Category Archives: Global health

A healthy society is a disaster resilient society

Disasters are usually measured by the number of deaths, injuries and damage to property that they cause. But, do these measures truly express the magnitude of damage to people’s health and quality of life?

In 2011, the earthquake that struck the Pacific coast of Tōhoku, with a magnitude of 9.0 (Mw), was the largest to ever hit Japan and the fourth most powerful in recorded history. Strong national building codes protected most of the buildings in Japan from this devastating earthquake and saved many lives as a result, but the people affected by that disaster still suffer from chronic illnesses, mental problems, loss of family and exposure to nuclear power plant accidents—most notably Fukushima, which continues to pose contamination risks due to the severe infrastructure damage it incurred during the earthquake. The public health situation of a community is a key factor in measuring their resilience against disasters, and accordingly, the strengthening of mental and physical health must be made a priority when looking to curb the risks posed such disasters in the future.

On the other side, the process of rebuilding after a disaster is just as important as the capacity and resilience building processes that happen prior to a disaster. Health professionals have an important role to play in facilitating mutual, cooperative relationships with non-health professionals as they work together to help rebuild communities. Specialists, such as those involved in disaster medicine, need to forge partnerships with general health providers to create a unified approach to community resilience and rebuilding programs. The role the health professional plays is not only important in the acute response to injuries caused by disasters, but also in preparedness work, which is crucial to later making an efficient response to any disaster.

800px-Damage_of_Tsunami_at_Naruse

In Japan, for example, nation-wide disaster medical response systems have saved many lives.  With the Tōhoku earthquake in 2011, systems such as disaster-base hospitals, disaster medical assistant teams (DMAT), staging care units (SCU), wide-area transportation systems, emergency medical information systems (EMIS) and disaster medical-public health coordinators worked efficiently in the immediate aftermath of the earthquake, saving countless lives and limiting the impact of the disaster.

Despite these efforts, however, the medical and public health needs of the affected people exceeded the relief capacities in place at the time and, indeed, for several months after the event. Mental health problems including post-traumatic stress disorder (PTSD), depression and alcoholism are still huge problems in those affected, and it will take years to find solutions to these issues. Medical and public health preparedness should be emphasized and prioritized in order to build resilience to disasters in the form of long-running, systematized global health programs.

During the International Symposium for Disaster Medicine and Public Health Management that took place last May, scientists and experts in disaster medicine and public health reached a consensus that health concerns should be imperative in the formulation of disaster risk reduction interventions. Prioritization of the people’s mental and physical health in the process of disaster risk reduction should be in included in frameworks and policy at all levels. Preparation for people who need special assistance, such as those with disabilities, children and women, elderly people, people with chronic illnesses, foreigners and travelers, cannot be made without their own participation in the process of disaster risk reduction planning. 

Immagine1

To achieve the above, education and training of general health-care providers and the continued development of the field of disaster medicine and public health are the only methods that will lead to long-lasting implementation.

All of this has been in the spotlight at the 3rd World Conference for Disaster Risk Reduction taking place in Sendai, Japan earlier this month. The Hyogo Framework for Action (HFA), endorsed by the UN General Assembly in 2005 to make the world more disaster resilient, will be revised in Sendai to reflect the post-2015 development agenda and give greater emphasis to the health of those vulnerable to the risk of natural disasters. The original HFA did not do enough to influence the design of existing national social protection mechanisms, particularly with regard to health programs and education schemes, which are crucial to building resilience to disasters. The new framework HFA framework under discussion in Sendai is meant to cover the next 20-30 years and will be expanded to include such important areas of social protection, like heath and education, effectively leading to the scaling-up of disaster resilience before disasters hit.

We, as health professionals, are striving to strengthen community resilience to disasters through the improvement of physical and mental health services. To do this, health professionals must be regarded as a key stakeholder working in concert with other professionals in the field of disaster risk reduction.

Shinichi Egawa (Tohoku University)

 

COHRED’s take on Prof. Egawa’s excellent contribution

In this guest post, Shinichi Egawa—Division of International Cooperation for Disaster Medicine, International Research Institute of Disaster Science (IRIDeS), Tohoku University—writes about disaster resilience as a necessary trait of ‘healthy’ societies. Governments across the globe are scaling up their combined efforts to reduce the risk of natural disasters. What role can evidenced-based health research, innovations and findings play in shaping local, regional and global Disaster Risk Reduction (DRR) responses? How can we change from ‘disaster preparedness’ to ‘increasing community resilience’? How can public, private and non-profit interactions be streamlined to increase efficiency and impact and reduce duplication? How can we optimize technology and human resource development in early warning, mitigation and post-disaster response? These and other key issues will be under the spotlight at the forthcoming Forum 2015 in Manila, Philippines, for which Prof. Egawa is part of the DRR scientific committee. COHRED firmly believes research and innovation are key to make societies healthy and thus, as Prof. Egawa maintains in his post, disaster-resilient. We therefore aim to stimulate widespread discussion on specific recommendations to strengthen national (health) research and innovation systems to make societies in low- and middle-income countries (LMICs) more resilient after natural hazards/disasters and adaptable to climate changes. Everyone interested in helping to develop the research and innovation systems of LMICs to become more disaster resilient – should be in Manila in August!

Carel IJsselmuiden (COHRED)

Social determinants of health at the Global Forum on Research and Innovation for Health 2015

*   *   *   *   *

SPEED READ

 – Health is heavily determined by the conditions in which people are born, grow, live, work and age, and these, in turn, are shaped by the distribution of money, power and resources at local, national and global levels. These factors are usually referred to as social determinants of health.

– The Council on Health Research for Development (COHRED) and its partners will host the Global Forum on Research and Innovation for Health (Forum 2015) in Manila, from 24-27 August 2015.

– Social determinants of health cut across many of Forum 2015 themes. In particular, they play a critical role in some of the topics that lay at the core of the programme, namely food safety and security, health in mega-cities and disaster risk reduction.

*   *   *   *   *

As world leaders shift their focus to the post-2015 Sustainable Development Goals, it is important not only to understand the impact of research and innovation on health in relation to broad development objectives, but also, it is critically important to emphasize the role that research and innovation can have in reducing health inequities.

Social determinants of health (SDH) are mostly responsible for health inequities. In other words, health is heavily determined by the conditions in which people are born, grow, live, work and age, and these, in turn, are shaped by the distribution of money, power and resources at local, national and global levels. The role of research and innovation in addressing SDH and promoting health equity has been emphasized by WHO’s Commission on Social Determinants of Health, which in 2008 published the report Closing the gap in a generation: Health equity through action on the social determinants of health: “[I]t is through the democratic processes of civil society participation and public policy-making, supported at the regional and global levels, backed by the research on what works for health equity, and with the collaboration of private actors, that real action for health equity is possible” .

With this in mind, COHRED, in partnership with the Philippine Department of Health and Philippine Department of Science and Technology, will host the Global Forum on Research and Innovation for Health (Forum 2015) in Manila, from 24-27 August 2015. Forum 2015 provides a platform where low and middle-income countries take prime position in defining the global health research agenda, in presenting solutions and in creating effective partnerships for action.

HR_forum logo+dates and placeOver the course of three days, Forum 2015 will use informative and interactive discussions, workshops, networking sessions and activities to allow participants to interact, inspire, learn and partner to increase their own impact. This event will bring together all stakeholders who play a role in making research and innovation benefit health, equity and development. This includes high-level representatives from government, business, non-profits, international organizations, academic and research institutions and social entrepreneurs among others.

The programme for this event will be built around two major pillars showcasing: (1) key concepts needed to improve the efficiency and effectiveness of research and innovation for health and development, as well as (2) ways that research and innovation contribute to solutions to important global health and development challenges faced by low and middle income countries today.

Forum 2015 programme pillars and themes

I. Increasing the Effectiveness of Research and Innovation for Health:
• Social accountability
• Increasing investments
• Country-driven capacity building

II. The role of Research and Innovation:
• Food safety and security
• Health in mega-cities
• Disaster risk reduction

Clearly, social determinants of health cut across many of these themes, but in particular, they play a critical role in the second pillar of this year’s programme, under the themes of food safety and security, health in mega-cities and disaster risk reduction.

For example, the objective of food security is not only to facilitate the accessibility of nutritious and sufficient food for people, but also to provide economic and physical access to food for socially vulnerable groups. Sessions under Forum 2015’s food safety and security theme will focus on research and innovation in scientific, economic, rights-based, and commercial terms to ensure new solutions and scale up existing efforts, to ensure that food and water remain – and become – accessible and affordable to all. Social determinants in this theme reveal themselves in choices taken in agricultural production, access and distribution of food, and even dietary habits and safety standards, which all vary by region and population.

342791

The rise of mega-cities creates a range of health challenges, both new and old – from the rise of NCDs and return of infectious disease, to traffic related accidents and mental health issues. These issues are shaped by social determinants including housing conditions, unsafe water sources and poor air quality, to poverty, marginalization and limited access to basic healthcare.

With regards to disasters, there is wide international agreement that efforts to reduce disaster risks and increase resilience must be systematically integrated into national policies, plans and practices. As governments all over the globe are taking initiatives to reduce their risks, sessions under the disaster risk reduction theme in Forum 2015 will examine issues related to vulnerable populations who disproportionately bear the brunt of that risk, along with the range of socio-economic factors that influence the health disparities that arise between these vulnerable groups and the general population.

While it is clear that social determinants affect the disparate health outcomes of population groups in relation to food security, health in mega-cities, and vulnerability to disaster, SDH research, as well as the need for high quality research on SDH, could appear throughout the Forum 2015 programme.

Forum 2015 encourages participation by all as the meeting programme spans a wide range of topics and input is welcome in form of organized session proposals and abstracts, also on how to feature SDH more prominently in the programme this year in Manila.

Anthony Nguyen and Charlie Kent (COHRED)

Universal Health Coverage: the right path towards equity and development

*   *   *   *   *

SPEED READ

– A large global coalition of more than 500 organizations from over 100 countries, has marked 12 December 2014 as the first-ever Universal Health Coverage Day, to reaffirm that health is a right, not a privilege, and that access to quality health care should never depend on where you live, how much money you have or your race, gender or age.

– Investing in health is a wise choice. Indeed, making universal health coverage a priority for all nations could be the cornerstone of the post-2015 sustainable development agenda and a powerful driver of economic growth in low- and middle-income countries.

– The Council on Health Research for Development (COHRED) proudly supports UHC Day and actively works on a number of activities at the global scale, all aimed at contributing to UHC through making the most out of the impact of research and innovation on the health and development problems of people in developing countries.

*   *   *   *   *

Health is a right, not a privilege

“Health for all, everywhere”. Simple and linear as it may sound, attaining this is indeed a formidable challenge. Each year 1 billion people can’t afford a doctor, pay for medicines or access other essential care, and another 100 million fall into poverty trying to access it. In Africa and Southeast Asia, for example, nearly a third of households have to borrow money or sell assets to pay for health care.

Taking action to rapidly change this grim reality, on 12 December 2012, the United Nations unanimously endorsed Universal Health Coverage (UHC), declaring that everyone, everywhere, has the right to access the quality health services they need without facing financial hardship. Shortly after, Margaret Chan, Director General of the World Health Organization stated that, “Universal health coverage (is) the single most powerful concept that public health has to offer. It is inclusive. It unifies services and delivers them in a comprehensive and integrated way, based on primary health care.”

Responding to that historic call, a global coalition of more than 500 organizations from over 100 countries is now marking 12 December 2014 as the first-ever UHC Day. Spearheaded by The Rockefeller Foundation and WHO, this coalition is stepping up to reaffirm that health is a right, not a privilege, and that access to quality health care should never depend on where you live, how much money you have or your race, gender or age.

uhc-day-logo-large@2x

Looking ahead, wisely: invest in health!

Making UHC a priority for all nations is not only a matter of justice and human rights. Rather, it could be the cornerstone of the post-2015 sustainable development agenda and a powerful driver of economic growth in low- and middle-income countries (LMICs). Health improvements drove a quarter of full income growth in developing countries between 2000 and 2011. At this rate of return, every US$1 invested in health would produce US$9-US$20 of growth in full income over the next 20 years.

To revisit the case for health investment, an independent commission of 25 renowned economists and global health experts from around the world came together from December 2012 to July 2013. The commission’s report, “Global Health 2035: A World Converging within a Generation”, was published in The Lancet on December 3, 2013 and launched on the same day at events in London, Tunis, and Johannesburg. The report clearly states that there is an enormous payoff from investing in health, and specifically makes the case that:

– the returns on investing in health are even greater than previously estimated;

– within a generation—by 2035—the world could achieve a “grand convergence,” bringing preventable infectious, maternal and child deaths down to universally low levels;

– taxes and subsidies are a powerful and underused lever for curbing non-communicable diseases and injuries;

– progressive universalism, a pathway to UHC that targets the poor from the outset, is an efficient way to achieve health and financial protection. Although some might believe that UHC is costly, studies consistently show that, when well-managed to provide quality care, it delivers better health outcomes at lower costs.

Thus, there is now widespread agreement that health may transform communities, economies and nations. But to tap into such a potential for development, the way that health care is financed and delivered must change, to be more equitable and more effective. Costs must be shared among the entire population through pre-payment and risk-pooling, rather than shouldered by the sick, and access must be based on need and unrelated to ability to pay.

Benefits can be almost immediate. If out-of-pocket spending for health services is eliminated or even reduced, money that families have to spend on health can now be spent on sending a child to school, starting a business or coping with an emergency. More broadly, UHC policies create resilient health systems: in times of distress, they mitigate shocks to people’s lives and livelihoods; in times of calm, they improve a community’s social cohesion and economic productivity.

9858C50C-9161-4C66-9AB3-5C3E6B705163

Adding the COHRED touch

COHRED proudly supports UHC Day. Delivering sustainable solutions to the health and development problems of people living in LMICs will require more than tackling health financing. If the medicines, health workers and health facilities do not exist, for example, it will be impossible to move toward UHC. In other words, strengthening health systems will be the key to ensure health for everyone and everywhere.

COHRED’s strong belief is that research and innovation play a crucial role in speeding up progress towards sustainable solutions to the health and development problems of people in LMICs. Either through enabling developing countries to identify their own national research priorities, or by providing leadership and effective solutions to support countries to build their own research and innovation systems for health and development, COHRED works actively to deliver UHC.

Last year, the WHO’s annual World Health Report was focused on “Research for universal health coverage”, remarking that UHC, with full access to high-quality services for prevention, treatment and financial risk protection, “cannot be achieved without the evidence provided by scientific research”. In the report, several examples of COHRED’s work are cited. These include Health Research Web, a global platform for information and interaction on health research for development, and RHInnO Ethics, a platform for research ethics review management.

Reaffirming its own commitment to contributing to UHC through research and innovation, COHRED is currently seeding the future, by shaping novel groundbreaking initiatives. In April 2015, the COHRED Fairness Index (CFI) will be officially presented in London. CFI is designed to provide an assessment tool to stakeholders to measure and report vital information that reflects their performance with respect to transparency, level of engagement, accountability and equity in their collaborations. The aim is to encourage good practices in North-South health research collaborations, for the benefit of health development and innovation in LMICs. Furthermore, COHRED and its partners are gearing up for the Global Forum on Research and Innovation for Health 2015, “People at the Center of Health Research and Innovation”. Planned for August 2015 in Manila, Philippines, Forum 2015 will bring together all stakeholders who have a part in making research and innovation benefit health, equity and development. Finally on stage as leading role actors of their own future, LMICs will take prime position in defining the global health research agenda that better suits their needs, in presenting solutions and in creating effective partnerships for action.

Universal health coverage is the final destination of a journey the World cannot afford to delay. Many paths lead to that destination. COHRED is making its way with determination and optimism about the impact of its global action.

Anthony Nguyen and Carel IJsselmuiden

Making the case for research and innovation for health in the post-2015 development agenda

In this guest post, Claire Wingfield—product development policy officer at PATH—writes about a new paper exploring why research and development (R&D) of high-priority health tools for diseases and conditions affecting low- and middle-income countries (LMICs) should be a critical component of the post-2015 development agenda.

A dearth of adequate health technologies and interventions targeting poverty-related diseases—like HIV/AIDS, malaria, tuberculosis, and neglected tropical diseases—means that millions of people in LMICs continue to die each year from preventable and treatable diseases and conditions. Progress on developing new interventions targeting the health priorities of LMICs has faltered because these diseases occur almost exclusively among the world’s poorest and most marginalized populations. Thus, there is little or no perceived commercial market encouraging companies to develop products targeting LMICs. Because the health burden imposed by poverty and social vulnerability remains far too high, achieving health for all is one major goal of the post-2015 development agenda.

In a new paper—developed by the Council on Health Research for Development, the Global Health Technologies Coalition, the International AIDS Vaccine Initiative, and PATH—the authors make the case for the inclusion of research and innovation for health as a central component of the post-2015 development agenda. The paper describes the impact that increased investments in R&D and innovation for health—particularly for the world’s poorest—have had in contributing to progress toward achieving the Millennium Development Goals (MDGs)—particularly for MDGs 4 (reduce child mortality), 5 (improve maternal health), and 6 (combat HIV/AIDS, malaria, and other diseases).

Credit: PATH/Gabe Bienczycki
Credit: PATH/Gabe Bienczycki

These investments have helped to create an enabling environment for research in and for the benefit of LMICs by increasing demand for new health technologies, expanding coverage of proven interventions, and strengthening the innovation infrastructure in these countries. Building on the work of The Lancet Commission on Investing in Health—a group of renowned economists and global health experts—the paper discusses the need for increased R&D investments by all countries to achieve the dramatic health gains envisioned in the post-2015 agenda.

Adequate levels of investment, as suggested by The Lancet Commission, are critical for spurring the development of new health tools, provided they align with financing needs in R&D—notably predictability and flexibility. But even that sort of investment alone does not guarantee more products, and it does not drive innovation toward the right type of products—those that are suitable, acceptable, affordable, and accessible to populations most in need. It is essential, therefore, that indicators for R&D for health tools that primarily affect LMICs address a comprehensive set of outcomes including financing needs, infrastructure and human resources needs, enabling policies, necessary partnerships, capacity strengthening, and access requirements.

Because poor health and disability contribute substantially to poverty, research and innovation for health is linked to improving economic prosperity and is critical to eradicating poverty. Therefore, it must be continuously prioritized within the post-2015 development agenda. Ultimately, the success or failure of the post-2015 agenda relies just as much on how the goals and targets are implemented as it does on how progress will be measured. Thus any research and innovation indicators measuring progress against the goals and targets outlined in the post-2015 agenda must also increase accountability of researchers, governments, and funders, and inform research processes. Inclusion of research and innovation for health must facilitate an enabling environment for research and innovation in LMICs and encourage endemic countries to set and pursue a domestically-driven health research agenda.

Credit: PATH/Evelyn Hockstein
Credit: PATH/Evelyn Hockstein

The post-2015 development agenda is an opportunity for LMICs to set their own health agendas and research priorities and to assert their leadership in strengthening the R&D landscape focused on the needs of the poorest and most marginalized populations. Therefore, it is essential that there is broad agreement among all of the relevant stakeholders that research and innovation for health—which includes the scaling up of proven health interventions as well as the development of new and improved high-priority health technologies—is critical to meeting the ambitious goals of eradicating poverty and ensuring sustainable development for all within a generation.

In support of the inclusion of research and innovation for health in the post-2015 agenda, over 150 organizations and individuals recently signed a petition to United Nations (UN) Secretary General Ban Ki-moon and Member States urging the UN to keep the research, development, and delivery of new and improved health tools for diseases and conditions impacting LMICs at the heart of the post-2015 development agenda. It is our hope that the Members States and other UN officials shaping the agenda will head this call.

Claire Wingfield (PATH)

 

Note: From the September issue of TDR news: “We are making good progress in a number of key initiatives with partners. For example, we’ve worked with COHRED, the Council on Health Research for Development, to develop a new internet platform that lists training opportunities and other important research management information in West Africa. West Africa Health Research Web (WAHRWeb) is a database and an announcement platform for research capacity training opportunities like ethics, grant writing, and clinical trials management for the 15 countries of the West African Health Organization (WAHO).”

Ebola virus outbreak: building national research capacity is key to prevention

*   *   *   *   *

SPEED READ #

– The worst outbreak of Ebola virus disease ever is causing havoc in West Africa, with death toll exceeding a thousand people. Accounting for the potential further spreading of the disease and its high mortality rate (55-60% in this outbreak), WHO declared the outbreak a “public health emergency of international concern”.

– Certainly not a top global health priority before, Ebola has been largely ignored, with no investment in research or treatment really made, despite the fact that it has been around for some 40 years.

– The only sustainable long way out is the development of local research and innovation systems for health, in the framework of global research partnership. The Council on Health Research for Development (COHRED) wants to call to action African countries to step up to the ‘research and innovation table’ by developing their own capacity, build funding lines for health research and innovation, and begin regional and international collaboration on the basis of their own priorities. This will help prevent not only Ebola, but also many other conditions prevalent in low- and middle-income countries that are not priorities in ‘Global Health’, therefore do not really attract attention and funding, and so will need to be covered by countries themselves.

# see Notes at the end of post for updates and further information 

*   *   *   *   *

Ebola strikes back

The worst outbreak of Ebola virus disease since the first appearance of this foe in 1976 in the Democratic Republic of Congo and in Sudan, is currently on stage. At the time of this writing, some 3069 suspect cases with 1552 deaths have been reported by the World Health Organization (WHO), of which 1752 cases and 897 deaths have been laboratory confirmed to be Ebola. First hitting the remote south-eastern forest region of Guéckédou in Guinea at the end of last year, it did not take much for the infection to spread to Guinea’s capital Conakry and then to neighbouring Liberia and Sierra Leone. More recently, Nigeria has also reported several suspect cases and at least six deaths, and infected people leaving the epicentre area have travelled as far as Saudi Arabia, Spain, Turkey and the United States. Accounting for the potential further spreading of the disease and its high mortality rate (55-60% in this outbreak), on 8 August 2014 WHO declared the outbreak a “public health emergency of international concern.

Although it has been around for some 40 years now, not much is known about Ebola virus, its origin, ecology, and transmission. Evidence has accumulated suggesting that fruit bats are the likely natural reservoir for Ebola virus, but humans can become infected upon close contact with a number of other animals, including chimpanzees and monkeys. Human-to-human transmission occurs from direct contact with the blood, secretions, organs or other bodily fluids of infected people, and indirect contact with environments contaminated with such fluids. There is currently no specific treatment to cure the disease, although several drugs are under development. Patients are (or should be) kept in isolation and given intensive supportive care.

2014 Ebola outbreak in West Africa. The putative first virus introduction and epicenter are in the vicinity of the town of Guéckédou in the Guinea southeastern forest region. Source: Centers for Disease Control and Prevention
2014 Ebola outbreak in West Africa. The putative first virus introduction and epicenter are in the vicinity of the town of Guéckédou in the Guinea southeastern forest region. Source: Centers for Disease Control and Prevention

Research is key to prevention

“The precise factors that result in an Ebola virus outbreak remain unknown, but a broad examination of the complex and interwoven ecology and socioeconomics may help us better understand what has already happened and be on the lookout for what might happen next, including determining regions and populations at risk,” recently wrote Daniel Bausch and Lara Schwarz in a PLoS Neglected Tropical Diseases’ editorial. “Although the focus is often on the rapidity and efficacy of the short-term international response, attention to these admittedly challenging underlying factors will be required for long-term prevention and control,” these authors continued.

Most likely, the relationship between Ebola and underdevelopment has played a major role in the outbreak emergence. Although rich in natural resources, Guinea is one of the poorest countries in the world, and precarious living conditions might well have caused people in search of food and wood in the forest to come into contact with infected animals, favouring viral spillover. The effect of environmental change on Ebola outbreak in West Africa and disease dynamics is another obscure issue. “So intriguing puzzles remain. Untangling these – through research that combines environmental, epidemiological, virological, veterinary, and social science with local knowledge – will be key to predicting and preventing future outbreaks of Ebola – in this and other regions,” remarked Melissa Leach.

So, consensus is growing around a pivotal point: research is needed in order to prevent even more devastating Ebola outbreaks in the future. And the Ebola story that is hitting worldwide headlines nowadays might serve as a paradigm for many other conditions prevalent in low- and middle-income countries (LMICs), but that in a shrinking world might rapidly become of international concern. Ebola has been largely ignored, with no investment in research or treatment really made, because a few hundred cases in a tropical country are not enough to end up on the ‘global health priority’ list. On the other hand, the failing status of health system in the outbreak region has been known and described for many years. In other words, nothing is new in this outbreak other than its magnitude and spread beyond West Africa.

What is the long way out? The answer lies in the development of local research and innovation systems for health, in the framework of global research partnership. Building national research capacity in LMICs will help improve health systems–not only for Ebola, but for a number of other ailments that are, or might become tomorrow, ‘under the radar’ globally speaking–through health systems research. Strengthening health systems in LMICs will also help to address questions that are locally relevant but do not show up in global ‘burden of disease’ statistics, possibly tapping into local knowledge and experiences, as suggested for Ebola. Finally, this approach can create innovative environments for global health because new researchers, new innovators, new business get active in global health research and innovation, attracting investments and spurring international collaborations.

ebola-guinea-data

A call to action

COHRED expresses the deepest condolences to all who lost family and friends, and countries who lost citizens to a neglected disease that has caused epidemics since four decades.

 COHRED’s work is totally relevant to the future prevention of this condition, both in terms of building national capacity in this region for ‘health systems research’ and in terms of making sure that countries for whom this is a priority will actually treat it like a research priority, unlike the rest of the world who pays attention because it now spreads outside a well-contained area. In the medium-to-long term, developing such research capacity can potentially lead to innovation capacity, in which solutions to priority problems come from the countries where the priorities are.

While Ebola virus is now under the spotlight, COHRED wants to call to action African countries (and other LMICs) to step up to the ‘research and innovation table’ by developing their own capacity, build funding lines for health research and innovation, and begin regional (and international) collaboration on the basis of their own priorities. Looking beyond the immediate horizon and, say, Ebola, this effort must comprise all major reasons for morbidity and mortality in LMICs, most of which are not priorities in ‘Global Health’, therefore do not really attract attention and funding, and so will need to be covered by countries themselves.

This is where COHRED can add value, with our ‘technical support’, ‘practical tools’, and ‘global action’ that support LMICs to build their own research and innovation systems for health, aiming at locally relevant, sustainable systems, not only to fight Ebola, but to tackle all health problems facing countries.

Carel IJsselmuiden and Gerald Keusch

 

Note: The devastating Ebola outbreak has been recently featured in the September issue of TDR news.

Note: “There’s never been a big market for Ebola vaccines,”…..that’s why  Ebola Vaccine, Ready for Test, Sat on the Shelf…..until now!

Note: Since the appearance of our post on the necessity of fighting Ebola by building national health research capacity, others have shared this view in the ongoing public debate. Here follows what recently expressed on the topic by South Africa Science and Technology Minister Naledi Pandor (the original press release can be found here):

Urgent need to build research capacity in Africa

20-10-2014

Pretoria – Science and Technology Minister Naledi Pandor says the Ebola outbreak in West Africa has illustrated the urgent need to accelerate focused investment in research in Africa.

This as the world is grappling with containing the virus that is devastating West Africa, with a death toll standing at over 4 000 currently. Most of the victims are in Guinea, Liberia and Sierra Leone.

Speaking at the European Organization for Nuclear Research (CERN) celebration of 60 years of peace and development in New York on Monday, Minister Pandor said science has been a significant contributor to social development in many parts of the world, citing breakthroughs to eradicate diseases such as polio and smallpox as a result of drug and vaccine development. 

“It is imperative for Africa’s scientists to work in Africa if they are to support development on the continent, if they are to play a role in smooth technology transfer and if they are to drive innovation,” the Minister said, citing the example of the Square Kilometre Array, which was resulting in brain gain for Africa for the first time in four decades.

Sub-Saharan Africa contributes about 2.3 percent of world’s Gross Domestic Product, but is responsible for only 0.4 percent of global expenditure on research and development. With 13.4 percent of the world’s population, it is home to only 1.1 percent of the world’s scientific researchers. 

Minister Pandor said it was thus logical to propose that focused, well-designed investment in science and innovation could offer Africa new opportunities for development in a range of sectors, as African countries were the major consumers of products of advanced scientific discovery.  

“Building world-class research infrastructure was one of the pillars for building competitive, knowledge-based activities to attract the best human capital resources,” she said. 

The Minister added that she was pleased by the significant contribution CERN had made to increasing world knowledge in new areas of scientific research.  

“We are pleased that several African countries have scientists who have participated in the Large Hadron Collider (LHC) research initiatives and we congratulate the leadership of CERN, who have been true world scientists seeking to attract scholars from the global community to the LHC,” she said. 

The CERN event celebrates the values of science and promotes the role of science in international debates and decision-making, and it actively supports science, technology, engineering and mathematics education.

Other speakers included Ban Ki-moon (UN Secretary-General), Prof. Carlo Rubbia (Nobel Physics Prize winner and former Director-General of CERN) and Kofi Annan (Nobel Peace Prize winner and former UN Secretary-General).

Research for Health must stay at the heart of the post-2015 Sustainable Development Framework

*   *   *   *   *

SPEED READ

– Work on outlining the post-2015 development agenda is coming to an end. The UN 68th General Assembly will meet in New York in September to define a set of Sustainable Development Goals (SDGs).

– “Ensure healthy lives and promote well-being for all at all ages,” reads proposed SDG 3. However, where does research for health stand in the new framework’s draft?

– To make sure that research, development, and delivery of new and improved health tools are kept at the heart of the post-2015 development agenda, the Council on Health Research for Development (COHRED) teamed up with the Global Health Technologies Coalition (GHTC) and the International AIDS Vaccine Initiative (IAVI) to address an appeal to Secretary General Ban Ki-Moon and Member States of the UN.

*   *   *   *   *

Looking beyond 2015

While the current Millennium Development Goals expire next year, work on outlining the post-2015 development agenda is brewing up. The UN 68th General Assembly will meet in New York in September to define a set of Sustainable Development Goals (SDGs) to focus on in the 15 years to come. The new “Sustainable Development Framework 2015-2030” is the result of a lengthy process. In particular, the proposal on SDGs was prepared by a 30-member Open Working Group (OWG), established under mandate by the Rio+20 Outcome document in June 2012. The OWG final report lays out some 169 targets spread across 17 SDGs that range from ending poverty in all its forms everywhere to strengthening the means of implementation and revitalize the global partnership for sustainable development.

Despite the considerable efforts deployed so far and the undeniable progress done in the process of arriving at this new post-2015 framework, however, many observers fear that to ensure “healthy lives at all ages”, one of the key goals currently envisioned in the development framework, a more explicit and full support to health research and related policies and capacity building will be needed in the final discussion.

To make sure that research, development, and delivery of new and improved health tools are kept at the heart of the post-2015 development agenda, COHRED teamed up with GHTC and IAVI to address an appeal to Secretary General Ban Ki-Moon and Member States of the UN.

imagemain400_634

The appeal

We, the below signatory organizations request that the UN fully supports in the post-2015 SDG-Framework the research, development, and delivery of new and improved medicines, vaccines, and other health tools for the diseases and health conditions that predominantly affect low- and middle-income countries as well as marginalized, vulnerable populations globally.

Thanks to the leadership of the UN and investments by Member States, the current Millennium Development Goals have made major contributions to improving the health and lives of millions of people around the world. A sustained focus on some of the greatest global health challenges has led to enormous progress in many areas, including significant improvements in the development and delivery of health tools such as drugs to treat HIV/AIDS, tuberculosis (TB) and malaria. Efforts to tackle diseases have also helped underpin progress in other important areas, such as gender equality, child mortality, and maternal health. Millions of lives have been saved.

However, major challenges remain, and the health burden imposed by poverty remains far too high. In this context, it is essential that the post-2015 development agenda retains a strong focus on eliminating poverty-related diseases and conditions. The post-2015 agenda must build on previous achievements to ensure that healthy lives and access to health services can be achieved in an equitable and sustainable way, leaving no one behind. This means ensuring universal access to proven health interventions. But it also means developing and delivering new health technologies which can help address the shortcomings of existing interventions and sustainably reduce morbidity and mortality over the longer term. This will require continued support for the research, development, and delivery of new tools to combat major epidemics like HIV/AIDS, TB, and malaria, as well as other poverty-related diseases and conditions ranging from neglected tropical diseases to reproductive, maternal, and child health. Continuous investment of human and financial resources in science, technology, and innovation is essential to achieve both economic and social development for all.

We are encouraged by the current inclusion of the need to support the development of new medicines and vaccines for diseases particularly affecting developing countries in the Zero Draft document of the Sustainable Development Goals. Concern remains, however, about the omission of medical devices and diagnostics which also contribute to improving health outcomes, the lack of clarity on how this effort will be funded, and how supporting policies, incentives, capacity building, collaboration, and knowledge and technology sharing will be defined and implemented.

As organizations working to save lives and improve health, we urge you to commit explicit and full support to health research and related policies and capacity building as a core component of a new, post-2015 agenda for equitable health and sustainable development for all. We ask that you press Member States to offer similar support, and to formally assess how to measure progress towards this goal, and how to fully and sustainably finance and enable the research, development, and delivery of essential new and improved health tools.

PATHMVI

A bigger role for science

It is not only the commitment to research for health that needs to be reinforced. Apparently, the recommended SDGs contain several other science-related issues that require attention. According to a recent SciDev.Net article, “[m]any of the quantified targets based on scientific evidence that appeared in earlier documents that laid out the SDGs have been replaced by blanks or removed entirely in the final document”. In other words, science experts fear that by approving a final resolution with vaguely indicated targets will permit politicians to adjust following efforts on the basis of economic convenience rather than scientific evidence. “For example, in April, possible climate change targets included an explicit two degrees Celsius limit, and dates for when carbon emissions should be arrested and reduced. The current outcome document is silent on these issues,” continues the SciDev.Net article.

 Carel IJsselmuiden

Health Research for All: the role of innovation in Global Health in the post-2015 development framework

*   *   *   *   *

SPEED READ

– The Council on Health Research for Development (COHRED), along with the Global Health Council (GHC), the Drugs for Neglected Diseases initiative (DNDi), the International AIDS Vaccine Initiative (IAVI), and the Global Health Technologies Coalition (GHTC) hosted an official nongovernmental organization (NGO) side session at the 67th annual World Health Assembly (WHA) to explore the role of R&D in the post-2015 development agenda.

– The event organizers developed a statement urging MemberStates and delegates to support health research and related policies and capacity building as a core component of a post-2015 agenda for equitable health and sustainable development.

–  WHA Member States approved a resolution on health in the post-2015 development agenda that called for completing the unfinished work of the health Millennium Development Goals (MDGs) and noted the importance of universal health coverage and stronger health systems.

*   *   *   *   *

The eight MDGs have been a milestone in global health and national development efforts, focusing concerted action on crucial themes such as halting the spread of HIV/AIDS, reducing child mortality and improving maternal health. However, as the final deadline of 2015 is rapidly approaching, it is evident that progress on the selected goals has been uneven within and across countries. Thus, further efforts and a renovated, stronger-than-ever global partnership is needed to arrive at a global development agenda beyond 2015.

COHRED, GHC, DNDi, IAVI, and the GHTC organized a side event focused on the critical role of global health research, development and innovation (R,D&I) in accelerating and sustaining progress in global health within the post-2015 development framework at the 67th annual WHA held May 18-24th 2014 in Geneva, Switzerland.

dsc_9068

Panelists included representatives from Kenya and Senegal member states as well as high-, low-, and middle-income country stakeholders from both public and private sectors: Dr. Seth Berkely, CEO of the GAVI alliance, Dr. Christine Sow, Executive Director of the GHC, Mr. Jon Pender, VP government affairs of GlaxoSmithKline, Prof. Osman Sankoh, CEO of the INDEPTH Network, Mr. Rob Terry, Manager of Knowledge Management at TDR and Prof. Carel IJsselmuiden, CEO of COHRED.

All the panelists stressed the importance of R,D&I for health and sustainable development. Rob Terry began his talk with a quote from Mary Lasker: “If you think research is expensive, try disease.” He then explained how the Global Health Observatory shall contribute in covering the current gaps in information on research activities in low- and middle-income countries (LMIC). Prof. Osman Sankoh, as spokesman of the INDEPTH network of 42 health and demographic surveillance systems in 20 LMICs, underscored the need for robust data on individual level to guide policymaking. Mr. Jon Pender said that the public private partnerships approach had delivered for global health and that health should remain a priority in the post-2015 agenda.  “Advocates have a job to do to ensure health is a priority in the post-MDG agenda where there will be 16 goals,” remarked IAVI in a tweet.

Both Kenya and Senegal representatives insisted on the need for new innovative health tools, higher national and international funding for R,D&I, as well as partnerships with the private sector. Principal Secretary of Health, Prof. Fred Segor said in Kenya the new 2013 S,T&I (Science, Technology and Innovation) Act pledged 2% of GDP to the national research fund. Seth Berkley said that equal health across the world cannot be achieved without new health tools and called for a truly global scientific movement to tackle effectively the challenges of R&D financing and capacity building.

Untitled

“GHC and its membership are collectively tasked with moving the needle in the direction we see for the future of global health. This means supporting evidence-based policy change and the operational elements that will mean its success. The World Health Assembly is a unique venue providing a platform for multi-sectoral, multi-issue engagement; the strength and profile of GHC’s membership means that our role can only increase over time. Going forward, we will be sure to optimize the collective impact of our actions and voices,” stated Christine Sow, Executive Director of the GHC, in a related blog post.

Reporting and commenting on the news on research and innovation as emerged from the WHA, GHTC’s coalition director Kaitlin Christenson wrote: “Early in the week, Member States also passed a resolution calling for new tuberculosis (TB) targets, which should be reflected in the post-2015 development agenda. The resolution specifically calls for a 95 percent reduction in deaths from TB by 2035 and notes research and innovation as one of three key pillars that will help achieve this goal.”

Prof. Carel IJsselmuiden, COHRED CEO and chairman of the session, ended the meeting with the following statement developed by the organizing NGOs, urging MemberStates and Delegates to support health research and innovation policies as a core component of the post-2015 agenda to achieve health and sustainable development for all:

 Statement on the role of Research and Innovation to Achieve Health for All and Sustainable Development

 67th World Health Assembly, Geneva, 22 May 2014

 Commitments to the Millennium Development Goals have made a major contribution to the success of global health efforts over the past decade, helping to sustain focus on some of the greatest global health challenges. The post-2015 development agenda must build on these achievements, to ensure that Healthy lives and access to health services for all can be achieved in an equitable and sustainable way.

Achieving equitable and sustainable Health for all requires continued support for Research and Development for new or improved medicines, vaccines, diagnostics, devices and other health tools that work for and are accessible to those most in need. Continuous investment of human and financial resources in science, technology and innovation to improve health and equity is essential to achieve economic and social development.

Strong political leadership, as well as international and multi-sectoral collaboration will be needed for achieving innovations in health care and delivery. In particular, we need policies, incentives and sustainable financing to fully support research and development of affordable and accessible vaccines, medicines, diagnostics, devices and other health tools for diseases that mostly affect low- and middle-income countries and/or marginalized populations. And we need a commitment to the development and implementation of policies that facilitate capacity building, collaboration and knowledge and technology sharing.

We urge Member States and Delegates at the World Health Assembly to explicitly support health research and related policies and capacity building as a core component of a new Agenda for equitable health and sustainable development.

By the end of the week, WHA Member States had approved a resolution on health in the post-2015 development agenda that called for completing the unfinished work of the health MDGs and noted the importance of universal health coverage and stronger health systems.

Golbahar Pahlavan (COHRED)

Tackling health inequalities: the MASCOT vision

*   *   *   *   *

SPEED READ

– Health inequalities are still affecting women and children in many areas of the word. The MASCOT project aimed at enhancing understanding and dissemination of strategies for addressing these inequalities through international co-operation.

– MASCOT brought together 11 partners and 3 world regions (Europe, Africa, and Latin America) to work towards selected targets. These included mapping the current status of maternal and child health inequalities in selected countries, identifying the best practices that should be implemented for tackling inequalities, and fostering multilateral collaboration and knowledge transfer.

– Among the many results/outcomes produced, an open source, freely searchable webDatabase has been developed that covers research on maternal health in low- middle- and high-income countries.

*   *   *   *   *

Health equity for the vulnerable ones

Building a better future for women and children is a universal must. Yet, in many countries, notably low- and middle-income countries (LMIC), inequalities in maternal, newborn, and child health interventions are a persistent reality, and progress towards the achievement of Millennium Development Goals (MDGs) 4 (reduce child mortality) and 5 (improve maternal health) remarkably slow. While some countries have made advances, these advances remain unknown to other countries which could still benefit from their experience.

The firm belief that international collaboration can help addressing health inequalities was the starting point for MASCOT (“Multilateral Association for Studying Health Inequalities and Enhancing North-South and South-South Cooperation”), a project that took place between October 2011 and March 2014 and was supported by the European Union’s Seventh Framework Programme. Co-ordinated by COHRED (Council on Health Research for Development), MASCOT gathered 11 partners and a number of experts from Africa, Latin America and Europe, to identify research being conducted on maternal and child health, and adequate and efficient strategies for tackling health inequalities affecting children, adolescents and mothers. This was in perfect line with COHRED’s focus on supporting research and innovation systems for health, equity and development.

In a nutshell, MASCOT aimed to create links between North-South and South-South efforts in addressing maternal and child health (MCH) and health inequalities, and to provide research-based evidence on best practice and policy advice for the development of future public health and health systems interventions.

brochure_cover

MASCOT at work

Reduce health inequalities, enhance efficiency of national health research systems (NHRS), enhance collaboration. This was the pole star of MASCOT action. Around these guiding objectives, the work was organized as work-packages intending to reach 6 specific targets:

• To select relevant countries for the studies and to standardise the procedures.

• To describe inequalities concerning MCH as well as strategies and activities currently put into practice to reduce these inequalities at national scale.

• To describe NHRS and detect dedicated projects and research teams working on MCH inequalities.

• To identify the best practices and evaluate their roles in the development of measures (policies or recommendations) that are and/or that should be implemented for tackling MCH inequalities.

• To develop and suggest country-specific strategies derived from best practices and best policy advice for strengthening NHRS, the use of research results for decision-making and the capacity to address MCH inequalities.

• To implement specific activities to stimulate the multi-lateral collaboration between countries and institutions in Africa, Latin America and Europe, enabling countries to make better use of research in addressing health inequalities in maternal and child health.

mascot_banner_201204021

Seeding the future now

MASCOT has developed a variety of results/outcomes that will be extremely useful for health professionals and other stakeholders working in the maternal and child health area. Much of the value of these results will become manifest in the future, as the guidelines and recommendations developed under the MASCOT vision will be applied and implemented.

Both national and regional reports were drafted, presenting the results of investigation on health inequality status, national research for health systems and their role in MCH research, and the impact of health research on development of policies and programmes.

An online platform to access MCH data collected from different sources and gathered, selected and analyzed through the MASCOT project has been put in place. This decision-support tool includes analyses of MCH inequalities gaps by country according to selected health indicators and PROGRESS categories (indicators of the social determinants of health), qualitative data on health research systems and MCH research by country, and qualitative data on research use strategies for tackling MCH inequalities by country. The following countries are included in the platform: Ghana, Guinea Bissau, Malawi, Mozambique, Tunisia, Bolivia, Chile, Costa Rica, Mexico.

Promoting the contact and knowledge transfer regarding MCH strategies between countries was one of the declared MASCOT objectives. Collaboration activities between Ghana and Mozambique and Costa Rica and Guatemala were supported and fostered under this framework. Ghana learned from Mozambique’s policy and experience with Maternity Waiting Homes as an effective approach to provide women the same access to quality and in-time basic and emergency obstetric care services. Costa Rica drew out key elements from ‘Hospitals without Walls’, an integrated health care strategy based on the provision of prevention, promotion and care with a community access and empowerment component, to assist Guatemala in their efforts to combat infant malnutrition.

 Another tangible result of MASCOT is the webDatabase on maternal health in low- middle- and high-income countries. The product of a systematic mapping of the maternal health primary research and systematic reviews published in the period 2000-2012, the database stems from a collaboration between partners in the MASCOT and WOTRO projects, from more than a dozen countries. The database includes research that examines maternal health interventional research in LMIC, dealing with health systems interventions, interventions in community settings, health promotion interventions, and interventions on five tracer clinical conditions (antepartum and postpartum haemorrhage, HIV and other sexually transmitted infections, hypertension and malaria). Also, research on maternal health interventions in high-income countries that occurred outside the health facility is included.

The webDatabase is open source and supports a variety of functions. Users can run searches and make reports. Searches can be carried out using key words and free-text terms. Reports enable visual mapping and analysis of the search results. Reports on the database work as “question” reports, whereby one can select a ‘parent’ code, such as HIV codes, and the results will give all the studies included on that topic.

COHRED was proud to co-ordinate this project, serving as it did as a clear reminder that the desire to address the gaps in maternal and child health outcomes between groups in society cuts across borders. This is a fantastic opportunity to give a heartfelt thanks to not only the European Commission for supporting this initiative, but also to all of our partners in this effort. The collaborative effort in the project was strong, and we believe that the outputs will continue serve as useful tools for researchers and policy makers in the future as they seek to identify and implement strategies to address the maternal and child health inequalities in their countries. 

Danny Edwards (Mascot Project Coordinator)

Forum 2015: People at the center of research and innovation for health

*   *   *   *   *

SPEED READ

– The Global Forum for Research and Innovation for Health is the successor of the Global Forum for Health Research that merged with the Council on Health Research for Development (COHRED) in 2011. Forum 2015, as it will be abbreviated, will provide an opportunity for everyone interested in pursuing global health, equity and development to meet, exchange information, find partners, design solutions and set research and innovation agendas – nationally, regionally and globally.

– Forum 2015 will be jointly hosted by the Department of Science & Technology and the Department of Health of the Philippines and COHRED in Manila, Philippines, 25-27 August 2015.

– Investment in health and in research and innovation for health is a key element for sustainable economic development. Strengthening national health research and innovation capacity and optimizing research and innovation systems will increasingly enable low and middle income countries, institutions and business to participate in setting a shared global health agenda and solve shared problems.

*   *   *   *   *

Towards a new Forum

Secretary Mario G. Montejo of the Department of Science and Technology (DOST) and COHRED signed the agreement for the Philippines to host the Global Forum for Research and Innovation for Health 2015 in Manila last 14 March 2014 during the 32nd Anniversary of the Philippine Council for Health Research and Development at Makati City, Philippines. [1]

The 2015 edition of the Global Forum will see the completion of a major transformation: from a platform focused on redistributing research resources from ‘North’ to ‘South’ as in ‘closing the 10/90 Gap’ towards a new Forum, that will emphasize the new global reality of the greatly increased capacity, funding and potential of low- and middle-income countries themselves in terms of research and innovation for health. Instead of being an advocacy platform for high-income countries to spend more on the problems of low- and middle-income countries, the new Forum will speak to the growing ability and assertiveness of low- and middle-income countries to be active partners in setting local, regional and global research agendas for health – and to their rapidly increasing ability and willingness to contribute to solving problems of both global and local relevance and reap the scientific, health and developmental benefits from doing so. An example of this is that the new Forum is no longer ‘donor-funded’ – but host countries contribute up to a third or more of all costs.

The new Forum will remain a place like no others, where governments, industry, non-profits, health sector organisations, science bodies, researchers and development experts – and you – can think, talk, meet, focus, design on improving health, equity and development, sustainably, through research and innovation.

“The strong participation of institutions from the North will signal a shift in the North-South relationship from donor to partner, made possible by the growing and maturing R&D capacity in the region and in the Philippines, blurring the borders that previously existed between North and South research institutions,” said Gerald Keusch, at the Schools of Medicine and Public Health, Boston University (MA, USA), and member of the COHRED Board. “I anticipate an exceptional meeting and many new scientific relationships developing as a result, both North-South and South-South, in support of their common goals to improve health, equity and development in low and middle income countries through the creation of strong national research and innovation systems.”

Secretary Mario G. Montejo of the Department of Science and Technology (left) and Prof. Carel IJsselmuiden of the Council on Health Research for Development (COHRED) (right) during the signing of  the Agreement for hosting the Global Forum for Health Research 2015 in Manila. Credit: Philippine Council for Health Research and Development
Secretary Mario G. Montejo of the Department of Science and Technology (left) and Prof. Carel IJsselmuiden of the Council on Health Research for Development (COHRED) (right) during the signing of the Agreement for hosting the Global Forum for Health Research 2015 in Manila. Credit: Philippine Council for Health Research and Development

“The Philippine National Health Research System (PNHRS) is a community-in-progress. In the first decade of its existence, the different stakeholders across all sectors of Philippine society interacted and worked together to develop a unified research agenda, implemented this agenda based on available resources, and built human capacity and support systems,” said Jaime C. Montoya, Executive Director of the Philippine Council on Health Research and Development. “Our country is investing more and more in health research. With increasing investments in health research, the need for a bigger pool of health research human resource, research facilities and support systems cannot be overemphasized. Research resources are important, not only for projects, but for people who will do the research, and translate the findings into health benefits that people can enjoy and confidently attribute to research.”

A strong regional flavor

“The agreement to host the Global Forum in Manila represents a landmark for the two partners, to look forward to expanding and developing health for research and innovation capacity in the Asian region in general, and in the Philippines in particular. The opportunities for regional networking this meeting will present are exceptional,” said Keusch.

Indeed, one of the declared objectives of Forum 2015 is to encourage diplomacy to create a regional approach to research and innovation for health as key factors of development. In 2015, Manila will also be host to the APEC meeting, and this year will be historic for the 10 ASEAN countries and beyond, as another major step on the road to ASEAN harmonization will be signed.  The ASEAN region has witnessed one of the strongest economic growth rates in the world in recent times, but this has not yet translated in a comparable development of science, technology and innovations for health. The explicit purpose, therefore, is to tap into the strong regional network of universities, research institutions, business, NGOs, media and more to let health research and innovation start serving everyone, both in the Philippines and other countries in the region.

Credit: Philippine Council for Health Research and Development
Credit: Philippine Council for Health Research and Development

“Global Forum 2015 in Manila will bring in a new level of recognition for Manila and the Philippines as an event venue for health research. In the process, the Philippine health research and innovation community will benefit through the exchange of expertise and information between and among international partners,” said Montoya. “Global Forum 2015 is an umbrella of many events, converging in August 2015, and spilling beyond the conference dates. We hope to bring a distinctly Philippine flavor to this global event, introducing new ways of engaging peoples of the world to the theme: People at the center of research and innovation for health.”

Watch this space for more information – but only after you have booked the dates : 25-27 August 2015! See you there.

Carel IJsselmuiden

[1] (see also: http://www.pchrd.dost.gov.ph/index.php/2012-05-23-07-46-36/2012-05-24-00-01-11/6656-dost-cohred-sign-agreement-for-philippine-hosting-of-global-forum-2015-in-manila)

Science for health diplomacy: complex problems need complex solutions

*   *   *   *   *

SPEED READ

– Almost any major problem in global health – from discovering new drugs to developing vaccines, to finding solutions to environmental changes that can affect health in vulnerable countries – requires research and innovation solutions that are beyond the scope of individual countries, organisation, or companies

– In the case of research and innovation for health, there are few, if any, functional platforms where multiple players can negotiate towards creating constructive solutions, or share global resources better. That is where COHRED wants to play a role

– Following the merger with the Global Forum for Health Research, COHRED will develop its ‘Global Action’ or ‘Science for Health Diplomacy’ arm to generate national, regional or global agreements or agreements involving a complex array of partners, enabling sustainable and usually complex solutions for complex global health problems

*   *   *   *   *

An interdependent world

Global health diplomacy is a relatively new concept, that can be loosely defined as “the processes by which government, multilateral and civil society actors attempt to position health in foreign policy negotiations and to create new forms of global health governance”. Or, to go with the words of the World Health Organization, “[g]lobal health diplomacy brings together the disciplines of public health, international affairs, management, law and economics and focuses on negotiations that shape and manage the global policy environment for health. The relationship between health, foreign policy and trade is at the cutting edge of global health diplomacy”.

Besides the ‘foreign policy and trade’ nuances, the reality is that almost anything that is relevant to major problems in global health – from discovering new drugs to developing vaccines, to finding solutions to environmental changes that can affect health in vulnerable countries – requires resources that are beyond the scope of individual countries, organisation, or companies.

Yet, there are currently very few platforms that can bring the many actors together in ways that lead to rapid and comprehensive research and innovation to the increasingly complex problems in global health. While there are successful examples, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, the GAVI Alliance, or IAVI, these represent mostly once-off efforts that can not be easily replicated to deal with the research and innovation needs in global health. In fact, we see no such platforms anywhere. Just think about the research and innovation challenges raised by drugs for neglected diseases, new vaccine development, genomic research to improve health in low-income countries, innovation required to deal with food security in Africa before climate change causes a permanent disaster, and more. Where can we combine the experts in ‘big data’ collation and analysis together with governments of low-income countries? How can the research capacity in private health care industry be made available to improve public health services? To name just a few examples.

Credit: European Business Review
Credit: The European Business Review

A role for COHRED?

That is where COHRED is aiming to locate its ‘Global Action’ work that follows our merger with the previous Global Forum for Health Research. We aim to play a role, driving the development of a much-needed platform for low- and middle-income countries to help set more strongly the global health and health research agenda and start featuring what they can contribute to it, as opposed to the past, with the agenda being mostly set by donors from the north.

Think about Africa for a moment. If Africa, politically speaking, would be able to portray itself as a continent of a billion consumers instead of “54 problem countries with a one or two stars” – and if COHRED can contribute to this in the field of research and innovation for health, we can literally turn another page in dealing with global health. If this platform would enable African players to find practical solutions, for example in pharmaceutical production, we can support this new look of Africa. Let us say that we can do a rational ‘division’ of research and innovation – South Africa to focus on HIV/AIDS research and pharmaceutical production, Kenya could take on tuberculosis, Tunisia could take on to high-tech drugs for non-communicable diseases, and so on.

The same can of course apply to other parts of the world. A major middle-income country, like the Philippines, could for example bring together ASEAN countries to think about how research and innovation can support the regional efforts and how it can help set and contribute to the global agenda for research and innovation for health. But in the absence of a reliable platform in which these countries can negotiate, even at the sub-regional level, it is going to be complex to talk about a shared research health agenda or a specific disease to tackle.

Recently, COHRED was officially invited to attend the 32nd anniversary celebration of the Philippine Council for Health Research and Development (PCHRD) in Manila, in March. PCHRD is a forward-looking, partnership-based national body responsible for coordinating and monitoring research activities in the Philippines. Given the number and severity of the natural disasters that struck the archipelago in the past years – including typhoons, floods, earthquakes, the latest one being typhoon Haiyan, that last November exacted a deadly toll of over 6000 people in the country – this year’s anniversary theme will be “The Filipino Resilience in Crises: Connecting Health R&D and Emergency Health Management”. Needless to say, apart from economic, social and environmental implications, these events also have important impact on the well-being and health status of large sectors of society. The celebration will also offer the opportunity to sign the agreement on delivery of the next Global Forum for Health Research meeting – in its new outlook – with the Ministry of Science & Technology of the Philippines. The previous Forum was held in 2012 in Cape Town, South Africa.

Philippine Council for Health Research and Development
Credit: Philippine Council for Health Research and Development

Forum meetings, Colloquia meetings. Although different in size, targeted topics, and audience, both are instrumental to the attempt to help build bridges, so that we can use the capabilities of countries, financiers and institutions to bring them together around solutions. At the inter-regional and continental level there are many issues that can be sorted out, in term of science and technology, and require a place where people can meet and talk and come up with solutions. “Meetings, and the successful execution of them, have become unfairly undervalued in my view. Important progress can be made on difficult global health issues, both in front and behind the scenes at well designed gatherings. Well structured, planned events  give people who don’t usually interact the chance to meet,” said Danny Edwards, Manager at COHRED Think, a Unit within COHRED that combines ideas, insights and intelligence to find innovative solutions to challenges and answers to opportunities that make research and innovation work even better. “The meetings we have held at COHRED strive to make these sort of productive interactions possible. We’ve emphasised an informal atmosphere, more interactive sessions, Chatham House rules where necessary, and work hard to bring in a broad mix of public and private players. Through all this we create an environment where understanding can be reached, decisions made, and partnerships formed. All aimed towards greater research for health and development.”

Carel IJsselmuiden