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PHA-Exchange Digest, Vol 75, Issue 1

Send PHA-Exchange mailing list submissions to


To subscribe or unsubscribe via the World Wide Web, visit
or, via email, send a message with subject or body 'help' to


You can reach the person managing the list at


When replying, please edit your Subject line so it is more specific
than "Re: Contents of PHA-Exchange digest..."


Today's Topics:


   1. Problems with pha-exch miggrating to a new host (Claudio Schuftan)
   2. Human Rights Report PHM UK (Claudio Schuftan)
   3. Health Essay Competition (Claudio Schuftan)
   4. Health and human rights (HHR) new blog - invitation for    PHM
      postings (Claudio Schuftan)
      (Claudio Schuftan)
   6. Dr M. Chan: Keynote address at the 12th World Congress on
      Public Health (Claudio Schuftan)
   7. Dr Binayak Sen Release-14th May Events - India, UK, USA
      (Claudio Schuftan)
   8. WB: World Development Indicators 2009 (Claudio Schuftan)
   9. TWN Press statement: Fair access to influenza treatments
      (Claudio Schuftan)
  10. A global fund for the health MDGs? (Claudio Schuftan)
  11. A global fund for the health MDGs? (2) (Claudio Schuftan)




Message: 1
Date: Mon, 4 May 2009 04:45:40 +0700
From: Claudio Schuftan
Subject: PHA-Exch> Problems with pha-exch miggrating to a new host
To: pha-exchange@phm.kabissa.org
Content-Type: text/plain; charset="iso-8859-1"


So sorry everybody. Probs are due to the migration to the new
server...glitches. Bare with us; being taken care of.
Some of you have been flooded with confusing subscribe/unsubscribe emails.
All addresses are being transfered to the new server. I have received a few
unsubscribe messages which I will process in the new address when it is
working well.
This is one of the latest messages you will get from this address. We will,
from now on, be phm-exchange (instead of pha-exchange).
Warm regards
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Message: 2
Date: Tue, 5 May 2009 00:52:15 +0700
From: Claudio Schuftan
Subject: PHA-Exch> Human Rights Report PHM UK
To: pha-exchange@phm.kabissa.org, Abhay Seema
Content-Type: text/plain; charset="iso-8859-1"


PHM in the UK, in association with Medact and Doctors for Human Rights has
completed a report on human rights and health in the UK. The report has been
submitted to the UN Committee on Economic, Social and Cultural Rights. It
can  be found on the UN high commission for human rights website;
http://www2.ohchr.org/english/bodies/cescr/cescrs42.htm under the list of
country reports.
>From Margaret Reeves, PHM UK coordinator
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Message: 3
Date: Thu, 7 May 2009 13:55:08 +0700
From: Claudio Schuftan
Subject: PHA-Exch> Health Essay Competition
To: pha-exchange@phm.kabissa.org
Content-Type: text/plain; charset="iso-8859-1"


From: Vern Weitzel
crossposted from: "[health-vn discussion group]" health-vn@anu.edu.au


The Global Forum for Health Research and The Lancet are sponsoring their
fourth joint essay competition with the theme Innovating for the health
of all, held in conjunction with Forum 2009, the annual meeting of the
Global Forum that takes place in Havana, Cuba, from 16 to 20 November.


The Global Forum's vision is of a world in which the potential of
research and innovation is fully utilized to address the health problems
of the poor. Innovation is defined as the creation, development and
implementation of a new product, process or service, with the aim of
improving efficiency, effectiveness or competitive advantage. Research
for health therefore goes far beyond medicine and biology, to include
sectors such as economics, environment, politics, sociology and others.
Innovating for the health of all involves both social and technological


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Message: 4
Date: Thu, 7 May 2009 14:07:53 +0700
From: Claudio Schuftan
Subject: PHA-Exch> Health and human rights (HHR) new blog - invitation
    for    PHM postings
To: pha-exchange@phm.kabissa.org
Content-Type: text/plain; charset="iso-8859-1"


I have received the following:
From: FXB HHR Journal HHRJOURNAL@hsph.harvard.edu


Dear Claudio,
Have you received a response from other PHM members to our journal's
proposal that they submit regular blog posts? We're particularly interested
in how blog contributions by PHM members can work and whether different
people would be willing to take it on.  Our primary interest is in receiving
blogs from a range of different PHM members in a regular and timely manner.
This blog will promote a number of voices on HHR issues, giving members of
PHM an opportunity to air their various perspectives.


Contributions are to be of 700-word pieces. Propose specific subjects and
let us know when we might anticipate receiving these postings.  In terms of
frequency, we anticipate that other groups will post an article on the
average rate of one every two weeks; so your GROUP may plan and have
such schedule in mind.


We look forward to the response!
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Message: 5
Date: Thu, 7 May 2009 14:13:15 +0700
From: Claudio Schuftan
To: pha-exchange@phm.kabissa.org
Content-Type: text/plain; charset="windows-1252"


From: Vern Weitzel
crossposted from: "[health-vn discussion group]" health-vn@anu.edu.au


New York, May  6 2009  2:00PM
The United Nations today announced a renewed round of international efforts
combat malaria with a reduced reliance on the controversial synthetic
Dichloro-Diphenyl-Trichloroethane (DDT).


A number of projects, involving some 40 countries in Africa, the Eastern
Mediterranean and Central Asia, are set to test non-chemical methods of
eradicating the deadly disease, ranging from eliminating potential mosquito
breeding sites and securing homes with mesh screens to deploying
mosquito-repellent trees and fish that eat mosquito larvae.


The new projects follow a successful five-year pilot programme using
alternatives to DDT in Mexico and Central America, where pesticide-free
techniques and management procedures have helped cut cases of malaria by
over 60
per cent.


The UN Environment Programme
and the World Health Organization
are spearheading the ten new projects, with close to $40 million in funding
the Global Environment Facility (GEF).


The agencies aim to cut DDT use by 30 per cent worldwide by 2014 and phase
the use of the pesticide completely by the early 2020s while staying on
with WHO malaria eradication targets.


“The new projects underline the determination of the international community
combat malaria while realizing a low, indeed zero, DDT world,” said UNEP
Executive Director Achim Steiner. “Today we are calling time on a chemical
rooted in the scientific knowledge and simplistic options of a previous


However, concern over DDT is matched by concern over the close to 250
malaria infections a year which result in over 880,000 deaths.


WHO Director-General Margaret Chan noted that the agency “faces a double
challenge, a commitment to the goal of drastically and sustainably reducing
burden of vector-borne diseases, in particular malaria, and at the same time
commitment to the goal of reducing reliance on DDT in disease vector


Malaria is caused by a parasite, transmitted through infected mosquito
bites. In
the human body, the parasites multiply in the liver and then infect red
cells, causing fever, headache, and vomiting between 10 and 15 days after
mosquito bite. If not treated, malaria can quickly become life-threatening
disrupting the blood supply to vital organs.
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Message: 6
Date: Thu, 7 May 2009 21:46:02 +0700
From: Claudio Schuftan
Subject: PHA-Exch> Dr M. Chan: Keynote address at the 12th World
    Congress on    Public Health
To: pha-exchange@phm.kabissa.org
Content-Type: text/plain; charset="windows-1252"


Keynote address at the 12th World Congress on Public Health
Istanbul, Turkey
27 April 2009
Steadfast in the midst of perils Dr Margaret Chan
Director-General of the World Health Organization


Mr President, Paolo Buss, Your Excellency, President Abdullah Gul,
Honourable Minister of Health, Recep Akdag, Professor Ishan Dogramaci,
colleagues in public health, ladies and gentlemen,


First, let me thank the government of Turkey and the Turkish Public Health
Association for organizing and hosting this world congress. It is a pleasure
to meet in beautiful and historic Istanbul, where so many cultures converge.


In the recent past, some world trends have converged to the vast benefit of
public health. Others threaten to set us back. We are meeting at a time when
public health is caught in a cross-current, with a potentially lethal


>From one direction, public health is bolstered by unprecedented commitment,
determination to reach ambitious goals, and creativity in finding ways to do
so. From another direction, public health is battered by the consequences of
bad policies made in other sectors.


Since the start of this century, we have seen the launch of new funding
mechanisms, new initiatives, and a host of new partnerships for health


Since the start of this century, commitments of official development
assistance for health have more than doubled. Health has never before
enjoyed such attention or benefitted from such wealth.


No one wants to see this momentum falter. But it is definitely under threat.
We have made some impressive progress, but new challenges keep arising.


Last year, our imperfect world delivered, in short order, a fuel crisis, a
food crisis, and a financial crisis. It also delivered compelling evidence
that the impact of climate change has been seriously underestimated.


All of these events have global causes and global consequences, with serious
implications for health. They are not random events.


Instead, they are the result of massive failures in the international
systems that govern the way nations and their populations interact. In
short: they are the result of bad policies.


Under the unique conditions of the 21st century, the consequences of faulty
policies are highly contagious. This contagion shows no mercy and makes no
exceptions on the basis of fair play.


Even countries that managed their economies well, did not purchase toxic
assets, and did not take excessive financial risks are suffering the


Likewise, the countries that have contributed least to greenhouse gas
emissions will be the first and hardest hit by climate change. The health
sector, which had no say when these policy decisions were made, will bear
the brunt of the consequences.


Already, nearly one billion people are living on the margins of survival.
These people have no coping capacity. It does not take much to push them
over the brink. There is no cushion to absorb the shocks of an economic
downturn, high food prices, climate change, more floods and droughts, and a
shrinking food supply.


Already, the costs of health care push an estimated 100 million people below
the poverty line each year.


These are bitter ironies at a time when the international community is
engaged in an unprecedented drive to reduce poverty and reduce the great
gaps in health outcomes.


Ladies and gentlemen,


Collectively, we have failed to give the systems that govern international
relations a moral dimension. The values and concerns of society rarely shape
the way these international systems operate.


In far too many cases, economic growth has been pursued, with single-minded
purpose, as the be-all, end-all, cure-for-all. The assumption that market
forces could solve most problems has not proved true.


Too many models of development have assumed that living conditions and
health status would somehow automatically improve as countries modernized,
liberalized their trade, and improved their economies.


This did not happen. In fact, some would argue that the rise of chronic
diseases is an indication that a country has successfully liberalized its
trade and modernized its economy.


Between the policy decisions and the assumed results falls the reality. The
rising tide of globalization has not lifted all boats. Instead, wealth has
come in waves that lift the big boats but swamp or sink many smaller ones.


In reality, the differences, within and between countries, in income levels,
opportunities, and health status are greater now than at any time in recent


Something has gone terribly wrong.


As the economists tells us, the current financial crisis is so severe
because it comes at a time of radically increased interdependence among


But it is not just nations, financial markets, and economies that are
closely interdependent. Different sectors are also closely intertwined.
Policy spheres are no longer distinct.


Our world’s fate and fortunes are truly interconnected in a web, so that if
you pull one string in one sector or system, the vibrations are felt in many
others. A policy that seems perfectly sound and good for one sector can have
severely negative side-effects in others.


The single-minded pursuit of economic growth, compounded by behaviours
motivated by greed, has had negative consequences well beyond the financial
and economic sectors.


Policy-makers have either failed to anticipate these consequences or assumed
that problems would be solved by market forces. This did not happen.


Let me be perfectly clear. I am not against free trade. I am not in favour
of protectionism. I am fully aware of the close links between greater
economic prosperity, at household and national levels, and better health.


But I do need to say this. The market does not solve social problems. Public
health does.


Ladies and gentlemen,


The financial crisis has ushered in a time of great soul-searching. As some
ask: have we gone adrift? Have the great ships of state lost their rudders?


According to many experts, the financial crisis is a watershed event. They
foresee transformational changes as the world rethinks how it works and
redesigns its international systems.


Where does public health stand as the world rethinks itself? How can we keep
this cross-current of promises and perils, of commitments and crises, from
turning into a deadly undertow for health?


I personally believe that public health offers much of what is now accepted
as missing in our flawed systems of international governance.


At the end of last month’s G20 summit in London, Prime Minister Gordon Brown
declared that the reign of the Washington Consensus is over. It needs to be
replaced by a new consensus that incorporates moral values. This view was
echoed by many others.


What we are now hearing is calls for a fundamental re-engineering of the
international systems. We are hearing clear calls, from leaders around the
world, to give these systems a moral dimension and to invest them with
social values – like equity, sustainability, community, and social justice.


Personally, when I hear these calls, I cannot help but think of primary
health care and the value system articulated in the Declaration of Alma-Ata
30 years ago.


Even before the financial crisis, many public health leaders saw great merit
in returning to the values, principles, and approaches of public health.


In my view, values like equity and social justice are more important now, in
this out-of-balance world, than ever before.


Human society has always been characterized by inequities. History has long
had its robber-barons, and its Robin Hoods. The difference today is that
these inequities, especially in access to health care, have become so


Technical tools for saving and prolonging lives keep getting better, yet
more and more people are left behind, excluded from the benefits of even the
older tools.


And there is a second difference. The revolution in information technology
makes these inequities highly visible, in real time. All around the world,
people’s expectations for health care are rising.


They want health care that is fair as well as affordable and of good
quality. Governments would be wise to heed this rising tide of expectations.
As the economists, and the historians, tell us, vast inequities, also in
health outcomes, are a precursor for social breakdown.


Ladies and gentlemen,


I see some good reasons for hope. Without question, public health is already
being used as a platform and a lever for giving this lopsided world greater
balance. And rightly so.


The principle of fairness in health is straightforward. People should not be
denied access to life-saving and health-promoting interventions for unfair
reasons, including those with economic or social causes.


In the health sector, fairness is not an abstract utopian ideal. It is a
matter of life or death.


The HIV/AIDS epidemic brought unprecedented attention to the issue of fair
access to health care. When effective antiretroviral treatments became
available, an ability to pay became equivalent to an ability to survive for
many millions of patients.


AIDS made inequitable access to health care both highly visible and
ethically unacceptable. This, in turn, helped build determination to tackle
many other inequities in health outcomes, especially when an inability to
pay for existing, effective interventions was considered a leading cause.


When we look at the health sector, we find some good evidence that fairness
is a priority for the international community, that equity matters, and that
the health sector is a prime entry point for its pursuit.


In a sense, the Millennium Declaration and its Goals operate as a corrective
strategy. They aim to ensure that globalization is fully inclusive and
equitable, and that its benefits are more evenly shared. They aim to give
this world a greater degree of balance: in opportunities, in income levels,
and in health.


The underlying ethical principle is straightforward: those who suffer or
benefit least deserve help from those who benefit most. In other words, the
Millennium Development Goals aim to compensate for international systems
that create advances and advantages, yet have no rules that guarantee the
fair distribution of these benefits.


In a sense, the Global Fund is a mechanism for the redistribution of wealth
in ways that bring down mortality in populations that cannot afford
life-saving interventions.


GAVI exists to help ensure that children are not denied the benefits of new
and more expensive vaccines simply because they were born in a poor country.


Advance market commitments for new vaccines aim to compensate for the fact
that industry will not invest in vaccine R&D for diseases of the poor, who
have no purchasing power.


UNITAID is a drug purchasing facility that draws funds from a levy on
airline tickets, graded according to class. Its slogan is telling: making
globalization equitable.


All of these initiatives and mechanisms are, in a sense, corrective
strategies for market failure, corrective strategies for a world that has
been growing more and more unfair, in deadly ways.


They are absolutely essential. This world will not, all by itself, become a
fair place for health. This must be a deliberate effort, underpinned by an
explicit value system.


It would be better, of course, if public health did not always have to
correct and compensate for flawed policies in other sectors, and flawed
systems of international governance.


But let me be frank. Support for public health can be fickle. We see very
welcome support for the purchasing of interventions, like vaccines, bednets,
and medicines for AIDS and TB. But investment in the health systems needed
to deliver these interventions has been neglected for decades.


We see a significant rise in funding for health, but not in support for the
general budgets of health ministers. Such budget support is essential for
planning, the training and retention of staff, national ownership, and the
responsibility and accountability of governments to their citizens.


Perhaps most telling, when policies aimed at health promotion cross purposes
with economic goals or corporate business strategies, economic interests
trump health concerns time and time again.


Can this change in the current climate of critical re-thinking?


The health sector remains chronically short of funds, and this situation
risks deteriorating further during the economic downturn.


We have long had to sell health to the highest bidder. We sell health to
ministers of finance as a good economic investment. We sell health to
ministers of foreign affairs as an investment in health security, or human
security, or epidemiological security. We sell health as human capital,
social capital, and an engine for productivity.


Can this change? In a better world, health would be pursued for its own
sake, its own intrinsic worth as a condition that allows people to develop
their human potential. In fact, as a basic human right.


Some political analysts in affluent countries have taken yet another lesson
from the financial crisis. As they say, it is time to understand that a
well-managed and generous welfare state is not an enemy of globalization.
Instead, it is the saviour.


Ladies and gentlemen,


In these difficult times, we have some powerful arguments and instruments at
our disposal.


We have a strong value system, eloquently articulated in the Declaration of
Alma-Ata. We have corrective strategies and facilities for steering, or at
least nudging, this world towards greater fairness, and thus upholding these


We have a powerful policy instrument in the report of the Commission on
Social Determinants of Health, issued last year. And we have a powerful
approach for operationalizing these values, strategies, and policies. This
is, of course, primary health care.


In conclusion, let me say this to all my colleagues in public health. Stay
steadfast. Steer steady through this turbulent sea of perils, old and new.


After all, public health has always been on course.
Thank you.
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Message: 7
Date: Thu, 7 May 2009 21:49:21 +0700
From: Claudio Schuftan
Subject: PHA-Exch> Dr Binayak Sen Release-14th May Events - India, UK,
To: pha-exchange@phm.kabissa.org
Content-Type: text/plain; charset="windows-1252"


   Reason:  Post to moderated list
>From kamayani
Two Years Too Much!!


Tentative list of Protests around the Globe on May 14 2009, the 2nd
anniversary of Dr. Binayak Sen’s Unjust Imprisonment. Send us an alert to
contact@binayaksen.net to include Protest/Solidarity Action on your area to
this list




   - *Chhattisgarh*
      - *Raipur*
      *Massive rally and courting of arrest on May 14th*
      On the evening of 13th May 2009 there will be a special event by
      singers, musicians, poets, theatre artists and others to protest the
      victimisation of Dr Sen and celebrate the determined public resistance to
      the decimation of democratic norms and values
   - *Delhi*
      - *Evening of protest and cultural programs on 14 May 2009 at Jantar
      Mantar* between 5 - 8 pm
      The program will be interspersed by street performances, leafleting
      and speeches by various activists. It is organised by Delhi
based groups and
      individuals who are part of the Free Binayak Campaign
   - *Jharkhand*
      - *Lalit Mehta Sahadat Divas*
      *A day of solidarity with NREGA activists and protest against state
      9.30 am: public meeting (“aam sabha”) at Daltonganj. Candlelight
      procession and cultural programme in Evening . More
   - *Maharashtra*
      - *Mumbai
      public meeting at the Dhuru Hall, Dadar (W) at 6 30 PM*
      This will follow a morcha by protesters. Public speeches, performance
      of well-known and young artistes, songs, recitations, reading out of
      original compositions by the poets, protest paintings exhibition
etc will be
      there. More Details
      - *Pune *(waiting for Details)
   - *Andhra pradesh*
      - *Public Meeting in Vizag *(waiting for Details)*
   - *Kerala*
      - *Public meeting in Calicut* (Waiting for Details)
      - *Statewide Campaign by SIO Kerala (*MAY 6-14)
   - *Karnataka*
      - *Bangalore
      Public seminar on May 9th (saturday)*
      Time: 2 pm to 5 pm
      Venue: SCM House, 29, 2nd Cross, Mission Road, Bangalore.
      Speakers: Dr K. Balagopal,(Human Rights Forum, Hyderabad) B.V.
      Seetharam (Karavali Ale, Mangalore), and B.N. Jagadeesha (Alternative Law
      Forum, Bangalore)
      *A Team of Activists from Karanataka will participate in Raipur
      Satyagraha on May 14th *


United Kingdom


   - *London*
      - *Demonstration to mark second anniversary of incarceration*
      May 14, from 2pm - 6pm, outside High Commission of India (Aldwych)
      (nearest tube Holborn)
      Release Binayak Sen now campaign (UK) | Event
Poster| (contact:
      at gmail.com
   - *Edinburgh :*
      - Outside Royal College of Surgeons, Nicholson Street. demonstration
      will end at the Indian Consulate in Rutland Square. (contact:
      at qmu.ac.uk ;  R.Jeffery at
   - *Bristol:*
      - vigil in the centre of the city (contact: margaret.hodson at
      blueyonder.co.uk )


United States


Candle Light Vigils, demonstrations, Human Rights Film
or a day long hunger fast.


   - *Buffalo *(Contact Vijay Loganathan )
   - *Philadelphia *(Contact Subhrajit )
   - *DC* (Contact Somu Kumar )
   - *New York*
   - *San Francisco*
   - *Boston *(Contact Somanth Mukherji )


      - vigil and protest in Boston- Cambridge area at Harvard Square, USA
      in the May 14th evening. AID MIT & Boston chapters,  Alliance
for seclar and
      democratic south asia, Sanhati-Boston etc and local CMC Vellore
alumni are
      organizing this.
      Event Poster | Event Web
Page| Facebook
   - *Seattle* (Contact Siddhartha Mitra
   - *Texas*
      - *Human Rights Film Festival on May 18th*
      Venue: Fun Asia, 1210 E.Beltline Rd., Richardson, TX 75081 PH#
      Organised by : AID India (Dallas chapter) in association with Amnesty
      More Details


More Info On US Actions


   - *Facebook*
      - *One Million Faces - Free Dr Binayak Sen,Time to End Injustice !*
      FACE BOOK COMMUNITY Solidarity Action by showing support to the cause
      by changing profile Picture at least for one day- May 14th 2009
      Event Page


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Message: 8
Date: Thu, 7 May 2009 22:08:18 +0700
From: Claudio Schuftan
Subject: PHA-Exch> WB: World Development Indicators 2009
To: pha-exchange@phm.kabissa.org
Content-Type: text/plain; charset="iso-8859-1"


> http://us-cdn.creamermedia.co.za/assets/articles/attachments/20997_devindicators.pdf
> World Development Indicators 2009 arrives at a moment of great uncertainty
> for the global economy. The crisis that began more than a year ago in the
> U.S. housing market spread to the global financial system and is now taking
> its toll on real output and incomes. As a consequence, an additional 50
> million people will be left in extreme poverty. And if the crisis deepens
> and widens or is prolonged, other development indicators-school enrolments,
> women's employment, child mortality-will be affected, jeopardizing progress
> toward the Millennium Development Goals.
> Statistics help us understand the events that triggered the crisis and
> measure its impact. Along with this year's 91 data tables, each section of
> the World Development Indicators 2009 has an introduction that shows
> statistics in action, describing the history of the current crisis, its
> effect on developing economies, and the challenges they face.
>  We need better data now to guide our responses to the current crisis and
> to plot our course in the future.
> Shaida Badiee
> Director
> Development Data Group
> The report emanates from the World Bank.
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Message: 9
Date: Thu, 7 May 2009 22:33:11 +0700
From: Claudio Schuftan
Subject: PHA-Exch> TWN Press statement: Fair access to influenza
To: pha-exchange@phm.kabissa.org
Content-Type: text/plain; charset="iso-8859-1"


From: Riaz K Tayob riaz.tayob@gmail.com






The current outbreak of swine flu (H1N1) outbreak has again highlighted
concerns that people in developing countries will have little or inadequate
access to much needed influenza vaccines or anti-viral treatments. Thus,
there is an urgent need for establishing a global system of fair and
equitable system for the sharing of the flu vaccines as well as anti-viral
treatments on the basis of need, wherein people in affected developing
countries have access.  The current discussion in the WHO on the sharing of
viruses and the sharing of benefits needs to conclude with the developing
countries ensured that they will have access to affordable anti-virals and
vaccines and the appropriate technology to make such products.


Last week the World Health Organisation alerted the international community
to the possibility of a full-scale pandemic, as it raised its pandemic alert
for the swine flu to stage 5. As of 3 May 2009, 17 countries have officially
reported 787 cases of influenza A(H1N1) infection.


The swine flu outbreak is a stark reminder that if a deadly pandemic were to
develop, there will be a desperate fight over limited supplies of anti-viral
treatments and vaccines, in which the developing countries will be at a vast


Today more than 90% of the global capacity for vaccine manufacturing is
located in Europe and in North America[1]. Developed countries through
³advance purchase agreements² with manufacturers have already reserved a
good portion of the limited current manufacturing capacity[2].  Thus in the
event of a pandemic, the world would be several billion doses short of the
expected demand.
If there is a worldwide pandemic of a new deadly influenza billions of doses
of anti-viral treatments and vaccines will be required in the developing
world and manufacturers will only be able to supply a small portion of what
is needed. The anti-virals and vaccines sold to developing countries are
also likely to be expensive, making them unaffordable for those in need.


Similarly the latest technology and know-how needed to produce the necessary
vaccines or anti-viral treatments are with manufacturers in developed
countries, and often protected by patents and trade secrets, and thus
inaccessible to manufacturers in developing countries.


The swine flu outbreak once again highlights the importance of the pandemic
influenza virus and benefit sharing negotiations taking place in the World
Health Organisation. While it began with the case of the deadly avian flu,
the negotiations are equally relevant to the present swine flu outbreak.


For the past 2 years developing countries led by Indonesia, Thailand, India,
Nigeria, Brazil have been fighting for reforms in the WHO influenza system
to ensure that developing countries (many of which contribute their viruses
for research and for manufacturing vaccines) are assured of access to
technology and know-how to build capacity in preparation of a pandemic as
well as affordable and timely treatments when pandemics break out.


However there has been fierce resistance from developed countries
particularly the US, EU and Japan, that would like to ensure that no
obligations are placed on their manufacturers to share their technology and
know-how, or treatments that developing countries need.


For developing countries to prepare for, or combat, a pandemic there needs
to be international solidarity, a call made ALSO by the Director General of
WHO, Dr. Margaret Chan.


This international solidarity needs to be realized in the upcoming
negotiations on influenza virus and benefit sharing that resumes on 15 May
in Geneva. There needs to be serious consideration of what a fair and
equitable system for benefit sharing should be and measures that will need
to be put in place to overcome patent and other intellectual property
Developing countries have proposed several measures on benefit sharing
---Obligating manufacturers that receive virus samples to contribute to a
WHO stockpile and to provide developing countries with vaccines and
anti-virals needed at a reasonable costs;
----Providing technology and know-how licences to allow manufacturing in
developing countries; and
----Obligating manufacturers to contribute a portion of their profits to a
fund which could be used for purchasing the needed vaccines or anti-virals
as well as building manufacturing and other relevant capacity in developing
countries. ----Ensuring that patents and IPRs do not block access to needed
and anti-virals as well as the technology to produce such products.


On measures to overcome patent and other intellectual property rights
barriers there are proposals that recipients of virus samples should not
claim patents over the samples or parts thereof. For any products produced
using the virus samples that are patented royalty free licenses have been
proposed to enable manufacturing in developing countries.


Without a system of fair and equitable benefit-sharing in place and measures
to overcome the intellectual property barriers, developing countries are
likely to be left without affordable vaccines or treatments since the
companies making them are located in developed countries which would want to
ensure the scarce supplies are given to their own people first.


The best solution is to help developing countries build their own capacity
to manufacture the vaccines and other treatments that are needed, so that
enough can be available for all that require them when there is an outbreak.
This is an urgent matter as millions of lives are at stake.


For further information please contact:
Sangeeta Shashikant
Third World Network,
Geneva Office
Tel (Mobile): +41 (0) 78 757 2331
Email: sangeeta@thirdworldnetwork.net


[1]   See WHO¹s Questions and answers related to vaccines for the
new influenza A(H1N1), available at


[2]   The 2006 WHO Global Pandemic Influenza Action Plan to
increase vaccine supply estimates that if manufacturers optimize current
output, the production capacity for potential influenza vaccine would be 500
million doses (inactivated trivalent vaccine).
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Message: 10
Date: Thu, 7 May 2009 23:45:33 +0700
From: Claudio Schuftan
Subject: PHA-Exch> A global fund for the health MDGs?
To: pha-exchange@phm.kabissa.org
Content-Type: text/plain; charset="windows-1252"


From: Vern Weitzel
crossposted from: "[health-vn discussion group]" health-vn@anu.edu.au




A global fund for the health MDGs?


Lancet, Volume 373, Issue 9674, Pages 1500 - 1502, 2 May 2009
doi:10.1016/S0140-6736(09)60835-7 Cite or Link Using DOI


Giorgio Cometto a , Gorik Ooms b, Ann Starrs c, Paul Zeitz d


The world is off track to achieve the health-related targets of the
Millennium Development Goals (MDGs) by 2015.1 Maternal mortality has
stagnated for two decades,2 child mortality is not declining fast
enough,3 HIV/AIDS still infects people faster than the pace of
antiretroviral treatment roll-out,4 and inequalities are widening within
and across countries.5


Addressing these crises will require increased funding and more
efficient spending. The next Board meetings of the Global Fund to Fight
AIDS, Tuberculosis and Malaria and the GAVI Alliance, scheduled for May
and June, respectively, present an opportunity to tackle these issues.


There is widespread recognition of the need for bold action to
streamline the global aid architecture for health. Last year WHO
launched an effort to "Maximise positive synergies between global health
initiatives and health systems",6 whose conclusions will be submitted to
the G8 in late June.


A Taskforce on Innovative International Financing for Health Systems was
established in September, 2008, to explore new strategies to mobilise
and channel resources for health systems.7 The executive directors of
the GAVI Alliance and the Global Fund recently wrote to the Taskforce
co-chairs that "It is time to take a comprehensive approach with the
necessary support from key donors to refocus on all of the
health-related MDGs".8


An interim report from one of the Taskforce working groups suggests
considering "the Global Fund and GAVI as a conduit for additional
resources for health systems [to achieve] MDG 4, 5 and 6".9


The scene is set: now is the time for explicit discussion of a global
fund for the health MDGs.


In the past ten years global health aid has increased substantially, in
particular for HIV/AIDS;10 while HIV/AIDS funding is still inadequate,
the resources committed to other health needs or to strengthen health
systems have seen only modest increases, or a relative decline.11


Development assistance for health has been constrained by the aim of
national financial autonomy—the expectation that nations receiving
assistance should eventually finance health services from domestic
revenues. This model is a major constraint to scaling up service
provision in countries where public services rely heavily on
international resources.


International aid to fight AIDS has escaped this constraint. Grounded in
a right to health approach, the so-called Harvard Consensus Statement,
while acknowledging that antiretroviral treatment would remain
unaffordable for some countries, argued that the international community
should support the rapid scale-up of AIDS treatment "on moral, health,
social and economic grounds".12


Another exceptional feature of the AIDS response has been its
multisectoral nature, which has allowed more effective action on the
social determinants of HIV transmission.


The idea that the aim of national financial autonomy should be set aside
for AIDS was based on the assumption that health systems were working
reasonably well, or could be improved with conventional development
assistance, but could not afford bulk procurement of antiretroviral
drugs. If that assumption had been correct, it would indeed have been
sufficient to create an exceptional funding channel for expensive drugs.
The reality, however, is that the health systems of many countries lack
basic capacity in governance, health financing, procurement, human
resources, and information systems.


Therefore health systems have often been unable to take full advantage
of the new funding channels, or, paradoxically, might have been weakened
by over-concentrating human and financial resources in specific


Only by comprehensively strengthening health systems will it be possible
to overcome structural challenges to service delivery, in particular the
shortage of health workers.14 Some lament that a decade of
disease-specific attention was a lost opportunity, because better
results would have been possible had greater resources been invested in
health systems. For others, the pressure to save lives through
disease-focused programmes was needed to overcome decades of
underinvestment in health systems.


We can agree to disagree on the past, but must start a constructive
discussion about the future. We propose that the exceptional approach
created for the fight against AIDS should be expanded: the entire global
health agenda must adopt a rights-based approach, which in some
countries requires challenging the model of national financial autonomy.


We therefore recommend that the Global Fund and the GAVI Alliance
gradually move towards becoming a global fund for all the health MDGs,
which will require substantially greater resources to address the
broader mandate. As a first step the next Global Fund and GAVI Alliance
board meetings should expand the review of their architecture to provide
greater support to national health plans, including co-financing
non-disease-specific human resources for health.


The desirable features of a global fund for the health MDGs are listed
in the panel. Such a fund should sustain the successful programmes and
expand the effective approaches pioneered by the Global Fund and the
GAVI Alliance, while extending the same principles to other health needs
and to general health system strengthening. A global fund for the health
MDGs would eventually allow the delivery of prevention and treatment
services for specific diseases through revamped general health services,
reducing transaction costs and streamlining the global health architecture.


Such radical, yet rational, action is our best chance of meeting—or at
least making significant progress toward—the health-related MDG targets
by 2015.




Desirable features of a global fund for the health MDGs

Focus on measurable improvements in health outcomes, with performance
evaluation framework that looks at coverage with services relating to
reproductive, maternal, newborn, and child health, HIV, malaria and
tuberculosis, other infectious and non-communicable chronic diseases,
quality of care, and fairness of financial contribution to the health systemClear mandate and funding criteria that address key bottlenecks in
health systems (including long-term predictable support for recurrent costs)Rights-based approach to health supported by new model of globally
shared financial sustainabilityCapacity to disburse resources beyond public system and beyond health
sector when this represents appropriate and cost-effective approach to
improve health outcomesGovernance and accountability structure open to civil society at
global and country levelsFlexibility to provide support to public sector on-budget or
off-budget, in form of grants and not loans, unconstrained by financial
ceilingsIndependent mechanism that judges proposals exclusively on technical

GC is a member of the GAVI Health System Strengthening Task Team; his
views are not necessarily those of Save the Children UK or of the GAVI
Alliance. GO, AS, and AZ declare that they have no conflicts of interest.




1 WHO. World health statistics 2008.
(accessed March
17, 2009).


2 Hill K, Thomas K, AbouZahr C, et alon behalf of the Maternal Mortality
Working Group. Estimates of maternal mortality worldwide between 1990
and 2005: an assessment of available data. Lancet 2007; 370: 1311-1319.
Summary | Full Text | PDF(133KB) | CrossRef | PubMed


3 Loaiza E, Wardlaw T, Salama P. Child mortality 30 years after the
Alma-Ata Declaration. Lancet 2008; 372: 874-876. Full Text | PDF(72KB) |
CrossRef | PubMed


4 UNAIDS. 2008 Report on the global AIDS epidemic.




(accessed March 17, 2009).


5 Commission on Social Determinants of Health. Closing the gap in a
generation: health equity through action on the social determinants of

(accessed March 17, 2009).


6 WHO. Maximising positive synergies between health systems and global
health initiatives.

(accessed March 17, 2009).


7 High Level Taskforce on Innovative International Financing for Health
Systems. Terms of reference and management arrangements.




(accessed March 15, 2009).


8 Lob-Levyt J, Kazatchkine M. Letter to the High Level Taskforce on
Innovative International Financing for Health Systems.




(accessed March 21, 2009).


9 Taskforce for Innovative International Financing for Health Systems.
Working group 2: raising and channelling funds. Progress report to




(accessed March 17, 2009).


10 Gordon JG. A critique of the financial requirements to fight
HIV/AIDS. Lancet 2008; 372: 333-336. Summary | Full Text | PDF(70KB) |
CrossRef | PubMed


11 Shiffman J. Has donor prioritization of HIV/AIDS displaced aid for
other health issues?. Health Policy Plan 2008; 23: 95-100. CrossRef | PubMed


12 Individual Members of the Faculty of Harvard University. Consensus
statement on antiretroviral treatment for AIDS in poor countries.

(accessed March 17, 2009).


13 Travis P, Bennett S, Haines A, et al. Overcoming health-systems
constraints to achieve the Millennium Development Goals. Lancet 2004;
364: 900-906. Summary | Full Text | PDF(188KB) | CrossRef | PubMed


14 Médecins sans Frontières: Help wanted: confronting the health care
worker crisis to expand access to HIV/AIDS treatment. MSF experience in
southern Africa.

(accessed March 17, 2009).


a Save the Children UK, London EC1M 4AR, UK
b Institute of Tropical Medicine, Department of Public Health, Antwerp,
c Family Care International, New York, NY, USA
d Global AIDS Alliance, Washington, DC, USA


E-mail: giorgiocometto@hotmail.com



[AIDS ASIA eFORUM] AIDS Analysis Asia-Pacific eNewsletter.


An eFORUM for peer-to-peer cross-cultural discourse on HIV and AIDS
related issues and concerns of people from Asia-Pacific region.
Views are of the authors. Privacy policy, ref; to the 'file' section.
We comply with the 'HONcode' standard for trustworthy
health information and global internet governance norms.


For further details, please contact the FORUM Editor,
by e-mail:  editoreaids@yahoo.com
health-vn Health in Viet Nam and the Region
Post message to list: health-vn@anu.edu.au
List information page: http://mailman.anu.edu.au/mailman/listinfo/health-vn
health-vn List from the Australia Vietnam Science-Technology Link
contact: Vern Weitzel vern@coombs.anu.edu.au


The accuracy of information from media articles posted on this list
cannot be guaranteed and should be verified before use.
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Message: 11
Date: Fri, 8 May 2009 00:17:58 +0700
From: Claudio Schuftan
Subject: PHA-Exch> A global fund for the health MDGs? (2)
To: pha-exchange@phm.kabissa.org
Content-Type: text/plain; cha

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