GHTA: Making Change in 2014


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 (, 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


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.

ARC for FB

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. 


Duke Hosts the Annual Universities Allied for Essential Medicines Conference


November 11, 2014

More than 200 students traveled from Brazil, Nepal, China, and many other countries to gather at Duke University for the 2014 Universities Allied for Essential Medicines (UAEM) conference organized by the Duke undergraduate chapter of UAEM. Throughout the two-day conference, students in fields ranging from economics to public health to law discussed the many issues related to securing access to medicine by all people, regardless of their location in the world.


Anthony So, DGHI faculty member and director of Duke’s Program on Global Health and Technology Access, opened the conference, urging students to hold universities accountable for their influence on the pharmaceutical supply chain and to be strategic in how the knowledge their research generates becomes translated into affordable treatments to those in need.

“Access to medicine is a fundamental cornerstone to policy work in global health,” said So. “UAEM has served as a powerful voice in ensuring how research discoveries in university labs become translated into affordable products available to those in need. It was inspiring to see students from all over coming together to pave the way forward for tackling these issues.”

He also highlighted the work of Josh Sommer, a Duke undergraduate student who went on to establish the Chordoma Foundation, and by age 24, became on of Forbes 30 under 30 for his breakthrough efforts to catalzye how drugs are brought to market for neglected and rare diseases.

Beyond the numerous panel discussions and breakout sessions, Anand Grover, Former UN Special Rapporteur and Director and Co-founder of Lawyers Collective, and Marine Buizzonière, Director of Open Society Public Health Program, further encouraged students to hold key players accountable for their actions and apply pressure on the United States government, as the U.S. is in a unique position to stimulate change. Members of leading non-governmental organizations such as Jamie Love, Director of Knowledge Ecology International, Peter Maybarduk, Director of Public Citizen, and Kimberely Bonner, Research Associate with Médecins Sans Frontières (MSF) Access Campaign engaged the students throughout the weekend and instigated in-depth conversations about the role that NGO’s play on the pharmaceutical supply chain.

Since UAEM was established by a group of Yale University law students and Mèdecins Sans Frontières in 2001, it has expanded into a worldwide student organization representing over 40 universities and 18 countries. The organization believes that universities and publicly funded research institutions can be part of the solution to the problem of access; the collaboration of UAEM students and other organizations not only creates awareness of these issues but also pushes for change at the policy level, which directly impacts the priorities of policy-making entities.

Throughout their international efforts, UAEM aims to promote access to medicines and medical innovations in low- and middle-income countries, ensure that university medical research meets the needs of people worldwide, and empower students to respond to the access and innovation crisis. To learn more about UAEM’s current proposals and how you can get involved, visit their website today.

(article from

Call for Applications: 2015 Global Health Fellows


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Summer 2015 Global Health Fellows Program
Geneva, Switzerland

See Program Brochure:
2015 Global Health Fellows Brochure

We are now accepting applications for the summer 2015 Global Health Fellows Program in Geneva, Switzerland.

The Global Health Fellows program is designed to equip students to join in the fight against HIV/AIDS, tuberculosis, malaria, and other pressing health challenges. The Program will provide students with both an academic and experiential perspective on how intergovernmental institutions, public-private partnerships, and non-governmental organizations shape global health policy. By combining internships and an intensive course on global health issues, the program is an unique opportunity to learn first-hand how global health policy is formulated and implemented. In the past, students have interned at a wide range of NGOs and intergovernmental organizations, including UNAIDS, the Special Programme for Research and Training in Tropical Diseases, UNHCR, the Global Alliance for Vaccines and Immunizations, and various offices of the World Health Organization, from the Department for Prevention of Noncommunicable Diseases to the Department of Public Health, Innovation and Intellectual Property.

The summer program includes:
· An Internship in Global Health Policy of 8-12 weeks in Geneva, including an intensive, one-week course, titled “Health Policy in a Globalizing World” and
· Opportunities throughout the summer to network and socialize with other policy interns and experts in global health

The Global Health Fellows Program offers students assistance in matching to internships in Geneva-based institutions, the opportunity to learn directly from experts working to resolve some of the world’s most significant challenges in global health, and a community of fellow students from around the world.

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The Global Health Fellows program is directed by Dr. Anthony So, Director of the Program on Global Health and Technology Access at Duke University. Past program participants include students drawn nationally and abroad, from all disciplines, including law, medicine, public health, public policy, international affairs, business, environmental studies, and other graduate or professional students interested in improving global health equity through policy.

The Global Health Fellows Program is part of the Program on Global Policy and Governance. The Program is sponsored by Duke’s Sanford School of Public Policy and co-sponsored by Duke’s Global Health Institute.

Typically internships take place between May and August of each summer. The course will take place in early July. There is flexibility on the start and end dates for individual students, but attendance for the course week is mandatory.

Want more Information?
Please see the accompanying brochure and visit our website for more details. Applications are due November 24, 2014 by 11:59 pm ET and require two letters of recommendation.

For questions, please contact or 919-613-9289.

***Join us for an information webinar on Friday, October 17th at 12 pm ET. Please RSVP to Maggie Woods if you wish to attend.

Migrant Children and Health Initiative Launched


Recently, the program partnered with groups nationwide to advocate for increased attention to and protections for migrant health. The website was launched to help spearhead the project.

Fact sheet giving an overview of situation:
Migrant Children and Health Fact Sheet

A resolution on ‘Addressing Immigrant Discrimination and Health Disparities’ introduced by Michael Rodriguez, MD, MPH and Viviana Martinez-Bianchi, MD, FAAFP and Jay W. Lee, MD, MPH, FAAFP was adopted by American Academy of Family Physicians at its annual Congress of Delegates meeting. The American Academy of Family Physicians resolution resolved that,

AAFP urge federal and state government agencies to ensure routine, evidence-based health care screening, access and treatment for newly immigrated populations; and be it further AAFP commit to stand against scaremongering, profiling and other discriminatory practices, and/or messaging that denigrates and/or depicts immigrant populations in such a light that leads towards marginalization as it relates to human rights and healthcare such as inaccurate accusations that immigrants pose major threats to public health; and be it further AAFP support policies to reduce health disparities borne by immigrants, refugees or asylees.

The American Medical Association (AMA) Resident & Fellow Section recently drafted a resolution to incorporate policies for addressing immigrant health disparities. The resolution urges U.S. federal and state agencies to ensure routine medical care access to immigrant populations, and calls for public awareness and prevention of stigma, profiling, and inaccurate accusations targeted towards immigrants in relation to their health status.

At WTO, Experts Discuss Solutions To Drugs Innovation Crisis; IP Not In The List


03/10/2014 by Catherine Saez, Intellectual Property Watch

The Universities Allied for Essential Medicines (UAEM) organised a panel at the World Trade Organization Public Forum this week on new approaches in university management of intellectual property. The panel gathered a diverse panel of experts giving their take on possible solutions to less innovation and higher prices of drugs, and the role of publicly-funded research.

The WTO Public Forum is taking place from 1-3 October (IPW, WTO, 2 October 2014).
Panellists at UAEM event

Panelists at UAEM event

Anthony So, director of the Program on Global Health and Technology Access at the Duke University Sanford School of Public Policy, said research and development (R&D) productivity in the pharmaceutical sector has been declining, despite growing inputs.

At the same time, he said, prices of new drugs have been “alarmingly” rising. He illustrated the fact by saying that 11 of the 12 cancer drugs approved in 2012 were priced over US$100,000 per patient per year. According to So, among the top 100 drugs in the US, “the median revenue per patient rose from US$1,258 in 2010 to US$9,396 in 2014.”

Publicly-funded research institutions have long been a large contributor to innovative drugs, he said, for example to “virtually all the important innovative vaccines” that have been introduced over the past 25 years.

On the lack of availability of “priority patents,” he said that some years ago the Malaria Vaccine Initiative had a project to pull together key patents to bring a new malaria vaccine to market. The patent landscape for malaria showed 167 patent families, held by 75 different organisations. Although the Initiative narrowed its search to 39 priority patents, by the time the patent landscape was conducted, nearly half of those priority patents were no longer available for licensing, he said. Many of these patents, he added, were originally held by publicly-funded research organisations.

De-linking the cost of R&D and the price of health products is a key concept, said So. Ways of making de-linkage possible include pull mechanisms, such as advance purchase commitments and prizes. Push mechanisms, such as research grants, might also be used so that universities play a strategic role in de-linkage, he said.

Robert Don, discovery and preclinical director for the Drugs for Neglected Diseases initiative (DNDi), said the organisation was created in 2003, and in the following 10 years delivered six new treatments, and is planning to deliver 11 to 13 more by 2018.

DNDi’s founding partners include MSF, the Indian Council for Medical Research, Kenya Medical Research Institute, and the Oswaldo Cruz Foundation in Brazil.

Don presented the case of ASAQ (he put it in caps in slide) a fixed dose combination of artesunate and amodiaquine for treating malaria. The drug was developed by DNDi with public funds, and the non-patented product was licensed to Sanofi, after the World Health Organization prequalification in 2008 (IPW, Public Health, 14 April 2008).

Government Perspective

Marcela Paiva Veliz, counsellor at the Permanent Mission of Chile, said from a practical health perspective, a number of different stakeholders are important in the process, such as the private sector, universities, patients, and civil society.

Completely dissociating R&D and prices might be difficult at this stage in terms of public policy, she said, but Chile is ready to explore this matter further. Access to essential medicines is “more or less covered” through public and private funding in Chile, she said.

On the international scene, the delegate underlined two initiatives: the Medicines Patent Pool, which she said was an interesting new initiative, supported by Chile which was looking forward to MPP moving to other diseases. The MPP currently covers HIV AIDS medicines.

She also cited the PAHO (Pan American Health Organization) Revolving Fund for Vaccine Procurement. She underlined the necessity to have a balanced approach to international regulation and the use of trade flexibilities.

Current IP Paradigm Obstructs Scientific Progress Says UAEM

Lukas Fendel, executive director of UAEM Europe, said UAEM is a group of international students, young researchers, and emerging global health leaders who believe that universities are “uniquely positioned to make a difference in the global R&D crisis.”

“We are currently stuck with an innovation infrastructure that attempts to incentivise R&D mainly by granting IP rights,” he said, which results in an innovation crisis. “There is a misalignment of R&D with the actual health needs of big populations,” he added, particularly relevant to neglected diseases.

The innovation issue runs parallel to the access issue, said Fendel. Drugs are priced out of reach for the population of low and middle-income countries for infectious diseases but also chronic diseases.

“IP-centred innovation eco-systems obstruct scientific progress and innovation,” according to Fendel. The patent landscape gets ever more complex and expensive to navigate, which leads to duplication of efforts among scientists, researchers, industry and the public sector, and results in corporate secrecy, strategic patenting and patent thickets.

University and public research institutions are well positioned to address the access and innovation crisis, he said, as they are “truly innovation hubs” and have a mission to promote public welfare through creation and dissemination of knowledge. They “should strive to establish a new campus drug culture, and should be active stewards of knowledge creation and dissemination in the public interest,” he said. In particular, this should be through the creation of internal policies for global access licensing and other socially responsible licensing mechanisms.

Universities should also “fervently” support open source drug discovery mechanisms, he said, and take part in existing ones. They “should teach critical approaches in economics rather than indoctrinate students with the neo-liberal consensus on how IP should be managed and treated.”

During the Q&A session, So remarked that universities sometimes hold fast to their IP “as the last piece of gold” due to the “lottery ticket” effect created by the current innovation system. Some 30 years after the Bayh-Dole Act, he said, less than 5 percent of research revenue comes from licensing revenues in the United States, he said.

Open Source Dividend as a Solution

James Love, director of Knowledge Ecology International, advocated openness in upstream research. Society does not reward the sharing of information, he said, and provides incentives through patents and trade secret to make research closed.

An open source dividend is a proposal to fix that problem, said Love. He explained that companies selling registered drugs would have to set aside a small percentage of the sale price into a fund to pay for the open source dividend.

Taking as example a drug from Roche with sales of US$500 million per month, one percent of the sales would represent US$ 60 million a year.

Then when a product is put into the market, a jury of experts would be appointed to examine evidence determining what type of research was used by the company to develop this product, such as academic papers, databases and open libraries.

The impact would be a new financial incentive to open source medical research and would encourage third party use, allowing greater access to knowledge data, materials and technology. There would be fewer patent thickets, and it would be less expensive to acquire rights to use knowledge data, materials and technology, Love said.

Other solutions include expanding access to government funded research, and placing research paper in open archives, he said.

Image Credits: Catherine Saez

“At WTO, Experts Discuss Solutions To Drugs Innovation Crisis; IP Not In The List” by Intellectual Property Watch is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

United States Takes Actions to Tackle Antibiotic Resistance


On September 18, 2014, the White House announced four different actions aimed to tackle antibiotic resistance: an Executive Orders signed by President Obama, a National Strategy, President’s Council of Advisors on Science and Technology (PCAST) report on Combating Antibiotic Resistance and $20 million prize for rapid point-of-care diagnostics.

Dr. Anthony So, director of the Program on Global Health and Technology Access, served as a member of the PCAST Antibiotic Resistance Working Group and provided advisory input to the PCAST report. The PCAST report includes recommendations to appoint a White House Director for National Antibiotic Resistance Policy, tasked with ensuring inter-agency collaboration and accountability among federal agencies, as well as establishment of the Interagency Task Force and Presidential Advisory Council.  Establishing such strong federal coordination and leadership is required to tackle the rising antibiotic resistance crisis.

It’s encouraging to see the Obama Administration taking action and showing leadership to address the global public health challenge of antibiotic resistance. We are especially pleased that the PCAST report calls for White House-level coordination and innovative approaches to financing new diagnostics and drugs, from prizes for diagnostics to delinkage mechanisms. Delinkage–which refers to approaches that divorce a drug company’s return on investment from volume-based sales of the antibiotic–might be particularly useful in helping to realign economic incentives.” said Dr. So.

The four actions are summarized below:

1. The Executive Order signed by the President Obama provides the following directives:

  • Establishment of a new Task Force for Combating Antibiotic-Resistant Bacteria charged with submitting a National Action Plan to the President by February 15, 2015 to implement the National Strategy and address the recommendations made by the PCAST.
  • Establishment of the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria composed of leading non-governmental experts.

2. The National Strategy provides details on actions for five goals to be achieved by 2020 in collaboration with partners from academic, public and private sectors involved in healthcare, public health, veterinary medicine, agriculture and food safety. The broad-ranging goals are to prevent the spread of resistant bacteria, strengthen national surveillance, accelerate research and development of diagnostics, vaccines and therapeutics, and improve international collaboration.

3. The PCAST Report on ‘Combating Antibiotic Resistance’  was developed in consultation with a working group of public and private sector experts spanning the human and veterinary health sectors. The report outlines a broad ranging set of actions for the US government to bring the antibiotic-resistance crisis under control.

The Executive Order signed by President Obama has not yet implemented all of the recommendations made by PCAST such as:

  • Doubling annual funding by United States to tackle antibiotic resistance from $450 million to $900 million;
  • Establishing a position for White House Director for National Antibiotic Resistance Policy (DNARP) to ensure inter-agency cooperation and accountability;
  • Establishing a national capability for pathogen surveillance based on genome analysis; or
  • Creating an Antibiotic Incentive Fund that would allow the Biomedical Advanced Research and Development Authority (BARDA) to provide financial and technical support to industry for development of new antibiotics.

4. Prize for Rapid, Point-of-Care Diagnostic Tests: The White House also announced the launch of a $20 million prize for new rapid point-of-care diagnostics. The National Institutes of Health (NIH) and Biomedical Advanced Research and Development Authority (BARDA) will cosponsor the prize for development of diagnostics to identify highly resistant bacterial infections. HHS will host a public meeting to engage public and private sector stakeholders to layout the parameters of the competition. This prize fund established by the Obama administration is higher than the £10 million Longitude Prize for diagnostics announced by the British Government, but lower than the $25 million prize fund recommended by the PCAST.


The full Executive Action, National Strategy, and PCAST Report are attached:

Executive Order — Combating Antibiotic-Resistant Bacteria The White House

National Strategy for Combating Antibiotic Resistance Bacteria

PCAST Report on Combating Antibiotic Resistance

Op-ed: The Meat of the Matter on Antibiotic-Resistant Infections


Dr. Anthony So, director of Duke’s Program on Global Health & Technology Access, and Dr. David Wallinga, director of Healthy Food Action, co-authored an op-ed highlighting the dangers of overuse of antibiotics in both humans and animals. The op-ed was published in News & Observer, a local North Carolina newspaper timed with the Farm Aid event in Raleigh, North Carolina from September 9-12, 2014. The op-ed calls for limiting the animal use of antibiotics for treating diseases, not for growth promotion, and emphasizes the need for data transparency related to sales and use of antibiotics, in order to hold food producers accountable.

The Meat of the Matter on Antibiotic-Resistant Infections

By Anthony So and David Wallinga

September 12, 2014


CHUCK LIDDY — 2002 file photo

We soon may be re-entering the medical Dark Ages. That’s no Chicken Little proclamation. In 2011, the World Health Organization warned of a return to a pre-antibiotic era “where common infections will no longer have a cure, and once again, kill unabated.”

Antibiotic-resistant infections already sicken at least 2 million Americans a year, killing over 23,000 of them. That’s far more than AIDS – or Ebola for that matter.

Reducing the huge overuse of antibiotics, both in humans and animals, is key. This overuse accelerates the development of disease-causing bacteria that are resistant to antibiotics. The Centers for Disease Control and Prevention estimates half of human antibiotics used and much of that used in food animals are unnecessary. According to data from the pharmaceutical industry, at least 70 percent of all antimicrobials sold in the U.S. are added to animal feed – typically not for treating sick animals but for promoting growth or substituting for better hygiene and infection control. These include human drugs like tetracycline and erythromycin.

The CDC has noted the strong scientific evidence that the use of antibiotics in these food animals can harm public health by transmitting these superbugs through our food supply to people.

Drastic reductions in antibiotic use on the farm are smart, and doable. Smaller family-run farms have helped create and expand the rapidly growing sector around organic and “wellness” foods, such as meats from animals raised in pastures or without antibiotics or added hormones.

But it hasn’t always been easy. Raleigh hosts Farm Aid this weekend, a benefit concert that for 28 years has focused on the challenges that continue to threaten the existence of family farms in America.

Adding antibiotics routinely to animal feed allowed larger-scale meat operations to avoid, at least in the short-term, the changes in farm practice that deter unnecessary antibiotic use. Since 1999, producers in Denmark – the world’s largest pork exporter – moved away from routinely using antibiotics in feed and instead invested in alternative practices such as better farm hygiene, infection control and vaccines. The result was 50 percent less antibiotic usage per kilogram of meat produced. The industry became both safer and more efficient, and productivity rose. Taking similar steps, the Netherlands decreased antibiotic use in agriculture by nearly 70 percent in less than half a decade.

Some of the biggest food companies in the U.S. are starting to make large-scale change as well. Perdue, the nation’s third-largest poultry producer, announced that it has now cut use of human-approved antibiotics from about 95 percent of its chickens. Retailers like Chipotle and Chick-fil-A are betting their future on meeting what they see as a consumer preference for meat raised without antibiotics.

What’s now needed are major changes in public policy and leadership among elected officials, including in North Carolina. We are home to the world’s first case of an infection resistant to carbapenem antibiotics – one of our last lines of defense against drug-resistant “superbugs.” More to the point, we host the largest swine slaughterhouse in the world – placing us second in the country among pork-producing states.

At the state level, North Carolina policymakers could offer incentives to farmers to use less antibiotics rather than the reverse. A North Carolina tax break on animal antibiotics as well as animal feed cost the state $140 million in 2011. Such a tax exemption clearly promotes rather than dissuades unnecessary antibiotic use.

In Washington, the North Carolina congressional delegation should call on the federal government to limit animal use of antibiotics for treating disease, not for growth promotion or other inappropriate reasons. We also must support farmers in introducing alternatives to antibiotics in animal production.

To hold food producers accountable, data on the sales and use of antibiotics must be transparent and publicly reported. The public deserves better monitoring of emerging drug resistance in our food supply, from farm to fork.

Read more here:

Link to article:

Launch of the Antibiotic Resistance Coalition


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

ARC Declaration frontpage_250px

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.

– END –

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.


Program Now Hiring Student Research Assistants!


Student Research Positions

Undergraduate and graduate students with an interest in global health are invited to apply for research assistant positions with the Program on Global Health and Technology Access. Research assistants are given the opportunity to take part in many program cropped-P1060313activities and research projects. Work study is available, but not required. If you are interested, please send a cover letter, writing sample, CV and transcript to

This position provides an opportunity to work with the Program on Global Health and Technology Access (GHTA) at Duke University’s Sanford School of Public Policy. The Program on Global Health and Technology Access is a program of scholarship, policy convening, and teaching on globalization and health equity, particularly viewed through the lens of innovation and access to health technologies.  As part of its work, the Program explores alternative policy models and strategies of R&D that would advance innovation and access to essential medicines, especially for those in low- and middle-income countries; investigates patterns of the ownership and sharing of knowledge to improve innovation of such health technologies; and organizes policy convenings of key stakeholders on these issues. The Director of the Program is Anthony So, Professor of the Practice of Public Policy and Global Health, who also serves as a Robert Wood Johnson Foundation Investigator in Health Policy Research. The Program serves as the Strategic Policy Unit of ReAct, a global network committed to raising policymaker awareness over antibiotic resistance; has supported the work of intergovernmental organizations, from the WHO’s Alliance for Health Policy and Systems Research to the UN Development Program; and completed commissioned work for the Institute of Medicine and the Global Commission on HIV and the Law. The Program also oversees an NIH Fogarty grant on the “Political Economy of Tobacco Control in Southeast Asia,” a regional research and capacity building effort that serves to enable those in Southeast Asia to respond more effectively to the challenge of tobacco use for the long term and on their own terms.

Responsibilities of the student research position include:

• Support and participate in research activities, including literature reviews, gathering and analyzing primary data, supervising student Research Assistants as needed, and generating policy memos and analyses. Prepare sections of journal articles, book chapters and other scientific papers and conduct the necessary literature searches required for their preparation.
• Working with the Program Director and research staff, prepare reports for funding agencies, briefings for policy meetings, and abstracts/presentations for domestic and international meetings.
• Review journals, abstracts and scientific literature to keep abreast of new developments and to obtain information regarding previous studies to aid in the planning of new studies.
• Work closely, although at times independently, with Program staff to support policy and research convenings, including identifying key areas, developing objectives and agendas, coordinating logistics and producing strategic outputs.
• Support the management and development—with other team members and partner organizations—of fellowship and training programs, from the Program’s graduate seminar course to the Global Health Fellows Program.
• Assist with the drafting of meeting agendas, presentations, policy briefings, case studies, classroom exercises, IRB protocols, grants, journal articles, or other writings with the Director.
• Apply multimedia tools and develop materials for the Program’s activities, including on-line web site postings, wiki additions or recorded interviews.
• Support the creation of Program presentations, including the effective use of Powerpoint or multimedia elements, for the classroom as well as on- and off-campus talks.
• Handle administrative needs of the Program, from correspondence and the filing of reimbursements to scheduling and travel itinerary arrangements.
• Support the Director in other Program activities as needed.

Duke Global Health Fellows Engage with Global Health Leaders in Geneva


Duke Global Health Fellows Engage with Global Health Leaders in Geneva

July 23, 2013

Spending the summer interning in Geneva, Switzerland, a hub for global health policy, the ninth cohort of Duke Global Health Fellows capped a week-long policy course by attending the opening session of the Trilateral Joint Technical Symposium on Medical Innovation.

The 23 fellows are from universities around the world, including Duke alumni and a student in the Duke Master of Science in Global Health. Hosted by the World Health Organization (WHO), World Trade Organization (WTO) and World Intellectual Property Organization, the event allowed fellows to pose questions to each of the Director Generals and to GAVI Alliance CEO Seth Berkley.

“It was very exciting to be a part of the symposium,” said Xiaochen Dai, a global health fellow and Master of Science in Global Health student at Duke. “The director-generals of WHO, WIPO and WTO and the CEO of GAVI gave inspiring presentations on medical innovations in global health.”

Also presenting at the technical symposium, Program Director and Duke professor Dr. Anthony So discussed new business models that overcome scientific and financial bottlenecks to pharmaceutical innovation and can transform how health technologies are distributed and brought to market. His talk “Antibiotic Resistance- Today’s Challenges, Tomorrow’s Solutions” highlighted the need for new approaches that involve tiering, pooling and push-and-pull financing mechanisms.

The symposium and a week-long course leading up to it helped the fellows gain new perspective into emerging global health policy issues. The course involving 25 expert seminar sessions and site visits enabled fellows to understand how policy issues come together in the field, from innovation and technology transfer to intellectual property rights and access to medicines.

“The Geneva Global Health Fellow Program is fantastic,” said Dai. “I loved the one-week course during which we were exposed to many interesting topics in global health and visited many important organizations in Geneva. This program has definitely broadened my horizon in global health and helped me make connections with future leaders in this field.”

“I felt like my comprehensive understanding of the vast domain of global health challenges was holistically influenced by hours of intense exchange from the over 40+ individuals from numerous organizations across Geneva who took time out of their busy schedules to share their insights with us,” said Braveen Ragunanthan, a fellow who recently graduated from Duke with a public policy degree and global health certificate. “We are equipped with a sharper sense of what challenges exist, and now have a greater sense of urgency to help address them.”

Organizations that work closely with the fellows include many WHO departments, the UN Development Program, UN Environment Program, the Global Alliance for Vaccines and Immunizations, the World Heart Federation, and the International Organization for Migration. Students also attended a dinner with various mentors in global health and visited the Strategic Health Operations Center (SHOC), where WHO monitors pandemic threats and infectious disease outbreaks.

Antibacterial Resistance takes Center Stage in Geneva



22 July 2013

Antibiotic resistance took center stage in Geneva, both at the Trilateral Symposium on Medical Innovation, hosted by the World Health Organization, the World Trade Organization and the World Intellectual Property Organization, on July 5th and in the findings of the 2013 update of Priority Medicines for Europe and the World launched on July 9thMany experts addressed antibiotic resistance as an urgent global health threat, including WHO Director General Margaret Chan.

In her opening remarks to the WIPO-WTO-WHO technical symposium on “Medical Innovation & Changing Business Models,” WHO Director-General Margaret Chan noted the urgent challenge of a post-antibiotic era and the dire consequences of running out of effective, first-line antibiotics. ReAct’s Strategic Policy Unit Director, Dr. Anthony So from Duke University, gave focus to these policy concerns by discussing the scientific and financial bottlenecks to innovation through the lens of antibiotic resistance (see symposium agenda and presentation here)

Discovering novel classes of antibiotics has proven to be a significant scientific challenge. Curing an infection in a few days- as opposed to treating a disease, like high blood pressure, for life- also results in lower returns for companies investing in antibiotic R&D compared to other therapeutic classes. The shortage of novel antibiotics is particularly worrisome given the growing burden of resistance and punctuates the need for looking at new business models. He suggested the need to innovate our approach to innovation, applying tiering and pooling as well as push and pull financing mechanisms in concert.

He called attention to the importance of piloting approaches that delink R&D investment from both prices and–in the case of antibiotics–quantity as well. However, with push financing like the EU’s Innovative Medicines Initiative or U.S. BARDA (the Biodefense Advanced Research and Development Authority) program or pull mechanisms like prizes for diagnostics, there also must come commensurate returns on these public sector investments, especially in ensuring life-saving antibiotics are affordable to those in need.

Illustrating the importance of collaborative R&D, he showed how the fledgling, but promising India Council on Scientific and Industrial Research’s Open Source Drug Discovery Initiative had already made significant strides in successfully sharing resources, risks and rewards to improve upstream innovation with an eye on downstream access. This 3Rs framework was discussed in an article in the BMJ.

In contributing to this panel, Richard Laing–lead author behind the WHO reportPriority Medicines for Europe and the World launched on July 9th–described the importance of antibiotic resistance in the 2013 update, that recalls the 2004 report’s conclusion that “we are facing the possibility of a future without effective antibiotics.”

In the report’s chapter on priority diseases and their reasons for inclusion, antibacterial drug resistance leads off as the first of a series of conditions. These conditions are “associated with a pharmaceutical gap in that many pharmaceutical treatments for them are already ineffective and many others will soon become ineffective. Both [antibacterial resistance and pandemic influenza] pose enormous threats to global public health which will require major multi-sectoral responses.”

In closing, Professor So reminded policymakers of how penicillin was brought to market, with concerted public-private partnership, as a generic drug during the second World War. And he concluded that: “Indeed the need today for a global R&D framework, beginning with efforts to address the public health challenge of antibiotic resistance, may give our children a future free from the fear of untreatable infections.”