Category: Health

The Rashomon-ization of the World Health Organization

An event happens. Four different people tell four different versions of what happened. How do we figure out how to move forward?

This is a very rough plot summary of Akira Kurosawa’s 1950 masterpiece Rashomon, but it’s also a pretty accurate description of what is happening to the World Health Organization these days. There’s probably a generation of folks who know Kurosawa because he was name-checked in Rent, but the Japanese director also gives us a window for thinking about international politics.

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Sorry Seems to Be the Hardest Word

It’s the eternal quandary of thinking about the intersection of international politics and global health: where does Elton John fit in? We now have an answer. It’s where we try to understand issues of moral and legal responsibility of an international organization.

About a month ago, I wrote about cholera and global health. One of the reasons cholera is such a big issue is because of the ongoing outbreak in Haiti—the worst in recent history, and one that we can directly trace to the 2010 earthquake and Hurricane Matthew in October. Natural disasters can obviously disrupt the sanitation systems that keep cholera from spreading. Haiti’s cholera outbreak is different, though; the disease came to the country with UN peacekeepers from Nepal. The soldiers’ untreated waste went into open pools, where it easily leaked into important waterways and spread to a population already grappling with a lack of sanitation infrastructure.

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Poo Haikus (and Other Unconventional Ways to Raise Awareness about Global Health)

Writing about poo

Raises awareness, saves lives

Oddest line on CV

I am definitely not a poet. Fortunately, the organizers of Poo Haiku had nearly 150 other entries from which to select 12 winners to have their haikus memorialized on the 2017 Poo Haiku calendar.

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World AIDS Day 2016

December 1 is World AIDS day.  Throughout the 2000s, AIDS received unprecedented attention and resources, particularly to support ten of millions of people’s access to life-extending anti-retroviral therapy. Attention and resources peaked in recent years, and while the problem in some respects has gotten better, it hasn’t gone away. More than 35 million people have died from AIDS already.  And yet,  there are still more than 35 million people living with the virus that causes AIDS, only half of whom have access to ARVs. While new infections and deaths have come down from their peaks, there are still more than 2 million new infections a year and more than a million deaths from AIDS.  We still have never gotten very good at AIDS prevention strategies, as changing risky behavior is hard.

AIDS funding largely held steady after the financial crisis, and with the U.S. the world’s largest source of foreign aid for AIDS, that reflected the durability of the bipartisan consensus to address AIDS that emerged under President George W. Bush. However, for the first time in five years, we saw a significant drop in resources for AIDS, and we’re starting to see negative signs in some places and some countries as new generations grow up without as much safe sex messaging.

With a Trump administration, we have almost no signs of what it intends to do on global health, as Jeremy Youde suggested here and Laurie Garrett wrote about yesterday.

Below, I’m going to embed some tweets from Jennifer Kates from the Kaiser Family Foundation who has done tremendous work in tracking AIDS finance over the years. I’ll try to say more what’s needed going forward in a separate post, as there is a need hold the line on efforts in the AIDS space but also do wider health systems strengthening. Accomplishing those twin tasks without adequate and even more resources is impossible so global health advocates will need to make their case on why doing the right thing now will avoid unnecessary deaths and expense later.

Finally, two books are worth your attention. David France, director of the Oscar nominated documentary How to Survive a Plague, is out with a print version of the story of US AIDS activists from ACT UP who made the cause a national issue in the era of Reagan and hastened the faster development of anti-retrovirals and wider changes in AIDS policy. There may be some lessons learned about civil disobedience and speaking truth to power that will be important in the years to come.

LGBTQ activist Cleve Jones, who was close to the gay activist Harvey Milk, is also out with a memoir on his life and advocacy including his work in founding the AIDS Memorial Quilt. Continue reading

What Do You Do with a Problem Like Zika?

Two years ago, more people probably knew that Stephen Breyer is on the Supreme Court (hint: it’s a really low number) than had even heard of the Zika virus. I certainly hadn’t, and I make my living studying global health politics. The entirety of published research on Zika could fit in a shoebox. Since the first reports of the virus appeared in Brazil, though, Zika has grabbed international attention, leading to travel warnings and even causing some athletes to pull out of the 2016 Summer Olympics in Rio.

Zika’s emergence changed the dialogue on global health and forced states and organizations to get involved. On 1 February 2016, the World Health Organization (WHO) declared Zika-related microcephaly to be a Public Health Emergency of International Concern (PHEIC). Nine months later, WHO ended the PHEIC for Zika, arguing that the organization should shift to a “robust longer-term technical mechanism.” Is WHO’s decision a reflection of the changing strategy necessary to tackle Zika, or is it evidence that the organization is waving the white flag and admitting defeat?

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What does Trump mean for global health?

Well, that was unexpected.

But it’s happened. The question now is, how will the election of Donald Trump change international relations?

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What Cholera Tells Us About Global Health

I’ve been marking essays for the past week (two big advantages of Australian academia: November is a spring month, and second semester ends before Halloween), and a lot of my students were writing about the right to health and what it would take to realize it in a meaningful sense. That, naturally, led me to thinking about cholera.

Few diseases can kill as rapidly as cholera. That alone should make it a key issue for global health. What makes cholera particularly important and interesting, though, is how much it says about our larger global health system and the interconnectedness between health and other issues.

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Patient Zero and Global Health

With any luck, the myth of Patient Zero being responsible for HIV/AIDS in the US will finally be completely put to rest.

Gaétan Dugas may not be a household name for most, but he’s the man who has largely been blamed for HIV/AIDS in the United States. Dugas was a gay French-Canadian airline steward who worked for Air Canada in the 1970s and 1980s. Because his work involved a significant amount of travel and because of the number of his sexual contacts, a 1984 study linked him to some other early cases (though it could not necessarily prove a direct line of infection).

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Ladies and Gentlemen, Your Candidates for WHO Director-General

When I walk down the street, I don’t see signs saying “Tedros for WHO” or “Vote Szócska.” The television and radio airwaves don’t have endless campaign commercials ending with the tagline, “I’m Flavia Bustreo, and I approve this message.” Sania Nishtar does not hold large public rallies in sports stadiums to bolster her candidacy. Neither David Nabarro nor Philippe Douste-Blazy do phonebanking.

These facts don’t distract from the fact that there is a vigorous and hotly-contested electoral race for the Director-General of the World Health Organization. Think of the current period as the primaries, with the general election campaign beginning when the WHO Executive Committee forwards the names of the three finalists to the World Health Assembly in February.

When WHO reformed its processes for selecting a new Director-General (which I detailed here), they set themselves up for a new and largely unprecedented experiment. For better or worse, most international organizations select their leaders through fairly opaque processes, and the public gets little glimpse into the decisionmaking process. Even when we have seen multiple candidates competing for the top office, such as the 2012 race for the presidency of the World Bank, the formal campaigns have tended to be brief.

WHO’s election process is different. It is openly contested. It features some of the same trappings of other political campaigns. It requires a degree of public engagement not usually seen in international organizations. The United Nations’ search for a new Secretary-General was supposed to be more transparent, but the process came to a surprising early conclusion when the 15 members of the Security Council announced their unanimous support for former Portuguese prime minister António Guterres.

So far, the WHO DG election does not show signs of ending early. Part of that may be because of the procedures WHO established for the election, but it also reflects the keen interest in the job. When the nomination period closed on 23 September, WHO announced that there were six candidates:

The final list of six surprised a number of observers. Tedros (as he prefers to be called), Douste-Blazy, and Nishtar were not surprises, as all three had essentially been campaigning for months prior to the official nomination period. Bustreo, Nabarro, and Szócska, though, were not among the names being bandied about.

The candidates themselves are an interesting mix. Despite the fact that WHO has been criticized for only having had DGs from Europe or Asia since 1973, only one candidate comes from outside those two regions. Two candidates—Tedros and Douste-Blazy—have served as their country’s Foreign Minister. Bustreo is the only candidate who is currently employed by WHO, but Nabarro headed up one of WHO’s post-Ebola reform panels and previously worked in the Director-General’s office. Nishtar would be the first Muslim to lead the organization if she were selected. Three of the candidates come from traditional donor states to WHO. All but Tedros are medical doctors, while Tedros holds a PhD in community health.

As part of the campaign process, the candidates are reaching out to the voters/member-states. Four of the candidates—Tedros, Douste-Blazy, Nabarro, and Nishtar—have specific campaign websites, and Bustreo and Szócska are active on Twitter. and all six responded to a candidate survey from The Lancet. The African Union announced its support for Tedros’ candidacy (and the value of having an African in the top job) earlier this year. Given that African states are the largest single bloc within WHO, that could give him an early advantage—assuming all AU member-states vote in unison.

All of the candidates appear to meet the basic requirements for the position, so which factors are likely to make a difference in the election? Let me call attention to three issues that are likely to play a big role in the deliberations. First, WHO’s budget is a mess. More than 80 percent of its outlays come from voluntary contributions pledged for specific programs. As a result, WHO has little control over how it spends most of its money, and it lacks the financial flexibility to allow it to respond to an emergency like Ebola. That said, member-states have been reluctant to give WHO more money without seeing proof of WHO’s efficacy. A successful candidate will need to show an ability to simultaneously get WHO the resources it needs to carry out its mission and convince member-states that it can use those funds efficiently and responsibly. There may also be opportunities to develop new financing structures, like UNITAID’s airline ticket levy. (Incidentally, Douste-Blazy has been the chair of UNITAID since 2006.)

Second, WHO needs to restore its international credibility. To a large degree, that is likely to mean that member-states are going to want to know specifics from the candidates about what sorts of reforms WHO will introduce to function better. WHO cannot do everything, so the question is what direction the different candidates would go in their understanding of the organization’s scope. That will also touch on how much autonomy WHO should have: is it there simply to do the member-states’ bidding, or should it have control over its own agenda?

Finally, WHO’s leader will need to show an ability to play politics. Outgoing DG Margaret Chan has been criticized for not being an effective diplomat, especially in contrast to someone like former WHO DG Gro Harlem Brundtland. Like it or not, global health is an inherently political field; a focus on solely on the technical aspects simply will not work in this environment. Indeed, Josh Busby, Karen Grépin, and I argued earlier this year that the next WHO DG specifically needs political experience.

In many ways, the WHO DG election could provide a template for international organizations looking to elect their leaders publicly and transparently. As such, it is all the more important to keep an eye on it—and to pick up some sweet campaign swag.

So You Want to Be the Next Director-General of the World Health Organization…

It should come as no surprise to anyone that a political scientist like me gets really excited about elections and campaigns, and we’re currently in the thick of a doozy of a campaign season. Candidates have splashy websites and brochures, and they regularly meet with voters to pitch their candidacies. Whoever wins will take over an organization whose standing in the world is up in the air—and the winner will have a big job restoring the organization’s place in the larger global landscape.

Of course, I’m talking about the campaign for the next Director-General of the World Health Organization. What else would I be describing?

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National Security, Health, and Responding to Emergencies

Why don’t government officials respond to global health emergencies the same way that they respond to national security crises? This is the question Congresswoman Rosa DeLauro (D-CT) raised last week. She was speaking at the public launch of a new report by the Brenthurst Foundation on international society’s failure to respond to the Ebola outbreak in West Africa in a timely manner—but much of the conversation focused on the current response to Zika.

If military officials said they needed $1.9 billion to prevent a global crisis, she argued, Congress would not hesitate to approve the money. Unfortunately, health emergencies don’t receive the same level of attention. “Why aren’t we listening to the generals of public health?” she asked. Instead of making the long-term investments to strengthen health systems and improve detection and treatment capabilities, DeLauro noted, we lurch from one crisis to another.

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Global Health Governance Syllabi Open Thread

So, I noted in a post a few weeks ago during APSA that I thought the discipline doesn’t pay enough attention to global environmental politics. Part of this is a function of training. I didn’t have a global environmental politics course to take during graduate school, but I teach one now. I posted a few syllabi in the post and comments thread.

I think the same thing is true of global health. Politics abound with global health whether it be the Ebola virus, Zika, pharmaceutical prices, the on-going HIV/AIDS crisis, the rise of non-communicable disease, the challenges of health systems strengthening. And this stuff is important! Continue reading

What Am I Reading? Inaugural Feature on Global Health #1

I’m on leave this year so my regular blogging might be a little scant, but I thought I’d introduce a new feature which is a periodic series “What Am I Reading?” I’d like to flag what I’m  reading on different topics, namely health, the environment, and foreign policy. This first one is on health.

Zika

  • Last week I had a piece on the Monkey Cage in the Washington Post on the Zika virus, presenting some empirical work on what frames might generate public concern and, in turn, more impetus for Congressional funding for Zika control
  • My colleague Abigail Aiken finds a potential increase in demand for abortion in the Americas
  • There is growing pressure on Congress to fund efforts to combat Zika which have stalled
  • In addition to a state of emergency in Puerto Rico, there is now local transmission of Zika in Miami. CDC director Frieden suggests pregnant women stay away from Miami Beach and possibly Miami as well
  • Here a pregnant mother who lives in Miami pleads for action

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Kristof and Political Scientists Agree!!!: Congress is playing with fire by avoiding Zika

Nicholas Kristof’s op-ed in the New York Times today, Congress to America: Drop Dead, laments Congress’ inaction on appropriating funding requested by the White House for proactive public health measures intended to stem the expected spread of the Zika virus in the United States. In April, I raised similar concerns here on the Duck, Chasing our Tails, where I asked:

It is puzzling why Zika has not garnered the same policy attention from Congress as the Ebola outbreak. Viewed through a security lens, the Zika outbreak more readily meets the attributes of a “threat” in its proximity to the U.S., in its pervasiveness, and in the fact that it poses a high risk for global transmission. Moreover, mobilization in response to humanitarian crises is generally more likely to occur when it strikes communities in close proximity to us (i.e. South America) or with whom we can identify (i.e. Americans).

[The fact that my blog post preceded Kristof’s by almost three weeks is particularly satisfying given Kristof’s frequent critiques that political scientists do not anticipate or contribute to real-world policy problems. Checkmate!] Continue reading

Chasing our tail: The Zika ‘emergency’ and stalled U.S. Congressional appropriations

On April 13th, the Centers for Disease Control reported 358 travel-associated Zika virus disease cases in the U.S. spanning 40 states and the District of Colombia. The U.S. territories of American Samoa, the U.S. Virgin Islands and Puerto Rico reported 471 locally acquired cases and 4 travel-associated cases. Since Zika is primarily transmitted by the Aedes species mosquito, the numbers of Zika virus disease cases are anticipated to rise once mosquito season is in full swing in the U.S. Yet, Congress has thus far refused to approve the $1.8 billion in emergency funding President Barack Obama requested in February. The House Appropriations Committee has instead asked the President to redirect funds previously designated for the fight against Ebola to the Zika outbreak.

It is puzzling why Zika has not garnered the same policy attention from Congress as the Ebola outbreak. Viewed through a security lens, the Zika outbreak more readily meets the attributes of a “threat” in its proximity to the U.S., in its pervasiveness, and in the fact that it poses a high risk for global transmission. Moreover, mobilization in response to humanitarian crises is generally more likely to occur when it strikes communities in close proximity to us (i.e. South America) or with whom we can identify (i.e. Americans).

Partisan politics might explain some of the Congressional stall tactics, though this would be a high stakes game to play.  So, what’s going on? I think the “emergency imaginary” has both enabled and constrained policy responses. First, because the Zika outbreak does not conform to conventional understandings of an “emergency,” policy action has been slow despite the demonstrated threats to the U.S. population. Second, because the Zika crisis is nonetheless viewed as an emergency, policymakers feel justified in diverting resources from other emergencies, even though it might produce mediocre results in both cases. Continue reading

Understanding the Emotional Impacts of Ebola: moving beyond crisis and stats to stories

This is a guest post by Dehunge Shiaka, researcher and gender expert in Freetown Sierra Leone

What are the emotional and psycho-social impacts of the Ebola epidemic in West Africa? With much of the media attention on the medical, international, and civil-military response to Ebola, this is a question that has largely been unaddressed. Yet it is inevitable that a virus that ravaged communities, halted economies, and killed thousands in a region would have multiple and lasting emotional impacts. Taking account of people’s extreme social and emotional reactions in emergency settings is vital to understanding the long-term impacts of Ebola. Moreover, a focused picture on emotion is necessary in trying to grasp the nature of the crisis and why resources should be dedicated not just to ‘eradicating’ the virus, but also to supporting communities struggling in a ‘post-Ebola’ era. This post provides a few examples of the emotional impact of Ebola and raises several questions about crisis, emotion, and the varying meanings of ‘impact,’ ‘virus free,’ and ‘security’ in relation to medical crises.

The first story takes place in Freetown, the capital, during the peak of the Ebola Virus Disease (EVD) outbreak in November 2014. It involved a one-week old baby who was found by the side of her dead mother. As part of the protocol at the time, the infant was driven in an ambulance to one of the holding centres for testing, but the baby was not immediately allowed in. Continue reading

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