Values, Policies and Rights

Outer packaging labelling of medicines in Southern African Development Community countries: comparative analysis of requirements and transition terms for harmonisation
Narsai K, Masekela F, Leufkens H, et al: BMC Health Services Research 24:111, 1-7, 2024

The COVID-19 pandemic highlighted an urgent need for harmonised requirements for the regulation of medicines. The authors compared outer packaging labelling requirements and transition terms for harmonization for countries in the Southern African Development Community (SADC) region. Data on legislation and/or regulatory guidelines for medicine outer packaging labelling from National Medicines Regulatory Authorities were obtained for countries in the SADC region by February 2023. A detailed comparative content analysis was conducted to determine alignment with the requirements of the SADC harmonised labelling guidelines to assess readiness levels of each country to transition to the SADC harmonised labelling guideline for outer packaging of medicines. Content analysis showed at least 11 out of 16 countries require national legal reform to transition to the SADC harmonised labelling guideline. In all cases where countries specified labelling requirements for outer packaging of medicines, these were stipulated in national medicines legislation. Even though there is a high level of alignment across the countries in terms of national labelling requirements, most countries in the SADC region would still require national legislative reform to transition to regional harmonised labelling requirements and then ultimately to continental requirements of the African Medicines Agency.

The Kampala Declaration on Health, Human Rights and Development
The Republic of Uganda Ministry of Health, CEHURD, September 2023, Uganda

This declaration was made by the delegates at the Inaugural Uganda National Conference on Health, Human Rights and Development held in Kampala in September 2023. The declaration makes several commitments, including that the Ministry of Health provide leadership for an integrated and multi-sectoral approach which recognises the intersectionality between SDG 3, human rights and other SDGs. It also commits to strengthen collaboration across all sectors in advancing the right to health; fast-track Government’s process of passing and implementing the National Health Insurance scheme in order to realise Universal Health Coverage; and urges Government through the Parliament to progressively increase financing for health in order to realise the Abuja Declaration of allocating 15% of national budget towards health. The declaration proposes to increase the generation and use of evidence in planning and implementing health interventions, including on social determinants of health; to make more progress on the Right to health in Uganda to realise Sustainable Development Goals.

WHO Asks Member States: Join Talks on Global Plastics Treaty, and Climate Action for Health
Fletcher E: Health Policy Watch, January 2024

A first-ever WHO initiative to join the global negotiations on a plastics treaty, as well as the first WHO decision on climate and health since 2008, are set to come before the World Health Assembly in May 2024. The draft decision on climate change and health, led by eight member states, including Peru, Kenya, the United Arab Emirates and the United Kingdom, reflects new evidence on the linkages between climate and health. The WHO propose to make health-related inputs into the new treaty instrument on plastics, including about particularly hazardous plastics or polymers that should be phased out, and play an active role in a UN science-policy panel on plastics pollution. A range of non-state actors criticised the absence of reference to “fossil fuels” as a driver of climate change in the draft climate and health decision, with one suggesting that WHO should treat fossil fuels like tobacco. The draft document calls upon WHO to clean up its own house by “firmly integrating climate across the technical work of the WHO at all three levels” and develop a “Roadmap to Net Zero by 2030 for the WHO Secretariat, in line with the UN Global Roadmap.”

Anti-gay law erodes Uganda’s gains in HIV fight ­PEPFAR chief
Nantume G: Monitor, Uganda, 2023

This article summarises points made In July 2023, by Amb Dr. John Nkengasong, the US Global AIDS Coordinator and Special Representative for Global Health Diplomacy, addressing African journalists in Washington DC on the gains of PEPFAR. He noted that the recent signing of the Anti-Homosexuality Act 2023 means that Uganda stands to lose funding of about $400 million from PEPFAR as annual support to HIV/Aids care and treatment.

Artificial intelligence for global health: cautious optimism with safeguards
Pujari S, Reis A, Zhao Y, et al: Bulletin of the World Health Organisation 101:6, 364–364A, 2023

The United Nations Secretary-General has stated that the safe deployment of new technologies, including artificial intelligence (AI), can help the world to achieve the sustainable development goals. Large language models generate responses that can appear authoritative and plausible to an end-user; however, without adequate controls in place, the veracity and accuracy of responses may be extremely poor. These models may be trained on data for which explicit consent may not have been provided, and they may not protect sensitive data (including health data) that users voluntarily feed into the AI-based tool. AI tools are increasingly being applied to public health priorities, and have the potential to assist with pattern recognition and classification problems in medicine – for example, early detection of disease, diagnosis and medical decision-making. For any beneficial impact, especially in low- and middle-income countries, ethical considerations, regulations, standards and governance mechanisms must be placed at the centre of the design, development and deployment of AI -based systems, with oversight by governments and their appropriate regulatory agencies. WHO has published guidance on Ethics and governance of AI for health, and has convened an expert group to develop additional guidance. The authors call for a multiagency global initiative on AI for health to improve coordination, leverage collective agency, and ensure that the evolution of AI steers away from a dystopian future towards one that is safe, secure, trustworthy and equitable.

Developing countries defend principle of ‘common but differentiated responsibilities’
Bozman P: Third World Resurgence 354: 19-22, 2023

The need to uphold the principle of ‘common but differentiated responsibilities’ (CBD) between developed and developing countries in global actions to address biodiversity and climate change was a major bone of contention at COP 15. The deadlock at COP 15 on whether or not to retain the CBD principle, which was placed in square brackets (indicating lack of consensus) throughout the evolution of the negotiating texts, stemmed from extremely divergent views between developed and developing countries, with the former refusing to accept it as a principle. The latter pointed out that it is an overarching principle enshrined in Principle 7 of the 1992 Rio Declaration on Environment and Development.

How gender is socially constructed in policy making processes: a case study of the Adolescent and Youth Health Policy in South Africa
Jacobs T, George AS: International Journal for Equity in Health 22:36;1-15, 2023

This paper explores the range of policy actors, narratives and different framings of gender, through Adolescent Youth Health Policy (AYHP), using a case study design and analysis of reporting of government, academia, youth and other members of the Adolescent Youth Health Policy Advisory Panel, and civil society. Gender power relations and more gender-transformative approaches discussed during the policy making process were not reflected in the final policy. Diverse gender narratives were juxtaposed, some becoming dominant in the policy-making process and consequently included in the final policy document. The constellation of actors’ gender narratives reveals overlapping and contested framings of gender and what is required to advance gender equality. The authors note that understanding actor narratives in policy processes contributes to bridging the disconnect between policy commitments and reality in advancing the gender equality agenda.

Stricter rules: Why better food regulations will help us fight obesity
Moloi M, Pretorius L: Bhekisisa, 16 May 2023

About one in four South Africans are reported to be obese, and almost as many are overweight. Obesity is a massive public health problem — affecting more than 650-million people worldwide — because it also leads to other health problems, such as diabetes, high blood pressure (also called hypertension) and heart disease. Often eating highly processed foods with lots of sugar, salt or fat, and fast food generally being cheaper than healthier options add to the country’s obesity problem. In the latest episode of Health Beat, Bhekisisa’s monthly TV show, Mia Malan speaks to public health researcher Susan Goldstein about what policymakers can do to help make South Africans healthier. Goldstein discusses the burden on the healthcare system, the need to ban advertising of ultra-processed foods to children, dismantling a food system that’s dominated by big, multinational companies and rethinking food systems towards healthier, more local and equitable alternatives. She explains why regulating the sale and advertising of highly processed foods (which can make us fat) and making it easier for people to buy healthy food at low prices are as crucial as finding medicines to fight obesity.

WHO: Zero Draft of the pandemic instrument creates an “illusion” of equity
Ramakrishnan N, Gopakumar K: Third World Network, February 2023

The zero draft of the proposed pandemic instrument being negotiated at the World Health Organization is argued by the authors to create an illusion of equity. Most of the inputs given by developing countries are observed to have been ignored. The authors are that proposed structure neglects two demands from developing countries. First, a different chapter scheme should be used which would reflect the logical order of the pandemic prevention, preparedness, response and recovery processes on the ground. Secondly, the broader phrase of “pandemic prevention, preparedness, response and recovery” should be used instead of “pandemic and recovery of health systems”. The zero draft continues to be silent on the determination of the pandemic status of a public health event and WHO’s role in determining the same. In effect, the text is viewed as simply seeking to generate “political will and commitment” on equity.

Amendments to the IHR Come to the Fore. Will the Pandemic Accord Lose Traction?
Patnaik P: Geneva Health Files, Online, November 2022

In 2021, when the negotiations towards a Pandemic Accord was not yet a reality, a number of member states were advocating for restoring the centrality of the International Health Regulations (IHR) (2005), and for amending these rules that already exist. This article covers the dynamics between the two parallel, somewhat competing processes: on the one hand, efforts to amend the International Health Regulations (IHR, 2005), and on the other, the process to arrive at a new Pandemic Accord. The authors argue that the IHR are back to the fore. The update outlines the changing contours of how countries are lining up along these two processes. Much of what countries aspire for, is noted to already exist. But the “targeted” amendments is where the politics lie. Who articulates what needs to be amended and why? Over the next 17 months when both these processes are expected to conclude, calling for attention to the evolution of these historic negotiations.