As a new year and a new decade kick off, World Health Organization WHO has released a list of urgent, global health challenges. This list, developed with input from their experts around the world, reflects a deep concern that leaders are failing to invest enough resources in core health priorities and systems.
This puts lives, livelihoods and economies in jeopardy. None of these issues are simple to address, but they are within reach. Public health is ultimately a political choice. WHO says there is a need to realize that health is an investment in the future, adding that countries invest heavily in protecting their people from terrorist attacks, but not against the attack of a virus, which could be far more deadly, and far more damaging economically and socially. A pandemic could bring economies and nations to their knees, which is why health security cannot be a matter for ministries of health alone.
All the challenges in the list demand a response from more than just the health sector, WHO warns. ‘’we face shared threats and we have a shared responsibility to act. With the deadline for the 2030 Sustainable Development Goals quickly approaching, the United Nations General Assembly has underscored that the next 10 years must be the ‘’decade of action’’. This according to WHO means advocating for national funding to address gaps in health systems and health infrastructure, as well as providing support to the most vulnerable countries. Investing now will save lives and money later.
According to the group, infectious diseases like HIV, tuberculosis, viral hepatitis, malaria, neglected tropical diseases and sexually transmitted infections will kill an estimated 4 million people in 2020, most of them poor. Meanwhile, vaccine-preventable diseases continue to kill, such as measles, which took 140 thousand lives in 2019, many of them children. Although polio has been driven to the brink of eradication, there were 156 cases of wild poliovirus last year, the most since 2014.
WHO indicated that the root causes are insufficient levels of financing and the weakness of health systems in endemic countries, coupled with a lack of commitment from wealthy countries. The climate crisis is a health crisis. According to World Health Organization, air pollution kills an estimated 7 million people every year, while climate change causes more extreme weather events, exacerbates malnutrition and fuels the spread of infectious diseases such as malaria.
The same emissions that cause global warming are responsible for more than one-quarter of deaths from heart attack, stroke, lung cancer and chronic respiratory disease. WHO says leaders in both the public and private sectors must work together to clean up air and mitigate the health impacts of climate change.
In 2019, over 80 cities in more than 50 countries committed to WHO’s an air quality guideline, agreeing to align their air pollution and climate policies. This year, the organization will work towards developing a set of policy options for governments to prevents or reduce the health risks of air pollution.
WHO further underscored that last year, most disease outbreaks requiring the highest level of WHO response occurred in countries with protracted conflict. The health organization also saw the continuation of a disturbing trend in which health worker and facilities were targeted. WHO recorded 978 attacks on health care in 11 countries last year, with 193 deaths. At the same time, conflict is forcing record numbers of people out of their own home, leaving tens of millions of people with little access to health care, sometimes for years.
Last year, WHO responded to 58 emergencies in 50 countries, deployed mobile medical teams, improved disease detection and warned systems and conducted vaccination campaigns. The group is working to save lives and prevent suffering by working with countries and partners to strengthen health systems, improving preparedness and expanding the availability of long-term contingency financing for complex health emergencies.
According to a report from the group, persistent and growing socio-economic gaps result in major discrepancies in the quality of people’s health. There’s not only an 18-year difference in life expectancy between rich and poor countries, but also a marked gap within countries and even within cities. Meanwhile, the global rise in non-communicable diseases, such as cancer, chronic respiratory disease and diabetes, has a disproportionately large burden in low and middle-income countries and can quickly drain the resources of poorer households.
It was also underlined that about one-third of the world’s people lack access to medicines, vaccines, diagnostic tools and other essential health products. Low access to quality health products threatens health and lives, which can both endanger patients and fuel drug resistance. Medicines and other health products are the second-largest expenditure for most health systems and the largest component of private health expenditure in low- and middle-income countries.
Every year, as WHO reported, the world spends far more responding to disease outbreaks, natural disasters and other health emergencies than it does preparing for and preventing them. A pandemic of a new, highly infectious, airborne virus- most likely a strain of influenza- to which most people lack immunity is inevitable. It is not a matter of if another pandemic will strike, but when, and when it strikes it will spread fast, potentially threatening millions of lives. Meanwhile, vector-borne diseases likes dengue, malaria, zika, and yellow fever are spreading as mosquito population’s move into new areas, fanned by climate change.
Lack of food, unsafe food and unhealthy diets are responsible for almost one-third of today’s global disease burden. Hunger and food insecurity continue to plague millions, with food shortages being perniciously exploited as weapons of war. At the same time, as people consume foods and drinks high in sugar, saturated fat, Trans fat and salt, overweight, obesity and diet-related diseases are on the rise globally. Meanwhile, tobacco use is declining in a few but rising in most countries, and evidence is building about the health risks of e-cigarettes.
WHO noted that chronic-investment in the education and employment of health workers, coupled with a failure to ensure decent pay, and has led to health workers shortages all over the world. This, it said, jeopardizes health and social care services and sustainable health systems. The world will need 18 million additional health workers by 2030, primarily in low- and middle-income countries, including 9 million nurses and midwives.
To trigger action and encourage investment in education, skills and jobs, the World Health Assembly has designated 2020 the year of the nurse and the midwife. Meanwhile, WHO stressed that more than 1 million adolescents aged 10-19 years die every year. The leading causes of death in this age group are road injury, HIV, suicide, lower respiratory infections and interpersonal violence.
Harmful use of alcohol, tobacco and drug use, lack of physical activity, unprotected sex and previous exposure to child maltreatment all increase the risks for these causes of death. In 2020, WHO will issue new guidance for policymakers, health practitioners and educators, called Helping Adolescents Thrive. The aim is to promote adolescents’ mental health and prevent the use of drugs, alcohol, self-harm and interpersonal violence, as well as provide young people with information on preventing HIV and other sexually transmitted infections, contraception, and care during pregnancy and childbirths.
However, the organization emphasized that new technologies are revolutionizing their ability to prevent, diagnose and treat many diseases. Genome editing, synthetic biology and digital health technologies such as artificial intelligence can solve many problems, but also raise new questions and challenges for monitoring and regulation. Without a deeper understanding of their ethical and social implications, these new technologies, which include the capacity to create new organisms, could harm the people they are intended to help, WHO warns.
The group set up new advisory committees for human genome editing and digital health last year, bringing together the world’s leading experts to review evidence and provide guidance. WHO is also working with countries to enable them to plan, adopt, and benefit from new tools that provide clinical and public health solutions, while supporting better regulation of their development and use.
Here is how one Permanent Secretary encapsulates the clear tension between democracy and bureaucracy in Botswana: “President Mokgweetsi Masisi’s Government is behaving like a state surrounded with armed forces in order to capture it or force its surrender. The situation has turned so volatile, for tomorrow is not guaranteed for us top civil servants.
These are the painful results of a personalized civil service in our view as permanent secretaries”. Although his deduction of the situation may be summed as sour grapes because he is one of the ‘victims’ of the reshuffle, he is convinced this is a perfect description of the rationale behind frequent changes and transfers characterising the current civil service.
The result of it all, he said, is that “there is too much instability at managerial and strategic levels of the civil service leading to a noticeable directionless civil service.” He continued: “Changes and transfers are inevitable in the civil service, but to a permissible scale and frequency. Think of soccer team coach who changes and transfers his entire squad every month; you know the consequences?”
The Tsunami has hit hard at critical departments and Ministries leaving a strong wave of uncertainty, many demoralised and some jobless. In traditional approaches to public administration, democracy gives the goals; and bureaucracy delivers the technical efficiency required for implementation. But the recent moves in the civil service are indicative of conflicting imperatives – the notion of separation between politicians and administrators is becoming blurred by the day.
“Look at what happened to Prisons and BDF where second in command were overlooked for outsiders, and these are the people who had sacrificially served for donkey’s years hoping for a seat at the ladder’s end. The frequency of the changes, at times affecting the same Ministry or individual also demonstrates some level of ineptitude, clumsiness and lack of foresight from those in charge,” remarked the PS who added that their view is that the transfers are not related to anything but “settling scores, creating corruption opportunities and pushing out perceived dissident and former president, Ian Khama’s alleged loyalists and most of these transfers are said to be products of intelligence detection.”
Partly blaming Khama for the mess and his unwillingness to let go, the PS dismissed Masisi for falling to the trap and failing to outgrow the destructive tiff. “Khama is here to stay and the sooner Masisi comes to terms with the fact that he (Masisi) is the state President, the better. For a President to still be making these changes and transfers signals signs of a confused man who has not yet started rolling his roadmap, if at all it was ever there. I am saying this because any roadmap comes with key players and policies,” he concluded.
The Ministry of Health and Wellness seems to be the most hard-hit by the transfers, having experienced three Permanent Secretaries changes within a year and a half. Insiders say the changes have everything to do with the Ministry being the centre of COVID-19 tenders and economic opportunities. “The buck stops with the PS and no right-thinking PS can just allow glaring corruption under his watch as an accounting officer. Technocrats are generally law abiding, the pressure comes with politically appointed leaders racing against political terms to loot,” revealed a director in the Ministry preferring anonymity.
The latest transfer of Kabelo Ebineng she says was also motivated by his firm attitude against the President’s blue-eyed Task Team boys. “The Task Team wants to own the COVID-19 pandemic and government interventions and always cry foul when the Ministry reasserts itself as mandated by law,” said the director who added that Masisi who was always caught between the crossfire decided on sacrificing Ebineng to the joy of his team as they (Task Team) were in the habit of threatening to resign citing Ebineng as the problem.
Ebineng joins the Office of the President as a deputy Coordinator (government implementation and coordination office).The incoming PS is the soft-spoken Grace Muzila, known and described by her close associates as a conformist albeit knowledgeable.
One of the losers in the grand scheme is Thato Raphaka who many had seen as the next PSP because of his experience and calm demeanour following a declaration of interest in the Southern African Development Community (SADC) Secretary post by the current PSP, Elias Magosi.
But hardly ten months into his post, Raphaka has been transferred out to the National Strategy Office in what many see as a demotion of some sort. Other notable changes coming into OP are Pearl Ramokoka formerly with the Employment, Labour and Productivity Ministry coming in as a Permanent Secretary and Kgomotso Abi as director of Public Service Reforms.
One of the ousted senior officers in the Office of the President warned that there are no signs that the changes and transfers will stop anytime soon: “If you are observant you would have long noticed that the changes don’t only affect senior officers but government decisions as well. A decision is made today and the government backtracks on it within a week. Not only that, the President says this today, and his deputy denies it the following day in Parliament,” he warned.
Some observers have blamed the turmoil in the civil service partly to lack of accountable presidential advisers or kitchen cabinet properly schooled on matters of statecraft. They point out that politicians or those peripheral to them should refrain from hampering the technical and organizational activities of public managers – or else the party (reshuffling) won’t stop.
In the view expressed by some Permanent Secretaries, Elias Magosi, has not really been himself since joining the civil service; and has cut a picture of indifference in most critical engagements; the most notable been a permanent secretaries platform which he chairs. As things stand there is need to reconcile the imperatives of democracy and democracy in Botswana. Peace will rein only when public value should stand astride the fault that runs between politicians and public managers.
Former Permanent Secretary to the President, Carter Morupisi, is fighting for survival in a matter in which the State has charged him and his wife, Pinnie Morupisi, with corruption and money laundering.
Morupisi has joined a list of prominent figures that served in the previous administration and who have been accused of corruption during their tenure in office. While others have been emerging victorious, Morupisi is yet to find that luck. The High Court recently dismissed his no case to answer application.
United States President, Joe Biden, is faced with a decision to make relating to the Covid-19 vaccine intellectual property after 175 former world leaders and Nobel laurates joined the campaign urging the US to take “urgent action” to suspend intellectual property rights for Covid-19 vaccines to help boost global inoculation rates.
According to the world leaders, doing so would allow developing countries to make their own copies of the vaccines that have been developed by pharmaceutical companies without fear of being sued for intellectual property infringements.
“A WTO waiver is a vital and necessary step to bringing an end to this pandemic. It must be combined with ensuring vaccine know-how and technology is shared openly,” the signatories, comprising more than 100 Nobel prize-winners and over 70 former world leaders, wrote in a letter to US President Joe Biden, according to Financial Times.
A measure to allow countries to temporarily override patent rights for Covid related medical products was proposed at the World Trade Organization by India and South Africa in October, and has since been backed by nearly 60 countries.
Former leaders who signed the letter included Gordon Brown, former UK Prime Minister; François Hollande, former French President; Mikhail Gorbachev, former President of the USSR; and Yves Leterme, former Belgian Prime Minister.
In their official communication, South Africa and India said: “As new diagnostics, therapeutics and vaccines for Covid-19 are developed, there are significant concerns [about] how these will be made available promptly, in sufficient quantities and at affordable prices to meet global demand.”
While developed countries have been able to secure enough vaccine to inoculate their citizens, developing countries such as Botswana are struggling to source enough to swiftly vaccine their citizens, something which world leaders believe it would work against global recovery therefore proving counter-productive.
Since the availability of vaccines, Botswana has been able to secure only 60 000 doses of vaccines, 30 000 as donation as from the Indian government, while the other 30 000 was sourced through COVAX facility. Canada, has pre-ordered vaccines in surplus and it will be able to vaccinate each of its citizens six times over. In the UK and US, it is four vaccines per person; and two each in the EU and Australia.
For vaccines produced in Europe, developing countries are forced to pay double what European countries are paying, making it more expensive for already financially struggling economies. European countries however justify the price of vaccines and that they deserve to buy them cheap since they contributed in their development.
It is evident that vaccines cannot be made available immediately to all countries worldwide with wealthy economies being the only success story in that regard, something that has been referred to as a “catastrophic moral failure”, head of the World Health Organisation (WHO), Tedros Adhanom Ghebreyesus.
The challenge facing developing countries is not only the price, but also the capacity of vaccine manufactures to be able to do so to meet global demand within a short time. The proposal for a patent waiver by India and South Africa has been rejected by developed countries, known for hosting the world leading pharmaceutical companies such US, European Union, the United Kingdom, and Switzerland.
According to the Financial Times, US business groups including pharmaceutical industry representatives, have urged Biden to resist supporting a waiver to IP rules at the WTO, arguing that the proposal led by India and South Africa was too “vague” and “broad”.
The individuals who signed the letter, including Nobel laureates in economics as well as from across the arts and sciences, warned that inequitable vaccine access would impact the global economy and prevent it from recovering.
“The world saw unprecedented development of safe and effective vaccines, in major part thanks to US public investment,” the group wrote. “We all welcome that vaccination rollout in the US and many wealthier countries is bringing hope to their citizens.”
“Yet for the majority of the world that same hope is yet to be seen. New waves of suffering are now rising across the globe. Our global economy cannot rebuild if it remains vulnerable to this virus.” The group warned that fully enforcing IP was “self-defeating for the US” as it hindered global vaccination efforts. “Given artificial global supply shortages, the US economy already risks losing $1.3tn in gross domestic product this year.”