and Boehringer Ingelheim, with Tau and others complaining that they had contravened the country’s Competition Act by abusing their dominant market positions on ARV prices. The SA Competition Commission’s Mapato Ramakgopa explained that the commission agreed with Tau and others, and had sought an order from the competition tribunal to compel the firms to grant voluntary licences to allow generic manufacturers to make genetic ARVs in return for a reasonable royalty. “The firms were found to have abused market dominance and fortunately, before the case could be heard by the tribunal, the manufacturers settled the matter and agreed to allow licences for generic and local manufacturers,” said Ramakgopa. Bittersweet victory “It was a bittersweet experience because of everyone who could not be saved,” said Tau, speaking at a commemorative event on Thursday. “I lost friends, family, colleagues. We lost millions of people who were breadwinners. But I will say I was happy with the outcome.” Finally, she and others could look forward to a life with access to affordable treatment. But Tau’s struggle for treatment access continues today as she is fighting for cheaper cancer drugs. “We know that, in developed countries, they’ve got cheaper drugs that can help people who have got cancer of different types, but we still have to pay it so I’m not feeling good about that,” said Tau. She is also still fighting the stigma faced by people living with HIV – and says that it is time for stand-alone HIV clinics – largely the result of special HIV funding – to be integrated as part of chronic care to spare those who need HIV care from being conspicuous when they go for treatment. “I blame us for having that HIV clinic. I wish HIV was just dealt with like other chronic diseases, normally without saying ‘this is an HIV thing’ because the stigma started there,” says Tau. Speaking on World AIDS Day, Tau said that she honoured those who had passed on and those newly infected and wished that AIDS awareness campaigns were active every day. Access to affordable medicine Access to affordable medicine continues to haunt people from poorer countries, as the COVID-19 pandemic showed when millions of people in low and middle-income countries could not get vaccines as these had all been bought by wealthy countries. The question of intellectual property (IP) rights on essential medicine is as burning an issue today as it was during the AIDS era. Fatima Hassan, director of the Health Justice Initiative (HJI), was one of the lawyers representing Tau and others – and more recently, has been campaigning for wider access to COVID-19 vaccines and therapeutics. Fatima Hassan ‘The reason we brought the case was because we saw the ‘Lazarus’ drugs. We saw them working for people in the USA. We saw them working for people in Europe.,” said Hassan. “We saw what Brazilian and Thai activists were doing to try to get compulsory measures in place for their governments to introduce generic therapies into their country. But our government was having none of that. It was in denial of the science and it refused to implement a public sector programme, which is the reason why we had to focus on the price of abuse in the private sector.” Hassan says that today’s struggles include fighting for access to expensive cancer treatments, exorbitant cystic fibrosis drugs and cabotegravir, an HIV prevention injection that received regulatory approval for use in South Africa on Thursday but remains too expensive for most. “Pharmaceutical companies have these IP monopolies which then means that we’ve got to continuously fight them on pricing because, in the absence of our government, taking the necessary executive action or issuing compulsory licences, we’re always going to have to rely on civil society or the Competition Commission to deal with the abuse of dominance, capture of the market and excessive pricing,” said Hassan. Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy
Twenty Years On, HIV Activist is Still Fighting for Access to Cheaper Medicine 01/12/2022 Kerry Cullinan HIV activist Hazel Tau Twenty years ago, Hazel Tau, a young South African living with HIV, and her peers had little chance of getting antiretroviral (ARV) treatment because it was completely unaffordable. The South African price for just one of the three ARV drugs she needed, AZT, was 665% higher than the best-priced generic available elsewhere in the world. Only around 20,000 South Africans with private healthcare were on ARVs at the time because of the price. So Tau, an activist with the Treatment Action Campaign, agreed to be one of the public faces of a challenge to the price of ARVs – cleverly brought as a complaint to the Competition Commission alleging that two pharmaceutical companies were charging excessive prices for first-line ARVs. At the time, then-president Thabo Mbeki disputed that HIV caused AIDS and claimed that ARVs were poison, so pressuring the government to act on drug prices was a non-starter. The targets were GlaxoSmithKline South Africa and Boehringer Ingelheim, with Tau and others complaining that they had contravened the country’s Competition Act by abusing their dominant market positions on ARV prices. The SA Competition Commission’s Mapato Ramakgopa explained that the commission agreed with Tau and others, and had sought an order from the competition tribunal to compel the firms to grant voluntary licences to allow generic manufacturers to make genetic ARVs in return for a reasonable royalty. “The firms were found to have abused market dominance and fortunately, before the case could be heard by the tribunal, the manufacturers settled the matter and agreed to allow licences for generic and local manufacturers,” said Ramakgopa. Bittersweet victory “It was a bittersweet experience because of everyone who could not be saved,” said Tau, speaking at a commemorative event on Thursday. “I lost friends, family, colleagues. We lost millions of people who were breadwinners. But I will say I was happy with the outcome.” Finally, she and others could look forward to a life with access to affordable treatment. But Tau’s struggle for treatment access continues today as she is fighting for cheaper cancer drugs. “We know that, in developed countries, they’ve got cheaper drugs that can help people who have got cancer of different types, but we still have to pay it so I’m not feeling good about that,” said Tau. She is also still fighting the stigma faced by people living with HIV – and says that it is time for stand-alone HIV clinics – largely the result of special HIV funding – to be integrated as part of chronic care to spare those who need HIV care from being conspicuous when they go for treatment. “I blame us for having that HIV clinic. I wish HIV was just dealt with like other chronic diseases, normally without saying ‘this is an HIV thing’ because the stigma started there,” says Tau. Speaking on World AIDS Day, Tau said that she honoured those who had passed on and those newly infected and wished that AIDS awareness campaigns were active every day. Access to affordable medicine Access to affordable medicine continues to haunt people from poorer countries, as the COVID-19 pandemic showed when millions of people in low and middle-income countries could not get vaccines as these had all been bought by wealthy countries. The question of intellectual property (IP) rights on essential medicine is as burning an issue today as it was during the AIDS era. Fatima Hassan, director of the Health Justice Initiative (HJI), was one of the lawyers representing Tau and others – and more recently, has been campaigning for wider access to COVID-19 vaccines and therapeutics. Fatima Hassan ‘The reason we brought the case was because we saw the ‘Lazarus’ drugs. We saw them working for people in the USA. We saw them working for people in Europe.,” said Hassan. “We saw what Brazilian and Thai activists were doing to try to get compulsory measures in place for their governments to introduce generic therapies into their country. But our government was having none of that. It was in denial of the science and it refused to implement a public sector programme, which is the reason why we had to focus on the price of abuse in the private sector.” Hassan says that today’s struggles include fighting for access to expensive cancer treatments, exorbitant cystic fibrosis drugs and cabotegravir, an HIV prevention injection that received regulatory approval for use in South Africa on Thursday but remains too expensive for most. “Pharmaceutical companies have these IP monopolies which then means that we’ve got to continuously fight them on pricing because, in the absence of our government, taking the necessary executive action or issuing compulsory licences, we’re always going to have to rely on civil society or the Competition Commission to deal with the abuse of dominance, capture of the market and excessive pricing,” said Hassan. Posts navigation Older postsNewer posts