MANILA — Over the past year, the global health community witnessed the re-emergence of decades-old diseases in crisis-hit areas, and saw new policies put at risk gains made in areas such as women’s health and HIV/AIDS.
But there have also been several bright spots: calls for more women in senior leadership positions have started to bear fruit, and new partnerships and alliances have formed to tackle old and emerging public health threats, such as antimicrobial resistance and noncommunicable diseases.
We’ve rounded up some of the biggest, headline-grabbing moments of 2017, from groundbreaking innovations and partnerships, to a multitude of controversies that grabbed the attention of the global health community.
1. WHO election
The election of Tedros Adhanom Ghebreyesus as director-general of the World Health Organization was historic, not only because he’s the first African to lead the U.N. aid agency, but also because his election was the first time all member states were allowed to vote.
Since taking office in July, Tedros has set in motion changes in the organization’s leadership and way of working, which has so far earned him nods of approval from within WHO as well as from outside partners and observers. He’s appointed more women in his senior management, including both of his deputy director-generals, which has gained praise among gender advocates. Other steps, however, such as his short-lived appointment of Zimbabwe’s resigned ex-president, Robert Mugabe, as ambassador in the fight against noncommunicable diseases, have been less popular.
As the honeymoon period of his leadership nears its tail end, Tedros’ challenge is putting to work his vision for the organization, which includes placing countries at the center of the WHO’s work and placing emphasis on WHO’s impact, amid an increasingly challenging funding environment for global health.
2. The reinstatement of the “global gag rule”
One of the Trump administration’s first policies that shook the global health world was the so-called global gag rule, or Mexico City Policy, which prevents foreign nongovernmental organizations that provide assistance or information related to abortion from receiving funding from the U.S. government. The policy first came out under President Ronald Reagan and has been shelved and reintroduced under different administrations since.
Global health advocates have strongly condemned President Donald Trump’s decision to reinstate it, given evidence of its impact on family planning efforts worldwide, as well as on women and their health. But instead of retreating, Trump decided to expand the policy’s coverage from just family planning streams to include almost all of U.S. global health assistance, with only a few exceptions, such as in cases of humanitarian relief. The expanded policy means that foreign NGOs won’t be able to receive any U.S. global health funding — both in the form of grants and contracts — if they continue to promote and provide abortion-related information and assistance.
Several donors have since stepped up to help fill the funding gap expected to emerge from the policy, although money raised to date is still dwarfed by the more than $8 billion U.S. global health funding that is on the line. The U.S. Senate has proposed amendments calling for a repeal of the policy, but the measure is expected to face strong opposition in the House.
3. The contentious Global Fund process
Besides WHO, one of the most anticipated elections of 2017 was the executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. With Mark Dybul no longer seeking a second term, the board launched the search for the fund’s next leader.
But the process was riddled with problems. The board had to restart its search in early 2017 after a leaked report on the final list of candidates in February led to questions and scrutiny, not only of the candidates but also of the Global Fund process. Their second attempt in November was more successful, although questions remain over last-minute considerations at the board meeting.
Three days before the scheduled board vote, Peter Sands, one of the four candidates, withdrew from the race. He later cited family reasons for the decision. But a day before the vote, Sands, the former chief executive of Standard Chartered PLC, asked the board to reconsider his candidacy. He was eventually allowed back in, and was selected to lead the Global Fund for the next four years.
4. The controversy over USAID’s largest health contract
This year Devex uncovered reports showing that the largest project ever funded by the U.S. Agency for International Development — a $9.5 billion health supply chain project implemented by Chemonics International — was experiencing major problems.
During the first three months of 2017, only 7 percent of shipments delivered through the USAID-funded supply chain arrived at their destination on time and in full. A wide range of issues, from management and staffing, to information systems, to a basic lack of health market knowledge crippled the project’s ability to deliver. These revelations prompted USAID and Chemonics to create a corrective action plan. The agency submitted a negative performance review of its largest implementing partner — and suspended salary increases for project employees until Chemonics showed improvement.
In recent months, key indicators have been trending upwards, and the U.S. contractor says it has turned a corner toward better planning and delivery. At the same time, USAID’s leadership continues to describe results as unacceptable, and the project’s poor performance to date has attracted congressional attention. Two U.S. lawmakers requested an inspector general review of the project, and a third plans to hold a hearing that will require USAID officials to explain what went wrong.
5. Cholera outbreak in Yemen
In the midst of a civil war, Yemen broke records by registering the worst cholera outbreak in history. While cases have started to decrease, nearly 1 million have been infected as of December, according to WHO. Now, Yemen faces another possible disease outbreak. As of early December, there have been more than 300 suspected cases of diphtheria in 15 of the country’s governorates. Organizations, however, continue to face multiple challenges to keep the disease from spreading, including a blockade on supplies and Yemen’s weakened health system.
6. U.S. policy shifts and budget cuts
In addition to the global gag rule and challenges with global health supply chains, U.S. policy shifts and proposed budget cuts are having ripple effects across other areas of global health.
While the President’s Emergency Plan for AIDS Relief, PEPFAR, has long enjoyed bipartisan support in Congress, it was not immune to cuts. The administration proposed some $800 million in cuts to HIV programs, including PEPFAR and the Global Fund to Fight AIDS, TB and Malaria. The advocacy group the ONE Campaign issued a sharp criticism of the administration’s actions toward U.S.-funded HIV/AIDS programs, saying that the cuts and policy changes “would squander the incredible progress that has been made.” In addition to the proposed cuts, the administration released a new strategy for PEPFAR in September, which targets resources to 13 focus countries with the potential to achieve epidemic control.
7. A momentum for gender equality
It was year marked by some wins for gender equality in global health, from senior appointments at WHO to the launch of several initiatives, such as Global Health 50/50, which aims to advance action and accountability for gender equality in global health institutions. Stanford University hosted the first Women Leaders in Global Health conference this year, with Women in Global Health, a relatively young organization, as an implementing partner.
But as Roopa Dhatt, co-founder and executive director of Women in Global Health suggests, old habits die hard. A number of photos circulated this year on social media showing mostly all-male panels at global health conferences and meetings. Calls for change have grown louder. The infamous photo of WHO’s Tedros in a meeting with World Bank President Jim Yong with mostly males at the discussion table sparked a huge outcry on social media early this year, prompting the WHO chief to admit they “need to do better.”
8. The death of global health leaders
The development community mourned the passing of some of global health’s most passionate advocates this year. Edutainer-statistician and professor of global health Hans Rosling died in February after a year-long battle with pancreatic cancer. Babatunde Osotimehin, who was serving on his second term as executive director of the U.N. Population Fund, died in June. Mahmoud Fikri, WHO regional director for the Eastern Mediterranean, also died in October following a heart attack. He was on his way to Montevideo, Uruguay, to attend the first global conference on noncommunicable diseases.
9. The word on vaccines
The Coalition for Epidemic Preparedness and Innovations launched in Davos early this year. The goal: have the necessary vaccines ready before another Ebola or Zika-like epidemic hits. CEPI raised an initial investment of $460 million during its launch, and its current focus is to develop vaccines for three priority diseases: MERS-CoV, Lassa, and Nipah viruses.
CEPI’s launch was followed by several developments on vaccines against rotavirus and malaria, but also some setbacks. The first-ever dengue vaccine, Dengvaxia, is currently facing intense scrutiny in the Philippines after French pharmaceutical giant Sanofi Pasteur, its manufacturer, released new findings that caution that individuals who have received the vaccine with no prior infection of dengue could be at increased risk of getting severe dengue in the future.
10. The fight against old and emerging public health threats
Early this year, philanthropists Bill Gates and Ray Chambers joined forces to convene an influential council of leading public and private sector leaders to build political will and mobilize resources that can support the development of new tools toward malaria treatment, prevention, and its eventual eradication. Members of the council, called the End Malaria Council, include high-profile names such as President Ellen Johnson Sirleaf of Liberia, Graca Machel, businessman and philanthropist Aliko Dangote, and Inter-American Development Bank President Luis Alberto Moreno.
The council inspires renewed energy toward malaria eradication. While experts highlight significant gains made against malaria over the years, this year’s World Malaria Report warns of stalled progress against the disease. The report notes there were 5 million more cases of malaria recorded in 2016, with the greatest increase in cases seen in Rwanda.
Threats of parasite resistance to several partner drugs for malaria treatment are also raising concerns, particularly in the Greater Mekong region. Drug resistance, not just to malarial drugs, is an issue that’s increasingly taking the spotlight in global health. An AMR Industry Alliance also launched this year to tackle its growing threat.
11. Philanthropists turn to ending noncommunicable diseases
NCDs account for the deaths of 40 million each year, but funding to reduce its burden have not been up to par. In 2017, however, the global health community, as Kent Buse of UNAIDS put it, “began to see fortunes turn for NCDs.” Not only did it gain political commitment and momentum in Montevideo during the WHO Global Conference on NCDs — where WHO’s Tedros announced a new high-level global commission on NCDs — but it also gained financial support and “Resolve” from big and influential philanthropic organizations such as the Bill & Melinda Gates Foundation, Bloomberg Philanthropies, and the Chan Zuckerberg Initiative. Experts argue what’s needed more than ever now is a focus on prevention.
12. Disease eliminations
While some countries have seen a reemergence of diseases, others this year reached elimination. In July, the pacific island of Tonga eliminated lymphatic filariasis as a public health problem after more than three centuries of its people suffering from the disease, which causes large swellings in different parts of an infected person’s body, particularly the limbs, scrotum, and breast. Cambodia and Laos, meanwhile, eliminated trachoma, the leading cause of blindness worldwide, in September.
In addition, this December, the WHO announced that six Caribbean territories and states have eliminated mother-to-child transmission of HIV and syphilis as a public health threat. The states and territories involved were Anguilla, Antigua and Barbuda, Bermuda, Cayman Islands, Montserrat, and Saint Kitts and Nevis.
Michael Igoe and Adva Saldinger contributed reporting.
Update, Jan. 3, 2018: This article has been updated to clarify that PEPFAR’s new strategy released in September targets resources to 13 focus countries with the potential to achieve epidemic control. This article was also updated to reflect that Stanford University was the host of the inaugural Women Leaders in Global Health conference, and nonprofit Women in Global Health as implementing partner.