Since 2000, China has hosted six ministerial Fora on China-Africa Cooperation (FOCAC), held every three years, in which health is but one of many areas of attention. In the last FOCAC, the accompanying Beijing Action Plan for 2013-15 listed cooperation in many areas – 6 in political, 9 in economic, 6 in cultural, and 6 in development – of which ‘medical aid and public health’ is one. This opinion piece discusses the strengths and challenges of the inaugural forum on health held in August 2013 and the Beijing declaration after the Forum, seen by the author to mark a turning point in the history of Chinese development and health cooperation to Africa. The author notes that China’s top-level leadership clearly sees the political, economic, and perhaps health importance of global engagement especially in Africa.
Health equity in economic and trade policies
How to foster agricultural development and food security in East Africa as the effects of climate change become more serious is the subject of the study East African Agriculture and Climate Change: A Comprehensive Analysis. The authors develop several weather-based scenarios for how climate change might affect countries in the region between now and 2050. National contributors from Burundi, the Democratic Republic of Congo (DRC), Eritrea, Ethiopia, Kenya, Madagascar, Rwanda, Sudan, Tanzania, and Uganda review the scenario results for their countries and propose a variety of policies to counter the effects of climate change on agriculture and food security. These policies include greater investment in agricultural research and extension, equitable access to land and inputs such as seeds and fertilizer, expanded irrigation, and improved infrastructure.
In 2012, the World Health Organisation’s Consultative Expert Working Group on Research and Development: Financing and Coordination (CEWG) proposed a binding convention that would mandate every signatory country to invest a minimum of 0.01% of its gross domestic product (GDP) in research and development (R&D) falling within the established scope. In this article, the author explores the proposed convention’s possible ramifications. In its narrowest interpretation, the convention would only address R&D gaps in areas where no suitable products exist. This would involve funding a publicly-driven pharmaceutical effort since, by definition, no commercial incentive exists in these areas. But even this approach leaves room for interpretation, the author argues. If narrowly interpreted, coverage would be limited to R&D gaps for Type II and III diseases; if more broadly interpreted, coverage would also extend to R&D gaps in Type I products suitable for developing countries. The author argues that, despite advances in global health, developing countries continue to have a shortage of appropriate tools to prevent, diagnose and treat many diseases. The proposed convention is intended to address this problem, but lack of clarity in the convention’s remit has left its scope open to interpretation. He calls for this uncertainty to be resolved in order for discussions to move forward.
The Medicines Patent Pool and Roche have announced an agreement to increase access in developing countries to valganciclovir, a key easy-to-take oral medicine to treat cytomegalovirus (CMV), a viral infection that can cause blindness in people living with HIV. The agreement will significantly improve access to Roche's valganciclovir for people living with HIV in 138 developing countries by making it up to 90% cheaper than current prices. As a second step, the Medicines Patent Pool and Roche will also enter into licensing and technology transfer negotiations to encourage the development of internationally approved quality generic versions of valganciclovir. The most widely used treatment for CMV in developing countries requires injections directly to the eye, which can be painful and also difficult to administer on a large scale. The Medicines Patent Pool will also work with other key stakeholders to develop long-term treatment strategies for scaling up the use of valganciclovir for treatment of HIV-related CMV in developing countries.
This study reviewed evidence on the impact of reproductive, maternal, newborn, and child health (RMNCH) on economic growth and development. The authors performed a systematic search of the published literature in electronic databases and consulted grey literature such as working papers and reference lists of selected articles. They found that GDP loss attributable to maternal mortality varies from US$0 per year in Botswana to US$504 per year in Ethiopia. If maternal mortality increases by one death, GDP per capita decreases by US$0.36 per year on average in 45 sub-Saharan countries. AIDS was found to have a negative effect on economic growth, especially in sub-Saharan Africa, although the magnitude varies among studies from 0.05% to 1% decline in GDP per capita. The intergenerational effect of HIV and AIDS is much higher, at 30-50% reduction of GDP per capita over four generations at a 15-20% HIV prevalence rate. The review revealed inadequate evidence on the impact of RMNCH on economic growth and development, which may, in part, be due to difficulties in measuring economic impact over extended time periods, and may also be due to the breadth of health states that fall within the RMNCH continuum. The authors argue that future research should focus on identifying the most cost-effective policy, programmes and interventions to prevent, reduce, delay or eliminate the complications of RMNCH.
The authors of this paper argue that there is scope to balance current fiscal consolidation efforts in favour of more equity with only limited adverse impact on potential growth. In particular, relatively little weight has been given to reducing tax expenditures and raising taxes on immovable property. A number of consolidation instruments are consistent with equity goals while doing little or no harm to potential growth: increases in the effective retirement age, raising efficiency in the education and health care systems, cutting certain tax expenditures, hiking taxes on immovable property and broadly-based consumption taxes. Increases in capital income taxes would also be equitable but need to be well designed to avoid being distortive. Calculations based on simplifying assumptions indicate that increasing household direct taxes would reduce income inequality, while cutting transfers by the same amount would have a larger and opposite effect on inequality. However, raising progressive labour income taxes could have adverse effects on long-run growth. Cuts in government wages and employment can yield fast consolidation gains but the authors warn that this needs to be accompanied by increases in efficiency of service delivery to avoid that reductions in public services mainly hit poor people.
In this article, the authors discuss the issue of how medicines may be eligible for patents and how this affects evergreening practices, whereby pharmaceutical companies extend the patent on their medicines by making slight modifications. However, evergreening of pharmaceutical patent protection, also includes patent monopolies over manufacturing processes, formulations, dosages, uses and methods of treatment. The authors present data that shows that evergreening patents have extended patent protection to nearly 50 years in some cases, well beyond the 20 year period provided in TRIPS. They argue that the net cost for society of evergreening patents is substantial and they have been proven to interfere and hinder fair competition in the pharmaceutical market, with the result that pharmaceutical companies can charge high monopoly prices for far longer than is justified. Because of its critical implications for competition and public health, India’s s.3(d) is becoming a model criteria for patent eligible subject matter in other countries. For instance, Brazil’s patent reform proposes to adopt such a provision. The invention threshold plays a critical role in the patent system. Setting the bar too low makes it easier for the patent system to be improperly exploited by those that use extended patent monopolies to extract economic rents. This behaviour should not be facilitated, the authors argue, as it unreasonably restricts society’s ability to benefit from the technology transfer trade-off.
According to this book, governments across the globe are being persuaded by economists that government spending on services like education and health is unnecessary and can only worsen the global economic crisis. To this effect they have advanced a policy of draconian budget cuts – austerity - to solve the financial crisis. However, the author of this book argues that the source of the financial crisis is not in government spending but the direct result of bailing out, recapitalising and adding liquidity to the broken banking system. Through these actions private debt was reclassified as government debt, which now is the responsibility of taxpayers to pay off, hence the proposed cuts in government spending. Blyth argues that historical evidence shows that austerity doesn't work when all states try it simultaneously: all they do is shrink the economy. He shows how austerity policies aggravated the Great Depression of the 1930s and created the conditions for seizures of power by the forces responsible for the Second World War: the Nazis and the Japanese military establishment. He concludes that the arguments for austerity are tenuous and the evidence thin. Rather than expanding growth and opportunity, the repeated revival of this dead economic idea has almost always led to low growth along with increases in wealth and income inequality.
For too long Africans have been dependent on aid and medicines from the West, argues the author of this article, but Brazil, India, China and South Africa (BRICS) are emerging as dominant players in Africa’s health markets. In the late-1990s, Brazil played an instrumental role in shifting the paradigm of healthcare and human rights when it challenged the World Trade Organisation (WTO) and its intellectual property regime. Brazil violated a WTO clause to provide antiretroviral drugs and to lower their price. This reaffirmed medicine as a fundamental human right. While many drugs continue to be developed in the West, India has stepped in to manufacture generic medicines for the world's poorest countries. Through low-cost support and commodities, India has filled a gap in the global market. China has an increasing role to play in the global health arena. It invested $36.1 billion in 2011 in research and development, placing the country in a position to become a major player in healthcare innovation. Additionally, given the sheer scale of industry and financial resources available, China has the capacity to develop and supply HIV drugs and technologies to meet the needs of the African epidemic. The departure of traditional international funders like the United Kingdom and the United States presents an opportunity for new sources of engagement with the growing BRICS economies. Investing in the health of Africa will fuel development, enhance diplomacy and build South-South solidarity, the author argues.
In this article, the author discusses the ramifications of a 2013 legal battle in the United States that ended with the court ruling unanimously that human genes cannot be patented. He argues that the implications of this ruling are far-reaching in terms of public health and equity. He views the case as an example of how societal inequality is a result not just of the laws of economics, but also of how we shape the economy through politics, including through almost every aspect of our legal system, in this instance intellectual property regimes. The right to life and right to health should not be contingent on the ability to pay. He also argues that some of the most iniquitous aspects of inequality creation within our economic system are a result of ‘rent-seeking’, namely profits, and inequality, generated by manipulating social or political conditions to get a larger share of the economic pie, rather than increasing the size of that pie. The world’s poorly designed intellectual property system encourages pharmaceuticals to pursue such rent seeking. And while advocates of intellectual property rights emphasise their role in promoting innovation, the author counters that most key innovations in history were motivated by the quest for knowledge, not financial gain. He provides evidence that the patent actually prevented the development of better tests, and so interfered with innovation.