By Jomo Kwame Sundaram
ROME, Dec 11 2015 (IPS)

The latest estimates are that over two billion people in the world suffer some micronutrient deficiencies, often referred to as “hidden hunger.” The main sustainable solution is to ensure adequate public health interventions, including clean water, sanitation and hygiene as well as healthy, diverse diets for all.

Jomo Kwame Sundaram. Credit: FAO

In the short term, however, it will be necessary to provide supplements of vitamins, minerals and trace elements to those especially vulnerable, e.g. due to displacement and emergency situations. There is a general consensus that such needs of pregnant and lactating mothers should be especially prioritized due to the intergenerational consequences of child stunting for such reasons.

Developing countries should be able to affordably access locally produced or imported generics of the vitamin and mineral supplements they require. Many current options associated with public-private partnership will instead strengthen the vested interests of the lucrative, large and fast-growing industry for nutrition supplements.

The need for supplementation to address urgent, short-term micronutrient deficiencies should qualify as part of the public health exception to the Trade-Related Aspects of Intellectual Property Rights (TRIPs) rules of the World Trade Organization (WTO). This has not been fully recognized ostensibly because people do not drop dead immediately due to “hidden hunger.”

TRIPS and generics production for developing countries

Under the TRIPS agreement, intellectual property rights (IPRs) — for copyright, trademark, geographical indication, industrial designs and patents — are extended to all signatory countries. Patents, most relevant to public health and access to medicines, give twenty years of protection to inventions.

In the current language, there are no explicit provisions for generic production of patented nutrition supplements. However, there is supposed to be a great deal of flexibility on the basis of public health needs, which could be extended to minerals and vitamins for supplementation.

The TRIPS Agreement provides space for countries taking measures to protect public health. Under Article 31, countries can issue compulsory licenses allowing firms or individuals to produce generic copies of patented products or processes for the domestic market without the owner’s consent in “case of a national emergency or other circumstances of extreme urgency or in cases of public non-commercial use.” The government can also determine adequate payment to the IPR holder.

At the Doha WTO conference in 2001 launching the Doha Development Round of trade negotiations, the Declaration on the TRIPS Agreement and Public Health affirmed the right of countries to protect public health, enable access to medicines, and determine the criteria for issuing a compulsory license. It emphasized that each country “has the right to grant compulsory licenses” and “the right to determine what constitutes a national health emergency or other circumstances of extreme urgency.”

This new text corrected the false impression that some health emergency was needed to justify compulsory licensing. It also spelt out that “public health crises, including those relating to HIV/AIDS, tuberculosis, malaria and other epidemics, can represent a national emergency or other circumstances of extreme urgency.”

Technology transfer

Under Article 66.2 of TRIPS, developed country governments are obliged to actively promote technology transfer in establishing manufacturing capabilities for patented processes in developing countries. The 2001 Declaration also reaffirmed the developed countries’ commitment to provide incentives to their corporations to enable technology transfer to the least developed countries. This was part of the original bargain for developing countries to provide protection of IPRs.

Developing countries also have the right to import generics if they lack manufacturing capabilities. A 2003 waiver allows countries unable to domestically produce pharmaceuticals to import them instead. Hence, under compulsory licensing, such countries can import externally produced patented drugs. Thus, while compulsory licensing allows countries to import cheaper generics from countries already producing them, to take advantage of TRIPS Agreement flexibility, countries need to legislate accordingly.

However, exemptions to pharmaceutical patent protection to the least developed countries, enabling them to import without issuing a compulsory license, were only extended until 2016. The upcoming Nairobi WTO ministerial should extend this exemption beyond next year.

While there appears to be legal space under TRIPS for developing countries to use compulsory licensing, they have effectively be prevented from doing this by complicated rules and procedural requirements. Consequently, use of compulsory licensing by developing countries has been largely limited to HIV/AIDS medicines, and almost exclusively used by middle-income countries. LDCs have not issued any compulsory licenses while the total number of applications has declined significantly in the last decade.

Needed actions

Existing TRIPS texts do not preclude compulsory licensing for local generic production in developing countries. However, extension of the right to use compulsory licensing and other such flexibilities to vitamin and mineral supplements is not explicit. While explicit permission is given to AIDs, malaria, tuberculosis and epidemics, even this is rarely used.

In light of the foregoing, the following revisions to WTO provisions to protect developing countries’ right to produce generic vitamin and mineral supplements should be introduced. This will also be in line with the July 2015 Addis Ababa Action Agenda’s commitment to facilitate technology transfer:

• Developing appropriate model legislation to facilitate development of the national legislation needed for compulsory licensing, etc.
• Provide free legal services to developing country governments interested in accessing TRIPS facilities.
• Identify and investigate relevant national vitamin and mineral supplement production needs in partnership with other governments to enable developed countries to meet their technology transfer obligations.

Developing countries need to act to overcome three major constraints to issuing compulsory licenses and bypassing patent legislation for public health. First, the governments must be strong enough to withstand business and political pressures. Second, it is necessary to have enabling legislation in place. Third, these countries need to have production capacity and distribution arrangements in place.
Also, the UN system should offer appropriate technical expertise to advance progress.

(End)

Excerpt:

By Germán Velásquez
GENEVA, Nov 10 2015 (IPS)

The important relationship between the examination of patents carried out by national patent offices and the right of citizens to access to medicines hasn’t always been well-understood. Too often these are viewed as unrelated functions or responsibilities of the state. And the reason is clear: patentability requirements are not defined by patent offices, but frequently by the courts, tribunals, legislation or treaty negotiators.

Germán Velásquez

Given the impact of pharmaceutical patents on access to medicines, patent offices should continue to align their work in support of national health and medicine policies, using the freedom permitted by the Trade Related Aspects of Intellectual Property Rights Agreement (TRIPS) to define patentability requirements.

The TRIPS Agreement requires all World Trade Organization (WTO) member states to incorporate into their legislation universal minimum standards for almost all rights in this domain: copyright, patents and trademarks.

A patent is a title granted by the public authorities conferring a temporary monopoly for the exploitation of an invention upon the person who reveals it, furnishes a sufficiently clear and full description of it, and claims this monopoly.

As with any monopoly, it may lead to high prices that in turn may restrict access. The problem is compounded in the case of medicines, when patents confer a monopoly for a public good and essential products needed to prevent illness or death and improve health.

According to the TRIPS Agreement, the patentability requirements used by national intellectual property offices require a product or manufacturing process to meet the conditions necessary to grant patent protection, namely: novelty, inventive step and industrial applicability (utility).

These three elements, however, are not defined in the TRIPS agreement and WTO Member States are free to define these three criteria in a manner consistent with the public health objectives defined by each country.

It is widely held that patents are granted to protect new medicines to reward the innovation effort. However, the number of patents obtained annually to protect truly new pharmaceutical products is very low and falling. Moreover, of the thousands of patents that are granted for pharmaceutical products each year, a few are for new medicines – e..g. new molecular entities (NMEs).

All of the above led the World Health Organization (WHO), in collaboration with the United Nations Conference on Trade and Development (UNCTAD), the United Nations Development Programme (UNDP) and the International Centre for Trade and Sustainable Development (ICTSD), to develop, in 2007, guidelines for the examination of pharmaceutical patents from a public health perspective.

The guidelines were intended to contribute to improving the transparency and efficacy of the patent system for pharmaceutical products, so that countries could pay more attention to patent examination and granting procedures in order to avoid the negative effects of non-inventive developments on access to medicines. The major problems can be identified in the current use of the patent system to protect pharmaceutical innovation: reduction in innovation, high prices of medicines, lack of transparency in research and development costs, and proliferation of patents.

A study carried out by the journal Prescrire analysed the medicines that were introduced to the French market between 2006 and 2011, arriving at the conclusion that the number of molecules that produced significant therapeutic progress reduced drastically: 22 in 2006; 15, 10, 7, 4 in the following years up to 2011, which was a year in which Prescrire declared that only one medicine of significant therapeutic interest was brought to the market. Given that France is one of the largest pharmaceutical markets in the world, the reduction in innovation confirmed France is a good indicator of the global situation.

Oncologists from fifteen countries recently denounced the excessive prices of cancer treatments, which are necessary to save the lives of the patients, and urged that moral implications should prevail; according to them, of the 12 cancer treatments approved in 2012 by the United States Food and Drug Administration, 11 cost more than 100,000 dollars per patient per year.

Since the 1950s, there have been some references to the costs of Research and Development (R&D) for pharmaceutical products. According to some sources the average cost of research for a new pharmaceutical product these figures have increased from 1 million dollars in 1950 to 2.5 billion dollars for the development of a single product.

During the summer of 2014, a number of European countries, including France and Spain, spent many months negotiating with the company Gilead on the price of a new medicine for hepatitis C known as Solvaldi. The price fixed by Gilead was 56,000 Euros per patient for a twelve-week treatment, or 666 Euros per tablet. According the newspaper Le Monde the price of each tablet was 280 times more than the production cost. In France, it is calculated that 250,000 patients should receive this medicine, the cost of which would represent 7 per cent of the annual state medicine budget.

The application of patentability requirements for medicines, given their public health dimension, should be considered with even more care than in the case of regular merchandise or luxury items. The first and most important step is to use the freedom permitted by the TRIPs Agreement to define the patentability requirements: novelty, inventive step and industrial applicability (utility) in a way that keeps sight of public interest in the wide dissemination of knowledge.

(End)

Excerpt:

Sixty-five years after a major international summit here on malaria, the mosquito-borne disease remains a scourge and its incidence may even be rising in parts of sub-Saharan Africa due to the combined effects of climate change, agricultural practices and population displacement.

Almost half the world’s population is deemed at risk of malaria, and an estimated 214 million people will contract it in 2015, with nearly half a million dying.

Credit: FAO

“Malaria is the number one public health problem in our country,” says Babria Babiler El-Sayed, director of Sudan’s Tropical Medicine Research Institute. Sudan has begun, with the assistance of FAO and the IAEA, to release sterilized male mosquitoes into the air in hopes that they crowd out their virile brethren and lead to reduced mosquito populations.

The Unite d Nations Food and Agriculture Organization (FAO) and the International Atomic Energy Association (IAEA) have used this “nuclear” technique with success against the lethal tsetse fly and the produce-destroying fruit fly. Malaria is a new area, and the two agencies are experimenting across East Africa with this so-called Sterile Insect Technique (SIT) of pest control.

And yet malaria is demonstrably preventable – and that is why it is explicitly named in Sustainable Development Goal No. 3 as something to be ended by 2030.

The key is not to rely on one method or tool but to develop integrated efforts to subdue the disease, notes El-Sayed.

That fits FAO’s broader approach. While working with the IAEA on the logistics and technology of SIT, field officers emphasize the need to integrate agricultural practices ranging from crop selection, tilling technique, water use and even rural home locations.

It’s a shift from 1950, when a World Health Organization conference held in Kampala resolved to support the intensive use of Dichlorodiphenyltrichloroethane (DDT) to eradicate the disease. As was learned the hard way, even such a potent chemical cannot on its own sustainably solve the problem. Indeed, in the emblematic case of the Tennessee Valley in the United States, it was a mass anti-poverty campaign coupled with a huge hydroelectric public-works program that led to the rapid demise of malaria without the use of chemicals in the 1930s.

Warmer climate helps bugs fly higher

Particularly alarming is malaria’s literal ascent into the densely-populated highlands of east Africa. Inhabitants of southwest Uganda and parts of Zambia and Rwanda typically lack the genetic resistance to malaria developed by farmers in mosquito-prone areas.

Climate change wreaks all sorts of changes in the risk profile of the human environment. For example, more and more Zambians are killed by crocodiles, lions and buffalos as they travel further for water in times of drought. Less headline-grabbing, but more pervasive, is the way one poor harvest can wipe out livelihoods, driving people to sell their livestock, tools and even land in a bid to survive and ending up mired in poverty. Similarly, pressure on the land – sometimes linked to civil conflict – is driving record flows of migrants, the majority of whom don’t leave their countries, but move into new ecosystems, as scores of Ugandans are doing by moving to the hilly southwest regions of this country and ultimately taking up a form of farming that enhances the risk of malaria.

Add to this the steady climb in average temperatures, which increase the potential habitat for the main malarial vectors and are “related to altitude rather than latitude,” according to recent research done by the International Food Policy Research Institute into why the incidence of malaria has risen so dramatically in Uganda’s upcountry. That spells special risks for elevations above 2,000 meters in Kenya, Ethiopia and Burundi, too.

Strategies must be integrated and local

Despite popular images today, malaria is not particularly a tropical disease. Indeed, it was the successful use of DDT in postwar Italy that galvanized the Kampala conference, even though it now appears the rising incomes linked to Marshall Plan-funded economic growth was the determining factor.

Integrated methods – farming techniques, crops themselves, and human practices such as the use of nets – are all part of any success story in malaria. Zambia’s Malaria Institute at Macha has, with international support, practically eliminated malaria in its southern district, and the credit should go primarily to an engaged community effort, according to Dr. Phil Thuma, one of the institute’s mainstays and an advocate of what he calls “full court press” tactics in battling the epidemic.

FAO has long been involved in distributing mosquito nets, one of the simple but critical tools in any effort. Indeed, one current FAO project promotes the use of insecticide-treated nets around livestock barns in Kenya and has led to a sharp uptick in dairy production as both humans and animals are healthier.

The media has long indulged in donor-depressing tales about Zambian fishermen using anti-mosquito nets to boost their catch or – in one quirky story from Uganda but published in Botswana – p eople using the nets to make bridal dresses. But in fact most people in eastern Africa have and use their government-provided nets today, and many buy another one in a sign of conviction about their utility, according to a detailed survey of actual behaviour in Tanzania.

The real problem is that many farmers have to get up before dawn, or stay out in their fields late, and as a result their work forces them to forgo protection during the biting hours.

Almost everybody knows the basics about malaria, but few had heard about climate change. Intriguingly, those with secondary or higher education tended to worry about unpredictable rain patterns while those with only primary education are focused on rising temperatures.

Empirical surveys clearly show that where cultivation practices reduce vegetation cover, temperatures rise in mosquito breeding sites. That means land use and reforestation efforts need to be part of the community-driven policy mix. Farmer field schools, a longtime FAO priority focus, are key to spreading knowledge that is locally useful, such as casting shade on breeding places or fostering fish in ponds.

Developing “malaria-smart” programs need to be drawn up with that in mind, especially given efforts to increase irrigation infrastructures to boost agricultural yields in sub-Saharan Africa. One survey in Ethiopia found that the rate of childhood malaria was seven times higher in villages within three kilometres of a microdam for irrigation than children living more than eight kilometres away.

Maize cultivation, a huge force in the region, may also be lifting the incidence of malaria because the higher-yield hybrid varieties used pollinate later in the year, helping fatten up mosquito larvae – meaning more, bigger and longer-living adult ones.

(End)

By Laurent Huber
GENEVA, Feb 18 2015 (IPS)

February 27 will mark the 10th anniversary of the World Health Organisation Framework Convention on Tobacco Control (FCTC), the first global public health treaty.

Today the FCTC has 180 Parties, making it among the most widely-adopted international instruments. About 90 percent of the world’s population falls under the FCTC’s protections.

The creators of the Convention were bold in their intentions – “to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption.”

An anniversary is an opportunity to look back and reflect, and to look forward and plan. Has the FCTC lived up to its lofty goals? Are we on track to end the tobacco epidemic? Is it too soon to judge?

1 billion deaths ahead?

It is no accident that the first global, legally-binding public health effort targeted tobacco. In the absence of action, the world gloomily looked ahead to one billion deaths from tobacco consumption in the 21st century.

In addition to that depressing figure, tobacco has profoundly negative consequences for the wealth of nations and individuals, for human rights, for development and for the environment. In 10 years, have we made a dent?

Yes. The FCTC came into being at a critical time in the history of the tobacco epidemic. Consumption was moving swiftly from the developed to the developing world, and growing overall.

Everywhere, tobacco addiction was becoming a burden on the poorest, most marginalised populations.

Tobacco industry profits were staggering, dwarfing the gross domestic products of most of the countries in which they operated.

This wealth was poured back into marketing, litigation and public influence to ensure the addiction of future generations.

In 2005, when the FCTC came into force, the tobacco industry was put on notice that the world had united against it.

Numerous victories

The public health community can point to specific victories. In 2004, Ireland became the first country to ban smoking in all public and work places. They have been followed by dozens more.

Several countries have struck at the core of the industry’s business model by banning marketing – including the display of products in stores – and corporate social responsibility schemes (Mauritius), and by requiring plain packaging (Australia).

Scores of countries have introduced graphic warning labels on packaging, and there have been large tobacco tax increases in countries not previously known for their strong tobacco control policies, such as Chile and the Philippines, to name just two.

There is a protocol to address the massive problem (often perpetrated by the industry itself) of illicit trade. An increasing number of governments are using litigation to hold the industry accountable for the consequences of its products.

Mainly health ministries

But – and you knew there was going to be a “but” – sober reflection is also called for. The number of tobacco users and deaths continues to rise. The tobacco industry, the vector of the epidemic, is not on its heels: the profit of the four biggest firms was over US$36 billion in 2013.

While we have succeeded in convincing health ministries of the importance of tobacco, other government sectors lag far behind.

The implementation of the all-important FCTC Article 5.3, calling for governments to refuse to cooperate with the tobacco industry in formulating health policy, is failing miserably in all but a few countries.

And when governments bravely move forward with cutting-edge tobacco control measures, they can expect an avalanche of tobacco industry lawsuits, both domestically and through international trade agreements, chilling the political will of other governments.

Mixed results, to be certain. Should we celebrate? Absolutely! No one expected the FCTC to be an instant cure. At the outset, the curve of the epidemic was simply too steep to believe that, in 10 years’ time, it could be reversed.

We’ve made great strides.

On 27 Feb, if you have been involved in this historic endeavour, take a moment to congratulate yourself and a colleague. And then on the 28th, let’s move forward with purpose to fill in the gaps. The FCTC is the beginning, not the end, of a long and purposeful journey.

Edited by Roger Hamilton-Martin

Excerpt:

Supporters (wearing red) of the opposition Movement for Democratic Change led by Morgan Tsvangirai after witnessing their party losing to President Robert Mugabe in last year's elections. They now face another disappointment as the fight to succeed Mugabe turns attention away from development. Credit : Jeffrey Moyo/IPS

By Jeffrey Moyo
HARARE, Nov 26 2014 (IPS)

With the ruling Zimbabwe Africa National Union Patriotic Front party in Zimbabwe seized with internal conflicts, attention to key development areas here have shifted despite the imminent end of December 2015 deadline for global attainment of the U.N. Millennium Development Goals (MDGs).

The eight MDGs targeted to be achieved by 31 December 2015 form a blueprint agreed to by all the world’s countries and the world’s leading development institutions.“Every development area is at a standstill here as ZANU-PF politicians are scrambling to succeed the aged Mugabe here and they have apparently forgotten about all the MDGs that the country also needs to attain before the 2015 deadline” – Agrippa Chiwawa, an independent development expert

But, caught up in the succession fight among ruling party politicians as the country’s 90-year old President Robert Mugabe – who has ruled this Southern African nation for the last 34 years – reportedly  battles ill health ahead of the party’s elective congress in December, development experts say the Zimbabwean government has apparently shifted attention from development to party politics.

“Every development area is at a standstill here as Zanu-PF politicians are scrambling to succeed the aged Mugabe here and they have apparently forgotten about all the MDGs that the country also needs to attain before the 2015 deadline,” independent development expert Agrippa Chiwawa told IPS.

The battle to succeed Mugabe pits Justice Minister Emerson Mnangagwa and the country’s Vice-President Joice Mujuru, who is currently receiving a battering from the former’s faction which has won sympathy from the country’s first family, with First Lady Grace Mugabe venomously calling for the immediate resignation of Mujuru before the ZANU-PF congress.

Chiwawa told IPS that despite the government having contained recent strikes by medical doctors here through appeasing them by reviewing their salaries, the public health sector is in a state of decay amid acute shortages of treatment drugs.

Elmond Bandauko, an independent political analyst, agrees with Chiwawa. “Internal fights within the ZANU-PF party are stumbling blocks to national, social and economic prosperity; the ZANU-PF government is concentrating on its party succession battles as the economy is on its knees and there is no projected solution to the economic woes the country faces at the moment,” he told IPS.

Fighting over who will succeed 90-year-old Robert Mugabe at the head of Zimbabwe’s ruling ZANU-PF party has relegated agriculture, like other development issues, to the side-lines if not outright neglect. Credit: Jeffrey Moyo/IPS

“Policy makers from the ZANU-PF government, who are supposed to be holding debates and parliamentary sessions and special meetings on how to move the country forward, are wasting time on political tiffs that do not save the interests of ordinary Zimbabweans,” Bandauko added.

Even the country’s education system has not been spared by the ruling party political milieu, according to educationists here.

“Nobody is talking about revamping the education system here as government officials responsible are busy consolidating their powers in the ruling party while national examinations are fast losing credibility amid leakages of exam papers before they are written, subsequently tarnishing the image of our country’s quality of education,” a top government official in the Ministry of Education told IPS on the condition of anonymity, fearing victimisation.

Even the country’s ordinary subsistence farmers, like Edson Ngulube from Masvingo Province in Mwenezi district, are feeling the pinch of the failure of politicians. “We can’t beat hunger and poverty without support from government with farming inputs,” Ngulube told IPS.

Yet for many Zimbabweans like Ngulube, reaching the MDGs offers the means to a better life – a life with access to adequate food and income.

Burdened with over half of its population starving, based on one of the U.N. MDGs, Zimbabwe nevertheless committed itself to eradicating hunger by 2015. But, with the Zanu-PF government deeply engrossed in tense power wrangles to succeed Mugabe, Zimbabwe may be way off the mark for reaching this target.

In addition, in September, the Food and Agriculture Organisation (FAO) sub-regional coordinator for Southern Africa, David Phiri went on record as saying that Zimbabwe could fail to meet the target to eradicating hunger by 2015 owing to conflict and natural disasters.

Zimbabwe’s 2012 National Census showed that more than two-thirds of Zimbabwe’s 13 million people live in rural areas and, according to the World Food Programme (WFP), this year about 25 percent of them need food aid or they will starve, and between now and 2015, 2.2 million Zimbabweans will need food support.

Zimbabwe’s Agriculture Minister Joseph Made is, however, confident the country is set to end hunger before the 2015 deadline. “We have land and we have hardworking people utilising land and for us there is no reason to doubt that by 2015 we would have eradicated hunger,” Made told IPS.

Claris Madhuku, director for the Platform for Youth Development (PYD), a democracy lobby group in Zimbabwe, perceive things rather differently.

“What actuates Zimbabwe’s failure to attaining MDGs is the on-going governance crisis, a result of the ruling ZANU-PF party’s internal wars to succeed the party’s nonagenarian President, which have not made development any easier,” Madhuku told IPS.

According to the PYD leader, in order for Zimbabwe to experience magnificent development, “the ruling party has to try and get its politics right.”

But with Zimbabwean President Mugabe apparently clinging to the helm of the country’s ruling party with renewed tenacity, it remains to be seen whether or not real development will ever touch the country’s soils.

(Edited by Phil Harris)

Health workers in an Ebola screening unit in Kenema government hospital, Sierra Leone. Health systems are not just a means for the technical delivery of goods and services; they are part of the core social fabric of societies. Credit: Tommy Trenchard/Demotix

By Alicia Ely Yamin
CAMBRIDGE, Massachussetts, Oct 27 2014 (IPS)

The catastrophic Ebola crisis unfolding in West Africa offers many lessons, not least for global anti-poverty efforts. These will culminate in a set of targets, to be agreed by the United Nations in 2015, known as the Sustainable Development Goals (SDGs).

First of all, the crisis should lead to a re-think of the triumphalism that has marked some of the global health debate in recent years, with some projecting a “grand convergence within a generation” between North and South, rich and poor countries, based upon the “end of preventable mortality, including from infectious diseases”.It is not a coincidence that, in addition to the legacy of colonial exploitation, and pillaging by their own corrupt and unaccountable governments in recent history, Liberia and Sierra Leone are two countries that have been ravaged by brutal civil wars.

Second, neither universal health insurance, without real access to public health as well as effective care, nor cash transfers, without connections to functioning systems, would have thwarted Ebola or the social devastation it is wreaking. Yet both are highly touted solutions to global poverty, and likely to be part of the SDG agenda.

Nor would “pay for performance”, whereby health workers are supposedly incentivised to be more productive by having compensation linked to quotas and outcomes.

All of which brings us to a third lesson from the crisis: silver-bullet solutions that focus on short-term outcomes, and often produce so-called ‘vertical’ interventions (that is, those de-linked from the broader context), actually do not work in the long term, or in the face of crises.

Human rights advocates have argued that there is a need to shift power relations to promote greater equity, to invest in strengthening institutions, to open spaces for meaningful participation by the people who are affected by health and development policies, and to construct effective and accessible accountability mechanisms.

Though often dismissed as airy-fairy, unmeasurable and utopian in mainstream public health and development circles, the Ebola catastrophe illustrates exactly why these investments are crucial.

Health systems are not just a means for the technical delivery of goods and services; they are part of the core social fabric of societies. They can either give expression to norms of solidarity and equality, or they can exacerbate social exclusion.

In the three most affected countries in West Africa, the health systems were all dysfunctional before Ebola hit, and were often a place where people – especially women and children – experienced their poverty and marginalisation.

The inadequate, and now decimated, health systems, and the rippling effects of the crisis on education, housing, and food, all raise issues of access to – and the enjoyment of – fundamental economic and social rights. These are just as important as the violations of civil rights, including unwarranted restrictions on movement, which might stem from the Ebola epidemic.

But it is equally important to realise how massive violations of human rights – civil and political, as well as economic and social – drive epidemics such as Ebola.

The unimaginable suffering we are witnessing is in no way simply an inevitable result of the “natural” pathophysiology or epidemiology of the disease.

It is not a coincidence that, in addition to the legacy of colonial exploitation, and pillaging by their own corrupt and unaccountable governments in recent history, Liberia and Sierra Leone are two countries that have been ravaged by brutal civil wars. These conflicts were fuelled by the rapacious global demand for precious minerals, and destroyed communities, dissolved family units, and disrupted farming, livelihoods and migration patterns.

Nor is it a coincidence that more than half the population in each heavily affected country lives in abject poverty (53 percent in Sierra Leone, 55 percent in Guinea, and 64 percent in Liberia). And, as noted above, women and children disproportionately suffer from the mass deprivation of economic and social rights that those numbers reflect.

I was in Sierra Leone when the evidence of the horrific atrocities during that civil war were everywhere to be seen: roadblocks which had previously been strung with human intestines, and beggars at street corners missing hands that had been cut off by the insurgents.

I was also there after the end of hostilities, when the humanitarian aid groups had mostly pulled out, leaving among other things a health system incapable of dealing with even the most basic health needs. Government facilities were missing essential supplies and medicines; health care workers often had no sutures or gloves, nor running water nor soap, and were using cell phones to provide light during surgical procedures.

The World Health Organization recommends a minimum of 23 healthcare workers per 10,000 people, but there is still a desperate shortage of health care workers in the affected countries; in Sierra Leone, there were just 0.2 physicians and 1.7 nurse/midwives per 10,000 people at the outset of this crisis.

When I visited in 2009, close to 50 percent of primary health care providers in Sierra Leone were receiving no salary. To survive they charged illicit fees, and for drugs, or sold bed nets on the private market.

We must learn lessons from the Ebola crisis: not just to build temporary structures staffed by foreigners, which will disappear like sand castles when the crisis is eventually contained, or other horrors on our television screens draw our attention away.

This time, let’s make sure we do not accept the status quo ante as ‘normal’, and instead make long-term commitments to strengthening health systems, including public health measures. These will create not just more productivity and healthy years of life expectancy, but also promote people’s own voice and agency and the possibility of living lives in dignity.

And let’s take the time in finalising the SDGs to consider how best to tackle the rules of the global economic order, including the unfair terms for global trade, that drive the structural inequalities between countries. These limit the possibility of people enjoying their human rights even in the best of times, and can help set the stage for these horrific social calamities.

Ebola has shown vividly that we live in an invariably globalised world. We owe it to those with whom we share this planet, and to future generations, to establish a Sustainable Development Agenda that, as the Universal Declaration of Human Rights says, promotes a “social and international order in which the rights and freedoms set forth [in that Declaration] can be fully realized” by everyone.

This article originally appeared on openGlobalRights

Edited by Kitty Stapp

Excerpt:

Credit: Twitter/@AntDeRosa

By Jim Lobe
WASHINGTON, Oct 22 2014 (IPS)

Despite media hype, missteps by federal health agencies, and apparent efforts by right-wing and some neo-conservatives to foment fear about the possible spread of the Ebola virus in the U.S., most of the public remain at least “fairly” confident in the authorities’ ability to deal with the virus.

Concern about the potential threat posed by the virus has clearly grown over the past two weeks, especially after two nurses at a Dallas hospital who helped treat a fatally infected Liberian man contracted the virus. But a major poll released Tuesday found that a clear majority of respondents expressed little or no concern that they or someone in their family will be exposed.“On the one hand, it is a genuine crisis in the countries where’s it’s happening, and therefore it deserves all the attention it can get. On the other hand, the nature of that attention is inappropriate, misleading, and scare-mongering." -- Andrew Tyndall

The survey, which was conducted Oct. 15-20 by the Pew Research Center, found that about six in 10 respondents (61 percent) said they have “a great deal” or a “fair amount” of confidence in U.S. hospitals “to diagnose and isolate possible cases of Ebola,” compared to 38 percent who said they have little or no confidence.

And 54 percent – only three percent lower than in another Pew poll taken in the days that followed Thomas Eric Duncan’s much-publicised hospitalisation — said they have a “great deal” or “fair” amount of confidence that the federal government will prevent a major outbreak of the deadly disease here.

The survey, however, found major differences in perception of the threat depending on the respondents’ political affiliations. In early October, for example, a third of self-identified Republicans said they were at least somewhat worried that they or their family members would be exposed to the virus. That percentage has since increased to 49 percent.

The loss in confidence in the government’s ability to prevent a wider outbreak has grown – albeit by not as large a percentage – among Republicans who tend generally to be ideologically more distrustful of government than Democrats or independents on most issues.

With the approach of mid-term Congressional elections in just two weeks, however, some Republican politicians and right-wing and neo-conservative publications and commentators appear to be deliberately fanning fears of Ebola’s spread and the government’s purported inability to deal with it, even conflating the virus’s prominence with the threat of terrorism and, specifically, the Islamic State of Iraq and the Levant (ISIL).

Indeed, the neo-conservative Weekly Standard’s lead editorial this week was entitled “Six Reasons to Panic”, while the Washington Post featured an op-ed by Marc Thiessen, a right-wing Republican commentator and fellow at the American Enterprise Institute (AEI), depicting a “nightmare scenario” in which “suicide bombers infected with Ebola could blow themselves up in a crowded place – say, shopping malls in Oklahoma City, Philadelphia and Atlanta – spreading infected tissue and bodily fluids.”

Commentators on Rupert Murdoch’s Fox News have conjured similar scenarios.

As noted by The New Republic this week, “a growing body of literature in psychology suggests that feelings of fear make people’s political outlook more conservative.”

The Ebola pandemic, which, according to official figures – unofficially, the estimates run much higher – has caused the deaths of well over 4,500 people in Liberia, Sierra Leone, and Guinea since its outbreak last spring, was almost entirely ignored by the mainstream media here until the end of July when two U.S. missionaries were infected and flown to the U.S. for treatment.

But it shot to the top of the news agenda with confirmation that Duncan, a Liberian who had flown to the U.S. for his son’s high school graduation, was admitted to a Dallas hospital Sep. 30 and tested positive for the virus. He died Oct. 8. Within a week, two nurses who had treated him also tested positive and are currently being treated in specially equipped and trained hospitals.

Since Duncan’s hospitalisation, Ebola has received more attention on three network nightly television news programmes – the single biggest source of information about international and national events for the U.S. public — than any other story, accounting for almost one third of total broadcast time over the past three weeks, according to Andrew Tyndall, publisher of the authoritative Tyndall Report which has tracked network news for 25 years.

He told IPS he had “very mixed feelings” about the networks’ coverage. “On the one hand, it is a genuine crisis in the countries where’s it’s happening, and therefore it deserves all the attention it can get,” he said.

“On the other hand, the nature of that attention is inappropriate, misleading, and scare-mongering in that it is so disproportionately focuses on the very low level domestic threat (Ebola poses), as opposed as to the actual crisis in the three West African nations.”

What applied to the three networks – CBS, ABC, and NBC – applied much more to the main cable news stations – Fox News, CNN, and MSNBC – whose coverage was, if anything, more sensational despite efforts by its resident health experts or guest epidemiologists to rein in the rampant speculation.

One CNN anchor, for example, offered up a similar scenario as the one described by AEI’s Thiessen, noting that “All ISIS would need to do is send a few of its suicide killers into an Ebola affected zone and then get them onto mass transit.”

Such panic-provoking commentary has naturally bolstered Republican efforts to generate a sense that the world was spinning increasingly out of control due to the “weakness” and incompetence of President Barack Obama and his administration, a theme that was made somewhat more credible by over-confident statements before the two nurses’ infection by administration officials, notably the head of the Centers for Disease Control and Prevention (CDC), about their ability to “stop [Ebola] in its tracks in the U.S.”

Backed by right-wing media, Republican lawmakers and candidates have demanded that the administration impose a ban on civilian air travel to the U.S. from the three West African countries – a position favoured by nearly three out of four respondents, according to recent polls, despite strong opposition by epidemiologists and other public-health experts who have warned that such a step would make it more difficult to track Ebola’s victims and those with whom they come in contact.

Obama sought initially to appease those demands by ordering temperature checks at five of the most important U.S. international airports for incoming passengers whose travel originated in the three West African countries. Faced with the growing political pressure, he expanded that order Tuesday by requiring passengers flying from those nations to enter the U.S. through one of those five airports.

Republican lawmakers, however, insisted that that was insufficient and are reportedly preparing legislation that would suspend U.S. visas for citizens of the Ebola-affected countries.

Despite the public’s concern about exposure to Ebola, large majorities of respondents, including 85 percent of Democrats and 70 percent of Republicans, said they supported the administration’s efforts to fight the virus in West Africa.

Those efforts include sending an estimated 3,000 U.S. servicemen and women to build treatment units and training facilities for health workers, and provide logistical support and transport for needed equipment and personnel, as well as more than 100 health specialists from the CDC and other agencies.

Jim Lobe’s blog on U.S. foreign policy can be read at Lobelog.com. He can be contacted at ipsnoram@ips.org

Edited by Kitty Stapp

Tank trucks being filled with water in front of Osman Bin Affan Mosque in Beirut. Credit: Oriol Andrés Gallart/IPS

By Oriol Andrés Gallart
BEIRUT, Jul 28 2014 (IPS)

In front of Osman Bin Affan Mosque, in a central but narrow street of Beirut, several tank trucks are being filled with large amounts of water. The mosque has its own well, which allows it to pump water directly from the aquifers that cross the Lebanese underground. Once filled, the trucks will start going through the city to supply hundreds of homes and shops.

In a normal year, the water trucks do not appear until September, but this year they have started working even before summer because of the severe drought currently affecting Lebanon.

This comes on top of the increased pressure on the existing water supply due to the presence of more than one million Syrian refugees fleeing the war, exacerbating a situation which may lead to food insecurity and public health problems.“The more we deplete our groundwater reserves, the less we can rely on them in the coming season. If next year we have below average rainfalls, the water conditions will be much worse than today” – Nadim Farajalla of the Issam Fares Institute (IFI)

Rains were scarce last winter. While the annual average in recent decades was above 800 mm, this year it was around 400 mm, making it one of the worst rainfall seasons in the last sixty years.

The paradox is that Lebanon should not suffer from water scarcity. Annual precipitation is about 8,600 million cubic metres while normal water demand ranges between 1,473 and 1,530 million cubic metres per year, according to the Impact of Population Growth and Climate Change on Water Scarcity, Agricultural Output and Food Security report published  in April by the Issam Fares Institute (IFI) at the American University of Beirut.

However, as Nadim Farajalla, Research Director of IFI’s Climate Change and Environment in the Arab World Programme, explains, the country’s inability to store water efficiently, water pollution and its misuse both in agriculture and for domestic purposes, have put great pressure on the resource.

According to Bruno Minjauw, Food and Agriculture Organization (FAO) representative ad interim in the country as well as Resilience Officer, Lebanon “has always been a very wet country. Therefore, the production system has never looked so much at the problem of water.”

Referring to the figures for rainfall, Minjauw says that “what we are seeing is definitely an issue of climate change. Over the years, drought or seasons of scarcity have become more frequent”. In his opinion, the current drought must be taken as a warning: “It is time to manage water in a better way.”

However, he continues, “the good news is that this country is not exploiting its full potential in terms of sustainable water consumption, so there’s plenty of room for improvement.”

Meanwhile, water has become an issue, with scarcity hitting particularly hard the agricultural sector, which accounts for 60 percent of the water consumed despite the sector’s limited impact on the Lebanese economy (agriculture contributed to 5.9% of the country’s gross domestic product in 2011).

“Some municipalities are limiting what farmers can plant,” explains Gabriel Bayram, an agricultural advisor with KDS, a local development consultancy.

Minjauw believes that there is a real danger “in terms of food insecurity because we have more people [like refugees] coming while production is diminishing.” Nevertheless, he points out that the current crisis has increased the interest of government and farmers in “increase the quantity of land using improved irrigation systems, such as the drip irrigation system, which consume much less water.” Drip irrigation saves water – and fertiliser – by allowing water to drip slowly through a network of  tubes that deliver water directly to the base of the plant.

FAO is also working to promote the newest technologies in agriculture within the framework of a 4-year plan to improve food security and stabilise rural livelihoods in Lebanon.

Sheik Osama Chehab, in charge of the Osman Bin Affan Mosque, explains that, 20 years ago, water could be found three metres under the ground surface. “Yesterday,” he told IPS, “we dug 120 metres and did not find a drop.”

Digging wells has long been the main alternative to insufficient public water supplies in Lebanon and, according to the National Water Sector Strategy, there are about 42,000 wells throughout the country, half of which are unlicensed.

However, notes Farajalla “this has led to a drop in the water table and along the coast most [aquifers] are experiencing sea water intrusion, thus contaminating these aquifers for generations to come. The more we deplete our groundwater reserves, the less we can rely on them in the coming season. If next year we have below average rainfalls, the water conditions will be much worse than today.”

Besides, he cautions, “most of these wells have not passed quality tests. Therefore there are also risks that water use could trigger diseases among the population.”

The drought is also exacerbating tensions between host communities and Syrian refugees.

The rural municipality of Barouk, for example, whose springs and river supply water to big areas in Lebanon, today can count on only 30 percent of the usual quantity of water available. However, consumption needs have risen by around 25 percent as a result of the presence of 2,000 refugees and Barouk’s deputy mayor Dr. Marwan Mahmoud explains that this has generated complaints against newcomers.

However, Minjauw believes that “within that worrisome context, there is the possibility to mitigate the conflict and turn it into a win-win situation, employing both host and refugee communities in building long-term solutions for water management and conservation as well as forest maintenance and management. This would be beneficial for Lebanese farmers in the long term while enhancing the livelihoods of suffering people.”

For Farajalla, part of the problem related to water is that “there is a general lack of awareness and knowledge among decision-makers” in Lebanon, and he argues that it is up to civil society to lead the process, pressuring the government for “more transparency and better governance and accountability” in water management.

He claims that “the government failed with this drought by not looking at it earlier.” So far, a cabinet in continuous political crisis has promoted few and ineffective measures to alleviate the drought. One of the most recent ideas was to import water from Turkey, with prohibitive costs.

“Soon, you will also hear about projects to desalinate sea water,” says Farajalla. “Both ideas are silly because in Lebanon we can improve a lot of things before resorting to these drastic measures.”

The U.S. government is in the final stages of weighing approval for an overhaul of regulations governing the country’s poultry industry that would see processing speeds increase substantially even while responsibility for oversight would be largely given over to plant employees.

U.S. Department of Agriculture (USDA), Food Safety Inspection Service (FSIS) inspector at a poultry processing facility in Accomac, Virginia checking for cleanliness and testing poultry for the Avian Influenza (AI) virus. Credit: USDA/public domain

The plan, which was originally floated by the U.S. Department of Agriculture (USDA) two years ago, is currently slated to be finalised by regulators next month. Yet opposition has been heating up from lawmakers as well as labour, public health and consumer advocacy groups.

On Thursday, over 100 such groups and businesses delivered a letter, along with nearly 220,000 petitions, to President Barack Obama, asking that the proposal be withdrawn.

“The proposed rule puts company employees in the role of protecting consumer safety, but does not require them to receive any training before performing duties normally performed by government inspectors,” the letter states.

“And lack of training is not the only impact this rule will have on workers. Increased [production] speeds will put worker safety in jeopardy … This proposed rule would let the fox guard the hen house, at the expense of worker safety and consumer protection.”

The proposed rule would see top chicken-processing speeds increased from the current 140 per minute to as high as 175. The rule would also decrease the number of federal inspectors assigned to processing plants by 75 percent, leaving the slack to be picked up by company employees.

The poultry industry has reportedly been pushing for these changes for decades. In return, the government would require that processors bathe each chicken carcass in chlorine and other chemicals, aimed at killing any pathogens that remain on the bird.

Last week, Bennie G. Thompson, a member of Congress, warned that the USDA is “unnecessarily endangering the lives of millions of Americans”.

Weak data

Federal pilot projects have been testing the new approach since the late 1990s. Yet critics warn that the results have been far less clear-cut than either the government or the industry has suggested.

“We did a snapshot analysis of how many defects employees were missing at these pilot plants, and found there was no consistency,” Tony Corbo, a senior lobbyist Food & Water Watch, an advocacy group, told IPS.

“In one turkey plant, for instance, there was a 99 percent error rate for one inspection category. We became concerned that the USDA was moving forward too fast with this change.”

The federal government’s official watchdog agency has formally corroborated this conclusion.“The industry says there’s no safety problem, but they’re in denial." -- Tom Fritzsche

The USDA “has not thoroughly evaluated the performance of each of the pilot projects over time,” the Government Accountability Office (GAO) warned in a report published in August, the second time it had come out with such findings.

“GAO identified weaknesses including that training of plant personnel assuming sorting responsibilities on the slaughter line is not required or standardized and that faster line speeds allowed under the pilot projects raise concerns about food safety and worker safety.”

In response to the report, the poultry industry noted that the USDA had already updated its analyses in support of the new rule, and that the sector’s safety record is not linked to processing speeds.

“Over the past 14 years of this pilot program there has been no evidence to substantiate the assertion that increased line speeds will increase injuries,” Ashley Peterson, a vice-president with the National Chicken Council (NCC), a trade group, said in a statement.

“It is not in a poultry company’s best interests to operate at speeds that would harm its workers, and common sense tells you it is not in a company’s best interest to operate at speeds that cannot produce safe and high quality poultry products.”

(The NCC has published responses to criticisms of the proposed regulatory changes here.)

For the moment, the Obama administration appears set on pushing through the new rule, characterising it as a cost-cutting measure.

Under the president’s new budget proposal, released earlier this week, the USDA’s inspections funding would be cut by nearly 10 million dollars, despite the fact that no rule has yet been finalised. Earlier, the federal savings have been estimated even higher – some 90 million dollars over three years.

“The 2015 budget recognises fiscal realities,” Agriculture Secretary Tom Vilsack said Tuesday. “Our leaner workforce continues to find ways to implement increasingly complex programs with fewer resources.”

For major poultry companies, meanwhile, speeding up processing speeds would save more than 250 million dollars a year.

“Most vulnerable” workers

Beyond public health, there are significant civil rights concerns surrounding the new poultry regulations proposal, as well. Last week, a national coalition of groups representing minority and poor workers briefed lawmakers here on concerns that the new rules would exacerbate existing labour problems.

“This proposal has us very concerned, as there are already pending requests with the regulators to require a reduction in these work speeds,” Tom Fritzsche, a staff attorney with the Southern Poverty Law Center, a watchdog group, told IPS.

“The health consequences for workers are already very severe, and the concern is that those injury rates are going to go way up. We’re joining other groups in asking whether the same hazards would be so prevalent if the poultry workforce were not made up mostly of women of colour.”

Last year, Fritzsche authored a study on poultry workers in the state of Alabama, three-fourths of whom said they had experienced injury or illness due to their work. Three-quarters also said that the speed of the processing line made their job more dangerous, in addition to broader allegations of egregious safeguards.

Workers “describe what one called a climate of fear within these plants,” the report states. “[E]mployees are fired for work-related injuries or even for seeking medical treatment from someone other than the company nurse or doctor … they describe being discouraged from reporting work-related injuries.”

The report calls poultry workers “among the most vulnerable” in the United States.

“The industry says there’s no safety problem, but they’re in denial. There is a huge and well-documented undercounting in employer-reported data,” Fritzsche says.

“Workers are repeating the exact same motion between 22,000 and 100,000 times per shift, and can develop some permanent disabilities from these repetitive motions. One study out of South Carolina found that 42 percent of workers had carpal tunnel syndrome – that’s astronomically high, and far higher than the industry ever likes to quote.”

A number of hospitals and clinics in Cuba have been remodelled. Credits: Jorge Luis Baños/IPS

By Patricia Grogg
HAVANA, Sep 7 2013 (IPS)

One challenge faced by the Cuban government, and a high priority for citizens, is improving the efficiency and sustainability of public health services, a constitutional right that the state is supposed to ensure for all.

The quality of healthcare services was a target of criticism during mass debates that were promoted by President Raúl Castro in a key Jul. 26, 2007 speech.

Many suggestions for improving the public health system also emerged from discussions on the draft social and economic policy guidelines that were later approved for the current process of “updating” the country’s development model.

The evident deterioration of hospitals, inadequate professional care, and a shortage of medical personnel were among the complaints most frequently expressed at that time.

“Since the early 2000s, the public has been dissatisfied with a large number of things,” Emilio Delgado, head of the Primary Health Care Department, admitted to IPS in an interview.

The official said that given the need to meet international medical “commitments,” the healthcare system was reorganised, resulting in a reduction of family doctor’s offices, which are the basic foundation of primary health care in Cuba.

Remedying that situation involved a restructuring that began in 2010 as part of a number of changes aimed at modernising Cuba’s socioeconomic model and building what the government describes as “prosperous and sustainable socialism.”

The ongoing restructuring process includes reducing payrolls across the entire public health system.

In 2009 the system had 582,538 workers, 69 percent of whom were women. By 2012 that number had been reduced to 490,245, with a similar proportion of women, according to Public Health Ministry records.

Delgado said the cuts have continued, to 486,000 health workers in July. These staff reductions involve offering other jobs to redundant workers described euphemistically in Cuba as “available”.

As a “very important” result of the ongoing changes, 11,550 family doctor’s offices are now operating nationwide, “almost double” the number before 2010, Delgado said. This system brings doctors closer to Cuban families and prevents unnecessary trips to the hospital, among other benefits.

Measures were also taken to rationally employ high technology and other resources, and investments continue to be made to rebuild hospitals.

“My husband had an emergency operation last week and I have no complaints. Even the hospital food has really improved,” Consuelo Aguilar, a teacher, told IPS.

Delgado said: “These changes had three main goals: to be more efficient and sustainable, that is, to provide the same services but with better quality and at a lower cost; to maintain our health indicators; and to achieve greater satisfaction among the population.”

He estimated that since 2010, more than two million pesos have been saved in healthcare spending.

According to other official sources, the healthcare system had grown in recent years, both in the number of workers and in the acquisition of costlier equipment. This translated into higher spending, which rose from 5.5 percent of GDP in 2004 to 9.6 percent in 2009.

After reorganising its healthcare facilities, Cuba now has 152 hospitals with a total of 40,318 beds; one doctor for every 133 inhabitants; one dentist for every 774; and one nurse for every 117. Life expectancy at birth is 77.9 years, and the infant mortality rate is 4.3 per 1,000 live births.

In parallel, health authorities hope the system will begin generating revenue of its own by marketing services to foreigners both inside and outside of Cuba, including teaching services.

“A large number of doctors from other countries want to and can self-finance training in their specialties here,” Delgado said.

Along with the challenge of sustainability, Cuba’s health system must also respond to the problems presented by the low birth rate, which now stands at 11.3 per 1,000; an aging population; and associated problems, such as cancer, the leading cause of death.

“We are preparing for all of these things, and in some cases, we have already taken precautions,” Delgado said.

Measures are being studied for encouraging women to have more children and to go in for more gynecological checkups. Likewise, treatment for female and male infertility is being expanded in order to offer “the possibility of pregnancy for thousands of couples who can’t have children,” he said.

Cancer, meanwhile, is a disease that requires specialised treatment and medicine and poses a different set of challenges, for which Cuba is preparing with the introduction of new diagnostic technologies and treatments. “There is a whole investment process underway in that sense,” Delgado said.

In his opinion, the greatest challenge in terms of healthcare services that are provided to all of Cuba’s citizens free of cost is achieving greater satisfaction among the population. “If people are dissatisfied, we have to keep finding out why,” he said. Hygiene and epidemiology are other areas that require more attention, he added.