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The global partnership for development: A review of MDG 8 and proposals for the post-2015 development agenda.
Washington, D.C., Center for Global Development, 2013 Jul.  p. (CGD Policy Paper No. 026)The eighth Millennium Development Goal (MDG 8) covered a ‘global partnership for development’ in areas including aid, trade, debt relief, drugs and ICTs. We have seen progress as well as gaps in the areas which were covered: more aid, but with quality lagging and a link to progress in MDG areas that was weak; a better rich world performance on tariffs but one that misses increasingly important parts of trade; broadly successful debt relief but an agenda on the support for private investment left uncovered; mixed progress on drugs access and absence of a broader global public health agenda; and a global ICT revolution with weak links to the MDGs or a global partnership. Migration, non-ICT technologies, the global environment, and global institutional issues were all completely unaddressed in MDG 8. Looking forward, by 2030, a global compact on development progress linking OECD DAC aid and policy reform to low income countries as target beneficiaries (the implicit model of MDG 8) would be irrelevant to three quarters of the world. Half of the rich world will be in non-DAC countries and the share of aid in global transfers will continue to shrink. Global public goods provision will increasingly require the active participation of (at least) the G20 nations. A post-2015 global partnership agenda should involve a mixed approach to compact and partnership issues: binding ‘global compact’ targets under specific post-2015 sectoral goals focused on the role for aid alongside a standalone global public goods goal with time bound, numerical targets covering trade, investment, migration, technology, the environment and global institutions.
Research and development to meet health needs in developing countries: Strengthening global financing and coordination. Report of the Consultative Expert Working Group on Research and Development: Financing and Coordination.
Geneva, Switzerland, WHO, 2012 Apr.  p.The Consultative Expert Working Group on Research and Development: Financing and Coordination (CEWG) was established by the World Health Assembly (WHA) in 2010 by resolution WHA63.28 with the principal task of deepening the analysis and taking forward the work done by the previous Expert Working Group on Research and Development: Coordination and Financing (EWG) which reported in 2010. Underlying both expert groups was the objective set out in the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property (GSPA-PHI): “to examine current financing and coordination of research and development, as well as proposals for new and innovative sources of financing to stimulate research and development related to Type II and Type III diseases and the specific research and development needs of developing countries in relation to Type I diseases.” In undertaking our work we were mindful of the request that we “observe scientific integrity and be free from conflict of interest” in our work and we also decided to be as open and transparent as possible by providing an open forum during our first meeting, calling for submissions, providing open briefings after each of our meetings, and publishing as much as possible on our web site. (Excerpt)
Essential medicines for mothers and children: a key element of health systems. Access to medicines and public pharmaceutical policy.
Entre Nous. 2009; (68):14-15.Medicines, when used appropriately, are one of the most cost effective interventions in health care. European countries spend an important part of their health budget on medicines, from 12% on average for the EU countries to more than 30% for the Newly Independent States (NIS) countries. Whereas in EU countries the larger part of the medicines expenditures are publicly funded through taxes and/or social health insurance, in the NIS and in the south eastern European countries it is often the patients who have to pay directly for the drugs themselves. This means that many patients simply do not get the drugs they need because they cannot afford them, and also may force families to incur enormous expenses as they sell their belongings in order to pay for their drugs and their health care.
European Journal of Public Health. 2007 Oct; 17(5):409.In public health teaching, tuberculosis (TB) has been a traditional example of how disease occurrence is determined by the triad agent, environment, host. And it has since long been standard textbook knowledge that there are strong socioeconomic determinants behind all three components: The agent is more prevalent and is spread more easily in conditions of crowding and poor hygienic conditions, and under these conditions several host factors are also more prevalent, such as malnutrition and alcoholism. In recent years another dimension has been added to the socioeconomic patterning of TB: An already very solid mass of research has highlighted the social and economic aspects of care and follow-up of patients with TB. A recent example of this research is the paper by Wang et al. in this issue of the journal, on differences in both patient's delay and doctor's delay in the diagnosis of TB, when comparing residents and non-residents (rural immigrants) in Shanghai. (excerpt)
Bulletin of the World Health Organization. 2007 Sep; 85(9):650.The WHO Model List of Essential Medicines, used by many countries to guide drug procurement and supply, has been a global standard for 30 years. Although this list has included some paediatric medicines, a children's list has not been systematically developed until now. To address this shortcoming, a subcommittee of the WHO Expert Committee on Selection and Use of Essential Medicines met in July 2007, to develop a list of essential medicines for children. In May 2007, the 60th World Health Assembly passed a resolution on Better Medicines for Children (WHA60.20) that described several strategies to improve access to essential medicines of adequate quality for children. As has been described in several reviews, the main causes of mortality in children can be treated by essential medicines such as antibiotics for infections or oral rehydration solution and zinc for diarrhoea. To apply this knowledge effectively requires that these medicines be available; yet suitable zinc tablets, for example, are still not included in many national essential medicines lists. (excerpt)
The dilemma of intellectual property rights for pharmaceuticals: the tension between ensuring access of the poor to medicines and committing to international agreements.
Developing World Bioethics. 2003 May; 3(1):27-48.In this paper, we provide an overview of how the outcomes of the Uruguay Round affected the application of pharmaceutical intellectual property rights globally. Second, we explain how specific pharmaceutical policy tools can help developing states mitigate the worst effects of the TRIPS Agreement. Third, we put forward solutions that could be implemented by the World Bank to help overcome the divide between creating private incentives for research and development of innovative medicines and ensuring access of the poor to medicine. Fourth, we evaluate these solutions on the basis of utilitarian considerations and urge that equitable pricing is morally preferable to the other solutions. (author's)
Bulletin of the World Health Organization. 2006 Sep; 84(9):685-764.The International Medical Products Anti-Counterfeiting Taskforce (IMPACT) aims to put a stop to the deadly trade in fake drugs, which studies suggest kill thousands of people every year. "We need to help people become more aware of the growing market in counterfeit medicines and the public health risks associated with this illegal practice," said Dr Howard Zucker, Assistant Director-General for the Health Technology and Pharmaceuticals cluster of departments at WHO. The taskforce will encourage the public, distributors, pharmacists and hospital staff to inform the authorities about their suspicions regarding the authenticity of a drug or vaccine. In a parallel move, the taskforce will help governments crack down on corruption in the sections of their police forces and customs authorities charged with enforcing laws against drug counterfeiting. Drug manufacturers will be encouraged to make their products more difficult to fake. (excerpt)
Geneva, Switzerland, UNAIDS, 1998 Oct.  p. (UNAIDS Best Practice Collection)The World Health Organization (WHO) estimates that over one-third of the world's population has no guaranteed access to essential drugs. There are various reasons for this lack of access. Worldwide, the most important is affordability (drugs cost more money than is available to pay for them) but legal, infrastructural, distribution and cultural factors are also serious obstacles. The influence of each of these factors is different from country to country, just as frequencies of diseases also vary greatly. Among its activities aimed at improving drug access in developing countries (including technical services such as help in drug procurement and performance of needs estimates), WHO has drawn up a Model List of Essential Drugs, which is updated every two years. The tenth list (1997) has 308 priority drugs that provide safe, effective treatment for the infectious and chronic diseases which affect the vast majority of the world's population. The drugs are selected on the basis of cost-effectiveness within each drug class (e.g. of the dozens of penicillins only eight appear on the Essential Drugs list). With WHO's encouragement, more than 140 countries have developed their own national essential drug lists taking into account local needs, costs and available resources. (excerpt)
Perspectives on Global Development and Technology. 2004; 3(1-2):131-152.This paper considers influences of globalization on three relevant health policy issues in South Africa, namely, private health sector growth, health professional migration, and pharmaceutical policy. It considers the relative role of key domestic and global actors in health policy development around these issues. While South Africa has not been subject to the overt health policy pressure from international organizations experienced by governments in many other low- and middle-income countries, global influence on South Africa's macroeconomic policy has had a profound, albeit indirect, effect on our health policies. Ultimately, this has constrained South Africa's ability to achieve its national health goals. (author's)
Bulletin of the World Health Organization. 2006 May; 84(5):338.The context for this theme collection is the publication of the report of the Commission on Intellectual Property Rights, Innovation and Public Health. The report of the Commission -- instigated by WHO's World Health Assembly in 2003 -- was an attempt to gather all the stakeholders involved to analyse the relationship between intellectual property rights, innovation and public health, with a particular focus on the question of funding and incentive mechanisms for the creation of new medicines, vaccines and diagnostic tests, to tackle diseases disproportionately affecting developing countries. In reality, generating a common analysis in the face of the divergent perspectives of stakeholders, and indeed of the Commission, presented a challenge. As in many fields -- not least in public health -- the evidence base is insufficient and contested. Even when the evidence is reasonably clear, its significance, or the appropriate conclusions to be drawn from it, may be interpreted very differently according to the viewpoint of the observer. (excerpt)
Bulletin of the World Health Organization. 2006 May; 84(5):371-375.Most countries have acceded to at least one global or regional covenant or treaty confirming the right to health. After years of international discussions on human rights, many governments are now moving towards practical implementation of their commitments. A practical example may be of help to those governments who aim to translate their international treaty obligations into practice. WHO's Essential Medicines Programme is an example of how this transition from legal principles to practical implementation may be achieved. This programme has been consistent with human rights principles since its inception in the early 1980s, through its focus on equitable access to essential medicines. This paper provides a brief overview of what the international human rights instruments mention about access to essential medicines, and proposes five assessment questions and practical recommendations for governments. These recommendations cover the selection of essential medicines, participation in programme development, mechanisms for transparency and accountability, equitable access by vulnerable groups, and redress mechanisms. (author's)
In: Global health and governance. HIV / AIDS, edited by Nana K. Poku and Alan Whiteside. Basingstoke, England, Palgrave Macmillan, 2003 Dec. 109-122.Today in much of Africa economic growth has slowed and living standards for the majority have suffered in the face of rising unemployment and mass poverty, resulting in incomes that are presently below the 1970 level. One problem that has been the focus of much attention and contention over the past 20 years is the huge foreign debt owed by African countries to bilateral donors and multilateral institutions. Debt servicing is consuming a disproportionate amount of scarce resources at the expense of the provision of basic services to the poor. In order to receive help in servicing their debts, countries must agree to implement structural economic reforms. This often entails drastic cuts in social expenditures, the privatisation of basic services, and the liberalisation of domestic trade consistent with WTO rules. These policy decisions have had a direct impact on the capacity of African countries to promote, fulfill and protect the right to health of their citizens. This is further compounded by ill-conceived privatisation of basic services such as water and health services, without any regard for the ability of the poor to access these essential services at a cost they can afford. Finally, adherence to WTO trade rules, which often comes as an extension of liberalisation policy, hampers the capacity of African governments to produce or purchase less expensive generic drugs for their citizen without fear of retaliation from the developed countries. (author's)
Drug Safety. 2005; 28(4):277-286.Artemisinin combination therapies (ACTs) have been recommended for the treatment of malaria in countries where there is widespread resistance to commonly used antimalarial drugs. Several sub-Saharan African countries are, therefore, in the process of introducing ACTs in their malaria drug policies. However, there is limited information about the safety of ACTs outside South East Asia, where their use has been well documented. As with all other new medicinal compounds, the monitoring of a drug's safety or ’pharmacovigilance’ is important, especially in areas where co-morbid conditions, such as HIV/AIDS, malnutrition and tuberculosis, are common. Because in most malaria endemic countries, particularly Africa, there are no pharmacovigilance programmes in place, it has been suggested that the introduction of ACTs offers an opportunity for these countries to put drug safety monitoring systems in place. Backed by the WHO Roll Back Malaria department and other international cooperating partners, five African countries, which are in the process of introducing ACTs (Burundi, Democratic Republic of the Congo, Mozambique, Zambia and Zanzibar), have drawn up action plans to introduce pharmacovigilance in their health sector. It is planned that once the safety monitoring of antimalarials has been established, these activities can then be extended to cover medicinal compounds used in other public health programmes, such as HIV/ALDS, tuberculosis and the immunisation programmes. This article looks at the rationale for pharmacovigilance, the process of setting up monitoring centres and the challenges of implementing the project in the region. (author's)
Nature. 2005 Jan 13; 433(7022):91.For Mrs Luat, the H5N1 avian flu virus could bring economic ruin. Three years ago, she and her husband borrowed US$12,500 to establish a small chicken farm in Hay Tay province, near the Vietnamese capital Hanoi. They raise 6,000 chickens at a time in their single shed, selling the entire stock every couple of months to a Thai company that distributes the meat within Vietnam. But last year, their shed lay empty for six months after H5N1 flu hit neighbouring farms. Mrs Luat estimates the couple's losses at $1,500. If it happens again, they may be unable to service their debts. While smallholders such as the Luats face the most immediate threat, the continuing presence of the H5N1 virus in Vietnam and neighbouring countries could spell a global disaster, in both economic and humanitarian terms. H5N1 is deadly to both chickens and people, but thankfully isn't easily transmitted from person to person. But if it exchanges genes with a mammalian flu virus, H5N1 could become a mass killer that would rapidly sweep the globe. If that happens, tens of millions of people could perish. (excerpt)
Nature. 2005 Jan 13; 433(7022):91.For Mrs Luat, the H5N1 avian flu virus could bring economic ruin. Three years ago, she and her husband borrowed US$12,500 to establish a small chicken farm in Hay Tay province, near the Vietnamese capital Hanoi. They raise 6,000 chickens at a time in their single shed, selling the entire stock every couple of months to a Thai company that distributes the meat within Vietnam. But last year, their shed lay empty for six months after H5N1 flu hit neighbouring farms. Mrs Luat estimates the couple's losses at $1,500. If it happens again, they maybe unable to service their debts. While smallholders such as the Luats face the most immediate threat, the continuing presence of the H5N1 virus in Vietnam and neighbouring countries could spell a global disaster, in both economic and humanitarian terms. H5N1 is deadly to both chickens and people, but thankfully isn't easily transmitted from person to person. But if it exchanges genes with a mammalian flu virus, H5N1 could become a mass killer that would rapidly sweep the globe. If that happens, tens of millions of people could perish. Since H5N1 starting spreading through Asian poultry flocks in 2003, the World Health Organization (WHO) has been sounding the pandemic alarm. Two main actions are required. First, surveillance for human and animal flu viruses in affected countries needs to be stepped up, to provide an early warning of the emergence of a possible pandemic strain. Second, nations around the world must develop plans to protect their populations should this occur. This will require stringent quarantine procedures, plus the rapid deployment of vaccines and antiviral drugs. (excerpt)
Lancet. 2004 Nov; 4:653.WHO is not doing enough to control rising levels of tuberculosis, according to researchers at Harvard University, MA, USA. Despite almost 10 years of Directly Observed Treatment, Shortcourse (DOTS), WHO’s main strategy for treating active tuberculosis infections and reducing its prevalence, most of the world remains no closer to controlling this disease. The DOTS programme detects tuberculosis by sputum-smear microscopy then administers standard shortcourse chemotherapy under a directly observed therapy approach. WHO’s goal is to identify 70% of patients with positive smears, and to cure 85% of them by the end of 2005. But this tactic, says author Timothy Brewer, is likely to have only a modest effect on population-based tuberculosis control. (excerpt)
Bulletin of the World Health Organization. 2004 Sep; 82(9):716.A decade after introducing the WHO recommended tuberculosis (TB) control strategy across half of China, a recent study showed that prevalence of the deadly bacterial disease that affects the lungs has fallen by about one-third. WHO and the Chinese Ministry of Health published a joint report in the Lancet on 30 July based on the findings of a survey conducted in 2000 among 376 000 people in all 31 provinces, autonomous regions and municipalities on the Chinese mainland. In the report, researchers compared TB prevalence in regions where the DOTS control strategy had been implemented with those in the rest of the country. Researchers concluded that — as a direct result of the project — there were 382 000 fewer cases of TB in 2000 than 10 years earlier, a 30% decline in prevalence, taking into consideration a larger and more aged population. WHO said TB remains a significant public health problem in China with 1.4 million new cases each year, where the most recent WHO data suggests that only four or five cases out of every 10 receive treatment through the DOTS programme. (excerpt)
Annals of Tropical Medicine and Parasitology. 2002; 96 Suppl 2:S3-S13.Human lymphatic filariasis (LF), the sequelae of which are commonly known as elephantiasis, results from infection with nematode filarial parasites, which are transmitted by certain species of vector mosquito. Transmission of these parasites to humans continues in more than 80 countries, with a combined population of well over 1000 million people at risk. In some situations, usually where economic progress has raised the standard of living, the disease has disappeared (Australia, South Korea, U.S.A). In other settings, specific public-health interventions, such as mass drug administrations (MDA) based on diethylcarbamazine (DEC) tablets (Suriname, Trinidad and Tobago) or the mass distribution of salt fortified with DEC (China), have led to the interruption of transmission. In most areas where LF remains endemic, the disease is an important health burden. Indeed, it probably causes the loss of more disability-adjusted life-years (DALY) than any other communicable parasitic disease except malaria. Lymphatic filariasis is a painful and profoundly disfiguring disease that has a major social and economic impact. Of the estimated 120 million people who are currently infected with the causative parasites, 40 million have the clinical manifestations of the disease. (excerpt)
Annals of Tropical Medicine and Parasitology. 2002; 96 Suppl 1:S3-S4.The African Programme for Onchocerciasis Control (APOC) was launched in December 1995 on the tidal wave of the resounding success of the 21-year-old Onchocerciasis Control Programme in West Africa (OCP). Six years later and now at the mid-point of its pre-determined existence, it is time to take stock and plan for the second half. This special Supplement contains a set of articles that focus on some key areas of the activities of APOC in the first phase. Each article makes a critical appraisal of the major achievements and shortcomings of the programme, from the start of operations in 1996, and identifies the main challenges for Phase 2. A succinct account of the state of affairs at the birth of APOC would help to put the achievements and the challenges in better perspective. The ultimate goal of APOC is 'to eliminate onchocerciasis as a disease of public-health importance and an important constraint to socio-economic development throughout Africa'. The prescribed strategy by which this goal is to be attained is 'the establishment of a self-sustainable ivermectin treatment programme' in the high-risk zones of all the endemic countries outside the OCP area. Where feasible, control would also be effected by local vector eradication. (excerpt)
Lancet Infectious Diseases. 2003 Jun; 3(6):317.April 25 was Africa Malaria Day. It was masked by the release of the Africa Malaria Report, a joint publication by WHO and UNICEF and the first comprehensive report charting the progress made towards achieving the Abuja targets of reducing the malaria burden in Africa by 2010. The report praises the progress in fighting the disease but reveals that current coverage of effective interventions against malaria is unacceptably low. Mortality, morbidity, and the adverse economic impact of malaria increased during the 1990s. Only 15% of young children sleep under a net, and only 2% use nets that are treated by insecticide. Chloroquine has lost its clinical effectiveness in most parts of Africa Sulphadoxine-pyrimethamine is still useful but there are areas in western Kenya where resistance is fast rising. Furthermore, new effective antimalarial drugs are just not accessible to those who need them. The report urges the international community to step up the momentum, insisting that greater resources of money and political motivation are required to reverse the trend. (excerpt)
Developing World Bioethics. 2001 May; 1(1):1-6.Many governments in developing countries, faced with millions of avoidable deaths of their citizens, have tried to import cheaper generic drugs from countries such as Thailand, Brazil and India. Invariably their attempts to save their citizens' lives has been met with lawsuits by pharmaceutical multinationals. Here are just a few examples of cases reported in local media in various developing countries. The picture that emerges is that of a global confrontation between pharmaceutical companies and the governments of developing countries. (author's)
In: While the world sleeps: writing from the first twenty years of the global AIDS plague, edited by Chris Bull. New York, New York, Thunder's Mouth Press, 2003. 401-412.Public concern over the global AIDS epidemic, particularly in Africa, has grown enormously in recent years, but there is considerable debate about what the international community can and should do about it. Especially controversial has been the high cost of antiretroviral drugs used to extend the lives of people with AIDS. The pharmaceutical companies that make these drugs price them beyond reach of the world's poor, but in November 2001 at the WTO meeting in Doha, Qatar, these companies were forced to accede to pressure from developing-country governments, nongovernmental organizations, and activists, and allow poor governments to adjust certain rigid patent rules applying to vaccines and drugs in order to protect public health. Despite this apparent triumph of international pressure, far more needs to be done. A coalition of governments and nongovernmental organizations, led by the UN, recently launched the Global Fund Against AIDS, Tuberculosis, and Malaria (referred to here as the Global Fund), and its performance will test how well such a global institution can confront the most serious health crises of our time, and perhaps in all of human history. (excerpt)
Health for the Millions. 2004 Jan; 30(4-5):28-29.Availability of essential drugs has been one of the major components of the Alma Ata Charter. Dr. Halfden Mahler, former Director General, WHO had called increasing pharmaceuticalisation of health care and the increasing power of the drug corporators and the drug exporting countries as neo colonialism. He set up the Drug Action Program in WHO that reported to him directly. The model essential drug list was brought out and the guidelines for National Drug Policy were drawn. (excerpt)
BMJ. British Medical Journal. 2003 Nov 22; 327:1188.The Global Fund to Fight AIDS, Tuberculosis and Malaria is under intense scrutiny from malaria researchers, who say that its limited resources are being wasted on useless malaria drugs. The controversy was sparked by the latest figures on the fund’s spending on malaria treatment in Africa. More is being spent on chloroquine, which costs just $0.10 (£0.06; €0.08) for each dose but which is largely ineffective in Africa, than on combination treatments based on artemisinin, which are highly effective but cost at least 10 times as much. The result, say the researchers, is that lives are being lost needlessly. (excerpt)
Epidemic of sexually transmitted diseases in Eastern Europe. Report of a WHO meeting, Copenhagen, Denmark, 13-15 May 1996.
Copenhagen, Denmark, WHO, Regional Office for Europe, 1996. , 14 p. (EUR/ICP/CMDS 08 01 01)In response to the alarming rise in sexually transmitted diseases (STDs) in the newly independent states, the WHO Regional Office for Europe, WHO headquarters and the Joint United Nations Programme on AIDS organized a meeting of experts from the most affected countries to exchange information and to identify priority actions for the control of the epidemic. The participants included 15 experts from Belarus, Kazakhstan, Latvia, the Republic of Moldova, the Russian Federation and Ukraine. The participants called for urgent action, including a careful assessment of the existing systems for STD control, reallocation of resources among the various activity areas and strong advocacy to generate awareness at the top level of government and strengthen its support for the recommended initiatives. They also urged that national coordination of programmes to promote sexual health and prevent STDs and HIV be strengthened, that statutory services be made more accessible and acceptable to patients and that efforts be made to ensure that all health workers managing patients with STDs, including those in the private sector, provide high-quality care. (author's)