Bad Hofgastein, Austria – A call to action to make stronger individual and collective commitments for climate change and health marked the end of the European Health Forum (Gastein).

The closing plenary session, titled “the global climate crisis: a public health emergency,” ended the varied program with discussions on two issues high on the political agenda – climate change and universal health coverage – recalling the commitments made by national governments at the Climate Action Summit and High-Level Meeting on Universal Health Coverage in New York early last week.

A recent report found that the healthcare sector is responsible for approximately 4.4% of global emissions. At the same time, it has been established that climate change fuels health issues such as increases in vector-borne disease, air pollution-related illnesses, and natural disasters. This relationship was highlighted by many of the panelists, who discussed the roles of individuals, governments, the health sector, and civil society in taking climate actions to improve health, and vice versa.

Closing plenary at the European Health Forum Gastein is “disrupted” by delegates with biodegradeable boomwhackers

The discussions around the climate-health nexus ended a three-day forum, organized around the theme “a healthy dose of disruption,” where over 600 policy makers, academics, clinicians, public health professionals, and young practitioners gathered to discuss topics ranging from cannabis regulation to electronic health records.

Key Remarks from “The Global Climate Crisis: A Public Health Emergency”

 

Clemens Martin Auer, president, European Health Forum Gastein – Step outside your narrow interest or silo and be part of this community of healthy disruptors because if we don’t do it, others will and their disruption will be destructive. Do it as a trailblazer, protector, a hospital worker, and illuminator, do it in your agency, in an NGO, as a health professional… There is no classical ‘treatment’ for climate change – it is a true multidisciplinary, intersectoral issue which affects everyone in this room.

 

Stella Auer, Extinction Rebellion, Austria – Truly ask yourself, with all that I currently know about the climate and ecological crises, am I doing enough? Am I acting accordingly?… Every other form of protest has not worked so far, and [climate change] has never been as dangerous as this situation we are in… All of you in the health sector have an important role to play, but before we can have such changes we need some form of disruption in the system. Civil disobedience has been very effective if you get 3.5% of the population involved, so I would ask you just as people to come join some form of rebellion.

 

Brigitte Zarfl, minister of Labor, Social Affairs, Health and Consumer Protection, Austria –  The situation around health and climate change is well known, there has been some efforts around that but we all know it is not enough…We have prepared systems to deal with the existing outcomes, regarding heat, air pollution and so on, but now we see that we have to use them. We have installed a heat telephone in Austria and had to activate it in the last two summers to protect vulnerable groups by informing them how to cope with the hot temperatures especially in the bigger cities…But we are also acting as producers of carbon dioxide… Health systems contribute to nearly 7% of the carbon dioxide production in Austria. This 7% of carbon dioxide emissions is caused by the use of pharmaceutical products, their production and their distribution and by the health sector, ambulance, and by the ways patients and professionals go to providers and to work places. We are working towards a better organization [to control healthcare sector emissions].

 

Andrew Haines, professor, Environmental Change and Public Health, London School of Hygiene and Tropical Medicine (LSHTM) – We can see the direct health effects [of climate change] from rising death rates from increased temperatures, increased frequency of floods and other natural disasters, and reduced labour productivity. We can see Indirect effects from changes in distribution of vector borne diseases and water borne diseases, and malnutrition from declining and lower nutritional-quality crop yields. Social and economic effects of climate change will push 100 million people back into poverty and increase the risk of conflict… The WHO estimates of a quarter of million extra deaths [due to climate change] per year are underestimates because they only reflect a limited number of health outcomes… We’re moving towards catastrophic health effects towards the middle of the century if we exceed the 1.5 degrees Celsius threshold, and we have a high probability of breaching the 2 degrees threshold. We are becoming increasingly aware that the health care sector is a major emitter… if it was a country, it would be the fifth biggest emitter of the world… In Europe we have a number of partial success stories. England’s National Health Service was able to reduce its emissions by about 18%. In Scandanavia and the Netherlands, we see a number of health care facilities moving towards zero emissions facilities.

 

Stefi Barna, co-director, Center for Sustainable Healthcare, UK – Even if we decarbonize our energy [in the healthcare sector], that only addresses 20-30 percent of health care. We have to work with each health specialty to see how we can reduce the carbon footprint. We found that implementing decarbonizing measures improves staff morale and reduces waste … Public health has the skills to bring this institutional change about… We can help them to ask the questions and take the lead in decarbonizing the way that medicine is practiced through designing leaner pathways and keeping people out of hospitals.

 

Veronika Manfredi, director, Quality of Life, European Commission Directorate-General for Environment (DG ENV) – The EU is one area of the world where we have managed to decouple growth from economic interests… We have the tools, we have the technologies. For example, in the area of water filtering techniques… EU companies have 41% of the international patents… What we need is stronger political will for climate action. In the first 100 days of their term, the EU president has promised to come up with a new climate law to achieve climate neutrality by 2050 that will really push Europe forward… However, we are facing a public health emergency when it comes to air quality. We’re very clear about zero tolerance for infringements of current standards, but we also want to make sure that European standards are fully aligned with WHO’s latest recommendations. The EU is not even aligned to the 2006 recommendation of the WHO [for fine particulates pm2.5 and 10] so we are not as protected as we should be.

Key Remarks from the Fireside Chat with Ilona Kickbusch

 

Vytenis Andriukaitus, outgoing commissioner for Health and Food Safety, European Commission – I follow the old definition of health which is a complete state of social and mental health being… and not merely the absence of disease. We need to keep as healthy as possible as long as possible… is it the goal of the health care system? Of course not. I practiced 27 years, I know what to do in surgery and what I can do with patients, but I don’t know what to do with people. We need to speak about the synergies of different pandemics; infectious pandemics, behavior pandemics, commercial pandemics… Young people need to create ten commandments to be healthier – including stop smoking. One cigarette butt can contaminate 150 meters of water, not only with toxic chemicals but also microplastics… We have commercial pandemics because multi-national companies are practicing an ethic of ‘produce, consume, and discard,’ when they should be practicing an ethic of ‘produce, consume, recycle.’ We need to raise health high on the agenda… how can climate disrupters understand that health is their business?

 

Piroska Östlin, acting regional director, WHO Europe Regional Office – WHO is very serious about environment and health, including climate change.. In Europe we are very active; we have a center in Bonn and are working on national action plans to help countries adapt to climate change and take mitigation measures… Just last year, we released the first ever WHO report on climate change and health, which helped inform the negotiations of all the parties to the United Nations Framework Convention on Climate Change (UNFCCC) Conference of the Parties (COP) in December 2018. We’re also active through the European Healthy Cities movement… somehow it is easier to work with several sectors all at once in cities, but we need to scale that model up for use at the national level.

 

Ilona Kickbusch, professor and chair of the Global Health Centre, Graduate Institute of International and Development Studies, Geneva – This movement needs a direction, and the direction is health in combination with climate change as a major determinant of health. It needs passion to bring about change, it needs better collaboration. There needs to be a much more forceful debate [among multilateral organizations]… that needs to reflect that passion and commitment. The WHO is definitely becoming more political and will become more political as it moves forward, but also needs a different types of disruption… This movement needs a lot of work behind the scenes that is not that visible… We must also respect those people who we often don’t see and whose names we don’t know.

 

Grace Ren contributed reporting to this story.

 

Image Credits: European Health Forum Gastein, Naomi Fein/Think Visual, European Health Forum Gastein.

San Diego, US (4 October 2019) – A trial involving a safe, novel ingestible sensor connected to a paired mobile device that lets medical staff remotely monitor patients’ intake of tuberculosis (TB) medicine, has shown better results than directly observed therapy (DOT), where a healthcare worker watches the patient swallow medication, leading researchers to suggest that the technology could be a game changer in high prevalence countries where treatment adherence remains a stumbling block to eliminating TB.

The randomised controlled trial conducted in California, was published today in PLOS Medicine ahead of the 50th Union World Conference on Lung Health be held in Hyderabad, India, October 30-November 2,2019.

Today TB is the world’s largest infectious disease killer, despite it being preventable, treatable and curable. In 2017, 10 million people globally fell ill with TB and 1.6 million died from the disease. India has the highest TB burden in the world with 1 in 4 people affected by the disease residing in the country.

Health workers provide directly observed therapy to a patient at home in Lima, Peru.

The trial demonstrates that Wirelessly Observed Therapy (WOT) was reported as highly accurate in recording medication ingestion (99.3 per cent) and persons with active TB using WOT were confirmed as taking 93 per cent of their daily prescribed doses as opposed to 63 per cent using DOT. All the patients using WOT completed treatment, were cured, and preferred it to DOT. The system allowed patients to manage their own medication taking, preserving patient privacy and autonomy, but also enabled highly targeted treatment support from practitioners with permission.

Poor adherence to TB treatment has long been associated with continued transmission, increased unfavorable treatment outcomes including relapse, and the emergence of drug-resistant TB.

“We are not doing people affected by TB justice when we have robust genomic diagnostic tests and the emergence of new antibiotic drugs that can cure TB but cannot guarantee consistent, convenient and private treatment support for them,” said Sara Browne, Professor of Clinical Medicine in the Division of Infectious Diseases & Global Public Health at the University of California San Diego, who led the trial.

“If we are serious about eliminating TB then we have to get some fundamental things right such as increased support for patient care that efficiently helps patients complete all of their treatment,” concluded Browne, who is also the founder of Specialists in Global Health (SIGH), a non-profit that provided funding for Bi-national participants in this trial.

The trial evaluated a novel technology termed Wirelessly Observed Therapy (WOT) consisting of a tiny ingestible sensor, a patch worn on the torso and a paired a mobile device.

The sensor is the size of a grain of sand and coated with tiny amounts of dietary minerals; one side with copper and the other with magnesium. When a pill is swallowed, the liquid in the stomach connects the two sides, generating an electrical signal that can be picked up by the torso patch.

WOT is FDA approved and can be accessed by patients with a physician’s prescription and downloadable app. It determined the accuracy of ingestion detection in clinical and home settings using WOT and subsequently compared, in a randomized control trial (RCT), confirmed daily adherence to medication in persons using WOT or directly observed therapy (DOT) during TB treatment.

The trial evaluated WOT in 77 participants with drug-susceptible TB in the continuation phase of treatment recruited from San Diego (SD) and Orange County (OC) Divisions of TB Control and Refugee Health, using ingestion sensor-enabled combination isoniazid 150 mg/rifampin 300 mg (IS-Rifamate) prescribed daily. In terms of accuracy, WOT was equivalent to DOT. WOT was superior to DOT in supporting confirmed daily adherence to TB medications during the continuation phase of TB treatment and was overwhelmingly preferred by participants.

“We are now moving into an era of all-oral regimens for the treatment of drug resistant TB, without the need for daily injections. And we now have an opportunity to explore the potential of medication adherence support using WOT in the use of TB treatment regimes worldwide,” said Dr. Constance Benson, Professor of Medicine in the Division of Infectious Disease & Global Public Health at the University of California San Diego and co-lead on the trial.

”We have a limited number of drugs available for the drug-resistant strains of TB and better treatment support will be essential to help ensure that the integrity of those drugs is preserved in the long term,” concluded Benson.

Dr. Mark Cotton, Distinguished Professor of Pediatrics and Child Health at Stellenbosch University and Tygerberg Children’s Hospital in  Cape Town South Africa, is an advocate of evaluating WOT in TB treatment.

“We must urgently evaluate the applicability of WOT in high prevalence countries such as India and South Africa where treatment adherence rates are often poor due to geographical barriers, stigma and poverty,” said Cotton. “WOT could potentially be a lifesaver for millions.”

Image Credits: WHO PAHO.

Bad Hofgastein, Austria – A stronger research agenda for cannabis is urgently required to guide European health policymakers through a bewildering maze of medical and recreational cannabis and cannabinoid products that are fast emerging on the European market, said researchers and policymakers at a panel session of the 2019 European Health Forum (Gastein), which concluded Friday.

Currently, awareness is low and policies are inconsistent regarding the regulation of both medical and recreational cannabis in Europe– a plant whose components includes hundreds of different molecules of very different active ingredients.

Adding to the complexity is the fact that the best known cannabis components, which are THC and cannabidiol (CBD), now appear to have diametrically opposed effects on the brain, and that is stimulating new opportunities for medical applications, but also new questions. CBD’s potential anti-anxiety and anti-psychotic properties are being explored by researchers in the United Kingdom and elsewhere – while a trademarked version of CBD, Epidiolex®, was recently approved by the US Food and Drug Administration as well as by the European Medicines Agency for treatment of a rare form of childhood epilepsy.

(Left-right) Lisbeth Vandem, EMCDDA; Ian Hamilton, Unviersity of York; Paola Kruger, patient advocate; Philip McGuire, Kings College London.

The contrasting impacts of CBD and THC on mental health were underlined by King’s College London Professor Philip McGuire who discussed the results of a recent trial that he led on the use of pure CBD in chronically schizophrenic patients. Those patients’ symptoms were reduced after a period of CBD use as an adjunctive therapy to their regular medication, as compared to patients administered a placebo.

“This is one of the first pieces of evidence that CBD might have anti-psychotic properties,” he told the panel, adding that in MRI scans conducted by researchers, CBD also had very different impacts on brain function than THC, and in some cases “completely opposite effects.”

“We found that the addition of CBD seemed to reduce psychotic symptoms. Its pathways of action on the brain seems to be very different.” While this research is only just emerging, it’s potential is huge because there have not been significantly new anti-psychotic drugs developed for several decades, McGuire told the panel. Based on findings from the recent trial and an as-yet unpublished trial on young adults with prodromal phase psychotic symptoms, he said the research team plans to embark on larger multi-country trials of CBD involving young adults at risk of psychosis in Europe and the United States.

Philip McGuire, King’s College London

“We know THC can cause anxiety and paranoia, and if CBD has the opposite effect then potentially it can be used to treat anxiety and paranoia,” said McGuire in a follow-up interview with Health Policy Watch.  “We have been studying the effects of cannabis on mental health for 20-30 years, initially that was  all about the adverse effects of THC… and then we learned more about CBD and that it seemed to have opposite effects to THC, and that led to thinking about using it as a medicine,” he said.  He added that he hoped that larger trials might lead to eventual regulatory approval for CBD in patients with certain mental health disorders, although he emphasized that the research is still in its early days.

“It’s very new, we have not known about CBD until relatively recently,” he said. “You have to be confident that it is safe and effective… if you have the trials, then the regulation follows because you can show x=z. Otherwise it is just based on opinion.”

Paradoxically, in the medical cannabis applications involving THC-rich products, which are already being used very widely in some countries of Europe, there have been relatively few strictly controlled clinical trials, the panel members noted. Some research, however, has reported positive outcomes for relief of conditions such as irritable bowel syndrome; chronic pain; as well as the symptoms or side effects associated with other chronic diseases or disease treatments, such as cancer.

Diversity of Products and Regulatory Approaches in Europe

Within the WHO European region, there is a growing diversity in the types of cannabis and cannabinoid compounds available, said Liesbeth Vandam, of the European Monitoring Centre for Drugs and Drugs Addiction (EMCDDA), citing a recent agency report.

But regulators, policymakers, health practitioners and the public, all are struggling to keep up with the flood of new products coming onto the market,  Within Europe there are very diverse approaches to regulation of cannabis and cannabinoid products for both medical and recreational use, said Vandam.

These range from cannabis products that are both legal and illegal, as well as natural and synthetic, to over-the counter CBD sold as food supplements, and which are likely to contain only very small amounts of actual CBD.

Some national regulatory agencies have legalized the medical use of cannabis-rich in THC for the treatment of pain and other chronic conditions, but with little recognition of the potential for medical applications of CBD. Other countries may allow CBD-rich products to be sold over-the counter, while cannabis products with higher levels of THC may be harder to obtain, including by prescription.

“Cannabis products have become increasingly diverse in Europe,” says the recent EMCDDA report, cited by Vandam. It notes that more detailed information needs to be collected on the precise components of various products being made available, at national and European levels, in order to better monitor health effects.”

Rising levels of THC in recreational cannabis. Credit: Ian Hamilton, University of York.

Other concerns expressed by the panelists included the steadily increasing THC potency of recreational cannabis products on the market today, as well as a cross-over influences from the medical cannabis market, which some fear could stimulate increased recreational use and abuse, particularly in adolescents and young adults whose developing brains are more vulnerable to THC.

The ratio of psychoactive THC to CBD in street cannabis in the UK has increased eight-fold between 1995 and 2014, noted Ian Hamilton, a senior  lecturer on addiction and mental health at the UK’s University of York,. In the United Kingdom, recreational cannabis is still illegal, and medical cannabis was approved for use only last year, but use has been very constrained by its high price and doctor’s reluctance to prescribe, he said.

Increased THC potency in street cannabis products has also been observed elsewhere across Europe, according to the recent EMCDDA study, said Vandam.

Needed: Coherent Research Agenda

Overall, she says, “there is a strong need for additional research and clinical studies including larger and better-designed trials; studies looking at dosage and interactions between medicines; and studies with longer-term follow-up of participants.”

Ian Hamilton, University of York, United Kingdom

Among the research and policy issues, adds Hamilton, are lack of agreed-upon definitions for the products tested and used, as well as for the recreational users, in terms of what levels of use might actually constitute dependency or addiction, with significantly greater health impacts.

“The UK government has struggled to come up with a policy for cannabis-based products, and they have struggled to be clear in their definitions,” he said. But key questions still remain open, such as whether policies also cover raw cannabis products, or cannabis-derived oils?

“In [addiction] research, the other problem is that different researchers define a regular [cannabis user] in different ways.  There needs to be more standardization in the terminology. There needs to be some agreement; otherwise we have all of these interesting bits of research, but we cannot compare them.”

Malta is another European country that has recently moved forward with the legalization of medical cannabis, including granting licenses for cannabis cultivation, noted Natasha Azzopardi-Muscat, a health professional with the National Directorate for Health Information & Research and President of the European Public Health Association.

“It’’s very clear, many countries are facing a new frontier, and we all have to learn together,” said Azzopardi-Muscat, who moderated the cannabis session.

She said that she was concerned, in particular, with the “blurring of the use between cannabis as a medicinal product and cannabis as a recreational product, and that is where we need to do further homework.

“Nobody quarrels to cannabis being elevated to the status of medicinal product if it can satisfy the traditional scientific thresholds for quality, safety, efficacy that are normally ascribed to medicines,” she added.

“But there is a wide difference between the wide varieties of the plant and its constituents – the different types of cannabinoids.  That is where the science starts to become really complicated, and the policy and regulatory issues become increasingly difficult.

“The key take-home lesson is that this is an issue which is scientifically very complex, which policymakers are going to find very difficult to regulate. And there isn’t a clear pool of expertise – it is fragmented between different research areas and activities.”

She said that she hoped the new flagship European Union research initiative, Horizon Europe, can provide a “window of opportunity to promote a clear research agenda that would be able to support policy agendas.

“My key message is to push the research agenda, involving both clinicians and public health specialists in a carefully structured debate. There is a window of opportunity to address this issue in Horizon Europe,” she said.  “I do see this as something that may be discussed on the European health policy agenda, but by then we may be too late, and we may be struggling to regulate a horse that has bolted.”

Natasha Azzopardi-Muscat, President, European Public Health Association

 

Image Credits: EHF-Gastein , EHF-Gastein, Ian Hamilton, University of York.

[World Health Organization]

Geneva (4 October 2019) – The World Health Organization (WHO) and football’s world governing body, FIFA, today agreed to a four-year collaboration to promote healthy lifestyles through football globally.

WHO Director-General Dr Tedros Adhanom Ghebreyesus and FIFA President Gianni Infantino signed the memorandum of understanding at WHO’s Geneva-based headquarters.

(left-right) Dr. Tedros and Gianni Infantino

“WHO is excited to be working with FIFA. Half the world watched the 2018 World Cup. This means there’s huge potential for us to team up to reach billions of people with information to help them live longer healthier lives,” said Dr Tedros.

Mr Infantino said: “I am extremely happy to announce this collaboration with WHO. Football is a unique, universal language and we want to use our platform and network to support health initiatives and promote healthy lifestyles all around the world.”
The agreement includes four areas of collaboration:

  • Advocacy to promote a healthy lifestyle through football.
  • Policy alignment to ensure tobacco-free environments at FIFA events; to encourage national football federations to adopt tobacco-free policies, including at stadiums; and to enable WHO to provide technical advice to FIFA on health matters.
  • Building on FIFA events to institute lasting improvements in health and safety.
  • Joint programmes and initiatives to increase participation in physical activity through football, in line with WHO guidance, as well as working with national associations and networks of WHO goodwill ambassadors, football players, coaches and volunteers to increase physical activity through football.

WHO will provide technical advice to FIFA on a variety of health matters, such as ensuring tobacco-free environments at FIFA events and encouraging national football federations to adopt tobacco-free policies, including at stadiums.

WHO and FIFA have already cooperated to ban tobacco at football tournaments, including the 2018 World Cup. They will build on efforts made to safeguard health at FIFA events and to institute lasting improvements in health and safety, for example around hygiene and disease prevention.

Joint programmes and initiatives with national associations and networks of footballers, coaches and volunteers will increase participation in physical activity in line with WHO guidance, and help to increase physical activity through football.

The collaboration aims to leverage the two organizations’ respective strengths to ensure health messages and activity-related programmes can have a major positive impact on the lives of people all around the world.

Related content:

– Link to memorandum of understanding: https://www.who.int/docs/default-source/documents/who-fifa-mou.pdf

Image Credits: John Zarocostas.

The 1000th Ebola survivor of the current outbreak in the Democratic Republic of the Congo (DRC) has just celebrated her return home.

“Today, amid our unrelenting work to end this tenth outbreak of Ebola virus disease in the Democratic Republic of the Congo, we celebrate a bright spot, which is actually 1000 bright spots – each person who has survived an Ebola infection,” said Dr. Matshidiso Moeti, regional director of the World Health Organization’s African Regional Office (WHO AFRO) in a statement.

Dr. Matshidiso Moeti visits the DRC during the Ebola outbreak

As of 1 October, a total of 3197 Ebola cases were reported, including 3083 confirmed and 114 probable cases, of which two thirds have died from the disease. However, of the 1555 cases that were admitted to treatment centers, 1000 have survived.

Ebola survivors have been key community advocates in this response, returning to their communities after being cured to encourage other people to seek care and contacts to get vaccinated.

Despite the optimism, Moeti notes, “..we have more to learn and more to do…We must work harder to build trust and to spread the message: surviving Ebola is possible, and we are here to make that happen.”

The recent decline in Ebola cases over the past three weeks should be interpreted with caution, as operational and security challenges in Mandima and Mambasa health zones, where 55% of the new cases reported in the last week are coming from, continue to cause delays in detecting and responding to new cases.

20 new confirmed cases of Ebola from North Kivu and Ituri provinces were reported from September 25 to October 1, versus 29 from September 17 – 24 and 57 in the week prior according to the latest WHO outbreak news.

In Mambasa, where 162 contacts have been lost to follow-up, delays in involving the community and civil society response have led to community mistrust – now WHO is working with local and civil society partners in the area to engage women’s groups and enhance community-based surveillance.

In Mandima health zone, where 169 contacts have been lost to follow-up, armed conflict and low EVD awareness have led to tension between Ebola response teams and local communities and difficulties investigating community deaths, thus the true number of cases is likely underreported. It has been 17 days since a major security incident in the Lwemba area in Mandima health zone forced Ebola teams to temporarily suspend activities, which greatly limited contact tracing efforts and response activities.

The outbreak hotspots have shifted from high density, urban settings to more rural, less densely populated areas, with fewer new cases coming from Butembo, Katwa, and Beni. The shift in outbreak hotspots to more rural areas may signal changes transmission dynamics, with more community-based transmission and less transmission in healthcare facilities. However, new accessibility and logistical challenges to reach affected villages may come up, especially as the rainy season approaches.

WHO has received US$61 million to fund the response through December 2019, leaving a predicted funding shortfall of approximately US$60-80 million as of October 2nd. Additional funds have been committed or pledged, but WHO continues to appeal to donors to provide generous support.

Image Credits: WHO AFRO.

Bad Hofgastein, Austria – Whether its work or leisure, Europeans are moving more and more between different countries on the continent – but their health records generally lag far behind.

And this can create big barriers to the treatment of chronic health conditions, not to mention effective diagnosis and treatment in emergencies, said members of a panel on digital health Thursday at the European Health Forum (Gastein).

Until just recently, even filling a prescription across borders was challenging, said Clemens Martin Auer, EHFG President and Special Envoy for Health for Austria’s Federal Ministry for Labour, Social Affairs, Health and Consumer Protection.

Marco Marsella

“We need data that can travel from one country to another seamlessly,” said Marco Marsella, head of the European Commission’s Directorate-General for Communications Networks, Content and Technology (DG Connect).

Finland and Estonia took one small step in that direction earlier this year by agreeing to a system of e-prescription exchanges, said Auer, and that model is now being followed by some 21 other countries.

But Auer said it will still take time for real transformation to occur.

On the plus side, the European Commission in 2019 issued a set of clear recommendations for harmonized standards that would ease the flow of e-health data between countries, while also protecting people’s privacy. But countries still need to formally adopt the new EU guidelines to unlock the electronic gates.

And once standards are formally in place, health care providers across the region will need to start updating and adapting their own electronic records systems– a process that would take considerable time considering the large and fragmented health care infrastructure that exists.

Fragmentation a Hallmark of Health Sector Services

“We should stop promising heaven on earth, when it comes to the health sector, there is no other sector that is as fragmented,” declared Auer.

In Austria alone, there are 10,000 outpatient medical clinics, 130 hospitals, and 1200 pharmacies, as well as facilities such as nursing homes, he noted in a follow-up interview. ”They all have totally different digital equipment operating. So this is a barrier; we need to invest in a new generation of digital infrastructure.”

Clemens Martin Auer

Paradoxically, digital transformation could be more expensive for more affluent developed countries, which began investing in electronic patient information systems ten or 20 years ago.

“When these systems were instituted, the purposes were totally different. It was not about sharing data. It was about optimizing internal processes,” Auer observed.  “But we have to speed up.  We don’t want the Googles and Amazons to take over the field of patient data sharing – although I don’t think they would succeed.”

The first wave of data sharing for e-prescriptions took place under the European Framework of CEF – Connecting European Facilities, Auer said.

The first countries were Finland and Estonia, now 21 member states are part of this first wave of cross border sharing of prescriptions and patient summaries, which started only in the spring, although countries are not yet sharing lab results or imaging.

“The next step would be that the European Commission as well as its member states will agree to only fund infrastructures that create an interoperable eco-space. So if a hospital in Stuttgart procures a new hospital information system, it will also be able to communicate with Paris or Lyon.

“The standards exist. One is the European Commission recommendation for electronic health record exchange formats. The others are guidelines agreed to by European Union member states on infrastructure requirements. Now, we have to politically take up these standards. And then we will see an acceleration of services. This is one of the last missing links.  And once these are adopted, we will see an acceleration of services.”

As for consumer concerns about data protection and data security of health records, Auer said that he is convinced that European data and privacy laws are robust enough to reassure patients that sensitive health information will not accidentally fall into the hands of third parties such as potential employers or creditors.

“There is a huge political consensus among the people who are responsible for the health care system that for the sake of the continuity of care, of processes and outcomes, we have to share data. And we also have sound regulation when it comes to data protection and data security; in general as a European region, on a policy level, we did our homework.”

Digitalization with a ‘Human Touch’  

Another critical aspect of the digital revolution in health is ensuring that new e-health applications are serving patients and health care workers needs, rather than introducing new apps or gadgets that could be difficult for some patients to manage.

“Whenever anyone thinks about digital, they think about an app, but digital is about all sorts of settings that may not be patient care, but support the patient care,” pointed out Indra Joshi, Digital Health & AI Clinical Lead of the National Health Service (NHS) England.

“Digitalization is so driven by technicians sometimes that we lose the main point of why we are doing this in the healthcare sector,” added Auer. “And the healthcare sector needs this to improve the quality of health care.”

The needs are endless. They range from digital solutions that can provide for more seamless continuity of care; to technologies that free doctors and nurses from mundane tasks; as well as methods to facilitate the aggregation of big data for research.

“Digitalization has the potential to increase the outcomes and the quality of processes,” said Auer, “But we need to think more about what does a doctor or nurse really need to get rid of the more routine work, and to free up health care professionals to provide more personalized treatment.”

As Chief Innovation Officer at one of Israel’s largest health funds, Clalit, Ran Balicer spends considerable time thinking about how such innovations can be put into the service of more people-centred health systems.

“There is a fear that digital transformation and Artificial Intelligence (AI) will reduce the human touch,” Balicer said. “This could not be further from the truth. In their daily work, physicians are doing too many repetitive tasks that do not require their unique skills.

“AI will allow doctors and nurses to go back to their real purpose. Digital transformation would offer us an opportunity to move away from the tyranny of reactive medicine and move towards proactive and preventive care,” he stressed.

“Assisted by data and AI, we can locate those patients in need of care before they actually become symptomatic,” he added. “AI will also allow us to move from ‘intuitive’ medicine to more field-safe mechanisms [for diagnosis and treatment]. Today 30% of care is wasted and human error is the third cause of death.”

“Overall, I think that this will allow us to have more of the human touch.”

(left-right) Marco Marsella; Ran Balicer; Clemens Martin Auer; Indra Joshi

Image Credits: NHS England, European Health Forum Gastein, European Health Forum Gastein, European Health Forum Gastein.

Bad Hofgastein, Austria – Promoting an “economy of well-being” can drive European development agendas more sustainably, as well as making health systems more human-centered and responsive to client’s needs, said Finland’s Vice Minister of Social Affairs and Health in a keynote address Thursday at the European Health Forum (Gastein).

The three-day conference, which began Wednesday, has brought together some 600 health policymakers, researchers and practitioners from around Europe to explore challenges, trends and directions for the region’s health systems under the theme “A Healthy Dose of Disruption.”

“The economy of well-being emphasizes the importance of placing individuals at the center of economic measures, and economic growth also improves people’s well-being,” said Eila Makipaa, the Finnish Vice Minister, speaking at a session devoted to the well-being theme. She noted that Finland has made the concept a cornerstone of its European Union presidency term, viewing it as a framework that can advance disparate issues from climate action to democracy.

“The role of well-being is crucial in the context of human rights and security; the economy of well-being is part of the Finnish presidency programme, where we also see how well-being policies can boost productivity, generate economic growth and social stability, and ensure that no one is left behind in our rapidly changing world.”

Social inclusion is not only a positive human value, it is good for the economy, added Josep Figueras, director of the European Observatory on Health Systems and Policies, noting that treatment of patients at advanced disease stages or reintegration of people who are unemployed are all more costly undertakings than preventive measures taken proactively.

“Well-being itself… is a way to bring the diverse sectors of health, social protection, gender, environment together under one umbrella,” he said.

Some countries like New Zealand and France, as well as regions such as Wales in the United Kingdom, are already using well-being measures to evaluate the performance of government in different public policy arenas, he observed. But  most European countries are “still struggling” with effective ways of monitoring and measuring progress in an economy built around ‘well-being.’

“We want to measure things differently, but how do we put that into practice within European policies and strategies?” he asked.

Well-Being In An Ageing World  

Creating an economy of well-being in ageing societies is a key element of the challenge for Europe as well as other developed countries, said Esko Aho. Aho, in 1991 became Finland’s youngest prime minister ever taking office at the age of 36. Today, at age 65, he continues to work as CEO of a private sector firm and he doesn’t envision retiring anytime soon.

”Silver is the next green,” said Aho.

Aho said that economies need to become more inclusive of older people – or else suffer the consequences of having too few active workers to support the health and social welfare benefits of people across the life cycle.

However, health and economic leaders have been slow in coming to grips with the new demographic realities facing Europe as well as other developed economies.

“There is a common view that older citizens are less productive,” observed Aho. “That is why they are kicked out first when you have to reduce your work force.” Recent research in the automobile industry contradicts that perception. It has shown that older employees’ competencies are equivalent to their younger counterparts – because older employees’ experience levels compensate for shortcomings in other areas.

Esko Aho addresses the audience.

“There are people who have the capacity to keep working until 80, but technically are retired. We have these standardized solutions, which we are afraid to change, we are afraid to move to more personalized solutions,” he said.

“The 100-year life is totally different than 65 year life when Bismarck created the pension system,” he added, referring to the German chancellor, Otto Von Bismarck, who in 1883 created the first mandatory retirement and pension system in a move to counteract growing Marxist influence.

Older workers also suffer from other forms of powerful but subtle discrimination which cause them to fall behind, added Jonathan Cylus, an economist and the London Hub Coordinator for the European Observatory on Health Systems and Policies. For instance, older people are less likely to be offered training opportunities than their younger counterparts – and that can cause them to fall behind their peers in performance, .

“We need to have a more equitable approach to ensure that older people are able to work, and that they have the same opportunities,” he said, noting that there are 100 million people over the age of 65 in Europe and while incomes often decline after retirement, consumption needs remain about the same, creating economic stress.

At the same time, he said one-size-fits all approaches need to be rejected.  “The knee jerk reaction is to raise pension ages and that can also cause stress among people who didn’t expect this,” he said.  “The economy of well-being is about more personalisation and more flexible policy-making.”

Image Credits: David Rowe, European Health Forum Gastein.

Sweden pledged to increase its support to the Global Fund by 14%, committing some SEK 2.85 billion (US $290 million) over the next three years, one of the latest in a line of donors to step to the call of the Global Fund’s Sixth Replenishment Conference, coming up next week on October 9-10 in Lyon.

The pledge was announced Thursday by Sweden’s Minister for International Development Cooperation, Peter Eriksson.

“In recent years, we have seen a tougher climate and dwindling interest in women’s rights, and particularly sexual and reproductive rights. For this reason, Sweden’s contribution to the Global Fund is particularly important,” said Eriksson in a Global Fund press release. “Through this increased contribution, Sweden will remain a strong donor to global action for health. And with this, we will also have increased expectations and demands that the Global Fund will deliver in Sweden’s priority areas, including preventive efforts, equitable health, human rights and sexual and reproductive health and rights.”

Peter Sands, Executive Director of the Global Fund, commended Sweden’s commitment saying: “Sweden’s investments in global health have contributed immensely in the fight against HIV, TB and malaria and in building strong health systems.”

The Swedish announcement follows recent pledges by Norway’s Prime Minister Erna Solberg to give NOK2.02 billion to the Sixth Replenishment, and Spain’s commitment for EUR100 million Euros. Five private sector partners announced new pledges for the Global Fund’s Sixth Replenishment during the World Economic Forum on Africa on September 4-6 in Cape Town.

Natalie Portman introduces Peter Sands and Erna Solberg at the Global Citizens Festival 2019

Meanwhile activity in the lead up to the conference has intensified with high-powered celebrities such as, Annie Lennox, Diane Kruger, Natalie Portman and Penélope Cruz launching a petition on change.org in an open letter addressed to today’s 7-year-olds, calling on the world to commit to end AIDS, TB and malaria by 2030 – when today’s children become adults. Portman also appeared live on stage calling on the world to step up the fight and support the Global Fund at the annual Global Citizen concert in New York on September 28.

The most recent Global Fund Results Report 2019 credits the partnership with saving 32 million lives from the three leading diseases that it is pledged to combat – HIV/AIDS, tuberculosis and malaria – since its inception in 2002.

The Global Fund’s Sixth Replenishment pledging conference will be hosted by French President Emmanuel Macron in Lyon, France on October 9-10 2019, with the goal to raise US $14 billion for the fund’s next three-year cycle.

At the United Nations General Assembly in New York last week, the Global Fund also joined 11 other major UN and international health agencies to launch a joint action plan, Stronger Collaboration, Better Health: Global Action Plan for Healthy Lives and Well-being for All, to better support countries to accelerate progress towards the health-related Sustainable Development Goals. This followed the landmark commitment by UN member states to scale up efforts to achieve universal health coverage by 2030.

Image Credits: Global Citizen.

As delegates gathered in New York for the UN General Assembly (UNGA) last week, tobacco companies were lurking on the margins to cultivate influence and undermine policies that would accelerate the Sustainable Development Goals. More than 140 health organizations from over 40 countries have joined me in calling on delegates to reject invitations to meet with tobacco companies and their front groups and to denounce tobacco industry partnerships.

This is the only tenable position for governments and UN agencies: few industries are as incompatible with the sustainable development goals as tobacco, which leaves behind a devastating trail of health, social, economic, and environmental harms.

Every year, the industry’s products claim 8 million lives among smokers and non-smokers exposed to second-hand smoke. Among adolescents, smoking and exposure to second-hand smoke leads to learning problems and cognitive impairment. Tobacco-related diseases are costly to treat, hindering progress towards UHC 2030. According to the World Health Organization (WHO), the costs to health and related productivity losses result in economic losses of around $1.4 trillion every year – equivalent to two percent of global GDP- with much of the burden placed on low- and middle- income countries. This $1.4 trillion does not include the social and economic costs of enduring cyclical poverty, widening inequality, poor labour practices, and environmental harms and far outweighs the $269 billion revenues from tobacco taxes.

Premature deaths place a financial burden on families, and cycles of ill health and poverty among vulnerable populations are reinforced when tobacco use diverts money from food, clothing, healthcare and education – widening inequality.

About 1.3 million children aged under 14 years work in tobacco fields.

Big tobacco’s thirst for profit has led to decades of poor labor practices. About 1.3 million children aged under 14 years work in tobacco fields, missing school and risking illness from nicotine poisoning related to handling tobacco leaves. Furthermore, the supply chain exploits small farmers in countries across Africa and Asia, leading to financial dependence. Research shows they make little to no profit (or even a loss) from the crop, but many are forced to continue growing tobacco because they are contracted or in debt to tobacco companies.

Beyond the devastating health, educational, and financial impacts, tobacco places a massive burden on our planet. Cigarette butts are the most littered product globally leading to massive air, land, water and sea pollution. Tobacco curing leads to significant deforestation. On top of these environmental harms, tobacco crops leach nutrients from land that could be used for crops to improve food security.

Satellite images show environmental damage from tobacco farming. In many countries, farmers clear forested land that is agriculturally marginal to grow tobacco—often by burning —and/or harvest wood for curing. Typically, the land is quickly abandoned and becomes unusable, often leading to desertification.

The industry tries to mask this reality, and the United Nations risks being complicit. Tobacco companies are using the Sustainable Development Goals as part of their strategy to diminish the focus on their accountability for harms caused and to launder their sordid reputations for the purpose of engaging with governments, the development community and UN organizations:

  • They use SDG logos in their reports, sponsor UN-linked events and launch global initiatives to divert public attention from the harm they cause and detract government attention from holding them accountable and liable for harms.
  • They claim they can use their knowledge of supply chains to improve productivity and economic outcomes for other crops, but tobacco cultivation continues to leave many tobacco farmers in poverty.
  • They claim to be actively engaged in eliminating child labor, using this issue to maintain relationships with the International Labour Organization (ILO) in particular, but decades after their well-publicized, so-called “corporate social responsibility” work in this area, the problem remains.
  • They claim their activities are essential to the economic success of many countries, when analysis consistently finds that tobacco-related costs incurred by their products significantly outweigh the tobacco industry’s contribution to government revenues, and
  • They claim their new products will help countries progress toward targets for reductions in tobacco use, when there isn’t sufficient independent evidence to support smoking cessation claims.

We know that these efforts are planned: tobacco industry documents reveal that access to the UN is part of a deliberate strategy to establish credibility, to gain access to policy makers for the purposes of undermining tobacco control and to open up new markets for its products.

Such infiltration has the potential to risk hard-won progress within the UN system. World Health Organization led efforts to protect policy from tobacco industry interference. Article 5.3 of the Framework Convention on Tobacco Control (WHO FCTC) states that “there is a fundamental and irreconcilable conflict between the tobacco industry’s interests and public health policy interests.” In its Framework for Engagement with Non State actors, WHO commits to not partner with tobacco industry or those furthering its interests. WHO also developed the Model Policy for UN agencies– a path which led to the exclusion of tobacco companies from the UN Global Compact, and the UN Economic and Social Council passing resolution E/2017/L.21, which calls upon all UN agencies to “implement their own policies on preventing tobacco industry interference.”

But even as UN agencies have worked to withstand industry pressure and close the door to tobacco companies, influential third parties are opening back doors for the industry to threaten the SDGs.

Concordia, the high profile, public private partnership-focused non-profit held its Annual Summit in New York this week to coincide with UNGA, attracting global leaders from UN agencies, business and the media. The organization actively promotes its partnership with the tobacco industry, with Philip Morris International (PMI) being featured in Concordia’s program in a manner that allows it to engage with policymakers and regulators, which could lead to a violation of Article 5.3. PMI’s CEO was invited to speak at Concordia’s Annual Summit in 2018 and 2019, but PMI isn’t the only tobacco company involved; British American Tobacco has used previous Concordia events to align itself with the health and development agenda. Tobacco sponsorship of Concordia events helps tobacco companies side-step bans on tobacco advertising, promotions and sponsorship, including corporate social responsibility activities, which some countries have implemented in accordance with Article 13 of the WHO Framework Convention on Tobacco Control.

In July, a PMI executive managed to directly address policymakers at a precursor event to the UN High Level Political Forum on Sustainable Development, through an invitation from the World Business Council for Sustainable Development (WBCSD).

Details about apparent lobbying efforts were leaked the same month. In a letter to UN Secretary General Antonio Guterres from Michael Møller, the retiring Director-General of the United Nations Office at Geneva advocated in favour of tobacco partnerships in the 2030 Agenda for Sustainable Development.

And on the eve of UNGA, PMI launched a video stating that it will be in New York “to be part of the conversation,” as well as posting a message targeted at delegates, saying they should  “talk with us, leave dogma behind”– a clear and arrogant declaration of intent to subvert settled UN policy.

These actions signal a renewed effort by the tobacco industry to infiltrate the UNGA and steer global policy to its advantage.

It’s vital that health and development advocates mobilize on this issue and hold UNGA delegations to account. STOP (Stopping Tobacco Organizations and Products) led an open letter, co-signed by 142 public health groups and individuals from 42 countries, calling on every member and observer at the UNGA to abide by the model policy and reject any engagement with the tobacco industry- including invitations from tobacco companies or those furthering their interests and proposals that support tobacco industry partnerships, funding and positions. STOP intends to deliver its message to UNGA delegates at the meeting, calling on them to avoid being complicit in the tobacco industry’s plans.

The message is simple: It is impossible to produce, market and sell tobacco products in a way that is compatible with public health or the UN’s 2030 Agenda, so partnerships with the tobacco industry directly contradict the Sustainable Development Goals.

It’s time to close the door on the tobacco industry and its allies.

_________________________________________

Atty. Deborah Sy is a Partner in STOP (Stopping Tobacco Organizations and Products), a tobacco industry watchdog, and Head of Global Public Policy and Strategy at the Global Center for Good Governance in Tobacco Control. Debby is a Johns Hopkins University IGTCI Awardee for Excellence in Advocacy (2012) for instituting tobacco industry monitoring activities, which won the Bloomberg Award (M) for HealthJustice- a think tank aimed at bridging the gap between health and law, where she is the founding trustee and senior advisor. She collaborated with the Harrison Institute of Public Policy at Georgetown University on the recognition of tobacco control issues in trade and investment negotiations. She provides legal assistance on universal health care, health promotion, good governance, food and drug regulation, intellectual property, taxation, trade as well as women and children’s rights.

Image Credits: Vital Strategies/WHO SEARO, tobaccoatlas.org/ Environmental Degradation photos from Landsat 8.

[The Medicines Patent Pool]

Geneva (2 October 2019) — The Medicines Patent Pool today announced the first of a two-step update of its database MedsPaL to include additional patented small molecule medicines following the publication of the World Health Organization (WHO)’s updated Model List of Essential Medicines (EML) in July.

Launched in 2016, MedsPaL is a free resource on the intellectual property status of patented medicines included in the WHO EML for low- and middle-income countries (LMICs). Initially covering selected HIV, hepatitis C and tuberculosis medicines in LMICs, MedsPaL expanded to all patented treatments on the EML in 2017.

“We are passionate in our belief that public health stakeholders must have simplified access to accurate patent information on essential medicines in order to make informed decisions when the time comes to procure and supply those important drugs to the people who need them,” said Charles Gore, Executive Director of the Medicines Patent Pool. “MedsPaL now provides patent and licensing data covering 96 priority medicines in more than 130 low- and middle-income countries and includes over 8,000 national patents and patent applications.”

This update includes data on patents for medicines to treat lung cancer, multiple myeloma, prostate cancer, atrial fibrillation, chronic obstructive pulmonary disease, nausea, post-partum haemorrhage, hypertension and for three antibiotics, namely abiraterone, afatinib, apixaban, aprepitant, bortezomib, carbetocin (heat-stable formulation), ceftazidime+avibactam, dabigatran, edoxaban, erlotinib, gefitinib, lenalinomide, meropenem+vaborbactam, plazomicin, rivaroxaban, telmisartan+amlodipine, telmisartan+hydrochlorothiazide and tiotropium. For some of these medicines, key patents have expired, but a number of relevant secondary patents remain in force in some LMICs.

Information on patented biologics will be made available in a second update before the end of the year.

“It is fundamental that countries willing to provide greater access to essential medicines can refer to a reliable up-to-date database like MedsPaL to check the patent status of the medicines they want to procure,” said Nicola Magrini, Secretary of the WHO Essential Medicines List. “Access to medicines is certainly an important pillar of Universal Health Coverage and MedsPaL supports its efficient implementation at country level.”

The MPP regularly updates the patent and licensing status data included in MedsPaL, including through data collected from national and regional patent offices from around the world. The MPP has signed collaborative agreements with the African Regional Intellectual Property Organization (ARIPO), the Eurasian Patent Office (EAPO), the European Patent Office (EPO), Argentina’s National Institute of Industrial Property (INPI), Brazil’s National Institute of Industrial Property (INPI), Chile’s National Institute of Industrial Property (INAPI), Dominican Republic’s National Office of Industrial Property (ONAPI), Ecuador’s National Service of Intellectual Rights (SENADI), the Egyptian Patent Office (EGPO), El Salvador’s National Registry Center (CNR), Peru’s National Institute for the Defense of Free Competition and the Protection of Intellectual Property (INDECOPI), South Africa’s Companies and Intellectual Property Commission (CIPC), and Uruguay’s National Directorate of Industrial Property (DNPI).

About the Medicines Patent Pool

The Medicines Patent Pool is a United Nations-backed public health organisation working to increase access to, and facilitate the development of, life-saving medicines for low- and middle-income countries. Through its innovative business model, the MPP partners with civil society, governments, international organisations, industry, patient groups and other stakeholders, to prioritise and licence needed medicines and pool intellectual property to encourage generic manufacture and the development of new formulations. To date, the MPP has signed agreements with nine patent holders for thirteen HIV antiretrovirals, one HIV technology platform, three hepatitis C direct-acting antivirals and a tuberculosis treatment. The MPP was founded by Unitaid, which serves as sole funder for the MPP’s activities in HIV, hepatitis C and tuberculosis. Funding provided by the Swiss Agency for Development and Cooperation (SDC) for MPP’s feasibility study on the potential expansion of its licensing activities into patented essential medicines made the upgrade of MedsPaL to include other EML treatments possible.

More information about the Medicines Patent Pool, its public health mission and impact: https://medicinespatentpool.org/

For more detailed information on a given patent or its interpretation, MedsPaL users are encouraged to contact national patent offices or consult legal counsel.

www.medspal.org

Image Credits: The Medicines Patent Pool.