GHTA: Making Change in 2014

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In 2014, the Program on Global Health and Technology Access at Duke University’s Sanford School of Public Policy made significant strides in its priority areas of research and policy work. Here are some of the year’s highlights:

  • At the start of the year, we completed a “Roadmap for Antibiotic Innovation” for the World Health Organization, which laid foundation for a meeting by year’s end, organized by WHO and the Drugs for Neglected Diseases Initiative, on how a new product development partnership for antibiotic innovation would fit within the landscape of current initiatives.
  • Working with a steering group of civil society groups, we as ReAct’s Strategic Policy lead launched the Antibiotic Resistance Coalition. Twenty groups across human medicine and veterinary sectors signed a Declaration, framed around four pillar areas, resulting from a joint authoring process and debuting at the World Health Assembly in May 2014.
  • Serving on the working group on antibiotic resistance, Dr. So and the GHTA Program provided significant input into the President’s Council of Advisors on Science and Technology’s Report to the President on Combating Antibiotic Resistance, which led to President Obama’s Executive Order and National Strategy on Antibiotic Resistance in September 2014.
  • The GHTA Program provided input to WHO’s Global Action Plan on Antimicrobial Resistance; served as part of the editorial team for Chatham House’s report on new business models for antibiotic innovation; contributed to a forthcoming Lancet series on antibiotic resistance; and co-authored case studies on innovation tackling antibiotic resistance that became part of the Alliance for Health Policy and Systems Research flagship monograph, Medicines in Health Systems: Advancing access, affordability and appropriate use, that debuted at the Third Global Symposium on Health Systems Research in Cape Town, South Africa.
  • The GHTA Program presented in policy fora ranging from WHO’s Technical Consultation on Innovative Models for New Antibiotics’ Development and Preservation to the Dag Hammarskjöld Foundation’s meeting on “Antibiotic Resistance: Towards National and Global Solutions” and in educational fora, ranging from the World Trade Organization’s Public Forum in Geneva to the American Medical Student Association’s regional conference at UNC-Chapel Hill and the Young Professionals Chronic Disease Network’s forum before the UN Non-Communicable Diseases Review in New York City.
  • Providing advisory input to the United Nations Development Program’s Access and Delivery Project, we completed two papers—one on how policy levers could influence pharmaceutical innovation and access from bench to bedside and the other on potential case study directions to take.
  • Growing out of our work on antibiotic resistance, the Program has taken up a new focus on healthy food systems. In our work with the Antibiotic Resistance Coalition, shared concerns about transparency of antibiotic sales, use and resistance data have emerged. From participating in a “Transatlantic Meeting on Food, Agriculture and Health Policy” at Rockefeller Foundation’s Bellagio Conference Center to family farm tours in advance of Farm Aid in Raleigh this year, the Program is taking steps to deepen its work on food policy issues. Timed with Farm Aid, we co-authored an op-ed with Dr. David Wallinga in the News & Observer on “The meat of the matter on antibiotic-resistant infections.”
  • In partnership with the South East Asia Tobacco Control Alliance (SEATCA) and the American Cancer Society, we brought our NIH Fogarty grant on “The Political Economy of Tobacco Control in Southeast Asia” to a close this year. Working with SEATCA and researchers in the region, we published three country-level papers analyzing the magnitude of illicit trade of tobacco. We held two regional research workshops—one in Bangsaen, Thailand and a second piggybacked on a larger policy conference held in the WHO – Western Pacific Regional Office (WPRO) headquarters office in Manila, Philippines; and laid the groundwork for continued research from household surveys completed in three countries (Vietnam, Thailand and Indonesia); and with researchers at Georgetown University, prepared the SimSmoke policy simulation model for use in selected ASEAN countries.
  • Invited to join a National Research Council Committee, Dr. So is contributing to the report, “Understanding the U.S. Illicit Tobacco Market:  Characteristics, Policy Context, and Lessons from the International Experience,” due out in 2015.
  • The GHTA Program not only taught the graduate seminar, “Designing Innovation for Global Health,” and the “Health Policy in a Globalizing World” course for Global Health Fellows, but also guest lectured in core courses for the MSc Global Health and MPP students as well as provided the global health track for Chinese government officials in the Duke Center for International Development’s SAFEA program.
  • In November 2014, the Program helped host the annual conference of the Universities Allied for Essential Medicines, bringing 200 students from a dozen countries to Duke University, along with expert speakers from Médecins sans Frontières and the Medicines for Malaria Venture to Knowledge Ecology International and the Aeras (a non-profit biotech advancing new TB vaccines). The conference also provided an opportunity to brief and support the joint UAEM-AMSA Task Force on Antimicrobial Resistance.
  • The Global Health Fellows Program completed its tenth year this past summer, and applications to join the 2015 cohort went up 40%. Alumnae from the Program led the creation of the UAEM-AMSA Antimicrobial Resistance Working Group, made it to the finalist round of the White House Fellows Program, and became the City Health Commissioner of Baltimore at age 31.
  • Dr. So continued his service on the national boards of Public Citizen and Community Catalyst, as well as in advisory capacities for the Universities Allied for Essential Medicines and Princeton University’s Center for Health and Well-Being. He also joined the GWU-Kaiser Health Plan Advisory Council on developing a residency training program focused on social mission.
  • Working with the UCLA Blum Center for Health and Poverty in Latin America, the University of Washington’s EthnoMed program and professional society leaders, the GHTA Program launched a campaign to encourage professional societies in medicine and public health to adopt positions against scaremongering directed at migrant children. The early results include a fact sheet, a website (MigrantChildrenHealth.org), and passage of resolutions against scaremongering at the American Academy of Family Physicians and the American Medical Association’s Resident and Fellows section.

Join the Resistance: Sign the Antibiotic Resistance Declaration

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The lack of effective antibiotics against resistant infections has the potential to affect us all – doctors and patients, farmers and consumers, humans and animals – without regard for international borders. In May 2014, over twenty civil society organizations from North and South, including US and Europe, and across those working on human and animal use of antibiotics—came together to form the Antibiotic Resistance Coalition.

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The Antibiotic Resistance Coalition launched the ‘Declaration on Antibiotic Resistance’ to advocate for policy change and action to prevent the post-antibiotic era from becoming a bleak reality. The Declaration calls for international leadership to take actions such as:

  • Prohibit the mis-promotion and advertising of antibiotics;
  • Promote new, needs-driven and open research and development models based on the principle of delinkage;
  • Phase out the use of antibiotics from routine disease prevention in livestock and end their use, altogether, for growth promotion;
  • Build robust systems, in all countries, to monitor and report antibiotic use and resistance trends in humans and animals; and
  • Improve public awareness to support an ecological understanding of the human-bacterial interaction and behavior change around antibiotic use.

During the Antibiotic Awareness Week from Nov 17th – 23rd we urge all to join the Resistance and sign the Antibiotic Resistance Declaration. We hope that you can use the social media toolkit available on the website or create your own messages and use the frame of the Declaration to effectively reach out to your constituents. 

 

Launch of the Antibiotic Resistance Coalition

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The Antibiotic Resistance Coalition, comprising civil society organisations and stakeholders from multiple sectors on six continents, has called on World Health Organization (WHO) Member States to pass a critical resolution (Combating antimicrobial resistance, including antibiotic resistance) at the 67th World Health Assembly that would spark concerted global action to control the escalating antimicrobial resistance crisis.

“Antimicrobial resistance—and particularly antibiotic resistance—is the most pressing public health issue facing the global community,” said Otto Cars, founder of ReAct (Action on Antibiotic Resistance). “If the resolution is not passed, and the WHO and its Member States do not act quickly, there will be disastrous global health consequences.”

Public health researchers estimate that, each year, millions of people around the world are infected with antibiotic-resistant bacteria, and hundreds of thousands of them die. Without immediate action, that toll is expected to worsen.

“We are on the precipice of a post-antibiotic era,” said Tim Reed, executive director of Health Action International. “Without a radical shift in the way antibiotics are marketed and used—and unless we overcome the gap in antibiotics discovery—antibiotic resistance will continue to become one of the greatest threats to humankind.”

The Antibiotic Resistance Coalition, in its declaration released today, asserts that consumer protection and public health must trumpthe pursuit of profit, and that effective antibiotics are global public goods. The Coalition also calls for international leadership and action to, in part:

  • Prohibit the promotion and advertising of antibiotics;
  • Promote new, needs-driven and open research and development models based on the principle of de-linkage (divorcing price from research and development costs and sales volumes);
  • Phase out the use of antimicrobials for routine disease prevention in livestock, and end their use, altogether, for growth promotion;
  • Build robust systems, in all countries, to monitor and report antibiotic use and resistance trends in humans and animals; and
  • Improve public awareness to support an ecological understanding of human-bacteria interaction and behaviour change around antibiotic use.

“Member States must deliver a strong mandate to the WHO to not only develop a pressing action plan on antimicrobial resistance, but also to ensure that public health is prioritised over commercial interests,” said Yoke Ling-Chee, program director with Third World Network. “Access to affordable and effective antibiotics is of particular importance for developing countries.”

WHO Member States are tentatively scheduled to vote on the resolution on Friday, 23 May. The Antibiotic Resistance Coalition will deliver an intervention to the World Health Assembly prior to the vote.

The Antibiotic Resistance Coalition is also inviting other civil society organizations around the world to sign its declaration, which is available at http://sites.duke.edu/ghtaprogram/files/2014/05/ARC-declaration-May-22-2014.pdf

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Antimicrobial resistance is a general term that refers to resistance to a compound that kills or stops the growth of microorganisms, including bacteria, fungus, parasites and viruses. Antibiotic resistance refers specifically to resistance to anti-bacterial agents.

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The Antibiotic Resistance Coalition consists of numerous civil society organisations and stakeholders from six continents working in the health, agriculture, consumer and development sectors. It advocates for policy change and action to prevent the post-antibiotic erafrom becoming a bleak reality. Established earlier this year, the Coalition resulted from a series of discussions and meetings organised by the following steering group members: Anthony So (ReAct / Duke University’s Program on Global Health and Technology Access), Niclas Hällström (What Next Forum), Martin Khor (South Centre), Tim Reed (Health Action International), Peter Maybarduk (Public Citizen), Eva Ombaka (ReAct / Health Action International) and David Wallinga (Healthy Food Action). Initial funding for the formation of the Coalition was provided by ReAct and the South Centre.

BACKGROUND DOCUMENTS: