Gavi is finding innovative partners we can all benefit from

Developing far-reaching global health interventions requires innovation, and with today’s constantly advancing technology opportunities for innovation are abundant. But ideas alone can not change the world. Ideas need a platform, financing as well as practical application measures to make an idea a reality. This is one reason why partnerships across sectors are vital.

Gavi, The Vaccine Alliance provides the perfect example of a successful partnership leading to innovation. Gavi is a public-private partnership bringing together the United Nation (UN), governments, the vaccine industry, private sector and civil society to improve childhood vaccine coverage in low income countries, as well as accelerate access to newly developed vaccines. Since 2000 Gavi has reached over 700 million children and prevented nearly 10 million deaths, but while this is important progress several challenges remain. Fertility rates in urban areas and fragile or conflict affected countries continue to grow which will make sustaining and increasing vaccine coverage more challenging. Additionally, the number of “zero-dose children,” children who have never received a vaccine, has not decreased since 2010. 

In order to address current challenges in vaccine coverage requires innovation. In 2016, Gavi launched the Innovation for Uptake, Scale and Equity in Immunization (INFUSE) program designed to improve vaccine delivery systems by connecting high-impact innovations with the countries that need them the most. Through building and utilizing partnerships over the last four years Gavi has hosted an annual call for innovators to submit proposals. Winners are chosen as “Pacesetters” who are then connected with investors and governments to help bring those ideas to market and scale.

This is made possible because of Gavi’s expansive network and reputation for successful partnerships.  While global health organizations could explore endless ways to replicate different Gavi efforts in partnership building, innovative funding strategies and technology advancement, global health organizations can also utilize Pacesetters’ innovative technologies for broader global health challenges. The call for innovations for 2019 was to address immunization issues specific to urban settings. Over the summer, three winners were chosen as Pacesetters out of 100 applicants.

  1. VillageReach Praekelt.org. In partnership these organizations created a chatbot technology powered by AI and machine learning to increase access to information about immunization services. Praekelt.org is a non-profit organization, based in South Africa, that utilizes mobile technology to solve social problems. The organization works in over 65 countries designing products using human centered design and agile development processes, and has developed several global health focused products.
  2. ZMQ Development leverages the power of storytelling to boost immunization rates in the slums of New Delhi. This non-profit organization, based in India, creates and implements practical technology linked tools and solutions to empower communities by providing timely information and connecting them with life-saving services. ZMQ has developed several innovative programs for global health, including programs for women’s health, HIV/AIDS and polio.  
  3. Premise. Premise Data provides an analytics platform using crowd-sourced data to help governments improve and optimize immunization services. Premise is a for-profit company, based in San Francisco, that aims to close the information gap by empowering a network of thousands of individuals around the globe to collect and share information with decision-makers. Premise has worked with international development organizations all over the world to help collect and optimize data.

Through INFUSE, Gavi has not only encouraged new innovation, but also made these ideas more recognized among the global community. As global health professionals knowing the potential resources and partnerships available is critical to program success. Now Gavi is doing some vetting for the rest of us by highlighting innovative Pacesetters. Let’s capitalize on INFUSE to form new successful partnerships to solve real world global health problems.

 

 

 

 

 

Global News Round Up

Politics & Policies

Health care can shift so that organizations across borders collaborate to help solve health care problems. Organizations can better solve problems related to access to care, research, training and development if they work together, not competitively.

It was the ambitious sanitation campaign aimed at giving almost half of India’s 1.3 billion population access to a toilet in just five years.  And last week, Indian Prime Minister Narendra Modi finally declared India free of open defecation.

Bill Gates told an audience at the University of Cambridge that global malnutrition will be solved and malaria will be virtually eliminated by 2040 if world leaders choose to fund scientific innovation.

During a meeting of heads of State, ministers, health leaders, policy-makers, and universal health coverage champions, the UN chief called UHC “the most comprehensive agreement ever reached on global health – a vision for Universal Health Coverage by 2030”

Programs, Grants & Awards

NEST360° is announcing $68 million in funding commitments from a consortium, including some of the world’s largest private foundations, for the first phase of an eight-year initiative to enable African hospitals to improve newborn survival by 50 percent and to establish a pipeline of local innovators, technicians and medical staff. 

The National Institutes of Health (NIH) has awarded 10 grants this year to UC San Francisco researchers as part of the NIH Helping to End Addiction Long-term (HEAL) Initiative. The awards to UCSF total more than $40 million and will fund projects ranging from better technologies for MRI imaging of back pain, to the use of deep-brain stimulation for treating chronic pain, to a new interdisciplinary research center for low back pain.

Research

In a new study, UC San Francisco scientists used maps of brain connections to predict how brain atrophy would spread in individual patients with frontotemporal dementia (FTD), adding to growing evidence that the loss of brain cells associated with dementia spreads via the synaptic connections between established brain networks.

In animals, infections are fought by the immune system. Studies on an unusual virus infecting wild koalas reveal a new form of ‘genome immunity.’

Diseases & Disasters

If you visited the Philadelphia International Airport earlier this month, you may have been exposed to measles. The Pennsylvania Department of Health warned the public on Friday that anyone who visited the airport on October 2 and 3 could have contracted the viral infection.

Ebola in the DRC has been corralled into a much smaller geographical area—27 zones, compared to 207 at the outbreak’s peak, the WHO’s Michael Ryan told reporters.

Kenya is seeing more and more addicts. The number of people injecting drugs jumped by more than 50% in the past eight years and the majority of users inject heroin, the health ministry says.

The World Health Organization is meeting in the Philippines after the country announced an outbreak of polio.  Environmental samples from sewage in Manila have been confirmed as containing the virus.

The United States remains committed to fighting Ebola in Africa, American health officials said, but the scope of the current outbreak in the Democratic Republic of Congo has become somewhat unclear.

Technology 

An ingestible sensor that allows doctors to remotely monitor tuberculosis patients’ intake of medication has the potential to save millions of lives and revolutionise treatment for the world’s most deadly infectious disease, researchers said.

Environmental Health

Climate change poses a huge threat to global health and is likely to trigger mass migration, food and water shortages and the spread of infectious diseases, experts have warned.

Pregnant women’s exposure to extreme heat raises their risk of being hospitalized, according to a new working paper distributed by the National Bureau of Economic Research — and black women, as in other pregnancy outcomes, appear to be more severely impacted than white women. What’s more, greater exposure to extreme heat can increase a newborn’s likelihood of a dehydration diagnosis and subsequent chances of returning to the hospital within the first year of life, the study found, for diagnoses including respiratory diseases and prenatal jaundice. 

Equity & Disparities

Narendra Modi is to declare that his flagship sanitation programme has ended open defecation in India, amid accusations that the scheme has sparked violence and abuse.

Six young women went to the U.N. to present a document that has no precedent: a Global Girls’ Bill of Rights.

Hundreds of thousands of healthcare facilities in low- and middle- income countries is deplorable. Take into account that this data includes developed countries. Worldwide, 1/4 lack basic water services and 1/5 lack adequate sanitation services, leaving 2 billion people without access to safe, affordable surgical care.

Foundations and nonprofits committed a new and substantial $120 million for global health at a convening in Washington, D.C., this past summer. The pledges of support focus on an urgent challenge across developing countries that doesn’t get much attention: ensuring safe water and sanitation at hospitals and health clinics around the world. 

Women, Maternal, Neonatal & Children’s Health

In 2015, Zika virus swept through Brazil and the Americas. In the three years since it ended, the pandemic has become an object of obsession for scientists, who have published more than 6,000 research papers about it. Researchers have been able to follow long-term health consequences in children infected with the virus before birth. 

Women represent 70% of the global health workforce but hold only 25% of the senior roles, according to World Health Organization. Amika George and Flaviana Matata talk about how their organizations are helping women have control over their bodies and their futures. 

Researchers from Ghana, Guinea, Myanmar and Nigeria, sent trained observers to three urban hospitals in each country to watch pregnant women from the time they were admitted until two hours after delivery. They found that of 2,016 women directly observed, 838 (41.6%) experienced physical or verbal abuse.

Perspectives on Global Health from Pharmacists Around the World, Part 3

As healthcare continues to morph and adapt based on the requirements of kind, compassionate, evidence-based care, pharmacists are playing a vital role in ensuring patient’s needs are met in countless regions across the earth. In this four-part IH Blog series, the pharmacy role accompanied by profession-related challenges and pharmacist-led global health initiatives will be explored within a profession that is often underappreciated. The following perspectives, shared by practicing pharmacy professionals from the United Arab Emirates (UAE), India, Cambodia, and the United States of America (USA) aim at highlighting various aspects of healthcare that should be properly addressed by governmental bodies, NGOs, and all stakeholders by both sustainable political will and empowering solutions. 

This third segment focuses on local and global pharmacist roles in each of these areas and the thoughts that pharmacists from these respective nation states have been willing to share with IH Connect.

Healthcare systems across the globe are unceasingly identifying novel approaches for health professionals to fulfill. The traditional roles that physicians, nurses, and other allied health workers performed in the past have metamorphosed as patient-care management is altered to effectively accompany patients. A few illustrations include: one of the most prominent international non-governmental organizations (INGO), Partners In Health, has a nurse – Sheila Davis – as it’s CEO contrasting a physician fulfilling this position; physician assistants and nurse practitioners being heavily utilized as primary care providers; and the introduction of community health outreach specialists as vital patient resources. The vocation of a pharmacist, in particular, has been altered significantly depending on the area of the world one inhabits. The majority of humanity believe that pharmacists are those who solely dispense medications, but several regions on the earth have realized the benefit of incorporating pharmacists in direct patient management, treatment guideline development, and even directors of ministries of health. Regardless of the development of pharmacy in a country, this healthcare profession is a key to kind, compassionate patient-centered care. The following commentaries from the United States of America, India, United Arab Emirates, and Cambodia explore the profession of pharmacy both locally and internationally while exposing initiatives to improve global health through pharmacists.  

 Dr. Moeung Sotheara, Ph.D. 

Clinical Research Assistant & Part Time Lecturer – University of Health Sciences

Phnom Penh, Cambodia 

In Cambodia, a large proportion of pharmacists work in community pharmacy, pharmaceutical enterprises and hospital pharmacy. However, there is still an insufficient presence of pharmacists in each area. In community pharmacy in particular, the inadequate presence of pharmacists is due to the current system of “name renting”, a legacy of post-war public health policy in response to the shortage of healthcare professionals. In such a system, any person having minimum knowledge in medicine dispensing and having been trained by the Ministry of Health for a specific period of time can “rent” a pharmacist’s name to apply for a pharmacy permit. Nevertheless, despite the growing number of pharmacists owning a pharmacy in recent years, the pharmacists’ role remains the traditional product-oriented functions of dispensing and distributing medicines and health supplies. In other words, pharmacists are still viewed as “simple medicine sellers” by the public. As the country develops and medicine consumption has increased, the pharmacist’s services in community as well as in hospital pharmacy must shift from medication dispensing to a focus on safe and effective medication use to achieve optimal patient outcomes. Pharmacists must assert themselves as medication experts and play a more active role in patient counseling and promoting the rational use of medicine. In addition, pharmacists must also be actively involved in public health. The functions of public health that can benefit from pharmacists’ expertise may include disaster preparedness, immunizations, preventive health measures and educating other healthcare providers about various techniques of prescribing medications and issues related to the drug use process.

Transitioning the discussion to global health, pharmacists have unique skill sets and assets that put them in a prime position to collaborate with members of the health care team to address global health issues and challenges. However, there is limited information on the role of the pharmacist in this field. There are 3 areas pharmacists can play in global health in the future: global health practice and program delivery, global health research, and global health policy. In the area of global health practice and program delivery, pharmacists can serve an important role on the health care team in under-served countries by helping address barriers to the delivery of care due to their knowledge of drug products, storage requirements, dispensing requirements, and logistics of pharmacy operations. They can improve clinical outcomes through patient-centered services such as glucose monitoring and blood pressure management, and also potentially work with local and national health organizations to help develop global health programs based on successful interventions made locally in the community. In the area of global health research, pharmacists who are affiliated with a university that has a focus on this area can assess global health projects and research initiatives to determine if opportunities exist for pharmacy to get involved and to add new dimensions to existing global health research. Finally, the outcomes of global health research often stimulate the need for proposing and evaluating global health policy at both the governmental and national level at which pharmacists can lend their expertise. As medication experts, pharmacists routinely exercise their knowledge of the rational use of medications, their cost-effectiveness, and the safety and efficacy of therapeutic regimens. These concepts can be applied domestically toward the development of policies that have global implications.

Nazgul Bashir, B. Pharm

Registered Pharmacist – Super Care Pharmacy

Dubai, United Arab Emirates

The role of the pharmacist varies from region to region and differs in several aspects. While there are areas of this world in which Pharmacists have vital roles in health sectors, there are other parts where pharmacists are given underutilized roles. Pharmacists are scattered throughout the community allowing them to be the most approachable healthcare professional – needing no appointment, no time restrictions and often being available 24 hours. Due to their aforementioned accessibility, their roles should be thoroughly revised, and the public should be made more adequately aware of their significance in communities.

Regarding the regional role of pharmacists in the United Arab Emirates, there was little utilization of pharmacists 10 to 20 years ago. Even now, some locations lack proper utilization due to their role being more product-based selling and dispensing any medication prescribed by the physicians. This occurs even though pharmacists in UAE are available in hospitals, health clinics, community and in retail stores allowing them significant access to patients.

To elaborate on the under-utilization of pharmacists, the current healthcare system typically does not promote pharmacist’s interventions in patient-management. This could include managing the dose of a hypertension agent, discussing change of therapy to more efficiently achieve patient outcomes, and a larger role in discharges from hospitals where pharmacists can provide counseling and follow-up.

Immunization is another role of pharmacists which could make a huge impact. Currently, most of the immunizations in this region are taking place in hospitals and health centers which are handled by nurses and physicians. However, this role can be handed to pharmacists in the community who can bring awareness to communities so that people won’t miss their vaccinations . In particular, many people are not even aware about the importance of flu shots. Pharmacists should be given an equal responsibility in bringing the awareness in a community and assisting people to receive their shots on time and prevent ailments. Counseling on family planning, use of contraception, palliative care, prevention of disease, identifying high-risk patients for diabetes and cardiovascular diseases are services not offered in pharmacies. Over-the-counter advice and educating patients on dietary supplements are often performed, but pharmacists are still underutilized overall.

However, the future of pharmacists in UAE look promising as several chain pharmacies make new exceptions in implementing more significant roles for their pharmacists. For example, physicians are advised to use the generic name so that pharmacists can choose to dispense the trade name.Additionally, pharmacists are being advised to minimize the use of antibiotics by making them strictly prescription based thus avoiding unnecessary use of them. Many barriers for increased pharmacist services need to be overcome: lack of time to offer services, shortage of pharmacists, lack of patient demand and low patient acceptance, lack of knowledge and skills, and underestimation of enhanced pharmacy services by physicians. With these barriers in mind, government and health authorities are planning their best and making promising change to bring the best of the pharmacy divisions.

Dr. Bryce Adams, Pharm D., RPh.

Oncology Medical Science Liaison

Washington D.C., United States of America 

Before delving into the role of the pharmacist in the United States, I would like to highlight the Oath of a Pharmacist as this serves as the model of how a pharmacist should view their role:

“I promise to devote myself to a lifetime of service to others through the profession of pharmacy. In fulfilling this vow:

  • I will consider the welfare of humanity and relief of suffering my primary concerns.
  • I will apply my knowledge, experience, and skills to the best of my ability to assure optimal outcomes for my patients.
  • I will respect and protect all personal and health information entrusted to me.
  • I will accept the lifelong obligation to improve my professional knowledge and competence.
  • I will hold myself and my colleagues to the highest principles of our profession’s moral, ethical and legal conduct.
  • I will embrace and advocate changes that improve patient care.
  • I will utilize my knowledge, skills, experiences, and values to prepare the next generation of pharmacists.

I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public.”

Currently, the USA is in the midst of a great shift in the pharmacist profession. According to 2017 statistics, 60% of pharmacists in the United States were practicing in retail pharmacies – this includes drug, merchandise, and grocery stores. However, these roles are expected to decrease over the coming years. There are several contributing factors for this decrease – one being a decrease in the price margins per prescription. As pharmacies make less money for each prescription that is filled, businesses have to fill more prescriptions with less staff. This can cause a host of issues, such as having less time to counsel patients, more reliance on technology to catch errors, an increase in likelihood for medication errors, and a more difficult time fulfilling the oath of a pharmacist. Ultimately, this leads to under-utilization of the pharmacist profession by placing less of a value on their role of positively impacting patient care.

Fortunately, pharmacists have been realizing this shift and have been proactive in adapting. They have achieved this by advocating for additional venues to provide value, such as being able to bill for medication therapy management services and administering vaccines. These services are extremely beneficial for patients and also increase revenue for the businesses. While roles in the retail setting are expected to decrease, roles in the hospital and ambulatory care settings are expected to increase. Currently, 30% of pharmacists are in these settings. With an increasingly elderly population, these roles are becoming even more important.

These aforementioned pharmacist provided-services typically utilize this profession in a more productive way by rounding with physicians and helping to inform clinical decisions for specific patients. The rest of pharmacists are scattered across a variety of specialties. Two of these specialties are academia and the pharmaceutical industry. Both of these have more of a global health impact, as academia is training the next wave of professionals who will have an international presence and will impact care while the pharmaceutical industry is developing the next wave of transformative medications that will improve patient care on a global level.

Before I finish, I want to revisit the oath of a pharmacist. As the United States healthcare system is being scrutinized due to the cost, as technology is becoming more utilized, and processes are becoming more automated, pharmacists will need to “embrace and advocate changes that improve patient care.” Pharmacists are in a unique position as the medication experts to greatly impact patient care, and it’s up to this profession to ensure that the right patient gets the right drug at the right dose via the right route at the right time.

Dr. Maneesha Erraboina, PharmD.

International Business Manager – Helics Group Scientific Networks 

Hyderabad, India 

In theory, the role of Indian pharmacists is to dispense medications by adjusting the dose for patients based on their health condition, and they play a major role in the rational use of drugs especially antibiotics. However, in India, it is very difficult to find a pharmacist in clinical hospital settings and none of the medical organizations have pharmacist professionals in the healthcare team. 

According to mainstream Indian psychology, most of the population only accepts medications from physicians rather than another profession, like pharmacists. This is an ongoing trait of Indian citizens that has existed for several years with very few signs of significant change in the future. 

In my own personal experience, I had an opportunity to attend an interview for a pharmacy position; however, the role was not directly related to dispensing medications. Due to the disconnect between the doctorate level education and the available job opportunities, I ended up in another profession within the health arena that wasn’t directly related to my education. Although I feel all PharmD. graduates are in a very good position today, they may need to explore unique opportunities as the profession catches up with the education level. 

In the future, I feel pharmacists could play an active role in the healthcare system as they are meant for patient care. I believe this feeds into having a primary role in clinical hospital settings. In addition, Pharm.D graduates will have other opportunities in clinical and medical research, pharmacovigilance, teaching, and scientific journal publishing companies in India.

In India pharmacists are underutilized in professional pharmacy roles such as a clinical pharmacist. However, in exploring other areas of the health field, Indian pharmacy graduates have taken advantage of their education to influence the global health society. As a personal example, my current role as an international business manager allows me to organize health conferences around the world to advance healthcare. As the pharmacy profession continues to grow and adapt across the globe, I believe one role for pharmacists will be ubiquitous: avoiding the irrational use of drugs to protect patients and improve health outcomes.

Have you read the latest issue of our newsletter, Section Connection?

The latest issue of Section Connection, the IH Section e-newsletter, is now available!

You can find the latest issue of the newsletter here: 

http://bit.ly/SectionConnection12

In this edition, you will hear more about the different Annual Meeting events our section hosts; learn more about our Student Committee; and get up close and personal with IH section member – Dr. Idong Essiet-Gibson. We will share updates from the Global Health Mentoring Committee, the Climate Change and Health Working Group, the Communications Committee and Social Media Subcommittee, the Systems Science for Health Systems Strengthening Working Group and the Community Based Primary Healthcare Working Group.

We hope you continue to stay connected and involved with our section. See you in November in Philadelphia!

Private Sector and Pandemic Preparedness: Beyond the $$

The global health community knows that the world is unprepared for the next influenza pandemic. While public health practices have come a long way in terms of preparedness since the 1918 Spanish flu, which killed around 50 million people, we are still far from ready for an outbreak of that scale today.

According to PreventEpidemics.org, more than 100 outbreaks occur daily and can be spread worldwide in just 36 hours because of increased global travel. The cry for better pandemic preparedness is loud (Bill Gates, Margaret Chan, former director of the World Health Organization (WHO) and Robert Redfield, Center for Disease Control and Prevention (CDC) director) but is only being heard in certain circles; and the global health community needs the message to get out more broadly, especially in the private sector. 

The bottom line

Disease outbreaks, even if they only occur within a country or region, affect everyone and negatively impact the global economy. A World Economic Forum/Boston Consulting Group report stated that epidemics have negative impact on the private sector by impacting their employees, customer bases and operations. 

The World Bank projects that a large pandemic will cause an average annual economic loss of 0.7 percent of global gross domestic product (GDP) or $570 billion USD. The 2009 H1N1 pandemic resulted in an economic loss of 0.14 percent of GDP, or $1.09 billion USD, and the Ebola epidemic in 2014 resulted in an economic loss of $2.2 billion USD in GDP, threatening macroeconomic stability, food security, human capital development and private sector growth across West Africa. 

The private sector is no stranger to making financial contributions for pandemic preparedness and response. In 2014 the private sector contributed $500 million USD to the Ebola outbreak response, and these days the private sector can financially assist in pandemic preparedness through the World Banks’ Pandemic Emergency Financing Facility (PEF). However, while financial contributions are always needed there are other ways the global health community can engage the private sector to improve pandemic preparedness.

More than money

In 2018, the WHO surveyed member states to assess global pandemic preparedness and found levels of preparedness to be “far from optimal” even among high and middle income countries. Based on these survey results the WHO identified several areas for improvement in regards to preparedness, four of which are particularly advantageous for private sector partnerships.  

  1. Conducting simulation exercises to test pandemic plans

The Institute for Disease Modeling (IDM) is one example of a private sector partnership to assist in pandemic preparedness. IDM’s Epidemiological MODeling software simulates the spread of disease to help determine the combination of health policies and intervention strategies that can lead to disease eradication. There are a number of other modeling and simulation tools available for pandemic preparedness, however, some of these tools require financial and/or technical resources not available to a global health organization. Private sector companies that use, or produce modeling software could be favorable partners for testing preparedness plans, since these companies already have the modeling skills to use the software and interpret results. 

      2. Establishing mechanisms to secure access to vaccines during a pandemic

There are two notable private sector partnerships already working to secure access to vaccines, GAVI, the Vaccine Alliance, and the Coalition for Epidemic Preparedness Innovations (CEPI) are both working on improving vaccine supply chains and healthcare infrastructure in low-and middle income countries in order to increase access to routine vaccinations, as well as secure access to vaccines during a health emergency.

       3. Preparing mechanisms to conduct risk communications and community engagement during a pandemic

There is also potential for collaboration with the private sector in regards to risk communications and community engagement. Social media companies already have platforms to engage large audiences, as well as lucrative business platforms to sell ideas, information and products. Engaging people in preparing for and acting appropriately during a pandemic will require persuading an audience – something social media companies have already mastered.

      4. Establishing SOPs to conduct systematic influenza risk assessments using surveillance data

Several consulting companies offer pro bono services, such as Deloitte and PwC. Consulting  firms have the business acumen to offer services that could help design effective pandemic SOPs for multilateral organizations, country governments and agencies, as well as non-governmental organizations working on pandemic preparedness. 

Building these private sector relationships needs to happen now, and not in the midst of the next outbreak. Mutually beneficial partnerships will ultimately help the private sector, the global health community as well as the entire population when, not if, the next pandemic occurs.