2015: A Year in Review through PEAH Contributors’ Stands

Authoritative insights by 2015 PEAH contributors added steam to debate on how to settle the conflicting issues that still impair equitable access to health by discriminated population settings worldwide

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by  Daniele Dionisio*

PEAH – Policies for Equitable Access to Health 

2015: A Year in Review through PEAH Contributors’ Stands

 

Now that 2015 just came to its end, I wish to thank the top thinkers and academics who enthusiastically contributed articles over the year. Their authoritative insights meant a lot to PEAH scope while adding steam to debate on how to settle the conflicting issues that still impair equitable access to health by discriminated population settings worldwide.

Find out below a list of summaries and relevant links:

Beatriz Becerra Basterrechea, Member European Parliament, pointed out that …there is a total lack of transparency on the prices paid by governments for medicines. There is no public access or transparency regarding the clinical trials which test the efficacy and security of our medicines. We do not know how much has been invested in research nor do we have mechanisms to trace costs of production. A legislative effort should be undertaken to achieve transparency in industry’s investments in R&D as a process which would benefit both corporate public image and patients’ access to medicines….

As regards challenging antimicrobial resistance, Shila Kaur, Coordinator Health Action International Asia Pacific (HAIAP), reminded us that at the 67th World Health Assembly in May 2014, WHO Member States agreed to a Global Action Plan (GAP) to tackle the escalating antimicrobial resistance, including antibiotic resistance, global public health emergency. She regretted that … Despite having undergone two rounds of consultation with the global health community prior to its tabling at the WHO Executive Board meeting in January 2015, the draft GAP gives no indication on how developing and less developed countries, with limited or even non-existent technical resources and capacities, will design and implement their own national plans… 

Inherently, Garance Fannie Upham, Deputy General Secretary, AC2BMR/WAAAR World Alliance Against Antibiotic Resistance, extensively reported on the book “AMR Control 2015”. As per her wordsThis book gathers more than 30 outstanding authors on a broad range of topics and concepts, from proposals for new Intellectual Property Rights approaches to R&D for antibiotics, to the latest data showing that the 44 billion dollars spent on antibiotic for animal husbandry may only be wasteful, to the need for urgent investments in water and waste management by banks and investors, or, last but not least, as it is top in the just adopted United Nations Global Plan of Action on AMR: infection prevention and control (IPC) as a must against AMR, Ebola and MERS.

As regards these issues, Matteo Zignol and Mario Raviglione, Global Tuberculosis Programme World Health Organization, underlined that Surveillance of resistance to anti-TB drugs remains a cornerstone of any effective TB control programme worldwide. With the availability of new technologies and new drugs, and the prospect of new regimens for the treatment of TB and MDR-TB, surveillance of drug resistance is evolving and adapting to continue being a critical tool to inform public health actions to fight TB. 

In unison, Kaspars Lunte, Team Leader Sourcing and Special Projects, Global TB Drug Facility, Stop TB Partnership/UN Office for Project Services added that …Stop TB Partnership’s Global Drug Facility (GDF) was established in 2001, with the aim of using donor funding to consolidate demand from different countries and negotiate affordable prices for quality-assured anti-tuberculosis drugs. Today, as one of the main players in the complex global market for TB drugs, the GDF plays a crucial role in not only shaping drug supply, but also in reducing the price of medicines.

From a complementary perspective, Giorgia Sulis, Lucia Urbinati, and Alberto Matteelli, Division of Infectious and Tropical Diseases – WHO Collaborating Centre for “TB/HIV co-infection and for TB elimination”, University of Brescia, Brescia, Italy, remarked thatPersons with LTBI (latent tuberculosis infection) have no signs or symptoms and are not contagious; however, they are at risk of progression from latency to active disease. On average, this happens in 5-10% of those affected during their lifetime, but some (“at-risk”) populations have a substantially higher risk of progression than the average. Hence, diagnosis and treatment of LTBI may represent an attractive strategy for TB prevention.

Linda Mans and Diana Hoeflake, Wemos Foundation, highlighted that …The world is 7.2 million health workers short. Low-income countries are particularly affected by the shortage of health personnel. Too few health workers are being trained and retained due to insufficient public investments in health care and medical staff. Migration of health workers increases the inequalities and presents a challenge for all countries. Vacancies in high-income countries have a pull effect on qualified health workers from low- and middle-income countries. One of the reasons is that health personnel are leaving for greener pastures – countries where salaries are higher and facilities are better…

In his article, Matthew Rimmer, Associate Professor, Australian National University College of Law, Canberra, reported that …At an international level, there has been a growing impetus for climate action in order to address public health risks associated with global warming…. As he maintained,…At the international level, there is a need to encourage fossil fuel divestment by governments, companies, and institutions in order to promote a healthy climate and a safe planet.

The article by Lawrence C. Loh, University of Toronto and The 53rd Week,  emphasized that…Modern transport planning has rapidly moved away from an expensive, outdated system of car-dependent suburban sprawl. Understanding that health is different from and more than healthcare, wider societal discourse needs to apply planning’s lessons learned to move away from a singular focus on healthcare that is similarly expensive and outdated. 

To the point, Claudio Schuftan, People’s Health Movement –PHM, provided a lot of forward-looking reflections on inequality and poverty reduction, as a reliable voice amidst the efforts to address today’s challenges involving policies, strategies and practices, and push for inclusive and sustainable development grounded on equity.

From a different point of view, Tomas Mainil and Olaf Timmermans, HZ University of Applied Sciences, Vlissingen, the Netherlands,  maintained in their contribution that Globally, countries need to overcome demographic tensions in their populations. The challenge for the Dutch province of Zeeland is to develop social innovation in response to key societal challenges in tourism and health: Coastal regions are confronted with demographic changes, especially ageing of inhabitants as well as visitors (tourists) and their changing needs health-related issues. A cross-border cooperation, wherein a common approach is developed to explore problems and enhance opportunities, benefits the possibility to address this challenge…Relevantly, the article outlines a professorship aimed at establishing a crossover between the tourism and health economies, developing innovative services that fit the changed needs of both inhabitants and visitors on healthy living related services/products and have an economic and social value.

Meanwhile, Sara Gorman, Department of Health Policy & Management, Columbia University Mailman School of Public Health, pointed out that …although new technology is essential, social change and social progress depend upon people, not on technologies. Social progress relies on understanding complex systems and the people who inhabit them first and foremost.

A couple of articles by Corie Leifer, AIDS Foundation East-West (AFEW), dealt with prison inmates:

Based on evidence that prisons are often a catalyst for the outbreak of contagious disease epidemics, the first article explored …why prisoners are at greater risk for contracting certain infections, why this inequity should not be tolerated, and how this issue is innately connected to the public health of the general population. As a follow-up, the second article highlighted …a few projects that are working to address the underserved population of prisoners and ex-prisoners, particularly those who use drugs.

To the point, Lesley Doyal, Emeritus Professor, School for Policy Studies University of Bristol, UK, stressed that … The major focus in both national and international responses to HIV  pandemic is now on ensuring that as many positive people as possible have sustainable access to the specific drugs. But, whatever their medical efficacy they can only ever provide a partial solution to what has become a ‘post- modern plague’ in so many of the poorest parts of the world. The coming decades are likely to be ones of increasing need and declining resources. Hence optimistic suggestions that drugs alone will soon bring an end to the pandemic will need to be treated with the greatest caution. 

And this occurs at a time when, as argued by Meri Koivusalo, Senior Researcher on Health Policy at National Institute for Health and Welfare, Helsinki The new generation trade agreements, such as the TPP (Trans-Pacific Partnership) and TTIP (Transatlantic Trade and Investment Partnership), have changed the ground and context of trade negotiations through extension of negotiations further to national policies and regulation. These new generation trade agreements have gained criticism… Relevantly, …from health policy priorities perspective, the more systemic danger of TTIP is that it could hinder necessary change of corporate profiteering and an already failing model for innovation and R&D towards pharmaceutical policy in the public interest…

On her part, Raffaella Ravinetto, Antwerp Institute of Tropical Medicine,  pointed out that In April 2015, The WHO Expert Committee, tasked with the review and update of the WHO Lists of Essential Medicines for adults (EML) and children (EMLc), recommended the addition of 36 new medicines to the EML, and of 16 to the EMLc. It is hoped that the indications of the WHO Expert Committee will be considered and followed by all the concerned stakeholders, including pharmaceutical companies and policy makers.

In this environment, the article by Iris Borowy, Aachen University, Germany, tackled challenges to global health from a multi-pronged, entwining perspective. She alerted that … Health threats from waste thrive on socio-economic inequalities in two complementary ways: while affluence in parts of the global population produces mass consumption and rapid discarding of products (i.e. waste), poverty in another part invites the concentration and uncontrolled dumping of waste which amplifies its dangers to health…On a global scale, this transfer of waste from rich to poor unfolds when high-income countries export part of their hazardous waste to Africa and Asia… 

From a different viewpoint, the article by Juan Garay, Head of Cooperation Section, Delegation of the European Union to Mexico, reminded us thatMeasuring health equity challenges many of the present global concepts and policies on Health. The tragic death toll from global Health inequity (injustice) requires a deep transformation of concepts and dynamics towards the universal right to Health…

On a complementary wavelength, Bashir Saiegh Saiegh, Founder and CEO of the Tulaitula Health Consulting Group, featured in-depth the World Network for Medical Diagnosis, as a clinical information system to support and facilitate the medical diagnosis and the medical treatment in resource-limited countries and worldwide.

As an useful addition, the article by Hongzhou LuTangkai Qi, and Jiaying Shen, Division of Infectious Disease Shanghai Public Health Clinical Centre affiliated to Fudan University, reminded us that Since the first H7N9 influenza case was diagnosed in 2013, the disease has involved more than ten provinces and municipalities of China. There are a number of cases diagnosed in the years 2014 and 2015, most of whom had a history of live poultry contact, although there are already strict limitations on the purchase of live poultry. This reflects the dilemma between the needs of disease prevention and pre-existing social economic factors… The authors discuss this issue starting from a recent case of human H7N9 influenza diagnosed in Shanghai and suggest measures to better manage the production and trading of live poultry.

From another perspective, Amina Aitsi-Selmi, Consultant in International Public Health, Global Disaster Risk Reduction/International Public Health, Public Health England, focused …on the Sendai Framework for Disaster Risk Reduction 2015-2030 and how it addresses health and vulnerability. As such, her article is equipped …to assist communities of research, policy in understanding the aim of the Sendai Framework and identifying synergies and foster collaboration, particularly through research and evidence-translation for policy makers.

Last but not least,  Vipin Varma, Principal Advisor (Health Affairs) & Founder , THOT Consultants – Ideas Without Borders, highlighted in his article that Since health education is the base of the modern healthcare pyramid, eradicating the silent public health epidemic of health illiteracy is the most cost-effective means to reduce the healthcare burden of developing nations, while moving the populations to greater self-reliance.

 

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*Daniele Dionisio is a member of the European Parliament Working Group on Innovation, Access to Medicines and Poverty-Related Diseases. He is an advisor for “Medicines for the Developing Countries” for the Italian Society for Infectious and Tropical Diseases (SIMIT), and former director of the Infectious Disease Division at the Pistoia City Hospital (Italy). Dionisio is Head of the research project  PEAH – Policies for Equitable Access to Health. He may be reached at d.dionisio@tiscali.it  https://twitter.com/DanieleDionisio 

 

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For Green Giving, 2015 Was the Year of the City

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The immediate cost of air pollution: millions of lives lost 

The Lancet: Scientists welcome new global climate change pact 

European Union Open Data Portal 

KEI’s December 19, 2015 submission to the US ITC regarding the TPP 

The Price Of Inequality For Puerto Rico 

DNDi Statement on KaloBios’ Intention to Raise Price of Chagas Drug and File for FDA Priority Review 

Pharma Bro’s Latest Move Targets Latinos 

The Missing Men: HIV Treatment Scale-Up and Life Expectancy in Sub-Saharan Africa 

Ending the HIV–AIDS Pandemic — Follow the Science 

PAEDIATRIC HIV ADVOCACY TOOLKIT 

The First Use of the Global Oral Cholera Vaccine Emergency Stockpile: Lessons from South Sudan 

WHO: End of Ebola transmission in Guinea 

A look back at Ebola 

Global Fund Outlines Investment Case to End Epidemics

MenAfriVac and the Struggle to Make Vaccines Affordable 

FROM PHARMACISTS TO WAREHOUSES, PACE IS IMPROVING THE HEALTH OF WOMEN IN UGANDA 

Brazil links Zika outbreak with dramatic increase in birth defects 

Business development for poverty reduction 

Dataviz remake: the fall in extreme poverty, the best news in the world 

Human Rights Reader 377 

The Many Consequences of Violence Against Sex Workers 

Government of India and World Bank Sign US$ 50 Million Project to Improve Education & Skills Training for Minority Communities in India 

 

 

 

 

 

Treating the Silent Epidemic: Health Literacy for All

Since health education is the base of the modern healthcare pyramid, eradicating the silent public health epidemic of health illiteracy is the most cost-effective means to reduce the healthcare burden of developing nations, while moving the populations to greater self-reliance

Vipin Varma

By Vipin Varma

Principal Advisor (Health Affairs) & Founder

THOT Consultants – Ideas Without Borders

 Treating the Silent Epidemic: Health Literacy for All

 

Background

Health literacy, defined as the ability to seek, process and apply health related information and knowledge is an essential public health investment. My twenty seven years of clinical, management and entrepreneurial journey as a health advocacy communications consultant in India and abroad has convinced me that healthcare literacy across all stakeholders is an essential, scalable, universal, valuable product-service.

Since health education is the base of the modern healthcare pyramid, eradicating the silent public health epidemic of health illiteracy is the most cost-effective means to reduce the healthcare burden of India*, while moving the population to greater self-reliance. Health literacy asymmetry is one of the key fundamentals affecting equity of healthcare and sustainable development. Even as a policy level initiative, this gap needs to be erased first and foremost, while allocating adequate and enhanced budgets for health literacy, education and promotion. In order to truly empower our citizens for self-care, we must provide them complete health literacy in keeping with the universal declaration of human rights and the right to health, as it is one of the main determinants and entitlements of healthcare.

For a perspective, both the USA and China now see it as a public health issue to be managed based on epidemiologic principles & have developed a National Action Plan to Improve Health Literacy. Only 12% of the US population is supposed to be proficient in health literacy and the US projections are a potential saving of almost $236 Billion per annum or up to $ 3.6 Trillion over a decade, as a result of enhanced public health literacy. Given our overall literacy standards, India can therefore, also greatly benefit from a dedicated Health Literacy Program, at various levels of government.

Need of the Hour

‘Prioritize the base of the healthcare pyramid’

Health literacy is the fertile soil on which we must cultivate our citizen-centric public & private sector healthcare systems and institutions. Piecemeal, sporadic IEC (Information, Education, Communication / BCC (Behavior Change Communication) components of various vertical programs have not been able to achieve a society-wide competence in health literacy and shall therefore, require an integrated program approach to achieve short, mid and long-term outcomes of public self-reliance in wellness & healthcare. This has been validated by secondary research and interactions with senior key stakeholders across the healthcare development spectrum.

Way Forward

The Health and Family Welfare Ministries and Departments across national, state and local governments should lead and orchestrate a branded total health literacy program, integrating with the relevant departments like education, women-child development, social welfare, labor, consumer affairs, information-broadcasting, pharmaceuticals, rural and urban development, as necessary. Strategic partnerships with civil society and corporate social responsibility can also be leveraged later.

Monitoring and robust evaluation (M&E) should be built into the plans, to ensure tracking of the positive health outcomes and documentation of the high cost-effectiveness of this integrated approach, as promised by the global evidence base on health literacy. Convergence and social accountability is essential to sustainably scale-up this program. This can also integrate well with both Digital India & Skill India initiatives and at least 6,50,000 jobs** can be created nationwide in this domain, at a modest estimate of 100 health educators per district.

Suggested Policy

Given the silent epidemic prevalence of health illiteracy & the current strategic imperative of public self-reliance for healthcare, we should ideally provision about 5-10% of the healthcare budget at each level of government for dedicated health literacy activities, to achieve optimal impact.

Even for a modestly literate population, the modern healthcare pyramid with health education as its base, suggests a public health literacy program should be allocated at least 5% of the healthcare budget. The minimum spend should be enshrined in policy guidelines at all levels and grantees should also be strongly encouraged to spend this well. This relatively small but strategically significant shift in priorities, can have strong cascade effects on the entire health resource pyramid and can even invert it, if executed well.

 

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*The Health Literacy program concept highlighted in this article is valid for any developing nation globally and I have just written it with my country in context, but I am certain most developing and many developed countries too, still do not attach sufficient significant importance to Health Literacy across the public, social and private health sectors.

**This is a conservative estimate and can vary with the strategic intent and number of districts in the developing country under consideration.

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WTO Members Clinch Agriculture Export Competition Deal, Weigh Next Steps for Negotiating Future 

 

 

 

 

 

 

 

 

 

 

 

COP21: Salute Inscindibile dal Futuro del Pianeta

A causa dei cambiamenti climatici la nostra salute è messa in pericolo ogni giorno. Un'aria satura di gas nocivi e fenomeni atmosferici sempre più imprevedibili e violenti danneggiano noi e l'ambiente in cui viviamo. Il recente Accordo COP21 siglato a Parigi lo scorso 12 Dicembre è un primo passo volto a ridurre l'emissione di gas effetto serra e quindi la presenza di quei fenomeni che ne sono diretta conseguenza. Ma, l’Accordo è davvero un impegno concreto da parte degli Stati? O la discrezionalità di questi ultimi ancora prevale?

Pietro_picture-150x150

by Pietro Dionisio

Degree in Political Science, International Relations

Cesare Alfieri School, University of Florence, Italy

COP21: Salute Inscindibile dal Futuro del Pianeta

 

Il recente accordo sui cambiamenti climatici siglato a Parigi il 12 dicembre 2015 dimostra la vitale importanza su scala mondiale di un  problema per il quale non è più possibile perdere tempo.

Le manifestazioni del mutamento climatico in atto sono molteplici. Alcune sono talmente discrete da non essere nel breve periodo percepibili, altre, purtroppo, si palesano brutalmente con devastazioni ambientali e alta letalità, impattando criticamente sulle economie dei Paesi colpiti e sulla salute umana, animale e vegetale.

La stessa Direttrice Generale dell’Organizzazione Mondiale della Sanità (OMS) Margaret Chan, in un discorso rilasciato lo scorso 8 Dicembre a Parigi nel contesto della Conferenza COP21, affermava che “l’accordo sui cambiamenti climatici non è un trattato atto soltanto a salvare il pianeta da danni profondi e irreversibili. Ma è anche un trattato sulla salute pubblica, con l’immenso potenziale di salvare vite umane in tutto il mondo.”

Fonti OMS informano che dal 2030 i costi previsti per la sanità dovuti ai danni provocati dai cambiamenti climatici potrebbero essere pari a 2-4 miliardi di dollari all’anno. Mentre, tra il 2030 e il 2050 si potrebbero registrare circa 250.000 morti per anno causate da malnutrizione, malaria, diarrea e stress fisico da ondate di calore.

Nessuna regione nel mondo è immune dagli effetti delle mutazioni climatiche, ormai in ascesa quasi esponenziale  e responsabili di effetti diretti e  indiretti sulla salute. Per effetti diretti generalmente si intendono le immediate conseguenze di siccità, inondazioni, ondate di calore o di freddo, e di tempeste di inaudita violenza. Per effetti indiretti si  intendono, invece, le possibili conseguenze comunque connesse al cambiamento climatico: tra gli esempi, le migrazioni di popoli (con correlato rischio conflitti), ovvero la comparsa, o l’incremento, di malattie precedentemente assenti o di minimo riscontro in un habitat specifico.

Il fatto che i Paesi partecipanti alla Conferenza di Parigi abbiano deciso di impegnarsi, anche mediante adozione di fonti energetiche “green economy”,  a ridurre l’emissione di gas effetto serra (Art.4) e a contenere l’aumento della temperatura non oltre +1,5°C rispetto ai livelli pre-industriali (Art.2)  potrebbe sicuramente implicare effetti positivi per la salute individuale e collettiva. All’opposto di una economia ancorata a carburanti fossili e perciò responsabile di maggior incidenza di malattie e neoplasie polmonari secondarie all’eccesso indotto di CO2 nell’aria respirata.

Oltre ad effetti ancora più gravi individuabili nel riscaldamento ambientale foriero di incontrollabili fenomeni atmosferici conseguenti a livelli mai prima raggiunti di gas effetto serra.

Ridurre l’emissione dei gas serra, quindi, è estremamente importante, con ricadute positive  attese sul miglioramento della salute delle popolazioni e sulla diversificazione nell’allocazione dei budget nazionali e familiari da spese sanitarie ad altri beni di consumo, con correlato risparmio per le casse statali. Nel merito, la Commissione Europea ha stimato che la diminuzione della mortalità ottenuta mediante la riduzione degli inquinanti atmosferici comporterebbe benefici stimabili in €17 miliardi per il 2030 e fino a €38 miliardi per il 2050.

Contestualmente alla riduzione delle emissioni, i sistemi sanitari dei Paesi, soprattutto i più sviluppati, sono tenuti ad un ruolo proattivo così da ottenere una riduzione dei costi e quindi fornire una maggior offerta di servizi economicamente accessibili e con targets non limitati alla gestione e cura delle patologie respiratorie indotte. Al riguardo, l’Ospedale Universitario Nazionale di Cheng Kung di Taiwan, nel 2011 ha promosso un progetto mirato alla riduzione delle emissioni di CO2 per un valore pari a circa 5,259 tons all’anno, così da aumentare il tasso di risparmio energetico complessivo del 150% c.a. e conseguire un risparmio di circa 571,962 dollari. Ma esempi  analoghi sono altresì documentabili negli Stati Uniti, Regno Unito e Corea del Sud.

Ancora citando le parole di Margaret Chan “Un Pianeta rovinato non può sostenere le vite umane in uno stato di buona salute. Un pianeta in salute e persone in salute sono due facce della stessa medaglia”.

Nessun dubbio che l’Accordo COP21 rappresenti un passo di estrema importanza, ma molto resta da fare e molte preoccupazioni devono essere sciolte. Riusciranno i Paesi a mettere da parte gli egoismi economico-politici per il fine superiore di preservare la natura, di cui siamo tutti parte, e  garantire alla generazione presente e a quelle future una vita migliore?

L’Articolo 21 dell’Accordo stabilisce chiaramente che affinchè  il testo entri in vigore e sia legalmente vincolante, almeno 55 Parti alla Convenzione (le cui emissioni costituiscano almeno il 55% di quelle globali) devono averlo firmato e ratificato.

Saranno questi numeri raggiunti in breve tempo? L’esperienza del Protocollo di Kyoto (1997) ci dimostra come i Governi di molti Paesi siano purtroppo lenti ad interiorizzare le giuste richieste, invece troppo spesso vissute come ostacoli al perseguimento dei propri interessi.

Il Protocollo di Kyoto riuscì ad entrare in vigore soltanto il 16 Febbraio del 2005 e gli Stati Uniti non lo hanno mai ratificato!

Lo svolgersi degli aventi sarà diverso per il COP21? L’Accordo è da considerarsi come un ulteriore esempio di buoni propositi o si tradurrà, invece, in celeri azioni condivise nell’interesse delle sorti del pianeta e di tutti i suoi abitanti?

Molti dubbi davvero rimangono poiché, mentre  i 29 Articoli costituenti l’Accordo si limitano a raccomandare agli Stati di tenere comportamenti virtuosi, nessuna sanzione purtroppo è stata prevista.

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Have you read the latest Global Health Watch Report?  
Tell us how to make it better! Fill the questionnaire at
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Canada’s New Government Should Reject the TPP Agreement in its Current Form

As it currently stands, the TPP text pushes beyond the rules of the WTO TRIPS Agreement  with the effect of further limiting the room for manoeuvre that countries need in order to protect the public good, including by trying to achieve non-discriminatory, affordable access to medicines. Instead of accepting the TPP provisions in their current form, Canada should demonstrate international leadership and honour its repeated commitments to global health, including access to medicines

Richard Elliottt

By Richard Elliott

Executive Director Canadian HIV/AIDS Legal Network, Toronto

Canada’s New Government Should Reject the TPP Agreement in its Current Form

 

On 5 November 2015, the text of the Trans-Pacific Partnership (TPP) Agreement was finally made public. Running to more than 6000 pages, it raises a host of grave concerns about its impact on everything from environmental protection to labour and other human rights, from internet privacy to food safety… and much more, including access to affordable medicines.

Before the final text was released, alarm bells were already ringing: for example, Médecins Sans Frontières has called the TPP “the most harmful trade pact ever for access to medicines” – and not just for those in the negotiating countries, but for many more, since the TPP is being billed as a model for future trade agreements across the globe.

What’s the Threat?

As outlined by the Legal Network and several other NGOs in an open letter to the newly-elected Liberal government, various aspects of the TPP are cause for concern when it comes to access to medicines:

  • New intellectual property (IP) rules on patents, as well as rules on “data exclusivity” over information submitted to get marketing approval of drugs, would be even more restrictive than what already exist at the World Trade Organization (WTO). These would further impede and delay the competition from generic drugs that is key to pushing down prices and therefore making medicines available to many more people. In addition, new, harsher provisions on enforcement of private IP rights would be available to big pharma to try to undermine competition – including injunctions, higher damages for patent infringement, and various border measures that could interfere with transit of legitimate generic medicines based on mere suspicion of infringing intellectual property rights claimed by big pharma.
  • So-called “transparency” provisions would create more opportunities for drug companies to challenge governments’ decisions about reimbursing medicines under public health insurance programs, while also allowing more direct marketing to consumers by drug companies. In the Canadian context, this would create an additional hurdle to overcome in eventually creating a truly national, equitable pharmacare programme, which has been a long-standing and major gap in the country’s system of public health insurance.
  • Finally, the TPP would expand so-called “investor-state dispute settlement” rules to cover IP rights. This would allow drug companies to sue governments if they interfere with companies “expectations of profit” through public interest laws or regulations on things such as patents, the use of data submitted in getting marketing approval for drugs, and setting prices of pharmaceuticals, including the prices at which drugs are covered under public health insurance plans. Canada is already facing the world’s first such suit by the pharmaceutical company Eli Lilly, which is attempting to push into new territory the interpretation of similar provisions in the North America Free Trade Agreement (NAFTA) – in which the company seeks to force changes to well-settled principles of patent law in Canada after two courts ruled two of the company’s patents were invalid because the product in question did not live up to the scope of the patent claimed. This is an unprecedented proceeding in seeking to expand investor-state dispute settlement provisions to IP claims; now the text of the TPP would give an explicit green light to such mischief, in a wider array of countries, with yet more of a chilling effect on the ability or willingness of governments to regulate in the public interest.

Time for Action

But there’s still time to head off this disaster for public health and human rights.

The TPP has to be ratified and implemented by the 12 negotiating countries before it takes effect.This makes it all the more critical that governments hear from the public, whose rights, health and lives will be affected by the TPP’s provisions.

This includes the new government in Ottawa. While PM Trudeau and the Liberal Party have stated support for the TPP in principle during the election, the party also declared that “it must keep its word and defend Canadian interests during these negotiations.”

Those interests clearly include access to affordable medicines. Canadians already pay some of the highest drug prices in the world and spending on pharmaceutical products is one of the three largest elements of our overall health care spending, year after year. No wonder, then, that Canadians have repeatedly expressed their opposition to longer patents for drug companies.

“Canadian interests” also include a commitment to ending the tragic global gap in access to medicines, particularly burdensome for developing countries facing multiple major public health challenges – including, but not limited to, HIV. This commitment was reflected in the widespread support – including from 80% of Canadians polled – for fixing the flaws in Canada’s Access to Medicines Regime (CAMR). Such fixes were, and are, needed so that the regime could deliver on Parliament’s previous unanimous pledge (a decade ago!) to support developing countries in getting more affordable, generic medicines.

Sadly, a bill to fix CAMR was narrowly defeated by the previous government in the last Parliament – and while the new government has not yet specifically committed to supporting those reforms again in the new Parliament (as it did previously), it did declare during the election that “there is no question that we need to get more low-cost medicines and other essential medical supplies and equipment to people in developing countries.”

Canada’s new government should not only fix the existing flawed CAMR, but also reject the TPP in its current form. The agreement’s provisions stand in direct contradiction to the goals of improving access to medicines, for Canadians and for people in developing countries. Canada should:

  • commit to a full public consultation on the TPP, including an independent assessment of its impact on human rights (including access to medicines), among other concerns;
  • refuse to ratify the TPP as long as it contains any “TRIPS-plus” provisions that exceed the already-restrictive rules on intellectual property that have been adopted at the WTO; and
  • reject any deal that extends the discredited, damaging “investor-state dispute settlement” system to cover intellectual property or other laws and regulations affecting pharmaceuticals, as this would enable pharmaceutical companies to impede regulation of this sector in the public interest.

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Related articles:

TPP: Up With Corporate Profits Outweighing Equity in Health!
http://www.peah.it/2015/11/tpp-up-with-corporate-profits-outweighing-equity-in-health/

Impact Of The TPP On The Pharma Industry http://www.ip-watch.org/2015/12/02/impact-of-the-tpp-on-the-pharma-industry/

TPP Strengthens Controversial IP Arbitration http://www.ip-watch.org/2015/11/30/tpp-strengthens-controversial-ip-arbitration/

US ITC notice for public comment, Jan 13, 2016 hearing, and Commission report on the TransPacific Partnership Agreement (TPP) http://www.keionline.org/node/2371

 

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South Africa’s NHI, a Spark of Hope for Health

South Africa's achievements towards a National Health Insurance (NHI) whole country system implementation need strengthening now that only 17 per cent of the population can access well sourced private health services, whereas most people have to rely on understaffed and overstretched public facilities. A refined NHI-related white paper, reportedly close to presentation to Cabinet for approval could be a milestone for all South Africans’ non-discriminatory access to health

Pietro_picture-150x150

by Pietro Dionisio

Degree in Political Science, International Relations

Cesare Alfieri School, University of Florence, Italy

South Africa’s NHI, a Spark of Hope for Health

 

The path towards a National Health Insurance (NHI) is fundamental to South Africa’s people. Indeed, South Africa’s history of reforming health care financing system dates back to the year 1928 when a “Commission on Old Age Pension and National Insurance” was established aiming at the constitution of an insurance scheme covering medical, maternity and funeral benefits for all low- income formal sector employees in urban areas.

Unfortunately, while the country is home to 53.4 million people with a 0,78 per cent annual growth rate in 2015, the achievement of Universal Health Coverage (UHC) remains a difficult task for three main reasons at least:

  1. At a time when the expenditures in either the private or public health sector are roughly the same (about R100 billion each, 9 per cent GDP overall), inequity is in the coverage since apartheid institutionalized social distortions are not easy to root out and the health system is divided too. Only a minority of the population (nearly 17 per cent) can access well sourced private health services, whereas who cannot (approximately 83 per cent) are forced to rely on understaffed and overstretched public facilities.
  2. Health scourges place a burdensome pressure on the health system since HIV/AIDS and tuberculosis are still leading causes of death now that maternal, neonatal and child mortality rates are high and Non Communicable Diseases (NCDs) are rising.
  3. South Africa is a middle-income country but after years of economic roller coaster (GDP contracted an annualized 1.3 per cent in the second quarter of 2015 over the previous quarter), doubts emerge as to the Government capacity to finance a health system reform requiring amazing infrastructural transformation and not only.

Since recent years the Government has been lavishing efforts aimed at the establishment of a national health insurance scheme. In this regard, a “Green Paper”, published in 2011, mapped out a two-phase strategy to move towards UHC over a 15-year period.

The first phase emphasized on how to make headway in improving the management and quality of (and access to) public, particularly primary care level, health services.

The second phase was intended to introduce a strategic purchasing mechanism by establishing a semi-autonomous National Health Insurance Fund (NHIF) whose sources would be pooled through general tax revenues and additional earmarked, pay-roll and pre-payment taxes.

In the Government’s vision, the introduction of a “National Health Insurance” (NHI) would help  improve access to quality health care services and provide financial risk protection against health-related catastrophic expenditures for the whole population.

What’s more, the “Green Paper” encourages the creation of a system whereby public and private providers would collaborate in supplying health services, health promotion and illness prevention.

Coherently, South Africa’s health Minister Aaron Motsoaledi steadfastly insisted on the implementation of NHI. In a related speech, delivered on 31 May 2011, he showed strong political will by stating that:

“The problem is that many believe that NHI is just the release of a document. For us in health, we know that it also involves an extensive preparation of the health care system while at the same time preparing a policy document and in this case, the reengineering of the Health Care System is very vital.”

Since then, NHI was introduced in 10 pilot districts which are still making headway in improving primary health care  through three kinds of working teams:

  1. School health teams including nurses at schools and mobile vans to check pupils’ eyes, ears and teeth;
  2. Ward-based outreach teams staffed by door-to-door nurses and community health workers aimed at safeguarding the health of pregnant women and children under five while educating people on healthy living;
  3. District medical specialist teams, made up of health experts tasked with supporting health workers, particularly clinic nurses.

These teams collaborate with each other to prevent hospitalization by finding out most vulnerable people to sickness and decentralizing the delivery of medicines for chronic illnesses from hospital pharmacies to more convenient places, including schools and private pharmacies.

Despite efforts, one of the problems South Africa still faces as regards implementation of the pilot projects above is drawing general practitioners-GPs (whose services will be essential for making public health facilities scale up performances) into actively working for public clinics. Fewer than 200 of the 8,000 GPs working in private practice have agreed to work in public clinics since the NHI pilot program was launched.

In the face of this, Dr. Motsoaledi recently declared that the Government would supply 180,000 hours to clinics in 10 pilot districts during the 2015/16 financial year so as to encourage private sector doctors to work in public clinics.

According to South Africa’s making law process, the 2011 “Green Paper” stands as a discussion document. Hence, while giving an idea of the general thinking that informs health policy, it was published for comment, suggestions or additional ideas. Hereinafter, a more refined document, a white paper, had to be drafted. This is what the South African people are waiting for.

As per Dr. Motsoaledi’s recent words, the long awaited white paper is finished now and will be presented to Cabinet for approval soon:

“We have completed with it, we have discussed with treasury , the next nearest space I get which cabinet says you are ready you can come in, I go there and present it chairperson and after presenting it to cabinet the very next day I will present it to the nation”.

The patience of South Africans will probably be rewarded shortly.

Concerns remain about the sustainability of the whole project, but Dr. Motsoaledi’s policy has to be considered positively. Definitely,  the efforts spent are producing results and the path taken might be the right one.

A little more persistence, a little more effort, and what seemed hopeless failure may turn to glorious success, in the words of Elbert Hubbard.