News Flash 479: Weekly Snapshot of Public Health Challenges

News Flash 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

News Flash 479

Weekly Snapshot of Public Health Challenges

 

Dr. Gregory D. Bossart Memorial One Health Scholarship 2022 Application Deadline July 1, 2022, 11:59 pm EDT

WHO Special session of the Regional Committee for Europe Virtual session, 10–11 May 2022: WHA75: Health emergency in Ukraine and neighbouring countries, stemming from the Russian Federation’s aggression 

MSF comments on the clinical trial resolution at the 75th World Health Assembly

Webinar Registration: People’s realities, determinants of health, democratic governance: Connecting dots outside the doors of the World Health Assembly – G2H2 policy debates, May 2022

Webinar Registration: Pillars of Health launch event in the European Public Health Week May 20, 2022 02:00 PM in Amsterdam

Social justice now for an equitable tomorrow: Reflections from the Consortium of Universities for Global Health Conference 2022

Reflections on Transforming Higher Education for the 21st Century: PART 2 Development of a Global ‘All Life’ Narrative by George Lueddeke

Call for Papers: PLOS Medicine Special Issue on the COVID-19 Pandemic and Global Mental Health

China’s Zero-COVID Strategy is ‘Unsustainable’, says Tedros After Six-Week Shanghai Lockdown

Three COVID-19 vaccine doses prove more protective than two in new study

COVID-19 vaccine delivery and demand ‘slowing down’

Africa’s vaccination effort is not losing steam. It is becoming more strategic

COVID-19, Long-Term Care, and Migration in Asia

End Malaria Faster: Taking Lifesaving Tools Beyond “Access” to “Reach” All People in Need

A DEADLY DIVIDE: TB COMMITMENTS VS TB REALITIES FINAL REPORT

Adenovirus, COVID-19 examined as possible cause for mysterious hepatitis

Catastrophic health expenditure in sub-Saharan Africa: systematic review and meta-analysis

WHO highlights glaring gaps in regulation of alcohol marketing across borders

Human Rights Reader 628: WOMEN ARE NEITHER A BIOLOGICAL NOR A DEMOGRAPHIC MINORITY, BUT THEY ARE TREATED AS A MINORITY

Most Maternal Deaths Are Preventable: How To Improve Outcomes in South Africa

Fighting child sexual abuse: Commission proposes new rules to protect children

If global health equity is to stand a chance, the UK must cancel its plans to offshore asylum seekers to Rwanda

Are death and suffering in Ukraine different than in Yemen, Afghanistan or Ethiopia? Double standards in humanitarian assistance

Systemic exclusion of Dalits within local governance: Between dream and reality of affirmative action policies for fair representation

Parameswaran Iyer: transforming sanitation behaviour at scale

Extended mandate: First meeting of Executive Steering Group on Shortages and Safety of Medicinal Products (MSSG)

Report: Hunger reached record high in 2021, may worsen in 2022

Cost of living crisis deepens malnutrition

Tyre wear: an underestimated source of air pollution that needs to be tackled 

Exclusive: U.N. climate czar Carney in new bid to get private equity onboard

Progress on reducing harmful gas flares is stalling, World Bank says

EU agencies push back glyphosate assessment to mid-2023

Vanuatu’s push for legal protection from climate change wins crucial support

Global Climate and Health Alliance: Upcoming climate and health events

 

 

 

 

 

 

 

 

 

 

Reflections on Transforming Higher Education for the 21st Century: PART 2

This paper was prompted by several factors: (1) an earlier invited  chapter,included in a book entitled  Civil Society and Social Responsibility in Higher Education, created in partnership with the International Higher Education Teaching and Learning Association; (2)  increasing global  awareness and  adoption of the One Health (and Wellbeing) concept/approach across political arenas and disciplines;   and (3) the urgency for academia - as it has historically done - to take a leadership role in responding  to the unprecedented and complex challenges the world now faces with climate change and upholding democracy at the top of global agendas. Recent elections in several European countries represent a welcome shift from authoritarianism and  populism - the erosion of liberal values  - to centrist politics, a trend that may be cause for optimism around the world.

Education, formal / non-formal, research and community engagement are key, as UNESCO advocates, in bringing “shared values to life” and cultivating “an active care for the world and for those with whom we share it.”  Transforming the way we “think and act” necessitates a more holistic understanding of  planet sustainability as well as re-thinking what and how we learn and, in particular, re-directing current conceptualisations  of  curricula, research and policy development  toward a new academic  “knowledge ecology (symbiotic relationship) between all living things  and the environment) through  the development of an “interconnected ecological knowledge system.”

Time is not on our side. The UN International Panel for Climate Change (IPCC) in its latest report has warned that unless we limit global warming to 1.5C. and cut carbon emissions by 43%  by 2030  the world is on course for catastrophic warming of 3.2 C by the end of this century. Biodiversity loss, emerging infectious diseases, such as Covid-19, and geopolitical tensions are also at the forefront of global crises in this decade, which must surely lead us to question our fundamental relationship to the planet  and to each other.

Because of subject-matter scope, the paper is being published by PEAH in three parts over few weeks span:

Part 1: The One Health & Wellbeing Concept

Part 2: Development of a Global ‘All Life’ narrative

Part 3: The international One Health for One Planet Education Initiative (1 HOPE) and the ‘ecological  university’

George Lueddeke

By George Lueddeke, PhD

Consultant in Higher, Medical, and One Health Education

Global Lead – International One Health for One Planet Education initiative (1 HOPE)

Reflections on Transforming Higher Education for the 21st Century

BRINGING ‘SHARED VALUES TO LIFE’

PART 2: Development of a Global ‘All Life’ Narrative

 (Part 1: The One Health and Wellbeing Concept)

 

On human thought, Beliefs, and behaviour

Throughout the millennia education has played a critical role in shaping human interactions, including to the present when after 4.5 billion years of evolution and revolutions – cognitive, agricultural, scientific, information– humanity is now at a precipice.

In A vision for human well-being: transition to social sustainability,  the authors argued that “[M]aintaining a healthy environment and transitioning toward sustainability”  is difficult  as “communities and societies are inherently conservative, and do not change unless something pushes them… despite the fact that many see disaster looming.”

Two of their key premises are that sustainability requires “human societies that function well” and that “social, economic and political breakdown only perpetuates environmental abuses.” The main obstacles to sustainable development, they asserted, can be traced to global unwillingness or capacity “to provide the resources necessary of the communities most in need” by ensuring “a more equitable global distribution of resources and empowerment” and “a global focus on growth in well-being instead of consumption.”

Taking a largely humancentric stance, the authors advanced that in order to achieve these aims we need a “systematic effort to monitor progress towards well-being (physical, social, emotional) and understand its drivers, “while recognising that communities currently in poverty will need additional consumption in order to do well.”

However, simply acknowledging that deprivation, hunger, suffering and inequities exist is not enough. We have the data, but, as David Wiebers, Emeritus Professor of Neurology at Mayo Clinic posits, too often we lack the “principal motivation to reach beyond ourselves and beyond what we may have thought possible, ” including extending “compassion and care”  to “beings other than humans, who also have a consciousness and a set of yearnings that demand uncompromising respect.” For Professor Wiebers “Scientific achievement is indeed a wonderful thing-in direct proportion to how much it either reflects or reinforces compassion for all life.”

As Figure 3 illustrates, both human and ecosystem measures (non-human animals, plants, environment) are critical as these interventions determine the health and wellbeing of humankind in a reciprocal relationship.  

Figure 3: Links between human well-being and the environment

(Source: Science Direct:   A vision for human well-being: Transition to social sustainability  [2012])

Building blocks for global sustainability

Today’s unprecedented perils demand major transformations to move societies in the direction of social and environmental sustainability. According to the authors, previously cited,  of ‘Why ecocentrism is the key pathway to sustainability,’ anthropocentrism, which, as mentioned,  “values other lifeforms and ecosystems insofar as they are valuable for human well-being, preferences and interests,” remains the main “ideology in most societies around the world – permeating academia and domestic and international governance.”

In contrast, the authors contend “that a fully sustainable future is highly unlikely without an ecocentric value shift that recognises the intrinsic value of nature and a corresponding Earth jurisprudence.”  Underpinned by ecocentric values and principles, learning that “cultivates an active care for the world and with those we whom we share it” remains our best option for ensuring the sustainability of the planet and all life. To these ends, several key constructs and developments are particularly timely and pivotal in shaping global education and research environments: the One Health (and Wellbeing) concept applied to all species and the planet, the Earth Charter and the UN-2030 Sustainable Development Goals: 

The One Health and Wellbeing Concept

The concept/approach, discussed previously, underpins the belief that “the health of people, other animals and the ecosystems of which we are a part are inextricably woven together,”  and emphasising “ respect and care to all life, and indeed to terrestrial and aquatic ecosystems themselves.”

The Earth Charter

Launched in 2000, the Earth Charter, (EC) was “[C]rafted by visionaries over twenty years ago” and, as summarised in Figure 4, “is a document with sixteen principles, organized under four pillars that seek to turn conscience into action” and “inspire in all people a new sense of global interdependence and shared responsibility for the well-being of the whole human family, the greater community of life, and future generations. It is a vision of hope and call to action.

The EC Education Center, located on the campus of the UN Mandated University for Peace in San José, Costa Rica, “offers a variety ofonline and on-site education programmes that highlight the importance of incorporating sustainability values and principles into decision-making and education. Its “work is implemented under the UNESCO Chair on Education for Sustainable Development with the Earth Charter, which generates educational programmes and research activities at the intersection of sustainability, ethics and education.” 

Figure 4: The Earth Charter

 Pillars and Principles -‘Turning Conscience into Action’

(Source: Earth  Charter Organisation: Celebrating 20 years of the Earth Charter with a new face! [2020])

The UN Global Goals 

Millennium Development Goals (2000-2015)

Coincidentally, the year 2000 also saw agreement by world leaders at a UN summit of the Millennium Development Goals (MDGs) setting targets for poverty reduction, primary education, equality, child mortality, maternal health, HIV/AIDS, malaria and other diseases, environmental sustainability and global partnerships.

While the final report acknowledged that progress was “made across the board, from combatting poverty, to improving education and health, and reducing hunger, “ much more needed to be done. UN Secretary-General Ban Ki Moon in the report Foreword highlighted that “we know what to do” and called for “unswerving political will, and collective, long-term effort“: tackling  root causes and do more to integrate the economic, social and environmental dimensions of sustainable development.”  

The Sustainable Development Goals (2016-2030)

Superseding the MDGs, on 25 September 2015, 193 Member States of the United Nations General Assembly ratified the UN 2030 Sustainable Development Goals (SDGs), as shown in Figure 5. 

Figure 5: The Sustainable Development Goals (SDGs) [2016])

(Source: United Nations,  [2016])

The UN Transformative Vision underpinning the seventeen SDGs focuses on both human and environmental needs prioritising the interconnections between the two. In the past few years, the root causes of global threats have become much clearer as are attempts to address these (e.g., surveillance data, green economy, prevention [vaccines]). However, global adoption of the SDGs and in particular its main aim to “create a more just, sustainable and peaceful world” remains a fundamental global challenge as current events and on-going risks are demonstrating. Truth, trust, compassion, and collaboration are key to planet sustainability but continue to be eroded by authoritarian agendas that place self-interests (e.g., geographical expansionism) despite the fact that climate change and conflicts threaten the future of all species including homo sapiens.

In this regard Professor Jared Diamond’s seminal book, Collapse:  How Societies Choose to Fail or Survive, based on, among others, “ancient Maya, Anasazi and Easter Island” societies,” is even more critical today than in 2005 when it was first published.  Main reasons for societal demise, the author concluded, were lack of “long-term planning and willingness to reconsider core values.” While the present world situation seems irreconcilable, perhaps placing our faith and trust in the new generation – Generation Z (born from 1997 onward) – is the way forward. As Mary Meehan, a cultural scientist said in a Forbes article several years ago: “They represent boundary-blurring countries and the reality of our shifting global culture. Already they display a great interest in and tolerance of ‘others.’ ”

A recent US cultural intelligence report entitled  Gen Z Complexities: You’ve Only Heard Half the Story highlights that in terms of politics, Gen Z   “are perceived to neatly fit under a liberal umbrella, focused on issues like social justice, climate activism, gun safety and voting rights.”   In addition, climate change and inaction are major concerns” prompting many to commit “their lives to finding a solution.”   Gaining “economic, social, and political power, the changes they’ll look to make will be structural, but not superficial” – which could not only encourage” humans to reconnect with their planet,”  as Professor Johan Rockström at the Stockholm Resilience Center advocates, but also take on board  the urgency to re-orient thinking from ‘it’s all about us’ (human-centrism) to ‘it’s about all species and planet sustainability (ecocentrism)”. 

Impact of Covid-19 on SDG progress

 The SDG Report 2020, prepared by the United Nations Department of Economic and Social Affairs (UNDESA) in collaboration with more than 50 international agencies, noted that progress on meeting SDG targets was already slow with many of the goals not reaching their targets by 2019. While the latter report was disappointing, the SDG Report 2021 was devastating, as most of the developments  over the past few years, were “halted or reversed,” also underscored  in a The Lancet Public Health editorial . The pandemic had “exposed and intensified inequalities within and among countries” as well as crises relating to climate, biodiversity loss and pollution, including increasing poverty, hunger, health, education, sanitation, greenhouse gas emissions, infectious diseases, to name a few areas – all threatening “peace and safety from violence” requiring “a major realignment of most countries’ national priorities toward long-term, cooperative, and drastically accelerated action.”

The university sector:  Valuing the SDGs – Impact Rankings 2021

In July 2019, the President of the 8th Economic and Social Council (ECOSOC) Youth Forum, where voluntary national reports against the SDGs were considered, voiced similar concerns calling “upon young people to continue to raise their voice, advocate for the SDGs, and hold their Governments accountable for the commitments made in the 2030 agenda.”

In this respect The Times Higher Education SDG Impact 2021 global university performance tables may be telling. The impact rankings are “the only global performance tables that assess universities against the UN SDGs” providing “comprehensive and balanced comparison across four broad areas: research, stewardship, outreach and teaching.” The 2021 impact rankings include submissions from 1,118 universities and 94 countries/regions. The UK’s University of Manchester leads other universities for the first time along with three Australian universities – the University of Sydney, RMIT University and La Trobe University in the top four. Interestingly, ‘Russia is the most-represented nation in the table with 75 institutions, followed by Japan with 73.’

Perhaps unsurprisingly, in terms of research priorities all top universities still focus on human health and well-being (human-centrism – SDG # 1,4,5,10,16; SDG #8, Decent Work and Economic Growth, and SDG #9, Industry Innovation and Infrastructure) and not with ensuring the sustainability of all life – plants, nonhuman animals and the environment (eco-centrism-) on which all life on this planet depends (SDG# 13,14,15 and climate emergency). SDG #16, Peace, Justice, and Strong Institutions is mentioned by only 5. Few universities, it seems, have considered how many of the solutions we seek are found in the natural world. 

Toward a new narrative for global sustainability (research and education!)

In his groundbreaking paper, ‘Implications of Transformative Changes for Research on Emerging Zoonoses,’ Professor Thijs Kuiken, argues for “a new narrative that promotes a sustainable way of living” and, as summarised  in the Table, “would be an integral part of nature and balance our needs with those of other living species”.  While his article focuses on zoonosis – infectious diseases of animal origin, his proposal has wider implications for education, research and public policy and transformative change toward sustainability implemented by “leaders of universities, institutes, societies, and funding bodies” across societal sectors and disciplines”.

Table:  Possible Effects of a New Narrative on Choice of Problems, Methods and Solutions of Research on Emerging Zoonoses

(Source: EcoHealth: ‘Implications of Transformative Changes for Research on Emerging Zoonoses, 2021)
Research section Current narrative New narrative
Research problem formulation Focus on human health Equal attention to health of ecosystems, animals, and humans
Emphasis of financial cost to society Equal attention to ecological, social, and financial costs to society
Restricted scope e.g., interaction between pathogen and human cost only Broad scope: interrelated ness of all organic and inorganic elements in the system included
Choice of scientific methods Emphasis on financial cost Equal emphasis on environmental impact
Development of solutions for addressing zoonotic disease issues Emphasis on current event Attention to all events of this nature
Short term Also, long-term
Solution for proximate causes well accepted Solution for proximate causes accepted only if action undertaken to deal with ultimate causes
Acceptability determined by possibility to continue financial profit of human activity involved Acceptability determined by improvement to health and well-being of humans and animals, and to health integrity of ecosystems
Reconciling global funding inequities and addressing new existential challenges

Adoption of a new ecocentric narrative could also raise awareness, highlighted in an informative article last year by Dr Bruce Kaplan, co-founder of the One Health Initiative and  Richard Seifman, UN Association of the National (USA) Capital Area. A follow-up commentary  underscored the pressing need to strengthen  funding of world organisations, including  WHO which receives approximately US $6 billion annually; the FAO, c. $2.6 billion and the OIE (the World Organisation for Animal Health (OIE), only c. $32 million!

As investments in humanity’s future, these figures pale in comparison to the global  human and  financial costs of Covid-19 to date:  6.25 million  deaths as well as  517 million cases; and economic costs: US $ 12.5 trillion and beyond , set against a world annual economy (Gross Domestic Product [GDP] – all goods and services) estimated around $ 95 trillion in 2021 and Global military spending  which for the first time stands at US $ 2 trillion – with  mainly the USA, China, India, UK, and Russia spending 65 % of the total.

These amounts are staggering and should make government and corporate policymakers re-think the rationales of these escalating expenditures, human values that underpin them and where they may eventually lead if not reconsidered on moral or injustice grounds alone and how to mitigate these in future.

Worldwide, about US $4.7 trillion are allocated to education annually but “only 0.5% is spent in low income countries, while 65% is spent in high income countries, even though the two groups have a roughly equal number of school-age children.”  Public spending on higher education is about US $1 trillion per year with a major “shift of higher education’s centre of gravity from the Global North to the Global South,” according to a “definitive world report” launched the by Toronto-based Higher Education Strategy Associates (HESA).

The number of higher education institutions in the Global South “nearly doubled from a little over 40,000 to nearly 70,000, to reach a global institutional total of 90,000” (versus c. 20,000 in the Global North.)  However, “the number of dollars per student is going up in the North, but going down in the South,” while funding in the Global North is allocated to “quality, equity and research,” whereas “[I]n the Global South, the money mostly goes to increased capacity and access.”

Concluding comment

In the  introduction to the SDG Report 2021,  Liu Zhenmin, UN Under-Secretary-General for Economic and Social Affairs, calls for “a unified vision of coherent, coordinated and comprehensive responses from the multilateral system.”  In light of the unprecedented risks we face (climate change, democracy,  political tensions), global  responses aligned with the SDGs necessitate, as the UN USG asserts,  “action and participation from all sectors of society, such as “ Governments at all levels, the private sector, academia, civil society and individuals – youth and women, in particular.”

————————————-

 Parts 1 and 2 of the present article have argued for the wider adoption of the ecocentric One Health and Wellbeing concept to underpin the Earth Charter values and principles and together informing the UN Transformative Vision and action, including cultivating, as UNESCO advocates,  “an active care for the world and for those with whom we share it.” 

Part 3 to follow considers societal options -education and policy directions -  for doing so.

News Flash 478: Weekly Snapshot of Public Health Challenges

News Flash 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

News Flash 478

Weekly Snapshot of Public Health Challenges

 

Webinar registration: People’s realities, determinants of health, democratic governance: Connecting dots outside the doors of the World Health Assembly – G2H2 policy debates, May 2022

University for Peace: Interactive E-Learning Module on Operationalizing the Right to Development in Implementing the Sustainable Development Goals. Round One: 22 June to 19 July 2022. Round Two: 19 October to 15 November 2022. Application Deadline: 5 June 2022

EPHA Meeting registration: MEP Interest Group Annual Meeting: Investigating the environmental dimensions of AMR. 17 May 2022 | 15:00 – 17:30 CEST | Online

Global Health Watch 6: UK Book Launch 30/05/22 19:00 – 20:30 Online

WHO Coronavirus (COVID-19) Dashboard

Omicron-led Surge Tests China’s Zero Covid Policy

After Months of Deadlock, WTO’s TRIPS Council Will Finally Discuss Intellectual Property Waiver Compromise

MSF urges governments to reject the draft COVID-19 text tabled at WTO, that would set a negative precedent

MSF: Vaccine Case Study Series

Understanding the Cost-Effectiveness of COVID-19 Vaccination in Nigeria

COVID-19 vaccine wastage in the midst of vaccine inequity: causes, types and practical steps

Audio Interview: Do We Need New Covid-19 Vaccines?

WHO recommends shorter treatment for drug-resistant TB

U.S. diplomats pressure European regulators to curb clinical trial transparency

Warren Urges Biden Administration to Lower Prescription Drug Prices Using Existing Executive Authority

Reflections on Transforming Higher Education for the 21st Century: PART 1 The One Health & Wellbeing Concept by George Lueddeke

Funding and Education Are Key to Effective Implementation of ‘One Health’ Agenda

One Health Commission: 2021 Annual Report

Stopping Human Diseases Often Starts With Animals

People’s Health Dispatch: Bulletin #24: Watching out for health in times of crisis

Human Rights Reader 627: GOVERNMENTS DO NOT HAVE ‘A RESPONSIBILITY’ IN RELATION TO POVERTY; THEY HAVE A LEGALLY ENFORCEABLE SOCIAL AND ECONOMIC RIGHTS DUTY!

Out of Africa: Rich Continent, Poor People

The Commission’s renewed Strategy for the EU’s outermost regions puts people first and unlocks their potential

Il talco e l’amianto: Una storia americana che offre molti punti di riflessione sulle case farmaceutiche, sulla salute pubblica nelle società ad economia di mercato di ieri e di oggi

Our May Issue: Telemedicine, Disparities, Pharmaceuticals & More

Reporting incidental findings from non-biological assessments in human subject research

Ethiopian drought leading to ‘dramatic’ increase in child marriage, Unicef warns

How NGOs and governments can address the growing child labor crisis

Humanitarian Surgery Initiative

Migration rights groups call on countries to demilitarise their borders

Analysis | The environmental component in EU National Roma Integration Strategies

MEPs massively back organic farming but snub Farm to Fork target

Europeans May Have to Sleep Under Mosquito Nets as Climate Change Changes Disease Patterns

DEVOURING THE RAINFOREST

‘Making Pandemics’: Deforestation is Laying Groundwork for Next Global Health Crisis

Tree loss in tropics casts doubt over climate goals

Ocean animals face a mass extinction from climate change, study finds

 

 

 

 

 

 

Reflections on Transforming Higher Education for the 21st Century: PART 1

This paper was prompted by several factors: (1) an earlier invited  chapter,included in a book entitled  Civil Society and Social Responsibility in Higher Education, created in partnership with the International Higher Education Teaching and Learning Association; (2)  increasing global  awareness and  adoption of the One Health (and Wellbeing) concept/approach across political arenas and disciplines;   and (3) the urgency for academia - as it has historically done - to take a leadership role in responding  to the unprecedented and complex challenges the world now faces with climate change and upholding democracy at the top of global agendas. Recent elections in several European countries represent a welcome shift from authoritarianism and  populism - the erosion of liberal values  - to centrist politics, a trend that may be cause for optimism around the world.

Education, formal / non-formal, research and community engagement are key, as UNESCO advocates, in bringing “shared values to life” and cultivating “an active care for the world and for those with whom we share it.”  Transforming the way we “think and act” necessitates a more holistic understanding of  planet sustainability as well as re-thinking what and how we learn and, in particular, re-directing current conceptualisations  of  curricula, research and policy development  toward a new academic  “knowledge ecology (symbiotic relationship) between all living things  and the environment) through  the development of an “interconnected ecological knowledge system.”

Time is not on our side. The UN International Panel for Climate Change (IPCC) in its latest report has warned that unless we limit global warming to 1.5C. and cut carbon emissions by 43%  by 2030  the world is on course for catastrophic warming of 3.2 C by the end of this century. Biodiversity loss, emerging infectious diseases, such as Covid-19, and geopolitical tensions are also at the forefront of global crises in this decade, which must surely lead us to question our fundamental relationship to the planet  and to each other.

Because of subject-matter scope, the paper is being published by PEAH in three parts over few weeks span:

Part 1: The One Health & Wellbeing Concept

Part 2: Development of a Global ‘All Life’ narrative

Part 3: The international One Health for One Planet Education Initiative (1 HOPE) and the ‘ecological  university’

George Lueddeke

By George Lueddeke, PhD

Consultant in Higher, Medical, and One Health Education

Global Lead – International One Health for One Planet Education initiative (1 HOPE)

Reflections on Transforming Higher Education for the 21st Century

Bringing ‘Shared Values to Life’

PART 1: The One Health and Wellbeing Concept

 
Article purpose

This paper  examines  how higher education can be encouraged to “think beyond ‘narrow academic pursuits” and  become more  “productive, disruptive forces for positive change and progress capable of understanding and solving complicated real-world problems.”

To these ends, the article considers four main themes:

  • existential risks facing our planet and civilisation;
  • a new worldview and narrative for global sustainability;
  • an international education initiative to help sustain life on the planet;
  • building interdisciplinary knowledge systems with “a concern for the whole Earth”.

Taken together, they lead to considerations for university transformation and global sustainability.

Planetary risks in the early decades of the third millennium

Planet  Earth is now in its sixth mass extinction phase with global wildlife  decline  – ‘the living forms that constitute the fabric of the ecosystems’– about 68 percent  loss since 1970.  The last species’ extinction on this scale was 65 million years ago when an asteroid wiped out the dinosaurs.

As mentioned in  Planet Earth: Averting a Point of No Return, we have become that “asteroid.” The urgency to reconsider civilisation priorities, integrate new values and adopt a more sustainable way of life could not be greater. To a large extent, beginning with the industrial era in the mid-eighteenth century, human progress has been accomplished at a high cost as Professor Samuel Myers in his lecture for the Academy of Medical Sciences at Harvard University reminded us a few years ago:

“… the scale of human impacts on our planet’s natural systems is hard to overstate: to feed ourselves, we annually appropriate about 40% of the ice-free, desert free terrestrial surface for pastures and croplands; we use about half of the planet’s accessible water, largely to irrigate our crops, and we exploit 90% of global fisheries at, or beyond, their maximum sustainable limits. In the process, we have cut down 7–11 million km² of the world’s forests and dammed more than 60% of its rivers. The quality of air, water, and land is diminishing in many parts of the world because of increasing global pollution. These and other processes are driving species to extinction at roughly 1000 times baseline rates while reducing population sizes of mammals, fishes, birds, reptiles, and amphibians by half in the past 45 years.”

Towards a new worldview

Our worldview remains the main obstacle or culprit in our struggle for planet survival. As shown in Figure 1, the world can be viewed through two main lenses: anthropocentric (human-centrism) or ecocentric (all life). In their comprehensive qualitative and quantitative grounded theory study How Ecocentrism and Anthropocentrism Influence Human-Environment Relationships in a Kenyan Biodiversity Hotspot, the authors note that

“While an anthropocentric mindset predicts a moral obligation only towards other human beings, ecocentrism includes all living beings. Whether a person prescribes to anthropocentrism or ecocentrism influences the perception of nature and its protection and, therefore, has an effect on the nature-related attitude.”

The authors of  Why ecocentrism is the key pathway to sustainability “see ecocentrism as the umbrella that includes biocentrism and zoocentrism  because all three of these worldviews value the non-human with ecocentrism having the widest vision.” In support, they cite Stan Rowe’s scientific rationale that “backs the value shift”: “All organisms are evolved from Earth, sustained by Earth. Thus Earth, not organism, is the metaphor for Life.”

Figure 1:  Human-Centrism and Eco-Centrism

(Source: PEAH- COP26: Tackling the Root Causes of Climate Change, 2021)

 

 

Integrative health concepts underpinning sustainability

According to a Johns Hopkins University  study distinguishing among three main interdisciplinary health concepts involving global experts, the researcher  identified three main camps, including:

(1) those that deal with “improving human health from the population perspective, transcending national borders, some including both preventive and individual-level clinical aspects” (e.g., public health, global health).

(2) those that are “largely concerned with the sustainability of our civilisation and resource consumption on the planet and human health” (e.g., planetary health, ecological health); and

(3) those that “encompass human, animal, plant, and environmental health and well-being” (e.g., One Health, One World-One Health).

The One Health concept

As shown in Figure 2, and underscored by the authors of ‘A Blueprint to Evaluate One Health,’  the One Health concept is integral to the ecocentric ethic (a moral purpose?), that is, shifting  from reactive sectoralised interventions (‘it’s all about us’) to multi-sector preventive actions at social, ecological, economic and biological levels of society” (‘it’s about all species’).

Figure 2: The One Health Triad

(Source: World Bank - ONE HEALTH Operational Framework for strengthening human, animal and environmental public health systems at their interface, 2018)

 

 

This holistic  perspective is reflected in the definition of One Health by the One Health High Level Expert Panel (OHHLEP) established on 21 May, 2021, co-chaired by Professor Wanda Markotter and Professor Thomas Mettenleiter. Responding to “global health threats” and promoting “sustainable development” with a view to developing “a common language and understanding around One Health”, members agreed that:

One Health is an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals, and ecosystems.

It recognizes the health of humans, domestic and wild animals, plants, and the wider environment (including ecosystems) are closely linked and inter-dependent.

The approach mobilizes multiple sectors, disciplines and communities at varying levels of society to work together to foster well-being and tackle threats to health and ecosystems, while addressing the collective need for clean water, energy and air, safe and nutritious food, taking action on climate change, and contributing to sustainable development.

 

 

Considered historically, the origins of One Health  can be traced  to ancient Greece and   “father of medicine,” also considered the first epidemiologist, Hippocrates (c. 400 BCE), who  urged  physicians to consider the environment in which patients  lived. While sanitation in ancient Rome is “legendary,” it likely made things worse largely because of  parasitic infections, and it took  another 1800 years or so before  basic understanding of the causes of diseases was possible.

In separate articles published in 2014, Professor John McKenzie et al. in Australia and Professor Paul Gibbs in the United States reached similar conclusions regarding One Health milestones. Both recognised  major contributions in the 19th and 20th centuries of  individuals such as  Dr. Rudolph Virchow, “the father of comparative medicine,” Sir William Osler, Sir John McFadyean,  Dr. James Steele and Dr. Calvin Schwabe; to name but a few leading lights.

The increase and severity of viral pandemics sweeping across the world in the 1990s and early decades of the 21st century spawned the proliferation of One Health organisations and networks. These included – in  2004: the Wildlife Conservation Society;  in 2008: the American Veterinary Association, the One Health Initiative, the Centres for Disease Control and Prevention; in 2009: Afrique One – ASPIRE , the One Health Commission; in 2010:  the Tripartite FAO, OIE, WHO, UNICEF, UNISIC, the World Bank, the  EcoHealth Alliance, the European Union.  One Health reports and conferences (e.g., Australia, Canada, China, South Africa, USA) alerted the world about the on-going microbial threats, emerging diseases, influenza, and pandemics.

While these developments were welcomed by the One Health community and policymakers, it became clear that there was a need for strengthening collaboration among multi-disciplinary partnerships and developing the expertise to operationalise the One Health approach. Both McKenzie and Gibbs called for leadership development, multi-level education and training courses, cost benefit analyses, and increasing interdisciplinary engagement beyond veterinary and human medicine.

Professor Gibbs’ query was particularly timely and relevant in 2014: Is One Health simply “a short-lived response” to “emerging diseases” or “a paradigm shift” leading “to a wide and deep-rooted commitment to interdisciplinary action for the protection and needs of society in the 21st century.”?

The first report, entitled the World at Risk in 2019,  of the  Global Preparedness Monitoring Board (GPMB), chaired by Dr. Gro Harlem Brundtland, former Prime Minister of Norway and Director-General of the World Health Organization, reflected an on-going concern for the slow global response to pandemics and impending global crises highlighting  “a cycle of panic and neglect.”

Early 2020 Covid-19 confirmed the world’s unpreparedness for a major global pandemic with unprecedented deaths, cases and socio-economic consequences leading to a frantic search for vaccines and unparalleled lifestyle changes – shining a light on global inequities and the need to place responsibility for the root causes of climate change, biodiversity loss and emerging infectious diseases on humankind.

Accountability for global threats was  confirmed for the first time with statements referencing One Health by member countries of  the Joint G20 Finance and Health Minister Meeting Communiqué  in  2021 and  the G7 Leaders’ Statement 2022 – perhaps  recognising  that no single nation has the capacity to address  global existential risks we face and heeding  esteemed naturalist and broadcaster Sir David Attenborough’s wake-up call:

The fact is that no species has ever had such wholesale control over everything on earth, living or dead, as we now have. That lays upon us, whether we like it or not, an awesome responsibility. In our hands now lies not only our own future, but that of all other living creatures with whom we share the earth.”

 

 

 

News Flash 477: Weekly Snapshot of Public Health Challenges

News Flash 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

News Flash 477

Weekly Snapshot of Public Health Challenges

 

Informal WHA75 pre-meeting for Member States, non-State actors in official relations and the Secretariat during 11 April to 6 May 2022

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WHO: World Immunization Week 2022 – 24 to 30 April

European Immunization Week 2022: Statement by Executive Director Emer Cooke – Why vaccines contribute to a “Long Life for All”

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News Flash 476: Weekly Snapshot of Public Health Challenges

News Flash 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

News Flash 476

Weekly Snapshot of Public Health Challenges

 

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Recently developed drugs for the treatment of drug-resistant tuberculosis: a research and development case study

MSF responds to new simplified WHO treatment guidelines for cryptococcal meningitis, the number two killer of people living with HIV/AIDS

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‘Missing’ India Air Pollution Data Restored to WHO Air Quality Database

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Worsening drought in Horn of Africa puts up to 20 million at risk: WFP

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News Flash 475: Weekly Snapshot of Public Health Challenges

News Flash 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

News Flash 475

Weekly Snapshot of Public Health Challenges

 

27 APRIL 2022 Launch Event: Global Health Watch 6

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Equitable Access to Innovative Pharmaceuticals by Thomas Pogge

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Equitable Access to Innovative Pharmaceuticals

Globalized in 1995 by the TRIPs Agreement, humanity’s dominant mechanism for encouraging innovations involves 20-year product patents, whose monopoly provisions enable innovators to reap large markups or royalties from early users. Reliance on monopoly rents in the pharmaceutical sector is problematic for two main reasons. First, it imposes great burdens on poor people who cannot buy patented treatments at monopoly prices and whose specific health problems are therefore neglected by pharmacological research. Second, it discourages pharmaceutical firms from suppressing diseases by fighting them at the population level. Both problems can be much alleviated by establishing a supplementary alternative reward mechanism that would invite innovators to trade their monopoly privileges on a patentable pharmaceutical for impact rewards based on the incremental health gains produced with it. Such an international Health Impact Fund (HIF) would create powerful new incentives to develop pharmaceuticals against diseases concentrated among the poor, rapidly to provide such remedies with ample care at very low prices, and to deploy them strategically to contain, suppress, and ideally to eradicate the target disease. By promoting innovations and their diffusion together, the HIF would greatly increase the cost-effectiveness of the pharmaceutical sector, benefiting the world’s poor especially

By Thomas Pogge

Leitner Professor of Philosophy and International Affairs

    Yale University, New Haven, USA

Equitable Access to Innovative Pharmaceuticals

 

Background

Equitable access to health requires equitable access to health care. In our world, such equitable access does not exist because billions of human beings are denied a minimally adequate income and also because patented pharmaceuticals are absurdly overpriced.

According to the latest FAO Report, three billion human beings – 41.9% of humankind – were unable, in 2019, to afford a healthy diet at an average cost of USD 4.04 per person per day at purchasing power parity[1] – even while the global average income (also purchasing-power-adjusted) was about USD 50 per person per day.[2]  Being so desperately poor, large percentages of humankind also lack safe drinking water,[3] adequate sanitation,[4] adequate shelter,[5]  electricity[6]  and basic education.[7] These severe deprivations make the poor much more prone to disease which in turn further reinforces their poverty. The grave injustice of these deprivations is apparent from the fact that they would not exist if poor people merely had their fair per capita share from the human exploitation of natural resources: minerals extracted, and planetary commons depreciated by human pollution. As it is, this natural wealth of our planet is unilaterally used and overused by a minority of humankind without compensation to the rest, while the poor must work very hard for their insufficient incomes.

The Monopoly Patent Regime

This severe injustice is further aggravated by the existing international rules governing innovation which, originating in the most affluent states, were foisted upon the rest of the world through the 1995 TRIPs Agreement, part of the WTO founding treaty.[8] These rules entitle innovators to 20-year product patents whose exclusivity provisions enable patentees to collect monopoly rents from early users.[9] Monopoly markups encourage development of innovations, but at the cost of greatly impeding their diffusion. This cost again falls most heavily upon the poor, who are excluded from advanced medicines during their patent period.

Monopoly patents lead to exorbitant prices, especially in the pharmaceutical sector. A typical example is sofosbuvir, an effective cure for hepatitis C, which Gilead Sciences introduced in the United States in 2013 under the brand name Sovaldi at a price of USD 84,000 per course of treatment. This is about 3000 times the cost of manufacture, a markup of 300,000%.[10] In poorer countries, where the upper classes are less affluent and less well-insured, patented drugs are priced much lower – but still unaffordable on the also much lower ordinary incomes there. Even five years after sofosbuvir’s market introduction, only about 7% of the 71 million persons living with hepatitis C had been treated, while the remaining 66 million remained ill and potentially infectious to others.[11] Such disease proliferation benefits the patentee who, by deploying its new drug in a global population-level strategy of disease eradication, would be reducing its current earnings and undermining its future sales.

Prices for advanced pharmaceuticals are set at such exorbitant levels because this is the most lucrative choice. Because economic inequalities are very large, even intra-nationally,[12] it is profit-maximizing to aim an important product at the affluent and well-insured: a lower price would not gain enough in increased sales volume to compensate for the loss in reduced profit margin. Each year, hundreds of millions suffer, and millions die, from lack of access to medicines that generic firms could and would supply quite cheaply if patent enforcement did not prevent them from doing so.[13]

Making pharmaceutical firms reliant on monopoly rents hurts the world’s poor also through its influence on R&D decisions. Firms that derive their earnings from monopoly markups ignore diseases that are heavily concentrated among the poor, as is shown by the strong correlation between disease-specific R&D investments and the average income of the corresponding patient population.[14] As a result, while male pattern baldness and erectile dysfunction garner abundant research attention, humanity is woefully underequipped with pharmaceuticals against the 20 WHO-listed “neglected tropical diseases,” which “cause devastating health, social and economic consequences to more than one billion people,”[15] as well as the familiar great diseases of poverty – including tuberculosis, malaria, hepatitis, pneumonia, and diarrhea – which routinely kill some six million people every year.[16]

Systematic neglect of the poor in both R&D and distribution of pharmaceuticals allows them to be a breeding ground where new diseases, such as Ebola, swine flu, and COVID-19, can gain traction and old diseases can survive and evolve new, perhaps more virulent or drug-resistant disease strains – as has happened with tuberculosis in China and India, and with malaria in South East Asia and Ethiopia. In this regard, the interests of poor and rich are well-aligned: we all want to see diseases contained, suppressed, and eradicated from this planet. But the only way to achieve this is with a population-level strategy that includes the poor.

Humanity has eradicated only one human disease, smallpox, in a joint effort led by the Soviet Union at the height of the Cold War.[17] We certainly could have eradicated other infectious diseases too, including most of those mentioned two paragraphs back. But under the current innovation regime, disease eradications are unlikely.[18] Here is why. Pharmaceuticals can protect people against harm from infectious diseases in two distinct ways. At the individual level, they can protect their users. At the population level, they can be deployed to contain and suppress a disease toward eradication, thereby saving people from being endangered by it in the first place. Although we consumers much prefer being benefited in the latter way, this way is money-losing for pharmaceutical firms which profit only by benefiting people in the former way. It is not profitable for them to address the needs of poor patients; and it is financial suicide for such a firm to suppress a disease for which it is selling an exclusive remedy. Under the current monopoly patent regime, pharmaceutical firms have a vital financial interest in the continued flourishing of their target disease. Thanks to this interest, the poor – though unable to afford patented medicines – nonetheless make a crucial indirect contribution to innovator profits.

To summarize and generalize. By relying on temporary monopolies, our current regime for stimulating and rewarding innovation generates two interrelated and highly destructive problems. It fails to realize huge potential benefits for poor people by guiding innovators to ignore their specific needs and to price existing innovations out of their reach. Relatedly, it fails to reward and hence to induce vast third-party benefits that a technology’s buyers and users care little about. The pharmaceutical sector illustrates both problems to perfection.

A Supplementary Health Impact Fund

Earning trillions of dollars on their patents each year,[19] patentees are willing and able to defend their privileges ferociously. The chances of achieving meaningful revisions of the TRIPS regime are therefore slim or nil. Twenty-five years of attempts at the WHO have yielded next to nothing; and the latest episode – the proposed TRIPS waiver for COVID-related products – has similarly been mired in shameful stalling and delay with daily reductions in the good it might yet accomplish. It is high time to explore the politically more realistic approach of addressing the problems without revision of the TRIPS framework.

The most important objective here is to incentivize firms to fully include poor people in their business strategy. Such inclusion requires an effective new pharmaceutical to be cheap enough to be affordable to all while delivering it to even the poorest is profitable enough for firms to want to do so comprehensively and effectively. In our world of widespread poverty, these two requirements stand in tension. There is no sales price that is low enough to fulfill the former and high enough to fulfill the latter requirement. To resolve this tension, firms must receive a delivery premium in addition to the sales price.

This can be achieved by creating a sector-specific add-on to the current regime: an international Health Impact Fund (HIF) that invites innovators to permanently forgo monopoly markups on a new patentable pharmaceutical in exchange for impact rewards. The word “invites” is key: innovators would have a choice, in regard to each qualifying innovation, whether or not to register it with the HIF.

The prohibition on monopoly markups could be implemented through open licensing or, perhaps preferably, through a tender process that selects two or three reliable contract manufacturers to mass-produce the registered pharmaceutical on the registrant’s behalf to meet global demand. Such a tender process affords superior economies of scale, facilitates health impact measurement, and makes it easy for the registrant to sell the product below its price cap into impoverished regions when the expected additional health gains make it profitable to do so.[20]

The HIF would pay registrants of a new pharmaceutical an alternative reward based on the incremental health gains produced with it. Here “health gains” are defined to include externalities, such as the benefits that use of a HIF-registered product confers upon third parties in the form of reduced infection risk. A registered pharmaceutical would earn its maximum reward by eradicating its target disease – and this even if the innovator then had no more patients left to treat with it.

Under the current monopoly regime, new pharmaceuticals that are just slightly better than existing alternatives can earn as much as first-in-class innovations; and duplicative products that do not improve the state of the art at all can still capture a large market share, thereby garnering huge profits and reducing the rewards of a preceding break-through innovation. The HIF avoids such inefficiencies by rewarding only incremental health gains, gains that would not have occurred without the registered innovation. It thereby discourages socially wasteful efforts to field a duplicative product against a HIF-registered innovation: if HIF-registered, the duplicate would earn too little for lack of incremental impact; if unregistered, it would earn too little because of its uncompetitive price.

The HIF would pay its rewards through fixed annual disbursements, each split among registered pharmaceuticals according to incremental health gains achieved in the preceding year. This principle of division ensures fairness among innovators, who are rewarded in proportion to benefit provided, all at the same reward-to-benefit rate. Each innovation would participate in ten of these annual disbursements and be freely available thereafter through open licensing.

So designed, the HIF would evolve a stable competitive reward rate. When innovators find it unattractive, registrations slow and the reward rate rises as older innovations exit at the end of their reward period. When the rate is seen as generous, it soon declines through proliferating registrations. Such predictable adjustment reassures registrants and funders alike that the reward rate is fair, and will continue to be fair, between them. By design, innovations earn competitive rewards.

The size of the annual disbursements can be set, and possibly raised, to attain the desired level of participation. If the HIF had annual disbursements of €6 billion, each registered pharmaceutical would participate in €60 billion worth of disbursements over its ten-year reward period. A commercial innovator would register a product only if it expected to make a profit over and above recouping its R&D expenses. There is some controversy over what these fixed costs per innovation (inflated to account for the risk of failure) amount to. The number of products registered with the HIF would throw light on this question because of the Fund’s self-adjusting reward rate. Were it to attract, say, 30 products, with three entering and three exiting in a typical year, this would show that the prospect of €2 billion over ten years is seen as satisfactory – neither windfall nor hardship.

The HIF improves upon innovation prizes and other pull mechanisms, such as advance market commitments,[21] in five ways. It constitutes a structural reform, establishing stable and predictable long-term innovation incentives. It lets innovators, who know their own capabilities best, decide which innovations to pursue across the whole range of disease areas. It avoids having to specify a precise “finish line” – hard to get right in advance – and instead rewards each registered innovation according to the benefits produced with its deployments. It avoids having to specify a reward-for-benefit rate, which instead evolves endogenously through market forces. It gives innovators strong incentives also to promote (through information, training, technical assistance, discounts, etc.) the fast, wide, impactful diffusion of their participating innovations.

The HIF would quite easily offset its cost through lower prices on registered pharmaceuticals and through large reductions in the global burden of disease, entailing cost-savings in other health care costs as well as substantial gains in economic productivity and associated tax revenues. Nevertheless, these great potential benefits must be appreciated, and this appreciation be converted into reliable long-term funding commitments. Innovators considering a high-impact R&D project must have firm assurance that they will get paid during their product’s first ten years on the market. If HIF rewards are perceived as uncertain, innovators will discount them with the result that its reward rate will be higher than necessary.

At least initially, reliable long-term commitments will have to be underwritten by states, with optionality again important for political feasibility. The HIF can get started with a few states, even just one. It makes sense to design the HIF so that it lets participating innovators sell their registered pharmaceuticals at patent-protected high prices in non-contributing affluent countries. This exception would give affluent countries a further incentive to join the funding partnership. It would also reduce the opportunity cost of HIF-registration, thereby raising the number of products the HIF would attract at a given size of annual disbursements.

With state contributions based on gross national income, the HIF might expand over time – through economic growth in contributing states, accession of new states, or agreement to raise the contribution rate – and would then attract more registrations. Similar growth could occur if states decided to devote part of an international tax – on greenhouse gas emissions, perhaps, or on financial transactions – to the HIF. In any case, the HIF should also welcome donations from non-state actors (foundations, corporations, individuals, and bequests), perhaps using them to build an endowment that could support an increasing share of its annual budget.

Most of the HIF’s cost would be borne by more affluent countries and people. The same is true of monopoly rents extracted from early buyers. But there is this crucial difference: impact rewards avoid excluding the poor. Such exclusion is deeply immoral, as when millions die from lack of medicines that generic manufacturers would be glad to supply quite cheaply. Such exclusion also harms us all by exposing us to dangers from diseases that emerge or propagate among the poor, often evolving new variants – or drug resistance, emerging when patients cannot afford to take the full dosage or full treatment course of an expensive drug.

Organizing a wide competition across the entire pharmaceutical sector, the HIF would create a new kind of competitive market that helps innovations achieve their full potential. Removing the headwind of monopoly rents and adding a tailwind of impact rewards, such a market transforms innovator motivation. While monopoly rewards incite massive efforts to deter, detect and terminate patent infringements, the HIF would encourage participating innovators actively to promote – through local-language instructions, adherence support, discounts, training, technical assistance, diagnostics, etc. – the rapid, widespread, and effective deployment of their technology for optimal benefit. It would stimulate innovators to holistically organize their research, development, marketing, and delivery operations toward producing the most cost-effective incremental health gains. In this way, the HIF would induce the development of precisely those high-value innovations that the current regime leaves inadequately rewarded. Innovators would have financial incentives to supply these new HIF-registered pharmaceuticals at very low prices and to collaborate with their large customers – national health services and organizations like the Global Fund, GAVI, Médecins Sans Frontières, and Partners in Health – on the optimal strategic deployment of these products aimed at containment, suppression, and ultimately eradication of the target disease. Creation of the HIF would greatly improve the prospects of permanently freeing humanity from some of the most destructive infectious diseases and greatly enhance humanity’s capacities to tackle new infectious diseases and disease strains.

A Health Impact Fund Pilot

The example of the Global Fund suggests that creation of the HIF is entirely possible. To mobilize the needed political support, it would be extremely helpful to try out the HIF approach on a smaller scale. COVID-19 was a great opportunity to do so. Instead, this pandemic became a depressing showcase for the flaws of the current monopoly regime. Effective vaccines were developed in record time. But manufacturing was scaled up slowly as innovators sought to safeguard their proprietary technologies and know-how, to avoid wasteful excess capacity, and to maintain a favorable demand-supply imbalance conducive to high prices. And the distribution of vaccines was driven not by a strategic effort to suppress the disease but by a scramble to maximize monopoly rents: innovators prioritized buyers who offered to pay more and rejected those who, only marginally profitable, might erode the product price and seemed more useful spreading and prolonging the pandemic with potential emergence of new disease variants.

Fortunately, a suitable HIF pilot is always feasible. Featuring a single reward pool of ca. €100 million, such a pilot might invite innovators to submit proposals of how they might, with one of their existing pharmaceuticals, achieve additional health gains in some selected poor country or region. An expert committee would select the four best proposals based on, inter alia, anticipated incremental health gains, prospects for broad, equitable access especially by the poor, susceptibility to reliable, consistent, and inexpensive health impact assessment, and promise of additional social value. Selected proponents – which might include non-commercial innovators such as DNDi and the TB Alliance – might then have three years for implementation. Thereafter, achieved health gains would be assessed – according to pre-agreed criteria, by an agency like the IQWIG, DEval or IHME – and the reward pool be divided proportionately.[22] The pilot would show how innovators respond to the novel competitive impact rewards, would help refine impact assessment, and would indicate how well impact rewards work in generating health gains and supplementary health policy insights. The most important objective here is to incentivize firms to fully include poor people in their strategy right from the start. For this to happen, an effective new pharmaceutical must be cheap enough to be affordable to all while delivering it even to the poorest must be profitable enough for firms to be eager to do so comprehensively and effectively. In our world of widespread poverty, these two requirements stand in tension. There is no sales price that is low enough to fulfill the former and high enough to fulfill the latter requirement. To resolve this tension, firms must receive a delivery premium in addition to the sales price. Such a premium, tied to health gain achieved, is an essential component of the Health Impact Fund approach, which offers firms performance rewards based on the real health gains they achieve with any of their products, on condition that they sell this product without markup (HealthImpactFund.org, 2021).

Conclusion

By supporting establishment of the HIF, citizens and governments of contributing states could take a real step toward fulfilling their long-declared commitments to human rights, poverty eradication, the 2030 Agenda of Sustainable Development Goals, and an international spirit of planetary solidarity.

The current global innovation regime perpetuates staggering global health deficits.  Creation of the HIF is an extremely cost-effective reform that could avert most of this harm – potentially freeing millions of poor people from their debilitating ailments and greatly raising humanity’s preparedness against communicable diseases. In fact, the HIF’s true cost is likely to be negative insofar as savings on registered pharmaceuticals and other health-care costs as well as gains in economic productivity and associated tax revenues would benefit the contributing funders – also indirectly by reducing the cost of health insurance, national health systems, and foreign aid. Further economies would arise from the HIF largely avoiding the wasteful expenditures now typical of the pharmaceutical sector: expenses for multiple staggered patenting in many jurisdictions with associated gaming efforts (e.g., evergreening), costs of preventing monopoly infringements, costs of duplicative innovations with mutually-offsetting competitive promotion efforts, economic deadweight losses, and costs due to corrupt marketing practices and counterfeiting. Thanks to these enormous inefficiencies of monopoly incentives, a shift toward impact rewards could dramatically improve global health and the lives of the poor without cost to anyone. Pharmaceuticals firms, in particular, would gain wholly new opportunities to do well by doing good: to earn money by benefiting rather than harming poor populations. Aligning profits with human needs, the HIF would make the business of innovation much more equitable in terms of research priorities and access to its fruits.

 

Endnotes

[1] FAO, IFAD, UNICEF, WFP and WHO, The State of Food Security and Nutrition in the World 2021 (Rome: Food and Agriculture Organization of the United Nations, 2021), https://doi.org/10.4060/cb4474en, Table 5, p. 27. Since 2019, the situation has become even much worse, as the crises of climate, COVID-19, and Ukraine have caused a unprecedented 68% surge in food prices, driving the FAO’s food price index from 95.1 in 2019 to 159.3 in March 2022 (https://www.fao.org/worldfoodsituation/foodpricesindex/en/).

[2] https://www.givingwhatwecan.org/post/2021/03/measuring-global-inequality-median-income-gdp-per-capita-and-the-gini-index/

[3] 2.2 billion human beings lack safe drinking water, http://www.who.int/news-room/fact-sheets/detail/drinking-water

[4] 2 billion people live without adequate sanitation, https://www.who.int/en/news-room/fact-sheets/detail/sanitation

[5] Well over 1 billion people lack adequate housing. UN Habitat, Fact Sheet 21: The Right to Adequate Housing, https://www.ohchr.org/sites/default/files/Documents/Publications/FS21_rev_1_Housing_en.pdf , p. 1.

[6] 940 million people have no electricity, https://ourworldindata.org/energy-access

[7] Some 160 million children aged 5–17 do wage work outside their own household and hence do not go to school (https://www.ilo.org/ipec/Informationresources/WCMS_800278/lang–en/index.htm) and over 750 million adults are illiterate (https://en.unesco.org/themes/literacy).

[8] John Braithwaite and Peter Drahos, Global Business Regulation (Cambridge: Cambridge University Press, 2000), esp. chapters 7, 10, 20, 21. Daniel Gervais, The TRIPS Agreement: Negotiating History, Fourth Edition (London: Sweet & Maxwell, 2012).

[9] TRIPS Agreement, https://www.wto.org/english/docs_e/legal_e/trips_e.htm, Articles 27, 28 and 33.

[10] Melissa J. Barber, Dzintars Gotham, Giten Khwairakpam, and Andrew Hill, “Price of a Hepatitis C cure: Cost of Production and Current Prices for Direct-Acting Antivirals in 50 Countries,” Journal of Virus Eradication 6, no. 3 (2020): 100001. Available at https://doi.org/10.1016/j.jve.2020.06.001

[11] Clinton Health Access Initiative, “Hepatitis C Market Report, Issue 1” (2020), p. 10. Available at https://www.globalhep.org/sites/default/files/content/resource/files/2020-05/Hepatitis-C-Market-Report_Issue-1_Web.pdf

[12] Sean Flynn, Aidan Hollis, and Mike Palmedo, “An Economic Justification for Open Access to Essential Medicine Patents in Developing Countries,” Journal of Law, Medicine and Ethics 37, no. 2 (2009), 184–208 at pp. 187–188.

[13] Arguably, cutting patients off from affordable access to life-saving drugs in this way constitutes a violation of their human rights. See Thomas Pogge, “The Health Impact Fund and Its Justification by Appeal to Human Rights.” Journal of Social Philosophy 40, no. 4 (2009), 542–569. http://onlinelibrary.wiley.com/doi/10.1111/j.1467-9833.2009.01470.x/abstract.

[14] Javad Moradpour and Aidan Hollis, “Patient Income and Health Innovation,” Health Economics Letter (2020). Available at https://doi.org/10.1002/hec.4160.

[15] See World Health Organization, “Neglected Tropical Diseases,” https://www.who.int/health-topics/neglected-tropical-diseases#tab=tab_1.

[16] Our World in Data reports 2.56 million deaths from pneumonia in 2017 (https://ourworldindata.org/pneumonia), 1.53 million deaths from diarrheal diseases in 2019 (https://ourworldindata.org/causes-of-death), 1.18 million deaths from tuberculosis in 2019 (https://ourworldindata.org/grapher/tuberculosis-deaths?tab=chart&country=~OWID_WRL), 627,000 deaths from malaria in 2020 (https://ourworldindata.org/malaria) and 79,000 deaths from hepatitis in 2019 (https://ourworldindata.org/grapher/deaths-from-acute-hepatitis-by-cause).

[17] Frank Fenner, Donald Henderson, Isao Arita, Zdenek Jezek, and Ivan Danilovich Ladnyi. Smallpox and its Eradication‎ (Geneva: World Health Organization 1988). https://apps.who.int/iris/handle/10665/39485.

[18] To be sure, non-commercial innovators occasionally obtain funds to work on such diseases, leading to successes like the recent malaria vaccine developed at Oxford University:  https://www.theguardian.com/commentisfree/2021/apr/25/new-vaccine-success-for-oxford-is-truly-remarkable. But they rarely have enough money for a successful tripartite campaign of product development, large-scale product manufacture, and global product distribution.

[19] In the pharmaceutical sector alone, sales of brand name products amount to about $800 billion annually. See International Federation of Pharmaceutical Manufacturers and Associations, “The Pharmaceutical Industry and Global Health” (2017), p. 5, https://www.ifpma.org/resource-centre/ifpma-facts-and-figures-report

[20] For more detailed discussion, see Thomas Pogge, “The Health Impact Fund: Enhancing Justice and Efficiency in Global Health,” in Journal of Human Development and Capabilities, 13, no. 4 (2012), 537–559 at pp. 550–552.

[21] See Michael Kremer and Rachel Glennerster. Strong Medicine: Creating Incentives for Pharmaceutical Research on Neglected Diseases (Princeton: Princeton University 2004); and Michael Kremer, Jonathan Levin, and Christopher M. Snyder. “Designing Advance Market Commitments for New Vaccines” (2020). Online at https://scholar.harvard.edu/files/kremer/files/amc_design_36.pdf.

[22] Sophisticated methods of health technology assessment exist and are widely used, especially by national and private insurers, so the HIF and its pilot could draw on these methods.

Towards a Culturally Diverse Aged Care System

Find out below an article by the Centre for Cultural Diversity in Ageing which is funded by the Australian Department of Health under the Partners in Culturally Appropriate Care (PICAC) program. The Centre provides expertise in culturally inclusive policy and practices for the aged services sector, while supporting aged care providers to address the needs of older people from culturally and linguistically diverse backgrounds

For more information visit www.culturaldiversity.com.au

By Nikolaus Rittinghausen

Senior Advisor & Project Officer

The Centre for Cultural Diversity in Ageing

PICAC Victoria, Australia

Towards a Culturally Diverse Aged Care System

Providers Can Tap into a National Program

 

Republished from the Centre for Cultural Diversity in Ageing Media Hub under permission by the Author
People from culturally and linguistically diverse backgrounds make up approximately a third of our older population, however, they are not a homogenous group. Each person is characterised by a unique identity which is influenced by life experiences and social, cultural, educational, economic and health determinants.

Culture, religion and migration experiences naturally shape the way people think and act. For example, people who were forced to leave their home country due to political persecution, often lack trust in government institutions and governmentrelated services.

The Partners in Culturally Appropriate Care Alliance (PICAC Alliance) is a national program funded by the Australian Department of Health to support aged care providers to deliver culturally appropriate care. It welcomes the Federal Government’s aged care budget which proposes a roadmap to ensure safer and better quality care for older Australians. One of the directions of the budget is the compilation of a new Aged Care Act which places human rights principles at the centre of governance and service delivery.

The PICAC Alliance has spoken on a number of occasions about the importance of incorporating the cultural, linguistic, and spiritual needs and preferences of older people from culturally and linguistically diverse backgrounds into the new Aged Care Act and that the human rights principles of the Act, such as the fundamental right to speak in one’s first language, are translated into everyday practice within the delivery of age services.

The PICAC Alliance recommends embedding inclusive service models and delivery into the heart of the organisation and that responding to the needs of all older, diverse people is deemed essential in delivering quality and equitable care.

The PICAC Alliance acknowledges the Federal Government’s major investment into translating and interpreting services to help culturally and linguistically diverse older people to access and navigate the aged care system. The PICAC Alliance further applauds the proposed implementation of the Specialist Verification Program, which will certify providers who offer specific services directed at diverse consumers. This program is intended to make specialist providers more accessible to these consumers, their families, carers and advocates. With the profile and preferences of consumers becoming increasingly diverse, aged care services and programs will need to more appropriately reflect this consumer diversity.

It is key that organisations have access to targeted support and training in relation to culturally inclusive governance and service delivery.

The PICAC Alliance supports aged care providers across Australia to develop culturally inclusive care across all levels of their organisations. The Federal Government also supports this notion through its Aged Care Diversity Framework. Launched in 2017, the framework highlights the need to strategically support older people with diverse characteristics.

The Centre for Cultural Diversity in Ageing, the PICAC Victorian provider, complemented the government’s approach to diversity and inclusion through the creation of its Inclusive Service Standards, which provide a strategic framework for services to adapt and improve their services and organisational practices so they are welcoming, safe and accessible.

To complement this framework, more resources are needed to give providers the necessary support, and further work is required to ensure the delivery of inclusive care.

Inclusive care is a concept and practice that is well developed in Australia due to the commitment by successive governments to multiculturalism, the principles of access and equity, and our culturally diverse older population.

As a country, we have the unique opportunity to continue this journey towards a culturally inclusive world-class aged care system.

The PICAC Alliance organisations and their resources, training and tailored supports have been instrumental in paving the way for inclusive care practices across Australia and supporting aged care providers on that journey.

The PICAC Alliance looks forward to continuing to support aged care service providers, and the wider aged care sector to journey towards a more inclusive aged care system.

 

 

News Flash 474: Weekly Snapshot of Public Health Challenges

News Flash 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

News Flash 474

Weekly Snapshot of Public Health Challenges

 

Covid, Conspiracy-Theories, and the Struggle for Health for All by Judith Richter 

G2H2 Annual Report 2021

WHO Watch for 75th World Health Assembly: Call for Watchers to participate to the World Health Assembly (May 2022 -physically)

WHO: Strengthening the Global Architecture for Health Emergency Preparedness, Response and Resilience

WHO: Public hearings regarding a new international instrument on pandemic preparedness and response 12 – 13 April 2022

Wed, 23 Mar 2022 Seminar in Brussels: International shared responsibility and solidarity: COVID-19 as a beneficial epidemic?

MSF urges governments to reject the draft COVID-19 text at WTO that would set a negative precedent

Neither the waiver people need nor a solution fit for a pandemic: Four reasons why we’re asking governments to reject the leaked text on COVID-19 at the WTO

ECDC and EMA issue advice on fourth doses of mRNA COVID-19 vaccines

Suspension of supply of COVID-19 vaccine (COVAXIN®)

GOVERNING PANDEMICS 101 ONLINE COURSE: 8 April- 15 July 2022

How President Biden Can Expand Global COVID-19 Test-To-Treat

Interview with Ani Herna Sari, tuberculosis activist od Indonesia, GFAN Speaker

Interview with Naomi Wanjiru, Community-activist, nurse in aids- and tuberculosis clinic in Kenya

Bed net that ‘grounds’ mosquitoes cuts malaria cases

Hunting the ‘perfect protein’ for malaria mRNA vaccine

WWF report says online wildlife trade on rise in Myanmar

The Global Implications of the War in Ukraine on Military and Other Spending

Human Rights Reader 623: DOES THE DIGITAL REALM PRESENT US WITH A TINA (there is no alternative) HUMAN RIGHTS PREDICAMENT?

The road to equality: How do EU Member States address inequalities through international cooperation?

Bulletin #22: Health as a bargaining chip People’s Health Dispatch Apr 2, 2022

Cadbury’s chocolate is made with cacao farmed by suppliers using child labour, I met the victims in Ghana

Public Food Procurement as a strategic tool to improve sustainability and trigger the transformation of food systems

Food is at the centre of Planetary Health – and the medical community needs to act upon it

Oxfam, others: West Africa facing worst food crisis in a decade

Why is the most harmful product the least regulated?

Meeting registration: Healthy Climate Prescription: What next? Apr 12, 2022 03:00 PM in Zurich

Heatwave Burns Through India Earlier Than Usual as Climate Crisis Deepens

Climate Mitigation Report Says 43% Reduction Needed in Carbon Emissions by 2030

WHO urges accelerated action to protect human health and combat the climate crisis at a time of heightened conflict and fragility

Green Deal: Modernising EU industrial emissions rules to steer large industry in long-term green transition

Green Deal: Phasing down fluorinated greenhouse gases and ozone depleting substances