Negotiations, Funding & Equity
This fortnight in Global Health & Pharma
Dear Friend of Global Health Conversations,
Plenty has happened this fortnight in the worlds of Global Health & Pharma. Skip to the Fortnight in resources for my curated takes. :)
I focus a little on the INB negotiations that recommence tomorrow, and look at developments in the administration and manufacturing of biologics in Kenya based on the fortnight’s happenings. For my part, I had a busy fortnight too - among other things - busily organising the podcast interviews for March & April, writing postcards, bidding farewell to a friend and spending a little time in London. All very enriching and I’m grateful for it.
As I write to you this evening, I am reflecting on my favourite reads & listens of the fortnight. I started The Making of Them: The British Attitude to Children and the Boarding School System. An interesting read and one that, based on my own prep school days, I can relate to at times and feel grateful to not relate in the slightest, at others. It reminded me of a conversation I heard recently about the harm people can suffer from the physical injuries sustained playing impact sports as children. Definitely a conversation worth having and one with so many viewpoints. We often think of public health as simply the diseases that people suffer. But public health encompasses all areas of our health - including accidents and injuries that may be sustained playing sports or in the workplace; along with our mental health, which, in terms of its associated morbidity and mortality, is oftentimes just as important.
Falling asleep on the plane to a little John Coltrane (← this rhymes) (A Love Supreme, Pt. IV - Psalm) and letting shuffle lead me to an old gem, Malian & in my liked songs, by Amadou and Mariam: Je Pense à toi. On repeat ever since. Postcard in Behind the scenes.
Until next fortnight, friend.
Christiana
1. Update: 8th Meeting of the Intergovernmental Negotiating Body (INB) for a WHO instrument on Pandemic Prevention Preparedness and Response
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Background
The ongoing WHO Intergovernmental Negotiating Body (INB) negotiations are focused on drafting and negotiating a pandemic agreement aimed at strengthening global pandemic prevention, preparedness, and response (PPPR). The negotiations are viewed as a critical opportunity to address systemic inequities in health access and response capabilities exposed by the COVID-19 pandemic. The process involves a comprehensive consultation and drafting effort, including public and regional consultations, aimed at producing a draft instrument for consideration by the World Health Assembly in May 2024. The proposed pandemic accord seeks to address deficiencies in health systems, enhance multi-sectoral collaboration, and improve access to health technologies and products.
On a separate note, proposals to amend the International Health Regulations (IHR) are also ongoing - aiming to improve global health product availability and affordability, establish databases and repositories for health products and cell lines, and develop regulatory guidelines for rapid health product approval. These amendments seek to enhance the WHO's capacity to manage public health information and coordinate responses to public health emergencies of international concern. However, there is debate over the feasibility and scope of some proposed amendments, highlighting the complexity of balancing global health governance with national sovereignty and legal considerations
Whats the latest?
Ahead of the 8th INB meeting on 19 February, key details of the pandemic agreement draft have been revealed, underscoring a focus on equity, global collaboration, and comprehensive strategies for pandemic management.
Current Draft Highlights:
Aims and Principles: The draft clarifies pandemic definitions and emphasizes global coordination for effective control.
Equity and Responsibilities: A significant theme is ensuring equity through pandemic prevention, preparedness, and response, detailing countries' duties in surveillance, health system resilience, and adopting a One Health approach.
Health Workforce and Cooperation: Articles highlight the importance of the health and care workforce, preparedness monitoring, and fostering international cooperation, alongside strategies to counter misinformation.
Research and Development: There's a push for equitable access to pandemic-related products and transparency in R&D funding agreements.
Contested Areas: Discussions continue on sustainable production, technology transfer, and a global supply chain network to mitigate resource competition during pandemics.
Financing and Implementation: Proposals include a "Coordinating Financial Mechanism" to support the agreement's implementation, particularly benefiting developing countries.
Institutional Framework: The draft outlines the establishment of a governing body and secretariat without provision for independent oversight.
Should I be worried?
In my opinion, no. This long and careful process is voted upon by member states representing their respective country’s best interests and values. These careful negotiations aim to produce a tool that can be effectively used and implemented in the case of a threat to best protect citizens, globally.
(Main Source ☕: Health Policy Watch)
2. Poverty & Inequity: Cervical Cancer in Africa and its Disproportionate effect on Girls and Women
In a recent article for the Daily Maverick, Dr. Ntombi Sigwebela, Regional Director of FIND, the diagnostics alliance, highlights cervical cancer as a critical health issue rooted in poverty and inequity, stressing the urgent need for inclusive access to treatment. Cervical cancer claims a life every two minutes, predominantly impacting women in lower-income countries and those living with HIV. Africa faces a severe burden, with millions at risk and thousands dying annually. The disease's link to HIV is particularly alarming, as infected women are six times more likely to develop cervical cancer.
WHO has set ambitious targets to eliminate cervical cancer as a public health threat by 2030. This initiative could save millions of lives over the next century by implementing widespread HPV vaccination and innovative screening methods. Dr. Nono Simelela, a former WHO Assistant Director General, emphasizes the transformative potential of HPV self-collection testing. This method could decentralize and simplify the screening process, making it more accessible to women at the primary healthcare level.
HPV, the primary cause of cervical cancer, can be effectively prevented with a vaccine. Additionally, self-screening techniques offer a promising alternative to traditional, more invasive procedures. Such innovations, coupled with increased governmental collaboration and investment in women-centric healthcare technologies, are critical steps towards reducing cervical cancer rates globally.
Efforts to Combat Cervical Cancer in Africa - An annual reduction of 70,000 cervical cancer deaths in Africa could be achieved with intensified efforts to end the disease by 2030, ensuring access to services for early detection and prevention. At the WHO Regional Committee for Africa meeting, health leaders urged immediate action to enhance essential services against cervical cancer, which disproportionately affects the continent. Despite the progress, with 26 African countries introducing the HPV vaccine, coverage and screening rates remain low. The call for action emphasizes the importance of women's health for societal well-being and the need for increased investment in cervical cancer control programs.
Zambia's Battle Against Cervical Cancer - Zambia ranks third worldwide in cervical cancer incidence, with a significant impact on its population. Efforts to combat this include a robust screening program initiated in 2006 and the introduction of HPV testing in 2019, aimed at early detection and prevention. Despite challenges, over 110,000 HPV tests have been performed, marking progress in the fight against cervical cancer. The government and partners are working to expand access to HPV testing and vaccination, aiming to meet WHO's 2030 SDG elimination targets.
HPV Vaccination in Nigeria - As discussed in a past newsletter, last year Nigeria's response to the high rates of cervical cancer included launching a huge HPV vaccination campaign targeting girls aged 9–14 years with a single vaccine dose, highly effective against the HPV types causing most cervical cancers. This initiative, supported by the Federal Ministry of Health and international partners like GAVI and UNICEF, aims to significantly reduce new cases and mortality.
Impact on girls and women in LMICs - Today, cervical cancer disproportionately affects African women, with some of the highest mortality globally; and women in low- and middle- income countries. This is a stark example of health inequity. And another way in which the world is failing girls and women. This highlights the urgent need for African initiatives to focus on equitable access to healthcare services, and a global push for the development of novel screening tools and devices to ensure that all women, regardless of their geographical or socio-economic status, can be protected.
(Sources: here, here, here & here)
3. Upcoming Replenishments: Navigating the 2024-2025 Development Funding Crunch
The upcoming 2024-2025 period is poised for a fundraising "traffic jam" in the realm of major development funds, with projections suggesting the need to raise over $100 billion. This confluence of replenishment campaigns, including those for the World Bank’s International Development Association, Gavi, (and so on, including Global Fund) marks a significant challenge against a backdrop of constrained foreign assistance budgets and geopolitical uncertainties. This scenario, exacerbated by elections in 6 of the 10 largest bilateral donor countries, introduces a precarious element of political unpredictability into the funding landscape.
The landscape of 2024-2025 starkly contrasts with the relatively successful outcome of the 2019-2020 replenishment cycle, where $60 billion was raised amidst less constrained fiscal environments. Today, the overlapping replenishment campaigns are set against a backdrop of reduced donor pledges and an increasing number of new funds vying for a finite pool of resources. The political landscape adds to the uncertainty, with upcoming elections in key donor countries potentially impacting foreign aid commitments.
Moreover, the entry of new and emerging donors offers a glimmer of hope but also presents questions about the distribution and focus of future aid. Traditional donors are navigating a complex web of competing priorities, both within the global health sector, pandemic preparedness and beyond, including climate finance.
See this late December press release: World Bank: The Pandemic Fund Announces Second Round of Funding with Half-a-Billion-Dollar Envelope
(Source: here)
4. Accelerating Healthcare Equity in Kenya: Some recent views from different facets
Kenya is taking significant strides towards improving equity and accessibility in healthcare and addressing disparities in cancer treatment, backed by global partners. The World Bank's commitment of $120 million to Kenya's vaccine production facility, inaugurated by the Kenya BioVax Institute, marks a development in the country's health sector. Set to commence operations in 2029, this facility aims to meet the rising demand for vaccines, reflecting Kenya's proactive stance on health security and self-reliance. This initiative is particularly timely, considering the impending reduction of support from GAVI (Kenya having approached the 3-year GNP threshold for support), extending its assistance until 2029 to facilitate a smoother transition for Kenya towards vaccine self-sufficiency.
Moreover, the World Bank's broader financial support to Kenya, amounting to $1.5 billion, underscores the institution's role in bolstering Kenya's economic and healthcare infrastructure. This funding is expected to fortify Kenya's foreign currency reserves, contributing to the country's fiscal stability and capacity to manage its healthcare needs effectively. Such multifaceted support is crucial as Kenya prepares to navigate the challenges of Eurobond maturity and seeks to enhance its healthcare deliverables.
In a separate development, the Max Foundation's partnership with Eli Lilly to provide free Verzenio® (abemaciclib, a biologic) for the treatment of advanced breast cancer in Kenya represents a significant leap towards addressing healthcare disparities. This collaboration under the Humanitarian PACT for Access to Critical Treatment aims to eliminate barriers to cancer care in low- and middle-income countries. Breast cancer, a leading cause of cancer death among women globally, poses a greater challenge in countries where late diagnosis and inadequate treatment are still common for many patients. By providing this biologic, this initiative seeks to hopefully improve access and outcomes for patients in Kenya and beyond, highlighting the power of partnerships in advancing health equity. There are so many prongs to this sort of wheel, so I feel that biological therapies in Kenya and other lower-middle income countries are something I will be keeping an eye on.
Behind the scenes:
Spent a little time in London, taking time out, browsing the shelves with Alison, and having a bite with a dear friend at my favourite French restaurant in the city.
Recent Podcast Episodes: In case you missed them! 💃🏾
Episode 13: Non Disease Related Causes of Death: Gender-Based-Violence, a public health issue
‘These are the ways in which women disproportionately die prematurely because of being women’. Throughout this episode, you will hear me use this phrase as I walk through the ways that gender based violence impacts the right to long and healthy life; as well as the real life stories of survivors told in their own words. Fortunate to have lived but with life long scars - physical and emotional.
Episode 14: What does Sustainability look like in the Pharmaceutical Industry? (ft Elisabetta Marani)
We talked about circular economy, greenwashing, net zero carbon emissions goals, the role of sustainability in Pharma, practical solutions and access to medicines as a key objective of the industry alongside furthering environmental sustainability aims. If you are a young professional interested in this area - be sure to listen to the end as Eli provides her expert advice for you. If you are not a young professional, be sure to listen to the very end for Eli's advice as to how we can all make a difference in our personal spheres of work.
Episode 15: Why do Americans pay (so much) more for healthcare?
In this solocast we discussed the cost of medical care. Particularly, I attempted to answer the question: Why do Americans pay (so much) more for healthcare? With my health economist hat on - I looked into transparency, drug prices and administrative costs. But are these only reasons that the US has the world’s third highest out of pocket health expenditure? And, moreover, how does this affect patients and patient outcomes?
If you enjoy this newsletter, please forward it to a friend. :)
Yours,
C