Reinventing Global Health

About Reinventing Global Health

This podcast is a package of ten one-hour episodes (seven in English and three in French) with eminent experts having multifaceted backgrounds in the private and public healthcare sectors in the U.S., Canada, and France. It aims at answering the following questions regarding global health, in their respective areas of expertise and based on their vast experience: What is the status? What are the trends? What are the challenges? Would you please give a few examples of projects that were successful or failed,explaining why? What are some solutions, in particular, what could be scaled? It was created and is moderated by Yann A. Meunier, MD, Global Health Expert based in Silicon Valley, California and former Director of International Corporate Affairs and Business Development for Stanford Hospital and Clinics.

Publisher

Yann A. Meunier, MD

Category

education · government · health & fitness

Language

en

Explicit

No

First episode

9 Feb 2023

Latest episode

11 Feb 2023

Latest episodes

10 episodes in the feed.

1. 

   11 Feb 2023

   Global Health from an African Perspective - with Joachim Kapalanga, MD

   Main points Definition of global health in the context of Africa Primary problems in quantity and quality in human resources confounded by the multiplicity of stakeholders Lack of harmonization of partnership and funding channels and modalities are different for stakeholders Lack of tracking of resources by governments Weak point: no direct government oversight of the project: no political will and/or no mechanism to harmonize the projects International programs often lack sustainability. Example: H3Africa Program (Human Heredity and Health in Africa) Competition for the same skilled workers to carry out international programs who are thus diverted from provided healthcare to local populations. It also participates in the brain drain (example: H3Africa) No prioritization of the programs in the interest of home countries (medications, tests, equipment). Example in South Africa: patient genetic difference between California and Africa Accountability: No separation between politics and judicial systems. As a result, there is no prosecution when waste or corruption occurs in many cases. Example: SASA conference Successes: H3Africa with sickle cell and genetic diseases / Training of workers skilled in global health / Help in rural areas To counter the brain drain, two examples: (1) Brain Circulation, (2) Carnegie Foundation (cross appointments) Rural areas. The situation has improved in the last decades but they are still underserved particularly regarding access and distribution. Moreover, facilities are underdeveloped, understaffed, and lack diagnostic tools. Example in Tanzania for the training of healthcare workers but it has plateaued. Priority: mother and children healthcare Collaboration between African countries: despite African Union’s efforts there is little collaboration. No continent-wide standards for healthcare Current Ebola outbreak in Uganda (date: 10/3/2020) Disproportion between funding and priorities: HIV/AIDS, TB, malaria are well funded at the expense of other diseases like neglected tropical diseases and chronic diseases Deciders for best ROI: African governments but external players like the Bill Gates foundation have their own projects. Political consequences if programs fail: no mechanism holding anybody accountable Influence of academia on decision-makers. Difficulty in developing policies to advise governments. They have problems on their own: insufficient funding, low salaries, lack of academic freedom, nepotism and lack of competent leaders and staff, lack of equal access to academic institutions High cost of tuition deprives African countries of bright students Advice for people wanting to get involved in global health in Africa: - Despite of challenges, follow your heart - Work in rural settings. Personal examples (1) in Tanzania, (2)        McMaster University, (3) Distributed medical education Advice to fix what is not working in global health in Africa: (1) Training level: Expand distributed medical education nationally or internationally in Africa, (2) More collaboration between academic institutions promoting global health creating guidelines Good example of a successful program that can be scaled: In Tanzania a training program initiated by a foundation in the Netherlands and taken by the Fogarty foundation Good example of program successful for sustainability: Nutritional program started by Oxfam against kwashiorkor and marasmus Example of good collaboration between anglophone and francophone countries: Rwanda and Uganda and DRC (Democratic Republic of Congo) regarding Ebola BIO Dr. Kapalanga is a physician-scientist and educator who received his medical education from Yale University, the state university of New York, queen’s university and the university of Guelph. He is currently professor of paediatrics at the Schulich school of medicine and dentistry and the South Western Ontario academic health network - knowledge translation group, Canada. His scholarly

2. 

   11 Feb 2023

   The Future of Global Health. The Main Healthcare Systemic Challenge: Prioritization with Yann Meunier, MD

   Main points Speaker introduction (international experience and expertise / pharmaceutical industry and corporate background) Presentation goals (road map for reaching maximum efficiency and efficacy in providing healthcare across the globe / providing food for thought to frame issues) Global and healthcare challenges: The African example The Clinton foundation as an example of unreliable funding One requirement to face multiple challenges: Prioritization Analogy: Medical emergency department Triage process Criterion #1 for global health: ROI with several dimensions (medical, financial, societal, political, moral, and personal) First concrete example: Acute vs chronic disease (tetanus vs HIV/AIDS) HIV/AIDS situation description HIV/AIDS age distribution HIV/AIDS treatment yearly cost (for life) Maternal and neonatal tetanus situation description 2022 study: Vaccination coverage of mothers in East Africa The financial calculus The question: Why is the choice not made in favor of the tetanus vaccination? Conclusion Fear: Resurgence of historical diseases with COVID-19 is in the news (TB, cholera, polio, HIV/AIDS, malaria) Second concrete example: Prevention vs cure (the tetanus example) Conditions for success (avoiding bureaucracy and making the hard choices) Solutions Priority #1: Good health Three values (equity / solidarity / liberty) One need: One accepted and respected leadership One urgency: A general political consensus Two sub-priorities: Nutrition and education One must: Erasing the African debt Three strategies: A new and serial approach / Thinking locally and acting globally / Consolidating global health Six suggestions: Mergers, coordinating superstructure, drastic limitation of face to face international conferences and congresses, the right to interfere in countries for healthcare reasons (particularly transmissible diseases) and the creation of global health blue helmet brigades, having poverty as the #1 risk factor for many diseases) The past and the future Food for thought Vision Conclusion BIO Dr. Yann Meunier is an international and multifaceted healthcare professional and a pioneer in academia, healthcare provision (in clinical settings and public health programs), research, and business. During his education, He studied medicine at Paris V University (France), the Federal University of Rio de Janeiro (Brazil) and The George Washington University (USA). He holds specialty degrees in emergency medicine (Paris XII University), and tropical diseases (Paris VI University), a certificate from the ECFMG, a certificate from Harvard University in internal medicine and two certificates from Stanford University in communication. During his career, In Academia He was Assistant Professor in Tropical Diseases and Public Health (Paris VI University), Adjunct Assistant Professor of Medicine (The George Washington University); Lecturer (The George Washington University Center for International Health), Director (Stanford Health Promotion Network), Manager in Health Promotion (Stanford Health Improvement Program), Mentor (Stanford Medscholars Research Fellowship Program), and Instructor (Stanford Health Improvement Program) He is widely published in the international medical literature and is the author or co-author of nine books on global health and tropical diseases (Oxford University Press and Springer published two). As Healthcare Provider Clinically He was (1) Private General Practitioner in France, Singapore (only European Private General Practitioner in the country), New Caledonia (first and only Private General Practitioner on the island of Lifou), and Nigeria (only European Private General Practitioner in Lagos), (2) Tropical Diseases Consultant (at the Pitie-Salpetriere hospital in Paris, France), (3) Chief Medical Officer for Chevron Oil Co. in Papua New Guinea (PNG), (4) Corporate Physician in Cameroon (for Cellucam), Nigeria (for Spie-Batignolles and Schlumberger), and China (for EDF), (5) he

3. 

   9 Feb 2023

   What is Wrong with Global Health in 2022? What are the Solutions? - with Alain L. Fymat, PhD, PhD

   COVID-19 has underlined the current poor state of global health. In this podcast, I have tried to identify the underlying problems that were evidenced, at least in part, by the root causes of the pandemic. My remarks were largely based on my published book “Pandemics: Prescription for Prediction and Prevention”*, especially its Chapter 18. To summarize: We live in an unruly, not easily managed world of ~ 8 billion people that is constantly growing. Notwithstanding the plethora of international, regional, national, and other organizations, there are glaring inequities among nations, principally between developed and poor ones. In particular, within the context of COVID-19, the prime organization among them, the World Health Organization (WHO), has been dilatory, at times issuing contradictory recommendations, and deferring to those powerful nations that fund it most (in this instance, China). In this context, humanity has again proven to have a short memory of past epidemics/pandemics, not having even clearly identified what are their root causes. It is therefore no wonder that these events will continue to haunt us till the end of times ... unless we are able to devise appropriate strategies for predicting/preventing them such as the one I have proposed. For this purpose, I have identified ten important measures: Highlight global health security; Create and strengthen necessary mechanisms; Promote multidisciplinary engagement; Strengthen multisectoral coordination; Emphasize the importance of financial preparedness; Improve early warning and detection; Collect and share data in a timely manner; Conduct laboratory testing; Develop joint outbreak response capacities; and Take appropriate science-based actions. I have also identified ten intertwined cardinal factors that are the root causes of pandemics that need to be simultaneously tackled and remedied: Rapid growth of global human population; Increased globalization; Environmental degradation and destabilization of ecosystems; Creation of new urban or agricultural ecosystems; Economies of scale and monocultures in agriculture and dysfunctional agrifood systems; Loss of land and ocean biodiversity; Water scarcity; Human-induced climate change; Societal inequities; and Irrational mass denialism of hard-won facts of science (vaccinations, antimicrobial overuse). Some of the above factors could be correlated with the United Nations (U.N.) Sustainable Development Goals (SDG). In the same book, I have offered a blueprint for a 6-level strategic pandemic prediction and prevention program that should herald the beginning of the end of pandemics: Creating of a new “World Environment Organization”; Shifting the current health paradigm to a “One-World/One-ecoHealth paradigm” that will be grounded by a new “International Pandemic Treaty” and other international laws; Involving international, intergovernmental, regional, and national health organizations; Incorporating the “Global Human Virome Project”; Actively developing models (epidemiological, climate-type) with their enabling technologies and databases: and Folding-in the development of vaccines & therapeutics and the corresponding research. The value and success of the proposed approach will be gauged by four measures: Reducing causes of new infectious diseases; Preventing outbreaks and epidemics from becoming pandemics; Preparing for potential future pandemics that could not be prevented; and Ensuring that the causing virus does not re-emerge thereafter (e.g., by sustaining itself in domestic animals). Within that blueprint, I truly believe we can reach a stage where pandemics could at long last be predicted and prevented. *Book (hard cover and paperback): Pandemics: Prescription for Prediction and Prevention: https://www.amazon.com/Pandemics-Prescription-Prediction-Alain-Fymat/dp/0228867215 BIO Dr. Fymat is a medical-physical scientist and an educator. He is the current President/CEO and Professor at the Interna

4. 

   9 Feb 2023

   Healthcare Systems and Global Health: The U.S. Example - with Michael J. Zema, MD

   The US Healthcare system has slowly evolved over the past century through a combination of legislative efforts, need assessment by the private sector and pioneering efforts by a few dedicated and resourceful patient care givers. As such, morphing over the decades and at times having been shackled by political compromise, it is not surprising that with its evolution there would be some unintended consequences. At this stage, to help create a future healthcare delivery system which can facilitate the timely, efficient and appropriate access to healthcare for those most in need at a cost that is sustainable, one must proceed carefully lest we continue to apply layer upon layer of more ineffectual “band-aids” as has been previously done. Healthcare is complicated and so therefore is its delivery. As HL Mencken once warned, “For every complex problem there is a solution which is simple direct and wrong.” In this digital world in which we now live, do not surrender to the vicarious technological varlets: fax, voice mail, email, text, electronic health records and artificial intelligence, the very effective and personable interactions with your colleagues and your patients, including a carefully performed physical examination. The latter represents an important transactional moment between doctor and patient, “a laying on of healing hands” which helps foster the trust needed for relational continuity and effective cure. To those who would have you believe that technology will totally replace this interaction, I would have them remember the old girl scouting adage…. “Make new friends but keep the old, the one is silver, the other gold”… Further, please never forget, “No one cares how much you know until they know how much you care.” Remember, even an intellectual argument, including detailed statistical analyses can at first appear quite cogent, but upon more careful examination may be found to be fraught with erroneous assumptions and even faulty methodology. Be critical in your review of the literature. As Benjamin Desraeli, 19th century Prime Minister of England twice over quite perspicaciously once stated, “There are three kinds of lies; lies, damned lies and statistics.” When reviewing the literature, remember to fix your sights on the proper target. Albert Einstein once stated, “Not everything that can be counted counts and not everything worth counting can be counted,” words of wisdom when applied to healthcare. OECD (Organization of Economic Cooperation & Development) https://www.oecd.org/health/health-statistics.htm World Index of Healthcare Innovation www.freopp.org/wihi/home Kaiser Family Foundation Schaeffer Center for Health Policy Brookings Institute Center for Medicare & Medicaid Services Commonwealth Fund https://www.commonwealthfund.org/international-health-policy-center/system-stats IMS Institute for Healthcare Information Global Medication Use in 2020 US Census Bureau https://www.census.gov/quickfacts/fact/table/US/PST045221 American Hospital Association https://www.aha.org/statistics/fast-facts-us-hospitals US Dept Health & Human Services Office of the Inspector General https://oig.hhs.gov/oei/reports/OEI-09-18-00260.pdf / https://oig.hhs.gov/oei/reports/OEI-06-18-00400.pdf Association of America Medical Colleges https://www.aamc.org/data-reports/reporting-tools/report/tuition-and-studentfees-reports 3M Clinical and Economic Research https://multimedia.3m.com/mws/media/2117913O/his-pm-cer-socioeconomicstatus-health-care-deliverysystem-performance-report-en-us.pdf American Association of Nurse Practitioners (AANP) https://www.aanp.org BIO Dr. Zema has enjoyed a tenure of forty plus years in the healthcare arena on the “inside” as physician trainee; private practitioner; member of a hospital medical board; vice president of a physician independent practice association; board member of a physician holding company; pharmaceutical industry and malpractice legal consultant; chief of cardiology at both c

5. 

   9 Feb 2023

   Global Health: Universal Preventive Medical Checkups in Three Modules (in French) - with Jean-Michel Lichtenberger, MD

   Plus on détecte précocement un problème de santé en devenir, plus son traitement sera facile, voire seulement possible. C’est une évidence. La médecine de plus en plus s’attache à chercher des « signaux faibles » qui permettent des diagnostics de plus en plus précoces. C’est le cas par exemple dans l’imagerie en utilisant de savants algorithmes. Mais c’est aussi le cas pour des choses aussi simples que de mesurer le taux d’hémoglobine glyquée à la recherche d’un diabète, de TSH à la recherche d’un dysfonctionnement de la thyroïde ou de PSA pour la prostate, voire une simple mesure de la tension artérielle. Bien d’autres examens sont possibles. Proposer de faire un « bilan de santé » est une fausse promesse car nul ne peut prétendre dresser l’état de la santé d’une personne dans son entièreté. Ce que l’on peut faire est d’explorer le plus probable pour une personne en fonction de ses antécédents personnels et familiaux, et des signes cliniques qu’il présente. Également, on va chercher ce qui est le plus fréquent épidémiologiquement pour sa tranche d’âge ou son genre. Ainsi pourra-t-on approcher un « bilan médical » ciblé qui a le plus de chances d’être pertinent pour une personne donnée. C’est pourquoi notre Centre Médical International propose des « bilans médicaux modulaires » attachés à une fonction (sommeil par exemple), ou à un organe (cœur par exemple), plusieurs modules pouvant être assemblés pour réaliser ce que d’autres appelleront un « bilan de santé ». Mais ce n’est pas le tout de dépister, encore faut-il savoir que faire de ce que l’on a trouvé. Après un bilan, on ne se précipite pas toujours sur un traitement médical ou une opération. Surtout lorsque l’on a détecté des signaux faibles ; il suffit parfois juste de mettre en œuvre des mesures de prévention de l’aggravation. Ou alors au moins de mesures accompagnant des traitements qui peuvent en être plus légers. Car c’est bien joli de faire un bilan pour détecter un sujet à considérer, mais qu’en fait-on ? L’important pour nous, ce sont les suites qu’on donne à un bilan. Certaines conduiront à un spécialiste pour approfondir une recherche parce qu’un résultat questionne. On entre dans la sphère médicale classique. D’autres conclusions ne conduiront qu’à des recommandations d’hygiène de vie. Elles sont fondamentales. Les déterminants de la santé sont loin d’être entre les mains des seuls médecins. Ils sont avant tout entre les mains de chacun ou de sa destinée. Pour le patrimoine génétique ou les traces laissées de l’enfance, on ne peut que les subir. Pour les facteurs importants conditionnant la santé de tout un chacun comme les facteurs sociaux, économiques ou familiaux, tout comme l’environnement, on ne peut pas faire grand-chose. Il reste toutefois de nombreux domaines sur lesquels on peut agir pour influencer considérablement l’avenir de sa santé. Il s’agit pour l’essentiel de l’activité physique, de l’alimentation, du sommeil, du stress et des addictions à commencer par le tabac. Notre objet dans le podcast était d’en souligner l’importance et leur place dans la médecine moderne. En effet celle-ci s’efforcera de plus en plus de ne pas être réactive – à savoir attendre la maladie pour agir, mais prospective – à savoir anticiper et prévenir les risques pour ne pas avoir à en traiter les conséquences plus tard. En ce sens, la prévention ne peut être utile que si elle rencontre le projet de santé d’une personne. Si un fumeur ne veut pas arrêter, un obèse ne pas arrêter de mal manger ou un sédentaire de rester devant sa télévision, une action préventive sur l’addiction, la nourriture ou l’activité physique sera inutile. Par contre, discuter avec son médecin de ses points faibles que l’on veut renforcer, et des moyens que l’on veut se donner pour améliorer sa santé, c’est ce qui permettra de travailler une prévention en santé vraiment utile pour éviter l’apparition de maladies, ou l’aggravation de pathologies existantes. BIO Parcours du Dr. Lichtenberger

6. 

   9 Feb 2023

   Global Health and Mass Vaccination: Current Challenges and the Best Way Forward (in French) - with Pierre Druilhe, MD

   Main points Unequivocal support for vaccines (examples of tetanus and yellow fever) Criteria for good vaccination The degree of difficulty increases incrementally: (1) Against viruses, bacteria and parasites, and (2) For chronic diseases (examples: TB, HIV/AIDS, malaria) Progress in empirical. Examples: Big for conjugated vaccines but small for adjuvants Strong and fast immunity induced by a germ translated into very good vaccines (examples: tetanus, diphtheria) Future: Molecular ecology of human-germ interaction Problem of misinformation on the internet (examples: aluminum hydroxide, measles) International vaccination requirements protect first and foremost a country not the individual Mass vaccination and COVID-19 Speed of action to produce the vaccine was worrisome for some people Live attenuated vaccine would have been “universal” and not variant-specific like with the spike protein but less efficient The vaccine winner was the fastest and easiest to manufacture (1 week on the computer / Available in 6 months) Nationalism, politics and capacity to conduct clinical trials and of production played a role in the choice of the technology RNA vaccines have been known for years Variants are selected by immunity pressure coming from mass vaccination and immunity gained from infection (asymptomatic or not) Possibility of the emergence of more virulent strains: Usually, in a pandemic the evolution is toward less pathogenic mutants Low mortality in Africa may be due to protective immune cross-reaction between the COVID-19 virus and coronaviruses causing seasonal rhinitis (4 different types) The current vaccines protect much more against death and severe forms of the disease than infection One should stop talking about antibodies A “universal” vaccine would take 3 years to develop There is a need for both vaccines and antiviral drugs Malaria 5,800 parasitic molecules. Over 30 years, 20 have been studied. Only 5 in details Usual approach: hypothesis verified by studies (examples: GPI-anchored and surface proteins). All the studies failed. In the global North they used models with rats. However, for example, malaria mortality is 0% in African tree rats but when a vaccine-candidate is studied in lab mice mortality is 100%. Similarly good results in animals do not translate into the same in humans Other approach based on reality and molecular ecology Vac4All studied 12 molecules that have shown no antigen variation Vaccine results with children in Mali and Burkina Faso have been encouraging (good efficiency and good tolerance) Immunogenicity has been increased with adjuvants Trials have been almost completed in adults BIO Dr. Druilhe is a physician, immunologist, parasitologist, inventor and entrepreneur. He started his research career at the Department of Tropical Medicine of the Pitie Salpetriere Hospital, where he initiated many first-of-a-kind malaria research experiments, including the first cultures of the pre-erythrocytic stages of the malaria parasites, characterization and cloning of P. falciparum liver stages antigens, and the investigation of natural immunity to malaria blood stages through passive transfer of African adult immunoglobulin in Thai individuals with malaria. For over 20 years (1987-2011), he led the Laboratoire de Parasitologie Bio-Medicale at the Institut Pasteur in Paris, France, where he pursued his scientific strategy of analysis of immunity to malaria in humans and where he and his team made major discoveries, identified novel mechanisms, not foreseen in animal models, and important molecules believed to be responsible for malaria immunity in humans. His work covers the wide breadth of vaccine research and development, including involvement in the organization and conduct of 8 vaccine clinical trials. He has authored around 330 Scientific Publications and holds more than 23 patents on inventions. His main scientific interests have been and remain the analysis of host-parasite immune interac

7. 

   9 Feb 2023

   Global Health and Chronic Diseases - with Julieta Gabiola, MD

   Main points Importance of chronic diseases in global health: (1) definition of chronic diseases, (2) their burden (morbidity and mortality are rising: 75% rule, premature deaths, in LMICs, preventable, economic impact, risk factors (example: poverty). Definition of chronic diseases. Challenges: (1) The fact they are asymptomatic for some time, (2) They are less “sexy”, (3) Misalignment of funds (compared to acute diseases), (4) Low and Medium Income Countries with less resources and not as well-equipped. Example of diabetes. Priorities: Investment mobilized toward (1) Training and education, and (2) Research in risk mitigation and prevention (behavior change). Personal example: (1) Historical background of medical mobile clinics (MMCs), (2) Missions (5,000 people per day, real impact?), microscopic and telescopic views, (3) Four platforms for ABCs: (a) Treatment, (b), Prevention by early screening and mitigation of risk factors, (c) Education of workers, students, public, and (d) Research. Launched in 2016. Telemedicine. Phenomenal results of MMCs: Efficiency, low cost, and prevention of the downstream consequences of chronic diseases. Impact of missions: Triage, preparation starts a year ahead of time, ROI? Obstacles to scaling: Cost (a kit costs $500), one gadget per community (vision: 1 per person by showing data of cost-effectiveness. Description of a mobile clinic (website: https://www.abcsforglobalhealth.org/). Only outreach program in the Philippines equipped with an Electronic Medical Record device (4 years of data). Problem of internet access and power supply in rural areas. In 4 communities. Upswing during COVID. Partnership with local healthcare structures: A big challenge. With universities and colleges: Going very well. Limited funding is a challenge. Night and day when compared to what was available before. Results at the individual level are fantastic. Public health level results: Available and they show tremendous results. Also decreases poverty and it can be scaled in the country and globally. Maintenance: Not the costliest aspect. 60 to 70% of the cost is due to salaries Global health trends for chronic diseases: WHO / Millennium Development Plan Targets for 10 years are not achieved. No practicality in the matter. The missing link is the connection with the people. Waste is more prominent in developing countries. Mobile technology should be embraced and emphasized. Advice for students: Have heart to serve. BIO Dr. Julieta Gabiola is a Clinical Professor of Medicine at Stanford University. She is an Educator’s for CARE faculty, teaching the Practice of Medicine at Stanford Medical School, while mentoring medical students longitudinally. She is involved in mentoring medical students with their MedScholar projects with focus on global health outreach programs. Her specialty is Internal Medicine with interest in chronic diseases like Hypertension and Diabetes. She is a Stanford CIGH faculty fellow. She practices Internal Medicine at Stanford Express Care, involved heavily in her foundation, ABC’s for Global Health with a mission to improve chronic disease management and outcomes in Filipinos in the Philippines and in the US. She collaborates with hospitals and universities in the Philippines to mitigate disparities in health care and improve health care access. She has partnered with institutions in the Philippines in research and health education. She provides opportunities for global health immersion in the Philippines to students from high school to medical school. She co-authored an interdisciplinary textbook in clinical assessment, published by Pearson. This book is poised to provide clinical assessment tools to various disciplines like medical students, nurse practitioners, physician assistants, and other paramedical practitioners. She was also one of the authors for DISRUPT, a book by Filipina leaders with the idea that in order to effect change, we must be willing to disrupt the statu

8. 

   9 Feb 2023

   Global Health and Healthcare Research - with Eran Bendavid, MD

   Main points Difference between healthcare and health Are we providing healthcare making a difference in people’s health? Healthcare research importance: What are the things that make a difference? Example: tuberculosis Importance of big data in global health research: large number of people needed to draw conclusions about the impact of measures without double blind trials. Example: Foreign aid Interface global health - public health - big data. Examples: global politics and global warming Influence of politics in healthcare research. Examples: Mexico City policy (abortion) and PEPFAR How do researchers maintain independence? Example: NIH Sources of funding at Stanford University. NIH, Stanford community (philanthropy) Mismatch between funding and public health priorities in developing countries. Examples: TB, HIV, malaria Main challenges for global health research. Difference between traditional research and global public good (examples: emerging diseases detection, guidelines). The latter is underfunded. Example: TB Strategic solutions with two examples: (1) A successful one and (2) a failure. For (1) Foreign aid with HIV/AIDS and GAVI, and (2) Clean water (book co-author: “Disease Control Priorities”) Government ownership and international intervention brigades for emergency situations (examples: Ebola, famines, wars) Research mechanisms: from top to bottom versus the inverse. The notion of respect and boots on the ground. Sharing research results: The usefulness of face to face international congresses given the cost and carbon footprint. BIO Dr. Bendavid’s academic appointments include: Associate professor, medicine - primary care and population health Senior fellow, stanford woods institute for the environment Senior fellow (by courtesy), freeman spogli institute for international studies Member, bio-x Faculty affiliate, institute for human-centered artificial intelligence (hai) Member, maternal & child health research institute (mchri) His work broadly investigates the drivers of population health improvements in developing countries. He studies how economic, political, and natural environments affect population health. He uses a mix of experimental, econometric, qualitative, modeling, and demographic tools to produce insights and strategies for improving health. A sample of current projects address the following questions:• What role does US foreign aid play in reducing mortality and improving equity in developing countries?• What forms of engagement in health improvements - social marketing, public health interventions, or community empowerment, for example - work, and which do not?• What effect do malaria control programs have on child mortality?• What combination of prevention strategies are most cost-effective for Africa’s HIV epidemic?• What is the evidence that foreign aid for health is good diplomacy?• Which populations are most vulnerable to the effects of climate conditions on the availability of food? His research focus is: Infectious disease. https://healthpolicy.fsi.stanford.edu/people/eran_bendavid

9. 

   9 Feb 2023

   Global Health: Can Technology Boost Equity? - with Grant Miller, MD

   Main points Importance of technology in global health: The single most important driver of health improvement around the world is technology Technology definition: Anything that defines how input is transformed in output (devices, drugs, know how, management, etc.) Example: the bacteriological revolution in the 19th Century Positive and negative aspects: Choices made on social preferences regarding redistribution Differentiation of technology with intrinsic property vs distributive property (expensive vs inexpensive ones). Economic growth increases inequity but it does not mean economic growth is bad. Wealth distribution is the issue Inexpensive technology has the potential to reduce health inequality from the get-go. Examples: (1) Rehydration therapy, (2) Penicillin, and (3) Antiretroviral drugs in places like sub-Saharan Africa Differentiation between progressive and regressive technologies. How are they produced and what are the incentives to produce and distribute them? Example: For the pharmaceutical industry, market forces are a regressive factor. Positive factors include the public sector, philanthropies but success benefits are not as direct and rewards as immediate as the for the market. Epidemiology of developed and developing countries is converging on chronic diseases. It will put the focus more and more on distribution Impact evaluation: Experimental methodology, and others like models done by international bodies How is technology prioritized? 2 ways: (a) Centralized (using cost-effectiveness guidelines). Example: endemic malaria and (b) Decentralized (people choosing their preferences) Access to potable water. Reasons for not being done: (a) Multiple actors having different incentives, and (b) Water disinfecting pills give it a bad taste Some progressive technologies address issues that don’t exist for high income households. Example: Cookers Value of better health (primary and secondary) Importance of politics. Misalignment of incentives (in government and other organizations) For the poorest: No other incentive than moral. Relying on philanthropy Trends for technology and health equity: Hopeful but the need is still great, but caution must prevail for chronic diseases Strategies to bridge the gap between developed and developing countries: Economic commitment, choice of technology (for example, technology related to nutrition). Real area of focus: Technologies that don’t require behavior change BIO As a health and development economist based at the Stanford School of Medicine, Dr. Miller's overarching focus is research and teaching aimed at developing more effective health improvement strategies for developing countries. His agenda addresses three major interrelated themes: First, what are the major causes of population health improvement around the world and over time? His projects addressing this question are retrospective observational studies that focus both on historical health improvement and the determinants of population health in developing countries today. Second, what are the behavioral underpinnings of the major determinants of population health improvement? Policy relevance and generalizability require knowing not only which factors have contributed most to population health gains, but also why. Third, how can programs and policies use these behavioral insights to improve population health more effectively? The ultimate test of policy relevance is the ability to help formulate new strategies using these insights that are effective. Academic Appointments Professor, Health Policy Senior Fellow, Freeman Spogli Institute for International Studies Senior Fellow, Stanford Institute for Economic Policy Research (SIEPR) Professor (By courtesy), Economics Member, Maternal & Child Health Research Institute (MCHRI) Affiliate, Stanford Woods Institute for the Environment Administrative Appointments Director, Stanford King Center on Global Development (2019 - 2019) Director, Stanford Cente

10. 

    9 Feb 2023

    Global Health: Access to Medications in Developing Countries (in French) - with Robert Sebbag, MD

    Main points 70 to 80% of the world population don’t have access to medications. It is not only a problem of cost but it also involves logistics and politics. HIV/AIDS changed the situation with the South African trial. The result was a tri-therapy cost 20 to 30 times lower. The economic model changed for drug companies. I showed what could be done for some diseases including other partners. My first challenge was malaria. Working with an agreement with DNDI (Drugs for Neglected Diseases Initiative) in 2004 with 3 conditions (1) Common development, (2) Cost less than 1euro in the adult and 5o cents in children for a 3-day treatment, and (3) No intellectual property and no patent. Financing came from the Global Fund to fight AIDS, TB, and malaria.  Manufacturing took place in Morocco from where the medications were exported. Half a billion treatments were sold. A very large impact on malaria resulted on the global scene. This program was coupled with others on education from UNICEF, and mosquito nets. example. It opened the door to this kind of partnership. Drug alone is not enough. Infrastructure, logistics and human resources also play a role. Compliance is also an obstacle. Local bridges are indispensable. We worked with NGOs. TB and HIV/AIDS are major examples for compliance and observance. It was replicated with African trypanosomiasis (sleeping sickness). It led to the discovery of fexinidazole, the first oral treatment for the disease. It was given for free. 2-prong partnership: (1) DNDI for the clinical trials and registration, and (2) Sanofi for the pharmaceutical aspect (dosage, number of pills, for example). A 10-day oral treatment was the final result. Disease elimination is in sight. Strategic priority is recommended by WHO taken by local or not by local authorities. One example: The president of Chad had never heard of sleeping sickness! Predominant role of awareness. After African nations’ independence Sleeping sickness exploded. Mobile units of disease detection in the villages and treatment (created by Eugene Jamot) were discontinued. Political obstacles: (1) The place given to international collaboration, (2) Health budgets with priorities matching epidemiological data, and (3) The brain drain. The situation is improving due to new communication means. Chronic diseases are a major challenge: Diabetes, cardio-vascular diseases, psychiatric diseases. Examples: Chronic psychoses and epilepsy. Education is the #1 priority for the latter. My program at Sanofi in this regard was stopped. Development assistance. Multilaterally: Global Fund to fight AIDS, TB, and malaria isa big success for malaria and HIV/AIDS less with TB. So is GAVI for vaccines. Bilaterally: Depends on the country. Ivory coast and France are a success story, for example. France with Myanmar, Mali, and Burkina Faso are failure stories. In some places Russians are taking over but they do not bring healthcare assistance. Chinese only build infrastructure (hospital, roads, etc.). In Asia and South America compare favorably to Africa. Compliance: A new drug in the Borole family will soon be available for the treatment of sleeping sickness and it requires a single oral intake. NGO challenges: Duplication, lack of control, no evaluation, one-shot interventions, and more. Solutions: (1) Make all forms of assistance dependent upon healthcare assistance, and (2) Establish priorities followed by commensurate budget allocations. This is tied to challenges linked to migrations. One example: TB. Governance and intervention in countries in case of health crisis: The Ebola example. BIO Dr. Robert Sebbag was Vice President, Access to Medicines at Sanofi-Aventis drug Co. In his role, he participated in the company’s access to medicines strategy development for the southern hemisphere. Prior to joining Sanofi-Aventis, he worked in Brussels for the European Pharmaceutical Industry Association (EFPIA) on creating a communicat

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