Integrating multi-national teams: over a decade of lessons learned in Chiapas with Partners in Health-Mexico

In a globalized world where pathology and risk can flow freely across borders, the discipline of global health equity has proposed to meet this challenge with an equal exchange of solutions, and people working toward those solutions. Considering the history of colonialism, ongoing economic exploitation, and gaping inequities across and within countries, these efforts must be taken with care. The Partners In Health program in Chiapas, Mexico was founded in 2011 by a team of leaders from both the United States and Mexico to strengthen the public health and care delivery systems serving impoverished rural populations. Key to the strategy has been to marshal funding, knowledge, and expertise from elite institutions in both the United States and Mexico for the benefit of an area that previously had rarely seen such inputs, but always in close partnership with local leaders and community processes. With now over a decade of experience, several key lessons have emerged in both what was done well and what continues to present ongoing challenges. Top successes include: effective recruitment and retention strategies for attracting talented Mexican clinicians to perform their social service year in previously unappealing rural placements; using effective fund-raising strategies from multinational sources to ensure the health care delivered can be exemplary; and effectively integrating volunteer clinicians from high-income contexts in a way that benefits the local staff, the foreign visitors, and their home institutions. A few chief ongoing challenges remain: how to work with local communities to receive foreign visitors; how to hire, develop, and appropriately pay a diverse workforce that comes with differing expectations for their professional development; and how to embed research in non-extractive ways. Our community case study suggests that multinational global health teams can be successful if they share the goal of achieving mutual benefit through an equity lens, and are able to apply creativity and humility to form deep partnerships.

Now is the Time to Scale Up Birth-Dose Hepatitis B Vaccine in Low- and Middle-Income Countries

Fewer than half of the world's infants have access to the birth dose of hepatitis B vaccine (HBV), which prevents mother-to-child transmission of HBV and subsequent liver cancer. Now is the time to expand access for infants born in low-resource settings.

The UTH-UMB Global Health Education Collaboration: Building a Bidirectional Exchange Based on Equity and Reciprocity

The global health exchange program between the University Teaching Hospitals (UTH) of Lusaka, Zambia and the University of Maryland, Baltimore (UMB) has been operating since 2015. As trainees and facilitators of this exchange program, we describe our experiences working in Lusaka and Baltimore, and strengths and challenges of the partnership. Since 2015, we have facilitated rotations for 71 UMB trainees, who spent four weeks on the Infectious Disease (ID) team at UTH. Since 2019 with funding from UMB, nine UTH ID trainee physicians spent up to six weeks each rotating on various ID consult services at University of Maryland Medical Center (UMMC). Challenges in global health rotations can include inadequate preparation or inappropriate expectations among high-income country trainees, low-value experiences for low- and middle-income country trainees, lack of appropriate mentorship at sites, and power imbalances in research collaborations. We try to mitigate these issues by ensuring pre-departure and on-site orientation for UMB trainees, cross-cultural mentored experiences for all trainees, and intentional sharing of authorship and credit on scientific collaborations. We present a description of our medical education collaboration as a successful model for building equitable and reciprocal collaborations between low- and middle-income countries and high-income countries, and offer suggestions for future program initiatives to enhance global health education equity among participants and organizations.

Characteristics of Global Health Careers among Graduates of a Global Health Equity Residency Training Program in the United States

Background

The number of global health (GH) physician training programs in the United States has increased in the past decade. Few studies have explored the demographics of individuals in these programs, the impact of global health training on career development, and specific factors associated with whether graduates achieve a career in global health.

Objectives

We aimed to describe characteristics of program graduates and quantify which previously identified factors were associated with achieving a self-defined career in GH among a cohort of graduates from one GH post-graduate training program in a highly resourced academic medical center in the United States between 2003 and 2018.

Methods

We conducted a cross-sectional survey and analyzed differences between participants who self-identified as having a career in GH compared to those who did not.

Findings

Among 59 individuals invited to participate, 53 (89.9%) responded to the survey. Having a GH mentor was associated with having a career in GH (OR 10.3; p = 0.004). Those who had a GH career were more likely to have a clearly-defined career path (p = 0.03), have institutional support in their current job (p = 0.00006), be able to manage the split between their GH and non-GH work (p = 0.0001), find funding to achieve their objectives in GH (p = 0.01), invest in their personal and family life (p = 0.05), and split work abroad and domestically with few challenges (p = 0.01).

Conclusions

We present sociodemographic and career characteristics for graduates from a GH training program in a highly resourced academic medical center in the United States. Mentorship, institutional support, funding, ability to balance GH with non-GH work, and time spent domestically or abroad are key factors associated with successful careers in GH. If institutional funding is allocated to strengthen these aspects of GH training, we anticipate more sustained GH career development.

A glimmer of hope: My reflections on global health efforts in Haiti

Many factors impact access to care and global health equity, which can be transformed by nursing. When healthcare infrastructure is suboptimal, nursing's role expands exponentially. In this reflection, I share my experiences accessing healthcare as a child in a low-resource community and highlight nursing activities to improve global health equity. Nurses can facilitate change by becoming active in communities, humanitarian organizations, policymaking, and advocacy.

Can we move beyond vaccine apartheid? Examining the determinants of the COVID-19 vaccine gap

While global health leaders call disparities in access to COVID-19 vaccines an 'apartheid,' this gap is not the first such disparity. The recurrence of these gaps in low and middle-income countries and especially in Africa, raises questions about their determinants and about the persistent failures of global health institutions to remediate them. We interrogate these determinants and questions by examining: (1) the distribution of COVID-19 vaccines; (2) primary determinants of vaccine access including availability and affordability; (3) factors affecting availability (hoarding, COVAX, and manufacturing capacity); and (4) factors affecting affordability (pricing, intellectual property rights (IPR), the TRIPS waiver and a potential pandemic treaty). We conclude that IPR constrained the affordability and availability of COVID-19 vaccines in ways inadequately addressed by COVAX and a waiver compromise thwarted by political, corporate, and philanthropic interests. While stronger limits to IPR in a pandemic treaty and a reformed International Health Regulations will not resolve structural inequities, they could meaningfully expand LMIC autonomy to protect public health. We urge equity-seeking Global South and North actors to fight for such IPR reforms as small and meaningful steps towards a more equitable global health order. Otherwise, criminally racist 'apartheids' will continue to be the norm when it comes to the distribution of essential health goods during global health emergencies.

University patenting and licensing practices in the United Kingdom during the first year of the COVID-19 pandemic

Universities' decisions during technology transfer may affect affordability, accessibility, and availability of COVID-19 health technologies downstream. We investigated measures taken by the top 35 publicly funded UK universities to ensure global equitable access to COVID-19 health technologies between January and end of October 2020. We sent Freedom Of Information (FOI) requests and analysed universities' websites, to (i) assess institutional strategies on the patenting and licensing of COVID-19-related health technologies, (ii) identify all COVID-19-related health technologies licensed or patented and (iii) record whether universities engaged with the Open COVID pledge, COVID-19 Technology Access Pool (C-TAP), or Association of University Technology Managers (AUTM) COVID-19 licensing guidelines during the time period assessed. Except for the Universities of Oxford and Edinburgh, UK universities did not update their institutional strategies during the first year of the pandemic. Nine universities licensed 22 COVID-19 health technologies. Imperial College London disclosed ten patents relevant to COVID-19. No UK universities participated in the Open COVID Pledge or C-TAP, but discussions were ongoing in autumn 2020. The University of Bristol endorsed the AUTM guidelines. Despite important COVID-19 health technologies being developed by UK universities, our findings suggest minimal engagement with measures that may promote equitable access downstream. We suggest universities review their technology transfer policies and implement global equitable access strategies for COVID-19 health technologies. We furthermore propose that public and charitable funders can play a larger role in encouraging universities to adopt such practices by making access and transparency clauses a mandatory condition for receiving public funds for research.

Nuclear Medicine Education Via Instagram: A Viable Method for Informal Lifelong Learning

Formal and informal lifelong learning allows nuclear medicine professionals to grow and change over time within this dynamic field. Over the past 2 decades, Internet-based websites have provided instantaneous access to informal learning opportunities, including nuclear medicine reference articles, videos and webinars, and case-based learning. More recently, medical educators have explored social media platforms such as Instagram, Facebook, and Twitter to provide nuclear medicine education. This article discusses the use of Instagram as a platform for lifelong learning in nuclear medicine. Several nuclear medicine Instagram sites are introduced and user characteristics and participation for a representative site are presented in an effort to learn more about this educational forum, which is increasingly being recognized among academic educators.

COVID-19 reveals weak health systems by design: Why we must re-make global health in this historic moment

The COVID-19 pandemic demonstrates the critical need to reimagine and repair the broken systems of global health. Specifically, the pandemic demonstrates the hollowness of the global health rhetoric of equity, the weaknesses of a health security-driven global health agenda, and the negative health impacts of power differentials not only globally, but also regionally and locally. This article analyses the effects of these inequities and calls on governments, multilateral agencies, universities, and NGOs to engage in true collaboration and partnership in this historic moment. Before this pandemic spreads further - including in the Global South - with potentially extreme impact, we must work together to rectify the field and practice of global health.

Human-centered design for global health equity

As digital technologies play a growing role in healthcare, human-centered design is gaining traction in global health. Amid concern that this trend offers little more than buzzwords, our paper clarifies how human-centered design matters for global health equity. First, we contextualize how the design discipline differs from conventional approaches to research and innovation in global health, by emphasizing craft skills and iterative methods that reframe the relationship between design and implementation. Second, while there is no definitive agreement about what the 'human' part means, it often implies stakeholder participation, augmenting human skills, and attention to human values. Finally, we consider the practical relevance of human-centered design by reflecting on our experiences accompanying health workers through over seventy digital health initiatives. In light of this material, we describe human-centered design as a flexible yet disciplined approach to innovation that prioritizes people's needs and concrete experiences in the design of complex systems.

Genomics research in Africa and its impact on global health: insights from African researchers

Africa may be heading for an era of genomics medicine. There are also expectations that genomics may play a role in reducing global health inequities. However, the near lack of genomics studies on African populations has led to concerns that genomics may widen, rather than close, the global health inequity gap. To prevent a possible genomics divide, the genomics 'revolution' has been extended to Africa. This is motivated, in part, by Africa's rich genetic diversity and high disease burden. What remains unclear, however, are the prospects of using genomics technology for healthcare in Africa. In this qualitative study, we explored the views of 17 genomics researchers in Africa on the prospects and challenges of genomics medicine in Africa. Interviewees were researchers in Africa who were involved in genomics research projects in Africa. Analysis of in-depth interviews suggest that genomics medicine may have an impact on disease surveillance, diagnosis, treatment and prevention. However, Africa's capacity for genomics medicine, current research priorities in genomics and the translation of research findings will be key defining factors impacting on the ability of genomics medicine to improve healthcare in Africa.