News Link n. 32


The news links are part of the research project GESPAM (Geopolitica, Salute Pubblica e Accesso alle Medicine/Geopolitics, Public Health and Access to Medicines), which aims to focus on the best options for the use of trade and government rules related to public health by resource-limited countries.



Il rilancio della cooperazione internazionale: perché solo insieme si cresce

PAHO Director’s Corner


Letters To The President Obama  

President Obama, Set a Goal to End Hunger

EU’s next step to fight global child hunger  

On Day One: Ensuring Food Security

Global health education in U.S. Medical schools

US FTC Finds Sharp Rise In ‘Pay-For-Delay’ Deals Blocking Generics

Free Drugs Are “Crucial Part” Of Neglected Topical Disease Fight

Could a new business model be the next wonder drug?

Developing countries’ private debt is on the rise, and the international institutions are ill-prepared

Official Offers Reflections On WHO Reform, Private Sector Role

Business’ Privileged Access To EU-India Trade Documents

World Trade Organisation’s new boss will face an in-tray filled with problems

Responsibility in the Time of Cholera: What the UN and Others Should Do in Haiti 

China, UK unveil joint global health program

Family planning stands pat

Looking Ahead at Global Health in 2013 






News Link n. 31


The news links are part of the research project GESPAM (Geopolitica, Salute Pubblica e Accesso alle Medicine/Geopolitics, Public Health and Access to Medicines), which aims to focus on the best options for the use of trade and government rules related to public health by resource-limited countries.


News Link 31

Dear President Obama: Africa is calling 

2013 EU humanitarian aid budget: Who gets what? 

Widespread Use Of New TB Drug Faces Challenges, Science Reports 

The Financial Transaction Tax: Globalization’s Payback Time for the World’s Poor…  

Q&A: Middle Eastern web technology for social change, with Esra’a Al Shafei

India rejects claims it exported fake medicine to Africa 

‘Two Indias exist everywhere, especially in healthcare’ – video…

Can India Defeat Poverty?…

Innovation to fund global health…

A  New  Agenda  for  the  G20:  Addressing  Fragile  States

Disease Eradication

Video of the Week: Cash and Carry with the World Food Programme in Zimbabwe

USTR holds NGO briefing on TPP negotiations

Top tech breakthroughs of 2012

Twelve countries sign UN treaty to combat illegal tobacco trade…

Information is key to effective malaria control 

FAO Food Price Index down 7 percent in 2012 











News Link n. 30


The news links are part of the research project GESPAM (Geopolitica, Salute Pubblica e Accesso alle Medicine/Geopolitics, Public Health and Access to Medicines), which aims to focus on the best options for the use of trade and government rules related to public health by resource-limited countries.

News Link 30

Aids, un nemico sempre in agguato: intervista con Mario Figoni


Il nuovo Global Burden of Disease study: cosa c’è di nuovo?

Emerging economies drive frugal innovation

Effect of vitamin A supplementation on cause-specific mortality in women of reproductive age in Ghana: a secondary analysis from the ObaapaVitA trial

First new tuberculosis drug for 50 years – works on drug-resistant forms of the disease

At Europe’s Doorstep, Fierce War Against TB

Editorial, Opinion Pieces Address Effects Of Health Worker Murders In Pakistan On Polio Eradication

Taking Calls on Abortion, and Risks, in Chile

Thai-EU FTA Raises Alarm for People With AIDS  

In China, Grass-Roots Groups Take On H.I.V./AIDS Outreach Work 

Global development podcast transcript: hopes and fears for 2013 

Renowned US doctor appointed to support UN efforts to eliminate cholera in Haiti

Q&A with Eric Goosby, US Global AIDS Coordinator

Transforming Health with Mobile Technology

Efforts To Eliminate FGM ‘Breaking New Ground’ With Approval Of U.N. General Assembly Resolution Opinion-FGM-Resolution.aspx 

Myanmar eyes microfinance, private sector development 

Collaborative Capacity Building In Intellectual Property: Leveraging On African Diaspora Exchange

US aid policy under John Kerry: Expect few changes 

Most-Read IP-Watch Stories Of 2012: India Pharma, Europe, ACTA, WIPO Technical Assistance, Gene Patents


News Link n. 29


The news links are part of the research project GESPAM (Geopolitica, Salute Pubblica e Accesso alle Medicine/Geopolitics, Public Health and Access to Medicines), which aims to focus on the best options for the use of trade and government rules related to public health by resource-limited countries.


News Link 29


Ricerca scientifica: non è sufficiente dire Bad Pharma

Ambassador Goosby Named Head Of State Department’s New Office of Global Health Diplomacy 

The Office of Global Health Diplomacy: A Christmas Miracle or Lump of Coal? 

Susan Rice withdraws for secretary of state

The U.S. Role in Global Polio Eradication

Science put at heart of US global AIDS strategy

US Chamber Holds Annual IP Attaché Roundtable, Announces New “IP Index”

KEI notes on the 15th round of Trans-Pacific Partnership Agreement (TPPA) negotiations in Auckland, New Zealand

The MDGs: Where Does Nutrition Fit?

Future of Agriculture: Online Discussion blog 

FAO: Poor Countries Must Invest in Farming to Tackle Hunger

Analysis: Five reasons malnutrition still kills in Nepal 

Waiting For Customs And Trademark Reforms, EU Rights Owners Get “Proactive” Against Fakes

Howard Berman Unveils Landmark Foreign Assistance Reform Legislation

Finally, a 2013 EU budget

EU to join efforts with the World Bank to develop water and energy in Central Asia

European Unitary Patent And Court Becomes Reality

Dispatch From Sweden: Development Talks, Gender Equality, and the Nobels



The Ongoing Fight for Safety, Equality, and Health

OP-ED: Women Out Loud

80 Programs to Improve the Health and Lives of Women in the Developing World

How Big Pharma Prevents The Poor From Accessing Life-Saving Medicines 

Will innovative financing replace ODA? 

The year of cataclysm for the NHS  





















Fondi in calo per le malattie neglette: un panorama frammentato da riordinare


 La Ricerca e Sviluppo (R&S) di nuovi strumenti diagnostici e terapeutici per le malattie neglette legate alla povertà (PRMN) è in sofferenza per la sensibile tendenza al ribasso dei finanziamenti


Fondi in calo per le malattie neglette: un panorama frammentato da riordinare

Daniele Dionisio


Come appena riferito da Policy Cures  “…Con 3 miliardi di dollari destinati nel 2011, i fondi per la ricerca globale nel settore superano oggi di circa 440 milioni di dollari gli stanziamenti del 2007, ma sono inferiori ai fondi del 2009, e simili a quelli del 2010…”€  [1, 2]

Questa stagnazione è preoccupante se si pensa che le PRMN (fra cui, ma non solo, AIDS, morbillo, polio, dengue, polmoniti, malaria, tubercolosi, malattia del sonno, leishmaniosi, diarree) insieme causano 5 milioni di morti all’€™anno nei paesi a basso reddito, dove 3 miliardi di persone sopravvivono con meno di 2 dollari al giorno  e le medicine salvavita protette dai brevetti sono fuori portata, mentre regole del commercio e governi stanno stravolgendo i diritti di proprietà intellettuale a favore di politiche allineate a interessi di monopolio [3-5]

Tutto questo in un momento in cui la assenza di una agenda operativa condivisa su scala mondiale rende ragione di un quadro generale decisamente frammentato, con sovrapposizione e duplicazione di iniziative.

In questo contesto, l’€™impegno dell’€™Unione Europea (UE) in R&S per PRMN  non è distribuito uniformemente fra gli Stati Membri, rappresenta solo lo 0.0024% del PIL combinato UE, e manca di adeguata condivisione con tutti i partners [6].

La UE dovrebbe coordinarsi e collaborare strettamente con le iniziative dei partners, non ultima la Roadmap appena lanciata dall’ Unione Africana sulla Responsabilità  Condivisa e Solidarietà  Globale per la Risposta ad AIDS, Tubercolosi e Malaria in Africa [7]

Ed è auspicabile una collaborazione più stretta della UE con il Fondo Globale per la Lotta ad AIDS, Tubercolosi e Malaria per compattare le forze in questi tempi di recessione economica globale [8].

Ma è altresì necessaria più aperta collaborazione UE con l’€™OMS circa i modelli e le fonti che l’€™OMS ha indicato e  sta esaminando per l’€™ottimale finanziamento di R&S per le malattie della povertà  [9]. Nel merito ben si presterebbero parte dei proventi (almeno il 10%) da  una Tassa sulle Transazioni Finanziarie oggi prossima all’€™attuazione in UE [10]  .

Nel frattempo gli Stati Uniti continuano a detenere un ruolo leader nella R&S per PRMN, anche attraverso le alleanze politico-strategiche che l’€™amministrazione Obama sta moltipicando negli scacchieri di Asia-Pacifico e Africa [11-14]

E questo mentre la spesa estera in R&S per PRMN da parte dei BRICS (Brasile, Russia, India, Cina, Sud Africa), soprattutto in termini di cooperazione Sud-Sud, è in lievitante ascesa, e gli Stati del Golfo, Turchia, Indonesia, Argentina, Messico e Corea del Sud sono protesi allo sviluppo di tecnologie per la salute in grado di coniugare innovazione, qualità  e basso costo [15, 16].

Riordinare questo panorama altamente frammentato è obiettivo prioritario se la R&S per PRMN deve fare di più e meglio. Allo scopo, sostegno generalizzato a OMS  e una agenda di lavoro comune per la condivisione delle priorità , senza dispersioni e ridondanze, sono assolutamente necessari.




















News Link n. 28


The news links are part of the research project GESPAM (Geopolitica, Salute Pubblica e Accesso alle Medicine/Geopolitics, Public Health and Access to Medicines), which aims to focus on the best options for the use of trade and government rules related to public health by resource-limited countries.


News Link 28

Changing the World: A Bold Endorsement of the Power of Vaccines and Immunization

Asia: Hopes rise in fight against HIV/AIDS 

Cancer’s New Battleground — the Developing World

Building Resilience to Recurrent Crisis. USAID POLICY AND PROGRAM GUIDANCE

Novartis vs. India: Supreme Court hearing ends


Chinese-Style Decentralization and Health System Reform

A beginner’s guide to land grabs 




Single European Patent Dominates IP Summit As European Parliament Vote Nears

GFINDER 2012 report

African scientists seek more commitment against tropical diseases 

Making bad drugs? Three strikes and you’re out 


DfID oversight of EU aid spending in poor countries gets ‘amber-red’ rating 

How corrupt is your government? 






News Link n. 27


The news links are part of the research project GESPAM (Geopolitica, Salute Pubblica e Accesso alle Medicine/Geopolitics, Public Health and Access to Medicines), which aims to focus on the best options for the use of trade and government rules related to public health by resource-limited countries.


News Link 27

“Good health at low cost”: il caso Etiopia

New Nestlé Chinese Medicine and World Health Organization 

New PEPFAR blueprint paves way toward AIDS-free generation

WHO Members Agree On “Strategic Work Plan” On Health R&D – But No Convention 

WHO Members Agree On Roadmap To Fight Poor Quality Medicines

Event This Week: The Creation Of Unitary Patent Protection In The European Union

Medicines Patent Pool Statement on Johnson & Johnson’s Darunavir Announcement

Pharma Companies Improving Access To Medicines But Lack Oversight Of Outsourced Clinical Trials, Analysis Says

Drug industry’s influence over research

Conflicted influences

Scientists and drug company connections

World Bank Group President Jim Yong Kim Opening Remarks at Neglected Tropical Diseases Conference, Washington DC

More infectious HIV strains spreading in India

Statement by the President on the Observance of World AIDS Day 

Treatment Action Group’s 2012 Report on Tuberculosis Research Funding Trends, 2005–2011

Mumbai Grapples With Drug Resistant TB Strain

China considers easing family planning rules

China bans hospitals from refusing patients with HIV-AIDS

What You Need to Know About Foreign Aid (And Why We Need to Protect It)

India Skirts Patent Laws to Help Companies and Poor

The US Proposal for IP Enforcement in the TPPA and Impacts for Developing Countries 


Interview: Mario Raviglione, Director WHO Stop TB Department



Mario Raviglione, Director of WHO Stop TB Department

GESPAM had the pleasure to interview Mr. Mario Raviglione as Director of the Stop Tuberculosis (TB) Department at the World Health Organization (WHO) since 2003.

Mario Raviglione joined WHO in 1991 to work on TB/HIV research and TB epidemiology in Europe. He contributed to the development of the DOTS (Directly Observed Treatment Short course) strategy in 1994, and set up the global drug-resistance surveillance project (1994) and the global TB surveillance & monitoring system (1995). In his first decade at WHO, he also worked on experimental regimens for treatment of latent infection in the mouse model (early 1990s), described the feasibility of preventive therapy in Africa (1995), first reported the TB control crisis in Eastern Europe (1993), and co-developed estimates and projections of the global TB epidemic. Between 1999 and 2003, Raviglione  was Coordinator for Strategy and Operations globally, taking charge particularly of surveillance and programme monitoring; operational research; TB/HIV and multi drug-resistant TB responses; and DOTS expansion worldwide.
Currently, as Stop TB Department Director, he is responsible for setting norms, policies and standards on global TB control, coordinating technical support, monitoring the global situation, and developing innovative interventions through translation of new evidence into policies & practice and through addressing system challenges such as community and private sector engagement.
He has published over 250 articles and chapters on the topics of infectious diseases, HIV/AIDS and TB in the most influential health journals and books, including in the last five editions of the prestigious Harrison's Principles of Internal Medicine. He is among the top 10 most cited authors in the TB field.
Mario Raviglione graduated from the University of Turin in Italy in 1980, and trained in internal medicine and infectious diseases in New York (where he was Chief Medical Resident at Cabrini's Medical Centre) and Boston, where he was appointed an AIDS Clinical Research Fellow at Beth Israel Hospital, Harvard Medical School. In 2005, he received the Princess Chichibu TB Global Award for his achievements in TB control. In 2009 he was nominated Fellow of the Royal Academy of Physicians (F.R.C.P., London, UK). In 2010 he received the Wolfheze 20 Year Jubilee Award for his contributions to modern TB control practices in Europe. As a leading expert in TB, Mario Raviglione  has served as a visiting professor at Johns Hopkins and Geneva Universities. He has been visiting professor at the medical schools of the University of Brescia and the University of Modena & Reggio Emilia in Italy, as well as at the Faculty of Science of the University of Pavia.

Background information from WHO Global Tuberculosis Report 2012  

... the global burden of TB remains enormous. In 2011, there were an estimated 8.7 million new cases of TB (13% co-infected with HIV) and 1.4 million people died from TB, including almost one million deaths among HIV-negative individuals and 430 000 among people who were HIV-positive....Globally, 40% of TB patients had a documented HIV test result... Almost 80% of TB cases among people living with HIV reside in Africa. 
....There were an estimated 0.5 million cases [of TB] and 64 000 deaths among children in 2011....
 The burden of TB is highest in Asia and Africa. India and China together account for almost 40% of the world'€™s TB cases. About 60% of cases are in the South-East Asia and Western Pacific regions. The African Region has 24% of the world'€™s cases, and the highest rates of cases and deaths per capita. Worldwide, 3.7% of new cases and 20% of previously treated cases were estimated to have MDR (multidrug resistant)-TB. India, China, the Russian Federation and South Africa have almost 60% of the world'€™s cases of MDR-TB. The highest proportions of TB patients with MDR-TB are in eastern Europe and central Asia. ...Extensively drug-resistant TB, or XDR-TB, has been reported by 84 countries; the average proportion of MDRTB cases with XDR-TB is 9.0%..... 

GESPAM:  Mr. Raviglione, the WHO-developed Stop TB Strategy aims to dramatically reduce the global burden of tuberculosis by 2015 by ensuring all TB patients, including for example, those co-infected with HIV and those with drug-resistant TB, benefit from universal access to high-quality diagnosis and patient-centered treatment. Which progress so far?

Mario Raviglione: The implementation of DOTS, later enhanced to the Stop TB Strategy, began in the mid-1990s. At that time, the global targets were to achieve everywhere 70% case detection and 85% cure rate. The case detection is today at around 65%, while the treatment success has been consistently above 85% over a number of years.  This means that despite a major increase in detecting cases worldwide, still one third of the estimated cases are not in the system. More importantly, impact targets have been achieved. The TB-related Millennium Development Goal of reversing the incidence trend has been achieved years ago and the other two international targets of halving prevalence and mortality in 2015 compared to 1990 are on track globally, although not in Africa and Europe. Overall, there is huge progress compared to the disastrous situation of the mid-1990s. However, with still 1.4 million deaths and 8.7 million cases every year, there is no room for complacency and TB remains a major killer worldwide.

GESPAM: MDR and XDR-TB:  please, add information about definitions, trends and latest treatment results.

Mario Raviglione: WHO defines MDR-TB as a form of tuberculosis that is resistant to at least isoniazid and rifampicin. Extensively drug-resistant TB (XDR-TB) is defined as MDR-TB + additional resistance to at least any fluoroquinolone and any of the 3 injectable agents. MDR-TB is estimated to affect nearly half a million cases every year, but we do not know exactly the figure since only 4% of TB patients worldwide today are exposed to drug susceptibility testing. If all cases detected had such testing, at least 310,000 patients would be detected. In reality, only 60,000 were reported in 2011 and the treatment success today is less than 50%. This means that these patients are likely to die frequently and spread the resistant strains to their communities.  Although we do not know global trends, we are aware that in some settings, MDR-TB is declining while in others, especially countries with an overlapping HIV epidemic, MDR-TB is on the increase. Major concerns are in the countries of the former Soviet Union where MDR-TB and XDR-TB are widespread.

GESPAM: The Stop TB Department functions include facilitating and engaging in partnerships for TB action. As such, what about factual collaboration with, and contributions from counterparts like the Global Fund, the European Union, BRICS countries, and the Gates Foundation, among others?

Mario Raviglione: WHO works closely with the Global Fund, especially in the past few months when we have been involved much more strategically than in the past as part also of a newly established TB committee that helps the GF secretariat to strategize on TB. It is in the common interest to collaborate since WHO has the mandate to support technically our Member States while the Global Fund is a financing mechanism providing the vast majority of external resources for TB control. With the European Union, it has not proven easy to develop a common agenda, and there isn’€™t one today. This may also be due to the lack of prioritization of tuberculosis, a killer of 4,000 patients every day, by most European countries. Paradoxically, the US Government is much more concerned about the threat of MDR-TB and XDR-TB coming from the EU neighboring countries that the EU itself. We work instead very closely with the BRICS. This year I visited China, India and South Africa, noticing how concerned and more and more committed they are about the TB problem. We also work closely with Brazil on their revolutionary social protection mechanism, truly providing access to the poorest, that we intend to further prioritize and disseminate. We are in constant contact with the Gates Foundation as they provide some support to our Department, although 90% of their investment in TB are focused on research.

GESPAM: As per the Global Tuberculosis Report 2012 mentioned before…..there are critical funding gaps for TB care and control. Between 2013 and 2015 up to US$ 8 billion per year is needed in low- and middle-income countries, with a funding gap of up to US$ 3 billion per year. International donor funding is especially critical to sustain recent gains and make further progress in 35 low-income countries (25 in Africa), where donors provide more than 60% of current funding…..There are also critical funding gaps for research and development. US$ 2 billion per year is needed; the funding gap was US$ 1.4 billion in 2010.

Inherently, do you think revenues from a Financial Transaction Tax (a quorum for which was just reached in the European Union through “€œenhanced cooperation procedure”€, could be a resource to partly channel towards TB funding gaps?

Mario Raviglione: Funding gaps, in my philosophy, are not just a matter for international donors. I believe that sustainable development requires domestic commitment and investment. The BRICS now cover more than 95% of their financial needs, but low-income countries, especially in Africa, still rely largely on external resources and the Global Fund covers 90% of these resources. We must therefore support these countries with a plan for progressive take-over by the Governments themselves over the next few years. The financial transaction tax is one way. The problem is that tuberculosis is too often forgotten when it comes to benefit from such initiative. This is why financial gaps exist.

GESPAM: What about WHO role and position regarding cheap TB medicines rolled out by India for poor countries’€™ needs?

Mario Raviglione: WHO’€™s position is that medicines can come from anywhere as long as they are of proven quality. In tuberculosis and in infectious diseases in general, this is key, as poor quality antibiotics not only do not help patients but in fact help create drug resistance.

GESPAM: As per a recent MSF report….South Africa has one of the highest burdens of drug-resistant tuberculosis (DR-TB) worldwide, with a conservative estimate of 13,000 new cases emerging each year. A new drug, bedaquiline (formerly known as TMC207) now offers hope for these patients. Yet despite positive outcomes in early clinical trials and recent agreement for a fast-track regulatory review in the United States and compassionate use in several European countries where the DR-TB burden is comparably low, the drug is not yet made available for patients in desperate need in South Africa....

What do you think about MSF call that bedaquiline (TMC207) be prioritized for drug-resistant TB patients in South Africa?

Mario Raviglione: We are working towards policy recommendations for Member States on how to introduce this new drug rationally (a second one will likely come out in late 2013), starting with the crafting of a proper regimen where the new drug is not administered alone, else drug resistance will develop quickly. We are also developing broader recommendations on how to provide wide access through accredited physicians and institutions who guarantee rational use.  We have been working also with South Africa that has asked WHO for a technical opinion on the issue.  If everything works as foreseen, we should be able to provide rapid advice to all countries in early 2013.

GESPAM: Children are often overlooked or misdiagnosed in National TB Programmes, and few child-friendly TB medicines exist   How is WHO tackling the gap of appropriate TB paediatric formulations?

Mario Raviglione: Paediatric TB has been clearly neglected by all as an important part of the response to TB. For the first time, the WHO global report 2012 included very detailed estimates of the burden, speaking of some half a million new cases every year and of some 70,000 deaths. This is a very large burden. Recently, WHO re-visited the existing drug dosages for children and issues specific recommendations on the correct formulations of fixed-dose combinations for children. Not surprisingly, at the moment, the pharmaceutical industry is not yet producing the correct formulations. A lot of efforts have to be made to work on the appropriate procedures to obtain new paediatric formulations including pharmacokinetic studies. We have encountered some difficulties to pursue the appropriate direction but it looks like, thanks to potential new grants, we may be able to overcome the obstacles and provide the pharmaceutical industry with the guidance and the support necessary for drug companies to start producing the correct formulations as defined by WHO. I am optimistic that this will happen within the next few months.

GESPAM: Thank you Mr. Raviglione for your enlightening answers.

Transnational health care and medical tourism

         Understanding 21st-century patient mobility. Towards a rationale of transnational health region development

 by Tomas Mainil
 University of Antwerp / NHTV Breda University of Applied Sciences
Publisher: NRIT Media, Nieuwegein  ISBN: 978-90-5472-219-9 (non-commercial edition)

Dr. Tomas Mainil is Lecturer at Breda University of Applied Sciences (the Netherlands).  He is responsible for the research line ´Transnational health care in sending and receiving contexts´ which was originated at the Centre for cross-cultural Understanding (CCU). He is research fellow at the Research Centre for Longitudinal and Life Course Studies (CELLO), University of Antwerp (Belgium).  He holds an MA in Sociology (Medical Sociology) and a MSc in Quantitative Analysis, and previously worked at the University of Antwerp (department Sociology) and Ghent University (department of General practice and primary health care) on health-related subjects.  His main interests are globalization and health, the policy and governance dynamics of transnational health care (PhD) and the internal and external characteristics of the transnational health user.

A full version of the PhD can be made available by the author:
Also forthcoming: Botterill, D., Pennings, G. and Mainil, T. (2013). Medical Tourism and Transnational Health Care. Basingstoke: Palgrave Macmillan.


International patients increasingly choose to be treated abroad. However, there are differences between the European perspective and other regional discourses about the globalizing health economy. The EU seeks to regulate internal patient mobility and values equality and social protection. Other regional discourses are confronted with  more privatizing/commodification in relation to patient mobility. The thesis examines the different terminologies that exist – such as cross-border healthcare and medical tourism -, arguing towards  the global terminology of transnational health care (Mainil et al., 2012):  2 archetypes of international patients (TBASs or Trans-border Access Searchers and CBASs or Cross-border Access Searchers) and 2 archetypes of professional stakeholders (RCAs or Receiving Context Actors and SCAs or Sending Context Actors) are distinguished.  Characteristics distinguishing TBASs and CBASs are geographical proximity/ distance, cultural proximity/distance and search strategies. Transnational health care is defined by more professional structures and communication networks that are also visible to and can be used by the patient.

The thesis then examines the life world of the transnational health user: 1. The role of the concept of ‘world-making’ on the websites of providers (Mainil et al., 2011); 2. The role of culturalism in the relations between medical professionals and patients (Mainil et al., 2013); 3. The role of the media in the discourse about medical tourism (Mainil et al., 2011); 4. The role of quality management in transnational health care (Mainil et al., 2012); 5. The relationship between public health and transnational healthcare (Mainil et al., 2013) and finally 6. The role of (regional) governments to steer patient mobility through context-controlled, sustainable health destination management (SHDM)/development (Mainil et al., 2012; Mainil et al., 2013).

1. The role of the concept of ‘world-making’ on the websites of providers

Globalization of health care also means that the internet is used by international medical providers to attract international patients. Providers use appealing lyrics and alluring images to use (smiling beautiful female patients and physicians) on their websites. However, the reality of offering health care is less related to the context of leisure, joy and pleasure. Within the study of tourism we know the concept of world-making: displaying images of vacation destinations that are not consistent with reality. The use of world-making in a healthcare context can, then, be ethically unjust.

2. The role of culturalism in the relations between medical professionals and patients

Jargen Habermas describes how two modes of action can be found in today’s society: communicative and strategic action. Communicative action takes place in mutual consultation and dialogue based on historical use while strategic action is based on decisions, power and speed. These two forms of action are also found in the medical tourism industry. We analyze how a department (International Office) within a hospital seeks to find a balance between these two types of action: they move between the international patients and medical professionals. It concerns the dialogue-based world of the patient with his concerns and hopes and on the other side  the professionalized world of doctors in a hospital who act strategically and work. This department attempts to act on the basis of a cultural sensitivity to the other, from an understanding of how the life world of the international patient is constructed. Therefore a need exists to act from an equilibrium in which cultural management can play a role.

3. The role of the media in written discourse on medical tourism

International newspapers (The Guardian, The Financial Times) as well as local newspapers (The Straits Times, Singapore, Bangkok Post, Thailand) display a discourse on medical tourism. This information is available to everyone. Often this information is normative. Before 2002, an ethical discourse is shown: be aware of the dangers for patients and medical professionals, medical tourism as a threat to national health systems.  After 2002 both international and local newspapers chose the market discourse in discussing medical tourism: it offers chances for new markets to consolidate and offers opportunities to multiple stakeholders. The ethical discourse is still present but has been serving the market perspective. It is this discourse that is reflected  in public opinion.

4. The role of quality management in transnational health care

Key stakeholders in transnational health care are hospitals. Hospitals’€™ focus on international patients can be formalized in an International Office (IO) to cater to non-medical services. In Belgium, this is less common, but in Germany or Singapore, such facilitation is present. We conducted a pilot study with regards to quality within such IOs through a benchmarking instrument,  incorporating the variables: medical treatment / facilities (accommodation / travel) / financial issues / quality (cultural / communicative / satisfaction). The various phases of the pilot study show that quality challenges largely depend on the national context and the strategy of the hospital.

5. The relationship between public health and transnational health care

The European Union has a history of  regulations on patient mobility. The synthesis of these regulations led to the “Directive on the Application of Patients ‘Rights in Cross-Border Healthcare”€, soon to be implemented by the Member States. This legal discussion can be linked to the debate over whether international patients can be seen as consumers or citizens with patient rights. The following considerations emerge: Do Europeans want to travel for their health? How should governments act when taking into account socio-economic differences between citizens and between states? How do these differences  relate to the current economic crisis? These considerations lead to several scenarios based on limited or extensive implementation of the Directive, whereby European international patients at times will be citizens with rights, but on other occasions care consumers.

6. The role of (regional) governments can use to steer patient mobility through a context-controlled, sustainable health destination management (SHDM) framework

Finally, all the factors in the context of transnational health care are bundled in a strong plea for a larger role for (regional) governments to strengthen their capacity to position  their regions as transnational health regions. In consultation with various stakeholders in the region, governments determine priorities for the regional system of medical expertise and specialization. In managing this regional health system, governments can make their health region profile visible to transnational health users and other regions. Governments are urged to work as health regions to depict both domestic and foreign patients  in structuring the identity of the region. Health regions comprise a sustainable policy route, as (regional) governments seek to attain public health goals.  We propose combining the notion of sustainable health destination management (SHDM) with the framework of (Smith et al., 2011) on bi-lateral agreements in transnational health care settings. If developed countries arrange bi-lateral agreements with developing and/or BRIC countries to assure health care exchanges, these agreements could align with a SHDM logic.  If for example the UK has bi-lateral agreements with India on health care exchanges, the UK could decide in a first stage  to focus on a bi-lateral agreement structure with a particular region in India, sending off patients to that region, building capacity, and ensuring that public health goals of both the UK and this Indian region are guaranteed.  In a second stage, other Indian regions could be targeted, with a focus on other medical specializations or even focusing on specific age groups such as senior citizens.  In using bi-lateral regional steering mechanisms, this could alleviate the current divide between the goals of  NGO’€™s and WHO, as opposed to the projection of  private healthcare diaspora in transnational health care. In combining SHDM and bi-lateral trade mechanisms  the proposed framework would serve as a vehicle or change agent to reverse the global south debate and to build up health care capacity based on collaborative governance (Brand and Michelsen, 2012).


Mainil T., Platenkamp V., Dinnie K., Botterill D., Van Loon F., and Meulemans, H. (2012). Transnational health care: the quest for a global terminology. Health Policy, 108(1), 37-44.

Mainil T., Platenkamp V. and Meulemans, H. (2011). Diving into the contexts of in-between worlds: world-making in medical tourism. Tourism Analysis, 15(6), 743-€“754.

Mainil, T., Platenkamp V. and Meulemans, H. (2013) Habermas, Transnational health care and cross-culturalism. In D. Botterill, G. Pennings & T. Mainil (Eds.), Medical Tourism and Transnational Health Care. Basingstoke: Palgrave Macmillan.

Mainil T., Platenkamp V. and Meulemans H. (2011). The discourse of medical tourism in the media. Tourism Review, 66(1/2), 31-€“44.

Mainil T., Platenkamp V., Dinnie K., Botterill D., Van Loon F., and Meulemans, H. (2012). Framing and measuring international patient management. In L.H. Friedman, G.T. Savage & J. Goes (Eds.), Annual Review of Health Care Management: Strategy and Policy perspectives on Reforming Health Systems, Volume 13, Bingley, UK: Emerald

Mainil, T. Commers, M. and Michelsen, K. (2013) Cross-border mobility within the European Union: from international to transnational health systems?. In D. Botterill, G. Pennings & T. Mainil (Eds.), Medical Tourism and Transnational Health Care. Basingstoke: Palgrave Macmillan.

Mainil, T., Dinnie, K., Botterill, D., Van Loon, F., Platenkamp, V. and Meulemans, H. (2013). Towards a model of sustainable health destination management based on health regions. In D. Botterill, G. Pennings & T. Mainil (Eds.), Medical Tourism and Transnational Health Care. Basingstoke: Palgrave Macmillan.

Botterill, D., Pennings, G. & Mainil, T. (2013). Medical Tourism and Transnational Health Care. Basingstoke: Palgrave Macmillan.

Smith, R., Marti­nez Alvarez, M., Chanda, R. (2011). Medical tourism: a review of the literature and analysis of a role for bi-lateral trade. Health Policy 103(2-3):276-82.

Brand, H., & Michelsen, K. (2012). Collaborative governance: The example of health conferences. In D. V. McQueen, M. Wismar, V. Lin, C. M. Jones, & M. (. Davies, Intersectoral Governance for Health in All Policies. Structures, actions and experiences (pp. 165-184). Copenhagen: WHO Office for Europe on behalf of the European Observatory on Health Systems and Policies.

News Link n. 26


The news links are part of the research project GESPAM (Geopolitica, Salute Pubblica e Accesso alle Medicine/Geopolitics, Public Health and Access to Medicines), which aims to focus on the best options for the use of trade and government rules related to public health by resource-limited countries.


News Link 26

HEALTH: TB response failing children

Here I Am: Leading the Fight Against Tuberculosis


WHO Members Agree On Roadmap To Fight Poor Quality Medicines

HEALTH: Breaking out of the cold chain

Nobel laureate Aung San Suu Kyi to combat AIDS-related stigma in new UN role

Dirk Niebel releases 100 million euros for the Global Fund

Commissioner Georgieva welcomes the European Union’s ratification of the new Food Assistance Convention

The long, slow tragedy of chronic hunger in southern Africa

Pushing Back Neglected Tropical Diseases in Africa

Private health insurance: implications for developing countries

Asia-Pacific leaders forge new alliance against malaria

UNAIDS: 2015 targets ‘feasible’ despite 30 percent resource gap 

EU Patent, Patent Court Could Finally Be Approved In Coming Weeks

Fixing Canada’s Access to Medicines Regime: Bill C-398

Thailand Expresses Interest in Joining Trans-Pacific Trade Talks, as TPP Leaders Set New Deadline

Patent Pool Signs Agreement With Laurus Labs To Increase Generic Production

Better Drug Use, Greater Efficiency

Health Policy After The Election

In Perspective: USAID moves in the right direction