MANILA — It’s been a tough year for global health. Another Ebola outbreak hit a conflict-affected part of the Democratic Republic of the Congo, straining public health capacities. With millions of children suffering from severe malnutrition in Yemen, organizations are struggling to fundraise. Measles outbreaks are being reported in different parts of the globe as misinformation erode people’s trust in vaccines.
These events reveal the persisting vulnerabilities and weaknesses of the global health system and the political and social challenges of the time. But there are others that showcase governments’ and global health actors’ failure to deliver on their commitments, prioritize public health, and submit to moral high ground.
In 2018, the global health community faced enduring #AidToo scandals. A groundbreaking report early in the year revealed gender disparities and deficiencies in gender policies at some of the biggest global health organizations and their programs. Several deals and partnerships were also questioned.
While some of these issues have been met with resolutions, others remain ongoing. Their impacts on global health are likely to be felt in the year ahead.
‘Crisis’ at UNAIDS
The report by an independent expert panel on the culture of bullying and harassment prevention and response at UNAIDS is perhaps the ultimate end-of-year shocker. It found an overwhelming atmosphere of fear and distrust and evidence of staff who complained of sexual harassment, or found themselves at the receiving end of ill-treatment and discrimination, but felt little was done to address their grievances.
While UNAIDS has policies in place to prevent these issues, they don’t appear to have been followed. For an organization mandated to champion the rights of people living with HIV, the prevailing culture within UNAIDS presented the greatest irony.
The report’s findings led to calls for a leadership change at UNAIDS, with many of the issues identified tied to failure to implement reforms and promote accountability. Anecdotes from staff presented in the report reveal little confidence in Michel Sidibé, its executive director, who has announced he is stepping down from his role in June 2019.
For some, that is not enough. The Swedish government has already announced it is freezing its support for the organization as long as Sidibé remains in office.
While the panel clarified it is not within its mandate to investigate individual cases, the report very much ties with the series of sexual misconduct allegations and harassment that’s come to light in the development sector, including those filed against former UNAIDS senior officials. Thomas Frieden, the former director of the U.S. Centers for Disease Control and Prevention and current president and CEO of Resolve to Save Lives, could be facing trial in January 2019. He was accused of groping a woman who filed a case against him in July.
TRIPS over tax
The U.N. high-level meetings on tuberculosis and noncommunicable diseases were the biggest global health events of the year. But much of civil societies’ hopes for the two meetings came crashing down after several of their requests failed to make it in the political declarations. This includes the deletion of taxes in the final NCDs document in exchange for the inclusion of the clause on the Trade-Related Aspects of Intellectual Property Rights — which allows countries to override patents in the name of public health, a crucial feature in the access to medicines debate — in the TB declaration.
Some health experts questioned whether it was the “right trade-off.” The lack of government commitments in the final declaration on taxation against unhealthy commodities such as tobacco and sugar-sweetened beverages is a worry for those pushing for more aggressive policies against these common NCDs risk factors.
As much as 90 percent of populations in middle- and low-income countries pay out of pocket for medicines, prompting calls for increased access. At the center of discussions on lowering costs, however, lies intellectual property rights.
MSF-Nauru government clash
Australia’s offshore detention policy for refugees and asylum seekers have long been the subject of criticism, but in October, it drew yet more after the Nauru government ordered the international medical humanitarian organization Médecins Sans Frontières to halt its mental health interventions on the island.
MSF condemned the decision and raised concerns about its implications on their patients, many of whom had suicidal thoughts or attempted suicide. While many experienced traumatic events prior to their arrival in Nauru, it was their detention on the island that was “most damaging to their mental health,” according to MSF.
In response, the Nauru government accused MSF of advancing its political agenda and acting against its nature as a humanitarian organization.
Cuban doctors for ‘export’
Thousands of Cuban doctors are leaving Brazil following a diplomatic meltdown between their government and the new Brazilian administration, which labeled the doctors as “Cuban slaves.”
Caught in the midst of the exodus is the Pan American Health Organization, an affiliate of the World Health Organization, based in Washington D.C. Several Cuban doctors have filed a case against the organization, accusing it of profiteering from the Mais Médicos program it helped launched in Brazil. The program essentially brought Cuban doctors to Brazil to help fill gaps in health care and was defined as a sort of South-South cooperation. But the doctors accused PAHO of violating international laws by participating in forced labor and human trafficking.
This is not the only legal issue PAHO has been involved in. In August, its legal counsel, Heidi Jiménez, told Devex the organization is still actively pursuing legal action against its former affiliate and fundraising arm, the PAHO Foundation, for the “unauthorized use of the PAHO name, mark, and goodwill” even after the termination of their agreement in 2015. The head of the foundation, however, said they’ve already changed their name to “Uniting for Health Innovation.”
Global Fund’s brief Heineken partnership
The Global Fund to Fight AIDS, Tuberculosis and Malaria partnered with global beer company Heineken in January. The partnership’s aim is for Global Fund and partners to tap into Heineken’s supply chain expertise to reach remote areas. But several global health actors, particularly those involved on the impact of alcohol use on public health, found it unacceptable and argued it creates a conflict of interest for the fund.
Amid the criticism, the Global Fund stuck with its decision. But by March, it decided to suspend the partnership after learning Heineken uses women to promote and sell its beer in several African countries.
Partnerships have become vital in development organizations’ quest to expand their programs and extend their reach, but it receives particular scrutiny in global health. The International Labour Organization, while not a global health organization per se, has received particular attention from global health actors for its financial partnership with the tobacco industry. In November, the ILO’s governing body reached a decision not to rely on tobacco industry funding for its projects targeting to eliminate child labor.
Global health’s blindspot
At a time of greater push for women’s rights and gender equality, the majority of global health organizations are lagging behind, according to a groundbreaking report that reviewed how 140 global health organizations fare when it comes to promoting gender equality both in their workplace and programs. Only 43 of organizations are headed by women, and only 25 have women board chairs. Only a few apply a full gender lens that take into account the health needs of individuals across the gender spectrum. Many organizations also lack gender-inclusive policies. Most reports on gender pay gaps are from the private sector.
A new report on gender equality shows a sort of "sea change" in the health sector. Twenty-five organizations have introduced new policies or assessed old ones to address gender gaps. But more organizations still need to step up.
According to a follow-up report in November, several organizations have recognized their shortfalls and stepped up their gender commitments and policies, but much more needs to be done, according to the co-founders of the Global Health 50/50 initiative.
Merck’s vaccine pullout
Global pharmaceutical giant Merck has been supplying its rotavirus vaccine, RotaTeq, to several low-income countries in West Africa through Gavi, the Vaccine Alliance, for the price of $3.50 per dose for years. But by 2020, the pharmaceutical company has advised Gavi it will no longer be able to deliver these vaccines to these countries due to supply constraints, leaving more than half a million children vulnerable to the deadly virus causing diarrhea among infants and young children. It could only supply two-thirds of the doses needed in West African countries in 2018 and 2019, as reported by NPR.
While there are other rotavirus vaccines available in the market, their uptake will require a few years given the regulatory process needed before a full national rollout in countries.
Merck, however, has received approval to sell its RotaTeq in China, where there is current crackdown on local vaccine manufacturers after the scandal in July revealed two Chinese companies sold hundreds of thousands of substandard vaccines for rabies, as well as diphtheria, pertussis, and tetanus.
Malaria resurgence in PNG
It takes huge investments and efforts to reduce the number of cases for any given health issue, so when malaria cases increased in Papua New Guinea after years of decline, global health actors and observers sought to understand why. Health Minister Puka Temu admitted to the government letting its guard down. The government winded down key interventions as it received decreased funding from the government budget and international partners, he said.