Nairobi, Kenya – The World Health Organization has commended efforts by the government of Uganda for keeping the deadly Ebola virus from spreading eastwards into the country from the Democratic Republic of the Congo (DRC), where a prolonged outbreak has claimed approximately 1,600 lives since last August.

The East African country has recorded only three confirmed cases of the disease since 11 June – when the first case was reported by WHO – linked to three people who had crossed the border into western Uganda from the DRC.

Another three suspected cases were being treated at a hospital near the DRC border, where health-workers have concentrated treatment facilities so as to contain the spread of the disease farther east in Uganda and the broader East Africa region.

Surveillance for ebola virus disease at the border between DR Congo and Uganda. Photo: WHO/Matt Taylor

The ability to check the spread of the highly contagious virus with a 68% fatality rate has so far been enabled by a good disease surveillance system managed by well-trained teams of health workers, according to Matshidiso Moeti, WHO Regional Director for Africa. Strong community-backed surveillance has also been critical, said Uganda’s Health Minister Jane Ruth Aceng.

“I commend Uganda for its quick response to the Ebola outbreak,” said Moeti to UN TV, when she toured western Uganda near the DRC border late last month (25-26 June). “I spoke with health authorities who told me how the training they had received in detecting the disease” enabled them to be “on high alert for patients with any signs of infection. They were able to move swiftly when the first Ebola cases arrived in their health facility,” she said, according to a WHO news release.

Uganda and the DR Congo share a porous 900 kilometre border – running through fertile and mineral-rich jungles. The rough terrain makes control over civilian crossing challenging. And on the DRC side, armed militias that oppose the DRC central government operate with relative impunity, particularly in the areas of Kivu. Nearby, Rwanda and Burundi also share a significant border with DRC, making Ebola surveillance by neighbouring countries even more important for the broader region.

Rapid Health Sector Mobilization & Ring Vaccination Strategy

Since the outbreak was declared in Uganda in early June, 1,063 ‘high risk individuals’ have been vaccinated Moeti said, adding that vaccination of contacts and contacts of contacts, a strategy known as ‘ring vaccination’, has shown good results in the DRC, and previously in other countries of West Africa.

The ring vaccination strategy has also contributed to the fact that there have been no new cases of Ebola in Uganda since 12 June, the latest WHO situation report noted.

Uganda has trained more than 9,000 of its health workers in detecting symptoms of Ebola, and has vaccinated nearly 5,000 workers against the disease.

Additionally more than 100 people who had contacts with people confirmed to have Ebola in Uganda are being monitored to enable a quick response if symptoms of the illness develop.

Community Leadership Key to Surveillance

With support from WHO and partners, another 16,000 community leaders and volunteers have been trained in remote border areas to help with disease surveillance; provide medical attention to potential patients; and alert authorities of suspected cases of infections, according to the WHO release.

The local teams, it said, serve as the “eyes and ears” of local and national emergency response systems supporting “surveillance, infection prevention and control, patient care, cross-border activities and coordination with communities.”

As a result of such community cooperation, all high-risk districts in the west of Uganda are able to screen people, identify suspect cases and trace the contacts of potential patients whenever needed, Uganda’s Health Minister Aceng said. “As of now we remain in a high alert, we will continue with our risk communication and sensitizing the population,” she said in a video of her visit to the field with Moeti.

She added that due to these efforts, there were no further known cases of Ebola transmission in Uganda presently, but monitoring efforts will continue until the pathogen was completely brought under control in the DRC.

In DRC, Community Mistrust & Unrest Continue to Fuel Ebola 

The 4 July situation report issued by the WHO indicated that in DRC, the epicentre of the outbreak, there were 285 new confirmed cases of Ebola during the 12 June – 2 July period, marking a trend of decreasing cases since the height of the epidemic in mid-April. A total of 2,369 cases have so far been recorded, with 2,275 confirmed cases resulting in 1,598 deaths, since the outbreak began in August of last year.

Source: WHO

The eastern DRC city of Butembo in DRC’s North Kivu region has borne the brunt of the outbreak, made worse by conflict and political instability that has seen health workers unable to reach patients, and in some cases lose their lives.

Teams of responders in the city of one million inhabitants have often faced community mistrust, fuelled by misinformation spread by politicians in the general elections that took place in late 2018.

Over the past six months, armed groups active in the area attacked health workers while looting and destroying Ebola treatment centres, during which frontline responders and security forces protecting them lost their lives, according to WHO reports.

WHO and Congolese authorities have been conducting awareness-raising activities for teams working in treatment and vaccination sites, aimed at helping to build community support and trust to ensure the safety of responders.

Unlike in the earlier outbreak in West Africa, the WHO and agencies involved in the current campaign have been relying heavily on vaccinations of people who have come into contact with victims, focusing on first and second degree contacts, demonstrating some success in containing the spread of the virus.

Despite this progress, the international NGO Médecins Sans Frontières (MSF/Doctors Without Borders) in its latest update lamented that attacks on health personnel have continued to date, which, coupled with inter-communal violence, contributed to the failure to end the outbreak – now more than ten months strong.

“Vaccination of contacts, contacts of contacts and frontline workers in Butembo and Katwa (the epicentre of the outbreak) is sometimes temporarily suspended because of threats to the safety of vaccination teams,” the organisation said.

However, it added that as a frontline entity involved in combating the disease, it now has the facilities, skills and scientific capacity to better manage the current outbreak, as compared to previous ones.

“We have new tools and improvements in the medical management of this epidemic, compared to previous Ebola epidemics, such as new developmental treatments; a vaccine that has given indications of being effective; Ebola treatment centres are more open and accessible for the families of patients; and provision of a higher level of supportive care,” it noted.

In Uganda, MSF declared that it will collaborate with health authorities “to improve the hygiene and infection prevention and control measures in Kagando and Bwera hospitals, where the confirmed Ebola cases were first admitted,” and would also “support the safe provision of care for medical needs unrelated to Ebola in these facilities, should the need arise.”

Image Credits: WHO/Matt Taylor, WHO.

[Republished from The Lancet]

Richard Horton, Editor-in-Chief of The Lancet, examines the issues around the pending appointment of a new executive director for UNAIDS, as well as the candidates for the post, following the May resignation of executive director Michel Sidibé. The selection process has fueled questions about who may now be best positioned to lead UNAIDS following a sexual harassment scandal that cast a shadow over the agency and its leadership – with some critics questioning whether it should continue as a separate institution altogether. Horton has led The Lancet since 1995, and has established the journal as a leading voice on cutting-edge health policy issues, ranging from antimicrobial resistance (AMR) to obesity and climate change. He is a recent recipient of the Roux Prize.

Richard Horton, Editor-in-Chief, The Lancet. Photo: ILO/A.Lwin

Who is best qualified to lead an organisation—UNAIDS—that has not only suffered severe reputational loss, but also faces threats to its continuing existence? UNAIDS is a jointly sponsored UN programme that has, in its own words, “led and inspired global, regional, national, and local leadership, innovation, and partnership to ultimately consign HIV to history”. But some observers believe this glorious history is just that—history. Rob Yates was recently appointed head of Chatham House’s Centre on Global Health Security. He wrote on Twitter last week that a new Executive Director of UNAIDS should have the “courage and ability to wind up the organisation and integrate it into @WHO”. Kul Gautam, a former Deputy Executive Director of UNICEF, argued that “now it’s time to question [UNAIDS] continuation”. Anthony Costello, most recently a Director at WHO, commented, “No one questions the need for a strong and distinct body for the HIV response. It’s whether UNAIDS would function better under the democratic accountability of the World Health Assembly which might have prevented its shameful recent history”. Laurie Garrett, a Pulitzer-Prize winning writer on global health, noted that those selecting the next Executive Director “MUST define clearly why the world needs UNAIDS & how it should fit in the global health landscape.” Is it time to choose a leader who will close down UNAIDS? Maybe one day. But not now. Predictions about the end of AIDS have been badly misjudged. According to the Global Burden of Disease Study, there were almost 1 million deaths from AIDS in 2017. Those deaths occur throughout the lifecourse, but the toll is especially severe among 15–49-year-olds (676 100 deaths). There are almost 37 million people worldwide living with HIV. And the incidence remains shockingly high—1·9 million people newly infected every year. Although the number of AIDS-related deaths is projected to fall, even by 2040 those deaths will still be unacceptably high (742 million, with a worst-case scenario of 2·3 million deaths). The AIDS epidemic is at a critical moment. Decelerating the political response by extinguishing UNAIDS now would be a catastrophic error.

Photo: UNAIDS/Sydelle Willow Smith

There are five candidates: Salim Abdool Karim (an infectious diseases epidemiologist and Director of the Centre for the AIDS Programme of Research in South Africa); Sani Aliyu (physician, infectious diseases expert, and Director-General of Nigeria’s National Agency for the Control of AIDS); Chris Beyrer (physician, HIV specialist, former President of the International AIDS Society, and Professor of Public Health and Human Rights at Johns Hopkins Bloomberg School of Public Health); Winnie Byanyima (engineer, politician, diplomat, and now Executive Director of Oxfam International); and Bernard Haufiku (physician and Namibia’s former Minister of Health and Social Services). Each candidate has strengths. Aliyu spearheaded Nigeria’s AIDS response under difficult political circumstances. Haufiku has ministerial experience. Byanyima knows how to run a complex global organisation. Karim is a highly respected HIV scientist whose work has transformed clinical practice. And Beyrer, whose partner died of AIDS in 1991, successfully uses human-rights approaches to protect and advance the health of marginalised communities in Asia, Africa, Latin America, Russia, and the US. There are disappointments. Only one woman? No forum for public debate and scrutiny? Appointment not election?

The next Executive Director of UNAIDS must fulfil five criteria. First, s/he must have the personal integrity to restore trust and credibility to a damaged organisation—and to give governments confidence to invest in the AIDS response. Second, s/he must have proven scientific understanding of the AIDS epidemic in order to be able to use evidence as a platform for political advocacy. Third, s/he must have demonstrable ability to represent and engage with civil society. Fourth, s/he must be able to point to their commitment to key vulnerable populations. And finally, s/he must be able to show transformational leadership of a large organisation. The Programme Coordinating Board of UNAIDS met in Geneva last week and “commended the strong competencies of all short-listed candidates”. After interviews, a Committee of Cosponsoring Organisations will deliver no more than three names to the UN Secretary-General, António Guterres. It is no exaggeration to say that his choice may determine the future fate of the AIDS epidemic.

Salim Abdool Karim, Director of the Centre for the AIDS Programme of Research in South Africa. Photo: Rajesh Jantilal/AFP/Getty Images
Sani Aliyu, Director-General of Nigeria’s National Agency for the Control of AIDS. Photo: Sani Aliyu
Chris Beyrer, Professor of Public Health and Human Rights at Johns Hopkins Bloomberg School of Public Health. Photo: Rajesh Jantilal/AFP/Getty Images
Winnie Byanyima, Executive Director of Oxfam International. Photo: Franke Tsang/South China Morning Post/Getty Images
Bernard Haufiku, Namibia’s former Minister of Health and Social Services. Photo: UN Photo/Rick Bajornas

 

 

 

 

 

 

 

 

 

Republished with permission from The Lancet: https://doi.org/10.1016/S0140-6736(19)31563-6. Click here, for more information about Richard Horton and The Lancet.

Image Credits: UNAIDS/Sydelle Willow Smith, ILO/A.Lwin, Rajesh Jantilal/AFP/Getty Images, Sani Aliyu, Franke Tsang/South China Morning Post/Getty Images, UN Photo/Rick Bajornas.

Only a month after a hotly-contested World Health Assembly resolution touched off a debate around “price transparency” as a way to improve access to medicines, a new controversy over how to stimulate access has emerged in another UN Forum, the Human Rights Council.

This time the debate is around ways to “delink” incentives for the research and development of new medicines from patent systems that “reward” companies or institutions investing in the drug’s development with a legal monopoly over sales of the end-product for years to come.

The sensitive “delinkage” issue is part of a draft Human Rights Council (HRC) resolution on “Access to medicines and vaccines in the context of the right of everyone to the enjoyment of the highest attainable standard of physical and mental health,” under consideration at this month’s session in Geneva.

Human Right Council. Photo: UN/Jean-Marc Ferré

“Delinkage” has become a mantra for many civil society and patient advocacy groups, as well as some governments, which perceive exclusive patent rights as a key driver in rising drug prices, limiting access to new treatments. The term broadly refers to alternative incentives or rewards that reduce reliance on patents as a means of financing R&D, yielding products that are cheaper and more readily available.

The draft HRC resolution on medicines access, due for its final review on 11 July, is backed by a core group of countries including Brazil, China, Egypt, India, Indonesia, Senegal, South Africa and Thailand. Representatives of that group point out that the recently contested delinkage paragraph was part of an already-approved 2016 version of the same resolution, and is merely being reaffirmed again in this year’s updated draft, which now has 27 co-sponsors in all.

“The Human Rights Council brings this resolution up every three years, because it is viewed as worthy in this context, to have a human rights perspective on access to medicines,” said Brazil’s representative Clara Solon in a public HRC consultation Tuesday.

The text calls upon countries “to continue to collaborate, as appropriate, on models and approaches that support the delinkage of the cost of new research and development from the prices of medicines, vaccines and diagnostics for diseases that predominantly affect developing countries, including emerging and neglected tropical diseases, so as to ensure their sustained accessibility, affordability and availability and to ensure access to treatment for all those in need.”

Two other paragraphs [8,9] ”encourage” governments, international organizations, NGOs, researchers and the private sector to pursue alternative R&D incentives, in terms such as the following:

  • “improved existing and alternative frameworks to adequately reward innovation, pricing and affordability of health products;” and
  • “to redouble efforts to achieve a continuous supply of quality, safe, effective and affordable health products through research and development that meets public health needs, for the efficient application and management of intellectual property standards, to carry out evidence-based selection of health products and seek fair and affordable pricing.”

Delinkage Supporters and Critics

Support for “delinkage” principles has been growing over the past decade, led by figures ranging from US Presidential hopeful Bernie Sanders to Nobel Prize winning economist Joseph Stiglitz and Bernard Pecoul of the Geneva-based Drugs for Neglected Disease Initiative. Countries supporting the idea have included India, The Netherlands, and the Group of 77, representing some 134 developing nations. Some private sector voices, notably former GlaxoSmithKline CEO, Sir Andrew Witty, have also expressed support for innovative ways to fund R&D.

The advocates assert that the current R&D system, based around granting exclusive patent rights for new drugs, is breaking down. Newly patented drugs that are coming onto the market are increasingly priced in a range that stretches the budgets of high-income countries, while leaving middle- and low-income countries out of the loop altogether.

The problem is particularly acute for drugs treating non-communicable diseases such as cancer, where new therapies can carry a $US 100,000+ annual price tag. And particularly if public funds or tax breaks are invested in drug R&D, then rewards other than exclusive patent monopolies should be considered for the final drug products, advocates assert.

“Access will always be unequal without the delinkage of R&D costs from the prices of drugs, vaccines, cell and gene therapies, diagnostic tests and other health technologies and services,” remarked Thiru Balasubramanian, of Knowledge Ecology International (KEI), in an interview. One of the groups that participated in last week’s HRC consultations, KEI has been a flagbearer of the delinkage concept.

At the same time some key developed countries, including Switzerland, Japan, Australia, and the European Union representative at the HRC, contend that existing patent systems remain the backbone stimulating R&D investments, and that the HRC resolution treads too far into territory outside of its traditional domain. They have asked for deletions or major changes in the paragraphs that reference “delinkage” as well as references to alternative R&D incentives.

“Delinkage is stated too broadly. As supporters of the global IP system [for medicine patents], we want to make sure that it keeps performing, while finding solutions in areas where it is not working. But we are very worried about taking a one-size-fits-all approach,” Nora Kronig, head of International Affairs at the Swiss Federal Office of Public Health, told Health Policy Watch.

“Looking at access to medicines broadly, there are a lot of elements that come into the chain. For instance, if you don’t have robust regulatory systems people can’t get medicines either. It is also untrue to talk about market failure with respect to the whole access to medicines issue,” she added.

While critics are increasingly adamant that the current system is cracking, “saying that that there is a global market failure on access to medicines generally is not accurate,” argues Kronig. “We are fully open to discuss possibilities where things are not working to find solutions to improve access to medical products, but what we are very worried about is to undermine a largely functional system to offset unquestioned distortions in sub-sectors of the markets for medicines.”

Informal Consultations on the Draft Resolution

At Tuesday’s informal consultations on the draft, other countries expressed concerns that the Human Rights Council may be duplicating work already being carried out by the World Health Organization and the World Health Assembly body of WHO member states.

“We share concerns about how we are use these very overstretched platforms,” said Canada’s delegate. “While still recognizing there is a role for human rights, … we would like to refrain from re-negotiating thoughts and technical issues that are already being discussed in other fora such as WHO and WHA.”

The final text of the HRC draft resolution, obtained by Health Policy Watch, reflects slight modifications in the disputed paragraphs, although terms like “delinkage” remain along with reference to alternative incentives for drug R&D.

Besides the core group, other co-sponsors of the resolution, so far, include HRC members from: Bangladesh, Iraq, Peru, Philippines, Qatar, Saudi Arabia, Tunisia, and Uruguay. UN member states and observers that are not officially members of the HRC can still co-sponsor HRC resolutions, and such supporters include: Algeria, Bolivia, Ecuador, Eswatini, Ethiopia, Haiti, Kuwait, Mongolia, Turkey, the United Arab Emirates and Palestine.

Talks with other countries will continue up until next Thursday, when the final resolution is formally reviewed by the HRC. But the essence of the three contested paragraphs would not change or be removed, core sponsors affirmed.

“The resolution has one paragraph mentioning de-linkage, and some European countries don’t like this,” said one delegate, who asked not to be named.

“But the resolution is not about delinkage, it touches on many aspects of access to medicine, including delinkage and alternative frameworks [for R&D], but we also talk about rights to health, health literacy, many other issues. It is very broad text.”

“We are not planning to make more changes in the text, but we will work very hard to add more cosponsors as well as to try to avoid public objections to the final text,” the delegate added. “But if it comes to it, we will have a vote.”

Image Credits: UN Photo / Jean-Marc Ferré, CDDEP.

The European Commission and European Union medicines regulatory agencies sent an open letter to all sponsors of EU-based clinical trials to remind them of their obligation to publish the results of the trials – both positive and negative – in a public database.

The open letter by the European Commission (EC), the European Medicines Agency (EMA) and the Heads of Medicines Agencies (HMA) reminded sponsors that according to a 2012 EC guideline, clinical trial summary results are required to be published in the EU Clinical Trials Database, EudraCT, and that publishing these results is their direct responsibility.

“Transparency and public access to clinical trial results, whether positive or negative, are fundamental for the protection and promotion of public health,” the EMA said in a press release.

“In addition, for those medicines which are placed on the market or used in further clinical trials, it allows patients and healthcare professionals, or any other citizen, to find out more information about medicines they might be taking or prescribing,” it said.

The letter noted that out of the 27,093 completed clinical trials in the EudraCT database, 68.2 percent are in compliance with the EU publication rules and 31.8 percent have missing results, which the letter identified as “an encouraging trend.”

However, it added that “there is still significant progress to be made,” citing that reporting compliance for non-commercial sponsors is low at 23.6 percent, compared to that of commercial sponsors at 77.2 percent.

The letter particularly encouraged academic and other non-commercial sponsors “to post the results of their trials in EudraCT in order to maximise their valuable contribution to meet public health needs and to advance clinical research especially where commercial interest is weaker.”

“Underreporting in general and selective reporting of trials with positive outcome may lead to potentially avoidable redundancies in the conduct of clinical trials and compromise the economic and scientific efficiency of clinical research,” it warned. “In addition, unreported clinical trials with unfavourable outcome can have negative public health implications.”

Image Credits: European Medicines Agency.

The Global Antibiotic Research & Development Partnership (GARDP) has announced its new “5 BY 25” strategy to mobilise global stakeholders to raise the €500 million needed to develop and deliver five new antibiotic treatments by 2025, to help tackle antimicrobial resistance (AMR).

Drug-resistant infections already cause at least 700,000 deaths globally each year, and affect people in countries across income levels; addressing the growing threat of AMR will be key to achieving universal health coverage (UHC) and the Sustainable Development Goals (SDGs), a GARDP press release explained.

“We are in a race against time to develop new antibiotics and make them accessible to the millions of people who need them. GARDP’s remarkable progress over the last three years in building strong partnerships and a talented team positions it well to meet this ambitious new goal,” said GARDP’s Chair of the Board, Professor Ramanan Laxminarayan, quoted in the release.

“WHO strongly welcomes the progress of GARDP to date and its new ambitious ‘5 BY 25’ goal which complements WHO’s Global Action Plan on AMR. We call on all key actors to support and collaborate with GARDP in line with the UN Interagency Coordination Group on AMR,” said Dr Hanan H. Balkhy, Assistant Director-General for AMR Division at WHO, in the release.

This “5 BY 25” strategy is part of GARDP’s new business plan, which was recently approved by the GARDP Board and will be launched at the World Health Summit in October. The strategy is detailed in a recent webinar by Dr Manica Balasegaram, GARDP Executive Director.

Calling on the support of member states, philanthropic and other global organisations, GARDP aims to develop five new treatments that will focus on the priority pathogens identified by the World Health Organization, along with current unmet needs for diseases and key populations. GARDP aims to achieve this by “developing assets in late stage clinical development and ensuring access,” the GARDP website explains.

The five categories of WHO priority pathogens include:

  • Carbapenem-resistant (CRAB): A. baumannii
  • Carbapenem-resistant (CRE): Enterobacteriaceae
  • Sexually transmitted infections
  • Children (paediatric antibiotics)
  • Neonatal sepsis

“Alarming levels of resistance are now reported in countries of all income levels, with the result that hundreds of thousands of newborns are dying of untreatable sepsis, and patients are suffering from gonorrhoea and serious bacterial infections that do not respond to any available antibiotics,” the release said. “While AMR has the highest burden in low to middle income countries, high income countries are also greatly affected.”

Image Credits: GARDP.

In a surprise appearance before the 2019 Congress of the International Council of Nurses, WHO Director-General Dr Tedros Adhanom Ghebreyesus said that investing in a stronger nursing workforce is essential for achieving universal health coverage (UHC). He proposed that “every country bring one nurse and one midwife to the World Health Assembly next year,” as part of planned celebrations of the International Year of the Nurse and the Midwife, saying: “The world must hear their voices and their stories.”

Health workers are not a cost, they’re “an investment that pays a triple return for health, gender equality and economic growth,” Dr Tedros said, citing the 2016 United Nations High-Level Commission on Health Employment and Economic Growth.

“The world is facing a shortfall of 18 million health workers needed to achieve and sustain universal health coverage by 2030,” added the Director-General in his remarks Sunday before the Congress. Nurses and midwives make up half of this projected shortfall – a gap of 9 million professionals.

“Good move Dr Tedros. Women deliver health to 5 billion people and will deliver UHC – 70% health workers are women, majority nurses with critical role on front-lines [of] global health. Investing in female health workforce is smart move,” said Ann Keeling of Women in Global Health in a Tweet.

The WHO Director-General also noted that a first-ever WHO State of the World’s Nursing report will be published next year ahead of the WHA and during the International Year of the Nurse and Midwife, marking the 200th anniversary of the birth of Florence Nightingale, the founder of modern nursing. A State of the World’s Midwifery report will also be launched around the same time. The year will also cap off a three-year NursingNow! campaign (2018-2020), which was aimed at raising the status of nursing worldwide.

Photo: Global Fund to Fight AIDS, Tuberculosis and Malaria

The appearance by Dr Tedros at the five-day Congress in Singapore, which ended yesterday, underscores the emphasis that the World Health Organization is putting on health workers as a key component of UHC strategies.

“We simply cannot achieve universal health coverage and the health-related targets in the Sustainable Development Goals unless we empower and equip nurses and midwives, and harness their power,” said Dr Tedros in his remarks at the conference, adding that “any society with too few health workers is operating with one hand tied behind its back.”

“We can have the best medicines, the best diagnostics, the best hospitals and the best health insurance, but if we don’t have health workers delivering safe, effective, people-centred care, we don’t have a health system.”

The International Council of Nurses (ICN) is a federation of more than 130 national nurses’ associations representing the millions of nurses worldwide. The theme of its 2019 Congress (27 June – 1 July) was to explore “the many ways in which nurses work to achieve universal access to health, not only providing health care but also addressing the social determinants of health, such as education, gender equality, poverty, etc.”

ICN President Annette Kennedy said at the Congress that the WHO’s “goal of Health for All will only be achieved if there are enough properly trained nurses working at the right time and in the right place.” She added that “ICN will always strive to influence health, social, educational and economic policies to bring the best out of nurses and ensure they can provide the world with the care, treatment and comfort that only they can deliver.”

The WHO Director-General emphasised the importance of the WHO partnership with ICN, which celebrated its 120th anniversary this year, “on a range of issues, including primary health care, universal health coverage, quality of care, noncommunicable diseases, antimicrobial resistance, and more.”

Dr Tedros also referred to last week’s G20 leaders declaration, issued on 29 June at the close of the G20 meeting in Japan, which includes the commitment to “strengthen health systems, with a focus on quality, including through enhancing health workforce and human resources.”

“We must all hold the G20 leaders to the commitments they have made,” he said.

Image Credits: Global Fund to Fight AIDS, Tuberculosis and Malaria.

Sounding a note of ever-increasing urgency, United Nations Secretary General Antonio Guterres told ministers gathered at a Global Preparatory Meeting for the UN Climate Action Summit, in Abu Dhabi that “we are in a battle for our lives” with regards to climate change, which is happening at an even faster pace that what top scientists had predicted.

He called on governments worldwide to stop subsidising fossil fuels and building coal power plants; put a tax on carbon emissions; and shift to a green economy powered by renewable energy, in order to cut greenhouse emissions 45 percent by 2030 and achieve carbon neutrality by 2050. Scientists estimate such drastic cuts are needed to keep global warning to 1.5°C, and avert “a catastrophe for life as we know it’, said Guterres.

The two-day conference (30 June-1 July) included a first-ever global gathering of health and environment ministers to talk about the health threats from air pollution and climate-induced disasters. That meeting signaled growing political recognition of the intimate links between climate change and health, including deaths and injuries from extreme weather as well as a global toll of 7 million air pollution-related deaths annually.

Climate threats strike at no less than the fundamentals of life itself, said Guterres in his remarks at Sunday’s opening session.

“Climate disruption is happening now and it is happening to all of us,” said Guterres in his opening address Sunday before the meeting of ministers of climate, environment, health and energy from around the world. “Every week brings new climate-related devastation. Floods, drought, heatwaves, wildfires, superstorms.”

“It is progressing even faster than the world’s top scientists have predicted, and it is outpacing our efforts to address it. Climate change is running faster than what we are,” he said, calling for a “rapid and deep change in how we do business, generate power, build cities and feed the world.”

Guterres said solutions should include major global shifts in how energy systems are financed and taxed. “First, let’s shift taxes from salaries to carbon,” he said. “We should tax pollution, not people. Second, stop subsidizing fossil fuels. Taxpayers’ money should not be used to boost hurricanes, spread drought and heat waves, and melt glaciers. Third, stop building new coal plants by 2020. We need a green economy, not a grey economy. New infrastructure must be climate-smart and climate-friendly. And we must provide sustainable, clean and affordable energy for the more than 800 million people who still live without access to power.”

The two-day Climate Action meeting in Abu Dhabi aims to build political will for slashing emissions ahead of the 23 September UN Climate Summit in New York City, which will bring together heads of state to make firm commitments on climate change.

Statements by United Arab Emirates (UAE) officials and other organisers described the ministerial meeting as an important political platform to raise the visibility of issues ahead of the Summit.

Health and Environment Ministers Meet in Abu Dhabi

Along with meetings on energy, infrastructure and finance, the “health-climate nexus” was another featured element of the Abu Dhabi event as health and environment ministers sat down together today for the first time ever.

Rodolfo Lacy, OECD Director of Environment was quoted saying that it was a “historic moment”.

The meeting was organised in collaboration with the World Health Organization and the UAE’s Ministry of Health and Prevention as well as the Ministry of Climate Change and Environment.

Organisers said that the meeting aimed to (a) strengthen and endorse health-centered climate mitigation and adaptation initiatives and (b) demonstrate political commitment to dual strategies for climate and health issues.

Themes addressed included: air pollution and health risks; reducing morbidity and mortality from climate-induced disasters and extreme weather events; and financing for creative solutions that simultaneously address climate threats and benefit health, for instance by cleaning up air pollution, water contamination, and improving waste management.

The ministers also discussed how such solutions could be integrated in government policies and programs, including Nationally Determined Contributions (NDCs) which are a voluntary mechanism by which countries commit to climate mitigation actions under the 2015 Paris Agreement, as well as, National Adaptation Plans.

“Fighting climate change is the best investment ever; we can save 7 million lives a year,” Thani Al Zeyoudi, UAE Minister of Climate Change and Environment, was quoted on Twitter as saying, referring to the WHO estimate for lives lost from outdoor and household air pollution every year.

Image Credits: Rodolfo Lacy/OECD.

Heads of state from the world’s largest economies concluded this year’s G20 Summit in Japan with a general declaration committing to advance global health priorities – but the statement still left much to be desired in terms of concrete goals and targets.

In the G20 Osaka Leaders’ Declaration, issued on Saturday at the close of the two-day meeting (28-29 June), heads of state committed to: move towards universal health coverage (UHC) through bolstering primary health care and access to medicines; promote healthy and active aging through the prevention of noncommunicable diseases; improve emergency preparedness & response;  provide support for African countries affected by the Ebola outbreak; and address antimicrobial resistance by identifying better models for antimicrobial drug research and development.

Other health-related topics addressed in the declaration included: climate change; transitioning towards clean energy; and sustainability of the world’s oceans, particularly the need to take action to address plastic litter and micro-plastics that are overwhelming aquatic life, with potential far-reaching impacts on important food sources.

Notably, in the declaration’s section on climate change, the United States reiterated “its decision to withdraw from the Paris Agreement because it disadvantages American workers and taxpayers,” but affirmed its commitment “to the development and deployment of advanced technologies to continue to reduce emissions and provide for a cleaner environment.”

The countries that remain signatories to the Paris Agreement, on the other hand, reaffirmed their “commitment to its full implementation, reflecting common but differentiated responsibilities and respective capabilities, in the light of different national circumstances.”

Participants in the G20 Summit, described as the “premier forum for international economic cooperation”, include leaders from 19 countries and the European Union, as well as invited guest countries and international organisations.

“Building on work done by previous presidencies,” the declaration states that G20 leaders “will strive to create a virtuous cycle of growth by addressing inequalities and realize a society where all individuals can make use of their full potential,” and to “further lead efforts to foster development and address other global challenges to pave the way toward an inclusive and sustainable world, as envisioned in the 2030 Agenda for Sustainable Development.”

Just ahead of the meeting, WHO Director-General Dr Tedros Adhanom Ghebreyesus told G20 leaders in a Tweet: “Our message is simple: health is a political choice. We call on G20 countries to invest in health, a driver of jobs & growth, and in preparing for and preventing emergencies, rather than just responding to them.”

In another Tweet, he posed three “asks” to G20 leaders:

  • Support the fight against Ebola in DRC [Democratic Republic of the Congo];
  • Invest in global health preparedness now, before the next pandemic ravages the global economy;
  • Commit to Health For All [through] UHC

Under the banner of the G20 Summit’s focus on financial markets and the world economy, the role of digital technologies was also a key theme throughout the summit and declaration, particularly its dual role of driving economic growth while offering cost-effective solutions to address global challenges.

Image Credits: G20.

An ambitious Global Action Plan to accelerate progress on some 50 health-related targets of the 2030 Sustainable Development Goals through better alignment of work in a dozen different UN and international agencies is open for public comments until Tuesday, 2 July.

Drafts of the Global Action Plan for Healthy Lives and Well-being for All (GAP) published so far reflect the heavy lifting that the agencies have yet to do in order to complete the plan as well as to etch out a clear strategy for implementation, both supporters and critics of the process told Health Policy Watch.

The plan is due to be launched at September’s meeting of the United Nations General Assembly. But key to its success is what happens after that – and particularly how it will work at the country level, those interviewed stressed.

“There are still more questions than answers on how this will work,” said one observer close to the process. “We know that the system is not efficient as it is now. You give money to two different organisations to do the same thing, [and] the countries have to respond to two agencies instead of one.”

And while improving coordination and efficiencies between agencies on the ground is a key goal – the plans’ backers and co-sponsors are also searching for creating ways to do that, without creating still more bureaucracy at the country level, which could make things worse, rather than better.

Some say that the name of the plan can also be misleading as it is not meant to be a global roadmap, as such, for achieving the SDGs, but rather a plan for how global health agencies can better work together to help countries advance their own health priorities across the 17 Sustainable Development Goals. Those include not only SDG 3 – Good Health and Well-Being – but also goals for No Poverty & Zero Hunger (SDGs 1 & 2), Gender Equality (SDG 5), Clean Water and Sanitation (SDG 6), Affordable and Clean Energy (SDG 7), Decent Work (SDG 8), Industry & Innovation (SDG 9), Sustainable Cities (SDG 11), and Climate Action (SDG 13) – all of which are intertwined somehow with health.

WHO, which is coordinating the overall GAP process, is hopeful that the public comments phase now underway will help address some of these thorny challenges as well as getting broader buy-in from countries, civil society and other actors.

“The signatory agencies are committed to ensuring an inclusive process in developing the Global Action Plan,” said Peter Singer, who is overseeing the process as Special Adviser to WHO Director-General, Dr Tedros Adhanom Ghebreysus. “In order to raise awareness about the online consultation process, WHO and the other agencies have shared the announcement via social media (website, twitter, newsletters, etc) and partner networks.” He added that the invitation to contribute had also been shared widely with civil society, drawing from a pool of some 250 NGOs in 70 countries. All of the inputs received will be considered in the development of the final Global Action Plan, to be launched at the UN General Assembly in September.  September’s UNGA will also host a High Level Meeting on Universal Health Coverage, 23 September.

Three-Pronged Strategy; Accelerated Action in Seven Areas

The draft Global Action Plan, also known as the GAP, is anchored in a three-pronged strategy including:

  • Stronger alignment between the 12 agencies that each operate large bureaucracies with their own goals, priorities and budgets;
  • Common milestones on progress for some 50 health-related SDG targets and indicators covering both infectious and noncommunicable diseases, as well as health risks related to poor nutrition and polluting energy sources in workplaces and in cities, such as air pollution;
  • Accelerated action in 7 thematic areas that offer special opportunities for rapid change, including: primary health care; sustainable finance; R&D and innovation; civil society engagement; action on environmental risks and commercial drivers of ill health (e.g. tobacco, alcohol & sugar); data and digital health; and innovative programmes for fragile states.

Originally initiated by the governments of Ghana, Germany and Norway, some 12 global health agencies signed a commitment in October 2018 to work together on the plan – a precedent in its own right. Those agencies included, Gavi, the Vaccine Alliance, the Global Financing Facility (GFF), the Global Fund to Fight AIDS, TB and Malaria, UNAIDS, UNDP, UNFPA, UNICEF, Unitaid, UN Women, World Bank Group, World Food Programme and WHO.

Donor countries reasoned that a better division of labour between this broad panoply of actors would presumably lead to greater efficiencies on the ground. That, in turn, would generate savings so that funds can accomplish more. It would also accelerate action in areas where progress is seriously lagging on ambitious SDG targets for dramatically reducing mortality from leading infectious and non-communicable diseases, as well as from health risks such as poor nutrition, unhealthy workplaces, unsafe drinking water, climate change, unsustainable urban growth and air pollution.

Some Elements of the Plan May Be More Advanced Than Others

UN insiders say that different agencies have approached the so-called GAP planning process with varying levels of knowledge, enthusiasm, and zeal. The results are apparent in the initial discussion drafts online now for public comment.

Some of those papers describe a detailed consultation process; metrics on the status quo; practical action points for moving ahead; and case studies of good practice. Others lack detail on the consultative process as well as a clear outline of the biggest risks and action points. For instance, a paper on “determinants of health,” led by UNDP and UN Women, passes over the health burden caused by urban environmental health risks such as air pollution, physical inactivity, and traffic injury, which health sector actors including WHO have said are central to confronting the non-communicable disease epidemic faced by an urbanising world.

Queried about this, UNDP, one of the leaders of the draft, was frank in acknowledging that the papers remain works-in-progress, where public comments may also help fill existing gaps and holes.

“UNDP fully agrees that unsustainable urbanization poses significant challenges to health and well-being,” said a UNDP spokesperson in response to a query. “This draft plan identifies environmental determinants as one of three priority areas needing more attention because of the increased understanding of threats such as air pollution on non-communicable diseases, and the pressing priority to focus on clean energy for health. In fact, UNDP and WHO recently launched an initiative to bring the health and energy sectors closer together to advance health.

“This plan is currently in draft form and open for public comments and we very much welcome feedback,” the UNDP spokesperson added. “We can aim to be more explicit in our reference to the potential for urban solutions, including for example through improvements in public transportation, to have multiple co-benefits for health – to reduce traffic injuries and be a positive contribution to climate action.”

At the other end of the scale, other “accelerator” themes have been approached with a sense of extreme urgency – as per a recent Wellcome Trust op-ed on the theme of Research & Development, Innovation and Access entitled “We’ve only got ten years left and no, I’m not talking about climate change.”

Wellcome Trust, together with WHO, led the work on this 10 page brief that aims to explore how R&D for critically needed diagnostics and medicines can be advanced more rapidly and also available more equitably in countries. The paper describes a process of country-based workshops and case studies to build a profile of existing gaps and needs, and concludes with an outline of 5 strategic goals, supported by key proposed actions, with ideas including: a global standard of “good access practices” for how public and private R&D investments will be designed to ensure availability, affordability and access; shifting public-sector co-funding for innovation to more countries and regions; creating a WHO clearinghouse of innovations ready to be scaled-up; and promoting country-led forums on R&D as well as an annual global forum to review, update and advance health products in the pipeline.

Asked by Health Policy Watch why such actions would make a difference, Alex Harris, Head of Global Policy at Wellcome said:

“During our 6-month consultation, a diverse group of consultees agreed that the most pressing issue we face is a lack of coordination and alignment. These five actions will ensure better alignment of global research and innovation for health systems with national research and health priorities. It sounds simple, but if we can implement these actions, then I believe our limited resources can be more efficiently and effectively directed to have the greatest impact on health over the next 10 years.”

Harris added that a number of the proposed actions are also “specifically designed to place country policy-makers’ and patients’ needs at the heart of research and innovation decision-making. They will alter the dynamic between global and local actors and contribute towards a positive shift in the centre of gravity for R&D and innovation.”

Harris, one of the champions of the GAP, agrees however that the process will only have an impact if it goes beyond the September launch of the fully-developed plan.

“We will have to work hard to ensure that the GAP continues to focus minds,” he said. “The danger is that following the launch we revert to business as usual. If we are to accelerate progress towards 2030, then we should be making tough decisions about how we will work differently and more effectively with one another to have greater impact. I’m looking forward to the launch at UNGA and working on making the GAP actions a reality.”

Image Credits: WHO.

Gavi, the Vaccine Alliance, just finalised its new strategic plan for 2021-2025, which aims to reach communities missed by previous immunisation efforts, including those most marginalised by poverty, geography and conflict. It also prioritises sustainability of vaccine programmes through co-financing arrangements with countries to build domestic investment in health and reduce reliance on Gavi funding.

“For the next five-year period equity will be the Alliance’s key guiding principle,” said Dr Ngozi Okonjo-Iweala, Chair of the Gavi Board, quoted in a Gavi press release. “This will mean focusing on those left behind, whether they be girls and women, refugees or remote communities, to ensure nobody goes without lifesaving vaccines.”

“With this new strategy we will make the millions of children around the world who are missing out on vaccines our absolute priority. By bringing immunisation to these missed communities the Alliance will also be extending primary health care systems, building a foundation for Universal Health Coverage,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance.

“[T]he 2021-25 period will mean new vaccines, new technologies and new approaches to help build healthier, wealthier communities across the developing world,” Berkley said, adding that this will bring “all the economic benefits that come with a healthier population.”

The Gavi Board yesterday approved the new strategy at the close of its latest meeting, which took place in Geneva from 26-27 June, according to the release.

The new strategy, “anchored in the Sustainable Development Goals” and “echoing its driving mission to leave no one behind,” is the culmination of 18 months of consultations with stakeholders. It will target four goals to increase the equitable and sustainable use of vaccines:

  1. To introduce and scale-up vaccines
  2. Strengthen health systems to increase equity in immunization
  3. Improve sustainability of immunisation programmes
  4. Ensure healthy markets for vaccines and related products

Since 2000, Gavi has greatly expanded the scope of its work, supporting countries to introduce more than 400 new and under-used vaccines. Gavi initially supported vaccines protecting against six infectious diseases, but by 2025, this number is expected to increase to at least 18. Over the next 5 year period, Gavi will also support vaccines to tackle outbreaks of infectious diseases such as Ebola, cholera and typhoid, and will increase its role in fighting antimicrobial resistance, the release said.

While “Gavi-supported countries reached a record 64 million children with a full course of basic vaccines in 2017, up from 41 million in 2000,” there are “still as many as one in ten children in Gavi-supported countries [that] receive no routine vaccines,” it said. To address this, Gavi is focusing its new strategy on closing this gap, including through innovative service delivery, strengthening primary care, and addressing gender-related barriers.

Co-Financing for Sustainability

In the new plan, Gavi will continue its co-financing arrangements with countries. These arrangements maximise the reach of Gavi funding while supporting countries to build domestic investment in health, particularly towards strengthening primary care systems, which are essential for effective vaccine programmes. As low-income countries become wealthier, they are expected to increase their proportion of financing, and to ultimately transition away from Gavi funding to self-finance their vaccine programmes.

“From 2011 to 2018, countries have increased the amount they themselves spend on Gavi-supported vaccines from US$ 36 million to US$ 475 million, and 19 countries are expected to have transitioned out of Gavi support completely by 2020,” according to the release.

At their meeting earlier this week, the Gavi Board requested that Gavi also “explore approaches to engaging with self-financing lower middle-income countries in recognition of major challenges in those countries.”

To further global efforts towards eradicating polio, the Board agreed to a new cost-sharing approach for inactivated polio vaccine (IPV). “Gavi will fully-finance the vaccine for the very poorest countries, however other countries which receive Gavi support for IPV will need to use the amount they currently spend on bivalent oral polio vaccine (bOPV) – roughly US$ 0.60 per child – for IPV once bOPV is withdrawn after eradication is certified.”

In an exception to their co-financing rule, the Gavi Board also approved an extension of Papua New Guinea’s transition from Gavi funding, extending it from 2020 until the end 2025, in light of particular challenges the country is facing with recent outbreaks of polio and measles, despite its considerable economic growth. “The Board therefore agreed that this exceptional situation warranted an extension to the country’s transition, subject to the government setting out and committing to reforms to the health sector,” the release said.

All of these plans set out in the strategy depend on Gavi’s successful replenishment for the 2021-2025 period, beginning with a high-level event hosted by the Japanese government in August 2019 at which Gavi will launch its call for investment, and culminating at a pledging event in London in summer 2020. Successful replenishment will enable Gavi to provide predictable financing for both vaccine manufacturers and implementing countries throughout the five year period.

Image Credits: Gavi, the Vaccine Alliance.