Tedros Adhanom Ghebreyesus, Director General of the World Health Organization (WHO), speaks to the media after the International Health Regulations Emergency Committee on Ebola in Congo, in Geneva, Switzerland, Wednesday, Oct. 17, 2018. The World Health Organization says it is “deeply concerned” by the ongoing Ebola outbreak in Congo but the situation does not yet warrant being declared a global emergency. (Salvatore Di Nolfi/Keystone via AP)
Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization © AP

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A lot has changed in the world since the 1978 Alma-Ata declaration called for “health for all”.

Since then, the Soviet Union — which had convened that gathering of health ministers — has imploded, the Berlin Wall has fallen, China has risen, and the host Kazakhstan has moved its capital to Astana. But this week’s Astana declaration suggests the aspiration four decades ago remains unmet. Half the world’s population still lacks access to essential health services.

As an article in the BMJ argued, the bold vision of the 1978 conference was less exploited by Soviet officials for international health diplomacy than is often perceived. But it was swiftly diluted in the west with a return to “vertical” interventions such as vaccination, a focus on a smaller group of cost-effective programmes and the encouragement of private sector involvement.

The new declaration from now-independent Kazakhstan marks a strong political commitment to improve access to services through primary care. It aims to address prevention as well as treatment, to reach the poorest and most remote communities, and to cover non-communicable as well as infectious diseases. What is lacking is detail: agreement on approaches, milestones, money or timelines. Without that, further progress will remain patchy.

Three questions

Tedros Adhanom Ghebreyesus, director-general of the World Health Organization

How satisfied are you with the Astana meeting this week?

It has gone very well. We have a declaration. You see a renewed commitment, a real seriousness. A declaration is just a [piece of] paper till it’s implemented. People are asking for us to start immediately. Let’s act while the iron is hot. It has given me confidence that participants are now asking how we address the human resources gap, the financing gap, the information issue, the use of technology — not just the “what” but the “how”. You can see people are serious.

Was there resistance from the US and other donors?

The draft declaration was discussed openly, and had more than 1000 public comments. Then the member states took over to negotiate. We reached an agreed document, with a footnote from the US, but we have an agreed text. We had about 60 ministers of health in Astana and 140 countries represented. It doesn’t matter at what level they attended the conference. All WHO member states are signatories. This adds to the WHO’s strategic plan and the Hamburg declaration of the G20. There is consensus on universal health coverage.

What are the next steps?

There is already political commitment by governments to build sustainable primary healthcare. That needs predictable multiyear financing. We hope governments and donors will honour their commitments with both domestic and international support. We have already selected trailblazer countries, with indicators on progress, gaps and where investment is needed. We need to move quickly to support them to do more. Another meeting won’t help: We have to get on the ground and try to do something. 


Brexit hopes and fears Possible fast-tracking of Sanofi's new flu vaccine by the MHRA, Britain's drug regulator, raised hopes that the country could gain a post-Brexit advantage by approving drugs more quickly than the rest of Europe. Flotillas may be used to bring in medicines if there is no Brexit deal. Researchers are fearful of the impact on British science. (FT)

News round-up

The cost of Ebola Rebel attacks on health officials in the Democratic Republic of Congo have led to a jump in Ebola cases. A new analysis puts the cost of the west African outbreak of 2014-2016 at $53bn — much higher than previous estimates. The biggest new factor in this study was deaths from other diseases which shot up as health resources were diverted. (Guardian, Reuters)

The anti-vaxx effect Brussels said vaccine confidence in Europe — trust in their effectiveness and safety and the system that delivers them — was the lowest in the world, thanks partly to anti-vaccine campaigners. A separate European Commission report laments the lack of co-ordination among EU member states. Developing vaccines for the world's top infectious diseases would cost $2.8bn to $3.7bn. (Europa, Vox)

Polio peril The WHO decided in 1988 to eradicate polio but getting to zero transmission is proving difficult, especially in conflict-stricken areas with deteriorating infrastructure, sanitation and vaccination rates. World Polio Day was marked with a warning the disease could come “roaring back” without more resources to immunise children. Listen to the tale of how India defeated the disease. (ReliefWeb, Arab News, Global Dispatches Podcast) 

China changes China’s birth restrictions may be scrapped entirely as politicians belatedly realise the country needs more babies. But much more must be done to address the implications of a rapidly-ageing society. (FT)

The struggle against stunting Poor nutrition means one in four of the world’s children suffer stunted growth, which can have life-long physical and mental consequences. Action has positive economic effects: for every dollar invested in nutrition there is a $17 gain, says the WHO. (Telegraph)

Tackling TB Improved availability of smartphones in developing countries brings great potential to help tuberculosis patients take their antibiotics, disseminate information and improve diagnosis. A drug-resistant form of the disease is causing concern in South Africa. (Stat, Telegraph)

Opioid optimism President Trump signed sweeping new legislation to curb the US opioid epidemic, including $6bn in funding, the expansion of addiction treatment, speeding up research on alternative drugs, and Medicaid funding for treatment centres. Deaths are starting to plateau. Drugmakers are pushing back against accusations they are to blame for the crisis. (The Atlantic, NPR, WSJ) 

Smoke signals Philip Morris was attacked for hypocrisy for its UK ad campaign encouraging smokers to quit. The company is promoting alternative tobacco “delivery systems” such as IQOS but is still heavily involved in selling cigarettes. Marlboro pulled its ecigarette pods from the market. (The Conversation, CNBC, FT) 

Medical cannabis warning Pain doctors in the UK attacked the legalisation of medical cannabis, saying there was little evidence of its effectiveness for chronic pain and could lead to an opioid-style addiction crisis. The FT explores what the Dutch can teach us about cannabis for medicinal — and recreational — use. (Times, FT)

Slashing sugar New York is leading a national US campaign to cut sugar in packaged foods by 20 per cent and in drinks by 40 per cent by 2025. Some 68 per cent of packaged foods and drinks contain added sugar. (WSJ) 

Action against AMR UK MPs said anti-microbial resistance was a “grave threat to health and should be a “top five” priority for government. English health authorities launched a “keep antibiotics working” campaign. A study suggests probiotics could help. The European Parliament voted to curb antibiotic use in farm animals. (BMJ, UK parliament, PHE, WEF, Guardian)

Best from the journals

Dangers of dirty air The first global study on air pollution and asthma showed the largest impacts to be in India and China. Asthma is the most prevalent chronic respiratory disease worldwide, affecting 358m people. British children are being put at risk from dirty air, but the FT lauds bold moves to tackle the problem in London. (Environmental Health Perspectives, Guardian, FT)

Citizen scientists Thanks to growing connectivity and developments such as cheap sensor technologies, public involvement in scientific research is growing in size and importance. Activities range from monitoring pollution to building Geiger counters to photographing stagnant water to help document the spread of mosquito-borne disease. (Nature)

Migrant health An overview of the healthcare needs of migrants who have been forced to leave their home countries because of conflict, torture, trafficking or environmental disasters. (BMJ) 

Health inequalities A new report highlighted glaring health inequalities in England. Rates of premature mortality are twice as high in the most deprived areas (Blackpool), compared with the most affluent (Wokingham). An interactive allows users to find out how many years of life are lost in their area to the 20 leading causes of premature death. (The Lancet) 

Podcast of the week

One in ten adults in Mozambique is HIV positive, making the country’s HIV prevalence the eighth highest globally. Listen to how sex workers are helping stop the spread of the disease. (Mosaic 31m)

Join the debate

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Final thought

War on drugs A new report argues that achieving a drug-free world is unrealistic and has led to policies which have undermined health, human rights, development and security. Is it time to end the rhetoric of the war on drugs? (International Drug Policy Consortium)

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