Geneva Health Forum Archive

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Public-Private Partnerships: Beneficial or Undermining?

Author(s): Louis J. Currat1
Affiliation(s): 1Former Executive Secretary, Global Forum for Health Research, Geneva, Switzerland
Key issues: Many infectious diseases affecting the developing world are potentially treatable in the longer term. However, economic disincentives have resulted in underinvestment in medical research for new vaccines and medicines targeted at these diseases. Thus, of the more than 1200 drugs that reached the global market in the past three decades, only an estimated two to three per cent were for tropical infectious diseases that primarily affect the poor. Worse yet, three million children die each year from diseases that could have been prevented with existing vaccines (for example vaccines against hepatitis B and Haemophilus influenzae type b), underlining the huge economic, social and cultural obstacles existing between the availability of products and their accessibility by poor populations. The main reasons for this situation are that, on the one hand, high costs and inadequate commercial returns have resulted in the withdrawal of the private commercial sector from investments in tropical disease research and commercialization of health products for the poor populations of developing countries. On the other hand, the public sector has concentrated its financing on basic health research and generally lacks the expertise, mechanisms and resources to discover, develop, register and commercialize new products. In other words, there is a disconnection (or several) in the pipeline for producing, developing, and delivering health products to the poor between the public and private commercial sectors and these disconnections may be different for different diseases.
Meeting challenges: How to reconnect and/or reinforce this pipeline? The solution has to come from joint undertakings of the public and private sectors. In many cases, the initiative to launch a public/private partnership is likely to come from the public sector, as the sector is ultimately responsible for ensuring that the poor have access to health products. It may also come from civil society organizations, pursuing a global health objective with private resources. Examples also exist where the initiative was taken by the private commercial sector.
Conclusion (max 400 words): When are PPPs needed? In short, one could say that the larger the disconnection in the product discovery/delivery pipeline between the public sector and the private commercial sector, the higher the rationale for launching a PPP. Are PPPs the only strategy to reconnect and reinforce the discovery/delivery pipeline? No, the public sector may decide to use push and pull interventions to help correct the structural problem of under-investment in the diseases of developing countries. If the disconnection is particularly large, it may choose to use push and pull interventions together with support to specific PPPs in order to speed up the impact on the health of poor populations. Do PPPs always work and are they always cost effective? With good management, the benefit/cost ratio of PPPs may be very high, i.e. the benefits of joint action may be much larger than what each institution could obtain separately for the same amount of time and resources invested. In cases where the overall estimated benefits become limited, while the costs remain high, it is justified to stop the investment in the partnership. To illustrate these points, the presentation will draw upon a few examples of actual PPPs.

Public Responsibility in Research and Development Partnerships

Author(s): Bernard Pécoul1
Affiliation(s): 1Executive Director, Drugs for Neglected Diseases Initiative, Geneva, Switzerland
Key issues: A fatal imbalance exists in the investment in new drugs for neglected diseases, such as sleeping sickness and leishmaniasis, versus diseases prevalent in wealthy countries. From 1975 to 2004, of the 1,556 new drugs marketed only 21 just over one percent were for infectious tropical diseases and tuberculosis, in spite of the huge need. So, not only are the poor in developing countries disproportionately suffering from curable diseases, but their needs are woefully unmet by the existing model of drug development.
Meeting challenges: This disparity is now widely acknowledged and is being addressed by new research as well as new initiatives. Several research initiatives have been set up in the last 5 years to address this issue, e.g., the Drugs for Neglected Diseases Initiative (DNDi), Medicines for Malaria Venture, and TB Alliance. The challenge here lies in procuring full financial and political support from governments so that the initiatives can achieve their goals of developing and delivering desperately needed, new, effective, needs-oriented medicines to neglected patients. Currently, only 16% of funding for these initiatives comes from governments, while almost 80% comes from philanthropic organisations. This is unsustainable. The importance of public responsibility in providing equitable access to these health tools is an essential part of DNDi’s message as a not-for-profit research organisation that works in close collaboration with public and private partners in both developing and developed countries. The need for increased public support of essential innovation for neglected diseases is a growing global concern. Governments are being urged to lose no more time in supporting new funding mechanisms for neglected disease research and development and to create a favourable environment to stimulate R&D. A handful of Innovative Developing Countries such as India, South Africa, Brazil, etc. are becoming more proactive in the field of drug R&D. Yet innovation in drug discovery for neglected diseases remains a critical gap.
Conclusion (max 400 words): This message has recently gained ground at the WHA 2006, which voted to adopt a resolution to establish a global strategy and a plan of action directed at public health, innovation and essential health research. These are positive steps towards addressing the greater problem of R&D for neglected diseases. Much more remains to be done.

Alternative Approaches to New Drug Development: Two R&D Initiatives

Author(s): Philippe Desjeux1, Bernard Pécoul2
Affiliation(s): 1Senior Programme Officer for Disease Control, iOWH, San Francisco, CA, USA, 2Executive Director, Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
Summary (max 100 words): Philippe Desjeux: The illnesses of invisible people usually stay invisible. This statement is reflective of the limited attempts to develop new treatment regimens for neglected diseases. Most of these diseases are preventable or curable, but often strike poor and marginalized people living in remote rural areas. Development of effective, safe and affordable drugs for neglected diseases is an urgent need. Many of the available drugs are not adequate: they are either toxic, difficult to administer or too expensive. Therefore, investment in drug research and development for neglected diseases is crucial to bridge the gap between the pharmaceutical R&D model and the unique requirements of the global health field, where the traditional market system does not work. Meeting the challenge: The Institute for OneWorld Health (iOWH) is the first non-profit pharmaceutical company in the USA, formed to address the 10/90 gap in health R&D. Our mission is to develop safe, effective and affordable new medicines for people with infectious diseases in the developing world. OneWorld Health’s core competencies lie in pharmaceutical product development. Our in-house teams identify development leads through partnerships with industry and universities. Together, iOWH works to optimize existing drug candidates, complete preclinical and clinical investigation needs, secure quality manufacturing of developed products, and obtain the necessary regulatory approvals to bring the product to the beneficiaries. Concurrently, iOWH collaborates to devise product delivery and access strategies with relevant stakeholders, which include governments, donors, and international NGOs. These Public-Private Partnerships (PPPs) allow for a more rapid development of new drugs by utilizing complementary skills and resources. iOWH’s current pipeline includes programmes for visceral leishmaniasis (VL), malaria, and diarrheal disease. Paromomycin, for the treatment of VL, is currently the most advanced pharmaceutical product for iOWH. After the completion of a Phase III clinical trial in Bihar, India, for paromomycin, iOWH has submitted the dossier for regulatory approval in India. iOWH’s product selection criteria is designed to meet the needs of the poor in the developing world. In addition to customary selection criteria such as scientific merit, probability of success, clinical and regulatory developmental path, iOWH examines the unmet medical needs in the developing world, cost-of-goods, and mechanisms of delivery, including the endemic country’s infrastructure. These criteria allow us to devise products that will be both appropriate for communities with high disease burden and affordable and accessible to the population in a manner which is sustainable. Conclusions: iOWH strives to provide a flexible and innovative vehicle to engage both the pharmaceutical and biotech industries, as well as public health organizations in global health product development. Through partnerships and collaborations, by adhering to the highest ethical standards for clinical research, and by utilizing the scientific and manufacturing capacity of the developing world, OneWorld Health can deliver affordable and effective new medicines where they are needed most.Bernard Pécoul: The majority world shoulders a disproportionate burden of disease and has few drugs with which to respond to this challenge. In 2005, Africa, Asia (excluding China)- Pacific, and Latin America, which housed 63 per cent of the world?s population, had a mere 11.7 per cent share of the world's $602 billion pharmaceutical market. This stark disparity is echoed in the dearth of research funding dedicated to the diseases prevalent in developing regions. Over the past 30 years, only 21 of the 1,556 new chemical entities marketed between 1975 and 2004 were for tropical diseases and tuberculosis. Millions continue to suffer from diseases such as tuberculosis, malaria, leishmaniasis, sleeping sickness, and Chagas disease. Regrettably, these diseases target impoverished populations with immune systems already weakened by hunger and other diseases. If patients are to have any hope of survival they urgently need new, more effective treatments for these diseases, as the few available drugs are compromised by poor efficacy, toxicity, long courses of treatment, parenteral administration and resistance to the parasite.
Meeting challenges: The Drugs for Neglected Diseases Initiative (DNDi), a not-for-profit drug R&D initiative, is seeking to research and develop new drugs for these neglected diseases. Existing treatments for these diseases are often inadequate and ineffective and patients need new medicines urgently. Founded by a group of 5 renowned medical research organizations including the Indian Council for Medical Research, the Oswaldo Cruz Foundation from Brazil, the Kenya Medical Research Institute, the Ministry of Health of Malaysia, and the Pasteur Institute, as well as the WHO’s Special Programme for Research and Training in Tropical Diseases, and Médecins sans Frontières (MSF), DNDi presents an alternative approach to drug development. It facilitates north-south and south-south collaboration, capacity building, and knowledge sharing among researchers, scientists, industry, and governments.
Conclusion (max 400 words): DNDi's current portfolio of 20 projects focuses on discovery and development projects for malaria, leishmaniasis, sleeping sickness, and Chagas disease. Its alternative approach will make new drugs available for the treatment of neglected diseases within the next decade. It is already on the road to success with its two fixed-dose artesunate-based combination therapies scheduled to be delivered to patients by the end of 2006.

Back to the Future for Migrants: Growing Challenges of Access

Author(s): Manuel Carballo1, A. Sundaram
Affiliation(s): 1International Centre for Migration and Health, Vernier, Switzerland
Key issues: At a time when progress toward the UN Millennium Development Goals is faltering, access to healthcare in general and reproductive healthcare in particular is becoming more of a challenge than ever. Despite the impressive progress being made in medical sciences, accessing quality healthcare is becoming more difficult for millions of people around the world. The problem is not unique to poor countries. In many of the richer countries, the number of people with limited access to healthcare services is growing. One of the contributing factors is migration.
Meeting challenges:

Migration is a complex health process. People move with health profiles that reflect socio-economic backgrounds, the diseases and health problems they may have confronted before they moved, and the experience they may have had with healthcare services and personnel in their home countries. The health of migrants is also a function of the way in which they move, what they had to do in order to move and what the modality of their movement was. Finally their health is affected by the social, political and economic context into which they are expected to insert themselves. Their access to healthcare if and when they need it is determined by all these factors and experiences. It is also influenced by their feeling of security, the extent to which they feel they are allowed to participate in the host health system, and the way in which they are received by and can communicate with healthcare personnel. The process is replete with pitfalls. Cultural perceptions and attitudes on the part of patients and healthcare providers intervene. National and local regulations concerning who is eligible for what and under which circumstances also play a critical role. So does the status of the migrant, the extent to which he or she is eligible for medical insurance, be it individually paid for or a shared responsibility between employers and employees. In many situations the underlying question is whether host societies have a positive attitude to migration and migrants, and whether migrants are seen as necessary. In the area of reproductive health we are on the verge of looking back to the future with patterns of maternal and newborn health that are reminiscent of situations that were obtained fifty or more years ago. Poor use of family planning and elevated requests for abortion are symptoms of the emerging scenario. So are the poor pregnancy outcomes and poor neonatal health, as well as late stage presentation for diagnosis of gynecological problems. In some countries of Europe, there are also signs that the incidence and prevalence of sexually transmitted infections may be becoming higher among migrant populations than others, and that women migrants may be especially vulnerable.

Conclusion (max 400 words): As we move into the 21st century and an era of growing mobility within and between countries, the question of access to healthcare in general and reproductive health in particular by migrants will weigh heavily on national policy makers, healthcare providers and the public at large. Everyone stands to gain from equitable access to quality care and ultimately everyone, be they migrants or non-migrants, stands to lose if inequities are allowed to emerge and persist. As migration continues to grow and become an even more indispensable part of social and economic development, it will become increasingly incumbent on all stakeholders to take up this issue and redress these inequities. Medical insurance coverage for all, more training of health personnel on multi-cultural health, greater focus on health promotion and disease prevention among migrants and their social insertion will go far in redressing the problem.

Global Public-Private Partnerships and Global Health Governance

Author(s): Eduardo Missoni1
Affiliation(s): 1Faculty of Sociology, Università degli Studi di Milano Bicocca, Milano, Italy
Key issues: Partnership, a good feelings evocative concept, is one of the trendiest key words in the international development jet set today. Repeatedly, declarations and commitments summarising international events conclude launching new global partnerships to solve the problems they have been addressing. The need for a wide commitment and shared responsibilities in the pursuit of development goals is often being mystified with the establishment of structured narrowly focused public-private partnerships whose promotion often responds more to ideological criteria than to sound comprehensive evaluation of costs and benefits. The notion of partnership for development is not new, however in the language of international meetings sponsored by, or with the participation of, UN agencies and other international and bilateral public actors, the rhetoric of partnership has now become dominant assuming the need for public-private joint-ventures, notwithstanding the lack of any evidence for that declared need.
Meeting challenges: Indicated as the eighth Millennium Development Goal and otherwise understood mainly in terms of shared values, goals, commitment and responsibilities, in the text of the Millennium Declaration the idea of partnership is translated into a pledge for strong partnerships with the private sector and civil society organizations in pursuit of development and poverty eradication. At the eave of the 21st century, Global Public-Private Partnerships have become one of the most notable features of the global arena. Pretending lack of public resources where the reality is one of reduced public commitment and of progressive privatization of international aid the GPPP model is repeatedly proposed at every Summit as the answer to the most varied and dramatic issues that the world is facing today. Including the GAVI which served as a prototype and the GFATM mostly imposed by a preconceived political agenda, at present there are more than 90 different health-related GPPP, duplicating efforts and further fragmenting global action for health, with heavy consequences also in terms of governance of national health systems and provision of health-care of beneficiary countries.
Conclusion (max 400 words): GPPPs offer easy quick-fix solutions to avoid more complex and disturbing global political rethinking and decisions. They involve issues of growing concern that need to be understood in the wider socioeconomical context of dominating neo-liberal ideologies that have influenced public policy since the early 1980s, with a growing commercialization of health care and the incapacity of WHO to keep up to its mandate and leadership. Important strategic decisions about health policies, appear to be taken in the new public-private setting, while WHO’s own legitimate authority is undermined, and its role reduced to pure technical assistance, in times when global health governance is widely felt as a critical issue.

Alternatives in Healthcare Financing: Examples from Low and Middle Income Countries

Author(s): Sania Nishtar1
Affiliation(s): 1President, Heartfi le, Pakistan
Summary (max 100 words): Pakistan currently principally uses three modes of financing health taxation, out of pocket payments and donor contributions of which the latter is the least significant in terms of size. The government spends 0.6 of its GDP and 11.6% of its development budget on health. Less than 3.6% of the employees are covered under the social security scheme and there is a limited social protection mechanism, which collectively serves the health needs of 3.4% of the population. The main issues in health financing include low spending, lack of attention to alternate sources of financing and issues with fund mobilization and utilization. With respect to the first, recently proposed health reforms make a strong case for promoting the reallocation of taxbased revenues and developing sustainable alternatives to low levels of public spending on health. With respect to alternative sources of health financing, the proposed reforms as articulated in the Gateway Paper lay stress on exploring policy options for private health insurance, broadening the base of Employees Social Security, creating a Federal Employees Social Security Programme, developing social health insurance within the framework of a broad-based social protection strategy, which scopes beyond the formally employed sector, establishing a widely inclusive safety net for the poor; mainstreaming philanthropic grants as a major source of health financing; developing a conducive tax configuration; generating greater corporate support for social sector causes within the framework of the concept of Corporate Social Responsibility and developing cost-sharing programmes, albeit with safeguards. The Gateway Paper regards efficient fund utilization a priority and lays stress on striking a balance between minimizing costs, controlling costs and using resources more efficiently and equitably in other words, getting the best value for the money, on the one hand, and increasing the pool of available resources, on the other. Specific interventions such as the promotion of transparent financial administration, budgeting and cost controls and enhancing the capacity to overcome onerous financial management procedures and decentralizing decision-making are underscored as a priority as is the need for ensuring greater financial procedural clarity at the federal-provincial-district interface.

Do Global Funds Really Facilitate Access to Health?

Presenter(s): Lola Dare, Marcos Cueto, Wibulpolprasert Suwit
Chair(s): Elisabeth Fee, Bernardino Fantini
Author(s): Elisabeth Fee1, Bernardino Fantini2, Marcos Cueto3 Lola Dare4, Wibulpolprasert Suwit5
Affiliation(s): 1Chief, History of Medication Division, National Library of Medicine, USA, 2Director, History of Medicine and Health Institute, Faculty of Medicine, University of Geneva, Switzerland, 3Professor Principal, Universidad Peruana Cayetano Heredia, Peru, 4Executive Secretary, African Council for Sustainable Health Development, Nigeria, 5Ministry of Public Health Advisor, Ministry of Health, Thailand
Summary (max 100 words): Numerous international funds have been set up in recent times to address global health challenges such as HIV, TB and malaria, in an effort to provide sustainable funding for selected diseases affecting billions of people in the poorer regions of the world. Despite impressive investments in terms of money and stakeholders  involvement at national and international levels, enabling the scaling up of specific health initiatives, the collective impact of these initiatives has sometimes created or exacerbated problems such as the poor coordination or duplication of programmes, heavy burdens on local health practitioners, variable degrees of country ownership, and a lack of alignment with country systems. Relying on the establishment of inclusive partnerships, financial institutions like the Global Fund to Fight AIDS, Tuberculosis, and Malaria do not take full responsibility for implementing funded programmes which require the active participation of partners in proposal development and realization (through Country Coordinating Mechanisms). One of the major reasons for the apparent ineffectiveness of global interventions is the historical weakness of the health systems of underdeveloped countries, which contribute to bottlenecks in the distribution and utilisation of funds. What are the pros and cons of the global funds from different country perspectives? In theory, the global funds programmes are to be continued and sustained in the long term by the countries themselves. Is this a reasonable expectation? Is the money coming into the global funds programmes (from the donors and also the recipient countries) new money, or is it simply being shifted from one health programme to another? How can the funds best support equity, universal coverage, and sustained improvement in health systems? performance? What are the key steps needed to implement the Paris declaration, with its guiding principles of ownership, harmonisation, alignment, results, and mutual accountability? This round table session will debate the pros and cons of the ways the global funds work (or fail to work) in practice and try to answer the above questions.

GHF2006 – PS19 – How to Increase Access to Medical Information?

Session Outline

Parallel session PS19, Friday, September 1 2006, 11:00-12:30
Chair(s): Guy Olivier Segond, Switzerland, Antoine Geissbuhler, Switzerland
The iPath Project: Global Exchange of Medical Knowledge and Information Using Virtual Communities
Kurt Brauchli, Pathology, University of Basel, Basel, Switzerland
Hopes: Lessons from a Practical Example
Line Kleinebreil, Direction informatique, Hôpital européen Georges Pompidou, Paris, France
The Raft Network: Five Years of Distance Continuing Medical Education and Tele-Consultations via the Internet in French-Speaking Africa
Cheick Oumar Bagayoko, Informatique Médicale, Hôpitaux Universitaires de Genève, Geneva, Switzerland
The Digital Solidarity Fund
Alain Clerc, Secretary-General, Digital Solidarity Fund, Switzerland

Session Documents

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Session Report

Submitted by: Jennie Hery-Jaona (ICVolunteers); Contributors: Lyne Calder (ICVolunteers)
Giving training not only on health care but also on the use of computers. Image: Jorge Garbino, ICVolunteers.org

As part of the broad topic on how to provide equal access to health, this symposium discussed how tools such as telemedicine can increase access to medical information and contribute to the reduction of the global digital gap. According to Guy Olivier Segond, former president of the State Council of Geneva and President of the Executive Committee of the Digital Solidarity Fund, information technology (IT) remains a "key tool to access health and improve the effectiveness of health systems".

In this context the four speakers presented different pilot projects to illustrate how Information Communication Technology (ICT) has positively influenced health care in rural areas.

Mr. K. Brauchli, a Swiss biologist and computer specialist, described the iPath project of global exchange of medical knowledge and information with virtual communities. He used the case of the Solomon Islands with a population of 450,000 to illustrate the challenges brought by limited resources and the shortage of trained staff and infrastructure, which lead to the lack of access to diagnosis. In this context, the telepathology service, launched in 2001, has been a successful experiment with more than 1,500 users and handling over 9,000 cases to date. Health workers are a major resource and they need access, not merely to information in general, but specifically to relevant and up-to-date information, as well as training and guidance. Mr. Brauchli argued that the key aspects of telemedicine are "its potential for sustainable transfer of knowledge, quality control and immediate feedback; the capacity to foster communication within the health system; overcoming professional isolation and, most importantly, to reduce the brain drain effect and the promotion of South-South collaboration". Telemedicine is also "accountable and transparent", and remains a useful tool as an "archive of material for later review and reference". He concluded that telemedicine can effectively contribute to strengthening health systems, because it "supports diagnosis and is timely and accurate" with a 90-97% concordance with clinical relevancy.

The second presentation, given by Dr. Line Kleinebreil of the Hôpital Européen Georges Pompidou, described another programme linked with ICTs and also using telemedicine. Health Operations Programme through Education and Sentinel networking (HOPES), originally started by Cheik Modibo Diarra in Mali, aims to contribute to the achievement of the Millennium Development Goals (MDGs) through updating and increasing the availability of training for primary care professionals. In 2003, HOPES entered into a partnership with the Université Numérique Francophone Mondiale (UNFM) based in Paris and is now essentially a North-South programme. Established in Mali and Burkina Faso since 2005, this programme sets up multi-media classrooms to create dialogue between medical students and professionals. Most of the teaching takes place at the Hôpital Européen Georges Pompidou through satellite video-conferencing. Although this technology is not new in itself, Dr. Kleinebreil stressed the programme's innovation in being linked with African universities and in giving training not only on health care but also on the use of computers. Recorded courses are also available offline on DVDs which have apparently proved very popular. This is a powerful way to disseminate information. Through re-watching the conferences, medical students and professionals are given the opportunity to discuss and comment. The programme is free of charge except for a registration fee for exams. Concerned with sustainability, HOPES shares classrooms with enterprises and aims to increase public-private partnerships. The goal is for the African centre to become independent after three years and to extend the system to other areas.

Trained in medical informatics, Dr. Cheick O. Bagayoko from Mali introduced the Réseau en Afrique Francophone pour la Télémédecine (RAFT) project, a "network for eHealth in Africa" and a key strategy in developing South-South training and links. Launched in Bamako, Mali, in 2001 the network soon expanded to reach countries like Mauritania, Senegal, Tunisia, Morocco, Burkina Faso, Niger and Madagascar. The training's main characteristic is its hybrid aspect, which encompasses "dialogue between concerned experts, the development of skills, fieldwork, collaboration with other projects and evaluation". Dr. Bagayoko emphasized the importance of telemedicine as a tool against professional isolation, which tends to discourage doctors from practicing in remote villages, where they are most needed. An important aspect of the RAFT project is the fact that the South can also share its experience with the North. For instance, some courses on tropical medicine are transmitted from Mali to the University Hospital of Geneva. On the whole the success of the project is illustrated by the 122 courses which took place between 2003 and 2006, 30% of which have been given from the South. However, challenges remain with organizational and individual problems; linked with a need for field knowledge. Dr. Bagayoko concluded his presentation by raising the question of ethics: "Is the installation of antennas and thus transmission of information more important than access to clean water?". There is no easy answer.

Mr. Alain Clerc, of the Digital Solidarity Fund (DSF), urged the information society to create a network to combine the various smaller projects involved in the same field, relating specifically to ICTs. He stressed equality of access as the main focus for spreading information. The DSF, recently inaugurated in Geneva after the two World Summits on the Information Society in Geneva and Tunis, is an organization aimed at reducing the global digital divide. The figures concerning this digital divide are striking: in developing countries only 2% of the population has access to new technologies whereas over 80% of the population does in more developed countries. The structure of the Digital Solidarity Fund is new in that it not only involves governments but also civil society and the private sector. The Fund does not operate on the ground; rather it is concerned with finding funds for local projects. It is aiming to establish an innovative financing mechanism: obtaining 1% of the value of all digital and material transactions to invest in the 80% of the population without access to new technologies. Mr. Clerc stressed that the Fund finances local projects in order to have a direct effect on the rural population and therefore help decrease or prevent brain drain. He concluded with a call to companies and hospitals which are not already doing so to invest 1% of their transaction costs according to the Fund's guidelines.

Following the presentations, important questions such as how to deal with the high cost of satellites and how to reach self-sufficiency were raised. It was noted that there is the prospect of launching an African satellite and that self-sufficiency will be boosted by communication centres funding multisectorial projects and by initiatives such as the Digital Solidarity Fund sponsoring South-South collaboration.

In conclusion, this symposium discussed the importance of IT particularly through telemedicine, and of the need for equity in the information society in order to achieve knowledge and health access for all.

Partnerships to Promote Global Public Health Security

Author(s): David L. Heymann1
Affiliation(s): 1Representative of the Director-General for Polio Eradication, World Health Organization, Geneva 27, Switzerland
Key issues:

The emergence of new infectious diseases such as Severe Acute Respiratory Syndrome (SARS) and avian influenza A (H5N1); and the re-emergence of others such as cholera and yellow fever combined with the increased speed and volume of international travel and trade have alerted countries to the ease with which infectious diseases can cross national borders and defy traditional defences. The international spread of infectious diseases from any country is an external danger from which state citizens need to be shielded through stronger systems of public health defence. Infectious diseases also threaten national security when deteriorating health trends in any one country lead to instability and social upheaval. Endemic infectious diseases are a particular security challenge as they resurge, because they behave in ways that can overwhelm social and public health infrastructures and cause demographic disparity. The emergence of AIDS and its rapid progression to endemicity convinced the world that a previously unknown pathogen can cause social and economic upheaval on a scale that threatens to destabilize whole regions.

Meeting challenges:

In developing countries, the destabilizing effect of AIDS, and other endemic diseases such as tuberculosis and malaria, is amplified by emerging and epidemic-prone diseases. Outbreaks and epidemics disrupt routine control programmes and health services, often for extended time periods, due to the extraordinary resources and logistics required for their containment. The dramatic interruption of trade, travel, and tourism that can follow news of an outbreak or epidemic thus places a further burden on public health systems in already fragile economies.

Conclusion (max 400 words):

Foreign policy agendas that aim to build a more secure world are increasingly including the emergence and resurgence of infectious diseases as a security challenge that needs to be addressed. They have global causes and consequences that can only be addressed through international global partnership, supported by strong national public health capacity. In April 2000, WHO launched the Global Outbreak Alert and Response Network (GOARN) as a partnership to keep the volatile microbial world under close surveillance and ensure that outbreaks are quickly detected and contained. This network of networks interlinks, in real time, over 110 existing networks that, together, posses much of the data, expertise and skills required to keep the international community alert to outbreaks and ready to respond. It was GOARN that detected and responded to the SARS outbreak in 2003, and it is GOARN that continues to watch over the current avian influenza pandemic threat.

Research Ethics in Africa: Needs and Opportunities

Author(s): Peter M. Ndumbe1
Affiliation(s): 1Microbiology, Haematology and Infectious Diseases, Faculty of Medicine and Biomedical Sciences, Yaounde, Cameroon
Key issues:

It is a truism that health policy as well as the teaching and practice of the health sciences ought to be guided by evidence. The collection and validation of this evidence has to depend on methodologically and ethically acceptable standards. Whilst there is some agreement that issues related to methodology have been fairly well addressed in low-income countries such as Cameroon, the same is not true for ethical issues.

Meeting challenges:

Training institutions for the health sciences such as the Faculty of Medicine and Biomedical Sciences in Yaounde have to take the leadership in ensuring that research is conducted in an ethical manner. Appropriate training has to be provided both to the teachers and to the students in this area. Since its creation in 1969, the Faculty of Medicine and Biomedical Sciences has forged the research culture into its graduates. All graduates have to provide a thesis, dissertation, or research report as part of the requirements for qualifying. Within the last fifteen years, the faculty has grappled with the issue of conducting research in an ethically sound manner. This has resulted in the installation of an Ethical Committee at the Faculty. In order to ensure its recognition and use, training had to be provided first for the teachers, and later for the students. Continuing education sessions are required for the teachers whilst every new crop of students is immersed into the ethical culture of conducting research. The major concerns encountered are the total neglect of the research culture in daily decision making and the assumption that health provision services are inherently good and cannot be challenged. Issues related to the financing of research are commonly found to be poorly understood by researchers. Other challenges related to the functioning of the Committee (administrative, displeasure with results, use of other facilities, financial, follow-up of studies) are dealt with in innovative manners and the Ethical Committee is becoming well known.

Conclusion (max 400 words):

In conclusion, although wrought with difficulties in the beginning, training institutions should provide leadership in ensuring that research is conducted in an ethical manner in low-income settings. This not only safeguards the dignity and human rights of participants, but also ensures that medical practice becomes accountable to its users.