Breaking News: Link 128

Breaking News Links, as part of the research project GESPAM (Geopolitica, Salute Pubblica e Accesso alle Medicine/Geopolitics, Public Health and Access to Medicines), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

 

Breaking News 128

An Encouraging Decline in Ebola Cases, But Critical Gaps Remain http://www.msf.org/article/ebola-decline-encouraging-critical-gaps-remain 

Statements by NGOs in official relations with WHO at the WHO governing body meetings https://apps.who.int/ngostatements/meetingoutline/196 

Ebola – is culture the real killer? http://www.irinnews.org/report/101064/ebola-is-culture-the-real-killer 

Post-Ebola, AU plans pan-African CDC https://www.devex.com/news/post-ebola-au-plans-pan-african-cdc-85384 

Training health workers yet another challenge in battling Ebola https://www.devex.com/news/training-health-workers-yet-another-challenge-in-battling-ebola-85367 

Progress in development of a new Ebola vaccine https://www.gov.uk/government/news/progress-in-development-of-a-new-ebola-vaccine 

World must prepare for ‘war’ against a global pandemic: Gates http://www.businessinsider.com/afp-world-must-prepare-for-war-against-a-global-pandemic-gates-2015-1?IR=T 

Oxfam calls for massive post-Ebola Marshall Plan http://www.oxfam.org/en/pressroom/pressreleases/2015-01-26/oxfam-calls-massive-post-ebola-marshall-plan

Finding And Supporting A Workforce With The Right Skill Mix http://healthaffairs.org/blog/2015/01/27/finding-and-supporting-a-workforce-with-the-right-skill-mix/ 

Fighting against diseases or strengthening health systems to deliver adequate care: what is the better choice? http://www.internationalhealthpolicies.org/fighting-against-diseases-or-strengthening-health-systems-to-deliver-adequate-care-what-is-the-better-choice/ 

UK university ranking reveals global health neglect http://www.scidev.net/global/disease/news/uk-university-ranking-global-health-neglect.html 

After Davos, UN paves way forward in addressing ‘most pressing global challenges’ http://www.un.org/apps/news/story.asp?NewsID=49937#.VMtBFGiG-m4 

FAO presents plan for eradicating hunger in Latin America and the Caribbean http://www.fao.org/news/story/en/item/275950/icode/ 

Food security hinges on agriculture partnerships https://www.devex.com/news/food-security-hinges-on-agriculture-partnerships-85355 

Innovation In Health Care Education: A Call To Action http://healthaffairs.org/blog/2015/01/29/innovation-in-health-care-education-a-call-to-action/ 

At Berlin Vaccine Summit, World leaders try their luck at spinning ‘Pharma’s Wheel of Fortune’ http://www.msfaccess.org/about-us/media-room/press-releases/berlin-vaccine-summit-world-leaders-try-their-luck-spinning- 

Vaccine price cut pledge not enough, critics tell Pfizer http://www.theguardian.com/business/2015/jan/26/vaccine-price-cut-pledge-pfizer 

Gavi Receives Record-Breaking Financial Pledges For Vaccines http://www.ip-watch.org/2015/01/29/gavi-receives-record-breaking-financial-pledges-for-vaccines/ 

Introducing WHO watch http://youtu.be/Jzg5bkY963U

As EU scraps aid, Indonesia introduces health insurance for the poor http://www.euractiv.com/sections/development-policy/eu-scraps-aid-indonesia-introduces-health-insurance-poor-311594 

Brazil Can Help Steer SDGs Towards Ambitious Targets  http://www.ipsnews.net/2015/01/opinion-brazil-can-help-steer-sdgs-towards-ambitious-targets/ 

Climalte finance eclipsed by fossil fuel subsidies  http://www.euractiv.com/sections/climate-change-road-paris/climate-finance-eclipsed-fossil-fuel-subsidies-311660 

The Responsible Investor’s Guide to Climate Change http://www.project-syndicate.org/commentary/fossil-fuels-divestment-renewables-by-jeffrey-d-sachs-and-lisa-sachs-2015-01#ZjmlfFXyBCUgTQMq.99 

The Case for Climate Clubs http://e15initiative.org/publications/the-case-for-climate-clubs/ 

FTT launch agreed for 2016 http://www.euractiv.com/sections/euro-finance/ftt-launch-agreed-2016-311669 

 

 

 

 

 

 

 

Life Saving Medicines and Patent Slaving Monopolies

...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....

Life Saving Medicines and Patent Slaving Monopolies

  

by

Beatriz Becerra Basterrechea  Member European Parliament 

Jacob Hammerstein Casanova Trainee to Beatriz Becerra Basterrechea

Javier Aparicio Rubio Accredited assistant

 

Since I took office last summer, I have been involved in a wide range of issues related to my parliamentary activities; issues which have led to a full engagement of my office team and their commitment. It has been a path of discovery and idea-gathering leading us deeper into full involvement. Amongst these, I have aimed my parliamentary work at getting involved in issues related to access to medicines, and specifically in drawing attention towards the ongoing struggle for universal access to treatment for Hepatitis C patients. Altogether, it is essential to highlight the need of looking at the full picture and broadening our focus on prospective alternatives to leave fatal resignation on such a crucial issue behind.

In this field, we have openly focused our discourse on the broader issues underlying access. I decided, together with my team, to outline a strategic working line focused on the unveiling of causes underlying lack of access and addressing structural issues with a pragmatic approach as a must to overcome unjust scenarios which otherwise can only be tackled circumstantially. One often gets the impression that industry’s marketing departments are delighted with public demands calling for health systems to pay exorbitant prices for their patented medicines. There is not a single multi-million advertising campaign which could have such a boosting effect on a company’s sales. What ball game are we playing? It should definitely be the one for common goods and public health.

In the case of Hepatitis C, immediate instruments exist to make a treatment which is believed to be very efficient -and interferon free, implying bigger patient eligibility- accessible and affordable for the vast majority of patients. A very feasible step, which just requires minimal coordination amongst States would be to prepare a pooled procurement strategy. Obviously, neither the EU Commission, under its internal market competences, nor member States, have shown a true political will to promote such strategy.

International treaties also offer concrete instruments which could be easily put in use to favour cheap and affordable Hep C second generation direct acting antivirals (DAAs). World Trade Organisation’s TRIPS, and its Doha Declaration interpretation offer more than enough flexibilities. Compulsory Licenses are a possible option for cases of public health emergencies. Such is the case in Spain, with an estimated 800.000 people infected with Hepatitis C. The lack of an active diagnosis strategy, and an exorbitant price of approximately 25.000 euros per treatment just for Sofosbuvir, has conditioned a national plan which has only been able to commit to the treatment of 5.000 patients with new DAAs. Under these circumstances, the issuing of a Compulsory License would be something to be considered. The EU Commission, in its 2010/03/31 Communication to the Council, Parliament, Economic and Social Committe and Committe of Regions on the EU’s Role in Global Health explicitly states: “On trade, the EU should work to ensure more effective use of TRIPS provisions to increase affordability and access to essential medicines”. Not only that, the possibility of issuing a Compulsory License also represents an added value to State´s bargaining and negotiation power with pharma companies for cheaper and affordable prices.

In India, a Patent Opposition to Gilead’s Sovaldi (commercial name for Sofosbuvir) has prospered under the premises of lack of novelty and innovation features in its molecular compound. Such a patent opposition is going to allow a treatment which was known in the US as the “$1000 dollar pill” to be produced and sold generically in India at around $100 for the full three month treatment.

This fact highlights another inexplicable situation. We, the public, as tax payers, have been turned into hostages of pharma research by becoming high risk venture capitalists. Academic research, financed with public funds, is then picked up by private corporations which take advantage of these lines of research to develop their molecular compounds which are then patented and resold to the public for exorbitant prices. How does public investment benefit public good in such cases? What mechanisms do we have as citizens to trace our investments in the development of patented drugs? The answer is unfortunately none. This is a lose-lose situation for the public.

The case of Hepatitis C drug Sofosbuvir could be related to such a phenomenon: Pharmasset Inc. took advantage of British academic research undergone at a public university to develop Sofosbuvir. This lab was later bought by Gilead for $11.000 million. It is remarkable that just after the first six months at market (and it still wasn’t at sale in most of the world’s territory), Gilead’s Sovaldi had made up for 50% of what they invested in the purchase of Pharmasset. It is not surprising at all that in the case of Sofosbuvir, Gilead didn´t even undergo research.

Everybody agrees on pharma’s rights to profits, but the limits to pharma’s profits should be clearly outlined and defined by a few basic principles.

One of pharma’s main arguments to justify off limits return on investment and profits is the risk involved in their research. We clearly reckon pharma´s risk taking position when undertaking research. Nevertheless, we encourage pharma companies to disclose clear figures on what percentage of their income is destined to R&D, as to other spheres of business, for example marketing. Once again we are confronted with a total lack of transparency. What´s the real average cost of developing a new drug?

Furthermore, we could draw a parallelism between the fight which underwent in the 90s and early 2000s for universal access to HIV Retro-Virals, with the ongoing struggle for universal access to Hepatitis C second generation DAAs. While in the past it has been proven, as with HIV treatments, that patent monopoly based biomedical systems are totally inefficient to guarantee fair access and affordability to medical treatment, history is unfortunately repeating itself in the case of Hepatitis C medicines.

This situation stresses the need of addressing the underlying structural factors which have brought us to the current situation. It all starts with a biomedical R&D model oriented at strengthening intellectual property monopolies and reaffirming exacerbated corporate profits over public interest and health. A cultural myth has prevailed which legitimises patent monopolies as the best incentive for R&D and drug development. This statement is deeply confusing and far from reality. The current system of biomedical R&D based on patent monopolies is really a handicap for research. Given the absolute lack of transparency in clinical trials, lines of research are often duplicated. Furthermore, pharma companies are more often focused on patent hunting and “evergreening” (applying minor changes in terms of innovation) their treatments for patent renewals than offering real added value drugs with proven therapeutic advantages. The current biomedical R&D system has proven, far from presenting incentives for research, to materialise in patent monopolies; compartmentalised and overlapping groups of multiple patents over single goods or technologies (thickets), lack of knowledge transfer and an obscure manipulation of the scientific method, all of which hinders innovation.

Regarding monopolies, other fundamental spheres of our economic activities have been regulated. Some clear examples of how regulation has incentivised competition and accessibility in terms of prices is the telecommunications sector. In this also strategic sector, efforts have been made to cap prices (see EU regulation on roaming), or to delink the pipeline process, meaning that one same enterprise cannot control the entire process: a single telecommunications company is no longer allowed to be the builder of the infrastructure,  owner of cables and towers, supplier, commercialise, advertise… all together.

There are specific and pragmatic alternatives to the current model. De-linkage in biomedical R&D would imply separating research and development costs from the final price of the medicine. This could be achieved through several instruments such as price incentives for open source medical research, patent pools, socially responsible licences, imposing strict conditions on the use and exploitation of public research by private corporations to assure a return for public interest, open access to scientific research developed and financed with public funds and transparency on trial results.

The European Council has repeatedly encouraged the EU and Member States to take steps in the direction of disassociating costs of R&D with the final prices of drugs, a clear example of which are the Council Conclusions on the EU Role in Global Health May/2010.

Furthermore, 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.

Given the nature of our parliamentary work as elected representatives serving public good, and furthermore, taking into account article 168 of the Treaty on the Functioning of the European Union (TFEU) stating “A high level of human health protection shall be insured in the definition and implementation of all Union policies and activities”, which we all supposedly commit to serve as members of this parliament, my demands on access to essential and lifesaving medicines could not differ from those I’ve exposed.

Antibiotic Resistance – Beginning of the End?

At the last 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.  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

Antibiotic Resistance -€“ Beginning of the End?

by  Shila Kaur

  Coordinator Health Action International Asia Pacific (HAIAP)

 

We are in a state of crisis, yet most people don’€™t even know this.  Antibiotics of last resort have become useless in treating infections; there is multi-drug resistant TB, malaria and gonorhhea to contend with and the bugs are mutating faster than our ability to find newer treatments.

In Malaysia the alarm bells were first sounded last year when the country encountered its first publicly reported cluster of deaths due to Carbapenem-Resistant Enterobacteriaceae.  The Borneo Post reported that up to August 2013, 10 people had died in Sibu Hospital from Carbapenem-Resistant Enterobacteriaceae.

The second tragedy occurred in the first week of October 2013 when four people died and 60 others were hospitalised after eating contaminated chicken at a wedding feast in Yan, in northern state of Kedah. The Health Department said it was most likely due to Salmonella contamination.

These two reports of lethal infections affecting the general public are just the tip of the iceberg. Many more cases are occurring throughout Malaysia, which do not come to public notice.  The situation is similar in many developing countries.  Antimicrobial or antibiotic resistance (AMR/ABR) is one of the most serious health threats the world faces. Infections from resistant bacteria are now common and some pathogens have even become resistant to multiple types or classes of antibiotics. With the increasing ineffectiveness of drugs of “last resort”€™, we are on the brink of a public health disaster/crisis. It is a ticking time bomb in our midst which needs to be taken seriously and urgently dealt with.

The threat is in fact global and the rest of the world is waking up to this, admittedly in various states of €˜unpreparedness€™.

ABR threatens to undermine the effectiveness of modern medicine as increasingly more strains of bacteria become resistant to the limited number of remaining antibiotics. The ramifications will be devastating to both human and animal health because there are no new antibiotics to treat some of the most serious infections. Millions of people have been infected with antibiotic resistant bacteria and hundreds lose their lives each year. Without a radical change in antibiotic usage, ABR will become one of the greatest threats to humankind, to security and to the global economy.

The World Health Organization states that ABR is no longer a prediction for the future but is happening right now, across the world. Standard treatments no longer work; infections are harder or impossible to control; the risk of the spread of infection to others is increased; illness and hospital stays are prolonged, with added economic and social costs; and the risk of death is greater – in some cases, twice that of patients who have infections caused by non-resistant bacteria.

In April 2014 WHO published its first ever comprehensive Global Surveillance Report on ABR, which stated, “€œThe problem is so serious that it threatens the achievements of modern medicine.  A post-antibiotic era – in which common infections and minor injuries can kill – is a very real possibility for the 21st century.€”

Common bacteria such as Escherichia coli, Klebsiella pneumonia and Staphylococcus aureus which  cause common health-care associated and community-acquired infections such as urinary tract infections, wound infections, bloodstream infections and pneumonia, have become resistant to the most potent antibiotics.  And there are no newer antibiotics anywhere is sight to battle the bugs.

In 2012, there were about 450 000 new cases of multidrug-resistant tuberculosis (MDR-TB).  Extensively drug-resistant tuberculosis (XDR-TB) has been identified in 92 countries.

Resistance to earlier generation antimalarial drugs is widespread in most malaria-endemic countries.  According to WHO, further spread or emergence in other regions, of artemisinin-resistant strains of malaria could jeopardize important recent gains in control of the disease.

Ten countries have already reported treatment failures due to resistance to treatments of last resort for gonorrhea.  Gonorrhea may soon become untreatable as no vaccines or new drugs are in development.

At the last 67th World Health Assembly in May 2014,  WHO Member States agreed to a Global Plan of Action to tackle this global public health emergency.  Contained in Resolution EB134.R13  Combating antimicrobial resistance, including antibiotic resistance, the Global Action Plan (GAP) aims to develop or strengthen national plans and strategies and international collaboration for the containment and control of the escalating AMR crisis.  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. The draft GAP continues to remain weak on critical issues of innovation, access to new antimicrobial medicines, regulation of promotion and marketing and use in animals, of such medicines.  The draft GAP fails to recognize that for developing countries the presence of political will alone is not sufficient to enable them to implement policies and measures required to address AMR. For developing countries, access to financial and technical resources for implementing actions to address AMR is critical.

The threat has also been recognized by policy makers at the highest global levels such as the G-7; it is listed topmost on the Global Health Security Agenda initiated by the United States.

National level action is therefore paramount and international cooperation essential in managing this crisis.

One driver of ABR is the unnecessarily reckless use of antibiotics in food animals for industrial meat production.  Most of this is largely to spur growth – not to treat disease. The more antibiotics are used and interact with bacteria, the faster resistance to antibiotics develops.

While the EU countries are far ahead with regards to regulations and control on the use of antibiotics in food animals, many countries lag far behind.  In Malaysia, despite the existence of the Animal Feed Act 2009 , use of antibiotics in animal feeds continues unabated.

A preliminary study of AMR in food-producing animals and foods, carried out by the Department of Veterinary Services (DVS) in 2012 found multi-drug resistant strains of Salmonella in live chickens in SALT -€“ supervised and certified farms* in central Malaysia.  Alarmingly, tests on mutton, beef and chicken food samples showed that more that 60% of Salmonella was isolated from imported beef and chicken.

Furthermore, live chickens sold at wet markets tested positive for Campylobacter.  More than a third of bacteria samples showed multidrug resistance. Frozen  burger patties taken from supermarkets and retail shops showed the presence of multidrug-resistant strains of Listeria monocytogenes; the most common forms of resistance involved tetracycline followed by erythromycin.

According to Institute for Medical Research (IMR) data from 37 hospitals throughout Malaysia, resistance to one or more antibiotics had increased from 2011 to 2012; the most potent antibiotics were becoming increasingly ineffective against some of the micro-organisms surveyed.  The actual state of AMR in the country is however unknown as IMR data is partial and does not cover all hospitals from both the public and private sectors.  A preliminary survey by Health Action International Asia Pacific (HAIAP) of countries in the region revealed weaknesses in health information systems in the public health sector. Countries lack capacities for data collection and analysis in the public health sector while the private sector remains largely unregulated.

Another driver of antibiotic resistance is the misuse of antibiotics through inappropriate prescribing practices by doctors and inappropriate use by patients. Doctors are known to prescribe antibiotics for  prevention or prophylaxis of bacterial infections in cases where the problem is viral and use of antibiotics is, in fact unnecessary.  The use of broad spectrum antibiotics where narrower spectrum ones would suffice is another common practice.

On the other hand are patients who, used to being treated with antibiotics for common self-limiting infections, continue to demand antibiotics for ailments where none are needed.

It is a dilemma. And rather than waste time pointing fingers at who created the demand – doctors or patients? -€“ it is time for both to take professional and personal responsibility.

Citizens of the world must collectively wake up to the unassailable facts that there are no more antibiotics left to treat common infections and that health care providers and facilities cannot replace personal hygiene, good sanitation practices and rational use of medicines.

Unless we do so, that apocalyptic scenario of zombie-like creatures with decaying limbs and torsos wandering around hopelessly, may not be so far-fetched after all.

 

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* The DVS awards the SALT certificate and logo to farms that meet the criteria of Good Animal Husbandry Practices (GAHP), animal health management, bio-security, good infrastructure and prudent use of drugs.  The certification scheme covers all types of livestock: beef cattle, dairy cattle, broiler chicken, layer chicken, breeder chicken, deer, goat, sheep and pig.

 

Health Action International Asia Pacific (HAIAP) aims to promote rational use of medicines and equitable health for all, with particular emphasis on the poorest of the poor. It is a network of more than 60 individuals and organizations ranging from powerful consumer organizations and development action groups and small grass roots organizations. Individuals who work with HAIAP consist mainly of health professionals comprised of doctors, pharmacists and academics. As the Coordinator of HAIAP, Shila Kaur responsibilities entail keeping members informed of network activities through HAI News and regular news mailings and emails; coordinating meetings/seminars/conferences; advocacy and lobbying; representation at meetings; coordinating research; fundraising and writing and publishing reports and publications.

Nurses and Doctors in a Globalized Context

"€˜Hanna Wafula lives in a small village in Zambia. She is 50 years old and lives with her husband and four grandchildren. Three of her six children have died: two when they were very young, and one last year at the age of 30. She notices that the doctor in the nearest health centre is rarely present. On the radio she heard that the government plans to spend more money on health care, but she has not seen any effects of increased spending yet. When she goes to the health facility, there is absolutely no guarantee there is a doctor or nurse to attend to her. The shortage of health personnel seriously impacts Hanna'€™s life. Should she be in need of medical care there might not be a health worker available to treat her or her family." (1)

 Human Resources for Health

Nurses and Doctors in a Globalized Context 

by Linda Mans and Diana Hoeflake *  **

Wemos Foundation

 

The world is 7.2 million health workers short (2). Low-income countries are particularly affected by the shortage of health personnel (3). 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. Case in point, 57 per cent of all physicians trained in Zambia now work abroad, mainly in wealthier countries (4).

If the international recruitment is not carried out responsibly, it can have serious repercussions. When the much needed health workers are recruited from fragile health systems, those systems can be dangerously undermined. Equally, individuals who go to work in unfamiliar settings may be vulnerable to various forms of exploitation if no appropriate measures are taken. Allutis et.al. (2014) state that the health workforce crisis can be regarded as “€˜one of the most pressing global health issues of our time (5)”€™. If nothing changes, the global health workforce shortage will reach 12.9 million in 2035 (6).

Europe is part of the problem. Various European countries recruit trained health personnel from abroad, a practice that is unsustainable, increases inequality and further weakens health systems in and outside Europe. In this context it is even more worrying that in the aging societies of European countries, the number of people who need long-term care is growing, thus fueling the demand for health workers. Forecasts indicate that, by 2020, Europe will need one to two million additional health workers (7). As the labour market becomes more globalized, rising demand is driving migration and mobility amongst health personnel.

Adequate measures are needed to prevent staff shortages anywhere in the world. In May 2010, the member states of the World Health Organization (WHO) adopted a global code of practice (WHO CoP) on the ethical recruitment of health workers (8). The WHO CoP encourages countries to solve their own (anticipating) shortages of health personnel in a sustainable and responsible manner. By adopting the code, member states agreed that they will be self-sufficient in the domestic health workforce deployment and that they will make sure that health systems in source countries are not undermined by international migration of health personnel. In addition, the WHO CoP calls for a fair and equal treatment of foreign health workers. By applying all the principles of the WHO CoP, countries become less dependent on foreign healthcare staff, and on a global and European scale they will subsequently pull away fewer health professionals.

Despite this code, political consensus on the sustainable management of health workforces and of health worker migration at the European level is still a long way off. There are powerful -€“ albeit sometimes short-sighted -€“ conflicting interests, and in many countries EU-driven austerity measures have put a damper on health expenditures and limit the implementation of policy options. Some countries attempted to lower expenditure through salary cuts or freezes and by reducing funds for training and retention purposes but these policies have exacerbated wage imbalances, thereby increasing health worker migration.

It’€™s therefore high time that all countries implement the principles of the WHO CoP. The Amsterdam-based advocacy organization Wemos calls on actors involved to abide by this code and advocates action towards achieving a sustainable health workforce and strengthening health systems. Wemos is member and coordinator of a European project entitled “€˜Health workers for all and all for health workers”€™ (HW4ALL). For the project, Wemos is working with civil society organizations (CSOs) in eight European countries: Belgium, the United Kingdom, Italy, Germany, Poland, Romania, Spain and the Netherlands. The project is designed to promote the responsible recruitment of health workers inside and outside the European Union. The CSOs are drawing attention to the consequences of the migration and mobility of health workers.

To ensure that everyone, anywhere in the world, has access to health workers, it is necessary that various ministries and other stakeholders, such as health care providers, work together on a sustainable future-oriented solution. Norway and Ireland are leading examples of WHO CoP implementation. They have implemented a sustainable national health care plan and experienced that this can only be achieved in cooperation with different ministries. For Ireland, the WHO CoP presents a particular challenge as this country employs relatively large numbers of nurses and doctors from outside Europe. Norway has been one of the trailblazers for the WHO CoP. Both countries have prioritized the creation of an effective registration system that can serve to signal areas in which shortages may arise. Additional effort is put into education and in-service training, partly with a view to increasing staff retention. Steps are also being taken to make careers in health care more attractive, such as by improving salaries. Where recruiting health workers from other countries is the only option, Norway and Ireland address the ethical aspects by making firm agreements with those countries. Furthermore, both Norway and Ireland provide aid to help them strengthen their health care systems. In doing so, globally sustainable and fair personnel policies can be ensured.

However, not solely destination countries but also the European Union (EU) can play an important role in contributing to fair and sustainable solutions for the health workforce crisis. In 2006, the EU stated that they “€˜(…) will strive to make migration a positive factor for development, through the promotion of concrete measures aimed at reinforcing their contribution to poverty reduction, including facilitating remittances and limiting the ‘brain drain’ of qualified people. (9)”€™ However, for the global human resources for health crisis to be addressed instrumentally, greater coherence between migration, health, development, trade, education, labour, fiscal and other health workforce and migration related policies of the EU is needed. At European level there is a multitude of interventions and tools addressing the issue, making policy coherence a vital element in solving the health workforce crisis. Policy coherence helps create the proper context to ensure that gains for both the European health workforce, the rights of the individual health worker and the health systems in sources countries in and beyond Europe are maximized and costs -€“ economic, social, human, administrative -€“ are kept to a minimum.

Wemos, together with the other members of HW4ALL, strongly encourages a viable health workforce through long-term investment in education and training, accompanied by coherent planning and policies at local, national, and regional level. In doing so, we promote the use of the WHO CoP as a framework to regulate the pan-regional approach to human resources for health and to strengthen health systems not only in Europe but also globally. For example, we call on the EU and its member states to grant equal treatment and equal rights to migrant health workers, and ensure the full portability of social security and pension rights. In addition, we explicitly advocate the adoption of a policy coherence framework for developing sustainable health workforces in and outside Europe. Further, we among others highlight the currently limited possibility for European States to -take effective measures to educate, retain and sustain a health workforce that is appropriate for the specific conditions of each country- (as requested by the WHO CoP) in the context of austerity measures currently imposed on many of them.

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We believe that everyone across the globe can have access to skilled health workers. Responsible and coherent policies for a sustainable health workforce will contribute to ensuring there are sufficient health providers available for everyone, everywhere. Then also Hanna and her family will receive health care whenever needed. That is why we advocate sustainable solutions for the global health workforce shortage!  

 Read more about the migration and mobility of health workers and the work of the HW4ALL project. 

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References

(1) http://www.wemos.nl/files/Documenten%20Informatief/Bestanden%20voor%20’Organisatie’/Bird’s_Eye_View_2011-2015.pdf

(2) World Health Organization. (2014). A Universal Truth: No Health Without a Workforce. Geneva: WHO Press.

(3) Sub- Saharan African countries suffer more than 24 per cent of the global disease burden, but have access to only three per cent of the world’s health workforce. In Germany there are 34 doctors per 10,000 inhabitants available, whereas countries like Zambia and Kenya have to survive with only one.

(4) Ferrinho, H. et.al. (2011). The human resource for health situation in Zambia: deficit and mal distribution. Human Resources for Health. 9: 30.

(5) Aluttis, C. (2014). The workforce for health in a globalized context – global shortages and international migration. Global Health Action 7: 23611.

(6) World Health Organization. (2014). A Universal Truth: No Health Without a Workforce. Geneva: WHO Press.

(7) European Union (2012). COMMISSION STAFF WORKING DOCUMENT on an Action Plan for the EU Health Workforce. http://ec.europa.eu/dgs/health_consumer/docs/swd_ap_eu_healthcare_workforce_en.pdf

(8) WHO Code of Practice on the International Recruitment of Health Personnel: http://www.healthworkers4all.eu/fileadmin/docs/gb/WHO_Code_of_Practice.pdf

(9) See para. 38 of the European Consensus on Development, OJ C 46/01, 24.02.2006.

*Article republished from WEMOS  November 20, 2014: http://www.wemos.nl/news/?v=2&lid=2&id=359&cid=3with permission.

** Linda Mans is the project coordinator of the European consortium project “Health workers for all and all for health workers”, of which Wemos is the leading party. Together with partners from 8 European countries, this project aims to promote cohesion between development cooperation policies and domestic health policies and practices of European Member States and thus facilitating the establishment of responsible health worker policies. Through this project, Linda calls for more concerted action for better training, recruitment, retention and deployment of staff in the Netherlands and Europe. The WHO Global Code of Practice on the International Recruitment of Health Personnel World Health constitutes the starting point. Linda maintains relations with the Health Workforce Advocacy Initiative (HWAI) and the Global Health Workforce Alliance (GHWA). 

     Diana Hoeflake is responsible for Wemos’ social media. She writes articles for Wemos’ website and for trade media on health and international development. In addition, Diana carries out policy analyses and desk studies for the purpose of Wemos’ activities. 

 

 

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Breaking News Links, as part of the research project GESPAM (Geopolitica, Salute Pubblica e Accesso alle Medicine/Geopolitics, Public Health and Access to Medicines), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings 

 

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Breaking News Links, as part of the research project GESPAM (Geopolitica, Salute Pubblica e Accesso alle Medicine/Geopolitics, Public Health and Access to Medicines), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

 

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Breaking News Links, as part of the research project GESPAM (Geopolitica, Salute Pubblica e Accesso alle Medicine/Geopolitics, Public Health and Access to Medicines), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

 

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Breaking News Links, as part of the research project GESPAM (Geopolitica, Salute Pubblica e Accesso alle Medicine/Geopolitics, Public Health and Access to Medicines), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings 

 

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2014: A Year in Review through GESPAM Contributors’ Stands

Authoritative insights by 2014 GESPAM contributors added steam to debate on how to settle the conflicting issues that still impair equitable access to health by discriminated population settings worldwide

2014: A Year in Review through GESPAM Contributors€’ Stands

by  Daniele Dionisio*

PEAH – Policies for Equitable Access to Health 

Now that 2014 is nearing 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 our 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 links to the relevant articles:

Ole Petter Ottersen and Desmond McNeill, University of Oslo, pointed out that the root causes of health inequities are to be found in weaknesses at supranational political domains including democratic deficit, weak accountability, institutional stickiness, missing institutions and restricted policy space for health. The authors envisage that achieving health equity is not just a matter of coming up with technical solutions and providing the means to finance them. Rather, it is a matter of  considering the political landscape and rectifying the dysfunctions in global governance that undermine health.

Relevantly, David Chiriboga former president of the UNASUR Health Council and former minister of health of Ecuador, reported that after setting up the public health infrastructure to fail, the World Bank and their allies are proposing a new solution: to create a publicly funded insurance package using the now expanded network of private providers, who will participate in the program, as long as they are guaranteed payment. As per Chiriboga terms, while reinforcing the notion that healthcare is a commodity and not a basic human right, this approach has several problems and side effects: fragmentation of care, higher cost, precedence of procedures over preventive medicine and further dismantling of the public healthcare system. At the same time, insurance packages divert attention and funds from a more comprehensive approach directed at modifying the root causes of disease, through socioeconomic interventions aimed at increasing equity”. 

In agreement, Natalie Van Gijsel, Medecine Pour le Tiers Monde, highlighted that the current privatization policies of the Philippine government do not provide an answer to the enormous health needs. The author contends that despite the name of the Philippine Universal Health Care€ program that claims to €œbring equity and access to critical health services to poor Philippinos€, commercialisation of health services would do exactly the opposite. Inherently, Van Gijsel complained about the fact that “€œ..the European Commission is supportive of these policies and formerly approved a contribution of  €33 million in support of the Health Sector Reform Agenda of the Philippine government..€.”

In their article, Sadhana Srivastava and Kanikaram Satyanarayana, Indian Council od Medical Research and Ministry of Health & Family Welfare, New Delhi dealt with the major concerns of several patent offices all over the world in respect of providing access, including the growing prevalence of €œsecondary€ patents (i.e., patents covering various ancillary features of existing medicines) and of a strategy called evergreening, that refers to patenting strategies to secure sequential and overlapping patents on a single object (qua invention) through trivial changes such as change in size, colour, dosage, delivery mechanism and composition of a patented drug. Inherently, the authors turn the spotlight on the recent developments India has achieved in the area of using TRIPS flexibilities and discuss the potential impact of effective implementation of these achievements for promoting  access to health care. 

On the same wavelength, Matthew Rimmer, Australian National University College of Law, Canberra, told about an independent “Pharmaceutical Patents Review Report”, published by the Australian Government on the 20th March 2014, that recommended to shorten and reduce patent term extensions, to address the problems of evergreening and data protection, and to reverse Australia’s passive approach to the negotiation of intellectual property and international trade. As such, Rimmer emphasizes the need for Australia to protect its public health interests including in ongoing negotiations for the Trans-Pacific Partnership agreement. 

From a similar point of view, Brook K. Baker, Northeastern University School of Law and Health GAP, maintained in his contribution that US business interests and government officials are trying to sell the idea that heightened intellectual property protections in India are essential to foreign investment, innovation, and achievement of public health goals. Instead, heightened intellectual property rights would  make India consumers captive to Big Pharma’s extortionate pricing at a time when there seems to be deference by the US and Indian governments to Big Pharma’s pressure. 

To the point, Carlos Passarelli, UNAIDS, stressed that the levels of enforcement of intellectual property rights (patents) may have critical impact in fostering or hindering access to medicines. He explained that  UNAIDS vision of €œzero new infections, zero AIDS-related deaths, and zero stigma and discrimination€ is based on the recognition that medicines are public goods and, therefore, the proprietary/private right must not prevail over the public interest. 

As regards these issues, Thomas Pogge, Yale University, stated that problems of innovation, access and delivery in the domain of pharmaceuticals still exclude billions of people from the health benefits that advanced medicines can provide. His article turned the spotlight on the Health Impact Fund as an initiative that could systematically and sustainably address these problems. 

Inherently, Olasupo Owoeye, Tasmania University Faculty of Law, discussed how patent pools and regional integration can be deployed as mechanisms for assuaging the African access to medicines €œimbroglio€. 

Unfortunately, as reported by Moses Mulumba, CEHURD Uganda, the generic pharmaceutical manufacturers in the East African Community region still produce at a cost disadvantage compared to their large-scale Asian counterparts. Aside from this, Mulumba’s article also highlights some of the key areas where civil society there has engaged and can still engage with local pharmaceutical industries to address these challenges. 

And this occurs at a time when, as written by Ella WeggenWemos Foundation, a study in Germany, France and the Netherlands has highlighted an alarming trend: the majority of medicines granted marketing authorisation has no added therapeutic value compared to medicines already on the market. In some cases the new medicine even did more harm than good.

On her part, Raffaella Ravinetto, Antwerp Institute of Tropical Medicine, pointed out that the issue of post-trial equitable access to essential medicines for treating non-communicable diseases in low and middle-income countries is raising increasing concerns. Her article suggests some short-term measures to fill in the relevant gaps.

Additionally, Karyn Kaplan, Treatment Action Group (TAG) reported that, while hepatitis C virus (HCV) infection can be cured now thanks to highly effective oral direct-acting antivirals (DAAs), that remains, however, only a distant dream for most who need it worldwide. Hence, her article urged to €œfight HCV DAA bank-busting price tags, and the intellectual property regime and the industry behind it, that collude to undermine public health€. 

In unison, William F. Haddad, Biogenerics, New York, blamed that hiding behind patents, Pharma has become immune to criticism and has developed a powerful constituency among politicians who often use prepared cliches to equate challenges to high prices as a threat to democracy. 

In this environment, the article by Shubha Ghosh, University of Wisconsin Law School, is one entry into the cottage industry of patent law analysis that was generated by Court’€™s unanimous decision in Association for American Pathologists v. Myriad Genetics as regards the patentability of DNA sequences. The author analyzes the decision and puts it in context, both present and the near future.  He states that,  although some found the decision devastating for the pharmaceutical and biotechnological industries, the ruling was not as fatal as some claimed, while setting the right course for the future of synthetic genetics.

The article by Lawrence C. Loh, University of Toronto and  The 53rd Week , took recent backlash cases against vaccinator staffs as a starting point and maintained that effective immunization programs protect our communities and our way of life from innumerable communicable diseases, while encouraging development efforts abroad. ….Eradication is a laudable goal that can only mean better health for all. Thus, it matters not if anti-vaccinators are radical militants or Hollywood celebrities; they stand with each other, and with these preventable diseases…€€.

Priya Shetty, Danny Edwards and Carel IJsselmuiden, COHRED and KwaZulu-Natal University, South Africa, remind us in their article that many low and middle-income countries (LMICs) are still struggling to finance indigenous research and development (R&D), that several are failing to meet continental declarations of intent such as the African Union target of 1% of GDP on R&D, and that in the next two years, LMICs may make significant strides in pushing their own R&D models, although it is clear that a radical re-think of how to fund, and how to incentivise R&D is needed if they are to get drug development for diseases of poverty resourced. As such, the authors assert that a bold new strategy requires perspectives including the voice of NGOs and civil society, if progress in R&D is to result in greater access and health equity. This is why LMICs should take the lead and not rely on external aid nor wait for international treaties to arrange what they can start and fund at home.

To the point, Claire Wingfield, PATH, wrote about a new paper exploring why R&D of high-priority health tools for diseases and conditions affecting LMICs should be a critical component of the post-2015 development agenda.

From a complementary perspective, Laura L. Nervi, University of New Mexico, pointed out that more attention should be paid to the consequences that the increasingly intricate panorama of international cooperation in health (ICH) has on LMICs, and to the complex set of connections of decision-making processes, power relations, and global/local articulations involved in planning, channelizing, and executing international aid. As such, the author aimed to give a glimpse at some of the (nonfinancial) issues that the governments of LMICs confront in the process of incorporating technical and financial ICH in their national health agendas.

Inherently, the paper by Sara Gorman, Columbia University Mailman School of Public Health, suggested that while individual donations cannot operate in lieu of government or multilateral funding, engaging the general public in global health issues and providing them with easy ways to donate could be extremely effective.

A couple of articles dealt with Chagas disease:

Alessandro Bartoloni and Lorenzo Zammarchi, University of Florence, Italy, regretted that even though Chagas disease has emerged as a potentially chronic or lethal illness in many non-endemic areas such as USA, Canada, Japan, Australia and several European countries, unfortunately only few governments in non-endemic countries have implemented adequate public health measures to avoid autochthonous transmission and provide appropriate care to subjects that are affected.

Moreover, Mabel Lenardon and co-Authors, Municipality of La Plata and Mundo Sano Foundation, Argentina, told about the experience carried out by the Secretariat of Health and Social Medicine of the Municipality of La Plata and Mundo Sano Foundation from July 2010 to December 2013 at school institutions of the Buenos Aires province and primary health care centers of the municipality. The partnership aimed to address the situation of people affected by Chagas disease from a comprehensive perspective, carrying out early diagnosis and timely treatment in a specific non-endemic geographic area.

From a different viewpoint, Cinzia Chighine, Tuscany Region, Italy, contributed an analysis drawing from her field experience in Lebanon. As such, while regretting that the Lebanese health care system is very fragmented due to the lack of a public health policy, strategic planning of services and their organizational structures, the author focuses on a recent process of decentralization whereby South Beirut Municipalities are improving primary healthcare services and integrated local welfare.

 

Last but not least, Iris Borowy, Aachen University, Germany, tackled challenges to global health from a multi-pronged, entwining perspective. She alerted that if the present trend continues, road traffic injuries (RTIs) are expected to kill approximately 1.9 million people per year by 2020, which would raise them to rank three of the leading causes of death. Borowy reported that over ninety percent of RTIs fatalities occur in low- or middle income countries, while being the most important cause of death among young people between 15 and 29 years of age.  As such, the author stressed that promoting non-motorized forms of transport, notably walking and cycling, would come with the double benefit of both mitigating the triple health burdens of RTIs, climate change and air pollution and of providing the positive health benefits of increased physical activity. This double advantage would appear true both for cities in high-income industrialized and in middle-income industrializing countries. 

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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