Breaking News: Link 189

Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings


Breaking News: Link 189


Nations sign historic Paris climate deal 

Is divesting from fossil fuels the best tactic for tackling climate change? 

EU court overturns carbon market free quotas in blow for big polluters 

Can Funders Help Filmmakers Connect With the Public on Climate Change? 

Mary Robinson on climate and development 

Ipaishe’s call to climate action  

The global land rights struggle is intensifying 

Malaria: TDR news and events 

Putting the pieces together for malaria eradication 

Countries on verge of beating malaria face new threat, study says 

Malaria: New research promises to ease access to ASAQ and ASMQ treatment  

WHO says Europe should prepare for Zika virus 

On Zika Preparedness And Response, The US Gets A Failing Grade 

From Ebola to Zika: What we’re learning about global health crises 

What role for DNDi in hepatitis C? 

Drugs for Neglected Diseases initiative and Pharco Pharmaceuticals to test affordable hepatitis C regimen with support of Malaysian and Thai governments 

Hepatitis C: Current barriers to treat patients and DNDi’s R&D strategy to address urgent needs 

ViiV Healthcare, Medicines Patent Pool Extend Licence for Dolutegravir to all Lower Middle-Income Countries 

TB Alliance and the Medicines Patent Pool Sign Memorandum of Understanding to Improve Access to TB Medicines in Resource-Limited Nations 

Surprise! Much Work Being Done On Transparency Of Patents On Medicines 

Biolyse Pharma offers to supply enzalutamide (Xtandi) for $3 per pill to Medicare and developing countries 

Medicines Supply Chains in Low and Middle Income Countries: Time to Reconsider Them 

May 10, 2016 UNPO Announces Washington Conference: “Land of Forsaken Voices: The Geopolitics of Justice, Impunity and Human Rights in Balochistan” 

Human Rights Reader 385 

Why Africa’s HIV crisis continues to devastate young women 

Listening to Africa 

Millions saved: new cases of proven success in global health 

Illicit Financial Flows (IFFs) 

King’s College, USA: 2nd International Healthcare Management Conference (IHMC) October 11 to 14, 2016 

Two Mega Funders Take Aim at Adolescent Sexual and Reproductive Health in Africa 

ATTAC – Aim to Terminate Tobacco And Cancer – Society: Interview

China tops new donor list as poorer countries enter ‘age of choice’ in development finance 

China’s New Foreign NGO Law Is Threatening Vital Advocacy Work 

Vaccine development needs global alliance 

ATTAC – Aim to Terminate Tobacco And Cancer – Society

PEAH is pleased to interview Dr. Sumedha Kushwaha and Dr. Manasvi Bawa Behl, as the General Secretary/Founder and the President of ATTAC - Aim to Terminate Tobacco and Cancer - Society

IMG-20160330-WA0014 Dr. Sumedha Kushwaha General Secretary/Founder Manasvi Bawa Behl

Dr. Manasvi Bawa Behl President

 ATTAC – Aim to Terminate Tobacco and Cancer – Society



PEAH: Dr. Sumedha, what does ATTAC commitment mean?

Dr. Sumedha: Established in August 2014 ATTAC (acronym for  Aim to Terminate Tobacco And Cancer) is a healthcare-based non- governmental, not-for profit Indian registered organisation committed to well-being of the humanity by providing a community-based oral-cancer screening and a tobacco-cessation program. Health and disease are truly international subjects. There are no boundaries of suffering for the humankind in any way.
Globally, tobacco, in all its forms, is a menace that has disrupted the socio-economic fabric of our country obstinately. It not only has devastating effects on the mankind but also cuts across all age-groups, genders, cultures, regions or religions, irrespective of anybody’s socio-economic status. Its consumers/users succumb to its addiction and accept it as a part of their lifestyle.
There are myriad cancerous and pre-cancerous lesions associated with tobacco consumption; hence, correct diagnosis at the correct time becomes essential to a good prognosis.

This is an era of shift in the spectrum of diseases from communicable to non communicable ones. Our focus is sync with that change. Along with this we understand that there is a world of facilities for health care problems and there is population to be served. We want to be the link between the two worlds.

PEAH: In general terms, what about your mission?

Dr. Sumedha: While collaborating with other parallel organizations, ATTAC strives to help attain a happy, creative and healthy human being whose health is protected and honored in society that is built on respect for dignity, justice and cure for all.


PEAH: Relevantly, can you tell us about the pillars of ATTAC engagement?

Dr. Sumedha: They can be summed up in deeply entwined practices:


Spread Awareness as a basic tool to make every one aware regarding the ill effects of both smoking and smokeless tobacco on health. Also, lending a hand for making information about various communicable and non communicable diseases available to the general population like signs and symptoms of various cancers, diabetes, hypertension etc.

Empowerment, to enable and empower all citizens (children, adolescents, adults and old) regardless of their socio-economic strata to quit tobacco in all forms. We also practically teach people about various diseases. Example for women- how to self examine for breast cancer/ to check for menstrual problems or cervical cancer, in men- how to see for signs of of prostate/oral cancer, we teach children how to keep their oral hygiene proper and wash hands effectively, we teach young mothers how to make ORS at home and focus on nutrition of the child, as for adults we tell them about various geriatric problems.


Caution, whereby we make people aware about second and third hand smoking in children and women. This is one of the most serious concern , we make sure risks and solution is understood easily.

Strategy and Assistance, whereby we provide health education through charts, audio-visual aids, self-help booklets, community based counselling sessions for various diseases. We have also gained assistance and support from smokers who have already quit and create a group called the ex-smokers group , who pro- actively take part in our camps.

ATTAC has opened a facility for low cost diagnostic tests and tied up with various health care facilities for subsidized treatment. Our focus is majorly prevention and early diagnosis of diseases because we understand that if diseases are detected at their initial stages, the per capita expenditure is reduced grossly. Therefore, unburdening the health care systems.

Follow up with Cure, that is one of the most integral part of ATTAC society. We follow up cases by the help of telephone calls, SMS, E-mails and short appointments. We believe that reinforcement is an important part of the entire treatment strategy and we should do that in order to attain best results.

PEAHWhat’s your say when it comes to the challenges organisations like ATTAC face in the developing world?

Dr. SumedhaIt is an irony that where a major chunk of the world population stays, least amenities are available. The gap between rich and the poor in this part of the world is gross, patients after initial screening provided by us for free, if are diagnosed to be positive, find the cost of treatment, a major hurdle. It becomes a struggle for the patients to afford the high cost of medicines, stay at hospitals and travel & accommodation near tertiary health care facilities.We, as an organization are looking forward to distribution of low cost medicines to patients, so that health care becomes a daily commodity for these patients rather than a far fetched dream.

PEAH: Dr. Manasvi, please detail regarding ATTAC’s field service model

Dr. Manasvi:  We conduct various types of camps/seminars to uproot deeply rooted vice:

 Five-day oral-cancer screening and tobacco-cessation program for both public, private sector, corporate and multinational organizations
Three-day workshop for schools and colleges to disseminate knowledge among students regarding the ill effects of tobacco consumption
Community-based camps on weekly basis.

ATTAC at Work 1

A holistic model- including presentations, one to one counseling/conversations and QnA quizzes- is prepared to enhance participation of otherwise reticent participants.
This program also reaches out to school children, who are the most susceptible as they fall in the inception stage of this vice, and for whom we organize  competitions, group discussions, and stage shows in various schools on regular basis.


We have around 5 tobacco cessations centers which can assist anyone who is ready to fight against cancer and tobacco.  These centers serve special assistance and consulting sessions along with medication if required.

PEAH: How has ATTAC vision been evolving since foundation?

Dr. Manasvi:  We started humbly as being just a healthcare based non – governmental organisation committed to well- being of the humanity. However, while working solely for the health based cause, we realised that health was a more complex issue and could not have been tackled without having a multi sectoral approach. Our vision broadened and we started to collaborate with other parallel organisations in the fields of hygiene and sanitation, education, skill development and women equality as well.


We believe in being in the field more than spending our time in the office. We do weekly camps wherein we reach the masses in the rural area and urban slums, schools, orphanages, old age homes, de-addiction centres to touch their lives in some form or the other (free health-checkups, providing education on health and hygiene). Our vision is not only a Pan India Organisation, but to make people understand that health and disease are international issues. Hence, the organisation wants to spread its wings globally.


ATTAC received “PRIDE OF INDIA” award for its contribution in the field of public health in the year 2015.

PEAH: Thank you Dr. Sumedha and Dr. Manasvi for your upfront vision and highly commendable engagement

Medicines Supply Chains in Low and Middle Income Countries: Time to Reconsider Them

In LMICs where access to medicines is essential to guarantee the health systems’ capacity to address people’s health needs, the inefficient fragmentation of supply chains is one of the main factors that increase the costs of medicines. Introducing a pre-wholesaler could help improve this inefficiency and reduce costs

Alex Henriquez

by  Alex Henriquez

Msc. Health Systems and Public Policy at the University of Edinburgh

Medicines Supply Chains in Low and Middle Income Countries: Time to Reconsider Them


In addition to the burden of ill-health caused by communicable and infectious diseases, populations from low and middle income countries –LMICs– have also started to face the increasing burden of poor health caused by non-communicable diseases –NCDs– (Yadav and Smith, 2014). This is especially concerning considering that by 2012 the NCDs mortality rate in low and middle income countries was higher compared to that in high income countries, 625 per 100000 population and 397 per 100000 population respectively (WHO, 2014).

Under such reality, the availability, affordability and quality of medicines should be considered prioritised aspects of national health systems. However, the reality is bleak and, paradoxically, access to medicines in low and middle income countries is mostly mediated by people’s willingness and ability to pay (Yadav and Smith, 2014). Furthermore, the cost of medicines in LMICs is considerably higher due to the modus operandi of pharmaceutical distribution networks (Yadav, 2015).

Cameron et al (2009) emphasise the organisation of a country’s pharmaceutical industry as an important aspect that determines medicines availability and affordability. Yet, this is a major challenge in LMICs where drug supply chains are excessively fragmented (Yadav and Smith, 2014). In LMICs there exist too many intermediaries between the manufacturer and the patient, none of which possess a reliable nationwide distribution network (Yadav and Smith, 2014). High mark-ups between different wholesalers increase the cost of medicines, preventing larger proportions of the population from accessing them (Yadav and Smith, 2014). In Mozambique, for example, the segmentation of the pharmaceutical market coupled with the diversification of wholesalers/suppliers enabled importers and retailers to increase the costs of medicines and make abnormal profits in spite of existing price regulations (Russo & McPake, 2009).

Yadav and Smith (2014) propose creating a pre-wholesaler as a solution to increase the availability of medicines and reduce their costs. A pre-wholesaler would be act as the contact point between different manufacturers and all national wholesalers. Although highly fragmented supply chains usually lead to higher medicines costs, creating a pre-wholesaler operation could help organise and aggregate a fragmented supply chain because pre-wholesalers improve the supply chain efficiency by reducing the sales between wholesalers (Yadav and Smith, 2014). Moreover, pre-wholesalers allow manufacturers to distribute their product to multiple wholesalers and achieve market penetration without adding any extra costs (Yadav and Smith, 2014). Preferably, any pre-wholesaler should be publicly managed to prevent the private sector from profiting excessively due to monopoly power.

Although Yadav (2015) also proposes to reduce the number of tiers in the supply-chain as an alternative to a pre-wholesaler, it is important to consider that many LMICs, unlike developed countries, lack nationwide distribution networks (Yadav and Smith, 2014). Therefore, reducing the number of tiers might be counter-productive in the sense of coverage across geographies unless there is a strong nationwide distribution chain.

To conclude, in LMICs where access to medicines is essential to guarantee the health systems’ capacity to address people’s health needs (Yadav, 2015), the inefficient fragmentation of supply chains is one of the main factors that increase the costs of medicines (Yadav and Smith, 2014). Introducing a pre-wholesaler could help improve this inefficiency and reduce costs (Yadav and Smith, 2014).


Cameron, A., Ewen, M., Ross-Degnan, D., Ball, D. and Laing, R. (2009). Medicine prices, availability, and affordability in 36 developing and middle-income countries: a secondary analysis. The Lancet, 373(9659), pp.240-249.

Russo G, & MCPake B. (2009). Medicine prices in urban Mozambique: a public health and economic study of pharmaceutical markets and price determinants in low-income settings. Health Policy and Planning. 25, 70-84.

WORLD HEALTH ORGANIZATION. (2014). Global Status Report on Non-Communicable Diseases 2014.

Yadav, P. (2015). Health Product Supply Chains in Developing Countries: Diagnosis of the Root Causes of Underperformance and an Agenda for Reform. Health Systems & Reform, 1(2), pp.142-154.

Yadav, P. and Smith, L. (2014). Pharmaceutical Company Strategies and Distribution Systems in Emerging Markets. Encyclopaedia of Health Economics, pp.1-8.

Breaking News: Link 188

Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings


Breaking News: Link 188


UHC is not single! It is married, polygamous and unfaithful! (and that’s great!) 

Challenging road ahead for universal health care in low- and middle-income countries 

The emergence and effectiveness of global health networks: findings and future research 

Key drivers for good health  

World drug problem: UN adopts new framework for policies to ‘put people first’ 

TTIP investment court ‘incompatible with human rights’ 

Trans-Pacific Partnership Provisions in Intellectual Property, Transparency, and Investment Chapters Threaten Access to Medicines in the US and Elsewhere 

CETA, TTIP and ISDS: Lessons from Canada 

Leaked IP Chapter Of Asian FTA Reveals Tough Rules For Poorer Partners, Civil Society Says 

Building Learning Health Systems to Accelerate Research and Improve Outcomes of Clinical Care in Low- and Middle-Income Countries 

Civil society calls for safeguards as BRICS bank approves first loans 

World Bank and AIIB sign first joint agreement 

AIIB partnership deals with other multilaterals a sign of standards commitment 

Key takeaways from the World Bank spring meetings  

IMF to help establish policies in Sub-Saharan Africa 

Officials Call for “Forceful, Balanced” Policy Mix at IMF-World Bank Meet 

Pope provides lesson for EU, aid to refugees 

Several hundred migrants feared dead in Mediterranean on anniversary of Lampedusa tragedy 

Syria: five years of humanitarian crisis 

US and China lead push to bring Paris climate deal into force early 

Water, health and the Sustainable Development Goals 

Water is life. El Niño and the threat to water access 

Climate justice and its role in the Paris Agreement 

Taxing tobacco and the new vision for financing development 

Compassionate and Proactive Interventions by Health Workers in the United Kingdom: A Better Approach to Prevent and Respond to Female Genital Mutilation? 

News from TDR Director, John Reeder 


The end of polio is near(ish) 

Fight against HIV doomed to fail without urgent focus on West and Central Africa 

Civil society urges Member States to support the Dutch EU Presidency’s vision on access to affordable medicines 

Breaking News: Link 187

Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings


Breaking News: Link 187


New UN report focuses on green, inclusive industrialization in Africa 

More Than a Lightbulb: Five Recommendations to Make Modern Energy Access Meaningful for People and Prosperity 

Rising hunger in Central America and Haiti as El Niño follows prolonged drought 

A human-centered approach to design for development 

Advance Market Commitments 

What Drug Patents Do Is Complicated: A Belated Contribution from Jenny Lanjouw Helps Sort It Out 

The price of health: the cost of developing new medicines 

Obama Administration memo: “Background on TPP Biopharma Provisions” describes how TPP will raise drug prices 

Comment on “A Dose of TPP’s Medicine” published by Foreign Affairs March 23, 2016 

Maximalist Machinations in the TPP: an Illustration with Biologics 

More than 50 groups call on U.S. Congress to stop worst trade deal ever for access to affordable medicines 

Drugs for Neglected Diseases initiative and Pharco Pharmaceuticals to test affordable hepatitis C regimen with support of Malaysian and Thai governments

MSF responds to DNDi hepatitis C announcement 

Farmaci essenziali: la Lista Modello dell’Organizzazione Mondiale della Sanità Migliorare le evidenze per estendere l’accesso alle cure Milano 28 Aprile 2016 

KEI comment on WIPO report on patents landscape for the WHO essential medicines list 

Congress sends Obama bill on Zika drug development 

SOCIAL MOVEMENTS CONFERENCE 10 and 11 October 2016, Brighton, UK 

Ideologies Fly In Discussion Of WIPO Pharma Report Calling For Less Ideology 

Millions Saved: What Works in Global Health? 

Human Rights Reader 384 

UN and western NGOs blocking humanitarian aid shake up, says ODI 

Development aid hits record: OECD 

The world needs a humanitarian fund to assist long-term crises 


Oxfam slams World Bank over funding tax dodgers 

Framework in place for World Bank and AIIB co-financing 

What’s Behind The Surging Interest In Raising The Age To Buy Tobacco? 

What’s This Funder Up to at the Nexus of Poverty, Pollution, and Parks? 

Millions Given, Hundreds of Millions of Acres Saved: The Battle for Canada’s Forests 

UN committee begins work on high seas biodiversity pact 

No Reason to Be Optimistic on World Water Day 

Comment on “A Dose of TPP’s Medicine” published by Foreign Affairs March 23, 2016

PEAH is pleased to post a comment by Fifa Rahman and Chase Perfect on a recent article "A Dose of the TPP's Medicine - Why U.S. Trade Deals Havent Exported U.S. Drug Prices" authored by Thomas J. Bollyky, Senior Fellow for Global Health, Economics, and Development at the U.S.Council on Foreign Relations

Fifa Rahman

by Fifa Rahman

Policy Consultant, Malaysian AIDS Council

chase perfect

and Chase Perfect (MA, MsPH)

Access to Medicines Policy Officer, HIV/HCV Drug Affordability Project Coalition Plus

Comment on “A Dose of TPP’s Medicine” published by Foreign Affairs March 23, 2016


With regards to the recently published submission

“A Dose of the TPP’s Medicine” by Thomas Bollyky

 we would like to highlight several problems with the article’s presentation. The first concerns the fact that the data Bollyky used to support his argument are not public. As such, there is no way to verify his claims, nor is there an opportunity to parse his excessively broad aggregate summary. The promulgation of conclusions drawn from private data lowers the standards for dialogue on any issue, but it has been especially damaging to the access-to-medicines debate. After all, it is not the first time that industry-friendly arguments have benefited from a glaring lack of transparency. Recent estimates from Joseph Dimasi et al. on the costs of drug development have employed much the same technique.

Also, given both the significant historical role of the USTR in denying millions of South Africans access to life-saving HIV medicines and the USTR’s continuous support for South Africa’s notoriously-regressive IP systems, we found it surprising that Mr. Bollyky would use South Africa as a comparison. In addition, Mr Bollyky stated that there was ‘no upward trend in the prices of drugs launched in the three years after these agreements went into force’. It takes more than three years for any effect to be seen on delay of generics. For example, Lexchin & Gagnon (2014) predict the increase in drug costs caused by the Comprehensive Economic Trade Agreement (a trade deal between EU and Canada, also known as CETA) will start in 2023 – with CETA implementation beginning in 2015.

Bollyky’s challenge not only lacks open evidence, it also misses the point; prices are already exorbitant, and already threaten patients’ access to medicines. By imposing further restraints on future capacity to act on this front, these trade deals double down on policies that led drug prices to levels that have–to speak plainly–deadly consequences.

Finally, we were disturbed that, despite the fact that Mr. Bollyky was previously the director of intellectual property and pharmaceutical policy at the Office of the U.S. Trade Representative (USTR), no mention of his past connections were made anywhere in his submission. In this spirit, we openly acknowledge our own affiliation with the access-to-medicines movement.


Fifa Rahman, Policy Consultant, Malaysian AIDS Council

Chase Perfect (MA, MsPH), Access to Medicines Policy Officer, HIV/HCV Drug Affordability Project Coalition Plus

Gaza Strip: the Press of War on People’s Health

The last war in the Gaza Strip has left many people in bad conditions. Their health, food, home security and living conditions as a whole got worse in the last year. The situation is unbearable and cannot improve without Israel pressure relief combined with not hypocrite help by the international system


by Pietro Dionisio

Degree in Political Science, International Relations

Cesare Alfieri School, University of Florence, Italy

 Gaza Strip: the Press of War on People’s Health


The last Gaza war had a huge impact on Palestinian people. There were 2,251 Palestinian deaths against 73 Israeli and 11,231 Palestinian injuries against 1,600 Israeli. But, the shadow of the war does not stop at this! In fact, the economic consequences are enormous. The slow pace of recovery in Gaza has been insufficient to make up for the 2014 recession and conflict. Timid signals of growth in the first quarter of 2015, driven by the reconstruction process, came to a halt in the third quarter. According to the International Monetary Fund, the Gaza economy is not expected to reach its 2013 annual level until the end of 2017.

Additionally, one and half year after the 2014 hostilities, more than 7,000 explosive remnants of war (ERW) are estimated to remain in the Gaza Strip. Only 30 per cent of ERW have been identified and removed. The remaining 70 per cent pose a threat to the population of Gaza, especially children and adults who work on agricultural land littered with ERW.

What’s more, victims are not only caused by war, but by low quality healthcare as well. In fact,  nearly 50 per cent of Gaza medical equipment is outdated and the average wait for spare parts is approximately 6 months. In 2014, the MoH Central Drug Store in Gaza reported that an average of 26 per cent of medicines on the essential drug list (124 of 481 items) and 47 per cent of medical disposables (424 of 902 items) were at or near zero stock for MoH facilities. The main reason was an insufficient budget rather than security restrictions imposed by Israel. Furthermore, increasing poverty is the most pervasive barrier to specialized health services access.

Limited opportunity for health professionals in Gaza to attend training courses abroad and access restrictions to get familiar with new medical techniques are also slowing down improvements in developing health care services in Gaza. Political disagreements between the concerned parties remain a challenge in spite of the April 2014 reconciliation between Ismail Hanijeh, the prime minister of Hamas, and a senior PLO delegation dispatched by the Palestinian President Mahmoud Abbas.

Moreover, as stated by the Office for the Coordination of Humanitarian Affairs (OCHA), the Gaza blockade is responsible for a chronic energy crisis in the coastal enclave, impairing service delivery, students’ educational outcomes, the functioning of hospitals and medical equipment and the working of more than 280 water and waste water facilities. Over recent weeks, these circumstances have further worsened and brought increased hardship to Gaza people, with daily electricity supply being only 4-8 hours on (12 hours off) schedule.

Gaza hospitals not only lack electricity but, as reported, the entire health care system is in ruins due to Israeli restrictions on the import of medical equipment from outside Gaza. Israel allows patients to receive medical care abroad only in life-and-death cases, involving a lengthy bureaucratic process. This leaves many Palestinians in Gaza suffering from severe orthopedic problems, visual and hearing impairments or other serious illnesses without access to the required medical care and treatments.

The poor living conditions are made even worse by food insecurity. As such, many Palestinian farmers, fishers and herders face many challenges. Relevantly, since the Separation Barrier and Israeli settlements expand, farmers have increasingly less land and water resources for their crops and animals.

Adding to access constraints, families face disproportionate economic hurdles. For example, many must rely on water brought by tankers, which costs four-times more than the networked water supply. The high costs of livelihood inputs – such as fertilizers and animal feed – reduce farmers’ profits and inflate market prices. These conditions lock communities in poverty, leaving one in five Palestinians food insecure. In particular, 47 per cent of Palestinian households in the Gaza Strip were food insecure in 2014, with a 2 per cent increase in 2015.

Food access decline in Gaza is a result of growing unemployment, high food prices, and extreme volatility of the economy. But, fortunately, something is moving on. On 3 April 2016, Israel just expanded the Palestinian fishing zone off the southern portion of Gaza’s coast to nine nautical miles from six, allowing fishing in areas that had been off limits for a decade. The expansion of the fishing zone is expected to add 400.000 shekels, nearly $ 106.000, to the 6 million shekels in annual revenue generated by Gaza’s fishing industry.

However, aside from the good news above, there’s nothing to be happy for since the situation as a whole is unbearable for almost all the population and many concerns are renewed every day. The fragile political context, the disastrous humanitarian conditions, as well as the lack of adequate water supplies and electricity services are just a few examples of the many issues on the table.

The resources received from international organizations may have limited impact without  Israel pressure relief. Furthermore, the international political fora should stop blathering nice words suitable for the occasion and leave the veil of hypocrisy. That’s nothing new, but the only way of guaranteeing a better future to Gaza population.


L’ Impegno dei BRICS per la Salute Globale

Il gruppo BRICS (Brasile, Russia, India, Cina e Sudafrica) sta contribuendo alla salute globale in un’ottica di multilateralismo fondato su stanziamenti economici, “capacity building”, facilitato accesso a terapie e assistenza, e sviluppo di nuove strategie e strumenti. Il crescente investimento in innovazione sanitaria, produzione di medicine, diagnostici e vaccini da parte dei BRICS prevedibilmente continuerà a rappresentare un beneficio per i Paesi poveri 


by Daniele Dionisio

Membro, European Parliament Working Group on Innovation, Access to Medicines and Poverty-Related Diseases

Progetto Policies for Equitable Access to Health – PEAH

  L’ Impegno dei BRICS per la Salute Globale


Brasile, Russia, India, Cina e Sudafrica, gruppo espresso dall’acronimo BRICS, sono note economie emergenti e globalmente rappresentano circa il 25% del prodotto interno lordo mondiale.

Se la crescita dei BRICS sembra ora rallentare, questi Paesi hanno mostrato migliori capacità di recupero dalla recente crisi finanziaria globale rispetto a USA ed Europa. Non stupisce, perciò, che il capitolo di spesa dei BRICS per cooperazione internazionale sia in ascesa. Complessivamente, i BRICS enfatizzano la cooperazione Sud-Sud e stanno contribuendo alla salute globale in un’ottica di multilateralismo  fondato su stanziamenti economici, “capacity building”, facilitato accesso a terapie e assistenza, e sviluppo di nuove strategie e strumenti.

Dopo il loro primo meeting a Pechino nel 2011, i ministri della Salute dei BRICS decisero nel 2012 di incontrarsi annualmente in occasione delle assemblee mondiali OMS. Ma già nel loro primo meeting quattro priorità furono condivise: rafforzamento dei sistemi sanitari nazionali BRICS (garantendo l’accesso alle tecnologie per la salute), investire nella lotta alle patologie infettive e a quelle non trasmissibili, sostegno a organizzazioni internazionali di riferimento e a partenariati per la salute globale, e trasferimento di tecnologie ai Paesi in via di sviluppo anche al fine della produzione autonoma di farmaci generici di qualità.

Le Sfide

Con l’eccezione del Sudafrica, le patologie non trasmissibili rappresentano il maggior problema per i BRICS. E l’incidenza è in crescita: la Russia ha uno dei più alti tassi mondiali di malattie cardiovascolari; mentre il carico di diabete è elevatissimo per Cina e India.

In aggiunta, i Paesi BRICS (Russia esclusa) sono endemici per almeno una delle più comuni patologie tropicali neglette (NTDs). Ed è dell’ ottobre 2015 l’impegno dei ministri BRICS della Salute “to strive for achieving the Global 2020 NTD control and elimination goals, for universal coverage of everyone in need by 2030.”

Altra importante area di sfida e influenza dei BRICS è il loro contributo al dibattito sulle attuali mutazioni climatiche esiziali per la salute. Russia, Cina e India detengono, infatti, enormi riserve di carbone (circa un quarto del volume mondiale), e mentre la Cina sta investendo in energia pulita, ha tuttavia in programma l’apertura di circa 70 nuovi aeroporti.

Al riguardo è notizia positiva che quattro dei BRICS (Russia esclusa) abbiano fondato un gruppo di coordinamento, chiamato BASIC, per esprimere una posizione unitaria sul problema climatico.


Le iniziative correnti includono HIV/AIDS, nutrizione infantile, finanziamenti multilaterali e “tobacco control”. Il Brasile è stato autorevole nel negoziato “Framework Convention on Tobacco Control”  ed è attualmente Paese “smoke-free” leader su scala mondiale data la dura legislazione anti-fumo per gli spazi pubblici.

Sulla scia del successo interno per l’accesso universale alle terapie anti-HIV, il Paese è impegnato nel supporto internazionale, incluso  l’investimento di 21 milioni di dollari per la costruzione di un impianto per farmaci specifici in Mozambico. Il Brasile ha devoluto, nel periodo 2006-2009, 106,5 milioni di dollari a OMS e PAHO (Pan-American Health Organization), si è impegnato per 20 milioni di dollari in vent’anni a GAVI (Global Alliance for Vaccines and Immunisation), e ha contribuito alla fondazione di UNITAID, di cui è generoso finanziatore.

Il Paese è, inoltre, accreditato produttore di farmaci generici di qualità e basso costo.

Sul fronte NTDs il Brasile sta collaborando con il Venezuela per la lotta alla cecità fluviale (oncocercosi) e ha realizzato un programma nazionale di controllo ed eliminazione delle aree endemiche per NTDs.

La Russia spende annualmente centinaia di milioni di dollari in cooperazione internazionale, soprattutto per la salute. Il suo contributo comprende stanziamenti per polio, vaccini e NTDs, oltre al supporto ad iniziative e partenariati per la salute globale (la Russia è partner di Banca Mondiale, OMS e Fondo Globale per la Lotta ad AIDS, TB e Malaria).

In coerenza il governo ha investito oltre 4 miliardi di dollari nel potenziamento, innovazione e sviluppo dell’ industria farmaceutica nazionale nell’ambito del programma Pharma 2020.

La Federazione Russa ha inoltre ospitato nel 2011 la prima conferenza internazionale sulle malattie non trasmissibili alla cui risposta globale ha destinato 36 milioni di dollari.

Il budget complessivo per aiuti all’estero è in crescita costante. Ma se il governo è sensibile alla salute internazionale, le problematiche sanitarie interne restano prioritarie. Alla salute globale l’India contribuisce con la produzione di farmaci e vaccini di qualità e basso prezzo (80% dei farmaci acquistati da donatori per i paesi in via di sviluppo; 60-80% dei vaccini approvvigionati tramite le Nazioni Unite), con la campagna di eradicazione della polio, e pure con il network “Pan-African Telemedicine and Tele-Education” che collega ospedali e università dell’Africa occidentale con controparti indiane per la diffusione e condivisione di pratiche ottimali. Queste iniziative si sommano alla erogazione di servizi a basso costo, come esemplificato dall’Aravind Eye Hospital la più grande organizzazione oculistica mondiale con 2,4 milioni di persone curate ogni anno. Aravind eroga servizi gratuiti, o a prezzi minimi, al 65% dei pazienti e ha assicurato assistenza tecnica all’estero, Cina ed Egitto inclusi.

Recentemente l’India ha istituito il “National Deworming  Day” e conduce il maggior programma mondiale per la distribuzione di farmaci anti-filaria: quasi metà della popolazione mondiale a rischio di filariasi linfatica vive, infatti, in India.

Il Paese ha sensibilmente aumentato le spese per cooperazione internazionale, Africa soprattutto, attraverso canali bilaterali di mutuo interesse e non ingerenza nelle politiche nazionali. La salute occupa uno spazio modesto nel complessivo stanziamento, ma il governo cinese ha investito considerevolmente in capitoli specifici, nel contempo potenziando l’industria farmaceutica nazionale e l’innovazione tecnologica interna (oltre 1 miliardo di dollari destinati a ricerca/sviluppo farmacologico e controllo/prevenzione delle infezioni).

Coerentemente, la Cina si è dotata di un nuovo piano nazionale contro la schistosomiasi la cui esperienza ha condiviso nel recente “Forum on China-Africa Cooperation” tenuto lo scorso dicembre in Sudafrica.

Alla salute globale la Cina provvede con team medici (migliaia di operatori cinesi sono attivi in oltre 60 Paesi per servizi e formazione), controllo della malaria, pianificazione familiare, ed investimento in innovazione sanitaria (nel 2011 il Ministero cinese per la Scienza e Tecnologia ha attivato un partenariato con la Bill & Melinda Gates Foundation inclusivo di sviluppo di nuove tecnologie sanitarie per i Paesi poveri).

L’impegno internazionale è modesto rispetto agli altri BRICS poichè il governo ha soprattutto investito nelle problematiche sanitarie interne, non ultimo il capitolo HIV/AIDS. Ma il contributo del Sudafrica, comunque importante, comprende la diagnostica della tubercolosi, la fornitura di vaccini, e finanziamenti per Ricerca&Sviluppo attraverso la propria Technology Innovation Agency. Al riguardo, oltre ad una innovativa GeneXpert diagnostica molecolare per tubercolosi, il Paese produce tutti i vaccini previsti dal South Africa’s Expanded Programme on Immunisation, che inoltre fornisce a Namibia, Botswana e Swaziland.

Più luci che ombre

Motivazioni economiche e politiche possono aver determinato l’impegno dei BRICS al supporto internazionale per la salute globale e lo sviluppo, e non mancano preoccupazioni circa l’efficacia nel tempo dei loro programmi. Nondimeno, il crescente investimento in innovazione sanitaria, produzione di medicine, diagnostici e vaccini da parte dei BRICS prevedibilmente continuerà a rappresentare un beneficio per i Paesi poveri.

I BRICS si sono impegnati alla collaborazione reciproca, e stanno cominciando a lavorare insieme per migliorare l’impatto dei loro programmi assistenziali. Nel contempo sono già operative agenzie centrali dedicate, come nel caso di Russia e Brasile, che aiuteranno a massimizzare l’impatto degli investimenti. La Cina ha un dipartimento per lo sviluppo all’interno del Ministero per il Commercio, e nel 2011 ha prodotto un “white paper” quale formale, pubblica visione d’insieme del suo approccio allo sviluppo internazionale.

Per progredire ulteriormente nella direzione intrapresa, i BRICS dovrebbero espandere ai Paesi vicini i modelli di cooperazione  adottati e massimizzarne l’impatto mediante un approccio trasversale. Giusto ad esempio, la lotta alle NTDs dovrebbe essere compresa nelle  campagne per la malnutrizione e l’accesso all’acqua potabile e alle prioritarie misure igieniche, sistemi fognari e “no open defecation” inclusi. Il conseguimento di questi obiettivi proteggerebbe le comunità dal circuito di rischio delle parassitosi intestinali.

Al riguardo sarebbe strumentale la copertura finanziaria offerta dalla nuova BRICS Development Bank. Auspicabilmente, la BRICS Bank dovrebbe investire in complementarietà con le controparti (Banca Mondiale, Fondo Monetario Internazionale, Banca Asiatica per lo Sviluppo, Banca Africana per lo Sviluppo,  Banca Asiatica per le Infrastrutture) relativamente ai progetti di salute e sviluppo  per i Paesi a risorse limitate.


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Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings


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