Health Breaking News 306

Health 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

Health Breaking News 306

 

PHM: Alternative Civil Society Astana Declaration on Primary Health Care 

Global Conference on Primary Health Care in Astana, Kazakhstan, October 25-26, 2018 

PHM: Building a Movement for Health 

‘Private Players in the Growth Paradox of Health Service Provision and Advancement in Uganda’ by Michael Ssemakula 

“The People’s Prescription”: New Report Calls For Value Creation Instead Of Value Extraction In Pharmaceutical R&D 

Antimicrobial Resistance At The World Investment Forum: UNCTAD, WHO Join Forces 

Presentation of GARDP by Dr Manica Balasegaram, Executive Director 

Register for REVIVE/GARDP upcoming webinars on antimicrobial drug development and catch-up on those you may have missed 

Towards national systems for continuous surveillance of antimicrobial resistance: Lessons from tuberculosis 

Trump administration and Big Pharma square off over proposal to televise drug prices 

Research Group Identifies Over-Patenting Of Pharmaceuticals In India, Calls For Patent Reform 

DNDi E-news October 2018 

Statement on the October 2018 meeting of the IHR Emergency Committee on the Ebola virus disease outbreak in the Democratic Republic of the Congo 

Ebola DRC latest numbers as of 16 October 2018 

The danger is clear in DRC Ebola outbreak 

Zambia on alert to quash future Ebola cases 

Ebola experts pulled from Congo amid ongoing outbreak 

Polio eradication target at risk as new cases recorded in Africa 

To eliminate TB we need imagination and ambition 

Cooks among TB-free nations 

A new public-private partnership drug stirs hope to curb maternal mortality 

The Drive To Quality And Access In Rural Health 

Farm and food policy innovations for the digital age 

World Food Day 2018: The elusive quest to end hunger  

Malnutrition is a staggering global burden – we must give new meaning to the food we eat 

True Cost of a Plate of Food Around the World 

Housing First: A Funder Boosts a Promising Model to Address Homelessness in Hawaii 

Reducing inequality: what is your country doing to tackle the gap between rich and poor? 

That Dire New Climate Report is a Call to Action for Every Funder. Here’s What Needs to Happen 

EU, Canada Officials Review CETA Performance, Endorse Recommendations on Climate and Gender 

Bill Gates launches EU clean energy ‘breakthrough’ fund in Brussels 

Private Players in the Growth Paradox of Health Service Provision and Advancement in Uganda

This paper focuses on the role of private actors in the direct provision of health care in Uganda, through provision of health related goods and services such as research, treatments, human resources, and healthcare financing. It maintains that, while the health sector system of Uganda is predominantly covered by the private health care in its current state, this has mostly benefited the rich and middle class citizenry with higher disposable incomes who can afford the high charges on treatment. The paper also stresses that much as the private profit motivated forces hike fees on health care, this can also be worsened and perpetuated by the public entities

 By Michael Ssemakula

Health Rights Researcher & Advocate

Human Rights Research Documentation Center (HURIC) & PHM-Network, Uganda

 Private Players in the Growth Paradox of Health Service Provision and Advancement in Uganda

 

 

When the people hear the datum of private health provision through pure private or public private synergies, they contextualize it as a neoliberal monetized service from the industrial medical complex phenomena of laissez-faire and capitalistic forces of economic systems.

This paper focuses on the role of private actors in the direct provision of health care, through provision of health related goods and services such as research, treatments, human resources, and healthcare financing.

Private sector’s engagement in the delivery of health care encircles a complex variety of activities done by non-governmental actors. These include national, multinational corporations, non-governmental organizations, private institutions including charitable bodies, and other non- and for-profit entities, and private individuals, such as general practitioners, professionals and consultants. Their professional undertakings in health are indispensable which include direct delivery of health care, advisory services, the management of health facilities, manufacturing and supply of healthcare merchandises such as pharmaceutical products, medicines and rehabilitation services like psychiatric services, and the financing of health care products and services. These roles and activities may also be carried out within a publicly managed and funded health care systems, though countries have embraced the use of Private Public Partnerships (PPP) to guarantee availability, accessibility and aquireability of quality health services.

It is significant to recognize and address private actors’ participation and contribution to the health sector vis-à-vis the global goal of achieving Universal Health Coverage (UHC) to strike a balance in division of roles performed by the two sectors. Government health entities are famously known for provision of mainly essential healthcare services, while their private counterparts providing health insurance services, highly specialized and expensive research services.

Case-in-line, the Production Possibility Frontier (PPF) health financing curves, of different countries especially in the Low Income Countries (LIC) show most of the times governments of these countries trade off research for Primary Health Care (PHC) due to the scarcity of health financing resources. According to the research by Melvin (2005), this indicates that more resources are earmarked and devoted towards PHC and other diseases treatment than health research and health insurance services on the PPF health financing curves during resource earmarking and appropriation. With such under-provision of resources to support significant health research, innovations and inventions, a void is left to be filled by the private players. For example, in Uganda research is mainly done by the private firms or charity foundations. In the recent past, research on an epidemic neglected tropical disease, the Nodding syndrome, in Uganda was funded by the Canada-based Raymond Chang Foundation. Nodding syndrome has killed and distressed lives of countless children in northern Uganda for a significant number of years (Kakumirizi, 2018). The government did not have the capacity to finance this hardcore research exercise, though it was in position to afford the air tickets of the seven Ugandan scientists who were sent to partake in this important science study in Canada.

Besides the research, in Uganda the health insurance policies are mainly provided by the private sector. The government mainly uses social security schemes for its populaces like employment old compensation scheme of the National Social Security Fund (NSSF) for  retired workers in private sector, and pensions and gratuities for the retired workers in public sector. However, those who are self-employed especially those in informal sector are out of this equation catered for by the government. The government has not yet considered the national health insurance scheme because it is considered to be expensive to the vast majority of the people and the government itself in terms of periodical premiums to be paid.

The outlook of the health sector in Uganda has been directed by the forces of price mechanism through the private health service providers due to the high degree of inelastic demand for the availability and accessibility of good quality health-related services. When Uganda embraced the divestiture and liberalization drive through the economic reform program of 1987 after the civil war, the majority of sectors’ operations and management systems were restructured and rationalized with the health sector inclusive. The landscape of the health sector system of Uganda changed to a mixed public and private service delivery system though it is predominantly covered by the private health care in its current state (Centre, 2015). Health in Uganda has slightly experienced a blighter note improvement through provision of better quality health care.

However, this has mostly benefited the rich and middle class citizenry with higher disposable incomes who can afford the high charges on treatment. Both the public and private sector in health now fall in the same equation of premiums charged on patients: example-in-view, when the Uganda government on September 13th, 2018 completed the construction of Mulago Specialized Women and Neonatal Hospital (MSWNH) in Kampala which started on June 9th, 2015 by the Arab contractors Osman Ahmed Osman and Company funded through a loan the government of Uganda obtained from the Islamic Development Bank. This was one of the paths to improve reproductive and maternal health, decongest Mulago National Referral Hospital and enhance treatment of women with difficult reproductive health complications to reduce referrals abroad for certain specialized treatment in reproductive and neonatal health category. Unfortunately, upon the completion of the facility, the Ministry of Health came up with a list of unaffordable fees on services that this new facility was to offer. This has become an impossible dream to many vulnerable women in Uganda to access this facility and resort to cheaper and affordable private health facilities that can offer good maternal health services according to reports (Salim, 2018).

This shows that much as the private profit motivated forces hike fees on health care, this can also be worsened and perpetuated by the public entities. Therefore in order to improve health care accessibility for all in both private and public sectors without exposing the citizenry to detestable financial hardships, proper health governance should be put into consideration through placing the niche on the following:

Reinforcing the work of the advisory boards, According to, the Public Health Act, 281, provides for the establishment of advisory board and states “For the purpose of this Act, the Minister shall establish a body to be known as the Advisory Board of Health comprising the chief medical officer, or his or her authorized representative, as chairperson and such other members as the Minister may see fit to appoint, including at least three non-officials resident in Uganda who shall be appointed for such period as the Minister may determine.” Regulating the private sector in health protects the citizenry against exploitation from the private individuals through price mechanism system. When their work is properly guided and operation boundary is well demarcated, more positive social outcomes towards health are realized. Therefore the line should be drawn between what the private and public sector should provide, such that essential health services especially in the Primary Health Care are not left solely for the private sector.

Rebuilding the policy space, capacities and systems that support equitable health access for all. The health and wellbeing of the citizenry is mainly dependent on the policies and systems in place and the capacities they have to sustainably maintain the health of nationals. Health as a natural fundamental right and principle, should not be capitulated fully to private sector to insure. It’s the mandate of the governments to shoulder the lead role in health promotion before the capitalist drivers, to guarantee equitable health access and a healthy populace. This affirms the hypothesis that higher productivity, efficiency and creation of a country’s wealth is dependent on its Human Development Index (HDI) through equal accessibility to good health, good education and good standard of living for the population, which is achieved through good policy space and systems.

Strengthening transparency in public health systems and processes in national health programming, budget process information, procurement processes and progress of the health service provision between public and private providers. This is still a challenge in Uganda: case-in-view, the government through the pressure of civil society organizations drafted the National Health Insurance Bill 2012, to increase the number of people on the insurance services because Uganda is the only country in East Africa that has not yet implemented the national health insurance for its citizenry. Countries like Kenya, Tanzania and Rwanda have now benefited from the introduction of Insurance schemes (Dennis, 2012). They have meaningfully upturned their Maternal, Newborn and HIV/AIDS national Indices by covering the poor and the most vulnerable indigent groups such as women living in the remote rural and poor peri-urban settings. However, due to the gaps in the information, very few people know about the progress of the aforementioned relevant Bill in Uganda. It has not been brought yet on the floor of parliament, policy makers are still grappling with the decision of who should provide the service between the public and private sector, or a partnership of the two, and such information is still limited to the public domain. The National Health Insurance implementation failure is partly connected to the political climate whereby the government of Uganda scrapped off the user fees in 2001 in public health centres. Ugandans have been gullibly deluded to have access to free-of-cost and affordable quality healthcare services in public facilities. However, the citizenry have continuously spent out of their pocket and owing to indirect involved costs such as transportation expenditures, supplementary fees to pay for the drugs and other pharmaceutical supplies from private merchants in pharmacies, clinics and private health facilities.

Strengthening accountability. This implies ensuring that there is an oversight over the work of private entities, and that regular reviews are conducted and shown on the results of health investments by institutions and private independent entities’ participation in diverse spheres of health.

 

References

Centre, E. P. (2015). Liberalisation and the growth paradox in Uganda. Kampala: eprc.

Dennis, O. (2012). Introducing the National Health Insurance Scheme is a key Solution to Inequity, Access and Quality of Health Services in Uganda. Kampala: The Action Group for Health, Human Rights and HIV/AIDS.

Kakumirizi, M. (2018, 9 26). Nodding breakthrough: Why government must finance research. Kampala, Central, Uganda.

Melvin, W. B. (2005). Economics. Newyork: Houghton Mifflin Company.

Salim, S. (2018). How much it will cost you to get treatment at Mulago Specialized Women Hospital. Kampala: Pulselive.

 

 

 

Health Breaking News 305

Health 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

Health Breaking News 305

 

‘Will Ever WHO’s Roadmap for Medicines Move into Action? The Threat of Neoliberal Polices, Corporate Interests Collusion’ by Daniele Dionisio 

Pharmaceutical lobbying and pandemic stockpiling of Tamiflu: a qualitative study of arguments and tactics 

New drugs: how much are governments paying for innovation? 

Gullible Travails 

The Medicines Patent Pool and ViiV Healthcare sign extension of HIV licence agreement for dolutegravir to include Mongolia and Tunisia 

South Africa: Showdown – SA Takes On the US for Cheaper Drugs 

Local Sourcing and Supplier Development in Global Health: Analysis of the Supply Chain Management System’s Local Procurement in 4 Countries 

Pathologist Shortage Hits Zimbabwe Hard 

TB Remains World’s Single Largest Infectious Killer, says WHO 

Peru pioneers new treatment for drug-resistant TB — a photo story 

Better integration of mental health and HIV services needed 

Childbirth and Early Newborn Care Practices in 4 Provinces in China: A Comparison With WHO Recommendations 

Beyond the Safe Motherhood Initiative: Accelerated Action Urgently Needed to End Preventable Maternal Mortality 

Public health system integration of avoidable blindness screening and management, India 

Ebola continues to ravage northeastern Congo 

Ebola latest numbers as of 10 October 2018 

Tedros: Ebola outbreak highlights weakness for panic-based response 

New health threats emerge for Sulawesi survivors 

The Global Fund as an ATM plus 

Human Rights Reader 462 

‘The Global Implications of the Gag Rule and its Manifestations on Reproductive Health Rights in Uganda’ by Denis Bukenya and Michael Ssemakula    

Another Hidden Horror of 21st Century Conflict: Children’s Suffering 

Some governments are stepping up on inequality – new Oxfam global index launched today 

History RePPPeated – How public private partnerships are failing 

Report exposes how PPPs across the world drain the public purse, and fail to deliver in the public interest 

Effectiveness of strategies to improve health-care provider practices in low-income and middle-income countries: a systematic review 

Why Technology Isn’t Always the Answer in Global Health 

Who Controls the Tap? Addressing Water Security in Asia 

UN gives 12-year deadline to crush climate change 

Climate change aid ‘not reaching those who need it most’ 

“Our Choices Matter More Than Ever Before” To Limit Climate Change 

Human activities to suffer dramatically from 2°C increase 

Melania’s trip to Africa says a lot about US foreign policy under Trump 

 

 

 

 

 

The Global Implications of the Gag Rule and its Manifestations on Reproductive Health Rights in Uganda

This paper examines the adversative effects of the Mexico City Policy (or Global Gag Rule) and the overflow-stream of fears towards health that it has drawn to the health rights advocates and NGOs in Uganda. The paper dissects into issues surrounding the policy especially in regards to other health related services that have been deprived of the susceptible key populaces in the pretext of putting a stoppage to abortion linked services

By Denis Bukenya

and Michael Ssemakula

Health Rights Researchers & Advocates

Human Rights Research Documentation Center (HURIC), and PHM-Network, Uganda

The Global Implications of the Gag Rule and its Manifestations on Reproductive Health Rights in Uganda

 

The world that is controlled by the frenzied ideological extremists who mind and care less about health is a terrible world. Putting health into consideration should be based on the changing landscape of the nations’ health priorities but not directed by the zillion selfish desires of the sentimental misogynistic political gossipers and propagandists whom the word health seem a soundless gong to their uncompassionate ears. Life has never been a patented good for the privileged few and therefore we all owe it respect in-disregard of the statuses and associations we subscribe to.

For that reason, it’s everyone’s obligation to break to the mantle all sorts of prejudices and partialities that circles a bondage around the right to health for the vulnerable and marginalized individuals. Therefore, as we en-route for the attainment of full Universal Health Coverage (UHC) century dream, closing the wide gender disparity and manifestations of institutionalized misogyny spaces that lower the health and dignity of women should be checked to achieve an egalitarian health for all goals. Countries should independently be allowed to design policies that align best with the priority needs of their nationals without dictation on what to choose. Certain policies can devastate the welfare of people if not properly checked before their implementation. When the current US president, Donald J Trump signed an executive order to implement the Global Gag Rule, it was undeniably true and an ugly corporate interlope to health in the early 2017. This was intended to put an end to federal funding going to multi-lateral groups which execute or provide any information on abortion during his maiden week in the office, few envisaged the policy’s eminent danger, and its despicable picture through its implications on Sexual Reproductive Health (SRH) which has started to gruesomely emerge.

Similarly known as the Mexico City Policy, the Global Gag Rule was first introduced by President Reagan in 1984, withdrawn by President Obama in 2009 and reinstated by President Trump in January 2017 (Jodi-Kay, 2017). This compels overseas Non-Governmental Organizations receiving US global health assistance to declare that they do not use their non US funds to offer pro-abortion services, advice and counsel patients about the choice of abortion, emergency contraception, post abortion services, or campaign for the decriminalization of the abortion. This is a broad policy that brackets in all global health organizations that receive US funding. It further stretches the consequences to the provision of other healthcare related services such as malaria or HIV/AIDS services which patients are now at the risk of not receiving.

This paper examines the adversative effects of the Mexico City Policy and the overflow-stream of fears towards health that it has drawn to the health rights advocates and NGOs. We shall further dissect into issues surrounding the policy especially in regards to other health related services that have been deprived of the susceptible key populaces in the pretext of putting a stoppage to abortion linked services.

Reports show how the policy has significantly weakened the financial capacity of the organizations working on AIDS, Zika virus disease, malaria, reproductive health and child healthcare especially in Africa through reduced provision of malaria medicines and family planning commodities such as condoms, rapid test kits, and HIV/AIDs antiretroviral drugs. The NGOs’ outreach program abilities and their inclusive overall capabilities to provide for the health needs of the women, girls, children and other vulnerable key populations such as the sex workers, refugees and the LGBTI communities in Uganda have been great strained. With time this has chronically stunted the healthcare improvement, undermining the effectiveness of the US investments in global health and compromising the progress of Sustainable Development Goal (SDG) #3.7 of ensuring universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes (WHO, 2015).

The hard-line volatile taste of the Global Gag Rule has been over salted that organizations, healthcare centres and clinics have cut down health services provided and downsized their staff due to the increased defunding insecurity as a result of the nonconformity to this policy. Marie Stopes Uganda shutdown 45 outreach teams across Uganda and twelve more are at a threat of being cut out. This project was offering cervical cancer and breast cancer screenings and promoting the use of Sayana press, a new brand of injectable contraceptive. This ended, however, thus causing SRH commodity stock-outs as shown in a report on the preliminary impacts of Trump’s expanded Global Gag Rule by (PAI, 2018). It was a significant project programme and an incorporated intervention for far-away populations to reach through provision of about 1.1 million Ugandans with contraceptives, and its efforts prevented over 342,800 unplanned pregnancies and 170,700 unsafe perilous abortions in the country (Jodi-Kay, 2017).

But since the organization is financially over stretched amidst aid cuts of over $120 million US-Dollars, they are unable to reach out to the most vulnerable communities and worst of all, the organization has laid-off many of its employees to adjust to the current aid defunding dynamics.

The policy has gone beyond intercepting the individual organizations’ work and started dismantling the work of networks. Before the policy, organizations that had inadequate SRH services would refer their patients and those that sought services such as contraceptive supplies, technical support and equipment, and family planning services to Marie Stopes Uganda or Reproductive Health Uganda. But after the implementation of the policy, organizations that chose to remain compliant to the Global Gag Rule switched from provision of such services and stopped referring people seeking reproductive health services like family planning from organizations that were nonconformists to the policy. This then has created a vacuum in the networks which are instrumental in providing holistic information on maternal mortality, supply chains, and clinical practices.

The research shows Uganda is shouldering the heaviest burden of adolescent and teenage pregnancies in sub-Saharan Africa. Twenty-five per cent, on average, of adolescent and teenage girls aged 15 to 19 are either pregnant or mothers already, while trend is rising in unsafe abortions from 294,000 in 2003 to 314,000 in 2013 as reflected in a report on the Global Gag Rule And What It Means For Africa (Jodi-Kay, 2017)

Uganda’s biggest share of its entire health budget depends on the global health assistance, with US government being largest donor and other health financing partners through the World Bank Global Financing Facility. In Uganda, reports indicate US global health funds pay for over 890,000 HIV positive Ugandans’ anti-retroviral treatment, about 93 percent of the patients. Uganda’s maternal mortality rate is 320 deaths per 100,000 live births, at a time when 33 percent of women aged 20 to 24 had a baby before they were 18 years old, as reflected in the Ministry of Health investment case report (MoH, 2016). This depicts the dire need for a comprehensive family planning for the young people.  Uganda’s HIV prevalence still stand at 6.5 percent, thereby making it the tenth-highest in the world.

With the apparent defunding dynamics due to the insensitive Mexico City Policy, the HIV prevalence rates are likely to make a spaceship up-short because organizations are trimming down their support towards SRH in Uganda. Despite the stringent law on abortion in Uganda, allowances and conditions are provided under Article 22 (2) of the constitution whereby abortion can be carried out, stating “No person has the right to terminate (abort) the life of an unborn child except as may be authorized by law.” This means that much as abortions are illegal in Uganda, there are situations where they could be allowable (Uganda, 1995) say if the mother’s life is in danger as a result of the pregnancy, and the abortion is necessary to save her life. However, under this expanded global policy, there is no consideration for this provision. There are hundreds-of-thousands of women facing the risk of losing out on this indispensable and essential reproductive healthcare and advice. This is because of the threat-net that has been casted around the operations of the Uganda’s largest and leading providers of family-planning, antenatal care and cancer screening services, which is making it difficult to reach out to women experiencing medical complications in pre- and post-natal periods.

The general picture of health in Africa is depicted by pathetic unhealthy space thriving ever with disease, poorly maintained dilapidated structures of health centres with ever essential medicines stock-outs, inadequate medical kits and equipment, and poorly remunerated human resources with overwhelming impossible queues of ever decrying patients to attend to and treat. This makes it impossible for the NGOs to provide some of these essential health services to reduce the gap in health service provision. Therefore, the Global Gag Rule is a great nonperforming neocolonialist policy and a disaster to the global south states especially in Africa and it deserves the heaviest denunciation from the right to life activists. It is the women and other key marginalized populations in Africa facing the heavyweight grip of this policy. Ever since the policy was put into effect, the dynamic diversion of the global health aid is shuttering health centers and clinics serving some of the developing world’s most vulnerable groups. The pain of closures is mostly appalling in the poorest remote parts of sub-Saharan Africa, where clinics managed by Non-Governmental Organizations are the key source of women’s reproductive healthcare. Several of these healthcare centers offer maternal health, HIV/AIDS prevention and treatment, counseling on sexual violence such as rape, defilement and Female Genital Mutilation (FGM).

Solution: Prioritizing investment in the public health and financing through a fairer planning and funds distribution for health in the national budget, is the ultimate remedy to close a gap that has been created due to the donor aid cuts. This helps the government to improve the provision of essential health services such as Sexual Reproductive Health services with the main focus on maternal and child health thus reducing Uganda’s reliance on the policy ideologies that hold life-saving aid at hostage through the conditioned- and foreign-tied aid.

 

Bibliography

Jodi-Kay, N. &. (2017). The Global Gag Rule And What It Means For Africa. Newyork: nycbar.

MoH. (2016). Investment Case for REPRODUCTIVE, MATERNAL, NEWBORN, CHILD AND ADOLESCENT HEALTH . Kampala: Ministry of Health- Uganda.

PAI. (2018). THE PRELIMINARY IMPACTS OF TRUMP’S EXPANDED GLOBAL GAG RULE. Washington DC: PAI.

Solomon, F. (2017). The White House Is Cutting More Funds for Overseas Health Organizations Linked to Abortion. Mombasa: Time.

Uganda, T. P. (1995). CONSTITUTION OF THE REPUBLIC OF UGANDA, 1995. Kampala: State house.

WHO. (2015). SDG 3: Ensure healthy lives and promote wellbeing for all at all ages. New york: WHO.

 

Will Ever WHO’s Roadmap for Medicines Move into Action?

 The safeguarding principles for equitable access to medicines embraced by the WHO and the UN system as a whole are under attack and watered down now that the stranglehold of neoliberal policies is mushrooming worldwide. In this context, some WHO Member States disappointingly run contrary to WHO directions while placing corporate interests and for-profit policies before people right to the equitable access to health

 

By  Daniele Dionisio

PEAH – Policies for Equitable Access to Health

Will Ever WHO’s Roadmap for Medicines Move into Action?

The Threat of Neoliberal Policies, Corporate Interests Collusion

 

A preliminary draft of the 2019-2023 Roadmap for Access to Medicines was just released by WHO amidst consultation with Member States and an informal discussion with stakeholders on 10-11 September, including a presentation to which a number of stakeholders provided comments. An online survey had already been carried out from 9 July to 31 August, to which some 56 countries secured answers.

As a follow-up to the WHO report on ‘Addressing the global shortage of, and access to, medicines and vaccines’ presented at the 71st World Health Assembly (WHA) in May, the draft roadmap included a list of 10 activity areas to be addressed during 2019-2023.

A revised draft will predictably be delivered in December, and then submitted to the WHO Executive Board meeting in January, and to the WHA in May 2019.

As such, while no conclusion is in the offing, there’s still a long way to go , as you’d expect also in the light of an appendix to the draft roadmap enlisting ‘KEY RESOLUTIONS OF THE HEALTH ASSEMBLY AND REGIONAL COMMITTEES, AND REGIONAL COMMITTEE DOCUMENTS FROM THE PAST 10 YEARS RELEVANT TO ACCESS TO SAFE, EFFECTIVE AND QUALITY MEDICINES, VACCINES AND HEALTH PRODUCTS’.

Heard correctly: ten years (without counting the ‘hard slog’ globally in the field the Agency has been engaging in since long before)!

Admittedly, if this year’s WHA seems to have delivered on its goals, one could infer, however, that deeply-routed conflicting issues across countries have undermined the outcomes of WHO efforts. This comes as no surprise in today’s world, as highlighted below in this editorial aimed at hammering awareness home that the safeguarding principles for equitable access to medicines embraced by the Agency and the UN system as a whole are under attack and watered down now that the stranglehold of neoliberal policies is mushrooming worldwide. In this context, some WHO Member States disappointingly run contrary to WHO directions while placing corporate interests and for-profit policies before people right to the equitable access to health.

The key to WHO functioning and success relies heavily on deep collaboration and sustainable financial support from Member States. Unfortunately, while this is not the case with the United States (US), all the more in Trump era, neither is it with the European Union (EU).

Indeed, while relying on established synergies with WHO, the EU seemingly lacks adequate coordination and collaboration with the Agency. Worse, a number of EU recent political choices run against WHO principles for fair access to medicines (these are meant in alignment with the WTO Agreement on Trade-Related Aspects of Intellectual Property Rights ­- TRIPS , and include facilitating the issuance of compulsory licences, rejecting the so-called evergreening of patents, restricting patents to genuine inventions only, and refraining from patent term extensions).

As would be the case of EU Regulation EC 469/2009 concerning the supplementary protection certificate (SPC) mechanism for medicinal products. Such an extended monopoly protection beyond new medicines’ 20-year patent term has undermined access to affordable generic drugs and biosimilars in Europe and led to unbearably spiralling prices of medicines for HIV/ AIDS, cancer and hepatitis C treatment. In a nutshell, by stifling generic competition, SPCs still keep up extortionate drug prices while exhausting earmarked national budgets for health and depriving patients of equitable access to lifesaving treatments.

Coupling with insights so far, other circumstances add to the matter of Member States and concerned parties insufficient collaboration with WHO.

Relevantly, what happened to the requests laid down a couple of years ago by the United Nations High Level Panel on Access to Medicines in their final report serving as a cornerstone, under the UN 2030 Agenda perspective, for all decisions regarding non-discriminatory access to treatments and care – and not just at a poor country level?

Among other recommendations, the report urged to begin negotiations at the WHO for a binding research and development treaty up to delinking R&D costs from the end prices of medicines (as a proposal backed in a report released in 2012 by the WHO established Consultative Expert Working Group-CEWG).

The Panel’s report contended that ‘Governments should require manufacturers and distributors of health technologies to disclose to drug regulatory and procurement authorities information pertaining to:

(1) the costs of R&D, production, marketing and distribution of health technology being procured or given marketing approval with each expense category separated; and (2) any public funding received in the development of the health technology, including tax credits, subsidies and grants.

It maintained that ‘Governments and the private sector must refrain from explicit or implicit threats, tactics or strategies that undermine the right of WTO Members to use TRIPS flexibilities’, while calling on governments engaged in international trade and investment negotiations to ensure that these do not include clauses contrary to their obligations to the right to health.

Moreover, the report insisted that ‘Governments should strengthen national level policy and institutional coherence between trade and intellectual property, the right to health and public health objectives by establishing national inter-ministerial bodies to coordinate laws, policies and practices that may impact on health technology innovation and access.

The success rate of Panel’s meaningful recommendations is hard bet in these times of rampant neoliberal globalization underpinning unfettered trade liberalization, meaning collusion between national-transnational corporations and their political counterparts. As maintained by AE Byrn, Y Pillay and TH Holtz in their Textbook of Global Health (2017 edition, Oxford University press): ‘..the exigencies of market competition and enormous corporate power mean that governments privilege economic priorities and corporate interests over social and environmental needs, even in settings where democratic institutions and decision-making processes are marked by integrity and representativeness….’

Inherently, as reported elsewhere, ‘In the contemporary policy environment, one element in particular connects health inequalities around the world: Neoliberalism as a set of norms that guide and justify policy, ultimately equating financial worth with moral worth. The connections are not only conceptual of course; they are also material and institutional, operating through such channels as campaign money, capital flight and the networks of power and privilege epitomised by the World Economic Forum, where the global super-elite meet to worry about the threat  posed to their fortunes by the rest of us’.

Not to mention that in today’s global landscape, which is torn by misalignment, litigations and frictions among the involved parties, governments look like they won’t be ready to embark on these recommendations as an opportunity to advance public health over political and commercial interests.

As such, no wonder the Panel’s report has received strong push-back from powerful nations even as  governments’ directions and trade agreements, largely instigated by the EU and the US, run contrary to the Panel’s principles while turning governments’ agendas into policies that protect monopolistic interests.

As regards the points above, the EU has been keen on undermining any progress on the R&D treaty mentioned before. On the same wavelength, the Panel’s request for cost transparency  to help curb extortionate drug prices looks like a difficult task at a time when pharma companies and their allies are lobbying policy decision makers  to scupper any rules that would force them to disclose the real R&D costs and profits of their medicines and the rationale for charging what they do. As such, no surprise that the report was opposed by the US Chamber of Commerce and the pharmaceutical industry.

All highlights here add to many debated questions because of their actual potential to negatively affect health and worsen inequalities in access to care and treatments. Just few examples:

– The credit policies of International Monetary Fund, World Bank and European Commission still incur criticism of indirectly stifling public spending, including for health, in the borrowing countries. As reported Conditionalities attached to loans from the World Bank and IMF were among the key negative influences  on health and its social determinants between 1980 and 2000 in many of the more than 75 low- and middle-income countries in which they were applied. Best available evidence suggests that this ‘neoliberal epidemics’ era is not over. In the future, neoliberalism is likely to reflect the erosion of territorial divisions between core and periphery, or the global North and the global South, in the world economy…’

– Unbridled TRIPS-plus measures still enforce intellectual property (IP) protection beyond what is required by the WTO TRIPS agreement. These measures encompass making it easier to patent new forms of old medicines that offer no added therapeutic benefit for patients (the so-called ‘ever-greening’); restricting ‘pre-grant opposition’, which allows a patent to be challenged before it is being granted; allowing customs officials to impound shipments of drugs on mere suspicion of IP infringement, including ‘in transit’ products that are legal in origin and destination countries; expanding data exclusivity beyond WTO’s request for data protection against unfair commercial use only; extending patent lengths beyond 20-year TRIPS requirements; and preventing drug regulatory authorities from approving new drugs if they might infringe existing patents.

Investor state dispute settlement (ISDS) provisions are in the crosshairs now that most currently-being negotiated or finalized trade agreements are charged with introducing ISDS clauses whereby many forms of government regulations, including TRIPS-compliant price cuts of medicines, could be sued by the patent owners for making pointless or erode their expectations.

These circumstances bode ill at a time when the US administration is lobbied by the pharmaceutical corporations,  European authorities are doing almost nothing to check the tide of ‘me-too’ drugs, and the European Medicines Agency keeps testing new medicines only in terms of safety and efficacy compared with a ‘pretend’ drug. And this occurs even as a WHO strapped for public financing sees its role thwarted by a number of international bodies and private donors resulting in overlapping/duplication of initiatives and undue pressure towards earmarked programs.

In such context, WHO Member States around the world should really put into practice what the EU Commission envisaged (alas, just in words?) some years ago  ‘At global level, the EU should endeavour to defend a single position within the UN agencies. The EU should work to cut duplication and fragmentation and to increase coordination and effectiveness of the UN system. It should support stronger leadership by the WHO in its normative and guidance functions to improve global health. The EU should seek synergies with WHO to address global health challenges. It should decrease the fragmentation of funding to WHO and gradually shift to fund its general budget.’

 

 

 

 

 

 

 

 

 

 

 

 

Health Breaking News 304

Health 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

Health Breaking News 304

 

WHO: Public Health Round-up 

Civil Society Reaction To The Commission Staff Working Document On HIV/AIDS, Tuberculosis And Viral Hepatitis  

Nigeria’s hidden HIV crisis 

HIV/Aids: China reports 14% surge in new cases 

AIDS 2018: Prison Corner and Harm Reduction Networking Zone Activities 

Despite Infectious Disease Outbreaks Linked To Opioid Crisis, Most Substance Abuse Facilities Don’t Test For HIV Or HCV 

Ebola situation report: Latest DRC numbers as of 4 October 2018 

Zimbabwe launches vaccine drive in bid to bring cholera outbreak under control 

Health workers in Yemen reach more than 306,000 people with cholera vaccines during four-day pause in fighting – WHO, UNICEF 

UN targets TB for eradication 

Towards all-oral and shorter treatment regimens for drug-resistant tuberculosis 

Variations in the quality of tuberculosis care in urban India: A cross-sectional, standardized patient study in two cities 

Neglected tropical diseases: treating more than one billion people in 2017 

Achieving dedicated programmes and funding for eye care 

US-Canada-Mexico Trade Agreement Provisions on Injunctions and Damages  

The EU Alliance with Africa: Is It Old Wine in New Bottles? 

UN Human Rights Council Passes Resolution On Peasants’ Rights Including Right To Seeds 

How India can improve its Take-Home Rations program to boost child and maternal nutrition 

Cost-effectiveness of financial incentives and disincentives for improving food purchases and health through the US Supplemental Nutrition Assistance Program (SNAP): A microsimulation study 

In an unhealthy food system, what role should SNAP play?  

WHO Head Highlights Tobacco Plain Packaging Victory At WTO; Vaping Lobbyists Hit Geneva 

Adults’ Uninsurance Rates Increased By 2018, Especially In States That Did Not Expand Medicaid—Leaving Gaps In Coverage, Access, And Affordability 

Key Linkages: A Foundation Works Across Sectors to Help Vulnerable Populations 

Future African and Indian health systems will have a lot in common – what can they learn from each other? 

WHO calls for increased investment to reach the goal of a toilet for all 

Hey Developers! Here Are Six Ways Your Technology Can Empower Women 

Q&A: Morocco’s ‘Argan queen’ put women in charge 

G20 Women’s Summit Pushes for Rural Women’s Rights 

Congolese doctor, Yazidi activist win Nobel Peace Prize for combating sexual violence 

Healthy cities of the European Region adopt the Belfast Charter, ushering in a new phase of commitment 

How Can We Improve Air Quality In Cities?