US Global Health Policy

U.S. Global Health Policy

{Photo credit: Warren Zelman}Photo credit: Warren Zelman

This story was originally published by The Hill.

No sooner had one outbreak of Ebola in the Democratic Republic of Congo (DRC) been declared over than another broke out. The latest outbreak is particularly threatening as it is in North Kivu province, an area beset with violence between rival militia groups. On top of struggling with violent conflict that has lasted, in some areas, for more than 20 years, the DRC is one of the world’s poorest countries and lacks a well-developed infrastructure.

Infectious disease outbreaks are more dangerous in countries like the DRC because fragile or severely off-track countries have little health care infrastructure to support the necessary steps to contain the outbreak. Although the DRC has had many Ebola outbreaks and more experience containing the disease than any other country, the conflict environment exacerbates the threat.

The Ebola epidemic was raging in West Africa. Management Sciences for Health’s staff in Liberia relayed that “treatment facilities are overrun with cases” and “whole parts of the health system are at a standstill.” Things got much worse before the epidemic was finally defeated. Over 11,000 people died horribly from the disease, leaving more than 16,000 children orphaned.

Once the world woke up to the crisis, there was a generous outpouring of assistance. As the response peaked, I was consumed by nagging questions: Where will we be four or five years from now? Will the world have gone back to sleep? What’s needed to protect the world from future outbreaks? To find the answers, I explored the lessons from epidemics over the last century – smallpox, AIDS, SARS, avian flu, swine flu, Ebola, Zika – and I drew on some of the best minds, experienced professionals and committed citizen activists in global health, infectious disease, and pandemic preparedness.

{Photo credit: Ben Greenberg/MSH}Peter SandsPhoto credit: Ben Greenberg/MSH

On November 13, approximately 100 global health security and development experts, public health practitioners, private sector representatives, academics, researchers, NGO staff members, scientists and students gathered at Harvard Medical School for the Ready Together Conference on Epidemic Preparedness. The day-long event was co-hosted by No More Epidemics, Management Sciences for Health (MSH), Harvard Global Health Institute, and Georgetown University Center for Global Health Science and Security with support from the James M. and Cathleen D. Stone Foundation. We attempted to find answers to the following questions: 1. What are the financial, economic and other risks to the private sector associated with major disease outbreaks and what is being done to minimize risk and ensure resilience?; 2. What innovations have been developed for pandemic preparedness?; 3. How can a whole of society collaboration be enhanced to ensure global health security?; and 4. How can we overcome barriers, ensure country engagement and public private partnerships?

Here are 5 key takeaways from the discussion:

1. “We must stop ignoring the economic risks. We need Finance Ministers to recognize health threats.”- Peter Sands 

Watch Peter's keynote

{Photo Credit: Warren Zelman}Photo Credit: Warren Zelman

Irrational medicine use and poor pharmaceutical management are widespread problems throughout all levels of Sierra Leone’s health system. Misuse, underuse, and overuse of medicines are particularly worrying because they contribute to the rise of antimicrobial resistance (AMR) and threaten the effective prevention and treatment of infections caused by bacteria, parasites, and viruses.

Recognizing that coordinated action is needed to minimize the emergence and spread of AMR, Management Sciences for Health (MSH) has catalyzed multidisciplinary and cross-sectoral coalitions to build awareness of the threat of AMR and advocate for its containment.

As part of its post-Ebola recovery work to strengthen its pharmaceutical system, Sierra Leone’s Directorate of Drugs and Medical Supplies (DDMS) partnered with the US Agency for International Development-funded Systems for Improved Access to Pharmaceutical and Services (SIAPS) Program, implemented by MSH, to develop efficient procurement, distribution, and inventory systems and establish stakeholder coordination and oversight mechanisms known as hospital Drug and Therapeutics Committees (DTCs).

MSH Delegation: Matthew Martin, Crystal Lander, Catharine Taylor, Marian Wentworth, Stuart Knight, Barbara Ayotte, and Alison Corbacio

As the Trump Administration released its truncated global health budget last week, ministers of health, members of civil society and the private sector, and government delegations met in Geneva for the annual World Health Assembly to discuss programs that exemplify the value of foreign assistance and its tangible effect on families in some of the poorest countries. In advance of the meeting, MSH released position statements on WHA agenda items. Dozens of governments led by Germany and South Africa, signed the Global Compact for Universal Health Coverage 2030 committing to make affordable and quality healthcare accessible for all. This year’s WHA was particularly historic with the nomination of the WHO’s first African Director-General, Dr.

Last week, the World Health Organization elected Dr. Tedros Adhanom Ghebreyesus as its next Director General. Amid his controversial campaign, I coauthored an open letter to the next Director General to prioritize factory farming, an eminent threat to global health.

Abstract:  Although the risk of onset in the next year, or in the next decade, cannot be quantified, a severe pandemic involving person-to-person transmission of a novel respiratory virus is considered by leading organizations to be a substantial global threat.  The ongoing threat posed by the H5N1 and H7N9 avian influenza viruses, and by the MERS coronavirus, should serve to remind us of the continuing importance of pandemic preparedness.  In a severe pandemic from a rapidly spreading novel respiratory virus, when all countries and all responding organizations will themselves be struck, most low-resource populations will fail to receive adequate medical supplies, and their health services will be more stressed than they are today.  However, these populations could, by employing well-planned, evidence-based measures, reduce disease transmission and care for those not severely ill, without substantial outside resources. Authoritative guidance must be developed, and support provided for country adaptation, planning for rapid roll-out, and testing of these plans.  

The Global Health Security Agenda (GHSA), launched in 2014 by the U.S. and other countries, is dedicated to strengthening the capacities of countries to prevent, detect, and respond to infectious disease threats. The GHSA aims to protect the poorest countries and most neglected populations and works to ensure health security benefits. The GHSA assumes a multi-sectoral, holistic approach to health security and preventing infectious disease.

It will take time for the GHSA to completely achieve its goals.  To do so, the global community must make a sustained effort to prevent, detect, and respond to future infectious disease threats and outbreaks, no matter where they occur.  We, the global community, can do this in several ways.

First, it is important to maintain the international momentum and engagement around health security as a priority focus area. The GHSA was constructed to encourage leadership from membership countries. Countries such as Finland, Indonesia,  Kenya, the United Kingdom, The Netherlands, and others have demonstrated strong leadership and strategic vision. This drive continues under the Chair of South Korea for the 2017 term.  

Unpublished

To mitigate the cross-border and national impacts of infectious disease threats, the Global Health Security Agenda (GHSA) was launched in 2014 to foster a collaborative approach to improve nations’ capacities to detect, prevent and respond to threats whether occurring naturally, deliberately or by accident. Law itself is not an explicit part of the overall GHSA, except in one package, Respond 2, that links public health with law and a multi-sectoral rapid response.  Law has become an element of the Joint External Evaluation (JEE) tool, launched in February 2016, and now on the table for revision (WHA 68/22 Add .1.). In May the World Health Assembly will take up consideration of progress towards a 2016 goal of 50 country assessments and next steps. WHO has begun a review of the JEE tool and requests for feedback are circulating.  This update focuses on the JEE element of legislation and proposes some simple fixes.     

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