Geneva Health Forum Archive

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GHF2008 – PS30 – Neglected Disease: Improving Patient Access to New Diagnostics

Session Outline

Parallel session PS30, Tuesday, May 27 2008, 16:00-17:30, Room 15
Chair(s): François Chappuis, Lecturer, Division of International and Humanitarian Medicine, Department of Community Medicine and Primary Care, University Hospitals of Geneva, Switzerland
Obstacles to Using Eflornithine on a Large Scale: Measures to Facilitate the Role of Each Stakeholder in the Field of DRC PNLTHA
Constantin Miaka Mia Bilenge, National Counsellor on Sleeping Sickness and Researcher, Ministry of Health, Democratic Republic of Congo 
Fighting Neglected Diseases: The Contribution of Sanofi-Aventis
Mireille Cayreyre, Director of Neglected Diseases and Central Nervous System, Access to Drugs, Sanofi-Aventis, France 
Neglected Diseases: Achievements and Challenges to Ensure Drug Access for NTDs: The Example of African and American Trypanosomiasis and Leishmaniasis
Jorge Alvar, Medical Officer, Control of Neglected Tropical Diseases, Communicable Diseases Cluster, WHO, Switzerland 
How Product Development Partnership Could Catalyze Needs-Driven Research and Bridge Gaps
Bernard Pecoul, Executive Director, Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland 

Session Documents

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Session Report

Contributors: Suzie Abessolo (ICVolunteers), Kate Brown (ICVolunteers)

M. F. Chappuis from Médecins Sans Frontières (MSF) introduced this session dedicated to the improvement of access to drugs and diagnosis. Four key speakers gave an overall picture of access to the diagnosis of neglected diseases: M. J. Alvar from the Neglected Diseases department of the World Health Organization (WHO); M. Bilenge from the National Human African Tripanosomiasis (HAT) programme, Democratic Republic of Congo (DRC) Brasavil; Ms. Cayreyre from the private medical company Sanofi-Aventis and M. Pecoul from the NGO Drugs for Neglected Diseases Initiative (DNDI). They defined what the tropical diseases and problems issues are such as lack of drugs, diagnosis and needs for sustaining progress. 

Mr. J. Alvar, in charge of the Control of Neglected Tropical Diseases (NTDs) at WHO, introduced his presentation by explaining how to recognize which tropical diseases are neglected. Examples of such diseases are Tripanosomiasis and Leishmaniasis. They are found specifically in poor countries, in the poorest populations and, most of the time, in the rural populations who don't have access to medication and health centres. Approximately one billion people are affected by more than one NTD. WHO has developed a Global Plan with nine strategies to combat NTDs, one of which is to ensure free and timely access to high-quality medicines and diagnostic and preventive tools. To achieve their objectives it is necessary to develop innovative and intensified disease management, increase preventive chemotherapy, transmission control and integrated Vector Management. It is crucial to decrease the cost of drugs (cost-effectiveness) and the most important of all is the availability and affordability of drugs.

The goals from this year to 2015 are to prevent, control, eliminate or eradicate neglected tropical diseases. The management of existing tools is very important in order to decrease treatment failures and resistant cases. A big gap remains between research and control. New strategies need to be identified. During, the last ten years, access to drugs for some of the most neglected diseases has been improved. (www.who.int/neglected_diseases/en/)

Mr. Miaka Mia Bilenge, the DRC National programme Advisor, presented a governmental approach to provision of medication, specifically Eflorithine, to people with sleeping sickness. The Republic of Congo is a huge country with a fragile political situation due to conflict and transportation difficulties. Health care components include: health education, preventive health care, environmental and family health. The organisation and control structure is divided into three levels: the National Level management in Kinshasa; the Provincial level which implements the strategic plans set by Kinshasa in their 515 health districts; and the Basic level of health centres, with around 5000 staff. In some areas the DRC Human Trypanosomiasis programme uses Eflornithine as a first line drug. This drug is taken for two weeks, four times a day, and needs to be administered with the support of excellent nursing care, well trained staff in the health centres and functioning logistics from WHO abroad and in the country. The improvement needed is a strong partnership and high level of commitment, mutual communication and close follow up. (http://www.minisanterdc.cd/pnltha.php)

Ms. M. Cayreyre, Marketing Director of Medication Access at Sanofi-Aventis, a socially responsible company, explained private sector activity. Sanofi-aventis is committed to an active role in access to medicines, fighting against some of the most neglected diseases of the developing world. Their strategy is threefold: a portfolio dedicated to diseases, the expertise of an international pharmaceutical company in terms of good quality manufacturing, and willingness to work in partnership with different partners (NGOs, national programmes, international organisations). The main areas covered are: preferential pricing (no profit-no loss), improvement of existing drugs, information, education and communication. They are present in seven priority areas: malaria, tuberculosis, sleeping sickness, leishmaniasis, epilepsy, mental health and vaccines. Between 2001 and 2006 more than one million vials were distributed, fourteen million tests performed and, according to WHO, 110,000 lives saved. Sanofi expect to consolidate these results and to contribute for the future with the hope of better products and continuous efforts of all the actors involved. (www.sanofi-aventis.com)

To conclude, M. B. Pecoul the Executive Director of DNDI presented the point of view of their NGO. Created in 2003, DNDI have seven founding partners: the Indian Council of Medical Research (ICMR), the Kenya Medical Research Institute (KEMRI), the Malaysian MOH, the Oswaldo Cruz Foundation, Brazil, Médecins Sans Frontières (MSF), the Institut Pasteur France, WHO/TDR (permanent observer). The vision is a collaborative, patients' needs-driven, virtual, non-profit drug research and development (R&D) organisation to develop new treatments against the most neglected communicable diseases. The primary objective is to deliver 6-8 new treatments by 2014 for leishmaniasis, sleeping sickness, Chagas diseas and malaria, to establish a strong portfolio that addresses patients' treatment needs. The secondary objective is to use and strengthen existing capacity in disease-endemic countries via project implementation. Two of the key issues are the development of new drugs for neglected diseases and to advocate for increased public responsibility. Even with current R&D, the need for new drugs is far from being addressed for the kinetoplastid diseases. It is important to seek pragmatic partnerships to deliver new field-adapted drugs for most NTD. M. Pecoul highlighted the need to deliver products to patients and to ensure that drugs are affordable and access is equitable.

After the presentations, the speakers were congratulated on the good results obtained in the past few years. One relevant question was about the partner chosen and medications under patent. Ms. Cayere observed that medication is chosen which is no longer subject to patent protection.

A Case of Liberia in New Disbursement for Strengthening the Health Systems

Author(s): B. T. Dahn1
Affiliation(s): 1Ministry of Health & Social Welfare, Monrovia, Liberia
Summary (max 100 words): The Health Sector of Liberia is being reformed following fifteen years of civil conflict. A National Health Policy and Plan was formulated in 2007 to address critical health issues. The Global Alliance for Vaccines and Immunization (GAVI) traditionally has supported Liberia in immunization system and injection safety. Over the past three years, DPT3 coverage has increased from 35% to 88%. Gains made in immunization could be jeopardized if, there are limited resources to support and strengthen the entire health system. In view of this and being cognizant of the confounding variables that impact on access and coverage of immunization and child health in general, GAVI approved the Health System Strengthening proposal in 2007. Major health system strengthening components being supported by GAVI include: strengthening Health Management Information System (HMIS), establishing a functional Monitoring and Evaluation Unit, Human Resource and training Unit, implementation of a Basic Package of Health Services including strengthening community health. The MOSWH with GAVI support and in collaboration with a multi-sectoral team in April 2008 conducted a community health assessment. There are some preliminary findings that we would like to mention as background to strengthening community health: i) the communities recognize their CHWs as valuable and with good results ii) the MOHSW supervises their interventions and activities iii) the training and certification has been done by MOHSW staff iv) the communities believe that they are “not responsible” for payment of CHWs and that MOHSW should do it. Community Health will be strengthened in Liberia by implementing three main activities:
1 – Development of a National Community Health Policy based on findings from the study Community Health Strategy to role out the community health policy Community Health Training Modules.
2 – As the ultimate beneficiaries of the Community Health workers is the community itself, enormous efforts will be undertaken to sensitize the communities to recognize the work of the Community health worker (CHWs TTMs and TMs) as part of their structure and also to reattribute their efforts and activities in the form of some sort of payment or incentives (cash or in-kind) which will ease the MOHSW of its pressure to pay them.
3 – The MOHSW of Liberia will then include the Community health policy and strategies to complement the other activities already being strengthened during the implementation of the BPHS with GAVI support: central level support ( national supervisors, HR development, HMIS etc) and health facilities support (EPI, HMIS, MCH and Newborn and especially IMCI).

Should the Development of New Antibiotics Be a Public Health Priority? Yes!

Author(s): G. B. Tomson*1, O. Cars2,  A. Heddini3
Affiliation(s): 1IHCAR Global Health, Karolinska Institutet, Stockholm, 2Infectious diseases, Uppsala University, 3Infectious Diseases, Uppsala Universitet, Uppsala, Sweden
Keywords: Antibiotic resistance, global threat, improved use, drug innovations
Background:

Antibiotic resistance has emerged as one of the most important global threats to public health. The global need for new antibiotics must be understood from two perspectives; first human rights and solidarity. The second antibiotic resistance cannot be addressed in isolation. Resistant bacteria are good travellers necessitating global action. The problem is multifaceted involving many aspects of human behaviour and societal structure. During the last decades, health sector reforms in LMIC focussed on privatisation and deregulation with financial incentives linked to irrational prescriptions. Although resistance is growing development of new antibiotics has declined. Only two new classes of antibiotics were introduced during the last 30 years. These drugs simply are not as profitable to the pharmaceutical industry as drugs that treat chronic conditions. The development of new antibiotics is highly challenging scientifically. There is already a significant mortality due to infections caused by antibiotic resistance. The post-antibiotic era has already been reached in many parts of the world, where physicians daily stand before severely ill patients who cannot be treated.The question is not whether or not we need new antibiotics – because we do – but by which mechanisms they should be developed. In addressing antibiotic resistance several areas need to be targeted: Improved use; Improved infection control/hospital hygiene; Development of novel antibiotics and complementary technologies (i.e. vaccines and new and/or improved diagnostic methods). It is not a matter of either or – but each of the above areas needs action. A completely new business model is called for, where the value chain in drug development is re-engineered to harness the capacity of both the private and public sectors and to ensure that any forthcoming products are made available to those who need them in all parts of the world. Elements of such a new model could include for example:
- Open source platforms for knowledge sharing that create the opportunity for synergy among scientists across organizations and geographic barriers
- Shared compound libraries specific for antibiotic drug discovery facilitating access to proprietary compounds for public-sector researchers
- Developing incentives for early development (crossing the “valley of death”) going from pre-clinical to clinical studies e.g. through Product Development Partnerships (PDPs)
- Support firms in low and middle income countries, small biotech, and scale-up of production at academic institutions that might enter antibiotic resistance R&D with lower opportunity costs and better economies of scale.
We cannot manage antibiotic resistance only relying on better use of existing drugs. There are important lessons to be learned from diseases such as malaria, TB and HIV.

GHF2010 – PS30 – Foreign Policy, Trade and Health: Finding The Right Balance

Session Outline

Parallel session PS30, Monday, April 19 2010, 16:00-17:30, Room 13
Chair(s): Nick Drager, Senior Fellow, Global Health Programme, Graduate Institute for International and Development Studies, Switzerland
Discussant: John Hancock, Counsellor, Economic Research Division, World Trade Organization, Switzerland
Summary: There is a growing realization that public health may be affected by trade and the rules set out in international trade agreements. Trade can affect health both positively and negatively. In particular, the increasing liberalization of trade in health services creates new opportunities while posing new challenges for the efficient, equitable and sustainable provision of health services. Many countries have undertaken extensive analysis of these issues, and have gained experience in implementing policies to steer developments in the desired direction. Meanwhile, other countries still struggle to find an entry point for dealing with these often complex and unfamiliar issues that require both knowledge and analytical capacities to understand them. In 2006, the World Health Assembly adopted a resolution on international trade and health, which calls on Member States to ensure that health and trade are balanced. It also highlights the need for capacity building to increase understanding of the health implications of trade and trade agreements. To support national governments in their effort to develop coherent policies on trade and health, WHO, in collaboration with WTO, and country partners are developing a toolkit to assess implications of trade and trade agreements for health. This tool is expected to be available by the end of 2010. Drawing on the experiences of two countries, this session brings together experts actively involved in the development of the toolkit. It presents the new instrument and how it will eventually inform policies and strategies in trade and health, helping countries to identify their capacity building needs in this area.
Shifting Territory: Trade Agreements and the Making of Health Policy in Barbados
Jamila Headley, Department of Public Health, University of Oxford, United Kingdom
Cart before the Horse: A Sri Lankan Experience of Negotiating Trade in Health Services
Manuj Weerasinghe, Senior Lecturer, Department of Community Medicine, Faculty of Medicine, University of Colombo, Sri Lanka
Introduction to the WHO Trade and Health Assessment Tool Kit
Chantal Blouin, Associate Director, Centre for Trade Policy and Law, Carleton University/University of Ottawa, Canada

Session Document

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Session Report

Photo by John Brownlee, ICVolunteers.org

Dr Nick Drager, chair of the Foreign Policy, Trade and Health session led an impromptu seminar on Global Health Diplomacy and Development, as none of the other speakers or presenters could attend the session. The focus of his presentation was on health diplomacy and the health care system. He discussed the changing policy environment, the development of new instruments, national foreign policy and health, and national global health strategies.

Dr. Drager's discussion on the changing policy environment covered the huge economic impact of infectious disease outbreaks; he cited the high economic cost of SARS versus the relatively small medical cost. In the past, the World Health Organization (WHO) had to rely on countries reporting any outbreak of a communicable disease before it could act; now, WHO has the Strategic Health Operations Centre (SHOC). Every morning, the SHOC meets to trawl through rumours, seeking the truth behind statements received from a number of sources from around the world. SHOC's task includes the verification of disease outbreaks.

A London-based school has been tasked with identifying key emerging issues in health care systems, as well as the top five non-health sector priorities that will affect health. Its work identified the key emerging issues as 1) the sharing of viruses and biological specimens for the development of vaccines; 2) diagnostics and medications; 3) anti-biotic resistance; 4) intellectual property, innovation, access to medicines; and 5) trade in health services. Dr. Drager stated that "developing countries are tired of giving up their specimens and having medicines created that they cannot afford". The school also identified the non-health sector issues as water, food, energy, climate change and population growth, factors that the speaker emphasised as key policy challenges for governments.

Dr. Drager then jumped into a discussion on the collaboration between the WHO and World Trade Organization (WTO). When delegations make official visits abroad, they are accompanied by delegates from the WHO and WTO. Initially this promotes greater access to key officials, but in fact complies with the rising crossover between health and trade. To illustrate his point, Dr. Drager presented a case study on Vietnam and its accession to the WTO. He pointed out that Vietnam had had to resolve specific health issues, such as infectious disease control, by complying with WTO trade accords.

The discussion continued about the risks and opportunities associated with trade in health services. The speaker sees trade as a key determinant of health, and the WTO Trade Related Aspects of Intellectual Property Rights Agreement (TRIPS) could exceed the importance of, for example, universal access to drugs. He noted that significant risks are associated with trade in health services, but they could be outweighed if the key questions were satisfied: lower costs, increased quality of care and increased access to care.

Regime design within the global health domain is another important factor for an equitable system. As evidence, Dr. Drager cited Indonesia’s reluctance to hand over specimens of the H5N1 virus. Indonesia, with the support of others, had rightly questioned the pressure to hand over their biological specimens. They knew that no benefit for their country would be derived from doing so, and argued that by putting the risk to global public health first they would be endangering their own population. Since the H5N1 epidemic, three years of negotiation were necessary to establish a more equitable and binding system of instruments. Although the negotiations are ongoing, talks have been stalled on three issues: intellectual property; whether benefits should be mandatory or voluntary; and trade policy.

In his description of the current range of WHO instruments, Dr. Drager questioned how future instruments and governance procedures should look. Drawing an analogy with the World Trade Organization (WTO) complaint procedure, he noted that governance procedures might have to include an enforcement system. He also pointed out the need to understand the interaction between instruments, to research the effectiveness of binding and non-binding instruments, and to develop a set of measurable criteria to evaluate their effectiveness. Negotiations, he added, were the key to developing instruments to stimulate national action and international cooperation.

The last topic addressed was the increasingly collaborative nature of foreign policy and the need to develop a global health policy. Today, global health touches on all the core functions of foreign policy, and some countries are preparing their diplomats to work in the field of global health strategy. A comprehensive United Nations General Assembly resolution has put ‘Global Health Foreign Policy’ on the international agenda.

Several countries are developing their global health strategies, and Dr. Drager presented the benefits at the national level. To identify priority areas for action, he said, would be the first step in the development of a strategy. The process will inevitably be a long one.

GHF2010 – PS17 – Are GHIs Moving Towards Effective Health Systems Strengthening?

Session Outline

Parallel session PS17, Monday, April 19 2010, 14:00-15:30, Room 4
Chair(s): Rachel Nugent, Deputy Director, Global Health, Centre for Global Development, USA, Wim Van Damme, Professor, Department of Public Health, Institute of Tropical Medicine, Belgium
Summary: The High-Level Dialogue convened in 2009 in Venice by WHO acknowledged 'that the impact of GHIs on health outcomes and health systems, though variable, has been positive on balance and has helped to draw attention to deficiencies in health systems'. This statement recognizes that GHIs and those who invest in country health systems have shared goals, namely to improve health and to save lives. In March 2009, the GFATM, GAVI and World Bank, with technical support from WHO, launched inter-agency consultations on aligning HSS funding frameworks with the aim of developing mechanisms for joint HSS funding and programming. These efforts seek to simplify investments to deliver results in line with country leadership. This session aims at providing a critical reflection on the whether the latter implies just adding another layer to an already complex aid architecture. This session will engage dialogue between GHF delegates and representatives of international organizations (GAVI, GFATM, WHO) about how to move forward with the health systems strengthening agenda.
Debat panel: Martin Taylor, Senior Policy Analyst, Strategy Performance and Evaluation Cluster, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Switzerland, Carole Presern, Managing Director, Special Projects, The Global Alliance for Vaccines and Immunization, Switzerland, Wim Van Lerberghe, Director, Department for Health System Governance and Service and Delivery (HDS), World Health Organization, Switzerland, Mit Philips, Analysis and Advocacy Unit, Médecins sans frontières, Belgium

Session Document

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Session Report

Contributors: Terri Kluzik (ICVolunteers), Josefine Ridderstrale (ICVolunteers)

Photo by John Brownlee, ICVolunteers.org

Are Global Health Initiatives (GHIs) helping or harming local health care systems in poor countries? This session described the present and the future funding of GHIs, highlighting three areas: the experiences and lessons of Ethiopia, the new integrated platform introduced by the Global Health Fund (GHF) and the trends of long-term impact of the availability of aid.

Should GHIs give long-term funding to countries so that domestic funding can catch up with the level of funding previously provided by donors? Dr. Gorik Ooms, from the Department of Tropical Health, Institute of Tropical Medicine in Antwerp, Belgium, demonstrated the long-term unreliability of global aid. If a country uses GHI funding to train and hire nurses, they may need to fire these workers when the aid ends.

Yibelta Assefa, Medical Services Director from Ethiopia, presented research on how Ethiopia, a challenged and poor country, has been impacted by global aid. They are facing a health care workforce shortage and migration of health care professionals. Health care trends in Ethiopia indicate the total health workforce is significantly lower than the World Health Organization’s (WHO) recommendation. For example, in 2002, 17% of nurses and 30% of doctors left the country.

According to Mr. Assefa, The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Alliance for Vaccines and Immunisation (GAVI) and World Bank have given resources to Ethiopia for health workforce training and salaries. He mentioned that funding has made a positive impact on local health systems and programme implementation, including increasing the numbers and capacity of the workforce. However, it has disrupted the functioning of general services by poaching highly skilled health workers from training institutions and because it lacks a long-term strategy.

Based on the experience in Ethiopia, Mr. Assefa recommends that GHIs should focus on funding that has a health system “mindset” with a long-term impact. They should support the broader health workforce strategy and align with the national healthcare policies and plans, supporting public sector human resources.

Focusing on the financial and global cooperation of GHIs, Dr. Shakarishvill, senior Advisor at the Global Fund, described the health systems funding platform, a joint initiative of the Global Fund, GAVI Alliance, the World Bank and the World Health Organization. They are developing mechanisms for channelling donor funding and improving GHIs by providing flexibility at the local level. The objective is to create a mechanism to harmonise cooperation between the partners and the countries, to decrease costs and increase efficiencies. They expect to launch the new initiative by 2011.

Dr. Kumar of UNICEF reinforced Mr. Shakarishvill’s remarks, stating that the goal of the integrated approach to funding GHIs is to simplify the process for countries to obtain funding.

H1N1 Vaccine Production: The Industry Perspective

Author(s): N. Hehme1
Affiliation(s): 1Biologicals & Vaccines, IFPMA, Geneva 20, Switzerland
Background: The global response to the 2009 / 2010 H1N1 influenza pandemic is the most comprehensive ever achieved, demonstrating that international organizations, national governments, scientists and manufacturers can work together quickly and effectively to protect populations around the world.
Methods:

For many years prior to the recent pandemic, the vaccine industry worked on preparations for a robust and rapid response to such an eventuality. This work included the development and testing of new vaccines and technologies, the adaptation of facilities for pandemic vaccine production and the establishment of comprehensive operational plans. Although these activities were in preparation for the H5N1 influenza threat, with the emergence of the novel H1N1 strain in 2009, the preparatory actions were able to be fully utilized, resulting in the rapid development, production and supply of vaccines targeting the new virus.

Results/Conclusions:

Within approximately three months of the pandemic declaration a number of manufacturers had undertaken production scale-up, manufactured doses for clinical trials testing and received approval from the regulatory agencies. This allowed various public health authorities to initiate vaccination campaigns targeting at-risk groups. Achieving this involved overcoming a number of challenges, as the rapid development and production of pandemic influenza vaccines is technically complex. As a result, close collaboration is required between WHO and essential regulatory laboratories, public health authorities and manufacturers. This presentation will explore this collaboration in more detail, and identify the ‘lessons learned’ that should inform future preparedness activities.

GHF2010 – PS35 – Pandemic Preparedness and Response: Lessons Learned from H1N1

Session Outline

Parallel session PS35, Monday, April 19 2010, 11:00-12:30, Room 2
Chair: Tessa Richards, Assistant Editor, British Medical Journal (BMJ), United Kingdom
H1N1 Preparedness and Response: Early Lessons Learned
Sandra Jack-Mounier, Lecturer, Department of Public Health and Policy, Communicable Diseases Policy Group, London School of Hygiene and Tropical Medicine, United Kingdom
Global Response to Pandemics: Navigating amidst Great Uncertainty
Dominique Legros, Medical Officer, World Health Organization, Switzerland
H1N1 Vaccine Production: The Industry Perspective
Norbert W. Hehme, Chair, IFPMA Influenza Vaccine Supply (IVS) International Task Force, Germany
The Ethics of Pandemic Preparedness for Migrants and Host Communities
Montira Inkochasan, Migration Health, International Organization for Migration, Laos

Session Documents

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Session Video

This session is available to watch using Dudal. To watch it you will need to have Java installed on your computer.

Session Report

Submitted by: Mary Picard (ICVolunteers); Contributors: Jane Marriott (ICVolunteers)

Healthcare practitioner administering the H1N1 live attenuated intranasal vaccine (LAIV), photo Public Health Image Library (PHIL) of CDC, James Gathany

Major lessons learned from the recent H1N1 flu pandemic were presented by representatives of the WHO, the International Organisation for Migration (IOM) and the pharmaceutical industry. Topics discussed were the importance of the revised International Health Regulation (IHR) in the sharing of information between governments, the necessity of communicating directly with the public and crisis management during the acute phase of the health crisis, and improved risk management models. Topics of ethics in pandemic preparedness among migrant communities and consequences for host governments were also examined.

Dominique Legros, Medical Officer for the World Health Organization (WHO), presented a talk entitled Global Response to Pandemics: Navigating Amongst Great Uncertainty. He discussed similarities and differences between the H1N1 pandemic and previous pandemics encountered in recent public health history such as Ebola, Marburg, SARS and Avian Flu.

The H1N1 pandemic varied from previous recent strains of influenza in that populations had very little immunity, the virus spread very quickly internationally and the concentration of deaths and complications were found in younger segments of the population. At the level of global coordination, it was the first time many countries were well prepared with stockpiles of vaccines and with coordinated and shared information and communication, due, in large part, to IHR which came into effect in 2007. Additionally, public access to information was not limited to government channels. Improved models of risk assessment by WHO and outside agencies allowed for improved tracking and coordination during the acute phase of the crisis. These models were used both in material (vaccine preparation) coordination and the tracking of health risks. For the first time, direct communication with the public became a critical factor. The speaker acknowledged that the handling of the pandemic by WHO was being reviewed by an external body, as outlined by the IHR, with preliminary findings being released in May of 2010.

Montira Inkoshasan, of Migration Health for the IOM Laos, spoke of the absolute necessity for the world and for individual governments to address the needs of migrant Groups and refugees in their planning. Ms Inkoshasan mentioned the fact that this vulnerable group is still largely neglected when it comes to host-nation planning, though this often occurs due to oversight rather than conscious neglect.

In a survey recently carried out by the IOM, it was found that only two global plans referred to the need for the clinical treatment of migrant workers and only one national plan recognised the risk of stigma and discrimination for these vulnerable groups. Language and addressing cultural differences is the key to creating viable planning options for migrant populations. It is the lack of fluency in the host-county’s language which has meant migrants and other vulnerable groups have been excluded in most of the National, Regional and Global Pandemic Plans.

The IOM will continue to promote awareness of migrant needs and their inclusion in pandemic preparation plans in all communities worldwide.

Ms Bernat of IFPMA Influenza Supply was standing in for Norbet Hehme of the same organization. She discussed the pharmaceutical industry’s review of the H1N1 pandemic, specifically the need for increasing global collaboration. The industry and WHO worked together to ensure that there was a plentiful supply of H1N1 vaccines before the start of the influenza season in November 2009 through constant communication and consultation.

However, Ms Bernat commented that for manufacturers to continue to strengthen their state of preparation, it is important to maintain and enhance both drugs and systems, particularly in regard to the support of developing countries. The industry is currently concerned with strengthening future preparedness and understands that information dissemination and communication are essential.

There is a need, underlined Ms Bernat, for WHO to work towards improving and standardising its communication systems to make future decision making more streamlined and therefore quicker and more effective.

Ms Bernat stated that the industry continues to learn from last year’s pandemic and is committed to improving its communication and vaccine production systems in conjunction with WHO.

The moderator, Mr R. Waldgate, a freelance journalist specializing in medicine and world health, most notably with the Lancet, stood in for Tessa Richards, assistant editor of the British Medical Journal. He began the discussion segment with the question of whether WHO was ready for a pandemic in South America. The answer was that it would depend, as always, on the level of demand for medication and that this was of course the unknown which makes a response so uncertain.

Mr Waldgate went on to ask whether public trust had been eroded by the controversy surrounding the response to last year’s H1N1 pandemic, which displayed communication failings and a rush to increase vaccine production which, in hindsight, may have been unnecessary.

Interestingly, Ms Bernat, speaking on behalf of the pharmaceutical industry, declined to respond but directed the audience to statements on this subject already issued by the industry’s official press.

A spokesman for Médicins sans Frontières (MSF) asked for some clarification of global capacity for vaccine production. Ms Bernat responded that total world-wide capacity is 4.49 million, which has to cover pandemic requirements as well as normal demand for doses of seasonal influenza vaccines.

There was a general consensus that more needs to be done to reach the world’s poorest populations and that this is largely the responsibility of individual countries. Intellectual Property Watch, here in Geneva, raised the point of unfair distribution of vaccines. During last year’s H1N1 pandemic, there was a shortfall in supply of vaccines in developing countries at the same time as there was a surplus elsewhere. The participants agreed that a fairer distribution needs to be made a priority in future.

An interesting question was raised by a manager from the University Hospital in Geneva (HUG) as to what can be done in the future about the significant number of the public who were reluctant to be vaccinated against H1N1, particularly here in Western Europe. The consensus was that this is a matter of better communication between health officials and the public. A new web-site is being planned by the Institut Pasteur in order to address the need for better dissemination of accurate information on health issues.

Interestingly, the public response differed around the world. In particular, there was a contrast between the public response in North America and that in Europe. The delegates believed the media had played a big role in this contrasting response and that communication between WHO and Governments needed to be looked at. Someone from the floor asked about how much the pharmaceutical industry had profited from the creation and distribution of the H1N1 vaccine. The panel referred to information published by individual pharmaceutical companies.

In an interview conducted after the meeting, Dominique Legros highlighted the role of a ‘no risk’ policy, which many governments around the world apply to public safety, in guiding them to err on the side of caution when judging possible vaccine requirements. Manufacturers plan production based on these government estimates. The current grounding of all commercial aircrafts in Europe is an example of this ‘no risk’ attitude at work.

Healthcare for All: The True Millennium Development Goal

Author(s): Bruno Gryseels1
Affiliation(s): 1Director, Institute of Tropical Medicine, Antwerp, Belgium
Meeting challenges: Health for All by 2000, the objective launched in 1978 by the World Health Organization at Alma Ata, was based on a strategy of accessible, comprehensive and responsive primary health care. Several countries have delivered proof of principle of this concept, be it that strong political will, sufficient resources and contextual flexibility are required. By 2000, however, most of the world’s poor still had no access to quality care for basic pathologies and continued to suffer unacceptable morbidity and mortality. The health Millennium Development Goals (MDG) have inconspicuously replaced the Alma Ata agenda. Without defining a clear strategy, they focus on measurable improvements by 2015 in child and maternal health, and the control of AIDS, malaria and tuberculosis. A wide array of international initiatives have taken up these challenges, while those concerned with other diseases reformulate their priorities and strategies so as to match the MDG. Most of these global programmes are steered from the North, promote universal approaches and vie for the same international funds and visibility. Coordination and contextualisation of and competition between the many vertical programs have to be managed by national health authorities. At the end of the line, the local health workers have to integrate the actions in their daily routine, while being already overburdened and under-equipped to deal with the daily demands of their patients. As the need for strong health systems to achieve sustainable disease control is being rediscovered, their primary objective is narrowed down to reaching the MDG. This notion, however, fails to meet the universal human right to comprehensive health care, the true needs of the communities, and the requirements for sustainable disease control.
Conclusion (max 400 words): Health for all may have been a too ambitious and somewhat misleading goal. An overarching agenda of health care for all would embrace both the Alma Ata objective and the MDG targets. In comparison, also the second MDG pleads for universal primary education rather than expected outcomes. First and foremost, accessible and comprehensive health care is a basic human right, and key to the well-being, dignity and development of individuals as well as communities. Second, structurally sound health services are a prerequisite for proper case management, and therefore indispensable for the control and surveillance of specific diseases including those targeted by the MDG. Moreover, quality health services are vital to ensure and maintain the intrinsic potential of drugs, vaccines and technology. Third, investments in research for new tools and strategies will only pay off if the results can be delivered through accessible and adequate health services. In turn, only strong health systems will provide the structural market conditions for the development of new drugs, vaccines and diagnostics, and for the attraction of sufficient and qualified human resources. Fourth, only a well-established health sector will be able to steer the intersectoral efforts that are needed for the prevention of infectious as well as non-communicable diseases. Finally, the development of community-based health care may become, as in the industrialized world a century ago, a strong motor for political empowerment and democratisation.