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Conteh INM, Braka F, Assefa EZ, Daniel EO, Ngofa RO, Okeibunor JC, Omony OE, Hakizimana JL, Wondimagegnehu A, Djingarey MH, Kobie AG, Kirigia DG, Mbasha JJ, Fekadu ST, Aderinola OM, Ahmat A, Asamani JA, Pallawo RB, Mpia LM, Diaw M, Kourouma M, Davi K, Condé S, Moakofhi K, Balami KY, Okamura M, De Wee RJ, Joseph G, Saguti GE, Andemichael GR, Abok P, Avwerhota M, Livinus MC, Okoronwanja HA, Makayoto L, Rutagengwa A, Ba MM, Kandako Y, Livinus PM, Diallo AM, Tengomo GLF, Belizaire MRD, Daizo A, Muzi B, Yam A, Ramadan OPC, D'khil LMM, Bonkoungou B, O'malley H, Gueye AS. Strengthening and utilizing response groups for emergencies flagship: a narrative review of the roll out process and lessons from the first year of implementation. Front Public Health 2024; 12:1405174. [PMID: 38818451 PMCID: PMC11138952 DOI: 10.3389/fpubh.2024.1405174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/29/2024] [Indexed: 06/01/2024] Open
Abstract
The World Health Organization Regional Office for Africa (WHO/AFRO) faces members who encounter annual disease epidemics and natural disasters that necessitate immediate deployment and a trained health workforce to respond. The gaps in this regard, further exposed by the COVID-19 pandemic, led to conceptualizing the Strengthening and Utilizing Response Group for Emergencies (SURGE) flagship in 2021. This study aimed to present the experience of the WHO/AFRO in the stepwise roll-out process and the outcome, as well as to elucidate the lessons learned across the pilot countries throughout the first year of implementation. The details of the roll-out process and outcome were obtained through information and data extraction from planning and operational documents, while further anonymized feedback on various thematic areas was received from stakeholders through key informant interviews with 60 core actors using open-ended questionnaires. In total, 15 out of the 47 countries in WHO/AFRO are currently implementing the initiative, with a total of 1,278 trained and validated African Volunteers Health Corps-Strengthening and Utilizing Response Groups for Emergencies (AVoHC-SURGE) members in the first year. The Democratic Republic of Congo (DRC) has the highest number (214) of trained AVoHC-SURGE members. The high level of advocacy, the multi-sectoral-disciplinary approach in the selection process, the adoption of the one-health approach, and the uniqueness of the training methodology are among the best practices applauded by the respondents. At the same time, financial constraints were the most reported challenge, with ongoing strategies to resolve them as required. Six countries, namely Botswana, Mauritania, Niger, Rwanda, Tanzania, and Togo, have started benefiting from their trained AVoHC-SURGE members locally, while responders from Botswana and Rwanda were deployed internationally to curtail the recent outbreaks of cholera in Malawi and Kenya.
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Affiliation(s)
- Ishata Nannie M. Conteh
- World Health Organization, Regional Office for Africa, Emergency Preparedness and Response Cluster, Brazzaville, Republic of Congo
| | - Fiona Braka
- World Health Organization, Regional Office for Africa, Emergency Preparedness and Response Cluster, Brazzaville, Republic of Congo
| | - Edea Zewdu Assefa
- World Health Organization, Regional Office for Africa, Emergency Preparedness and Response Cluster, Brazzaville, Republic of Congo
| | - Ebenezer Obi Daniel
- World Health Organization, Regional Office for Africa, Emergency Preparedness and Response Cluster, Brazzaville, Republic of Congo
| | - Reuben Opara Ngofa
- World Health Organization, Regional Office for Africa, Emergency Preparedness and Response Cluster, Brazzaville, Republic of Congo
| | - Joseph C. Okeibunor
- World Health Organization, Regional Office for Africa, Emergency Preparedness and Response Cluster, Brazzaville, Republic of Congo
| | - Otto Emmanuel Omony
- World Health Organization, Regional Office for Africa, Emergency Preparedness and Response Hub, Nairobi, Kenya
| | - Jean Leonard Hakizimana
- World Health Organization, Regional Office for Africa, Emergency Preparedness and Response Hub, Nairobi, Kenya
| | - Alemu Wondimagegnehu
- Hubert Department of Global Health Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Mamoudou H. Djingarey
- Hubert Department of Global Health Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Aminata Grace Kobie
- World Health Organization, Regional Office for Africa, Universal Health Promotion and Social Determinant, Brazzaville, Republic of Congo
| | - Doris Gatwiri Kirigia
- World Health Organization, Regional Office for Africa, Universal Health Promotion and Social Determinant, Brazzaville, Republic of Congo
| | - Jerry-Jonas Mbasha
- World Health Organization, Regional Office for Africa, Emergency Preparedness and Response Cluster, Brazzaville, Republic of Congo
| | - Senait Tekeste Fekadu
- World Health Organization, Regional Office for Africa, Emergency Preparedness and Response Cluster, Brazzaville, Republic of Congo
| | - Olaolu Moses Aderinola
- World Health Organization, Regional Office for Africa, Emergency Preparedness and Response Cluster, Brazzaville, Republic of Congo
| | - Adam Ahmat
- World Health Organization, Regional Office for Africa, Universal Life Course, Workforce, Brazzaville, Republic of Congo
| | - James Avoka Asamani
- World Health Organization, Regional Office for Africa, Universal Life Course, Workforce, Brazzaville, Republic of Congo
| | | | | | - Mor Diaw
- World Health Organization, Country Office, Niamey, Niger
| | | | - Kokou Davi
- World Health Organization, Country Office, Lome, Togo
| | - Siaka Condé
- World Health Organization, Country Office, Lome, Togo
| | - Kentse Moakofhi
- World Health Organization, Country Office, Gaborone, Botswana
| | | | - Mie Okamura
- World Health Organization, Country Office, Abuja, Nigeria
| | | | - Gabriel Joseph
- World Health Organization, Country Office, Windhoek, Namibia
| | | | | | - Patrick Abok
- World Health Organization, Country Office, Addis Ababa, Ethiopia
| | | | | | | | | | | | - Mawule Mady Ba
- World Health Organization, Country Office, Dakar, Senegal
| | - Youba Kandako
- World Health Organization, Country Office, Brazzaville, Republic of Congo
| | | | | | | | | | - Arsène Daizo
- World Health Organization, Country Office, Ndjamena, Chad
| | - Biranga Muzi
- World Health Organization, Country Office, Ndjamena, Chad
| | - Abdoulaye Yam
- World Health Organization, Regional Office for Africa, Emergency Preparedness and Response Cluster, Brazzaville, Republic of Congo
| | - Otim Patrick Cossy Ramadan
- World Health Organization, Regional Office for Africa, Emergency Preparedness and Response Cluster, Brazzaville, Republic of Congo
| | - Lala Moulaty Moulaye D'khil
- World Health Organization, Regional Office for Africa, Emergency Preparedness and Response Cluster, Brazzaville, Republic of Congo
| | - Boukare Bonkoungou
- World Health Organization, Regional Office for Africa, Emergency Preparedness and Response Cluster, Brazzaville, Republic of Congo
| | - Helena O'malley
- World Health Organization, Regional Office for Africa, Emergency Preparedness and Response Cluster, Brazzaville, Republic of Congo
| | - Abdou Salam Gueye
- World Health Organization, Regional Office for Africa, Emergency Preparedness and Response Cluster, Brazzaville, Republic of Congo
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Wenham C, Stout L. A legal mapping of 48 WHO member states' inclusion of public health emergency of international concern, pandemic, and health emergency terminology within national emergency legislation in responding to health emergencies. Lancet 2024; 403:1504-1512. [PMID: 38527480 DOI: 10.1016/s0140-6736(24)00156-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/10/2024] [Accepted: 01/25/2024] [Indexed: 03/27/2024]
Abstract
WHO has determined a public health emergency of international concern (PHEIC) seven times, and beyond this nomenclature declared COVID-19 to be a pandemic. Under the International Health Regulations (IHR), and through their operationalisation in the joint external evaluation (JEE), governments are urged to create suitable legislation to be able to enact a response to a public health emergency. Whether the pandemic declaration had a greater effect than a PHEIC in encouraging goverments to act, however, remains conjecture, as there is no systemic analysis of what each term means in practice and whether either has meaningful legal implications at the national level. We undertook a legal scoping review to assess the utilisation of PHEIC and pandemic language within national legislation in 28 WHO member states. Data were collected from national websites, JEE reviews, COVID Analysis and Mapping of Policies Tool, Natlex, and Oxford Compendium of National Legal Responses to COVID-19. We found that only 16% of countries have any reference to the PHEIC in national legislation and 37·5% of countries reference the term pandemic. This finding paints a weakened picture of the IHR and PHEIC mechanisms. Having such legalese enshrined in legislation might enhance the interaction between WHO determining a PHEIC or declaring a pandemic and resulting action to mitigate transnational spread of disease and enhance health security. Given the ongoing negotiations at WHO in relation to the amendments to the IHR and creation of the pandemic accord, both of which deal with this declaratory power of the PHEIC and pandemic language, negotiators should understand the possible implications of any changes to these proclamations at the national level and for global health security.
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Affiliation(s)
- Clare Wenham
- Department of Health Policy, London School of Economics and Political Science, London, UK.
| | - Liam Stout
- Department of Health Policy, London School of Economics and Political Science, London, UK
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Gostin LO, Meier BM, Abdool Karim S, Bueno de Mesquita J, Burci GL, Chirwa D, Finch A, Friedman EA, Habibi R, Halabi S, Lee TL, Toebes B, Villarreal P. The World Health Organization was born as a normative agency: Seventy-five years of global health law under WHO governance. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002928. [PMID: 38602939 PMCID: PMC11008771 DOI: 10.1371/journal.pgph.0002928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
The World Health Organization (WHO) was born as a normative agency and has looked to global health law to structure collective action to realize global health with justice. Framed by its constitutional authority to act as the directing and coordinating authority on international health, WHO has long been seen as the central actor in the development and implementation of global health law. However, WHO has faced challenges in advancing law to prevent disease and promote health over the past 75 years, with global health law constrained by new health actors, shifting normative frameworks, and soft law diplomacy. These challenges were exacerbated amid the COVID-19 pandemic, as states neglected international legal commitments in national health responses. Yet, global health law reforms are now underway to strengthen WHO governance, signaling a return to lawmaking for global health. Looking back on WHO's 75th anniversary, this article examines the central importance of global health law under WHO governance, reviewing the past successes, missed opportunities, and future hopes for WHO. For WHO to meet its constitutional authority to become the normative agency it was born to be, we offer five proposals to reestablish a WHO fit for purpose: normative instruments, equity and human rights mainstreaming, sustainable financing, One Health, and good governance. Drawing from past struggles, these reforms will require further efforts to revitalize hard law authorities in global health, strengthen WHO leadership across the global governance landscape, uphold equity and rights at the center of global health law, and expand negotiations in global health diplomacy.
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Affiliation(s)
- Lawrence O. Gostin
- O’Neill Institute for National & Global Health Law, Georgetown Law School, Washington, District of Columbia, United States of America
| | - Benjamin Mason Meier
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Safura Abdool Karim
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, United States of America
| | | | - Gian Luca Burci
- Global Health Centre, Graduate Institute of International and Development Studies, Geneva, Switzerland
| | - Danwood Chirwa
- Faculty of Law, University of Cape Town, Cape Town, South Africa
| | - Alexandra Finch
- O’Neill Institute for National & Global Health Law, Georgetown Law School, Washington, District of Columbia, United States of America
| | - Eric A. Friedman
- O’Neill Institute for National & Global Health Law, Georgetown Law School, Washington, District of Columbia, United States of America
| | - Roojin Habibi
- Faculty of Law, University of Ottawa, Ottawa, Canada
| | - Sam Halabi
- O’Neill Institute for National & Global Health Law, Georgetown Law School, Washington, District of Columbia, United States of America
| | - Tsung-Ling Lee
- Graduate Institute of Health and Biotechnology Law, Taipei Medical University, Taipei, Taiwan
| | - Brigit Toebes
- Faculty of Law, University of Groningen, Groningen, The Netherlands
| | - Pedro Villarreal
- Max Planck Institute for Comparative Public Law and International Law, Heidelberg, Germany
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Luo X, Jia K, Xing J, Yi J. The utilization of nanotechnology in the female reproductive system and related disorders. Heliyon 2024; 10:e25477. [PMID: 38333849 PMCID: PMC10850912 DOI: 10.1016/j.heliyon.2024.e25477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
The health of the reproductive system is intricately linked to female fertility and quality of life. There has been a growing prevalence of reproductive system disorders among women, particularly in younger age groups, resulting in significant adverse effects on their reproductive health. Consequently, there is an urgent need for effective treatment modalities. Nanotechnology, as an advanced discipline, provides innovative avenues for managing and treating diseases of the female reproductive system by enabling precise manipulation and regulation of biological molecules and cells. By utilizing nanodelivery systems, drugs can be administered with pinpoint accuracy, leading to reduced side effects and improved therapeutic efficacy. Moreover, nanomaterial imaging techniques enhance diagnostic precision and sensitivity, aiding in the assessment of disease severity and progression. Furthermore, the implementation of nanobiosensors facilitates early detection and prevention of ailments. This comprehensive review aims to summarize recent applications of nanotechnology in the treatment of female reproductive system diseases. The latest advancements in drug delivery, diagnosis, and treatment approaches will be discussed, with an emphasis on the potential of nanotechnology to improve treatment outcomes and overall quality of life.
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Affiliation(s)
- Xin Luo
- Department of Medical Cell Biology and Genetics, School of Basic Medical Sciences, Basic Medicine Research Innovation Center for Cardiometabolic Diseases, Ministry of Education, Southwest Medical University, Luzhou, 646000, Sichuan, China
- Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Keran Jia
- Department of Medical Cell Biology and Genetics, School of Basic Medical Sciences, Basic Medicine Research Innovation Center for Cardiometabolic Diseases, Ministry of Education, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Jinshan Xing
- Department of Neurosurgery, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Jingyan Yi
- Department of Medical Cell Biology and Genetics, School of Basic Medical Sciences, Basic Medicine Research Innovation Center for Cardiometabolic Diseases, Ministry of Education, Southwest Medical University, Luzhou, 646000, Sichuan, China
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Hartman J, Dholakia K. An Exploratory Study of Physical Therapists From High-Income Countries Practising Outside of Their Scope in Low and Middle-Income Countries. JOURNAL OF BIOETHICAL INQUIRY 2023; 20:543-562. [PMID: 37861947 DOI: 10.1007/s11673-023-10305-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 12/03/2022] [Indexed: 10/21/2023]
Abstract
PURPOSE To quantify how often physical therapists from high-income countries (HIC) travelling to low- and middle-income countries (LMIC) practise outside their scope of practice, in what circumstances, and their likelihood of doing the same in the future. METHODS An exploratory descriptive study using a survey. RESULTS One hundred and twenty-six licensed physical therapists from around the world participated. Physical therapists typically spent less than a month (73.8 per cent) in LMIC; 67.5 per cent believed that physical therapists practise outside of their scope, and 31.7 per cent reported doing so. Reasons were believing that something is better than nothing (47.5 per cent ), a mismatch between the physical therapist's and host's expectations (40.0 per cent ), and preserving their relationship with the host (25.0 per cent ). It was deemed appropriate by 64.5 per cent to practise outside of their scope in some situations and 53.8% considered repeating the activity in the future. Half of the respondent's first experience in LMIC occurred as a student or in their first decade of practice. CONCLUSIONS Working in LMIC requires a keen understanding of the risks and challenges associated with such experiences. To ensure best practice, a skill set that consists of critical self-reflection, systems thinking, and structural competency combined with clinical competency and accountability is imperative.
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Affiliation(s)
- J Hartman
- Department of Family Medicine and Community Health, Doctor of Physical Therapy Program, University of Wisconsin, School of Medicine and Public Health, 5110 Medical Sciences Center, 1300 University Ave, Madison, WI, 53706, USA.
| | - K Dholakia
- Institute for Physical Therapy Education, Widener University, One University Place, Chester, PA, 19013, USA
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Bhaumik S, Zwi AB, Norton R, Jagnoor J. How and why snakebite became a global health priority: a policy analysis. BMJ Glob Health 2023; 8:e011923. [PMID: 37604596 PMCID: PMC10445399 DOI: 10.1136/bmjgh-2023-011923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/30/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Snakebite was added to the WHO neglected tropical disease (NTD) list in 2017, followed by a World Health Assembly resolution in 2018, and an explicit global target being set to reduce the burden in 2019. We aimed to understand how and why snakebite became a global health priority. METHODS We conducted a policy case study, using in-depth interviews, and documents (peer-reviewed and grey literature) as data sources. We drew on Shiffman et al's framework on global health network to guide the analysis. RESULTS We conducted 20 interviews and examined 91 documents. The prioritisation of snakebite occurred in four phases: pre-crescendo, crescendo, de-crescendo and re-crescendo. The core snakebite network consisted of academics, which expanded during the re-crescendo phase to include civil society organisations and state actors. The involvement of diverse stakeholders led to better understanding of WHO processes. The use of intersecting and layered issue framing, framing solutions around snake antivenoms, in a background of cross-cultural fascination and fear of snakes enabled prioritisation in the re-crescendo phase. Ebbs and flows in legitimacy of the network and reluctant acceptance of snakebite within the NTD community are challenges. CONCLUSION Our analyses imply a fragile placement of snakebite in the global agenda. We identify two challenges, which needs to be overcome. The study highlights the need to review the WHO criteria for classifying diseases as NTD. We propose that future prioritisation analysis should consider identifying temporal patterns, as well as integrating legitimacy dimensions, as in our study.
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Affiliation(s)
- Soumyadeep Bhaumik
- Injury Division, The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, New South Wales, Australia
- Meta-research and Evidence Synthesis Unit, The George Institute for Global Health, New Delhi, India
| | - Anthony B Zwi
- School of Social Sciences, UNSW, Sydney, New South Wales, Australia
| | - Robyn Norton
- Injury Division, The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, New South Wales, Australia
- The George Institute for Global Health, Imperial College, London, UK
| | - Jagnoor Jagnoor
- Injury Division, The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, New South Wales, Australia
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Wernli D, Falcone JL, Davidshofer S, Lee K, Chopard B, Levrat N. Emergent patterns in global health diplomacy: a network analysis of the resolutions adopted by the World Health Assembly from 1948 to 2022. BMJ Glob Health 2023; 8:bmjgh-2022-011211. [PMID: 37024116 PMCID: PMC10083823 DOI: 10.1136/bmjgh-2022-011211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/21/2023] [Indexed: 04/08/2023] Open
Abstract
From a complexity perspective on governance, multilateral diplomacy is based on interactions between people, ideas, norms, policies and institutions. This article uses a computer-assisted methodology to better understand governance systems as a network of norms. All World Health Assembly (WHA) resolutions that were available from 1948 to 2022 were collected from the WHO Institutional Repository for Information Sharing (IRIS) database. Regular expressions were used to identify how resolutions cite other resolutions and the resulting relationships were analysed as a normative network. The findings show that WHA resolutions constitute a complex network of interconnected global health issues. This network is characterised by several community patterns. While chain-like patterns are associated with specific diseases programmes, radial patterns are characteristic of highly important procedural decisions that member states reaffirm in similar situations. Finally, densely connected communities correspond to contested topics and emergencies. While these emergeng patterns suggest the relevance of using network analysis to understand global health norms in international organisations, we reflect on how this computational approach can be extended to provide new understandings of how multilateral governance systems work, and to address some important contemporary questions about the effects of regime complexity on global health diplomacy.
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Affiliation(s)
- Didier Wernli
- Global Studies Institute, University of Geneva, Geneva, Switzerland
- Department of Computer Science, Faculty of Science, University of Geneva, Geneva, Switzerland
| | - Jean-Luc Falcone
- Department of Computer Science, Faculty of Science, University of Geneva, Geneva, Switzerland
| | | | - Kelley Lee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Bastien Chopard
- Department of Computer Science, Faculty of Science, University of Geneva, Geneva, Switzerland
| | - Nicolas Levrat
- Global Studies Institute, University of Geneva, Geneva, Switzerland
- Faculty of Law, University of Geneva, Geneva, Switzerland
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Moser F, Bump JB. Assessing the World Health Organization: What does the academic debate reveal and is it democratic? Soc Sci Med 2022; 314:115456. [PMID: 36274457 DOI: 10.1016/j.socscimed.2022.115456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 09/17/2022] [Accepted: 10/09/2022] [Indexed: 11/05/2022]
Abstract
The World Health Organization (WHO), the leading global authority in public health, routinely attracts loud calls for reform. Although Member States negotiate reform internally, academic debate is more public, and can generate ideas and provide independent accountability. We investigate why authors advocate for WHO reform so commonly. We wondered if this literature had potentially useful themes for WHO, what methods and evidence were used, and we wanted to analyze the geography of participation. We conducted a systematic review using four databases to identify 139 articles assessing WHO or advocating for reform. We discuss these using categories we derived from the management literature on organizational performance. We also analyzed evidence, country of origin, and topic. The literature we reviewed contained 998 claims about WHO's performance or reform, although there were no standard methods for assessing WHO. We developed a framework to analyze WHO's performance and structure a synthesis of the claims, which find WHO imperiled. Its legitimacy and governance are weakened by disagreements about purpose, unequal Member State influence, and inadequate accountability. Contestation of goals and strategies constrain planning. Structure and workforce deficiencies limit coordination, agility, and competence. WHO has technical and normative authority, but insufficient independence and legal power to influence uncooperative states. WHO's identity claims transparency, independence, and courage, but these aspirations are betrayed in times of need. Most articles (88%) were commentaries without specified methods. More than three-quarters (76%) originated from the US, the UK, or Switzerland. A quarter of papers (25%) focused on international infectious disease outbreaks, and another 25% advocated for WHO reform generally. Many criticisms cite wide-ranging performance problems, some of which may relate to obstructive behavior by Member States. This literature is incomplete in the geographic representation of authors, evidence, methods, and topics. We offer ideas for developing more rigorous and inclusive academic debate on WHO.
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Affiliation(s)
- Fabian Moser
- Institute of Public Health, Charité - Universitätsmedizin Berlin, 10117, Berlin, Germany.
| | - Jesse B Bump
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA; Bergen Center for Ethics and Priority Setting, University of Bergen, Norway; Initiative on the Future of Health and Economic Resilience in Africa, Boston MA 02115, USA.
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Zhang H, Wang Q, Chen J, Rangel-Buitrago N, Shu Y. Cruise tourism in the context of COVID-19: Dilemmas and solutions. OCEAN & COASTAL MANAGEMENT 2022; 228:106321. [PMID: 35990780 PMCID: PMC9376310 DOI: 10.1016/j.ocecoaman.2022.106321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/09/2022] [Accepted: 07/31/2022] [Indexed: 06/15/2023]
Abstract
COVID-19 cases on international cruise ships have attracted extensive attention from the international community as well as the world's tourism and shipping industry. This virus highlighted the plight that must be faced by cruise ships in complicated times and situations such as pandemics. The comparative method is adopted to analyze the management measures taken by the "Diamond Princess", "Costa Serena", "Westerdam" and "Grand Princess" cruises in response to the COVID-19 pandemic and then to summarize the common dilemmas faced by these cruise ships, including defects of their internal environment, unclear health-care obligations during an epidemic, weak collaboration between the parties involved and their limited performance, and widespread infodemic and unfavorable public opinion. Given these dilemmas, measures are suggested to deal with the "cruise dilemma", including establishing and defining isolation standards on boards, enhancing the capacity of international organizations, the international community's joint response to the pandemic, promoting cooperation between countries, building an effective mechanism for the broad participation of the whole society, and standardizing the release of information and reasonably guiding public social opinion.
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Affiliation(s)
- Hu Zhang
- School of International Law, East China University of Political Science and Law, Shanghai, China
| | - Qiuwen Wang
- School of International Law, East China University of Political Science and Law, Shanghai, China
| | - Jihong Chen
- College of Management, Shenzhen University, Shenzhen, China
- Shenzhen International Maritime Institute, Shenzhen, China
| | - Nelson Rangel-Buitrago
- Programas de Fisica y Biologia, Facultad de Ciencias Básicas, Universidad del, Atlántico, Barranquilla, Atlántico, Colombia
| | - Yaqing Shu
- School of Navigation, Wuhan University of Technology, Wuhan, China
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Nay O, Barré-Sinoussi F. Bridging the gap between science and policy in global health governance. Lancet Glob Health 2022; 10:e322-e323. [PMID: 35180406 PMCID: PMC8846599 DOI: 10.1016/s2214-109x(21)00567-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/02/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Olivier Nay
- University of Paris Panthéon Sorbonne, Paris, France.
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Contesting Legitimacy of Global Governance Institutions: The Case of the World Health Organization During the Coronavirus Pandemic. INTERNATIONAL STUDIES REVIEW 2021; 23:viab047. [PMCID: PMC8574549 DOI: 10.1093/isr/viab047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
This article examines the (de)legitimation of a global governance institution (GGI) in the throes of a full-blown legitimacy crisis: the World Health Organization (WHO) during the coronavirus pandemic. Substantively, it fleshes out systematically the discursive (de)legitimating practices of six (types of) actors: the Trump administration, US allies, US quality press, global health-scientific community, the WHO, and the Chinese government. To that end, it synthesizes elements from the rich literature on legitimacy and elaborates a conceptual apparatus bolstered by operational sources of legitimacy. Empirically, it is grounded in a qualitative content analysis of a purpose-built data corpus of 458 texts that contain justifications for (de)legitimation. In so doing, this study not only presents a holistic and yet granular view of discursive (de)legitimation by some pivotal actors surrounding the WHO and its pandemic response, but offers general insights on legitimacy and (de)legitimation of GGIs during times of crisis.
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Ip EC. The constitutional economics of the World Health Organization. HEALTH ECONOMICS, POLICY, AND LAW 2021; 16:325-339. [PMID: 32744214 DOI: 10.1017/s1744133120000249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This paper brings a constitutional economics perspective to bear on the World Health Organization (WHO), the flagship United Nations intergovernmental health organisation, which is obligated by its Constitution to achieve 'the highest possible level of health' for the world's peoples. The WHO has in the seven decades of its existence used its formidable legislative powers only sparingly. It has been widely chided for being weak in regional coordination and unresponsive to transnational emergencies like the West African Ebola outbreak of 2014-2016. In 2020, it found itself at the centre of the COVID-19 pandemic and in the middle of the Sino-American geopolitical tug-of-war. This paper traces the discordance between the Constitution's stated purposes and the actual track record of the WHO not back to its organisational culture nor to weak leadership but to the design of the Constitution itself. It analytically distinguishes the Constitution's expressive from its instrumental halves, and shows that, whilst the former embodies a 'constitutional moment' of international health solidarity right after the Second World War, the latter embodies a reserved and limited delegation from member-states that are jealous of their sovereignty.
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Affiliation(s)
- Eric C Ip
- Centre for Medical Ethics and Law, The University of Hong Kong, Hong Kong SAR, China
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13
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Abstract
This study argues against the expansive approach to the WHO reform, according to which to be a better global health leader, WHO should do more, be given more power and financial resources, have more operational capacities, and have more teeth by introducing more coercive monitoring and compliance mechanisms to its IHR. The expansive approach is a political problem, whose root cause lies in ethics: WHO's political overambition is grounded on WHO's lack of conceptual clarity on what good leadership means and what health (as a human right) means. This study presents this ethical analysis by putting forth an alternative: the humble approach to the WHO reform. It argues that to be a better leader, WHO should do much less and have a much narrower mandate. More specifically, WHO should focus exclusively on coordination efforts, by ensuring truthful, evidence-based, consistent, and timely shared communications regarding PHEIC among WHO member-states and other global health stakeholders, if the organization desires to be a real global health leader whose authority the international community respects and whose guidance people trust.
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Affiliation(s)
- Thana C de Campos-Rudinsky
- School of Government, Pontificia Universidad Catolica de Chile, Von Hügel Institute, University of Cambridge, and UNESCO Chair in Bioethics and Human Rights
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14
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Hassan I, Mukaigawara M, King L, Fernandes G, Sridhar D. Hindsight is 2020? Lessons in global health governance one year into the pandemic. Nat Med 2021; 27:396-400. [PMID: 33723454 DOI: 10.1038/s41591-021-01272-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 01/28/2021] [Indexed: 11/09/2022]
Abstract
Fourteen months into the SARS-CoV-2 pandemic, we identify key lessons in the global and national responses to the pandemic. The World Health Organization has played a pivotal technical, normative and coordinating role, but has been constrained by its lack of authority over sovereign member states. Many governments also mistakenly attempted to manage COVID-19 like influenza, resulting in repeated lockdowns, high excess morbidity and mortality, and poor economic recovery. Despite the incredible speed of the development and approval of effective and safe vaccines, the emergence of new SARS-CoV-2 variants means that all countries will have to rely on a globally coordinated public health effort for several years to defeat this pandemic.
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Affiliation(s)
- Ines Hassan
- Global Health Governance Programme, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Mitsuru Mukaigawara
- Harvard Kennedy School, Cambridge, MA, USA.,Division of Infectious Diseases, Department of Medicine, Okinawa Chubu Hospital, Okinawa, Japan
| | - Lois King
- Global Health Governance Programme, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Genevie Fernandes
- Global Health Governance Programme, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Devi Sridhar
- Global Health Governance Programme, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK.
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15
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Race Against the Pandemic: The United States and Global Health. J Emerg Med 2020; 60:402-406. [PMID: 33334648 DOI: 10.1016/j.jemermed.2020.10.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/30/2020] [Accepted: 10/19/2020] [Indexed: 11/20/2022]
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16
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Munkholm L, Rubin O. The global governance of antimicrobial resistance: a cross-country study of alignment between the global action plan and national action plans. Global Health 2020; 16:109. [PMID: 33176810 PMCID: PMC7656753 DOI: 10.1186/s12992-020-00639-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 10/26/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a growing problem worldwide in need of global coordinated action. With the endorsement of the Global Action Plan (GAP) on AMR in 2015, the 194 member states of the World Health Organization committed to integrating the five objectives and corresponding actions of the GAP into national action plans (NAPs) on AMR. The article analyzes patterns of alignment between existing NAPs and the GAP, bringing to the fore new methodologies for exploring the relationship between globally driven health policies and activities at the national level, taking income, geography and governance factors into account. METHODS The article investigates the global governance of AMR. Concretely, two proxies are devised to measure vertical and horizontal alignment between the GAP and existing NAPs: (i) a syntactic indicator measuring the degree of verbatim overlap between the GAP and the NAPs; and (ii) a content indicator measuring the extent to which the objectives and corresponding actions outlined in the GAP are addressed in the NAPs. Vertical alignment is measured by the extent to which each NAP overlaps with the GAP. Horizontal alignment is explored by measuring the degree to which NAPs overlap with other NAPs across regions and income groups. In addition, NAP implementation is explored using the Global Database for Antimicrobial Resistance Country Self-Assessment. FINDINGS We find strong evidence of vertical alignment, particularly among low-income countries and lower-middle-income countries but weaker evidence of horizontal alignment within regions. In general, we find the NAPs in our sample to be mostly aligned with the GAP's five overarching objectives while only moderately aligned with the recommended corresponding actions. Furthermore, we see several cases of what can be termed 'isomorphic mimicry', characterized by strong alignment in the policies outlined but much lower levels of alignment in terms of actual implemented policies. CONCLUSION To strengthen the alignment of national AMR policies, we recommend global governance initiatives based on individualized responsibilities some of which should be legally binding. Our study provides limited evidence of horizontal alignment within regions, which implies that regional governance institutions (e.g., WHO regional offices) should primarily act as mediators between global and local demands to strengthen a global governance regime that minimizes policy fragmentation and mimicry behavior across member states.
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Affiliation(s)
- Louise Munkholm
- Department of Social Sciences and Businesses, Roskilde University, Universitetsvej 1, 4000 Roskilde, Denmark
| | - Olivier Rubin
- Department of Social Sciences and Businesses, Roskilde University, Universitetsvej 1, 4000 Roskilde, Denmark
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17
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Gostin LO, Moon S, Meier BM. Reimagining Global Health Governance in the Age of COVID-19. Am J Public Health 2020; 110:1615-1619. [PMID: 33026872 DOI: 10.2105/ajph.2020.305933] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Lawrence O Gostin
- Lawrence O. Gostin is with the O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC. Suerie Moon is with the Global Health Centre, Graduate Institute of International and Development Studies, Geneva, Switzerland. Benjamin Mason Meier is with the Department of Public Policy, University of North Carolina at Chapel Hill
| | - Suerie Moon
- Lawrence O. Gostin is with the O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC. Suerie Moon is with the Global Health Centre, Graduate Institute of International and Development Studies, Geneva, Switzerland. Benjamin Mason Meier is with the Department of Public Policy, University of North Carolina at Chapel Hill
| | - Benjamin Mason Meier
- Lawrence O. Gostin is with the O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC. Suerie Moon is with the Global Health Centre, Graduate Institute of International and Development Studies, Geneva, Switzerland. Benjamin Mason Meier is with the Department of Public Policy, University of North Carolina at Chapel Hill
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18
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Stevenson M, Youde J. Public-private partnering as a modus operandi: Explaining the Gates Foundation's approach to global health governance. Glob Public Health 2020; 16:401-414. [PMID: 32762617 DOI: 10.1080/17441692.2020.1801790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In its first decade, The Bill and Melinda Gates Foundation (BMGF) focused much of its efforts on enabling the establishment of transnational public-private partnerships (PPPs) oriented towards increasing low-income country (LIC) access to essential health technologies. Critics have argued these efforts further enriched already profitable firms which long ignored the needs of populations with limited purchasing power, while lessening political will to invest in urgently needed public sector capacity to produce essential health technologies independently of market pressures. Missing from these critical analyses were the perspectives of those shaping BMGF's global health programming. Drawing on interviews with senior BMGF staff and external affiliates undertaken between 2010 and 2012, this article seeks to address this gap. We argue that BMGF's embrace of PPPs was adopted out of the belief that neither public agencies nor industry were capable of providing LICs with essential health technologies autonomously, and that their conflicting mandates required an honest broker to initiate and sustain collaboration between the two sectors. The Foundation's comparative advantage in global health governance was thus seen by those informing its work, as its capacity to negotiate such partnerships, which we argue has also been the basis of its agenda-setting influence in this domain.
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Affiliation(s)
- Michael Stevenson
- School of Public Health and Health Systems, University of Waterloo, Hamilton, Canada
| | - Jeremy Youde
- College of Liberal Arts, University of Minnesota Duluth, Duluth, MN, USA
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19
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Reddy SK, Mazhar S, Lencucha R. The financial sustainability of the World Health Organization and the political economy of global health governance: a review of funding proposals. Global Health 2018; 14:119. [PMID: 30486890 PMCID: PMC6264055 DOI: 10.1186/s12992-018-0436-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 11/07/2018] [Indexed: 11/25/2022] Open
Abstract
The World Health Organization (WHO) continues to experience immense financial stress. The precarious financial situation of the WHO has given rise to extensive dialogue and debate. This dialogue has generated diverse technical proposals to remedy the financial woes of the WHO and is intimately tied to existential questions about the future of the WHO in global health governance. In this paper, we review, categorize, and synthesize the proposals for financial reform of the WHO. It appears that less contentious issues, such as convening financing dialogue and establishing a health emergency programme, received consensus from member states. However, member states are reluctant to increase the assessed annual contributions to the WHO, which weakens the prospect for greater autonomy for the organisation. The WHO remains largely supported by earmarked voluntary contributions from states and non-state actors. We argue that while financial reform requires institutional changes to enhance transparency, accountability and efficiency, it is also deeply tied to the political economy of state sovereignty and ideas about the leadership role of the WHO in a crowded global health governance context.
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Affiliation(s)
- Srikanth K. Reddy
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, Rabinovitch House, 3640 de la Montagne, Montreal, QC H3G 2A8 Canada
| | - Sumaira Mazhar
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Raphael Lencucha
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, Rabinovitch House, 3640 de la Montagne, Montreal, QC H3G 2A8 Canada
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20
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Prince MJ. Back to the future with PACK. BMJ Glob Health 2018; 3:e001231. [PMID: 30483417 PMCID: PMC6231110 DOI: 10.1136/bmjgh-2018-001231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 11/04/2022] Open
Affiliation(s)
- Martin James Prince
- Health Service and Population Research Department, King's College London, London, UK
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21
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Tzeravini E, Tentolouris A, Tentolouris N, Jude EB. Advancements in improving health-related quality of life in patients living with diabetic foot ulcers. Expert Rev Endocrinol Metab 2018; 13:307-316. [PMID: 30381974 DOI: 10.1080/17446651.2018.1541403] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Diabetic foot ulcer (DFU) constitutes a burden to patients with diabetes deteriorating their quality of life. Health related quality of life (HRQoL) can now be quantified with the use of specific tools; some of them provide a holistic approach to patients' well-being, while others are disease specific or even region specific. Many of these tools are applicable to patients with DFU. This review will present current data about the impact different interventions in the management of DFU on quality of life related parameters. AREAS COVERED We performed a search of literature using keywords 'diabetes mellitus', 'diabetic foot ulcer', 'diabetic foot', 'health related quality of life', 'quality of life' and 'SF-36' to identify studies that contained data about the relationship between different interventions and quality of life of patients with diabetic foot ulcers. EXPERT COMMENTARY Available data are not sufficient to conclude on the impact of interventions aimed to heal DFU on HRQoL. There is need for more, better designed studies and meta-analysis to estimate the effect of treatments on HRQoL in patients with DFUs. The development of new, diabetic foot specific tools will help to improve our knowledge in this field.
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Affiliation(s)
- Evangelia Tzeravini
- a Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Medical School , National and Kapodistrian University of Athens, Laiko General Hospital , Athens , Greece
| | - Anastasios Tentolouris
- a Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Medical School , National and Kapodistrian University of Athens, Laiko General Hospital , Athens , Greece
| | - Nikolaos Tentolouris
- a Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Medical School , National and Kapodistrian University of Athens, Laiko General Hospital , Athens , Greece
| | - Edward B Jude
- b Department of Medicine, Diabetes Centre , Tameside Hospital NHS Foundation Trust , Ashton-under-Lyne , UK
- c Department of Medicine , Manchester University , Manchester , UK
- d Manchester Metropolitan University , Manchester , UK
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22
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Sethi N. Research and Global Health Emergencies: On the Essential Role of Best Practice. Public Health Ethics 2018; 11:237-250. [PMID: 30429871 PMCID: PMC6225813 DOI: 10.1093/phe/phy014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This article addresses an important, overlooked regulatory challenge during global health emergencies (GHEs). It provides novel insights into how, and why, best practice can support decision makers in interpreting and implementing key guidance on conducting research during GHEs. The ability to conduct research before, during and after such events is crucial. The recent West-African Ebola outbreaks and the Zika virus have highlighted considerable room for improvement in meeting the imperative to research and rapidly develop effective therapies. A means of effectively capturing these experiences and folding them into future decision-making is lacking; the need for effective practical translational measures remains. The challenge for the research community lies in extracting meaningful action-guiding content from pre-existing guidelines-which draw upon practical examples of guidelines 'in action'-that assist in determining how to act in a particular (future) situation. Insights are provided into the role of best practice as a means to do so; such examples can provide invaluable support to decision makers in interpreting high-level guidance; overarching guidelines retain their necessary level of generality and flexibility, whilst corresponding best practice examples-which incorporate important lessons learned-illustrate how such guidelines can be interpreted at a practical level.
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Affiliation(s)
- Nayha Sethi
- Liminal Spaces, Mason Institute, University of Edinburgh
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23
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Ljungman D, Vaughan KA, Park KB, Makasa EM, Marten R, Meara JG. World Health Organization: Leading surgical care toward sustainable development in the era of globalization. Surgery 2018; 164:1137-1146. [PMID: 30205897 DOI: 10.1016/j.surg.2018.06.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 06/05/2018] [Indexed: 11/17/2022]
Affiliation(s)
- David Ljungman
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Kerry A Vaughan
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA; Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA
| | - Kee B Park
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA
| | - Emmanuel M Makasa
- Ministry of Foreign Affairs, Lusaka, Zambia; School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Robert Marten
- London School of Hygiene and Tropical Medicine, London, England
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA; Department of Plastic & Oral Surgery, Boston Children's Hospital, Boston, MA
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24
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Te V, Floden N, Hussain S, Brolan CE, Hill PS. What did the Go4Health policy research project contribute to the policy discourse on the sustainable development goals? A reflexive review. Global Health 2018; 14:51. [PMID: 29769100 PMCID: PMC5956956 DOI: 10.1186/s12992-018-0367-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/01/2018] [Indexed: 11/10/2022] Open
Abstract
Background In 2012, the European Commission funded Go4Health—Goals and Governance for Global Health, a consortium of 13 academic research and human rights institutions from both Global North and South—to track the evolution of the Sustainable Development Goals (SDGs), and provide ongoing policy advice. This paper reviews the research outputs published between 2012 and 2016, analyzing the thematic content of the publications, and the influence on global health and development discourse through citation metrics. Findings and discussion Analysis of the 54 published papers showed 6 dominant themes related to the SDGs: the formulation process for the SDG health goal; the right to health; Universal Health Coverage; voices of marginalized peoples; global health governance; and the integration of health across the other SDGs. The papers combined advocacy---particularly for the right to health and its potential embodiment in Universal Health Coverage—with qualitative research and analysis of policy and stakeholders. Go4Health’s publications on the right to health, global health governance and the voices of marginalized peoples in relation to the SDGs represented a substantial proportion of papers published for these topics. Go4Health analysis of the right to health clarified its elements and their application to Universal Health Coverage, global health governance, financing the SDGs and access to medicines. Qualitative research identified correspondence between perceptions of marginalized peoples and right to health principles, and reluctance among multilateral organizations to explicitly represent the right to health in the goals, despite their acknowledgement of their importance. Citation metrics analysis confirmed an average of 5.5 citations per paper, with a field-weighted citation impact of 2.24 for the 43 peer reviewed publications. Citations in the academic literature and UN policy documents confirmed the impact of Go4Health on the global discourse around the SDGs, but within the Go4Health consortium there was also evidence of two epistemological frames of analysis—normative legal analysis and empirical research—that created productive synergies in unpacking the health SDG and the right to health. Conclusion The analysis offers clear evidence for the contribution of funded programmatic research—such as the Go4Health project—to the global health discourse.
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Affiliation(s)
- Vannarath Te
- School of Public Health, The University of Queensland, Herston Road, Brisbane, Australia.,National Institute of Public Health, Ministry of Health, Phnom Penh, Cambodia
| | - Nadia Floden
- School of Public Health, The University of Queensland, Herston Road, Brisbane, Australia
| | - Sameera Hussain
- School of Public Health, The University of Queensland, Herston Road, Brisbane, Australia.,Canadian Society for International Health, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Claire E Brolan
- School of Public Health, The University of Queensland, Herston Road, Brisbane, Australia.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Peter S Hill
- School of Public Health, The University of Queensland, Herston Road, Brisbane, Australia.
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25
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Benmarhnia T, Huang JY, Jones CM. Lost in Translation: Piloting a Novel Framework to Assess the Challenges in Translating Scientific Uncertainty From Empirical Findings to WHO Policy Statements. Int J Health Policy Manag 2017; 6:649-660. [PMID: 29179291 PMCID: PMC5675583 DOI: 10.15171/ijhpm.2017.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 02/21/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Calls for evidence-informed public health policy, with implicit promises of greater program effectiveness, have intensified recently. The methods to produce such policies are not self-evident, requiring a conciliation of values and norms between policy-makers and evidence producers. In particular, the translation of uncertainty from empirical research findings, particularly issues of statistical variability and generalizability, is a persistent challenge because of the incremental nature of research and the iterative cycle of advancing knowledge and implementation. This paper aims to assess how the concept of uncertainty is considered and acknowledged in World Health Organization (WHO) policy recommendations and guidelines. METHODS We selected four WHO policy statements published between 2008-2013 regarding maternal and child nutrient supplementation, infant feeding, heat action plans, and malaria control to represent topics with a spectrum of available evidence bases. Each of these four statements was analyzed using a novel framework to assess the treatment of statistical variability and generalizability. RESULTS WHO currently provides substantial guidance on addressing statistical variability through GRADE (Grading of Recommendations Assessment, Development, and Evaluation) ratings for precision and consistency in their guideline documents. Accordingly, our analysis showed that policy-informing questions were addressed by systematic reviews and representations of statistical variability (eg, with numeric confidence intervals). In contrast, the presentation of contextual or "background" evidence regarding etiology or disease burden showed little consideration for this variability. Moreover, generalizability or "indirectness" was uniformly neglected, with little explicit consideration of study settings or subgroups. CONCLUSION In this paper, we found that non-uniform treatment of statistical variability and generalizability factors that may contribute to uncertainty regarding recommendations were neglected, including the state of evidence informing background questions (prevalence, mechanisms, or burden or distributions of health problems) and little assessment of generalizability, alternate interventions, and additional outcomes not captured by systematic review. These other factors often form a basis for providing policy recommendations, particularly in the absence of a strong evidence base for intervention effects. Consequently, they should also be subject to stringent and systematic evaluation criteria. We suggest that more effort is needed to systematically acknowledge (1) when evidence is missing, conflicting, or equivocal, (2) what normative considerations were also employed, and (3) how additional evidence may be accrued.
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Affiliation(s)
- Tarik Benmarhnia
- Institute for Health and Social Policy, McGill University, Montreal, QC, Canada.,Department of Family Medicine and Public Health & Scripps Institution of Oceanography, University of California, San Diego, CA, USA
| | - Jonathan Y Huang
- Institute for Health and Social Policy, McGill University, Montreal, QC, Canada
| | - Catherine M Jones
- Chaire approches communautaires et inégalités de santé, Institut de recherche en santé publique, École de santé publique, Université de Montréal, Montreal, QC, Canada
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26
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Hall W. Don't Discount Societal Value in Cost-Effectiveness Comment on "Priority Setting for Universal Health Coverage: We Need Evidence-Informed Deliberative Processes, Not Just More Evidence on Cost-Effectiveness". Int J Health Policy Manag 2017; 6:543-545. [PMID: 28949468 PMCID: PMC5582442 DOI: 10.15171/ijhpm.2017.03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/08/2017] [Indexed: 11/09/2022] Open
Abstract
As healthcare resources become increasingly scarce due to growing demand and stagnating budgets, the need for effective priority setting and resource allocation will become ever more critical to providing sustainable care to patients. While societal values should certainly play a part in guiding these processes, the methodology used to capture these values need not necessarily be limited to multi-criterion decision analysis (MCDA)-based processes including 'evidence-informed deliberative processes.' However, if decision-makers intend to not only incorporates the values of the public they serve into decisions but have the decisions enacted as well, consideration should be given to more direct involvement of stakeholders. Based on the examples provided by Baltussen et al, MCDA-based processes like 'evidence-informed deliberative processes' could be one way of achieving this laudable goal.
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Affiliation(s)
- William Hall
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
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27
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Abimbola S, Topp SM, Palagyi A, Marais B, Negin J. Global health security: where is the data to inform health system strengthening? BMJ Glob Health 2017; 2:e000481. [PMID: 29082024 PMCID: PMC5656113 DOI: 10.1136/bmjgh-2017-000481] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 07/21/2017] [Indexed: 11/04/2022] Open
Affiliation(s)
- Seye Abimbola
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Anna Palagyi
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Ben Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity and the Children’s Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia
| | - Joel Negin
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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28
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van de Pas R. Global Health in the Anthropocene: Moving Beyond Resilience and Capitalism Comment on "Health Promotion in an Age of Normative Equity and Rampant Inequality". Int J Health Policy Manag 2017; 6:481-486. [PMID: 28812849 PMCID: PMC5553218 DOI: 10.15171/ijhpm.2016.151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 12/07/2016] [Indexed: 12/22/2022] Open
Abstract
There has been much reflection on the need for a new understanding of global health and the urgency of a paradigm shift to address global health issues. A crucial question is whether this is still possible in current modes of global governance based on capitalist values. Four reflections are provided. (1) Ecological –centered values must become central in any future global health framework. (2) The objectives of ‘sustainability’ and ‘economic growth’ present a profound contradiction. (3) The resilience discourse maintains a gridlock in the functioning of the global health system. (4) The legitimacy of multi-stakeholder governance arrangements in global health requires urgent attention. A dual track approach is suggested. It must be aimed to transform capitalism into something better for global health while in parallel there is an urgent need to imagine a future and pathways to a different world order rooted in the principles of social justice, protecting the commons and a central role for the preservation of ecology.
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Affiliation(s)
- Remco van de Pas
- Department of Public Health, Unit of Health Policy, Institute of Tropical Medicine, Antwerp, Belgium
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Cave E. Voluntary vaccination: the pandemic effect. LEGAL STUDIES (SOCIETY OF LEGAL SCHOLARS) 2017; 37:279-304. [PMID: 32336855 PMCID: PMC7165755 DOI: 10.1111/lest.12144] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 06/14/2016] [Accepted: 06/17/2016] [Indexed: 06/01/2023]
Abstract
Justification of a voluntary vaccination policy in England and Wales rests on tenuous foundations. Two arguments against voluntary vaccination are gaining ground. The first is that globalisation necessitates preparedness strategies for pandemics. Assuming sufficient supply, compulsory vaccination of adults and children constitutes a potential policy option in the context of a severe, vaccine-preventable pandemic outbreak. The second argument is that children have a right to preventive medicine and thus to vaccination. The influence of the UN Convention on the Rights of the Child and its emphasis on parents as the trustees of their children's best interests, and the increasingly global nature of our collective and individual responsibilities with respect to the transmission of vaccine-preventable disease present challenges to the right to refuse vaccination on our own behalf and on behalf of our children. Exploring methods of compulsion and persuasion utilised across Europe, the USA and Australia, this paper argues that necessity and proportionality must be reassessed, and national public health law and policy setting out a graduated and proportionate approach to compulsory vaccination developed as a matter of priority.
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Affiliation(s)
| | - Linsey McGoey
- Department of Sociology, University of Essex, Colchester, UK
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Woodall J. Why Has the Health-Promoting Prison Concept Failed to Translate to the United States? Am J Health Promot 2016; 32:858-860. [PMID: 27687616 DOI: 10.1177/0890117116670426] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Two decades since the World Health Organization Regional Office for Europe published a report on health promotion in prison that stimulated further debate on the concept of the "health-promoting prison," this article discusses the extent to which the concept has translated to the United States. One predicted indicator of success for the health-promoting prison movement was the expansion of activity beyond European borders; yet 2 decades since the European model was put forward, there has been very limited activity in the United States. This "Critical Issues and Trends" article suggests reasons why this translation has failed to occur.
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Affiliation(s)
- James Woodall
- 1 Centre for Health Promotion Research, Leeds Beckett University, Leeds, United Kingdom
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Fieno JV, Dambisya YM, George G, Benson K. A political economy analysis of human resources for health (HRH) in Africa. HUMAN RESOURCES FOR HEALTH 2016; 14:44. [PMID: 27443146 PMCID: PMC4957394 DOI: 10.1186/s12960-016-0137-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 06/21/2016] [Indexed: 05/23/2023]
Abstract
BACKGROUND Despite a global recognition from all stakeholders of the gravity and urgency of health worker shortage in Africa, little progress has been achieved to improve health worker coverage in many of the African human resources for health (HRH) crisis countries. The problem consists in how policy is made, how leaders are accountable, how the World Health Organization (WHO) and foreign donors encourage (or distort) health policy, and how development objectives are prioritized in these countries. METHODS This paper uses political economy analysis, which stems from a recognition that the solution to the shortage of health workers across Africa involves more than a technical response. A number of institutional arrangements dampen investments in HRH, including a mismatch between officials' tenure in office and program results, the vertical nature of health programming, the modalities of Overseas Development Assistance (ODA) in health, the structures of the global health community, and the weak capacity in HRH units within Ministries of Health. A major change in policymaking would only occur with a disruption to the political or institutional order. RESULTS/CONCLUSIONS The case study of Ethiopia, who has increased its health workforce dramatically over the last 20 years, disrupted previous institutional arrangements through the power of ideas-HRH as a key intermediate development objective. The framing of HRH created the rationale for the political commitment to HRH investment. Ethiopia demonstrates that political will coupled with strong state capacity and adequate resource mobilization can overcome the institutional hurdles above. Donors will follow the lead of a country with long-term political commitment to HRH, as they did in Ethiopia.
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Affiliation(s)
- John Vincent Fieno
- Regional HIV/AIDS Program, U.S. Agency for International Development, Pretoria, South Africa
| | - Yoswa M. Dambisya
- East, Central and Southern Africa Health Community, Arusha, Tanzania
| | - Gavin George
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Kent Benson
- Regional HIV/AIDS Program, U.S. Agency for International Development, Pretoria, South Africa
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Kirigia JM, Nabyonga-Orem J, Dovlo DYT. Space and place for WHO health development dialogues in the African Region. BMC Health Serv Res 2016; 16 Suppl 4:221. [PMID: 27455065 PMCID: PMC4959356 DOI: 10.1186/s12913-016-1452-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Majority of the countries in the World Health Organization (WHO) African Region are not on track to achieve the health-related Millennium Development Goals, yet even more ambitious Sustainable Development Goals (SDGs), including SDG 3 on heath, have been adopted. This paper highlights the challenges - amplified by the recent Ebola virus disease (EVD) outbreak in West Africa - that require WHO and other partners' dialogue in support of the countries, and debate on how WHO can leverage the existing space and place to foster health development dialogues in the Region. DISCUSSION To realise SDG 3 on ensuring healthy lives and promoting well-being for all at all ages, the African Region needs to tackle the persistent weaknesses in its health systems, systems that address the social determinants of health and national health research systems. The performance of the third item is crucial for the development and innovation of systems, products and tools for promoting, maintaining and restoring health in an equitable manner. Under its new leadership, the WHO Regional Office for Africa is transforming itself to galvanise existing partnerships, as well as forging new ones, with a view to accelerating the provision of timely and quality support to the countries in pursuit of SDG 3. WHO in the African Region engages in dialogues with various stakeholders in the process of health development. The EVD outbreak in West Africa accentuated the necessity for optimally exploiting currently available space and place for health development discourse. There is urgent need for the WHO Regional Office for Africa to fully leverage the space and place arenas of the World Health Assembly, WHO Regional Committee for Africa, African Union, Regional economic communities, Harmonization for Health in Africa, United Nations Economic Commission for Africa, African Development Bank, professional associations, and WHO African Health Forum, when it is created, for dialogues to mobilise the required resources to give the African Region the thrust it needs to attain SDG 3. CONCLUSIONS The pursuit of SDG 3 amidst multiple challenges related to political leadership and governance, weak health systems, sub-optimal systems for addressing the socioeconomic determinants of health, and weak national health research systems calls for optimum use of all the space and place available for regional health development dialogues to supplement Member States' efforts.
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Affiliation(s)
- Joses Muthuri Kirigia
- Systems and Services Cluster, World Health Organization Regional Office for Africa, B.P. 06, Brazzaville, Congo
| | - Juliet Nabyonga-Orem
- Systems and Services Cluster, World Health Organization Regional Office for Africa, B.P. 06, Brazzaville, Congo
| | - Delanyo Yao Tsidi Dovlo
- Systems and Services Cluster, World Health Organization Regional Office for Africa, B.P. 06, Brazzaville, Congo
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Abstract
INTRODUCTION The Ebola Virus Disease (EVD) outbreak in West Africa raised ethical issues about structural disadvantage; the duty to care of healthcare workers; the use and study of unregistered agents; the use of restrictive measures like mass quarantine and the importance of public trust. SOURCES OF DATA WHO reports, literature on EVD and ethics. AREAS OF AGREEMENT The use of restrictive measures and the testing of unregistered agents is ethical if support for individuals or communities is provided. AREAS OF CONTROVERSY Controversy exists over ethical trial design for the study of unregistered agents and over the limits of the duty to care. GROWING POINTS The role of the WHO in outbreak control and research oversight needs rethinking and further support. Solidarity in global health needs fostering. AREAS TIMELY FOR DEVELOPING RESEARCH Research is needed on how to restore and enhance health systems and public trust in EVD-affected countries.
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Affiliation(s)
- Alison K Thompson
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, Ontario, Canada M5S 3M2
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Governance for health in a changing world: special issue. Public Health 2015; 129:831-2. [PMID: 26178139 DOI: 10.1016/j.puhe.2015.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Governance for health: special issue commentary. Public Health 2015; 129:866-7. [PMID: 26169686 DOI: 10.1016/j.puhe.2015.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Cluzeau F. Governance for health: special issue commentary. Public Health 2015; 129:864-5. [PMID: 26169684 DOI: 10.1016/j.puhe.2015.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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