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Dear Colleagues,
Next Monday (6 September), the new flagship report from the Alliance for Health Policy and Systems Research, “Learning health systems: pathways to progress”, will be launched in a webinar. Focus:health systems strengthening through a learning lens. A teaser perhaps: “Learning health systems are those that make the link between past actions, the effectiveness of those actions, and future actions. Learning is a forward-looking and actionable lens through which to view the strengthening of health systems, building on existing frameworks, and linked to the agendas of improved equity, efficiency, resilience, people-centredness, self-reliance and improved quality. The importance of learning is increasingly pronounced in the current context, with the growing focus on the abilities of health systems to respond to pandemics, to transition from foreign aid to domestic funds, and to capitalize on the information revolution to achieve their goals.” Makes sense.
Between you and me, though, given the current state of the world, I also hope for a “learning” global health architecture sooner rather than later, properly taking into account the need to Decolonize & Democratize Global Health, planetary health ( plus “aligning” economic system), the social, commercial & political determinants of health, global tax justice,… you name it. Throwing in some top notch “double-loop” and even “triple-loop learning” 😊. Unfortunately, such a global health architecture isn’t on the horizon yet. Nor are current geopolitics helping much, or some of our European leaders and Pharma CEOs, greatly skilled in ‘smoke & mirrors’ “global solidarity” (borrowing a term from Els Torreele on Twitter). Although at least a few of these seem to believe their own rhetoric.
Anyway. A few crucial months are coming up now. While global health security (& related governance) discussions are gaining momentum in Geneva and elsewhere, on Wednesday, the WHO Hub for Pandemic and Epidemic Intelligence was inaugurated in Berlin. Continuing in our ‘learning mode’, ‘Collaborative intelligence’ seemed the watchword there.
In the run-up to a global Covid summit in conjunction with UNGA (or so we hope – ugh),an urgent call was – again – launched to finally come up with a comprehensive global vaccine plan for the entire world. Last weekend, Devi Sridhar, signalling that charity [read: COVAX] has failed, already summarized what should be done instead, in a Guardian op-ed. Speaking of charity’s rather lousy “track record”, on Tuesday, former co-chairs of the Independent Panel for Pandemic Preparedness and Response called on high-income countries to urgently deliver on their pledged COVID-19 vaccine doses to low- and middle-income countries: instead of 1 billion doses (as advocated by the panel), only 99 million doses donated have been shipped via COVAX — of which 89 million doses to the 97 COVAX AMC countries, by Sept 1. Less than 10 %, in other words. End of last week, the heads of the Multilateral Leaders Taskforce on COVID-19 had already issued a similar call to “finally” tackle the vaccine inequity crisis in a decisive way. Let’ s hope Biden, Bourla and others pay attention to these various desperate calls. It certainly won’t be for a lack of them.
Enjoy your reading.
Kristof Decoster
https://www.devex.com/news/what-s-going-on-between-african-nations-and-the-eu-100658
“…. More than a 1 ½ year after her trip [i.e. Ursula von der Leyen’s trip to Addis Abeba, AU capital] and despite the commission’s release of a comprehensive strategy for Africa early last year, that partnership [“between equalz] has yet to flourish. A high-level AU-EU summit scheduled for October 2020 has repeatedly been stalled, even as African leaders have strengthened ties with other global powers, particularly China. The COVID-19 pandemic contributed to derailing the European Commission’s efforts, but experts said there may also be a disconnect between the priorities of the two continents, with Europe focused on climate change and migration and Africa determined to end the COVID-19 pandemic and jump-start its economies. There is also a discomfort with Europe’s attempts to dominate the relationship, especially at a moment when other investors are lining up….”
“… The global response to COVID-19 has only exacerbated any divisions. As Europe has charged ahead of much of the rest of the world in securing and administering vaccines, its leaders are at the forefront of blocking the effort spearheaded by South Africa and India within the World Trade Organization to waive intellectual property protections on COVID-19 vaccines and other tools. “How the EU and Africa cooperate on health, on the vaccine rollout in Africa have become really, really key political questions,” said Chloe Teevan, a policy officer in the European External Affairs program at the European Centre for Development Policy Management….”
S Dixon-Declève, J Antonio-Campo et al ; https://www.project-syndicate.org/commentary/the-world-needs-a-food-systems-stability-board-by-sandrine-dixson-decleve-et-al-2021-08
« The absence of a Food Systems Stability Board is a notable gap in the global governance architecture needed to bolster sustainability and resilience. By agreeing to launch consultations regarding the creation of such a body, governments could contribute to a better future for hundreds of millions of highly vulnerable people. »
« … A quartet of international meetings – the UN Food Systems Summit in September 2021, the G20 summit in October, the UN climate conference (COP26) in November, and the Nutrition for Growth Summit hosted by the Japanese government in December – offer a rare opportunity to focus international attention on the hunger and food-security crisis, and its links to the changing climate. Each of these gatherings could pave the way for the creation of an FSSB of national governments and international organizations working to address this issue. This could be part of a broader global effort to enhance food governance and achieve – in the words of the government of Indonesia, which will hold the G20 presidency in 2022 – a “just and affordable transition toward net zero.”…”
“The United Kingdom has lost more than 200 development professionals since last year’s merger of the Department for International Development and the Foreign & Commonwealth Office, Devex has learned….”
D Fidler; https://www.thinkglobalhealth.org/article/pandemics-pathological-politics-and-international-order
David Fidler’s review of "Aftershocks: Pandemic Politics and the End of the Old International Order" (by Kahl & Wright).
· PS: Via Twitter: Matthew Kavanagh will “serve as Special Advisor to Winnie_Byanyima @UNAIDS for the coming year. On temp leave from teaching @Georgetown to support transformative policy & knowledge work of new Global AIDS Strategy.”
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00252-X/fulltext
By C C Tan et al.
IJHPM - Health Coverage and Financial Protection in Uganda: A Political Economy Perspective (by some Italian authors).
https://www.politico.com/news/2021/08/30/hhs-unveils-office-climate-change-507603
“”…The [US] federal health department is creating a new office to address climate change as a public health issue, in an effort to tie growing environmental concerns to the administration’s broader health equity agenda. The Office of Climate Change and Health Equity will take a wide-ranging approach to evaluating the impact that the warming planet is having on people’s health, including initiatives aimed at reducing health providers’ carbon emissions and expanding protections to the most vulnerable populations….”
“When Algerian service stations stopped providing leaded petrol last month, this marked the successful end to a global campaign to eliminate this “major threat to human and planetary health”. Celebrating the official end of the use of leaded petrol on Monday, United Nations Secretary-General Antonio Gutteres said that when the global campaign to eliminate the use of tetraethyllead (TEL) as a petrol additive started in 2002, 117 countries were still using TEL. “Today, there are none. Lead in fuel has run out of gas, thanks to the cooperation of governments in developing nations, thousands of businesses, and millions of ordinary people,” said Gutteres in a video message….”
“The UN Environment Programme (UNEP), which led the campaign, said that the same approach to TEL elimination should also be applied to eliminating fossil fuels….”
See also the Guardian – Leaded petrol era ‘officially over’ as Algeria ends pump sales
And the Guardian - Make historic campaign to ban leaded petrol ‘blueprint to phase out coal’, says UN
“… research finds small rise in exposure to air pollution leads to higher risk of needing treatment…”. Coverage of a new study published in the British Journal of Psychiatry.
“Between a third and half of the world’s wild tree species are threatened with extinction, posing a risk of wider ecosystem collapse, the most comprehensive global stocktake to date warns. Forest clearance for farming is by far the biggest cause of the die-off, according to the State of the World’s Trees report, which was released on Wednesday along with a call for urgent action to reverse the decline….”
https://news.un.org/en/story/2021/09/1098662
“Climate change and increasingly extreme weather events, have caused a surge in natural disasters over the past 50 years disproportionately impacting poorer countries, the World Meteorological Organization (WMO) and UN Office for Disaster Risk Reduction (UNDRR) said on Wednesday. According to the agencies' Atlas of Mortality and Economic Losses from Weather, Climate and Water Extremes, from 1970 to 2019, these natural hazards accounted for 50 per cent of all disasters, 45 per cent of all reported deaths and 74 per cent of all reported economic losses. There were more than 11,000 reported disasters attributed to these hazards globally, with just over two million deaths and $3.64 trillion in losses. More than 91 per cent of the deaths occurred in developing countries. But the news is far from all bad. Thanks to improved early warning systems and disaster management, the number of deaths decreased almost threefold between 1970 and 2019 - falling from 50,000 in the 1970s to less than 20,000 in the 2010s. the report explains….”
https://www.brettonwoodsproject.org/2021/08/imf-surveillance-and-climate-change-transition-risks/
“New analysis by ActionAid USA and the Bretton Woods Project finds that IMF policy advice has undermined a just energy transition since that Paris Agreement was signed..”
M Viera, S Moon et al ; https://f1000research.com/articles/10-190/v2
“The past two decades have witnessed significant growth in non-commercial research and development (R&D) initiatives, particularly for neglected diseases, but there is limited understanding of the ways in which they compare with commercial R&D. This study analyses costs, timelines, and attrition rates of non-commercial R&D across multiple initiatives and how they compare to commercial R&D….”
Conclusions: “The quantitative data suggest that costs and timelines per candidate per phase were largely in line with (lower-end estimates of) commercial averages. We were unable to draw conclusions on overall efficiency, however, due to insufficient data on attrition rates. Given that non-commercial R&D is a nascent area of research with limited data available, this study contributes to the literature by generating hypotheses for further testing against a larger sample of quantitative data. It also offers a range of explanatory factors for further exploration regarding how non-commercial and commercial R&D may differ in costs and efficiency.”
“Johnson & Johnson (JNJ.N) said on Tuesday its experimental vaccine failed to provide sufficient protection against HIV in sub-Saharan Africa to young women who accounted for a large number of infections last year. The results from the mid-stage study are the latest setback to efforts to develop a vaccine to prevent HIV or human immunodeficiency virus…”
See also Stat News - Johnson & Johnson’s HIV vaccine fails first efficacy trial
PS: the vaccine was based on the same adenovirus design that J&J uses for its COVID-19 vaccine and supported by the Gates Foundation, among others.
https://www.devex.com/news/ebola-case-reported-in-cote-d-ivoire-was-false-positive-who-says-100692
“The World Health Organization on Tuesday walked back its declaration of an Ebola outbreak in Côte d'Ivoire after an additional laboratory examined the patient’s samples and found no evidence of the virus. … … the Institut Pasteur in Lyon, France, took a second look at the samples and found she tested negative for Ebola. “Further analysis on the cause of her illness is ongoing,” according to WHO….”
And on WHO’s “no regrets policy”: “No regrets: Guinea declared an end to a four-month-long Ebola outbreak in June. After the supposed case in Côte d'Ivoire was announced in mid-August, 5,000 vaccines were transferred from Guinea to Côte d'Ivoire for use by health workers, first responders, and those who had been in contact with the woman. WHO also released $500,000 from its Contingency Fund for Emergencies. The agency calls this its “no-regrets” policy, in which it launches into response mode “before all the dimensions and consequences of an emergency or outbreak are known with the aim of saving as many lives as possible.”
Links:
The Conversation - The first human case of Marburg virus in West Africa is no surprise: here’s why
Global Health Research & Policy - A systematic review of qualitative literature on antimicrobial stewardship in Sub-Saharan Africa
M Dhimal et al ; https://www.tandfonline.com/doi/full/10.1080/16549716.2021.1963069
“Nepal adopted the Multisectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (MSAP) in 2014. Implementation of the plan has been challenging, with limited participation from non-health sectors. The overall aim of the study was to gain the perspectives of key stakeholders involved in the Nepal MSAP on the barriers and facilitators to its implementation, through the participation of relevant sectors in the plan….”
And via Stat News: Salt substitute gains traction in new large [NEJM] study
“…. We … know low-salt diets and potassium supplements can lower blood pressure. Until now, there was no gold-standard evidence for trying a salt substitute that replaces part of the sodium chloride with potassium chloride. A large, randomized clinical trial tested the salt substitute in about 21,000 people in rural China with poorly controlled blood pressure who had a history of stroke or were 60 or older. After five years, people who took the salt substitute had significantly lower rates of cardiovascular disease or death compared to people who used regular salt, with no apparent serious side effects. “Wider effectiveness is hard to predict” beyond China, an editorial notes….”
Links:
SS&M - Global collective action in mental health financing: Allocation of development assistance for mental health in 142 countries, 2000–2015 (by V Iemmi)
Lancet Oncology - The UK's contribution to cancer control in low-income and middle-income countries
From the Lancet Oncology Series - Global cancer control networks “In this Series, Danielle Rodin and colleagues and Susannah Stanway and colleagues outline the rationale and impetus behind the development of national global cancer control networks in Canada and the UK, respectively, to create a formal structure and coordinated strategy for collaboration with LMICs in global cancer control….”
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00388-0/fulltext
Comment linked to a new Lancet GH study - What’s needed to improve safety and quality of abortion care: reflections from WHO/HRP Multi-Country Study on Abortion across the sub-Saharan Africa and Latin America and Caribbean regions
“The addition of the hormonal intrauterine device to the product catalogue of the US Agency for International Development is a game changer that will allow millions more women in low-income and middle-income countries (LMICs) to have access to a highly effective, long-acting reversible contraceptive method, albeit two to three decades after their counterparts in Europe and the USA. Already, the International Contraceptive Access Foundation in Nigeria and the Expanding Effective Contraceptive Options project in Zambia have been working with partners to introduce the hormonal intrauterine device in both private and public sector outlets, as well as mobile outreach systems. However, given the high unmet need and growing demand for modern contraception in both countries, these efforts have just scratched the surface. …. … research on long-acting reversible contraceptives in LMICs remains scarce, and hence the study by Aurélie Brunie and colleagues reported in The Lancet Global Health is a valuable contribution, given the drive to scale up hormonal intrauterine device use….”
“…. To understand how these disadvantages—and adolescents’ abilities to respond to them—intersect to shape opportunities and outcomes, this Special Issue draws on the Gender and Adolescence: Global Evidence conceptual framework which accounts for gender roles and norms, family, community and political economy contexts in shaping adolescents’ capabilities. Implicitly critiquing a focus within youth studies on individual agency, the articles advance our understanding of how adolescents’ marginalisation is shaped by their experiences, social identities and the contexts in which they are growing up. An analytical framework foregrounding intersectionality and collective capabilities offers a means to politicise these findings and challenge uncritical academic celebration of individual agency as the means to address structural problems….”
Link:
D Gotham et al ; https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0256883
Cfr tweet: “The public sector invested >$250m developing underlying tech & @CepheidNews 's GeneXpert platform+assay Their key role stands in contrast to the lack of public sector ability to secure affordable pricing/maintenance agreements. "
« The paper examines three decades of the history of patents and pandemics that begins with the HIV/AIDS pandemic and TRIPS. This history demonstrates that the patent system is itself a huge source of risk when it comes to managing the risks of pandemics. From this history ten core lessons are extracted. The central message of the paper is that developing countries will have to focus on collaborations among themselves with the aim of building a wide base of rich manufacturing experience in the production of medicines and therapies. They can expect no priority of treatment under the present patent-mediated response to pandemic.”
https://apps.who.int/iris/bitstream/handle/10665/344562/9789240033863-eng.pdf
“The Global strategic directions for nursing and midwifery (SDNM) 2021-2025 presents evidence-based practices and an interrelated set of policy priorities that can help countries to ensure that midwives and nurses optimally contribute to achieving universal health coverage (UHC) and other population health goals. The SDNM comprises four policy focus areas: education, jobs, leadership, and service delivery. Each area has a “strategic direction” articulating a goal for the five-year period, and includes between two and four policy priorities…..”
D Russell et al ; https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-021-00643-7?utm_source=dlvr.it&utm_medium=twitter
Focus on HICs in this article.
https://www.vox.com/22632695/long-covid-19-vaccines-delta-variant-pandemic
Check it out.
https://www.devex.com/news/deep-dive-is-covid-19-vaccine-equity-a-pipe-dream-100588
Neat overview of the state of affairs on various vaccine equity fronts, as of late last week.
V Haldane et al ; https://gh.bmj.com/content/6/8/e006406
“….This study describes the process of adapting and developing role-specific guidelines for comprehensive COVID-19 infection prevention and control in low-income and middle-income countries (LMICs)….” “….Based on key lessons learnt, we synthesise a novel set of principles for developing guidelines during a public health emergency. The SPRINT principles are grounded in situational awareness, prioritisation and balance, which are responsive to change, created by an interdisciplinary team navigating shared responsibility and transparency.”
https://www.theguardian.com/world/2021/sep/01/covid-toxic-divides-could-shape-europe-years-study
“Radically different experiences of the Covid-19 pandemic have created toxic geographical, generational and societal divides across Europe that could shape the continent’s politics for years to come, according to a study. Research by the European Council on Foreign Relations based on polling in 12 EU states shows a “tale of two pandemics and two Europes”, with the past 18 months taking a vastly different toll on regions, age groups and individuals in the bloc…..”
Vaccination reduces risk of long Covid, even after breakthrough infection. Some of the early evidence on this important issue. “People who are fully vaccinated against Covid-19 appear to have a much lower likelihood of developing long Covid than unvaccinated people even when they contract the coronavirus…”
L de Vries et al ; https://gh.bmj.com/content/6/9/e006597
“ Additional investments in infectious disease surveillance are preferably based on sound economic evaluations considering the specific characteristics of infectious disease surveillance, however, a framework for cost-effectiveness analyses capturing the specific characteristics is yet non-existent….”
Links:
· Telegraph - Red tape keeps Covid vaccine out of reach for nearly 4m undocumented migrants across Europe
· FT – GSK hopes for vaccine success as new shot enters late-stage trial
https://www.economist.com/china/2021/08/28/african-swine-fever-is-spreading-rapidly-in-china-again
“The country has kept covid-19 in check, but its pigs are dying in droves.”
https://www.cgdev.org/publication/challenge-reallocating-sdrs-primer
By M Plant.
https://www.devex.com/news/the-wash-sector-s-biggest-enemy-corruption-100663
“Cities must address corruption and integrity failures if they’re to achieve the Sustainable Development Goal 6 on clean water and sanitation for all. That’s the message coming from the new Water Integrity Global Outlook 2021. … As it stands, over 14% of the urban population lacks access to safe drinking water and 38% doesn’t have safely managed sanitation. According to the report — which was produced by WIN — efforts to reduce those numbers are being jeopardized by the mismanagement of WASH project funding, inflated water prices, kickbacks, and sextortion. In fact, the report estimates that between 6% and 26% of total WASH expenditure is lost to corruption on a yearly basis. If the annual cost to meet SDG 6 sits at $114 billion that means a loss of between $6.8 billion and $30 billion…”
For more on World Water Week 2021, see also Devex - 3 takeaways from World Water Week 2021.
“ Search engines that highlight key papers are keeping scientists up to date.”
https://www.nature.com/articles/d41586-021-02385-x
“The ZyCoV-D vaccine heralds a wave of DNA vaccines for various diseases that are undergoing clinical trials around the world.”
Links:
· Critical Public Health - ‘Open’ relationships: reflections on the role of the journal in the contemporary scholarly publishing landscape