On 19 September, the World Health Organization released a new report that reaffirms the world is running out of antibiotics to fight key and deadly infections due to the fast pace of resistance by bacteria and the lack of new antibiotics to replace or supplement the existing antibiotics. Most new drugs in the pipeline are only modifications of existing classes of antibiotics and are short term solutions, says the WHO. And there are very few potential treatment options for antibiotic resistant infections causing the greatest health threats including resistant TB. This article by TWN explore the issue and the level of (under)investment in new treatments. It argues further for improved infection prevention and control and for fostering appropriate use of existing and future antibiotics.
Health equity in economic and trade policies
The report Honest Accounts 2017: how the world profits from Africa’s wealth explores how Africa’s wealth is effectively “stolen” from the continent and “calculates the movement of financial resources into and out of Africa and some key costs imposed on Africa by the rest of the world”. Nick Dearden, director of Global Justice Now, writes that although there is money coming into the continent in the form of remittances, there is a larger amount leaving the continent in the form of taxes, “repatriate[d]” profits and illegal trade. A 2014 estimate suggests that rich Africans were holding a massive $500-billion in tax havens. Africa’s people are effectively robbed of wealth by an economy that enables a tiny minority of Africans to get rich by allowing wealth to flow out of Africa. With few exceptions, countries with abundant mineral wealth experience poorer democracy, weaker economic growth, and worse development. The author raises that to prevent tax dodging, governments must stop prevaricating on action to address tax havens.
This article is based upon data gathered during a study conducted in partnership with the World Intellectual Property Organisation on the patent status of products appearing on the World Health Organisation’s 2013 Model List of Essential Medicines (MLEM). It is a statistical analysis aimed at answering: in which developing countries are patents on essential medicines being filed? Patent data were collected by linking those listed in the United States and Canada’s medicine patent registers to corresponding patents in developing countries using two international patent databases (INPADOC and Derwent) via a commercial-grade patent search platform (Thomson Innovation). The respective supplier companies were then contacted to correct and verify their data. The authors tallied the number of MLEM patents per developing country. A subset of 20 of the 375 (5%) products on the 2013 MLEM fit the inclusion criteria. The number of MLEM patents per country was positively associated with human development index (HDI), gross domestic income (GDI) per capita, total healthcare expenditure per capita, population size, the Rule of Law Index, and average education level of the country. Population was a powerful predictor of the number of patent filings in developing countries along with GDI and healthcare expenditure. Broad surveillance and benchmarking of the global medicine patent landscape is valuable for detecting significant shifts that may occur over time. With improved international medicine patent transparency by companies and data available through third parties, the authors suggest that studies such as this will be increasingly feasible.
This study measured the ‘best possible health for all’, incorporating sustainability, to establish the magnitude of global health inequity. The authors identified countries with three criteria: firstly, a healthy population—life expectancy above world average; secondly, living conditions feasible to replicate worldwide—per-capita gross domestic product (GDP-pc) below the world average; and thirdly, sustainability—per-capita carbon dioxide emissions lower than the planetary pollution boundary. Using these healthy, feasible, and sustainable (HFS) countries as the gold standard, the authors estimated the burden of global health inequity (BGHiE) in terms of excess deaths, analysing time-trends (1950–2012) by age, sex, and geographic location. Finally, the authors defined a global income ‘equity zone’ and quantified the economic gap needed to achieve global sustainable health equity. A total of 14 countries worldwide met the HFS criteria. Since 1970, there has been a BGHiE of about 17 million avoidable deaths per year (about 40% of all deaths), with 36 life-years-lost per excess death. Young children and women bore a higher BGHiE, and, in recent years, the highest proportion of avoidable deaths occurred in Africa, India, and the Russian Federation. By 2012, the most efficient HFS countries had a GDP-per capita/ year of US$2165, which the authors proposed as the lower equity zone threshold. The estimated US$2.58 trillion economic gap represents 3.6% of the world's GDP—twenty times larger than current total global foreign aid. Sustainable health equity metrics provide a benchmark tool to guide efforts toward transforming overall living conditions, as a means to achieve the ‘best possible health for all.’
President of the United Republic of Tanzania, John Magufuli has met with Prof John Thornton, Chairman of Barrick Gold Canada, parent company of Acacia Mining to discuss the issue of mineral sand exportation in Tanzania. The new development came after Dr Magufuli received two reports on the exportation of mineral concentrates abroad for smelting. The first committee probed at the technical aspects of the concentrate and the second committee examined the economic and legal frameworks around the export. Both reports damned Acacia for foul play and suggested that Tanzania lost over Sh100 trillion since it started exporting concentrates in the late 1990s. Dr Magufuli who was accompanied by the Minister for Legal and Constitutional Affairs Prof Palamagamba Kabuki said the meeting was successful and Barrick have “repented” for what has happened and they are ready to compensate Tanzania for the loss that has been incurred over the years. Dr Magufuli announced on a video clip tweeted on the official government spokesperson account that Barrick have “repented” and are ready to compensate Tanzania for the loss incurred over the years. Garrick Gold Canada is the largest shareholder of the Acacia Mining Company. On March 2017, the export of mineral concentrates by Barrick from Tanzania was stopped by Presidential directive.
In this letter over 200 scientists, policy experts and others concerned persons are urging the new World Health Organisation Director-General to recognise and address factory farming as a growing public health challenge. The authors suggest that WHO negotiate country-level standards for antibiotic use in animal husbandry, in coordination with the Food and Agricultural Organisation. Member states should be encouraged to articulate specific, verifiable standards for what constitutes legal antibiotic use in animal farms. Further, meat producers should dispose of antibiotics and waste residue properly to prevent environmental contamination and excess greenhouse gas emissions and work with all relevant ministries, including those outside of health, to reduce the size and number of factory farms to better balance dietary need and ecological capacity. WHO should discourage member states from subsidising factory farming and its inputs, which can cause significant harm to the public and consider the application of relevant fiscal policies in member states that would help to reduce meat demand and consumption, especially where consumption exceeds health recommendations. WHO should encourage member states to adopt nutrition standards and implement health education campaigns which inform citizens of the health risks of meat consumption and work closely with ministers of health and agriculture to formulate policies that advocate for a greater proportion of plant-based foods in the diets of member states. Lastly, they recommend that the WHO should consider funding the scientific development of plant-based and other meat alternatives, which have the potential to eliminate or reduce the harms of factory farming.
In April and May 2017, the Constructing Future Cities project supported by the British Council engaged with 5 women artists on the topic of future cities. Mputa identified the fact that women do not feel safe and are not safe in cities as something that needs to be addressed. Sputa noted that one would experience a space differently if one had an opportunity to contribute and to be informed during the design process. One would take pride in the space, be able to use the space effectively and educate others on spaces in the city. Her vision of a future city; a city that acknowledges its past, celebrates the present and plans for change, an inclusive city designed by its inhabitants and explored by its visitors. Her artwork makes use of hatching to illustrate and merge faces, landscapes and cityscapes. Creating rhythm and pattern emphasised by the use of colour. Mlati identified a need to expand thinking about energy sources, moving beyond solar panels as infrastructure towards thinking of an intersection of art, architecture and energy. Mlati notes that those whose experiences of the city have flourished despite alienation hold clues from future urban practice.
In her final address to the World Health Assembly (WHA) as WHO Director-General, Dr. Margaret Chan identified access to medicines as the most contentious issue of her decade-long tenure. That struggle was engaged, she said, “especially when intellectual property and the patent system were perceived as barriers to both affordable prices and the development of new products for diseases of the poor.” Dr. Chan also had advice for the delegates gathered before her at the Palais de Nations in Geneva: “Listen to civil society. Civil society are society’s conscience.” Just a few hours after Dr. Chan yielded the podium, a spirited demonstration was held outside the grounds of the Palais de Nation. Organised by the student-led advocacy group Universities Allied for Essential Medicines, the demonstrators called for the WHA delegates and the new director-general to listen to the WHA’s member states from Southeast Asia, Africa, and Latin America. Those nations have long called for WHO to prioritise the medicines issue. The term “de-linkage” was repeated by many panellists at an antimicrobial resistance discussion which happened at a side event. It describes a drug development model that is an alternative to the current intellectual property paradigm, where government-granted patent monopolies allow drug prices to be hiked to levels that are sometimes hundreds of times above the price of production. The justification for the high prices is that the price charged for medicines needs to fund research and development. Deliberately “de-linking” the R&D costs from the price of medicines bypasses those calculations, and instead undercuts the very foundation of the monopoly pricing argument. It calls for taking advantage of the already-significant government and philanthropic commitment to research and using it to fund non-profit R&D to a sufficient level that the price of medicines does not need to be connected to research costs. This would allow medicines to be far more affordable
Over 200 scientists, policy experts and others concerned persons are urging the new World Health Organisation (WHO) Director-General to recognise and address factory farming as a growing public health challenge. Just as the WHO has bravely confronted companies that harm human health by peddling tobacco and sugar-sweetened beverages, they argue that it must not waver in advocating for the regulation of industrial animal farming. Total consumption of antibiotics in animal food production is projected to grow by almost 70% between 2010 and 2030. According to the WHO, two of the three most commonly used classes of antibiotics in U.S. animal farming—penicillins and tetracyclines—are of critical importance to humans. Practices such as the constant low dosing of antibiotics and environmental pollution through animal waste make industrial animal farms the perfect breeding ground for antibiotic resistance by allowing transmission into the environment and nearby community. The authors raise other risks of industrial animal farming and call on WHO to strengthen WHO’s Global Action Plan on Antimicrobial Resistance to encourage member states of the WHO to ban the use of growth-promoting antibiotics in animal farming, as well as low-dose “disease prevention” antibiotics. Member states should be encouraged to articulate specific, verifiable standards for what constitutes legal antibiotic use in animal farms. Amongst other recommendations they argue that WHO should encourage member states to adopt nutrition standards and implement health education campaigns to inform citizens of the health risks of meat consumption and work closely with ministers of health and agriculture to formulate policies that advocate for a greater proportion of plant-based foods in the diets of member states. Lastly, they recommend that the WHO should consider funding the scientific development of plant-based and other meat alternatives, which have the potential to eliminate or reduce the harms of factory farming.
States should control corporations across national borders to protect communities from the negative impacts of their activities, UN human rights experts have said in an authoritative new guidance * on the Obligations of States parties to the International Covenant on Economic, Social and Cultural Rights (CESCR) in the context of business activities. “States should regulate corporations that are domiciled in their territory and/or jurisdiction. This refers to corporations which have their statutory seat, central administration or principal place of business on their national territory,” the experts of the UN Committee on Economic, Social and Cultural rights say in the guidance*, officially termed the General Comment, published today. In practice, the Committee expects home States of transnational corporations to establish appropriate remedies, guaranteeing effective access to justice for victims of business-related human rights abuses when more than one country is involved. In light of the practices revealed by the Panama Papers and the Bahamas Leaks, the General Comment emphasizes that States should ensure corporate strategies do not undermine their efforts to fully realize the rights set out in the Covenant. The new General Comment sets out what States can and must do in order to ensure that companies do not violate rights such as the right to food, housing, health or work, which the States themselves are bound to respect: “Businesses cannot ignore that the expectations of society are changing. The first ones to change shall be rewarded by consumers, whose purchasing choices are increasingly driven by immaterial aspects — the reputation of the company, and the ethical and sustainability dimensions associated with its products.” The issue of business and human rights has been addressed recently in different forums, including the Human Rights Council and the International Labour Conference, and through a combination of tools — regulations, self-imposed codes of conduct, economic incentives and action plans. Zdzislaw Kedzia, the Vice-Chair of the UN Committee on Economic, Social and Cultural rights noted that “It may be tempting for States to seek refuge behind the initiatives taken by the corporate sector, rather than adopting the appropriate regulatory and policy initiatives that they must adopt. Our General Comment seeks to recall their obligations under the Covenant and define the role they must assume in regulating corporate conduct.”