Category: APHA IH Section

Realizing the full potential of pharmaceutical industry partnerships

by awpain, posted in APHA IH Section, Pharmaceuticals

Successful partnerships between pharmaceutical companies and global health organizations have been increasing access to medicines and vaccines since the 1970s. From early partnerships in the Expanded Program on Immunization, to GAVI, the Vaccine Alliance and Access Accelerated the research-based pharmaceutical industry, which spends over $149 billion on research and development (R&D) every year, has an important role to play in global health.

Over the last 50 years the pharmaceutical industry has learned that global health is about more than just medicines and vaccines, and with the integrated nature of the Sustainable Development Goals, public-private partnerships are increasingly important. According to the International Federation of Pharmaceutical Manufacturers and Associations, the industry understands that global health requires building and supporting strong health systems, developing public health education and strengthening standards and regulations. This is why in 2018, 17 out of the 20 largest pharmaceutical companies (accounting for 70 percent of global pharmaceutical revenues) developed a business strategy, supported by goals and targets, to address access to medicines in low-and middle-income countries (LMICs), according to an Access to Medicine Foundation report. 

Good, but not good enough

However, much of the increased access to medicines has been made by a small percentage of pharmaceutical companies, and has overwhelmingly been focused on a handful of diseases. Of the 20 companies assessed by the Access to Medicine Foundation report, five companies (GlaxoSmithKline, Johnson & Johnson, Merck KGaA, Novartis and Sanofi) were found to be conducting 63 percent of R&D on products urgently needed by people in LMICS; and nearly all of the R&D from these companies was focused on five diseases: malaria, HIV/AIDS, tuberculosis, Chagas disease and leishmaniasis. 

While overall, pharmaceutical companies are entering LMIC markets, the industry still puts profits first.  Between 2008 and 2018 more medicines for profitable non-communicable diseases were developed for people in high-income countries, than medicines for diseases of poverty. Additionally, only four out of 20 pharmaceutical companies supported international trade agreements designed to ensure the world’s poor benefit from innovative medicines and vaccines. 

Closing the gaps

Public perception does matter to the pharmaceutical industry. According to the Reputation Institute, between 2017 and 2018 the pharmaceutical industry saw a 3.7 percent decline in its reputation score, and overall the industry had a significant decline in the public’s perception of industry transparency, openness and authenticity. The decline of public trust and confidence in the industry has also led to a decline in the public’s willingness to buy by eight percent between 2017 and 2018. One way to improve company reputation is through global health partnerships, and with recent negative media attention on the industry, between the opioid epidemic and price-fixing drugs, it is no secret that the industry could use a reputation boost.

So how can the global health community capitalize on this? The Access to Medicines Foundation has an effective recipe for engaging pharmaceutical companies in global health: one, setting clear priorities endorsed by global health experts; two, advocating for publicly funded mechanisms to reduce investment risk and shape less profitable markets; and three, finding sustainable funding support from multiple donors, including the government. One example of a mutually beneficial partnership is GAVI, which used pooled procurement mechanisms to encourage pharmaceutical companies to enter fragile markets in LMICs to strengthen the global vaccine market. 

In 2018 the reputation scores for the top 22 pharmaceutical companies were made public, creating an opportunity for global health organizations to engage poorly ranked companies. Global pharmaceutical sales are expected to reach over $1 trillion by 2022, so resources for global health partnerships are abundant, and organizations should consider targeting partnerships with companies impacted by negative public perception; turning a bad reputation into increased affordable access to life-saving medications. 

 

“Tejas means friend” and other lies we tell ourselves.

by hanstewart, posted in APHA IH Section, mental health

If you hear me speak more than a few sentences, you’ll hear the unmistakable accent. And as soon as I can find a natural way to fit it into the conversation, I’ll tell you flat out: I’m from Texas.

As a Texan, I was required to take one year of Texas history in the seventh grade, a statewide tradition since 1946. In Texas history, you’ll undoubtedly learn a few facts that every one of us 29-million Texans has engraved in our hearts.

1.     You don’t pick bluebonnets. They’re a sacred part of our state’s landscape.

2.     Texas was a sovereign nation once: the Republic of Texas. 

3.     California may have more people, but we’re bigger in size.

4.     “Tejas means friend”.

I’ve always found the root of the state’s name to be fascinating, because it has evolved with the land itself and represents the story of Texas. The word traces back to the Caddo word for “friend”, taysha. That word would be misspelled and mispronounced to be Tejas and eventually, Texas. For those of us whose hearts are deeply intertwined with the “Lone Star State”, the root of the word feels right. It embodies our roots, who we were, and the Southern hospitality on which we grew up. The origin of Texas’ name does NOT embody who we are today.

Texas has become the frontline of continued inhumane policy experimentation by the Trump administration. To deter undocumented entry to the United States and tamp down the number of asylum claims made at ports of entry, Trump and his nominated officials began separating children from their caregivers. 2,654 children were taken from their parents, guardians, and chaperones during the peak of this policy’s enforcement, and most of those children were detained in Texas.

The science around this matter is still developing, but one thing is certainly clear: this is bad news for the cognitive development and mental health outcomes of these children. In fact, the picture is becoming clearer that family separation policies produce rates of toxic stress and trauma that are as detrimental to the child psyche at the violence as the violence and insecurity they are fleeing. Researchers, and even the United Nations, cite evidence that separating children from their caregivers creates the type of emotional disturbance and dysregulation seen in survivors of torture.

We aren’t talking about acute emotional disturbance that will recede after reunification. The child’s brain has evolved to be incredibly respondent to its environment. Continued exposures to “fight, flight, or freeze” (especially in the absence of a trusted attachment figure) train the brain to bypass emotional inhibition and complex, rational thought to depend on more primitive survival mechanisms. This means permanent alteration of the brain, shrinking the prefrontal cortex and hippocampus (the parts of the brain that largely control decision making, working memory, and personality expression).  Their brains, and often their relationships with the parents, may never recover. 

“Here we have taken away what science has said is the most potent protector of children in the face of any adversity—the stability of the parent-child relationship”

– Jack Shonkoff

It’s not just theoretical damage happening in research studies void of a human face. Children inside these Texas detention centers have reported high rates of insomnia, decreased ability to concentrate, diminished literacy (even in their native languages), severe mood swings, and feeling constant states of panic and fear. And when they leave, their medical records (including any psychiatric care they’ve needed or received) are often incomplete. Many of these children will receive asylum in the United States, and we will have to face the mental health epidemic we created with a mental health system that is underfunded and culturally inadequate.

Sweeping separation of families and detainment of children was theoretically stopped, but the Human Rights Watch has found that nearly 200 children have been subject to the continuation of this policy since last year. There is no law on the books in the US that requires the separation of families at the border. This was a policy decision that can be rescinded as quickly as it was haphazardly implemented.

These children have often experienced trauma before they ever arrive at our border. They have left the familiarity and comfort of home. They are often physically vulnerable at the end of their migration journey. And they are welcomed with something that, for most of them, is even more traumatic: facing the hostility of a foreign country all alone.

This isn’t exclusively a Texan issue. ICE detention centers now exist in all 50 states. And it isn’t uniquely American, as 100 other countries have policies that allow children to be detained as part of standing immigration policy. But Texas has become ground zero for what the inhumane treatment of children looks like. Texas is no longer a land of Southern hospitality. It certainly isn’t embodying the state motto of “friendship”. And no one should be angrier about what’s happening in our home state than Texans ourselves. 

This article was written in memory of the children who needlessly died in Texas as a result of inhumane immigration policy. These faces represent the failure of all of us.

From top left to bottom right:

Mariee Juarez, aged 2, died after leaving a detention center in Dilley, TX

Carlos Hernandez Va’squez, age 16, died in US custody in Brownsville, TX

Jakelin Caal Maquin, age 7, died in US custody in El Paso, TX

Juan de Leo’n Gutie’rrez, age 16, died in US custody in Brownsville, TX

Malaria SBC Evidence Discussion Webinar: Prescriber and Patient Interventions, 8/6

by ihsection, posted in APHA IH Section, Events and Webinars

How can research findings inform and improve social and behavior change (SBC) programs? What questions can SBC practitioners keep in mind to help sift through research, interpret publications, and apply lessons learned? Join Breakthrough ACTION for the third in a series of online guided discussions following a journal club format about malaria SBC evidence on August 6, 2019, from 9:30 a.m. to 10:30 a.m. (EDT). More information about the article and how you can prepare for and participate in the online discussion is found below.

Featured presenter

Dr. Clare Chandler, Co-director of the London School of Hygiene and Tropical Medicine Antimicrobial Resistance Centre

About the article

In the article Prescriber and patient-oriented behavioural interventions to improve use of malaria rapid diagnostic tests in Tanzania: facility-based cluster randomised trial, the impact of a health worker training and health worker patient-oriented training were compared with the standard government training on rapid diagnostic tests. This facility-based cluster randomized trial demonstrated that a combination of prescriber and patient behavioral interventions can reduce prescription of antimalarials to patients without malaria to near zero. Small group training with SMS messaging was associated with a significant and sustained improvement in prescriber adherence to rapid diagnostic test results.

Preparing for the discussion

Download and read the article.
Download and use the Discussion Guide, which has questions to consider as you read and to help you follow along during the webinar discussion.

Register to Attend

Building Global Health Funding Opportunities

by awpain, posted in APHA IH Section

By Amanda Pain

Sustainable funding in global health is often a rallying cry among practitioners. A consistent funding stream can make or break the effectiveness of a global health program, but this funding can be hard to come by. The need for additional funding for global health, especially in regards to achieving Sustainable Development Goal (SDG) 3, is great. In fact, researchers estimate an additional $371 million per year is needed to achieve SDG 3 by 2030 in Low and Middle Income Countries (LMICs). Overall funding for global health has plateaued since 2010, and changing political landscapes and priorities can make government funding ephemeral. With the current Trump administration’s proposed cuts to global health funding, organizations need to look for new funding streams.

Historically, the private sector has always played a role in funding global health initiatives. Private sector funding can not only offer more consistent funding for a program, but can also be more flexible in adapting programs to meet community specific needs in LMICs. Corporations also know that giving back to communities, and developing philanthropic endeavors, is good for business. While there are several private sector funders, many corporations are looking for non-profits and non-governmental organizations (NGOs) that have missions that align with company culture; and at times competition for these funding sources can be fierce. Therefore, looking beyond existing corporate funders to growing companies with nascent, or undeveloped philanthropy programs, presents global health organizations with a opportunity to secure sustainable funding, and assist in creating a corporate philanthropy program from scratch.

How can organizations find these successful growing companies?

Companies today have been waiting longer to announce an I.P.O. (initial public offering), sometimes waiting for Series F or G rounds of funding before going public. However, once a company receives Series C funding from venture capitalists and investors it is considered to be growing successfully, as well as making a profit. Additionally, after eBay set aside funds for charitable giving in 1998 before going public this became a growing trend in the tech industry. This means global health organizations do not necessarily have to wait until a company goes public before reaching out to partner on potential philanthropy initiatives. One example of a tech company partnering with global health organizations is the Tableau Foundation, which aims to make the world a better place with data. 

Of course organizations want to seek out companies where a potential partnership can be mutually beneficial, therefore identifying growing companies and understanding the business platform will be necessary before pitching ideas for philanthropic endeavors. Crunchbase.com is a platform that analyzes start-ups to help investors identify successful companies. Another resource is Gartner annual vendor ratings that showcase company strengths. Global health organizations can use these resources to identify viable companies as potential sustainable funders.  

While investigating growing companies will require staff time and resources the potential for a sustainable partnership with the private sector is worth the effort. Helping design a company’s philanthropic programs is an opportunity for global health organizations to build funding opportunities that are flexible and consistent, rather than trying to morph organizational mission and goals into the prescribed priorities of current funders. 

The Rise of Global Mental Health

by hanstewart, posted in APHA IH Section

The constitution of the World Health Organization (WHO) opens with a definition of health that underscores the importance of “mental…well-being.” Even still, mental health has struggled to achieve parity in global health. For much of its history, the field of mental health developed parallel to public health. Mental health, and the lack of it, was nebulous and eluded the gold standards of clinical measurement like bioassays and microscopy. As a result, psychology and psychiatry (components of the larger field of mental health) were shunned by other disciplines for a perceived lack of scientific basis and over-emphasis of sociological factors. Those with mental disorders, cognitive and developmental impairments were thusly cared for largely by religious institutions and, eventually, asylums rampant with inhumane treatment and neglect. 

Psychiatric patients in Bucharest sleep two to bed with feet bound;
Image Credit: Bernard Bisson

By the 1970’s the United States was moving toward deinstitutionalization and curiosity about how to effectively study and treat mental illness in the context of culture. Mental health research worldwide began engaging with patients as active participants with “lived experience.” The sharing of epidemiological data around mental health indicators became more fluid. The push for data-driven and evidence based decision making in global mental health produced big payoffs. The 1990’s saw both the WHO’s first World Mental Health Report and the first iteration of The Global Burden of Disease study. 

These publications highlighted the sheer burden of poor mental health. Of the ten leading causes of disability, five were mental illnesses, including the leading cause of disability in the world: unipolar major depression. Self-inflicted injury was among the top ten leading causes of premature death in developed countries. While the psychiatric epidemiological data continued to underscore the need for new interventions and novel funding mechanisms for global mental health, not much has changed. Last year, the Lancet Commision on global mental health and sustainable development released a 45-page report outlining a global health crisis that is severely underfunded relative to its burden on society. Even in developed countries, only 20% of individuals living with depression will receive adequate treatment. In developing countries, the number is a dismal 4%. But only 1% of global health development funds are allocated to mental health programs. That comes out to just $0.85 per year of healthy life lost to mental illness, compared to $144 for HIV/AIDS programming and $48 for malaria and tuberculosis. 

Even if the funding existed, global health education has yet to produce a reliable pipeline of mental health professionals with the skills necessary to address the crisis. Educators at schools of public health in the United States have identified that mental health is still not adequately integrated into public health curriculum. Johns Hopkins remains the only school of public health in the country with a dedicated mental health department. While the majority of other public health programs offer coursework that have mental health as a component of its curriculum, few programs offer tracks or courses that have mental health as its primary focus, leaving students interested in the field to piecemeal their education together through independent study and practicum/thesis work. 

(Read the study on mental health in schools of public health here)

The evidence is clear that global mental health should be recognized as a global health and global development priority. Despite the lack of full acceptance by the global health donor community and larger public health community, the field of global mental health has continued to grow. Organizations like the Movement for Global Mental Health serve as collaboration spaces for mental health researchers and advocates. The Lancet Commission on Global Mental Health continues to produce calls for action that elicit drastic, even if short-lived, spikes in mental health earmarked development assistance. And just this year, the field’s superstar, the Peter Piot or Paul Farmer of global mental health, Dr. Vikram Patel was awarded the prestigious John Dirks Canada Gairdner Global Health Award. 

“...All countries can be thought of as developing countries in the context of mental health“

Patel et al.

We are living in the age of a changing climate, protracted humanitarian crises, and a global population that is increasingly forcibly displaced from their homes. The burden of mental health problems will continue to pose a threat to health that will require the unique skill set of the field of global mental health. Leaders like Dr. Patel continue to advance the global mental health agenda in an effort to realize the complete definition of health that lies at the core of global health. For those of us for whom global mental health is our calling and passion, we must continue to push for our place at the table when the global health agenda is being set. 

Note: One of the photographs used in this blog appears elsewhere on the internet in an unredacted form. However, to protect the privacy and dignity of those who appear in the photograph, I’ve elected to hide their faces.

Global Mental Health: How Are We Doing? (WHO)