Resilient health systems, free at the point of use, are a global public good by WHO, MSF, Save the Children 3:27pm 22nd Apr, 2015   3 June 2015    The world is no better prepared today than a year ago to respond to Ebola. (MSF)    The global health system remains unprepared for mass disease epidemics warns the international humanitarian aid organisation Médecins Sans Frontières (MSF). MSF urges the leaders of the G7 countries at this weekend’s G7 summit in Elmau, Germany to commit to developing an efficient emergency response system against epidemics and international health crises, following the devastating Ebola outbreak in West Africa. The Ebola outbreak also underlines the real need to urgently fund the development of drugs and diagnostics for neglected diseases and to ensure access to existing medicines for patients in developing countries.    “If a global pandemic were to strike tomorrow, there is still no well-resourced, coordinated international response in place to kick in. The G7 leaders must recognise this gaping hole in our global health system and take concrete action to address it, or risk losing thousands of more lives in the next major epidemic,” says Dr. Joanne Liu, MSF International President. “There is a real danger of going back to business as usual: no major hospital would shut down the ER unit to only focus on general practice – both are needed for the world’s patients.”    The global failures encountered in the response against Ebola - not sounding the alarm on time, ineffective surveillance, slow international response, absence of leadership, lack of treatments and vaccines – are not unique. They are the reality in many emergencies MSF teams confront today.    “There is a palpable vacuum of global health leadership today. At the World Health Assembly last week in Geneva, the shouts of WHO reform seem to have dwindled, with UN Member States failing to pledge additional core funding, and no clear agreement on how to make a rapid and effective response a reality,” says Florian Westphal, MSF Germany, Managing Director. “We hope that the G7 leaders will show greater political leadership and prioritise health emergencies to prevent future epidemics from spiralling so far out of control.”    The global health and aid system currently rewards countries for reaching long-term development targets, but there is little incentive for countries to declare outbreaks of infectious diseases for fear of harming trade and tourism. Moving forward, countries need to be incentivised for publicly recognising an outbreak, while wealthy nations should deploy staff and resources to support Ministries of Health that are unable to cope alone.    Germany, which is chair of the G7 during 2015, has set three health issues on the G7 agenda: Ebola, neglected diseases and antimicrobial resistance. The lacking medicines and medical tools in these disease areas all reflect a broken research and development system, where needed tools are either priced far out of reach, or are simply not developed.    "The G7 summit has rightly put major burning health problems on the agenda, but they’re not talking about fixing the R&D system so we can turn this around," says Philipp Frisch of MSF’s Access Campaign. “The lack of R&D for Ebola, antimicrobial resistance and neglected diseases is an enormous problem; millions of people suffer from diseases for which there are no effective drugs or vaccines, because they don’t represent a lucrative market for the pharmaceutical industry. The leaders of the G7 must prioritise funding for research and development into these unmet health needs.”    Drug-resistant tuberculosis is among the neglected diseases for which new drugs, vaccines and diagnostics are urgently needed. MSF treats thousands of people worldwide each year, using a two-year regimen of antibiotics that can cause horrible side effects—from constant nausea to psychosis and deafness—while managing to cure only one in two people. Some forms of the disease are now virtually no longer treatable due to resistance to existing drugs.    At the same time, existing vaccines and treatments are priced out of reach. New exorbitantly-priced hepatitis C treatments are a prime example, as are new vaccines that many so-called ‘middle-income’ countries cannot afford. While Germany showed leadership in hosting an important pledging conference to pay for new vaccines in Berlin this year, the government has done little to ensure overpriced vaccines are made more affordable for all developing countries.    "Wealthy, developed countries must take urgent action against the market failure in the pharmaceutical research and development," said Frisch. "The inaction of the international community on R&D, including the countries of the G7, has led to many preventable deaths, as drugs are not developed or are too expensive. R&D should prioritise the lives and health of people over profits."    http://www.msf.org/article/g7-world-no-better-prepared-today-year-ago-respond-ebola    A Wake-Up Call: Lessons from Ebola for the world’s health systems    Almost 30 countries are highly vulnerable to an Ebola-style epidemic jeopardising the future of millions of children, warns Save the Children in its new report ‘A Wake Up Call: Lessons from Ebola for the world’s health systems’.    The report ranks the world’s poorest countries on the state of their public health systems, finding that 28 have weaker defences in place than Liberia where, alongside Sierra Leone and Guinea, the current Ebola crisis has already claimed 9,000 lives, and provoked an extraordinary international response to help contain it.    The agency warns that an increasingly mobile population intensifies the threat of infectious disease outbreaks and, added to the emergence of two new zoonotic diseases each year – those that can be passed between animals and humans - it is crucial to invest in stronger health systems to avoid a virus spreading faster and further than the current Ebola outbreak.    The report also advises that prevention is better than cure, finding that the international Ebola relief effort in West Africa has cost $4.3bn, whereas strengthening the health systems of those countries in the first place would have cost just $1.58bn.    Ahead of an Ebola summit attended by world leaders in Brussels this week, the charity warns that alongside immediate much needed support to Sierra Leone, Liberia and Guinea, lessons need to be learnt and applied to other vulnerable countries around the world.    Justin Forsyth, Save the Children’s CEO, said: “A robust health system could have stopped Ebola in its tracks saving thousands of children’s lives and billions of dollars.    “Without trained health workers and a functioning health system in place, it’s more likely that an epidemic could spread across international borders with catastrophic effects.    “The world woke up to Ebola but now people need to wake up to the scandal of weak health systems, which not only risk new diseases spreading, but also contribute to the deaths of 17,000 children each day from preventable causes like pneumonia and malaria.”    The reports’ index looks at the numbers of health workers, government spending on health, and mortality rates. Somalia ranks lowest, and is preceded by Chad, Nigeria, Afghanistan, Haiti, Ethiopia, Central Africa Republic (CAR), Guinea, Niger, and Mali.    In a snapshot of dangerously inadequate global health systems the index shows:    In Afghanistan, public spending on health is just $10.71 per person per year, compared to $3,099 in the UK; and In Somalia, there is one health worker for every 6,711 people – by comparison in the UK there is one health worker for every 88 people.    As well as rebuilding the fractured health systems of Liberia, Sierra Leone and Guinea following the Ebola crisis, Save the Children is calling for:    The international community to make a clear commitment to Universal Health Coverage for every country – the principle that every person should have access to essential health care, not just those that can afford it – including the IMF encouraging countries to collect progressive taxes and increase investments in public health services;    Countries to increase domestic tax revenue to 20% of GDP and allocate at least 15% of their national budgets to health;    Donors to ensure that the aid they give is better aligned and contributes to building comprehensive primary healthcare systems;    The new Sustainable Development Goals – which will replace the Millennium Development Goals, due to be negotiated at the UN General Assembly in New York in September – to explicitly include a commitment to Universal Health Coverage; and World leaders to commit to end preventable maternal, new-born and child deaths by 2030.    Notes:    The Health Access Index ranks the 75 ‘Countdown Countries’, which shoulder 95% of global maternal, new-born, and child deaths. A coalition of institutions including Save the Children, The WHO, and The Lancet chart their annual progress towards MDGs 4&5.    ‘Health workers’ include doctors, nurses and/or midwives.    ‘Zoonotic diseases’ are defined by the Centre for Disease Control as diseases ‘that can be passed between animals and humans’.    ‘Universal Health Coverage’ is defined by the WHO as ‘to ensure that all people obtain the health services they need without suffering financial hardship when paying for them’.    17,000 children under five die every day, according to UNICEF Child Mortality Report 2014.    http://reliefweb.int/report/world/wake-call-lessons-ebola-world-s-health-systems http://www.thelancet.com/infographics/global-health-security    Building resilient health systems and learning from the Ebola crisis. (Oxfam)    It took the threat of a global health crisis to illustrate the failings of Africa’s health systems. Resilient health systems, free at the point of use, are evidently a global public good. They are essential for the provision of universal health coverage and for a prompt response to outbreaks of disease.    Resilient health systems require long-term investment in the six key elements that are required for a resilient system: an adequate number of trained health workers; available medicines; robust health information systems, including surveillance; appropriate infrastructure; sufficient public financing and a strong public sector to deliver equitable, quality services. Global investment in research and development for medical products is also critical.    This briefing paper identifies lessons from the current Ebola crisis, as well as previous outbreaks, to review what is required to build resilient health systems in West Africa and beyond. The paper presents recommendations for affected countries, governments, donors and international organizations.    http://policy-practice.oxfam.org.uk/publications/never-again-building-resilient-health-systems-and-learning-from-the-ebola-crisis-550092    April 2015    Global vaccination targets ‘off-track’ warns World Health Organization (WHO)    Progress towards global vaccination targets for 2015 is far off track with 1 in 5 children still missing out on routine life-saving immunizations that could avert 1.5 million deaths each year from preventable diseases. In the lead-up to World Immunization Week 2015 (24 -30 April), the World Health Organization (WHO) is calling for renewed efforts to get progress back on course.    In 2013 nearly 22 million infants missed out on the required three doses of diphtheria-tetanus-pertussis-containing vaccines (DTP3), many of them living in the world’s poorest countries. WHO is calling for an end to the unnecessary disability and death caused by failure to vaccinate.    “World Immunization Week creates a focused global platform to reinvigorate our collective efforts to ensure vaccination for every child, whoever they are and wherever they live,” said Dr Flavia Bustreo, WHO Assistant Director-General, Family, Women''''s and Children''''s Health. “It is critical that the global community now makes a collective and cohesive effort to put progress towards our six targets back on track.”    In 2012, all 194 WHO Member States at the World Health Assembly endorsed the Global Vaccine Action Plan (GVAP), a commitment to ensure that no one misses out on vital immunization. However, a recent independent assessment report on GVAP progress rings an alarm bell, warning that vaccines are not being delivered equitably or reliably and that only one of the six key vaccination targets for 2015 is currently on track – the introduction of under-utilized vaccines.    Many countries worldwide have experienced large measles outbreaks in the past year, threatening efforts to achieve the GVAP target of eliminating measles in 3 WHO Regions by end-2015.    Actions to get back on track    A global collaborative drive for immunization, begun in the mid-1970s — with the establishment of the Expanded Programme on Immunization in all countries — achieved dramatic results, raising vaccination levels from as low as 5% to more than 80% in many countries by 2013. WHO estimates that today immunizations prevent between 2 and 3 million deaths annually and protect many more people from illness and disability.    Although progress has stalled in recent years, this early success demonstrates the potential of vaccines, which are increasingly being extended from children to adolescents and adults, providing protection against diseases such as influenza, meningitis and cervical and liver cancers.    The GVAP recommends three key steps for closing the immunization gap:    Integrating immunization with other health services, such as post-natal care for mothers and babies; strengthening health systems so that vaccines continue to be given even in times of crisis; and ensuring that everyone can access vaccines and afford to pay for them.    Dr Jean-Marie Okwo-Belé, Director of Immunization, Vaccines and Biologicals at WHO, says the Organization will work to increase its support to all countries that are lagging behind in meeting immunization targets. In May this year, WHO will bring together high-level representatives of 34 countries with routine vaccination (three doses of DTP3) coverage of less than 80% to discuss the challenges faced by countries and to explore solutions to overcome them.    Although many countries are already vaccinating four out of five children with DTP3, a full one-third of countries are still struggling to reach the ‘fifth child’, meaning millions of children remain at risk of illness, disability or death because they are not getting the immunizations they need.    “There is no one centralized approach that can ensure vaccines are delivered and administered to each child. Vaccination plans on the ground need to be adapted not just to countries, but to districts and communities,” said Dr Okwo-Belé. “What is required is a truly concerted effort and much stronger accountability so that each one of the key players involved fulfills its mandate and helps close the immunization gap.”    Critical operational needs to ensure wider vaccination and delivery on the ground, include:    Finding ways to simplify vaccination procedures in the field; Improving vaccination delivery to reach every last child, especially those living in remote and inaccessible areas. Ensuring vaccine affordability and strengthening vaccine supply chains;    Training more health workers, skilled managers and providing supportive supervision; Improving the quality of data collected by countries and using this to improve immunization operations.    Overcoming challenges posed by conflict, natural disasters and other crises. Increasing awareness and demand for immunization by communities; and greater accountability linked to micro-planning of vaccination operations and clear lines of responsibility.    Earlier this year, donor countries and institutions pledged to meet the funding needs of Gavi, the Vaccine Alliance that brings together public and private sectors to create equal access to new and underused vaccines for children living in the world’s poorest countries.    Further information http://www.who.int/campaigns/immunization-week/2015/en/ Visit the related web page
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